CFT Workbook and Study Guide

Introduction: The Who, What, Why, and How of Personal Training

Unit 1: Metabolism
Unit 2: Basic Anatomy and Physiology
Unit 3: Muscle Anatomy and Physiology

Unit 4: Kinesiology of Exercise

Unit 5: Biomechanical Concepts of Exercise
Unit 6: Muscloskeletal Deviations
Unit 7: Muscle Mechanics

Unit 8: Strength
Unit 9:Cardiovascular Training Theory
Unit 10: Flexibility
Unit 11:Body Composition

Unit 12: Program Development

Unit 13: Basic Assessment of Fitness Participants
Unit 14: Training Principles
Unit 15: Periodization
Unit 16: Determining Training Loads

Unit 17: Weighing the Truth on Exercise and Nutrition

Unit 18: The Basics of Sound Nutrition
Unit 19: Estimating Caloric Needs
Unit 20: The ISSA Zig-Zag Approach to Muscle Gain and Fat
Loss
Unit 21: Fad Diets and Nutrition
Unit 22: Supplementation

Unit 23: Exercise and Older Adults

Unit 24: Exercise and Adaptive Fitness
Unit 25: Exercise and Our Youth
Unit 26: Exercise and Hypertension
Unit 27: Exerise and Diabetes
Unit 28: Exercise and Arthritis
Unit 29: Exercise and Coronary Heart Disease
Unit 30: Exercise and Pregnancy
Unit 31: Exercise and Asthma
Unit 32: Exercise and Sports Medicine in the Trenches
Unit 33: Basic First Aid

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 Section One: Anatomy and Physiology
Unit 1: Metabolism
Introduction

Fred Hatfield, Ph.D., MSS & Dan Gastelu, MS

As we have uncovered in the introduction, we have a tremendous influence on shaping the health and fitness
attitudes and practices of those around us like friends, family members, co-workers and clients.

Your ability as fitness professionals to educate and effectively draw your clients into the fitness lifestyle and
optimal health comes from a plan that is based in the knowledge of muscular, cardiopulmonary and
metabolic adaptations. These adaptations are known as the training effect. The “training effect” is your body’s
adaptation to the learned and expected stress imposed by physical activity. Your bodies begin to change at
the cellular level, allowing more energy to be

released with less oxygen.Your heart and capillaries become stronger and more dispersed in order to allow a
more efficient flow of oxygen and nutrients. Your muscles, tendons and bones involved with this activity also
strengthen to accommodate a better proficiency at performing this activity. In time your body releases
unnecessary fat from its frame and your stride and gait become more efficient. Your resting heat rate and
blood pressure drop. These adaptations can be achieved through an educated trainer who can develop an
appropriate fitness and health plan.

Training effect: An increase in functional capacity of muscles and other bodily tissues as a result of increased
stress (overload) placed upon them.

While these muscular, cardiopulmonary and metabolic adaptations are indeed important we must understand
that these positive adaptations would not be possible without sufficient energy to bring about this training
effect. Therefore we must begin by learning about where this energy comes from.

Where Does Energy Come From?

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All energy on earth comes from the sun. Plants use the light energy from the sun to form carbohydrates,

fats and proteins. Carbohydrates are sugars and starches used by the body as fuel molecules and to

store energy. Fats are compounds that store energy. Proteins are important components of cells and

tissues and are large complex molecules composed of amino acids. (We will discuss carbohydrates,

fats and proteins in more detail in Section 5 of this text.) Humans and other animals then eat plants and

other animals to obtain energy required to maintain cellular activities. The body uses carbohydrates, fats

and proteins consumed daily to provide the necessary energy to maintain cellular activity both at rest

and during activity. Since all cells require energy, your bodies must have a way to convert carbohydrates,

fats and protein into a biologically usable form of energy to fuel physical activity. The ability to run, jump

and lift weights is contingent on and limited by your ability to transform food into biological energy.

These physical abilities are contingent on thousands of chemical reactions that occur throughout our

bodies all day long. Collectively these reactions are known as metabolism. These many chemical

reactions occurring in our bodies must be regulated to maintain a balance. The body consists of trillions of

cells, which are organized into tissues, organs, and systems. We will discuss this intricate organized

system in more detail in Unit 2. The body’s

components work together in a highly organized manner to maintain a balance. Metabolic activities
are continually occurring in the trillions of cells in your body and must be carefully regulated to
maintain a constant internal environment, or steady state. This steady state must be maintained
regardless of your ever-changing external environment.This automatic tendency to maintain a
relatively constant internal environment is called homeostasis.

Homeostasis: The automatic tendency to maintain a relatively

constant internal environment

Homeostasis

Walter Bradford Cannon is credited with coining the term homeostasis to refer to the processes that
maintain a constant internal body environment. For homeostasis to work, there must be feedback systems
that various physiological functions turn off and on. Imagine a feedback system like the thermostat in
your furnace or air conditioning system. If the temperature increases above the set point determined by
the system, then the thermostat shuts off the furnace. In this way the temperature is kept at a desired
steady state. If the temperature decreases below the set point determined by the system, then the
thermostat turns on the furnace to maintain a desired steady state. A feedback system revolves around a
cycle of events. Information about a change is fed back to the system so that the regulator (in this
example the thermostat) can control the process (in the above example of temperature regulation).

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A good example of homeostasis in the body
is the method by which the body maintains a
constant temperature of 98.6 degrees
Fahrenheit. If physical exertion or external
heat causes the body temperature to rise,
the brain sends a signal to increase the rate
of sweating. Heat is carried away in the
evaporating sweat. If body temperature
begins to drop due to a cold external
environment, shivering begins to generate
heat and keep the body temperature at that
critical 98.6 degrees F. Other metabolic
functions under homeostatic control include:

• Hormone production and concentration

level maintenance.

• Maintenance of serum oxygen levels and

carbon dioxide levels.

• pH balance in the blood and cells.

• Water content of cells and blood.

Figure 1-1:Homeostasis example
• Blood glucose levels, and other nutrient
levels in the cell.

• Metabolic rate.

The concept of homeostasis is of special interest to the fitness enthusiast. You are in equilibrium with the
environmental stimuli imposed upon you. Think for example, how your muscles change in response to
different training programs. If you spend most of your time lifting heavy weights, your muscles will grow
larger. A shift in your homeostasis has taken place. The simple action of weight lifting causes more protein
synthesis in the muscles being exercised with weights. Hormone levels change to accommodate this
growth. On the other hand, if you choose to run several miles per day, your muscles will take a different
form: develop a higher endurance capacity, stimulate the formation of more fat burning slow twitch
muscle fibers, and develop a higher capacity to use oxygen in energy production. Nutrient intake is an
important factor, which can affect your homeostatic balance as well. Eating too much of the wrong foods,
or too little of the right foods can cause homeostasis to shift. Too much fat and calories, and your body
stores fat. Not enough protein, and your muscles break down. Not enough carbohydrates, and you will feel
tired sooner. For optimum homeostasis and metabolism, eating the right nutrients in the right amounts at
the right times is vital.

Metabolism

In order to build biomolecules and sustain life, the body needs energy. The body gets its energy from the
breakdown of nutrients like glucose, amino acids and fatty acids, To construct molecules there must be
molecular destruction going on simultaneously to provide the energy required to drive these biochemical
reactions.

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 The many biochemical processes that make up the body’s
Metabolism: The metabolism are categorized into two general phases; anabolism
chemical processes and catabolism. From the start, it must be understood that
occurring within a anabolism and catabolism occur simultaneously all the time.
living cell or organism However, they differ in magnitude depending on the level of
that are necessary for activity or rest and on when the last meal was eaten. When
the maintenance of anabolism exceeds catabolism, net growth occurs. When
life. In metabolism catabolism exceeds anabolism, the body has a net loss of
some substances are substances and body tissues and may lose weight.
broken down to yield
energy for vital Anabolism includes the chemical reactions that combine different
processes while other biomolecules to create larger more complex ones. The net result
substances, necessary of anabolism is that new cellular material is made, such as
for life, are enzymes, proteins, cell membranes, new cells, and growth of the
synthesized. many tissues. That energy is stored in the form of glycogen
and/or fat, and in muscle tissue. Anabolism is necessary for
Anabolism: The growth, maintenance, and repair of tissues.
building up in the
body of complex Catabolism is the term used to describe the chemical reactions
chemical compounds that break down complex biomolecules into simpler ones for
from simpler energy production, to recycling of molecular components, or for
compounds (e.g., their excretion. Catabolism provides the energy needed for
proteins from amino transmitting the nerve impulses and muscle contraction.
acids). Metabolism includes only the chemical changes that occur within
tissue cells in the body. It does not include those changes to
Catabolism: The substances that take place in the digestion of foods in the
breaking down in the gastrointestinal system. A healthy metabolism needs many
body of complex nutrients to function optimally. A slight deficiency of even one
chemical compounds vitamin can slow down metabolism and cause chaos throughout
into simpler ones the body. The body builds thousands of enzymes to drive your
(e.g., amino acids to metabolism in the direction influenced by activity and nutrition.
individual proteins). So, when you are training several hours a day, you better make
sure that
your diet contains the nutrients it needs to feed the many metabolic pathways.

Your Metabolic Set Point

From the discussion of homeostasis and metabolism above, you can see that the body is a
tightly run collection of many biochemical reactions. During the intensive study of weight
loss, it was
discovered that your body seeks to maintain a certain base rate
Metabolic set point:
of metabolism, which has come to be called your metabolic set
The base rate of
point (which results in your basal metabolic rate). This set
metabolism that your
point is controlled by your genetics and the environmental
body seeks to
factors. Researchers have demonstrated that you can change
maintain; results in
your metabolic set point through dietary means and physical
your basal metabolic
activity.
rate.

The metabolic set point is the average rate at which your

Basal metabolic
metabolism runs, and will result in a body composition set point.
rate: The minimum
People with a slow metabolism seem to store fat easily, while

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people with a fast metabolism seem to be able to eat and never
get fat. Your metabolic set point can be influenced by the energy required to
external environment (climate), nutrition, exercise, and other maintain the body’s
factors. Studies have demonstrated that when individuals go on life function at rest.
a low calorie diet, the body’s metabolic set point becomes lower Usually expressed in
to conserve energy. It actually resets itself to burn fewer calories per hour per
calories, thereby conserving energy. Exercise tends to keep the square meter of the
metabolic rate up, and more aerobic exercise tends to cause the body surface.
body to burn more fat for energy.

Energy Metabolism

Energy metabolism is a series of chemical reactions that result in the breakdown of foodstuffs
(carbohydrate, fat, protein) by which energy is produced, used, and given off as heat. Roughly, the body
is about 20% efficient at trapping energy released. About 80% is released as heat, which explains why
your body heats up quickly when you exercise. A closer look at your muscle anatomy reveals that the
mode of energy storage and energy systems used is related to your physical activity.

Physical activities can be classified into four basic groups, based on the energy systems that are used to
support these activities.

• Strength-Power: Energy coming from immediate ATP stores. Shot put, power lift, high jump, golf
swing, tennis serve, or a throw; lasting about 0 to 3 seconds of all out effort.
• Sustained-Power: Energy coming from immediate ATP and CP stores. Sprints, fast breaks, football
lineman; lasting about 0 to 10 seconds of near maximum effort.
• Anaerobic Power-Endurance: Energy coming from ATP, CP, and lactic acid. 200- to 400-meter
dash, 100-yard swim; lasting about 1 to 2 minutes.
• Aerobic-Endurance: Energy coming from the oxidative pathway. Events lasting over 2 minutes in
duration.

In power events, which last

a few seconds or less, the
muscles depend on the
immediate energy system,
namely ATP and CP
reserves. In speed events,
the immediate and non-
oxidative, or glycolytic
energy sources are utilized.
In endurance events, the
immediate and non-
oxidative energy sources
are used, and the oxidative
energy mechanisms become
a more important source of
energy. ATP and CP are
replenished from energy
derived from complete
breakdown of glucose, fatty
Figure 1-2:Homeostasis example
acids, and some proteins.

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Conclusion

We need energy to maintain the many chemical and physical activities of the body. As we have learned, all energy
comes from the sun. Plants use this solar energy to perform chemical reactions to form carbohydrates, fats and
protein. Humans, like animals, consume plants and other animals to obtain the energy required to maintain cellular
activities. These cellular activities known as metabolism are maintained under homeostatic controls. These many
chemical reactions occurring in our bodies must be regulated to maintain a balance between the trillions of cells in our
body. These cells maintain balance through an intricate organization system. We will now discuss this intricate
organized system known as the body.

Summary

We need energy to maintain the many chemical and physical activities of the body. All energy comes from the sun.
Plants use solar energy to perform chemical reactions to form carbohydrates, fats and protein. Humans like animals
consume plants and other animals to obtain the energy required to maintain cellular activities.

I. The body’s components work together in a highly organized manner to maintain a balance, this balance is known as
homeostasis.

A. Metabolism can be defined as all of the chemical processes that occur in the body. Metabolism is categorized into
two general phases; anabolism (building phase) and catabolism (breaking down phase).

B. The food you eat can either be burned to liberate energy, converted into bodyweight, or excreted.

1. The calories coming from protein are used for maintenance, repair, and growth of new tissues and organs. Calories
from carbohydrates are used for energy. Calories from conventional sources of a fat are prone to be stored as fat since
it already has the same molecular structure as body fat.

II. Energy metabolism is a series of chemical reactions that result in the breakdown of foodstuffs (carbohydrate, fat,
protein) by which energy is produced, used, and given off as heat.
A. ATP, an acronym for adenosine triphosphate, is the molecule that stores energy in a form that can be used for
muscle contractions.

1.Our muscle cells can produce ATP by any one or a combination of three metabolic pathways: the ATP/CP pathway,
glycolytic pathway and/or oxidative pathway.

2.The formation of ATP without oxygen is known as anaerobic metabolism. This includes the ATP/CP and the anaerobic
glycolytic pathway. Short-term activities at higher intensities utilize ATP production from anaerobic energy pathways.

a. In the ATP/CP system, the P (phosphate) is separated from the C (creatine) and combines with ADP (adenosine di-,
meaning two, phosphates) to reform ATP (adenosine tri-, meaning three, phosphates). One molecule of CP results in
the reformation of 1 molecule of ATP. This system is sufficient for 3 to 15 seconds of ATP production.

b. In non-oxidative glycolysis, glucose or glycogen is converted to lactic acid. One molecule of glucose results in 2
molecules of ATP and 1 molecule of glycogen results in 3 molecules of ATP. This system is reliable for 1 to 2 minutes of
all out effort.

3. The formation of ATP with oxygen is known as aerobic metabolism. This includes the aerobic glycolytic pathway and
the oxidative pathway. Long-term activities with a low to moderate intensity utilize ATP production from aerobic
sources.
a. The aerobic metabolism of 1 molecule of glucose results in the production of 38 molecules of ATP and 1 molecule of
glycogen results in the production of 39 ATP.
4. Glycogen is essential for both anaerobic and aerobic activities. Muscles being strenuously exercised will rely on
glycogen to power strength generating muscle contractions. In endurance exercise, while the primary fuel is fatty
acids, glycogen is also utilized.
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5. Monitoring your metabolism is possible through Nitrostix or handheld, portable, indirect calorimeters.

Unit 2: Basic Anatomy and Physiology

Levels of Organization in the Human Body

The complex interaction of the principal systems of the human body

Figure 2-1
culminate in what is known as the training effect. These principal
systems are part of an intricate system, with varying levels of
organization. The simplest level is the chemical level. The atom is
the smallest amount of a chemical element. Atoms can combine to
form molecules. About 98% of the human body is composed of only
six elements: oxygen, carbon, hydrogen, nitrogen, calcium and
phosphorous. The next level is the cellular level. Atoms and
molecules bind to form the building blocks of the body. Each cell
consists of specialized cell parts called organelles. The nucleus,
which is the control center of the cell, is an organelle. The next
level of organization is the tissue level. A tissue is a group of
closely related cells specialized to perform a specific function. The
four main tissues in the body are muscle tissue, nervous tissue,
connective tissue and epithelial tissue. These tissues are then Tissue: A collection of
organized into organs like the heart or brain.These organs and similar cells and their
tissues work together to perform specific functions of the body’s intracellular substances.
system. These body systems make up the human body.

Cells

Just as every molecule has building blocks, so do tissues and structures. Cells form the fundamental units
of life. Together they somehow organize themselves into the human body. The human body is composed
of an estimated 100 trillion cells of various forms and functions. Striated muscle cells can be several
inches long and have the unique ability to shorten in length, thereby causing muscle contractions. Fat cells
are small and round in shape and function to store fatty acids for energy needs during lean times.

Another magnificent characteristic of cells is that they can reproduce themselves. In fact, cells can only
arise from pre-existing cells. Our complex body originates from the union of two existing cells, the female
egg and the male sperm. These sex cells merge to form one larger cell called the zygote, which is the
starting point of a multi-trillion-celled human body. The zygote divides and forms two cells. (Sometimes,
these two zygote cells become separated and develop independently of each other, forming twins.) The
two zygote cells continue to divide and form four cells. This process continues forever. Even when the
total number of cells reaches a relatively fixed amount, cells continue to divide to replace old or dead
cells. As we live, cells are continually dying and being produced.

Cellular Components

Each type of cell has its own anatomy and physiology. This is accomplished by subcellular structures called
organelles. Each cell typically contains the following organelles.

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Plasma Membrane

Picture the cell as an inflated balloon. The outer boundary is

Fatty acids: Any of a
called the plasma membrane, or cell membrane. It is a complex
large group of
structure made up of mostly proteins and a phospholipid
monobasic acids,
bilayer. The phospholipid bilayer (which is made up of glycerol,
especially those found
two fatty acids, and a phosphate group) forms a double-
in animal and vegetable
walled balloon-like structure, with proteins embedded in these
fats and oils.
bilayer sheets. The nutritional significance of this structure is
that the cell membrane is made up of fatty acids, which are
Triglycerides: The
part of the phospholipid bilayer. For this reason, fats are an
storage form of fat
important part of the diet, and while we need to make sure we
made up of three fatty
do not eat too much, we do need an appropriate amount to
acids and a glycerol
serve the essential building blocks for all cells. Fats are
group.
especially important for athletes training to gain
muscle mass and for long distance athletes whose metabolisms burn up a tremendous
amount of fatty acids. (Fats consist mainly of three fatty acids attached to the three carbon
glycerol molecules; thus the name, triglycerides.)

Insulin: A polypeptide
hormone functioning in The plasma membrane can selectively allow the transport of
the regulation of the molecules through it and also actively transport certain
metabolism of compounds across it via special mechanisms. It is therefore
carbohydrates and referred to as a semi-permeable plasma membrane. This gives
fats, especially the the cell control over what substance and how much of a
conversion of glucose substance it allows inside. Additionally, the cell can rid itself of
to glycogen, which undesirable compounds while retaining desirable ones. Insulin
lowers the blood is an important hormone that is responsible for stimulating the
glucose level. uptake of glucose and amino acids across the plasma
membrane. Insulin levels increase in the body after a meal to
Glucose: Principal ensure that these vital nutrients get into the cells. There are
circulating sugar in the ways to maximize the function of insulin through
blood and the major supplementation and timing of meals around training, which will
energy source of the be discussed later.
body.

Golgi Apparatus

The Golgi apparatus consists of stacks of tiny, oblong sacs embedded in the cytoplasm of the cell near the
nucleus. Recent research has presented convincing evidence that the Golgi sacs are responsible for
synthesis of carbohydrate biomolecules. These carbohydrates are then combined with the proteins made
in the endoplasmic reticulum to form glycoproteins. Glycoproteins function as enzymes, hormones,
antibodies, structural proteins, and so on. As the amount of glycoprotein produced within the Golgi sac
increases, the sac becomes inflated. At this point, small spheres form along the surface of the Golgi sac
and break away. These globules contain the glycoproteins, which are transported to the cell membrane
and then out of the cell, into the bloodstream to be used by other cells.

Lysosome

Lysosomes are other sac-like structures whose size and shape change with the degree of their activity.
They start out small, and as they become active, they increase in size. Lysosomes contain a variety of
enzymes, which act as catalysts, directing all major biochemical reactions. These enzymes are capable of
breaking down all of the main components of the cell, such as protein, fat, and nucleic acid. The broken-
down products formed inside the lysosome can be used as raw materials for synthesis of new
biomolecules or for energy. In this way, lysosomes serve to contain and isolate these important cellular
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digestive enzymes and thereby prevent complete digestion of the cell. They also play a limited role in the
engulfing and destroying of bacteria that may enter the cell.

Mitochondria

After the nucleus, mitochondria are probably the most known and talked about organelle in the athletic
arena, due to their role in the generation of energy. Referred to as the powerhouse of the cell,
mitochondria are small complex organelles that resemble a sausage in shape. They consist of a smooth
outer membrane, which surrounds an inner membrane, forming a sac within a sac. The inner membrane is
folded like an accordion, and forms a number of inward extensions called cristae.

The enzymes that are essential for making one of the most important biomolecules, ATP (adenosine
triphosphate), exist in the mitochondria. It is here in the mitochondria that ATP stores the energy, which
is used to power biological functions. More will be said about ATP in the units to follow. Within the inner
mitochondria membrane, catabolic enzymes (which are involved in breaking down of biomolecules)
catalyze reactions that provide the cells with life-sustaining energy.

Nutrients like glucose and fatty acids are made of carbon atoms
Fatty acid: Any of a
linked together with chemical bonds. When these chemical bonds
large group of
are broken, energy is released. Within the intricate confines of the
monobasic acids,
mitochondria, this energy can be trapped and stored in the ATP
especially those found
molecule, which can then make use of it. In other words, the
in animal and
energy from glucose is transferred to the ATP molecule, and the
vegetable fats and oils.
energy is now in a form that the body can use.
These biological structures are the main components of the cell.
Some of the other structures include glycogen granules, Glycogen granule:
which store glycogen and enzymes for glycogen breakdown and Structure of the cell
synthesis. Although not a structure, the cytoplasm is worth that stores glycogen
mentioning. This liquid portion of the cell is the site of many and enzymes for
reactions, including gluconeogenesis (glucose and glycogen glycogen breakdown
formation), fatty acid synthesis, activation of amino acids, and and synthesis.
glycolysis (the first phase of breaking down glucose to make
ATP molecules for energy). Gluconeogenesis:
Chemical process that
Tissues converts lactate and
pyruvate back into
While the cell is the fundamental unit of life, tissues are the glucose.
fundamental units of function and structure for the human body.
Tissues are defined as the aggregation of cells bound together Glycolysis: The
working to perform a common function. For example, cells of metabolic process that
the adrenal cortex form a glandular tissue that produces several creates energy from
hormones, including androgens, glucocorticoids, and the splitting of glucose
mineralocorticoids. Muscle tissue is made up of special muscle to form pyruvic acid or
fiber cells that collectively have the ability to shorten in length lactic acid and ATP.
and form
the basis of contractile tissue. In this section, you will learn about the basic tissues that
make up your body. The human body is considerably complex, yet the tissues that form it
can be separated into four basic groups: epithelial, connective, muscle and nervous tissue.

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Epithelial Tissues

Epithelial tissues are found throughout the body:

Squamous
as a continuous external layer over the whole
epithelium:
body (skin), on most of the body’s inner cavities,
Epithelium consisting
and making up the body’s several glands. On the
of one or more cell
surface, epithelial tissues function to protect
layers, the most
underlying cells from bacterial invasion, adverse
superficial of which is
chemicals, and drying. On the inside, they
composed of flat,
function as absorbing and secreting tissues, e.g.,
scalelike or platelike
digestive system glands. Epithelial tissues are
cells.
divided into four groups, and are distinguished
according to the shape of the cells they are made
Cuboidal epithelium:
up of. They are as follows:
Epithelial tissue
consisting of one or
1. Squamous epithelium is tissue
more cell layers, the
composed of one layer of flat cells. It is
most superficial of
located in the linings of the mouth,
which is composed of
esophagus, and blood and lymphatic
cube-shaped or
vessels. Substances can easily diffuse
somewhat prismatic
through this layer of cells.
cells.
2. Cuboidal epithelium is made of cube-
shaped cells as found in the lining of
Columnar
kidney tubules.
epithelium:
3. Columnar epithelium is tissue that
Epithelium consisting
resembles a column or pillar in shape.
of one or more cell
These cells are widespread throughout the
layers, the most
body, forming linings in the digestive tract
superficial of which is
and respiratory tract. They function as
composed of elongated
secretory cells or absorptive cells. Some
and somewhat
also have small hairs, called cilia, which
cylindrical cells
beat rhythmically and move materials out
projecting toward the
of a passage, as in the respiratory tract
surface.
where cilia serve to sweep out foreign
matter that may pass into the lungs.
4. Glandular epithelial cells secrete mucus Glandular: Of, relating
and hormones, like those of the salivary to, affecting, or
and thymus glands. resembling a gland or
its secretion

Nervous Tissues

Nervous tissue is made up of several types of cells that are responsible for the control of the bodily
functions. Nervous tissue is found in the brain, spinal cord, and nerves, which branch out to all
parts of the body. The types of nervous tissues are neurons, neuroglia, and neurosecretory cells.
1) Neurons conduct nerve impulses, register sensory impulses, and conduct motor impulses. The
central neuron body contains a nucleus surrounded by cytoplasm, and two projections at either
end. The two types of projections are axons, which generally conduct impulses away from the
body of the nerve cell, and dendrites, which conduct impulses from adjacent cells inward toward
the cell body. 2) Neuroglia consists of a delicate network of branched cells and fibers that supports
the tissue of the central nervous system. 3) Neurosecretory cells secrete (as their name implies)
substances that may have an effect elsewhere in the body.

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Body Systems

Figure 2-2a The human body is an incredible biological

phenomenon composed of several interdependent
systems that are responsible for maintaining life. All of
the tissues interact in one way or another to form
functional body units referred to as systems.
Essentially, the body is one living system made up of
many sub-systems. However, for academic purposes
anatomists and physiologists refer to these sub-
systems as systems. There are ten principle systems of
the body. The following systems make up the human
body.

Integumentary
system: Bodily system
(1) The integumentary system consists of the skin and the consisting of the skin
structures derived from it. and its associated
structures, such as the
(2) The skeletal system helps to support and protect the body hair, nails, sweat
and consists of bones and cartilage. glands, and sebaceous
glands.
(3) The muscular system consists of large skeletal muscles
that allow us to move, cardiac muscle in the heart, and smooth Skeletal system:
muscle of the internal organs. System consisting of
bone and cartilage that
(4) The nervous system consists of the brain, spinal cord, supports and protects
sense organs and nerves, which regulate other body systems. the body.

(5) The endocrine system consists of the glands and tissues Muscular system:
that release hormones and works with the nervous system in System consisting of
regulating metabolic activities. large skeletal muscles
that allow us to move,
(6) The Circulatory system consists of the cardiovascular cardiac muscle in the
system and the lymphatic system. heart, and smooth
muscle of the internal
organs.

Figure 2-2b

(6a) The cardiovascular system consists of the heart

and blood vessels and serves as the transoprtation
system.

(6b) The lymphatic system is a subsystem of the

circulatory system, which protects the body against
disease.

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 Lymphatic system:
Subsystem of the
circulatory system,
which protects the
body against
disease.

(7) The respiratory system consists of the lungs and

air passageways, which supply oxygen to the body and
remove carbon dioxide.

(8) The digestive system consists of the digestive tract and

glands that secrete digestive juices into the digestive tract Urinary system: Main
and is responsible for the breakdown of foods and waste excretory system of the
elimination. body, which consists of the
kidneys, ureter, urinary
(9) The urinary system is the main excretory system of the bladder and urethra.
body, which consists of the kidneys, ureter, urinary bladder
and urethra. Reproductive system:
System consisting of
The final systems of the body are the: gonads, associated ducts,
and external genitals
(10) reproductive systems. Each reproductive system concerned with sexual
consists of gonads and associated structures, which maintain reproduction.
sexual characteristics and are responsible for reproduction.

Although each system can be separated out from the rest, without the other systems, its function
cannot be carried out to completion. For example, if the muscular system were disconnected from
the nervous system, nerve impulses sent down neurons would have no effect on stimulating
muscle contraction. Of these ten principle systems there are six that are most pertinent to health,
physical fitness and personal training: the respiratory system, the circulatory system, the nervous
system, the endocrine system, the skeletal system and the muscular system. We will cover the
respiratory system, circulatory system, digestive system, nervous system and endocrine system in
this unit.

The Respiratory System

Respiratory system:
The respiratory system consists of the lungs and air System consisting of
passageways leading to and from them: mouth, throat, the lungs and air
trachea, and bronchi. The respiratory system supplies passageways, which
oxygen and eliminates carbon dioxide to tissues in supplies oxygen to the
helping to regulate the pH balance of the body. body and removes
Respiration is the overall exchange of gases between carbon dioxide.
the atmosphere, the blood and the cells.

It all begins with the lungs. This is where the air you breathe is processed; the oxygen is removed and
then transferred to the bloodstream for distribution throughout your body. The amount of air that your
lungs can process is the first limiting factor on your condition.

13
 Figure 2-3
To understand how conditioned lungs can process
more air, it is necessary to understand the process.
The lungs are like a dairy where bulk milk comes in
and the cream is separated from it. The cream is
then bottled and sent off for distribution. Empties
come back, get flushed out and receive more cream
and the process starts all over again.

Think of oxygen as the cream of the air you breathe. When bulk air comes into your lungs,
the oxygen is extracted from it, “bottled” in red blood cells (hemoglobin) and then sent off
on the
bloodstream assembly line for distribution. When they reach the
Hemoglobin: An
tissue, the “bottles” exchange oxygen for carbon dioxide and
oxygen-transporting
water and then carry these wastes back to the lungs where they
protein found in blood
are flushed out. The “bottles” are then ready to pick up more
cells.
oxygen and start the process all over again.

The air we breathe is approximately 21 percent oxygen and 79 percent nitrogen, with negligible traces of
other gasses. This ratio rarely varies. What does vary is the amount of air we can process. If your lungs
cannot process enough air, they cannot extract enough oxygen to produce enough energy. Two factors
limit the lungs’ ability to process air.

First, the lungs have very little muscle of their own. Expansion and contraction of the lungs is dependent
on the muscles of the rib cage and the diaphragm. As you inhale, the muscles surrounding the lungs
create a larger area in the lung cavity, thereby creating a partial vacuum. Aided by this differential in
atmospheric pressure, air then rushes in. When exhaling, the muscles, aided somewhat by the natural
elasticity of your lungs and chest wall, contract to create greater atmospheric pressure inside the lungs
than outside your body. Inhaling is the air is being “sucked” in; exhaling is the air being “pushed” out.

The process described is with the body at rest, and most Figure 2-4
bodies at rest consume basically the same amount of
oxygen, and consequently inhale and exhale just about the
same amounts of air.

Now, as you move into physical activity, the amount of air

you can inhale and exhale is limited. The first limiting factor
is the size of the vacuum your muscles can create for the
lungs to expand into; the second is the size of the area they
can be squeezed back into.

Conditioned athletes have the capability to inhale more air and sustain the process for longer periods.
Conditioned athletes are also more capable of exhaling more wastes, because the muscles around their
lungs have been trained and are more efficient. All this is related to the condition of the muscles
surrounding the lungs.

14
 The second limiting factor on how much air your lungs can
Vital capacity: The process is the condition inside the lungs. Lungs vary in size; a
usable portion of the larger individual will naturally have proportionately larger lungs.
lungs. In terms of sports performance, we are less concerned with the
size, or total capacity,
of the lungs than we are with how much of that capacity is usable. This usable portion is
called the vital capacity, and it is measured in the laboratory by assessing the amount of
air that can be completely exhaled in one deep breath.
Research has shown that a conditioned individual will have a vital capacity equaling approximately 75
percent of his or her total lung capacity. However, a deconditioned person may match this percentage by
virtue of good biology. To differentiate between the two individuals we look at the maximum minute
volume. This is the amount of air that a person can process during one minute

Maximum minute of vigorous exercise. The results of this test will generally provide a clear
volume: The amount indication of who is the conditioned individual and who is the deconditioned
of air that a person can individual. Con-ditioned athletes may force as much as 20 times their vital
process during one capacity through their lungs in one minute, while deconditioned individuals
minute of vigorous might be hard-pressed to force even 10 times through. They simply lack the
exercise. muscle and strength endurance to perform at any higher level.

After your usable lung volume has been measured, the

remainder of the air in your lungs is called the residual
Residual volume: The
volume. This volume is fixed, and even a conditioned athlete
remainder of the air in
cannot breathe it in or out. For instance a newborn child will
the lungs after the
likely float on water because the residual air in its lungs could
usable lung volume has
not be exhaled. This test is used at times to determine whether
been measured.
the child was stillborn or had lived for a short time. However,
too much residual volume is unhealthy. If your
body deteriorates from inactivity or disease, the unusable portion of the lungs may increase,
providing less space for normal breathing, let alone vigorous exercise. Ultimately, shortness
of breath results from even light activity, like climbing a flight of stairs. When you need more
oxygen in a hurry, the muscles controlling the lungs will not be in condition to force high
volumes of air through them, and the usable space within the lungs may be seriously
reduced.

The training effect can reverse both trends. Exercising the muscles surrounding your lungs will increase
their strength and efficiency and help open more usable lung space. This has the net effect of increasing
your vital capacity and reducing the residual volume. In each instance, it makes your lungs more efficient
organs to process more air and extract more of the essential oxygen. The oxygen supply to the blood at
rest is only about one cup per minute. Extreme exercise in a trained athlete can step this up to one gallon
per minute. At rest, only about 12 percent of the stagnant air in the lungs is renewed during each breath.

