Issa CPT Text Book - Unlocked

Foundations and Applications for a
CERTIFIED PERSONAL TRAINER

Tenth Edition
CONTRIBUTORS
Vanessa Scott, BS Michelle Kirk, Ph.D
Senior Production Manager, ISSA Arlington, VA
Scottsdale, AZ
Jeremy Richter, MBA, MA
Kelly Fortis, MA San Diego, CA
Gilbert, AZ
Rex Owens, BS, MSc.
Jenny Scott, MS, Sacramento, CA
Senior Content Developer, ISSA
Scottsdale, AZ Daniel Ramos-Alvarado, MS
El Dorado, CA
John Bauer, BA
Content Developer, ISSA
Mountain View, CA
Madison Grey, BA
Content Coordinator, ISSA
Tempe, AZ
ACKNOWLEDGEMENTS
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Official course text for: ISSA’s Certified Personal Trainer
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Foundations and Applications for a
SUBJECTS
COVERED
CERTIFIED PERSONAL TRAINER

Psychology of behavior change
Human anatomy and physiology
Energy systems
Human metabolism
Biomechanics and human movement
Principles of program design
Flexibility training
Cardiovascular training
Resistance training
Exercise selection and technique
Cueing clients
Nutrition and supplementation
Common chronic health conditions
Lifespan considerations
Growing and marketing a personal training business
Emergency management in fitness

TABLE OF CONTENTS
1| HEALTH, FITNESS, AND PERSONAL 7| CLIENT ASSESSMENTS 203
TRAINING 9 • Subjective Assessments 204
• The History of Personal Training 10 • Objective Assessments 209
• The Future of Personal Training and Fitness 17 • Body Composition Assessments 210
• ISSA Certified Personal Trainer Code of Ethics 18 • Cardiorespiratory Fitness Assessments 222
• VO2 Max Norms 227
2| PSYCHOLOGY OF BEHAVIOR CHANGE 21 • Muscular Strength and Muscular Endurance Assessments 228
• Behavior Change 22 • Movement and Posture Assessments 233
• Stages of Change 24 • Posture and Movement Assessments 236
• Processes of Change 26 • Interpreting Findings 247
• Motivational Theories and Applications 30
• Motivational Interviewing 38 8| ELEMENTS OF FITNESS 261
• Blending SDT and MI 44 • The Warm-up 265
• Setting Goals That Motivate Behavior 45 • Flexibility Training 265
• Scope of Practice 54 • Core Training 266
• Balance Training 268
3| MOVEMENT SYSTEMS 57 • Reactive Training 272
• The Nervous System 59 • Resistance Training 278
• The Muscular System 70 • Cardiorespiratory Training 278
• The Skeletal System 80 • The Cooldown 281
• Joints in the Human Body 87
9| PRINCIPLES OF PROGRAM DESIGN 283
4| SUPPORTING SYSTEMS 95 • Acute Variables of Fitness 284
• The Circulatory System 96 • The Principles of Fitness 293
• The Lymphatic System 106 • Periodization 299
• The Respiratory System 108 • Overreaching and Overtraining 302
• The Endocrine System 111 • Training Categories and the Elements of a Fitness Program 304
• The Digestive System 120
• The Integumentary System 127 10| CONCEPTS OF FLEXIBILITY TRAINING 311
• Methods of Flexibility Training 314
5| CONCEPTS OF BIOMECHANICS 129 • Flexibility and the Principle of Specificity 315
• Anatomical Reference Terms 130 • Acute Variables for Flexibility 316
• Balance, Equilibrium, and Stability 138 • Dynamic Stretching 318
• The Laws of Motion 142 • Pre-Contraction Stretching 338
• Friction 148 • Static Stretching 343
• Levers 152 • Flexibility and Special Populations 359
• Torque 155 • Self-Myofascial Release 360
• Muscles as Movers 156
11| CONCEPTS OF CARDIOVASCULAR
6| ENERGY AND METABOLISM 181 EXERCISE 367
• Cells 182 • Benefits of Cardiovascular Exercise 368
• Food as Energy 185 • Cardiovascular Training Principles 372
• Adenosine Triphosphate (ATP) 186 • Modifying Acute Training Variables 374
• Anaerobic Energy Production 188 • Measures of Cardiorespiratory Fitness 381
• Aerobic Energy Production 190 • Warm-Up and Cooldown 392
• Metabolism and Energy Balance 194 • Physiological Adaptations to Aerobic Exercise 393
• Modes of Cardiovascular Exercise 395
• Environmental Influences on Activity 409
12| CONCEPTS OF RESISTANCE TRAINING 413 18| BUSINESS AND MARKETING 661
• Benefits of Strength Training 415 • Styles of Personal Training 662
• Classifying Strength 417 • Starting a Personal Training Business 668
• Strength Curve 419 • Marketing a Business 671
• Strength Training and Training Principles 420 • The Client Life Cycle 680
• Physiological Adaptations to Anaerobic Exercise 426 • The Importance of Client Retention 686
• Modifying the Acute Training Variables 427 • Managing a Personal Training Business 687
• Resistance Equipment 437 • Personal Training Best Practices:
• Comparing Free Weights and Weight Machines 440 Advice from Seasoned Fitness Professionals 690
• Body Weight Exercise 442 • Code of Ethics 694
• Rep and Set Schemes 443
• Sample Strength Training Workouts 444
19| SAFETY AND EMERGENCY
SITUATIONS 697
13| EXERCISE SELECTION AND TECHNIQUE 449 • Own the Fitness Floor 698
• Common Exercise Injuries and Injury Prevention 450 • CPR Certification 702
• Key Communication Principles 452 • Injury Prevention 704
• Cueing 455 • Emergency Equipment and Protocols 704
• Movement Categories 457 • When to Call Emergency Services 711
• Exercise Categories 490
GLOSSARY 716
14| NUTRITION FOUNDATIONS 507
• Macronutrients 508 REFERENCES 765
• Water 528
• Micronutrients 530
• Dietary Guidelines and MyPlate 538
• Understanding Food Labels 543
• Common Diet Trends 546
• Portion Sizes 561
15| SUPPLEMENTATION 567

• What Is a Dietary Supplement? 568
• Nutritional Supplements 570
• Performance Supplements 583
• Ergogenic Aids 592
• Botanical Supplements 597
16| CHRONIC CONDITIONS 601

• Exercise and Hypertension 602
• Exercise and Diabetes 608
• Exercise and Arthritis 614
• Exercise and Coronary Heart Disease 621
• Exercise and Asthma 625
17| LIFESPAN POPULATIONS 631

• Exercise and Youth 632
• Exercise and Older Adults 641
• Exercise and Pregnancy 651
• Exercise and Adaptive Fitness 655
ISSA | Certified Personal Trainer | 8
HEALTH, FITNESS, AND
CHAPTER 01
PERSONAL TRAINING
LEARNING OBJECTIVES
1 | Describe what a personal trainer does and who they can help.
2 | List the subject matter a successful personal trainer must be educated in.
3 | Describe the general benefits of personal training as it relates to exercise

and physical activity.

CHAPTER 01 | Health, Fitness, and Personal Training
The fitness industry is a multibillion-dollar business bringing in more than $94 billion in
2019 according to the International Health, Racquet & Sportsclub Association (IHRSA). The
industry includes fitness technology and wearables, wellness programs, large and small
membership-based gyms, fitness studios, nutrition services, and physical recovery services.
Within these aspects of fitness, personal training is one of the most prevalent.
THE HISTORY OF PERSONAL TRAINING

The roots of personal training are difficult to pinpoint. Some say personal training started
in the 1950s, when personal trainers were first becoming actively certified, while others
contend that personal training dates back to the beginning of recorded history. Dedicated
health and fitness destination resorts dating back to the 1800s have been identified.
While the profession and terminology associated with personal training did not yet exist, the
concept of optimal health (which is the motivation behind the profession) was already being
touted by ancient philosophers. Around 400 BC (before Christ), Hippocrates wrote:
Eating alone will not keep a man well; he must also take exercise. For food and exercise, while
possessing opposite qualities, yet work together to produce health…and it is necessary, as it
appears, to discern the power of various exercises, both natural exercises and artificial, to know
which of them tends to increase flesh and which to lessen it; and not only this, but also to
proportion exercise to bulk of food, to the constitution of the patient, to the age of the individual.
PERSONAL TRAINING DEFINED

The profession of personal training is a relatively new field that continues to expand its
boundaries and redefine itself. Prior to the early 1980s, no minimal requirements existed
to qualify or identify a person as a personal trainer. People engaging in training was fairly
uncommon. Many learned about training solely through personal experiences in the gym.
Recognizing the need for standardization and credibility, Dr. Sal Arria and Dr. Frederick Hatfield
pioneered a program of personal fitness training that merged gym experience with practical
and applied sciences.
Today, a personal fitness trainer can be defined as a person who educates and trains clients
in the performance of safe and appropriate exercises to effectively lead them to optimal
health. Personal trainers can be self-employed (in-home and private) or work in health
clubs, physicians’ offices, physical therapy clinics, wellness centers, schools, hospitals,
rehabilitation facilities, and private studios.

What a Personal Trainer Knows
As the industry continues to expand its boundaries and the realm of scientific knowledge
concerning the human response and adaptation to exercise continues to grow, it is essential
for personal trainers to be competent in the following topics and subjects:
• Exercise programming
• Exercise physiology
• Functional anatomy and biomechanics

BIOMECHANICS:
• Fitness assessments The study of the mechanical
laws governing movement
• Nutrition and supplementation of living organisms.
• Common chronic diseases
• Basic emergency and safety procedures

CHRONIC DISEASES:
Conditions lasting a year
• Psychological and physiological challenges throughout the stages of life or more that limit daily
activities and/or requires
• Human behavior and motivation ongoing medical attention.
Arguably, the science of motivation and changing behaviors are the most important aspects
of a successful health and wellness program. However, many fitness professionals do not
know enough about either to effectively help clients make lasting change.
A fitness professional’s ability to educate and effectively draw clients into the fitness lifestyle
and optimal health comes from a plan that is based in the aforementioned areas as well as
the knowledge of muscular, cardiovascular, and metabolic adaptations. These adaptations

are known as the training effect. The training effect is the body’s adaptation to the learned
TRAINING EFFECT: and expected stress imposed by physical activity. When the body experiences the training
The body’s adaptation to
the learned and expected effect, it begins to change at the cellular level, allowing more energy to be released with less
stress imposed by physical
activity. oxygen. The heart and capillaries become stronger and more dispersed to allow a more
efficient flow of oxygen and nutrients. The muscles, tendons, and bones involved with this
RESTING HEART RATE activity also strengthen to become more proficient. In time, the body releases unnecessary
(RHR): fat from its frame, and movements become more efficient. Additionally, resting heart rate
The measure of heart rate
when completely at rest. (RHR) and blood pressure drop.
These adaptations can be achieved with the help of an educated trainer who can develop
BLOOD PRESSURE:
an appropriate fitness and health plan for most individuals. To be effective, this plan must
The force of blood pushing
against the walls of the account for the basic principles of fitness training: overload, specificity, individual differences,
arteries during the two
phases of the cardiac cycle. reversibility, periodization, rest, overtraining, and stimulus variability. The plan requires a thorough
understanding of the major muscles of the body and how they work, as well as an understanding
of metabolism—how the body converts food into other forms of energy. In addition, trainers must
learn about the function and regulation of the lungs, heart, blood vessels, hormones, brain, and
nerves at rest and during exercise. Once a fitness professional has the knowledge and support to
develop comprehensive, individualized, and periodized plans that effectively produce the training
effect, they can make a drastic impact on the lives and health of their clients.
THE CURRENT STATE OF HUMAN HEALTH

The US surgeon general’s Physical Activity and Health report supports the role of physical activity for
good health and disease prevention. The National Institutes of Health released a consensus
statement on the importance of physical activity for cardiovascular health. In addition, the Centers
HYPERTENSION: for Disease Control and Prevention (CDC) launched the Healthy People initiative, which lists physical
High blood pressure reading activity, fitness, and nutrition at the top of 22 priority areas. Finally, the American Heart Association
more than 140/90 mm Hg.
included physical inactivity and low fitness levels, along with smoking, hypertension, and high
cholesterol, as primary risk factors for disease.

RISK FACTORS:
Variables associated with
increased risk of disease or Unfortunately, although the resounding benefits of physical activity and fitness are touted and
infection.
reported, the United States is currently undergoing an obesity epidemic. In the United States,
25 to 35 percent of people remain sedentary (inactive). To make matters worse, federal

OBESITY:
An abnormal or excessive
resources and funding for physical activity programs have lagged far behind other aspects of
accumulation of bodyfat health. Health and physical education in schools are low priorities, and when school districts
that may cause additional
health risks. are looking to trim their budgets, health and physical education programs are among the first
expenditures to be reduced or cut altogether.

Each year in the United States, people spend more than $2.5 trillion on health care. This
enormous figure translates into an expenditure of almost $7,000 for each member of the
US population. Regrettably, this financial commitment has neither shown signs of abating nor
produced satisfactory results with regard to treating a wide variety of chronic health problems.
Attempts to identify the factors that have been major contributors to this virtual epidemic
of medical problems have produced a litany of probable reasons why such a large number
of individuals are so apparently unhealthy, including poor eating habits, sedentary lifestyle,
stress, and poor health habits (e.g., smoking). At the same time, a number of studies have
been undertaken to identify what, if anything, can be done to diminish either the number or the
severity of medical problems affecting the public. These studies have provided considerable
evidence that exercise and increasing physical activity has substantial medicinal benefits for
people of all ages.
PERSONAL TRAINING CLIENTELE

According to IHRSA, as of 2019, health club memberships are projected to reach 230 million
worldwide by the year 2030, and health club memberships among children under 18 years of
age have increased by 187 percent since 1987. The number of people considering personal
training services continues to grow. According to IHRSA’s annual Health Club Consumer Report
(2019), 52.9 million Americans aged 6 years and older are members of health clubs. Over 12
percent of these members pay for the services of a personal trainer, and over 6 million health
club members alone paid for a personal trainer this past year. In-home sessions, park boot
camp sessions, and other nontraditional training sessions were not included in the gym data.
Figure 1.1 Health Club Members by Generation (IHRSA, 2019)

Here are some statistics from the report:
• Three out of five personal training clients are women.
• Clients report an average of 18 sessions with a trainer.
• The average personal trainer charges between $15 and $100 per hour—with the
average being $50 per hour.
• The average number of training sessions used in 12 months breaks down as follows:
SESSIONS PERCENTAGE
1-6 sessions 47 percent
50+ sessions 11 percent
Not reported 11 percent
• The number of training sessions clients of different ages used break downs as
follows:
AGE RANGE SESSIONS
6-11 years old 22 sessions
55+ years old 24 sessions
These statistics support the growing trend and need for personal training services. While
those 6 million people who purchased personal training services are sold on the need for
personal training, there are many millions more who do not know or understand the benefits
of hiring a personal trainer regardless of their health and fitness goals. This population
represents the greatest opportunity for growth and income for fitness professionals.

BENEFITS OF PERSONAL TRAINING
Two of the most widely publicized efforts to investigate the possible relationship between
exercise and disease were longitudinal studies, each of which involved more than 10,000
subjects. In a renowned study of 17,000 Harvard graduates, Dr. Ralph Paffenbarger found
that men who expended approximately 300 calories a day (the equivalent of walking briskly
for 45 minutes) reduced their death rates from all causes by an extraordinary 28 percent and
lived an average of more than two years longer than their sedentary classmates. Another
study conducted by Dr. Steven Blair of the Cooper Institute for Aerobics Research in Dallas
documented the fact that a relatively modest amount of exercise has a significant effect on
the mortality rates of both men and women. The higher the fitness level, the lower the death
rate (after the data was adjusted for age differences between the 13,344 subjects in this
eight-year investigation). An analysis of the extensive data yielded by both studies suggests
one inescapable conclusion: exercise is medicine!
Accepting the premise that regular exercise can play a key role in reducing the risk of medical
problems and decreasing health care costs is critical. Despite the vast number of individuals
who lead a sedentary lifestyle, the need for and the value of exercising on a regular basis is
an irrefutable fact of life (and death). For example, after a detailed review of the results of
his long-term investigation, Dr. Paffenbarger concluded that not exercising had the equivalent
impact on a person’s health as smoking one and a half packs of cigarettes a day. Fortunately,
with few exceptions, most people are too sensible to ever consider ravaging their health
by smoking excessively. Unfortunately, many of these same people fail to recognize the
extraordinary benefits of exercise in the prevention of medical problems.

Any list of the medical problems and health-related conditions that can be at least partially
treated and controlled by exercise would be extensive. Exploring the most significant of these
health concerns, here are details on how exercise is thought to help alleviate each condition:
• Allergies: Exercise is one of the body’s most efficient ways to control nasal
congestion (and the accompanying discomfort of restricted nasal blood flow).
• Angina: Regular aerobic exercise dilates blood vessels, increasing blood flow and
thereby improving the body’s ability to extract oxygen from the bloodstream.
• Anxiety: Exercise triggers the release of mood-altering chemicals in the brain.

JOINT:
• Arthritis: By forcing a skeletal joint to move, exercise induces the manufacture of
An articulation between two
bones in the body. synovial fluid (fluid found in the cavities of synovial joints), helps to distribute it over
the cartilage, and forces it to circulate throughout the joint space.

CARTILAGE: • Back pain: Exercise helps to strengthen the abdominal muscles, the lower back
Firm, flexible connective
tissue that pads and extensor muscles, and the hamstring muscles (muscles in the upper back of the
protects joints and
structural components of leg).
the body.
• Bursitis and tendinitis: Exercise can strengthen the tendons, enabling them to
handle greater loads without being injured.

TENDONS:
Strong, fibrous cords made • Cancer: Exercise helps maintain ideal body weight and helps keep body fat to a
of collagen that attach
muscle to bone. minimum.
• Carpal tunnel syndrome: Exercise helps build up the muscles in the wrists and
forearms, thereby reducing the stress on arms, elbows, and hands.
• Cholesterol: Exercise helps to raise HDL (high-density lipoprotein, the “good”
cholesterol) levels in the blood and lower LDL (low-density lipoprotein, the “bad”
cholesterol) levels.
• Depression: Exercise helps speed metabolism and deliver more oxygen to the
METABOLISM: brain; the improved level of circulation in the brain tends to enhance mood.
Chemical processes within
the body that convert food • Diabetes: Exercise helps lower blood sugar levels, strengthen the skeletal muscles
into energy.
and heart, improve circulation, and reduce stress.
• Fatigue: Exercise can help alleviate the fatigue-causing effects of stress, poor
DIABETES:
A condition characterized by circulation and blood oxygenation, bad posture, and poor breathing habits.
an elevated level of glucose
in the blood. • Glaucoma: Exercise helps relieve intraocular hypertension (the pressure buildup on
the eyeball that heralds the onset of glaucoma).
• Headaches: Exercise helps force the brain to secrete more of the body’s opiate-like,
pain-dampening chemicals (e.g., endorphins and enkephalins).

• Heart disease: Exercise helps promote many changes—a decrease in body fat, a
decrease in LDL cholesterol, an increase in the efficiency of the heart and lungs, a
decrease in blood pressure, and a lowered heart rate—that collectively lower the
risk of heart disease.
• High blood pressure: Exercise reduces the level of stress-related chemicals in the
HEART DISEASE:
A term used to describe
bloodstream that constrict arteries and veins, increases the release of endorphins, several different heart
conditions.
raises the level of HDL in the bloodstream, lowers resting heart rate (over time),
improves the responsiveness of blood vessels (over time), and helps reduce blood
pressure through maintenance of body weight.
• Knee problems: Exercise helps strengthen the structures attendant to the knee
(muscles, tendons, and ligaments), thereby facilitating the ability of the knee to
LIGAMENTS:
withstand stress. Short bands of tough but
flexible fibrous connective
• Lung disease: Exercise helps strengthen the muscles associated with breathing tissue connecting two
bones or cartilages or
and helps boost the oxygen level in the blood.
holding together a joint.
• Memory problems: Exercise helps to improve cognitive ability by increasing the
blood and oxygen flow to the brain.
• Menstrual problems: Exercise helps to control the hormonal imbalances often
associated with premenstrual syndrome (PMS) by increasing the release of beta-
endorphins.
• Osteoporosis (fragile bones): Exercise promotes bone density, thereby lowering an
individual’s risk of experiencing a bone fracture.
THE FUTURE OF PERSONAL TRAINING AND FITNESS

The need for personal training services continues to grow. It is imperative that fitness
professionals keep up with the evolving recommendations for health and physical fitness
that have a direct application for fitness programs and exercise recommendations. With
the emergence of the latest technologies, information regarding health and fitness is easily
accessible. However, because of the plethora of confusing and conflicting health and fitness
recommendations available, it is important that fitness professionals work to help clients,
friends, and family members simplify the science, identify credible resources, and navigate
the numerous fitness and nutrition myths.

As individuals who are committed to a long-term career in health and fitness, personal
trainers will continue expanding their knowledge through additional courses in corrective
exercise, corporate wellness, youth fitness, senior fitness, nutrition, and pre- and postnatal
specializations to better serve their clients in achieving and living the fitness lifestyle. This
lifelong commitment to learning is also reflected in the personal training recertification
requirements that remain a standard in the industry. Individually and collectively, personal
trainers have an inherent responsibility to positively influence and guide the health and
fitness attitudes of those around them.
ISSA CERTIFIED PERSONAL TRAINER CODE OF ETHICS

Upon receipt of the ISSA certificate, members effectively become representatives of a leader
in the fitness certification industry and thus are expected to conduct themselves according
to the highest standards of honor, ethics, and professional behavior at all times. These
principles are intended to aid ISSA members in their goal to provide the highest quality of
service possible to their clients and the community.

Requirements for Certification
1. Certification will not be issued to any student/member/candidate who does not
successfully complete or meet all pertinent qualifications or has not achieved
passing scores on the relevant ISSA examinations.
2. Certification will not be issued to any student/member/candidate unless they have
successfully completed a cardiopulmonary resuscitation (CPR) and automated

CARDIOPULMONARY
RESUSCITATION (CPR):
external defibrillator (AED) certification as evidenced by a current and valid CPR/AED
An emergency procedure
card. involving chest
compressions and, often,
Code of Ethics artificial ventilation to
circulate blood and
preserve brain function
1. The ISSA certified fitness professional shall maintain a professional client-trainer in an individual in cardiac
arrest.
relationship at all times. Fitness professionals have the obligation to properly
assess clients, program for their needs, and provide health care referrals as
AUTOMATED EXTERNAL
needed for the best interest of the client. They must respect the client’s choices
DEFIBRILLATOR (AED):
and decisions regarding their own health and provide accurate, factual information. A portable electronic
device that can identify and
They shall not misrepresent their education or credential(s) or work outside of their electrically correct heart
scope of practice. arrythmias, ventricular
fibrillation, and tachycardia.
2. The ISSA certified fitness professional shall not discriminate on the basis of sex,
gender, race, religion, national origin, color, or any other basis deemed illegal.
3. The ISSA certified fitness professional shall maintain any and all primary and
supplementary certifications (including CPR certification as required) that are
necessary to execute their job. They will not misrepresent their status in regard to
certification or qualification to ISSA, clients, or an employer.
4. The ISSA certified fitness professional shall uphold their social responsibility to
promote inclusion and educate and inform within the scope of practice.
5. The ISSA certified fitness professional shall use their best judgment to maintain a
safe training environment for clients. This includes the space being used and the
movements being executed. At no time shall harm to others be intended.

PSYCHOLOGY OF
CHAPTER 02
BEHAVIOR CHANGE
LEARNING OBJECTIVES
1 | Define behavior and behavior change.
2 | Explain the purpose of the stages of change and how they are applicable
in fitness and wellness.
3 | Define motivation, the self-determination theory, and motivational

interviewing.
4 | Describe the components of a SMART goal.
5 | Explain the scope of practice for psychology and behavior change for a
personal trainer.

CHAPTER 02 | Psychology of Behavior Change
There are infinite reasons why individuals hire a personal trainer. The commonality, though,
is that they have acknowledged that they want, or need, to improve their health or physical
fitness. In other words, the client wants to change their current state to a more desirable
state. The change sought by the client may be self-motivated, or perhaps it is a change
directed by a medical professional (e.g., the client’s doctor told them they need to increase
their exercise level to manage their weight, lower their cholesterol levels, or decrease their
risk for diabetes). Whatever the change needed and the reason for the change, the personal
trainer will play a critical role. The client is hiring a personal trainer because they need
help initiating the change, reinforcing the change, and maintaining the necessary behavior
changes to reach their health and fitness goals.
It is well understood that personal trainers need to be experts on physical and physiological
factors related to health and fitness. The success of a personal trainer, however, does not
hinge on their knowledge and skill regarding physiological principles alone. For example,
a trainer can design a quality training plan and be highly skilled in teaching and coaching
techniques. But what happens if the client is lacking the motivation to engage in, and
follow through with, the training plan? Success, such as the client’s progress toward and
achievement of their desired goal, will largely depend on the client’s readiness and motivation
to make the necessary changes. Therefore, another critical skill set for personal trainers is to
understand the psychology of behavior change and be able to apply its principles to support
their clients through the behavior change process.
BEHAVIOR CHANGE
Before discussing behavior change, it is important to first understand what is meant by the
term “behavior.” Simply put, a behavior is an action that can be observed, measured, and
BEHAVIOR: modified. Behavior can be further defined based on its context. For example, physical activity
An action that can be
observed, measured, and behavior is often defined as the movement of the body that requires energy expenditure,
modified.
whereas exercise behavior is often defined as movements or actions that are planned and
executed routinely for the purpose of increasing physical fitness. Within a client’s health and
fitness goals, there can be several behaviors that impact goal progress and achievement.
Furthermore, some behaviors overlap to influence other potential behavioral targets.
TYPE 2 DIABETES: For example, lack of sufficient sleep can influence a person’s health, such as the increased
A long-term metabolic
risk of obesity, type 2 diabetes, and high blood pressure. Behaviors that can improve sleep
disorder that is
characterized by high blood include nutritional aspects (e.g., avoiding caffeine and high-caloric intake before bedtime)
sugar, insulin resistance,
and relative lack of insulin. and exercise (e.g., daily physical activity can improve the onset of sleep).

SELECTING THE TARGET BEHAVIOR
Identifying the target behavior is the foundational step in the behavior change process. Based on
the initial intake and assessment, the personal trainer and client can discuss which behavior(s)
ought to be made the priority focus. Behavior change takes effort, energy, and time. Therefore,
even if many of the client’s current behaviors need to be adjusted, it is important to narrow
the focus to just a few at a time so that the client is not overwhelmed. The decision of which
behaviors to target first ought to be based on the impact that the behavior has in progressing the
client from their current state to their desired state. Once the target behavior(s) are selected by
the personal trainer and client, then the trainer can guide the client through a systematic goal-
setting process, which will be discussed later in this chapter.
OVERARCHING GOAL GENERAL BEHAVIORS SPECIFIC BEHAVIORS

MACRONUTRIENT
INTAKE
Nutrition
HYDRATION
behavior
MODALITY
Physical activity
behavior DURATION
Improve body
composition HOURS PER
Sleep 24-HOUR PERIOD
behavior
PREPARATION FOR SLEEP
BEHAVIORS
Cognitive
behavior MANAGING STRESS
COGNITIVE APPRAISAL
Figure 2.1 The Impact of Behavior on Health Goals
INFLUENCES ON BEHAVIOR
There are multiple influences on a person’s behavior such as internal stimuli (i.e., a person’s
conscious and unconscious self-talk), external stimuli (i.e., environmental cues and triggers),
TRANSTHEORETICAL
and cultural or societal norms, to name a few. Thus, behavior change is a complex process MODEL (TTM):
that requires a skillful and multimodal approach. One of the most popular models of behavior A behavior change model
focused on the stages of
change adopted by practitioners within the field of health and fitness is the transtheoretical change, the process of
changing behavior, self-
model (TTM). efficacy, and the decision
balance.
The TTM is a multifaceted framework that encompasses four key distinct but interrelated
constructs:
1. Stages of change (i.e., a person’s stage of readiness to engage in the healthier/

desired behavior)
2. Processes of change (i.e., the factors influencing how a person transitions from
one stage to another)
3. Self-efficacy (i.e., the person’s belief in their capability to enact the goal behavior)
SELF-EFFICACY: 4. Decisional balance (i.e., determination of whether the person deems the change
The certainty of one’s ability
to accomplish a particular process worth pursuing)
task.
According to the TTM and the supporting research, satisfying the conditions within each of these
four constructs is required for a client to make progress through the behavior change process.
To effectively help a fitness client make lifestyle changes that support their goals and promote
longevity, a personal trainer should be able to:
• Determine their client’s stage of change and identify the next steps to support
healthy behavior change
• Understand the three underlying components of self-determined behavior to support

program design and training session execution
• Use the motivational interviewing (MI) technique to foster internal motivation

MOTIVATIONAL • Use the tool of goal setting most effectively
INTERVIEWING (MI):
A collaborative, client-
focused method of guiding
STAGES OF CHANGE
a client toward a self- Behavior change is not an isolated event that happens all at once; it is a dynamic process
identified motivation for
change. that unfolds over time. According to the TTM, behavior change involves progressing through
a series of stages. The five stages of change include pre-contemplation, contemplation,
STAGES OF CHANGE: preparation, action, and maintenance. Individuals typically do not move through the stages in
The series of temporal a linear fashion; instead, they tend to follow a cyclical path. That is, an individual may progress
stages of readiness that a
person progresses through and regress through the various stages. Furthermore, an individual can spend weeks to
during the behavior change
process. months in any given stage. Just as a personal trainer must take inventory of a client’s
physical developmental needs, a trainer must also take inventory of their client’s needs
within the behavior change process.
This begins with identifying which stage of change the client is in. Although there are self-
assessments (i.e., questionnaires) that exist to assess an individual’s readiness to change,
one of the best ways for personal trainers to determine the client’s stage is through a
personal interview. In this manner, personal trainers can meet with clients in a safe and
private space to ask questions of their client for the purpose of evaluating information that
may indicate their readiness to change.

Table 2.1 Stages of Change
STAGE OF
DESCRIPTION KEY INDICATORS
CHANGE
Lacks the belief they could change

(quit a behavior or start a behavior),
In denial, or ignorant, that even if they wanted to
a change is necessary,
Pre-contemplation Perceives no control over their behavior
possible, or worth the effort
(e.g., resigned to their current state)
within the next six months
Defeated by failed prior attempts to
change
Aware of potential benefits of making
Contemplate making a a change but perceive the costs (e.g.,
change in the next six time, effort, sacrifices) outweighing the

Contemplation benefits
months but reluctant to
commit
Procrastinating making efforts toward
the behavior change
Begins to take small steps toward

Committed to make a the target behavior change (e.g., buys
change in the target behavior exercise apparel or equipment, signs
Preparation
within 30 days; engages in up for a gym membership, collects
preparation activities information, initiates the hire of a
personal trainer)
Actively doing things to change or

modify behavior
Engaged in change behavior
Action for less than six months; new Structures their environment in ways
behavior is not fully stabilized that support their healthy behavior
(e.g., avoids temptations that trigger
the undesirable behavior)
New behavior becomes second nature
Sustaining their new, healthy Greater confidence in ability to

Maintenance behavior for more than six maintain the new behavior
months
Greater sense of control over their
behavior

TEST TIP!
A personal trainer can use these client cues to help identify a client’s stage of change.
STAGE DESCRIPTION CLIENT CUE(S)
“I won’t.”
Pre-contemplation Not ready for change “I can’t in the next six

months.”
Thinking about “I may in the next six

Contemplation
changing months.”
Preparing to make a “I will in the next

Preparation
change month.”
Action Taking action to change “I’m doing ____ now.”
Maintaining positive “I’ve been doing ____

Maintenance
behaviors for at least six months.”
PROCESSES OF CHANGE
According to the TTM, there are 10 processes of change (i.e., strategies and techniques) that
PROCESSES OF can influence an individual’s transition from one stage to the next. Personal trainers can use
CHANGE: the processes of change to support the client’s advancement through the stages and stabilize
The strategies and
techniques that can the behavior once the client reaches the maintenance stage. The processes are broken down
influence an individual’s
transition from one stage of into two categories: experiential and behavioral. Experiential processes influence behavior
change to the next.
indirectly by focusing on the thoughts, perceptions, or feelings that an individual might have
about the target behavior. Experiential processes include consciousness-raising, dramatic
relief, self-reevaluation, environmental reevaluation, and social liberation.
Behavioral processes of change focus on active strategies and influence behavior directly
by manipulating environmental, social, or situational cues to encourage the desired
behavior. Behavioral processes of change include self-liberation, helping relationships,
counterconditioning, reinforcement management, and stimulus control.

Table 2.2 The Experiential Process of Change
EXPERIENTIAL
PROCESSES OF DESCRIPTION PRACTICAL SUGGESTIONS
CHANGE
Getting the facts. Providing factual information and

Increasing information about data relevant to the client’s current
Consciousness- self and of the unhealthy, behavior and target behavior
raising undesired behavior (current
state of behavior) and/or their
potential new behavior
Invoking emotions. Using MI techniques to engage the

Experiencing and expressing client’s emotions (e.g., engaging in
emotional reactions to the idea supportive, empathetic listening to
of continuing the unhealthy allow clients to express emotions
Dramatic relief
behavior (e.g., staying the without judgment or insinuating a
same) and to the idea of need for them to stop or change the
initiating a change (e.g., emotion)
enacting the healthy behavior)
Helping clients clarify their core

Creating a new self-image.
values, identifying healthy role
Rethinking one’s self-image
Self-reevaluation models, and visualizing oneself
to include the possibility of a
reaching and maintaining the desired
successful behavior change
behavior change
Realizing the effect on others. Asking the client to reflect on how their
Reflecting on how one’s current behaviors are impacting others around
Environmental behavior affects the physical them; asking the client to consider
reevaluation environment and people around another person’s perspective on the
them to include those they care impact of their behavior (e.g., increase
about empathy)
Helping clients realize how the desired,

healthier behavior is valued within
their social communities and society
Noticing societal acceptance.
at large; helping bridge the client’s
Increasing awareness of how
Social liberation motivational need of a sense of
the healthy, desired behavior is
connectedness to others who actively
supported by society
engage in the target behavior, such as
societal role models and/or people
within the client’s social circle

Table 2.3 The Behavioral Process of Change
BEHAVIORAL
PROCESSES OF DESCRIPTION PRACTICAL SUGGESTIONS
CHANGE
Ensuring the training program/intervention

accounts for motivational needs of autonomy
and competence; for example, enhancing
Committing with confidence.
autonomy by providing multiple choices or
Committing to take action
Self-liberation options within the behavior change plan, and
with the belief that change is
enhancing competence by engaging in self-
possible
efficacy strategies (e.g., vicarious experience—
sharing relevant examples of success and
testimonies of relatable individuals)
Generating social support.

Helping clients connect to social groups or
Establishing relationships where
individuals with similar goals and values,
one feels safe to share personal
Helping relationships virtually and/or in-person; encouraging clients
challenges and receive support
to recruit accountability partners or small
such as encouragement and
support groups
guidance
Making substitutions. Helping clients identify healthier behaviors that

Counterconditioning Finding healthier alternatives for can be substituted for less healthy or problem
unhealthy behaviors behaviors
Helping clients create a plan to celebrate

Using rewards and feedback. small and big successes, such as using
Using rewards and feedback rewards for accomplishing short-term goals;
Reinforcement
strategically to reinforce positive providing feedback and positive reinforcement
management
behavior and acting on one’s when client engages in positive behaviors;
values teaching clients to capitalize on self-monitoring
techniques (e.g., smart apps, journaling)
Helping clients identify purposeful cues

Managing the environment. in their environment to trigger the healthy,
Avoiding stimuli that trigger desired behavior (e.g., creating implementation
Stimulus control the unhealthy behavior and intentions); helping clients identify ways to
intentionally creating cues that restructure their environment to remove or
trigger the healthy behavior overcome stimuli that trigger the unhealthy,
undesired behavior

How can a personal trainer determine which process(es) will have the greatest impact on
the client’s progress? Research is mixed on which processes may be most impactful at
specific stages. For example, experiential processes have been found most effective in the
early stages of change for individuals who are quitting unhealthy behaviors (e.g., smoking
cessation), whereas behavioral processes have been strongly associated with enhancing
healthy behaviors, such as increasing physical activity.
Furthermore, current research has indicated that using both experiential and behavioral processes
of change may be most beneficial for increasing levels of moderate physical activity. The bottom
line is that there is no one-size-fits-all approach. The most effective process of change at any given
time (e.g., stage of change) will depend upon both the target behavior and the individual.
To select processes of change that are most relevant for the individual client, a personal trainer
should consider the key barriers, concerns, and challenges that clients have communicated in
regard to making the desired (or prescribed) behavior change. If a personal trainer encounters a
client whose predominant barriers to committing to the behavior change stem from the way they
think, feel, or perceive the behavior or their ability to successfully change their behavior, then the
most effective processes to help the client progress may be experiential processes.
On the other hand, if a personal trainer encounters a client whose primary challenges are
related to the client’s environment, choices, or habitual responses, then the personal trainer
may find that behavioral-based processes will be most effective in aiding the client’s progress.
It is possible for an individual to relapse during the behavior change process and revert to an
earlier stage. If this happens, supportive behaviors of a personal trainer include helping the
client to effectively cope with the consequences. Also, personal trainers can help the client to
reflect on the lessons learned through the experience and emphasize the growth as a result
of the lessons learned. Lastly, the personal trainer can help the client determine what to do
next, along with how to implement the lessons learned into their way forward.
Although there is much to consider regarding behavior change and each of the stages, there
is a need to make sure the client is able to effectively navigate the stage they are currently
experiencing. To best help the client, the personal trainer ought to be aware of strategies
to support the client’s motivation. Building upon the theme of getting to know the client,
listening to the client, and having a lens of meeting their needs, the motivation strategies that
will be discussed in this next section are focused on helping the client find the motivation for
change within themselves.

MOTIVATIONAL THEORIES AND APPLICATIONS

It is no secret that motivation is a key ingredient to accomplishing one’s goals. Therefore,
an ideal client is one who is self-motivated. The self-motivated client follows the training
plan to a T and shows up to each training session ready to work and give it all they’ve got.
This, however, is more the exception than the norm. Therefore, personal trainers ought to
be equipped with the knowledge, skills, and strategies to help clients acquire the motivation
necessary to make positive behavior changes and achieve their personal goals.
Effectively motivating people to do what needs to be done to accomplish the goal is a
common challenge for individuals in leadership positions, such as personal trainers, coaches,
teachers, and businesspeople alike. Most leaders know that the carrot-and-stick approach
(e.g., providing rewards or issuing punishment) doesn’t produce lasting change but instead
is a short-term strategy that requires constant work and attention on the leader’s part. The
SELF-DETERMINATION
quest to determine what motivates people, or how to better motivate clients, can be
THEORY (SDT):
A general theory of human addressed by focusing on the basic psychological needs of humans and drawing upon the
motivation that suggests
a person is motivated to internal motivation of the clients. Therefore, this section will cover two theories regarding
change by three basic
psychological needs of
motivation: self-determination theory (SDT) and MI.
autonomy, competence, and
relatedness.
FUNDAMENTALS OF MOTIVATION
Motivation includes two key components: direction of effort and intensity of effort. Direction
MOTIVATION:
The reason(s) one has for is what a person is drawn to or trying to achieve, such as the target behavior. Intensity is the
behaving in a certain way.
amount of energy and effort put forth toward the target.
INTRINSIC When a person participates in a task or activity because they find it inherently enjoyable, then
MOTIVATION: it is referred to as intrinsic motivation. For instance, someone who loves to run may engage
The drive to execute
in the activity for no other reason (e.g., weight management, aerobic fitness) other than
behaviors that are driven
by internal or personal because the person simply enjoys doing it. Unfortunately, intrinsic motivation toward healthy
rewards.
behaviors is not the case for all people. Many people will require extrinsic motivation—
motivation to behave in a specific way that is driven by external factors such as recognition,
EXTRINSIC
MOTIVATION: money, or praise. For this precise reason, it can be difficult for a person to change from
The drive to perform unhealthy behaviors to healthier ones because it requires a person to actively seek out and
certain behaviors based
on external factors such draw upon other sources of motivation.
as praise, recognition, and
money.

Figure 2.2 Intrinsic and Extrinsic Motivation
Motivation can come from a variety of sources. It can come from external factors, such as
listening to pump-up music, earning a reward, or hearing an inspiring pep talk. Motivation can
also come from internal factors, such as one’s core values and beliefs, basic human needs,
and self-identity. Although external motivation (e.g., the carrot-and-stick approach) can be
effective in the short term, fostering an internal motivation is much more effective when it
comes to the lasting motivation required for successful behavior change.
SELF-DETERMINATION THEORY
Just as humans have basic biological needs such as oxygen, sleep, clean water, and nutrition,
humans also have basic psychological needs. According to the SDT, there are three innate
and universal psychological needs, which include autonomy, relatedness, and competence.
Each plays an important role in a person’s motivation, well-being, and life satisfaction. This
section will review each component with particular emphasis placed on practical ways a
personal trainer can incorporate each psychological need into the training environment and
program design.

Table 2.4 Basic Psychological Needs
PSYCHOLOGICAL NEED DESCRIPTION
The basic need to feel in control of one’s

Autonomy
own behavior and goals
The basic need to feel effective and

Competence
capable in one’s actions
The basic need to feel a sense of

Relatedness
belonging and connection to others
Autonomy
Autonomy is the need to feel in control of one’s own behavior and goals. Autonomy can also
AUTONOMY: be described as a need for self-governance. An individual feels a sense of autonomy when
The need for self-
governance and control they are given the opportunity to make choices and take actions in line with their interests
over one’s own behaviors.
and values. When autonomy is satisfied, a client is more likely to engage in the activity
wholeheartedly rather than simply go through the motions.
TEST TIP!
Autonomy is important for most fitness clients! A personal trainer will educate clients
during their training with the goal of giving them the autonomy to exercise and remain
active and healthy on their own.
For example, a personal trainer can teach a client how to properly do a squat and help
them make better nutritional choices.
Autonomy support from the trainer begins with the program design. Based on the client’s
goals, a personal trainer uses their expertise to create a solid training framework. Rather
than dictating the client’s behaviors within the plan and expecting compliance, a personal
trainer ought to incorporate autonomy-supportive behaviors such as seeking input from the
client. For example, a trainer may offer the client to select which specific exercises they prefer
to do from a list of options. This approach can help strengthen the client’s commitment to
the plan and promote adherence.

Table 2.5 Autonomy-Supportive Behaviors
AUTONOMY-SUPPORTIVE PRACTICAL
BEHAVIOR EXAMPLES
• Helping the client minimize self-imposed

pressure (e.g., focusing on process-oriented
goals over outcome goals)
• Helping the client cope with perceived

Minimizing pressure
pressure from others (e.g., family member,
sports coach, physician)
• Setting and communicating realistic

expectations of the client
• Coaching the client to be an active

participant in the goal-setting process
Avoiding controlling behavior • Avoiding the use of “guilt” or “shame” as a

tool to motivate behavior
• Minimizing the use of external rewards
• Allowing the client to express their emotions

or feelings
Acknowledging the client’s feelings
• Listening with empathy and acceptance
• Validating their feelings
A personal trainer may work with some clients who did not voluntarily sign up for training.
In other words, some clients may feel they are not given a choice in the targeted behavior
change. For example, a youth client may be participating in the training sessions due to
parental force, or an adult client may be participating in training sessions because of their
doctor’s orders. In these situations, it is even more important that trainers allow the client to
be involved in the decision-making process whenever possible.

TRAINER TIP!
Scenario: Autonomy-support in action
Instructions: The trainer should read the scenario that pertains to implementing autonomy
within a personal training session. Then, the personal trainer should consider possible
actions to take if faced with the situation and how the different actions could impact the
client’s motivation in the moment, as well as over the long run.
Scenario: Sue, the client, has set a goal to be able to accomplish 10 strict pull-ups by the
time she turns 30, which is in 12 weeks. She currently can do five strict pull-ups. Sue and
her personal trainer, Coach Molly, have developed a training program that incorporates
pull-ups twice a week into her strength training regimen. Sue shows up for her training
session with Coach Molly and says that she does not want to do pull-ups, even though it is
on the training plan for the day. What should Coach Molly do? How can Coach Molly ensure
Sue makes progress toward her goal while also honoring Sue’s need for autonomy?
Possible solutions: There is no one-size-fits-all solution to this scenario. The best

solution will depend upon many factors such as the trainer-client relationship and the
trainer knowing when and how to push their client past their comfort zones and when
to adjust plans to accommodate the client’s requests. In this scenario, Coach Molly
engaged Sue in conversation about her resistance to do pull-ups. Coach Molly asked
why Sue was not wanting to do them on this particular day, showed empathy, and
then gave Sue some alternative exercises to choose from that could target the same
muscle groups and keep Sue on track for progressing toward her goal of 10 strict pull-
ups. Fundamentally, the key for personal trainers is to care for the client and let their
voice be heard. Allowing the client a greater sense of control over their actions can
lead to more enjoyment and satisfaction and sustain motivation over time.
Competence
Competence is the need to feel effective when operating within the environment. Clients will
COMPETENCE: be more motivated to take actions that help them achieve their goals if they believe they have
The basic need to feel
a sense of mastery and the knowledge, skills, and abilities for success. Lack of perceived competence can impact
operate effectively within
the environment. the behavior change process by decreasing motivation.
For example, some clients who are new to exercise may feel intimidated to go to the gym.
It can be uncomfortable to be in a new environment and not know what to do or not feel
capable of performing the exercises correctly. Perhaps of all three of the basic psychological

needs, personal trainers are most familiar with and best trained for supporting the need for
competence. A standard expectation of the personal trainer is to help the client develop their
competence in health-related behaviors. Even still, there is more to it than teaching proper
form or developing a program that leads to health and fitness improvements.
There can sometimes be a discrepancy between the client’s actual (i.e., demonstrated and
measured) competence and the client’s perceived competence. For instance, a client may
have the physical skill to perform an exercise such as the hang clean, but they may not have
the confidence in their ability to perform the hang clean. Although personal trainers are not
expected to engage in psychological skills coaching with the client, it is within the scope of
practice for trainers to help clients realize their actual potential and become more self-aware
of their actual abilities. The perceived competence can be conditioned through consistent
and specific positive feedback and asking the client to self-identify what they did well.
Table 2.6 Competence-Supportive Behaviors
COMPETENCE-
PRACTICAL EXAMPLES
SUPPORTIVE BEHAVIOR
• Being consistent with the structure and routine of

training sessions so clients know what to expect
Providing structure and routine
• Encouraging clients to adopt routines into their
exercise regiments
• Matching skill level with task difficulty to provide

opportunities for success
Providing the optimal level of • Encouraging performance goals that are challenging
challenge yet feasible
• Breaking down complex movements into

manageable parts
• Teaching proper physical technique (e.g., strength

Providing the opportunity to
training exercises, running, stretching)
learn and master new skills
• Teaching proper mental techniques (e.g., where to focus
or what to focus on, how to cope with failed reps)
• Providing constructive and informative feedback

when correcting behavior
Providing feedback
• Providing effective praise to reinforce positive
behaviors

Competence is closely related to the concept of self-efficacy, which is the certainty of one’s
ability to accomplish a particular task. Self-efficacy is one of the four constructs within the
TTM. There is a subtle difference, though, between self-efficacy as described in the TTM and
competence as described by the SDT. Self-efficacy represents acquired or learned cognitions
pertaining to the belief in one’s ability to accomplish specific future tasks, whereas the
need for competence represents an innate motive for behavior pertaining to a more
general experience. Simply put, self-efficacy can be trained by targeting one’s cognitions
(or perceptions), but competence is a need that is met by personal trainers engaging in
competence-supportive behaviors.
Relatedness
Relatedness is the need to feel connected to and supported by others, as well as a sense of
RELATEDNESS: belonging within a group or community. In the context of exercise and health behavior, the
The need to feel connected
to and supported by others need for relatedness is often overshadowed by the need for autonomy and competence;
as well as a sense of
belonging within a group. however, research has demonstrated that there is a positive association between relatedness
and exercise behavior. For real-world examples, one may consider two leading exercise
modalities within the fitness industry, CrossFit and Peloton. Both fitness regimens capitalize
on connectedness, community, and a sense of belonging. Satisfying the innate need for
relatedness should not be overlooked.
Personal trainers are typically hired because of the value they bring to the client’s goal
pursuit; however, trainers who appreciate the value added by the client will more fully satisfy
the client’s need for relatedness. A client’s sense of belonging can be amplified when they
feel they have something to contribute to the relationship or group.
Enhancing your effectiveness as a trainer relies on consistent learning and growth. Clients
can often be the trainer’s best teacher. For example, clients can provide feedback as to what
elements of the training session or program worked well for them and what didn’t. Clients may
also suggest creative solutions to behavior change challenges that a trainer hadn’t thought
of before. Lastly, clients can offer their professional and life experiences to their personal
trainer, which can facilitate the trainer’s personal and professional growth. Acknowledging
that value can be added by both the trainer and the client to enrich the working relationship.

Table 2.7 Relatedness-Supportive Behaviors
RELATEDNESS-
PRACTICAL EXAMPLES
SUPPORTIVE BEHAVIOR
• Building rapport with the client; getting

to know one another within professional
bounds
Allowing for meaningful • Allowing for informal socialization between

interpersonal interactions clients or between client and trainer before
and after the workout
• Introducing the client to others (i.e., gym

staff members, other clients)
• Starting and ending each session with a

positive tone
Promoting positive emotions to
strengthen connections • Making training sessions “fun”
• Engaging with a sense of humor
• Encouraging clients to join social groups

(social media or in-person at the gym or
within the community) that support the
Promoting camaraderie and target behavior or relate to the client’s goals
cohesion and values
• Avoiding making social comparisons; using

competitive tactics sparingly
• Providing positive feedback
Engaging in effective • Clearly communicating expectations and

communication boundaries
• Using active listening
Although the innate psychological needs outlined by the SDT are each unique, they are
not mutually exclusive. For instance, personal trainers who engage in autonomy-supportive
behaviors will likely also tap into the client’s need for relatedness. Additionally, allowing the
client to share about areas in their lives, of which they have high levels of competence, can be
a motivating factor for the client to adhere to the training schedule and attend their training
sessions. People are motivated when they feel and can express their competence.

MOTIVATIONAL INTERVIEWING
Each client has unique personalities, experiences, and circumstances that influence their
motivation for change, specifically their progress through the stages of change (e.g., pre-
contemplation to contemplation to preparation to action to maintenance). An effective
method for personal trainers, then, is to help the client discover the unique motivation that
lies within them. This can be done by using the MI method.
Motivational Interviewing is a collaborative, client-focused method of guiding a client toward a
self-identified motivation for change. The underlying aim of MI is to elicit the client’s own
change talk. Change talk is self-motivating speech; it is the verbal expression of one’s desire
for change, ability to change, or reasons one needs to change. Through appropriate
OARS MODEL:
A communication model for questioning and listening, trainers then work to reinforce the client’s own arguments and
motivational interviewing
that includes open-ended motivations for initiating, or progressing through, the behavior change. The OARS model,
questions, affirmations,
reflective listening, and
which includes four communication skills or techniques, provides tangible actions that
summarizing. trainers can take to increase MI effectiveness. This model supports a communication style
that can increase motivation as well as build the client-trainer relationship known as rapport.
RAPPORT:
A close, harmonious Table 2.8 The OARS Model
relationship in which all
parties involved understand
one another’s feelings and
TECHNIQUE HOW TO EXAMPLE
communicate well.
Using “what” or “how” questions
O: Open-ended instead of “why” questions to gain “How important is it for
questions clarifying information and avoid the client you to make a change?”
responding with justification for behavior
“I am so glad you came

Affirming a personal strength or ability
to the gym today—it isn’t
A: Affirmations of the client; affirming what the client
always easy to prioritize
has already done or done well
your health.”
Listening with the intent to understand, “You’re feeling upset because

R: Reflective
observe client body language and behavior, you didn’t achieve your
listening
and offer a reflection of what was said nutrition goals last week.”
Providing a collective summary of what

was talked about, making connections
“So let’s go over what we
S: Summarizing between client’s own responses, or
have talked about so far.”
summarizing the plan of action moving
forward

MI can be especially effective in the earlier stages of change. That being said, MI is not a
method of convincing, persuading, or coercing a client into change. The MI method does not
generate the motivation; it reveals it. For clients who demonstrate a readiness for change,
the method of MI may not be necessary because the client already possesses self-motivation
and has sought out a trainer ready to learn and improve their health and fitness. In fact, the
use of MI could potentially limit the progress of the client.
TEST TIP!
The goal of MI is to guide someone toward solving their own problems and uncovering
their reasons for any mixed feelings or contradictory feelings (ambivalence). A personal
trainer gives them autonomy over the process but does NOT come up with a solution
for them!
Exceptions could occur, though, where trainers may choose to use the MI method with clients
in advanced stages of change. For example, a trainer’s job is to consistently challenge the
client outside of the client’s comfort zone. As a client improves their fitness level, the trainer
may introduce a new behavior (i.e., advanced technique) or raise the intensity expectation
(e.g., increase weight resistance) to adequately challenge the client and yield continued
fitness improvement. In these situations, a client may demonstrate a resistance to the
changes within the program. If so, then trainers can engage in the MI method to work through
the client’s resistance.
The method of MI has grown over the past quarter of a century. More and more
professionals and practitioners have incorporated MI into their work, without guided
oversight or accountability to its integrity, which has led MI to be misconstrued at times.
Clearing up misconceptions about MI is important to ensure that personal trainers have
an accurate understanding of when and how to use the interviewing method and for what
purposes.

Table 2.9 Misconceptions and Facts of MI
MISCONCEPTION FACT
MI is a method that involves a set of

1. MI is a technique with communication skills to engage in to
prescribed steps. effectively respond to the moment-to-moment
changes in what the client says.
2. MI is a natural communication MI is a skill that is learned and mastered with

style; it doesn’t take effort. consistent practice over time.
3. Trainers can use MI to convince

MI does not generate a client’s motivation;
or persuade a client to make
it reveals the motivation that already exists
important changes to their
within the client.
health.
The focus of MI is to elicit change talk

(e.g., pros) rather than place emphasis on
4. Constructing a decisional
counterchange talk (e.g., cons); for some
balance (e.g., pros and cons) is
clients, constructing a decisional balance can
an essential step of MI.
reinforce their own reasons to not make a
change.
5. MI can be used for selling Using MI for selling purposes is unethical and
purposes (e.g., sell training compromises trust and respect between the
services or gym memberships). trainer and client, which damages rapport.
Behavior change isn’t easy; it takes work. It is often easier to stay the same. Therefore, it
is common, and expected, for a person to experience resistance to change. The greater the
resistance, the less likelihood that change is made. Resistance is a form of energy in which
personal trainers can either lessen or intensify. Minimizing resistance is not as simple or
cut-and-dry as a trainer might think. The MI method, though, can help guide the process of
minimizing resistance.
MI is the integration of many skills used together as necessary per any given moment.
There is not a set structure for what to do, just as there is never a set pattern of words and
content that one person says, let alone every single person. The focus of MI is on the client.
Therefore, the strategy and skills used in any moment will change based on what the person
needs in the moment. There are four guiding principles of MI that can assist a personal
trainer in using the method effectively:

• Not trying to “fix” a client or their behavior
• Understanding the client’s motivations
• Listening to the client
• Empowering the client
RESISTING THE URGE TO “FIX”

During trainer-client communications, clients often share challenges, problems, or reasons
why they are resistant to make a behavior change. When this happens, a personal trainer
must resist the urge to try to actively “fix” the client’s problems by telling the client what to
do. For example, a client may tell their personal trainer that changing their nutrition behavior
has been challenging due to their love for potato chips, and the trainer’s immediate response
is to suggest that the next time the client wants something crunchy that they should reach for
celery instead. How might this affect the conversation moving forward? How might this impact
the client’s nutritional behavior moving forward?
Offering expertise and suggestions (i.e., providing quick “fixes”) is a natural urge, given that
personal trainers are passionate and knowledgeable about improving health and well-being.
Although well-meaning, telling clients what to do, such as why to change or how to change,
is ineffective. If it were as easy as that, then the Centers for Disease Control and Prevention
recommendations for healthy behaviors (e.g., exercise, nutrition, and sleep) would be enough to
motivate behavior change, and the US would not be faced with an obesity epidemic. But most
experienced personal trainers will attest that giving clients information or statistics does not
translate into action. Resisting the urge to “fix” the client’s resistance will allow the conversation
to continue, which allows the client to discover solutions for themselves that produce a greater
commitment to the behavior change process, which is the whole premise of MI.
UNDERSTANDING THE CLIENT’S MOTIVATION TO CHANGE

The second key principle of MI is understanding the client’s motivation to change. Some
clients may say the reason they have hired a personal trainer is because they need motivation.
Motivation is a general term. The client may mean they need direction, or they might mean
they need willpower. It is within the realm of MI to ask for clarification of what the client
means. This would also help to clear up any unrealistic expectations of the trainer.
It may be worth sharing with the client that despite the trainer’s effort to motivate the client,
by using external motivators such as offering rewards for short-term goals or delivering an
enthusiastic pep talk each training session, this is not the type of motivation that sustains

positive behavior. A personal trainer can help the client appreciate that it is their own
personal reasons for change that create the motivation to initiate and sustain a behavior
change. Educating the client about the psychology of behavior change may help them take
more ownership of the process.
Trainers influence the client’s internal motivation to change by asking quality, open-ended
OPEN-ENDED questions—questions that require more than a yes or no answer and encourage the client to
QUESTIONS:
Questions that require more communicate the “how” and “why.” Following the client’s response, a trainer can provide a
than a yes or no answer
reflection or summary of what the client has shared, emphasize the change talk that the
and encourage the client
to communicate the “how”
trainer hears the client speak, and ask for clarification. As the personal trainer draws out the
and “why.”
client’s arguments or reasons for change, it creates a discrepancy between the client’s
present behavior and their goals and values. When the client gains greater awareness of the
discrepancy, it is likely to decrease their resistance for change and ultimately enhance their
personal decision to make a change.
LISTENING TO THE CLIENT

The third principle of MI is listening to the client. To fully understand the client’s motivation,
a trainer needs to listen to what the client has to say. The quality of listening matters too. For
clients to be willing to explore their innermost motivations and verbally express them to the
personal trainer requires more than just active listening; it requires listening with empathy.
EMPATHY: Empathy is the ability to understand and share in the feelings of others. Listening with
The ability to understand
and share in the feelings of empathy involves looking at the situation from the client’s point of view.
others.
Along with empathy, clients may be seeking (or needing) validation. Validation is a response
that shows acceptance of the other person’s feelings and point of view. Validating the client’s
thoughts, feelings, and behavior can be done, even if a trainer doesn’t agree or approve of
them. A simple validating statement, such as “I can see how that could be so difficult for
you,” can go a long way in helping the client to feel heard. When a client feels heard, they are
more likely to be open to listen in return.
EMPOWERING THE CLIENT

The fourth principle of MI is empowering the client to make the change. Clients feel
empowered to make a change when they play an active role in developing and implementing
the plan. Therefore, trainers who engage the other three principles of MI and incorporate

need-supportive behavior to promote autonomy, competence, and relatedness will positively
contribute to the client’s sense of power and control over their choices and their actions, and
ultimately their behavior change.
A client’s belief in their ability to make progress in the behavior change process or accomplish a
goal (e.g., self-efficacy) is a key factor in whether a person transitions from the pre-contemplation
stage to the contemplation stage of change. Even at the later stages of change, self-efficacy plays
a pivotal role because the client will be challenged throughout the whole process. Specifically, the
behavior change process will challenge clients physically and mentally.
For example, there will be physical behaviors that clients must engage in according to their
fitness program, such as engaging in strength exercises and/or meal planning. Likewise,
clients must engage in mental behaviors such as coping with setbacks (e.g., temporary
relapses). The personal trainer’s role is to help the client develop the knowledge, skills,
and abilities to successfully execute these behaviors. When clients feel equipped with the
requisite tools, then they are more likely to feel empowered to make a change.
PROVIDING INFORMATION IN MI
When using MI, the trainer’s role is to draw out information from the client. This role requires
that a trainer resist the urge to provide certain information to the client, such as reasons
the client should make a change or solutions to the client’s obstacles. This behavior can be
challenging for a trainer who is used to being in the “expert” role, providing health and fitness
information, advice, and guidance. However, most experienced trainers can attest that giving
expert advice does not automatically lead to the client making the advised changes. Advice
and expertise alone will not inspire change unless the client is ready and willing to receive it.
There is a time and place for trainers to impart their expertise onto the client, but it will
require self-regulated, purposeful behavior on the trainer’s part. The developers of the MI
method, William Miller and Stephen Rollnick, suggest using the elicit-provide-elicit approach
to providing information to clients. Using the elicit-provide-elicit technique can help clients be
more receptive to the expert advice offered by a trainer and, thus, have a better likelihood of
the client acting on the advice.

Table 2.10 The Elicit-Provide-Elicit Approach
STEPS EXAMPLES
Elicit: exploring the gaps in the client’s

knowledge on the relevant health or Trainer: “Would you like me to give you
fitness topic and asking permission to some strategies to support your goal to
provide information to determine if the improve your body composition?”
client is interested and open to receiving it
Trainer: “Increasing your water intake

may be a good place to start for you;
Provide: providing information using
sometimes, the hunger sensation
common, relatable language and in
is a sign of dehydration. Consuming
small, manageable chunks
adequate water may help decrease your
caloric intake.”
Elicit: checking for understanding Trainer: “How does that sound?”
BLENDING SDT AND MI

With an understanding of the SDT and MI, it is evident that there is some level of overlap.
Mainly, both methods place priority on the client, such as the client’s needs to have a sense
of control over their choices and actions along with the ability to discover their means (i.e.,
motivations) for control that can effectively produce a change. As with most psychological
theories and areas within the field, the number of options available to integrate and the
possibility of nuances across clients are unending.
Although a selection of practical suggestions has been given, it would be impractical to provide
a complete how-to guide. Any attempt to do so would undoubtedly fail at encompassing
enough variance to satisfy the needs of both trainer and client. Rather than specific examples,
a trainer should consider the intent of the two concepts and how they can be blended to
amplify the motivational effect.
Although the focus has been on supporting the behavior change of clients, it has likely also
indirectly encouraged behavior change within personal trainers. For example, this section on
motivation alone has drawn attention to behaviors that trainers can engage in to positively
influence the client’s behavior. Just like a client, a trainer may have resistance to initiating
or engaging in some of the behaviors discussed. In certain cases, a personal trainer may
see MI as a daunting task that isn’t worth the effort. If so, the trainer might consider how
engaging in MI does or does not align with their values, desires, and who they are as a

person. The trainer may also look toward their own needs of autonomy, competence, and
relatedness. The trainer can take the concepts learned from this chapter and choose how to
implement them, which will support their need for autonomy.
The personal trainer might also consider their competence and perhaps seek additional
information or someone who could provide them feedback on their skill of MI or their need-
supportive behaviors. Strengthening connections with a mentor or other professionals in the
field may help to satisfy the trainer’s need for relatedness while simultaneously increasing
the trainer’s capacity to satisfy their client’s need for relatedness.
A fitness professional is encouraged to routinely self-assess their trainer behaviors to
determine which behaviors of SDT and MI the trainer may already be incorporating and
in which areas they have room for improvement or expansion. A trainer will naturally have
strengths and weaknesses. Although it is common to target weaknesses, it can be just as
valuable to engage in strength-based behavior. As the client begins to embody one method, it
can make it easier to embody the other. The focus of either approach is on the client. It is up
to the client—via the questions, empathy, and care demonstrated by the trainer—to identify
what they can do to enable change and therefore support their own success.
SETTING GOALS THAT MOTIVATE BEHAVIOR

Goal setting, when done properly, is one of the most impactful strategies for motivating
behavior because goals provide clients with a sense of purpose, direction, and energy. Goal GOAL SETTING:
The process of identifying
setting within health and fitness is the client-directed process of identifying their ideal or the client’s ideal state,
determining their current
desired state, determining their current state in relation to the desired state, and defining the state, and defining the
actions that must be taken
actions that must be taken to close the gap. An effective goal plan includes processes to to close the gap.
increase the probability of goal achievement. Therefore, a trainer’s competence in the
fundamental components of goal setting will help the trainer use this tool more effectively
with their clients. The fundamental components of goal setting that will be covered in this
section include using long-term and short-term goals, SMART goal intentions, implementation
intentions, and monitoring and feedback processes.

Table 2.11 Fundamental Components of Effective Goal Setting
FUNDAMENTAL COMPONENTS
Complementary long-term and short-term goals
SMART goal intentions
Implementation intentions
Monitoring
Feedback
It is human nature for there to be resistance whenever a person is told what to do. Therefore,
it is critical that clients play a central role in the goal-setting process. When the client
constructs their own goals, with the support and guidance from the trainer, then this will
foster ownership over the training program and create more buy-in.
Trainers should guide the client to set both long-term goals and short-term goals. Long-term
goals refer to the desired outcome the client wishes to achieve. Long-term goals can have a
timeline of one year or more. Identifying a meaningful long-term or outcome goal provides a
OUTCOME GOAL: sense of purpose. Meaningful goals are those that align with a client’s values and priorities.
A goal where the end
result is a specific desired A clear, meaningful outcome goal also promotes an openness to try new strategies and find
outcome.
creative solutions to obstacles.
Short-term goals are those that a client wants to achieve in the near future. Short-term
goals can have a timeline from a few days to weeks to months or up to a year. Establishing
short-term goals provides direction and effort toward actions that will lead a person closer
to realizing their outcome goal. Long-term goals and short-term goals complement one
another—long-term goals provide motivation for a client to engage in short-term goals, and
short-term goals are the steppingstones toward the long-term goals.
Goals can also be categorized as process or outcome goals. Similar to short-term goals, a
process goal is a smaller goal that must be achieved in an attempt to reach a larger result.
PROCESS GOAL: The modifications to the process help lead clients to their ultimate end goal—for example, “I
A goal where the focus is
on the process or action want to exercise for 30 minutes per day for the next six months.” On the other hand, an
that will lead to the desired
end result. outcome goal is a goal that is associated with a specific end result. “I want to lose 15
pounds before December 20” is an outcome goal. Clients should set both process and
outcome goals for long-term success.

SMART GOALS
One of the most popular methods for setting effective goals is to follow the SMART principle,
which stands for: SMART PRINCIPLE:

Acronym to enable goals
to be more objective; S—
Specific: The goal is well-defined and clear as to what the client intends to do. The example specific, M—measurable,
A—achievable, R—relevant,
goal, however, directs specific behavior to be taken. T—time-bound.
Measurable: The goal provides three specific criteria to follow. It clearly identifies the extent
to which the action needs to occur, such as two miles, 36 minutes, three times a week.
Achievable: The achievability will depend upon the individual client, particularly the client’s
time constraints, physical abilities (i.e., fitness level), and mental abilities (i.e., self-efficacy).
Relevant: The goal demonstrates relevance because it addresses an important health
behavior (e.g., exercise) for weight management. An additional check for relevance is to
ensure that short-term goals align with the client’s long-term/outcome goals.
Time-bound: The goal has a clearly defined time frame: within one week’s time (e.g., seven
days), the client plans to walk three times. Having a timeline prevents procrastination and
creates a sense of urgency. Other goals may incorporate a deadline or date to which the goal
will be achieved (e.g., “I will lose five pounds by February 1”).
Mea
cific su
pe
ra
S
ble
Ti m e-B o u
Smart
a ble
Goals
iev
d
ch
A
n
R eleva nt
Figure 2.3 SMART Goals

SMART goals transform a subjective goal (e.g., “I want to feel better about my weight”) into
SUBJECTIVE GOAL: an objective goal (e.g., “I want to improve my body composition by 3 percent within three
A goal based on a
subjective outcome that months”). A subjective goal means there is room for interpretation as to whether the person
will be dependent on
the interpretation of the achieved the goal or not. Although there is some value to subjective goals, objective goals
individual client.
offer the ability to measure and quantify the amount of progress made toward the goal.
OBJECTIVE GOAL: Objectivity is advantageous for both long-term goals and short-term goals. Other advantages
A goal based on objective, to creating objective goals include:
quantifiable data that
can be measured and
evaluated. • Provide data, facts, and information that can lead to greater awareness for the
client and trainer alike, so adjustments can be made, if necessary
• Minimize faulty perceptions or interpretation as to whether the client is engaging in
the right behaviors, at the right amount, and with the right intensity and commitment
to achieve the goal
• Provide clear markers for when a goal is achieved and can be celebrated
• Increase accountability of the client
For a client who is 50 pounds overweight and currently engaged in moderate activity, a
subjective goal, one that would be less likely to motivate behavior change, might be “I will do
more cardio.” While doing more cardio could benefit the client, this goal is too ambiguous.
Instead, a strong short-term goal following the SMART principle might be “I will walk two miles
under 36 minutes at least three times a week.”
IMPLEMENTATION INTENTION
It is true that objective, SMART goals can motivate and direct behavior; however, even a
SMART goal can fail if the client does not follow through on it. This is especially true if the
client has low self-regulation skills. Too often, people rely on “feeling motivated” or “being
inspired” to engage in their goal behaviors. It can be frustrating for a trainer to hear a client
say they did not engage in the target behaviors because they “just didn’t have the motivation
this week.” How, then, can a personal trainer help a client to act upon the goal? The answer
is to leverage the client’s situational cues and automate goal behavior. This can be done by
incorporating implementation intentions within the goal-setting process.

IMPLEMENTATION
INTENTION: An implementation intention is a preset plan that specifies when or where to act on the goal
A preset plan that links
critical situations (e.g., behavior. Implementation intentions link critical situations (e.g., anticipated obstacles or
anticipated obstacles or
opportunities) to goal- opportunities) to goal-directed responses and, thus, leverage the power of cues. The general
directed responses.
framework of implementation intentions is stating the situation (e.g., “When _______ arises”)

followed by the goal-directed action or behavior (e.g., “then I will _____”). This is called a
“when/then” statement.
Let’s revisit the goal “I will walk two miles under 36 minutes at least three times a week.”
The target behavior is walking. An implementation intention that demonstrates linking an
opportunity with a goal-directed response is “When I finish my morning coffee, I lace up my
shoes and head out the door.” An implementation intention that demonstrates linking an
obstacle with a goal-directed response is “When I want to hit the snooze button, I visualize
the outcome of achieving my goal.” The trainer and client can work together to determine how
to integrate SMART goals and implementation intentions within the goal plan. Perhaps the
client would benefit from having one implementation intention to go with each SMART goal.
On the other hand, the client may create one implementation intention to support their priority
behavior for the week.
MONITORING
A critical piece to the goal-setting process is monitoring progress toward the goal. Monitoring,
also referred to as tracking, is the process of observing and taking notice of routine behaviors
MONITORING:
The process of observing
that impact goal progress and achievement. Monitoring ensures that the goal and the goal and taking notice of routine
behaviors that impact goal
plan (e.g., prescribed training plan) remain priorities to the client because they require progress and achievement.
attention to be given to one’s behaviors on a routine basis. There are various mechanisms
that can be used to monitor progress, such as self-monitoring and using technology (e.g.,
smartwatches or mobile applications).
Self-Monitoring
When working with clients, personal trainers should encourage clients to engage in self-
monitoring, which is the process of documenting one’s own daily actions and behaviors that
influence goal progress. For example, a personal trainer may ask the client to record the work
performed between training sessions, such as the frequency of training (e.g., days per week)
and the amount of work performed (e.g., number of repetitions and sets; the weight used
for each exercise). Another example is asking the client to keep a daily nutrition log. Trainers
should foster autonomy by providing the client with options of how to monitor and track their
behaviors and progress. Some clients may prefer paper and pen (e.g., journal or calendar)
while others may prefer electronic or technological tracking methods.

The information that the client and trainer collect is useful feedback that can be used to
evaluate the efficacy of the training program. Furthermore, monitoring increases client
accountability to follow through with the plan and engage in target behaviors that impact
goal progress. Trainers can check with the client to determine the role they want or need
the trainer to play in the accountability process. The feedback received through the
monitoring process can help both trainer and client to make improvements, if necessary,
as well as reinforce positive behaviors and celebrate small wins.
Use of Technology
The use of technology, such as fitness trackers (e.g., smartwatches) and mobile
applications (apps), has increased in popularity over the past decade. Not only are
fitness trackers and mobile apps more frequently used, but research has demonstrated
positive results such as increased engagement in exercise and greater physical activity
levels compared to nonusers. Yet even technology has its limitations. When the novelty
of the technology wears off, then there is typically a drop in motivation that leads to low
retention rates.
According to the motivational technology model, the most effective technological
methods for tracking or monitoring health and fitness behaviors are those that fulfill a
person’s psychological needs outlined by the SDT. The most effective tracking devices
and mobile apps, therefore, in sustaining health behaviors incorporate features that
promote autonomy (e.g., self-determined goals; choice of modality), competence (e.g.,
exercise instruction; visible progress such as graphs and metrics), and relatedness (e.g.,
interactivity within a social support network; a sense of belonging to a community).
Clients may turn to personal trainers for recommendations as to which mobile app or
fitness tracker to use. Therefore, trainers must be diligent to evaluate and screen for
ones that are accurate (i.e., valid information and metrics), relevant to the individual
and target behavior, and user-friendly. The table below presents practical strategies for
personal trainers to evaluate and screen health and fitness technology before making
recommendations to clients.

Table 2.12 Evaluation of Fitness Technology
STRATEGY OBJECTIVE
To assess the credibility, validity, and reliability of the

Reviewing scientific
technology. For example, is the app/tracker supported
literature and app
by evidence-based research? Does the app/tracker
clearinghouse websites
provide accurate, reliable measures and metrics?
To gain insight of the positive and negative

experiences from current or past users to include
Reviewing app satisfaction with the usability as well as the
descriptions, user ratings, effectiveness in supporting one’s goals or target
and user reviews behavior. Additionally, consumers provide feedback
that can help determine if the paid versions are worth
the financial investment for the client.
To evaluate the accuracy of the information provided

and assess whether the functions and features
adequately address the target behavior and elements
Piloting the technology
of the behavior change process. Firsthand experience
firsthand
using the interface can also provide the trainer with
insight into how user-friendly it is and enable a trainer
to answer specific questions from clients.
Seeking feedback from the

To discover what peers are recommending (or not
trainer’s professional or
recommending).
social network
After a trainer recommends an app or tracker or

becomes aware that a client is using a specific
technology, then the trainer ought to follow up
to assess how well the technology is working for
Eliciting feedback from
that specific client. Usefulness will vary based on
clients
the individual’s preferences, target behavior, and
technological savviness. Even if it is a quality app, it
does not guarantee it will be deemed useful for every
client.

Feedback
The feedback given from the personal trainer to the client is also a factor that contributes
to a client’s perceived competence. For the client to develop their proficiency in exercise
movements and/or fitness level, the client must operate within a feedback loop for growth.
The personal trainer’s role is to provide quality feedback such as constructive criticism and
effective, specific praise that can directly increase the client’s competence.
Correcting mistakes is essential for growth and development; through constructive criticism,
the client can learn what adjustments must be made to ensure safety and movement
effectiveness. For the feedback to increase the client’s competence level, though, criticism
needs to be delivered constructively. When a trainer identifies and communicates what was
specifically done incorrectly and provides clear instruction on how to make the appropriate
corrections, then the client can gain confidence in their ability to do it right next time. If the
criticism is too general (e.g., “You’re doing it wrong”) or pervasive in nature (e.g., claiming
the client is lazy or uncoordinated), then it can negatively impact the client’s perceived
competence and decrease the client’s motivation to put forth the effort to try again.
Many personal trainers focus only on giving corrections. Praising positive behaviors can be
just as effective in developing the client’s skill if it is done in a specific manner. Although
cheering a client on with “good job” and “way to go” after a successful set of an exercise
is not discouraged, this generic praise does not directly reinforce the desired behaviors.
Conversely, when a trainer identifies and communicates the specific behavior that the client
did well, then the client knows what to repeat for future success. Identifying specific moments
of success via effective, specific praise enables for greater consistency of successful effort.

Table 2.13 Examples of Constructive Criticism and Effective Praise
EXERCISE/ GENERIC CONSTRUCTIVE

BEHAVIOR CRITICISM CRITICISM
“You’re still allowing “Your weight is too far forward;

Back squat: poor form your knees to track in shift your weight to your heels
front of your toes.” and hinge at your hips.”
“I see you didn’t track your

behavior last week. Moving
Client failed to track forward, try to make this a
“If you don’t track your
behaviors (e.g., priority because doing so will
behavior, then you’ll
nutrition log or help you get the most out of
never make progress.”
exercise) last week working with a trainer and,
ultimately, help you to achieve
your goal.”
“That mindset will hold you

Mindset: client says, back. Focus on learning the
“Don’t be so negative.”
“This is too hard.” technique I’ve just shown you;
you’ll get better with practice.”
EXERCISE/
GENERIC PRAISE EFFECTIVE PRAISE
BEHAVIOR
“Good job; you maintained a

Lunge: completed a
“Good job.” strong core and got the full
set with good form
range of motion.”
“I’m proud of you for tracking

Client tracked behavior
your behavior three days last
(e.g., nutrition log or “Something is better
week. I know tracking takes
exercise) three out of than nothing.”
time and effort, so this shows
seven days last week
commitment to your goal.”
“Yes! I noticed you were really

Mindset: client says, “I focused and got your mind
“Yeah, awesome!”
did it; that felt good!” and body dialed in for the set.
It worked!”

The effective praise strategy can further be elevated when it is connected to the long-term
goals of the client and their overall ability. Identifying the specific action within a squat that
went well is powerful for success, especially when adding in that the overall progression of
learning the complex movement is impressive and powerful to experience. The trainer who
communicates specific growth in the client and the progress made toward the client’s goals
enables a greater sense of competence and motivation from the client.
SCOPE OF PRACTICE
This chapter has provided practical knowledge of the psychology of behavior change within
the health and fitness domain. It has also presented actions that personal trainers can
take within their scope of practice, such as identifying their client’s motivational needs,
accounting for the client’s motivational needs within the program design, and creating a
motivational climate that best supports the client’s progress through the behavior change
process. As described in this chapter, the role of a personal trainer does include coaching
clients through psychological processes; however, trainers must be aware of their boundaries
of ethical practice and not cross over into the role of professional psychologists. If or when
a personal trainer encounters a situation that exceeds their competency or comfort, then
the trainer should refer the client to the appropriate professional, such as a licensed clinical
psychologist or an exercise and sport psychology practitioner.
Table 2.14 When to Refer to an Appropriate Psychology Professional
EXERCISE AND
LICENSED CLINICAL
PRACTITIONER SPORT PSYCHOLOGY
PSYCHOLOGIST
PRACTITIONER
Increasing self-confidence Diagnosing and treating

clinical depression
Decreasing exercise anxiety
Diagnosing and treating
Increasing self-motivation
clinical anxiety
Goal or issue
Optimizing energy levels
Emotional/mood disorders
Performing under pressure
Eating disorders
(e.g., for athletes or fitness
competitors) Substance abuse

MOVEMENT SYSTEMS
CHAPTER 03
LEARNING OBJECTIVES
1 | Describe the structures and functions of the nervous system.
2 | Describe the structures and functions of the muscular system.
3 | Describe the structures and functions of the skeletal system.
4 | Name the different types of connective tissues and their unique functions.

CHAPTER 03 | Movement Systems
The human body is organized in levels of increasing complexity. At the microscopic level,
there are subatomic particles (protons, neutrons, electrons), which make up atoms. Atoms
group together to form molecules. Molecules make up organelles, which are small cellular
structures that perform specific functions within the human cell. Cells aggregate into the
various tissues that make up organs and organ systems. Finally, the organ systems, as a
ORGAN SYSTEMS: collective, comprise the organism that is the human.
A group of organs working
together to perform
biological functions.
LEVEL
LEVEL EXAMPLE
EXAMPLE
Atoms
Atoms Hydrogen
Hydrogen H
Chemical
Chemical
H H
Molecules
Molecules Water
Water O
Organelle Nucleus
Organelle Nucleus
Cellular
Cell
Cell
Cell Muscle
Musclecell
cell
Tissue Muscle
Muscletissue
tissue
Organ
Organ Heart
Heart
Organ System
Body System Muscular system
Muscular system
Organism
Organism Humanbeing
Human being
Figure 3.1 The Organizational Levels of the Human
Human movement happens when multiple organ systems work together in an interrelated way.
The body has 11 organ systems operating to keep us alive and healthy. Of those 11 systems,
the nervous system, muscular system, and skeletal system are the 3 most prominent organ
systems responsible for human movement. They execute specific functions in concert with
one another to create movement. The skeletal system provides most of the physical support
for the body, and the muscular system operates to make voluntary movements (playing the
piano, exercise) and involuntary movements (heartbeat, digestion) based on signals from the
nervous system.

Of the three primary organ systems involved in human movement, the nervous system is the
most important—it is the command center of the body. All movement (for exercise, sport, and
daily activities) is dictated by the nervous system. Training adaptations and physical fitness
cannot be fully understood without knowledge of how the human nervous system generates,
propagates, and interprets neural signals. Therefore, it’s essential to understand and work to
develop this system of the body when designing training programs.
THE NERVOUS SYSTEM

The nervous system consists of the brain, spinal cord, and nerves and is responsible for
controlling the voluntary (conscious or deliberate) and involuntary (automatic) functions of the
body and the mind. The entire system is of an intricate network that controls and coordinates
many body movements and functions via chemical signaling.
Nervous tissue: plays a key role in the nervous system’s ability to sense, analyze and interpret NERVOUS TISSUE:
Tissue found in the brain,
information, and respond appropriately. There are three types of nervous tissue: spinal cord, and nerves that
coordinates body activities.
Neurons: responsible for transmitting signals to and from other neurons, muscles, or glands.
They communicate with chemical messengers across a synapse, or neural junction, which is NEURONS:
the site where the message is relayed from one neuron to the next. The most fundamental
component of the brain and
nervous system capable
of transmitting information
to and from other neurons,
muscles, or glands.

NEUROGLIA:
Cells in the brain and spinal
cord that form a supporting
structure for the neurons
and provide them with
insulation.
Figure 3.2 Neural Synapse
NEUROSECRETORY
Neuroglia: also known as glial cells, these are neural tissues that support, insulate, and
TISSUES:
Neurons that translate protect neurons.
neural signals into chemical
stimuli.
Neurosecretory tissues: translate neural signals into chemical stimuli. These tissues make
neurohormones, hormones produced and released by nerve cells, that are released into the
CELL BODY: bloodstream.
The core and central
structure of a neuron
containing a nucleus and A neuron or nerve cell is the most fundamental component of the brain and nervous system.
other specialized organelles
that aid in nervous system They are electrically excitable with the capability of transmitting information to and from
function.
other neurons, muscles, or gland cells. It is through these neurons that the human body can
receive sensory information from the outside world and communicate motor commands to
AXON:
The thin tail-like structure
our muscles for both voluntary and involuntary movements.
of a neuron that generates
and conducts nerve The three main components of a neuron are the cell body, axon, and dendrites. The cell body
impulses.
is the core of the neuron. It contains a nucleus, maintains the structure of the neuron, and
provides energy to drive actions. The axon is the thin tail-like structure that connects to the
DENDRITES:
Rootlike structures cell body of the neuron and conducts nerve impulses. Dendrites are the receiving part of the
branching out from the
cell body that receive and neuron. They are like roots that branch out from the cell body, receiving and processing
process signals from the
signals from the axons of other neurons.
axons of other neurons.

Figure 3.3 Structures of a Neuron
Neurons are typically separated into one of three classifications based on their function:
sensory neurons, motor neurons, or interneurons. SENSORY NEURONS:

Nerve cells involved in
communicating tactile,
Sensory neurons send information to the brain and spinal cord in response to tactile (sense
auditory, or visual
of touch), auditory, or visual stimuli. Motor neurons receive information from the brain or information.
spinal cord to produce muscular contractions or activate glands. Interneurons connect
neurons to other neurons often communicating signals between motor and sensory neurons. MOTOR NEURONS:
Nerve cells that initiate
muscle contraction or
activate glands.
INTERNEURONS:
Nerve cells that connect
neurons to other neurons.
Figure 3.4 The Neuromuscular Connection

CENTRAL NERVOUS SYSTEM

CENTRAL NERVOUS
The nervous system is separated into two different divisions, the central nervous system
SYSTEM (CNS):
The part of the nervous (CNS) and the peripheral nervous system (PNS). The CNS consists of the brain and spinal
system consisting of the
cord and is the control center of the body and mind. The CNS receives sensory input and
brain and spinal cord.
functions to organize, analyze, and process information. The PNS consists of all of the other
PERIPHERAL NERVOUS nervous tissue outside of the CNS, including all the cranial and spinal nerves that run
SYSTEM (PNS): throughout the body. The PNS is responsible for conveying motor commands, carrying sensory
The nerves and ganglia
information to the CNS and regulating involuntary functions.
(relay areas for nerve
signals) outside of the brain
and spinal cord. The Brain and Brain Stem
The human brain is composed of three main parts, the cerebrum, cerebellum, and the brain
CEREBRUM:
stem. The cerebrum is the largest part of the brain, consists of two hemispheres, and is
The uppermost and
largest part of the brain generally responsible for receiving and processing sensory information and controlling the
consisting of a left and right
hemisphere; responsible body. The cerebral cortex is the outer portion of the cerebrum and is where most information
for receiving and processing
sensory information and processing happens. The cerebellum is positioned below the cerebrum and controls
controlling the body.
conscious motor coordination.
CEREBELLUM: The brain stem consists of the midbrain, pons, and the medulla oblongata. The midbrain plays
The region of the brain an important role in motor movement and the processing of auditory and visual information.
responsible for conscious
motor coordination. The pons links the medulla oblongata to the thalamus and helps control sleep, breathing,
facial expression and movement, and posture. The medulla oblongata plays a prominent role
BRAIN STEM: in involuntary functions like coughing, sneezing, and swallowing, along with functions of the
The trunk of the brain,
consisting of the medulla heart, and is located at the base of the brain stem.
oblongata, pons and
midbrain that continues The cerebrum is divided into two hemispheres—the left hemisphere and the right hemisphere.
downward to form the
spinal cord. The right hemisphere controls movements on the left side of the body, and the opposite is
true for the left hemisphere. For example, if someone suffers an injury to one side of the
CEREBRAL CORTEX: brain, motor function on the opposite side will be affected. This “crossover” is known as
The part of the brain where
most neural integration decussation and occurs at the junction of the medulla oblongata, the lowest part of the brain
occurs.
stem, and the spinal cord.
MIDBRAIN: Although both hemispheres of the brain are distinct and associated with specific functions,
The brain region they are closely intertwined with each other to create the basis of how each individual moves,
responsible for motor
movement and processing thinks, and functions.
auditory and visual
information.

PONS:
The brain region responsible
Table 3.1 Brain Hemispheres and Functions for posture, facial movement,
and sleep.
LEFT HEMISPHERE RIGHT HEMISPHERE
Language Spatial perception

MEDULLA OBLONGATA:
The base of the brain stem,
responsible for involuntary
Logical processing Creativity functions like swallowing,
sneezing, and heart function.
Science and math Intuition
Controls muscles on right side Controls muscles on left side THALAMUS:

The brain region responsible
Each hemisphere is divided into four lobes: frontal, parietal, temporal, and occipital. for relaying sensory and
motor signals and regulating
consciousness.
The frontal lobe is at the front of the brain and is involved in motor control, emotion, and
language. The frontal lobe contains the motor cortex, which is responsible for the planning
and coordination of movement. The prefrontal cortex, responsible for problem-solving,

DECUSSATION:
The point of crossover of
impulsivity, attention, and language, is also located in the frontal lobe. the nervous system in
vertebrates located between
the medulla oblongata and
The parietal lobe is directly behind the frontal lobe and is involved in processing sensory the spinal cord.
information. It is home to the somatosensory cortex, which processes sensations like pain,
temperature, and touch. FRONTAL LOBE:

The brain lobe involved in motor
control, emotion, and language.
MOTOR CORTEX:
The region of the frontal
lobe that plans and
coordinates movement.
PREFRONTAL CORTEX:
The part of the frontal lobe
responsible for high-level
thinking and language.
PARIETAL LOBE:
The brain lobe involved
in processing sensory
information.
SOMATOSENSORY
CORTEX:
The region of the parietal lobe
responsible for processing
Figure 3.5 Lobes of the Human Brain sensations like pain,
temperature, and touch.

The temporal lobe of the brain is on the sides (literally meaning “near the temples”) and
TEMPORAL LOBE: processes hearing, memory, emotion, and some parts of language. The auditory cortex,
The lateral lobe of the brain
responsible for hearing, responsible for hearing, is located here.
memory, and emotion.
The last lobe is the occipital lobe, which is located at the very back of the brain. It contains
AUDITORY CORTEX: the visual cortex, responsible for processing visual information.
The region of the temporal
lobe responsible for
hearing.
OCCIPITAL LOBE:
The posterior lobe of the
brain responsible for vision.
VISUAL CORTEX:
The specific region of the
occipital lobe responsible
for sight and visual
perception.
Figure 3.6 The Regions of the Human Brain
HYPOTHALAMUS: The hypothalamus plays a key role in maintaining homeostasis, or the body’s
The region at the base of automatic tendency to maintain a constant internal body environment through various
the brain responsible for
maintaining homeostasis. processes, including pH (measure of acidity or alkalinity), temperature, blood glucose (blood
sugar) levels, and blood pressure.

HOMEOSTASIS:
A self-regulating process The Spinal Cord
by which the body
maintains the stability of The spinal cord is a tube of nervous tissue that extends from the brain to the bottom of the
its physiological processes
for the purpose of optimal spine. It is the connection point between the brain and the body—all nerve impulses travel
function.
through the spinal cord to and from the brain. The spinal cord is incredibly important and is
carefully protected by the vertebrae (bones of the spine), meninges (membranes that enclose
SPINAL CORD: the brain and spinal cord), and cerebrospinal fluid (fluid that acts as a cushion and protects
The neural tissue extending
from the medulla oblongata the brain and spinal cord).
to the lumbar region (lower
back) of the vertebral
column.

THE PERIPHERAL NERVOUS SYSTEM
The second part of the nervous system is the peripheral nervous system (PNS). The PNS
is made up of nervous tissue that exists outside of the brain and spinal cord. Its primary
purpose is to connect the CNS to the rest of the body via the extensive network of nerves
CRANIAL NERVES:
that serve the limbs and organs of the body. The 12 sensory and motor
nerves extending directly
There are 12 cranial nerves—nerves extending directly from the brain—and 31 spinal nerves from the brain.
that extend from the CNS to the peripheral organs and muscles. The cranial and spinal
nerves serve two main functions: receiving sensory information along with sending and SPINAL NERVES:
Bundles of nerves
relaying motor and autonomic signals between the brain, spinal cord and the body. It’s connected to the spinal
cord carrying information
important to note that reflexes are not processed by the brain. Reflexes are involuntary toward the periphery.
reactions to a stimulus that is processed directly within the spinal cord.
Ganglia are structures containing collections of bodies of nerve cells. They act as a relay for
nerve signals, where nerves enter and deliver a signal while another nerve within the ganglia
receives the signal and moves that signal on from the ganglia to the next site.
Figure 3.7 Regions of the Spine

Table 3.2 Spinal Nerves
NUMBER OF SPINAL NERVES
Cervical spine Thoracic spine Lumbar spine Sacral spine Coccyx
8 pairs 12 pairs 5 pairs 5 pairs 1 pair
EFFERENT NEURONS: The PNS is comprised of afferent and efferent neurons. The afferent neurons are sensory,
Motor neurons sending
information from the CNS sending information, or stimuli, from the body toward the CNS. Efferent neurons are motor
to the muscles to generate
movement. neurons responsible for carrying signals from the CNS to the muscles to generate movement.
TEST TIP!
AFFERENT NEURONS:
Sensory neurons sending Afferent signals Arrive at the CNS. Both afferent and arrive start with the letter A.
information from a stimulus
to the CNS.
Efferent signals Exit the CNS. Both efferent and exit begin with the letter E.
SOMATIC NERVOUS Voluntary and Involuntary Neural Control

SYSTEM:
The part of the nervous The PNS is divided into two divisions: the sensory division and the motor division. The motor
system in charge of
controlling voluntary
division further divides into the somatic nervous system and the autonomic nervous system,
movement. which control voluntary and involuntary movement. The somatic nervous system controls
voluntary movement, such as exercise, chewing, and waving. Involuntary movement, such as
AUTONOMIC NERVOUS cardiac function, breathing, and digestion, is controlled by the autonomic nervous system.
SYSTEM:
The part of the nervous The autonomic nervous system is further divided into the sympathetic and parasympathetic
system responsible for
systems.
involuntary functions and
movement.
The sympathetic nervous system is activated by stress-related activities and is often referred
to as the “fight-or-flight” system because it elevates heart rate and increases cellular
SYMPATHETIC
NERVOUS SYSTEM: metabolism (energy use). On the other hand, the parasympathetic nervous system is
The autonomic system associated with control of the body systems while at rest. The parasympathetic nervous
responsible for “fight-or-
flight.” system is often described as “rest and digest” as it slows the heart rate and controls
digestion.
PARASYMPATHETIC
NERVOUS SYSTEM:
The autonomic system
responsible for “rest and
digest.”

Nervous System
Central Nervous System (CNS) Peripheral Nervous System (PNS)
Brain Spinal cord Motor Neurons Sensory Neurons

(Efferent) (Afferent)
Receives and processes Conducts signals to and
sensory information, from the brain, controls CNS to muscles Sensory organs
initiates responses, reflex activities and glands to CNS
stores, memories
generates thoughts and
emotions
Somatic Nervous System Autonomic Nervous System
Controls voluntary Controls involuntary

movements responses
Sympathetic Division Parasympathetic Division
“Fight-or-Flight” “Rest and Digest”
Figure 3.8 Divisions of the Nervous System
FUNCTIONS OF THE CENTRAL NERVOUS SYSTEM

The CNS controls and regulates all systems of the body as well as fosters communication
among and between those systems.

INTERNAL STIMULI:
Sensory Impulses Sensory input from within
the body.
Millions of sensory receptors throughout the body are constantly perceiving and communicating
stimuli. Internal stimuli are changes happening inside the body, including changes in internal
EXTERNAL STIMULI:
temperature, pH (acidity or alkalinity), carbon dioxide concentration, or electrolyte levels. Sensory input from external
sources.
External stimuli, messages from outside the body, may include fluctuations in environmental
temperature, light, or sound. Collectively, the information the body receives for processing,
MECHANORECEPTORS:
whether internal or external, is called sensory input. Nervous system receptors
responding to mechanical
Sensory input from receptors known as mechanoreceptors transmit information via the stimuli such as sound or
touch.
somatic nervous system to control voluntary movement. Along with sensory input, the brain
must have a sense of body position as it moves. Perception or awareness of body movement
PROPRIOCEPTION:
and position in space is known as proprioception. Perception or awareness of
body movement or position.

Mechanoreceptors relay information concerning sensory stimuli such as touch, pressure,
MYELIN SHEATH: vibration, and skin tension to the CNS. There are three types of mechanoreceptors:
The insulation of neuron
axons, made of proteins • Tactile receptors: collect and communicate sensations of touch.
and fats, which propagates
neural impulses. • Proprioceptors: communicate the position of the body and movement.
• Baroreceptors: collect and communicate changes in blood pressure.

NERVE IMPULSES:
The myelin sheath around the axon of a neuron insulates the pathway (much like the
The electrical signals used
for nerve communication. insulation around electrical wire) and increases the speed at which impulses are sent and
received. Mechanoreceptors have large myelinated axons, and because of this myelination,
SENSORY the axons of mechanoreceptors are termed low-threshold axons. Low-threshold axons are
INTEGRATION: typically large, conduct faster, and are easier to stimulate electrically. In other words, they are
The way the brain works to
affect responses to neural sensitive to stimuli and send rapid feedback to the CNS. High-threshold axons on the other
input.
hand conduct more slowly and are less sensitive to electrical stimulus.
MOTOR UNIT: Integration of Sensory Input

A single motor neuron
and the muscle fibers it The input collected by receptors is translated into electrical signals or nerve impulses. The
controls.
brain interprets these impulses to perceive sensations, have thoughts, or form memories.
The brain makes decisions based on the sensory input it receives at every moment. The way
MOTOR UNIT POOL:
A group of motor units that the brain works to affect responses to neural input is known as sensory integration.
work together.
Motor Function
MECHANICAL WORK: When sensory input has been integrated by the CNS, efferent signals are sent to the tissues
The amount of energy
transferred by a force, of the body to, for example, generate a muscle contraction or secrete a hormone. These
the product of force and
distance.
actions are known as motor function.
Motor function includes both voluntary and involuntary muscle contractions. These
EXTRAFUSAL MUSCLE contractions occur in part because of the firing of a motor unit. A motor unit is a single motor
FIBERS:
neuron that corresponds to a group of contractable muscle fibers. A motor unit pool describes
Fibers that cause muscle
contraction and mechanical a group of motor units that work in conjunction to cause muscle action. When muscle
work.
contraction and, thus, mechanical work is created, the name given to the standard skeletal
muscle fibers is extrafusal muscle fibers. The neurons that innervate (supply with nerves)
ALPHA MOTOR
NEURONS: these fibers are called alpha motor neurons. These neurons originate in the brain stem and
Motor neurons originating in spinal cord and work specifically to initiate muscle contraction.
the brain stem and spinal
cord that initiate muscle
contraction.

Axon terminals at neuromuscular junctions
Spinal cord
Motor unit pool
{
Motor Motor
unit 1 unit 2
Nerve
Axon of
Motor neuron motor
cell bodies neuron
Muscle Muscle fibers
Figure 3.9 Motor Unit Function

EXCITATION-
The motor units and the skeletal muscles they innervate (supply with nerves) make up the
CONTRACTION
COUPLING:
structural elements that create movement. The physiological process they must go through
The physiological process
to turn an electrical impulse into a mechanical response is called excitation-contraction of converting a neural
impulse into a mechanical
coupling. A nerve impulse sent to skeletal muscle fibers is called an action potential. The response.
action potential causes an interaction between a motor neuron and its associated muscle
fibers. ACTION POTENTIAL:

An explosion of electrical
activity caused by a neural
The amplitude—or strength—of a nerve’s action potential is independent of the strength—or impulse.
magnitude—of the stimulus. This is referred to as the all-or-none principle. Any stimulus
above the neuron’s threshold will trigger the same action potential and propagate an electrical ALL-OR-NONE
signal. In other words, a nerve either fires or it does not. For example, performing a bicep curl PRINCIPLE:
The principle stating
with a 5-pound weight, an external stimulus, would initiate a response from the nervous the strength of a neural
electrical signal is
system to fire as many motor neurons needed to lift the 5-pound weight. If the 5-pound weight
independent of the
were to be exchanged for a 10-pound weight, the nervous system response would need to magnitude of the stimulus
so long as the neural
recruit additional motor neurons in order to lift the additional weight. All recruited motor threshold is achieved.
neurons fire at a maximal strength, regardless of the number recruited.

THE MUSCULAR SYSTEM

Under the control of the motor neurons is the muscular system. There are more than
600 named muscles in the human body contributing to locomotion. They can only pull
via contraction and are often found in pairs or groups to allow for the dynamic movement
humans can create. These groupings of muscles can work together or in opposition to one
another. The speed and intensity of muscle contractions depend upon the type of muscle
fiber comprising each muscle.
TYPES OF MUSCLE TISSUE

There are three different types of muscle tissue: cardiac, smooth, and skeletal. All three vary
in their cellular structure, location, and function.
Cardiac Muscle Tissue
Cardiac muscle tissue (striated involuntary muscle tissue) composes the wall of the heart.
CARDIAC MUSCLE: It functions to contract the heart and pump blood throughout the body. Cardiac muscle cells
Striated involuntary muscle
tissue found in the heart. are often branched and fuse into one another. And their nuclei are more centered compared
to skeletal tissue. Fortunately, cardiac muscle tissue does not fatigue easily; the period of
rest in between contractions is all it needs. Even during periods of intense exercise, it is the
skeletal muscle tissue that fatigues first.
Smooth Muscle Tissue
Certain organs and organ systems in the body need to contract to push food or other
substances around the body. Smooth muscle, sometimes called visceral muscle, makes up
SMOOTH MUSCLE: most of these organs. The blood vessels, stomach, intestines, and bladder are all made of
Muscle tissue in the gut
and internal organs that is smooth muscle tissue. These muscle tissues contract slowly, operate involuntarily, and do
involuntarily controlled.
not fatigue easily.
Contractions of smooth muscle are triggered by hormones, neural signals from the autonomic
nervous system, and local factors. For example, humans do not have to think about pushing
food from the stomach to the large intestine; it happens automatically. In some cases,
stretching the muscle can trigger contraction.
SKELETAL MUSCLES: Skeletal Muscle Tissue

The voluntary muscles
attached to bones via Skeletal muscles are the most common muscle type in the human body. Skeletal muscle
tendons (thick fibrous
connective tissue) that tissue (striated voluntary muscle tissue) is found attached to bones, in extrinsic eyeball
produces human movement.
muscles, and in the upper third portion of the esophagus (tube that connects the throat to

the stomach). This tissue functions to move the bones and eyes. It also moves food during
the first part of swallowing. Skeletal muscle tissue is made up of long muscle cells (muscle
ACTIVITIES OF DAILY
fibers) that bear the unique characteristic of being multinucleate (containing many nuclei).
LIVING:
Characteristically, skeletal muscle tissue fatigues easily and cannot sustain prolonged The tasks usually
performed in the course of
maximal-effort contractions. a normal day in a person’s
life, such as eating,
toileting, dressing, bathing,
or brushing the teeth.
CONNECTIVE TISSUE:
Tissue that supports,
connects, or binds other
tissues or organs.
SARCOPLASM:
The cytoplasm of a muscle
fiber.
GLYCOGEN:
The stored form of glucose
found in the liver and
muscles.
Figure 3.10 Types of Muscle Tissue

MYOFIBRILS:
STRUCTURE OF SKELETAL MUSCLE Parallel filaments that form
muscle.
Skeletal muscle is what allows a person to move, exercise, and perform activities of daily
living. It is made of muscle tissue, connective tissue, nerve tissue, and vascular tissue.
MYOFILAMENTS:
Muscle fibers are the individual cells making up the muscle. The filaments of myofibrils
composed of actin and
myosin.
Most cells in the body are filled with a thick solution inside called cytoplasm; however, muscle
cells have sarcoplasm, which contains more oxygen-binding proteins and granules of stored
glycogen. Most of the sarcoplasm within muscle cells is made of myofibrils, cylindrical
ACTIN:
The thin filaments of
bundles consisting of two types of myofilaments: muscle myofilaments where
myosin bind to contract
muscles.
1. Actin filaments have a thin diameter and are made of spirals of actin protein.
2. Myosin filaments have a thick diameter and are made of several hundred molecules
MYOSIN:
of myosin protein. The thick filaments of
myofilaments with a fibrous
head, neck, and tail that
bind to actin.

Myofibrils are organized like a chain. Each link in the chain is a contractile unit called a
SARCOMERE: sarcomere. The length of a muscle fiber depends upon the length of a sarcomere and the
The contractile unit of
muscle tissue. position of the thick and thin filaments. The boundary at either end of the sarcomere is the
Z line. Actin attaches to the Z line, and it is at the Z line that force transmission occurs.
Z LINE:
The lateral boundary of
the sarcomere where the
myofilament actin attaches.
Figure 3.11 The Sarcomere of Skeletal Muscle
A skeletal muscle can have hundreds or thousands of muscle fibers. Fibers are bundled together
with connective tissue to give support and structure. Each individual muscle fiber is covered by a
connective tissue called the endomysium. The endomysium helps to create the appropriate
ENDOMYSIUM: environment for the chemical exchange required for muscle contraction. At the molecular level,
The connective tissue
covering each muscle fiber. calcium, sodium, and potassium are exchanged for muscle contraction. Capillaries and nerves
also exist in the endomysium to deliver nutrients and remove waste products.

EPIMYSIUM:
Fibrous elastic tissue that
surrounds a muscle.
FASCICULI:
Bundles of muscle fibers;
the singular is “fascicle.”
PERIMYSIUM:
The connective tissue that
covers a bundle of muscle
fibers.
Figure 3.12 The Structure of Skeletal Muscle TENDON:

A strong, fibrous cord made
of collagen that attaches
The epimysium is a fibrous elastic tissue that surrounds a muscle. Within the muscle there muscle to bone.
are bundles of muscle fibers called fasciculi. These bundles are made up of up to 150
individual muscle fibers and are surrounded by a layer of connective tissue called the
PERIOSTEUM:
A dense layer of vascular
perimysium. connective tissue
enveloping the bones
except at the surfaces of
Each connective tissue within the muscle body meets at the site of connection between the the joints.
muscle and tendon, called the myotendinous junction. From here, the tendon extends to the
bone for attachment to the periosteum. NEUROMUSCULAR

JUNCTION:
SKELETAL MUSCLE CONTRACTION The space between a motor
neuron and muscle fiber.
For the musculature of the musculoskeletal system to contract, it must receive a signal from
the CNS. These signals (action potentials) travel along the nervous system and eventually
NEUROTRANSMITTER:
connect with muscles via motor neurons. The motor neurons meet with the muscle cell at a A chemical messenger
that transmits messages
synapse called the neuromuscular junction, and a unique neurotransmitter called between neurons or from
acetylcholine is released. neurons to muscles.
ACETYLCHOLINE:
The neurotransmitter
released by an action
potential at the
neuromuscular junction.

Figure 3.13 Motor Neuron
Acetylcholine attaches to receptors on the outside of the muscle fiber, which starts a multistep
chemical reaction, releasing calcium into the muscle cells of the fibers. The presence of
calcium and adenosine triphosphate, or ATP (the main energy molecule in cells), is the driving
factor for the binding of actin and myosin for muscle contraction.
1. Brain sends out electrical signal

Brain
2. Signal travels through the spinal cord
3. To the spinal nerves
4. To the motor neurons
5. Resulting in the propagation of
Spinal cord
an electrical current through the
muscle fiber
Spinal nerves 6. Electrical signal triggers the release
of calcium inside the muscle fiber
Motor neurons 7. The released calcium binds to the
contractile protein ACTIN
8. This permits its interaction with the
MYOSIN contractile protein
9. ATP provides the energy that permits the
“walking” of MYOSIN across the ACTIN
10. This pulling action of the MYOSIN
across the ACTIN results in the
shortening of the muscle fiber during
MUSCLE CONTRACTION.
Figure 3.14 Muscle Contraction

An electrical impulse, or action potential, stimulates the release of calcium into the muscle
cell, which binds to the actin filaments. This allows interaction and binding with myosin. The
myosin can now pull on the actin to begin shortening the muscle. Through a series of
contractions, the myosin head pulls across the actin filament, the filaments slide past each
other, and this results in muscle contraction. This is known as the sliding-filament theory of
muscle contraction. The action potential is a limiting factor, which means when the impulse SLIDING-FILAMENT
subsides, so does muscular contraction.
THEORY:
The interaction of actin
and myosin that describes
the process of muscle
contraction.
Figure 3.15 Sliding Muscle Filaments
TYPES OF MUSCLE FIBERS

There are two categories of skeletal muscle fibers with different energy needs, capabilities,
and purposes in human movement. These two categories are slow-twitch muscle fibers and
fast-twitch muscle fibers. The activity, and the intensity of the activity, determines which
muscle fiber type is utilized most.

Slow-Twitch Muscle Fibers
Slow-twitch or type I fibers have a lot of mitochondria, the component of a cell that is most
TYPE I FIBERS:
noted for energy production and sometimes referred to as “the powerhouse of the cell,” and
Slow-twitch, fatigue-
resistant muscle fibers with a high concentration of myoglobin (an oxygen-storing protein in muscle) and other oxygen-
high mitochondrial density.
metabolizing enzymes. Slow-twitch muscle fibers derive energy from aerobic metabolism
(energy made in the presence of oxygen) and are ideal for endurance and low-intensity
MITOCHONDRIA:
An organelle with a double activities of longer duration. Often called oxidative fibers, type I fibers contract relatively
membrane and many folds
inside responsible for slowly, and are highly fatigue resistant.
generating the chemical
energy needed for Fast-Twitch Muscle Fibers
biochemical reactions.
Fast-twitch fibers contract quickly and with greater force than slow-twitch fibers. Fast-twitch
muscle fibers are further divided into type IIa fibers and type IIx fibers. They are selectively
TYPE IIA FIBERS: recruited for high-intensity activities requiring strength and power. Type IIa fibers fatigue
Fast-twitch, moderately
fatigable muscle fibers with relatively quickly but have a moderate mitochondrial density, meaning they can contract
moderate mitochondrial
density. through most intermittent athletic activity and recover well. They derive energy from anaerobic
metabolism (energy made without the presence of oxygen), do not require oxygen to function,
TYPE IIX FIBERS: and are ideal fibers for longer bouts of anaerobic movement.
Fast-twitch, fast-fatigable
muscle fibers with low Type IIx muscle fibers are also fast-twitch fibers that fire with great power and strength.
mitochondrial density.
Known as super fibers, these type II fibers fatigue slightly faster than IIa fibers. Type IIx fibers
have a much lower capillary density (giving them a white color versus the pink color of the
type IIa fibers) and a low mitochondrial density, which contributes to their high fatigue rate.
Individuals who participate in endurance activities generally have more type I muscle fibers,
while those who participate in power and intermittent sports have more type II muscle fibers.
Table 3.3 Sports and Muscle-Fiber Recruitment
TYPE I MUSCLE FIBER TYPE II MUSCLE FIBER

DOMINANT ATHLETES DOMINANT ATHLETES
Cross-country runners Weightlifters
Triathletes Gymnasts
Distance swimmers Baseball players
Cyclists Paddle sport players
Nordic skiers Wrestlers

Size Principle of Motor Recruitment
The force (strength or energy) output of a muscle is related to the stimulus it receives.
Different muscle fibers have different liability to recruitment. This liability refers to how easily
and quickly muscle fibers can be recruited. The higher the liability, the more likely a muscle
fiber will fire more easily and quickly when compared to a lower liability muscle fiber. Type I
fibers, also known as slow-twitch fibers (i.e., the smaller slower fibers) have high liability to
recruitment, while type IIa and IIx, also known as fast-twitch fibers (i.e., larger, faster fibers)
have a moderate liability. The size principle of fiber recruitment (also called the Henneman
principle) states that fibers with a high level of liability are recruited first and that those with SIZE PRINCIPLE OF
lower levels of liability are recruited last. According to the size principle, motor units are
FIBER RECRUITMENT:
Principle stating that
recruited in order according to their recruitment thresholds and firing rates. In other words, motor units are recruited
in order according to their
motor units will be recruited in order from smallest and slowest firing rate to largest and recruitment thresholds and
firing rates.
fastest firing rate. Since most muscles contain a range of type I and type II fibers, force
production can be very low or very high. Therefore, to get to a high-threshold motor unit, all
the motor units below it must be sequentially recruited first. Picking up the phone versus
curling a 75-pound dumbbell exemplifies this principle. The lower-threshold motor units are
recruited to pick up the phone. In order to pick up the 75-pound dumbbell, the higher-threshold
motor units must be recruited in addition to the low-threshold motor units.

FUSIFORM MUSCLE:
Spindle-shaped muscle.
MUSCLE FIBER ARRANGEMENT

CONVERGENT
The arrangement of skeletal muscle fibers, or the direction in which they run, influences the
MUSCLE:
action they have on the skeleton and the movement they create. Muscle fibers converging
from a broad origin (fixed
point where the muscle
Fusiform muscle are spindle-shaped with a large muscle belly like the biceps muscle, while
attaches closest to the
convergent muscle (also called triangular muscle) is broad on one end with fibers converging torso) to a single tendon
of insertion (fixed point
and narrowing on the other end, like the pectoralis major (chest). Circular muscle surrounds where the muscle attaches
furthest from the torso).
external openings of the body, which are sometimes referred to as sphincters.
CIRCULAR MUSCLE:
Muscle fibers surrounding
an opening in the body.

Parallel: Fascicles parallel to longitudinal

axis of muscle; terminate at either end in
flat tendons.
Example: Stylohyoid
Multipennate: Fascicles attach obliquely
PARALLEL MUSCLE: from many directions to several tendons.

Example: Deltoid
Muscle fibers running
parallel to the axis of the Fusiform: Fascicles nearly parallel to
muscle. longitudinal axis of muscle; terminate in
flat tendons; muscle tapers toward tendons
where diameter is less than at belly.
PENNATE MUSCLES:
Example: Biceps brachii
Unipennate: Fascicles are arranged on
Muscles with fascicles only one side of tendon.
that attach obliquely Example: Flexor pollicis longus
(diagonally).
PENNIFORM:
Muscle fibers that run
diagonally in respect to the
tendon similar to a feather. Bipennate: Fascicles are arranged on
Convergent: Fascicles spread over broad area both sides of centrally positioned tendon.
coverage at thick central tendon; gives muscle Example: Soleus

UNIPENNATE MUSCLE: triangular appearance.
Unipennate muscle: muscle Example: Pectoralis
fibers extending from one
side of a central tendon.
Figure 3.16 Patterns of Muscle Fiber Arrangement
BIPENNATE MUSCLE: Parallel muscle fibers run parallel along the axis of the muscle, like the sartorius, a long
Muscle fibers extending
muscle in the thigh. There are also several forms of pennate muscles that attach to a central
from both sides of a central
tendon. tendon at an oblique (diagonal) angle. Some fibers are penniform and run diagonally in
respect to the tendon that runs through its fibers. This arrangement allows for high force
MULTIPENNATE production and muscles that produce great power. Unipennate muscle has muscle fibers
MUSCLE: that only attach on one side of the central tendon. Bipennate muscle has muscle fibers
Muscle fibers extending
from both sides of multiple extending from both sides of the central tendon in a feather-like pattern. Finally, multipennate
central tendons.
muscle has multiple central tendons with muscle fibers extending from each in both directions.

MUSCLE ACTIONS
MUSCLE ACTIONS:
The muscles of the human body are capable of three types of muscle actions: concentric, Force production by a
muscle that can result in
eccentric, and isometric. These are often referred to as muscle actions instead of types of
a change of length (i.e.,
contractions simply because the definition of a contraction does not apply to eccentric and shortening or lengthening)
or no length change at all.
isometric contractions. Concentric muscle action is an overall shortening of a muscle as it
is producing tension (acceleration of a movement), while eccentric muscle action is the

CONCENTRIC MUSCLE
overall lengthening of a muscle as it is producing tension (deceleration of a movement). An ACTION:
isometric muscle action results in no change in length of a muscle as it produces tension When the length of a
muscle shortens as tension
(stabilization of a movement). In order of strength, from strongest to weakest, these is produced.
contractions are eccentric, isometric, and concentric.

ECCENTRIC MUSCLE
ACTION:
When the length of a
muscle increases as
tension is produced.
ISOMETRIC MUSCLE
ACTION:
When the length of a
muscle remains constant
as tension is produced.
Eccentric Concentric
(lengthening) (shortening)
Figure 3.17 Types of Muscle Actions
Muscle tissue has a built-in mechanism that can amplify the concentric muscle action—the
stretch-shortening cycle (SSC). Because of the SSC, muscle tissue can load and release force
STRETCH-SHORTENING
through the elastic properties of the soft tissue - this is like the energy a rubber band can release CYCLE (SSC):
when quickly stretched and released. There are three phases to the SSC. First is the eccentric or The cycling between the
eccentric (stretch) action
loading phase, followed by the amortization phase (transition phase) and then immediately of a muscle and the
concentric (shortening)
followed by the concentric phase. When given the right stimulus, skeletal muscle can gain the action of the same muscle.
ability to take advantage of the additional energy created in the loading phase (stretching the
rubber band) and release it in the concentric phase. The SSC contributes greatly to explosive
movement like jumping, and it can be enhanced with the proper plyometric training.

THE SKELETAL SYSTEM

The last major organ system involved in human movement is the skeletal system. Structure
and support for the human body come from the skeleton and its 206 individual bones. These
bones provide a framework for the attachment of muscle tissue, which generates the joint
JOINT: movement required for locomotion.
An articulation between two
bones in the body.
In a fetus, bones begin to form around six weeks gestation, and portions of the skeleton do
not stop growing until around 25 years of age. Throughout the lifespan, bones gain and lose
density in response to the demands placed on the body, aging, and nutrition.
AXIAL SKELETON:
The bones of the head,
trunk, and vertebrae.
Figure 3.18 Skeletal System of the Human Body

APPENDICULAR
SKELETON: THE AXIAL SKELETON
The bones of the shoulder The human skeleton is divided into two parts: the axial skeleton and appendicular skeleton.
girdle, pelvic girdle, and
limbs. The axial skeleton has 80 bones, including the bones of the skull, spine, and ribs.

Figure 3.19 Appendicular Skeleton and Axial Skeleton
Table 3.3 The Bones of the Axial Skeleton
SKULL
Parietal (2) Temporal (2) Frontal (1)
Occipital (1)
AUDITORY OSSICLES (SMALL BONES OF THE EARS)
Malleus (2) Incus (2) Stapes (2)
FACIAL
Maxilla (2) Zygomatic (2) Mandible (1)
Nasal (2) Platine (2) Inferior nasal concha (2)
Lacrimal (2) Vomer (1)
VERTEBRAL COLUMN
Cervical vertebrae (7) Thoracic vertebrae (12) Lumbar vertebrae (5)
Sacrum (1) Coccyx (1)
THORACIC CAGE
Sternum (1) True ribs (7) False ribs (5)

THE APPENDICULAR SKELETON

There are 126 bones that make up the appendicular skeleton. They include the bones of the
shoulder girdle, pelvic girdle, and limbs.
Table 3.4 The Bones of the Appendicular Skeleton
SHOULDER GIRDLE
Clavicle (2) Scapula (2)
PELVIC GIRDLE
Hip bones (ilium, ischium, pubis) (3) Sacrum (1)
Coccyx (1)
UPPER EXTREMITY
Humerus (2) Radius (2) Ulna (2)
Carpals (16) Metacarpals (10) Phalanges (28)
LOWER EXTREMITY
Femur (2) Tibia (2) Fibula (2)
Patella (2) Tarsals (14) Metatarsals (10)
Phalanges (28)

Figure 3.20 Full Human Skeleton
CATEGORIES AND FUNCTIONS OF BONE

The skeletal system plays several important roles within the body. Bones provide support and
protection for organs, produce blood cells, store and release minerals and lipids, and provide leverage
for movement. There are five types of bone in the human skeleton, each with its own specific function:
1. Flat bones protect the internal organs and provide a large surface area for muscles
to attach. They are somewhat flat and thin but may be curved, as in the ribs.
2. Short bones in the body are cube-shaped and provide stability and a limited

amount of movement. Examples include the carpals (bones in the wrist) and
tarsals (bones in the ankle).
3. Long bones support body weight and facilitate movement. The long bones are
longer than they are wide, a cylinder shape. Examples include the femur (thigh
bone), the tibia and fibula (bones of the lower leg), and the humerus (upper arm
bone between the elbow and shoulder)
4. Sesamoid bones are small and round. Found in the joints and within tendons,
they reinforce and protect tendons from stress and wear and tear. The patella
(kneecap) is an example of a sesamoid bone.
5. Irregular bones serve a variety of purposes, including protecting vital organs. They
have complex shapes, like the vertebrae.
radius and ulna

Long Bone Sesamoid bone
patella
femur (kneecap)
Short Bone
carpals
Flat bone
tarsals
sternum
Irregular
bone
scapula
Figure 3.21 Bone Classifications

Table 3.5 Human Bones: Shape, Structure, and Function
SESAMOID IRREGULAR
FLAT BONES SHORT BONES LONG BONES
BONES BONES
Protect organs Provide stability and Support body Reinforce and Protect organs
and provide a limited movement weight and facilitate protect tendons
Function large surface movement from stress and
area for muscles wear
to attach
Somewhat flat Cube-shaped Cylindrical, longer Small and Complex and

Shape and thin but may than they are wide round irregular
be curved
Skull Wrist Lower extremity Knee joint Spinal column

Occipital Scaphoid Tibia Patella Vertebrae
Parietal Lunate Fibula Pelvis
Musculotendon
Frontal Triquetral Femur Pubis
Nasal Hamate Metatarsals Flexor tendon Ilium
Lacrimal Pisiform Phalanges of foot Ischium
Vomer Capitate
Upper extremity Flexor tendon of
Trapezoid
Thoracic cage Humerus thumb
Trapezium
Sternum Radius
Location Carpals
Ribs Ulna
and name
Clavicle Ankles/Feet Metacarpals
Calcaneus Phalanges
Pelvis
Talus
Coxal
Navicular
Shoulder Cuboid
Scapula Lateral cuneiform
Intermediate
cuneiform
Medial cuneiform
Tarsals
BONE STRUCTURE
BONE MARROW:
Bone is composed of 50 to 70 percent minerals, 20 to 40 percent organic matrix, 5 to 10 The soft, spongelike tissue
in the center of most bones
percent water, and less than 3 percent lipids (fats). The way bone is structured allows it to containing stem cells of
red or white blood cells or
provide support and protection as well as store calcium and bone marrow.
platelets.

Bone marrow, the spongy tissue in bones, is either red or yellow. Red bone marrow holds
stem cells that develop into red blood cells, white blood cells, and platelets, which aid in
blood clotting. Yellow marrow stores fat cells for energy. Cancellous bone is also known as
CANCELLOUS BONE: spongy bone. Spongy bone, however, is not as flexible as the name implies. Rather, this type
The meshwork of spongy
tissue (trabeculae) of of bone has open spaces that may house bone marrow. Cancellous bone also supports
mature adult bone, typically
found at the core of shifts in weight distribution.
vertebral bones and the
ends of the long bones.
Figure 3.22 Anatomy of Bone
The next layer of bone is dense, porous compact bone. Also called cortical bone, compact
COMPACT BONE:
A denser material, also bone is made of calcium and minerals and can withstand compressive forces. The fibers in
known as cortical bone,
compact bone are arranged in a honeycomb pattern, which allows nerves and blood vessels
making up the hard
structure of the skeleton. to pass through the honeycomb and supply the bone with oxygen and nutrients. Lastly,
covering each bone everywhere except the joints is the periosteum. This is a vascular
connective tissue responsible for repairing, protecting, and growing bones.

OSTEOGENESIS:
The process of bone
formation or remodeling. BONE FORMATION
Bone formation is a constant process. Throughout life, old bone is continually replaced with
new bone. This process of bone remodeling or formation is called osteogenesis. Cells called
osteoblasts play a significant role in this process by depositing new bone material.

Some changes in bone are caused by acute trauma like a break or fracture. Myositis
ossificans occur when bone tissue forms within a muscle or other soft body tissue as a result
MYOSITIS OSSIFICANS:
A condition when bone
of a traumatic injury. However, it is not only trauma or injury that can cause bone remodeling. tissue forms within a
muscle or other soft tissue
During human growth, bone can be formed as a replacement of connective tissue or to as a result of trauma or
replace cartilage based on when and where the formation occurs in the body. Exercise is also injury.
considered a stressor and can affect how bone reacts. The added loads and resistance from
regular exercise can help to increase bone mass and density in humans. This bone adaptation CARTILAGE:
Firm, flexible connective
is explained by Wolff’s law, which states that changes in form and function of a bone will be tissue that pads and
adaptive to the loads placed upon it. In other words, strength training helps to build stronger protects joints and
structural components of
bones. the body.
JOINTS IN THE HUMAN BODY WOLFF’S LAW:

The explanation for bone
One additional and crucial component of human movement is the articulation point between
adaptations as a result of
two bones—a joint. The joints in the body are what allow movement to occur. Joints are the loads placed on them.
classified by the type of tissue they contain: fibrous, cartilaginous, or synovial.
Fibrous joints are connected by dense connective tissue made of collagen. They allow for
FIBROUS JOINTS:
very little movement. Fibrous joints can be further divided into three types: Joints with fibrous
connective tissue joining
1. Sutures or synarthrodial joints: This type of joint is found in the skull. During birth, two bones that allow for
very little movement.
sutures are flexible to allow the baby to pass through the birth canal, and they
become more rigid with age.
2. Syndesmoses: found between some long bones like the tibia and fibula.
3. Gomphosis joints: attach teeth to the sockets of the maxilla and mandible.
Figure 3.23 The Sutures of the Skull

Cartilaginous joints are joined by either fibrocartilage, the most rigid and strong cartilage, or
CARTILAGINOUS hyaline cartilage, which is softer and more widespread. Cartilaginous joints are slightly
JOINTS: movable and are further divided into primary and secondary joints:
Moderately movable joints
made of fibrocartilage or
hyaline cartilage. 1. Primary: epiphyseal (growth) plates
2. Secondary: intervertebral discs (layers of cartilage between vertebrae)
SYNOVIAL JOINTS:
Fluid-filled joints found
between bones that move
against one another.
NON-SYNOVIAL
Figure 3.24 Cartilaginous Joints: Intervertebral Discs (Blue)
JOINTS:
Joints that lack a fluid
junction. The most common and movable joints in the human body are synovial joints, also known as
diarthrodial joints. Non-synovial joints, or synarthroses, are fibrous and cartilaginous and do
ARTICULAR CAPSULE: not allow for much movement. This allows them to provide greater structural integrity. In
The envelope surrounding a
synovial joints, bones are separated by a synovial joint cavity made of dense, irregular
synovial joint.
connective tissue. The outside of the cavity, known as the articular capsule, is part of the
periosteum. The cavities are filled with synovial fluid to reduce friction and form a film over
SYNOVIAL FLUID:
A viscous fluid found in the joint surfaces, and they are lined by a synovial membrane.
cavities of synovial joints.

Bone
Muscle
Synovium
Synovial fluid
Cartilage
Tendon
Capsule Tendon sheath

(ligaments) lined by synovium
Figure 3.25 The Synovial Joint of the Knee
CLASSIFICATIONS OF SYNOVIAL JOINTS

Synovial joints permit movement and are categorized by the type of movement they allow,
known as arthrokinematics. Synovial joints are classified into six categories:

ARTHROKINEMATICS:
1. Ball-and-socket joint: Also known as an enarthrodial joint, this joint allows a wide The broad term meaning
joint motion that can be
range of movement in many directions. Examples are the shoulder and hip joints. used in reference to all joint
motions.
2. Saddle joint: The sellar or saddle joints are like ball-and-socket joints but cannot
rotate. Examples include the trapezium and the first metacarpal joint (joint between
the thumb and wrist).
3. Hinge joint: The hinge joints include the elbows, ankles, and knee joints. They
allow a wide range of movement in one plane (direction).
4. Gliding joint: The arthrodial or gliding joints of the body include the tarsals and
metatarsal of the foot. In these joints, two flat bones press up against each other.
5. Pivot joint: Trochoidal or pivot joints rotate around a long axis (line that runs
parallel to the joint). The radioulnar joint of the forearm is a pivot joint.
6. Condyloid joint: Also known as an ellipsoid joint, these joints move in two
directions—one direction primarily with a small range in another direction. Rotation
is not allowed in these joints. The radiocarpal joint at the wrist is a prime example.

Pivot Joint
Ball and Socket Joint
Hinge Joint
Saddle Joint Ellipsoid Joint
Gliding Joint
Figure 3.26 Types of Joints
OTHER JOINT CATEGORIES

The relative location of a joint can classify it into one of three other categories: proximal,
middle, and distal. Proximal joints, meaning closest to the midline of the body, are the
foundation for the legs and arms. Examples include the shoulder and hip. Middle joints are
generally hinge joints with a motion primarily moving forward and backward like the knee.
Lastly, distal joints, or those joints that are farther from the midline of the body, create a
CLOSE-PACKED JOINT
variety of intricate movements. The wrist is an example of a dynamic distal joint.
POSITION:
The most stable joint
position, when the JOINT POSITION
connective tissue is taut
and neighboring bones have The movability of joints makes them dynamically stable or unstable. The position where
the most contact.
bones make contact with one another is referred to as a joint position. In a close-packed
joint position, a joint is the most stable, connective tissue is taut, and the articulating bones
LOOSE-PACKED JOINT
have the greatest area of contact with one another. Full extension of the knee puts the knee
POSITION:
The less stable joint joint in a close-packed position. Loose-packed joint position describes any possible joint
position represented by any
position other than the closed-packed position. This is often during movement when the joint
other joint position other
than close-packed. capsule is lax and neighboring bones are not aligned.

TENDONS
Tendons connect muscle to bone and serve as a mechanical bridge to transmit the force
created by muscle contraction. When the muscle shortens or contracts, the tendon transfers
that force to the bone at an attachment site. The angle and length of attachment of the
tendon to the bone affect how the muscle acts on the affected bone.
Tendons are strong, relatively inflexible, and can withstand the force generated by heavy loads
without being injured. For example, the flexor tendons of the foot can support a load of more
than eight times one’s body weight. A muscle alone could not withstand the same amount
of tension.
GOLGI TENDON
Receptors in the joints, muscles, and tendons provide information to the brain regarding the ORGAN:
The proprioceptive sensory
location in space and speed and force of movement. To prevent injury, tendons contain a
organ that senses muscle
proprioceptive sensory organ called the Golgi tendon organ. This organ responds to changes tension in a tendon and
inhibits muscle action.
in muscle tension. It prevents the overstretching or tearing of a muscle by sensing the rate
and force of muscle tension and inhibits muscle action in the same muscle through a
feedback loop. This differs from the proprioceptive sensory organ within muscle fibers called
FEEDBACK LOOP:
The return of a system’s
the muscle spindle, which detects the rate and force of muscle stretch but promotes muscle output as input for a future
action.
contraction instead of inhibiting it. However, these sensory organs work closely together
controlling flexibility and muscle control.

MUSCLE SPINDLE:
stretch in a muscle and
Sensory neuron from Spinal column promotes muscle action.
Golgi tendon organ Dorsal root
Dorsal root
ganglion
Golgi tendon
organ
Alpha motor neuron
Spinal nerve
Ventral root
Muscle Inhibitory
interneuron
Tendon
Figure 3.27 Feedback Loop
Tendons appear in many different shapes and sizes in the body, based on their function. Long,
thin tendons help with fine motor skills like writing, while short, wide tendons help with power
and endurance movements.

LIGAMENTS
Ligaments are tough bands made of collagen and elastin connecting bone to bone, forming
LIGAMENTS: joints. They help prevent excessive movement within a joint that may cause damage. The
Tough bands of connective
tissue made of collagen knees, ankles, elbows, and shoulders are all supported by ligaments. If a ligament is injured,
and elastin connecting
bone to bone. torn, or disconnected, the associated joint will become highly unstable.
The location of a ligament can be extrinsic, intrinsic, or capsular with respect to the joints.
ELASTIN:
The knee joint can serve as an example, given it contains all three types of ligaments:
A highly elastic connective
tissue allowing many
tissues to retain their 1. Extrinsic ligament: This type of ligament is located on the outside of the joint. An
shape.
example is the lateral collateral ligament (LCL), which resists abnormal movement
away from the midline, termed varus stress.

VARUS: 2. Intrinsic ligament: the anterior cruciate ligament (ACL) and posterior cruciate
An abnormal joint
movement away from the ligament (PCL) are situated inside the knee joint to resist anterior and posterior
midline of the body (i.e.,
bowlegged). (forward and backward) movement of the tibia, respectively.
3. Capsular ligament: The medial collateral ligament (MCL) is a capsular ligament,
JOINT CAPSULE: so called because it is continuous with the joint capsule. It resists valgus stress
A thin, strong layer at the knee by keeping the joint approximated.
of connective tissue
containing synovial fluid in
freely moving joints.
VALGUS:
An abnormal joint
movement toward the
midline of the body (i.e.,
knock-kneed).
Figure 3.28 The Ligaments of the Knee
Overall, tendons and ligaments are imperative for protecting the body during the demands
of a sport. They absorb energy during activities like jumping and cutting and are designed
to withstand tension. Both tendons and ligaments can only exert a pulling force, and their
tensile strength can be improved with proper training.

CARTILAGE
PERICHONDRIUM:
Cartilage resists compressive forces, makes bones more resilient, and offers support and
The connective tissue
flexibility in some areas. There are no nerves or blood vessels in cartilage, making cartilage enveloping cartilage
everywhere except at a joint.
injury recovery a long, arduous process. Removal of waste and absorption of nutrients from
and within the tissue happens via diffusion with surrounding tissues.
ARTICULAR
Like bone, cartilage is covered by a specialized fibrous tissue. The perichondrium has an CARTILAGE:
A form of hyaline cartilage
inner layer that forms chondroblasts, which are cells that play a role in making new cartilage, located on the joint surface
and an outer layer with fibroblasts, which are cells that produce collagen for growth. of bones.
Articular cartilage is a connective tissue covering the end of long bones and provides smooth
NOCICEPTORS:
bone-on-bone contact in freely moving joints. When the cartilage is degraded or lost from Pain-sensitive nerve endings.
overuse or aging, bone-on-bone contact results in pain and stiffness at the joint.
The periosteum and endosteum coverings of bone contain pain-sensitive nerve endings
HYALINE CARTILAGE:
A transparent cartilage found
called nociceptors. Since joint motion should not be painful, articular cartilage covers the on most joint surfaces and
in the respiratory tract, which
ends of moving bones to block the pain signal and reduce compressive stress. contains no nerves or blood
vessels.
All cartilage is made up of dense collagen fibers embedded in a firm, gelatinous substance.
This gives it the consistency of plastic to provide tensile strength while still being more pliable
FIBROCARTILAGE:
than bone. There are three types of cartilage in the body: An elastic and tough tissue
containing type I and type II
collagen.
1. Hyaline cartilage: This deformable but elastic type of cartilage is the most
widespread. It is found in the nose, trachea, larynx, bronchi, and the ends of ribs
as well as at the ends of bones in the form of articular cartilage. MENISCUS:
A form of fibrocartilage
2. Fibrocartilage: This tough tissue is found in the intervertebral discs and at the present in the knee,
wrist, acromioclavicular,
insertions of tendons and ligaments. It also forms the lateral or medial meniscus sternoclavicular, and
in the knee. temporomandibular joints.
3. Elastic cartilage: This is the most pliable form of cartilage. It gives shape to the
external ear, the auditory tube of the middle ear, and the epiglottis.
ELASTIC CARTILAGE:
Flexible cartilage present in
the outer ear, inner ear, and
epiglottis.
EPIGLOTTIS:
A piece of elastic cartilage
in the throat that opens
during breathing and closes
during swallowing.
Cartilage
Figure 3.29 Cartilage

SUPPORTING SYSTEMS
CHAPTER 04
LEARNING OBJECTIVES
1 | Name and describe the body’s supporting organ systems outside the
nervous, skeletal, and muscular systems.
2 | Differentiate between the types of respiration the body can perform.
3 | List the endocrine hormones and their functions.
4 | Identify the organs of the digestive system and their individual functions.

