Program Design and Implementation

Question 1

Fundamentals of Exercise Program Design
The Dynamic Warm-Up
The Training Stimulus
The FITTE Principle
Exercise Regression (回歸) and Progression (進展)
Detraining (取消訓練)
Training Protocols
Manipulation of Training Variables
Periodization (週期話; 分期)

Answer 1

• Components of an exercise program include a dynamic warm-up, the training stimulus (the type of exercises] being applied), and proper cooldown.
• A warm-up should always be performed before beginning an exercise routine because it effectively prepares the body for activity.
  1. With this in mind, it’s important to consider what type of activity is going to be performed during the workout and make sure to design the warm-up based on this activity.
  2. The program design should always consider which muscles will be stimulated during the routine and prepares those muscle groups for the forces that will be placed on them during dynamic movements.
• Static Stretching does not adequately prepare the human movement system for the dynamic exercises found in nearly all fitness routines. It’s helpful in improving the flexibility of the muscles but has also been shown to limit strength and power output for hours post-stretch.
• To prepare muscles for any dynamic activity (e.g. weightlifting, running, swimming, tennis, etc.), a dynamic warm-up should be incorporated into the workout. Dynamic stretching involves exercises that mimic the day’s activity and short-duration stretches to prepare the muscles for the forces they will encounter during the workout.
• There are several types of stretching: static stretching, dynamic stretching, ballistic stretching, and PNF stretching.
  1. Ballistic Stretching — a high-speed version of dynamic stretching that can be potentially harmful to the joints.
  2. PNF stretching — requires the assistance of a trainer and can be more effective than static stretching at increasing range of motion.
• Prior to designing the dynamic warm-up, it’s important to consider:
  1. which joints will be used
  2. what patterns and plane of motion the joint will be moving in
  3. which muscle groups will be involved in the activity.
• A well-rounded dynamic warm-up should include:
  1. about 5 mins of low-intensity aerobic exercise (that uses a large percentage of the body’s muscle mass or at least the muscles that will be the focus of the workup. e.g. light jogging, cycling, stair climbing, etc. will help improve blood flow and muscle elasticity for exercise)
  2. about 15 mins of 5+ reps of exercises/dynamic stretches that relate to the movements in the workout (e.g. walking lunge as a dynamic warm-up to prepare the quad/hamstrings/glutes for weighted stationary lunges in a weightlifting routine).
• Training Stimulus — the type of exercises being applied in the program, and how they are implemented can have varying effects. This is why it’s important to develop goals before the start of any training program.
  1. For example, if the goal is to increase muscle size, a program designed to focus on muscular hypertrophy is optimal for the client. However, if the goal is to develop speed and agility, exercises that develop muscular power may need to be incorporated as a training stimulus.
  2. Training specificity should also be taken into consideration. Specificity refers to developing a training program to achieve a specific goal determined by the PT and client. Training specificity can be applied to both resistance training and cardiovascular training. (e.g. if a client’s goal is to run a 5k race, the client’s primary mode of cardiovascular training should be running or jogging).
• Programs that follow a proper progression of intensity tend to yield the best results. Progression refers to an increase in program difficulty through increased frequency and intensity of exercise throughout the client’s fitness program. Therefore, it’s important for the PT to assess the client’s abilities and implement an appropriate number of sets and reps.
• Rest Period — a set amount of recovery time between sets or exercises that allows the muscles to sufficiently replenish to properly perform the exercise again; should be implemented between consecutive sets.
• Too little rest may prevent the client from completing the goal number of reps or may lead to improper form, while too much rest can reduce the beneficial response of the exercise. The rest period will vary based on the load (the amount of weight lifted with proper form) involved during a specific exercise.
• Volume — the total number of sets, reps, and exercises; varies according to the goal of the fitness program. The volume of the training programs should also progress according to the client’s fitness level and goals.
• The FITTE Principle — following the FITTE principle is very helpful in designing effective fitness programs. Much of the FITTE principle will be determined by the fitness level of the client and the client’s progress through the fitness program. These variables should start off moderately and progress to higher intensities as the program progresses.
  1. Frequency (of exercise) — will vary for each client (e.g. beginners may start with 2 days of total body strength training per week and can eventually be progressed to 3 days per week on non-consecutive days to avoid overuse injuries. Advanced exercisers may be able to do a split resistance training routine 4+ times per week that breaks out workouts into muscle groups).
  2. Intensity (of exercise) —should follow a steady progression throughout the exercise program to ensure that the client’s musculoskeletal system is prepared for the forces it will face. 2.1. The principle of overload (gradually increasing the difficulty of each successive workout by manipulating the training variables) should be achieved with each workout to ensure that the muscles receive stress significant enough to induce a beneficial adaptation to exercise. A rapid progression of exercise difficulty could lead to a plateau in progress or potential injury.
  2.2. There are a number of ways to adjust the intensity of the workout, including:
  (1) increasing the weight
  (2) decreasing the stability (e.g. standing on an unstable surface while performing a squat)
  (3) changing the center of gravity (e.g. performing an overhead squat rather than a traditional back squat)
  (4) increasing the rate at which the exercise is performed (e.g. power-developing exercises such as plyometrics or Olympic lifting).
  2.3. Progression of intensity in resistance training is critical for achieving the goals of the client.
  (1) Lower-intensity workouts focusing on developing muscular endurance should be the starting point. Lighter loads and higher rep ranges are best for new clients (e.g. one set of each exercise at 65-75% of the client’s 1RM for 10-15 reps, then progress to multiple sets in the same load range). This intensity will help develop the client’s muscular endurance and improve neuromuscular adaptation to exercise.
  (2) After 6+ weeks, the PT should increase the intensity of the workout by increasing the load (e.g. load is increased to 65-80% of the client’s 1RM). Reps will decrease to a minimum of 8-12. This intensity will help the client develop muscle size (aks muscular hypertrophy).
  (3) The next progression focuses on developing muscular strength achieved by increasing the weight to 85-100% of 1RM and decreasing the rep range to 1-8 reps. The key concept to remember with resistance training progression is that the intensity increases as the weight increases.
  2.4. Cardiovascular training should be progressively increased by increasing the time, rate, or distance of exercise. This can be achieved by monitoring the heart rate during cardio exercises. If the client is having difficulty tracking heart rate, the PT can teach the client how to utilize a RPE (rate of perceived exertion, using a scale of 1 to 10) to judge how challenging the cardio workout is.
  3. Time (or duration of exercise) — the client will need to develop a tolerance for longer workouts by building up muscular and cardiovascular endurance.
  (1) For resistance training programs, the earlier phases may emphasize dynamic warm-up and technique practice prior to loading, and stretching and cooldown following loading. As the client progresses, more time can be dedicated to weightlifting and the duration of the workouts (how much time the client can dedicate to finess) can increase. Early programs, however, should include around 8 exercises that work all the primary musculature of the body.
  (2) Cardiovascular training will start with short durations and gradually increase as the client’s tolerance for the exercise increases.
  4. Type (or mode of exercise) — when selecting the type of exercise, the PT should take into account the client’s recreational activity, sports, fitness goals, time available for an exercise program, and any limitations that may prevent certain modes of training.
  5. Enjoyment (of exercise) — enjoyment of exercise is important because it promotes client compliance. Program compliance can be challenging when the client is not a fitness enthusiast. This is why it’s important to find exercises the client likes and design the program accordingly.
• It’s important for the PT to understand both the proper progression and the proper regression of an exercise.
  1. Regression — a decrease in exercise difficulty (to accommodate individuals who cannot perform an exercise due to either physical limitations or inexperience). A PT must understand that not everyone is capable of performing the same exercises.
  2. Progression — the human body goes through motor learning stages that can help determine exercise progression. These stages include:
  (1) Cognitive learning stage — associated with faltering while performing a skill and may look awkward. When teaching an exercise technique, this learning stage may indicate that the exercise is too difficult and requires regression/modification.
  (2) Associative learning stage — defined by more precise movement patterns but still maintains a level of difficulty that prevents unhindered movement. This learning stage shows an appropriate level of difficulty for a client. The client is able to perform the exercise with proper technique, but with subtle yet obvious difficulty.
  (3) Autonomous learning stage — indicates that the client has mastered the technique and requires further progression of the exercise.
• Detraining — refers to the body’s deleterious reactions to stopping a fitness program, which can become evident in as little as 2 weeks (it’s important for the PT to understand how quickly the effects of detraining occur when stopping a fitness program). In this short time frame, detrimental effects occur in both cardiovascular fitness and muscular fitness.
