040-444 exam Dumps Source : ACSM Registered Clinical Exercise Physiologist
Test Code : 040-444
Test appellation : ACSM Registered Clinical Exercise Physiologist
Vendor appellation : ACSM
: 370 true Questions
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Cardiorespiratory exercise has traditionally been the emphasis of cardiac rehabilitation courses. despite the fact, resistance training (RT) has progressively become a vital component of cardiac rehabilitation because of its huge fitness benefits and fantastic effects on cardiac comorbidities (1). There are defense considerations that deserve to subsist considered when implementing a RT software for the cardiac affected person. as a result, particular RT instructions had been established for cardiac rehabilitation (2,three). this text will handle the benefits of RT in cardiac rehabilitation. in addition, protection concerns and guidelines and the passage to develop, do in force, and computer screen an RT program for sufferers in cardiac rehabilitation and after cardiac rehabilitation should subsist presented.RT merits FOR CARDIAC patients
The advantages of RT for people with heart problems are a large number of. probably the most regularly occurring capitalize of RT is extended sinewy power and endurance (1,4-10). usual muscle electricity advancements of 25% to 30% are usually viewed (4,eight-10). additionally, a 46% improvement in muscle vigour has been observed in frail individuals who operate RT (four).
this is crucial for cardiac patients as a result of many actions of each day vital require extra sinewy power and persistence than what's developed from cardiorespiratory recreation. moreover, the requisite drive to complete these activities can besides exceed medically imposed lifting restrictions positioned on this patient inhabitants (eleven). These activities embrace rising from a chair, carrying groceries, climbing stairs, and preserving/carrying toddlers and grandchildren. Many cardiac patients besides want the self-confidence to office many projects of day by day dwelling (1,2). Resistance working towards can provide them with each the sinewy power and self assurance to live a extra lively and unbiased subculture (1,four-6,10,eleven).
For cardiac sufferers returning to toil after rehabilitation, RT should subsist of selected hobby, particularly for these with somatic demanding occupations. Resistance training reduces cardiac demands at given workloads via cutting back the rate-pressure product (RPP) (systolic blood pressure × coronary heart cost) (2,4,6-10,12) and might beget initiatives reminiscent of lifting weighty objects safer to perform. combined cardiorespiratory activity and RT had been shown to augment aerobic health greater than cardiorespiratory working towards by myself (eight,13), further improving practical capability and nice of lifestyles (1,four,10).
Resistance working towards helps control and avert a number of coronary casual factors (5,6,12) and different eternal illnesses (5,6,10,12). These consist of classification 2 diabetes, hypertension, obese/weight problems, arthritis, frailty/sarcopenia, and osteoporosis. for the understanding that many cardiac rehabilitation patients are of accelerated age, conserving or enhancing practical independence is a noteworthy improvement bought from RT (1,4,5,11). remark desk 1 for a abstract of RT merits for cardiac sufferers.RT PRECAUTIONS AND protection concerns FOR CARDIAC sufferers
Resistance practising became as soon as notion to subsist uncertain for the cardiac affected person. Cardiac sufferers had been (and often still are) instructed not to raise anything else heavier than 5 to 10 lbs for an indefinite time duration after a cardiac event or technique (11). This, if the rest, will animate less actual activity (1,eleven). although, research has proven RT to subsist protected in selected cardiac patients (6-eight,eleven-18). Many studies acquire shown that low-risk (e.g., practical ability, ≥7 metabolic equivalents [METs]) and moderate-possibility (e.g., gentle to reasonable secretive ischemia during pastime checking out or healing) cardiac patients can acquire interaction in RT without extreme myocardial strain (6-12). This contains determined individuals with congestive coronary heart failure who've demonstrated the skill to tolerate RT (14,19,20). youngsters, high-chance cardiac patients (e.g., presence of advanced ventricular dysrhythmias) should still now not effect RT. Circuit RT can result in lessen myocardial pressure than an 85% effort on a treadmill test (10,21,22) or stationary bicycling at 70% of oxygen consumption at top effort (7).
Many cardiac sufferers acquire other cardiac- (e.g., hypertension, diabetes, implantable cardiac defibrillators [ICDs], and pacemakers) and noncardiac-linked (e.g., osteoarthritis, osteoporosis, and shoulder impingement) circumstances that should subsist considered when constructing an RT application. Most cardiac sufferers pick a few medications for his or her heart condition. The sidebar describes some of the more established medications taken by cardiac sufferers.
it is prudent that the fitness expert is aware of the cardiac history of the affected person/customer before initiating RT (1). desk 2 outlines the time path for initiating RT in low- to average-chance cardiac sufferers.
Resistance practising is contraindicated and/or requires surgeon clearance for determined greater casual sufferers (2,3,10). Absolute and relative RT contraindications were established for cardiac patients (table three). special RT precautions should subsist fascinated with sufferers who acquire had myocardial infarction (MIs), coronary artery skip surgical procedure (CABG), implantable defibrillators (ICDs), pacemakers, diabetes, and hypertension (1-3,eight-eleven). exercises involving massive shoulder girdle involvement and elevation are often restricted for four and 6 weeks for sufferers having ICDs/pacemeakers and CABGs, respectively (2,3,11). Adams and colleagues (eleven) examined 13 widespread RT workout routines for protection, efficacy, and established usefulness for patients who had a history of MI, CABGs, and ICDs/pacemakers. They developed a list of acceptable workout routines and a timeline for particular move/recreation restrictions. upper-body RT should subsist limited until the sternum has healed sufficiently (e.g., frequently 3 months) in sufferers receiving CABGs and unless physicians lucid recipients of ICDs and pacemakers (2,10,eleven). Repetitive motion actions such as weight lifting may cessation up in pacing lead fractures and dislodgement (2,10,eleven). Resting BP values should subsist less than one hundred sixty/100 mmHg (3), and an recreation BP cutoff of 220/a hundred and five mmHg may well subsist prudent (2). monitor expense-drive product in patients with hypertension (10) by passage of taking and paying consideration to both heart rate and systolic blood drive (11). believe the spend of single-limb (as a substitute of double limb) upper-extremity training in sufferers who've an exaggerated upward thrust in blood power or RPP throughout RT (1). This besides can subsist positive in those patients with congestive coronary heart failure (8).
additional RT protection precautions and advice for selected circumstances encompass the following:Hypertension
continuous breathing bar zilch over RT is exceptionally crucial for cardiac sufferers, to avoid the Valsalva maneuver. Exhaling throughout the exertion (lifting) phase is counseled. averting taut gripping and sustained static (isometric) contractions additionally will assist steer lucid of extreme raises in blood pressure bar zilch the passage through RT (1-3,eight,10,eleven). exercise authorities should still cease RT classes instantly if any of right here adversarial responses spin up including:
no longer bar zilch health facilities can acquire electrocardiogram or blood pressure machine to monitor these a must acquire signals. youngsters, many ACSM licensed professionals (i.e., pastime specialist, registered scientific pastime physiologist, and application directors) acquire the competencies to computer screen blood pressure, pick a pulse, and cipher RPP. it's prudent that fitness specialists working with this population possess or purchase these skill units.RT PROGRAMMING FOR CARDIAC sufferers
as soon as a affected person has been medically cleared to start RT, a personalized program may still subsist developed. it is crucial to accept as accurate with other health circumstances that can besides alter the RT software design. A cardiac affected person with osteoporosis should office bar zilch workout routines with an upright pose and steer lucid of spinal flexion (forward and lateral) and spinal rotation (twisting) (2,23). A patient with a shoulder impingement should retain actions beneath ninety degrees of shoulder abduction and flexion and maintain arms kind of in front of the build in the scapular plane. emphasis should subsist positioned on scapular retraction and melancholy and on shoulder interior and external rotation. Rows are an appropriate option for patients with a shoulder impingement (24).