CHAPTER 04 | Supporting Systems
The human body is a complex and interconnected synergy of 11 organ systems. All organ
systems have unique functions that are necessary for proper body function. The nervous,
muscular, and skeletal systems work together to generate human movement. However, a
fitness professional must also understand the body’s other organ systems to understand
their importance in overall function, health, and wellness.
CIRCULATORY
SYSTEM:
A closed system circulating
blood through the body,
consisting of the heart,
blood vessels, and blood. Although all organ systems play a critical role in the overall functioning of the human body
beyond human movement, systems such as the respiratory, circulatory, and endocrine
CLOSED SYSTEM: systems have a direct impact on the responses and adaptations to physical activity and
A physical system that does
not allow for the movement
exercise. Organ systems like the reproductive and urinary system are less applicable to the
of matter into or out of the work of a fitness professional.
system.
ARTERIES:
THE CIRCULATORY SYSTEM
Blood vessels carrying The circulatory system consists of the heart, arteries, veins, capillaries, and blood and is
oxygenated blood away
from the heart and to the responsible for circulating blood throughout the body. The primary function of the circulatory
tissues.
system is to facilitate the exchange of oxygen and carbon dioxide, thereby transporting oxygen
from the lungs to the body tissues and moving carbon dioxide from the tissues to the lungs to be
VEINS: excreted. Moreover, this system is considered a closed system, circulating the blood within its
Blood vessels carrying
blood toward the heart to own vascular system, and, therefore, maintaining blood flow within the organ system itself.
remove waste and pick up
more oxygen.
In addition, the circulatory system is also responsible for the transport of nutrients from the
digestive system to body tissues and serves as a clearing house for the biochemical waste
CAPILLARIES:
Fine-branching blood products resulting from physical activity, such as weight training or aerobic exercise. The
vessels forming a network
arteries carry oxygenated blood away from the heart and to the tissues, veins carry blood
between the arterioles and
venules, where transport toward the heart to remove waste and pick up more oxygen, and capillaries transport
of nutrients and oxygen or
carbon dioxide occurs on a nutrients and oxygen or carbon dioxide at the sites of exchange (extremities, organs, and
microscopic scale.
bone marrow).

Blood vessels are elastic, smooth muscle tissues that expand and contract to facilitate the
flow of blood throughout the body. Healthy blood vessels maintain their elasticity and allow
blood to flow easily, whereas unhealthy blood vessels lose their elasticity, impede blood flow,
and increase the risk for blood clots. However, regular and consistent cardiovascular exercise
can help preserve the overall function of the blood vessels.
capillary region of the upper

body (head and arms)
CO2 O2
Jugular vein Carotid artery
Capilary region of the lung
Pulmonary vein Pulmonary artery
Superior vena cava
Aorta
Left atrium
Right atrium
Right ventricle Left ventricle
Inferior vena cava

Lymph node
Hepatic vein
Hepatic portal vein

Lymphatic vessels Mesenteric arteries
Renal vein
Renal artery
lliac vein Iliac artery
CO2 O2
capillary region of the lower
body (trunk and legs)
Figure 4.2 Circulatory System

THE CARDIOVASCULAR SYSTEM

The main structures of the cardiovascular system are the blood vessels and the heart. “Cardio”
comes from the Greek word “kardia,” meaning “pertaining to the heart.” “Vascular” comes from
the Latin term “vascularis” and means “pertaining to vessels that circulate fluids.”
Blood Vessels
There are five types of blood vessels found in the body. The blood vessels that carry
oxygenated blood away from the heart to the body’s tissues are the arteries. As the arteries
narrow and blood moves farther away from the heart, it enters smaller branches of the
arteries called arterioles. The arterioles provide approximately 80 percent of the total
ARTERIOLES: resistance of blood throughout the body as they further distribute blood to the capillaries.
The smaller branches of
the arteries leading to the These vessels are so small that a single red blood cell can barely pass through them. After
capillaries.
the oxygen has been moved into the body’s tissues for cellular use, oxygen-poor blood is
transported back to the heart through increasingly larger venules before reaching the veins.
VENULES:
The small branches of the
veins gathering blood from
the capillaries.
Figure 4.3 The Blood Vessels

The Heart
The heart is a four-chambered organ made of cardiac muscle that is referred to as the
myocardium. The left atrium and right atrium are the two upper chambers of the heart, while
ATRIUM:
the left ventricle and the right ventricle are the two lower chambers of the heart. The right One of the two upper cavities
atrium receives deoxygenated blood from the body. It then moves on to the right ventricle, of the heart passing blood
to the ventricles. The plural
where it is pumped via the pulmonary arteries to the lungs to receive oxygen. This oxygenated is “atria.”
blood then returns from the lungs via the pulmonary veins to the left atrium, where it is
moved into the left ventricle through the aorta and out to the rest of the body. The aorta is VENTRICLE:
One of the two lower cavities
the main artery in the body that supplies oxygenated blood to the circulatory system. of the heart passing blood to
the body or to the lungs.
Circulation within the heart is known as pulmonary circulation, whereas blood flow between
the heart and the rest of the body is defined as systemic circulation.
PULMONARY
The heart beats about 100,000 times per day. For every minute of work, the heart pumps five ARTERIES:
Blood vessels moving blood
to six quarts of blood around the body, which is roughly 2,000 gallons of blood pumped per day. from the heart to the lungs.
PULMONARY VEINS:
Pulmonary Artery Blood vessels returning
oxygenated blood to the
Ascending aorta
heart from the lungs.
Superior vena cava
Left Atrium AORTA:

The main artery in the body
that supplies oxygenated
blood to the circulatory
Right atrium system.
Left Ventricle
PULMONARY
CIRCULATION:
The blood flow between the
Right Ventricle heart and the lungs.
SYSTEMIC
CIRCULATION:
Figure 4.4 Interior View of the Heart The blood flow between the
heart and the rest of the
body.

Ascending aorta
Pulmonary Artery
Superior vena cava
Left Atrium
Right atrium
Left Anterior
Descending Branch
Right Ventricle
Left Ventricle
SUPERIOR VENA CAVA:
The blood vessel moving Figure 4.5 Vascularization of the Heart
blood from the upper body
and head to the heart.
Oxygen-rich blood returning from the lungs flows from the pulmonary vein into the left atrium
INFERIOR VENA CAVA: of the heart. The atrium contracts, pushing blood down into the left ventricle. When the
The blood vessel moving
ventricle contracts, the blood moves through the aorta and out into the body for circulation.
blood from the lower body
to the heart.
Blood returns from the body to the heart via the superior vena cava and the inferior vena
cava. The superior vena cava carries deoxygenated blood from the arms, head, and upper
METABOLISM:
Chemical processes within body, while the inferior vena cava carries deoxygenated blood from the lower body to the
the body that convert food
into energy. aorta. The returning blood is oxygen poor, having distributed oxygen to cells throughout the
body to support metabolism. The right atrium fills with the deoxygenated blood, which then
ATRIOVENTRICULAR flows into the right ventricle. From the right ventricle, the blood leaves the heart via the
(AV) VALVES: pulmonary artery and travels to the lungs to pick up oxygen and diffuse carbon dioxide out of
Valves between the atria
and ventricles preventing the body. Between each atrium and ventricle are atrioventricular (AV) valves (also called
the backward flow of blood
cuspid valves), which keep the blood flowing in one direction.
during cardiac contractions.

From head, neck, and upper body To head, neck, and upper body
Superior vena cava Arteries
Aorta
To right lung Pulmonary

artery
To left lung
From right lung From left lung
Branches of right Branches of left

pulmonary vein pulmonary vein
Left atrium
The right Mitral (bicuspid) Oxygenated

Right atrium valves
atrium receives Semilunar (aortic) blood from the
deoxygenated valves pulmonary vein
Tricuspid valve
blood from the Left Ventricle returns to the left
body’s tissues. Right ventricle Purkinje fibers atrium.
Septum
Blood passes Interior vena cava Blood passes
Aorta
through the To trunk and lower extremity through the
From trunk and lower extremity
tricuspid (AV bicuspid (mitral)
valve) to the right valve to the left
ventricle. ventricle.
The right ventricle The left ventricle

pumps blood into ejects blood
the pulmonary through the aortic
artery. (semilunar) valve
into the aorta for
transport in the
Figure 4.6 Chambers of the Heart systemic circuit.
TEST TIP!
The heart anatomy can be confusing. Use these tips to remember how blood flows
through the heart:
The atrium (plural: atria) receives blood; ventricles pump it out.
Blood leaving the right ventricle will be right back—it moves to the lungs for oxygen
before returning to the heart.
Blood leaving the left ventricle has left—it is headed out to the body.
“Tri before you bi”—the tricuspid valve is on the right side of the heart and the bicuspid
valve is on the left side. Blood passes through the “tri” before the “bi”—right side,
then left.

The heartbeat that moves blood throughout the body and through the lungs is an intricate
CARDIAC CYCLE: rhythm between the atria and ventricles. A cardiac cycle is one alternating cycle of contraction
The action of the heart from
the start of one heartbeat to and relaxation of the heart during one heartbeat. The contraction phase is known as systole.
the beginning of the next.
When the ventricle contracts, it increases the pressure in the blood vessels. The relaxation
phase is known as diastole. Systole and diastole are controlled by a pathway of nerves that
SYSTOLE:
The heartbeat phase create the consistent, rhythmic heartbeat. Inside the right atrium is the sinoatrial (SA) node.
where muscle contraction
moves blood from the heart The SA node initiates the heartbeat by generating an electrical signal that causes the atria
chambers to the arteries.
to contract. The electrical signal moves through atria through the nerve pathway to a junction
located between the right atrium and right ventricle called the atrioventricular (AV) node.
DIASTOLE: When excited, the AV node excites additional nerve branches (bundle of His and the Purkinje
The heartbeat phase where
the cardiac muscle relaxes fibers) and causes the subsequent contraction of the ventricles. Since the SA node contracts
and the heart chambers fill
with blood. first and its electrical stimulation cascades to cause the ventricular contraction of the heart,
it is considered the natural pacemaker of the heart.

SINOATRIAL (SA)
NODE:
The pacemaker of the
heart that generates the
first electrical signal of a
heartbeat and stimulates
the atria to contract.
ATRIOVENTRICULAR
(AV) NODE:
The nerve node between
the right atrium and right
ventricle that propagates
the electrical signal from
the SA note to more distal
heart nerves that cause
ventricular contraction.
Figure 4.7 The Nerves of the Heart

STROKE VOLUME:
The amount of blood
pumped by the left
ventricle of the heart in The amount of blood the left ventricle pushes out in one heartbeat is known as stroke
one contraction.
volume. Exercise strengthens the smooth muscles of the heart and increases stroke volume.
The physiological adaptation occurring with cardiovascular exercise causes the heart to beat
HEART RATE: more efficiently (more slowly) when circulating blood, thus lowering the heart rate. The heart
The number of heartbeats
per minute. rate is the number of beats per minute of the heart. Changes in heart rate are facilitated in

the cardiac center of the brain—the medulla oblongata. Here, sympathetic and parasympathetic
messages are interpreted, and heart rate is adjusted to meet the oxygen and energy demands
of the body. Factors beyond the sympathetic and parasympathetic nervous system such as
emotions, ion concentration (e.g., sodium), level of conditioning, and body temperature also
influence heart rate.
In unconditioned individuals, stroke volume will likely be lower, while the heart rate both at
rest and during activity will likely be higher. This means the heart must beat more times
to pump the same volume of blood, and it is pumping faster, which can, over time, lead to
weakening of the heart muscle or even heart failure. When the heart pumps faster as with
an increased heart rate, this allows less time for the ventricle to fill with blood after each
heartbeat, which also reduces stroke volume.
TEST TIP!
Application of Heart Rate and Conditioning
The American Heart Association norms state that resting heart rates can range between
60 beats per minute (bpm) and 100 bpm, depending on the person. A more conditioned
individual will have a lower resting heart rate in general. Assuming two people were at
complete rest for 24 hours, a comparison of their heart rates may look like this:
Conditioned person:
60 bpm x 60 minutes = 3,600 beats per hour (bph)
3,600 bph x 24 hours = 86,400 beats per day (bpd)
Deconditioned person:
80 bpm x 60 minutes = 4,800 bph
4,800 bph x 24 hours = 115,200 bpd
Even at rest, a deconditioned individual’s heart is beating nearly 30,000 more beats
per day than a more conditioned person. However, no one is completely at rest 24
hours a day. Ordinary activities of daily living along with additional deliberate exercise
will cause the deconditioned heart to beat proportionately faster than a conditioned
heart during the same activity. Over the life of the individual, the additional work and
strain on the heart of a deconditioned person can be detrimental.

The pulse is the rhythmic expansion of the blood vessel each time blood is pushed from the
PULSE: left ventricle. It can be found anywhere an artery is close to the surface of the skin and rests
A rhythmical throbbing of
the arteries as blood is against something solid like a bone, tendon, or ligament. The most common sites to take a
propelled through them.
pulse are at the radial artery in the wrist and the carotid artery in the neck. Blood pressure
is a measurement of the force of blood flow within the blood vessels. It is measured using a
BLOOD PRESSURE:
The force of blood pushing sphygmomanometer.
against the walls of the
phases of the cardiac cycle.
SYSTOLIC: Figure 4.8 Radial and Carotid Artery Pulse

The pressure in blood
vessels when the
heart beats (ventricular According to the American Heart Association, normal blood pressure is anything less than
contraction).
120/80 mm Hg. Blood pressure is written as systolic pressure (the pressure during the
contraction phase of the heartbeat) over diastolic pressure (the pressure during the relaxation
DIASTOLIC:
phase of the heartbeat). Hypotension is the condition of low blood pressure measuring
vessels when the heart 90/60 mm Hg or less. During hypotension, the brain does not receive enough oxygen, which
rests (ventricular filling).
can cause dizziness or fainting. Hypertension is the term for blood pressure measured at or
HYPOTENSION: above 140/90 mm Hg. Chronic hypertension can cause health issues like heart disease.
Low blood pressure Symptoms of hypertension include headaches, vision problems, chest pain, and an irregular
measuring 90/60 mm Hg
or lower. heartbeat.
HYPERTENSION: TEST TIP!

High blood pressure To remember which number is where in a blood pressure measurement, remember that
measuring more than
140/90 mm Hg. the heart has to contract before it relaxes. Systolic pressure is pressure on artery walls
during contraction, while diastolic pressure is the pressure when the heart is at rest.
Therefore, systolic/diastolic.
The reading with pressure (systolic) will always be bigger than the reading at rest (diastolic).

Table 4.1 Blood Pressure Categories
CATEGORY SYSTOLIC MM HG DIASTOLIC MM HG
Normal <120 <80
Elevated 120–129 <80
Pre-Hypertensive (Stage 1) 130–139 80–89
Hypertension (Stage 2) 140+ 90+
Hypertensive Crisis >180 >120
There are four factors affecting blood pressure measurements. When these factors increase,
so does blood pressure.
1. Cardiac output: how much blood the heart is pumping per minute.
2. Blood volume: the total volume of blood contained in the circulatory system.
CARDIAC OUTPUT:
The amount of blood
3. Peripheral resistance of arteries: the elasticity (or lack thereof) of artery walls. pumped through the heart
per minute.
4. Blood viscosity: the thickness of blood moving through circulation.
BLOOD VOLUME:
Blood The total volume of blood
within the circulatory
Blood is a specialized type of connective tissue. It is found in all areas of the body, except system of an individual.
epithelial tissue, and is approximately 55–60 percent plasma, 40 percent red blood cells, and
2 percent white blood cells and platelets. PERIPHERAL

RESISTANCE:
Red blood cells are also known as erythrocytes and are, by volume, the most numerous type The vascular resistance of
the arteries to blood flow.
of blood cells in the body. Their primary function is carrying oxygen from the lungs to the
body’s tissues. Platelets are irregularly shaped cells found in the blood and the spleen. Their
BLOOD VISCOSITY:
primary function is to help form blood clots to stop bleeding and promote wound healing.
The thickness and
“stickiness” of blood and
The white blood cells are integral in the body’s immune response. There are several types of how it affects its flow
through the blood vessels.
white blood cells, each with unique functions:
• Basophil—a large white blood cell that locates and destroys cancerous cells and is
responsible for the histamine response during an allergic reaction.
• Neutrophil—the most numerous white blood cells (40–70 percent in humans)
responsible for the primary immune response of the ingestion or enzymatic digestion
of foreign microorganisms.

• Eosinophil—white blood cells that play a role in allergic reactions and immune
defense against multicellular parasites.
• Monocyte—an immune cell that helps remove dead or damaged tissues and
provides support to the other types of white blood cells.
• Lymphocyte—white blood cells that include natural killer cells, B cells, and T cells,
which kill tumor cells, produce antibodies, and kill infected or cancerous cells,
ANTIBODIES: respectively.
Blood proteins that
combine with other
substances in the body to
recognize foreign bodies
as part of the immune
response.
Figure 4.9 Types of Blood Cells
THE LYMPHATIC SYSTEM

The lymphatic system is considered a part of the circulatory system. During exercise, the lymphatic
LYMPH:
The colorless fluid of the
system regulates fluid volume and pressure within the tissues. The major structures of the lymphatic
lymphatic system. system include the lymph nodes, tonsils, spleen, and thymus. This system contains lymph, a
colorless fluid surrounding tissues that carries white blood cells. Lymph is created when blood
INTERSTITIAL FLUID: plasma flows through the capillary walls and into the interstitial fluid between cells. Approximately
The fluid found between
cells. 90 percent of the fluid leaving the capillaries is returned via the lymphatic system.

The key functions of this system include:
• Balancing interstitial fluids
• Absorbing fats and fat-soluble vitamins
• Defending against illness and disease
Figure 4.10 The Lymphatic System
Lymph nodes are found throughout the body and help to filter lymph before it is returned to
the blood for circulation. The lymph nodes remove diseases (pathogens), create antibodies,
generate lymphocytes and store other white blood cells. Antibodies are blood proteins that
combine with other substances in the body to recognize foreign bodies such as viruses and
bacteria as part of the immune response. The tonsils are clusters of lymphatic tissue found

on either side of the back of the throat. They serve to protect the body from any foreign
pathogens that may be introduced to the body through the nose or mouth.
The spleen is the largest lymphatic structure in the human body. It filters and serves as a
reservoir for blood. In the case of severe blood loss, the spleen contracts to release more
blood into circulation. Finally, the thymus serves to manage the immune T cells (lymphocytes
that target foreign particles in the body), which travel from the bone marrow to the thymus
gland to mature.
THE RESPIRATORY SYSTEM

The respiratory system consists of the following structures:
Nose and nasal cavities: The nose is made of bone and cartilage. Air and particles enter the
body through the nose.
Pharynx: The pharynx is commonly called the throat and is a passageway for both air and
food.
Larynx: This passageway is between the pharynx and trachea.
Trachea: This is the main passageway of air into the lungs.
Bronchi: This is the passageway of air into the functional tissues of the lungs.
Lungs: The right lung has three lobes, while the left lung has two lobes. The lungs are
separated by a membrane partition called the mediastinum, which is where the heart sits.
The primary function of the respiratory system is to bring fresh air into the body while removing
waste gases like carbon dioxide. Other functions of this system include:
• Providing oxygen for metabolic processes

RESPIRATION: • Removing waste products of metabolism
The intake of oxygen
and subsequent release • Regulating the pH of blood
of carbon dioxide in an
organism. Respiration is the act of breathing and is the process through which the respiratory system
completes these necessary tasks. Every few seconds, autonomic nerve impulses initiate
inhalation and exhalation—a task that requires no effort or thought in healthy individuals.
PULMONARY
VENTILATION: Pulmonary ventilation is also known as breathing. When we breathe in, air from the external
The process of exchange of
air between the lungs and environment travels through the nose or mouth, down through the pharynx, and past the
the ambient air.
larynx. The trachea is the main airway to the lungs. From here, the air passageway divides

into the left and right bronchi, which supply the left and right lungs with air. Inside the lungs,
the bronchi branch into smaller vessels known as bronchioles and eventually to alveoli, the
smallest functional pulmonary tissues.
nasal passage
nostril
epiglottis pharynx
larynx
primary bronchus
secondary bronchus
trachea
tertiary bronchi
INSPIRATION:
Breathing air into the lungs.
lung
alveoli EXPIRATION:
Breathing air out of the
bronchioles lungs.
diaphragm
Figure 4.11 Pulmonary Anatomy DIAPHRAGM:

The dome-shaped muscle
that separates the lungs
and pleural cavity from the
PULMONARY VENTILATION abdomen.
Air moves into the lungs during inspiration and out during expiration. Inspiration is breathing
air into the lungs, while expiration is the exhale of air out of the lungs during a single breath. DIFFUSION:
The movement of air into and out of the lungs is controlled by changes in atmospheric The passive movement
of molecules or particles
pressure caused by the contraction and relaxation of the diaphragm. The diaphragm is the along a concentration
gradient or from regions
dome-shaped muscle that separates the lungs and pleural cavity from the abdomen and, of higher concentration
to regions of lower
upon contraction, increases the volume of the lungs to draw air in. concentration.
Gases move from areas of high pressure to areas of low pressure in a process called
diffusion. During inspiration, the diaphragm muscles contract. This pulls the rib cage out and
THORACIC CAVITY:
The chest cavity enclosed
up, increasing the space (volume) inside the thoracic cavity. The thoracic cavity is also by the ribs, sternum, and
spinal column.
known as the chest cavity, and it is enclosed by the ribs, sternum, and spinal column. As the
volume of the thoracic cavity increases, the pressure within the alveoli—known as intra-
INTRA-ALVEOLAR
alveolar pressure—decreases so that air is pulled into the lungs. The opposite is true for
PRESSURE:
expiration as the diaphragm relaxes. The pressure in the alveoli is slightly above atmospheric The pressure within the
alveoli that changes
pressure, and the lungs are slightly elastic, which drives air out of the lungs. Therefore, throughout respiration.
inhalation is an active process, as muscle contraction is required, while expiration is passive,
as the diaphragm relaxes to push air out of the lungs.

Inhalation Expiration
Figure 4.12 Respiration
External Respiration
The exchange of gases between the lungs and blood is known as external respiration, and
EXTERNAL this exchange occurs at the alveoli. Alveoli are encapsulated by capillaries, which facilitate
RESPIRATION: the exchange of gases between the lungs and the blood. Deoxygenated blood returning to the
The exchange of gases
between the lungs and the lungs is high in carbon dioxide and low in oxygen. During inspiration, oxygen from the lungs
blood.
(high-level concentration) diffuses into the blood, and during expiration, carbon dioxide moves
from the blood to the lungs to be excreted. The oxygenated blood following diffusion continues
through the circulatory system to deliver oxygen to the necessary organs and tissues.
Internal Respiration
Internal respiration occurs at the cellular level. Following external respiration, oxygen binds
INTERNAL to hemoglobin, a protein found in the red blood cells, which carries the oxygen to the cells.
RESPIRATION: As oxygen is delivered to the necessary cells, biomolecular waste products, such as carbon
The process of diffusing
oxygen from the blood into dioxide, are released. Carbon dioxide then binds to the hemoglobin, which carries it back to
the interstitial fluid and into
the cells. the lungs to be removed.

Figure 4.13 External vs. Internal Respiration
THE ENDOCRINE SYSTEM HORMONES:

Chemical messengers
The endocrine system regulates growth, development, homeostasis, reproduction, and stored, created, and
released by endocrine
metabolic activities through chemical messengers known as hormones. Hormones are
glands.
stored, created, and released by endocrine glands and regulate most bodily functions. The
endocrine system is also composed of exocrine glands, which produce substances that are
ENDOCRINE GLANDS:
released through a duct or opening on the body’s surface. Ductless glands releasing
hormones that remain
within the body.
Hormones regulate nearly all our bodily functions. They regulate growth and development, help
us cope with both physical and mental stress, and regulate all forms of training responses,
EXOCRINE GLANDS:
including protein metabolism, fat mobilization, and energy production. Resistance training Glands that produce and
release substances through
is a natural stimulus that can cause an increase in tissue mass. These adaptations are
ducts or openings on the
influenced by the changes in circulating hormonal concentrations as a result of exercise. body’s surface.
HORMONES AMINO ACIDS:

Simple organic compounds
Hormones are made of amino acids, lipids, or peptides (chains of amino acids). The sex
known as the building
hormones estrogen and testosterone and those secreted by the adrenal cortex (aldosterone blocks of proteins.
and cortisol) are lipid hormones, also known as steroids.

STEROIDS:
Lipid hormones can diffuse across the plasma membrane of cells, while other hormones A class of chemicals
characterized by their
cannot. Amino acid and peptide hormones must attach to cells with surface receptors that carbon structure, working
to reduce inflammation and
will, once bound, trigger a desired reaction within a cell. the activity of the immune
system.
A negative feedback loop is one method of hormone regulation in the body. When a hormone

is secreted and received by another cell, that cell sends information back to the endocrine
system to stop or reverse the production of that hormone.
Some hormones are controlled by the release of other hormones. For example, the pituitary
gland releases corticotropin, which begins the production of cortisol (from the adrenal glands)
during stress. Thyrotropin, or thyroid-stimulating hormone (TSH), stimulates the production of
hormones from the thyroid.
Other hormones are released after direct neural stimulation. For example, antidiuretic
hormone (ADH) is released into the bloodstream from nerve cells in the hypothalamus.
Table 4.2 Endocrine Glands and Their Hormones
EFFECTS OF
CONTROL OF
EXERCISE ON
HOST HORMONE HORMONE FUNCTION HORMONE
HORMONE
SECRETION
SECRETION
Anterior Stimulates tissue growth;

pituitary Growth hormone mobilizes fatty acids for Hypothalamic- ↑ with increasing
(GH) energy; inhibits carbohydrate releasing factor exercise
metabolism
Hypothalamic TSH-
Stimulates production and release ↑ with increasing
Thyrotropin (TSH) releasing factor;
of thyroxine from thyroid gland exercise
thyroxine
Stimulates production and Hypothalamic

Corticotropin
release of cortisol, aldosterone, ACTH-releasing Effects unknown
(ACTH)
and other adrenal hormones factor; cortisol
Hypothalamic
FSH works with LH to stimulate FSH- and LH-
Gonadotropin production of estrogens and releasing factor;
No change
(FSH & LH) progesterone by ovaries and female: estrogen
testosterone by male testes and progesterone;
male: testosterone
Inhibits testosterone; mobilizes Hypothalamic PRL- ↑ with increasing

Prolactin (PRL)
fatty acids inhibiting factor exercise
Block pain; promote euphoria;

Stress: physical/ ↑ with long-
Endorphins affect feeding and female
emotional duration exercise
menstrual cycle

Table 4.2 Endocrine Glands and Their Hormones (CONT)
EFFECTS OF
CONTROL OF
EXERCISE ON
HORMONE
SECRETION
SECRETION
Posterior Vasopressin Controls water excretion by Hypothalamic ↑ with increasing

pituitary (ADH) kidneys secretory neurons exercise
Stimulates muscles in uterus

Hypothalamic
Oxytocin and breasts; important in birth Effects unknown
secretory neurons
and lactation
Adrenal Promotes use of fatty acids and

cortex protein catabolism; conserves
Cortisol ↑ in heavy
blood sugar: insulin antagonist; ACTH; stress
Corticosterone exercise only
has anti-inflammatory effects
with epinephrine
Angiotensin and
Promotes retention of sodium, plasma potassium ↑ with increasing
Aldosterone
potassium, and water by kidneys concentration; exercise
renin
Adrenal Epinephrine:
medulla Facilitates sympathetic activity, ↑ with heavy
increases cardiac output, Stress stimulates exercise;
Epinephrine
regulates blood vessels, hypothalamic
Norepinephrine
increases glycogen catabolism sympathetic nerves norepinephrine:
and fatty acid release ↑ with increasing
exercise
Thyroid Thyroxine (T4)

Stimulates metabolic rate; TSH; whole-body ↑ with increasing
Triiodothyronine
regulates cell growth and activity metabolism exercise
(T3)
Pancreas Promotes CHO transport into

cells; increases CHO catabolism
Plasma glucose ↑ with increasing
Insulin and decreases blood glucose;
levels exercise
promotes fatty acid and amino
acid transport into cells
Promotes release of glucose

Plasma glucose ↑ with increasing
Glucagon from liver to blood; increases fat
levels exercise
metabolism

Table 4.2 Endocrine Glands and Their Hormones (CONT)
EFFECTS OF
CONTROL OF
EXERCISE ON
HORMONE
SECRETION
SECRETION
Parathyroid Raises blood calcium; lowers Plasma calcium ↑ with long-term

Parathormone
blood phosphate concentration exercise
Ovaries Controls menstrual cycle;

↑ with exercise;
Estrogen increases fat deposition;
FSH, LH depends on
Progesterone promotes female sex
menstrual phase
characteristics
Testes Controls muscle size; increases

number of red blood cells;
Testosterone LH ↑ with exercise
decreases bodyfat; promotes
male sex characteristics
Kidneys Stimulates aldosterone Plasma sodium ↑ with increasing

Renin
secretion concentration exercise
ENDOCRINE GLANDS
Endocrine glands secrete hormones directly into the blood to be transported to their target
tissues. Since they circulate, hormones come in contact with nearly every cell in the body.
However, hormones are specific in that they can only act on target cells that have receptors
on the cell surface specifically for that hormone.
The major glands of the endocrine system include:
Hypothalamus: The main role of this gland is to maintain homeostasis. It either stimulates
or inhibits heart rate, blood pressure, body temperature, fluid and electrolyte balance, thirst,
ELECTROLYTE: appetite, body weight, glandular secretions of the stomach and intestines, the release of
Minerals in the body that
have an electric charge. substances influencing the pituitary gland, and sleep cycles.
Pineal gland: The only hormone this gland is known to secrete is melatonin.
Pituitary gland: Pituitary hormones control other parts of the endocrine system, including the
thyroid gland, adrenal glands, ovaries, and testes.
Thyroid: The main function of the thyroid is to regulate metabolism.
Parathyroid: There are four parathyroid glands that help regulate calcium levels in the body.

Thymus: The thymus is only active until puberty. Before puberty, it stimulates the development of
T lymphocytes, which play a role in the lymphatic system’s defense against illness and infection.
Adrenal: The adrenal glands are attached to the kidneys and are made up of the adrenal
cortex and adrenal medulla. Hormones secreted by the adrenal cortex are essential to life.
Those secreted by the adrenal medulla are not.
Pancreas: The main role of the pancreas is to maintain blood glucose balance.
GLUCOSE:
Ovaries: The ovaries secrete hormones essential for female reproductive development and A simple sugar the body
uses for energy production
fertility. on the cellular level.
Testes: The testes are responsible for maintaining male reproductive health.
Pineal gland
Hypothalamus
Pituitary gland
Thyroid gland
Thymus
Pancreas
Adrenal glands
Testes
(male)
Overies
(female)
Figure 4.14 Endocrine Glands
HORMONAL RESPONSES TO EXERCISE

Many hormones are sensitive to exercise. These hormones can increase blood glucose
(blood sugar) levels, affect the heart rate, and alter muscular force production, contraction

rate, and cellular energy production. Some hormones can affect how the muscles repair and
grow as well. The primary hormones a fitness professional should be familiar with as they
relate to physical activity and exercise include:
• Testosterone
INSULIN:
• Growth hormone (GH)
A hormone produced in the
pancreas to regulate blood
• Insulin-like growth factor
sugar.
• Insulin
TESTOSTERONE: • Cortisol
A steroid hormone found in
both males and females. • Catecholamines
Testosterone
OSTEOPOROSIS: In mammals, testosterone is primarily secreted in the testes of males and the ovaries of
A skeletal condition that
results in weak or brittle females, although small amounts are also secreted by the adrenal glands. It is the principal
bones.
male sex hormone and is classified as a steroid. In men, testosterone plays a key role in
health and well-being as well as in the prevention of osteoporosis. On average, an adult

CATABOLIC:
Metabolic activity involving human male body produces about 40 to 60 times more testosterone than an adult human
the breakdown of molecules
female body. However, females are more sensitive to the hormone behaviorally.
such as proteins or lipids.
Not all exercise protocols elicit increases in the circulating concentrations of hormones in the
PROTEIN SYNTHESIS: body. A significant amount of force is required to activate high-threshold motor units not
The process of arranging
amino acids into protein typically stimulated by endurance exercise. Keep in mind, however, high-intensity endurance
structures.
exercise can have a very dramatic catabolic effect. An increase in testosterone may occur to
maintain protein synthesis to keep up with this protein breakdown. Following an exercise
ANABOLIC:
The process of creating session, remodeling of the muscle tissue begins in the presence of hormonal secretions to
larger molecules from
smaller units.
stimulate anabolic action.
The primary anabolic hormones involved in muscle tissue growth and repair aside from
GROWTH HORMONE testosterone are growth hormone (GH) and insulin-like growth factors (IGF).
(GH):
A hormone released by the Training experience and age of participants also affect testosterone. Research suggests that
pituitary gland that stimulates
growth in animal cells. males under 30 have higher increases in free testosterone as a result of long-term high-
intensity training than do females of any age or males over 30.

INSULIN-LIKE GROWTH
FACTORS (IGF): Growth Hormone (GH)
A protein similar to insulin
Secreted from the pituitary gland and made from more than 190 amino acids, growth
that stimulates growth of
cells. hormone may:

• Increase protein synthesis
• Increase fat breakdown
• Increase collagen synthesis
• Decrease glucose utilization
Growth hormone secretion is at its peak during adolescence. With good nutrition, sleep, and
training, levels of GH can be kept higher later in life. Research suggests that people who
maintain higher levels of GH because of exercise in their younger years are more likely to
have a healthier body composition later in life.
Many of these hormone actions may be helped by insulin-like growth factor (IGF). Growth
hormone stimulates both the release of IGFs and the availability of amino acids for protein
synthesis. Without growth hormone, IGF cannot be released by the liver.
The time of day affects the blood secretion levels of GH, with the highest levels observed
at night. Like with testosterone, the intensity of training matters regarding the hormonal
response of GH in the body. Heavy loads with shorter rest periods are shown to elicit a
stronger GH response post-exercise. Growth hormone may have an anti-insulin effect, and
research suggests it suppresses the ability of insulin to stimulate the uptake of glucose in
tissues and enhances glucose synthesis in the liver.
Insulin-Like Growth Factors
Many of the effects of growth hormone are mediated by insulin-like growth factors from
the liver. IGFs travel in the blood attached to binding proteins, then are released as free
hormones to interact with receptors on target cells. Fat cells have relatively high levels of
IGF in comparison to skeletal muscle, which has very little of its own. With high-intensity
training, research suggests that the amount of IGF in the bloodstream and the number of IGF
receptors found in the body increase as a prominent training adaptation.
Insulin
Released by the pancreas, insulin increases cellular uptake of glucose-synthesizing muscle
glycogen, which in turn decreases blood glucose. Small increases in blood insulin levels will
slow or stop the breakdown of fat (adipose tissue) for energy with glucose becoming the
primary source. During prolonged workouts, blood glucose reduction along with decreased
insulin production can greatly increase the mobilization of fatty tissue for energy production.

Figure 4.15 How Insulin Works
TEST TIP!
Insulin helps move glucose into the cells. Insulin = IN the cells.
Cortisol
Secreted by the adrenal gland, cortisol is catabolic and causes a breakdown of protein in the
CORTISOL: muscles. Cortisol is an antagonist that inhibits glucose uptake and utilization. It has been
A catabolic hormone
released in response to found to be released during high-intensity exercise and as a stress response (emotional and
physical and emotional
stress. physical). It has a greater catabolic effect in fast-twitch muscle fibers than in slow-twitch
muscle fibers.
Some research on cortisol and sleep cycles suggests that moderate to low-intensity exercise
KETONE BODIES: can reduce blood cortisol levels instead of increasing them. This is largely attributed to the
Molecules released by the
liver in starvation states for differing levels of physical stress the body undergoes in low intensity versus high-intensity
an alternate energy source.
exercise. Also, excess cortisol may cause the body to release ketone bodies and bring on a
state of ketosis. Ketone bodies are typically produced during times of low food intake or
KETOSIS:
A metabolic process that starvation to provide an alternate source of cellular energy. However, too many ketone bodies
occurs when the body
does not have enough in the blood can cause ketoacidosis, making the blood fatally acidic.
carbohydrates for energy;
the liver metabolizes fatty
acids to produce ketones
as a replacement energy
source.

TEST TIP!
Remember that cortisol can be good or bad based on how long it remains elevated.
Short-term cortisol elevation:
• Increases blood sugar (glucose) levels
• Enhances the brain’s use of glucose
• Reduces inflammation
• Reduces unnecessary bodily functions during the fight-or-flight response
Extended-duration cortisol elevation:
• Increases appetite
• Increases blood pressure
• Promotes weight gain
• Contributes to type 2 diabetes
Catecholamines
The “fight-or-flight” hormones epinephrine, norepinephrine, and dopamine are released by the
adrenal glands in response to stress and are referred to as catecholamines. Like with cortisol,
CATECHOLAMINES:
epinephrine will increase with heavy resistance training as heavy resistance training is very Hormones released by the
adrenal glands into the
stressful on the body. Since epinephrine is involved in metabolism, force production, and the rate blood as a result of stress.
of response of other hormones such as testosterone and IGFs, the stimulation of catecholamines
is likely one of the first hormonal changes in response to resistance exercise.
EXOCRINE GLANDS
Exocrine glands release secretions that are carried to an epithelial or skin surface and
secreted via ducts. They allow the body to expel substances that contain mucus, proteins,
water, enzymes, and ions. Examples of exocrine glands include the sweat glands, sebaceous
glands (secrete oils), mammary glands (secrete milk), and digestive glands producing
enzymes and other substances in the digestive tract. Substances secreted from the exocrine
glands are non-hormonal in nature, but the production of the secretions is controlled by the
release of hormones within the body.
TEST TIP!
Remember that EXOcrine glands secrete substances that EXIT the body, while
ENDOcrine glands produce substances that remain within the body.

THE DIGESTIVE SYSTEM

The digestive system collectively breaks down food into smaller molecules for use in energy
production at the cellular level. There are six functions the digestive system is responsible
for regarding the breakdown of food for energy:
1. Ingestion: taking food in through the mouth.
2. Mechanical digestion: the process of chewing (mastication) and the churning and
mixing actions of the stomach that further break down food.
3. Chemical digestion: enzymes released throughout the digestive tract are released
to break food into smaller molecules.
4. Movements: food moves through the digestive system by the rhythmic contractions
of the smooth muscle of the digestive tract—a process known as peristalsis.

PERISTALSIS: 5. Absorption: simple molecules get absorbed by the cell membranes in the lining of
The muscular contractions
of the smooth muscle of the small intestine into blood or lymph capillaries.
the digestive tract, which
moves food through the 6. Elimination: the removal of waste products and indigestible particles.
digestive tract.
The digestive tract—beginning at the mouth and ending at the anus—is between four and
six meters long in the average adult. Unlike the circulatory system, it is an open system with
openings at both ends. Important digestive system components include the:
• Mouth
• Esophagus
• Stomach
• Small intestine
• Large intestine and rectum
• Liver
• Gallbladder
• Pancreas

MOUTH
Food enters the digestive system through the mouth. The mouth has four functions in the
digestive process. First, the mouth physically breaks apart food via mastication (chewing) to
reduce the size of ingested food pieces. Second, it mixes food with saliva to create a moist
mass called a “bolus.” Once a bolus is formed, food is ready to be swallowed. Saliva contains
digestive enzymes that begin the chemical breakdown of the components of food and provide
lubrication as the bolus moves into the esophagus.
Third, the mouth helps to regulate the temperature of food by either cooling it or warming it. This
is an important function, as many digestive enzymes function best at certain temperatures.
For humans, this range is close to normal body temperature. Finally, the mouth initiates the
swallowing of food to move it along the digestive tract.
Figure 4.16 Swallowing
ESOPHAGUS
The esophagus extends between the pharynx and stomach and is the transport conduit
for food and water traveling to the stomach. When the bolus enters the esophagus, an
involuntary wave of muscle contractions is triggered, propelling the food mass down into
the stomach. This muscle contraction action is known as “peristalsis.” This peristaltic wave
travels down the esophagus at the rate of about three inches per second. Once at the base
of the esophagus, a ringlike muscle (the esophageal sphincter) is reached, which relaxes to
allow the food into the stomach.

STOMACH
The stomach is a muscular sac about two quarts in volume. It is responsible for the storage
and gradual release of food into the small intestine, digestion through chemical secretions
and the physical activity of churning the digesting food, and transport of ingested food down
the gut.
The stomach secretes several types of substances to aid in the breakdown of food. Mucus
acts as a protective layer to lubricate the stomach wall and a buffer against acidic secretions.
Hydrochloric acid is also secreted in the stomach and helps to keep the stomach relatively
free of microorganisms (bacteria) while maintaining the low pH (more acidic) inside the
stomach. Hydrochloric acid also acts to catalyze the action of pepsins, which begin the
digestion of proteins.
Figure 4.17 The Stomach Anatomy
While the intestines are known as the primary location for absorption, the stomach can
absorb some nutrients as well. The stomach can absorb water, glucose, alcohol, aspirin,
some other drugs, and certain vitamins such as niacin. The fact that water and glucose can
be partially absorbed through the stomach is a benefit for quick replenishment of these
nutrients during exercise. Some popular sports drinks take advantage of this fact by including
glucose as a main ingredient.

The stomach only begins the process of breaking down complex molecules. Complete
digestion of these substances occurs farther along in the digestive tract. Complex molecules
are broken down into their smaller components (e.g., proteins into amino acids). This
breakdown process, also called “hydrolysis,” continues in the intestines when the partially
digested material in the stomach enters the small intestine through the pyloric sphincter
muscle. At this stage, it is called chyme. CHYME:

A pulpy, acidic fluid that
moves from the stomach
SMALL INTESTINE to the small intestines
containing partially digested
The small intestine stretches about 12 feet long and is divided into three main regions: food and gastric juices.
duodenum, jejunum, and ileum. The duodenum is connected to the stomach and makes up
the first part of the small intestine. Some absorption takes place here, but it is primarily
a location for the storage and continued breakdown of food. The next regions of the small
intestine, the jejunum and ileum, are responsible for most of the nutrient absorption.
Duodenum
Large Intestine
Transverse colon
Ascending colon Small Intestine
Jejunum
Ileum
Appendix
Sigmoid colon
Rectum
Anus
Figure 4.18 Anatomy of the Intestines
To accomplish complete absorption, the inside surface of the small intestine has a unique
anatomy. Instead of being a flat surface, like that of the skin, the small intestine is lined with
special cells called villi. These villi are very small fingerlike projections that line the entire
inner surface of the intestine. The surface area of the intestine is greatly increased by the
villi. Each villus is served by blood vessels. When nutrients pass through the cells of the villi,
they are transported into the blood vessels and then to the liver.

Figure 4.19 Small Intestine Villi
The lymphatic system is also present within the villi and works to transport ingested fats. A
small projection called a lacteal extends into the villus and is responsible for about 60 to 70
percent of ingested fat being transported to the liver.
LARGE INTESTINE AND RECTUM

The large intestine is about three feet long. The area where the ileum and large intestine
join is called the cecum. The appendix is found at the end of the cecum as well. In the
large intestines, some final absorption of water, minerals, and vitamins occurs. Bacteria are
present in the large intestine, and through their metabolism, they produce vitamins that are
absorbed, such as vitamin K. The large intestine (also called the colon) stores the waste
products of digestion.
The further decomposition of fecal matter by bacterial action produces gas. The amount of
gas produced varies depending on the nutrient substrate that makes it down to the colon.
When the proper stimulus occurs, the colon empties its contents into the rectum, triggering
defecation. Normally, the rectum remains empty and rectal filling occurs due to peristalsis.
The more fiber in the diet, the softer the feces and the easier it is to eventually defecate.

Figure 4.20 Large Intestine Anatomy
LIVER
The liver is the largest gland in the body. It gets oxygenated blood from the hepatic artery (the
major blood vessel that carries blood from the liver) and nutrient-rich blood from the digestive
tract through the hepatic portal vein (the vein carrying blood to the liver from the stomach,
spleen, pancreas, and intestines).
The liver serves many important functions, including:
• Secretion of plasma proteins, carrier proteins, hormones, prohormones, and
apolipoprotein
• Making and excreting bile salts
• Storage of fat-soluble vitamins
• Detoxification and filtration
• Carbohydrate, protein, and lipid metabolism
GALLBLADDER
Attached to the liver is the gallbladder. Its primary role is to store bile for use in digestion. BILE:
A bitter greenish-brown
Bile is made of water, bile salts, bile pigments, and cholesterol, and it helps in the digestion alkaline fluid aiding
and absorption of fats. digestion, secreted by
the liver and stored in the
gallbladder.

PANCREAS
The pancreas is located behind the stomach. It has both endocrine and exocrine functions in
the body and plays a major role in digestion by secreting the digestive enzymes amylase,
trypsin, peptidase (protease), and lipase. Salivary amylase is an enzyme found in saliva that
SALIVARY AMYLASE: converts starches and glycogen to more simple sugars, while trypsin acts in the small
An enzyme found in saliva
that converts starches and intestine to break down protein. Peptidase also breaks down proteins, and lipase helps to
glycogen to more simple
sugars. digest dietary fat. Specialized cells on the pancreas called the islets of Langerhans secrete
the endocrine hormones insulin, glucagon, and somatostatin to control blood sugar and
regulate the activity of the gastrointestinal tract.
Figure 4.21 Liver, Gallbladder, and Pancreas

THE INTEGUMENTARY SYSTEM
The integumentary system is the largest human organ system. It covers the entire human
INTEGUMENTARY
body and is made up of skin, hair, and nails. This system protects the internal organ systems
SYSTEM:
from damage and disease, prevents water and fluid loss, and helps to regulate body Organ system protecting
the body; composed of
temperature. The layers of the skin also include the exocrine glands and sensory nerves.The skin, hair, and nails.
skin has three layers:
The epidermis is the outermost layer of the skin that makes the skin taut and creates a
EPIDERMIS:
waterproof barrier. The outermost layer of the
skin.
The dermis lies beneath the epidermis and is the layer holding blood cells, sweat glands, hair
roots (follicles), and connective tissues.

DERMIS:
Deep to the epidermis;
The hypodermis is the deepest layer of skin that holds subcutaneous fat and connective holds blood vessels, sweat
glands, and hair follicles.
tissues.
HYPODERMIS:
The deepest layer of skin
housing fat cells and
connective tissues.
Epidermis
SUBCUTANEOUS FAT:
Dermis Generally harmless fat cells
located just beneath the
skin.
Hypodermis
Figure 4.22 Human Skin

CONCEPTS OF
CHAPTER 05
BIOMECHANICS
LEARNING OBJECTIVES
1 | Define the vocabulary terms for anatomical position and movement.
2 | Explain Newton’s laws of motion.
3 | Describe the classes of levers and give examples of each within the
human body.
4 | Explain the key concepts of muscles as the movers of the body.

CHAPTER 05 | Concepts of Biomechanics
Bones, muscles, connective tissues, and the nervous system work together to produce
BIOMECHANICS: movement. A personal trainer must have a firm grasp of healthy human movement to
The study of the mechanical
laws governing movement effectively assess a client’s movement patterns to build safe and effective training programs.
of living organisms.
Two fields of study specifically help fitness professionals understand and classify human
movement: biomechanics and kinesiology.

KINESIOLOGY:
The study of the mechanics
Kinesiology explores the human movement in exercise, everyday life, and sport while
of human movement.
biomechanics looks at a biological system (e.g., the human body), applying scientific concepts
from physics and mechanics to describe how the system moves. Both biomechanics and
kinesiology play a major role in exercise selection and training execution to produce desired
fitness adaptations while avoiding injury.
ANATOMICAL REFERENCE TERMS

The terms used to reference an anatomical position or location are used extensively in
ANATOMICAL biomechanics and fitness training. Each term is valuable in helping fitness professionals
POSITION: understand and articulate different movements and locations on the body and refers to the
The anatomically neutral
body position facing forward body when in anatomical position—facing forward with the arms at the sides of the body and
with the arms at the sides
of the body and palms palms and toes pointing straight ahead.
and toes pointing straight
ahead.
Figure 5.1 Anatomical Position

Table 5.1 Anatomical Terms
ANATOMICAL
DEFINITION
LOCATION TERM
Front of the body or toward the front relative to

Anterior or ventral
another reference point
Back of the body or toward the back relative to

Posterior or dorsal
another reference point
Superior Above a reference point
Inferior Below a reference point
Position closer to the center of the body relative to a

Proximal
reference point
Distal Position farther from the reference point
Medial Position relatively closer to the midline of the body
Position relatively farther from the midline of the

Lateral
body
Prone Lying facedown
Supine Lying on one’s backside
Further beneath the surface relative to another

Deep
reference point
Closer to the surface relative to another reference

Superficial
point
Unilateral Refers to only one side
Bilateral Refers to both sides
Ipsilateral On the same side
Contralateral On the opposite side
Caudal Toward the bottom
Cephalic Toward the head
Volar Relating to the palm of the hand or sole of the foot

Cephalic
Superior
Right Left
Midline
Proximal
Medial
Anterior Posterior Lateral
(Ventral) (Dorsal)
Caudal Distal
Proximal
Inferior
Distal
Lateral View Anterior View
Figure 5.2 Anatomical Locations or Positions
ANATOMICAL MOVEMENT
The terms for anatomical movement are also critical to understanding the biomechanics of
the body. These terms are widely universal within the health and fitness field and describe
how the muscles of the body act on the skeleton and generate movement.

Table 5.2 Terms for Anatomical Movement
TERM DEFINITION/ACTION
Abduction Movement away from the midline
Adduction Movement toward the midline
Flexion Movement decreasing the angle between two body parts
Extension Movement increasing the angle between two body parts
Lateral flexion Flexion in the frontal plane
Protraction Abduction of the scapula
Retraction Adduction of the scapula
Elevation Movement in a superior direction
Depression Movement in an inferior direction
Plantar flexion Extension of the foot downward (inferiorly)
Dorsiflexion Flexion of the foot upward (superiorly)
External rotation Rotational movement away from the midline
Internal rotation Rotational movement toward the midline
Circular movement of a limb extending from the joint where

Circumduction
the movement is controlled
Inversion Movement of the sole of the foot toward the median plane
Eversion Movement of the sole of the foot away from the median plane
Pronation Turning the palm or arch of the foot down
Supination Turning the palm or arch of the foot up
Hyperextension Position that extends beyond anatomical neutral
Ipsilateral Same-side movement
Contralateral Opposite-side movement
Lateral Situated away from the midline
Medial Situated toward or closer to the midline

PLANES OF MOTION
The anatomical planes of motion are used to describe the direction of movement. The frontal
plane, sometimes called the coronal plane, divides the body into anterior and posterior
FRONTAL PLANE:
An imaginary line that halves. Lateral movements such as hip and shoulder abduction occur in this plane. The
divides the body into
sagittal plane divides the body into left and right halves. Flexion and extension occur in this
anterior and posterior
halves. plane. There are few movements that are performed exclusively in the sagittal plane—most
movements are a combination of two or more planes of motion. However, a movement such
SAGITTAL PLANE: as the squat is largely in the sagittal plane.
An imaginary line that
divides the body into left
and right halves. The transverse plane divides the body into inferior and superior halves, and it runs
perpendicular to the frontal and sagittal planes. Anything requiring rotation, such as a golf
TRANSVERSE PLANE: swing or throwing a ball, occurs in this plane. The contralateral (opposite) motions of the
An imaginary line that
shoulders and hip while walking are in the transverse plane, though the body from afar
divides the body into
inferior and superior halves. seems to be moving forward with sagittal plane arm and leg swings.
Everyday activity involves movement in all three planes. Therefore, designing fitness programs
that incorporate movement in all three planes is critical. Though clients move in all three
planes, humans may have reduced range of motion (ROM) in the frontal and transverse
RANGE OF MOTION
planes and may lack extension of the spine (in the sagittal plane) from excessive sitting and
(ROM):
The measurement of moving predominantly in a single plane. Joints are healthiest when able to move through a
movement around a specific
joint or body part. normal ROM without restriction and ROM for a joint is specific to each individual.
Figure 5.3 Anatomical Planes

Abduction
Adduction Abduction
Adduction
OTHER MOVEMENTS IN THE FRONTAL

PLANE INCLUDE:
Trunk lateral flexion and extension
Scapula depression
Scapula elevation
Scapula upward rotation
Eversion Inversion Scapula downward rotation
Figure 5.4 Movements in the Frontal Plane

Flexion
Flexion
Hyperextension
Extension
Extension
OTHER MOVEMENTS IN THE SAGITTAL

PLANE INCLUDE:
Knee flexion and extension
Dorsiflexion
Trunk flexion and extension
Shoulder flexion and extension
Plantarflexion
Figure 5.5 Movements in the Sagittal Plane

Horizontal abduction
Horizontal
adduction
Lateral rotation
Medial rotation
OTHER MOVEMENTS IN THE

TRANSVERSE PLANE INCLUDE:
Torso rotation
External rotation
Head and neck rotation

Internal rotation
Scapular retraction
Scapular protraction
Figure 5.6 Movements in the Transverse Plane

BALANCE: BALANCE, EQUILIBRIUM, AND STABILITY

An even distribution of
weight enabling someone In human movement, balance, equilibrium, and stability are constantly challenged.
or something to maintain
Maintaining optimal position is critical to reduce the effort to hold position and produce or
its center of gravity within a
base of support. accept force. Balance describes the ability of an individual to maintain their center of gravity
within a base of support while stability describes the body’s resistance to change in joint or
EQUILIBRIUM: body position. Gravity is the attraction between objects and the earth. It is an attraction that
A state in which opposing
forces or influences are exists between all objects, everywhere in the universe. All objects on earth are subject to the
balanced.
forces of gravity. Muscular force is generated to move the skeleton, and therefore, creating
movement innately creates an imbalance or instability within the body. This is known as
STABILITY:
The ability to control and dynamic balance—when the body can remain upright over a moving base of support. This
maintain control of joint
ability allows humans to move while executing the tasks of daily living as well as exercise and
movement or body position.
sport performance. Helping clients improve this ability can be life-changing, enhancing their
lives in both work and play. Static balance, on the other hand, is the ability to remain upright
CENTER OF GRAVITY:
The hypothetical position and balanced when the body is at rest.
in the body where the
combined mass appears
to be concentrated and the TEST TIP!
point around which gravity
appears to act. There are different types of movement:
• Sustained force movement is where continuous muscle contractions occur

BASE OF SUPPORT:
The area beneath an object to keep moving a weight.
or person that includes
every point of contact that • Dynamic balance movement is where constant agonist-antagonist muscle
the object or person makes
with the supporting surface. contractions occur to maintain a certain position or posture.
• Ballistic movement is where inertial movement exists after an explosive
GRAVITY: or quick, maximum-force contraction; here is pre-tensing of the muscle in

The attraction between
the eccentric contraction so the muscle can contract concentrically with
objects and the Earth.
maximum speed and quickness.
MUSCULAR FORCE: • Guided movement occurs when both the agonist and the antagonist contract
Involves the contraction of a to control the movement.
muscle while exerting a force
and performing work. It can Receptors in the joints, muscles, and tendons help you know where your body is in
be concentric (shortening),
eccentric (lengthening), or space. This is called kinesthesis.
isometric (tension without
joint movement).
DYNAMIC BALANCE:
The ability to remain upright
and balanced when the
body and/or arms and legs
are in motion.

STATIC BALANCE:
The ability to remain upright
and balanced when the
body is at rest.
Stability and balance are maximized when the center of gravity can be determined and, if MASS:
The amount of matter in an
necessary, shifted. The center of gravity is the point at which both body mass and weight are
object.
equally distributed. Although somewhat similar terms, this simple example can help clarify
the difference between weight and mass. A rocket and astronaut launched from earth into
WEIGHT:
space both weigh increasingly less the farther they travel away from earth (gravity). Their The gravitational force of
attraction on an object.
mass, however, stays the same.
Stability and balance are affected by numerous factors such as changes in the center of
gravity—some controllable (such as the choice of stance width) and some uncontrollable
(rocky ground). When an individual’s center of gravity falls within a base of support, the
individual will be balanced. In general, when the base of support is larger, the individual will
find balance easier (e.g., squatting on two legs vs. squatting on one leg). When a line is drawn
straight down from the center of gravity, it is known as the line of gravity. To remain balanced,
LINE OF GRAVITY:
this line of gravity should fall within the base of support—the feet. When the line of gravity is A vertical line straight
through the center of
within the base of support, an individual is stable. When outside of the base of support, a
gravity.
reaction needs to take place to remain balanced.

Line of gravity
Center of gravity
Figure 5.7 Center and Line of Gravity
The height of the center of gravity will affect an individual’s balance, and a small change
can make a large difference. A personal trainer may adjust someone’s center of gravity by
adjusting their foot position and stance. For example, executing a dumbbell overhead press
with the knees locked and the feet side by side does not provide a lot of balance or stability
while moving the weight overhead. To improve balance, the feet can be moved to hip width,
and the knees can be held in a soft bend. The change in height is small but has a significant
impact. The lower and wider base of support prevents the exerciser from tipping over and
increases both balance and stability. Splitting the legs front and back, while maintaining the
hip width, would make the overhead movement even more stable. Which plane of motion a
base is widened in is a critical factor for improving balance and stability and is dependent on
the intended movement or exercise.
Training for balance has been shown to be beneficial in improving dynamic joint stabilization.
This type of training focuses on reflexive (without conscious thought) joint alignments while
moving to prevent falling and optimize movement. Training for balance requires placing a
demand on a client’s ability to maintain balance, which is how far outside the base of support
the client can move without losing control of their center of gravity. Standing on one leg may
be an appropriate challenge for most. Reaching to catch a ball while standing on one leg may

benefit others, such as athletes. The outcome of balance training is to enhance a client’s
awareness of their limit of stability (their kinesthetic awareness). Kinesthetic sense is based
on proprioception, which is awareness of the position of the joints. Altered joint motions due
to tight muscles (muscle imbalance) can cause faulty alignment both in static and dynamic
postures. For example, tight chest muscles can pull the shoulders forward.
JOINT MOBILITY AND STABILITY

Human movement requires joints to be both mobile and stable. Ultimately, healthy joints
should have the ability to move through the proper range of motion but with control. This is a
collaboration between the nervous system’s desire to move and send signals to muscles to
produce force, and the muscles’ efficiency at controlling joint motion. Muscular efficiency is
producing the right amount of force with the right muscles at the right time. Joint mobility is
defined as the degree of movement around a joint before movement is restricted by JOINT MOBILITY:
The degree of movement
surrounding tissues (tendons, ligaments, body fat, or muscles). Therefore, joint stability is around a joint before
movement is restricted by
the ability of the muscles around a joint to control movement or hold the joint in a fixed surrounding tissues.
(stable) position.
JOINT STABILITY:
TEST TIP! The ability of the muscles
around a joint to control
Joints typically needing greater mobility: foot/ankle, hip, thoracic spine, shoulder, and wrist movement or hold the joint
in a fixed (stable) position.
Joints typically needing greater stability: knee, lumbar spine, cervical spine, and elbow
The mobility and stability allowed by joints are important for maintaining proper posture and
function. Movement dysfunctions are derived from overactive (tight) and underactive (weak)
musculature, which affects the movement at a joint. A single joint with dysfunction may then
cause dysfunction with other joints inferiorly and superiorly as well.
Keep in mind, joint mobility can be limited by many factors including the uncontrollable factors
of age, sex, genetics, body type, and joint shape which can vary in humans. Joint mobility can
be affected by someone’s level of fitness which is controllable.
Though there are many uncontrollable factors, training will play the most significant role in
improving joint mobility. Improvements in mobility may be limited by exercise program design
and program adherence by the client.

THE LAWS OF MOTION

Sir Isaac Newton’s laws of motion explain what is observed in fitness and human movement.
LAWS OF MOTION: These laws of physics relate an object’s motion (such as a dumbbell’s) to the forces acting on
The laws of physics
describing movement. it (muscle actions) and gravity. Newton’s laws of motion help fitness professionals understand
how objects behave when standing still, while moving, and when forces act on them.
NEWTON’S FIRST LAW: INERTIA

FORCE:
The interaction that creates Newton’s first law states that a body in motion tends to stay in motion while a body at rest
work or physical change.
Its components are tends to stay at rest unless acted on by an outside force. Muscular contraction produces
magnitude, direction, point force and can change the status of movement such as going from a static standing posture
of application, and line of
action. to taking a step forward.
Inertia is defined as the resistance to action or change and describes the acceleration and
INERTIA:
The resistance to action deceleration of the human body. Running on inclines or declines and tools such as parachutes
or change and describes
the acceleration and add resistance to the object in motion—the body—and thus will increase the intensity of the
deceleration of the human
activity.
body.
With no outside
ACCELERATION: forces, this object
will never move.
The rate of change of
velocity.
With no outside
forces, this object
DECELERATION: will never stop.
A special type of
acceleration where a Figure 5.8 Inertia
person or object is slowing
down.
NEWTON’S SECOND LAW: ACCELERATION

Newton’s second law of motion has two parts. First, a change in acceleration of mass occurs
in the same direction of the force causing it. Throwing a medicine ball in a specific direction
makes the medicine ball accelerate in the direction it was thrown. Second, the change of
acceleration is directly proportional to the force causing it and inversely proportional to
the mass of the body. How hard an individual throws the medicine ball will determine how
much acceleration there will be, though the medicine ball’s mass will also determine its
acceleration. Mass is the amount of matter in an object, so assuming that gravity is constant,
mass and weight can be directly related to each other.
a = change in v / change in t

In this equation, a is acceleration, v is velocity, and t is time. So acceleration is the change
in velocity (final velocity minus starting velocity) divided by the change in time (elapsed time),
VELOCITY:
The speed of an object and
and the outcome is measured in meters per second squared (m/s2). In the common example the direction it takes while
moving.
of cars accelerating from 0 to 60 miles per hour, the car that can achieve 60 miles per hour
in the shorter time has the higher rate of acceleration.
In this law of motion, force is equal to an object’s mass multiplied by its acceleration: using
the medicine ball example, the amount of force a medicine ball would impact something with
would be determined by its mass (how much of it there is) multiplied by its acceleration (how
fast it is traveling).
F=mxa
This law is essential to exercise. In tandem with the law of inertia, a dumbbell lying on the
floor is in a state of resting inertia. It will not move unless someone picks it up or moves it.
However, for it to move, a force greater than the weight of the dumbbell must be applied. It is
therefore relatively simple to pick up a 5-pound dumbbell. However, a heavier dumbbell, such
as a 50-pound weight, will be harder to move.
The greater
the force...
The greater the

acceleration.
Figure 5.9 Acceleration
There is an inverse relationship between force and velocity known as the force-velocity curve.
FORCE-VELOCITY
CURVE:
As it relates to muscle contraction, the speed of muscle contraction (or more specifically
A representation of the
changes in the muscle length) changes the amount of force of the contraction and, as a inverse relationship
between force and velocity
result, affects the amount of power that can be produced. Consider the equation: in muscle contraction.
F x velocity = P
Where F is force and P is power.

Force
Eccentric Muscle
Action
Isometric
Force
Concentric Muscle
Action
Maximum Maximum
Lengthening Velocity Shortening
Velocity Velocity
Figure 5.10 The Relationship Between Force and Velocity
In the example of a dumbbell biceps curl, the force on the dumbbell is applied to begin the
movement. The dumbbell begins to move upward against gravity and generates momentum—
MOMENTUM: measured as mass times velocity. If enough momentum is developed, the muscle will no
The quantity of motion of a
moving body, measured as longer need to provide force on the weight to temporarily maintain its current state of
a product of its mass and
velocity. movement before gravity pulls it back down again. This is what allows a person performing a
barbell clean to stop pulling upward and get under the bar to catch it.
If an increase in mass increases the amount of force needed to move the object, then
the same is true if the acceleration is greater. Maximum-force effort can quickly accelerate
an object, for example, when kicking a ball. The effort required to decelerate the body in
the movement of a maximum-effort kick must be large enough to overcome the force of
the acceleration used to perform the skill. This is one of the reasons strength training is
useful in avoiding sport-related injuries. Being stronger helps a person slow down their own
movements when necessary.
It is also true that a muscle cannot stop an object in motion if it cannot generate enough
force to do so. Take, for example, the seated lat pull-down exercise. If the weight of the weight
stack is too heavy for the latissimus dorsi to control concentrically, the exerciser will “cheat”
and recruit the musculature of the core to create a swing, and thus momentum, to bring the
bar down. Since the latissimus dorsi cannot handle the load, during the eccentric action of

releasing the bar back to the starting position, the weight stack will gain momentum that
overpowers the muscles in the body. As a result, the weight will come crashing back down to
the stack instead of being controlled back to the start.
NEWTON’S THIRD LAW: ACTION AND REACTION

Newton’s third law states that for every action, there is an opposite and equal reaction.
Put simply, the human body provides the force to move, and the surface on which it moves
provides a reactionary force.
Every action has an equal and opposite reaction
Figure 5.11 Action and Reaction
Changing the training environment is an easy way to apply this law of motion. When running, for
example, the ground is acting on the runner as they stride. It is relatively easy to run on a
smooth, flat surface such as a track or blacktop. However, when the surface is changed to the
beach, the runner will have to overcome the resistance of shifting sand under their feet to
generate more forward motion. Sand creates a different reaction because it lessons the
SPEED:
runner’s force on contact. Using Newton’s laws shows that the sand’s inertia is overcome (first
The ability to move the body
law), causing it to move in the direction of the applied force or foot strike (second law), and that in one direction as fast as
possible.
the opposite force (third law) is not equal due to the effect of the second law on the sand.
Whereas on a hard surface, the force would be equal and opposite. The result is a loss of speed
GROUND REACTION
and force as the sand shifts. Ground reaction force (GRF) describes this phenomenon. GRF is FORCE (GRF):
the force the ground exerts on a body it is in contact with. For every stride the runner makes, The force the ground exerts
on a body it is in contact
their contact with the ground will be met with an equal and opposite force. with.

Figure 5.12 Ground Reaction Force (GRF)
The interaction between two objects that results in a change to the motion of those objects
is known as force. This interaction can be a push or a pull coming from an external source
FRICTION:
The resistance of relative (gravity and friction) or an internal source (muscles pulling on bones) and is the foundation
motion that one surface
or object encounters when
for the creation of movement (both acceleration and deceleration).
moving over another.
There are three types of force that can occur between two objects: compression, tensile, and
shear. Compression force occurs when two surfaces press toward one another, causing
COMPRESSION FORCE:
The force of two surfaces them to be compacted. An example of compression is the vertebrae of the spine. While in an
pressing toward one
another. upright position, gravity acts as a force that causes a level of compression among the
vertebrae. Tensile force is the opposite—pulling two contact surfaces apart. An example of
TENSILE FORCE: tensile force could be hanging from a pull-up bar. In this example, the bones of the shoulder
The force when two
surfaces pull apart from
joint are being pulled apart. Shear force is created when two surfaces move or glide across
one another. one another. Shear force can occur in the knee when the bone of the lower leg is relatively
stable and the bone of the upper leg moves across (over the top of) it. Another example is a
SHEAR FORCE: deadlift or the position of the hip in a hinge and resultant shear on the spine. Forces are not
The force of two surfaces
moving across one another. good or bad. They exist all around people, to people, and in people. What matters most is
how someone helps create, diminish, or enhance these forces through movement training.
An exerciser manipulates these forces, often unconsciously. Aspects of forces such as
direction, location, magnitude, frequency, duration, variability, and rate all play a role in
creating the right challenge the body needs to adapt.

Compression Tension Shear
MUSCULAR
CONTRACTION:
The shortening or
resistance to lengthening of
a muscle fiber.
Figure 5.13 Types of Force

LINEAR MOTION:
Movement along a line,
Muscles of the human body can only pull to create movement. Therefore, voluntary motion of straight or curved.
the human body is always initiated by a muscular contraction. These contractions initiate
and propagate movement and are the source of force within the body. There are two types of ANGULAR MOTION:
Rotation around an axis.
motion for human movement: linear motion and angular motion. Movement can occur in
either a straight or curved line (linear motion) or rotate around an axis (angular motion).
AXIS:
Point of rotation around
Joint movement is almost always angular motion. In the musculoskeletal system, linear and which a lever moves.
angular motions are related. For example, the angular motion of a joint can produce the
linear motion of walking forward. This also applies to movements occurring beyond the body DISPLACEMENT:
but resulting from the motion of the body. For example, the angular motion of the joints to The distance an object is
displaced from a starting
produce a baseball bat swing creates linear motion in the object struck—the baseball. point.
Displacement describes the distance an object is moved from its starting point or location.
DISTANCE:
For example, in baseball, the displacement from home base to first base is 90 feet. The The total or sum of the
length an object travels.
displacement from home base to first base, and back to home base is 0 feet since the batter
would be back to the same location. Distance refers to the total or sum of the length of
ANGULAR
travel. The distance from home base to first base is 90 feet. In the same example, if someone
DISPLACEMENT:
went from home base to first base and then back home they would travel a total distance of The change of location of
an object that is rotating
180 feet. The concepts of linear and angular movement can be applied to both displacement
about an axis.
and distance. Angular displacement refers to the change in location, measured in degrees
of rotation, of an object that is rotating about an axis while linear displacement is the distance LINEAR
an object moves in a straight line. The velocity of an object refers to the direction and rate of DISPLACEMENT:
its displacement. Speed is more simply the measure of the distance traveled by a body in a The distance an object
moves in a straight line.
unit of time or, in other words, how fast the object is moving.

FRICTION
Friction is a physical force affecting the body’s ability to create force, accelerate, and
decelerate. Friction is the force created by the resistance between two surfaces of two
objects moving across one another. It is the force that allows the body to walk forward. The
planted foot grips the ground due to friction and can push downward and backward, which
causes the ground to push forward (equal and opposite, Newton’s third law) on the foot. This
equal and opposite force in this case is known as the GRF.
Friction can be
• static,
• sliding, or
• rolling.
Static friction is the friction of an object that does not move. The forces against the object
are equal to the forces being placed on it. Sliding friction is the friction between two surfaces
where one or both are moving against one another. It is sometimes referred to as kinetic
friction. Finally, rolling friction is the force that resists a surface rolling across another such
as a ball bearing or a wheel on a road surface.
Figure 5.14 Types of Friction

Depending on the movement, friction may or may not be desired. When walking or running on
a solid surface, the participant relies on the friction between the feet and the ground to exert
force against each other and propel the body forward. Loose gravel will lower friction and
cause the exerciser to lose their footing. However, a figure skater would prefer less friction
because it keeps their skates moving smoothly across the ice.
PRINCIPLES OF BIOMECHANICS
There are seven principles of biomechanics—grouped into four distinct categories—explained
by the laws of motion and kinetics. In physics and as it relates to physical exercise, kinetics KINETICS:
The study of forces acting
is the study of the forces that act on (energy that pushes or pulls) a mechanism. The
on a mechanism.
categories of biomechanics include the following:
1. Stability
2. Maximum effort (maximum amount of force or velocity)
3. Linear motion
4. Angular motion
Table 5.3 Principles of Biomechanics: Overview
CATEGORY PRINCIPLE(S) DESCRIPTION EXAMPLE
The ability to maintain control Maintaining the positioning

Stability Stability (i.e., resist change) of a joint or of the trunk, hips, and legs
position. during a push-up.
The maximum amount of force Performing a one-rep

Maximum Production of
produced by a muscle or group of maximum (1RM) for a
effort maximum force
muscles. barbell bench press.
Production The maximum movement velocity, Vertical jump.

of maximum or muscular contraction speed, for
velocity a muscle or group of muscles. Throwing a baseball.

Table 5.3 Principles of Biomechanics: Overview (CONT)
CATEGORY PRINCIPLE(S) DESCRIPTION EXAMPLE
A larger arc of a golf swing

Linear The greater the applied force on
Force-velocity will produce greater force
the same object, the greater the
relationship and therefore move the golf
velocity.
ball farther.
The body moves forward

Direction of Movement occurs in the direction
as the stroke applies force
movement opposite the applied force.
backward while swimming.
In a barbell squat, the bar

goes up when an exerciser
applies force against it
The force exerted by the ground to because the ground won’t
a body in contact with it. Because move. In a bench press,
Ground the ground does not move when the bar goes in the same
Reaction Forces applying force against a movable direction of the force the
(GRFs) object, the object will move in exerciser applies because
the same direction of the force the bench is solidly held by
applied by the person. the ground. The exerciser
is applying force down onto
the bench rather than into
the bar.
The motion of an object around A figure skater spinning.

Angular a fixed point or axis. All lever
motion Angular motion actions are angular, and therefore Elbow motion in a biceps
most joint movements are curl because the ulna spins
angular. on the humerus.
A figure skater during a

triple-axel jump. In the
air, there is very little
Conservation
Angular momentum is constant acting against the skater’s
of angular
until an external force acts on it. rotation. When gravity pulls
momentum
the skater back down, the
friction of the blade on the
ice will stop the spin.

ANGLE OF MUSCLE PULL
When doing strength exercises, the strength at the various points throughout a ROM will vary
based on the angle the muscle is pulling. For example, when executing a biceps curl, it is
more difficult to begin the curl with the elbow fully extended than if the elbow is in slight
flexion. When the muscle contracts, much of the force is exerted on the joint to stabilize the
elbow rather than the forearm to lift the weight. Most of the force moves to the biceps muscle
MECHANICAL
ADVANTAGE:
only as the elbow approaches a 90-degree angle. This advantage near the right angle is
The ratio of force that
known as a mechanical advantage, and it means the body is stronger at the established creates meaningful
movement compared to the
angle. Positions of least mechanical advantage are often called “sticking points.” force applied to generate
the movement.
90 degree elbow flexion

Full elbow extension
Figure 5.15 Angle of Biceps Pull in Elbow Flexion
WORK
Moving the body and exercising are examples of measurable work. Work is the energy
WORK:
transferred when force is applied to an object and is represented by the following formula: Force times distance
measured in foot-pounds.
W=FxD
where W is work, F is force, and D is distance or displacement. The greater the force and the
farther the distance moved, the greater the work being done.

POWER
POWER:
The combination of strength Power is defined as the amount of work done in a unit of time. The key is the amount of time
and speed—the ability
for a muscle to generate needed for execution. Power refers to the rate at which work can be done. Walking up a flight
maximal tension as quickly of stairs requires work and walking up a flight of stairs faster requires more power. It’s a
as possible.
measurable quantity. Work and power differ in the amount and rate of energy used. For
example, if a lifter executing a squat with a 300-pound loaded barbell has to move a distance
of 3 feet from the bottom position to the top position, the work done is calculated as follows:
W = 300 pounds x 3 feet
W = 900 feet/pound
This calculation assumes that bodyweight and external factors are omitted. To calculate
the amount of power, the time taken to execute the movement must be considered as well.
Assume it took 3 seconds to move the barbell.
900 feet/pound divided by 3 seconds = 300 feet/pound of work per second.
However, if it only took 2 seconds to move the load, the result is quite different.
900 feet/pound divided by 2 seconds = 450 feet/pound of work per second
The shorter-duration lift was done with more power (450 feet/pound vs. 300 feet/pound).
MECHANICAL WORK: This simply shows that the faster mechanical work is done by the body, the greater the
Is the amount of energy
power, and the slower mechanical work is done, the lesser the power.
transferred by a force,
the product of force and
distance.
LEVERS
Levers are the most common mechanical machines within the human body. They cannot be
LEVERS:
A rigid or semirigid bar altered, but the body can use them to be more efficient. A lever consists of a rigid bar and an
rotating around a fixed point
when force is applied to
axis or point of rotation the lever moves around. Levers rotate around an axis (or fulcrum) as
one end. a result of force (also referred to as load or effort) applied to move weight or applied against
resistance.
FULCRUM:
The point on which a lever Within the body, the bones are the levers, the joints are the axis (fulcrum), and the muscles
rests or is supported and
on which it pivots. contract to apply force. There are three classes of levers within the human body, and the
location of the fulcrum, resistance, and effort (force) differentiate the first-, second-, and
third-class levers.

The location of the applied force and effort will vary based on the type of lever being used.
However, the arms of the lever remain consistent. The effort arm is the length of the lever
EFFORT ARM:
The portion of the lever arm
arm between the applied effort and the axis while the resistance arm is the lever length between the applied effort
and the axis.
between the load and the axis. The moment arm represents the perpendicular distance
between the axis or joint in the body and the line of the force being applied.
LEVER ARM:
The rigid bar portion of a
lever that rotates around
Load Effort the fulcrum.
Effort Arm
Mu
sc
le
Resistance Arm Fulcrum rm
tA
Fo
en
rc
om
e
M
Effort: Lever Arm
Biceps contract and
pull forearm upwards
Joint
Center
Load:
Forearm and hand
Fulcrum:
Elbow joint flexes
are lifted RESISTANCE ARM:
as biceps contract The portion of the lever arm
between the load and the
axis.
Figure 5.16 The Lever Arms

MOMENT ARM:
The perpendicular distance
FIRST-CLASS LEVER between the fulcrum and
the line of the force being
For a first-class lever, the fulcrum (axis) is located between the effort and the load (resistance). applied.
This type of lever creates balanced movements when the fulcrum is centrally located between
the effort and load—as seen with a seesaw. The fulcrum, however, can be offset to one side
or the other as with the triceps in elbow extension or the action of the point on which a lever
rests or is supported and on which it pivots.
In the human body, an example of a first-class lever is the extension and flexion of the neck,
with the fulcrum at the base of the skull.
SECOND-CLASS LEVER
For a second-class lever, the load (resistance) is located between the fulcrum (axis) and
the effort. Force movements are easily created by second-class levers because the load
can be moved with relatively small effort with the fulcrum at the extreme end of the lever. A
wheelbarrow and a nutcracker are examples of second-class levers.
In the human body, an example of a second-class lever is the plantar flexion of the foot used

to raise up to the toes, with the ball of the foot acting as the fulcrum. Few instances of this
type of lever can be found in the body.
THIRD-CLASS LEVER
For a third-class lever, the effort is between the fulcrum (axis) and the load (resistance).
These levers are adept at producing speed and ROM and are the most common type of lever
in the body. Like shoveling dirt or paddling a boat, this lever requires a decent amount of
effort (force) to move a small load.
Most levers in the human body are of the third class. An example of a third-class lever is the
elbow flexion driven by the biceps brachii, with the elbow joint acting as the fulcrum.
Figure 5.17 Classifications of Levers

TORQUE
TORQUE:
Torque is force applied rotationally. Because most joint movements happen through the use The turning effect of
an eccentric force. The
of levers that apply force rotationally, most joint movements are a result of torque rather than
rotational analog of force.
linear force. Just as a linear force is a push or a pull, a torque can be thought of as a twist to
an object around a specific axis. The rotary motion thus describes the movement around a
ROTARY MOTION:
fixed axis moving in a curved path. The movement around
a fixed axis moving in a
curved path.
Torque is determined by multiplying the force (effort) by the length of the force arm, which is
the distance between the fulcrum and the force or load. This is sometimes called a lever arm.
It is crucial to understand, however, that the torque can be increased by lengthening the force
FORCE ARM:
The distance between the
arm and increasing the leverage to move the load. fulcrum and the force or
load application in a lever.
Figure 5.18 Torque and the Length of the Force Arm
Levers and torque are important to understand because some human movement requires
levers in multiple places working simultaneously, such as when throwing a tennis ball. Most
of the joints and levers in the body will be used as an individual steps, rotates, and swings
their arm to throw the ball. The combination of these joints is a factor of the principle of
maximum velocity—the more joints involved, the more force that can be produced.
Torque affects human movement because the length of the lever determines velocity. For
example, a tennis player can strike a tennis ball harder and with more velocity with a straight
arm than with a bent elbow because the lever (their arm and the racket together) is longer
and can move faster. This is also evident in sports such as baseball, hockey, and golf, where
lengthy implements are used. The increase in speed occurs at the end of the lever where
force is applied to the load. The speed of movement at the fulcrum does not have to increase
for the velocity to increase at the end of the lever when the lever arm is lengthened.

MUSCLES AS MOVERS
ORIGIN:
The proximal muscular Muscles create movement by generating force and transferring that force to the attached
attachment point to a bone.
bones via the connective tissue (tendons). The origin of a muscle is where it attaches to a
bone, closest to the midline of the body (proximal). The insertion point is the opposite end
INSERTION: of the muscle, the distal end (farther from the midline). Some muscles, like the biceps brachii
The distal muscular
attachment point to a bone. have multiple bundles of muscles referred to as the different heads of the muscle. They have
separate origins but share the same insertion.
INSERTIONS AND ORIGINS

Anterior Anterior
Origin
Origin
Insertion
Insertion
PECTORALIS MAJOR DELTOID
Posterior Posterior
Insertion
Origin
Insertion
Anterior
Origin
TRAPEZIUS LATISSIMUS DORSI
Figure 5.19 Upper Body

Posterior Posterior
Origin
Insertion Origin
Insertion
SUPRASPINATUS INFRASPINATUS
Posterior Anterior
Insertion
Insertion
Origin
Origin
TERES MINOR SUBSCAPULARIS
Figure 5.20 Rotator Cuff

Posterior Posterior
Origin
Insertion Origin
Insertion
TRICEPS BRACHII ANCONEUS
Anterior Anterior Lateral
Origin
Origin
Origin
Insertion Insertion
Insertion
BICEPS BRACHII BRACHIALIS BRACHIORADIALIS
Figure 5.21 Upper Arm

Anterior Anterior
Origin
Origin
Insertion
Insertion
VASTUS LATERALIS VASTUS INTERMEDIUS
Anterior Anterior
Origin Origin
Insertion
Insertion
VASTUS MEDIALIS RECTUS FEMORIS
Figure 5.22 Quadriceps Group

Posterior Posterior Posterior
Origin
Origin
Origin
Insertion
Insertion
Insertion
BICEPS FEMORIS SEMITENDINOSUS SEMIMEMBRANOSUS
Posterior Posterior Anterior
Origin Origin
AGONIST:
The primary muscle Origin
used for a mechanical
movement.
Insertion
SYNERGISTS: Insertion
Insertion
Muscle(s) supporting the
mechanical movement of a
prime mover.
GASTROCNEMIUS SOLEUS TIBIALIS ANTERIOR

ANTAGONIST:
Figure 5.23 Hamstring Group and Lower Leg
Muscle(s) opposing the
mechanical movement of a
prime mover.
The muscles of the human body are often arranged in groups or pairs based on their actions
and the joints on which they exert force. An agonist, or prime mover, is the primary muscle
SHERRINGTON’S
LAW OF RECIPROCAL involved in a joint movement while synergists are secondary muscles supporting the action
INHIBITION: of the prime mover.

A law that states that for
every muscle activation, An antagonist muscle opposes the action of a prime mover for a given movement. Muscle
there is a corresponding
inhibition of the opposing antagonism is explained through Sherrington’s law of reciprocal inhibition, stating that for
muscle.
every neural muscle activation, there is a corresponding inhibition of the opposing muscle. A
single muscle may become a prime mover, a synergist, or an antagonist depending on the

direction and angle of a movement pattern. Stabilizer muscles work to stabilize joints and
support joint movement, but they themselves do not contribute greatly to the joint motion. A
STABILIZER MUSCLES:
The muscles playing
personal trainer must understand these relationships for assessments and program design the role of stabilizing or
minimizing joint movement.
for optimal muscle targeting regardless of the training type.
An example of a group of muscles working together in this fashion is a dumbbell curl. The
biceps brachii is the agonist, the brachioradialis is a synergist and the triceps are the
antagonist.
Figure 5.24 The Agonist and Antagonist for a Biceps Curl
Table 5.4 Example: Agonist, Synergist, and Antagonist Muscles
CLASSIFICATION EXERCISE EXAMPLE
Agonist Biceps Curl Biceps
Synergist Biceps Curl Brachioradialis
Antagonist Biceps Curl Triceps
Knowledge of muscle location and their relationship to joints is an important part of
understanding the movement muscles create. The muscular and skeletal systems work
together and use neural input to create movement around a joint. When a muscle contracts,
typically one attachment point will move toward the other. And although the muscle always

contracts from both ends toward the center, muscle contraction brings those two points
(origin and insertion) closer together, thus creating a movement. A basic understanding of
muscle origins and insertions is critical in understanding why individual muscles pull bones
in specific directions and how muscles help to create the major joint actions.
There are a few additional components of human physiology that affect muscles and
LENGTH-TENSION movement. First, the length-tension relationship is the force a muscle can produce at specific
RELATIONSHIP: muscle lengths. As an individual moves a joint, the overlap of the contractile proteins (actin
The amount of tension a
muscle can produce with and myosin) changes, and this affects the potential for the development of cross-bridges and
respect to its length.
therefore muscle-force production. Muscles have an optimal length that they can produce
force from.
FORCE-COUPLE
RELATIONSHIP: Second, the force-couple relationship describes a situation where two or more muscles
Two or more muscles acting acting in different directions influence the rotation of a joint in a specific direction. The biceps
in different directions that
influence the rotation of a and triceps provide a simple example of this, just as a force couple at the knee would be the
joint in a specific direction.
quadriceps and the hamstrings. Lastly, there are also muscle synergies that occur when a
pair of muscle forces act together on a joint to produce movement. An example of this is the
MUSCLE SYNERGIES:
The activation of a group synergy between the internal and external obliques. They work together to create movements
of muscles to generate
movement around a like trunk rotation and lateral flexion.
particular joint.
For certified personal trainers, understanding the forces and physiology affecting human
movement makes it easier to create safe and effective training programs. Continued education
on the concepts of biomechanics can also help trainers put together more personalized plans
for their clients.
Correct anatomical knowledge of muscle connection function is invaluable in helping
certified personal trainers make safe and effective programming decisions. The following
INNERVATION: figures and tables will assist in the understanding of muscle origin and insertion, and
The distribution or supply of therefore muscle action, the specific movements that each muscle is responsible for, and
nerves.
innervation, the nerves that control the muscles.

MUSCLES OF THE UPPER ARM
Anterior
Humerus
Posterior
Biceps brachii
Long head
Short head
Triceps brachii
Lateral head
Long head
Medial head
Brachialis
Triceps brachii
Long head
Lateral head
Medial head
Figure 5.25 Upper Arm

1. Humerus (bone)
2. Biceps brachii (long head)
3. Biceps brachii (short head)
4. Triceps brachii (lateral head)
5. Triceps brachii (long head)
6. Triceps brachii (medial head)
7. Brachialis

MUSCLES OF THE FOREARM
Anterior Posterior
Superficial Superficial
Brachioradialis
Brachioradlialis
Extensor carpi radialis
Pronator teres longus
Anterior
Deep Extensor carpi radialis
Flexor carpl radialis
brevis
Palmaris longus
Flexor carpi ulnaris
Flexor carpi ulnaris
Extensor
digitorum
Supinator
Flexor
pollicis longus
Flexor
digitorum profundus
Pronator quadratus
Figure 5.26 Forearm
1. Brachioradialis 7. Flexor pollicis longus
2. Pronator teres 8. Flexor digitorum profundus
3. Flexor carpi radialis 9. Pronator quadratus
4. Palmaris longus 10. Extensor carpi radialis longus
5. Flexor carpi ulnaris 11. Extensor carpi radialis brevis
6. Supinator 12. Extensor digitorum

Table 5.5 Elbow and Radioulnar Joint
Elbow and Radioulnar Joint
MUSCLE ORIGIN INSERTION ACTION INNERVATION
Long head:
supraglenoid Flexion
tubercle above of elbow,
the superior lip of Tuberosity
supination of
glenoid fossa of radius Musculocutaneous nerve
Biceps brachii forearm
and bicipital (C5, C6)
Short head: Weak flexion
aponeurosis
coracoid process of shoulder
scapula and upper joint
lip of glenoid fossa
Distal half of
Coronoid process Flexion of Musculocutaneous
Brachialis anterior portion of
of the ulna elbow nerve (C5, C6)
humerus
Flexion
of elbow,
pronation
from
Lateral surface, supinated
Distal two-thirds of
distal end of the to neutral
Brachioradialis lateral condyloid Radial nerve (C5, C6)
radius at styloid position,
ridge of humerus
process supination
from
pronation
to neutral
position
Long head:
Long head:
adduction of
infraglenoid tubercle
the shoulder
below inferior lip
joint,
of glenoid fossa of
extension of
scapula
elbow
Olecranon
Triceps brachii Lateral head: upper process of the Radial nerve (C7, C8)
half of posterior ulna All heads
surface of humerus are involved
Medial head: in the
distal two-thirds of extension of
posterior surface of the elbow
humerus
Posterior surface
Posterior surface of
of the olecranon Extension of
Anconeus lateral condyle of Radial nerve (C7, C8)
process of the the elbow
the humerus
ulna

MUSCLES OF THE SHOULDER

Shoulder
Anterior Posterior
Clavicle
Spine of scapula
Supraspinatus
Humerus
Biceps brachii Subscapularis Humerus

Long head
Short head Infraspinatus
Teres minor
Deltoid
Anterior Posterior
Clavicle
Posterior deltoid Anterior deltoid
Lateral deltoid Lateral deltoid
Anterior deltoid Posterior deltoid
Humerus Humerus
Figure 5.27 Shoulder and Deltoid
1. Humerus (bone)
2. Clavicle (bone)
3. Anterior deltoid
4. Lateral deltoid
5. Posterior deltoid
6. Supraspinatus
7. Infraspinatus
8. Subscapularis
9. Teres minor

Table 5.6 Shoulder Joint
SHOULDER JOINT
Anterior:
abduction,
Anterior:
Anterior: deltoid flexion, horizontal
anterior Anterior: axillary
tuberosity on adduction, and
lateral third of nerve (C5, C6)
lateral humerus internal rotation
clavicle
of glenohumeral
joint
Middle:
Middle: lateral Middle: deltoid
abduction of the Middle: axillary
aspects of tuberosity on
Deltoid glenohumeral nerve (C5, C6)
acromion lateral humerus
joint
Posterior:
abduction,
Posterior: Posterior: extension,
inferior edge deltoid horizontal Posterior: axillary
of spine tuberosity on abduction, and nerve (C5, C6)
scapula lateral humerus external rotation
of glenohumeral
joint
Flexion,
adduction,
Coracoid Medial border
and horizontal Musculocutaneous
Coracobrachialis process of of middle
adduction of (C5–C7)
scapula humeral shaft
glenohumeral
joint
Medial two- Weak abduction

Superiorly on
thirds of and stabilization Suprascapular
Supraspinatus greater tubercle
supraspinatus of humeral head nerve (C5)
of humerus
fossa in glenoid fossa

SHOULDER JOINT
External rotation,
Medial horizontal
aspect of abduction, and
Posteriorly on
infraspinatus extension of the Suprascapular
Infraspinatus greater tubercle
fossa just glenohumeral nerve (C5, C6)
of humerus
below spine of joint; stabilization
scapula of humeral head
in glenoid fossa
External rotation,
horizontal
Posteriorly on
abduction, and
middle, upper Posteriorly on
extension of Axillary nerve (C5,
Teres minor aspect of greater tubercle
glenohumeral C6)
lateral border of humerus
joint; stabilization
of scapula
of humeral head
in glenoid fossa
Internal rotation,
adduction, and
Entire anterior
extension of Upper and lower
surface of Lesser tubercle
Subscapularis glenohumeral subscapular nerve
subscapular of humerus
joint; stabilization (C5, C6)
fossa
of humeral head
in glenoid fossa
Posteriorly on
inferior third of Extension,
Medial lip of
lateral border internal rotation,
intertubercular Lower subscapular
Teres major of scapula and adduction
groove of the nerve (C5, C6)
and slightly of glenohumeral
humerus
superior to joint
inferior angle

MUSCLES OF THE BACK
Superficial Deep
Semispinalis capitis
Rhombold minor
Semispinalis cervicis
(underlying)
Rhombold major
Trapezius
Multifidus
Erector Spinae
Spinalis
Longissimus
Latissimus
dorsi
Quadratus
lumborum
External Iliocostalis
Obliques
Figure 5.28 Back
1. Trapezius 7. Rhomboid minor
2. Latissimus dorsi 8. Rhomboid major
3. External obliques 9. Multifidus
4. Semispinalis capitis 10. Spinalis (erector spinae group)
5. Semispinalis cervicis 11. Longissimus (erector spinae group)
6. Quadratus lumborum 12. Iliocostalis (erector spinae group)

Table 5.7 Back
BACK
Posterior crest Adduction,
of ilium, back extension, and
of sacrum, and Medial side of internal rotation of

Latissimus glenohumeral joint; Thoracodorsal
spinous process of intertubercular
dorsi nerve (C6–C8)
lumbar and lower groove of humerus
horizontal abduction
T6–T12, slips from
of glenohumeral
lower three ribs
joint
(Retraction) draw
Medial border of scapula toward
Spinous process of Dorsal scapula
Rhomboid scapula below spinal column
C7 and T1–T5 nerve (C5)
spine (downward rotation;
elevation)
Upper: base of Upper: accessory
Upper: scapula
skull, occipital Upper: posterior nerve (cranial
elevation and
protuberance, and aspect of the nerve XI and
extension of the
posterior ligaments lateral clavicle branches of C3,
head at neck
of neck C4)
Middle: medial Middle: accessory
Middle: elevation,
Middle: spinous border of the nerve (cranial
upward rotation,
Trapezius process of 7C and acromion process nerve XI and
and adduction of
T1–T3 and upper border branches of C3,
scapula
of acromion C4)
Lower: accessory
Lower: depression
Lower: base of nerve (cranial
Lower: spinous adduction and
scapular spine nerve XI and
process of T4–T12 upward rotation of
(triangular shape) branches of C3,
the scapula
C4)
Dorsal scapular
Above base of
Levator Transverse process Elevates medial nerve C5 and
scapular spine on
scapulae of C1–C4 margin of scapulae branches of C3
medial border
and C4

MUSCLES OF THE MIDSECTION
Pectoralls major
Quadratus
lumborum
Serratus anterior Linea alba
Psoas
Linea semilunaris
External oblique
Rectus sheath
Internal oblique
Rectus Abdominis
Erector Spinae
Transverse abdominis
(above: underlying)
Figure 5.29 Midsection
1. Pectoralis major 7. Linea alba
2. Serratus anterior 8. Linea semilunaris
3. External oblique 9. Rectus sheath
4. Internal oblique 10. Quadratus lumborum
5. Rectus abdominis 11. Psoas
6. Transverse abdominis 12. Erector spinae

Table 5.8 Trunk and Spinal Column
Trunk and Spinal Column

Inferior surfaces of
Superior
costal cartilages Depresses ribs and
Rectus surface of Thoracic spinal
(ribs 5–7) and flexes vertebral
abdominis pubis around nerves (T7–T12)
xiphoid process of column
symphysis
sternum
Cartilages of
the lower ribs, Intercostal
Transversus Compresses
iliac crest, and Linea alba and pubis iliohypogastric and
abdominis abdomen
lumbodorsal ilioinguinal nerves
fascia
Compresses
External and Intercostal
External Linea alba and iliac abdomen; depresses
inferior borders iliohypogastric and
oblique crest ribs; flexes, bends to
of ribs 5–12 ilioinguinal nerves
side; or rotates spine
Inferior surfaces of Compresses

Lumbodorsal Intercostal
Internal ribs 9–12, costal abdomen; depresses
fascia and iliac iliohypogastric and
oblique cartilages 8–10, ribs; flexes, bends to
crest ilioinguinal nerves
linea alba, and pubis side; or rotates spine
(Protraction) draws
Anterior aspect
Surface of medial border of
Serratus along entire length Long thoracic
upper nine ribs scapulae away from
anterior of medial border of nerve (C5–C7)
at side of chest vertebrae (upward
scapula
rotation)

MUSCLES OF THE CHEST
Pectoralis major
Subclavius
(underlying to clavicle)
Pectoralis minor
Figure 5.30 Chest
1. Pectoralis major
2. Subclavius
3. Pectoralis minor

Table 5.9 Chest
CHEST
Clavicular: internal
Clavicular: flat rotation, horizontal
Clavicular:
tendon 2 or 3 adduction, flexion
medial half Clavicular:
inches wide abduction, and
of anterior lateral pectoral
to the adduction (when the
surface of nerve (C5–C7)
outer lip of arm is 90˚
clavicle
intertubercular of abduction of the
glenohumeral joint)
Pectoralis
major Sternal:
anterior
Sternal: internal
surfaces
rotation, horizontal
of costal Sternal: medial
Sternal: groove adduction,
cartilage of pectoral nerve
of humerus extension, and
first six ribs (C8, T1)
adduction of the
and adjacent
glenohumeral joint
portion of
sternum
(Protraction) draws
Anterior Coracoid
Pectoralis scapula forward Medial pectoral
surfaces of process of
minor (downward rotation; nerve (C8, T1)
ribs 3–5 scapula
depression)
Underside of
Depresses the
Sternal end the middle Subclavian nerve
Subclavius clavicle and elevates
of first rib third of the (C5, C6)
first rib
clavicle

MUSCLES OF THE UPPER LEG AND HIPS
Psoas
Anterior Posterior
Iliacus
Gluteus medius
Gluteus minimus
deep to (under)
gluteus medius
Tensor
Fasciae latae
Gluteus maximus
Sartorius
Adductor
longus Gracillis
Gracilis
Vastus
Rectus femoris lateralis
Vastus lateralis Biceps femoris
Vastus medialis Semitendinosus

Semimembranosus
Figure 5.31 Upper Leg
1. Psoas 9. Rectus femoris
2. Iliacus 10. Vastus lateralis
3. Gluteus medius 11. Vastus medialis
4. Gluteus minimus 12. Gluteus maximus
5. Tensor fasciae latae 13. Biceps femoris
6. Sartorius 14. Semitendinosus
7. Adductor longus 15. Semimembranosus
8. Gracilis

Table 5.10 Hip and Pelvis
Hip Joint and Pelvic Girdle
Anterior iliac Superior aspect

spine of the of patella Flexion of hip,
Femoral nerve
Rectus femoris ilium and groove and patellar extension of
(L2–L4)
(posterior) above tendon to tibial knee
the acetabulum tuberosity
Posterior quarter
of the crest of Oblique ridge on Extension of hip
ilium, posterior lateral surface and external
Inferior gluteal
surface of of greater rotation of hip,
Gluteus maximus nerve (L5, S1–
sacrum and trochanter and lower fibers
S2)
coccyx near the iliotibial band of that assist in
ilium, and fascia fasciae adduction
of lumbar area
Extension of hip,
Upper anterior flexion of knee, Sciatic nerve-
Semitendinosus Ischial tuberosity medial surface and internal tibial division
of tibia rotation of hip (L5, S1–S2)
and knee
Extension of hip,
Posteromedial
flexion of knee, Sciatic nerve-
surface of
Semimembranosus Ischial tuberosity and internal tibial division
medial tibial
rotation of hip (L5, S1–S2)
condyle
and knee
Long head:
Long head: sciatic nerve-
ischial tuberosity tibial division
Extension of hip,
(S1–S3)
Lateral condyle flexion of knee,
Biceps femoris of tibia and head and internal
Short head:
of fibula rotation of hip Short head:
lower half of
and knee sciatic nerve-
linea aspera and
peroneal division
lateral condyloid
(L5, S1–S2)
ridge

Table 5.11 Knee Joint
Knee Joint
Intertrochanteric
line, anterior and
inferior borders of
greater trochanter Lateral border
gluteal tuberosity, of patella and Femoral nerve
Vastus lateralis Knee extension
upper half of the patellar tendon to (L2–L4)
linea aspera, tibial tuberosity
and entire lateral
intermuscular
septum
Upper border
Upper two-thirds
Vastus of patella and Femoral nerve
of anterior surface Knee extension
intermedius patellar tendon to (L2–L4)
of the femur
tibial tuberosity
Medial half of
Entire length
upper border
of linea aspera Femoral nerve
Vastus medialis of patella and Knee extension
and the medial (L2–L4)
patellar tendon to
condyloid ridge
tibial tuberosity

MUSCLES OF THE LOWER LEG
Anterior Posterior Deep
Anterior Soleus
Gastrocnemius Extensor
hallucis
longus Lateral
Tibialis
anterior
Soleus
(underlying) Posterior Lateral
Peroneus longus
Extensor
digitorum Tibialis
longus posterior
Peronieus
brevis
Figure 5.32 Lower Leg
1. Tibialis anterior 5. Gastrocnemius
2. Peroneus longus 6. Soleus
3. Extensor digitorum longus 7. Peroneus brevis
4. Extensor hallucis longus 8. Tibialis posterior

Table 5.12 Foot and Ankle
Ankle and Foot

Medial head:
posterior
surface of
the medial
Plantar
femoral Posterior
flexion
condyle surface of the
of the Tibial nerves
Gastrocnemius calcaneus
ankle and (S1, S2)
Lateral head: (Achilles
flexion of
posterior tendon)
the knee
surface of
the lateral
femoral
condyle
Posterior
surface of
Posterior
the proximal
surface of the Plantar
fibula and Tibial nerves
Soleus calcaneus flexion of
proximal (S1, S2)
(Achilles the ankle
two-thirds of
tendon)
the posterior
tibial surface
Inner surface
Dorsal
Upper two- of medial
flexion of Deep peroneal
thirds of the cuneiform
Tibialis anterior ankle and nerve (L4–L5,
lateral surface and the first
inversion S1)
of tibia metatarsal
of foot
bone

ENERGY AND
CHAPTER 06
METABOLISM
LEARNING OBJECTIVES
1 | Identify the organelles of the human cell.
2 | Define and explain the three primary energy systems in the human body.
3 | Describe how the energy systems overlap.
4 | Define metabolism and energy balance and the factors that affect each.

CHAPTER 06 | Energy and Metabolism
The human body requires a constant supply of energy to move and function properly. Energy
MACRONUTRIENTS: comes from the sun and is transferred to humans and animals through the ingestion and
A type of food necessary in
large quantities in the diet to digestion of macronutrients as plant and animal foods. Once consumed, the body goes
support function and energy
production, i.e. carbohydrate, through a series of intricate processes to break down the food and turn it into usable energy
protein, and fat.
- this is know as metabolism. The study of this (how energy is transformed in living organisms)
is called bioenergetics.
METABOLISM:
Chemical processes within
the body that convert food
into energy.
CELLS
Cells perform all functions of life. They carry out specialized functions, convert nutrients into
energy, and create structure for the body. There are many types of cells with different locations
BIOENERGETICS:
The study of how energy is and functions within the body, but they all have the same basic components a fitness
transformed in living organisms.
professional must generally understand to better grasp energy and metabolism. Cells consist
of a membrane that encompasses multiple organelles and genetic material. Organelles are
CELLS:
The building blocks of all tiny structures within the cell, each with a unique function.
living organisms.
PLASMA MEMBRANE
ORGANELLES: The plasma membrane surrounds all organelles and the cytoplasm of a cell. The membrane
Tiny structures within cells,
each with a unique function. has two layers made up of lipids (fats) and proteins. Referred to as the phospholipid bilayer,
it is made up of glycerol, two fatty acids, and a phosphate group. Proteins on or within the
PLASMA MEMBRANE: phospholipid bilayer assist in cellular reactions and the transport of macronutrients into and
The cellular membrane made
out of the cell.
of lipids and proteins that forms
the external boundary of the
cytoplasm and regulates the
passage of molecules in and
out of the cytoplasm.
CYTOPLASM:
The viscous fluid inside a living
cell excluding the nucleus.
PHOSPHOLIPID
BILAYER:
The dual layer of lipids that
make up the cell membrane
of most human cells.
FATTY ACIDS:
The smaller, absorbable
building blocks of the fat that Figure 6.1 The Cell Membrane
is found in the body.

The membrane is semipermeable—meaning some molecules can pass through it. Some
require a transport protein while others do not. The presence of cholesterols within the
DEOXYRIBONUCLEIC
ACID (DNA):
membrane allow cells to maintain their fluidity and structure at varying temperatures. Self-replicating genetic
material in human cells.
NUCLEUS
The nucleus has its own membrane and holds deoxyribonucleic acid (DNA). DNA forms GLUCONEOGENESIS:
The generation of new
strands called chromosomes, which contain the genetic blueprints for each unique cell in the glucose molecules from
non-carbohydrate carbon
human body. Eye color, height, skin tone, and hair texture are some of the many features
substrates.
influenced by the strands of DNA carried in the nucleus.
Cytoplasm or cytosol is the viscous fluid inside the plasma membrane excluding the nucleus. GLYCOLYSIS:
The breakdown of glucose by
The cytoplasm is the site of many cellular reactions such as the following: enzymes, releasing energy
and pyruvic acid.
• Gluconeogenesis (the creation of glucose from non-carbohydrate substrates)
• Fatty acid synthesis MITOSIS:

Cell division that results in two
• The activation of amino acids cells identical to the original cell.
• Glycolysis (the breakdown of glucose)
The nucleus of the cell also initiates cell division, known as (mitosis). In this process, the cell RIBOSOMES:
Small cellular organelles
divides itself to produce two cells from one. involved in polypeptide and
protein synthesis.
RIBOSOMES
Ribosomes are small, spherical organelles made of protein and ribonucleic acid (RNA). They can ENDOPLASMIC
be free-floating in the cytoplasm or attached to another organelle—the endoplasmic reticulum
RETICULUM (ER):
A network of tubules attached
(ER). Proteins made by free-floating ribosomes are intended to act inside the cell. Proteins made to the nuclear membrane in cells.
from attached ribosomes are intended to be transported outside of the cell to act.
ROUGH ENDOPLASMIC
ENDOPLASMIC RETICULUM (ER) RETICULUM:
Endoplasmic reticulum with
The ER is an organelle that forms a network of canals within the cytoplasm and is continuous ribosomes attached.
with the nuclear membrane. An ER with ribosomes attached is a rough endoplasmic
reticulum. A smooth endoplasmic reticulum (SER) has no ribosomes attached. The SER’s SMOOTH ENDOPLASMIC
primary role in the cell is to produce lipids and, in some cases, metabolize them and RETICULUM (SER):
Endoplasmic reticulum that
associated products. The SER in liver cells, for example, enables glycogen to be broken down lacks ribosomes.
into glucose. An SER is also involved in the production of steroid hormones in the adrenal
cortex and endocrine glands. In muscle cells, the SER releases calcium ions to trigger the GLYCOGEN:
contraction of muscle cells and is called the sarcoplasmic reticulum.
found in muscle tissue and
the liver.

GOLGI APPARATUS
Located near the nucleus and ER, the Golgi apparatus creates vesicles—or transport
GOLGI APPARATUS:
An organelle of folded bubbles—that move proteins from inside the cell to the cell membrane to be released to their
membranes responsible for
final destination in the body. Many of these proteins are called glycoproteins, and they have
packaging and transporting
membrane-bound proteins. attached carbohydrate groups. Glycoproteins play an important role in cellular communication
and interactions and the function of enzymes, hormones, antibodies, and cell structural
GLYCOPROTEINS: proteins.
A class of proteins with
a carbohydrate group(s)
attached. LYSOSOMES
These organelles serve as the digestive system of the cell. Lysosomes have about 50
LYSOSOMES: different enzymes that break down materials the cell has absorbed. They can also digest and
An organelle filled with
digestive enzymes that destroy elements within the cell that are no longer needed. The digested product in a
breaks down materials the
cell has absorbed. lysosome is either used to create cellular energy or can be used to create a new molecule.
MITOCHONDRIA: MITOCHONDRIA
An organelle with a double Mitochondria are known as the powerhouse of the cell. They are small, complex organelles
membrane and many folds
inside responsible for that contain their own DNA. During a process called oxidative phosphorylation, the mitochondria
generating the chemical
energy needed for convert macronutrients into chemical energy for the cell.
biochemical reactions.
In cardiac muscle cells, about 40 percent of the space in the cytoplasm is occupied by
OXIDATIVE mitochondria. In liver cells, about 20 to 25 percent of the space is taken up by mitochondria.
PHOSPHORYLATION: A higher mitochondrial density equals a higher energy output potential for a cell.
The energy-producing
process that occurs in
mitochondria in the presence
of oxygen.
Figure 6.2 Cell Components

FOOD AS ENERGY
The food (i.e., macronutrients) humans ingest must be broken down to be used at the
cellular level for energy production. The manual and chemical breakdown of food begins in
the digestive system.
There are three macronutrients required by the body: carbohydrate, protein, and fat. They are
called macronutrients because they are needed in large quantities daily to support the body’s
normal function and energy production. Carbohydrates (carbs) are one of the main sources of
energy for the body and are broken down into glucose or stored as glycogen in the liver and
muscles for future use. Whatever is not used or stored as glycogen gets converted to GLUCOSE:
A simple sugar the body
triglycerides and stored as fat. Glucose circulates in the blood to be used for energy around uses for energy production
on the cellular level.
the body. Glycogen is made up of many connected glucose molecules. When blood glucose is
low, the body breaks down glycogen into glucose to be released into the bloodstream.
When the body is at rest, it is estimated that approximately 70 percent of the body’s energy TRIGLYCERIDES:
The main component of
needs are met by fat sources, and approximately 30 percent of the energy need is met with
adipose tissue made of
carbohydrate sources. However, when energy production is sufficient for immediate demands, three fatty acids and a
glycerol molecule.
excess carbohydrates are stored in adipose tissue (body fat) as triglycerides. When dietary
fat is digested, it is broken down into fatty acids—the smaller building blocks of fats—for use
in energy production or triglycerides for storage in adipose tissue.
Protein is not a primary substrate for energy metabolism unless the body is in a state of
severe starvation or when the intake of the other macronutrients is insufficient to support
energy demands. Protein has too many important roles in the body, so carbohydrates and fats
are preferred sources of energy. Protein plays a significant role in the following:
• Growth and maintenance of tissue (anabolism)
• Protein enzymes aid in biochemical processes
• Protein hormones relay nervous system messages
• Build connective tissues such as tendons, ligaments, and cartilage
• Helps maintain blood pH via hemoglobin
• The proteins albumin and globulin support fluid balance RESPIRATORY

• Creation of antibodies to fight infection QUOTIENT (RQ):
A method of determining
• Transport and store nutrient the fuel mix being used;
a way to measure the
The body will use each macronutrient differently, and, depending on the activity level and relative amounts of fats,
carbohydrates, and proteins
energy demand, the mix of which macronutrient is providing most of the energy will vary. The
being burned for energy.
respiratory quotient (RQ) is a calculation that estimates which macronutrient is predominantly

being used for fuel at a point in time. RQ is the ratio of the volume of carbon dioxide expired
(breathed out) to the volume of oxygen being consumed (breathed in), which is known as
indirect calorimetry. The amounts of oxygen used for the metabolism of fat, carbohydrate,
INDIRECT
and protein differ. Therefore, differences in the RQ indicate which nutrient source is being
CALORIMETRY:
A way to measure energy predominantly used for energy purposes.
expenditure by oxygen
consumed and carbon
RQ = volume CO2 exhaled / volume of O2 inhaled
dioxide produced.
The RQ for carbohydrates is 1.0, whereas the RQ for fat is 0.7. Fat has a lower RQ value
because the fatty acids require more oxygen for the process of oxidation the chemical
reaction of combining with oxygen or removing hydrogen.
The RQ for energy production from protein is about 0.8, and the average person at rest will
have an RQ of about 0.8. However, the resting RQ is typically from a mixture of using fatty
acids and carbohydrates, not protein, for energy production. In a normal diet containing all
three macronutrients, about 40 to 45 percent of the energy is derived from fatty acids, 40
to 45 percent from carbohydrates, and 10 to 15 percent from protein. This rate of energy
production varies based on diet, physical activity, and the individual’s level of physical training.
ADENOSINE TRIPHOSPHATE (ATP)

Macronutrients are not directly used as energy, nor are the resulting substrates from
digestion. Rather, these substrates (glucose and fatty acids) are converted into adenosine
ADENOSINE triphosphate (ATP), the energy currency of the cells.
TRIPHOSPHATE (ATP):
An energy-carrying molecule
used to fuel body processes.
Figure 6.3 Adenosine Triphosphate (ATP)

ATP is a combination of adenine and three phosphate groups. The bonds between the
phosphate groups store energy that is released when that bond is broken. When energy is
needed in the cell, for muscle contraction for example, the bond of the end phosphate (P) is
broken, and energy, heat, and a hydrogen ion (H+) are released. Roughly 40 percent of the
energy from ATP is used for cellular work, and the rest is released as heat.
ATP ► ADP + P + energy + heat + H+
During physical exercise, ATP is used in muscle cells to generate muscle contraction. ATP
works with myosin in the sarcomere to contract and release the filaments. During contraction,
ATP is broken down by the enzyme ATPase. This causes the phosphate group to split from ATP
to generate energy and create adenosine diphosphate (ADP) and a free phosphate (P). The
ADP and P attach to the myosin head and bind to the actin filament. ADENOSINE
DIPHOSPHATE (ADP):
When movement occurs (when the sarcomere shortens), the ADP and phosphate (P) are released. An organic compound
essential to the flow of
Another molecule of ATP attaches to the myosin, causing the actin to detach and relax the muscle. energy in living cells.
Muscle contraction requires two molecules of ATP to complete the contract/relax sequence.
Figure 6.4 ATP and Muscle Contraction

For the cell to continue work, more ATP must be created. This is done in several ways
depending on the intensity and duration of activity. The body metabolizes the food we eat
through three distinct energy pathways—the ATP/creatine phosphate system (ATP/CP),

ENERGY PATHWAYS: anaerobic glycolysis, and the oxidative pathway. Each energy pathway is effective at producing
The chemical-reaction
pathways that supply the energy for various intensities and durations of activity.
body with energy on a
cellular level.
ENERGY SYSTEMS
ANAEROBIC AEROBIC
(WITHOUT OXYGEN) (WITH OXYGEN)
ATP/CP GLYCOLYSIS OXIDATIVE
Figure 6.5 Energy Systems
ANAEROBIC ENERGY PRODUCTION

The body stores a limited amount of ATP in the muscle cells, and this ATP is available for
immediate energy needs. Stored ATP can only supply energy for up to 10 seconds of work.
Examples of activities that use stored ATP include shot put, powerlifting, high jump, a golf
ANAEROBIC: swing, a tennis serve, and a pitch or throw.
Without or not requiring
oxygen.
After stored ATP is used, the cell creates energy using the immediate energy of the ATP/
creatine phosphate (ATP/CP) pathway. This energy pathway is anaerobic, meaning it does not
CREATINE PHOSPHATE
require the presence of oxygen.
(CP):
A high energy molecule
stored in skeletal muscle, the ATP/CREATINE PHOSPHATE (CP) ENERGY PATHWAY
myocardium, and the brain.
Creatine phosphate (CP), also known as phosphocreatine, is a compound stored in muscle
cells. After immediate energy stores of ATP are used, CP is broken down to create more ATP
ATP/CP ENERGY
PATHWAY: in what is known as the ATP/CP energy pathway. ATP becomes ADP when a phosphate bond
The anaerobic energy system is broken and the resulting energy is used for work. To create another molecule of ATP, one
that provides rapid energy
using creatine phosphate to phosphate group needs to be added back to a molecule of ADP. CP lends this phosphate
generate ATP.
group to the recycling of ADP back into ATP.

Creatine kinase is the enzyme that breaks CP into creatine and phosphate. Once broken
into individual molecules, the phosphate group attaches to ADP to create ATP. Like ATP, CP is
only found in small amounts in the muscle cells where it is stored. During maximum-intensity
activity, CP stores can be depleted in less than 10 seconds. For these short durations, the
ATP/CP energy system supports short, powerful activities such as a high jump, a 100-meter
sprint, or lifting a heavy load two to three times.
ANAEROBIC GLYCOLYSIS
For activities that last from 10 to 120 seconds (2 minutes) and when the immediate demand
for oxygen is greater than the supply, the body must tap into a second energy pathway.
ANAEROBIC
Anaerobic glycolysis uses one molecule of ATP to convert glucose to glucose phosphate.
GLYCOLYSIS:
Glycogen can also be used in this process. The anaerobic energy system
converting glucose to lactate
when oxygen is limited.
Anaerobic glycolysis produces a metabolic by-product called lactic acid and is sometimes
referred to as the lactic acid system. Lactic acid, also called lactate, is used in the body in
three ways:
LACTIC ACID:
The chemical by-product of
anaerobic glycolysis.
1. To make ATP
2. To make glucose in the liver
3. As a signaling molecule
Recent research on lactic acid shows that the body benefits from producing it. Researchers
have found that cells make lactate all the time, not just under maximal exertion and not
just anaerobically. Recent findings suggest that lactic acid is a major source of energy used
to repair and refuel the energy systems when those systems are taxed to the point that
metabolic by-products are generated (metabolic stress).
During intense activity, mitochondria in the cell prefer lactate for energy. Lactate also signals
the body to stop the metabolism of fat for energy and switch to the faster metabolism of
glucose and glycogen. As more lactic acid is produced, it is released into the blood for use by
the heart and brain, which both prefer it (over glucose or glycogen) for energy. However, when
excess lactic acid and hydrogen ions build up in the tissues as a by-product of metabolism,
they lead to muscular fatigue and muscular soreness. This buildup in the muscle cells causes
the burning sensation many people describe during intense activity.

The point at which the body switches from metabolism requiring oxygen to primarily anaerobic
ANAEROBIC metabolism is called the anaerobic threshold while the point where muscle tissue begins to
THRESHOLD: make large amounts of lactate (exponential increases) is referred to as the lactate threshold
The point at which the
body switches from aerobic and can lead to lactic acidosis. At this point, the body must stop or slow down until the lactic
metabolism to primarily
anaerobic metabolism. acid is cleared. Physical training increases the number of mitochondria in the cells, increasing
the efficiency of the cells to use lactate for energy production.

LACTATE THRESHOLD:
The maximum effort or
intensity an individual can
AEROBIC ENERGY PRODUCTION
maintain for an extended When cells exhaust the immediate ATP energy stores and glucose has been depleted, the
time with minimal effect on
blood lactate levels. This aerobic energy pathways will begin to dominate energy production. The aerobic energy
is the point where muscle
tissue begins to make large pathways are dominant in sustained activities lasting more than 120 seconds (2 minutes)
amounts of lactate.
and include the process of aerobic glycolysis, fatty acid oxidation, and, in extreme
circumstances, gluconeogenesis.
LACTIC ACIDOSIS:
The accumulation of excess
The oxidative energy pathway is a primary source of energy when the body is at rest or
H+ causing muscle fatigue
and soreness. during low-intensity activities. Carbohydrates and fats are the primary fuel for this system,
with fat providing most of the energy when energy demands are low and the glucose from
AEROBIC ENERGY carbohydrates increasing in comparison as the intensity of activity and immediate energy
PATHWAYS: needs increase.
Cellular energy pathways that
require oxygen for energy
production.
OXIDATIVE ENERGY PATHWAY
It is not important for a fitness professional to know every step that occurs during aerobic
AEROBIC GLYCOLYSIS:
metabolism. However, it is important to understand the general steps and the outcome as it
The breakdown of glucose
to ATP in the presence of relates to energy production. Aerobic metabolism produces a large amount of ATP, but it does
oxygen.
so through a series of steps including glycolysis, the Krebs cycle, and the electron transport
chain. This means the aerobic production of ATP is more efficient but also takes more time
OXIDATION:
The chemical reaction of to occur.
combining with oxygen or
removing hydrogen.
Glycolysis means, literally, the breakdown of glucose, and this metabolic process occurs both
anaerobically and aerobically. In the absence of oxygen, the process is anaerobic glycolysis,
OXIDATIVE ENERGY
and the by-product of this process is lactate. In the presence of oxygen, the process is called
PATHWAY:
An aerobic energy pathway aerobic glycolysis, and the by-product of this energy pathway is pyruvate, which serves as a
using primarily fat and
carbohydrates to produce
transitional molecule in the many stages of aerobic metabolism.
energy.

Pyruvate is broken down into acetyl coenzyme A (also known as acetyl-CoA), which then
enters the Krebs cycle in the mitochondria during aerobic metabolism. When acetyl-CoA is
KREBS CYCLE:
A series of chemical reactions
oxidized, it creates two molecules of ATP, carbon dioxide, and hydrogen ions. inside the mitochondria that
use acetyl-CoA to generate
ATP and other substrates
Hydrogen ions released during the Krebs cycle move into the electron transport chain (also that contribute to the electron
transport chain.
known as oxidative phosphorylation). These electrons contain a large amount of energy and
are passed down a series of proteins located in the membrane of the mitochondria. A series
ELECTRON TRANSPORT
of reactions happen as the hydrogen ions are transported across the membrane of the
CHAIN:
mitochondria, and the process produces 35–38 molecules of ATP. A series of proteins in the
mitochondrial membrane
that transfer electrons and
hydrogen ions across the
membrane to generate ATP
from ADP.
PYRUVATE:
A metabolic intermediate
molecule in several energy
pathways.
Figure 6.6 The Stages of Aerobic Metabolism
Triglycerides (stored fats) are high-energy substrates. One molecule of fat (e.g., palmitic acid)
can produce up to 129 molecules of ATP. The body will prioritize fatty acid metabolism when
the body is at rest because energy is not required immediately or in large quantities. However,
the body prefers to use sugars for energy since the process of fatty acid metabolism requires
more oxygen to execute than the conversion of glucose and glycogen to ATP.
During a process known as beta-oxidation, triglycerides are broken down into fatty acids—or
the smaller components of fats. These fatty acids are further broken down into acetyl-CoA,
which can then enter the Krebs cycle for aerobic glycolysis. It is important to distinguish that
fats can only be used in this way for energy production in the presence of oxygen.

GLUCONEOGENESIS
Amino acids are a “last resort” energy substrate. Gluconeogenesis is the process by
which muscle protein is broken down or catabolized. In times of starvation, in very long-
duration activities, in situations where glucose is low or insufficient, and in highly trained
individuals, amino acids are converted to glucose in the liver. Glucose is then released into
the bloodstream and used to generate energy in working cells. The amino acid alanine is the
most prominently used amino acid for this process.
Gluconeogenesis is limited by the availability of the enzymes required to drive protein
breakdown. During long-duration activities or starvation, hypoglycemia—or excessively low

HYPOGLYCEMIA: blood glucose levels—can occur. Low blood sugar stimulates the production of the hormone
The condition of lower-than-
normal blood glucose. glucagon, which in turn stimulates the production of the enzymes required for gluconeogenesis
and will stimulate protein breakdown.
THE ENERGY SYSTEM OVERLAP

All these energy systems are interconnected, and all three are operating at all times.
However, the intensity and duration of activity dictates which energy system dominates
energy production at any moment in time.
Anaerobic and aerobic metabolism happen simultaneously during exercise according to
the energy system overlap. During low-intensity, long-duration exercise, aerobic metabolism
supplies the body with energy, and fatty acids are the primary substrate used. During high-
intensity exercise, the body relies on both anaerobic and aerobic energy systems, and
carbohydrates are the preferred energy substrate for high-intensity, short-duration exercise.
However, these ratios change based on dietary intake.
Amino acids are oxidized when muscle glycogen is used up and quickly used carbohydrates
are a limited fuel source. When amino acids are depleted, the body must still maintain blood
sugar to fuel the nervous system and other working cells. Gluconeogenesis is the backup
fuel generation system for low- to moderate-intensity activity.
People in peak physical condition can use more fatty acids as a primary energy substrate
(yielding more ATP), but their bodies may use higher amounts of protein via gluconeogenesis.

ATP/CP System
Aerobic System
Glycolytic System
Energy Contribution (%)
0 10 20 30 40 50 60 120 180 240 300 360

Running Time (seconds)
ATP/CP System Glycolytic System Aerobic System

• 0-10 seconds • 10-120 seconds • Over 2 minutes
• 100m sprint • 400m swim • Marathon
Figure 6.7 Energy System Overlap
Consider a resistance training workout where a client is executing an exercise at a moderate
intensity and the exercise lasts for 60 seconds. The client then takes a 2-minute rest before
completing the next set. During the first set of activity, they will likely be relying on energy
produced during glycolysis—the anaerobic energy system that dominates for activities lasting
1 to 2 minutes. Then during their rest of approximately 2 minutes, the energy demand is
relatively low, and the oxidative energy system will dominate during this time.
Similarly, sitting quietly to read this textbook does not require a lot of immediate energy. The
body is using the oxidative energy pathway and, in most cases, relying on fatty acid oxidation
for energy. If the reader was to quickly stand up and begin sprinting, the dominant energy
system will shift based on the duration of the sprint and the body’s immediate energy need.
A 10- to 15-second sprint will rely on the ATP/CP energy pathway while a 90-second sprint will
likely rely on anaerobic glycolysis.
Steady-State versus Intermittent Exercise Metabolism
Aerobic metabolism is a more efficient means of energy production—meaning it yields more
ATP per substrate used. In addition, the by-products, carbon dioxide and hydrogen, are more
easily eliminated from the body than the by-products of anaerobic processes. However, in
the first moments of exercise, aerobic metabolism is minimally active and cannot meet
immediate energy needs. Therefore, all activity draws energy first from stored ATP, then from
the phosphagen energy pathway, then glycolysis. When the anaerobic threshold is achieved,
the body uses the aerobic or oxidative system as its primary output.

During steady-state exercise, in which the level of exertion stays constant from start to
STEADY-STATE finish, the body reaches an aerobic plateau. Here aerobic metabolism remains the primary
EXERCISE: source of energy. When exercise stops, oxygen consumption remains elevated for a short
Exercise that maintains a
steady level of exertion from time to return the body back to its resting metabolic state. This is known as excess
start to finish.
postexercise oxygen consumption (EPOC) or oxygen debt. EPOC helps replenish ATP stores
used up during exercise and eliminates waste products via respiration. When ATP has been
EXCESS POSTEXERCISE
OXYGEN CONSUMPTION restored and waste products eliminated, the body returns to baseline respiratory rate,
(EPOC): temperature, and heart rate.

The amount of oxygen
required to restore normal During most team sports, energy demands are intermittent, that is, lasting for short periods
metabolic status.
of time with frequent rests, such as football, basketball, and baseball. When energy demands
are great, such as during a sprint down the field, energy is provided anaerobically. When
the body stops or slows, oxygen consumption stays high to restore ATP. This cycle happens
continuously. If high-intensity bouts are short, recovery time is short. If bouts are longer, then
recovery will also take longer. Eventually, aerobic energy metabolism kicks in to supply energy
for continued short, intense, intermittent activity.
METABOLISM AND ENERGY BALANCE

Metabolism is the detailed and complicated chemical process of aerobic and anaerobic
metabolism occurring within the cells of the body. The human body requires a certain amount
of energy to engage in physical activity and to survive. This energy comes from the external
source of food consumed in the diet. The breakdown of the nutrients in food yields Calories
CALORIES (CAL): (Cal). A Calorie is the amount of energy needed to raise the temperature of 1 kilogram of
The amount of energy
needed to raise the water by 1°C (4,184 joules) at a pressure of 1 atmosphere. Each of the primary nutrients
temperature of 1 kilogram
of water by 1°C (4,184 humans consume (protein, fat, and carbohydrate) yields a specific number of Calories per
joules) at a pressure of 1
atmosphere.
gram consumed. The term kilocalorie is at times used instead of the term Calorie. For the
purpose of accounting for the energy contained in foods these terms may be used
interchangeably.
Table 6.1 Calorie Content of Macronutrients
SOURCE CAL YIELD PER GRAM
Nutritional carbohydrate 4 Cal
Nutritional protein 4 Cal
Nutritional fat 9 Cal

When energy intake in the form of nutrients is equal to energy expenditure, it is known as
energy balance. A positive energy balance means more energy is consumed than expended.
ENERGY BALANCE:
The state achieved when
The physiological result is weight gain in humans. A negative energy balance means more energy intake is equal to
energy expenditure.
energy is expended than consumed. The physiological result is weight loss in humans.
For the personal trainer, the basic energy balance equation is relatively simple as it relates to POSITIVE ENERGY
clients and is often distilled down to calories in versus calories out. However, there are BALANCE:
More energy is consumed
several factors that affect the energy consumption of the human body beyond cellular
than expended.
metabolism. Total daily energy expenditure (TDEE) is a result of the accumulation of three
main processes in the body including resting metabolic rate (RMR), the thermic effect of NEGATIVE ENERGY
food (TEF), physical activity, and physical growth. BALANCE:
More energy is expended
than consumed.
TOTAL DAILY ENERGY

EXPENDITURE (TDEE):
The accumulated calorie
burn made up of resting
metabolic rate, the thermic
effect of food, physical
activity, and physical growth.
RESTING METABOLIC
RATE (RMR):
Figure 6.8 The Simplification of Energy Balance The energy expenditure
of metabolic and physical
RESTING METABOLIC RATE (RMR) processes when the body is
at rest.
The RMR is the rate of energy expenditure when the body is at rest. It includes the energy
required to support cardiac function and respiration, repair internal organs, maintain body
THERMIC EFFECT OF
temperature, and balance water and ion concentrations across cell membranes. It consumes FOOD (TEF):
about 70 percent of the body’s TDEE in a 24-hour period and is the most influential of the The energy expenditure
associated with food
physical processes consuming energy. digestion and absorption.
The RMR is directly correlated to body size and sex. Determining the exact RMR for an individual
is nearly impossible. However, accurate formulas have been developed for health and fitness
professionals to closely estimate the overall caloric needs for an individual. The Bland-Altman
analysis has been widely used to predict an individual’s RMR using the following formulas:
Men = 66.4730 + (13.7516 x weight in kg) + (5.0033 x height in cm) – (6.7550 x age in years)
Women = 655.0955 + (9.5634 x weight in kg) + (1.8496 x height in cm) – (4.6756 x age in years)

CALORIC EXPENDITURE
The Harris-Benedict equation is used to estimate total daily calorie expenditure (DCE). This
DAILY CALORIE calculation incorporates the RMR and an activity level factor (ALF) that accounts for the
EXPENDITURE (DCE): individual’s daily physical activity level and the TEF.
The total number of calories
an individual expends
including their resting Table 6.2 Calculating Calorie Expenditure
metabolic rate, activity level
factor, and the thermic effect CALCULATING CALORIC EXPENDITURE
of food.
metric: DCE=ALF x [(13.75 x WKG) + (5 x HC) - (6.76 x age) + 66]
MALE
imperial: DCE=ALF x [(6.25 x WP) + (12.7 x HI) - (6.76 x age) + 66]
ACTIVITY LEVEL
metric: DCE=ALF x [(9.56 x WKG) + (1.85 x HC) - (4.68 x age) + 655]
FACTOR (ALF): FEMALE
Multipliers that reflect
imperial: DCE=ALF x [(4.35 x WP) + (4.7 x HI) - (4.68 x age) + 66]
varying levels of activity.
WHERE
ALF = Activity level factor AND ALF HAS THE FOLLOWING VALUES
DCE = Daily caloric expenditure Sedentary: ALF = 1.2
HC = Height in centimeters Lightly active: ALF = 1.375
HI = Height in inches Moderately active: ALF = 1.55
WKG - Weight in kilograms Very active: ALF = 1.725
WP = Weight in pounds Extremely active: ALF = 1.9
Understanding an estimation of how many calories the body is expending along with how the
body will use consumed calories is a key component of success. Simply counting calories will
not lead to changes in body composition. Instead, the ideal energy balance must be achieved
for body composition change.
The heat liberated from a particular food during digestion, whether it is fat, protein, or carbohydrate,
is determined by its individual molecular structure, and this structure determines its thermic
effect. The higher the thermic effect of any particular food, the higher the metabolic rate will be.
A fitness professional must understand what the body is consuming and, more importantly, know
how the body will use the consumed calories for energy production.
THERMIC EFFECT OF FOOD (TEF)

DIET-INDUCED The TEF is the energy associated with the breakdown of food by the body. The TEF accounts
THERMOGENESIS: for the heat loss when the body digests carbohydrate, fat, and protein in food and makes up
The thermic effect of
macronutrient digestion and about 10 percent of TDEE. Also referred to as diet-induced thermogenesis, the TEF varies
absorption.
based on the macronutrient. For example, fats have a lesser thermic effect during digestion

and absorption than protein and carbohydrates. The overall macronutrient composition of
food consumed will also affect the TEF. Foods heavier in carbohydrates or protein will increase
the body’s heat production more than meals heavier in fats.
PHYSICAL ACTIVITY
Physical activity is second only to the RMR in terms of its contribution to daily energy
expenditure, making up about 20 percent of TDEE. Physical activity can be split into two
distinct categories: exercise activity thermogenesis (EAT) and non-exercise activity
EXERCISE ACTIVITY
THERMOGENESIS (EAT):
thermogenesis (NEAT). EAT includes planned, structured, and repetitive movement with the
Energy expended as a result
goal of improving or maintaining physical fitness. It contributes approximately 5 percent to of planned, structured, and
repetitive movement with
TDEE. NEAT involves any other movements carried out by the muscles that require energy like the goal of improving or
maintaining physical fitness.
simple activities of daily living, such as bathing, doing laundry, and cooking. It contributes
approximately 15 percent to TDEE. The more someone moves or exercises, the more energy
they will expend. Energy expenditure from physical activity can be calculated using the heart
NON-EXERCISE ACTIVITY
rate as compared to resting heart rate data or through diaries of physical activity and this will
THERMOGENESIS (NEAT):
Energy expended as a result
be covered in training applications. Individuals with smartwatches and activity trackers can of any movements of the
body that require energy. This
also use these technologies to estimate calorie expenditure from physical activity. includes all activities of daily
living outside of planned and
structured workouts.
% OF TDEE EAT - 5%
TEF - 10%
NEAT - 15%
RMR - 70%
Figure 6.9 Breakdown of Total Daily Energy Expenditure (TDEE)
GROWTH
The body is constantly growing, changing, and repairing. Millions of cells die daily, and millions
of cells are created to replace them. For babies, infants, and youth, their bodies are maturing
and growing into their adult sizes at a rapid rate, meaning more cells are being created than
are dying daily. The same applies for pregnant and lactating females. The energetic cost of
physical growth can be an important factor for a personal trainer to consider when creating
exercise programming for a youth who is still growing and for a pregnant or lactating client.