A good way to test the breathing condition of your lungs is to take a deep breath and see how long you
can hold it. Most adults in moderately good physical condition and with healthy lungs should be able to
hold their breath for 50 seconds or longer. Most individuals in average condition will have a respiration
rate of 10 to 16 breaths per minute. Respiration rate is measured at rest with the subject breathing within
a normal resting heart rate. The training effect can have beneficial effects on normal breathing resulting in
fewer breaths per minute. Exercising the muscles surrounding the lungs will increase their strength and
efficiency, which increases usable lung capacity. This has the net effect of increasing the vital capacity and
reducing residual volume. The training effect thus transforms the lungs into more efficient organs capable
of processing more air and extracting more of the essential oxygen.

15
Circulatory System

The circulatory system serves as the transportation system Figure 2-5

of the body. The heart, arteries and veins are part of this
system. The circulatory system consists of two subsystems,
the cardiovascular system and the lymphatic system. In the
cardiovascular system
the heart pumps blood through a
Circulatory system:
vast system of blood vessels. The
System consisting of
lymphatic system helps preserve
the heart and blood
fluid balance and protects the
vessels that serves as
body against disease. We will first
the transportation
discuss the blood.
system.

Blood Anatomy

Blood has four main constituents: plasma, erythrocytes,

leukocytes and platelets. Plasma, the fluid portion of blood,
is composed of numerous chemicals including sugars, minerals
and proteins (albumin, globulin and fibrinogen). Erythrocytes,
containing hemoglobin, carry oxygen, supplying it to all the
tissues of the body. Leukocytes, of which there are several
types, serve principally to combat infections. Platelets are
important in the mechanism of blood clotting. Plasma: The fluid
portion of blood.
The total volume of blood in the body is dependent on the size
of the individual and the state of training. The average blood Erythrocyte: Blood
volume range is from 5 to 6 liters in men and 4 to 5 liters in cell that contains
women. The composition of whole blood is 55% plasma (of hemoglobin to carry
which 90% is water, 7% plasma proteins and 3% other), and oxygen to the bodily
45% formed elements (of which > 99% is red blood cells, and tissues; a biconcave
<1% white blood cells and platelets). Mature red blood cells disc that has no
(erythrocytes) have no nucleus and therefore cannot nucleus. Red blood cell.
reproduce. They must be replaced with new cells every 4
months. This balance is very important because adequate
Leukocyte: Cell whose
oxygen delivery to body tissues depend on having a sufficient
primary function is to
number of carriers: red blood cells. A decrease in the number
combat infections.
or function of red blood cells can hinder oxygen delivery and
thus affect performance.
Platelet: Cytoplasmic
body found in the
blood plasma that
functions to promote
blood clotting.

16
 Alveoli: Capillary-rich
air sacs in the lungs
where the exchange of
oxygen and carbon
dioxide takes place.
Figure 2-6: Composition of whole blood.
Law of Gaseous
Diffusion: Principle
that states that a gas
will move across a
semipermeable
membrane (alveolar,
capillary, etc.) from an
area of high
concentration to an
area of lower
concentration.

Respiratory and Circulatory Interaction:

Here Is How It Works!

From the lungs, the oxygen goes directly into the bloodstream – the “assembly line” of the body. Your
lungs contain millions of tiny air sacs, called alveoli, around which the blood flows. These sacs are like
tiny balloons filled with air dangling in the liquid of your bloodstream. The air is forced into these sacs by
atmospheric pressure. Then, following the Law of Gaseous Diffusion, the oxygen moves from the area
of higher pressure in the alveoli to the red blood cells where the pressure is lower (the red blood cells are
now in effect “empty bottles,” having delivered their supply of oxygen and disposed of the returning
wastes).

The limiting factors here include the number of red blood cells, the amount of hemoglobin they carry and
total blood volume. Even if your lungs could process more oxygen, your body tissue still would not receive
more oxygen unless there were more “bottles” to put it in for delivery.

This is another benefit of the training effect. It produces more blood, resulting in more hemoglobin, which
carries the oxygen; more red blood cells, which carry the hemoglobin; more blood plasma, which carries
the red blood cells; and consequently, more total blood volume. Laboratory tests have repeatedly shown
that people in good physical condition invariably have a larger blood supply than deconditioned people of
comparable size. An average-size person may increase his or her blood volume by nearly a quart in
response to aerobic conditioning and the red blood cell count increases proportionately.

All of which means that there are now more “bottles” not only to deliver the oxygen, but more “empties”
to carry away the wastes. The removal of carbon dioxide and other waste products is just as important in
reducing fatigue and increasing endurance as the production of energy. It is like your own home. For
example, even if you keep good food around, you still have to clean out the garbage regularly if you
expect to keep living there.

17
When the “bottles” get to the tissue level, unload the oxygen
and pick up the wastes from the tissue cells, the process by
which they do it is described as osmosis. The oxygen and food In a treadmill test,
particles, now in liquid form, pass through the cell membrane, conditioned adult
and waste products exit the cell in the opposite direction. That males would start with
basic life cycle is represented here: materials for nourishment a diastolic pressure
and energy going in and the leftover wastes going out. To of 70 and experience a
complete the cycle, when the carbon dioxide and other wastes slight increase during
are carried away in the bloodstream via the veins and reach the their run. Then, upon
lungs, the Law of Gaseous Diffusion now works in reverse. The stopping, they would
pressure of the carbon dioxide in the veins is greater than it is in return to normal within
the alveoli, so it passes freely into the alveoli and is exhaled a few minutes.
with the expired air. Deconditioned people,
however, abd
The efficiency of this cycle, and its capacity for gas exchange, is especially the
a function of the training effect. The more exercise you perform, overweight types,
the stronger the training effect will be; the less you do, the might start with a
weaker it will be. diastolic pressure of
90, then shoot up to
This is all with the body at rest and the heart beating at a 105 during exercise,
normal rate. Physical activity and emotional stress raise the and take tem minutes
heart rate. They also raise the blood pressure because the heart or more to recover.
is pumping more blood into the system at a faster rate.
Excessive demands on the heart can cause trouble in people Diastolic pressure:
with pre-existing medical conditions. Pressure exerted on
the walls of the blood
Most people, especially those with clinical conditions, reduce vessels during the
their blood pressure significantly after adhering to an exercise refilling of the heart.
program for even a few weeks. The blood vessels make
compensatory

adjustments to handle the increased workload because of the exercise they get regularly. Almost all of the
body systems do so in response to increased adaptive stress. Once again, this is called the training effect.

Years ago, treatment for high blood pressure was “rest and relaxation.” But recent reports, like the
Surgeon General’s Report, suggest that regular exercise can be an effective means of reducing high blood
pressure.

One of the most famous and amusing done in the area of vascularization was reported by
a researcher who set a weight on the floor, tied a rope to it, ran the rope over a pulley
fastened to the edge of a table, then sat on the other side of the table and looped the rope
over the middle finger of his right hand. Then in time to a metronome, he began lifting the
weight. The first time, and for many weeks thereafter, the best he could do was 25 lifts
before his finger became fatigued. To expand the experiment, he had a mechanic in the
building lift the weight occasionally, and the mechanic always beat him.

One day, about two months later, the researcher began his usual lifts, but found his finger
wasn't tired at 25. He kept going and ultimately reached 100. He suspected what had
happened and brought the experiment to a rather unorthodox conclusion. He invited the
mechanic in again and made a small bet that he could beat him. The mechanic accepted
and lost.

What the researcher suspected, of course, was that his finger muscles had undergone

18
 vascularization in response to the adaptive stress of exercise. More blood vessels had
opened up, creating new routes for delivering more oxygen, and they apparently did not
open up one at a time but a whole network at a time.

Another effect of conditioning on the blood vessels is an augmented blood supply made possible by the
creation of new routes supplying blood to the working muscles. This vascularization is the most essential
factor in building endurance and reducing fatigue in the skeletal muscle. Saturating the tissue with oxygen
and carrying away more wastes is an extremely vital factor in the health of the heart, the most important
muscle of all. Larger blood vessels supplying the heart tissue with energy-producing oxygen considerably
reduce the chances of cardiac failure. Even if a heart attack were to occur, the improved blood supply
would help to keep surrounding tissue healthy and improve chances for a speedy recovery.

There is one final problem involving the blood vessels, and that is
Metabolism: All of
fat metabolism. Metabolism is a big word with a reasonably
the chemical
simple meaning; it means change. We have already touched on
processes that take
one kind of metabolism, energy metabolism: foodstuffs burned by
place in the body that
oxygen are changed into energy. We will talk about energy
are necessary for the
metabolism more as we discussed in unit 1. Tissue metabolism is
maintenance of life.
another form of

metabolism and is the process by which foodstuffs are changed to make new tissue.

Fat is one of the foodstuffs; proteins and carbohydrates are others. Dietary fat is important because it is
one of the major factors in the development of arteriosclerosis. It is also important in the development of
cholesterol. The crust found on the inner walls of arteries in arteriosclerosis (hardening of the arteries)
contains large amounts of cholesterol.

Your body can tolerate and easily metabolize a moderate amount of fat, but as you will learn later in the
text, high-fat diets strain its metabolic capabilities. When this happens, fat circulates in the bloodstream
for prolonged periods following fatty meals, and the length of time it takes to get rid of it depends on your
condition.

The training effect does three things for blood vessels:

1. It enlarges them and makes them more pliable to pressure.

2. It increases their number for saturation coverage.
3. It helps keep their linings clear of corrosive materials.

Tissues are the end of the assembly line, where the oxygen is turned over to the consumer and the waste
products are picked up for carting away. Each cell is like a small factory, with its own receiving and
shipping facilities, storeroom and power plant for creating energy, heat and new protoplasm, the stuff of
which all cells and all living things are made. All the food you eat and all the oxygen you breathe is meant
to serve this one tiny little factory.

19
The Digestive System

The digestive system starts at the mouth, runs some 25 feet

Digestive system: through the trunk of the body, and ends at the anus. It is
System consisting of basically a strong muscular tube lined with thick epithelium with
the digestive tract and specialized cells, which differ depending upon which part of the
glands that secrete digestive system you examine. The digestive system is also
digestive juices into referred to as the alimentary canal, gastrointestinal system, and
the digestive tract. the gut. The digestive system is the life support of the body and
Responsible for the the connection with the external environment. Food is eaten and
breakdown of foods somehow the body breaks it down into useful biomolecules to
and waste elimination. obtain the energy necessary for life and the building blocks
necessary for growth.
Digestion is a process where food is broken down through
Digestion: The
chemical and physical means so the nutrients can be absorbed.
process of mechanical
Nutrients are absorbed through the intestinal walls, transported
or chemical breakdown
by the blood to the liver, and then transported further onto the
of food into absorbable
trillions of cells via the bloodstream. As you will soon discover,
molecules.
the digestive system is quite complex and remarkable.

The functions of the digestive system include:

a. Receipt, mastication (chewing), and transport of ingested substances and waste products.
b. Secretion of acid, mucus, digestive enzymes, bile and other materials needed to break down food.
c. Digestion of ingested foodstuffs.
d. Absorption of nutrients.
e. Storage of waste products.
f. Excretion.
g. Auxiliary functions.

Physical Components

The digestive system is made up of several anatomically different structures which make up the gut and
several organs attached to the gut that provide essential functions to the entire process of digestion. The
pancreas, for example, supplies important enzymes to help break apart complex food substances. The
following will review these major structures and discuss their functions.

Mouth

Food enters the digestive system through the mouth. The mouth has four functions it exerts on the
ingested food. First, the mouth physically breaks apart food by mastication, more commonly referred to as
chewing, thus reducing it in size. Chewing your food thoroughly is vital to digestion. Thorough mastication
ensures you will get the full benefit of the digestive enzyme ptyalin and physically reduce in size the
foodstuffs, like protein, so the stomach can perform its digestion functions more easily.

20
 Figure 2-8

Second, it mixes the food with saliva creating a moist

mass, called a bolus, which is then made ready for
swallowing. The saliva also contains the digestive
enzyme ptyalin, which begins the chemical
breakdown of starch (carbohydrates). Saliva also
serves to lubricate the food for its journey down the
esophagus into the stomach. Mucus proteins in the
mouth also help the food particles stick together. The
masticated food mass is swallowed and passed
through the pharynx and then into the esophagus.

Thirdly, the mouth regulates temperature by either cooling or warming the food. Temperature regulation
is important as enzymes function at their best within a narrow temperature range. For humans, this range
is held closely to normal body temperature. Also, delivery of cold food can hasten the emptying of the
stomach and reduce the efficiency of digestion. Although this accelerated digestive process is generally
viewed as negative, one exception is when drinking fluid before and during exercise or competition.
Emptying fluids from the stomach faster will rehydrate the body more quickly. The fourth major function
of the mouth is that it consciously initiates swallowing when the food is ready.

Esophagus

The esophagus extends between the pharynx and stomach and is the transport conduit for food and water
traveling to the stomach. When the bolus enters the esophagus, an involuntary wave of muscle
contractions is triggered which propels the food mass down into the stomach. This muscle contraction
action is known as peristalsis. This peristaltic wave travels down the esophagus about three inches per
second. Once at the base of the esophagus, a ring-like muscle is reached, the esophageal sphincter, which
relaxes to let the food into the stomach. Keep in mind that at the same time food is let into the stomach,
the esophageal sphincter is keeping food from spurting out of the stomach, back up the esophagus. If the
sphincter weakens or malfunctions, the acidic contents of the stomach may shoot up into the esophagus
and produce an unpleasant, bitter sensation in the throat known as heartburn. Heartburn has nothing to
do with the heart; the term developed because the pain may develop in the area of the chest associated
with the heart. To reduce stress on the esophageal sphincter, it is a good practice to eat sitting up and to
try not to over fill your stomach with huge meals.

Nervous System
Nervous system:
System comprised of
brain, spinal cord, The nervous system is the control Nerve impulse: A
sense organs and center of the body and the network brief reversal of the
nerves. Regulates for internal communication. A membrane potential
other systems. skeletal muscle cannot contract until that sweeps along the
it is membrane of a
stimulated by a nerve impulse. Without the central control of neuron.
the nervous system, coordinated human movements are
impossible. Central nervous
system: System
The Mind-Body Link comprised of the brain
and spinal column.
Your nervous system is made up of two major parts: the central
nervous system and the peripheral nervous system. The Peripheral nervous

21
central nervous system (CNS) is comprised of your brain and your
system: Relays
spinal column. You should think of the CNS as being one organ
messages from the
and not separate. The CNS receives messages and after
CNS to the body (the
interpreting them it sends instructions back to the body. The
efferent system), and
peripheral nervous system (PNS) does two things: 1) it relays
relays messages to the
messages from the CNS to the body (the efferent system), and 2)
CNS (the afferent
it relays messages to the CNS (the afferent system) from the
system) from the body.
body.

Figure 2-9: The two major divisions of the nervous system are the central and peripheral
systems. The central nevous system includes the brain and the spinal cord. The peripheral
nervous system has two subdivisions, the autonomic and somatic systems. The autonomic
nervous system acts on blood vessels, glands and internal organs. It is divided into two
parts, the parasympathetic nervous system, which slows body functions thus conserving
energy, and the sympathetic nervous system, which speeds body functions thus increasing
energy use. The somatic nervous system primarily innervates the skeletal muscles, so it is
most involved with physical activity.
The system seems no more complex than turning your light
Efferent system:
switch on and off, but it does get more complicated. For example,
System designed to
your efferent system — the system designed to cause action —
cause action; consists
is divided into two distinct and important parts: the somatic
of the somatic and
system, which is responsible for voluntary action; and the
autonomic systems.
autonomic system, which processes and activates involuntary
action.
Somatic system:
System responsible for
Your afferent system — the part of the PNS that sends
voluntary action.
messages to the CNS — receives messages through three
different classes of receptors:
Autonomic system:
System that processes
1. Proprioceptors, located in joints, muscles, tendons and the
and activates
inner ear, are responsible for picking up messages such as
body position and movement (kinesthesia).

22
 2. Exteroceptors, located near the surface of your skin, which
involuntary action.
receive information from outside your body such as sight,
touch, pressure, heat or cold.
3. Interoceptors, located in your blood vessels and viscera, Afferent system: The
which report inner body sensations such as hunger, thirst, part of the PNS that
pain, pressure, fatigue or nausea. sends messages to the
CNS.

The functions of the nervous system as a whole are widely varied, so it is often simpler to remember the
three main things that the nervous system does for the human body.

1. It senses changes inside and outside your body.

2. It interprets those changes.
3. It responds to the interpretations by initiating action in the form of muscular contractions or
glandular secretions.

There are many articles and rhetoric regarding the crucial link between your mind and your body: that link
is your nervous system — the CNS and the PNS. We will now explore some of the implications of this
mind/body link.

Neural Adaptations

Can you modify your nervous system to your advantage? That is the big question. What good does it do
for you to know all about how the nervous system works unless you can gain some sort of tangible
payback? And, if you can expect some sort of physical reward for working hard to understand your
mind/body link, will the reward be of sufficient magnitude to warrant giving it the attention and time to
extract payment?

The answer to that last question is a resounding YES! Not only can you modify certain aspects of your
nervous system function, but the rewards in terms of sports success can indeed be significant. Some of
the most apparent areas of concern to athletes are improved strength output, better mental
concentration, greater training intensity, pain management, and glandular secretions. All of these areas
are modifiable to at least a measurable degree, and can therefore improve your efforts in the gym. All are
inextricably related to and controlled by your nervous system.

Strength is ultimately controlled by the mind. The strength of

Contraction: The your muscle contraction is modified by both internal and
shortening of a muscle external stimuli, which the CNS interprets on the basis of both
or increase in tension. built-in defense mechanisms (e.g., your muscle spindles and Golgi
tendon organs)
as well as past experience. Strength output then is a voluntary movement, the stimulus for
which originates in your various receptors, interpreted by the brain and called into action by
efferent motor neurons leading from the CNS to your muscles.

What part of this process can be modified to produce greater strength? It is probably true that the
excitation threshold of individual motor units inside your contracting muscles can be altered somewhat, as
can that of the Golgi tendon organs. Heavy training, explosiveness training and full amplitude movements
appear to modify these elements to a measurable degree, thereby improving strength output.

But the greatest source of modification lies in the mind, your brain. How you perceive the weight, how you
approach your training, how you view its importance in impacting the rest of your life and how strongly
you cherish your goals all have a degree of influence on how much you can lift.

23
Endocrine System Endocrine system:
System consisting of
The endocrine system works with the nervous system to maintain the glands and tissues
the steady state of the body. The endocrine system helps regulate that release hormones.
growth, reproduction, use of nutrients by cells, salt and fluid It works with the
balance and metabolic rate. The nervous system is also important nervous system in
in stress regulation. The endocrine system consists of tissues and regulating metabolic
glands that secrete chemical messengers called hormones. activities.

Your Hormones

Various glands that comprise the endocrine system secrete hormones. The two types of hormones,
steroids and polypeptides, diffuse into the blood and course through your body and eventually act upon a
target organ. According to scientists, we have only a minute idea as to what actions each hormone has
individually or how they interact.
Hormones are extremely important in the human body. Every morsel of food you eat, every supplement
you ingest and every training act you perform in the gym is modified in some way by the hormonal
interactions each act instigates. You are virtually captive to your hormones.

A Primer on Hormones

Hormones are made up of amino acids and can be divided into several classes based on their chemical
makeup. The classifications are amino acid derivatives, peptides/protein and steroids. It is the chemical
structure that influences the way in which the hormone is transported in the blood and the manner that it
exerts its effects on the tissue (or muscles). Without delving that deeply into neuroendocrinology, we can
demonstrate how the chemical structure of the hormone will determine how it will exert its effects on the
given tissues. For example, while the lipid-like structures of steroid hormones require that they be
transported bound to plasma protein (to dissolve in the plasma), that same lipid-like structure allows them
to diffuse through cell membranes to exert their effects. These hormones exist in very small quantities in
the blood and are measured in microgram, nanogram, and picogram amounts.

Steroidal hormones are produced from cholesterol in the gonads and the cerebral cortex, while
polypeptide hormones are manufactured in the many other glands (see Table 1.1) from various amino
acid combinations.

Hormones regulate nearly all your bodily functions. They regulate growth and development, help us cope
with both physical and mental stress, and they regulate all forms of training responses including protein
metabolism, fat mobilization and energy production. In a nutshell, they do it all.

It is very important to remember that endocrine function does not function independently of the nervous
system. These two systems act together as synergists in hormonal regulatory functions. Therefore fright,
pain, cold, and all other senses of both environmental and bodily happenings will activate hormonal
responses in a complex array.

Hormones will basically act in three different ways. They can:

1. Alter the rate of synthesis of your cellular protein.

2. Change the rate of enzyme activity.
3. Change the rate of transport of nutrients through the cell wall.

Although the effects that hormones exert directly upon various bodily functions are complicated to
understand, the resultant effects, and indirect effects, are often of greatest concern to a bodybuilder. It is

24
like a cue ball hitting another ball, which in turn, causes yet a third ball to go into the pocket. The cue ball
had a direct effect upon ball number two, but an indirect effect upon ball number three.

Insulin

Insulin is a hormone released from your beta cells in the islets of Langerhans in the pancreas. It increases
cellular uptake of glucose, which in turn causes increased synthesis of muscle glycogen. This leads to a
decrease in blood-borne glucose, which then causes a decrease in insulin production. During prolonged
workouts, blood glucose reduction along with decreased insulin production increases the mobilization of
stored fat.

Thyroid Hormones

Your anterior pituitary is sometimes referred to as the “master gland” because of all the important
hormones it produces. The anterior pituitary releases a substance called thyroid stimulating hormone
(TSH). The thyroid gland, located in your neck, releases two hormones, thyroxine (T4) and
triiodothyronine (T3). The T4 hormone raises the metabolic rate of all cells by as much as four times,
greatly facilitating carbohydrate and fat metabolism. It is believed that over the course of time, careful
eating and exercise patterns can increase your metabolic rate by some sort of “setpoint” calibration
mechanism.

The Adrenal Hormones

Your adrenal glands are comprised of two parts, the cortex (outer
layer) and the medulla (inner), which are important to you. Epinephrine: A
Exercise dramatically increases output of epinephrine which in hormone produced by
turn causes increased blood flow to working muscles, enhanced the adrenal gland that
cardiac output, the mobilization of energy substrate, causes the “flight or
glycogenolysis, fat mobilization and other “gearing up for stress” fight” response.
functions.

Your cortex releases a group of hormones called the adrenocortical hormones (mineralocorticoids,
glucocorticoids and androgens). Your mineralocorticoids — there are three — are comprised chiefly of
aldosterone.

Aldosterone regulates the reabsorbing of sodium in the distal tubules of the kidneys. High levels of
aldosterone cause sodium in the kidneys to be reabsorbed into the blood instead of being excreted with
the urine. Low aldosterone, on the other hand, causes sodium to be excreted in large amounts through
the urine. Therefore aldosterone is responsible for controlling sodium balance in your body, and directly
impacts upon whether you retain water in the interstitial spaces.

High aldosterone causes a rise in extracellular fluid. This condition causes an increase in blood volume,
which in turn causes increased cardiac output and blood pressure. During exercise, there is a constriction
of blood vessels to the kidneys, so the kidneys are forced to release an enzyme called renin into the
bloodstream. Renin then stimulates the release of yet another kidney enzyme called angiotensin, which
stimulates the adrenal cortex to release aldosterone.

Cortisol

Another corticosteroid, cortisol, is of interest in regard to training

Cortisol: A
efforts. Cortisol is catabolic, which means it causes a breakdown
corticosteroid that
of protein in muscles. Increased cortisol secretion also acts as an
causes a breakdown of
insulin antagonist by inhibiting glucose uptake and utilization.
25
High cortisol levels cause the liver to split the fat molecules that
protein in muscles.
are mobilized via cortisol activity into ketoacids. High levels of
ketoacids in the extracellular fluid can cause a dangerous
situation to persist called ketosis. This is a common occurrence Ketosis: An abnormal
among those who have been on a carbohydrate-restricted diet increase of ketone
(such as before a bodybuilding contest, for instance, or to make bodies in the body;
weight in a particular sport). usually the result of a
low-carbohydrate diet,
fasting or starvation.

Psychological Effect

The mind can benefit as much as the body does from exercise. Research in the area of psychology and
physical activity supports a relationship between physical fitness, mental alertness and emotional stability.

An example of this relationship is that improved endurance makes the body less susceptible to fatigue,
and consequently less likely to commit errors, mental or physical. Your performance, whatever your job,
can be sustained longer without the necessity for frequent breaks. People who are physically fit usually
have a better outlook, a little more self-confidence and often do well in whatever their talents and
ambitions prompt them to try.

Conclusion

Through reading this unit you have learned about all of the ten principal systems of the human body and
how exercise positively affects all of these body systems. You have learned that a few of the physiological
benefits of exercise are that it increases blood volume, enlarges blood vessels, increases the number of
blood vessels, lowers resting heart rate, improves minute volume, and helps keep blood linings clear of
corrosive materials. Exercise also reduces peak levels of hyperacidity and its discomforts such as ulcers.
You learned that the three roles of the nervous system are that it senses changes inside and outside your
body, it interprets those changes, and it responds to the interpretations by initiating action in the form of
muscular contractions or glandular secretions. The nervous system is such a complex system that it is not
advised to tamper with its mechanisms.

Unit Summary

Anatomy is the science of body structure. Physiology is the science behind how our body functions.

The biological response is the initial reaction to stress on our body. The training effect is our body’s
response to learned and expected stress. The net result is the ability to perform activities more easily with
less noticeable biological reaction resulting in increased quality of life.

1 The human body consists of levels. Chemicals make up cells, cells associate to form
. tissues, tissues function together in body systems, and these body systems make up the
human body.
A. Cells form the fundamental units of life.
1. Cellular components include the plasma membrane, nucleus,
ribosomes, endoplasmic reticulum, Golgi apparatus, lysosome and
mitochondria.
B. Tissues are the fundamental units of function and structure for the human body.
1. Tissues are defined as the aggregation of cells bound together which work

26
 together to perform a common function and are classified as epithelial tissue,
connective tissue, muscle tissue and nervous tissue.
C. The body can be divided into ten main body systems: integumentary system,
skeletal system, muscular system, nervous system, endocrine system, circulatory
system (of which the lymphatic system is a subsystem), respiratory system,
digestive system, urinary system and the reproductive systems

1. The respiratory system consists of the lungs and air passageways leading to
and from the lungs, mouth, throat, trachea, and bronchi. The respiratory
system supplies oxygen, eliminates carbon dioxide and helps regulate the ph
balance of the body.

2. The circulatory system serves as the transportation system of the body. The
heart, arteries and veins are part of this system. The circulatory system
consists of two subsystems, the cardiovascular system and the lymphatic
system.

a. In the cardiovascular system the heart pumps blood

through a vast system of blood vessels. Blood has
four main constituents: plasma, erythrocytes,
leukocytes and platelets.

b. The heart tissue is mostly muscle. Unlike the lungs,

the heart does its own work. The heart takes
oxygen-laden blood from the lungs and pumps it
throughout the body. Carbon dioxide-laden blood is
taken back from the body and pumped into the
lungs where it is exchanged for more oxygen.

3. The digestive system consists of the digestive tract and glands that secrete
digestive juices into the digestive tract. It is responsible for the breakdown of
foods and waste elimination.

a. The components of the digestive

system are the mouth, esophagus,
stomach, small intestine, large
intestine, rectum, pancreas, liver
and gallbladder.

4. The nervous system is the body’s control center and network for internal
communication. A skeletal muscle cannot contract until it is stimulated by a
nerve impulse.

5. The endocrine system works with the nervous system to maintain the steady
state of the body. The endocrine system helps regulate growth, reproduction,
use of nutrients by cells, salt and fluid balance, and metabolic rate. The
nervous system is also important in stress regulation. The endocrine system
consists of tissues and glands that secrete chemical messengers called
hormones.

27
a. Hormones are made up of
amino acids and can be divided
into several classes based on
their chemical makeup. The
classifications are: amino acid
derivatives, peptides/protein
and steroids.

i. Insulin increases cellular uptake of glucose. Glucagon

performs the opposite function of insulin. Together they
stimulate blood sugar levels in the body.

ii. Growth hormone (HGH or hGH) is the most abundant

hormone produced by the pituitary gland. HGH is the
largest and most complex protein created by the
pituitary gland.

b. The thyroid gland, located in your neck, releases two hormones,

thyroxine (T4) and triiodothyronine (T3).

c. Your adrenal glands are comprised of two parts, the cortex (outer
layer) and the medulla(inner).

Unit 3: Muscle Anatomy and

28
 Physiology

Paul O. Davis, Ph.D., FASCM with portions by Frederick C. Hatfield, Ph.D.

All of our body systems contribute to the dynamic, delicately Musculoskeletal

balanced state of the body. Movement of the body is contingent system: Body system
on the interaction of the muscular system and the skeletal that consists of the
system. These two systems are commonly referred to as the bones, joints,
musculoskeletal system and consist of the bones, the joints, connective tissue, and
the connective tissue and the muscles. muscles.

Muscles alone do not move weights. They function by moving the bones that rotate about
connective tissue. Bones provide structural support and our muscles have the ability to
convert chemical energy into mechanical energy. Joints transmit forces through the bones of
the body to the external environment.

The Skeletal System

The average human adult skeleton has 206 bones joined to ligaments and tendons to form a
supportive and protective framework for underlying soft tissues and muscles. The skeletal
system serves several important functions in the body:

Figure 3-1a

1. Bones serve as levers that transmit muscular

forces.

2. Our skeletal system protects our organs.

3. Our skeletal system serves as a framework for

other tissues and organs.

4. Bones serve as banks for storage and release of

minerals like calcium and phosphorous.

The skeleton consists of the axial and appendicular skeleton. Axial skeleton: Bones

29
There are 80 bones in the axial skeleton, consisting of the skull,
consisting of the skull,
spine, ribs and sternum. There are 126 bones in the
spine, ribs and
appendicular skeleton: 60 in the upper extremities, 60 in the
sternum.
lower extremities, 2 in the pelvic girdle, and 4 in the shoulder
girdle.
Appendicular
skeleton: Bones
consisting of the upper
and lower extremities,
Bones including the pelvic
and shoulder girdles.
Each of these 206 bones consists of three layers: the bone
marrow, compact bone and the periosteum. Within the long bone
is a central marrow cavity known as bone marrow.
The red marrow produces red blood cells, which carry Figure 3-1b
oxygen, white blood cells, which fight infection, and
platelets, that help stop bleeding. Yellow marrow
consists mainly of fat cells. Surrounding the marrow
is a dense rigid bone called the compact bone.
Cylindrical in shape, the dense layers of the compact
bone are honeycombed with thousands of tiny holes
and passages. Nerves and blood vessels run through
these passages that supply oxygen and nutrients to
the bone. This dense layer of compact bone supports
the weight of the body and is comprised mainly of
calcium and minerals. Each bone is covered by the
periosteum, which is a layer of specialized connective
tissue and acts as the skin of the bone. The inner
layer of the periosteum contains cells that produce
bone. These three bone layers work together to
handle the aforementioned skeletal system functions.

The 206 bones that make up the skeleton are divided into two categories, the axial skeleton
(trunk and head) and the appendicular skeleton (arms and legs). These bones also vary in
shape and size. There are five main categories of bones: flat bones, short bones, long bones,
sesamoid bones and irregular bones.

1. Flat bones provide protection and include the

Figure 3-2
ilium, ribs, sternum, clavicle and scapula. They are
usually characterized by a curved surface where it is
either thick at the tendon attachment or very thin.

2. Short bones provide some shock absorption and

include carpals and tarsals. They are usually
characterized as small, cubical shaped, solid bones.

3. Long bones provide structural support and include

the tibia, fibula, femur, radius, ulna and humerus.
Their long cylindrical shaft with relatively wide
protruding ends usually characterizes them.

4. Sesamoid bones provide protection as well as improve

Musculotendinous:
mechanical advantage of musculotendinous units and include

30
units in the patella and the flexor tendons of the toe and thumb.
Of, relating to, or
They are usually characterized as small bones embedded within
affecting muscular and
the tendon of a musculotendinous unit.
tendinous tissue.

5. Irregular bones serve a variety of purposes in the body and include bones throughout the
spine as well as the ischium, pubis and maxilla.
Muscle Anatomy and physiology

Paul O. Davis, Ph.D., FASCM with portions by Frederick C. Hatfield, Ph.D.

All of our body systems contribute to the dynamic, delicately Musculoskeletal

balanced state of the body. Movement of the body is contingent system: Body system
on the interaction of the muscular system and the skeletal that consists of the
system. These two systems are commonly referred to as the bones, joints,
musculoskeletal system and consist of the bones, the joints, connective tissue, and
the connective tissue and the muscles. muscles.

Muscles alone do not move weights. They function by moving the bones that rotate about
connective tissue. Bones provide structural support and our muscles have the ability to
convert chemical energy into mechanical energy. Joints transmit forces through the bones of
the body to the external environment.
The Skeletal System
The average human adult skeleton has 206 bones joined to ligaments and tendons to form a
supportive and protective framework for underlying soft tissues and muscles. The skeletal
system serves several important functions in the body:
Figure 3-1a

1. Bones serve as levers that transmit muscular

forces.

2. Our skeletal system protects our organs.

3. Our skeletal system serves as a framework for

other tissues and organs.

4. Bones serve as banks for storage and release of

minerals like calcium and phosphorous.

