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ACSM considers the implementation of the new ACSM licensed personal trainer™ application to exist a key artery in addressing the rising fee of weight problems within the U.S. and other international locations as neatly as the massive number of americans who now not engage in a enough stage of actual undertaking. through this new certification, ACSM additionally hopes to multiply public safety, as many people depend on personal trainers as a chief supply of fitness and health assistance. The influx of ACSM experts will assist alleviate current confusion among the public and employers about what constitutes a towering quality/credible certification.
To develop into an ACSM certified personal trainer™, a professional esteem to exhibit crucial potential corresponding to the requirements for ACSM’s existing certifications. these certifications are based on probably the most rigorous examinations that exist, and people who slouch are among the most effective-prepared authorities in the container. the new certification, despite the fact, will permit specialists who haven't attained a bachelor’s degree to exist licensed through ACSM.
"One third or extra of the very own trainers at the instant interacting with the regularly occurring public haven't earned a college degree,” referred to Steven J. Keteyian, Ph.D., FACSM, Chair of ACSM’s committee amenable for certification programs. “This, coupled with the business’s staggering odds for boom, represents a tremendous chance to multiply the general public’s health. They deserve to exist sure that these individuals esteem the abilities if you want to allow them to deliver now not best protected guideline however additionally particularly useful suggestions to shoppers and the public.”
The extra certification will boost and complement ACSM’s current product line, which contains the ACSM fitness/fitness teacher, ACSM activity specialist, and ACSM Registered medical pastime Physiologist. ACSM will now exist capable of position well-expert and competently organized authorities along the gross continuum of the fitness and fitness industry, from health clubs to outpatient scientific clinics.
“folks that develop into ACSM licensed own Trainers™ will not only possess, however disclose mastery of the core odds so that you can enable them to bring activity tips safely and effortlessly within a well-defined scope of observe,” observed Mike Niederpruem, ACSM country wide Director of Certification and Registry programs. “they'll no longer falter to refer individuals to different undertaking professionals whose practising and education esteem outfitted them to cope with greater complicated fitness issues and dangers.”
ACSM contains the world’s most suitable specialists in undertaking physiology, cardiology, sports food, biomechanics, public fitness, and outright scientific and scientific disciplines critical to the fitness knowledgeable. ACSM can exist organizing an array of functions and information to advocate personal trainers in their education and persevered knowledgeable growth.
through an unique partnership with the electronic testing company Pearson VUE, ACSM will give computing device-primarily based checking out for the brand new ACSM licensed own trainer exam. The exam will exist the primary within the trade to present “on-demand” trying out and instant consequences notification. Candidates can exist examined at a date and time of their picking at any of Pearson VUE's 3,700 licensed testing facilities world wide. Candidates will pick up hold of a printout of their exam consequences, broken down with the aid of content area, which contains their flow/fail popularity.
Cardiorespiratory endeavor has traditionally been the emphasis of cardiac rehabilitation courses. despite the fact, resistance training (RT) has regularly develop into a crucial ingredient of cardiac rehabilitation on account of its large fitness advantages and towering quality outcomes on cardiac comorbidities (1). There are defense issues that necessity to exist regarded when imposing a RT program for the cardiac patient. because of this, selected RT guidelines esteem been based for cardiac rehabilitation (2,3). this article will wield the advantages of RT in cardiac rehabilitation. in addition, defense concerns and guidelines and the artery to improve, enforce, and monitor an RT program for patients in cardiac rehabilitation and after cardiac rehabilitation should exist presented.RT merits FOR CARDIAC patients
The merits of RT for people with cardiovascular disease are a large number of. the most general odds of RT is improved athletic might and patience (1,4-10). habitual muscle power advancements of 25% to 30% are customarily viewed (four,eight-10). in addition, a forty six% growth in muscle vigour has been observed in frail people who function RT (4).
here's distinguished for cardiac patients as a result of many actions of daily dwelling require greater athletic electricity and patience than what is developed from cardiorespiratory endeavor. moreover, the requisite force to comprehensive these activities may additionally exceed medically imposed lifting restrictions positioned on this affected person inhabitants (11). These activities encompass rising from a chair, carrying groceries, mountain climbing stairs, and holding/carrying infants and grandchildren. Many cardiac patients likewise necessity the self assurance to operate many initiatives of daily animate (1,2). Resistance training can supply them with each the athletic power and self belief to live a greater dynamic and independent culture (1,four-6,10,11).
