Fitness Assessment Manual

Fitness Assessment
National Association for Fitness Certification

Copyright 1/1/2016
2
Table of Contents
Program Insights ........................................................................................................... 4
Program Objectives ...................................................................................................... 5
Program Lesson Planning ............................................................................................. 6
Section I
THEORIES AND EVIDENCE FOR NEEDS ASSESSMENTS ....................................... 8
Chapter 1. Combating Cardiovascular Disease ............................................................ 9
Chapter 2. Combating Muscular Degeneration ........................................................... 25
Chapter 3. Understanding Assessments ..................................................................... 32
Section II
FITNESS ASSESSMENTS ......................................................................................... 37
Chapter 4. Assessing for Postural and Functional Analysis ........................................ 38
Chapter 5. Assessing Body Composition .................................................................... 62
Chapter 6. Cardio-Respiratory Assessment ................................................................ 86
Chapter 7. Muscular Strength and Endurance Assessment ..................................... 102
Chapter 8. Flexibility Assessment and Training ........................................................ 117
Section III
GUIDELINES: SAFE PRACTICES AND POST ASSESSMENT PROGRAMMING . 132
Chapter 9. Cardiovascular Programming and Guidelines ......................................... 133
Chapter 10. Muscular Strength Programming ........................................................... 151
Chapter 11. Exercise Safety Guidelines .................................................................... 166
Chapter 12. Caring for the Back ................................................................................ 175
Chapter 13. Training Programs for Older Adults ....................................................... 184
Chapter 14. Sport and Skill Fitness Programming .................................................... 190
Chapter 15. Additional Programming Options ........................................................... 209
Chapter 16. Special Populations ............................................................................... 217
APPENDIX A: Frequently Asked Questions .............................................................. 228

APPENDIX B: Exercise Modifications ....................................................................... 241
APPENDIX C: Fitness Assessment Study Guide ...................................................... 243
APPENDIX D: Glossary ............................................................................................ 251
APPENDIX E: Sample Forms to be Used by Trainers .............................................. 255
National Association for Fitness Certification, Inc. NAFC Fitness Assessment Manual, 2016. All rights reserved. 3
Program Insights
The Fitness Assessment Program is designed to teach you to apply

assessment techniques to measure cardiovascular endurance, muscular
strength and endurance, flexibility, and body composition. You will learn
how to administer these tests and apply test results to individual program
development and goal-setting.
Understand and learn how to apply:
 Body composition assessment.
 Recommended client body-weight based on recommended
body fat percentage values.
 Assessments to determine cardio-respiratory fitness.
 Cardio-respiratory endurance assessment test results.
 Predictions of oxygen uptake and caloric expenditure from
exercise heart rate.
 Assessments to determine muscular strength and endurance.
 Interpretation of strength testing results.
 The variables that govern the development of muscular strength
and muscular endurance.
 A battery of muscular flexibility tests to assess overall body
flexibility.
 Flexibility test results.
Program Objectives
The goal of passing the NAFC Fitness Assessment Program is to provide

you with a measure of competence in the area of health and fitness
assessment. The NAFC has set forth standards that must be met in order
to achieve a competent level. These standards are linked to specific skills
and objectives that are associated with fitness assessment implementation
and application.
Upon completion of the program you will be able to:
 Understand and apply at least two common methods to assess
body composition.
 Assess cardio-respiratory fitness through several different testing
protocols.
 Interpret cardio-respiratory endurance assessment results.
 Predict oxygen uptake and caloric expenditure from exercise heart
rate data.
 Assess muscular strength and endurance through different
strength-testing protocols.
 Interpret strength testing results.
 Recognize the variables that govern the development of muscular
strength and endurance.
 Assess flexibility.
 Administer performance tests to assess skill-related fitness.
 Formulate a comprehensive fitness program based on the results
of the fitness assessment.
Program Planning
The NAFC Fitness Assessment Program is a self-paced program that

allows you the flexibility of progressing through educational materials at
your convenience. These materials prepare you to pass the theory and
practicum exams and requirements.
Step 1: Review Your Materials
Now that you have received your NAFC Fitness Assessment Program
materials, make sure you review them so you can ultimately prepare to
pass your exams. This step-by-step outline will provide you with the NAFC
Fitness Assessment Program content in the order in which you should
progress through the materials.
The manual is broken into three sections: theories and evidence,
assessments, and exercise guidelines. Each chapter has a corresponding
chapter in the other sections. Review the table of contents to decide on the
best approach to read through and apply the materials.
Step 2: Take Your Theory Exam

The NAFC provides a secure online theory exam. This exam can be taken
from the comfort of your own home. Your computer or laptop must be
equipped with a webcam, tablets and other devices will not function
efficiently. When ready, please follow the online instructions to complete
your exam.
If you need to make other arrangements to take your exam you may call:
1-800-324-8315 or email admin@nafctrainer.com for assistance.
Step 3: Theory Exam Results

A minimum score of 80% is needed to pass your exam. You will receive
your results immediately upon completion.
Step 4: Prepare For Your Practicum Exam
Option 1: The NAFC provides opportunities throughout the year in

different locations all over the country to attend practical application
workshops. These workshops teach you to become a more competent
trainer. Workshops are designed to help students gain skills that would be
otherwise achieved in a trainer’s first years of training. This workshop may
be attended, with the practical exam completed at the workshop, for a cost
of $200.00 when purchased with your NAFC Personal Training program.
Option 2: The NAFC also offers an online practical exam as well; this
exam is included in the price of your Personal Training materials. In
preparation for the NAFC online practical exam, please review and
understand your practical application workbook, which is also included in
your materials.
The NAFC highly recommends that you elect Option 1 as your choice for
your practical exam. However, the NAFC also realizes that students may
not be able to attend a Practical Application Training Workshop. If you elect
Option 2, the NAFC allows only one retake. If you fail to pass at your
second attempt, you will be required to find and attend a hands-on three-
day workshop. The price for this workshop is $249.00.
Step 5: Practical Exam Results

If you have chosen to take the online practical exam, your test scores will
be received immediately upon completion.
OR
Within 2 weeks after the NAFC receives the results of your practical exam
from your instructor the NAFC will notify you whether you have passed or
failed to achieve the minimum score of this exam.
1
Combating Cardiovascular Disease
Affecting women and men of all ethnicities, cultures and backgrounds,

cardiovascular and heart disease can impact those who are both sedentary
and active. In fact, heart disease is the leading cause of death in the United
States and worldwide. According to the Center for Disease Control (CDC),
in 2008:
 About 600,000 people died of heart disease in the United States every
year–that’s 1 in every 4 deaths.
 Coronary heart disease is the most common type of heart disease,

killing nearly 380,000 people annually.
 Every year about 720,000 Americans have a heart attack. Of these,

515,000 are a first heart attack and 205,000 happen in people who have
already had a heart attack.
 Heart disease is the leading cause of death for both men and women.
More than half of the deaths due to heart disease in 2009 were in men.
 Coronary heart disease alone costs the United States $108.9 billion
each year. This total includes the cost of health care services,
medications, and lost productivity.
In addition to the CDC, according to the World Health Organization (WHO),

cardiovascular diseases killed 17.5 million people in 2012. Of these
staggering findings, 7.4 million people died of ischemic heart disease, 6.7
million from stroke, 3.1 million chronic obstructive pulmonary disease
(COPD) and 1.1 million from hypertensive heart disease.
It comes as no surprise, then, that physicians, scientists, researchers and

pharmaceutical companies, amongst other organizations, continually invest
incalculable resources into learning more about methods to assess and
combat cardiovascular diseases. Personal trainers and fitness
professionals have a responsibility to not only assess and educate clients
about their physical appearance and weight goals, they have a
responsibility to educate clients of ways to stave off cardiovascular
diseases.
Cardiovascular Disease
By definition, cardiovascular disease is the

build-up of plaque in the walls of the
body’s blood vessels. A build-up of plaque
is also called atherosclerosis which, and
when developed, narrows the arteries and
restricts blood flow. This clot or blockage,
an effect of narrowing arteries, can result
in heart attacks, strokes, heart failures,
arrhythmias, or heart valve difficulties.
Cardiovascular disease can be fatal.
Studies show that the disparity between

sedentary populations and moderate
exercisers is the greatest when comparing
risk factors for cardiovascular disease. Going to the gym every day for
several hours to achieve a certain level of fitness is not the most conducive
method of developing a healthy heart, though it is definitely one method of
pursuing improved health. Research does suggest that maintaining a
consistent amount of small bouts of exercise will improve health and
extreme programs are not the answer to sustainable health. Consistency
and accountability are keys to sustainability.
A moderate amount of exercise a few times a week is more effective than

small bouts of exercise, and during studies groups that exercise the most
consistently have the lowest risk factors of cardiovascular disease. Starting
small and gradually increasing exercise intensity overtime can dramatically
decrease the risk and symptoms associated with cardiovascular disease
and early mortality.
Although genetics plays a role in the likelihood of developing heart disease,

researchers believe it is largely preventable. Rather than succumbing to a
sedentary lifestyle, developing a healthy exercise regime and maintaining
nutritional health are key attributes in increasing cardio-respiratory
endurance, thus delaying and preventing the prevalence of this disease.
Cardio-respiratory Physiology
According to the President’s Council on Physical Fitness and Sports,

cardio-respiratory endurance can be defined as the, “body’s ability to
deliver oxygen and other nutrients to tissue and to remove waste products
over a sustained period of time.” Cardio-respiratory and cardio-pulmonary
indicates something to do with the heart and respiratory system or the heart
and lungs, respectively. Ultimately, the cardiovascular system and its
functioning is what is being addressed by cardio-respiratory and cardio-
pulmonary, and throughout the manual these terms may be used
interchangeably.
How is cardio-respiratory health measured, and why is it important to
measure it? The body functions as a machine; individual parts have a
specific function and task to perform. When one of those parts is unable to
do its job, the whole machine struggles.
Aside from the heart, one of the most important “parts”, or set of organs, of
the cardiovascular and pulmonary systems are the lungs. The lungs are a
conduit that passes oxygen to the heart via alveoli and hemoglobin in the
bloodstream to create oxygenated blood. This oxygenated blood is
important because it can be pumped to the rest of the organs and tissue to
create energy.
Obviously, when the body is at rest it does not need much energy.
However, when moving (i.e. standing, walking, running, and jumping) or
exercising and exerting effort on the body’s systems (i.e. nervous,
circulatory, skeletal and muscular), the body must circulate more oxygen to
the organs and tissues.
This is when the oxygen in the bloodstream is most important and is most
beneficial to physical health. To produce energy in motion, the body turns
calories (food substrates) and fat into adenosine triphosphate (ATP).
ATP is a substance present in all living cells. Through this high-energy
phosphate bond, metabolic processes are biochemically created and
energy is transported to the cells.
When exercising for long periods of time, more ATP is used, and systems
are created to increase and maintain cardio-respiratory endurance. The
heart becomes better able to deliver adequate amounts of oxygen to the
organs and tissues. Conversely, if the energy needed is not accessible,
fatigue is experienced.
Cardio-respiratory Endurance
The modernization of society continually strives to make life simpler, easier

and increasingly convenient. Ultimately this has, unfortunately, created
adverse effects to overall health. The amount of overall activity level in past
centuries has greatly been reduced. Where once society depended upon
hunting, farming, gathering, building and manually hauling items for
sustenance and sustainability, it now depends on the use of machines,
technology, agriculture, and food preservation.
In fact, it is not uncommon for adults to sit in front a computer for 8 hours a
day, drive home in a relaxed position, microwave a meal and sit in front of
the television for a few hours before going to bed. Daily tasks of this
sedentary nature require a minimal level activity and result in a lack of
exercise unless a purposeful routine is established.
This lack of movement, resulting in an increase of sickness and disease,

has created a need for organized fitness and exercise routines. Organized
exercise, including, but not limited to group fitness classes, personal
training sessions, and walking with friends or co-workers, have been used
to supplement sedentary lifestyles with much needed movement and
exercise. Although the body can function without high levels of flexibility or
strength, it cannot survive without an efficient cardio-respiratory system.
Aerobic exercise helps to create an efficient cardio-respiratory system.
Many tasks we participate in require a level of cardio-respiratory endurance

and muscular strength. Raking the leaves, vacuuming the floor, running to
catch a bus, playing with children, and lifting grocery bags, are all examples
that require the exertion of energy and physical stamina to complete the
task. When lacking stamina, the heart is forced to work harder to pump
more blood throughout the body. Without a level of developed strength,
extra demands on the heart cause strain and debilitation of the heart’s
functionality. Maintaining a minimum of moderate exercise on a daily basis
will increase the endurance capabilities of the cardio-respiratory system.
Beyond regular exercise there are many daily life changes we can
encourage our clients to implement to create a stronger endurance system.
If living in an urban area, suggest choosing to walk to the store instead of
driving. Having to walk back home with groceries in a bag will offer an even
more intense cardiovascular challenge! Encourage the giving up on closer
parking spots, thus choosing to walk a ways to an entrance is another way
to easily increase activity.
Once in the building, ask your clients to consider taking the stairs as
opposed to the elevator. This will certainly get the heart pumping before
work or after sitting at a desk for hours at a time! On a lunch break, your
clients can walk around the block and track their steps. An added bonus to
cardio-respiratory endurance is this will also aid digestion, and if it becomes
a competitive event at work, it can create that much more of a
cardiovascular benefit!
When at home watching television, assign exercises to be completed

during commercial breaks – perhaps a few repetitions of push-ups or sit-
ups. This will also increase muscular and core strength! Small changes can
create big differences, and the ultimate goal for your client should include a
stronger, healthier cardio-respiratory system.
This said, there are some disagreements regarding the best way to
exercise. Some believe the body burns more fat when it performs low
intensity exercises as opposed to the performance of high intensity
exercises. The assumption is that low intensity- exercises can be prolonged
over extended amounts of time, thus low-intensity must be more effective in
achieving a healthy lifestyle and reduced cardiovascular risk.
This initially appears to be true because the body burns carbohydrates,

rather than fat, during high intensity aerobic activity. However, it is
important to note that although the focus may be on burning body fat, the
actual amount of calories burned during low-intensity exercise occurs at a
much lower percentage than that of high-intensity exercise. The pay-off is
greater at higher intensities.
To further explore this, the body burns approximately 1.5 calories per
minute at rest while we perform daily activities like working, washing the
dishes, watching TV or casually shopping. When participating in moderate
activities like walking, yoga, lifting weights, biking or jogging, the amount of
calories burned per minute increases to 3–4. That is double! If participating
in a high-intensity exercise like running or speed swimming, caloric burn
increases to 8–10 calories per minute. Anything that increases the heart
rate can improve caloric burn and metabolic functioning; encourage your
clients to consciously work to safely increase their heart rate through
cardiovascular activity!
When encouraging clients to intensify their activity level, be mindful that

implementing new exercises or new exercise routines should be done
gradually. Deciding to spontaneously “burn off” a candy bar or other
dessert by going for a 6-mile run followed by a 3-mile swim would not be
the best or healthiest route when adding new exercises or encouraging
your clients to maintain their heart health.
This quick, over-the-top increase of intensity could not only compromise the
client’s health and create a risk of delayed onset muscle soreness
(DOMS), it could also cause your reputation as a safe and effective trainer
to be questioned. Remember, new exercises and routines should be
introduced gradually, at a level that is comfortable yet challenging. After
making an adjustment to an exercise load, gradually increase the intensity
until a performance peak has been reached. These moderate changes will
continue to help your clients combat cardiovascular disease and keep them
coming back for more.
Measuring Cardio-respiratory Endurance
Determining an individual’s ability to maintain and sustain energy is closely

linked to aerobic, or cardio-respiratory, endurance. This sustainability
measure can be found by performing a VO2 max test, which is a measure
listed as “milliliters (mm) of oxygen (O) used in one minute per kilogram
(kg) of body weight”. VO2 max, or maximal oxygen uptake, refers to the
amount of oxygen that can be used during intense exercise. Oxygen
uptake is defined by the amount of oxygen that the body is conditioned to
deliver throughout its system. The more oxygen that is available during
maximal exercise, the more ATP can be produced. And recall, an
increased level of ATP is analogous to increased energy.
Although typically reserved for professional and elite athletes, VO2 max
testing is reliably found only after extensive sports lab or hospital lab
testing. It is a physically demanding, exhausting, and painful test that
requires active concentration. However, the benefits of this test far
outweigh the exhaustion achieved during the test. Knowing VO2 max can
change the ways in which your client reaches their personal best in
cardiovascular training and peak performance.
During the clinical VO2 max test, participants are fitted with a mask and
placed on a bicycle or treadmill. In specific increments of time, the
requirement of energy and aerobic output is increased – usually involving
an increase in speed and intensity. Through obtaining measurements of
volume and oxygen concentration of inhalations and exhalations,
researchers are able to assess how much oxygen is being used. Usually,
the researcher will notice a linear relationship to oxygen used and intensity
of exercise. When this linear relationship plateaus, VO2 max has been
achieved. At no less than 4 minutes, typical tests require 10–15 minutes of
time and maximal output for participants.
Although lab testing is the most accurate method of assessing VO2 max,
there are a vast array of websites and apps that provide VO2 estimates for
consumers. Remember, the most reliable estimates will require the
participant to perform exercise over a few minutes. The most common
assessments include a step test, walk a mile, or run/walk 1.5 miles.
It is interesting to note that men can have a maximal oxygen uptake 15% –
30% higher than women. When compared to women, men tend to have
higher hemoglobin content and a larger heart size. They also tend to have
lower body fat percentages. The larger heart, higher hemoglobin, and lower
body fat percentage increases circulation and increases maximal oxygen
capabilities.
Additional testing options for estimating VO2 max are discussed later in the
text.
Benefits of Aerobic and Anaerobic Exercise
To better understand what can be done to improve cardio-respiratory

endurance, it is necessary to learn about aerobic or endurance exercises
that support the aerobic and anaerobic systems. The difference between
aerobic and anaerobic exercise is the level of intensity.
Aerobic exercise requires a large amount of oxygen to help the body

maintain endurance; aerobic means with oxygen. These exercises may
include, but are not limited to: running, downhill and alpine skiing, surfing,
jump roping, swimming (i.e. distance), rapid hiking, bicycling, dance
classes, and most aerobic classes.
Anaerobic, on the other hand, means without oxygen. Anaerobic exercises
are those that enable the body to perform short, quick bursts of energy.
Due to the intensity of anaerobic exercises, they are unable to be sustained
for more than a short period of time without some type of recovery.
Common forms of anaerobic exercises include: track competitions (i.e. 100-
400 m sprints), swimming short distances (speed), gymnastic performance,
heavy weight lifting, H.I.I.T.(i.e. high intensity interval training) class/training
sessions, and some Cross Fit exercises occur in short bursts, thus making
them anaerobic exercises.
Aerobic Training
When implementing a regular aerobic program/activity into daily life, the

overall benefits clients frequently claim include mood enhancement, an
increase in focus and mental clarity, and a better feeling overall. These
benefits are in addition to physical health and well-being enhancements.
Other improvements occur internally, and the amount of oxygen the body is
able to distribute throughout the circulatory system is one of them. With an
increase in aerobic activity the body adapts and is subsequently able to
exercise for longer periods of time without becoming exhausted. The
amount of improvement, of course, will depend upon an individual’s level of
physical ability prior to initializing an aerobic program.
For example, if a client is not used to any form of exercise and they begin
to participate in a cardiovascular program completing aerobic activities,
they could easily see as much as a 50% increase in oxygen (VO2 max). By
comparison, if your client is already active, and has experience with a
specific aerobic program or level of activity, the increase may be 15 – 20%.
In addition to improved oxygen circulation, aerobic activities also increase
the ability to distribute oxygen through hemoglobin. This is due to a higher
number of red blood cells, which are used for oxygen transportation. An
increase in oxygen transportation also increases the amount of oxygen in
the blood, thus making it more accessible during aerobic activity.
Since the heart is the main organ that pumps oxygenated blood throughout
the body (approximately 5–6 liters of blood per minute) aerobic exercise
affects the heart. Exercise, because of the increase in blood flow, can
increase the size of the heart. When increasing aerobic exercise intake,
cardiac output increases. This coincides with the amount of energy the
body needs.
The amount of blood the heart is able to pump at rest (resting heart rate
or RHR) depends on the strength and size of it. When this need, or rate, is
increased, the amount of blood the heart produces while at rest also
changes. The more blood the body pumps, the higher the stroke volume
will be. Stroke volume is the amount of blood pumped by the left ventricle in
one contraction, and approximately 2/3 of the blood in this ventricle is
expelled with each beat. Stroke volume, along with heart rate, determines
cardiac output, or the amount of blood the heart can pump per minute. As
a result, with regular cardiovascular or cardio-respiratory aerobic activity,
the heart pumps slower and with a longer rest in between beats.
For example, if a trainer assesses a client’s heart rate, changes their

exercise intensity, and re-assess their heart rate again after six to eight
weeks of consistent aerobic exercise, it may be noticed that the heart rate
has decreased by ten to twenty beats per minute. Therefore, the fewer
beats per minute the heart produces, the stronger it will be. Because the
average person’s heart produces about 60 to 100 beats per minute at rest,
it is recommended to measure re-assess heart rate every six weeks to
gage differences.
Another way to measure the heart rate is to see how many beats per
minute can be produced under specific workloads (cardiac output). For
example you might take the pulse of your client after running the mile in a
pre-determined amount of time. Then, the client would continue to practice
the same activity – which would raise their cardio-respiratory endurance.
After six weeks, you would check their heart rate again. Their heart rate
should decrease because their ability to pump blood has increased.
Although not as easily measureable, cell energy also improves with

consistent aerobic exercise. When exercising, the amount of mitochondria
in the body grows, which in turn increases the body’s competency in
producing more energy. At the cellular level, the mitochondria are where
energy is produced. When oxygen is sufficient, it is able to turn glucose into
ATP.
Additionally, when participation in exercise programming is frequent, the

body becomes better trained to recover from that activity at a more rapid
pace. Muscle tissues, fluids, and internal energy expended during periods
of exercise, through exercise, are regenerated more rapidly. Even the
smallest parts of the body are affected by an increase in exercise. The
capillaries, which are responsible for the delivery of oxygen and nutrients
to tissues, are affected by the increase of oxygen used during exercise.
The maintenance of a healthy lifestyle, including aerobic exercise, allows
the body to increase capillary density (the amount of capillaries present at
a particular site). In turn, this enables an improvement in the ability for the
capillaries to deliver oxygen to the muscle, thus increasing performance.
This cycle is beneficial to the body and the circulatory system, especially to
the heart.
When the body is in constant movement, it also experiences changes in its

equilibrium that can affect the heart rate, electrolyte count, blood pressure,
and body temperature. Blood pressure is improved too. This balance, or
homeostasis, occurs more efficiently when your client regularly participates
in aerobic exercise. This change in equilibrium, in turn, will help your client
evade heart disease, clogged arteries, an aneurysm and even damage to
the brain.
Finally, exercise will help to develop fat burning enzymes in the body that
may have been lost due to a sedentary lifestyle. Our bodies can only create
these enzymes naturally when we exercise. If we can help clients build up
a greater storage of these enzymes, they will burn fat more efficiently.
Improved cardio-respiratory endurance, increased blood flow, improved

mood, and overall body change. These are very convincing reasons that
any time is a great time to begin a healthy cardio-respiratory exercise
routine, and the way to track progress, is of course, through continual
fitness assessments.
Notes:
2
Combating Muscular Degeneration
Is strength training appropriate for everyone? YES! This aspect of fitness

is extremely important for everyone. Possessing stronger muscles will help
your clients carry out common tasks with an increase in ease and a
decrease of injury. Moving furniture, playing with children, cooking, taking
the groceries into the house, and carrying luggage require lifting, carrying,
hauling, transporting, and pushing objects. Having the strength and
confidence to complete these, and many other activities, is essential in
supporting an active lifestyle.
Benefits of Strength Training
Your clients may be

surprised to learn that the
practice of weight training
can contribute to weight loss.
When participating in a
strength training program,
the body begins to utilize fat
for energy due to its low
aerobic quality; this “anaerobic” quality increases the body’s ability to burn
fat. Strength training can also promote stronger bones, ligaments, muscles,
and tendons, which in turn promotes stronger joints. In addition to these,
metabolism is increased when lifting weights, which is also conducive to
weight loss.
Weight training can help to decrease blood sugar and maintain healthy
levels by increasing the amount of glucose used during exercise and by
increasing muscle tissue to increase storage. Blood sugar, or glucose, is
derived from carbohydrate consumption, is converted to glycogen, and is
stored in the muscles and liver. During weight training and other activities
when our bodies need fuel, glycogen is broken down into glucose and
utilized for energy. Also, increasing muscle mass allows the body to have
more storage room for glycogen, thereby promoting a healthier blood sugar
level. As an additional bonus, when the body appropriately uses glucose, it
can contribute to steadier levels of insulin and the body’s ability to use it
efficiently, thus decreasing symptoms of type 2 diabetes.
In addition to improving metabolism and preventing symptoms of diabetes

through the proper utilization of carbohydrates (glucose) and glycogen
(stored in the muscles and liver), the practice of weight training is an
important factor in the prevention of injury. The stronger the bones and
muscles are, the more likely your client will be able to not only stay healthy
and strong, but they will also recover more rapidly when faced with injury.
Weight training promotes improved bone density, which can increase your
clients’ chances of lessening the potential seriousness of a fall or break.
This becomes particularly important with an aging population which may be
more likely to suffer from frequent falls and broken bones.
Muscular Strength and Aging
As clients age, many may develop sarcopenia, which is defined as the

loss of the muscular ability, muscular function, and strength from within the
body. This can negatively affect their ability to live independently and to
perform daily tasks such as: cooking, taking out the trash, walking around
the store, and taking a shower. This lack of independence may result in the
need to live in assisted living homes in order to avoid jeopardizing health
and reducing the likelihood of injury. Muscular strength, again particularly
as your client ages, becomes an increasingly important component of
sustaining a high quality of life.
If possible, begin your client on a strength training program early. When

muscle is developed at an early age, the body is not as susceptible to
deterioration. If your client is older and has not participated in weighted
activities, introducing it into their training program design is invaluable.
Even at an older age, strength training gains made in training can reverse
the effects of the aging process. Regaining independence is a wonderful
reward for developing and maintaining a strength training routine.
Having good bone density is crucial for an aging population, as it also

decreases the chances of a serious injury if an accident were to occur. Low
bone density can be a result of osteoporosis (weak and brittle bones) and
will put your client at a higher risk of breaking bones. Strength training can
help to build stronger and healthier bones and muscles for a healthier
lifestyle at any stage. Keep in mind that if a senior exerciser reports heart
problems or other conditions on their PAR-Q or health history form, they
will need to consult a physician prior to beginning a weight training
program.
Participating in a weight training program can also increase metabolism.
As your client ages their metabolism is likely to slow down. In part this may
be a result of a more sedentary lifestyle. Another part of this may be
because they continue to consume the same amount of calories as they did
when their activity levels were higher. This not only increases weight and
decreases metabolism, it does so through the loss of muscle mass and
lean body tissue. However, weight training can help to maintain, if not
increase, metabolic functioning. If your client holds more muscle than fat on
their body they are more likely to have a higher
metabolism. As metabolic functioning increases,
muscles are able to better use fat to create
energy.
Lifting weights can increase muscle mass. This is

referred to as hypertrophy, which can positively
affect the increase of the metabolic rate. A
quicker metabolism will help your client maintain
a healthier weight and reduce the chances of
further weight gain later in life. The older they
become, the fewer calories the body will burn because most of your clients
will be active in their later years. However, building more muscle will greatly
increase their chances to maintain freedom and independence at an older
age.
Hypertrophy, or the enlarging of muscular size through the enlargement of

muscle cells and fibers, is not only important to older populations. Athletes,
body builders, and other populations will also seek to create hypertrophy of
the muscles.
Gender Differences
Women and men have different bodies and they respond to various
exercises in different ways. Typically, a woman’s body will not develop
muscles larger than a man’s. This is due to significant genetic differences
that occur before birth. However, if a woman were to train with great
intensity and focus, she could, in theory, develop larger muscles than a
man who never participated in a weight training program. But if a man were
to put the same amount of time into developing his muscles, he would
easily surpass the female in muscle size.
Women in Weight Training
Surprisingly there has been a common

misconception amongst women that weight
lifting will lead to an unwanted increase in
muscle size. When men complete weight lifting
exercises, their muscles are genetically
formulated to expand in size (hypertrophy)
because of the amount of muscle fibers they
hold and the different types of hormones in their
bodies. This is not the case with most women.
When women perform resistance exercises,
genetically, it enables their muscles to gain
strength, rather than a tremendous increase in size.
Although there are still many who believe that a woman’s muscle mass will
increase considerably if they participate in a weight training program, the
recent mediums of social media and popular television has increased the
awareness of this inaccurate stigmatization. Women, such as Jennifer
Aniston, Demi Moore, and Michelle Obama, have been in the limelight as
having leanness in body mass while not regarded as being “bulky or
masculine”. Rather, these women are considered “fit”. The media has
contributed to the decreased belief that weight training will increase bulk.
There are, however, women who participate in intensive weight training

programs in which their goal is to increase their bulk, or size. These women
often train for hours each day with heavy weights and little rest. Further,
some of the muscular appearance of these women can be contributed to a
body-building technique that allows an individual to appear larger than they
really are. When lifting weights consistently, they do not allow the blood
time to drain out of the muscles, so the extra blood gives the muscles a
larger appearance. This technique is called “pumping”, and is not
recommended for the average client, though it is beneficial for those who
are competing in muscle and strength training competitions.
Remember, in addition to purposeful and intense training, there is a heavy

focus on the body builder’s nutrition, since diet influences both performance
and size. The goal of increased size tends to be different than the average
woman’s who seek a trainer to reach an overall goal of becoming more fit.
An additional method a woman is able to use to appear larger or to

increase their bulk is to use steroids for enhancing their weight-lifting ability
and physical appearance. The side effects of steroids cause women to
possess more masculine attributes like: a lowered voice, facial hair, smaller
breasts, and large muscle size. Steroids can also cause harmful,
detrimental to health, side effects which greatly diminishes the benefits
weight training can offer. The use of steroids is frowned upon by many in
the fitness industry and the risks of using them far outweigh the benefits,
and the NAFC does not support the use of steroids to achieve goals.
Today, some female athletes continue to use anabolic steroids or other

performance enhancing drugs to improve their performance during
competition. They are not alone. Their male counterparts also use these
drugs to enhance their performance. When exposed, medals and awards
are stripped from possession and further participation in the sport becomes
questionable. Major athletes in competitive cycling, baseball, and football
have been chastised for using drugs that alter or increase performance.
Use of these drugs is now considered “cheating to win”. Using muscular
enhancement drugs to look or to feel stronger is strongly discouraged.
Again, the overall negative effects far outweigh the positive gains.
Some women who participate in extreme exercise programs experience

amenorrhea, or the complete loss of their menstruation cycle. This factor
has not proven to be damaging to the body or to provide risks for
pregnancy. If your client is menstruating and they are worried about
exercising, they should listen to their body to make sure they do not push
outside of what is best for their body. Amenorrhea is most common in elite
athletes who regularly participate in high intensity and have minimal body
fat. Dysmenorrhea, on the other hand, is a condition where women feel
extreme discomfort during their menstruation cycle. While exercise is not
cure for this condition, it promotes healthy circulation, which can be a relief
to painful menstrual cramps.
In the end, genetics will oftentimes determine the ability to put on and to
maintain muscle mass. Encouraging your client to actively participate in a
weight training program will allow them to build muscle mass regardless of
race, age, or gender. The difference lies in body type, which stems from
genetics, being that some will be able to build muscle more rapidly than
others. Hypertrophy, or the increase of mass of a muscle, is largely reliant
upon genetic differences according to individual and unique levels of bodily
hormones such as testosterone, estrogen, and progesterone.
Changes in Body Composition
If your client’s goal is to lose weight and to look fit and trim, weight lifting is
a suggested tool for fat loss. Lifting weights and participating in resistance
training can indirectly decrease the amount of fat that surrounds the
muscle fibers. This decrease may not be indicated on the scale, as muscle
mass weighs more than fat mass. Using the scale to track progress is not
recommended; rather, the use other fitness assessments to monitor
change in size of the body, changes in inches, decreases in body
composition and how clothes fit, tend to be better indications of progress.
Additionally, assessing muscular strength can be used to monitor gains in
strength.
An accurate body fat reading with a qualified professional can also be a

better measure of progress. Remember, the body functions as a protective
mechanism; so, in the areas of the body where there is not enough lean
body mass, it will protect itself by covering itself with fat mass. Therefore,
lifting weights will promote a shapely, toned physical body and appearance.
When strength training is a part of a balanced program that includes
cardiovascular training, flexibility training and proper nutrition, optimal
results can be achieved.
3
Understanding Assessment
Although we may be on a steady plan of health and fitness, there are many
reasons to continually assess physical fitness levels. Continued motivation
is one reason to assess a workout plan, and assessments are tools to
gauge present realities. Using assessments to know where clients are
enables us to decide on the best way to proceed. In addition to motivation,
other reasons for consistently assessing and re-assessing health and
fitness levels include:
 helping to identify the major and minor changes that have been
made. If there is no starting point, it will be difficult to celebrate
successes.
 measuring improvements. If progress towards goals is not being met,
through consistent and progressive assessments, programs can be
adjusted to match goals.
 evaluating current fitness level. It is oftentimes counterproductive to
compare an individual’s progress to another’s. However, being aware
of progress can be utilized as a method to stay on track.
 assisting in goals and aspirations. The record-keeping of fitness goals
and achievements, including being able to overcome obstacles and
pitfalls, better equip clients to maintain a steady path.
Just as trainers use assessments to track personal progress, clients seek

out personal trainers and fitness professionals to help them track their
progress. Having a strong understanding of how assessments are used to
measure progress will not only help us achieve our goals as trainers, it will
also help our clients gradually track and reach their goals. Thus, we define
fitness assessment as – the ability to apply a series of tests that help
analyze levels of fitness and performance, through which, a personalized
fitness program can be developed.
Responders vs. Non-Responders

