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Exercise Programming:
From Initial Screening(s) and
Baseline Assessments to the
Exercise Prescription
Fitness/Wellness Specialist Responsibilities
• Educate clients
• Conduct pretest health evaluationsConduct pretest health ...
The Exercise “Science Artist”
“….exercise prescription is the
successful integration of exercise
science with behavioral t...
Exercise Programming and
Prescription
Definition:
Elements of Exercise Prescription
FITT-P
Exercise Prescription vs.
Health Related Fitness
Factors To Consider When Designing
An Exercise Prescription
• Health status
• Risk factor profile
• Medical evaluation
• I...
Why do we care about health
screening and risk stratification?
Health Screenings
• Par – Q
• Medical History
Questionnaire
• Coronary Risk factor
analysis
• Disease Risk Classification
...
Self-Guided Screening
• PAR-Q and You
▫ Physical Activity Readiness Form
 Figure 2.1, p. 24 (ACSM)
 For pregnancy, p. 19...
Professionally Guided Screening
• Health fitness/clinical assessment and activity
programming conducted and supervised by
...
CVD Risk Factor Thresholds for
Use with ACSM Risk Stratification
•Positive and Negative Risk
Factors
(Table 2.2, p. 27, AC...
CVD Risk Factor Thresholds for Use with ACSM Risk
Stratification
Positive Risk Factors (Table 2.2, p. 27, ACSM)
CVD Risk Factor Thresholds for Use with ACSM Risk
Stratification
Positive Risk Factors (Table 2.2, p. 27, ACSM)
Calculating BMI
• BMI = weight in kg. / height in meters2
Weight: 180 lbs
Height 5 ft. 8 in.
What is the client’s BMI clas...
BMI Classification
Hypertension
Cholesterol Classifications
ClassificationClassification TCTC LDL-CLDL-C TGTG
Optimal
Near/above
optimal
100-129
Borderlin...
HDL–C Classification
Classification HDL-C
Low
Normal
High (this is good!)
Fasting Blood Glucose
From 70 to 99 mg/dL
From 100 to 125 mg/dL
>126 mg/dL on more than one test
CVD Risk Factor Thresholds for Use with ACSM Risk
Stratification
Negative Risk Factors (Table 2.2, p. 27, ACSM)
How do I remember all of those risk
factors?
Case Study #1
• Bob Marley
▫ 54 year old male
▫ Cigarette smoker
▫ Brother died of MI age 55
▫ BP: 130/82
▫ HDL-C: 44 mg/d...
• Jane is a 46 year old female. She has a family
history of breast cancer (mom was diagnosed at 47
and sister at 36). She ...
Medications
• Blood pressure control **
▫ Diuretics
▫ Beta-blockers
▫ ACE Inhibitors
▫ Angiotensin II receptor
blockers
▫ ...
Medications
• Beta blocker (BP)
▫ Decrease force of
contraction
▫ Decrease cardiac workload
▫ Decrease demand for O2 in
my...
Medications
Meds HR BP
Beta Blocker
Nitrate
Calcium Channel Blocker
Diuretics
Ace Inhibitors
Bronchodilators
Thyroid meds
...
Table 2.1 ACSM Risk Stratification Categories for
Atherosclerotic CVD (Figure 2.4 ACSM p. 28)
• CVD, pulmonary, or metabolic disease
▫ CVD: Coronary, peripheral vascular, or
cerebrovascular disease
▫ Pulmonary: COPD,...
Major symptoms or signs suggestive of cardiopulmonary or metabolic
disease.*
_____________________________________________...
ACSM Figure 2.3
Case Study
• Lolo Jones
▫ 26 years old, non-smoker
▫ BMI: 24.6 kg/m2
▫ Asthmatic, normal cholesterol and BP
▫ Fasting gluc...
Exercise Testing and Participation
Recommendation Based on Risk
• Once risk classification established,
appropriate recomm...
Maximal Graded Exercise Test (GXT),
Reasons for Max. Testing in the Clinical Setting:
 To find the true max. HR for exerc...
Submaximal Exercise Tests
• Sheri is a low risk client. She was told by her
previous trainer that she should not have a GXT
done because according t...
