NASM Section 4 + 5

Health history questionnaire (HHQ)

Includes information about a client’s medical history and lifestyle habits

Where should a client’s resting heart rate be measured?

On the radial pulse

Blood pressure

• the outward pressure exerted by blood on the arterial walls

• a normal reading is 120/80 mmHg

Anthropometry

field of study of the measurement of living humans for purposes of understanding physical variation in size, weight, and proportion

Anthropometric measurements

• Body fat assessments

• BMI

• Circumference measurements

What do anthropometric measurements help to do?

They provide useful information related to predicting a client’s risk for morbidity and mortality

Methods of measuring body fat percentage

• underwater weighing

• skinfold measurements

• bioelectrical impedance analysis

Cardiorespiratory assessments

help the fitness professional identify safe and effective starting exercise intensities + appropriate modes of cardiorespiratory exercise

Examples of cardiorespiratory assessments

• VO2max test

• YMCA 3-minute step test

• Rockport walk test

• 1.5 mile run test

VO2max test

• considered the gold standard for identifying cardiorespiratory fitness

• requires client to exert maximal effort

• requires specialized equipment and training

Talk test

Informal cardiorespiratory assessment used to gauge the intensity of cardiorespiratory activity based on the client’s ability to hold a conversation

VT1 test

• Incremental test performed on any device (treadmill, bike, etc.) that gradually progresses in intensity and relies on how a person talks to determine the event when the body undergoes a significant metabolic change

• Aims to estimate when the body is using a balance of fuels (50% fat + 50% carbs)

VT2 test

Measures the intensity where the body can work at its highest sustainable steady-state intensity for more than a few minutes

Contraindication

A specific situation where a medication, procedure, or exercise should be avoided because it may prove to be harmful to the individual

Physical activity readiness questionnaire (PAR-Q+)

A detailed questionnaire designed to assess an individual’s physical readiness to engage in structured exercise

Body mass index (BMI)

the measurement of a person’s weight relative to his or her height, which is used to estimate the risks of obesity

Bioelectrical impedance analysis (BIA)

a body composition assessment technique that estimates body fat percentage by measuring the resistance to the flow of electrical currents introduced into the body

BMI classification

• < 18.5 = underweight

• 18.5 - 24.9 = healthy weight

• 25 - 29.9 = overweight

• 30 - 34.9 = obese

• 35 - 39.9 = obesity ii

• > 40 = obesity iii

Waist to hip ratio (WHR)

• the relative score expressing the ratio of the waist circumference to the hip circumference, which correlates to the risk for developing CVD

• waist measurement / hip measurement = WHR

WHR classifications

• Low health risk: M=0.95 or lower, W=0.80 or lower

• Moderate health risk: M=0.96-1.0, W=0.81-0.85

• High health risk: M=1.0+, W=0.86+

Jackson and Pollock Seven-Site Measurement

• Men + women: chest, mid-axillary, sub scapular, triceps, abdomen, supra iliac, thigh

During-Womersley Four-Site Measurement

biceps, triceps, sub scapular, supra iliac

Jackson and Pollock Three-Site Measurement

Men: chest, abdomen, thigh

Women: triceps, supra iliac, thigh

3 postural distortions

1. pes planus distortion syndrome

2. upper crossed syndrome

3. lower crossed syndrome

Pes planus distortion syndrome

Characterized by flat feet, knee valgus, and internally rotated + adducted hips

Lower crossed syndrome

Characterized by an anterior pelvic tilt + excessive lordosis of the lumbar spine

Upper crossed syndrome

Characterized by a forward head + protracted shoulders

Overhead squat assessment

• first movement assessment performed for clients

• serves as the basis for all other movement assessments

• evaluates dynamic posture, core stability, and neuromuscular control of the whole body during a squatting motion

What should you look for during an OHSA?

• Anterior view: feet turning out or knees caving in

• Lateral view: low-back arching, excessive forward lean of the torso, or arms falling forward

Single-leg squat assessment

• should only be used by clients who performed well in the OHSA + if the professional is planning single-leg exercises in the program

• good assessment of an individual’s ability to balance

• important for consideration of activities of daily living and exercise programming