Scientists have determined that some respond to diet and exercise in a
positive fashion; they are called “responders”. “Non-responders”, on the
other hand, are those who do not have the same immediate reaction to diet
and exercise. The distinction between responders and non-responders may
be associated with factors such as poor muscle strength or health;
research continues in this area. Whether a responder or a non-responder, it
is healthy to accept that individual bodies are unique and they may never
react or respond the way in which we intend.
Further, it must be accepted that our bodies are different and will therefore
respond to different stimuli. Even if two identical twins were put on the
same exercise and diet program, their bodies would respond differently to
the input and output experienced. This principle of individuality explains
that we cannot expect our bodies to react to external and internal changes
in ways similar to all others. This is why consideration must be placed on
and individual’s genetic and hereditary factors – what is inherited can make
a difference in the ability to notice and experience progress. Individual
biochemistry helps to explain when clients who are responders and clients
who are non-responders.
The principle of individuality further helps to explain why some never seem
to gain weight while some gain weight rapidly. While it is a common
assumption that someone who is 50 pounds overweight will have an easier
time losing 5 pounds than someone who is 5 pounds overweight, this is not
always the case. Usually, the people who make the greatest changes in
their diet and exercise reap the greatest changes and results. However, if
immediate change is not perceivable when aerobic exercise is improved, it
helps to understand that approximately 5% of the population fit into the
non-responder category. Assessing fitness levels, taking regular
measurements, and modeling a program that best fit an individual’s body is
the best way to influence results, and this is achieved through the
implementation of fitness assessments.
Remember, not all positive changes are seen with the “naked eye”. If your
client is making choices that we know have a positive outcome –
immediately seen or not – continue to encourage them and provide
knowledge that their body is benefitting from their hard work.
Improvements in exercise and diet will help combat sickness and prepare
the body for the physical demands life brings. A choice to move should be
a sustainable lifestyle choice. Regardless of the type of daily exercise:
swimming, running, walking the stairs, walking the dog, practicing yoga,
going to the gym, playing with children, etc., we know there is a positive
benefit, internally. With regular and consistent physical exercise, your
clients will be healthier, happier individuals internally and externally. Level
of activity, progress towards goals, and motivation can all be measured
with assessments.
Maintaining motivation, responders, non-responders and the principle of

individuality support why consistent assessments are an invaluable and
necessary resource in a trainer’s toolkit. Remember, fitness assessments
include the ability to apply a series of tests that help analyze levels of
fitness and performance, through which, a personalized fitness program
can be developed. In order to gain a full understanding of a client’s physical
state, and to help them set SMART, safe and achievable goals, the NAFC
recommends conducting the following fitness assessments: postural, body
composition, cardio-respiratory, muscular strength, muscular endurance
and flexibility. In addition, maintaining a record of biometric numbers (i.e.
blood pressure, pulse oxidation, heart rate, and other vital measurements)
are also valuable resources in understanding the total client.
Notes:
4
Assessing for Postural
and Functional Analysis
Not only must a client’s body fat be assessed, which is often what trainers
think of as a first assessment, a trainer must also be aware of a client’s
individual biomechanics. This can initially be achieved by assessing
posture. It is highly recommended that you complete an analysis for all
newcomers to any weight training or exercise training program.
This chapter provides a basic understanding of how to assess posture. To

guide your learning, the NAFC has created a 2-page Postural Assessment
form, located at the end of this manual, which you can download, print, and
use for all new clients. As such, and as you progress through this chapter
on postural and functional analysis, it will be beneficial to reference this
document throughout your study.
Postural Analysis, once mastered, is a very valuable assessment tool. It

involves not only recognizing the way a person sits, but evaluating the
ways in which they walk and stand. A skilled postural analysis can
drastically modify the exercises you need to emphasize with your clients.
Functional Analysis, to complement postural analysis, is the observance

of physical movements that can give you insights into the actual
biomechanics behind your clients’ movements. The way a person walks or
moves can say a great deal about where muscle imbalances may be
located. By observing movement patterns, you will be able to recommend:
 muscles that need stretching
 muscles that need strengthening
 necessary exercises to help correct these imbalances
Knowing which exercises and which stretches to use with your clients will
enable you to design a program that will bring changes more quickly than
you can imagine. If exercises, based on individual needs, are done
correctly and modified specifically, you can create a new body and an
improved frame of mind for your clients. Exercise without regard to postural
and functional deviations, however, risks reinforcing abnormalities and
diminishing training effectiveness. Additionally, pain from workouts may
occur and future problems may be exacerbated.
As your knowledge and understanding of the biomechanics behind posture

and function progresses, you can create programs that will produce truly
amazing results. Helping to restore a person’s posture will help increase
athletic performance, alleviate biomechanical stress that produces aches
and pains, improve the overall health of your clients, and will help your
clients feel better and be better able to function at a higher level.
Postural Assessments
Posture is determined by a multitude of factors, including: emotional state,

body type, habits, heredity, and muscular balance. Most importantly,
posture is determined by our vestibular and proprioceptive systems and the
feedback the body produces. Our proprioceptive and vestibular systems
control the body’s balance and coordination. Fortunately, core work and
balance training help to develop these systems, and when done correctly, it
becomes possible to change sub-clinical postural deviations by stimulating
feedback centers.
Proper analysis requires that you look at the entire body while observing
individual parts. As tedious as that may sound, as your skills improve, you
will find that the body generally follows specific patterns of movement.
Gravity assists in this, and the human body is sensitive to the forces of
gravity. In fact, a large percentage of the brain is dedicated to
counteracting gravity’s forces. So, the body will always alter itself to
accomplish two things:
 It uses balance to remain upright and functional.

 It shifts itself entirely in order to keep the eyes level for coordination,
balance, and reflexes.
Assessing Movement
Feet and gait evaluation will allow you to understand the kinetic chain and
how it is ultimately affected by movement. As a trainer, you need to
understand that the angle of the joints and bones are just as crucial as
understanding muscular dysfunctions that cause misalignments, then
include adjustments in your program to strengthen weakened areas while
working to increase the length in other areas. Making observations about
the feet and ankles, recognizing common shifts while walking and standing,
and examining the body from the side view will help you to perform an
effective postural assessment.
Two Common Shifts
Beginning with the feet and working up the body, is how to begin to
evaluate the effects gravity has had on the body. As the eye becomes
more skilled, you will notice patterns in the ways in which people move and
walk and differences in the soles of the shoes. Once able to identify these
patterns, you will be able to apply exercises that address an individual’s
balances and imbalances, strengths and weaknesses. One detail you will
notice most quickly is that people tend to commonly shift their weight one
way or another. These shifts have ramifications on posture and movement.
Shift One: An individual’s hips are uneven, which creates a mild scoliosis,
or curvature of the spine. This produces a shoulder height difference, which
also creates a head tilt. When this person stands, he/she usually stands on
the shorter leg. Standing on the shorter leg levels the eyes, which
normalizes coordination and reflexes. However, this creates a muscle
imbalance which will worsen overtime, will create aches and pains, can
increase headaches, and can lead to visceral disease.
Shift Two: An individual has not maintained an adequate level of exercise

or completed core exercises. They will likely have little to no abdominal
strength, which can contribute to hyperlordosis, which is an exaggerated
curve in the lumbar spine or a swayback. This condition brings the body’s
weight backwards, thus making it difficult to stand. As a result, the body
reacts by creating kyphosis, an exaggerated rounding of the back, and an
anterior head carriage, or protrusion of the head and chin. With this shift,
the body is balanced, but it is biomechanically stressed. Symptoms such as
low back pain or shoulder pain may be present.
Being aware of common shifts in the body will prepare you to plan
programs for clients. To begin, start with the feet and work your way up the
body as you begin to evaluate the effects of gravity on the body.
Eventually you will start to see patterns and learn the exercises to correct
them. Practice each day watching various people’s gait (the way the walk;
their stride) and observe closely for shifts and compensations throughout
the body. With practice, you will develop a practiced eye for detail.
Understanding Pronation and Supination: Foot-Ankle Evaluation
When examining the feet for pronation or supination, examine the ways in
which your client’s feet turn in or out.
In looking at the feet for pronation, you will notice your client walks on the
inside of their feet, which creates a flattened arch. This individual typically
suffers from plantar fasciitis and will also have bunions. In addition, they
may walk more pigeon-toed, and are likely to have a callus under their big
toe. Lastly, you may also notice a heel whip, which is an external rotation
of the femur that causes rotational misbalances and excessive load on the
hips, ankles, and feet.
On the other hand, individuals whose feet are in supination will typically
walk on the outsides of their soles. You may notice an external rotation of
the feet and your subject may have a callus on the outside of the foot.
When examining your client look for (and ask yourself):
 Does their ankle dive in or out in calcaneal eversion or inversion?

 Is their arch flat?
 Is there a bunion?
 Is one foot different than the other? This is common in many students.
 Observe and evaluate feet when in gait. When the lead foot hits the
ground, look for the patterns of a correct heel strike and toe push off.
 Watch your student walk at least 20 paces away slowly and quickly.
 If a person is predominately a pronator then they do not get through
proper dorsiflexion and will not push off the big toe.
 If a person is predominately a supinator, you will notice that they walk
on the outside of their feet and would find it difficult to move through
plantar flexion.
 If a person has one of each it will be obvious and will affect the rest of
the kinetic chain.
 You may notice a leg length difference that could lead to back pain
due to carrying dysfunctional muscles.
The Pronated Foot: Simple Observations
 Pronation will lead to a tighter gastrocnemius, soleus and posterior

tibialis. Many runners suffer from tight Achilles tendons due to not
being able to achieve dorsiflexion.
 This can affect the knee because it cannot get through extension,
which leads to knee problems. The knee will also show more valgus
or “knocked knee”.
 Those with this type of knee tracking may have swelling and chronic
pain that will ultimately affect their gait.
 This condition can also lead to further meniscus issues, which are
more common in women than men.
 Pronation or a flattened arch may require an arch support in a shoe to
create more supination of the foot. This enables the foot better
dorsiflexion. Buying a shoe that is designed for pronation will help.
 Over-the-counter orthotics can be beneficial, but they can also

become a crutch. It is highly advised that if the person pronates, that
they avoid wearing high heels for any extended period of time.
Strategies for Dealing with Pronation
 Standing exercise: Have clients lift through the arches of their feet.
 Have them massage their feet prior to any workout or movement.
 Complete standing towel pulls. Placing a towel under their feet, have
them try to lift the towel with the muscles of their feet.
 Try to imagine playing the piano with the toes; this may be difficult
with a bunion, but will improve with practice.
 When doing any type of squats, place a small towel underneath the
arches to give the feet support when barefoot.
 Lead and demonstrate for the client. Ask them to walk slowly and to
try and push off the big toe.
 Guide the client to lunge their right foot in front of their left and make
sure their left foot is slightly internally rotated. The arms should
remain at shoulder height, since this will force dorsiflexion and
calcaneal inversion. Have your client repeat on both sides.
 Have your client lunge right foot in front of the left and do same as
above. Watch all movements carefully, and be sure to switch legs.
The Supinated Foot: Simple Observations
 Supination, or high arch, may require teaching your client to learn to

push off through the first and second ray or the “first and second toe”
when walking or running. They may need a heel support that will
create more plantar flexion.
 Supination will lead to a tighter anterior tibialis and can create shin
splints in runners and walkers. The knee will show more of a varus or
“bow-legged” position.
 Varus is more common in men and/or those who suffer from ACL
injuries. Watch the way their foot hits the ground.
 Supinators are also more prone to ankle sprains due to over-utilizing

the muscles on the outer part of the foot and ankle.
 Supination will be more common in male clients, as you will see them
walk somewhat like a duck.
Strategies for Dealing with Supination
 Clients should consider wearing a supportive shoe that does not have
too much arch support and is custom designed for a supinator.
 Over-the-counter orthotics may be beneficial.
 Prior to beginning any exercise you may also try having your client
massage their feet using therapy balls, their hands or a golf ball.
Then proceed with the following exercises:
o Stand and place a small towel under the outside of the feet
while squatting.
o Stand and place a towel under the mid-tarsal joint when

squatting.
o Stand with knees bent while swinging the arms.
o Walk and swing the arms simultaneously like “gorilla arms.”
o Standing lunge with feet parallel, reach arms upward while

focusing on lengthening the anterior tibialis.
Walking and Gait Analysis: Foot-Ankle-Knee Evaluation
 Pronation will lead to tight gastrocnemii, posterior tibialis, and

soleus. This can lead to a possible injury to the Achilles tendon.
 Tight gastrocnemii will lead to a lack of knee extension. This is due

to more effort being required for ankle dorsiflexion.
 Walking evaluation: look to see that the foot goes through toe
push off and the ankle goes through dorsiflexion.
 Walking evaluation: ask the client to walk with a natural walk, then
a wide bent knee walk like “Groucho Marx.”
Strategies for Dealing with Foot-Ankle Knee Pronation
 Standing lunge: position rear foot with hip in internal rotation, bend
and extend the front knee keeping the rear heel on the ground. Focus
on driving the heel into the floor while either keeping hands on the
waist, reaching arms above shoulders or arms below the knee. Then
add rotations in both directions focusing on keeping the heel down.
 Ask the client to complete a squat and watch which ankle dorsi flexes
with more ease.
 While in gait, this client will walk on the inside of the foot and the
knees will most likely collapse inward or are in “valgus.”
 Re-test the squat walk.
Strategies for Dealing with Foot-Ankle Knee Supination
According to NAFC advisor, Dr. Kenneth Bishop, DC, “Those who over
supinate can be at an increased risk for inversion sprains. Not only
because they have a predisposition to that movement, but because the
peroneal muscles can become inhibited and lose reactivity to different foot
positions upon strike and push off.”
Symptoms of Foot-Knee Ankle Pronation include:
 Ankle is prone to inversion sprains.

 Hyper-extended knees.
 While in gait, this individual will walk on the outside of the foot and the
knees will most likely bow out or are in “varus.”
Recommended exercises:
 Standing lunge with front leg straight and rear knee bent. Flex and
point the front foot.
 Place foot on top of the chair.
 Massage shins.
Understanding How Supination and Pronation Affect Posture:
 Pronation can lead to all of the abovementioned and ultimately can

lead to a condition known as lordosis. This individual will possibly
have low back pain, and the condition is more common in females
than in males. The pelvic carriage is anterior thus putting pressure on
the lumbar spine.
 Supination can lead to a posterior pelvic carriage, flattened lumbar

spine, and excessive thoracic spine, excessive curvature to the
cervical spine, thus causing a forward head lean. This can lead to the
condition called kyphosis.
Side View Examination

Remember, when completing a postural analysis, always observe the
person from the bottom up since upper body compensations are often from
lower body shifts. Notice how proper alignment exists when the plum line
travels slightly anterior to the lateral malleolus (ankle), through the greater
trochanter (hip), through the middle of the acromion (shoulder) and through
the ear canal.
Basic things to look for in side view include:
 Anterior head carriage: occurs when the ear canal lies forward of
the plum line.
 Shoulder protraction: occurs when the acromion of the shoulder

comes anterior of the plum line.
 Shoulder internal rotation: by standing to the side of the client,

place your hand flat across the anterior portion of the shoulder. You
should be able to see your fingernails. If the shoulder is rolled in, it
will obscure the view of your fingernails.
 Kyphosis: rounding of the thoracic spine (slouching).
 Lordosis: if the lumbar curve is accentuated, it’ classified as lordosis.
 Hyperlordosis: if the lumbar curve is over accentuated, it is

classified as hyperlordosis.
 Hypolordosis: if the lumbar is flattened, it is called hypolordosis.
 Pelvic tilt: normal pelvic position occurs when the anterior superior
iliac crest (ASIS) is level with the pubis. If the pelvis rocks forward, it
is referred to as anterior pelvic tilt. If it rocks backward, it is a
posterior pelvic tilt.
 Greater trochanter: normally, the greater trochanter lines up with the

plum line.
 Knee position: normal knee position is not locked but slightly flexed.
 Lean: normal body weight rests slightly anterior to the lateral

malleolus, up through the middle of the femur. When we shift our
body weight either forward to the toes or back on the heels, it will
create changes throughout the whole body.
Common patterns of postural abnormalities
In this course, we deal with each deviation as a group because general

correction will often help most postural abnormalities. General correction is
often required before isolation exercises will begin to take effect. Each of
the following abnormalities can exist separately, but usually they exist in
groups. In continuing education classes you will be able to separate them
one-by-one for greater postural correction capabilities.
The Knees
Again, always start your postural exam from the ground up. Oftentimes, the
knees will give you clues as to how to change a person’s body.
Normal knee position
Excessive bend
Usually caused by tight hamstrings
 Work on lengthening the hamstrings
Genu recurvatum
Hyperextension of the knees often

caused by hamstrings and quadriceps
muscle imbalance. That is, one muscle
group is greater than 75% in strength or
size than the other.
 Stretched and weak: Gastrocnemius,
hamstrings
Lower Cross Syndrome: Side View Examination
Lower Cross Syndrome occurs when your client has an anterior

lean/anterior pelvic tilt and hyperlordosis, which is characterized by the
lower half of the body swaying forward pushing the greater trochanter in
front of the plum line. This position is often created by an anterior pelvic tilt
and is often part of a hyperextension. Individuals that suffer from this
condition may present hyperextension of the knees. This position creates
compensatory tight erector spinae muscles and often low back pain.
Hyperlordosis: signified by a hyperextension of the lumbar region.
Anterior pelvic tilt: signified by ASIS tilting in front of the pubis
Tight, shortened, and weak: psoas, quadriceps, erector spinae and

quadratus lumborum
Stretched and weak: abdominals, hamstrings and gluteus maximus
Anterior lean: Signified by having the body weight forward on the toes
Modifications for Lower Cross Syndrome
These individuals usually imprint their spine on the carriage (or floor)
because they believe this is a proper neutral spine. Neutral spine for this
type usually has a mild arch. Maintaining neutral spine becomes the most
important factor in this person’s routine. It may become necessary to place
a towel under the client’s low back, as a reminder, until a greater arch can
be produced.
 Stretching the psoas becomes crucial in producing a normal curve.

Make sure a neutral spine is maintained during exercises. Also, be
sure to not overwork the psoas during exercises. Keep the core
engaged throughout all exercises.
 Place a towel under the lumbar spine.
 Stretch the calves.
 Focus on dorsiflexion to lengthen the calves.
Lower Cross Syndrome Discussion
Lower Cross Syndrome is generally caused by a muscular imbalance in the
body, from front to back. In other words it is an imbalance of muscle
strength and flexibility. These individuals generally carry their weight on
their toes (anterior lean). They generally have locked knees and muscular
imbalances between the strength of their quadriceps and hamstrings. In
order to correct these issues you will need to remind them to stand with
their weight farther back, into their heels, and remember to bend their
knees as they stand. As far as correcting the imbalance, you will need to
strengthen the core and the hamstrings. Paying special attention to psoas
stretches such as low lunges for example, will help this condition (see
picture showing knees on floor with hips pressed forward below). If the
psoas is tight, they will hyperextend the back. If one side is tighter than the
other, it will create a rotation of the hip complex, which leads to pelvic
rotation.
Upper Cross Syndrome: Side View Examination
Upper Cross Syndrome is composed of kyphosis, shoulder internal
rotation, shoulder protraction, and anterior head carriage. These together
are referred to as an Upper Cross Syndrome as they usually occur together
and are all corrected with the same exercises and stretches. This condition
is usually caused by overactive internal rotation of the shoulders, weak
external rotators, and weak scapular retractors, which overtime causes
shortening and weakening of the sternocleidomastoids and sub occipitals.
Traditionally, these individuals suffer from shoulder tightness and injuries,
headaches, and stiff necks. These individuals often have trouble relaxing.
Anterior head carriage: signified by the ear canal being anterior to the
plum line, it is often compensatory to the upper back position.
Tight, shortened and weak: sternocleidomastoid and sub-occipitals
Stretched and weak: para vertebral muscles and all hyoid muscles
Shoulder protraction: signified by shoulders anterior of the plum line
Tight, shortened and weak: pectoralis major and anterior deltoid
Stretched and weak: rhomboids, mid/lower trapezius and serratus

anterior
Shoulder internal rotation: due to overpowering internal rotators and

weak external rotators
Tight, shortened and weak: subscapularis, pectoralis major and

latissimus dorsi
Stretched and weak: infraspinatus and teres minor and posterior

deltoid
Kyphosis: distinguished by rounding of the middle back (thoracic spine)
Shortened and weak: pectoralis muscles
Stretched and weak: rhomboids, mid/lower trapezius and upper

erector spinae
Modifications for Upper Cross Syndrome
The cervical spine often needs to be supported if there is a significant

kyphosis or if the client has a significant amount of muscle in the upper
thoracic region. Lifting the head and lengthening through the neck will often
correct rounding shoulders and abdominal cervical position. This can be
easily helped by using a small 3-4 inch rolled up towel or a small yoga
block placed under the head.
For these individuals, the cervical spine is often easily fatigued and may
require extra support during cervical flexion exercises. They need to know
they can drop their heads if they begin to have pain. These individuals will
often need constant reminders to lower their shoulders.
If shoulder or neck pain occurs, you may need to adjust their posture. Often
the aches will disappear with minor adjustment. When individuals complain
of shoulder pain during exercises, most of the time they have improper
shoulder position due to postural deviations. Correcting this position often
treats the problem. If these individuals have neck pain during abdominal
exercises, you may modify the exercise by having them do a cervical
isometric exercise in all directions to strengthen weak paraspinals.
Bottom line for Upper Cross Syndrome
For individuals with this postural imbalance, do not emphasize too many
exercises that put this person into spinal flexion, such as crunches for
example. Exercises and stretches that open the chest and strengthen the
external rotators of the shoulder joint are more beneficial. Stretches that
lengthen muscles that are internal rotators such as the latissimus dorsi,
pectorals, and biceps are all also beneficial.
Crossed Pelvis Syndrome
Hip level: this is often the most

difficult to fully understand.
Pelvic function often
determines the position of most
of the body’s posture. This
position is often determined by
the position of the sacral iliac
joints (SI) and the muscular
balance surrounding those
joints.
The joints shift because of

unilateral or bilateral shifts in
the muscles.
 Unilateral shift or up shift

creating hip hiking or
antalgic posture
Shortened and weak: quadratus lumborum, psoas, and erector spinae on
the side that they are tightened or in spasm. Often, this individual will have
a positive hip drop and patellar tracking issues.
Bilateral shift or crossed pelvis syndrome
The psoas will tighten up, shifting the SI joint on that side to go anterior
superior. The SI joint on the opposite side will go posterior inferior as the
contra lateral quadratus lumborum spasms to maintain stability.
Consequently, the hamstrings, quadriceps, and erector spinae will spasm
to stabilize this area. This area eventually will become tightened and weak
or shortened and weak.
Finding balance is the solution to this problem. Find the tight and weak
muscles and balance them through a combination of stretching and
exercise. Remember most body positioning is determined by hip position.
To balance the body, stretch both sides evenly. Then stretch the tighter
side a second time to balance out the body.
Posterior View Examination
Normally, the alignment of the plum line travels down the middle of the
head through the spine. Use the inferior angle of the scapula as an
indicator of the position. Run your hand down the spine for scoliosis and
spinal rotation. Use the iliac crest as the indicators for hip level. Observe
the gluteal fold for leveling. Make sure both knees are even, as leg length
differences will be masked if they are not.
Shoulder level: Shoulders should be even but there will often be a mild
deviation due to dominant hand preference. Usually there is greater sloping
on the dominant side caused by muscular strength differences of the whole
upper back. Use upper cross protocol.
Scapular winging: The scapula should be retracted evenly on both sides

with only two or three finger widths from the spine to the scapula. Winging
is caused by protraction and internal rotation of the shoulder. Strengthening
the serratus anterior muscles provides benefit. Use upper cross protocol.
Scoliosis: Scoliosis occurs when the vertebra rotates to one side or the
other. This can be structural or functional. Either way, it is often related to
hip rotation and leg length. Try to balance muscular strength and flexibility.
Look for muscular development side-to-side in addition to vertebral
positioning. If the vertebra rotates to the right, then the spinous process
rotates to the left midline and the paravertebral muscle will spasm. Use the
Adams Test to test for functional or structural changes. If it is functional, try
to stretch the concave sides of the spine using “Mermaid” stretches. If it is
structural, use the same protocol but do not expect to see changes; they
have grown that way over time.
According to Kenneth Bishop, Doctor of Chiropractic of Integrated Body
Therapeutics, the Adams Test begins with the following procedure:
While the patient is standing, the examiner observes for rib hump when the
client attempts to touch their toes.
Interpretation: Abnormal rib hump on one side = scoliosis
Adams test is a screening test to detect the presence of a thoracic,

scoliotic curve. The client is instructed to stand with feet together, and to
bend forward, attempting to touch their toes, as the examiner stands
behind or in front of the client to observe for an asymmetrical hump on one
side of the patients ribcage. If an asymmetrical hump is observed, scoliosis
may be suspected. The client may already be aware of a scoliotic curve
and may have consulted a qualified physician for evaluation. If not, the
client should be referred to a qualified healthcare professional for further
evaluation. In adolescents, untreated scoliosis may be rapidly progressive if
not treated and may eventually become debilitating, thus evaluation is
absolutely necessary.
The NAFC strongly advises that trainers obtain a Physician’s Release form
(see back of this manual for a copy) or referral, in addition to the completed
PAR-Q, if a client has scoliosis and/or pre-existing spinal conditions.
Hip level/low back rotation: hips should be even side-to-side. Use the
iliac crest to check the level. Hip level is often related to muscular balance
of the psoas, hamstrings, quadriceps, abdominals, quadratus lumborum,
and erector spinae. Hip level is almost always compounded by leg length
differences. Create balance side-to-side and front to back through exercise
and stretching. Recommend the client to see a professional about orthotics
if the leg length difference does not seem to change over time.
Achilles tendon line: bowed away from midline, this is inversion or
supination of the feet. When bowed toward the midline, it is eversion or
pronation.
In conclusion, there are many factors that contribute to posture. Emotional

state, body type, habits, heredity, vestibular and proprioceptive systems,
and muscular balances, amongst other factors contribute to a client’s ability
to appropriately complete exercises safely and effectively. As a trainer, it is
invaluable to be able to evaluate a client’s posture. With the results of this
evaluation, the trainer can address muscle imbalances, in specific regard to
muscles that need to be lengthened and straightened, in the complete
program design for the client. The result? Your client receives a better-
rounded, individualized, complete plan that specifically targets actions and
exercises that can increase their biomechanical functioning.
Notes:
5
Assessing Body Composition
In order to lose body fat it is

necessary to first determine how
much of the body is comprised of
actual body fat (fat mass) and
how much weight makes up
muscle mass (lean body mass).
The ratio of fat mass (FM) to lean
body mass (LBM) makes up total
body composition, or total body
weight. Thus, in order to lose
body fat, both trainer and client
must be aware of body composition. This chapter will look more closely at
body composition, body fat percentage and methods used to assess it.
In past years, doctors and scientists regarded body composition using

charts that were solely based on age, height, and body type. This
information was used to direct clients towards the pursuit of what an ideal
or health weight should be; however, it also led to many inaccurate
understandings of body composition. In addition to these limited
measurements, charts used at the beginning of the 20th century
categorized weight in regards to body frame and size. However, since
these charts did not consider the vast differences amongst human bodies,
it was discovered that these measurements and charts were an ineffective
measurement tool.
Not only did these charts not take into account body weight variables,
neither did they take into consideration the amount of an individual’s body
fat. For example, if a football player used the charts of the early 20th
century to determine his body weight based on size alone, he may have
been considered as obese or very overweight. Newer methodologies have
shown that most football players have a larger muscle mass and
consequently weigh more because of their lean body mass. Lean body
mass weighs more than fat mass. When we take into account the body fat
percentage of this football player, we may learn that he is actually very
healthy – despite his heavy weight and mass.
In contrast to the football player mentioned above, there are also many who
have the appearance of being “skinny” but are inactive and unhealthy. It
was once assumed that because one was thin they were also healthy, but
science has shown that this is not always the case. When these individuals,
in spite of their thin appearance, are largely sedentary and have a high
body fat percentage, they are at risk of disease.
Both of the cases listed above give cause to evaluate body fat percentage
as a method of assessing body composition. Prior to learning how to
assess though, let us consider essential and nonessential fat in terms of
healthy body functioning and conditioning.
Essential vs. Nonessential Body Fat
The body needs a certain amount of body fat in order to survive and
function properly. When this fat is stored subcutaneously in the tissue that
lies directly beneath the skin, it has three purposes: insulation, energy and
padding. When we are feeling cold, this fat helps to provide warmth. When
running a marathon and energy is needed, this fat regulates the nutrients
the body needs and helps us cross the finish line. If we fall down, this fat
protects our muscles and organs, keeping them from injury. This necessary
percentage of body fat is distributed throughout the body in the tissues that
make up the cells, organs, and bones, and is considered to be essential
body fat. It is a necessary fat that is essential to proper body functioning
and provides insulation, protection and energy.
It is necessary to note that women require a higher percentage of essential
body fat than men. As compared to a man’s essential body fat of 3%, a
woman’s sexual organs (i.e. the breasts and uterus), require approximately
12% in order to ensure proper body functioning.
Nonessential fat, on the other hand, is an excess of fat. When stored in

excess, this accumulates in different areas. Typically, men retain excess fat
in the abdomen, whereas women store this fat around the hip and thigh
areas.
How to Assess Body

Composition
Testing for body fat

composition is not an
exact science; there is
always some margin of
error that must be
included. Depending on
the type of testing utilized, this margin of error can have up to a 4%
differential. For instance, if body composition has been tested at 25%, the
margin of error suggests it may be as low as 21% or has high as 29%. This
range of measurement error is called the Standard Error Estimate (SEE).
All body fat test measurements have a SEE, and as a professional, it is
beneficial to know not only a variety of ways to assess body fat, but also
the margin of error of the testing used most frequently. This said, ways to
assess body fat percentage, include:
Dual Energy X-Ray Absorptiometry (DXA)
 Hydrostatic Weighing
 Air Displacement (Plethysmography)
 Skinfold Measurements
 Girth Measurements
 Bioelectrical Impedance
 Body Mass Index (BMI)
 Waist Circumference
When choosing a method to determine body composition, the most

imperative reminder is to use the same technique for both pre and post-test
weight loss and muscle gain. Maintaining a consistent method of testing is
extremely important in accurately assessing progress and change. Varying
testing techniques between pre-tests and post-tests creates
inconsistencies when tracking results.
Dual Energy X-ray Absorptiometry

Dual energy x-ray is a
modern method that was
first developed to measure
bone density. Because of
the technology used during
this testing, it is now
considered the most
effective and most accurate
method of assessing overall
body fat percentage.
For this assessment, a scanner and two lasers are used; one laser is used
to measure tissue while another measures everything expect for fat. One
outcome is then subtracted from the other to determine the percentage of
total body fat. This method has the lowest SEE at +/- 1.8% which makes it
the most accurate measurement. Again, this is the best choice for body fat
assessment. Depending on your area, though, it may be difficult to find a
qualified professional with the access to appropriate technology to perform
the measurement test.
Hydrostatic Weighing
After the DXA, hydrostatic weighing is the next
best method of assessing body composition.
This, like the previous assessment, is because of
its effectiveness and accuracy. In fact, there are
several similarities between the DXA and
hydrostatic weighing. Both require a certified and
experienced professional to administer the test,
both require access to large equipment and
technical information, and both require a fitness
or other specialized lab to perform the testing.
What makes hydrostatic weighing different, though, is an understanding
that fat weighs less than muscle, or fat mass weighs more than lean body
mass. As such, this test compares “dry weight”, or land weight, to
underwater buoyant weight.
The procedure for hydrostatic weighing includes the following:
First, wearing minimal clothing, participants are asked to sit on a

specialized chair over a tank of water. This is where the first measurement
of weight is recorded. Then, as the participant is immersed 100%
underwater, they are asked to expel all of the air from their lungs. The air
that is left in the lungs is also buoyant, so if the participant does not
complete the full exhalation, they will receive a higher body fat reading. If
there is an inaccurate measure of lung capacity, the test participant will not
gain an accurate reading. For this reason, the assessor will repeat the
process mentioned more than once. This helps to ensure they get an
accurate measurement of body fat.
There are a few procedural aspects to consider prior to participating in this

type of test. First, the SEE value is estimated at +/- 2.5%. Second, this
process is time consuming and may require up to thirty minutes to
determine an accurate measurement. Third, since participants are
immersed 100% into the water, if they are claustrophobic or suffer from
aquaphobia, this will not be the best test for them. In sum up, and as a
reminder, to increase the effectiveness during the test, participants must
remember to:
 Exhale all of the air out of the lungs.

