Chapter 9
Motivate – Encourage performance and adherence.
Assess – Evaluate health and fitness status.
Train – Ensure safe and effective training.
Educate – Help clients become informed consumers.
Refer – Direct clients to healthcare professionals when needed.
Conduct an interview to assess compatibility and set goals.
Have the client complete health appraisal forms.
Evaluate risk factors for chronic diseases.
Assess and interpret results.
Refer to medical professionals if needed.
Obtain medical clearance and recommendations.
Explain services, experience, and certifications.
Define roles, boundaries, and expectations.
Discuss client goals using the SMART method:
Outlines services, expectations, cost, policies, and termination.
Becomes a legally valid document once signed.
Coronary Artery Disease (CAD)
Pulmonary and Metabolic Diseases
Orthopedic Issues
Self-Recall of Symptoms
✅ Cost-effective, easy to administer.
❌ Only assesses safety of exercise, not risk factors.
Physical Activity Readiness Questionnaire (PAR-Q)
Evaluates moderate to vigorous exercise suitability.
Health/Medical Questionnaire
More detailed, includes risk factors and family history.
Lifestyle Inventories (diet, stress, activity level).
Informed Consent (details risks, benefits, and responsibilities).
Release of Risk (legal waiver of injury claims).
Require a pre-participation physical exam.
Parents cannot sign liability waivers for children.
High risk but benefits include better body composition and self-esteem.
Family History: Early onset of heart disease in immediate relatives (before 55 years in men, 65 years in women).
Hypertension: Blood pressure above 140/90 mmHg on multiple occasions.
High Cholesterol Levels: LDL > 130 mg/dl, HDL < 40 mg/dl, or total cholesterol > 200 mg/dl.
Smoking: Current smoker or quit within the last six months.
Physical Inactivity: Sedentary lifestyle with minimal physical activity.
Diabetes: Type 1 or Type 2, with fasting glucose levels > 126 mg/dl.
Obesity: BMI > 30 or waist circumference > 102 cm (men) or > 88 cm (women).
Thyroid Disorders: Hyperthyroidism or hypothyroidism impacting metabolic rates.
Asthma: History of exercise-induced bronchospasm.
Chronic Obstructive Pulmonary Disease (COPD): Limited breathing capacity affecting endurance.
Sleep Apnea: Disruptions in sleep leading to fatigue and cardiovascular risks.
Joint Issues: History of arthritis, osteoporosis, or recurring joint pain.
Previous Injuries: Past fractures, ligament tears, or spinal issues affecting mobility.
Postural Problems: Spinal misalignment, scoliosis, or significant muscle imbalances.
Dietary Habits: High intake of processed foods, excessive alcohol consumption.
Stress Levels: Chronic stress leading to hormonal imbalances and cardiovascular risk.
Medication Use: Any prescriptions that may impact heart rate, blood pressure, or metabolism.
Identify risk factors based on screening questionnaires.
Determine exercise intensity suitability.
If needed, refer to a physician before starting a program.
Use a Physician Referral Form to inform doctors.
Allow doctors to provide recommendations for exercise programs.
Unsupervised Program
Suitable for healthy individuals.
Clients exercise independently or with occasional PT check-ins.
Supervised Program
For clients with minor health conditions but can still participate safely.
Supervised by a certified professional (CPT).
Medically Supervised Program
For high-risk clients.
Requires constant monitoring by health professionals (e.g., clinical setting).
Keep detailed records of client information and screenings.
Always refer clients to a doctor if uncertain about any risk factors.
Ensure clients fully understand risks and benefits before beginning exercise.
Establish baseline data for goal setting
Track progress over time
Identify strengths & weaknesses
Set short, intermediate, & long-term goals
Document progress for comparison with norms (e.g., ACSM guidelines)
Formative: Ongoing assessment with specific test protocols, allows adjustments
Summative: Final evaluation of progress over a set period (training cycle, class, season)
Test-Retest Reliability: Repeating the test on the same person/group within 1-3 days
Intra-Rater Reliability: Tester must administer the test the same way every time
Key Note: A trainer can be reliable but not accurate!
