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What are the phases of the OPT model?
Optimum Performance Training Model:
-Phase 1: Stabilization Endurance Training
-Phase 2: Strength Endurance Training
-Phase 3: Hypertrophy Training
-Phase 4: Maximal Strength Training
-Phase 5: Power Training
What is chronic disease?
incurable illness or health condition that last more than 1 year
What is considered obese?
BMI > 30+ or at least 30 lbs overweight for their height
What is overweight?
BMI 25-29.9 or between 25-30 lbs overweight for their height
How to calculate BMI?
703 (weight in lbs/height^2 in inches)
Diabetes type 1?
Pancreas doesn't produce insulin
Diabetes type 2?
Deficient insulin receptor
What is deconditioned?
lost physical fitness (muscle imbalances, decreased flexibility, lack of core/joint stability)
What does training the body's proprioceptive abilities do?
Improves balance, coordination, posture
What is proprioceptively enriched environment?
unstable YET controllable physical situation where exercises cause body to use internal balance/stabilization mechanisms

Ex: stability ball dumbbell chest press or single leg squat vs bench press or barbell squat
What was OPT model made for?
For society that has more structural imbalances and susceptibility to injury than every before; this can systematically progress any client to any goal
What are the goals of the stabilization endurance training phase of OPT?
Increase ability to stabilize joints and maintain optimal posture
What are the training strategies of the stabilization endurance training phase of OPT?
-proprioceptively challenging environment (stability)
-low loads, high repetitions
What is the goal for strength endurance, hypertrophy, and maximum strength training of OPT?
Maintain stabilization endurance while increasing prime mover strength
What does strength endurance training improve?
stabilization endurance, prime mover, strength, overall work capacity, joint stabilization, lean body mass
What are the training strategies of the strength endurance training?
-moderate loads and repetitions (8-12)
-perform 2 exercises in superset: one traditional strength exercise in stable environment (bench press) and one stabilization exercise in less stable but controlled environment (stability ball push up)
What are the training strategies for the hypertrophy training?
-high volume, moderate to high loads
-moderate or low repetitions (6-12)
Who benefits from maximum strength training?
For ppl looking for maximal prime mover strength by lifting heavy loads
What are the training strategies for maximum strength training?
-high loads, low repetition (1-5)
-longer rest breaks
What is the goal of power training?
develop speed and power
What are the details around power training?
Use traditional strength exercises (w/ heavy loads) superset with power exercises(light load, fast)

ex: power exercises are medicine ball chest pass, soccer throw, squat jump
What are the training strategies for power training?
-superset: 1 strength and 2 power exercise (perform all power exercises as fast as can be controlled)
What is the kinetic chain?
Interaction of nervous, skeletal, muscular systems responsible for human movement
What is the nervous system's sensory function?
allows body to sense changes to internal/external environment

ex: respond to touch, sound, light, other stimuli
What is the nervous system's integrative function?
allows body to analyze/interpret sensory info and allow for proper decision making

ex: transmit nerve impulses between neurons
What is the nervous system's motor function?
neuromuscular response to sensory info

ex: transmit nerve impulses from brain/spinal cord to the effector sites
What are muscle spindles?
Sensory receptors within muscles
-run parallel to muscles
-sensitive to changes in muscle length and rate of length of change
-regulate contraction of muscles via stretch reflex mechanism (prevents overstretching)

Think: sensitive to lengthening, so opposite action = shorten and not over stretch
What are Golgi tendon organs?
-located where skeletal muscle fibers insert into tendons of skeletal muscle
-sensitive to changes in muscular tension and rate of tension change
-activation causes the muscles TO RELAX (preventing excessive stress)

Think: sensitive to tension, so wants to do opposite = relax
Describe joint receptors
located in/around joint capsule
-signal extreme joint positions
What are the two jobs of bones?
1) leverage (levers)
2) support (posture)
How are bones constantly renewed?
"remodeling" process = follows lines of stress placed on the bone (bad leads to more bad)
-broken down/removed by OSTEOCLASTS
-new bone by OSTEOBLASTS
What are the 5 types of bones?
1) Long = irregular/widened bony ends
-consist of compact bone (strength/stiffness)
-ex: humerus, femur
2) Short = similar in length/width, cubical in shape
-consist of spongy bone (aborbs shock)
-ex: carpals, tarsals
3) Flat = thin bones comprise of two layers of compact bone sandwiching spongy bone
-protects internal structures/provides attachments for muscles
-ex: sternum, scapulae, ribs, cranial bones
4) Irregular = unique shape and functions
-ex: vertebrae, pelvic bones, some facial bones
5) Sesamoid = small bones in joint capsules or where tendon passes over joint
-improve leverage and protect joints from damage
-ex: Patella
What are the components of long bone?
1) Epiphysis = ends of long bones (primary growth site)
2) Diaphysis = shaft = primary role is support
3) Epiphyseal plate = region connecting diaphysis to epiphysis
4) Periosteum = tough, fibrous membrane (provides attachment points for tendons)
5) Medullary cavity = space inside diaphysis, contains marrow (useful energy reserve)
6) Articular (hyaline) cartilage = hard, white, shiny tissue that cover articular ends of bones to reduce friction
What is the neutral spine?
Optimal arrangement of curves (which has the least amount of load)
What are the 3 major curvatures of the spine?
1) posterior cervical = concavity (curves in)
2) anterior thoracic = convexity (curves out)
3) posterior lumbar = concavity (curves in)
What are the 3 major types of joint motion?
1) roll (ex: squat)
2) slide (ex: knee extension)
3) spin (ex: pronation/supination of forearm)
What are the kinds of joints?
-Nonsynovial (no joint cavity/fibrous connective tissue, little or no movement) such as sutures, pubic bones
-Synovial (80% of joints) = produces synovial fluid, has joint cavity/fibrous connective tissue
Describe the kinds of synovial joints.
1) Gliding joints = no rotation, slide past each other (ex: carpals of hand)
2) condyloid joints = formed by fitting condyles of one bone into cavities of others, moves in one plane (ex: knee)
3) hinge joints = uniaxial, moves in sagittal plane (ex: elbow)
4) saddle joints = one bone fits like saddle on another; moves in two planes (sagital, joint of thumb frontal)= (the only ex: carpometacarpal)
5) pivot joints = only one axis, moves in one plane of motion (tranverse) ex: radioulnar
6) ball and socket joints = most mobile of joints, moves in 3 planes (ex: shoulder)
Describe ligaments
-fibrous connective tissue connect bone to bone
-provide static/dynamic stability, proprioception, guidance, limitation of improper joint movement
-made primarily of collagen (some elastin)
-poor vascularity
Describe muscles
-multiple bundles of muscle fibers held tgt by connective tissue
-bundle 1 = actual muscle surrounded by epimysium and then wrapped in fascia
-bundle 2 = fasicle. This is made up by many individual muscle fibers wrapped by endomysium, then wrapped in perimysium.
What does connective tissue allow for?
forces to be generated by muscle to be transmitted to components of muscle to bones
-create motion
-help form tendons
Describe tendons
-attach muscles to bones
-anchor where muscle can exert force to control bone/joint
-poor vascularity (like ligaments)
Describe muscle fibers
-wrapped by sarcolemma
-contain cell components like sarcoplasm, nuclei, mitochondria, myofibrils
Describe myofibrils
-contain myofilaments such as actin (thin) and myosin (thick)
-actin/myosin form repeating sections separated by Z lines (each section is a sarcomere)
What is a sarcomere?
functional unit of muscle
What does tropomyosin do?
-located on actin
-blocks myosin when muscle is relaxed
What does troponin do?
-located on actin
-provides binding site for both calcium and tropomyosin when a muscle needs to contract
What is a motor unit?
one motor neuron and the muscle fibers it innervates with
What does the overall strength of a muscle contraction depend on?
size + # of motor unit
Describe type 1 muscles
-slow twitch
-more capillaries, mitochondria, myoglobin
-red fibers
-increased oxygen
-smaller in size
-less force produced
-slow to fatigue
-long term contractions (stabilization)
Describe type 2 muscles
-fast twitch
-white fibers
-fewer capillaries, mitochondria, myoglobin
-decreased oxygen
-larger size
-more force
-quick fatigue
-short term contractions (force and power)
What are the two subcategories of type 2 muscles?
-type 2a = higher oxidative capacity, slower fatigue; called "immediate fast twitch fibers"