 Know they will be completely immersed under the water for 5–10
seconds at a time until an accurate reading is gathered.
 Keep the body and mind calm so the machine can get an exact
measurement.
 Be able to repeat this procedure 8–10 times if necessary.
Air Displacement (Plethysmography)
This technique is less time consuming than
hydrostatic weighing, but since it is newer
and requires a lot of expensive technology,
it may not be found in many fitness
assessment labs. Prior to beginning the
testing, the assessor measures the volume
in a “bod-pod”, or egg-like container. Then,
participants are placed into the pod, during
which time the assessor measures the
volume of the egg again. With the difference of the volume of the empty
pod and the pod with body weight added, or the amount of air that has
been displaced, the assessor can determine a participant’s body fat
percentage.
Using air displacement to determine body fat percentage is a simple,

quick procedure with a SEE of +/- 2.2%. However, scientists have not yet
invested the time to test reliability in the areas of age, ethnicity, gender, or
athletic background. As such, the validity and accuracy of the results, over
various populations, causes professionals to apply the results cautiously.
Skinfold Thickness
The Skinfold Thickness method is perhaps the cheapest, easiest, and

most accessible method available to determine body fat. In order to
conduct the test, an expert uses calipers to measure the amount of
subcutaneous body fat (fat underneath the skin) to determine the
percentage of body fat. Used commonly by fitness trainers, this testing
does not require participants to visit a specialized fitness lab; rather, it can
be done in a client’s home, at a fitness facility, a park, or anywhere a
professional chooses to take their calipers (to the client’s discretion, of
course).
Different skinfolds sites are used to test

men and women, and though there are a
number of places on the body a person
can measure to get accurate results of
body fat, the NAFC recommends taking
three skinfold measurements. For men,
the most commonly measured skinfolds
include: the chest (Figure 2.1), the
abdomen (Figure 2.2), and the thigh
(Figure 2.3). Women, on the other hand, are most commonly measured on:
the triceps (Figure 2.4), the suprailiac (Figure 2.5), and the thigh (Figure
2.3). Please note, practicing this technique often will help achieve a more
accurate and consistent reading.
Anatomical Landmarks for Skinfold Measurement
The procedure of skinfold testing is as follows:
1- Identify the anatomical location of the skinfold. Take all measurements

on the right side of the body.
2- Hold the calipers in your dominant hand perpendicular to the skinfold.
Place the pads ¼ inch directly under your fingers.
3- Release the trigger and wait 1–2 seconds before reading the dial to the
nearest 0.5mm.
4- Repeat steps 1–3 until three skinfold sites have been measured.
5- If you feel you need to re-measure any site, repeat steps 1–4 with a 20
second rest period before re-measuring the skinfold.
6- Add the sums of the three testing sites and refer to Table 5.2 for men
and Table 5.3 for women for the measurement of body fat percentage.
7- Take the given body fat percentage shown on the table and cross-
reference it with Table 5.1. This will give the individual’s classification.
There are various factors that can affect the results of skinfold testing.
When taking measurements, you want to wait until the body is properly
hydrated. Since exercising prior to the test will skew the readings, remind
participants that they are not allowed to do any exercising prior to the test.
It is prudent to have an experienced professional conduct each
measurement, and trainers need to advise each participant to follow-up
with the same professional. The same professional that conducts the pre-
test should also perform the post-test; this will help to ensure more
accurate results. Also, for the purpose of consistency, and as mentioned
earlier, be sure to take all measurements on the right side of the body. If all
of these steps are followed correctly, SEE readings of +/- 3.5% can be
easily obtained for a skinfold testing assessment. Purposeful and frequent
practice will lead to being considered a trained professional.
Percentage of Body Fat
Percent Body Fat (%)
Women 20-39 years 40-59 years 60-79 years
Essential 8-12 8-12 8-12
Low/Athletic 13-20 13-22 13-23
Recommended 21-32 23-33 24-35
Over fat 33-38 34-39 36-41
Obese ≥39 ≥40 ≥42
Men 20-39 years 40-59 years 60-79 years
Essential 3-5 3-5 3-5
Low/Athletic 6-7 6-10 6-12
Recommended 8-19 11-21 13-24
Over fat 20-24 22-27 25-29
Obese ≥25 ≥28 ≥30
Table 5.1
MEN
Sum of
under
Skinfolds 23–27 28–32 33–37 38–42 43–47 48–52 53–57 0ver 57
22
(mm)
8–12 1.3 1.8 2.4 3 3.6 4.1 4.7 5.3 5.8
13–17 3.2 3.8 4.4 4.9 5.5 6.1 6.7 7.2 7.8
18–22 5 5.6 6.2 6.7 7.3 7.9 8.5 9 9.6
23–27 6.7 7.3 7.8 8.4 9 9.6 10.2 10.7 11.3
28–32 8.3 8.9 9.5 10 10.6 11.2 11.8 12.4 12.9
33–37 9.8 10.4 11 11.6 12.2 12.8 13.3 13.9 14.5
38–42 11.3 11.9 12.5 13.1 13.7 14.3 14.8 15.4 16
43–47 12.8 13.4 14 14.5 15.1 15.7 16.3 16.9 17.5
48–52 14.2 14.8 15.4 16 16.6 17.1 17.7 18.3 18.9
53–57 15.6 16.2 16.8 17.4 18 18.5 19.1 19.7 20.3
58–62 17 17.5 18.1 18.7 19.3 19.9 20.5 21.1 21.7
63–67 18.3 18.9 19.5 20.1 20.7 21.3 21.8 22.4 23
68–72 19.6 20.2 20.8 21.4 22 22.6 23.2 23.8 24.4
73–77 20.9 21.5 22.1 22.7 23.3 23.9 24.5 25.1 25.7
78–82 22.2 22.8 23.4 24 24.6 25.2 25.8 26.4 27
83–87 23.4 24 24.6 25.2 25.8 26.4 27 27.6 28.2
88–92 24.7 25.3 25.9 26.5 27.1 27.7 28.3 28.9 29.5
93–97 25.9 26.5 27.1 27.7 28.3 28.9 29.5 30.1 30.7
98–102 27.1 27.7 28.3 28.9 29.5 30.1 30.7 31.3 31.9
103–107 28.3 28.9 29.5 30.1 30.7 31.3 31.9 32.6 33.2
108–112 29.5 30.1 30.7 31.3 31.9 32.5 33.1 33.8 34.4
113–117 30.7 31.3 31.9 32.5 33.1 33.7 34.3 34.9 35.6
118–122 31.9 32.5 33.1 33.7 34.3 34.9 35.5 36.1 36.7
123–127 33 33.6 34.2 34.8 35.5 36.1 36.7 37.3 37.9
128–132 34.2 34.8 35.4 36 36.6 37.2 37.8 38.5 39.1
133–137 35.3 35.9 36.5 37.2 37.8 38.4 39 39.6 40.2
138–142 36.5 37.1 37.7 38.3 38.9 39.5 40.1 40.8 41.4
143–147 37.6 38.2 38.8 39.4 40 40.7 41.3 41.9 42.5
148–152 38.7 39.3 39.9 40.6 41.2 41.8 42.4 43 43.6
153–157 39.8 40.4 41.1 41.7 42.3 42.9 43.5 44.1 44.8
158–162 40.9 41.5 42.2 42.8 43.4 44 44.6 45.3 45.9
163–167 42 42.6 43.3 43.9 44.5 45.1 45.8 46.4 47
168–172 43.1 43.7 44.4 45 45.6 46.2 46.9 47.5 48.1
173–177 44.2 44.8 45.5 46.1 46.7 47.3 48 48.6 49.2
178–182 45.3 45.9 46.5 47.2 47.8 48.4 49 49.7 50.3
183–187 46.4 47 47.6 48.2 48.9 49.5 50.1 50.8 51.4
188–192 47.4 48.1 48.7 49.3 50 50.6 51.2 51.8 52.5
193–197 48.5 49.1 49.8 50.4 51 51.7 52.3 52.9 53.6
198–202 49.6 50.2 50.8 51.5 52.1 52.7 53.4 54 54.6
Table 5.2
Women
Sum of
under
Skinfolds 23–27 28–32 33–37 38–42 43–47 48–52 53–57 0ver 57
22
(mm)
8–12 2.4 2.7 2.9 3.2 3.5 3.8 4 4.3 4.6
13–17 5.5 5.8 6.1 6.3 6.6 6.9 7.2 7.4 7.7
18–22 8.2 8.5 8.8 9 9.3 9.6 9.8 10.1 10.4
23–27 10.6 10.9 11.2 11.4 11.7 12 12.3 12.5 12.8
28–32 12.8 13.1 13.4 13.6 13.9 14.2 14.5 14.7 15
33–37 14.9 15.1 15.4 15.7 15.9 16.2 16.5 16.8 17
38–42 16.8 17 17.3 17.6 17.9 18.1 18.4 18.7 19
43–47 18.6 18.8 19.1 19.4 19.7 20 20.2 20.5 20.8
48–52 20.3 20.6 20.9 21.1 21.4 21.7 22 22.2 22.5
53–57 21.9 22.2 22.5 22.8 23.1 23.3 23.6 23.9 24.2
58–62 23.5 23.8 24.1 24.4 24.7 24.9 25.2 25.5 25.8
63–67 25.1 25.3 25.6 25.9 26.2 26.5 26.8 27 27.3
68–72 26.6 26.8 27.1 27.4 27.7 28 28.2 28.5 28.8
73–77 28 28.3 28.6 28.8 29.1 29.4 29.7 30 30.2
78–82 29.4 29.7 30 30.2 30.5 30.8 31.1 31.4 31.7
83–87 30.7 31 31.3 31.6 31.9 32.2 32.5 32.7 33
88–92 32.1 32.4 32.6 32.9 33.2 33.5 33.8 34.1 34.4
93–97 33.4 33.7 33.9 34.2 34.5 34.8 35.1 35.4 35.7
98–102 34.6 34.9 35.2 35.5 35.8 36.1 36.4 36.6 36.9
103–107 35.9 36.2 36.5 36.7 37 37.3 37.6 37.9 38.2
108–112 37.1 37.4 37.7 38 38.3 38.5 38.8 39.1 39.4
113–117 38.3 38.6 38.9 39.2 39.5 39.7 40 40.3 40.6
118–122 39.5 39.8 40.1 40.3 40.6 40.9 41.2 41.5 41.8
123–127 40.6 40.9 41.2 41.5 41.8 42.1 42.4 42.7 43
128–132 41.8 42.1 42.3 42.6 42.9 43.2 43.5 43.8 44.1
133–137 42.9 43.2 43.5 43.8 44.1 44.3 44.6 44.9 45.2
138–142 44 44.3 44.6 44.9 45.2 45.4 45.7 46 46.3
143–147 45.1 45.4 45.7 46 46.2 46.5 46.8 47.1 47.4
148–152 46.1 46.4 46.7 47 47.3 47.6 47.9 48.2 48.5
153–157 47.2 47.5 47.8 48.1 48.4 48.7 49 49.3 49.6
158–162 48.2 48.5 48.8 49.1 49.4 49.7 50 50.3 50.6
163–167 49.3 49.6 49.9 50.2 50.5 50.7 51 51.3 51.6
168–172 50.3 50.6 50.9 51.2 51.5 51.8 52.1 52.4 52.7
173–177 51.3 51.6 51.9 52.2 52.5 52.8 53.1 53.4 53.7
178–182 52.3 52.6 52.9 53.2 53.5 53.8 54.1 54.4 54.7
183–187 53.3 53.6 53.9 54.2 54.5 54.8 55.1 55.4 55.7
188–192 54.3 54.5 54.8 55.1 55.4 55.7 56 56.3 56.6
193–197 55.2 55.5 55.8 56.1 56.4 56.7 57 57.3 57.6
198–202 56.2 56.5 56.8 57.1 57.4 57.7 58 58.3 58.6
Table 5.3
Girth Measurements
Another way to measure the amount of body fat that has been lost or
gained is to measure an individual’s girth, or circumference.
Circumference measurements, or measuring around a site, can vary from
dominant side to non-dominate side, with the dominant side usually having
a larger circumference. However, since girth measuring requires only a
measuring tape and a system of recording measurements, it is a simple
way to assess clients.
Using the inches side of the measuring tape for each circumference
measurement, girth measurement sites should include the following. The:
Neck:
Measure across the Adam’s apple (Figure
2.6).
Chest:
Around the upper latissimus dorsi, below the
armpits, and across the broadest area of the
chest (Figure 2.7).
Biceps:
With the arm fully extended and palm facing
forward, measure each arm individually at
the maximal circumference (Figure 2.8).
Waist:
Just below the last rib and above the
hipbones, measure the narrowest point of
the waist (Figure 2.9).
Abdomen:
If no apparent waist is visible, this
measurement can be used in place of the
waist measurement. Measure at the
umbilicus level (Figure 2.9).
Hip:
Ask the client to place feet together in a
neutral stance and measure above the
gluteal fold at the widest portion of the
gluteals (Figure 2.10).
Thigh:
With legs slightly apart, measure each thigh
individually at the maximal circumference
(Figure 2.11).
Calf:
Between the knee and ankle joint, measure
each calf individually at the maximal
circumference (Figure 2.12).
Please note, although girth measurements measure a change in size, the

SEE is +/-4%. This is, in part, due to professional error. To increase
accuracy, be mindful to measure in the same locations pre and posttest.
In addition to size differences, girth measurements can be used to calculate

body fat. However, in addition to the measurements listed above, for
women it is also necessary to measure the forearm at the fullest point and
the wrist at the smallest point. To calculate, use the appropriate gender
equation for your client.
To calculate body fat using girth measurements:

1- Calculate Lean Body Mass (LBM).
2- Apply the appropriate formula:
For Males:
(weight in pounds (lbs) X 1.082) – (waist circumference in inches (in) X
4.15) + 94.42 = LBM
Example: (162 lbs X 1.082) – (31 in. X 4.15) = 141 lbs LBM
For Females:
(weight in lbs X 0.732) – (waist circumference X 0.157) – (hip
circumference X 0.249) + (forearm circumference X 0.434) + (wrist
circumference ÷ 3.14) + 8.987 = LBM
Example: (130lbs X 0.732) – (29in X 0.157) – (35in X 0.249) + (9in X
0.434) + (6in ÷ 3.14) + 8.987 = 96.695lbs LBM
3 – Subtract total weight from lean body mass
4- Body fat percentage = (body fat weight x 100) ÷ Total Body Weight
5- Based on percentage, use Table 5.1 to determine body fat classification.
Bioelectrical Impedance
Scientists developed this portable device with the idea that fat does not
conduct electricity as well as lean tissue; with the machine, the percentage
of body fat can be determined with a pre-established equation. However,
when put to use, it was discovered that results were variable and
inconsistent. Although a simple procedure in theory, unreliable results have
led to a loss of credibility for this type of testing.
When used, the process of bioelectrical impedance involves the

administration of a painless electrical current sent throughout the body’s
tissues to measure hydration levels, lean body mass and fat percentages.
Because there is a wide selection of technology that measures using this
electrical current, there is a subsequent range of SEE. Thus, depending on
the type of device used, bioelectrical impedance has a SEE of 3–4 %.
Body Mass Index (BMI)
A person’s height and weight are needed to calculate body mass index.
For much of the population, BMI is a reliable indicator of body fat and can
be used to better understand the risk for disease and other health related
issues. However, this test is not recommended for athletes, body builders,
or those with large muscle mass.
Due to the fact that calculating BMI is a relatively quick and easy method,
many doctors and exercise scientists use it to assess for obesity. After
understanding the other body fat assessment techniques, it is easy to see
that this formula is the most accessible because of the low cost and the
general availability – especially for low or constricted income populations.
To calculate BMI, use one of the formulas below:

A. Divide weight in kilograms (kg) by the square of the height in meters
(m), or
B. Multiply body weight in pounds (lbs) by 703 and divide this product by
the square of height in inches.
Example: for an individual weighing 172 lbs (78kg) at 67 in (1.7m) tall
[78 ÷ (1.7)2] can be broken down into [172lbs x 703 ÷ (67)2] which
results in a BMI of 27.
People who have a BMI that is below 18.49 are considered underweight,
while those that have a BMI between 25 – 29.99 are considered
overweight. Therefore, a measurement between the range of 18.5 and 24.9
is considered the target body fat percentage range.
If a person is overweight and measures between 25–30 BMI, he or she has

a 25% higher risk of developing illness, disease, and may experience early
mortality. When BMI is >30 the risk of illness, disease, and early mortality
increases 50–100%. Therefore, if an individual exceeds a BMI of 30, they
are considered obese and are at greater risk of disease-related health
problems. Similarly, those in the underweight and obese categories are
also at great risk of health-related disease and must be made aware of the
issues that can arise from not maintaining an appropriate BMI.
Studies have shown that many people in the United States are being
classified as obese, and this trend has continued to increase. Developing
an awareness of health issues involved with obesity can be an effective
way to combat this trend. Using the BMI method is a powerful way to get
this information out to the public, and as a result, many physicians’ offices
use it regularly with clients. However, this method is not an accurate
assessment for weight lifters, elite athletes, those with large frames, or
those with larger muscle masses. As stated early in this chapter, body
weight is not always a good indicator of body fat.
Waist Circumference/Body Shape
Due to the fact that those who develop weight around the midsection are at
greater risk for disease, physicians created a technique to quickly assess a
person’s risk of type II diabetes and risks of high blood pressure
(hypertension). Waist circumference, taken around the fullest part of the
midsection, can be done without expensive technology or equipment.
Basically, if men have a waist circumference of 40 inches or greater, or if
women have a waist circumference of 35 inches, he or she could have fat
deposits surrounding the organs (intra-abdominal), which can be more
detrimental to health than fat that lies subcutaneously.
There are many different body shapes, but the two most common are
endomorph (pear-shaped) and mesomorph (apple-shaped). Endomorph
body shapes most commonly store fat in the hips, buttocks, and thighs.
Mesomorphs, on the other hand, most frequently store fat in the
midsection. Unfortunately, the latter is at a higher risk of health issues-
which is why the waist circumference method exists.
In addition to endomorphs and mesomorphs, there is one other

classification for obese persons in regards to where fat is stored. When fat
is stored in the abdomen, this type of obesity is called Android Obesity. In
contrast, when fat is stored in the hips and thighs, it is referred to as
Gynoid Obesity. Although both are detrimental to health, people classified
with android obesity are at greater risk of damaging the internal organs. In
each of these cases – endomorphs, mesomorphs, and those diagnosed
with andriod or gynoid obesity – it is highly imperative for physicians to
assess overall health and for qualified trainers to assist both client and
physician in the quest to maintain a healthy program of exercise and
nutrition.
Disease Risk Relative to Waist Circumference (WC)

Men Disease Risk Women
< 35.5 Low < 32.5

35.5 – 40.0 Moderate 32.5 – 35.0
> 40 High > 35.0
Once the percentage of body fat has been determined, it is necessary to

look back at tables 5.1, 5.2, and 5.3 to assess body composition according
to health and fitness standards. For example, a 30-year old female, with a
19% body fat, would fall into the categories of being in excellent physical
fitness shape, have a lower risk of health issues, and at the current level of
fitness, should be able to keep the body healthy.
If an individual is classified as overweight or obese, it is advisable that they
change their lifestyle to lower their risk of health-related issues. As a
reminder, underweight individuals are also at risk of disease, especially
when essential fat percentages fall lower than 3% and 12% for men and
women, respectively.
It is also important to distinguish between those who are thin and those
who are underweight. A person who has a low body fat, but is a healthy
athlete is different from a person who is unhealthy and underweight due to
malnutrition. If a person does not maintain enough essential body fat, they
are also at an increased risk for health-related disease and early mortality.
How to Find Recommended (Ideal) Body Weight
Now that we have looked more closely at the various tools to assess body
fat percentage, the last step is to evaluate a healthy body weight. Because
television, Internet ads, and magazines can skew understandings of health,
it is imperative to help clients set healthy goals. This can be done by
matching each individual’s health objectives with a desirable body fat
percentage and the weight that coincides with it. Below are some helpful
formulas for setting ideal weight.
 Determine the pounds of the body weight (BW) that are fat (FM) by
multiplying body weight by the current percent of fat (%F) expressed
in decimal form:
o FM = BW x %F
 Determine lean body mass (LBM) by subtracting the weight from the
total body weight. Remember that anything that is not fat must be part
of lean body mass:
o LBM = BW – FM
 Select the desired body fat percentage (DFP) based on the health or
high fitness standards given in the tables earlier in the chapter.
 Compute the recommended body weight (RBW)
o RBW = LBM ÷ (1.0 – DFP)
As an example, use the following scenario to calculate the recommended

body weight for the client below:
Gender: Female Age: 19 BW: 160 lbs %F: 30% (.30)
1. FM = BW X %F 2. LBM = BW – FM
FM = 160 X .30 = 48 lbs LBM = 160 – 48 = 112 lbs
3. DFP = 22% (.22) 4. RBW = LBM ÷ (1.0 – DFP)

RBW = 112 ÷ (1.0 – .22)
Recommended Body Weight (RBW) = 112 ÷ .78 = 143.6 lbs
Body Composition Assessment with Age
Once over the age of 25, an individual is at risk of gaining 1–2 pounds each
year. This is the average estimated weight gain in the United States and is
usually in direct correlation with a lack of exercise and an increase in food
consumption. Dependent upon the goals of your client, NAFC suggests re-
assessing body composition on a monthly, bi-yearly, or yearly basis.
Frequent assessment increase awareness and your client will be more
likely to adhere to an exercise regimen. At a minimum, they are more likely
to monitor the amount of exercise they complete daily, weekly, and
monthly. When body composition and consistent exercise are included in a
healthy nutrition plan, you will increase the likelihood that your client is able
to reduce their risks of obesity and a diagnosis of a health-related disease.
As a trainer, you can help combat health risks that are attached to
unhealthy lifestyles.
To summarize, if you have access to the technology and the professionals,

obtaining body fat testing using the hydrostatic weighing or air
displacement methods are the most accurate methods in assessing overall
body fat. If these methods are unavailable, there are many other ways to
access, including: skinfold testing, girth measurements, and waist
circumference amongst others. Of these, skinfold thickness testing is the
next most accurate way to assess body fat. Finally, if these are all
unavailable, taking girth measurements and using the formulas included in
this chapter to identify target weight and body fat percentage are an ideal
way to apply industry accepted methods of assessing clients.
Due to lean body mass weighing more than fat mass, fixating on the
number presented on the scale as a measure of progress is simply
inadequate. Remember to remind your participants that these
measurements will simply show them where they are currently. They are
tools, a starting point, to be used to help them to set realistic and attainable
goals. Once goals have been identified, they should work to create healthy
habits, in the context of their individualized and specific plan. All of this
should occur simultaneously while continuing to educate clients on the
benefits of exercise, improved health, and fitness.
Using body composition assessments to measure progress will assist your

clients in their quest for better health and will allow the trainer to create a
path for the client to follow.
Notes:
6
Cardio-respiratory Assessment
According to the President’s Council on Physical Fitness and Sports

(2014), cardiorespiratory endurance can be defined as the, “body’s ability
to deliver oxygen and other nutrients to tissue and to remove waste
products over a sustained period of time.” Cardio-respiratory indicates it
deals with the heart and respiratory system, whereas cardio-pulmonary
relates to the heart and lungs. Ultimately, the cardiovascular system and its
functioning is what is addressed by cardio-respiratory, and these terms are
used interchangeably.
When we adapt to higher consumptions of oxygen through an increase in

exercise, our organs and tissues function more efficiently. For instance, if
two people weighing two different amounts, as an example, have the same
VO2 max, researchers know that the lighter person has a higher VO2 max
per kilogram, and is therefore taking in more oxygen.
So how does one assess the amount of oxygen the body is taking in? It can
be assessed by measuring the amount of oxygen during aerobic
activity that the body takes in per minute. VO2 Max is measured as liters
(l/min)per minute or milliliters per kilogram per minute (ml/kg/min). The
latter is used most frequently because measuring the weight of the body in
kilograms produces a more accurate reading.
Components of Oxygen Uptake
As was explained previously, the way to measure oxygen uptake in the

body is to measure the number of times the heart beats per minute.
Stroke volume, or the amount of blood pumped by the left ventricle in one
contraction, along with heart rate, determines cardiac output, or the amount
of blood the heart can pump per minute. This measure also shows the
amount of oxygen the organs and tissues can remove from the system.
When the body is at rest this rate is called the VO2 which is a sub-maximal
rate; whereas, when the body is in motion at maximum peak levels, the rate
is called the VO2 max or maximal rate. Because maximal-effort tests are
not able to be done in general fitness facilities, submaximal tests are used
to estimate VO2 max. Submaximal means the test does not require an all-
out effort, and the exactness of results is not the same, but these tests are
good indications of a predicting the maximal oxygen uptake for your clients.
Heart Rate
A person’s heart rate (beats per minute; pulse) is variable and is due, in
part, to the amount of exercise that is being completed. Athletes, or top
performers in elite physical shape, may have a heart rate as low as 40
beats per minute. This, however, is not typical for the average population.
At rest, the average heart pumps 60–100 beats per minute; at a maximum
rate, in contrast, the heart can pump as quickly as 200 beats per minute.
Children up to age 11 have a higher maximum heart rate than adults. This
maximum tends to decrease around the age of 12. Remember, the more
conditioned a client is, the lower their heart rate will be. Scientists speculate
that this allows the heart to have more flow per stroke, which in turn creates
more rest between beats.
Heart rate is frequently measured by the pulse felt using either the carotid
or the radial artery. When visiting a physician’s office it is not uncommon
for them to assess a client’s heart rate using the radial, or wrist, artery
(Figure 6.1). You may have experienced this when a practitioner lightly
holds on to your wrist and using their middle and index fingers, counted the
rhythmic pulse they felt at the site of the radial artery.
Similarly, you may have seen sprinters and runners using their carotid
artery, found on the neck, to assess their heart rate (Figure 6.2). After
warming up or after an intense sprint on the track, they are frequently seen
with their middle and index fingers held gently at their neck to count their
heart beats (pulse) to assess their heart rate. Pulse should be calculated
for a full minute.
Figure 6.1 Figure 6.2
Whenever conducting a heart rate assessment, it is imperative to not use

the thumb to check for a pulse. The thumb has its own pulse and may
create a miscalculation. Finally, heart rate monitors are also very beneficial
when assessing heart rate. Using the technology in the heart rate monitor,
heart rate can be displayed without stopping to calculate or count the beats
of the heart.
Stroke Volume
The blood flow per stroke has a range of about 50 milliliters to 200 milliliters
per beat. This range is dependent upon the physical aptitude of the
individual being tested. When we train our clients to withstand higher
endurance exercises, we increase the amount of blood that flows in and
away from the heart. This ability comes from the strength of the heart and
the amount of blood it pumps from the left ventricle into the body. This, in
turn, will also increase the amount of oxygen uptake your client’s body can
handle.
Assessing VO2 Max
With a goal of producing maximal effort (maximal oxygen uptake), to

determine peak energy exertion it is not uncommon for trainers and testing
professionals to require client’s to first complete a health history
questionnaire prior to completing a Vo2 max test. In addition to completing
a health history, males 45-years and older, and females 55-years and older
must also have a physician present during the test. For the health and
safety of your client, a physician must also be present if the test is being
administered on those who have a history of coronary heart disease or any
person at risk of injury. Requiring clients to complete screenings, including
health history questionnaires and Physical Activity Readiness
Questionnaires (PAR-Q) will ensure you are able to provide the safest
options for your clients.
You may remember that VO2 max is most reliably found only after
extensive sports or hospital lab testing and is often performed on elite
athletes. It is a physically demanding, exhausting, painful test that requires
active concentration as client’s exert themselves to maximal effort.
During the test, your client will be fitted with a mask and placed on a bicycle
or treadmill. In specific increments of time, the requirement of energy and
aerobic output is increased – usually involving an increase in speed and
intensity. Through obtaining measurements of volume and oxygen
concentration of inhalations and exhalations, researchers are able to
assess how much oxygen is being used. When the linear relationship of
oxygen used and exercise intensity plateaus, VO2 max has been achieved.
Testing takes no less than 4 minutes, though generally last 10–15 minutes.
While this type of lab testing is the most accurate method of assessing VO2
max, there are a number of tests that can provide trainers with reasonable
estimates of VO2 max for their clients, and are considered submaximal
tests. Remember, the most reliable estimates require the participant to
perform exercise over a few minutes.
Submaximal VO2 Testing
There are a wide variety of sub-max tests available to estimate VO2 max
levels. Submaximal tests are generally easier to administer than VO2 max
tests, and can be administered in groups, with some modifications, when
needed. Although there are more tests available than what is included in
your manual, the five submaximal (sub-max) tests that are most commonly
used to reasonably estimate VO2 max includes:
 The step test

 The 1.0 mile walk test
 The 1.5 mile run test
 The bicycle test
 The 12-minute swim test*
For reasons including accessibility of equipment and preference, trainers
typically become proficient at administering one of above tests with their
clients. However, it is beneficial to be familiar with each of the various
assessments because clients do not always fall into one category. As an
example, if a client has weak knees but loves to swim, the 12-minute swim
test would be a great option to determine their VO2 max. On the same note,
most facilities have steps available for trainer use, which makes the step
test easily administered. An option for those who would like to compare
results would be to try multiple tests and analyze the results of each. As
with all assessments, growth is reflected in consistency of measure.
Trainers should be sure to use the same test to compare pre-test and post-
test results.
Step Test
Since very little equipment is needed for the step test assessment, it is a
simple sub-max test to administer. As with VO2 max assessments, the step
test can be intense and requires clients to use concentration as they reach
their peak. If your client is unable to complete this test due to weak knees,
legs or foot problems, are in ill health, or are unable to step onto a 12-inch
platform, the 1- mile walk test, rather than the step test, is advisable.
Equipment needed: a bench or step set 12-inches high, a metronome, a

timer and or stopwatch, and something to record/measure heart rate.
Procedure:
1- Set the timer and/or alarm for 3 minutes. If able to acquire both, the
timer can be used to measure time and the alarm as an indicator to
let your client know when to stop.
2- Begin the metronome. Client’s should step to a steady 4x4 pace (up,
up, down, down). Using this beats per minute (bpm), men should
complete approximately 24 steps per minute (96 bpm). Women
should step at 88 bpm, or 22 steps per minute.
3- At the three minute mark, the client should stop stepping.
4- Using the carotid (preferable here) or radial artery, take the pulse for
15-seconds and multiply it by 4 to convert it to heart bpm.
5- Log the results on the measurement sheet. (Remember, pulse is
taken for a total of 1 minute, which is why it is multiplied by 4) after
measuring for 15 seconds).
6- Compare the results to Table 6.1 to determine your client’s
classification. Then, use this information when setting goals and
designing programs for each client.
7- To calculate Vo2 max, use the following gender-specific equations:
a. Men: VO2 max = 111.33 – (0.42 x Recovery HR)
b. Women: VO2 max = 65.81 – (0.1847 x Recovery HR)
3 Minute Step Test Results Classification
Age (years)
18-25 26-35 36-45 46-55 56-65 ≥66 Ranking
50-76 51-76 49-76 56-82 60-77 59-81 Excellent

79-84 79-85 80-88 87-93 86-94 87-92 Good
88-93 88-94 92-88 95-101 97-100 94-102 Above Average
103- 103- 104-
Average
95-100 96-102 100-105 111 109 110
113- 111- 114-
Below Average
102-107 104-110 108-113 119 117 118
121- 119- 121-
Poor
111-119 114-121 116-124 126 128 126
131- 131- 130-
Very Poor
124-157 126-161 130-163 159 154 151
52-81 58-80 51-84 63-91 60-92 70-92 Excellent
85-93 85-92 89-96 95-101 97-103 96-101 Good

104- 106- 104-
Above Average
96-102 95-101 100-104 110 111 111
Women
113- 113- 116-
Average
104-110 104-110 107-112 118 118 121
120- 119- 123-
Below Average
113-120 113-119 115-120 124 127 126
126- 129- 128-
Poor
122-131 122-129 124-132 132 135 133
137- 141- 135-
Very Poor
135-169 134-171 137-169 171 174 155
Table 6.1
Compare the results above with Table 6.2 and Table 6.3. Note that
Recover Heart Rate (RHR) less than 110 bpm are not shown in the table.
This table, and those that follow, can be used to set goals and create
cardio-respiratory programming.
Percentile Values For Maximal Aerobic Power
Age (years)
Percentile 20-29 30-39 40-49 50-59 60-69 Ranking
90 54.0 52.5 51.1 46.8 43.2 Well Above

80 51.1 48.9 46.8 43.3 39.5 Average
70 48.2 46.8 44.2 41.0 36.7 Above
60 45.7 44.4 42.4 38.3 35.0 Average
Men
50 43.9 42.4 40.4 36.7 33.1

Average
40 42.2 41.0 38.4 35.2 31.4
30 40.3 38.5 36.7 33.2 29.4 Below
20 39.5 36.7 34.6 31.1 27.4 Average
Well Below
10 35.2 33.8 31.8 28.4 24.1 Average
90 47.5 44.7 42.4 38.1 34.6 Well Above

80 44.0 41.0 38.9 35.2 32.3 Average
70 41.1 36.8 36.7 32.9 30.2 Above
Women
60 39.5 36.7 35.1 31.4 29.1 Average

50 37.4 35.2 33.3 30.2 27.5
Average
40 35.5 33.8 31.6 28.7 26.6
30 33.8 32.3 29.7 27.3 24.9 Below
20 31.6 29.9 28.0 25.5 23.7 Average
Well Below
10 29.4 27.4 25.6 23.7 21.7 Average
Table 6.3
Suggested Health-related Minimums for VO₂ Max (mL O₂/ kg/min)
VO₂ Max
Age Group Men Women
< 45 36.0 32.0
50 34.0 31.0
55 32.0 29.0
60 31.0 28.0
> 65 30.0 27.0
Rockport 1.0- Mile Walk Test
If your client is unconditioned, is injured, has weakened knees, legs, or foot

problems, or is unable to complete another type of sub VO2 max test, the
Rockport 1-Mile Walk can provide an adequate estimate of VO2 max. The
only stipulation with this assessment is that the client must aim to get their
heart rate up to 120 beats per minute. Once this heart rate has been
obtained, the client’s walk can commence.
Equipment needed: timer, a distance of 1-mile*, a calculator, and

something to record/measure heart rate (*this can be done on a treadmill.)
Procedure:
1- As a warm-up, prepare your client for the test by increasing their

heart rate to at least 120 bpm.
2- Using the timer, record how long it takes for your client to walk 1-mile.
3- Use the following equation to calculate VO2 max.
VO2 Max = 132.852 – (0.0769 x W) – (0.3877 x A) + (6.315 x G) –
(3.2649 x T) – (0.1565 x H)
W: Weight (in lbs)
A: Age (years)
G: Gender Factor—use 0 for females and 1 for males
T: Time to complete 1-mile walk (decimal value-include seconds)
H: 1- minute heart rate measured with 10 seconds of test completion
* Women ages 13 – 29 must multiply their total by 0.78 to obtain their

result.
* Men ages 13 – 29 must multiply their total by 0.83 to obtain their

result.
4- Once your client’s Rockport score has been calculated, refer to

Table 6.4 at the end of the chapter for their classification.
1.5-Mile Run Test
The 1.5 Mile run test is efficient and easy to use. It measures the amount of
time it takes a person to complete a 1.5-mile run at maximum speed. A
note of caution: the 1.5-Mile run is a challenging test and should be
performed by those who are conditioned to complete it. On average, it
takes an untrained individual 6 – 8 weeks to prepare the body to finish this
test without risk of injury. Without proper training, this test can be very
dangerous and should not be attempted; the walk test and the step test are
great alternatives. Remember, if your client is a male over the age of 45 or
a female over the age of 55, it is recommended that they receive a
physician’s clearance prior to participating in this test.
Equipment needed: timer, a distance of 1-mile*, a calculator, and

something to record/measure heart rate
*This can be done on a treadmill.
Procedure:
1- Have your client complete a short warm up.