LIFESTYLE AND METABOLISM

The lifestyles people lead include their dietary patterns, activities, and even their opinions
and behaviors. A personal trainer is initially focused on the activities of a client and,
secondarily, on their dietary patterns as they relate to health and fitness goals.
In general, an eating pattern with an excess of a particular macronutrient will cause the
body to use that nutrient preferentially over other macronutrients for energy production.
For example, an eating pattern high in carbohydrates will use that energy substrate
preferentially. A low-carbohydrate eating pattern that is high in fat will cause the body to
use fat for energy. Training intensity also influences which substrate the body will use
for energy.
WEIGHT MANAGEMENT
An additional concept for metabolism and energy balance a personal trainer will want to
understand at a high level is that of weight management or the physiological processes

WEIGHT and techniques one uses to achieve or maintain a specific body weight. Much of weight
MANAGEMENT:
The physiological processes management involves optimal nutrition, proper calorie intake, and exercise in combination
and techniques one uses
as opposed to independently.
to achieve or maintain a
specific body weight.
Fitness and nutrition programs vary depending on a client’s needs and goals. Most effective
nutrition programs though are more similar than different. The goal of a nutrition program
is to help clients focus on what really matters by bringing awareness and attention to all
nutrition components. Paying close attention to calories and the types of food consumed is
a key factor in building muscle, losing fat, and improving overall health. All effective eating
patterns recommend consuming nutrient dense and minimally processed foods to help
eliminate nutrient deficiencies. This requires monitoring levels of appetite and managing food
intake. It does not mean having to count calories all the time, but rather finding sustainable
hunger and satiety levels and promoting regular exercise.

Promote
Raise Nutrition
Regular
Awareness
Elements Exercise
of Effective
Nutrition
Plans
Control
Focus on Food
Appetite and
Quality
Food Intake
Eliminate
Nutrient
Deficiencies
Figure 6.10 Elements of Effective Nutrition Plans
Energy balance is a complex process that involves factors beyond food and exercise.
Individual psychological factors, environmental factors, genetic factors, and hormonal
responses influence how much one eats and how many calories the body needs for all activity.
Unfavorable changes in energy balance lead to unfavorable changes in reproductive function,
brain metabolism, and restorative functions. This includes energy deficits that decrease
estrogen and testosterone production and lower the brain’s ability to function.
Calories in food are released when the body breaks down and absorbs food. They provide energy
in the form of heat, which allows the body to function. The more calories a food has, the more
energy it provides. However, eating excess calories can lead to an increase in bodyfat.

TRAINER TIP!
Calculating resting metabolic rate (RMR) is just as important as calculating a client’s
daily caloric expenditure (DCE) for overall nutrition purposes. The RMR estimates the
minimum number of Calories someone should be consuming to support basic body
function, while the DCE gives insight into the client’s overall Calorie expenditure.
For a fat loss goal, a deficit of 200 to 500 calories per day from the DCE is recommended
to create a Calorie deficit but still support body functions. This is a negative energy
balance; Calories out is greater than Calories in.
Conversely, for a muscle gain goal, a surplus of 200 to 500 Calories (or more) is
recommended to support muscle repair and muscle building. The actual Calorie surplus
will be individualized based on the client’s training frequency, intensity, and recovery needs.
This is a positive energy balance; Calories in are greater than Calories out.
For client’s working to maintain their weight, the DCE is important as it provides insight
into the number of Calories the client should be consuming to create energy balance;
Calories in are equal to Calories out for weight maintenance.
BODY TYPES
Body type, or somatotype, helps to classify someone’s body structure. While there is no
SOMATOTYPE: magic pill for diet or training based solely on body type, the characteristics of a client’s body
Categories of physical body
type. can provide insights into their movement patterns, physical abilities, and nutritional needs.
There are three general body shapes with generally accepted characteristics for each:
ectomorph, endomorph, and mesomorph.

Table 6.3 Body Types and Their Training and Nutritional Considerations
BODY TRAINING NUTRITION

DESCRIPTION
TYPE CONSIDERATIONS CONSIDERATIONS
Long and lean with little May need a higher

bodyfat and little muscle carbohydrate and
Can have a hard time
Ectomorph mass protein diet to maintain
gaining weight.
body weight and muscle
Narrow shoulders and hips mass
May need a diet lower

Thicker, rounder build with
in carbohydrates and
lots of bodyfat and lots of
high in protein to
Endomorph muscle mass
Gains weight easily. prevent excess fat
Large upper arms and storage and support
thighs high levels of muscle

mass
May need a more

Athletic, muscular build balanced diet that is
Can gain or lose weight
Mesomorph with broad shoulders and a focused on daily calorie
without much effort.
healthy body weight expenditure for energy
balance
Figure 6.11 Common Body Types

CLIENT ASSESSMENTS
CHAPTER 07
LEARNING OBJECTIVES
1 | Explain the purpose and importance of fitness assessments for a fitness
professional.
2 | Describe the most common subjective assessments a personal trainer

uses and the information they gather.
3 | Define static and dynamic posture assessments and examples of each.
4 | Describe the most common body composition assessments used in

fitness.
5 | Name and explain common cardiovascular assessments used by fitness

professionals.
6 | List common muscular strength and endurance assessments and their

purpose as fitness assessments.

CHAPTER 07 | Client Assessments
Before meeting with a client to conduct any physical assessments, a fitness professional
must collect and review health information. The initial documents and fitness assessments
are essential for collecting health and exercise history, building rapport with a client, and
understanding a client’s limitations, goals, and potential setbacks during an exercise
program. In addition to providing a comprehensive view of the client’s health, fitness
assessments also supply the fitness pro with the important data they need to individualize a
client’s training program and the baseline measurements to help track progress. There are a
variety of different fitness assessments available that can help a fitness pro gather this
information. However, it’s important to note that the assessments that are selected by the
trainer will vary depending on the client. There are two main types of fitness assessments,
objective and subjective. Subjective assessments include anything that a trainer observes in
SUBJECTIVE the client or any information gathered from the client. Subjective data is influenced by the
ASSESSMENTS:
Fitness assessments that
person observing or collecting it. These differ from the objective assessments that collect
require observation or a measurable and repeatable data like body weight, circumference measurements, and bodyfat
subjective, opinion-based
measure. percentage. Objective data is not influenced by the person collecting it because it is a
measurable numeric value.
Movement assessments are also an important tool in fitness and may be considered
subjective or objective. While these assessments do collect measurable, repeatable data,
they are also subject to the fitness professional conducting the assessment as well as the
client performing them. For example, during a squat, factors like the height of the client will
affect how much forward lean is “normal” for that individual. The exact measure of the angle
of the torso to the thighs will likely not be consistent across all clients. Fitness professionals
should begin with subjective assessments. After the initial client intake forms have been
completed, physical assessments, posture assessments, and movement assessments,
which are objective data, can be performed. Objective assessments also include measuring
OBJECTIVE body composition, girth measurements, and skinfold measurements.
ASSESSMENTS:
Fitness assessments
that collect repeatable, SUBJECTIVE ASSESSMENTS
measurable data such
as body composition Forms completed by a fitness client hold personal information such as the client’s contact
or circumference
measurement. information, medical history, medications, or health conditions. The purpose is not to gather
data so the fitness professional can diagnose or treat a client but rather to provide insight to
help the fitness pro design safe and effective training programs. This information must be
collected carefully and stored securely to protect the client’s information and their privacy.
Personal trainers are not considered health care professionals, so it is not required to follow
the protective guidelines of programs like the Health Insurance Portability and Accountability

Act (HIPAA). However, it is important for fitness professionals to implement methods to keep
client information secure and confidential.

THE HEALTH
INSURANCE
This piece of American legislation outlines the security and privacy protocols for protected PORTABILITY AND
health information (PHI). PHI is defined as “any information held by a covered entity which ACCOUNTABILITY ACT
concerns health status, provision of health care, or payment for health care that can be linked
(HIPAA):
An American legislation
to an individual.” However, there are instances that HIPAA or related privacy obligations would designed to protect
the health care data,
apply like when a medical referral is made or a medical professional shares patient information information, and payment
details of patients.
with a fitness professional with the written consent of the client. The following paperwork
should be the first forms a client fills out and is called the initial interview packet:
INITIAL INTERVIEW
• Client intake form PACKET:
The first health and liability
• PAR-Q intake forms that a client
will complete before
• Health History Questionnaire beginning to work with a
fitness professional.
• Liability waiver
• Physician’s letter of clearance (as applicable)
• Three-day dietary record
CLIENT INTAKE FORM

The client intake form is a foundational form that gathers demographic information such as
address, phone number, and email from a client. It also asks basic questions such as “Has
CLIENT INTAKE FORM:
A basic intake form to
your doctor ever diagnosed you with a heart condition?” or “Have you ever had a heart gather a client or potential
client’s demographic
attack?” These questions help the trainer begin assessing personal health history. This form information and general
health history.
also includes questions regarding the client’s health and fitness goals. These questions allow
the client to think about what they want to achieve in their fitness program and offer the
trainer insight into the client’s motivation and current barriers to success.
The short and general nature of this form makes it ideal to use for people participating in
complimentary or introductory training sessions or classes. The fitness professional can
collect enough information to know if there are any health issues, they should be aware of
when working with a client. The client intake form also provides an opportunity to have an
initial conversation with a client. This can be used to begin the process of rapport building
and can even be used as a sales tool in a complimentary session setting. The other forms
a client will complete once they commit to an exercise program will provide the trainer with
greater detail.

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

PHYSICAL ACTIVITY
The physical activity readiness questionnaire (PAR-Q) is an extension of a client’s medical
READINESS
history and is completed by the client after committing to their program but before starting
QUESTIONNAIRE
(PAR-Q): the exercise programming. It allows the trainer to understand a client’s potential risk for
An intake form to assess a injury and gives an in-depth look at health history within the scope of practice.
client’s readiness to begin
a physical activity program
and assess injury potential. The PAR-Q includes several yes-or-no questions, including the following:
• Has a doctor ever told you that you should only perform physical activity as
recommended by a doctor?
• Do you know of any reason why you should not participate in physical activity?
• In the past 30 days, have you had chest pain at any point?
At the end of the questionnaire, guidelines are provided for the next steps based on how many
questions the participant answered yes to. Generally, if there were one or more affirmative
answers, the recommendation is to obtain a doctor’s approval and written clearance before
beginning an exercise program.
HEALTH HISTORY QUESTIONNAIRE

A client’s health history is important to a personal trainer, as it will give them insight into
potential health concerns, conditions, or medications that may affect their training protocols.
The health history questionnaire collects data on present and past exercise experience,
HEALTH HISTORY
tobacco use, and nutrition. This information is important to better understand a client’s
QUESTIONNAIRE:
A detailed client intake form general habits. The questionnaire is typically two to four pages in length and includes
that gathers information on
a client’s present and past questions such as these:
health and medical history.
• Have you experienced any of the following conditions? (This typically precedes a
long list of many different conditions to select from, such as chest pain, diabetes,
high blood pressure, irregular heartbeat, etc.)
• What medications are you currently taking?
• What is your current level of physical activity?
LIABILITY WAIVER
LIABILITY WAIVER:
A short form that, when A brief liability waiver form can offer protection to the fitness professional and the facility they
signed by a client, releases
a fitness professional and/ are working in, if applicable, in the form of a waiver of injury liability. Every fitness program has
or their training facility
an inherent risk of injury, and by reading and signing this form, the client is accepting any and
from any liability should
the client be injured while all risk associated with training and agreeing not to hold the trainer or facility liable should an
working with them.
injury occur during training or within the facility. This form is an industry standard.

It should be noted that this is a legally binding document. The sample liability waiver provided
by ISSA is an example, and it is strongly suggested that the fitness professional modify the
form for their needs and have it reviewed by a licensed legal professional in their state.
PHYSICIAN’S LETTER OF CLEARANCE

Some clients may be in treatment for or recovering from a condition for which they were under
the care of a physician or other licensed health professional. This can include post-surgery
rehabilitation, physical therapy, occupational therapy, or injury recovery. Personal trainers are
not within the scope of practice to continue such treatments. Other clients that might require
this type of clearance may simply be new to fitness and in poor physical condition when
beginning a program.
To ensure a client is cleared for activity, regardless of the reason, a physician’s letter of
PHYSICIAN’S LETTER
clearance is strongly recommended. This letter is written by the client’s medical professional
OF CLEARANCE:
and states the client has been examined and is cleared to begin an exercise program. Such A signed letter from a
client’s health care provider
a letter should also include, in writing, any restrictions or limitations the medical professional stating they are cleared
for physical activity and
would like the client to adhere to. For example, they may only be able to work in specific heart
exercise that should also
rate ranges or for a specific length of time during each training session. include any restrictions
or limitations they should
adhere to.
This letter, if provided, gives the fitness professional the peace of mind of knowing that the
client is cleared for a training program. It should be kept securely with all other forms and
records. It’s important to note that although this letter can be helpful in assuring the client’s
safety, care must be taken in how it is requested. The fitness professional should ensure
the client understands what needs to be included in this letter and exactly why it’s needed. A
lack of compassion in this situation could result in a client feeling as if they are beyond the
ability to improve their physical condition. This could lead to them discontinuing their training
program or effectively demotivate them to take control of their health.
THREE-DAY DIETARY RECORD

Versions of the three-day dietary record are often used in nutrition coaching. However, most fitness
THREE-DAY DIETARY
programs have a nutrition component, and nutrition is a major contributing factor to success in an
RECORD:
exercise program. The three-day dietary record form gives clients the opportunity to write down the A common fitness and
nutrition intake form that
foods and amounts (if known) that they consume daily. Clients should be instructed to be as honest allows clients to log their
food consumption for
and precise as possible. Inaccurate information will hinder their progress and does not provide the three consecutive days to
observe their habits.
fitness professional with a full, accurate picture of the client’s nutritional habits. Some clients may
need additional education on things such as portion sizes, food measuring tools, and nutrition-
tracking technologies to ensure they are providing accurate information.

After collecting the completed forms for health history, previous injuries, nutrition habits,
lifestyle habits, and medical conditions, a personal trainer should take time to review the
details with the client and ask any follow-up questions. This is when a fitness professional
can begin to understand a client’s previous successes and failures with exercise and nutrition
before making any recommendations or adjusting an existing program.
Follow-up questions should be general and aimed at gaining clarifications, if needed. They
should NOT ask for details on medical conditions, reasons someone is taking certain
medications, or lifestyle preferences. For example, asking for the frequency of a certain habit
or how long someone has had a condition is okay. Asking about sexual preferences or how
someone developed a medical condition is not advised.
The intake forms along with a trainer’s notes from the initial client interview establish the
basis of the client profile. This profile holds all documents, forms, notes, and information on
CLIENT PROFILE: their goals and experience in fitness.
The collection of a client’s
health and intake forms,
biometric measurements Applicable sample intake paperwork for a fitness professional can be found at the end of
(physical measurements
this chapter.
like weight, height, etc.),
training plan, and liability
waivers.
ABSOLUTE CONTRAINDICATIONS
The fitness professional should review the information collected and look for potential
contraindications before meeting with the client a second time. Contraindications are
CONTRAINDICATIONS: reasons that a client should not begin or continue an exercise program because of an
Factors that serve as a
reason to withhold training increased risk of injury or adverse health consequences.
because of harm that it
may cause.
The following are some examples of instances or reported conditions that are contraindicated
for exercise and a fitness professional should NOT accept a client:
• Unstable coronary heart disease (CHD)—a condition where the heart does not get
enough blood or oxygen flow.
• Decompensated heart failure—new or worsening signs and symptoms of heart
failure.
• Uncontrolled heart arrhythmias—irregular heartbeat that is not controlled.
• Severe pulmonary hypertension—extremely high blood pressure.
• Severe and symptomatic aortic stenosis—narrowing of the aortic valve that causes
shortness of breath or fatigue.
• Acute myocarditis, endocarditis, or pericarditis—inflammation of the heart muscle,

heart chambers, or the sac that surrounds the heart respectively.
• Uncontrolled hypertension—high blood pressure that is not under control with
medication or dietary interventions.
• Aortic dissection—a tear in the aorta.
• Marfan syndrome—a genetic disorder affecting connective tissue and that commonly
affects the heart, eyes, blood vessels, and skeleton.
• Active proliferative retinopathy or moderate or worse non-proliferative diabetic
retinopathy—damage to the blood vessels of the eyes.
RELATIVE CONTRAINDICATIONS
Clients who report any of the following conditions may begin a fitness program after
consulting with their physician and providing the trainer with written approval and
guidelines from the physician:
• Risk factors for CHD—risk factors include high blood pressure, poor cholesterol,
diabetes, obesity, smoking, and physical inactivity.
• Diabetes—high or uncontrolled blood sugar.
• Low functional capacity (Metabolic equivalent (METs))—the inability to exert
energy and effort for activities such as dressing, eating, and moving around. METABOLIC
Adequate functional capacity is anything over four METs and can include walking up
EQUIVALENT (METS):
The measure of the ratio
stairs, cleaning, swimming, and jogging. of a person’s expended
energy to their mass while
• Musculoskeletal limitations—limitations to mobility, dexterity, or general function, performing physical activity.
including injuries, post-surgery, and recovery from injury.
• Pacemaker or defibrillator—devices implanted in the body to regulate the heartbeat
or return it to normal should it become irregular.
If there are no contraindications for getting started, the next appointment can be set.
OBJECTIVE ASSESSMENTS
The objective fitness assessments are designed to collect measurable data. Unlike subjective
assessments, objective assessments have one distinct answer and are not subject to opinion or
observer variance. From body composition to cardiorespiratory fitness assessments and strength
tests, many objective assessments are at a trainer’s disposal based on the needs of each
specific client. In combination with the subjective assessments, they provide a personal trainer
with a wide range of information that is used for programming, motivation, and client success.
Keep in mind that not every assessment is ideal for every situation. A person’s goals, comfort

level, access to tools, current fitness level, and even budget can all play a role in which
assessment is the right choice.
When completing client assessments, consistency is key to accuracy. The following are
considerations for objective assessments:
• Weigh clients at the same time of day. For example, if they weigh themselves first
thing in the morning, each subsequent weight measurement should be complete
first thing in the morning.
• Take circumference and caliper measurements on the same side of the body each
time. There is no requirement to take them on one side or the other; it’s important
to remain consistent.
• Use the same equipment to take objective measurements. For example, use the
same scale, measuring tape, or body fat measuring device for consistency.
TEST TIP!
Easy Ways to Remember Objective and Subjective
Objective: Root word object. You are objective whenever you are discussing an object or
something concrete that you can touch. The information that makes up your objective
BODY COMPOSITION: statement should also be concrete, solid objects like data or measurements.
The physical makeup of the
body considering fat mass
and lean mass. Subjective: Something you can’t point to. They are based on experience, opinions,
facts, and emotions.
LEAN BODY MASS:

The fat-free mass of the
body calculated by total BODY COMPOSITION ASSESSMENTS
weight minus the weight of
bodyfat. Since adiposity—or the amount of bodyfat someone has—is a risk factor for most diseases,
it is important to track body composition for most clients. Body composition is the measure
CHRONIC DISEASE: of fat mass and lean body mass. Excess fat is a precursor to chronic disease, but too little
A condition lasting a year bodyfat can also have negative health consequences, including vitamin deficiencies, a
or more that limits daily
activities and/or requires weakened immune system, insulin resistance, amenorrhea, and decreased metabolism.
ongoing medical attention.
The norms for bodyfat mass differ by sex since the distribution and amount of essential
bodyfat also differ by sex. Research suggests that females have between 6 and 11 percent
AMENORRHEA:
The absence or cessation higher bodyfat than males on average. This is attributed to female hormones, including
of a menstrual cycle in
females. estrogen, and the biological functions of the female body, such as childbearing and lactation.
A fitness professional should be familiar with the appropriate bodyfat ranges by sex but

understand that these are a guideline. Each individual client will have a “normal” range.
For example, depending on body type, some clients may naturally maintain a bodyfat range
considered to be low or in an athletic range.
Table 7.1 Bodyfat Percentage Norms

LOW/ HIGH/
SEX ATHLETIC FIT AVERAGE
ESSENTIAL OVERWEIGHT
11–16
Males 4–6 percent 7–10 percent 17–25 percent 26 percent or higher
percent
21–24
Females 10–12 percent 13–20 percent 25–31 percent 32 percent or higher
percent
In addition to bodyfat percentage, an individual’s distribution of bodyfat is affected by sex, age,
body type, and activity levels. Men typically carry bodyfat in the abdominal region, while women
tend to store bodyfat on the hips, thighs, and triceps. Measuring body composition determines
the amount of fat mass and fat-free mass an individual has, and this can be done in many ways.
Once a testing method or methods are chosen, they must be consistently retested to measure
progress. The following methods for measuring body composition are organized from most to
least accessible: BMI (body mass index) is the easiest test for a trainer to conduct, requiring only
height and weight measurements. A DEXA (dual-energy X-ray absorptiometry) scan is the least
accessible, requiring additional expense, specialized equipment, and trained staff.
BODY MASS INDEX

Body mass index (BMI) is a measure for predicting disease risk but may not be suitable for more
fit clients as it does not consider a person’s lean body mass. Lean body mass is a client’s total BODY MASS INDEX
weight minus the weight of bodyfat and includes muscle tissue, organs, bone, and other tissues.
(BMI):
A predictive health measure
BMI is calculated by dividing a client’s weight in kilograms by their height in meters squared: of weight divided by height
squared.
BMI = weight (kg) / height (m2)
Ranges of BMI measurements can advise a trainer if a client is within a healthy range or not
in many cases. However, clients with large amounts of muscle mass may not be accurately
represented by BMI.
Below 18.5 = underweight
18.5–24.9 = normal
25–29.9 = overweight
30 or above = obese

Figure 7.1 Body Mass Index
TEST TIP!
Remember that BMI is a reliable tool, but it only considers height and weight without
considering fat or lean mass. Be sure to use other assessment methods along with
BMI to get the full picture (including muscle mass) of the client’s body composition.
You can have 100 people the same height and weight and they would all have the
same BMI, but they could have very different body compositions.
WAIST-TO-HEIGHT RATIO
Waist-to-height ratio is a measurement used to predict an individual’s obesity-related heart
WAIST-TO-HEIGHT disease risk and is easy to obtain. As the name suggests, it measures the waist circumference
RATIO: divided by the client’s height.
An objective assessment to
measure cardiometabolic
risk. A flexible tape measure and a regular tape measure will be needed. First, the client should
stand with the back of their head, shoulder blades, buttocks, calves, and heels against a
wall. The fitness professional can mark the top of the client’s head on the wall with a pencil
and then measure up to that point from the floor. Height should be recorded.

To measure the waist:
• Males: The tape is placed around the waist at the belly button. The tape should
be snug against the body without being so tight that it presses into the body. The
measurement is then recorded.
• Females: The client places their forefinger and middle finger on top of the belly
button. The tape is wrapped around the abdomen, resting just on top of the
forefinger. The measurement is then recorded.
The measurement may be repeated two additional times, taking the average of the two most
similar readings. The following formula is used to determine the client’s ratio, and then the
table can be used to determine their health rating:
Waist-to-height ratio = (waist circumference / height) × 100
The same unit of measure must be used for both waist circumference and height (for example,
inches or centimeters).
A female that is 60 inches (152.4 centimeters) tall with a waist circumference of 28 inches
(71.12 centimeters) would determine her waist-to-height-ratio as follows:
Imperial: (28 in. / 60 in.) × 100 = 46.7
Metric: (71.12 cm. / 152.4 cm.) = 46.7
Table 7.2 Waist-to-Height Ratio Norms
MEN RATING WOMEN
<35 Underweight <35
35–43 Extremely slim 35–42
43–46 Slender and healthy 42–46
46–53 Healthy ideal weight 46–49
53–58 Overweight 49–54
58–63 Seriously overweight 54–58
>63 Extremely obese >58

GIRTH MEASUREMENTS
Also referred to as circumference measurements, girth measurements assess the
CIRCUMFERENCE circumference around specific body regions, including, but not limited to, the hips, thigh,
MEASUREMENTS: neck, and chest. A trainer may determine which measurements are the most applicable
The measurement of the
circumference of specific based on the client’s goals. For example, a trainer can measure upper-arm circumference if
body regions.
a client wishes to increase muscle mass and reduce bodyfat percentage. This measurement
can be tracked with a flexed or relaxed arm measurement, as long as the measurement used
(flexed or relaxed) remains consistent throughout the program. The following measurement
instructions are for a relaxed limb which is the most common technique.
Figure 7.2 Circumference Measurement
It is often recommended that measurements be taken on the right side of the body for
consistency. If there is a compelling reason to measure on the left side or in an area that
is outside of the normal parameters, it should be noted so that future reassessments are
administered in the same way. It is best to take each measurement three times to ensure
accuracy and take the average of the two most similar readings and record that number.

Neck
The tape measure is placed around the neck, just below the larynx, ensuring the tape is
horizontal all the way around.
Upper Arm: Relaxed
The client should stand with their arms at their sides and shoulders relaxed. The trainer should
wrap the tape around the thickest part of the upper arm and write down the measurement.
Forearm: Relaxed
With the client seated or standing, ask them to hold their arm out with the palm of the hand
facing up. Measure around the forearm at the area of the largest circumference. The client
will keep their hand open with the palm facing up.

Waist
Males: The tape is placed around the abdomen at the belly button and drawn flat against the
skin without pressing into the skin. The trainer can then record the measurement.
Females: The client places her forefinger and middle finger on top of the belly button. The
trainer can then wrap the tape around the abdomen, resting just on top of the forefinger.
Hips
The client must stand with their feet together. The trainer can ask the client to find the tops of
their hip bones (iliac crest) and then ask the client to place the heel of each palm on top of the hip
bones and place their palms and fingers pointing down, resting on their hips. The trainer should
stand on the right side of the client and place the tape around the hips, using the fingertips as a
guide for where to place the tape. The tape should be horizontal all the way around.

Thigh
From a standing position, the client can rest their arms down their sides. The point where
the fingertips reach is where the trainer will measure. Standing on the right side of the client,
the trainer can wrap the tape around the thigh, just below the fingertips, and draw the tape
flat against the skin without pressing it into the skin. This measurement can also be taken
from a certain distance above the top of the patella (kneecap). Typically, five or seven inches
above are common placements.
Calf
The client should stand with the feet hip-width apart. The trainer can kneel at the right side of
the client and wrap the tape around the visually widest part of the calf. The tape is tightened
flat against the skin without pressing into the skin, and the measurement is recorded.

Waist-to-hip ratio (WHR) can be ascertained from the circumference measurements and is
WAIST-TO-HIP RATIO a measure that can help predict someone’s risk of heart disease like the waist to height ratio,
(WHR): regardless of BMI. Certain people will not get accurate results from this measurement,
A predictive health
measure comparing the including children, individuals under five feet tall, and those with a BMI of 35 or greater
circumference of the waist
to the circumference of the because this measure does not take into account lean body mass, fat mass, or fat distribution,
hips.
which can vary greatly in these populations.
WHR = waist circumference / hip circumference
The same unit of measure must be used for both waist circumference and height (for example,
inches or centimeters).
Table 7.3 Waist-to-Hip Ratio Norms
MEN HEALTH RISK WOMEN
0.80 or less Low 0.95 or less
0.81–0.85 Moderate 0.96–1.0
0.86 or more High 1.0 or more
SKINFOLD MEASUREMENTS
BODY DENSITY:
The compactness of the
The use of skinfold measurements is valuable for closely approximating body density and
body determined by dividing body composition without being cumbersome, costly, or too intimidating. This test is slightly
its mass by its volume.
more accurate than girth measurements but may require more practice to produce accurate
results. Highly trained technicians may achieve accuracy of up to 3.7 percent.
Just like girth measurements, it is recommended that measurements be taken on the same
side of the body. The trainer should grasp the skin at the site with the thumb and forefinger
and then pinch. Next, the trainer should place the calipers one to two centimeters away from
the thumb and forefinger, perpendicular to the skinfold, and halfway between the crest and
base of the fold. The caliper lever is released while still pinching the skin. The trainer can
then read the dial and record the measurement to the nearest millimeter.
When taking skinfold measurements, the data from seven locations on the body can be used.
However, a more common and faster method uses three sites. The appropriate sites for the
three-site measure differ by sex due to the natural variation in fat distribution on the body.

Triceps measurement: With the arm relaxed and to the side, a vertical skinfold measurement
is taken halfway between the shoulder and the elbow.
Subscapular measurement: Locate the middle of the scapula and measure a vertical skinfold
about one inch from the spine.
Figure 7.9 Posterior Caliper Sites: Triceps and Subscapula
Chest (pectoral) measurement: Measure about one inch below the collarbone and two to
three inches out from the inside edge of the pectoral muscle. Be sure to stay on the pectoralis
and avoid breast tissue if you are measuring a female. Pull the skinfold in a vertical direction.
Midaxillary measurement: Measure the fold in a horizontal line at the point where a vertical
line from the mid axilla (middle of armpit) intersects with a horizontal line level with the
sternum. Pull the skinfold in a vertical direction.
Suprailiac measurement: Measure about halfway between the navel and the top of the hip
bone. This should be at or near the area where the oblique and abdominals meet. Pull the
skinfold in a vertical direction.
Abdominal measurement: Measure about one inch to the left of and one inch down from the
navel. Pull the skinfold in a vertical direction.
Thigh measurement: Measure in the middle of the quadriceps. If the area is too tight, you
made need to go up one to two inches. Pull the skinfold in a vertical direction.

Figure 7.10 Anterior Caliper Sites: Chest, Midaxillary, Suprailiac,

Abdominal, and Thigh
Table 7.4 Skinfold Measurement Locations and Formulas
SEVEN-SITE BODY
THREE-SITE BODY DENSITY METHOD
DENSITY METHOD
Male and female Male Female
Triceps
Chest/pectoral
Midaxillary Chest/pectoral Triceps
Subscapular Abdomen Suprailiac
Suprailiac Thigh Thigh
Abdomen
Thigh
Seven-site formula for males Seven-site formula for females
1.112 − (0.00043499 × sum of

1.097 − (0.00046971 × sum of skinfolds) +
skinfolds) + (0.00000055 × [sum of
(0.00000056 × [sum of skinfolds2]) − (0.00012828 ×
skinfolds2]) − (0.00028826 × age) =
age) = body density
body density
Three-site formula for males Three-site formula for females
1.10938 − (0.0008267 × sum of

1.0994921 − (0.0009929 × sum of skinfolds) +
skinfolds) + (0.0000016 × [sum of
(0.0000023 × [sum of skinfolds2]) − (0.0001392 ×
skinfolds2]) − (0.0002574 × age) =
age) = body density
body density

Once body density has been determined with the appropriate formula, the Brozek equation
can be used to estimate bodyfat percentage for both men and women:
[(4.570 / body density) − 4.142] × 100 = bodyfat percentage (BF%)
BIOELECTRIC IMPEDANCE
Bioelectrical impedance analysis (BIA) is a relatively simple, quick, and affordable method
for tracking body composition and, ideally, should be used in conjunction with other BIOELECTRICAL
measurements for a balanced perspective of the client’s body composition.
IMPEDANCE ANALYSIS
(BIA):
A method for body
composition measurement
using a weak electrical
current to measure the
resistance of body tissues.
Figure 7.11 BIA Device
BIA devices send a safe electric current from one point through the body to another point,
measuring the time it takes for the current to travel between the two points. Muscle cells
contain more water than fat cells; therefore, the faster the current travels through the body, the
higher the lean muscle mass. Although convenient, these measurements can vary depending
upon an individual’s hydration status and timing of their last meal. Generally, BIA devices have
an accuracy of plus or minus 4 percent. Most affordable devices may not adequately measure
bodyfat as the electrical current may not be strong enough. It is advised to purchase models
with dual frequencies for more accurate readings.

AIR DISPLACEMENT PLETHYSMOGRAPHY (ADP)

ADP is safe and accurate for measuring fat mass and fat-free mass in adults and children.
From start to finish, the test takes about five minutes. The accuracy of this device has made
it the standard for body composition testing. Body weight is measured before the individual
enters the chamber. Body volume is then determined by measuring the volume of the empty
chamber compared to the volume of the chamber with the individual inside. Once weight and
volume are calculated, body density is calculated, and that value is placed into an equation
to determine the percentage of fat. This test requires a private room, the ADP chamber,
and specialized training for staff. There may be local facilities offering this test to which the
trainer can refer clients, as it can be expensive and is not a portable option.
HYDROSTATIC WEIGHING
HYDROSTATIC
The hydrostatic weighing method is much the same as air displacement plethysmography
WEIGHING:
A tool to measure body but uses water rather than air. It is fairly accurate, with a variance of around 2.5 percent.
composition using water
displacement and tissue Lean muscle is denser than fat, making lean individuals heavier underwater than individuals
density.
with more fat mass. Body weight is measured before the individual steps into a large tank of
water. The individual must expel all the air from their lungs and be completely submerged
while the underwater weight is measured. This is done three times, and the values are
averaged. The technician then uses a special equation to determine lean and fat mass
percentages. Much like ADP, this method can be highly accurate but can also be a costly and
impractical method, particularly in a health club setting.
DUAL ENERGY X-RAY ABSORPTIOMETRY

Dual energy X-ray absorptiometry (DEXA) is the most accurate bodyfat test available. The
DUAL ENERGY X-RAY
ABSORPTIOMETRY X-ray determines the amount of bone, fat tissue, organ tissue, and muscle mass in the body.
(DEXA): Because DEXA scans bone mass, it can also determine whether a client has osteoporosis,
An X-ray scanning test
making it a valuable assessment for older clients. Despite the value of the information
to determine body
composition. gained from this method, it is not common for it to be used in the health and fitness profession
because of factors like cost and lack of availability or convenience.

OSTEOPOROSIS:
A skeletal condition that
results in weak or brittle CARDIORESPIRATORY FITNESS ASSESSMENTS
bones.
The level of cardiorespiratory fitness of a client determines how well their heart, lungs, and
muscles will perform during varying degrees of exercise intensity. When testing a client’s
DYSPNEA: cardiorespiratory fitness, there are objective and subjective measures. Objective data
Difficulty or labored
breathing. includes the client’s resting heart rate and blood pressure. Subjective data includes client
reports of perceived exertion or difficulty breathing—dyspnea.

There are two measurements a personal trainer should have for a client before they engage in
cardiorespiratory fitness assessments: resting heart rate and blood pressure. Both can be taken
by the client or a health professional and reported to the personal trainer for consideration.
Resting heart rate (RHR) should be taken when the client is at rest—first thing in the morning
before sitting up is ideal. The average typically can range between 60 and 100 beats per minute. RESTING HEART RATE
While the measure of RHR can vary, and well-trained athlete can be on the lower end of that range.
(RHR):
It is taken by pressing lightly with the first and index fingers on the radial artery (wrist) or the when completely at rest.
carotid artery (neck) and counting the number of heartbeats in 60 seconds. Often this is done by
measuring for a shorter timeframe like 10 seconds and multiplying by six to get an estimate of
the 60-second RHR. This can also be done by using a stethoscope, which is a tool used to listen
to breathing and heartbeats, on the left side of the sternum.
TEST TIP!
There are several factors that can influence a person’s heart rate during the day even
while at rest.
• High temperatures: Pulse may raise when in higher temperatures.
• Emotions: Stress, anxiety, and excitement can all cause a rise in heart rate.
• Medications: There are medications that can increase or decrease heart
rate.
• Stimulants: Caffeine, nicotine, and tobacco can all cause a rise in heart rate.
• Recent exercise: Heart rate will usually remain elevated immediately following
a workout.
• Standing up: There will usually be a spike in blood pressure when getting up
from a seated position.
Because blood pressure can be influenced by many things, it is ideal to take this
measurement after waking up and before getting out of bed for a more accurate reading.
Blood pressure is not typically a measurement that a personal trainer will take. The blood
pressure is measured with a blood pressure cuff and stethoscope. When a client reports
blood pressure, it is important to confirm what a “normal” range is for the individual as this
may vary. Blood pressure readings can also vary throughout the day with the most accurate
readings being immediately after waking and before sitting up. Regardless of what time of day
blood pressure is measured, it’s important that it is taken at the same time of day for

consistency. Chronically high blood pressure, known as hypertension, will be a concern for
HYPERTENSION: both client and trainer as it can affect exercise selection and programming.
High blood pressure reading
Table 7.5 Blood Pressure Norms
RANGE READING (MILLIMETERS OF MERCURY)

Normal Less than 120/80 mm Hg
Elevated Systolic between 120 and 129 and diastolic less than 80 mm Hg
Stage 1 hypertension Systolic between 130 and 139 or diastolic between 80 and 89 mm Hg
Stage 2 hypertension Systolic at least 140 or diastolic at least 90 mm Hg
The general purpose of the cardiovascular assessments is to determine a client’s VO2 max
VO2 MAX: measurement. This refers to the maximum amount of oxygen an individual can use during
The maximum amount of
oxygen an individual can exercise, and it can be improved with training. An improvement in VO2 max indicates higher
use during exercise.
cardiovascular fitness and performance as well as reduced risk for heart disease and
diabetes. The reading can be used to accurately assess cardiovascular fitness and capacity.
Ventilatory threshold (VT) is also commonly used and establishes the point where ventilation
VENTILATORY increases faster than the volume of oxygen available.
THRESHOLD (VT):
The threshold where
ventilation increases faster
TRACK TESTS
than the volume of oxygen. Track tests are aptly named as they are typically completed on a track. However, they may
be completed on a treadmill as well. These tests are still commonly used to assess the
cardiovascular fitness of those new to working out or with a low fitness level because they are
performed with less than maximum effort (submaximal). The current physical condition and
capability of the client can help in determining the correct test to use. Running may not be a
safe or feasible option for some clients, so a walk test would be the best choice.

Cooper 12-Minute Run
This test is suitable for most populations as it can be modified to match the client’s fitness
level. The total distance completed (walk/run/combination) is recorded at the end of 12
minutes. To find the approximate VO2 max, the following equation is used:
(35.97 × miles completed) − 11.29 = estimated VO2 max
(22.35 × kilometers completed) − 11.29 = estimated VO2 max
The 1.5-Mile Run
The fitness professional will record the time it takes the client to complete a 1.5-mile run and
compare the results to the norms table below. These norms are not age-adjusted and may be
different for youths, seniors, or clients with different abilities. Information may also be used
to set the baseline for tracking progress, rather than be compared to norms.
Table 7.6 The 1.5-Mile Run Standards
RATING MALES FEMALES

Very poor >16:01 minutes >19:01 minutes
Poor 16:00–14:01 minutes 19:00–18:31 minutes
Fair 14:00–12:01 minutes 18:30–15:55 minutes
Good 12:00–10:46 minutes 15:54–13:31 minutes
Excellent 10:45–9:45 minutes 13:30–12:30 minutes
Superior <9:44 minutes <12:29 minutes
Rockport One-Mile Walk
Body weight is measured before this test. The client should walk as fast as possible, without
jogging or running, for one mile. At the end, the trainer should immediately take the client’s
pulse for one minute and note the time it took to complete the mile (may also be completed
on a treadmill). The following equation can be used to find estimated VO2 max:
Males:
139.168 − (0.388 × age) − (0.077 × weight in pounds) − (3.265 × walk time in
minutes) − (0.156 × heart rate) + 6.318 = estimated VO2 max
Females:
139.168 − (0.388 × age) − (0.077 × weight in pounds) − (3.265 × walk time in
minutes) − (0.156 × heart rate) = estimated VO2 max

STEP TEST
The Harvard Step Test is used as a predictive measure of a client’s VO2 max and aerobic
fitness level. A variation is the three-minute step test for deconditioned clients. The trainer
should instruct clients to inform them immediately if they have pain or discomfort during the
test, so the trainer may stop it if necessary.
A step or platform that is 12 inches high (30.5 centimeters), a stopwatch, and a metronome
METRONOME: are needed. This test lasts for five minutes or until the client reaches exhaustion—when they
A device marking time at a
selected rate. cannot maintain the stepping rate for 15 consecutive seconds. The trainer should ensure
clients understand the tempo they are striving for before beginning the assessment. Clients
should be instructed not to talk during the test and are not allowed a warm-up prior.
The metronome is set to 96 beats per minute. The client will step on each beat of the metronome
with an “up–up–down–down” rhythm. At the end of the test, the client can sit on a chair or bench.
After one minute the heart rate can be checked again. The fitness professional should count the
number of beats for 60 seconds. The following table can be used to compare the results to peer
group norms.
Table 7.7 Step Test Norms (in beats per minute, bpm)
MALES
18–25 26–35 36–45 46–55 56–65 65+

Age
years years years years years years
Excellent 50–76 51–76 49–76 56–82 60–77 59–81
Good 85–93 85–92 89–96 95–101 97–103 96–101
Above
88–93 88–94 92–88 95–101 97–100 94–102
average
Average 95–100 96–102 100–105 103–111 103–109 104–110
Below
102–107 104–110 108–113 113–119 111–117 114–118
average
Poor 111–119 114–121 116–124 121–126 119–128 121–126
Very poor 124–157 126–161 130–163 131–159 131–154 130–151

Table 7.7 Step Test Norms (in beats per minute, bpm) (CONT)
FEMALES
18–25 26–35 36–45 46–55 56–65 65+

Age
Excellent 52–81 58–80 51–84 63–91 60–92 70–92
Good 85–93 85–92 89–96 95–101 97–103 96–101
Above
96–102 95–101 100–104 104–110 106–111 104–111
average
Average 104–110 104–110 107–112 113–118 113–118 116–121
Below
113–120 113–119 115–120 120–124 119–127 123–126
average
Poor 122–131 122–129 124–132 126–132 129–135 128–133
Very poor 135–169 134–171 137–169 137–171 141–174 135–155
Table 7.8 VO2 Max Norms
MALES (ML/KG/MIN)
Age
Rating
18–25 26–35 36–45 46–55 56–65 65+
Excellent >60 >56 >51 >45 >41 >37
Good 52–60 49–56 43–51 39–45 36–41 33–37
Above average 47–51 43–48 39–42 36–38 32–35 29–32
Average 42–46 40–42 35–38 32–35 30–31 26–28
Below average 37–41 35–39 31–34 29–31 26–29 22–25
Poor 30–36 30–34 26–30 25–28 22–25 20–21
Very poor <30 <30 <26 <25 <22 <20

Table 7.8 VO2 Max Norms (CONT)
FEMALES (ML/KG/MIN)
Age
Rating
18–25 26–35 36–45 46–55 56–65 65+
Excellent >56 >52 >45 >40 >37 >32
Good 47–56 45–52 38–45 34–40 32–37 28–32
Above average 42–46 39–44 34–37 31–33 28–31 25–27
Average 38–41 35–38 31–33 28–30 25–27 22–24
Below average 33–37 31–34 27–30 25–27 22–24 19–21
Poor 28–32 26–30 22–26 20–24 18–21 17–18
Very poor <28 <26 <22 <20 <18 <17
MUSCULAR STRENGTH AND MUSCULAR ENDURANCE ASSESSMENTS

Before creating exercise programs for clients, muscular strength and endurance assessments
can be useful when training intermediate or advanced clients. The client must be sufficiently
warmed up before attempting maximal lifts. Moderate intensity general warm-ups are
recommended in addition to specific warm-ups. Specific warm-ups are exercises or movements
SPECIFIC WARM-UPS:
Activities that prepares the executed that mimic the movements that will be performed during sport or in an exercise
body for specific exercise
training session at a lower level of intensity. Beyond warming the muscles and ligaments,
to follow by incorporating
movements that mimic the specific warm-ups increase muscle force production via neuromuscular facilitation and improve
planned activity.
outcomes of maximal strength tests. A rest period between one and five minutes should be
allowed between the warm-up and each assessment attempt. Keep in mind that the goal and
ONE-REPETITION MAX the current physical condition of the client should be considered when selecting assessments.
(1RM): Those that are beginners or in a deconditioned state are not likely to need their one-repetition
A single maximum-strength max (1RM) measured.
repetition with maximum
load.
There are established norms for age and sex for bench press, push-ups, and sit-up or crunch
tests. However, maximal lifts may also be specific to the client’s goals and include squats,
MUSCULAR
rows, deadlifts, biceps curl, power clean, and so forth. When administering one repetition
ENDURANCE TESTS:
Assessments testing the max (1RM) muscular strength tests, a spotter (or two) must be present in addition to the
ability of a muscle group fitness professional. 1RM tests require the participant to lift as much load as possible for a
to overcome resistance
in as many repetitions as single repetition. Muscular endurance tests require the participant to complete as many
possible.
repetitions as possible within a predetermined technique standard of a particular exercise. If

the standard is not met, reps are not counted, or the test is discontinued if safety becomes
a concern. These types of assessments test the participant’s ability to complete as many
repetitions as possible to determine the endurance of a muscle group.
BENCH PRESS TEST

Many average clients should not perform a true 1RM test to avoid injury. More advanced
clients, on the other hand, are better suited for this assessment style. Before performing a
strength test with any client, a personal trainer should ensure that the client can perform the
exercise with proper form. Strength testing of any kind might not be appropriate for some
clients. In order to test a client’s strength earlier in the process, less complex exercises can
be selected; instead of a bench press, for example, a machine chest press can be used. The
1RM can also be estimated using higher repetitions and with the equation below.
To find a safe starting point to test the client’s 1RM, the trainer should choose a weight the
client can lift for approximately 10 repetitions with good form. If the client can perform more
than 20 repetitions, the trainer can allow a three- to five-minute break, increase the load by 5
to 10 percent, and conduct the test again.
The number of completed repetitions is multiplied by 2.5. Then, that number is subtracted
from 100. That value is then divided by 100 to get a decimal value. This provides the
estimated percentage of 1RM. Next, the weight that was lifted is divided by the estimated
percentage of 1RM to estimate the 1RM of the exercise. Finally, the estimated 1RM is divided
by the client’s body weight. This determines a value that can then be used to compare the
client to peer norms in the following table.
100 − (number of reps × 2.5) / 100 = estimated percentage of 1RM
Weight lifted / estimated percentage of 1RM = estimated 1RM
Estimated 1RM / body weight = comparable assessment value
For example, a client is a 34-year-old female weighing 142 pounds. She was able to bench-
press 65 pounds six times.
6 repetitions × 2.5 = 15
100 − 15 = 85
85/100 = 0.85
65 lb. / 0.85 = 76.47 or estimated 1RM
76.47/142 = 0.54

According to the norms for this assessment (see table below), this client’s score is in the “fair” range.
Table 7.9 1RM Bench Press Assessment Standards

VALUES FOR BENCH PRESS STRENGTH IN 1RM/BODY WEIGHT IN POUNDS
Rating Age in Years
Men 20-29 30-39 40-49 50-59 60+
Excellent >1.26 >1.08 >0.97 >0.86 >0.78
Good 1.17-1.25 1.01-1.07 0.91-0.96 0.81-0.85 0.74-0.77
Average 0.97-1.16 0.86-1.00 0.78-0.90 0.70-0.80 0.64-0.73
Fair 0.88-0.96 0.79-0.85 0.72-0.77 0.65-0.69 0.60-063
Poor <0.87 <0.78 <0.71 <0.64 <0.59
Women 20-29 30-39 40-49 50-59 60+
Excellent >.78 >0.66 >0.61 >0.54 >0.55
Good 0.72-0.77 0.62-0.65 0.57-0.60 0.53-0.59 0.51-0.54
Average 0.59-0.71 0.53-0.61 0.48-0.56 0.43-0.50 0.40-0.50
Fair 0.53-0.58 0.49-0.52 0.44-0.47 0.40-0.42 0.37-0.40
If a client has any wrist, shoulder, or elbow problems that would prevent them from doing this
assessment test, have them consult with their physician to determine how to proceed with
the client’s upper body strengthening program.
PUSH-UP TEST
When administering a push-up test, the client will complete as many push-ups as possible
in a one-minute period. To complete a push-up the hands should be just outside of the
shoulders at chest height and the body in a plank position from head to heels. The elbows
must bend to a 90-degree angle with each repetition, and the plank position should be
maintained throughout the repetitions. The norms below are for standard push-ups; however,
this assessment may be modified to suit the individual’s current fitness level.
For men, the standard is to perform push-ups from the toes, while women perform push-ups
from the knees. The test ends when the client can no longer complete any more push-ups
with ideal form.
If using a modified push-up, the trainer should make a note in the client’s file (for example,
knee push-ups or wall push-ups). Norms will not apply to any modified exercises but may
be used as a baseline measurement for future reference. It is important to also use the
modification for reassessments.

Table 7.10 Push-Up Assessment Standards (number of reps)
MALES
Age
Percentile 20–29 30–39 40–49 50–59 60–69

years years years years years
90 41 32 25 24 24
80 34 27 21 17 16
70 30 24 19 14 11
60 27 21 16 11 10
50 24 19 13 10 9
40 21 16 12 9 7
30 18 14 10 7 6
20 16 11 8 5 4
10 11 8 5 4 2
FEMALES
Age
Percentile 20–29 30–39 40–49 50–59 60–69

years years years years years
90 31 27 25 19 18
80 27 22 21 17 15
70 21 20 17 13 13
60 19 17 16 12 11
50 18 16 14 11 9
40 14 13 11 9 6
30 13 10 10 6 4
20 10 7 8 3 0
10 6 1 4 0 0
90th percentile = excellent; 70th percentile = above average; 50th percentile = average; 30th
percentile = below average; 10th percentile = poor

If a client has any wrist, shoulder, or elbow problems that would prevent them from doing this
assessment test, the client should consult with their physician to determine how to proceed
with the client’s upper body strengthening program.
LOWER BODY STRENGTH TEST

In the same way as the bench press test, the 1RM seated leg press can be used to assess
a client’s leg strength. A fitness professional can assess clients using the seated leg press
machine (weight stack) or with a lying leg press (plate loaded), as long as each time the
client is reassessed, the equipment used is consistent for comparison purposes. Through a
process of trial and error, the appropriate load and repetitions can be completed to estimate
the 1RM for the client. The estimated 1RM will be divided by the client’s body weight to
determine a value. The value is compared to a standard to determine the client’s leg strength
rating as found in the following table.
Lower Body Strength = 1RM / body weight (lb.)
Table 7.11 Lower Body Assessment Standards
VALUES FOR SQUAT STRENGTH IN 1RM/BODY WEIGHT IN POUNDS
Rating Age in Years
Men 20-29 30-39 40-49 50-59 60+
Excellent >2.08 >1.88 >1.76 >1.66 >1.56
Good 2.00-2.07 1.80-1.87 1.70-1.75 1.60-1.65 1.50-1.55
Average 1.83-1.99 1.63-1.79 1.56-1.69 1.46-1.59 1.37-1.49
Fair 1.65-1.82 1.55-1.62 1.50-1.55 1.40-1.45 1.31-1.36
Poor <1.64 <1.54 <1.49 <1.39 <1.30
Women 20-29 30-39 40-49 50-59 60+
Excellent >1.63 1.42 >1.32 >1.26 >1.15
Good 1.54-1.62 1.35-1.41 1.26-1.31 1.13-1.25 1.08-1.14
Average 1.35-1.53 1.20-1.34 1.12-1.25 0.99-1.12 0.92-1.07
Fair 1.25-1.34 1.13-1.19 1.06-1.11 0.86-0.98 0.85-0.91
If a client has any knee or hip problems that would prevent them from doing this assessment
test, their physician should be consulted to determine how to proceed with the client’s leg
strengthening program.

MOVEMENT AND POSTURE ASSESSMENTS
MUSCULAR
Movement and posture assessments allow a fitness professional to determine potential
IMBALANCE:
muscular weaknesses or muscular imbalance a client may have that can be effectively When the muscle or
muscles on one side of the
addressed in a fitness program. An imbalance occurs when the muscle or muscles on one body are stronger, weaker,
or more or less active than
side of the body are stronger, weaker, or more or less active than the corresponding muscle the corresponding muscle
on the other side of the body. Muscular imbalances can lead to poor movement patterns, on the other side of the
body.
pain, or even cause injuries if not addressed.
KINETIC CHAIN:
THE KINETIC CHAIN A system of links—or
The kinetic chain is used in fitness to easily understand how the body moves. By definition, joints—in the body that
generate and transfer force
the kinetic chain is effectively a system of links—or joints—that generate and transfer force from one to the other.
from one to the other. These links are known as kinetic chain checkpoints. Kinetic chain
checkpoints are points in the body where movement dysfunction can be consistently and KINETIC CHAIN
easily observed. As applied to gym exercises, these are points where breaks in technique will
CHECKPOINTS:
The six anatomical
usually occur. locations of predictable
movement patterns where
movement dysfunctions can
There are six critical checkpoints within the kinetic chain that are used to identify movement be detected.
dysfunctions. They are typically reviewed from the floor up:
1. Foot and ankle

2. Knee
OVERACTIVE
3. Hips
MUSCLES:
4. Spine Muscles that are shortened
beyond the ideal length-
5. Shoulders
tension relationship with
6. Head and neck high neural activation that
feel tight.
The kinetic checkpoints can be used as consistent and repeatable locations to observe
movement patterns and posture. Whether for an assessment or during activity, these
UNDERACTIVE
checkpoints offer information regarding muscular weakness, muscular overactivity, and MUSCLES:
potential injury risk. Generally, muscles that appear to be shortened tend to be overactive Muscles that are
lengthened beyond the
muscles with high neural activation, while muscles that appear to be lengthened are inhibited, ideal length-tension
relationship and are,
underactive muscles (weakened) with low neural activation. therefore, inhibited and less
capable of producing force.
At each kinetic chain checkpoint, there are groups of muscles that work together to generate
various movements. These muscle synergies work to refine and better control movement MUSCLE SYNERGIES:
around a joint, and a single muscle can be a part of more than one synergy. An example of this The activation of a group
of muscles to generate
can be found in elbow flexion. The biceps brachii acts as the agonist or prime mover while the movement around a
particular joint.
brachioradialis, a muscle of the forearm acts synergistically to assist with the elbow flexion.

A muscular force couple is another example of synergy. A force couple happens when two or
MUSCULAR FORCE more muscles generate force in different linear directions at the same time to produce one
COUPLE:
movement. To make a right turn on a bicycle, for example, the right arm must pull inward as
Two or more muscles
generate force in different the left arm pushes outward. Each arm produces force in a different direction, yet it results
linear directions at the
same time to produce one in one movement.
movement.
An example of a force couple in a common exercise is during the deadlift. The glutes pull the
back of the hip downward while the abdominals pull the front of the hip upward to produce
hip extension during this exercise.
The Foot and Ankle
The joint actions at the foot and ankle include inversion and eversion as well as dorsiflexion
and plantarflexion. Movement at the ankle is largely supported by the muscles of the lower
leg, but it is also supported by a large network of tendons extending from these muscles. The
tendons extend into the toes to control fine motor control of the joints of the toes.
The Knee
The knee joint can flex and extend with a minimal capability for lateral flexion. The muscles
supporting the knee joint often cross the knee and an additional joint. For example, the
gastrocnemius crosses the knee and ankle joints.
The Hip
The hip actions include flexion and extension, abduction and adduction, and internal and
external rotation. Hip rotation can occur when the hip is neutral, flexed, or extended. The hip
joint is one of the most flexible joints in the human body and a checkpoint a personal trainer
must pay close attention to. Not only does this musculature support the stabilizing
lumbopelvic hip complex (LPHC), but it also controls the movement of the lower extremities.
LUMBOPELVIC HIP
COMPLEX (LPHC): The remaining muscles associated with the LPHC act to transition the upper body to the lower
The musculature of the hip body and help transmit the forces generated from flexion, extension, and rotation of the trunk.
that attaches to the pelvis
and lumbar spine and In all, there are between 29 and 35 muscles within the LPHC attaching to the spine or pelvis.
works to stabilize the trunk
and lower extremities.
The Spine
There are three sections of vertebrae within the spinal column. The lumbar spine (low back)
and the thoracic spine (mid back) are the two sections that will make up this kinetic chain
checkpoint.

Figure 7.12 Vertebral Column
The Lumbar Spine
The lumbar spine is commonly called the low back and includes spinal vertebrae L1–L5. If there
is a muscular dysfunction at the hips, glutes, abdominals, or upper leg, it can manifest here.
Fitness professionals can look for hyperextension or flattening of the lumbar spine during gait
or squat assessments. These deviations from the ideal lumbar spine positioning can indicate
muscular dysfunctions in the LPHC that must be addressed during a training protocol.
The Thoracic Spine
The thoracic spine consists of 12 vertebrae near the middle of the spine. There is a natural
curve in the T spine to support the scapula on the back and provide support and strength for
the upright human body. The “S” curvature of the spine acts like a shock absorber. During
an assessment, rounding through this spinal region can indicate dysfunctions in the chest,
upper back, and even the lumbar spine. It will also affect the neck and head movement.
The Shoulder
The shoulder is the most movable joint in the human body and serves as an important part of
the kinetic chain during an assessment. However, the large range of motion this joint allows
also makes it less stable than other joints. The muscles, ligaments, and tendons closely
surrounding or deep to the joint primarily act as stabilizers. The muscles and tendons that
are more superficial to the shoulder, the ones you can see, are responsible for moving it.

Generally, anterior muscles are responsible for shoulder flexion and horizontal adduction.
Posterior muscles of the shoulder are responsible for extension and horizontal abduction.
The Head and Neck
Finally, the head and neck provide information along the kinetic chain about what is occurring
in the shoulder girdle, thoracic spine, rib cage, LPHC, and cervical spine. The shoulder girdle
SHOULDER GIRDLE: refers to the clavicle, scapula, and coracoid bones of the appendicular skeleton. The muscles
The clavicle, scapula, and
coracoid bones of the associated with the shoulder girdle are responsible for moving the scapulae, and they work
appendicular skeleton.
in conjunction with the muscles of the shoulder to coordinate movements of the upper limbs.
KINETIC CHAIN MOVEMENT

Within the kinetic chain, there are two types of exercises: open and closed. A closed kinetic
chain movement keeps the most distal aspect of the body segment in action fixed or
CLOSED KINETIC stationary. The squat is a closed-chain exercise with the feet grounded on the floor as the
CHAIN MOVEMENT: lower body flexes and extends. Other examples include the lunge, a push-up, or a pull-up.
A movement keeping the
distal end of the body
segment in action fixed. In an open kinetic chain movement, the distal aspect of the body segment in action is free
(i.e., not fixed). Most open-chain movements are single-joint exercises, like the biceps curl or
OPEN KINETIC CHAIN seated leg extension. However, a combination movement, such as a curl and press, would be
MOVEMENT: considered an open-chain movement since the hands are freely moving.
A movement in which the
distal aspect of the body
segment in action is free
(i.e., not fixed).
POSTURE AND MOVEMENT ASSESSMENTS
Subjective assessments to observe posture and movement patterns should be executed
next. These are considered subjective because static posture and dynamic movement
patterns are subject to the individual, can vary from day to day, and, with such variation, may
not be indicative of a chronic muscular issue. For example, a client may have trained one
day and have residual muscle tightness that may manifest as a slight tilt in their hips during
a postural assessment the following day. While the observable postural deviation can help
STATIC POSTURE: a trainer identify potential tight or weakened musculature to address, proper recovery and
Posture when standing
flexibility techniques employed to address temporary muscular dysfunctions will also likely
upright and still.
remedy the observed postural dysfunction when the assessment is repeated.
MOVEMENT Static posture is typically observed from a standing position from the anterior, posterior, and
ASSESSMENTS: lateral view. Movement assessments are viewed from the anterior, posterior, and lateral
Observation and critique
of movement patterns or angles in most cases. These assessments can offer invaluable information for a trainer for
exercise form.
exercise programming and the prescription of flexibility and recovery techniques for optimal

movement. These assessments can also serve as preventative measures to help clients
avoid poor movement patterns that may result in injury, discomfort, or pain.
Postural and movement assessments should be repeated periodically throughout an exercise
program. The ideal frequency will depend on the client’s goals and their desired timeline.
Static posture assessments can be repeated on a quarterly basis (every three months),
while movement assessments can be reassessed more often—for example, assessing
a client’s movement patterns at the beginning of their program and then again any time
a major acute training variable is changed during their program like resistance (load) or
intensity. Reassessing before changing major acute variables ensures the client is moving
well, is mastering the required movement patterns, has a functional and optimal joint range
of motion, and is not at risk for injury.
POSTURE
There are several postural deviations a trainer will look for during this assessment and
when training clients. Each is characterized by different muscular overactivity or weaknesses
along the kinetic chain. Fitness professionals should take note of the observable deviations
from the floor to the head and use this data to further explore muscular dysfunction. These
observations are not for diagnosing structural (bone) malformations or deviations.
IDEAL POSTURE:
Ideal posture is when the feet, knees, and hips are level and even and point straight ahead.
Optimal body positioning
The spine will have a normal S curve, the head and neck are neutral (balanced over the body and structural alignment.
and center of gravity), and the arms hang naturally and evenly at the sides. This is also
referred to as a neutral posture. Perfect, neutral posture is not common, and most people will
have some degree of deviation.
Posture is important for health and is needed to keep internal organs in place and allow them
to work effectively. For example, excessive low back flexion can cramp the intestines and
cause digestive issues. In the same way, excessive rounding of the shoulders can constrict
the chest cavity and cause breathing issues.
Posture can affect how the body moves, runs, walks, jumps, and lifts weights. For example, a
runner with rounded shoulders and a collapsed chest may have trouble staying upright while
running. As a result, they may have trouble generating an effective knee drive or long enough
stride—both of which can affect their efficiency.
Many postural deviations will affect the spine. It is a key structure in the human body that

supports the weight of the head, trunk, and upper extremities. The spine is also an attachment
point for many muscles in the body, like the muscle of the back, the shoulder girdle, and the
chest muscles. To allow for proper human movement, the spine must be firm with the ability
to be flexible when appropriate. The natural curve of the spine resembles the letter “s” and
the average range of motion is between 30 and 40 degrees of spinal flexion and 15 to 20
degrees of spinal extension.
Anterior Posterior
Top View spinous process
Cervical
verterbal
foramen
Intervertebral disc Thoracic

body (cross section)
vertebral end plate annulus
fibrosus
nucleus
pulposus
vertebral end plate

Side View
Side View
Lumbar
body
Sacrum
verterbal spinous process
foramen
Coccyx
Figure 7.13 The Spine
SPINAL DEVIATIONS
There are several spinal deviations that can be observed during both assessment and general
movement. While observing clients for deviations is not intended to diagnose or treat
structural issues, it can help a personal trainer identify potentially overactive and weakened
musculature that can be addressed within a fitness program. The goal is pain-free movement
and injury prevention during training. Lordosis is also known as lower cross syndrome. It is
LORDOSIS:
The excessive inward curve characterized by an anterior pelvic tilt, which causes an excessive inward curve at the lumbar
of the lumbar spine.
spine. The tummy protrudes due to weakness through the abdominals, tightness through the
hip flexors causes the pelvic tilt, and the combination can lead to lower back pain.
Kyphosis is also an excessive curve of the spine but is found in the upper spine (thoracic)
KYPHOSIS:
The exaggerated rounding region. Sometimes called upper cross syndrome, kyphosis is common in those who sit with
of the thoracic spine.
poor posture. The hips are in an anterior tilt and the feet may be flexed and the knees

hyperextended. This posture will also cause a forward head position, overexaggerating the S
curve of the upper spine.
Flat back posture effectively lessens the S curve of the spine (lumbar flexion) with a posterior
FLAT BACK:
pelvic tilt. This causes hyperextension of the knee and, in response, a forward neck and head. An excessive lumbar flexion
and posterior pelvic tilt.
The swayback posture is similar to flat back but with a larger lumbar curve that protrudes the
buttocks.
SWAYBACK:
Scoliosis is a sideways curvature of the spine, and it is relatively common, especially in A posterior tilt with
excessive extension of the
youth. The two most obvious symptoms are an observably curved spine with visual examination lumbar spine that protrudes
the buttocks.
and uneven shoulders from the anterior or posterior view.
The spine is not the only observable posture assessment point along the kinetic chain. The foot SCOLIOSIS:
The sideways curvature of
and ankle complex can provide a lot of information as to why there may be issues at the knees
the spine.
or hips. A forward head can indicate overactivity through the cervical extensors, and rounded
shoulders may indicate overactive pectorals. Again, muscles that appear to be shortened tend
to be overactive with high neural activation, while muscles that appear to be lengthened are
inhibited, or weak, with low neural activation. Armed with this information, a trainer can design
appropriate stretching and strengthening protocols for a client’s unique posture.
Table 7.12 Postural Deviations and Associated Muscle Imbalances
POSSIBLE TIGHT POSSIBLE WEAK

MALALIGNMENT
MUSCLES MUSCLES
Abdominals (especially
Lordosis Lower back (erectors), hip flexors
obliques), hip extensors
Lower back (erectors), hip

Flat back Upper abdominals, hip extensors
flexors
Oblique abdominals, hip

Swayback Upper abdominals, hip flexors
extensors
Internal oblique, shoulder adductors Erector spinae of the thoracic

Kyphosis (pectorals and latissimus), spine, scapular adductors (mid
intercostals and lower trapezius)
Forward Head Cervical extensors, upper trapezius Neck flexors

Ideal Posture Lordosis Kyphosis Scoliosis
Figure 7.14 Posture Deviations
POSTURE SELF-CHECK
Knowing the status of your own posture will help to assess the posture of your clients. To
assess your posture, perform this self-check: Stand with your back against a wall. Your heels,
backs of the calves, buttocks, upper back, and head should comfortably touch the wall. If
you must strain to make all points of contact, then it’s likely that there are some postural
deviations.
Another effective method is to secure a string to the ceiling and hang a weight at the end
of the string. Stand so that the string is lined up with the nose, and then have a front-view
picture taken (or look in a mirror). Notice whether the shoulders are leaning to one side or
another or if more of the body is on one side of the line. With good posture, there should be
symmetry (alignment matches) on both sides of the string.
To get a graphic representation of how weight is distributed in front of you and behind you,
try lining up the string in the middle of your shoulder down to the floor. This method of
postural self-check also shows whether you have any major deviations in spinal curvature or
positioning of the hips.

Head
Upper
back
Buttocks
Back of
calves
Heels
Figure 7.15 Posture Self-Check
OTHER COMMON DYSFUNCTIONS

Outside of the typical standing posture dysfunctions, an individual’s foot position and
handedness should also come into consideration. An individual’s handedness refers to which
side of their body is prominently used. If someone is right-handed, a trainer may observe a HANDEDNESS:
The tendency to use one
depressed right shoulder and a higher right hip indicating an overactive right side. The side of the body more
naturally than the other.
opposite can be said of a left-handed individual. Handedness can help to explain observed
muscle weaknesses and overactivity, especially in those who perform repetitive movement
patterns.
A common observation during posture and movement assessments is knee valgus (genu
valgum) or knee varus (genu varum). Knee valgus, also known as being knock kneed, occurs
KNEE VALGUS:
The position of the knee
when the knees are closer to the midline of the body than normal. This posture dysfunction near the midline of the body
(i.e., knock knees).
can cause:
• bunions; KNEE VARUS:

The position of the knee
• ACL issues; away from the midline of
the body (i.e., bowlegged).
• Achilles tendonitis;
• posterior tibialis tendonitis;
• shin splints;
• tarsal tunnel syndrome; or

Q ANGLE:
• low back pain. The quadriceps angle
formed between the
Knee varus, or bowlegged posture, occurs when the knee is farther away from the midline. quadriceps muscle and the
patellar tendon.
Both postures affect the Q angle. The Q angle (Q for quadriceps) is designated by the line of

pull of the patellar ligament and the mechanical axis of the hip formed by the superior iliac
spine and the longitudinal axis of the femur.
A normal Q angle will vary by sex, with females having a larger angle to start—around 15
degrees. Knee valgus increases this angle to 20 degrees or more and knee varus decreases
the Q angle below 10 degrees. A trainer can observe and make note of a Q angle that
appears to deviate from exercise with the intent of preventing further changes.
Figure 7.16 Q Angle and Knee Position
DYNAMIC POSTURE ASSESSMENTS

There are several types of movement assessments a trainer can have a client perform. No
matter which assessment is chosen, it is important to ensure the client understands the
movement they are being asked to perform. For example, if they have never performed a
squat, they should be informed on how to perform the basic movement beforehand to avoid
injury.The squat assessment is a functional subjective assessment for clients of all ages. For
SQUAT ASSESSMENT: this assessment, a client will complete a basic squat. The goal is not to coach them into
The movement assessment
of body mechanics during proper form (yet) but to observe their habitual form during the range of motion. The squat
a squat with the goal of
identifying movement should be completed unloaded (without weight) to prevent influence from external forces and
dysfunctions along the
with a moderate, controllable tempo. Five to ten squats are ideal to observe a repetition from
kinetic chain.
the anterior, posterior, and lateral angles without causing fatigue that may exacerbate
deviations in the client’s posture.

Figure 7.17 Squat Assessment— Lateral, Anterior
Common observations during a squat assessment may include:
• knee valgus;
• forward lean (excessive)
• lumbar spine hyperextension
• heel elevation
• eversion of the foot
• lateral weight shifting
Each observable deviation during the squat assessment can offer insight into overactive and
underactive musculature similar to the postural assessment. This information is not used to
diagnose structural dysfunctions. Instead, assessment observations can be used to address

muscular dysfunctions and prevent injury. A personal trainer will need to have a general
understanding of the potentially tight or weakened musculature with each observation to
address it in a training program.

Table 7.13 Squat Assessment Observations
POSSIBLE WEAK
MALALIGNMENT POSSIBLE TIGHT MUSCLES
MUSCLES
Adductors
Gluteus maximus
Biceps femoris
Knee valgus Gluteus medius
TFL
Vastus medialis
Vastus lateralis
Gastrocnemius (medial)
Semitendinosus Soleus
Foot turnout (eversion
Semimembranosus Gastrocnemius (lateral)
and external rotation)
Sartorius Biceps femoris
Gracilis
Soleus
Gastrocnemius
Gluteus maximus
Psoas
Forward lean Erector spinae
Rectus femoris
Anterior tibialis
Rectus abdominis
External obliques
Psoas
Gluteus maximus
Rectus femoris
Transverse abdominus
Lumbar extension TFL
Hamstring complex
Erector spinae
Multifidus
Latissimus dorsi
Heel elevation Tibialis (anterior) Soleus
Tibialis (anterior and

Gastrocnemius (lateral)
Foot pronation (arch posterior)
Biceps femoris
collapse) Gluteus medius
TFL
Adductors
Gluteus medius (same TFL (same side of shift)

side of shift) Gastrocnemius
Lateral weight shift Tibialis (anterior) Soleus
Adductors (opposite side Piriformis
of shift) Gluteus medius
Biceps femoris (opposite side of shift)

The overhead squat assessment is very similar to the standard squat assessment, with the
addition of arm range of motion during the movement. The client will complete an unloaded OVERHEAD SQUAT
squat while holding their arms overhead.
ASSESSMENT:
The movement assessment
of the overhead squat
From the start position, the desired movement pattern maintains the elbows back by the ears with the goal of identifying
movement dysfunctions
with arms extended straight overhead and shoulders away from the ears. If a client is unable along the kinetic chain.
to achieve this position, it should be noted the arms will likely fall forward during the squat.
Figure 7.18 Overhead Squat Assessment— Lateral, Anterior
As with all other dynamic postural assessments, this overhead squat should be observed
from a lateral, posterior, and anterior position. During the squat, look for the same potential
deviations as for the squat as well as the movement of the arms from the starting position
relating to head position, forward lean, and, specifically, flexion and extension of any part
of the spine from the lateral view. This assessment is highly effective in identifying core
musculature and shoulder girdle dysfunctions.
Table 7.14 Overhead Squat Assessment Observations
POSSIBLE WEAK
MUSCLES
Adductors
Gluteus maximus
Biceps femoris
Knee valgus Gluteus medius
TFL
Vastus medialis
Vastus lateralis

Table 7.14 Overhead Squat Assessment Observations (CONT)

POSSIBLE WEAK
MUSCLES
Soleus
Gastrocnemius
Gluteus maximus
Psoas
Forward lean Erector spinae
Rectus femoris
Anterior tibialis
Rectus abdominis
External obliques
Foot turnout Semitendinosus Soleus

(eversion and Semimembranosus Gastrocnemius (lateral)
external rotation) Sartorius Biceps femoris
Gracilis
Heel elevation Tibialis (anterior) Soleus
Tibialis (anterior and

Gastrocnemius (lateral)
Foot pronation (arch posterior)
Biceps femoris
collapse) Gluteus medius
TFL
Adductors
Gluteus medius (same TFL (same side of shift)

side of shift) Gastrocnemius
Lateral weight shift Tibialis (anterior) Soleus
Adductors (opposite side Piriformis
of shift) Gluteus medius
Biceps femoris (opposite side of shift)
Psoas
Gluteus maximus
Rectus femoris
Lumbar spinal Transverse abdominus
TFL
extension (arching) Hamstring complex
Erector spinae
Multifidus
Latissimus dorsi
Rectus abdominus
Spinal flexion Erector spinae
External obliques
(rounding)
Pectoralis major & minor

Table 7.14 Overhead Squat Assessment Observations (CONT)
POSSIBLE WEAK
MUSCLES
Flexors of the cervical Upper trapezius

Forward head spineExtensors of the Levator scapulae
thoracic spine sternocleidomastoid
Middle and lower trapezius

Rhomboids
Latissimus dorsi
Supraspinatus
Arms fall forward Pectoralis major & minor
Infraspinatus
Teres major
Teres minor
Subscapularis
Upper trapezius
Shoulder elevation Middle and lower trapezius Levator scapulae
sternocleidomastoid
INTERPRETING FINDINGS
Many assessments have norms and standards with which to compare the client’s results.
Some tests require the trainer to use mathematical formulas to calculate values that can
then be interpreted. Other tests are valuable only for subjective data but may require time
for the trainer to review photos or videos and note the findings. The trainer should take
time to review the assessment results within the context of the intake paperwork, make
comparisons to established norms and standards, and determine what the collective data
means for the health of the client. These findings will be compiled in the client profile along
with all objective assessment data for further review and future reference. Assessment data
is also used to guide exercise selection during programming with the goal of keeping clients
safe, moving effectively, and working toward their unique fitness goals.

PAR-Q
Physical Activity Readiness Questionnaire
Regular physical activity is part of a healthy, balanced lifestyle. If you are planning to become more physically active, start by
answering the following questions. Individuals of any age should check with their doctor before beginning a fitness program.
This questionnaire is designed for people aged 15 to 70.
Please answer the following questions honestly with a YES or a NO:
YES NO 1. Has your doctor ever diagnosed you with a heart condition AND told you to only do physical
activity they can supervise?
YES NO 2. Does your doctor currently prescribe you drugs for your blood pressure or heart condition?
YES NO 3. Do you feel chest pain during physical activity?
YES NO 4. Do you lose your balance due to dizziness OR have you lost consciousness in the last 12 months?
YES NO 5. Do you have a bone, joint, or soft tissue problem that may be irritated by physical activity?
YES NO 6. In the past 30 days have you had chest pain at any point?
YES NO 7. Do you have any other reason to NOT do physical activity?
If you answered YES to one or more questions:

Talk to your doctor BEFORE you begin physical activity and BEFORE completing any fitness assessments. Discuss
the questions you answered YES to with your doctor. Find out what activity you are cleared to partake in and any
next steps your doctor wishes you to take.
DELAY becoming more active:
If you answered NO to all questions:
• If you are not feeling well
If you answered no honestly to all PAR-Q questions, you may • If you are or may become
pregnant
• Become more physically active; start slowly and build up • If your health suddenly
gradually. changes
• Take part in fitness assessments.
• Consult with a fitness professional for guidance.
SIGN and RETURN a copy of this form to your fitness professional.

“I have read, understood to my satisfaction, and completed this questionnaire. I acknowledge that my fitness professional may
retain a copy of this form for their records and it will be kept with confidentiality in compliance with applicable laws.”
Name ________________________________________________________ Date _________________________
Signature _____________________________________________________ Witness _______________________
Signature of parent/guardian/care provider (if applicable) _____________________________________________
NOTE: The PAR-Q is intended to be completed prior to participation in a fitness assessment or physical activity. This activity
clearance is valid for 12 months from the date completed and becomes INVALID should your health change and you may
answer YES to any of the above questions.

Personal Training Liability Waiver
E
Name:________________________________________________________________________________
Date of Birth: __________________ Email: __________________________________________________
L
Address:______________________________________________________________________________
P
City:__________________________________________ State:____________ Zip Code: ______________
Primary Phone Number: _________________________________________
M
Name, Relationship, & Phone of Emergency Contact:
____________________________________________________________________________________
A
Training Facility Name: __________________________________________________________________
S
Training Facility Address: _________________________________________________________________
Do you have any physical limitations that could be aggravated by exercise (e.g., back, neck, shoulder, or knee
problems)?
E
If so, please explain:________________________________________________________________________
L
It is my responsibility to inform my trainer of any physical limitations before beginning a training program.
P
I represent and warrant that I am in good physical health and do not suffer from any medical condition
that would limit my participation in training offered at The Training Facility. I understand that it is my
M
responsibility to consult with a physician prior to and regarding my participation in any personal
training, fitness training, or group training. I understand the risks associated with the activities offered
by The Training Facility and I agree to follow all instructions so that I may safely participate in training,
workshops, or other activities.
S A
I hereby WAIVE AND RELEASE The Training Facility, its owners, officers, employees, and instructors from
any claim, demand, or cause of action of any kind resulting from or related to my participation in the
programs offered at the facility. In taking part in personal training, fitness training, or group training at
The Training Facility, I understand and acknowledge that I am fully responsible for any and all risks,
injuries, or damages, known or unknown, which might occur as a result of my participation in personal
training, fitness training, or group training.
I have read the above release and waiver of liability and fully understand its content. I am
legally competent to sign and voluntarily agree to the terms and conditions stated above.
Print name: ____________________________________________ Signature:_____________________________
Date Signed:_______/_______/_______
If participant is under 18: As Parent or Legal Guardian of _______________________________, I consent to the

above terms and conditions.
Print name: ____________________________________________ Signature:_____________________________
Date Signed:_______/_______/_______
Disclaimer: The form is provided by ISSA as an example. It is strongly suggested that the fitness
professional modify the form for their needs and have it reviewed by a licensed legal professional in their
state.


Print your answers. Please Print Clearly.
Name: Date of Birth: Age:
Address:
City, State, Zip:
Home Phone: Work Phone:
Employer: Occupation:
In case of emergency, please notify:
Name: Relationship:
Address:
City, State, Zip:
Home Phone: Work Phone:
Physician Information
Current Physician: Phone:
Are you under the care of a physician, chiropractor, or other health care professional for any reason Yes No
(circle)? If yes, list reason:
Are you taking any medications? (If yes, please list) Yes No
Medication: Dosage/Frequency: Condition:
List any and all allergies:
Has your doctor ever diagnosed you with high blood pressure? Yes No
Has your doctor ever diagnosed you with a bone or joint problem that has been or could be Yes No
made worse by exercise?
Are you over 65 years of age? Yes No
Are you used to vigorous exercise? Yes No
Please note: Possession of this form does not indicate certification status with ISSA. To confirm active certification status, please contact (866) 653-7561. Information
gathered from this form is not shared with ISSA. ISSA is not responsible or liable for the use or incorporation of the information contained in or collected from this form.
Always consult your doctor concerning your health, diet, and physical activity.

MEDICAL INFORMATION - Please answer the following questions (circle one):
1. Have you experienced any chest pain associated with either exercise or stress? Yes No If yes, please explain:
2. Have you experienced shortness of breath with or without exercise? Yes No If yes, please explain:
3. Have you experienced fainting or light-headedness? Yes No If yes, please explain:
4. Have you had a recent hospitalization for any cause? Yes No If yes, please explain:
5. Do you have any orthopedic conditions (including arthritis)? Yes No If yes, please explain:
6. Have you ever experienced a rapid heartbeat or palpitations? Yes No If yes, please explain:
7. Is there any reason why you should not follow a regular exercise program? Yes No If yes, please explain:
Please indicate if a blood relative (parent, sibling, first cousin, etc.) has a history of any of the following conditions (circle one). If
there is family history for any condition, please check the box to the left. On the line to the right, please indicate who in the family
has or had this condition.
❍ Asthma: ____________________________________________________________________________
❍ Respiratory/Pulmonary Conditions: ____________________________________________________________________________
❍ Diabetes: Type I: Type II: How Long? ____________________________________________________________________________
❍ Epilepsy: Petite Mal: Grand Mal: Other: ____________________________________________________________________________
❍ Osteoporosis: ____________________________________________________________________________
❍ Coronary Artery Disease: ____________________________________________________________________________
❍ Heart Attack: ____________________________________________________________________________
❍ Hypertension: ____________________________________________________________________________
❍ High Blood Pressure: ____________________________________________________________________________
❍ Stroke: ____________________________________________________________________________


Lifestyle/Habits - Please check the box that describes your current habits:
1. Do you smoke? Yes / No If yes, how often:
❒ Former user; Date quit:
❒ 1 or fewer cigarettes per day
❒ 2 to 5 cigarettes per day
❒ 6 to 10 cigarettes per day
❒ More than 10 cigarettes per day
2. Do you drink caffeine? Yes / No If yes, how often:

❒ Several times a day
❒ Once per day
❒ Few times per week
❒ Few times per month
3. Do you drink alcohol? Yes / No If yes, how often:

❒ Several times a day
❒ Once per day
❒ Few times per week
❒ Few times per month
4. On average, how many hours of sleep do you get each night?

❒ More than 10 hours
❒ 8-10 hours
❒ 5-7 hours
❒ Less than 5 hours
5. On average, what is your energy level like each day?

❒ High energy
❒ Moderate energy
❒ Low energy
Dietary Factors - Please indicate if you (personally) have a history of the following (circle one):
Anemia: Yes / No
Gastrointestinal Disorder: Yes / No
Hypoglycemia: Yes / No
Thyroid Disorder: Yes / No
Pre/Postnatal: Yes / No

Cardiovascular - Please indicate if you (personally) have a history of the following (circle one):
High Blood Pressure: Yes / No
Hypertension: Yes / No
High Cholesterol: Yes / No
Hyperlipidemia: Yes / No
Heart Disease: Yes / No
Skipped Heartbeat: Yes / No
Heart Attack: Yes / No
Stroke: Yes / No
Bypass or Cardiac Surgery: Yes / No
Angina: Yes / No
Gout: Yes / No
Phlebitis or Embolism: Yes / No
Other (please explain): Yes / No
Please list any other diagnosed conditions and the date of diagnoses below:


Pain History - Check if you have or have had pain in the following. If yes, please describe:
❍ Head/Neck: __________________________________________________________________________________________________________________________
❍ Upper Back: __________________________________________________________________________________________________________________________
❍ Shoulder/Clavicle: __________________________________________________________________________________________________________________________
❍ Arm/Elbow: __________________________________________________________________________________________________________________________
❍ Wrist/Hand: __________________________________________________________________________________________________________________________
❍ Lower Back: __________________________________________________________________________________________________________________________
❍ Hip/Pelvis: __________________________________________________________________________________________________________________________
❍ Thigh/Knee: __________________________________________________________________________________________________________________________
❍ Arthritis: __________________________________________________________________________________________________________________________
❍ Hernia: __________________________________________________________________________________________________________________________
❍ Surgeries: __________________________________________________________________________________________________________________________
❍ Other: __________________________________________________________________________________________________________________________
Nutrition
Are you on any specific food/diet plan? Yes No
If yes, please list and advise who prescribed it:
Do you take dietary supplements? Yes No

If yes, please list:
Do you notice your weight fluctuating? Yes No
Have you experienced a recent weight gain or loss? Yes No

If yes, explain how:
Over what amount of time?
If you consume caffeine, what types of beverages do you consume that contain caffeine?
How would you describe your current nutritional behaviors?
Other food/nutritional issues you want to include (food allergies, mealtimes, etc.)

Work and Environment
Please check the box that best describes your work and exercise Habits.
❍ Intense occupational and recreational effort
❍ Moderate occupational and recreational effort
❍ Sedentary occupational and intense recreational effort
❍ Sedentary occupational and moderate recreational effort
❍ Sedentary occupational and light recreational effort
❍ Complete lack of activity
How stressful are your environments (circle one)?
Work: Minimal Moderate Average Extremely
Home: Minimal Moderate Average Extremely
Do you work more than 40 hours a week? Yes No
Anything else you would like your personal trainer to know?
PRINTED NAME:
SIGNATURE: DATE:
SIGNATURE OF PARENT:
or GUARDIAN (for participants under the age of 18)
WITNESS:

3-DAY DIETARY LOG Page 1 of 4
Name: Date:
This dietary record must be as accurate as possible. Please do not alter your eating habits or modify your meals to change what
is logged. It is essential to be precise and honest because this log will aid your fitness professional in creating the best plan of
action for your current behaviors and lifestyle.
Instructions
1. Please keep this log with you at all times and log meals, snacks, drinks, and anything else you consume as accurately as
possible.
2. Whenpossible,useafoodscaleormeasuringspoonsorcups.Ifyoudonotfinishanentireservingthatwaslogged,please
adjust the log accordingly. Avoid guessing or estimating as much as possible.
3. Please list each food item in a meal separately.
4. For packaged items, use labels to determine quantities.
5. Include the time of day and any relevant notes in the last column.
6. Please log your food/drink consumption for three consecutive days. If there are special events or circumstances that
affect your nutrition on a certain day, please note this in the far right column. This will provide your fitness professional
with the appropriate insight. If you wish to log for more than 3 days, please do so.
7. Have this log completed and ready for your next session.
Example Log
Quantity Time of Day/

Food Item
(g, ml, Tablespoons [Tbs],
(include brand name)
teaspoons [tsp], cups [c], etc.)
Additional Notes
Breakfast 8:00 am - In a hurry
Toast 2 pcs
Margarine 1 tsp
Orange Juice 8 oz
Lunch 12:00 pm - Homemade pizza
Small pizza (pepperoni, mushroom,

12-inch diameter
cheese)
Dinner 5:00 pm
Chicken 4 oz
Baked Potato 8 oz
Mixed Frozen Vegetables (peas,

2c
carrots, corn)

Name: Date:
Day 1

Food Item
Additional Notes

Name: Date:
Day 2

Food Item
Additional Notes

Name: Date:
Day 3

Food Item
Additional Notes

ELEMENTS OF FITNESS
CHAPTER 08
LEARNING OBJECTIVES
1 | Name and describe the common goals of a fitness program and elements
of each.
2 | List the elements of a fitness program that should be incorporated for

health and optimal physical performance.
3 | Describe the components of each element of an effective fitness program.

CHAPTER 08 | Elements of Fitness
There are many reasons why someone would seek the guidance of a certified fitness professional.
The most common reasons tend to be associated with weight loss or weight management.
However, clients also seek out personal trainers to help improve their athletic performance, have
a better quality of life, or support their psychological health. Regardless of the goal, it’s critical
that a personal trainer uses their knowledge of the different elements of fitness to design unique
training programs in alignment with each client and their individual goals.
In addition to the client’s goals, a personal trainer should also prioritize the overall health of
the client and the fundamental skills associated with daily movement and the management
of basic physical needs:

CARDIOVASCULAR
ENDURANCE: • Grooming and personal hygiene
The measure of the
cardiovascular system’s • Dressing
(heart and blood vessels)
ability to perform over an • Toileting and continence
extended period.
• Transferring and ambulating
• Preparing food and eating

MUSCULAR STRENGTH:
The measure of force • Tasks that contribute to income
produced by a muscle or
group of muscles. To design a healthy, balanced, and effective training plan that aligns with a client’s goals, a
personal trainer should focus on the following five components of fitness:
MUSCULAR
• Cardiovascular endurance
ENDURANCE:
The ability of a muscle • Muscular strength
or group of muscles to
continuously exert force • Muscular endurance
against resistance over
time. • Flexibility
• Body composition
FLEXIBILITY: These components are often used as a gauge for an individual’s overall health. Although
The range of motion of a
muscle and its associated improving one component has its own benefits, striving to make improvements to all of them
connective tissues at a
joint or joints. is a key to balanced well-being.
BODY COMPOSITION:
The physical makeup of the
body considering fat mass
and lean mass.

Table 8.1 Common Fitness Program Goals
COMPONENT OF FITNESS PHYSIOLOGICAL BENEFITS
Cardiovascular endurance • Increases energy
• Improves stamina
• Helps control blood pressure
• Improves blood cholesterol
• Helps regulate blood sugar
• Burns calories to maintain body composition
• Promotes brain health
• Improves body’s cellular efficiency
• Reduces risk of disease
• Improves state of mind
Muscular strength • Maintains body composition
• Increases energy
• Increases bone density
• Enhances strength for activities of daily
living
• Reduces risk of disease
• Improves mental well-being
• Decreases risk of injury
• Improves posture
• Enhances longevity
Muscular endurance • Improves stamina
• Reduces fatigue
• Increases metabolism
• Reduces risk of injury
• Improves mood
• Increases sleep quality
• Prevents age-related decline in brain function
• Promotes ability to exercise longer

Table 8.1 Common Fitness Program Goals (CONT)
COMPONENT OF FITNESS PHYSIOLOGICAL BENEFITS
Flexibility • Reduces risk of injuries
• Improves balance
• Promotes better posture
• Reduces pain
• Improves physical performance
• Increases range of motion
• Improves circulation
TYPE 2 DIABETES: Healthy body composition • Decreases risk of type 2 diabetes

A long-term metabolic
disorder that is • Decreases risk of hypertension
characterized by high blood
sugar, insulin resistance, • Decreases risk of heart disease
and relative lack of insulin.
• Promotes a healthier metabolism
• Fosters a better range of motion

HEART DISEASE:
A term used to describe • Provides energy for activities of daily living
several different heart
conditions. • Promotes better functioning of organs
• Regulates hormones
• Helps control weight
• Improves circulation
• Enhances healthy lung function
• Promotes healthy pregnancy
• Improves sleep quality
ELEMENTS OF A FITNESS PROGRAM

When designing a well-balanced fitness program, there are specific elements a personal
trainer should consider. Each element has specific health and wellness benefits and
variability in how they may be executed based on the client’s needs and abilities. Not all
these elements need to be addressed in every workout, but they should all be considered at
some point, to some degree, in a comprehensive fitness program.
The elements of a fitness program are:
• The warm-up

• Flexibility training
• Core training
• Balance training
• Reactive training
• Resistance training
GENERAL WARM-UP:
• Cardiorespiratory training Nonspecific, low-intensity
activity including dynamic
• The cooldown stretching and light
cardiovascular activity with
THE WARM-UP the purpose of increasing
blood flow, respiration, and
A warm-up is necessary for preparing the body for the activity or training. A general warm-up body temperature.
is simple and will increase blood flow, respiration, body temperature, and neurological
activation of the major muscle groups. For example, a warm-up could consist of walking on a SPECIFIC WARM-UP:
Movements used to
treadmill or riding a stationary bike for five minutes before a training session. prepare the body for a sport
or specific exercises.
A specific warm-up intentionally mimics movements that will be part of the workout or activity.
In this way, specific movement patterns and the tissues associated with those movement DYNAMIC
patterns are prepared for the upcoming activity. Warm-ups may include variations of dynamic STRETCHING:
Movement-based active
stretching and light cardiovascular activity.
stretching where muscles
engage to bring about a
Every training session should include a warm-up for several reasons. First, the increased blood stretch.
flow reduces muscle stiffness (increases extensibility) and can prevent injury. Second, warm
muscles contract and relax faster with a higher rate of contraction and better neuromuscular FLEXIBILITY TRAINING:
An element of fitness using
activation. Third, the increased respiration delivers oxygen to the bloodstream and body more stretching to increase the
range of motion of a joint or
effectively during activity, and, finally, a warm-up can help a client mentally prepare for the group of joints and allow for
forthcoming workout. increased ranges of motion.
FLEXIBILITY TRAINING STATIC STRETCHING:

Lengthening a muscle and
Flexibility is a critical element of fitness that is often overlooked. Flexibility training uses holding the lengthened
position.
stretching to increase the range of motion of a joint or group of joints and allow for increased
ranges of motion. It is an important aspect of all training programs, as flexibility and range of
LENGTH-TENSION
motion begin to diminish in most people around the age of 25.
RELATIONSHIP:
The amount of tension a
Static stretching is ideal for a cooldown rather than a warm-up protocol. It has been shown
muscle can produced as
to change the length-tension relationship of a muscle fiber, which can increase the risk of a function of sarcomere
length.
injury or alter performance if it’s done before an activity.

CORE TRAINING
The abdominal muscles aren’t the only muscles included in the core, so core training involves more
CORE TRAINING: than just targeted abdominal work. Core training refers to strengthening the musculature of
Refers to strengthening
the musculature of the the abdominals, back, and lower body that directly influence the lumbopelvic hip complex (LPHC).
abdominals, back, and
lower body that directly
influence the lumbopelvic
Table 8.2 Muscles of the Core and LPHC
hip complex (LPHC).
Hip adductors Gluteus medius Gluteus minimus
LUMBOPELVIC HIP Erector spinae Rectus abdominus Gluteus maximus

COMPLEX (LPHC):
Hamstring complex Quadriceps Hip flexors
The musculature of the hip
that attaches to the pelvis
and lumbar spine and Transverse abdominus Internal obliques External obliques
works to stabilize the trunk
and lower extremities. Multifidus Pelvic floor muscles
Core training is an element of fitness necessary for every client. Research suggests that a
ABDOMINAL BRACING: strong core contributes to increased sports performance, stability, reduced back pain, and
Activation of the trunk increased functional strength for everyday activity.
muscles to support the
spine.
Proper core training exercises work to stabilize the spine by targeting as many of the core
muscles as possible to work in tandem. In addition to specific core training exercises, the
BALANCE TRAINING:
Exercises to strengthen
technique of abdominal bracing during exercise can also help strengthen the core. Abdominal
the stabilizer muscles bracing activates the muscles of the trunk to support the spine and hold the pelvis in a
and prime movers of the
core and legs to improve neutral position. Examples of exercises that activate the core and use abdominal bracing
dynamic stability.
include planks, hinges, rotational movements, and balance training. Because the core needs

to be strong and functional in all planes of motion, a well-rounded exercise program will
include exercises that challenge the core in all planes of motion.
The standard crunch is an exercise that emphasizes the rectus abdominis muscle. To perform
a crunch, lie on the back with the knees bent and the bottom of the feet on the ground and
approximately hip-width apart. Contract the abdominals to shorten the distance between the
bottom of the ribs and the top of the pelvis. The shoulders should rise off the ground slightly.
Slowly return to the start position.
The plank is an exercise that challenges the ability of the core to maintain a neutral position.
On the floor facedown, rest the body’s weight on the forearms and toes. The goal is to keep
the body in a straight line. The ankles, knees, hips, and shoulders should be in line with each
other, and the eyes should face down keeping the head and neck in alignment.

The cable woodchop exercise is a rotational exercise that emphasizes the musculature of the
hips and torso. Stand with a cable to the side of the body in a high position. Feet should be
approximately hip width apart. Grab the handle with both hands above the shoulder and the
chest facing the cable. Swing the cable across the body and downward toward the opposite
thigh by rotating the hips and torso in a wood-chopping motion. This movement should be
initiated and controlled by the hips and torso rather than the arms.
BALANCE TRAINING
Balancing, in everyday life or during athletic performance, requires a significant amount of
sensory input. Visual input from the eyes, auditory input from the ears, and input regarding
the body in space are gathered by proprioceptors in the muscles and tendons. In addition,
motor control and muscle power are necessary to maintain stability. Purposeful movements
that require balance and stability include walking, doing laundry, lifting weights, and even
relatively simple recreational activities such as fishing. Muscular strength is an important
component of balance. Strong muscles stabilize the joints—spine, knees, ankles—and help
prevent falls. Reflexive movements, such as recovering from a stumble, also require balance,
motor control, and muscular strength.
The body systems involved in balance can be affected by injury, illness, neurological disorders,
medications, and advancing age. Balance training involves manipulating and stimulating sensory
systems to challenge the ability to maintain one’s center of gravity and remain upright.

These systems include the following:
• Visual: opening or closing the eyes
• Vestibular (or inner ear): moving the head by focusing the gaze in different directions
during an exercise
• Somatosensory: manipulating body position or using an unstable surface
The reported benefits of balance training include
• improved static and dynamic stability,
• reduced incidence of recurrent ankle injury,
• reduced low back pain (with core training), and
• reduced joint pain (with strength training).
Balance training should become progressively more difficult. For example, one might progress
a balance training program by practicing the following movements:
1. Floor: two legs
2. Floor: single-leg with step
3. Floor: single-leg with ball
4. Floor: single-leg
5. Balance pad: two legs
6. Balance pad: single-leg with step
7. Balance pad: single-leg with ball
8. Balance pad: single-leg
Balance training is a key component in preparing the body to progress in a fitness or training program
and should be incorporated to help support better movement, performance, and quality of life.

The single-leg balance exercise is an effective way to introduce balance training into a
program. Begin standing upright and slowly lift one foot off the ground. The goal is to maintain
this position. As balance begins to fail, return to the upright single-leg position as quickly as
possible while maintaining control.
The BOSU is a tool that can be used to add an unstable surface to an exercise and therefore
add additional challenge to balance. The two-leg balance on the BOSU (standing on the flat
side) is a progression from balancing on a stable surface. To perform the exercise, stand on
the flat side of the BOSU with a slight bend in the knees and hips. The goal is to minimize
movement back and forth and stay on the BOSU.

The step up to balance is a dynamic balance exercise because the step-up portion moves the
body from one position to another. This creates momentum, which adds an additional challenge
to the balancing leg. To perform the exercise, use a short, stable step at approximately knee
height. Step one foot forward and place it on the step. Drive through the front foot to lift the body
and back foot over the step. The body should end in an upright position with the back foot coming
up into a high-knee position. Hold the top position until fully balanced and under control.
The step up to balance on a BOSU has all the elements of the step up to balance but adds
the unstable surface of the BOSU. To perform the exercise, use the BOSU as the stepping
surface. Step one foot forward and place it on the dome side of the BOSU. Drive through the
front foot to lift the body and back foot over the BOSU. This is the point where balance and
control are tested differently than with a stable step, as the surface is soft and unstable. The
body should end in an upright position, with the back foot coming up into a high-knee position.

Hold the top position until fully balanced and under control.
REACTIVE TRAINING
Although sports are most often associated with the need for speed, agility, and quickness (SAQ),
nonathletes can benefit from the incorporation of reactive training into their fitness programs as well.
REACTIVE TRAINING:
Quick, powerful movements Defined as quick, powerful movements with an eccentric action followed by an immediate
with an eccentric action
followed by an immediate concentric action, reactive training trains the body to be explosive, fast, and agile. Speed, agility,
concentric action.
and quickness are required for most athletic endeavors. Speed is the ability to move the body in
one direction as fast as possible. Agility is defined as the ability to accelerate, decelerate,
SPEED: stabilize, and change direction with proper posture. Quickness is the ability to react and change
The ability to move the body
in one direction as fast as body position with a maximum rate of force production. Success in athletic performance is usually
possible.
attributed to one or all these. However, so are general function and locomotion.
AGILITY: Though reactive training is commonly used to develop explosive, powerful movements, a by-
The ability to accelerate,
decelerate, stabilize, and product of training in this manner is the improvement of the body’s ability to safely accept the
change direction with
forces created, thereby providing an increased level of injury resistance. Day-to-day life may, at
proper posture.
times, provide a challenge in which a client needs to avoid a fall or rapidly respond to something
unexpected, such as a cup falling off a table. Speed, agility, and quickness are critical skills that
QUICKNESS:
The ability to react and can help an individual catch themselves from that fall or react to grab the falling cup.
change body position with
a maximum rate of force
production. Many studies have proven the benefits of training for speed, agility, and quickness. Here are
some of the findings:
COUNTERMOVEMENT: • Improved performance in sprints, jumping performance in countermovement, and

A movement or other action
made in opposition to continuous jumping (bounding)
another action.
• Improved power performance in sports

• Improved VO2 max, agility, visual vigilance, and cognitive performance
• Increased time to exhaustion
• Improved muscle strength for movements in all directions
• Improved efficiency in reception and processing of brain signals
• Enhanced development of all motor skills
• Reduced time to reaction
• Improved balance
• Improved measures of functional ability
• Improved body composition; cardiovascular, aerobic, and anaerobic fitness; strength;

agility; and performance-related measures for athletes
Training abilities in SAQ innervates the nervous system, making movement patterns nearly
automatic and therefore more efficient. Training more efficient movement patterns helps
prevent injuries during extreme training and in sports competitions.
Some elements and methods used in training SAQ include medicine balls, agility ladders,
cones, ropes, hills, parachutes, hurdles/gates, boxes, and plyometric training.

PLYOMETRIC
The lateral shuffle drill helps to improve or assess quickness, agility, and body control as it TRAINING:
relates to lateral movement. Set two cones 5 to 10 yards apart. Be sure to record the chosen Reactive training seeking
maximum force in the
distance if using this drill as an assessment. Start in an athletic position. Feet about hip shortest amount of time.
width apart and a slight bend in the hips and knees. Facing the same direction the entire
time, start by one of the cones and side shuffle back and forth between the cones, touching
each cone with the outside hand. The goal is to shuffle, without crossing the feet, as quickly
as possible while maintaining body control. Count the number of times shuffled back and
forth in 20 seconds.

The box drill is another valuable exercise that can be used to improve agility, speed,
quickness, change of direction, and body control. This drill can also be used as a test to
record improvements in those same attributes. It is performed by running around four cones
that are set up ten yards apart in a square configuration.
To successfully complete the drill, the participant will do the following:
1. Start next to cone 1
2. Sprint to cone 2
3. Side shuffle to cone 3
4. Back-pedal to cone 4
5. Finish by turning and sprinting past cone 1
The participant must go around the outside of each cone. If performing this drill as a test, a
stopwatch must be used to record the time taken to complete the drill.
Shuffle
❷ ❸
Backpedal
Sprint
❶ ❹
Start /
Finish
Turn and Sprint
Figure 8.1 Box Drill
PLYOMETRICS
Plyometric exercises are those involving repeated maximum stretching and contracting of
STRETCH-SHORTENING muscles in the shortest amount of time. Methods used in plyometric exercises include
CYCLE (SSC): hops, jumps, leaps, bounds, depth jumps, split lunges, box jumps, explosive push-ups, and
The cycling between the medicine ball throws.
eccentric (stretch) action
of a muscle and the
concentric (shortening) Plyometric exercises increase muscle power by enhancing the stretch-shortening cycle
action of the same muscle.
(SSC). The SSC is an almost instantaneous cycle of muscle actions made up of three

phases. First is the eccentric contraction phase (lengthening of the muscle), where the
muscle stores energy; next is the transitional period (amortization phase); and last is the
concentric contraction phase (shortening of the muscle), where the stored energy is released.
Compressing a spring builds tension in the coils, storing energy for the rebound. Applying
more force or speed to compress the spring builds more energy, causing the spring to rebound
higher or further. In a fitness application, a “run up” creates a higher or longer jump compared
with jumping from a stationary position. This springlike action enhances athletic performance
in both explosive and endurance sports.
The squat jump is an example of a plyometric exercise for the lower body. To perform the
exercise, start in an upright position. Then quickly drop down into a squat position to load
energy into the muscles of the legs and hips. Immediately drive through the ground explosively
to extend the hips and knees and jump into the air. Land softly, bending at the ankles, knees,
and hips to spread the force of the landing throughout the lower-body musculature.
Plyometrics are effective for:
• promoting positive changes in neural and musculoskeletal systems, muscle
function, and athletic performance;
• enhancing bone mass in prepubertal/early pubertal children, young women, and
premenopausal women;
• changing the stiffness of elastic components of the muscle-tendon complex of
plantar flexors;
• improving lower-extremity strength, power, and SSC muscle function; and
• reducing the risk of lower-extremity injuries in female athletes.

The body adapts to plyometric exercise in many ways, including
• improved intermuscular coordination,
• increased muscle size,
• improved storage and use of elastic energy,
• increased active muscle working range,
• enhanced involuntary nervous reflexes,
• increased muscular pre-activity, and
• enhanced motor coordination.
The split jump is a lower body plyometric exercise. The exercise is performed in a split stance
(one foot forward and the other foot back). From this position, quickly lower into a lunge
position for the eccentric phase of the exercise. This is immediately followed a concentric
contraction of the lower musculature of the body to propel (jump) into the air. Switch the
positioning of the legs while in the air (the front leg will move to the back while the back leg
moves to the front). Land softly and under control, keeping the knees in alignment with the
feet. From here, immediately lower into the lunge position and explode into the next rep
(again switching the position of the legs in the air). Repeat for the desired number of reps.
The speed skater is a lower body plyometric exercise that focuses on lateral agility. The
movement is a lateral back and forth hop. Starting in an athletic position (slight bend in
the hips and knees), push off the left foot to hop laterally, landing on the right foot. Land
in an athletic position with control of the body. Immediately press off with the right foot to
jump back to the starting position, landing on the left foot. Continue to repeat the process
for the desired number of repetitions. Special attention should be given to the landing leg

and the trail leg. Be sure to control the lateral momentum that will influence the landing leg
by keeping the knee in alignment with the foot. The trail leg will have momentum as well.
Control it and do not let it cross past the body or the landing leg.
An example of an upper-body plyometric is the plyometric push-up. To perform the exercise,
begin in a standard push-up position (arms extended), then quickly drop down by bending at
the elbows and shoulders to load the upper-body musculature with energy. Immediately and
explosively push back toward the starting position and leave the ground. Land softly, bending
at the elbows and shoulders to absorb the force of the landing.

RESISTANCE TRAINING
RESISTANCE TRAINING: Resistance training, also called strength training, involves exercises with the explicit intent
The category of training
of increasing strength, endurance, muscle size (hypertrophy) or power. To promote muscular
that includes physical
activities designed to adaptation, resistance training must be challenging enough to tear the muscle fiber. As a
increase muscle mass,
improve strength, muscular result, many people experience muscle soreness and delayed onset muscle soreness
endurance, or muscular
power. (DOMS) with resistance training. DOMS is specifically caused by muscle microtearing that
occurs during eccentric (lowering) muscle action. Muscular strength is divided into several
DELAYED ONSET categories to distinguish purpose and execution.

MUSCLE SORENESS
(DOMS):
Muscle pain or stiffness
resulting from microtearing
of tissue during eccentric
muscle action that is
felt several days after
unaccustomed exercise.
TARGET HEART RATE CARDIORESPIRATORY TRAINING

(THR): The cardiorespiratory system serves several primary functions including:
The estimated beats per
minute that needs to
be reached to achieve a • Delivery of oxygen and nutrients to the cells
specific exercise intensity.
• Removal of carbon dioxide and metabolic waste products
• Regulation of body temperature

RATES OF PERCEIVED
• Maintenance of pH balance (a measure of acidity and alkalinity)
EXERTION (RPE):
A subjective sliding scale of • Delivery of hormones to target tissues
a client’s perception of their
exercise intensity. Training the cardiorespiratory system requires continuous, rhythmic exercise involving large
muscle groups. The body’s response to exercise is directly proportional to the oxygen
HEART RATE ZONES: demands of the skeletal muscles. When exercise intensity is low, oxygen uptake and cardiac
Percentages of maximum
heart rate associated with output is low. When intensity increases, oxygen uptake and cardiac output increase to match.
a desired physiological
adaptation. This type of exercise may include walking, jogging, running, cycling, swimming, aerobics,
rowing, stair climbing, hiking, cross-country skiing, and dancing.
Cardiorespiratory training uses target heart rate (THR), rates of perceived exertion (RPE),
and heart rate zones to determine intensity and drive physiological adaptations. The THR

denotes a specific percentage of estimated maximum heart rate (220 minus a person’s age)
to achieve during training, while the RPE is a subjective sliding scale of a client’s perception
MAXIMUM HEART
RATE:
of their exercise intensity.
The estimated maximum
number of times the heart
should beat per minute
STEADY-STATE ACTIVITY during exercise. Calculated
by subtracting a person’s
Continuous activity performed at a fixed level of exertion is called steady-state exercise. Walking,
age from 220.
running, cycling, and swimming are examples. The heart requires a constant supply of oxygen for
continuous activity. At rest, the myocardial capillaries absorb 70 to 80 percent of blood oxygen. STEADY-STATE
Skeletal muscles absorb only about 25 percent. The body adapts to regular steady-state exercise EXERCISE:
Exercise that maintains
by increasing blood flow to the heart to keep up with its aerobic energy demands.
a steady level of exertion
from start to finish.
In addition, blood volume increases in response to regular steady-state activity. Oxygen uptake
and delivery increase three to four times (from 4 or 5 mL of oxygen per 100 mL of blood to 15
or 16 mL per 100 mL). The blood vessels branch out and form additional capillaries to deliver
more blood to the working muscles. Pulmonary ventilation increases almost immediately at
the onset of exercise. Respiratory centers in the brain stem and proprioceptors in moving
joints and limbs send signals to the body to increase respiration.
The heart adapts as well, increasing the size and strength of the left ventricle to increase
contraction strength and blood capacity. A stronger left ventricle increases the stroke volume,
or the amount of blood pushed out during contraction. Because the heart is stronger and
pushes more blood per beat, the resting heart rate is lower in trained individuals.

INTERVAL TRAINING
Interval training involves a series of low- to high-intensity workouts combined with periods of
INTERVAL TRAINING:
Training that varies between rest or lower-intensity activity. Interval training has been proven to produce many of the same
high- and low-intensity
work to challenge the adaptations as steady-state training but with less volume (up to 90 percent) and time
cardiorespiratory system.
commitment. In fact, steady-state training would have to be performed up to four times longer
than interval training to produce the same physiological adaptations.
A common form of interval training is high-intensity interval training (HIIT). High-intensity

HIGH-INTENSITY
segments are brief—10 to 45 seconds—at 85 percent or more of VO2 Max. Each training session
INTERVAL TRAINING
has less than or equal to just 10 minutes of high-intensity work. HIIT is a low-volume workout that
(HIIT):
Interval training with short produces training adaptation with less time spent. A simple example is sprinting around a track
intervals at near maximum
effort and less intense as the work intervals with either walking or jogging in between as the rest intervals.
recovery periods.
Just as with cardiovascular endurance training, interval training has been found to have the
following benefits:
• Increases in oxidative capacity of skeletal muscles
• Strengthening of the left ventricle
• Increase in stroke volume
• Improvement in peripheral vascular structure and function (veins and arteries in the
arms, legs, hands, and feet)

THE COOLDOWN
COOLDOWN:
A post-activity cooldown has both physiological and mental benefits. Taking time to slow Gradually slowing the body
after activity to return to
down and reduce the resistance of exercise before ending a training session allows the body
homeostasis or close to
temperature, blood pressure, heart rate, and breathing rate to return to a level closer to homeostasis.
normal. This is an ideal time to static stretch and perform self-myofascial release (SMR) to
promote muscle recovery and optimal length-tension relationships within muscle fibers.
SELF-MYOFASCIAL
RELEASE (SMR):
Mentally, a cooldown allows the exerciser to focus their energy, recap what they just completed, Applying manual pressure
to an adhesion or
and prepare for recovery and the remainder of their day. Skipping a cooldown means muscle overactive tissue to elicit
an autogenic inhibitory
tissue abruptly stops contracting. This may lead to blood pooling in the extremities, muscle response, which is
characterized by a decrease
cramps, or muscle stiffness. The interruption of blood flow is cited as a top reason not to forgo a in the excitability of a
contracting or stretched
cooldown period. Research also suggests that neuromuscular recovery increases and the risk of
muscle arising from the
injury in subsequent training decreases with a gradual slowing of the body after activity or sport. Golgi tendon organ.
TEST TIP!
The cooldown is an ideal time for static stretching. The body is still warm from activity
which means the muscles are more pliable. Additionally, muscles may tighten during
a workout so the static stretching can aid in restoring a normal resting length to the
musculature.

PRINCIPLES OF
CHAPTER 09
PROGRAM DESIGN
LEARNING OBJECTIVES
1 | List and describe the most common acute training variables in fitness.
2 | Describe each of the primary principles of program design and how a

fitness professional uses them to create exercise programming.
3 | Describe the common types of exercise periodization.
4 | Define overreaching and overtraining in exercise and fitness.
5 | Define the elements of an effective fitness program.

CHAPTER 09 | Principles of Program Design
Fitness program design is defined as the systematic development of a fitness program or

FITNESS PROGRAM process using assessments, the elements of fitness, periodization, and periodic
DESIGN: reassessment. A fitness program must work through the following elements:
The systematic
development of a fitness
program or process using • The warm-up
assessments, the elements
of fitness, periodization, • Flexibility training
and periodic reassessment.
• Core training
• Balance training
PERIODIZATION:
An organized approach • Reactive training
to training involving
progressive cycling of • Resistance training
various aspects of a
training program during a • Cardiorespiratory training
specific time.
• The cooldown
However, program design is not as simple as creating workouts for each element and putting
them together. The principles of program design are fundamental propositions that serve as
PRINCIPLES OF the foundation for effective fitness programming. These principles outline the ways that
PROGRAM DESIGN: training adaptations occur along with the variables within a fitness program. Variety and
Fundamental propositions
to serve as the foundation creativity in exercise programming are dictated by these principles as well.
for effective fitness
programming.
Each of the principles considers the acute training variables. In fitness, acute training
variables detail how an exercise is performed. They are the most fundamental components
ACUTE TRAINING
of designing training programs, and they are essentially what drive the potential adaptations
VARIABLES:
The components that of the body. To understand the principles of fitness, a fitness professional must first
specify how an exercise
or training program is understand the acute training variables.
performed.
ACUTE VARIABLES OF FITNESS

The acute training variables are modified on the basis of the client’s abilities, desired training
outcomes, and progress through their training program. They include the following variables:
• Type
• Exercise selection
• Exercise order
• Intensity
• Sets
• Repetitions
• Frequency
• Range of Motion

• Time
• Tempo
MUSCULAR
ENDURANCE:
• Time under tension The ability of a muscle
or group of muscles to
• Rest continuously exert force
against resistance over
Proper manipulation of these variables leads to achieving training goals in an optimal and time.
efficient manner. The possible muscular adaptations that occur due to training are increases
in muscular endurance, hypertrophy, strength and power. HYPERTROPHY:

An increase in muscular
size as an adaptation to
TYPE exercise.
Exercise type refers to the techniques, equipment, or methods used to complete an activity.
This includes all modalities of exercise—cardio training, resistance training, flexibility, STRENGTH:
plyometrics, etc. The exercise type describes the equipment used as well—for example, The amount of force that
can be created by a muscle
alternating a client between a lying leg press and a back squat for a similar movement pattern or group of muscles.
performed a different way or using the elliptical trainer for cardiovascular training in one
session and a stair mill in another. POWER:

The combination of strength
Using their knowledge of the training session’s location and the equipment available, a trainer for a muscle to generate
maximal tension as quickly
will need to appropriately select and vary the type of equipment used for effective and safe
as possible.
energy system training and muscle activation.
TYPE:
EXERCISE SELECTION The techniques, equipment,
or methods used to
Exercise selection refers to the specific exercises executed in a workout session. In many complete an activity.
programs, this is one of the most important training variables to adjust to ensure optimal
adaptation. For example, in a strength training program, a hip thrust will be more effective for EXERCISE SELECTION:
glute muscle activation than a barbell back squat. On the other hand, a barbell back squat is The specific exercises
executed in a workout
the optimal choice if overall lower-body strength development is the goal. The training goal session.
should dictate exercise selection and how exercises are prioritized in exercise programming.
Exercises that fill time or allow the prime movers to rest are most effective if they do not
target the same prime mover—for example, performing a lying leg raise while allowing the
arms to rest after a heavy biceps curl.

EXERCISE ORDER
Exercise order refers to the order in which exercises are completed. High-intensity compound
EXERCISE ORDER:
The order in which exercises—multi-joint movements that require multiple muscles or muscle groups such as
exercises are completed
squats, bench presses, Olympic lifts, box jumps, etc.—are made a priority before completing
within a training session.
accessory exercises. In other words, it makes sense to do the exercises that require the
COMPOUND most effort and control first and save the less intense exercises for the end of a training
EXERCISES: session.
Multi-joint exercises that
require the use of multiple Accessory exercises are additional, focused movements that strengthen synergist and
muscles or muscle groups.
supporting muscles to help a person better perform a primary movement. For example,
during a workout focused on the pulling muscles of the back, core training and exercises for
ACCESSORY
shoulder stabilization should be completed after the main movements. Done this way, the
EXERCISES:
Supplementary focused high-intensity compound exercises can be given the full focus and energy they require at the
movements or exercises
that strengthen synergist beginning of the workout. The accessory exercises, which require less energy are done later
and supporting muscles
to help a person better in the workout. They will help increase core strength and improve the stability of the shoulder
perform a primary
during both pushing and pulling movements.
movement.
INTENSITY
Intensity is the measurable amount of force or effort given to an activity or exercise. High-
INTENSITY: intensity is often associated with higher anaerobic energy demand, while lower intensity is
The measurable amount of
force or effort given to an associated with aerobic energy demand. Low-intensity activity, such as steady-state
activity or exercise often
expressed as a percentage cardiovascular training, can elicit aerobic adaptations with longer-duration sessions. High-
of effort compared to a
intensity efforts can be associated with muscular strength and power adaptations. Intensity
person’s maximum effort.
is often expressed as a percentage of effort compared to the maximum effort—for example,
ONE-REPETITION MAX 70 percent of one-repetition maximum (1RM) (the maximum load that can be moved for one
(1RM): repetition) or 70 percent of maximum heart rate.

A single maximum-strength
repetition with maximum Load is a term used specifically to describe the amount of resistance used (intensity) in a strength
load.
training exercise. During strength training, the type and amount of resistance will vary depending
on the tool used. This resistance can come from free weights, bands, cables, machines, and body
LOAD:
A term used to describe weight. Load is correlated to muscle fiber recruitment; in other words, the greater the load, the
the amount of resistance
used in a strength training greater the amount of muscle fiber recruitment necessary to move the load.
exercise.
A common misinterpretation of this terminology is that “high-intensity” means difficult and
“low-intensity” means easy. This is not necessarily the case. High intensity means a high
amount of force or effort. A single maximum high jump would be defined as a high-intensity

effort. On the other hand, power walking is generally considered a low-intensity effort, even
though power walking for an hour may be a challenging workout. This means that a single
maximum high jump is the more intense activity, but power walking may, in fact, be the more
challenging workout overall.
Table 9.1 Resistance Training Intensity Protocol By Training Goal
TRAINING GOAL INTENSITY (% 1RM)
Muscular endurance 67 percent or less
Hypertrophy 67 – 85 percent
Maximum strength 85% or greater
Power
80 – 90 percent
Single-repetition event
75 – 85 percent
Multiple-repetition event
SETS
A set is the number of times an exercise or group of exercises (superset) is completed. The
number of sets executed in a training session will be adjusted based on the client’s training SET:
The number of times
goals. Each training outcome has an ideal range of sets for each exercise to promote the an exercise or group of
exercises is completed.
desired adaptation. The number of sets will also depend on the number of repetitions and
relate closely to the workout time and, in many cases, intensity.
Table 9.2 Sets Protocol By Training Goal
TRAINING GOAL SETS
Muscular endurance 1–3 sets
Hypertrophy 3–4 sets
Maximum strength 3–5 sets
Power 3-5 sets
REPETITIONS
The term repetitions (reps) describes the number of times an exercise is completed within a
REPETITIONS (REPS):
The number of times an
set. Each repetition contributes to muscle fatigue, muscle damage, and the physiological exercise is completed
within a set.
response during recovery. They can be varied within a training program to induce or avoid

intraset muscle fatigue. Intraset muscle fatigue is the fatigue that occurs within a single set
INTRASET MUSCLE of an exercise—for example, one training day limits repetitions to 10, but during another training
FATIGUE: session, the repetitions continue until maximum fatigue is achieved with the same load.
Muscle fatigue that occurs
within a single set of an
exercise. Table 9.3 Repetition Protocol By Training Goal
TRAINING GOAL REPETITIONS
Muscular endurance 15 or more repetitions
Hypertrophy 6 – 12 repetitions
Maximum strength 1 – 6 repetitions
Power 1 – 5 repetitions
FREQUENCY
Exercise frequency describes the number of times training occurs within a specific period.
EXERCISE FREQUENCY: Frequency can also apply to the number of times or how often a specific exercise is performed.
The number of times
training occurs within a This variable is linked to the desired training outcome. For example, those looking for
specific period, or the
number of times or how improved cardiovascular endurance (distance runners or swimmers) may increase the
often an exercise is
frequency of training sessions each week to force this adaptation. The increase in frequency
executed.
will, in turn, increase the time spent performing an activity (assuming other variables remain
constant), which drives endurance. Those looking to add to the total weekly volume in their
weight training routine may move from a weekly training frequency of three days per week to
four days per week.
Other reasons for adding frequency to a workout or specific exercise could be when the goal
is improving skill, increasing or maintaining flexibility, or simply increasing total daily activity.
Examples include the following:
• Daily body weight squats to improve the skill of performing the movement with good form
• A daily flexibility routine to counteract sitting at a desk all day
• Adding morning and evening walks to add to total daily activity
RANGE OF MOTION
RANGE OF MOTION Range of motion (ROM) is the amount of movement in a joint measured in degrees. In an
(ROM): exercise, particularly those in which multiple joints are moving, the range of motion will be
The measurement of
movement around a specific the total movement of all primary joints involved, which adds up to the total distance the joint
joint or body part.
travels in a single repetition of the exercise. For a fitness professional, it is imperative to help

clients understand that the proper ROM or the proper form for an exercise can be specific to
the individual. In other words, proper ROM means the distance that a person can move
through an exercise with coordination and timing and without pain.
Partial repetitions are an example of adjusting the range of motion in an exercise. Partial
reps are repetitions of an exercise intentionally done with a reduced ROM. There are a few PARTIAL REPETITIONS:
Repetitions of an exercise
reasons partial reps may be used, including: intentionally done with a
reduced range of motion.
• working around a part of the ROM that is dysfunctional or uncomfortable,
• maximizing overload of a particular muscle within a movement, and
• prioritizing the weakest points in a range of motion to strengthen the movement as a whole.
TIME
The time is the duration of an activity or training session. The overall duration of an exercise
bout is, again, tied to the desired training outcome. Endurance typically requires the use of TIME:
The duration of an activity
the aerobic energy system with longer sessions; resistance training sets and sessions may or training session.
not take as long in total to be effective. In many cases, resistance training is based on the
time necessary to complete the selected exercise prescription, while endurance and aerobic
training are based on increasing the time spent doing aerobic activity to make the aerobic
energy system more efficient.
TEST TIP!
Acute variable mnemonics: how to remember the acute training variables.
FITT Principle—applies most often to cardiovascular training
F – Frequency: number of times a cardiovascular exercise is performed (per week)
I – Intensity: the amount of effort expended during the activity (level, speed, incline)
T – Type: the type of cardiovascular exercise completed (bike, treadmill, stair mill)
T – Time: the duration of the activity
The Five Rs—applies most often to resistance training
R – Repetitions: the number of times the range of motion is completed consecutively
R – Rest: the time spent resting between repetitions or between sets
R – Recovery: the time spent recovering between exercise sessions
R – Resistance: the load (weight) used for an exercise
R – Range of motion: the total amount of joint movement used during an exercise

TEMPO
The tempo is the speed at which an exercise or movement pattern is executed. This includes
TEMPO: the time spent on the eccentric, isometric, and concentric muscle actions. Slower tempos will
The speed at which an
exercise or movement increase the time spent per repetition and, thus, per set.
pattern is completed.
As with all other acute training variables, the tempo of an exercise should be aligned with
the training goal. Slower tempos can be used for practicing exercise technique or for creating
programming that increases the total time in each set. Faster tempos allow for training fast,
explosive muscular contractions.
Tempo is written as
eccentric count : isometric hold count : concentric count : isometric hold count
For example, completing a biceps curl with a tempo of three-count eccentric (lowering), no isometric
hold, one-count concentric (lift or contract), and no isometric hold would read as 3:0:1:0.
Table 9.4 Tempo Protocol By Training Goal
TRAINING GOAL TEMPO
Muscular endurance 4:0:6:0
Hypertrophy 3:1:3:1
Maximum strength 3:0:1:0
Power Fastest controllable tempo
Another consideration regarding tempo is the time it takes a client to learn new movements.
To successfully learn a new movement or exercise, the client should start by using slow
tempos. This will help the participant gain competence and confidence in their ability to
perform the movement safely and effectively.
TIME UNDER TENSION TIME UNDER TENSION

(TUT): Time under tension (TUT) is directly related to tempo. It refers to the amount of time a
The amount of time a muscle is engaged, or under tension, in a set. The main takeaway for time under tension is
muscle is engaged as a
set, completed from start that increasing TUT will also increase training volume and time. The table below shows the
to finish.
effect of tempo on TUT for a set and an entire training session.

Table 9.5 Time-Relate Training Variables Compared to Number of Repetitions
TUT FOR EXERCISE VOLUME TUT FOR ENTIRE

NUMBER OF NUMBER OF
TEMPO THE SET (IN (NO. OF REPS) IN TRAINING SESSION
REPETITIONS SETS
SECONDS) TRAINING SESSION (IN SECONDS)
8 2:0:2:0 32 5 40 160
4 5:0:5:0 40 5 20 200
3 10:0:10:0 60 5 15 300
Adapted from M. Wilk, A. Golas, P. Stastny, M. Nawrocka, M. Krzysztofik, and A. Zajac, “Does Tempo of Resistance Exercise Impact Training
Volume?” Journal of Human Kinetics 62, no. 1 (June 13, 2018): 241–50, https://doi.org/10.2478/hukin-2018-0034.
REST
Rest is the amount of time spent in recovery between sets. When considering the time
between training sessions, rest is also referred to as recovery time. The rest periods are REST:
The amount of time spent
important not only for cardiovascular recovery but also for metabolic (energy system) recovery. in recovery between sets or
repetitions.
The intensity of the set of an exercise performed will determine which energy system is
dominant and, therefore, the amount of rest that is needed between sets. Additionally, to
RECOVERY TIME:
drive specific adaptations (e.g., strength or endurance), rest between sets must be taken into The rest time allowed
account and monitored to ensure the desired result. between training sessions.
The need for recovery also applies between training sessions. As the intensity and volume of
training sessions increases, the time needed to optimize recovery between sessions will also
increase. Methods of recovery will include restful sleep, sound nutrition, and low-intensity
movement or active recovery practices that will promote blood flow and flexibility. Active
ACTIVE RECOVERY:
recovery is low-intensity exercise or activity that can promote and accelerate muscular and
Low-intensity exercise or
metabolic recovery. It is generally more beneficial for promoting and accelerating recovery activity that can promote
and accelerate muscular
from higher-intensity activities. and metabolic recovery.
Each variable can change based on the ability of the exerciser, the stage of training, and the
goals of training. The variables may also affect each other as they are modified. For example,
the number of sets or repetitions can vary within a workout. Generally, as the number of sets
decreases, the number of individual exercises in a workout will increase. In the same manner, as
the number of repetitions increases, the load used will likely decrease. As load decreases, the
exerciser may increase the tempo of the exercise along with their perceived intensity throughout
a set. As the intensity increases, the rest needed will increase or decrease depending on the
phase of training the exerciser is in and the desired adaptation. Those seeking the adaptation
of endurance may shorten rest periods, while those seeking power may increase the rest period.

Table 9.6 Rest Protocol By Training Goal
TRAINING GOAL REST BETWEEN SETS
Muscular endurance 30 – 60 seconds
Hypertrophy 30 – 60 seconds
Maximum strength 2 – 5 minutes
Power 1 – 2 minutes
TEST TIP!
There are five variables to focus on for most clients: sets, reps, intensity, tempo, and rest.
Sets are variable based on the training goal. Beginners will only need one to two sets
per exercise. As the body adapts, the number of sets can increase.
Repetitions play a large role in muscle adaptation. The phase of training will determine
the ideal rep counts, such as 2–12 reps for hypertrophy or 15–25 reps for endurance.
The intensity of an activity or exercise is also based on the training phase and goals.
Strength training should maintain an intensity of no more than 20 percent more than
the exerciser’s 1RM to achieve the desired training outcomes. Resistance training
has an inverse relationship between reps and intensity—as the reps decrease, the
intensity increases.
Tempo is especially important when working with athletes but should not be
overlooked with the general population. It is written as “eccentric : isometric :
concentric : isometric,” or “lowering : pause : lifting : pause.” For example, a squat
may be performed at a 3:1:3:1. TUT for each repetition of the squat described is
eight seconds; therefore, a set of 10 squats performed at this tempo would have a
TUT of 80 seconds. Slower tempos produce higher TUT and are typically associated
with physiological adaptations such as muscular endurance and hypertrophy, whereas
quicker tempos produce lower TUT and are typically associated with maximal force
production.
Finally, rest is necessary to avoid injury and promote optimal performance. The
intensity or resistance used will determine the rest needed. For loads less than 60
percent of maximum, 45 seconds to two minutes is recommended. Activities of 90
percent or more of maximum can require three to five minutes of rest.

THE PRINCIPLES OF FITNESS
The principles of fitness outline the ways that training adaptations occur as well as the
variables within a fitness program. These science-based principles should be the basis for
the programming decisions a trainer makes when creating fitness programs and selecting
exercises and acute variables for each individual client.
PRINCIPLE OF SPECIFICITY
The principle of specificity states that training must be specific to one’s goals, as the
PRINCIPLE OF
adaptations they will see will be based on the type of training completed. All clients should
SPECIFICITY:
begin with training that is right for their current fitness level. As fitness develops, they may The concept that training
must be specific to an
progress to advanced exercises or exercise techniques. For example, a client training for a
individual’s goals, as
marathon must incorporate running into their training program, and, ideally, running is the the adaptations they will
see will be based on the
main component of the program. Complementary exercises would then balance the program training completed.
and help prevent overtraining.
An individual training for an obstacle course event must train for the specific requirements
of that race—grip strength, muscular endurance, mental toughness, and proprioception are
examples of these requirements.
Figure 9.1 Soccer Skill Training versus Soccer Gameplay

SAID PRINCIPLE:
SAID PRINCIPLE Specific adaptations to
imposed demands—stress
The SAID Principle reinforces the principle of specificity. SAID is an acronym that stands for
on the human system,
specific adaptations to imposed demands. The body adapts specifically to the stress placed whether biomechanical or
neurological, will require the
upon it, and each sport or activity has its unique mix of physical requirements. Performance body to adapt specifically to
those demands.
is dependent upon the body adapting to those specific demands and becoming stronger,

faster, leaner, or more powerful. The specificity of training will be metabolic, muscle fiber–
specific, mechanical, or neuromuscular. This means if someone is working to improve their
aerobic capacity for endurance, their training should focus on type I muscle fibers and the
aerobic energy system.
For example, training for a 200-meter dash is much different from training for a 10K or
endurance event. A sprinter may vary resistance to gain speed by running up hills or stadium
stairs to train type II muscle fibers, anaerobic muscular capacity, and the cardiovascular
system for fast oxygen uptake and transport. An endurance athlete will vary the duration of
their workouts to improve muscular endurance and aerobic cardiovascular capacity.
Table 9.7 Specific Adaptations to Physical Demands
SPECIFIC ADAPTATIONS ANAEROBIC TRAINING AEROBIC TRAINING

TO ANAEROBIC AND (HIGH POWER (LOW POWER
AEROBIC EXERCISE OUTPUT) OUTPUT)
Performance
Muscle endurance Increases Increases
Muscle strength Increases No change
Vertical jump Increases No change
Aerobic power No/slight increase Increases
Sprint speed Increases No/slight increase
Anaerobic power Increases No change
Body composition
Fat-free mass Increases No change
Percent bodyfat Decreases Decreases
Muscle fiber
Capillary density No change or decreases Increases
No change or slight
Fiber size Increases
increase
Fast heavy chain myosin Increases No change or decreases
Type II muscle fiber conversion Almost all convert Most convert

Table 9.7 Specific Adaptations to Physical Demands (CONT)
SPECIFIC ADAPTATIONS ANAEROBIC TRAINING AEROBIC TRAINING

TO ANAEROBIC AND (HIGH POWER (LOW POWER
AEROBIC EXERCISE OUTPUT) OUTPUT)
Mitochondrial density Decreases Increases
Bone and connective tissue
Bone density No change or increases No change or increases
Collagen content May increase Varies
Ligament strength Increases Increases
Tendon strength Increases Increases
Metabolic energy stores
Stored creatine phosphate Increases Increases
Stored adenosine triphosphate Increases Increases
Stored triglycerides Increases Increases
Stored glycogen Increases Increases
Enzyme activity
Myokinase Increases Increases
Creatine phosphokinase Increases Increases
Lactate dehydrogenase No change or varies Varies
Phosphofructokinase No change or varies Varies
PRINCIPLE OF VARIABILITY
Another principle is the principle of variability. Training programs must include variations in
PRINCIPLE OF
intensity, duration, volume, and other aspects of practice. The acute variables of a fitness
VARIABILITY:
program must be changed to prevent plateaus, overuse injuries, boredom, and burnout. Also, Training programs must
include variations in
modifying the variables changes the mode of exercise and the results realized. It is important intensity, duration, volume,
and other aspects of
to consider the following research:
practice.
Seventeen young male participants followed either a hypertrophy training program or a
strength training program.

