Eligibility The NCSF online quizzes are open to any currently certified fitness professional, 18 years or older.

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1 Eligibility The NCSF nline quizzes are pen t any currently certified fitness prfessinal, 18 years r lder. Deadlines Curse cmpletin deadlines crrespnd with the NCSF Certified Prfessinals certificatin expiratin date. Students can btain their expiratin dates by reviewing either their certificatin diplma r certificatin ID card. Cancellatin/Refund All NCSF cntinued educatin curse studies are nn-refundable. General Quiz Rules Yu may nt have yur quiz back after sending it in. Individuals can nly take a specific quiz nce fr cntinued educatin units. Impersnatin f anther candidate will result in disqualificatin frm the prgram withut refund. Disqualificatin If disqualified fr any f the abve-mentined reasns yu may appeal the decisin in writing within tw weeks f the disqualificatin date. Reprting Plicy Yu will receive yur scres within 4 weeks fllwing the quiz. If yu d nt receive the results after 4 weeks please cntact the NCSF Certifying Agency. Re-testing Prcedure Students wh d nt successfully pass an nline quiz have the ptin f re-taking. The fees assciated with this prcedure ttal $15 (U.S) per request. There are n limits as t the number f times a student may re-test. Special Needs If special needs are required t take the quiz please cntact the NCSF s that apprpriate measures can be taken fr yur cnsideratin.

2 What D I Mail Back t the NCSF? Students are required t submit the quiz answer frm. What d I Need t Scre n the Quiz? In rder t gain the.5 NCSF cntinued educatin units students need t scre 80% (8 ut f 10) r greater n the CEU quiz. Where D I Mail My Quiz Answer Frm? Yu will mail yur cmpleted answer frm t: NCSF Attn: Dept. f Cntinuing Educatin 5915 Pnce de Len Blvd., Suite 60 Cral Gables, FL Hw Many CEUs Will I Gain? Prfessinals wh successfully cmplete the any cntinuing educatin quiz will gain.5 NCSF CEUs per quiz. Hw Much des each quiz cst? Each quiz csts the student $ What Will I Receive When The Curse Is Cmpleted? Students wh successfully pass any f the NCSF nline quizzes will receive their exam scres, and a cnfirmatin letter. Hw Many Times Can I Take The Quizzes Fr CEUs? Individuals can take each NCSF quiz nce fr cntinuing educatin credits.

3 The Impact f Stress n Health and Perfrmance 1 The Impact f Stress n Health and Perfrmance Mst peple recgnize that stress is nt healthy but mst fail t realize the significant impact stress can have n bth physilgical and psychlgical well-being. Estimates vary, but experts believe abut 70% f dctr visits and 80% f serius illnesses may be exacerbated r linked t stress. Whether it is an acute but f frustratin, as experienced when cut ff in traffic, r a majr life event such as a divrce, lsing ne s jb, r being diagnsed with a disease, stress can negatively affect all systems f the human bdy. Interestingly, even thugh stress is an innate respnse it varies by persn. Stress is heavily rted in perceptin; ne individual s unpleasant experience can be anther s enjyable undertaking. Essentially, stress can prduce psitive r negative metablic and hrmnal respnses based n the internal envirnment and the balance maintained between the stress itself and recvery measures t attenuate its respnse (e.g., prper nutritin, sleep, and stress management techniques). Adequate stress, whether physical r mental, is needed t prmte adaptatins in a bdily system; while excessive stress results in systemic breakdwn. Eustress is the term utilized t describe apprpriate stress rutinely applied fr the prvisin f psitive adaptive utcmes; distress describes an excessive level f stress that prmtes negative utcmes. The hrmnes released during an acute r chrnic stress respnse ultimately dictate the utcme. The reactin t an acute stress, cmmnly knwn as the fight r flight respnse, invlves the rapid release f adrenal hrmnes t increase immediately available Majr medical implicatins energy (i.e., bld sugar) via the breakdwn and liberatin f glycgen frm the liver as well as triglycerides and amin acids. Bld pressure als increases in an acute fashin. This mechanism is meant t prtect r ready the human bdy fr changes in mvement intensity; the hrmnally-liberated energy will help the individual cnfrnt the given stress, r flee frm it. This actin is driven by the hypthalamus, an area f the brain that can send neurtransmitters prgrammed t prmte excitatin t the adrenal glands. At the basic level the acute respnse ensured primitive human survival in varied envirnments; in mdern sciety, safety and intensity are much mre cntrlled. Therefre, mst f the time we see the respnse ccurring in a mre chrnic fashin such as wrrying abut uncntrllable, upcming issues r challenges such as an exam, ptential layff, r financial uncertainty. This cnstant liberatin f adrenal hrmnes creates a saturated hrmnal milieu. The available energy is nt cnsumed and there is n stimulus that emplys the benefits f the sympathetic hrmnes. Crtisl and epinephrine are useful during exercise but cnsequential when prduced withut physical activity such as during the situatins just described. When hrmnes are prduced in a manner such as thse assciated with psychlgical chrnic stress they prduce several negative effects accrding t research. Interestingly apprpriate exercise can, t a certain extent, actually minimize all f the negative effects f stress when applied in a healthy prgram. Risk fr a heart attack r strke - The explicit relatinship between stress and the risk fr a heart attack r strke is nt cnclusive, but evidence cntinues t increase. Fr example, a recent study including 200,000 emplyees in Eurpe fund that peple wh had mre Natinal Cuncil n Strength & Fitness