-type 2b = low oxidative capacity, quicker to fatigue
What do agonists do? What are the associated muscles with exercises?
Prime mover (muscles most responsible for a particular movement)

ex:
-hip extension (gluteus max)
-chest press (pectoralis major)
-overhead press (deltoid)
-row (latissimus dorsi)
-squat (gluteus maximus, quads)
What do synergists do? What are the associated muscles with exercises?
Assist prime mover

ex:
-hip extension (hamstring complex/erector spinae)
-chest press (anterior deltoid/triceps)
-overhead press (triceps)
-row (posterior deltoid/biceps)
-squat (hamstring complex)
What do stabilizers do? What are the associated muscles with exercises?
Stabilize while prime mover and synergist work

ex:
-hip extension (tranversus abdominis, internal oblique, multifidus - deep muscles in low back)
-chest press (rotator cuff)
-overhead press (rotator cuff)
-row (rotatoe cuff)
-squat (tranverse abdominis)
What do antagonists do? What are the associated muscles with exercises?
Oppose prime mover

ex:
-hip extension (psoas - deep hip flexor)
-chest press (posterior deltoid)
-overhead press (latissimus dorsi)
-row (pectoralis major)
-squat (psoas - deep hip flexor)
What are the primary endocrine glands?
-hypothalamus
-pituitary
-thyroid
-adrenal glands
What are the 2 types of catecholamines and what do they do?
1) Epinephrine = adrenaline (increased HR, SV, elevate blood glucose, opened airways)
2) Norepinephrine = opposite of epi, fight or flight response
What is the role of testosterone?
Growth and repair of tissue
-raised lvls indicate anabolic (tissue building) training
What is the role of cortisol?
-opposite of testosterone
-tissue breakdown
-released during stress to maintain energy through breakdown of carbs, fats, protein
What is the role of growth hormone?
-growth/development during childhood up until puberty
-increases development of bone, muscles, protein synthesis
-increases fat burning
-strengthens immune
What is the typical resting heart rate?
70-80 BPM
What is stroke volume?
Amt of blood pumped out of heart per contraction
-It is the difference between end diastolic volume and end systolic volume
-120ml EDV and 50 ml ESV = SV 70ml
How much blood does avg human have?
4-6L
What does normal breathing use?
primary respiratory muscles (diaphragm, external intercoastals)
What does heavy breathing use?
additional use of secondary respiratory muscles (scalenes, pectoralis minor)
What are the two respiratory airways?
Conducting airways = all the structures that air travels through before entering respiratory airways
-gatherinig station
-air to be purified/humidified
-warmed/cooled

Respiratory airways = collect channeled air from conducting airways and transport gases through diffusion
What is the best measure of cardiorespiratory fitness?
Maximal oxygen consumption (VO2 max)
-expensive to test w/ accuracy
-can be estimated through Rockport walk test (walk as fast as possible for 1 mile) , step test (step on and off box for 3 minutes), YMCA bike protocol test (Bike ride twice at 3 minutes each)
What happens because of abnormal breathing patterns?
-overuse of secondary respiratory muscles (if due to shallow, upper chest breathing)
-affect posture (lightheadedness, headaches, dizziness)
-can lead to altered carbon dioxide and oxygen blood content (can lead to anxiety)
-Inadequate oxygen causing retention of metabolic waste (muscles will feel fatigue and stiff)
-Inadequate joint motion can lead to restricted/stiff joints
What are the 3 substrates?
Carbohydrates, fats, proteins (order of importance)
-primary sources of chemical energy
-energy comes from ATP
For one cycle of a cross bridge, how many ATPs are needed?
2
Describe the ATP-PC System.
-immediate use
-simplest/fastest
-occurs w/ oxygen
-activated by onset of activity
-provides energy for HIGH INTENSITY SHORT DURATION
-transfers phosphate from phosphocreatine to an ADP molecule
Describe the glycolysis system
-short term use
-can produce significantly greater amount of energy than ATP-PC
-30-50 s of duration (ideal for 8-12 repetition exercise)
-need to covert to glucose 6 phosphate before glucose can be used
-can be aerobic (pyruvic acid) or anaerobic (lactic acid)
Describe the oxidative system
-long term use
-slowest, most complex
-ability to produce energy for indefinite period of time
-requires oxygen
-happens via aerobic glycolysis, Krebs cycle, ETC
-complete metabolism of single glucose molecule produces 35-40 ATP
What is one way to measure work output during exercise?
By measuring oxygen consumption
What is EPOC?
excess post exercise oxygen consumption = state in which the body's metabolism is elevated for a time after exercise

-During intermittent exercise, the anaerobic to aerobic processes occurs multiple times with each change of work requirement
What is the respiratory quotient (RQ)?
amt of carbon dioxide expired divided by the amount of oxygen consumed

RQ of 1 = 100% fuel coming from carbohydrates

RQ of 0.7 = 100% fuel coming from fats

(Anything in the middle is a mix of carbs and fats)
Describe joint motion.
Movement in a plane that occurs on an axis running perpendicular to that plane
What are movements in the sagittal plane? (forward and backwards movements)
-Flexion = bending where the angle DECREASES
-Extension = straightening where angle INCREASES

Ex: bicep curls, tricep pushdowns, squats, front lunges, calf raises, walking, running vertical jump, climbing stairs, shooting a basketball
What are movements in the frontal plane?(side to side movements)
-Adduction = movement of the segment toward the midline (decrease in angle)
-Abduction = movement away from midline of the body (increase angle)

Ex: side lateral raises, side lunges, side shuffling
What are movements in the transverse plane? (rotational/diagonal movements)
-Internal rotation = joint rotation toward midline
-External rotation = joint rotation away from midline
-Horizontal abduction = movement from anterior position to lateral position
-Horizontal adduction = movement from lateral position to anterior position

Ex: cable trunk rotations, dumbbell chest fly, throwing ball/Frisbee, golfing
What are the movements in scapular motion?
-Retraction = adduction = shoulder blades come together
-Protraction = abduction = shoulder blades move apart
-Elevation = shoulder blades come up
-Depression = shoulder blades come down
What are the different muscle actions (iso-)
Isotonic = constant muscle tension
-Eccentric = muscle develops tension while lengthening (lengthening = contractile force is LESS than resistive force)
-moving in same direction as resistance, decelerates/reduces force
-ex: landing from a jump, lowering a weight
-Concentric = contractile force is GREATER than resistive force, causing shortening of muscle and visible joint movement
-moving opposite direction of force, accelerates/produces force
-ex: jumping upward, lifting a weight

Isometric = constant muscle length
-No visible movement with/against resistance, dynamically stabilizing force
-contractile force is EQUAL to resistive force
-ex: pausing, stabilizing holds, etc

