Shoulder Stability

Exercise Training
Peter Ronai, M.S.
Community Health Ahlbin Rehabilitation Centers
ACSM Registered Clinical Exercise Physiologist®, ACSM Exercise Specialist®
and ACSM Health/Fitness InstructorSM
Bridgeport, Conn.
www.acsm.org
The rotator cuff and periscapular muscle groups 1. Scapular depressions - primarily for the trapezius,
contribute to the dynamic, functional stabilization of lower serratus anterior and pectoralis minor
the shoulder joint. Functional stability is defined as 2. Rows - primarily for the rhomboids and middle
possessing adequate stability to perform functional trapezius fibers
activities and results from interaction between static 3. Pushups with a plus and wall pushups - primarily
and dynamic components (Meyers). These for the serratus anterior
components were reviewed in the ACSM’s Certified 4. Scapular punches-primarily for the serratus
News, September 2002 issue. Stability training is an anterior
essential component of a general shoulder and/or 5. Shoulder girdle shrugs4, 5, 6, 7, 8, 9,10, 11, 19, 20, 21, 22
rotator cuff strengthening program.1, 2, 3, 4, 5, 6, 7, 8, 9, 10,
11
Strategies for improving both rotator cuff strength Figures 1 and 2 demonstrate proper execution of
Volume 12, Number 3 December 2002 and shoulder stability include the following: periscapular muscle strengthening exercises. Rowing
IN THIS ISSUE 1)proximal strengthening of periscapular muscles;2, 3, and shrug exercises can be done with free weights,
4, 5, 6, 8, 9, 11
2)rotator cuff muscle strengthening;2, 6, 8, 9, machines, or resistive bands. The American College of
❙ Shoulder Stability Exercise Training, 10, 12
3)sensorimotor training;1, 7, 10, 13, 14 4)flexibility Sports Medicine recommends performing multiple
page 1 training; (Almekinders, 5, 6, 9, 15, 16Joeb, Bruzga, Wilk, exercise sets consisting of eight to twelve repetitions
Hebert, Tyler), and 5)modification of standard weight per set for improving both strength and endurance.23
❙ Call for Volunteers, page 4
training exercise techniques.2, 8, 9, 10, 12, 17, 18 (Morrison,
❙ Ask the Experts, page 5 Malanga, Mantone, Williams, Bruzga, Wilk, Fees).
This article will discuss some of the many exercise
❙ Osteoporosis and Exercise, page 6 strategies for improving shoulder stability, and
recommendations for strengthening the rotator cuff
❙ Ten Indisputable Reasons to Renew and periscapular muscles.
Your ACSM Certification, page 8
Proximal Stability and
❙ ACSM Recertification/Renewal Periscapular Muscle
Form, page 9 Strengthening
❙ ACSM’s Certified News Continuing A stable scapula provides the foundation for all
Figure 1: Row at finish. Keep chest up and out and shoulders relaxed.
Education Self Tests, page 11 shoulder joint muscle activity and motion. Strong
periscapular muscles contribute to smooth synchro- Rotator Cuff Muscle
nized shoulder function. As mentioned in ACSM’s Strengthening
Remember:
This will be the last issue of Certified News, September 2002, scapular depres-
ACSM’s Certified News sion, rotation and tilt are essential movements. Specific rotator cuff muscle strengthening exercises
for all certifications expiring Common periscapular muscle strengthening exercises can follow a proximal scapular stability exercise
December 31, 2002. program and include:
contributing to normalized scapular control include:
Note: The views expressed in the ACSM’s Certified News articles do not
necessarily reflect the positions of the American College of Sports Medicine. Continued on page 2

American College of Sports Medicine • www.acsm.org 1

Shoulder Stability Figures 3 illustrates proper execution of a rotator cuff
Continued from the cover strengthening exercise.

Initially, internal and external rotation can be done

1. Internal rotation
with the arm at the side flexed at a 90 degree angle
- primarily
in the 30/30 position (30 degrees of abduction and
activates the
30 degrees of internal rotation). Generally a rolled Figure 3: Horizontal Extension rear view (Finish). Keep arms below
subscapularis
towel is placed between the medial arm and the shoulder height.
2. External rotation
axilla. This places the supraspinatus tendon on slack equal resistance (counter force) to that produced by
- primarily
(relaxed with no tension on it) and pressure against the limb. The muscle’s effective torque actually varies
activates the
the towel (adduction) can reduce both deltoid activity throughout the joint geometric range of motion based
infraspinatus and
and shoulder pain.2,12 Internal and external rotation on internal changes in mechanical advantage and
teres minor
can also be performed in various degrees of abduction muscle length. Maximal concentric torques occur at
3. Scaption -
to simulate cocking and throwing motions if pain free. low velocities such as 30 to 60 degrees per second
primarily
Appropriate exercise modalities include elastic while torque generating capacity reduces with
activates the
resistance bands or tubes, dumbbells, selectorized increases in velocity.24 Eccentric torque producing
supraspinatus
machines, or isokinetic dynamometers. capacity generally increases with increased dynamom-
4. Horizontal Figure 2: Closed Kinematic Chain
eter velocity. Figure 4 & 5 are illustrations of internal
extension below Scapular Depression.
Isokinetic exercises involve dynamometers and and external rotation exercises on an isokinetic
90 degrees of abduction - primarily activates the
velocity specific exercises on machines like the Cybex dynamometer.
infraspinatus, teres minor and posterior deltoid
or Biodex. The dynamometer movement arm will
5. Rowing - both a periscapular and posterior rotator
never travel faster than its pre-selected velocity. In
cuff exercise
order to maintain matching velocity with the
6. Scapular depressions - both a periscapular muscle
dynamometer, maximal force must be applied
stabilizing and rotator cuff strengthening exercise
throughout the joint range of motion. The
7. Shoulder extension - a periscapular, posterior
dynamometer’s force transducer creates a relatively
deltoid and posterior rotator cuff exercise2, 3, 20, 21, 22