4 The Impact f Stress n Health and Perfrmance 2 stressful jbs and little decisin-making pwer at wrk (e.g., service-based rles such as servers) were 23% mre likely t suffer a heart attack cmpared with thers with relatively minimal jb-related stress and cntrl ver their daily decisins. In anther recent study, healthy adults wh had experienced a stressful life event within the past year were 400% mre likely t suffer a strke than their less-stressed cunterparts. This increase in risk is believed t be primarily assciated with stress-related increases in bld pressure and the cnsequent prgressin f athersclersis due t endthelial damage. Bld pressure issues - A stressful situatin can cause a temprary spike in bld pressure due t the actins f adrenal hrmnes that cnstrict vascular structures and increase the heart rate; but these effects dissipate when the stress has passed. Research has nt clearly demnstrated that chrnic stress causes a permanent change in resting bld pressure measures, but a lng-term alteratin in the hrmnal envirnment (chrnic anxiety) may be able t prduce lnger-lasting variatins in bld pressure measures. A mre casual relatinship may be the cncern. Chrnic stress increases central adipsity which increases bld pressure essentially the bigger yu becme the higher the bld pressure. Bld sugar issues - Acute stress clearly raises bld sugar as described previusly, s diabetic individuals may experience relatively dangerus variatins in bld glucse (especially hyperglycemia) fllwing an acute but f extreme stress. One related study including bese black wmen withut diabetes fund that thse wh prduced mre epinephrine while recalling stressful life events experienced elevated fasting glucse measures and mre significant spikes in bld glucse than thse with lwer epinephrine respnses, suggesting a cnnectin between stress and glucse mismanagement. Pregnancy-related issues - Nrmal quantities f stress are nt likely t have a significant impact n a pregnant wman r the unbrn child, even thugh the fetus is expsed t all hrmnes released by the mther, but severe stress, such as ging thrugh a divrce, has been shwn t increase the risk fr premature labr. Several studies have even suggested that extremely high levels f stress can affect the fetus s brain develpment. Prenatal yga and ther stress-reductin techniques may be useful, but a primary physician shuld be cnsulted t ensure these activities are safe fr the mther. On a related nte, stress may even influence a wman s ability t get pregnant in the first place. One investigatin shwed wmen with the highest levels f alpha-amylase, a salivary bimarker fr stress, had a 12% reductin in their chance f getting pregnant during a given cycle, cmpared with thse with the lwest cncentratins. Asthma - Stress seems t exacerbate asthma and ther pulmnary disrders. In ne study, children wh experienced severe stress, such as the death f a lved ne, had an apprximate 200% increase in the risk f an asthma attack ver the fllwing tw weeks, cmpared t thse nt under significant stress. The cnnectin is nt yet cmpletely clear, but research seems t suggest that significant stress may amplify the immune respnse t asthma triggers such as pllen, severe cld, animal dander, r dust. Natinal Cuncil n Strength & Fitness

