ISSA CPT cheat sheet

Sliding filament theory: calcium binds troponin, tropomyosin shifts, myosin heads cross-bridge with actin and pull the Z-lines toward each other.

The sarcomere is the functional contractile unit of muscle, bounded by two Z-lines.

Type I fibers: slow oxidative, high mitochondrial and capillary density, low force, high fatigue resistance; recruited first at low intensities.

Type IIx fibers: fast glycolytic, high force and contraction velocity, low fatigue resistance; recruited at high intensities or fast velocities.

Muscle spindle detects stretch and rate of stretch, driving the monosynaptic stretch reflex; the Golgi tendon organ detects tension and produces autogenic inhibition.

Adult skeleton: 206 bones, divided into 80 axial and 126 appendicular bones.

Cardiac output = heart rate x stroke volume; resting values average about 5 L/min (70 bpm x ~70 mL).

Sagittal plane = flexion/extension; frontal plane = abduction/adduction; transverse plane = internal/external rotation.

Osteoblasts build bone and osteoclasts resorb it; bone remodels along lines of mechanical stress (Wolff's law).

ATP-PC (phosphagen) system: dominant for roughly 0-10 seconds of maximal effort, requires no oxygen, rate-limiting enzyme is creatine kinase.

Fast glycolysis: dominant from about 10 seconds to 2 minutes, nets 2 ATP per glucose; pyruvate is reduced to lactate when glycolytic flux exceeds mitochondrial capacity.

Oxidative phosphorylation: dominant beyond ~2 minutes, occurs in mitochondria, yields roughly 36-38 ATP per glucose molecule and requires oxygen.

RER 0.70 indicates fat oxidation, 1.00 indicates carbohydrate, ~0.85 indicates a mixed substrate mix; values above 1.00 reflect hyperventilation rather than fuel use.

HRmax = 220 minus age as a population estimate; the Tanaka equation is 208 minus (0.7 x age).

Karvonen method: target HR = ((HRmax - HRrest) x intensity percentage) + HRrest.

Cardiac output rises linearly with exercise intensity; stroke volume plateaus near 40-60% of VO2max, so the remaining rise comes from heart rate.

Lactate threshold occurs near 50-60% of VO2max in untrained individuals and 70-80% in trained individuals; endurance training shifts it to a higher percentage.

EPOC (excess post-exercise oxygen consumption) magnitude scales primarily with exercise intensity and duration.

Torque = force x moment arm, where moment arm is the perpendicular distance from the force line of action to the axis of rotation.

Lever classes: first class has the fulcrum between effort and load (triceps at the elbow); second class has the load between (calf raise); third class has the effort between (biceps curl); most human joints are third class.

Force-velocity relationship: concentric force decreases as velocity increases; eccentric force exceeds isometric force, which exceeds concentric force.

Length-tension relationship: active tension is maximal at optimal actin-myosin overlap near resting length and falls with over- or under-shortening.

Stability increases with a wider base of support and a lower center of gravity; balance requires the center of gravity to remain within the base of support.

Open kinetic chain = distal segment free to move (leg extension); closed kinetic chain = distal segment fixed (squat), producing greater joint compression and co-contraction.

Newton's third law: the ground reaction force equals and opposes the force the body applies to the ground.

Greater angle of pennation increases a muscle's force capacity but reduces fiber shortening velocity and effective range of motion.

Eccentric actions can generate roughly 1.2-1.6 times concentric force and are associated with the greatest delayed-onset muscle soreness.

PAR-Q+: any 'yes' response indicates the client should obtain medical clearance before beginning or progressing an exercise program.

Blood pressure categories: normal <120/<80; elevated 120-129 and <80; stage 1 hypertension 130-139 or 80-89; stage 2 hypertension 140/90 mmHg or higher.

BMI = weight (kg) / height (m)^2; underweight <18.5, normal 18.5-24.9, overweight 25.0-29.9, obese 30.0 and above.

Waist circumference risk thresholds: greater than 102 cm (40 in) in men and greater than 88 cm (35 in) in women.

Normal resting heart rate is 60-100 bpm; lower resting values generally reflect higher aerobic fitness.

ACSM risk stratification: low risk = no symptoms and no more than one risk factor; moderate = two or more risk factors; high = symptoms or known cardiovascular, metabolic, or renal disease.

Epley 1RM estimate = load x (1 + reps/30); accuracy declines beyond about 10 repetitions.