  1. Improvements in cardiovascular fitness from aerobic training programs - such as improved cardiac output, maximal oxygen uptake, and mitochondrial function in skeletal muscle - decline rapidly after stopping aerobic exercise.
  1.1. Furthermore, continuing aerobic activity following a long hiatus does not return the individual to the peak level of cardiovascular fitness; this can take months of training at lower intensities and gradual progression.
  1.2. It’s more beneficial to the client to lower the intensity of the cardiovascular workout and continue to train at lower intensities than it is to stop aerobic training completely.
  2. Muscular fitness declines more gradually following cessation of a weight-training program.
  2.1. Though there is a limited effect on the strength of the muscle, the muscular cross-sectional area is reduced gradually over time. (In individuals who have previously been training, the effects on muscular fitness after discontinuing strength training are less significant, since the body retains some of the strength gains achieved through resistance training following weight-training cessation).
  2.2. A decline in strength after weeks of detraining can be attributed to the loss of muscle cross-sectional area.
  2.3. With the effects of detraining in mind, the training program should be regressed by utilizing lighter loads or easier modifications following a period with no resistance training.
• As the client progresses, the program complexity can be progressed as well. Examples include:
  1. Super Set — involves performing a first exercise for one full set, immediately followed by working the opposite (antagonist) muscle groups for one full set (e.g. bench press for a set of 8 reps + bent-over rows for a set of 8 reps).
  2. Pyramid Set — involves selecting an exercise and performing consecutive sets at increasing loads, followed by sets of decreasing loads (e.g. 10 reps at 75% of 1RM -> 8 reps at 80% of 1RM -> 6 reps at 85% of 1RM -> 8 reps at 80% of 1RM -> 10 reps at 75% of 1RM). The client is working with multiple rep ranges and weight categories within a single workout, which requires both muscular endurance and muscular strength.
  3. Circuit Training — this style of training is beneficial for clients who tend to get bored waiting around for the next set because it keeps them in continuous motion. When selecting exercises for a circuit training session, the PT should try to utilize different muscle groups with each exercise. This approach will help avoid absolute fatigue, minimizing rest periods, and will provide a well-rounded workout that prevents muscular imbalances.
  3.1. Vertical Loading — Designing a circuit that minimizes rest by selecting various muscle groups is called vertical loading, which is often done by starting at the top of the kinetic chain and working down to the bottom.
  3.2. Horizontal Loading — Performing consecutive exercises for the same muscle groups with intermittent rest periods. 3.3. Because of the reduced rest periods involved in circuit training, the client’s fitness level should be considered before beginning this type of program.
• When deciding how to adjust the fitness program, the PT must analyze which energy system are being utilized in the client’s activity. The training program should improve the client’s ability to perform using the energy system most commonly used in that activity (e.g. if the client plays a sport involving short sprints, such as football, the client will benefit most by following a periodized program that develops muscular power. The PT needs to consider how to adjust the training variables to mimic the energy requirements of the sport).
• Periodization — the planned breakdown of the overall training program aimed at achieving a specific fitness goal and peak performance, essentially the blueprint of a client’s program and how it will be implemented.
  1. The PT’s job is to design each phase of the program, the timeline to follow, when to adjust training variables and when the client should transition to the next phase.
  2. The goal of periodization is to elicit General Adaptation Syndrome, or physiological adaptation to exercise through proper periodization and use of the overload principle.
  3. There are several different cycles, periods, and phases in the blueprint of the client’s training program.
  3.1. Macrocycle — typically the overall program, which includes the in-season and off-season for athletes and a full program for general clients. In-season is the period in which athletes are actively practicing for and competing in their sport/event, and off-season is the period in which they are not involved in active practice or competition.
  3.2. Mesocycles — typically involve a large portion of the program in which the load and volume are gradually progressed over a period of 6-12 weeks (dependent upon the timing of athletic competitions).
  3.3. Microcycles — typically shorter cycles within a mesocycle, dedicated to a specific load and volume range aimed at a particular adaptation. Microcycles can be described as phases of training aimed at specific adaptation (e.g. endurance phase, hypertrophy phase, strength phase, and power phase). Each phase provides the PT with the goal of the microcycle and what load and volume should look like.
• The periods of an exercise program are important because they help determine how the client is progressing.
  1. Preparatory Period — the start of a training program typically associated with lower intensities of exercise with the goal of improving muscular endurance, muscular hypertrophy, and the basic strength of a client.
  1.1. Exercises involved in this period may not follow the exact specificity of the client’s sport/event and will be of lower difficulty.
  1.2. This period helps the client learn exercise technique and build a base of training for the next phase.
  2. 1st Transition Period — Transition periods occur after the preparatory period (1st transition period) and at the end of the periodization (2nd transition period).
  2.1. The 1st transition period shifts the program toward more event-specific movements that improve peak strength and power prior to competition. This period should be planned to occur just prior to the start of the athlete’s season, tryouts, or competition.
  3. Competitive Period — following the 1st transition period, occurs during the athlete’s event/season and is defined by the absolute peak of performance with significant focus on power movements and sport-specific training or maintenance of fitness through moderate-intensity, higher-volume workouts.
  3.1. For a client with a short competitive period (e.g. shot putter), the PT should design the competitive period for peak performance when the athlete can focus on more specific movements, like power exercises at low volume and high loads, and place more emphasis on throwing technique.
  3.2. Athletes with longer seasons may require a focus on performance maintenance throughout the season. The PT should design and implement a program that cycles back through the phases to have the athlete peak leading up to the most important competitive events (e.g. the 1st in-season match, toughest opponent, and playoffs).
  4. 2nd Transition Period — following the competitive period, typically a period of active rest.
  4.1. During this time, the athlete will take a break to actively recover through recreational activities that may not be related to their sport.
  4.2. The athlete should remain active during this time period; however, resistance training may be eliminated for about 2 weeks.
  4.3. This period allows athletes to recover from minor injuries and recuperate from the stress placed on the body during peak conditioning and competition.
• The main goal of periodization is to have the client reach peak athletic performance exactly when needed. This is achieved through proper program design and implementation. There are two main types of periodization:
  1. Linear Periodization — a steady progression toward higher intensities: a standard endurance/hypertrophy phase, then a strength phase, then a peak strength/power phase.
  1.1. This method is highly beneficial to athletes preparing for competition because it allows the body to undergo general adaptation syndrome steadily and without risk of overtraining.
  1.2. Linear periodization generally allows for easy-to-follow resistance guidelines and simple transitions to the next phase for clients.
  2. Undulating Periodization — a program that varies the intensity of the workouts within the microcycle, but that gradually increases the overall program intensity over the macrocycle.
  2.1. For instance, the 1st workout of the week may focus on loads and volumes aimed at increasing muscular hypertrophy, the 2nd workout may be designed for improved strength, and the last for muscular endurance.
• Periodization is an important way to optimize training programs for improved performance. When evaluating a sport for program design, the PT should consider the following:
  1. energy systems used in the sport
  2. length of off-season
  3. length of in-season
  4. length of competitive period
  5. goal of program
  Each of these factors will help the PT to decide how to break down the training components from macrocycle to microcycle.
• Training programs will vary greatly among sports and sometimes even by the position within each sport. It’s the PT’s responsibility to research and evaluate the sport prior to designing the athlete’s exercise program. Athletes with long seasons may undergo multiple mesocycles during the course of the season. The PT must be able to implement the principles of overload and specificity, and manipulate training variables throughout the exercise program. It’s not optimal to cycle muscular endurance during the season (e.g. baseball) because it contributes to excessive fatigue that can hinder the athlete’s performance.
• Clients with shorter athletic seasons or fewer competitive events (e.g. triathletes, Ironman athletes, marathoners) will have a somewhat different periodization. The goal will be to peak for a single event rather than a full competitive season. In this example, the athlete can stretch out the mesocycles, implementing 4-week microcycles of each phase. As with all programs, there should be a gradual progression of intensity to elicit the effect of general adaptation syndrome. The preparatory and 1st transition periods will be elongated compared to those of a baseball player, simply because triathletes/marathoners do not have 3 or 4 competitions per weeks during the season. The competitive period for these athletes is shorter and culminates in the event itself, emphasizing heavy loads with minimal rep involving power-based movements such as plyometrics.