Hypertrophy program: three sets of 10 repetitions at 10RM (max weight that can be lifted
10 times) with a 90-second rest
Strength program: seven sets of 3 repetitions at 3RM (max weight that can be lifted 3 times)
and three minutes of rest between sets
At the end of the eight-week study, there was no difference in muscle thickness between
the two groups. However, the strength training group significantly increased 1RM in bench
press and squat.
Although both types of training—hypertrophy and strength—produced similar results in
muscle thickness, only strength training increased muscular strength. The specific training
protocol used was more effective than a general program for improving maximal strength.
PRINCIPLE OF INDIVIDUAL DIFFERENCES OR DIMINISHING RETURNS

Everyone is different. Individuals within the same family—even twins—have a different
genetic blueprint, cellular proteins, and gene expressions. Genetics influences everything
from body size and shape, chronic health conditions, muscle fiber type, recovery time, and
propensity for injury. And genes at least partially determine the degree to which a client will
see results and how quickly a client will see results from their program. The principle of
PRINCIPLE OF individual differences states that there is no one specific way to train every individual.
INDIVIDUAL
DIFFERENCES: In the early ’80s, researchers assessed a collegiate swim team throughout an intense 75-day
The concept that there
training program. They measured four physiological parameters and found that even though each
is no one specific way to
train every client due to the person followed the same training protocols, results varied. For example, during the peaking
uniqueness of each person.
program, different physiological and performance profiles were noted among the athletes.
This research emphasizes the need for trainers to seriously consider individual differences.
The goal should always be to help clients reach their goals in the safest, most timely manner.
In addition to the genetic differences between individuals, the fitness professional must
consider lifestyle differences. These include dietary and training preferences, previous and
DIMINISHING
current medical conditions, sex, motivation, and past experiences.
RETURNS:
A concept stating that
Finally, the concept of diminishing returns suggests that clients will eventually hit a ceiling in
everyone has a set genetic
limit to their potential, and, their fitness performance. This theory states that everyone has a set genetic limit to their
eventually, the effort put
into training will no longer potential. Eventually, the effort put into training, which initially lead to a great deal of result,
produce the same results.
will begin to yield less and less results.

PRINCIPLE OF PROGRESSIVE OVERLOAD
For fitness to progress, the body must be forced to adapt to or overcome a stress greater than
what is normally encountered. This is known as the principle of progressive overload. Put
simply, to increase biceps strength, a client must lift a resistance greater than one they are PRINCIPLE OF
unaccustomed to for an adaptation to occur.
PROGRESSIVE
OVERLOAD:
The body must be forced
Progressive overload must be incremental to be effective. This applies not only to resistance
to adapt to or overcome a
training but also to various exercise methods and variables: stress greater than what is
normally encountered.
• Range of motion: progress is made by lifting the same load with a slightly increased
degree of range of motion in the joints involved—for example, squatting a few
inches lower than before.
• Training volume: altering training volume allows a person to lift the same load for
more repetitions or perform more sets with the same load and number of repetitions. TRAINING VOLUME:
The total amount of
• Intensity: increasing intensity means increasing the load or lifting the same load work performed, typically
measured as Sets x Reps x
with greater speed and acceleration. Load (or intensity).
• Training density: training density is the amount of work done in a specified amount
of time. Rest times can be manipulated so that more work is done in the same TRAINING DENSITY:
A combination of volume
amount of time or so that the same amount of work is completed in less time. For and time equaling the total
volume of work in a specific
instance, a fitness professional can prescribe a circuit of five exercises to be
amount of time.
completed as many times as possible within a 30-minute window. This is also
known as “as many reps as possible,” or AMRAP.
• Frequency: increasing frequency means doing the same amount of work more often
during a given period of time (e.g., a week).
PRINCIPLE OF REVERSIBILITY
Put simply, the principle of reversibility means “use it or lose it.” A sedentary client will see PRINCIPLE OF
significant gains within the first few weeks of training due to neuromuscular facilitation. After REVERSIBILITY:
Clients lose the effects
a few more weeks, observable changes occur through physiological and structural adaptations.
of training after they stop
However, training effects will diminish if clients discontinue physical activity for two weeks or working out.
more. This is known as detraining. But it’s important to note that the detraining effects can
be reversed when training is resumed. DETRAINING:

The diminishing of physical
adaptations after two
weeks or more of not
training.

GENERAL ADAPTATION SYNDROME

The general adaptation syndrome (GAS), first discussed in the 1930s, states that the body
GENERAL ADAPTATION
goes through three stages of adaptation in response to stress. This idea is the reason
SYNDROME (GAS):
The three stages of periodization is used in training. If a training stimulus is intense enough, fitness will decrease
adaptation the body goes
through in response to
for a brief time. However, the body then goes through a period of supercompensation, where
stress—alarm, resistance, the trained function has a higher performance capacity than the baseline.
and exhaustion.
The three stages of stress adaptation are the alarm stage, resistance, and exhaustion.
SUPERCOMPENSATION:
The post-training period Alarm Stage
during which the trained
function/parameter has The alarm stage is the body’s initial response to stress. Symptoms include fatigue, weakness,
a higher performance
capacity than it did before or soreness. Individuals will see gains in strength but mostly through neuromuscular changes.
the training period.
This stage may last from two to three weeks.
Resistance Stage
After continued exercise, the body will enter the resistance stage around four to six weeks. At
this point, changes in the body include biochemical, mechanical, and structural. Clients may
experience improvements in muscle size and strength.
Exhaustion Stage
The exhaustion stage may happen at any time in GAS. Symptoms in this stage mimic those
of the alarm stage, but without adequate rest or recovery, the client may experience burnout,
overtraining, injury, or illness.
High
The body’s resistance to stress can

only last so long before exhaustion
sets in.
Stress
Resistance
Stressor occurs
Low
Phase 1 Phase 2 Phase 3
Alarm reaction Resistance Exhaustion
(mobilize (cope with stressor) (reserves
resources) depleted)
Figure 9.2 General Adaptation Syndrome Stages

An extension of the GAS is the stimulus-fatigue-recovery-adaptation principle. Training
stimuli produce a general response based upon the level of intensity of the training stressor. STIMULUS-FATIGUE-
The greater the workload, the more fatigue accumulates and the longer it takes for the body
RECOVERY-ADAPTATION
PRINCIPLE:
to completely recover and adapt. As the individual recovers from and adapts to the stimuli, The concept that training
response is based on the
fatigue dissipates, and preparedness and performance increase. The more the individual is
stimulus intensity, and
exposed to a stimulus with proper recovery, the better the body will adapt. the greater the stimulus
intensity is, the longer the
recovery needed to produce
Studies have shown that although recovery is an important part of the training equation, it the adaptations will be.
is not always necessary to reach a state of full recovery before engaging in another workout
session. The training schedule can take advantage of recovery timing to accelerate or
enhance training adaptations.
PERIODIZATION
To periodize a training program means to break it into different phases, each of which is
designed to elicit specific physiological adaptations. The primary goals of periodization are
as follows:
• Manage fatigue and reduce the possibility of overtraining
• Improve readiness for competition or sports season
• Help set and manage short-term and long-term goals
There are several methods of organization used by fitness professionals. Linear, reverse
linear, undulating, block, and conjugated periodization are the current types discussed in the
TRAINING
fitness industry. Each method divides the overall program into three periods: macrocycle,
MACROCYCLE:
mesocycle, and microcycle. The overall training period,
usually one year or more.
A training macrocycle is typically one to four years long. Although, a macrocycle may be a
shorter period. For example, many popular training packages last 12 weeks. This represents TRAINING MESOCYCLE:
A training phase in the
a training program as a whole.
annual training plan
made up of three to nine
A training mesocycle lasts from three to nine weeks while the training microcycle is the microcycles.
shortest training cycle. It can be a single training session or, typically, a single week. The
method used to organize these training cycles will vary based on the individual and their TRAINING
training goals.
MICROCYCLE:
A one-week-long cycle of
training sessions, or a
single session.

Table 9.8 Training Cycles
JAN. FEB. MAR. APR. MAY JUNE JULY AUG. SEPT. OCT. NOV. DEC.
Macrocycle
Mesocycle Mesocycle Mesocycle Mesocycle
13 microcycles 18 microcycles 8 microcycles 13 microcycles
LINEAR PERIODIZATION
Linear periodization progresses from low-intensity to high-intensity across the entire
LINEAR macrocycle, generally progressing from high repetitions of lighter resistance to low repetitions
PERIODIZATION: of higher resistance. Linear periodization is also known as traditional periodization. As time
Progresses from low-
intensity to high-intensity progresses, training volume decreases while intensity increases, and exercise selection
across the entire
macrocycle. remains constant.
In this model, eventually the client will reach 100 percent of their maximum strength. When
this happens, the individual will only perform one maximal lift per set or a 1RM. Linear
periodization is more effective when used over a mesocycle.
Table 9.9 Example of Linear Periodization
WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5
Repetitions 10 8 6 5 2
Percentage
65 percent 70 percent 75 percent 80 percent 85 percent
of 1RM
UNDULATING PERIODIZATION
Undulating periodization follows an alternating pattern. Training volume and intensity roll
UNDULATING through a program and may change either daily or weekly. This method was developed to
PERIODIZATION: prevent the neural fatigue experienced when training at a high intensity.
Short durations of
hypertrophy training
alternated with short Daily Undulating Periodization
durations of strength and
power training. Volume and intensity change from day to day during the microcycle.
Table 9.10 Example of Daily Undulating Periodization
DAY 1 DAY 2 DAY 3 DAY 4
70 percent 10IRM 80 percent 10IRM 75 percent 10IRM 85 percent 10IRM

Weekly Undulating Periodization
Volume and intensity vary from week to week. Mesocycles last about 14 days, and three or
four different workouts are staggered throughout. One week, for example, intensity is high,
and volume is low. The next week, volume is high, and intensity is low.
Table 9.11 Example of Weekly Undulating Periodization
WEEK 1 WEEK 2 WEEK 3 WEEK 4
Intensity High Low High Low
Volume Low High Low High
Following a strict undulating model, volume and intensity remain within a set range, and
exercises are consistent. The variables of resistance, sets, and repetitions change throughout.
BLOCK PERIODIZATION
During a block-periodized program, each mesocycle has a specific purpose. In many cases,
training progresses through the following training categories: SPEED, AGILITY, AND
• Foundational training: elements of flexibility, mobility, core, and balance training
QUICKNESS (SAQ)
TRAINING:
• Strength training: resistance training that includes both body weight and loaded activity The training category
including reactive, ballistic,
• Metabolic training: aerobic and anaerobic energy system training including plyometric, and agility
training.
cardiovascular exercise and intervals
• Speed, Agility, and Quickness (SAQ) training: elements of agility and plyometric training
PHASE POTENTIATION:
All periodized training should build from one cycle to the next, which is known as phase The strategic sequencing
of programming categories
potentiation. Block periodization offers a general format for progression. However, not all to increase the potential
clients will progress to later phases such as power or plyometrics. of later training and
increase long-term adaptive
potential.
PROGRAMMING WITH PERIODIZATION
Periodized programs are designed to systematically develop fitness. Each cycle should build BLOCK
a level of fitness necessary to complete the next cycle so the program may progress. Training PERIODIZATION:
Highly concentrated,
progressions typically progress as follows: specialized workloads
focused on achieving
• Stable ► unstable maximum adaptation.
• Static ► dynamic
• Unloaded ► loaded
• Slow ► fast
• Simple ► complex

Stability is a major concept of biomechanics. It should always be a focus before mobility as

MOBILITY: it can help a client improve skeletal misalignments, muscular imbalances, and ideal
The ability of a joint to
move freely through a given movement patterns. Hence the importance of the assessment process with a focus on
range of motion.
identifying movement and muscular dysfunctions.
OVERREACHING AND OVERTRAINING

OVERREACHING: Without adequate rest and recovery, clients may suffer from overreaching, overtraining, or,
An accumulation of training
or non-training stress rarely, overtraining syndrome (OTS). Overreaching is a cumulative training effect in which
resulting in a short-term
decrease in performance stressors cause a short-term decrease in performance capacity. Overtraining takes this one
capacity.
step further, with a long-term decrease in performance capacity because of stress.
Overtraining syndrome is a systemic response to excessive stress.

OVERTRAINING:
An accumulation of training Many clients, especially deconditioned clients, may experience some of the following
or non-training stress
resulting in a long-term symptoms as part of developing fitness. However, fitness follows fatigue, which drives
decrease in performance
capacity. adaptation. When symptoms are chronic or long-lasting, then overtraining may be occurring.
For well-conditioned clients, very intense training may cause severe fatigue. However,
periodizing the program means planning for these intense cycles and then for rest and
OVERTRAINING
recovery to prevent overtraining.
SYNDROME (OTS):
A maladapted response to
excessive exercise without OVERTRAINING SIGNS AND SYMPTOMS
adequate rest, resulting in
perturbations of multiple There are two forms of overtraining. One affects the sympathetic nervous system and the
body systems (neural,
endocrine, and immune) other the parasympathetic nervous system. Each client is different, but if a client experiences
coupled with mood
any one or more of the following signs and symptoms, it may mean that it is time to cut back
changes.
on training. Symptoms of overtraining may include
• physical performance decline even as training continues;
• change in appetite;
• weight loss;
• sleep disturbances;
• elevated resting heart rate;
• elevated resting body temperature;
• muscle cramps;
• irritability, restlessness, excitability, anxiousness;
• loss of motivation and vigor in training;
• lack of mental concentration and focus; and
• lack of appreciation for normally enjoyable things.

CAUSES OF OVERTRAINING
Scientists have not yet determined the cause of overtraining syndrome. However, there are
several theories, some of which include the following causes or contributing factors:
• Low glycogen: low stores of glycogen cause fatigue and a decline in performance.
• Cumulative microtrauma: repeated stress on muscles, bones, tendons, and nerves
causes cellular damage that can get worse over time.
• Decreased glutamine: immune dysfunction increases sensitivity to infection, which
could be caused by decreased glutamine.
• Oxidative stress: when the body is unable to fight free radicals caused by exercise,
muscle damage and fatigue result.
• Autonomic nervous system stress symptoms of OTS often occur when the
parasympathetic nervous system works overtime.
• Hypothalamic causes: symptoms of overtraining syndrome may result if the
hypothalamus or hormonal axes are not working properly.
• Cytokine release: inflammation and cytokine release can cause many symptoms
of OTS.
TEST TIP!
Avoiding overtraining
Following a periodized training program does not guarantee the avoidance of
overtraining, but it is a start. Here are additional tips to avoid overtraining:
Use a training journal.

Heart rate, oxygen uptake, and blood lactate levels are the best predictors of
overtraining. Record sets, repetitions, exercises, rest between sets, and heart rate
during exercise. Record the client’s perceived exertion, sleep quality, and nutritional
habits. If performance declines or the client feels overly taxed, it will be easier to
determine the possible cause.
Vary training methods.

Following a periodized plan reduces the risk of overtraining. Programs should be
periodized and progressive to yield the best results.

Apply preferred therapies.

There are many therapies available to reduce muscle soreness and ease discomfort.
It is best to find cost-effective therapies that provide relief quickly.
Get enough sleep.

Sleep is a critical part of recovery. Both quality and quantity matter. Many researchers
believe deep sleep is the most restorative phase of sleep. During deep sleep,
muscles relax, blood supply to muscles increases, growth hormone is released, and
tissues are repaired.
Avoid or minimize other stressors.

It may not be possible for all clients to avoid or neglect stress outside of the exercise
session. However, the body reacts to all stress in a similar fashion. Therefore,
minimizing environmental, social, biochemical, and other stress is recommended
to avoid overtraining.
Increase resilience.
Techniques such as meditation, mindfulness, visualization, and hypnotherapy may
help reduce stress. They can also help improve mindset and mental toughness.
Because a major factor in training is the “mental game,” the mind must also be part
of the recovery process.
TRAINING CATEGORIES AND THE ELEMENTS OF A FITNESS PROGRAM

The progressions of a training protocol provide a flexible outline a trainer can use to create
client workout programs. Whether within a single workout or over the course of a few weeks,
the elements of fitness can be divided into four training categories:
• Foundational training
• Strength training
• Metabolic training
• Speed, agility, and quickness training
FOUNDATIONAL TRAINING
Foundational training encompasses the elements of flexibility, mobility, core, and balance
FOUNDATIONAL
training. These are foundational concepts that serve to prepare the body for movement.
TRAINING:
The basic training elements These elements are also ideal parts of a dynamic warm-up and are easy to incorporate into
of flexibility, balance, and
every training session, regardless of how developed a training program has become. The
core training.
difficulty or intensity of the elements will likely progress as the client’s program advances—

for example, starting with a basic forearm plank for 30 seconds as part of core training. With
each new workout, the trainer can increase the acute variable of time spent in the plank.
When the desired maximum time is achieved, the type of plank can be altered to make it
more challenging.
Table 9.12 Example of Foundational Training Progression
TRAINING WEEK 1: WEEK 1: WEEK 1: WEEK 2: WEEK 2: WEEK 2:

SESSION DAY 1 DAY 2 DAY 3 DAY 1 DAY 2 DAY 3
Forearm Forearm Forearm

Type of Forearm Forearm Forearm plank with plank with plank with
plank plank plank plank alternating alternating alternating
leg lift leg lift leg lift
Duration of
30 sec 45 sec 60 sec 30 sec 45 sec 60 sec
plank hold
STRENGTH TRAINING
Strength training is a category that includes resistance training. Resistance can include body
weight as well as tools such as dumbbells, kettlebells, barbells, and resistance bands to STRENGTH TRAINING:
The category of training that
build strength, increase muscle mass, and improve muscular endurance. includes resistance training
for increased muscle mass
and improved strength and
Following the principle of progression, a trainer may have an unconditioned client begin
muscular endurance.
resistance training with simple body weight exercises. This creates the opportunity to correct
improper movement patterns and begin to improve neuromuscular efficiencies before adding
load. Next, resistance bands can be added, then weights in the form of dumbbells, barbells,
etc. Again, this progression of load can happen within a microcycle (single workout) or over a
mesocycle based on the client’s abilities and goals.
For example, a progressing load within a training session might look like this:
traditional push up >> standing resistance band chest press >> barbell bench press
The training variables of tempo, repetitions, volume, rest, and time under tension (TUT) are of great
focus during resistance training. Using the desired adaptation, hundreds of variable combinations
can be made. The tempo of resistance exercise affects the volume and TUT most closely.

Table 9.13 Resistance Training and Acute Variables
TIME
TRAINING TEMPO
REPETITIONS VOLUME REST UNDER
GOAL (EXAMPLE)
TENSION
1–3 <20
Strength 2:0:2:0 1–5 3–5 sets
minutes seconds
Muscular 1–2 >70

6:0:4:0 13+ 1–3 sets
endurance minutes seconds
1–3 ~40
Hypertrophy 3:1:3:1 6–12 3–4 sets
minutes seconds
METABOLIC TRAINING
Metabolic training is geared toward the training of both the aerobic and anaerobic energy
METABOLIC TRAINING: systems. The technical definition of metabolic training is any exercise that helps to improve
A style of training that
typically uses high-intensity the performance of the energy systems. This category typically uses high-intensity intervals
intervals to train both the
aerobic and anaerobic to train both the aerobic and anaerobic energy systems. The exercise choices can be
energy systems.
traditional cardiorespiratory exercises, such as using a treadmill or elliptical, or compound
resistance training movements. These would be done with a relatively fast tempo and little to
no rest. The total volume would depend on the goal and fitness level of the individual.
This style of training addresses conditioning of all three energy systems, is a good choice for
maximizing calorie burn, and trains the body to perform dynamic movements. Many of these
dynamic movements would be power exercises and being plyometric in nature, would fall into
the category of SAQ.

Table 9.14 Energy Systems and Metabolic Training
ENERGY SYSTEM WHEN IT DOMINATES TRAINING EXAMPLE
ATP/CP 0-10 seconds 40-yard full sprint
Single kettlebell circuit (15

Glycolytic 10-120 seconds swings, 8 snatches each arm,
10 goblet squat jumps)
Aerobic 2 minutes + 20-minute elliptical session
SPEED, AGILITY, AND QUICKNESS (SAQ) TRAINING

SAQ training is a category that not all clients will work through, or they may only use certain
parts of it. For example, agility training is a functional aspect of any training program to
improve balance and prevent falls and injury. However, jump training or ballistic training for
explosive power may not be within the goals of every client. BALLISTIC TRAINING:
A form of power training
involving throwing weights
The speed at which the elements of SAQ training must occur to be effective will increase or jumping with weights to
improve explosive power.
the heart rate, elicit higher calorie burn, and challenge the metabolic systems on the basis
of duration. Therefore, these elements can be used for metabolic training and high-intensity
intervals. However, they do require a strength and mobility foundation before they can be
implemented.
Example exercises that can be used with both the general population and athletes include
ball slams, squat jumps, ladder drills, and explosive push-ups.
When used for athletic performance, SAQ training should follow the principle of specificity and
relate to the movements of the athlete’s sport. Keeping exercise selection specific and applicable
will guarantee skill advancement with the appropriate manipulation of training variables.

Table 9.15 Acute Training Variable for Power Training
TRAINING TEMPO
REPETITIONS VOLUME REST
GOAL (EXAMPLE)
Fastest
Power controllable 1–5 3–5 sets 1-2 minutes
tempo
Table 9.16 Training Categories and Elements
FITNESS PROGRAM ELEMENT(S)

TRAINING CATEGORY
AND TYPES
Flexibility training
Foundational training Core training
Balance training
Strength training Resistance training
High-intensity interval training (HIIT)

Metabolic training
Cardiorespiratory training
Reactive training
Speed, agility, and quickness Ballistic training
training
Plyometric training
Agility training
*Bolded program elements are usually part of most fitness programs, regardless of training goal.

TEST TIP!
Foundational Training
SAQ Strength
Training Training
Metabolic Training
The training categories each hold unique elements of fitness. However, based on the
needs and goals of a client, the order and time spent in each category will vary. A
personal trainer will use training cycles to establish a timeline for a client to reach
their goal or milestone. Then, within those training cycles, the trainer can distribute
the categories and elements to best elicit the desired adaptations.
A trainer should always consider the important principles of program design, such as
specificity, overload, and progression to ensure safe, effective training advancement.

CONCEPTS OF
CHAPTER 10
FLEXIBILITY TRAINING
LEARNING OBJECTIVES
1 | Describe the benefits of flexibility training.
2 | Identify and explain the acute variables for flexibility training.
3 | Explain the difference between static and dynamic stretching and how to
use them in an exercise program.

CHAPTER 10 | Concepts of Flexibility Training
Flexibility is defined as the range of motion (ROM) of a muscle and its associated connective
FLEXIBILITY: tissues at a joint or joints. It is an element that has great variability based on the involved
The range of motion of a
muscle and its associated joint or joints and an individual’s physical state. A client who increases their flexibility can
connective tissues at a
joint or joints. improve a joint’s ROM—the extent of movement of a joint measured in the 360 degrees of a
circle. Increasing flexibility can have a positive impact on many fitness qualities including
RANGE OF MOTION posture, balance, ROM, and general performance.
(ROM):
The measurement of
Although flexibility has many benefits, having flexible muscles has not been directly linked to
movement around a specific a reduced risk of injury. However, many of the named benefits of flexibility have been found
joint or body part.
to reduce injury risk. In other words, having adequately flexible muscles may not limit injuries
CONNECTIVE TISSUES: by itself, but better balance as a result of adequately flexible muscles can limit falls and
Tissues that support, therefore injuries. Improved balance, posture, and muscle strength are a few of the benefits
connect, or bind other
tissues or organs. associated with optimal flexibility.
Table 10.1 Benefits of Flexibility Training
BENEFIT DESCRIPTION
Improved Many additional benefits of flexibility are related to having a greater

ROM ROM. Tight muscles reduce the ROM at joints, limiting a person’s ability
to perform activities of daily living (ADL) such as reaching overhead,
standing up straight, or optimal positioning for picking up heavy loads.
Improved Poor posture is often the result of overactive muscles, which can pull joints
posture out of alignment. Muscles with sufficient ROM can reduce imbalance and
allow joints to move in a proper ROM to maintain ideal posture.
Improved Joints that move through a full ROM help keep the body balanced
balance during movement. Better balance, especially as people age, helps
prevent falls and injuries.
Decreased Tight muscles create pain by putting strain on bones, ligaments,

chronic pain and tendons. Flexible muscles have less tension, thereby reducing
pain. Stretching—along with hydration and dietary habits—reduces
the occurrence of muscle overactivity and altered length-tension
relationships.
Improved Overactive muscles often have a reduced capability to create muscular

muscle force due to the altered length-tension relationship of the muscle fibers.
strength Flexibility improves this length-tension relationship, which can increase
the muscular strength of the same fibers.

Table 10.1 Benefits of Flexibility Training (CONT)
BENEFIT DESCRIPTION
Improved Flexible muscles and ideally aligned joints allow the body to move
performance more efficiently. Flexible and optimally strong muscles lead to
enhancements in sports performance or ADL performance when the
correct training variables are applied.
Improved With reduced pain and tightness, being flexible has been found to
mood improve mood by eliciting feelings of relaxation and comfort.
Genetics plays a significant role in an individual’s flexibility, so some clients will be naturally
more flexible than others. The structure and shape of the joint have a direct effect on the
amount of flexibility in that joint. No matter the starting point, flexibility can be enhanced by
committing to a relatively brief stretching routine at least three times a week.
While flexibility is important, so too is strengthening the muscles around the joint to prevent
injury. There needs to be adequate strength throughout the joint’s ROM, including working
antagonist muscles equally. Using light weights and going through the full ROM will promote
improved flexibility. As fatigue sets in, ROM decreases because the muscles tighten due to
the workload. Therefore, stretching after a workout is essential to maintaining full ROM.
Most people tend to lose flexibility as they age, but that is due, in part, to inactivity. When not
in use, the connective tissue in the joints becomes shortened, can stiffen, and can lose
elasticity. Regular exercise and dynamic and static stretching can help maintain the full ROM
and counteract the natural loss of function that comes with age. Past injuries also can affect
STATIC STRETCHING:
Lengthening a muscle and
overall flexibility. Generally, women are considered to be more flexible than men, but anyone holding the lengthened
position.
can make flexibility improvements.
For the general population who need to improve or maintain ROM, clients should be advised
to stretch daily. If needed, they should allow adequate recovery between intense stretching
bouts, typically one or two days. If flexibility is a necessary component of the client’s lifestyle,
as for a gymnast, then flexibility should be a major focus during the preseason and throughout
the competitive season. Joints with a history of injury or immobility should be simultaneously
strengthened and stretched during the off-season training cycles. Additionally, there is a HYPERMOBILITY:
The condition of having
portion of the population that experiences hypermobility, meaning they have excessive
excessive amounts of
amounts of ROM in a joint or joints. A focus on strengthening those areas as opposed to range of motion in a joint
or joints.
additional flexibility training is best in this situation.

METHODS OF FLEXIBILITY TRAINING

Stretching can be characterized by the way in which it is performed. Active stretching involves
ACTIVE STRETCHING:
A muscle actively a muscle actively contracting to stretch another. No external force is applied to perform the
contracting to stretch
stretch. For example, while lying on the floor in a supine position, a client can lift one straight
another.
leg up toward the ceiling to stretch the hamstrings. To hold or enhance the position, the hip
DYNAMIC STRETCHING: flexors and quadriceps are can actively fire to continue the stretch of the hamstrings. Active
Movement-based active stretching should not be confused with dynamic stretching, which involves movement
stretching where muscles
engage to bring about a through a ROM. Passive stretching, on the other hand, involves an external force such as a
stretch.
stretching strap or the hand to move a joint to the end of a ROM. For example, a client could
complete a standing quadriceps stretch with the foot in the hand.

PASSIVE STRETCHING:
An external force such as a
Flexibility training includes several components to promote optimal length-tension
stretching strap or the hand
to move a joint to the end relationships and joint mobility. It is a modality that should be included often throughout
of a range of motion.
training periodization as part of a balanced and effective training protocol. Flexibility and its
components are critical in maintaining optimal movement patterns, and flexibility is also a
SELF-MYOFASCIAL
RELEASE (SMR): large component of corrective exercise to improve movement patterns, reduce chronic pain,
Applying manual pressure and prevent injury. Optimal flexibility training may include the following components:
to an adhesion or
overactive tissue to elicit
an autogenic inhibitory • Static stretching: This technique involves holding a joint at the end of its ROM for a
response, which is
characterized by a decrease period of time, generally up to 60 seconds.
in the excitability of a
contracting or stretched
• Dynamic stretching: This includes actively moving a joint through its entire ROM.
muscle arising from the
• Self-myofascial release (SMR): This technique involves applying manual pressure
Golgi tendon organ.
to an adhesion or overactive tissue to elicit an automatic muscle inhibition
ADHESION: response.
Area of scar-like tissue that • Ballistic stretching: Often referred to as bouncing stretching, this technique uses
causes organs and tissues
to stick together. the momentum of the body or limb to force it beyond a normal ROM by bouncing in
and out of a stretched position. Examples include a client bending forward to reach
BALLISTIC for the toes and bouncing at the bottom or a person in martial arts who is practicing
STRETCHING: kicking as high as possible. These techniques could benefit a client who is prepping
Uses the momentum of
the body or limb to move their body for dynamic athletic activities. However, because this technique is bouncy
it through and beyond a
normal range of motion. and completed under less control, a potential issue that can occur is the tearing of
This technique uses
bobbing, bouncing, pulsing, soft tissue (muscle or connective tissue), particularly without a proper warm-up.
or jerking to achieve a
stretch.

• Proprioceptive neuromuscular facilitation (PNF) stretching: This is an advanced
technique that incorporates the contraction and relaxation or stretching of a muscle.

PROPRIOCEPTIVE
NEUROMUSCULAR
RANGE OF MOTION FACILITATION (PNF)
STRETCHING:
The main components of flexibility also have merit when discussing ROM specifically. A A flexibility technique
passive range of motion is a movement that is not produced by the person themself but used to increase range of
motion and neuromuscular
rather by an external force. This happens, for example, when a physical therapist moves a efficiencies.
client’s shoulder through a full ROM. An active range of motion occurs when a person fires a
muscle or group of muscles to create a ROM. For example, a client moves their own shoulder PASSIVE RANGE OF
through a ROM during circumduction. MOTION:
The range of motion
Flexibility training promotes an ideal ROM at one or more joints which, in turn, can improve a achievable when aided by
an external force.
client’s resisted range of motion—that is, the ROM available while a load is also being moved
through that ROM. This is illustrated, for example, when a client completes scaption (scapular
ACTIVE RANGE OF
elevation) with a dumbbell in hand.
MOTION:
A muscle or group of
muscles contract to create
FLEXIBILITY AND THE PRINCIPLE OF SPECIFICITY a range of motion.
The principle of specificity states that training should be specific and relevant to the sport,
activity, or movement pattern and individual to be effective. This training principle can be RESISTED RANGE OF
directly applied to flexibility training as well. The stretch selection, tempo, and ROM should MOTION:
Range of motion available
correlate to the movement pattern to be trained for optimal benefit. while a load is also being
moved through that range
of motion.
POSITION AND SPEED
For maximum effectiveness, stretching exercises must be similar in form and speed to the skill
needing improvement. For example, slow, static stretching will not improve high and fast kicking
movements in the same way that dynamic stretching movements will. Conversely, dynamic
stretching methods have limited ability to improve a static skill, such as a split on the floor.
STRENGTH AND RESISTANCE

Safe and effective resistance training programs have a beneficial effect on joint mobility. In
flexibility training, the primary concern is that there be adequate strength throughout a joint’s full
ROM. If, during an exercise, a relatively high load is used in a relatively weak portion of the ROM
of the movement, loss of control and injury could occur. For this reason, resistance training should
incorporate a joint and a muscle’s full ROM and work antagonist muscle pairs evenly.

FLEXIBILITY TRAINING PROGRESSION

Just as periodized training has an ideal progression, so too does a flexibility regimen. Ideally,
after a general warm-up, dynamic stretching and SMR are performed to promote ideal muscle
length (a length-tension relationship) and reduce altered joint movement. Once muscle
overactivity (tightness) has been addressed, a specific warm-up related to the upcoming
training session, activity, or sport is performed. This includes muscle activation exercises as
MUSCLE ACTIVATION appropriate. Activation exercises are low-level resistance movements employed to increase
EXERCISES: blood flow to a muscle or muscle group and activate the nervous control of a muscle. Static
Low-level resistance
movements to activate stretching and additional SMR should follow the completion of the training session or activity
blood flow and activate
the nervous control of a to promote recovery and aid in a proper cooldown.
muscle.
The flexibility training progression is as follows:
1. General warm-up
2. Dynamic stretching, SMR
3. Specific warm-up
4. Exercise bout
5. Static/passive or pre-contraction stretching, SMR
ACUTE VARIABLES FOR FLEXIBILITY

Many of the same acute variables applied to fitness programming for resistance training can
and should be manipulated in flexibility training for optimal results.
INTENSITY
Tension in a stretch is like intensity or resistance during exercise. Stretching methods can
range from intuitive limbering—stretching after waking or when standing up from the desk at
INTUITIVE LIMBERING: work—to aggressive stretching regimens as performed by dancers, martial artists, and
Stretching after waking or
when standing up from a gymnasts. The former is useful for releasing adhesions and microscopic tissue bonding after
prolonged seated position.
periods of inactivity, while the latter is designed to radically increase a joint’s ROM.
Discomfort and pain are subjective experiences, and everyone has varying tolerances to
both. Stretching to the point of mild to moderate discomfort is recommended if the goal is to
improve ROM. However, lighter stretch intensities have been found to be effective for recovery
and fluid circulation during or after a training session.

TIME
The ideal amount of time or duration for holding a stretch depends on many factors. The main
thing to consider is the type of stretching method being used. Dynamic stretching involves
movement through a ROM that lasts only a moment or so each repetition. Static and pre-
contraction stretching involve holds lasting 10 to 30 seconds each, up to one minute overall.
Stretching sessions need not last any longer than about 20 minutes to be effective.
BREATH CONTROL
During stretching, clients should breathe normally. Muscles require oxygen in varying levels to
function. Clients should avoid holding their breath because this can increase blood pressure
and prolong muscle tension while diminishing the flow of oxygen throughout the body.
FREQUENCY
Frequency is a variable that must be considered with flexibility training. Consistency is a key
factor in making gains or simply maintaining ROM throughout the body. For a general fitness
program, it is recommended that static stretching be done two to three days per week.
STRETCH SELECTION
The specific stretches employed will be based on the needs and activities of each client as
well as when they will be used in relation to a workout. Specific types of flexibility are optimal
before, during, or after an exercise session and on recovery days.
BEFORE DURING AFTER REST/RECOVERY

ACTIVITY ACTIVITY ACTIVITY DAYS
Dynamic Stretches Dynamic Stretches Static Stretches Self-Myofascial Release
General Warm-up (Active Recovery) PNF Stretches PNF Stretches
Specific Warm-up Self-Myofascial Release Dynamic Stretches
Ballistic Stretches
Self-Myofascial Release
Figure 10.1 Flexibility Technique Timing
A fitness professional should choose individual stretches based on the upcoming activity if
completed before an exercise session and to target tight muscles after training and on days
designated for recovery.

DYNAMIC STRETCHING
In dynamic stretching, momentum is used to propel the muscle into an extended ROM without
holding the position at the end. In most cases, these movements mirror those that will be
performed during the ensuing workout or sport, and the movements should be controlled to
prevent injury. Dynamic stretching differs from static stretching in that the positions are not
held and the muscles themselves bring about the stretch.
Typically, 10–15 minutes is all that is required for a warm-up and flexibility protocol before a
training session. Stretching should be done to the point of mild discomfort to increase ROM.
A fitness professional should advise clients to breathe normally during stretching to enhance
relaxation and improve the lengthening effect.
For athletes, whether competitive or recreational, the stretching and flexibility training should
be specific to the activity to be performed. The most commonly used movement patterns
should be the focus, and dynamic or ballistic stretching should start at low intensity and
progress as the body warms up. An example of this is a baseball player doing dynamic
rotation through the hips and torso prior to swinging the bat.

ARM CIRCLES
A client should start in a standing position with the feet hip width apart and the arms down
at the sides of the body. The client should laterally abduct their arms until they are parallel
to the floor, keeping the shoulders relaxed and away from the ears. They will slowly create
the movement of circumduction with the arms, starting with small circles toward the front.
Every two to three circles, a fitness professional should instruct the client to begin making the
circles a little bigger. The client should repeat the movement in the forward direction until the
arm circles are as large as possible and the client achieves the largest ROM possible around
the shoulder (glenohumeral) joint. Then the client should return the arms to parallel to the
floor and begin the small circles again, this time rotating the arms in the opposite direction.
Again, every two to three circles, the fitness professional should instruct the client to make
the circles bigger. The client should continue until the arm circles are as large as possible
and a full ROM is achieved at the shoulder joint.
DYNAMIC TIP:
Arm circles can be done bilaterally (with both arms at once) or unilaterally (with one
arm at a time).

SHOULDER FLEXION AND EXTENSION

As the name suggests, this dynamic stretch simply executes flexion and extension at the
shoulder joint. This exercise starts with a client standing with the arms at the sides of the
body, palms facing the midline. Then the client can actively flex one or both shoulders to
elevate the arm(s) overhead to the end of range, avoiding spinal hyperextension (extending
beyond neutral or upright). Once at the end of range, the client can allow momentum to
bring the shoulder into extension and repeat. The arm will likely move posteriorly beyond the
starting position for full extension. Ten to 15 repetitions can be completed before resting.
DYNAMIC TIP:
This dynamic stretch can be completed unilaterally or bilaterally—one arm at a time
or both together.

SINGLE-LEG SWINGS—SAGITTAL PLANE
A client should start in a standing position with feet hip width apart and arms free, or, if
needed, the client can stand next to a wall for balance support. The client should shift the
body weight into the right foot and gently lift the left foot, standing tall from the top of the
head to the right heel, while avoiding leaning to the right as much as possible. Allowing
momentum to work, the client swings the leg forward to the end ROM and then backward to
the end ROM. Some activation of the hip flexors and glutes will occur to move the leg to the
end of range. The torso should remain upright and stable during this stretch. This can be
repeated 10 to 15 times on the left before switching legs.
DYNAMIC TIP:
The leg swing in the sagittal plane is a faster dynamic stretch. The core should remain
braced to prevent excessive lumbar flexion and extension. A fitness professional
should pay careful attention to the client’s ROM to ensure muscle strain does not
occur. Although a faster stretch, the pace of the movement should also be kept
moderate and under control.

SINGLE-LEG SWINGS—FRONTAL PLANE

This stretch is similar to the sagittal plane leg swings, except the leg will swing medially and
laterally. Some activation of the glute and adductors will occur to move the leg to the end
of range. A client’s arms can be free, or, if balance is difficult, both hands can be placed on
a wall in front of the body for balance (ensuring enough distance between the wall and the
body to allow the leg to move freely). Starting from a standing position, with the feet hip width
apart, the client should shift their weight to the right leg and gently lift the left foot, allowing
momentum to work, and abduct the left leg to the end of range without allowing excessive
lateral flexion of the spine. The leg should swing (adduct) and cross the midline as far as
allowable, again without excessive lateral spinal flexion. This swing can be repeated 10 to
15 times before switching legs.
DYNAMIC TIP:
To focus this dynamic stretch on the adductors, the client should abduct the leg as
far as possible. Ideally, with additional repetitions, the range of leg adduction should
increase as the adductors are stretched.

WALKING SCOOPS
Starting from a standing position with feet hip width apart, a client should take a small step
forward with the left leg so the left heel is about six inches beyond the right toe. Keeping both
legs extended (not locked), the client should use both hands to trace down the left leg while
hinging at the hips. The arms and torso will make a sweeping motion down the left leg, as
far toward the floor as they can reach, and then make a full circle overhead and back to the
starting position. The client should shift their body weight and take a small step forward with
the right foot and complete the sweeping motion again. This can be repeated 5 to 10 times
for each leg.
DYNAMIC TIP:
It is not necessary to keep the back flat during this dynamic stretch. Allowing the spine
to curve will help to dynamically stretch the spinal erectors as well.

ALTERNATING KNEE HUGS

Beginning in a standing position, a client should take a small step forward with the left leg,
shift their body weight forward onto the left leg, and bring the right knee toward the chest.
With both hands, the client should grab the right knee and gently pull it toward the torso
for a one to two count before releasing the leg and taking a step forward with the right leg.
Next, the client should shift the body weight forward onto the right leg and bring the left knee
toward the chest, gently pulling the knee toward the torso with both hands. Clients minimize
excessive extension or arching of the back as the knee is pulled to the torso. A fitness
professional can encourage the client to continue to alternate steps and legs for 5 to 10
steps on each side. This stretch also targets the glutes.
DYNAMIC TIP:
Keeping a soft bend in the knee of the extended leg, engaging the glutes, and bracing
the core will help with balance. For those unable to keep balance, this dynamic stretch
can be executed from a supine position on a mat, alternating bringing one knee toward
the chest at a time.

STANDING HIP CIRCLES
From a standing position, with feet hip width apart, a client should shift their body weight to the
left leg and gently lift the right leg, avoiding excessive lateral spinal flexion. The client should
begin making the circle by flexing the right knee to 90 degrees and extending the hip so the leg
is behind the body, then actively abduct and externally rotate the right leg to the end of range. In
a controlled circular motion, the client should adduct and internally rotate the right leg back to
the starting position. This can be repeated 5 to 10 times before switching the direction of rotation
with the same leg. The client should start by flexing the hip to elevate the knee before externally
rotating and abducting the leg as far as possible and finishing in hip extension and knee flexion.
Again, this can be repeated 5 to 10 times before switching legs.
DYNAMIC TIP:
This dynamic hip stretch can be performed while stationary or walking. When walking,
the client’s feet will alternate, the forward circles are executed when moving forward,
and the backward circles are performed when moving backward.

ALTERNATING ARM HUGS

Starting in a standing position with feet about shoulder width apart, a client should have both
arms horizontally abducted with the palms facing forward. Keeping the shoulders relaxed (not
elevated), the client should horizontally adduct the right arm and use the left hand at the right
elbow to pull the arm as close to the chest as possible. The client should hold for a one count
and then release both arms back to the starting position and switch arms. Next, the client should
horizontally adduct the left arm and use the right hand at the left elbow to pull the arms as close
to the chest as possible and then release back to the starting position. A fitness professional can
encourage the client to continue to alternate arms for 5 to 10 repetitions for each arm.
DYNAMIC TIP:
Make sure the client keeps their shoulders relaxed during the pull at the end of range.

INCHWORM WALKOUT
A client should start from a standing position with the feet hip width apart. Hinging from
the hips, the client places both hands on the floor directly in front of the toes. A fitness
professional should have the client bend the knees if necessary. One hand at a time, the
client walks the hands out in front of the body, allowing the hips to come down until a high
plank position is achieved. The client should hold for a short pause, then they will slowly
walk the hands back toward the feet one at a time. Again, the client should bend the knees
if necessary. Once the hands are back directly in front of the feet, the client should shift their
body weight to the midfoot and slowly return to the tall standing position. This exercise should
be completed for the desired number of repetitions.
DYNAMIC TIP:
For an additional challenge, a push-up can be added at the bottom from the high plank
position before returning to the start position.

TIN SOLDIER
Similar to the sagittal plane leg swing, the tin soldier uses a bit of momentum and active hip
flexion to raise the leg to the end of range. However, it eliminates the hip extension aspect of
the swing. Starting in a standing position with feet hip width apart, a client should keep their
arms free, or if needed, they can stand next to a wall for balance. Next, the client should shift
the body weight into the right foot and gently lift the left foot, avoiding leaning to the right as
much as possible. The client should actively flex at the hip and swing the leg forward to the
end ROM, then return the foot to the starting position and switch legs. This exercise can be
alternated for 5 to 10 repetitions on each leg.
DYNAMIC TIP:
The tin soldier can be a full-body dynamic stretch by adding the arms. As the leg
swings forward, the opposite hand reaches for the toes. The hips are allowed to hinge
slightly, and the torso can rotate as the hand reaches so long as the core remains
braced.

FORWARD LUNGE TO REACH
Starting from a standing position, a client should take a large step forward with the left leg
and flex both knees and lower into a lunge, bringing the right knee gently down to the floor
into a half-kneeling position. The body weight is shifted forward into the left foot while the
chest is tall. The client should bring the right arm overhead and hold for a two count before
lowering the arm and returning to the half-kneeling position. The forward shift and arm raise
can be repeated 5 to 10 times before returning to the standing position and switching sides.
DYNAMIC TIP:
When reaching the arm overhead, a slight lean can be added in the opposite direction
to intensify the stretch. For example, the client can bring the right arm overhead and
lean to the left.

REVERSE LUNGE WITH TWIST

Starting from a standing position with the feet hip width apart and hands together at the
chest, a client should take a large step backward with the left leg into a lunge position.
Hovering the left knee over the floor, the client will rotate the hands, torso, and head to the
right as far as possible without leaning to the right or losing balance. Then the client should
return to face forward and return the left foot back to the start position. This exercise should
be repeated on the right leg with the torso rotation going to the left (toward the leg that is
forward).
DYNAMIC TIP:
For clients who have poor balance, the twist can be removed from this dynamic stretch.
A client can balance themselves against a wall or a stationary object when taking the
step back into the lunge position if necessary.

LATERAL LUNGE SHIFTS
Starting from a standing position, a client should take a large step laterally with the left foot
so that both feet are outside of the shoulders. The left knee is flexed, and the body weight
is shifted toward the left (as in a lateral lunge) for a one to two count. After returning to the
center, the client should flex the right knee and shift their body weight to the right for a one
to two count and then again return to center. The client should continue to alternate sides for
10 to 15 repetitions on each side before returning to the standing position. Ideally, the range
of the shift will increase with additional repetitions.
DYNAMIC TIP:
When shifting laterally, the client should avoid letting the knee move past the same
side’s toe. This can be done by hinging slightly at the hips during the shift, pushing the
glutes back, and allowing the chest to drop slightly.

HIGH KNEES
A client should start from a standing position with the feet hip width apart and the arms down
at the sides of the body. Then the client flexes the right hip and knee to bring the leg up in
front of the body as if marching. The left arm will also come forward with the elbow bent at 90
degrees, and the right arm will move back with a 90-degree elbow bend. When full hip flexion
is achieved, the client should replace the right foot back to the floor and switch legs. The
arms will also switch as the left hip and knee flex. The right arm will be forward and the left
leg back. When full hip flexion is achieved, the client should return the left foot back to the
floor. The client should continue alternating legs for the desired amount of time or number of
repetitions on each side.
DYNAMIC TIP:
To increase the intensity of this dynamic stretch, a fitness professional should instruct
the client to speed up the march. It can be progressed to a run in place with a focus on
achieving a 90-degree bend at the knee and keeping the foot directly under the knee
when the knee is flexed. At a faster pace, the client can move their hands to the front
of the body at about belly button height for balance.

GLUTE KICKS
Starting from a standing position with the feet hip width apart and the arms at the sides of
the body, a child should bend the elbows to 90 degrees with the arms still at the sides. The
client should shift their weight slightly to the left foot. Then they will flex the right knee and
bring the right heel as close to the glutes as possible. The client should quickly return the
foot back to the floor and shift their weight to the right foot. The knee flexion is repeated on
the left leg, bringing the left heel as close to the glutes as possible. Again, the client should
quickly replace the left foot back to the floor. The client should continue alternating legs for
the desired amount of time or number of repetitions on each leg.
DYNAMIC TIP:
As with the high knees, this dynamic movement can be sped up to increase the
intensity. A fitness professional should ensure the client can control the flexion of their
knees and maintain balance at the faster pace. For clients who need assistance with
balance, they can support themselves with a wall or stationary object if necessary.

WORLD’S GREATEST STRETCH

A full-body dynamic stretch worth mentioning is the world’s greatest stretch. The series of
movements are intended to be repeated on both sides of the body and dynamically stretches
the entire body with a focus on the hips and core musculature. Each step in the series can
take up to three or four breaths.
Beginning in a standing position, the client should take a large step forward at hip width
with the left leg and flex the left knee while keeping the right leg extended (not locked).
After bringing both hands down to the floor on the medial (inside) side of the left foot, the
client should allow the hips to sink toward the floor as much as possible while relaxing the
shoulders and breathing normally. Their body weight should be shifted forward gently toward
the left foot and back toward the right calf, and they should drive the heel toward the floor
two to three times. Next, the client should take the right arm and reach under the left knee,
allowing the trunk to rotate, and reach as far as possible. Then the client should bring the
right arm overhead, rotating in the opposite direction. The hand should not rotate past the
right shoulder, but the torso will rotate, and the chest opens to the right. The arm movement
can be repeated two to three times, under the left leg and open to the right. The client should
return the right hand to the floor before lifting the chest, extending the left knee, and returning
to the standing position. The series should be repeated on the opposite side of the body.
DYNAMIC TIP:
This dynamic stretch can be advanced in many ways, including the following:
• Instead of holding the high lunge with hands on the floor, the client can come
to the elbows.
• A hamstring stretch can be added by shifting the glutes back toward the back
heel and extending the forward leg while reaching for the toe.
• During the high-lunge shifts, the same side’s hand can be used to press the
knee laterally and rotate the torso toward and away to open the hips.

HIP OPENERS
Beginning in a standing position, a client should take a large step forward at hip width
with the left leg and flex the left knee while keeping the right leg extended (not locked).
After bringing both hands down to the floor on the medial (inside) side of the left foot, the
client should allow the hips to sink toward the floor as much as possible while relaxing the
shoulders and breathing normally. Their body weight should be shifted forward gently toward
the left foot and back toward the right calf, and they should drive the heel toward the floor for
the desired number of repetitions or amount of time.
DYNAMIC TIP:
To intensify the stretch, the client can bring the left hand to the left knee, relax the
shoulder away from the ear, and press the knee away from the midline of the body.

STANDING TORSO ROTATION

Starting in a standing position with the feet shoulder width apart, a client should flex the
elbows to 90 degrees and abduct the arms to become parallel to the floor. The torso is gently
and actively rotated to the left until the end of range with the arms and eyes following. After
returning to the center, the client should actively rotate to the right to the end of range with
arms and eyes following and then return to the center once again. The client can continue to
alternate sides for 10 to 15 repetitions per direction.
DYNAMIC TIP:
The rotation of the torso can extend into the hips as well. As the torso turns, the body
weight is shifted into the same side’s foot, and the opposite foot will rotate onto the
toe, lifting the heel.

LATERAL OVERHEAD REACH
Starting from a standing position with the feet just outside of the hips and the arms at
the sides of the body, the client should laterally abduct the left arm and take it overhead.
A fitness professional should ensure the elbow remains as extended as possible. Once
overhead, the client will laterally flex the spine and lean to the right as far as possible, then
return to standing and replace the left arm back to the side of the body. The client should
repeat the exercise on the right side. The client will laterally abduct the right arm until it is
overhead, then laterally flex the spine and lean to the left as far as possible. Next, the client
should return to the upright position and replace the right arm back to the side of the body.
This exercise should be repeated for the desired amount of time or number of repetitions on
each side of the body.

PRE-CONTRACTION STRETCHING
Pre-contraction stretching is a type of PNF stretching involving contracting the muscle to be
stretched or its antagonist before the stretch. When contracting the same muscle, it is
referred to as contract-relax (CR) stretching, and when contracting the antagonist, it is

CONTRACT-RELAX (CR)
called contract-relax antagonist contract (CRAC) stretching. Pre-contraction stretching is
STRETCHING:
Contracting a given muscle often partner-assisted, but tools such as a towel or stretching strap may also be used to
before stretching the same
muscle. achieve the end ROM.
CONTRACT-RELAX
ANTAGONIST
CONTRACT (CRAC)
STRETCHING:
Contracting an antagonist
muscle before stretching
the agonist.
With this technique, the contraction should last at least five seconds. While most pre-
contraction stretching techniques suggest using a maximum contraction—from 75 to 100
percent maximum contraction—research has shown that contractions at 20 to 60 percent
are also effective for increasing ROM. After the contraction, the stretch (relaxation) should
last from 6 to 10 seconds to improve ROM and muscle pliability. Fitness professionals
PLIABILITY:
The quality of being easily should advise clients to breathe through the stretch.
bent or flexible.

HOLD RELAX
This type of PNF stretching is performed using a stretching band or suspension straps for
self-administered therapies. With the assistance of a licensed physical therapist, athletic
trainer, or massage therapist, hold relax (HR) stretching can be done easily on the upper
extremities:
1. The extremity should be passively moved to a painless end ROM.
2. A client should hold at the end of range for 10 seconds.
3. This sequence can be repeated for up to four repetitions.
Ideally, each repetition will force a greater end of range.
Gastrocnemius
Starting seated on a mat with both feet fully extended in front, a client should wrap their
hands or a stretching strap around the ball of the right foot. While sitting erect and relaxing the
shoulders, the client should gently pull the stretching strap until the full range of dorsiflexion
is found. The client can hold for 10 seconds, then relax before starting the next repetition.

Quadriceps
Starting in a standing position with the feet hip width apart and using a chair or a wall for
balance if needed, a client should shift their body weight to the right foot and avoid leaning
to the side. The stretching strap is placed over the left midfoot and over the left shoulder.
Using the stretching strap for leverage, the client should flex the left knee, bringing the heel
toward the left glute without excessive lumbar extension. Keeping the knees together, the
client should gently pull the left heel toward the glutes until the end of range is found. This
stretch can be held for 10 seconds before releasing and moving on to the next repetition.
PNF TIP:
This stretch can be executed from the floor as well. A fitness professional should have
the client lay prone on a mat instead of stand. The client will place the stretching
strap over the midfoot on the side being stretched. During the stretch, the fitness
professional should instruct them to keep their hips on the floor to the best of their
ability as they move the foot closer to the glutes.

Hamstrings
Beginning by lying supine on a mat with both legs extended and arms at the sides, a client
should place the stretching strap around the left foot at midfoot. Keeping the leg extended,
the client should use the strap as leverage and flex the left hip, bringing the leg to 90
degrees. The strap should be used to gently pull the leg toward the chest while keeping the
shoulders relaxed. When the end of range is found, the client can hold for 10 seconds before
relaxing and then repeat for the desired number of repetitions.
Glutes
This stretch is like the hamstring HR stretch, but the leg will be held at a different angle.
Beginning by lying supine on a mat with both legs extended and arms at the sides, a client
should place the stretching strap around the left foot at midfoot. Keeping the leg extended,
the client should use the strap as leverage and flex the left hip, bringing the leg to 90
degrees. The strap should be used to gently pull the leg toward the right shoulder without
allowing the left hip to elevate. When the end of range is found, the client can hold for 10
seconds before relaxing and then repeat for the desired number of repetitions.

Adductors
This stretch is similar to the hamstring and glute HR stretches, but again, the leg will be held at
a different angle. Beginning by lying supine on a mat with both legs extended and arms at the
sides, a client should place the stretching strap around the left foot at midfoot. Keeping the leg
extended, the client should use the strap as leverage and flex the left hip, bringing the leg to 90
degrees. The strap should be used to gently pull the leg toward the left shoulder without allowing
the left hip to elevate. In many cases, the foot will move wider than the same side’s shoulder for
an adductor stretch to be felt. When the end of range is found, the client can hold for 10 seconds
before relaxing and then repeat for the desired number of repetitions.
Pectorals
Using suspension straps, this stretch begins with a client facing away from the anchor point
and with handles in each hand. The client slowly moves away from the anchor and allows the
arms to elevate (as in scaption) to chest height. Then the client continues to move away from
the anchor and allows the arms to horizontally abduct and open the chest. When the end of
range is found, the client can hold for 10 seconds before relaxing and then repeat for the
desired number of repetitions.
PNF TIP:
This stretch can also be performed in the same way as the static pectoral stretch by
using a wall or stationary object for self-application.

STATIC STRETCHING
All resistance training workouts should be followed by a few minutes of static stretching
to allow the involved joints to regain their full ROM. Such stretching also helps to reduce
muscle soreness after exercise. In addition, static stretching can help maintain balanced
musculature, which promotes good posture. Muscles tend to become less elastic once the
body cools down after a workout, so stretching immediately after the workout maximizes
muscle length and ROM.
To perform a static stretch, a client should hold the target muscle in a stretched position
for 10 to 30 seconds. Each stretch should be repeated twice. Studies have not found any
additional benefits after two to four repetitions of a stretch. But some studies have found
a negative impact on performance at six repetitions. A fitness professional should advise
clients to stretch only to the point of mild discomfort, not pain, and to breathe deeply through
the stretch.
Static stretching is ideal for a cooldown as opposed to a warm-up protocol. It has been shown
to change the length-tension relationship of a muscle fiber, which can increase the risk of
injury or alter performance if done prior to activity. The loss of strength resulting from acute
static stretching is known as “stretch-induced strength loss.” The specific causes for this

type of stretch-induced loss in strength are not clear. Some researchers have suggested
neural factors, while others suggest mechanical factors.
PECTORALS
Chest Opener
Starting in a standing position with feet hip width apart and a soft bend at the knees, a client
should bring both hands behind the body and interlock the fingers. Next, the client should
gently press the interlocked hands down while retracting the shoulder blades to open the
chest, allowing the chin to lift slightly while breathing normally. This stretch can be held for
up to 30 seconds before releasing.

Single-Arm Pectoral Stretch
Starting in a standing position next to a wall on the right side of the body, a client should
abduct the right arm and place the palm against the wall at chest height, with fingers facing
toward the posterior. Taking small steps, the client should gently turn the body (torso and
legs), leaving the hand in place, and keep rotating until the end of range in the right pectoral
is found, holding for up to 30 seconds. The client should breathe normally and then release
and switch arms.
STATIC TIP:
To keep this static stretch in the pectorals, the client should avoid elevating the
shoulder, and the hand should be placed at or below chest height.

ARMS
Overhead Triceps Stretch
Seated or standing, the shoulders are relaxed, and the spine is neutral. A client should
bring the left arm into full flexion overhead and flex at the elbow to drop the left hand down
toward the left shoulder. The right hand is placed behind the left elbow to keep the shoulder
in flexion. The client should breathe normally and hold for up to 30 seconds before releasing
the arm and switching sides.

Biceps Stretch
Standing with feet hip width apart, with a neutral spine, and with arms fully extended at the
sides, a client should flex the right shoulder to bring the arm parallel to the floor, palm up.
The client should take the left hand and gently press the four outreached fingers of the right
hand down toward the floor until the end of range is found. The right arm must remain fully
extended. The shoulders are relaxed, and breathing is normal. This stretch can be held for up
to 30 seconds before releasing both arms and switching sides.
STATIC TIP:
This static stretch can also be performed against a wall. The arm to be stretched
should be brought to flexion at chest height, with shoulders relaxed and the palm
pressed against the wall as much as possible with the fingers pointing down. Another
version is done kneeling. The hands are placed on the ground slightly in front of the
knees, shoulder width apart with the elbows fully extended. The palms are down,
and the hands are externally rotated until the fingers point posteriorly. Once in this
position, sitting the hips back can intensify the stretch if needed.

LATISSIMUS DORSI
Child’s Pose
Starting in a kneeling position with the feet and knees just outside the hips, a client should
bring the hands to the floor (a mat is optional) in front of the knees and walk them away while
keeping the glutes as close to the heels as possible. Next, the client should continue to walk
both hands forward as far as possible, allowing the head to fall between the elbows and the
chest to fall toward the floor. This stretch can be held for up to 30 seconds before releasing.
STATIC TIP:
For a deeper stretch, the arms can be elevated by placing them atop a stability
ball, chair, or bench, and the head can be allowed to fall between the elbows. When
elevated, this stretch can be performed unilaterally or bilaterally.
LEVATOR SCAPULAE
Starting in a standing or seated neutral position, a client should take the right arm behind
the back and bend the right elbow to 90 degrees. Then the client should raise their left arm
and place the left hand on the right side of their head. They will turn their chin to the right
while gently pulling the head down and to the left with the left hand. A fitness professional
should instruct the client to bring the chin as close to the chest as possible and to keep
both shoulders down and away from the ears. This stretch can be held for 20 to 30 seconds
before releasing and switching sides.

SPINAL ERECTORS
Knees to Chest
Beginning by lying supine on the floor, a client flexes the hip and brings their knees into the
chest as close as possible. They should wrap their arms around the knees for support. A
fitness professional should ensure the client’s head remains rested on the floor to keep the
neck relaxed. The client should actively hug the knees for the duration of the stretch. This
stretch should be held for 30 seconds before gently releasing the legs back to the floor.
STATIC TIP:
To intensify this stretch, the client can gently rock their body left and right while hugging
the knees into the chest. The fitness professional should ensure the movement
remains small so that the client does not roll over to one side uncontrolled.

Forward Fold
This stretch starts from a standing position with the feet about hip width apart and the arms
down at the sides of the body. Beginning at the shoulders, a client should drop the chin
toward their chest and slowly roll their spine as they hinge at the hips. The arms will remain
lengthened, with a soft bend in the knees, and the arms will passively reach toward the floor.
They will fold forward as far as possible, keeping the head relaxed and hanging neutrally.
Once the fullest spinal flexion is achieved, the client should hold the stretch for 30 seconds
before slowly reversing out—stacking the spine one vertebrae at a time. The head will be the
last part of the body to reach the upright position.
STATIC TIP:
Not all clients will be able to reach the floor in a forward fold.
To intensify this stretch, when in full spinal flexion, a fitness professional should
instruct the client to take each hand and grab the opposite elbow. Keeping the arms
relaxed, they can add a gentle sway to the left and right or forward and back.
This stretch can also be completed from a seated position. The client will tuck the
chin and slowly roll the spine and hinge at the hips. In the end position, their chest will
be near or on their thighs, and the head will hang neutrally at or between the knees.

HIP FLEXORS
Starting from a standing position with feet hip width apart, a client should take a large step
forward with the left leg, keeping the toes of both feet pointing forward. Both hands are
brought to the forward knee as it is flexed. The client should allow the hips to sink straight
down toward the floor while keeping the right leg extended (not locked) and elevated. The right
heel may elevate. The shoulders are relaxed, and breathing is normal. The client should hold
for up to 30 seconds before returning to the standing position and switching legs.
STATIC TIP:
This can also be executed from a high kneeling position with a shift in weight toward the
forward foot. The torso is kept elevated, and the arm(s) can also be elevated overhead.

ABDOMINALS
Cobra
Beginning by lying prone on the floor, a client should relax the feet (plantar flexion) and place
the hands even with the chest as if starting a push-up. The client should keep the hips on the
floor and press through the palms to elevate the chest. A fitness professional should ensure
the chin remains neutral and have the client extend their arms as far as possible. The client
should breathe normally and hold the stretch for 30 seconds before slowly lowering the chest
back to the floor.
STATIC TIP:
To intensify this cobra stretch, when the client has the arms extended and the chest
elevated, they can alternate looking over one shoulder, then the other. When looking
over the right shoulder, the fitness professional should instruct them to press the left
hip into the floor. The opposite is true when looking over the left shoulder—the client
should drive the right hip toward the floor.
GLUTES AND PIRIFORMIS

Pigeon
This stretch starts by kneeling on a mat. A client should bring the left knee straight forward
and place the left foot in front of the right hip. The outside of the left shin should now rest on
the floor. As much as possible, the right leg is extended behind the body with the front of the
thigh resting on the floor. The torso will be propped up on the extended arms, and the hands
are placed on each side of the left knee, with palms down. The client should allow the hips
to relax down toward the floor and relax the shoulders. The primary stretch is in the left glute.
The client should breathe normally and hold for up to 30 seconds before switching sides.

STATIC TIP:
To intensify the stretch, the client can come to the elbows during the hold. Also, not all
individuals will be able to bring both hips to the floor during this static stretch. A yoga
block or blanket can be placed under the elevated hip to reduce strain and support
the hip.
Lying Figure-Four Stretch
Lying supine with the legs extended and the arms at the sides, a client should flex both knees
and bring the bottoms of the feet to the floor. The right ankle is crossed over the left knee,
and the right hip is allowed to open (external rotation of the femur). The client should reach
the left arm around the lateral aspect of the left thigh and the right arm between the thighs
and hook them together behind the left knee. The left leg is gently guided toward the chest.
The greatest stretch will be felt in the right glute. When the end of range is found, the client
can hold for up to 30 seconds before releasing the feet back to the floor and switching sides.

QUADRICEPS
This stretch starts in a standing position with the feet hip width apart and using a chair or a
wall for balance if needed. The body weight is shifted to the right foot, and leaning to the side
should be avoided. A client should flex the left knee, bringing the heel toward the left glute
without excessive lumbar extension, and reach back and take hold of the left foot. Keeping
the knees together, the client should gently pull the left heel toward the glutes and hold for
up to 30 seconds, while breathing normally, before releasing back to the starting position
and switching legs.
STATIC TIP:
This static stretch can also be performed lying prone on the floor to prevent excessive
lumbar spine extension. This is a good option for clients with overactive hip flexors or
poor balance.

HAMSTRINGS
Standing Hamstring Stretch
Starting in a standing position with the feet hip width apart, a client should take a small step
forward with the left foot and plant the heel, keeping the toes elevated. The foot is in active
dorsiflexion. Then the client should hinge at the hips while reaching both arms toward the left
toes. To maintain a focus on the hamstrings, the client should keep the back flat (to avoid
thoracic rounding) and breathe normally. This stretch can be held for up to 30 seconds before
returning to standing and switching feet.
STATIC TIP:
The forward foot can be elevated to intensify the static stretch. To place the forward
heel, an exercise step, plyometric box, or even a chair can be used. The higher the
elevation, the more balance will be required in the stationary leg.
Seated Figure-Four Toe Reach
This stretch begins in a seated position on the floor with both legs extended in front. Sitting
erect with the shoulders relaxed, a client should flex the right knee and bring the bottom of
the right foot to the medial aspect of the left leg. Keeping the back flat, the client should
reach with both hands toward the left toes (or as far as possible). It is important to breathe
normally while holding for up to 30 seconds before returning to the seated position and
switching legs.

STATIC TIP:
Keeping the back flat on this (and most) hamstring stretch(es) helps to maintain a
neutral pelvis. This, in turn, can help lengthen the hamstrings specifically. On the other
hand, rounding the spine when reaching for the toes can promote an anterior pelvic
tilt, which, while great for elongating the spinal erectors, places the hamstrings in a
shortened position.
Lying Single-Leg Hip Flexion
A client should begin by lying supine on the floor with both legs extended and arms at the
sides. Keeping the leg extended, the left hip is flexed, bringing the left leg to 90 degrees.
Using both hands, the client should take hold of the leg just behind the knee, gently pulling
the leg toward the chest while keeping the shoulders relaxed. When the end of range is
reached, the stretch can be held for up to 30 seconds before releasing the leg back to the
floor and switching sides.
STATIC TIP:
Depending on how tight the hamstrings are, the knee may naturally bend on both legs,
whether elevated or not. If necessary, the leg on the mat can be bent, and the foot
can be placed flat on the floor to protect the spine and allow for adequate hip flexion
on the alternate side.

Butterfly Stretch
Beginning in a seated position with both legs fully extended in front, a client should sit
erect and relax the shoulders. Next, the client should flex both knees, bring the soles of the
feet together, and then move the heels as close to the body as possible while allowing the
knees to fall outward. The hands can rest on the feet or extend out in front of the body. The
client can hinge from the hips for a slight lean forward and hold for up to 30 seconds before
releasing.
STATIC TIP:
Based on flexibility, some clients may not be able to lean forward much, if at all.
Therefore, they can relax their chin toward their chest (while minimizing rounding of
the midback) and allow gravity to assist the static hold.

CALVES
The calf complex consists of two muscles: the more superficial gastrocnemius and the deep
soleus. Both can be stretched with static holds.
Gastrocnemius
A client should stand facing a wall or stationary object with feet hip width apart for support
and place both hands on the wall or object for support. After taking a large step back with
the left foot, the client should lean into the hands while keeping the arms fully extended (not
locked) and drive the left heel toward the floor. This can be held for up to 30 seconds, while
breathing normally, before releasing back to the starting position and switching legs.
STATIC TIP:
The angle of the back foot can change the head of the gastrocnemius, a muscle with
two heads (medial and lateral), that is primarily stretched. The heel should be moved
toward the midline to focus on the medial head, and the foot should be moved away
from the midline to focus on the lateral head.

Soleus
This static stretch is similar to the gastrocnemius stretch with one minor addition to target
the deeper muscle group. A client stands facing a wall or stationary object with feet hip width
apart for support and places both hands on the wall or object for support. After taking a large
step back with the left foot, the client should lean into the hands while keeping the arms
fully extended (not locked) and then drive the left heel toward the floor. Next, the client flexes
at the left knee as if trying to touch it to the wall to stretch the soleus specifically. The hips
will shift toward the posterior to keep the heel as close to the floor as possible. This stretch
should be held for up to 30 seconds, while breathing normally, before releasing back to the
starting position and switching legs.
FLEXIBILITY AND SPECIAL POPULATIONS

In general, it seems that static stretching is most applicable to athletes who need to be flexible
in their sport since ROM determines their ability to perform some of the skills necessary in
their sport. Examples might include gymnasts or dancers. Older adults may also benefit more
from static stretching than other techniques. Studies have shown that static stretching of
the hip flexors and extensors may improve gait in older adults and that 10 weeks of static
stretching of the trunk increased spinal mobility.

Further, older adults may need to hold a stretch longer than the recommended 10 to 30
seconds. For example, a recent study found that stretching for 60 seconds resulted in greater
hamstring flexibility in older adults.
Studies suggest sex-related responses to different stretching techniques. Some data
indicates that males respond better to CR stretching and females benefit more from static
stretching.
SELF-MYOFASCIAL RELEASE
Fascia is connective tissue that attaches, supports, encloses, and separates muscles from
other muscles and internal organs. Tight fascia—resulting from injury, lifestyle, or inflexibility—
often causes pain or movement dysfunction. Myofascial release (MFR) stretches and
MYOFASCIAL RELEASE loosens the fascia using gentle, gradual, sustained pressure or stretch on areas of excessive
(MFR): tension. After MFR therapy, muscles move more freely, restoring ROM and reducing pain.
Stretches and loosens the
fascia using gentle, gradual,
sustained pressure or MFR can be performed by a practitioner or by oneself. Foam rolling and roller massage are
stretch on areas of tension.
popular forms of this technique called self-myofascial release. It is important to note that
when using techniques such as foam rolling, a slow and deliberate approach (rolling an inch
per second for example) is best.

Foam rolling, or SMR, is a technique that applies pressure to overactive (tight) tissue. Using
autogenic inhibition, the overactivity (tightness) of the targeted tissue is released as inhibition
from the Golgi tendon organ occurs. SMR has been found to increase short-term flexibility AUTOGENIC
with minimal effect on muscle contraction or performance.
INHIBITION:
The decrease in excitability
of a contracting or
Tools such as a foam roller, lacrosse balls, and hand rollers are readily available for SMR stretched muscle arising
from the Golgi tendon
applications. The effects of SMR make it an ideal technique to use before and after training. organ.
Foam rolling is done prior to activity to encourage optimal length-tension relationships and
increase joint ROM, and it is done after activity to aid in returning muscle fibers back to their GOLGI TENDON
optimal length and prevent the formation of tissue adhesions. ORGAN:
SMR can be performed on nearly any region of the body except the lumbar and cervical spine.
tension in a tendon and
The thoracic spine has muscles and structures, such as the scapula and rhomboids, that inhibits muscle action.
protect the vertebrae from the directly applied pressure. However, the lumbar and cervical
spine lack protection, and the application of pressure may directly affect these areas if the
spine is contraindicated.
THORACIC SPINE
Starting with the foam roller at approximately the eighth thoracic vertebrae (midback), a client
should use their legs to create movement up or down the back. It is important that a fitness
professional advise clients to extend their head and neck over the foam roller to achieve full
motion and decrease strain on the neck. The foam roller should not be used on the lumbar
spine due to the excessive pressure placed directly on the vertebrae.

LATISSIMUS DORSI
A client should lie with the foam roller on the lateral and posterior aspects of their rib cage
with their arm extended over their head. The client can use their legs to create the rolling
movement over the area, which extends from the inferior edge of the scapula through the
posterior arm.
TENSOR FASCIAE LATAE AND ILIOTIBIAL BAND

A client should lie prone (facedown) with the roller under the hips. One side can be completed
at a time. To effectively apply pressure to the tensor fasciae latae (TFL; a muscle on the lateral
thigh) directly, the arms can be used to prop the body to one side, placing the anterolateral
portion of the crease of the hip on the roller. The feet can be staggered or stacked, and the
trunk can be supported by the hand or elbow.

The body should be rotated until the lateral (outer) aspect of the hip is on the roller. Moving
slowly, the hands can be used to maneuver the body and allow the foam roller to move down
the iliotibial (IT) band until an adhesion or tender spot is identified. The client should apply
pressure statically at that point for 60–90 seconds before continuing toward the knee.
RECTUS FEMORIS
All heads of the quadriceps are important to foam roll: the rectus femoris, vastus intermedius
(deep to the rectus femoris), vastus medialis, and vastus lateralis. Although the vastus
lateralis is the largest of the four, the rectus femoris originates at the anterior inferior iliac
spine (and the supraacetabular groove) and plays a role in hip flexion while the others are
only involved in knee action.
A client should lie prone (facedown) on the foam roller with the trunk propped on the elbows, as
with a plank. The feet will be elevated as well. Starting with one leg (though both are on the roller)
and beginning at the top of the thigh, the body is maneuvered to roll toward the knee until an
adhesion is located. The knee is flexed and extended slowly 6–10 times. Then with the knee in
flexion and the ankle dorsiflexed, alternating internally and externally, the femur is rotated to bring
the foot toward and away from the midline. The rotations are completed 6–10 times each way
before proceeding toward the knee and locating the next adhesion to be addressed.

ADDUCTORS
A client should lie prone on the floor with the foam roller parallel to the hip and thigh. The
knee and hip are flexed on the same side as the roller to bring the inner thigh atop the roller.
The lower body will look like the number four. The leg and foot can relax to place maximum
body weight onto the foam roller. The trunk is propped on the elbows, as with a plank. Starting
with the roller on the medial aspect of the knee, the body is maneuvered to move the foam
roller toward the groin until an adhesion is identified.
PIRIFORMIS
The piriformis works as an external hip rotator during hip extension and abducts the hip during
hip flexion. It works in conjunction with the glutes and lies deep in the gluteus maximus.
A client should be seated atop the foam roller and can choose a side to address first.
Crossing that leg and placing the ankle over the knee will allow the external rotation of the
femur. The other leg is brought to a flexed position, placing the foot flat on the floor. The client
should lean toward the side of the top leg, allowing the torso to be propped up on the hand
or elbow. The lateral aspect of the glute will be receiving the applied pressure.

CALVES
Sitting with one or both calves perpendicular to and on top of the foam roller, a client should
use their arms to create the rolling movement. Plantar flexion and dorsiflexion of the foot will
offer additional exposure of and pressure on adhesions in the calves.

CONCEPTS OF
CHAPTER 11
CARDIOVASCULAR
EXERCISE
LEARNING OBJECTIVES
1 | Describe the benefits of cardiovascular exercise.
2 | Identify and explain the acute variables for cardiovascular exercise.
3 | Identify common modes of cardiovascular training.
4 | Explain the common environmental influence on physical activity.

CHAPTER 11 | Concepts of Cardiovascular Exercise
From getting out of bed to participating in sports, human movement is an essential component
of survival. While the nervous system determines the task and sends the appropriate signals
to muscles, which in turn move a person, the cardiovascular system is responsible for
supplying nutrients to and transporting waste from tissues. Modern society requires little
physical effort from most people; therefore, to stave off various diseases such as cancer,
diabetes, and heart disease, cardiovascular exercise is crucial.
Cardiorespiratory specifically refers to the heart, blood vessels, and lungs, while cardiovascular
specifically refers to the heart and blood vessels.
Note: Cardiorespiratory exercise and cardiovascular exercise are used interchangeably in
this text.
BENEFITS OF CARDIOVASCULAR EXERCISE

Cardiovascular exercise is an important contributor to overall health and wellness. Performing
aerobic exercise and stimulating the cardiovascular system helps keep the heart, blood
AEROBIC EXERCISE: vessels, and lungs healthy. However, there are many other proven benefits to a regular cardio
Exercise that improves or
is intended to improve the routine, including the following:
efficiency of the body’s
cardiorespiratory system in
• Reduces fatigue
absorbing and transporting
oxygen.
• Improves energy levels
• Reduces depression
• Reduces stress and anxiety
• Prevents some types of cancer
• Enhances self-image
• Slows the effects of aging
• Improves sleep
• Improves mental acuity (sharpness of the mind, determined in memory, focus,
concentration, and understanding)
REDUCES FATIGUE
Research shows that sedentary people who begin a regular exercise program reported a
reduction in fatigue. This includes symptoms of fatigue such as drowsiness, sore muscles,
slowed reflexes, and irritability. This effect occurs in diverse populations, including healthy
adults, cancer patients, and people with diabetes and heart disease. In these studies, the
average effect of exercise was greater than the effect of stimulant drugs such as caffeine.

IMPROVES ENERGY LEVELS
A more robust cardiovascular system allows the heart to pump more blood per beat, supply
more blood to itself between beats, and therefore increase efficiency. Less resistance to blood
flow, increased volume of blood filling the heart for transport, and stronger heart contraction
produce the efficiency. Research also suggests that improving blood flow simultaneously
increases the amount of oxygen being delivered to the brain. Optimal cognitive function (brain
function) is supported by sufficient oxygen supply to the brain and can improve alertness and
energy levels in people of all ages.
REDUCES DEPRESSION
In the US, 1 in 10 adults struggles with depression and many turn to antidepressant drugs
for relief. However, Harvard Health suggests that exercise may work as well as medications to
relieve depression. Clients suffering from severe depression should consult their physicians
before stopping any form of treatment or before starting physical activity.
High-intensity exercise stimulates the production of endorphins, hormones that promote

ENDORPHINS:
feelings of well-being. This results in acute feelings of happiness. Low-intensity exercise Hormones that promote
feelings of well-being.
sustained over time releases neurotrophic proteins or growth factors. These proteins
stimulate nerve cell growth and the creation of new neural pathways and connections. The
resulting increases in brain function make people feel better.

GROWTH FACTORS:
Proteins that stimulate
nerve cell growth and the
creation of new neural
REDUCES STRESS AND ANXIETY pathways and connections.
Many of the same mechanisms that help improve depression also help relieve stress and anxiety.
When stress affects the brain, the effects are felt throughout the body. The opposite is also true.
Exercise can immediately elevate a person’s mood for hours after cessation. In addition, research
suggests that regular exercise has a protective effect against stress, anxiety, and depression.
One study showed that those who engaged in regular vigorous exercise were 25 percent less
likely to develop depression or an anxiety disorder within the next five years.
PREVENTS SOME TYPES OF CANCER

New research from the American Cancer Society and the National Cancer Institute links
exercise with a lower risk of thirteen different cancers. The findings linked leisure-time
physical activity, such as gardening, walking, bowling, and horseback riding, with reduced risk
of breast, colon, esophageal, and endometrial cancers as well as kidney cancer, liver cancer,
myeloid leukemia, and stomach cancer.

Regular intentional physical activity was strongly associated with a reduced risk of multiple
myeloma (a blood cancer) and cancers of the bladder, head and neck, lungs, and rectum.
ENHANCES SELF-IMAGE
People who participate in regular exercise develop strength, muscle density, flexibility,
coordination, and balance and in turn, can make positive changes to the look and function
of their bodies. Multiple studies suggest that improving physical fitness helps people feel
more competent and confident, positively influencing the way they feel about their bodies
and boosting self-esteem. When a person perceives an improvement in their physical fitness
through physical activity—based on weight loss, muscle tone, strength, endurance, and so
forth—it triggers an improvement in body image, which can reinforce exercise as a part of a
healthy lifestyle.
SLOWS THE EFFECTS OF AGING

Studies following sedentary and active aging populations have shown that aging is not the
same for all people. Older, active people had health markers similar to those 20 or 30 years
HEALTH MARKERS: their junior. For example, older adults who engaged in regular cardiovascular activity:
Tools at the service of
health professionals that
objectively measure and • experienced decreased loss of muscle mass or strength,
evaluate indicators of
normal biological processes • did not increase body fat or cholesterol levels,
or pathogenic processes
(i.e., blood pressure). • did not experience a reduction in testosterone levels (males), and
• had stronger immune systems with T cell (a type of white blood cell that helps
protect the body) counts as high as those of a young person.
IMPROVES SLEEP
The Centers for Disease Control and Prevention (CDC) estimates nearly one-third of adults
get the recommended seven to nine hours of sleep per night and two-thirds of teens are not
getting the recommended eight hours per night needed to maintain good health. Chronic
SLEEP DEPRIVATION:
Achieving a less than ideal sleep deprivation leads to an increased risk for physical and mental illness and costs
sleep duration.
businesses and the health care system billions of dollars each year.

Table 11.1 Sleep Recommendations
THE NATIONAL SLEEP FOUNDATION’S SLEEP RECOMMENDATIONS

BY AGE GROUP
Group Age Sleep Recommendation
Newborns 0–3 months 14–17 hours
Infants 4–11 months 12–15 hours
Toddlers 1–2 years 11–14 hours
Preschoolers 3–5 years 10–13 hours
School-age children 6–13 years 9–11 hours
Teenagers 14–17 years 8–10 hours
Younger adults 18–25 years 7–9 hours
Adults 26–64 years 7–9 hours
Older adults 65+ years 7–8 hours
As little as 10 minutes of aerobic exercise can improve the quality of sleep and increase
the overall duration of sleep through all sleep stages. Early morning and afternoon exercise
have been found to have the most beneficial effects for people looking for improved sleep
quality. Exercising at night may negatively affect sleep quality, but the data is not conclusive.
The theory is that increased blood flow, exposure to bright light, and brain oxygenation have
an energizing effect on the brain and may impair the body’s natural production of melatonin.
Better sleep allows people to improve their recovery, allowing them to exercise more regularly.
IMPROVES MENTAL ACUITY

Exercise directly benefits memory and cognition by reducing insulin resistance, reducing
inflammation, and stimulating the release of growth factors. The sum benefits of these
actions affect the health of brain cells and the creation of new blood vessels in the brain and
can enhance the growth and longevity of new brain cells.
Many studies have shown that the prefrontal cortex and medial temporal cortex—the parts of
the brain responsible for thinking and memory—are larger in active people than in sedentary
people. In addition, engaging in a regular fitness program for as little as six months is
associated with an increase in the size of certain areas of the brain.

CARDIOVASCULAR TRAINING PRINCIPLES

The principles and components of program design are a common thread through all areas
of physical fitness, from warm-up to flexibility, strength training, and cardiovascular work.
Each principle and component helps explain how to best program cardiovascular training
for each client. How long, how hard, and how often clients train are determined by the
underlying principles.
The type of cardiovascular exercise and the associated acute training variables chosen for
each client must be specific to benefit the client’s desires. A marathon runner and a sprinter
do not follow the same training program. The more specific the cardiovascular training is to
the sport or activity, the greater the improvement in performance the client can expect.
PRINCIPLE OF INDIVIDUAL DIFFERENCES

Fitness assessments provide information about a client’s current fitness level and
potential challenges. The data collected should be used to determine the appropriate
training loads and progression. Periodic reassessments give a fitness trainer insights
into how clients have adapted to the prescribed program and what manipulations need
to occur to drive success. A program that works for one client should not be assumed to
work for another.

As the body adapts to training, systematic and progressive stresses are placed on the
body to facilitate its adaptive response. Much like resistance training, changes to volume,
intensity, and frequency should all be progressively increased to initiate adaptations to
cardiovascular training. Depending on the client’s goals, shorter rest periods, longer bouts of
exercise, faster bouts of exercise, or more frequent bouts of cardiovascular exercise can be
applied to overload the cardiovascular system and elicit change. However, the progression
of all variables should be gradual—frequency, intensity, or duration should not be increased
by more than 10 percent each week. Furthermore, only one to two variables should be
manipulated at a time to prevent overreaching or overtraining.
The effects of aerobic exercise are not permanent. Research shows that cardiorespiratory
fitness declines sharply within two weeks of stopping intense endurance training. Fitness

returns to pretraining levels after 10–32 weeks of detraining. However, systematically
decreasing the frequency and duration of exercise while maintaining intensity is beneficial to
avoid overtraining and will not significantly decrease VO2 max.

VO2 MAX:
The maximum amount of
GENERAL ADAPTATION SYNDROME oxygen an individual can
The body goes through three stages in response to adequately intense exercise—alarm, utilize during exercise.
resistance, and exhaustion. During the alarm stage, the body experiences symptoms
of fatigue, weakness, or soreness. This stage lasts from two to three weeks. During the
resistance stage, the body experiences biochemical, mechanical, and structural adaptations
to improve efficiency in response to the stress applied during training. Finally, during the
exhaustion stage, the body again suffers symptoms of fatigue, weakness, or soreness,
though with greater intensity. If training is maintained at the same level, instead of adapting
positively, the client may experience burnout, overtraining, injury, or illness.
A properly periodized cardiovascular training program allows adequate and timely recovery to
avoid the stage of exhaustion. This includes manipulating acute training variables as well as
programming rest and recovery. ACUTE TRAINING

VARIABLES:
Fitness-Fatigue Paradigm The components that
specify how an exercise is
performed.
Higher-intensity cardiovascular training leads to greater fitness adaptation but also generates
greater fatigue. Clients will likely require more rest and time for recovery after intense training
bouts or cycles. If training stays at a consistent high intensity, fatigue will increase and result
in reduced performance.
If training intensities are low, so reduced are fitness adaptations, fatigue, and performance.
However, research has shown that fatigue dissipates at a faster rate than fitness. If
appropriate training strategies and periodization are used, then fitness and performance
levels will increase while fatigue levels decrease.
Tapering
During a taper period, the volume or frequency of training decreases to allow the body
adequate rest and recovery. During this recovery time, there must be a focus on low-intensity TAPER PERIOD:
A training period where
technique work and nutritional interventions for optimized physical recovery and performance. the volume or frequency of
training decreases to allow
Tapering is commonly used in conjunction with a periodized program to help athletes and the body adequate rest and
recovery.
bodybuilders peak and fully recover for competition.

MODIFYING ACUTE TRAINING VARIABLES

Commonly manipulated acute training variables for cardiorespiratory training are as follows:
• Frequency
• Intensity
• Time/duration
• Type
• Resistance
• Rest
• Recovery
With any programming periodization, only one to two variables are manipulated at a time to
allow for adaptation. This also allows a trainer to determine which variables are the most
effective at eliciting a desired training response for each client.
FREQUENCY
For aerobic endurance performance, three to six training sessions per week is typical. The
“ideal” training frequency depends on the intensity and duration of each training bout, the
training goal(s), the training status of the client, and the specific sport season for athletes.
For cardiovascular health, the American Heart Association recommends the following:
Table 11.2 Cardiovascular Frequency Recommendations
RECOMMENDATIONS RECOMMENDATIONS
FOR ADULTS FOR YOUTH
150 minutes or 2.5 hours Should be physically

Fat loss or
per week or more of active with opportunities
endurance 3–5 years
moderate-intensity aerobic to move throughout the
goal
activity day
Strength or 60 minutes per day of

75 minutes per week of
hypertrophy moderate to vigorous-
vigorous aerobic activity
goal intensity physical activity
6–17
years
Any combination of At least 3 days per week
General
moderate to vigorous- of vigorous intensity
fitness goal
intensity aerobic activity activity

Volume
Volume is easily manipulated during each session by increasing the amount of work completed,
specifically the amount of time spent performing cardiovascular activity. Increasing frequency
or duration or both increases volume.
• Cardiovascular intensity can be measured using several different methods:
• VO2 Max: the maximum rate of oxygen consumption measured during exercise
• Target heart rate (THR): the goal heart rate to reach a specific level of physical TARGET HEART RATE
exertion for cardiovascular fitness improvement (THR):
The estimated beats per
• Rate of perceived exertion (RPE): measured by the Borg rating scale (6–20) or the minute that need to be
reached to achieve a
modified exertion scale (0–10), a quantitative and subjective measure of exertion specific exercise intensity.
during physical activity
• Talk test: the use of the ability to speak during exercise as a gauge of the relative RATES OF PERCEIVED
intensity EXERTION (RPE):
A subjective sliding scale of
• Metabolic equivalent (MET): the measure of the ratio of a person’s expended a client’s perception of their
exercise intensity.
energy to their mass while performing physical activity
Table 11.3 Rating of Perceived Exertion: Borg and Modified Borg Scales TALK TEST:
The ability to speak during
THR exercise as a gauge of the
BORG MODIFIED BREATHING, EXERCISE relative intensity.
(PERCENT
RPE RPE TALK TEST TYPE
OF MAX HR)
METABOLIC
6 No exertion EQUIVALENT (MET):
0 The measure of the ratio
7 of a person’s expended
Very light breathing. 50–60 percent Warm-up energy to their mass while
8 Can sing “Happy performing physical activity.
1 Birthday” easily.
9
10
2 Deeper breathing but
11 comfortable. Able to 60–70 percent Recovery
hold a conversation.
12
3
13
Able to talk but difficult
70–80 percent Aerobic
to hold a conversation
14 4

Table 11.3 Rating of Perceived Exertion: Borg and Modified Borg Scales
(CONT)
THR
BORG MODIFIED BREATHING, EXERCISE
(PERCENT
RPE RPE TALK TEST TYPE
OF MAX HR)
15 5 Starting to breathe
hard and getting
80–90 percent Anaerobic
uncomfortable to carry
16 6
a conversation
17 7 Deep and forceful

breathing.
Uncomfortable and
18 8
High intensity,
unable to talk. 90–100 percent
VO2 max
19 9 Extremely hard
20 10 Maximum exertion
INTENSITY
Cardiorespiratory training intensity can be measured using the Borg RPE or modified RPE
scales, METs, the talk test, THR, or a personal heart rate monitor. Some of the acute variables
that can be manipulated to affect intensity are the following:
• Rest: decrease rest time to increase intensity
• Resistance: increase resistance to increase intensity
• Speed: increase speed to increase intensity
There are six standardized types of cardiovascular training. Each is a slight modification of
the acute variables as well:
1. Low intensity, long duration or low-intensity steady state (LISS): cardiorespiratory

MAXIMUM HEART exercise between 60 and 75 percent of maximum heart rate that remains within
RATE: the aerobic threshold
The estimated maximum
number of times the heart 2. Moderate intensity, medium duration: 70 to 85 percent of maximum heart rate
should beat per minute
during exercise. Calculated effort that aims to remain aerobic. For untrained clients, the percent of maximum
by subtracting a person’s
age from 220. heart rate may be lower.

3. High intensity, short duration or high-intensity interval training (HIIT): 80 percent
of maximum effort or greater during work periods, with lower-intensity rest periods
that are long enough to allow the heart rate to recover
4. Aerobic intervals: sub-maximum effort during work periods to remain within the
aerobic threshold
5. Anaerobic intervals (Tabata): maximum effort during 20-second work periods with
short 10-second complete rest for eight rounds or four minutes total. RPE 10 effort.
Fartlek (“speed play” in Swedish) is an outdoor running style that uses landmarks and terrain
to increase or decrease running speed. Fartlek training is a way to modify several variables FARTLEK:
A training system for
at once. There are two common types of Fartlek workouts: time-based and random. distance runners that
continually varies terrain
and pace to enhance
Time-based intervals include the following:
conditioning and eliminate
boredom.
• Fixed time: exercise for a set period for each interval
• Varying time: each interval will be a different length of time
• Varying pace: each interval will have a different speed
Random intervals are completely dependent on the runner. For example, a client may
mark intervals using trees or signs—run from this tree to that tree, recover as necessary,
and then repeat. Intervals may be based on terrain—walk up hills and run down them. Or
a client may change pace whenever a new song comes on the radio. Distance can also
be used to mark intervals.
The intensity of a physical activity can be classified based on oxygen requirements. The
amount of oxygen the body uses is directly proportional to the energy used during the
activity (in the form of adenosine triphosphate [ATP]). METs are used to estimate the
energy expenditure for many common physical activities. At rest, the body uses about 3.5
milliliters (mL) of oxygen per kilogram (kg) of body weight per minute. The resting level
of oxygen consumption is referred to as 1.0 MET. An 8.0 MET level would equal eight
times the amount of oxygen used at rest. Using METs as a reference with clients, grading
intensity by multiples of resting level can assist clients in understanding their intensity.
Many modern cardiovascular machines use METs, and METs can be converted to other
work measurements such as kilocalories per minute or watts.
Although the MET method can be used for prescribing exercise intensity, it has two limitations.
First, environmental factors—heat, humidity, cold, wind, altitude, pollution, differences in terrain,
and so forth—can change the way the cardiovascular system responds to a given MET level.

As a result, the cardiovascular system may be working harder at the “same” MET level. If a
task gets harder because of, say, heat or altitude, the body requires more oxygen, burning more
kilocalories; therefore, the task would not be at the same MET level. For example, brisk walking
(3.5–4 miles per hour [mph]) equals 5 METs, but in a hot environment, it may require more
work or a higher MET level to accomplish the same task. In another scenario, brisk walking at
3.5 mph while wearing a weighted vest would require more oxygen, increasing the MET level.
The more oxygen the body uses during physical activity, the more Calories it will burn. METs are
used to estimate the energy expenditure for many common physical activities.
Second, as fitness improves, a client needs to exercise at higher MET levels to continue to
advance fitness per the principle of progressive overload. For these reasons, THR and RPE
are more commonly used to indicate exercise intensity than the MET because of ease of use.
Using the same example of brisk walking (3.5–4 mph) equaling 5 METs, as fitness levels
increase, THR and RPE may decrease.
A fitness professional can use the following equation to determine the Calories expended for
a client’s favorite activity:
METS × 3.5 × Bodyweight (KG) / 200 = Calories per Minute
TEST TIP!
The acronym for the most common cardiorespiratory training variables is FITT.
F: Frequency
I: Intensity
T: Time
T: Type
TIME/DURATION
The duration of a training session is inversely related to exercise intensity. The longer the exercise
session, the lower the intensity. The higher the intensity, the shorter the exercise session.
Calorie burn for individuals will vary based on physical size and fitness level. Here are some
examples that can equal approximately a 250-Calorie expenditure:

Table 11.4 Duration of Cardiovascular Activity Equaling 250 Calories
MODERATE HIGH
LOW INTENSITY, INTENSITY, INTENSITY,
DESCRIPTION
LONG DURATION MODERATE SHORT
DURATION DURATION
Activity and Slow walking Brisk walking Moderate jogging

duration for 60 minutes for 45 minutes for 20 minutes
Speed 3.0 mph 4.0 mph 6.0 mph
Liters of oxygen
per minute 0.9 L O2 /min 1.1 L O2 /min 2.7 L O2 /min
consumed
Approx. Calories
250 Cal burned 250 Cal burned 250 Cal burned
burned
TYPE
Walking, running, swimming, cycling, rowing, circuit training, and many sports are variations
of exercise that affect the cardiovascular and respiratory systems. There is no ideal type of
cardiovascular training. Activities that a client enjoys and align with their goals should be the
primary training type to ensure exercise satisfaction and commitment to training.
RESISTANCE
Incline and speed can be modified on most cardiovascular machines. Cardiovascular training
machines such as treadmills, step mills, cycles, and rowing machines also include resistance
settings to increase or decrease training intensity. In addition, training intensity can be
increased by adding resistance via equipment or by modifying the training environment.
Equipment such as ropes, sleds, parachutes, resistance bands, and weights—weighted vests
or kettlebells—can be added to aerobic exercises to increase intensity and variability.
Choosing different training environments also changes the intensity and variability of a
workout. For example, hills or stadium stairs increase intensity by manipulating the incline or
decline of the activity. Training on sand, grass, artificial turf, or rocky trails changes the level of
impact to joints (less impact) and increases intensity because the surface shifts underfoot.
Training on solid surfaces, such as concrete, increases the impact to joints but decreases
the overall level of intensity.

Water can also be used as resistance. Aerobic training in the water can be effective but also
gentle on joints. Training intensity can be increased or decreased by adding paddles for more
resistance or floatation devices for varied buoyancy.
Though a change in resistance (load), tool, and environment can vary intensity and variability,
these changes can also alter movement mechanics. Pushing or pulling a light load on a
sled will change the intensity, and a heavier load can enhance or compromise movement
mechanics and should be considered with the desired outcome in mind.
RECOVERY
Intense exercise must be followed by adequate rest and recovery to allow positive adaptations
and avoid overtraining. If training is the stimulus and nutrition the building blocks, recovery
is what allows for and fosters adaptations such as tissue repair. Recovery can be active or
passive. For example, foam rolling or stretching is “active,” while and sleep and hydration
are “passive.” Recovery is as important a component as training and nutrition, though often
overlooked. Many seasoned marathon runners, for example, follow a three- to four-week taper
plan to conclude a training cycle or prepare for an event. This means that training volume
is reduced during the final two to four weeks before the race. Common practice is to reduce
weekly volume (mileage) by 20 to 30 percent each week.
For example, if a client’s highest mileage week is 42 miles, the first taper week mileage would
be reduced by 8.5–12.5 miles. Training intensity (speed) will remain at race pace, but the
overall training volume will decrease.
Table 11.5 Aerobic Endurance Training Types

FREQUENCY DURATION (ACTIVITY
TRAINING TYPE INTENSITY
PER WEEK PER SESSION)
Low-intensity Race distance or longer Approx. 70 percent
1–2
steady-state (LISS) (Approx. 30–120 minutes) of VO2 max
At lactate threshold;
Pace/tempo 1–2 Approx. 20–30 minutes at or slightly above
race pace
3–5 minutes
Intervals 1–2 Close to VO2 max
(1:1 work-to-rest ratio)
30–90 seconds Greater than
Repetition 1
(1:5 work-to-rest ratio) VO2 max
Varies Between
distance and pace/
Fartlek 1 Approx. 20–60 minutes
tempo training
intensities

Range of Motion
Range of motion can be manipulated to meet many objectives. For example, if a new client
wants to train for a marathon but was previously sedentary, they may complain of low back
pain or other issues. Tight hip flexors caused by prolonged sitting or repetitive activities such
as jogging or cycling can shift the pelvis, resulting in anterior pelvic tilt. This specific postural
deviation causes imbalances throughout the musculature of the lumbopelvic hip complex but
specifically contributes to inactivity and weakness in the gluteus maximus. Range of motion
training interspersed with cardiovascular training can fix muscle imbalances, improve running
efficiency, and reduce low back pain.
MEASURES OF CARDIORESPIRATORY FITNESS

The overall health of a person’s cardiorespiratory system is critical to their ability to engage
in physical activity and exercise and can be assessed through a process called spirometry.
Spirometry uses a spirometer to measure the airflow into and out of the lungs, including
measurements of the following: SPIROMETER:
An apparatus for measuring
the volume of air inspired
• Maximum voluntary ventilation: the volume of air breathed out in a specified time
and expired by the lungs.
with maximum effort
• Vital capacity: the greatest volume of air that can be expelled from the lungs after
VITAL CAPACITY:
taking the deepest possible breath The greatest volume of air
that can be expelled from
• Tidal volume: the lung volume representing the normal volume of air displaced the lungs after taking the
deepest possible breath.
between normal inhalation and exhalation when extra effort is not applied
• Total lung capacity: the volume of the lungs when fully inflated
TIDAL VOLUME:
• Residual volume: the volume of air remaining in the lungs after maximum exhalation The lung volume
representing the normal
volume of air displaced
between normal inhalation
and exhalation when extra
effort is not applied.
Figure 11.1 Spirometer

VITAL CAPACITY
The vital capacity of the lungs is the greatest volume of air that can be expelled from
the lungs after taking the deepest possible breath. Using a spirometer, vital capacity is
measured by how much air is exhaled after a person breathes in as much air as possible.
Vital capacity measures the functional portion of a person’s lungs and, for healthy adults,
typically measures around 3,000 to 5,000 mL, depending on age, sex, height, and mass. Low
vital capacity (generally below 3 liters [L] or 3,000 mL) is generally a symptom or a sign of a
respiratory problem or disease.
The average adult has a normal breathing rate of 12 breaths per minute. A conditioned athlete
may breathe as much as 20 times their vital capacity over one minute, while a deconditioned
person may not even reach 10 times their vital capacity in one minute. However, aerobic
exercise can improve vital capacity by strengthening the muscles involved in respiration and
increasing the efficiency of the lungs.
TIDAL VOLUME
The tidal volume is the lung volume representing the normal volume of air displaced between
normal inhalation and exhalation when extra effort is not applied. This means it is a measure
of how much air moves into and out of someone’s lungs while at rest. On average, tidal
volume is about 10 percent of a person’s vital capacity.
People with larger bodies have larger lungs than those of smaller stature, which also means
they may have a higher natural tidal volume. Although this value will be different among
people of varying body size, an average adult tidal volume is about one-half of a liter (500 mL)
per breath in healthy males and slightly less (approximately 400 mL) per breath in healthy
females.
The following factors influence tidal volume and vital capacity:
• Age: Lungs are at their maximum capacity during early adulthood and decline with
age.
• Sex: Female reproductive hormones lower aerobic power and pulmonary function.
• Body size: Smaller bodies naturally have smaller lung capacity.
• Physical conditioning: Lung capacity improves (up to about 15 percent) with frequent
aerobic exercise.

During exercise, tidal volume typically increases as breathing becomes deeper. This allows the
lungs to take in more oxygen and expel more carbon dioxide. However, tidal volume does reach
a plateau based on exercise intensity. During low- to moderate-intensity exercise, research
has shown that the increase in tidal volume and breathing rate is roughly proportionate to the
exercise intensity. However, at higher intensity efforts, a plateau in tidal volume is reached,
and the only way to increase respiration is to increase the number of breaths per minute.
MINUTE VENTILATION
The total amount of air entering the lungs over the course of one minute is called the minute
ventilation. This cardiorespiratory measurement is directly related to a person’s tidal volume MINUTE VENTILATION:
The total amount of air
and is calculated as: entering the lungs over the
course of one minute.
Minute ventilation (MV) = respiratory rate × tidal volume (TD)
where the respiratory rate describes how many breaths the person takes per minute.
The average adult has a minute ventilation of about 6 L per minute. During exercise, tidal volume
and breathing rate increase to supply working cells more effectively with oxygen for metabolism
and to remove waste products. Thus, minute ventilation also increases. The average healthy
adult’s breathing rate increases to 35 to 45 breaths per minute based on intensity during exercise
as their tidal volume also increases. Research has shown that healthy adults typically have a
minute ventilation of approximately 100 L during heavy exercise. Well-conditioned clients can have
a minute ventilation of up to 160 L during maximum-effort exercise.
Unconditioned people, those with chronic health conditions that affect the lungs directly
or the surrounding structures, and people with neuromuscular diseases that progressively
weaken the muscles involved in respiration may have reduced minute ventilation. These
physical conditions can also cause the body to become reliant on muscles outside those
typically used for respiration (e.g., the abdominals), and these people may have shallow,
rapid, or labored breathing. For a fitness professional, this is important to recognize because
it can affect a client’s ability to breathe adequately during physical activity, and the intensity
or effort may need to be adjusted.
VO2 MAX
A person’s VO2 max is a calculation of how much oxygen the body can use during intense exercise
(V, volume; O2, oxygen). The more oxygen the body can use during exercise, the more cellular
energy can be produced to fuel that exercise. Recent research has shown that although VO2 max
is partially predetermined by genetics, it may also be increased with appropriate training.

VO2 max is measured as the volume of milliliters of oxygen consumed per kilogram of body
weight per minute (mL/kg/min) and is most accurately calculated in a laboratory setting. The
Astrand-Rhyming Cycle Ergometer Test uses a bicycle to measure all-out efforts under a strict
protocol. While this is not conducted in most fitness settings (some facilities do have the
proper equipment and trained staff), the Rockport Walk Test (RWT) is often executed more
easily. This assessment requires a one-mile walk on a treadmill as fast as possible and has
been found to be relatively accurate for the estimation of VO2 max in adults aged 20 to 69.
With the Rockport Walk Test, VO2 max is calculated as:
Estimated VO2 max (mL/kg/min) = 132.853 – (0.0769 × body weight [lb]) – (0.3877 × age)
+ (6.3150 × sex) – (3.2649 × RWT time in minutes and hundredths) – (0.1565 × 1 – HR)
where age is in full years (no fractions), the sex variable is zero (0) for females and one (1)
for males, and the HR is the beats per minute taken at the end of the mile assessment. The
mile walk time is written in minutes and hundredths. For example, a time of 10:30 is 10.5
minutes, or a time of 11:15 is 11.25 minutes.
This estimation has been found to have an error margin of +/– 5, so the result should
account for this margin of error. For example, a VO2 max calculation of 35 mL/kg/min would
estimate between 30 and 40 mL/kg/min.
Some research has shown a link between heart rate and a person’s subjective RPE and VO2
max. Specifically, heart rate during activity can be used to estimate the VO2 max in many
clients. A general, though less accurate, calculation of VO2 max considers estimated
maximum heart rate and resting heart rate (RHR).

RESTING HEART RATE
(RHR): VO2 max = 15.3 × (max heart rate / resting heart rate)
when completely at rest. where maximum heart rate is calculated as 220 minus age and resting heart rate is beats
per minute at rest (or the number of heartbeats at rest for 30 seconds multiplied by 2).
The norms for VO2 max also consider sex. It is important to understand that these calculations
are merely estimations unless completed under laboratory supervision, but the overall results
can be improved with cardiorespiratory training. For consistency, whichever method is used to
estimate VO2 max initially should be repeated for future evaluations.

Table 11.6 VO2 Max Norms by Sex
VALUE FOR VO2 MAX
VO2 Max Norms for Men as Measured in ml/kg/min
Age Very Poor Poor Fair Good Excellent Superior
35.0- 38.4- 45.2- 51.0-

13-19 <35.0 >55.9
38.3 45.1 50.9 55.9
33.0- 36.5- 42.5- 46.5-

20-29 <33.0 >52.4
36.4 42.4 46.4 52.4
31.5- 35.5- 41.0- 45.0-

30-39 <31.5 >49.4
35.4 40.9 44.9 49.4
30.2- 33.6- 39.0- 43.8-

40-49 <30.2 >48.0
33.5 38.9 43.7 48.0
26.1- 31.0- 35.8- 41.0-

50-59 <26.1 >45.3
30.9 35.7 40.9 45.3
20.5- 26.1- 32.3- 36.5-

60+ <20.5 >44.2
26.0 32.2 36.4 44.2
VO2 Max Norms for Women as Measured in ml/kg/min
25.0- 31.0- 35.0- 39.0-

13-19 <25.0 >41.9
30.9 34.9 38.9 41.9
23.6- 29.0- 33.0- 37.0-

20-29 <23.6 >41.0
28.9 32.9 36.9 41.0
22.8- 27.0- 31.5- 35.7-

30-39 <22.8 >40.0
26.9 31.4 35.6 40.0
21.0- 24.5- 29.0- 32.9-

40-49 <21.0 >36.9
24.4 28.9 32.8 36.9
20.2- 22.8- 27.0- 31.5-

50-59 <20.2 >35.7
22.7 26.9 31.4 35.7
17.5- 20.2- 24.5- 30.3-

60+ <17.5 >31.4
20.1 24.4 30.2 31.4

METABOLIC EQUIVALENT (MET)

The MET is the measure of the ratio of expended energy to the person’s mass while performing
physical activity. This measure considers the metabolic rate at rest and the metabolic rate
required to support an activity. One (1) MET is equal to a person’s metabolic rate when at
rest. One (1) MET is approximately 3.5 mL of oxygen consumed per kilogram of body weight
and is calculated as:
1 MET = weight (kg) × 3.5 mL
For example, a 150-pound person (68.04 kg) would have a 1 MET of 68.04 kg × 3.5 mL =
238.14 mL of oxygen per minute.
A MET value of four would mean this person is using four times the amount of oxygen and
has a metabolic rate four times that of their metabolic rate at rest. Energy expenditure can
vary by age and fitness level, but for most healthy adults, MET values can be helpful in
exercise planning and as a gauge for the effort being put forth during activity.
Several activities have been calculated in METs for the average adult. The approximation of METs
can be used to estimate the number of Calories burned during each activity for an individual.
Table 11.7 Estimated MET Values for Specific Activities
LIGHT MODERATE VIGOROUS

< 3.0 METS 3.0–6.0 METS > 6.0 METS
Housework Walking at very brisk pace

Sitting at a desk: 1.3
(cleaning, sweeping): 3.5 (4.5 mph): 6.3
Sitting, playing cards: Weight training Bicycling 12–14 mph

1.5 (lighter weights): 3.5 (flat terrain): 8
Standing at a desk: Golf Circuit training

1.8 (walking, pulling clubs): 4.3 (minimal rest): 8
Strolling at a slow Brisk walking

Singles tennis: 8
pace: 2.0 (3.5–4 mph): 5
Weight training
Washing dishes: 2.2 Shoveling, digging ditches: 8.5
(heavier weights): 5
Yard work
Hatha yoga: 2.5 Competitive soccer: 10
(mowing, moderate effort): 5
Swimming laps Running

Fishing (sitting): 2.5
(leisurely pace): 6 (7 mph): 11.5

The Caloric value of an activity can be estimated using the MET value for the activity, body
weight in kilograms, and the following formula:
Calories burned per minute = (activity METs × 3.5 × bodyweight [kg]) / 200
For example, consider the 150-pound person again. Their weight in kilograms is 68.04 kg,
and they are walking at a very brisk pace with a MET value of 6.3.
Calories per minute = (6.3 × 3.5 × 68.04kg) / 200
= (1500.282) / 200
= 7.5 Calories per minute
7.5 Calories per minute × 60 minutes = approximately 450 Calories burned per hour
during this activity.
LACTATE THRESHOLD
Another means for calculating the efficiency of the cardiorespiratory system is the lactate
threshold. Lactate is a by-product of metabolism that is produced by blood cells, the brain, LACTATE THRESHOLD:
The maximum effort or
and muscle tissue. It is used to supply the cells with energy when there is a lack of oxygen intensity an individual can
maintain for an extended
or when normal cellular metabolism is disrupted. Lactate is a fuel, not a waste product. time with minimal effect on
blood lactate levels.
However, the threshold where lactate builds up in the tissues faster than it can be cleared is
an important indicator of cardiorespiratory endurance performance and can be improved with
cardiorespiratory training.
The measure of the lactate threshold measures the maximum effort or intensity a person
can maintain for an extended time with minimal effect on blood lactate levels. This requires
a blood draw to measure blood lactate levels, which makes it accurate but not necessarily
practical in a fitness setting. Lactate threshold is often expressed as approximately 75
percent of VO2 max or 85 percent of the maximum heart rate for the average person and can
vary based on fitness level.
VENTILATORY THRESHOLD
Closely related to the lactate threshold is the ventilatory threshold (VT). This measure tracks
VENTILATORY
changes in carbon dioxide extraction, oxygen consumption, and breathing rate and volume.
THRESHOLD (VT):
Ventilatory threshold represents the lactate threshold—the level of intensity where blood The threshold where
ventilation increases faster
lactate accumulates faster than it can be cleared from the body—and it causes a person to than the volume of oxygen.
breathe faster (increase their breathing rate) to consume more oxygen and expel more carbon

dioxide. It is measured with a breathing mask or based on observable breathing rates as
opposed to the blood draw needed to accurately measure lactate thresholds.
For the average adult, the ventilatory threshold is at exercise intensities between 50 and 75
percent of maximum. An unconditioned client will reach their ventilatory thresholds at lower
physical intensities than a trained one. For example, walking may elevate an unconditioned
client’s breathing rate, while someone who has been training for a while may need to be
running at a seven-mile-per-hour pace to elevate their breathing rate.
It is also related to VO2 max in that ventilatory thresholds occur before maximum oxygen
uptake. Ventilatory threshold 1 (VT1) occurs when the breathing rate begins to increase
during activity, and ventilatory threshold 2 (VT2) is at a relatively high-intensity effort when the
person is out of breath. When someone achieves their VO2 max, they will no longer be able
to continue their exercise or activity.
VO2 Max
exercise needs to
VT2 conclude due to
exhaustian
breathing increased to
point where person is
out of breath
VT1
breathing begins to
increase
rest Maxiumum
Figure 11.2 Ventilatory Thresholds and VO2 Max
MAXIMUM HEART RATE

Maximum heart rate is the maximum beats per minute someone’s heart can achieve during
activity, and it is a measure that is estimated to help determine exercise intensity for
cardiorespiratory training. Testing to determine a client’s actual maximum heart rate requires
the client to work at maximum capacity, which is not practical for a fitness setting. However,
an estimation of maximum heart rate is commonly found using the following formula:
Maximum heart rate (HRmax) = 220 – age

where age is in whole years. While commonly used to estimate maximum heart rate, this
formula has a margin of error of +/– 10 to 15 beats.
There is great variability by client and age on actual heart rate maximums. For example,
a well-conditioned client will likely have a higher maximum heart rate and a lower resting
heart rate because their cardiorespiratory system is more conditioned and efficient and can
handle more work than an unconditioned client. With that in mind, a fitness professional can
estimate a client’s heart rate and corresponding heart rate zones, but this formula should
not be used as an absolute.
HEART RATE ZONES

The heart rate is a key indicator for exercise intensity and is used by fitness professionals to
prescribe intensity and evaluate fitness levels. There are five heart rate zones that generally
correspond with exercise intensities. Each zone represents a range of the percentage of
maximum heart rate and an RPE. As with the maximum heart rate estimation, heart rate
zones are also estimations and can vary based on the training status, health condition, age,
and body size of the client.
Zone 1 is a very light intensity and equates to 50 to 60 percent of maximum heart rate and
an RPE of 1 to 2. Examples of zone 1 activities include a warm-up, a cooldown, and a slow
walking pace. This zone can be used to slightly elevate the heart rate, promote physical
recovery, and promote optimal metabolism. Activities in zone 1 can be sustained for extended
periods.
Zone 2 is a light intensity and equates to 61 to 70 percent of maximum heart rate and an
RPE of 3 to 4 (easy). Lightweight resistance training, a light jog, or walking up a flight of
stairs would fall into zone 2 cardiorespiratory intensity. Breathing at this intensity is light,
and the client may begin to sweat. Training in this zone can improve both muscular and
cardiorespiratory endurance and can be sustained for extended periods.
Zone 3 is a moderate training intensity and equates to 71 to 80 percent of maximum heart rate
and an RPE of 5 to 6 (moderate). Breathing may begin to deepen with moderate sweating in this
zone. Based on the percentage of maximum heart rate, training in zone 3 is generally still aerobic,
and aerobic fitness can be improved. Hiking, a moderate jog, and moderate-paced resistance
training are generally zone 3 activities that can elicit this level of heart rate response.

Zone 4 is generally moving into anaerobic exercise and is a challenging intensity. Training in
ANAEROBIC EXERCISE: this zone equates to 81 to 90 percent of maximum heart rate and an RPE of 7 to 8 (hard).
Short-duration muscle
contractions that break Training in zone 4 can only persist for moderate amounts of time and elicits feelings of
down glucose without using
oxygen. physical fatigue and heavy breathing to the point that the client cannot carry on a conversation.
For example, running at a five-kilometer run pace, cardiorespiratory interval training, or
resistance training intervals would fall into zone 4. Training in this heart rate zone can promote
anaerobic fitness improvements and improve performance capacity.
The final heart rate zone is zone 5. Zone 5 is maximum effort and equates to 91 to 100
percent of maximum heart rate with an RPE of 9 to 10 (very hard). This intensity can only be
maintained for short durations, and it will feel like an all-out effort. Training in this zone can
improve athletic performance, fast-twitch muscle fiber development, and sprint speeds. Not
all clients will need to reach this heart rate zone. However, unconditioned clients may reach
this zone and RPE at lower heart rates than estimated, while more conditioned clients will
see the opposite effect.
ZONE 1 • 50-60% Max HR

Very light activity, such as warm-up/cooldown
ZONE 2 • 61--70% Max HR

Light activity, such as slow-paced jogging, walking
up a flight of stairs, lightweight low resistance
ZONE 3 • 71--80% Max HR

Moderate activity that increases aerobic endurance,
such as moderate jogging, cycling, or rowing
ZONE 4 • 81--90% Max HR

Hard anaerobic activity, such as high rep ball slams,
boxing, or heavy weight lifting
ZONE 5 • 91--100% Max HR

Extreme hard maximum exertion activity, such as
sprinting. All out effort!
Figure 11.3 Heart Rate Zones
To calculate the beats per minute that equate to each heart rate zone during cardiorespiratory
fitness prescription, a client’s maximum heart rate will be multiplied by the high and low
ranges of each zone. For example, consider a 35-year-old client.

HRmax = 220 – 35 = 185 beats per minute
Zone 1: 185 bpm × 0.50 = 92 bpm
185 bpm × 0.60 = 111 bpm
Zone 1 = 92 to 111 beats per minute
Zone 2: 185 bpm × 0.61 = 113 bpm
185 bpm × 0.70 = 129 bpm
Zone 3: 185 bpm × 0.71 = 131 bpm
185 bpm × 0.80 = 148 bpm
Zone 4: 185 bpm × 0.81 = 149 bpm
185 bpm × 0.90 = 166 bpm
Zone 5: 185 bpm × 0.91 = 168 bpm
185 bpm × 1.0 = 185 bpm
Again, these heart rate beats per minute are not absolute but can provide general guidance
as to where the client’s heart rate needs to be to achieve the desired cardiorespiratory
training effect.
HEART RATE RESERVE AND TARGET HEART RATE (THR)

Heart rate reserve (HRR) calculates the difference between a person’s estimated maximum
heart rate and their resting heart rate. It is a metric that can be tracked and improved as the HEART RATE RESERVE
resting heart rate decreases with cardiorespiratory conditioning. A fitness professional can
(HRR):
Maximum heart rate minus
use this formula to calculate HRR: resting heart rate.
HRR = HRmax – HRrest

HRR can also be used to calculate a client’s THR. THR is the desired heart rate to be
achieved based on the desired exercise intensity, and this measure also considers the
person’s maximum and resting heart rates. THR can be calculated with the Karvonen formula
KARVONEN FORMULA: as follows:
The formula to estimate
a target heart rate with
consideration of heart rate THR = ([HRmax – HRrest] × desired intensity) + HRrest
reserve and resting heart
rate. Consider the 35-year-old client again with a resting heart rate of 55 beats per minute. If the
trainer would like them to work at 80 percent training intensity, their THR would be calculated
as follows:
HRmax = 220 – 35 (age) = 185 bpm
HRR = 185 bpm – 55 bpm (resting) = 130
THR = ([HRR] × 0.80 [intensity]) + 55 (resting)
= (130 × 0.80) + 55
= 104 + 55
THR = 159 bpm for 80 percent exercise intensity
WEARABLE FITNESS TECHNOLOGIES

Wearable fitness technologies track physical activity, such as heart rate, steps taken, and
Calories burned. Most come with a three-axis accelerometer to track movement in every
direction. Physical activity has numerous benefits to health, wellness, and fitness. Tracking
physical activity is an effective way to monitor activity. Most people tend to overestimate time
spent in vigorous intensities and underestimate sitting and low-intensity activities unless they
have objective data. Wearables are a great way for clients to get a feel for how hard or long
they are working and how active they are. Objective data can help a fitness professional set
and monitor realistic goals for clients.
WARM-UP AND COOLDOWN

A general warm-up should be conducted before a cardiorespiratory training bout to increase
heart rate, breathing, and body temperature and to psychologically prepare the client for
exercise. A general warm-up should include 5–10 minutes of low- to moderate-intensity
activity. Examples of general warm-up exercises include walking, jogging in place, walking
lunges, jumping jacks, or a few slow laps in the pool.

Self-myofascial release and targeted stretching for movement preparation should also be
conducted during the warm-up period. This is especially true for clients with a history of injury,
muscle imbalance, or tightness in certain muscles.
Specific warm-ups are done to further enhance performance of the exercise activity to follow and
should come after the general warm-up. A specific warm-up should include dynamic movements
that mimic the exercises that follow. Warm-up exercises should target the joints and muscles that
will be used in the workout. This may include lower-intensity intervals of the activity such as leg
swings before running stadium stairs or high-knee marching before sprint intervals.
A fitness professional should allow at least 30 seconds to 3 minutes of rest before beginning
the training session.
After the exercise bout, a client should perform a cooldown. A proper cooldown routine will
allow the heart rate and body temperature to return to normal. The cooldown period may last
from 5 to 10 minutes but should ideally last until the heart rate is back to normal. Elements
of flexibility may be added to the cooldown after heart rate has returned to resting.
During exercise, the heart must pump a greater volume of blood to support working muscles.
The muscles aid in this process by contracting with more force against the blood vessels. With
this force helping the blood resist gravity, it quickly returns to the heart to be reoxygenated and
sent back out to the body. If intense exercise is stopped abruptly without allowing the body to
cool down, blood may pool in the lower extremities and cause dizziness or loss of consciousness.
PHYSIOLOGICAL ADAPTATIONS TO AEROBIC EXERCISE

Aerobic exercise burns stored fat from adipose tissue, improves cardiovascular health and
fitness, and improves the body’s ability to recover after intense exercise. Aerobic exercise is
typically longer duration and relies on slow-twitch muscle fibers, which contract slower and
at a lower intensity. One major training adaptation of aerobic exercises is the increase in the
size and number of type I muscle fibers to improve endurance performance.

Aerobic exercise cannot change type II muscle fibers into type I fibers contrary to popular
belief. These fiber types are too inherently different. However, some muscle fibers can begin
to favor and take on similar characteristics as another type of fiber based on the activity of
the person. This can occur, for example, if a sedentary person becomes more active and
begins to train for an athletic event such as powerlifting. While the adaptations surely do not
come overnight, this person, with proper training, will start to generate larger type II muscle
fibers and train a relatively low number of type I fibers to support their activity.
ATROPHY:
The wasting away or loss of In the same respect, type II fibers are more prone to atrophy with nonuse. This means there
muscle tissue.
are physiological mechanisms in the fast-twitch fibers that make them more likely to
degenerate than the more readily activated type I fibers.

ANGIOGENESIS:
The development of new Aerobic training also increases the number and size of blood vessels because of the need
blood vessels.
for higher levels of oxygen. Capillary networks surround the muscle fibers in a process called
angiogenesis. Increased amounts of nutrients and oxygen supply the muscles with fuel, and
MYOGLOBIN:
A protein in muscle cells waste is removed faster. This, in turn, supports muscular endurance, resistance to fatigue,
that carries and stores
and recovery.
oxygen.
Aerobic exercise also triggers important metabolic changes in muscle tissue, including an
AEROBIC CAPACITY: increase in mitochondria and myoglobin. Mitochondria are necessary for energy production,
A measure of the ability of
the heart and lungs to get and myoglobin stores the oxygen needed for that process. These changes improve aerobic
oxygen to the muscles.
capacity, a measure of the ability of the heart and lungs to get oxygen to the muscles. Many
of these adaptations contribute to the body’s increased ability to store muscle glycogen and

use fat for energy with aerobic training as well. Since fatty acids are a more efficient source
of ATP, assuming adequate nutrition, the body will increase its ability to release fatty acids into
the bloodstream during aerobic exercise.
CARDIAC MUSCLE ADAPTATIONS

Aerobic exercise is ideal for strengthening the heart muscle, lungs, and blood vessels.
A strong, healthy heart efficiently supplies working muscles, organs, and tissues with
oxygenated, nutrient-rich blood and removes metabolic waste.
As the body is conditioned through aerobic exercise, the cardiac muscle strengthens, delivery
of blood and oxygen to the heart itself is improved, and the heart chambers empty and fill
more efficiently. All these adaptations improve the pumping capacity of the heart. The heart
can then pump more blood with fewer heartbeats, reducing the resting and maximum heart
rates of trained people.
MODES OF CARDIOVASCULAR EXERCISE

Along with the various cardiovascular machines available, there are several basic modes of
cardiovascular exercise. Walking and running serve as the foundation for most cardiovascular
training sessions. Proper form, movement mechanics, and ranges of motion contribute to
the efficacy of any cardiovascular activity and will prevent overuse injuries. Choosing an
appropriate mode of exercise for clients involves client goals, convenience, preference, and
client ability. The mode a client will consistently use may be the best option, at least initially.
WALKING
Walking is a low-impact workout suitable for most clients. A fitness professional should coach
clients on posture, foot motion, stride, and arm swing to get the most from this exercise.

Posture
• Stand straight with feet about hip width apart, toes pointed forward, shoulders
relaxed and pulled back, and chin parallel to the ground.
• Engage the core muscles by pulling the belly button back toward the spine.
• Do not lean forward or arch the back.
Foot Motion
• Follow a heel-toe motion with the heel striking the ground first.
• Roll through the step from heel to toes, and push off with the toes.
Stride
• Keep a natural stride distance; do not overextend the front leg. The heel should
strike the ground close to the front of the body.
• The back leg is what propels the body forward. Keep the rear foot on the ground for as
long as possible, then push off with the toes as the hip and knee reach full extension.
• Hips should move front to back, not side to side.
Arm Swing
• Close the hands into loose fists, but do not clench the fists because this can raise
blood pressure.
• The arms should swing naturally from relaxed shoulders. The forward hand should
not cross the midline of the body.
• Keep the elbows close to the body.
RUNNING
The basic mechanics of running are similar to those of walking. However, the foot strike differs.
Here are some additional tips a fitness professional should share to cue proper running form:
• Shoulders should trace an “X” pattern. As the right foot comes forward, the left
shoulder moves forward. While the left foot is back, the right shoulder should be
forward. Shoulders should stay relaxed and over the hips.
• Lean slightly into the run by hinging at the hips and bracing the core. This helps engage
the gluteus maximus for more power through the stride as the hip and knee extend.
• Knees should fall in line with hips and midfoot. Measure by imagining a line from
the front of the hip joint through the knee joint and through roughly the second and
third toe.
• The most efficient running stride is one in which the shin is perpendicular to the

ground, directly underneath the hips, torso, and head when the foot strikes the
ground and is bearing the weight of the body. However, for running fast, an anterior
or positive shin angle means increased force application in the direction desired.
• The ideal foot strike when running occurs at the forefoot versus the heel (when
walking).
TREADMILL
Treadmills are commonly used for walking or running, as part of a warm-up or cooldown, or
for cardiovascular endurance assessments. Here is how a client can safely use a treadmill:
• With the treadmill off, grab the handrails and place feet on the sides of the belt.
Attach the safety clip to the clothing, and press the “Start” button.
• The belt will move slowly. Place one foot at a time onto the moving belt. Start
walking.
• Remove hands from the handrails.
• Walk or run with proper form without holding on to the handrails.
• To get off the treadmill, allow the belt to stop completely. Place feet on the sides of
the belt. Hold on to the handrails. Remove the safety clip. Step off, one foot at a time.

STAIR-CLIMBER AND STEP MILL

A stair-climber has pedals that move up and down to mimic walking up steps. A step mill is a
revolving staircase that simulates walking or running up a flight of stairs. Here is how a client
can safely mount and dismount these machines:
• With the machine off, grasp the handrails. Step up, one foot at a time, and place
feet on the pedals or step. If on a step mill, climb to the highest step.
• Attach the safety clip to the clothing. Press the “Start” button.
• To dismount, make sure the pedals are immobile or the steps have come to a
complete stop. Grasp the handrails. Unclip the safety clip from the clothing. Step
off, one foot at a time.
Form and Posture on a Stair-Climber
The handrails on the stair-climber should only be used for getting onto and off the machine
or for balance as necessary.
• Stand upright. Hinge slightly forward from the hips.
• Keep the entire foot on the pedal.
• Steps should be moderately deep, not short or choppy.
Form and Posture on a Step Mill
• Use the handrails for getting onto and off the step mill or for balance as necessary.
• Stand upright. Keep a neutral spine. Relax the shoulders and look straight ahead.
• Do not hunch over or lean on the handrails.

SWIMMING
Swimming is a very low-impact aerobic activity and is often used as a recovery technique
because of its minimal impact on the body. In addition to the benefits realized by aerobic
exercise, swimming offers the following:
• Reduced exercise-induced asthma symptoms from exercise in moist air
• Increased lung volume, which helps further reduce asthma symptoms
• Improved bone strength, especially in postmenopausal women
• Relief from arthritis symptoms such as joint stiffness and pain
To safely coach clients in the pool, it is best for a fitness professional to become a certified
swim instructor or water safety instructor through the Red Cross or to refer a client to one.
CYCLING
Cycling is a versatile, low-impact sport that can be done outdoors or indoors, in urban or rural
areas. Variables in cycling that affect intensity include the following:
• Tires: Road bikes have thinner tires that reduce resistance on the street, while
mountain bikes have thicker, rugged tires to grip the terrain for better traction.
• Cycle frame: In outdoor cycling, the lighter the frame, the lower the resistance.
• Cadence: The rhythm at which pedals affect muscle activation. One study showed
that higher speeds increased hamstring activation, while slower speeds engaged
the quadriceps.
• Environment: Weather affects cycling performance in outdoor cycling.
• Terrain: The condition of streets or trails affects overall performance as do incline
and decline (hills).

The muscles engaged in cycling include the gluteus maximus, semitendinosus,
semimembranosus, biceps femoris, adductor magnus, vastus lateralis (externus), vastus
intermedius, vastus medialis (internus), gastrocnemius, soleus, plantaris, tibialis posterior,
flexor hallucis, and flexor digitorum longus.
Here’s how a fitness professional can properly adjust a cycle for comfort, ergonomics, and
performance:
Table 11.8 Upright and Recumbent Bike Setup Procedures
UPRIGHT CYCLES RECUMBENT CYCLES
Adjust the saddle (seat) to hip height. Lift the

Adjust the seat so that the extended leg has a slight
knee to a 90-degree angle from the hip, and
bend in the knee.
adjust the saddle to the height of the thigh.
Clients with lower back issues may benefit from

When seated, the extended leg—with the riding a recumbent rather than an upright cycle.
pedal at the bottom of its rotation—should However, clients with knee pain or injury may benefit
have a slight bend in the knee. more from upright cycles because recumbent cycles
put much more strain on the legs and knees.
With the pedals parallel to the floor, the knee

of the forward leg should be over the ball of
the foot.
Handlebars should be far enough away to

allow a slight bend in the elbows. For clients
with lower back issues, raise the handlebars
until they are comfortable.

ROWING
Rowing is a low-impact aerobic activity that engages the legs, core, back, and arms. It is ideal for
including in cross-training. To mount the rowing machine, a client should sit on the seat and bring
the seat to the front of the machine, nearest the flywheel. Then the client should place feet into
the stirrups and secure the straps across the toes at the base of the great toe joint. Grasping the
oar with the thumbs under the handle, the client should maintain a light grip.
Each rowing movement has four parts:
• The catch: This is the starting position. The shins should be vertical, lats engaged,
shoulders relaxed, and core engaged. The client should lean slightly forward with
shoulders just in front of hips. A fitness professional should coach the client to
not allow the shoulders to round forward. Some of the muscles engaged in this
position are the deltoids, triceps, trapezius, serratus anterior, erector spinae, rectus
abdominus, hamstrings, tibialis anterior, and gastrocnemius.
• The drive: With back straight, core tight, and feet secured, the client should push
back with the lower body. Some of the muscles engaged in this position are the
biceps, brachialis, brachioradialis, erector spinae, hamstrings, gastrocnemius,
soleus, quadriceps, and gluteus maximus.

• The finish: When the legs are almost fully extended, the client should hinge
backward at the hips and use the upper back to pull the oar toward the chest. The
oar should touch just below the chest. A fitness professional should cue the client
to engage the lats, not the shoulders or biceps. The drive and finish should be
one continuous movement. Some of the muscles engaged in this position are the
biceps, brachialis, brachioradialis, forearm extensors, latissimus dorsi, trapezius,
quadriceps, posterior deltoid, and gluteus maximus.
• The recovery: This is the return to the catch. The client should extend the arms
before leaning forward at the hips. Once the hands pass over the knees, the client
should allow the knees to bend. Then the client should slide the seat forward and
assume the catch position. Some of the muscles engaged in this position are the
trapezius, rectus abdominus, hamstrings, anterior deltoid, triceps, wrist extensors,
and gastrocnemius.
Figure 11.1 Rowing Movement Pattern

JUMP ROPE
Skipping rope offers an intense aerobic workout and may improve balance, coordination, and
motor control. In addition, studies have shown that regular rope skipping can increase bone
density for young females.
Beginners and novices may find it easier to jump with a beaded rope rather than a cloth or
vinyl rope. To find the right length rope, a client should grasp the handles and step on the
middle of the rope. The handles should reach the armpits.
A fitness professional should find an area at least four-by-six feet large with enough overhead
clearance for the rope to pass. The jumping surface should be a wood floor, a plywood floor,
or an impact mat. Fitness professionals should be cautious of having clients jumping on hard
or uneven surfaces such as concrete or grass. If a client is not conditioned for jumping, a
high volume of jumping is not warranted and does not follow the principles of progression.
A client should practice upper and lower body movements separately. Fitness professionals
should coach clients to stay on the forefoot to better absorb impact.
BATTLE ROPES
A battle rope is a heavy rope used for intense metabolic conditioning. Some research
suggests that a 10-minute workout with battle ropes meets heart rate and energy expenditure
thresholds to increase cardiorespiratory fitness. HIIT with battle ropes may improve aerobic
and anaerobic capacity after just one month.
Battle ropes vary by length, thickness, and material.

Table 11.9 Battle Rope Variants
LENGTH THICKNESS MATERIAL
Natural fibers: manila
From 30 feet to 100 feet 1.0 inches to 2.0 inches Synthetic fibers: polypropylene,
Dacron, or nylon
A large space with a solid anchor on which to affix the rope is needed for battle rope
workouts. The most popular use of battle ropes is wave exercises. Pulling exercises are done
by wrapping the rope around the anchor.
Here are some guidelines for varying muscle activation and intensity:
• Thickness: Thicker ropes increase intensity by activating the forearm and hand
muscles to challenge (and develop) grip strength. They also add resistance to the
workout because they are heavier.
• Length: Longer ropes require more space than shorter ropes but provide more
challenge while doing wave exercises.
• Distance from the anchor: Waves should reach all the way to the anchor. The
further a client stands from the anchor, the more challenging the workout.