Isokinetic = constant velocity of motion
-muscle shortens at constant speed over the full range of motion
-muscle tension is maximum throughout the whole range of motion
What is force?
interaction that results in acceleration or deceleration of an object; characterized by magnitude and direction
Describe the different types of muscle relationships.
Length tension relationships = resting length of muscle and tension the muscle can produce at this resting length
-optimal muscle length = when actin and myosin filaments have the greatest degree of overlap, allow for max connections, allow for max force production

Force velocity curve = relationship of muscle's ability to produce tension at differing shortening velocities (the faster you lift, the harder it gets)

Force couple relationships = muscle groups working tgt to produce movement around a joint
-internal/external obliques = trunk rotation
-upper trap/lower serratus ant = upward rotation of scapula
-glut max, quads, calf = hip/knee extension during walking, running, etc
-gastroc, peroneus longus, tibialis post = performing plantar flexion at the foot ankle complex
-deltoid and rotator cuff = shoulder abduction
What is the fulcrum, bones, muscles, resistance in the body?
-Fulcrum = joint axis
-Bones = levers
-Muscles = create the motions by pulling on bone
-Resistance = body weight or object weight
What are the 3 kinds of levers?
First class = fulcrum in middle
-like a seesaw
-ex: nodding head

Second class = resistance in the middle (fulcrum and effort on either side)
-like a load in wheelbarrow
-ex: full body push ups or calf raises

Third class = effort in middle (between resistance and fulcrum)
-most limbs are 3rd class levers
-ex: human forearm during bicep curl (fulcrum is the elbow, effort is bicep, load is the dumbbell)
What determines motor behavior?
Motor control = integrated internal/external sensory info with previous experiences to generate a motor response

Motor learning = utilization of motor control through practice and experience (based on feedback)
-Internal feedback =sensory info used by body to reactively monitor movement and environment
-External feedback =info provided by an external source, such as a trainer or mirror to supplement internal feedback

Motor development = change in motor behavior over time, throughout a lifespan
What is sensorimotor integration?
Ability to gather and interpret sensory information and to select and execute proper motor responses
What does fitness assessments allow for?
Continually monitor a client's needs, functional capabilities, and physiologic effects of exercise

-pre participation health screening
-resting physiologic measurements (HR, BP, Ht, Wt)
-measurements to help determine fitness lvl
What's the purpose of PAR-Q?
The Physical Activity Readiness Questionnaire designed to determine safety or possible risk of exercising
-aimed to identify CV disease before working out
What are the effects of common movement patterns?
-Extended periods of sitting = tight hip flexors, postural imbalances, potentially poor cardio conditioning
-Repetitive movements = pattern overload to muscles and joints causing trauma/kinetic chain dysfunction
-Mental stress = elevated resting HR/BP/Ventilation at rest and exercise
What is a good indicator of overall cardio fitness?
Resting HR (3 mornings in a row and taking the avg of the HR)

-typical resting HR is 70-80
What is a strong indicator of overall cardio fitness?
Exercise HR

-Estimated max HR = 220-age
Describe HR training zone 1
Purpose = build aerobic base/aid in recovery
Intensity = 65-75%
Describe HR training zone 2
Purpose = increase aerobic and anaerobic endurance
Intensity = 76-85%
Describe HR training zone 3
Purpose = build high end work capacity
Intensity = 86-95%
What is the heart rate reserve?
Aka Karvonen method = establishing training intensity on basis of difference between a client's predicted max HR and their resting HR
How to calculate your target heart rate?
[(HR max- HRrest) x desired intensity] + HRrest
1) What is the essential fat percentages?
2) What is the athletic fat percentages?
3) What is the recommended <34 fat percentages?
4) What is the recommended 35-55 fat percentages?
5) What is the recommended 56< fat percentages?
1) M: 3-5%, F: 8-12%
2) M: 5-13%, F: 12-22%
3) M: 8-22%, F: 20-35%
4) M: 10-25%, F: 23-38%
5) M: 10-25%, F: 23-38%
How to calculate body fat percentage with the Durnin formula?
Measure 4 skinfolds: biceps, triceps, subscapular, iliac crest then plug into chart w/ sex and age
-body fat% x scale weight = fat mass
-scale weight - fat mass = lean body mass
How to calculate body fat percentage with circumference measurements?
7 measurements include: neck, chest, waist, hips, thighs, calves, biceps
-waist to hip ratio (divide waist by hip) should be no higher than 0.8 (women) and 0.95 (men)

BMI = weight (kg) / height (m^2)
or
BMI = [weight (lb) / height (in^2) ] x 703

BMI w/ lowest risk of disease = 22-24.9
What is the mos valid measurement of cardiorespiratory assessments?
Cardiopulmonary exercise testing (CPET) = maximal oxygen uptake
-but expensive, takes long time, lack of willingness to perform

So resort to submaximal testing = allows for prediction or estimation of VO2 max
What is the YMCA 3 minute step test?
96 steps/min on a 12 in step
-measure HR afterwards for 60s, compare to chart
What is the Rockport walk test?
-record client's Wt
-walk 1 mile as fast as possible on a treadmill
-record the time
-record client's HR
-use formula to calculate oxygen consumption
What is the basis for identifying muscle imbalances? What are the 3 primary postural distortion patterns?
Static postural assessment

-Pronation distortion syndrome = flat feet, lock knees
-Lower crossed syndrome = arched lower back
-Upper crossed syndrome = forward head, rounded shoulders
Pronation distortion syndrome summary
Lower crossed syndrome summary
Short muscles: gastroc, soelus, hip flexor complex, adductors, lats, erector spinae

Lengthened muscles: ant tib, post tib, gluetus max, gluteus medius, transversus abdominis, internal oblique

Altered joint mechanics
-increased = lumbar extension
-decreased = hip extension

Possible injuries: hamstring complex strain, anterior knee pain, low-back pain
Upper crossed syndrome summary
Short muscles: upper trap, levator scapulae, sternocleidomastoid, scalenes, lats, teres major, subscapularis, pectoralis major/minor

Lengthened muscles: deep cervical flexors, serratus anterior, rhomboids, mid traps, lower traps, teres minor, infraspinatus

Altered Joint Mechanics:
-increased = cervical extension, scapular protraction/elevation
-decreased = shoulder extension, shoulder external rotation

Possible injuries: headaches, bicep tendonitis, rotator cuff impingement, thoracic outlet syndrome
In the static postural assessment, what should you check for?
-neutral alignment
-symmetry
-balanced muscle tone
-specific postural deformities

Focus on the kinetic chain checkpoints:
-foot and ankle
-knee
-lumbo-pelvic-hip complex (LPHC)
-shoulders
-head and cervical spine
Describe the different views during static postural assessment.
Anterior view
-foot ankles: straight and parallel (NOT flattened or externally rotated)
-knees: inline w/ toes (NOT adducted or abducted)
-LPHC: pelvis lvl w/ both anterior superior iliac spines in same transverse plane
-shoulders: lvl, NOT elevated or rounded
-head: neutral position, NOT tilted or rotated

Lateral view
-foot ankles: neutral position, leg vertical at right angle to sole of foot
-knees: neutral position (NOT flexed nor hyperextended)
-LPHC: pelvis neutral position (NOT anteriorly (lumbar extension) or posteriorly (lumbar flexion) rotated)
-shoulders: normal kyphotic curve (NOT excessively rounded)
-head: neutral position (NOT in excessive extension (jutting forward)

Posterior view
-foot ankles: heels straight and parallel (NOT overly pronated)
-knees: neutral position (NOT adducted or abducted)
-LPHC: pelvis level, as above
-shoulders: level (NOT elevated or protracted)
-head: neutral (NOT tilted or rotated)
Describe the dynamic postural assessments for overhead squat. What does this access?
Assesses dynamic flexibility, core strength, balance, overall neuromuscular control (same as single leg squat)