For cardiac sufferers returning to travail after rehabilitation, RT might exist of specific hobby, primarily for these with physical worrying occupations. Resistance practising reduces cardiac calls for at given workloads by means of cutting back the rate-power product (RPP) (systolic blood force × coronary heart cost) (2,four,6-10,12) and may win tasks reminiscent of lifting hefty objects safer to function. combined cardiorespiratory activity and RT were proven to enrich aerobic health greater than cardiorespiratory practising lonesome (8,13), additional bettering functional capacity and august of life (1,4,10).
Resistance training helps exploit and prevent a number of coronary risk factors (5,6,12) and different chronic ailments (5,6,10,12). These consist of category 2 diabetes, hypertension, obese/weight problems, arthritis, frailty/sarcopenia, and osteoporosis. on account that many cardiac rehabilitation sufferers are of extended age, maintaining or bettering purposeful independence is a noteworthy improvement acquired from RT (1,four,5,11). behold desk 1 for a summary of RT merits for cardiac sufferers.RT PRECAUTIONS AND safety concerns FOR CARDIAC sufferers
Resistance working towards was once concept to exist unsafe for the cardiac affected person. Cardiac sufferers esteem been (and infrequently still are) instructed now not to lift the relaxation heavier than 5 to 10 lbs for an indefinite time length after a cardiac sustain or artery (11). This, if anything else, will motivate much less physical pastime (1,eleven). despite the fact, analysis has proven RT to exist protected in selected cardiac sufferers (6-8,eleven-18). Many reviews esteem shown that low-chance (e.g., functional ability, ≥7 metabolic equivalents [METs]) and reasonable-chance (e.g., gentle to reasonable taciturn ischemia outright over endeavor trying out or healing) cardiac sufferers can engage in RT devoid of immoderate myocardial stress (6-12). This includes Definite people with congestive heart failure who esteem established the means to tolerate RT (14,19,20). youngsters, excessive-risk cardiac patients (e.g., presence of complicated ventricular dysrhythmias) may still now not operate RT. Circuit RT can set off diminish myocardial stress than an eighty five% exertion on a treadmill examine (10,21,22) or stationary bicycling at 70% of oxygen consumption at peak exertion (7).
Many cardiac sufferers esteem other cardiac- (e.g., hypertension, diabetes, implantable cardiac defibrillators [ICDs], and pacemakers) and noncardiac-linked (e.g., osteoarthritis, osteoporosis, and shoulder impingement) conditions that should exist regarded when establishing an RT program. Most cardiac patients pick a number of medications for his or her coronary heart circumstance. The sidebar describes one of the crucial greater run-of-the-mill medicinal drugs taken through cardiac patients.
it's prudent that the health professional is sensible of the cardiac history of the patient/customer earlier than initiating RT (1). desk 2 outlines the time course for initiating RT in low- to moderate-chance cardiac sufferers.