2- When reading, using the timer, record how long it takes for your client
to run a 1.5-mile.
3- Use the following equation to calculate VO2 max estimate.
VO2 Max = 88.02 + (3.716 x G) – (0.0753 x W) – (2.767 x T)*
W: Weight (in lbs)
G: Gender Factor—use 0 for females and 1 for males
T: Time to complete 1-mile walk
H: 1- minute heart rate measured with 10 seconds of test completion
* There are a few different equations to predict VO2 max when using
the 1.5-mile run test.
Bike Test
Along with the Rockport 1-mile Walk Test, the bike test is an option for
your clients who may be overweight or who have issues with joint and
muscle pain. This assessment is appropriate for this population because
your clients are not required to support their own body weight; rather, they
are able to sit on the bike seat during the assessment. The bike test is
another submaximal test for estimating VO2.
Equipment Needed: stationary bicycle, a bike ergometer, stopwatch, a

metronome and something to record/measure
heart rate.
*It is also beneficial to have an additional person

to assess heart rate, since this needs to be
evaluated every minute for six minutes.
Procedure:
While on the bike your client will be asked to

work at a level that raises their heartbeat per
minute to 120–170. If your client is over the age
of 50, they are not required to reach these goals, but should continue to
work towards a total of 130–140 beats per minute. This will ensure the
stress on the body is not beyond its ability to recover.
Due to the variability of tests and programs used to conduct the bike test, it
is recommended that you consult with the manager at your facility to
determine how they administer the test.
12–minute Swim Test*
The swim test is the most complicated assessment to administer and due
to the ventilation that is also required when swimming, this test requires a
maximum effort and concentration. It is recommended to limit the swim test
as a last option for clients who are unable to perform any of the other
submaximal tests, as this is a maximal effort test.
The swim test will require your client to swim as far as

possible in 12 minutes. This is an area of concern as
the test administrator because bpm will be affected by
your client’s ability to swim. Other reasons that can
result in inaccurate calculations include: uneven
breathing rhythm, buoyancy differences due to weight,
exhaustion, and an inability to monitor the exertion of
energy in the water. Other variables that may limit the
accuracy of the swim test include:
 Cardio-respiratory fitness categories are determined by the distance

swim in 12 minutes. If anything interferes with your client’s ability to
swim 12 minutes their results will be skewed.
 A lack of swimming ability, or the lack of ability to swim long distances,
makes this test better for conditioned/trained swimmers.
 The swim test is considered a maximal test, thus medical clearance is
highly recommended.
Using submaximal VO2 assessments to analyze a client’s cardio-respiratory
system will enable trainers to not only be able to set moderately
challenging goals, the results of these assessments can also be used to
create plans for the continued, improved functioning of the circulatory and
cardiovascular systems, decreasing the risk of cardiovascular disease and
increasing overall quality of life.
Notes:
7
Muscular Strength and Endurance
Assessments
The amount of strength or weakness a muscle has is largely dependent

upon the ability of the muscle cells. When involved in a strength training
workout, strain is placed on muscle cells. This, in turn, increases the
number of muscle cells – causing a muscle to grow or increase in size
(hypertrophy). The reverse of this is also true. If strain on a muscle group,
perhaps primarily due to a sedentary lifestyle (i.e. rhomboids or pectoralis
major), then muscle cells will shrink or waste away, thus remaining weak
and small. This deterioration of a muscle is called atrophy. The more
muscles are able to atrophy, or decrease in size and waste away, without
adequate strength training or use, the more overall health and fitness is
compromised. A level of strength is an important component of daily living,
as it allows the body the power to perform tasks and to complete physical
feats. Muscular assessments help identify strengths and weaknesses and
those muscles/muscle groups that need to be strengthened.
There are many tests that can be used to assess muscular strength: the
handgrip strength test, the push-up test, the sit-up test, etc. One of the
most imperative components of the assessment’s accuracy, and the ability
to provide the best ability of a client’s performance, is to focus a muscular
assessment on various muscle groups.
The handgrip test solely measures the strength of the hands while
endurance and strength tests are formulated to measure the strength of the
upper body, lower body, and core muscles. Assessing the strength of many
muscle groups provides a stronger estimate of total, whole body strength.
As with all assessments and training programs, prior to initiation, clients
should complete PAR-Q and health history forms in the event a physician’s
consent is necessary.
The Handgrip Strength Test
The handgrip test is a test of grip strength. As

such, it is best when used as a supplemental,
to, additional strength assessments. This test
requires the use of a handgrip dynamometer,
which is an instrument that isometrically
measures the strength in the hand and forearm.
Handgrip strength is an isometric exercise, or one in which the angle of
the joint and the length of the muscle do not change while the exercise is
performed. Since this motion is static and there is no range of movement, it
differs greatly from other assessments. If limited in time, however, handgrip
can be quickly assessed. Also, if your client is involved in a sport that
requires gripping, throwing, catching, etc. this is a valuable assessment to
include.
Body Weight Muscular Endurance Tests
These performance tests will require your client to complete a series of

exercises that do not need much equipment. During the assessments
below, trainers measure the amount of repetitions a client can complete
without assistance and while maintaining proper form and alignment. As
with previously mentioned assessments, trainers should have a method to
record a client’s data while the tests are being conducted. Lastly, so that
clients understand what is expected while completing the tests, trainers
should be able to demonstrate each exercise.
Push-up Test: Clients perform as many push-ups as they can. There is no

time limit. When form begins to decline, or when another correct push-up
cannot be performed, the test is complete.
Abdominal Curl/Sit-Up Test: There are many variations to this test.

Some require trainers to use a metronome or taped recording; thereby,
clients complete sit-ups at a predetermined rate. An alternative to this, and
similar to the push-up test, clients complete as many sit-ups as they can
without compromising form. Another alternative still is to have clients
perform as many sit-ups as they can in a predetermined amount of time.
Whichever method is selected, trainers should be sure to use the same
method during pretest and posttest.
Triceps Dips Test: To assess upper body strength, the original version of
this assessment required clients to perform as many dips as possible on a
parallel bar. Since this equipment is not always available, an alternative to
this assessment requires clients to perform as many dips as possible in 1-
minute, and a chair can be used instead of parallel bars. Only dips
completed with proper form/alignment count towards the total.
Endurance Jump Test: This assessment can measure cardiovascular

strength and lower body endurance. During the assessment, clients jump
over a hurdle no more than 12 inches high as many times as possible in
30-seconds. The same hurdle should be used during the pretest and the
posttest.
Participation in each of the assessments listed above provides trainers an
overall view of the muscular endurance of their clients. The next type of
tests will require the use of resistance machines.
Muscle Strength and Endurance Tests Using Machines
Prior to beginning the following assessments, trainers need to decide and

make evident their goal of the assessment. Machines with resistance can
be used to assess a 1 max rep (1RM), or the most weight with which a
client can push, or a maximum weight that can be lifted for six repetitions
with accurate form/alignment (the latter is preferred if this is the
assessment chosen). If this is the goal and once the amount has been
determined, through a strength training program the trainer will work to
increase the weight so clients show gains in strength and size. If, on the
other hand, a trainer assesses endurance, they will measure the amount of
repetitions that clients can complete accurately with a lower amount of
weight. Training endurance will enable the client to lift for longer periods of
time without fatigue. To show strength gains and overall improvement, the
strength program will either increase the amount of weight that can be lifted
or will increase the amount of repetitions that can be completed accurately.
The tests below are best completed at a facility that has a variety of fitness
equipment. Because the set points on various machines can vary and
because machines can challenge muscles differently, pretests and
posttests should be completed on the same machine. Using the same
machines will increase the accuracy and validity of the assessment.
The following exercises are completed on weight machines to assess

muscular strength and endurance: lat pull down (latissimus dorsi), leg
extension (quadriceps), bench press (pectoralis major), curl up (biceps),
abdominal crunch (rectus abdominis), leg curl (hamstrings), triceps
extension triceps).
To determine the maximum amount of weight your client can lift, consider
using a chart such as the one below. Determine resistance to be used on
each lift (multiply body weight by the percentages below).
Lift % Body Weight % Body Weight Resistance Repetitions

Men (lbs) Women (lbs)
Lat Pull Down .70 .45
Leg Extension .65 .50
Bench Press .75 .45
Curl- Up, or N/A N/A
AB Crunch N/A N/A
Leg Curl .32 .25
Arm Curl .35 .18
Have clients perform the maximum number of continuous repetitions

possible and record their results in the columns provided. Remember to
use NAFC’s ANSER and R/BE Equation protocols while conducting all
tests.
Be sure to adjust each machine to fit your client. And, once completed,
Table 7.1 can be used for proper classification.
Rating Chart of Muscle Strength and Endurance Tests
% Rank Lat Pull Leg Ext. Bench Curl-Up AB Leg Curl Arm Curl
for Men Press Crunch
99 30 25 26 100 100 24 25
95 25 20 21 81 100 20 21
90 19 19 19 65 100 19 19
80 16 15 16 52 66 15 15
70** 13 14 13 44 45 13 12
60* 11 13 11 31 38 11 10
50 10 12 10 28 33 10 9
40 9 10 7 25 29 8 8
30 7 9 5 22 26 6 7
20 6 7 3 17 22 4 5
10 4 5 1 10 18 3 3
5 3 3 0 3 16 1 2
% Rank Lat Pull Leg Ext. Bench Curl-Up AB Leg Curl Arm Curl
Women Press Crunch
99 30 25 27 100 100 20 25
95 25 20 21 100 100 17 21
90 21 18 20 97 69 12 20
80 16 13 16 77 49 10 16
70** 13 11 13 57 37 9 14
60* 11 10 11 45 34 7 12
50 10 9 10 37 31 6 10
40 9 8 5 28 27 5 8
30 7 7 3 22 24 4 7
20 6 5 1 17 21 3 6
10 3 3 0 9 15 1 3
5 2 1 0 4 0 0 2
* Health Fitness Standard ** 70% or above client is at a High Physical Fitness Standard
Muscular Strength and Endurance Rating: Circle each and discuss the findings with your client.
Muscular Strength and Endurance Goals: Discuss the test results and recommend a training
program.
TABLE 7.1
Assessments for Older Populations
While many of the tests already mentioned may be appropriate for

much of the population, there is a need for modifications or
alternatives to the assessments for populations who are unable to
complete traditional exercises. The exercises below can be used in
place of other muscular endurance and strength assessments and
are appropriate for older populations.
Leg Strength:
Option 1: Chair squats can be executed with the client standing in

front of a chair. As the client squats, gently tapping the chair provides
a kinesthetic connection for them. Each time the chair is tapped
counts as one squat. See Table 7.2 for classification.
Option 2: Similar to option 1, in this version of the chair squat the

client begins sitting, rather than standing. With arms crossed at the
chest, rather on the edge of the seat for support, clients should
perform as many squats as possible for 30-seconds. Use Table 7.2
for the appropriate classification.
Option 3: Clients who have trouble with squats can complete wall
squats. The amount of time they are able to sit against the wall,
determines their classification. Use Table 7.3.
Upper Body Strength:

Option 1: A relative weight bench press can be completed on an
inclined bench for clients who have difficulty getting up and down.
Rather than a bar, the trainer may choose to have the client complete
chest presses using handheld dumbbells rather than a weighted bar
that is a percentage of the client’s bodyweight. Clients should
complete as many as possible with correct alignment/form.
Option 2: Sitting in a chair with a 4 or 5 pound and 8 pound weight

for women and men respectively, the client will complete as many
bicep curls as possible in 30-seconds. Dependent upon the client, this
test can be completed with both arms simultaneously or individually.
Specific instructions on delivering this test to elder clients can be
found at AAHPERD recommendation. Table 7.4 shows the
classification for older men and women.
AGE Below Average Average Above Average
MEN’S
60 – 64 <14 14 – 19 > 19
65 – 69 <13 13 – 18 > 18
70 – 74 <12 12 – 17 > 17
75 – 79 <11 11 – 16 > 16
80 – 84 <10 10 – 15 > 15
85 – 89 <8 8 – 14 > 14
90 – 94 <7 7 – 12 > 12
WOMEN’S
60 – 64 <12 12 – 17 > 17
65 – 69 <11 11 – 16 > 16
70 – 74 <10 10 – 15 > 15
75 – 79 <10 10 – 15 > 15
80 – 84 <9 9 – 14 > 14
85 – 89 <8 8 – 13 > 13
90 – 94 <4 4 – 11 > 11
* Adapted from http://www.topendsports.com/testing/tests/chair-stand.htm
Table 7.2
Rating Males Females
Excellent > 100 > 60
Good 75 – 100 45 – 60
Average 50 – 75 35 – 45
Below Average < 25 > 20
*From http://www.topendsports.com/testing/tests/wall-sit.htm
Table 7.3
AGE Below Average Average Above Average
MEN’S
60 – 64 <16 16 – 22 > 22
65 – 69 <15 15 – 21 > 21
70 – 74 <14 14 – 21 > 21
75 – 79 <13 13 – 19 > 19
80 – 84 <13 13 – 19 > 19
85 – 89 <11 11 – 17 > 17
90 – 94 <10 10 – 14 > 14
WOMEN’S
60 – 64 <13 13 – 19 > 19
65 – 69 <12 12 – 18 > 18
70 – 74 <12 12 – 17 > 17
75 – 79 <11 11 – 17 > 17
80 – 84 <10 10 – 16 > 16
85 – 89 <10 10 – 15 > 15
90 – 94 <8 8 – 13 > 13
* From http://www.topendsports.com/testing/tests/arm-curl.htm
Table 7.4
Assessment of Muscular Strength & Endurance

Understanding the difference between muscular strength and muscular
endurance is an important aspect to consider when helping your clients
meet their goals. If the desire is to increase muscle size, it may be
necessary to work on muscle strength which comes from heavier lifting or
“sub-maximal” lifting. This method requires performing a smaller amount of
repetitions but a greater amount of weight. If, on the other hand, the focus
is to increase muscular endurance or to appear less bulky, focusing on
increasing the number of repetitions and decreasing resistance within each
set of an exercise may be the strategy needed to help your clients reach
their goals.
Prior to initializing a strength training program, an assessment of muscular
strength helps to identify where a client is and will further assist the trainer
in establishing the best program for a client’s goals. Using classification
tables will also assist in setting the best goals for a client’s program.
Remember to increase validity, as with all assessments, the pretest and
posttest should be conducted using the same methods. Further, if the client
reports risks, maladies or dysfunctions on the PAR-Q and/or health history
screenings, a physician’s consent may first be needed prior to beginning
any type of testing.
Preparing for Muscular Assessments and Training Programming
The maximum amount of weight (max weight) a person can lift is defined
by the amount of weight they can lift for a total six repetitions. Usually,
weight lifters work up to their max weight so they do not risk injury.
To reach a “six-rep” weight goal requires a great deal of practice, drive and
dedication. When weight lifters measure their maximum resistance by
determining what amount they can lift for one repetition, it is called a 1
repetition max (1RM); however, this type of training can be dangerous.
When working towards a max weight, NAFC programming recommends
beginning this type of programming by completing six repetitions to ensure
safety.
Endurance training, in contrast, measures how much a person can lift or

push consecutively without fatigue. For instance, measuring the amount of
push-ups or squats that can be achieved (using proper form) until fatigue is
an example of endurance training. Another method demonstrating
endurance is to put a specific amount of resistance on a machine and
measure the number of times that the weight can be lifted without
compromising proper form or technique.
Resistance
A pertinent question to ask regarding the practice of weight lifting is: how
much weight is the correct amount to lift to gain the most effective results?
The amount of weight lifted is called resistance. The formula for
determining this requires the knowledge of the maximum load a client can
lift for a single repetition (1RM). Once determined, the formula can be
applied. The formula is (1 RM x .80). For example, if your client’s 1RM for
bench-press is 100 lbs. they should aim to lift 80 lbs. for 10-15 repetitions.
Most sets will not have equal repetitions because the muscles in the body
are not of equal size, ability, or function. You will want your client to
complete more repetitions for the areas of larger muscle mass (i.e. legs
and back) while the smaller muscles may support fewer reps (i.e. the
biceps and triceps). Further, exercises that require multiple joints will
support higher repetitions (i.e. bench press and leg press). It is common
that people complete between three and twelve repetitions per each set.
This, of course, depends on their goals. With more repetitions comes more
strength. The more moderately challenging repetitions you require your
clients to perform well, the more muscular strength they will develop.
An alternative to the 3 to 12 repetition programming listed above is a

progressive resistance training style. Progressive resistance training
style enables clients to lift increasingly heavier weights overtime. When
your client lifts 80% of their 1RM overtime the body will strengthen and that
amount will not require the same effort. When the client is not as
challenged by that amount, more weight should be added. For example, a
training program requires a client to leg press 200 lbs. for 12 repetitions for
3 weeks. If at the end of the third week they no longer feel fatigue, the
amount lifted may be increased by five to ten pounds. This will ensure the
client consistently develops stronger muscles.
If your client does not feel comfortable working with a weight amount that is
80% of their 1 RM, lifting a lesser amount will still incite change. They may
feel more comfortable lifting a lesser weight with an increase in repetitions.
Muscle and endurance will increase overtime. Many body-builders lift this
way because increasing repetitions creates an increase in blood flow;
therefore, muscles look larger to the naked eye. This tactic of pumping up
ones’ muscles is often for show and is not a permanent way to increase
muscle size or hypertrophy of the body.
If uncertain about determining the most appropriate repetition to assign to

your client, it is safe to begin with 10 repetitions. This amount ensures
results and effective training. If your client works to lift 60-80% of their 1 RM
amount, and perform ten repetitions per set for each muscle group, they
will be working towards a healthier and stronger body.
Sets
Now that you have determined how much your client should lift and how
many repetitions they should complete, the next step in developing their
program is to determine how many sets they will complete. Sets are
basically the number of times a group of repetitions will be completed.
If your client bench presses 100 lbs. and they lift that amount ten times and
rest, how many times do they need to complete this action to see results?
An adequate amount of sets is one to three, yet these amounts will vary
according to each individual’s goals, progress, and resistance used.
If your client is pressed for time, performing 1 set per 8 – 12 repetitions will
increase results (if that weight is close to the 1 RM amount). Muscles will
get more exercise if 2 – 3 sets per repetition amount are completed. Lifting
more than this on a continued basis will increase fatigue, requiring the
muscles to subsequently need more recovery time in between weight
training days. Two to three days of strength training per week is a sufficient
amount for most of the population.
Similar to repetition numbers, you can increase the amount of sets

performed according to the size and function of the muscles working.
Exercises that work larger muscle groups and multi-joint muscles, like the
bench and leg press, can withstand more sets than smaller muscle groups,
like bicep curls and knee extensions. Keeping this in mind will help develop
stronger muscle groups while not fatiguing the smaller ones.
In sum, there are a number of muscle assessments that can be used to

help a client reach their goals. Use these assessments to decide how to
further strengthen muscle groups using reps and sets that work well with
your client and the amount of time they will dedicate to their training
program.
Lastly, be sure to review the documents supplied in the appendix. These

tools will help you develop strong programming for your clients, programs
obtain valuable information from your clients. With this information, you will
be able to create sustainable strength and change for your clients.
Notes:
8
Flexibility Assessments and Training
What is the importance of flexibility for weight loss, muscle endurance or

power? Some ask, “Why should I spend time stretching after my workout
when I barely have enough time to complete my workout?” These
questions are valid and they are indicative of why most people do not
stretch properly after an exercise session. The fact of the matter is
stretching takes time and it is not easy to measure the results right away.
Working to improve a client’s flexibility and their ability to stretch properly

can directly affect their ability to complete aerobic sessions and longer
weight training lifts. When muscles are not stretched properly, the
ligaments begin to shorten and tighten, which limits the amount of flexibility
clients may have in a workout. These ligaments are a crucial part of proper
weight training and aerobic exercise. Imagine the limitation that comes with
the inability to fully extend a hamstring or the problems that may occur
during a strenuous run if the muscles or ligaments cannot extend properly.
Muscular Flexibility
So what is flexibility and why is it so important? Flexibility describes the

range of motion a joint can withstand without injury. Some of us have a
better ability for a higher range of flexibility depending on factors like age
and gender, but anyone can see improvement with proper training. Most
people do not realize the importance of flexibility in injury prevention, even
outside of intense training. Some people, due to a lack of flexibility, pull
muscles while performing daily tasks like vacuuming or lifting objects. If the
ligaments and muscles are not ready to be extended to a certain level, your
client is at higher risk of injury. As such, flexibility is an important
component in a balance training program.
Benefits of Flexibility
Maintaining a level of flexibility not only helps in the performance of daily

tasks, it also builds up the ability of the joints and the tissue that surrounds
those joints so that participation in extra activities, including weight training
and exercise, is possible. When muscles are more elastic and the body is
more flexible, your client will begin to feel better and their overall
performance will increase. Flexibility programs are recommended for
anyone participating in a weight training program, all people involved in
cardiovascular training, and all athletes who participate in sports. Basically,
flexibility training is needed for everyone.
When developing a stretching routine your client can practice daily or after
workouts, they may notice previously unseen benefits. Posture will
improve, which will subsequently increase the health of the back muscles
and spinal cord. Increased flexibility will contribute to better exercise and
body movements. Flexibility will also help your client look and feel more
graceful, which can be crucial to improving athletic performance and
functional movement. Remember that a flexible body can promote a more
flexible mind, as a rigid body can be a factor in a rigid mind. This becomes
more noticeable as we age. Flexibility training is good for the mind and
body and when combined with added strength, can be a tremendous factor
in improving from illness, maintaining balance, and enhanced living.
Health benefits are also seen through participation in a flexibility training
program, including proper stretching and regular stretching. One health
benefit includes relief from muscle aches, pains, and knots that are a result
of stress from work and a variety of sources. Regularly stretching also
results in a decrease of blood pressure and anxiety levels. If your client is
female and struggles with intense pain during menstruation, called
dysmenorrhea, regularly stretching has been shown to decrease the
intensity.
As previously discussed, stretching after a workout also helps to prevent

injury. After exercising intensely, muscles react by contracting. It is helpful
to lengthen and stretch them post-workout.
Although there are terrific benefits from participating in a flexibility program,

your clients must be cautious. Overstretching can cause injury, just as
under-stretching can. Educate your clients to stretch properly and when
their body indicates they have stretch too far, which is a result of stretch
reflex offered by muscle spindles and the Golgi tendons, they must listen.
Assessment of Flexibility
There are many methods to assess flexibility, but the most frequently used
test to assess hamstring flexibility is a version of a sit and reach test. While
early forms of this assessment did not take into account the length of limbs,
(i.e. shorter individuals with longer arms had a distinct advantage and
showed increased flexibility) however newer versions have modified this
form to include lever length. In addition to hamstring flexibility, other
assessments include: trunk rotation, adductor and abductor length, and
shoulder flexibility.
These assessments can be very specific, so it is best to measure flexibility
through a variety of tests to get the most accuracy. This is especially true
because all joints have different levels of flexibility and they will yield
different flexibility results. Different activities and the level of participation in
these activities, of course, require different range of motion and this has an
impact on flexibility.
As a result of their jobs and daily tasks, many of your clients will repeat the
same activities each day. For this population the Total Body Rotation Test
and the Shoulder Rotation Test, both of which measure the ability to
perform functional and common movements, are ideal for client
assessments.
Factors Affecting Flexibility
A common question heard is, “What if I am not flexible enough to begin

stretching?" It could be argued that this is exactly why someone SHOULD
start stretching! There are many factors that will affect a person’s degree of
flexibility. Some can be changed and others are out of our control.
Regardless, your client’s exercise program can include daily stretches, and
this will impact their overall flexibility. Other factors that affect flexibility are:
age, gender, genetic makeup, body fat percentage, ligament and joint
ability, bone shape, tendons and skin. Furthermore, all joints have
different abilities and the same flexibility result cannot be expected from the
hip as can be found in the knee.
When stretching is practiced daily, with slow movements and longer

allotments of time, it can greatly improve muscular flexibility. However as
an absolute minimum, the American College of Sports Medicine
recommends stretches to be performed 2 – 3 days a week. This elongation
of muscle tissue is crucial to the improvement of flexibility over a longer
period of time. The more it is practiced, the more the muscles will remain
flexible. Stretching can also improve muscular ability in shorter periods of
time. Shorter stretches, when completed after workouts, exemplifies this
and will increase muscular ability during and after a workout.
Body temperature is also important for proper stretching. One of the

reasons many people do not enjoy stretching before a workout is because
their muscles feel cold and therefore tighter. When exercising, the body
temperature rises; warmer muscles are better able to reach a greater range
of motion. This is why it is highly recommended that your clients stretch
after a workout. A warm-up is recommended before exercise. This warm-up
should include dynamic movements of concentric and eccentric actions that
increase heat and prepare the body for the workout ahead. Warming-up
before and stretching after work to ensure safety and success in recovery
before the next workout session.
Excess fat (adipose tissue) around the muscles and joints can adversely
affect flexibility too. When joints are padded with too much fat, they lose
their ability to function to their greatest ability and are hindered by much
resistance. This is another reason it is important to maintain a healthy
weight that is proportional to your height and body type.
Men may compare themselves to women who tend to be more flexible. It is

a generic truth that women are more flexible than most men, and much of
this can be attribute to lifestyle. As a result, women often have an easier
time doing deeper stretches than men, but they are also at risk of losing
this ability without proper strength training. Both men and women can
always improve their ability to stretch by sticking to consistent practice,
regardless of how uncomfortable it may seem initially. Be mindful –
sometimes, being too flexible can mean a lack of stability in the muscles
and joints, while being overly tight can mean strong and stable, but if not
stretched out, is weak due to being over-tightened.
Overall, your client needs to stay active in a flexibility program to increase

and maintain their flexibility. Many people enjoy stretching after a workout;
this may be the best time to work on flexibility and to improve range of
motion. Further, carving out a time each day to complete stretching
exercises and making this a routine will increase your client’s physical
ability, decrease their injury-risk and muscle atrophy, and improve their
overall flexibility and performance.
Flexibility for Older Adults
As the body ages, it can lose the ability to perform certain tasks, particularly
when adequate movement patterns and range of motion have not been
established. A loss of flexibility can be detrimental to the overall health an
aging population. Without strong flexibility, exercise can be painful.
Exercising through a full range of motion may be difficult and your client
may be less likely to adhere to flexibility and strength training programs. A
lack of muscular range of motion can also cause your clients to fatigue
quickly. Adding stress in ways the body has not been stressed can be
exhausting! When flexibility, aerobic exercise and strength training habits
are created early, aging populations are better able to sustain a higher
quality of life.
A lack of flexibility can severely limit the ability to do simple things like
bending down to pick up things, turning the head to see what is behind you
(especially in your car), maintaining balance when taking a walk, reaching
for an item at the back of a tall cabinet, or getting out of bed. If your client is
unable to perform basic tasks they will not be able to live alone or drive a
car, and these tasks provide feeling of independence.
Older adults frequently suffer from falls that put them in the hospital. In fact,
one of the more common types of falling involves the breaking of the
hipbone, which can be catastrophic to an independent way of life. The
maintenance of an exercise program that includes appropriate
cardiovascular, strength, and flexibility training is preventative healthcare.
Even if your client is already over the age of 60, they can still begin a
flexibility program that will help them maintain the health of their muscles
and joints. It is never too late to take steps to become healthier; however,
the sooner clients begin, the more they will benefits they will reap.
Muscular Flexibility Recommendations
Assisting clients in the development of a flexibility training program is just

as important as their cardiovascular and strength training needs. Through a
regimented training program, it is possible to stretch the joints longer and
farther. In the development of the program, be sure to include all joints and
muscles so your client receives a well-balanced program that will benefit
the entire body, and remember, at a minimum, they should stretch at least
2 -3 times a week. However, NAFC recommends participating in a
flexibility program 5 – 6 times a week.
Much like weight training, it will be necessary to overload the muscles

beyond what they are used. For many, this simply requires stretching to a
point of moderate discomfort and holding the stretch for 20 – 30 seconds. A
similar program of modified amounts of repetitions and resistance to ensure
that you are progressing can be applied to stretching. This will give the
muscles an increased range of motion and will enable your clients to
perform activities with greater ease and improved performance.
Not only should your clients stretch after workouts, a stretching or flexibility
program can be completed every day of the week. Stretches completed
prior to going to bed will help work out the stress from the day. Be sure to
also show your client how to stretch the back and core, as back pain can
be debilitating. Back pain is a common place for injury and this is in part
due to inflexibility of the core muscles and hamstrings. Stretching the back
and core muscles, especially after periods of sitting, can prevent back pain.
Types of Stretches
There are many types of stretches trainers can use with their clients. Some
of the more common include: ballistic, slow and sustained (static), dynamic
and proprioceptive neuromuscular facilitation (PNF).
Ballistic Stretching
Ballistic stretches are those that involve rapid bouncing motions to stretch
muscles and loosen ligaments. When done incorrectly, it is a dangerous
style of stretching and is not recommend for most clients. It is advised that
a physician be consulted prior to introducing this style of stretching into a
fitness program. Although some athletes perform ballistic stretches, the
NAFC does not encourage using ballistic stretching for the general
population.
Static Stretching
This form of stretching is the most common type and helps to develop
greater flexibility over a longer period of time. When stretching the muscles,
they are positioned in a way that lengthens them to a point beyond their
current length. This is how flexibility is improved. Once this is achieved, the
stretch should be held in this moderately uncomfortable position for 10 – 30
seconds. This will enable the muscle to relax and stretch and also
supports the stretch reflex. This technique is slow and easy and it should
not provide any increase in risk of injury (unless the client pushes beyond
the muscle’s capacity).
Dynamic Stretching
Dynamic stretches are most commonly performed during a warm up.

These stretches are used to prepare the body for the work that will be
completed during the workout or training session. Through dynamic
stretches, clients move through a full range of motion that includes both
concentric and eccentric actions that increase heat and prepare the body
for the workout ahead.
Proprioceptive Neuromuscular Facilitation (PNF)
Proprioceptive Neuromuscular Facilitation, or PNF stretching, was first

developed as a type of rehabilitation for the muscles. When performing
PNF stretching with clients, trainers increase the contraction and
relaxation effect on the muscles. This enables the trainer to target certain
joints and muscle groups, especially ones that may be in pain. PNF
stretching is an isometric exercise that requires a trainer to stretch a client’s
muscle in a static position rather than through a complete range of motion.
There are certain steps to follow to correctly to complete a PNF stretch:
First: once in position, your client will need to push in the direction of the
stretch so there is pressure on the joint or muscle.
Second: trainers begin to push against their client’s pressure, in the
opposite direction of the original movement, while he or she tries to hold
the position that has been established. This will force the muscle to
contract.
Third: when this has been accomplished for 5 seconds, the client will be
able to completely relax their muscle, which enables the trainer to be able
to increase the pressure on the original stretch.
Fourth: After the stretch has been deepened beyond the starting position,
begin the contraction again and try to create force against your client’s
pressure. Hold this position for 5 seconds; then, allow the client to relax
while the stretch is also released.
This procedure can be repeated until results are noticed, even increasing
the resistance time up to 30 seconds, which will allow the muscles to
contract for a longer period of time.
The effectiveness of this stretching method is high and can be more

beneficial than slow-sustained stretching because it also helps to
strengthen the muscle while it is contracted. However, it may create more
discomfort and requires trust between patient and client in order to safely/
adequately perform the stretch.
Intensity of Stretching
When it comes to feeling the intensity of stretching, it is not necessary to

feel a great amount of pain in order to increase results. In fact, if pain is felt,
too much pressure may be being applied on the joint or muscle. Be sure to
gradually work with your client towards greater flexibility through stretches
that may be mildly uncomfortable but not painful.
Two types of elongation can occur due to flexibility training and the
lengthening of soft tissue – elastic elongation and plastic elongation.
Elastic elongation is a temporary lengthening of soft tissue. This type of
stretching is often looked at as a Slinky toy. When resistance is applied, the
slinky is stretched, however, once the resistance is let go, the slinky returns
to its original shape. This is elastic elongation. Plastic elongation, on the
other hand, is a permanent lengthening of soft tissue. This is a permanent,
non-recoverable type of elongation.
Repetitions
Studies suggest it is best to do complete two to four repetitions of each

stretch. These stretches should be held for 10 – 30 seconds. Although this
might seem time-consuming, it is worth the effort and will help clients reach
optimal results. Once flexibility has been improved, hold time may be
increased to one minute, but research does not demonstrate benefits
beyond a one minute holding time. The NAFC recommends holding
stretches for 10 – 30 seconds per repetition.
Frequency
When beginning a flexibility program, encourage your clients to

stretch 5 – 6 days a week. As with other forms of training, after
completing a 6 – 8 week program gains should be noticed and
increased flexibility achieved. For continued effectiveness your client
may reduce their frequency to minimum of 2 – 3 days a week.
Stretches should continue to be held for 10 – 30 seconds for each of
the 2 – 4 repetitions.
When to Stretch
As stated, the best time to stretch is after a workout when muscles are
warm, or when it is needed in order to release the acid that builds up while
training. Some like to stretch before a workout, and although this is not
“bad”, it is better to warm up the muscles first with a short cardio routine.
Before lifting weights, your client should always do 5 – 10 minutes of
walking, jogging, or cycling so their muscles warm up with the increase in
blood flow. Your client may complete a few dynamic stretches after that,
especially stretches that move through a full range of motion and mimic the
exercise movements they will perform during their workout.
If your client participates in sports that require many impact movements like
jumping, pivoting, and springing movements, they should perform longer
warm ups, approximately 10 minutes, and stretches prior to the game,
practice, or work out. This will help them prep the muscles and prevent
injury. This type of preparation lends itself to dynamic stretches.
There is not much evidence that stretching after a workout is far superior to
any other time in the day, yet it makes sense because that is when the
muscles are contracted. When they contract, they shorten so stretching
them forces them to elongate back to their normal length or longer,
depending on the duration of the stretch. Sometimes, determining the type
of stretching that is best will involve some trial and error. Your client should
practice stretching before or after a workout and at other points in the day.
This will help them determine when and how they will accomplish the
greatest gains in flexibility.
Flexibility Programming
When adding flexibility exercises to a training program, for a balanced

program, include stretches for the:
o Neck o Erector Spinae

o Deltoids: posterior & o Pectoralis Major
anterior o Abdominals
o Gastrocnemius o Hamstrings
o Biceps o Quadriceps
o Triceps o Latissimus Dorsi
o Anterior Tibialis o Adductors & Abductors
o Rotators o Hip Flexors
Aim to create approximately 15 minutes of stretches, especially at the

conclusion of a workout. Although it may be difficult initially, if consistent,
stretching will increase the range of motion for your clients.
Contraindicated Exercises
These exercises, although often recommended in classes like yoga and

Pilates, can put strain on the muscles or joints involved and should be
avoided. Some of them include: unsupported forward flexion, toe touches,
back arches and full neck rotations. At first they may seem to be harmless,
but after many repetitions they can become harmful for unconditioned
participants. Be sure to familiarize yourself with these exercises before
asking your client to perform them. Sometimes a physical therapist or
doctor may require your client to perform some of these exercises to
rehabilitate a joint or muscle that is in pain. When asked to do these
exercises, remember to work with a professional who is qualified and
experienced to ensure your client receives the best possible outcome.
In sum, flexibility training is an important part of a balanced training
program. Not only does improving flexibility reduce the risk of injury, it also
increases range of motion and reduces pain and muscle/joint aches. In a
balanced program, increasing flexibility further benefits overall
performance, and as such, trainers should spend time educating clients
about flexibility benefits and incorporating this practice into every exercise
program.
Notes:
9
Cardiovascular Strength Programming
and Guidelines
Readiness for Exercise
When making a cognitive choice for lifestyle changes that ask clients to
modify their habits and exercise on a regular basis, it is something they
need to be ready to commit to for the long term. Obesity can greatly be tied
to poor fitness and dieting habits, and is on the rise in the United States.
Many doctors are battling the accompanying health issues that occur co-
morbidly with this condition. It has been proven that a healthy diet and
consistent exercise can benefit everyone in countless ways, but it is
necessary to adhere to healthy plans. Remember, as a trainer, you are
promoting a lifestyle change rather than a quick fix. If you can encourage
your clients to make healthy choices and stay committed to a living a
healthy life, they can expect to improve their overall quality of life.
One way to encourage your clients to get the most out of their goal to
improve their lifestyle is to immerse them in education. Suggesting they
read books and magazines on clean diet and proper diet and can become
empowering. Bringing diversity and variety into the workout will further keep
your clients on the path to health. Asking your clients to declare their goals
to loved ones, friends, and family and surrounding themselves with others
who are also setting specific, measurable, achievable, realistic, and
time-based goals will also help your client improve their quality of life.
Remember, motivation is key in making lifetime changes, and trainers are
catalysts for creating and maintaining this motivation.
Encourage clients to create lists or journals that declare their goals.

