Email:

Name:
Phone:

Date:
Exercise contradictions:

1.

List the medications you take on a regular basis.

2.

3.

Do you have diabetes? High Cholesterol? Metabolic Syndrome

No Yes

Have you had a stroke?

No Yes

4.

Has your doctor ever said you have heart trouble?

No Yes

5.

Do you take asthma medication?

No Yes

6.

Are you, or do you have reason to believe, you may be pregnant?

No Yes

8.

Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in
physical activity/exercise?

7.

Do you have any other medical condition(s) that may make it dangerous for you to participate in physical
activity/exercise?

No Yes

Cardiac Risk Factors

17. Do you smoke cigarettes on a daily basis?

If yes, how many cigarettes per day do you smoke (or did you smoke in the past two years)? per day

No Yes

18.

No Yes

Has your doctor ever told you that you have high blood pressure?

19. Has your father, mother, brother, or sister had a heart attack or suffered from a stroke before the age of 65?

If yes:

a) Was the relative male or female?

b) At what age did he or she suffer the stroke or heart attack?

c) Did this person die suddenly as a result of the stroke or heart attack?

No Yes

Main Goals
Exercise History
Commitment
Motivation
Expectations from trainer
$

I _____________ recognise that the instructor is not able to provide me with medical advise with regard to my medical fitness and that
this information is used as a guideline to the limitations of my ability to exercise and acknowledge that, by signing this document, I have been
informed of the need to obtain a physicians examination and approval prior to beginning this exercise program. I fully understand that the
program may be strenuous and choose to participate completely voluntarily. I accept all responsibility for my health and any resultant injury or
mishap that may affect my well being or health in any way. I hold harmless of any responsibility, the instructor, facility or any persons involved
with this program or testing procedure.
_____________________________ Signature _____________________________Date

Name:
Phone:
Injury or pain

Notes

Email:

Date:

Warm up sets 60 seconds rest between all sets on a 4010 tempo

Sets

Reps

4 (40%)

(40%)

(60%)

(70%)

(80%)

DB press %100

SA DB row %100

120 seconds rest between all sets on a 4010 tempo

85% Close grip bench press

Reps

Reps

120 seconds rest between all sets on a 4010 tempo

17.5% External rotation from knee
Left

Right

18.5% Bent over trap 3 lift

Left

Right

120 seconds rest between all sets on a 4010 tempo

37.5% Seated DB shoulder press
Left

Right

17.5% Incline Powell raise

Left

Right

120 seconds rest between all sets on a 4010 tempo

Pull up
Left

Right

Left

Right

Name:
Phone:

Email:

Date:
Exercise contradictions:

THE KLATT TEST

Left leg

Right leg

Height 1
Height 2
Height 3

Jump to lateral side - weak hip abductors

Jump tp medial side - weak hip adductors
Jump forward
- weak hamstrings
forward head lean - weak posterior chain
Forward torso lean - weak glute max
Lateral torso lean - weak QL
knee tracking inwards - weak VMO
Foot jumps in place but
externally rotates - weak hip rotators

BIERING SORENSEN TEST

Back ex
100%
Sit up
65%
Side plank
55%
Side plank
55%

SQUAT

Right
Left

Squat: knee

ankle

hip
Lunge: knee

ankle

hip
Heel knee stops - calves
Trunk forward - Hip flexors
Knee inwards - weak VMO
Torso Lean - QL
Foot spins - external rotators

STATIC TENSION

Name:
Phone:

Email:

Date:
Exercise contradictions:

OBSERVATION

SQUAT TEST

MUSCLES

Hips push back / forward torso lean

Short hip flexors

Knee buckle in & out for split second

Short ITB

Knees collapse in

Weak hamstrings glute VMO and hip rotators

Knees buckle in on acent

Weak hamstring & glute

Knees widen

Short adductors

Shift in hip height torso lean

Short Ql to side of shift

Back rounding

Short erector spine

Feet spin out

Short piriformis

Heels lift

Short gastroc & soleus

Weight shifts to one side

Short piriformis to side of shift

Hamstring

LENGTH TENSION TESTS

UPPER BODY
LOWER BODY
External rotation

Hamstring lateral head

Internal rotation

Hamstring medial head

Lats

Adductors long

Tricep

Adductors short
Hip Flexors
Quad
ITB
Piriformis
Glute
External rotation
Internal rotation

Name:
Phone:

Email:

Date:
Exercise contradictions:

Charles Poliquin BioSignature Modulation

Date
Date
19/1/08
Chin
Overall
Cheek
Overall
Pectoral
Androgen
Triceps
Androgen
Subscapular
Insulin
Supra-illiac
Insulin
Mid-axillary
Thyroid
UmbilicalGrowth
Cortisol
Knee
Growth Hormone
Medial Calf
Growth Hormone
Quadriceps
Estrogen
Hamstrings
Estrogen
Weight
Height
Belly Button
Bust
Butt
Thighs
Arms

Date

Date

Date

Date

Date

Date

Date

Date

Date

Date

Poliquin diet principals by Charles Poliquin

To lose fat quickly, I like what I call the Protein Goal diet. High protein (1.5-2 grams of animal protein per pound
of bodyweight), high omega 3s (1.5 grams per percentage of bodyfat in fish oils), and carbs limited to green
veggies, but those can be eaten in unlimited amounts.
To fit in that much protein, shoot for six to seven meals a day. BCAAs during training can count as a 7th meal. A
two-hour fast before bed is recommended, so if you screw up and only hit four or five meals one day, dont try
to cram in the last two. Hey, you messed up, but you still made 80% today, and thats okay. Start again the next
day.
After a strict initial 14 day boot camp phase, a cheat meal every 5 days is added until the client is under 10%
bodyfat, and then they can have a full cheat day. As for the ladies, same thing; just times the protein goal by .6.
Most nutrititonists tend to advocate diets that had worked for them, which isnt always a good thing if the
coach is a carb tolerant ectomorph. While I am definitely a fan of low carb diets for 75% of the population, he
acknowledges that most can still get results with a carb-based diet. It just requires more precision than what the
average Joe is usually able to commit to.
Need a handy way to calculate the amount of protein to eat per meal? Animal protein is roughly 22% protein;
so 100g of chicken, beef or scallops etc. would translate to around 22g of protein. So if your daily protein intake
is 400 grams and you consume 6 meals a day, shoot for 300 grams of animal protein at each meal. (300 x 22%
= 66 grams of protein, x 6 meals 396 grams a day.) Its not ultra exact of course, but then again, you dont
need to be obsessive compulsive to lose bodyfat.
All is not lost for the 75% of the population who dont tolerate carbs well. I am of the opinion that by getting
lean and staying lean for a solid 18 months, you can actually make yourself carb tolerant. Just watch the
subscapular skinfold site: as the reading goes down, carbohydrate tolerance goes up.
Food rotation, especially varying your proteins, is very important but it doesnt need to be complicated. I
suggest labeling the meats you usually cook at home as home foods, and make a point of avoiding those meats
when dining out or traveling. So, for example,chicken, salmon and bison at home; steak, eggs and halibut on the
road. In a nutshell, that is what the Protein Goal is all about.

10 Steps to Mastering a Low-Carb Diet

by Charles Poliquin
Step 1: Eat every two to three hours.
Having frequent meals is very important to balance your insulin and cortisol levels. It also keeps you from
being hungry and consequently eating something you shouldnt. There are two schools of thought on this:
Some people say three meals are best, and others say six meals are best. In my experience, people who truly
transform their bodies typically eat at least five to six meals a day.
Step 2: Eat a complete protein with each meal.
Your best bet in protein is anything that could once fly, swim or run in the wild. Choose meats that are wild
caught, free range or pasture raised.
Step 3: Eat two to three cups of vegetables with every meal.
Many people complain of constipation when they switch to a low-carb diet. Thats because they arent eating
enough vegetables.
Step 4: Eat a healthy fat with each meal.
Healthy fats include organic coconut oil, organic butter from pasture raised cows, olive oil, nut oils, avocados and,
of course, fish oil (as a supplement).
Step 5: Eat foods in their natural state.
Avoid processed foods.
Step 6: Drink only calorie-free liquids.
Water, organic green tea and organic coffee are the best choices. Avoid artificially sweetened beverages.
Step 7: Eat carbs (other than vegetables) only when deserved.
There are two options: (a) eat carbs postworkout, but only if you are lean, and/or (b) allow yourself a highercarb meal every five to seven days.
Step 8: Eat a wide variety of foods.
Avoid eating the same thing day in and day out because it can lead to food intolerances and nutrient deficiencies.
Step 9: Be prepared.
Prepare your meals in advance and have them with you when you go to work.
Step 10: Eat to satisfy your own needs and goals.
Dont eat something just to please the people around you. Choose to eat what you want; dont let someone
make you feel bad because you are not eating the same crappy food they are.
If you follow these simple rules at least 90 percent of the time, you will see results. Let me break this down for
you: If you plan to eat every three hours and you have your first meal at 7 a.m., that means you can get five
meals in, with your last one at 7 p.m. Five meals a day for seven days means 35 meals per week. In order to hit
the 90 percent mark, that means 32 of your 35 meals need to be on point.
That leaves you with three meals each week in which you can go off-track. Remember, though, skipping a meal
counts as an off-track meal. At the end of each day, tally your score. Its important to keep track; initially you will
be surprised how far you are from 90 percent. With time, though, you will get better and better.