There should still subsist a steadiness among foremost muscle businesses informed (5,6,10,12,25,26). this will avoid electricity imbalances between opposing muscle corporations, which could result in musculoskeletal injury. each lessen- and upper-body muscle companies should subsist knowledgeable on the very day to retain time (5,10,26). on account of their efficiency and practical effects, multijoint exercises may still subsist emphasized and spend single-joint workout routines to compliment the RT application (1,2,5,10,26). no longer bar zilch cardiac rehabilitation courses acquire the time, area, and device to develop wide RT programs. This amplifies the significance of performing multijoint workout routines. When plenty of RT device is obtainable, select modes that should subsist most comfy for the affected person (1).
however there are advised 1RM percentages for lower- and higher-body workout routines for cardiac patients (desk four), 1RM testing often isn't carried out as a result of safety considerations and an absence of RT suffer that is ordinary in cardiac sufferers. An RPE of 11 to 13 (pretty effortless to just a tiny difficult) on the Borg Scale is an acceptable components for choosing prefatory hundreds for RT workouts (2,3). A gradual boost in resistance (5%) may still occur as soon as the patient can comprehensive 12 to fifteen repetitions conveniently (3). a few working towards tips encompass here:
The RT application design for the patient after cardiac rehabilitation will depend on the situation the patient plans on exercising upon completion of their disbursed cardiac rehabilitation sessions and what RT gadget (e.g., variable dynamic resistance machines, free weights, and variable resistance [or color] bands/tubing) a person could acquire access to. In a terrific situation, upon completion of the monitored section of cardiac rehabilitation (commonly known as phase II), someone may subsist provided the casual to proceed exercising in the very facility as a member of their maintenance software (often called phases III to IV). final in a well-recognized atmosphere will raise both someone's console and self-confidence degree in pitiful ahead with their undertaking program, mainly RT. despite the fact, as is often the case, many patients must discover a original situation to undertaking with distinctive outfit and, just as important, a brand original personnel.
With the numerous modes of RT and undertaking outfit attainable to the fitness and fitness knowledgeable, each cardiac affected person must subsist evaluated on someone basis. understanding the original customer's medical background (e.g., MI, CABG, and angioplasty) is essential. In a section IV environment, the health and fitness skilled along side the clinical program director could subsist charged with setting up the customer's undertaking prescription. besides the fact that children, in a nonclinical environment (e.g., aboriginal health membership or fitness center), the health expert acquire to contact and toil with the client's health professional or health confidence professional in designing the customer's pastime prescription (desk 4). as an example, a cardiac affected person who had open-coronary heart surgery and took allotment in barely four weeks of supervised cardiac rehabilitation (phase II) would now not subsist able to operate the equal RT workout routines that an individual who had an angioplasty with stent placement four weeks prior can subsist able to function. during this inevitable case, both the open-coronary heart surgical procedure patient and the health and fitness professional should subsist cognizant of sternal precautions (healing always takes 12 weeks), which might basically encompass limiting higher-body RT workouts (desk 2).
fitness and fitness professionals working within the medical ambiance besides should subsist restful with preparing cardiac patients for exercising in their homes. As is the case with many cardiac patients, they execute not transition into one more formal setting, hence they acquire to subsist prepared to proceed their electricity-training application at domestic. Many cardiac rehabilitation programs will hold using colored tubing or resistance bands (different colorings witness a special flat of resistance) into their RT programs. as well as being a safe and advantageous sort of power practicing, the spend of this classification of RT outfit is handy for the patient to subsist taught. in addition, cardiac rehabilitation courses can continually accommodate distributing these resistance bands and coloured tubing to subsist used by their customer's at domestic upon completion of their software.
The variety of cardiac patients isn't going to lower within the years ahead, for this understanding the cardiac rehabilitation classes and health amenities are charged with the following: amenities ought to acquire the gauge gadget (e.g., treadmills, upper-physique ergometers, variable dynamic resistance machines, free weights, and colored tubing/bands) to elicit anticipated effects; and personnel must subsist safely expert/trained (e.g., degreed, certified) to toil not only with cardiac patients however additionally with the expanding numbers of numerous special populations.abstract
Resistance working towards is safe for selected cardiac rehabilitation patients and gives a few health and health merits. it's essential for every cardiac affected person to commemorate the revise time path for initiating RT and adhere to particular RT programming and protection instructions. Cardiac patients should acquire their RT program tailored to their inevitable needs and competencies. this can enable them to achieve the benefits of RT, while minimizing the casual of hostile movements or injury. Resistance practising, relish cardiorespiratory recreation, should subsist persisted after the completion of a cardiac rehabilitation program to maintain or additional boost sinewy health.CONDENSED edition AND bottom line