Look for these 5 compensations:
Excessive forward lean of LPHC (lateral); probable overactive muscles
-soleus, gastroc, hip flexor complex, abdominal complex
Probable underactive muscles:
-anterior tib, gluteus max, erector spinae

Low back arches of LPHC (lateral);
Probable overactive muscles:
-hip flexor complex, erector spinae, lat
Probable underactive muscles:
-hamstring complex, intrinsic core stabilizers (transverse abdominis, multifidus, transversospinalis, internal oblique pelvic floor)

Arms fall forward of Upper Body (lateral)
Probable overactive muscles:
-lats, teres major, pectoralis major/minor
Probable underactive muscles:
-mid/lower traps, rhomboids, rotator cuff

Feet turn out (anterior)
Probable overactive muscles:
-soleus, lateral gastroc, biceps femoris (short head)
Probable underactive muscles:
-medial gastroc, medial hamstring complex, gracilis, sartorius, popliteus

Knee moves inward (anterior) *Note that this is the same for single leg squat as well*
Probable overactive muscles:
-adductor complex, biceps femoris (short head), TFL, vastus lateralis
Probable underactive muscles:
-gluteus medius/maximus, vastus medialis oblique (VMO)
Describe the dynamic postural pushing assessment.
Checkpoint: LPHC
Compensation: low back arches
Probable overactive muscles: hip flexors, erector spinae
Probable underactive muscles: intrinsic core stabilizers

Checkpoint: shoulder complex
Compensation: shoulder elevation
Probable overactive muscles: upper traps, sternocleidomastoid, levator scapulae
Probable mid/lower trap: mid/lower traps

Checkpoint: head
Compensation: head migrates forward
Probable overactive muscles: upper trap, sternocleidomastoid, levator scapulae
Probable underactive muscles: deep cervical flexors
Describe the dynamic postural pulling assessment.
Checkpoint: LPHC
Compensation: low back arches
Probable overactive muscles: hip flexors, erector spinae
Probable underactive muscles: intrinsic core stabilizers

Checkpoint: shoulder complex
Compensation: shoulder elevation
Probable overactive muscles: upper trap, sternocleidomastoid, levator scapulae
Probable underactive muscles: mid/lower traps

Checkpoint: head
Compensation: head protrudes forward
Probable overactive muscles: upper trap, sternocleidomastoid, levator scapulae
Probable underactive muscles: deep cervical flexors
What is the push up test from performance accessment?
Measures upper body muscular endurance
-perform push ups for 60 s or to exhaustion w/o compensation
-must touch chest to floor (record amt of touches)
What is the Davies test from performance accessment?
Assesses upper extremity agility and stabilization
-while in push up position, switches off touching two points 36 inches apart
-record the number of touches in 15 s
What is the shark skill test from performance accessment
Assesses lower extremity agility and neuromuscular control
-client stands on 9 square grid, hands on hip, standing on one leg
-follows direction to hop from box to box, always returning to the center
What is the upper extremity strength assessment?
Bench press
-estimates one rep max on overall uppder body strength
-considered an advanced assessment for strength specific goals only
-warm up w/ light resistance for 8 to 10 reps
-1 min rest
-add 10-20 lbs for 3-5 reps
-2 mins rest
-repeat last two steps until failure between 2 to 10 reps
-use chart to estimate one rep max
What is the lower extremity strength assessment?
Squat
-estimates one rep max squats and overall lower body strength
-considered an advanced assessment for strength-specific goals only
-warm up w/ light resistance for 8 to 10 reps
-1 min rest
-add 30-40 lbs for 3-5 reps
-2 mins rest
-repeat last two steps until failure between 2 to 10 reps
-use chart to estimate one rep max
What are mechanoreceptors?
Golgi tendon organ (GTO) + muscle spindle fibers

GTO: sense muscle tension
Muscle Spindle Fibers: senses muscle lengthening

GTO: relaxes the muscle in response
Muscle Spindle Fibers: contracts the muscle in response

GTO: normal rxn to avoid injury
Muscle Spindle Fibers: normal rxn to avoid injury
What are characteristics of stabilizer muscles?
-smaller in size
-type 1 muscle fibers (slow twitch)
-prone to weakness

ex:
-rotator cuff - shoulder
-core inner unit - multifidus, transverse abdominus, pelvic floor muscles, internal oblique - stabilize pelvis and spine
-knee - VMO, popliteus - knee
What is postural distortion pattern?
predictable patterns of dysfunction that develop when the HMS is misaligned and not functioning properly over time

-muscle imbalance --> poor posture --> improper movement --> injury
What are muscle imbalances?
alterations in the lengths of muscles
What is reciprocal inhibition?
simultaneous relaxation of one muscle and the contraction of antagonist
What is synergistic dominance?
synergists take over function for a weak or inhibited prime mover
What is arthrokinetic dysfunction?
biomechanical and neuromuscular dysfunction leading to altered joint motion
What do muscle spindles do?
prevent muscles from stretching too far or too fast

-lengthened muscle stretches --> increases muscle spindle excitement --> microspasms/feeling tightness (contraction)
What is autogenic inhibition?
neural impulses that sense tension > than the impulses that cause muscles to contract

-stretches should be held long enough for the GTO to override signal from muscle spindles (30s)
Describe the cumulative injury cycle.
tissue trauma --> inflammation --> muscle spasm (as a protective mechanism) --> adhesions --> altered neuromuscular control --> muscle imbalance
Describe Davis's law.
soft tissue models along the lines of stress
What are the 3 phases of flexibility training?
1) Corrective = increase joint ROM, improve muscle imbalances, correct altered joint motion
-Includes: self myofascial release and static stretching
-Appropriate for OPT phase 1

2) Active = improve extensibility of soft tissue and increase neuromuscular efficiency using reciprocal inhibition
-Includes: self myofascial release and active isolated stretching (allows for agonists/synergist muscles to move limb through full ROM while functional antagonists are being stretched)
-Appropriate for OPT phases 2, 3, 4

3) Functional = self myofascial release and dynamic stretching (requires integrated, multiplanar soft tissue extensibility w/ optimal neuromuscular control, full ROM, or movement without compensation)
-Appropriate for OPT phase 5
Describe myofascial release.
-focuses on neural + fascial system
-gentle pressure onto elastic muscle fibers stimulates GTO --> autogenic inhibition --> decreases muscle spindle excitation --> release tension
-sustain pressure for 30s
Describe static stretching
-passively taking muscle to tension point and hold for 30s to 1 min
-GTO stimulated --> inhibitory effect produces (autogenic inhibition)
-contracting antagonistic muscles while holding stretch can reciprocally inhibit the muscle being stretched --> enhance stretch

-during warm up, this should only be used for tight/overactive areas
-during cool down, should be used for the major muscles worked on
Describe active isolated stretching
-use agonists and synergists to dynamically move joint into ROM
-increases motorneuron excitability --> creates reciprocal inhibition of muscle being stretched
-recommended for warm up
Describe dynamic stretching
force production of muscle and body's momentum to take joint through full available ROM
-uses reciprocal inhibition to improve soft tissue extensibility
-perform 10 reps using 3-10 dynamic stretches
What is altered reciprocal inhibition?
a muscle inhibition which causes inhibition of its functional antagonist
What are the 5 components of physical fitness?
-muscular strength
-muscular endurance
-flexibility
-body composition
-cardiorespiratory fitness (top priority from standpoint of preventing chronic disease and improving health/quality of life)
What should each cardio session have?
Warm up, conditioning, cool down