Metabolic Syndrome
>100
Factors To Consider When Designing
An Exercise Prescription
• Health status
• Risk factor profile
• Medical Evaluation
• I...
Purpose of Health Related Fitness
Testing
• Educate participants about present health-
related fitness status relative to ...
Components of Health Related Fitness
1. Body weight and body composition
2. Cardiorespiratory Endurance (Fitness)
3. Muscu...
Measures of Weight or Body Comp.
Anthropometric measures:
Cardiorespiratory Endurance (CRE) /
Cardiorespiratory Fitness (CRF)
• Ability of heart, lungs, and circulatory system to
s...
Musculoskeletal Fitness
• Ability of skeletal muscle systems to perform work
• Muscle strength
• Muscle endurance
Muscular Strength Testing
 Grip Strength
 One Repetition Max.
 4, 5, or 6 Rep Max
•
Muscular Endurance Testing
 Curl U...
Flexibility
• “Sit and Reach” test
Components of Health Related Fitness
1. Body weight and body composition
2. Cardiorespiratory Endurance (Fitness)
3. Muscu...
Test Validity, Reliability, and Objectivity
• Validity
• Reliability
• Objectivity
Prediction equations
• To whom is equation applicable?
▫ Population specific vs. general
• How were variables measured by ...
Feasibility
Efficacy
Health history
Goals
Things to keep inThings to keep in
mind:mind:
Preparing to Test Your
Client/Athlete
What should be the
proper order of testing?
• Flexibility
• Body composition
• Muscular fitness
• HHQ/Risk stratification
...
Give client specific instructions as
to what to wear, what to bring, and
what to expect on testing day!
Always have your supplies
and equipment ready
before the client arrives!
Make the client as
comfortable as possible!
Be professional, be confident,
be yourself!
Test Interpretation
• Calculate necessary values
• Classify client results by comparing to
established norms or percentile...
Factors To Consider When Designing
An Exercise Prescription
• Health status
• Risk factor profile
• Medical Evaluation
• I...
Characteristics of Exercise Program Dropouts &
Factors Related to “Dropping Out”
Reinforcing Factors for Exercising
(Promoting Adherence)
Exercise Program Design
Principles
Exercise Program Design Principles
• Specificity of Training
• Overload training
• Progression
• Initial values
• Inter-in...
Principle of Specificity
The training effects from any exercise are specific
to the activity and the muscles involved.
Overload Training
Progression
Inter-individual variability
• Responses to a training stimulus vary amongst
individuals
• What are some factors that vary...
Initial Values
Diminishing Returns
Reversibility
Genetic
Ceiling
Clinical Tests
• Physical Exam
• Lipid Panel and Glucose Levels
• Blood Pressure
• 12-Lead ECG
• Graded Exercise Test
Case Study
• Height: 5’5”
• Weight: 138lbs
Case Study
• Sonia Sotomayor
▫ 44 year old female with BMI of 23 kg/m2;
▫ WC = 35inches
▫ BP: 134/82; does not smoke
▫ HDL...
Case Study
• Mike Magiske
▫ 62 year old, sedentary male
▫ Quit smoking 5 months ago
▫ Impaired fasting glucose (Pre-diabet...
• You have determined that Spencer is a high risk
client. Spencer wants to begin a moderate
walking program.
