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Chapter 21

Creatingan Exercise

ProgramIN THIS CHAPTER

Prioritizing Needs

Case Studies

Course of Action

Refined Program Criteria

Sample Program Format

Modification Techniques

Duration of Program Cycles

Program Tracking

CHAPTER 21 REV_Layout 1 9/20/12 1:28 PM

The traditional approach to exercise programs uses the FITT principle. FITT represents F-frequency, I-intensity, T-time, and T-type. This principle suggests that all programming is based on frequency, duration, intensity, and mode of exercise. In personal training, the principle is somewhat limited, as the frequency is dictated by client finances and available time, and the duration has been standardized to reflect one hour of work. This leaves the options of intensity and mode to the discretion of the trainer. Due to the limited frequency and duration, most programming is forced to combine all of the aspects of a comprehensive program into a 120 to 180 minute time period per week. Maximizing the exercise or contact time with a client is vital to goal attainment. Personal trainers should account for every minute of a workout session. In the early stages of an exercise program, the rest interval may necessitate complete recovery. After improved fitness status has been attained, different activities can be used during the rest interval to work on progressive skills. For instance, if a chest press is completed and a sixty-second rest period is used between sets, it may be an opportune time to work on stability, dynamic flexibility, or low level therapeutic back activities. If future progressions will require activities which require balance, a client could be acclimated to standing on a single foot, or practice stabilizing on a stability disc. These ideas ultimately save time. Personal trainers should always be looking for ways to promote improvements when any contact time is made available.

Introduction The exercise prescription is technically defined as a premeditated, structured format of quantified stress, applied in appropriate dosages in a manner that stimulates adaptations in the physiological systems of the body. This suggests that each action defined by the exercise program has a specific purpose related to the intended outcome. To successfully create an exercise prescription, a personal trainer must identify the physiological needs of the client and determine the specific exercise components that will attend to them. This requires a multi-dimensional approach and a thorough review of all the factors involved (19). Writing an effective exercise program is the most difficult task required of the personal trainer. Due to the number of health-related considerations, different personal goals, training aptitudes, and the limitations in contact time needed to address all the physiological issues, exercise programming for even the average personal training client can become somewhat complicated. Although programming may present different challenges for the personal trainer, the task can be managed effectively by using the proper approach. In previous chapters, the needs analysis was addressed as a means to identify how to extract the relevant information from the findings of the health screening and behavior questionnaire, resting and physical evaluations, subjective reports, and observational data collection (18). Recording each finding provides the basis for the program decision making process. Identifying the needs of the client, ranking the needs, coming up with solutions, and integrating the solutions in a program matrix so that they adhere to the client’s individual goals is how personal trainer programs are designed to individually cater to each client (28). Prioritizing Needs The easiest way to become proficient in program design is to 1) become knowledgeable enough to identify the important findings during a comprehensive screening and evaluation, 2) be able to correctly prioritize the defined needs, 3) know what activities and exercises address the problems, based on physiological adaptation response, and 4) be able to competently implement the exercise principles and program components in a manner specific to the goals (16). Thoroughly evaluating the findings that create the needs analysis often indicates broad categories of need. Early conclusions about what the program should entail can be refined to create a specific list of objectives. This list should further be refined to identify solutions that can be combined to provide the needed adaptation-based stress in the most efficient manner and within the

reasonable capabilities of the client. Segmenting the exercise bout and using a weekly format will also aid in covering the relevant issues while still maintaining a focus on client specific goals. Most personal trainers find that the needs analysis identifies more relevant issues than are indicated by the initial goals defined by the client. The prevention of disease and age-limiting factors should be addressed with priority. Deficiencies in health-related fitness and musculoskeletal imbalances should also be ranked among the most important issues. In many cases, the actions used within the program can cover many benefits and address more than one area of concern simultaneously (11). For instance, aerobic exercise will aid in cardiorespiratory fitness, while also contributing to reductions in weight and blood pressure (22). Time management within the program becomes an important factor to ensure that the necessary issues and defined goals are attended to within the limited contact time a personal trainer has with a given client. ~Quick Insight~

Creating an Exercise Program NCSF CPT

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The following section covers three case studies intended to provide some ideas on how to program for multiple factors within the same workout session. Each workout is segmented, with specific emphasis based on the individual’s presented needs analysis. Training in adaptation specific segments allows for more total body

improvements than emphasizing a single adaptation response in each exercise session. A dose-response relationship is associated with physical adaptations (4). Therefore, the more often the stress can be applied, the faster the rate of improvement.