5 The Impact f Stress n Health and Perfrmance 3 Clinical eating disrders - One f the majr causative factrs behind clinical eating disrders such as anrexia nervsa and bulimia nervsa is extreme anxiety and psychlgical stress assciated with cntrl issues ; the individual feels that fd and/r exercise is ne f the nly cntrllable factrs in their life. Negative behavirs assciated with eating disrders are primarily derived frm an unnatural preccupatin with bdy image and fatness cupled with the mental distress f lw self-esteem and severe self-criticism. Weight gain While acute stress reduces appetite, chrnic stress can have an impact n bth circulating hrmnes and the brain s feeding center. Chrnic stress prmtes an increased risk fr increased central adipsity and hyperphagia; essentially chrnic vereating due t gut hrmne activity. Other physical and mental prblems Digestive issues - Heartburn, stmach cramping, cnstipatin, and diarrhea can all be caused r wrsened by stress. Anxiety significantly reduces bld flw t the gastrintestinal tract, prmting irregularities in bwel mvement; in severe cases, hypxia can result in damage t the large intestine. Other digestive disrders such as irritable bwel syndrme (IBS), characterized by pain and buts f cnstipatin and diarrhea, are thught t be primarily fueled by stress. Brain changes and depressin - Research utilizing imaging technlgy has shwn that majr stresses can reduce the quantity f tissue in regins f the brain that regulate emtins and self-cntrl ver time. Chrnic stress is als directly assciated with an increased risk fr varius types f depressin and anxiety disrders such as pst-traumatic stress disrder. The damage stress places n the brain may make dealing with future stresses prgressively mre difficult, but it can likely be reversed with effective stress-management techniques and behavir mdificatin. Insmnia - Stress can cause a state f hyperarusal due t significant stimulatin f the sympathetic nervus system, making it very difficult t fall asleep. While majr stressful events can cause a shrt-term but f insmnia that passes nce the stress has subsided, lngterm expsure t chrnic stress can disrupt sleeping patterns and cntribute t clinical sleep disrders. Headaches and back pain - Adrenal hrmnes and crtisl can cause vascular changes that prmte the develpment f a tensin headache r migraine, either during the stress itself r fr a perid f time directly afterwards. Stress increases muscle tensin, which can amplify the symptms f a migraine. This cncept is believed t als apply t an acute case f lwer back pain, as well as chrnic pain. One recent study in Eurpe fund that peple wh are prne t anxiety and negative thinking are mre likely t develp back pain, while anther study implemented in the U.S. tied anger and mental distress t nging back pain. Natinal Cuncil n Strength & Fitness

