Clinical Exercise Physiology, Fourth Edition
By Jonathan K. Ehrman, Paul M. Gordon, Paul S. Visich and Steven J. Keteyian
Contents:
Preface
Instructor Resources
Student Resources
Acknowledgments
Part I: Introduction to Clinical Exercise Physiology
Chapter 1: The Profession of Clinical Exercise Physiology
Jonathan K. Ehrman, PhD
Paul M. Gordon, PhD, MPH
Paul S. Visich, PhD, MPH
Steven J. Keteyian, PhD
The Past, Present, and Future of Clinical Exercise Physiology
Professional Organizations and Certifications Throughout the World
Professionalization of Clinical Exercise Physiology
Conclusion
Chapter 2: Promoting a Physically Active Lifestyle
Gregory W. Heath, DHSc, MPH
Josh M. Johann, MS
Benefits of Physical Activity
Participation in Regular Physical Activity
Conclusion
Chapter 3: General Principles of Pharmacology
Steven J. Keteyian, PhD
General Properties of Drugs
Routes of Administration
Phases of Drug Effect
Mechanism of Action
Pharmacotherapy
Conclusion
Chapter 4: General Interview and Examination Skills
Quinn R. Pack, MD, MSc, FACC
Hayden Riley, MS
General Interview
Physical Examination
Conclusion
Chapter 5: Graded Exercise Testing
Steven J. Keteyian, PhD
Micah Zuhl, PhD
Indications
Contraindications
Procedures for Preparing, Conducting, and Interpreting a Graded
Exercise Test
Graded Exercise Testing With Diagnostic Imaging
Conclusion
Chapter 6: Exercise Prescription
Steven J. Keteyian, PhD
Exercise Training Sequence
Goal Setting
Principles of Exercise Prescription
Cardiorespiratory Endurance
Skeletal Muscle Strength and Endurance
Flexibility Training
Conclusion
Part II: Endocrinology and Metabolic Disorders
Chapter 7: Diabetes
Sheri R. Colberg, PhD, FACSM
Mechanism of Action
Pharmacotherapy
Conclusion
Chapter 4: General Interview and Examination Skills
Quinn R. Pack, MD, MSc, FACC
Hayden Riley, MS
General Interview
Physical Examination
Conclusion
Chapter 5: Graded Exercise Testing
Steven J. Keteyian, PhD
Micah Zuhl, PhD
Indications
Contraindications
Procedures for Preparing, Conducting, and Interpreting a Graded
Exercise Test
Graded Exercise Testing With Diagnostic Imaging
Conclusion
Chapter 6: Exercise Prescription
Steven J. Keteyian, PhD
Exercise Training Sequence
Goal Setting
Principles of Exercise Prescription
Cardiorespiratory Endurance
Skeletal Muscle Strength and Endurance
Flexibility Training
Conclusion
Part II: Endocrinology and Metabolic Disorders
Chapter 7: Diabetes
Sheri R. Colberg, PhD, FACSM
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 8: Obesity
David C. Murdy, MD
Jonathan K. Ehrman, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 9: Hypertension
Amanda L. Zaleski, MS
Antonio B. Fernandez, MD
Beth A. Taylor, PhD
Linda S. Pescatello, PhD, FACSM, FAHA
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 10: Hyperlipidemia and Dyslipidemia
Peter W. Grandjean, PhD, FACSM, ACSM–CEP, EIM3
Stephen F. Crouse, PhD, FACSM
Larry Durstine, PhD, FACSM, FAACVPR
Paul G. Davis, PhD, FACSM, RCEP
Benjamin Gordon, PhD, RCEP
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 11: Metabolic Syndrome
Mark D. Peterson, PhD, MS
Paul M. Gordon, PhD, MPH
Flor Elisa Morales, MS
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 12: Chronic Kidney Disease
Samuel Headley, PhD
Sahil Bawa, MBBS
Michael Germain, MD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Part III: Cardiovascular Diseases
Chapter 13: Acute Coronary Syndromes: Unstable Angina Pectoris
and Acute Myocardial Infarction
Ray W. Squires, PhD, MAACVPR, FACSM, FAHA
Pathophysiology
Clinical Assessment
Exercise Training: Inpatient Cardiac Rehabilitation
Exercise Training: Early Outpatient Cardiac Rehabilitation
Exercise Prescription
Conclusion
Chapter 14: Revascularization of the Heart
Neil A. Smart, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription and Training
Conclusion
Chapter 15: Chronic Heart Failure
Steven J. Keteyian, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 16: Peripheral Artery Disease
Ryan J. Mays, PhD, MPH, MS
Ivan P. Casserly, MB, BCh
Judith G. Regensteiner, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 17: Cardiac Electrical Pathophysiology
Kerry J. Stewart, EdD
David D. Spragg, MD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription and Training
Conclusion
Part IV: Diseases of the Respiratory System
Chapter 18: Chronic Obstructive Pulmonary Disease
Satvir S. Dhillon, MSc
Dennis Jensen, PhD
Jordan A. Guenette, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 19: Asthma
Brian W. Carlin, MD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 20: Cystic Fibrosis
Michael J. Danduran, MS