Resistance practising is contraindicated and/or requires physician clearance for Definite greater possibility patients (2,three,10). Absolute and relative RT contraindications had been topic for cardiac sufferers (table 3). special RT precautions deserve to exist desirous about sufferers who've had myocardial infarction (MIs), coronary artery skip surgical procedure (CABG), implantable defibrillators (ICDs), pacemakers, diabetes, and hypertension (1-three,8-11). workouts involving broad shoulder girdle involvement and height are frequently confined for 4 and 6 weeks for patients having ICDs/pacemeakers and CABGs, respectively (2,three,11). Adams and colleagues (eleven) examined 13 habitual RT workout routines for protection, efficacy, and benchmark usefulness for patients who had a background of MI, CABGs, and ICDs/pacemakers. They developed a list of usurp workouts and a timeline for inevitable stream/undertaking restrictions. upper-physique RT should exist limited unless the sternum has healed sufficiently (e.g., generally three months) in sufferers receiving CABGs and unless physicians pellucid recipients of ICDs and pacemakers (2,10,11). Repetitive movement actions such as weight lifting can lead to pacing lead fractures and dislodgement (2,10,eleven). Resting BP values should still exist less than a hundred and sixty/one hundred mmHg (3), and an pastime BP cutoff of 220/a hundred and five mmHg could exist prudent (2). pomp screen fee-pressure product in sufferers with hypertension (10) by using taking and paying attention to each heart fee and systolic blood pressure (eleven). harmonize with using single-limb (instead of double limb) higher-extremity working towards in patients who esteem an exaggerated tower in blood pressure or RPP perquisite through RT (1). This can likewise exist positive in those sufferers with congestive coronary heart failure (8).
further RT safety precautions and assistance for particular circumstances encompass the following:Hypertension
continual respiration outright over RT is particularly vital for cardiac patients, to steer pellucid of the Valsalva maneuver. Exhaling perquisite through the exertion (lifting) section is advised. warding off tense gripping and sustained static (isometric) contractions likewise will assist avoid immoderate raises in blood pressure outright the artery through RT (1-3,eight,10,eleven). recreation specialists should still quit RT classes instantly if any of perquisite here antagonistic responses befall including:
now not outright fitness amenities can esteem electrocardiogram or blood power gadget to computer screen these vital signals. although, many ACSM certified experts (i.e., recreation expert, registered scientific endeavor physiologist, and program administrators) esteem the talents to monitor blood drive, pick a pulse, and calculate RPP. it's prudent that fitness experts working with this inhabitants 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 personalised application may still exist developed. it's essential to accept as perquisite with different fitness circumstances that can likewise alter the RT application design. A cardiac patient with osteoporosis should still operate outright workouts with an upright posture and retain away from spinal flexion (ahead and lateral) and spinal rotation (twisting) (2,23). A affected person with a shoulder impingement may still retain movements beneath 90 degrees of shoulder abduction and flexion and preserve hands a runt bit in entrance of the physique in the scapular aircraft. emphasis may still exist placed on scapular retraction and melancholy and on shoulder inner and external rotation. Rows are a suitable option for sufferers with a shoulder impingement (24).
There may still exist a poise among principal muscle corporations educated (5,6,10,12,25,26). this could abide away from electricity imbalances between opposing muscle companies, which might influence in musculoskeletal harm. each lower- and upper-body muscle corporations should exist knowledgeable on the very day to retain time (5,10,26). on account of their efficiency and functional results, multijoint workout routines should still exist emphasized and utilize single-joint workout routines to praise the RT program (1,2,5,10,26). not outright cardiac rehabilitation courses esteem the time, area, and machine to foster extensive RT classes. This amplifies the import of performing multijoint workout routines. When a number of RT machine is attainable, select modes that will exist most at ease for the affected person (1).
besides the fact that children there are informed 1RM percentages for decrease- and higher-physique workout routines for cardiac patients (table 4), 1RM checking out often isn't carried out because of safeguard issues and a scarcity of RT adventure that is benchmark in cardiac sufferers. An RPE of 11 to 13 (fairly gentle to a runt hard) on the Borg Scale is a suitable formulation for determining initial loads for RT workout routines (2,3). A gradual enhance in resistance (5%) should still whirl up as soon as the affected person can complete 12 to fifteen repetitions readily (3). a number of practicing suggestions consist of here:
The RT software design for the patient after cardiac rehabilitation will depend upon where the affected person plans on exercising upon completion of their distributed cardiac rehabilitation classes and what RT outfit (e.g., variable dynamic resistance machines, free weights, and variable resistance [or color] bands/tubing) a person will esteem access to. In an wonderful circumstance, upon completion of the monitored aspect of cardiac rehabilitation (regularly known as aspect II), someone might exist offered the random to proceed exercising in the very facility as a member of their upkeep program (frequently referred to as phases III to IV). last in a confidential environment will boost each a person's solace and self belief smooth in relocating ahead with their activity program, above outright RT. youngsters, as is often the case, many sufferers must find a brand new zone to pastime with different device and, simply as important, a new group of workers.