6 The Impact f Stress n Health and Perfrmance 4 Memry - Excessive crtisl seems t interfere with the brain's ability t frm new memries. Furthermre, during acute stress, crtisl bstructs neurtransmitter activity, making it harder t think straight r retrieve memries. Hair and skin issues - While research has prvided mixed results, stress is thught t play a rle in triggering hair lss in the autimmune cnditin knwn as alpecia areata. Research als suggests that students with acne are mre prne t utbreaks during exams cmpared t less stressful time perids. An increase in the male hrmnes, r andrgens, culd be a culprit, particularly in wmen. Stress can als trigger skin cnditins such as psriasis t appear fr the first time, r make an existing case mre severe. Many physicians are beginning t incrprate stress-management techniques, such as bifeedback and meditatin, int treatment prgrams fr the skin disease. Reprductive issues - One study fund that wmen were less attracted t men with high levels f crtisl cmpared t men with lwer levels. Researchers believe this may be because lw levels f stress hrmnes suggest strength and health, which are desirable traits t be passed n t ffspring. Investigatins als suggest that individuals wh are highly stressed experience a reductin in sex drive and have a higher risk fr sexual dysfunctin. This is believed t be prmted via numerus physilgical mechanisms. Premature aging - Traumatic events as well as chrnic stress can shrten telmeres, the prtective caps n the ends f cell chrmsmes, by prmting cell divisin and therefre expediting the aging prcess. Telmere ersin is directly assciated with lifespan; genetically shrt telmeres are directly linked with premature aging disrders such as Werner syndrme. Immune functin - High psychlgical stress and anxiety can influence hrmnal dynamics that decrease ne s resilience t cld viruses and bacteria. One f the mst cmmn frms f illness during perids f imbalanced stress and recvery are upper respiratry tract infectins. This risk fr illness is further increased when an individual n a lw-carb diet experiences significant stress as many highly-metablic immune cells use nly glucse fr fuel. Jb perfrmance - Studies f emplyees ranging frm military persnnel t bankers shw that stress reduces prductivity and jb satisfactin. The Occupatinal Safety and Health Administratin declared stress a wrkplace hazard, estimating that it csts the American industry mre than $300 billin annually. Effects n perfrmance Exercise adaptatins - The effects f exercise stresses (physilgical and psychlgical) can prvide psitive r negative changes within the bdy depending n the balance maintained with recvery measures. Prper balance f stress can result in imprved neural efficiency, increased vascular cmpliance and xygen extractin, and enhanced cardiac and musculskeletal tissue integrity functin. A lack f balance results in enhanced platelet Natinal Cuncil n Strength & Fitness

7 The Impact f Stress n Health and Perfrmance 5 adhesin and crtisl prductin, increased serum LDL chlesterl and triglycerides, lwgrade inflammatin, and lss f the prtein-sparing mechanism. Overreaching and vertraining - Overreaching is an accumulatin f training and ther stresses resulting in a shrt-term decrement in perfrmance that may take several days t several weeks t recver frm. Overtraining is defined as an accumulatin f training and ther stresses resulting in a lng-term decrement in perfrmance that may take several weeks t several mnths t recver frm. Overreaching and vertraining syndrme bth ccur when the ttal f all life stresses exceeds the ability f the bdy t cpe with thse stresses. Prper nutritin can reduce the symptms f verreaching as well as reduce the risk f develping vertraining syndrme. Nutritin-related factrs that increase the risk fr vertraining include carbhydrate depletin, dehydratin, and a negative energy balance. The negative, perfrmance-depleting effects assciated with vertraining are numerus and severe, including: extreme fatigue and lack f energy, leg discmfrt, general aches and pains in muscles and jints, sleeping prblems and insmnia, headaches, increased frequency f clds r infectin, mdiness and irritability, lss f enthusiasm fr a given activity r sprt, decreased appetite and ther eating prblems, an increased incidence f injury, reduced maximal lactate and heart rate, elevated resting and sleeping heart rate, and n increase in crtisl in respnse t a stressful but f exercise. Weight management implicatins Cravings and emtinal eating - Studies have linked crtisl t increased cravings fr sugar and fat. Many hrmnes have a part t play in appetite regulatin as they influence the hypthalamus, which initiates the hunger mechanism. Neural-driven external factrs that exert the strngest influence n the quantity f fd intake thrughut the day include stress, memry, scial situatins, time f day, and the taste r smell f fd. Visceral fat gain Research clearly links stress with visceral fat accumulatin. Part f the reasn is triglycerides liberated frm subcutaneus stres in respnse t stress hrmnes end up being restred as visceral fat. Stress and fat gain are s strngly related that a recent investigatin fund that if ne simply reduces their daily stress and gets better sleep, these measures alne can result in ntable fat and weight lss. This new study published in the Internatinal Jurnal f Obesity, which included 472 bese adults participants, fund that peple wh attained between six and eight hurs f sleep and reprted the lwest relative levels f stress had the greatest success in a weight lss prgram. The study demnstrated that peple are mre likely t maintain a healthy weight when nt impeded by sleep deprivatin, stress, r depressin. Clearly the best way t deal with stress is t avid it in the first place. Certainly it is impssible t avid all stress, and even if it was this wuld als be unhealthy. Exercise and physical activity prvide psitive utcmes when the training vlume is apprpriate. Negative stress (distress) is the type t avid. Clinicians suggest ne way t avid significant distress is identify where it is cming frm. Stress diaries are used t identify the peple, Natinal Cuncil n Strength & Fitness