Case Study One Mr. Thomson is a 51-year old High School principal. He is 5’ 11” tall and weighs 224 lbs. He was previously sedentary and has hired a trainer based on his doctor’s recommendation during a recent physical examination. In the initial meeting Mr. Thomson identified his personal goals as reducing body fat, reducing his blood pressure, and increasing his overall stamina. He has been cleared for exercise by his physician. During his initial screening and subsequent evaluation, the following information was collected. The initial needs analysis has provided general recommendations for activities that should be used within the exercise training bout. The solutions require refinement to identify the specific activities to be used in the exercise program. Due to the fact that Mr. Thomson will be able to train two days a week limits any particular emphasis within the program design but will provide enough stress application for health improvements.

Course of Action Need Solution Aerobic Exercise Steady state training 60-65% HRR Behavior Education Diet and lifestyle coaching Increase Activity Maximize daily activity Negative Caloric Balance 300-400 kcal expenditure per session Increase Caloric Expenditure Daily task sheet Resistance Training Total body activities 50-70% 1RM Increase Specific ROM Static and dynamic ROM exercises

Identified Need Current Status Solution Resting Blood Pressure 140/87 mmHg Aerobic exercise Behavior education Resting Heart Rate 82 bpm Aerobic exercise Activity Status Sedentary Increase activity Body Composition 23% Negative caloric balance Abdominal Girth 38 inches Negative caloric balance Increase caloric expenditure Cardiorespiratory Fitness 37 ml · kg-1 · min-1 Aerobic activity Upper Body Strength Moderate deconditioning Resistance training Lower Body Strength Mild deconditioning Resistance training Trunk Endurance Poor Increase strength and endurance Flexibility Poor ROM hamstrings, Increase specific ROM

glutes, trunk rotators, hip flexors

Additional Intermittent low back pain Muscle balance Pelvic stability

NCSF CPT Creating an Exercise Program

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Following the refinement phase, the specific activities to address the need have been defined. The next step is to place them in a two-day program that is appropriate to the client’s capabilities. For this individual, the program must emphasize caloric expenditure and provide time for aerobic activity, flexibility, and resistance training exercise. Reviewing the protocols used for resistance training in Chapter 18, it makes sense to employ some time-saving systems. Due to the fact that he is new to exercise, the sets, repetitions, intensity, and rest periods should be moderate in nature. Using higher repetition ranges will aid in movement proficiency and allow for work of a more continuous nature to meet caloric expenditure goals. The nervous system will not require significant stress for adaptations due to his current fitness status. An effort should be made to combine exercises whenever possible to save time and increase functional demands. It normally takes several sessions to ensure movement economy before adding any new level of complexity (3). The following program assumes the client has been adequately instructed and has gained appropriate levels of efficiency in performing the prescribed exercises.


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The program format allowed for the application of the appropriate stress within the desired period of time. Based on the current rest to work ratio, the client is able to accomplish more than 45 minutes of work and attain the intended caloric expenditure in the designated time allotment. In some cases, additional rest may be required to address individual exercise tolerance, but by varying the muscle groups used and employing reasonable intensity expectations, the desired amount of work can be accomplished. As the client adapts to the stress, intensities may increase, consistent with recommended progression rates, and rest intervals may be reduced or manipulated to reach the goal effect. Many trainers do not utilize aerobic conditioning during the personal training workout, which may be a mistake. Aerobic exercise is necessary for improved health and the reduction of disease risk (26). Additionally, it adds to the total caloric expenditure (32). For this individual, it is certainly necessary to contribute to caloric expenditure, as he presents the pre-stages of hypertension and metabolic disease risk. As the client improves in aerobic capacity, interval training can be added to further the adaptation response.