Lauren Camarda, MD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Part V: The Immune System
Chapter 21: Cancer
Dennis J. Kerrigan, PhD
John R. Schairer, DO
Kerry S. Courneya, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 22: Human Immunodeficiency Virus
Mansueto Neto, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Part VI: Disorders of the Bones and Joints
Chapter 23: Arthritis
Andrew B. Lemmey, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 24: Osteoporosis
Lora M. Giangregorio, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 25: Nonspecific Low Back Pain
Jan Perkins, PT, PhD
Tim Zipple, PT, DSc
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription and Training
Conclusion
Part VII: Neuromuscular Disorders
Chapter 26: Spinal Cord Injury
Mary P. Galea, PhD
Eduardo Cofré Lizama, PhD
Andisheh Bastani, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 27: Multiple Sclerosis
Linda H. Chung, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 28: Cerebral Palsy
Désirée B. Maltais, PT, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 29: Stroke
Christopher J. Womack, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 30: Parkinson’s Disease
Angela L. Ridgel, PhD
Brandon S. Pollock, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Part VIII: Special Populations
Chapter 31: Children
Timothy J. Michael, PhD
William A. Saltarelli, PhD
Definition
Scope
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Chapter 32: Older Adults
Jerome L. Fleg, MD
Daniel E. Forman, MD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription and Training
Conclusion
Chapter 33: Depression
Benson M. Hoffman, PhD
Krista A. Barbour, PhD
James A. Blumenthal, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription and Training
Conclusion
Chapter 34: Intellectual Disability
Bo Fernhall, PhD
Tracy Baynard, PhD
Definition
Scope
Pathophysiology
Clinical Considerations
Exercise Prescription
Exercise Training
Conclusion
Glossary
References
About the Editors
Contributors
Preface:
The profession of clinical exercise physiology continues to evolve.
Likewise, the role of the clinical exercise physiologist in health care
continues to grow. Most cardiac rehabilitation programs employ at least
one clinical exercise physiologist, because it is recognized that they are
uniquely trained to appreciate normal and abnormal cardiorespiratory
responses to exercise as well as prescribe exercise in patients across a
variety of clinical conditions. And although it is still true that the day-today
duties of many clinical exercise physiologists primarily involve
patients with cardiovascular disease, clinical exercise physiologists
continue to expand their role, working with other patient populations,
including those with cancer, musculoskeletal disorders, and metabolic
diseases such as chronic kidney disease and diabetes. The clinical exercise
physiology profession includes an ever increasing amount of research—
and the incorporation of the results from such research into evidence-based
guidelines for the treatment of patients with a variety of diseases. Since the
third edition of this text, the number of PubMed-referenced articles that
include the key words “clinical exercise physiologist” has nearly doubled.
Another example of the development of the profession is the continued
growth of the Clinical Exercise Physiology Association (CEPA) in the
United States. The CEPA was established in 2008 to serve practitioners in
the field through advocacy and education. Importantly, the CEPA has
published its official journal, the Journal of Clinical Exercise Physiology
(JCEP), since 2012. And beginning in 2018, JCEP is also the official
journal of the Exercise and Sports Science Australia (ESSA), the leading
clinical exercise physiology association serving Australia and New
Zealand. This exemplifies the advancement of the clinical exercise
physiology profession around the world. Each of these professional
organizations offers continuing education and credits, which are vitally
important to maintaining clinical exercise physiology–related
certifications. Organizations such as ESSA, the American College of
Sports Medicine (ACSM), the American Council on Exercise (ACE), and
the Canadian Society for Exercise Physiology (CSEP) offer clinical
certifications that identify individuals as having the required knowledge as
defined by each organization. And the number of clinical exercise
physiology programs recognized by the Commission on Accreditation of
Allied Health Education Programs (CAAHEP) continues to grow.