Question 2

Designing an Exercise Program
Conducting A Needs Analysis
Program Design for Weight Management
Program Design for General Health Benefits
Program Design for Athletic Performance
Program Design for Fitness Improvements
Manipulating Training Variables for Specific Outcomes
Choosing Exercises
Exercise Selection to Promote Muscular Balance
Exercise Selection for Sports Specificity
Exercise Order
Training Frequency and Rest Periods
Assigning Training Frequency Based on Training Goals
Monitoring Exercise Intensity
Training Load and Repetition
Volume
Progression
Assigning Progression Based on Training Goal

Answer 2

• The Needs Analysis (goal setting) should always be performed prior to starting the client’s fitness program which will help the PT discern how to plan the exercise program, which should be designed according to the overall goal of the client. An effective method for developing goals is to utilize the SMART goal acronym.
• SMART goals are specific, measurable, action-oriented, realistic, and time-stamped goals that can be developed in the needs analysis with the client.
  1. Specific — the goal is detailed and tells exactly what the client hopes to accomplish (e.g. I want to lose 10 lbs).
  2. Measurable — there is a specific number or amount to reach (e.g. the client wants to be able to deadlift 250 lbs).
  3. Action-Oriented — require the client to put forth a significant effort in order for the goal to be accomplished.
  4. Realistic — the goal is not outside the realm of possibility for the client (e.g. losing 10 lbs in 10 weeks instead of 30 lbs in 3 weeks).
  5. Time-Stamped — have set start and end dates. The client should make a point to select a final date for achieving the goal. This gives the PT an idea of how to properly design and implement the training program and how to set up the periodization for the client’s goals.
• An effective weight management program will include a combination of consistent cardiovascular exercise, a variety of resistance training, and proper nutrition.
  1. Weight management program design uses a steady progression of training variables aimed at improving muscular and aerobic fitness. The program should start with 2 days of resistance training and 3 days of aerobic training per week (can eventually progress to 3 days of resistance training and up to 5 days of aerobic training per week, then the PT can gradually increase the intensity of the program by manipulating other training variables).
  2. Those focused on weight loss should begin a resistance training program by building muscular endurance. Though traditional linear weightlifting (multiple sets with rest periods) is effective, circuit training may keep the client more engaged in the program.
  3. Following muscular endurance, the program should progress to a muscular hypertrophy phase, which benefits a weight-loss program because increases in muscle mass help increase the client’s resting metabolism.
  4. Power-based exercises are beneficial because they are very high intensity; however, they are not always necessary in a weight-loss program.
  5. Resistance training programs that involve all the major muscle groups and a variety of modes (e.g. body weight, free weights, machine weights, cable resistance, resistance bands, etc.) will provide the most benefit while preventing the program from become stale.
  6. For weight loss, cardiovascular exercise is very important; however, the mode is not significant. With this in mind, the client can decide how to incorporate cardio and select the most enjoyable method.
  7. Cardio training for weight loss should also follow a steady progression. Moderate-intensity aerobic exercise should be performed 3 days a week, for 30 mins per session unless the clients are less fit. The PT should instruct the client to progress in small increments (<10% every couple of weeks) to avoid overuse injuries from advancing too quickly.
  8. It’s also important for the PT to inform the client of appropriate weight-loss goals and healthy, sustainable weight-loss methods. It’s healthier to gradually increase/decrease weight rather than gain/lose it rapidly. Gradual weight changes typically involve about 1-2 lbs per week.
• Program design for general health benefits:
  1. Similar to weight management program, the key concepts include a gradual progression of frequency, intensity, and duration of exercise that also keeps the client engaged in the program.
  2. The program should implement a combination of both cardio and resistance training for optimal results.
  3. The PT can also design the exercise program based on the client’s daily activities, recreational activities and other interests.
  4. For general health benefits, it will be most effective to keep the program simple and follow the basic guidelines of the FITTE principle, the overload principle and exercise progression.
  5. Beginner clients will spend a longer period of time developing muscular endurance, hypertrophy, and basic strength. The program design may not require highly technical power movements, and the PT should consider the physical condition of the client when adding high-impact/high-intensity exercises like power movements.
  6. In general, the program should start with 2 sessions of muscular-endurance-based resistance training and 3 aerobic endurance workouts a week. A gradual progression will eventually include a potential 3rd resistance training session and more frequent cardio workouts after 6 weeks of training has been completed.
  7. Cardio training should also follow a gradual progression of intensity. Since the client is not training aerobically for improved performance it doesn’t matter what mode of exercise the client uses. Allowing the client to select an enjoyable form of aerobic fitness will help with program compliance.
• Program design for athletic performance:
  1. Designing an exercise program for athletes requires a particular focus on specificity. The goal should be to have the athlete reach peak performance at competition time.
  2. More competitive athletes will benefit from incorporating a linear periodization that progressively increases in intensity, weight, and power while simultaneously decreases in volume.
  3. In general, sports are performed in multiple planes of motion. However, some sports place most of their emphasis on specific movements and the program design should model this performance.
  4. In terms of cardio exercise for athletic performance, the PT should consider the energy system used to perform the activity. Many sports that seem to benefit from long-distance cardio activity may actually be hindered by it.
  5. Long-distance cardio exercise encourages the slow-twitch muscle fibers in the body to become dominant. Although these muscles are great at keeping the athlete moving for long duration (e.g. in a 5k race), they do little to improve the athlete’s anaerobic capacity to sprint for short distance. This is better accomplished by performing anaerobic sprints, agility- and power-developing drills that work the same energy systems the body uses for sports such as tennis/basketball/baseball/football/soccer/hockey. These sports require peak power development from fast-twitch muscle fibers. The PT’s analysis of the athletic event should reveal which energy system to focus on in the athletes fitness program.
• Program design for fitness improvements:
  1. Goals for fitness improvement should reflect the components of SMART goals and could involve a variety of components. The client could be looking to improve muscular strength, improve muscular endurance, reduce body fat, build muscle, improve aerobic endurance, or improve something more specific, such as a particular lift.