INFORMATION FOR SUBSCRIBERS

ACSM’s Certified News (ISSN# 1056-9677) is published by the ACSM’s Certified News
American College of Sports Medicine Committee on Certification and Registry Boards. Editor — Hilary Welch-Petrowski, M.S. Figure 4: A External Rotation form Figure 5: Internal Rotation in the
Frequency: Published electronically four times a year (March, June, September, Committee Chair — Mitchell H. Whaley, Ph.D., FACSM the 30/30 position on an isokinetic 30/30 position on an isokinetic
and December). The March and September issues are also available in print form.
Administration dynamometer. A towel can be dynamometer. Can place a towel
Correspondence should be addressed to: Certification & Registry Department, placed between arm and ribcage. between arm and ribs.
American College of Sports Medicine, 401 West Michigan St., Indianapolis, IN 46202- President — Edward T. Howley, Ph.D., FACSM
3233. Tel.: (317) 637-9200, ext. 126, Fax: (317) 634-7817. Publications Committee Chair — Jeffrey L. Roitman, Ed.D., FACSM
Executive Vice President — James R. Whitehead
For information regarding membership, contact: American College of During the earlier stages of rehabilitation, higher
Sports Medicine, 401 West Michigan St., Indianapolis, IN 46202-3233. Tel.: National Center Newsletter Staff
(317) 637-9200, ext. 139, Fax: (317) 634-7817. Members should contact
velocity isokinetics are used to reduce the amount of
Cathy D. Stewart, National Director of Certification and Registry Programs
ACSM directly concerning changes of address. Jennifer Norris, Certification Program Manager
counter-force imposed on healing tissues and against
Disclaimer: The articles published in ACSM’s Certified News have been carefully Veronica Clark, Certification Program Coordinator joint surfaces. The range of motion can be within
reviewed, but have not been submitted for consideration as, and therefore are Lisa Duncan, Certification Program Coordinator
not, official pronouncements, policies, statements, or opinions of ACSM. Karen Pierce, Director of Professional Education and Distance Learning
pain-free limits. Utilizing a velocity spectrum between
Information published in ACSM’s Certified News is not necessarily the position of Heather Lloyd, Professional Education Coordinator 120 and 240 degrees per second seems to provide
the American College of Sports Medicine or the Committee for Certification and
Registry Boards. The purpose of this newsletter is to inform certified individuals
D. Mark Robertson, Assistant Executive Vice President the greatest carryover of strength to other veloci-
Beau Keyes, Director of Publications and Marketing
about activities of ACSM and their profession and about new information relative David Brewer, Publications Coordinator ties.12, 23 Several authors10, 25, 26 have published
to exercise and health. Information presented here is not intended to be
information supplemental to the ACSM’s Guidelines for Exercise Testing and © American College of Sports Medicine 2002. ISSN # 1056-9677. ACSM suggested glenohumeral joint muscle strength ratios.
National Center, 401 West Michigan Street, Indianapolis, IN 46202-3233 USA;
Prescription or the established positions of ACSM.
E-mail: certification@acsm.org Tel.: (317) 637-9200, ext. 126;
In general, the external rotators should be 66 to 75
Copyright Information: ACSM’s Certified News is copyrighted by the Fax: (317) 634-7817; Web Site: www.acsm.org percent the strength of the internal rotators in a
American College of Sports Medicine. No portion(s) of the work(s) may be ACSM CERTIFICATION RESOURCE CENTER: 1-800-486-5643
reproduced without written consent from the Publisher. Permission to reproduce healthy shoulder.10, 25, 26
copies of articles for noncommercial use may be obtained from the American
College of Sports Medicine, 401 West Michigan St., Indianapolis, IN 46202-
3233. Tel.: (317) 637-9200, ext. 128, Fax: (317) 634-7817
Sensorimotor Training
A mixture of closed and open kinematic chain
exercises are appropriate choices for reestablishing
Continued on page 3

2 ACSM’s Certified News, Vol. 12, No. 4 • December, 2002

Continued from page 2 General Exercise Technique 5. Almekinders, L.Impingement syndrome. Clin Sports Med.
2001;20(3):491-504.
afferent pathways, enhancing kinesthesia, facilitating Modifications 6. Joeb, C., Coen, M. and Screnar, P. Evaluation of impingement
co-activation of muscle force couples, and eliciting syndromes in the overhead-throwing athlete. J Athletic Train.
preparatory and reactive muscle contractions.1, 10, 14 The cocking (90 degrees abduction with 90 degrees 2000;35(3):293-299.
Each factor contributes to dynamic shoulder stability. of external rotation) and empty can positions (flexion 7. Kibler, B. Closed kinetic chain rehabilitation for sports injuries. Phys
Med Rehabil Clin N Am. 2000;11(2):369-384.
Closed kinematic chain activities involve the distal or abduction with maximal internal rotation) can
8. Mantone, J., Burkhead, W. and Noonan, J. Nonoperative treatment of
(hand or foot) segment of the kinetic chain being exacerbate painful shoulder symptoms.2, 8, 9, 10,12, 17, 18 rotator cuff tears. Orthop Clin N Am. 2000;31(2):295-311.
fixed against the floor, a wall, or an apparatus. 9. Bruzga, B., and Spear, K. Challenges of rehabilitation after surgery. Clin
Muscles surrounding the more proximal joint surface Overhead activity modifications include: Sports Med. 1999;18(4):769-793.
provide joint stability through antagonistic muscle co- 1. Performing activities in the plane of the scapula 10. Wilk, K., Meister, K., and Andrews, J. Current concepts in rehabilitation
of the overhead athlete. Am J Sports Med. 2002;30(1):136-151.
contractions. These exercises mimic more functional 2. Limiting motion within pain-free extremes
11. Paine, R,. and Voight, M. The role of the scapula. J Orthop Sport Phys
activities and include squats, lunges, leg presses, step- 3. Avoiding the “cocking” (90/90) position Ther. 1993;18(1):386-391.
ups, stair climbing, running (support phase), throwing 4. Avoiding the “empty can position” 12. Williams, J. and Kelly, M. Management of rotator cuff and
impingement injuries in the athlete. J Athletic Train. 2000;35(3):300-314.
(lower extremity ground force generation), pushups,
dips, pull-ups, chin-ups, rope climbing, walking on Weight training exercises warranting technique 13. Uhl, T., Mattacola, C. and Johnson, D. Clinical assessment and
rehabilitation of shoulder and knee sensorimotor control. Orthop.
your hands, etc. Closed chain activities create minimal modifications include: 2002;25(1):75-78.
joint shearing forces and reproduce proprioceptive 1. Wide grip bench press with high bar placement 14. McMullen, J., and Uhl, T. A kinetic approach to shoulder rehabilitation.
stimuli.7, 10, 13, 14 Open kinematic chain activities 2. Behind the neck lat pulldown J Athletic Train. 2000;35(3):329-337.

involve free movement of the most distal segment of 3. Behind the neck press 15. Hebert, L., Moffet, H. and Dionne, C. Scapular behavior in shoulder
impingement syndrome. Arch Phys Med Rehabil. 2002;83(1):60-69.
the kinematic chain. Because the distal link is not 4. Pushups
16. Tyler, T., Nicholas, S., and Roy, T. Quantification of posterior capsule
fixed, open chain exercises involve a greater degree 5. “Empty can” lateral shoulder raises tightness and motion loss in patients with impingement. Am J Sports Med.
2000;28(5):668-673.
of movement of all joints in the kinematic chain and
17. Malanga,, G., Jenp, Y.N. and Growney, E. et al. EMG analysis of
provide less stability for the proximal joints. shoulder positioning in testing and strengthening the supraspinatus. Med
Examples include leg curls, throwing (upper extremity Sci Sports Exerc. 1996;28(6):661-664.
during the acceleration phase), leg extensions, 18. Fees, M., Decker, T., Snyder-Mackler, L. et al. Upper extremity weight
training modifications for the injured athlete. Am J Sports Med.
running (during the flight phase), lat pulldowns, 1998;26(5):732-742.
shoulder presses, bicep curls, and bench presses.2, 3 19. Ludewig, P., and Cook, T. Alterations in shoulder kinematics and
The following exercises are a few examples of associated muscle activity in people with symptoms of shoulder
impingement. Phys Ther. 2000;80(3):276-291.
appropriate choices for improving proprioception,
20. Bradley, J. and Tibone, J. Electromyographic analysis of muscle action
kinesthesia and dynamic stability. about the shoulder. Clin Sports Med. 1991;10(4):789-805.
Figure #6: Sensorimotor conditioning. Pushups with a Biomechanical 21. Townsend, H., Jobe, F., Pink, M., et al. Electromyographic analysis of
Closed Chain Ankle Platform Stabilizer (BAPS) board. the glenohumeral muscles during a baseball rehabilitation program. Am J
Sports Med. ;19(3):264-272.
1. Plyometric pushups with a mini-trampoline
22. Hintermeister, R., Lange, G., Schultheis, J. et al. Electromyographic
2. Weight shifting on a Biomechanical Ankle activity and applied load during shoulder rehabilitation exercises using
Platform Stabilization (BAPS) board Summary elastic resistance. Am J Sports Med. 1998;26(2):210-220.
3. Dynamic rhythmic stability on a Physioball or 23. Kraemer, W., Adams, K., Cafarelli, E. et al. Progression models in
medicine ball Dynamic stability contributes to a healthy shoulder. A resistance training for healthy adults. American College of Sports Medicine
comprehensive exercise program incorporates open Position Stand. Med Sci Sports Exerc. 2002;34(2):364-380.
4. Wheel barrow walking 24. Rokito, A., Zuckerman, J., Gallagher, M. et al. Strength after surgical
5. Hand walking on a stairclimber or treadmill and closed kinetic chain activities for the periscapular repair of the rotator cuff. J Shoulder Elbow Surg. 1996;5(1):12-17.
stabilizing muscles, rotator cuff, and sensorimotor 25. Halder, A., Itoi, E., and Nan-Kai, A. Anatomy and biomechanics of the
Open Chain systems. Exercise technique modifications are also shoulder. Orthop Clin N Am. 2000;31(2):151-176.