Journaling can be useful when they list the reasons for exercise. This may
include:
 increasing energy levels and losing 5 inches by June…
 increasing energy levels in 3 months so I better service others at …
 losing 5 inches from my belly by June of this year so I feel more

attractive in my clothes
Sometimes writing down the disadvantages or constraints of not exercising

can be helpful as well:
 I need to lose 20 pounds because my doctor says my heart needs to

be healthier or I will…
 My family history suggests that diabetes is prevalent ,so I need to

work on prevention because…
Once your clients have made the decision to create and stick to their goals,
trainers can help make sure they reach their goals. Maintaining a journal
will help your client recognize that the benefits of exercise far outweigh the
reasons for not exercising. This recognition will allow your clients to avoid
setbacks and relapses as they occur. Removing excuses and creating
change is a necessary step in improving health.
To maximize the benefits of working out, clients must appreciate the

intricacies of their heart muscles. Just like all other muscles in the body, the
heart will grow stronger and larger when participating in a moderately-
challenging exercise program. This muscle, one of the most important in
the body, needs proper attention through cardio-respiratory exercises.
Fortunately, there is an acronym that can be applied to teach clients the

purpose of training. The F.I.T.T. Principle, which stands for Frequency,
Intensity, Type and Time (duration), can be applied to help create and
monitor the best program to assist your clients in meeting their goals.
However, remember, it is advised for males over the age of 45, and
females over the age of 50, to consult a physician prior to beginning any
exercise program to ensure it is not too intense or strenuous for their body.
FITT
Frequency of Exercise
Frequency is the amount of exercise your client will complete each week. It
is determined by the goals of the client and the goals of the program
created for each individual client. Remember, the American College of
Sports Medicine suggests a minimum of 5–6 days of cardiovascular and 2
– 3 days of muscular endurance training exercise each week. Flexibility
should also be incorporated in training, and NAFC suggests 5–6 days of
flexibility training be completed each week. Flexibility sessions may follow
cardiovascular and muscular endurance training, and 15–30 minutes each
session is enough to release the stress placed on the muscles during
training. Many trainers create programs for clients in packages of 2 or 3
training sessions per week and this is a minimum. It is recommended that
outside of those training sessions, clients participate in other forms of
cardiovascular programming. Approximately six to eight weeks of
consistent training is necessary to truly recognize the benefit of improved
strength, posture, and physique. This time is needed to fully commit to
lifestyle changes.
Body-builders often visit the gym more frequently than other athletes; this is
because of their specific fitness goals. Since their goals are to hypertrophy,
to grow stronger and larger muscles, they often lift lower amounts of weight
more frequently to circulate larger amounts of blood to muscles, making
them appear larger. This may be achieved by lifting twice a day, with
staggered routines to target different muscle groups, but this is not
necessary for someone who is not working towards this specific goal. The
body-builder also balances lighter lifting days with strong, resistance max
training days. This provides benefits of strength, size, and definition.
Intensity of Exercise
Intensity describes the degree and rate of effort clients will exhibit in an
exercise session. This variable rate, depending on age and performance
ability of the client, will vary between 40%–85%, and is the level at which
clients should train to maximize their cardiovascular benefit. Determining
target, or training, heart rate reserve provides clients with a target heart
rate that promotes optimal training capacity based upon the difference
between maximum heart rate (MHR) and resting heart rate (RHR), which is
the heart rate reserve (HRR).
The range 40%–85% of intensity allows for training with older adults and
senior populations as well as athletic and fit populations. For “average”
clients desiring to increase overall conditioning or weight loss goals, it is
suggested they train at intensities between 60–85% of their HRR. Working
below this level of intensity may not yield the desired results, and unless
working with elite athletes, working above this intensity may cause injury.
For average clients, working between a 60–70% THR it is considered a

recovery zone. When training between 70%– 80% it is considered an
aerobic zone, which you will recall allows ATP-CP to be recreated. And,
when training in a zone that is 80% and higher, it is considered to be an
anaerobic zone.
The Karvonen formula, which measures this intensity, is a mathematical

equation that allows trainers to calculate intensity levels for their client.
Target, or training, heart rate (THR), maximum heart rate (MHR), heart rate
reserve (HRR), and resting heart rate (RHR) are applied in the calculation.
The Karvonen Formula is:
220 – age = MHR
MHR – RHR = HRR
HRR x Intensity + RHR = THR
Another way (in words) to calculate Karvonen’s formula to calculate THR:
 Find maximum heart rate by subtracting age from 220: (MHR) = 220-
AGE.
 After being sedentary for at least 20 minutes, assess resting heart
rate (RHR) by monitoring the pulse for 60 seconds.
 Subtract RHR from MHR. This equals HRR
 Find heart rate reserve (HRR) by subtracting RHR from
MHR (MHR-RHR=HRR).
 Figure out training intensity (TI) by multiplying the HRR by the percent
of output (40, 50, 60, & 85 %), then add those amounts back to RHR.
For a 30 year old with a RHR of 60 beats per minute the range of intensity
would look as follows:
MHR: 220-30=190 BPM
RHR: 60 BPM
HRR: 190-60 = 130 BPM
40% Training Intensity: (130 X .40) + 60 = 112 BPM
85% Training Intensity: (130 X .85) + 60 = 170.5 BPM
Therefore, this person works with low intensity when the heart rate is
between 112 and 125 BPM, moderate intensity between 125 and 138 BPM,
and high intensity if when working between 138 and 170.5 BPM.
Understanding how to use this formula to regulate intensity level in fitness

assessments will help you offer your clients a training edge that can help
them maximize their potential. Beginning exercisers should start out with a
lower intensity and gradually work their way up to a greater intensity. Once
a certain level of consistency has been established, training between the
60-85% intensity levels is ideal for both maintenance and improvement.
Moderate vs. Vigorous Cardiovascular Exercise
When aerobic exercise became a trend in the 70’s there was a lot of
emphasis on the level at which clients worked out, with special attention to
higher levels. However, after extensive research in the 80’s and 90’s,
scientists concluded that lower levels of exercise are also effective. As
research has continued, scientists are in agreement that although effective,
low-level exercise is not equal to high-level exercise. Although moderate-
level activities have proven to be good for the body and great for overall
health, vigorous activities are more effective, will help clients utilize workout
times more efficiently, and will help your client reach their weight loss
goals.
So what are the benefits of higher intensity workouts? At a greater intensity

calories are expended more efficiently, which can also aid in the building of
stronger muscles. This training is also important in disease prevention;
working the heart at a level where it is challenged will cause it to build
stronger defense mechanisms toward heart disease and hypertension.
Monitoring Exercise Heart Rate
When starting a cardio-respiratory endurance

program, monitoring the heart rate often is
recommended as this allows clients to experience
their boundaries of low and high intensity training.
A simple way to monitor this is by checking pulse.
For example, while running or riding a bike, ask
your client to check their pulse for fifteen seconds
and multiply that number by four to get the
number of beats per minute. Practicing this for a
5-minute duration to gain an accurate reading.
Monitoring this for the first few days of training can provide a good
indication of how the client needs to modify intensity to meet their goals.
Beginners need to remember that it is not necessary to work at the 85%

training intensity when initiating a new program – even experienced
athletes have to work up to this intensity. However, once clients are able to
reach that level, it will become easier to maintain while also making greater
gains. Consistently exercising at the 85% level will ensure excellent cardio-
respiratory conditioning and will reap the benefits that come with having a
stronger heart and a healthier oxygen intake level.
Rate of Perceived Exertion
Because it is not always convenient to stop exercise to measure heart rate,

a convenient graph with descriptive words was created to help provide an
estimate of “perceived” intensity. Borg’s Rate of Perceived Exertion Scale
(RPE), usually based on a scale of 1 – 10, is a subjective scale that can
help offer an idea of intensity, or the degree to which clients are exerting
effort based on the way they feel. For example, this scale shows that if
clients work at 60%, the perceived exertion would be somewhat hard. If
training at 70%, the perceived exertion is vigorous. So when checking for
heart rate is not an option, using RPE to understand the current levels of
exertion allows a trainer to modify this level based on the purpose of our
workouts.
Although this is a valuable tool, the RPE Scale is not as accurate as the
actual data provided by assessing heart rate. However, checking for heart
rate a few times during exercise and comparing the results with those on
the RPE scale can together be an effective way to determine desired
intensity levels.
It is necessary to note that RPE can be used to assess intensity levels of

clients who are on medications to control heart rate. If your client is on
beta-blockers, for instance, their heart rate will be stabilized. Assessing
their heartrate by measuring their pulse will provide an inaccurate
assessment of heart rate. Beta-blockers are frequently prescribed to clients
who have hypertension, glaucoma, migraines and heart conditions. Using
Borg’s RPE scale to monitor intensity is an acceptable way to assess
intensity for this population.
After intensity has been established, clients/trainers should keep a record

of the intensity of each workout. This data provides proof of change in
cardiovascular output. When training, remember to take into account the
humidity and heat, the miles above sea level, and the amount of sleep
accomplished. These factors can greatly affect performance, the level of
energy and/or the heart rate, and the effort of clients.
Time for Exercise
How often a client exercises should be tailored to fit their individual fitness
levels and goals. If the focus is on endurance training, a good place to
start for a beginning client is by setting a goal of completing 15–30
minutes of moderate exercise for three non-consecutive days a week.
After three to six weeks, the heart muscles should be stronger and
training sessions frequency and duration can be increased.
If, on the other hand, the focus is on significant weight loss, clients may
concentrate on long duration exercise sessions of 30–60 minutes, at a
moderate pace for three days a week. This style of exercise is proven to
promote weight loss and caloric expenditure in the initial stages of an
exercise plan.
If in “good” shape prior to beginning a training program, clients can work

to train three to five days a week at higher intensities. Remember to
measure the heart rate to stay well aware of the desired level of intensity.
If working out for more than five days a week, be sure the body can
physically handle this amount of training. Typically, the muscles need to
rest in between exercise days in order to reduce injury, to promote
adequate healing time and recovery.
Some professional athletes train six to seven days a week to increase their
anaerobic threshold, but this does not improve their VO2 max. A benefit to
this sort of workout plan is that the body is prepared for high endurance
challenges such as marathons, triathlons, and long distance swimming
and/or cycling. For an average population that is not working toward these
goals, this frequency may be excessive.
The United States Surgeon General recommends that Americans workout

a minimum of three to five days a week for 30–60 minutes to remain
healthy and strong. This recommendation implies that all Americans should
aim to get some sort of activity accomplished almost every day.
Duration of Exercise
So what is an ideal amount of time for clients to spend on a workout? This

will vary from person to person depending on their current performance and
their short-term and long-term goals. However, a general healthy
recommendation is that clients maintain a plan in which each session is
20–60 minutes in duration. This should be performed daily. If the goal is to
lose a significant amount of weight, this can be increased to 90 minutes,
but caution must be taken to avoid over-training. Also, remind clients they
need time to heal and recover from strenuous training sessions.
Knowing how to calculate the amount of intensity and the level of exertion
allows clients to workout “smart”. This can mean shorter workout sessions.
If clients train at an intensity level of 60%– 85% they may only have to train
for 20–30 minutes to get the same results they would achieve from a 45-
minute workout at a 50% level of intensity. For those who are older, it is
recommended to workout at a lower level of intensity while adding more
recovery time as needed.
What should clients do when they do not have time for a 30-minute workout
on consecutive days? Consider having them complete a couple of 15-
minute workouts to make up for a missed 30-minute routine. This may not
have the same effect as a continual exercise session, but they will still
benefit from this type of high-intensity program. Strong bursts of intensity,
followed with short durations of rest can maximize time and effort. In the
end, doing a little activity will be better than not doing anything at all.
Type (Mode) of Exercise
The heart is not selective, nor does it care if exercise is performed on a

bike or in a pool. If fitness classes, downhill skiing or running is preferred to
bicycling, then it makes sense to engage in these exercises. There are
many different aerobic exercises to choose from and they can all keep
clients moving: skiing, swimming, and stationary bicycling and an elliptical
are a few activities to do inside during the cold winter months. Switching to
running, walking, rollerblading, and bicycling can add variety during the
warmer summer months. Remember to choose exercises that use the
major muscle groups and have a continuous rhythm – this will ensure that
they are aerobic exercises – and select options your client enjoy.
Additionally, it is important to lift weights so injury can be prevented. This

aspect of health and heart is very important because the entire body needs
healthy muscles to complete the workouts that are in the exercise plan and
in daily functioning and lifting.
In terms of mode of exercise, clients should find something they enjoy.

When exercise is enjoyable, or when clients see the benefit of the training,
they are more likely to adhere to the training program.
Putting FITT to Practice
When beginning a new session, it is always recommended to begin with a

warm up that prepares the muscles for each intended activity. This does
not have to be intensive; instead, choose a light exercise that will prepare
the muscles for a more intense workout. Some examples include riding an
exercise bike, walking on the treadmill, doing light calisthenics, moving
through dynamic stretches, or using a rowing machine. These warm-ups
are necessary as they will help to prevent injury and to promote a
successful exercise session.
A post exercise cool down to transition from high or moderate intensity

movements is also necessary for a safe workout. A cool down plays a
major role in helping muscles discard some of the waste product (i.e. lactic
acid) built up while training. Because blood often pools in the legs after an
abrupt stop, a cool down also helps the muscles distribute the blood evenly
throughout the body. Further, a cool down can lower the heart rate and
breathing patterns gradually so the body can transition gently into a regular
breathing cycle, and the ability to regain a regular breathing pattern quickly
after training is a sign of cardiovascular health.
Including stretching and flexibility in the cool down phase is very beneficial;
muscles become more flexible and will less likely be overly tightened or
sore the following day. One of the best recommendations for an effective
cool down is to walk or to jog for five minutes immediately after finishing an
exercise session. This should be followed up with stretches and light
calisthenics. Remember that the time in between the warm-up and cool-
down periods is important; allow transitions to be smooth and gradual.
Dedicate time to this when implementing training programs.
To recap, if there is not enough time in a session, increase the intensity of

the workout and decrease the duration. Remember, a workout for 30
minutes at an intensity of 65%–85% can guarantee that clients will notice
similar results than if they were training for an hour at a low to moderate
intensity level. It is important to emphasize the need to gradually work up to
this intensity level to avoid injury. For beginners and/or those who seek
weight loss, focus on a lower intensity for longer durations of time.
In developing well-balanced programming for clients, aim to focus on

various types of training during a week and include cardiovascular,
muscular, and flexibility segments. Rotate these exercises. For instance,
one week ask clients to maintain three days of intense cardio-respiratory
fitness to promote physical and cardio endurance. Off days can be
supplemented with low intensity fitness activities and resistance training.
This type of training system will put your clients on a path of benefiting from
a healthy lifestyle. Implementing this type of exercise plan for 20–60
minutes five to six days a week is ideal. Once these new habits have been
created, clients will notice the changes in their physical appearance and
mental outlook. Consistent exercise is life changing.
Fitness Benefits of Aerobic Activities
Physicians often express how much an exercise is worth by using

metabolic equivalents (METs). METs represent the amount of energy
used during a physical activity as compared to the amount of energy that is
used during rest. For instance, while sleeping, METs are estimated at 0.9
and at rest METs are 0.1. Running at full speed, on the other hand,
produces 18.0 METs. Therefore, the greater the work during an activity, the
higher the METs numerical value will be.
So how is METs useful? Paying attention to the amount of METs used is

helpful in burning calories for weight loss. When choosing the most
effective exercise for weight loss, focus on those that use major muscle
groups and are rhythmic in nature. Some good examples are swimming,
cycling, running, rowing and stair climbing. Of course working out at a
higher intensity will burn a higher amount of calories too; this will, in turn,
help to promote an ideal and healthy weight.
The benefits of doing different activities will greatly depend on the level of
intensity. In terms of caloric expenditure, when running greater benefits can
be reaped than walking. If swimming, as opposed to doing lap after lap
without much effort, gains would be greater by adding sprints into the
session. When calculating METs, remember a greater output of energy
(frequency, intensity, time) will generally bring greater gains in results.
In various programs, pay attention to the amount of impact a certain

exercise has on a client’s body. For instance, jumping rope and playing
football both compromise the health of the joints, so they are sports and
activities that may be done at a minimum. Overworking the body will only
hinder the chances of moving forward in an exercise program, so choose
exercises wisely.
It is most important to consider that exercise must be continuous. It is

unrealistic to expect to train at high intensities for a week and notice
outstanding results the remainder of the month. Reality suggests that after
two weeks of inactivity, the benefits of exercise begin to diminish. If
exercise lacks for two to eight months, this decrease is far greater. The key
to staying with a plan lies in a client’s level of commitment and adherence.
Adhering to an Exercise Program
When clients begin to focus their efforts on creating a new lifestyle, it is

recommended to start slowly to avoid burnout. If they attempt to do too
much at once, they are more likely to fail to meet their fitness goals.
Studies show that people are more likely to adhere to new habits if
changes are added slowly and gradually. After beginning a new regime of
fitness, frequency can always be adjusted to reap the most benefit from
exercise. Heart rate should also continue to be monitored to ensure clients
stay at a level that benefits their heart and oxygen uptake; diet should
promote optimal health. Making exercises a routine part of life, rather than
something that must be done, will more likely promote adherence.
Remind your clients that starting a new plan or adding changes to a routine
is oftentimes difficult, but staying committed to this new lifestyle will pay off
in the end. Trainers must always engage their clients as they reassess their
goals, reevaluate their motivations, and treat their bodies with respect as
they endeavor to reach a “new body”. Encourage your clients to allow
themselves time to adapt to change, while being aware that obstacles will
occur and they may fall off the plan. No one is perfect and it is from these
times clients will show the most growth. Monitoring FITT goals will help put
clients on a path to achieving the goals they set for themselves and will
help your client adhere to their exercise training program.
A Lifetime Commitment
As soon as clients stray from their fitness goals they put themselves at risk
for disease and other health related issues. Maintaining a cardiovascular
fitness program requires a lifetime commitment rather than a temporary
solution. The key is to remind clients that implementing a new plan toward
health and wellness takes commitment, perseverance and practice. By
choosing to work with a trainer they have already committed to making a
change. Support your client in their goals and remind them they will reach
them with continued effort.
Notes:
10
Muscular Strength Programming
In a previous chapter, trainers learned several assessments to measure

muscular strength and muscular endurance. Detailed information was given
on determining the appropriate number of reps and sets per exercise. This
chapter dives deeper into muscular conditioning. Principles of strength
training and muscle fibers will be discussed in depth. These principles will
help the trainer design effective programs for their clients.
Factors That Affect Strength
There are four factors that are important to understand when developing
muscular strength: neural simulation, type of muscle fiber, overload, and
specificity of training. These four factors have great impact on the physical
body and the changes that develop while training.
Neural Simulation
The body is made up of a series of motor units, or motor neurons, which

are a part of the central nervous system. They form a web of neurons that
when stimulated, send neurotransmitters to the muscle fibers they are
attached to. These neurons control the movements of the muscles, and the
function of these motor neurons is to stimulate the muscles to act – which
is defined as innervation. Some parts of the body do not require a great
deal of innervations because they are not made up of many muscle fibers
(i.e. the eye), while other larger muscles have up to 1,000 muscle fibers
and require much more stimulation.
When motor neurons in the body are stimulated, this “innervation” causes
the muscles to contract on either a large or small scale, which is
determined by the amount of effort that is being expended. The more the
muscles contract, the more strength and endurance they will build up over
time. Furthermore, the more these contractions are amplified, either with
the amount of weight used or the frequency of stimulation, the larger the
muscle fibers will become.
Types of Muscular Fiber
Prior to this section we discussed the difference between aerobic, or low

intensity and oxygenated exercise, and high intensity, or non-oxygenated
exercise. Correspondingly there are muscle fibers that work with these two
types of exercise: slow-twitch muscle fibers and fast twitch muscle
fibers. In general, fast-twitch fibers help the body to perform the anaerobic
exercise while the slow twitch fibers aid in aerobic exercise. Fast twitch
fibers are used for bursts of energy, whereas slow twitch are used for
sustained activities (i.e. marathons).
When lifting weights the body utilizes fast-twitch fibers because the actions
force the muscle to perform rapid movements in a short duration of time.
However, this is not always the case with weight lifting. When slower
movements are executed and result in less strain, the body first utilizes
slow-twitch muscle fibers. However, when the workout is intensified by
completing faster or stronger movements, the body accesses the fast-
twitch muscle fibers to successfully complete actions.
The number of muscle fibers each client has is genetically pre-determined.
With exercise, though, muscle fiber abilities and strength improve. This,
enhanced recruitment of muscle fibers, is the result of training regularly.
Overload Principle
The success of weight training depends on the amount of increased force

regularly placed on the muscles. Your client will not be able to enhance
their muscle strength or endurance unless those muscles are challenged
through continuous movement and resistance training. The overload
principle states: you must improve the ability of muscle fibers and the
amount of muscle fibers used for contraction to develop the health of
your muscular system over time. In basic terms, muscles must be
continually and regularly challenged to see results. There are six primary
ways to achieve this:
 Increase the resistance placed on muscles during workouts.

 Increase the amount of repetitions completed so muscle
endurance improves over time.
 Maximize the speed at which repetitions are completed.
 Minimize the amount of rest in-between low-weight sets, as this will
improve muscle endurance, or extend the amount of rest in-between
high-weight sets to improve muscle strength.
 Vary weights to increase the amount of repetitions completed per set.
 A combination all of the above methods.
Specificity of Training
If your client wants to focus on training for a specific sport, for instance to
improve performance on the baseball field or in the swimming pool, there
are specific exercises they can do that will directly benefit their
performance. Focusing on movements performed during a specific sport
will improve the performance in that sport. This training is called specific
adaptation to imposed demand (SAID).
SAID can apply to athletes who want to improve performance or to those

with injuries who want to regain the strength of injured area. For example, a
runner might focus on endurance training for the legs so they will have
more strength during a marathon. If someone has broken an arm and
would like to build up the muscles after they atrophied in the cast, they may
complete specific arm exercises to regain strength (after a full bone
recovery and authorization from a doctor).
Basically, the SAID principle, or the specificity of training principle, supports

training specific muscle groups. When training goals target a specific
musculature, that musculature will benefit from the training.
Principles Involved in Strength Training
There are certain principles to weight training that will better help your client
make healthy gains for the body as a whole. The more education provided
to clients on weight training, the more benefits they are sure to notice. Of
course, all clients will have different reasons for practicing weight training,
therefore programs need to best suited for each individual training program.
Nonetheless, there are certain elements that all weight training programs
rely on for efficacy: mode of training, resistance, sets, frequency, and
training volume. These principles are outlined below.
Mode of Training
There are two modes of training that trainers need to familiarize themselves
with – isometric and isotonic. Isometric training is an anaerobic exercise,
which is also referred to as static muscle training, because there is no joint
movement or muscle length change. For example, when a client holds a
weight in a locked position, with resistance against their muscles, they
challenge their muscles but they do not move. Some sports that involve
isometric modes of training include: gymnastics, wrestling, mountain biking,
and alpine skiing. In each of these sports, athletes are sometimes required
to hold a certain position for long periods of time (i.e. the hand grip on your
bike) or to push or pull against an object.
These exercises will either be a part of the sports that are already being
played or your client can incorporate them into their workout. Some
examples include: putting them into the plank position (the up part of a
pushup) and holding that position for an extended period of time (i.e. 30
seconds). Another example of isometric holding patterns would be sitting
against the wall and holding the wall squat for 30-60 seconds. Exercises
like these will build muscular strength and improve bone density.
Isotonic (or dynamic) training encompasses all of the other exercises the
body does throughout a fluid range of motion. These actions are performed
daily and involve naturally lifting, such as lifting groceries, pushing a car
door closed or bending over to pick up something off the ground. These
tasks can be performed in the gym with more effort, like pushing and
pulling weights or lifting barbells.
There are two different types of dynamic training that are important to
understand: concentric and eccentric resistance. Concentric resistance
is a positive resistance that causes muscle to shorten. Eccentric resistance,
in contrast, is a negative resistance that causes muscle to lengthen. For
example, when performing a bicep curl and the weight is raised towards the
biceps, the muscle contracts and it shortens so that it can handle the
resistance. This is the concentric phase of the exercise. As the weight is
uncurled, the bicep muscle goes through an eccentric action and lengthens
to manage the resistance.
Ideally your client should focus on performing both the concentric and
eccentric phase of each action in a skilled and careful manner. It is just as
important to lower a weight properly as it is to lift it. Actually, some research
shows that eccentric motions contribute more to muscle hypertrophy (size),
yet they can also contribute to delayed onset muscle soreness (DOMS).
Weight machines are not needed to perform isotonic exercises because

body weight, free weights, and bands can create resistance. These
exercises require your client to also work to improve balance while moving
the weight from point A to point B. If working out using machines in a gym,
then all forms (fixed and variable resistance machines or isokinetic
machines) are effective. Machines, and all other forms of resistance
training, help move a chosen resistance through a desired range of motion
and the weakest angle of the joint determines the maximum amount of
weight that lifted. This range of motion is often called dynamic constant
external resistance (DCER).
More about Resistance
In recent years the technology of weight resistance training has moved in

interesting directions and scientists have developed new machines to
better assist athletes and enthusiasts on their mission for stronger muscles.
Some of the new developments are isokinetic training and variable
resistance machines. The intent of these machines is to improve the
amount of weight resistance a person’s muscles can handle in a full range
of motion, while maintaining the same amount of weight resistance for the
differing angles and joints.
With isokinetic machines the muscle is forced to contract in a uniform

manner so there is no variability in the movement. Depending on the goals
of the client, this style may be a good option. However, these exercises
and variable resistance machines have not proven to be more effective
than free weights and should not be considered superior.
Free Weights vs. Machines
Weight lifting can be traced back to the Greek society, where Greeks used
and developed various forms of heavy objects to increase muscle mass
and strength. Eventually barbells and dumbbells were invented with
improved grip position and easier maneuverability. To this day these
devices are still used to build stronger muscles and bones. However,
scientists cannot resist making improvements on many things and
enhanced mechanical devices to better aid the weight-lifting process have
been developed.
Some people argue that weight lifting machines do not have the same
effect as free weights because free weights demand that the body balance
the weight while it also works against resistance. This argument will
continue until scientists are able to determine unequivocally so that one is
much more effective than the other. For now, a strength training program
that includes both machines and free resistance are beneficial to the overall
development of muscular strength.
More about SETS
If a client is a beginner, one way trainers can ease their body into a regular
lifting regime is to always warm up the muscles by lifting fifty percent of
their 1 RM amount for the first one or two sets. This is completed before
clients complete the two to three sets of intensive lifting. For the final sets,
the muscle group should work to the point of exhaustion. This strategy, which
is called training to the point of muscular failure, will help a new client
begin to gain confidence, strength, and muscular endurance.
Delayed Onset Muscle Soreness (DOMS) is a type of muscle soreness

and muscle pain that results after a strength training workout – usually one
in which many sets of repetitions are performed. DOMS often appears one
to two days after the workout and can result in tremendous difficulty moving
the trained muscle group through a full range of motion. Although DOMS
suggests the muscle group has been worked to fatigue, most clients will not
want to experience DOMS.
There are ways you can help your client avoid this when they begin
working with increased repetitions and sets during a workout. On the first
workout day, after completing muscle assessments to determine 1RM, new
clients should begin by completing one set of light lifting per muscle group.
The next strength training day, one set of 50% RM and one set of 80% RM
and two sets can be completed. The following strength training day,
gradually increases the number of sets completed and trainers will
encourage their clients to perform one light set and two heavier sets of
lifting.
The key to gradually increasing resistance amount is to allow the body

ample time to adapt to the exercise and time to recover. This will ensure
clients do not feel overly sore or too tired to make exercise a priority.
Gradually increasing sets and resistance to a goal of completing 10–12
repetitions per 1–3 sets will encourage adherence to a strength training
program.
Various methods of recovery in between sets will provide recovery to

muscle groups during training. When lifting lower amounts of load, it is not
necessary to take long recovery breaks, 30 – 90 seconds in between sets
is more than ample time. The heavier the resistance, however, the more
time is needed in between sets. One to five minutes of recovery prior to
completing another set will allow the muscle group to rest, thus decreasing
the risk of compromising form and losing body alignment during training.
As was discussed previously, the two phosphate energy productions

systems that work to give muscles energy to contract during weight
training, which requires anaerobic energy, are the ATP and ATP-CP
systems. Creatine phosphate works to store energy in the muscles and to
maintain the level of adenosine triphosphate in the body. Adenosine
triphosphate supplies the muscles with energy so sets can be performed.
If the muscle group is not allowed enough time to regenerate back to a
balanced state, fatigue will set in and performing sets to the greatest
potential will not be possible. To allow muscles to build-up this storage of
phosphates for the next set, recovery time of one to five minutes between
sets must be allowed.
Again, be sure to adjust the amount of recovery for the type of training
employed. If the focus on working out is to improve muscle endurance and
your client is working with lighter weights and higher repetition, rest periods
are short. If your client is working towards building more strength and is
training with heavier weights and decreased repetitions, the rest period
should be slightly longer, 2–3 minutes in duration. And, if your client is
performing heavy bursting lifts, with very short repetitions, recovery should
last between 3 – 5 minutes to build up the energy store that was expended.
Circuit training, or the method of combining cardiovascular training and

strength training or several types of strength training, will allow your clients
to get the most from their workout and their time. During times of muscle
recovery, training programs can include that the client boosts their heart
rate with an alternative type of exercise. Circuit training can also include
combining other muscle groups. For example, your client may train one
muscle group (i.e. legs), and while the legs rest, abdominals can be
trained. This is a popular technique used to complement strength training
programs and will decrease wasted time during training. Consider
beginning slowly with this technique. As your client learns more and
responds to the training program, a preferred pattern of circuit training will
emerge.
Many women believe that lifting lower amounts of weights with higher reps
is the key to having a lean and less bulky body. For most, this is a myth
though; it has been proven that muscular endurance training does not
produce these results. When pairing strength training for muscle
development with cardiovascular training for weight loss (and a healthy diet,
of course) your client can develop a leaner body with decreased fat and
increased tone and definition. This is the best way to obtain the quickest
and most dramatic results.
Training Volume
A popular form of weight training called periodization is achieved by

rotating between a different volume and intensity over a set period of time.
Weight trainers practice this method to ensure they are not over training
their muscle. Most who participate in periodization change their volume and
intensity over a 12-week period. Clients can either lift lower resistance
loads with more repetitions to increase muscle size or lift heavier loads with
fewer repetitions to increase muscle strength. Modifying the amount of
weight lifted or the amount of repetitions completed modifies training
volume and will help the muscles to rest in cycles.
So how is the volume of a workout measured? Volume (V) is determined by

the following equation: V= the sum of all repetitions in a workout
multiplied by the amount of resistance that used for those repetitions.
For example, if four sets of ten repetitions using a 100 lb weight are
performed in one training session, V= (10+10+10+10) x 100 = 40 x 100 V=
4,000 OR 40 x 100= 4,000. Calculating this will help trainers cycle between
different amounts of time and intensity during a program. Keeping track of
weight and fitness goals using periodization will also help your client stay in
tune with what they hope to accomplish.
Frequency
Results are determined by frequency of exercise, level of intensity, and the

amount of weight lifted during training. If lifting a heavy resistance, two to
three days of recovery in between strength training sessions is enough to
recover. If this time is not allowed, overtraining may occur. It is possible to
train more frequently. Staggering training, (i.e. upper body one day, lower
body the next) will allow the client to train more frequently.
Typically it takes 6 to 8 weeks of consistent training to truly see results.