  2. For example, the client may be interested in improving his 1RM bench press. This goal requires improvements to muscular strength in the pectorals, triceps, and anterior deltoid muscles. Prior to beginning the program periodization, the PT should first assess the client’s current 1RM bench press to set a realistic goal. Exercise selection should be specific and include exercises that relate to the bench press movement, gradually progressing from developing muscular endurance to hypertrophy and finally to strength and power movements. Although the goal is to improve the strength of the primary muscle groups for bench press, exercise selection should not be limited to only these muscle groups but should also include exercises for the muscular antagonists of the pectorals triceps, and anterior deltoids.
  3. Proper programming also helps reduce the chance of developing muscular imbalance due to unilateral program designs. One effective way to achieve this balance in a program aimed at improving 1RM exercises is a 4-day split routine, which dedicates alternating days to different muscle groups and their muscular synergists (e.g. 1st day - push muscles: triceps, chest, shoulders; 2nd day - pull muscles: biceps, scapular retractors, posterior deltoids, back muscles; 3rd day - all major muscle groups in the legs: quadriceps, hamstrings, calves, glutes, hip flexors; 4th day - core musculature).
  4. Powerlifters focus on improving their 1RM on 3 specific lifts: bench press, back squat, and deadlift, none of which involve muscular power. The 1RM is a measure of muscular strength. Olympic lifters perform either the barbell snatch or barbell clean and jerk, which requires muscular power.
  5. A program design for a half-marathon runner will benefit the client most by including more aerobic training. However, resistance training should be incorporated too because it helps improve maximal oxygen uptake (VO2 max), as well as lactic acid threshold and neuromotor control. All these components are essential to a runner’s fitness profile. The improved VO2 max will help with cardiovascular efficiency, improved lactic acid threshold will help reduce the buildup of lactic acid in the bloodstream, and improved neuromotor control will help with running technique and efficiency. Resistance training should involve all the major muscle groups of the body to promote muscular balance. The resistance training goal should be to increase intensity gradually in an attempt to peak just before the event, with exercises focused on muscular strength/power.
• The PT should know exactly how to manipulate training variables in a client’s program for desired outcomes. Important variables are the number of sets, reps, rest periods and load used for a specific muscular adaptation to exercise.
• It’s important that PTs base exercise selection around the data collected from the client’s need analysis, medical background, and fitness assessment.
• Prior to the start of any fitness program, the PT must ensure the client is cleared for exercise by a physician, if this is indicated by the client’s medical history and a PAR-Q.
• Exercise selection becomes easier to determine after the client’s goal is set.
• Although it’s not within the PT’s scope of practice to develop a meal plan for the client, a PT may provide research-based recommendations on dietary guidelines for weight loss.
• Often the client’s medical history or health status will create difficulties in designing a fitness plan. The PT must be aware of past injuries, surgeries, and current health concerns, such as elevated BP, smoking, and heart conditions, which may be affected by exercise.
• During the fitness assessment process, the PT should attempt to test all of the major fitness components, including body composition, flexibility, cardiovascular fitness, muscular strength, and muscular endurance. The results can be compared to national normative values to evaluate which areas need improvement and which areas require maintenance only.
• Periodic retesting will also help in exercise selection and program design. Retesting should occur after approximately 6-12 weeks, depending on the length of the program, to see if the client is making progress. This will allow PT to fine tune the exercise program and select exercises for areas needing further improvement.
• Exercise selection to promote muscular balance:
  1. Exercise selection should always promote muscular balance of the movement system. Muscular imbalances are often caused by overuse related to the client’s occupation, while postural deviations may be related to daily sedentary habits and unilateral training programs.
  2. Training muscles that are already shortened/tight because of poor posture can further emphasize the muscular imbalance and potentially cause injuries (e.g. sedentary office workers tend to have forward-rounding shoulders and tight hip flexors. This muscular imbalance should be assessed through a visual examination of posture and addressed by strengthening the scapular retractors of the upper back, stretching the chest and anterior deltoids muscles, and stretching the hip flexors sufficiently post workout).
  3. When developing the client’s fitness program, PT should make sure to include exercises that work all the major muscle groups of the body, without exception. (This is true even in situations where the client’s goal is to increase her 1RM bench press load. Exercises that work the muscular antagonists of bench press movement, such as bent-over rows, should be implemented to decrease risk of muscular imbalances in the shoulders).
  4. Muscular balance is also based on the planes of motion in which exercises are performed. Human movement occurs in distinct planes of motion: sagittal, frontal, and transverse plane. Since many muscles work in multiple planes of motion, it’s very important that PT incorporate a wide variety of exercises for each muscle group.
  5. For example, the client’s program may include the dumbbell bench row exercise to address the trap, lats, and bicep muscles in the sagittal plane of motion. However, the same muscles function during a pull-down exercise in the frontal plane of motion. Performing both these exercises will help promote muscular balance of the trap, lats, and bicep muscles.
• Exercise selection for sports specificity:
  1. Choosing exercises to improve sports performance requires analysis of the sport itself, in conjunction with the overall fitness assessment.
  2. The PT should consider movement patterns and associated muscle groups of the sport when selecting exercises for an athlete’s program. Additionally, the fitness assessment should test the energy systems being used during the sport and incorporate exercises to improve the identified energy system.
  3. The training program should always follow the principle of specificity when it comes to improving sports performance.
  4. Utilizing the planes of motion, muscle groups, and energy systems can save PT a lot of time when attempting to identify which exercises are best for the athlete. However, some sports may be more challenging for a PT to identify which exercise is best for a particular muscle group.
  5. It might seem that the bench press is the best upper body exercise for football players since they are constantly pushing off one another with their arms. This is a common misconception, since the bulk of force required is generated by the leg and core musculature and transmitted to the upper body. Football players will benefit more from performing the push-press exercises that forces the athlete to generate force with the legs, stabilize with the core, and transmit the force to the arms and shoulders to press the weight overhead. This doesn’t necessarily mean the athlete should not perform the bench press but simply that the bench press should not be utilized as a measure of the athletes fitness for the sport.