Principles of fitness assessment student
Principles of fitness assessment student
Principles of fitness assessment student
Principles of fitness assessment student
Principles of fitness assessment student
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  • If you come into my office, and I have never met or spoken with you, I have no idea what you need, want, in terms of activity, exercise or fitness. To do this I need to learn more about you, your health, goals,
  • Purpose of an exercise prescription
  • Intensity more problematic than liking exercise equipment/machine/mode
  • Pros cons
  • Age: Men > 45 y.o.; Female > 55 y.o. 2. Cigarette smoking: Current cigarette smoker, OR those who quit within the previous 6 months, OR exposure to environmental tobacco smoke 3. Obesity: BMI of > 30 kg/m 2 , OR Waist girth of: > 102 cm (40 in) for men & > 88 cm (35 in) for women 4. Dyslipidemia: LDL-C > 130 mg/dL OR HDL < 40 mg/dl OR on lipid lowering medications If TC only measure available: TC > 200 mg/dL Family History: MI, coronary revascularization, or sudden death < 55 years of age in father or other male first-degree relative (brother or son), OR < 65 years of age in mother or other female first-degree relative (sister or daughter) 6.Impaired glucose (pre-diabetes): Impaired fasting glucose: > 100mg/dL but < 126 mg/dL OR Impaired glucose tolerance: > 140 mg/dL but <200mg/dL *both confirmed by measurements on at least 2 separate occasions 7. Sedentary lifestyle: Not participating in at least 30 minutes of moderate intensity physical activity on at least 3 days/week for at least 3 months 8. Hypertension: Blood pressure ≥140/90 mmHg, confirmed by measurements on at least 2 separate occasions, OR on antihypertensive medication
  • A CODFISH
  • Low Risk: Asymptomatic men and women who have < 1 CVD risk factor from Table 2.3 Moderate Risk Asymptomatic men and women who have > 2 CVD risk factors from Table 2.3 High Risk Individuals who have know CVD, pulmonary, or metabolic disease OR 1 or more signs and symptoms listed in Table 2.2
  • Girth measurements : Useful for obese people who may be uncomfortable with skinfold measurements or underwater weighing. Pattern of BF distribution imp. predictor of health risks of obesity
  • Estimated vs. actual Submaximal and maximal Graded exercise tests (GXTs) Field tests Maximal testing in clinical setting To aid in the diagnosis of CVD in moderate risk individuals or in those who are symptomatic To determine the safety of an exercise program To follow the progress of known disease To find the true max. HR for exercise prescription To measure or estimate VO2 max. To help plan a safe and effective exercise program Submax Evaluate progress and provide feedback. Use as a basis for educating clients about concepts of fitness. MAY provide a basis for exercise prescription. Sub-max. cycle ergometer test (Astrand-Rhyming or YMCA Protocol): Used to estimate VO 2 max. from heart rate at a sub-max. workload. 2. Step test: Can estimate VO 2 max. from heart rate achieved after stepping for 3 minutes. 3. Cooper’s 1.5 mile or 12 minute run Can estimate VO 2 max. from time for 1.5 mile run or distance completed in 12 minutes. 4. Rockport 1 mile walk test: Can estimate VO 2 max. from heart rate after walking 1 mile.
  • Muscle strength Max force or tension Muscle endurance Maintain submax force over time
  • Test of trunk flexion, measures low back & hip flexibility, common measure of overall flexibility.
  • Test may have high reliability but not high validity – sit and reach test – poor validity as a measure of lower back flexibility
  • Not interested in activities Don’t understand prescription Changes in health status No time! Overweight Smoker Personality factors such as anxiety & low self efficacy No spousal support Inconvenient exercise facilities No social support Not seeing improvement
  • Support of family & friends Doctor’s recommendation Convenient facilities, parking Non-threatening environment (dress etc.) Individualized program Personal attention Positive feedback (BP, assessments) Presence of successful peer role models Incentives Enjoy activities Improvement in health statu
  • Work a lot harder for less change as you get closer to genetic ceiling
  • Sonia Sotomayor
  • Transcript of "Principles of fitness assessment student"

    1. 1. Exercise Programming: From Initial Screening(s) and Baseline Assessments to the Exercise Prescription
    2. 2. Fitness/Wellness Specialist Responsibilities • Educate clients • Conduct pretest health evaluationsConduct pretest health evaluations • Select, administer, interpret tests to assessSelect, administer, interpret tests to assess components of physical fitnesscomponents of physical fitness • Design exercise prescriptionsDesign exercise prescriptions • Lead classes/Give presentations • Analyze client exercise performance and correct errors • Motivate clients • Reassess clients/athletes – be dynamic!
    3. 3. The Exercise “Science Artist” “….exercise prescription is the successful integration of exercise science with behavioral techniques that result in long term program compliance and attainment of the individual’s goals.” ACSM Guidelines for Exercise Testing and Prescription, 2000, pg 140
    4. 4. Exercise Programming and Prescription Definition:
    5. 5. Elements of Exercise Prescription FITT-P
    6. 6. Exercise Prescription vs. Health Related Fitness
    7. 7. Factors To Consider When Designing An Exercise Prescription • Health status • Risk factor profile • Medical evaluation • Individual’s goals • Baseline values • Exercise preferences • Program design principles • Adherence factors
    8. 8. Why do we care about health screening and risk stratification?