1. Medicine ball tosses often warranted. 26. Meister, K. Internal impingement in the shoulder of the overhand
athlete:Pathophysiology, diagnosis and treatment. Am J Orthop. 2
2. Proprioceptive neuromuscular facilitation (PNF) 2000;29(6):433-8.
References
patterns with medicine balls About the Author
1. Myers, J. and Lephart S. The role of the sensorimotor system in the
athletic shoulder. J Athletic Train. 2000;(3):351-363. Peter Ronai, M.S., is an Exercise Physiologist and Manager at the
Flexibility Exercises 2. Morrison, D.,Greenbaum, B. and Einhorn A. Shoulder impingement.
Community Health Ahlbin Rehabilitation Centers (Affiliate of Bridgeport
Hospital) in Bridgeport, Conn. He is also an adjunct instructor at Sacred
Orthop Clin North Amer. 2000 Apr;(2):285-293.
Heart University in Fairfield, Conn. He is an ACSM Registered Clinical
Because a tight posterior and inferior joint capsule can 3. Voight , M. and Thompson, B. The role of the scapula in the Exercise Physiologist® and a certified Exercise Specialist and Health/
contribute to shoulder impingement, gentle capsular rehabilitation of shoulder injuries. J Athletic Train. 2000;35(3):364-372. Fitness Instructor. He is a member of the ACSM Registered Clinical
4. McCluskey, G. and Getz, B. Pathophysiology of anterior shoulder Exercise Physiology Practice Board and Continuing Professional Education
stretching is warranted.5, 6, 9, 10, 15, 16 instability. J Athletic Train. 2000;35(3):268-272. Subcommittee.

American College of Sports Medicine • www.acsm.org 3

 opportunities (workshops, distance learning, etc.) as

Call for Volunteers they relate to certification or registry. This subcommit-

tee is also responsible for developing and evaluating
the recertification and renewal policies and procedures
and for developing and maintaining a network of
Cathy D. Stewart, MS, CHES ACSM credentialed professionals.
National Director of Certification & Registry Boards
American College of Sports Medicine Ethics: This subcommittee is responsible for
developing and modifying, as needed, a code of
The American College of Sports Medicine (ACSM) was Plan, including overseeing host sites and serving as conduct for ethical behavior of ACSM credentialed
created by people like you to advance health through account representatives. professionals. This subcommittee will triage
science, medicine and education. How does ACSM allegations of ethical misconduct by ACSM creden-
fulfill this primary focus? Through your contributions Health/Fitness Instructor Certification
tialed professionals and forward legitimate claims to
as a committee member! ACSM is the world’s largest Subcommittee (H/FI): The H/FI subcommittee
the Ethics Committee of the College for consideration.
multidisciplinary sports medicine and exercise science will consist of no less than 12 and no more than 18
organization in the world with more than 18,000 individuals, at least two of whom must be Fellows. Examinations: This subcommittee is responsible for
International, National, and Regional Chapter All members must possess ACSM Health/Fitness developing and managing the examination item bank,
members. Celebrating our 50th year, ACSM is InstructorSM or higher level of credentialing. analyzing examination questions, reviewing
internationally known as the leading source of state- examination blueprints, assuring content validity, and
Exercise Specialist Certification
of-the-art research and information on sports medicine developing criteria for passing scores.
Subcommittee (ES): The ES subcommittee will
and exercise science. Your involvement as an ACSM consist of no less than nine and no more than 12 International: This subcommittee is responsible for
member and as a committee volunteer makes individuals, at least two of whom must be Fellows. managing the international certification programs,
possible the continuing advancement of our field and All members must possess ACSM Exercise Specialist® including implementing and monitoring approved
the College’s wide-ranging programs. or ACSM Program DirectorSM certification. international policies and procedures as defined within
Committees play critical roles in the College, and all the International Certification Management Plan.
Clinical Exercise Physiologist Registry
members are invited to express an interest in serving Board (RCEP): The RCEP Practice Board will consist Marketing & Public Education: This subcommit-
on any National Committee. Preference is usually of no less than 12 and no more than 16 individuals, tee is responsible for developing and disseminating
given to ACSM Fellows and those individuals who at least two of whom must be Fellows. Two-thirds of information resources to candidates, consumers,
have been active in the Regional Chapter programs. the members must be an ACSM Registered Clinical employers, governmental agencies, legislative bodies,
The Committee on Certification and Registry Boards Exercise Physiologist®. The Board is comprised of health care providers and university faculty regarding
(CCRB) is requesting your participation in fulfilling its members representing the six practice domains and the definition, role, and training of ACSM credentialed
mission to “develop, provide, and market high various occupations such as physicians and allied professionals. This subcommittee is also responsible
quality, accessible, affordable credentials and healthcare providers, basic and/or applied scientists, for developing and implementing marketing strategies
continuing education programs for health and exercise college/university educators, consumers, employers, for ACSM credentialing programs.
professionals who are responsible for preventive and regulators and health insurers.
rehabilitative programs that influence the health and Publications: This subcommittee is responsible for
well-being of all individuals.” While the ACSM Board Seven supporting subcommittees are responsible for managing the review process for all proposed and
of Trustees maintains the responsibility for the the support of the credentialing process and programs approved publications assigned for oversight by the
College, including the structure and activities of the offered across the U.S. and in twenty countries College’s Publications Committee. This subcommittee is
CCRB, it is understood that normally the CCRB will abroad. Following are brief explanations of each also responsible for recommending editorial or writing
have exclusive responsibility and authority to subcommittee’s responsibilities: groups for CCRB publications.
determine all programmatic aspects of the
credentialing examination and related educational Academic Standards and Clinical/Practical To volunteer for a position on the ACSM Committee
processes, including content, cut-scores, levels and Competencies (ASCC): This subcommittee is on Certification and Registry Boards, please visit the
types of examinations and instruction, and organiza- responsible for developing and administering policies ACSM website to submit a Committee Interest Form:
tion and delivery of these services. and procedures to verify that examination candidates http://www.acsm.org/membership/
meet academic and practical/clinical experience committeeOpportunities.htm#committeeintform
The CCRB is divided into three credentialing groups guidelines established by each credentialing Also, notify the certification and registry department
that are responsible for (1) determining candidacy subcommittee or board. This will involve establishing of your Committee Interest Form submission and
qualifications, and evaluating patterns and trends in and maintaining relationships with colleges and which subcommittee you are interested in volunteer-
scope of practice and standards of care that affect universities that prepare students for ACSM ing: certification@acsm.org
candidacy qualifications; (2) developing, managing credentialing examinations.
and evaluating workshops and/or certification/ Thanks for your dedication and support of the ACSM
registry examinations; and (3) adhering to the Continuing Professional Education (CPE): certification and registry programs!
applicable policies and procedures contained within This subcommittee is responsible for the development,
the ACSM Certification and Registry Management management and oversight of continuing education