  6. One major benefit that aerobic and anaerobic endurance athletes achieve through resistance training programs is improved biomechanical efficiency. As fatigue sets in, the body tends to compensate during movement and lose efficiency, contributing to further fatigue. Anaerobic athletes receive the added bonus of increasing their speed by developing muscular power.
• Exercise Order:
  1. The key concepts of exercise order are: always start with a dynamic warm-up prior to a workout, and try to perform exercises from highest intensity to lowest intensity. Following these concepts will help reduce the risk of injury and early fatigue.
  2. Exercises in the dynamic warm-up should follow movement patterns similar to those listed in the day’s workout. Performing similar, low-intensity versions of the same exercises helps prepare the muscles that will be involved, making them more elastic and initiating muscular activation. Also, the increased blood flow to the muscles supplies oxygen needed for increased activity levels.
  3. The warm-up itself should involve 10 mins of stretches and dynamic movement patterns that involve most major muscle groups, and 5 mins of light, progressive aerobic exercise to increase blood flow to the muscles. The warm-up may also include performing SMR techniques which focuses on compressing the connective tissue surrounding the muscles to release adhesions that may cause movement compensation or limit flexibility, without the deleterious effects associated with static stretching.
  4. Following the dynamic warm-up, the exercise should start with high-intensity, large-muscle-group exercises. Following the warm-up, the body has not depleted much of its energy sources, meaning fatigue has not yet set in and technique will not be compromised. When muscles become fatigued, they begin to recruit their synergists for repeated movements in compensation, causing technique to break down. Therefore, exercises that involve a lot of techniques, such as Olympic lifting/plyometrics/agility training, should be implemented early in the workout.
  5. Resistance training should follow high-intensity exercise. Resistance training is higher intensity than aerobic activity but lower intensity than power- and agility-based movements. Therefore, the resistance-training phase of the program should be completed between the highest- and lowest-intensity exercises.
  6. Cardio training can be saved for the end of the workout just prior to flexibility training as it’s typically less technique oriented and form will not suffer as much from the fatigue of the resistance training. Also, the energy system being utilized by the body differs once the client has reached the 3-min mark. Unlike the phosphagen system used in the first 6 secs of high-intensity exercises or anaerobic glycolysis used in the first 3 mins, aerobic exercise is based around the body’s ability to convert oxygen to ATP using the body’s adipose stores.
  7. Flexibility training should be completed at the end of the workout. Goniometry (測腳法) may be performed to assess various areas of tightness among the muscles. Flexibility training can involve a number of methods (e.g. static stretching, assisted stretching, PNF stretching) to improve the range of motion in the client. PNF should be performed only by trainers who are well trained in the methods, because knowledge of biomechanics is necessary for proper form.
• Flexibility and stretching should be performed at the end of the program because the muscles become more elastic once they are warmed up through exercise, and the client can achieve greater ranges of motion. The elasticity also makes it safer for the client and prevents overstretching, which can lead to prolonged weakness and sometimes injury.
• The exercise order will occasionally vary based on the client. For example, clients with health concerns that cause rapid fatigue may benefit more from performing cardio exercise first, allowing for a longer warm-up period prior to resistance training. Some individuals may not be healthy enough for certain dynamic stretching movements and just pedaling on the recumbent bike will elicit a stretch for their legs.
• In general, the warm-up should include movements similar to the exercises panned in the workout, and the workout should start with higher intensity, larger muscle groups. The circuit program can often keep the client interested and more compliant. In this case, the workout should still start with dynamic warm-up, followed by higher-intensity exercises at the start of the circuit and lower-intensity exercises toward the end of the circuit, followed by cardio exercise and static stretching for the end of each workout.
• The exercise order for those with specific training goals will follow a similar pattern:
  1. dynamic and specific warm-up
  2. high-intensity resistance training using large muscle groups
  3. lower-intensity resistance training using smaller muscle groups
  4. cardiovascular training (following the specificity of the client’s goal)
  5. flexibility training
• Training Frequency and Rest Periods:
  1. Exercise frequency and rest periods will depend on a number of factors: the client’s availability, training goals, and fitness level.
  2. Work-to-rest ratio: how long the client is exercising compared to how long they are waiting in recovery. When a client is starting an exercise program, a work-to-rest ratio of 1:1 should allow adequate recovery for most healthy individuals.
  3. Resistance training rest periods will depend primarily on the load and volume being utilized in the workout (e.g. muscular endurance: 30 secs, muscular hypertrophy: 30-90 secs, muscular strength and power: around 3 mins). The rest periods will depend on the load the client lifted and should generally lengthen with increasing loads.
  4. Certain training methods can change the rest period. For example, using circuit training, supersets, or pyramid sets can decrease rest periods. Rest periods in circuit training should be brief (10-15 secs) between exercises and longer (90 secs) at the end of the circuit. For supersets, the rest period between exercises will depend on the load and volume.
  5. For cardio exercise, rest periods will be determined by the client’s goals and type of cardio training method being used. Starting with a duration that the client is able to complete will also provide encouragement and keep the client more compliant.
• Assigning Training Frequency Based on Training Goals:
  1. Training frequency will depend on the client’s current fitness level and goals set with the PT prior to starting a fitness program.
  2. Goals can help determine how to progress frequency in a client’s training program. For improvements to fitness gains (e.g. an increase in weight lifted), the trainer may consider implementing a 4-day split lifting routine for intermediate and advanced clients. This allows clients to focus on specific muscle groups on separate days and promote muscular hypertrophy and strength.
  3. For clients seeking improvements on long-distance running/biking/swimming, the trainer should consider utilizing a 2- or 3-day, full body resistance training program in addition to cardio training 5 days a week. The addition of the resistance training will help increase maximum oxygen uptake (VO2 max) and lactate threshold, and improve body mechanics and movement efficiency, improving the client’s cardio performance.