During this time it is suggested that the frequency of a strength training
program include at least two days of lifting each week. If the goal is
achieved within this time frame, your client may want to decrease to one
day of strength training a week. This tapering will allow for the
maintenance of the goal. If training an athlete, it is recommended that
strength training a minimum of 2 days a week with other types of physical
exercise interspersed on the other days. This will maintain adequate
muscular shape and cardiovascular functioning.
As mentioned, it is not uncommon for bodybuilders to train more frequently

than other resistance-based athletes because their priorities are tailored to
certain fitness goals.
Dietary Guidelines for Strength Training
When lifting weights, proteins and amino acids, the building blocks of
proteins, in the muscles break down and it becomes necessary to replenish
those by increasing the amount of protein consumed. The more your client
trains, the more protein they will need to stay healthy and strong. The
recommended amount of protein for the average person is 0.8 grams
per kilogram of weight. Athletes should consume between 1.2 grams and
1.7 grams of protein each day. So, a person weighing 62 kilograms
(approximately 135 pounds), will need to consume approximately 50 grams
of protein per day (.8 x 62 = 49.6). This equation can be used to determine
how much protein your client needs to maintain a healthy body weight with
the right amount of nutrients to help them stay strong.
Most Americans get a sufficient amount of protein because it is standard for

all meals to have some sort of protein portion. If this is the case for your
client, they are probably taking in enough protein already. Asking your
client to create a weekly food journal, in which they measure the amount of
protein and other nutrients they take in each day, will give them a better
idea of how much they need to increase or decrease their overall
consumption.
If your client does not consume a minimum of three portions of protein daily
and they begin a heavy workout regime, they should consider increasing
their intake amount to 1.5 grams of protein per kilogram (or 93 grams per
day). Also, if your client is vegetarian, or would like to replace that protein
intake with an increased amount of complex carbohydrates, simply
increase the amount of calories consumed by 250–500 per day. During
exercise the body will be expending a large amount of energy and calories,
particularly if they exercise often with a high intensity. The need to replace
those lost calories and nutrients is crucial for peak performance.
Most people believe that working out on an empty stomach is the best way
to burn the most calories. This misconception costs them important energy
during a workout. It is beneficial to eat a small snack that is high in protein
and/or nutrients (e.g., yogurt, salmon, fruit, nuts, or hummus) an hour or so
prior to exercising. This creates a substantial energy burst during your
workout. However, encourage your client to make sure the meal is light.
Heavy intake prior to training can create an upset or uneasy stomach.
Eating a healthy snack up to an hour after exercise is important to replenish

the nutrients your client may have lost. During exercise, muscles lose
glycogen stores and since glycogen contributes to the body’s ability to burn
fat, it needs to be replenished. Carbohydrates provide the body with this
very essential nutrient, and consuming them with added protein is a way to
improve the amount of insulin the body produces for glycogen production.
The first hours (the optimal time to increase muscle recovery is 45 minutes)
after an intense workout are the most important. Eating a snack or meal
with a preferred 4:1 carbohydrate to protein ratio will be the most
beneficial toward promoting recovery. Although a 3:1 ratio will suffice,
continuous research suggests the 4:1 as having the most benefit. Nutrients
must be replaced after intense exercise has been completed.
As a personal trainer it is important to remember that recommending diets

and writing menu plans for your client is out of your scope of practice.
Adhering to guidelines established by the United States Food and Drug
Administration (USFDA) is best practice. If a trainer desires involvement in
nutritional consulting, it is advised that they collaborate with registered
professionals or complete a comprehensive nutritional foundations course,
such as (NAFC Nutrition Foundations Course).
Notes:
11
Exercise Safety Guidelines
When creating a workout designed for the needs of your client, there are
many variables to keep in mind so effectiveness and performance are
enhanced while the likelihood of injury is decreased. Injuries are frustrating
and can be a decision maker in a person’s desire to make life changes for
his or her health. This is why it is important to progress methodically, to
make sure the right precautions are used to maintain good strength and
consistency in your client’s workout. Below are a few ideas to keep in mind
when implementing exercise into daily routine.
Make sure the training program created for your client is comprehensive –
that the entire body is included. Resist the temptation to create a program
based on strengths alone. All muscles are important and they work
together to not only keep the client healthy and strong but to create balance
and optimal functioning. If your client wants stronger arms, they also need
to work their core and shoulders. If the focus is only on certain groups your
client risks an injury in the muscular regions that are neglected. Remember,
core muscles are the most important in the body because they provide
energy for the rest. If all sessions begin or end with core training, they are
guaranteed to not be forgotten.
Prior to lifting or participating in any exercise session your client should

warm up the muscles with stretches and movements with large range of
motion. Increasing blood flow to the muscles will loosen them up and they
will be less likely to fatigue during a workout. For instance, if your client
stretches for five minutes and gets on an exercise bike for another five,
their muscles will be ready for a good workout.
When your client lifts heavy loads, be sure they are spotted well. A failure
to maintain the load could result in injury. Also, when lifting heavy weights,
be sure your client does not cheat themselves by compromising form to
prematurely increase resistance level. Lifting a load that is too heavy will
force the recruitment of other muscles and joints to complete the
movement.
If you notice your client has to jerk their body or use their back to complete
the motion, it is a good indication that the load needs to be lightened. Lifting
motions should be fluid and constant throughout the entire motion. Do not
try to increase their resistance until they have completely trained their
muscles to handle the load. Keeping proper form will reduce the likelihood
of injury.
In addition to correct weights and proper body alignment, during the

workout be sure to focus on correct balance while lifting, especially when
your client is training with free weights. The key to proper balance is a
strong core and good posture. When your client trains with free weights,
teach them to begin with lighter weights and focus on their balance. Use
mirrors to help them monitor the length of their spine and the angle of their
body. If your client has to bend or fold to complete a motion, attempt to
decrease the weight to determine if the exercise can be completed without
compromising alignment.
As stated above, first complete exercises that work core muscles and the
large muscle groups in the body so your client does not risk early fatigue.
Focus on spinal muscles, leg muscles, and shoulder muscles before
training the arms and neck. This will ensure that the most energy goes into
working the muscles that are most important for your body.
When designing a weight lifting plan, study which muscles are oppositional
so your client receives a balanced workout. This will also help to ensure the
entire body is trained. Whenever completing one muscle group, the
opposing muscles can also be trained. Some examples include: quadriceps
and hamstrings; biceps and triceps; and abdominals and back.
Your client should focus on breathing patterns when they are lifting
weights. It is easy to forget to breathe when training and many people
create the habit of holding their breath – especially while working with
heavier weights. Not breathing can create complications because it keeps
blood from getting the precious oxygen it needs in order to sustain proper
flow. When training, your client should take full breaths and try to maintain
a constant flow of oxygen to the body. Give the muscles enough time to
recover between sessions so they will be ready for the next workout. By
doing this your client can avoid injury, have more energy for the next
workout session, and energy for all they must complete during the day.
When working out, also train your client to pay attention to the way their
body feels. If their joints or muscles are sending signals that they are being
pushed beyond their capacity, the client should take it easy for a day or
two. Allowing the body ample recovery time for the muscles and joints to
recuperate is more important than the workout itself.
Again, be sure to spot your client during workout sessions, especially when
training with free weights. Because more muscles are being recruited to
stabilize the body with free weights, when the muscles fatigue your client
may need assistance. Be aware of your client, but also teach your client to
be aware of their limits.
Finish all exercise routines with a cool-down that includes adequate

stretching and flexibility movements. This will help your client avoid delayed
onset muscle soreness and injury. Teach your client to take care of their
body and they will reap the full benefits of participation in a properly
developed training program.
Training in Hot and Humid Conditions
When the outside temperature comes close to or exceeds the temperature

of the body (98.6 degrees), clients may have a difficult time maintaining a
healthy body temperature. The body naturally sweats to release heat and
this can be a problem when the air is too humid, or filled with water, for the
sweat to evaporate. These are two of the main reasons exercising in hot
and humid weather can be detrimental to health. Overheating can result in
unexpected death.
When exercising in extreme heat, your clients may feel as if they are using
all of their energy to maintain the mechanics of running, biking, swimming,
etc. However, 60–70% of that energy is not being used as mechanical
energy; it is being converted into chemical energy and releasing excess
heat. This is how the body cools down. If unable to adequately release this
heat (i.e. sweat) your client could suffer trauma.
The amount of heat the body needs to raise its temperature 1°C, or
approximately .38 calorie per pound of body weight. If a 165 pound person,
for example, is exercising in an environment where they were unable to
release heat, for every 62.7 calories (165 x .38) burned, the body
temperature will increase by that 1°C. That is, if this person were to run four
miles and burn approximately 400 calories then the body temperature
would raise by 6°C (400 ÷ 62)! This level can be dangerous for the body
and for the overall health of the runner. Even when the air temperature is
low, the percent of humidity in the air can create fatal issues.
There are three primary illnesses one can suffer from when the body
becomes overheated. In case of emergency, it is important for trainers to
be familiar with them:
 Heat cramps: result when the body begins to cramp up from the heat,
oftentimes it occurs co-morbidly with dehydration. Exercise should
immediately be ceased and attention placed on cooling off and re-
hydrating – taking in fluids that will replenish the water lost. Also,
massage may relieve the pain of heat cramps. If this alleviates the
cramps, medical attention may not be needed.
 Heat Exhaustion: feeling dizzy, faint, clammy, weak or lethargic,

profusely sweaty, or an increasing headache, may be signs of heat
exhaustion. If a client displays these symptoms, they should immediately
increase their fluid intake and get out of the heat. Encourage them to lie
down and apply a cold compresses, or cold packs, to the body. This
should reduce their body temperature. Call an ambulance if the
symptoms are not reduced within a half hour.
 Heat Stroke: an increase in body temperature, with an inability to sweat,
are indications of heat stroke. The skin will feel dry and clients may
display symptomology that further includes vomiting and diarrhea. If this
occurs seek emergency help immediately. With heat stroke, most
people become disoriented and are unable to communicate that they
need help. Call an ambulance. While waiting for the ambulance, give the
client fluids, place cold towels on his/her body and remove them from
the sun/heat if possible.
When exercising for long periods of time in controlled and uncontrolled

environments, it is beneficial to ensure clients stay properly hydrated.
When training for participation in a marathon, as an example, fluids must
be replaced as sweat increases. For every 20 minutes of exercise, 8oz of
water should be replaced. This will limit the dehydration and over-
heatedness clients may experience. While it is possible to drink too much
water during training, which can lead to cramps and sluggishness, the
average client will not do this.
When exercising for periods of time longer than an hour, water should be
replaced with a sports drink or other beverage that contains electrolytes
and glucose, as this will create sustainable energy and continued
performance for longer periods of training. Although it takes approximately
30 minutes for sugar to be absorbed, increasing hydration will allow a
continuance of performance. Drinks that are too sweet are not good for this
purpose because they slow down the amount of water the body can absorb
during exercise. It is best to stick to drinks such Powerade®, Vitamin
Water, and other electrolyte-containing drinks rather than canned soda.
When participating in prolonged bouts of exercise, beverages that contain
sugar and sodium are refreshing and are able to replenish that which the
body needs.
Extreme changes in climate can have a significant impact on the health and
performance of clients. Symptoms can range from being mild to severe,
from headaches to death. For this reason, when training in hot and humid
conditions, trainers must stay aware of the physical condition of their client,
monitor their physical performance closely, and ensure clients are properly
hydrated, being mindful to get them out of the heat when needed.
Training in Extreme Cold Climates
Because the body produces heat as a natural way to fight external cold,
clients are not as at risk when training in cold climates as they are when
training in extreme heat. Precautions, however should definitely be taken
once the training has concluded. It is not advised that clients sit in clothing
that has been drenched in sweat, particularly when the air is extremely
cold. Sweating, and being wet in an extremely cold climate may put clients
at risk of hypothermia.
There are many ways to prevent hypothermia, and being mindful of

presenting symptoms will allow clients to train outdoors safely and
effectively. Symptoms of hypothermia are noticeable and may begin with
shivering. As hypothermia sets in, these feelings can progress to include
dizziness and numbness. If this occurs, clients should be able to warm up
by moving the training session indoors. Further precautions and
recommendations will ensure the safety of the client and the integrity of the
training session. It is recommended to practice the following precautions to
ensure safety when training in extremely cold environments:
 Clothing should be layered with synthetic fibers being closest to the
skin. Wearing cotton clothing is not a good idea because it takes a
long time to lose moisture once it has been saturated.
 Wear something on the neck and head to prevent heat-loss. Keep

waterproof material on the outer layer of the skin.
 If the conditions are windy, exercise against the wind on the way out
and with the wind on the way in.
 Wear a ski mask when temperatures extremely cold.
 Always wear gloves or mittens. They will protect the hands and
generate heat.
 Carry a backpack with dry, extra clothes.
In sum, it is possible to exercise safely and effectively in a plethora of

conditions and environments. When establishing a program for your
client, take into account their needs, the accessibility to equipment, and
the goals of their program. This will ensure the program created is not
only safe but also provides diversity, variety, and excitement; all of which
will keep your clients coming back for more!
Notes:
12
Caring for the Back
Evaluating Body Posture
How many of us have ever seen a picture or taken a glance in the mirror,
just to feel surprised to see that our back is severely rounded? This poor
posture is common and most people do not pay attention to how their
posture affects their everyday life. “Text-neck” is becoming popular in a
culture that spends large amounts of time hunched over with a forward
head or with chin protruding. When into the habit of not sitting up straight,
the strength of the back muscles and the health of the spine are
immediately compromised. If we, as trainers, notice it, it is necessary for us
to educate our clients on their posture and the health of their lower back
and spine.
Many people suffer from horrible back pain, especially that which can be
attributed to the way they navigate features on their smart phone or while
sitting at a desk, in a car, or at the dinner table. The way we sit can make
individuals prone to musculoskeletal issues that arise in the neck, back,
shoulders, hips, and knees. When not aware or careful, daily patterns of
movement, which form habits, may be detrimental to healthy posture and
the overall health of the spine.
This is why it is important to analyze the ways in which your clients sit so
you can move towards implementing a program that creates a stronger
back and core, a healthier system. When posture is improved, it makes it
easier to walk, stand, sit, exercise, run, and even sleep. Fortunately, there
are exercises that can be done to improve posture and the overall health of
the back and shoulders.
One of these exercises brings awareness to posture held throughout the

day. When at a desk, ask clients to take a minute each hour to evaluate the
way they naturally sit. Have them do the same in the car and while on their
morning jog, for example. Encourage clients to think about how they hold
their shoulders and posture while standing or when they are having a
conversation with someone. Watch for the body’s relationship to gravity. Be
aware of shifts and compensations that occur throughout the day.
If after completing an initial postural assessment you want more guidance,

consider additional types of posture evaluations and professionals who can
conduct them. Of course, be sure to make sure this person is a
professional, such as an NAFC certified Pilates’ instructor or healthcare
professional. Correcting posture is very important. If you notice a postural
imbalance with your client, consider consulting a professional who is
qualified in dealing with these issues. In addition to assessments, show
your clients what correct posture looks like by encouraging them to consult
a few pictures/images that provide examples of what it looks like to sit, lift,
bend, drive, read, and stand correctly. These pictures can be used to
observe how these tasks are executed.
Using a mirror, to explicitly measure posture while standing, can be a

useful tool. To use this, your client will need a plumb line (or a line with a
weight at the end of it), a camera, and two mirrors. Place the mirrors so
they rest at an 85° angle and place the plumb line in the middle. Then,
draw another line, perhaps with a piece of tape, down the middle of the
right mirror and stand so that the line goes directly through the reflection of
your back in the right mirror while standing with your left side towards the
plumb line. Take your client’s picture so they can see their body’s angle in
the mirrors – the body according to the lines. The angles of the back and
shoulders can be measure while analyzing the image captured.
This procedure should help your clients discover how their posture is when
standing. If you do not want to do this exercise, please consult the pictures
provided in this book to compare client’s posture with the correct ones
provided. Seek out where your client needs improvement and ask them to
put it in their logbook. This will be a reminder for them to check their
posture on a regular basis. In addition, keep it as a part of their
measurements since this is an assessment tool that can be used to monitor
progress. Remember, posture can show attitude and outlook on life!
Preventing Lower Back Pain
If lower back pain is experienced for more than 3 months, it is considered

chronic. Chronic pains do not usually go away until something is done to
correct it. Although lower back pain is common amongst the greater
population, it has been determined that this pain is 80% preventable, and
there are simple ways it can be avoided. Most of the time back pain can be
attributed to poor posture (which can lead to a weak spine), a poor diet
(which ultimately yields excess weight gain), a sedentary lifestyle (which
leads to muscle atrophy), an injury, or psychological stress (which causes
muscle tension and soreness).
These poor habits can cause minor damage to the back and spine over an
extended period of time. Minor damage can build-up to a major concern
that could potentially create great pain and the inability to move or walk for
weeks.
Many consumers who have careers where they are required to frequently
lift large/heavy items (i.e. movers, warehouse workers), in addition to those
who drive as a profession, commonly report having problems with their
backs. This is because sitting for prolonged amounts of time can cause the
muscles in the back, cervical spine, thoracic spine and/or lumbar spine to
begin to lose their strength or are taxed in unnatural positions. Further, due
to atrophy of the back muscles in a sedentary lifestyle, people who have to
sit for excessive amounts of time are also at great risk of injury. If those
muscles are not involved in exercise, they are at risk of injury due to
increased weakness.
Evidence continues to support that having weak abdominal muscles is a

great contributor to lower back pain. This is due to the increased forward tilt
of the pelvis. As a result, it puts too much pressure on the spine, which
leads to back aliments. Also, it is important to maintain a healthy weight to
not build-up too much fat around the midsection. Men, because they tend
to store fat in this area, are especially prone to this.
Posture is also of great importance for lower back health. Paying attention
when sitting, standing, walking, and driving creates an awareness that it is
difficult to always have perfect posture but this awareness can also cause
posture to improve. Working with a qualified fitness professional who can
help to find neutral spine can alleviate lower back pain. Neutral spine varies
from individual to individual. Things to ask/look for include:
 Is the spine in a neutral position?

 Are the joints in correct alignment?
 Where are my muscular imbalances and compensations?
Be sure to remind clients to practice all of the positions held throughout the
day to increase good posture. Remember, the body will always go back to
what it is used to, so re-training the body to stay in correct posture will be a
continual work in progress. Good posture increases the health of the spine
and is the basis of all healthy and functional movement.
What to Do If Your Client Has Already Developed Back Pain
If back pain is persistent, even when at rest, clients should consult a

physician to make sure there is no spinal damage or serious injury.
Sometimes a physician can prescribe medications (i.e. muscle relaxers) to
help ease the debilitating pain. This pain may also be slightly relieved by
sleeping with a pillow beneath your legs to take the pressure off of the
lower back.
If low back pain lasts longer than 3 months or increases in the same time
frame, a medical professional should be consulted (i.e. a doctor or
chiropractor). For pain that persists, it is needed to make sure that there
are no serious back issues such as bone fractures, spinal stenosis or disc
herniation. A massage therapist can aid in getting the muscles back in
order and help to reduce discomfort. A consistent exercise and health
management plan is essential to stronger muscles and a healthier skeletal
system.
If there are no serious problems, there are ways to begin to reverse back
pain. First, stretches for the muscles that are in pain will make them feel
less tight and will relieve some of this discomfort. Participation in an
exercise regime will strengthen those muscles.
 Start by doing cardiovascular exercise. This will help lose weight and
will eventually relieve some of the strain that is put on the back from
an excess of weight. After a back injury rest may be required, but
when able exercise will help create change, strengthen, and relieve
pain.
 Follow up aerobic exercises with a weight-training program that

targets weakened muscles. Weight training helps to strengthen the
muscles that support the spine and also builds stronger bones. Be
careful to avoid overloading the back muscles with too much weight;
they perform many tasks during the day that are endurance based.
Complete about 12 repetitions per muscle group with a weight
amount that is not too difficult to lift.
 Finally, be sure to always stretch the muscles worked to avoid further

injury. When stretching the back muscles, be sure to not over stretch
the muscles that are strained. Instead, begin with mild force on the
muscles that are being stretched. Gradually increase that amount
over a longer period of time.
If wanting to specifically strengthen the back, it becomes necessary to
complete exercises that focus on the core muscles. Pilates is a great
modality and can increase core strength, particularly if clients are able to
find good instruction that emphasizes a therapeutic focus. There are also
specific exercises that can be completed to help the back muscles. Lower
back extensions and core strengthening exercises such as planks, lateral
trunk flexion, and pelvic tilts are often used to strengthen this area.
Completing these regularly will also increase results. Remember, staying
healthy and keeping active is the best way to heal the back. Taking pills will
only mask pain and create a false sense of healing. Strengthening can
heal.
Stress and Low Back Pain
It is noteworthy to mention that stress can negatively affect health,

especially the back. Imagine your client being in an office with a huge
looming deadline. They are furiously typing on their computer and can only
think about getting the project by their deadline. Meanwhile their muscles
are contracted and their posture is poor. Their back muscles are strained
and are contributing to the achy feeling that is present throughout their
entire body. Unfortunately, they feel they do not have time to think about
this and remain in the same position for hours. This may be the lifestyle of
many of the clients you regularly train. If this is the case, their back is going
to fail in the end and they will suffer dearly. Improved posture and muscular
strength may help to alleviate their pain. Use awareness to create change.
Through training, physical health is the most important thing to maintain

because without it your client will be rendered helpless and will not only be
restricted from performing tasks, but will be unable to complete regular
tasks. Take this into consideration when they report symptoms of stress,
some of which may be manifested in upper or lower back pain. There are
ways to overcome stress and anxiety. Ask your clients to take a minimum
of five minutes (ideally, first thing in the morning) to sit in a quiet space, and
focus on the type of deep breathing that helps to calm the nervous system
and sets the body into a position that promotes strength and length. This
technique can be used to set the mode for a non-stressful start to the day.
In conclusion, the back is a part of the core. Back pain can be debilitating
and poor habits, including poor flexibility and posture can contribute to
these debilitating symptoms. Making adjustments in training programming,
improving strength, reducing excess weight, increasing flexibility, and
adjusting alignment can both reduce upper and lower back pain and
perhaps more importantly, can prevent future pain.
Notes:
13
Training Programs for Older Adults
Exercising and Aging
After World War II there was a great “boom” in the economics and birth rate in
the United States. In 1950 alone, well over 3 million babies were born, and
that trend did not start to decrease until 1957. Sixty-five years after this boom
began there are more than 77 million Americans who are beginning to face a
retirement age. Furthermore due to advancements in technology, many of
these people will be living for much longer than their parent’s generation,
perhaps even 50 more years! This time period, which is referred to as the
baby boom, is increasingly being represented in fitness facilities and gyms
across the country.
It is for this reason that exercise amongst people over age 50 is becoming
a trend that will probably increase over the next few decades. It is
becoming acceptable for many retired people to spend part of their day
lifting weights to improve muscle strength and to incite weight loss. Even
the parents of this “older” population, this baby boom generation, are being
educated on the benefits of exercise and are practicing techniques to stay
healthier.
Doctors know it is important to encourage older adults to exercise because

it increases their chances to live independently for a longer time. When
people have stronger muscles, bones, and cardio-respiratory endurance,
they are less likely to have trouble with their motor skills, thus allowing
them to live alone longer. While some people do not mind living with
assistance, to others independence can be a precious commodity. There
are some differences in the type of exercises that aging adults can do to
ensure that they do not compromise their health and can further promote a
longer independent life.
Training Older Adults
So why is there such a large trend in exercise and weight training amongst
older adults? Scientists have found that cardio-respiratory endurance
activities, through better use of the heart and lungs, help aging populations
stay healthier for extended periods of time. Weight training helps to build
stronger bones and to create a stronger muscle mass for everyday
activities like taking out the trash, picking things up, carrying groceries,
doing yard work and cooking. There are also psychological benefits that
come from participating in an exercise program; with a healthy exercise
routine, comes feelings of vitality and physical attractiveness, both of which
can enhance mood, overall confidence, and vitality.
Although the best way to stay healthy in later years is to begin a strong
exercise and weight training program early, many do not choose this. Work
and family are frequently reasons supporting why health is not a priority in
younger years. However, increasing populations of older adults are
compensating for lost time; more are participating in training programs.
Stronger muscles can be built after years of sedentary living, though the
gains may be slower. Even if a client has never touched a barbell or set
foot inside a gym until after retirement, they can work to develop positive
body change and increased health.
Remember many clients hold their breath when lifting weights. It is

important to train older clients, in particular, to breathe properly when
training. For an older population that may also have health conditions, it is
important for them to breathe when training. Through proper breathing,
oxygen uptake maximum can be extended and respiratory health improved.
Exercise also combats against diseases and health-related issues that

develop in advanced ages. It is well supported that exercise lowers blood
pressure, maintains a healthy weight and decreases the likelihood of
developing diseases like dementia. Arthritis and osteoporosis symptoms
can be reduced with participation in a regular strength training and exercise
program. The heart, cardiovascular system, brain, and muscles all benefit
from healthy exercise, weight training, and flexibility training.
If an inactive adult were to let life pass by without any exercise, between
the ages of 30 and 50 he would see a decrease in muscle strength. More
than half of total muscle strength would decrease after the age of 50.
Fortunately, it is never too late to reverse that cycle and many aging adults
have been able increase their muscle strength well after the age of 50. All
adults should practice weight training regardless of age. Even a 90-year old
adult can make significant changes in muscle strength if he commits to
exercise and resistance training.
Exercise also combats weight gain, which is a common occurrence with

people as they age. It is normal for people to put on weight as the decades
pass, and if there is no emphasis on a healthy diet or exercise plan, weight
can accumulate quickly. This weight gain is normal because most are
naturally less active as they age, especially after retirement. So
supplementing this inactivity with an exercise routine is the best way to
reverse the weight gain.
Flexibility is also very important for aging adults. Poor flexibility can lead to
difficulty with everyday tasks like bending, driving, and mobility. If an older
adult tries to stretch for at least 15 minutes a day, he can make great
improvements and develop increased functionality.
If your new client is an aging adult and would like to begin an exercise
program to stay fit and get stronger, the NAFC recommends consulting with
their physician first (remember PAR-Q). It is beneficial for clients to
complete a physical to make sure their body can handle a new exercise
plan. Their physician can also suggest exercises that are best suited for
their body. Often, doctors recommend low impact cardio sports like cycling,
swimming, and walking, accompanied by low resistance lifting and a
flexibility routine. However, everyone’s body is different and there may be a
specific exercise that your client needs to perform to improve their overall
health.
Make sure the exercise plan selected is appropriate for your client and your
client’s conditions. Avoid including activities that are too exhausting or
taxing because they may cause the heart rate to elevate beyond a safe
level – which may be detrimental to their health. Be sure weights are not
too heavy for your client, but do continue to challenge them to a level that
matches their goals. When implementing cardio-respiratory exercises,
monitor heart rate to determine whether or not it increases too quickly.
Remember, this may be tricky if your client is on beta-blockers because this
medication alters the heart rate. Overall, when working with an aging
population, it is best to keep their program at a level that is manageable,
healthy, and increases their overall well-being. Changes should be made
gradually and while monitoring the effects of the changes. This will promote
longevity and increased overall wellness.
Notes:
14
Sport and Skill Fitness Programming
Skill and Sport-Related Fitness
Involvement in sports and/or sports activities have been shown to increase

life skills in athletes. Hard work, determination, competition, and
performance are skills that are taught on the sport and practice fields
(courts, arena, etc.). For athletes, participation becomes more than
exercise. Team building, socialization, coordination, and fun are all
achieved during sporting activities. Training in a sport and through sport
activities also improves agility, balance and coordination, and focus.
Participation in sports training usually requires specific skills in order to be

successful. Athletes who compete in sports such as: basketball, baseball,
hockey, football, and volleyball all follow specific training programs in the
development of their abilities. In order to be successful, athletes must do
more than exercise to be successful. Many of these athletes practice more
than 10,000 hours in order to reach an elite status. This practice not only
prepares them for the physical and mental demands of the sport, it also
creates muscle memory patterns that increase their ability to participate in
the sport.
During sport practices, team leaders and coaches train athletes to create
patterns of muscle and body mechanic memories. Plays are rehearsed,
drills are performed, and sequences of specific motions are practiced.
Once these patterns have been memorized athletes are pushed to perform
faster, stronger, and with more agility. This is usually achieved because the
athletes have been conditioned to respond appropriately.
Take soccer for instance. When playing soccer, athletes often run
continuously for up to 90 minutes during a game, with a 15-minute break at
the half. During this time they not only endeavor to reach peak personal
strength and performance, they are also challenged mentally and must
concentrate on all of the actions and reactions of opposing team members.
Because of the practice training soccer players receive, many of these
athletes aspire to participate in other sports as well. They have the
endurance to swim, run track, participate with cross country teams and
because of their leg strength, they may punt on a football team.
This type of physical exercise can be beneficial in daily life as well. Playing
with children around the yard or at the park shows quickness and
cardiovascular health. For example, being able to take the stairs rather
than elevators and/or walking to the store tend to not be difficult tasks for
those who are conditioned.
Advancing from treadmills and elliptical trainers, when clients seek

alternatives for cardiovascular conditioning, trainers may be able to point
clients in the direction of a sport or activity that will capture their attention
and create the cardiovascular and strength benefit needed by clients.
Participating in a sport or recreation league, rather than watching television,
is a far better way for your client to spend their time. Once they become
committed to exercise, particularly in ways that are of interest to them, they
will be more likely to adhere to their training program. Determining the type
of exercise that is best for your client is instrumental to their success.
Sport-specific and skill-related training comes with various assessments
that can be completed prior to introducing a skill-based training program.
Tests to assess agility, speed, quickness and reaction time, balance,
power, and coordination are available. These include but are not limited to:
vertical jump and hitting (i.e. baseball/football) tests for power, sprint tests
for speed, shuttle and cone drills for agility, static and dynamic tests for
balance, and both hand-eye tests for both reaction and coordination.
Benefits of Skill-Related Fitness
There are benefits to skills-based, or sports-related, training programs. The

first is agility. Agility, or the ability to move nimbly and quickly, is a skill that
enables one to change the position and/or direction of the body quickly.
This involves training the body to move back and forth in a rapid motion
(i.e. in a tennis match or on a soccer field). This too could be helpful in a
real life situation. If needing to suddenly change directions to avoid a car or
a heavy object, being agile would enable one to move quickly to respond to
and avoid potential danger.
Balance and core stabilization are other skills gained when sports-training.
Surfing, snowboarding, diving and skiing are great ways to work on this
skill. Increased balance will enable clients to avoid falls and the risks that
are associated with falling.
As discussed previously, many older adults are at risk of falling and

breaking bones because they have not maintained, or do not have, proper
balance. Developing and improving this skill is important to overall health.
Coordination, which is the ability to move gracefully and with well-

balanced movements, is a skill that can be developed while participating in
sports like baseball, hockey, football, cheerleading, basketball, and golf.
Typically, these sports require hand-eye and foot coordination, for example.
Being able to run and catch a ball or to hit a moving object requires
coordination.
This skill, which requires harmony between both muscles and the nervous
system, is beneficial for everyday tasks like catching or deflecting falling
items and maneuvering items into the right position. For instance, when in
the kitchen opening a cupboard, one may need to be prepared for that item
that was not sitting properly on the shelf. These things happen all the time;
being able to coordinate body movements to respond appropriately is a key
to avoiding mishaps.
Power, or the ability to produce a maximum amount of energy at a given

time, is another tool that can be developed in skilled programs like
volleyball, baseball, jumping and boxing. Since power requires both force
and speed, it is probably one of the most important skills and can be helpful
while climbing stairs, lifting furniture, or pushing children on a swing. These
things require the use of increased force, or power, to improve
effectiveness.
Reaction time and speed can be developed, though they can be grouped
with coordination and agility, are also increased through skill-based training
programs. Many of the sports listed above require speed and a short or
quick reaction time. Sports such as Ping-Pong, archery and swimming rely
on reaction time for improved performance. Speed is defined as the ability
to move or to rapidly propel the body from one position to another. Along
the same lines, reaction time is the time it takes to respond to a particular
stimulus. A heightened awareness of what is happening at all times and
developing a quick response is how this skill is developed. Taking care of
children and watching that they do not fall, trip, eat toxic substances or run
into things requires a quick reaction time. Also, taking preventative
measures to ensure that you are ready to deal with these obstacles is
crucial to a healthy life.
Team Sports
So why should someone play sports to set skill-related fitness goals? Many
who learn these skills in youth, enjoy being able to continually enhance
their skills by participating in team sports. Others may enjoy trying new
things and learning to play a new sport meets that need. Either way,
participation in sport creates muscular strength and cardiovascular benefit
in addition to improving agility, power, balance, and coordination. A benefit
in becoming involved in playing team sports lies in the fact sports
encourages exercise, gives reasons to meet new people, helps participants
stay in shape over a long period of time, and promotes working with others
to complete a common goal.
Unlike going to the gym which can be put off under the best conditions, a
team sport encourages accountability. The team needs all of its players.
Further, socializing with people who share common interests in staying
physically fit becomes inspirational. This, in turn, promotes commitment
and adherence to an exercise training program.
Team sports can be easy on the body and mind if choosing to participate in
a relaxed league, or they can be very intense and physically demanding if
choosing to play on a league that is designed that way. The goal remains to
increase physical activity and adherence to an exercise program. Whether
choosing to practice 3 times a week or on the weekends only, consistency
is key to developing sports-related skillsets. Trainers can recommend that
clients find a league that is compatible with their skills and competition
desires and compete at a level that is best suited to their goals and time
constraints.
Preparing for Sports Participation
If your client is interested in participating on a sports team, the best way to

prepare for the sport is to begin conditioning practices and exercises.
Without these, or if the body is unaccustomed to particular movement
patterns, performance may suffer and your client may experience muscle
soreness.
Also, if not physically prepared for a sport, injury due to fatigue may occur.
Therefore, it is safer to prepare for sports performances by developing a
level of conditioning. This may come from team practices or preparation
through training sessions prior to joining a team.
Base Fitness Conditioning
Before starting a new sport or season, make sure that your client is
physically able to play. If they have a history of heart problems or
respiratory issues, your client may need to consult a physician prior to
joining or beginning a conditioning routine. Otherwise, training for practice
and game play should begin six weeks before the season opens. This
conditioning should include exercises in weight lifting to strengthen muscles
and improve power and endurance; cardio-respiratory exercises to prepare
the cardiovascular system; and flexibility exercises to the increase range of
motion (ROM) and length of muscles and joints after meeting the demands
of the exercise routines. Implementing all of these factors into a weekly
workout plan will help clients reap the full benefits of a strong, safe season.
When starting a weight training program, be sure to start your client off
slowly. Prepare a program that enables them to lift weights 2–3 times a
week with at least a day of rest after a session. Progress the program to
lifting 3 sets of 10-12 repetitions to work the major muscle groups. Include
the muscles that are used when practicing specific sports. Building them up
is crucial to injury prevention and sustainable performance.
For better adherence, when beginning a cardio-respiratory endurance

program choose activities that are fun or enjoyable, or try cross training to
add variety. Some of these options may include: participating in a group
class, swimming, running, hiking, biking, rowing, or stair climbing. After the
first few weeks of training, when their body has adapted to exercise and
muscle soreness is less frequently achieved, increase the challenge of the
workout. To see a change, push your client to a point where it is somewhat
difficult to breathe. Increase their heart rate and challenge the client to
experience “mild fatigue” at the end of the workout. Sometimes working
with a partner may help them achieve this goal. If it is beneficial, consider
small group training sessions so your client acts as an accountability
partner and support system.
When stretching, move the joints throughout a full range of motion in ways
that mimic the sports activity. As a safety precaution this aspect of health is
very important for participants. If participants are unable to move their joints
in the directions required by the sport, they might experience injury.
Further, remember to stretch after every workout and on non-workout days.
Stretch for 15–30 minutes, holding each stretch for 15–30 seconds.
Complete 2–3 repetitions per stretch but never force a stretch; stretches
should be mildly uncomfortable but not painful. Apply enough pressure so
the stretch is felt. Target all of the major muscles, and pay particular
attention to those that are used regularly in the sport (i.e. latissimus dorsi,
pectorals, and gluteal area).
Also encourage your client to maintain a healthy diet. With an increase in

energy, this will assist in the ability to participate in sport rehearsals and
competitions. The more body fat is held the more difficult it becomes to
keep up with the rest of the team or group, so clients should focus on
eating healthier meals, especially before a game, and use fitness
assessments and performance to monitor goals.
Sport Specific Conditioning
If deciding to train clients who are competitive athletes or who wish to

become competitive athletes, it will be important for trainers to familiarize
themselves with specific sports and the exercises that are advantageous to
the skill. Determine the major muscles involved to create a workout that will
help improve overall performance and train with exercises that are
conducive to the goals of the sport being played.
Aim to do this at least 6 weeks before beginning the season. If your client
starts before this, they can still expect great results. For example, if playing
soccer, add running to the program. If skiing, more quadriceps resistance
training is needed to improve muscle endurance. For swimming, perform
exercises to strengthen the shoulders and legs. If participating in sports
that require long durations of aerobic exercise, mimic those movements in
the workout. If participating in sports that are more anaerobic, sprints for
example, complete shorter and faster exercises that will improve bursts of
power.
Interval Training
Interval training increases the intensity of a workout. This style of training

involves combining short-bursts of power, (i.e. for example lifting or
sprinting) with a short recovery phase, followed by an additional speed or
power moves. Interval training has proven to be an effective method of
training clients to see weight loss and strength results. For example, a
runner might complete speed bursts every 3 minutes, sprint for one minute
and recover for 2 minutes. Through the increase in demand, it helps the
body adapt to a higher level of fitness and training. Incorporating exercises
that are both aerobic and anaerobic are important elements to interval
training and to skill-related training programs.
Interval training can also be used in strength training programs by

increasing endurance and varying pace. Performing an increase in
repetitions at a pace where momentum may contribute to the set, then
following those with fewer reps at a slower pace, which incorporates more
controlled rhythms, is an example of interval training through weight
training. As efficient as this program is, it does require an acclimation to
increased demands on the total body.
For new clients, consider 30-second bursts followed by a 1.5-minute rest,