4 ACSM’s Certified News, Vol. 12, No. 4 • December, 2002

Ask the Experts strength is the primary goal then resistance training
needs to be done first, if cardiovascular endurance is
the goal, then it should be done first. Research
shows that doing cardiovascular training prior to
I am starting graduate school in the fall for appropriate ACSM credential for professionals working weight training reduces the loads that can be lifted
a Masters in Exercise Science. I would like in cardiac rehabilitation is the ACSM Exercise during subsequent weight training which theoretically
to get into Cardiac Rehabilitation following Specialist® certification. Successfully completing the limits the potential gains in strength. Similarly,
my Masters. I was wondering what Exercise Specialist credentialing process sends a performing weight training prior to cardiorespiratory
would be a proper line of action in strong message to employers that you have the
endurance training might reduce the absolute (though
preparing for this. – J. Jacobson required knowledge, skills, and abilities to function
not necessarily the relative or percentage of maximal
competently in a cardiac rehabilitation program.
The question as to how best to prepare oneself during Discuss with your academic advisor when the best oxygen uptake) intensity a client can utilize during
a Master’s degree program for a career in cardiac time would be to consider applying for this aerobic exercise.
rehabilitation is an interesting one. Naturally, a first credentialing examination.
step is to attempt to select a graduate program that is From a practical viewpoint for most clients where the
strong in clinical exercise physiology but that is also Larry Hamm, PhD, FACSM, FAACVPR goal is generally not performance but health and
acceptable in terms of location, costs, and other Dr. Hamm is Associate Professor of Exercise Science and Director of the fitness, performing cardio respiratory training first is
personal factors. Exercise Science Laboratory in the School of Public Health and Health generally recommended. An effective approach to
Services at The George Washington University Medical Center,
Washington, D.C. He received his Ph.D. degree from the University of
optimizing overall health and fitness outcomes from
Master’s degree curricula can vary considerably Minnesota. Dr. Hamm is a clinical exercise physiologist with 25 years of an hour training program is outlined below:
between educational institutions. It would be ideal to experience in cardiac rehabilitation, clinical exercise testing, and health
choose a curriculum that emphasizes the clinical care administration. This experience includes directing hospital-based and
1. 5 minutes of light aerobic warm-up
community-based cardiac rehabilitation programs, as well as, an office-
applications of exercise physiology and also includes based program in a private cardiology practice. Dr. Hamm is a certified 2. 5-10 minutes of general stretching
course content such as pathophysiology of cardiac ACSM Program DirectorSM for preventive and rehabilitative exercise 3. 20-25 minutes of aerobic training at target heart
diseases, cardiovascular medications, electrocardio- programs. He is a Fellow in the American College of Sports Medicine, the
American Association of Cardiovascular and Pulmonary Rehabilitation rate and perceived exertion
graphy, exercise testing and training patients with
(AACVPR), and the Society of Geriatric Cardiology. He is a current 4. 20 minutes of circuit resistance training
heart disease, secondary prevention of heart disease, member of the AACVPR Board of Directors and is active on ACSM and
and more. Since many cardiac patients have a AACVPR national committees. Dr. Hamm has published and presented
5. 5 minute aerobic cool-down
variety of co-morbidities, it would be recommended to both nationally and internationally on topics related to cardiac
rehabilitation and clinical exercise physiology. Tom LaFontaine, PhD, FACSM, FAACVPR
have course work that also includes information about
Dr. LaFontaine has nearly 30 years experience in delivering cardiovascular
pulmonary diseases, non-insulin dependent diabetes
Should I have a client weight train or do rehabilitation, secondary and primary prevention, and health and fitness
mellitus, and peripheral artery disease. programs to the public. He also has coached several endurance and
cardiorespiratory exercise first?
strength trained athletes. Tom has been a member of the American
Perhaps of equal or greater importance to course – A. Thummel College of Sports Medicine since 1975 and is certified as an ACSM
Program DirectorSM and Registered Clinical Exercise Physiologist. He is a
work is having opportunities to apply your newly National Strength and Conditioning Association Certified Strength and
acquired knowledge and skills in the real world. For In my view, the answer to this question depends
Conditioning Specialist and Certified Personal Trainer. Tom is a member of
cardiac rehabilitation, this means getting out among entirely on what the client’s goals are. If increasing the ACSM Registered Clinical Exercise Physiologist® Practice Board.
cardiac patients in the hospital and rehabilitation Self Test #4 Answers: 1.a 2.b 3.d 4.True 5.a Self Test #2 Answers: 1.c 2.b 3.c 4.c 5.d
settings. Take advantage of every opportunity to gain Self Test #3 Answers: 1.d 2.True 3.b 4.d 5.b Self Test #1 Answers: 1.b 2.d 3.d 4.a 5.c
practical experience working, under supervision, with Continuing Education Self Test Answer Key for ACSM’s Certified News, Vol. 12, No. 3 • December, 2002
patients. It doesn’t matter whether this is in the form
of an internship for academic credits or as a volunteer.
Practical experience not only expands your knowledge Call for Authors!
base and improves your clinical skills but also makes
you more attractive to a potential employer. A The editor of ACSM’s Certified News is looking for authors. The purpose of ACSM’s Certified News is to
possible bonus is that it is not an uncommon provide certified professionals with current information in the field, the opportunity to earn continuing
experience for former student interns to be hired by certification credits, exposure to other professionals and programs, and to make general announcements.
the facility where they successfully completed an Each article must be educational, practical, and concise. Membership in the College is not required for
internship experience. publication in the newsletter, nor does it influence editorial decisions.
Towards the end of your graduate program or after If you would be interested in writing an article for a future edition of ACSM’s Certified News, please contact
graduation, prepare yourself to take one of the ACSM the ACSM Certification Department via e-mail: certification@acsm.org Tel.: (317) 637-9200, ext. 126.
credentialing examinations. Currently, the most This is not only an excellent opportunity to share your knowledge, but you also earn 10 ACSM-CECs.

American College of Sports Medicine • www.acsm.org 5

Osteoporosis protective response by the bones prevents damage to
the skeletal system. People with osteoporosis often
become inactive due to the fear of falling and

and Exercise
fractures, which sets off a vicious cycle. The lack of
physical activity accelerates the decline in bone mass,
and also increases the risk for heart disease.2