Face Validity: Appears to test what it should (e.g., 1-RM → Muscular Strength)
Content Validity: Experts confirm the test covers all relevant areas (e.g., volleyball tests should assess jumping ability)
Construct Validity: Can distinguish between different performance levels (e.g., athlete vs. general population)
Criterion-Related Validity: Field-based tests validated against laboratory tests
Direct: Autopsy, Biopsy
Indirect: BMI, Skinfolds, DXA, BIA
Client Factors: Health, training status, age, sex
Trainer Factors: Experience, following protocol
Equipment: Calibration & maintenance
Environment:
High Heat/Humidity: Affects endurance testing
Altitude (>1,900 ft): Requires 9-12 days to adjust
Pollution: Air Quality Index impacts performance
Test Setting: Reduce distractions and anxiety
Educate client on test details & expectations
Consider risk-to-benefit ratio
Ensure proper facilities & calibrated equipment
Client readiness:
Adequate sleep
Proper dietary intake & hydration
Medication awareness
Proper attire
Resting Measures (HR, BP, Body Composition)
Non-Fatiguing Tests (Flexibility, Balance)
Muscular Strength Tests (1-RM)
Muscular Endurance Tests (YMCA Bench, Curl-Up)
Submaximal Aerobic Tests (Step-Test, 12-Min Walk/Run)
Resting Measures (HR, BP, Body Comp)
Non-Fatiguing Tests (Flexibility, Vertical Jump)
Agility Tests (T-Test)
Maximum Power/Strength (1-RM)
Sprint Tests (40-Yard Dash)
Muscular Endurance Tests (1-Min Sit-Ups)
Anaerobic Capacity Tests (Wingate, 300-Yard Shuttle)
Aerobic Capacity Tests (GXT, 1.5-Mile Run)
Chest pain, dizziness, nausea
Abnormal BP response
Shortness of breath
Equipment failure
Client requests to stop
Norm-Referenced Standards:
Compare scores to a similar population
Expressed as a percentile rank
Example: 50% percentile ≠ failing! It means they performed better than 50% of the norm group
Criterion-Referenced Standards:
Compares results to health-based benchmarks (e.g., CVD risk factors)
Conduct periodic retesting
Track progress & adjust program accordingly
Equipment: Stopwatch, Stethoscope, HR Monitor, Radial Pulse, Carotid Pulse
Factors Influencing HR:
Tobacco: ↑ Resting HR; ↑ or ← Exercise HR
Caffeine: ↑ or ← Resting & Exercise HR
Temperature: ↑ HR in hot environments
Altitude: ↑ HR above 4,000 ft
Stress & Digestion: ↑ HR
Body Position: ↓ HR when supine, ↑ HR when moving to sitting/standing
Time of Day: ↓ HR in the morning, ↑ or ← in afternoon/evening
Medications: Variable
Equipment: Sphygmomanometer, BP Cuff, Stethoscope
Common Errors:
Backward stethoscope
Bell under the cuff
Dial not at eye level
Cuff too low on arm
Seat subject for 5 min
Place cuff 1 inch above brachial artery
Position: Palm up, feet flat, stethoscope on antecubital space
Inflate:
160 mmHg OR
20 mmHg above expected BP
Release pressure at 2-3 mmHg/sec
First Korotkoff sound = SBP, Disappearance = DBP
Record BP in even numbers
Take 2 measurements, ensuring SBP & DBP differ by ≤5 mmHg
Allow 2 min between readings
Height: Barefoot, standing erect, heels together, deep breath (cm)
Weight: Remove heavy clothing/jewelry (kg)
BMI Formula: Weight (kg) / Height² (m²)
Equipment: Caliper, Tape, Marker
General Rules:
Right side of the body
No lotions or wet skin
Measure & mark site
Firm grasp, perpendicular measurement
Chest: Diagonal fold
Men: Halfway between anterior axillary line & nipple
Women: 1/3 of the way
Mid-Axilla: Vertical fold at the xiphoid process
Triceps: Vertical fold, posterior mid-upper arm
Subscapula: Diagonal fold below the shoulder blade
Abdomen: Vertical fold, 2cm from umbilicus
Suprailium: Diagonal fold above iliac crest