31
The skeleton consists of the axial and appendicular skeleton. Axial skeleton: Bones
There are 80 bones in the axial skeleton, consisting of the skull, consisting of the skull,
spine, ribs and sternum. There are 126 bones in the spine, ribs and
appendicular skeleton: 60 in the upper extremities, 60 in the sternum.
lower extremities, 2 in the pelvic girdle, and 4 in the shoulder
girdle. Appendicular
skeleton: Bones
Bones consisting of the upper
and lower extremities,
Each of these 206 bones consists of three layers: the bone including the pelvic
marrow, compact bone and the periosteum. Within the long bone and shoulder girdles.
is a central marrow cavity known as bone marrow.
The red marrow produces red blood cells, which carry Figure 3-1b
oxygen, white blood cells, which fight infection, and
platelets, that help stop bleeding. Yellow marrow
consists mainly of fat cells. Surrounding the marrow
is a dense rigid bone called the compact bone.
Cylindrical in shape, the dense layers of the compact
bone are honeycombed with thousands of tiny holes
and passages. Nerves and blood vessels run through
these passages that supply oxygen and nutrients to
the bone. This dense layer of compact bone supports
the weight of the body and is comprised mainly of
calcium and minerals. Each bone is covered by the
periosteum, which is a layer of specialized connective
tissue and acts as the skin of the bone. The inner
layer of the periosteum contains cells that produce
bone. These three bone layers work together to
handle the aforementioned skeletal system functions.
The 206 bones that make up the skeleton are divided into two categories, the axial skeleton
(trunk and head) and the appendicular skeleton (arms and legs). These bones also vary in
shape and size. There are five main categories of bones: flat bones, short bones, long bones,
sesamoid bones and irregular bones.

1. Flat bones provide protection and include the

Figure 3-2
ilium, ribs, sternum, clavicle and scapula. They are
usually characterized by a curved surface where it is
either thick at the tendon attachment or very thin.

2. Short bones provide some shock absorption and

include carpals and tarsals. They are usually
characterized as small, cubical shaped, solid bones.

3. Long bones provide structural support and include

the tibia, fibula, femur, radius, ulna and humerus.
Their long cylindrical shaft with relatively wide
protruding ends usually characterizes them.

32
 4. Sesamoid bones provide protection as well as improve
Musculotendinous:
mechanical advantage of musculotendinous units and include
Of, relating to, or
units in the patella and the flexor tendons of the toe and thumb.
affecting muscular and
They are usually characterized as small bones embedded within
tendinous tissue.
the tendon of a musculotendinous unit.
5. Irregular bones serve a variety of purposes in the body and include bones throughout the
spine as well as the ischium, pubis and maxilla.
Joints

A joint, or articulation, is formed when two bones connect. There are two major classifications of joints:
synarthrodial (a joint with no separation or articular cavity, such as the skull) and diarthrodial (a freely
movable joint with an articular cavity).

Joint: Point where two A diarthrodial (freely movable) joint has an articular cavity encased in a
bones connect. ligamentous capsule. Synovial fluid lubricates the smooth cartilage
inside the capsule. Diarthroidal joints are classified in six categories:
Synovial fluid: A fluid arthroidial (gliding) joint, condyloidal (biaxial ball-and-socket) joint,
that lubricates the smooth enarthrodial (multiaxial ball-and-socket) joint, giglymus (uniaxial hinge)
cartilage in joints. joint, sellar (saddle) joint and trochoidal (pivot) joint.

Figure 3-3
1. Arthrodial (gliding) joints permit limited gliding
movement and include bones of the wrist and the
tarsometatarsal joints of the foot. They are
characterized by two flat, bony surfaces that press
up against each other.

2. Ginglymus (hinge) joints permit a wide range of

movement in one plane. Examples of hinge joints are
the elbow, ankle and knee joint.

3. Condyloidal (ellipsoid) joints permit movement in

two planes without rotation and include the wrist
between the radius and the proximal row of carpal
bones and the second, third, fourth and fifth
metacarpophalangeal joints.

4. Enarthrodial (multiaxial ball-and-socket) joints permit movement in all planes and include the shoulder
and hip joints.

5. Sellar (saddle) joint permits ball-and-socket movement with the exception of rotation. The thumb is the
only saddle joint in the body and is capable of reciprocal reception.

6. Trochoidal (pivot) joints permit rotational movement around a long axis as with the rotation of the
radius at the radioulnar joint.

33
Connective Tissue

The primary function of dense connective tissue is to connect muscle to bone and to connect joints
together. Comprised of fiber called collagen, mature tissue has

fewer cells than other tissues and

therefore, needs (and receives) less blood Collagen: Fibrous protein that forms tough connective
and the oxygen and other nutrients found tissue.
in it.

Each collagen bundle is comprised of several fibers, which, in turn, contain several fibrils. These fibrils
contain the actual collagen molecules, which are triple helix in structure.

Muscular System

All body movements from walking, running, and even circulating blood depend upon the actions of
muscles. Some 600 muscles work together with the support of the skeletal system to create motion. An
additional 30 or so muscles are required to insure the passage of food through the digestive system, to
circulate blood, and to operate specific internal organs. In exercise physiology, muscles are the main
operative tissue, expending energy, generating wastes, and requiring substantial nutrition. Muscles differ
in appearance when observed under the microscope because of their underlying cellular structure. Two
appearances are recognized: striated muscle tissue and smooth muscle tissue. Based on functional and
structural differences, muscle tissue is divided into three types (skeletal, cardiac, and smooth).

Muscular tissues

Cardiac Muscle Tissue

Cardiac muscle tissue (striated-involuntary muscle tissue) composes the wall of the heart. It functions to
contract the heart and pump blood through body. Cardiac muscle cells are often branched and their nuclei
are more centered than with skeletal muscle cells. They have a tendency to branch and fuse into each
other. Fortunately, cardiac muscle tissue does not fatigue easily; the period of rest in between
contractions is all it needs. Even during periods of intense exercise, it is the skeletal muscles that fatigue
first.

Smooth Muscle Tissue

Smooth muscle tissue (smooth-involuntary muscle tissue) is found in walls of the tubular viscera of
digestive, respiratory, and genitourinary tracts; in walls of blood vessels and large lymphatics; in ducts of
glands; in intrinsic eye muscles (iris and ciliary body); and in erector muscle of hairs. It functions to move
substances along their respective tracts, change diameter of blood vessels, move substances along
glandular ducts, change the diameter of pupils and shape of lens, and erect hairs. Like cardiac muscle
tissue, smooth muscle tissue cells are elongated, but differ in having pointed ends and only one nucleus
per cell. They contract more slowly than striated muscle and therefore do not fatigue easily.

34
Skeletal Muscle Tissue

Skeletal muscle tissue (striated-voluntary muscle tissue) is found attached to bones, in extrinsic eyeball
muscles, and in the upper third portion of the esophagus. Skeletal muscle tissue functions to move the
bones and eyes. It also moves food during the first part of swallowing. Skeletal muscle tissue is made up
of long muscle cells (muscle fibers) that bear the unique characteristic of containing many nuclei, called
multi-nucleate. Characteristically, skeletal muscle tissue cannot sustain prolonged all effort contractions,
as they easily fatigue. Our main focus will be on the skeletal muscles, which are the voluntary muscles
attached to bones.

Reference Positions

As trainers we need a foundation to develop an understanding of the musculoskeletal system, its planes of
motion, joint classifications and joint movement. The anatomical position is the most widely used
reference point for analyzing the body. The anatomical position is one in which the individual is in an
upright position, facing straight ahead, feet parallel and palms facing forward.

Table 3-1: Anatomical Directional Terminology

Anterior In front or in the front part

Anteroinferior In front and below

Anterolateral In front and to the side, especially the outside

Anteromedial In front and toward the inner side or midline

Anteroposterior Relating to both front and rear

Caudal Below in relation to another structure; inferior

Cephalic Above in relation to anotherstructure; higher, superior

Contralateral Pertaining or relating to the opposite side

Beneath or below the surface; used to describe relative depth or

Deep
location of muscles or tissue

Situated away from the center or midline of the body, or away from
Distal
the point of orgin.

Dorsal Relating to the back; posterior

Inferior (infra) Below in relation to another structure;caudal

Ipsilateral On the same side

On or to the side; outside, farther from the median or midsagittal

Lateral
plane

Relating to the middle or center; nearer to the medial or midsagittal

Medial
plan

35
Posterior Behind, in back, or in the rear

Posteroinferior Behind and below; in back and below

Posterolateral Behind and to one side, specifically to the outside

Posteromedial Behind and to the inner side

Posterosuperior Behind and at the upper part

Prone The body lying face downward; stomach lying

Proximal Nearest the trunk or the point of origin

Near the surface; used to describe relative depth or location of

Superficial
muscles or tissue

Superior (supra) above in relation to another structure; higher, cephalic

Supine Lying on the back; face upward position of the body

Ventral Relating to the belly or abdomen

Volar Relation to palm of the hand or sole of the foot

Muscle Terminology

Locating muscles and knowing their relationship to the joints is critical in understanding the
effects muscles have on joints. When a muscle contracts it tends to pull both ends toward
the middle or belly of the muscle. If neither of the bones to which a muscle is attached were
stabilized, then both bones would move toward one another during contraction. However in
our bodies one bone is more stabilized by a variety of factors which results in the less
stabilized bone moving during contraction. The
points of attachment are known as the insertion
and the origin of the muscle. Origin: The proximal
attachment; generally
Origin considered the least
moveable part or the
The origin is the proximal attachment. This is part that attaches
generally considered the least moveable part or closest to the midline
the part that attaches closest to the midline or or center of the body.
center of the body.
Insertion: The distal
Insertion attachment; generally
considered the most
The insertion is the distal attachment. This is moveable part or the
generally considered the most moveable part or part that attaches
the part that attaches furthest from the midline furthest from the
or center of the body. midline or center of the
body.

36
Table 3-2a: Shoulder Muscles

Relating to Shoulder Girdle

Muscle Orgin Insertion Action Innervation

Upper: base Upper: Upper: Upper: accessory nerve (cranial nerve XI

of skull, posterior scapula and branches of C3, C4)
occipital aspect of elevation
protuberance the lateral and Middle: accessory nerve (cranial nerve XI
and clavicle extension of and branches of C3, C4)
posterior the head at
ligaments of Middle: neck Lower: accessory nerve (cranial nerve XI
neck medial and branches of C3, C4)
border of Middle:
Middle: the elevation,
spinous acromion upward
Trapezius
process of process rotation and
7C and T1- and upper adduction of
T3 boarder of scapula
acromion
Lower: Lower:
spinous Lower: depression
process of base of adduction,
T4-T12 scapular upward
spine rotation of
(triangular the scapula
shape

Above
base of Elevates
Transverse
Levator scapular medial Dorsal scapula nerve C5 and branches of C3
process of
scapulae spine on margin of and C4
C1-C4
medial scapulae
boarder

(retraction)
draw
Medial scapula
Spinous
boarder of toward
process of
Rhomboid scapula spinal Dorsal scapula nerve (C5)
C7 and T1-
below column
T5
spine (downward
rotation)
(elevation)

37
 (protraction)
Anterior
draws
aspect
medial
Surface of along
border of
Serratus upper 9 ribs entire
scapulae Long Thoratic Nerve (C5-7)
anterior at side of length of
away from
chest medial
vertebrae
boarder of
(upward
scapula
rotation)

(protraction)
draws
Anterior Coracoid scapula
Pectoralis
surfaces3rd process of forward Medial pectoral nerve (C8-T1)
minor
to 5th ribs scapula (downward
rotation)
(depression)

Muscle Structure and Function

Muscles are largely composed of protein, with a hierarchical system of organization from large groups to
small fibers. A muscle is a group of motor units that are physically separated by a membrane from other
groups of motor units. A muscle is connected to bones through tendons. See Figure 3-9 on the following
page for a diagram of muscle composition.

A motor unit consists of a single neuron and all of the muscle fibers innervated by it. The ratio of nerves to
fibers determines the fine motor control available to that muscle. For example, the hand has fewer fibers
per motor unit than do the muscles of the calf.

The muscle fiber is Figure 3-9

composed of myofibrils,
which are small bundles of
myofilaments.
Myofilaments are the
Myofilaments: The
elements of the muscle that
elements of the muscle
actually shorten upon
that actually shorten
contraction. Myofilaments
upon contraction;
are made up mainly of two
made up mainly of two
types of protein, myosin
types of protein: actin
(short, thick filaments) and
and myosin.
actin (long, thin filaments).
Two other important
Myosin: Short, thick proteins comprising
contractile filaments. myofibrils are troponin and
tropomyosin, involved in the
Actin: Long, think contractile response.
contractile filaments.

38
 The main function of muscle tissue is contraction. This contraction
of muscle can be brought about by either involuntary or voluntary
Voluntary muscles
stimuli. Voluntary muscle tissues receive nerve fibers from the
tissues: Receives
somatic nervous system. Therefore, their contraction can be
nerve fibers from the
voluntarily controlled. Skeletal muscles are the major voluntary
somatic nervous
muscle tissue. Involuntary muscle tissues receive nerve fibers
system that can be
from the autonomic nervous system and cannot be voluntarily
voluntarily controlled.
controlled, except in a few rare cases. The eternal pump, the
(e.g., skeletal muscles)
heart, is an example of an involuntary muscle tissue.

Involuntary muscle
With few exceptions, single muscles never contract by
tissues: Receive nerve
themselves. Rather, specific sets of muscles contract together or
fibers from the
in sequence. The production of complex movements responsible
autonomic nervous
for even the simplest of tasks is dependent upon a
system and cannot be
correspondingly subtle control mechanism. This is the
voluntarily controlled,
responsibility of the nervous system, which neutralizes the actions
except in a few rare
of muscles that are not required and causes the contraction of
cases. (e.g., the heart)
muscles that are required. The spinal cord and brain exercise this
control through the motor nerve fibers.
Figure 3-10 Each muscle cell does not have an individual line from the CNS (central nervous
system). Impulses travel down the nerve axon from the CNS, branching off to supply
a group of muscle cells, which contract together. In order to coordinate muscular
movement, the CNS must be supplied with information about the length of the muscle
and the tension of the tendons, which attach it to the skeleton. This information is
provided by special sense organs called “muscle spindles” which measure the strain in the
be used to pre-set the tension of muscles.

Muscle spindles: Special

sense organs that
measure the strain in the
muscle and can be used to
pre-set the tension of
muscles.

Skeletal muscles must contract rapidly in response to signals from the CNS, and they must develop
adequate tension at the same time to produce an effective mechanical force. Examination of skeletal
muscle reveals a junction between the nerve fiber and the muscle surface. The surface acts as an
amplifier, increasing the effect of the tiny current coming down the nerve fiber to stimulate the larger
muscle fiber. The arrival of the nerve impulse triggers the release of a chemical called acetylcholine from
the motor nerve ending. This passes across the gap to stimulate the membrane of muscle fiber. This
stimulation, in the form of an electric current, passes along the surface of the muscle and causes it to
contract. It takes only 1/1000th of a second for the current to pass along the surface of the muscle fiber.
The fiber releases unless yet another impulse arrives. If this chemical mechanism is blocked, the result
would be paralysis.

39
Figure 3-6a:
Major muscles of the human body: anterior
view

Figure 3-6b:
Major muscles of the human body: posterior
view

Figure 3-7a:
Upper arms

Figure 3-7b:
Forearms

40
 Figure 3-7c:
Shoulders/deltoid

The Size Principle of Fiber Recruitment

Force output of muscle is related to the stimulus it receives.

Recalling from Table 2.3, different muscle fibers have different Size Principle of
liability to recruitment with Type I fibers having the highest Fiber Recruitment:
liability, Type IIa and IIc having a moderate liability and Type Principle stating that
IIb having a low level of liability. The Size Principle of Fiber fibers with a high level
Recruitment (also called the Henneman Principle) states that of reliability are
fibers with a high level of reliability are recruited first; those recruited first; those
with lower levels of reliability are recruited last. According to the with lower levels of
size principle,motor units are recruited in order according to reliability are recruited
their recruitment thresholds and firing rates. Since most last.
muscles contain a range of Type I and Type II
fibers,force production can be very low or very high. Therefore, to get to a high-threshold
motor unit, all of the motor units below it must be sequentially recruited. Picking up the
phone versus curling a 75-pound dumbbell exemplifies this principle. The lower threshold
motor units are recruited to pick up the phone while the higher threshold motor units are
recruited to curl a 75-pound dumbbell.

Neuromuscular Concepts

The “All-or-None” Theory

When a nerve carries an impulse of sufficient magnitude down to

the muscle cells that comprise the motor unit, the myofibrils do All-or-none reaction:
the only thing they know how to do — contract, or shorten. Each Concept stating that a
myofibril does not do this by degrees, but rather contracts totally. unit is either
It responds with an all-or-none reaction. In other words, a unit completely relaxed or
is either completely relaxed or fully contracted. It is never partly fully contracted; it is
contracted. A muscle fiber (including myofibrils) and its never partly
corresponding motor unit respond to a nerve stimulus with the contracted.
all-or-none reaction.

However, not all of the motor units comprising a muscle are activated during any given movement. You
are able to exercise a gradation of response by increasing or decreasing the amount of chemo-electrical
impulse to the muscle. That’s why you can lift a fork to your mouth or curl a heavy dumbbell. Both are
similar movements, but curling a fork involves only those motor units with a very low excitation threshold;
curling the dumbbell requires many more motor units.

41
 Stretch reflex: A
The Stretch Reflex
built-in protective
function of the
neuromuscular system The stretch reflex is a built-in protective function of the
in the muscle spindle. neuromuscular system in the muscle spindle, a proprioceptor
found in the belly of a muscle. In contrast to the Golgi tendon
organ, which is in series with the force plane of the muscle, the
Proprioceptor:
muscle spindle is in parallel with the force plane. The action is
Specialized sensory
similar to that of the Golgi tendon organ in that it protects
receptors located in
against overload and injury in what is known as the “stretch
tendons and muscles
reflex” action (example: the knee-jerk response used by
sensitive to stretch,
physicians to test your muscle’s response adequacy).
tension, and pressure.

The stretch reflex serves as a regulatory mechanism that enables the muscle to adjust automatically to
differences in load and length without having to receive messages from higher order centers (your brain)
of the nervous system. Other proprioceptors are located in and around all the joints of the body. These
sensors provide constant information to the nervous system regarding the special relationship of the joint
to the rest of the body: movement, position, speed, etc.

Adaptations to Training
Exercise will stimulate a series of metabolic responses that affect
the body’s anatomy, physiology, and biochemistry. The
Anatomy: The science
magnitude of changes is driven primarily by whether the exercise
of the structure of the
is anaerobic or aerobic. The type and duration of exercise will
human body.
physically stimulate muscles to develop more fast or slow twitch
muscle fibers, and in turn dictate the primary energy mix used.
Physiology: The
High intensity exercise simulates fast twitch muscle fiber
science concerned with
development, while low intensity exercise results in slow twitch
the normal vital
muscle fiber development. There are also a series of hormonal
processes of animal
changes that occur on an overall basis during exercise and during
and vegetable
non-exercising periods. These changes also are benefited and
organisms.
facilitated with a nutrient profile that matches the type of
metabolic flux.

Aerobic Adaptations

Aerobics, whether it be aerobic endurance training or some form of cardiovascular work on a treadmill,
stepper, or bike, has numerous benefits, from fat burning to cardiovascular health to improved recovery
abilities. Many trainees may stay away from aerobics fearing that it will result in muscle loss. This muscle
loss is usually a direct result of an inadequate supply of calories to sustain the aerobic work rather than
the aerobics itself. A bodybuilder who loses muscle during a period of aerobic training is not eating enough
to compensate for the calories expended.

Aerobics forces oxygen through your body, increasing the number and size of your blood vessels. Blood
vessels transport oxygen and nutrients to muscles and carry waste products away for muscular growth,
repair and recovery. Without aerobics in your training program your body cannot create any new supply
routes for your newly developed muscles. Type I fibers are said to possess an oxidative capacity greater
than that of Type II fibers both before and after training. Whereas strength and hypertrophy training
produce somewhat similar muscular adaptations, aerobic training adaptations are different. There may be
a gradual conversion of Type IIb fibers to Type IIa fibers. This type of adaptation is significant because
Type IIa or fast oxidative glycolytic fibers possess as greater oxidative capacity than Type IIb fast
glycolytic fibers, as well as being more similar characteristically to Type I fibers. The result is a greater
number of muscle fibers that can contribute to endurance performance.
42
Some important metabolic changes take place inside the body through aerobic training. First at the
cellular level, aerobic exercise adaptations include an increase in the size and number of mitochondria and
greater myoglobin content. Mitochondria (cellular furnaces where fat and other nutrients are burned) are
the organelles in cells that are responsible for aerobically producing ATP via oxidation of glycogen. When
the larger and more prevalent mitochondria are combined with an increase in the quantity of oxygen that
can be delivered to the mitochondria through higher levels of myoglobin, the aerobic capacity of the
muscle tissue is enhanced.

Second, aerobic exercise appears to increase levels of myoglobin.

Myoglobin is a protein that transports oxygen from the ATP: Adenosine
bloodstream into the muscle fibers. Finally, this adaptation triphosphate; an
increases the level and activity of the enzymes involved in the energy-storing
aerobic metabolism of glucose. Larger mitochondria in greater compound found in
numbers, increased levels of aerobic enzymes, coupled with cells, which release
increased blood flow all boosts the fat burning capabilities of the energy when needed
muscle fibers. by the body.

Anaerobic System Changes CP: Creatine

phosphate; a high-
Anaerobic training greatly increases the body’s functional capacity energy phosphate
for development of explosive strength and maximization of short- molecule that is stored
term energy systems. Some of the major changes measured as a in cells and can be
result of anaerobic exercise include an increased size and number used to immediately
of fast twitch muscle fibers. In addition, anaerobic work results in resynthesize ATP.
an increased tolerance to higher levels of blood lactate, an
increase in enzymes involved in the anaerobic phase of glucose Creatine: Organic acid
breakdown (glycolysis) and an increase in muscle resting levels of generally found in the
ATP, CP, creatine, and glycogen content. Finally, anaerobic muscle as
changes include an increase in growth hormone and testosterone phosphocreatine
levels after short bouts (45 to 75 minutes) of high intensity (creatine phosphate)
weight training. Growth hormone and testosterone in addition to that supplies energy
insulin and insulin-like growth factor-1 are the four hormones that for muscle contraction.
are directly responsible for muscle hypertrophy.

Hypertrophy

There are several points of interest to the athlete. The first is that when you train, the intensity and
duration will influence the physiology of muscle tissue and development of muscle fibers. The long
distance runner tends to develop slow twitch muscle fibers, while the powerlifter develops fast twitch
muscle fibers. One reason the fast twitch muscle fibers increase in size is to increase the capacity to store
more adenosine triphosphate and creatine phosphate (ATP and CP). ATP and CP are needed for explosive
energy that lasts only a few seconds. The second reason is that the physiological conditioning of muscle
tissue determines which fuel source is used. Power athletes need more muscle glycogen to fuel their
muscles, while endurance athletes need both muscle glycogen and fatty acids.

Muscular Hypertrophy

Muscular hypertrophy is simply the increase in the size of

Hypertrophy: An
muscle fibers. Muscle fibers increase in size in response to
increase in the cross-
adaptive overload stress. Adaptation takes place in several ways.
sectional size of a
The principal mechanism for muscular hypertrophy is by individual
muscle in response to
muscle cells increasing the number of their myofibrils. This
probably occurs as a result of increased amino acid transport into

43
the cells (caused by tension), which enhances their incorporation
strength training.
into contractile protein. However, muscle hypertrophy also occurs
as a result of proliferation (in size and number) of mitochondria,
myoglobin (storage protein), extracellular and intracellular fluid, Capillarization: An
capillarization (tiny blood vessels surrounding cells), and fusion increase in size and
between muscle fibers (principally Type IIb) and surrounding number of tiny blood
satellite cells. vessels surrounding
cells.

In addition to increasing the size of the muscle fibers, increasing

Hyperplasia: An the number of muscle fibers also seems to be a logical
increase in number of mechanism of muscle growth. Increasing the number of muscle
cells in a tissue or cells is called “hyperplasia” and its occurrence is a topic of
organ, excluding tumor heated scientific controversy. Researchers have reported the
formation, whereby possibility of fiber splitting in their research reports (longitudinal
bulk of the part or division of muscle fibers resulting in new muscle cells). But some
organ may be researchers have criticized the methodology used in their
increased. studies, and the issue remains unresolved, probably until visual
evidence of the
phenomenon is available. Healthy weight gain programs should promote increases in muscle
mass (hypertrophy) and only increase body fat mass to the correct percentage for health
and performance. More details will be covered in the nutrition section of this text.

Controversial Theories

One of the more controversial theories of muscle adaptation focuses on changes in fiber type distribution.
Whether one muscle fiber type can change to another has been shown in certain studies but not in others.
Furthermore, sports scientists have often argued whether changes take place or merely a fiber takes on
different characteristics closer to another fiber type.

Several studies have suggested that a Type II fiber can change to or take on characteristics of a Type I
fiber with increased endurance activity. This seems highly reasonable in that endurance training has been
shown not to increase (and may even decrease) the amount and size of heavy-chain myosins as well as
increase mitochondial density. With this training, even the powerful Type II fibers will decrease in maximal
power output.

It is also widely held that Type I fibers cannot change to Type II fibers. However, studies have shown that
in training above the anaerobic threshold, Type I fibers decreased while Type II (especially Type IIc)
increased. Rival studies suggest that in such training, an increase in Type II fiber area is possible, as
opposed to actual fiber conversion.

Type IIb to Type IIa or IIc fiber conversion is also a possibility (as discussed earlier in this unit). Studies
have shown that untrained subjects have 16% of their total muscle mass in Type IIb fiber type. However,
after one week of training, this 16% disappeared. Other studies have shown that Type IIb fiber
distribution decreases with training while Type IIa distribution increases (with little change in Type I or
IIc). Not many studies have specifically looked at Type IIb or Type IIc fibers. However, if such Type IIb
fiber conversion is possible in any aspect, it must involve keeping the muscle cell from destroying itself
(recall that Type IIb fibers produce an extremely high amount of force) and cortisol must be blocked
before such conversions are possible.

44
Conclusion

The reasoning behind discussing these three systems of the individual’s body in one unit is simple. The
body works in harmony; every system is vital to growth and development. However, the tissues of the
neuromuscular system (from the brain to the tendons and ligaments) produce movement. The brain
controls all, the central and peripheral nervous system delivers the message, the muscles produce the
force and the connective tissues (particularly the tendons) regulate it. Teach the brain to ask for more and
it will. Allow the rest of the nervous system to deliver more and it will. Demand the muscles to produce
more and they will. Finally, ask the tendons and ligaments to allow more and they will.

Of course, it will take an integrated approach to training and you will have to ask much of your recovery
abilities to optimize training. The respiratory system will have to deliver more oxygen. The digestive
system will have to process more nutrients. The cardiovascular system will have to deliver the oxygen and
nutrients (as well as take away waste products). The endocrine system will have to do a better job at
regulating hormonal output to allow better utilization of energy and encourage tissue growth.

45
 Section Two: Kinesiology and
Biomechanics
Introduction

As ISSA trainers and, more importantly, fitness educators, we

should know how movement impacts posture, body mechanics, Kinesiology: The
and body musculature. Regardless of student motivation science or study of
(improving physique, strength, endurance, and muscle tone), a movement, and the
basic understanding of kinesiology and biomechanical principles active and passive
plays an important role in establishing fitness-training programs structures involved.
for beginners.
Kinesiology is the study of human motion and deals mainly with the muscles and muscle
functions. It describes movement, which muscles are involved in the movement, and how
they are involved. It
explores the muscular involvement in strength exercises and
Biomechanics: The sports technique while biomechanics looks at the physical
study of the factors involved in the movement. By applying basic scientific
mechanical aspects of laws it is possible to come up with accurate descriptions not only
physical movement, of what should take place in the exercise, but also the role that
such as torque, drag, each key joint action and muscle plays. Thus by studying the
and posture, that is physical characteristics of the human body and the principles of
used to enhance mechanical physics, you can better guide workouts. You will also
athletic technique. have the basis for selecting and using specific exercises to
produce the results desired.

Biomechanics is the study of movement, more specifically, the movement involved in a

strength exercise, or in the execution of a sports skill. It deals mainly with physical factors
such as speed, mass, acceleration, levers and force and the physical functions of the
movement. Some think of biomechanics as the science of movement based on principles
derived from physics and anatomy. It explains the why of a movement and how the
movement can be improved through scientifically-based modifications.

Biomechanics and kinesiology help to determine what exercises a person should do, how the
workouts should be conducted, how effective exercise execution is and if the exercises you
use are safe. Biomechanics shows you the way to do exercises most effectively while
kinesiology tells you exactly which muscles are involved in the particular actions that take
place in the exercise. As fitness educators we should be concerned not only with various
techniques of movement, but also how movement impacts posture, body mechanics, and
body musculature. Regardless of student motivation (improving physique, strength,
endurance, or muscle tone), a basic understanding of biomechanical principles plays an
important role in establishing fitness programs for beginners.

46
Unit 4: Kinesiology

Fred Hatfield, Ph.D., MSS & Michael Yessis, Ph.D.

Proper exercise selection plays an important role in the overall process of program development. However,
before going into a detailed analysis of exercises and the muscles involved it is necessary to have a good
understanding of how our muscles function. It is important to have a solid comprehension of the various
types of muscular contractions, as well as the different dynamic and static regimes in which the muscles
must operate during execution of strength and explosive exercises. This will enable you to effectively
evaluate both your own and your clients’ exercises and exercise execution.

Types of Muscle Contractions

Concentric Contraction

In a concentric contraction the muscles

shorten to produce movement. It is
sometimes known as overcoming
strength. In other words, when the
muscle contracts, it overcomes the
resistance and the cause of the
resistance is set into motion. An example
is the biceps curl. When you contract the
biceps and other elbow flexor muscles
you get movement of the forearm, which
raises the weight held in the hand.
Concentric strength is usually measured
by the maximum amount of weight that
can be overcome in one repetition.
Figure 4-1: Types of muscle actions. Two types of isotonic
actions are concentric (force overcomes resistance) and
eccentric or negative (resistance overcomes force).
Isometric (opposing forces are equal) muscle action occurs
when the muscle attempts to shorten against an unyielding
opposing force.

Eccentric Contraction

In an eccentric contraction (often known as a yielding contraction), the muscle lengthens (stretches) as it

47
contracts. The more the muscle lengthens or the faster it is stretched, the greater the tension that is
developed. The eccentric contraction plays a very important role in controlling and stopping movement
and in preparing the muscles for an explosive type contraction. For example, in the biceps curl exercise,
when you return to the initial position, the same muscles are involved and they remain under contraction
as they lengthen when you lower the weight. Since gravity is the force involved in lowering the weight,
the eccentric contraction counteracts the pull of gravity to guide the movement. The intensity of the
contraction depends on the resistance being handled. In a ballistic movement, as the muscle lengthens it
increases in the intensity of its contraction. When it is strong enough, it stops the movement. The
eccentric contraction can generate up to 50% greater tension than the concentric. This is why the
eccentric contraction is so powerful not only in controlling and stopping movement, but also in generating
sufficient tension in the muscles for them to contract explosively.

Isometric Contraction

In an isometric contraction you exhibit strength but there is no movement of the limbs. The
muscle develops tension and there is some shortening of the muscle fibers and tendons, but
there is no limb or body movement. This type of contraction is seen in the stabilization of a
joint or body as
when you hold a particular position to execute an
Stabilization: The act
exercise. You can generate approximately 20% greater
of being stable or
strength in an isometric contraction than you can in a
balanced.
concentric contraction.

Antagonist: When executing a strength exercise, all three of the muscle

Something opposing or contractions are involved. As you perform a movement, the main
resisting the action of muscles undergo a concentric contraction while the antagonist
another. muscles undergo an eccentric contraction. The adjacent

parts of the body that are not in use are stabilized via the isometric contraction. Thus, all
three operate simultaneously, each with a very important purpose. See Figure 4-1.

Muscle Roles

Prime Mover or Agonist

Prime mover: Main
muscle involved in a
A muscle is called a prime mover or agonist when it is the main
concentric contraction.
muscle involved in a concentric contraction. Thus in the biceps
curl the biceps brachialis and brachioradialis are agonists for
Assistant mover:
elbow flexion. Also, many muscles are prime movers in more than
Muscle that plays a
one action. For example, the biceps is also the prime mover in
secondary role to the
forearm supination.
prime mover involved.
Assistant Mover
Agonist: Denoting a
muscle in a state of
An assistant mover usually plays a secondary role to the prime contraction, with
mover muscles involved. However, secondary muscles sometimes reference to its
play a main role in certain ranges of motion or exercises. An opposing muscle, or
example is the pronator teres in elbow flexion. It is a prime mover antagonist.
in pronation and an assistant in elbow flexion. Usually secondary

48
or assistant muscles are not as powerful in the movement as the
main agonists or prime movers.

Antagonist

An antagonist muscle is one which has an action directly opposite to that of the agonist. When an agonist
undergoes a concentric contraction, an antagonist undergoes an eccentric contraction to guide the
movement and to stabilize the joint. As the movement goes through the full range of motion, the
antagonist muscle develops greater tension and stops the movement before it goes beyond the normal
ROM.

It should also be noted that the role of antagonist and agonist can change depending upon the action
taking place. For example, in the biceps curl, the biceps is a prime mover while the triceps is the
antagonist. When the triceps is involved in elbow extension it becomes a prime mover and the biceps
becomes its antagonist. Thus we see how the muscles can serve different functions. See Figure 4-2.

During a muscular
Co-contraction: When both contraction,
the agonist and antagonist especially when the
undergo contraction. weights are very
heavy, both
the agonist andantagonist undergo contraction
(known as co-contraction). This is needed to
stabilize or hold the joint in place while the action
occurs. When the resistance is very light, the agonist
and antagonist are not strongly contracted. The
antagonist undergoes a strong eccentric contraction
mainly to slow down and stop movement before there
is injury to the joint. When the weights are very
heavy and both agonist and antagonist are under
contraction, the antagonist contracts eccentrically Figure 4-2: Biceps curl.
and lengthens to make the movement possible.

Types of Movements

A muscle can contract with different amounts of force and in different ways to produce different types of
movement. This includes:

Sustained Force Movement

Sustained force movement is movement in which there are continuous muscle contractions to keep
moving a weight. In other words, the prime muscles involved throughout the ROM apply force. It is
usually seen in the slow lifting of a heavy weight and usually involves co-contraction of the antagonists.
Sustained force can apply to holding a weight with no movement (isometric contraction).

