Case-study and Progressive

Exercise Programme

Learner Name: Kate O'Hara Date: 7/9/17

Assessment element 3: Case Study and Progressive Exercise Programme

You are required to find an older person who is aged 70 or over (friend, family member,
neighbour) to be your client for the purpose of this case-study. The client must be a real person
and should not be simulated.

Once completed, you should submit your case-study and programme for marking through the
HFE online learning system. If you have any questions about what should feature in this case-
study, please do not hesitate to contact your learner support tutor.

The pass criteria for this assessment is set out in the following table.

The learner: Outcome

1. Identified the difference between behavioural goals and outcome goals

2. Collected and recorded information from:

a. Pre-exercise health screening
b. Assessments of functional capacity

3. pre-exercise health screening assessment of functional capacity

4. Explained accurately the findings of this screening/assessment

5. Negotiated person-centred, SMART goals (short, medium and long-term)

6. Adhered to evidence-based guidelines when planning sessions within a

progressive programme

7. Produced a progressive programme that was tailor-made

8. Produced a progressive programme that meets the clients functional needs

9. Produced a progressive programme that meets the psychological needs of

the client

10. Produced a progressive programme that meets the clients goals

11. Produced a progressive programme that contains the following session

components: warm-up, main workout and cool down

12. Recorded the programme in an appropriate format

To pass this case-study you require a 3 or C in all of the boxes. Questioning can be used and
will be indicated by Q and then 3 or R, depending on the outcome.
3 = Pass, R = Refer, Q = Question, C = Pass with comment
15
Physical Activity Readiness
Questionnaire - PAR-Q
(revised 2002) PAR-Q & YOU (A Questionnaire for People Aged 15 to 69)
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most
people. However, some people should check with their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the
ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being
very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.

YES NO
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity
recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?

4. Do you lose your balance because of dizziness or do you ever lose consciousness?

5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a
change in your physical activity?

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart con-
dition?

7. Do you know of any other reason why you should not do physical activity?

If YES to one or more questions

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell
you your doctor about the PAR-Q and which questions you answered YES.
You may be able to do any activity you want as long as you start slowly and build up gradually. Or, you may need to restrict your activities to

answered those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
Find out which community programs are safe and helpful for you.

NO to all questions DELAY BECOMING MUCH MORE ACTIVE:

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
start becoming much more physically active begin slowly and build up gradually. This is the
safest and easiest way to go.
take part in a fitness appraisal this is an excellent way to determine your basic fitness so
that you can plan the best way for you to live actively. It is also highly recommended that you
have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor
before you start becoming much more physically active.
if you are not feeling well because of a temporary illness such as
a cold or a fever wait until you feel better; or
if you are or may be pregnant talk to your doctor before you
start becoming more active.
PLEASE NOTE: If your health changes so that you then answer YES to
any of the above questions, tell your fitness or health professional.
Ask whether you should change your physical activity plan.

Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing
this questionnaire, consult your doctor prior to physical activity.

No changes permitted. You are encouraged to photocopy the PAR-Q but only if you use the entire form.
NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes.

"I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction."
Elaine Howell
NAME_________________________________________________________________________

EEHowell 14/06/17
SIGNATURE________________________________________________________________________________ DATE_______________________________________________________

SIGNATURE OF PARENT ________________________________________________________________________ WITNESS____________________________________________________

or GUARDIAN (for participants under the age of majority)

Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and
becomes invalid if your condition changes so that you would answer YES to any of the seven questions.

Canadian Society for Exercise Physiology www.csep.ca/forms

Functional Assessment Results
Using the following functional assessments, record your clients actual scores from these
assessments and their corresponding classification or grade.
In the event that any of the assessments were not completed or scored, please indicate the
reasons.

8ft Up and Go

5.79 secs
5.38 secs
4.95 secs

Chair Sit and Reach

plus 4 inches

Back Scratch Test

plus 1.5 inches

30 Second Chair Stand

17

Note: Please ensure that these assessment scores and classifications, including that from the
EQ-5D-5L questionnaire on the following page, are factored in to your goal setting and
subsequent exercise prescriptions.

17
 Elaine Howell
Clients name:

Under each heading, please tick the ONE box that best describes your health TODAY.