  4. Frequency can play a major role in overtraining and overuse injuries. It’s important for the trainer to inform clients of the risks of overuse associated with resistance and cardio training. Clients who consistently perform resistance training on the same muscle groups on consecutive days are at higher risk of developing overuse injuries (e.g. constantly loading the chest and shoulders can cause inflammation of the bursae (滑囊) and tendons and wear down the cartilage).
  5. Cardio overtraining is caused by a combination of duration, distance, and frequency. It’s a common issue with those training for long-distance running events to try and progress too rapidly.
• Monitoring Exercise Intensity:
  1. There are a number of ways to monitor exercise intensity: heart rate, perceived exertion, VO2 max, and METs (metabolic equivelents).
  2. Exercise intensity helps the trainer determine if the client is achieving the workout goal for the day. Using the simpler methods, such as determining a target heart rate zone or rate of perceived exertion, can help the trainer save time and maximize the efficiency of the workout.
  3. Target heart rate zone can be determined by calculating the client’s estimated maximum heart rate using the Karvonen formula, whereas the rate of perceived exertion (RPE) is simply described on a scale of how hard the client feels they are working. Though RPE is not quite as accurate, it saves the time of stopping the client to check his pulse and determine if he is at 65% of his maximum heart rate.
  4. VO2 max is more complicated to determine and accuracy requires expensive lab equipment. There are formulas to calculate maximal oxygen uptake, but the still require more time than utilizing target heart rate zone or RPE scales.
  5. METs (metabolic equivalents) are a measurement of the body’s caloric energy consumption during exercise compared to it’s consumption at rest. Resting in a seated position, the body has a MET level of 1 kilocalorie per kilo of body weight per hour. While exercising, an individual’s MET level is a multiple of this number depending on the exercise intensity. For the client’s sake, it’s simpler to ask the client to utilize either RPE or the talk test to determine intensity.
• Training Load and Repetition:
  1. Assigning a training load can be achieved through repetition maximum testing. The 1RM test is an accurate tool for developing training loads with athletic clients or clients who are currently participating in a training program.
  2. Since 1RM test relies heavily on technique and full range of motion, it’s not necessarily the best method for clients who are new to exercise. With beginner clients, it’s more beneficial to have them perform a multiple repetition maximum test and then estimate a 1RM.
  3. Assigning a target heart rate for new clients requires the trainer to first determine the client’s maximal heart rate in beats per minute (bpm). There are several methods to determine a client’s maximal heart rate: estimation based on age, the Karvonen formula, and exercising stress test protocols.
  3.1. Stress testing protocols typically involve complicated and expensive equipment not found in fitness centers and therefore is less practical.
  3.2. Estimating maximal heart rate based on age can help the trainer to quickly determine exercise target heart rate zones (Estimated Maximal Heart Rate = 220 - age).
  3.3. A more accurate measure of target heart rate zone can be determined using the Karvonen formula, a more complicated formula that utilizes the client’s estimated maximal heart rate described above, his target heart rate training zone, and his resting heart rate (Target Heart Rate = Resting Heart Rate + target % * [Estimated Maximal Heart Rate - Resting Heart Rate]). For example, target % = 65% for aerobic endurance training and 90% for anaerobic endurance training.
  4. The fitness level of the client should be considered prior to assigning the training heart rate zone. Also, the trainer should gradually progress the training program toward the client’s goal. If the goal is to complete a marathon/long-distance cycling challenge, the program may not necessitate performing above certain percentage of the client’s maximal heart rate.
• Volume — a function of the number of sets, reps, and exercises in a workout.
  1. Muscular Endurance — 15+ reps, 1-3 sets per exercise for beginners and 3+ sets for advanced clients, rest periods: 30 secs.
  2. Muscular Hypertrophy: 8-12 reps, 3 sets per exercise, rest periods: 60-90 secs.
  3. Muscular Strength: 1-8 reps, 1-3 sets per exercise for beginners and 3+ sets for advanced clients, rest periods: 3-5 mins.
  4. Muscular Power (the exercise should be performed at a faster rate, lighter loads than with muscular strength training): up to 6 reps, 3+ sets per exercise, rest periods: 3 mins.
  5. The closer the repetition range and load come to 1RM, the more emphasis is placed on building muscular strength. Power exercises are typically the highest intensity and should be implemented in a progressive manner as well. e.g. the client’s back squat 1RM weight may be 200lbs but the jump squat weight will top out at 60lbs and 6 reps.
• Progression — a gradual increase in the intensity of a training program by manipulating training variables incrementally.
  1. The goal of exercise progression is to accomplish the principles of training overload and specificity by manipulating the training variables in a program.
  2. Progression can be applied to the principles of overload and specificity to make sure the training stimulus is challenging enough to elicit the body’s natural adaptation to the stress.
  3. Overload requires the trainer to adjust one variable of the program (e.g. frequency, intensity, time, mode) in order to make consecutive workouts more difficult. Consistent overloading during consecutive workouts will ensure the client is adequately stressed with each workout and will avoid the risk of reaching a training plateau (a point in the client’s training program where no further progress is being achieved due to lack of overload).
  4. The trainer should know when and how to adjust training variables in a program in order to ensure progressive overload is being achieved. Adjusting a client’s training variables will depend mostly on how the client adapts to the exercises. Increases to the training load should not exceed 10% and should be applied when the client has been able to complete the current workout without compensation more than once.
  5. Once a client has mastered an exercise technique, the trainer can increase the intensity of the exercise. When adjusting the difficulty of resistance training programs, it’s safest to modify only one variable from workout to workout.
  6. Cardio program design should also follow a steady progression. Adjustments to cardio mode, intensity, duration, and frequency should not exceed 10% per workout because there’s a higher risk of overtraining beyond that point. The trainer should ask the client to be aware of how his body responds to the adjustment and avoid increasing the distance, duration, or frequency if he is still experiencing significant muscular soreness following a workout. The delayed onset muscle soreness (DOMS) is a sign that the overload principle was accomplished and no further increase is required until the body has adapted.
• Assigning Progression Based on Training Goal: The goal of the fitness program helps determine how to progress the exercise mode, intensity, time, and frequency.