• Wave size/pace: Wave size is subjective, but the larger the upper body motion,
the larger the wave and the greater the intensity. Likewise, pace can increase or
decrease intensity. The faster the pace (the smaller the wave), the more intense
the workout.
• Body position: To vary muscle activation, vary body position. A client should try
kneeling, squatting, lunging, sitting, and doing a plank position to target different
muscle groups.
• Wraps: To perform pulling exercises, a fitness professional can wrap the rope
around an anchor, and the client can pull the rope through the anchor, hand over
hand, and repeat. Intensity can be added by increasing the number of wraps around
the anchor.
KETTLEBELLS
Kettlebells were originally used for recreation and competitive strength athletics. They
continue to be used as such and have added functionality in circuit training as a cardiovascular
challenge. The benefits of kettlebell training include reduced pain in the neck, shoulders,
and low back and stronger overall musculature. Some studies report increased aerobic
conditioning for intercollegiate athletes, while other studies report no change in aerobic
capacity for sedentary adults. Kettlebell swings are complex movements that should be
progressively trained using first no or little weight and then increasing weight as form and
fitness improve.
Common kettlebell exercises include the following:
• Deadlift
• Halo
• Lunge
• Overhead press
• Row
• Goblet squat
• Swing
• Turkish getup

HALO
OVERHEAD
PRESS
GOBLET
SQUAT
Figure 11.2 Kettlebell Exercises: Halo, Overhead Press, and Goblet Squat
CIRCUIT TRAINING
Circuit training includes strength training and cardiovascular training. A circuit is a group of
CIRCUIT TRAINING: exercises performed in succession. Each exercise is done for a predetermined number of
Body training that combines
endurance, resistance, repetitions or amount of time before moving on to the next exercise with little to no rest
high-intensity interval, and
aerobic training. between exercises.
The benefits of circuit training are constant among many populations, including healthy
adults, youth, seniors, obese adults, and adults with cardiometabolic syndrome and risk
factors for cardiovascular disease. Some proven benefits are as follows:
• Improved body composition
• Increased strength
• Improved cardiovascular performance
• High adherence rate to training

Even the following greater results are realized when circuit training is manipulated to create HIIT:
• Improved peak oxygen uptake
• Increased perception of general health
• Decreased RPEs
• Improved quality of life
• Decreased systolic and diastolic blood pressures
• Increased stroke volume
• Improved emotional well-being
To implement circuit training, a fitness professional should measure the one-repetition
maximum (1RM) for each exercise to be performed and determine the training intensity for
each. Between 40 and 70 percent of 1RM is recommended. Since measuring 1RM can
be problematic, the use of a time frame, such as “should reach fatigue in 30 seconds” or
“completes 15 to 20 reps in 30 seconds,” is recommended. This will at least provide the
fitness professional with a rough guideline concerning what weight to use depending on what
the circuit training is targeting.
CROSS-TRAINING
Cross-training is a method of training outside one’s chosen sport. For athletes, it helps avoid
overuse injuries and can help maintain training adaptations during seasonal training cycles. CROSS-TRAINING:
The action of training or
For general fitness clients, it is a way to improve and maintain overall fitness while increasing practice in two or more
sports or types of exercise
engagement and exercise compliance. to improve fitness or
performance in one’s main
Research has shown that cross-training: sport.
• improves muscular endurance better than weight training alone,
• produces similar cardiovascular endurance benefits to running alone, and
• reduces the risk of injury from lifting heavy objects compared with weight training alone.
For strength-based athletes, cross-training should include cardiovascular endurance training.
For aerobic endurance athletes, cross-training should include lower-impact aerobic activities and
resistance training. Flexibility training is also a sound addition to any cross-training program.
Too much cross-training violates the fitness principle of specificity. Therefore, if a client has
sport-specific goals, a fitness professional should include cross-training in the off-season or
during a taper.

OTHER SPORTS APPLICATIONS

Sports that require constant movement are considered aerobic. These include basketball,
cross-country skiing, dancing, fencing, gymnastics, hiking, hockey, ice-skating, kayaking,
lacrosse, martial arts, racquetball, in-line skating, skateboarding, snowboarding, soccer, and
tennis—to name a few. Many of these are cyclic activities in which the same movement is
CYCLIC ACTIVITIES: repeated, but some are considered acyclic activities in which different movements are
Activities that use the same
movement in repetition. involved. Nearly every sport’s performance can be improved with the use of intervals, but the
dominating energy system should be the focus of an effective cardiovascular training program.
ACYCLIC ACTIVITIES:
Activities that incorporate Table 11.10 Energy System Guidelines
different movement
patterns throughout. WHEN TIME REQUIRED
ENERGY TYPICAL
SYSTEM IS FOR FULL
SYSTEM ACTIVITIES
DOMINANT RECOVERY
Resistance training
<200 Msprints
ATP/CP 0-10 seconds 3–5 min.
Plyometrics and
ballistics
Badminton
Soccer
10-120
Glycolytic Gymnastics 20–60 min.
seconds
Hockey
100–400 M sprints
Long-distance running
2 min. and Swimming

Aerobic 24–72 hr.
longer
Rowing
Cycling

ENVIRONMENTAL INFLUENCES ON ACTIVITY
Many sports have seasons that endure extreme weather conditions. Exercise in extreme heat
or extreme cold places additional stress on the body beyond exercise-induced stress. A fitness
professional is responsible for making choices about training variables, and environment,
including how long and how often a client can train in a given location safely and effectively,
is one of those variables.
EXTREME HEAT
Each person’s acclimatization state, fitness level, and hydration status affect the body’s
ability to dissipate heat to the environment. When temperatures are high, the body depends
on evaporative heat loss—perspiration or sweating—to maintain body temperature.

EVAPORATIVE HEAT
Scientific studies regarding skeletal muscle metabolism during exercise in the heat versus LOSS:
cold have shown the following in heated conditions: Cooling the body and
releasing heat via
evaporation of water and
• Increased plasma lactate levels electrolytes from the skin.
► Lactic acid levels rise when oxygen levels decrease.
• Increased muscle glycogen use
► Depletion of glycogen will reduce muscle endurance.
• Increased serum glucose concentration
► Body’s response to energy demand. Depletion of liver glycogen storage will

lead to the onset of fatigue.
• Decreased serum triglyceride concentration
► There is less fat in the bloodstream, likely due to both less triglyceride
manufacture and more muscle use during exercise.
• Increased anaerobic metabolism during submaximal exercise
► The body expends energy faster than blood can supply the muscles with
oxygen. To keep muscles fueled in this oxygen-deprived state, the body
increases anaerobic metabolism using glucose.
The causes of these conditions may include reduced muscle blood flow and a redistribution
of blood flow away from internal organs in favor of skeletal muscle.

When body temperature rises, the body produces sweat to release excess heat. Sweating
rates of one liter per hour may result in dehydration, increasing the thickness of blood and
decreasing total blood volume. Both conditions can reduce the amount of heat lost and result
in an elevated core temperature, which can be detrimental to health.
EXTREME COLD
During cold exposure, the body reduces heat loss with peripheral vasoconstriction and
PERIPHERAL shivering. Peripheral vasoconstriction during exercise constricts smaller arterioles near the
VASOCONSTRICTION: skin to keep blood closer to the core of the body. This protective response also limits blood
Constriction of smaller
arterioles near the skin flow to the muscles and has been found to contribute to a decrease in muscle function and
to keep blood closer to
the core of the body and exercise capacity. Shivering is a generally involuntary contraction or twitching of muscle
preserve heat.
tissue as a physiological means of heat production, and it is only observed in humans and
other mammals. Vasoconstriction occurs first, then shivering if body temperature continues
SHIVERING:
Involuntary contraction or to drop below a set point.
twitching of muscle tissue
as a physiological means of Temperature balance within the body in extreme cold and the necessity for shivering are
heat production.
dependent on a few factors:
• Severity of environmental stress
• Effectiveness of peripheral vasoconstriction
• Intensity and mode of exercise
A person’s sex, age, and acclimatization state affect the body’s thermoregulatory responses
to cold. However, the most important factor affecting thermoregulatory tolerance in cold
ALTITUDE TRAINING:
Training at altitudes greater environments is body composition. Bodyfat provides insulation for the body, so those with
than 2,500 meters above
higher body fat mass will have a less severe reaction to extreme cold than those with less
sea level with the goal
of increasing the blood’s body fat mass.
oxygen carrying capacity.
ALTITUDE
ERYTHROPOIETIN
Altitude training includes training at altitudes greater than 2,500 meters above sea level
(EPO):
A hormone with a role in with the goal of increasing the blood’s oxygen-carrying capacity. Specifically, there is an
the proliferation of red
blood cells. increase in erythropoietin (EPO) in the event of chronic hypoxia or lack of oxygen, over a
period of weeks. EPO is a hormone produced by the kidneys and liver that plays a large role
HYPOXIA: in the production of red blood cells. The resulting training adaptation subsequently improves
Lack of oxygen.
sea level endurance performance by increasing lung capacity, increasing the lactic acid
threshold, and positively influencing red blood cell volume and hemoglobin mass.

Acclimatization to altitude occurs between 12 and 14 days at moderate altitudes, up to
2,300 meters, but can take up to several months.
AIR QUALITY AND POLLUTION

Acute exposure to air pollution, including car emissions, ozone, dust, pollen, and mold, has
been found to significantly reduce exercise performance. However, the benefits of habitual
exercise, even in polluted conditions, seem to win out. In a large-scale study, the Danish Diet,
Cancer, and Health study, researchers found that long-term exposure to air pollution while
exercising did not reduce the benefits of physical activity on overall health. Furthermore,
evidence suggested that exercise reduced the risk of overall mortality by 25 percent.
Even though habitual exercise in polluted areas still has positive effects on health, scientists
suggest finding areas with less pollution in which to exercise. There is no sense in taking two
steps forward and one step back. Thinking through the best options possible in a creative way
will only enhance a fitness professional’s value to their clients.

CONCEPTS OF
CHAPTER 12
RESISTANCE TRAINING
LEARNING OBJECTIVES
1 | Describe the benefits of cardiovascular exercise.
2 | Identify and explain the acute variables for cardiovascular exercise.
3 | Identify common modes of cardiovascular training.
4 | Explain the common environmental influence on physical activity.

CHAPTER 12 | Concepts of Resistance Training
There are five categories of strength, and each plays a role in programming and acute variable
RELATIVE STRENGTH: selection and manipulation in fitness. They range from general fitness to sports performance
The individual’s body weight
in relation to the amount applications. Relative strength and maximum strength explain the way strength is measured,
of resistance they can
overcome and found with while starting strength, explosive power, and speed strength are all components of strength.
the following calculation:
1RM / body weight = force All can be trained and improved with the correct acute variables.
per unit of body weight.
Table 12.1 Strength Categories
MAXIMUM STRENGTH: STRENGTH CATEGORY DEFINITION

The ability for a muscle (or
muscle group) to recruit
The ability to recruit as many motor units as possible
and engage as many Starting strength
muscle fibers as possible. instantaneously at the start of a movement.
Determined by considering the individual’s body

STARTING STRENGTH: weight in relation to the amount of resistance
The ability to recruit as
many motor units as Relative strength they can overcome and found with the following
possible instantaneously at calculation: 1RM / body weight = force per unit of
the start of a movement.
body weight
POWER: The ability for a muscle (or muscle group) to recruit

Maximum strength
The combination of strength and engage as many muscle fibers as possible
for a muscle to generate The combination of strength and speed—the ability
maximal tension as quickly
as possible. Power for a muscle to generate maximal tension as quickly
as possible
SPEED STRENGTH: The ability of a muscle or muscle group to absorb

The ability of a muscle or Speed strength
muscle group to absorb and
and transmit forces quickly
transmit forces quickly.
TRAINER TIP!
Power is a function of strength.
Power is defined by the equation:
force x distance
time
Force is mass times acceleration: F = M x A
The more strength an individual or athlete has, the more muscular power they are
capable of producing. Training for explosive power couples that strength with the speed
of muscle contraction with the aim to produce maximal force as fast as possible.

BENEFITS OF STRENGTH TRAINING
The multitude of benefits from strength and resistance training fall into one or more of these
categories: body composition, metabolic health, physical capacity, quality of life, and longevity.
As little as 10 weeks of resistance training has been proven beneficial to increasing lean body
mass, increasing metabolic rate, reducing fat mass, helping manage or prevent diabetes,
enhancing cardiovascular health, and promoting bone health.
INCREASING LEAN BODY MASS

Completing just 12–20 exercise sets, two to three nonconsecutive days per week, can
increase muscle mass in youth, adults, and the elderly. This increase in muscle mass, known
as hypertrophy, is due to the increase in the size of muscle cells.

HYPERTROPHY:
An increase in muscular
INCREASING RESTING METABOLIC RATE size as an adaptation to
Resistance training stimulates muscle protein turnover, requiring up to 100 Calories (Cals) exercise.
per day or more in additional energy. Chronic strength training increases lean muscle mass,
which, in turn, requires more energy at rest, raising the resting metabolic rate (RMR) by about
20 Cals per day per pound of muscle added. Acutely, microtrauma caused to muscle tissue
during a training session increases the body’s energy needs by 5–9 percent for up to 72
hours following exercise.
REDUCING FAT MASS

A 20-minute circuit training workout burns roughly 200 Cals during exercise and another 50
Cals during the first hour after the workout. Following a routine of just two circuit training
sessions per week would burn about 5,000 additional Cals over the course of 30 days. With
VISCERAL FAT:
proper nutrition intervention, this calorie deficit can help reduce body fat overall. Fat accumulated within
the abdomen and around
internal organs. It has
TYPE 2 DIABETES PREVENTION AND MANAGEMENT potentially negative effects
on arteries, the liver, and
Resistance training programs of higher volume and higher intensity have been found to the breakdown of sugars
improve insulin resistance and glucose tolerance. The American Diabetes Association and fats.
recommends that individuals exercise all the major muscle groups three days per week,
gradually progressing to three sets of 8 to 10 repetitions at high intensity. This kind of HEMOGLOBIN A1C
exercise decreases visceral fat and has been proven to reduce hemoglobin A1c (HbA1c) —a
(HBA1C):
A minor component of
type of hemoglobin linked to sugar. Resistance training is especially helpful for middle- and hemoglobin to which
glucose is bound.
older-aged adults to counteract the age-related declines in insulin sensitivity.

ENHANCING CARDIOVASCULAR HEALTH

Strength training helps reduce resting blood pressure. Twenty minutes of resistance training
paired with 20 minutes of aerobic activity, done two to three days per week for at least 10
weeks, is proven to reduce blood pressure for adults from 21 to 80 years old. Further,
resistance training may increase high-density lipoprotein (HDL) cholesterol by 8–21 percent,
HIGH-DENSITY
decrease low-density lipoprotein (LDL) cholesterol by 13–23 percent, and reduce
LIPOPROTEIN (HDL):
A lipoprotein that removes triglycerides by 11–18 percent.
cholesterol from the blood.
It is sometimes considered
the “good cholesterol.” TEST TIP!
Did you know that HDL is known as the “good” kind and LDL is known as the ”bad”
LOW-DENSITY kind of lipoprotein?
LIPOPROTEIN (LDL):
The form of lipoprotein The body produces and has a use for both, but not all cholesterol is bad!
in which cholesterol is
transported in the blood. It
is sometimes considered HDL carries cholesterol from the bloodstream to the liver, so it does not cause arterial
the “bad cholesterol.”
blockages. LDL, on the other hand, keeps cholesterol in the arteries, where it can
build up and cause plaque, which is known as atherosclerosis.
TRIGLYCERIDES:
The main component of PROMOTING BONE DEVELOPMENT
three fatty acids and a Every year, bone mineral density declines by 1 to 3 percent for adults who do not participate in
glycerol molecule.
resistance training. For women, resistance training has been shown to increase bone mineral
density by over 3 percent. However, if resistance training is stopped, then bone density gains
are reversed. Young men also build bone mass, by 2.7–7.7 percent, by resistance training.
REVERSING AGING IN SKELETAL MUSCLE

There is scientific evidence that suggests exercise is able to slow and reduce the effects of
aging. In one study, circuit training was found to increase the number of mitochondria and
oxidative capacity of muscle tissue. The study looked at the muscle tissue of adults in their
late 60s after participating in circuit training. They found healthy mitochondria similar to
those of a 23-year-old.
Strength or resistance training has also been proven to improve physical performance,
movement control, balance, posture, walking speed, functional independence, cognitive
abilities, and self-esteem. Affected participants report reduced low back pain and discomfort
from arthritis and fibromyalgia.

Multiple studies have demonstrated the mental health benefits of not just cardio but also
resistance training for adults. These include improving symptoms for those suffering from
fatigue, anxiety, and depression.
CLASSIFYING STRENGTH
Strength can be further classified by determining whether it is anaerobic, aerobic, linear, or
nonlinear. By definition, anaerobic means without oxygen, while aerobic means in the presence
of oxygen. Linear strength means there is a correlating relationship between two variables—
when one variable changes, so does the other in the same way and vice versa. Nonlinear LINEAR STRENGTH:
Two or more strength
strength has variables that are not directly correlated. For example, as strength increases (or variables that are directly
correlated to one another.
decreases), so does muscular power in the same muscle group(s). Though the relationship
may not be balanced as a 1:1 ratio, this is a linear strength relationship. The relationship of
NONLINEAR
flexibility and maximal strength, on the other hand, is a nonlinear relationship as one is not
STRENGTH:
directly related to the other. Greater strength does not mean someone is more flexible, nor Two or more strength
variables that are not
does improving one’s flexibility mean they will get stronger. directly correlated to one
another.
ANAEROBIC AND AEROBIC STRENGTH

Anaerobic strength activities derive energy from the ATP/CP energy pathway and anaerobic
glycolysis. An anaerobic strength activity can only be sustained for up to 60 seconds before
ADENOSINE
stored energy is used up. Activities include
TRIPHOSPHATE (ATP):
An energy-carrying
• shot put, molecule used to fuel body
processes.
• powerlifting,
• high jump,
CREATINE
• golf swing, PHOSPHATE (CP):
• 200- to 400-meter sprint, and A high-energy molecule
stored in skeletal muscle,
• high-intensity interval training (HIIT). the myocardium, and the
brain.
It takes roughly three to five minutes for the body to restock the cells with adenosine
triphosphate (ATP) or creatine phosphate (CP) after this kind of all-out effort.
ENDURANCE
Aerobic strength is also known as endurance strength. It is the ability to sustain a submaximal
STRENGTH:
The ability to sustain a
activity for a longer duration. Aerobic strength requires oxygen for energy and is fueled by submaximal activity for a
longer duration.
aerobic glycolysis, the oxidative pathway, or gluconeogenesis.

Table 12.2 Energy System Basics
WHEN THE TYPICAL TIME REQUIRED

ENERGY
SYSTEM IS ACTIVITIES FOR FULL
SYSTEM
DOMINANT RECOVERY
Resistance training
Short sprints
ATP/CP 0-10 seconds 3–5 min.
Plyometrics
Ballistics
Badminton
Soccer
10-120 Gymnastics
Glycolysis 20–60 min.
seconds
Hockey
Short to intermediate
sprints
Long-distance running
2 min. and Swimming

Aerobic 24–72 hr.
longer
Rowing
Cycling

LINEAR AND NONLINEAR STRENGTH ENDURANCE
Any activity that requires a sustained effort for an extended period is a linear strength
endurance activity. For example, a marathon requires a sustained effort for several hours. LINEAR STRENGTH
Strength and endurance are directly correlated. Another example of a linear activity is an
ENDURANCE ACTIVITY:
Activity that requires a
800-meter or longer swimming event. These events are cardiovascular in nature—requiring sustained, all-out maximum
effort for an extended
aerobic energy—but cannot be completed without adequate strength endurance. period.
A nonlinear strength endurance activity can be anaerobic or aerobic. Examples include

NONLINEAR STRENGTH
basketball or soccer, in which players use intermittent bursts of agility, speed, and power for
ENDURANCE ACTIVITY:
a long duration. Another example is a competitive powerlifter. The athlete must complete nine An activity with intermittent
activity and rest periods.
maximum lifts to be scored and as many as 20 near-maximum warm-up lifts during the three-
or four-hour competition. Because the event has intermittent rest periods and the activities
are not sustained, the activity is nonlinear.
STRENGTH CURVE
The strength curve is a visual representation of the amount of force produced over a range
of motion (ROM). Strength curves differ for exercises and individuals and are important to
understand regarding exercise selection, equipment used, and even when considering tempo
and time under tension during movement execution.
ASCENDING STRENGTH CURVE

In an ascending strength curve, more force is applied toward the end range of motion than
during the beginning or middle phase. For example, during the squat, it is possible to lift more
weight from above parallel to the top of the movement. This means that much lighter loads
would be necessary if starting from below parallel.
DESCENDING STRENGTH CURVE

A descending strength curve is opposite the ascending strength curve. Loads are easier to
leverage at the beginning ranges of motion than in the latter. A rowing exercise uses less
strength at the beginning of the movement than at the end, when the elbows are pulled back.
Exercises with a descending strength curve get more difficult toward the end range of motion.

BELL-SHAPED STRENGTH CURVE

In a bell-shaped strength curve, the beginning and ending phases of movement are more
difficult than the middle. An example is the biceps curl. The biceps muscle is at a mechanical
disadvantage at the bottom of the curl. Between 60 and 110 degrees of flexion, the biceps
muscle gains leverage and produces more force. At the end range of motion, the biceps
muscle is at a mechanical disadvantage again and therefore has less potential force
production.
Ascending
Descending
Force
Bell-Shaped
Joint Angle
Figure 12.1 Strength Curves
STRENGTH TRAINING AND TRAINING PRINCIPLES

While there are many general fitness principles and training variables, there are some that are
specific to strength and resistance training - load, intensity, time under tension, and exercise
selection, to name a few variables. It is through proper application of these variables, and
the way that resistance training can create overload, that adaptations such as maximizing
strength, power, and hypertrophy can be achieved efficiently.
Muscle fiber type also plays a role in the adaptations of an individual. Those with a higher
amount of type II fibers will have greater success in building muscle size, strength, and power
relative to those with predominantly type I muscle fibers. Those with mostly type I fibers are
physiologically predisposed to have greater success with endurance gains.

Exercises typically progress from a general type (simple) to a more sport-specific or goal-
oriented type (complex) as training continues. Assessments allow a trainer to uncover a
client’s starting point and plan the appropriate progression for their goals and abilities.
To improve general health, fitness, and functional capacity, a balance of several kinds of
exercise should be included in the training program. The training goal helps determine the
ideal balance of general and specific exercises.
TEST TIP!
A client’s goal should determine the specific types of training modalities chosen. For
example, to become better at throwing, the muscles involved in throwing, like the
pectoralis major, must be trained. How they are trained is the question. The mechanics
(the throwing motion) of throwing must be trained and not just the individual muscle
as in a chest press.
General Exercises
General exercises can also be considered foundational exercises. In other words, movements
GENERAL EXERCISES:
can produce overall strength and efficiency gains but do not necessarily transfer to
Foundational exercises that
performance of specific skills. Isolation and compound movements using free weights, train overall strength.
cables, or machines fall into this category. General exercises include the bench press, cable
row, plank, squat, and leg press.
Benefits of including general exercises include a reduced injury risk and an increase in the
following:
• Muscle hypertrophy
• Motor unit recruitment
• Bone density
• Connective tissue strength
• Increased cardiovascular capacity
ISOLATION EXERCISES ISOLATION EXERCISES:

Single-joint exercises
Isolation exercises are single-joint movements that primarily activate individual muscles or
that primarily activate an
smaller muscle groups. The biceps curl, triceps extension, leg curl, and leg extension are individual muscle or muscle
group.
examples. Isolation exercises improve muscle control, strength, and hypertrophy while also

working to balance musculature—as long as both agonist and antagonist muscles are
worked—and enhance the physique and strengthen connective tissue.
Isolation exercises also help target muscles that are not fully activated during compound
movements. For example, research has found that hamstring activation is inherently low
during exercises such as the leg press and squat. To help strengthen the hamstrings, one
can perform isolation movements.
COMPOUND EXERCISES
Compound exercises engage multiple joints and many muscle groups throughout a range of
COMPOUND motion. Compound exercises increase muscle hypertrophy and bone density and strengthen
EXERCISES: connective tissues. Examples include
Multi-joint movement
exercises that require the
use of multiple muscles or • squats,
muscle groups.
• lunges,
• deadlifts,
• bench press, and
• chin-ups.
Applying specificity to exercise selection means training the musculature as well as the
neuromuscular connections that innervate the movement. Select exercises use the same
movement pattern that a client wants to improve. For example, to increase strength through
the squat movement, a client will train primarily with the squat, not the leg press. This ensures
the prime movers, synergists, and stabilizers for a squat are all addressed and strengthened
appropriately and in proportion. This also facilitates improvements in coordination of the
musculature involved in an exercise such as the squat as opposed to the leg press.
TEST TIP!
Most major movement patterns in everyday life and in sports are multi-joint movements
that can be trained with compound exercises. This means not only are they a good choice
to train multiple muscle groups at once, but they have direct translation to function.

Specific Exercises
Exercises that directly improve performance and are predominantly skill-based are specific
exercises. The best specific exercises target a particular skill set and, when performed SPECIFIC EXERCISES:
Exercises that directly
properly, enhance that ability. A baseball pitcher improves pitching skills and speed by improve performance and
functional capacity.
practicing pitching. Lacrosse athletes responsible for scoring, called “attackers,” need to
practice shooting to improve shooting skills. Therefore, sport-specific practice should never
be disregarded for strength and conditioning.
Specific exercises must be like the target activity and mimic specific:
• joint movements,
• movement direction,
• range of motion, and
• speed of movement.
Examples of specific exercises include the standing single-arm chest press, which is
transferrable to the sports of football, rugby, and ice hockey, as well as any other sport where
the athlete must push away an opponent.
CROSS-BODY EXERCISES
Cross-body exercises more closely mimic the natural movement of the body in space.
Considering how humans walk, the arm and shoulder on one side “link” diagonally to the hip
and leg on the other side so that:
• the left arm and shoulder are forward,
• the left hip and leg are back,
• the right arm and shoulder are back, and
• the right hip and leg are forward.
The terms “x-factor” and “serape effect” were coined to refer to the interaction between
various muscles causing the body to move in a crisscross manner, primarily referring to
trunk rotation. These muscles—ipsilateral rhomboids, serratus anterior, external abdominal
obliques, contralateral internal abdominal obliques, and adductors—attach via fascia in a
crisscross manner around the body.
Although research is being done regarding the x-factor, there are no proven training methods.
However, because cross-body action is a natural human movement, it should be included
in a well-balanced strength training program. Many recent studies have tried to quantify the

x-factor to determine how best to train for more power in, say, a golf or baseball swing. Like
plyometric exercises, the x-factor muscles use the stretch-shortening cycle. Researchers
suggest that flexibility and efficient interaction of x-factor muscles may increase performance.
For example, a 2016 study on badminton technique suggests that training focused on
increasing the efficiency of cross-body movement should focus specifically on how the x-factor
is incorporated into the kinematic chain of the arm and the racket. A more recent study found
that although skilled golfers had greater rotational flexibility, they did not use that flexibility to
increase x-factor efficiency to improve clubhead speed.
To load x-factor muscles, clients can use single-arm or offset loading (uneven weights) and
vary the stance. Examples of exercises include single-arm standing cable press, high-to-low
cable chop, and suitcase carry.
EXPLOSIVE EXERCISES
Exercises that engage many muscles in a sequential, powerful, quick movement are explosive
exercises. Soccer, tennis, boxing, shot put, Olympic lifting, sprinting, and many other sports
require explosive movements. Explosive movements follow a triphasic pattern of alternating
bursts of agonist and antagonist muscle activation.
Phase 1—eccentric: the loading phase of the movement
Phase 2—amortization: the transition time between phase 1 and phase 3
Phase 3—concentric: agonist taking advantage of the stored energy from the eccentric
action and firing explosively
Choosing the right explosive movements is key to program success. Since most sports are
explosive or ballistic in nature, adding fast, ballistic movements into the training program
improves neuromuscular coordination and control and prevents injury. Movements should be
trained in various directions as power is direction-specific.
Finally, when considering specificity, the following should be noted:
A recent study measured electrical activity of the upper and lower lateral hamstrings and the
upper and lower medial hamstrings during the stiff-legged deadlift and lying leg curl exercises.
When compared with the stiff-legged deadlift, the lying leg curl caused significantly greater
activation of the lower lateral and lower medial hamstrings. Since each movement offers unique
but complementary benefits, it is recommended to include at least one movement focused at the
hip joint (deadlift) and one focused at the knee joint (leg curl) to properly train the hamstrings.

No single type of resistance exercise can address the various needs of the human body.
Rather than using just one type of resistance, the client should vary the resistance throughout
the training cycles based on the physical qualities that are most desired.

For fitness to progress, the body must be forced to adapt to or overcome a stress greater
than what is normally encountered. Range of motion, volume, intensity, density, and frequency
can all be progressively overloaded to influence adaptations. For the trainer, it is important to
understand which acute training variable to overload for the desired result.
The idea of “use it or lose it” applies to all aspects of fitness. For example, researchers
followed an Olympic rower who took eight weeks off from training after hitting peak fitness
during the Olympic games. It took 20 weeks of training to return to their previous fitness level
after a two-month hiatus. Several observations have been made regarding detraining and
resistance training:
• Detraining happens about three to four weeks after training stops.
• Muscle atrophy may occur as soon as two weeks after training stops.
• Endurance performance declines by 4–25 percent after just three to four weeks of
ATROPHY:
The wasting away or loss of
no exercise. muscle tissue.
• VO2 max goes down by 6–20 percent at around four weeks of detraining.
• Flexibility declines by 7–30 percent after four weeks of detraining.
• Bed rest or immobilization increases the rate of muscle atrophy.
TAPERING
Tapering is a planned reduction in training to avoid detraining and increase gains prior to
competition. Tapering should meet three objectives: TAPERING:

A decrease in training
volume or frequency to
1. To reduce fatigue as much as possible allow the body adequate
rest and recovery.
2. To increase or maintain fitness at competition levels
3. To enhance specificity
Recent research has found that tapering strength training can lead to performance gains
from 0.5–6 percent, the average being 3 percent. This can be significant. For example, if a
powerlifting athlete peaks at 2,000 pounds, then a taper could increase their maximal lift by
60 pounds.

During a taper, intensity must remain at or slightly above competition levels. Volume (reps x
sets x weight) and frequency then should be reduced.
Some studies suggest that volume be reduced by 30–70 percent to improve maximal
strength. However, the principle of individual differences comes into play here as well as the
fitness-fatigue paradigm:
• Individual A has been following an intense training program for 10 weeks and has
a competition in two weeks. This person may benefit from a 70 percent drop in
training volume.
• Individual B has been training intensely for four weeks and has a competition in
two weeks. This person may benefit more from a one-week taper at 35–40 percent
reduced volume.
Tapering is not only for elite athletes. Before moving from one training cycle to another,
general fitness program participants also benefit from a taper period.
PHYSIOLOGICAL ADAPTATIONS TO ANAEROBIC EXERCISE

Anaerobic exercise uses glycolysis without the presence of oxygen. In practical terms, it is
ANAEROBIC EXERCISE: harder and shorter movement and can increase the size and quantity of fast-twitch fibers.
Short-duration muscle
contractions that break More fast-twitch muscle fibers means greater strength, power, and larger muscle size.
down glucose without using
oxygen. Anaerobic exercise includes short-duration activities such as weightlifting (resistance
training), powerlifting, sprints, and high-intensity intervals.
Anaerobic activity cannot last as long as aerobic activity. The lack of oxygen triggers a buildup
of lactic acid and excess protons (H+), causing pain and muscle fatigue. However, individuals
who engage in anaerobic activity more frequently develop a higher threshold to lactate and
proton buildup.

In addition, anaerobic exercise increases glycolysis—the breakdown of glucose for energy.
This further increases levels of ATP and creatine phosphate (CP), which can be quickly
changed to ATP and used for energy. Intramuscular creatine levels also increase, helping
supply energy for muscle contraction. CREATINE:

An organic compound that
aids in the recycling of ATP
Muscle hypertrophy occurs with an increase in mitochondria, myoglobin, extracellular and in the energy systems.
intracellular fluid, capillarization, and fusion of muscle fibers to surrounding satellite cells. In
addition, resistance exercise generates thicker myofibrils, or contractile tissue, increasing the
size of individual muscle fibers.
Except for muscular hypertrophy, the cellular changes found in endurance training do
not usually happen with resistance training. However, resistance training increases the
development of connective tissue. The epimysium and tendons become stronger to support
more powerful muscular contractions and prevent injury.
MODIFYING THE ACUTE TRAINING VARIABLES

As with cardiovascular training, commonly manipulated acute training variables for resistance
training include the following:
• Frequency
• Intensity
• Time/duration
• Type
• Tempo
• Range of motion
• Repetitions
• Sets
• Rest
FREQUENCY
The client’s overall level of fitness, as determined by assessments, is the most important
factor to consider when prescribing exercise frequency. In addition, daily workload from
exercise or on-the-job tasks must be considered as well as the ultimate training goal. For
example, warehouse or construction workers perform many lifts throughout the workday. They
may not be able to do more than two or three days per week of strength training without
reaching a state of overtraining.

Beginner and Novice Training Status
New trainees should train no more than two to three nonconsecutive days per week when
training the entire body. Generally, one to three days of rest should be scheduled between
sessions to promote recovery.
Table 12.3 Example Beginner Training Prescription
EXERCISE REST
TRAINING DAYS
PRESCRIPTION PRESCRIPTION
Monday and Thursday Whole-body exercises Two days of rest
Tuesday, Thursday, and

Saturday
One day of rest between
or sessions
Whole-body exercises
Monday, Wednesday, and

Friday
Intermediate Training Status
Training frequency may increase to three or four days per week for slightly more experienced
clients. Intermediate clients more often follow a split-routine when training frequency is
SPLIT-ROUTINE: increased. A training split allows the client to recover while keeping training volume high.
The division of training
sessions by body part or
body region. Table 12.4 Example Intermediate Training Prescription
EXERCISE REST
TRAINING DAYS
Monday and Thursday:
Monday, Tuesday, upper body

Two days of rest per major
Thursday, and Friday muscle group
Tuesday and Friday: lower
body
Monday: chest
Tuesday: back Three days of rest per

Monday, Tuesday,
week; one week of rest
Thursday, and Friday
Thursday: legs per major muscle group
Friday: core

Advanced Training Status
Most clients won’t progress to the advanced level of training. However, clients who have
reached intermediate training status and want to continue to build strength should consider
increasing training frequency to increase training volume—a key factor in developing lean
mass and strength. The split training for an advanced client will also be more detailed.
Table 12.5 Example Advanced Training Prescription
EXERCISE REST
TRAINING DAYS
Double split routine
Two sessions per day

Monday, Tuesday, Three days of rest per
Alternating: Upper-body
Thursday, and Friday week
push exercises; lower-
body, upper-body pull
exercises; core
Week 1:
Thursday rest day
Three days of training,
Week 2:
Alternating: upper-body one day of rest
Friday rest day
push exercises; lower-
body, upper-body pull Workouts on unspecified
Week 3:
exercises days; rest day is not the
Saturday rest day
same each week
Week 4:
Sunday rest day
The latest research shows that muscle groups can fully recover and be ready for more training
within three days after a hard training session. Therefore, when muscle hypertrophy is the
goal, total volume is a determining factor.
Total training volume = sets x weight x reps

Training at a significant intensity, 65–85 percent of one-repetition max (1RM), results in

ONE-REPETITION MAX more and faster muscle growth. A recent meta-analysis observed that participants who
(1RM): performed two training sessions per week for each muscle group increased hypertrophy by
A single maximum-strength
repetition with maximum 6.8 percent over 6 to 12 weeks. Those who trained each muscle group once per week
load.
experienced only a 3.7 percent increase in muscle growth over the same period. The net
result is 48 percent more growth for the biweekly training group.
INTENSITY
Training intensity is the amount of effort being put forth and is expressed as a percentage
of one-repetition maximum for resistance training activities. Intensity can also be measured
in relation to 10 repetitions. For instance, if a client lifts 150 pounds for 10 repetitions and
cannot complete another lift, that is their 10-repetition maximum.
The rate of perceived exertion (RPE) is another way to measure exercise intensity. This
subjective scale is moderately accurate but allows the exercise participant to offer insight
into what they are feeling and their level of effort.
Table 12.6 Resistance Training Intensity Protocol for a Training Goal
TRAINING GOAL INTENSITY (PERCENTAGE 1RM)
Muscular endurance 67 percent or less
Hypertrophy 67 percent–85 percent
Maximum strength 85 percent or greater
Power
80 percent–90 percent
• Single-repetition event
75 percent–85 percent
• Multiple-repetition event
The table below can be used to determine how much weight to use in a given exercise based
on the approximate 1RM of a client. For example, if a client had a 1RM of 150lbs for the
barbell bench press and their goal was to gain strength, then a training program would require
working at 85 percent or greater of their 1RM for that exercise. The 1RM (150lbs) intersects
with 85 percent of 1RM at 127.5lbs, which would be the correct weight to use.

Table 12.7 Percentage of 1RM Chart
1RM
PERCENTAGE OF 1RM
(LBS)
95% 90% 85% 80% 75% 70% 65% 60% 55% 50%
10 9.5 9 8.5 8 7.5 7 6.5 6 5.5 5
20 19 18 17 16 15 14 13 12 11 10
30 28.5 27 25.5 24 22.5 21 19.5 18 16.5 15
40 38 36 34 32 30 28 26 24 22 20
50 47.5 45 42.5 40 37.5 35 32.5 30 27.5 25
60 57 54 51 48 45 42 39 36 33 30
70 66.5 63 59.5 56 52.5 49 45.5 42 38.5 35
80 76 72 68 64 60 56 52 48 44 40
90 85.5 81 76.5 72 67.5 63 58.5 54 49.5 45
100 95 90 85 80 75 70 65 60 55 50
110 104.5 99 93.5 88 82.5 77 71.5 66 60.5 55
120 114 108 102 96 90 84 78 72 66 60
130 123.5 117 110.5 104 97.5 91 84.5 78 71.5 65
140 133 126 119 112 105 98 91 84 77 70
150 142.5 135 127.5 120 112.5 105 97.5 90 82.5 75
160 152 144 136 128 120 112 104 96 88 80
170 161.5 153 144.5 136 127.5 119 110.5 102 93.5 85
180 171 162 153 144 135 126 117 108 99 90
190 180.5 171 161.5 152 142.5 133 123.5 114 104.5 95
200 190 180 170 160 150 140 130 120 110 100
210 199.5 189 178.5 168 157.5 147 136.5 126 115.5 105
220 209 198 187 176 165 154 143 132 121 110

Table 12.7 Percentage of 1RM Chart (CONT)
1RM
PERCENTAGE OF 1RM
(LBS)
95% 90% 85% 80% 75% 70% 65% 60% 55% 50%
230 218.5 207 195.5 184 172.5 161 149.5 138 126.5 115
240 228 216 204 192 180 168 156 144 132 120
250 237.5 225 212.5 200 187.5 175 162.5 150 137.5 125
260 247 234 221 208 195 182 169 156 143 130
270 256.5 243 229.5 216 202.5 189 175.5 162 148.5 135
280 266 252 238 224 210 196 182 168 154 140
290 275.5 261 246.5 232 217.5 203 188.5 174 159.5 145
300 285 270 255 240 225 210 195 180 165 150
310 294.5 279 263.5 248 232.5 217 201.5 186 170.5 155
320 304 288 272 256 240 224 208 192 176 160
330 313.5 297 280.5 264 247.5 231 214.5 198 181.5 165
340 323 306 289 272 255 238 221 204 187 170
350 332.5 315 297.5 280 262.5 245 227.5 210 192.5 175
360 342 324 306 288 270 252 234 216 198 180
370 351.5 333 314.5 296 277.5 259 240.5 222 203.5 185
380 361 342 323 304 285 266 247 228 209 190
390 370.5 351 331.5 312 292.5 273 253.5 234 214.5 195
400 380 360 340 320 300 280 260 240 220 200
TIME/DURATION
Time refers to the total amount of time an activity or exercise session lasts. Accumulating
time doing general physical activity can account for long-term health benefits. According to
the 2018 Physical Activity Guidelines for Americans, 2nd Edition, 150 minutes of moderate-
intensity aerobic exercise is the recommended amount for adults on a weekly basis.
Time is also used to measure the duration of planned bouts of exercise. It is common for
cardiovascular exercise to have a planned amount of time associated with each session.

TYPE
The type of exercise selected is determined by training goals. With resistance training, there
are several possible exercise types with a combined multitude of individual exercises to
choose from, such as barbell, cable, kettlebell, dumbbell, etc. Each has its benefits and
drawbacks, depending on the desired training outcome. Within each type are two important
sub-variables: grip, or hand placement, and breath control throughout a range of motion.
GRIP:
Grip Hand placement.
Grip describes the way the hands are spaced and positioned on the implement being used.
There are seven different grip types that can be modified for greater specificity or enhanced
overload:
1. Supinated: the palm faces up toward the ceiling.
2. Pronated: the hand or forearm is rotated, and the palm faces down or back.
3. Neutral: the palms face each other (facing the body’s midline).
4. Alternated: one hand grasps the bar in a supinated position, while the other grasps
the bar in a pronated position.
5. Hook: the barbell is held by gripping the thumb between the barbell and fingers.
HOOK:
6. Open: the thumb does not wrap around the bar. Gripping the thumb between
the barbell and fingers.
7. Closed: the hand wraps fully around the bar.
A 1996 study found that supine grips were the strongest, followed by grips in the neutral
position due to their activation of the biceps. Pronated grips were the weakest due to their
involvement of the triceps as synergists. While the triceps are a larger grouping of muscles
than the biceps, it has been demonstrated that the biceps generate more force and are,
therefore, stronger. This is an important consideration before increasing loads. The fitness
professional should ensure that the client’s grip strength—the force applied by the hand to
pull or suspend a load—is strong enough to handle the load. GRIP STRENGTH:
The force applied by the
hand to pull or suspend a
Breath Control load.
How one breathes during exercise is important. In most cases, trainees should exhale with
exertion—the concentric action—and inhale during the eccentric action. The bench press
is an example. The client inhales during the eccentric lowering of the bar to the chest and
exhales at the bottom and through the concentric movement to elevate the bar. The exhale
during the exertion not only focuses the exerciser on the hardest part of the movement but
also serves as an unconscious initiation of abdominal bracing to protect the spinal column.

Clients will often hold their breath during exercise movements when they are not conscious
of it. The fitness professional should cue them throughout the range of motion to promote
optimal breath control. If they don’t breathe throughout the range of motion, they may
experience symptoms of dizziness, seeing stars, or syncope due to a lack of oxygen. Clients
SYNCOPE: with hypertension or heart problems should be especially mindful of their breathing to avoid
Temporary loss of
consciousness related to complications.
insufficient blood flow to
the brain.
TRAINER TIP!
An advanced breathing technique includes deliberately taking a deep breath to help
stabilize muscles of the abdomen, back, and core muscles and protect the spine during
exertion. Experienced and well-trained athletes performing structural exercises (exercises
that load the vertebral column) with heavy loads often use this technique, known as the
Valsalva maneuver.
VALSALVA MANEUVER:
The act of forcibly exhaling The Valsalva maneuver involves expiring against a closed glottis (part of the larynx). When
with a closed windpipe,
where there is no air that
this is combined with contracting muscles of the abdomen and rib cage, it creates rigidity
is exiting via the nose or
in the entire torso via increasing intraabdominal pressure. Inhaling and holding the breath
mouth.
on exertion, as opposed to exhaling with exertion, provides up to 20 percent greater force,
stabilizes the spine, and helps prevent low back injuries.
TEMPO
The tempo used during exercises in part determines the amount of time muscle tissues
will be under tension and how fast those muscle tissues will be contracting. Total tempo
accounts for the eccentric, isometric, and concentric muscle actions of an exercise.
Tempo is written as follows:
eccentric count : isometric hold count : concentric count : isometric hold count
Table 12.8 Tempo By Training Goal
TEMPO (EXAMPLE IN
TRAINING GOAL
SECONDS)
Muscular endurance 4:0:6:0
Hypertrophy 3:1:3:1
Maximum Strength 3:0:1:0
Power Fastest controllable tempo

RANGE OF MOTION
Range of motion can be manipulated to meet many objectives. For example, if a client’s goal
is to perform 10 pull-ups, then beginning with a small range of motion, such as a straight-
arm hang, will increase grip strength and be a good initial step for beginners. From there, the
client can use assistance (a step, rubber resistance loop, or machine) to perform a bent-arm
hang. The next step would be to perform eccentric lowering from the bent-arm position to
improve muscular strength (also known as negative pull-ups). Finally, the client would practice
a full range of motion pull-up with or without assistance from a loop or machine.
Complex Olympic lifts and variations—hang clean, power clean, push press, clean and press,
deadlift, and snatch—should be trained by first isolating and training each range of motion,
then combining the movements to perform the exercise through the full range of motion.
Little or no resistance should be used to begin. The client can progressively overload the
movement as form improves and strength increases.
Partial repetitions—exercise movements performed through a limited range of motion—are
a popular resistance training technique. Trainers and athletes use partial repetitions for PARTIAL REPETITIONS:
Repetitions of an exercise
increasing volume and time under tension, working around injuries in the upper or lower intentionally done with a
reduced ROM.
extremities, and overcoming “sticking points”- the weakest point in a range of motion for an
exercise.
The science suggests that partial ROM repetitions could be used as supplemental exercises
when added to a balanced training program. Research has compared full and partial range of
motion repetitions on the bench press with regard to strength adaptations. There were three
groups within this research: a partial ROM, a full ROM, and a combination group. After 10
weeks of training, all groups had nearly identical strength improvements. However, the full
ROM group experienced greater levels of strength, cross-sectional areas, fascicle length, and
subcutaneous fat loss.
REPETITIONS
One repetition is one completion of a single range of motion for an exercise. Modifying
the number of repetitions completed affects exercise outcomes. A range, for example
6–12, means that the individual should be able to complete at least 6 but no more than
12 repetitions. If the individual can continue past 12 repetitions without fatiguing, then the
resistance is inadequate to promote adaptation and must be increased.
The ideal repetition count will be based on the desired training outcome as well as, like most

variables, the exerciser’s strength level and abilities. Repetition ranges and the associated
resistance used to challenge the muscles are closely correlated to exercise intensity.
Table 12.9 Repetition Protocol for a Training Goal
TRAINING GOAL REPETITIONS
Muscular endurance 15 or more repetitions
Hypertrophy 6–12 repetitions
Maximum strength 1–6 repetitions
Power 1–5 repetitions
SETS
A set is the number of times an exercise or group of repetitions is completed. The desired
training outcome is part of what dictates the number of sets within a program. Each training
outcome has an ideal range of sets for each exercise.
Table 12.10 Set Protocol for a Training Goal
TRAINING GOAL SETS
Muscular endurance 1–3 sets
Hypertrophy 3–4 sets
Maximum Strength 3–5 sets
Power 3–5 sets
REST
Rest is as important as the other variables for achieving fitness goals. Rest can occur between
repetitions, between sets, and between training sessions. For the purposes of resistance and
strength training, rest is most often considered as the time allowed between sets for the
metabolic recovery of the trained muscles before attempting subsequent sets of work.
TRAINER TIP!
It is important to consider the general adaptation syndrome (GAS) when prescribing
rest between sessions, between specific muscle group training, and between training
cycles. The fitness professional should conduct assessments and monitor the client for
symptoms of overtraining.

Table 12.11 Rest Protocol for a Training Goal
TRAINING GOAL REST BETWEEN SETS
Muscular endurance 30–60 seconds
Hypertrophy 30–60 seconds
Maximum strength 2–5 minutes
Power 1–2 minutes
WARM-UP AND COOLDOWN

Before resistance training, moderate-intensity general warms-ups and specific warm-ups are
recommended. Specific warm-ups, beyond warming the muscles and ligaments, increase
muscle force production via neuromuscular facilitation. Self-myofascial release (SMR)
should also be conducted during the warm-up to promote optimal muscle length-tension
relationships.
After a training session, the cooldown should be sufficient to allow the heart rate and body
temperature to return to baseline. Completing SMR after the exercise bout may acutely
reduce muscle soreness, improve arterial function, improve vascular endothelial function, and
increase parasympathetic nervous system activity. All these benefits can work to enhance
recovery from training.
RESISTANCE EQUIPMENT
The fitness industry is well known for its ingenuity in creating new exercise equipment. Some
equipment serves to train a single movement pattern or muscle group, while others are
multifunctional. No matter what is trained, each piece of resistance training equipment will fall
into one of the four categories of resistance: constant, variable, accommodating, or static.
CONSTANT RESISTANCE
Barbells, dumbbells, kettlebells, and medicine balls are categorized as constant resistance
equipment. The weight of the dumbbell does not change throughout the range of motion.
Although it may feel heavier at some points in a lift—the bottom or top of a biceps curl—due
to gravity and the angle at which it is moved, the weight of the equipment is constant.

VARIABLE RESISTANCE
Variable resistance equipment changes the resistance throughout the range of motion to
match the various exercise strength curves. This includes rubber-based resistance such as
loops, tubes, and bands, as well as chains.
Research has compared traditional resistance training to variable resistance training. A study
group added 30 percent of their 1RM as band tension to one weight training session, one
time per week. Results found that adding variable resistance to one training session per week
enhanced athletic performance over traditional resistance training. This included increased
squat and bench press 1RM values and vertical jump height.
ACCOMMODATING RESISTANCE
Accommodating resistance machines control the resistance throughout the full range
of motion. Some machines were built to create constant speed or resistance. However,
resistance bands are also commonly used as accommodating resistance equipment. For
example, using a resistance band at the knees during a squat creates greater tension in
the glutes during the range of motion as the femur is externally rotated (the knees pressed
laterally) to create tension in the band.
Research shows that this type of training is useful for increasing sprint speed—when used
as part of the warm-up for muscle activation—peak power output and jump height due to
increased neuromuscular control and activation in the affected muscles.

STATIC RESISTANCE
Static resistance is also known as an isometric contraction. With static resistance, the
muscle develops tension but does not contract nor relax—the muscle fiber length remains
constant. Examples include planks and bent-arm hangs. In most cases, isometrics is not
considered functional. Holding a dumbbell in a fixed position only strengthens the muscle in
that position and at that length. However, in some sports, isometrics translates into athletic
skills. Examples of sports that use isometrics include the following:
• Alpine skiing
• Climbing
• Gymnastics
• Horseback riding
• Judo
• Motocross
• Mountain biking
• Shooting
• Wrestling
FUNCTIONAL
Advanced-strength athletes use a training method called functional isometrics. Functional
ISOMETRICS:
The combination of partial
isometrics combines partial reps with isometric holds. This technique is used to overcome repetition training and
isometric holds.
sticking points in movements. For example, to overcome the sticking point in a bench press,

pins can be placed in the rack near the top of the trainee’s sticking point. The client can push
the bar (unweighted) up into the pins with maximal force and then hold the contraction by
pushing the bar firmly against the pins for five to six seconds.
Research suggests that 15 percent more force is created in an isometric versus concentric
contraction. Strength gained from functional isometrics only transfers 15 degrees to the joint
angle being worked. The localized strengthening effect does not have a huge transference to
the overall ROM but can help trainees overcome weak points within a ROM.
COMPARING FREE WEIGHTS AND WEIGHT MACHINES

Two common modalities of resistance training are free weights and weight machines. Free
FREE WEIGHTS: weights are loads that are not attached to an apparatus, such as barbells and dumbbells.
Loads that are not attached
to an apparatus. Weight machines are pieces of equipment with a fixed or a variable range of motion that uses
gravity and a load to generate resistance. Each has benefits and drawbacks, and the ideal
WEIGHT MACHINES: modality will be based on the client’s desired training goal or goals. In many cases, both
Pieces of equipment with
fixed or a variable range of modalities are programmed throughout a periodized program to introduce training variability,
motion that uses gravity
promote progressive overload, vary intensity, and prevent boredom.
and a load to generate
resistance.

BENEFITS OF FREE WEIGHTS
Benefits of free weights include the following:
• Free weights are less expensive and take up less storage space. They may be more
practical in a home gym.
• They are more versatile. Exercise can target any muscle group with this simple
equipment.
• Free weights help develop greater power, as compared to machines.
• Working out with free weights is a more efficient way to reach most fitness goals,
including increasing strength and muscle size, changing body composition, and
weight loss.
• Exercises done with free weights better mimic neurological patterns of actual fitness
and sports skills than those done on a machine or with a fixed ROM.
• Free weights recruit more of the smaller synergist and stabilizer muscles.
DRAWBACKS OF FREE WEIGHTS

Drawbacks of free weights include the following:
• Changing weights on barbells and dumbbells is time-consuming and poses a hazard
if they are not secure and slide off during an exercise.
• Using free weights requires more physical space. This is a safety issue if several
people are using free weights in a small space.
• It is not always possible to completely isolate an individual muscle with free weight
exercises.
BENEFITS OF WEIGHT MACHINES

Benefits of weight machines include the following:
• Certain machines are much better at isolating a single muscle or group of muscles
for the purpose of generating progressive overload.
• Machines make more efficient use of space in a gym where there are many people
working out at the same time.
• Working with machines may be faster. Changing the resistance is more efficient and
quicker.
• With a proper introduction and guidelines, novice resistance training clients may
find machines to be safer.

DRAWBACKS OF WEIGHT MACHINES

Drawbacks of weight machines include the following:
• The movements done on a machine are not as natural as those done with free
weights.
• It’s more difficult to recruit stabilizer and helper muscles with machines, especially
when seated.
• Many machines have limited positional adjustments and do a poor job of
accommodating people who are shorter or taller than average.
• The repetitive motions used when working out with a machine can lead to overuse
injuries.
• Most weight machines are specialized, which means multiple machines are needed
to get a full-body workout.
• Weight machines can be cost-prohibitive, even for many gyms.
• High-speed weight training for power is far more difficult to do with a machine.
BODY WEIGHT EXERCISE

BODY WEIGHT Body weight exercises are essentially calisthenics—movements performed with no additional
EXERCISES: load other than what the exerciser’s body provides. While body weight training has many
Movements performed with
benefits, one drawback to this variation of training is that there is no way to add resistance.
no additional load other
than what the exerciser’s In terms of the principles of fitness, body weight training cannot adhere to the principle of
body provides.
progressive overload as it has its limits.

One of the most effective uses for body weight training is with clients who are new to strength
training. It’s a safe way to ease into lifting and gives the fitness professional a chance to
teach clients proper movement mechanics. When clients get stronger and have mastered the
movement patterns, then resistance can be added. Some other important benefits of body
weight exercises include:
• Body weight training is accessible and inexpensive. Everyone can do it.
• The intensity of the body weight exercises can be manipulated by varying tempo,
speed, time under tension (TUT), and adding plyometric moves.
• Body weight exercises are largely functional movements and can improve core strength.
• Body weight movement improves balance and stability.

SINGLE SET:
The use of one set per
REP AND SET SCHEMES exercise or muscle group.
The use of different rep and set schemes can help determine the amount of work done in a
given workout. They are a way to either cluster or spread out the work depending on the goal MULTISET:
Multiple sets per exercise
of the day and the overall goal of the client. Some of the common rep or set schemes include
or muscle group.
the following:
• Single set training: the use of one set per exercise or muscle group. STRAIGHT SETS:
The use of the same weight
• Multiset: adds volume by performing multiple sets per exercise or muscle group. for every set.
• Straight sets: done by using the same weight for every set.
• Supersets: done by performing two exercises back-to-back followed by a short rest.

SUPERSETS:
Two exercises, typically
Typically, the two exercises are opposing muscle groups, such as a pull followed by opposing muscle groups,
performed back-to-back
a push. followed by a short rest.

• Drop set: an advanced training technique where a set is done until failure or fatigue,
DROP SET: the weight is “dropped” or lowered, and the exerciser continues until another
Technique in which a set is
done until failure or fatigue, failure. This can continue for several rounds.
the weight is “dropped” or
lowered, and the exerciser • Ascending pyramids: a set scheme that uses a light to heavy approach, meaning
continues until another
failure; can continue for lighter weights are used to start the workout and they get progressively higher. This
several rounds.
style may sacrifice total volume but may allow for quicker recovery and turnaround
between workouts.
ASCENDING
PYRAMIDS: • German volume training: a method in which 10 sets of 10 repetitions are done of
Lighter weights are used to
start the workout, and they an exercise with one minute of rest between sets.
get progressively higher
with subsequent sets.
SAMPLE STRENGTH TRAINING WORKOUTS
The adaptation of the muscular system to an exercise program will rely heavily on how the
GERMAN VOLUME
workouts are structured and progressed over time. Structuring the acute variables correctly
TRAINING:
A method in which 10 sets and understanding which variables need to be progressed are at the heart of goal-specific
of 10 repetitions are done
of an exercise with one exercise programming. The following sample workouts highlight the resistance training
minute of rest between
sets. portion of a workout (proper warm-up and cooldown are still recommended) and how to
structure the acute variables for the different goals.
MAXIMIZING STRENGTH
Maximizing strength as a primary fitness goal focuses on progressively increasing the load
used during workouts. This style of training can result in greater motor unit recruitment and
greater overall force production. Force equals mass multiplied by acceleration (F = M x A).
With this type of training, force (F) production is increased by emphasizing the mass (M) part
of the equation. In other words, intensity (load) will be the primary variable that will need to
be progressed throughout the program to achieve this result. Special attention should be
given to rest period length as well to ensure that proper recovery of ATP stores allows for
subsequent maximal efforts.

Table 12.12 Sample workout for maximizing strength
LOAD/
EXERCISE SETS REPS TEMPO REST
INTENSITY
Barbell chest 85 percent or 2–5

3–5 sets 1–6 3:0:1:0
press greater minutes
Dumbbell 85 percent or 2–5

3–5 sets 1–6 3:0:1:0
incline press greater minutes
85 percent or 2–5
Barbell row 3–5 sets 1–6 3:0:1:0
greater minutes
Seated cable 85 percent or 2–5

3–5 sets 1–6 3:0:1:0
row greater minutes
MAXIMIZING HYPERTROPHY
Increasing muscular size (hypertrophy) is a common fitness goal. This style of training
requires relatively high levels of volume along with short rest periods. As volume is the
primary acute variable that would need to be progressed during a hypertrophy program, there
would eventually be a need to create a split training routine. An example of this would be
splitting upper-body pushing, upper-body pulling, and lower body into three separate workouts.
Table 12.13 Sample workout for maximizing hypertrophy
LOAD/
INTENSITY
Dumbbell 67–85 30–60

3–5 sets 6–12 3:1:3:1
chest press percent seconds
Dumbbell 67–85 30–60

3–5 sets 6–12 3:1:3:1
chest fly percent seconds
Chest press 67–85 30–60

3–5 sets 6–12 3:1:3:1
machine percent seconds
Triceps
67–85 30–60
extension 3–5 sets 6–12 3:1:3:1
percent seconds
pushdown

MAXIMIZING POWER
The goal of increasing power focuses on force production with greater velocity. This should
result in muscle contraction happening at a faster rate. Keeping in mind that power equals
force multiplied by velocity (P = F x V), this style of training will emphasize the velocity (V)
part of the equation. The tempo used for maximizing power should be fast while under
control. Moving as fast as possible with loss of control will not serve the participant in terms
of maximizing power or minimizing potential injury. As the client progresses and they have
maximized movement velocity, increases in intensity will become necessary.
Table 12.14 Sample workout for maximizing power
LOAD/
INTENSITY
Fastest
75–85 1–2
Jump squats 3–5 sets 1–5 controllable
percent minutes
tempo
Fastest
Plyometric 75–85 1–2
3–5 sets 1–5 controllable
push-ups percent minutes
tempo
Overhead Fastest
75–85 1–2
medicine ball 3–5 sets 1–5 controllable
percent minutes
throw tempo
Fastest
Medicine ball 75–85 1–2
3–5 sets 1–5 controllable
soccer throw percent minutes
tempo
MAXIMIZING MUSCULAR ENDURANCE

Maximizing muscular endurance focuses on increasing the ability to continuously perform a
movement (contract muscles) against resistance. Higher volume through increased sets and
reps is the primary way to progress with this goal in mind. The higher volume of this style of
training may also lend itself to those looking to reduce body fat because of the relatively high
workload, which can result in relatively higher calorie burn.

Table 12.15 Sample workout for maximizing muscular endurance
LOAD/
INTENSITY
67 percent or 15 or 30–60
Push-ups 1–3 sets 4:0:6:0
less more seconds
Assisted pull- 67 percent or 15 or 30–60

1–3 sets 4:0:6:0
ups less more seconds
Goblet 67 percent or 15 or 30–60

1–3 sets 4:0:6:0
squats less more seconds
Dumbbell
Romanian 67 percent or 15 or 30–60
1–3 sets 4:0:6:0
Deadlift less more seconds
(RDL)

EXERCISE SELECTION
CHAPTER 13
AND TECHNIQUE
LEARNING OBJECTIVES
1 | Describe the three different learning styles.
2 | Define verbal and nonverbal communication and how a fitness professional

uses both.
3 | Explain exercise cueing and its importance in exercise and fitness.
4 | Identify the fundamental movement categories that classify human

movements.
5 | List exercises applicable to each fundamental movement category.
6 | Identify the prime mover(s) for each exercise presented.

CHAPTER 13 | Exercise Selection and Technique
Exercise selection is one of the primary acute training variables the personal trainer will
consider when building exercise programming. Exercise selection can determine factors such
as the potential intensity of the exercise, training outcome, or even enjoyment of the program
by the client. When considering which exercises to select for a program, the trainer must
consider the following:
• The target muscle groups or movement patterns
• Muscle groups or movement patterns to avoid that will prevent injury or overuse
• Skill or comfort level of the client with specific movements
• Available tools, space, or exercise equipment
For most training programs, there’s an excess of different exercises a trainer can select.
Most exercises can be divided into how they are performed and the fundamental human
movements they incorporate. A well-rounded exercise program should incorporate exercises
from each category of movement to promote optimal health, mobility, strength, and
MOBILITY: musculoskeletal function. For the most part, the variety of exercise choices come from the
The ability of a joint to
move freely through a given many variations of each foundational movement pattern including the use of different
range of motion.
equipment, starting positions, exercise machines, surfaces, or grips.
COMMON EXERCISE INJURIES AND INJURY PREVENTION

Before learning about movement categories and exercise technique, it is important for a
fitness professional to understand why proper exercise technique is important. “Ideal” form
will vary by client since factors such as flexibility, joint mobility, strength, and body size can
impact the range of motion a client will have. However, proper form and technique can prevent
injury and encourage optimal muscular recruitment during a movement pattern. When ideal
muscular recruitment occurs, movement and muscular compensation can be avoided.
There are many common reasons a client may have an injury during exercise:
• Misuse of the acute training variables: when load, speed, rest, and so forth are not
implemented in a way the body can handle. For example, performing a back squat
too quickly or with too much weight.
• Improper training progression: when the acute training variables are implemented
out of order. For example, a beginning client performing jump squats without properly
training and progressing their ability to squat with both feet flat on the floor.
• Poor mobility or flexibility: Both mobility and flexibility impact every movement
pattern. Whether the client has stiff joints, poor range of motion at a joint or joints,

or low muscle pliability, they may see what is known as altered arthrokinematics,
or the altered movement of joint surfaces, or movement dysfunctions including ALTERED

synergistic dominance when a synergist (helper) muscle takes over a movement
ARTHROKINEMATICS:
Altered movement of joint
pattern when the prime mover fails. surfaces.
• Poor exercise form or technique: A client may experience movement dysfunctions
that lead to injury when they perform an exercise incorrectly. This can include moving SYNERGISTIC
without proper stabilization such as abdominal bracing or making compensations
DOMINANCE:
When a synergist (helper)
where other muscles take over for the action of the prime mover (synergistic muscle takes over a
movement pattern when
dominance or inhibited musculature). For example, having weak or inhibited glutes the prime mover fails or
is too weak to control the
for many movement patterns including walking can cause low-back pain, hip or knee movement.
pain, and overactive hip flexors.
• Poor preparation for movement: When a warm-up is skipped (general or specific),
the body may not be prepared to execute the necessary movement patterns.
• Insufficient energy or exhaustion: When the body is fatigued, under recovered, or
exhausted, movement will suffer, and injury can result. This can apply both within
an exercise session, from one session to the next, or over time with overtraining.
EXERCISE PROGRESSION AND REGRESSION PROGRESSIONS:

Most exercises have a standard technique for proper execution that may vary by person. Modifications to acute
training variables that
Exercises can have progressions that increase the challenge of the movement and regressions increase the challenge of a
movement pattern.
that decrease the challenge of the movement. For example, adding weight to a movement to
progress it or removing weight from the exercise to regress it. Variables that can be
REGRESSIONS:
manipulated to create a progression or regression include load (weight), tempo (speed),
Modifications to acute
range of motion, movement complexity, or novelty. training variables that
decrease the challenge of a
movement pattern.
Increasing tempo adds the challenge of generating speed and controlling the body when
moving at greater speed through a movement. For example, progressing from a body weight
squat to a squat jump. Decreasing tempo can be used as a regression to allow someone
to master technique, but it can also be a progression if time under tension becomes the
emphasis, as with a very slow push-up.
Increasing the range of motion of an exercise can increase the challenge since a load is
traveling for a greater distance, which will require more work and higher levels of control. A
decrease in range of motion may allow for the client to work in a range that they can better
control and move through without pain. Trainers should consider a lunge for this concept.
Lunging forward and moving all the way to the ground may be too great of a range of motion

for some people. Their maximum range of motion should be determined by the distance they
can travel in the movement with coordination and without pain.
An increase in movement complexity can increase the challenge, such as pairing two
movements together in the reverse lunge with rotation. This exercise combines two different
movement patterns with several joints moving, which increases the necessary coordination
and stability to complete the exercise. Keeping movements simple (fewer movement patterns
and joint movements) can act as a regression and teach individual aspects of a complex
movement pattern before combining them.
Movement novelty simply refers to movements that are new or highly untrained. Breaking
down a more complex movement pattern into simple components is a way to regress a novel
movement and strengthen the individual aspects before combining them and increasing the
speed at which they are executed.
KEY COMMUNICATION PRINCIPLES

Just as there are many ways to effectively design a workout, there are many different ways to
teach and communicate with clients. When teaching clients exercise and progressing them
through a training session, clear communication is required to prevent injury and ensure
optimal form and movement execution. While some personal trainers may have the ability to
easily communicate clearly and directly, most trainers need to work at it.
NONVERBAL:
Not involving words or
speech. Communication encompasses much more than just spoken words. The quality of interactions
with clients is reflected in how trainers greet their clients, teach them movement patterns,
BODY LANGUAGE: and answer their questions along the way. An effective first step to successful teaching is
Communication of a
gaining the clients’ trust, and to do this, trainers must understand that some valuable
nonverbal form with gestures
or body movement. communication techniques are nonverbal.
SPATIAL RELATIONS: NONVERBAL COMMUNICATION

How objects are located
Nonverbal communication has three components
relative to one another in
space.
• body language,
• spatial relations, and

PARALANGUAGE:
Components of speech • paralanguage.
like tone, pitch, facial
expressions, cadence, and Body language incorporates communication through physical appearance, posture, gestures,
hesitation noises.
touch, and changes in facial and eye movements. The face is the most expressive part of

the body, and facial expressions are an important part of communication and developing
impressions of other people. Smiling transcends cultural and language barriers and can be
an effective way to offer positive encouragement and understanding.
Posture is another key element of body language and is an indicator of self-esteem, openness,
and kinesthetic awareness (an individual’s sense of their body and how it moves). Clients will
look to personal trainers to set an example, so it is important for trainers to maintain good
posture both inside and outside the gym.
Proxemics is the study of what is communicated by the way a person uses personal space.
Edward T. Hall, an anthropologist and considered the father of proxemics, described four distinct PROXEMICS:
The study of what is
zones used when interacting with others: intimate distance (0–18 inches), personal distance communicated by the way
a person uses personal
(1.5–4 feet), social distance (4–12 feet), and public distance (12–20 feet). A personal trainer’s space.
interactions with clients will primarily fall in the personal and social distances, although it is
possible that they may enter the intimate distance. Asking for permission to come into this zone
is recommended, always with new clients and frequently with regular clients, to determine their
comfort level with the trainer’s presence in such close proximity.
There are many elements to delivering a message to clients; what a personal trainer does
and how they do it speaks more loudly than what they say. Personal trainers should practice
their own nonverbal messages and strive for congruence among the various forms of verbal
and nonverbal delivery.
The Importance of Listening
One of the greatest communication skills a personal trainer can acquire is the ability to listen.
As a personal trainer, it is important to foster trust and build rapport with clients and support
their growth.
• Active listening is the act of paraphrasing or stating in one’s own words what
someone has just said. Personal trainers can use lead-ins such as “I hear you
ACTIVE LISTENING:
Paraphrasing or stating
saying…” and “Do you mean…?” Paraphrasing keeps the trainer more involved in in one’s own words what
someone has just said.
the conversation, helps them to remember what was said, eliminates
miscommunication, and makes clients feel that they are being heard. Asking more
questions for clarification may be necessary, especially if the client is discussing a
complex issue they are working through.

• Empathic listening is another useful listening skill. The ability to understand how
EMPATHIC LISTENING: the clients feel, whether they are new to exercise, working with an injury or condition,
The ability to understand
how the clients feel and or working through something else, establishes a foundation of trust. As a personal
empathize with them.
trainer, it is important to practice humility, and empathetic listening is an excellent
way to better relate to clients and resist being placed on a pedestal.
VERBAL COMMUNICATION
The introduction of language to communication is not a requirement, but a luxury. So
much goes into overall communication and the addition of speech can cause confusion or
miscommunications. Attention to detail is necessary with language to ensure the intended
message is conveyed.
Paralanguage
Paralanguage comprises the vocal components of speech considered separate from the
actual meaning of the words. It includes things like pitch, articulation, tempo, and volume.
ARTICULATION: These elements make a huge impression on clients, so it is worth refining them.
The ability to pronounce
distinctly—to enunciate.
Pitch occurs by tightening or loosening the vocal cords. Intense feelings of joy, fear, or anger
cause the voice’s pitch to rise. When a person is depressed, tired, or calm, the voice relaxes
and the pitch decreases. The most dramatic pitch change should occur when saying the most
important words of the message.
Articulation is the ability to pronounce distinctly—to enunciate—which is an extremely
valuable tool. Clients should be able to hear and clearly understand a trainer’s cues.
Tempo, or the speed at which words are spoken, is also important. If words are spoken too
slowly, a client’s attention may wander. On the other hand, if words are spoken too rapidly,
some clients may find it difficult to follow the instructions.
The volume of a personal trainer’s voice can vary depending on the workout, and it can convey
different emotions and energy levels. Finding the right volume comes with experience and an
awareness of one’s own voice. If unsure of how well clients can hear instruction, the trainer
should not hesitate to ask.
A vital part of becoming a successful personal trainer is the ability to instruct effectively in
each of the three forms - visual, auditory, and kinesthetic. Each form corresponds with the
way people communicate and the way they learn.

• Visual learners tend to process information quickly, use descriptive language, and
are prone to using hand gestures. They learn best through seeing the information VISUAL LEARNERS:
People who learn by seeing
being taught. This could include reading text, looking at pictures or diagrams, or information.
watching someone demonstrate a movement.
• Auditory learners prefer to learn by hearing instructions. They do best by listening
and rely on both speaking and hearing to process information. Auditory learners AUDITORY LEARNERS:
People who learn by hearing
often like to repeat information back to ensure their understanding of a concept or information.
movement.
• Kinesthetic learners learn best through movement and hands-on activities. They
can be slower to process information and respond better to physical touch than KINESTHETIC
verbal instruction. They prefer being active when learning and rely on the senses of
LEARNERS:
People who learn by
touch, smell, and taste in the learning experience. physical touch.
Effective trainers remain aware of all three types of learners. This includes learning different
types of instruction to better relate to clients in their “language.”
Language Choices
Personal trainers should be selective with the words they choose and consciously construct
the phrasing of their instructions, keeping in mind that literal and implied meanings are not
always the same. For example, the instruction “straighten your spine” is ambiguous and can
be frustrating for clients because it is not physically possible to straighten the spine due to
its natural curves. A clearer cue would be “lengthen your spine” or “elongate your spine” to
indicate increasing the space between each vertebra and the sensation of growing taller.
Using clear, active language rather than passive or overly descriptive language is essential for
personal trainers. An instruction such as “straighten your arms” is much clearer and action-
oriented than “your arms are straightening,” which implies that clients are already doing what
is asked of them. Using excessive or complex jargon, such as “dorsiflex your ankle” or “flex
through the hip,” should be avoided because these instructions are ambiguous and difficult
for clients to understand in many cases. Keeping language clear and simple will ensure that
the greatest number of clients can benefit from the trainer’s knowledge and guidance.
CUEING
Cueing is an important part of personal training. The ability to cue with clarity and precision CUEING:
plays a huge role in each client’s movements and overall success. Every client has a different To give a reminder or a
direction.
learning style, so effective cueing involves both good communication skills and an ability to

adapt based on clients’ individual needs. Most individuals will have a dominant learning
preference, whether visual, auditory, or kinesthetic, but it will not be exclusive. As cues are
refined, it is important to cultivate a greater understanding of the cues that might work best
for each learning preference.
VISUAL CUEING
Visual learners tend to learn best by seeing what is being taught through physical
demonstration. To best serve those who learn visually, movements must be clear and concise.
Any unnecessary movements or transitions should be avoided, and (if relevant) a movement
can be broken down to ensure that clients can understand the proper execution. Particularly
with advanced or more complex movements, trainers should consider offering a step-by-step
demonstration. For example, when teaching a deadlift, the trainer may individually break
down the start, stand, hinge, and knee flexion components so the client can understand the
full movement and see it in action.
VERBAL CUEING
Auditory learners learn best by listening to verbal cues. Much of the cueing a personal trainer
will deliver will be verbal. The ability to succinctly provide verbal feedback to clients and
reinforce correct movement patterns is a vital skill and takes practice. Here are a few things
to consider while refining verbal cues:
1. Trainers should avoid over-instructing or feeling the need to narrate every moment.
Clients can only take in so much information at once, and the level of the client
should be considered. Newer clients may need more guidance while more advanced
clients likely have a better understanding of how to execute certain movements.
2. Trainers should avoid using overly technical language. Although it is important to
have a solid understanding of the biomechanics of each exercise, trainers should
stick to simple language so clients have a clear understanding of what they are
being asked to do.
3. Trainers should watch to see if clients are responding to verbal cues. If not, it may
be that the concept was not explained clearly, or repeating the same cue using a
different language is necessary. It could also be that the action being taught is too
complex for the level of the client, which may call for a different form of instruction,
such as a physical demonstration or a regressed form of the movement first.

KINESTHETIC CUEING
Kinesthetic learners absorb instruction best through hands-on learning. Physical cueing can
be effective, particularly for new clients as it helps them develop kinesthetic awareness.
While hands-on learning can be useful, any kind of physical touch between a personal trainer
and client must be appropriate. It is important to ensure that clients feel comfortable with
the use of touch and that it has been approved by the client.
MOVEMENT CATEGORIES
There are six fundamental movement categories. They can help to ensure that exercise
selections are being made to accommodate a specific fitness goal and meet the basic criteria MOVEMENT
of maintaining general movement skills and capacity. They are not an absolute description of
CATEGORIES:
The six fundamental
an exercise but are used as organizational categories. With this in mind, it’s important for movements that are the
basis for most exercise
fitness professionals to note that there are exercises that can overlap more than one selections in exercise
programming.
movement category.
The movement categories (in no particular order) are
• Hinge
• Push
• Pull
• Squat
• Lunge
• Locomotion
In addition to the movement categories, the following exercise categories are also applied:
• Core
• Isolation and activation
HINGE
The hip hinge is a forward and backward movement of the upper body (spine remains neutral)
while the hips remain at the same height and move back rather than downward to counterweight HIP HINGE:
A forward and backward
the movement of the head and rib cage. The primary joint involved is the acetabulofemoral movement of the upper
body while the hips remain
joint (hip joint). at the same height and
move back.
During a hip hinge, the prime mover creating hip extension is the gluteus maximus, with
some strong help from the hamstring group. Hinges can also be used to strengthen the

erector spinae along the spine as they will be isometrically acting to maintain the neutral
spine position. This position is a foundational movement for many exercises and should be
mastered early in an exercise program.
Barbell Deadlift
Prime movers: Hamstrings, Quadriceps, Glutes
Begin by stepping up to the barbell with the shins to the bar and with the feet just outside
hip width. Next, hinge to the bar, and place the hands just outside the shins with an overhand
grip. The back should remain flat with the shoulders down and away from the ears. Press
through the midfoot to come to a standing position with the barbell in hand, while avoiding
pulling to stand up by using the arms to lift the weight before extending the legs. The glutes
are engaged while standing with a slight posterior pelvic tilt. The knees should remain
stacked over the ankles (pressing out) to engage the glutes. To return to the starting position,
a hip hinge is initiated until the barbell reaches the knees. Then, keeping the knees over the
ankles, begin to bend the knees while maintaining a flat back and pushing the hips back with
the goal of maintaining a close-to-vertical shin angle.
TRAINING TIP:
For clients with limited mobility or strength, fitness professionals should elevate the
starting position of the bar using plates or boxes. Also, they must watch for jerking at
the start of the movement or bouncing consecutive reps off the ground.

Dumbbell Romanian Deadlift (RDL)
Prime movers: Hamstrings, Glutes
To begin the exercise, pick up the dumbbells and stand tall. Keep the shoulders down, brace
the abdominals, and initiate a hip hinge. Keeping a slight bend in the knees, hinge until a
stretch in the hamstrings is felt. Typically, the weight will be between the knee and mid shin.
To return to the standing position, squeeze the glutes and hamstrings with bodyweight in the
midfoot. Do not allow the upper body to pull the weight up and extend the hips, placing all the
effort into the lower back as opposed to the glutes and hamstrings. Glutes are engaged with
a slight posterior pelvic tilt at the top of the movement pattern.
TRAINING TIP:
Trainers should coach clients to drive the knees out during the descent of this exercise
to keep the glutes engaged and protect the low back. The shoulders should remain
relaxed and the cervical spine neutral (chin down as if holding an orange between the
chin and the chest) to avoid spinal extension throughout the range of motion.

Kettlebell Swing
Begin standing with the feet just outside the hips with the kettlebell in hand. Hinging from
the hips and keeping the back flat, bring the kettlebell between the knees. The arms and
shoulders remain relaxed through the swing. Resist the urge to force the weight through the
range of motion and instead focus on the hip thrust. Next, quickly extend the knees and
hips to full extension (standing position), driving the head straight up. Hyperextension of the
spine should be avoided. The glutes are squeezed, and the core is braced for stability. The
kettlebell will follow an arc in front of the body and should swing naturally, no higher than the
shoulders. Remain in the upright and engaged position as the kettlebell follows its natural
arc back toward the hips. Just as the weight reaches the front of the pelvis, hinge quickly,
allowing the weight to finish just behind (and between) the knees, and immediately begin the
next repetition, starting with a powerful knee and hip extension.
TRAINING TIP:
Trainers should coach the client to look for a standing plank position at the top of each
rep. They should also ensure the client doesn’t force the kettlebell to move with the
arms. Instead, the weight should “swing” as the hips control the movement.

Dumbbell Single-Leg RDL
Begin in a standing position with the desired weight in the hands and with the arms fully
extended at the sides (or slightly in front of the thighs). With the feet set about hip width
apart and a soft bend in the knees, hinge from the hips while elevating one leg, keeping the
back flat, the shoulder blades in place, and the abdominals braced. The leg being elevated
should have a flexed foot and remain level (even) with the back. Hinge until a stretch is felt
in the hamstring of the stationary leg—typically the hands or load will be between the knee
and mid shin. Next, squeeze the glutes and hamstring on the stationary leg to return to a
standing position while keeping the elevated leg in alignment with the flat back. The glutes
are engaged with a slight posterior pelvic tilt before beginning the next repetition.
TRAINING TIP:
The hip on the elevated side should not be allowed to rotate open, and the hips and
chest should remain square to the floor during the range of motion. If the client has
issues with balance, instead of elevating one leg, coaches should encourage them
to adopt a staggered stance with the front foot flat on the ground and the back foot
elevated to the toes for stability.

PUSH
Pushing movements are categorized as upper body exercises in which the arms themselves,
or the arms and a tool directed by the arms, move away from the body. This can happen
vertically (overhead) or horizontally (anteriorly) and everything in between. The primary joints
involved in these movements will be the glenohumeral joint (shoulder) and the elbow joint.
The direction of the push will directly affect the prime mover of the shoulder joint. In a vertical
push, the deltoids will be the primary mover at the shoulders, with the triceps being the
primary mover at the elbows. In a horizontal push, the pectoralis major will be the primary
mover at the shoulders, with the triceps again being the primary mover at the elbows.
Push-Up
Prime mover: Pectoralis Major
Begin in a high plank position with the body in a straight line from the head to the feet.
The hands are placed just outside of shoulder width and even with the middle of the chest.
Maintain the plank position, and bend the elbows to lower the body toward the floor. The
bottom of the push-up is reached when the elbows are bent to a 90-degree angle. Press
through the hands to engage the chest and extend the elbows back to the starting position.
TRAINING TIP:
A modified push-up can be executed from the knees with the body in a straight line
from the knees to the head. Also, the range of motion at the elbows will vary based
on a client’s strength, flexibility, and body size. For example, someone with a larger
chest may not achieve a 90-degree elbow bend before their chest contacts the floor.

Standing Cable Chest Press
For this exercise, the handles on the cable cross should be set at approximately chest height.
Begin standing in front of a cable cross, facing away from the machine. The feet can be
parallel or in a staggered stance for balance, but in either position, the feet should be about
hip width apart. Grab the handles of the cable cross with one in each hand, and bend the
elbows to approximately 90 degrees. The arms will be parallel to the floor in the start position
with the shoulders relaxed and away from the ears. Press the hands forward to fully extend
(but not lock) the elbows. Slowly flex the elbows and return to the starting position.
TRAINING TIP:
This variation of a chest press challenges the core and the stability of the shoulder
joint when cables are used. The body should not shift forward, nor should the
shoulders elevate or the head move forward, during this exercise. Trainers should
coach clients to brace the core and maintain the height of the arms throughout the
range of motion. If additional stability is necessary, trainers should have the client
execute this exercise from a seated position (with or without a backrest).

Barbell Bench Press
Lie supine on a flat bench with the feet on the floor and the head, shoulders, and glutes in
contact with the bench. Grasp the barbell just outside of shoulder width, and with a pronated
grip (palms facing the feet), lift the barbell off the rack. Keep the shoulders down and away
from the ears, and begin to flex the elbows to lower the barbell. Lower the bar until it touches
the chest (or just above the chest) before extending the elbows back to the starting position.
TRAINING TIP:
The shoulders, head, and glutes should stay in contact with the bench throughout the
range of motion, and the wrists should remain rigid. Trainers should coach clients to
brace their abdominals during the concentric press to stabilize and support the spine.

Dumbbell Chest Press
With dumbbells in hand, lie supine on a flat bench with the feet on the floor and the head,
shoulders, and glutes in contact with the bench. Extend the arms over the chest for the
starting position. Slowly flex the elbows to lower the dumbbells toward the lateral aspect of
the chest, keeping the wrists over the elbows until the upper arm is parallel to the floor. In a
controlled manner, press the dumbbells back to the starting position by extending the elbows
and engaging the pectorals.
TRAINING TIP:
There are several possible grips for this exercise, including palms toward the midline
(neutral) or palms pronated (facing the feet). Regardless of grip, the wrists should
remain stacked over the elbows to control the weight and engage the pectoral muscles.

Dumbbell Seated Overhead Press
Prime mover: Deltoid
Begin seated on a flat bench (no back) or an upright bench (with a back) and feet flat on the
floor with the knees bent at 90 degrees. Bring the dumbbells to the shoulders with the palms
facing the midline (neutral grip) and the elbows flexed and near the abdomen. Brace the
abdominals, press the weight overhead, and extend the elbows while keeping the shoulders
down and away from the ears. Avoid arching the back (spinal extension) when pressing the
weight overhead. Slowly flex the elbows and return to the starting position.
TRAINING TIP:
The grip for the overhead press can also be pronated (palms facing away) or supinated
(palms facing the body).

Machine Chest Press
Sit in the machine with the glutes, upper back, and head in contact with the seat. Grip the
handles of choice (neutral or wide grip). Brace the abdominals, press the arms of the machine
overhead, and extend the elbows while keeping the shoulders down and away from the ears.
Avoid arching the back (spinal extension) when pressing the weight overhead. Slowly flex the
elbows and return to the starting position.
TRAINING TIP:
When using exercise machines that have adjustable seat heights or other settings,
trainers should be sure to record the seat and handle settings for future reference.

Machine Assisted Dips
Prime mover: Triceps Brachii
Adjust the weight pin for the desired amount of assistance (may require trial and error to find
the right assistance). Step into the assisted-dip machine, and place the feet on the foot bar
(or kneel on the knee pad if appropriate). Place the hands on the dip bars with the elbows
fully extended and the shoulders relaxed and away from the ears. Shift the weight into the
arms, and slowly flex the elbows to approximately 90 degrees to lower the body down. Avoid
elevating the shoulders. Press through the hands to extend the elbows back to the starting
position.
TRAINING TIP:
Trainers should coach clients to keep their elbows in toward the midline during the
eccentric lowering. It is also important that trainers tell clients to always keep their
shoulders down during this movement pattern. If the shoulders elevate, trainers
should increase the assistance until proper form can be maintained.

PULL
Pulling movements are upper body exercises in which the arms, or the arms and a tool
directed by the arms, are moved closer to the body. Much like pushing, this can happen
vertically (from overhead) and horizontally (posteriorly) with additional angles in between. The
primary joints involved in these movements will be the shoulders and the elbows.
In a vertical pull, the prime mover at the shoulder will be the latissimus dorsi, with the biceps
being the prime mover creating flexion at the elbow. In a horizontal pull, where the joint action is a
shoulder extension, the prime mover at the shoulder again is the latissimus dorsi with the biceps
moving the elbows. In a horizontal pull where the joint action is a horizontal abduction, the prime
mover at the shoulder will be the posterior deltoids, with the biceps again moving the elbow.
Barbell Bent-Over Row
Prime mover: Latissimus Dorsi
Begin with the shins behind a barbell loaded with the appropriate weight. Hinge from the hips, and
grip the bar just outside of shoulder width. Come to a standing position with the barbell. Again,
hinge from the hips, keep a soft bend in the knees, and keep the back flat with the arms fully
extended to find the starting position. Hold the hinged position, and pull the barbell toward the
belly button by flexing the elbows. The elbows should move straight back, not out and away from
the torso. Slowly extend the elbows and lower the barbell back to the starting position.
TRAINING TIP:
Clients should master the hip hinge before attempting an unsupported bent-over row
(any variation) to protect the low back and avoid injury. Also, avoid bouncing during
the concentric action (the pull) when possible to prevent synergistic dominance or
“cheating.”

Standing Single-Arm Cable Row
Begin standing under a cable cross machine with a single handle set at a height between the
belly button and chest. Grip the handle, and step back from the pulley to engage the weight.
Set the feet at hip width with a soft bend in the knees (or stagger the stance if additional
stability is necessary). Brace the core, and keep the shoulders down and away from the
ears during elbow flexion and shoulder extension to pull the handle toward the torso. Slowly
extend the elbow and flex the shoulder to guide the handle back to the starting position.
TRAINING TIP:
The grip may vary for this exercise—pronated (palm down), supinated (palm up), neutral
(palm toward the midline), or rotating (from pronated to neutral or supinated) based
on the client’s mobility. Trainers should cue clients to brace the core when standing or
if additional stability is needed, have the client execute the movement from a seated
position, for example, on a flat bench, an upright bench, or a stability ball.

Seated Cable Row
Set the appropriate weight on the weight stack, and sit on the extended bench. Reach
forward, grab the handle(s) of the machine, and place the feet on the foot platforms. Relax
the shoulders, and sit tall with the arms starting fully extended. Flex the elbows, brace
the core, and pull the handle(s) in toward the mid abdomen. Slowly extend the elbows and
release the handle(s) back to the starting position.
TRAINING TIP:
Trainers should coach clients to minimize the forward and backward shifting of the
torso during the concentric and eccentric action with this exercise to avoid straining
the back. The shoulders should stay down and away from the ears throughout the
range of motion.

Lat Pulldown
Sit in the lat pulldown machine, and adjust the leg roller pads to secure the upper thigh in
place with the knees bent at 90 degrees. Grip the pull bar with the desired grip just outside
of shoulder width, and begin with the arms fully extended. Relax the shoulders down, and
pull the pull bar down toward the upper chest while maintaining an upright posture. Avoid an
excessive lean back or swinging the torso during the concentric pulling phase. Extend the
elbows back to the starting position in a controlled manner.
TRAINING TIP:
The grip and hand placement for this exercise may also vary—pronated, supinated, or,
with the appropriate machine handle, neutral (wide or narrow). As the client sets up in
the machine, trainers should coach them to keep their knees at a 90-degree angle or
greater (feet in front of them) as opposed to behind them. Placing the feet behind or
under the seat promotes lumbar extension, which is undesirable.

Pull-Up
Begin standing under the pull-up bar. Reach up, and grip the bars with the desired grip (wide,
neutral, underhand, or overhand). Relax the shoulders, and brace the core. Pull the body up
toward the bar, and bring the eyes to the level of the hands (or slightly higher). Slowly lower
the body back to the starting position in a controlled manner.
TRAINING TIP:
Trainers should coach the client to think of the pull-up as if it is a hanging plank to
stabilize the core and prevent swinging. The shoulders should remain as relaxed as
possible and down and away from the ears throughout the range of motion.

Machine Assisted Pull-Up
Adjust the weight pin for the desired amount of assistance (may require trial and error to find
the right assistance). Step into the assisted-pull-up machine, and place the feet on the foot
bar (or kneel on the knee pad if appropriate). Reach up, and grip the bars with the desired
grip (wide, neutral, underhand, or overhand). Relax the shoulders, and brace the core. Pull the
body up toward the bar, and bring the eyes to the level of the hands (or slightly higher). Slowly
lower the body back to the starting position in a controlled manner.
TRAINING TIP:
Trainers should ensure the client keeps their shoulders down and away from their ears
throughout the range of motion. Clients should also maintain a kneeling plank position
with the core braced and the hips tucked to stabilize the spine.

Upright Row
Prime mover: Deltoids
Begin standing with the barbell (straight or EZ bar) in hand with the desired hand placement.
The arms start fully extended, with the weight resting in front of the upper thighs. Roll the
shoulders back and down, and brace the core. Remain upright, and pull the barbell up the
front of the body, leading with the elbows. Avoid elevating the shoulders during the pull.
Slowly lower the barbell back to the starting position with the arms fully extended.
TRAINING TIP:
Trainers should coach clients to guide the bar up the front of the body to minimize
strain on the shoulder joint. Hand placement can also be varied—wide, neutral, or
close grip—based on the client’s shoulder mobility. Trainers should also keep in mind
that a full range of motion may vary as the shoulder abducts during the pull. This
exercise may not be ideal for clients with shoulder impingements or injuries, and
another exercise that targets the deltoids should be selected.

SQUAT
The squat is level-change movement in which a person goes from a standing position to a
lower position by bending at the hips, knees, and ankles. The primary joints involved will be
the hip joint, the tibiofemoral joint (knee joint), and the talocrural joint (ankle joint).
During a squat, the prime mover at the hips will be the gluteus maximus, at the knees it will
be the quadriceps, and at the ankles it will be the calf muscles (soleus and gastrocnemius).
Squat-like movements can also be performed with various machines. These machines allow
for varying loads to be applied to the movement pattern at the hips, knees, and ankles
without necessarily involving a level change.
With any squat movement, mobility and muscle flexibility in the calves, adductors, glutes, and
hip flexors is imperative. For clients with poor mobility or muscular imbalances, these body
regions may need to be addressed with myofascial release, stretching, or an effective warm-
up to prevent injury. A fitness professional may use squat or overhead squat assessments to
identify potential areas of concern.
Goblet Squat
Prime movers: Quadriceps, Glutes
This exercise begins with the elbows flexed to hold the load at chest height against the
body. The feet are set just outside the hips, with a soft bend in the knees. Keeping the
neck neutral, hinge from the hips, bend the knees, and then drive the knees out to engage
the glutes. The ideal end of range puts the glutes just below the crease of the hips and the
elbows on the inside of the knees. Press through the midfoot to extend the knees and hips
and return to the starting position.
TRAINING TIP:
The load can be held at the chest or with the arms extended down in front of the
body. A slight lean forward is acceptable and expected with a goblet squat. Excessive
lumbar extension should be avoided, and there is no need for a posterior pelvic tilt
(called a butt wink) at the bottom of a squat.

Barbell Back Squat
Standing in front of a racked barbell, step under the bar, and place it either on the trapezius
and shoulder (high bar) or just above the spine of the scapula (low bar). With the feet set
just outside the hips and a soft bend in the knees, lift the barbell, and take a step back.
Keeping the abdominals braced and the neck neutral, hinge from the hips while bending the
knees. Ideally, the thighs will go just below parallel to the ground. Press through the midfoot,
keeping the hips back, and extend the knees and hips to come back to the starting position.
The glutes are engaged with a slight posterior pelvic tilt before beginning the next repetition.
TRAINING TIP:
Trainers can use a depth marker (block, bench, or step) if necessary to mark an
appropriate stopping point for the client. They should ensure the client’s knees track
in the same direction as the big toe for proper muscle activation.

Dumbbell Split Squat
Starting from a standing position with the dumbbells in hand and the arms fully extended
and relaxed, take a large step forward with one foot while maintaining a hip-width stance and
keeping a soft bend in both knees. Bend the back knee toward the floor, keeping each knee in
alignment with its respective ankle, and bend until the front knee reaches a 90-degree angle.
Press through the toes of the back foot and the midfoot on the forward foot to extend both
knees and return to the starting position.
TRAINING TIP:
The split squat can be loaded in a multitude of ways, including with a barbell, a
CONTRALATERAL dumbbell, a kettlebell, and resistance bands. This vertical loading variation can be
LOADING:
Loading the body on the executed bilaterally or unilaterally. There is also the option for unilateral contralateral
opposite side of the work
being executed. loading—the opposite side of the forward leg—or ipsilateral loading—the same side
as the forward leg. A slight lean forward is acceptable in a split squat (any variation)
IPSILATERAL LOADING: or a lunge. This will reduce low-back activation and focus the effort on the hamstrings
Loading the body on the
same side as the work
and glutes primarily while minimizing knee pain or malalignment.
being executed.

Seated Leg Press
Adjust the weight stack to the desired load, and sit into the machine. Place the feet just
outside of hip width on the foot platform, and lower the seat carriage to the lowest position.
Press through the feet to extend the legs and push the seat back to the starting position.
Keeping the back and head rested on the seat, bend the knees to lower the seat and raise
the weight stack. When the knees reach approximately 90 degrees, press through the midfoot
to extend the legs back to the starting position.
TRAINING TIP:
Trainers should take the time to adjust the machine for the height of the client and
note the settings for future use. Clients should avoid locking the knees at the top of
the range of motion. Also, foot placement may be varied on this machine—wide, sumo
(wide with feet pointing outward), or close. Regardless of the foot position, clients
should ensure the knees track over the respective ankle..

Angled Leg Press
Add the desired load, and sit into the leg press. Place the feet just outside of hip width on
the foot platform. Press through the feet to extend the knees and reach the starting position.
Keeping the back and head rested on the seat, bend the knees to lower the carriage toward
the torso. When the knees reach approximately 90 degrees, press through the midfoot to
extend the legs back to the starting position.
TRAINING TIP:
Trainers should coach clients to keep their hips and glutes against the seat at the
bottom of the range of motion to avoid stressing the spine. They should also avoid
locking the knees at the top of the range of motion. Foot placement may be varied on
this machine—wide, sumo, or close. Regardless of the foot position, clients should
ensure the knees track over the respective ankle.

LUNGE
The lunge is a step and return movement. In other words, from a stationary position, a person
steps (in any direction) with one leg while the other remains stationary and then returns to the
starting position. Like the squat, it typically also has an element of level change. The primary
joints involved will be the hip, knee, and ankle joints.
During a lunge in the sagittal plane, the prime mover at the hips will be the gluteus maximus,
at the knees it will be the quadriceps, and at the ankles it will be the calf muscles. As the
lunge becomes more of a diagonal or frontal plane movement, the prime movers remain the
same, but there will be an added element with musculature along the lateral side of the hips,
knees, and ankles providing synergistic support.
Dumbbell Forward Lunge
Starting from a standing position with the feet hip width apart, take a large step forward,
maintaining the hip-width foot placement. Bend the back knee toward the floor until the forward
knee reaches approximately 90 degrees of flexion. Next, press through the midfoot of the forward
foot and the toe of the back foot, engage the hamstring, and push with the glute to extend both
legs and return to the standing starting position. The glutes are engaged with a slight posterior
pelvic tilt before beginning the next repetition on the same leg (or switching legs).
TRAINING TIP:
The step for a lunge in any direction is relatively large, but clients should not overreach.
If there is pulling or pain in the adductors or groin, shorten the step taken. Ideally, both
knees should reach approximately 90 degrees of flexion without bumping the back
knee on the floor.

Reverse Lunge
Starting from a standing position with the feet hip width apart, take a large step back, maintaining
the hip-width foot placement. Bend the back knee toward the floor until the forward knee reaches
approximately 90 degrees of flexion. Next, press through the midfoot of the forward foot and the
toe of the back foot, engage the hamstring, and push with the glute to extend both legs and return
to the standing starting position. The glutes are engaged with a slight posterior pelvic tilt before
beginning the next repetition on the same leg (or switching legs).
TRAINING TIP:
A slight hinge forward can help a client with balance during lunging movements, but
the hips should be shifted posteriorly and the weight distributed evenly over both feet
(in the toes of the rear foot and the midfoot of the forward foot).

Step-Up
Prime movers: Quadriceps, Hamstrings, Glutes
Starting by standing in front of a platform of the desired height, lift one leg with the knee
flexed, and place the entire foot onto the platform. Hinging from the hips will shift bodyweight
into the elevated foot. Pressing through the midfoot, squeeze the glutes, and extend the
knee and hip on the elevated leg until the entire body comes to a standing position atop
the platform. The glutes are engaged with a slight posterior pelvic tilt before beginning the
descent to the starting position. The last leg onto the platform is the first one off. Lifting the
foot and stepping down from the platform slowly, work to keep the elevated knee in alignment
with the same side’s ankle to keep the glutes engaged, and always brace the core.
TRAINING TIP:
There is no ideal height for a step-up, so trainers should adjust the height to that
which their client can lower from under control. Trainers should watch for a hard
landing of the trailing or down leg because this demonstrates a lack of control during
the lowering process. Also, the elevated foot can remain elevated between repetitions,
or it can be brought down to the floor. If alternating legs, the client can bring both feet
back to the floor before the next repetition.

Lateral Lunge
Starting from a standing position with the feet straight and hip width apart, take a large
step to the side. The stationary foot remains straight, and the same side knee will remain
extended. On the side of the body that the step was taken, hinge at the hips, and flex the
knee as in a single-leg squat. The ankle, knee, and hip should be aligned at the bottom of
the range of motion. Press through the foot, extend the bent knee, and return to the starting
standing position.
TRAINING TIP:
Trainers can use a line on the floor to guide the position of the stepping foot. A hinge
is necessary for proper hip and knee flexion during the descent. At the bottom of
the range of motion, if the knee is inside the ankle, coaches should cue the client to
either press the knee out to engage the glutes or take a smaller step to the side when
initiating the repetitions.

Reverse Lunge with Rotation
Prime movers: Quadriceps, Glutes, Core
Hold a weight or weighted implement (such as a medicine ball) in front of the chest with
the elbows tight to the body and shoulders relaxed and away from the ears. Starting from a
standing position with the feet hip width apart, take a large step back, maintaining the hip-
width foot placement. Bend the back knee toward the floor until the forward knee reaches
approximately 90 degrees of flexion. As the knee is flexing to the end of range, rotate the
torso and weight in hand as far as possible in the direction of the forward leg. Rotate back
to a neutral spine in a controlled manner. Next, press through the midfoot of the forward
foot and the toe of the back foot, engage the hamstring, and push with the glute to extend
both legs and return to the standing starting position. The glutes are engaged with a slight
posterior pelvic tilt before beginning the next repetition on the same leg (or switching legs).
TRAINING TIP:
The load can be held at the chest as described or with extended arms in front of the
body to challenge shoulder strength and stability for more advanced clients. Trainers
should watch for undesirable shifting at the feet, knees, or hips during the rotation.

LOCOMOTION
Locomotion, as a human movement category, is a broad term referring to the ability to move
LOCOMOTION: from one place to another using the limbs. This can include walking, running, skipping,
Movement from one place
to another. swimming, and crawling. For the purposes of this course, the focus is on bipedal locomotion,
or movement done on two feet. During bipedal locomotion, the primary joints involved will be
BIPEDAL the hips, knees, and ankles.
LOCOMOTION:
A form of locomotion in Farmer Carry
which a person moves from
one place to another using Prime movers: Quadriceps, Core
the legs.
Start in a standing position with the feet at hip width and the desired weight next to the feet.
Hinge to reach down and grasp the weight, and return to a standing position. With the weight in
hand, walk forward, one foot at a time, with a slow, steady pace. Walk for the desired distance or
number of steps before stopping with parallel feet. Hinge to place the weight back onto the floor.
TRAINING TIP:
The client should easily be able to deadlift a farmer’s carry load, which makes it safe
to pick up or put down at any time. The shoulders should remain relaxed and away
from the ears throughout the movement, and trainers should cue clients to keep
the torso and core as steady as possible. If the client begins to shift side to side
dramatically, the trainer should cue them to brace the core and consider reducing the
carry load until proper core stabilization can be achieved.

Suitcase Carry
Prime movers: Quadriceps, Core
Start in a standing position with the feet at hip width and the desired single weight next to
the feet. Hinge to reach down and grasp the weight in one hand, and return to a standing
position. With the weight in hand, walk forward, one foot at a time, with a slow, steady pace.
Avoid leaning to the side of the load being carried. Walk for the desired distance or number
of steps before stopping with parallel feet. Hinge to place the weight back onto the floor.
TRAINING TIP:
A client should learn the unilateral (single leg) deadlift before performing the suitcase
carry to ensure adequate core strength. This makes it safe to put it down at any time.
If the client begins to shift side to side dramatically, the trainer should cue them to
brace the core and consider reducing the carry load until proper core stabilization can
be achieved.

Dumbbell Walking Lunge
Starting from a standing position with the feet hip width apart, take a large step forward,
maintaining the hip-width foot placement. The back knee is bent toward the floor until the
forward knee reaches approximately 90 degrees of flexion. Press through the midfoot of the
forward foot and the toe of the back foot, engage the hamstring, and push with the glute
to extend both legs, bringing the back foot forward to be even with the forward foot. The
glutes are engaged with a slight posterior pelvic tilt before beginning the next repetition and
switching legs.
TRAINING TIP:
Lines on the floor are helpful to guide proper foot alignment during this exercise.
Trainers should avoid excessively long steps that may overextend the adductors and
groin, where the front foot lands hard on the heel and the back foot gets dragged
forward.

Monster Band Walk
Prime movers: Tensor Fasciae Latae, Glutes
From a standing position, place a mini band around both legs at the knees or the ankles.
Slightly flex the knees and hips with a partial hinge, then proceed by walking in a diagonal
pattern forward, stepping laterally.
TRAINING TIP:
Clients should use the arm movement to drive a contralateral gait pattern if that is
desired. They should avoid excessive lateral shifting with each forward step.

Lateral Band Walk
Prime movers: Glutes
From a standing position, place a mini band around both legs at the knees or the ankles. In a
partial hinge with the feet about hip width apart, step laterally with the right foot first, ensuring
the knee remains above the ankle, then move the left foot in the same direction until the feet
are again hip width and parallel. Continue in one direction until the desired number of steps
are taken, and then reverse direction.
TRAINING TIP:
Trainers can use lines on the floor to guide the position of the stepping foot. If the
trailing foot is dragged into external rotation or eversion (the toes turn out), clients
should shorten the step. Trainers should coach clients to avoid excessive lateral
shifting with each lateral step and cue clients to brace the core.
EXERCISE CATEGORIES
The following exercise categories address two common classifications: core, as well as
isolation and activation. Many exercises in these categories can fit within the movement
categories, but the exercises may not fit into them as easily. Additionally, some of these
exercises do not fit within the movement categories but are deserving of attention because
of their value in exercise programming. In any case, core exercises along with isolation and
activation exercises are an important and common component of many exercise routines.

CORE
Core exercises specifically help to train the muscles of the pelvis, lower back, hips, and
abdomen. When there is weakness or dysfunction in any of these areas, postural and stability
issues are likely. The importance of training the core very much has to do with overall function
as opposed to the widely accepted thought that training the core leads to a lean midsection.
A strong core contributes to overall strength, power production, balance, and stability, as well
as lowering the incidence of low-back pain.
Forearm Plank
Prime mover: Core
Begin in a kneeling position. Come to a prone lying position with the forearms on the floor
and the elbows directly under the shoulders. Extend both legs and dorsiflex the feet. Shift
the body weight to the forearms (relaxed hands) and the toes, and lift the hips off the floor.
The body should maintain a straight line from the heels to the back of the head. Tuck the
hips (posterior pelvic tilt) by squeezing the glutes, and engage the shoulders by pressing the
forearms into the floor and lifting the chest away from the floor. The neck is neutral, and the
eyes are fixed on a spot between the forearms on the floor. Hold for the desired duration.
TRAINING TIP:
Trainers should coach the client to hold themselves up with both their arms and
feet to ensure the entire body remains engaged. They should cue clients to breathe
normally during the isometric hold.

Glute Bridge
Prime movers: Core, Glutes
Lie flat on the back (supine) with the knees flexed and the feet flat on the floor. Initiate the
movement by raising the pelvis off the ground. Keeping the hips raised toward the ceiling, press
through the heels to perform hip extension and squeeze the glutes at the top or end range of
motion. Slowly lower the hips back down to the floor before beginning the next repetition.
TRAINING TIP:
Trainers should coach clients to perform abdominal bracing throughout the range of
motion to engage the abdominals and support the spine. Additional resistance can
be added to progress this exercise in the form of resistance bands at the knees or
weight added at the hip.
Abdominal Crunch
Prime mover: Rectus Abdominus, External Oblique
Begin lying supine (face up) on the floor. Keep the shoulders relaxed and away from the ears,
and bring both hands up behind the head or in front of the chest. Gently tuck the chin toward
the chest, and flex the spine to bring the lower ribs closer to the pubic bone. Lift until the
shoulder blades lift off the floor while keeping the lumbar spine securely on the floor. Slowly
lower back down to the mat to the starting position.
TRAINING TIP:
Trainers should cue clients to breathe normally and perform a posterior pelvic tilt
before beginning this exercise. This will flatten the lumbar spine to the floor and
engage the abdominals effectively. Clients should not pull on the cervical spine with
their hands. Instead, trainers should cue them to focus on engaging the abdominals
to lift the shoulders off the floor.

Abdominal Double Crunch
Prime mover: Rectus Abdominus, Rectus Femoris, External Oblique
Begin lying supine (face up) on the floor. Keep the shoulders relaxed and away from the ears,
and bring both hands up behind the head. Gently tuck the chin toward the chest, and flex the
spine to bring the lower ribs closer to the pubic bone. At the same time, flex the hips, lift the
feet off the floor, and bring the knees up over the hips. Lift until the shoulder blades lift off the
floor while keeping the lumbar spine securely on the ground. The elbows will meet the knees
(or get close) over the torso. Slowly lower back down to the mat to the starting position.
TRAINING TIP:
Trainers should cue clients to breathe normally and perform a posterior pelvic tilt
before beginning this exercise. Clients should not pull on the cervical spine with their
hands. Instead, trainers should cue them to focus on engaging the abdominals and
hip flexors to lift the shoulders and feet off the floor. Trainers should also coach clients
to pull the belly button in toward the floor for abdominal bracing.

Back Extension
Prime mover: Erector Spinae
Set the back extension apparatus to the desired height. Step into the apparatus, support the
bodyweight by using the handles, and secure the feet. Release the handles, and flex the hips to
allow the torso to move toward the floor for the starting position. Keeping the chin and spine in a
neutral position, squeeze the glutes, and slowly lift the torso until the body is in a straight line from
head to heels. Release back down to the starting position in a controlled manner.
TRAINING TIP:
The appropriate height for this apparatus places the thigh pads just below the crease of
the hips to allow for adequate hip flexion. Clients should avoid spinal hyperextension at
the top of the range of motion. This exercise may be loaded but should be progressed
slowly to ensure adequate core strength.

ISOLATION AND ACTIVATION
Isolation exercises and activation exercises contribute greatly to exercise programming.
ISOLATION EXERCISES:
Isolation exercises are typically single-joint movements and can be used to add stress to Single-joint exercises
that primarily activate an
specific areas of the body to promote hypertrophy (muscle growth). Activation exercises are
individual muscle or muscle
typically low-intensity exercises and can be used as part of a specific warm-up or as a part of group.
a corrective exercise program used to improve muscular imbalances.

ACTIVATION
Seated Calf Raise EXERCISES:
Low-intensity exercises
Prime mover: Gastrocnemius, Soleus that bring on additional
blood flow and activate
Load the machine with the appropriate weight, and sit on the seat with the ball of each foot the nervous control of a
muscle. Often used as part
on the foot platforms. Adjust the knee pad if necessary to secure the lower legs in place. of a specific warm-up or as
part of corrective exercise
Raise onto the toes to release the load lever before relaxing the feet and pressing the heels programming.
down toward the floor (dorsiflexion) as far as possible at the starting position. Raise up onto
the toes (plantarflexion) as far as possible, then release back to the starting position. CORRECTIVE
EXERCISE:
TRAINING TIP: Exercise programming used
to improve function through
Clients should avoid excessive forward and backward weight shifting during the range assessing and improving
muscle imbalances.
of motion to avoid synergistic dominance when moving the load. The range of motion
at the ankle will vary by client based on flexibility, ankle mobility, and strength.

Incline Bench Fly
Prime mover: Pectoralis Major, Anterior Deltoid
Begin lying supine (face up) on an incline bench with dumbbells in hand. Ensure the head,
shoulders, and low back are supported on the bench and the feet are flat on the floor. Extend
the arms with the weights up over the chest with the palms facing the midline of the body. With
a soft bend in the elbows and relaxed shoulders, slowly open the arms (horizontal abduction
of the shoulder) until a stretch is felt in the pectorals. Avoid hyperextending (arching) the
spine during the eccentric lowering of the weight. Engage the pectorals, and slowly bring the
arms back to the starting position above the chest.
TRAINING TIP:
The ideal bench angle for incline upper body movements is between 15 and 30
degrees. Trainers should ensure clients keep the weights over the chest as opposed
to over the chin or face to protect the shoulder joint and engage the chest muscle.
Trainers should cue clients to brace the core throughout the range of motion to
support the spine.

Dumbbell Bent-Over Reverse Fly
Prime movers: Rhomboids, Rear Deltoid
Begin in a standing position with the appropriate weights in hand. With the feet hip width
apart, hinge at the hips, and maintain a flat back until the back is approximately 45 degrees
in relation to the floor. Allow the arms to hang toward the floor, and put a soft bend in the
elbows. Minimize torso movement, and slowly raise each arm laterally (horizontal abduction
of the shoulder) until they reach the level of the back. In a controlled manner, release the
arms back down to the starting position.
TRAINING TIP:
Trainers should coach clients to master the deadlift and hip hinge before teaching the
bent-over reverse fly since they serve as the foundation of the setup. Throughout the
range of motion, the body should not bounce, the spine should remain neutral, and the
shoulders should remain relaxed and away from the ears.

Dumbbell Front Raise
Prime mover: Anterior Deltoid
Begin in a standing position with the feet at hip width and the dumbbells in hand. Keep a
soft bend in the knees, and bring the dumbbells to the front of the thighs with the arms fully
extended. Keep the shoulders relaxed and away from the ears. Both elbows remain extended
as the weight is raised to approximately chest height. Slowly lower the weight back down to
the thighs in a controlled manner.
TRAINING TIP:
Trainers should teach this movement as a standing plank to encourage core bracing
and isolate the shoulder activation. Trainers should also cue clients to avoid forward
and backward swinging of the torso, bouncing, or swinging during the range of motion.

Leg Extension
Prime mover: Quadriceps
Set the leg extension machine to the appropriate seat position. The knees should be aligned
with the mark on the lever arm of the leg pad (located on most leg extension machines). Sit
into the machine, and place both feet behind the ankle pad. Sit back and keep the shoulders,
glutes, and low back on the seat. Dorsiflex the ankles, and extend the knees until the legs
are as straight as possible. Slowly flex the knees and lower the machine lever arm back to
the starting position.
TRAINING TIP:
Trainers should cue clients to relax their upper body during the leg extension exercise
and breathe normally. The entire range of motion should be smooth, and clients
should avoid allowing the weight to slam back to the starting position. The orientation
of the feet may be varied—neutral (straight), eversion (turned out), or inversion (turned
in)—for different quadriceps activation.

Dumbbell Lateral Raise
Prime mover: Deltoid
Begin in a standing position with the feet at hip width and the dumbbells in hand. Keep a
soft bend in the knees, and bring the dumbbells at the side of the body up with the arms fully
extended. Keep the shoulders relaxed and away from the ears. Both elbows remain extended
as the weight is raised approximately parallel to the floor. Slowly lower the weight back down
to the lateral aspect of the thighs in a controlled manner.
TRAINING TIP:
Trainers should cue clients to brace the core throughout the range of motion, as well
as to avoid swinging, bouncing, or excessively abducting the shoulders (higher than
shoulder height). Clients can execute this exercise from a seated position (on a flat
bench or upright bench) to reduce the demand on the core musculature.

Prone Leg Curl
Prime movers: Hamstrings
Lay face down on the pads for the body and grasp the handles to stabilize the upper body.
The knees should be aligned with the pivot point of the machine. Place the lower legs under
the ankle pads so the undersides of the pads touch the calves just above the ankles. Without
moving your upper body, curl your lower legs until the ankle pads are almost touching your
gluteus maximus. Lower the weight back down until just prior to full extension and repeat.
TRAINING TIP:
Trainers should coach clients to brace the core and avoid shifting their weight in the
leg-curl machine. The weight should be controlled both eccentrically and concentrically,
and if this is not possible, the weight should be reduced.

Hip Adduction Machine
Prime movers: Adductor Group
Sit in the adductor machine with one foot in each foothold. Use the lever on the side to open
the footholds as wide as possible for a starting position. Sit back and keep the glutes, low
back, and shoulders on the seat. Squeeze the legs toward the midline of the body, keeping
the core braced and the ankles in dorsiflexion. Then release the legs back to the start
position in a controlled manner.
TRAINING TIP:
The only joint that should be moving in this exercise is the hips. Trainers should cue
clients to control the weight in both directions to prevent injury from excessive or fast
movement.

Hip Abduction Machine
Prime mover: Gluteus Medius, Gluteus Minimus, Piriformis
Sit in the abduction machine with feet in the footholds. If necessary, use the lever on the side
to bring the feet and knees together. Sit back and keep the glutes, low back, and shoulders
on the seat. Press the knees into the pad to abduct the legs from the midline. At the end of
range, slowly release back to the starting position in a controlled manner.
TRAINING TIP:
The only joint that should be moving in this exercise is the hips. Trainers should
cue clients to control the weight in both directions to prevent the weight stack from
slamming down.

Cable Triceps Pushdown
Prime mover: Triceps Brachii
Begin standing in front of a cable machine with the rope attachment set at the top. Grip the
rope handles with a neutral grip (palms toward the midline) and the elbows flexed and at the
sides of the body. Roll the shoulders down and back, keep a soft bend in the knees, and
press the rope down toward the feet by extending the elbows as far as possible. Slowly flex
the elbows to return to the starting position.
TRAINING TIP:
Trainers should cue clients to brace the core and keep the shoulder blades on the
back of the body to prevent the shoulders from rolling forward at the end of the range
of motion.

Dumbbell Biceps Curl
Prime mover: Biceps Brachii
Begin in a seated or standing position with the appropriate dumbbells in hand and the arms
fully extended. Initiate the curl by flexing the elbow to move the dumbbell toward the shoulder.
The elbows will stay close to the sides of the body throughout the range of motion. Slowly
extend the elbow to release the weight back to the starting position.
TRAINING TIP:
Whether seated or standing, trainers should cue clients to brace the core and relax
the shoulders away from the ears throughout the range of motion. Clients should avoid
swinging, allowing the elbows to splay out from the sides of the body, or “cheating” to
get a full range of motion.

NUTRITION
CHAPTER 14
FOUNDATIONS
LEARNING OBJECTIVES
1 | Name the three macronutrients and their primary functions in the body.
2 | List the general recommendations for macronutrient intake.
3 | Define dehydration and explain the general recommendations for water intake.
4 | Explain the nutritional importance of minerals, vitamins, and antioxidants.
5 | List the general recommendations for micronutrient intake.
6 | Describe the recommendations of The Dietary Guidelines for Americans.
7 | Explain how to read a nutritional food label and visualize general

portion sizes.
8 | Name and describe common diets and eating patterns.

CHAPTER 14 | NUTRITION FOUNDATIONS
There are two primary categories of nutrients that make up the human diet. They include the
MACRONUTRIENTS: macronutrients carbohydrates (carbs), fiber, fats, protein, and water and micronutrients,
A type of food necessary
in large quantities in the such as vitamins, minerals, and antioxidants. Each plays an important role in general health,
diet to support function
and energy production, i.e. normal body function, recovery, and human performance. Any fitness professional will confirm
carbohydrate, protein, and
fat. that most of the success of a fitness or performance program lies in the nutritional habits of
the individual. For that reason, a personal trainer should be able to identify and explain the
MICRONUTRIENTS: role of the major nutritional components of a healthy diet, recognize and make suggestions
Substances required in to improve unhealthy eating habits, and be prepared to answer the nutritional questions a
small quantities in the
diet for optimal body client is sure to have.
functioning; vitamins and
minerals.
TEST TIP!
ANTIOXIDANTS: It is outside the scope of practice for a Certified Personal Trainer to prescribe meal
Substances that protect the plans to clients. However, they can review a client’s eating habits and make suggestions
body from free radicals and
the cellular damage they of ways they can improve and eat to support their fitness goals.
cause.
CATABOLISM:
MACRONUTRIENTS
The breaking down in The three macronutrients required by the body are carbohydrates, protein, and fat. Each is
the body of complex
molecules into more simple needed in large quantities daily to support the body’s normal functioning and to support
molecules.
additional physical activity. To create molecules within the body that are usable for repair and
growth, there is a delicate balance that must be achieved between catabolism and anabolism.
ANABOLISM: Catabolism describes the breaking down of more complex molecules into simple molecules,
The building of complex
molecules in the body like when a protein is broken down into individual amino acids. Anabolism describes the
from more simple, smaller
molecules. opposite—the creation of more complex molecules from more simple molecules, like when
amino acids are linked together to form proteins. Each macronutrient has specific and, in
AMINO ACIDS: some cases, unique physiological uses that a fitness professional should be familiar with.
Simple organic compounds
known as the building CARBOHYDRATES
blocks of proteins.
Carbs are the main source of energy for the human body. After being digested, carbohydrates
are processed into glucose, which is converted to energy and used to support various
GLUCOSE:
A simple sugar the body metabolic processes including physical and mental activity. When sugar moves into the cells,
uses for energy production
on the cellular level.
blood glucose begins to stabilize. If all the glucose is not used for energy, some of it is stored
in the liver as glycogen.
GLYCOGEN: The primary source of energy for high-intensity exercise comes from carbohydrates. Carbs
found in the liver and protect muscle mass (protein) from being catabolized during exercise and fuel the central
muscles.
nervous system and brain. Limiting carbs results in more nitrogen loss. Nitrogen is a

component of amino acids, and when there is not enough present, muscle breakdown occurs.
There are two types of carbohydrates: simple and complex.

MONOSACCHARIDES:
Any of the class of sugars
that cannot be hydrolyzed
Simple Carbohydrates to give a simple sugar.
Simple carbohydrates are just that—simple, short-chain carbohydrates. They are small
molecules known as monosaccharides (the simplest form of sugar) and disaccharides (two DISACCHARIDES:
Any of a class of sugars
monosaccharides together). Simple sugars are easily broken down and converted to energy with molecules that contain
two monosaccharide
because they are relatively small molecules. Therefore, when simple carbs are eaten, blood residues.
glucose levels will increase quickly. Simple carbohydrates are naturally occurring in fruits,
vegetables, milk, and milk products. Processed foods also contain simple carbohydrates. PROCESSED FOODS:
Sucrose, maltose, and lactose are common disaccharides, and glucose and fructose are Foods that have been
frozen, packaged, enhanced
common monosaccharides. with vitamins or minerals
(fortified), previously
cooked, or canned
Complex Carbohydrates to preserve them for
consumption.
Complex carbohydrates are made of larger molecules that are broken down into
monosaccharides. Starches and fibers, whole grain breads and cereals, starchy vegetables, and
legumes are examples of complex carbohydrates. These carbs are known as polysaccharides
(meaning many monosaccharides) and contain longer chains of sugar, which take longer to
digest. Therefore, the consumption of complex carbs can help to maintain blood sugar levels
and prevent rapid blood glucose fluctuations.
Glycemic Index
All foods affect blood glucose differently, and sugar levels are not dependent on just the type
or amount of carbs consumed. The measure of how quickly blood glucose increases after
carbohydrate ingestion is known as the glycemic index (GI). Foods are scored from 1 to 100,
GLYCEMIC INDEX (GI):
A system that ranks foods
with the slower-digesting carbs (blood glucose increases at a slower rate) at the low end and on a scale from 1 to 100
based on their effect on
fastest-digesting carbs (blood glucose increases at a faster rate) at the high end. Pure blood sugar levels.
glucose measures 100 on the glycemic index. Proteins and fats are not scored on this index.
The GI of a food is typically considered to be low, medium, or high according to the following
ranges:
Low GI: 1 to 55
Medium GI: 56 to 69
High GI: 70 and above

Figure 14.1 Glycemic Index
The GI of a food depends on several factors, including the type of sugar. Fructose has a
value of 19, whereas maltose, for example, has a value that exceeds the normal GI scale at
105. Foods that are high in the component of starch called amylose have a lower GI because
they are difficult to digest. Amylose and amylopectin molecules make up starch and can
sometimes be resistant to digestion. In addition, processed foods will generally have a higher
GI than less processed or whole foods.

INSULIN:
A hormone produced in the The preparation and ripeness of food can alter the GI of a food. The longer a food is cooked,
pancreas to regulate blood
sugar. the higher the GI. Heat makes the chemical bonds in carbohydrates easier to break by
digestive enzymes. Complex carbohydrates in fruit break down into simple carbohydrates
HYPOGLYCEMIA: as the fruit ripens. Unripe bananas have a GI of 30, and an overripe banana has a GI of 48.
The condition of lower-than-
normal blood glucose The GI is a useful tool in determining the impact of foods on blood sugar. Foods with a high
GI will increase insulin levels, causing hypoglycemia and increasing hunger. This could lead
OBESITY: to overeating and weight gain. Foods with a low GI are digested slowly and do not increase
An abnormal or excessive
accumulation of body fat insulin as dramatically. This increases satiety and keeps hunger at a more manageable level.
that may cause additional
health risks.
Some studies have found that eating lower GI foods results in less overeating, a better
cholesterol reading, and decreased risk of obesity or diabetes. If the client has diabetes,
DIABETES: then eating a diet of low GI foods may reduce the complications of diabetes. Low-glycemic
A condition characterized by
an elevated level of glucose foods do not spike blood sugar levels and therefore help maintain insulin sensitivity. This
in the blood
also allows the body’s cells to use glucose more effectively.

It should also be noted that the combinations of foods can affect their glycemic impact
and digestion. For example, a meal high in fat will require more time in the stomach for the
breakdown and packaging of dietary fat before the stomach is emptied. A higher-fat meal will
also promote the body’s release of insulin, which serves to control blood glucose levels. This
can reduce the immediate GI impact of the meal consumed and delay or reduce the amount
of glucose in the bloodstream. On the other hand, a meal low in fat but high in carbohydrate
or sugar can exaggerate the body’s GI response and cause a rapid change in blood sugar and
insulin production—greater than any one meal ingredient alone.

US DEPARTMENT OF
Intake Recommendations: Carbohydrates
AGRICULTURE (USDA):
Carbohydrates are essential nutrients that most people need in their diets in significant A US federal department
that manages programs for
quantities for good overall health. The acceptable macronutrient distribution range for daily food, nutrition, agriculture,
natural resources, and rural
carbohydrate intake for adults is 45 to 65 percent of total daily Calories, as recommended development.
by the Dietary Guidelines for Americans. This means that for a diet of 2,000 Calories per
day, carbohydrate intake should be around 900 to 1,300 Calories. For weight loss, daily VITAMINS:
Organic compounds
carbohydrate intake can drop to as low as 25 to 40 percent. essential for normal growth
and nutrition.
The US Department of Agriculture (USDA) and other major nutritional science institutions
recommend getting carbohydrates from unprocessed or minimally processed whole grains,

MINERALS:
vegetables, fruits, and beans. Processed food includes foods that have been frozen, packaged, Elements in food that the
body needs to develop and
enhanced with vitamins or minerals (fortified), previously cooked, or canned to preserve them function.
for consumption. Conversely, unprocessed foods are the natural, edible parts of an animal or
plant that have not been cooked, frozen, or otherwise fortified for preservation. These may UNPROCESSED
also be referred to as fresh or raw foods. FOODS:
Fresh or raw foods that are
the natural, edible parts of
Unprocessed carbs naturally contain fiber, while processed carb options often have the fiber
an animal or plant.
removed. The lack of fiber in refined carbs may promote overeating and increase weight gain.
FIBER:
A type of carbohydrate
derived from plant-based
foods that the body is
unable to break down.

Table 14.1 Food Sources of Carbohydrates
CARBOHYDRATE GRAMS OF CARBOHYDRATES

SOURCE PER 100 GRAMS OF SOURCE
Almonds 4g
Apple 9g
Asparagus 1g
Banana 19 g
Barbecue sauce 8g
Beef sirloin 0g
Beer 2g
Bread (brown, one slice) 48 g
Broccoli 2g
Butter Trace
Cashews 28 g
Celery 1g
Cheddar cheese Trace
Cheese pizza 25 g
Cheesecake 35 g
Chicken 0g
Coconut 6g
Cod 0g
Coffee 0g
Crab 0g
Cream cheese (plain) Trace
Doughnut 49 g
Flounder 0g

Table 14.1 Food Sources of Carbohydrates (CONT)

Goat milk 5g
Grapes 13 g
Hamburger 22 g
Hardboiled egg Trace
Honey 76 g
Human milk (breast milk) 7g
Jelly 69 g
Lettuce 1g
Mango 15 g
Margarine Trace
Mayonnaise Trace
Mustard 21 g
Onion 5g
Orange 6g
Oysters (raw) Trace
Peanut butter 13 g
Peanuts 6g
Pickles 6g
Pineapple 12 g
Pistachios 19 g
Plain yogurt 6g
Pork chop 0g
Potato 20 g

Table 14.1 Food Sources of Carbohydrates (CONT)

Prawns/shrimp 0g
Raisins 64 g
Red wine Trace
Rice 30 g
Salami (sliced) 2g
Salmon 0g
Scallops Trace
Skim milk 5g
Spinach 1g
Sponge cake 53 g
Swiss cheese Trace
Tuna 0g
Turkey (roasted) 0g
Vegetable oil 0g
Vinegar 1g
Walnuts 5g
Whole milk 5g
FIBER
Dietary fiber is a type of carbohydrate found in plant sources that the body cannot digest.
Fiber is an important nutrient that supports digestion, weight management, blood sugar, and
cholesterol. It promotes bowel movements and helps get rid of harmful substances in the
body. This keeps the digestive system clean and healthy. There are two types of fiber: soluble
and insoluble.

Figure 14.2 Sugar (left), Starch (middle), and Fiber (right)
Soluble Fiber
Soluble fiber dissolves in water and absorbs water from partially digested food. It helps slow
the digestion process and regulate blood glucose levels, which leads to lower levels of low-
density lipoprotein (LDL) cholesterol. Foods rich in soluble fiber include beans, oatmeal, LOW-DENSITY
nuts, lentils, apples, and blueberries. High-fiber foods such as fruits are low-calorie foods,
LIPOPROTEIN (LDL):
The form of lipoprotein
which make it easier to lower caloric intake. in which cholesterol is
transported in the blood. It
is sometimes considered
Insoluble Fiber the “bad cholesterol.”
Insoluble fiber does not dissolve in water and instead adds bulk to the stool. This helps food
move through the digestive tract. It promotes regularity, prevents constipation, and cleanses
the colon. Adding bulk to a diet increases satiety, leading to less eating. Whole wheat bran,
whole grain couscous, brown rice, nuts, legumes, carrots, cucumbers, and tomatoes are good
sources of insoluble fiber.
Many foods provide both soluble and insoluble fiber. The more natural a food is, the more
fiber it contains. Processed foods have less fiber, and meat, dairy, and sugar have no fiber.
When foods are refined, such as white rice and bread, the fiber has been removed.
Prebiotics
Prebiotics are fibers that are fermented in the gut. Bacteria necessary for digestion use
prebiotics as food. Some whole grains, bananas, greens, onions, garlic, soybeans, and
artichokes contain prebiotic fibers. These foods contain plant fibers that help healthy bacteria
grow in the gut. Prebiotics also improve calcium absorption, metabolism, and digestion and
help process carbohydrates.

Intake Recommendations: Fiber
Fiber is essential to one’s health, yet the typical American still falls short of the recommended
daily amount. The National Academy of Medicine recommends that women consume 25
grams of fiber per day and men consume 38 grams. Although beneficial to overall health,
increasing fiber intake too quickly could lead to gas, bloating, and cramps. Gas is a by-
product of digesting fiber and a common side effect of high-fiber diets.
Though fiber is removed from processed foods, many of them have added fiber. These types
of food can help individuals increase their daily intake. Ingredients such as polydextrose,
psyllium husk, pectin, and soluble fiber dextrin are examples of added fiber. Eating foods
with added fiber may increase overall intake for improved health. However, the nutrition label
should be examined closely for added sugar and/or sodium, and intake should be monitored.
FIBER AND DISEASE

The body cannot digest fiber, but it is a vital nutrient for good health and longevity. Many
studies have been conducted on the role of dietary fiber intake and disease prevention.
Adequate fiber intake has been found to reduce instances of the following:
• Heart disease. Fiber protects the body against heart disease by decreasing bad
cholesterol (Low-Density Lipoprotein or LDL) and improving insulin resistance.
• Type 2 diabetes. An increase in complex carbohydrate and fiber intake can help
regulate blood sugar and prevent the progression of type 2 diabetes.

FATS:
Organic compounds that • Diverticulitis. Fiber softens the stool, which can prevent the inflammatory condition
are made up of carbon,
hydrogen, and oxygen. Fats in the intestines and colon.
are a source of energy in
foods and are also called • Colon cancer. Fiber in the diet keeps the intestinal tract moving and healthy, which,
lipids. They come in liquid
in turn, keeps the colon functioning properly and reduces the risk of colon cancer.
or solid form.
• Breast cancer. Research has found a 12–19 percent lower risk of breast cancer in
HYDROCARBONS: adolescent and adult females who consumed adequate fruits and vegetables (fiber) daily.
A compound of hydrogen,
and carbon, such as any FATS
of those that are the chief
components of petroleum Fats—sometimes referred to as lipids—are necessary for vital bodily functions. They are
and natural gas.
organic molecules made up of carbon and hydrogen elements joined together in long groups
called hydrocarbons. The arrangement of these hydrocarbon chains and their interaction with
FATTY ACIDS: each other determine fat type. In addition, fat stores energy, protects vital organs, provides
The smaller, absorbable
building blocks of the fat insulation, transports fat-soluble vitamins, and plays a role in tissue growth and hormone
that is found in the body.
production. It also helps the body use vitamins and keeps skin healthy. Fatty acids are the

smaller, absorbable building blocks of the fats found in the body and the fats humans ingest,
which come in several forms including saturated and unsaturated fats. Three fatty acids
combine with glycerol to form a triglyceride. Triglycerides are a type of fat and in fact are the
TRIGLYCERIDE:
most common form of fat in the body (bodyfat). The body makes triglycerides and as a part The main component of
of the diet they make up the majority of the fats that we eat. three fatty acids and a
glycerol molecule.
H H H H H H H H H H H H H H H H H
Saturated
O
H–C–C–C–C–C–C–C–C–C–C–C–C–C–C–C–C–C–C Butter
Animal fats
OH
H H H H H H H H H H H H H H H H H Tropical oils (coconut)
Monounsaturated
H H H H H H H H H H H H H H H H H Olive oil
Avocados
O
H–C–C–C–C–C–C–C–C–C=C–C–C–C–C–C–C–C–C Peanuts
OH Pecans
H H H H H H H H H H H H H H H
Unsaturated
Almonds
one double bond
Polyunsaturated
Omega-3/Omega-6
H H H H H H H H H H H H H H H H H Flax
O
Fish
H–C–C–C–C–C–C=C–C–C=C–C–C–C–C–C–C–C–C
Hemp
OH Canola
H H H H H H H H H H H H H
Safflower
multiple double bonds
Figure 14.3 Structure of Fats
Saturated Fat
Saturated fats are usually solid at room temperature and have no double bonds within the
molecular structure. Therefore, it is “saturated” with hydrogen atoms. Saturated fats are
considered to be a detrimental fat and can cause cholesterol buildup in the arteries and
increase the risk for heart disease. Food sources include butter, solid shortening, lard,
cheese, red meat, ice cream, coconut oil, and palm oil.
Unsaturated Fat
Unsaturated fats are considered to be a beneficial fat and are usually liquid at room
temperature. Two types of unsaturated fats are monounsaturated fatty acids (MUFA) and
polyunsaturated fatty acids (PUFA). Monounsaturated fats such as omega-9 fatty acids are so
called because they have only one double bond in their molecular structure.
Polyunsaturated fats have more than one double bond. Polyunsaturated fats include omega-3
fatty acids, where the position of the double bond is found three carbon atoms from the end
of the molecular chain acids, and omega-6 fatty acids, where the last double bond is found
six carbon molecules from the end of the fatty acid chain.