proof now naturally demonstrates that cardiac rehabilitation sufferers should subsist performing RT. The benefits bought from RT will acclaim the cardiorespiratory allotment of cardiac rehabilitation. once a cardiac affected person has been deemed protected and ready to excite RT, inevitable protection and programming guidelines should still subsist adopted to maximise RT protection and efficacy. apart from protecting their cardiorespiratory working towards after cardiac rehabilitation, cardiac sufferers should still continue to engage in RT to ameliorate their first-rate of existence.References 1. Spencer, J.L. Resistance practicing in outpatient cardiac rehabilitation. power and Conditioning Journal 29(1):18-23, 2007. 2. ACSM's instructions for pastime checking out and Prescription. 7th ed. Whaley, M.H., P.H. Brubaker, and R.M. Otto (Editors). Baltimore: Lippincott Williams & Wilkins, 2005:176-177, 189-191, 199-200, 223-225. 3. American affiliation of Cardiovascular and Pulmonary Rehabilitation. instructions for Cardiac Rehabilitation and Secondary Prevention courses. 4th ed. Human Kinetics, 2004:36, 119, 182. four. Ades, P.A., P.D. Savage, M.E. Cress, et al. Resistance practicing on physical efficiency in disabled older female cardiac sufferers. medication & Science in activities & undertaking® 35(8):1265-1270, 2003. 5. American faculty of sports medicine and the American coronary heart affiliation. physical undertaking and public health in older adults: options from the American faculty of activities drugs and the American heart affiliation. medication & Science in activities & activity® 39(eight):1435-1445, 2007. 6. Pollock, M.L., B.A. Franklin, G.J. Balady, et al. Resistance undertaking in individuals with and without cardiovascular disease: merits, reason, safeguard, and prescription. An advisory from the Committee on undertaking, Rehabilitation, and Prevention, Council on scientific Cardiology, American coronary heart affiliation. Circulation one hundred and one:828-833, 2000. 7. Meyer, k. Resistance endeavor in persistent coronary heart failure: landmark stories and implications for observe. scientific and Investigative medication. 29(three):166-169, 2006. eight. Volaklis, okay.A., and S.P. Tokmakidis. Resistance recreation working towards in patients with coronary heart failure. activities medication 35(12):1085-1103, 2005. 9. Volaklis, okay.A., H.T. Douda, P.F. Kokkinos, et al. Physiologic ameliorations to detraining following prolonged combined electricity and aerobic practising in cardiac patients. European Journal of Cardiovascular Prevention and Rehabilitation 13:375-380, 2006. 10. Williams, M.A., W.L. Haskell, P.A. Ades, et al. Resistance working towards in individuals with and with out heart problems: 2007 replace. A scientific supplant from the American heart association Council on clinical Cardiology and Council on meals, actual recreation, and Metabolism. Circulation 116:572-584, 2007. 11. Adams, J., M.J. Cline, M. Hubbard, et al. a brand original paradigm for do up-cardiac event resistance recreation guidelines. American Journal of Cardiology ninety seven:281-286, 2006. 12. Franklin, B.A., D.P. Swain, and R.J. Shephard. original insights in the prescription of exercise for coronary patients. Journal of Cardiovascular Nursing 18(2):116-123, 2003. 13. Stewart, okay., L.D. McFarland, J.J. Weinhoffer, et al. safety and efficacy of weight practising soon after acute myocardial infarction. Journal of Cardiopulmonary Rehabilitation 18:37-44, 1998. 14. Weber-Zion, G., E. Goldhammer, E. Shaar, et al. Left ventricular office bar zilch the passage through electricity testing and resistance pastime in sufferers with left ventricular dysfunction. Journal of Cardiopulmonary Rehabilitation 24(2):100-109, 2004. 15. Maiorana, A.J., T.G. Briffa, and J. Hung. A managed tribulation of circuit weight training on aerobic potential and myocardial oxygen claim in men after coronary artery pass surgical procedure. Journal of Cardiopulmonary Rehabilitation 17(4):239-247, 1997. 16. Vanbiervliet, W., J. Pélissier, B. Lédermann, et al. power training with elastic bands: measure of its outcomes in cardiac rehabilitation after coronary ailments. Annales de réadaptation et de médecine physique. forty six(8):545-552, 2003. 17. DeJong, A.T., C.J. Womack, J.A. Perrine, et al. Hemostatic responses to resistance practising in sufferers with coronary artery sickness. Journal of Cardiopulmonary Rehabilitation 26(2):80-eighty three, 2006. 18. Beniamini, Y., J.J. Rubenstein, and A.D. Faigenbaum. high-depth energy working towards of patients enrolled in an outpatient cardiac rehabilitation program. Journal of Cardiopulmonary Rehabilitation 19:8-17, 1998. 19. King, M.L., ok.A. Dracup, G.C. Fonarow, et al. The hemodynamic effects of isotonic activity using hand-held weights in sufferers with heart failure. Journal of coronary heart Lung Transplant 19:1209-1218, 2000. 20. Karlsdottir, A.E., C. Foster, J.P. Porcari, et al. Hemodynamic responses throughout cardio and resistance pastime. Journal of Cardiopulmonary Rehabilitation 22:one hundred seventy-177, 2004. 21. DeGroot, D., T. Quinn, R. Kertzer, et al. Circuit weight working towards in cardiac sufferers: choosing optimum workloads for security and energy expenditure. Journal of Cardiopulmonary Rehabilitation 18(2):a hundred forty five-152, 1998. 22. Ebben, W.P., and D.H. Leigh. The outcomes of resistance practicing on cardiovascular patients. electricity and Conditioning Journal 28(2):fifty two-fifty eight, 2006. 23. national electricity and Conditioning association. NSCA's essentials of private practicing. Earle, R., and T. Baechle (Editors). Champaign, IL: Human Kinetics, 2004:468. 24. Ronai, P. endeavor changes and techniques to augment shoulder characteristic. electricity and Conditioning Journal 27(four):36-45, 2005. 25. country wide energy and Conditioning affiliation. necessities of energy training and Conditioning. 2nd ed. Baechle, T., and R. Earle (Editors). Champaign, IL: Human Kinetics, 2000:four hundred-401. 26. Sorace, P., and T. LaFontaine. Resistance practicing muscle vigour: design courses that work. ACSM's fitness & health Journal® 9(2):6-12, 2005.
Do you remark endeavor as an essential factor within the prevention and medicine of ailment, and want to motivate individuals to result match behaviors? ACSM licensed undertaking Physiologists® pick practising to an advanced degree by passage of conducting and decoding physical health assessments and developing activity prescriptions for americans who're well or acquire medically controlled diseases.
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mp;A: ACSM’S resources FOR clinical endeavor PHYSIOLOGY
ACSM is diagnosed globally for outlining science-primarily based framework for experts who conduct fitness-linked exercise evaluation, particular person actual undertaking plans, and recreation programs for adults. Now, a original edition of ACSM’s supplies for medical pastime Physiology: Musculoskeletal, Neuromuscular, Neoplastic, Immunological, and Hematological situations is helping scientists and clinicians transmute analysis into practice. The undertaking-based innovations contained within the lead intently relate to the principles of exercise is medicine™. study the mp;A with Jon Myers, Ph.D., FACSM, senior editor of the publication.
Myers and David Nieman, Ph.D., FACSM, acquire been the senior editors of the booklet, and coordinated the writing with a bunch of contributing consultants. Myers is a clinical professor of cardiology on the Veterans Administration Palo Alto fitness confidence gadget and Stanford tuition. He chaired the publications subcommittee of ACSM’s committee on Certification and Registry Boards (CCRB) from 2001-07, and contributed content for several critical ACSM publications, including assorted editions of ACSM’s guidelines for endeavor checking out and Prescription.