Case Study Two Miss Carter is a 25-year-old real estate agent. She is 5’ 6” tall and weighs 135 lbs. She has been previously active and is an avid tennis player. She has hired a trainer to improve her tennis performance and is looking for overall conditioning. During the initial meeting, she identified her personal goals as improving her strength and speed on the court and would like to create better muscle tone throughout her body. During her initial screening and subsequent evaluation, the following information was collected.

Identified Need Current Status Solution Resting Blood Pressure 116/68 mmHg Maintain Resting Heart Rate 65 bpm Maintain Activity Status Active Maintain Body Composition 27% Negative caloric balance Waist Girth 27 inches Negative caloric balance Hip Girth 34 inches Negative caloric balance Cardiorespiratory Fitness VO2max 43 ml . kg-1 . min-1 Aerobic activity Upper Body Strength Moderate levels Resistance training Lower Body Strength Moderate levels Resistance training Trunk Endurance Good Flexibility Bilateral difference in Increase specific ROM shoulder range ROM Mild hip flexor tightness Anaerobic Power Moderate Increase power Agility Test Moderate Increase lateral speed The exercise prescription for Miss Carter places less emphasis on training for health purposes and more on enhancing fitness and movement capabilities. The exercise program will need to address power, strength, and performance endurance. The program should emphasize muscle balance due to the higher risk for injury associated with her sport activity, especially within the shoulder and elbow joints (17). The activities should address each body segment but focus on coordinated movements with particular consideration for the acceleration and deceleration requirements of her stop and go movements on the tennis court (12).

Course of Action Need Solution Aerobic Training 70-80% HRR Resistance Training Total Body 65-80% 1RM Flexibility Training Shoulders, Hips Body Composition Caloric Expenditure Sport Specific Training Power, Agility


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Due to the sport specific nature of the training, energy system considerations will dictate the order of the program components so that fatigue does not negatively affect the activity performance (10). Recalling the recommended order of operations from Chapter 12, power and speed activities should be performed early in the session, followed by complex activities and those that utilize the most resistance (13; 14). In many cases, rate of perceived exertion can be used to adjust rest intervals for client-specific tolerance to the exercise volume and intensity (6).


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Sport-specific training differs from general health and fitness training as the emphasis is on the performance components of fitness. During the early stages of the program, developmental strength and movement proficiency are very important to support the subsequent progressions. More strength is needed in performance activities due to the deceleration requirements of most sports. The pace of the workout bout should challenge the systems but not be so rigorous that movement technique becomes compromised. As motor patterns are reinforced, greater stability components can be added, consistent with the functional-based training paradigm.


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Case Study Three Mr. Jones is a 67-year-old retired lawyer. He is 6’ tall and weighs 208 lbs. He has been sedentary, but has decided to join the fitness center to occupy his time. Upon meeting Mr. Jones, he clearly has no particular goals, but would like to become more mobile, as he feels he has slowed down with advancing age. He required a medical referral, but has been cleared for exercise. During his initial screening and subsequent evaluation, the following information was collected. Identified Need Current Status Solution Resting Blood Pressure 131/88 mmHg Aerobic exercise (medicated) Behavior education Resting Heart Rate 78 bpm Aerobic exercise Activity Status Sedentary Increase activity Body Composition 21% Negative caloric balance Abdominal Girth 36 inches Negative caloric balance Increase caloric expenditure Cardiorespiratory Fitness VO2max 29 ml · kg-1 · min-1 Aerobic activity Upper Body Strength Deconditioned Resistance training Lower Body Strength Mod. deconditioning Resistance training Trunk Endurance Poor Resistance training Flexibility Poor ROM hamstrings, Increase specific ROM glutes, trunk rotators, hip flexors, back extensors trunk flexors, shoulder flexors Mr. Jones has notable limitations due to muscle imbalance and poor flexibility. Based on his overall deconditioning, he will only be able to train at low to moderate levels until his muscular and aerobic fitness improve (8). He requires physical activity aimed at movement range and functional applications (25). Conventional training can be utilized, but to more dramatically affect his performance, dynamic, closed-chain, compound movements are warranted (30). Need Solution Aerobic Exercise Steady-State Training 50-55% HRR Behavior Education Diet and lifestyle coaching Increase Activity Maximize daily movement through a full range of motion Negative Caloric Balance 150-200 kcal expenditure per session Increase Caloric Expenditure Daily tasks sheet Resistance Training Total body compound activities 50-70% 1RM Increase Specific ROM Static and dynamic ROM