Sources of monounsaturated fats include olive oil, sesame oil, canola oil, peanut butter,
peanuts, cashews, and avocados. Sunflower seeds, pumpkin seeds, corn oil, safflower oil,
HIGH-DENSITY soybean oil, pine nuts, walnuts, salmon, tuna, and sardines are good sources of polyunsaturated
LIPOPROTEIN (HDL): fatty acids. Unsaturated fats are often labeled as a “good fat” because they improve high-
A lipoprotein that removes
cholesterol from the blood. density lipoprotein (HDL) (HDL cholesterol) levels, reducing the risk for heart disease.
It is sometimes considered
the “good cholesterol.”
Trans Fat
Trans fats are a type of unsaturated fat. Known as another detrimental fat, trans fats are
CORONARY ARTERY
DISEASE (CAD): both naturally occurring and man-made. Natural trans fats come from animal products such
The narrowing or blockage as beef, lamb, and dairy, and artificial trans fats are created by adding hydrogen to liquid
of coronary arteries.
vegetable oils. Artificial trans fats are used to prolong the shelf life of processed foods.
OMEGA-6 Trans fat can be found in some vegetable shortenings and margarine, crackers, cookies,
FATTY ACIDS: snacks, and foods fried in partially hydrogenated oil. The problem with trans fat is that it
A family of pro-inflammatory
and anti-inflammatory elevates LDL cholesterol and lowers HDL cholesterol. This may increase the risk of coronary
polyunsaturated fatty acids
that have in common a final artery disease (CAD).
carbon-carbon double bond.
Essential Fatty Acids
OMEGA-3 Essential fatty acids cannot be synthesized by the human body, which means they must be
FATTY ACIDS: obtained from the diet. The primary essential fatty acids are linoleic acid omega-6 fatty acids
An unsaturated fatty acid
occurring chiefly in fish oils. and linolenic acid omega-3 fatty acids. Others include arachidonic acid (omega-6),
eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) (omega-3). Arachidonic
EICOSAPENTAENOIC acid is required by the body but can be made from other essential fatty acids. EPA and DHA
ACID (EPA): are also required by the body but are made from other essential fatty acids.
A fatty acid found in
fish and fish oils, which
is believed to lower Table 14.2 Sources of Essential Fatty Acids
cholesterol, especially
cholesterol bound to low- FATTY ACIDS FOOD SOURCES
density lipoproteins.
Safflower oils, sunflower oils, corn oils, soy oils,
Linoleic acid (omega-6)
DOCOSAHEXAENOIC primrose, pumpkin, wheat germ
ACID (DHA): Linolenic acid (omega-3) Fish oils, flaxseed, pumpkin, soy, and canola
An omega-3 fatty acid that
is a primary structural
component of the human Arachidonic acid (omega-6) Chicken, beef, pork, fish
brain, cerebral cortex, skin,
sperm, testicles, and retina. EPA and DHA (omega-3) Cold-water fatty fish, salmon, shrimp, oysters, trout

Intake Recommendations: Fats
AMERICAN HEART
The American Heart Association (AHA) recommends keeping fat calories to 30–35 percent ASSOCIATION (AHA):
of daily Calorie intake. Staying closer to 20 percent is beneficial for weight loss and A nonprofit organization
that funds cardiovascular
maintenance. The International Olympic Committee recommends following a meal plan with research and educates
consumers on healthy living
no less than 15–20 percent of fat for highly active individuals and athletes. and good cardiac care.
Table 14.3 Fat Recommendations Based On Calorie Intake
Total 15 PERCENT 20 PERCENT 25 PERCENT 30 PERCENT 35 PERCENT

calories
per day Calories Grams Calories Grams Calories Grams Calories Grams Calories Grams
3,000 450 50 600 67 750 83 900 100 1,050 117
2,500 375 42 500 56 625 69 750 83 875 97
2,250 338 38 450 50 563 63 675 75 788 88
2,000 300 33 400 44 500 56 600 67 700 78
1,750 263 29 350 39 438 49 525 58 613 68
1,500 225 25 300 33 375 42 450 50 525 58
The requirements for essential fatty acids vary by age. Although many studies have shown
that essential fatty acids play a critical role in preventing cardiovascular disease, cancer,
arthritis, hypertension, and diabetes. Fatty acids are also critical for optimal brain and vision
function. The Recommended Daily Allowance (RDA) for essential fatty acid is general, and
there may be differences for special populations, including athletes. The following are the RECOMMENDED DAILY
nutritional reference intakes as published by the National Academy of Medicine in 2006:
ALLOWANCE (RDA):
The average daily level of
intake that is sufficient
Linoleic acid: 17 grams per day for men ages 19–50; 12 grams per day for women ages to meet the nutrient
requirements of nearly all
19–50 (97%-98%) healthy people.
Alpha-linolenic acid: 1.6 grams per day for men ages 19–50; 1.1 grams per day for women
ages 19–50

Table 14.4 Food Sources of Fat
GRAMS OF FAT PER

FAT SOURCE
100 GRAMS OF SOURCE
Almonds 54 g
Apple Trace
Asparagus Trace
Banana Trace
Barbecue sauce 7g
Beef sirloin 21 g
Beer Trace
Bread (one slice) 1–2 g
Broccoli Trace
Butter 81 g
Cashews 47 g
Celery Trace
Cheddar cheese 34 g
Cheese pizza 12 g
Cheesecake 35 g
Chicken 7g
Coconut 62 g
Cod 1g
Coffee Trace
Crab 5g
Cream cheese (plain) 47 g
Doughnut 16 g
Flounder 11 g

Table 14.4 Food Sources of Fat (CONT)
GRAMS OF FAT PER

FAT SOURCE
100 GRAMS OF SOURCE
Goat milk 5g
Grapes Trace
Hamburger 10 g
Hard-boiled egg 11 g
Honey Trace
Jelly 0g
Lettuce Trace
Mango Trace
Margarine 80 g
Mayonnaise 79 g
Mustard 29 g
Onion Trace
Orange Trace
Oysters (raw) 1g
Peanut butter 54 g
Peanuts 34 g
Pickles Trace
Pineapple Trace
Pistachios 54 g
Plain yogurt 4g
Pork chop 19 g
Potato Trace

Table 14.4 Food Sources of Fat (CONT)
GRAMS OF FAT PER

FAT SOURCE
100 GRAMS OF SOURCE
Prawns/shrimp 2g
Raisins Trace
Red wine 0g
Rice Trace
Salami (sliced) 45 g
Salmon 8g
Scallops 1g
Skim milk Trace
Spinach 1g
Sponge cake 27 g
Swiss cheese 29 g
Tuna 22 g
Turkey (roasted) 7g
Vegetable oil 100 g
Vinegar 0g
Walnuts 52 g
Whole milk 9g
PROTEIN
Protein is made of chains of amino acids, which are necessary for building and maintaining
body tissues. Protein may be broken down for energy, but it is not a preferred energy
source for the body. Typically, protein breakdown for energy occurs when intake of the other
macronutrients is insufficient, during times of starvation (overall negative energy balance), or
in cases of extreme exertion. To determine the metabolic use of protein, scientists measure

nitrogen levels. A positive nitrogen balance occurs during periods of growth and recovery.
A negative nitrogen balance happens when the body uses more protein than is taken in.
Examples might be starvation, infection, or after burn injury.
Amino Acids
Amino acids are the building blocks of protein. They are made of the following four elements:
hydrogen, oxygen, nitrogen, and carbon. The human body requires 20 different amino acids
for proper tissue growth and function. Of those, nine are essential amino acids that must be
ESSENTIAL AMINO
obtained from the diet.
ACIDS:
Amino acids that are not
Table 14.5 Amino Acids made by the body in the
optimal amounts and
9 ESSENTIAL AMINO ACIDS NON-ESSENTIAL AMINO ACIDS therefore must be obtained
through the diet.
Cannot be made by the body, must be Not essential in the diet as the body can
obtained from the diet. synthesize it.
Isoleucine (BCAA) Alanine
Leucine (BCAA) Arginine
Histidine Asparagine
Lysine Aspartic acid
Methionine Cysteine
Phenylalanine Glutamic acid
Threonine Glutamine
Tryptophan Glycine
Valine (BCAA) Proline
Serine
Tyrosine
COMPLETE PROTEIN:
A food source containing all
Proteins are either complete or incomplete. A complete protein has all the essential amino nine essential amino acids
the body needs.
acids in sufficient amounts. For example, dairy, eggs, meat, poultry, seafood, and soy protein
are complete proteins. Quinoa and soy are plant-based complete proteins.

Incomplete proteins are either missing or do not have an adequate amount of one or more
INCOMPLETE essential amino acids. Most plant-based sources of protein—beans, peas, grains, nuts,
PROTEINS: seeds, greens—do not have a complete amino acid profile. Incomplete protein sources,
A food source that lacks
one or more of the nine when eaten together, can provide a complete amino acid profile. These are called
essential amino acids.
complementary proteins.
Consuming complete protein is critical to maintaining lean body mass. Combinations of
incomplete proteins may be used to ensure adequate intake of essential amino acids. These
can include nuts with whole grains such as peanut butter on whole wheat toast. Whole
grains with beans, such as beans and rice or hummus and pita bread, also make a complete
protein. Beans with nuts can be combined to make a complete protein as well.
Intake Recommendations: Protein
Protein intake is weight-adjusted and decreases with age. Intake recommendations vary
based on physical activity, sex, and health status. It is also dependent upon client goals.
Increasing protein intake leads to greater strength and muscle mass gains when paired with
resistance exercise. When in a negative energy balance, it helps preserve muscle mass.
Increased protein intake also limits age-related muscle loss and provides greater muscle
MUSCLE PROTEIN
protein synthesis (MPS).
SYNTHESIS (MPS):
A process that produces
protein to repair muscle
WEIGHT-ADJUSTED RECOMMENDATIONS
damage and oppose Guidelines for protein intake include the estimated average requirement (EAR) and the RDA,
muscle breakdown.
which are 0.66 and 0.80 per kilogram (kg) of body weight per day. These recommendations
are independent of age, sex, and body composition. It is important to recall that protein is
ESTIMATED AVERAGE
REQUIREMENT (EAR): needed during times of growth. Humans experience the fastest rate of growth during infancy.
The average daily nutrient So, protein intake should be high during this time.
intake level that is
estimated to meet the
requirement of half the During childhood, up until the adolescent growth spurt, protein intake is reduced by 1.0
healthy individuals in a
specific life stage or sex. grams per kilogram (g/kg). The recommendation for adults is further reduced by 0.4 g/kg.
However, these calculations are for sedentary individuals and do not take into account body
composition goals, level of activity, or health-related issues impacting protein needs. Muscle
growth, physical strength, and other physical-related goals require more protein intake.
ACTIVITY-ADJUSTED RECOMMENDATIONS
The RDA of protein is 0.8 g/kg of body weight or 0.36 grams per pound (g/lb) of body weight.
Most research points to an optimal intake of 0.7–1.0 g/lb or between 10 percent and 35
percent of daily calories.

To promote skeletal muscle protein growth and physical strength in individuals with minimal
physical activity, 1.0 g/kg of body weight per day is recommended. For those involved in
moderate physical activity, 1.3 g/kg per day is recommended, and for intense physical activity
1.6 g/kg per day is recommended. Studies show that long-term consumption of protein at 2
g/kg of body weight per day is safe for healthy adults.
For every one gram of protein, there are four Calories, and the tolerable upper limit—the
highest nutrient intake that will likely not generate adverse health effects in most adults
in the general population—is 3.5 g/kg of body weight. Protein intake impacts metabolic
rate, increasing the number of Calories burned. Recent studies have shown that protein
intake of around 25–30 percent of daily Calories boosts metabolism by 80–100 Calories per
day. Adequate consumption of high-quality protein from plant sources and animal products
is essential for human growth and development. Plant-based protein sources contain
unsaturated fat, which lowers LDL cholesterol—a risk factor for heart disease. Plant sources
also contain no cholesterol.
Table 14.6 Plant-Based Sources of Protein
FOOD TYPE FOOD SOURCES
Legumes Lentils, peas, edamame, soybeans, peanuts
Beans Adzuki, black, fava, chickpeas, kidney, pinto
Nuts Almonds, pistachios, cashews, walnuts, pecans
Seeds Hemp, pumpkin, sunflower, flax, sesame, chia
Whole grains Kamut, teff, wheat, quinoa, rice, millet, oat,
Vegetables and fruits Corn, broccoli, asparagus, brussels sprouts
Table 14.7 Food Sources of Protein
GRAMS OF PROTEIN PER

PROTEIN SOURCE
100 GRAMS OF SOURCE
Almonds 17 g
Apple 0.2 g
Asparagus 2g

Table 14.7 Food Sources of Protein (CONT)

PROTEIN SOURCE
100 GRAMS OF SOURCE
Banana 0g
Barbecue sauce 2g
Beef sirloin 24 g
Beer 0.3 g
Bread (brown, one slice) 8g
Broccoli 3g
Butter 0.4 g
Cashews 18 g
Celery 0.9 g
Cheddar cheese 26 g
Cheese pizza 9g
Cheesecake 4g
Chicken 29 g
Coconut 5g
Cod 21 g
Coffee 0.2 g
Crab 20 g
Cream cheese (plain) 8g
Doughnut 6g
Flounder 25 g
Goat milk 3g
Grapes 1g


PROTEIN SOURCE
100 GRAMS OF SOURCE
Hamburger 14 g
Hardboiled egg 12 g
Honey 0.4 g
Jelly 0.6 g
Lettuce 1g
Mango 0g
Margarine 0.4 g
Mayonnaise 2g
Mustard 29 g
Onion 0.9 g
Orange 0g
Oysters (raw) 11 g
Peanut butter 23 g
Peanuts 17 g
Pickles 0g
Pineapple 0.5 g
Pistachios 19 g
Plain yogurt 4g
Pork chop 22 g
Potato 2g
Prawns/shrimp 23 g


PROTEIN SOURCE
100 GRAMS OF SOURCE
Raisins 1g
Red wine 0.2 g
Rice 2g
Salami (sliced) 19 g
Salmon 20 g
Scallops 23 g
Skim milk 10 g
Spinach 5g
Sponge cake 6g
Swiss cheese 29 g
Tuna 23 g
Turkey (roasted) 28 g
Vegetable oil Trace
Vinegar 0.4 g
Walnuts 11 g
Whole milk 3g
WATER
Water makes up around 60 percent of total body weight in adults and about 75 percent in
children. Water is critical to life and plays many important roles in the body. It keeps tissues
in the mouth, eyes, and nose lubricated and lubricates the joints. Water also protects vital
DEHYDRATION: organs and tissues and prevents constipation and dehydration. It dissolves certain minerals
A harmful loss or removal
of water in the body. and carries nutrients and oxygen to the cells. It also plays a critical role in regulating body
temperature and helps the kidneys and liver by flushing out waste products from the body.

TEST TIP!
It is important to remember the 3-3-3 rule:
The body can go:
3 minutes without air,
3 days without water,
and 3 weeks without food.
Many factors influence how much water the body needs to function properly. Hot climates, ELECTROLYTES:
physical activity, fever, and diarrhea or vomiting increase the body’s need for water. Body Minerals in the body that
have an electric charge.
composition and size, age, and medical conditions also influence fluid intake needs. Without
adequate water intake, the body becomes dehydrated. When dehydrated the body cannot
INTRACELLULAR FLUID
maintain proper temperature, electrolytes become unbalanced, joints may not work properly, (ICF):
and blood pressure may increase or decrease. Water in the body can be divided into Water found within the cells
of the body.
intracellular fluid (ICF) and extracellular fluid (ECF). ICF is water found within the cells of the
body, while ECF is water found outside the cells and between tissues. Approximately two-
EXTRACELLULAR
thirds of the body’s total water is found within the cells, and one-third of the body’s total water FLUID (ECF):
is found outside the cells. Water found outside the
cells and between tissues.
Table 14.8 Intracellular and Extracellular Fluid Table
INTRACELLULAR EXTRACELLULAR
FLUID (ICF) FLUID (ECF)
Outside of cell membranes:
• 25% within vascular system, makes

Enclosed within cell
Found up plasma portion of blood volume
membranes
• 75% known as interstitial fluid, which
surrounds cells and connective tissues
About 2/3 of the

Makes up About 1/3 of the body’s water
body’s water
Potassium and
Higher In Sodium and chloride
magnesium
Lower In Sodium and chloride Potassium and magnesium

Signs and symptoms of dehydration include increased thirst, dry mouth, very yellow or
dark urine, very dry skin, dizziness, rapid heart rate, headache, lack of energy, tiredness,
confusion, fainting, heat cramps, heat stroke, brain swelling, seizures, fluid loss resulting in a
reduction of blood volume and insufficient blood pumping by the heart (hypovolemic shock),
organ failure, and death.
INTAKE RECOMMENDATIONS: WATER

In general, between 91 and 125 fluid ounces or 2.7 to 3.7 liters of water per day is
recommended for adults. About 20 percent of that intake comes from food. The human body
relies on water to function properly. Cells and skin need water to function, which is why it is
important to stay hydrated.
Drinking fluids is not the only way to maintain water levels, however. Fruits and vegetables
are an effective source of water as well. Vegetables consisting of mostly water include
cucumbers, cabbage, lettuce, and celery. Fruits made up of mainly water include tomatoes,
watermelon, apples, and oranges. Other foods high in water content are yogurt, soup, tea,
cottage cheese, and shrimp.
MICRONUTRIENTS
Macronutrients such as carbohydrate, fiber, fat, protein, and water are those nutrients that are
needed in large amounts in the diet. The body also requires micronutrients. Micronutrients
(vitamins and minerals) are chemical elements or other substances needed in only trace
amounts to support normal growth and development. Although they are only needed in small
amounts, micronutrients play critical roles within the body.
MINERALS
The body needs several minerals to support bone development and growth as well as muscle,
heart, and brain function. For example, calcium helps maintain teeth and bones, helps blood
to clot, and aids in nerve and muscle function. Iron forms blood cells and transports oxygen,
and potassium works to regulate water balance in the cells, helps with nerve function, and
regulates heart rate. Sodium is known as an electrolyte and helps balance water levels in
the cells and stimulates nerves. Zinc helps with carbon dioxide removal, helps heal wounds,
and forms enzymes.
Some minerals are required in large quantities (macrominerals), while others are only required
in trace amounts (trace minerals).

Table 14.9 Macrominerals and Microminerals
MACROMINERALS TRACE MINERALS
Calcium Cobalt
Chloride Copper
Magnesium Fluoride
Phosphate Iodine
Potassium Iron
Sodium Manganese
Selenium
Zinc
Minerals are not a direct source of energy, meaning they do not provide Calories in the diet.
They enter the body in the simplest form, and the body does not need to break them down
before they can be absorbed. Minerals are also resistant to damage from heat. This means
that storing and cooking minerals do not affect their functions.
Minerals found in foods come from the environment, such as the soil and water a plant takes
up while growing. They are then incorporated into the animals that consume those plants. So,
regardless of whether a human consumes the plant directly or an animal product, all minerals
come from nature.
VITAMINS
Vitamins are also micronutrients, and each plays a specific role in the body like promote cell
function, growth, and development. These organic compounds are needed in small amounts
and are required to live. The human body does not produce enough on its own and therefore
vitamins must be obtained from food. Vitamins are broken down into categories: fat-soluble
and water-soluble.
Oftentimes, people struggle with how they look and feel because their physiology doesn’t
work the way it should. This can be a hormonal imbalance, but it’s more often dietary
deficiency—not getting the right nutrients in the right amounts to get the best results. When
the body is deficient in key nutrients, normal physiology doesn’t work properly. And when the
body doesn’t work as it should, oftentimes people feel ill, perform poorly, and will fail to see

physical adaptations as expected. Energy levels, appetite, strength, endurance, and mood
all rely on getting enough of these essential nutrients.
Dietary deficiencies, therefore, are the first red flag that indicates something’s wrong. And they
are more common than one may think. Chances are clients have at least one deficiency, no
matter how good they think their eating habits are. Some of the most common micronutrient
deficiencies are:
• Vitamin B7
• Vitamin D
• Vitamin E
• Chromium
• Iodine
• Molybdenum
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90
Selenium 15%
Phosphorus 21%
Riboflavin 22%
Niacin 24%
Thiamin 28%
Vitamin B12 30%
Copper 31%
Iron 34%
Vitamins
Vitamin B6 35%
Zinc 42%
Vitamin C 48%
Vitamin A 55%
Magnesium 68%
Calcium 73%
Folate 75%
Vitamin E 86%
% of Americans NOT meeting RDA
Figure 14.4 Percentage of the US Population Not Meeting the RDA

Source: US Department of Agriculture (2009).

For this reason, a fitness professional should help clients identify what they feel physically
and mentally during training while monitoring their eating habits to ensure overall nutrient
intake is adequate and supports their fitness goals. It is important to note that fitness
professionals should refer clients to a dietician or their physician for deficiency testing and
dietary modifications to specifically address micronutrient deficiencies.
Fat-Soluble and Water-Soluble Vitamins
Fat-soluble vitamins are absorbed along with fat in the diet. They can be stored in fatty tissue
in the body. Water-soluble vitamins are broken down and absorbed with water but are not
stored in the body.
Table 14.10 Vitamins and Minerals Overview
VITAMIN NECESSARY FOR: FOOD SOURCES:
Liver, carrots, pumpkin, sweet potatoes,
Vitamin A Eyes, bones, immunity, reproductive function spinach, collards, kale, egg yolks, beets,
mustard greens, winter squash
Rainbow trout, salmon, Swordfish, tuna,

Bone health, blood calcium levels, cell growth,
Vitamin D halibut, sardines, rockfish, egg yolks,
immunity, teeth integrity
mushrooms, shrimp, beef liver
FAT SOLUBLE
Protecting cell membranes and other fatty Almonds, sunflower seeds, spinach, Swiss
Vitamin E acids from oxidation, protecting, while blood chard, avocado, peanuts, turnip greens,
cells, immunity, overall antioxidant function hazelnuts
Kale, collards, spinach, turnip greens, beet

Vitamin K1 Blood coagulation and bone metabolism greens, dandelion greens, Swiss chard,
Brussels sprouts, broccoli, asparagus
Bone metabolism, appropriate calcium

Cheese, egg yolks, grass-fed butter, chicken
Vitamin K2 deposition, supporting growth and
liver, chicken breast, beef, dairy
development

Table 14.10 Vitamins and Minerals Overview (CONT)
VITAMIN NECESSARY FOR: FOOD SOURCES:
Sunflower seeds, pork, peas, barley,

Vitamin B1 Acting as an enzyme cofactor for
navy beans, black beans, lentils, oats,
(Thiamin) carbohydrate and amino acid metabolism
asparagus, beef liver, tahini, pinto beans
Beef liver, cottage cheese, yogurt,

Vitamin B2 Acting as an enzyme cofactor for soybeans, white mushrooms, milk,
(Riboflavin) carbohydrate and fat metabolism spinach, whole wheat, almonds, eggs,
shrimp
Beef liver, yellowfin tuna, chicken breast,

Vitamin B3 Carbohydrate and fat metabolism, DNA pork loin, salmon, swordfish, whole
(Niacin) replication and repair wheat, buckwheat, mushrooms, canned
tomato products
Assisting with fat and arbohydrate

Shiitake mushrooms, avocado, trout,
metabolism, cholesterol production, and
Vitamin B5 yogurt, chicken, lobster, peas, crab,
supporting hair, skin, eyes, liver, nervous
(Pantothenic crimini mushrooms, sweet potatoes,
system, reproductive function, red blood
Acid) potatoes, lentils, egg yolk, beef liver,
cell production, adrenal gland function, and
turkey
WATER SOLUBLE
digestion
Tuna, turkey, beef, chicken, salmon,

Acting as an enzyme cofactor for
Vitamin B6 sweet potatoes, sunflower seeds,
carbohydrate and amino acid metabolism,
(Pyridoxine) chickpeas, potatoes, pork loin, bananas,
synthesis of blood cells
swordfish, spinach, plantains
Nuts, egg yolks, sweet potatoes, onions,

Vitamin B7 Acting as an enzyme cofactor in
liver, salmon, peanuts, mushrooms, pork,
(Biotin) carbohydrate, fat and protein metabolism
chocolate, oats, tomatoes
Spinach, lentils, pinto beans, chickpeas,

Acting as an enzyme cofactor for amino add
Vitamin B9 asparagus, broccoli, romaine lettuce,
metabolism, DNA synthesis, metabolism of
(Folate) cowpeas, black beans, kidney beans,
homocysteine
chicken liver
Formation of blood, nervous system

Vitamin B12 Shellfish, beef liver, beef, sardines,
function, enzyme cofactor in metabolism of
(Cobalamin) salmon, tuna, cod, dairy
homocysteine
Collagen synthesis, immune function,

Vitamin C Sweet peppers, citrus fruits, broccoli,
synthesis of hormones, synthesis of
(Ascorbic strawberries, kiwi, guava, kohlrabi,
neurotransmitters, synthesis of DNA,
Acid) papaya, Brussels sprouts
enhancement of iron absorption, anti-oxidation

MINERAL NECESSARY FOR: FOOD SOURCES:
Bone/tooth health, acid-

base balance, nerve impulse Green vegetables, soybeans, nuts/
Calcium
transmission, muscle seeds, fish, dairy
contraction
Fluid balance, nerve impulse

Chloride transmission, digestive health, Table salt
antibacteria
Cell membranes and

neurotransmitters, liver Shellfish, beef and beef liver, eggs,
Choline metabolism, transportation of salmon, pork, chicken tomato
nutrients, controls homocysteine products
levels in fetus during pregnancy
Broccoli, barley, oats, onions,

Glucose transport, metabolism
Chromium green beans, tomatoes, potatoes,
of DNA/RNA, immune function
prunes, nuts, brewer’s yeast
Sesame seeds, cashews,

mushrooms, barley, soybeans,
Assisting many enzyme systems,
Copper tempeh, sunflower seeds, navy
iron transport, immune function
beans, garbanzo beans, lentils,
walnuts, liver, seafood
Seafood, legumes, whole grains,

Fluoride Teeth and bone health drinking water (check local levels),
green tea
Synthesis of thyroid hormones,

temperature regulation, Sea vegetables, saltwater seafood,
Iodine
reproductive health, nervous dairy, eggs, strawberries
system health
Soybeans, lentils, spinach, beans,

Oxygen transport, hemoglobin,
olives, raisins, brown rice, broccoli,
Iron myoglobin, assists in enzyme
pumpkin seeds, tuna, flounder,
systems
chicken, pork, beef

MINERAL NECESSARY FOR: FOOD SOURCES:
Assisting more than 300 enzyme

Legumes, spinach, Swiss chard,
systems, bone health, muscle
Magnesium nuts, seeds, whole grains, fruits,
contraction, immunity, regulate
avocado, poultry
blood sugar and blood pressure
Assisting various enzyme systems, Whole grains, nuts, legumes,

Manganese
bone/cartilage health seeds, tea, leafy green vegetables
Acting as an enzyme cofactor

involved
Molybdenum in carbon, nitrogen, and sulfur Legumes, nuts, whole grains
cycles, metabolism of drugs/
toxins (e.g., purines, nitrosamines)
Dairy, soybeans, sardines, beef

Fluid balance, bone health, part
Phosphorus liver, lentils, pumpkin seeds, eggs,
of ATP
almonds, peanuts, peanut butter
Fluid balance, nerve impulse

Potassium Vegetables, fruit, dairy, fish
transmission muscle contraction
Tuna, shrimp, sardines, salmon,

Carbohydrate and fat metabolism, poultry, cod, chicken, shrimp, Brazil
Selenium
antioxidant, immune function nuts, mushrooms, barley, whole
grains, walnuts, eggs
Fluid balance, acid-base balance,

Salt, greens, most foods contain
Sodium nerve impulse transmission ,
some sodium
muscle contraction
Certain B-vitamins and amino

Sulfur acids, acid-base balance, Protein dense foods
detoxification of liver
Beef, sesame seeds, pumpkin

Assisting more an 100 enzyme
seeds, lentils, chickpeas, cashews,
Zinc systems, immune health, growth/
whole grains, oats, oysters, turkey,
sexual maturation, gene regulation
shrimp

Antioxidants
Free radicals are molecules with unpaired electrons, and they are created in the body during
cellular metabolism. People are also exposed to free radicals in the environment, such as
tobacco, alcohol, pollution, ultraviolet (UV) rays from the sun or artificial UV rays from tanning
beds, or from substances found in food.
These imbalanced molecules travel around the body looking for another electron to pick up to
balance the electrical charge of the atom. This causes damage to cells, proteins, and DNA.
ALZHEIMER’S
Damage from free radicals may contribute to chronic diseases from cancer to heart disease,
DISEASE:
Alzheimer’s disease, and vision loss. Antioxidants work to prevent or delay damage caused Progressive mental
deterioration that can occur
by free radicals. Antioxidants donate electrons to free radicals to neutralize the charge and in middle or old age, due to
generalized degeneration of
prevent damage.
the brain.
The following substances are known for their antioxidant properties:
• Beta-carotene
• Coenzyme Q10
• Glutathione
• Flavonoids
• Lipoic acid
• Manganese
• Phenols
• Phytoestrogens
• Polyphenols
• Selenium
• Vitamin C
• Vitamin E

DIETARY GUIDELINES AND MYPLATE

US DEPARTMENT OF
The US Department of Health and Human Services and US Department of Agriculture
HEALTH AND HUMAN
SERVICES: (USDA) create and update the Dietary Guidelines for Americans to promote sustainable,
A US federal department healthy food choices for lifelong health and good nutrition. With the aim of preventing chronic
that oversees public health,
welfare, and civil rights diseases such as cancer, hypertension, stroke, heart disease, and other chronic conditions,
issues.
the guidelines address what to eat and what to avoid eating for optimal health.
DIETARY GUIDELINES Foods available to American consumers today include fresh, packaged, and processed
FOR AMERICANS: products. To make the best choices, it is important for consumers to read and understand
Guidelines for healthy,
lifelong eating habits for food labels. Even the simplest food packaging includes a nutrition label, a list of ingredients,
Americans two years of age
and older.
and often nutrition and health benefit claims. The Food and Drug Administration (FDA)
regulates each of these elements for accuracy and effectiveness.
FOOD AND DRUG The current dietary guidelines are useful for making healthy food choices and crafting a well-
ADMINISTRATION
rounded eating pattern. Nutrition coaches and fitness professionals can use these guidelines
(FDA):
A US federal department as the basis for helping clients develop healthier eating habits to support their goals.
that regulates the
production and distribution
of food, pharmaceuticals,
tobacco, and other
The first half of the 164-page
consumer products.
Dietary Guidelines contains
chapters related to various
EATING PATTERN: nutrition topics.
The types of food and
beverages an individual
consumes. The second half of the
Dietary Guidelines contains
the Dietary Guidelines
Appendix with helpful tables
of foods, nutrient sources,
calorie intake, and more.
In addition to nutrition,
the Dietary Guidelines
also contains information
about physical activity
recommendations.
Figure 14.5 The Dietary Guidelines for Americans

THE DIETARY GUIDELINES FOR AMERICANS
The Dietary Guidelines are organized progressively, starting with five core concepts, which are
followed up with more detailed guidelines for food choices.
Concept one: following a healthy eating pattern across the lifespan.
All food and beverage choices matter. Choosing a healthy eating pattern at an appropriate
calorie level will help achieve and maintain a healthy body weight, support nutrient adequacy,
and reduce the risk of chronic disease.

NUTRIENT DENSITY:
Concept two: focusing on variety, nutrient density, and food amounts. The amount of nutrients
in a food relative to the
number of calories it
To meet nutrient needs within calorie limits, it is important to choose a variety of nutrient- provides, usually measured
per 100 kilocalories.
dense foods across and within all food groups in recommended amounts.
Concept three: limiting calories from added sugars and saturated fats and reducing
sodium intake.
A healthy eating pattern should be low in added sugars, saturated fats, and sodium.
Concept four: shifting to healthier food and beverage choices.
It is important to choose nutrient-dense foods and beverages across and within all food
groups in place of less healthy choices and consider cultural and personal preferences to
make these shifts easier to accomplish and maintain.
Concept five: supporting healthy eating patterns for all.
Everyone has a role in helping to create and support healthy eating patterns in multiple
settings nationwide, from home to school, at work, and in communities.
The Dietary Guidelines’ key recommendations for healthy eating patterns should be applied in
their entirety. There are complex, interconnected relationships between dietary components
that can be missed if only a few recommendations are followed.
Limiting Added Sugars ADDED SUGARS:

Any type of sugar that is
It is equally important to consider what to limit in a diet for a healthy eating pattern. These added to a food or beverage
when it is processed. This
include added sugars, certain fats, and sodium. These are of concern for public health in the
is compared to natural
United States. Specified limits can help individuals achieve healthy eating patterns within sugars found in whole
foods, such as fruit or milk.
Calorie limits.

The recommendation for added sugars, those sugars not found naturally in whole foods, is
to limit consumption to less than 10 percent of daily Calories. This is based on modeling of
food patterns and national data on calorie intake. Once all the recommended food groups are
consumed for a typical individual, there is no room for added sugars.
Limiting Unhealthy Fats
Calories from saturated and trans fats should be limited to less than 10 percent of Calories
per day. This recommendation is based on research that shows replacing saturated fats
with unsaturated fats is associated with a reduced risk of cardiovascular disease. As with
added sugars, once food recommendations are met within a day, there is little room for extra
calories from saturated fats.
Limiting Sodium
Sodium intake is recommended in quantities less than 2,300 milligrams per day. This is the
tolerable upper intake level set by the National Academy of Medicine for people ages 14 and
older. The Dietary Guidelines for Americans provides a recommendation for younger children.
Limiting Alcohol
The current recommendation for alcohol consumption is to limit beverages to one drink per
day for women and two per day for men, which is considered moderate drinking. Consuming
more than the recommendation is considered heavy drinking and carries health risks. The
Dietary Guidelines for Americans provides more information about who should abstain
completely.
THE FOOD PYRAMID TO MYPLATE

A previous representation for the Dietary Guidelines, and one that most consumers still
recognize, is the Food Pyramid. It acted as a visual tool to help individuals make better
choices about food and create a healthy eating pattern.

Figure 14.6 The Food Pyramid (Retired)
The Food Pyramid used the number of servings per day of each food type to represent how
much the average American should consume. It included servings for grains, vegetables,
fruits, meats and other protein sources, dairy, and fats. The gradual thinning of the categories
up the pyramid was intended to demonstrate that grains should be the focus of the diet, with
each subsequent food group making up a smaller and smaller portion. Left out, however,
was a distinction between healthier whole grains and processed, sugary foods such as white
pasta and cereals that are now known to have contributed to the US obesity epidemic.
Newer resources take fats, oils, and sweets out of the graphics completely. Processed foods,
desserts, and sugary beverages are now treated as foods to avoid as much as possible. The
food pyramid is also now thought to have put too little focus on fruits, vegetables, and protein
sources. The research that led to the transition from the Food Pyramid to MyPlate puts a
MYPLATE:
The current visual nutrition
greater focus on the Dietary Guidelines and choosing larger quantities of healthy whole foods. guide published by the
USDA Center for Nutrition
Policy and Promotion.
While the Food Pyramid was a popular resource, it is now considered dated. It has been
replaced with the simplified, updated MyPlate representation. The official reason for the
change is to simplify the visual tool and to promote healthy eating for a new generation of
Americans. The guidelines presented are the same as those from the Dietary Guidelines, but

the MyPlate tools and graphics are intended for use by the general population. They provide
resources that fitness professionals can use to communicate effectively with clients.
MyPlate is shaped like a plate with colorful fractions dedicated to dairy, vegetables, fruits,
protein, and grains. This helps people visualize filling their plates at each meal with appropriate
amounts of each food type. It is easy enough for a child to understand. Fats and sugars
previously at the top of the Food Pyramid are left off the MyPlate graphic because of how they
contribute to obesity in the overall population. Fitness professionals can use the MyPlate
graphic as a teaching tool to explain healthy food choices and proportions to their clients.
Figure 14.7 MyPlate
FRUITS AND VEGGIES
According to the USDA, half of a healthy plate should be fruits and vegetables. The focus
should be on choosing whole fruits and vegetables, which may include fresh, frozen, dried,
or canned products with no additives. One can enjoy fruits as a sweet snack or dessert or
with meals to increase daily intake. Vegetables should be varied in type and color. There are
several healthful ways to prepare vegetables: sautéed, roasted, raw, or steamed.

GRAINS
Whole grains should fill up a quarter of a well-rounded plate. At least half the grains consumed
daily should be whole grains. Any processed product is considered whole grain if the first or
second item on the ingredients list is whole grains. Whole grain foods include brown rice,
oatmeal, popcorn, whole wheat pasta, and whole grain breads.
PROTEIN
Lean proteins make up the final quarter of MyPlate. Seafood, beans, unsalted nuts and
seeds, eggs, poultry, and lean meats are great choices for protein. It is important to choose
a variety of protein sources for building muscle tissue; for bone, blood, and skin health; and
to produce hormones. Consuming protein from several different sources provides a variety of
amino acids for the body to use.
DAIRY
For dairy products, MyPlate encourages a switch to low-fat or fat-free products to reduce
saturated fat intake. Foods such as sour cream, heavy cream, and regular cheese can be
replaced with lower-fat varieties.
Simple changes such as choosing vegetable oils instead of butter and choosing water over sugary
drinks can have a big effect over time. Nutrition coaches and trainers can encourage change by
focusing their clients on small steps. A client should choose one thing to change at a time, such
as adding a fruit to every meal for a week or increasing the serving of vegetables in each meal.
Habits generally take two to four weeks to form, and consistency is key. When it comes to eating,
overhaul diets that change everything about one’s diet at once are impossible to maintain. The
guidelines are a great way to inform and promote small, sustainable lifestyle changes.
UNDERSTANDING FOOD LABELS

Being able to read and comprehend the nutritional content of the food an individual consumes
is an important component of success. Personal trainers should have a strong understanding
of how to read nutrition labels, which foods are good sources of certain nutrients, and
understand the dietary guidelines so they can easily relay it to their clients. While most foods
have a list of ingredients and some also have Calorie and nutrients-per-serving information NUTRITION FACTS:
A label required by the
listed on the package, most fresh and whole foods do not have a package to list this information
FDA on most food and
on. So, this information comes from reading the nutrition labels of products that have nutrition beverages that details the
food’s nutrient content.
facts and using the many credible online resources available for those that do not.

Under the FDA nutrition labeling regulations, certain ingredients and nutrition information
must be listed on most packaged foods and supplements. Food labels will have ingredient
listings and other nutritional information, such as the amount of fat, protein, carbohydrates,
and certain vitamins and minerals. The only vitamins and minerals required to be listed on a
food label are vitamin D, calcium, potassium, and iron. If a vitamin or mineral claim is made
or it is added to the product, then it must also be listed on the nutrition panel. An ingredient
INGREDIENT LIST:
A list provided on a food list will name each ingredient in descending order of amount, with the first ingredient being
label of each ingredient in a
product in descending order
the most prominent. If water is the first ingredient on the list, then water is the most
of prominence. prominent ingredient. However, the exact amount of each ingredient will not be provided in
the ingredient list.
NUTRITION FACTS LABELS

The nutrition facts label is designed to provide information that can help consumers make
informed choices about the food they purchase and consume. The FDA seeks to protect and
inform the consumer by making the label conveniently located on the packaging, easy to read,
and precise in its details.
Easy to Read
Current nutrition facts labels have been updated to make them easier to read. The original
look of the label remains, but there are important updates including the bolding and increase
in text size for details like serving size (the amount of food in one serving), Calories per
serving (number of Calories in one serving), and servings per container (the total number of
servings in the entire package).
Manufacturers must declare the amount, in addition to percent daily value (DV), of vitamin D,
DAILY VALUE (DV): calcium, iron, and potassium in each serving of a product. Daily values are reference amounts
Reference amounts
expressed in grams, of nutrients to consume or not to exceed and are used to calculate the percent daily value
milligrams, or micrograms
of nutrients to consume or that manufacturers include on the label. They can voluntarily declare the gram amount for
not to exceed each day.
other vitamins and minerals if they are present or added to the product as well.
The footnote has been updated to better explain what percent daily value means. It will read:
“*The % daily value indicates how much a nutrient in a serving of food contributes to a daily
diet. 2,000 Calories a day is used for general nutrition advice.” The percent daily value helps
consumers understand the nutrition information in the context of a total daily diet of 2,000
Calories, unless otherwise specified on the label.

Note: The images above are meant for illustrative purposes to show how the revised nutrition facts label might look. All labels represent
fictional products.
Figure 14.8 Sample Food Labels
Added sugars, in grams and as the percent daily value, are now included on the nutrition
facts label. Scientific data shows that it is difficult to meet nutrient needs while staying within
Calorie limits if more than 10 percent of total daily Calories are consumed through added
sugar, and this is consistent with the 2021–2025 Dietary Guidelines for Americans.
Also required are the amounts of vitamin D, potassium, iron, and calcium. Any other listed
vitamins and minerals are optional. While continuing to require “total fat,” “saturated fat,”
and “trans fat” on the label, “Calories from fat” is no longer listed. The importance lies in the
type of fats consumed versus the Calories from fat.
Serving Sizes and Labeling Requirements
By law, serving sizes must be based on the amounts of foods and beverages that people are
actually eating, not what they should be eating. The amounts people consume for a serving
have changed over time, and a reference amount is a standard used to determine serving
sizes by the FDA. For example, the reference amount for a serving of ice cream was previously
half of a cup but is now two-thirds of a cup, and the reference amount for a yogurt cup has
decreased from eight ounces to six ounces.

Figure 14.9 How Serving Sizes Have Changed- Then (right) versus now (left)
Package size affects what people eat, so for packages that are between one and two servings,
such as a 20-ounce soda or a 15-ounce can of soup, the Calories and other nutrients will be
required to be labeled as one serving. If the package is larger, the addition of another column
with the words “per package” details the nutritional values if the entire package is consumed
at once, as well as the reference amount for a single serving.
COMMON DIET TRENDS

The word “diet” originates from the Greek word diaita, meaning “way of life.” The initial
DIET:
The foods that a person or
meaning included everything that encompasses a lifestyle. Today the term has a more limited
community eats most often meaning. It describes the foods that a person habitually eats, whether it be to lose weight,
and habitually; a choice of
regular foods consumed maintain or improve health, or for medical reasons.
for the purpose of losing
weight or for medical
reasons. Many people use the term “diet” to refer to a pattern of eating with the goal of rapid weight
loss, extreme physical transformation, or prevention of chronic disease. A well-balanced diet
and consistent, healthy eating habits provide more stable health and weight benefits over time.
There are many different diet plans targeted to consumers. They promise a range of benefits:
• Rapid weight loss
• Long-term weight loss
• Improved gut health
• Lower risk of diabetes
• Improved cardiovascular health
• Lower blood pressure

Some diets have delivered everything they promise. The World Health Organization (WHO)
has even recognized some popular diets as sustainable and healthy lifestyle choices.
However, other diets fall by the wayside because they don’t deliver results or are harmful.
To help guide clients, a fitness professional must be aware of popular trending diets and
their risks and benefits.
DETOX DIET
A detox diet is based on the idea that the body benefits from periodic detoxification. There
is a lot of variety in detox diets, but they generally begin with a period of fasting followed by
a strict diet of raw fruits and vegetables, water, or juices. The initial fast can range from two
days to a week, followed by two to seven days of liquid or decreased calorie intake.
Also known as cleanses, detox diets claim to cleanse the body of toxins, refresh the digestive
tract, and reset metabolism. Weight loss may be significant on a detox, but it is largely a
result of water loss. Some individuals report a boost in energy during and after a detox.
Science suggests this is a result of removing processed foods and sugars from the diet while
reducing calorie intake. Short term, this can be beneficial, but detoxing for extended periods
of time is contraindicated. There is no solid research to prove a cleanse or detox is necessary
or beneficial unless ordered by a licensed health professional.
There are several popular cleanses, including the colon cleanse, juice cleanse, and the
liver detox.
LOW- AND NO-FAT DIETS

The American Heart Association recommends that no more than 30 percent of daily Calories
come from fat. However, the safe lower limit for fat consumption has never been established.
During the low-fat food trend, many manufacturers reduced fat in products like yogurt, cheese,
milk, cereals, salad dressing, nut butters, pastries, frozen desserts, and butter substitutes.
They replaced the fat with fillers, sugars, and chemicals for better taste, texture, and
consistency. These artificial additives can cause gastrointestinal distress, digestion issues,
and skin problems.
A very low-fat diet can initially lead to weight loss if calorie guidelines are followed. However,
critics warn that the benefits are negated by decreases in plasma cholesterol levels and health
issues for special populations like pregnant or lactating women, children, and the elderly.

It is also important to note that dietary fat is important for hormone production and
regulation. A low-fat diet can upset hormone balance and cause health problems in both
men and women.
EATING BY BLOOD TYPE

A popular diet in the early 2000s was the genotype or blood type diet. A naturopathic
physician named Peter D’Adamo developed the diet after theorizing that a person’s blood
type determines how they respond to certain foods.
D’Adamo created a guide to eating by blood type:
• Blood Type A: People with this blood type should consume fruit, vegetables, tofu,
seafood, soy, and whole grains, and avoid most meats. Ideally, their diet is mostly
vegetarian, with some fish, and largely organic and fresh because of a sensitive immune
system.
• Blood Type B: People with this blood type should choose green, non-starchy vegetables
(spinach, asparagus, green beans, artichokes), lean meats (except chicken), and low-fat
dairy while avoiding corn, wheat, lentils, tomatoes, and peanuts. Because of digestive
sensitivity, this diet is supposed to be largely gluten-free.
• Blood Type AB: AB types should focus on tofu, seafood, dairy, and green leafy vegetables
while avoiding caffeine, alcohol, and cured meats. These individuals supposedly have
low stomach acid.
• Blood Type O: Type Os should eat a diet of lean meats, poultry, fish, and vegetables
while avoiding grains, beans, and dairy.
A study with more than 1,400 subjects found some interesting results. Regardless of their
blood type, the participants were given a list of foods to choose from for a one-month period.
Based on their natural food choices, researchers determined which of the blood type diets
they most closely followed. Researchers also assessed the participants’ cardiovascular
health and made other physical health measurements.
Those who followed the Type A pescatarian diet (plant-based diet that allows dairy, eggs,
fish, and other types of seafood) had reductions in their BMI, waist circumference, blood
pressure, cholesterol levels, and insulin resistance. The AB diet protocol showed reductions
in blood pressure, cholesterol levels, and insulin resistance but no change in BMI or waist
circumference. Type O meat-eating dieters had a reduction only in blood triglycerides, and
Type B eaters showed no significant changes.

None of the research completed on genotype or blood type dieting supported the claims that
a certain blood type responded more to a certain diet or that there were better results than
an average calorie-restricted diet.
RAW FOOD DIET

Proponents of the raw food diet believe that cooking foods to certain temperatures leaches
nutrients and destroys proteins and enzymes. The diet is rich in foods like pressed fruit
and vegetable juices, raw or dehydrated fruits and vegetables, raw nuts and seeds, raw and
sprouted grains and legumes, and fermented items like sauerkraut and kimchi. Dieters may
also eat raw eggs, fish, and some types of meat.
The raw diet is not marketed as a weight loss diet but a disease prevention plan. The
main claim of proponents is that the diet improves enzyme activity and digestion, but this
remains unproven.
Critics of the raw food diet have a lot of concerns, including the risks of eating raw and
undercooked meat and animal products. Raw meats and animal products can carry pathogens
like salmonella, E. coli, staphylococcus, and listeria. They can cause serious infections that
may be fatal. For vegan raw dieters, deficits in some micronutrients, like B12, may be an
issue. Vitamin B12 is found in meat, chicken, dairy, and eggs and is a vital component for
maintenance of the body’s blood and nerve cells.
LOW-ENERGY DIET (LED) AND VERY LOW-ENERGY DIET (VLED)

Low- and very low-energy diets are physician-supervised. A low-calorie diet is considered
800–1,200 Calories daily while a very low-Calorie diet is less than 800 Calories daily. These
diets can be successful for weight loss because of the drastic Calorie restriction conducted
in a clinical setting. Without guidance, it is very difficult to adhere to these restrictions.
Clinical studies following individuals on LEDs and VLEDs found body weight reductions of
10–15 percent. These diets help with weight loss, weight maintenance, management of
conditions like obesity, type 2 diabetes, sleep apnea, and cardiovascular disease.
Exercise is generally not recommended on low- and very low-calorie diets. Research has shown
that weight loss and maintenance on these diets are most successful with higher protein
levels and lower glycemic index foods. This allows blood sugar to stay relatively consistent,
reduces blood insulin spikes for those with diabetes or prediabetes, and decreases hunger.

After the initial weight loss on LEDs and VLEDs, weight gain is typical without ongoing support.
This is driven by downregulation of hunger hormones and the tendency to exceed the maximum
Calorie recommendations. Individuals are hungrier and feel less satisfied after eating and,
without guidance, tend to overeat. The addition of reduced-Calorie meal replacements and
fortified formulas for the maintenance phase promotes satiety and prevents binging.
In some clinical settings, dieters may be able to maintain weight loss with one to three meal
replacements (or formulas) daily to keep the Calorie count as low as possible. Depending on
the macronutrient makeup of the diet, some individuals achieved and sustained ketosis as
a by-product of the diet.
PLANT-BASED DIETS
A plant-based diet minimizes, restricts, or completely leaves out meat and animal products.
PLANT-BASED DIET: Research has shown that adopting a plant-based diet is not only cost-effective but can help
Eating mostly or entirely
foods that are plants or lower body mass index (BMI), blood pressure, cholesterol levels, and heart disease risk factors.
derived from plants.
There are several variations of a plant-based diet.
Vegan
Vegans do not consume or use any animal products or by-products. This includes meat,
poultry, game, fish, eggs, dairy, honey, and animal-derived food ingredients like gelatin. A
vegan diet may be limited in omega fatty acids, vitamin B12, and folate. Vegans may need to
supplement these nutrients.

Lacto-Vegetarian
This diet does not allow for any meat, poultry, fish, or eggs but does include dairy. Again,
folate, vitamin B12, and omega fatty acids may be limited for lacto-vegetarians. Including
dairy increases calcium intake, protects bones, and aids in muscle tissue functioning and
metabolic processes.
Ovo-Vegetarian
An ovo-vegetarian eats eggs and foods with eggs as ingredients but not any dairy or meat. The
inclusion of eggs makes up for the loss of some B vitamins. Eggs provide high-quality protein.
Lacto-Ovo Vegetarian
This is the most common type of vegetarianism and what most people mean when using the
term. Lacto-ovo vegetarians eat dairy and eggs but no meat, poultry, or fish.
Pescatarian
A diet that allows for dairy, eggs, fish, and other types of seafood is pescatarian. The name
derives from the Spanish word for fish, pescado. Frequent fish consumption poses a risk
of mercury exposure, but it is possible to choose types of seafood with less mercury. And
there are benefits too: fish is a lean protein source, and fatty fish provides essential omega
fatty acids.
Pollotarian
Derived from the Spanish word for chicken, a pollotarian diet includes dairy, eggs, and chicken
as well as other poultry. Individuals on this diet must be careful to get enough iron, zinc, and
vitamin B12 from foods or supplements.
Flexitarian
A flexitarian enjoys a mostly vegetarian diet but may occasionally consume any type of fish,
poultry, or seafood. The diet is mostly plant-based but leaves room for animal products. Between
2 and 5 percent of the US population is vegetarian or vegan. Plant-based diets are generally
beneficial for overall health but do not necessarily improve weight loss. These diets are supported
by researchers and health professionals and have no real adverse health effects.
Studies have shown that vegans have a decreased risk for diabetes, hypertension, and
cardiovascular disease as compared to those who eat plant-based diets with some eggs,
dairy, or meat.

Table 14.11 Plant-Based Eating Styles
PLANT- NOTHING
BASED MEAT GAME POULTRY FISH EGGS DAIRY ANIMAL-
TYPE DERIVED
Vegan       
Lacto-
vegetarian
      
Ovo-vegetarian       
Lacto-ovo-
vegetarian
      
Pescatarian       
Pollotarian       
Flexitarian   Some Some   
KETOGENIC (KETO) DIET

The keto diet is also based on restricted carbohydrate intake. On the keto diet, only about
KETO DIET:
A popular diet that reduces
20 percent of daily Calories come from carbs. This amounts to about 50 grams based on a
carbohydrate intake to 2,000-Calorie diet.
deliberately increase fat
metabolism and ketones in
the blood. The remaining Calories are divided between fats (55–60 percent) and protein (30–35
percent). This is approximately 275–300 grams of protein and 66–77 grams of fats daily.
If executed correctly, the keto diet will lead to a state of ketosis in the first week. Ketones
KETOSIS:
A metabolic process that are naturally produced as an energy source by the liver when insulin and glucose are low.
occurs when the body
does not have enough
They are a product of fat metabolism and can act to suppress appetite and fuel the body.
carbohydrates for energy; Once ketosis is achieved, the goal is to consistently remain in this state.
the liver metabolizes fatty
acids to produce ketones
as a replacement energy Studies have shown that the benefits of keto include an increase in HDL cholesterol, a
source.
decrease in LDL cholesterol, lower blood glucose levels, and significant BMI reduction and
weight loss. If carbohydrates are reintroduced in the diet, the results reverse.
KETOACIDOSIS: Ketoacidosis is a dangerously high level of ketones in the blood. It requires immediate
An increase in blood acidity
caused by excess ketones medical care. This extreme condition is usually caused by starvation, but it may be triggered
in the bloodstream.
by following a ketogenic diet.

The keto diet can also cause side effects similar to those of any low-carb diet: headache,
fatigue, bad breath, constipation, and dehydration. A study done by the Harvard School of
Public Health also connected carb-restrictive diets to an increased risk of kidney stones,
osteoporosis, and increased blood levels of uric acid.
ATKINS DIET
The Atkins Diet is both a brand and a diet that has been popular for years. Food products
made and packaged specifically for Atkins dieters are widely available and easy to find,
making it a convenient choice.
The diet is very low in carbohydrates, with 90–95 percent of Calories from protein and fats.
For an average 2,000-Calorie diet, this amounts to 1,800 calories a day from fat and protein
and 200 Calories daily from carbohydrates (50 grams or less).
Research has shown that low-carb diets such as this can increase metabolic output (basal
metabolic rate) by 50–90 Calories a day. But eating this way may also reduce the hormones
leptin and ghrelin, which in turn increases appetite. These effects can be counteracted by
reducing fat intake and increasing calories from protein sources to about 30 percent.
Critics of the Atkins diet say it causes low energy, impairs cognitive function, and increases
gastrointestinal distress because of the high levels of fat. The first two weeks of the diet,
the induction phase, limits carbohydrates to just 20–25 grams per day. This is intended to
induce ketosis.
Phases two, three, and four slowly reintroduce carbohydrates back into the diet starting at 25–50
grams per day, finally going up to 100 grams per day for the long-term maintenance phase.
Despite the restrictions with Atkins, research has shown that adherence to the diet can
improve metabolic syndrome and diabetes, reduce high blood pressure, and lower
cardiovascular disease risk. Weight loss depends on the total calories consumed in the diet. METABOLIC
SYNDROME:
The risks of the Atkins diet have been studied, but the long-term health effects are still A cluster of at least
three biochemical
relatively unknown. It is too new to have enough data to make this determination. Health
and physiological
professionals generally have several concerns about a high-fat, low-carbohydrate diet: abnormalities associated
with the development of
cardiovascular disease and
• Deficiencies in trace minerals and vitamins
type 2 diabetes.
• Inadequate fiber
• No better long-term weight loss results than low-calorie diets
Additionally, there are side effects of a low-carb diet, including bad breath, headaches, fatigue,
dizziness, constipation, and dehydration.

CARNIVORE DIET
The carnivore diet consists of eating meat and animal products exclusively. Beef, lamb, pork,
ANIMAL PRODUCTS: veal, chicken, and eggs are staples of the diet. Carnivore dieters avoid vegetables, low-
Any material derived from
the body of an animal, lactose dairy, fruits, legumes, nuts, seeds, and grains. Carb restriction on the carnivore diet
including dairy products,
eggs, honey, and gelatin. triggers ketosis. It is the ketogenic state that produces weight loss on this diet.
Supporters of the diet cite human evolution as support for the carnivore diet. They believe
that because humans evolved as hunters, they are designed to eat and process meat and
animal products. Weight loss and ketosis are often considered the main benefits of the diet.
Some people also report better digestive health and higher testosterone levels.
Long-term kidney damage from high protein intake is under investigation. Studies have shown
that the carnivore diet can lead to higher blood serum fat levels over time. Critics of the diet
also cite nutrient deficiencies, specifically plant-based vitamins and minerals, as a major
issue. Additionally, high protein intake increases uric acid in the blood, which can lead to
conditions like gout.
PALEO DIET
The Paleo diet has gained momentum in the past 10 years and is relatively popular. Many
people refer to it as “clean eating.” It differs from the carnivore diet by including fruits,
vegetables, nuts, and seeds. Paleo dieters avoid dairy products, legumes, processed foods,
and refined sugars. It is a simple plan based on ancestral hunting and gathering. It is
generally low in carbohydrates and high in protein.
Figure 14.10 The Paleo Diet Pyramid

People who turn to the Paleo diet are usually looking to lose or maintain weight and to eat
a simple, healthy diet. The simpler diet plan, along with avoidance of sugar and processed
foods, naturally leads to a lower Calorie intake. Paleo has become very popular, and it is
now easier to find related products in grocery stores and restaurants. However, purchasing a
processed product for a diet that promotes unprocessed eating defeats the purpose. People
truly interested in a strict Paleo diet should avoid consuming anything other than whole foods.
Studies show that this well-balanced approach can reduce overall weight without compromising
muscle tissue. It has been shown to reduce bad cholesterol and blood triglycerides, lower
blood pressure, and decrease resting insulin levels.
Critics raise concerns about the nutrition of the Paleo diet for active people and athletes. The
avoidance of grains and carbs reduces energy levels. Studies of athletes have shown that
individuals need between three and six grams of carbohydrates per pound of bodyweight to
support their activity levels.
The diet is also challenging for vegetarians and vegans as eating legumes is discouraged.
Legumes are a major protein source for most plant-based eaters. More research is needed
to study the long-term effects of the Paleo diet.
GLUTEN-FREE
Gluten is a mix of proteins found in grains like wheat, rye, and barley. It gives elasticity to
dough made from these grains. In individuals with celiac disease, gluten triggers an immune
response that damages the lining of the small intestines. This causes discomfort and
GLUTEN:
A mixture of proteins found
disrupts nutrient absorption. Ultimately, it can lead to serious health conditions, including in wheat, rye, and barley
and gives dough its elastic
depression, infertility, headaches, skin rashes, seizures, and neuropathy. Some people are texture.
sensitive to gluten but have less severe reactions.
CELIAC DISEASE:
A gluten-free diet may include: An autoimmune disorder
that affects the small
• Fish, poultry, and meat intestines and that is
caused by gluten in
• Dairy without added ingredients the diet.
• Gluten-free grains like quinoa, rice, and oats
• Starches like potatoes, corn, almond flour, and corn flour
• Nuts and seeds
• Vegetable oils and butter
• Eggs
• Fruits and vegetables

Gluten-free adherents avoid anything with wheat, barley, or rye. This includes ingredients
and foods like malt, beer, and brewer’s yeast. Candy, baked goods, popcorn, pretzels, chips,
crackers, and many condiment sauces like soy sauce and teriyaki sauce include gluten or
gluten-based ingredients.
Avoiding gluten isn’t necessary for anyone without a gluten allergy or celiac disease, but
many healthy people choose this diet. Cutting out wheat and other grains is essentially a
low-carbohydrate approach, which can lead to weight loss. Depending on the foods eaten,
a gluten-free diet may lead to improved cholesterol levels, better digestive health, and the
elimination of many processed foods from the diet.
Without guidance or balanced, healthy food choices, a gluten-free diet may increase calorie
intake. Many processed gluten-free foods include added sugar and calories to replace the
grains removed. Studies have also shown that a gluten-free diet can cause constipation or
diarrhea. To go gluten-free healthfully, individuals should reach for naturally gluten-free foods:
vegetables, fruits, fresh meat, fish, dairy products, and poultry.
Another concern critics have about any diet that cuts out gluten is that wheat products are often
fortified with micronutrients like vitamin B and iron. There is a risk of deficiencies on this diet.
THE DASH DIET

DASH stands for Dietary Approaches to Stop Hypertension. It was developed based on research
conducted by the National Institutes of Health. The primary audience for the DASH diet is anyone
with high blood pressure, with the goal of reducing hypertension with fewer or no medications.
The diet is simple. There are no special food restrictions, just a weekly plan of a healthy
2,000 Calories per day. The diet focuses on low-fat dairy, fish, poultry, beans, nuts, and
vegetable oils while avoiding fatty meats, full-fat dairy, coconut and palm oil, and sweets. The
DASH diet can be followed with a normal sodium intake of up to 2,300 milligrams daily or
with reduced sodium intake of up to 1,500 milligrams daily.
The DASH diet recommends that 55 percent of daily Calories come from carbohydrates,
approximately 27 percent from unsaturated fats, 6 percent from saturated fats, and 18 percent
from protein. Tips include filling the plate with colorful, whole foods and including two or more
servings of fruits and vegetables per meal, with a particular emphasis on dark, leafy green
vegetables. In addition to lowering blood pressure, the DASH diet has other health benefits:
prevention of bone loss, improved cardiovascular health, and weight loss or maintenance.

MEDITERRANEAN DIET
Global health and wellness research has shown that people who live in several Mediterranean
countries, including Greece, Spain, and Italy, have lower rates of chronic health issues. This is
widely attributed to the typical diet of the region.
The benefits of the Mediterranean diet are so widely recognized and accepted that the WHO
and the United Nations Educational, Scientific, and Cultural Organization (UNESCO) have
added the diet to its list of intangible cultural heritages. The listing aims to protect the “skills,
harvesting, cooking, and consumption of food” that the diet promotes.
Figure 14.11 The Mediterranean Diet

The Mediterranean diet consists of moderate portions of fruits, vegetables, whole grains,
legumes, potatoes, nuts, seeds, olive oil, fish, poultry, dairy, and eggs, with minimal red meats.
Olive oil, nuts, and seafood are eaten regularly in this diet. The high levels of heart-healthy
omega-3 fatty acids in them may be a major reason that chronic disease and cardiovascular
risks are lower in the Mediterranean population. The diet is often recommended to people
who have a high risk of heart attack, arterial plaques, and stroke.
The fresh, light foods that make up this diet are filling and satisfying. Over time, this naturally
leads to a decrease in calorie intake and helps promote weight loss. Studies have shown that
the Mediterranean diet can reduce cardiovascular disease risk up to 30 percent and trigger
a significant reduction in the risk of developing type 2 diabetes.
INTERMITTENT FASTING
Intermittent fasting is a type of diet that focuses on the timing of food intake in a 24-hour
FASTING: period or weekly rather than on specific types of food. There are two popular variations of the
Abstaining from consuming
food for a period of time. fasting diet: 5/2 and 16/8.
The 5/2 Diet
The 5/2 fasting diet involves eating a normal, balanced, and healthy diet five days a week
and fasting for two days. The fasting days are not strictly days with no food. The idea is to
consume 25 percent—or even less—of a normal day’s Calories.
With 2,000 Calories for a normal day, this means eating just 500 Calories or less on fasted
days. The fasted days should not be consecutive, and this eating plan does not restrict types of
food. The simplicity of the diet makes it easy for most people to maintain. Over the course of a
week, it is possible to reduce calorie intake by about 3,000 Calories, or one pound of bodyfat.
The 16/8 Diet
The 16/8 method involves abstaining from food entirely for 16 consecutive hours per day and
eating only during an eight-hour window each day. The eight hours should align with the most
active hours of the day to avoid fatigue.

Figure 14.12 16/8 Fasting
For example, for an adult who gets up at 7:00 a.m., works from 9:00 a.m. to 5:00 p.m., works
out at 6:00 p.m. and goes to bed at 11:00 p.m., a good time for the eight-hour eating window
is between 10:00 a.m. and 6:00 p.m. There are no food requirements, but as with the 5/2
plan, the diet should be balanced and healthful.
Both of these popular versions of intermittent fasting work by reducing the overall Calories
consumed and encouraging healthy eating habits. This type of dieting works best for those
clients who are able to eat a normal or recommended amount of Calories most of the time.
Studies have shown that fasting not only helps people consume fewer Calories but also leads
to moderate weight loss, less muscle wasting, decreased serum leptin and blood levels of
triglycerides, and increased LDL cholesterol.
Intermittent fasting isn’t for everyone. For some clients, it may be too difficult to restrict
Calories during fasting periods or to avoid food entirely for 16 hours. The struggle can lead to
an unhealthy relationship with food and eating and even binge eating. For those who are able
to abstain with minimal side effects or distress, intermittent fasting can have positive benefits.

CARB CYCLING
Carb cycling is another dietary approach that focuses on timing. It involves making targeted
CARB CYCLING:
increasing and reducing reductions and increases to carb intake on a daily, weekly, or monthly basis.
carb intake on a daily,
weekly, or monthly basis.
This style of diet is often used by fitness and bodybuilding competitors. It may also appeal
to people trying to lose fat, bust a weight loss plateau, or maintain a high level of physical
performance while dieting. The frequency and duration of cycling carbohydrates depend
on activity level. In general, carb intake is reduced or cut during low-activity periods and
increased during performance and high-activity periods.
There are several situations in which carb cycling can be useful. It’s possible to drop carbs
for a period of time, for instance, to reach the desired bodyfat percentage. From there, carbs
are slowly reintroduced. Bodybuilders and figure competitors use this strategy. Endurance
and strength athletes often increase carb intake ahead of a competition or race to ensure
adequate and even excess glycogen stores. For general fitness enthusiasts, an easy way to
carb cycle is to keep to a lower carb diet during the work week and increase carbs on off days.
Athletes will cycle according to training and activities, adding more carbs on heavy workout
days and less on low-intensity or rest days.
When carbs are added back into the diet after an extended phase of dieting (for example, a
week or longer), this is called a refeed. This decreases the hormone leptin to help reduce the
REFEED:
Reintroducing feelings of hunger and boost the resting metabolic rate, which can be downregulated with
carbohydrates into the diet
after an extended reduction prolonged low-Calorie intake.
of a week or more.
There are few good studies on carb cycling because it is a style of eating with a lot of
individual variety. However, research on low carbohydrate intake suggests it may improve
insulin sensitivity and promote the use of fat as fuel. Much of the feedback on carb cycling is
based on personal experiences and anecdotal evidence. Risks of carb cycling are like those
for low-carbohydrate diets during periods of low or minimal intake. The refeed period may turn
into an unhealthy binge.

LIMITING FACTORS FOR NUTRITIONAL CONSISTENCY
There are many choices a client may make that keep them from seeing results or success.
When related to nutrition, these are known as nutritional limiting factors, and they can include:
NUTRITIONAL
• Overeating processed foods LIMITING FACTORS:
The nutritional choices a
• Not eating enough protein client makes that keep
them from making progress
• Not eating enough vegetables or seeing results.
• Eating too much too quickly
• Eating without being hungry
• Not eating when they feel hungry
• Skipping meals
• Consuming too many sugar-sweetened beverages
• Poor sleep and recovery
• Using food to manage emotional stresses
• Lack of basic food preparation skills
Once a client ensures they are making the right nutritional selections, the amount of food and
macronutrient breakdown of their food can be addressed to ensure they are supporting their
health and fitness goals. In a nutritional coaching program that stays within the scope of a
personal trainer, clients may receive resources like handbooks, websites, databases of food
facts, spreadsheets for logging, and help when planning meals. However, optimal nutrition
is more than just counting calories. In fact, Calorie counting is not very accurate since it
depends on the person reporting the intake and can be affected by things like differences in
food preparation and labeling accuracy.
PORTION SIZES
Personal trainers can help clients easily establish how much food they should be consuming
using their own hand as the measuring device.
• Protein portions should be about the size of the palm of the hands
• A portion of vegetables should be about the same size as a fist
• A cupped hand is a serving of carbohydrates
• A fat portion should be about the size of a thumb

The hand is a helpful portion size tool for several reasons. First, the hands are portable.
Second, they are scaled to the size of the person. Larger people need more food and tend to
have larger hands, while a smaller person likely needs less food and has smaller hands. Third,
someone can control their intake by not counting Calories directly but controlling their portions.
Assuming clients eat about four meals a day, the following details a good starting point for
most clients:
Table 14.12 Approximate Portion Sizes Per Meal By Sex
MALES—FOR EACH MEAL
2 palms of protein-dense food
2 fists of vegetables
2 cupped handfuls of carbohydrates
2 thumbs of fat-dense foods
FEMALES—FOR EACH MEAL
1 palm of protein-dense food
1 fist of vegetables
1 cupped handful of carbohydrates
1 thumb of fat-dense foods

CALORIE CONTROL: A SIMPLE GUIDE
For Men
Calorie counting is often complicated, tedious, and inaccurate. So here is an easier way to
control Calories. No weight-scales or measuring cups. No calculators or smart phones. Just
the ability to count to two. And your hand. To build your meals:
2 palm portions of protein dense foods 2 fists of vegetables with each meal
with each meal
2 cupped handfuls of carb dense foods 2 entire thumbs of fat dense foods with
with each meal most meals
Note: Your hand size is related to your body size, making it an excellent portable and
personalized way to measure and track food intake.
Also note: Just like any other form of nutrition planning, this guide serves as a starting point.
Stay flexible and adjust your portions based on hunger, fullness, and other important goals.

CALORIE CONTROL: A SIMPLE GUIDE

For Women
Calorie counting is often complicated, tedious, and inacurate. So, here is an easier way
to control calaories. No weigh-scales or measuring cups. No calculators or smart phones.
Just the ability to count to one. And your hand. To build your meals:
1 palm portion of protein dense 1 fist of vegetables with each meal
foods with each meal
1 cupped handful of carb dense foods 1 entire thumb of fat dense foods
with each meal with most meals
Note: Your hand size is related to your body size, making it an excellent portable and
personalized way to measure and track food intake.
Also note: Just like any other form of nutrition planning, this guide serves as a starting
point. Stay flexible and adjust your portions based on hunger, fullness, and other
important goals.

IDEAL STARTER PLATE
• Eat slowly and stop eating when you’re 80% full.
• Follow hunger cues. Eat more or less based on your apppetite.
• Choose mostly whole foods with minimal processing.
• Choose local or organic foods when possible.
• Use smaller or larger plates based on your own body size.
Note: Just like any other form of nutrition planning, this guide serves as a starting point. Stay
flexible and adjust your portions based on hunger, fullness, and other important goals.

SUPPLEMENTATION
CHAPTER 15
LEARNING OBJECTIVES
1 | Explain the importance of vitamins and minerals in supplements.
2 | Identify supplements that enhance exercise performance and recovery.
3 | Define the benefits of incorporating ergogenic aids and botanicals in a

person’s nutrition plan.

CHAPTER 15 | Supplementation
Personal trainers are often asked about supplementation and the extent to which nutrients,
VITAMINS: compounds, and products influence health and fitness goals. Supplements make it easier to
Organic compounds
essential for normal growth consume adequate amounts of vitamins and minerals, which are essential nutrients the
and nutrition.
body needs in small amounts. Even though small amounts are required, it can be difficult to
sustain a broad, healthy nutrition plan consisting of nutrient-rich foods such as fruits,
MINERALS:
Elements in food that the vegetables, whole grains, low-fat protein, and legumes. While it is not the responsibility, or
body needs to develop and
function.
within the scope of practice, of a personal trainer to prescribe and recommend dietary
supplements, knowledge of dietary supplements can help fitness professionals provide
DIETARY appropriate supplement guidance, increasing value and support for members and clients.
SUPPLEMENT: Fitness professionals can help clients navigate misinformation and understand what they
A product containing one
should look for to ensure their dietary supplements are safe, effective, of a superior quality,
or more dietary ingredients
that is intended to and free from contaminants, banned substances, or impurities.
supplement a person’s
nutrition plan.
WHAT IS A DIETARY SUPPLEMENT?

DIETARY INGREDIENT: The National Institutes of Health defines a dietary supplement as a product that contains
A vitamin, mineral, herb,
botanical, or amino acid one or more dietary ingredients and is intended to supplement a person’s nutrition plan.
used to supplement a
Before digging into commonly used dietary supplements, it is important to know that the
nutrition plan to increase
total dietary intake of Federal Food, Drug, and Cosmetic Act defines a dietary ingredient as a vitamin, mineral,
ingredients.
herb, botanical, or amino acid. It is a substance used to supplement a nutrition plan by
increasing the total dietary intake. This could be a concentrate, metabolite, constituent,
HERB:
Any plant with leaves, extract, or combination of the preceding substances. Common supplements may be
seeds, or flowers used for
flavoring food and medicine. designated as performance supplements, nutritional supplements, ergogenic aids, and
botanical supplements.
BOTANICAL:
Substance obtained from a
Table 15.1 Supplement Categories
plant and used as an additive.
NUTRITIONAL PERFORMANCE ERGOGENIC BOTANICAL
TYPE
SUPPLEMENTS SUPPLEMENTS AIDS SUPPLEMENTS
AMINO ACID:
A simple organic compound
Vitamins, minerals, Compounds
known as the building block
of proteins. proteins, herbs, consumed to Made from plant
Natural or synthetic
and amino acids specifically parts or extracts
nutrients intended
PERFORMANCE Description
to supplement a
consumed to promote enhance and intended to
metabolic and physical performance supplement a
SUPPLEMENTS: nutrition plan
Supplements intended performance and during exercise or nutrition plan
to help enhance athletic recovery competition
performance.

Supplements can come in many different forms including capsules, tablets, liquids, and
powders. ERGOGENIC AIDS:

Substances that enhance
energy production and
Unlike prescription drugs, dietary supplements are not required to be tested for safety or provide athletes with a
competitive advantage.
effectiveness before going to market. While the Food and Drug Administration (FDA) is not
in the business of approving dietary supplements, it can “disapprove” them and remove a
FOOD AND DRUG
product that is shown to be harmful or a public health risk. Also, it is illegal to market a
ADMINISTRATION
dietary supplement product as a treatment or cure for a specific disease or as being able to
(FDA):
alleviate the symptoms of a disease. A US federal department
that regulates the
production and distribution
NUTRITIONAL DEFICIENCIES of food, pharmaceuticals,
tobacco, and other
There are many elements to an effective nutrition plan, and supplements may serve as a vital consumer products.
component. These elements include nutrition awareness, food quality and portion control,
eliminating nutrient deficiencies, and engaging in regular exercise. Nutrient deficiencies can
be problematic, contributing to chronic conditions. According to the World Health Organization
(WHO), iron deficiency is one of the most common nutrient deficiencies contributing to
worldwide anemia. There are many conditions that can cause anemia, among them are
genetic factors, impaired metabolism, heavy menstruation, and even intestinal diseases. ANEMIA:
A condition marked by a
Anemia affects one-third of the world’s population and contributes to increased morbidity and deficiency of red blood cells
or of hemoglobin in the
mortality. Supplementation may help eliminate nutrient deficiencies such as this. blood resulting in extreme
fatigue.
There are special situations where some individuals may be at risk of developing nutritional
deficiencies, so there are cases where taking dietary supplements can be a good idea.
Individuals restricting calories by consuming less than 1,200 Calories a day are at risk of
missing out on important nutrients. Individuals with food allergies or intolerances are more
likely to avoid complete food groups such as whole grains or dairy, respectively, and they
will have to obtain nutrients from alternative sources. Additionally, people who spend little
to no time outside under the sun, or those who consistently use sunscreen outside, may
eventually create a vitamin D deficiency. Also, women contemplating pregnancy and those
who are pregnant will require additional folate to prevent certain birth defects and more iron
to increase the blood supply for a growing baby.

NUTRIENT REQUIREMENTS
Every five years, the United States Department of Health and Human Services and the United
States Department of Agriculture (USDA) publish the Dietary Guidelines for Americans. The
Dietary Guidelines for Americans provides science-based advice on nutrient needs to promote
optimal health and reduce the risk of chronic disease. Its focus is on providing quantitative
guidance about foods, and it emphasizes giving recommendations about food and beverages.
In contrast, the Food and Nutrition Board, an arm of the National Academy of Medicine, has
set standards for nutrient requirements in the form of Dietary Reference Intakes (DRIs). A
DIETARY REFERENCE subgroup of these DRIs is the Recommended Daily Allowance (RDA), which provides a safe
INTAKES (DRIS):
A set of standards and adequate reference for most people to decrease their risk of chronic disease. The RDA
estimating how much of a
specifies the amount of a vitamin or mineral that is needed to maintain health and stay
nutrient should be ingested
that is used in planning
nourished. It is based on an average daily level of intake sufficient to meet the nutrient
eating patterns for healthy
individuals. requirements of most people, in this case, 97–98 percent of healthy people. RDAs were
originally set to be a standard that would serve as a goal for optimal nutrition. These
RECOMMENDED DAILY references are meant to be applied to people of different ages. According to the USDA, many
ALLOWANCE (RDA):
The average daily level of people do not meet the RDAs for many micronutrients and these RDAs are not intended for
intake that is sufficient to
individuals with deficiencies.
meet the needs of nearly all
(97%-98%) healthy people.
NUTRITIONAL SUPPLEMENTS
According to a 2019 consumer survey given by the Council for Responsible Nutrition,
supplement use is at an all-time high with multivitamins/minerals (MVMs) being the most
MULTIVITAMINS/ used. Most individuals take supplements to maintain or improve health and to help fill small
MINERALS (MVMS):
Supplements or pills nutritional gaps. Additionally, of all the supplements that a client may ask about, the most
containing a combination of
common is typically an MVM formula. The notion that a person can get everything they need
vitamins and minerals.
by eating a balanced diet is confounded by many factors such as current health status, food
intake, and lifestyle. The 2020–2025 Dietary Guidelines for Americans states that the general
population in the US fails to meet the recommendations for food groups and nutrient intakes.
This means most Americans have eating patterns that are not aligned with dietary
recommendations. Moreover, they are not meeting their intake needs for nutrients such
as vitamins and minerals.

Supplements are not intended to cure or treat medical conditions, and that application
exceeds a personal trainer’s scope of practice. However, MVM supplement use is warranted
to prevent long-term nutrient insufficiencies associated with premature aging and higher risk
of age-related decline. As clients age, their nutritional needs increase, which means being
aware of what foods are consumed becomes critical. MVMs offset deficiencies that worsen
from inadequate food intake and certain medications.
DAILY VALUES: VITAMINS

The Daily Value (DV) is what an individual typically sees on the label of a dietary supplement.
It was developed by the FDA to help the consumer determine how much of a nutrient is in a
DAILY VALUE (DV):
Reference amounts
serving when compared to the requirement for that nutrient. Labels are expressed with the expressed in grams,
milligrams, or micrograms
“%DV” symbol and show the percentage of a serving that contributes to obtaining the total of nutrients to consume or
not to exceed each day.
DV. For example, if the DV for a vitamin is 500 micrograms (mcg) and the container for a
supplement indicates the supplement has 50 mcg in a serving, then an individual will meet
10 percent of their need for the day with one serving. The DV is meant to make it easier for
individuals to understand what their daily dietary needs are. Since labels are small, the
number is just one value and can sometimes be the same as the RDA.
Table 15.2 RDA for Vitamins
VITAMIN PURPOSE FOODS DV
Biotin • Energy storage Avocados Liver 30 mcg
• Protein, Cauliflower Pork

carbohydrate,
Eggs Salmon
and fat
metabolism Fruits
Whole grains
Folate/Folic • Prevents birth Asparagus Green leafy 400 mcg DFE

acid defects vegetables
Avocado
Important for • Protein Orange juice
Beans and
pregnancy metabolism
peas
• Red blood cell
Enriched grain
formation
products

Table 15.2 RDA for Vitamins (CONT)
Niacin • Cholesterol Beans Pork 16 mcg

production
Beef Poultry
• Converts food
Enriched grain Seafood
into energy
products
Whole grains
• Digestion
Nuts
• Nervous system
function
Pantothenic • Converts food Avocados Poultry 5 mcg

acid into energy
Beans and Seafood
• Fat metabolism peas
Sweet potatoes
• Hormone Broccoli
Whole grains
production
Eggs
Yogurt
• Nervous system
function Milk
• Red blood cell Mushrooms

formation
Riboflavin • Converts food Eggs Mushrooms 1.3 mcg

into energy
Enriched grains Poultry
• Growth and
Meats Seafood
development
Milk Spinach
• Red blood cell
formation
Thiamin • Converts glucose Beans and peas Pork 1.2 mcg

into energy
Enriched grain Sunflower
• Nervous system products seeds
function
Nuts Whole grains

Vitamin A • Growth and Cantaloupe Green leafy 900 mcg RAE

development vegetables
Carrots Current RDAs
• Immune function Pumpkin from the DRI
Dairy products
• Reproduction Red peppers reports for
Eggs
vitamin A are
• Red blood cell Sweet potatoes
formation Fortified cereals expressed as
micrograms of FORTIFIED:
• Skin and bone
retinol activity Having had vitamins or
formation other supplements added
equivalents so as to increase the
• Vision nutritional value.
(RAE).
Vitamin B6 • Immune function Chickpeas Salmon 1.7 mg
• Nervous system Fruits (other Tuna

function than citrus)
• Protein, Potatoes
carbohydrate,
and fat
metabolism
• Red blood cell

formation
Vitamin B12 • Converts food Dairy products Meats 2.4 mcg

into energy
Eggs Poultry
• Nervous system
Fortified cereals Seafood
function
• Red blood cell

formation
Vitamin C • Antioxidant Broccoli Kiwi 90 mg
• Collagen and Brussels Peppers

connective sprouts
Strawberries
tissue formation
Cantaloupe
Tomatoes and
• Immune function
Citrus fruits tomato juice
• Wound healing
and juices

Vitamin D • Blood pressure Eggs Fortified 20 mcg

regulation margarine
Deficient Fish
in most • Bone growth Fortified orange
Fish liver oil
Americans • Calcium balance juice
Fortified cereals
• Hormone Fortified soy
Fortified dairy
production beverages
• Immune function Sunlight
• Nervous system
function
Vitamin E • Antioxidant Fortified cereals Peanuts 15 mg AT
• Formation of Fortified juices Vegetable oils Current RDAs

blood vessels from the DRI
Green Wheat germ
• Immune function vegetables reports for
vitamin E are
Nuts and seeds
expressed as
milligrams of
alpha-tocopherol
(mg AT).
Vitamin K • Blood clotting Broccoli Spinach 120 mcg
• Strong bones Collard greens Turnip greens
Kale
Note: AT = alpha-tocopherol; DFE = dietary folate equivalent; mcg = microgram; mg =

milligram; RAE = retinol activity equivalent (adapted from FDA fact sheet)

DAILY VALUES: MINERALS
Minerals are inorganic elements found in soil and water that the body needs to function properly
and develop. The body requires a certain amount of minerals to build strong bones and convert
food into energy. A client’s nutrition plan should provide all the minerals the body needs to
maintain cell and immune system function, but for various reasons, individuals can become
deficient. Having a poor nutrition plan over a prolonged period can lead to mineral deficiencies.
In addition, the ability of the body to absorb calcium typically decreases with age, so regular
calcium supplementation will become important as people get older. Each mineral serves its own
purpose, is found in a variety of foods, and is required in different amounts.
Table 15.3 RDA for Minerals
MINERAL PURPOSE FOODS DV
Calcium • Blood clotting Almond, rice, Fortified juices 1,300 mg
• Bone and teeth coconut, and hemp

Fortified soy
formation milks
beverages
• Constriction and Dairy products
Green vegetables
relaxation of Fortified cereals
Tofu
blood vessels
• Hormone
secretion
• Muscle
contraction
• Nervous system
function
Chloride • Acid-base Celery Seaweeds 2,300 mg

balance
Lettuce Table salt and sea
• Converts food salt
Olives
into energy
Rye Tomatoes
• Digestion
Salt substitutes
• Fluid balance
• Nervous system
function

Table 15.3 RDA for Minerals (CONT)
Chromium • Insulin function Broccoli Spices (garlic and 35 mcg
• Protein, Fruits basil)

carbohydrate, Turkey
Grape and orange
and fat
juices Whole grains
metabolism
Meats
Copper • Antioxidant Chocolate and Nuts and seeds 0.9 mg
• Bone formation cocoa

Organ meats
• Collagen and Crustaceans and
Whole grains
connective shellfish
tissue formation Lentils
• Energy
production
• Iron metabolism
• Nervous system
function
Iodine • Growth and Breads and cereals Seafood 150 mcg

development
Dairy products Seaweed
• Metabolism
Iodized salt Turkey
• Reproduction
Potatoes
• Thyroid hormone
production
Iron • Energy Beans and peas Raisins 18 mg

production
Dark-green Seafood
• Growth and vegetables
Whole-grain,
development
Meats enriched, and
• Immune function fortified cereals
Poultry
• Red blood cell and breads
formation Prunes and prune
juice
• Reproduction
• Wound healing

Magnesium • Blood pressure Avocados Potatoes 420 mg

regulation
Bananas Raisins
• Blood sugar
Beans and peas Wheat bran
regulation
Dairy products Whole grains
• Bone formation
Green leafy
• Energy
production vegetables
• Hormone Nuts and pumpkin

secretion seeds
• Immune function
• Muscle
contraction
• Nervous system
function
• Normal heart
rhythm
• Protein formation
Manganese • Carbohydrate, Beans Spinach 2.3 mg

protein, and
Nuts Sweet potato
cholesterol
metabolism Pineapple Whole grains
• Cartilage and
bone formation
• Wound healing
Molybdenum • Enzyme Beans and peas Whole grains 45 mcg

production
Nuts

Phosphorus • Acid-base Beans and peas Poultry 1,2500 mg

balance
Dairy products Seafood
• Bone formation
Meats Whole-grain,
• Energy enriched, and
Nuts and seeds
production and fortified cereals
storage
and breads
• Hormone
activation
Potassium • Blood pressure Bananas Prunes and prune 4,700 mg

regulation juice
Beet greens
• Carbohydrate Spinach
Juices
metabolism
Milk Tomatoes and
• Fluid balance tomato products
Oranges and orange
• Growth and
juice White beans
development
Potatoes and sweet Yogurt
• Heart function
potatoes
• Muscle
contraction
• Nervous system
function
Selenium • Antioxidant Eggs Poultry 55 mcg
• Immune function Enriched pasta and Seafood

• Reproduction rice
Whole grains
• Thyroid function Meats
Nuts

Sodium • Acid-base Breads and rolls Poultry 2,300 mg

balance
Cheese Sandwiches
• Blood pressure
Cold cuts and cured Savory snacks
regulation
meats
Soups
• Fluid balance
Mixed meat dishes
Table salt
• Muscle
contraction Mixed pasta dishes
• Nervous system Pizza

function
Zinc • Growth and Beans and peas Nuts 11 mg

development
Beef Poultry
• Immune function Dairy products Seafood
• Nervous system Fortified cereals Whole grains

function
• Reproduction
• Taste and smell
• Wound healing
Note: mcg = microgram; mg = milligram (adapted from FDA fact sheet)
NUTRIENT ABSORPTION
It is critical for a fitness professional to understand the role the digestive system plays
in nutrient absorption, especially for vitamins and minerals. The gastrointestinal (GI) tract
coordinates and controls the absorption sites for nutrients and helps remove toxins. An
individual with a fully functioning GI tract may absorb more than 95 percent of the food
consumed. Dietary ingredients including vitamins and minerals are absorbed by the cells
lining the inside of the digestive tract and are used for metabolic processes. The pathways
of metabolism depend on nutrients that are broken down to produce energy, which helps the
body build new cells and protein.

Organs such as the esophagus, stomach, and intestines work together to mechanically break
down and digest food in the body. The absorption site of nutrients depends on the type
of dietary ingredient. The duodenum is the first part of the small intestine leading to the
jejunum, which makes up the middle part of the small intestine. This site is responsible
for breaking down and absorbing nutrients, though some nutrients will be absorbed before
reaching the small intestine or after in the ileum.
Esophagus
Fundus
Body
PRINCIPAL ABSORPTION SITES FOR NUTRIENTS
Stomach
Pylorus
Antrum
Minerals Bile
Monosaccharides
Pancreatic
enzymes
Duodenum
Fatty acides, mono Vitamins A&D
and diglycerides
Disaccharides
Water Amino
and sodium acids and
simple Water-soluble
peptides vitamins
Jejunum
Bile salts Ileocecal valve

Vitamin B12
Ileum
Cecum
Ascending colon
Water, sodium,
potassium, vitamin K
Figure 15.1 Principal Absorption Sites for Nutrients
SUPPLEMENTATION AND LIFE STAGES

All stages of life are unique and affect health and disease risk differently. Various guidelines
offer specific recommendations for all life stages, including infants, toddlers, and pregnant
and lactating women. Dietary guidelines from around the world can be found through the
UPPER LIMIT (UL):
The highest level of nutrient USDA’s National Agricultural Library, which provides information on the nutrient needs
intake that is likely to pose necessary to support healthy dietary patterns for people in specific countries. Vitamin and
no risk of adverse effects
for almost all individuals in mineral needs vary during each stage of life. Formulations should address common
the general population.
deficiencies without going over the Upper Limit (UL) suggested for each nutrient.

Some MVMs are made to supplement the general population while others are formulated to
meet specific needs. A great example of this is iron and folate intake needing to be higher for
menstruating women than for men of the same age. The daily recommendations for vitamins
A, B, E, and K and the mineral zinc are based on body size, and since men are typically larger,
they generally need to intake more than women.
A man’s MVM supplement might contain extra lycopene, which has been shown to protect
against prostate cancer. When choosing an MVM supplement, it is important to find the
appropriate one based on sex and age. Children’s vitamins are often made in a chewable
form. They are made with fewer amounts of certain vitamins and minerals because some
vitamins and minerals such as iron may be toxic to children at certain levels. However, for
seniors, nutrients such as vitamins B12 and D are needed in larger quantities and become
more prevalent in MVM supplements.
Ages 4–13
Nutritional requirements for children are higher than those for adults in proportion to body
weight. Rapid growth and development make proper nutrition critical at this age. Unfortunately,
intake recommendations are not based on data specific to children. Instead, adult intake
values are reduced using a mathematical formula that accounts for metabolic body weight
and growth.
Ages 13–18
During puberty, physical changes occur that affect males and females differently. Starting as
young as 10 years of age and going up to 16 years, growth and cognitive development occur,
which require adequate nutrient intake. The period that follows the onset of puberty and
develops a child into an adult is called adolescence. Micronutrient intake during adolescence
decreases in comparison to childhood, with childhood being the period that starts at two
years of age and stops at adolescence. For example, the DV for vitamin A is higher during
childhood. Some adolescents may also require combined calcium-magnesium supplements
if dietary intake is not enough. In addition, many adolescents use sunscreen while outdoors;
therefore, a vitamin D supplement may also be required.

Prenatal, Pregnant, and Breastfeeding
Proper nutrition is important all the time and even more important during pregnancy because
the food women consume is also the main source of nutrients for the baby. It is crucial that
women obtain adequate amounts of iron, folate, calcium, vitamin D, and protein. Maternal
malnutrition may cause neural tube defects, premature birth, or low birth weight. Additionally,
there is an increased risk of anemia as a woman’s body attempts to increase her blood
supply for her baby. Becoming severely anemic during pregnancy has been associated with an
increased mortality rate during labor. Nutrient intake from a nutrition plan and supplements
should ultimately support the mother and growing fetus. A woman’s gynecologist should
provide specific recommendations based on her individual needs.
Micronutrient intake is generally higher for lactating mothers than pregnant women. Exceptions
to this are iron, folate, and calcium, which should be reduced during breastfeeding. Lactating
women who meet the RDA for energy are likely to meet the RDA for all nutrients. To maintain
health, lactating women should follow a nutrition plan consisting of nutrient-rich foods.
Elderly
Beginning at the age of 65, metabolism slows down, and nutrient intake requirements
change. Folate intake should increase to help reduce homocysteine (an amino acid) levels in
the blood. Vitamins B6 and B12 and folate break down homocysteine to create other
chemicals the body needs. High homocysteine levels may indicate a vitamin deficiency.
Without treatment, elevated homocysteine increases the risks for dementia, heart disease,
and stroke. Increasing riboflavin intake may help prevent the development of age-related
INTERNATIONAL UNITS cataracts, a clouding in the lens of an eye and reduce the risk of fracture in women. Aging
(IU):
The quantity of a substance also reduces the capacity for the body to synthesize vitamin D in the skin. Therefore, the
that has a biological effect.
Linus Pauling Institute recommends a daily intake of 2,000 international units (IU) of vitamin
Amount varies depending
on the substance. D. In addition, calcium intake minimizes bone loss and should be at 1,000–1,200 milligrams
(mg) per day. Intrinsic factor (IF), necessary for vitamin B12 absorption in the gut, activity
INTRINSIC FACTOR (IF): also tends to decrease.
A substance secreted by
the stomach that enables
the body to absorb vitamin MEAL REPLACEMENTS
B12.
Meal replacements are generally a prepackaged drink, bar, or powder used to replace a
meal. The addition of vitamins and minerals in meal replacements makes them a convenient
supplement for many individuals. Meal replacements may be popular in weight-loss programs,
low-calorie diets, and even in medical weight-loss programs. Research on meal replacements

proves that they work for weight loss. A meta-analysis of 30 weight-loss studies found that
meal replacements were as effective as traditional meal plans. Participants in these studies
often cited the convenience of meal replacements for weight-loss success. Nevertheless,
fitness professionals should consider what research studies have shown about meal
replacements before suggesting them.
Table 15.4 Meal Replacement Considerations and Research
MEAL REPLACEMENT CONSIDERATIONS AND RESEARCH
Meal replacements significantly increase weight loss during

the first four months of a program.
Program length Supports prolonged weight loss
May be helpful for initial weight loss but not for long-term
maintenance
Meal replacement shakes and drinks are often associated

with weight loss.
Shakes and liquids

Intake with 388 Calories (Cal) in total energy at dinner time
alone contributed to improvement in body composition in men
and women who were overweight or obese.
Solid meal replacements may be better options for weight

loss.
Solid meal
replacements May increase satiety and decrease hunger
SATIETY:
May also increase program compliance over the long term The feeling of fullness and
satisfaction.
There are many factors that contribute to how much people consume and the number of
calories required. When nutrients are consumed in excess of calorie needs, these nutrients
are stored as body fat. Meal replacement shakes are often higher in vitamin, mineral, and
protein content, which can help those seeking lean mass gain. Understanding energy balance
ENERGY BALANCE:
is crucial to knowing when and how to implement meal replacement shakes as a supplement The state achieved when
energy intake is equal to
to food. energy expenditure.
PERFORMANCE SUPPLEMENTS
Fitness professionals want clients to feel, look, and perform their best. Supplementation
beyond a basic MVM aims to get the specific nutrients at the correct place and time to

maximize performance and recovery. Creatine monohydrate (CM) taken pre-workout to

CREATINE maximize high-intensity muscle contractions and strength is an example of this. There are
MONOHYDRATE (CM): undoubtedly many more products and ingredients that prepare the body for exercise, impact
An organic compound that
increases phosphocreatine performance, and enhance recovery.
levels and adenosine
triphosphate (ATP) energy
production leading to Performance supplements contain different ingredients, many of which are vitamins, minerals,
enhanced strength and
power. protein, creatine, and herbs. This category of supplements is intended to improve both activity
and recovery. It includes ergogenic aids, which are specifically taken to improve activity or
performance. The Office of Dietary Supplements lists the following ingredients as popular for
exercise and athletic performance with suggested ULs based on past research studies.
Table 15.5 Popular Fitness Supplements for Exercise and Athletic Performance
EFFECT ON EXERCISE AND

INGREDIENT SAFE GENERAL UL
PERFORMANCE
Vitamin C:
Minimizes free radical damage to 2,000 mg/day
Antioxidants (vitamin skeletal muscle
C, vitamin E, and Vitamin E:
coenzyme Q10) Reduces muscle fatigue, 1,000 mg/day
inflammation, and soreness
Coenzyme Q10: 120 mg
Increases blood flow and delivery

of oxygen and nutrients to muscle
Arginine Up to 9 g/day
Increases secretion of human
growth hormone
Increases synthesis of carnosine,

a dipeptide that buffers changes 1.6–6.4 g/day for up to
Beta-alanine
in muscle pH, reducing muscle eight weeks
fatigue
BRANCHED-CHAIN Dilates blood vessels in exercising

310–682 mg or 2 cups
Nitrate (beetroot
AMINO ACIDS muscle
of beetroot juice 2.5–3
extract)
(BCAAS): Improves energy production hours before exercise
A group of three essential
amino acids (leucine,
isoleucine, and valine) that Branched-chain amino Metabolized by mitochondria in
help the body build muscle Up to 20 g/day in
acids (BCAAs): leucine, skeletal muscle to produce energy
and decrease muscle divided doses
fatigue. isoleucine, and valine during exercise

Table 15.5 Popular Fitness Supplements for Exercise and Athletic
Performance (CONT)
EFFECT ON EXERCISE AND
INGREDIENT SAFE GENERAL UL
PERFORMANCE
Reduces perceived pain and

Up to 400–500 mg/day
Caffeine exertion and increases fat
for adults
metabolism
Improves bone and joint health and

Calcium Up to 2,500 mg/day
helps muscles contract
Increases delivery of oxygen and

Citrulline 6 g/day
nutrients to muscle
Helps muscles generate energy for 3–5 g/day for up to 12

Creatine
short-term anaerobic activity weeks
Metabolism and energy production
Improves immune function and

Glutamine preserves protein stores 0.42 g/kg of body weight
Reduces fatigue and decreases

muscle soreness
Increases oxygen uptake
Reduces heart rate and decreases

Iron Up to 45 mg/day
lactate concentration during
exercise, which in turn increases
blood flow
Note: g = gram; kg = kilogram; mg = milligram.

See vitamin and mineral tables earlier in the chapter for reference
PROTEIN
Resistance and endurance exercise are recommended to build and maintain strength, maintain CATABOLIC:
Metabolic activity involving
and improve health and counteract the effects of aging. Stronger muscles contribute to a the breakdown of molecules
such as proteins or lipids.
more active lifestyle, which supports well-being and good health. Further, maintaining muscle
strength reduces the risk of chronic disease, functional limitations, and physical disability.
ANABOLISM:
Even though resistance training may lessen the catabolic effects of aging, muscle strength The building of complex
molecules in the body
and metabolism still decline with age. Dietary protein supplementation counteracts these from more simple, smaller
molecules.
effects by boosting protein anabolism, and such supplementation is essential to maintain

strength and general health even at a young age. When a client fails to consume adequate
amounts of dietary protein, supplements can help make up for the deficiency. In addition, low-fat
and low-calorie protein sources may be an ideal weight-loss solution for some because they
provide an essential nutrient in a convenient form.
Protein Quality Scoring
To understand the rating scales used to classify proteins, a fitness professional should first
consider what protein is needed for. Protein is made up of amino acids, with some of them
MUSCLE PROTEIN being essential (the body cannot create them) and needing to be consumed from an outside
SYNTHESIS (MPS): source. Others are nonessential, and the body can manufacture them internally from other
A process that produces sources. Dietary protein must be consumed to get these essential amino acids (EAAs),
protein to repair muscle
damage and oppose and certain protein sources are better able to meet the EAA needs of the human body than
muscle breakdown.
others.
BIOLOGICAL VALUE As such, a way of “scoring” a dietary protein source on its ability to meet these essential
(BV): needs was created. The higher the score, the higher the content of EAAs, and the better this
The percentage of protein
used by the body. food source could sustain all of protein’s various functions in the body. However, it is important
for a fitness professional to understand that once EAA needs are met, ingesting more of
BIOAVAILABILITY: them will not cause greater muscle protein synthesis (MPS). Higher-rated proteins can
The amount of a substance
that enters the circulation
simply meet the needs of the body with less total protein. In contrast, eating lower-rated
when introduced into the proteins will raise a client’s total protein intake needs. In addition, the biological value (BV)
body and is effective.
of a protein measures the proportion of absorbed protein from a food that is incorporated
PROTEIN into the proteins of the human body. The BV is measured in percentage values and expresses
DIGESTIBILITY- how readily the digested protein can be used in protein synthesis, which is also known as
CORRECTED AMINO bioavailability.

ACID SCORE
The protein digestibility-corrected amino acid score (PDCAAS) measures the bioavailability
(PDCAAS):
Measures the nutritional of a protein and its amino acid profile. PDCAASs range from 0 to 1.00, but some proteins,
quality of protein.
such as whey protein isolate, can have a score higher than 1.00. This method was adopted
in 2003 with some criticism, for example, about where the nitrogen was measured and the
DIGESTIBLE
target research group of preschool-age children.
INDISPENSABLE
AMINO ACID SCORE The latest measure of protein quality is the digestible indispensable amino acid score (DIAAS).
(DIAAS): Adopted in 2013, it also measures bioavailability and amino acid profile. The difference is that
Measures the amount of
amino acids absorbed by the PDCAAS measures how much protein is absorbed after it leaves the small intestine. These
the body.
scores offer valuable insights when deciding which protein is right for a client.

PROTEIN SOURCES
Meat, poultry, seafood, beans, peas, eggs, and nuts are protein sources. The amount of
protein a client needs depends on many factors including age, sex, and level of physical
activity. Those who are more physically active need extra protein for muscle repair and growth.
It is important to consider the quality of protein and to choose a variety of foods to improve
the health benefits of protein.
Plant-Based Protein
Vegetarian and vegan nutrition plans may lead to insufficient protein intake because plant-
based proteins naturally contain less amounts of total protein compared to animal-based
protein sources. Vegetarians must consume a variety of plant-based foods to obtain the
required amount of amino acids. These foods include legumes, soy products, grains, nuts,
and seeds. Additionally, consuming more plant-based protein instead of animal-based protein
has been shown to contribute to a reduced risk of chronic diseases.
TEST TIP!
Examples of high-protein plant-based foods include:
Legumes
Nuts
Seeds
Soy
Hemp INCOMPLETE
PROTEINS:
A food source that lacks
Many plant-based protein sources are incomplete proteins and do not contain all the EAAs one or more of the nine
essential amino acids.
the body needs to build cells. Soy, chickpea, rice, spirulina, quinoa, oat, and hemp seed
protein are popular alternatives to animal-based proteins. However, sometimes to make a
complete protein, two foods need to be combined and consumed together. Examples of
COMPLETE PROTEIN:
A food source containing all
complete protein combinations include whole wheat toast and peanut butter, beans and rice, nine essential amino acids
the body needs.
and pita chips and hummus.

Table 15.6 BV and PDCAAS of Plant-Based Protein
BV AND PDCAAS OF COMMON PLANT-BASED PROTEIN
Protein Source BV PDCAAS
Soy protein isolate 94 1.00
Chickpeas 53 0.78
Rice 83 0.47
Spirulina 95 1.00
Quinoa 83 0.79
Oats 86 0.59
Hemp seed 86 0.52
Animal-Based Protein
Animal proteins such as meat, eggs, and milk are complete proteins. They contain all the
EAAs the body needs. Other animal-based protein sources are fish, chicken, cheese, bison,
and turkey. These high-quality protein sources contain adequate amounts of vitamin B12,
vitamin D, and zinc, which are all found in larger quantities in animal-based proteins compared
to plant-based ones.
Red meat is also a great source of protein and contains vitamins and minerals essential
to health. For example, red meat contains enough iron to help make DNA and keep red
blood cells healthy. However, there are studies showing that increasingly eating red meat,
particularly processed meat, over a long period of time is linked to an increased risk of
disease and mortality. For this reason, it is important for a client to focus on eating a variety
of animal proteins and to limit unprocessed red meat consumption.
Milk-Based Protein
Whey and casein are two proteins that come from milk, and both contain all nine EAAs. In
milk, casein are the curds, and whey is the liquid. When being processed into a powder,
casein and whey are separated from each other. Whey contains a large amount of the amino
ANTICATABOLIC: acid L-cysteine and is one of the primary proteins found in dairy products. It also provides a
Properties that protect
muscle mass from being large amount of EAAs needed for body function. On the other hand, casein is digested more
broken down.
slowly than whey, which means it releases amino acids gradually and is anticatabolic. This

helps reduce muscle breakdown in circumstances where a client may go a long period of time
without eating. Casein is often consumed prior to sleep because this is generally a long
fasting period.
Table 15.7 BV and PDCAAS of Animal-Based Protein
BV AND PDCAAS OF COMMON ANIMAL-BASED PROTEIN
Protein Source BV PDCAAS
Whey protein isolate 104 1.00
Casein isolate 77 0.78
Fish 76 0.90
Chicken 79 0.95
Beef 80 0.92
Protein Timing
Protein timing is a controversial approach used to optimize training effects, such as muscle
growth and strength gains. It is based on the idea of consuming protein as close to a training
session as possible. This includes before, during, and after exercise.
The general train of thought is that after exercise there is a limited time window during which
protein is needed to increase protein synthesis. A refractory period follows this short window,
REFRACTORY PERIOD:
and it can take a few hours before a spike in MPS can occur again. So, it may be beneficial A window where muscle
protein synthesis (MPS)
to consume a protein supplement before the refractory period.
becomes resistant and
amino acids are used for
A fast-acting protein such as whey that consists of leucine promotes optimal MPS. However, other processes.
insulin is needed for protein and leucine to be effective, which is why a carbohydrate source paired
with protein following a workout is more effective. Some studies report that this combination
results in a larger increase of lean body mass compared to just a protein source alone.
Variables that a fitness professional should consider for total protein needs are a client’s age,
weight, caloric intake, activity level, and goals. The current RDA for healthy individuals is 0.8 grams
(g)/kilogram (kg)/day, and for more active individuals, 1.4–1.6 g/kg/day is appropriate. Claims of
increased muscle mass, increased fat loss, improved performance, and greater recovery influence
the popularity of protein supplements. Consuming such high amounts of protein can be achieved
more comfortably through protein supplements and may help clients reach the RDA.

GLUTAMINE
Glutamine is a conditionally dispensable amino acid found in dietary proteins and made by
the body. It is not an EAA except in times of illness or stress. This is why glutamine plays a
critical role in immune system function and gut health. It is produced naturally in the body,
but supplementation may be beneficial when levels are low. When the body is under excess
stress, such as during injury or illness, glutamine levels decrease. As a precursor for protein,
glutamine supplementation plays a role in metabolism, nitrogen balance, and protein
synthesis. These growth factors involve cell proliferation, which leads to an increase in cell
CELL PROLIFERATION: number and assists with tissue growth.
The process by which a
cell grows and divides to
produce new cells. Glutamine has anticatabolic effects, reduces cortisol levels, and elevates growth hormone
levels. In research studies, glutamine has been shown to be effective in dosages of 2 to
5 g per day. Athletes have been known to consume up to 10 g per day. However, more
current research is needed to establish and confirm any associated benefits. The benefits
are interesting for athletes who engage in prolonged exercise, but beside minimal fatigue
markers, glutamine supplementation seems to have little effect on physical performance.
Another study examined the effects of 30 g of glutamine in type 2 diabetes patients and
showed a significant difference in reduced waist circumference and increased fat-free mass. It
is important for a fitness professional to remember that glutamine is often combined with other
dietary ingredients and ergogenic aids, so the benefits cannot be attributed to just glutamine.
Glutamine is the body’s most abundant free amino acid. It is produced in the muscles and
distributed by the blood to the tissues. During times of stress, the body may use more
glutamine than the muscles can replenish, and muscle wasting can occur. After surgery or
traumatic injury, protein, specifically nitrogen, is necessary to repair wounds and keep the
vital organs functioning. About one-third of this nitrogen comes from glutamine.
OMEGA-3 FATTY ACIDS

Next to an MVM formula, omega-3 supplements are likely the second most commonly known
supplement for consumers. Just as there are EAAs in protein, there are essential fatty acids
in dietary fat. Fats are necessary in a nutrition plan for cellular health, but the typical American
nutrition plan has an unfavorable ratio of omega-6 to omega-3 fatty acids. Simply put, omega-6
fatty acids tend to be pro-inflammatory, while omega-3 fatty acids tend to be anti-inflammatory.

The ratio of omega-6 to omega-3 fatty acids in typical Western diets is approximately 16:1,
with most of those omega-6 fatty acids coming from vegetable oils. This includes sunflower
oil, soybean oil, corn oil, cottonseed oil, and any processed foods that contain them. An
ideal ratio would be 4:1. Fatty and oily fish are known to be the best dietary sources of
omega-3 fatty acids, but many Americans do not consume enough of them. That is why
omega-3 supplementation is highly recommended by most health and regulatory agencies
and organizations worldwide.
Fish oil is a popular supplement taken to increase omega-3 intake, but increasing omega-3
intake to compensate for excess omega-6 fatty acids is not safe. It is crucial to decrease
omega-6 fatty acids when the ratio of omega-6 to omega-3 fatty acids is extremely high. A
ratio that is too high may contribute to increased inflammation in the body and is caused by
consuming too much seed and vegetable oils.
As with any nutrient, supplementation should be considered if a client is not intaking enough
through their nutrition plan. Dietary forms of omega-3 include fatty fish, nuts, seeds, and
some plants. Two servings of fatty fish a week provide beneficial levels of the essential
omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
As with all supplement use, it is best to look for a brand that is third-party validated for
content and certified to be free of mercury and other environmental contaminants. Mercury
is a well-known heavy metal and is linked to many degrees of toxicity. Fish contain mercury
due to industrial sources giving off hazardous air pollutants that fall to the ground and
contaminate the water. Since trace amounts of toxins remain in fish oil supplement products,
it is important to select a brand validated by a third party.
Plant-Based Alternatives
Although DHA and EPA are found mostly in seafood, they are essential nutrients for fish and
other sea creatures. Essential nutrients must be taken into the body from an outside source.
Fish get dietary DHA and EPA from algae and seaweed. This means that DHA and EPA are not
originally found in fish. Instead, fish absorb omega-3 by consuming algae. POLYUNSATURATED
FATS:
Other plant-based sources of omega-3 are chia seeds, alga oil, hemp, walnuts, and flaxseeds. Fat molecules containing
more than one unsaturated
Algal oil is a vegan alternative to fish oil that is high in both DHA and EPA. One study found algal
carbon bond, are liquid at
oil equal to cooked salmon in terms of omega-3 absorption. Omega-3 fatty acids are an essential room temperature, and
solid when chilled.
part of polyunsaturated fats and have been shown to prevent heart disease and stroke.

ERGOGENIC AIDS
An ergogenic aid is a nutritional, pharmacologic, physiologic, or psychologic aid that enhances
exercise capacity. Some techniques, such as carbo-loading, are safe and widely accepted. Others,
such as the use of anabolic-androgenic steroids (AAS), are banned by governing bodies. For this
ANABOLIC- discussion, a fitness professional should recognize that steroids are not dietary supplements.
ANDROGENIC Rather, they are drugs, and when used by healthy individuals with no physiological need other than
STEROIDS (AAS):
Synthetic variations of the desire to look, perform, or recover better, steroids are illegal.
the male sex hormone
testosterone. As for dietary supplements as ergogenic aids, the American Academy of Pediatrics opposes their
use for young athletes. Allergic reactions and GI disorders may result from overusing supplements
and may increase the risk for obesity in children and adolescents when used excessively. When
and if applicable, a fitness professional should first discuss supplement recommendations with
a parent or guardian before making any recommendations to a child or minor. The Academy of
Nutrition and Dietetics, Dietitians of Canada, and American College of Sports Medicine published
their position statement on nutrition and athletic performance in 2016, stating,
Supplement use is best undertaken as an adjunct to a well-chosen nutrition plan. It is rarely
effective outside these conditions and not justified in the case of young athletes.
The effects of certain ergogenic aids must be carefully weighed before choosing to
supplement. In most cases, performance and other gains can be realized through proper
training and a well-balanced nutrition plan. Ergogenic supplement use will not make up for
a poor nutrition plan and training. However, all else being equal and correct, there are some
compounds that can be effective.
CREATINE
Creatine is one of the most researched and effective ergogenic supplements, with the
monohydrate form being the most studied form of creatine. The goal of supplementing with
CM is to increase intramuscular levels of creatine and speed the regeneration of creatine
phosphate (CP), which is expended during energy production. Similar in concept to the carbo-
loading done by endurance athletes to increase glycogen stores, strength and power athletes
load creatine to increase CP levels, delaying its depletion and decreasing repletion time.
Activities dependent on CP as an energy source, including sprinting, resistance training, and
other sports requiring repetitive bursts of speed and power (football, baseball, rugby, hockey,
etc.), could also benefit from creatine supplementation. Creatine increases speed and energy

in short bouts of high-intensity activities or sports, which leads to improved performance.
Since aerobic/endurance activity is not CP dependent, creatine supplementation does not
improve such activities.
Creatine may cause bloating and lead to water weight gain as a result of muscles retaining
more water. In fact, due to the supplement drawing water into the muscles and the potential
for weight gain associated with creatine-loading regimes, performance could theoretically be
impaired. It is inadvisable for beginning exercisers to supplement with creatine. The ability to
enhance muscle contractile strength and power relatively quickly can outpace the neurological
adaptations that allow an exerciser to control those gains, increasing the possibility of an
injury.
Women and men can expect the same types of responses to creatine supplementation. It
is best to prepare a client for the possibility of weight gain, specifically from water retention,
with this supplement. Creatine contains no calories and therefore has no impact on fat
metabolism. However, individual physical responses to creatine supplementation are common,
as with any supplement use. Creatine is an amino acid already naturally found in muscles,
which means some clients may have higher levels than others to begin with. Each individual
converts substances differently, and dietary intake can influence a client’s normal creatine
levels. Since dietary creatine is mostly obtained via animal muscle meats (beef, chicken,
etc.), those who do not consume these foods often or at all will respond more dramatically
to creatine supplementation.
BETA-ALANINE
Beta-alanine (BA) is a nonessential amino acid produced naturally in the body. It aids in the
production of other protein building blocks, such as carnosine, and plays a role in muscle BETA-ALANINE (BA):
A nonessential amino acid
endurance during high-intensity exercise. BA supplementation has been shown to increase
that is naturally produced
skeletal muscle levels of carnosine, which is an intramuscular pH buffer and antioxidant. by the body.
Supplementing with BA can lower exercise-induced acidosis, potentially delaying fatigue and
improving performance. In addition, free radicals are produced at an accelerated rate during ACIDOSIS:
When the kidneys and lungs
exercise and are thought to contribute to exercise-induced damage and fatigue. cannot keep the body’s pH
in balance due to excess
Supplementation with BA may reduce these negative effects in exercising muscles and help acid in body fluids.
maintain performance levels.
A systematic review of BA supplementation found moderate- to high-quality studies supporting
the findings that BA may increase power output and training capacity, decrease feelings
of fatigue and exhaustion, and have positive effects on body composition and carnosine

content. Carnosine is a protein building block that is naturally produced in the body and
mainly found in working muscles. In addition to muscle function, carnosine plays a role in
heart and brain function by preventing cell damage. Carnosine studies show intake ranges
of 4 to 6 g/day for at least two weeks to improve exercise performance. The most common
side effect noted in BA supplementation is paresthesia. This is a harmless side effect and
results in a numbness or tingling feeling in the face and neck.
Branched-Chain Amino Acids
Branched-chain amino acids (BCAAs) are a group of three EAAs including leucine, isoleucine,
and valine. Leucine is an essential BCAA, and EAA formulas have been shown to play a role
in MPS. Isoleucine and valine aid in muscle development, increase endurance, and promote
muscle recovery and repair.
These EAA formulas, and leucine itself, stimulate MPS via a regulatory “switch” called the
“mammalian target of rapamycin complex 1.” Studies have shown benefits such as increased
and more rapid recovery following exercise, increased MPS (especially in older and elderly
populations), decreased muscle protein breakdown, and reductions in muscle soreness.
The body uses amino acids to make proteins, which are the building blocks to cell, tissue,
and organ function. BCAAs play an important role in metabolism including muscle growth,
recovery, and repair while leucine and isoleucine specifically promote blood sugar control.
However, the body requires all the EAAs for optimal benefits such as reducing exercise fatigue
and improving energy metabolism.
STIMULANTS
Stimulants are often used in sports to enhance performance and by those seeking faster
STIMULANTS: weight loss. These substances speed up body systems and elevate alertness, mood, and
A class of drugs that
temporarily improve awareness. They can raise heart rate, temperature, blood sugar, and blood pressure; constrict
physical or mental function.
blood vessels; and open the pathways of the respiratory system. In addition, they can
decrease feelings of hunger or fatigue. Many stimulants can be addicting, but each has its
own unique effects. They are often found in supplements, as seen with caffeine in energy
drinks, which are often used to boost energy during workouts. Stimulants change the way the
brain works by altering how nerve cells communicate. For example, they can cause a buildup
of dopamine in the brain, making an individual feel intense pleasure and increased energy.

Caffeine is a popular stimulant that shows some benefit during exercise through increases in
epinephrine. Epinephrine, also known as adrenaline, is a hormone produced by the adrenal
glands and helps break glycogen down into glucose for usable energy. It also significantly
increases power output for trained and sedentary clients. Research shows that caffeine may
have a greater effect on mood and reaction time in abstained caffeine consumers compared
to those who habitually consume caffeine.
Energy drinks often contain guarana, taurine, L-carnitine, and ginseng. Unfortunately, there
is not enough existing research on these ingredients to determine whether they have any
effect on energy separately or together. For example, L-carnitine may reduce fatigue for elderly
people with low muscular endurance. However, other research on L-carnitine has found no
influence on low-intensity, long-duration cardio exercise.
“Ginseng” is a general term that includes several different types of plants. Plants that fall
under the “ginseng” label include ashwagandha (Indian ginseng), Eleutherococcus senticosus
(Siberian ginseng), Eurycoma longifolia Jack (Malaysian ginseng), and many others. With such
a variety of ginseng options, it is difficult to know which kind is used in energy drinks and
what effects it might have.
BANNED SUBSTANCES
Some ergogenic aids have been banned for use by many organized sports organizations
to prevent unfair advantages. Once an athlete consumes and exceeds certain levels of
ergogenic aids, the side effects increase. Ergogenic aids are used to provide athletes with a
competitive advantage and must be monitored. Part of the reason for their ban is the fact that
they often have contaminants that can be harmful to health. They may also be listed as “not
for human consumption” in some cases. Some ergogenic aids are available for therapeutic
use monitored by a physician.
AAS are known for increasing muscle size and strength. A physician may prescribe steroids
to treat hormonal issues including low testosterone or disease-related muscle loss. However,
outside of a physician’s care, the use of steroids is inadvisable. A fitness professional should
remember that AAS are not dietary supplements but drugs, and as such AAS exceed a
personal trainer’s scope of practice.

TEST TIP!
Negative Mental Health Effects of AAS
• Paranoid jealousy
• Extreme aggression
• Delusions
• Impaired judgment
• Mood swings
Physical Effects
• Increased risk of liver disease
• Increased risk of cardiovascular disease
• Hypertension
• Acne
• Baldness
Effects in Men
• Shrinking testicles
• Breast growth
• Reduced sperm count
• Impotence
• Reduced sex drive
• Increased risk of prostate cancer
Effects in Women
• Deep voice
• Growth of facial and body hair
• Abnormal menstruation
• Enlarged clitoris
• Decreased breast size
Effects in Teens
• Premature puberty
• Stunted growth (closure of growth plates)

BOTANICAL SUPPLEMENTS
Botanical preparations are marketed in the US as dietary supplements and can include
nutrients such as herbs, enzymes, organ tissues, amino acids, and vitamins and minerals. A
botanical is a plant or plant part containing various medicinal properties. Due to their benefits
on health, they have become increasingly popular. A fitness professional should keep in mind
that they are not labeled as drugs but rather as dietary supplements because, by law, the
manufacturers of supplements cannot claim their products treat or prevent any disease.
Botanical supplements are used to maintain or improve health by supplementing a nutrition
plan with various health benefits. They come in many forms including fresh and dried
plants, plant parts, and extracts. The safety of botanicals is determined by the makeup of
the supplement, how the body responds to it, and the amount or dosage consumed. Each
botanical is consumed for different reasons ranging from fat loss to immune system function,
better sleep, and reduced anxiety. The following botanicals were selected for their popularity
and prevalence in the health and fitness industry.

Table 15.8 Botanical Supplements
BOTANICAL PRIMARY USAGE RESEARCH NOTES
Reduce anxiety, Most research is done Dosages vary

Cannabidiol
improve sleep, and on mice, not humans. depending on form
(CBD)
increase weight loss Results are inconclusive. and use.
Proven effective as an Taking 2 g/day shows

Lower blood sugar
antidiabetic compound anti-inflammatory
Cinnamon by increasing insulin
and may reduce properties and lower
sensitivity
cholesterol blood sugar levels.
Results vary but show

Build up the immune
a reduction in length No optimal dose or
Echinacea system and protect
of sickness with type
against allergies
supplementation.
Consistent findings
Can be supplemented
Antioxidant and for increasing HDL
via a nutrition plan or
anti-inflammatory and decreasing LDL
aged garlic capsules.
Garlic properties that protect by 10–15 percent
Taking 300 mg/day
against allergies and reduces blood pressure
has been shown to
build immunity and frequency of the
manage hypertension.
common cold.
May increase HDL

and decrease LDL.
Improve the movement No research regarding
Reduces inflammatory
of food in the stomach gut health, increase in
Ginger markers. Comes in
for gut health and testosterone found in
forms such as fresh
increase testosterone infertile men
or dried roots, tablets,
and liquid extract.
May reduce LDL, lower

Increase fasting blood glucose,
Fat loss effect is minor
Green tea norepinephrine and increase oxygen
and unreliable
induce fat loss uptake, and reduce
muscles soreness

Table 15.8 Botanical Supplements (CONT)
BOTANICAL PRIMARY USAGE RESEARCH NOTES
Does not suppress Has a desired effect

appetite, may increase on appetite and weight
Hoodia Increase fat loss
blood pressure and loss. Little available
heart rate research in humans.
Promote cell repair May reduce acne

No research to support
Milk thistle for liver health and lesions with direct
claims
detoxification application to the skin
Not effective at Mixed and

Increase testosterone
increasing testosterone inconsistent findings
Saw palmetto levels and improve
or suppressing prostate regarding sexual
prostate health
growth function
May reduce menstrual

Improve sleep and Research points to no pain and symptoms of
Valerian
reduce anxiety effect. PMS. Commonly used
before bedtime.
Note: g = gram; HDL = high-density lipoprotein; LDL = low-density lipoprotein; mg = milligram
reference the vitamin and mineral tables earlier in this chapter

CHRONIC CONDITIONS
CHAPTER 16
LEARNING OBJECTIVES
1 | Explain the risk factors for hypertension.
2 | Identify safe and effective fitness interventions the positively impact blood
glucose.
3 | Define the different types of arthritis.
4 | Define conditions and behaviors that contribute to heart disease.
5 | Explain exercise considerations for people with asthma.

CHAPTER 16 | Chronic Conditions
There are many chronic conditions a client may have or may develop over their lifetime. A
chronic condition is a health condition or disease that has long-lasting effects. Many are
related to lifestyle and eating patterns and can be addressed with modifications of the same.
However, some chronic conditions are hereditary and require additional adjustments and
considerations. A fitness professional must have a clear understanding of common chronic
conditions they may encounter for several reasons: first, to identify the limitations a client may
have; second, to better create an effective training program with these limitations in mind;
and third, to identify if and when a client should be referred to a health care professional for
further guidance or modifications to treat a chronic condition.
It is important for the trainer to understand that the information presented in this chapter
does not qualify them to adequately serve demographics with chronic conditions. It is meant
HYPERTENSION: to provide foundational knowledge the trainer can then build upon. Fitness professionals
High blood pressure reading who desire to serve populations with chronic conditions should seek out advanced training,
stay within their scope of practice, and always refer to other professionals when appropriate.
Personal trainers should also be aware of clinical practice guidelines and work to collaborate
BLOOD PRESSURE:
The force of blood pushing with a health care team as a supporting professional.
against the walls of the
Before designing a program, a personal trainer should use the client intake paperwork to
phases of the cardiac cycle.
collect subjective and objective data on a client. This will help identify any potential chronic
SYSTOLIC: conditions. The trainer may also choose to require a physician’s approval before the client
The pressure in blood begins a fitness program.
vessels when the
heart beats (ventricular
contraction).
EXERCISE AND HYPERTENSION
The Centers for Disease Control and Prevention (CDC) reports that one in three adults in the
DIASTOLIC:
United States has high blood pressure (HBP) or hypertension. Individuals with hypertension
vessels when the heart typically have blood pressure readings of over 140 systolic and 90 diastolic, and this can be
rests (ventricular filling).
problematic if they are considering starting an exercise program. Hypertension increases the
risk for the two major leading causes of death for Americans: heart disease and stroke.
STROKE:
When the blood flow to the Unfortunately, there are no signs or symptoms to alert an individual to any problems. The only
brain is interrupted long
enough to cause damage. way to diagnose the condition is by regularly checking one’s blood pressure.
Of the roughly 75 million people suffering from hypertension, only about half of them have it
RISK FACTORS: under control. Increasingly, youth are being diagnosed with hypertension, and experts expect
Variables associated with
increased risk of disease or a steady rise in diagnosed cases for both populations. Although this condition is silent, there
infection.
are risk factors to watch for that may help with prevention and/or early detection.

Lifestyle choices relating to diet and exercise affect blood pressure. Preexisting or current
health conditions, including family history, also put individuals at a higher risk for developing
hypertension.
Medications are often prescribed to control blood pressure, although leading research and
treatment organizations suggest the first course of action should be lifestyle modification. Recent
meta-analyses have established that both aerobic and resistance exercises can lower diastolic
blood pressure. Even a small numerical drop in blood pressure values, such as 3 mm Hg, improves
an individual’s chances of surviving a heart attack by 5 percent and stroke by 8–14 percent.
Postexercise hypotension (PEH) is the term used to describe the initial drop in blood pressure
POSTEXERCISE
within the first minutes after an exercise session. Symptoms can present themselves in the form
HYPOTENSION (PEH):
of fatigue, hearing difficulties, nausea, dizziness, and fainting. Not all individuals may present A drop in blood pressure in
the first minutes after an
symptoms, so the personal trainer should remain vigilant. Initial studies regarding PEH have been exercise session.
conducted on participants in walking and running programs as well as after bouts of resistance
training, high-intensity interval training, yoga, and, most recently, playing active video games.
It is important to make sure clients are well hydrated and incorporate active recovery periods
within the workout when clients appear to be struggling during the session. Additionally, the
personal trainer should collaborate with the health care provider to help clients develop
healthier lifestyle habits, even if hypertension is hereditary, to prevent concurrent conditions

HEREDITARY:
from developing and negatively impacting client health. Relating to the biological
process responsible for
passing on traits from one
TEST TIP! generation to another.
The prefix “hyper” is a Greek word that means “over.” The difference between
hypertension and hypotension can be distinguished by remembering this as someone
with hypertension has HIGH blood pressure. The opposite would be hypotension.
BLOOD PRESSURE RISK FACTORS

To manually measure blood pressure, a cuff is wrapped around the arm just above the elbow.
The cuff is inflated while the practitioner listens to the pulse at the anterior space of the
elbow where the upper arm and forearm meet. The first number is the systolic and is recorded
when the pulse is first heard. The air in the cuff is then slowly released, and the diastolic is
MILLIMETERS OF
recorded when the pulse can no longer be heard. Electronic blood pressure monitors can also MERCURY:
be used but, while convenient, may not be as accurate. Values are measured in millimeters The measure of a unit of
pressure.
of mercury, or mm Hg. For example, the final value is written as 120/80 mm Hg.

Table 16.1 Blood Pressure Levels
BLOOD
SYSTOLIC DIASTOLIC
PRESSURE
Normal Less than 120 mm Hg Less than 80 mm Hg
Prehypertension 120–139 mm Hg 80–89 mm Hg
Hypertension 140 mm Hg or higher 90 mm Hg or higher
There are many risk factors for developing hypertension. For most clients, HBP is the result
OBESITY: of a combination of factors such as obesity, an unhealthy diet, and physical inactivity, as well
An abnormal or excessive as smoking and alcohol consumption. A personal trainer can determine if a client is at a high
accumulation of bodyfat
that may cause additional risk for hypertension by conducting a thorough evaluation before the first training session.
health risks.
Obesity
Obesity is linked to higher levels of low-density lipoprotein (LDL) cholesterol and triglycerides
and lower levels of high-density lipoprotein (HDL) cholesterol. When artery walls are hardened
DIABETES: and narrowed with cholesterol plaque, the heart must work harder to pump blood through
A condition characterized by
them, increasing intravenous pressure. Obesity is a major risk factor for hypertension.
an elevated level of glucose
in the blood.
Diabetes Mellitus
ATHEROSCLEROSIS: Diabetes impacts the body in a few ways that may contribute to increased blood pressure. It
The buildup of fats, changes the way the body manages insulin and damages blood vessels. This leads to
cholesterol, and other
substances in the artery reduced nitric oxide levels, which regulate blood pressure. Low levels of nitric oxide in the
walls.
blood can lead to atherosclerosis.

TEST TIP!
About 6 out of 10 people who have diabetes have high blood pressure. This
means nearly 60 percent of people with diabetes mellitus have hypertension.
Diabetes causes sugars to build up in the blood. The body will naturally try to get
rid of excess sugar by urinating, leading to dehydration. This not only leads to
increased blood pressure but also increases the risk for heart disease.
Unhealthy Diet
There are many components to one’s diet that increase the risk for hypertension. High sodium
and low potassium consumption are two components that increase blood pressure. Sodium
intake can increase water retention, which in turn will increase blood flow resistance. It is
important to counterbalance high levels of sodium with potassium. Potassium helps excrete
sodium through urine and lessens resistance in blood vessels.
Physical Inactivity
Sedentary behaviors play a major role in developing hypertension. Staying physically active
helps prevent weight gain and lessens the chance of other health issues developing. It is
recommended to achieve at least thirty minutes of physical activity per day to lower the risk
of hypertension.
Alcohol Consumption
Excessive alcohol consumption can raise blood pressure. The mechanism as to how this
occurs remains inconclusive, but there are theories. One suggested mechanism is that too
much alcohol creates inflammation within the body, which then creates oxidative injury to
blood vessels. To avoid these negative effects, it is recommended to avoid alcohol or to
drink in moderation. According to the Dietary Guidelines for Americans, moderate drinking is
up to one drink a day for women and up to two drinks a day for men. Alcohol can contribute
to unhealthy weight gain and may create a narrowing of blood vessels, both of which may
compound and increase the effects of preexisting HBP.
Tobacco
Smoking can make breathing difficult and reduces the amount of oxygen that blood carries.
Chemicals in tobacco, such as nicotine, damage lung tissue and arteries and lead to
increased blood pressure.

As a reminder, the above information can be used to identify whether a client is at a high risk
for hypertension, not to diagnose it. Small lifestyle modifications can help to reduce one’s
risk for chronic disease and promote longevity.
PROGRAM DESIGN
Improvements in diastolic blood pressure, strength, and cardiorespiratory fitness, and an
increase in lean body mass can occur within eight weeks. These changes impact the health
of the client, reducing the risk of HBP. However, one study that followed participants over the
course of eight weeks noted no change in systolic blood pressure. Therefore, eight weeks
may not be enough to start seeing improvements, so a 12-week program may be best.
A client should not expect to see changes in their blood pressure values until around week 12
in their training. Many studies have demonstrated a drop of about 3 mm Hg in systolic blood
pressure after a 12-week fitness program. Again, this has significant value as it reduces
cardiac and stroke morbidity.
Exercise Options
For clients with blood pressure over 160/100 mm Hg, their doctor should be consulted
before beginning a weight-lifting routine as heavy resistance can temporarily increase blood
pressure. Clients should not perform heavy overhead lifts but should vary exercises between
the upper body and lower body.
Table 16.2 Exercise Options for Hypertension
TYPE OF ACTIVITY FITNESS PRESCRIPTION
150-minute moderate-intensity exercise per week

Cardiorespiratory
Or 75 minutes of vigorous activity
exercise
Or any combination of moderate and vigorous activity
Moderate-high intensity exercise two days per week.

CONCURRENT Resistance exercise
Increase intensity over time, warm-up, and cooldown.
TRAINING:
Including both
Clients can also perform circuit training known as concurrent training, which may be the
cardiorespiratory exercise
and resistance training into most efficient way to help clients lower blood pressure and reduce hypertension risk. It has
a fitness program.
a better overall impact on cardiovascular disease risk factors.