Ballistic Movement

Ballistic movement is movement in which there is inertial movement after an explosive or quick,
maximum-force contraction. Usually there is pre-tensing of the muscle in the eccentric contraction so that
the muscle can contract concentrically with maximum speed and quickness. The weight is put into
acceleration and continues movement on the momentum generated. No additional force has to be applied
to keep the limb or object in motion. To stop the movement there is deceleration due to gravity and/or to
the eccentric contraction of the antagonist muscles. The tension the antagonists develop as the ROM
49
increases becomes strong enough to stop the moving limb. If there is no stopping of the limb, the weight
must be released before you can go into a follow-through phase to dissipate the forces and come to a
complete stop.

Guided Movement

Guided movement is movement that occurs when both the agonist and the antagonist contract to control
the movement. Guided movement is seen most often in fine skills such as when you are writing or when
you must move a limb through a specific movement pattern. Very important here is the eccentric
contraction of the antagonist muscles since they are responsible for most of the guiding work. The prime
movers are responsible for putting and keeping the limb in motion.

Dynamic Balance Movements

Dynamic balance movements are movements in which there are constant agonist-antagonist muscle
contractions to maintain a certain position or posture. For example, if you stand on one leg you will not be
able to stand perfectly still since there are constant slight correctional movements of the body. For
example, as you begin to lose balance in one direction, the antagonists contract to pull you back into
position. The pull will usually take you slightly beyond the beginning position, at which time the muscles
on the opposite side contract to bring you back in alignment. Thus there are constant low-level
contractions to keep you in a posture or in balance.

Unit 5: Biomechanical Concepts of Exercise

Biomechanics

Knowledge of joints, muscle structure, and their possible actions lead to a better
understanding of what occurs during the execution of strength and other exercises. In
addition, it is necessary to understand the mechanical and physical factors involved in
exercise and movement, which determine both how effectively and safely the exercise is
executed. On the following pages,
brief descriptions of some of the key concepts derived
from biomechanics are brought out. Examples of Biomechanics: The
specific exercises are used where applicable but will study of movement.
be discussed in detail in Unit 8.

Stability

Maintaining a stable (balanced) body is necessary to ensure safety during exercise execution. Stability
also helps produce the desired results when using free weights. With machine weights, when you assume
the necessary position, there is little need to balance your body as you execute the exercise. (This is
based on the premise that the machines allow you to do the exercise correctly.)

For example, when doing an overhead press the muscles of the legs and trunk must contract to hold you
in place. The trunk must be rigid to provide a stable base for effective contraction of the shoulder muscles.
If not, any change in the balance of the weights overhead may make you lose your balance, which in turn
could cause injury, especially if you lose control of the weights.
The basic principles of stability are simple: The larger your base of support, the greater your stability. This
is why you should most often assume a position with the feet approximately shoulder width or wider.

50
Standing with your feet together results in a very small support base, which will not give you the
foundation needed for stability when doing heavy lifts, especially overhead lifts.

Another way of increasing stability is to bend your knees in order to lower your center of gravity (where
your weight is concentrated). The lower your body is, the more stable you become. For example, in order
to prevent lower body movement and keep the spine vertical during shoulder (upper body) twisting, it is
important that you bend your knees to stabilize the lower body and hips. This will keep the spine from
falling out of alignment and limit the movement to the shoulders. The bent-knee position also helps to
prevent knee injuries.

Foot placement also plays an important role. If your feet are parallel and shoulder-width apart, the weight
should be close to you or overhead. This is the preferred stance in most exercises because you have good
stability in a left to right direction. In a stride position (e.g., cable overhead triceps press) you can better
balance the weight in a forward-backward direction.
When lying on a bench, always place the feet on the floor. This increases sideward stability. Keeping the
feet on the bench creates an unstable position — especially when you use heavy weights and/or a barbell.
It becomes even more important to keep the feet on the floor when doing explosive or throwing actions.

Components of Force

Muscular force is exhibited in a push or pull type motion: Actions that cause motion. Only the muscles (or
more accurately, muscle strength) can create the force needed to put an object into motion. When moving
a weight in a strength exercise, there are four components of force that must be taken into consideration.

First is the magnitude or how much force is applied to the dumbbells, barbells, or machine handles. If you
wish to lift a barbell weighing 100 pounds, you must apply more than 100 pounds of force to lift it. Keep
in mind that additional force is needed to overcome the weight of the limbs and body involved and to
overcome resting inertia.

Second, the force must have direction: The way in which the force is applied. For example, is it applied
horizontally, vertically, or a combination of both? This information is especially important in sports such as
running, swimming, and in the throwing events.

Third is the point of application of the force: Where the force is applied on the body or implement being
used. It plays a role in many exercises from the overhead press to the squat. For example, if you hold a
barbell in the middle of the bar with your hands close to one another, the force applied is close to the
center of mass of the bar and the exercise becomes more effective. But in this situation, greater balance
is also needed, especially if the barbell is long (such as an Olympic bar). In this case, you must assume a
wider grip, in which you apply force at two points to raise one barbell. This loses efficiency but enhances
safety and enables you to do the exercise. In sports, the point of application of force is where the hand or
fingers are in contact with a ball when shooting (basketball) or throwing (baseball). In hitting, it is where
the ball and hitting implement make contact; for example, a golf ball on the club head, a baseball on a
bat, or a tennis ball on a racquet.

51
Fourth is line of action or line of force. To depict line of action, a straight line is drawn from the point of
application of force through the direction of force. The more directly the force is applied in exactly the
same direction as the intended movement, the greater the amount of force that goes in this direction. It is
important to understand that you can push in one direction to get motion in another direction, usually a
side component. For example, if you have a very wide stance in the squat, as in the sumo style, you have
less distance to rise up when doing the squat but the force generated by each leg does not go straight
upward, it is at an angle to the body. As a result only a portion of the total force raises you. To raise all of
the applied forces that go through the body’s center of gravity, you must keep the feet under the hips. In
sports, the legs must drive the hips upward or forward or a combination of both in various jumping and
running actions. Thus, it is important that the feet remain directly under the hips when the force is applied
in the intended direction.

Angle of Muscle Pull

When you do a strength exercise, the strength exhibited at different points in the range of motion will vary
because of the angle at which the muscle pulls. For example, if you do a biceps curl beginning with fully
extended arms, it is more difficult to generate sufficient force to start moving the weight than when you
start with the arms bent. When your arm is straight, the biceps muscle inserts at an angle of
approximately 10 degrees on the radius bone of the forearm. When the muscle shortens (i.e., when you
begin the curl), most of the muscle’s force goes into the joint to stabilize the elbow rather than to raise
the forearm with the weight.

When the angle of insertion approaches 90 degrees, all the force of the muscle is used in raising the
weight (all the strength generated is used to rotate the forearm). Because of this, you are much stronger
when there is approximately a 90-degree angle in the elbows than when the arms are extended. This is
known as having a mechanical advantage, which means that you can do more work at this angle of
muscle pull.

If you use a weight that is the most you can overcome in the early range of motion, it may appear light
when you approach the 90-degree angle in the elbow. To overload the muscle in this range you must use
more weight or go through a shorter ROM; this would translate into not fully straightening the arms in the
bottom position. Doing only this over a long period of time, however, results in loss of flexibility.

The body is best suited for speed, not force. Thus, even though you are weak at the beginning of a
straight-arm elbow flexion movement, you possess the ability to develop great speed in the hand (if the
resistance is not too great). Very little shortening of the muscles produces a large movement of the hand.
This is known as having a physiological advantage, which is very important in speed and quick
movements.

Inertia

Inertia is based on Newton’s first law of motion. There are two types of inertia, resting and
moving. Resting inertia means that when an object is at rest it tends to stay at rest unless
acted upon by some outside force. A loaded barbell or dumbbell lying on the ground has
resting inertia. In order to lift it, you must apply a force greater than the weight of the
implement itself.

Moving inertia means that when an object is in motion it will remain in motion unless acted
upon by some outside force. Thus, once you put a barbell or dumbbell into motion it will
continue on its own accord without additional application of force to keep it moving. This
can easily be seen with lighter weights. For example, when doing lateral arm raises with
straight arms and light weights, you will experience the weights “flying” upward without
your effort if you apply a vigorous thrust in the bottom position.

52
 When you use heavy weights in a strength exercise, the movement is slow so that you must
apply force through the entire ROM to keep the weights in motion. In this case, although
the heavy weights are moving they will quickly stop because of the constant force of
gravity. Gravity pulls down and thus creates the slow speed. However, if the weight moves
too fast (as when you “throw” a heavy weight, such as a medicine ball), it may require
great force to stop it at the end of the range of motion. If your muscles are not capable of
generating this stopping force, injuries can occur if you do not release the weight. The role
of the eccentric contraction is especially important here.

The further away the mass of the object is during weight lifting, the greater the inertia,
especially on the return. This means that when the weight is moving, it is more difficult to
control regardless if it is moving up or down, though it is especially difficult on the down
return when gravity pulls. Because of this, you should always position yourself as close as
possible to the weight you are lifting. The closer the weight, the easier it becomes to control
because there is less lateral rotational inertia. The further away the mass, as in straight-
arm front or lateral arm raises, the more difficult it is to move the weights with control.

Note also that with straight arms, you can use a lighter weight and it will feel the same as a
heavy weight held at half the distance. It is because of this that most bodybuilders bend
their elbows to bring the weights closer to their bodies. A bent-elbow position also allows
them to use more weight. However, it is important to understand that when you bend the
elbow you may be putting the arm in a different position, which will change the muscular
involvement. In the front-arm raise when you bend the arms the elbows may turn out
approximately 45 degrees. You will therefore be doing a combination of front and lateral
arm-raise exercises.

The use of heavy weights is not always best for precise strength development. By using a
long lever arm to create greater rotational inertia, you can create great resistance with
lighter weights. Also very important to consider is that the stress on the spine is
considerably less when lighter weights are used. This is especially important for beginners.

The Relationship between Force, Mass and Acceleration

Newton’s Second Law of Motion deals with force and its relationship to mass and acceleration. In essence,
in order to create a force you must place a mass into motion with acceleration and a change in velocity.
Note that mass multiplied by velocity is known as momentum. Thus in our weightlifting example, when a
weight (mass) is moving (has velocity), it has momentum.

Momentum is seen in many exercise machines that use weight stacks attached to a cable. When you do
the exercise you must adjust the speed of your movement to how fast the weights move up and down. If
you move the resistance levers at a very fast rate, the weight stack will continue to move when you stop.
Thus at times the weight may be going up when it should be going down or vice versa. When this
happens, the cables may bind or snap off the pulley. Therefore, to do an exercise quickly you must use
machines that allow for quick movements, or you must use free weights or rubber tubing.

A key point to keep in mind when training is that when the muscle generates a force, there must be
acceleration of the weight. In other words, the speed of the object must be increasing to be a true force.
When first starting an exercise you must generate force. When the weight is stationary and you begin
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movement, you accelerate the weight. However, once the weight is in motion it only has velocity. You are
no longer creating force unless you are changing the speed of the object.

In essence, you must place the weight into acceleration to get it moving. Once the weights are in motion,
they have momentum. For some reason, acceleration and momentum of weight have become
unacceptable to many trainers. They consider acceleration and momentum dangerous — to be avoided at
all costs. Rather than avoiding it, though, you should understand what is taking place and thus prepare
the body to handle the forces that are encountered. Force, acceleration and momentum can be your allies
rather than your enemies. The key is to learn how to make best use of them.

If a force is maximal or if a weight is accelerated at a maximal speed, then you must release it in a
throwing or pushing action because it will be impossible for the muscles of the body to stop the weight or
the limb from continuing its movement. The heavier the weight or the greater the acceleration of the
weight, the more difficult it is to stop it. It is because of this that most strength exercises are performed at
a slow to moderate speed.

Note that even light weights can generate tremendous force when they are accelerated, as in some
aerobic routines. A five-pound weight with extended arms moving rapidly can generate a tremendous
amount of force that must be stopped by the eccentric contraction of the antagonist muscles. If they are
not sufficiently strong to stop the movement, an injury may occur. In general, you can increase speed of
execution in some exercises, usually at the beginning of the movement, so that momentum will carry the
weight through the remaining range before there is damage to the joints. But a strong eccentric
contraction of the antagonistic muscles is still needed to stop the movement.

In addition to creating force to move a weight against the pull of gravity, it is also necessary to create a
force to counteract gravity when lowering weights. In this case, gravity is the major force pulling the
weight down. Your muscles contract eccentrically to create the force needed to control the downward
movement of the weight. Keep in mind that gravity causes a weight to go into motion at increasingly
greater rates of speed. Gravity exhibits an acceleration of approximately 32.2 feet per second squared.
Thus for every second of downward fall, a weight gains greater speed.

Care must be taken when handling weights, especially heavy weights. If they drop from a high height, the
amount of force upon landing can be extremely high. Even the height of a few feet can cause a weight to
have a force of several times its actual weight. Because of the acceleration produced by gravity, you must
always control the weights on the (negative) return with the eccentric contraction.

Work

The actual amount of work that you do is measured by the formula W = F x D, where W= work, F= force,
and D= distance or displacement of the object being moved. The greater the force and the greater the
distance over which the force is being applied (the weight is moved), the more work is done. When you
hold a weight in the hands with an isometric contraction, even though the muscles are generating great
tension and you may use a lot of energy to hold the position, you are not doing any work because you are
not moving the weight any distance. For work to be done, there must be movement. If not, you are only
expending energy, which is not work. Energy is more physiological, while work is more mechanical.

Power

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The term “power” is often misused in fitness and sports literature. Power is often equated with the amount
of force one generates, but this is only partially correct. In physics and in most sports, power is defined as
the work done in a unit of time. To calculate it, you must first consider the time involved in executing the
movement. For example, if you do a squat with a 300-pound barbell and you move the barbell three feet
from the bottom position to the top position, you will have done 900 foot pounds of work. (W = 300 lb x 3
ft = 900 ft•lb) In reality, you actually lifted more, but for simplicity, your body weight and external factors
are not taken into consideration.

To calculate power, we will use the same example, but consider the amount of time it took to lift the
weight three feet. For simplicity, let us say it took 3 seconds. Therefore 900 foot pounds of work divided
by 3 seconds equals 300 foot pounds of work per second. If you executed the squat in approximately two
seconds, then the amount of power generated would be 450 foot pounds per second. Thus you can see
how the amount of power generated depends very much on the amount of time it takes to accomplish the
work. The faster you do the work, the greater the amount of power. The slower the work is done, the less
the power.

Much confusion has arisen in this area because of powerlifting. In this sport, maximal weights are lifted
slowly and it should be considered a pure strength sport. The amount of power is not great in comparison
to that of a weightlifter, who lifts maximal weights as quickly as possible. The weightlifter exhibits much
greater power than a powerlifter, but the powerlifter exhibits greater strength than the weightlifter.

Equal and Opposite Reactions

Newton’s third law of motion, known as the equal and opposite reaction principle, applies to weightlifting
and bodybuilding exercises. When doing an exercise such as the push-up, you must push against the floor
with your hands. The floor, in turn, pushes against you and as a result you raise the trunk. This is known
as reactive force. The same concept applies when jumping. When you land on the ground you apply a
force against the ground and it, in turn, applies an equal and opposite force against you to propel you into
the air.

Levers

A lever is defined as a rigid bar that turns about an axis of rotation or fulcrum. In the body, bones
represent bars, joints represent fulcrums and muscles contractions represent force. The lever rotates
about the fulcrum as a result of the force being applied to it to cause its movement against a resistance or
weight. The amount of resistance can vary from maximal to minimal. In fact, the bones themselves or the
weight of the body segment may be the only resistance applied. All lever systems have each of these

55
three components in one of three possible arrangements. The arrangement of these points and the
direction in which the force is being applied will determine the type of lever being used.

First-Class Levers

The first-class lever is similar to the seesaw, in that it has its fulcrum between the force and the
resistance. When you sit on one end you apply a downward resistance on one side of the fulcrum and
upward force on the other side. If someone else sits on the opposite side another downward resistance is
brought into play, and if the weights are equal and the distance from the fulcrum is equal, you will be in
balance with no movement occurring. In order to get movement, you will have to make your body heavier
(or lighter) to place it into motion. Nodding the head is an example of a first-class lever. The head is the
resistance and the contraction of the neck muscles lifts the weight around the fulcrum (the joints of the
neck). First-class levers do not produce a great amount of force. They do produce a maximum range of
motion and speed of movement.

Second-Class Lever
In the second-class lever, the weight (resistance) is
distributed between the axis of rotation (fulcrum) Figure 5-1
and the application of force. This type of lever is
most suited for a gain in force. It is easily visualized
as a wheelbarrow. The fulcrum is the wheel and the
weight is in the bucket located in the middle; your
arms pulling upward on the handles generates the
force. The second-class lever is exemplified when you
rise up on your toes. This type of leverage allows you
to walk and run and is very effective for overcoming
resistance. One weight-training exercise that utilizes
the second-class lever is the push-up. In this case,
the fulcrum is the balls of the feet in contact with the Click above to enlarge
floor, the weight is the center of gravity of your image
mass, and the force is in the arms, pushing you
upward.

Third-Class Lever

In the third-class lever the force is applied between the fulcrum and the resistance. This is the most
common type of lever found in the body. For example, in the biceps curl, the biceps inserts approximately
one inch below the elbow joint. The point of attachment is known as the point of application of force. The
elbow is the axis of rotation (fulcrum) and the resistance is the forearm and weight held in the hand. Thus
the distance from the point of application of force to the fulcrum is very short (the force arm) and
mechanically inefficient. The key reason for this is that the resistance arm, the distance from the fulcrum
to where the weight is located, is quite long. This places the weight far from the application of force. A
short force arm and a long resistance arm is most advantageous for speed, not for the production of force.
In the case of speed, a short contraction of the muscle can move the end of the limb (hand) a great
distance, even though there is very little movement at the actual insertion of the muscle on the bone. This
relationship is also advantageous for ROM. The speed advantage of the third-class lever system is most
important in sports, not when lifting weights. Individuals with short limbs have an advantage in lifting
heavier weights because of their shorter resistance arms. There are, however, exceptions to this. In the
deadlift, for example, longer arms allow you to raise the weight less distance.

Wheel and Axle

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Wheel and axle-like arrangements in the body are needed for the transmission of force. A good illustration
of this is shoulder joint medial and lateral rotation. For example, hold the upper arms in line with the
shoulders, elbows bent 90 degrees, and the forearms vertical and holding a weight in the hands. Lower
the forearm downward behind the head, maintaining the 90-degree angle (or greater) in the elbow to
execute lateral rotation with the fulcrum along the long shaft of the humerus.

When you raise the hand in the opposite action you execute medial rotation in which the humerus rotates
in the opposite direction on its long axis. In this case, there is a short radius of rotation of the humerus,
but with the forearm bent at a 90-degree angle you generate considerable speed or force at the end of the
forearm (the hand). Many strength exercises involve some rotation of the arms (or legs). To prevent
injury when executing medial and lateral rotation you should not execute other actions in the same joint
at the same time.

Pulley Systems

Another muscular-structural arrangement in the body is the pulley. Pulleys are very common in exercise
machines, such as in the lat pulldowns, to create a greater mechanical advantage and to move the limbs
freely. In the body we find a pulley-type system in the knee joint, more specifically, with the patella. The
quadriceps tendon (ligament) goes over the patella to insert on the tibia bone in the shin. Because of the
patella protrusion, the quadriceps tendon inserts a greater angle to create more of a straight-line force
when the knee is in the bent position. As a result you can generate greater force, which goes around the
patella to change the direction of pull. There are few such pulley-type muscle arrangements in the body.

Most pulley (cable) systems (free weight machines) create the ability to guide and move the resistance
handles in various directions. Depending upon the configuration of the pulley or pulleys you can increase
or decrease the amount of effective resistance. Some pulley machines even have an extremely strong
negative component. After you do the exercise and the weight stack is raised, the amount of force
involved in lowering the weights can be extremely high. Thus, care must be taken on different exercise
machines. To prevent injury, they should be examined before using appreciable weight.

Torque

Important in understanding how force is produced in weight-training exercises is the concept of torque. Its
definition is simple: It is the magnitude of twist around an axis of rotation (fulcrum). Thus torque (twist) is
rotary (angular) movement in any plane about an axis. Torque is seen in almost all movements of the
body as, for example, when you do single-joint actions. In isolated movements the axis of rotation is fixed
so that the bony lever moves in a circular arc. For example, in knee-joint extension the foot circumscribes
an arc of a circle because it is moving on an angular pathway. When you twist the shoulders they rotate
around a stationary vertical axis and make an arc of a circle when viewed from above.

When torque is produced, the force is applied at some distance away from the axis of rotation. For
example, picture yourself driving a car and turning the steering wheel. The hand applies a force on the
wheel (rim) with the axis in the center of the steering column. This is known as an off-center force or,
more accurately, an eccentric force. But the rotating or turning force is called torque. It should also be
noted that the axis of rotation could also be in motion. This is sometimes needed for safety.

For example, in the seated leg-extension exercise in which your thigh is immobile, the forces generated in
the knee joint are extremely high when you straighten the leg. Because of this, this exercise has been
negatively criticized as being potentially dangerous. Exercises with rubber tubing (as in the Active Cords
set) counter this danger. Assume a standing position and hold the thigh up at approximately 45 degrees
and then straighten the leg against the resistance of rubber tubing. In this action the thigh moves slightly

57
as the leg is extended, and the axis therefore moves. Thus the thigh is a safety valve, which helps to
decrease the negative forces makes the movement more natural — especially for sports such as running.

Pushing

In some compound (multi-joint) exercises, rather than solely using a rotary component to move the
weight, you use a push pattern in which the hands or feet move in a straight line. This pushing action is
seen in exercises such as the leg press, overhead press, dips, and triceps pushdown. To move the
extremity in a straight line, you must involve more than one joint action. For example, in the leg press
there are simultaneous rotary actions at the knee (extension) and hip (extension) joints to move the feet
in a straight line. In the overhead press the shoulder joints undergo flexion (elbows in front) or abduction
(elbows out to the side) as the elbow joints undergo extension. The hands then move in a straight line
upward.

Pulling

Pulling is the opposite of pushing. The hands or feet move in a straight line while two or more joints are in
rotary action. For example, in the seated row, your body is stable and your hands move in a straight line
as you pull them in toward the body. Extension in the shoulder joint along with flexion in the elbow joint
occur simultaneously to allow the hands to move in a straight line. The same occurs when doing a chin or
pull-up. In this case, the body moves in a straight line upward while the hands remain in place, and there
is flexion in the elbow joint together with extension or adduction in the shoulder joint.

Gravity

Gravity is the downward pulling force that creates resistance. For maximum resistance when using free
weights, it is important that you adjust your body position so that the weight that you are handling is
moving as much as possible against the pull of gravity. For example, in the triceps kickback, only when
your arm is almost fully extended does the triceps work fully against gravity in the upward phase of
movement. When the forearm is vertical there is very little resistance to overcome. The resistance
increases as the arm straightens because you are now working more against the pull of gravity.

To make the triceps kickback most effective, the body should be horizontal so that the ending ROM is
against gravity. Since the triceps is also involved in shoulder extension, you should then raise the straight
arm upward above the level of the back. This makes the movement much more difficult since you now
have a long lever when raising the dumbbell against the pull of gravity. This action goes completely
against gravity and you will find that is more difficult than all the preceding movements.

Center of Gravity and Line of Gravity

Center of gravity is referred to as the point in the body around which your weight is equally distributed. It
is considered to be the point where all your weight is concentrated (balanced). This point is usually located
in the hips but it can also fall outside the body, as for example, when the body is rotating in space in a
pike position.

When you drop a vertical line straight down from the center of gravity, it is known as the line of gravity. It
should fall within your base of support (formed by an outline around your feet( in order for you to be in
balance. If it falls outside the base of support, you will be in motion: The motion of falling. When doing
strength exercises, it is critical that the line of gravity fall within your base of support in order for you to
remain in balance.

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Kinesthesis

Kinesthesis is the ability to perceive your position and movement of the body or body limbs in space.
Kinesthesis relies on the use of various receptors in the joints, muscles, and tendons. For example, the
muscle spindle, which lies in parallel with the muscle fibers, is activated when the muscle is stretched
during an eccentric contraction. (This is known as the stretch reflex.)

The Golgi tendon organs are other receptors located at the junction of the tendon and the muscle. They
respond to the amount of stretch taking place in the tendon and the muscle. It is important to understand
that when a muscle stretches the tendon also stretches. It is very elastic tissue and can withstand great
tension. When activated, the Golgi tendon organs trigger the antagonistic muscle groups to stop the
movement and to inhibit the agonist muscle contraction. This is done to avoid possible injury to the
muscle-tendon relationship. Because of their actions, it is much easier to fully stretch a muscle when the
Golgi tendon organs are shut down.

There are also receptors located in the joint capsules and ligaments that relay information to the brain,
such as a change in position, speed of movement, or the acceleration of the limbs that occur at the joints.
These receptors are very sensitive and fire when there is a small change (up to two degrees) in joint
position. There are also many pressure receptors that are very active in posture. When there is any
deviation in position, they are fired so that a correction can be made to bring you back into the normal
position.

Vision

Related to kinesthesis is the use of visual reference points or visual cues when doing exercises. For
example, focusing on a particular object during an exercise enables you to better balance your body and
to keep yourself oriented to your surroundings. To verify this, merely try doing an exercise with your eyes
shut and you will see how difficult it is to control your movements.

The visual cue must be such that it does not change the position of your head, which also relates to the
balance mechanisms in your ears. For example, many weight trainees look up at the ceiling when doing a
squat in order to maintain an arch in the lower back. In so doing they have difficulty orienting their body.
More effective is to have stronger back muscles to maintain an arched position and to look directly ahead
when doing the exercise. You can then maintain the arch more easily and yet have good balance.

Now that we have a solid base of understanding, with regard to muscles and muscle functions as they
relate to human motion, we can deduct that deviations in normal body mechanics can adversely affect
human movement and, more importantly, our clients’ fitness success. Before we delve into the specifics of
human movement and the relationship between various muscles in our body, we will uncover postural
deviations as they relate to sound body movement.

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 Unit 6: Musculoskeletal Deviations
Posture

In the past, the analysis of posture and exercises to correct posture were strongly emphasized. Since that
time, posture appears to be mostly ignored. When you have good posture, your muscles are basically in
balance and your body is symmetrical. When there is a deviation in posture, it is usually due to a lack of
strength of particular muscles to hold the body in the needed position. For example, weak erector spinae
muscles of the lower back are the main culprits in not being able to maintain an erect trunk in standing
and walking, or maintain proper back posture when lifting weights.

Benefits of Good Posture

Most people are usually unaware that they have poor posture. More startling is that they show little
concern about having good posture. However, for athletes and fitness-minded individuals, posture should
be of great concern. The reason for this is quite simple: posture can determine the outcome of your
performance and well-being. Before relating how this can happen, it is necessary to first examine some of
the benefits of good posture.

Good posture is important to health. It is needed to keep the organs in place and to allow them to work
efficiently and effectively. For example, if you have swayback, the intestines press against the floor of the
abdominal cavity, instead of being held in place. This interferes with their normal work. If you have
rounded shoulders and an excessively rounded upper back, there is constriction in the chest cage.
Because of this, it becomes impossible to completely fill the lungs with air, which is vital in athletic
performance and fitness activities.

Posture affects how you walk, run, jump, lift weights, and execute other skills. For example, if you have
rounded shoulders, your arms may be slightly in front of your body instead of hanging alongside your
body. As a result, you may find that instead of lifting the arms sideways directly overhead, you are lifting
them up and in front of the body. This changes the muscular movement and the movement pathway.

If you cannot hold your trunk erect during running, you will not have an effective push-off or knee drive
for a long stride length. Even in walking, if your feet or thighs are excessively rotated outward, greater
stress will be placed on the hip and knee joints. If walking in this manner is carried on for a long period of
time, injuries to these joints can occur.

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Figure 6-1: Postural self-check. To check find out if you have good posture, stand with your back against
a wall. Your heels, backs of the calves, buttocks, upper back and head should comfortably touch the wall.

Posture plays an important role in the prevention and rehabilitation of back problems. For example, tight
hip flexors may keep your pelvis tilted forward, causing swayback. If the hip flexors are too weak and the
abdominal muscles are strong, it may cause flattening of the spine. If the upper portion of the hamstrings
is too tight, they do not allow you to hold the arch in your lower back when doing exercises such as the
squat, or when bending over to lift something. When your abdominal muscles are too tight they flatten the
spine, which places excessive pressure on the anterior aspects of the spinal discs. If they are too weak,
they may cause swayback.

By strengthening and stretching the necessary muscles to create good posture, you not only prevent
injuries but also rehabilitate them. Merely correcting posture is often all that is needed to relieve back
pain. For example, pulling the head back into proper alignment is often sufficient to produce the normal
curvature of the vertebral column. By lifting the head and looking forward you can activate the lower back
muscles to hold the spine in place and alleviate the problem.

Good posture makes you feel good. Because of its many benefits, such as ease of movement, good
balance of muscle strength and flexibility, proper positioning of the spine, and proper functioning of the
internal organs, your body “feels” good and you feel good. You feel alive, ready to perform and are proud
of yourself. Thus, posture should be of prime focus in all fitness activities.
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Posture is dynamic. Good posture is relatively easy to attain and maintain. Part of it is learning new habits
of sitting, standing, walking. But the major factor is strengthening the key muscles that hold you in the
proper posture.

Self Check

To find out if you have good posture, stand with your back against a wall. Your heels, backs of the calves,
buttocks, upper back and head should comfortably touch the wall. If you must strain to make all points of
contact, then you probably have some deviations. Also effective is to secure a string to the ceiling and
hang a weight at the end of the string. Stand so that the string is lined up with your nose and then have a
front-view picture taken (or look in the mirror). Note if your shoulders are leaning to one side or another
or if more of your body is on one side of the line. With good posture, you should be symmetrical on both
sides of the string.

Lining up the string in the middle of your shoulder down to the floor is also effective. It gives you a
graphic representation of how your weight is distributed in front and behind you. It will also show if you
have any major deviations in spinal curvature or positioning of the hips.

Postural Deviations

The relative strength and flexibility of the spinal muscles play a role in the alignment of the trunk and
pelvis. When there are imbalances, three abnormal conditions result: lordosis, scoliosis and kyphosis.

In lordosis, the superior iliac crests of the pelvis move forward and downward from the normal anatomical
position. This is known as anterior tilt of the pelvis. In most cases, the hip-joint flexor muscles are
shortened and the abdominal muscles are lengthened or severely relaxed.
In posterior pelvic tilt, the hip flexor and the low-back muscles stretch while the abdominal and hamstring
muscles shorten. Posterior tilt is not as common as anterior tilt and is rarely brought about by lack of
muscular strength. Both anterior and posterior pelvic tilt place the lumbar vertebrae in potentially
dangerous positions because of increased disc pressure and a change in the line of gravity of the trunk.

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Figure 6-2: Postural deviations.

Malalignment Possible Tight Muscles Possible Weak Muscle

Lordosis Lower back (erectors), hip flexors Abdominals (especially obliques), hip
extensors
Flat-Back Upper abdominals, hip extensors Lower back (erectors), hip flexors

Swayback Upper abdominals, hip flexors Oblique abdominals, hip extensors

Kyphosis Internal oblique, shoulder adductors Erector spinae of the thoracic spine, scapular
(pectorals and latissimus), intercostals adductors (mid and lower trapezius)
Forward Cervical extensors, upper trapezius Neck flexors
Head

In scoliosis, there is excessive lateral curvature of the spinal column. If the curvature is relatively minor
you can do exercises to stretch the concave side and strengthen and shorten the convex side of the curve.
This usually brings about straightening of the spine. If there is also rotation of the vertebral column, the
affected abdominal oblique or erector spinae muscles must be strengthened.

Kyphosis is an exaggerated anterior-posterior curvature of the spinal column. It occurs most frequently as
excessive forward bending of the thoracic area and is seen most frequently in older adults. It is usually
associated with osteoporosis and osteoarthritis and can result in the hunchback position. It also appears to
occur more frequently with younger adults as a result of practicing poor posture and performing an
excessive number of crunches through a shortened range of motion.

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The term “flat-back” is used frequently in conjunction with a kyphotic condition since the exaggerated
curvature of the thoracic spine creates a reduction in the natural lumbar curvature. The flattening that
occurs creates a posterior tilt condition of the pelvis.

Rounded shoulders are sometimes associated with kyphosis of the thoracic vertebrae, but it is not the
same condition. A round shoulder condition is technically abduction or protraction of the scapula. This
creates a “hollow” chest condition. You can have abducted scapulae without having a kyphotic condition,
or you can have both conditions.

Role of Posture in Athletic Performance

Most people have some alignment deviation. As a result, the body does not work at maximum efficiency.
It is analogous to a machine. When a machine is properly aligned, the working parts act efficiently. The
machine will last much longer than one that is out of alignment. In a misaligned machine, wear and tear
on the bearings increases, and stress and strain on the working parts produce general depreciation.

Since our bodies are like machines, when optimal performance is desired, it is essential that you pay
attention to the alignment of your body parts. The balance of all the muscles acting on any joint or body
part affects proper maintenance of alignment.

Faulty posture indicates a shift of a body segment in relation to the other segments. In addition, there is a
shifting of joint positions (or alignment) in relation to the normal gravitational line. Under optimal
conditions, all body segments are lined up properly so that undue stress does not fall on any one
particular joint. When there is misalignment, stress is placed on particular joints. For example, if your
shoulders drop forward, your head goes back and your pelvis rotates to the rear. If you constantly lean to
one side, your pelvis tilts sideways and your spine curves to the opposite side, sloping one shoulder.
Therefore, if you assume and maintain an out-of-line position, your body must adjust the controlling
ligaments and muscles. In other words, if one body part is out of alignment, another body part must
likewise get out of alignment to balance it. Keep in mind that approximately 75% to 80% of the work of
the muscles is involved merely to obtain and maintain joint stability for good joint stability.

