ACE Senior Fitness Specialist cheat sheet

Adults 65+ should accumulate at least 150 minutes/week of moderate-intensity aerobic activity, or 75 minutes/week of vigorous activity, or an equivalent mix.

Muscle-strengthening activities involving all major muscle groups should be performed on 2 or more days per week.

Balance training is recommended for older adults at risk of falls, 3 or more days per week.

The 2018 Physical Activity Guidelines remove the previous 10-minute bout requirement; activity of any duration counts toward the weekly total.

Age stereotypes and self-perceptions of aging influence activity participation; negative self-perceptions predict lower physical activity levels.

Physical activity reduces risk of all-cause mortality, functional limitation, and falls; benefits accrue even when activity begins late in life.

Sedentary behavior should be reduced; some activity is better than none, and older adults should move more and sit less throughout the day.

Social connectedness and purpose (e.g., volunteering, caregiving) are key determinants of sustained activity in older adults.

Maximal heart rate declines with age; the widely used estimate is 208 minus (0.7 x age), and the traditional 220 minus age overestimates HRmax in older adults.

VO2max declines roughly 10% per decade after age 30 in sedentary adults, with accelerated decline after age 60.

Sarcopenia: age-related loss of muscle mass and strength, accelerating after age 50; dynapenia refers specifically to loss of strength.

Arterial stiffness increases with age, raising systolic blood pressure and pulse pressure while blunting the baroreflex response to posture change.

Reduced skin blood flow and sweating responses impair thermoregulation, increasing heat-stress risk during exercise in older adults.

Bone mineral density declines, especially in postmenopausal women, raising fracture risk; weight-bearing and resistance exercise are osteogenic.

Reaction time and processing speed slow with age; motor unit loss and reduced nerve conduction velocity contribute to slower movement.

Cognitive changes include declines in fluid abilities (processing speed, working memory) while crystallized abilities remain stable; exercise is associated with preserved executive function.

The PAR-Q+ is a self-administered screening tool; if all questions are answered 'no,' the individual may generally begin light-to-moderate activity without medical clearance.

A 'yes' to any PAR-Q+ question requires follow-up via the ePARmed-X+ physician clearance form before unrestricted exercise.

The ACSM preparticipation algorithm uses current exercise participation plus signs/symptoms and known disease to determine whether medical clearance is needed.

Red flags requiring medical referral: chest pain or pressure, unexplained dyspnea, syncope, palpitations, and new-onset unilateral weakness or speech difficulty (stroke signs).

Medical clearance is recommended before vigorous-intensity exercise for sedentary individuals with known cardiovascular, metabolic, or renal disease.

Orthostatic hypotension is defined as a systolic drop of 20 mmHg or diastolic drop of 10 mmHg within 3 minutes of standing.

Falls risk screening: a positive screen includes one or more falls in the past year, fear of falling, or gait/balance problems; refer for further assessment.

Medication review is essential; polypharmacy (commonly defined as 5 or more medications) increases fall and adverse-event risk during exercise.

The 30-Second Chair Stand assesses lower-body strength and endurance; below-average repetitions for age and sex indicate elevated fall risk.

The 8-Foot Up-and-Go measures agility and dynamic balance; a time of 9 seconds or more suggests increased fall risk in older adults.

The 2-Minute Step Test estimates aerobic endurance; count the number of full steps (knee raised to a height between patella and iliac crest).

The Chair Sit-and-Reach and Back Scratch assess lower- and upper-body flexibility, respectively; measure distance to or past the toe/fingers.

The 6-Minute Walk Test measures functional aerobic capacity; record total distance and monitor for symptoms.

The Timed Up and Go (TUG): a time of 12 seconds or more is associated with increased fall risk; 13.5 seconds or more is a common cutoff for frailty screening.

The Short Physical Performance Battery (SPPB) combines balance, gait speed, and chair stands; scores of 10 or below indicate increased disability risk.

The Berg Balance Scale (0-56 points) predicts fall risk; scores of 45 or below are associated with increased fall risk.

Aerobic prescription: moderate intensity (40-59% HRR or 64-76% HRmax) for 30 minutes, 5 days/week, or vigorous (60-89% HRR) for 20 minutes, 3 days/week.

Resistance training: 2-3 days/week, 1-3 sets of 8-12 repetitions at 60-70% 1RM for beginners, progressing to 70-80% 1RM for strength gains.

Flexibility: static stretches held 30-60 seconds, 2-3 repetitions per muscle group, at least 2-3 days/week.

Balance training should include static and dynamic tasks, progressive challenge, and task-specific activities such as tandem stance, heel-toe walking, and single-leg stance.

Use the Rating of Perceived Exertion (RPE) 6-20 scale; moderate intensity corresponds to RPE 11-13 ('fairly light' to 'somewhat hard').

The talk test is a practical intensity guide: the ability to talk but not sing indicates moderate intensity.

Progression principle: increase frequency, intensity, or duration gradually; initial gains can be made with low-intensity activity in deconditioned older adults.

Warm-up (5-10 minutes) and cool-down (5-10 minutes) are especially important to reduce cardiovascular and musculoskeletal risk in older adults.

The Transtheoretical Model stages: precontemplation, contemplation, preparation, action, maintenance; interventions should match the client's stage.

Self-Determination Theory identifies autonomy, competence, and relatedness as basic psychological needs that drive intrinsic motivation.

Social Cognitive Theory: self-efficacy is a key determinant of exercise adherence; mastery experiences are the strongest source of self-efficacy.

The Health Belief Model: behavior change depends on perceived susceptibility, severity, benefits, and barriers, plus cues to action and self-efficacy.

SMART goals (specific, measurable, achievable, relevant, time-bound) improve adherence compared with vague intentions.

The FITT-VP principle (Frequency, Intensity, Time, Type, Volume, Progression) structures exercise prescription and communication with clients.

Motivational interviewing uses open-ended questions, reflective listening, and affirmation to build intrinsic motivation and resolve ambivalence.

Adherence strategies include self-monitoring, social support, action planning, and problem-solving barriers; relapse is a normal part of behavior change.