With the a variety of modes of RT and recreation machine attainable to the health and health knowledgeable, every cardiac affected person ought to exist evaluated on a person groundwork. understanding the brand new customer's scientific background (e.g., MI, CABG, and angioplasty) is standard. In a section IV environment, the fitness and fitness professional along with the clinical software director can exist charged with setting up the customer's pastime prescription. besides the fact that children, in a nonclinical atmosphere (e.g., autochthonous fitness club or fitness center), the fitness expert esteem to contact and travail with the client's health professional or health professional in designing the client's recreation prescription (table 4). as an example, a cardiac affected person who had open-heart surgical procedure and took portion in exactly 4 weeks of supervised cardiac rehabilitation (phase II) would not exist ready to discharge the equal RT exercises that an individual who had an angioplasty with stent placement four weeks prior would exist able to perform. in this inevitable case, each the open-coronary heart surgery affected person and the fitness and health knowledgeable ought to exist cognizant of sternal precautions (healing usually takes 12 weeks), which would essentially involve limiting higher-body RT workouts (table 2).
fitness and fitness experts working in the clinical atmosphere additionally must exist comfy with preparing cardiac patients for exercising of their homes. As is the case with many cardiac sufferers, they don't transition into a further formal environment, hence they necessity to exist organized to continue their electricity-practicing application at home. Many cardiac rehabilitation classes will accommodate using coloured tubing or resistance bands (distinct colours point out a different smooth of resistance) into their RT courses. in addition to being a safe and helpful kind of energy working towards, using this classification of RT outfit is convenient for the patient to study. moreover, cardiac rehabilitation courses can always accommodate distributing these resistance bands and coloured tubing to exist used by artery of their customer's at domestic upon completion of their application.
The number of cardiac sufferers isn't going to lessen within the years forward, thus the cardiac rehabilitation classes and health facilities are charged with the following: amenities should esteem the simple gadget (e.g., treadmills, upper-body ergometers, variable dynamic resistance machines, free weights, and coloured tubing/bands) to elicit expected outcomes; and cadaver of workers should exist correctly expert/educated (e.g., degreed, licensed) to travail now not most effective with cardiac sufferers but likewise with the expanding numbers of various particular populations.summary
Resistance practising is protected for selected cardiac rehabilitation patients and offers a number of fitness and fitness advantages. it is crucial for each and every cardiac patient to celebrate the suitable time route for initiating RT and cling to inevitable RT programming and safety instructions. Cardiac patients should esteem their RT program tailored to their particular wants and knowledge. this may allow them to achieve the merits of RT, while minimizing the risk of opposed events or damage. Resistance practicing, fancy cardiorespiratory recreation, may still exist persisted after the completion of a cardiac rehabilitation application to hold or further multiply athletic fitness.CONDENSED edition AND final analysis
facts now evidently demonstrates that cardiac rehabilitation sufferers should exist performing RT. The benefits received from RT will compliment the cardiorespiratory ingredient of cardiac rehabilitation. once a cardiac patient has been deemed protected and ready to arouse RT, selected defense and programming instructions should exist adopted to maximise RT safeguard and efficacy. moreover keeping their cardiorespiratory practising after cardiac rehabilitation, cardiac sufferers may still continue to esteem interaction in RT to multiply their best of life.References 1. Spencer, J.L. Resistance training in outpatient cardiac rehabilitation. might and Conditioning Journal 29(1):18-23, 2007. 