    9. 9. Health Screenings • Par – Q • Medical History Questionnaire • Coronary Risk factor analysis • Disease Risk Classification • Informed Consent • Physical Exam • Lipid Panel and Glucose Levels • Blood Pressure • 12-Lead ECG • Graded Exercise Test Clinical Tests
    10. 10. Self-Guided Screening • PAR-Q and You ▫ Physical Activity Readiness Form  Figure 2.1, p. 24 (ACSM)  For pregnancy, p. 196 (ACSM) • AHA/ACSM Health/Fitness Facility Pre- participation Screening Questionnaire ▫ Figure 2.2, p. 25 (ACSM)
    11. 11. Professionally Guided Screening • Health fitness/clinical assessment and activity programming conducted and supervised by appropriately trained personnel • Professionally guided screening includes: ▫ Coronary Risk factor analysis ▫ Review more detailed health/medical hx info and risk stratification ▫ Detailed recommendations for PA/exercise, medical exam, exercise testing, physician supervision
    12. 12. CVD Risk Factor Thresholds for Use with ACSM Risk Stratification •Positive and Negative Risk Factors (Table 2.2, p. 27, ACSM)
    13. 13. CVD Risk Factor Thresholds for Use with ACSM Risk Stratification Positive Risk Factors (Table 2.2, p. 27, ACSM)
    14. 14. CVD Risk Factor Thresholds for Use with ACSM Risk Stratification Positive Risk Factors (Table 2.2, p. 27, ACSM)
    15. 15. Calculating BMI • BMI = weight in kg. / height in meters2 Weight: 180 lbs Height 5 ft. 8 in. What is the client’s BMI classification? Weight: 257 lb Height 5 ft. 9 in. What is the client’s BMI classification?
    16. 16. BMI Classification
    17. 17. Hypertension
    18. 18. Cholesterol Classifications ClassificationClassification TCTC LDL-CLDL-C TGTG Optimal Near/above optimal 100-129 Borderline High High >240 160-189 200-499 Very High >190 >500
    19. 19. HDL–C Classification Classification HDL-C Low Normal High (this is good!)
    20. 20. Fasting Blood Glucose From 70 to 99 mg/dL From 100 to 125 mg/dL >126 mg/dL on more than one test
    21. 21. CVD Risk Factor Thresholds for Use with ACSM Risk Stratification Negative Risk Factors (Table 2.2, p. 27, ACSM)
    22. 22. How do I remember all of those risk factors?
    23. 23. Case Study #1 • Bob Marley ▫ 54 year old male ▫ Cigarette smoker ▫ Brother died of MI age 55 ▫ BP: 130/82 ▫ HDL-C: 44 mg/dL ▫ TC: 188 mg/dl ▫ Fasting glucose: 112 mg/dl (verified 2x) ▫ Height: 5’7.5”; Weight: 160 lbs ▫ Light activity 3 days/week, 30 min (last 3 years) ▫ Medications: ACE-inhibitor, diuretic
    24. 24. • Jane is a 46 year old female. She has a family history of breast cancer (mom was diagnosed at 47 and sister at 36). She quit smoking when she was 21. She has been walking briskly (mod) for 45 minutes, 3 days per week, for the last 6 months. Her height is 5’2” and she is 130 lbs and her waist circumference is 33”. Her cholesterol and glucose levels are all within normal range, though her HDLs are 62mg/dl. Her blood pressure is 126/88.