SPECIAL CONSIDERATIONS
COMPETENCY:
Safety is always a top priority for fitness training. The main goal of designing a fitness program The ability to do something
is to help the client integrate exercise into their lifestyle. Educating the client is a key component successfully or efficiently.
of helping the client develop competency and autonomy. Coaching points include the instruction
of breath control, intensity control, and incorporating both a warm-up as well as a cooldown. AUTONOMY:
The need for self-
governance and control
Controlled Breathing over one’s own behaviors.
It is important to advise the client not to hold their breath. Holding the breath while exercising
increases intravenous pressure and may cause syncope and injury. Additionally, it is best to SYNCOPE:
Temporary loss of
avoid using the Valsalva maneuver for those who have HBP. This maneuver is a technique consciousness related to
insufficient blood flow to
used among some weight lifters to engage the core and maximize force production. It is the brain.
particularly used when lifting heavy weight.
Maintaining Intensity VALSALVA MANEUVER:

The act of forcibly exhaling
with a closed windpipe,
If a client is taking medication to control blood pressure, then it is necessary to adjust how the
where there is no air that
maximum heart rate is determined. Beta blockers block specific receptors to reduce the effects is exiting via the nose or
mouth.
of signals sent to increase heart rate. When these receptors are blocked, the heart does not
receive messages to speed up and maintains a slower rate and lower blood pressure.
BETA BLOCKERS:
One of the most widely
Thus, to determine the maximum heart rate, a different equation must be used: prescribed classes of drugs
to treat hypertension.
162 – (0.7 x age) = estimated maximum heart rate (HRmax)
Another appropriate measure for clients with hypertension is the talk test. If clients can carry TALK TEST:
The ability to speak during
a full conversation, they can pick up the pace. If brief exchanges are manageable, with the exercise as a gauge of the
relative intensity.
need to pause and breathe, the pace is just right. Clients should slow their pace when short
sentences make them out of breath, or if they need to stop frequently.
Warm-Up and Cooldown
A warm-up is essential for clients with HBP as it allows the blood vessels to slowly expand
to accommodate greater blood flow. A gradual warm-up should help the client achieve their
target heart rate. At least 10 minutes is necessary, more if the client has been inactive for a
long time. The cooldown at the end of the workout is equally important. It is important to not
allow the client to immediately stop activity. The personal trainer can include flexibility or yoga
postures to slowly bring the client’s heart rate back to pre-exercise values. A proper cooldown
will also reduce muscle soreness.

Healthy Food Choices

DIETARY
APPROACHES TO STOP Dietary suggestions should be handled carefully. Personal trainers should check local laws to
HYPERTENSION (DASH) determine what information they are allowed to dispense within legal parameters. In most
DIET: cases, it is acceptable to share widely published general nutrition knowledge. In this case,
A low-sodium, whole-
food diet created for the personal trainers may suggest the Dietary Approaches to Stop Hypertension (DASH) diet.
treatment of hypertension.
This DASH diet promotes eating plenty of vegetables, fruits, and whole grains. It suggests
limiting fatty foods and sugars. This means eating fish, poultry, beans, and nuts but avoiding
fatty meats, dairy, and tropical oils. Clients should choose foods that are low in sodium, low
in saturated and trans fats, and rich in potassium, calcium, magnesium, fiber, and protein.
Figure 16.1 DASH Diet
INSULIN: EXERCISE AND DIABETES

A hormone produced in the
pancreas to regulate blood When someone eats a meal, the food is converted into energy for the body to use. In healthy
sugar.
individuals, the pancreas secretes insulin. Insulin regulates many metabolic processes that
provide cells with energy. This helps the cells collect glucose from the blood to turn it into energy.
HEART DISEASE: In the case of diabetic clients, the body either doesn’t make enough insulin to collect glucose
A term used to describe
several different heart from the blood, or the body doesn’t use the insulin efficiently. In either case, what results is
conditions.
excess glucose in the blood, leading to heart disease, vision loss, or kidney disease over time.

Men with diabetes are two to three times more likely to suffer a cardiovascular disease-
related event than men without diabetes. Women with diabetes are three to five times more
CARDIOMETABOLIC:
A combination of metabolic
likely than women without diabetes to suffer the same. Also, deaths related to myocardial dysfunctions mainly
characterized by insulin
infarction (heart attack) for men and women with diabetes are double that of their healthy resistance, impaired
glucose tolerance,
counterparts. Diabetes negatively impacts the body through cardiometabolic conditions. dyslipidemia, hypertension,
and central adiposity..
Prediabetes is the presence of diabetic indicators that are above normal and may possibly
evolve into type 2 diabetes without proper intervention and control. In the US, one in three PREDIABETES:
adults have prediabetes, many of whom have no idea they have the condition. Type 1 diabetes A condition where blood
glucose is higher than it
makes up just 5 percent of diagnosed cases of diabetes, while type 2 diabetes makes up the should be, but not in the
diabetes range.
remaining 90–95 percent. Cases of diabetes have more than tripled in the last 20 years,
costing over $325 billion in medical expenses and lost work and wages. Prediabetes, type 2
TYPE 2 DIABETES:
diabetes, and gestational diabetes are lifestyle diseases and can be reduced or prevented A long-term metabolic
disorder that is
by participation in a lifestyle modification program.
characterized by high blood
sugar, insulin resistance,
and relative lack of insulin.
TEST TIP!
A personal trainer can remember the purpose of insulin by thinking of insulin as
TYPE 1 DIABETES:
the door of a castle that controls when glucose gets “in.” A chronic condition in which
the pancreas produces little
or no insulin.
TYPES OF DIABETES
All carbohydrates are broken down into glucose in the blood. When the pancreas cannot GESTATIONAL
produce insulin, the body is unable to transport this glucose from the blood to cells in the DIABETES:
A condition characterized
body. As a result, blood glucose levels rise, which leads to hyperglycemia. There are three by an elevated level of
glucose in the blood
main types of diabetes with each disease determined by insulin response.
during pregnancy, typically
resolving after the birth.
Type 1 Diabetes
Type 1 diabetes is thought to be an autoimmune response in which the body attacks and HYPERGLYCEMIA:
Elevated blood glucose.
destroys its own beta cells in the pancreas that make insulin. Nutrition and lifestyle habits
do not cause this condition, and individuals with type 1 need to take insulin shots (or wear
an insulin pump) every day.

NORMAL TYPE 1 DIABETES
Figure 16.2 Type 1 Diabetes
Type 2 Diabetes
INSULIN RESISTANCE: Type 2 diabetes is a preventable condition caused by unhealthy lifestyle habits. In this
An impaired response condition, cells do not respond normally to insulin, so the pancreas makes more to try and
of the body to insulin,
increasing levels of blood signal the cells to work. The pancreas cannot keep up with the demand and begins to shut
glucose.
down. This is known as insulin resistance.
Figure 16.3 Type 2 Diabetes
Gestational Diabetes
This condition occurs in pregnant women who do not have diabetes. Roughly 2 to 10 percent
of pregnancies develop gestational diabetes. With all the physiological changes that happen
in a woman’s body during pregnancy, the body becomes insulin resistant, increasing the need
for insulin. Some cases may be controlled by diet, and others need insulin injections. In most
cases, it is resolved after the birth.

Exercise is a proven, safe, and effective intervention to lower blood glucose. When muscles
contract during movement, cells can absorb glucose from the blood with or without insulin.
During and after physical activity, insulin sensitivity is increased, and muscle cells will use
available insulin to uptake glucose for energy. This is how exercise lowers blood glucose in
the short term and how it gradually lowers hemoglobin A1c (HbA1c) after a regular physical
HEMOGLOBIN A1C
(HBA1C):
activity program is implemented. The higher the glucose concentration in the blood, the higher A minor component of
the level of HbA1c. hemoglobin to which
glucose is bound.
RISK FACTORS
HYPOGLYCEMIA:
There is a chance that blood glucose may become too low. Hypoglycemia can happen quickly The condition of lower-than-
and needs to be treated immediately. Hypoglycemia can happen when there is too much normal blood glucose.
insulin in the body, when a client has waited too long without a meal or snack, if they haven’t
eaten enough, or if they’ve already exercised or engaged in some sort of physical activity.
Symptoms of low blood sugar are different for everyone but may include the following:
• Shakiness
• Nervousness or anxiety
• Sweating, chills, or clamminess
• Irritability or impatience
• Dizziness and difficulty concentrating
• Hunger or nausea
• Blurred vision
• Weakness or fatigue
• Anger
• Stubbornness or sadness
At the same time, there are many risk factors for developing diabetes or hyperglycemia.
Before prescribing a workout program, it is important to determine if any of the following are
true. If so, clients are at a higher risk of developing diabetes.
Being Overweight
Being overweight is a primary risk factor for prediabetes, type 2 diabetes, and gestational
diabetes. It is not a risk factor for type 1 diabetes. Diet and lifestyle choices don’t affect
type 1 diabetes because it is an autoimmune response (immune system attacking otherwise
healthy cells). Though, all other types of diabetes can develop from having excess bodyfat,
which is a direct result of nutrition and lifestyle choices. When a client’s bodyfat increases,
their body becomes more insulin resistant.

Age
Diabetes can develop at any age, but the risk of prediabetes increases after age 45. The risk
of developing type 2 diabetes also increases after age 45. Type 1 diabetes is more likely to
develop as a child, teen, or young adult, and gestational diabetes can occur at age 25. There
is evidence showing a strong relationship between age of onset and type 2 diabetes. This
research also shows that type 1 diabetes is most common in youth, accounting for more than
85 percent of all diabetes cases below the age of 20.
Family History
Family history is a strong indicator of the likelihood of developing diabetes. In most cases,
the risk of prediabetes increases when a client has a parent or sibling with type 2 diabetes.
Family medical history represents many genetic factors that can develop in the future. It is
important for clients to know if they are at risk and immediately make necessary changes to
their diet and lifestyle.
Physical Activity
Inactivity is a lifestyle choice that puts clients at a greater risk for prediabetes. Keeping
clients engaged in physical activity helps prevent unhealthy weight gain. Exercise promotes
effective use of insulin within muscle cells. This leads to the breakdown of sugar, which is
used as energy, limiting glucose buildup in the blood.
Gestational Diabetes
POLYCYSTIC OVARY If a woman has diabetes during pregnancy or gives birth to a baby over nine pounds, she will
SYNDROME:
be at a higher risk for developing prediabetes. The child is also at a higher risk of developing
A hormonal disorder
common among women of prediabetes. Women with polycystic ovary syndrome have a higher risk of prediabetes too.
reproductive age.
Ethnicity
Ethnicity is a risk factor for all types of diabetes. Black, Hispanic, American Indian, and Asian
American people are at a higher risk for prediabetes and type 2 diabetes. African American,
Hispanic and Latino American, American Indian, Alaska Native, Native Hawaiian, and Pacific
Islander ethnicities are at a high risk for gestational diabetes. The Caucasian ethnicity is one
of the only risk factors for type 1 diabetes.

PROGRAM DESIGN
First, it is important to have a physician’s approval before moving forward. When meeting
with a new client for the first time, a personal trainer should ensure they have visited with a
diabetes educator. They must have a current record of blood sugar readings and know their
signs and symptoms. Knowing how to treat their hypoglycemia or hyperglycemia is important.
Low- to moderate-intensity activity is safe and effective for helping clients with prediabetes and
RETINOPATHY:
type 2 diabetes lower the risk of a cardiovascular disease event and developing other complications Disease of the retina that
results in impairment or
associated with diabetes. Clients with existing retinopathy, neuropathy, or nephropathy may also
loss of vision.
safely participate. However, vigorous activities such as high-impact exercise or heavy lifting should
be avoided as they may increase the risk for a cardiac event or other injuries.
NEUROPATHY:
Disease or dysfunction
Moderate- to high-intensity training has been shown to reduce the risk of death for clients with of one or more peripheral
nerves, typically causing
diabetes regardless of their age, level of education, body mass index (BMI), blood pressure, numbness or weakness.
total cholesterol, or smoking status. Exercise has also demonstrated a protective effect for
clients at any level of BMI, blood pressure, cholesterol, or smoking. Although exercise is NEPHROPATHY:
generally advisable for clients with diabetes, there are some contraindications to be mindful of. Disease or damage of the
kidney.
Clients with type 1 or type 2 diabetes, who also have advanced peripheral neuropathy or
proliferative retinopathy, should avoid vigorous aerobic activity and heavy lifting. Clients may ADVANCED
still engage in low- to moderate-intensity aerobic activity and light resistance training. At each
PERIPHERAL
NEUROPATHY:
session, the personal trainer and client should discuss when the client last ate. A client’s A result of damage to
peripheral nerves that
current blood glucose reading will reflect how long ago a client consumed food. Clients should
often causes weakness,
have necessary insulin or glucose pills available for additional support during exercise. numbness, and pain.
Some data suggests that by working with a trained health and fitness professional, clients
PROLIFERATIVE
can reduce the risk of developing type 2 diabetes by 58 percent or up to 71 percent for clients RETINOPATHY:
over 60 years of age. When developing a fitness program for this demographic, small and An overgrowth of blood
vessels around the retina.
sustainable lifestyle changes can be implemented. Clients should be educated on healthy
food choices and finding ways to manage stress. Motivation and encouragement help clients
as they face difficulties and setbacks. Clients shouldn’t be instructed to change too much
too soon. In addition, adequate sleep is essential. Finally, working with clients with diabetes
should be a collaborative effort with health care providers, family, and friends.

COMORBIDITIES:
The simultaneous presence
Any client with prediabetes, type 1 diabetes, or type 2 diabetes, with or without diagnosed
of two chronic diseases or comorbidities, should be required to undergo specialized screening by their physician before
conditions in a person.
getting started with a physical fitness program.
EXERCISE STRESS In addition, an exercise stress test is recommended for all persons with type 2 diabetes who
TEST: have been diagnosed with one or more comorbidities, such as cardiovascular disease, eye
An assessment that
usually involves walking problems, nerve problems, and kidney problems. This includes clients who have greater-than-
on a treadmill or riding a
stationary bike while heart normal waist circumference, increased triglycerides, hypertension, advanced age (age 60 or
rhythm, blood pressure, and
breathing are monitored. over), a history of smoking, and a family history of cardiovascular disease.
Monitoring blood glucose before and after exercise is necessary to prevent hypoglycemia,
KETOACIDOSIS: hyperglycemia, and ketoacidosis which is an overproduction of ketones. This must be a
A serious complication of
diabetes that occurs when collaborative effort between the fitness professional and client.
the body produces high
levels of blood acids called
ketones. Tracking this data helps the trainer and client become familiar with how the client’s blood
glucose responds to exercise. The trainer can then use this data to demonstrate the benefits
KETONES: of physical activity to the client and track how the client’s body reacts to different activities.
By-products of the
breakdown of fatty acids. In addition to monitoring clients’ blood glucose, foot care is important for clients with diabetes
as well. Peripheral neuropathy, a complication of diabetes, can reduce pain sensations in the
feet and mask injuries or issues. Clients should wear cotton socks and well-fitted athletic
shoes appropriate for the activity. After each exercise session, the client should check their
feet for sores, blisters, irritation, cuts, or other injuries.
Clients should also stay well hydrated during exercise and follow general nutritional guidance
to help with fat loss and heart health. Diabetes self-care requires much of the individual
and can become mentally and emotionally draining. Willpower is not enough for clients to
succeed. The personal trainer must be a source of inspiration, motivation, and education and
be encouraging, helping clients view setbacks as opportunities for growth and helping them
develop habits around self-care that are simple, enjoyable, and rewarding.
EXERCISE AND ARTHRITIS

Arthritis, inflammation of the joints, comes in several forms and impacts the lives of over 50 million
Americans. That number is expected to rise to almost 80 million people by 2040. The following
list includes a description of each form, signs and symptoms, and causes and risk factors, and
general guidelines are presented for creating safe fitness programs for this demographic.

Table 16.3 Arthritis Conditions
CONDITION DESCRIPTION
A degenerative joint disease caused by wear and tear of the joints. The
OSTEOARTHRITIS:
hands, hips, and knees are most typically affected by osteoarthritis, Degeneration of joint
Osteoarthritis causing loss of strength, reduced flexibility, reduced proprioception, and cartilage and the underlying
bone.
joint pain. Over 30 million US adults have this condition, 68 percent of
whom are over 65 years old.
An autoimmune and inflammatory disease that most commonly affects RHEUMATOID
Rheumatoid
the hands, wrists, and elbows. About 1 percent of Americans have this ARTHRITIS (RA):
arthritis (RA) A chronic progressive
condition; two-thirds are women.
disease causing
A condition that causes pain all over the body, sleep problems, inflammation in the joints.
Fibromyalgia fatigue, and emotional and mental distress. Clients with this
(FM) condition have abnormal pain perception processing, a side effect of FIBROMYALGIA (FM):
the condition, which causes them to be much more sensitive to pain. A chronic disorder
characterized by widespread
An inflammatory arthritis that affects one joint of the body at a time— musculoskeletal pain,
typically the big toe. This condition comes and goes unpredictably. fatigue, and tenderness in
Gout localized areas.
When the disease is active, it is called a flare, and when it is dormant,
it is called a remission.
ABNORMAL PAIN
PERCEPTION
Osteoarthritis
PROCESSING:
In this condition, the cartilage within a joint breaks down, causing friction between bones and An increase in the
subjective interpretation of
worsening over time. Friction within the joint causes pain or aching, stiffness, reduced range discomfort due to abnormal
sensory processing in the
of motion, and swelling. In some cases, osteoarthritis reduces function and causes disability. central nervous system.
TEST TIP!
GOUT:
The prefix “osteo” refers to bone. This helps to make it clear that osteoarthritis A disease in which
defective metabolism of
is a breakdown and inflammation of the bone within a joint.
uric acid causes arthritis.
Rheumatoid Arthritis
FLARE:
With RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This can A sudden surge in
rheumatoid arthritis
cause long-lasting pain, poor balance, and deformities in the joints. As this condition is an
inflammation.
autoimmune response, pain and aching, stiffness, tenderness, and swelling occur in more
than one joint and on both sides of the body, whereas osteoarthritis may only present in one
REMISSION:
joint, unilaterally. Clients with RA may lose weight, suffer from fevers, fatigue, and weakness. A significant reduction in
symptoms and signs of
Fibromyalgia rheumatoid arthritis.
Clients diagnosed with FM will experience the disease differently. Pain and stiffness all
over the body, fatigue, depression and anxiety, sleep problems, headaches (migraines),
and problems with thinking, memory, and concentration are common. Some clients may

experience numbness or tingling in the hands and feet and pain in the face or jaw, as well as
digestive problems such as pain, bloating, constipation, or irritable bowel syndrome.
Additional complications include more hospitalizations, reduced quality of life, and high rates
of depression and death from suicide and injuries. The exact causes of fibromyalgia are not
known, but theories include genetics, infections, physical or emotional trauma, and stress.
Gout
Though gout usually only occurs in one joint at a time—the big toe, lesser toe joints, ankle,
or knee—it is intensely painful and accompanied by swelling, redness, and heat. This occurs
HYPERURICEMIA:
An abnormally high level of due to hyperuricemia, or too much uric acid in the body. Uric acid crystals build up in the
uric acid in the blood.
joints, fluids, and tissues.
All joints are required for movement, which is why arthritis pain and stiffness can be perceived
as a barrier to physical activity. Many clients with arthritis will avoid leisure activities they
once enjoyed and may miss work due to pain or immobility. The resultant inactivity causes
muscle atrophy and weakness, leading to further reductions in activity and muscle wasting.
Although science does not support the notion, many people (some physicians included) still
believe that intensive weight-bearing exercise causes undue stress on the joints, increasing
disease activity and causing further joint damage. Still, others believe that physical activity,
such as playing elite sports, causes arthritis and should be avoided. However, studies
observing the joints of arthritis sufferers found similar degeneration in the joints of former
athletes and the general population.
The key to success for clients with arthritis is a well-designed fitness program that addresses
the specific needs and goals of the client. Though it will take between six and eight weeks for
joints to get used to a new level of activity, the long-term benefits of exercise can help clients.
RISK FACTORS
Prior to describing exercise program design, it is important to understand the many risk
factors associated with arthritis. Some risk factors, such as obesity and overuse, can play a
critical role in day-to-day exercise prescription.
Age
The chance of developing rheumatoid arthritis and osteoarthritis increases with age. The
highest onset for rheumatoid arthritis is around age 60 while most cases of fibromyalgia are
diagnosed by middle adulthood. Aging causes bones to become less dense or more fragile.
This changes the composition of bone and cartilage.

Sex
Women are more prone to rheumatoid arthritis and osteoarthritis. About two to three times more
women than men have RA while osteoarthritis is more common in women after age 50. Two times
more women than men have fibromyalgia. And more males than females are diagnosed with gout.
Obesity
Obesity is a major risk factor for all forms of arthritis. This includes rheumatoid arthritis,
osteoarthritis, fibromyalgia, and gout. Being overweight places a greater load on the joints and
increases stress. This leads to breakdown of cartilage at a faster rate, especially at the knees.
Genetics HUMAN LEUKOCYTE

Genetics is a risk factor for rheumatoid arthritis and osteoarthritis. One of the most significant ANTIGEN (HLA):
Genes that help the
risk factors for rheumatoid arthritis is human variation in genes called human leukocyte immune system distinguish
the body’s own proteins
antigen (HLA). These genes or proteins regulate the immune system. When they don’t from foreign antigens.
function, the body becomes more at risk for rheumatoid arthritis.
Overuse
Osteoarthritis involves the breakdown of cartilage in the joint. This is caused by wear and
tear on the joint over time. Overuse is also a risk factor for fibromyalgia. Pain and stiffness
throughout the body can be exacerbated by overuse.
Smoking
Individuals with certain genes who are exposed to cigarette smoke are more likely to develop
RA. Children exposed to smoke are two times more likely to develop RA as an adult than
children who are not. Smoking can worsen symptoms of arthritis.
Health History LUPUS:

A chronic autoimmune
Women who have never given birth are at a greater risk of developing RA, and a protective disease that creates
effect has been found when women breastfeed. Comorbidities such as lupus or RA put inflammation and pain in
various parts of the body.
clients at a higher risk for having fibromyalgia. Family history and post-traumatic stress
disorder (PTSD) are also risk factors for fibromyalgia. For gout, certain health conditions such
POST-TRAUMATIC
as congestive heart failure, hypertension, and diabetes put clients at a higher risk. STRESS DISORDER
(PTSD):
Nutrition A persistent mental and
emotional stress that
Poor nutrition is a risk factor for many health conditions. When it comes to arthritis, gout is occurs as a result of injury
or psychological shock.
the most affected by diet. Drinking alcohol and eating or drinking food or beverages high in

fructose increase the risk of gout. A diet high in purines—red meat, organ meat, anchovies,
PURINES: sardines, mussels, scallops, trout, and tuna—can make gout even worse.
A number of biologically
important compounds, such
as adenosine, caffeine, and
uric acid.
PROGRAM DESIGN
Clients can rest assured that exercise is safe and will be effective at helping to manage
symptoms, reduce arthritis pain, and reduce or prevent complications of comorbidities. The
literature supporting physical activity in the treatment of arthritis far surpasses previous
findings that were contradictory. But as previously mentioned, it is best to start low and go slow.
To begin, a fitness trainer should conduct a thorough assessment. In addition to gathering
objective data via the PAR-Q and questionnaires, subjective data can be collected by doing
physical assessments. The focus should be on functional muscle strength and posture.
Arthritis exercise programs must focus on range of motion, isometric strength (tension with
no movement), isotonic strength (tension with movement), and functional strength (tension
doing specific activities) just like anyone else. Greater emphasis on a complete warm-up
along with extra caution used when progressing exercises will be necessary.
Clients should perform a warm-up and slowly move joints through their full range of motion.
Then they can begin isometric exercises, performed every other day. Isometric movements
place the least amount of stress on joints.
After one to two weeks, depending on the client, isotonic exercises can be implemented.
Isometric exercises can be gradually replaced to continue strengthening muscles. Once
the client has a foundation of strength built, functional exercises can be incorporated.
Appropriate activities include but are not limited to swimming, walking, table tennis, and
dancing. Clients should avoid running and contact sports to reduce the risk of injury or
aggravating the disease.
Aerobic Exercise
Clients can start with as little as 5 or 10 minutes of physical activity, two or three times per
day, until they can reach the following recommendations:
• 150 minutes of moderate-intensity aerobic activity, or

• 75 minutes of vigorous-intensity activity, or
• A combination of moderate- and vigorous-intensity exercise (one minute of vigorous
activity is similar to two minutes of moderate-intensity activity).
• Including low-impact exercises such as brisk walking, cycling, swimming, water
aerobics, light gardening, group exercise classes, or aerobic dance classes.

Clients should incorporate flexibility training daily. Applying moist heat for 10 to 15 minutes
even before stretching helps warm the connective tissue to avoid injury. In addition, the
fitness trainer should advise clients to work on balance at least three days per week for 10
to 15 minutes per session. Exercises may include walking backward, standing on one foot, or
tai chi. These can be included before or after an aerobic exercise session.
Strength Training
Personal trainers can help clients slowly meet the following recommendations for strength
training. Suggesting that clients take pain medication before a workout should be avoided.
Instead, trainers can work with clients to find the right time of day to exercise—when pain and
discomfort are minimal, and joints are flexible.
Clients should aim for two to three days per week of resistance training. Some research has
found that training two times per week produces about 80–90 percent of the strength gains
achieved by training more frequently. But with the many fears clients face regarding exercise,
starting out with just a couple of days per week will enhance program adherence, making it
more difficult for clients to cite time constraints as an excuse. Clients should allow for 48
hours of rest between sessions.
It is reasonable to expect clients to achieve intensity levels around 80 percent of their one-
repetition max (1RM) if they are allowed to slowly progress. Fitness programs can begin
with single-set workouts of 6 to 10 exercises to move each of the major muscle groups.
Even though single sets may not produce the same adaptations as multisets, clients will
benefit from a more consistent, less time-consuming fitness regimen. Dropout rates go up
dramatically when clients are required to exercise for more than 60 minutes, so clients
should stick with whole-body fitness sessions. The added benefit is that whole-body workouts
often result in greater overall strength and muscle hypertrophy, as well as improvements in
aerobic capacity and endurance performance, than traditional split routines.
Suggested Exercise Progression for Those with Arthritis*
Week 1: one set of 15 repetitions at 60 percent 1RM
Week 2: two sets of 15 repetitions at 60 percent 1RM
Week 3: three sets of 15 repetitions at the same intensity
Weeks 4–6: three sets of 12 repetitions, increasing to 70 percent 1RM
Weeks 7–24: three sets of 8 repetitions, progressing to 80 percent 1RM

*Progression used in one scientific study on rheumatoid arthritis with positive results

One- to two-minute rest periods between sets appears to be optimal to suit the needs of
this demographic. In addition, using a 4:0:2:0 tempo (four-count eccentric to two-count
concentric) has produced the most favorable results. Finally, it is important to teach clients
how to breathe through movements to avoid the Valsalva maneuver and the resultant rise in
blood pressure.
Many of the recommendations made for general health are the same for persons with arthritis
and include self-management skills, physical activity, engaging in group fitness programs,
scheduling regular visits to the doctor, and maintaining a healthy body composition.
However, when arthritis is coupled with other health conditions, clients may find it difficult
to meet specified guidelines. Certain comorbidities, such as heart disease, diabetes, and
obesity, respond positively to increases in physical activity and improvements in diet, but in
addition to citing lack of time, competing responsibilities, lack of motivation, and difficulty
finding enjoyable activities, clients with arthritis cite other disease-specific barriers to fitness.
Clients can have a fear of making arthritis pain worse or causing additional joint damage.
A fitness professional is responsible for helping eliminate uncertainty about how much and
which type of exercises are safe for joints.
The CDC suggests the following SMART plan of action for clients with arthritis:
S: starting low and going slow
M: modifying activity when symptoms increase but trying to stay active
A: activities should be “joint-friendly”
R: recognizing safe places and ways to be active
T: talking to a health professional or certified exercise specialist
A fitness professional can help clients follow these guidelines and add the accountability,
encouragement, and education they need to stick with it. When coaching clients, they should
be educated on the benefits of exercise for their condition and taught proper exercise
techniques, including form, breathing, and tempo. It is important to help clients find activities
they enjoy and that are accessible.

Clients should integrate fitness into their lifestyle, rather than being forced to rearrange their
life around fitness. A fitness professional should teach activities that clients can do safely
with little equipment or fear of injury. And it is important to set expectations. For example,
mild aches and pains are expected after a good workout session; joint swelling or stiffness
means modifications should be made.
EXERCISE AND CORONARY HEART DISEASE

According to the CDC, every 40 seconds someone in the United States has a heart attack,
which is roughly 790,000 Americans per year. Of those, just over 25 percent are individuals
who have already had a heart attack. Perhaps the most devastating statistic, though, is that
20 percent of those heart attacks are silent—the heart attack occurs, the individual doesn’t
know it happened, and the damage to the heart is done.
Heart disease is the leading cause of death in the US for both men and women, and the
leading cause of heart attacks is coronary artery disease (CAD). Sometimes a severe CORONARY ARTERY
spasm, while other times a sudden contraction of the coronary artery, stops the blood flow to DISEASE (CAD):
The narrowing or blockage
the heart, causing a heart attack. of coronary arteries.
However, clients with coronary heart disease (CHD) who participate in regular exercise
increase their life expectancy, decrease the risk of future coronary heart disease-related
events, reduce symptoms of CHD, and lessen the physical response to exercise exertion.
Positive health behaviors, such as exercise, help clients manage their health and take an
active role in their recovery from a heart attack.

HEART DISEASE
Coronary artery disease is the most common type of heart disease in the US and is a result
of a buildup of plaque (cholesterol) in the wall of the arteries. This gradual process is called
atherosclerosis. Over time the arteries narrow and become less elastic, making it more
difficult for the heart to pump blood to the body and for the blood to return to the heart.
Atherosclerosis is a silent condition. Eventually, the heart doesn’t get enough blood, and the
individual experiences chest pain or discomfort.
Table 16.4 Other Heart-Related Conditions
CONDITION DESCRIPTION
This is an irregular or unusually fast or slow heartbeat. Two types

of arrhythmia include ventricular fibrillation, which may lead to
Arrhythmia
death if not treated right away with an electrical shock, called
defibrillation, and atrial fibrillation, which may cause a stroke.
The heart becomes enlarged or stiff. This makes it harder for the
Cardiomyopathy
heart to pump blood to the rest of the body.
Also called congestive heart failure, this is when the heart is too
Heart failure weak to pump blood to meet the body’s needs. Fluids build up in
the lungs, liver, gastrointestinal tract, arms, and legs.
The blood vessels in the arms and legs become narrowed or

Peripheral
stiff—usually the cause of atherosclerosis—and blood flow is low
arterial disease
or fully blocked.
Angina is the most common symptom of CAD and progressively weakens the heart muscle,
ANGINA: leading to an arrhythmia or even heart failure. In many cases, a heart attack is the first
A condition marked by
severe chest pain. symptom an individual with heart disease experiences.
RISK FACTORS
Almost half of all Americans have at least one key risk factor for developing heart disease.
These include hypertension, high cholesterol, and smoking. Other conditions and behaviors
that contribute to increased risk are being overweight, obesity, diabetes, poor diet, inactivity,
and excessive alcohol consumption.
Obesity
Having excess body fat contributes to bad cholesterol and lowers good cholesterol. It leads
to HBP and diabetes, which are risk factors of their own. Consuming a diet high in saturated
fats, trans fat, and cholesterol is linked to heart disease.

Physical Inactivity
Being inactive leads to unhealthy weight gain and fat buildup in the arteries. This causes
damage to the blood vessels and leads to cardiovascular disease. It is important for clients
to achieve at least 30–60 minutes of aerobic exercise three to four times per week.
High Blood Pressure
HBP puts extra stress on coronary arteries. Hypertension becomes a major risk factor for
heart disease when a buildup of plaque becomes present. This plaque is a buildup of fat,
cholesterol, and other substances in the blood and leads to atherosclerosis.
Smoking
Cigarette smoking also increases the amount of plaque buildup in blood vessels. The narrower
the arteries become, the more blood clots present. This leads to HBP and is a major risk
factor for heart disease.
Diabetes
High blood sugar damages the nerves that control the heart. Those with diabetes are more
likely to have HBP and other health conditions that contribute to the risk for heart disease.
A buildup of sugar in the blood can damage blood vessels and increase the force of blood
through the arteries.
PROGRAM DESIGN
If a client has heart disease, it is likely they have had a CAD-related event and participated
in a cardiac rehabilitation (CR) program. The CR program has four phases: acute phase,
subacute phase, intensive outpatient therapy, and independent ongoing conditioning. This
program may last 12 weeks or more and is beneficial in the recovery process. However, less
than half of all patients eligible for outpatient programs enroll after discharge from acute
care.
Clients who have had a cardiac event but have not completed their CR should be advised to do
so before exercising on their own or with a personal trainer. If a client has completed the first
three phases of a CR program and is now in phase four—independent ongoing conditioning—
the personal trainer can proceed as usual by collecting the physician’s approval letter and
initial intake paperwork and conducting fitness assessments.

Aerobic exercise intensity should gradually increase until the client can participate in the
following recommendations:
• 150 minutes of moderate-intensity aerobic activity per week, or
• 75 minutes of vigorous-intensity aerobic activity per week, or
• any combination of the two.
Low exercise capacity contributed more to early death from a heart attack than other major
risk factors. Clients with low exercise capacity—those who are afraid to begin an exercise
program because they are weak or deconditioned—benefit most from exercise programs.
These clients can see improvements in exercise capacity from 16 to 46 percent after
moderate-intensity and vigorous-intensity exercise programs, respectively. Improved exercise
capacity protects against the incidence of heart attack and improves chances of survival
after a first episode. Clients should be closely monitored during exercise sessions for signs
and symptoms of a heart attack.
In a 2005 survey, only one in four respondents were aware of all the major symptoms of a
heart attack. When working with clients with a history of heart disease, it is essential the
personal trainer know the signs and symptoms of a heart attack and how to respond. All ISSA
certified trainers are required to maintain a current CPR with AED and first aid certification.
The signs and symptoms of a heart attack include the following:
• Chest pain or discomfort
• Upper-body pain, such as in the arms, back, neck, jaw, or upper stomach
• Shortness of breath
• Nausea, lightheadedness, or cold sweats
If some, or all, of these symptoms are present, the fitness professional should immediately
call 911.
The Henry Ford Exercise Testing Project tested the exercise capacity of nearly 30,000 men
and women around the age of 53 and then followed up with participants 11 years later.
What they found was not that the major risk factors—hypertension, hyperlipidemia, obesity,
diabetes, and smoking—were associated with the deaths of participants (almost 7 percent
had died during the study). Rather, low exercise capacity contributed more to the risk of death
after the first heart attack.

Educating clients on the importance of exercise and diet is part of the personal trainer’s
job, but the trainer should help clients develop the skills necessary to maintain or improve
their health. Clients who feel in control of their health outcomes are more likely to adhere to
healthy lifestyle habits, such as exercise and eating a heart-healthy diet, than clients who do
not feel in control.
Those who do not participate in exercise say they feel too tired, lack motivation, don’t like
the soreness or discomfort associated with exercise, feel that exercise is boring, say they
have no time, or are afraid they are too weak or deconditioned to start a fitness program.
For these clients, simply providing instruction is not enough. Coaching should increase the
client’s readiness for change, build self-efficacy, enhance self-motivation, and gradually build
adherence to long-term healthy habits.
EXERCISE AND ASTHMA

ASTHMA:
Asthma is a chronic respiratory disease that afflicts roughly 300 million people worldwide. A respiratory condition
marked by spasms in
Scientists expect another 100 million cases by 2025. Asthma is characterized by airway
the bronchi of the lungs,
inflammation, airway hyperresponsiveness, and reversible airway obstruction. Unfortunately, causing difficulty in
breathing.
in most cases, doctors don’t know the causes of asthma; however, having a family history of
the disease increases the likelihood someone will have it.

HYPERRESPONSIVENESS:
The acute, early phase of
What most people associate with this condition is asthma attacks. Asthma attacks are an asthma attack.
triggered by irritants that cause the airway to constrict. Triggers are different for each person,
but some common triggers include the following: TRIGGERS:

Any chemical, irritant, or
• Tobacco smoke allergen that causes an
inflammatory response of
• Dust mites the airways.
• Outdoor air pollution
• Cockroach allergen
• Pets
• Mold
• Smoke from burning wood or grass
• Infections such as flu HYPERVENTILATION:

To breathe at an abnormally
Other less common triggers may include physical exercise, some medicines, cold and dry air,
rapid rate, increasing the
some foods, food additives, and fragrances. Even strong emotions such as stress, anxiety, or rate of loss of carbon
dioxide.
fear may lead to hyperventilation and an asthma attack.

Asthma can be controlled by medicine. Some medicines are inhaled while others are taken
in pill form. Quick-relief medications control the symptoms of asthma attacks, and long-term-
control medications help to reduce the number and severity of attacks but are not helpful
during an asthma attack.
Another method of controlling asthma is exercise. Sedentary lifestyles and deconditioning
play key roles in the development of symptoms in obese clients with asthma. However,
exercise has been proven to improve airway hyperactivity, psychosocial factors, and health-
related quality of life. Exercise also reduces airway inflammation.
RISK FACTORS
Once someone is diagnosed with asthma, they have it forever, and asthma attacks may
happen at any time. The airways resemble a tree with many branches, with the airways getting
smaller the further out they branch. When an asthma attack occurs, the sides of the airways
swell and shrink. Less air gets in and out of the lungs, and mucous created by the body clogs
the airways further. There are many risk factors that increase the signs and symptoms of an
WHEEZING:
Breathing with a whistling asthma attack. Signs and symptoms include wheezing, shortness of breath, tightness in the
or rattling sound in the
chest. chest, and coughing. Some attacks may resolve on their own, while others will require the
help of medication.
Sex
Asthma occurs in children and more often in boys than girls. Young males often have smaller
airways than young females. As children grow older and reach age 20, the numbers for males
and females who have asthma become closer. At age 40, more females have adult asthma
than males.
Family History
Genetics increases the risk of asthma. According to the CDC, if a person has a parent with
asthma, they are three to six times more likely to develop asthma than someone who does
not have a parent with asthma.
Allergies
Indoor allergies and outdoor allergies are risk factors. Dust mites, mold, and pollen can
trigger acute asthma. Triggers are different for each person, but environmental factors are
known to trigger signs and symptoms of asthma.

Smoking
Any exposure to cigarette smoke in the prenatal and postnatal stages increases the risk of a
child getting asthma. Smoking creates inflammatory responses in the lungs and airways. This
puts excessive stress on lung function and obstructs airflow.
Obesity
Obesity is a risk factor for asthma because it increases leptin (a hormone that inhibits hunger)
in the body. This produces a pro-inflammatory response in the lungs. Excess weight around the
chest can constrict the lungs and make it difficult to breathe. Fat tissue leads to asthma in clients.
ASTHMA CONDITIONS
Overweight and obese clients are 38 and 92 percent more likely to develop asthma, CORTICOSTEROIDS:
A group of natural and
respectively, than clients with a healthy BMI. Obesity also makes disease management much synthetic steroid hormones
produced by the pituitary
more difficult. Clients with asthma who are also obese report worse clinical control of their gland.
symptoms, poorer quality of life, reduced lung function, reduced response to corticosteroids,
and more psychosocial (behaviors influenced by social factors) symptoms. However, weight
loss improves asthma symptoms, improves management and control over the disease, and
reduces the need for medication. EXERCISE-INDUCED

BRONCHOCONSTRICTION
Table 16.5 Table 15.8 Botanical Supplements
(EIB):
Asthma attack triggered by
Condition Description doing sports or physical
activity.
Exercise-induced asthma, also called exercise-induced
bronchoconstriction (EIB), is diagnosed as a 10 percent
Exercise-induced GASTROESOPHAGEAL
or more reduction in FEV1 (forced expiratory volume) after
bronchoconstriction (EIB) REFLUX DISEASE
exercise. This may sometimes be the only sign that a
(GERD):
client has asthma. A condition in which acidic
gastric fluid flows backward
Clients with gastroesophageal reflux disease (GERD) are into the esophagus,
resulting in heartburn.
more likely to develop asthma than healthy clients, and
Gastroesophageal reflux between 50 and 80 percent of clients with asthma report
disease (GERD) symptoms of GERD. The trainer and client must also be CHRONIC
aware that medications may increase GERD-related OBSTRUCTIVE
symptoms. PULMONARY DISEASE
(COPD):
Chronic obstructive pulmonary disease (COPD) may
A lung disease
Chronic obstructive coexist with asthma, especially in clients who have characterized by chronic
obstruction of lung airflow
pulmonary disease asthma and smoke. However, the symptoms of COPD and
that interferes with normal
(COPD) asthma are similar and hard to distinguish and should be breathing and is not fully
reversible.
properly diagnosed by a medical professional.

Other side effects related to asthma include muscle dysfunction and reduced functional
capacity. Clients with asthma are more likely to be inactive because of disease symptoms.
Disuse leads to deconditioning and further disuse. Because asthma influences the amount
of oxygen taken into the body, fatigue is a common side effect, especially in the lower
extremities. Clients may not feel like they are having an asthma attack but may feel like they
need to stop exercising because their legs are tired.
PROGRAM DESIGN
When designing a training program for the client, the training environment should be free
from allergens and pollutants that could trigger the client’s asthma. Checking outdoor air
quality before a training session should dictate whether a client will train outside on the
track or inside on the treadmill. In cold, outdoor environments, clients should wear a mask or
scarf. Choosing sports with intermittent bouts of activity, such as tennis, volleyball, softball,
or baseball is ideal. Clients should stay properly hydrated and allow for both a warm-up and
a cooldown.
When it comes to resistance training, assessments can be used to determine appropriate
training loads. The personal trainer can assess the client’s target heart rate before beginning
aerobic training, beginning at 50–60 percent of VO2 max and increasing slowly, about 5
percent every two weeks. Clients with asthma should not exercise in excess of 80 percent
VO2 max.
Using a heart rate monitor is ideal, but clients may also use the Borg RPE scale to share
perceived level of exertion. Sixty percent of VO2 max is about equal to 12 or 14 on the Borg
scale. Throughout the exercise session, the personal trainer can ask clients to rate leg
discomfort and difficulty breathing.
Clients with asthma benefit from exercise and should be encouraged to be more active. The
program and disease management will get easier with time, but realistic expectations should
be set, and appropriately trained staff should be available in case of respiratory emergencies.
ACTION PLAN: SPECIAL CONSIDERATIONS

A set of individualized
written instructions, In some situations when working with clients with chronic conditions, including clients with
designed with a doctor, that asthma, it is necessary to collect the action plan they created with their physician. The
details how a person with
asthma should manage fitness trainer and relevant personnel should have copies of this document and know where
their asthma at home.
to find the client’s medications and how to use them. Information found on the action plan

includes the client’s symptoms, broken down into green, yellow, and red categories. There
should also be a list of medicines, along with how much the client should take and when to
take them. Emergency contact numbers should also be listed.
Athletes
Athletes seem to have a higher prevalence of asthma than the general population. Sometimes,
however, athletes will have respiratory symptoms similar to asthma without actually having
asthma. It is important, then, that clients who report having asthma provide a letter from their
physician with their diagnosis and action plan.
Symptoms vary during different periods of life. Athletes may not have had asthma in childhood
and may not have any symptoms following their sport career. Children with asthma may not
experience symptoms during adolescence, but symptoms may return later in life. If a client
has been diagnosed with asthma but hasn’t had symptoms in a while, they still have asthma
and must have an action plan and medications available during exercise sessions.
Medications GLUCOCORTICOIDS:
A group of corticosteroids
Certain asthma medications can alter muscle fiber size and type. High doses of glucocorticoids involved in the metabolism
of carbohydrates, proteins,
cause muscle atrophy and loss of strength, a side effect called steroid myopathy. This
and fats.
impacts the muscle contractile system and may lead to reduced motor function and ventilatory
performance.
STEROID MYOPATHY:
Weakness primarily to
Psychosocial proximal muscles of
the upper and lower
Anxiety, depression, and panic disorders are more frequent in clients with asthma than the extremities and neck
caused by treatment with
general population. It is important to note that a client who has been diagnosed with both corticosteroids.
asthma and depression may not adhere to exercise programs or asthma treatment programs
in follow-up visits with health care providers to ensure the successful management of the
disease.

LIFESPAN
CHAPTER 17
POPULATIONS
LEARNING OBJECTIVES
1 | Explain effective exercise methods for youth based on their age and
development stage.
2 | Name common fitness-related health considerations for older adults.
3 | Describe effective elements of fitness for senior populations.
4 | Discuss exercise and fitness options for women during pregnancy.
5 | Define adaptive fitness and the ways a fitness professional can make
fitness more accessible.

CHAPTER 17 | LifeSpan Populations
Designing individualized training programs for every client is key to a personal trainer’s long-term
success. However, the needs of a client vary by individual, and those needs also change throughout
the different stages of life. Therefore, it is essential for a fitness professional to understand the
mental and physical differences of the various stages of life to effectively program and coach clients.
EXERCISE AND YOUTH

Children are naturally active in most cases, but they can still benefit from regular exercise.
Active children can handle the physical and emotional challenges of childhood, may experience
fewer physical injuries as their bodies grow, and may sleep better, which supports healthy
development. Unfortunately, not all children are as active as they should be to experience the
benefits and build lifelong healthy habits as they grow. In fact, research has found a number
of alarming conclusions concerning exercise and youth:
OBESITY: • Worldwide, childhood obesity rates have tripled since the 1970s.
An abnormal or excessive • 17 percent of children (ages 6–11) are classified as obese (United States).
accumulation of bodyfat
that may cause additional • Over 21 percent of adolescents (ages 12–19) are obese (United States).
health risks.
• Only 5 percent of American adolescents are meeting recommendations for sleep,
exercise, and screen time.
SCREEN TIME: • Only 3 in 10 children and 1 in 10 adolescents meet daily recommendations for
The time spent using a
device such as a computer, physical activity and screen time.
television, smartphone, or
games console. • 30 percent of children and 50 percent of adolescents do not meet the
recommendations for either physical activity or screen time.
In many cases, an inactive (sedentary) lifestyle and technology advances that make it easier
for children to remain inactive have been named as primary causes of the declining health
status of youth. Poor eating habits are another major contributor to the rise in childhood
obesity. There are many consequences to inactivity and obesity, but these consequences
can be minimized with the introduction of physical activity. A child with excess bodyfat can
experience health complications, including:
• hypertension,
• high cholesterol,
• type 2 diabetes,
• coronary heart disease,
• stroke,
• osteoarthritis,
• cancer,
• sleep apnea and breathing problems, and
• depression, anxiety, and other mental disorders.

According to data from the Centers for Disease Control and Prevention (CDC) in the United
States, any elementary school classroom likely has at least one child with hypertension and
another three children with elevated blood pressure. Similarly, type 2 diabetes was once
considered a condition that developed in adulthood but is now seen more frequently in young
children with a 21 percent increase in youth diagnoses between 2001 and 2009. MOTOR SKILLS:
The ability to learn and
manage the process of
Childhood obesity and poor health related to physical inactivity can also decrease quality of moving the body in a
coordinated way.
life, impact brain structure and function, and negatively impact motor function and coordination.
In healthy kids, play and socialization opportunities help children develop motor skills—the
ability to learn and manage the process of moving their bodies in a coordinated way. When a
SOCIAL
STIGMATIZATION:
child is unable to develop the correct motor skills and meet developmental milestones at a The disapproval of, or
young age, they may experience physical setbacks as they mature. discrimination against,
a person based on
perceivable social
In addition to the physical challenges, being overweight or obese often leads to mental characteristics.
stumbling blocks. Children who are obese may become victims of social stigmatization,
discrimination, and bullying. These detrimental interactions can increase the likelihood of BULLYING:
An unwanted, aggressive
anxiety, depression, dysfunctional eating patterns, and low self-esteem for young people. behavior among school-
aged children that involves
a real or perceived power
BENEFITS OF EXERCISE imbalance.
Science has identified many positive effects of exercise in youth. We know that children
and adolescents need at least one hour of physical activity each day, including two to three DYSFUNCTIONAL
days per week of high-intensity aerobic activity, resistance training, or bone-strengthening EATING PATTERNS:
May include behavior
exercises. Research has also found that commonly associated with
eating disorders, such
• children who participate in physical fitness programs have higher self-concepts than as food restriction, binge
eating, and purging.
those who are inactive;
• children who participate in aerobic exercise programs have the potential to increase
COGNITIVE
their self-efficacy, creativity, self-esteem, internal locus of control (belief that the FUNCTIONING:
individual is responsible for their own success), test scores for cognitive functioning, An intellectual process
by which one becomes
and classroom behavior; aware of, perceives, or
comprehends ideas.
• adolescents who follow a muscular strength program benefit from a 20–35 percent
reduced risk of premature mortality;
• physically stronger adolescents were 15–65 percent less likely to have psychiatric
(mental health) problems; and
• adolescents who participate in resistance training can reduce their risk of suicide
by 20–30 percent.

The benefits of strength training in youth populations include:
• increasing muscle endurance and strength,

• improving bone density,
• reducing risk of physical injury,
• improving self-esteem, and
• improving athletic performance.
Strength has been shown to improve with both high- and low-load resistance training, although
muscular size gains are not significant during childhood. Much of these improvements may
be due to neuromuscular improvements as muscles are recruited more efficiently and more
muscle fibers are engaged in movement patterns. For this reason, load should only be
increased once proper exercise form and technique have been learned and demonstrated.
Children between the ages of 6 and 10 years of age can support strength development
by incorporating resistance training into games (play) and simple exercises or movement
patterns. However, children can begin low-volume, low-intensity strength training with an
emphasis on foundational exercises and proper form as young as 7 or 8 years old. When
children reach the ages of 11 to 14, they can begin to implement circuit training and strength
exercises using light free weights with low to medium volume and low intensity. By the ages
of 15 to 18, adolescents can begin specialized training for specific sports and athletic
endeavors. By this age, training volume and intensity can be increased, and more equipment
variety can be introduced.
There are also benefits of cardiorespiratory training for youth, including:
• improving heart and lung capacity and function,

• reducing excess bodyfat,
• reducing the risk of depression,
• reducing the risk of general diseases (heart disease, cancer, type 2 diabetes, etc.), and
• promoting healthy blood pressure.
Endurance cardiorespiratory training for young children should have an emphasis on fun and
games such as relays and races to keep children engaged. Once children reach puberty, their
PUBERTY: hormones begin to change, as do their bodies and physical capabilities. At this life stage,
The period of hormonal
change in an adolescent children can experience greater improvements in endurance training and can begin to
where they reach sexual
maturity. specialize their training to promote skill development specifically. For example, research
suggests that athletes progressing through puberty can physiologically endure longer-duration
activities and drills such as sprinting and interval training.

Plyometrics aims to increase muscular power and is often the focus of youth training. When
proper form and technique are coached, plyometrics can have many benefits for kids, such as:
• improving speed and agility,
• improving explosive power,
• improving sport-specific skills, and
• reducing sports-related injuries.
Flexibility training is an aspect of fitness that is important for growing children as their bones
and muscles often grow at different rates. It also improves muscle pliability and can help
improve neuromuscular control and coordination in kids. The benefits of flexibility training in
youth include:
• improved joint health and mobility,
• improved range of motion, and
• reduced risk for injuries.
Injury Prevention for Youth
When children are exercising, it is imperative to remember that proper form, proper use of
the equipment, and proper supervision are essential. While many strength training–related
injuries are due to misuse of equipment, there are many other considerations to protect youth
clients during exercise.
A personal trainer should focus on the following considerations when working with youth
clients:
• ensuring proper instruction and form at all times,
• using proper training progression,
• adjusting exercise intensity to meet the child’s physical capabilities,
• always including a warm-up and cooldown,
• always supervising children during the entirety of a training session,
• using appropriate equipment and making sure the client knows how to use each
piece correctly,
• requiring proper attire and shoes for training,
• ensuring adequate rest during exercise sessions and promoting rest on off days,
• using cross-training to prevent injury and keep children engaged, and
• encouraging optimal hydration and nutrition before, during, and after exercise.

Sleep is also an important aspect of a training program to promote physical recovery. However,
for kids, sleep is also necessary for brain development, improving memory and learning, and
optimal physical development.
TEST TIP!
General recommendations for sleep:
• Children aged 3 to 5 years need 10 to 13 hours of sleep
• School-aged kids between the ages of 6 and 12 require 9 to 12 hours of sleep
• Adolescents aged 13 to 18 years should get 8 to 10 hours of sleep each night
CHILDHOOD DEVELOPMENT
Creating effective youth exercise programs requires a strong understanding of the growth and
development processes and milestones of a child and adolescent. These include physiological
SENSITIVE PERIOD:
A time or stage in a and psychological components that vary based on the age and physical maturity of the child.
person’s development when
they are more responsive to
external stimuli and quicker
Young Children: Under Six Years Old
to learn particular skills.
Physiology: After the rapid growth and development from birth to age two, growth slows. This
age is considered a sensitive period for motor skills development. At this point, young
PARALLEL PLAY:
children are more responsive to what they see, hear, and touch and will learn skills and
A form of play in which
children play adjacent to movement patterns easily.
each other, but do not try
to influence one another’s
behavior. Psychology: This age group enjoys parallel play, and children are still learning to share, work
in a team, and follow detailed instructions. Children in this stage learn new skills via
SCAFFOLDING: scaffolding, or modeling behavior.
A process in which teachers
model or demonstrate how Children under six should be exposed to indoor and outdoor opportunities to play and have
to solve a problem, and
then step back, offering interactive play with their caregivers. Play and activities should be mainly unstructured but
support as needed.
emphasize improving their balance, walking, running, and kicking with a focus on reducing
sedentary times in their day.

GROSS MOTOR SKILLS:
The abilities required in
order to control the large Coaching children in this age group can be challenging, but they do learn and benefit from
muscles of the body for
physical activity. When they are young, it is best for trainers to teach gross motor skills—the
walking, running, sitting,
crawling, and other control of large muscles of the body—and help improve hand-eye coordination, muscle
activities.
coordination, and balance in an environment without many rules and restrictions.

Fitness professionals should incorporate positive reinforcement to help children develop a
love and appreciation for physical activity. They are too young to try to master skills or a sport
POSITIVE
REINFORCEMENT:
but can focus on the processes of learning a skill instead. Professionals should focus on
Including a favorable
controlling their environment and encourage them to play and practice however they like. outcome, event, or reward
after a child completes a
Coaching needs to be encouraging, fun, and loving. desired behavior or action.
Activities for children under six years of age may include
• freeze tag,
• duck, duck, goose,
• treasure hunts,
• T-ball,
• follow the leader, and
• kicking a ball into a goal.
Children: 6–10 Years Old
Physiology: Children have continued slow, steady growth until the adolescent growth spurt
ADOLESCENT GROWTH
when they see rapid physical changes in height and weight. This is an ideal stage for both
SPURT:
gross and fine motor skills development, and exercise can become more detailed and A rapid increase in the
individual’s height and
challenging. weight during puberty.
Psychology: Children aged 6 to 10 years can successfully join and work in a group, manage
conflict, take turns, find new friends, and manage relationships. They have very high self-
esteem and are eager to learn new skills. Social comparisons, when youth compare
themselves to others, also begin during this stage.
Also during this stage, children are improving in their hand-eye coordination as well as the
coordination of muscles. They are also improving in their balance and can pick up activities
such as riding their bike without training wheels or swimming, and are improving their skills
for running, jumping, and climbing. Children at this age should begin participating in more
intense exercise, such as running and strengthening exercises to benefit the cardiorespiratory
PERSONAL
and musculoskeletal system. DEVELOPMENT:
Activities that improve
A personal trainer should emphasize personal development and process goals over outcome awareness and identity,
develop talents and
goals for kids of this age. This includes encouraging children to practice skills and movements potential, build human
capital and facilitate
regularly while still emphasizing fun. Coaching should be warm and encouraging, but with employability, enhance
more specific and directive guidance. A fitness professional may also begin to set expectations the quality of life, and
contribute to the realization
for kids between 6 and 10 years of age. of dreams and aspirations.

Activities for children 6 to 10 years of age should include cardiorespiratory, flexibility, and
WEIGHT-BEARING strengthening exercises. At this age, strengthening exercise does not have to mean
EXERCISE:
weightlifting. Instead, kids can focus on weight-bearing exercise that uses body weight only,
Activities that move one’s
own body weight against such as:
gravity.
• running and jogging,

• dancing,
• push-ups and pull-ups,
• sports activities,
• gymnastics,
• stretching, and
• climbing and wrestling.
Adolescents: 11–19 Years Old
Physiology: Adolescents will experience a growth spurt between the ages of 10 and 13
for girls, and 12 to 15 for boys. This growth spurt is accompanied by dramatic hormonal
changes. Height increases faster than weight, and caloric needs are relatively high during this
time of physical growth. Girls will develop wider hips as a result of hormonal changes while
boys may experience fast height and weight changes as well as broadening of the shoulders.
In general, girls mature earlier and faster than boys. For this reason, girls may see
greater improvements in physical performance and coordination sooner than boys early in
adolescence, but their rate of improvement often slows as girls approach maturity and the
EGOCENTRIC: rate of physical improvements in boys begins to increase.
Thinking only of oneself,
without regard for the
feelings or desires of
Psychology: Adolescents in this age range often think and behave in their own best interest
others. (egocentric) as they begin to discover their personal identity. They tend to think everyone is
watching them (known as having an imaginary audience) and may become embarrassed
IMAGINARY AUDIENCE: quite easily if they fail or blunder social tasks. Youth in this age range also may take
An individual imagines and
believes that multitudes of unnecessary risks such as skipping school, fighting, substance use, and illegal activities like
people are enthusiastically
listening to or watching vandalism and trespassing.
them.
In this age group, youth can begin learning specialized motor skills such as those pertaining
to sports. Adolescents who have consistently played sports during childhood are ready to
refine movement patterns they have already learned. At this age, a trainer can use visuals to
assess and refine movements and begin to identify physical strengths and weaknesses to
be trained. These young adults also may benefit from progress tracking and assessments to
help them improve their fitness level.

A fitness professional should understand that not every child is involved in athletics from
a young age. The learning and skill development process happens in a stepwise manner
regardless of age. If the adolescent is new to sports or physical activity, they should be
coached as a beginner to the skills and movements. Coaches should encourage newer
athletes to choose a sport they enjoy and that matches their levels of skill and coordination.
DIFFERENCES BETWEEN CHILDREN AND ADULTS

Thinking physiologically, children differ greatly from adults. The many differences will impact
how children exercise, the way they move, their physical abilities, and their needs regarding
nutrition, hydration, and physical recovery. There are some differences between children and
adults that a fitness professional should be aware of:
• Children have less blood volume than adults. Blood volume during exercise is
reduced due to sweating and salt (electrolyte) loss naturally, so this can make
children more susceptible to dehydration. Lower blood volume can also affect
temperature regulation and make children more likely to experience hyperthermia,

HYPERTHERMIA:
or excessively high body temperature, during prolonged exercise. The condition of excessively
high body temperature.
• Children and youth have smaller airways with more soft tissue than adults. This
physical limitation may limit the lung capacity and, thus, training intensity possible
for younger children.
• Children have faster respiratory rates and heart rates than adults. Babies under one
year of age breathe 30 to 60 breaths per minute, children 1 to 11 years average 12 to
20 breaths per minute, and youth up to 19 years average 12 to 18 breaths per minute
at rest. The average adult takes 12 to 16 breaths per minute. Infant heart rates range
between 100 and 160 beats per minute, children 1 to 11 years average 70 to 120
beats per minute, and teens up to 19 typically have a resting heart rate of 60 to 100
beats per minute. The average adult has a resting heart rate between 60 and 90 beats
per minute as well. A faster resting breathing and heart rate for children means that the
increases in both metrics during exercise may limit their potential training intensity and
duration without overtaxing the cardiorespiratory system.
• Children have more skin surface area in relation to weight than adults. This can make
youth more susceptible to excessive fluid loss and dehydration during prolonged
exercise or activity in hot, humid environments.
• Children have less muscle mass and fat mass than adults. This can make a child more

vulnerable to injury, bruising, or blunt trauma (especially during contact sports) than an
adult. It can also have implications for musculoskeletal coordination and control.
• A child’s vision doesn’t fully develop until the age of eight. Depth perception is
often developed by the age of two, but youth may still be developing hand-eye
coordination and the ability to see sharply until they are well into school age. This
can affect their ability to execute tasks and play games with fast-moving objects
like ball sports and games.
• Children going through puberty have poor coordination and balance. This is
mostly due to their rapid physical growth that changes their center of gravity. For
adolescents in this life stage, specific skills like ball handling, agility, speed, and
coordinated movement can be affected.
EXERCISE PROGRAMMING FOR YOUTH

Children and adolescents ages 2 to 19 should get at least 60 minutes of physical activity per
PRESIDENTIAL YOUTH day. The Presidential Youth Fitness program suggests any activity that impacts the whole
FITNESS PROGRAM: child is beneficial. This means that aerobic capacity, muscular strength and endurance,
A comprehensive school-
based program that flexibility, and body composition are all important factors to consider when developing a
promotes health and
regular physical activity for program for a young client. These are also key areas of fitness to assess before initiating a
America’s youth.
training program with a youth client.
FITNESSGRAM: Youth Fitness Assessments

A noncompetitive standard
performance assessment
FitnessGram, based upon the scientifically established Healthy Fitness Zone from the Cooper
to measure aerobic Institute, is a noncompetitive standard performance assessment to measure each of these
capacity, muscular strength
and endurance, flexibility, areas of fitness. As with any client, children must have their current fitness level determined,
and body composition.
and the FitnessGram is the most current standard to use.
Table 17.1 FitnessGram Youth Fitness Assessments
AREA OF FITNESS PERFORMANCE ASSESSMENT
Aerobic capacity PACER test, one-mile run, or walk test
Skinfold, bioelectrical impedance (BIA), or body mass index

Body composition
(BMI)
Flexibility Back-saver sit and reach, shoulder stretch
Muscular strength and Curl-up, trunk lift, 90-degree push-up, modified pull-up, flexed
endurance arm hang

The PACER test is a cardiovascular assessment with multiple stages that gets progressively
more difficult as the assessment continues. It challenges children to run laps of either 15
or 20 meters to the sound of a beep that gets faster as time goes on. They continue to
run until they can no longer stay with the beep. The maximum number of laps can then be
entered into the FitnessGram software to receive a score along with the assessments for
body composition, flexibility, strength, and endurance.
More on the PACER test can be found at:
www.fitnessgram.net/pacertest/
And more on the FitnessGram software can be found at:
www.fitnessgram.net/software
Acute Training Variables for Youth
The acute training variables to consider for a youth exercise program are like those for adult
programming. They include training volume, load, exercise choice and order, rest, velocity,
range of motion, and training frequency. Similarly, the training cycles within a periodized
program also apply to youth exercisers and will prevent boredom, promote adaptation, and
reduce injury risk. Since children are growing and experiencing spurts of physical development,
the length of the training cycles will likely need to be modified accordingly.
Much research has been done to support the fact that resistance and strength training are
acceptable and, in most cases, desirable for children. Periodized and appropriate resistance
training has been found to protect muscles and connective tissue from injury, improve physical
performance, increase bone density, and improve coordination and movement patterns in SENESCENCE:
The process or state of
children of all ages. It has also been noted that the timing of puberty will affect strength growing old.
and plyometric improvements in adolescents as the levels of anabolic hormones such as
testosterone will expedite physical adaptations during this life stage. CHRONOLOGICAL AGE:
The number of years a
person has lived.
EXERCISE AND OLDER ADULTS
Senescence is the process of aging, and it presents differently in every person. Physical FUNCTIONAL
activity is a key factor in graceful aging and retention of strength and balance—two very CAPACITY:
The capability of performing
important aspects of injury prevention and longevity in older adults. Chronological age—or
tasks and activities that
the number of years a person has lived—does not necessarily equate to physiological age or people find necessary or
desirable in their lives.
actual functional capacity of the physical body.

According to the American Heart Association, living a sedentary lifestyle is a major risk factor
for many chronic health conditions for adults. It is also a risk factor that is completely
controllable. Exercise has been found to slow the physical and, in some cases, mental
decline associated with aging. It can decrease the severity of functional limitations that aging
can create, such as joint stiffness and poor flexibility, and improve quality of life. As adults
grow older, it is more important to be able to perform activities of daily living like bathing,
ACTIVITIES OF DAILY
cooking, walking, and standing than it is to perform the nonfunctional task of squatting 300
LIVING:
The tasks usually pounds. Many older adults pursue fitness so they can maintain or improve their level of
performed in the course of
a normal day in a person’s fitness, move well and with less pain, improve their quality of life, and maintain their social
life, such as eating,
toileting, dressing, bathing, and physical independence.
or brushing the teeth.
All activities of daily living are related to an exercise movement pattern. Standing up from a
chair and climbing in and out of a car mimic a squatting movement. Lifting small children,
a laundry basket, or groceries from the trunk are essentially deadlift movements. Picking
up and placing a box of old photos onto a high shelf for storage is like a clean and press.
Recognizing these movement patterns makes creating functional and effective exercise
programs simpler for the older adult client.
EXERCISE AND CHRONIC HEALTH CONDITIONS

By 2030, it is estimated that the number of American adults aged 65 or older will be close to
70 million out of a projected 360 million population. There is sure to be high demand for the
health care system to care for this vast demographic as they age, especially for those who do
not remain healthy and active. Although aging naturally causes some declines in health and
function, the severity of the declines can be greatly reduced by living a healthy lifestyle. Several
key indicators have been measured and found to decline between the ages of 20 and 80:
• Maximal oxygen uptake: declines by approximately 50 percent

• Maximal cardiac output: declines by approximately 25 percent
• Maximal heart rate: declines by approximately 25 percent
SARCOPENIA:
The degenerative loss of • Maximal stroke volume: declines by approximately 15 percent
skeletal muscle mass.
The average rate of decline (per decade) for adults over the age of 50 has also been
measured:
DYNAPENIA:
The age-associated loss
• Loss of muscle mass or sarcopenia: declines by approximately 6 percent
of muscle strength that is
not caused by neurologic or • Reduction in muscle strength or dynapenia: declines by approximately 12 to 14 percent
muscular disease.
• Reduction of bone mass: declines by approximately 10 to 15 percent

Baby boomers (those born between 1946 and 1964) may suffer from additional health
complications with age as well. This may include metabolic syndrome which is a collection of
BABY BOOMERS:
A person born in the years
factors that increase the risk of type 2 diabetes and heart disease. following World War II, when
there was a temporary
marked increase in the
Frailty affects one’s ability to recover from illness and injury, increases the risk of birth rate.
hospitalization, falls, requiring daily assistance, and premature mortality. It is characterized
as an increased vulnerability that can be caused by conditions such as sarcopenia and METABOLIC
dynapenia in older adults. SYNDROME:
A cluster of at least
three biochemical
Having excess weight in the form of bodyfat can also lead to health issues such as asthma,
and physiological
diabetes, hypertension, orthopedic complications, cardiovascular disease, high cholesterol, abnormalities associated
with the development of
sleep apnea, and depression. cardiovascular disease and
type 2 diabetes.
In many cases, an adult or senior with one chronic health condition will often have additional
health conditions that are related to or caused by the first. About 80 percent of people aged FRAILTY:
An increased vulnerability
65 years and older are living with at least one chronic health condition, and approximately 50
resulting from aging-
percent are living with two chronic health conditions. These are known as comorbidities, associated decline in
reserve and function
which are disorders or diseases that often appear together. For instance, a client may suffer across multiple physiologic
systems
from cardiovascular disease, hypertension, obesity, and Parkinson’s disease.
Another condition that senior clients may be at risk for is osteoporosis. This common condition SLEEP APNEA:
A disorder of breathing
affects more than 3 million adults (mostly elderly) in the United States annually. The body is
during sleep.
constantly absorbing and replacing bone tissue, but when bone is absorbed and not created to
replace itself, the skeleton becomes weak and brittle. Osteoporosis is often asymptomatic until a COMORBIDITIES:
bone break or fracture occurs. Fractures most commonly occur in areas of the body that bear The simultaneous presence
of two chronic diseases or
most of the load or are exposed during a fall, such as the wrists, spine, and hips. conditions in a person.
Load-bearing exercise is strongly recommended by medical professionals as a preventative

PARKINSON’S
measure for osteoporosis along with a healthy diet and, for some individuals, medications.
DISEASE:
Resistance training has been shown to increase bone density and stimulate bone remodeling A progressive disease
of the nervous system
and repair due to the tension created by muscle action and tendonous tension directly on marked by tremor, muscular
rigidity, and slow, imprecise
the bones. However, high-impact exercise and exercises that heavily compress the spine are
movement.
contraindicated for those with osteoporosis.
OSTEOPOROSIS:
THE ROLE OF FITNESS PROFESSIONALS IN HEALTH CARE A skeletal condition that
results in weak or brittle
Until recently, health and health care have been focused on the symptoms that accompany an ailment
bones.
or disease instead of the prevention of the condition over the life span. The medical community is
placing a new focus on the person as a whole, considering not only symptoms but lifestyle factors

that contribute to overall health. This is a new concept to many seniors who are used to visiting
several health care specialists such as the endocrinologist for their diabetes, rheumatologist for
their arthritis pain, and primary care physician for treatment and monitoring of their hypertension.
Fitness professionals now have a larger role in health care and preventative care. A personal
trainer should be aware of the needs of an older demographic to design effective exercise
programs that support a well-balanced fitness lifestyle. Before creating a fitness program for
seniors, it is important for fitness professionals to obtain medical clearance from their new
client’s primary care physician and to collect client intake paperwork. It is then necessary to
discuss their chronic health conditions and create two separate lists:
1. Long-term mortality risk: for instance, a client with heart disease, as well as
osteoporosis, should focus on managing the more severe condition. In this case,
that would be heart disease.
2. Symptom limitations: if a client is suffering from osteoporosis, their associated

limitations will impact their exercise training and acute training variables.
The health condition that poses the greatest risk to the client’s health must be prioritized
without overlooking the limitations placed on the client as the result of comorbidities.
TEST TIP!
• Maintenance of a fitness level is considered a successful intervention for a
senior client.
• For example, if a 65-year-old client has been working out for five years but
experiences no change in their cardiorespiratory fitness, they have prevented
normal decline and have, therefore, been successful!
SENIOR FITNESS TESTS

Fitness assessments and evaluations should be conducted once a senior client is approved
to engage in exercise. Evaluations in the form of fitness tests allow a fitness professional
to create an overview of a client’s health and current fitness level. Senior fitness tests differ
slightly from traditional objective and movement assessments since strength assessments
like the 1RM tests are generally not applicable to this population.
Rikli and Jones created the Functional Fitness Test for Seniors. This is a safe alternative to
FUNCTIONAL FITNESS traditional assessments that modifies the physical demands and is a good starting place for
TEST FOR SENIORS: testing older clientele. These simple and easy-to-use assessments include the chair stand, back
A simple, easy-to-use
battery of test items that scratch test, and two-minute step test. Normal range of scores for men and women are provided,
assess the functional
fitness of older adults. with the word normal being defined as the middle 50 percent of the population for each respective
category. Those who score above the provided ranges should be considered above average for

their age, and similarly, those who score below should be considered below average for their age.
Table 17.2 Senior Fitness Assessments
FITNESS
EVALUATE HOW TO PERFORM AT RISK
TEST
Lower-body strength for activities

With arms folded across chest, count Less than 8
30-second of daily living (ADL) such as
the number of stands that can be fully unassisted stands
chair stand getting out of a chair, gardening,
completed within 30 seconds. for men and women
or navigating stairs.
Upper-body strength that Count the number of biceps curls that can
measures ADL such as carrying be completed within 30 seconds while Less than 11 curls
Arm curl
groceries, lifting grandchildren, or holding a hand weight (5 lb. or 2.27 kg for for men and women
putting dishes away. women; 8 lb. or 3.63 kg for men).
Count the number of full steps completed

within two minutes. Each knee must be raised
Two-minute Stamina for activities such as Less than 65 steps
to point midway between the kneecap and hip
step test shopping, traveling, or yard work. for men and women
bone. Only the number of times the right knee
reaches required height is scored.
While seated at the front of a chair and with Minus four inches or
Lower-body flexibility for more for men
Chair sit one leg extended, reach toward the toes
preventing lower-back pain,
and reach with the hands. Count the number of inches
balance, posture, and falls. Minus two inches for
between fingers and tip of toe.
women
Speed, agility, and balance to Count the number of seconds needed to get
Greater than 9
Eight foot help in activities such as walking up from a seated position, then walk eight
seconds for men and
up and go through crowds or playing at the feet (2.44 m), turn, and return to a seated
women
playground with grandkids. position.
Begin standing. Place one hand behind the

back and slowly move it up the spine toward
Flexibility in the upper body, which the head. The opposite hand is placed behind
Back the neck and is slowly moved down the spine
may affect the ability to reach up
scratch with the goal of bringing both hands as close N/A
high, change a light bulb, or open
test together (or overlapping) as possible.
the refrigerator.
Repeat with the opposite hands (switch

hand placement).

Table 17.3 Normal Ranges for Men

AGE-RANGE
60–64 65–69 70–74 75–79 80–84 85–89 90–94
Chair stand
14–19 12–18 12–17 11–17 10–15 8–14 7–12
(no. of stands)
Arm curl
16–22 15–21 14–21 13–19 13–19 11–17 10–14
(no. of reps)
Two-min step
87–115 86–116 80–110 73–109 71–103 59–91 52–86
(no. of steps)
Sit and reach
-2.5–+4.0 -3.0–+3.0 -3.5–+2.5 -4.0–+2.0 -5.5–+1.5 -5.5–+0.5 -6.5– -0.5
(inches)
Eight foot up
and go 5.6–3.8 5.7–4.3 6.0–4.2 7.2–4.6 7.6–5.2 8.9–5.3 10.0–6.2
(seconds)
Back scratch
-6.5–+0.0 -7.5– -1.0 -8.0– -1.0 -9.0–2.0 -9.5– -2.0 -10.0– -3.0 -10.5– -4.0
(inches)
Table 17.4 Normal Ranges for Women

AGE-RANGE
60–64 65–69 70–74 75–79 80–84 85–89 90–94
Chair stand
12–17 11–16 10–15 10–15 9–14 8–13 4–11
(no. of stands)
Arm curl
13–19 12–18 12–17 11–17 10–16 10–15 8–13
(no. of reps)
Two-min step
75–107 73–107 68–101 68–100 60–91 55–85 44–72
(no. of steps)
Sit and reach
-0.5–+5.0 -0.5–+4.0 -1.0–+4.0 -1.5–+3.5 -2.0–+3.0 -2.5–+2.5 -4.5– -1.0
(inches)
Eight foot up
and go 6.0–4.4 6.4–4.8 7.1–4.9 7.4–5.2 8.7–5.7 9.6–6.2 11.5–7.3
(seconds)
Back scratch
-3.0–+1.5 -3.5– -1.5 -4.0–+1.0 -5.0–+0.5 -5.5–+0.0 -7.0– -1.0 -8.0– -1.0
(inches)

DESIGNING A SENIOR FITNESS PROGRAM
When programming for a senior client, the health condition that places a coach’s client at
the greatest risk for mortality should be the primary focus of exercise interventions. However,
trainers may introduce modifications to work around or accommodate for any secondary
conditions and limiting factors.
Each client is unique and may require a high degree of monitoring to be successful.
Therefore, it’s important for personal trainers to be flexible in their program design and allow
for modifications in acute variables such as frequency, intensity, types of exercise, and time
(to include duration, rest, and time of day). For example, trainers should consider modifying
workouts to decrease the exercise volume or intensity during an arthritis flare-up. It might
also be beneficial for a client to have their workout moved from the gym to the pool for relief
of weight-bearing symptoms. If pain or fatigue are too much for the older client on a given
day, the trainer should reschedule the session to another day when the limiting symptoms
are less restrictive.
Periodization rules for the general population still apply to seniors, but, as with youth, the
length of training cycles is likely to be abbreviated based on the client’s needs and abilities.
Heart and Respiratory Fitness
Research has identified minimum standards for cardiovascular exercise in seniors for
improved health and to prevent the risk of developing heart disease. These guidelines include
• 150 minutes per week of moderate-intensity aerobic exercise (30-minute workouts
five times per week),
• 75 minutes per week of vigorous-intensity aerobic exercise (30-minute workouts
three times per week), or
Seniors with a long history of being sedentary, or who have limiting factors such as arthritis or asthma,
may need to start off with only 10 to 15 minutes of moderate-intensity activity at a frequency that fits
into their lifestyle. In addition to the subjective information collected during initial assessments with
a client, the data from the two-minute step test will determine a valid starting point and the goals
a trainer will help a client set. General guidelines for the acute variables of frequency, intensity, and
time have been established for common chronic health conditions.

Table 17.5 Acute Variables for Chronic Health Conditions
CONDITION FREQUENCY INTENSITY TIME
Arthritis 3-5 days/wk 40% to <60% HRR 2-30 min/day
Cardiac
4-7 days/wk 40% to 80% HRR 20-60 min/day
Disease
Dyslipidemia ≥ 5 days/wk 40% to 75% HRR 30-60 min/day
Hypertension ≥ 5 days/wk 40% to <60% HRR 30-60 min/day
Obesity ≥ 5 days/wk 40% to <60% HRR 30-60 min/day
Osteoporosis 3-5 days/wk 40% to 60% HRR 30-60 min/day
Type 2 Diabetes 3-7 days/wk 50% to 80% HRR 20-60 min/day
For aerobic activity, a client’s cardiovascular health and joint health must be taken into
consideration. The fitness professional can identify specific exercises that will produce
the greatest adaptation without creating undue stress or physical pain. Rowing, recumbent
cycling, aerobic stepping, and upper-body ergometers are reasonable alternatives to the
treadmill, upright bike, or walking for clients with joint or cardiovascular limitations.
Muscle Strengthening
The same considerations should be made when it comes to muscle strengthening. Fitness
professionals should identify exercises that will produce the greatest desired adaptations but
do not elicit pain. Strength training for seniors is a critical component to healthy aging and
is safe and effective when done properly. However, oftentimes senior clients will not do well
with bodyweight exercises without first addressing mobility. A shuffling gait (walking pattern),
reduced range of motion, or poor posture will limit an older client’s ability to correctly perform
some movement patterns. Safe equipment modifications in these cases include resistance
bands, changing body position (sitting instead of standing), or using exercise machines.
Coaches can start with closed kinetic chain exercises to support the joints, such as balancing
on one leg or squats and shoulder taps, then gradually progress to open chain exercises
such as seated knee extensions, leg curls, and bench press with a focus on balance and
stabilization exercises in all three planes of motion.

Depending on each client’s abilities, acceptable methods of strength training for this
population include the use of bands, machines, free weights, and calisthenics. Exercise
intensity should follow a certain set of guidelines:
• One set of 8–10 repetitions for exercises working the major muscle groups on two
to three nonconsecutive days of the week.
• The trainer should ask the client to rate their exertion on a scale of 0 to 10, with a 0
equating to no movement and 10 to an all-out effort.
• Moderate-intensity exercise (a perceived effort of 5 or 6) should allow the client
to perform 12–15 repetitions, and high-intensity exercise (a 7 or 8 on the scale)
should permit between 8 and 10 repetitions.
It has been shown that resistance training with higher volume is associated with larger
improvements in lean body mass for seniors as well. Contraindications are relative
and dependent on the health conditions of each senior client. For example, clients with
osteoporosis should avoid excessive loading of the spine as can occur during a leg press
exercise. Nevertheless, most clients with preexisting conditions can safely begin a muscle-
strengthening program by performing loaded exercises that involve little to no movement of
the spine and then progress within the client’s limits.
Flexibility Training
Older adults aged 55 to 86 years of age may see a decrease in flexibility of the shoulder and
hip joints by approximately six degrees per decade. At the age of 70, this decline may naturally
become even more severe. Although flexibility training in older adults increases range of
motion, it is still unclear how daily functional movements are impacted. Regardless, senior
clients should engage in flexibility training to promote optimal biomechanics and posture.
Light, static stretching of the major muscle groups at least twice per week can improve the
quality of life in older adults, and daily stretching can be an integrated part of their fitness
lifestyle. Flexibility exercises are best done after a thorough warm-up and may even be done
immediately after walking, or directly after a hot shower to improve muscle pliability.
Balance Training
Balance training is essential for senior populations because it helps prevent falls and
associated injuries and challenges the body’s ability to sense its position in space and time.
The ability to balance will decrease with advancing age, making seniors more susceptible to
common injuries like tripping while walking or stepping off a sidewalk, or slipping on a wet or

uneven surface. When this ability degrades, the body can become unstable, especially with
movement.
Balance training can easily be integrated into various parts of a workout, but it works best
during the warm-up or during the workout since it can be taxing on the neuromuscular system.
It is recommended that balance training be performed three days per week for about 10 to
15 minutes per session. Proprioceptive components are critical for this type of training and
include training on unstable or uneven surfaces and closing the eyes during movement to
challenge the sense of feel without visual information.
Safety is always of utmost priority, so a personal trainer should always be close by to assist
or provide a support during balance exercises. Balance exercises should progress in the
same manner as exercise in general—from standing on a stable surface such as the floor,
to balancing on one leg, as well as using a bench or chair with arms, before progressing to
exercises with a Swiss ball.
Mental Training
Physiological decline is inevitable with age, but mental activity, social involvement, and
physical activity have been found to improve memory function, focus and clarity, and mental
sharpness.
Science supports the fact that genetics determines about half of the human’s memory
capacity. That leaves another 50 percent that can be challenged and improved. Lifestyle and
habits including nutritional habits, exercise habits, and level of education can contribute to
how the other half of one’s memory will function.
Physiological age and chronological age are considered separate measures of aging. Another
recent study found that people in their 70s may have as many young neurons—essential to
learning and memory—as teenagers. This is contrary to findings just 20 years ago when
research supported the idea that it was not possible to grow new neurons as humans age.
ALZHEIMER’S Other studies have also discovered that reducing sedentary behavior may improve brain
DISEASE:
A progressive mental health for those at risk for progressive mental degeneration conditions such as Alzheimer’s
deterioration that can occur
disease. Both cognitive and physical training have positive effects on the brain, and it has
in middle or old age, due to
generalized degeneration of been found that moderate-intensity exercise can improve brain structure and function and
the brain.
may reverse neural decay in older adults.

EXERCISE AND PREGNANCY
It is commonly asked whether pregnant females can exercise safely. The general answer
is that those who were active prior to pregnancy should be able to continue their regular
activity unless advised otherwise by a physician. However, it is never too late for women
who are inactive prior to becoming pregnant to begin an exercise program. In fact, exercise
is highly recommended for preparing a woman’s body for carrying and delivering a child and
for improving the health of the unborn baby. Starting an exercise program may also help a
pregnant woman reduce or prevent feelings of anxiety, tension, fear, and panic about childbirth.
Many physicians believe that prenatal exercise should be a critical part of a woman’s
pregnancy. It is recommended that pregnant females do at least 150 minutes of moderate-

PRENATAL:
Occurring or existing before
intensity exercise and three days of resistance training each week. However, it is estimated birth.
that fewer than one in four pregnant women meet the minimum recommendations for physical
activity during pregnancy. Exercise can help a pregnant woman connect to her mental and POSTPARTUM:
The period of time following
emotional state and enjoy a more balanced, healthful pregnancy and postpartum period. childbirth.
PHYSIOLOGICAL AND ANATOMICAL CHANGES DURING PREGNANCY

A woman’s body goes through many changes during pregnancy, and these changes impact
nearly every organ system in her body. It is critical for fitness professionals to understand
these physiological changes at a high level so that they can create the most beneficial and
effective exercise program.
Pregnancy is divided into three trimesters, and each trimester is approximately 12 weeks.
Many of the major physiological and anatomical changes will happen within the first and
PROGESTERONE:
second trimesters alone. Female hormone that
regulates the menstrual
cycle and is crucial for
In the first trimester of pregnancy, important hormonal changes occur. At the time of pregnancy, pregnancy.
progesterone levels increase to develop the lining of the uterus, which supports the fertilized
egg as it implants to grow. Also, levels of the hormone relaxin are released from the corpus RELAXIN:
A sex hormone that
luteum in the ovary and eventually the placenta, and this hormone will reach its highest levels
facilitates birth by causing
during this time. Relaxin, as its name suggests, relaxes the wall of the uterus in preparation relaxation of the pelvic
ligaments.
for pregnancy and eventually relaxes the ligaments of the pelvic region.

Other joints can also become more flexible, which can limit the body’s ability to stabilize itself.
There is an increase in the elasticity of muscles and tendons, which can lead to reduced
muscle actions during exercise. In addition, there will be an increase in the elasticity and size
of the heart, veins, and arteries, leading to dilation of blood vessels. This, in turn, can cause
vascular underfill of the heart where blood vessels have expanded, but because the amount
of blood in the body has not increased, there is not enough blood to fill up the heart. This
can cause a drop in blood pressure and create feelings of fatigue and dizziness known as
orthostatic hypotension with changes in position such as getting up from lying on the floor.
During the second trimester, biomechanical changes will create new challenges. As the baby
grows within the uterus, there is a significant shift in a woman’s center of gravity, causing the
pelvis to tilt forward and increasing lumbar lordosis. This may encourage poor posture and
create low-back pain in some women. A woman’s weight will naturally increase with the
growth of the baby, and there may be a need to urinate more frequently as the uterus presses
on the bladder. Weight gain, changes in the alignment of the pelvis, and changes in hormones
contribute to hypermobility from joint laxity, which can lead to postural compensations such
HYPERMOBILITY: as flat feet from fallen arches or feet that appear externally rotated from overpronation.
The condition of having
excessive amounts of These uncontrollable physical changes will need to be carefully monitored by a fitness
range of motion in a joint
or joints. professional with modification and adjustments to variables such as body position and
exercise selection made when appropriate.
In the third and final trimester of pregnancy, dramatic physiological changes slow, but the
increase in body weight will likely continue to affect the client. A growing baby may compress
the major blood vessels that run to and from the heart when the client is lying in a supine
position, causing a drop in blood pressure, feelings of lightheadedness, as well as a reduction
of blood flow to the baby. For this reason, it is recommended that pregnant women limit the
amount of time in back-lying positions. A woman may also experience shortness of breath,
swelling, backaches, and insomnia during the third trimester, making exercise, progress, and
DIASTASIS: physical recovery from activity more challenging. There is also an inherent risk of diastasis—
The separation of the large
abdominal muscles during or the separation of the large abdominal muscles—as the abdomen becomes distended or
pregnancy.
during core exercises such as crunches and sit-ups.

Table 17.6 Physiological and Anatomical Changes during Pregnancy
BODY SYSTEM OBSERVABLE CHANGES
• Resting heart rate increases
• There is a 45 percent increase in blood volume
• Stroke volume and cardiac output increase
Cardiovascular • Respiratory rate may increase up to 50 percent
system • There is a 15–20 percent increase in oxygen consumption during exercise
• Lung capacity decreases
• There is a decrease in oxygen availability
• Risk for orthostatic hypotension
• Bodyweight increases, placing more stress on joints
Musculoskeletal • Elasticity of muscles, tendons, and ligaments increases
system • The center of gravity changes, causing issues with balance
• Postural changes contribute to compensations
• Levels of relaxin and progesterone increase
• Thyroid-stimulating hormones released more often

Endocrine system
• Insulin resistance is increased due to a continuous supply needed for the fetus
• More lipid (fat) use leading to ketogenesis
In many cases, there are significant differences in weight gain between those who exercise
during pregnancy and those who do not. Postpartum BMI is lower for women who exercise
than for those who do not, and women who enter pregnancy overweight and do not exercise
may experience a more difficult delivery. By continuing or beginning a fitness program during
pregnancy, women may improve their general health and physical function, reduce bodily pain,
have more energy to participate in fun social activities, and enjoy pregnancy.
SPECIAL CONSIDERATIONS FOR PREGNANCY

Women experience many changes during pregnancy, and many of these changes are expected.
However, there are instances where exercise is contraindicated, and special considerations
must be made. For this reason, it is important for all clients to obtain clearance from their
doctor before continuing or beginning an exercise program while pregnant. Contraindications
can be relative, meaning they are dependent on certain conditions. Contraindications can
also be absolute, meaning there are no exceptions, and a woman should discontinue or avoid
exercise while pregnant. If a client shows any signs or symptoms that are unusual, trainers
should talk to them about the issue immediately and refer them to their doctor.
Absolute Contraindications
Absolute contraindications for a pregnant client mean the client’s physician will diagnose
these conditions. Coaches should not continue with the exercise program if the client
presents with any of the following conditions:
• Incompetent cervix
PLACENTA PREVIA:
A condition in which the • Persistent vaginal bleeding
placenta partially or wholly
blocks the neck of the • Placenta previa after 26 weeks gestation
uterus, thus interfering with
normal delivery of a baby. • Premature labor
• Preeclampsia
PREECLAMPSIA: • Uncontrolled diabetes or other systemic disorder
A condition in pregnancy
characterized by high blood Relative Contraindications
pressure, sometimes
with fluid retention and
If a pregnant client presents with certain conditions, coaches must refer them to their
proteinuria.
physician or request a letter from their physician to continue exercising:
• Severe anemia
• Extreme morbid obesity
• Extremely underweight
• Poorly controlled hypertension, seizure disorder, or thyroid disease
• Orthopedic limitations
• Maternal cardiac arrhythmia
With obesity on the rise, another major concern during pregnancy is the condition of
GESTATIONAL gestational diabetes - also called gestational diabetes or GDM. This is the temporary
DIABETES: condition of diabetes that only occurs in a pregnant female during her pregnancy. Between 2
A condition characterized
by an elevated level of and 10 percent of pregnancies result in GDM, which can increase the risk for complications
glucose in the blood
during pregnancy, typically during pregnancy and increase the risk for the child to develop diabetes later in life. A fasting
resolving after birth.
blood glucose test is administered by a medical professional between 24 and 28 weeks into
the pregnancy to detect and diagnose GDM. This condition can be managed by proper
nutrition, but, in some cases, insulin is needed to manage blood sugar for the duration of the
pregnancy. For those who require insulin, exercising will reduce the amount of insulin needed
to manage their GDM compared to women who do not exercise.

PROGRAM DESIGN FOR PREGNANT CLIENTS
In a normal and healthy pregnancy, exercise has not been found to negatively affect fetal birth
weight, size, or gestational age. Rather, exercise can help ease pregnancy-related symptoms,
maintain glycemic control, and reduce or maintain pregnancy and postpartum body weight.
Controlling these variables provides beneficial outcomes for the unborn baby as well.
Exercise during pregnancy should be based on the client’s previous exercise level and
preferred exercise methods and should be considered in the context of pregnancy symptoms
and current health status. Women who were not exercising before becoming pregnant should
start slowly and progress gradually. Provided there are no contraindications, the goal of the
prenatal exercise program should be to eventually achieve moderate-intensity exercise for
20 to 30 minutes on most days of the week. Fitness goals for a pregnant client should
not include weight loss or performance improvement. Instead, exercise should focus on the
maintenance of current health status.
Acute training variables such as frequency, resistance, tempo, and type can be modified
as normal for pregnant clients. However, coaches should pay special attention to physical
DISABILITY:
reactions during and after exercise to ensure there are no complications being caused. Clients A physical or mental
condition that limits a
who exercised regularly before pregnancy may continue their exercise programs, although, as person’s movements,
senses, or activities.
pregnancy progresses, some modifications may be necessary (for example, removing supine
exercises after the first trimester). Clients should not start new or more intense exercise
IMPAIRMENT:
programs during any stage of pregnancy.
The state of being
diminished, weakened,
Core Training or damaged, especially
mentally or physically.
Stability of the core and pelvic floor is an important part of a prenatal strength training
program. The core and pelvic floor help to protect the pelvis and the lumbar spine. Fortunately, ACTIVITY LIMITATION:
there are alternatives to core training besides traditional supine crunches that a pregnant The quantitative and
qualitative measure of
client can take advantage of. Abdominal training options for the prenatal client can include disability referring to
difficulties experienced by
deliberate pelvic tilts (anterior and posterior), core bracing and isometric holds, quadruped an individual in executing a
task or action.
exercises like the bird dog, and some plank variations.
EXERCISE AND ADAPTIVE FITNESS PARTICIPATION

A disability is any condition of the body or mind that makes certain activities more difficult for
RESTRICTIONS:
A problem experienced by
the individual with the condition. Impairment, activity limitation, and participation an individual in involvement
in life situations.
restrictions are types of disabilities defined by the CDC.

The Americans with Disabilities Act (ADA), signed by President George W. Bush, was modeled
after the Civil Rights Act and section 504 of the Rehabilitation Act. This legislation protects the
rights of people with disabilities to include equal employment opportunities, rights to purchase
goods and services, and participation in state and local government programs and services.
For the fitness industry and other physical activity areas such as local parks and recreation,
the ADA brought about the need to create tools and facilities that made exercise in these
spaces more accessible for people with disabilities. The focus then became inclusion -
INCLUSION: understanding the relationship between the way people function (physically or mentally) and
The act of including into
a group, involvement and how they participate in society. A disability should not determine the activities a person can
empowerment, where
or cannot participate in. Rather, activities should accommodate all different abilities and
the inherent worth and
dignity of all people are desires so that everyone may enjoy every aspect of life.
recognized.
Adaptive physical fitness programs help bridge this gap and bring into the fold those persons
with vision, movement, thinking, remembering, learning, communicating, hearing, mental
ADAPTIVE PHYSICAL
FITNESS: health, or social disabilities. Though there are a wide range of needs and each person is
The art and science of affected differently by their disability, adaptive fitness programs offer opportunities for anyone
developing, implementing,
and monitoring a carefully to fall in love with and enjoy the benefits of a fitness lifestyle.
designed physical fitness
program for a person with a
disability. MAKING EXERCISE ACCESSIBLE
Unfortunately, those with disabilities do not have the same access to health care as others
without disabilities. Women with disabilities are less likely than women without disabilities
to have had a mammogram during the past two years. It is thought that limited access to
health care can increase the occurrence of chronic conditions such as heart disease, stroke,
diabetes, or cancer. It is important for fitness professionals to understand the scope of work
ahead before diving into the details of serving this demographic.
Table 17.7 Aerobic Activity by Disability Type
PERCENTAGE OF ESTIMATED
DISABILITY
POPULATION THAT NUMBER OF
TYPE
DOESN’T GET EXERCISE PEOPLE
Mobility Dysfunction 57 percent 34,770,000
Cognitive Disability 40 percent 24,400,000
Vision Disability 36 percent 21,960,000
Hearing Impairment 33 percent 20,130,000
No disability 26 percent 84,682,000

Source: Centers for Disease Control and Prevention

Roughly three out of five people with a mobility issue do not get any aerobic activity. Most
of the time this is because of limited access to facilities or resources. Disabilities can be
caused by any number of factors:
• Disorders in single genes such as Duchenne muscular dystrophy.
• Disorders of the chromosomes such as Down syndrome.
• The result of a mother’s exposure to teratogens during pregnancy such as alcohol,

cigarettes, or the disease Rubella.
• Related to developmental conditions like autism spectrum disorders.
• Related to an injury such as a traumatic brain injury.
• The result of a chronic condition such as vision loss, nerve damage, or loss of limb
due to complications from diabetes.
An impairment can be structural such as the complete loss of a body component (amputation)
or it can be functional such as the complete or partial loss of a body part, such as a joint that
no longer moves. In any of these cases, it is rare that an individual is 100 percent disabled.
Whatever abilities a coach’s clients have, that coach should help them find a sport, game,
or activity that they enjoy, that challenges them, and that helps improve their overall health.
Around 25 percent of Americans have a condition that disables them, and that number sits
around 15 percent worldwide. When a person identifies as disabled and accepts that identity
as positive and affirming, outcomes are beneficial: one study reported that persons with
multiple sclerosis who identify positively with their condition report less depression and
reduced anxiety.
Those born with a disability (congenital) report higher life satisfaction than those who acquire
CONGENITAL:
a disability later in life. Perhaps this is because an individual born with a disability knows no Relating to a disease
or physical abnormality
other outcome and develops their personality and character within the context of that
present from birth.
disability, whereas an individual who loses an extremity, for example, may feel as though they
have lost their identity and now has to relearn their body and the way they participate in
society. It’s important for fitness professionals to allow clients to grieve their disability in
whatever way they need to. But it’s also important that fitness professionals help clients see
that there is still a world of opportunity for these individuals. An essential component of this
process requires an understanding that it is not the fitness professional’s job to tell the client
when they’re ready to try new things, but instead to listen to the client and their needs. These
psychological considerations should be front of mind for a personal trainer, but it is not within
their scope to diagnose or treat them.

The benefits of fitness do not discriminate between an amputee and a person with all
four extremities. The same physiological benefits available to a 25-year-old male with no
intellectual disability are the same benefits available to a peer with Down syndrome or a
traumatic brain injury. Fitness is for everyone and helps to:
• reduce the risk of heart disease, stroke, diabetes, and some cancers;
• improve self-confidence and autonomy;
• reduce feelings of depression;
• increase quality of life and life satisfaction scores;
• increase longevity; and
• reduce some symptoms of chronic medical conditions.
Fitness programming is fundamentally similar for clients with disabilities and those without.
The fitness professional needs to be aware of cardiovascular fitness, muscular strength,
muscular endurance, flexibility, balance, agility, speed, neuromuscular coordination, and
body composition management in each program but also understand that some clients’
disabilities may require alterations or subtractions in these areas.
PROGRAM DESIGN
In general, when designing a fitness program for a client with a disability, it is important for
trainers to get the client engaged in the amount and type of activity that is right for them. Find
opportunities for them to increase their activity in ways that meet their needs and abilities
and start slowly but encourage their client to stay active since any activity is better than none.
All acute training variables can be manipulated for clients with disabilities. However, as with
pregnant women, their physical reactions during and after exercise should be monitored to
ensure no complications are being created.
When a fitness professional is working with children with disabilities, their number one factor
in choosing a healthy activity should be enjoyment. They should help the child develop a love
for fitness by creating an environment in which they feel accepted, successful, accomplished,
and competent. They should also help the child to make friends, develop motor skills, and
learn independence, as well as allow them to choose how they want to participate—as an
individual or on a team. Coaches should encourage them to interact with peers with and
without disabilities.
Recommendations for cardiovascular fitness and muscular strength and endurance exercises
are similar to those suggested for general populations.

General recommendations for cardiovascular fitness may include:
• 30 minutes of moderate-intensity aerobic activity five times per week,
• 25 minutes of vigorous-intensity aerobic activity five times per week, or
Recommendations for muscular strength and endurance include moderate- to high-intensity

exercises, moving all the major muscle groups, on two or more days per week. Children and
adolescents should engage in 60 or more minutes of physical activity per day, such as playing
at the playground, riding bicycles, and playing sports. Other components of the physical fitness
program will be dependent upon the client’s current fitness level, stated goals, and abilities.
Benefit of Competitive Sports

The Working Wounded Games is an adaptive fitness competition open exclusively to those
with disabilities. Not surprisingly, the athletes who participate in this and similar programs are
thriving. A recent study examined program participation feedback and perceived improvements in
fitness, mood, and self-confidence of those who participated in this type of event. Sixty percent
of participants reported an improvement in muscular strength, muscular endurance, flexibility,
balance, mood, and self-confidence. These benefits weren’t limited to participants’ physical
performance—many reported improvements in cognition, affect, and social skills as well.
Researchers believe the supportive and encouraging community environment helps to further
enhance the adaptive athlete’s social well-being. The Special Olympics, serving those with
physical and intellectual disabilities, is now in its fifth decade and offers multiple opportunities
for athletes to participate in sports competitions around the world. The Paralympics, started
in 1948, is for athletes with various physical disabilities and is so named because it occurs
in tandem or shortly after the International Olympic Games. Athletes can compete in sports
such as alpine skiing, athletics, badminton, basketball, bocce, bowling, cricket, cross-country
skiing, cycling, equestrian, figure skating, flag football, floorball, floor hockey, golf, gymnastics,
handball, judo, kayaking, netball, powerlifting, roller skating, sailing, snowboarding,
snowshoeing, soccer, softball, swimming, table tennis, tennis, triathlon, and volleyball.
The American Association of Adapted Sports Programs (AAASP), started after the 1996
Paralympic Games, gives disabled students the opportunity to experience school sport
participation like their nondisabled peers do. They partner with school districts along with
state and national agencies and have helped to develop standardized competition rules and
seasons, safety guidelines, coaches, and official training and guidelines for compliance and
inclusivity. The AAASP can be a great resource for fitness professionals and facilities for
information on creating and operating sports programs for the disabled. Specific fitness
programming for the athletes may require additional education specific to their needs.

BUSINESS AND
CHAPTER 18
MARKETING
LEARNING OBJECTIVES
1 | Differentiate between the most common styles of personal training.
2 | Explain the purpose and components of a business plan for a fitness

professional.
3 | Describe the stages of the client life cycle.
4 | Explain the types of marketing a fitness professional can use to

communicate with current and potential clients.

CHAPTER 18 | Business and Marketing
Personal training is a relationship business. Much of the success of a trainer is dependent
on their ability to build rapport with clients and prospective clients, communicate effectively,
and understand and cater to the needs of each individual client.
Personal trainers often work for corporate gyms and health clubs. However, opportunities
exist to work in many other locations, including community centers, fitness studios,
independent gyms, schools, physical and occupational therapy offices, and assisted-living
INDEPENDENT facilities, or as independent contractors. An independent contractor works for themselves
CONTRACTOR: and is contracted to provide services for a company as a nonemployee.

Someone who works
for themselves and is Regardless of where a personal trainer is employed, the personal trainer is essentially running
contracted to provide
services for a company as their own small business. Starting and growing a fitness business requires the consideration
a nonemployee.
of important business aspects, including the following:
BUSINESS PLAN: • The style of personal training sessions to offer

Outlines the structure,
marketing, and growth of a • A business plan to lay out “how” a personal training business will be operated
new business.
• Attraction and conversion of clients and customer referral acquisition
• Client retention
• Marketing and brand creation
• An understanding of one’s financial needs and how much work and revenue
generation is necessary to meet those needs
STYLES OF PERSONAL TRAINING

The styles of personal training generally describe how a training session is conducted and
with how many clients. The following are the common styles of training:
• In-person training
• Virtual training
• Hybrid training
• Buddy training
• Small group personal training
• Group exercise
Each style of training requires foundational fitness knowledge in subjects such as anatomy,
CUEING:
A communication that biomechanics, programming, and cueing, but there are unique elements to consider with
prompts a client to engage
in a movement pattern or
each style of training. For example, training a large group requires different communication
conveys proper technique. and cueing skills than one-on-one training.

IN-PERSON TRAINING
IN-PERSON TRAINING:
In-person training is done face-to-face in a live setting and can include one-on-one training Live, face-to-face fitness
with a client and a trainer or be executed in larger groups. The benefits of live, in-person training done individually or
in small or large groups.
fitness instruction include greater clarity and understanding and the ability to correct a client’s
form and interact with them directly. Many clients prefer having live instruction, especially if
they are relatively new to exercise, since they can ask questions and receive instant feedback.
VIRTUAL TRAINING
Online or virtual training is growing in popularity with both trainers and clients. Sessions can
VIRTUAL TRAINING:
be conducted via websites, phone applications, or social media platforms. Training formats Remote training sessions
conducted via website,
can include videos, livestreaming interactions, and chat forums. Virtual training allows a phone applications, or
fitness professional to reach a larger client base and meet the client in their environment. social media platforms.
Conducting training sessions online requires specific equipment for a high-quality experience.
A personal trainer will need to consider the following aspects of how they conduct online
sessions:
• Virtual platform: There are many platforms, such as Zoom, video calls, and Google
Meet, for conducting virtual meetings. A personal trainer should select a platform
that is easy to use, is accessible to all clients, and has the features they will need.
Features to consider include screen sharing, chat capability, and the ability to record
sessions as well as send and receive attachments while in the call.
• Camera: For quick video calls, a phone can suffice. However, for longer or more
regular sessions, a personal trainer may consider investing in a high-quality camera
or a computer with high camera quality. Having better image quality during a video
call can enhance the training relationship and promote engagement in the virtual
session.
• Lighting: Many virtual personal trainers neglect lighting when on a call. However,
having a well-lit space can ensure clients can clearly see the personal trainer—this
is essential when demonstrating proper form. Ring lights attached to a device or a
computer are commonly used to illuminate a trainer’s face and space for a video.
Lights do not have to be expensive to be effective.
• Space and appearance: The space where a trainer sets up for an online training
session matters. The background should be clean, free of clutter, and free of
distractions. Setting up in a space that is similar to where an in-person session

would be held is ideal. Even though the session is on video, a personal trainer
should also be dressed professionally and appropriately for the activities that will
be performed.
• Exercise equipment: Virtual training is typically conducted with no or minimal
exercise equipment. Programming will have to be practical to meet the requirements
of the camera view and available equipment.
A website or app is another essential tool for a virtual fitness professional. This allows
clients to log in for communication and to access resources as needed. A website or app can
also include scheduling for live consultations, client handouts, progress tracking, payment
options, helpful education, and a library of blogs and videos.
Figure 18.1 Virtual Personal Training
HYBRID TRAINING
A relatively new style of training is hybrid personal training. Hybrid training is a combination
HYBRID PERSONAL of in-person and virtual training. A personal trainer will work with a client in person at a
TRAINING: frequency that meets the client’s needs. Then when they are not together physically, the
A training approach that
utilizes in-person and virtual fitness professional can connect with the client virtually to provide exercise guidance and
training styles to allow
for easier, more frequent nutrition guidance, answer questions, and conduct progress evaluations and assessments.
access to the fitness
professional. Hybrid training makes holding clients accountable to their program and their progress easier
since the fitness professional can touch base with the client as often as necessary.

BUDDY TRAINING
BUDDY TRAINING:
In fitness, buddy training is when a personal trainer works with two clients at the same time. Exercise instruction
This training style can make individualized exercise instruction more affordable for participants between a personal trainer
and two clients at the same
since the cost per hour is often divided between both participants. Exercising with a partner time.
can also increase motivation, accountability, and exercise compliance for all participants.
Buddy training can also provide a safe and comfortable environment for those clients who
may have anxiety in social settings. Working out with a spouse or trusted friend can provide
the motivation and accountability they need.
Figure 18.2 Buddy Training
SMALL GROUP PERSONAL TRAINING

Small group personal training is exercise instruction delivered to two to four clients at once. SMALL GROUP
Similar to buddy training, this training style can make individualized instruction more affordable PERSONAL TRAINING:
Exercise instruction
for participants, as the cost of an hour of the trainer’s time is less per participant but offers
delivered to two to four
the trainer an opportunity to make more per hour as well. For example, a trainer who charges clients at the same time.
$60 per hour for one-on-one training may charge $30 per hour per participant for small group
training. With six participants, that means the trainer is making $180 for the hour—three
times their regular hourly rate.
Small group personal training can increase client motivation, accountability, and adherence to
an exercise program when rapport is built between the trainer and all participants. This style
of training also allows the trainer to maintain a high level of contact and interaction with each
participant to offer an individualized training experience.

Figure 18.3 Small Group Personal Training
LARGE GROUP TRAINING

Large group training expands the concepts of small group training to much larger groups.
Common examples are boot camp–style classes, running or adventure racing groups, and
strength and conditioning sports camps. With groups ranging from 20 to 50 participants and
possibly beyond, it is often necessary to add additional instructors to ensure the quality of
the experience.
Some large group offerings are seasonal in nature, such as sports camps and large outdoor
boot camps. It is important that the planning and marketing of these seasonal offerings are
done several months ahead of the start date. Fitness professionals should consider having
rates that include drops in pricing as well as pricing for the entire session. An example of
this is a one-month outdoor boot camp that has 10 workouts in the month. A monthly rate
of $150 would equal $15 per workout. A suggested drop-in rate (paying for a single class)
might be $20.

TRAINER TIP!
With small group personal training, a fitness professional will need to consider the
following:
Space and equipment: Specifically how much space and what equipment is available
to support all participants. This is part of what determines how many people can
properly participate in this group.
Exercise programming: With small groups, it is important to keep all participants
engaged. Exercise programming must specifically consider the goals and abilities
of each participant, and exercise selection should also consider the space, format
(circuit, timed rounds, etc.), and modifications needed for the session.
Observability: When programming exercise for a small group, the fitness professional
will attempt to watch all participants at the same time. This is challenging. To minimize
injury risk, the trainer should program one to two exercises at a time that require
observation while keeping other exercises that are happening simultaneously simpler.
For example, in a small group of three clients, one client is doing a back squat, one
is doing push-ups, and the other is doing a plank. The back squat is the exercise the
trainer will spend most of their time correcting and observing, while the other two
exercises are less likely to need as much correction.
The larger the small group, the more challenging programming becomes. Small group
trainers must master the skills of verbal cueing, precise exercise demonstration, GROUP EXERCISE:
Large group training that
motivating others, and attention to detail (e.g., exercise form, proper movement is often choreographed
and where all participants
patterns, how to properly modify exercises, etc.) to be successful. are executing the same
exercises simultaneously.
GROUP EXERCISE
Group exercise is a form of large group training that is often offered in a choreographed group
CERTIFIED
GROUP FITNESS
format. Spin classes, kickboxing classes, interval-based group workouts, step aerobics
INSTRUCTORS:
classes, barre, Pilates, and many yoga classes are forms of group exercise. These classes Fitness professionals
certified in delivering large
are typically taught by certified group fitness instructors as opposed to the certified personal group fitness classes.
These classes are often
trainers in the previous styles of training. Group exercise classes often begin with a group
choreographed and require
warm-up and end with a group cooldown. During the workout session, all participants are specific training in a
particular class format.
doing the same thing in most cases (or may be split into groups doing the same exercises).

Figure 18.4 Group Exercise Class
STARTING A PERSONAL TRAINING BUSINESS

When setting up a business, a fitness professional must consider the legal structure. A
business’s structure will determine who is involved in the business, each involved party’s
role in the business, when and how profits and expenses are divided, and how taxes will
be paid. The structure also determines how liability is shared among the business and the
responsible parties.

BUSINESS STRUCTURES
SMALL BUSINESS
There are several common business structures a personal trainer can choose from. The ideal
ADMINISTRATION
structure will be based on the number of individuals involved in the business and the needs
(SBA):
of these parties. The four primary business structures are as follows: A US government agency
established in 1953 to
promote economic growth
• Sole proprietorship by helping new and existing
small businesses and
• Partnership providing advice, financial
assistance, counseling,
• Limited liability company (LLC) and tips for sustainable
business growth.
• Corporation
Sole Proprietorship
SOLE
According to the Small Business Administration (SBA), the sole proprietorship is the most PROPRIETORSHIP:
common business structure in the United States. Businesses using this structure include The most common
business structure, in
coaching businesses, home-based companies, and retail businesses. In this format, the which the single owner has
complete control over and
owner of the business has full control over the company’s operations. liability for a business.
Sole proprietors are responsible for paying their own taxes and keeping business and financial
records. The owners are also personally responsible for the debts and financial obligations
of their business.
Partnership
As the name suggests, a partnership structure joins two or more people together to run a PARTNERSHIP:
business. Each partner has an equal stake in the business’s losses and profits. Each party A business structure with
two or more people running
is also responsible for paying taxes and record keeping. the business who share
liability and responsibility
for the business’s
A drawback of a partnership is that each partner is also personally responsible for the losses performance.
and financial obligations of the business and the actions of the other partners. To avoid
communication issues, all agreements and changes to a partnership business should be
documented in writing, legally reviewed, and signed by all parties.
Limited Liability Company
The limited liability company (LLC) is a relatively new business structure. LLCs can operate
like partnerships, with multiple stakeholders that are referred to as members. As the name LIMITED LIABILITY
suggests, the members in an LLC are limited as to their liability for the financial obligations
COMPANY (LLC):
A corporate structure in
of the business. This makes the structure appealing for many business owners. However, the US limiting the liability
of the owner; it combines
some business types, such as banks and insurance companies, are restricted from forming aspects of corporations and
sole proprietorships.
LLCs for this reason.

Corporation
CORPORATION:
A business structure in The corporation is the most complex of the four business structures. Owners and operators
which the owners and
operators are separated are shielded from liability in this business structure, and they are regulated by the local laws
from the liabilities of the
where they operate. Corporations have separate tax rates from other business structures,
business.
and the owners and operators within a corporation pay their own taxes.
The following are the two subchapters within corporations:
• C corporations: The business itself is liable for the tax burdens of financial losses
and gains of the corporation.
• S corporations: The shareholders are responsible for the tax burdens of losses
and gains.
WRITING A BUSINESS PLAN

Planning is an important stage in the process of starting a small business. It includes learning
about competing businesses, the available market, and accessing funding. A business plan
outlines the structure, marketing, and growth of a new business.
The SBA is an organization available to all small business owners and anyone interested
in starting a business. The SBA offers resources such as consultants and business
loans. Business experts help small business owners plan, launch, manage, and grow their
operations. Most major cities have a local office.
According to the SBA, there are two types of business plans. The traditional business plan is
detailed, time consuming, and useful for any new business owner looking to secure funding.
It should provide detailed information about growth and financial projections so investors or
banks can make funding decisions. A lean business plan is shorter and contains less detail.
It is generally used internally for planning and is not shared externally with investors.
Traditional Business Plan
The traditional format is great for detail-oriented individuals looking for a comprehensive
overview and plan for a new business. The following are the elements of a traditional
business plan:
MISSION STATEMENT: • The executive summary includes the what and the why of the business. It should
A short statement of why a
business exists and their outline the basics of the financials, mission statement, vision, and products or
overall goal for operating.
services offered. It is an introduction or an abstract.

• A detailed company description and market analysis should be included and will
explain the business’s target market and give an in-depth look at local competitors.
MARKET ANALYSIS:
A qualitative and
This should highlight the personal trainer’s experience and anything that sets them quantitative assessment
of a business market that
apart from the rest of the market. examines product and
service volume, buying
• The business plan should describe the business organization type. Many small patterns, regulations, and
business competition.
businesses with just one or two owners are LLCs. The plan should describe the
ownership structure and whether there will be employees or independent contractors.

TARGET MARKET:
• A comprehensive description of services offered should also include an estimate of The particular group(s) of
consumers that a product
customer life cycle.
or service targets.
• Marketing is also important in a business plan. All planned strategies for marketing
should be outlined here. CUSTOMER LIFE

• A traditional business plan is generally used to get funding, so it must include CYCLE:
The steps a customer goes
financial projections and funding requests. This part can be complicated and requires through when considering,
buying, and using a product
some specialized knowledge. It may be a good idea to work with an accountant or
or service, including
the SBA to determine how to develop this section. The financial projections must be awareness, engagement,
evaluation, purchase,
based on data and be reasonable and attainable to secure funding from investors experience, and bonding
and advocacy.
or loans from a bank.
Lean Business Plan
A lean business plan will include most of the same information as a traditional business
plan but with much less detail. This type of plan is used primarily for the owner and any other
employees to organize the structure, finances, and plans for future growth.
A lean format is appropriate for smaller businesses that will be starting quickly and offering
few services. It should establish the products and services offered, the values of the company,
how customers will find the business, marketing plans, and a brief study of the market and
target audience.
Regardless of type, a business plan is an important step in starting a small business. It helps
with planning and organization. New trainers should take advantage of resources during the
planning process, including the SBA or a local chamber of commerce.
MARKETING A BUSINESS
Once a business has been structured and its ideal clientele has been identified, marketing
the business is imperative. Marketing is essential for bringing awareness to a new business
and attracting new clients. The first component of marketing is the creation of a business

name, brand, and logo. Creating a name and look for a new business is a great time to also
start considering the goals and a mission statement to help clarify the brand and goals.
This is just the beginning of what a personal trainer needs to consider to market and grow
a business. In fact, a large portion of any new fitness professional’s extra time is spent
marketing and attracting new clients.
In the initial stages of a fitness business, details such as these must be established:
• What are the business’s services?

• Who is its target market?
• How does it offer its services (in person, online, or both)?
• What is the price for each service offered?
• How do people pay the business owners?
• Where will the fitness professionals train their clients (if applicable)?
TRAINER TIP!
Creating a Mission Statement
Every trainer should have a mission statement. It’s a short explanation of who they
work with, what they offer, and why they are unique—kind of like an elevator pitch.
That’s a short description that can be given to anyone who asks, “Why do you do what
do you do?” or “What’s your purpose?” The following are examples:
Nordstrom: to give customers the most compelling shopping experience possible.
Tesla: to accelerate the world’s transition to sustainable energy.
A fitness professional: to deliver quality, effective, goal-focused fitness and wellness

services.
Creating a Vision Statement
A vision statement is slightly different but just as important. It states the desired
outcome that results from the business achieving its mission. The following are
examples:
LinkedIn: to create economic opportunity for every member of the global workforce.
Facebook: to connect with friends and people across the world.
A fitness professional: to educate clients and improve longevity and quality of life
through fitness.

HOW TO IDENTIFY THE TARGET MARKET
CLIENT PERSONA:
As the fitness industry continues to grow, it is crucial that trainers have a clearly defined A fictional person that
target market. This will help set them apart from others in the industry. Creating a client represents the key
characteristics of a trainer’s
persona is an important first step in identifying the target marketing and understanding the preferred clientele.
client life cycle. By understanding their ideal client, a trainer can do a better job marketing to
these individuals based on who they are, where they live, their household income, and more.
When developing a client persona, trainers should ask the following questions:
• Is this person male or female?

• How old is this person?
• What does this person do for a living?
• How much money does this person make?
• Is this person a parent?
• What is this person’s current fitness level?
• What is this person’s goal? To increase strength? Lose fat? Train for an event?
• What are this person’s biggest challenges?
Here is an example of a client persona:
Mary is a 35-year-old woman. She is a new mom who works part-time at the local fabric
store. Her husband is a high school teacher. Prior to pregnancy, Mary spent two days/week
at the gym lifting weights. She ran outside for 30 minutes three days/week. Mary has spent
12 weeks on maternity leave and would like to lose the “post-baby tummy” and train for her
first half marathon.
With this information, one would gather that the trainer likely specializes in postpartum fitness
and fat loss for moms of middle-class income. Now that the trainer has put thought into who their
ideal client is, they can make a plan to find and market to people who match their ideal client.
CREATING A BRAND
Defined as selecting a logo or symbol that is easily identifiable, branding is more than a
graphic. A brand can elicit feelings from consumers. It can create anxiety or promote BRANDING:
A name, logo or symbol that
innovation. It can also differentiate one fitness professional from another. identifies and differentiates
a product from other
products.
In the fitness industry, and all industries, there are familiar brands that mean something. It
may be a brand associated with bodybuilding culture or one that is closely tied to at-home
fitness. This branding creates familiarity and an expectation. Those looking for a bodybuilding
gym will know where to go and expect a bodybuilding look, feel, and culture.

Much consumer testing has been done to determine how people react to shapes, colors,
and logos. Technically speaking, curves on a logo often are viewed as having a feminine
connotation, while hard-edged shapes like triangles and squares denote stability and balance.
Straight lines give the feeling of professionalism and organization.
When deciding on a logo, design specialists recommend the following:
• The brand should be defined “first.”
• The competition’s designs should be analyzed.
• A style and color scheme should be chosen (and stuck with).
• A font should be chosen and used consistently.
SOCIAL MEDIA AND ONLINE PRESENCE

Social media and a website are the hallmarks of modern marketing. They are necessary for
a business to have success and growth. These are likely to be the two main pathways that
lead customers to new businesses. As the owner of a small business, it can be tempting to
combine existing personal sites and profiles with those of the company. Doing that should be
avoided; it’s better to keep separate accounts, websites, and social media profiles.
CALLS TO ACTION:
Marketing statements that Business profiles and marketing materials must include frequent engagement opportunities
demand an immediate
response from the through blogs, photos, teaser articles, informative posts, and calls to action. Calls to action
recipient—for instance,
“Sign up now” or “Click are statements that encourage immediate action. These keep businesses relevant and in
here to learn more.”
front of potential clients.

Business social media sites must be active with regular followings and linked to potential
clients and relevant businesses and influencers. Using hashtags—social media tags that aid
HASHTAGS:
Social media tags users
in online searches and finding content with a certain theme—and other fitness and wellness can create to help others
find messages and posts
profiles can help a fitness professional connect with the target market. with a specific theme or
content.
Relevant and high-traffic social media platforms that personal trainers should consider using
include the following:
• YouTube
• LinkedIn
• Pinterest
• Instagram
• Facebook
• Snapchat
• TikTok
Each platform offers a unique way to share credentials and services. They can also showcase
results and client testimonials. These are typically free platforms that are small business
friendly. Many also have paid options for accounts that provide opportunities for greater
visibility, advertising, and targeting of potential clients.
POSITIVE SHAREABLE MARKETING MATERIAL

Using positive client reviews—with the reviewers’ permission—is a great way to prove the
value of a fitness professional’s services and create inspirational and effective marketing
content. Testimonials from clients, before and after photos, and client stories are effective
attention-capturing tools for reaching new potential clients on social media and through a
business website.
After a trainer has worked with a client long enough to build a relationship and for the client
to see results, the trainer should consider asking them to leave a public review on a platform
such as Facebook or Google. These online reviews provide credibility that will be visible to
others who are in the early stages of the client life cycle.
A testimonial and social proof are great marketing tools in fitness. Testimonials can be SOCIAL PROOF:
A success story of a
written or in video form and detail a client’s success or story with a trainer and their program.
program or something
Social proof is a success story of a program or something similar to prove that the style of similar to prove that the
style of training works.
training works.

With a client’s permission, before and after photos or testimonials may be able to be used
in marketing material and online outlets. Building a bank of testimonials is a good idea to
establish trust in a brand and make sure people will recognize that brand as an authority.
Marketing materials and posts using client testimonials and stories should be positive,
informative, colorful, and engaging. Trainers should encourage comments, discussions, and
questions for these kinds of posts and reply promptly.
EMAIL MARKETING
Especially if a fitness professional offers online or virtual training, email is a huge
communication and marketing tool. Emails can be sent to people in any stage of the client
PROSPECT:
process, from inquiring to prospect to client. They can also be used to send and receive
A person who has shown
interest in a product or intake forms and various assessments like photos or weekly measurements.
service and is a potential
customer.
The look and branding of a personal trainer’s email communication should be in line with
their logo and the definition of their brand. The colors, layout, and diction used should be
consistent. Personal trainers can use email communication as a way to provide helpful
information, nurture potential clients toward taking the next step (purchasing a product or
service), and keep current and potential clients engaged. If a trainer isn’t a fan of fad diets,
they shouldn’t trash them. Instead, they should offer valuable information and articles that
support the eating patterns they know are successful.
Not every email should ask for something other than a reply. The most common email
communication mistake is treating email as a one-way conversation. Trainers should invite
replies with catchy subject lines and questions that require a response. The more a trainer
can get someone to interact via email, the more engaged and interested that person will be.
Email Frequency and Length
What is sent via email is more important than how often it’s sent. It’s important to try different
types of content and track what is most valuable and engaging to potential and future clients.
Examples of content include informative content, blog articles, details pertinent to each
client and their goals, and information answering a question a trainer may have received from
a prospect. This type of email communication is what gets opened and read.
Although the content is most important, it is still imperative for a personal trainer to consider
the frequency of their emails. Generally, two to three emails a week is optimal. But a few
different email cadences should be trialed to determine what is most ideal for the fitness
professional and their clientele.

Much marketing research has been completed to determine the optimal email length for
effective communications. On average, an email with 50–125 words is ideal. Emails are
long enough to offer something valuable but short enough to remain concise and not be
visibly overwhelming. Even the subject lines matter. About 40 characters (not 40 “words”)
is the recommended length for an attractive email subject line. The text should be catchy
and, in many cases, include a directive such as “New Video: The Hip Thrust Explained!”—36
characters.
Relationship Emails
Whether engaging with a current client for the 50th time or a prospect for the first time, effective
email communication seeks to build a relationship. These emails are conversational, with the
goal of delivering information or answering questions. Since many clients will often have
the same questions, these emails can be easily made into templates and then customized
before being sent, including, for example, questions regarding what to eat before and after a
workout or information on posture assessments and how the trainer uses the results to tailor
the client’s program.

RELATIONSHIP
Short, concise text with minimal headers and graphics is best. People will begin to look
EMAILS:
forward to emails if they know they will be useful and pertinent to them. Relationship emails Emails used to engage with
clients and prospects and
feel like sending a note to a friend. build a relationship.
Strategic Emails
Strategic emails explain why a fitness professional does what they do—training philosophies,
STRATEGIC EMAILS:
program structure, the value a trainer provide to a client, and more about themselves. This is
Email communications
an ideal communication method for prospects and new clients. Without preaching to the that explain why a trainer
does what they do, training
reader, a trainer can outline their education and training strategies to better connect with the philosophies, and more
about themselves.
goals and needs of each client. This is a way to establish oneself as an authority in one’s
discipline and build trust.
This email type is also easily templated for convenient access and use. A trainer should
create a brief email that explains who they are and why they do what they do and keep it
handy. Branding should be included for easy recognition. A trainer can also copy and paste
bits of their philosophy email into other emails, such as promotional and reengagement
emails, for consistency.

Promotional Emails
PROMOTIONAL
EMAILS: Just as the name implies, promotional emails present a product or service, build value in it,
An email communication and then incentivize someone to purchase it. The most effective promotional emails are set
series that presents an
offer or promotion for a up as a series of three to five emails sent over as many days. The initial email will present
limited time.
the promotion and generate excitement. The following emails will reinforce the promotion,
solicit a response and questions, and highlight the end date of the promotion.
The request for a response and the end date are two of the most important aspects of a
promotional email. When asking for a response, a fitness professional is offering to answer any
questions a client may have. These questions may be the only thing stopping a potential client
from signing up to train with them. Email does not have to be a one-way conversation. Prospects
and clients who reply are often the most interested and closest to making a purchase.
The end date is important for several reasons. First, no promotion is infinite. The sense of
exclusivity is lost if the promotion is always running. Second, it creates a sense of urgency.
The psychological concept of the fear of missing out is real. Many people will rush to purchase
something if there is a chance they will miss it. Finally, having an end date helps warrant the
multiple emails that will be sent over a short period. Each email builds urgency and reminds
the prospective client of what is being offered.
Then, when the promotion ends, fitness professionals should stay firm on the end date. The
email series for that offer will end, and services and prices will return to normal.
Onboarding Emails
The onboarding process happens in multiple steps: paperwork, assessments, programming,
then training. So, too, will onboarding emails. These emails should be set up as a series and
ONBOARDING EMAILS: always be authentic. The trainer should infuse their voice, philosophies, and personality into
A series of email
communications that gather these emails. For those who train online, this may be the first and only way some clients
the required documentation
interact with the fitness professional.
and assessments to begin
a training program.
First, if there was a deliverable promised, it should be delivered in the initial onboarding
email—for example, a free written workout, free session, video, or piece of content. Clients
want to know that a trainer will deliver what was promised. These free sessions or pieces of
content are at times used to create interest for those that have not made a purchase yet and
to capture their contact information. This initial email is the ideal place to ask prospective
clients such as these to make a purchase as well. Trainers should share promotions, if
available, and ask for the sale. It is possible to turn onboarding emails into promotional
emails over a few days if a prospect has not committed or purchased yet.

Once a client has made their purchase and is ready to train, the intake process should
begin. When doing this by email, fitness professionals should send the required forms and
information in smaller emails as opposed to one long email with several attachments. For
example, over three business days, the following may be sent:
• Day 1: Client intake form, health history questionnaire, PAR-Q, and dietary log; the
trainer should ask for them back by a specific day and request the client begin food
logging for a specified number of days.
• Day 2: Training policies and client/trainer expectations; the trainer should clarify
any questions.
• Day 3: Schedule assessments (video format or in person) as soon as possible; the
trainer should communicate when the program will start and, after assessment,
begin program design and delivery.
Ideally, this process will not take longer than a week. Clients are likely to be excited and
ready to begin as soon as they make their purchase, and a trainer must capitalize on this
urgency. However, outlining clear expectations and timelines in the initial emails will help
clients understand the process. For example, explaining training philosophies will help a new
client understand what the forms are for, what the trainer gathers from assessments, and
why injury prevention and effective programming are both important.
Reengagement Emails
It is important not to forget about previous clients or leads. Some clients may leave a trainer LEADS:
Potential clients not yet
if they deem their services were not effective for them. For others, it may simply be timing. using a professional’s
services.
They might have moved, changed jobs, or had some other circumstance out of their control.
Reengagement emails reach back out to former clients and prospects a trainer has lost
touch with to see if they are interested in rejoining.

REENGAGEMENT
EMAILS:
Use short emails that ask for a response. Here is an example: An email communication
method to reach out
to former clients and
Subject Line: Hey, Brian! Are you still training? prospects and encourage
a reply.
Body: Hey, Brian!
It’s Sarah from Monner Training! I’d love to have you back in the training group on Saturdays!
Are you interested?
Yours in health,
Sarah Monner

This communication is short, is to the point, and asks for a reply. If the recipient is interested,
they will likely reply with an affirmative and ask for more information. If they are not interested,
they will likely reply with a no or not reply at all. There is no harm in asking. If the timing
was not right or the recipient is still interested, this email will help reengage them back into
dialogue. For those not ready to commit, a trainer can reenter them back into their list of
emails they send periodically—informational, strategic, or promotional.
COLLABORATING WITH INFLUENTIAL PEOPLE

Just as a trainer works to build relationships with their clients, it is also important to build
relationships with people in the community. Introducing others to a brand authentically, in
nontraditional marketing ways, offers many benefits. For example, a hairstylist at a high-end
salon talks with many people every day. If these are affluent people who are willing to spend
time and money on their appearances and luxury services, they may also be interested in
hiring a personal trainer. A trainer should consider offering an occasional complimentary
session to someone who’s influential, such as a hairstylist. Trainers should actively connect
with other professionals who share a similar target market. The following examples generally
have client crossover with the fitness industry:
• Hairstylists
• Chiropractors
• Physical therapists
• Nutritionists
Similarly, by hosting a complimentary group exercise class for this individual and their clients,
a trainer will have the opportunity to connect with several potential clients. It will be a win-win
for the hosting professional (a free class for their clients) as well as the personal trainer.
THE CLIENT LIFE CYCLE

A fitness professional must understand the steps the average client goes through when
considering, buying, and using personal training services—the client life cycle. Each step
is important for attracting and converting potential clients, providing them with a positive
and productive fitness experience, and keeping them engaged and motivated to continue to
employ a trainer’s services.

Figure 18.5 Perfect Customer Lifecycle
ATTRACT NEW POTENTIAL CLIENTS

The fitness industry is seasonal, and there are expected ebbs and flows in the business. For
example, many new clients hire fitness professionals in January as they set and commit to
health-related New Year’s resolutions. Conversely, many personal trainers will see a reduction
in client sessions completed, income, and training interest during November and December,
as there are several holidays at this time of year when clients may be traveling or less
available. Similarly, dips in business may also be seen in May and June, as this corresponds
to many children getting out of school for the summer and an increase in family travel.
Finding potential new clients, also known as leads, can be a daunting challenge. There
are many different ways to market, and when starting a business, marketing budgets are
generally small yet manageable. Many trainers likely cannot afford to create television or
online advertisements to market themselves. However, social media apps now have less
expensive but highly effective advertising options available.
To combat the seasonality of the fitness industry, a personal trainer should always be looking
for and working to attract new potential clients. This can be done with marketing and CLIENT REFERRALS:
advertising both in-person and online, reaching out to interested individuals to set up initial A method of marketing
where current or former
training sessions (often free of charge), or encouraging paying clients to bring or refer their clients refer friends and
family to a professional for
friends and family. Client referrals are a powerful tool for building and growing a personal services by word of mouth.
training business.

CAPTURE LEADS
There are many ways to generate leads. From websites and social media to in-person events
and trade shows, fitness professionals encounter prospective clients all the time. If a trainer
is not generating leads, there is a good chance their business is “not” growing.
Many leads that a fitness professional will encounter will not sign up to train with them
immediately. When a trainer meets new leads, the key is to collect their information so they
can be contacted about the trainer’s services. Email lists, referrals, and business cards from
the leads should be used to collect the contact information of people who are interested in
the trainer’s services (or whom the trainer feels could benefit). Then it’s easy to reach out
with offers, information, and valuable content to establish the fitness professional and what
they do. This is the first step in nurturing leads.
NURTURE AND CONVERT LEADS

Once leads are collected, the nurturing process begins. In marketing for any industry, nurturing
leads is the process of building and reinforcing a relationship with a buyer (or potential buyer)
throughout the sales process. Specifically, before the lead purchases anything from the
trainer, they can be nurtured with periodic contact via phone, text, or email and sent valuable
(and free) information that applies to their goals or invitations to seminars, workout sessions,
or workshops. The goal of nurturing leads is to ensure they understand what services the
fitness professional offers and allow the lead to interact with the trainer, ask questions, and
see value in their services. The goal is lead conversion—a lead moving from someone who’s
interested to someone who purchases something from the fitness professional. They may
complete a one-time purchase or commit to an ongoing training program based on what they
have found value in.
HOW TO CREATE VALUE

Creating value is an essential component of a successful business, regardless of the
industry. Potential clients are considering whether they should invest their time, money, and
attention in return for an anticipated result. It’s important for a personal trainer to share their
personal story and their “why” behind what they do—a client who resonates with that will
want to know more.
But more importantly, how does what the trainer does and why the trainer does it help the
potential client? What does the client get out of it? What can the trainer do for the client that
is worth the investment? The trainer should consider the following:

What is the tangible value of working with a trainer?
• I am hiring an expert.
• I am hiring someone who has experience leading others to a similar goal.
• I am hiring someone who can develop a plan for me.
What are the issues working with a trainer helps solve?
• I do not feel comfortable working out by myself.
• I cannot seem to hold myself accountable for healthier habits. I’ve tried many times
and failed.
• I do not have a person in my life who encourages a healthier lifestyle.
• I try to eat well and work out, but I don’t know what I am doing.
The way a personal trainer communicates this information in their marketing resources and
when communicating with potential clients is one of the keys to their lead conversion.
INITIAL ASSESSMENT
When the client is ready to commit to the program, the initial assessment can take place. Client
forms (subjective assessments) will be provided to the client during the initial assessment.
During this assessment, it is also important for a fitness professional to spend time getting
to know a client and learning their goals. This allows trainers to create programming that’s
customized and based on someone’s personality, likes, and dislikes. The more thorough the
initial assessment is and the more information that’s gathered about the client, the more
customized the program will be. Fitness assessments are an important part of establishing
a baseline fitness level and should include the following:
• How the client heard about the program
• Health history questionnaire
• Liability waiver
• PAR-Q
• Physician’s release, if necessary
• Fitness assessments
• Goal setting
This is also a good time for the personal trainer to set expectations for the program. For example, a
trainer should be sure a new client understands their refund policy (if applicable), their cancellation
policy for training sessions, and how and when to contact the trainer during the program.