A high development of the agonist-antagonist function is essential to the development of coordinated,

skilled movement, since antagonists control the speed, range and force of the action of agonists. This is
true of the main muscles involved and of all the stabilizers of the joints that are activated. This includes
the stabilizer muscles that hold the joint of the non-moving part in place to allow for movement at the
other end of the muscle. There must be a good balance between the opposing muscles.

When you have faulty posture, the normal length of the opposing muscles is changed so that if one is
shortened, its opponent must be stretched or lengthened. Therefore, any skill that you execute is affected
by the performance of these muscles. When there is faulty posture, movement is abnormal.

For example, if you have round shoulders, you may have adaptive shortening of the pectoralis major and
the serratus anterior, as well as tight anterior shoulder joint ligaments. The opposing muscles, the mid-
lower trapezius and rhomboids are overstretched. Thus the scapulae will not only swing apart but also
rotate, resulting in the lowering of the tips of the shoulders.

onsequently, the more muscle mass that is developed, the greater the force that is applied to the joint.
Because of this, the stress on the joint increases and the imbalance is increased even more.

Two factors operate in round shoulders. First, your arm weight and head weight fall forward of the line of
gravity. Therefore, they must be compensated for by an increase in the dorsal curve of the spine. This, in
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turn, must be balanced by a forward position of the pelvis and increased lumbar lordosis (arching). Such a
shift of body weight onto the forefoot tends to increase pronation and foot arch depression.

Second, all arm work (shot put, discus, javelin, baseball pitching, golf swing or exercise execution such as
the bench press or dumbbell fly) will show decreased efficiency because the weakened rhomboids have
become long and the pectorals short. As a result, your arm cannot be moved back to the maximum
shoulder joint range since the contractile length of the pectoralis major will not allow it.

Deficiencies can also be seen in the shoulder girdle rotation (e.g., when twisting with a barbell on the
shoulders). This is because the spinal column cannot rotate on a “straight” axis, as the spine is now bent.
Thus more attention should be given to the antagonist musculature instead of only trying to develop the
agonist. You must restore the muscle balance. This is essential to arm and shoulder girdle performance.

In the lumbar area, you must strengthen the abdominal muscles, especially the internal and external
oblique muscles that are mainly responsible for forward shoulder rotation and flattening the abdominal
wall. In addition, you must stretch and strengthen the erector spinae by doing back raises to a position
above level. You can also do the reverse sit-up and reverse trunk twist to stretch the erectors even more,
and at the same time strengthen the abdominal muscles. Other muscle group pairs should be corrected in
a like manner if there is any imbalance.

The key to having a well-aligned and balanced body is to proportionally develop the muscles (agonists) on
one side of the joint with the muscles on the other side of the joint (antagonists). Only in this way will the
muscles keep your joints in the natural state and not allow any deviations to occur. Not only will you feel
better when you have this development, you will also look better and perform more efficiently.

Tonus
Muscular tonus is associated with blood circulation and economy in movement. Improper alignment results
in additional muscular effort and strain, especially since it creates rotary movements at the various joints.
If excess muscular effort is sufficient to produce fatigue, it can eventually affect your health. In more
severe cases the strain on the joints can be sufficient to alter structure. There is also evidence to indicate
that chronic strain contributes to the development of arthritic types of ailments in later life. Such
alterations mean limited use of body parts and continued fatigue and strain.

The Spine

Figure 6-3
The spine is the keystone of body structure. It must
support the weight of the head, trunk and upper
extremities. In addition, it is the solid point of
attachment for most of the muscles, anchoring and
controlling the pectoral-shoulder girdle as well as the
latissimus dorsi and other muscles of the back, which
move the arm. These functions require a strong,
well-supported spinal unit. In addition, the spine
encloses and protects the spinal cord and the nerves,
which lead to and from it. Click above to enlarge
image

Because of this, the spine should be firm, carefully articulated and not too flexible. You should be able to
maintain the four natural curves of the spine at all times. The ROM will vary from person to person, but
should be approximately 30 to 40 degrees of spinal flexion forward and 15 to 20 degrees of spinal
extension to the rear. Going beyond these limits is usually indicative of excessive flexibility, which leads to
additional spinal problems.

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Problems Associated with Long-Term Seated Postures

Perhaps the most common oversight made by bodybuilders and other athletes is failing to consider the
risks of day-to-day, non-training activities. Typically, most trainees will be very careful about their form
when exercising (which comprises, at most, 20% of all daily activities), yet totally ignore the potential
consequences of other activities that make up a much greater portion of our lives. When problems arise,
blame is usually assigned to the training activity.

Everyone spends a considerable amount of time sitting. Given this fact, it is prudent to study this postural
position, and in particular, its effects on the spine. People are usually surprised to learn that pressures on
the vertebral disks are higher when sitting than when standing, or even lying down. In fact, some experts
suggest that intradiscal pressure when seated is up to 11 times greater than when lying down. This risk is
particularly insidious because sitting is not normally associated with back pain, whereas standing often is.

How Sitting Results in High Loads to the Vertebral Disks

Many people who experience back pain while standing for long periods of time will feel better when they
sit down. It is difficult for them to understand just how sitting can place undue pressure on the vertebral
disks. In order to understand this concept better, let us have a look at the following:

1. First, the distinction must be made between the back muscles and the vertebral disks. When you
stand for long periods, the disk pressure is relatively low, but you nevertheless feel pain. The pain
results from fatigued low-back muscles.

2. Increased pressure on the disks in and of itself does not necessarily cause immediate pain. Thus,
we are often unaware of this pressure, which in the long term can lead to deformative changes in
the disks.

3. Now to the real mystery: how can sitting create higher intradiscal pressure than standing? It is
because when standing, your body weight is distributed over a wide variety of structures, including
muscles, tendons, ligaments and joints. Upon sitting down, however, the abdominal “corset”
relaxes, which causes a majority of your body weight to load the disks. As we mentioned earlier,
you probably will not feel any pain at all when this happens. Over the long term though, the
constant, increased load upon the disks can result in a multitude of problems, from impinged nerve
roots to degenerative osteoarthritic changes.

Workplace Ergonomics

Since sitting is inescapable for most of us, the best advice is to 1) limit time spent sitting as much as
possible, and 2) design your workplace with the following in mind:

1. Chairs with lumbar supports (sufficient to maintain but not exaggerate the normal lordosis, or
sway, of the spine) have been shown to lower intradiscal pressures compared to chairs without
these supports.

2. Chairs with armrests also reduce pressure on the disks.

3. Sitting in a reclined position (120 degrees seems optimal) lowers disk pressure, so make sure your
chair allows you to alternate positions.

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 4. Since keeping the knees close together makes you more prone to “slumping,” choose a chair that
is wide enough to keep your knees apart. Also, if you sit at a desk for long periods of time, make
sure that it allows you enough space to open your knees.

5. When selecting a chair, adjustability is crucial. Because people come in different shapes and sizes,
they have unique needs for their workstation setup. An adjustable chair will ensure that you can
optimize your own workstation for the best possible ergonomic effect.

6. At your workstation, your chair and desk arrangement should be such that your forearms rest on
the desk with your elbows at a 90-degree angle close to your sides. This position reduces stress on
the trapezius and surrounding muscles of the upper back and neck.
Spinal disorders are preventable! Although the dangers of sitting for prolonged periods of time may
not seem like a pressing issue at the moment, over the years it has a cumulative effect on the
spine.

The Feet

Seemingly small, insignificant deviations can lead to major changes in the entire body. For example, if the
feet are not sufficiently strong to keep the body in balance and the shins in line with the feet, the knees
can change their position. This can affect the hips, which in turn will affect the spine, which can then affect
head position. Each joint will then be limited in the actions that it is capable of, especially when the
deviation is coupled with tight muscles on one side and weak muscles on the other.

Even being able to balance your weight has a very profound bearing on the feet. How the legs are used in
activities such as running is directly related to the influence of the joints, ligaments and muscles in the
limbs above it. Thus, any problems in the lower body affect the upper body and vice versa.

For example, many athletes including bodybuilders have a lateral tilt of the pelvic girdle. This usually
occurs to compensate for deviations above or below the pelvis. Studies have shown that up to 50% of
individuals can have a lateral tilt of the pelvis of one-quarter inch or more. It can be caused by having one
arch of the foot lower than the other, greater angulation of the knee on one side, an increase or decrease
in the angle on the neck of the femur (the angle that the bone runs from the hip to the knee in a normal
standing position), rotation of the femoral shaft (which can have the knee pointed outward or inward) and
the size and shape of one ilium (the bone on the sides of the hips) as compared with the opposite one.

Such asymmetry and tilting of the pelvis will result in asymmetrical muscle lengths and a tilt in both hip
axes, which produce an eccentric action between the two joints. The transmission of weight and forces
acting on the legs and feet will be different. Consequently, the wear and tear on the ligaments and joints
will be different.

The Pelvis

Even more common among bodybuilders and athletes is a forward tilt of the pelvis, which results when
the upper pelvis drops forward, resulting in excessive arching of the lower spine. If this is coupled with a
slight lateral tilt of the pelvis, there is torsional force from the twisting of the spinal column. When this
occurs, one hip socket as well as one side of the hip will be further forward than the other. In this case,
the hip-joint flexor muscles will be shortened and the lower back muscles will be tightened.

Excessive arch in the lower back can result from low-back problems or from deviations of the pelvic girdle.
The pelvis and spine are so interrelated that it is almost impossible to say which is primarily at fault in
causing any particular problem. However, note that the vertebral column is flexible and often
compensates for any pelvic faults by changing position in corresponding planes, so that in a well-muscled
person these changes can be easily overlooked.

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An increase in the forward tilt of the pelvis in relation to the adaptive shortening of the hip flexors and the
lower trunk extensors upsets the normal antagonism in the forward and backward direction. But this
antagonism must be brought into a balanced action for the best performance when lifting weights. In this
case, shortening the abdominal muscles in front and the gluteal muscles in back is essential to attaining
the best position of the pelvis in relation to the trunk.
In addition, the hip lifting action of the quadratus lumborum and latissimus dorsi hold the leg on the same
side up during the swing phase in walking and running, while the rotational action of the internal and
external obliques brings that side of the hip forward. Not only must the one side be pulled forward, but the
alternating action of the opposite oblique must also relax enough to allow the serratus anterior and the
shoulder girdle to be rotated backward. The balance of these trunk muscle torque groups is a vital
element in all locomotor progression.

When there is any structural pelvic asymmetry, there cannot be symmetrical action of the lower trunk
muscles because of the torque in the pelvis and the compensatory curvature and torque of the spinal
column. The latissimus dorsi, quadratus lumborum, iliopsoas and abdominal obliques are all affected, and
there must be an imbalance in the length and strength of the contralateral muscles.

Deviations in our musculoskeletal system must be assessed and then modified to correct or prevent
further deviation from occurring. Now that we can accurately assess some of the more common deviations
that we may encounter with our clients, we can cover the musculoskeletal system including joint action,
joint make-up, muscle involvement, and the associated relationships between various muscle groups in
the body.

Unit 7: Muscle Mechanics

Introduction

Exercises are usually described in very general terms in books, magazines and websites. These
generalities lead to misunderstandings, which more often than not lead to injury. However, an exercise
analysis answers questions such as: If the exercise is effective, why is it effective? What is the role of
each joint action? Which actions can be changed to make the technique more effective? How can joint
body or limb movements be changed to bring in greater involvement of specific muscles? How can specific
actions be made more powerful? Should the exercise be modified? If so, how? Most sources of standard
instruction fail to address important points such as these. The most accurate way to determine the key
actions and muscles involved in a strength exercise is to biomechanically and kinesiologically analyze
movement. Only in this way can we as future fitness educators determine which joint actions and muscles
play a major role and if the exercise is effective and safe. We will discuss the musculoskeletal system with
regard to joint action, joint makeup, muscle involvement and the associated relationships between various
muscle groups in the body.

The Knee

The knee joint is made up of the end of the femur and tibia bones. The ends of these bones consist of two
shallow convex surfaces into which semicircular shaped femoral condyles fit. Because of the shape, the
bony stability of the knee is extremely weak. To improve stability many ligaments surround the knee joint.
For example, the posterior cruciate ligament prevents forward displacement of the femur on the tibia. The
anterior cruciate ligament prevents backward displacement of the femur on the tibia. The medial and
lateral ligaments provide stability on the medial and lateral sides. The knee joint is stabilized posteriorly
by the popliteal ligament and anteriorly by the patella ligament.

The knee joint must allow movement yet be stable enough to absorb and withstand the forces created by
the weight of the body and the forces generated while

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participating in different activities. For example, the knee must counteract the negative landing forces in
running and jumping and in weightlifting exercises.

Because of the roles the knee must play, ligament and muscular stability assume important roles. For
example, when the knee is extended it remains stable since it is surrounded by fairly taut ligaments from
all sides and from within. However, when the knee is flexed some of the ligaments loosen to allow for
greater movement. Because of this, the muscular arrangement around the knee is extremely important in
maintaining the stability needed to prevent injury.

The knee is stabilized on the anterior side by the quadriceps, on the medial side by the sartorius and
gracilis, on the lateral side by the tensor fascia latae and on the posterior side by the hamstring muscle
group from above and the gastrocnemius from below. Because of the small angle of attachment of the
quadriceps to the tibia, a large stabilizing component is always acting on the knee joint. This is particularly
important when the hamstrings are contracting strongly and the knee is flexed beyond 90 degrees at
which point the hamstrings have a backward dislocating component. To counteract this force there is
usually hip flexion, which serves to maintain hamstring length so that tension is maintained.

When the leg is bent 80 to 90 degrees or more and the sartorius, gracilis and gastrocnemius muscles
contract, they create a dislocating component at the knee joint. From 180 (straight leg) to 90 degrees of
flexion, most of the muscles crossing the knee provide a rotary and stabilizing effect. When knee flexion is
less than 90 degrees, a dislocating component occurs in some of the muscles. The knee also has weak
bony and ligamentous arrangements, which contribute to its vulnerability.

The major movements that are possible in the knee joint are flexion and extension. Medial and lateral
rotation takes place only when the knee is flexed. This allows the foot to turn when it is free to move, and
the trunk to turn when the foot is fixed to the ground as for example, when wearing cleats or spikes. If
rotation occurs when the leg is straight, it may cause knee injury.

Muscles of the Knee

The muscles of the knee joint are predominantly two-joint muscles, which also cross and act at the hip
joint. This includes the hamstrings, rectus femoris of the quadriceps group, gracilis, sartorius and the
tensor fascia latae muscles. The gastrocnemius is another two-joint muscle of the knee, which also
crosses the ankle joint. The two-joint muscle arrangement provides efficiency of movement in walking and
running. However, a two-joint muscle cannot stretch enough to allow full range of motion at both joints at
the same time. Nor can it contract enough to produce complete movement at both joints at the same
time. A common example of this is when you try to flex the hip and extend the knee fully at the same
time or to simultaneously extend the hip and flex the knee fully. The hamstrings cannot contract or
stretch enough to allow either of these combinations to be performed in total.

Although the hamstring muscles are usually considered as a group, there are important differences
between them. The biceps femoris, attached on the lateral side, and the semimembranosus and
semitendinosus attached on the medial side of the knee, produce lateral and medial rotation respectively
when the knee is flexed. If an imbalance in strength exists as for example if the biceps is stronger than
the “semi” muscles, lateral rotation at the knee occurs when the knee is flexed.

This can be seen when doing the leg extension and leg curl exercises. The hamstrings work to flex the
knee, but because of the imbalance the biceps overpowers the semis and causes the lower leg to be
laterally rotated as the knee is flexed. To correct this condition you must work the hamstrings while
keeping the lower legs medially rotated. If the medial hamstring muscles are weaker than the lateral
muscles, as the lower leg swings forward it will be medially rotated.
A similar situation exists when an imbalance occurs in the strength of the quadriceps muscles, particularly
the vastus medialis and lateralis. The vastus muscles must be strong enough to stabilize the patella and
keep it in its groove during knee extension, especially in forceful contractions of the quadriceps. If the

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medialis is weak, the patella becomes laterally displaced because of the pull of the vastus lateralis. In this
case or if the reverse imbalance exists, it can cause chondromalacia (degeneration of cartilage) if
continued over a long period of time.

Relationship between the Gastrocnemius and the Hamstrings

The gastrocnemius, the major muscle of the posterior shin, functions to extend the foot (plantar flexion).
It ties in with the hamstrings at the knee joint where they are both involved in knee joint flexion. In
addition, the insertion of the gastrocnemius on the femur helps to provide greater stability.

To be most effective the gastrocnemius must be taut in order to have a strong contraction at the knee
joint. This means you must put the foot into flexion (dorsiflexion) to stretch the Achilles tendon and to
make the gastrocnemius muscle taut so that when it contracts, it will shorten the upper tendons at the
knee immediately. In this case the muscle shortening will not result in taking up the slack of a relaxed
Achilles tendon if the toes are pointed when the knee flexion takes place.
The practice of putting one end of a two-jointed muscle on stretch in order to elicit a strong contraction at
the other end is very important for maximal development of two jointed muscles. This includes muscles
such as the hamstrings, the rectus femoris of the quadriceps group, the biceps, long head of the triceps
and others.

Relationship between the Quadriceps and the Hamstrings

It is not uncommon to hear that the strength of the hamstrings must equal that of the quadriceps.
Because of this, many personal trainers and strength coaches strive to get an equal balance of strength
between these two muscle groups. However, the quadriceps should always be stronger than the
hamstrings in almost all instances. The exact ratio should depend on the angle in the knee and the
position of the thigh at the hip joint.

For example, the quadriceps has four separate muscles, three of which are fairly large. The muscle mass
of the quadriceps is much greater than that of the hamstrings and its workload is also much greater. The
quadriceps muscles are anti-gravity muscles that must contract to not only keep you erect but to move
you in walking, running and jumping activities. The hamstrings (at the knee joint) are hardly involved in
these activities. In regard to size, only one of the hamstrings (the biceps femoris) has two heads and a
substantial amount of muscle mass. The semitendinosus and semimembranosus have very small muscle
bellies; thus, from the sheer size of the quadriceps and its functions, it stands to reason these muscles
should be stronger. Note that at the hip joint the hamstrings are stronger than the one muscle of the
quadriceps (rectus femoris). Also, other muscles come into play at the hip joint for both flexion and
extension.

In the knee joint (leg) extension exercise all four heads of the quadriceps are involved. Since the rectus
femoris is a two-jointed muscle, the hip end must be placed on stretch for the lower end to act strongly at
the knee. If not, the main function of the remaining three heads (vastus lateralis, medialis and
intermedius) is knee joint extension. They are not affected by the position of the leg at the hip in order to
have an effective or maximal contraction.

The rectus femoris, the two-jointed muscle of the quadriceps group, plays a major role in knee joint
extension when it is placed on stretch at the hip joint. To do this the leg must be in line with the body
when the knee joint extension takes place. If you are in a seated position (in which most testing and
exercise is done) there is slack at the upper end of the rectus femoris. When it contracts in knee joint
extension, the initial shortening takes up the slack of the upper muscle tendons and, as a result, its
contribution to knee extension is not as great as possible.

For a stronger contraction of the hamstrings in the knee (leg) curl exercise, the hip joint end of the
hamstrings must be placed on stretch. (This is why the seated knee curl seems easier than the more

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popular lying variant). However, the hamstring muscles cannot generate the same amount of strength
exhibited by the quadriceps (all other training factors being equal).

More important than being concerned with the strength ratio between the quadriceps and the hamstrings
is to develop these muscles as needed for bodybuilding or for sports performance. Keep in mind that as
you increase the strength of the quadriceps you are then capable of getting greater strength of the
hamstrings and vice versa. Thus, both of these muscles should be fully developed.

The Ankle and Foot

The ankle joint is made up of the tibia and the talus bones. Because the end of the tibia is somewhat
concave and the talus below it is convex, the bony stability is fairly strong. Since the ankle must withstand
great stress, there are strong ligaments surrounding the joint to provide even greater stability.

Movements possible at the ankle are flexion (dorsiflexion) and extension (plantar extension). The axis of
rotation for the ankle is not in a true frontal plane. It is oriented slightly backward and downward on the
lateral side. The tilt creates a slight disorientation of the foot from true anterior-posterior plane motion
during plantar flexion and dorsiflexion. In other words the foot does not remain in the same position
during its up and down movement.

The subtalar joint is located between the talus and calcaneus. This is the joint that is typically involved in
ankle sprains or strains. It is an intertarsal joint (involves several bones of the foot) while the ankle joint
has only two bony parts, one in the shin and one in the foot. The subtalar joint allows for different
positions of the foot and leg in response to weight bearing, particularly when running on uneven or curved
paths. It is the main connection between foot mobility and stability of the ankle and leg.

In plantar flexion there are simultaneous movements of the foot around the subtalar and ankle axes (i.e.,
a combination of eversion at the subtalar joint and extension at the ankle joint). There is a combination of
inversion at the subtalar joint and dorsiflexion at the ankle when executing ankle joint flexion.

Having muscle strength on both sides of the ankle and foot is important in maintaining joint integrity. Any
imbalances in the strength or flexibility of the surrounding musculature result in misalignment. This in turn
must be counteracted by muscular contractions or ligament tension. If not, postural imbalances occur.

People with shinsplints usually have significantly greater plantar flexor (extensor) strength than dorsiflexor
(flexor) strength and greater movement of the calcaneus during the support phase of walking and
running. Overdevelopment of the ankle extensors tends to also cause a muscular imbalance between the
strength of the foot supinator and the pronator muscles, which may result in lateral ankle sprains,
particularly when landing after being airborne.

Muscles of the Ankle

The gastrocnemius is the major ankle extensor muscle of the shin. It is located on the upper posterior side
of the lower leg and gives the rounded form to the calf. At the upper end there are two tendons that
attach to the posterior side of the condyles of the femur, while at the lower end, the tendons from the two
heads of the muscle run diagonally downward to attach to the Achilles tendon.

Lying directly beneath the gastrocnemius is the soleus, which has similar functions to the gastrocnemius.
Its upper attachment is on the tibia and fibula and its lower attachment blends into the Achilles tendon on
the calcaneus. The soleus is slightly wider than the gastrocnemius and together they form a functional unit
sometimes called the triceps surae. Collectively these muscles are extremely strong — when combined
with the Achilles tendon they are even stronger. They can exert a force of over 900 pounds in ankle
extension.

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The tibialis anterior is the main muscle on the anterior side of the shin. Its muscle mass is located high on
the shin while its tendon at the lower end crosses the ankle joint and inserts on the inner and under
surface of the foot arch. This is one reason why the tibialis anterior not only dorsiflexes the foot but also
turns the sole of the foot inward. It plays a major role in maintaining the foot arch.

The Spine

The most important functional unit of the body is the vertebral (spinal) column. It provides the main
framework and foundation for most of the movements of the body and extremities. The spinous and
transverse processes serve as attachments of the deep and superficial muscles of the back which produce
forward, backward and lateral bending, and small amounts of rotation of one vertebrae on another. The
size of the processes and the corresponding muscles increase as you move down the vertebral column and
are largest in the lumbar area.

The movements of the spinal column include movements of one vertebrae on another separated by the
intervertebral discs. There are also movements between the facets of successive vertebrae, which are
freely movable. The intervertebral discs allow slight movement and function in shock absorption. Although
the joint between any two adjacent vertebrae does not allow a great deal of motion, multiple vertebral
joints produce a great range of motion in flexion, extension, hyperextension, lateral flexion to both sides,
and rotation. Note that movement is limited in the thoracic area because of the attachment of the ribs and
the longer spinous processes on the thoracic vertebrae.

The vertebral column lacks great bony stability and relies to a great extent on the ligaments and muscles
for support. If they become stretched or weakened, the integrity of the column is weakened, and the
vertebrae must absorb the forces. This sometimes results in vertebral disc damage, especially in shock
type activities.

The ligaments can hold the vertebral column together, but continued reliance upon them as a result of
weak muscles or a strength imbalance between antagonistic groups of muscles can result in excessive
stretching of the ligaments, which becomes permanent. This often occurs in excessive static or passive
stretching and, as a result, there may be damage to the discs and spinous processes.

Muscles of the Spine (Midsection)

The abdominal musculature (rectus abdominis, internal and external oblique, transverse abdominis) acts
to prevent the vertebral column from being continually hyperextended. The rectus abdominis (and, to a
limited extent, the internal and external obliques) acts to pull the anterior pelvis toward the sternum or to
pull the rib cage down toward the pelvis. Both of these actions result in spinal flexion in which the rectus
abdominis has a large stabilizing component since its line of action is parallel to the spinal column. The
obliques have a rotary component but cancel out this action when the muscles on both sides of the
abdomen simultaneously contract.

From physiology it is known that when a muscle contracts, the entire muscle undergoes contraction. This
is true of the abdominal muscles; however, because the rectus abdominis is relatively long, one end is
stabilized when it contracts in order to produce movement in the other end. For example, when doing a
sit-up or crunch, the pelvic girdle is held in place firmly via contraction of the hip joint muscles so that the
shoulders will rise toward the feet. Because of this, you experience shortening mainly of the upper fibers
of the rectus abdominis. The lower fibers do not undergo the same amount of shortening. For the most
part it remains under isometric contraction and, as result, you get development mainly of the upper fibers.

To produce shortening of the rectus abdominis in the lower fibers of the abdomen, it is necessary to do
exercises such as the reverse sit-up (reverse crunch) or hanging leg raises. In these exercises the pelvic
girdle is in motion while the chest and shoulders are stabilized. The upper fibers of the abdominal muscles
remain isometrically tensed.

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This appears to hold true in all exercises with relatively long muscles. There is a distinct difference in the
amount of shortening or the intensity of the contraction that can be seen in different parts of the muscle.
When the muscle is relatively short, it is not noticeable. The biggest difference may be in the shortening of
the tendons at the end that is involved in movement.

The internal and external obliques are unique in their functions. For example, when the right side of the
external oblique contracts it pulls the shoulders down and to the left. If the left side of the external
obliques contract they pull the shoulders down and to the right. The internal obliques on each side have
an opposite function. When both the internal and external obliques contract on both sides simultaneously
they cancel out their rotational effects, and the movement results in flexion.

Because the lower fibers of the internal oblique are relatively horizontal it does not appear to play a major
role in movements. Its main function appears to be to hold in the abdominal viscera together with the
transverse abdominis. However, it is still possible to see some contraction in this area when the internals
work together with the external oblique muscles to produce full rotation of the shoulders (or hips if they
are free to move).

For example, if the pelvis is stabilized, contraction of the upper right external oblique and the lower left
internal oblique create a long pull down and to the left. Contraction of the upper left external oblique and
the lower portion of the right internal oblique produces strong downward rotation to the right. If the
shoulders are stabilized, and the hips are in motion, then we see movement in the opposite direction. For
example, the left external and the right internal oblique rotate the right hip up and to the left while the
right external and left internal oblique rotate the left hip up and to the right.

Because of the overlapping functions of most midsection muscles, they provide for more safety and
strength of the core area of the body. For example, in lateral movements of the spine, not only are the
abdominal muscles involved, but also the erector spinae and the quadratus lumborum located on both
sides of the lumbar spine. When the pelvis is in motion the lower latissimus dorsi, which attaches to the
upper, outer surface of the pelvis, is also involved. Thus there is some interplay between the muscles of
the midsection together with the muscles of the back.

There is also some interplay between the pectoralis major and the external obliques. Note that the fibers
of the pectoralis major in the very lowest section run downward at an angle. In the European literature,
this is considered the abdominal portion of the pectoralis major. In the U.S., we usually only distinguish
the upper and lower fibers of the pectoralis major, and do not divide it into three sections.

Examination of the lower fibers of the pectorals shows that the fibers run downward and are almost in line
with the external oblique fibers as they come close to one another. Thus, as the lower portions of the
pectoralis major contract they may also tie in with contraction of the external obliques to create
movement across the entire anterior trunk. This may be seen when doing chin-ups and pull-ups when
your body rises in front and when doing pull-downs across the body.

The deep musculature on the posterior spine is composed of many small pairs of muscles that span one or
more vertebrae. All of the muscles are situated so that they have large stabilizing components. The larger
muscles are collectively known as the erector spinae. They run from the sacrum of the pelvis to the head
and are angled out somewhat to cover both sides of the spine. The erector spinal muscles are biggest and
strongest in the lumbar area. They hold the trunk erect and are involved in spinal extension,
hyperextension, lateral flexion and rotation to the rear. Thus, maintaining strength of the spinal muscular
is important throughout life.

The pelvis connects the trunk with the lower extremity. During weight bearing exercises when the legs are
fixed, the pelvis changes positions relative to the femur. However, as the pelvis moves on the thigh, the
vertebral column must change position since it is connected to the pelvis at the sacrum. When you are
airborne or when the lower body is free to move, the pelvis moves with movement in the lumbar spine.

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The legs may move as a unit with the hips or individually.
The extensor muscles of the spine are called anti-gravity muscles. They apply forces on the skeletal
framework to counteract the pull of gravity. As a rule, they are responsible for posture, especially an erect
trunk position.

The muscles of the hip joint also control movement of the pelvis. They are involved in all movements of
the pelvis when the axis is in the hip joint. When the axis is in the waist, the midsection muscles are
involved. Thus, we see a multitude of muscles that are involved with movement and stabilization of the
pelvis and spine, which can be considered the core body areas. By keeping the hip and midsection strong
and the body parts in good alignment, you can have a pain free, mobile and functional spine for your
entire lifetime.

Relationship between the Abdominal Muscles and the Hip Flexors

The abdominal and hip flexor muscles work together in a manner similar to the hip extensors and the
erector spinae muscles of the lower back. The abdominal muscles (rectus abdominis, external and internal
obliques) and the hip flexors (iliopsoas, pectineus and rectus femoris) work together in order to create
maximum ROM in your ability to raise the legs as high as possible.

When you are in good alignment in a standing position and raise one leg (keeping it straight), the hip
flexor muscles contract concentrically to raise the leg approximately 30 to 45 degrees (more if you have
great hip joint flexibility). As you raise the leg, the erector spinae muscles remain under isometric
contraction to stabilize the pelvis. When the leg goes higher than the 30 to 45 degree angle, the pelvic
girdle then rotates posteriorly (upper hips move backwards) to allow the leg to rise higher. At this time
the rectus abdominis and oblique muscles undergo concentric contraction to rotate the hips and the hip
flexor muscles switch to an isometric contraction to maintain the hip/leg position as a unit. The erector
spinae muscles switch to an eccentric contraction to control the rotation of the pelvis.

If you begin with the leg well behind the body then the abdominal muscles will have to first undergo a
concentric contraction to rotate the pelvis posteriorly and bring the leg in alignment with the body. The hip
flexor muscles at this time remain under an isometric contraction to stabilize the hip-leg unit. When the
leg is vertical, the muscular contraction switches and the hip flexors undergo a concentric contraction to
raise the leg while the pelvis remains stable with an isometric contraction of the erectors. In some cases,
you may find some residual abdominal muscle contractions and the pelvis may move somewhat but it will
be little in comparison to movement of the leg.

The Shoulder

The bony arrangement of the shoulder joint consists of a shallow socket (glenoid fossa) into which the
spherical head of the humerus fits. Less than half of the humerus is in the socket at any one time and the
bony arrangement is therefore weak. Because it is a ball and socket type joint, the shoulder joint is a
multi-axial joint (the same as in the hip joint) that allows for the following movements: flexion,
extension/hyperextension; transverse (horizontal) adduction and abduction; abduction and adduction;
medial (inward) and lateral (outward) rotation and circumduction. The shoulder joint is designed for
mobility and therefore sacrifices bony and ligamentous stability.

Muscles of the Shoulder Joint

The musculature surrounding the shoulder joint is arranged so that it produces large stabilizing
components especially by the four rotator cuff muscles (supraspinatus, teres minor, infraspinatus and
subscapularis). Regardless of the position of the arm, the anterior, posterior and middle deltoids also have
large stabilizing components because of their small angle of pull. Further stability is provided by the long
heads of the biceps brachii on the anterior shoulder and the triceps on the posterior side. As with the
deltoid muscle, the upward pull of these muscles is counteracted by the downward pull of the rotator cuff
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muscles (except for the supraspinatus).
Most of the other muscles surrounding the shoulder joint also exert a stabilizing force, but their main
function is to move the arm. In addition, as the arm moves into motion, the muscles involved change their
angles of pull considerably. Thus they may not always be major stabilizers (or movers) of the shoulder
joint.

The muscles that serve as the primary movers of the arm at the shoulder joint are the deltoid,
coracobrachialis, pectoralis major, latissimus dorsi and teres major, the long and short heads of the biceps
and the long head of the triceps on the posterior side. The muscles located on the front of the chest and
shoulder are involved mainly in flexion and horizontal adduction while those on the posterior side are
involved mainly in extension and horizontal abduction.

The latissimus dorsi and teres major muscles on the posterior side rotate the arm medially at the shoulder
joint. In addition, the infraspinatus and the teres minor, also located on the posterior side of the humerus,
act in a wheel-axle like mechanism to laterally rotate the arm around the longitudinal axis of the humerus.
The subscapularis, located on the anterior side of the humeral head, also functions in a wheel-axle like
mechanism to medially rotate the arm. The supraspinatus is attached to the top of the humeral head and
functions as a first class lever to pull the top of the humeral head inward. As a result the humerus moves
into abduction.

The latissimus dorsi and teres major are located mostly on the upper sides of the back and insert on the
front side of the humerus. When they contract they pull the front of the arm medially in a wheel axle
arrangement, extend the arm and retract the shoulder beyond the level of the back. In the wheel and axle
arrangement the wheel is represented by the forearm and hand if the elbow is extended. The ROM of the
hand when the elbow is flexed during shoulder joint medial rotation varies depending on the amount of
elbow flexion. It is greatest when there is 90 degrees of elbow flexion and smallest when the arm is
straight. This should be taken into consideration when doing rotator cuff exercises especially when you
hold a Strength Bar in the hands. The positioning of the arms is also important.