    25. 25. Medications • Blood pressure control ** ▫ Diuretics ▫ Beta-blockers ▫ ACE Inhibitors ▫ Angiotensin II receptor blockers ▫ Calcium channel blockers ▫ Vasodilators ▫ Nitrates • Asthma ** ▫ Oral or inhaled bronchodilators • Glycemic control ▫ Biguanides (Metformin, Glucophage) ▫ Alpha-glucosidase inhibitors (Precose, Glyset) ▫ Sulfonylureas (Glucotrol, Amaryl) • Cholesterol lowering ▫ Statins (Lipitor, Zocor, Provachol) ▫ Nicotinic acid (Niacin) ▫ Fibrates • Thyroid ** ▫ Thyroid hormone medicine, levothyroxine sodium (Synthroid, Levoxyl, or Levothroid)
    26. 26. Medications • Beta blocker (BP) ▫ Decrease force of contraction ▫ Decrease cardiac workload ▫ Decrease demand for O2 in myocardium • Nitrates (BP) ▫ Vasodilator ▫ Decrease preload and cardiac workload • Ca2+ channel blockers (BP) ▫ Prevent vasoconstriction ▫ Prevent coronary artery spasm ▫ Increase O2 supply to myocardium • Diuretic (BP) ▫ Increase H2O excretion ▫ Decrease blood volume • Ace inhibitor (BP) ▫ Prevent vasoconstriction ▫ Prevent H20 retention ▫ Decrease blood volume
    27. 27. Medications Meds HR BP Beta Blocker Nitrate Calcium Channel Blocker Diuretics Ace Inhibitors Bronchodilators Thyroid meds Nicotine
    28. 28. Table 2.1 ACSM Risk Stratification Categories for Atherosclerotic CVD (Figure 2.4 ACSM p. 28)
    29. 29. • CVD, pulmonary, or metabolic disease ▫ CVD: Coronary, peripheral vascular, or cerebrovascular disease ▫ Pulmonary: COPD, asthma, interstitial lung disease, cystic fibrosis ▫ Metabolic: diabetes (I or II), thyroid disorders, renal, or liver disease Cardiovascular, Pulmonary, and Metabolic Disease - - HIGH RISK!
    30. 30. Major symptoms or signs suggestive of cardiopulmonary or metabolic disease.* ___________________________________________________ 1. Pain, discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may be ischemic in nature 2. Shortness of breath at rest or with mild exertion 3. Dizziness or syncope (fainting) 4. Orthopnea/paroxysmal nocturnal dyspnea (labored breathing; discomfort in breathing in any but erect position) 5. Ankle edema 6. Palpitations or tachycardia 7. Intermittent claudication 8. Known heart murmur 9. Unusual fatigue or shortness of breath with usual activities ___________________________________________________ *These symptoms must be interpreted in the clinical context in which they appear, since they are not all specific for cardiopulmonary or metabolic disease. See description of each in ACSM Guidelines. ___________________________________________________ Figure 2.3 ACSM p. 26
    31. 31. ACSM Figure 2.3
    32. 32. Case Study • Lolo Jones ▫ 26 years old, non-smoker ▫ BMI: 24.6 kg/m2 ▫ Asthmatic, normal cholesterol and BP ▫ Fasting glucose: 85 mg/dl ▫ Sprint athlete – works out 6 days/week 2+ hours per day (vigorous activity) for last 2 years ▫ No family history of heart disease ▫ Sister, 22, has Type 2 diabetes
    33. 33. Exercise Testing and Participation Recommendation Based on Risk • Once risk classification established, appropriate recommendations may be made regarding:
    34. 34. Maximal Graded Exercise Test (GXT), Reasons for Max. Testing in the Clinical Setting:  To find the true max. HR for exercise prescription  To measure or estimate VO2 max.  To determine baseline aerobic fitness level  To help plan a safe and effective exercise program  To aid in the diagnosis of CVD in the mod. risk or in those who are symptomatic (*with ECG*)  To follow the progress of known disease (*with ECG)
    35. 35. Submaximal Exercise Tests
    36. 36. • Sheri is a low risk client. She was told by her previous trainer that she should not have a GXT done because according to ACSM GXTs are only for moderate to high risk clients. • Do you agree or disagree with her previous trainer? Why?