DELIVER SERVICES
Once the lead has become a paying client and expectations have been set, the trainer can
add the client to their schedule and deliver their services. It is important that any promises
made during the nurture and conversion processes are fulfilled promptly. For example, if a
trainer offers a free written workout or a free shirt upon signup for 12 training sessions, they
should ensure it is delivered immediately upon the client’s enrollment into the program.
UPSELL CLIENTS
Throughout the client life cycle, the trainer has an opportunity to upsell. An upsell is a
UPSELL: technique used in sales where a client is encouraged to purchase additional services,
A sales technique where
a client is encouraged products, or add-ons to generate more revenue—for example, selling supplements, apparel,
to purchase additional
services, products, or or other services such as nutrition guidance or physical recovery sessions to clients once
add-ons to generate more
they have begun their program. Upselling is an opportunity to present additional options,
revenue.
products, and services that provide value to the client and their goals. These extra offerings
also serve to increase a client’s commitment to their program since they are investing
additional money toward it.
FOLLOW-UP ASSESSMENT
Follow-up assessments should happen throughout the program and are a valuable component
of the personal training experience. Not only is this helpful for tracking progress, but by
revealing and discussing the outcomes with a client, the trainer also increases the likelihood
that a client will renew their package. Follow-up assessments should include the following:
• Revisiting existing goals

• Fitness assessments
• Setting new goals
• Action plan
• Recommitment
• Reinvestment
GET REFERRALS
A referral is an important and valuable way to build a personal trainer’s clientele. When a current
or past client refers friends or family for services, it means they trust the trainer and value the
services they offer. Referrals may even come from someone who has never been a client but
had a positive interaction with a fitness professional at a workshop, the gym, or a seminar, for
example. All interactions a personal trainer has with current clients or leads are important.
Even those interactions that do not end in an immediate sale could lead to a referral.

When to Ask for Referrals
Any time can be good to ask for a referral or testimonial. But people are most excited about
a trainer’s services when they are seeing results and making effective lifestyle changes. It is
advantageous for a trainer to leverage that excitement to get a quote or review for marketing
or to ask for a referral. The client may have family or friends who admired their progress and
showed an interest in the fitness professional’s personal training services.
A trainer can ask for more information about the people a client knows so they can create
offers targeted at those who are interested. For instance, if a client talks about a friend
struggling with losing weight and setting goals, a personal trainer may ask more about the
situation and offer an opportunity to bring a friend for free on a future training date. This can
allow the personal trainer an opportunity to make a connection with the friends of their clients
and provide a unique offer that encourages those friends to sign up.
Some trainers find success in offering rewards for referrals. It could be as simple as an
entry into a monthly drawing for apparel or gift cards or a free session if the referral makes
a purchase. A reward can be an effective, an inexpensive, and a motivating way to drive the
referral process.
Quick follow-up with referrals is essential to act on interest in the moment. People are
easier to talk to—and objections are easier to overcome—when they are excited and highly
motivated to change.
Promoters versus Detractors
When building a reputation, personal trainers and small business owners encounter two
types of people:
• Promoters are those who had positive experiences with a fitness professional and
their services. They are happy with their results and will likely refer friends or family.
• Detractors are unsatisfied with their interactions with or services provided by a
fitness professional. Detractors will usually make themselves known quickly. It is
important to directly reach out to any detractors as quickly as possible to hear their
concerns, empathize with them, and, if possible, offer a solution.
Conducting periodic surveys of current, past, and potential clients can provide useful
information on the effects of marketing materials, a fitness professional’s social media
presence, and client satisfaction.

THE IMPORTANCE OF CLIENT RETENTION

Trainers must invest time and attention with each potential and existing client. The effort it
takes to recruit a new client is greater by far than the effort it takes to maintain an existing
one, given the trainer is fulfilling their role and the expectations of the client. Consistently
creating value and creating a positive experience for clients are key components in retaining
clientele.
CLIENT ACCOUNTABILITY
Accountability is one of the main reasons a client hires a personal trainer. Putting together
an amazing health and fitness game plan is part of the experience when working with a
trainer. But the results come from executing and following through with the plan. It has been
shown that having a coach in most any endeavor will improve results. This is true in personal
training. Whether a client is meeting with their trainer virtually or in person, showing up for
another person is a big step that will become easier over time and with a trainer who brings
value.
RELATIONSHIP BUILDING
Putting the “personal” in personal training creates rapport and builds trust between the
trainer and client. A trainer’s work goes beyond a 30-minute workout. During this time, clients
tend to open up about their work life, homelife, what stresses them out, and what they do for
fun. The following tips provide value and will strengthen the relationship, leading to long-term
commitment and client retention:
• Listen actively.
• Say and do things that reflect the client was heard.
• Recognize their birthday.
• Email articles and tips that are of interest to them.
• Perform weekly check-ins through text or email.
RENEWING CLIENT PROGRAMS

When a client is nearing the end of their package of sessions or subscription (in the case of a
month-to-month contract), there are multiple ways a trainer can encourage a renewal. It is not
the client’s responsibility to ask what the next steps are. Instead, a personal trainer should be
actively selling the renewal before the final session. Additionally, it is a good business practice
to plant the seed of a potential renewal to give clients time to plan their finances accordingly.

One way to pique a client’s interest in additional training is to reference the progress they’ve
made. Recognizing their hard work reinforces that the sessions are effective and that their
financial investment, along with their time, has been well spent. Using future-based language
and referencing what they will be doing “next month” or “in another eight weeks” will help
them set their sights on future goals and future progress and make the necessary financial
arrangements to continue investing in their trainer. Periodic reassessments can reinforce the
value of working with their trainer. Knowing they performed two push-ups at the start of the
program and now they can do six push-ups is extremely valuable. Trainers should spend time
recognizing their progress and giving an overview of what that means for the next several
weeks.
MANAGING A PERSONAL TRAINING BUSINESS

Selling and servicing personal training sessions are what a personal trainer does when they
are working the business. Tracking the finances of the business, documenting client contracts,
marketing their programs, and evaluating their business as a whole is what a personal trainer
does when they are managing their business. Being a proactive and organized manager
of the business will ensure continued success and growth along with a positive customer
experience.
SCOPE OF PRACTICE
One of the most important components of a personal training business is understanding and
staying within the scope of practice. Throughout their careers, trainers will come upon various SCOPE OF PRACTICE:
scenarios that may be outside their scope of practice. Trainers should familiarize themselves The practices, procedures,
and actions a personal
with their scope of practice in this role. Stepping outside their role as a trainer can put them trainer is permitted to
undertake in keeping
at risk of becoming responsible for the information or advice they shared. The following are with their professional
certification.
common conditions that are present in the personal training setting. If personal trainers
encounter a client or potential client with any of these conditions, they should not give advice
or make a diagnosis but refer them to the appropriate professional.
• Injuries
• Medical concerns
• Eating disorders
• Mental illness, including depression
• Specific meal planning

TRACKING TRAINING SESSIONS

Just as each trainer has a unique training style and approach, their preferred tracking method
should be what works best for them. There are various options when it comes to tracking
sessions, all of which help maintain organization. The simplest method includes using a pen
and paper. Websites, apps, and software programs can be highly useful, particularly as the
business grows. This makes it possible to track sessions or client notes on one’s smartphone
or tablet. Software programs can also help trainers manage their revenue, costs, and
expenses, which can be developed into a profit and loss statement (P&L statement).
PROFIT AND LOSS
STATEMENT: FINANCIAL CONSIDERATIONS
A financial statement
summarizing revenues, Regardless of how great a trainer is at building relationships and bringing value to their
costs, and expenses in a
clients, if they are not financially savvy, their business will struggle. Personal trainers must
given time period.
consider their expenses when establishing client rates. The following expenses are often
overlooked and should be considered early in the business’s startup:
• Paid social media ads

• Time spent marketing
• Time spent preparing client sessions
• Equipment (resistance bands, weights, mats, etc.)
• Certification renewal
• Continuing education
• Cardiopulmonary resuscitation (CPR)/automated external defibrillator (AED) and
first aid certification
• Rental space
• Paying to park during sessions
• Liability insurance
• Business license
SALES
While not everyone is comfortable “selling,” it’s a skill that can be improved with practice.
Going into a sale with a financially focused mindset can provide additional drive and
determination. However, there’s more to it than financial motivation. Here are the three ways
a personal trainer can improve their ability to sell:
One: Focus on bringing value. Rather than asking “What’s in it for me?” a trainer who
emphasizes service, value, and quality will have a strong foundation of credentials that
increases the likelihood of a client purchasing packages.

Two: Don’t use high pressure. Just as a trainer wouldn’t expect a new client to perform 60
seconds of burpees on day one, they also shouldn’t expect someone to purchase a package
right away either. As indicated in the customer life cycle, it takes time to convert a lead into
a client. People want to learn more about a trainer’s services before they sign up with them.
Talking with the client, answering their questions, and showcasing one’s expertise will warm
them to the idea of purchasing a package.
Three: ASK! If someone hasn’t purchased a package yet, it doesn’t mean they aren’t ready to.
Sometimes life happens and their schedule, family, or work matters take over. Stay in touch,
and when all else fails, a trainer should take the assertive approach and ask for the sale.
A simple “Let’s get started. When are you available for the first session?” might be all the
encouragement they need to seal the deal.
As the sale is made, fitness professionals should have a professional contract ready for the
client to sign. The contract is a way for both the trainer and the client to agree to the terms
of the program. These terms can include the following:
• Cost of the services

• Number of sessions purchased
• Cancellation policy
• Future payment dates (in the case of a payment plan)
CONSIDER OTHER PRODUCTS AND SERVICES

When it comes to personal training, the possibilities are endless. From one-on-one training
to group exercise and virtual workouts, the fitness industry continues to grow. The following
are additional revenue streams that trainers can tap into while sharing their expertise and
building credibility:
• Collaborating through paid social media posts with fitness and wellness brands
• Contributing blog content to fitness and wellness brand websites
• Creating fitness programs for clients to do on their own (this is an affordable way
to introduce them to the programming, which may lead them to purchase a full one-
on-one package)
• Writing and selling an e-book
• Writing and selling a recipe book
• Selling online courses
• Hosting fitness retreats or camps
• Hosting workshops

PERSONAL TRAINING BEST PRACTICES: ADVICE FROM SEASONED FITNESS

PROFESSIONALS
Becoming a personal trainer means learning the science of the human body to be able to act
as an expert in the field of human movement. A personal trainer can go so far as to obtain
a PhD in exercise physiology or biomechanics. This level of subject matter expertise can
serve a personal trainer well, as it is this knowledge that can create expert-level exercise
programming. This is only part of the equation when it comes to the success of most personal
training careers. There is more to the job than just subject matter expertise. Other pieces of
knowledge, skills, and abilities lend themselves to career success in this field. This section
highlights some of those that are common among successful professionals.
BE ORGANIZED AND USE A SCHEDULING TOOL

Many of the best trainers are organized trainers. These trainers typically have systems they
use to keep themselves organized. A filing system for current and potential clients (hard copy
or virtual) allows for good record keeping. This can help a trainer manage the long-term plan
related to the client’s fitness goal and keep track of potential or new clientele. Creating a plan
for each day and each training session is necessary so every session is personalized and
thought out. Minimally, a general outline of the day’s workout should be prepared.
Time management is key as a personal trainer. Using a scheduling tool becomes a necessity
as one becomes busier and is juggling several appointments daily. Examples of scheduling
tools range from simple appointment books to more technology-based websites or mobile
phone applications. Trainers must manage the scheduling of their appointments with clients
along with scheduling time to dedicate toward developing their business. A growing business
does not happen accidentally, so using a tool to schedule time for finding new leads,
following up with old leads, and marketing oneself is also necessary. It’s important for fitness
professionals to also manage the parts of their lives that are outside their businesses. Using
a scheduling tool to set aside time for meals, workouts, dentist appointments, and so on
helps trainers ensure that time in their businesses and lives is organized, without conflict,
and accounted for.

TRACK CLIENT RESULTS
Clients, in general, hire a personal trainer to achieve goals. Many of those goals are measurable
goals. As covered in the Assessments chapter, a personal trainer can assess and track
metrics such as weight, bodyfat percentage, circumference, strength, and endurance. While
working with a client, the personal trainer should also track how clients perform during their
workouts, if they are completing other tasks related to their program (such as completing a
daily walk), or if they are doing their workouts at all.
All this information plays an important role for the trainer and the client. For the trainer, it
acts as a tool to coach the client, track progress, or indicate that changes need to be made.
For the client, it can confirm that their hard work is paying off or help them see they are not
holding themselves accountable to the process.
BE ON TIME
Being on time is not only an expectation clientele and employers will have, but it is also a
necessity for the personal trainer to ensure preparedness and organization. If a trainer has
an appointment starting at 8:00 a.m., on time does not mean 8:00 a.m. for the trainer.
They should be present and preparing beforehand. If this 8:00 a.m. client expects to have
the session completed and move on with their day by 9:00 a.m., then on time also means
completed on time. To be prepared and organized, many employers will recommend a 10-
to 15-minute buffer prior to starting a personal training session. If a trainer has several
appointments scheduled back to back, it becomes more important that the trainer is prepared
for their clientele before the start of those sessions. Additionally, it’s critical that the trainer
manage each session so they end with time to spare to prepare for their next client.

MEET AND NURTURE LEADS

A common misstep personal trainers make in growing their business is failing to manage
their leads. Often, trainers in a health club setting will meet new members (potential new
clients) and set complimentary appointments with them to discuss goals and possibly take
them through a workout. Things may go well, but the new member may not be ready to hire
the trainer. This is where the mistake happens: lack of follow-up. The trainer has spent
time and energy starting a relationship but then does nothing to nurture and further the
relationship. Potential clients become actual clients when they trust the trainer enough to pay
for their services. Sometimes that trust must be built over more than just one complimentary
session.
The personal trainer must have a system in place for keeping track of their leads. Minimally,
as they meet new potential clients, trainers will want to track their names, contact information,
and results of their last contact with them. Over time this list can become long, and in terms
of building a business, it is in the best interest of the personal trainer to be able to follow
up with people they have already interacted with and have some level of rapport with. The
alternative is continually meeting new people and never speaking with them again.
PRACTICE SELF-CARE
As a professional in the health and fitness industry who will be coaching clientele toward a
healthy and fit lifestyle, the personal trainer must practice what they preach. This does not
necessarily mean big muscles, a low bodyfat percentage, or impressive athletic feats. What
it does mean is a lifestyle that includes a healthy personal exercise practice, nutrition that
helps the trainer feel their best, and rest and recovery that lets them show up every day ready
to serve their clients. This can lend itself to their credibility as a professional. Additionally,
managing their hygiene and appearance play a role in how clients and potential clients may
perceive them. Trainers are often viewed as sources of inspiration and people who set a high
standard of health and fitness. Managing how they present themselves to the public can
have a significant influence on how they appear to potential clients.
CONTINUING EDUCATION AND PERSONAL DEVELOPMENT

The health and fitness industry has evolved greatly over the years, and so has our understanding
of the science involved in optimizing human health and performance. Because of this, the
personal trainer must continue their education to not only broaden their understanding but
also stay current with the latest industry developments.

Continuing education can offer trainers the ability to specialize within the profession. Some
personal trainers specialize in strength and conditioning, golf performance, rehab-based
training, and youth exercise. Continuing education can also offer personal trainers the
opportunity to become better businesspeople, learning leadership and management along
with entrepreneurial topics.
As the industry continues to evolve, more and different opportunities are becoming available.
Those who seek education and evolve with the industry will be those most suited to succeed.
Industry newsletters, conferences, and educational companies such as ISSA are some of the
best resources for staying up to date.
PERSONALIZING THE TRAINING EXPERIENCE

Excellent customer service should be a consistent component of the personal trainer’s role
with current and potential clients. Being prepared and on time are the minimal standards of
customer service. To further improve the customer experience for clients, adding a personal
touch is highly recommended. Here are some examples of how to personalize the training
experience:
• Acknowledge special occasions

► Birthdays or holidays (special themed workouts, birthday cards)
► 100 sessions completed
► Achieving a goal
• Have items on hand for clients (especially if they forget to bring them)
► Water
► Towels
► Hair ties
MAINTAINING APPROPRIATE RELATIONSHIP BOUNDARIES

The relationship between a trainer and their clients can at times be a close personal
relationship. First and foremost, it is a professional relationship. This professional
relationship entails the communications and interactions relevant to the goals of the client
and the trainer’s role. Maintaining a clear separation between the professional relationship
and anything more personal is the responsibility of the trainer. Preserving this boundary
helps the trainer maintain a professional reputation and keeps them protected from any
potential liability. Some additional tips that can help personal trainers set and maintain
appropriate boundaries include the following:

• Establishing appropriate avenues and times for client communication

• Being mindful of discussing sensitive or personal subjects
• Being clear about and enforcing established policies
• Staying within the scope of practice
• Maintaining appropriate levels of privacy if sharing personal life details
CODE OF ETHICS
A code of ethics is a set of guiding principles that drives the actions of a professional. It
CODE OF ETHICS: identifies the best practices for honest, fair, and equitable service for all parties involved—
A set of guiding principles
that drives the actions of a the coach and the client.
professional.
The code of ethics covers standards from each of these five categories:
• Integrity: being straightforward, honest, and transparent

• Objectivity: remaining unprejudiced and avoiding conflict, bias, or outside influence
• Professional competence: committing to education and professional knowledge to
improve coaching skills throughout one’s career
• Confidentiality: protecting the privacy of clients in all forms
• Professional behavior: acting to build and preserve one’s reputation as a health
coaching professional

ISSA CODE OF ETHICS
The ISSA Certified Personal Trainer shall do the following:
• Act with integrity in relationships with colleagues, peers, and other health care
professionals.
• Maintain a professional client–trainer relationship at all times. Personal training
professionals have the obligation to properly assess clients, program for their
needs, educate them, and provide health care referrals as needed for their best
interest.
• Refrain from soliciting business from another professional’s clients or students.
• Respect the client’s choices and decisions about their own health and provide
accurate, factual information.
• Truthfully represent their education or credential(s) to ISSA, clients, or an employer
and work inside their scope of practice.
• Do not discriminate on the basis of sex, gender, race, religion, national origin, color,
or any other basis deemed illegal.
• Maintain any and all primary and supplementary certifications (including CPR
certification as required) that are necessary to execute their job.
• Uphold their social responsibility to promote diversity and inclusion and educate
and inform within the scope of practice.
• Use their best judgment to maintain a safe training environment for clients. This
includes the space being used and the recommendations being offered. At no time
shall harm to others be intended.
• Accurately represent their services and what is reasonably expected from a training
relationship with clients.
• Keep up to date on new developments, concepts, and practices in the wellness
industry to promote professional excellence.
• Maintain a strict level of privacy and confidentiality with patient information and
programs.
• Maintain a clean appearance that is consistent with good hygiene and appropriate
working attire.

SAFETY AND
CHAPTER 19
EMERGENCY
SITUATIONS
LEARNING OBJECTIVES
1 | Explain the purpose of a CPR/AED certification for a fitness professional.
2 | Identify recommended safety equipment that should be in a fitness facility.
3 | Describe the most common emergency situations a personal trainer may

encounter.
4 | Identify instances when emergency services should be called.

CHAPTER 19 | Safety and Emergency Situations
DISCLAIMER
Under no conditions does ISSA accept responsibility regarding any consequences that
stem from the use of the information provided in this safety and emergency situations
chapter.
The following information is provided as a study aid and is not intended for use as
a first aid manual. The following information is intended as information for safety
awareness and is in NO way to be used as a substitute for CPR, AED, or first aid
training, OSHA compliance, job training, or for proper equipment use.
During exercise, remaining safe means following a proper warmup and cool down protocol,
using proper form, and challenging the body with appropriate resistance and workloads.
Safety also applies to the environments where exercise takes place. Fitness professionals
must be aware of common and potential safety hazards and situations, how to address them,
and understand their role in keeping themselves and clients safe during activity.
OWN THE FITNESS FLOOR

Fitness professionals work in a variety of environments and facilities. The area where clients
exercise is often called the ‘workout floor’- or ‘the floor’ for short. This area is where a
personal trainer will spend most of their time when working with clients. When they are not
training clients, they will still be out on the floor taking care of the equipment, meeting and
engaging with members, prospecting for new clients, and selling products and services.
Regardless of the type of environment a personal trainer works in, there are safety and
cleaning duties that need to be tended to on a regular basis. Some of these include:
• Keeping all equipment clean
• Ensuring all equipment is in working order
• Properly storing equipment that is not in use
EQUIPMENT CLEANLINESS
Fitness equipment is touched and used frequently in most cases. While most fitness facilities
ask clients to clean equipment before and after use, this does not always happen. Regularly
cleaning fitness equipment like weight machines, dumbbells and barbells, and mats with
cleaning and sanitizing chemicals can reduce the number of bacteria, dirt, and contaminants
that can make clients and employees sick. Cleaning also offers a trainer the opportunity to
look at equipment and identify machines or tools that need repair or replacement.

It should be differentiated that cleaning and sanitizing are not the same thing. Cleaning can
be done with soap and water while disinfecting and sanitizing require the use of chemicals.
For clarity, each are defined by the U.S. Center for Disease Control and Prevention (CDC):
• Cleaning- Removing dirt and impurities from surfaces or objects with a detergent
(like soap) and water. Cleaning does NOT kill germs, but it removes them and lowers
the risk of spreading infection.
• Disinfecting- Killing germs and virus on surfaces or objects with the use of
chemicals. Disinfecting does not necessarily remove the germs from the surface
when it kills them, but it lowers the risk of infection.
• Sanitizing- Cleaning and killing germs on surfaces or objects enough to bring the
microbe level to an acceptable range.
Sample Safety and Cleanliness Checklist for a Fitness Facility.
FACILITY FLOOR
F Clean and free of loose debris or equipment
F Wooden floor is free of dust, splinters, or protruding nails or screws
F Carpets, rubber floors or interlocking mats are secure and free of tears, gaps
or bulges
F Walking paths are clear of wires (plugs for cardio), small exercise tools and other debris

WALLS
F Electrical outlets or wires are not protruding in activity areas
F Walls, mirrors and windows should be cleaned daily.
F Mirrors are not cracked or distorted and are securely fixed
F Mirrors should be at least 20 inches off the floor. Equipment should be placed
at least six inches from the mirrors.
CEILING
F Maintain all light fixtures and replace any broken or non-functioning bulbs.
F Replace any missing ceiling tiles, cover exposed ducts or pipes.
EXERCISE EQUIPMENT FOR STRETCHING AREA
F Mats should be cleaned and disinfected prior to heavy use times of day
F The floor should be free of loose debris or equipment.
F Restore all equipment to its proper place.
AEROBIC OR PLYOMETRICS AREA
F The floor should be free of loose debris or equipment.
F Restore all equipment to its proper place.
F Ensure all the equipment is in working order
EQUIPMENT FUNCTIONALITY
Fitness equipment can range from simple, like a dumbbell or kettlebell, to complex, like a cable
cross machine with many different parts, pulleys, and cables. For safety and functionality,
it is important that all fitness equipment is kept in good working order. Loose pieces or
equipment that is not operating properly can cause injuries to users and impair the function
of a machine. For example, any machine that uses cables will have altered resistance if the
cable coverings are torn or frayed. Similarly, a seat that has torn fabric or a dumbbell with a
loose handle can pinch skin or cause cuts or lacerations during use.
Often, simple equipment maintenance and the identification of needed repairs falls on the
fitness professional. More complicated repairs, reupholstering, and parts replacements are
typically handled by a maintenance team, or a professional fitness equipment care company.

Many fitness facilities will have a reporting process for broken or damaged equipment. For
example, entering the equipment number, a description of the damage, and the date it was
first identified into a log that maintenance or a manager checks daily. If a trainer is working
for themselves, they will need to establish their own processes for identifying, replacing, and
repairing broken fitness equipment.
EQUIPMENT STORAGE
Exercise equipment should be stored appropriately with the goal of minimizing safety or trip
hazards and prolonging the life of the equipment. This means storing smaller equipment in
a safe, appropriate location like a hook on a wall, a designated weight rack, or in a basket.
This also applies to the storage positions for larger, stationary equipment like treadmills,
large machines, and stationary bikes for example. Larger equipment should be set to the off
position (turned off or unplugged if preferred) with all accessories stored properly.
In the case of a stationary bike, for example, many facilities prefer the seat and handlebars
to be set to the lowest position and gears released for manual bikes. This neutral position
takes tension off the gear system and makes use easier for the next person.
For plate-loaded equipment, all plates should be stored on the appropriate weight trees when
not in use. Plates should not be left on the floor, in walkways, or leaning against equipment
where they pose a trip hazard or could fall and smash a foot.
Fitness professionals who work in a facility will often be tasked with walking the gym floor and
picking up stray fitness equipment. Every opportunity on the floor is a chance for a personal
trainer to prospect for new clients regardless of the tasks they are completing. In many
cases, a trainer will also clean any dirty equipment they come across and take time to engage
with members, clients, and guests as they pick up and store equipment.

CPR CERTIFICATION
CARDIOPULMONARY
It is a basic requirement for a certified personal trainer to have a certification in
RESUSCITATION (CPR):
An emergency procedure cardiopulmonary resuscitation (CPR) which is often combined with training on how to use
involving chest
compressions and, often, an automated external defibrillator (AED). A CPR and AED certification teaches a personal
artificial ventilation to
circulate blood and
trainer how to identify risk factors for emergency health situations like cardiac arrest or
preserve brain function injuries. It also prepares a fitness professional to provide potentially life-saving aid in the
in an individual in cardiac
arrest. event of an emergency in the fitness setting. This requirement is necessary upon initial
certification and for the renewal of a Certified Personal Trainer (CPT) certification.
AUTOMATED EXTERNAL
DEFIBRILLATOR (AED):
A portable electronic
device that can identify and
electrically correct heart
arrythmias, ventricular
fibrillation, and tachycardia.
CARDIAC ARREST:
An electrical malfunction
of the heart that causes
irregular heartbeat.
Figure 19.1 Chest Compressions for CPR
CPR is an emergency procedure used to manually preserve respiration and heart function in
an individual who is in cardiac arrest. It involves chest compressions and, in some cases,
artificial ventilation (breathing) to keep the victim’s blood oxygenated and circulating.
An AED is a portable device that is used before or during CPR to diagnose the status of the
heart. Specifically, an AED can identify if someone is experiencing a life-threatening arrythmia
(irregular heartbeat), ventricular fibrillation (rapid fluttering of the ventricles), or tachycardia
(rapid heartbeat). Many businesses, schools, and office buildings have at least one AED on
site. When working in a fitness facility, it is important to identify (1) if the facility has an AED
and (2) where it is located in case of emergency.

Figure 19.2 Automated External Defibrillator (AED)
Many organizations offer CPR courses, including ISSA. In the U.S., The American Heart
Association and the Red Cross are common CPR course administrators. Contact your local
CPR administrator for more information on in-person and online CPR courses offered near you
that will meet your individual needs.
www.redcross.org
www.americanheart.org
THE GOOD SAMARITAN LAW

The Good Samaritan Laws are legal protections offered for people who provide reasonable
GOOD SAMARITAN
assistance to someone who they believe to be injured, ill, or incapacitated. These laws are
LAWS:
applicable in most of the United States and some areas of Canada. In many other countries, Legal protections offered
in much of the U.S. and
these laws and protections do not exist. The challenging part is that these legal protections Canada that protect an
individual who offers
vary by local jurisdiction. However, in all instances, the four basic components of the Good assistance, CPR, or first
aid to someone else in an
Samaritan Laws are:
emergency situation before
trained help arrives.
1. Permission can be given by the injured or ill person if possible.
2. Assistance or care was provided in an appropriate manner (not recklessly).
3. The person protected by the Law was NOT the person who caused the accident.
4. Care was provided because it was an emergency and trained aid had not yet arrived.
Under these protections, the individual providing aid cannot be sued for additional injuries

caused during a rescue attempt. For example, broken ribs that are a result of chest
compressions during CPR are relatively common. If a victim sustains broken ribs from a
rescuer providing CPR, the rescuer may be legally protected from liability for this additional
injury. This policy is in place to encourage people to help one another in emergencies without
the fear of repercussions. This is not intended as legal advice and should not take the place
of advice from a qualified legal professional.
INJURY PREVENTION
Part of ensuring a positive and safe experience for clientele is taking the proper steps to
ACUTE INJURY: prevent injury. Acute injury describes a type of injury or an illness that is of rapid onset and
Describes a type of injury
or an illness that is of rapid progression. These types of injuries are usually the result of a specific impact or trauma to
onset and progression.
the body. Chronic injury refers to an injury, illness or disease that develops slowly and is
persistent and long-lasting. Many chronic injuries have mild symptoms, sometimes referred
CHRONIC INJURY:
to as cumulative trauma or overuse. Both acute and chronic injuries can be made less likely
Refers to an injury, illness,
or disease that develops when the personal trainer takes the following steps:
slowly and is persistent and
long-lasting.
• Always ensure a proper warm-up.
• Show students correct technique and alignment as well as proper posture and body
position for each exercise.
• Show clients the proper use of exercise equipment and machines
• In complex movement or exercise patterns, establish the correct movement or
pattern before adding speed.
• Create exercise programming that builds in rest and recovery to avoid overtraining.
• Offer modification to accommodate different fitness levels.
• Control the number of repetitions performed in one given set.
• Always ensure a proper cool-down and stretch.
EMERGENCY EQUIPMENT AND PROTOCOLS

A fitness professional may need to utilize emergency equipment at one time or another.
Outside of the AED, a first aid kit is commonly accessed for necessary items ranging from
bandages to tweezers. The first thing to be aware of is where all emergency equipment is
located in a workplace or building should it be needed quickly.

FIRST AID KIT
FIRST AID:
First aid is a term that describes the first and immediate aid given to someone with a minor The first and immediate
or serious injury, illness, or condition. The goal of first aid is to prevent the issue from aid given to someone with
a minor or serious injury,
worsening, promote recovery, and, in extreme cases, preserve life. illness, or condition.
A first aid kit is a compact box that is pre-stocked with supplies for general medical
FIRST AID KIT:
interventions. They can be purchased fully stocked or a kit can be made with the appropriate A compact box that is pre-
stocked with supplies for
items. Like the AED, most businesses, office buildings, and schools have at least one first aid triage and general medical
interventions.
kit available. Typical items you will find in a first aid kit include:
• Adhesive bandages- these are available in various sizes and are ideal for minor
cuts, abrasions, and puncture wounds.
• Butterfly closures- these help close open wounds and hold the edges of skin firmly
together.
• Rolled gauze- gauze is a wrap that allows freedom of movement and is recommended
for securing dressings or pads.
• Nonstick sterile pads- these are soft, absorbent pads that cover wounds and create
an optimal environment for wound healing. They are recommended for bleeding,
burns, and infections.
• First aid tape- these tapes come in a variety of thicknesses and are often
waterproof. They can be clear, cloth, or paper-based for different degrees of rigidity
or adhesiveness.
• Tweezers- these can be used to remove debris from a wound like dirt, pieces of
glass, or splinters.
• Thermometer- a thermometer is used to measure body temperature. While oral

thermometers are more accurate, they are not as hygienic as a digital thermometer
that measures the temperature at the temple or in the ear canal.
• Ice packs- ice packs in a first aid kit are inactive until the inner packaging is
punctured, and the contents are mixed together. These are ideal for acute injuries
like strains, sprains, localized swelling, or muscle pain.
• Analgesics- these are a classification of drug that provides relief from pain. They
can be oral such as ibuprofen or topical in gel or cream form.
Some commercial first aid kits may also include antacids, burn cream, latex gloves, a CPR
mask, items to make a small splint, and eye patches as well.

Figure 19.3 Example First Aid Kit
EMERGENCY EXIT PLAN

In every location where exercise is performed, there should be an emergency exit plan, or
EMERGENCY EXIT
emergency evacuation plan, in place. This includes outdoor spaces, gyms, studios, homes,
PLAN:
A visual plan of how and schools, and other buildings. It will clearly identify how to evacuate a building or space in
where to exit a space in the
event of an emergency. case of emergency. An emergency exit plan is a written and visual tool often hung on a wall
in plain sight that:
• Includes a drawn floorplan of the space.
• Clearly labels all exit and entry doors, stairwells, and elevators.
• Visually identifies the location of the viewer on the floorplan.
• Clearly identifies the exit routes form the current location.
• Identifies where to go in case the elevators are not operational (if applicable).
• Clearly identifies a designated meeting place outside of or away from the facility or
space.

Figure 19.4 Example Emergency Evacuation Plan
Other important considerations for an effective emergency exit plan include:
• Identifying when an emergency exit is necessary (fire, earthquake, etc.)
• Identifying a clear chain of command during an emergency for employees, clients,

and visitors.
• Determining a way to account for all employees, guests, and visitors after an
evacuation has taken place.
Most fitness facilities will have an emergency exit plan in place and will share it with all
employees. However, if you are a fitness professional with your own space or working with
in-home clients, this information may need to be created or discussed for safety.
SAFETY SUPPLIES
There are several other safety supplies that every fitness space should have. These include,
but are not limited to:
• Flashlights- flashlights may be needed in the event of a power outage.
• Toolbox- tools will be necessary to fix many pieces of equipment and general
repair an upkeep in a building. Common tools to have on hand include screwdrivers
(power or manual), pliers, a wrench set, Allen wrench set, a hammer or mallet, and
additional screws, nails, washers, nuts, and bolts of various sizes.
• Wet floor signs- in case of a spill, a wet floor sign will highlight the potential slip
hazard.
• Safety vests- these valuable tools make the wearer more visible. They can be used
in emergency evacuations or any other situation where someone needs to be seen
easily (taking out the trash in the dark, power outage, cleaning or work crews, etc.).

• Fire extinguisher- In case of a small, manageable fire, the fire extinguisher is useful
and should be placed in an easy-to-access location. Depending on building size,
many buildings have more than one.
• Disposable gloves- gloves can be used for cleaning, first aid, and any other situation
where the wearer needs to be shielded. It is recommended to have an additional box of
gloves outside of those that may be in a first aid kit as they are a high use item.
• Bloodborne pathogen cleanup kits- used for safe and sanitary fluid and blood spills
• Mop and broom- these are used for daily cleaning, but also for emergency spills or
debris cleanup.
• Cleaning towels- towels will likely be used for cleaning equipment, surfaces, and
spaces. It is important to distinguish cleaning towels from towels intended for use
on the body. If possible, cleaning towels should be a different color and stored in
a separate location.
• Cleaning and sanitizing solutions- these are used frequently to clean and sanitize
equipment, surfaces, and spaces like the restrooms and offices. Extreme care
should be taken with all chemicals and every chemical in the building should have a
material safety data sheet (MSDS) available. An MSDS provides information about
hazardous ingredients, health risks, chemical reactions, handling precautions, and
exposure limitations for a chemical product.
INCIDENT REPORTING
As a business practice, personal trainers and fitness facilities must document incidents
concerning first aid or emergency situations. The information that should be gathered includes:
• Person’s name
• Contact information
• Injury or illness
• How the injury occurred
• Site of incident
• Witnesses and their contact information
These reports can serve the trainer and facility in several ways. Learning from the incident
and creating strategies for the future can help to avoid the same incident from happening
again. They can provide detailed information for a medical or legal professional. They can
also act as a document that contain follow up details for the trainer or facility manager.

FIRST AID SITUATIONS
First aid situations refer to the care given to a person that is injured or ill until medical
treatment is available. In some cases, such as minor injuries, first aid care may be enough.
In other cases, a condition may escalate or may be more serious and advanced care may
become necessary.
Blisters
Blisters can appear as redness from friction accompanied by production of fluid under affected
area. As they can be uncomfortable or painful continued exercise may not be recommended
without proper treatment. If punctured, the blister should be cleansed and protected with pad
and dressing.
Fainting
Fainting is a temporary loss of consciousness. Light headedness, dizziness, paleness, and
light sweating are common symptoms that often precede fainting.
Assume anyone found unconscious to have a possible head injury and do not give the
victim anything by mouth. Do not move the victim unless absolutely necessary. Look for an
emergency medical ID around neck or wrist that could suggest a cause for unconsciousness
and keep the victim prone and quiet if they regain consciousness. Check to make sure there
is a clear airway, breathing, and circulation.
Hypoglycemia
Hypoglycemia, or low blood sugar, can often be caused by diabetes treatments. Dizziness,
weakness, blurred vision, excessive hunger, cool, moist skin are common symptoms. There is the
possibility of seizure, confusion, headache, and anxiety. They should consume fluids with sugar
(fruit juice) or candy bar, if they are conscious. If the victim is unconscious, call 911 immediaately.
Flu or Fever
Flu and fever often are accompanied by a combination of swollen glands, high temperature,
fatigue, and congestion. Advise clients to go the doctor, rest, and DO NOT EXERCISE!
Heat Cramps
Cramps are a painful involuntary contraction of a muscle or group of muscles. They can be
caused by overuse, dehydration or the loss of minerals due to excessive sweating. Generally,
rest, gentle stretches, ice, and of course rehydrating can help to alleviate the pain.

Heat Exhaustion
Heat exhaustion is a progression from heat cramps and can include pale clammy skin, a
rapid weak pulse, weakness, headache or nausea, and cramps in the abdomen or limbs.
The victim should lie down with their head level or lower than the body. If possible, move the
victim to cool place, but protect them from getting too cold. They should rehydrate with water
and electrolytes as soon as possible.
Heat Stroke
Heat stroke is a very serious heat related condition where the body has become unable to
regulate is temperature. It can be identified by symptoms such as the cessation of sweating,
a rapid strong pulse, and flushed, hot skin. Loss of consciousness may occur and it is
important to call 911 immediately. Cool the body with a cold, wet towel.
Lacerations and Abrasions
Lacerations and abrasions or cuts and scrapes of the skin may cause bleeding and should
be tended to before continuing with exercise. In some cases, depending on the severity and
location of the laceration or abrasion it will not be recommended to continue with exercise.
The wound and surrounding skin should be cleansed immediately to prevent infection. A
sterile pad should be held firmly over the wound until bleeding stops before changing the pad
and bandaging the area loosely.
Contusions
A contusion (bruise) is a region of injured tissue or skin where blood capillaries have been
ruptured. Discoloration is likely at the contusion site with continued color changes during the
healing process. Applying ice is recommended.
Shock
Shock an acute medical condition brought on by a sudden drop in blood flow and blood pressure
through the body. Cold clammy skin, a pale face, nausea or vomiting, and shallow breathing are
common symptoms. The victim may be chilled or shaky. Correct the cause of shock if possible
(bleeding). The victim should remain lying down, with a focus on staying warm, keeping their
airway open and their legs elevated. They should consume fluids if they can swallow.
FRACTURES, SPRAINS, STRAINS, AND DISLOCATIONS

Fractures, sprains, and strains may be difficult for a fitness professional to tell apart. For this
reason, first aid treatment of any of these conditions should be treated as though they were a

fracture. Signs and symptoms of any of these conditions may include a grating sensation of bones
rubbing together, pain, tenderness, swelling, bruising, and an inability to move the injured body
part. First aid for any of these conditions should control bleeding (if present) and care for shock.
Sprains are injuries to the connective tissue in a joint or group of joints. The ankle and wrist
are common locations for sprains. A strain occurs in a muscle. They can happen anywhere
but are most common in the low back, neck, shoulders, and hamstrings. A relatively high
amount of trauma is usually necessary for a joint dislocation to occur. The most common in
a fitness setting would be shoulders and fingers. It is not advised for the personal trainer to
attempt resetting the joint.
Cold packs can also help to reduce swelling and relieve pain. Only trained rescue workers
should move victims with traumatic injuries. Head, neck, and back injuries are serious and
require special care for movement and transport.
R.I.C.E.
All victims with fractures, dislocations, sprains, and strains require professional medical
attention. However, if a client cannot get medical care until a later date, the R.I.C.E. method
can help reduce pain and inflammation from an injury.
• R- REST: Ensure the individual is in a safe location and minimize movement.
• I- ICE: Apply ice or a cold pack to the injured area. This is usually done in ten to
20-minute intervals for several hours after an injury or until medical attention is
received.
• C- COMPRESSION: Wrap the injured area with clothing or bandage with pressure
applied.
• E- ELEVATION: Elevate the injured body part above the level of the heart.
WHEN TO CALL EMERGENCY SERVICES

The above first aid situations sometimes require additional and sometimes immediate
professional medical care. There are also other general circumstances when a fitness
professional should call emergency services as soon as possible to ensure timely medical
attention. These include:
• Chest pain- specifically, chest pain lasting more than a few minutes.
• Loss of Consciousness- for any reason. A medical professional can help determine
the underlying cause.

• Shortness of breath- especially when it occurs abruptly, seek medical help right
away to determine the cause and prevent further complications.
• Head Injuries- these can range from mild to severe and may cause concussions.
Contact help especially if accompanied with other symptoms like seizure, headache,
nausea or vomiting, slurred speech, confusion, weakness, or a loss of coordination.
• Broken Bones- more than basic first aid cannot be offered by anyone other than a
medical professional for broken bones.
• Heart Conditions- specifically, heart attack or arrythmias that cause chest pain,
loss of consciousness, or shortness of breath should be attended to by a medical
professional.
• Abnormal vision or dizziness- blurry vision, double vision, and loss of vision may be
symptoms of a more serious medical condition.
• Vomiting- if there is blood in the vomit or it is accompanied by other symptoms like
a headache, abdominal pain, or a fast heartrate, it can be a symptom of a greater

condition.
• Deep cuts- more severe cuts and lacerations will need to be closed with sutures
and may affect major blood vessels.
• Severe abdominal pain- a medical professional would need to determine the cause.
It could be as simple as gas or as serious as an inflamed or ruptured appendix
which would require an operation immediately.
BLEEDING
Major bleeding may be life-threatening and will require immediate attention. Bleeding can be
internal or external and come from three sources:
• An artery
• A vein
• A capillary
Arterial bleeding is characterized by spurts of blood with each beat of the heart, is bright red
in color (though blood darkens when it contacts the air) and is usually severe and difficult to
control. Arterial bleeding requires immediate medical care.
Venus bleeding is characterized by a steady flow and the blood is often darker in color. Venus
bleeding is easier to control than arterial bleeding. Capillary bleeding is generally slow and
oozing in nature and has a higher risk for infection than other types of bleeding. Controlling
the bleeding with a sterile pad can prove useful until emergency services arrives.

NOSE INJURIES
Severe nosebleeds can be frightening and lead to shock if enough blood is lost. In the event
of a nosebleed, the client should sit down, pinch the nostril shut, and lean forward. This will SHOCK:
An acute medical condition
prevent blood from running into the throat and can slow the bleeding. brought on by a sudden
drop in blood flow through
the body.
Once the bleeding has stopped, the victim should rest quietly until it can be confirmed that
the bleeding has ended. Talking, walking, or blowing the nose may disturb the blood clot and
cause the bleeding to resume. All uncontrolled nosebleeds require prompt medical attention.
DIABETIC EMERGENCIES
Sugar is required for energy production and insulin is the primary hormone that helps the body
regulate and use sugar. When the body does not produce enough insulin or cannot regulate
blood sugars, diabetes can result. Individuals with diabetes can have two types of emergencies:
• Insulin Shock
• Diabetic Coma
Insulin Shock
Insulin shock occurs when there is too much insulin in the body. This condition rapidly
reduces the amount of sugar in the blood and cells in the brain can be damaged as a result. INSULIN SHOCK:
A medical condition caused
Insulin reactions can be caused by taking too much medication, failing to eat, heavy exercise, by too much insulin in the
body that results in stark
and emotional factors. drops in blood glucose.
Signs and symptoms of insulin shock may include:
• Fast breathing
• Fast pulse
• Dizziness
• Weakness
• Loss of consciousness
• Vision difficulties
• Sweating
• Headache
• Hunger
• Numb hands or feet
A person in insulin shock needs sugar immediately. If the person is conscious, they should
consume sugar in any form- candy, fruit, juice, or a soft drink. Monitor the victim carefully and
seek additional medical assistance.

Diabetic Coma
A diabetic coma occurs when there is too much sugar and not enough insulin in the body. In
DIABETIC COMA: this case, the cells cannot take up glucose well and will not be able to function effectively.
A comatose state resulting
from excessively high blood This condition can develop over the course of several days. Diabetic comas can be caused
sugar levels.
by eating too much sugar at once, failure to take a prescribed medication, stress, and
infections.
Signs and symptoms of a diabetic coma include:
• Drowsiness
• Confusion
• Deep and fast breathing
• Thirst and dehydration
• Fever
• Loss of consciousness
• Sweet or fruity-smelling breath
People with symptoms of a diabetic coma may still be conscious. If there is suspicion of the
condition, first ask if they have eaten or if they have taken their medications. If they have
eaten but are having symptoms, it may be a diabetic coma. If they have not eaten, but did not
take their medications, they may be experiencing insulin shock. Monitor the victim carefully
and seek additional medical assistance.
STROKE
Stroke can occur when the blood flow to the brain is interrupted long enough to cause
STROKE: damage. This can be caused by a blood clot in an artery in the brain, a clot that is carried to
When the blood flow to the
brain is interrupted long the brain in the blood stream, a ruptured brain artery, or the compression of an artery in the
enough to cause damage.
brain. First aid for this condition consists of recognizing the signs and symptoms and seeking
medical attention. Signs and symptoms of a stroke include:
• Weakness or numbness in the face, arm, or leg (often o one side of the body only)
• Dizziness
• Confusion
• Headache
• Ringing in the ears
• Mood changes

• Difficulty speaking
• Unconsciousness
• Uneven sized pupils
• Difficulty breathing or swallowing
• Loss of bladder control
If you suspect a person is having a stroke, have them stop all activity and rest while you
immediately seek a professional medical assistance. Observe the victim while help is on the
way and be prepared to administer CPR if needed (and if trained to do so).
SEIZURE
A seizure is a burst of uncontrolled neural activity that causes temporary abnormalities in
muscle movements or muscle tone, behaviors, or sensations. Often, people will become stiff, SEIZURE:
A burst of uncontrolled
twitch, or go limp when having a seizure. Seizures are common and are caused by other neural activity that causes
temporary abnormalities
conditions like insulin shock, infections, head injuries, or drug reactions. in muscle movements or
muscle tone, behaviors, or
Many individuals will feel a warm sensation before the onset of a seizure. People who have sensations.
seizure conditions may recognize the impending episode and physically move themselves out
of danger. Seizures can range from mild to severe with mild episodes lasting a few seconds.
Sever seizures can be prolonged and involve uncontrollable muscle spasms, rigidity, loss of
consciousness, loss of bladder or bowel control, or, in extreme cases, breathing may stop
temporarily.
If someone is having a seizure:
• Immediately call for professional medical help
• Clear the area of other people or other objects that may cause injury
• Do not attempt to restrain the person and do not put anything in their mouth.
• Their clothing should be loosened and someone should stay with the person to
monitor them until assistance arrives.

GLOSSARY
3-Day Dietary Record - A common fitness and nutrition intake form that allows clients to log their food consumption for three consecutive
days to observe their habits - 205, 207
A
Abdominal Bracing - Activation of the trunk muscles to support the spine - 266
Abnormal Pain Perception Processing - An increase in the subjective interpretation of discomfort due to abnormal sensory processing
in the central nervous system - 615
Acceleration - The rate of change of velocity - 142, 143, 822
Accessory Exercises - Supplementary focused movements or exercises that strengthen synergist and supporting muscles to help a
person better perform a primary movement - 286
Acetylcholine - The neurotransmitter released by an action potential at the neuromuscular junction - 73, 74
Acidosis - When the kidneys and lungs cannot keep the body’s pH in balance due to excess acid in body fluids - 593
Actin - The thin filaments of muscle myofilaments where myosin binds to contract muscles - 71, 72
Action Plan - A set of individualized written instructions, designed with a doctor, that details how a person with asthma should manage
their asthma at home - 628
Action Potential - An explosion of electrical activity caused by a neural impulse - 69
Activation Exercises - Low-intensity exercises that bring on additional blood flow and activate the nervous control of a muscle. Often
used as part of a specific warm-up or as part of corrective exercise programming - 495
Active Listening - Paraphrasing or stating in one’s own words what someone has just said - 453
Active Range Of Motion - A muscle or group of muscles contract to create a range of motion - 315
Active Recovery - Low-intensity exercise or activity that can promote and accelerate muscular and metabolic recovery - 291
Active Stretching - A muscle actively contracting to stretch another - 314
Activities Of Daily Living - The tasks usually performed in the course of a normal day in a person’s life, such as eating, toileting, dressing,
bathing, or brushing the teeth - 71, 642
Activity Level Factor (ALF) - Multipliers that reflect varying levels of activity - 196
Activity Limitation - The quantitative and qualitative measure of disability referring to difficulties experienced by an individual in executing
a task or action - 655
Acute Injury - Describes a type of injury or an illness that is of rapid onset and progression - 704

Acute Training Variables - The components that specify how an exercise is performed - 284, 373
Acyclic Activities - Activities that incorporate different movement patterns throughout - 408
Adaptive Physical Fitness - The art and science of developing, implementing, and monitoring a carefully designed physical
fitness program for a person with a disability. - 656
Added Sugars - Any type of sugar that is added to a food or beverage when it is processed. This is compared to natural
sugars found in whole foods, such as fruit or milk - 539, 545
Adenosine Diphosphate (ADP) - An organic compound essential to the flow of energy in living cells - 187
Adenosine Triphosphate (ATP) - An energy-carrying molecule used to fuel body processes - 186, 417
Adhesion - Area of scar-like tissue that causes organs and tissues to stick together - 314
Adolescent Growth Spurt - A rapid increase in the individual’s height and weight during puberty - 637
Advanced Peripheral Neuropathy - A result of damage to peripheral nerves that often causes weakness, numbness, and
pain - 613
Aerobic Capacity - A measure of the ability of the heart and lungs to get oxygen to the muscles - 394
Aerobic Energy Pathways - Cellular energy pathways that require oxygen for energy production - 190
Aerobic Exercise - Exercise that improves or is intended to improve the efficiency of the body’s cardiorespiratory system in
absorbing and transporting oxygen - 368, 393, 394, 395
Aerobic Glycolysis - The breakdown of glucose to ATP in the presence of oxygen - 190
Afferent Neurons - Sensory neurons sending information from a stimulus to the CNS - 66
Agility - The ability to accelerate, decelerate, stabilize, and change direction with proper posture - 272
Agonist - The primary muscle used for a mechanical movement - 160, 161
All-Or-None Principle - The principle stating the strength of a neural electrical signal is independent of the magnitude of the
stimulus so long as the neural threshold is achieved - 69
Alpha motor Neurons - Motor neurons originating in the brain stem and spinal cord that initiate muscle contraction - 68
Altered Arthrokinematics - Altered movement of joint surfaces - 451
Altitude Training - Training at altitudes greater than 2,500 meters above sea level with the goal of increasing the blood’s
oxygen carrying capacity - 410

GLOSSARY
Alzheimer’s Disease - A progressive mental deterioration that can occur in middle or old age, due to generalized degeneration
of the brain - 537, 650
Amenorrhea - The absence or cessation of a menstrual cycle in females - 210
American Heart Association (AHA) - A nonprofit organization that funds cardiovascular research and educates consumers
on healthy living and good cardiac care - 519, 547
Amino Acids - A simple organic compound known as the building block of proteins - 111, 508, 523, 568, 829, 834
Anabolic - The process of creating larger molecules from smaller units - 116, 832
Anabolic-Androgenic Steroids (AAS) - Synthetic variations of the male sex hormone testosterone - 592
Anabolism - The building of complex molecules in the body from more simple, smaller molecules - 508, 585
Anaerobic - Without or not requiring oxygen - 188, 189, 190, 192
Anaerobic Exercise - Short-duration muscle contractions that break down glucose without using oxygen - 390, 426
Anaerobic Glycolysis - The anaerobic energy system converting glucose to lactate when oxygen is limited - 189
Anaerobic Threshold - The point at which the body switches from aerobic metabolism to primarily anaerobic metabolism - 190
Anatomical Position - The anatomically neutral body position facing forward with the arms at the sides of the body and palms
and toes pointing straight ahead - 130
Anemia - A condition marked by a deficiency of red blood cells or of hemoglobin in the blood resulting in extreme fatigue - 569
Angina - A condition marked by severe chest pain - 622
Angiogenesis - The development of new blood vessels - 394
Angular Displacement - The change of location of an object that is rotating about an axis - 147
Angular Motion - Rotation around an axis - 147, 149, 150
Animal Products - Any material derived from the body of an animal, including dairy products, eggs, honey, and gelatin - 554
Antagonist - Muscle(s) opposing the mechanical movement of a prime mover - 160, 161
Antibodies - Blood proteins that combine with other substances in the body to recognize foreign bodies as part of the
immune response - 106, 107
Anticatabolic - Properties that protect muscle mass from being broken down - 588

Antioxidants - Substances that protect the body from free radicals and the cellular damage they cause - 508, 537
Aorta - The main artery in the body that supplies oxygenated blood to the circulatory system - 97, 99, 101
Appendicular Skeleton - The bones of the shoulder girdle, pelvic girdle, and limbs - 80
Arteries - Blood vessels carrying oxygenated blood away from the heart and to the tissues - 96, 101
Arterioles - The smaller branches of the arteries leading to the capillaries - 98
Arthrokinematics - The broad term meaning joint motion that can be used in reference to all joint motions - 89
Articular Capsule - The envelope surrounding a synovial joint - 88
Articular Cartilage - A form of hyaline cartilage located on the joint surface of bones - 93
Articulation - The ability to pronounce distinctly—to enunciate - 454
Ascending Pyramids - Lighter weights are used to start the workout, and they get progressively higher with subsequent sets - 444
Asthma - A respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing - 625, 626, 627
Atherosclerosis - The buildup of fats, cholesterol, and other substances in the artery walls - 604, 622
ATP/CP Energy Pathway - The anaerobic energy system that provides rapid energy using creatine phosphate to generate
ATP - 188, 193
Atrioventricular (AV) Node - The nerve node between the right atrium and right ventricle that propagates the electrical signal
from the SA note to more distal heart nerves that cause ventricular contraction - 102
Atrioventricular (AV) Valves - Valves between the atria and ventricles preventing the backward flow of blood during cardiac
contractions - 100
Atrium - One of the two upper cavities of the heart passing blood to the ventricles. The plural is “atria.” - 99, 100
Atrophy - The wasting away or loss of muscle tissue - 394, 425
Auditory Cortex - The region of the temporal lobe responsible for hearing - 64
Auditory Learners - People who learn by hearing information - 455, 456
Autogenic Inhibition - The decrease in excitability of a contracting or stretched muscle arising from the Golgi tendon organ - 361
Automated External Defibrillator (AED) - A portable electronic device that can identify and electrically correct heart
arrythmias, ventricular fibrillation, and tachycardia - 19, 702

GLOSSARY
Autonomic Nervous System - The part of the nervous system responsible for involuntary functions and movement - 66
Autonomy - The need for self-governance and control over one’s own behaviors - 32, 33, 34, 607
Axial Skeleton - The bones of the head, trunk, and vertebrae - 80
Axis - point of rotation around which a lever moves - 78, 89, 147, 150, 152, 153, 154, 155, 242
Axon - The thin tail-like structure of a neuron that generates and conducts nerve impulses - 60, 69
B
Baby Boomers - A person born in the years following World War II, when there was a temporary marked increase in the birth
rate - 643
Balance - An even distribution of weight enabling someone or something to maintain its center of gravity within a base of
support - 6, 138, 826, 832, 843, 844
Balance Training - Exercises to strengthen the stabilizer muscles and prime movers of the core and legs to improve dynamic
stability - 265, 266, 268, 269
Ballistic Stretching - Uses the momentum of the body or limb to move it through and beyond a normal range of motion. This
technique uses bobbing, bouncing, pulsing, or jerking to achieve a stretch - 314
Ballistic Training - A form of power training involving throwing weights or jumping with weights to improve explosive power -
307, 308
Base Of Support - The area beneath an object or person that includes every point of contact that the object or person makes
with the supporting surface - 138
Behavior - An action that can be observed, measured, and modified - 6, 21, 22, 23, 24, 40, 45, 816, 817, 838, 842, 843, 844
Beta-alanine - A nonessential amino acid that is naturally produced by the body - 584, 593
Beta Blockers - One of the most widely prescribed classes of drugs to treat hypertension - 607
Bile - A bitter greenish-brown alkaline fluid aiding digestion, secreted by the liver and stored in the gallbladder - 125
Bioavailability - The amount of a substance that enters the circulation when introduced into the body and is effective - 586
Bioelectrical impedance Analysis (BIA) - A method for body composition measurement using a weak electrical current to
measure the resistance of body tissues - 221
Bioenergetics - The study of how energy is transformed in living organisms - 182
Biological Value (BV) - The percentage of protein used by the body - 586

Biomechanics - The study of the mechanical laws governing movement of living organisms - 5, 6, 11, 129, 130, 149, 150,
820, 822
Bipedal Locomotion - A form of locomotion in which a person moves from one place to another using the legs - 486
Bipennate Muscle - Muscle fibers extending from both sides of a central tendon - 78
Block Periodization - Highly concentrated, specialized workloads focused on achieving maximum adaptation - 301
Blood Pressure - The force of blood pushing against the walls of the arteries during the two phases of the cardiac cycle - 12,
104, 602, 604
Blood Viscosity - The thickness and “stickiness” of blood and how it affects its flow through the blood vessels - 105
Blood Volume - The total volume of blood within the circulatory system of an individual - 105
Body Composition - The physical makeup of the body considering fat mass and lean mass - 210, 262
Body Density - The compactness of the body determined by dividing its mass by its volume - 218
Body Language - Communication of a nonverbal form with gestures or body movement - 452
Body Mass Index (BMI) - A predictive health measure of weight divided by height - 211
Body Weight Exercises - Movements performed with no additional load other than what the exerciser’s body provides - 442,
443
Bone Marrow - The soft, spongelike tissue in the center of most bones containing stem cells of red or white blood cells or
platelets - 85, 86
Botanical - Substance obtained from a plant and used as an additive - 568, 597, 598
Brain Stem - The trunk of the brain, consisting of the medulla oblongata, pons and midbrain that continues downward to form
the spinal cord - 62
Branched-Chain Amino Acids (BCAAs) - A group of three essential amino acids (leucine, isoleucine, and valine) that help the
body build muscle and decrease muscle fatigue - 584, 594
Branding - A name, logo or symbol that identifies and differentiates a product from other products - 673, 677
Buddy Training - Exercise instruction between a personal trainer and two clients at the same time - 662, 665
Bullying - An unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance - 633
Business Plan - Outlines the structure, marketing, and growth of a new business - 662

GLOSSARY
C
Calls To Action - Marketing statements that demand an immediate response from the recipient—for instance, “Sign up now”
or “Click here to learn more.” - 674
Calories (Cal) - The amount of energy needed to raise the temperature of 1 kilogram of water by 1°C (4,184 joules) at a
pressure of 1 atmosphere - 194, 199, 200
Cancellous Bone - The meshwork of spongy tissue (trabeculae) of mature adult bone, typically found at the core of vertebral
bones and the ends of the long bones - 86
Capillaries - Fine-branching blood vessels forming a network between the arterioles and venules, where transport of nutrients
and oxygen or carbon dioxide occurs on a microscopic scale - 96
Carb Cycling - Increasing and reducing carb intake on a daily, weekly, or monthly basis. 560
Cardiac Arrest - An electrical malfunction of the heart that causes irregular heartbeat - 702
Cardiac Cycle - The action of the heart from the start of one heartbeat to the beginning of the next - 102
Cardiac Muscle - Striated involuntary muscle tissue found in the heart - 70
Cardiac Output - The amount of blood pumped through the heart per minute - 105
Cardiometabolic - A combination of metabolic dysfunctions mainly characterized by insulin resistance, impaired glucose
tolerance, dyslipidemia, hypertension, and central adiposity. - 609
Cardiopulmonary Resuscitation (CPR) - An emergency procedure involving chest compressions and, often, artificial
ventilation to circulate blood and preserve brain function in an individual in cardiac arrest - 19, 702
Cardiovascular Endurance - The measure of the cardiovascular system’s (heart and blood vessels) ability to perform over an
extended period - 262, 263
Cartilage - Firm, flexible connective tissue that pads and protects joints and structural components of the body - 16, 87, 89, 93
Cartilaginous Joints - Moderately movable joints made of fibrocartilage or hyaline cartilage - 88
Catabolic - Metabolic activity involving the breakdown of molecules such as proteins or lipids - 116, 585
Catabolism - The breaking down in the body of complex molecules into more simple molecules - 508
Catecholamines - Hormones released by the adrenal glands into the blood as a result of stress - 116, 119
Celiac Disease - An autoimmune disorder that affects the small intestines and that is caused by gluten in
the diet - 555

Cell Body - The core and central structure of a neuron containing a nucleus and other specialized organelles that aid in
nervous system function - 60
Cell Proliferation - The process by which a cell grows and divides to produce new cells - 590
Cells - The building blocks of all living organisms - 590
Center Of Gravity - The hypothetical position in the body where the combined mass appears to be concentrated and the point
around which gravity appears to act - 138, 140
Central Nervous System (CNS) - The part of the nervous system consisting of the brain and spinal cord - 62
Cerebellum - The region of the brain responsible for conscious motor coordination - 62
Cerebral Cortex - The part of the brain where most neural integration occurs - 62
Cerebrum - The uppermost and largest part of the brain consisting of a left and right hemisphere; responsible for receiving
and processing sensory information and controlling the body - 62
Certified Group Fitness Instructors - Fitness professionals certified in delivering large group fitness classes. These classes
are often choreographed and require specific training in a particular class format - 667
Chronic Disease - A condition lasting a year or more that limit daily activities and/or requires ongoing medical attention - 11, 210
Chronic Injury - Refers to an injury, illness, or disease that develops slowly and is persistent and long-lasting - 704
Chronic Obstructive Pulmonary Disease (COPD) - A lung disease characterized by chronic obstruction of lung airflow that
interferes with normal breathing and is not fully reversible - 627
Chronological Age - The number of years a person has lived - 641
Chyme - A pulpy, acidic fluid that moves from the stomach to the small intestines containing partially digested food and
gastric juices - 123
Circuit Training - Body training that combines endurance, resistance, high-intensity interval, and aerobic training - 386, 406
Circular Muscle - Muscle fibers surrounding an opening in the body - 77
Circulatory System - A closed system circulating blood through the body, consisting of the heart, blood vessels, and blood - 96
Circumference Measurements - The measurement of the circumference of specific body regions - 214
Client Intake Form - A basic intake form to gather a client or potential client’s demographic information and general health
history - 205

GLOSSARY
Client Persona - A fictional person that represents the key characteristics of a trainer’s preferred clientele - 673
Client Profile - The collection of a client’s health and intake forms, biometric measurements (physical measurements like
weight, height, etc.), training plan, and liability waivers - 208
Client Referrals - A method of marketing where current or former clients refer friends and family to a professional for
services by word of mouth - 681
Closed Kinetic Chain Movement - A movement keeping the distal end of the body segment in action fixed - 236
Closed System - A physical system that does not allow for the movement of matter into or out of the system - 96
Close-Packed Joint Position - The most stable joint position, when the connective tissue is taut and neighboring bones have
the most contact - 90
Code Of Ethics - A set of guiding principles that drives the actions of a professional - 694
Cognitive Functioning - An intellectual process by which one becomes aware of, perceives, or comprehends ideas - 633
Comorbidities - The simultaneous presence of two chronic diseases or conditions in a person - 614, 617, 643
Compact Bone - A denser material, also known as cortical bone, making up the hard structure of the skeleton - 86
Competence - The basic need to feel a sense of mastery and operate effectively within the environment - 32, 34, 35, 36
Competency - The ability to do something successfully or efficiently - 607
Complete Protein - A food source containing all nine essential amino acids the body needs - 523, 587
Compound Exercises - Multi-joint exercises that require the use of multiple muscles or muscle groups - 286, 422
Compression Force - The force of two surfaces pressing toward one another - 146
Concentric Muscle Action - When the length of a muscle shortens as tension is produced - 79
Concurrent Training - Including both cardiorespiratory exercise and resistance training into a fitness program - 606
Congenital - Relating to a disease or physical abnormality present from birth - 657
Connective Tissue - Tissues that support, connect, or bind other tissues or organs - 71
Contract-Relax Antagonist Contract (CRAC) Stretching - Contracting an antagonist muscle before stretching the agonist - 338
Contract-Relax (CR) Stretching - Contracting a given muscle before stretching the same muscle - 338
Contraindications - Factors that serve as a reason to withhold training because of harm that it may cause - 208, 209

Contralateral Loading - Loading the body on the opposite side of the work being executed - 478
Convergent Muscle - Muscle fibers converging from a broad origin (fixed point where the muscle attaches closest to the
torso) to a single tendon of insertion (fixed point where the muscle attaches furthest from the torso) - 77
Cooldown - Gradually slowing the body after activity to return to homeostasis or close to homeostasis - 281
Core Training - Refers to strengthening the musculature of the abdominals, back, and lower body that directly influence the
lumbopelvic hip complex (LPHC) - 265, 266
Coronary Artery Disease (CAD) - The narrowing or blockage of coronary arteries - 518, 621, 622
Corporation - A business structure in which the owners and operators are separated from the liabilities of the business -
669, 670
Corrective Exercise - Exercise programming used to improve function through assessing and improving muscle imbalances 495
Corticosteroids - A group of natural and synthetic steroid hormones produced by the pituitary gland - 627
Cortisol - A catabolic hormone released in response to physical and emotional stress - 113, 116, 118, 819
Countermovement - A movement or other action made in opposition to another action - 272
Cranial Nerves - The 12 sensory and motor nerves extending directly from the brain - 65
Creatine - An organic compound that aids in the recycling of ATP in the energy systems - 417, 427
Creatine Monohydrate (CM) - An organic compound that increases phosphocreatine levels and adenosine triphosphate
(ATP) energy production leading to enhanced strength and power - 584
Creatine Phosphate (CP) - A high-energy molecule stored in skeletal muscle, the myocardium, and the brain - 188, 417
Cross-Training - The action of training or practice in two or more sports or types of exercise to improve fitness or performance
in one’s main sport - 407
Cueing - A communication that prompts a client to engage in a movement pattern or conveys proper technique - 455, 456,
457, 662
Customer Life Cycle - The steps a customer goes through when considering, buying, and using a product or service,
including awareness, engagement, evaluation, purchase, experience, and bonding and advocacy - 671
Cyclic Activities - Activities that use the same movement in repetition - 408
Cytoplasm - The viscous fluid inside a living cell excluding the nucleus - 182, 183

GLOSSARY
D
Daily Calorie Expenditure (DCE) - The total number of calories an individual expends including their resting metabolic rate,
activity level factor, and the thermic effect of food - 196
Daily Value (DV) - Reference amounts expressed in grams, milligrams, or micrograms of nutrients to consume or not to
exceed each day - 544, 571
Deceleration - A special type of acceleration where a person or object is slowing down - 142, 822
Decussation - The point of crossover of the nervous system in vertebrates located between the medulla oblongata and the
spinal cord - 63, 818
Dehydration - A harmful loss or removal of water in the body - 528
Delayed Onset Muscle Soreness (DOMS) - Muscle pain or stiffness resulting from microtearing of tissue during eccentric
muscle action that is felt several days after unaccustomed exercise - 278
Dendrites - Rootlike structures branching out from the cell body that receive and process signals from the axons of other
Deoxyribonucleic Acid (DNA) - Self-replicating genetic material in human cells - 183
Dermis - Deep to the epidermis; holds blood vessels, sweat glands, and hair follicles - 127
Detraining - The diminishing of physical adaptations after two weeks or more of not training - 297
Diabetes - A condition characterized by an elevated level of glucose in the blood - 7, 16, 510, 604, 605, 608, 609, 610, 612,
614, 623, 824, 826, 827, 830, 831, 835, 838, 839, 840, 842
Diabetic Coma - A comatose state resulting from excessively high blood sugar levels - 714
Diaphragm - The dome-shaped muscle that separates the lungs and pleural cavity from the abdomen - 109
Diastasis - The separation of the large abdominal muscles during pregnancy - 652
Diastole - The heartbeat phase where the cardiac muscle relaxes and the heart chambers fill with blood - 102
Diastolic - The pressure in blood vessels when the heart rests (ventricular filling) - 104, 105, 602, 604
Diet - The foods that a person or community eats most often and habitually; a choice of regular foods consumed for the
purpose of losing weight or for medical reasons - 546, 547, 549, 552, 553, 554, 556, 557, 558
Dietary Approaches to Stop Hypertension (DASH) Diet - A low-sodium, whole-food diet created for the treatment of
hypertension - 608

Dietary Guidelines for Americans - Guidelines for healthy, lifelong eating habits for Americans two years of age and older -
507, 511, 538, 539, 540, 545
Dietary Ingredient - A vitamin, mineral, herb, botanical, or amino acid used to supplement a nutrition plan to increase total
dietary intake of ingredients - 568
Dietary Reference Intakes (DRIs) - A set of standards estimating how much of a nutrient should be ingested that is used in
planning eating patterns for healthy individuals - 570
Dietary Supplement - A product containing one or more dietary ingredients that is intended to supplement a person’s
nutrition plan - 568
Diet-Induced Thermogenesis - The thermic effect of macronutrient digestion and absorption - 196
Diffusion - The passive movement of molecules or particles along a concentration gradient or from regions of higher
concentration to regions of lower concentration - 109
Digestible Indispensable Amino Acid Score (DIAAS) - Measures the amount of amino acids absorbed by the body - 586
Diminishing Returns - A concept stating that everyone has a set genetic limit to their potential, and, eventually, the effort put
into training will no longer produce the same results - 296
Disability - A physical or mental condition that limits a person’s movements, senses, or activities - 655, 656
Disaccharides - Any of a class of sugars with molecules that contain two monosaccharide residues - 509
Displacement - The distance an object is displaced from a starting point - 147
Distance - The total or sum of the length an object travels - 147
Docosahexaenoic Acid (DHA) - An omega-3 fatty acid that is a primary structural component of the human brain, cerebral
cortex, skin, sperm, testicles, and retina - 518
Drop Set - Technique in which a set is done until failure or fatigue, the weight is “dropped” or lowered, and the exerciser
continues until another failure; can continue for several rounds - 444
Dual Energy X-Ray Absorptiometry (DEXA) - An X-ray scanning test to determine body composition - 222
Dynamic Balance - The ability to remain upright and balanced when the body and/or arms and legs are in motion - 138
Dynamic Stretching - Movement-based active stretching where muscles engage to bring about a stretch - 265, 314, 316, 317, 318
Dynapenia - The age-associated loss of muscle strength that is not caused by neurologic or muscular disease - 642

GLOSSARY
Dysfunctional Eating Patterns - May include behavior commonly associated with eating disorders, such as food restriction,
binge eating, and purging - 633
Dyspnea - Difficulty or labored breathing - 222
E
Eating Pattern - The types of food and beverages an individual consumes - 538
Eccentric Muscle Action - When the length of a muscle increases as tension is produced - 79
Efferent Neurons - Motor neurons sending information from the CNS to the muscles to generate movement - 66
Effort Arm - The portion of the lever arm between the applied effort and the axis - 153
Egocentric - Thinking only of oneself, without regard for the feelings or desires of others - 638
Eicosapentaenoic Acid (EPA) - A fatty acid found in fish and fish oils, which is believed to lower cholesterol, especially
cholesterol bound to low-density lipoproteins - 518
Elastic Cartilage - Flexible cartilage present in the outer ear, inner ear, and epiglottis - 93
Elastin - A highly elastic connective tissue allowing many tissues to retain their shape - 92
Electrolyte - Minerals in the body that have an electric charge - 114, 529
Electron Transport Chain - A series of proteins in the mitochondrial membrane that transfer electrons and hydrogen ions
across the membrane to generate ATP from ADP - 191
Emergency Exit Plan - A visual plan of how and where to exit a space in the event of an emergency - 706
Empathic Listening - The ability to understand how the clients feel and empathize with them - 454
Empathy - The ability to understand and share in the feelings of others - 42
Endocrine Glands - Ductless glands releasing hormones that remain within the body - 111, 114
Endomysium - The connective tissue covering each muscle fiber - 72
Endoplasmic Reticulum (ER) - A network of tubules attached to the nuclear membrane in cells - 183
Endorphins - Hormones that promote feelings of well-being - 369
Endurance Strength - The ability to sustain a submaximal activity for a longer duration - 417
Energy Balance - The state achieved when energy intake is equal to energy expenditure - 195, 199, 583
Energy Pathways - The chemical-reaction pathways that supply the body with energy on a cellular level - 188

Epidermis - The outermost layer of the skin - 127
Epiglottis - A piece of elastic cartilage in the throat that opens during breathing and closes during swallowing - 93
Epimysium - Fibrous elastic tissue that surrounds a muscle - 73
Equilibrium - A state in which opposing forces or influences are balanced - 6, 138, 820
Ergogenic Aids - Substances that enhance energy production and provide athletes with a competitive advantage - 568, 569, 595
Erythropoietin (EPO) - A hormone with a role in the proliferation of red blood cells - 410
Essential Amino Acids - Amino acids that are not made by the body in the optimal amounts and therefore must be obtained
through the diet - 523
Estimated Average Requirement (EAR) - The average daily nutrient intake level that is estimated to meet the requirement
of half the healthy individuals in a specific life stage or gender - 524
Evaporative Heat Loss - Cooling the body and releasing heat via evaporation of water and electrolytes from the skin - 409
Evidence-Based Practice (EBP) - Practices, interventions, and strategies that are based on scientific evidence - 69, 73, 93,
205, 414, 508
Excess Postexercise Oxygen Consumption (EPOC) - The amount of oxygen required to restore normal metabolic status - 194
Excitation-Contraction Coupling - The physiological process of converting a neural impulse into a mechanical response - 69
Exercise Activity Thermogenesis (EAT) - Energy expended as a result of planned, structured, and repetitive movement with
the goal of improving or maintaining physical fitness - 197
Exercise Frequency - The number of times training occurs within a specific period, or the number of times or how often an
exercise is executed - 288
Exercise-Induced Bronchoconstriction (EIB) - Asthma attack triggered by doing sports or physical activity - 627
Exercise Order - The order in which exercises are completed within a training session - 284, 286
Exercise Selection - The specific exercises executed in a workout session - 284, 285
Exercise Stress Test - An assessment that usually involves walking on a treadmill or riding a stationary bike while heart
rhythm, blood pressure, and breathing are monitored - 614
Exocrine Glands - Glands that produce and release substances through ducts or openings on the body’s surface - 111, 119
Expiration - Breathing air out of the lungs - 109, 110
External Respiration - The exchange of gases between the lungs and the blood - 110

GLOSSARY
External Stimuli - Sensory input from external sources - 67
Extracellular Fluid (ECF) - Water found outside the cells and between tissues - 529
Extrafusal Muscle Fibers - Fibers that cause muscle contraction and mechanical work - 68
Extrinsic Motivation - The drive to perform certain behaviors based on external factors such as praise, recognition, and
money - 30
F
Fartlek - A training system for distance runners that continually varies terrain and pace to enhance conditioning and eliminate
boredom - 377, 380
Fasciculi - Bundles of muscle fibers; the singular is “fascicle.” - 73
Fasting - Abstaining from consuming food for a period of time - 558, 559
Fats - Organic compounds that are made up of carbon, hydrogen, and oxygen. Fats are a source of energy in foods and are
also called lipids. They come in liquid or solid form - 516, 517, 519, 540, 542
Fatty Acids - The smaller, absorbable building blocks of the fat that is found in the body - 182, 516, 518, 519
Feedback Loop - The return of a system’s output as input for a future action - 91
Fiber - A type of carbohydrate derived from plant-based foods that the body is unable to break down - 511, 514, 515, 516
Fibrocartilage - An elastic and tough tissue containing type I and type II collagen - 93
Fibromyalgia (FM) - A chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in
localized areas - 615
Fibrous Joints - Joints with fibrous connective tissue joining two bones that allow for very little movement - 87
First Aid - The first and immediate aid given to someone with a minor or serious injury, illness, or condition - 705, 709, 711, 714
First aid kit: A compact box that is pre-stocked with supplies for triage and general medical interventions - 705
FitnessGram - A noncompetitive standard performance assessment to measure aerobic capacity, muscular strength and
endurance, flexibility, and body composition - 640, 641
Fitness Program Design - The systematic development of a fitness program or process using assessments, the elements of
fitness, periodization, and periodic reassessment - 284
Flare - A sudden surge in rheumatoid arthritis inflammation - 615

Flat Back - An excessive lumbar flexion and posterior pelvic tilt - 239
Flexibility - The range of motion of a muscle and its associated connective tissues at a joint or joints - 5, 6, 262, 264, 265,
311, 312, 314, 315, 316, 317, 359
Flexibility Training - An element of fitness using stretching to increase the range of motion of a joint or group of joints and
allow for increased ranges of motion - 264, 265
Food And Drug Administration (FDA) - A US federal department that regulates the production and distribution of food,
pharmaceuticals, tobacco, and other consumer products - 538, 569
Force - The interaction that creates work or physical change. Its components are magnitude, direction, point of application,
and line of action - 142, 143, 144, 146, 147, 150, 151, 153, 155, 162, 818
Force Arm - The distance between the fulcrum and the force or load application in a lever - 155
Force-Couple Relationship - Two or more muscles acting in different directions that influence the rotation of a joint in a
specific direction - 162
Force-Velocity Curve - A representation of the inverse relationship between force and velocity in muscle contraction - 143
Fortified - Having had vitamins or other supplements added so as to increase the nutritional value - 573, 574, 575, 579
Foundational Training - The basic training elements of flexibility, balance, and core training - 301, 304, 308
Frailty - An increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic
systems - 643
Free Weights - Loads that are not attached to an apparatus - 440, 441
Friction - The resistance of relative motion that one surface or object encounters when moving over another - 6, 146, 148
Frontal Lobe - The brain lobe involved in motor control, emotion, and language - 63
Frontal Plane - An imaginary line that divides the body into anterior and posterior halves - 134
Fulcrum - The point on which a lever rests or is supported and on which it pivots - 152, 153
Functional Capacity - The capability of performing tasks and activities that people find necessary or desirable in their lives - 641
Functional Fitness Test for Seniors - A simple, easy-to-use battery of test items that assess the functional fitness of older
adults - 644
Functional isometrics - The combination of partial repetition training and isometric holds - 439
Fusiform Muscle - Spindle-shaped muscle - 77

GLOSSARY
G
Gastroesophageal Reflux Disease - A condition in which acidic gastric fluid flows backward into the esophagus, resulting in
heartburn - 627
General Adaptation Syndrome (GAS) - The three stages of adaptation the body goes through in response to stress—alarm,
resistance, and exhaustion - 298
General Exercises - Foundational exercises that train overall strength - 421
General Warm-Up - Nonspecific, low-intensity activity including dynamic stretching and light cardiovascular activity with the
purpose of increasing blood flow, respiration, and body temperature - 265
German Volume Training - A method in which 10 sets of 10 repetitions are done of an exercise with one minute of rest
between sets - 444
Gestational Diabetes - A condition characterized by an elevated level of glucose in the blood during pregnancy, typically
resolving after birth - 609, 654
Glucocorticoids - A group of corticosteroids involved in the metabolism of carbohydrates, proteins, and fats - 629
Gluconeogenesis - The generation of new glucose molecules from non-carbohydrate carbon substrates - 183, 192
Glucose - A simple sugar the body uses for energy production on the cellular level - 115, 185, 192, 508, 535, 820, 826, 830
Gluten - A mixture of proteins found in wheat, rye, and barley and gives dough its elastic texture - 555, 556
Glycemic Index (GI) - A system that ranks foods on a scale from 1 to 100 based on their effect on blood sugar levels - 509
Glycogen - The stored form of glucose found in muscle tissue and the liver - 71, 183, 185, 189, 508
Glycolysis - The breakdown of glucose by enzymes, releasing energy and pyruvic acid - 183, 188, 189, 190
Glycoproteins - A class of proteins with a carbohydrate group(s) attached - 184
Goal Setting - The process of identifying the client’s ideal state, determining their current state, and defining the actions that
must be taken to close the gap - 45
Golgi Apparatus - An organelle of folded membranes responsible for packaging and transporting membrane-bound proteins - 184
Golgi Tendon Organ - The proprioceptive sensory organ that senses muscle tension in a tendon and inhibits muscle action
- 91, 314, 361
Good Samaritan Laws - Legal protections offered in much of the U.S. and Canada that protect an individual who offers
assistance, CPR, or first aid to someone else in an emergency situation before trained help arrives - 703

Gout - A disease in which defective metabolism of uric acid causes arthritis - 615, 616
Gravity - The attraction between objects and the Earth - 138, 140
Grip - Hand placement - 433
Grip Strength - The force applied by the hand to pull or suspend a load - 433
Gross Motor Skills - The abilities required in order to control the large muscles of the body for walking, running, sitting,
crawling, and other activities - 636
Ground Reaction Force (GRF) - The force the ground exerts on a body it is in contact with - 145
Group Exercise - Large group training that is often choreographed and where all participants are executing the same exercises
simultaneously - 662, 667
Growth Factors - Proteins that stimulate nerve cell growth and the creation of new neural pathways and connections - 369
Growth Hormone (GH) - A hormone released by the pituitary gland that stimulates growth in animal cells - 112, 116, 117
H
Handedness - The tendency to use one side of the body more naturally than the other - 241
Hashtags - Social media tags users can create to help others find messages and posts with a specific theme or content - 675
Health History Questionnaire - A detailed client intake form that gathers information on a client’s present and past health
and medical history - 206
Health Markers - Tools at the service of health professionals that objectively measure and evaluate indicators of normal
biological processes or pathogenic processes (i.e., blood pressure) - 370
Heart Disease - A term used to describe several different heart conditions - 17, 264, 608, 621
Heart Rate - The number of heartbeats per minute - 102
Heart Rate Reserve (HRR) - Maximum heart rate minus resting heart rate - 391
Heart Rate Zones - Percentages of maximum heart rate associated with a desired physiological adaptation - 278
Hemoglobin A1c (HbA1c) - A minor component of hemoglobin to which glucose is bound - 415, 611
Herb - Any plant with leaves, seeds, or flowers used for flavoring food and medicine - 568
Hereditary - Relating to the biological process responsible for passing on traits from one generation to another - 603

GLOSSARY
High-Density Lipoprotein (HDL) - A lipoprotein that removes cholesterol from the blood. It is sometimes considered the
“good cholesterol.” - 416, 518
High-Intensity Interval Training (HIIT) - Interval training with short intervals at near maximum effort and less intense
recovery periods - 280
Hip Hinge - A forward and backward movement of the upper body while the hips remain at the same height and move back
- 457
Homeostasis - A self-regulating process by which the body maintains the stability of its physiological processes for the
purpose of optimal function - 64
Hook - Gripping the thumb between the barbell and fingers - 433
Hormones - Chemical messengers stored, created, and released by endocrine glands - 111, 112, 115, 119, 819
Human Leukocyte Antigen (HLA) - Genes that help the immune system distinguish the body’s own proteins from foreign
antigens - 617
Hyaline Cartilage - A transparent cartilage found on most joint surfaces and in the respiratory tract, which contains no nerves
or blood vessels - 88, 93
Hybrid Personal Training - A training approach that utilizes in-person and virtual training styles to allow for easier, more
frequent access to the fitness professional - 664
Hydrocarbons - A compound of hydrogen, and carbon, such as any of those that are the chief components of petroleum and
natural gas - 516
Hydrostatic Weighing - A tool to measure body composition using water displacement and tissue density - 222
Hyperglycemia - Elevated blood glucose - 609
Hypermobility - The condition of having excessive amounts of range of motion in a joint or joints - 313, 652
Hyperresponsiveness - The acute, early phase of an asthma attack - 625
Hypertension - High blood pressure measuring more than 140/90 mm Hg - 7, 12, 104, 105, 224, 602, 604, 606, 608, 623,
829, 835
Hyperthermia - The condition of excessively high body temperature - 639
Hypertrophy - An increase in muscular size as an adaptation to exercise - 285, 287, 288, 290, 292, 296, 306, 415, 430,
434, 436, 437, 445

Hyperuricemia - An abnormally high level of uric acid in the blood - 616
Hyperventilation - To breathe at an abnormally rapid rate, increasing the rate of loss of carbon dioxide - 625
Hypodermis - The deepest layer of skin housing fat cells and connective tissues - 127
Hypoglycemia - The condition of lower-than-normal blood glucose - 192, 510, 611
Hypotension - Low blood pressure measuring 90/60 mm Hg or lower - 104, 838
Hypothalamus - The region at the base of the brain responsible for maintaining homeostasis - 64
Hypoxia - Lack of oxygen - 410
I
Ideal Posture - Optimal body positioning and structural alignment - 237
Imaginary Audience - An individual imagines and believes that multitudes of people are enthusiastically listening to or
watching them - 638
Impairment - The state of being diminished, weakened, or damaged, especially mentally or physically - 655, 656
Implementation Intention - A preset plan that links critical situations (e.g., anticipated obstacles or opportunities) to goal-
directed responses - 48
Inclusion - The act of including into a group, involvement and empowerment, where the inherent worth and dignity of all people
are recognized - 656
Incomplete Proteins - A food source that lacks one or more of the nine essential amino acids - 524, 587
Independent Contractor - Someone who works for themselves and is contracted to provide services for a company as a
nonemployee - 662
Indirect Calorimetry - A way to measure energy expenditure by oxygen consumed and carbon dioxide produced - 186
Inertia - The resistance to action or change and describes the acceleration and deceleration of the human body - 142
Inferior Vena Cava - The blood vessel moving blood from the lower body to the heart - 97, 100
Ingredient List - A list provided on a food label of each ingredient in a product in descending order of prominence - 544
Initial Interview Packet - The first health and liability intake forms that a client will complete before beginning to work with
a fitness professional - 205
Innervation - The distribution or supply of nerves - 162

GLOSSARY
In-person Training - Live, face-to-face fitness training done individually or in small or large
groups - 662, 663
Insertion - The distal muscular attachment point to a bone - 156, 157, 158, 159, 160
Inspiration - Breathing air into the lungs - 109
Insulin - A hormone produced in the pancreas to regulate blood sugar - 113, 116, 117, 118,
510, 608, 610, 820
Insulin-Like Growth Factors (IGF) - A protein similar to insulin that stimulates growth of cells
116
Insulin Resistance - An impaired response of the body to insulin, increasing levels of blood
glucose - 610
Insulin Shock - A medical condition caused by too much insulin in the body that results in
stark drops in blood glucose - 713
Integumentary System - Organ system protecting the body; composed of skin, hair, and
nails - 127
Intensity - The measurable amount of force or effort given to an activity or exercise often
expressed as a percentage of effort compared to a person’s maximum effort - 284, 286, 287,
289, 297, 301
Internal Respiration - The process of diffusing oxygen from the blood into the interstitial fluid
and into the cells - 110
Internal Stimuli - Sensory input from within the body - 67
International Units (IU) - The quantity of a substance that has a biological effect. Amount
varies depending on the substance 582
Interneurons - Nerve cells that connect neurons to other neurons - 61
Interstitial Fluid - The fluid found between cells - 106
Interval Training - Training that varies between high- and low-intensity work to challenge the
cardiorespiratory system - 280
Intra-Alveolar Pressure - The pressure within the alveoli that changes throughout respiration - 109
Intracellular Fluid (ICF) - Water found within the cells of the body - 529

Intraset Muscle Fatigue - Muscle fatigue that occurs within a single set of an exercise - 288
Intrinsic Factor (IF) - A substance secreted by the stomach that enables the body to absorb
vitamin B12 - 582
Intrinsic Motivation - The drive to execute behaviors that are driven by internal or personal
rewards - 30
Intuitive Limbering - Stretching after waking or when standing up from a prolonged seated
position - 316
Ipsilateral Loading - Loading the body on the same side as the work being executed - 478
Isolation Exercises - Single-joint exercises that primarily activate an individual muscle or
muscle group - Single-joint exercises that primarily activate an individual muscle or muscle
group - 421, 422, 495
Isometric Muscle Action - When the length of a muscle remains constant as tension is
produced - 79
J
Joint - An articulation between two bones in the body - 16, 80, 89, 90, 92, 141, 147, 153,
165, 166, 167, 176, 177, 818, 822, 824, 825, 826
Joint Capsule - A thin, strong layer of connective tissue containing synovial fluid in freely
moving joints - 92
Joint Mobility - The degree of movement around a joint before movement is restricted by
surrounding tissues - 141
Joint Stability - The ability of the muscles around a joint to control movement or hold the joint
in a fixed (stable) position - 141
K
Karvonen Formula - The formula to estimate a target heart rate with consideration of heart
rate reserve and resting heart rate - 392
Ketoacidosis - An increase in blood acidity caused by excess ketones in the bloodstream -
552, 614
Keto Diet - A popular diet that reduces carbohydrate intake to deliberately increase fat
metabolism and ketones in the blood - 552

GLOSSARY
Ketone Bodies - Molecules released by the liver in starvation states for an alternate energy
source - 118
Ketones - By-products of the breakdown of fatty acids - 614
Ketosis - A metabolic process that occurs when the body does not have enough carbohydrates
for energy; the liver metabolizes fatty acids to produce ketones as a replacement energy
source - 118, 552
Kinesiology - The study of the mechanics of human movement - 130, 816, 818, 820, 822
Kinesthetic Learners - People who learn by physical touch - 455, 457
Kinetic Chain - A system of links—or joints—in the body that generate and transfer force
from one to the other - 233
Kinetic Chain Checkpoints - The six anatomical locations of predictable movement patterns
where movement dysfunctions can be detected - 233
Kinetics - The study of forces acting on a mechanism - 149, 821, 823, 824, 827
Knee Valgus - The position of the knee near the midline of the body (i.e., knock knees) - 241,
242, 244, 245
Knee Varus - The position of the knee away from the midline of the body (i.e., bowlegged) - 241, 242
Krebs Cycle - A series of chemical reactions inside the mitochondria that use acetyl-CoA to
generate ATP and other substrates that contribute to the electron transport chain - 190, 191
Kyphosis - The exaggerated rounding of the thoracic spine - 238, 239, 240
L
Lactate Threshold - The maximum effort or intensity an individual can maintain for an
extended time with minimal effect on blood lactate levels - 190, 387
Lactic Acid - The chemical by-product of anaerobic glycolysis 189, 190
Lactic Acidosis - The accumulation of excess H+ causing muscle fatigue and soreness - 190
Laws Of Motion - The laws of physics describing movement - 142
Leads - Potential clients not yet using a professional’s services - 679, 682, 692
Lean Body Mass - The fat-free mass of the body calculated by total weight minus the weight
of bodyfat - 210, 211

Length-Tension Relationship - The amount of tension a muscle can produced as a function
of sarcomere length - 265
Lever Arm - The rigid bar portion of a lever that rotates around the fulcrum - 153
Levers - A rigid or semirigid bar rotating around a fixed point when force is applied to one
end - 6, 152, 154, 155
Liability Waiver - A short form that, when signed by a client, releases a fitness professional
and/or their training facility from any liability should the client be injured while working with
them - 205, 206
Ligaments - Short bands of tough but flexible fibrous connective tissue connecting two bones
or cartilages or holding together a joint - 17, 92
Limited Liability Company (LLC) - A corporate structure in the US limiting the liability of the
owner; it combines aspects of corporations and sole proprietorships - 669
Linear Displacement - The distance an object moves in a straight line - 147
Linear Motion - Movement along a line, straight or curved - 147, 149
Linear Periodization - Progresses from low-intensity to high-intensity across the entire
macrocycle - 300
Linear Strength - Two or more strength variables that are directly correlated to one another
- 417, 419
Linear Strength Endurance Activity - Activity that requires a sustained, all-out maximum
effort for an extended period - 419
Line Of Gravity - A vertical line straight through the center of gravity - 139, 140
Load - A term used to describe the amount of resistance used in a strength training exercise
- 286, 297
Locomotion - Movement from one place to another - 486
Loose-Packed Joint Position - The less stable joint position represented by any other joint
position other than close-packed - 90
Lordosis - The excessive inward curve of the lumbar spine - 238, 239, 240

GLOSSARY
Low-Density Lipoprotein - The form of lipoprotein in which cholesterol is transported in the
blood. It is sometimes considered the “bad cholesterol.” 416
Lumbopelvic Hip Complex (LPHC) - The musculature of the hip that attaches to the pelvis
and lumbar spine and works to stabilize the trunk and lower extremities - 234, 266
Lupus - A chronic autoimmune disease that creates inflammation and pain in various parts
of the body - 617
Lymph - The colorless fluid of the lymphatic system - 97, 106, 107
Lysosomes - An organelle filled with digestive enzymes that breaks down materials the cell
has absorbed - 184
M
Macronutrients - A type of food necessary in large quantities in the diet to support function
and energy production, i.e. carbohydrate, protein, and fat - 182, 186, 194, 508, 530
Market Analysis - A qualitative and quantitative assessment of a business market that examines
product and service volume, buying patterns, regulations, and business competition - 671
Mass - The amount of matter in an object - 139, 142, 822, 828, 829, 833, 844
Maximum Heart Rate - The estimated maximum number of times the heart should beat per
minute during exercise. Calculated by subtracting a person’s age from 220 - 279, 376, 388, 391
Maximum Strength - The ability for a muscle (or muscle group) to recruit and engage as many
muscle fibers as possible - 414, 430, 436, 437
Mechanical Advantage - The ratio of force that creates meaningful movement compared to
the force applied to generate the movement - 151
Mechanical Work - Is the amount of energy transferred by a force, the product of force and
distance - 152
Mechanoreceptors - Nervous system receptors responding to mechanical stimuli such as
sound or touch - 67, 68, 818
Medulla Oblongata - The base of the brain stem, responsible for involuntary functions like
swallowing, sneezing, and heart function - 63
Meniscus - A form of fibrocartilage present in the knee, wrist, acromioclavicular, sternoclavicular,
and temporomandibular joints - 93

Metabolic Equivalent (MET) - The measure of the ratio of a person’s expended energy to
their mass while performing physical activity - 209, 375
Metabolic Syndrome - A cluster of at least three biochemical and physiological abnormalities
associated with the development of cardiovascular disease and type 2 diabetes - 553, 643
Metabolic Training - A style of training that typically uses high-intensity intervals to train both
the aerobic and anaerobic energy systems - 301, 304, 306, 308
Metabolism - Chemical processes within the body that convert food into energy - 6, 16, 100,
181, 182, 191, 193, 194, 198, 820, 824, 828, 833, 834, 836, 840
Metronome - A device marking time at a selected rate - 226
Micronutrients - Substances required in small quantities in the diet for optimal body
functioning; vitamins and minerals - 508, 530
Midbrain - The brain region responsible for motor movement and processing auditory and
visual information - 62
Millimeters Of Mercury - The measure of a unit of pressure - 603
Minerals - Elements in food that the body needs to develop and function - 511, 529, 530,
531, 533, 534, 535, 536, 568, 575, 580
Minute Ventilation - The total amount of air entering the lungs over the course of one minute
- 383
Mission Statement - A short statement of why a business exists and their overall goal for
operating - 670
Mitochondria - An organelle with a double membrane and many folds inside responsible for
generating the chemical energy needed for biochemical reactions - 76, 184
Mitosis - Cell division that results in two cells identical to the original cell - 183
Mobility - The ability of a joint to move freely through a given range of motion - 302, 450
Moment Arm - The perpendicular distance between the fulcrum and the line of the force being
applied - 153
Momentum - The quantity of motion of a moving body, measured as a product of its mass
and velocity - 144

GLOSSARY
Monitoring - The process of observing and taking notice of routine behaviors that impact goal
progress and achievement - 46, 49, 816
Monosaccharides - Any of the class of sugars that cannot be hydrolyzed to give a simple
sugar - 509
Motivation - The reason(s) one has for behaving in a certain way - 30, 31, 41, 838
Motivational Interviewing - The direction and intensity of effort - 24
Motivational Interviewing (MI) - A collaborative, client-focused method of guiding a client
toward a self-identified motivation for change - 24
Motor Cortex - The region of the frontal lobe that plans and coordinates movement - 63
Motor Neurons - Nerve cells that initiate muscle contraction or activate glands - 61, 66, 68, 74
Motor Skills - The ability to learn and manage the process of moving the body in a coordinated
way - 633
Motor Unit - A single motor neuron and the muscle fibers it controls - 68
Motor Unit Pool - A group of motor units that work together - 68
Movement Assessments - Observation and critique of movement patterns or exercise form
- 204, 236
Movement Categories - The six fundamental movements that are the basis for most exercise
selections in exercise programming - 457
Multipennate Muscle - Muscle fibers extending from both sides of multiple central tendons - 78
Multiset - Multiple sets per exercise or muscle group - 443
Multivitamins/Minerals (MVMs) - Supplements or pills containing a combination of vitamins
and minerals - 570
Muscle Actions - Force production by a muscle that can result in a change of length (i.e.,
shortening or lengthening) or no length change at all - 79
Muscle Activation Exercises - Low-level resistance movements to activate blood flow and
activate the nervous control of a muscle - 316

Muscle Protein Synthesis (MPS) - A process that produces protein to repair muscle damage
and oppose muscle breakdown - 24, 586
Muscle Spindle - The proprioceptive sensory organ that senses muscle stretch in a muscle
and promotes muscle action - 91
Muscle Synergies - The activation of a group of muscles to generate movement around a
particular joint - 162, 233
Muscular Contraction - The shortening or resistance to lengthening of a muscle fiber - 142, 147
Muscular Endurance - The ability of a muscle or group of muscles to continuously exert force
against resistance over time - 262, 263, 285, 287, 288, 290, 292, 306
Muscular Endurance Tests - Assessments testing the ability of a muscle group to overcome
resistance in as many repetitions as possible - 228
Muscular Force - Involves the contraction of a muscle while exerting a force and performing
work. It can be concentric (shortening), eccentric (lengthening), or isometric (tension without
joint movement) - 138
Muscular Force Couple - Two or more muscles generate force in different linear directions at
the same time to produce one movement - 234
Muscular Imbalance - When the muscle or muscles on one side of the body are stronger, weaker,
or more or less active than the corresponding muscle on the other side of the body - 233
Muscular Strength - The measure of force produced by a muscle or group of muscles - 262,
263, 268, 278
Myelin Sheath - The insulation of neuron axons, made of proteins and fats, which propagates
neural impulses - 68
Myofascial Release (MFR) - Stretches and loosens the fascia using gentle, gradual, sustained
pressure or stretch on areas of tension - 360
Myofibrils - Parallel filaments that form muscle - 71, 72
Myofilaments - The filaments of myofibrils composed of actin and myosin - 71
Myoglobin - A protein in muscles cells that carries and stores oxygen - 394

GLOSSARY
Myosin - The thick filaments of myofilaments with a fibrous head, neck, and tail that bind to
actin - 71
Myositis Ossificans - A condition when bone tissue forms within a muscle or other soft tissue
as a result of trauma or injury - 87
MyPlate - The current visual nutrition guide published by the USDA Center for Nutrition Policy
and Promotion - 538, 540, 541, 542, 543
N
Negative Energy Balance - More energy is expended than consumed - 195
Nephropathy - Disease or damage of the kidney - 613
Nerve Impulses - The electrical signals used for nerve communication - 68
Nervous Tissue - Tissue found in the brain, spinal cord, and nerves that coordinates body
activities - 59
Neuroglia - Cells in the brain and spinal cord that form a supporting structure for the neurons
and provide them with insulation - 60
Neuromuscular Junction - The space between a motor neuron and muscle fiber - 73
Neurons - The most fundamental component of the brain and nervous system capable of
transmitting information to and from other neurons, muscles, or glands. 59, 60, 61, 66
Neuropathy - Disease or dysfunction of one or more peripheral nerves, typically causing
numbness or weakness - 613
Neurosecretory Tissues - Neurons that translate neural signals into chemical stimuli - 60
Neurotransmitter - A chemical messenger that transmits messages between neurons or
from neurons to muscles - 73
Nociceptors - Pain-sensitive nerve endings -93
Non-Exercise Activity Thermogenesis (NEAT) - Energy expended as a result of any movements
of the body that require energy. This includes all activities of daily living outside of planned
and structured workouts - 197
Nonlinear Strength - Two or more strength variables that are not directly correlated to one
another - 417, 419

Nonlinear Strength Endurance Activity - An activity with intermittent activity and rest periods - 419
Non-synovial Joints - Joints that lack a fluid junction - 88
Nonverbal - Not involving words or speech - 452
Nutrient Density - The amount of nutrients in a food relative to the number of calories it
provides, usually measured per 100 kilocalories - 539
Nutritional Limiting Factors - The nutritional choices a client makes that keep them from
making progress or seeing results - 561
Nutrition Facts - A label required by the FDA on most food and beverages that details the
food’s nutrient content - 543
O
Oars Model - A communication model for motivational interviewing that includes open-ended
questions, affirmations, reflective listening, and summarizing - 38
Obesity - An abnormal or excessive accumulation of bodyfat that may cause additional health
risks - 12, 510, 604, 617, 622, 627, 632, 648, 816, 834, 835, 842, 844
Objective Assessments - Fitness assessments that collect repeatable, measurable data
such as body composition or circumference measurement - 204
Objective Goal - A goal based on objective, quantifiable data that can be measured and
evaluated - 48
Occipital Lobe - The posterior lobe of the brain responsible for vision - 64
Omega-3 Fatty Acids - An unsaturated fatty acid occurring chiefly in fish oils - 518
Omega-6 Fatty Acids - A family of pro-inflammatory and anti-inflammatory polyunsaturated
fatty acids that have in common a final carbon-carbon double bond - 518
Onboarding Emails - A series of email communications that gather the required documentation
and assessments to begin a training program - 678
One-Repetition Max (1RM) - A single maximum-strength repetition with maximum load - 228,
286, 430
Open-Ended Questions - Questions that require more than a yes or no answer and encourage
the client to communicate the “how” and “why.” - 38, 42

GLOSSARY
Open Kinetic Chain Movement - A movement in which the distal aspect of the body segment
in action is free (i.e., not fixed) - 236
Organelles - Tiny structures within cells, each with a unique function - 182
Organ Systems - A group of organs working together to perform biological functions - 58
Origin - The proximal muscular attachment point to a bone - 156, 157, 158, 159, 160
Osteoarthritis - Degeneration of joint cartilage and the underlying bone - 615, 617
Osteogenesis - The process of bone formation or remodeling - 86
Osteoporosis - A skeletal condition that results in weak or brittle bones - 116, 222, 643, 648
Outcome Goal - A goal where the end result is a specific desired outcome - 46
Overactive Muscles - Muscles that are shortened beyond the ideal length-tension relationship
with high neural activation that feel tight - 233
Overhead Squat Assessment - The movement assessment of the overhead squat with the
goal of identifying movement dysfunctions along the kinetic chain - 245
Overreaching - An accumulation of training or non-training stress resulting in a short-term
decrease in performance capacity - 302
Overtraining - An accumulation of training or non-training stress resulting in a long-term
decrease in performance capacity - 302, 303
Overtraining Syndrome (OTS) - A maladapted response to excessive exercise without
adequate rest, resulting in perturbations of multiple body systems (neural, endocrine, and
immune) coupled with mood changes - 302
Oxidation - The chemical reaction of combining with oxygen or removing hydrogen - 190
Oxidative Energy Pathway - An aerobic energy pathway using primarily fat and carbohydrates
to produce energy - 190
Oxidative Phosphorylation - The energy-producing process that occurs in mitochondria in the
presence of oxygen - 184

P
Paralanguage - Components of speech like tone, pitch, facial expressions, cadence, and
hesitation noises - 452, 454
Parallel Muscle - Muscle fibers running parallel to the axis of the muscle - 78
Parallel Play - A form of play in which children play adjacent to each other, but do not try to
influence one another’s behavior - 636
Parasympathetic Nervous System - The autonomic system responsible for “rest and digest.” 66
Parietal Lobe - The brain lobe involved in processing sensory information - 63
Parkinson’s Disease - A progressive disease of the nervous system marked by tremor,
muscular rigidity, and slow, imprecise movement - 643
Partial Repetitions - Repetitions of an exercise intentionally done with a reduced range of
motion - 289, 435
Participation Restrictions - A problem experienced by an individual in involvement in life
situations - 655
Partnership - A business structure with two or more people running the business who share
liability and responsibility for the business’s performance - 669
Passive Range Of Motion - The range of motion achievable when aided by an external force
- 315
Passive Stretching - An external force such as a stretching strap or the hand to move a joint
to the end of a range of motion - 314
Pennate Muscle - Muscles with fascicles that attach obliquely (diagonally) - 78
Penniform - Muscle fibers that run diagonally in respect to the tendon similar to a feather - 78
Performance Supplements - Supplements intended to help enhance athletic performance -
568, 584
Perichondrium - The connective tissue enveloping cartilage everywhere except at a joint - 93
Perimysium - The connective tissue that covers a bundle of muscle fibers - 73
Periodization - An organized approach to training involving progressive cycling of various

aspects of a training program during a specific time - 284, 299, 300, 301

GLOSSARY
Periosteum - A dense layer of vascular connective tissue enveloping the bones except at the
surfaces of the joints - 73
Peripheral Nervous System (PNS) - The nerves and ganglia (relay areas for nerve signals)
outside of the brain and spinal cord - 62
Peripheral Resistance - The vascular resistance of the arteries to blood flow - 105
Peripheral Vasoconstriction - Constriction of smaller arterioles near the skin to keep blood
closer to the core of the body and preserve heat - 410
Peristalsis - The muscular contractions of the smooth muscle of the digestive tract, which
moves food through the digestive tract - 120
Personal Development - Activities that improve awareness and identity, develop talents and
potential, build human capital and facilitate employability, enhance the quality of life, and
contribute to the realization of dreams and aspirations - 637
Phase Potentiation - The strategic sequencing of programming categories to increase the
potential of later training and increase long-term adaptive potential - 301
Phospholipid Bilayer - The dual layer of lipids that make up the cell membrane of most
human cells - 182
Physical Activity Readiness Questionnaire (PAR-Q) - An intake form to assess a client’s
readiness to begin a physical activity program and assess injury potential - 206
Physician’s Letter Of Clearance - A signed letter from a client’s health care provider stating
they are cleared for physical activity and exercise that should also include any restrictions or
limitations they should adhere to - 205, 207
Placenta Previa - A condition in which the placenta partially or wholly blocks the neck of the
uterus, thus interfering with normal delivery of a baby - 654
Plant-Based Diet - Eating mostly or entirely foods that are plants or derived from plants - 550
Plasma Membrane - The cellular membrane made of lipids and proteins that forms the
external boundary of the cytoplasm and regulates the passage of molecules in and out of
the cytoplasm - 182
Pliability - The quality of being easily bent or flexible - 338

Plyometric Training - Reactive training seeking maximum force in the shortest amount of
time - 273
Polycystic Ovary Syndrome - A hormonal disorder common among women of reproductive
age - 612
Polyunsaturated Fats - Fat molecules containing more than one unsaturated carbon bond,
are liquid at room temperature, and solid when chilled - 591
Pons - The brain region responsible for posture, facial movement, and sleep - 63
Positive Energy Balance - More energy is consumed than expended - 195
Positive Reinforcement - Including a favorable outcome, event, or reward after a child
completes a desired behavior or action - 637
Postexercise Hypotension (PEH) - A drop in blood pressure in the first minutes after an
exercise session - 603
Postpartum - The period of time following childbirth - 651, 653
Post-Traumatic Stress Disorder (PTSD) - A persistent mental and emotional stress that
occurs as a result of injury or psychological shock - 617
Power - The combination of strength and speed—the ability for a muscle to generate maximal
tension as quickly as possible - 152, 285, 287, 288, 290, 292, 308, 414, 430, 434, 436, 437, 446
Prediabetes - A condition where blood glucose is higher than it should be, but not in the
diabetes range - 609
Preeclampsia - A condition in pregnancy characterized by high blood pressure, sometimes
with fluid retention and proteinuria - 654
Prefrontal Cortex - The part of the frontal lobe responsible for high-level thinking and language - 63
Prenatal - Occurring or existing before birth - 651
Presidential Youth Fitness Program - A comprehensive school-based program that promotes
health and regular physical activity for America’s youth - 640
Principle Of Individual Differences - The concept that there is no one specific way to train
every client due to the uniqueness of each person - 296

GLOSSARY
Principle Of Progressive Overload - The body must be forced to adapt to or overcome a
stress greater than what is normally encountered - 297
Principle Of Reversibility - Clients lose the effects of training after they stop working out - 297
Principle Of Specificity - The concept that training must be specific to an individual’s goals,
as the adaptations they will see will be based on the training completed - 293
Principle Of Variability - Training programs must include variations in intensity, duration,
volume, and other aspects of practice - 295
Principles Of Program Design - Fundamental propositions to serve as the foundation for
effective fitness programming - 284
Processed Foods - Foods that have been frozen, packaged, enhanced with vitamins or minerals
(fortified), previously cooked, or canned to preserve them for consumption - 509, 515, 541
Processes Of Change - The strategies and techniques that can influence an individual’s
transition from one stage of change to the next - 24, 26
Process Goal - A goal where the focus is on the process or action that will lead to the desired
end result - 46
Profit And Loss Statement - A financial statement summarizing revenues, costs, and
expenses in a given time period - 688
Progesterone - Female hormone that regulates the menstrual cycle and is crucial for
pregnancy - 651
Progressions - Modifications to acute training variables that increase the challenge of a
movement pattern - 451
Proliferative Retinopathy - An overgrowth of blood vessels around the retina - 613
Promotional Emails - An email communication series that presents an offer or promotion for
a limited time - 678
Proprioception - Perception or awareness of body movement or position - 67, 842
Proprioceptive Neuromuscular Facilitation (PNF) Stretching - A flexibility technique used to
increase range of motion and neuromuscular efficiencies - 315
Prospect - A person who has shown interest in a product or service and is a potential
customer - 676

Protein Digestibility-Corrected Amino Acid Score (PDCAAS) - Measures the nutritional
quality of protein - 586
Protein Synthesis - The process of arranging amino acids into protein structures - 116
Proxemics - The study of what is communicated by the way a person uses personal space - 453
Puberty - The period of hormonal change in an adolescent where they reach sexual maturity
- 634
Pulmonary Arteries - Blood vessels moving blood from the heart to the lungs - 99
Pulmonary Circulation - The blood flow between the heart and the lungs - 99
Pulmonary Veins - Blood vessels returning oxygenated blood to the heart from the lungs - 99
Pulmonary Ventilation - The process of exchange of air between the lungs and the ambient
air - 108
Pulse - A rhythmical throbbing of the arteries as blood is propelled through them - 104
Purines - A number of biologically important compounds, such as adenosine, caffeine, and
uric acid - 618
Pyruvate - A metabolic intermediate molecule in several energy pathways - 191
Q
Q Angle - The quadriceps angle formed between the quadriceps muscle and the patellar
tendon - 241, 242
Quickness - The ability to react and change body position with a maximum rate of force
production - 272
R
Range of Motion (ROM) - The measurement of movement around a specific joint or body
part - 134 , 284, 288, 312, 315
Rapport - A close, harmonious relationship in which all parties involved understand one
another’s feelings and communicate well - 38
Rates of Perceived Exertion (RPE) A subjective sliding scale of a client’s perception of their
exercise intensity - 278, 375

GLOSSARY
Reactive Training - Quick, powerful movements with an eccentric action followed by an
immediate concentric action - 265, 272, 273
Recommended Daily Allowance (RDA) - The average daily level of intake that is sufficient to
meet the needs of nearly all (97%-98%) healthy people 519, 570
Recovery Time - The rest time allowed between training sessions - 291
Reengagement Emails - An email communication method to reach out to former clients and
prospects and encourage a reply - 679
Refeed - Reintroducing carbohydrates into the diet after an extended reduction of a week or
more - 560
Refractory Period - A window where muscle protein synthesis (MPS) becomes resistant and
amino acids are used for other processes - 589
Regressions - Modifications to acute training variables that decrease the challenge of a
movement pattern - 451
Relatedness - The need to feel connected to and supported by others as well as a sense of
belonging within a group - 32, 36, 37
Relationship Emails - Emails used to engage with clients and prospects and build a
relationship - 677
Relative Strength - The individual’s body weight in relation to the amount of resistance they
can overcome and found with the following calculation: 1RM / body weight = force per unit
of body weight - 414
Relaxin - A sex hormone that facilitates birth by causing relaxation of the pelvic ligaments - 651
Remission - A significant reduction in symptoms and signs of rheumatoid arthritis - 615
Repetitions (REPS) - The number of times an exercise is completed within a set - 284, 287, 288,
Resistance Arm - The portion of the lever arm between the load and the axis - 153
Resistance Training - The category of training that includes physical activities designed to
increase muscle mass, improve strength, muscular endurance, or muscular power - 265, 278
Resisted Range Of Motion - Range of motion available while a load is also being moved
through that range of motion - 315

Respiration - The intake of oxygen and subsequent release of carbon dioxide in an organism
- 108, 110, 111
Respiratory Quotient (RQ) - A method of determining the fuel mix being used; a way to measure
the relative amounts of fats, carbohydrates, and proteins being burned for energy - 185
Rest - The amount of time spent in recovery between sets or repetitions - 285, 289, 291,
292, 297, 306, 308
Resting Heart Rate (RHR) - The measure of heart rate when completely at rest - 12, 223, 384
Resting Metabolic Rate (RMR) - The energy expenditure of metabolic and physical processes
when the body is at rest - 195
Retinopathy - Disease of the retina that results in impairment or loss of vision - 613
Rheumatoid Arthritis (RA) - A chronic progressive disease causing inflammation in the joints
- 615
Ribosomes - Small cellular organelles involved in polypeptide and protein synthesis - 183
Risk Factors - Variables associated with increased risk of disease or infection - 12, 602
Rotary Motion - The movement around a fixed axis moving in a curved path - 155
Rough Endoplasmic Reticulum - Endoplasmic reticulum with ribosomes attached - 183
S
Sagittal Plane - An imaginary line that divides the body into left and right halves - 134
SAID Principle - Specific adaptations to imposed demands—stress on the human system, whether
biomechanical or neurological, will require the body to adapt specifically to those demands - 293
Salivary Amylase - An enzyme found in saliva that converts starches and glycogen to more
simple sugars - 126
Sarcomere - The contractile unit of muscle tissue - 72
Sarcopenia - The degenerative loss of skeletal muscle mass - 642
Sarcoplasm - The cytoplasm of a muscle fiber - 71
Satiety - The feeling of fullness and satisfaction - 583

GLOSSARY
Scaffolding - A process in which teachers model or demonstrate how to solve a problem, and
then step back, offering support as needed -636
Scoliosis - The sideways curvature of the spine - 239, 240
Scope Of Practice - The practices, procedures, and actions a personal trainer is permitted to
undertake in keeping with their professional certification - 687
Screen Time - The time spent using a device such as a computer, television, smartphone, or
games console - 632
Seizure - A burst of uncontrolled neural activity that causes temporary abnormalities in
muscle movements or muscle tone, behaviors, or sensations - 715
Self-Determination Theory (SDT) - A general theory of human motivation that suggests a
person is motivated to change by three basic psychological needs of autonomy, competence,
and relatedness - 30
Self-Efficacy - The certainty of one’s ability to accomplish a particular task - 24
Self-myofascial release - 24, 36, 281, 314
Self-Myofascial Release (SMR) - Applying manual pressure to an adhesion or overactive
tissue to elicit an autogenic inhibitory response, which is characterized by a decrease in the
excitability of a contracting or stretched muscle arising from the Golgi - 281, 314
Senescence - The process or state of growing old - 641
Sensitive Period - A time or stage in a person’s development when they are more responsive
to external stimuli and quicker to learn particular skills - 636
Sensory Integration - The way the brain works to affect responses to neural input - 68
Sensory Neurons - Nerve cells involved in communicating tactile, auditory, or visual information
61, 66
Set - The number of times an exercise or group of exercises is completed - 287
Shear Force - The force of two surfaces moving across one another - 146
Sherrington’s Law Of Reciprocal Inhibition - A law that states that for every muscle activation,
there is a corresponding inhibition of the opposing muscle - 160

Shivering - Involuntary contraction or twitching of muscle tissue as a physiological means of
heat production - 410
Shock - An acute medical condition brought on by a sudden drop in blood flow through the
body - 710, 713
Shoulder Girdle - The clavicle, scapula, and coracoid bones of the appendicular skeleton - 236
Single Set - The use of one set per exercise or muscle group - 443
Sinoatrial (SA) Node - The pacemaker of the heart that generates the first electrical signal of
a heartbeat and stimulates the atria to contract - 102
Size Principle Of Fiber Recruitment - Principle stating that motor units are recruited in order
according to their recruitment thresholds and firing rates - 77
Skeletal Muscles - The voluntary muscle attached to bones via tendons (thick fibrous
connective tissue) that produces human movement - 70
Sleep Apnea - A disorder of breathing during sleep - 643
Sleep Deprivation - Achieving a less than ideal sleep duration - 370
Sliding-Filament Theory - The interaction of actin and myosin that describes the process of
muscle contraction - 75
Small Business Administration (SBA) - A US government agency established in 1953 to
promote economic growth by helping new and existing small businesses and providing advice,
financial assistance, counseling, and tips for sustainable business growth - 669
Small Group Personal Training - Exercise instruction delivered to two to four clients at the
same time - 662, 665
SMART Principle - Acronym to enable goals to be more objective; S—specific, M—measurable,
A—achievable, R—relevant, T—time-bound - 47, 48
Smooth Endoplasmic Reticulum (SER) - Endoplasmic reticulum that lacks ribosomes - 183
Smooth Muscle - Muscle tissue that occurs in the gut and internal organs that is involuntarily
controlled - 70
Social Proof - A success story of a program or something similar to prove that the style of
training works - 675

GLOSSARY
Social Stigmatization - The disapproval of, or discrimination against, a person based on
perceivable social characteristics - 633
Sole Proprietorship - The most common business structure, in which the single owner has
complete control over and liability for a business - 669
Somatic Nervous System - The part of the nervous system in charge of controlling voluntary
movement - 66
Somatosensory Cortex - The region of the parietal lobe responsible for processing sensations
like pain, temperature, and touch - 63
Somatotype - Categories of physical body type - 200
Spatial Relations - How objects are located relative to one another in space - 452
Specific Exercises - Exercises that directly improve performance and functional capacity - 423
Specific Warm-Ups - Activities that prepares the body for specific exercise to follow by
incorporating movements that mimic the planned activity - 265, 228
Speed - The ability to move the body in one direction as fast as possible - 145, 147, 272,
822, 824
Speed, Agility, And Quickness (SAQ) Training - The training category including reactive,
ballistic, plyometric, and agility training - 301
Speed Strength - The ability of a muscle or muscle group to absorb and transmit forces
quickly - 414
Spinal Cord - The neural tissue extending from the medulla oblongata to the lumbar region
(lower back) of the vertebral column - 64, 69, 74
Spinal Nerves - Bundles of nerves connected to the spinal cord carrying information toward
the periphery - 65, 74
Spirometer - An apparatus for measuring the volume of air inspired and expired by the lungs - 381
Split-Routine - The division of training sessions by body part or body region - 428

Squat Assessment - The uncoached movement assessment of body mechanics during a
squat with the goal of identifying movement dysfunctions along the kinetic chain - 242
Stability - The ability to control and maintain control of joint movement or body position - 6,
138, 139, 141, 149, 823
Stabilizer Muscles - The muscles playing the role of stabilizing or minimizing joint movement - 161
Stages Of Change - The series of temporal stages of readiness that a person progresses
through during the behavior change process - 24
Starting Strength - The ability to recruit as many motor units as possible instantaneously at
the start of a movement - 414
Static Balance - The ability to remain upright and balanced when the body is at rest - 138, 139
Static Posture - Posture when standing upright and still - 236, 237
Static Stretching - Lengthening a muscle and holding the lengthened position - 265, 313,
314, 316, 343
Steady-State Sxercise - Exercise that maintains a steady level of exertion from start to finish
- 194, 279
Steroid Myopathy - Weakness primarily to proximal muscles of the upper and lower extremities
and neck caused by treatment with corticosteroids - 629
Steroids - A class of chemicals characterized by their carbon structure, working to reduce
inflammation and the activity of the immune system - 111
Stimulants - A class of drugs that temporarily improve physical or mental function - 594
Stimulus-Fatigue-Recovery-Adaptation Principle - The concept that training response is
based on the stimulus intensity, and the greater the stimulus intensity is, the longer the
recovery needed to produce the adaptations will be - 299
Straight Sets - The use of the same weight for every set - 443
Strategic Emails - Email communications that explain why a trainer does what they do,
training philosophies, and more about themselves - 677

GLOSSARY
Strength - The amount of force that can be created by a muscle or group of muscles - 285,
292, 296, 301, 304, 305, 306, 308
Strength Training - The category of training that includes resistance training for increased
muscle mass and improved strength and muscular endurance - 292, 301, 304, 305, 308
Stretch-Shortening Cycle (SSC) - The cycling between the eccentric (stretch) action of a
muscle and the concentric (shortening) action of the same muscle - 79, 274
Stroke - When the blood flow to the brain is interrupted long enough to cause damage - 602,
710, 714
Stroke Volume - The amount of blood pumped by the left ventricle of the heart in one
contraction - 102
Subcutaneous Fat - Generally harmless fat cells located just beneath the skin - 127
Subjective Assessments - Fitness assessments that require observation or a subjective,
opinion-based measure - 204, 236
Subjective Goal - A goal based on a subjective outcome that will be dependent on the
interpretation of the individual client - 48
Supercompensation - The post-training period during which the trained function/parameter
has a higher performance capacity than it did before the training period - 298
Superior Vena Cava - The blood vessel moving blood from the upper body and head to the
heart - 97, 99, 100, 101
Supersets - Two exercises, typically opposing muscle groups, performed back-to-back followed
by a short rest - 443, 444
Swayback - A posterior tilt with excessive extension of the lumbar spine that protrudes the
buttocks - 239
Sympathetic Nervous system - The autonomic system responsible for “fight or flight.” - 66
Syncope - Temporary loss of consciousness related to insufficient blood flow to the brain -
434, 607
Synergistic Dominance - When a synergist (helper) muscle takes over a movement pattern
when the prime mover fails or is too weak to control the movement - 451

Synergists - Muscle(s) supporting the mechanical movement of a prime mover - 160
Synovial Fluid - A viscous fluid found in the cavities of synovial joints - 88, 89
Synovial Joints - Fluid-filled joints found between bones that move against one another -88, 89
Systemic Circulation - The blood flow between the heart and the rest of the body - 99
Systole - The heartbeat phase where muscle contraction moves blood from the heart
chambers to the arteries - 102
Systolic - The pressure in blood vessels when the heart beats (ventricular contraction) - 104,
105, 602, 604
T
Talk Test - The ability to speak during exercise as a gauge of the relative intensity - 375, 607
Tapering - A decrease in training volume or frequency to allow the body adequate rest and
recovery - 425, 426
Taper Period - A training period where the volume or frequency of training decreases to allow
the body adequate rest and recovery - 373
Target Heart Rate (THR) - The estimated beats per minute that needs to be reached to
achieve a specific exercise intensity - 278, 375
Target Market - The particular group(s) of consumers that a product or service targets - 671
Tempo - The speed at which an exercise or movement pattern is completed - 64, 285, 290,
291, 292, 306, 308
Temporal Lobe - The lateral lobe of the brain responsible for hearing, memory, and emotion - 64
Tendon - A strong, fibrous cord made of collagen that attaches muscle to bone - 16, 73, 89, 91
Tensile force - The force when two surfaces pull apart from one another - 146
Testosterone - A steroid hormone found in both males and females - 114, 116, 819
Thalamus - The brain region responsible for relaying sensory and motor signals and regulating
consciousness - 63
The Health Insurance Portability and Accountability Act (HIPAA) - An American legislation
designed to protect the health care data, information, and payment details of patients - 205

GLOSSARY
Thermic Effect of Food (TEF) - The energy expenditure associated with food digestion and
absorption - 195
Thoracic Cavity - The chest cavity enclosed by the ribs, sternum, and spinal column - 109
Tidal Volume - The lung volume representing the normal volume of air displaced between
normal inhalation and exhalation when extra effort is not applied - 381
Time - The duration of an activity or training session - 285, 289, 290, 291, 306
Time Under Tension (TUT) - The amount of time a muscle is engaged as a set, completed
from start to finish - 285, 290, 306
Torque - The turning effect of an eccentric force. The rotational analog of force - 16, 155, 818
Total Daily Energy Expenditure (TDEE) - The accumulated calorie burn made up of resting
metabolic rate, the thermic effect of food, physical activity, and physical growth - 195
Training Density - A combination of volume and time equaling the total volume of work in a
specific amount of time - 297
Training Effect - The body’s adaptation to the learned and expected stress imposed by
physical activity - 12
Training Macrocycle - The overall training period, usually one year or more - 299
Training Mesocycle - A training phase in the annual training plan made up of three to nine
microcycles - 299
Training Microcycle - A one-week-long cycle of training sessions, or a single session - 299
Training Volume - The total amount of work performed, typically measured as Sets x Reps x
Load (or intensity) - 297, 300
Transtheoretical Model (TTM) - A behavior change model focused on the stages of change,
the process of changing behavior, self-efficacy, and the decision balance - 23
Transverse Plane - An imaginary line that divides the body into inferior and superior halves
- 134
Triggers - Any chemical, irritant, or allergen that causes an inflammatory response of the
airways - 625, 626

Triglyceride - A chemical compound formed when three fatty acids combine with glycerol. The
most abundant fat in the body - 185, 191, 416, 517
Type - The techniques, equipment, or methods used to complete an activity - 284, 285, 289,
294, 305
Type 1 Diabetes - A chronic condition in which the pancreas produces little or no insulin -
609, 612
Type 2 Diabetes - A long-term metabolic disorder that is characterized by high blood sugar,
insulin resistance, and relative lack of insulin - 22, 264, 609, 610
Type I Fibers - Slow-twitch, fatigue-resistant muscle fibers with high mitochondrial density -
76, 77
Type IIa Fibers - Fast-twitch, moderately fatigable muscle fibers with moderate mitochondrial
density - 76
Type IIx Fibers - Fast-twitch, fast-fatigable muscle fibers with low mitochondrial density - 76
U
Underactive Muscles - Muscles that are lengthened beyond the ideal length-tension
relationship and are, therefore, inhibited and less capable of producing force - 233
Undulating Periodization - Short durations of hypertrophy training alternated with short
durations of strength and power training - 300
Unipennate Muscle - Muscle fibers extending from one side of a central tendon - 78
Unprocessed Foods - Fresh or raw foods that are the natural, edible parts of an animal or
plant - 511
Upper Limit (UL) - The highest level of nutrient intake that is likely to pose no risk of adverse
effects for almost all individuals in the general population -580
Upsell - A sales technique where a client is encouraged to purchase additional services,
products, or add-ons to generate more revenue - 684
US Department of Agriculture (USDA) - A US federal department that manages programs for
food, nutrition, agriculture, natural resources, and rural development - 511, 532, 538

GLOSSARY
US Department of Health and Human Services - A US federal department that oversees
public health, welfare, and civil rights issues - 538
V
Valgus - An abnormal joint movement toward the midline of the body (i.e., knock-kneed) - 92
Valsalva Maneuver - The act of forcibly exhaling with a closed windpipe, where there is no air
that is exiting via the nose or mouth - 434, 607, 620
Varus - An abnormal joint movement away from the midline of the body (i.e., bowlegged) - 92
Veins - Blood vessels carrying blood toward the heart to remove waste and pick up more
oxygen - 96
Velocity - The speed of an object and the direction it takes while moving - 143, 144
Ventilatory Threshold (VT) - The threshold where ventilation increases faster than the volume
of oxygen - 224, 387
Ventricle - One of the two lower cavities of the heart passing blood to the body or to the
lungs - 99, 100, 101
Venules - The small branches of the veins gathering blood from the capillaries - 98
Virtual Training - Remote training sessions conducted via website, phone applications, or
social media platforms - 662, 663, 664
Visceral Fat - Fat accumulated within the abdomen and around internal organs. It has
potentially negative effects on arteries, the liver, and the breakdown of sugars and fats - 415
Visual Cortex - The specific region of the occipital lobe responsible for sight and visual
perception - 64
Visual Learners - People who learn by seeing information - 455, 456
Vital Capacity - The greatest volume of air that can be expelled from the lungs after taking
the deepest possible breath - 381, 382
Vitamins - Organic compounds essential for normal growth and nutrition - 511, 531, 532,
533, 534, 535, 536, 568, 571, 572, 573, 574, 576, 577, 578, 579, 580, 582
VO2 Max - The maximum amount of oxygen an individual can use during exercise - 6, 224,
225, 226, 227, 228, 373, 376, 380, 383, 384, 385, 387, 388

W
Waist-To-Height Ratio - An objective assessment to measure cardiometabolic risk - 212, 213
Waist-To-Hip Ratio (WHR) - A predictive health measure comparing the circumference of the
waist to the circumference of the hips - 218
Weight - The gravitational force of attraction on an object - 7, 139, 821, 825, 829, 830, 832,
837, 839
Weight-Bearing Exercise - Activities that move one’s own body weight against gravity - 638
Weight Machines - Pieces of equipment with fixed or a variable range of motion that uses
gravity and a load to generate resistance - 440, 442
Weight Management - The physiological processes and techniques one uses to achieve or
maintain a specific body weight - 198
Wheezing - Breathing with a whistling or rattling sound in the chest - 626
Wolff’s Law - The explanation for bone adaptations as a result of the loads placed on them - 87
Work - Force times distance measured in foot-pounds - 151, 152
Z
Z line - The lateral boundary of the sarcomere where the myofilament actin attaches - 72

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CHAPTER 8: ELEMENTS OF FITNESS

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CHAPTER 9: PRINCIPLES OF PROGRAM DESIGN

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CHAPTER 15: SUPPLEMENTATION

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CHAPTER 16: CHRONIC CONDITIONS

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CHAPTER 17: LIFESPAN POPULATIONS

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CHAPTER 18: BUSINESS MARKETING

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CHAPTER 19: SAFETY AND EMERGENCY SITUATIONS

Elba, I., & Ivy, J. W. (2018). Increasing the Post-Use Cleaning of Gym Equipment Using Prompts and Increased Access to
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Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542176/

ABOUT ISSA
As a leader in fitness education and certification, ISSA has educated hundreds
of thousands of personal trainers in 174 countries. ISSA is committed to
helping students gain the knowledge and skills necessary to make an impact
and fill the global need for highly-educated certified fitness professionals. This
newly updated Certified Personal Trainer textbook features the vital information
students will need to be successful in the health and fitness industry. Readers
will explore the muscular, skeletal, and nervous systems, effective exercise
programming, and how optimal nutrition and small behavior changes can
transform people’s lives. It even covers how to start and grow an impactful
personal training business. Chapter by chapter, ISSA provides the most
current science-based information backed by the latest research in exercise
science, wellness, and fitness. More importantly, students will find practical and
actionable tips to help them both earn an ISSA Personal Trainer Certification
and build lasting careers in this dynamic field.

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Foundations and Applications for a

CERTIFIED PERSONAL TRAINER

Official course text for: ISSA’s Certified Personal Trainer

Copyright © 2021 ISSA LLC

Produced by ISSA LLC, Phoenix, AZ, 85020

CERTIFIED PERSONAL TRAINER

Human anatomy and physiology

Biomechanics and human movement

Principles of program design

Exercise selection and technique

Nutrition and supplementation

Common chronic health conditions

Growing and marketing a personal training business

Emergency management in fitness

15| SUPPLEMENTATION 567

16| CHRONIC CONDITIONS 601

17| LIFESPAN POPULATIONS 631

3 | Describe the general benefits of personal training as it relates to exercise

ISSA | Certified Personal Trainer | 9

THE HISTORY OF PERSONAL TRAINING

touted by ancient philosophers. Around 400 BC (before Christ), Hippocrates wrote:

possessing opposite qualities, yet work together to produce health…and it is necessary, as it

PERSONAL TRAINING DEFINED

and applied sciences.

rehabilitation facilities, and private studios.

ISSA | Certified Personal Trainer | 10

for personal trainers to be competent in the following topics and subjects:

• Functional anatomy and biomechanics

• Common chronic diseases

• Basic emergency and safety procedures

the knowledge of muscular, cardiovascular, and metabolic adaptations. These adaptations

ISSA | Certified Personal Trainer | 11

THE CURRENT STATE OF HUMAN HEALTH

cholesterol, as primary risk factors for disease.

25 to 35 percent of people remain sedentary (inactive). To make matters worse, federal

expenditures to be reduced or cut altogether.

ISSA | Certified Personal Trainer | 12

people of all ages.

PERSONAL TRAINING CLIENTELE

Figure 1.1 Health Club Members by Generation (IHRSA, 2019)

ISSA | Certified Personal Trainer | 13

Here are some statistics from the report:

• Three out of five personal training clients are women.

• Clients report an average of 18 sessions with a trainer.

average being $50 per hour.

1-6 sessions 47 percent

7-11 sessions 12 percent

12-24 sessions 11 percent

25-49 sessions 8 percent

50+ sessions 11 percent

Not reported 11 percent

AGE RANGE SESSIONS

6-11 years old 22 sessions

12-17 years old 26 sessions

18-34 years old 15 sessions

35-54 years old 14 sessions

55+ years old 24 sessions

ISSA | Certified Personal Trainer | 14

one inescapable conclusion: exercise is medicine!