-general vs specific warm up = 5-10 mins of low to moderate intensity
-cool down = to restore back to normal condition (at rest, 15-20% blood to skeletal muscles; during exercise, 80-85% blood to skeletal muscles; plasma volume can decrease by 10-20% during intense exercise)
Suggested warm up activities for stabilization clients, strength clients, power clients
Stabilization clients: self myofascial release (30s/ muscle), static stretching (30s, muscle), cardio (5-10 mins)

Strength clients: self myofascial release (30s/muscle), active isolated stretching (1-2 s, 5-10 reps/muscle), cardio (5-10 mins)

Power clients: self myofascial release (30s/muscle) and dynamic stretching (10 reps/side)
What is FITTE principle?
Frequency, intensity, time, type, enjoyment

Frequency: general health (small quantities every day); improved fitness (higher intensity 3-5 days/wk)

Intensity: calculated via HR, power, or % max oxygen consumption or oxygen uptake reserve
-moderate intensity = <60% reserve
-recommended intensity is 40-85% (40% being threshold for deconditioned individuals)

Time: 2.5 hrs of moderate-intensity aerobic activity every week
-or 1 hr 15 mins of vigorous intensity aerobic activity
-or mix of intensities

Type: to be considered aerobic, must be:
-rhythmic
-large muscle groups
-continuous
How to find Vo2 reserve?
target Vo2R = [(Vo2max-Vo2rest) x intensity desired ] + Vo2rest
What is peak metabolic equivalent (MET) method?
METs used to describe energy cost of physical activity as multiples of resting metabolic rate. 1 MET = 3.5 mL 02 kg min or equivalent to avg resting metabolic rate of adults
How to find peak max HR?
220-age
What is the ratings of perceive exertion method?
moderate intensity equal to "somewhat hard" (12-14) on the 6-20 Borg scale
Ventilatory threshold
point during graded exercise where ventilation increases disproportionately to oxygen uptake (going from aerobic to anaerobic)
What are the 3 stages of cardio training?
Stage 1:
-65-75% HR (12/13 on perceived exertion scale)
-work up to 30-60 mins continuous exercise
-when they can maintain zone 1 HR for 30 mins 2-3x a week, ready for stage 2

Stage 2:
-76-85% HR (14-16 perceived exertion)
-focus on increasing workload (speed, incline, lvl)
-alternate w/ stage 1 within workouts and between days at first
-progress from a work to rest ratio from 1:3 to 1:1

Stage 3:
-86-95% HR (17-19 perceived exertion)
Describe the local stabilization system
Muscles that attach directly to the vertebrae
-type 1 (slow twitch) muscle fibers w/ high density of muscle spindles
-responsible for intervertebral and intersegmental stability (works to limit excessive compressive, shear, and rotational forces btw spinal segments)
-primary muscles: transverse abdominis, internal obliques, multifidus, pelvic floor musculature, diaphragm
Describe the global stabilization system
Muscles that attach from the pelvis to the spine
-act to transfer loads btw upper and lower extremity
-provide stability btw pelvis and spine, provide stabilization and eccentric control of core during functional movements
-primary muscles: quadratus lumborum, psoas major, external obliques, portions of internal oblique, rectus abdominis, gluteus medius, adductor complex
Describe the movement system
Muscles attach the spine and/or pelvis to the extremities
-concentric force production and eccentric deceleration during dynamic activties
-primary muscles: lat, hip flexors, hamstring complex, quads
What is the drawing-in maneuver?
Recruits local core stabilizers by drawing navel in toward the spine
What leads to increased activation of the local and global stabilization?
unstable environment
What are the goals of core training?
develop optimal lvls of neuromuscular efficiency, stability, and functional strength

1) intervertebral stability (neuromuscular)
2) lumbopelvic stability (neuromuscular)
3) movement efficiency (functional strength)

-clients begin at the highest level at which he can maintain stability and optimal neuromuscular control
What are the 3 levels of core training?
1) core stabilization training (phase 1)
-improve neuromuscular efficiency and intervertebral stability
-ex: marching, floor bridge, floor prone cobra, plank

2) core strength (phase 2, 3, 4)
-improve dynamic stabilization, concentric strength, eccentric strength, neuromuscular efficiency
-ex: ball crunch, back extensions, reverse crunch, cable rotations

3) core power (phase 5)
-improve rate of force production
-ex: rotation chest pass, ball medicine ball pullover throw, front MB oblique throw, soccer throw
What is balance?
body in equilibrium and stationary
-requires: optimal muscular balance, joint dynamics, neuromuscular efficiency by using visual ,vestibular, proprioceptive inputs
What is dynamic balance?
to move and change directions under varying conditions without falling
What is limit of stability?
distance outside the base of support one can move without losing control of center of gravity
Time and frequency of balance training programs needed to improve both static and dynamic balance ability?
10 mins a day, 3x/wk for 4 wks
What is the goal of balance training?
Increase client awareness to his/her limit of stability through controlled instability
List the balance progressions
-easy to hard
-simple to complex
-stable to unstable
-static to dynamic
-slow to fast
-two arms/legs to single arm/legs
-open eyes to closed eyes
-known to unknown (cognitive task)
What are the 3 levels of balance training?
1) balance stabilization (phase 1)
-improve reflexive (automatic) joint stabilization to increase joint stability
-involve little joint motion
-body placed in unstable environments so it learn show to react
-ex: single leg balance, balance reach, hip internal/external rotation, lift and chop, throw and catch

2) balance strength (phase 2, 3, 4)
-improve neuromsucular efficiency
-involve dynamic eccentric/concentric movement of the balance leg
-movements require dynamic control in mid range of motion; isometric stabilization at the end of range of motion
ex: single leg squat, single leg squat touchdown, single leg romanian deadlift, multiplanar step up to balance, multiplanar lunge to balance

3) balance power (phase 5)
-develop proper deceleration ability to move from dynamic to controlled stationary position; also high levels of eccentric strength, dynamic neuromuscular efficiency, reactive joint stabilization
-ex: multiplanar hop w/ stabilization, single leg box hop up/down with stabilization
What is the integrated performance paradigm?
Forces must be damped (eccentrically), stabilized (isometrically), and accelerated (concentrically) in order to move with efficiency
What are the 3 phases of plyometric exercise?
1) eccentric phase = cocking/loading phase
2) amortization phase = dynamic stabilization, transition phase, muscle switches from overcoming force to imparting force
3) concentric phase = unloading phase
What is the purpose of plyometric exercise?
-ability to train specific movement patterns at a more functionally appropriate speed
-only to be incorporated once client has achieved strength base, proper core strength, and balance
What is the goal of plyometric training?
decrease rxn time
What are stretch-shortening cycles?
eccentric and concentric contractions repeated as a series
What is the speed of muscular exertion limited by?
neuromuscular coordination
What are the 3 levels of plyometric training?
1) plyometric stabilization (phase 1)
-establish optimal landing mechanics, postural alignment, and reactive neuromuscular efficiency
-ex: squat jump, box jump up/down, multiplanar jump

2) plyometric strength (phase 2, 3, 4)
-more dynamic eccentric and concentric movement
-improve dynamic joint stabilization, eccentric strength, rate of force production, neuromuscular efficiency
-exercises performed in a repetitive fashion w/ short rest time
-ex: squat jump, tuck jump, butt kick, power step up

3) plyometric power (phase 5)
-further improve rate of force production, reactive strength, dynamic neuromuscular efficiency, optimal force production
-involve entire muscle action spectrum and contraction velocity spectrum
-performed as fast and explosively as possible
-ex: ice skaters, single leg power step up, proprioceptive plyometrics
What is speed the product of?
Stride rate x stride length