    37. 37. Metabolic Syndrome
    38. 38. >100
    39. 39. Factors To Consider When Designing An Exercise Prescription • Health status • Risk factor profile • Medical Evaluation • Individual’s goals • Baseline Values • Exercise preferences • Program Design Principles • Adherence factors
    40. 40. Purpose of Health Related Fitness Testing • Educate participants about present health- related fitness status relative to standards and age and gender norms • Provide data helpful in development of exercise prescriptions ▫ Address all fitness components ▫ Baseline data and follow – up ▫ Motivate participants ▫ Stratify risk
    41. 41. Components of Health Related Fitness 1. Body weight and body composition 2. Cardiorespiratory Endurance (Fitness) 3. Muscular Endurance 4. Muscular Strength 5. Flexibility
    42. 42. Measures of Weight or Body Comp. Anthropometric measures:
    43. 43. Cardiorespiratory Endurance (CRE) / Cardiorespiratory Fitness (CRF) • Ability of heart, lungs, and circulatory system to supply O2 and nutrients effectively to working muscles • Typically expressed as VO2max • Clinical submaximal and maximal tests ▫ Field tests
    44. 44. Musculoskeletal Fitness • Ability of skeletal muscle systems to perform work • Muscle strength • Muscle endurance
    45. 45. Muscular Strength Testing  Grip Strength  One Repetition Max.  4, 5, or 6 Rep Max • Muscular Endurance Testing  Curl Up  Push Up
    46. 46. Flexibility • “Sit and Reach” test
    47. 47. Components of Health Related Fitness 1. Body weight and body composition 2. Cardiorespiratory Endurance (Fitness) 3. Muscular Endurance 4. Muscular Strength 5. Flexibility
    48. 48. Test Validity, Reliability, and Objectivity • Validity • Reliability • Objectivity
    49. 49. Prediction equations • To whom is equation applicable? ▫ Population specific vs. general • How were variables measured by the researchers who developed equation?
    50. 50. Feasibility Efficacy Health history Goals Things to keep inThings to keep in mind:mind:
    51. 51. Preparing to Test Your Client/Athlete
    52. 52. What should be the proper order of testing? • Flexibility • Body composition • Muscular fitness • HHQ/Risk stratification • CRE / CRF • Resting BP and HR
    53. 53. Give client specific instructions as to what to wear, what to bring, and what to expect on testing day!
    54. 54. Always have your supplies and equipment ready before the client arrives!
    55. 55. Make the client as comfortable as possible!
    56. 56. Be professional, be confident, be yourself!
    57. 57. Test Interpretation • Calculate necessary values • Classify client results by comparing to established norms or percentile rank • Discuss results with clients ▫ Provide hard copy of results to client ▫ Keep a copy for your records!
    58. 58. Factors To Consider When Designing An Exercise Prescription • Health status • Risk factor profile • Medical Evaluation • Individual’s goals • Baseline Values • Program Design Principles • Exercise preferences • Adherence factors
    59. 59. Characteristics of Exercise Program Dropouts & Factors Related to “Dropping Out”
    60. 60. Reinforcing Factors for Exercising (Promoting Adherence)
    61. 61. Exercise Program Design Principles
    62. 62. Exercise Program Design Principles • Specificity of Training • Overload training • Progression • Initial values • Inter-individual variability • Diminishing returns • Reversibility
    63. 63. Principle of Specificity The training effects from any exercise are specific to the activity and the muscles involved.
    64. 64. Overload Training Progression
    65. 65. Inter-individual variability • Responses to a training stimulus vary amongst individuals • What are some factors that vary amongst individuals?
    66. 66. Initial Values Diminishing Returns Reversibility
    67. 67. Genetic Ceiling
    68. 68. Clinical Tests • Physical Exam • Lipid Panel and Glucose Levels • Blood Pressure • 12-Lead ECG • Graded Exercise Test
    69. 69. Case Study • Height: 5’5” • Weight: 138lbs
    70. 70. Case Study • Sonia Sotomayor ▫ 44 year old female with BMI of 23 kg/m2; ▫ WC = 35inches ▫ BP: 134/82; does not smoke ▫ HDL-C: 42 mg/dl ▫ Father had MI age 42, Sister MI age 50 ▫ Brother has T2DM, diagnosed age 35 ▫ Fasting glucose: 95 mg/dl ▫ Mod exercises 5 days per week, 30 min (last 2 months) ▫ Meds: aspirin for knee pain from a sporting injury
    71. 71. Case Study • Mike Magiske ▫ 62 year old, sedentary male ▫ Quit smoking 5 months ago ▫ Impaired fasting glucose (Pre-diabetes/insulin resistance) ▫ Obese --Low HDLs ▫ Normal Triglycerides ▫ Mother died of CVD age 57
    72. 72. • You have determined that Spencer is a high risk client. Spencer wants to begin a moderate walking program.
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