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Many of the exercises have been modified from their traditional forms to cater to the reduced physical capacity of Mr. Jones. Combining exercises whenever possible can help create more functional-based activities (29). The aerobic exercise component may be done in two segments to avoid leg fatigue unless otherwise tolerated by the client. Repetitions should be high due to lower intensity load assignments and the need for motor patterning and increased range of motion (9). The flexibility component is necessary to reduce the limitations associated with the client’s current conditions and will make good use of the training time. Additionally, movement cone drills will allow for increased activity and encourage movements in different directions at controlled speeds to enhance gait stability.


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With program components for limited mobility, new exercisers often use modified versions of the traditional movements to allow for a building block approach, while reducing the deleterious effects from excess fatigue from the exercise (24). If overly aggressive movements are used early in the exercise bout, the total number of quality movements performed later may be limited. For example, performing abdominal flexion from the floor may be too demanding, and the deconditioned muscle may only allow for a limited number of proper repetitions. Moving Mr. Jones to a seated incline position provides for a mechanically advantaged start position but still activates the intended muscle group. Progressions should focus on increased movement range and more complex actions. One of the goals of the early stages of this program is to stimulate activity in as many movements and muscle groups as is reasonably possible in a single exercise session (1). Total body flexibility should be encouraged in each workout to enhance ROM for later, progressively applied techniques. bbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb


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Case Studies in Review Each of the three case studies demonstrates the variety of training possibilities that exists in programming for diverse populations. Personal training clients may each require different methods and systems to best address the issues they present. Based on this fact, the employment of numerous program options is necessary to cater to the various client characteristics, which often results in a program as diverse as the clients themselves. Traditional approaches to personal training follow a modified body builder/strength program that is often ineffective at meeting the needs of most clients. Although 8-10 exercises performed using three sets of ten repetitions is a stress that will cause adaptations, it does not provide for the many individual needs of the average client. Writing exercise prescriptions requires appropriate management of the needs assessment and the defined goals. Based on the three case studies, it should be evident that an individualized approach is necessary for long-term success. Testing results and evaluation criteria should be incorporated into the program and used to create the foundations of the prescribed stress (21). Using the test scores as baseline values, appropriate application of the exercise principles will help ensure each defined objective is met (31). Recalling the use of effective goal strategies, focusing on daily and weekly objectives is necessary to stay on track for short-term goal attainment. Keep the goals measurable and consistent with the tests and evaluation criteria used to assess training effectiveness. A recommended approach is to use movements and systems in the program that are similar or the same as those used in testing. This strategy will provide for quantified improvements that the clients can see, fostering a positive psychological impression as to their capabilities. When setting the goals, be conscious of time constraints and the dose-response gradient of physiological adaptations. The nervous system is quick to respond to stress, whereas the muscular and cardiovascular systems experience a slower adaptation process. Effective use of exercise principles is another key consideration in the exercise prescription. The principle of specificity should be based on the physiological and biomechanical analysis, as well as the goals established for the client (5). The principle of specificity is necessary to ensure the proper energy pathways and movements are utilized to impose the appropriate demand. Progressive overload should be consistent with the physiological adaptation process (15). Early stages of the exercise experience warrant progressively applied overload that matches the individual’s performance.