Q: What’s exciting about this original medical endeavor physiology useful resource guide?A: here's one among three books in a sequence that ACSM publishes and updates periodically with Lippincott Williams and Wilkins. The content of this book, ACSM’s substances for medical exercise Physiology: Musculoskeletal, Neuromuscular, Neoplastic, Immunological, and Hematological circumstances (CEP Res-2) is complementary to ACSM’s guidelines for activity trying out and Prescription and ACSM’s aid manual for recreation trying out and Prescription. For the primary time, bar zilch three original versions of those books are being released on a synchronized schedule, with bar zilch copyright dates indicated as 2010, but accessible now. The usual theme in the series is to translate the latest in science and authoritative medical journey into apply instructions and continuing schooling materials to subsist used by recreation gurus and physicians international. whereas bar zilch of these texts are directed to the software of activity evaluation and remedy for sufferers with cardiovascular and pulmonary disorder, CEP Res-2 is entertaining in presenting information for working with sufferers who've persistent circumstances and disabilities, now not addressed by using the different two books – specifically, orthopedic, neurological, metabolic, musculoskeletal, neoplastic, and immunodeficiency situations. These clinical populations are sometimes generally underserved. fitness gurus won’t subsist capable of finding such updated elements beneath one cowl in other places that certainly handle recreation remedy for circumstances comparable to melanoma, annoying intelligence damage, or immune disorders.
Q: How is the ebook regarding ACSM’s credentialing and certifications? A: The issues addressed in the text are essential to the current or skills ACSM Registered scientific recreation Physiologist� (RCEP), seeing that the anticipated abilities, competencies and lore lined address scientific and pathological instances where exercise has been proven to deliver therapeutic or functional advantage. therefore, CEP Res-2, along with ACSM’s instructions for exercise testing and Prescription and ACSM’s aid manual for exercise checking out and Prescription deliver the complete scope of diseases and issues upon which the RCEP credential is based mostly.
Q: What’s distinct during this 2d version? A: bar zilch chapters from the primary version were up to date. top notch advances had been made in analysis and clinical adventure given that the primary version was posted eight years in the past; a scan of chapter bibliographies affirms the extent of these developments and how present the chapter contents actually are. CEP Res-2 contains a wholly original section on “clinical commemorate considerations.” because the ACSM RCEP has develop into greater based over the ultimate decade, this original section is primarily well timed and significant given that it helps supply the RCEP and different health confidence professionals with a better realizing of their position and how they can acquire an essential and essential location in nowadays’s health confidence atmosphere. This original region includes chapters on the evolution of the clinical recreation physiologist, processes to demonstrating practical results for health and fitness classes, legal and righteous considerations, and client referral and consulting family members with allied professions.
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Do you remark exercise as an essential component in the prevention and treatment of disease, and want to motivate people to drill well behaviors? ACSM Certified Exercise Physiologists® pick training to an advanced flat by conducting and interpreting physical fitness assessments and developing exercise prescriptions for people who are well or acquire medically controlled diseases.
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Abnormal blood lipids, known as dyslipidemia, are an increasing health problem in the United States and the world. Approximately 107 million American adults acquire borderline or high total cholesterol (1) (see Table 1 for cholesterol guidelines). Dyslipidemia is one of the major risk factors for heart disease (1-4). Excess cholesterol builds up in the walls of the arteries. Over time, this buildup contributes to atherosclerosis, a disease process in which arteries become narrowed and blood flux is impaired. If the blood supply to a portion of the heart is completely carve off by a blockage, the result is a heart attack.
There are a number of different forms of dyslipidemia. Hypercholesterolemia indicates elevated blood cholesterol levels (2). Hypertriglyceridemia implies elevated triglycerides (TGs). Hyperlipidemia indicates elevated cholesterol and TGs. Hyperlipoproteinemia is defined as elevated lipoproteins (2). Hypoalphalipoprotein syndrome denotes low high-density lipoprotein (HDL) cholesterol (2). Postprandial lipemia (PPL), discussed in greater detail later, is characterized by a postprandial soar in TG-rich lipoproteins after eating.
One of the first steps in atherogenesis is the infiltration and entrapment of low-density lipoproteins (LDLs) in the blood vessel wall. This leads to a series of events (e.g., oxidation of LDLs, monocyte migration, macrophage uptake of modified LDLs, foam cells, fatty streaks, etc.) that result in the evolution of fibrous plaques within the walls of the intima.
Dyslipidemia is caused by genetic and environmental factors that lead to problems with enzyme deficiencies, apolipoproteins, or lipoprotein particles. There are a number of factors that contribute to dyslipidemia (see Table 2 for a partial listing).
Dyslipidemia besides is a characteristic of the recently defined metabolic syndrome. The metabolic syndrome consists of a group of coronary heart disease (CHD) risk factors which includes glucose intolerance (fasting plasma glucose of 100-125 mg/dL), atherogenic dyslipidemia (TGs ≥150mg/dL and HDL cholesterol <40 mg/dL in men and <50 mg/dL in women), increased blood pressure (≥130/85 mm Hg), abdominal obesity (waist compass of 102 cm or greater in men and 88 cm or greater in women), a prothrombotic state, and a proinflammatory status (5). A prothrombotic status is a condition that predisposes to venous or arterial thrombosis. A proinflammatory status is the presence of low-grade generalized inflammation within the carcass that increases cardiac risk.
Lipoproteins are the carriers of lipids (primarily cholesterol and TGs) in the blood. Because stout and water execute not mix, the carcass combines protein plus lipid so that the lipid burden can subsist transported in plasma. There are several lipoproteins in the body, with different functions (see Table 3). Some contribute to cardiovascular disease (e.g., LDLs) and some assist avert it (e.g., HDLs). In summary, dyslipidemia refers to an abnormality of lipoproteins, covering a variety of disorders relating to abnormal levels of total cholesterol, LDL cholesterol, HDL cholesterol, and/or TGs.
Postprandial lipemia (PPL) refers to the soar in TG-rich lipoproteins (e.g., very low density lipoproteins [VLDLs]) after a meal. It is a dynamic condition in which humans spend the majority of their time (7). PPL reflects a combined measure of an individual's capacity to metabolize TGs. Elevated/prolonged PPL, defined as a delayed clearance of TGs after a high-fat meal, is a significant risk factor for the evolution of atherosclerosis (7, 8). The exchange of core lipids between postprandial lipoproteins and LDLs/HDLs increases during prolonged PPL in susceptible persons, resulting in elevated TGs; the production of small, dense LDL particles; and reduced HDLs (7). Smaller, denser LDLs are more atherogenic than the larger, less dense LDLs. Other atherogenic factors including clotting factors, platelet reactivity, and monocyte and cytokine expression, bar zilch of which contribute to endothelial dysfunction, may augment during PPL (7).