-referring to straight ahead speed = distance covered divided by time
What is agility?
ability to start, stop, change direction quickly
-refers to change in movement direction, cadence, speed
What is quickness?
ability to react to a stimulus and appropriately change motion with maximal rate of force production
What is frontside mechanics?
triple flexion of ankle, knee, and hip as a unit
-proper alignment of lead leg and pelvis during sprinting, which includes ankle dorsiflexion, knee flexion, hip flexion, and neutral pelvis
-associated w/ better stability, less braking forces, increasing forward driving forces
What is backside mechanics?
triple EXTENSION of the ankle, knee, and hip as a unit
-proper alignment of rear leg and pelvis, includes ankle plantarflexion, knee extension, hip extension, neutral pelvis
-associated w/ stronger push phase, including hip knee extension, gluteal contraction, backside arm drive
What are the benefits of speed, agility, and quickness training?
-weight loss
-coordination
-movement proficiency
-injury prevention

Note: when using SAQ for weight loss, clients' HR must be kept appropriate elevated

ex:
-youths: red light, green light, follow the snake (follow the pattern of a rope, one foot on each side, forward and backward)

-weight loss population: jump rope, cone shuffles, ladder drills, box drill, partner mirror drill

-seniors: cone/hurdle step overs, stand up to figure 8
What are the 3 lvls of SAQ training?
1) stabilization (phase 1) = 4-6 drills w/ limited horizontal inertia and unpredictability
-ex: cone shuffles, agility ladder drills

2) strength (phase 2, 3, 4): 6-8 drills w/ greater horizontal inertia but limited unpredictability
-ex: T drill, box drill, stand up to figure 8

3) power (phase 5): 6-10 drills w/ max horizontal inertia and unpredictability
-ex: modified box drill, partner mirror drill, timed drills
What should be the immediate progression of a single leg dumbbell curl?
a) single leg, alternating arm, stable
b) single leg, single arm, stable
c) two leg, alternating arm, unstable
d) two leg, single arm, unstable
What is GAS?
General adaptation syndrome = describes how the body responds and adapts to stress
What are the 3 stages of stress response?
1) alarm reaction = initial rxn to stressor (increased oxygen, blood supply)
2) resistance development = increased functional capacity to adapt to stressor (increasing motor unit recruitment)
3) exhaustion = prolonged intolerable stressor produces fatigue and leads to a breakdown in system or injury (stress fractures, muscle strains, joint pain, emotional fatigue)
What is SAID?
Principle of Specificity or specific adaption to imposed demands = the body will adapt to the specific demands that are placed on it
-mechanical specificity = weight and movements placed on the body
-neuromuscular specificity = speed of contraction and exercise selection
-metabolic specificity = the energy demand placed on the body

-note: weight loss programs apply all 3
What is stabilization?
the body's ability to provide optimal dynamic joint support to maintain correct posture during all movements
-requires high lvls muscular endurance
-improved by training in controlled, unstable environments
What are examples of stabilization exercises?
Total body = ball squat curl to press; step up balance, curl, to overhead press

Chest = ball dumbell chest press; push up

Back = standing cable row; ball dumbbell row

Shoulder = single leg dumbbell scaption; seated stability ball military press

Biceps = single leg dumbbell curl; single leg barbell curl

Triceps = supine ball dumbbell triceps extension; prone ball dumbbell triceps extension

Legs = ball squat; multiplanar step up to balance
What is muscular endurance?
ability to produce/maintain force production for prolonged time
-helps to increase core and joint stabilization (which is the foundation that hypertrophy, strength, power is built upon)
What is muscular hypertrophy?
enlargement of skeletal muscle fibers (bc increase in myofibril proteins or myofilaments)
-achieved through low to intermediate rep range w/ progressively higher loads
What is strength?
ability of neuromuscular sys to produce internal tension to overcome external force
-result of activating neuromuscular sys
What are examples of strength exercises?
Total body = lunge to two arm dumbell press; squat, curl, to two arm press

Chest = flat dumbbell chest press; barbell bench press

Back = seated cable row; seated lat pulldown

Shoulder = seated dumbbell shoulder press; seated shoulder press machine

Biceps = seated two arm dumbbell biceps curl; biceps curl machine

Triceps = cable pushdown; supine bench barbell triceps extension

Legs = leg press; barbell squat
What type of muscle is being trained during stabilization training?
type 1 slow twitch muscle fibers
-slow contracting
-low tension output
-resistance to fatigue
What type of muscle is being trained during strength training?
type 2 muscle fibers
-quick contracting
-high tension output
-prone to fatigue
What is power?
ability to produce greatest possible force in the shortest possible time (force x velocity)
-increase in power is achieved by increasing force or velocity
-maximize training by using both heavy and light weights
What does modern training programs emphasize?
-appropriate exercise selection
-all muscle actions
-multiple planes of motion
-repetition tempos
What are examples of power exercises?
Total body = two arm push press; barbell clean

Chest = two arm medicine ball chest pass; rotation chest pass

Back = medicine ball pullover throw; soccer throw

Shoulder = front medicine ball oblique throw; overhead medicine ball throw

Legs = squat jump; tuck jump
What are the different types of resistance training systems?
1) single set system = 1 set per exercise
-good for beginning clients or maintenance
2) multiple set
3) pyramid = progressive or regressive step approach
-ex: 10-12 reps light to 1-2 reps heavy
4) superset
-8 to 12 reps no rest
-either two exercises for same muscle group vs antagonist muscle groups
5) drop sets = perform set to failure, drop weight, continue
-reps are 2 to 4
-triple drop
6) circuit training system = series of exercises performed one after another w/ minimal rest
-low to moderate number of sets (1-3) w/ moderate to high reps (8-20) w/ short rest periods (15-60s)
7) peripheral heart action system = switch between upper and lower body exercises during circuit
-distributes blood flow
8) split routine system = train different parts of body on different days
9) vertical loading = progressing workout vertically downwards by alternating body parts trained from set to set
-total body exercise
-chest
-back
-shoulders
-biceps
-triceps
-legs
10) horizontal loading = performing all sets of an exercise or body part before moving on to next exercise/body part
-3 sets of chest, then 3 sets of back, etc)
-appropriate for maximal strength and power training
-longer rest periods btw sets
What is tempo?
controls amount of time muscle is active or producing tension in the following scheme:

a= eccentric
b = isometric
c= concentric
What tables to focus on from Chapter 14?
1) table 14.2 training volume adaptation
2) table 14.7 phase 1: stabilization endurance training - all of the resistance training acute variable and tempo for core
3) table 14.8 phase 2: strength endurance training - all of the resistance training acute variable and tempo for core
4) table 14.9 phase 3: hypertrophy training - all of the resistance training acute variable and tempo for core
5) table 14.10 phase 4: maximal strength training - all of the resistance training acute variable and tempo for core
6) table 14.11 phase 5: power - all of the resistance training acute variable and tempo for core
What is program design?
a plan for specific goals
What are acute variables to consider (how each exercise is to be performed)?
-repetition = one complete movement (a/b/c)
-set
-training intensity = individual effort vs max effort
-repetition tempo
-training volume = total amt of work performed in specified time
-rest interval
-training frequency
-training duration
-exercise selection