Mobility
I have no problems in walking about

I have slight problems in walking about

I have moderate problems in walking about
I have severe problems in walking about
I am unable to walk about

Self-care
I have no problems washing or dressing myself

I have slight problems washing or dressing myself

I have moderate problems washing or dressing myself
I have severe problems washing or dressing myself
I am unable to wash or dress myself

Usual activities (eg, work, study, housework, family or leisure activities)

I have no problems doing my usual activities

I have slight problems doing my usual activities

I have moderate problems doing my usual activities
I have severe problems doing my usual activities
I am unable to do my usual activities

Pain/discomfort
I have no pain or discomfort

I have slight pain or discomfort

I have moderate pain or discomfort
I have severe pain or discomfort
I have extreme pain or discomfort

Anxiety/depression
I am not anxious or depressed

I am slightly anxious or depressed

I am moderately anxious or depressed
I am severely anxious or depressed
I am extremely anxious or depressed

Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0
18 Central YMCA Qualifications 2012
We would like to know how good or bad your health is today. The best health
you can imagine
This scale is numbered from 0 to 100.
100 means the best health you can imagine. 100

0 means the worst health you can imagine.

Mark an X on the scale to indicate how your health is TODAY.
Now, please write the number you marked on the scale on the line below.
90

90
Your health today:

80

70

60

50

40

30

20

10

UK (English) v.2 2009 EuroQol Group. EQ-5D

is a trademark of the EuroQol Group
The worst health
you can imagine

Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0
Central YMCA Qualifications 2012 19
 Pre-exercise assessment and
goal setting
14/06/17
Learners name: Kate O'Hara Date:
Elaine Howell
Clients name:

Clients personal details

Age 67 Gender Female

Health assessment outcomes (include a copy of heath questionnaire) PAR-Q

Current medical conditions Medications and associated exercise implications

Arthritis in hands and knees - osteoarthritis, mildly affected No medication taken

Functional assessment outcomes (include scores and interpretation of scores)

Timed up and go Flexibility hamstring Timed chair rise EQ-5D
and shoulder

Best score 4.95 seconds
This falls into the lower end
of average scores for a client
in this age bracket and is well
within a normal rage, very
close to being better than the
norm which is between 4.8
and 6.4 seconds
Measurement for sit and
reach was +4" which is well
wihin the normal range of
-0.5 to +4.5" and falls close
to better than the norm
Low risk of functional
impairment with this score
and generally good flexibility
in the hamstrings
17
The average range for
female clients in my client's
age range is 11-18 so she
falls well within the norm and
is almost better than the
norm
11111 relating to no
problems with mobility,
selfcare, activity, pain or
anxiety
VAS score 90 - at the top
end of the scale indicating a
high subjective self score for
health

Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0
20 Central YMCA Qualifications 2012
 Readiness to participate in exercise and reasons for participation, including motivation and
attitude

At preparation stage and feeling keen and ready to commit. Would like to lose weight, and firm and tone but primary goal is to
improve fitness and health. My client is aware that she is ageing and wants to make sure that she is fitter to improve and
maintain health as she ages. She would like to firm her tummy muscles and improve her pelvic floor strength.

List three behavioural goals

1 To attend regularly and consistantly

2 To work hard and with 100% effort

3 To maintain a healthier lifestyle in terms of diet and regular exercise

Current activity levels

F 3x week

I Moderate

T 30-60 minutes

T Brisk walking around the village where she lives, attends one senior Zumba class

Activity level goal

F 5 x week

I Moderate to high

T 60 minutes plus

T Gym, swimming, maybe a fitness class which is age appropriate

Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0
Central YMCA Qualifications 2012 21
 Clients SMART goals to include: at least one short-term (18 weeks) at least one medium-term (924
weeks) and at least one long-term (6 months+) goal
Short-term
Increase participation to 5 x week

Medium-term
30 minutes continuous on cross trainer at moderate intensity - to meet currentexercise guidelines

Long-term

Lose 7lbs

Barriers to achieving goals Strategies to overcome barriers

Time Will endeavour to make time, will try to complete during the
week and attend at the weekend if unable to do so

I agree that the information in this pre-assessment and goal setting form is a realistic assessment of my
needs and goals.
Elaine Howell EEHowell 14/06/17
Clients name: Signature: Date:
Kate O'Hara KJOHara 14/06/17
Learners name: Signature: Date:

Assessors name: Signature: Date:

IQAs name: Signature: Date:

Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0
22 Central YMCA Qualifications 2012
 Progressive programme: warm-up
Learners name: Kate O'Hara Date: 17/06/17
Learner Assessment Record | Version 1.0 | Central YMCA Qualifications 2011
Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1)
Week 1
Exercise name, intensity
and time
Static bicycle, low to
moderate intensity, RPE 9
building to 11, 15 minutes
Erector spinae stretch -
dynamic, slow and controlled,
6 per side
Seated spine twist, slow and
controlled, 6 either side
Lunges (shallow), 6 per side,
slow and controlled
23
Purpose relating
to goals, medical
conditions, functional
assessment
Warm up body and prepare
for main phase
Stretch lower spine and
prepare for main phase
Stretch spine ready for main
phase
To prepare the body for the
main phase
Teaching points
Ensure saddle at correct
height and cadence is 90 to
100, adjust resistance as
required
Supine, hand to side, palms
down, knees bent, allow
knees to drop to one side
slowly, then back to centre
and to other side
Seated, legs abducted
slightly, arms out straight to
sides, shoulders back and
down, sitting tall, twist from
side to side moving arms,
keeping lower half still
Standing position, lunge
forward with alternating legs
keeping spine tall and chest
high
Adaptation/tailoring
state how the exercise
(column 1) has been
adapted/tailored
for the client
Longer warm up as
deconditioned and due to age
Common area for stiffness
and tension in the aging
population
Common area for stiffness
and tension in the aging
population
Shallow due to osteoarthritis
and stiffness in knees
Progression by week 12 Progression by week 24
Decrease time to 12 minutes
and increase resistance as
fitness improves
Increase ROM, add in a turn
of the head to the opposite
side to the legs
Increase ROM
Increase ROM to deeper
lunges
Decrease time to 10 minutes
and resistance as fitness
improves
Increase ROM, add in a kick
of the top leg as the legs go
to the side
Add a tap towards the toes to
add in a hamstring stretch
Progress to walking lunges
24
Progressive programme: warm-up continued
Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0
Week 1
Exercise name, intensity
and time
Squats, 5 reps, slow and
controlled
Shoulder rolls, 6 forward, 6
backwards
Central YMCA Qualifications 2011
Purpose relating Teaching points
to goals, medical
conditions, functional
assessment
To prepare the body for the
main phase
To prepare for the main
phase
Adaptation/tailoring Progression by week 12 Progression by week 24
state how the exercise
(column 1) has been
adapted/tailored
for the client
Standing tall, feet hip width, Shallow squats to begin with, Increase ROM, add an arm Add a transfer of weight onto
toes turned out slightly if increase ROM as appropriate reach at the top tip toes at the top
needed, sit bottom back and
down and then bend the
knees as you squat feeling
the weight through the heels,
chest upright, don't lean
forward
Feet hip width, standing tall, Simple exercise suitable for Increase ROM Add in arm circles
roll the shoulders forwards someone new to the gym
and then backwards
squeezing the shoulder
blades together as you bring
the shoulders back
 Progressive programme: CV component
Kate O'Hara 17/06/17
Learners name: Date:
Learner Assessment Record | Version 1.0 | Central YMCA Qualifications 2011
Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1)

Week 1 Purpose relating Teaching points Adaptation/tailoring Progression by week 12 Progression by week 24
Exercise name, intensity to goals, medical state how the exercise
and time conditions, functional (column 1) has been
assessment adapted/tailored
for the client

Cross trainer, 15 mins, RPE To improve cardiovascular Standing tall with your hands Lower impact exercise due to Increase to 30 minutes, Add in some interval type
11-13 fitness on the handles and feet on osteoarthritis in knees increase resistance as harder efforts into the
the pedals, push the feet and fitness imroves session
arms in a circular motion
rhythmically
25
26