2. ACSM's instructions for pastime checking out and Prescription. seventh 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 association of Cardiovascular and Pulmonary Rehabilitation. instructions for Cardiac Rehabilitation and Secondary Prevention courses. 4th ed. Human Kinetics, 2004:36, 119, 182. 4. Ades, P.A., P.D. Savage, M.E. Cress, et al. Resistance working towards on physical efficiency in disabled older womanish cardiac patients. medication & Science in activities & recreation® 35(8):1265-1270, 2003. 5. American faculty of activities medication and the American coronary heart association. physical recreation and public fitness in older adults: thoughts from the American college of activities medicine and the American coronary heart affiliation. medication & Science in sports & recreation® 39(8):1435-1445, 2007. 6. Pollock, M.L., B.A. Franklin, G.J. Balady, et al. Resistance undertaking in people with and with out heart problems: advantages, purpose, defense, and prescription. An advisory from the Committee on pastime, Rehabilitation, and Prevention, Council on medical Cardiology, American coronary heart association. Circulation a hundred and one:828-833, 2000. 7. Meyer, okay. Resistance exercise in perpetual coronary heart failure: landmark reports and implications for observe. clinical and Investigative medicine. 29(3):166-169, 2006. 8. Volaklis, k.A., and S.P. Tokmakidis. Resistance endeavor working towards in sufferers with coronary heart failure. sports medication 35(12):1085-1103, 2005. 9. Volaklis, okay.A., H.T. Douda, P.F. Kokkinos, et al. Physiologic differences to detraining following extended mixed power and cardio training in cardiac sufferers. European Journal of Cardiovascular Prevention and Rehabilitation 13:375-380, 2006. 10. Williams, M.A., W.L. Haskell, P.A. Ades, et al. Resistance practising in individuals with and without heart problems: 2007 replace. A scientific update from the American heart association Council on scientific Cardiology and Council on nutrients, physical recreation, and Metabolism. Circulation 116:572-584, 2007. eleven. Adams, J., M.J. Cline, M. Hubbard, et al. a new paradigm for apportion up-cardiac sustain resistance recreation instructions. American Journal of Cardiology 97:281-286, 2006. 12. Franklin, B.A., D.P. Swain, and R.J. Shephard. New insights within the prescription of exercise for coronary patients. Journal of Cardiovascular Nursing 18(2):116-123, 2003. 13. Stewart, k., L.D. McFarland, J.J. Weinhoffer, et al. safety and efficacy of weight practising quickly after acute myocardial infarction. Journal of Cardiopulmonary Rehabilitation 18:37-44, 1998. 14. Weber-Zion, G., E. Goldhammer, E. Shaar, et al. Left ventricular feature throughout 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 controlled affliction of circuit weight practicing on cardio potential and myocardial oxygen exact in men after coronary artery bypass surgery. Journal of Cardiopulmonary Rehabilitation 17(four):239-247, 1997. 16. Vanbiervliet, W., J. Pélissier, B. Lédermann, et al. electricity training with elastic bands: measure of its results in cardiac rehabilitation after coronary illnesses. Annales de réadaptation et de médecine physique. 46(8):545-552, 2003. 17. DeJong, A.T., C.J. Womack, J.A. Perrine, et al. Hemostatic responses to resistance working towards in sufferers with coronary artery ailment. Journal of Cardiopulmonary Rehabilitation 26(2):eighty-83, 2006. 18. Beniamini, Y., J.J. Rubenstein, and A.D. Faigenbaum. high-depth energy practicing of patients enrolled in an outpatient cardiac rehabilitation application. Journal of Cardiopulmonary Rehabilitation 19:8-17, 1998. 19. King, M.L., okay.A. Dracup, G.C. Fonarow, et al. The hemodynamic effects of isotonic recreation the usage of hand held weights in sufferers with coronary heart failure. Journal of heart Lung Transplant 19:1209-1218, 2000. 20. Karlsdottir, A.E., C. Foster, J.P. Porcari, et al. Hemodynamic responses outright the artery through cardio and resistance endeavor. Journal of Cardiopulmonary Rehabilitation 22:a hundred and seventy-177, 2004. 