1-minute bursts with 3 minutes rest, or 5 minute bursts with 10-minutes
rest. Interval programming can be altered to best fit your clients.
Communicate the goals of interval training by explaining the work and rest
intervals, provide clear instructions and expectations that will set your client
up for success.
If interval training becomes a regular part of your client’s routine, be sure to

allow enough time for recovery and rest. The major changes that occur to
the body occur during times of rest. If your client over trains they fatigue the
muscles and will increase the occurrence of injury.
Periodization
Periodization, or training in cycles of increasing and decreasing intensities,

was initially used by bodybuilders who needed to rest in the off-season,
needed to greatly increase their muscle mass during preseason, and
increase optimal conditioning during competitions. The technique is similar
to those who participate in other sports where consistent exercise is
required but benefit is seen in tapering training sessions to allow the body
time to recover. Through these intervals of work and rest, the body does
not stagnate and can continue to advance perform at optimal levels.
Periodization is used by professional athletes who are required to function

at peak levels during the season. They let their bodies enjoy rest in the off-
season which fuels the energy required to perform when the season begins
again. This does not mean that they quit training or working out; rather,
they decrease the training load to let the body recover.
There are three cycles in the periodization program that aid athletes in the
maintenance and record-keeping of their fitness goals, including:
macrocycles, mesocycles, and microcycles. The first cycle, the
macrocycle, refers to the entire period of training that a person uses to stay
fit. This can be a year or a full season, depending on the sport program and
goal. It can also be a portion of year if a person, for example, has two
marathons to run in different seasons of the year. Within the macrocycle
are three phases that include preparation for the competition, the
competition, and recovery from the competition. A complete macrocycle
includes all of these elements.
Also within the macrocycle are mesocycles, the smaller units of time within
the macrocycle that make up the weeks and months of training. During this
cycle, athletes focus on building their training to increase in intensity as the
competition season prepares to begin. When the season concludes,
training lessens in intensity.
Finally, are the microcycles that make up a given workout. Within the
microcycle athletes mix up their exercises so they do not risk boredom or
fatigue. Keeping a log of the exercises completed on certain days is a
necessary method to maintaining a balanced program within the
macrocyles, mesocycles and microcycles.
During most macrocycles, there is a build-up of intensity that begins with

endurance training for longer mesocycles, 6–8 weeks of low weight and
high repetitions, for example. These are followed by shorter and stronger
bursts that help to build muscles and strength – approximately 2–3 weeks
of high weight and low repetitions. Once the athlete reaches their peak
performance level, they are able to maintain that for 1–2 weeks, before
beginning a slowing period which allows the muscles to recover.
The periodization concept is beneficial to athletes because it helps them

maintain control and keep track of their progress. If a person were training
for a sprint swim competition, for example, they could prepare by doing
cross training and light lifting during the off season, longer distance
swimming and heavier lifting in the pre-season, and sprints for time and
swim-specific lifting during competition times. When this athlete finishes the
race, they can then lower the exercise level to recover from the intensity of
race preparation.
Periodization has been shown to help develop muscles without fatiguing

them when training for a competitive season, but organization for a
periodized training programming is important for efficiency, especially for
those who exercise often and for long periods of time. Most athletes know
that there is a point at which the muscles “top out”, or will not grow any
larger or stronger. This is why it is important to cycle through different
levels of rest and strength training cycles so the muscles are the strongest
and the largest at the point of competition. Forcing muscles into fatigue
without rest would make it impossible to maintain perfect strength when it is
the needed most.
Even if your clients are not preparing to compete in a sports event, this type
of training can be helpful for maintaining a healthy balance of exercises
throughout the year. Working in cycles can help to combat against fatigue
and boredom. Periodization will also increase the monitoring and tracking
of performance and the transitions the body makes during training
throughout the year.
Exercise-Related Injuries
There are many reasons as to why some suffer from injuries when
participating in sport and non-sport activities. High impact activities; failure
to warm-up, stretch or develop an appropriate range of motion for activities;
low quality shoes; preexisting injuries; and failure to care for or properly
maintain health and body functioning are all reasons why injuries occur.
High impact sports, for example, can increase strength, power, and cardio-
respiratory endurance, but they can also create trauma and increase the
impact felt on the knees, hips, feet and joints. It is necessary to follow safe
guidelines for participation in sports and non-sport exercise sessions.
Encourage your clients to check their shoes. Wearing low or poor quality
shoes during sport activities puts the knee joints and legs in jeopardy.
Fitness coaches recommend changing shoes every six months or every
500 miles. If your client has pre-existing injuries, be sure they consult their
physician to discuss an action plan that will prevent those injuries from
reoccurring. Proper rest and techniques (i.e. RICE) must be followed to
allow the body to heal after aggravating an old or acquiring a new injury.
Dealing with Acute Sports Injuries
If dealing with an injury from a sports-related activity, it is advisable that

your client take a break from that sport until the injury heals. If your client is
unwilling to stop exercising for fear of losing all that has been gained,
encourage them to find another sport or activity that does not include the
use of that muscle, bone or limb. If your client has suffered an injury while
running, removing the impact with swimming exercises, for example, may
help them continue to train without exacerbating their running injury.
The general first aid remedy once injuries have occurred involves
implementing R.I.C.E. Rest the impacted area. Ice, to decrease swelling,
should be applied to the injury a couple times a day. Compress the area
with a bandage, and Elevate when able. If the injury is new, it is appropriate
to apply ice for 20 minute intervals, 3–5 times daily. If the pain subsides or
the swelling decreases, after a few days this can be minimized to 1–2 times
daily until the swelling has dissipated. A compress applied to the injury, a
bandage or a wrap, should be applied until the swelling goes down and the
pain is eased. Remember, while trainers are professionals, they are not
physicians. If R.I.C.E. does not help your client, it may be necessary for
them to see a medical professional. Further, if you believe your client has
fractured or broken a bone or dislocated a joint, do not try to remedy the
situation. This is out of a trainer’s scope of practice. Rather, it is advised
that your client consult a doctor so the injury can be properly treated before
it becomes worse.
Muscle Soreness and Stiffness
Muscle soreness and stiffness is not uncommon when participating in a

taxing workout. For some, this becomes problematic because muscle
soreness can deter a client from continuing to pursue a workout program.
When suffering from delayed onset muscle soreness (DOMS), which can
appear as soon as 12 hours and up to two days after an intense training
session, clients may become discouraged. It is believed that when weight
training, microscopic tears in the muscle tissues and an overstretching of
the tissues that connect the muscles to the joints occurs. While the
minuscule tearing allows hypertrophy to occur, excessive discomfort can be
prevented by stretching after completing exercise, and more importantly, by
easing into a new training program.
If your client suffers from DOMS after a new workout, encourage them to
keep moving. Participating in low-impact exercises increases blood flow
and can relieve the sensitivity they experience. Additionally, taking a warm
bath can help ease the ache. Also, in addition to maintaining a proper diet
so the muscles receive the nutrients needed to recover, leading sports
nutritionists recommend taking vitamin E as a supplement to alleviate this
type of soreness.
Muscle Cramps
When there are not enough fluid or electrolytes in the body or there is not
general coordination between opposing muscles in the body, muscles tend
to cramp, which can cause a feeling of intense pain in any given region. If
this happens, clients should massage the muscle and stretch it out until the
cramp has subsided. Bananas, which contain a high content of potassium,
are well known to prevent muscle cramps. In addition, staying hydrated can
decrease muscle cramps, and if involved in extreme exercise for over an
hour, electrolytes can be replaced by sipping on sports drinks.
If your client suffers from frequent muscle cramps or is pregnant, taking

calcium supplements may help relieve cramping. This can assuage the
symptoms for pregnant women as well as for exercisers, athletes and the
general population.
Side Stitch
A feeling of sharp pain that occurs underneath the rib cage is often called a
side stitch and begins soon after exercising. Some people report they feel
this pain when they eat food or drink water shortly before they begin an
intense exercise or when they stress their body beyond its capabilities.
These observations have lead scientists to believe that the problem arises
when there is not enough oxygen being delivered to the lungs, although
some people experience this pain on a regular basis, even when they are
in great shape. This has led other scientists to believe the problem may
also be genetic.
Regardless, if your client develops a side stitch while exercising, allow

them time to slow down while also encouraging them to walk it off. If this is
not successful, have them lie on the ground with their knees at their chest.
They should take deep breaths and wait for the stitch to go away. Have
them consider the factors that may have caused the issue – diet, breathing,
illness, etc. If they consumed a large meal or drank too much water prior to
exercising, have them decrease their intake prior to training. This may help
to prevent or reduce the occurrence of side stitches.
Shin Splints
Shin splints are severe pains in the anterior tibialis region and may be the
result of poor conditioning, low arches, poor posture, heavy impact on hard
surfaces, muscle fatigue, or improper shoes or shoe fitting. There are not
many things to remedy shin splints except putting legs in hot water to
relieve the pain or icing them before or after sport participation. Chances of
getting shin splints may be reduced by stretching before a workout,
changing shoes frequently, inserting insoles to increase arch support, and
losing weight. Strengthening the anterior tibialis and lengthening the
gastrocnemius may also decrease the severity of the occurrence of shin
splints.
Exercise Intolerance
This syndrome occurs when a person’s body is not able to perform

exercise that it should be physically capable of performing (considering age
and physical fitness level). There are many reasons this may develop.
Trainers can detect it by listening to their clients and by making sure the
exercises they perform are not too difficult or strenuous and/or beyond their
capabilities.
If a client’s heart rate is much higher than usual, or if their heart rate does
not recover to 120 beats per minute within 5 minutes after finishing
exercise, you may need to either consult a doctor or reduce the intensity of
their programming.
Also, if your client reports feeling sick, nauseous, dizzy, weak, cramping, or
lightheaded when training, they need to immediately stop what they are
doing. The best way to prevent this syndrome is to encourage your clients
to listen to their bodies. If they feel like they are pushing beyond what they
are physically able to, consider regressions that may train the same goal
while assisting the client in completing their program. Also, reexamining the
purpose of the exercise and the goal of the training program is imperative.
The most important aspect of exercise is take actions that are conducive to
health and overall well-being. Listen to your clients, learn their limitations,
but encourage them to listen to their body too.
Conclusion
This manual can serve as a guide to the various types of fitness

assessments that can be conducted. Through the use of these assessment
results, continue to reassess your clients’ goals and make modifications if
and when it becomes necessary. Age does not matter when beginning a
fitness program. Proper exercise participation enables all to maintain a
healthier lifestyle and could prolong life for many years to come. Once
making the decision to prioritize the importance of fitness and weight
training, your client can learn to make the choices that will positively
correlate with life decisions that are positive and healthy.
In the end, one of the most important responsibilities of fitness

professionals is that they promote overall health and positive well-being for
their clients. Training programs should be goal-oriented and lead clients on
a path of healthier, enhanced living. All of your clients will be able to benefit
from gaining muscle strength, improving endurance, and increasing
flexibility. When this training is supplemented with proper nutrition, your
client can reach their ultimate fitness goals and enhance their vitality and
overall outlook on life.
Assessments should create and help monitor measurable results.

Adherence to training, relapses and progressions are able to be monitored
through regular fitness assessments. The data from these guide both
trainer and client in creating the most beneficial, most complete, most
effective program for goal accomplishment.
Now is the time to create training programs that will increase your client’s
success – lives that are stronger, healthier, and filled with vitality and
longevity.
Notes:
15
Additional Programming Options
Core Strength Training
With the increased awareness and benefits of mat work style classes, (i.e.
Pilates and Yoga) there has been a resurgence of interest in the core
muscles and their importance to the body. If these muscles, which include
the abdominal, back, and hip are weak, then the parts of the body that are
attached to the core are also weak. The core is a source of energy for the
rest of the body and the stronger it is, the more the body benefits as a
whole. The muscles in the core run up the spine from the hips to the neck
and shoulders and the limbs cannot contract properly without a stable
source to draw from.
The back and spinal muscles are just as important as the abdominals when
it comes to the health of the core. When working to improve core
functioning, many people like to include exercises that work the
abdominals, back, and spinal muscles simultaneously. In fact, when these
muscles are not strengthened simultaneously, there is a greater risk of
lower and/or upper back injury. When the back spasms or is in pain, it
becomes difficult to compete many functional exercises. Exercise and
movement becomes very difficult, so it is invaluable to strengthen these
muscles – individually and simultaneously.
Creating a training program that incorporates exercises for posture,
balance, and core functioning will enable your clients to participate in daily
tasks with greater ease and ability, and of course less injury.
Some common exercises found in core training programs, include: planks,

squats, stability ball exercises, sit-ups/ crunches, latissimus pull downs,
dead lifts, wood chops, quadruped exercises, and oblique work. This,
however, is just the tip of the iceberg when it comes to movements and
exercises that train the core. In fact, many more options can be found in
the NAFC Weight Training Manual. With so many core options available, a
routine that is varied, interesting, and fun can be easily developed,
adopted, and adapted to meet the needs of your clients.
Pilates-style Exercise Systems
Although the Pilates’ and mat work style

exercise systems seem new to the modern
era, they were actually developed in the early
20th century. This style of training has been
used by soldiers and many professional
dancers in that era. The German physical
therapist Joseph Pilates first developed the
exercises, which used a series of springs to
produce resistance training for the muscles.
He used this type of exercise while working to
help soldiers recuperate during World War I. There, he successfully helped
all those who were training under him resist an influenza virus that was
terrorizing England. Further, he attributed their wellness to the training the
soldiers received in the internment camps.
One of the many reasons behind the success of Pilates was the use of
resistance to produce stronger core muscles. Pilates claimed that these
muscles were the energy source of the body and their strength was of the
upmost importance. For this reason, including the lifted upright, dynamic
posture that helps people seem taller, dancers were attracted to Pilates’
programming. Additionally, Pilates focused on developing muscles that
were long, strong and lean, which was of great appeal to dancers. Pilates
reached new audiences, and both men and women incorporate this style of
exercise in their strength, core and flexibility training to increase their
overall strength.
Many Pilates’ and Pilates’ style classes include the use of tools and
devices that help develop stronger balance and stability. Classes use mats,
balls, straps, and springs, amongst other items, to challenge the deep
muscles that lie beneath the tissue. Usually Pilates’ exercises are slow and
methodical, demanding its participant to concentrate on both breath and
flow. This is why the exercise is considered good for the mind and body.
Both have to synergistically work together to accomplish the task of
completing exercises and creating stronger core functioning.
Benefits of Pilates’ exercises are numerous and they are often

recommended for people who have joint problems because they were
developed to remedy this issue. They are also known to increase flexibility,
muscle definition, and balance. If your clients want additional programming
options to enhance core training, improve posture, and synergistically work
mind and body, they may want to consider a Matwork style, Pilates, Yoga,
or fusion-style class.
For more information on courses Matwork and Pilates courses, visit NAFC
Trainer.
Stability Exercise Balls
Stability balls are large inflatable balls that can be

used for a plethora of exercises to improve
flexibility, strength, core muscles, and balance.
They are excellent tools for core development, and
because of the recent rise in popularity, stability
ball enthusiasts have created many exercises that
work the abdominals, back, hips, chest, and other
limbs.
The secret behind the effectiveness of the stability

ball relies in the fact that when performing exercises, one must force
themselves to maintain their positioning on the ball. This increases muscle
engagement because while working to complete an exercise, it is also
necessary to remain balanced on the ball. Balance, of course requires
stability, so this compound exercise benefits all core functioning. This is
what makes training with a stability ball unique.
There are a few things to consider when beginning stability ball

programming. The most benefit from this program is achieved when a
proper fit is achieved. The size of a stability ball used is associated with
height. Basically, the taller an individual is, the more centimeters will be
needed. Common sizes include 45cm, 55cm, 65cm, 75 cm and 85cm.
Proper fit increases safety and alignment during training.
If your client has back problems, the stability ball is a great way to engage
the core muscles without increasing injury. The soft airy material is great for
abdominal exercises and should not contribute to back pain.
Take the time to become proficient at this style of training. Be cautious

when introducing exercises to new clients. And remember to regress and
progress exercises as needed. Balance, stability, and muscle recruitment
can all be achieved using this form of exercise, and if unstable, that should
be the first goal – to increase stability.
Elastic Band and Resistance Tube Exercises
These tools are useful for resistance and flexibility training but are also
used to rehabilitate muscles and to improve strength without the use of
machines. Although there are many styles of these elastic bands, they are
generally easily accessible and inexpensive. Further, they are durable,
versatile, small, and easily
transportable, especially
when traveling. The bands
may be thick or slim and
tubular and allow for the
creation of resistance for the
joints through endless series
of motions and angles.
The amount of resistance the

bands provide can be modified by lengthening or shortening the tubes.
The shorter or thicker the bands tend to be, the more tension users will
experience.
Because sizes vary and tension may be modified, it may be hard to believe,
but these bands can be as useful as an entire gym when used correctly.
They are capable of working muscles in the concentric phase (the positive
lifting portion of a resistance exercise), the eccentric phase and the
negative release of a resistance exercise. Actions required for full motion
and complete range of motion can be achieved through the use of bands
and tubes.
As with many new exercises, the only drawback to band exercises is that
they may be difficult to maneuver at first. Vary the length and the type of
exercises for clients. Working with bands will add another dimension and
alternative to exercising programming for your clients.
In short, whether participating in mind-body classes, using stability balls, or

varying exercises through the use of resistance bands, the type of exercise
programming available to your clients can be limitless. It is no longer
necessary to train clients in a gym environment or fitness facility alone and
adding diversity can increase the effectiveness of the training program.
Incorporating the completion of health and physical activity readiness

questionnaire (PAR-Q) forms, conducting a variety of fitness assessments
including posture, cardiovascular, muscular, and flexibility, and adding
diversity to your individual client’s training programming, will provide the
best outcome for your clients. A plethora of exercise options and tools are
available to help your client reach their goals. Listen to their needs, address
their imbalances, create challenging, modifiable programs and assess,
assess, assess to monitor progress. Using these tools, your clients will be
well on their way to success.
Notes:
16
Exercise for Special Populations
Special Populations Defined
Special population is a term that is frequently associated with groups who

may not fit into an “average” category. These groups include, but are not
limited to, older/senior/elderly populations, patients with illnesses or chronic
diseases, and pre-natal and post-natal clients. Again, this is not an
exhaustive list, but it is necessary for the trainer to be aware of the many
conditions their clients may present. For the sake of this chapter a few
populations will be targeted.
Asthma
Asthma is a disease of the lungs that can make breathing a difficult chore.
Wheezing, coughing, shortness of breath and chest tightness are common
symptoms that may be displayed by asthmatic clients. Scientists do not
know how people develop asthma; they just know that it forces the
esophagus to contract and restrict the amount of air that is allowed
through. Asthmatics also suffer from a swelling of their mucus membrane.
This can make it harder to exercise and participants may feel
uncomfortable while exerting energy.
Although some modifications to an exercise program may be required,

many asthmatics can fully participate in a fitness regime. In fact, their
symptoms of asthma may be decreased with consistent exercise. Because
illness and environmental conditions can trigger asthmatic symptoms, to be
successful when working with this population, clients should:
 Always carry an inhaler or quick-relief medication with them. This can

be life-saving.
 Limit strenuous cardiovascular exercise, especially when illness or
asthma symptoms are present.
 Warm-up prior to beginning a workout. This is especially true in
colder climates/colder months when the temperature outside can
constrict circulation.
 Monitor their feelings during exercise. Many asthmatics learn their
reactions well enough that they can predict when an attack is likely to
occur.
 Never workout alone. In the event an issue arises, working out with a
friend or trainer will ensure the asthmatic client is always safe.
When asthmatics participate in a regular exercise program their body is

better able to adapt to the demand created by the exercise. This
consistency can reduce the likelihood of exercise-induced asthma attacks.
Those who are new to exercise should begin gradually – a couple of times
a week at a low intensity to allow the body time to adapt to a new exercise
program. Proper warm-ups and cool-downs are imperative.
Be creative in the program development for an asthmatic client. For some

clients, pool workouts will be appropriate. Water can moisten the
esophagus, which can decrease symptoms and increase performance. In
dry or extreme cold climates, some asthmatics may wear a face mask. This
will ensure moisture reaches air passages, thus creating favorable
breathing conditions and reducing asthma attack triggers.
As their body becomes conditioned, asthmatics may be eager to

participate in challenging exercises. This can be done when their
symptoms are carefully monitored and their progress tracked.
Arthritis
Arthritis is a disease that causes pain and inflammation in the joints and
tissues. Flare-ups may be mild or extreme; there are over 100 types of
arthritis and forms of arthritis that cause pain. However, the most common
include: osteoarthritis, rheumatoid arthritis, fibromyalgia, and gout.
Depending on the form of the disease, clients with arthritis may have pain
in the knees, hands, feet, fingers, wrists, neck, or spinal cord. Symptoms
may also influence the internal functioning and immune symptoms of
clients and resulting in not just pain at the joints but also irreparable
damage to the joints. This disease can be extremely painful – debilitating –
so when working with this population great care is needed to ensure clients
do not suffer.
Participating in consistent exercise programs can provide relief to arthritic

clients. Depending on the needs of the client, when beginning an exercise
program, trainers should begin with low-impact to moderate exercises.
Once gaining the approval of a physician and perhaps a physical therapist,
the arthritis client’s exercise program should include exercises to: improve
range of motion, increase the strength of the bones, and cardiovascular
conditioning. Walking, cycling, swimming, tai-chi, and gentle Yoga are ideal
for arthritic clients. Strength training exercises should be completed 2–3
days a week with at least 1 day of rest in between. This is especially
necessary if the client notices their joints are swelling or are more painful
after exercise. The overall need for arthritic clients is that they keep
moving. Once they begin moving, also be sure to have your clients stretch
and participate in a flexibility program. This will keep the joints loose and
reduce the likelihood of injury.
Diabetes
Diabetes is a hormonal disease that occurs when the body cannot make or
cannot use insulin efficiently. Insulin, which is produced in the pancreas,
regulates blood sugar levels. When the body does not efficiently use
glucose, or blood sugar, it builds up in the blood, thereby raising blood
glucose levels. Presenting symptoms of diabetes can include: frequent
urination, excessive thirst, unexplained weight loss, extreme hunger,
changes in vision, tingling or numbness in the hands or feet, dry skin,
irritability, and lethargy. These symptoms coincide with insulin levels and
the inability of glucose to effectively enter the cells.
While there are several types of diabetes, including gestational and others
based on illness, patients are primarily diagnosed as being type I or type II
diabetics. Type I, or insulin-dependent diabetes, most consistently effects
youth. Type II, on the other hand, is an insulin-resistant form of diabetes; it
more commonly affects adults. Although studies have suggested that
regular physical exercise and moderate weight loss are instrumental in
preventing (and delaying) type II diabetes, many type II diabetics also
require medication. The best medication for prevention and the delaying of
symptomology is an exercise program that addresses the health, fitness,
dietary and emotional well-being of the diabetic client.
Exercise and proper nutrition are instrumental in improving the overall

health and wellness of diabetic and pre-diabetic patients. NAFC stresses
how important it is that fitness trainers provide sound, research-based
strategies when creating programs to train this population of clients. As
such, these clients can receive great benefit from working with personal
trainers and from taking group fitness classes. For diabetic clients, fitness
professionals should:
 encourage physical activity. Walking, cycling, running, swimming,

stair climbing, participation in fitness classes, and sports are excellent
ways to increase physical activity.
 motivate clients to participate in daily moderate to vigorous exercise,

in intervals of at least 30 minutes. This will not only increase physical
health but mental health as well.
 develop strength training programs, as this will build muscle and

increase metabolic functioning. Include at least 2 days of strength
training to a fitness program; however, avoid heavy lifting, especially
if a client is suffering from other complications (i.e. hypertension,
blood vessel or visual problems).
 establish a flexibility routine. This will increase the client’s range of

motion, decrease the occurrence of injury, and increase blood
circulation.
 insist clients check their glucose levels prior to each workout session,
and ask them to always carry a snack or glucose tablets with them.
Some clients may also need to check their levels at the conclusion of
their workout. According to ACSM, maintaining a blood sugar level
between 100 and 200 mg/dL is optimal for healthy exercise. The
Mayo Clinic permits a range of up to 249 mg/dL as safe for exercise.
 increase movement and activity throughout the day, not just when
working with a trainer. Suggest wearing a pedometer to track steps
taken, take the stairs instead of the elevator, park as far as possible
from an entrance, and stretch often!
 ensure clients train in socks and shoes. Diabetic patients may

struggle with neuropathy (nerve damage), or poor circulation. Shoes
will protect their feet. Further, wearing shoes will reduce the
occurrence of blisters, sores, or other irritations of the feet.
In order to ensure improved and sustained health, in addition to regular

exercise, clients should stay hydrated and consume well-balanced,
nutritious, and frequent meals. Skipping meals is devastating to the diabetic
body because food manufactures glucose and creates energy. This
balance is necessary for ideal body functioning. Remember, type II
diabetes can be prevented with proper eating habits and exercise.
When diabetics develop a strong sense of awareness and recognition of

their blood sugar needs, they are able to quickly address imbalances.
Listening to and watching these clients and developing honest relationships
with them, will clue the trainer into what they may be physically feeling
during any given training session. This awareness and knowledge creates
strength, accessibility, and adherence to a diabetic’s workout.
Pre-Natal and Post-Natal Exercise
Pregnancy can be an emotional, exciting, anxious time for clients, and

adherence to an exercise program is a key strategy in the overall health
and well-being for both the baby and the mother. It is beneficial for women
to exercise while they are pregnant for the sake of their bodies and for the
sake of the child that they are carrying. With pre-natal exercise moms-to-be
are better able to manage their weight, improve their posture, release back
pain, improve circulation, increase flexibility, increase energy/stamina,
decrease muscle tension, increase their psychological state, and prepare
themselves for a healthier birthing process.
Exercising 3 to 4 times a week is sufficient for most pregnant clients, as

this allows their changing body time to recover after exercise. Common
exercises for pregnant clients often include those that are low-impact, such
as swimming, walking, yoga, elliptical training, and stationary cycling.
However, those clients who were active prior to pregnancy are able to
maintain a more active lifestyle during pregnancy.
Here are some things your pregnant client can do to stay healthy during
her pregnancy:
 Consult a physician about what their body is capable of doing while

pregnant.
 Breathe when training.
 Do not exercise at an elevation above 6,000 feet.
 Stay active for at least 30 minutes a day, a minimum of 3–4 days a
week.
 Exercise at a moderate level that will keep your heart rate in the low
to moderate range on the heart rate scale.
 Modify the workout to performing exercises (like the ones mentioned

above) that will not compromise pregnancy.
 If your client enjoys exercising at a higher intensity, continue to follow

this plan in the beginning stages of pregnancy. As they gain weight,
lower the intensity so they do not put too much stress on the body.
 Remove the focus away from losing weight. It is normal to gain

weight when pregnant, so accepting this as part of the process is a
healthier route.
 During exercise, make sure clients stay hydrated and fueled with
enough nutrients to stay strong and energetic. Consuming more
calories is necessary and natural. Plan to eat lots of fruits,
vegetables, nuts, complex carbohydrates, and lean proteins.
 Exercising in weather that is either uncomfortably hot or cold is not

conducive to health. If they must exercise in these conditions,
encourage them to dress accordingly.
 As clients approach the third trimester and beyond, avoid practicing

exercises that require clients to lie on her back. This will block flow of
blood to the baby.
 Incorporate stretching and flexibility into all muscles worked.
 Avoid balance drills and exercises as the equilibrium, coordination,
and proprioception will be off – especially as pregnancy progresses.
 Be aware of diastasis recti, or the separation of the left and right

abdominal muscles. Pregnant women may develop this when too
much stress is placed on the abdominal muscles. For this reason,
women who are 12-weeks or more pregnant should not overly stress
the abdominal muscles.
Your client should always pay attention to her body so she does not risk
injury. If she feels fatigued, insist she take a break, drink water, and rest.
Do not allow them to push beyond what is healthy for her body or her baby.
Potential problems to watch for include: pain, discomfort, cramps,
emotional weakness, breathing problems, a dramatically increased heart
rate, sickness, nausea, contractions, bleeding, swelling or lack of proper
weight gain.
Once the baby is born, many women experience postpartum depression

after giving birth, especially when they feel overweight and unattractive. If
your client stays in shape throughout their pregnancy, they are more likely
to continue that mode after childbirth. The better able to adhere to an
exercise plan they are, the better they will look and feel, and the better able
they will have to stay positive about their new life and the life of their
newborn child.
While it is safe and necessary for clients to train when pregnant, trainers
must be aware of the changes the pre-natal and post-natal body
undergoes. When working with this population, if in doubt, don’t. Consult a
physician or your client’s physician to ensure client and baby stay and
remain safe.
For additional information on training pre-natal and post-natal women,

contact the American College of Obstetricians and Gynecologists.
Notes:
APPENDIX A: FREQUENTLY ASKED QUESTIONS
Frequently Asked Questions
Q. What should determine ideal body weight?
A. While there are many considerations that must be taken into account
when answering this question, ideal body weight is dependent upon each
individual person. Different body types and builds, health concerns and/or
limitations, and a combination of these factors determines ideal weight. If a
client desires a healthy body fat percentage, an ideal range for women
between the ages of 20 and 39 is 21-32% while for men between the ages
of 20 and 39 the ideal range is 8%-19% body fat. Although if your client is
focused on losing weight and would be satisfied with a normal percentage,
reaching the percentages of an athlete may not be desirous.
While is can be helpful to consult with a nutritionist or a dietician to learn