Question 3

Aerobic Endurance Training

Answer 3

• Steady-state heart rate training is generally what people think about when trainers refer to cardio. However, there are other methods of cardio training, such as interval and zone training, that can be incorporated into a client’s program for exercise variety. The client’s goal will help determine which type of aerobic endurance training is best for the client’s progress.
• Steady State Aerobic Training — running at the same pace or maintaining the same heart rate throughout the duration of the cardio workout.
  1. Helps develop the capacity of the cardiovascular system to sustain long durations of aerobic exercise through increased cardiac output and mitochondrial function at the muscles.
  2. Utilizes the body’s excess adipose tissue as a fuel source rather than depleting the muscles’ glycogen stores that are utilized during resistance training and interval training.
  3. Develops the slow-twitch, type I muscle fibers that are the key to improving aerobic metabolism for sustained activities which benefits long-distance competitors.
  4. Since steady-state aerobic training is at a lower intensity over a longer duration than interval training, the stress on the client is lower.
  5. The downside is that it can negatively affect the performance of strength and power athletes (e.g. those in football/baseball/lacrosse/ice hockey/tennis, etc.). Therefore, the trainer should implement steady-state aerobic endurance training in programs for long-distance athletes and clients exercising for general health benefits.
• Interval Training — use a different energy system from steady-state training and tends to be performed at >90% of the client’s maximum heart rate.
  1. The work-to-rest ratio associated with interval training is best determined by the client’s physical condition or goals. Programs for athletes should utilize the duration of the work-to-rest ratio associated with their sport.
  2. Develops the fast-twitch, type II muscle fibers of the body that are associated with high-intensity sports performance and the anaerobic glycolytic energy system.
  3. Has several advantages over steady state: it takes much less time to complete a workout, burns more calories in a shorter period of time, and keeps the workout interesting. The high-intensity workout stimulates the body to produce hormones associated with weight loss and muscular hypertrophy and promotes caloric expenditure through excess post-exercise oxygen consumption for hours following the workout.
  4. The downside is that the higher intensity workout puts more stress on the joints and muscles. The clientele may have to progress to the level where their body can tolerate the training. Intervals do not necessarily need to be high intensity to be effective. Utilizing an interval style of training can also help prepare individuals seeking to improve in longer-distance running/swimming. For example, the client can take periodic breaks to recover the necessary energy to continue for a 30-min running session. Breaking long-distance events into manageable intervals can be beneficial for clients new to training.
• Zone Training — built around simple measurable intensities using the RPE or the client’s ability to hold a conservation while exercising.
  1. Typically broken down into several zones that use ventilatory threshold levels associated with increasing intensities of exercise. The progression of exercise still involves an increase of 10% or less to avoid overtraining.
  2. The 1st zone (RPE around 4 out of 10, should be able to hold a conversation while exercising): clients stay in the 1st zone until they are able to accumulate 30 mins of sustained cardio exercise.
  3. The 2nd zone (RPE around 5 or 6): marks the breach of the 1st ventilatory threshold that signifies an increase in respiration rate associated with higher-intensity exercise. The start of the phase may incorporate intervals to build up the client’s aerobic fitness levels. At this stage, the client will have difficulty holding a conversation as the respiration rate increases and intensity climbs. Also, lactic acid levels will begin to increase, but the increased breathing will help buffer the blood, allowing the person to continue exercising.
  4. The 3rd zone: marks the breach of the 2nd ventilatory threshold and an additional increase in the respiration rate. This zone is characterized by high-intensity anaerobic activity, the inability to hold a conversation, and reaching lactate threshold. At this stage, the interval lengths will drop significantly as lactic acid levels in the blood continue to rise at a rate the body cannot bugger. Rest periods are required for the body to be able to continue at the same pace.
  5. Zone training advantages — gradual progression toward higher intensities will increase fitness level, burn calories more efficiently, promote compliance through exercise varieties, and improve lactate thresholds.
  6. Zone training disadvantages: different clients will respond to increases in exercise intensities differently (as their ratings of RPE is subjective). Higher intensity zones are more stressful on the body mechanically, and the uncomfortable feeling of breaching the lactate threshold may turn some clients off to this type of training.
• Both aerobic and anaerobic cardio training produce short- and long-term effects in an exercise program.
  1. Acute effects associated with aerobic endurance training: increased cardiac output, increased blood flow to the musculoskeletal system, blood pressure regulation (including a post-exercise decrease in bp for up to 15 hrs), increased respiration, decreased stress, and increased myocardial blood flow.
  2. Chronic effects of aerobic endurance training: improved stroke (脈搏) volume, improved oxygen uptake or VO2 max, decreased resting heart rate, decreased blood pressure, reduced body fat, improved capillary density, and the development of slow-twitch muscle fibers.
  3. Acute effects of anaerobic cardio training: similar to aerobic cardio training, such as an increase in heart rate, respiration, blood flow, cardiac output, and oxygen uptake. Another response is the acute systolic increase in bp specific to physical activity.
  4. Chronic adaptation to anaerobic cardio training: improvements to lactate threshold, fast-twitch muscle fiber development, reduced body fat percentage, muscular strength and power development, and sprint performance.