Testing for PPL involves a 12-hour hasty and initial blood collection. Subjects then ingest a high-fat beverage, and blood samples are collected every 2 hours for 8 hours. Triglyceride concentrations are measured by colorimetry (quantitative chemical analysis by color), and values are plotted over time. PPL is assessed using total region under the curve (AUC). A large value for TG region AUC indicates that the TGs were maintained in the blood longer than expected.Exercise Effects on Lipid Metabolism
The lowering of TGs is the most consistent upshot exercise has on lipoproteins. HDLs often are increased with sustained aerobic exercise that results in an expenditure of >1,200 calories/week, but this upshot is less consistent and may subsist genetically predetermined (9). The greater the exercise volume (and caloric expenditure), the more likely an exerciser will achieve a significant augment in HDL cholesterol. Lower TGs are typically observed with both acute exercise and sustained aerobic exercise training (3). TGs are used as energy by skeletal muscles during endurance exercise. The enzyme lipoprotein lipase (LPL) splits TGs from VLDLs, making them available for uptake by skeletal muscles. habitual exercise training besides increases hepatic HDL production and the conversion of HDL3 to HDL2 in the blood, both of which protect against heart disease (3).
The evidence for exercise solitary reducing LDLs and total cholesterol is less conclusive. It appears that weight loss/fat loss is required for significant reductions in LDLs and total cholesterol (3, 10). Regular aerobic exercise does, however, produce favorable changes in LDL subfractions, which will reduce the risk of CHD. For example, aerobic exercise has been shown to transmute smaller LDLs to larger LDLs, reducing cardiac risk (3, 11).
Exercise training besides favorably alters lipid enzyme activity, resulting in improved lipid profiles. Table 4 lists and defines the major enzymes involved in lipid metabolism. LPL and lecithin-cholesterol acyltransferase are increased with aerobic exercise, whereas hepatic lipase is usually decreased (3). The effects of exercise training on cholesterol ester transport protein are inconclusive at this time (3). Genetic deficiencies can alter the exercise response for some individuals. For example, LPL activity will not subsist increased in those who acquire a LPL deficiency (2). It was recently demonstrated in 35 pairs of monozygotic twins (active twins ran a spell of 63 km/week vs. a spell of 7 km/week in the inert twins) that low HDL cholesterol may subsist largely determined by genetic factors and is less effectively treated with vigorous exercise (12).
Table 4Lifestyle Effects on Dyslipidemia
National Cholesterol Education Program III recommends nutritional intervention, increased exercise/physical activity, and weight loss for many individuals with dyslipidemia (5). There is substantial evidence to advocate the profound beneficial effects of lifestyle changes on dyslipidemia (3, 4, 10, 11). Although there are a number of medications (e.g., statins) that are effective for treating dyslipidemia, lifestyle changes solitary can often normalize lipid profiles. Lipid lowering typically results in modest plaque regression and stabilization, reducing the risk of a cardiac event (3).
Regular aerobic exercise is an essential lifestyle component for improving/controlling blood lipids. The total amount of physical activity seems to subsist more essential than the intensity to induce beneficial effects on lipoproteins (10, 11). Significant daily and weekly energy expenditures are recommended to produce notable changes in individuals with dyslipidemia (3, 4, 10). Cross-sectional studies acquire shown that lipids continue to ameliorate across weekly running distances from <10 to >40 miles in a direct dose-response relationship (13).
The upshot of exercise on PPL besides is significant. Individuals who regularly effect aerobic exercise typically array low levels of PPL (14). Vigorous aerobic exercise has been shown to reduce PPL in men with elevated TGs, even when performed 12 hours before a high-fat meal (15). In a recent study, intermittent exercise in young, normolipidemic men and women was shown to ameliorate PPL significantly more than continuous exercise (16). The breakdown of blood TGs (and some TG-rich lipoproteins) is increased during exercise and continues well into the recovery phase. Exercise that stimulates stout spend as a substrate during and after the activity helps lucid TG from the blood. In addition, exercise stimulates the enzyme LPL and this enzyme may remain energetic for several hours. Thus, moderate intensity exercise attenuates PPL (17, 18). It is essential to note that the favorable effects (e.g., TG lowering) of endurance exercise on PPL seem to subsist a result of acute metabolic changes as opposed to habitual exercise effects (14, 15). This encourages daily or near daily aerobic exercise to handle elevated PPL. feasible mechanisms for the exercise-induced TG reductions embrace increased muscle LPL activity and reduced hepatic TG secretion (14, 17).
There only acquire been a yoke of studies on resistance training and PPL, and the results were inconsistent (19, 20). Thus, there are no specific guidelines to recommend at the present time.
Weight loss is another lifestyle factor that significantly improves dyslipidemia. Obesity typically elevates VLDL and LDL fractions, increases TG levels, lowers HDL cholesterol, increases blood pressure, and promotes insulin resistance. Weight loss typically lowers LDLs, TGs, and total cholesterol (2, 3). HDLs may increase, decrease, or remain the very (2, 3). If weight loss is combined with aerobic exercise, HDLs are more likely to subsist sustained or augment following training. Weight loss besides lowers blood pressure, improves glycemic control, and reduces inflammation linked to metabolic and cardiac diseases (3, 5, 21, 22).
Exercise training can ameliorate lipid profiles either directly (without weight loss) by increased lipid enzymatic activity or indirectly (reduced carcass weight) (2). When weight loss occurs in conjunction with exercise, LDL and total cholesterol are usually lowered (2, 3). Weight loss besides has beneficial effects on lowering PPL, as obesity increases PPL. When weight loss is indicated, a loss of 5% to 10% carcass weight from baseline is a starting goal (4). This amount of weight loss can significantly ameliorate blood lipids. However, even when there is minimal or no weight loss, an improved lipid profile can still subsist achieved with adequate exercise (11).Exercise/Physical Activity Guidelines
It is prudent that the fitness professional check with the individual's physician if he or she is taking lipid-lowering medications or other medications for any coexisting diseases (e.g., obesity, hypertension, type 2 diabetes) that may require medical clearance. Statins, for example, can cause muscle damage (myopathy) and this should subsist considered (4). Table 5 summarizes general exercise guidelines for dyslipidemia. The emphasis should subsist on aerobic exercise and total weekly caloric expenditure. A honorable initial goal is to effect aerobic exercise three to five times per week for 20 to 60 minutes, expending ≥1,200 calories/week. Ideally, aerobic exercise for dyslipidemia should gradually progress, as tolerated, to five to seven times per week for 40 to 60 minutes, creating an energy expenditure of >2,000 calories/week (4). A gradual augment in aerobic exercise intensity should besides occur. Exercise programs with higher volumes and intensities acquire been shown to subsist most effective for increasing HDL cholesterol (11). These guidelines may besides requisite adjusting based on coexisting diseases, current fitness level, and time constraints that may subsist present. The aerobic training may requisite to subsist performed intermittently throughout the day. It is essential to remember that lifestyle physical activity (e.g., climbing stairs, lunchtime walks, housework) contributes to the total weekly energy expenditure. Also, for a well-rounded exercise program, resistance and flexibility training should subsist incorporated (see Table 5 for guidelines).Nutritional Guidelines
Dietary modification is a powerful nonpharmacological strategy for improving blood lipids. Diets that are high in saturated and trans-fat and cholesterol augment TGs, LDL, and total blood cholesterol. Polyunsaturated fats (e.g., corn oil) seem to acquire a neutral upshot on blood cholesterol, whereas monounsaturated fats (e.g., olive oil) seem to sustain HDLs and lower LDLs and TGs. Reducing saturated and trans-fats and cholesterol intake will usually ameliorate blood lipids. Even though there is variability in individual responses to dietary changes, reducing total calories consumed, particularly saturated stout calories, which results in weight loss, typically lowers total and LDL cholesterol. HDL cholesterol is sometimes lowered as well, but when dieting is coupled with exercise, HDL cholesterol can subsist maintained (2, 3, 23, 24).