Thigh: Vertical fold, midway between hip & knee
Medial Calf: Vertical fold, medial lower leg
Waist: Smallest girth of abdomen
Hip: Largest girth of buttocks
Tape: Parallel to ground, snug fit
Check Equipment: Calibrated, seat height correct
Warm-up: Maintain position, establish cadence
Monitor Test:
Work Rate (kg/m/min or Watts)
HR steady-state = Last 15-20 sec of each minute
Measure BP & RPE at stage end
Measure the outcome variables: measure HR at the end of each stage or until; steady-state
Cool Down: 4 min active/passive
Equipment: Cycle ergometer, Metronome, Stopwatch, HR/BP equipment
Cadence: 50 rpm throughout
3-minute stages: 220- age
HR taken at min 2 & 3
Continue if HR varies >5 bpm
Stop When: HR reaches 85% age-predicted max
Plot WR at Heart rate max
VO2max = [(10.8 x Predicted Max W) / BW in kg] + 7
Cadence: 50 rpm, 6-min constant workload
Work Rate:
Males, untrained = 300/600 kg/m/min
Males, trained = 600/900 kg/m/min
Females, untrained = 300/450 kg/m/min
Females, trained = 450/600 kg/m/min
HR Monitoring:
If <120 bpm after 2 min → ↑ WR
If >120 bpm → Continue for 6 min
Take avg HR at min 5 & 6
Step Height: 12-inch (30cm) box
Cadence: 96 bpm (24 steps/min)
Duration: 3 min
Post-Test HR: Taken immediately after for 1 min
12-Minute Run/Walk:
Measure distance covered in meters
VO₂ Max = (0.0268 × Distance) - 11.3
1.5-Mile Run:
Measure time in minutes
VO₂ Max = 88.02 – (0.1656 × BW) – (2.76 × Time) + (3.716 × Gender)
●Untrained males
○(0.046 x H) – (0.021 x A) – 4.31
■Mine = 41.7; true value = 39.8
●Untrained females
○(0.046 x H) – (0.021 x A) – 4.93
●Aerobically trained males
○(27.387 x BW) + (26.634 x H) – (27.572 x A) + (26.161 x D) + (114.904 x I) + (506.752 x Y) – 4609.791
●Aerobically trained females
○(18.528 x BW) + (11.993 x H) – (17.197 x A) + (23.522 x D) + (62.118 x I) + (278.262 x Y) – 1375.878
●H=height(cm); A=age(yr); D=duration of training(hrs/wk); I=intensity(RPE scale); Y= # of years training
Warm-up 5-10 reps (40-60% estimated 1-RM)
1-min rest, ↑ weight for 3-5 reps (~5-20% increase)
2-min rest, estimate near-max weight for 2-3 reps
2-4 min rest, attempt 1-RM
Adjust weight if necessary (±2.5-10%)
Weight: 80 lbs (men), 35 lbs (women)
Metronome: 60 bpm (30 reps/min)
Terminate When: Cannot maintain cadence
Setup: 2 pieces of 4” tape, 10cm apart
Metronome: 50 bpm (25 reps/min)
Max: 25 reps
Measures: Lower back endurance
Position: Prone, hands under forehead, legs extended
Lift Legs: Hold as long as possible
Record Time (sec)
Box Zero Point: 26 cm
Reach Score: Distance reached past toes
Tape Placement: 15-inch mark
Heels: Touching tape (~10-12 inches apart)
Zero Point: 15-inch mark
Chapter 12
Flexibility
The ability of a joint to move freely through a full range of motion (ROM).
Timing: Before exercise for dynamic activities (e.g., basketball), after for less dynamic ones (e.g., cycling).
Benefits
Improves movement efficiency, prevents muscular imbalances, enhances coordination, and reduces injury risk.
Tight quadriceps, iliopsoas, and back muscles can lead to lower back pain.
Factors Affecting Flexibility
Joint Structure: Hinge (elbow) vs. ball-and-socket (shoulder).
Muscle & Connective Tissue: Stiff muscles reduce ROM; compliant muscles increase it.
Hyperlaxity: Excessive ROM, requires caution.
Age: Decreases with time. Sex: Females tend to be more flexible.
Temperature: Higher body temp improves flexibility. Activity Level: Active individuals are more flexible.
Resistance Training: Can increase or decrease ROM based on execution.
Tissue Adaptations
Elasticity: Temporary lengthening of muscles.