Question 4

Special Populations
Exercise for Seniors, Children and Adolescents, and Pregnant Women
Training Individuals with Stable Chronic Conditions

Answer 4

• Special populations refer to senior adults, children and adolescents, pregnant women, and clientele who have limitations due to health concerns.
• Seniors who perform resistance training regularly can help maintain bone mineral density, improve their balance, and maintain a healthy posture. Additionally, seniors who perform cardio exercise regularly keep their respiratory and circulatory systems healthy, preventing numerous health-related risks associated with sedentary lifestyles.
• Resistance training in children and adolescents can help develop healthy bones and has no effect on their overall growth (a common myth associated with resistance training for children is that it may stunt their growth or damage the growth plates in the bones).
• Continuing training during pregnancy helps reduce the risk of many potentially harmful conditions associated with pregnancy, such as gestational diabetes (任陳糖尿命) and hypertension.
• Seniors
  1. Resistance training for seniors should emphasize working the major muscle groups associated with activities of daily living. For example, the step-up exercise is helpful in improving balance when climbing stairs.
  2. Strength training 2 times a week at lower to moderate intensities, ranging from 40 to 70% of 1RM, is ideal. The exercises should include working the larger muscle groups of the body for 1 to 2 sets of 10 or fewer exercises per session, at low load and higher volumes (approximately 15 reps).
  3. Cardio training for seniors should include up to 5 sessions per week at 30 - 60 mins of low- to moderate-intensity aerobic exercise. The trainer should recommend using heart rate monitoring or perceived exertion to track the intensity of the client’s cardio activity.
  4. The trainer should consider the possibility of arthritic joint among seniors and try to avoid exercise methods that cause excessive stress, such as plyometrics, running, and many types of calisthenics (健身操).
• Youth population (children and adolescents)
  1. Human bones develop quickly at a young age and eventually stop producing more bone tissue as a person ages. That’s why it’s important to start weight-bearing exercise at a young age.
  2. For youth populations, the key concepts a trainer must consider are proper supervision, load, and safe progression.
  3. Children and adolescents should always have adult/professional supervision while performing new exercise programs. The fine motor skills that develop with age are not always present in youths, which can cause improper technique during resistance training exercises. Also, they should not be progressed too quickly or given inappropriately heavy weights.
  4. Exercise should equate to 60 mins per day throughout the week and can be a combination of resistance training, sports, and aerobic training.
  5. Resistance training 2 to 3 days a week is beneficial to children as long as the trainer is focusing more on developing form and technique and less on increasing the weight lifted.
  6. Resistance training protocols should focus on lighter loads and higher volumes, emphasizing form over everything else.
  7. Trainers should make sure that children and adolescents make frequent water breaks to ensure proper hydration, since it promotes thermoregulation and prevents potential overheating.
  8. Children and adolescents benefit most from participating in a wide variety of physical activities in order to prevent potential overuse injuries from repeated sessions of the same movements (e.g. youthful baseball pitchers).
• Pregnant Women
  1. Pregnant women who are cleared for exercise benefit significantly from continuing their resistance and cardio training programs.
  2. The trainer and client will need to monitor the intensity of the activity throughout training sessions.
  3. Resistance training is recommended 2 to 3 times per week. Proper breathing technique should be emphasized, longer rest periods are advisable, and intensity should be kept moderate.
  4. The trainer should incorporate large muscle group exercises at repetition ranges of 10-15 and in 1-3 sets. Time between sets can be increased to ensure resistance training intensity is kept at a safe level.
  5. Cardio recommendations should include at least 30 mins per session on most days of the week. Aerobic activity modes should be low risk, non-contact, and moderate intensity (should be able to hold a converasation through their cardio exercise) to avoid risk of fetal injury.
  6. Should perform abdominal exercises while seated slightly upright rather than flat on their backs.
• Training Individuals with Stable Chronic Conditions:
  1. Conditions that can have potentially dangerous outcomes include stable coronary artery disease and other cardiovascular diseases, diabetes mellitus, obesity, metabolic syndrome, hypertension, arthritis, chronic back pain, osteoporosis, COPD (chronic obstructive pulmonary disease), and chronic pain.
  2. Prior to the start of any fitness program for clients with these diseases, the trainer must require that these individuals seek medical attention and exercise clearance before continuing. Also the trainer may require the clients to ask their physicians about any other limitations that should be implemented in the exercise program. In particular, cardiovascular diseases may require the trainer to start exercise far below standard recommendations.
  3. For clients with diabetes, monitoring blood sugar levels before and after exercise may be indicated, and the trainer should make sure to monitor the patient for signs and symptoms of rapid changes in blood sugar. If there are signs/symptoms, the trainer should discontinue exercise and keep juice on hand to counteract the effects.
  4. Obese clients may require exercise modification to minimize joint stress or difficulty performing certain exercises. The trainer should avoid high-contact exercises that involves jumping. Obesity can also increase the client’s risk of overheating and may trigger difficulty breathing.
  5. The trainer should educate clients with hypertension on increasing their activity levels through simple methods. Hypertension can increase the client’s risk for heart attacks or stroke, and should be monitored by the trainer in a new training program.
  6. Arthritis can cause a decrease in range of motion, joint pain, instability, and muscular atrophy at the joints in affects.
  The goal of resistance training for clients with arthritis should be to develop stability through strengthening the muscles that support the joint. Resistance training at moderate loads with high volume can help improve muscular strength and tone and provide joint stability. The trainer should implement cardo training the minimizes joint impact to reduce further degradation of the joints, and instruct the client to static stretch post-exercise to maintain joint flexibility of the arthritic joints.
  7. Clients with chronic back pain will benefit most from improved flexibility and core strength through isometric exercise (e.g. planks). Often low back pain is influenced by muscular imbalances of the lower body due to sedentary lifestyle or careers. The trainer should emphasize performing abdominal bracing (腹部支撐) exercises and the plank regularly and should implement flexibility training for the hamstrings and hip flexor muscles. Exercises involving excessive flexion and extension of the spine should be limited or avoided completely unless instructed by a physician as part of a rehabilitation program.
  8. Osteoporosis often affects seniors, especially women, and causes a deficit in bone mineral density. Clients with osteoporosis benefit most from load-bearing activities (e.g. resistance training). Exercise recommendations should include 2-3 days of 8-10 exercises that work the major muscle groups of the body. The earlier the client begins load-bearing exercises, the better the chances of preventing osteoporosis.
  9. COPD makes cardio exercise and breathing very challenging. Frequency should still start around 3 days a week; however, cardio sessions may last for only 15 mins or less, depending on how serious the client’s condition is.
  10. Clients with chronic pain may require the trainer to adapt the program on a day-to-day basis, making changes to the program during the session. The trainer should start the session by asking how the client is feeling and try to assess which exercises may not be indicated for the day. Frequent implementation of flexibility training may benefit these individuals and they will often feel better after the workout regardless of how much pain they had before.
• Figure out what kind of learner you are: visual, auditory, kinesthetic, or a combination, and make that your primary learning tool. Visual learners tend to excel through reading info thoroughly, auditory learners through hearing the info, and kinesthetic learners through performing actions associated with the info.