Neural efficiency often contributes to a rapid adaptation rate in the first 4 to 6 weeks, when adequate volume is used. During this preparation cycle, clients may experience improvements beyond the norm and progressions can accelerate, necessitating supported adjustments. The emphasis should still be on skill acquisition and motor learning rather than resistance-based overload. Once the body reaches its initial adjustment response, shifting back to a progression rate of 2.5% per week is usually an appropriate progressive overload goal (2). More aggressive progressions usually lead to faulty movement patterns, incorrect performance via neuromuscular compensation, and can potentially result in injury. Monitoring individual performance will best define the progression rate for each individual client. One key consideration is that the body adapts to stress based on its duration of exposure, intensity, and the frequency of application. Therefore, the number of times a client engages the program components will determine the rate of adaptation and subsequent progression. A client who participates at a frequency of 3x per week will progress at a proportionately faster rate than if he or she used a frequency of only 2x per week (20). Notable adaptations often require 7-12 exposures to the stress, but again, the nervous system is more expeditious in responding to exercise demands. Individual considerations are the foundation of exercise programming in personal training. As mentioned earlier, each person presents a unique group of characteristics that shapes the exercise prescription. Exercise experience, physical limitations, exercise tolerance, genetic factors, and daily lifestyle factors all must be considered to shape the program in a manner that best caters to the individual client. This notion supports the need for a thorough evaluation of every client before designing a client-specific exercise regimen. Tweaking the traditional program concept to reflect the client-specific interests is often warranted for optimal results. Taking advantage of the multitude of variables presented under the auspices of physical activity helps to facilitate an effective program and positive experience for the client. Modification Techniques Almost every component of exercise can be modified in a way that refines the delivery of stress. Exercises, movements, environments, set-repetition schematics, intensities, speeds, stability, complexities, and a host of other variables can all be adjusted to fit the client’s needs. The continuum that exists between ease of movement and movement difficulty allows for an immeasurable number of possible scenarios. The goal should be to identify the exact compilation of stresses that allows the client to experience ongoing


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Periodization Model The periodization model is a programming method that plans for specific emphasis within a given training cycle, directed at focusing on specific goals (27). In a sense, this model partitions each cycle to highlight certain deficiencies or objectives. Ultimately, over the course of several individual cycles, all goals can be achieved. In most cases, an extensive program cycle of six or eight months is broken down into smaller cycles. It works on the same concept of goal-oriented behavior, which uses short-term goals to reach long-term goals. This is a relevant concept for client psychology, because short-term goal attainment reinforces efforts and contributes to motivation and compliance. Likewise, breaking the training into segments aids in effective tracking, and planned routine evaluations at the end of each cycle can identify effective and ineffective components of the program. This strategy will help prevent prolonged periods of programming errors by identifying them earlier and can help to distinguish areas that warrant modification. In periodization, the concept is to accomplish one group of adaptations to support the next. The traditional periodization approach uses a preparation phase, endurance/hypertrophy phase, strength phase, and performance phase(7). Each phase reflects a progressive increase in complexity and intensity. In the sports model, the phases are characterized by ever-increasing sport-specific behavior. In personal training, the emphasis will be dictated by the client’s overall goals, as well as identified needs. In both cases, the building block approach is used to gradually progress to more intensified focus on the program’s ultimate purpose.