Plasticity: Permanent elongation with stretching.
To maximize plasticity: Stretch to mild discomfort, hold for a time, and ensure warm muscles.
Types of Flexibility Training
Ballistic Stretching: Uses momentum, risky due to stretch reflex.
Static Stretching: Held for ~30 sec, may negatively impact dynamic activities.
Dynamic Stretching (mobility routine): Functional movements, avoids bouncing.
PNF Stretching: Most effective for increasing ROM (hold-relax method), but higher injury risk.
Active vs. Passive Stretching: Active uses self-applied force, and passive uses a partner/device.
Warm-Up
Passive: Showers, heating pads, massage (effective,but not practical).
General: Jogging, cycling, jump rope (increases HR, blood flow, muscle temp).
Specific: Activity-specific movements, aids mental prep and help complex skills be performed.
Effects: Increased blood flow, nerve sensitivity, ROM; decreased muscle viscosity.
Stretching alone does not increase core temperature.
Guidelines: Warm-up for 5-15 minutes, should not cause fatigue.
Body Weight & Stability Ball Exercises
Body Weight Training: Uses own weight for resistance, good for endurance, not for max strength.
Stability Ball Training: Originally for rehab, now in sports/elderly fitness, enhances core challenge.
Research on Stability Balls
Core Activation: Conflicting evidence on oblique and spinal muscle activation.
Core Training Benefits: Strengthens spinal stabilizers, improves posture, balance, proprioception, and flexibility (useful for pregnancy).
Disadvantages: Doesn’t significantly improve sports performance or hypertrophy.
Stability Ball Safety
Proper technique is critical.
Ball size matters—incorrect placement reduces effectiveness.
Suspension Training & Manual Resistance
Suspension Training: Adjustable straps for resistance variation.
Manual Resistance Training: Partner-applied resistance.
Stability Balls & Sport Performance
Anecdotal evidence suggests core strength improves athletic performance.
Specificity: Useful for sports requiring balance on unstable surfaces (e.g., surfing).
Limitations: Cannot train at intensities ≥80% of max effort.
Chapters 13 & 15
Safety First: Supervise and monitor exercise technique to prevent injuries.
Teach Proper Form: Never assume a client knows the correct technique.
Demonstrate: Show proper form before having a client perform an exercise.
Pronated Grip: Palms down, knuckles up.
Supinated Grip: Palms up, knuckles down.
Alternated Grip: One hand supinated, one hand pronated.
Hook Grip: Thumb wrapped under fingers; used for Olympic lifts to improve grip strength.
5-Point Body Contact (Supine Lifts):
Back of head
Upper back and shoulders
Lower back and buttocks
Right foot
Left foot
5-Point Body Contact (Prone Lifts):
Chin or cheek
Chest and stomach
Hips and front of thighs
Right hand
Left hand
Standing Exercises: Feet between hip & shoulder-width apart, flat on the floor, weight in heels. Women typically have a wider stance than men.
Full ROM maximizes exercise benefits and maintains flexibility.
Speed depends on exercise type:
Traditional exercises: Controlled pace.
Power exercises: Performed explosively.
General Rule:
Exhale during the sticking point (hardest part).
Inhale during the easier phase (eccentric).
Valsalva Maneuver: Holding breath while exerting force.
Pros: Increases intra-abdominal pressure, stabilizing spine.
Cons: Reduces venous return, increases BP, risk of fainting.
Used for maximal structural lifts (e.g., squat, deadlifts).
Not recommended for submaximal lifts, as it impedes core muscle development.
Overhead/Over-Face Exercises (Barbell): Spotter uses an alternated grip inside the client’s hands.
Dumbbell Exercises: Spot near wrists (not elbows) for safety.
Communication is key: Client should signal readiness before unracking and re-racking weights.
Power Lifts (Olympic Lifts): Should NOT be spotted. Lifters must learn how to safely "miss" a lift.
Open Kinetic Chain: Distal body part is free-moving.
E.g., Leg extensions, biceps curls.
Closed Kinetic Chain: Distal body part is fixed.
E.g., Squats, push-ups.
Essential for beginners to prevent plates from sliding.
Restricting knees from moving past toes can increase lower back stress.
A slight knee movement past the toes is not inherently bad and may be necessary for proper mechanics.