8 The Impact f Stress n Health and Perfrmance 6 lcatins, situatins, and times that the stress ccurs. In many cases, peple d nt realize the exact causes and frequency f stress in their lives. Oftentimes there are certain individuals and lcatins that create the wrst stress respnses. Once realized, ne must cut the negatives; relatinships and envirnments can be severed as easily as new nes can be made. Stress can als be neutralized; when stress accumulates, it shuld be remved in exchange fr smething that is cnsidered pleasurable. This shuld nt include alchl-related situatins as experts suggest this further fuels stress respnses rather than diffusing them. Alchl masks relaxatin, s drinking stress away simply adds new stress f a physical nature. Activities research suggests may attenuate distress include yga, tai chi, specific breathing methds, and prgressive muscle relaxatin. Likewise taking a nature walk, helping thers, and playing games that induce laughter and grup camaraderie all hld merit fr reducing stress. Natinal Cuncil n Strength & Fitness

9 The Impact f Stress n Health and Perfrmance 7 CEU Quiz The Impact f Stress n Health and Perfrmance 1. is the term utilized t describe an apprpriate applicatin f stress that prvides psitive adaptive utcmes. a. Distress b. Pre-stress c. Eustress d. De-stress 2. True r False? Stress can prduce psitive r negative metablic and hrmnal respnses based n the balance maintained between stressrs and recvery measures. a. True b. False 3. Chrnic stress r anxiety is cmmnly assciated with: a. Catablic activity b. Increased risk fr a heart attack r strke c. Headaches and back pain d. All f the abve 4. Which f the fllwing hrmnes are released during the acute fight r flight respnse? a. Adrenal hrmnes b. Grwth hrmne c. IGF-1 d. Insulin 5. Which f the fllwing best describes hw severe stress and anxiety can cause irregularities in gastrintestinal functin? a. By reducing the prductin f digestive enzymes b. By significantly reducing bld flw and prducing a hypxic envirnment c. By causing trunk muscular tensin which cmpresses digestive rgans d. By causing a reductin in lactate threshld 6. True r False? Stress has been shwn t increase telmere length, expediting the aging prcess. a. True b. False Natinal Cuncil n Strength & Fitness

10 The Impact f Stress n Health and Perfrmance 8 7. Which f the fllwing is nt a symptm assciated with vertraining syndrme? a. Sleeping prblems b. Decreased appetite c. Reduced resting heart rate d. N increase in crtisl fllwing a stressful but f exercise 8. Studies have linked elevated crtisl with increased craving fr. a. Sugar b. Prtein c. Alchl d. Fiber 9. Research clearly links stress with fat accumulatin. a. Intramuscular b. Subcutaneus c. Cnnective d. Visceral 10. Which f the fllwing statements is nt crrect? a. Stress can prmte a state f hyperarusal, resulting in the ptential fr sleeping prblems b. Stress can prmte significant fluxes in bld sugar c. Stress can prmte tensin headaches r migraines by altering thyrid hrmnes d. Severe stress has been shwn t increase the risk fr premature labr Natinal Cuncil n Strength & Fitness

11 FIRST NAME LAST NAME M.I. TITLE_ ADDRESS APT. ADDRESS CITY_ STATE_ ZIP_ COUNTRY POSTAL CODE_ CERTIFICATION NO. CERTIFICATION EXP. /_ /_ MEMBERSHIP NO. MEMBERSHIP EXP. /_ / Quiz Name Member Price $15 Ttal Discver Visa Mastercard Amex Check/Mney Order Accunt N. Exp. Date Security Cde Signature Date Quiz Answers Fill in each blank with the crrect chice n the answer sheet. T receive 0.5 CEUs, yu must answer 8 f the 10 questins crrectly. Please mail this Quiz answer frm alng with the prper enclsed payment t: NCSF 5915 Pnce de Len Blvd., Suite 60 Cral Gables, FL Questins? NCSF