21. DeGroot, D., T. Quinn, R. Kertzer, et al. Circuit weight working towards in cardiac sufferers: deciding upon surest workloads for safeguard 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 practising on cardiovascular sufferers. energy and Conditioning Journal 28(2):fifty two-fifty eight, 2006. 23. national energy and Conditioning association. NSCA's necessities of non-public practicing. Earle, R., and T. Baechle (Editors). Champaign, IL: Human Kinetics, 2004:468. 24. Ronai, P. endeavor modifications and techniques to enhance shoulder feature. power and Conditioning Journal 27(four):36-forty five, 2005. 25. countrywide energy and Conditioning association. necessities of electricity training and Conditioning. 2nd ed. Baechle, T., and R. Earle (Editors). Champaign, IL: Human Kinetics, 2000:400-401. 26. Sorace, P., and T. LaFontaine. Resistance working towards muscle energy: design programs that work. ACSM's fitness & health Journal® 9(2):6-12, 2005.
a safe and advantageous recreation program can esteem a honorable impact on the indicators of athletic dystrophy with the aid of expanding muscle energy and patience, enhancing mobility and reducing the random of falling. typical physical activity can additionally advocate enhance your steadiness and coordination, and raise your habitual excellent of life. The key's to check what category of activity is finest for you and to comply with a software that comprises your individual needs and considerations.Getting outright started
speak along with your doctor earlier than starting an undertaking software and put a question to for particular programming strategies.
Take outright drugs as counseled by means of your health professional.
The goals of your program should exist to enrich your useful potential and capability to function activities of day by day residing, boost muscle power and patience, improve latitude of motion, and slash back your possibility of damage.
opt for actions that you savour and may accomplish consistently. If going for walks is simply too elaborate, cycling, rowing, swimming and chair actions are decent options.
if your fitness stage is low, tower with shorter classes (10 minutes) and regularly build up to 20 minutes or extra, 4 to 6 days per week.
function moderate-to-low resistance working towards three days per week. accomplish three units of 10 or extra repetitions. Wait ~ forty eight h between work-outs of the identical muscle community.
Do range-of-motion stretching workouts on a regular basis to prevent contractures and to retain run-of-the-mill flexibility.
Pay consideration to the artery you are sentiment during undertaking and pick general breaks outright through if mandatory. Your exercises may still exist comfortable and never strained.
when you've got myotonic MD, myotonia congenita or paramyotonia congenita, avoid exercising in cold water.
Cardiac concerns escort some sorts of athletic dystrophy, which may additionally restrict your pastime skill.
prevent exercising on my own, drink lots of fluids and abide away from strenuous pastime in scorching and humid situations.
Your undertaking software should exist designed to maximise the merits with the fewest risks of hectic your health or physical situation. accept as perquisite with contacting a certified fitness and fitness expert* who can travail with you and your physician to set up functional goals and design a secure and helpful software that addresses your selected needs.
For extra counsel, hunt advice from www.exerciseismedicine.org or e mail email@example.com.
* in case your health care professional has now not cleared you for impartial actual endeavor and would such as you to exist monitored in a medical institution surroundings or a clinical health facility, win sure to recreation most effective below the supervision of a licensed skilled. The American college of activities drugs (ACSM) has two corporations of licensed health specialists that could meet your wants. The ACSM certified medical activity specialist (CES) is certified to advocate those with coronary heart disease, diabetes and lung sickness. The ACSM Registered scientific pastime Physiologist (RCEP) is qualified to aid sufferers with a wide array of fitness challenges. You can likewise locate outright ACSM-certified health specialists through the utilize of the ProFinder at www.acsm.org.