Specificity: Training must match desired outcomes (e.g., muscle type, energy system).
Overload: Stress must exceed normal levels to see progress.
Variation: Manipulating sets, reps, load, tempo, and rest to ensure adaptation.
Periodization: Structured changes in training variables over time.
Progression: Continuous increases in training intensity over time.
Initial Consultation & Fitness Evaluation
Determine client’s resistance training experience.
Assess training frequency, intensity, and exercise proficiency.
Exercise Choice
Match exercises to client needs.
Beginners: 1 exercise per muscle; Intermediate: 2-3 exercises; Advanced: 3+ exercises.
Training Frequency
Beginners: 2-3x/week (full body).
Intermediate/Advanced: 3-7x/week (split routines).
Exercise Order
Power → Core → Assistance.
Multi-joint → Single-joint.
Target 1 goal -> less specific movement patterns
Core Exercises (multi-joint, large muscle groups): (Main part of the program)
Squat, deadlift, bench press, lat pulldown, seated row.
Structural Exercises (require torso stability):
Squat, deadlift, snatch.
Assistance Exercises (single-joint, smaller muscle groups): (Secondary Emphasis)
Leg curl, biceps curl, lateral raises.
Load = % of 1RM.
Inversely related to reps.
Volume = Sets × Reps × Load(weight). MUST USE ALL 3
Repetition Ranges:
Muscular Endurance: ≥15 reps, low weight.
Hypertrophy: 8-12 reps (moderate to heavy loads).
Strength: ≤6 reps (heavy loads, multiple sets).
Power: 1-6 reps (fast, explosive movements).
2-for-2 Rule: If a client performs ≥2 reps more than their target for 2 consecutive sessions, increase weight.
RM testing
2 for 2 rule
Strength/Power: 2-5 minutes.
Hypertrophy: 30-90 seconds.
Endurance: ≤30 seconds.
Prevents plateaus and overtraining.
Within-Session Variations:
Compound Set: Two different exercises for the same muscle group (no rest).
Super Set: Two exercises for opposing muscle groups (no rest).
Rest-Pause: Brief rests within a set to extend time under tension.
Pyramiding: Increasing/decreasing loads across sets.
Vascular Occlusion: Holding an isometric contraction before reps.
Within-Week Variations:
Alternating intensities (e.g., 75% 1RM one day, 68% 1RM another).
Linear Periodization: Gradual increase in intensity, decrease in volume.
Best for beginners.
Nonlinear (Undulating) Periodization: Frequent fluctuations in load/volume.
Best for intermediate/advanced athletes.
Macrocycle (Yearly Plan) → Mesocycle (Weeks to Months) → Microcycle (Days to Weeks).
Beginner (3x/Week, Full Body)
Squat, bench press, lat pulldown, leg curl, biceps curl.
Intermediate (4x/Week, Split Routine)
Upper/lower body splits.
Advanced (6x/Week, Push-Pull-Legs Split)
Alternating heavy/light days.
Proper Hydration
Essential for regulating body temperature, energy metabolism, and joint lubrication.
Fluid recommendations:
Consume ~5 to 7 ml per kg body weight at least 4 hours before exercise.
Weigh before and after exercise—replace each lb lost with 20-24 oz (~0.6-0.7L) of fluid.
Prolonged exercise (>1 hr) requires electrolyte replenishment.
Appropriate Clothing & Footwear
Loose-fitting, breathable clothing.
Shoes should provide cushioning, stability, flexibility, and be replaced after 300-500 miles of use.
Special Considerations:
Flat shoes for weightlifting (improves mobility, prevents excessive trunk flexion).
High-heeled tennis shoes for those with poor ankle mobility (temporary use).
Barefoot training may help high-impact runners.
Warm-up & Cool-down
5-15 min warm-up to gradually elevate HR.
5-15 min cool-down to reduce HR safely.
Stretching post-exercise to improve flexibility.
Exercise Prescription Variables
Frequency, Intensity, Duration must be tailored to individual fitness levels.
Proper Breathing Techniques
Should be relaxed and regular, adapting to intensity levels.
Primary muscles: Quads, hamstrings, glutes, iliopsoas, tibialis anterior, gastrocnemius, soleus.