Pushing + pulling assessments

• evaluate function of the upper extremity and concurrent core stability

• impairments: low-back arching, shoulders elevating, or head jutting forward

Performance assessments

• can be used for clients looking to improve athletic performance

• measure maximal strength, power, muscular endurance, and speed + agility

Bench press and squat strength assessments

• Used to measure maximal strength capabilities

• advanced assessments for strength-specific goals

• may not be suitable for clients with limited resistance training experience

Vertical jump and long jump assessments

Measure lower-body power

LEFT assessment

• designed to test lateral speed and agility

• considered an advanced assessment for speed and performance-specific goals

40-yard dash assessment

Evaluates reaction capabilities ,acceleration, and maximal sprinting speed

Pro shuttle test

• Assesses acceleration, deceleration, agility, and control

• appropriate for clients seeking to assess agility and sprinting speed

Potential overactive muscles with pes planus distortion syndrome

• Gastrocnemius and soleus

• Adductor complex

• Hip flexors

Potential underactive muscles with pes planes distortion syndrome

• Anterior and posterior tibialis

• Gluteus maximus and medius

Potential overactive muscles with lower crossed syndrome

• Hip flexors

• Lumbar extensors

Potential underactive muscles with lower crossed syndrome

• Gluteus maximus and medius

• Hamstring complex

• Abdominals

Potential overactive muscles with upper crossed syndrome

• Pectoralis major and minor

• Levator scapula and sternocleidomastoid

• Upper trapezius

Potential underactive muscles and upper crossed syndrome

• Middle and lower trapezius, rhomboids

• Deep cervical flexors

What muscles are over/underactive when the feet turn out during an OHSA?

• Overactive: gastrocnemius/soleus, hamstrings complex

• Underactive: anterior + posterior tibilalis, gluteus maximus + medius

What muscles are over/underactive when the knees cave in during an OHSA?

• Overactive: tensor fascia latae, adductor complex

• Underactive: gluteus maximus + medius, anterior + posterior tibialis

What muscles are over/underactive when the low-back arches during an OHSA?

• Overactive: hip flexors, lumbar extensors, latissimus dorsi

• Underactive: gluteus maximus, hamstrings complex, abdominals

What muscles are over/underactive with an excessive forward trunk lean during an OHSA?

• Overactive: hip flexors, gastrocnemius/soleus, rectus abdominis + external obliques

• Underactive: gluteus maximus, hamstrings complex, lumbar extensors

What muscles are over/underactive when the arms fall forward during an OHSA?

• Overactive: latissimus dorsi, pectoralis major + minor, teres major

• Underactive: middle + lower trapezius, rhomboids, posterior deltoids, portions of the rotator cuff

What muscles are over/underactive when the knee caves in during a single-leg squat assessment?

• Overactive: tensor fascia latae, adductor complex

• Underactive: gluteus maximus, hamstrings complex, abdominals

What muscles are over/underactive when the low-back arches during a pushing assessment?

• Overactive: hip flexors, lumbar extensors

• Underactive: gluteus maximus, hamstrings complex, abdominals

What muscles are over/underactive when there is scapular elevation during a pushing assessment?

• Overactive: levator scapulae, upper trapezius

• Underactive: lower trapezius

What muscles are over/underactive when the head juts forward during a pushing assessment?

• Overactive: levator scapulae, sternocleidomastoid

• Underactive: deep cervical flexors

What muscles are over/underactive when the low-back arches during a pulling assessment?

• Overactive: hip flexors, lumbar extensors

• Underactive: gluteus maximus, hamstrings complex, abdominals

What muscles are over/underactive when there is scapular elevation during a pulling assessment?

• Overactive: levator scapula, upper trapezius

• Underactive: lower trapezius

What muscles are over/underactive when the head juts forward during a pulling assessment?

• Overactive: levator scapula, sternocleidomastoid

• Underactive: deep cervical flexors

Integrated training

Combination of flexibility, cardiorespiratory, core, balance, plyometric, SAQ, and resistance training into one system

Fundamental movement patterns

Squatting, hip hinge, pulling, pushing, and pressing

Optimal ROM

allows joints to move freely

Acute variables for training

• repetitions

• sets

• training intensity

• repetition tempo

• rest interval

• training volume

• training frequency

• training duration

• exercise selection

• exercise order

Benefits of flexibility training

• Increased joint ROM

• Possible decrease in muscle soreness

• Potential reduction in injury risk

Benefits of cardiorespiratory training

• Decreased heart rate + blood pressure

• Increasing stroke volume + cardiac output

Benefits of core training

• Enhanced posture

• Better bodily functions for daily living

• Increased balance

• Stabilization + coordination of kinetic chain

• Minimized low-back pain

• Improved skill-related movements

Benefits of balance training

• Reducing risk of falls and ankle sprains

• Improving proprioception + agility-based activities

Benefits of plyometric training

• Improved bone mineral density + soft tissue strength

• Expression of power and explosiveness

• Increasing metabolic expenditures required for weight management

Benefits of SAQ training

Improved top speed, change of direction, and rate of acceleration + deceleration

Benefits of resistance training

• Increased endurance, strength + power

• Muscular hypertrophy

• Weight management

3 levels of the OPT model

1. Stabilization

2. Strength

3. Power

Phase 1 Stabilization Endurance Training

• In level 1 of the OPT model

• Focused on teaching optimal movement patterns (pushing, pulling, pressing, squatting, hip hinging), core + joint stability