My Take On The Top Ten Foods For Body Builders

by Charles Poliquin
Muscle Media does get it right in some cases: Four foods on the list I would recommend for anyone interested
in building muscle, getting lean, or achieving optimal athletic performance. Lets review the list, consider the
authors reason for applauding each food, and see how nearly 20 years of research changes things.
#1: Egg Whites
Whole eggs are on my list of best foods for fat loss because, as the Muscle Media author wrote, they are made
up of pure proteinprotein thats considered nearly perfect because of its sublime blend of amino acids. Eggs
also contain a nice dose of choline, which protects the liver from accumulating fat. Consuming more choline
elevates levels of the energizing neurotransmitter acetylcholine, which can also increase growth hormone.
Incorrectly feared due to their cholesterol content, recent research shows eggs dont elevate serum cholesterol.
The author of the Muscle Media article had issue with the fat-laden, cholesterol-rich yolk, and cautioned
readers to avoid it. In fact, the body uses the cholesterol to produce testosterone and other androgenic
hormones, which support body composition.
Take Away: Eat whole eggs a few days a week for an excellent protein source and extra choline. Also, the
fats in the yolks lower the glycemic response of the eggs, allowing for better glucose and insulin management.
Avoid relying solely on eggs for your proteineat a wide variety of animal proteins for best health, muscle
development, and optimal body composition.
#2: Sweet Potatoes/Yams
There is nothing wrong with sweet potatoes and yams in general. The typical sweet potato contains a small
amount of protein and fat, and about 24 grams of relatively slow-digesting carbohydrates. Eating them baked or
steamed is not a bad idea, but consider that one sweet potato contains about 150 calories, and if you add butter,
oil, or other ingredients to it, that number goes up. Get a better calorie bang for your buck from animal protein.
Then, replace sweet potatoes with green vegetables, colored peppers, eggplant, mushrooms, hearts of palm,
spaghetti squash, and water chestnuts for a vegetable that is better for body composition.
Take Away: Eat sweet potatoes for a flavorful sweet treat, or a refuel day. Unless you are ripped and need to put
some muscle mass, dont make them a staple in your diet and be sure to avoid eating them with added sugar or
other such ingredients that you see around the holidays like marshmallows.
#3: Broccoli
I completely agree that broccoli and the related cruciferous vegetables are excellent body composition foods.
They contain a compound that helps the body clear excess estrogen, and they provide a nice dose of fiber, a ton
of antioxidants, and are very slowly digested.
The Muscle Media author likes broccoli for its cancer fighting properties and high nutritional value. He points out
that the typical serving contains 155 percent of the RDA for vitamin C, roughly half the calcium of a cup of milk,
and substantial quantities of folate, vitamin B6, manganese, potassium, and beta carotene.
Take Away: Eat broccoli regularlybut not chronically at every meal!and round out your cruciferous veggie
intake with cauliflower, bok choy, kale, collards, arugula, and radishes for optimal body composition.
#4: Tuna
The French nickname for tuna is la poubelle de la mer, which means garbage can of the sea. All tuna has toxic
levels of mercury and should be completely avoided for health and body composition. Tuna does contain omega3 fats and a lot of protein, but the toxicity level sends it straight to the list of worst foods for body composition