Advantages:
Controlled speed & incline.
Lower impact than outdoor running.
Handrail support for beginners.
Disadvantages:
Lack of air resistance (reduces energy demand).
Lower energy cost than outdoor running.
Stepping On:
Hold handrails while straddling the belt.
Start at 1.0 mph, step onto the belt, adjust speed gradually.
Primary muscles: Quads, hamstrings, glutes, erector spinae, gastrocnemius, soleus.
Advantages:
Lower knee stress than real stairs (4x higher force on normal stairs).
Disadvantages:
Fixed step height, unsuitable for beginners.
Handrail Usage Reductions:
Light grip → Fingertips → One hand → One finger.
Primary muscles: Quads, hamstrings, glutes, iliopsoas, tibialis anterior, gastrocnemius, soleus.
Advantages:
Low impact, full-body engagement, increased calorie burn.
Key Technique:
Keep full foot in contact with the pedals.
Avoid excessive knee movement past toes.
Primary muscles: Quads, hamstrings, glutes, tibialis anterior, gastrocnemius, soleus.
Advantages:
Non-weight bearing, good for orthopedic issues.
Disadvantages:
Local muscle fatigue can limit cardiovascular benefits.
Seat Adjustment:
Leg should be nearly extended (5% flexion) at the lowest pedal position.
Primary muscles: Upper and lower body, including biceps, deltoids, traps, lats, abs, and erector spinae.
Advantages:
Engages both upper & lower body, non-weight bearing.
Common Issues:
Beginners use too much upper body.
Individuals with back pain tend to round their back.
Primary muscles: Quads, hamstrings, glutes, iliopsoas, tibialis anterior, gastrocnemius, soleus.
Technique:
Posture: Run/walk tall, shoulders relaxed, body over hips.
Foot Strike: Heel → ball of foot → push-off.
Arm Action: Should assist, but excessive movement reduces efficiency.
Stride Length/Frequency: Plyometrics improve both.
Consider:
Orthopedic limitations (e.g., low-impact for arthritis).
Equipment availability.
Client’s fitness goals.
Proper technique to prevent injury.
Specificity: Training must match the goal.
FITT Principle:
Frequency: 2-5 sessions/week.
Intensity: 50-85% HRR.
Time: 20-60 min/session.
Type: Running, cycling, swimming, etc.
Beginner: 2-5 days/week.
Intermediate: 3-5 days/week.
Advanced: >5 days/week.
Intensity Classification:
Inactive: 30% HRR.
General population: 50-85% HRR.
Advanced: 85%+ HRR.
Age-Predicted Max HR (APMHR)
220 – Age = APMHR.
Target HR Range: 50-85% HRR.
Karvonen Formula:
HRR = APMHR – RHR.
Target HRR = (HRR × intensity %) + RHR.
Rate of Perceived Exertion (RPE):
Accounts for respiration, exertion, emotional response.
Inverse relationship with intensity.
Beginner:
75 min/week vigorous (3 × 25 min OR 2 × 40 min).
150 min/week moderate (3 × 50 min OR 5 × 30 min).
Intermediate:
75-150 min/week vigorous (3-5 × 25-50 min).
150-300 min/week moderate (3-7 × 30-50 min).
Advanced:
May exceed 300 min/week.
Lower intensity, longer duration (30-120 min, ≤2 days/week).
Below lactate threshold.
Threshold training (1-2 days/week).
Steady: 20-30 min at or above lactate threshold.
Intermittent: 3-5 min bursts with 30-90s rest.
90-100% HRR work periods, <50% HRR rest.
Work-rest ratios: 1:1 to 1:3.
Types:
Short HIIT (30-60 sec bursts, fast glycolysis).
Long HIIT (1:30-4 min bursts, slow glycolysis).
Sprint (5-30 sec max effort, creatine-phosphate system).
Cross-Training (CT):
Combines multiple cardio modes (e.g., running + cycling).
Helps reduce overuse injuries.
Concurrent Training (CT):
Combines resistance training & endurance training.
Requires careful balance to prevent interference effects.
Improvement:
Progressively increases frequency, intensity, or duration (≤10% per week).
Maintenance:
Maintains current fitness level (minimum 2x/week).
Use variety to sustain motivation.