Prevention should be the primary goal of osteoporo-

Paul Sorace, M.S.
sis.7 Prevention means achieving maximal peak bone
Center for Allergy, Asthma, & Immune Disorders
Hackensack University Medical Center mass during childhood and young adult years, which is
ACSM Registered Clinical Exercise Physiologist® accomplished through a healthy diet and exercise. The
Hackensack, N.J. diet should contain sufficient calcium (i.e., dairy
products, green leafy vegetables, beans) and vitamin
Osteoporosis is a progressive disease characterized by increased bone resorption and reduced intestinal D (i.e., sunlight exposure and fortified foods). The
a weakening and thinning of the bones leading to an absorption of calcium.2,3 Bone loss is most prominent avoidance of smoking and limited alcohol, caffeine,
increased risk of fractures.1 Bone is a living tissue the first 5 to 7 years after the start of menopause. and animal protein consumption reduces calcium loss,
consisting of mostly collagen and calcium. Collagen Type II osteoporosis occurs after the age of 70 and is as does adequate boron intake (i.e., fruits, veg-
provides the soft framework and calcium phosphate caused by a vitamin D deficiency and secondary etables). A regular program of weight-bearing
hardens this framework and adds strength. During hyperparathyroidism.2 The following are risk factors exercise helps maximize BMD and along with a proper
childhood and early adult years, bone modeling occurs for osteoporosis: diet, may slow and even stop bone loss with
where bones become larger and denser until peak increasing age.1,7 There is some evidence that
bone mass is reached at approximately 30 years of 1. Female gender individuals who combine exercise and hormone
age.13 Once the bones become mature, bone 2. Caucasian \ Asian race replacement therapy may achieve net gains in bone
remodeling occurs where old bone is removed 3. Positive family history density.2 The effects of physical activity on BMD is as
(resorption) and new bone is laid down (formation). 4. Advanced age follows: The activity helps maximize BMD during
This process of resorption and formation helps 5. Premature menopause childhood and young adulthood; it helps maintain
maintain the health of the skeletal system. As we 6. Prolonged premenopausal amenorrhea BMD during pre-menopausal years; and it helps
advance in age, bone loss occurs through the years. 7. Nulliparity (never bore children) prevent BMD loss and the progression of disease
The activity of bone forming cells begins to decrease 8. Low body weight \ small framed during postmenopausal years. 1,2,3,7,14,17
around 35 years of age.2 Bone remodeling still 9. Insufficient physical activity
occurs but the resorption activity becomes greater than 10. Chronic smoking The following five aspects of exercise training should
the formation activity which causes a steady decrease 11. Use of glucocorticoids (steroids) or be considered when developing a program for
(0.5 -1% per year) in bone mineral density (BMD).13 anticonvulsants individuals with osteoporosis: 1) The exercise effects
A reduction in total BMD is referred to as osteopenia. 12. Excessive alcohol and caffeine consumption are site-specific. That is, the weight or load must be
Once bone loss becomes so significant that frailty sets 13. Low calcium intake applied to the specific area that needs to be
in and minor falls cause fractures, the condition of 14. Eating disorders (bulimia, anorexia nervosa) strengthened1,16; 2) The bones must be overloaded
osteopenia becomes osteoporosis. The most common and stressed beyond what they normally experience1,6,
fracture sites are the proximal femoral neck (hip),
20
; 3) The exercise effects are reversible. Any positive
lumbar spine, and the wrist.3 Although men do get Along with losing bone mass through the years, results gained from exercise training will be lost if the
osteoporosis, the condition is considered a women’s individuals experience a loss of muscle mass with training is stopped or reduced3; 4) Individuals who
disease (80% of sufferers are women). Warning signs increasing age. Known as sarcopenia, this loss of typically see the greatest response from exercise are
include loss of height, spinal deformities such as muscle mass is accelerated with physical inactivity. 2 those that started out with the lowest BMD; 5)
kyphosis, and severe back pain. A painless procedure As muscle tissue decreases, less muscle is available to Everyone has a certain genetic potential that will
called a bone scan (e.g.- DEXA) can diagnose both pull on bones. This reduced stress on the bones leads determine the rate and absolute response to an
osteopenia and osteoporosis.3 to a drop in bone mass. Weight-bearing exercise exercise training program.1 The goal of an exercise
increases muscle mass and in turn the stress on the program should be to increase BMD during and shortly
There are two types of osteoporosis. Type I usually bones.5,6,9,15 The applied force or mechanical load after adolescent growth spurts, maintain BMD in
sets in between 50 and 75 years of age. The deforms the bone and stimulates osteoblast and adults, and eliminate BMD loss and improve balance
presumed mechanism is an estrogen deficiency, which osteocyte activity, which increases collagen production in older adults to reduce the risk of falling.1,3 Evidence
typically occurs with menopause. A reduction in and helps increase or maintain the existing level of has shown that women who are physically active have
estrogen (hypoestrogenism) appears to cause BMD by adapting to the applied load.9,12 This Continued on page 7

6 ACSM’s Certified News, Vol. 12, No. 4 • December, 2002

Continued from page 6 muscular strength and endurance, and dynamic References

balance. For osteopenia and osteoporosis, a heavier 1. American College of Sports Medicine. Osteoporosis and Exercise. Position
fewer hip fractures than their sedentary counter- Stand. Medicine & Science in Sport & Exercise, 27:4, 1995, pp. 1- 7.
parts.1,11,14 Medical clearance from a client’s physician resistance should be used, allowing an individual to 2. American College of Sports Medicine. 1997. Exercise Management for
should be obtained before initiating an exercise perform 6-10 repetitions for 3-4 sets.3, 15 However, Persons with Chronic Diseases and Disabilities, Human Kinetics; 161-166.
program. A stress test may be prescribed to check for when beginning a resistance training program it is 3. American College of Sports Medicine. 1998. ACSM’s Resource Manual
for Guidelines for Exercise Testing and Prescription, ed. J. L. Roitman, M.
the presence and severity of coronary artery disease, appropriate to perform 10-15 repetitions for 1-3 sets Kelsey, T. P. LaFontaine, D. R. Southward, M. A. Williams, and T. York. 3rd
and to recommend an appropriate exercise intensity.2 until a baseline strength level and exercise tolerance is ed. Baltimore: Williams & Wilkins; 288-293.
The program should be well balanced and include established. Exercises for all the major muscle groups 4. Bassey EJ, Ramsdale SJ. Increase in femoral bone density in young
women following high-impact exercise. Osteoporosis Int. 4:72-75, 1994.
aerobic exercise (preferably weight-bearing), should be performed 2-3 times per week, with a focus
5. Bevier, W., R. A. Wiswell, G. Pyka, et. al. Relationship of body
flexibility, and resistance training. on the lower extremities and trunk extensors. composition, muscle strength, and aerobic capacity to bone mineral
Strengthening the trunk extensors sometimes helps density in older men and women. J. Bone Miner. Res. 4:421- 432. 1989.
Cardiovascular exercise should be performed 3-5 days reduce low back pain.2 Increased muscular strength 6. Dalsky, G. P., K. S. Stocke, A. A. Ehsani, E. Statoplsky, W. C. Lee, and S.
J. Birge. Weight-bearing exercise training and lumbar bone mineral content
per week for 20-30 minutes per session at 40-70% in the hip abductors and thigh extensors increases in postmenopausal women. Ann. Intern. Med. 108:824- 828. 1988.
peak heart rate.2 Because it is weight-bearing, lateral stability, which will improve dynamic balance. 7. Drinkwater, B. L. Exercise in the prevention of osteoporosis. In:
walking is a preferred mode.8 Any weight-bearing Osteoporosis, Proceedings, C. Christiansen and B. Riis (Eds.). Rodovre,
The progressive overload principle and exercise Denmark Osteopress Aps., 1993, pp. 105-108.
aerobic activity that is more intense than normal daily
8. Forwood, M. R. and A. W. Parker. Repetitive loading, in vivo, of the
activities can stimulate new bone formation.6,17 For a variation should apply to any training program where tibiae and femora of rats: effects of repeated bouts of treadmill running.
sedentary person, brisk walking may be adequate osteogenesis is a goal. Just as muscles respond and BoneMiner. 13:35- 46, 1991.
stimulation while a more active individual may require adapt to increased demands placed upon them, so 9. Frost, H. M. Structural adaptations to mechanical usage (SATMU).
Redefining Wolfs Law. Anat. Rec. 226: 403- 422, 1990.
running or interval training.10 Persons who have does the skeletal system.16,20 Variation in the exercise
10. Frost, H. M. Why do marathon runners have less bone than weight
experienced vertebral fractures in the past may have mode will apply a force in a unique pattern and as a lifters? A vital-biomechanical view and explanation. Bone 20(3): 183-
altered centers of gravity and balance. Therefore, result, an adaptive response will occur.1 Weight- 189. 1997.
when walking on the treadmill, it is recommended bearing and structural exercises should be emphasized 11. Jacobsen, P.C., W. Beaver, S.A., Grubb, T.N. Taft, and R.V. Talmadge.
Bone density in women: college athletes and older athletic women. J.
that they hold the handrails to prevent a possible fall. to maximize mechanical loading.16,17 Structural Orthop. Res. 2:328-332, 1984.
Water exercise, though not normally recommended for exercises are movements that direct the force through 12. Keller, T. S. and D. M. S. Pengler. Regulation of bone stress and strain
increasing or maintaining BMD due to the reduced the hip and spine and use multiple muscles thereby in the immature and mature rat femur. J. Biomech. 22 (11/2): 1115-
1127, 1989.
mechanical loading, does have some benefits.18 It allowing for greater loads. Examples include squats,
13. Marcus R., Kosek J., Pfefferbaum A., et al. Age-related loss of
will increase muscle strength and endurance, dynamic bent-leg deadlifts, and lunges. Bench presses and trabecular bone in premenopausal women: A biopsy study. Calcif Tiss Int
balance, and cardiovascular conditioning, and is an overhead presses are recommended for the upper- 35:406-409, 1983.