more about how to decrease body fat mass and increase lean muscle
mass, doctors may also help determine whether or not a person is at risk
for adult onset diabetes, high cholesterol or high blood pressure. Health
risks can intensify the need to decrease body fat percentage and increase
weight loss. Excess weight and body fat can induce health problems that
are detrimental to the future of an individual. Therefore learning about
these health risks is important for all consumers. Fortunately, working
towards a lower percentage body fat will ultimately decrease the risk of
many health problems such as diabetes, high blood pressure, and coronary
heart disease.
Once your client reaches their weight goal, they may strive to attain higher
standards of a healthy weight by decreasing their overall body weight
percentage or their body mass index (BMI).
Q. Is body fat assessment accurate?
A. Often. Although body fat assessment is not an exact science, it is

crucial to learn to administer this assessment properly. False information
attained by unaccredited sources can lead to poor understandings of body
fat. Body fat is a tool many people will base their goals on, so it is
especially valuable to obtain accurate measures. Whichever method is
used – DXA, BMI, skinfold, girth, etc. it is necessary to assess well.
Practice using calipers and other equipment. Practice and accurate
assessment results are instrumental in increasing health and awareness.
Q. What does the future of body fat assessment look like?
A. The current way to determine the amount of ideal body fat percentage is
to analyze age, gender, and amount of physical activity. Men and women
have different BMI’s due to their body composition. Women usually have a
higher percentage than men, but this is not indicative to overall health. With
increased age, many deal with an increase in body fat percentage. This is
also very important. In the future, assessments will further hone in on the
changes of the body. Human error will be removed from calculations as
more science and technology is included in the administration of the
assessment. 3-D models will be standard. This will allow trainers to more
analytically obtain measures of body fat and body composition, and they
will be better able to suggest training programs for their clients.
Q: Is where fat held important? Does it matter where fat “sits”?
A. Yes! Research shows that fat within the body, around the organs rather
than under the skin, can be detrimental to health. Due to this new
information, doctors and researchers are now designing new methodology
that can better assess where the fat lies on the body: underneath the skin,
in between muscles, and overall.
Q. What is more important for good health: aerobic fitness or

muscular strength?
A. Contrary to popular belief, both muscular strength and aerobic exercise

are equally important as one aspect depends on the other in order to be
most effective. While cardio fitness prevents heart disease and promotes
respiratory health, muscular fitness prevents injury so clients can effectively
and efficiently continue to participate in an active lifestyle. Both aerobic and
muscular strength also contribute to healthy bones and a strong back and
core. Both are required for maintaining a sustainable lifestyle.
Q. Which should come first – muscle strength or cardiovascular

endurance?
A. What’s the goal? If the goal is to lose weight and burn calories, it is
necessary to add cardiovascular endurance exercises to the training
regime. For one reason, heavy lifting can fatigue the body. If the focus is
cardio-respiratory endurance, and weight training is secondary in goals, the
client should complete more extensive cardio exercise. Weight training
should include lifting lighter weights or performing shorter repetitions.
Sometimes cardio training can be a good way to warm up the muscles for
your strength training and vice versa.
If the desire is to build stronger muscles, work on the physique, and
improve the overall tone and size of the musculature. Weight training may
be completed first with cardiovascular exercises completed afterwards.
Ideally, 20–40 minutes of strength training 3 days a week, followed by 15–
60 minutes of cardio-respiratory endurance training – which can be
staggered – allows the body to rest and also increases the overall demand
on the body. Developing this pattern will enable change to occur.
Q. Do “big” muscles turn into fat when a person stops training?
A. Muscles and body fat are two separate entities. When weight training,
muscle cells are able to increase in the body (the actual number varying
between men and women and their hormonal differences) enabling them to
grow in size. Even if a client increases muscular strength, if they consume
too many calories or maintain an unhealthy diet, their muscles may appear
to have less tone, definition, and size, which is due to the amount of fat
cells in the body. The secret to achieving a lean, strong body is to practice
a combination of weight training and cardio endurance while maintaining a
healthy, balanced diet. These are the tools to health and vitality. If one (i.e.
diet) aspect is neglected, the others may lose their effectiveness.
Q. To develop a “six-pack” what strength training exercises are best?
A. As stated above, the secret to lean muscle mass is not only strength
training but also proper diet. Performing 1,000 crunches a day will not
result in a “six-pack” if a layer of fat pads the abdominal muscles. Pairing
abdominal exercises with a reduction of caloric intake increases the
chances of losing fat.
It is common for men to store the majority of their excess fat in their
abdominal area while many women tend to store it in their hips. When
caloric consumption is reduced and cardio-respiratory exercises are paired
with abdominal resistance exercises, the appearance or leanness of the
abdominal muscles will result.
According to leading Sports Nutritionists, the key to obtaining any degree of

leanness will be in great part due to a proper nutrition. In fact, 75-80% of
reaching our goals will be determined by this factor.
Q. Should clients experience a physical “high” after and during

exercise?
A. Feelings of extreme excitement and increased energy after completing a

run is what coined the term, “runner’s high”. It has been speculated that
when the body is involved in strenuous cardiovascular activity the pituitary
glands release endorphins that can create a rush or “high” feeling. It’s
adrenaline, it’s endorphins, and it can make individuals feel “wired”.
Sometimes after a powerful workout this feeling can last for an hour or
more and can make clients feel exceptional. It seems that although this
does not have to be the goal of all workouts, it is beneficial that the body
responds to a heavy workout in a positive way. This can be just another
reason to stay in shape and to progress the body to new levels of fitness.
These endorphins can also act as opiates for pain, thus helping you to
continue in a rigorous race or competition.
Along the same lines, many women who have given birth claim that this
rush of endorphins helped to ease the intense pain of childbirth. Studies
have shown that women who are in better shape during the birthing
process feel less pain because of the high level of endorphins that their
body is able to release. This is just another reason to get healthy and stay
fit, especially when you are pregnant.
So, while not all people will experience this rush, it is possible that an
increase in endorphin release and adrenaline will cause some to report a
“high”.
Q. Should clients eat before exercise?
A. Although every ”body” is different, research suggests that the body

needs nutrients to consume while exercising. Eating a huge meal before
going for a 10-mile run is however, not advised since it can lead to stomach
cramps or gastrointestinal discomfort. Conversely, eating something small
(i.e. a granola bar or banana) is great fuel before a longer workout. Some
prefer to drink protein shakes or sports drinks before they workout. These
digest quickly and usually contain sugar that provides energy for
endurance.
Remember that carbohydrates are a great fuel source for exercise because
they provide the body with glucose, which is then converted into glycogen
for the muscles. Try to avoid eating too much and allow time for the body to
digest prior to beginning a workout. As everyone’s biochemistry is different,
experiment with how the body reacts to different foods to see what the best
is for varying individuals. Take note to not start an exercise session on an
empty stomach, as this will lead to a loss of energy, which can result in
muscles and energy stores burning out quickly.
Q. How long should clients wait to exercise after eating?
A. Scientific data has not released a magic number to answer this question;
individuals have reported different experiences. Some who eat a large meal
prior to participating in strenuous exercise report feeling nauseous, bloated,
and other feelings of malaise. Others, on the other hand, do not report the
same feelings of gastrointestinal discomfort. To reduce discomfort and any
potential discomfort, especially if intensity levels will be high during training,
it is suggested to consume a small snack 1–2 hours prior to exercise. This
will increase energy and metabolic functioning to be able to complete the
workout.
If a large meal is consumed prior to training, it is suggested that clients take

a walk after eating, as this will aid digestion and increase the body’s ability
to process the meal. Again, if participating in strenuous exercise, it is
helpful to wait 1-2 hours after you eat to reduce the occurrence of
stomachaches or cramps. Usually, it is best to eat a small meal up to an
hour before exercise so clients do not feel sick in the middle of the workout.
Q. For the best results, what should clients eat after exercise?
A. Immediately following a workout it is suggested to consume a 4:1 (or

3:1) balance of carbohydrates and protein.
However, as a meal, sports nutritionists agree that a mixture of complex

carbohydrates (i.e. wheat breads, brown rice, or grains), lean proteins (i.e.
chicken, fish and turkey) and good fats (i.e. olive oil or avocados) are an
optimal mixture for a post-exercise meal. Many people point to a well-
balanced ratio of 40-45% carbohydrate, 20-35% protein, and 15-20% fat
ratio per meal in general. Again, this will vary from person to person and
will be in great part determined by age, weight, activity level, gender, and
above all each person’s individual biochemistry.
The purpose of the carbohydrates is to fuel the body with glycogen to

provide the muscles with enough energy to repair after a strong workout.
Protein’s function is for the rebuilding of amino acids (the building blocks of
proteins) for muscle repair. Fat, due to its ability to provide satiety, is a
great appetite suppressant and will create feelings of being fuller for longer
periods.
If unable to have a well-balanced meal after exercising, clients can prepare

something that is easy to carry. For example, string cheese, almonds,
apples, peanut butter, tuna fish or a protein bar can help stave off hunger
for a short amount of time prior to having a full meal. They will also give the
body the fuel it needs for recovery while providing something to burn after a
challenging workout. This promotes a healthy way to condition the
metabolism as well for optimal results!
Q. What should clients wear when exercising? Do shoes and socks

matter?
A. This answer will depend on preference, but there are certain items that
are agreeably comfortable during exercise. Dry-wick materials absorb or
“wick” away sweat during training. If excessive sweating is a concern, dry-
wick may be preferable. Look for materials that are made from wool, linen,
silk, or any other synthetic material like nylon, polyester, and acrylic. Cotton
generally does not work well for exercise because it does not dry very
quickly so avoid this material.
If working out in the sun or in intense heat, try to avoid the hottest part of
the day (12–4pm depending on geographic region). Wear fabrics that are
light in weight and in color and are loose-fitting. Stay away from black
asphalt and concrete because these surfaces reflect heat more so than
grass or dirt.
Adequately cushioned or protective socks are desirable by many. For

runners in particular, some like to wear two pairs of socks that are made
from an acrylic material as this decreases the likelihood of blisters.
Diabetics should always wear socks.
Technology available in shoes today is pretty advanced, so when

purchasing new shoes, select those that are closest to the style of exercise
being pursued. Running shoes, trail shoes, dance shoes, and trail shoes
are often purchased when participating in selected exercise programs.
Shoes should have decent breathability and a comfortable fit.
Be aware of options for orthotics. For those who suffer from pronation (an
inward rotation of the foot) or supination (an outward rotation of the foot) it
may be beneficial to consult with an orthopedist prior to purchasing shoes
for best fit and performance options.
Lastly, shoes should only be worn for six months or up 500 miles-
whichever comes first. Discard old and worn shoes to avoid compromising
the health of the feet and legs.
Q. What is the best time of the day to exercise?
A. There are only a few restrictions when it comes to time of day and
exercise and this is dependent upon individual preference and tolerance
levels. Extreme heat and cold may make exercise completion a challenge.
Extreme heat and high humidity can quickly fatigue and dehydrate the
body. When exercising in extreme cold, on the other, proper protective
clothing and accessories to retain heat may be needed. If it is a challenge
getting out of bed early, stick to a nighttime program. If an evening regime
increases adrenaline, morning may be best.
Q. Why shouldn’t clients exercise in hot and humid weather?
A. When the temperature of outside air exceeds or becomes close to the

temperature of the body (98.6 degrees) people have a hard time
maintaining a healthy body temperature. The body naturally sweats to
release heat and this can also be a problem when the air is too humid, or
filled with water, for the sweat to evaporate. These are two of the main
reasons exercising in hot and humid weather can be detrimental to health.
This can sometimes result in heat sickness, heat stroke or unexpected
death.
Q. Should clients train when they are sick?
A. With a common cold – (i.e. coughing, sneezing, runny nose, and sore
throat), most are able to participate in a training program if they feel able to.
However, when sick, your client risks spreading that sickness to all with
whom they come in contact. If ill with a cold, it is advised that clients train
outside or at home, as these seem to be better alternatives.
If, on the other hand, a client has the flu (i.e. fever, aches, vomiting,
hacking cough, etc.) they should rest and recover. Once symptoms have
subsided, and the client is no longer contagious, they may ease back into a
workout program that allows them to recuperate.
Q. Is stretching before an exercise routine recommended for injury
prevention?
A. Many fitness experts have taught that stretching before an exercise

routine can help prevent injury and can benefit the overall routine.
However, this data is not conclusive. In fact, some scientists suggest it can
hinder the routine by limiting the amount one can lift.
The general consensus is that mild aerobic exercise before a weight

training session is more beneficial than stretching. Five minutes warming
up on an exercise bike or elliptical trainer, rather than static stretching, will
better prepare the body for muscle resistance exercises. This does not
suggest that stretching is not necessary, it just implies that stretching at the
end of a workout is the best way to see optimal results. Remember,
flexibility will vary from individual to individual as will one’s ability to use it
for prevention of injury.
Q. Does stretching increase weight loss?
A. Overall, the amount of calories that are burned during flexibility training
is not significant enough to be effective towards a weight loss goal. The
best way to think about stretching and flexibility is as a supplement to your
regular workout, one that helps you to decrease your chance of injury and
post- exercise pain or discomfort. Furthermore, stretching creates length,
which can increase the flexibility and range of motion during exercise.
Q. Should stretching hurt to be effective?
A. Deep stretching, like heavy weightlifting is something that must be

attained slowly. It is necessary to increase the intensity of stretches
gradually to see the best results. If feeling a large amount of tension while
stretching, it may be necessary to decrease the length of a stretch (i.e.
bending the knees rather than maintaining fully extended legs), hold the
position longer time and gradually increase the amount of tension. This will
ensure that not too much stress is placed on the muscles. Remember a
healthy stretch is mildly uncomfortable but should never be painful.
Q. What is the best way to exercise?
A. There are many ways to exercise, and there is not one exercise type
that includes a full body training that encompasses strength training, cardio
training and flexibility. It is for this reason that a fitness regime is varied and
dynamic. Outside of weight training and stretching, cardiovascular fitness
can be broken up into many different types of exercises that will maintain
interest and challenge. It can be easy to get stuck in a fitness rut if the
same exercises are constantly performed. However, if varied (i.e.
running/walking on Monday, swimming on Wednesday, and jump roping on
Friday) interest may be sustained and adherence to a fitness program
constant.
Q. Does exercise reverse the effects of smoking?
A. The reason that cigarettes are so bad for the body is because they
contain carbon monoxide, which succeeds in combining with hemoglobin
much faster than the oxygen in the blood stream and carcinogens, which
can be cancerous. Hemoglobin is responsible for transporting oxygen to
muscles; if it is overtaken by carbon monoxide before it can do that, the
muscles do not receive the amount of oxygen that they need. Quitting
smoking unfortunately does not reverse the damage done while smoking.
Nevertheless, the sooner someone quits the better they will be.
When your client quits smoking their body will be able to transport more
oxygen to the blood stream and subsequently to their muscles. This will
make them feel much better while working out, which can also help them
maintain an exercise plan. When doing physically demanding exercise
especially, they should notice improved breathing.
The good news about quitting smoking is that it does improve the functional
capacity of the pulmonary system. When smoking, this passage is
constricted, thus hindering the overall ability to breathe properly. Shortly
after quitting, clients will report feeling like they can take in more air.
When your client quits smoking, encourage them. The reduction of nicotine
in their blood system, the slowing of their metabolism can cause an
increase in weight, but this can be reversed. Encourage your clients to quit
smoking and replace it with exercise.
Appendix B: EXERCISE MODIFICATIONS
Exercise Modifications per Body Area
These modifications can be applied to clients who need to modify their

exercise because of injury or other concern.
 Spine/Neck
 Limit the range of motion and speed of movement.
 Limit the range of motion to the back, looking up.
 Gentle stretching.
Low Back
 Avoid arching the back when lifting the legs. Limit the height of the
leg.
 Limit the amount of spinal hyperextension.
 Use supported stretching.
 Place the hands on the thighs, wall or back of a chair for support
during forward flexion.
 Bend the knees slightly during exercises to protect the low back.
 Develop abdominal strength and torso stabilization.
 Perform isometrics with the spine in a neutral position to provide

muscular control and stability.
 Pelvic stabilization minimizes the involvement of the hamstring

muscle group during lumbar extensor movements.
Abdominal Exercises
Advanced:
 Curl-ups with weights or holding counts
 Curl-ups with longer levers
 Curl-ups with rotation
Modified or Less Intense:
 Curl-ups with head supported or short levers
 Curl-ups lifting only slightly off the floor
Shoulder
 Limit the number of consecutive repetitions of any shoulder exercise.
 Use moderate weight and gradually develop a full range of motion.
 Avoid isometric extending of the arms out to the side or with elbows
up.
Knees
 Avoid going beyond 90-degree flexion

 Limit the use of full squats
 Use correct alignment with the knees lined up with foot direction
 Keep the knees over the ankles
 Squats and Lunges - Sit back on the heels and turn the feet slightly
outward
 Distribute body weight evenly between front and back legs
 Curl-ups with weights or holding counts
 Curl-ups with longer levers
 Curl-ups with rotation
APPENDIX C: STUDY GUIDE
Fitness Assessment Study Guide
1) How much of the body is comprised of body fat (or fat mass) and how
much weight makes up lean muscle mass?
2) Why aren’t height/weight charts accurate for assessing BMI?
3) What effect does physical inactivity and constant negative calorie

imbalance have on lean body mass?
4) Where does the body store fat in the tissue and what are its 3 basic
functions?
5) Skinfold thickness, as a means for body composition assessment, is

based on what principle?
6) What are the skinfold measurement sites for men and for women?
7) What steps can be taken to ensure the accuracy of skinfold

measurements?
8) Describe the technique for body fat assessment according to skinfold
thickness.
9) What are pros and cons of girth measurements?
10) Where are the girth measurement sites measured for women and men?
11) Briefly explain the procedures for determining girth measurements.
12) What is bioelectrical impedance and how does it measure body fat?
13) What are pros and cons of bioelectrical impedance? How accurate is
it?
14) What is the purpose of the waist-to-hip ratio measurement and what is
the procedure for determining it?
15) Calculate your Body Mass Index (BMI). Determine your disease risk
and classification BMI:
Disease risk:
Classification:
16) What are the shortcomings of BMI measurements?
17) Should an individual strive for achieving optimal levels of essential body
fat? Why or why not?
18) What is the formula for determining recommended body weight?
19) Starting at age 25, what happens to the average American body weight
each year?
20) How does resting heart rate reflect fitness values?
21) List the factors that affect flexibility.
22) What are the harmful effects of modern-day technology?
23) What abnormality in posture would cause excessive bend in the knee?
24) How does the cardio-respiratory system function?
25) What is the difference between aerobic and anaerobic exercise?
26) How is the level of cardio-respiratory endurance determined?
27) What does it mean when individuals have higher oxygen consumption?
28) Define the following:

heart rate –
stroke volume –
cardiac output –
29) What is the most precise way to determine maximal oxygen uptake?
30) What is the 1.0-Mile Walk Test and who is it for?
31) Describe the procedure for the 1.0-Mile Walk Test.
32) What is the Step Test and who should or should not take it?
33) What equipment is needed to perform the Step Test?
34) List the abnormalities a client, whose feet are in pronation, may have.
35) What does a lower heart rate mean? Why is it lower?
36) List the recommendations for exercise during pregnancy.
37) Determine your training intensity using the formula in your text.
38) Describe the recommendations for monitoring heart rate during

exercise.
39) Is training above the 85% max heart rate (HR) recommended? Why or
why not?
40) What is the Rate of Perceived Exertion (RPE)? When is this used?
41) What is the purpose of a warm-up and what does it consist of?
42) How is muscular strength measured?
43) How is muscular endurance measured?
44) Will a single strength test provide a good assessment for overall body
strength? Why or why not?
45) What are the principles that must be followed when prescribing a
strength-training program?
46) Where is the energy derived from when strength training? How long
does it take to replenish these energy stores?
47) What is the recommended frequency of training for strength

maintenance?
48) Define the following: Training volume, Periodization and Over-training.
49) What is the objective of plyometric training?
50) Is stretching an appropriate activity to perform before a workout?
51) What are the essential fat recommendations for men and women?
52) What is the difference between android and gynoid obesity?
53) What are benefits of aerobic exercise?
54) How does exercise impact the heart?
55) Describe mitochondria. How does it affect energy?
56) How is hemoglobin related to energy production?
57) Explain the value of using the Karvonen Formula to measure intensity?
58) Explain the principle of individuality.
59) Describe the three energy production types. At what points are each
system utilized?
60) Explain the difference between hypertrophy, atrophy, and sarcopenia.
61) Describe motor neurons and their role in the central nervous system.
62) Why is maximal oxygen higher in men than in women?
63) Why are METs used to represent energy expenditure? How are high
levels of METs different from low levels?
64) How are dysmenorrhea and amenorrhea related?
65) Describe the following terms:

Power –
Speed –
Reaction Time –
Balance –
65) What is the difference between chronic and acute back pain?
66) What are important tips to remember when working with older
populations?
67) When beginning a training program with a new client, what are
invaluable fitness assessments to complete?
68) What are benefits of conducting fitness assessments?
69) How many skinfold sites does the NAFC recommend using to assess
body composition?
70) When developing a flexibility program, stretches should be held for how
many seconds? How many times should the stretches be completed?
Appendix D: GLOSSARY AND IMPORTANT TERMS
Glossary
Activities of daily living - Behaviors that drive people to perform normal
functions in life
Adenosine Triphosphate (ATP) - High energy compound the body uses
for immediate energy
Aerobic - Exercise that requires oxygen to produce the necessary energy
(ATP) to carry out a given activity
Alveoli - Air sacs in the lungs where oxygen is taken up and carbon
dioxide is released from the blood
Anaerobic - Exercise that does not require oxygen to produce the
necessary energy (ATP) to carry out activity
Anaerobic threshold - Highest percentage of maximal oxygen uptake that
an individual can exercise for an extended time without accumulating high
levels of lactic acid
Android obesity - Obesity pattern seen in people who store fat in the trunk
or abdominal area
Anthropometric measurement - Techniques used to measure body girths
at different sites
Arterial-venous oxygen difference - Amount of oxygen removed from the
blood as determined by the difference in oxygen content between arterial
and venous blood
Body composition - Fat and non-fat components of the human body
Body Mass Index (BMI) - Technique to determine thinness and excessive
fatness that incorporates height and weight to estimate critical fat values to
determine risk for disease
Cardiac output - Amount of blood pumped by the heart in one minute
Cardio-respiratory endurance - Ability of the lungs, heart, and circulatory
system to deliver adequate amounts of oxygen to the cells to meet the
demands of prolonged physical activity
Circuit training - Alternating exercises by performing them in sequence of
three to six or more, rest between sets is minimal and cardio-respiratory
exercise is used at times
Contraindicated exercises - Exercises that are not recommended
because they may cause injury. The risk outweighs the benefit from
performing such exercises
Dynamic training - Strength training method referring to an isotonic
muscle contraction
Dysmenorrhea - Painful menstruation
Elastic elongation - Temporary lengthening of soft tissue
Exercise - Type of physical activity that requires planned, structured, and
repetitive bodily movement, intended to improve one or more components
of physical fitness
Fixed resistance - Type of exercise in which a constant resistance is
moved through a joint’s full range of motion
Flexibility - Achievable range of motion at a joint without causing injury
Frequency Intensity Type Time (FITT) - Acronym used to describe four
exercises recommended
Gynoid obesity - Obesity pattern seen in people who store fat primarily
around the hips and thighs
Heart Rate Reserve (HRR) - Difference between maximal heart rate and
resting heart rate
Hemoglobin - Iron-containing compound found in red blood cells, that
transports oxygen
Maximal oxygen uptake - Maximum amount of oxygen the body is able to
utilize per minute of physical activity (in ml/kg/min), and is the best indicator
of aerobic fitness
MET (Metabolic Equivalent) - Rate of energy expenditure at rest; 1 MET
is the equivalent to oxygen uptake of 3.5 ml/kg/min.
Metabolism - Energy and material transformations that occur within living
cells and is necessary to sustain life
Mitochondria - Structures within the cells where energy transformations
take place
Muscular endurance - Ability of a muscle to exert sub maximal force
repeatedly over time
Muscular strength - Ability of a muscle to exert maximum force against
resistance
Obesity - Excessive accumulation of body fat, usually at least 30 above
recommended body weight, BMI above 30
Overtraining - Emotional and physical condition marked by increase
fatigue, decreased performance, persistent muscle soreness, and mood
swings as a result of excessive physical training
Overweight - Excess amount of weight against a given standard, a BMI of
25 – 29.9
Oxygen uptake - Amount of oxygen the body uses
Percent body fat - Amount of fat in the body based on a person’s weight
Periodization - Training approach that divides training programs into
cycles using a systematic variation of training intensities and volume to
enhance performance
Physical activity - Bodily movement produced by skeletal muscles,
requires energy and produces health benefits
Pilates - Training program that uses exercises designed to help strengthen
the body’s core by developing pelvic stability and abdominal control;
coupled with focused breathing patterns
Plastic elongation - Permanent lengthening of soft tissue
Plyometric exercise - Explosive jump training that incorporates speed and
strength training to enhance explosiveness
Progressive resistance training - Gradual increase of resistance over a
period of time
Proprioceptive neuromuscular facilitation (PNF) - Mode of stretching

that uses reflexes and neuromuscular principles to contract and relax the
muscles being stretched
Rate of Perceived Exertion (RPE) - Perception scale to monitor the
intensity of aerobic exercise, used with clients on Beta-blockers or other
various heart medications
Recommended Body Weight – The recommended body weight that
decreases health risks; also known as ideal or healthy body weight
Sarcopenia - Age-related loss of lean body mass, strength, and function
Static stretching – Slow and sustained stretches; exercises in which the
muscles are lengthened gradually through a joint’s full range of motion
Specific Adaptations to Imposed Demand (SAID) - Training principle
stating for improvements to occur in a specific activity, the exercises
performed during strength training should resemble closely to the
movement patterns within that activity
Strength training program - designed to improve strength and/or
endurance through a series of progressive resistance training exercises to
overload muscles
Stretching - Moving the joints beyond the accustomed range of motion
Stroke volume - Amount of blood pumped by the heart in one beat
Subcutaneous fat - Fat that is directly under the skin
Subluxation - Partial dislocation of a joint
Underweight - Extremely low body weight, BMI of 18.5% or lower
Variable resistance - Training using machines and weights equipped with
differing amounts of resistance
Vigorous exercise – Cardio-respiratory exercise that requires intensity
above 60 percent of maximal capacity
Appendix E: SAMPLE FORMS TO BE USED BY TRAINERS
Forms Included:
Program Evaluation
Posture Assessment 1 Front View
Posture Assessment 2 Side View
Physical Activity Readiness Questionnaire (PAR-Q)
Program Design
Physician’s Consent
NAFC Program Evaluation Form
Have the candidate complete the following exercises. Then provide a score
of 1 to 5, 1 being the best.
You may add additional comments within the box, or on a separate piece of
paper.
Exercise:
Shoulders (deltoids/trapezius) Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Upper Back Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Outer Back Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Chest Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Biceps Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Triceps Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Quadriceps Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Gluteals Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Hamstrings Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Calves Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Abdominals Score Comments
Explanation
Demonstration
Correction/Spotting
Exercise:
Lower Back/Erector Spinae Score Comments
Explanation
Demonstration
Correction/Spotting
Evaluation
Overall Impression
Score Comments
Confidence
Leadership Quality
Instructional Skill
• Reverse Grip
• Reverse Grip
Please Initial Correct Box Next to the Corresponding Question:
Yes No
Has your doctor ever said that you have a heart condition and that you should only
◄
do physical activity recommended by a doctor?
◄ Do you feel pain in your chest when you do physical activity?
In the past month have you had chest pain when you were not doing physical
◄
activity?
Do you lose your balance because of dizziness or do you ever lose
◄
consciousness?
Do you have bone or joint problems that could be made worse by a change in your
◄
physical activity?
◄ Do you know any other reason why you should not do physical activity?
If you answered 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 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.
• You may need to restrict your activities to 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 programs are safe and helpful for you.
If you answered NO honestly to ALL questions:
• Start becoming 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.
Delay becoming much more 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.
• 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: and their agents assume no liability for persons who
undertake physical activity. If in doubt after completing this questionnaire, consult your doctor prior to
physical activity. 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 hereby affirm that I have read and understood the above. Any questions I had were
answered to my full satisfaction.
Print Client’s Name Signature Date
Print Client’s Name Signature Date
CLIENT:_________________________________________________________________________________ Date: ________________
Age: ________________________ Ph.# ___________________________ Email: ___________________________________
Have you ever worked with a personal trainer? Yes □ No □ If so, were you satisfied with the results? Yes □ No □
Please describe: who, when, why: __________________________________________________________ (Continue on the back)
What are your goals?
Specific:
Measurable:
Accurate:
Realistic:
Time Bound:
Injuries and Special Conditions
What:
When:
Treatment:
Limitations:
Comments:
Current and Past Activities
Weight Training □ • Cardio Training □ • Yoga □ • Pilates □ • Dance □ • Other (What?)
Desired equipment:
Active hobbies or sports:
How often: When:
Lifestyle
Job/School/Activities: (Continue on the back)
Stress Level: High □ Medium □ Low □
Diet:(Meals per day, water consumption): (Continue on the back)
Vitamins/Supplements:
Do you smoke cigarettes? Yes □ No □ | Use of Alcohol: Yes □ Frequency: No □
Days of the week you are available:
Weight Training: Mon Tue Wed Thu Fri Sat Sun____
Cardio Training: Mon Tue Wed Thu Fri Sat Sun____
Times(s) of day: Mon Tue Wed Thu Fri Sat Sun____
Length of session: Mon Tue Wed Thu Fri Sat Sun_____

Doctor's Name: Ph.# Fax#__________
Dear Doctor has expressed interest in the following:

□ Beginning an exercise program with (your facility)
□ Creating a nutrition/diet plan.
□ Participating in a fitness assessment protocol, including a 1-minute aerobic step test, hamstring reach
flexibility, body composition measurements, and muscular endurance bench press test.
Currently, this participant exhibits the following health concerns/risks:

□ hypertension □ family health history:
□ hypercholesterolemia □ orthopedic concerns:
□ cigarette smoker □ male over 45 without a current physical
□ diabetes
□ other concerns: _____________________________________________________________
Please check all of the following that apply and mail or fax this form at your earliest convenience to:
(Please print) Name of your facility:
Address: Fax ________
□ I agree to the full participation of this individual.

□ I agree to the participation of this individual with the following limitations:
□ I would like to see this individual before they engage in physical activity.
□ I do not agree that this individual is a candidate to exercise at _________________________
Reason: _____________________________________________________________________
Doctor's signature
I give permission for my physician to disclose the above information and any other information that may be
relevant to my participation in the fitness program at
(Your facility): ________________________________________________________________
Patient's signature: __________________________________________________ Date: _____
Thank you,
Fitness Facility Representative: ________________________________________ Date: _____

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Fitness Assessment

National Association for Fitness Certification

APPENDIX A: Frequently Asked Questions .............................................................. 228

The Fitness Assessment Program is designed to teach you to apply

The goal of passing the NAFC Fitness Assessment Program is to provide

The NAFC Fitness Assessment Program is a self-paced program that

Step 2: Take Your Theory Exam

Step 3: Theory Exam Results

Option 1: The NAFC provides opportunities throughout the year in

Step 5: Practical Exam Results

Affecting women and men of all ethnicities, cultures and backgrounds,

 Coronary heart disease is the most common type of heart disease,

 Every year about 720,000 Americans have a heart attack. Of these,

In addition to the CDC, according to the World Health Organization (WHO),

It comes as no surprise, then, that physicians, scientists, researchers and

By definition, cardiovascular disease is the

Studies show that the disparity between

A moderate amount of exercise a few times a week is more effective than

Although genetics plays a role in the likelihood of developing heart disease,

According to the President’s Council on Physical Fitness and Sports,

The modernization of society continually strives to make life simpler, easier

This lack of movement, resulting in an increase of sickness and disease,

Many tasks we participate in require a level of cardio-respiratory endurance

When at home watching television, assign exercises to be completed

This initially appears to be true because the body burns carbohydrates,

When encouraging clients to intensify their activity level, be mindful that

Determining an individual’s ability to maintain and sustain energy is closely

Benefits of Aerobic and Anaerobic Exercise

To better understand what can be done to improve cardio-respiratory

Aerobic exercise requires a large amount of oxygen to help the body

When implementing a regular aerobic program/activity into daily life, the

For example, if a trainer assesses a client’s heart rate, changes their

Although not as easily measureable, cell energy also improves with

Additionally, when participation in exercise programming is frequent, the

When the body is in constant movement, it also experiences changes in its

Improved cardio-respiratory endurance, increased blood flow, improved

Is strength training appropriate for everyone? YES! This aspect of fitness

Benefits of Strength Training

Your clients may be

In addition to improving metabolism and preventing symptoms of diabetes

As clients age, many may develop sarcopenia, which is defined as the

If possible, begin your client on a strength training program early. When

Having good bone density is crucial for an aging population, as it also

Lifting weights can increase muscle mass. This is

Hypertrophy, or the enlarging of muscular size through the enlargement of

Women in Weight Training

Surprisingly there has been a common

There are, however, women who participate in intensive weight training

Remember, in addition to purposeful and intense training, there is a heavy

An additional method a woman is able to use to appear larger or to

Today, some female athletes continue to use anabolic steroids or other

Some women who participate in extreme exercise programs experience

Changes in Body Composition

An accurate body fat reading with a qualified professional can also be a

Just as trainers use assessments to track personal progress, clients seek

Responders vs. Non-Responders

Maintaining motivation, responders, non-responders and the principle of

This chapter provides a basic understanding of how to assess posture. To

Postural Analysis, once mastered, is a very valuable assessment tool. It

Functional Analysis, to complement postural analysis, is the observance

As your knowledge and understanding of the biomechanics behind posture

Posture is determined by a multitude of factors, including: emotional state,

 It uses balance to remain upright and functional.

Two Common Shifts