-There is an inverse relationship between sets, repetitions, and intensity
General program design continuum:
a) muscular endurance/stabilization
b) hypertrophy
c) maximal strength
d) power
a) muscular endurance/stabilization
Reps: 12-20
Sets: 1-3
Intensity: 50-70% 1 RM
Tempo: slow (4/21)
Rest periods: 0-90s

b) hypertrophy
Reps: 6-12
Sets: 3-5
Intensity: 75-85% 1RM
Tempo: moderate (2/0/2)
Rest periods: 0-60s

c) maximal strength
Reps: 1-5
Sets: 4-6
Intensity: 85-100% of 1RM
Tempo: fast/explosive
Rest periods: 3-5 mins

d) power
Reps: 1-10
Sets: 3-6
Intensity: 30-45% of 1 RM or <10% of body weight
Tempo: fast/explosive
Rest periods: 3-5 mins
What are the 3 kinds of exercises?
-single joint = isolates one major muscle group or joint (bicep curls, tricep pushdowns, calf raises)
-multijoint = two or three joints (squats, lunges, step ups, chest presses, rows)
-total body = multiple joint movements (step up balance to overhead press, squat to two arm press, barbell clean)
Describes the exercise selection continuum regarding the training level and type of exercise appropriate.
1) stabilization level
-total body
-multijoint or single joint
-controlled unstable

2) strength level
-total body
-multijoint or single joint

3) power level
-total body
-multijoint (explosive)
How to progress or regress the different OPT phases in systematic fashion?
1) stabilization phase = +/- proprioception
2) strength phase = +/- volume or load
3) power phase = +/- speed or load
Describe the progression continuum of increasingly unstable environment for the stabilization continuum, lower body, and upper body respectively.
1) stabilization continuum
-floor
-sport beam
-half foam roll
-foam pad
-balance disc
-wobble board
-bosu ball

2) lower body
-two leg stable
-staggered stance stable
-single leg stable
-two leg unstable
-staggered stance unstable
-single leg unstable

3) upper body
-two arm
-alternating arms
-single arm
-single arm with trunk rotation
What are macrocycles?
1 year of training (annual plan)
What are mesocycles?
1-3 month training periods
What are microcycles?
1 week plans inside mesocycles
What are the characteristics of stabilization (phase 1) of OPT?
-optimal lvls of stabilization strength and postural control
-increase proprioception, volume, intensity and decrease rest periods
-lasts 4 wks
What are the characteristics of strength endurance (phase 2) of OPT?
-increase stabilization endurance, hypertrophy, strength
-superset techniques in more-stable exercise then with stabilization exercise in similar motion
What are the characteristics of hypertrophy training (phase 3) of OPT?
-maximal muscle growth
-high volume w/ minimal rest periods
What are the characteristics of maximal strength training (phase 4) of OPT?
-increasing load placed on body
-improves recruitment of more motor units
-rate of force production
-motor unit sync
-rest periods may increase as loads get heavier
What are the characteristics of power (phase 5) of OPT?
-increase rate of force production (or speed of muscle contraction)
-power = force x velocity
-should train both heavy and light loads
-combines strength exercise w/ power exercise (explosive stuff)
OPT model applications for:
1) body fat reduction
2) hypertrophy
3) improving general sports performance
1) alternate btw phase 1 and 2, one phase per month, 3x a week
2) alternate between as such: 123, 234, 1234, 321, 3x a week
3) power + strength endurance constant, plus alternate on and off stabilization each month
What are close chained exercises?
distal extremities (hands/feet) are in FIXED position and force applied is not enough to overcome resistance; typically applies for bodyweight training
-push ups
-pull ups
-squats
What are open chained exercises?
distal extremities (hands/feet) are NOT IN fixed position and force applied is great enough to overcome resistance; typically applies for free weight training
-bench press, lat pull down, leg extension machine
What OPT phases would likely use body weight training?
phase 1 and 2
What is beneficial about stability balls?
-increase stability demand
-reinforce proper posture during squat
-greater ROMs
-not recommended for use w/ max force building exercises
What phases ideal for bosu balls?
phase 1, 2, 5
How do children differ from adults in terms of exercise?
-do not typically exhibit plateau in oxygen uptake at max exercise
-less efficient (exercise at higher percentage of their peak oxygen uptake)
-do not produce sufficient levels of glycolytic enzymes to sustain high intensity exercise
-delayed/limited sweating (due to immature thermoregulation)
-relatively high peak oxygen uptake levels = has endurance
-program recommendations = 60 mins/day
What to consider about seniors exercising?
-higher BP
-arteriosclerosis (normal), atherosclerosis (self caused), peripheral vascular diseases

BP considerations:
-prehypertensive = 120/80 to 139/89
-at risk = 140/90+

Recommendations:
-self myofascial release and static stretching
-stage 1 and 2 cardio
-stabilization training
-pick exercises not prone to falls or foot problems
-30-60 mins/day or 8-10 min bursts
-progress to free sitting or standing exercises when possible
What to consider about obesity?
-72 million Americans are obese (34%)
-worse balance, slower gait velocity, shorter steps

Recommendations:
-focus on energy expenditure, balance, proprioceptive training
-burn 200 to 300 calories per workout
-watch out for supine/prone positions (BP flucuations)
-standing might be most comfortable
-phases 1 and 2 OPT most appropriate
-appropriate breathing
-avoid machines
-40 to 60 min/day, 5x/wk
What to consider about diabetes?
type 1 = does not produce enough insulin
type 2 = cannot respond normally to insulin

Recommendations:
-consider to prevent blisters and foot microtrauma when recommending walking
-careful about carb intake and insulin use
-similar guidelines to obese ppl
-careful w/ self myofascial release
-phase 1 and 2 OPT most appropriate
-initially, but do be aware to avoid weight bearing activities
-watch out for hypoglycemia
-intensity no greater than 50-90% in beginning
What to consider about hypertension?
-blood pressure over 140/90
-plan to reduce BP should include diet, exercise, weight loss, medication
-avoid supine/prone positions (due to changing BP)

Recommendations:
-static and active stretching
-avoid foam rolling (bc involves laying down)
-standing core exercises preferred over supine core exercises
-careful w/ plyometric training
-resistance training in seated or standing positions
-use circuit or peripheral heart action training system to keep blood flowing
-breathe normally
-avoid vlasalva maneuver (overgripping)
What to consider about coronary heart disease?
-caused by atherosclerosis
-treatment = aggressive multidisciplinary lifestyle intervention

Recommendations:
-stay in upper safe limit exercise (HR)
-monitor own heart rate
-use rate of perceived exertion (0-11)/talk test to measure intensity
-aerobic low intensity exercise recommended
-need to be exercising for 3 months before starting resistance training
-use circuit or PHA training system
What to consider about osteoporosis?
-osteopenia is like pre osteoporosis
-osteoporosis:
-bone mineral density reduced
-microstructure disrupted
-actual bone proteins altered
-commonly affects neck of femur and lumbar vertebrae
-primary osteoporosis = normal aging; due to lower production of estrogen/progesterone
-secondary osteoporosis = caused by medical condition

Recommendations:
-fall prevention (for elderly)
-combine resistance training w/ flexibility, core, balance training
-50 to 90% HR
-focus on hips, thighs, back, arms
-use stable machines if client cannot get well
-plyometric training not recommended
-higher intensities (75-85%) needed to stimulate bone formation
-minimal 6 months consistent training to have effect
What to consider about arthritis?
-arthritis =inflammatory condition of joints
-osteoarthrisis =degenerative cartilage
-rheumatoid arthritis = degenerative joint

Recommendations:
-need to change exercise if pain last > 1 hr
-avoid high intensity or high repetition
-low volume circuit program or multiple session format is best
-be aware that steroids increase fracture risk
-these individuals have decreased strength/proprioception, decreased ability to balance while standing, loss of knee extensor strength
What to consider about cancer?
-44% for men; 38% for women