and health.
Its amusing that tunaa worst food makes the MM2K best list, whereas cold water fish (herring, mackerel,
orange roughy, salmon, and catfish), which is my number one best foods for fat loss, makes the MM2K worst list
of foods for body builders! This highlights the need for specific, correct, research-based nutritional information for
optimal body composition and health.
Take Away: Avoid tuna completely, but include small cold water fish in your diet for a nice dose of omega-3 fats.
Opt for salmon, mackerel, white fish, sardines, mackerel, and anchovies, and round out omega-3 intake by taking
DHA-rich fish oil.
#5: Oatmeal
If you are serious about body composition, eliminating all grains, including oats, is a good choice for two reasons.
First, although oats do not contain gluten, they are often contaminated by gluten, making them allergenic for
people with celiac disease or gluten sensitivity. Even if you are completely fine eating gluten, oats themselves can
be inflammatory for some people.
Second, they are a grain and they elevate insulin much more than any protein, nut, or lower glycemic vegetable.
Better body composition and blood sugar results will come from avoiding ALL GRAINS.
Third, of all foods, according to Dr. William Davis, oatmeal is the top acidifying food after wheat. Increasing acid
load takes a toll on the human body. From osteopenia to muscle atrophy, acid load has been associated as being
one of the culprits.
Take Away: Simply, oats and oatmeal just cause too many sensitivity and blood sugar issues to be on any list of
best foods for body composition. In fact, no grain would be on my top ten list, however, if you choose to eat
carbs, choose instead the seed quinoa because it contains a better amino acid profile. Besides quinoa is a seed,
not a grain, and has been shown to raise IGF-1 levels.
#6: Bananas
The Muscle Media author likes bananas because they are convenient, available year-round, and nutritiousall
good reasons, but not good enough for a list of best foods for body builders. There are so many BETTER fruits
for body composition such as the antioxidant-rich array of berries (blueberry, strawberry, raspberry, blackberry),
cherries, kiwis, and grapes. All of these fruits have been shown to blunt the insulin response of high-carb foods,
and many of them have been called anti-obesity foods by food scientists.
In contrast, bananas have a moderately high fructose content (about 7 grams per banana), more calories,
and higher glycemic index than berries and other fat loss fruits. Bananas have also been shown to increase
serotonin, which makes it a terrible pre-workout food. Yet, many fitness/muscle building publications still put them
in their pre-workout meals.
Take Away: If you love bananas, eat them occasionally post workout. Instead of relying on them as your go-to
fat loss fruit, eat a wide variety of in-season fruits, with a focus on antioxidant-rich ones. The best time to take
them is as a post-workout feed.
#7: Turkey Breast
The key when eating turkey, as the Muscle Media author points out, is that it needs to be high quality. Ground
turkey may have organ meats, other meats, skin, and who knows what else in it. Plus, non-organic turkey will be
pumped full of growth hormones, antibiotics, and other nasty things that you need to avoid.

Take Away: Include organic turkey in your diet in moderation. Vary your protein source regularly, opting for coldwater small fish and organic, pastured or wild meat. Avoid all non-organic meat.
#8: Whole Wheat Pasta
Contrary to popular belief, pasta is not fattening. Fat Italian opera singers got that way because they heap
mountains of cheese and fat-willed sauces on their pasta, writes the Muscle Media author inanely. The idiocy of
this statement aside, whole wheat pasta is a processed food that is made from a grain.
It is energy dense, elevates blood sugar, spikes insulin, and should be avoided if body composition is your goal.
What very few people know is that pasta has a fake low glycemic index, when measured at the two hour mark.
Pasta wrecks havoc on insulin levels 6.5 hours after its ingestion.
Take Away: There is no nutritional benefit from pasta that you couldnt get from quality protein, smart fats, and
produce. Avoid pasta and other grains if your goal is to get lean and build muscle.
#9: Carrots
Really, carrots? Its fine to eat carrots occasionally, but they wouldnt make my ten best list of foods for anything
other than to turn you orange. The Muscle Media author likes carrots because they are sweet and have a lot of
vitamin A and C, however, there are many more nutritious veggies than the carrot. See that list provided under
the sweet potato entry for better veggie choices for body builders.
Take Away: Eating carrots in a salad or on occasion is fine, but dont rely on them as your go to vegetable. Also,
opt for whole carrots rather than diced, shaved, or juiced because this processing speeds digestion and raises the
glycemic response to eating them. Raw carrots are relatively low-glycemicthe University of Sydney estimates
they have a glycemic index of about 20, but cooking them raises that number to about 40.
#10: Legumes (lentils, peas, and beans)
Legumes are a great protein and fiber source, and best body composition results come from eating a wide
variety daily. The Muscle Media author correctly points about that they make up the absolute best source of
plant protein but he doesnt like peanuts and chick peas due to their higher fat content.
Chick peas provide a minor amount of good fat, and supplementing the diet with chick peas has been shown
to improve cholesterol level and glycemic control in one study. In another study of a population of Australians,
eating chick peas daily was shown to blunt hunger. So, theres nothing wrong with chick peas, and peanuts
contain antioxidants such as resveratrol. Plus, studies show regularly eating peanuts along with other nuts can
promote health and body composition.
Take Away: Eat a wide variety of beans, peas, and lentils regularly for a great protein source and nice dose of
fiber. Opt for whole versions rather than processed or mashed for the best body composition results. Its not
that organic peanut butter or hummus are bad for you, they will simply require less energy to digest, and may
contain added oils or other ingredients. Obviously, avoid eating any one type of legume daily because this can
lead to food intolerances.