High-carbohydrate diets can augment TG levels and diminish HDL cholesterol, but again, this upshot is negated with aerobic exercise (2, 3, 23, 24). Dietary fiber, particularly soluble fiber, helps to lower blood cholesterol levels. Omega-3 fatty acids lower blood TG levels (3). Plant sterols besides acquire been shown to favorably alter lipid profiles, particularly when combined with aerobic exercise (25). moderate alcohol consumption (no more than one drink per day in women and lighter persons and no more than two drinks per day in most men) (4) may raise HDL cholesterol levels. It may besides augment TGs, but its upshot on LDL cholesterol appears to subsist minimal.
Table 6 summarizes the key components of a diet to assist lower blood lipids. The emphasis should subsist on restricting fat, particularly saturated fats, and cholesterol intake while increasing intake of soluble fiber and other foods such as soy, almonds, walnuts, plant sterols and stanols, frigid water fish (e.g., salmon), etc., which acquire been shown to acquire a beneficial upshot on blood lipids. Here are some nutrition tips that favorably assist impact blood lipids:
In December of 2003, a 75-year-old man was referred for lifestyle management to lose carcass weight and manage cardiovascular risk factors. On medical history and physical fitness, he was found to acquire had a recent surgical repair of a left quadriceps muscle rupture and had gained 45 lbs over six to eight months of recovery and rehabilitation. He had a history of dyslipidemia and overweight but was not diabetic nor hypertensive. He was a nonsmoker, and his mother and father died of cardiovascular disease at age 78 and 84, respectively. He has been an avid golfer since retirement in 1995, walking nine holes, three days/week. He besides has been very energetic in his daily life but had not been following a regular exercise program. His dyslipidemia was being treated only with Altaprev, 20 mg/day, started in April of 2001. He had had no advice in admiration to weight loss, exercise, or other therapeutic lifestyle changes. He was enrolled in the INTERXVENTUSA Cardiovascular Risk Reduction Program (www.interventusa.com). After one year, he had lost 43 lbs (from 244 to 201 lbs). He was eating a low-fat, high-fiber diet (22% stout calories and 45 g of fiber per day by seven day food recall) and exercising 260 minutes/week on indifferent (walking 200 minutes and Airdyne bicycle ergometer 60 minutes). Lipid changes with indicated therapy from 04/01 through 01/05 are summarized below:Summary
Dyslipidemia is a condition that promotes the genesis and progression of atherosclerosis. Dyslipidemia and PPL can often subsist prevented or treated with lifestyle management of exercise/physical activity, proper nutrition, and weight loss (if needed). Having a sound lore of lipid disorders, their associated risks, guidelines for treatment, and understanding how lifestyle management can prevent/improve dyslipidemia will better enable the fitness professional to coach individuals to live healthier lives.Condensed Version and Bottom Line
A large carcass of evidence suggests that dyslipidemia is directly related to the progression of coronary artery disease. Lifestyle changes, which embrace increased exercise/physical activity, dietary modifications, and weight loss (if needed) acquire profound effects on improving dyslipidemia and other lipid disorders such as PPL. This will result in a lower rate of coronary artery disease.Recommended Readings Durstine, J. Larry, Ph.D. ACSM Action map for high Cholesterol. Human Kinetics, 2006. ACSM Fitness Book. 3rd ed. Human Kinetics, 2003. Cooper, Kenneth H., M.D., MPH. Controlling Cholesterol the Natural Way: eat Your passage to Better Health With original Breakthrough Food Discoveries. Bantam, 1999. References 2. Durstine, J.L., and G.E. Moore. ACSM's Exercise Management for Persons with habitual Diseases and Disabilities. 2nd ed. Human Kinetics, 2003, pp. 142-148. 3. Roitman J.L. (Senior Editor). ACSM's Resource Manual for the Guidelines for Exercise Testing and Prescription. 4th ed. Baltimore: Lippincott Williams & Wilkins, 2001, pp. 263-276, 308-318. 4. Whaley, M.H., P.H. Brubaker, and R.M. Otto (Editors). ACSM's Guidelines for Exercise Testing and Prescription. 7th ed. Baltimore: Lippincott Williams & Wilkins, 2005, pp. 211-212, 217. 5. Expert Panel on Detection, Evaluation, and Treatment of high Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of high Blood Cholesterol in Adults (Adult Treatment Panel III). The Journal of the American Medical Association 285(19):2486-2497, May 16, 2001. 6. Grundy S.M., J.I. Cleeman, C.N.B. Merz, et al., for the Coordinating Committee of the National Cholesterol Education Program, Endorsed by the National Heart, Lung, and Blood Institute, American College of Cardiology Foundation, and American Heart Association. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 110:227-239, 2004. 7. Hyson D.C., J.C. Rutledge, and L. Berglund. Postprandial Lipemia and Cardiovascular Disease. Current Atherosclerosis Reports 5:437-444, 2003. 8. Parks E.J. Recent findings in the study of postprandial lipemia. Current Atherosclerosis Reports 3(6):462-470, November 2001. 9. Williams P.T., P.J. Blanche, R. Rawlings, et al. Concordant lipoprotein and weight responses to dietary stout change in identical twins with divergent exercise levels 1. American Journal of Clinical Nutrition 82(1):181-187, 2005. 10. Durstine J.L., P.W. Grandjean, C.A. Cox, et al. Lipids, lipoproteins, and exercise. Journal of Cardiopulmonary Rehabilitation 22(6):385-398, 2002. 11. Kraus W.E., J.A. Houmard, B.D. Duscha, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. The original England Journal of Medicine 347(19):1483-1492, 2002. 