appropriate alternative for individuals with osteoarthri- body. It is important to note that strength exercises 14. Paganini-Hill, A., A. Chao, R.K. Ross, and B. Henerson. Exercise and
other factors in the prevention of hip fracture: The Leisure World Study.
tis in weight-bearing joints.2 performed in a seated position apply a reduced Epidemiology 2:16-25, 1991.
mechanical load to the hip region.3 As a result, with 15. Pocock, N. A., J. W Eisman, T. Gwinn, P. Sambrook, P. Kelly, J.
Flexibility and balance training are important for the exception of hip abduction, seated resistance Freund, and M. M. Yeates. Muscle strength, physical fitness, and weight
but not age to predict femoral neck bone mass. J. Bone Miner. Res. 4(3):
individuals with osteoporosis. Static and PNF exercises have little effect on BMD in the hip region. 441-448. 1989.
stretching should be performed 5-7 times per week to Impact activities, such as jumping in place, have been 16. Rubin, C.T. and L.E. Lanyon. Regulation of bone mass by mechanical
increase joint range of motion and body awareness. shown to have positive effects on BMD.19 A jumping strain magnitude. Calcif. Tissue Int. 37:411-417, 1985.
Balance and stability training improve proprioceptive program can compliment a strength training program 17. Snow-Harter, C., M.L. Bouxsein, B.T. Lewis, D.R. Carter, and R.
Marcus. Effects of resistance and endurance exercise on bone mineral
skills. Examples of this type of training include rising in non-osteoporotic individuals. A protocol, such as 50 status of young women: a randomized exercise intervention trial. J. Bone
from a chair without using arm muscles, standing on jumps in place, can be performed with the intensity of Miner. Res. 7:761- 769, 1992.
one leg, walking backwards, and doing obstacle jumps (e.g., height, speed) adjusted according to the 18. Taaffe, D. R., Snow-Harter C., Connolly D. A., et al. Differential effects
of swimming versus weight-bearing activity on bone mineral status of
courses.2,3 Physio-balls offer a variety of stability individual’s fitness level, abilities, and age. eumenorrheic athletes. J Bone Miner Res 10:586-593, 1995.
exercises to strengthen core muscles, improve posture, 19. Taaffe, D. R., T. L. Robinson, C. M. Snow, and R. Marcus. High impact
and promote a neutral spine. In summary, exercise plays an important role in the exercise promotes bone gain in well-trained female athletes. J. Bone
Miner. Res. 12(2): 255-260. 1997.
prevention and slowing the progression of osteoporo-
20. Virvidakis, K., E. Georgion, A. Konkotsidis, K. Ntalles, and C.
Strength training is the most important component of sis. An exercise program should be individualized and Proukasis. Bone mineral content of junior competitive weightlifters. Int. J.
an exercise program for the osteoporotic population reviewed regularly so modifications can be made if Sports Med. 11: 214-246. 1990.
since it is most likely to exceed the minimal effective there are changes in a person’s symptoms or health About the Author
strain (MES). MES is the threshold strain that must status. Open and frequent communication with an Paul Sorace, M.S., is an Exercise Physiologist for the Center for Allergy,
individual’s physician or physical therapist will ensure a Asthma, & Immune Disorders at Hackensack University Medical Center,
be surpassed in order for net gains in bone mass to N.J. He is also the Director of Training at the Forum Fitness Club in
occur.9 Strength training provides large mechanical safe and effective exercise program. Bayonne, N.J. Paul presents fitness seminars throughout the East Coast
loads on the skeletal system and helps increase and he is an ACSM Registered Clinical Exercise Physiologist®.

American College of Sports Medicine • www.acsm.org 7

Ten Indisputable Reasons to
RenewYour ACSM Certification
Sue Beckham, Ph.D., FACSM
ACSM Registered Clinical Exercise Physiologist®
Assistant Professor, University of Texas at Arlington
Arlington, Texas