Sources: ACSM’s instructions for pastime trying out and Prescription and other ACSM publications.
ACSM © 2010 American college of activities medicine
Cite this: Exercising With athletic Dystrophy: Prescription for fitness - Medscape - Apr 13, 2010.
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Registered Clinical Exercise Physiologist (ACSM) Median Hourly Rate by JobJob Average MinMax AU$29.11
Get a personalized salary report!Precise Estimated
Exercise can aid people prevent or manage heart problems.
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Clinical exercise specialists travail in heart health clinics, cardiovascular rehabilitation facilities, fitness centers and doctor's offices to aid people avoid or recoup from heart health or metabolic problems through exercise. Exercise specialists design individualized exercise programs to aid their clients change established patterns of behavior, improve their health and enhance their lives.
Abnormal blood lipids, known as dyslipidemia, are an increasing health problem in the United States and the world. Approximately 107 million American adults esteem borderline or towering 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 stream is impaired. If the blood supply to a portion of the heart is completely slash 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 tower 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 train of events (e.g., oxidation of LDLs, monocyte migration, macrophage uptake of modified LDLs, foam cells, fatty streaks, etc.) that result in the progress 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 likewise 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 circuit 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 cadaver that increases cardiac risk.
Lipoproteins are the carriers of lipids (primarily cholesterol and TGs) in the blood. Because chubby and water accomplish not mix, the cadaver combines protein plus lipid so that the lipid purport can exist 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 aid prevent 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 tower in TG-rich lipoproteins (e.g., very low density lipoproteins [VLDLs]) after a meal. It is a dynamic condition in which humans disburse 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 progress 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, outright of which contribute to endothelial dysfunction, may multiply during PPL (7).
Testing for PPL involves a 12-hour fleet 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 zone under the curve (AUC). A large value for TG zone 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 effect exercise has on lipoproteins. HDLs often are increased with sustained aerobic exercise that results in an expenditure of >1,200 calories/week, but this effect is less consistent and may exist genetically predetermined (9). The greater the exercise volume (and caloric expenditure), the more likely an exerciser will achieve a significant multiply 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. chronic exercise training likewise 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 lonesome 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, defer conducive changes in LDL subfractions, which will reduce the risk of CHD. For example, aerobic exercise has been shown to convert smaller LDLs to larger LDLs, reducing cardiac risk (3, 11).
Exercise training likewise 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 exist increased in those who esteem a LPL deficiency (2). It was recently demonstrated in 35 pairs of monozygotic twins (active twins ran a intend of 63 km/week vs. a intend of 7 km/week in the supine twins) that low HDL cholesterol may exist 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 advantageous 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 lonesome 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 exist more distinguished than the intensity to induce advantageous effects on lipoproteins (10, 11). Significant daily and weekly energy expenditures are recommended to defer notable changes in individuals with dyslipidemia (3, 4, 10). Cross-sectional studies esteem shown that lipids continue to improve across weekly running distances from <10 to >40 miles in a direct dose-response relationship (13).
The effect of exercise on PPL likewise is significant. Individuals who regularly discharge aerobic exercise typically pomp 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 improve 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 chubby utilize as a substrate during and after the activity helps pellucid TG from the blood. In addition, exercise stimulates the enzyme LPL and this enzyme may remain dynamic for several hours. Thus, moderate intensity exercise attenuates PPL (17, 18). It is distinguished to note that the conducive effects (e.g., TG lowering) of endurance exercise on PPL look to exist a result of acute metabolic changes as opposed to chronic exercise effects (14, 15). This encourages daily or near daily aerobic exercise to treat elevated PPL. workable mechanisms for the exercise-induced TG reductions involve increased muscle LPL activity and reduced hepatic TG secretion (14, 17).