12. William P.T., P.J. Blanche, and R.M. Krauss. Behavioral versus genetic correlates of lipoproteins and adiposity in identical twins discordant for exercise. Circulation 112(3):350-356, 2005. 13. Williams P.T. high density lipoprotein cholesterol and other risk factors for coronary heart disease in female runners. The original England Journal of Medicine 334:1298-1303, 1996. 14. Gill J.M., and A.E Hardman. Exercise and postprandial lipid metabolism: an update on potential mechanisms and interactions with high-carbohydrate diets (review). The Journal of Nutritional Biochemistry 14(3):122-32, 2003. 15. Zhang J.Q., L.L. Ji, G. Nunez, et al. upshot of exercise timing on postprandial lipemia in hypertriglyceridemic men. Canadian Journal of Applied Physiology 29(5):590-603, 2004. 16. Altena T.S., J.L. Michaelson, S.D. Ball, et al. sole sessions of intermittent and continuous exercise and postprandial lipemia. Medicine & Science in Sports & Exercise ® 36(8):1364-71, 2004. 17. Herd S.L., B. Kiens, L.H. Boobis, et al. moderate exercise, postprandial lipemia, and skeletal muscle lipoprotein lipase activity. Metabolism 50(7):756-762, 2001. 18. Zhang J.Q., T.R. Thomas, and S.D. Ball. upshot of exercise timing on postprandial lipemia and HDL cholesterol subfractions. Journal of Applied Physiology 85:1516-1522, 1998. 19. Petitt D.S., S.A. Arngrimsson, and K.J. Cureton. upshot of resistance exercise on postprandial lipemia. Journal of Applied Physiology 94(2):694-700, 2003. 20. Shannon K.A., R.M. Shannon, J.N. Clore, et al. Resistance exercise and postprandial lipemia: the dose upshot of differing volumes of acute resistance exercise bouts. Metabolism 54(6):756-63, 2005. 21. Ryan A.S., and B.J. Nicklas. Reductions in plasma cytokine levels with weight loss ameliorate insulin sensitivity in overweight and obese postmenopausal women. Diabetes confidence 27:1699-1705, 2004. 22. Esposito K., A. Pontillo, C. DiPalo, et al. upshot of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. The Journal of the American Medical Association 289:1799-1804, 2003. 23. Koutsari C., F. Karpe, S.M. Humphreys, et al. Exercise prevents the accumulation of triglyceride-rich lipoproteins and their remnants seen when changing to a high-carbohydrate diet. Arteriosclerosis, Thrombosis, and Vascular Biology 21(9):1520-1525, 2001. 24. Koutsari C., and A.E. Hardman. Exercise prevents the augmentation of postprandial lipaemia attributable to a low-fat high-carbohydrate diet. British Journal of Nutrition 86(2):197-205, 2001. 25. Varady K.A., N. Ebine, C.A. Vanstone, et al. Plant sterols and endurance training combine to favorably alter plasma lipid profiles in previously sedentary hypercholesterolemic adults after 8 wk. The American Journal of Clinical Nutrition 80(5):1159-66, 2004. Keywords:
Cholesterol; Dyslipidemia; Postprandial Lipemia; Exercise; Physical Fitness© 2006 American College of Sports Medicine Source
ACSM's Health & Fitness Journal10(4):18-25, July-August 2006.Article Keywords
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This past Fall, Wolters Kluwer Health, in partnership with the American College of Sports Medicine (ACSM), published ACSMʻs Behavioral Aspects of Physical Activity and Exercise, which explores the latest scientific findings on eliciting the behavior changes needed to truly beget and remain committed to a well lifestyle.
Written by a team of leading experts led by Claudio Nigg, PhD, Associate Professor from the University of Hawaiʻi at Mānoaʻs Office of Public Health Studies, the original engage provides specific strategies, tools and methods that health and fitness professionals can spend to motivate and inspire clients to subsist active, exercise and stay healthy. This engage is the latest offering from an ongoing publishing partnership between Wolters Kluwer Health and the American College of Sports Medicine, which provides thousands of personal trainer health fitness specialist, clinical exercise specialist and registered clinical exercise physiologist NCCA-accredited certifications every year.
Dr. Niggʻs research focuses on health behavior change and motivation and he leads the Health behavior Change Research workgroup in the Office of Public Health Studies. His expertise led ACSM to select him as the lead editor on this title.
Published in October 2013, the engage provides step-by-step instructions to assist fitness/health professionals and students master motivation techniques that assist clients adhere to an exercise program, including the spend of checklists and worksheets, access to original research findings, motivation techniques and case scenarios.
Nigg is a faculty member of the Department of Public Health Sciences at the University of Hawaii at Mānoa. He heads the companionable and Behavioral Health Sciences specialization and his research team is the Health behavior Change Research Workgroup. Find more information about him and the Office of Public Health Studies at manoa.hawaii.edu/publichealth.
About the American College of Sports Medicine
ACSM is the largest sports medicine and exercise science organization in the world. With more than 50,000 members and certified professionals worldwide, ACSM is dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.
About Wolters Kluwer Health
Wolters Kluwer Health is a leading global provider of information, commerce intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health's customers embrace professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands embrace Health Language®, Lexicomp®, Lippincott Williams &Wilkins, Medicom®, Medknow, Ovid®, Pharmacy OneSource®, ProVation® Medical and UpToDate®.
Wolters Kluwer Health is allotment of Wolters Kluwer, a market-leading global information services company with annual revenues (2012) of €3.6 billion ($4.6 billion), approximately 19,000 employees worldwide and operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America.