• Helps clients become familiar with various modes of exercise

Phase 2 Strength Endurance Training

• In level 2 of the OPT model

• Focused on enhancing stabilization endurance while increasing prime mover strength

• Supersets can be used here

Phase 3 Muscular Development Training

• In level 2 of the OPT model

• Designed for individuals who have the goal of maximal muscle growth or altered body composition

Phase 4 Maximal Strength Training

• In level 2 of the OPT model

• Works toward maximal prime mover strength by lifting heavy loads

Phase 5 Power Training

• In level 3 of the OPT model

• Focused on increasing maximal strength and rate of force production

• Supersets can be used here

Phase 2 example supersets

• Strength-focused exercise > stabilization-focused exercise

• Chest: bench press > push-up

• Back: seated cable row > standing cable row

• Shoulders: shoulder press machine > single-leg dumbbell overhead press

• Legs: barbell squat > single-leg squat

Phase 5 example supersets

• Strength-focused exercise > power-focused exercise

• Chest: bench press > med ball chest pass

• Back: lat pulldown > med ball soccer throw

• Shoulders: dumbbell shoulder press > front med ball oblique throw

• Legs: barbell squat > squat jump

Flexibility

the normal extensibility of all soft tissues that allows the complete ROM of a joint

Relative flexibility

Process in which the HMS seeks the path of least resistance during functional movements

Human movement system (HMS)

• also known as the kinetic chain

• comprises the muscular, skeletal, and nervous systems

• can be classified into 2 regional chains: the upper kinetic chain + lower kinetic chain

What can muscle imbalances be caused by?

• postural distortions

• repetitive movement

• cumulative trauma

• emotional duress

• poor training technique

• poor bodily control

• biased training patterns

What can muscle imbalances result in?

• altered reciprocal inhibition

• synergistic dominance

• osteo- and arthrokinematics dysfunction

Synergistic dominance

• Neuromuscular phenomenon that occurs when synergists take over function for a weak or inhibited prime mover

• leads to altered reciprocal inhibition of the antagonist muscle

What can altered joint motion be caused by?

Altered muscle length-tension relationships, force-couple relationships, and poor joint surface motion = poor movement efficiency

Neuromuscular efficiency

• the ability of the nervous system to recruit the correct muscles, produce force, reduce force, and dynamically stabilize the body’s structure in all 3 planes of motion

• an individual must have proper flexibility in all 3 planes of motion

Scientific rationale for flexibility training

Illustrated through the concept of pattern overload and the cumulative injury cycle

Types of flexibility training

Self-myofascial techniques, static, active, and dynamic stretching

Force-couple relationships

the synergistic action of multiple muscles working together to produce movement around a joint

Autogenic inhibition

neural impulses that sense tension are greater than the impulses that cause muscles to contract, providing an inhibitory effect to the muscle spindles

Pattern overload

consistently repeating the same pattern of motion over long periods of time that can lead to dysfunction or injury

Davis’s law

States that soft tissue models along the lines of stress

Self-myofascial rolling

• Mechanism of action: Autogenic inhibition

• Training variables: 1-3 sets, hold each tender area for 30 seconds

Static stretching

• Mechanism of action: Stretch tolerance and/or reciprocal inhibition

• Training variables: 1-3 sets, hold each stretch for 30 seconds

Active stretching

• Mechanism of action: Reciprocal inhibition

• Training variables: 1-3 sets, hold each stretch for 1-2 seconds + repeat for 5-10 repetitions

How can you increase the effectiveness of hip flexor, adductor, and latissimus dorsi static + active stretches?

posteriorly rotate the pelvis

Dynamic stretching

• Mechanism of action: Reciprocal inhibition

• Training variables: 1-3 sets, 5-10 repetitions, 3-10 exercises

Cardiorespiratory fitness

Reflects on the ability of the cardiovascular and respiratory systems to supply oxygen-rich blood to skeletal muscles during sustained physical activity

What is a strong predictor of morbidity and mortality?

a person’s cardiorespiratory fitness

FITTE-VP principle

• Frequency

• Intensity

• Type

• Time

• Enjoyment

• Volume

• Progression

What is the recommended frequency for cardiorespiratory exercise?

• Moderate-intensity: at least 5x per week (150 mins)

• Vigorous-intensity exercise: at least 3x per week (75 mins)

• A combination is also acceptable

Intensity

level of demand that a given activity places on the body

Methods for monitoring cardiorespiratory exercise intensity

• VO2 max

• Using percentages of maximal heart rate (HRmax)

• Heart rate reserve (HRR)

• Metabolic equivalents (METs)

• Ratings of perceived exertion (RPE)

• Talk test

What should each exercise training session include?

• A warm-up phase

• A conditioning phase

• A cool-down phase