Submaximal tests (YMCA cycle, 3-minute step test, 1.5-mile run) estimate VO2max from heart rate or performance time rather than direct gas measurement.

SMART goals: Specific, Measurable, Achievable, Relevant, Time-bound.

FITT-VP: Frequency, Intensity, Time, Type, Volume, Progression.

ACSM aerobic prescription: 150 min/week of moderate or 75 min/week of vigorous activity, accumulated in 30-60 minute sessions on 3-5 days per week.

ACSM resistance prescription for general fitness: 2-3 days/week, 2-4 sets, 8-12 repetitions at 60-70% 1RM for major muscle groups.

2-for-2 rule: increase resistance when the client completes two or more repetitions beyond the goal in the final set on two consecutive sessions.

Periodization hierarchy: macrocycle (~1 year) contains mesocycles (several weeks to months) which contain microcycles (~1 week).

Linear periodization progresses from high volume/low intensity to low volume/high intensity; undulating periodization varies volume and intensity within the same week.

SAID principle: specific adaptation to imposed demands, meaning training must resemble the targeted outcome in energy system, velocity, and movement pattern.

Reversibility: measurable strength and aerobic capacity losses begin within roughly 2 weeks of detraining.

Volume-load = sets x repetitions x load and is the standard metric for quantifying and progressing resistance training.

One pound of body fat stores approximately 3500 kcal; a 500 kcal daily deficit theoretically produces about 1 lb of fat loss per week.

Protein: RDA 0.8 g/kg/day; 1.4-2.0 g/kg/day for resistance-trained individuals; 1.6-2.2 g/kg/day during energy restriction to preserve lean mass.

Carbohydrate: 3-5 g/kg/day for general training and 6-10 g/kg/day for endurance athletes in heavy training.

Fat: 20-35% of total energy intake; intakes below 20% can compromise fat-soluble vitamin status and hormone production.

Mifflin-St Jeor: men RMR = (10 x kg) + (6.25 x cm) - (5 x age) + 5; women = (10 x kg) + (6.25 x cm) - (5 x age) - 161.

Resting metabolic rate accounts for roughly 60-75% of total daily energy expenditure; physical activity adds approximately 15-30%.

Body water loss of about 2% of body mass impairs aerobic performance and cognitive function.

Per-meal protein dose of 20-40 g (about 0.2-0.4 g/kg) is the typical range shown to stimulate muscle protein synthesis.

Glycogen loading uses 6-10 g/kg/day of carbohydrate for 1-3 days before endurance events lasting longer than 90 minutes.

Acute soft-tissue injury guidance: PEACE (Protection, Elevation, Avoid anti-inflammatories, Compression, Education) followed by LOVE (Load, Optimism, Vascularization, Exercise).

Hypertension: avoid the Valsalva maneuver and heavy isometric loading; emphasize moderate aerobic work and low-to-moderate load resistance training.

Diabetes: exercise 1-3 hours post-meal, carry fast-acting carbohydrate, monitor glucose, and inspect feet; hypoglycemia risk can persist for hours after training.

Pregnancy: avoid prolonged supine positioning after the first trimester, contact sports, and activities with high fall or abdominal trauma risk.

Osteoporosis: weight-bearing and resistance training are beneficial, but heavy spinal flexion, rotation, and high-impact loading raise fracture risk.

Youth: emphasize technique with bodyweight or light loads; open growth plates are vulnerable to repetitive maximal loading.

Older adults: balance training 2-3 days/week plus resistance training 2 or more days/week counteracts sarcopenia and reduces fall risk.

Asthma: a prolonged warm-up and humidified air reduce exercise-induced bronchoconstriction.

Return to training after injury: physician clearance, pain no greater than 3/10, and full pain-free range of motion before load progression.

Scope of practice: trainers design and supervise exercise and provide general health education; diagnosis, medical treatment, and disease-specific diets fall outside it.

Negligence requires four elements: duty of care, breach of duty, causation, and damages.

Contract elements: offer, acceptance, consideration, capacity, and legality.

Informed consent discloses risks, benefits, alternatives, and the right to withdraw at any time.

SOAP note format: Subjective, Objective, Assessment, Plan.

Client records are confidential and may be shared only with written authorization or where legally required.

Emergency action plan: post the facility address, AED location, and emergency number, and document every incident.

Professional liability insurance and current CPR/AED certification are standard practice requirements.

Monthly revenue = active clients x sessions per month x session rate; retention rate = clients retained / clients at start of period.