The first edition of Clinical Exercise Physiology, published in 2003, has
developed into a cornerstone textbook for the field, quickly becoming a
primary textbook for both upper-level undergraduate students and graduate
students preparing to work as clinical exercise physiologists. The two
original purposes for developing this book remain today in the book’s
fourth edition: (1) to provide a contemporary review of a variety of chronic
diseases and conditions for the clinical exercise physiologist in training,
and (2) to provide a comprehensive resource for people working in the
field. Another use of this text is as a resource for those preparing for the
ACSM clinical examinations. At the time of publication the ACSM still
offers two clinical certifications: Registered Clinical Exercise Physiologist
(ACSM-RCEP) and Clinical Exercise Physiologist (ACSM-CEP; note that
this name changed from Clinical Exercise Specialist in 2015). The ACSM
plans to combine these certifications into a single clinical certification
(ACSM-CEP) in early 2019. This is seen as a natural part of the evolution
of clinical exercise physiology as a profession.
This fourth edition of Clinical Exercise Physiology is fully revised. The
initial section of the book presents six foundational chapters, including an
excellent review of the history of clinical exercise physiology, a
description of the essentials of the physical examination, and a review of
the general properties of drugs and pharmacotherapy. The remaining
chapters, the core of the book, are specific to particular conditions and
populations of patients. These chapters are organized into seven parts:
endocrinology, cardiovascular diseases, respiratory diseases, immunology,
orthopedic and musculoskeletal conditions, neuromuscular disorders, and
special populations.
As with the previous editions, a general format was used for each of the
chapters in parts II through VIII of this fourth edition of Clinical Exercise
Physiology. Each of the chapters in these sections begins with an
introduction to the specific disease that includes the definition and scope
of the condition and a discussion of the relevant pathophysiology. This is
followed by a look at the medical and clinical considerations, including
signs and symptoms, diagnosis, exercise testing, and evidence-based
treatment. Each chapter concludes with an overview of the exercise
prescription for the disorder being discussed, with special emphasis placed
on any disease-specific issues that might alter the exercise prescription.
Each chapter also contains several practical application boxes. In each of
the disease-specific chapters, two of these practical application boxes
focus on the exercise prescription and on information to consider when
interacting with the patient. A third practical application box reviews the
relevant literature and discusses the physiological adaptations to exercise
training, including the potential mechanisms by which exercise can
influence primary and secondary disease prevention.
Each clinical chapter (parts II thru VIII) also has a companion case study
that can be accessed via the web resource. Each of these cases focuses on
an actual patient, progressing from initial presentation and diagnosis to
therapy and exercise treatment. Each case study concludes with several
questions that can be used for facilitating group discussion in the
classroom or for the individual learner to consider when preparing for a
clinical exercise physiology certification examination.
To keep abreast of trends and new research in the field, the chapters on
metabolic syndrome, graded exercise testing, exercise prescription, chronic
kidney disease, and heart failure have undergone major revision.
Additionally, all of the remaining chapters have undergone a thorough
revision to ensure that the material is consistent with current science and
evidence-based practice guidelines. Finally, a new chapter has been added
to address Parkinson’s disease.
Few, if any, upper-level undergraduate courses or graduate-level clinical
exercise physiology programs currently provide students with the breadth
of information required to sit for the ACSM clinical examination. Those
who plan to study for this or any similar certification examination should
understand that no single text provides in-depth coverage of all the clinical
populations that benefit from physical activity and exercise. But this text
may be as close as one can come. In all, Clinical Exercise Physiology
addresses 28 different diseases and populations.
Besides serving as a textbook for students, Clinical Exercise Physiology is
an excellent resource guide for exercise professionals to have in their
office. Its consistent organization, case studies, discussion questions, upto-
date references, and feature boxes are designed to provide the
information required for effective study. In fact, the content was developed
based on the knowledge and skills assessed in the ACSM clinical exercise
physiologist examination (and the previous registered clinical exercise
physiologist examination).