Progressive programme: CV component continued

Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0

Week 1 Purpose relating Teaching points Adaptation/tailoring Progression by week 12 Progression by week 24
Exercise name, intensity to goals, medical state how the exercise
and time conditions, functional (column 1) has been
assessment adapted/tailored
for the client
Central YMCA Qualifications 2011
 Progressive programme: strength component
Kate O'Hara
Learners name: Date:
Learner Assessment Record | Version 1.0 | Central YMCA Qualifications 2011
Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1)
Week 1
Exercise name, intensity
and time
Squats, 12 reps, no weights,
1 set
Sit to stand, 12 reps, 1 set
Seated deadlift with
theraband, 12 reps, 2 sets
Upright row with band, 12
reps, 2 sets
27
Purpose relating
to goals, medical
conditions, functional
assessment
Full body strength exercise
Functional exercise
Strengthen lower back and
stretch hamstrings
To strengthen upper back for
good posture
17/06/17
Teaching points Adaptation/tailoring Progression by week 12 Progression by week 24
state how the exercise
(column 1) has been
adapted/tailored
for the client
Standing tall, feet hip width, No weights, focus on good Increase ROM , increase 2 Add free weights, increase to
toes turned out slightly if form before progressing to sets, decrease to 10 reps per 3 sets, 8 reps per set
needed, sit bottom back and adding weight set
down and then bend the
knees as you squat feeling
the weight through the heels,
chest upright, don't lean
forwardtall on a chair rise up
Sitting Functional exercise Add in a small weighted ball Add in a larger weighted ball
to a standing position and
then sit back down without
using your hands to assist
Seated position, band round Start off as a band exercise Use a small kettlebell Use a weighted bar
feet, lean forwards with a to build initial strength
straight back hinging from
the hips and with some
tension in the band, come up
to seated position
Feet hip width, pull band with Band exercise initially to Progress to using a weighted Using TRX and adding some
tension keeping elbows high ensure correct form bar bodyweight be leaning back
and squeezing shoulders
together at the top of the
movement
28
Progressive programme: strength component continued
Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0
Week 1
Exercise name, intensity
and time
Single leg deadlift, 12 reps,2
sets
Seated band chest press,
10 reps, 2 sets
Plank, 30 seconds
Side plank, 30 secs each
side
Central YMCA Qualifications 2011
Pelvic floor, 12 reps slow
and controlled, 1 set
Purpose relating Teaching points Adaptation/tailoring Progression by week 12 Progression by week 24
to goals, medical state how the exercise
conditions, functional (column 1) has been
assessment adapted/tailored
for the client
Improve balance Holding TRX in hands, Use TRX until balance Increase ROM Perform without holding
hinge from hips, lean improved TRX
forwards balancing on on
leg and lifting the other
behind
Firming and toning Seated with band behind Band exercise to develop Use free weights Increase to 3 sets
seat, tension in the band correct form and increase
with arms bent and elbows strength
high, bring the arms forward
against the band tension
Core strength Weight on elbows and bent Knees to start with as new Elbows and feet Hold for 60 seconds
knees in a prone position, to exercise
hold body in a strainght line,
breating in through nose
and out through mouth
Core strength eight on elbows and bent Knees to start with as new Elbows and feet Hold for 60 seconds
knees in a sideways to exercise
position, hold body in a
strainght line, breating in
through nose and out
through mouth
Improve pelvic floor Supine, knees bent, focus To improve pelvic floor 2 sets 1 slow and controlled 3 sets - slow, fast, slow
on lifting and holding pelvic (slow twitch), 1 set fast (fast
floor in time with your twitch)
breathing
 Progressive programme: cool down
Kate O'Hara
Learners name: Date:
Learner Assessment Record | Version 1.0 | Central YMCA Qualifications 2011
Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1)
Week 1
Exercise name, intensity
and time
Treadmill, low to moderate
intensity, RPE 9-11, 15 mins
Upper back stretch, 5-6/10, 60
secs
Quad stretch, 60 secs each
leg, 5-6/10
Calf stretch, 60 secs each
side, 5-6/10
29
Purpose relating
to goals, medical
conditions, functional
assessment
To allow the body to cool
down after main phase
To stretch muscles after main
phase
To stretch muscles after main
phase
To stretch muscles after main
pha
17/06/17
Teaching points Adaptation/tailoring Progression by week 12 Progression by week 24
state how the exercise
(column 1) has been
adapted/tailored
for the client
Standing tall and walking in a Longer cooldown as new to 12 minutes cooldown 10 minutes cooldown
heel to toe action, wear safety exerciose
strap
Feet hip width, arms clasped Stretching muscles used in 45 secs 30 secs
in front, round shoulders and main phase
upper back and hold stretch
Holding onto bar, bring heel Stretching muscles used in 45 secs Let go of bar
towards bottom, knees main phase
together and push hips
forward to deepen stretch
Take a step forward, front Stretching muscles used in 45 secs 30 secs
knee bent, back leg straight main phase
and push back heel down
towards floor, both feet facing
forwards
30
Progressive programme: cool down continued
Level 3 Award in Adapting Exercise for Independently Active, Older Adults (600/5879/1) | Learner Assessment Record | Version 1.0
Week 1
Exercise name, intensity
and time
Seated hamstring stretch,
5-6/10, 60 secs
Supine stretch, 5-6/10, relax
and breathe
Central YMCA Qualifications 2011
Purpose relating Teaching points
to goals, medical
conditions, functional
assessment
To lengthen hamstrings
Full body stretch and relax
Adaptation/tailoring Progression by week 12 Progression by week 24
state how the exercise
(column 1) has been
adapted/tailored
for the client
Seated, one leg abducted, Maintaining hamstring Increase ROM Supine theraband stretch
other foot tucked into thing flexibility
hinge at hips towards straight
leg toe/ankle and hold
Supine, reach arms above Stretch and relax, finishing Focus more on breathing Concentrate on breathing
head and imagine someone supine so client can get up during relaxation technique in for 4, hold for 4,
pulling fingers and toes in and recover in their own time out for 8
opposite directions, hold
stretch for 60 secs then relax
focusing on breathing in
through nose, out through
mouth