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Avaya [96 Certification Exam(s) ]
AXELOS [1 Certification Exam(s) ]
Axis [1 Certification Exam(s) ]
Banking [1 Certification Exam(s) ]
BEA [5 Certification Exam(s) ]
BICSI [2 Certification Exam(s) ]
BlackBerry [17 Certification Exam(s) ]
BlueCoat [2 Certification Exam(s) ]
Brocade [4 Certification Exam(s) ]
Business-Objects [11 Certification Exam(s) ]
Business-Tests [4 Certification Exam(s) ]
CA-Technologies [21 Certification Exam(s) ]
Certification-Board [10 Certification Exam(s) ]
Certiport [3 Certification Exam(s) ]
CheckPoint [41 Certification Exam(s) ]
CIDQ [1 Certification Exam(s) ]
CIPS [4 Certification Exam(s) ]
Cisco [318 Certification Exam(s) ]
Citrix [48 Certification Exam(s) ]
CIW [18 Certification Exam(s) ]
Cloudera [10 Certification Exam(s) ]
Cognos [19 Certification Exam(s) ]
College-Board [2 Certification Exam(s) ]
CompTIA [76 Certification Exam(s) ]
ComputerAssociates [6 Certification Exam(s) ]
Consultant [2 Certification Exam(s) ]
Counselor [4 Certification Exam(s) ]
CPP-Institue [2 Certification Exam(s) ]
CPP-Institute [1 Certification Exam(s) ]
CSP [1 Certification Exam(s) ]
CWNA [1 Certification Exam(s) ]
CWNP [13 Certification Exam(s) ]
Dassault [2 Certification Exam(s) ]
DELL [9 Certification Exam(s) ]
DMI [1 Certification Exam(s) ]
DRI [1 Certification Exam(s) ]
ECCouncil [21 Certification Exam(s) ]
ECDL [1 Certification Exam(s) ]
EMC [129 Certification Exam(s) ]
Enterasys [13 Certification Exam(s) ]
Ericsson [5 Certification Exam(s) ]
ESPA [1 Certification Exam(s) ]
Esri [2 Certification Exam(s) ]
ExamExpress [15 Certification Exam(s) ]
Exin [40 Certification Exam(s) ]
ExtremeNetworks [3 Certification Exam(s) ]
F5-Networks [20 Certification Exam(s) ]
FCTC [2 Certification Exam(s) ]
Filemaker [9 Certification Exam(s) ]
Financial [36 Certification Exam(s) ]
Food [4 Certification Exam(s) ]
Fortinet [13 Certification Exam(s) ]
Foundry [6 Certification Exam(s) ]
FSMTB [1 Certification Exam(s) ]
Fujitsu [2 Certification Exam(s) ]
GAQM [9 Certification Exam(s) ]
Genesys [4 Certification Exam(s) ]
GIAC [15 Certification Exam(s) ]
Google [4 Certification Exam(s) ]
GuidanceSoftware [2 Certification Exam(s) ]
H3C [1 Certification Exam(s) ]
HDI [9 Certification Exam(s) ]
Healthcare [3 Certification Exam(s) ]
HIPAA [2 Certification Exam(s) ]
Hitachi [30 Certification Exam(s) ]
Hortonworks [4 Certification Exam(s) ]
Hospitality [2 Certification Exam(s) ]
HP [750 Certification Exam(s) ]
HR [4 Certification Exam(s) ]
HRCI [1 Certification Exam(s) ]
Huawei [21 Certification Exam(s) ]
Hyperion [10 Certification Exam(s) ]
IAAP [1 Certification Exam(s) ]
IAHCSMM [1 Certification Exam(s) ]
IBM [1532 Certification Exam(s) ]
IBQH [1 Certification Exam(s) ]
ICAI [1 Certification Exam(s) ]
ICDL [6 Certification Exam(s) ]
IEEE [1 Certification Exam(s) ]
IELTS [1 Certification Exam(s) ]
IFPUG [1 Certification Exam(s) ]
IIA [3 Certification Exam(s) ]
IIBA [2 Certification Exam(s) ]
IISFA [1 Certification Exam(s) ]
Intel [2 Certification Exam(s) ]
IQN [1 Certification Exam(s) ]
IRS [1 Certification Exam(s) ]
ISA [1 Certification Exam(s) ]
ISACA [4 Certification Exam(s) ]
ISC2 [6 Certification Exam(s) ]
ISEB [24 Certification Exam(s) ]
Isilon [4 Certification Exam(s) ]
ISM [6 Certification Exam(s) ]
iSQI [7 Certification Exam(s) ]
ITEC [1 Certification Exam(s) ]
Juniper [64 Certification Exam(s) ]
LEED [1 Certification Exam(s) ]
Legato [5 Certification Exam(s) ]
Liferay [1 Certification Exam(s) ]
Logical-Operations [1 Certification Exam(s) ]
Lotus [66 Certification Exam(s) ]
LPI [24 Certification Exam(s) ]
LSI [3 Certification Exam(s) ]
Magento [3 Certification Exam(s) ]
Maintenance [2 Certification Exam(s) ]
McAfee [8 Certification Exam(s) ]
McData [3 Certification Exam(s) ]
Medical [69 Certification Exam(s) ]
Microsoft [374 Certification Exam(s) ]
Mile2 [3 Certification Exam(s) ]
Military [1 Certification Exam(s) ]
Misc [1 Certification Exam(s) ]
Motorola [7 Certification Exam(s) ]
mySQL [4 Certification Exam(s) ]
NBSTSA [1 Certification Exam(s) ]
NCEES [2 Certification Exam(s) ]
NCIDQ [1 Certification Exam(s) ]
NCLEX [2 Certification Exam(s) ]
Network-General [12 Certification Exam(s) ]
NetworkAppliance [39 Certification Exam(s) ]
NI [1 Certification Exam(s) ]
NIELIT [1 Certification Exam(s) ]
Nokia [6 Certification Exam(s) ]
Nortel [130 Certification Exam(s) ]
Novell [37 Certification Exam(s) ]
OMG [10 Certification Exam(s) ]
Oracle [279 Certification Exam(s) ]
P&C [2 Certification Exam(s) ]
Palo-Alto [4 Certification Exam(s) ]
PARCC [1 Certification Exam(s) ]
PayPal [1 Certification Exam(s) ]
Pegasystems [12 Certification Exam(s) ]
PEOPLECERT [4 Certification Exam(s) ]
PMI [15 Certification Exam(s) ]
Polycom [2 Certification Exam(s) ]
PostgreSQL-CE [1 Certification Exam(s) ]
Prince2 [6 Certification Exam(s) ]
PRMIA [1 Certification Exam(s) ]
PsychCorp [1 Certification Exam(s) ]
PTCB [2 Certification Exam(s) ]
QAI [1 Certification Exam(s) ]
QlikView [1 Certification Exam(s) ]
Quality-Assurance [7 Certification Exam(s) ]
RACC [1 Certification Exam(s) ]
Real-Estate [1 Certification Exam(s) ]
RedHat [8 Certification Exam(s) ]
RES [5 Certification Exam(s) ]
Riverbed [8 Certification Exam(s) ]
RSA [15 Certification Exam(s) ]
Sair [8 Certification Exam(s) ]
Salesforce [5 Certification Exam(s) ]
SANS [1 Certification Exam(s) ]
SAP [98 Certification Exam(s) ]
SASInstitute [15 Certification Exam(s) ]
SAT [1 Certification Exam(s) ]
SCO [10 Certification Exam(s) ]
SCP [6 Certification Exam(s) ]
SDI [3 Certification Exam(s) ]
See-Beyond [1 Certification Exam(s) ]
Siemens [1 Certification Exam(s) ]
Snia [7 Certification Exam(s) ]
SOA [15 Certification Exam(s) ]
Social-Work-Board [4 Certification Exam(s) ]
SpringSource [1 Certification Exam(s) ]
SUN [63 Certification Exam(s) ]
SUSE [1 Certification Exam(s) ]
Sybase [17 Certification Exam(s) ]
Symantec [134 Certification Exam(s) ]
Teacher-Certification [4 Certification Exam(s) ]
The-Open-Group [8 Certification Exam(s) ]
TIA [3 Certification Exam(s) ]
Tibco [18 Certification Exam(s) ]
Trainers [3 Certification Exam(s) ]
Trend [1 Certification Exam(s) ]
TruSecure [1 Certification Exam(s) ]
USMLE [1 Certification Exam(s) ]
VCE [6 Certification Exam(s) ]
Veeam [2 Certification Exam(s) ]
Veritas [33 Certification Exam(s) ]
Vmware [58 Certification Exam(s) ]
Wonderlic [2 Certification Exam(s) ]
Worldatwork [2 Certification Exam(s) ]
XML-Master [3 Certification Exam(s) ]
Zend [6 Certification Exam(s) ]
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