1. Stay steps ahead of other professionals in your field. The amount of research published in the areas of exercise physiology, sports medicine and fitness is growing
rapidly. The number of articles listed on MEDLINE using the keyword “exercise” increased by 54% in the ten-year period 1990-1999 as compared to 1980–1989.
Continuing education not only allows you to maintain certification but keeps you abreast of the latest developments and trends in exercise and sports medicine.
Thirty percent of ACSM certified individuals fail to renew their certification. This is an alarming statistic considering the exponential growth of knowledge in our field.
Would you want to see a doctor or physical therapist that failed to meet the required continuing education necessary to keep his/her medical license current? The
same concept applies to all fitness and clinical professionals.
2. The consumer is more educated and informed than at any time in history thanks, in part, to the Internet. Hence, consumers are seeking health/fitness professionals
certified by nationally and internationally renowned organizations they can trust to train and certify professionals and provide for their continuing education needs.
ACSM is dedicated to educating the consumer through its affiliation with organizations like the American Heart Association and American Diabetes Association. Every
time an interested consumer is exposed to ACSM educational materials, they are reminded that ACSM is the industry standard for certification, education and
research.
3. ACSM credentials are the “gold standard” and are well-respeced in the health & fitness and clinical fields. Certification with ACSM sets you apart with distinction and
provides you with a competitive edge. By maintaining your ACSM certification you are able to take on more works-site responsibilities and your opportunities for
employment and advancement are increased.
4. Market yourself through ACSM’s Online Database Locator. ACSM will soon publish a list of certified and registered ACSM professionals on their Web site. This will
allow the consumer and employer to find ACSM certified individuals who reside in their area and verify credentials. This service is free; just log onto the ACSM
website at http://www.acsm.org/certification/FORMS/online_locator_signup.asp.
5. As a certified professional, ACSM offers a great educational tool in the ACSM’s Certified News newsletter. This newsletter contains articles written by experts in the
health and fitness and clinical fields. Each issue also has the Ask The Expert column with answers to questions that are important to you. Beginning in 2003, ACSM
will begin publishing this newsletter bi-monthly online at http://www.acsm.org/certification/certifiednews.htm and the May/June and November/December issues
will be printed and mailed directly to the certified professional.
6. ACSM helps you stay abreast of late-breaking research and new trends in exercise science and sports medicine through our various publications. These publications are
available for purchase through the ACSM Web Site, www.acsm.org, or as part of membership benefits. Please visit the membership pages in the ACSM Web Site for
more information on membership levels and benefits. You can also find national and international workshops and conferences which offer ACSM approved continuing
education programs for certified individuals by visiting http://www.acsm.org/meetings/calendar.htm.
7. ACSM certification provides you and your place of employment with professional credibility. ACSM will notify your employer, at your request, when you renew your
certification. Your employer will receive a letter from ACSM acknowledging your certification renewal and information about ACSM and its certification programs.
8. ACSM is dedicated to helping you reach your professional goals. No other fitness or sports medicine organization in the world supports their certified and registered
professionals with as many resources. ACSM provides opportunities to network with other ACSM certified professionals at Regional Chapter and National meetings. You
can also find a list of ACSM’s Position Stands on current topics important to your practice on the ACSM Web Site. These can be downloaded and shared with your
clients, employees and peers.
9. ACSM constantly strives to provide its certified professionals with the best service and information possible. If you have suggestions or ideas that will help ACSM to
better meet your needs, e-mail us at certification@acsm.org with your ideas.
10. Last but not least, you have confidence in knowing that you are an important part of the largest and most prestigious sports medicine organization in the world. ACSM is
working to improve all aspects of our profession. For example, ACSM is currently working to credential university degree programs. This will provide the potential
student with a list of undergraduate and graduate programs that meet ACSM guidelines for certification and registry. These efforts will improve the standard of care
necessary for continued growth and professionalism in all areas of sports medicine and fitness.
Be a spokesperson for ACSM and motivate other fitness professionals to become more involved in the future of our industry. It only takes a few moments to share ACSM
programs, certifications and research with another professional. It’s as easy as forwarding the address to ACSM’s Web Site. Get involved and help mold the future of your
profession!

8 ACSM’s Certified News, Vol. 12, No. 4 • December, 2002

 ACSM Recertification/Renewal Form
Please make any corrections in your name and/or address in the section below. Complete the form by providing the additional information to the best of your knowledge
and return to ACSM with payment. If you have any questions about what counts for CECs, please visit http://www.acsm.org/certification/requirements.htm. Return this
form with payment to ACSM National Center, P.O. Box 663607, Indianapolis, IN 46266, or e-mail: certification@acsm.org, or fax: (317) 634-7817.

ACSM ID Number: ______________________________________ or ACSM ID Number: _________________________________

❑ Dr. ❑ Mr. ❑ Mrs. ❑ Ms.

Last Name: ________________________ First Name: _________________________ Middle Name: ______________________

Address: ___________________________________________________________________________________________

City _____________________________ State____________ Postal Code ________ Country ______________________

Home Tel.: ________________________ Business Tel.: ________________________ Fax: __________________________

E-mail address: ________________________________________ Date of Birth: _____________________________________

Certification Level(s): ❑ GEL ❑ ETT ❑ H/FI ❑ RCEP ❑ ES ❑ H/FD ❑ PD

ACSM CECs applicable for this period: ________________________________________________________________________

Amount of CECs earned from other organizations: _________________________________________________________________

I, by the signature affixed below, understand that continuing education credits and CPR certification are a necessary component of, and requirement for,
valid ACSM Certification/Registration. I certify that I have met all of the requirements for this level of credential and will provide proof when necessary.
I have completed the above application to the best of my knowledge and the information is accurate and true.

Applicants signature (required): X ____________________________________________________________

Recertification Fee: GEL & ETT $40

ES & H/FI, RCEP $60
PD & H/FD $80
Multiple Recertification/Renewal Fee $5

Please indicate the amount enclosed (all payments must be made in US dollars): $ __________________________________

❑ Check Enclosed • ACSM Federal ID# 23-6390952 ($25 fee for all returned checks)

Charge above total to: ❑ MasterCard® ❑ VISA® (All 13 or 16 numbers must be given)

■■■■■■■■■■■■■■■■ ■■/■■
month year
Expiration Date

Signature authorizes ACSM to charge credit card: X ____________________________________________________

American College of Sports Medicine • www.acsm.org 9

 Online Locator Service Congratulations!
The ACSM Certification and Registry Department is continuing development of Congratulations to those individuals who earned ACSM credentials between July
the online locator/referral service for all ACSM credentialed professionals. This 1, 2002 and September 31, 2002! Please visit our online Certified News
locator service will allow anyone with an ACSM certification or registration to publication at http://www.acsm.org/certification/certifiednews.htm to view a
submit contact information to be included in an online database. To register complete listing. Over 600 people passed an ACSM certification or passed the
online, visit http://www.acsm.org/certification/FORMS/ Registry exam during that time frame!
online_locator_signup.asp.

This new service on the ACSM Web Site will allow anyone to locate informa-
tion regarding ACSM certified professionals in their area. Locating individuals Two ways to get in touch with the
who have achieved the “Gold Standard” in certifications will be as easy as
visiting the ACSM Web Site.
ACSM Certification Resource Center:
Please check the ACSM website, www.acsm.org, frequently for updates 1-800-486-5643 or
regarding this new service and how you can register your profile in our
database.
www.Lww.com/acsmcrc
REGISTER ONLINE! www.acsm.org

You are invited to attend

ACSM’s 2003 Health & Fitness
Summit & Exposition
Presented by the American College of Sports Medicine
In Cooperation with the American Council on Exercise
at the Reno Hilton
April 9-12, 2003 Reno, Nevada

10 ACSM’s Certified News, Vol. 12, No. 4 • December, 2002

 SELF-TEST # 1: The following questions were taken from the article “ Shoulder Stability Exercise Training”
by Peter Ronai published in this issue of ACSM’s Certified News.
1. According to the article, the _____ exercise is the best choice for strengthening the lower trapezius, serratus anterior and
pectoralis minor muscles.
a. shoulder girdle shrugs
b. shoulder depressions (pressdowns)
c. rows
d. internal/external rotation
ACSM’s Certified News 2. Which velocity on an isokinetic dynamometer would create the least counter torque to the shoulder joint?
Continuing Education Self Tests a. 60 degrees per second
b. 120 degrees per second
For order information for articles published in c. 180 degrees per second
Medicine & Science in Sports & Exercise®, go to d. 240 degrees per second
http://www.acsm-msse.org 3. The _____ exercise is considered closed chain and would contribute to enhanced joint stability and kinesthetics, while reducing
For order information for articles published in joint surface shearing forces.
ACSM’s Health & Fitness Journal ®, go to a. behind-the-neck lat pull-downs
http://www.acsm-healthfitness.org b. medicine ball tosses
c. shoulder presses
d. pushups on a mini-trampoline
4. Light stretching of the _____ and _____ is often warranted to help prevent shoulder impingements.
Staying up to date with the a. posterior and inferior joint capsule
b. anterior and superior joint capsule
ACSM Calendar of Events c. latissimus dorsi and pectoralis major
d. infraspinatus and teres minor
Whether it’s upcoming dates, home study 5. Each of the following strategies would be considered preventive exercise modifications EXCEPT:
opportunities, or upcoming conferences, you will a. performing exercises in the plane of the scapula
find the latest continuing education information in b. avoiding the “empty can “ position if painful
the ACSM Calendar of Events at http:// c. performing behind-the-neck lat pull-downs and shoulder presses
d. limiting motion within pain-free range
www.acsm.org/meetings/calendar.htm .
Calendar entries include conferences endorsed by SELF-TEST # 2: The following questions were taken from the article “Exercise and Osteoporosis” by Paul
Sorace published in this issue of ACSM’s Certified News.
ACSM that offer continuing education credits. If
1. Which of the following is not a risk factor for osteoporosis?
you would like to have your meeting reviewed for
a. insufficient calcium intake
endorsement, go to http://www.acsm.org/pdf/ b. insufficient physical activity
endapp.pdf to access the Guidelines for c. excessive boron intake
Endorsement and Continuing Education Credit d. use of glucocorticoids
application. For questions on ACSM continuing 2. Who will likely see the greatest response in bone mineral density (BMD) from exercise training?
education opportunities or the ACSM endorsement a. individuals that increase calcium and vitamin D intake while training
b. individuals that have the lowest initial levels of BMD
process or to receive the monthly calendar of c. individuals that are of Caucasian or Asian race
events e-mail, please contact Heather Lloyd at d. individuals that perform water exercise
hlloyd@acsm.org . For questions on non-ACSM
3. What percentage of individuals with osteoporosis are women?
endorsed continuing education that could be a. 60
accepted for recertification, please contact Jennifer b. 70
Norris at jlnorris@acsm.org . c. 80
d. 90
4. Which of the following types of training will most likely exceed the minimal effective strain?
a. PNF stretching
b. running
c. strength training
d. water exercise
5. Which strength exercise has the greatest overall impact on bone mineral density?
a. leg press
b. seated hip abduction
c. overhead press
d. squats
Continued on page 12