When your arms are all the way to the rear of the body and the scapulae are retracted (i.e., moved close
together), the initial contraction of the muscles on the front of the body (pectoralis major and anterior
deltoid) move the head of the humerus more to the front in order to produce horizontal flexion in the
shoulder joint. The posterior rotator cuff muscles counteract this forward force component. Problems arise
in the shoulder joint if the stabilizing forces are not effective in counteracting the dislocating forces of the
muscles involved in the movement.

The action of arm abduction is complex. The supraspinatus initiates the first few degrees of shoulder
abduction. It is a first-class lever arrangement, which gives a better angle of pull than does the deltoid
muscle. The deltoid does not come into play until the arm is approximately 45 degrees out to the side and
up. As shoulder joint abduction takes place the scapula upwardly rotates in coordination with the arm
movement. In general, the scapula rotates about two degrees for every three degrees of arm movement.
In this way, the acromion process of the scapula is moved out of the way as the greater tuberosity of the
humerus gets close to it.
Shoulder impingement usually occurs in activities that require the arm to be abducted or flexed and
medially rotated, as for example in baseball pitching. Also susceptible are tennis players and swimmers. In
addition, this combination of actions occurs when you do lateral arm raises to shoulder level with the arm
medially rotated (thumb down).

Some people believe that the impingement syndrome is a rotator cuff impingement, but the long head of
the biceps can also become impinged. Most authorities agree that inflammation occurs from the squeezing
of the supraspinatus tendon, which passes over the head of the humerus. Because of this you should
beware of doing lateral arm raises only to the level position. It may be a contributing cause to shoulder
impingement, especially when done vigorously. Also it limits your shoulder joint flexibility.

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The latissimus dorsi and teres major muscles on the posterior side rotate the arm medially at the shoulder
joint. In addition, the infraspinatus and the teres minor, also located on the posterior side of the humerus,
act in a wheel-axle like mechanism to laterally rotate the arm around the longitudinal axis of the humerus.
The subscapularis, located on the anterior side of the humeral head, also functions in a wheel-axle like
mechanism to medially rotate the arm. The supraspinatus is attached to the top of the humeral head and
functions as a first class lever to pull the top of the humeral head inward. As a result the humerus moves
into abduction.

The latissimus dorsi and teres major are located mostly on the upper sides of the back and insert on the
front side of the humerus. When they contract they pull the front of the arm medially in a wheel axle
arrangement, extend the arm and retract the shoulder beyond the level of the back. In the wheel and axle
arrangement the wheel is represented by the forearm and hand if the elbow is extended. The ROM of the
hand when the elbow is flexed during shoulder joint medial rotation varies depending on the amount of
elbow flexion. It is greatest when there is 90 degrees of elbow flexion and smallest when the arm is
straight. This should be taken into consideration when doing rotator cuff exercises especially when you
hold a Strength Bar in the hands. The positioning of the arms is also important.

When your arms are all the way to the rear of the body and the scapulae are retracted (i.e., moved close
together), the initial contraction of the muscles on the front of the body (pectoralis major and anterior
deltoid) move the head of the humerus more to the front in order to produce horizontal flexion in the
shoulder joint. The posterior rotator cuff muscles counteract this forward force component. Problems arise
in the shoulder joint if the stabilizing forces are not effective in counteracting the dislocating forces of the
muscles involved in the movement.

The action of arm abduction is complex. The supraspinatus initiates the first few degrees of shoulder
abduction. It is a first-class lever arrangement, which gives a better angle of pull than does the deltoid
muscle. The deltoid does not come into play until the arm is approximately 45 degrees out to the side and
up. As shoulder joint abduction takes place the scapula upwardly rotates in coordination with the arm
movement. In general, the scapula rotates about two degrees for every three degrees of arm movement.
In this way, the acromion process of the scapula is moved out of the way as the greater tuberosity of the
humerus gets close to it.
Shoulder impingement usually occurs in activities that require the arm to be abducted or flexed and
medially rotated, as for example in baseball pitching. Also susceptible are tennis players and swimmers. In
addition, this combination of actions occurs when you do lateral arm raises to shoulder level with the arm
medially rotated (thumb down).

Some people believe that the impingement syndrome is a rotator cuff impingement, but the long head of
the biceps can also become impinged. Most authorities agree that inflammation occurs from the squeezing
of the supraspinatus tendon, which passes over the head of the humerus. Because of this you should
beware of doing lateral arm raises only to the level position. It may be a contributing cause to shoulder
impingement, especially when done vigorously. Also it limits your shoulder joint flexibility.

The Shoulder Girdle

The shoulder girdle is made up of the clavicle and the scapula. However, all movements of the scapula are
usually considered movements of the shoulder girdle. They include elevation, depression, upward rotation,
downward rotation, protraction (abduction) and retraction (adduction).

Because the shoulder is designed for mobility, its stability is reduced. The muscular arrangements of the
shoulder girdle and the shoulder joint are such that they provide the stability lacking as a result of the
weak arrangements of the bones and ligaments. However, the muscles must be strong enough to provide

76
the necessary stability. A lack of upper body strength accounts for many of the injuries in the shoulder
region.

Injury to the ligaments and muscles of the shoulder girdle is possible if the stabilizing components of the
muscles are not strong enough to hold the joint together. Also, since the shoulder girdle is fairly mobile
relative to the trunk, in many instances it must be a stable base against which the muscles of the shoulder
joint pull. During forceful overarm motions the strength of the agonistic and antagonistic muscles
surrounding the shoulder girdle prevents overuse strains on the surrounding tissues.

In most activities involving the upper extremity, the shoulder girdle is responsible for the initiation of the
movements. For example, elevation of the scapula initiates lifting the arm; depression precedes pulling
the arm downward; protraction occurs before reaching, throwing or pushing forward; retraction initiates
pulling backward; upward rotation takes place for increasing the range of overhead reaching; and
downward rotation allows for forceful arm adduction at the shoulder joint.

Relationship between the Shoulder Joint and the Shoulder Girdle

The shoulder joint muscles are responsible for moving the arm while the shoulder girdle muscles (which
work in synchronization with the shoulder joint muscles) are responsible for moving the scapula (and
clavicle). The muscles work closely with one another to ensure smooth, full ROM in the shoulder joint.

In bodybuilding, the muscles of the back, shoulder and chest are usually trained separately. However, it is
impossible to isolate the muscles of the back, chest or shoulder. For example, execution of the military
press involves the clavicular pectoralis major of the chest, anterior deltoid of the shoulder and the
trapezius and serratus anterior muscles of the shoulder girdle. All of these muscles are prime movers for
their actions. Thus you strongly involve chest, shoulder, and back muscles in the military press.

Rather than thinking about isolation of body parts, you should learn how the muscles work together as
you do a particular exercise to truly understand what is occurring. In this way you get a better
understanding of not only how the exercise is executed, which muscles play a major role and how they
can be best developed, but how you can prevent injury to the shoulder joint.

For example, when doing lateral arm raises, it is commonly believed that the arms should only be raised
to the level position, because if you went above the level position only the trapezius (or some other
muscle) is involved and the deltoid would no longer be active. In reality, it is just the opposite. The deltoid
is strongest from the level position to 180º (when the arms are overhead), and the trapezius works
through the full ROM of the arm (0 to 180 degrees). Keep in mind that the shoulder girdle muscles can
only move the scapulae, and shoulder joint muscles can only move the arm. They work together in all arm
movements. Without coordinated movement of the scapula and arm, it would be impossible to move the
arm through an appreciable ROM. Also, you will have great difficulty in moving the arm comfortably and
safely

Before going into how the muscles are involved in moving the scapula and arm, it is important to
understand the functioning of the trapezius muscle of the upper back. This very important muscle has four
sections, each of which has a separate action, yet they work together in most movements. For example,
the very uppermost portion of the trapezius (Part I) is involved in scapula elevation, as seen in the shrug
exercise.

Directly below this section (Part II) some of the trapezius muscle fibers are fairly vertical, some are
horizontal and some are in-between. The more vertical fibers are involved in elevation of the scapula,
while the more horizontal fibers are involved in upward rotation of the scapula. To produce rotation
(around an axis in the middle of the scapula), the horizontal and partially horizontal fibers pull the upper
part of the trapezius in toward the spine.

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Part IV of the trapezius, the very lowermost portion of the muscle where the fibers are almost vertical,
works together with Part II to pull down on the inner border of the scapula to rotate the scapula upwards.
In addition, the serratus anterior, which is located under the armpits and attaches to the outer border of
the scapula, pulls the lower outer border to also rotate the scapula upward. These three muscles pulling
on different parts of the scapula produce upward rotation needed whenever you raise the arm upwards,
either sideways or in front, as for example, when doing lateral or front arm raises and the overhead press.

Part III, the middle part of the trapezius, is involved in adduction of the scapula: movement in which the
scapula moves inward toward the spine. Parts II and IV assist in this action, which is also indicative of the
importance of this movement. In addition the rhomboid muscle, which is located directly underneath the
trapezius, is also involved in adduction of the scapula.

Part IV of the trapezius is also a prime mover for depression in which the scapula moves directly
downward. This is the opposite of elevation, which is performed by Part I. Depression of the scapula is
very important for initiating all downward movements of the arm from an overhead position. For example,
when you are doing the pull-up or chin-up, the scapula must be pulled down before the arm can start
coming down. Also involved in depression of the scapula is the pectoralis minor, located on the chest
beneath the pectoralis major.

The pectoralis minor and rhomboid have another major action, which is opposite that of the trapezius:
downward rotation of the scapula. Thus it is possible to see how some of the muscles work together as
prime movers, yet may have another directly opposite action. This is very beneficial for controlling
movement of the scapula. For example, the serratus anterior is a prime mover for upward rotation and
abduction of the scapula. It works together with the trapezius in scapula upward rotation but against it in
abduction since the middle trapezius is a powerful adductor.

The Elbow

The elbow joint is made up of the ends of the humerus and ulna bones. Because the radius also articulates
with the humerus it can also be considered part of the elbow. The annular ligament, which encircles the
head of the radius and attaches to the ulna, allows the radius to rotate around the ulna on a longitudinal
axis of the forearm to provide for pronation and supination. The only movements possible at the elbow
joint are flexion and extension.

The anterior muscles are the main elbow joint flexors (biceps, brachialis, brachioradialis and pronator
teres), which are arranged mechanically around the elbow joint. Other anterior muscles such as the wrist
flexors and extensors pass over the elbow to insert on the humerus. The lines of force of the wrist flexor
(and extensor) muscles pass so close to the elbow joint that their function at the elbow is mainly
stabilizing.

The muscular stability of the elbow is considered strong due to the number of muscles that act as
stabilizers on the anterior side. Positions in which the muscles have dislocating components (when they
are at greater than 90 degrees of flexion) occur when the muscles are so shortened that the tension is
minimal. The main elbow flexors have stabilizing and rotary functions.

The biceps is most often considered a two-joint muscle. However, it acts on three joints (shoulder, elbow,
radioulnar) and should be strengthened in all of these actions. This includes shoulder joint flexion with the
elbow extended, elbow flexion with the shoulder joint held in extension and supination with the elbow bent
at a 90-degree angle.

The bony arrangement and muscular stability of the posterior elbow result in a strong posterior elbow. The
main muscle on the backside of the elbow is the triceps. From its attachment on the olecranon process of
the ulna it covers the length of the humerus. Because of the structure of the posterior elbow, the triceps
helps to stabilize the elbow when it pulls at an angle greater than 90 degrees to the long axis of the ulna.

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The triceps is a first-class lever when it pulls at a 90-degree angle to the long axis of the ulna. In this
position 100 percent of its effort goes to the rotary function.

Because the triceps is a two-jointed muscle, the long head of the triceps lengthens at the shoulder when
shoulder flexion takes place and simultaneously shortens at the elbow end (elbow extension) to allow a
full ROM at the shoulder. This is good for economy but not maximum strength. To fully strengthen all
three heads of the triceps you should do resistance exercises in which you extend the shoulder joint with
the elbow extended and extend the elbow with the shoulder joint flexed. An exercise in which you extend
the shoulder joint with the elbow extended is the two-part triceps kickback. The lying 45 degrees elbow
extension exercise is an example of elbow extension with the shoulder joint flexed.

Relationship between the Shoulder and the Elbow

The actions of the triceps and biceps muscles at the shoulder joint are secondary to those at the elbow
joint. Because of their attachment to the scapula, when doing elbow flexion or extension exercises, the
muscles of the shoulder joint must contract to hold the shoulder and arm in place, i.e., to be stabilized. If
not, the muscles will have a tendency to perform their actions at both the elbow and shoulder joints. A
multitude of muscles come into play both for shoulder stability and to allow for a well-executed movement
at the elbow joint.

The two heads of the biceps cross the shoulder joint to attach on the scapula. However, their action at the
shoulder joint is relatively weak, and they come into play only when the resistance is sufficiently great. At
this time they act mainly as secondary movers and help stabilize the shoulder joint. Since only the long
head of the triceps crosses the shoulder joint it plays a role as a stabilizer but even more importantly, as a
prime mover for shoulder joint extension. Thus it plays a key role not only at the shoulder but at the
elbow. The rotator cuff muscles handle most of the stabilization work on the posterior shoulder.

The Forearm

The RadioUlnar Joint

The radioulnar joint is a combination of three joints located at the wrist, elbow and in between the ulna
and radius bones. These joints are not very stable and the surrounding ligaments provide the needed
support. The interosseous membrane, which is located between the shafts of the radius and ulna along
their entire length, make up the middle joint. This membrane helps to prevent the ulna and radius from
sliding past each other. Because the muscles are also attached to the interosseous membrane, it acts to
transfer stress from the radius and ulna.

The movements of the radioulnar joint consist of pronation and supination. At the elbow the radius rotates
around the annular ligament and does not change positions relative to the ulna. At the wrists, when the
forearm is in pronation, the radius crosses over the ulna so that it is then on the inner side of the ulna.
When the forearm is in supination the radius is on the lateral side of the ulna.

The muscles of the radioulnar joint act as stabilizers and produce either pronation or supination. This
includes the biceps, supinator, pronator teres, and pronator quadratus. The pronator quadratus and the
supinator are situated so that they pull from the ulna on the radius to produce pronation and supination
respectively. The pronator teres has a stabilizing component but also pulls across the elbow and is thus
involved in elbow flexion when the resistance is great. It also counteracts the pull of the biceps for
supination when performing elbow flexion.

The attachment of the biceps on the medial side of the radius allows the biceps to produce supination
when the forearm is in pronation. When the forearm is pronated the tendon of the biceps is wrapped
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around the radius. This positioning causes the biceps to be weak in elbow flexion. This is why a pull-up is
easier to perform when the forearm is supinated.

A similar situation occurs with the brachioradialis. Its attachments on the inner side of the humerus and
outer side of the radius make it a pronator to the neutral position. When the forearm is pronated, the
biceps and the brachioradialis work together in supination. The brachialis plays no role in radioulnar
movements because it is attached to the ulna. This particular arrangement of the elbow flexors must be
taken into account when analyzing elbow flexion exercises such as pull-ups (forearm in pronation), chin-
ups (forearm in supination), neutral grip pull-ups and other elbow flexion exercises.

The Wrist

The wrist joint consists of the ends of the radius and ulna bones of the forearm with the carpal bones of
the hand. The movements of the wrist joint include flexion and extension/hyperextension, radial and ulna
flexion (abduction), and adduction (respectively). Although the bony stability of the wrist is weak, it has
fairly strong ligaments to supply stability. There are also many muscle tendons that cross the wrist on all
sides to provide additional stability, especially if they are strong.

Wrist Joint Muscles

The major flexors of the wrist are the flexor carpi radialis, flexor carpi ulnaris, and the palmaris longus.
These muscles are located on the front of the forearm (i.e., on the palm side of the hand). The major
extensor muscles of the wrist include the extensor carpi radialis longus, extensor carpi radialis brevis, and
extensor carpi ulnaris. They are located on the back of the forearm (i.e., on the back-of-the-hand side of
the forearm).

The main muscles involved in wrist abduction (radial flexion) include the flexor carpi radialis and extensor
carpi radialis longus and brevis. In ulna flexion (wrist adduction) the flexor carpi ulnaris and the extensor
carpi ulnaris are the major muscles involved. Note how both the flexor and extensor muscles participate in
the lateral movements of the hand.

The wrist flexors and some of the finger flexors have dual functions. Their muscle mass is located within
the forearm and their tendons cross the wrist joint to attach on the bones of the hand. When the muscles
contract and shorten, the tendons also shorten, producing an action in the wrist.

Relationship between the Elbow and the Wrist Muscles and Actions

The elbow and wrist are tied in via the wrist flexor and extensor muscles. These muscles cross the wrist
and elbow joints (from their attachment on the hand to their attachment on the humerus). Because of this
they have a role at the elbow as well as the wrist, although they are primarily wrist muscles, since their
major function is at the wrist. At the elbow joint the muscles are relatively weak and their angle of pull is
more into the joint rather than in moving the forearm. Thus their function is to act more as stabilizers
when you execute elbow joint exercises. The forces created by the wrist extensors are also directed into
the joint. Thus they act similarly to the wrist flexors at the elbow.

The elbow joint is used in most all upper body exercises and movements. A common injury is tendinitis
felt on the back of the elbow. While most think it is their elbow hurting, it is in reality the tendons from
their hands, due to poor grip. Most people assume that this is their triceps tendon in their elbow. Most
likely, it is the tendon from the wrist flexor muscles. This set of muscles originates from the rear side of
the elbow (medial epicondyle of the humerus) and inserts onto the fingers in different arrangements.
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During lying triceps extensions (skull crushers), some trainees will allow their wrist to be bent backwards.
This will cause stress and chronic pain to the backside of the elbow. This can be fixed by maintaining a
strong grip on the bar and keeping your wrist flexed or stiffened. Remember to keep a firm and correct
grip on the bar.

Conclusion

By looking at specific exercises it is possible to see even more clearly exactly how the muscles function
together and how some of the biomechanical principles apply. By having a stronger comprehension of the
proper biomechanics and kinesiology of the major muscles involved in resistance training exercises, you
can successfully select appropriate exercises that will optimize the muscle potential for yourself, your
clients and loved ones.

Unit Summary

I. The most accurate way to determine the key actions and muscles involved in a strength exercise is to
biomechanically and kinesiologically analyze the movements.

A. The ends of the femur and tibia bones make up the knee joint.

1. The muscles of the knee joint are predominantly two-joint muscles including the hamstrings, rectus
femoris of the quadriceps group, gracilis, sartorius and the tensor fascia latae muscles. The
gastrocnemius is another two-joint muscle of the knee, which also crosses the ankle joint.

a. The gastrocnemius, the major muscle of the posterior shin, functions to extend the foot (plantar
flexion). It ties in with the hamstrings at the knee joint where they are both involved in knee joint
flexion. In addition, the insertion of the gastrocnemius on the femur helps to provide greater
stability.

b. The muscle mass of the quadriceps is much greater than that of the hamstrings. The quadriceps
should always be stronger than the hamstrings in almost all instances for their workload is much
greater.

B. The ankle joint is made up of the tibia and talus bones.

1. The gastrocnemius is the major ankle extensor muscle of the shin. The soleus has similar functions
to the gastrocnemius. The tibialis anterior is the main muscle on the anterior side of the shin.

C. The spine (vertebral column) is the most important functional unit of the body. It provides the main
framework and foundation for most of the movements of the body and extremities.

1. The abdominal musculature (rectus abdominis, internal and external oblique, transverse
abdominis) acts to prevent the vertebral column from being continually hyperextended.
a. The abdominal muscles (rectus abdominis, external and internal obliques) and the hip flexors
(iliopsoas, pectineus and rectus femoris) work together to create maximum ROM in your ability to
raise the legs as high as possible.

D. The bony arrangement of the shoulder joint consists of a shallow socket (glenoid fossa) into which the
spherical head of the humerus fits.

1. The muscles that serve as the primary movers of the arm at the shoulder joint are the deltoid,
coracobrachialis, pectoralis major, latissimus dorsi and teres major, the long and short heads of the
biceps and the long head of the triceps on the posterior side. The muscles located on the front of

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 the chest and shoulder are involved mainly in flexion and horizontal adduction while those on the
posterior side are involved mainly in extension and horizontal abduction.
2. The shoulder girdle is made up of the clavicle and scapula. All movements of the scapula are
usually considered movements of the shoulder girdle. These movements include elevation,
depression, upward rotation, downward rotation, protraction (abduction) and retraction
(adduction).

a. The shoulder joint muscles are responsible for moving the arm while the shoulder girdle muscles
(which work in synchronization with the shoulder joint muscles) are responsible for moving the
scapula (and clavicle). The muscles work closely with one another to ensure smooth, full ROM in
the shoulder joint.

E. The ends of the humerus and ulna bones make up the elbow joint.

1. The anterior muscles of the elbow joint are the biceps, brachialis, brachioradialis and pronator
teres. The posterior muscles on the backside of the elbow are the triceps and anconeus.

a. The actions of the triceps and biceps muscles at the shoulder joint are secondary to those at the
elbow joint. Because of their attachment to the scapula, when doing elbow flexion or extension
exercises, the muscles of the shoulder joint must contract to hold the shoulder and arm in place to
be stabilized.

F. The radioulnar joint is a combination of three joints located at the wrist, elbow and in between the ulna
and radius bones.

1. The muscles of the radioulnar joint act as stabilizers and produce either pronation or supination.
This includes the biceps, supinator, pronator teres, and pronator quadratus.

G. The ends of the radius and ulna bones of the forearm with the carpal bones of the hand make up the
wrist joint.

1. The major flexors of the wrist are the flexor carpi radialis, flexor carpi ulnaris and the palmaris
longus, which are involved in wrist flexion, extension/hyperextension and radial and ulna flexion
(abduction) and adduction (respectively).

a. The elbow and wrist are tied in via the wrist flexor and extensor muscles and have a role at the
elbow as well as the wrist. Although they are primarily wrist muscles, at the elbow joint the
muscles are relatively weak and their angle of pull is more into the joint rather than in moving the
forearm. Thus, their function is to act more as stabilizers when you execute elbow joint exercises.

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 Section Three: Health and Physical
Fitness
Unit 8: Strength
Introduction

Physical activity plays an essential role in the quality of life because it increases energy and promotes
physical, mental and psychological well-being as well as serving as preventive medicine. Several studies
have explored the relationship between physical activity and the overall quality of life (Sheppard 1996),
which include variables like social, mental and psychological well-being. A reduced risk of developing
premature health problems and the potential of a longer life in addition to increased energy, physical,
mental, psychological and social well-being are some of the compelling reasons to promote health and
physical fitness.

The Surgeon General’s Report on Physical Activity and Health (USDDHS 1996) reviews the evidence
relating physical activity to reduced risks of a variety of health problems. There is evidence that physical
activity it related to a lower risk of premature development of many health problems like: anxiety,
atherosclerosis, back pain, cancer, chronic lung disease, coronary heart disease, diabetes, obesity,
hypertension and osteoporosis. Many of these topics will be covered in the Exercise as Preventative Health
Care Section of the text. We can improve our quality of life by preventing or delaying the premature
development of the aforementioned health problems.
Total fitness involves an integrated approach that is dynamic, multidimensional and also relates to
heredity and environmental factors. Total fitness is striving for the highest quality of existence including
mental, psychological and physical components.

Components of Fitness

Heredity: Even though heredity influences physical fitness and health, we can all lead healthy or
unhealthy lives regardless of our genetic makeup. It is not possible to establish the relative portion of an
individual’s health or fitness that is determined through heredity, therefore your genetic background
neither dooms or guarantees success in achieving total fitness.

Environment: Our environment includes our climate, altitude, pollution as well as social factors like
friends, parental values and workplace characteristics that affect our fitness and health. Our past and
present environments affect us all. For example, some children do not have adequate food as part of their
surroundings and therefore cannot focus on other components of fitness until basic needs are met.

Freedom From Disease or Injury: Years of living in a toxic environment, poor eating habits, inactivity
and the myriad complications stemming that result can cause or exacerbate otherwise preventable disease
and injury. One can certainly not consider himself/herself “fit” if disease or injury is present. Think of the
word disease as “the absence of ease” or “dis-ease.” Not so coincidentally, clients who are happy and “at
ease” are also generally more healthy and fit.

Personal Interest: One of the major components of fitness involves personal choices: time spent in the
sun, smoking, drinking, arguing and worrying. Everything from wrinkles to osteoporosis, from arthritis to
atherosclerosis, and from dental care to dermatoses are signs of premature aging. Most are preventable to
a far larger extent than thought possible. People who have, over a lifetime, cast caution to the wind in

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regards to health and fitness practices suffer higher levels of “disease” compared to those who have lived
a fitness lifestyle.

Freedom From Stress: Many psychologists say that “stress” should be measured by how well you are
able to “control” outcomes in your life. A busy corporate president with a majority share of ownership is
less likely to succumb to the physiological ravages of stress, for example, than a much-scrutinized football
trainer.

Mind-Body-Spirit Link: The YMCA adopted a triangle (in which the points of that triangle were “mind,”
“body” and “spirit”) from the Native Americans. All religions in one way or another recognize the
importance of this link. Will it help you run faster? Fight through a tackle? Concentrate on a free throw?
Well, miraculous things have happened! However, any client who does not focus on his/her overall
happiness with life will indeed suffer and never realize his/her full potential. Because this is true, this
component of sport fitness is the most important of all!

It is difficult to separate health and performance related physical fitness. Certainly, they overlap. For
simplicity, health related fitness components include cardiovascular endurance, strength, flexibility, and
body composition. Performance related fitness includes all of the above along with power, agility, speed
and balance. As future ISSA personal trainers we should understand each fitness component with special
attention being given to the components of strength fitness, cardiovascular fitness, flexibility and body
composition. We will focus on these four physical components of physical fitness and training in the
upcoming section of the text.

Strength

Physical inactivity is a primary risk factor for coronary heart disease similar to smoking, hypertension and
high serum cholesterol as indicated by the Surgeon Generals Report. In addition to cardiovascular
concerns, a lack of adequate muscular strength in conjunction with a decrease in bone density due to an
increase in age are definite health concerns of our general population. A lack of adequate muscular
strength can lead to a decrease in our musculoskeletal functions. Strength developed through resistance
training helps to develop our musculoskeletal system. This unit will focus on the fitness component of
strength and the development of strength through resistance training.

What Is Strength?

Strength is an infinitely complex concept that cannot be adequately described or understood in a single
fleeting thought process. So many factors interrelate to produce the concept of strength. If there were a
single statement that could describe strength it would be as follows:

Your ability to contract your muscles with maximum force, given constraints stemming from:

1. Structural/anatomical factors

2. Physiological/biochemical factors

3. Psychoneural/psychosocial factors

4. External/environmental factors

Putting it into fitness-related terms, strength is your ability to exert musculoskeletal force against an
external object (such as a barbell, the ground or an opponent), and it comes from four main sources:

1. How your body is put together as an efficient “machine”

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 2. How your internal systems work to create energy and promote repair, remodeling and growth in
response to training
3. How your skills, attitudes, belief systems and tolerance to pain interrelate to allow your body to
function at peak efficiency
4. How factors external to your body (e.g., weather, gravity, equipment) can be manipulated to
produce greater force output

This definition of strength is, to some, a somewhat “radical” departure from the traditional definition
wherein “strength” is distinguished from “endurance.” This old definition is related to the aerobic-
anaerobic continuum, with “strength” (in the one repetition-maximum tradition) at the anaerobic end of
the continuum and “endurance” at the aerobic end. Thus, strength and endurance were seen as
“opposites” of one another. This notion seems reasonable upon first thought. However, it makes infinitely
more sense to view the aerobic-anaerobic continuum as the template or “superstructure” for
understanding strength.

As you read on, you will begin to understand strength and all the factors that affect it. You will learn how
to manipulate them at will as part of an integrated approach to scientific training. As a result, you will be
able to perform better than ever.

THE CATEGORIES OF STRENGTH

The factors that are known to affect force output must be accounted for in one’s use of the word
“strength.” A distinction must be made because the array of factors affecting each “kind” of strength is
unique. The training regimen used to acquire each “kind” of strength is also unique.

Limit Strength

Limit strength is the amount of musculoskeletal force you can generate for one all-out effort. It is your
athletic “foundation.” All of your muscles should have a good level of limit strength. It is like building your
house on a rock instead of in the sand. While it is important for all athletes, only powerlifters need to
maximize their limit strength for competition.

There are three kinds of limit strength:

1. Eccentric strength: how much weight you can lower without losing control
2. Static strength: how much weight you can hold stationary without losing control
3. Concentric strength: how much weight you can lift one time with an all-out muscle contraction

Absolute Strength

Absolute strength is the same as limit strength with one important distinction. Limit strength is achieved
while “under the influence” of some form of work-producing aid (supplements, hypnosis, therapeutic
techniques, etc.), while absolute strength is achieved through training alone. That makes “limit” strength
more important for your purposes. All athletes should take every available advantage science has to offer,
short of using drugs or other illegal techniques or strategies which are against the rules. “Absolute”
strength is still an important concept for fitness enthusiasts, kids, and weekend warriors.

Speed Strength

You may have heard this kind of strength referred to as “power.” Speed strength, however, is a more
descriptive term. There are two types of strength under the general heading of speed strength: 1) starting
strength and 2) explosive strength (explained below). Speed strength is how well you apply force with
speed. Its importance in most sports cannot be overemphasized, as this kind of movement is what it takes
to stimulate your fast-twitch muscle fibers to respond.
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Starting Strength

Your ability to “turn on” as many muscle fibers (muscle cells) as possible instantaneously is referred to as
starting strength. Firing a 100 mph fastball requires tremendous starting strength. So does each footfall in
a 100-meter sprint, or throwing a quick knockout punch in boxing.

Explosive Strength

Once your muscle fibers are turned on, your ability to LEAVE them turned on for a measurable period is
referred to as “explosiveness.” A football lineman pushing his opponent, or a shot putter putting the shot
as far as possible are examples of explosive strength in action. Olympic-style weightlifting (snatch and
clean and jerk) is perhaps the best example of maximum explosive strength in action. The ultimate form
in which explosive strength is displayed is called “acceleration.”

Anaerobic Strength

The word “anaerobic” means “without oxygen.” So, if your activity is performed without your muscles
having to be supplied with oxygen in order to allow them to perform that activity it is anaerobic. Of
course, you need oxygen to stay alive, and you will have to “repay” your muscles the oxygen “debt” you
owe after performing anaerobically. You do this by breathing hard once you stop. Scientists classify
movements in sports as being “driven” by the “ATP/CP” energy pathway, the “glycolytic” pathway or the
“oxidative” pathway. The first two do not involve oxygen and are therefore considered anaerobic. ATP/CP
refers to the biochemicals inside your muscles that produce energy for your muscles to work (adenosine
triphosphate and creatine phosphate). Glycolytic refers to the sugar stored inside your muscles called
glycogen. When you run out of ATP and CP, you have to begin using that glycogen to resynthesize the ATP
and CP so work can continue. Neither of these two-muscle energy processes need oxygen for them to
work.

Linear Strength Endurance

Your ability to sustain all-out, maximum running speed is an example of linear anaerobic strength
endurance. The word “linear” simply means that the same movement is repetitively performed, such as
running strides or doing reps in bodybuilding. Marathon running, then, is an example of linear aerobic
strength endurance.

Non-Linear Strength Endurance

Your ability to play with exceeding explosiveness play after play during the entire game is an example of
non-linear anaerobic strength endurance. A powerlifter in competition must perform 9 maximum lifts on
the lifting platform, and perhaps as many as 20 near-maximum warm-up lifts during a three or four hour
competition. That also requires tremendous anaerobic strength endurance. And, because the lifts are
performed with intervals of time between each (as opposed to rowing, running or other “linear” sports
movements), the term “non-linear” anaerobic strength endurance is used. Playing a particularly fast-
paced basketball game or soccer match for an hour or two would be examples of non-linear aerobic
strength endurance, with intermittent bursts of speed strength (jumping, starting, dodging, etc.) also
being displayed.

Aerobic Strength

The word “aerobic” means “with oxygen.” The efficiency with which you get oxygen to your working
muscles and remove the metabolic wastes that are building up there is called cardiovascular endurance —
the key to exerting force under aerobic conditions. There are two kinds of aerobic strength: linear and
non-linear. These two terms are described above in the discussion on anaerobic strength. Measures of
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your cardiovascular efficiency are 1) a low heart rate (how many times your heart beats each minute), 2)
a high stroke volume (how much blood you pump out of your heart with each beat), 3) a high ejection
fraction of the left ventricle (the percentage of blood in the left ventricle of your heart muscle that is
pushed out with each beat), and 4) a high maximum oxygen uptake ability (how much oxygen your
muscles use during exercise).

Factors Affecting Strength

The factors affecting strength were listed earlier. To recap, they are structural/anatomical, physiological/
biochemical, psychoneural/psychosocial and external /environmental. All of these factors can be
augmented, manipulated or in some way made more efficient through various and timely applications of
one or more of the eight “technologies” of training.

Bear in mind that many of the factors affecting strength are inextricably interrelated and may be directly
or indirectly, positively or negatively, affected by your attempts to augment any of them, regardless of
which technologies are employed in training. For example, long, slow distance running (aerobic) will
invariably hamper your efforts to achieve maximum starting strength. There are many similar scenarios,
and the wise coach or athlete will learn to avoid this often-costly kind of mistake.