There only esteem been a pair of studies on resistance training and PPL, and the results were incongruous (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 exist sustained or multiply following training. Weight loss likewise lowers blood pressure, improves glycemic control, and reduces inflammation linked to metabolic and cardiac diseases (3, 5, 21, 22).
Exercise training can improve lipid profiles either directly (without weight loss) by increased lipid enzymatic activity or indirectly (reduced cadaver weight) (2). When weight loss occurs in conjunction with exercise, LDL and total cholesterol are usually lowered (2, 3). Weight loss likewise has advantageous effects on lowering PPL, as obesity increases PPL. When weight loss is indicated, a loss of 5% to 10% cadaver weight from baseline is a starting goal (4). This amount of weight loss can significantly improve blood lipids. However, even when there is minimal or no weight loss, an improved lipid profile can still exist 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, kind 2 diabetes) that may require medical clearance. Statins, for example, can reason muscle damage (myopathy) and this should exist considered (4). Table 5 summarizes general exercise guidelines for dyslipidemia. The emphasis should exist on aerobic exercise and total weekly caloric expenditure. A honorable initial goal is to discharge 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 multiply in aerobic exercise intensity should likewise occur. Exercise programs with higher volumes and intensities esteem been shown to exist most effective for increasing HDL cholesterol (11). These guidelines may likewise necessity adjusting based on coexisting diseases, current fitness level, and time constraints that may exist present. The aerobic training may necessity to exist performed intermittently throughout the day. It is distinguished to recall 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 exist incorporated (see Table 5 for guidelines).Nutritional Guidelines
Dietary modification is a powerful nonpharmacological strategy for improving blood lipids. Diets that are towering in saturated and trans-fat and cholesterol multiply TGs, LDL, and total blood cholesterol. Polyunsaturated fats (e.g., corn oil) look to esteem a neutral effect on blood cholesterol, whereas monounsaturated fats (e.g., olive oil) look to sustain HDLs and lower LDLs and TGs. Reducing saturated and trans-fats and cholesterol intake will usually improve blood lipids. Even though there is variability in individual responses to dietary changes, reducing total calories consumed, particularly saturated chubby 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 exist maintained (2, 3, 23, 24).
High-carbohydrate diets can multiply TG levels and diminish HDL cholesterol, but again, this effect 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 likewise esteem 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 likewise multiply TGs, but its effect on LDL cholesterol appears to exist minimal.
Table 6 summarizes the key components of a diet to aid lower blood lipids. The emphasis should exist 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, cold water fish (e.g., salmon), etc., which esteem been shown to esteem a advantageous effect on blood lipids. Here are some nutrition tips that favorably aid impact blood lipids:
In December of 2003, a 75-year-old man was referred for lifestyle management to lose cadaver weight and manage cardiovascular risk factors. On medical history and physical fitness, he was establish to esteem 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 likewise has been very dynamic 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 esteem 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% chubby calories and 45 g of fiber per day by seven day food recall) and exercising 260 minutes/week on tolerable (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 exist prevented or treated with lifestyle management of exercise/physical activity, proper nutrition, and weight loss (if needed). Having a sound erudition 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 cadaver of evidence suggests that dyslipidemia is directly related to the progression of coronary artery disease. Lifestyle changes, which involve increased exercise/physical activity, dietary modifications, and weight loss (if needed) esteem 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 arrangement for towering 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 artery to Better Health With New Breakthrough Food Discoveries. Bantam, 1999. References 2. Durstine, J.L., and G.E. Moore. ACSM's Exercise Management for Persons with chronic 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 towering 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 towering 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 chubby 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 New 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. towering density lipoprotein cholesterol and other risk factors for coronary heart disease in female runners. The New 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. effect 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. lone 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. effect 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. effect 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 effect 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 improve insulin sensitivity in overweight and obese postmenopausal women. Diabetes care 27:1699-1705, 2004. 22. Esposito K., A. Pontillo, C. DiPalo, et al. effect 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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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 [752 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 [1533 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 [65 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 [375 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 [282 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 [135 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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