American College of Sports Medicine • www.acsm.org 11

Continued from page 11
SELF-TEST # 3: The following questions were taken from the article “Exercise Variability: A Prescription for
Overuse Injury Prevention” by Janet S. Dufek, Ph.D., FACSM published in ACSM’s Health & Fitness Journal®,
July/August 2002; 6:4, pgs.18-23.
1. An overuse injury can be defined as
a. consistently perceptible pain caused by the breakdown of connective tissue
b. repetitive microtrauma to the neuromuscular and skeletal systems
c. a continual application of a force or load
d. b & c are correct
2. True or False: Fit, healthy people perform more variably at below maximum levels of performance.
3. In studying variability as it relates to running, Dr. Barry Bates at the University of Oregon determined that
ACSM’s Regional Chapters
a. Elite athletes display less performance variability than non-elite athletes.
b. Elite athletes are extremely variable in their foot strike patterns. By becoming a member of one of the 12 Regional
c. Elite athletes demonstrate the same foot contact pattern time after time. Chapters of the American College of Sports
d. a & c are correct.
Medicine (ACSM), you have the opportunity to
4. Within-activity cross-training ideas applied to running include all of the following EXCEPT get up close and personal with local talent...sports
a. Rotate running shoes daily.
b. Run part of the route backwards.
medicine and exercise professionals who make
c. Run on the opposite side of the road. headlines on a regular basis. Each Regional
d. Wear ankle weights while running. Chapter hosts an Annual Meeting – a quality
5. To help prevent overuse injuries, it is recommended not to increase the frequency, intensity, and/or duration of exercise by more meeting with great networking and career
than _____ each week. development opportunities. Sound interesting?
a. 5 to 10% For more information on how to become a part of
b. 10 to 15%
c. 15 to 20% a Regional Chapter, please visit the Regional
d. 20 to 25% Chapter center on ACSM’s Web Site, http://
www.acsm.org/reg_chapters/index.htm .
SELF-TEST # 4: The following questions were taken from the article “A controlled trial of hospital versus
Earn ACSM Continuing Education Credits through
home-based exercise in cardiac patients” by Heather M. Arthur, Ph.D. et al. published in ACSM’s Medicine &
Science in Sports & Exercise®, October 2002; 34:10, pgs.1544-1550. ACSM’s Regional Chapters. Amount of credits
vary for each Chapter. To view a complete list of
1. _____ of eligible patients are enrolled in institution-based cardiac rehabilitation programs after CABG surgery.
a. 25-30% upcoming ACSM Regional Chapter meetings,
b. 30-35% please visit our website at http://
c. 35-40% www.acsm.org/reg_chapters/
d. 40-45%
regionalmeetings.htm . For more information or
2. According to the authors, the primary weakness of studies done in the past looking at home-based exercise programs is number of CECs offered at a specific chapter,
a. a lack of patient randomization
b. a lack of a standardized protocol
contact the Chapter contact for that chapter.
c. a small sample size
d. irregular telephone monitoring
3. Patients were excluded from this hospital versus home-based exercise program study if they
a. were under 42 years of age
b. had recurrent angina
c. had previously participated in an out-patient cardiac rehabilitation program
d. b and c are correct
4. True or False: The home-based group had a higher frequency of exercise sessions per week compared with the hospital-based
group.
5. Results of this study by Dr. Arthur et al. demonstrate
a. improvements in exercise capacity in both the home-based and hospital-based groups
b. a lower mean waist-to-hip ratio in the hospital-based group
c. greater improvements in quality of life for the hospital-based group
d. a and c are correct

12 ACSM’s Certified News, Vol. 12, No. 4 • December, 2002

 DECEMBER 2002 CONTINUING EDUCATION SELF TEST ANSWER FORM
For the Self-Test Answer Key, see page 5
Continuing Education Test Numbers 1, 2, 3, and 4 • CEC Credit Offering Expiration Date: December 31, 2003

SELF TEST NUMBER 1 (1.0 CEC): SELF TEST NUMBER 2 (1.0 CEC): SELF TEST NUMBER 3 (1.0 CEC): SELF TEST NUMBER 4 (1.0 CEC):
After reading each statement, please After reading each statement, please After reading each statement, please After reading each statement, please
select the best answer: select the best answer: select the best answer: select the best answer:

1. A B C D 1. A B C D 1. A B C D 1. A B C D
2. A B C D 2. A B C D 2. True False 2. A B C D
3. A B C D 3. A B C D 3. A B C D 3. A B C D
4. A B C D 4. A B C D 4. A B C D 4. True False
5. A B C D 5. A B C D 5. A B C D 5. A B C D

Please print or type ❑ ACSM National Member/ACSM Alliance member — $10

❑ Non-ACSM member — $15
Name: __________________________________________
Mail this form with a check ($25 fee for returned checks) or money order in the
Address: _________________________________________ amount of $10 ($15 for non-ACSM members) to:

City: __________________ State: ________ Zip: ______

American College of Sports Medicine
Business Telephone: ( ) _____________________ P.O. Box 663607
E-mail: ________________________________________ Indianapolis, IN 46266
Federal ID number 23-6390952
❑ ACSM Member (Member ID# _________________________ )
❑ Nonmember (ID# ________________________________ ) www.acsm.org
These activities have been approved for the designated continuing education
credit per self test form for certified professionals.
I attest that I have read the self test articles and answered the above questions using the knowledge gained through the articles referred to in this issue.

Signature _________________________________________________________________ Date ____________________

RETURN TO ACSM EDUCATION DEPARTMENT ❑ My address is incorrect; please correct as shown.

NONPROFIT
POSTAGE
www.acsm.org PAID
PERMIT #6580
ACSM’S Certified News ISSN # 1056-9677 INDIANAPOLIS IN
P.O. Box 1440
Indianapolis, IN 46206-1440 USA

ADDRESS SERVICE REQUESTED

American College of Sports Medicine • www.acsm.org 13