Recommendations:
-low to moderate intensities
-lowly progress cardio training (5 mins to 30 mins)
-core and balance exercises are essential
-plyometrics not recommended (until they have done 3 phase 1 workouts per week)
-phase 1 and 2 for resistance training
What to consider about pregnancy?
-flexibility and core training impt for posture
-core stabilization exercises improve pelvic floor strength
-not advised in 2nd or 3rd trimesters (supine/prone, torso twist)

Recommendations:
-static and active stretching, self myofascial release as tolerated
-cardio stage 1 (stage 2 only on doctor's advice)
-plyometric training not recommended after 1st trimester
-after giving birth, women need to focus on posture, joint alignment, muscle imbalances, stability, motor skills, and recruitment of deep core stabilizers
What to consider about chronic lung disease?
-restrictive lung disease = due to fibrous lung tissue causing decreased ability to expand
-chronic obstructive lung disease = altered airway through lungs caused by airway obstruction caused by mucus production

Recommendations:
-use lower body cardiorespiratory and resistance training
-use PHA system
-40 to 60% peak work capacity, work up to 20-45 min
-adequate rest intervals
What to cosnider about intermittent claudication/peripheral arterial disease?
-intermittent claudication = +++ symptoms caused by peripheral arterial disease (limping, lameness, pain in lower leg)
-peripheral arterial disease = narrowing of major arteries supplying lower extremities

Recommendations:
-intermittent format
-don't exceed established HR upper limit
-focus on aerobics, emphasis on walking
-don't recommend self myofascial release
-phase 1 and 2 suggested
-consider leg pain
-exercise should cause symptoms = stimulus for increasing local circulation
How many calories does 1 g of carb, fat, or protein have respectively?
4, 9, 4
What is resting metabolic rate?
amt of energy expended while at rest
-70% of TEE (total energy expenditure)
-avoid declines in RMR by avoiding starvation diets
What is thermic effect of food (TEF)?
amt energy expended above RMR due to digestion for storage and use
-6 to 10% of TEE
What is the energy expended during physical activity?
above RMR and TEF
-20% of TEE
How to estimate TEE?
[weight (lbs) x 10 = RMR ] x activity factor (1.2-2.1) = TEE
What are complete proteins?
animal sources, dairy and meats
What are incomplete proteins?
grains, legumes, nuts, seeds, veggies
What is the breakdown of skeletal muscle?
72% water, 22% protein, 6% fat, glycogen, and minerals
What is the protein requirement for 1 lb of muscle?
100g protein
What are the general protein recommendations for:
1) sedentary adults
2) strength athletes
3) endurance athletes
1) 0.8g (0.4 g/lb)
2) 1.2-1.7 g (0.5-0.8g/lb)
3) 1.2-1.4 g (0.5-0.6 g/lb)
What is the recommended dietary allowance for protein?
0.8 g /kg/day
-10 to 35% total caloric intake
What are monosaccharides?
single sugar unit
-glucose
-fructose
-galactose
What are disaccharides?
two sugar units
-sucrose
lactose
maltose
What is glycemic index?
rate at which ingested carb raises blood sugar
-high: >70
-moderate: 56-69
-low: <55

Food lower on GI are good sources of complex carbs, high fiber, high overall nutritional value
What are the 2 types of fiber?
soluble fiber = moderates blood glucose lvls, lower cholesterol
-oats
-legumes
-barley
-uncooked fruits/veggies

insoluble fiber = passes through digestive system in its original form
-reduce risk of colorectal cancer, hemorrhoids, constipation

-daily intake = 25 to 38 g of fiber
What are the carbohydrate intake recommendations?
General: 6-10 g/kg/day, 45-65% total caloric intake

Before exercise: consume high carb meal 2 to 4 hrs before exercising for more than an hour

During exercise: consume 30-60g of carb every hour

After exercise: consume 1.5g per kg of carb within 30 minutes

Weight loss: no need to reduce carb intake for weight loss
What are the different kinds of fat sources:
1) monounsaturated fat
2) polyunsaturated fat
3) saturated fat
4) trans fat
1) monounsaturated fat = olive oil, canola oil, peanut oil, avocados
2) polyunsaturated fat = vegetable oils, omega 3, nuts, seeds
3) saturated fat = meat, poultry, lard, butter, cheese, cream, eggs, whole milk, tropical oils
4) trans fat = stick margarine, shortening, fried foods, fast food, many baked goods
What are the fat intake recommendations?
adults: 20-35% of daily calories
athletes: 20-25% of daily calories
no health benefits consuming less than 15% daily
What happens in the presence of higher fat levels?
body decreases glycogen synthesis --> chronically elevated levels of blood sugar
What is the water consumption recommended?
adult human = 60% water
-sedentary men/women should consume 3.0L (13 cups) / 2.2L (9 cups) per day
-those who want to lose weight should drink an additional 8 ounces of water per 25 pounds above ideal weight
What are fluid replacement guidelines?
-14 to 22 oz fluid 2 hours before exercise
-5 to 12 oz of fluid for every 15-20 minutes of exercise
-16 to 24 oz for every pound of body weight lost after exercise
What is the estimated average requirement?(EAR)?
avg daily nutrient intake lvl estimated to meet requirement of half the healthy individuals who are in a particular life stage and gender group
What is the recommended dietary allowance (RDA)?
avg daily nutrient intake to meet nearly all (97-98%) of healthy individuals
What does excess vitamin A during conception/early pregnancy cause?
birth defects
What does excess vitamin D cause?
calcification of blood vessel s
What does excess vitamin B6 cause?
permanent damage to sensory nerves
What's the most ergogenic response to stimulants (caffeine)?
3-6 mg per kg body weight, to be ingested about 1 hour before exercise
How long does PTs have to make good first impression?
20s
What are the stages of change?
1) stage 1: precontemplation
-clients have no intention to change
-strategy: education

2) stage 2: contemplation
-clients think about becoming more active in the next 6 months, but may have possible misconception
-strategy: more education (PTs have huge influence on this group); develop long term motivational programs; discuss ways to deal w/ perceived cons of exercise

3) stage 3: preparation
-planning to begin exercising regularly in the next month
-unrealistic expectations for change, high risk of disappointment and early dropout
-strategy:
-clarify goals/expectations
-maintain belief of importance
-discuss programs
-consider client's schedules, preferences, health concerns
-ask about previous successful experiences
-avoid injury/discomfort prone exercises
-discuss building social support network

4) stage 4: action
-clients have started to exercise but not yet maintained behavior for 6 months
-strategy: education
-discuss barriers to exercise
-anticipate upcoming disruption
-develop actions/solution plans

5) stage 5: maintenance
-clients have maintained changes for 6 months and more but tempted to return to old habits of less exercise
-strategy: maintenance check in plan; give suggestions tailored to personal preference
What questions to think about during assessing stage?
1) what experiences has the client had with physical activity in the past?
2) what worked best/least? what contributed to them quitting?
3) what has kept them from exercising in the past 6 months?
4) what did they do when disruptions (holidays, travel) occurred?
What is important about the initial session?
20 seconds to make first impression
-relationship building (spend at least 30 minutes just talking)
-determine client's readiness to exercise
-determine what stage client is in

Things to talk about:
-daily activities
-importance of physical activity
-health concerns
-stres lvls
-fitness goals
-input about what they want
What are SMART goals?
S = specific
M= measurable
A= attainable
R= realistic
T = timely
What are the 4 different interpretations of communication?
1) what speaker means
2) what speaker say s
3) what listener hears
4) what listener thinks speaker means
What are the different kinds of support?
instrumental, emotional, informational, companionship
What are the 4 P's of marketing?
1) product
2) price
3) place
4) promotion (push or pull)