Other Strength Classifications

Over the years, many different classification schemes have been devised in order to develop a better
understanding of strength and the best methods of acquiring it. Here are a few of the more enduring
terms used to differentiate strength classifications. You will see that they are either incomplete or too
general.
General Strength is a term that many coaches use to describe limit strength in all of your muscle groups
and body movements. In this category, you train all the muscle groups without concentrating on the
muscles that assist your particular sport skills. Training for general strength will give you a foundation (a
“base”) for your sport. Once you have developed general (overall) body strength, you should then work on
the limit strength of the particular muscle groups that will be most involved when you perform the event
in which you compete. Traditionally, this has been called specific strength.

Each sport skill requires a specialized type of strength, or “special strength.” Shot putters, for example,
need explosive strength and starting strength, while wrestlers need anaerobic strength endurance to be
able to apply limit strength or speed strength in their movements throughout the match. Many sports
(tennis and golf being two examples) require the application of starting strength (“ballistic force”) with
perfect control.

The Strength Curve

Figure 8-1
You breathe in and out. Your heart beats. You rear
back and throw. You squat down and stand back
up. Your foot hits the ground and your knee bends
in preparation for the next push-off in running or
walking. This is movement, and we define it by the
amount of force produced. Producing force requires
strength. When you put movement — any
movement at all — on a piece of paper, it’ll look
something like Figure 8-1 below.
Click above to enlarge image
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This is what life is all about on earth. We do nothing else with our musculoskeletal selves. It is called the
strength curve, and it is virtually ubiquitous. So it seems reasonable that we should know it.

1. This is the beginning of your movement. You rear back to throw, your foot hits the ground and
your knee bends, or you squat down to jump. All involve “eccentric” strength.

2. You make the transition from backward to forward, from down to up. “Static” strength is required.
This is called the “amortization phase” of a movement.

3. Force is applied in hitting, throwing, jumping or the push-off in each running step. This is called
“concentric” strength.

4. It usually takes a fraction of a second to exert any given amount of force in any given movement.
In sports, the only exception is powerlifting, where a movement may take a full second or longer to
complete.

5. This is the maximum amount of force you impart in your movement.

6. This line represents your limit strength — your 1-rep max. You never quite equal your “limit” or
“absolute” strength levels in sports movements (except powerlifting) because the movements are
over with so quickly.

Let’s pull this strength curve apart bit by bit. You are going to be amazed at what you learn from this little
exercise.

The Seven Factors

Factor One: The Angle of “Q”

Look at the straight line tangent to the upward curve (concentric strength) on Figure 8-1. Measure the
angle. This is called the “Q” angle, and it is the definition of starting strength. The steeper the line the
greater the number of muscle fibers you will have simultaneously recruited in the movement.

Factor Two: The Angle of “A”

Now draw several tangent lines along the length of the upward curve. Measure the angle of each tangent,
and compare each angle to the preceding one. There are three possibilities:

1. Each subsequent angle gets smaller

2. Each subsequent angle stays the same

3. Each subsequent angle gets bigger

Clearly, in the example below, each subsequent angle becomes more and more acute.

Three Permutations of Angle “A” If the angle of each successive tangent becomes greater and greater, you
are going faster and faster in your application of greater force. If each angle stays the same, this means
that your speed is increasing linearly as you apply greater force. If
In training for muscle mass or strength, the only acceptable technique is to attempt to make each
subsequent angle bigger. This technique is called “compensatory acceleration.” This sort of positive
acceleration while increasing force output is functionally impossible to attain in the final third of the
movement while lifting weights in a traditional fashion. This is because you must slow the weight down in
anticipation of lockout. But you nonetheless try in the interest of 1) improving the quality of your overload
stress, and 2) increasing the time under maximum tension (TTI — Time/Tension Index). Moving the

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weight slowly does not MAXIMIZE the tension developed by your muscles, and therefore the quality of
overload it receives is commensurably lessened. Compensatory acceleration will be discussed in greater
detail later.

Factor Three: Force

The maximum amount of force output you produce during any given movement is called Fmax. (Refer to
Figure 8-1). It is fairly obvious that in most athletic endeavors you would like your force output to be as
high as possible. Of course, this does not hold true when you are trying to do a delicate movement like a
jump shot or a putt.

Factor Four: Time

Referring again to Figure 8.1, measure how long it takes from the beginning of upwards (concentric)
movement to exert maximum force (Fmax). This is called Tmax, and usually it is appropriate to make
Tmax as short as possible. Again, jump shots and putts withstanding.

Factor Five: The Relationship between Time and Force

Now, remember back to high school science class when your teacher told you that…

P = fd / t

(Power is equal to the force times the distance per unit time.)

In similar fashion, Fmax divided by Tmax is the definition of explosive strength. If starting strength (the
“Q” angle) is your ability to turn on as many motor units as possible instantaneously, then explosive
strength is your ability to leave them turned on. The two are NOT the same! And the training required to
maximize each is not the same either. Collectively they’re referred to as “speed strength.”

Factor Six: The Relationship Between Limit Strength and Fmax

In any athletic movement, Tmax is so short that it is not possible to get all of your motor units turned on.
Not even close! Because it fits into the time constraint, only powerlifting tests limit strength.

Former Soviet scientists believed that nothing should ever be done to cause an increase in the distance
between Fmax and limit strength. They believed that the definition of a great athlete was one whose Fmax
came close to his/her limit strength. They believed that, in the world of sport, speed is king!

LIMIT STRENGTH AND F-MAX relationship. This is a phenomenal concept. Understand that simply
working limit strength is NOT the way for an athlete to become great. In fact it would slow you down if
carried to the extreme. The coaches of yesteryear were right when they would not allow their players to
lift for fear that doing so would foul up their “touch” (skill), make them muscle-bound or slow them down.
The reason is that continually hammering limit strength, your 1-RM (which was pretty much all that the
early weight lifters knew how to do), will eventually result in muscle being synthesized beyond the point
where one’s strength-to-weight ratio is greatest. Added strength, when carried to this extreme, almost
invariably means added weight, slower movement speed, and inability to achieve positive acceleration (a
steep “Q” angle) let alone greater explosive strength.

So, this being the case, we must give consideration to the concept of “functional strength,” or the amount
of limit strength necessary to maximize Fmax without causing an increase in the difference between Fmax
and limit strength. Simply put, one’s strength-to-weight ratio is very similar to one’s functional strength
requirements, and it is generally different from sport to sport because the demands of each sport are
different.

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We do, however, acknowledge that in activities such as archery, bowling, curling and other similar
activities, the concept of strength-to-weight ratio has far less relevance than it does for (say) football
linemen or bodybuilders, whose chief competition objective is to get massive muscle irrespective of
movement efficiency.

Factor Seven: The Amortization Phase

Picture this: A pitcher rears back with his arm, holding the position until all of his inner forces are
summoned, and with great Herculean effort hurls the ball. Will it go 100 mph? Not a chance! The total
body movement involved in pitching that fast requires heavy reliance on stretch reflex and tissue
viscoelasticity in one’s shoulder muscles. These factors contribute to the speed of the push off the rubber
and to the violent twisting of the body. As these actions are performed in sequence, the force imparted to
the ball comes from a summation of forces.

So, it is critical in most sports that you work hard to

1) make it possible to maximize the sum of all forces involved in producing maximum force output, while
2) keeping yourself uninjured! The very thought of turning the amortization phase (that brief moment
between the eccentric and concentric contraction) into a checkmark-sharp direction change is enough to
make one cringe! There is the culprit that is responsible for many a sports career being ended. It is called
“ballistic” stress.

While you certainly cannot take your new (untrained) client to this level of stress until a strong foundation
is established, neither should you completely avoid it. Sport is VERY ballistic, and if you are to summon
the forces successfully without getting injured, you better learn how to TRAIN ballistically! It will prepare
you to summon the forces and to accept them as well. There are many safe and effective ways to do this.

Methods of Training to Improve the Strength Curve

Training for Limit Strength

Limit strength is how much musculoskeletal force you can generate for one all-out effort. The only athlete
who displays limit strength in competition is the powerlifter. There is no reason to continuously build limit
strength; however, it should serve as a foundation for further training. ALL athletes do need a certain level
of limit strength and, therefore, it should be the first objective on your list in altering the strength curve.

How much limit strength is needed for each athlete? Only vague estimates have been made for other
athletes. Dintiman, Ward and Tellez in their book Sports Speed note that before speed training (involving
the other 6 features of the strength curve) can be initiated, athletes should be able to leg press or squat
2.5 times their body weight (higher level athletes as much as 3 or 4 times their bodyweight). The same
authors also suggest that the ham/quad ratio of limit strength should be 0.8:1. These are just guidelines
and the Principle of Individual Differences may dictate otherwise. As for upper body limit strength, even
less research has been conducted. There is only one way to “best” develop limit strength. That is to lift
heavy. Refer to Figure 8-1 for guidelines.

Improving Acceleration Ability (A1...n)

Acceleration is best achieved by improving explosive strength (your ability to turn on as many muscle
fibers as possible and leave them on). In the strength curve, the Angles of A should become greater and
greater (positive acceleration). It comes down to one thing: To improve acceleration, you MUST
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compensatorily accelerate while you train! Running drills involving acceleration as well as the Olympic lifts
should also be used to improve acceleration.

In most cases, this should be your secondary area of concern. Acceleration training should only be started
after a solid foundation of limit strength has been achieved. It should also come before improving starting
strength and amortization, as acceleration is gradual while the others are ballistic in nature. At this point
in training, the tissues of the body will most likely not be ready for such stress.

Improving Starting Strength (Angle Q)

Angle Q involves starting strength (being able to turn on as many fibers at once instantaneously). While
acceleration can be “gradual,” starting strength is not — it happens all at once. Using Compensatory
Acceleration Training, plyometric training, the various Olympic lifts, and running drills involving quick
starts should improve starting strength.

Improving Speed Strength

(Fmax, Tmax, and F/T)

Speed strength is comprised of starting and explosive strength. Improving the Angles of A and Q will also
improve speed strength. By obeying the Principles of Overload and the SAID Principle your speed strength
will improve. Most athletes do not have a continuous need to improve limit strength. In fact, the
relationship between limit strength and Fmax should be kept as small as possible.

Many coaches in the past believed that weight training would make their athletes “big, bulky, inflexible
and slow.” Today many of us shun such myths, however, the “old timers” were partially right. The old
views of strength training only focused on limit strength, and did not recognize that there are several
types of strength and various methods to develop them. It was not until pioneers like Stan Jones (most of
you know him as the Hall of Fame lineman for the Chicago Bears, but he was also a top strength coach for
many NFL teams) figured out that training explosively with weights could also improve explosiveness on
the field when integrated into a proper conditioning program. Stan Jones said it best: “It started out as an
edge and then became a necessity.”

While increasing limit strength is a worthwhile goal, it should not be at the expense of the other factors in
the strength curve. Remember the SAID Principle and Specificity Principle in your training and you will
never have to worry about becoming “big, bulky, slow and inflexible.”

Improving Amortization
How important is shortening the amortization phase? Try to pitch a fastball by rearing back, pausing
momentarily, and then throwing. Try to jump by squatting down, stopping, and then jumping. The tension
built up during the eccentric contraction is released during the amortization phase and combined with the
initial force of the concentric contraction. A short amortization period is so vital to many athletic skills that
those skills would not be around without it. Skills that involve a short amortization phase are purely
ballistic in nature. They involve two primary components: starting strength and a stretch reflex. Both are
improved with plyometric training (especially depth jumps) as well as skill training.

Each of the factors of the strength curve has a direct bearing on all others. Shorten the amortization
phase, and the Angle Q will be increased. Increase the Angle Q and Tmax will decrease. Decrease Tmax
and the ratio of F/T is improved and so on. This is why an integrated approach to training is so important.
You simply do not increase one factor of the strength curve OR one component of athletic fitness without
affecting many others (wheth er it be in a positive or negative way).

The order in which you improve these factors is also of importance. The Specificity Principle ultimately
states that training techniques should go from general to specific in nature. The techniques to improve
speed strength and amortization will FAIL if the proper foundation has not been established.

It should also be noted that in order to improve the latter features of the strength curve, the former ones

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must remain intact. Limit strength must remain optimal all through the training process. No one training
technique is implemented on it is own. While training for speed strength and its components, you still
must do something to keep the foundation upon which it was built. It is only through a well-planned
periodized program that this is achieved.

There you have it. Ways to improve strength. Improve the factors and you will transform your strength
curve from this

WEIGHT TRAINING

We have discussed strength in detail as a component of physical fitness. The development of strength
involves the selection of appropriate exercises. Proper execution of these selected exercises is imperative,
as we have outlined in the kinesiology and biomechanics unit of the text. The selection of appropriate
exercises is part of the process of program development. The development of an effective program is a
process that will be discussed in detail in Section four of this book. While the topic of program design is
extensive and can fill volumes of books, we will provide a brief overview of program design as it relates to
weight training.

Programs should be periodized and adhere to Seven Granddaddy Laws: principle of individual differences,
overcompensation principle, overload principle, SAID principle, use/disuse principle, GAS principle and the
principle of specificity as well as the principle of variability and the principle of the central nervous control.
Within these principles are variables like intensity, volume, duration, frequency, balance and recovery that
must be manipulated in order for progression to occur. Once your goals have been identified through the
ISSA drawing in phase, which we will also cover in Section four, selecting appropriate exercises for your
clients’ intended goals is the next step.

Weight Training Technologies

Selecting exercises from the hundreds of pieces of equipment available can be quite an overwhelming
task. Technology is evident all over the fitness world today. Do you remember the first time you ever
stepped foot in a gym? You probably heard noises from chains clanking over pear-shaped sprockets, air
releasing from valves, the squishing of fluid being forced through tiny apertures, and, most noticeable of
all, the clang of heavy iron hitting the floor. Your senses were being barraged with the various
technologies of equipment available today. The four basic forms of fitness equipment available on the
market today are constant resistance devices, variable resistance devices, accommodating resistance
devices and static resistance devices.

The Four Technologies Of Training Equipment

Constant Resistance Devices

The term “constant resistance” means that a weight (resistance) does not increase or decrease during the
course of exercise. The resistance remains constant from the beginning of an exercise movement to its
completion.

No matter how many times you lift a barbell or dumbbell, the weight remains the same. When you lift a
weight attached to a cable and pulley system, the weight remains the same too, provided the pulley is
round rather than elliptical.

This form of weight training (or resistance training) has two limiting features: 1) it does not correct for
changes in musculoskeletal leverage that occur during an exercise movement, and 2) it does not correct
for reduced force output stemming from fatigue. When you lift a weight your leverage changes during the
joint movement. For example, when you perform a deep-knee bend, or a squat, with a barbell resting on
your shoulders, the amount of muscular force you have to exert near the bottom of the squat movement
is far more than the force near the top of the movement. The reason for this is that the closer to the erect
standing position you come, the more your musculoskeletal leverage improves. The improved leverage
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means that you do not have to work as hard during the easy phase of the movement and therefore
benefit somewhat less than you do during the hard phase. Remember the most important law of
conditioning: Your muscles need stress to grow bigger, stronger, or more enduring. With some of the
beneficial stress gone in the easier ranges of a movement, the exercise is a bit less effective than it might
be. When you do the lift repetitively, it gets more difficult because of fatigue. In order to complete a set of
ten repetitions, you will have to begin with a weight that is probably too light to force an appreciable
adaptive response.

However, constant resistance exercises also have their advantages. Many sports scientists believe that
constant resistance training is more natural and therefore more effective in the long run. In other words,
the changes in musculoskeletal leverage during the movement of an exercise conform to the way the
human body works. Therefore, exercising in this way will help you achieve better results.

Variable Resistance Devices

When you hoist a weight by pulling on a cable that goes over the top of a pulley and is attached to a
weight, you are engaged in constant resistance training. If the pulley is not round, or if the hole in the
pulley is not in the center, the amount of weight you lift at different points in your movement will change
because the lopsided pulley — the offset cam — changes the leverage for you. Clever scientists during the
latter part of the 1800s found that they could vary the resistance this way and make the variance roughly
coincide with the natural variance in each joint’s leverage. In other words, they were able to make the
amount of weight increase or decrease during an exercise movement. This is variable resistance training.

As with constant resistance training, variable resistance training has its advantages and disadvantages.
One major disadvantage is that the movement is not natural, and therefore causes “confusion” in the
brain centers that interpret the force and movement pattern. The result, according to some experts, is
that muscular gains in strength and size are slower in coming and are limited in their final potential.

Another major disadvantage, one shared by all exercise machines regardless of their underlying
technology, is that because the movement pattern is directed for you, surrounding muscles that act as
stabilizers and assistants are not stressed and therefore never have the chance to grow. This is not the
way Mother Nature intended things to be. In every natural body movement you use far more than one
muscle. Many of these utilized muscles help control the movement pattern or assist in moving the
resistance. Others act as stabilizers of the trunk or limbs so that the main muscle(s) can act more
efficiently. None of these other important muscles are provided with sufficient stress to force them to
become bigger, stronger, or more enduring when using machines that do the balancing or controlling of
the weight for you.

This disadvantage is the chief reason some athletes opt to use free weights (dumbbells and barbells) in
their training. There are, however, several exercises that do not lend themselves to free weight training.
Machines then become very desirable. In fact, most professional athletes and bodybuilders use a
combination of machines and free weights in their training.

Returning to the topic of variable resistance technology, there are many forms of variable resistance for
exercise equipment. Cams and elliptical pulleys are only two. Dynamic Variable Resistance technology
developed by Universal has also become extremely popular.

Universal’s DVR machinery operates on the same theory as Nautilus and Paramount’s offset cams, but
uses a rolling lever system. As you lift a weight on Universal’s machines, the lever arm becomes shorter or
longer by action of a rolling fulcrum point. Like the offset cam, the rolling fulcrum allows you to match
your musculoskeletal leverage changes to the variations in resistance afforded by the machine. This is the
major advantage of all variable resistance devices.

To understand why varying the resistance through an exercise movement is advantageous, recall one of
the most important basic principles of conditioning. The overload principle states that you can maximize

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the level of stress you place on your muscles by making them work as hard as possible throughout the full
range of motion in any given exercise. That is precisely what variable resistance machines attempt to do.

To demonstrate this important advantage, let us try the same exercise discussed earlier, the deep-knee
bend, or squat. Lower your body to a squatting position and begin to rise back up to a standing position.
Notice that near the bottom of the squat your leverage is the poorest and you can move less weight than
near the top where your leverage is best. This means that your hip and leg muscles are only benefiting
near the bottom because the stress is greatest there. The stress on your muscles decreases as you ascend
back to a standing position. In fact, near the top of the movement the stress becomes so minimal that
virtually no gain in strength, size, or endurance is likely. This is because you have not stressed your
muscles more than they have grown accustomed to.

With variable resistance machines, the stress is increased throughout the ascent from the squat position
and matches the improvement in your musculoskeletal leverage. The result is that you are now receiving
ample overload stress throughout the entire range of motion. This makes your muscles work more than
usual and growth occurs.

Numerous other forms of variable resistance devices have found their way into the fitness marketplace.
Springs, rubber bands, surgical tubing, and many other home-use and health-club-quality equipment all
make your job of picking the most suitable equipment more difficult.

The biggest drawback of variable resistance devices, apart from their unnatural feel, is that it is quite
impossible to perfectly match the variance in human musculoskeletal leverage by manipulating the
resistance you apply. People come in all shapes and sizes. Precisely replicating their leverage with
machine leverage is not possible, making the concept of variable resistance theoretical at best. Rolling
lever systems such as Universal, and offset cams such as Cybex and Paramount, Nautilus, and others
come closest, however. Remember that all of these devices are effective — some just more than others.

Accommodating Resistance Devices

Accommodating resistance machinery is designed to allow you to exert maximum resistance throughout
the full range of movement in each of your exercises. In so doing, you are able to maximize the amount of
exercise stress your muscles receive. But there is a big difference. While variable resistance devices
operate on the theory that the amount of resistance changes to match the leverage changes in your body,
accommodating resistance maintains the resistance by controlling the speed of your exercise movement.

When you push against a resistance that can go only at a fixed rate of speed, it does not matter what your
leverage is. You will be able to exert maximum force in any position. Even though you can exert more
force at the top of a squat movement than you can at the bottom, with accommodating resistance
technology you will be able to maximize the amount of muscular force being applied throughout the entire
squat movement.

Of course, the advantage gained in being able to apply maximum overload force throughout the entire
range of each exercise movement is that you are now able to increase the amount of time that adaptive
overload is applied in each exercise. But is this really an advantage?

Some sports scientists say no, that the accommodating resistance technology is no more than another
marketing gimmick to improve sales. However, time is a critical element of overload, almost as important
as tension. Tension (resistance that is stressful enough to cause muscles to adapt), together with
sufficient time over which it is applied, go hand in hand to produce superior gains. All three technologies
are very effective. Each has its distinct advantages and disadvantages.

The one feature that all accommodating resistance device manufacturers claim as the chief advantage of
controlled speed exercise is the fact that it eliminates ballistic movement. This improves the quality of
overload throughout the exercise movement and eliminates the danger of overextended joints,

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 uncontrolled movements, and pulled muscles.

As with variable resistance devices, however, accommodating resistance movements are unnatural. It
seems that the brain is not adapted to accepting the unnaturalness of controlled speed; ballistic
movements are the way nature intended muscles and joints to work. Taking a look at how controlled
speed training is accomplished provides a clue as to why some scientists believe this to be true.

The resistance machines manufactured by Keiser use compressed air to control movement speed. The
advantage of using air is that it can be moved very rapidly to and from a storage reservoir, making it
possible to precisely control resistance at any point in an exercise movement. Reducing the amount of air
pressure by routing some air back to the storage reservoir makes it possible to continue exercising as
fatigue sets in. The press of a button or pedal conveniently located on the machine can accomplish this.

Several different machines use friction to control speed. The mini-gym uses a combination of clutch plates
and flywheels. Reducing or increasing the amount of friction between the clutch plates can control speed.
Unlike the Keiser equipment, this equipment requires that you stop exercising in order to adjust the
tension (speed).

Many upper body and lower body ergometers (exercise bicycles) use friction as well. Many of the growing
variety of stair climbers also employ friction, although most use fluid “shock absorbers.” These ingenious
devices allow you to simulate walking upstairs, quickly or slowly, without having to return to the bottom
for another set. They resemble miniature escalators.

Electricity-driven machines such as several varieties of ergometers and treadmills use the speed of the
motor to control walking or running speed.

Yet another accommodating resistance apparatus uses fluid cylinders similar to a car’s shock absorbers.
By adjusting the whole diameter through which the fluid passes, you can vary the speed of movement.
The most noteworthy example of this sort of technology is found in the Hydra-Gym line. Their equipment
can, like Keiser’s, be adjusted without interrupting your exercise. Most rowing machines on the market
use fluid in the same way the Hydra-Gym does.

The plethora of devices finding their way into the fitness marketplace is testimony to the incredible
popularity the fitness craze enjoys today. It is safe to say that nearly all of these devices work. They all
can, if used properly and consistently, help you to attain a level of fitness greater than that with which you
started. Most offer miraculous results, but in the final analysis it is you who must do the work. No machine
yet developed can do that for you.

Static Resistance Devices

Contracting your muscles without movement is called static contraction. The term isometric exercise was
coined to describe this form of stress. During the fifties and early sixties, this form of exercise was
heralded as a major technological breakthrough. In bandwagon fashion, athletes the world over adopted
isometric exercises as a major strength-building technique. The public obligingly followed their lead.

Isometrically contracting a muscle (pushing or pulling on an immovable apparatus) made you strong only
in that position. In order to become stronger throughout the entire range of movement, you would have to
pull or push at every angle throughout the entire range. Of course, this was impossible from a practical as
well as technological standpoint. The isometric movement died a quiet death.

To make a muscle stronger throughout an entire range of movement, exercise scientists found you must
stress the muscle through the entire range of movement. The nerves running from the brain and spinal
column to the muscles are not capable of delivering an electrochemical impulse in ranges of movement

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other than that for which they are made. Static muscle contraction does make you stronger in the position
to which it is applied, and therefore has some uses in sports training. Isometric exercise is not
recommended for those with heart problems or high blood pressure, due to the extreme stress imposed
through training.

One adaptation of isometric exercise is called functional isometrics. Therein, you contract a muscle and
the resistance moves over a limited distance, but then stops against an immovable resistance placed in its
path. For example, weightlifters like to press a weight from the shoulders upward to head height where
there are iron pins placed in the rack to stop their movement. The isometric position is held for about 6 to
10 seconds. Typically, about 75 percent of one’s maximum weight is used in such an exercise, and it is
repeated two or three times. It is believed that functional isometrics is the best way there is to overcome
“sticking points” in a movement’s range.

Noteworthy Devices and Techniques

Calisthenics
There are many devices on the market that are designed to deliver cardiovascular benefits, chiropractic
(spinal) fitness, and sports skill improvement. Often, these devices are difficult to categorize on the basis
of the four technologies of fitness equipment discussed earlier. Let’s review some of them, as you will
surely run into many of them in your quest for fitness.

Any time you use your own body weight as a source of resistance, you are using constant resistance
technology. Push-ups, pull-ups, jumping jacks, even stretching, fall into this category. Sometimes special
apparatuses facilitate calisthenic exercise. The dancer’s bar, chin-up bars, adjustable step-up platforms for
use in aerobics classes, twisting platforms, slant boards for sit-ups, skipping ropes, inversion machines,
and miniature trampolines are but a few of the well-known calisthenic apparatuses on the market today.

Some calisthenic exercises are designed to improve endurance (either cardiovascular or in a single muscle
group), strength, or flexibility. Others, like the Nordic Track ski simulator and the roller ski shoes, are
designed to deliver both cardiovascular benefits as well as sports skill. Another example of sports skill
calisthenics is the agility drill. Even running and jogging are considered calisthenic exercises because you
use your own body weight. Adding small hand-held weights or ankle weights makes running more
stressful.

If there are no springs, offset cams, shock absorbers, or other devices attached to vary or control
movement, then calisthenic exercises are actually a special application of constant resistance technology.
The reason is quite simple: If your body weight is sufficiently heavy, it delivers overload to the muscles. In
this light, then, calisthenics are just like constant resistance weight training.

The most important point to remember about calisthenics is that if your muscles do not receive more
stress than what they are used to, you are wasting your time. You will not benefit from non-stressful
exercise. If a calisthenic movement is too easy, simply begin using free weights or machines. Weight
training takes up where calisthenics leave off.

Springs and “Power Rods”

Stretching a spring becomes more difficult the more it is stretched. As long as the increasing difficulty
matches your improving leverage through an exercise movement, it will be effective as an exercise device.
This rarely happens, though, and springs are therefore relegated to a position of lesser effectiveness as a
form of resistance.

“Power rods,” however, are made of fiberglass or other forms of plastic, and bend and twist relatively
uniformly, at least initially. Of course, nearing the end point of the bend or twist movement, further
bending or twisting becomes more difficult. These power rods are a popular innovation in home gym
equipment because of their ease of use.

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Rubber Bands and Surgical Tubing

There are numerous machines that incorporate rubber bands or surgical tubing. Soloflex is one such
machine, which uses elastic pieces of rubber (“blocks” of rubber) for its source of resistance. If you want
more resistance, you simply add more blocks. Devices such as the Soloflex apparatus, hand-held elastic
stretch devices and the like are no more effective than the spring mentioned above, and their popularity is
due more to their convenience, low cost and aggressive marketing than their effectiveness. Still, all such
devices work, provided they are not buried in the closet.

Comparison between Machines and Free Weights

Advantages of Free Weights

1. Dumbbells and barbells are more effective in developing the smaller synergistic (helping) muscles
and stabilizer muscles.
2. Free weight exercises more closely match the neurological patterns of associated sports skills from
a biomechanical point of view, because of joint kinesthesis, leverage similarities, and bodily
involvement.
3. Barbells and dumbbells are more versatile.
4. Barbells and dumbbells are less expensive.
5. Barbells and dumbbells take up less space.
6. Greater overall strength can be achieved using barbells and dumbbells.
7. Power is improved more efficiently and to a greater extent through the use of free weights.
8. Other aspects of fitness, including size, flexibility, reduced body fat, and muscle toning are
achieved more efficiently through the use of free weights.

Disadvantages of Barbell and Dumbbell Training

1. Barbells and dumbbells that are adjustable can come apart if care is not taken to tightly secure the
collars.
2. Adjustments in weight from set to set requires affixing or removing plates and replacing and
removing collars — often a time-consuming and tedious ordeal.
3. You need large spaces to use barbells and dumbbells; it can be hazardous for large groups of
unorganized people to use them in a small area.
4. In certain exercises, it is difficult, if not impossible, to derive maximum isolation of a muscle or
muscle group.

Advantages of Machines

1. Some machines are more efficient in isolating a muscle or muscle group for more efficient
overload.
2. For group use, some machines are more efficient in terms of space utilization (especially Universal
machines).
3. Machines are easier to use, and therefore faster workouts are possible. Less time is usually wasted
changing plates and waiting for spotters.

Disadvantages of Machines

1. All machines are not alike, but most require the moving of a weight along a predetermined path (or
track), making it nearly impossible to derive synergistic or stabilizer muscle strength.

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 2. Machines that control movement velocity (such as isokinetic machines) or vary the resistance over
a given movement (such as Nautilus or Universal machines) have removed the “natural” aspect
from the exercise. Many physiologists claim this renders such machines less effective in developing
strength and size citing differing neurological input as the chief reason.
3. Because of machine construction constraints, it is generally impossible to achieve maximum
velocity, and high-speed training is often a prerequisite in sports training. The machines may
break, jerk about violently, or simply not accommodate such training.
4. Most machines are built to serve the average sized person. Very short or very tall people find it
almost impossible to use many of the machines currently on the market.
5. Machines tend to be in a price range beyond the means of many gym owners, and often beyond
the means of commercial spas as well.
6. Many machines are so specialized that one would have to purchase several in order to get even a
marginally effective workout, floor space and budget permitting.
7. The space-age appearance of many machines lulls users into believing that high technology equals
maximum efficiency in achieving fitness goals, a sentiment that is definitely not true. Nothing beats
hard work.
8. The cam designs on variable resistance machines are frequently (more often than not) inaccurate;
that is, they do not conform to the force curve of the intended movement. Thus, far less benefit is
derived from its use than you would expect from free weights.

The Bottom Line

Different pieces of fitness equipment are designed for different purposes. Use the machine, free weight,
etc., that best meets your objectives and those of your athletes. However, experienced exercise scientists
and practitioners alike agree that in the case of weight training technology, the “lowly” dumbbell and
barbell reign supreme.

THE LOST ART OF DUMBBELL TRAINING

There are several different kinds of dumbbells, each having unique advantages. There are also literally
hundreds of dumbbell exercises for practically every muscle in the body, and single joint or multi-joint
movements in all planes. It is virtually impossible to discuss all of the various dumbbell training methods
and exercises. Therefore if you want an excellent listing of practically every conventional dumbbell
exercise known to man, you may wish to purchase Bill Pearl’s best-seller book, Keys To The Inner
Universe.

In comparison to any other method of resistance exercise, dumbbell training is the ultimate form of weight
training. There are a lot of reasons why this is so. As a general rule, dumbbells enjoy the same advantage
over machines that barbells do. The main advantage is that they allow for synergistic and stabilizer
muscles to come into play far more prominently than most machines are capable of doing. In fact, this is
also the major advantage that dumbbells have over barbells. The reason is that stabilizers must act in all
directions with dumbbells, whereas the barbell connects your two hands together, thereby offering a
measure of greater stability. We will identify some of the types of dumbbells that have found their way to
market, and then list a few unique exercises that have been done since the days when dumbbells were
first invented.

Kettle Bells

The kettle bell predates dumbbells, both having their roots in Europe. The first ones were simply large
solid chunks of iron with a handle inserted into it, and were sometimes trapezoid and sometimes spherical
in shape. Later, near the turn of the century, Professor Anthony Barker, a chiropractor from New York,
made them hollow so that lead shot could be poured inside to adjust the weight. The earliest model
weighed 30 pounds empty, adjustable up to 100 pounds. Nowadays, kettle bells are still available and are
generally made of plastic so that they can be filled to various weights with water.

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Solid Dumbbells

Solid dumbbells come with spherical ends, cylindrical ends and, more recently, octagonal ends. The
octagonal dumbbells do not roll away from you when you put them down. While some lifters prefer the
cylinders because they are more compact, there appears to be little difference in the “feel” or ease of
management between them.

Fixed Plate Dumbbells

Fixed plate dumbbells are the most widely used dumbbells in gyms today. These dumbbells are comprised
of regular exercise plates ranging from 10 pounds down to 1 1/4 pounds. They used to have sleeves to fit
over the center (handle), but nowadays the center is made anywhere from 1 1/4 inch in diameter to 3
inches in diameter (see oversized grip dumbbells below). The plates are retained on the ends of the bar
with screws. The single disadvantage of this type of dumbbells is that the screws almost always become
loose or stripped when the dumbbells are dropped frequently.

Oversized Grip Dumbbells

Alan Calvert, one of the important forefathers of modern weight training, recommended thick handles in
his 1924 book, Super-Strength. More recently, in his book, Dinosaur Training: Lost Secrets of Strength
and Development, Brooks Kubik also talks about the advantages of using dumbbells with 2 to 3 inch
circumference handles. He believes that the large diameter handles are better for improving gripping
strength (forearm muscles as well as muscles intrinsic to the hand), an important factor in many sports.
Also, in the muscles targeted with the dumbbell exercise, more motor units are activated using the thicker
handles in comparison to standard 1 1/4 inch handles. The reason behind this increased motor activity is
believed to be a reduced inhibitory response normally brought on by the relatively low excitation threshold
of the Golgi tendon organ. Some preliminary electromyographical data compiled by Jerry Telle in 1997
supports the notion.

Olympic Dumbbells

The bearing-equipped rotating ends of an Olympic dumbbell bar offer the distinct advantage of being far
more easily managed when the lifter is pulling the dumbbell(s) to the shoulders or overhead. This is
because the inertia of the moving ends of solid dumbbells is eliminated. If you are performing compound
(multi-joint) movements, this feature is indispensable for maximizing the amount of weight you can
handle. But be careful! Make sure the collars are tight before every set!