~Quick Insight~

improvements in health, fitness, and movement efficiency without being overtrained. This compilation of stress involves adding or reducing the actual training demand. This fine balance must be adjusted to prevent the demand from being too great where the client struggles or too little where the client does not progress due to lack of intensity. The decision to adjust the situation should be based on observation, experience, and logic. Duration of Program Cycles Exercise programs are aimed at eliciting an adaptation response. Once the degree of adaptation has been attained, the program must progress to create a new perceived stress in order for the next level of physiological improvement to occur. With regard to the priority of the adaptations, programs evolve from different emphases and foci to new directions. The priority focus should continually address physiological need and goal attainment. Recalling the characteristics of effective goal setting, there is a designated time period in which efforts should concentrate on achieving short- and long-term goals. Programming activities and components, including the application of progressive overload and physiologically specific stress, should reflect the time period of the training cycle. In most cases, training cycles last 6, 8, 10, or 12 weeks in length (23). Utilizing a designated length of time allows for a premeditated and structured application of stress. Retesting the emphasized components at the end of the training cycle identifies the effectiveness of the programming and sets the values for the next training cycle. When the needs list is extensive, the training cycles may employ specific emphasis in a building block approach and change at the beginning of each new cycle. For instance, the initial training cycle may be a 6-week program to emphasize motor learning, movement patterning, baseline endurance, and general conditioning in preparation for more challenging training protocols. The next training cycle may emphasize specific movement strength and more coordinated activities requiring 8 weeks of training to attain the necessary adaptation response. The actual training cycle length will be based on the client contact time, fitness status, training experience, and training aptitude. If a client does not comply with the initially programmed frequency, the training cycle may have to be lengthened to allow for adequate exposure to the exercise stress. Concentrating on specific goals, rather than taking a broad approach to address everything at one time increases the likelihood of timely goal attainment. This is not to suggest selecting only one or two issues and ignoring the rest of the needs list but

rather implies planned emphasis, based on a system of priority. Program Tracking Program components should be tracked on a daily basis to gauge the program’s effectiveness and progress. Trainers should record each performance so that progressive overload is properly applied in each training bout. When adaptation to the exercise occurs, the body requires a new perceived stress to support continued improvements. Many exercisers use the same stress routinely, which explains why they spend so much time in the gym without experiencing any change to their physique or measured performance. Tracking is also valuable in identifying how effective each program component is at addressing its intended purpose. If certain areas of improvement are noticed, the


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programmed activities are serving their intended role in those areas. If other areas are not showing signs of improvement, then the applied stress is incorrect on some level. Trainers should review the intensity, volume, rest interval used, and specificity of the stress to identify the problem. If tracking is not used, these errors may not be recognized until the end of the training cycle, which is an unnecessary waste of both time and effort. Identifying these obstacles early on allows for productive program adjustments. Likewise, if results are relatively slow, the stress should be analyzed to determine if it is adequate. In many cases, adaptations occur to the initial exercise stress and adjustments to new progressions are either overly aggressive or insufficient to stimulate the next level of physiological alterations.

Program tracking is also necessary from a liability standpoint. If a personal trainer finds him or herself involved in litigation, the program components are often reviewed for appropriateness. If the programming information is limited or non-existent, it becomes difficult to defend correct procedure because no tangible proof exists. Documenting and maintaining program records is a professional act that should be a standard of all personal training services. Additionally, using the programs to identify client improvements instills confidence in one’s professional capabilities and can be used for motivation in the program. For example, clients who do not show improvements in body composition may want to give up or assume the personal trainer is not fully competent. Providing reinforcement through other adaptation improvements may be the justification needed to keep clients motivated and on track.

Chapter Twenty One References

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24. Singh MA. Exercise to prevent and treat functional disability. Clin Geriatr Med 18: 431-vii, 2002.

25. Singh MA. Exercise to prevent and treat functional disability. Clin Geriatr Med 18: 431-vii, 2002.

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28. Topp R. Development of an exercise program for older adults: pre-exercise testing, exercise prescription and program maintenance. Nurse Pract 16: 16-1, 25, 1991.

29. Topp R, Mikesky A and Bawel K. Developing a strength training program for older adults: planning, programming, and potential outcomes. Rehabil Nurs 19: 266-73, 297, 1994.

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32. You T, Murphy KM, Lyles MF, Demons JL, Lenchik L and Nicklas BJ. Addition of aerobic exercise to dietary weight loss preferentially reduces abdominal adipocyte size. Int J Obes (Lond) 30: 1211-1216, 2006.


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