Smart Dumbbells

“Smart Dumbbells,” named and invented by Anthony Valentino (Rackbell Systems, Inc.) in 1996, are a
refreshing improvement over regular fixed dumbbells on at least three counts. First, there is a built-in
curved rod that spans the handle in such a way that it is far safer and easier to spot the user. Second, the
dumbbell set comes with a unique rack overhanging the user so they can begin by taking the dumbbells
off the rack and replacing it at the end of the set in a fashion quite similar to what is done with a barbell.
This is significant in that lying down and getting back up with a heavy set of dumbbells is a chore none
relish, particularly novices to the iron game. It is downright scary and often fraught with danger. Another
advantage is that the dumbbells are rarely dropped, keeping them (or the floor) from being damaged.

Power Block Dumbbells

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Invented by David Shields, of Jacksonville, Florida, during the late 1980s (who, by the way, also invented
the “Selex” selectorized barbell), this remarkable device marks the first major improvement in the
dumbbell since it was made adjustable at the turn of the century. The PowerBlock (somewhat different in
technology than the earlier Shields model), named and marketed by former Muscle & Fitness editor, Jeff
Everson, consists of a fully adjustable (in 2.5 pound increments) set of cube-shaped dumbbells and stand.
Putting the connected retainer pins in the desired holes easily makes adjustments in weight. There are
some remarkable features that bear mention. First, because there are four stabilizer bars spanning the
two ends (with the padded handle in the middle of them), anyone can easily spot the user without having
to hold the user’s wrists or elbows. Simply hold onto one of the top stabilizer bars. This makes the Power
Block safer than conventional dumbbells. Next, with several sets of Power Blocks in your commercial gym,
all of the trainees can use the same amount of weight if they choose. No more waiting to do your set.
They take up far less space than a conventional rack of dumbbells, can never be misplaced, and are
considerably cheaper than a full set. These are all advantages for their applicability to a well-equipped
home gym as well. While they are not designed to be dropped (no dumbbells are), they are surprisingly
durable if it happens inadvertently.

Dumbbell Stabilizers

Yet another invention to make dumbbells more “user-friendly” has hit the market recently. It consists of a
built-in forearm sleeve attachment on the dumbbell handles. Slip your hands into the sleeve and grasp the
handle. The sleeve has a cross bar, which places the weight on your forearms rather than in your hands.
The device has one advantage that makes it worth mentioning: If you have arthritis or other hand/wrist
problems that make dumbbell training difficult or impossible, you can still do your dumbbell work.

Unique or Forgotten Dumbbell Exercises

The inventor of the lead-shot filled dumbbells was Professor Anthony Barker. In 1911 he marketed a wall
poster course called “A Complete Course in Heavy Dumbell Exercises, To Obtain Strong, Healthy Muscles.”
Note that “Dumbell” is spelled with one “b.” Therein was explained the startling necessity to wear a “well
made jock strap…to protect the back and the wall of the stomach, eliminating all dangers of strain or
rupture.” More startling than that was the array of dumbbell exercises that Barker chose to include in his
course. In the example bodybuilding program presented below, you will see only common exercises, which
are performed routinely today. Here is a sampling of a few of the unique dumbbell exercises that were
depicted and explained. Bear in mind that each and every one of them required tremendous stabilizer
strength and control to execute, a feature sorely missing in today’s machine-oriented gyms.

One Arm Dumbbell Bent Press (Great for shoulders, triceps and anterior serratus.)

Lying One Arm Dumbbell Support, and Then Stand Up (An unbelievable exercise in stability and
control, let alone strength!)

One Arm and Two Arm Dumbbell Snatch (Still a popular exercise among many athletes, especially
football down linemen.)

One Arm and Two Arm Clean and Press (Pulling the weight from the floor, especially the one arm pull,
is extremely difficult without the stability afforded by a long bar. The press is great for shoulders, triceps
and serratus anterior.)

One Arm and Two Arm Clean and Jerk (Same thing as the press. Going overhead with the weight is
quite tenuous because of the balance required during the explosive execution of the jerk.)

One Arm Dumbbell Table Curls (Starting from a slightly bent arm position with the weight already at chest
height is amazingly rigorous.)
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Advantages of Dumbbell Training

1. You are constantly forced to adjust and readjust the position of the dumbbell(s), therefore
synergistic (helping) muscles and stabilizer muscles act more prominently, which improves overall
strength and protects against potential injuries.
2. Dumbbell exercises can be tailored easily to more closely match the neurological patterns of
associated sports skills owing to improved joint kinesthesis, leverage similarities, and total body
involvement.
3. Dumbbells are more versatile than machines or barbells. Any movement can be done with
dumbbells, whereas machines restrict you to their movement, and barbells typically require
symmetrical movement between left and right sides.
4. A set of adjustable dumbbells is less expensive and takes up less space than other home gym
machines, making it the ideal home gym choice.
5. The PowerBlock dumbbell sets take up less space for both home and commercial gyms.

Safety and Efficiency in Dumbbell Training is a Must

1. Smaller synergists and stabilizer muscles are more prominently targeted during dumbbell training
and can fatigue before the prime mover(s), which can result in a loss of control over the dumbbells
during the exercise.
2. Dumbbells that are adjustable can come apart if care is not taken to tightly secure the collars.
Check them before each set.
3. Adjustments in weight from set to set requires affixing or removing plates and replacing and
removing collars, which can be a time consuming and tedious ordeal. Clearly, this speaks well for
having an entire rack of fixed dumbbells or a power block.
4. Trying to find the right weights is a common and exasperating experience in most gyms. This can
easily be solved if trainees would put the dumbbells back in their proper order when they have
completed their set.
5. Waiting for someone to finish with the set of dumbbells you need in order to continue your workout
is also a problem at many gyms. Another “plus” for the Powerblock.
6. You need a large space to use dumbbells. It can be hazardous for large groups of unorganized or
inexperienced people to use them in a small area. Keep a sharp peripheral perspective for errant
passersby.
7. In certain exercises, it is difficult, if not impossible, to derive maximum isolation of a muscle or
muscle group. While this can be an advantage, in some bodybuilding applications (e.g., most lower
body exercises) it can be a limiting factor.
8. The injury rate in commercial gyms is higher around the dumbbell rack than anywhere else in the
gym, not so much from improper exercise technique as from dropped weights, tripping, distraction
or bumping caused by passersby, and improper cradling of dumbbells on the rack. A bit of common
sense renders these hazards insignificant!

EXERCISE MACHINES

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Most exercise machines are made to fit the theoretical average person. If you are of average build,
positioning on most machines should allow you to do the exercise in a relatively safe manner. However,
for short, tall and or obese people, exercise machines may be dangerous.

Adjustability

One of the most important features that an exercise machine should have is adjustable positioning. This is
especially important in exercises in which you must move limbs in a manner safe to the joints and to
target particular muscles. For example, in the pec-deck and reverse fly exercises the seat should be
adjusted so that the arms can be situated in line with the shoulders and travel in a horizontal pathway
during execution. If you are seated too low you will be pushing upward in the action, which will develop
different musculature. The same applies if the seat is too high which forces you to push downward. In
some cases the exact pathway may be injurious to the joints if freedom of movement is restricted in any
way.

Adjustability is important in exercises such as the lat pulldown. You should be able to reach an overhead
bar without having to raise up to grasp it and then sit down and pull the bar down as you sit down and
secure your legs. It is especially difficult to correctly position yourself while holding a bar with great
tension on it. A potentially dangerous situation exists with the seated cable row machine. If you have to
reach too far forward to grasp the handles when you are in a seated position, you will have a rounded
back, which creates tremendous compression forces on the discs when you begin to pull the handle back.
A rounded spine placed under great loads is more prone to injury, and consequently this is one of the
most frequent causes of low back injury.

Adjustments on the seated calf machine are needed so that you can get into a position where your knees
are at a 90-degree angle and there is a corresponding 90-degree angle in the hip joint. In this way you
can sit upright while doing the exercise. If your knees are too far forward or backward, you will have
difficulty executing the exercise through the full ROM.

Overhead press machines should be adjustable so that you can sit directly under the handles that you
push up. In addition, the handles should go straight up so that you do not end up pushing forward or
backward near the end of the range of motion. When you find yourself pushing in a direction other than
directly upward it may create low back or shoulder problems. In fact, almost all seated exercises in which
you handle considerable weights above the head compress the spinal discs (especially in the lumbar area)
more so than if you were in a standing position using free weights. When you are seated you are unable to
use your legs as absorbers of force and there is a strong tendency to round the lower spine. This is why
the standing position is usually preferred.

The four-way hip machines also require precise adjustments. There should be an adjustable platform to
raise or lower the body to adjust height. This is needed to bring the hip joint in line with the axis of the
resistance lever. If the axis of the machine and the hip joint are not lined up, compression and shearing
forces may be developed in the hips during execution of the exercises.

Range of Motion Adjustments

ROM adjustments should be available on exercise machines. Multi-hip and leg extension machines should
be adjustable so that the leg can be placed in the proper position at the beginning of the exercise and be
able to move to a safe ending position. For example, most knee joint extension machines start with the
shin underneath the thigh. In this position the knee is at an unfavorable angle and there are tremendous
forces if the resistance is great, literally pulling the knee apart when you start. For maximum safety you
should start with a 90-degree or less angle in the knee joint (measured behind the knee).

Pec Deck Machines

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All pec deck machines should be adjustable so that you can sit down and place your arms against the
resistance pads with the arms in line with the shoulders. If instead you begin with your arms as far behind
the body as possible, the initial stress on the shoulders is very high when initiating the forward pushing
action. This in turn can create stretch marks and injure the shoulder joint. In the reverse pec-deck the key
to safe and effective execution is to make sure that your seat is adjusted properly so that when you grasp
the handles and pull back, the arms are in line with the shoulders. You should be able to pull well behind
the level of the back with slightly bent or straight arms.

Hamstring Machines

Hamstring machines can be potentially dangerous when a flat bench is used. In this case, as the knee
joint flexion occurs the pelvic girdle rises to raise the origin of the hamstrings to provide for a stronger
contraction. This action creates excessive arching in the spine, which may be injurious if there is any
twisting of the hips. More effective is an angled bench so that the pelvic girdle is positioned high, in hip
joint flexion. The seated knee curl machine, which automatically stretches the upper end of the
hamstrings, is most effective for developing hamstring strength.

Calf Raise Machines

For safety and effectiveness in using a calf (heel) raise machine, the shoulder pads must be sufficiently
high. This is needed so you do not have to round the back to get into position to push the resistance pads
up high enough before you can assume an erect position. (This also applies to a squat machine.) The foot
platform should be situated directly under the pads so that the trunk is erect and not inclined forward or
backward when doing the exercise. In addition, there should be handgrips for better balance and stability.

Seated Leg Press Machines

In the seated leg press it is important that the feet be placed flush against the resistance platform. Area of
placement is also important. If the feet are placed low (in line with the hips) there is more equal
distribution of effort between the knee and hip joints. This positioning is usually difficult to attain on most
machines. When the feet are placed high and the knees come closer to the chest, there is more
involvement of the hip extensor muscles. Also, when the knees come very close to the chest, there is
rounding of the spine, which can be injurious to the spine.

Leg Press Machines

Leg press machines should also have ROM adjustments to prevent the knee from collapsing against the
chest or coming too close to the chest during execution of the exercise. Not only are such extreme
movements dangerous to the lower back but also to the knees. Improper exercise technique on these
machines has resulted in many low back injuries.

Hack or Smith Machines

When doing the hack or Smith machine squat it is important that the feet be placed approximately 12 to
15 inches in front of your line of gravity. This is needed to allow the spine to stay in its normal anatomical
position as you make the descent and ascent. If you place the feet directly under the shoulders as you do
in the free squat exercise, there will be great stress thrown on the knees and a tendency to round the
lower back. In the squat, hack squat and leg press, it is usually best that the angle in the knee not reach
much less than 90 degrees (measured behind the leg).

Hip Adduction/Abduction Machine

To use most hip abduction and adduction machines you must sit with the legs almost perpendicular to the
trunk. From this position you push the legs out (abduction) or in (adduction) sideways against resistance.
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Because the hip joint is basically at a 90-degree angle of flexion, you can get irritation of the tendons and
muscles in the hip joint when you execute the movements. Also, they become more susceptible to injury if
you push vigorously. More effective and safer is to have a straight body position when you execute the hip
abduction and adduction movement. If you must use the seated version, you should not use extremely
heavy weights, which can exacerbate the problem.

Biceps Machines

When using most of the common biceps machines to isolate the elbow flexor muscles you place the upper
arms against a support pad when you do the exercise. In so doing, the elbow pushes against the pad as
you curl the resistance upward. This can place stress on the elbow. Whenever possible, have the elbow
free of support when you execute the exercise. In this case be sure that you do not hyperextend the
elbows especially when using very heavy weights. In addition, you should not lean too far forward when
placing your arms as when using the bench pad in an opposite manner. This gives the upper biceps,
muscles and tendons greater slack, which results in less muscle tension and a greater possibility of
hyperextending the arms.

Triceps Machines

On most triceps machines the backs of the arms are placed against a support pad to stabilize the arm and
isolate the elbow extension movement. It is important that the elbow be free of support, so that you do
not push into the pad with the elbow during the movement. This can place great stress on the olecranon
process, an extension of the upper arm bone. Also, the axis of the machine should line up with the axis of
the elbow.

Lateral Arm Raise Machines

When using the lateral arm raise machine, you are limited to only half the range of motion. You typically
begin with the elbows close to the sides of the body and raise them until the upper arms are level. This
does not work the deltoid muscle through its full range of motion, as does the overhead press.

Back Extension Machines

Back extension machines should be used mainly for stabilization of the spine. The machines should have
adjustable seats so that the resistance pad is in the middle of the upper back. With the axis in the hip
joint you push back in hip joint extension while you keep the back stabilized. If you flex and hyperextend
the back as you do the exercise it can be injurious because of the compression and shearing forces.

Much more effective to strengthen the erectors is to lower the trunk from a prone horizontal position with
the axis in the waist. In this way you have full flexion of the spine in the initial position. When you raise
the trunk, it is against the force of gravity up to and above the horizontal position. This exercise, known
as the back raise, is best done on a Yessis Back Machine or Glute-ham Developer as it was originally
named. Because of its adjustability it can fit all different body lengths and provide safe and effective
development of the erector spinae through a full ROM. A Roman chair can also be used but only if you can
correctly position yourself.

Abdominal Machines

Care must be taken when using abdominal machines. Some of them are limited to flexion of the upper
(thoracic) spine in a crunching action, which is effective for development of the upper fibers of the rectus
abdominis. Although you get an effective contraction of the upper fibers of the rectus abdominis, if you do
not return to the normal spine position, you may end up tightening the abdominal muscles to create a
permanently rounded upper back, also known as the hunchback condition. To prevent this you must be
able to return to the normal spine position before doing the next repetition or to stretch the upper spine

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after completing the set.

Some machines have the axis in the hip joint rather than in the waist. In such cases the abdominal
muscles undergo an isometric contraction to stabilize the midsection while you perform hip flexion. In
almost all machines going through the full ROM involves both dynamic and static contractions of the
abdominal muscles through a considerable portion of the ROM with involvement of the hip flexors creating
a full ROM.

If you are not correctly positioned when using the abdominal rotational machines, you may be working the
erector spinae muscles rather than working the internal and external oblique muscles. If the abdominal
muscles are involved, as you rotate forward you will also experience a tendency toward slight flexion of
the spine near the end of the full ROM. If you feel the lower back muscles contracting, you are rotating to
the rear, which leads to slight hyperextension near the end of the full ROM. You should be cognizant of
which muscles are undergoing contraction when you do rotational exercises. If not, it can lead to injury if
you are striving to contract one set of muscles when the opposite muscles are in action.

Balance

A major negative criticism of exercise machines is in the lack of balance when doing the exercise. Many
people consider this a positive factor for safety. But, because balance plays such an important role in
everyday activities as well as in sports, it is a factor that should not be ignored. If you cannot balance
yourself when doing a free weight exercise with light weights, then you are in serious trouble and need
specialized rehabilitation to improve your balance capabilities. Undertaking a strength training program
will then be much safer regardless of the equipment you use. Keep in mind that you must still stabilize the
joints to allow the muscles to contract properly.

Free weight exercises can help you develop great balance capabilities and you will not have to rely on
doing supplementary balance exercises. For example, the use of large inflated balls, also known as fit
balls, Swiss balls, physio-balls, etc, is a common occurrence today. These balls can be used effectively,
but care must be taken when using the balls with elderly people, and even people who do not have good
balance. Exercises on the balls require high levels of balance. For some reason these exercises are
deemed to be perfectly safe, but exercises done with free weights are deemed to be dangerous. You
should understand that all exercises can be dangerous if performed incorrectly. Once you have the
capabilities and understand how the exercise should be executed, it is very safe. If you do not have the
physical abilities to do the exercise correctly, then it can be very dangerous.

Even a “simple exercise” such as the squat is very dangerous regardless of whether it is done with free
weights or machine weights. If you do not have the strength to hold the natural curvature of the spine,
the exercise will be dangerous. In addition, you must have ample flexibility in the hip joint to enable you
to make the descent safely without the knees protruding out over the toes or over your base of support
when in the down position. You should not automatically assume that one type of exercise is safe and
another is not. All exercises can be safe or they can be dangerous.

VARIOUS OTHER TECHNOLOGIES USED IN TRAINING ATHLETES

Training does not take place in the weight room alone. While a lot takes place in the weight room, training
goes far beyond simply lifting weights. Listed next are several tools that you can use to more efficiently
train your clients. We will discuss these tools here.

Stability Balls

Stability balls have been around for numerous years. They were originally used in physical therapy and
have crossed over to the fitness field with great success. Today stability balls are used by professional
strength coaches to train elite athletes and by personal trainers to improve the quality of life of their
clients. With the exception of free weights, there is probably no other training tool that can be used for so
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many different functions. A stability ball allows abdominal training to go through a full range of motion
that cannot be accomplished from exercises done on the floor. All weight training exercises done on
benches can also be performed on stability balls with the added benefit of core musculature recruitment
and greater proprioceptive work. Trainers should be well versed in the proper set up and use of the
stability ball before beginning any exercise program. Bodybuilders, athletes, and fitness enthusiasts are
quickly learning the benefits of stability ball training and so should you. Realizing the importance of
stability ball training, the ISSA offers a continuing education course (by Master Trainer Doug Holt) on
Stability Ball Training, which can be used to further your training knowledge.

Proper Stability Ball Sizing

Choosing the proper sized stability ball is as important as teaching the proper technique of the exercise
you intend to use on the ball. Proper ball sizing can reduce the chance of injury to the low back and
especially the knees. If your client will be sitting on the ball, their feet should be flat on the floor and their
hips and knees should form at least a 90-degree angle with each other. In general, the guidelines for
proper ball sizing are as follows:

Treat each client as a unique individual when sizing the ball. Some individuals have longer legs while some
have shorter legs than the norm. The best way to properly size your client for the first session is to
measure the joint angle when they sit on the ball. You will therefore need a variety of sizes for different
clients.

Burst or Anti-Burst

Stability balls come in a variety of shapes and sizes. When purchasing a ball your primary consideration
should be safety. This usually comes down to the individual using the ball and what the intended use will
be. If there is going to be an application of weights used with the balls, then it is highly recommended that
you use an anti-burst ball.

An anti-burst ball simply means that the ball will not pop like a balloon if it rolls over a nail, splinter, or
other sharp object. Instead it will slowly deflate, allowing the user to come down slowly rather than fall
with weights onto the ground. This is a particularly important safety mechanism when working with
someone with back problems or when using the ball with any type of weight. These balls are not patch
safe, so once they have a leak they need to be returned to the manufacturer or discarded. The anti-burst
balls generally range in level of quality that can be depicted by the weight capacity of the ball. For heavy-
duty users, there are stability balls available with maximum capacities well over 1,000 pounds.

Medicine Balls

Medicine balls usually range between 2 and 18 lbs. They are an excellent means of training for upper body
speed-strength. Medicine balls are made of soft material (leather, rubber and stuffing) so they can safely
be caught, repelled or thrown. While you can throw a dumbbell, it would be unadvisable to try to catch
one and you certainly would not try it at high speed. Another advantage of medicine ball training is that
compensatory acceleration training can be done with literally no inertia because when you release the ball
the resultant stress on the joints is far less.

VARIOUS OTHER TECHNOLOGIES USED IN TRAINING ATHLETES

Training does not take place in the weight room alone. While a lot takes place in the weight room, training
goes far beyond simply lifting weights. Listed next are several tools that you can use to more efficiently
train your clients. We will discuss these tools here.

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Stability Balls

Stability balls have been around for numerous years. They were originally used in physical therapy and
have crossed over to the fitness field with great success. Today stability balls are used by professional
strength coaches to train elite athletes and by personal trainers to improve the quality of life of their
clients. With the exception of free weights, there is probably no other training tool that can be used for so
many different functions. A stability ball allows abdominal training to go through a full range of motion
that cannot be accomplished from exercises done on the floor. All weight training exercises done on
benches can also be performed on stability balls with the added benefit of core musculature recruitment
and greater proprioceptive work. Trainers should be well versed in the proper set up and use of the
stability ball before beginning any exercise program. Bodybuilders, athletes, and fitness enthusiasts are
quickly learning the benefits of stability ball training and so should you. Realizing the importance of
stability ball training, the ISSA offers a continuing education course (by Master Trainer Doug Holt) on
Stability Ball Training, which can be used to further your training knowledge.

Proper Stability Ball Sizing

Choosing the proper sized stability ball is as important as teaching the proper technique of the exercise
you intend to use on the ball. Proper ball sizing can reduce the chance of injury to the low back and
especially the knees. If your client will be sitting on the ball, their feet should be flat on the floor and their
hips and knees should form at least a 90-degree angle with each other. In general, the guidelines for
proper ball sizing are as follows:

Ball Diameter User Height

42 cm. Ball (16 inches) Under 4’ 10”

53 cm. Ball (21 inches) 4’ 10” to 5’ 4”

65 cm. Ball (25 inches) 5’ 5” to 5’ 11”

75 cm. Ball (29 inches) Over 6’ 0”

Treat each client as a unique individual when sizing the ball. Some individuals have longer legs while some
have shorter legs than the norm. The best way to properly size your client for the first session is to
measure the joint angle when they sit on the ball. You will therefore need a variety of sizes for different
clients.

Burst or Anti-Burst

Stability balls come in a variety of shapes and sizes. When purchasing a ball your primary consideration
should be safety. This usually comes down to the individual using the ball and what the intended use will
be. If there is going to be an application of weights used with the balls, then it is highly recommended that
you use an anti-burst ball.

An anti-burst ball simply means that the ball will not pop like a balloon if it rolls over a nail, splinter, or
other sharp object. Instead it will slowly deflate, allowing the user to come down slowly rather than fall
with weights onto the ground. This is a particularly important safety mechanism when working with
someone with back problems or when using the ball with any type of weight. These balls are not patch
safe, so once they have a leak they need to be returned to the manufacturer or discarded. The anti-burst
balls generally range in level of quality that can be depicted by the weight capacity of the ball. For heavy-
duty users, there are stability balls available with maximum capacities well over 1,000 pounds.

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Medicine Balls

Medicine balls usually range between 2 and 18 lbs. They are an excellent means of training for upper body
speed-strength. Medicine balls are made of soft material (leather, rubber and stuffing) so they can safely
be caught, repelled or thrown. While you can throw a dumbbell, it would be unadvisable to try to catch
one and you certainly would not try it at high speed. Another advantage of medicine ball training is that
compensatory acceleration training can be done with literally no inertia because when you release the ball
the resultant stress on the joints is far less.

EXERCISE FUNDAMENTALS

While there are hundreds of exercises to choose from when developing a resistance training program,
there are some fundamentals that are common among resistance training exercises. Breathing
considerations, grip, warm-ups and cool-downs are four areas in which basic fundamentals should be
known.

Grip

There are three basic grips used in weight training. They are the supinated (palm up) grip, the pronated
(palm down) grip, and the neutral grip, which is mid-position between the supinated and pronated grips
and looks like a handshake. In addition to these grips there are less common grips known as the
alternated grip and the hook grip. In an alternated grip one hand is pronated and the other is supinated.
In a hook grip, which is similar to the pronated grip, the thumb is positioned under the index and middle
finger on the same side of the bar. In addition when the thumb does not wrap around the bar it is called
an open grip and when the thumb is wrapped around the bar it is known as a closed grip. The particular
grip used in an exercise often determines which muscles are involved in the exercise.

For example, in a chin-up the supinated grip is used, while in a pull-up the pronated grip is used. When
you use the supinated grip there is extension in the shoulder joint. With the pronated grip, when it is
wider than shoulder width, the elbows point out to the sides allowing shoulder joint adduction to take
place. Each of these actions involves different portions of the same and different muscles.

A similar situation exists when doing push-ups. If you point the fingers in front with the elbows alongside
the body, there is flexion in the shoulder joint. If you point the fingers inward with the elbows pointing out
to the sides, there is horizontal adduction, which involves the same and different muscles.

Utilizing different grips or changing grips or hand (and elbow) position during exercise execution allows
you to more effectively work specific muscles. For example, the neutral grip produces a straight line of pull
for the biceps. The supinated grip is also very effective for the biceps, even though the pull is not in a true
straight line. In the pronated grip the tendon of the biceps wraps around the radius so that it does not
have an effective line of pull. When the hand is pronated and locked in place, as when using a barbell
(reverse curl), the biceps is unable to function well. This is also why the pull-up is more difficult than a
chin-up.

Breathing Considerations

Breathing plays an important role not only in exercise, but also in relaxation. When your respiratory
muscles are strong, you are capable of taking in and processing more air per breath. As a result, you can
get greater amounts of oxygen, which the body needs not only for the production of energy but to help in
your recovery.

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The stronger your respiratory muscles are, the more effective your cardiovascular endurance. By
improving the strength of the muscles involved in breathing, you will be able to prevent the onset of
fatigue as well as recover faster. Respiratory fatigue occurs before cardiovascular fatigue; therefore your
breathing is directly related to your endurance as well as to your lifting.

How you breathe is very important during exercise execution. You should develop proper breathing
patterns from the start. We recommend that trainees new to the fitness lifestyle should exhale through
the sticking point and inhale during the less strenuous portion of the lift. The sticking point can be referred
to as the transition from the eccentric to the concentric contraction. This is also known as the amortization
phase.

Proper Breathing during Specialized Exercises

Breathing considerations for advanced athletes can be different from that of new trainees. There are some
situations in which breath-holding may be appropriate. The widely used recommendation to exhale on
exertion is based on theory, not research or actual practice, and applies mainly to new trainees and or
people with heart and circulatory system problems. For example, if you hold your breath for too long (up
to eight seconds with a maximal exertion), you could pass out. This is because the internal pressure in the
chest and abdomen increases when you hold your breath on exertion. If it increases greatly, it squeezes
down on the blood vessels shuttling blood and oxygen to and from the heart. When this happens, you can
black out (but rarely, and only on maximum exertion).

If you are without cardiovascular problems and you do not hold your breath for more than a few seconds
as needed in the recommended exercises, breath-holding on exertion is perfectly safe. For experienced
and well-trained athletes performing structural exercises (exercises that load the vertebral column) with
high loads, the Valsalva Maneuver can be helpful. It makes the exercises safer and more effective. If you
have high blood pressure or other circulatory system or heart problems, avoid heavy resistance and
breath-holding. In fact, you probably should not participate in a strength or explosive sport, which
requires not only great physical exertion but intense breath-holding.

Inhaling and holding the breath briefly on exertion comes naturally in all sports. Many studies have shown
that whenever athletic skills are executed properly, athletes hold their breath on the exertion — during the
power phase when maximum force is generated. The breath-holding is important for generating greater
force, having more accuracy and control, as well as for the prevention of injury.

The Valsalva Maneuver involves expiring against a closed glottis, which when combined with contracting
muscles of the abdomen and rib cage muscles, creates rigidity in the entire torso which aids in supporting
the vertebral column. Inhaling and holding the breath on exertion provides up to 20 percent greater force,
stabilizes the spine, and helps prevents lower back injuries. It transforms the trunk (and sometimes the
whole body) into a stable unit against which your hips, shoulders, and arms can move more effectively.

Breathing exercises can also help you relax. For example, it is not uncommon to read that you should
inhale and then exhale before starting a race, game or skill execution. This is a good technique to help you
relax. But before starting, it is important that the muscles have some tension — not excessive tension, but
sufficient tension to take off with power. This is why you should never completely exhale before starting.
Hold slightly more than your usual breath.

Thus, inhalation and breath-holding are needed immediately before and during execution of the key
actions. Studies done with devices to monitor breathing patterns have proven this beyond any doubt. To
execute a powerful lift or take-off in sports, you must hold your breath during execution.

In effective breathing, do not take a maximal breath and then hold it. Doing this can make you very
uncomfortable. Just take a breath slightly greater than usual and then hold it to experience the positive
benefits. This is especially important for stabilizing the body, holding the spine in position, and getting
greater power in execution of the skill. The breath-holding time is very short. You should have no fear of

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holding the breath too long or of overexerting yourself.

Exhalation, especially after a deep breath, is very beneficial for relaxation. Thus, any time you exhale
during execution of a maximal lift, you are telling the muscles to relax rather than to remain under
contraction to accomplish the work that has to be done. This, in turn, will weaken your body greatly and
can lead to injury. Some exhalation during a lift can be of benefit. For example, if you are doing a very
heavy squat, or handling great weight in a squat, and you are coming up out of the down position very
slowly, the amount of pressure being built up is quite great. To relieve some of this pressure, exhale
slightly through pursed lips to relieve some of the pressure. However, do not let all the air out until you
have passed the sticking point, or most difficult part of the up phase. Exhaling after you have passed the
most difficult part of the lift is also very important for relieving the built-up thoracic and abdominal
pressure. The key is to be sure that you exhale after passing the sticking point, not before. Too often
exhalation at this time is taken to indicate exhalation on exertion, but it is truly after the exertion, not
during. Keep in mind that proper breathing is essential to successful execution of strength exercises,
especially when handling heavy weights.

Breath-holding on exertion is a natural consequence. If no one told you how to breathe, you would
automatically hold your breath when lifting a heavy weight. You also hold your breath when receiving an
object coming at you, as for example when someone is throwing a medicine ball or even a punch. You
need the breath-holding to stabilize the body, to better withstand the force or the blow that you are about
to receive.

Warm-up

Most clients believe that warming up before working out or competing is essential in improving
performance and preventing injuries. They do various types of exercise to warm up, slowly going through
the motions of their sport, stretching, running in place. Of what benefit is warming up before training or
competing? To come up with a complete answer, you must be specific. What kind of warm-up are you
doing? For what kind of activity are you warming up? What are your clients’ current physical abilities?

Siff and Verkhoshanshansky in their book, Supertraining (1996), address these questions: “The warm-up
serves to raise the body to the necessary work capacity. The warm-up comprises two types: general and
specific. The purpose of the general warm-up is to increase the functional potential of the body as a
whole, whereas the purpose of the specific warm-up is to establish the optimal relationship between the
forthcoming movements. A work-capacity increase via the warm-up is determined both by central nervous
and muscular system changes.”

The benefits of a proper warm-up include:

1. Increases in the rate at which muscles contract

2. Increases in electrical activity of a muscle
3. Increases in the limit strength of the muscle
4. Increases in the amount of time that a muscle is able to maintain a contraction or series of
contractions (up to a certain point)
5. Improvement in connective tissue’s ability to accept force
6. Injury-potential reduction

However, it appears that warming up is not necessary in all sports, and may even prove to be detrimental.
Dr. B. Don Franks, a sports physiologist at the University of Tennessee in Knoxville, has thoroughly
reviewed the literature on warming up. Franks summarized his findings on warm-ups in a unit in Dr.
Melvin Williams’ book, Ergogenic Aids in Sport (Human Kinetic Publishers, 1983).

The theoretical purposes of warm-up exercises include:

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 1. Increased muscle temperature associated with enhanced dissociation of oxygen from red blood
cells.
2. Improved metabolic adjustment to heavy work.
3. Increased velocity of nerve conduction.
4. Greater numbers of capillaries opened in the muscles.

There are several psychological factors created by warm-ups. Skilled performance improves with activity
identical or directly related to the sport. Prior physical activity improves the “mental set” or attitude of the
client, especially when the activity is identical or directly related to the skill. Warm-ups cause an increased
“arousal,” or enthusiasm, eagerness and mental readiness. There is, however, one potentially negative
effect of warm-ups; fatigue from the prior activity can decrease performance. Therefore make sure your
warm-ups do just that: warm up the body rather than tire it out.

Franks investigated three areas of concern regarding whether or not warming up improves athletic
performance.

1. The circumstances under which performance could be enhanced.

2. The circumstances under which performance could be diminished.
3. The circumstances under which no change in performance will occur.

Below is a list of Franks’ general findings from his literature review:

1. Clients engaged in short, explosive types of sports such as powerlifting benefit from warming up.
2. Clients engaged in progressive-type sports or endurance events do not benefit from warming up.
3. Warming up before an endurance-type sport often will decrease performance because of fatigue.
4. Direct warm-ups (exercise directly related or the same as the sport) of moderate intensity and
duration prior to explosive sports enhance trained clients’ performance, but not necessarily that of
untrained clients.
5. Indirect warm-ups (exercise not directly related to the sport) often can aid performance, as can
bicycling for 4 to 5 minutes and/or flexibility (stretching) exercises.
6. Almost all studies showing a detrimental effect from warming up used untrained people as the
subjects, who apparently could not tolerate high-intensity warm-ups.
7. Heavy, non-related warm-ups interfere with one’s ability to perform sports skills requiring careful
control.
8. Your warm-up should ensure improved performance. Detailed journals of warm-ups will yield the
best type, intensity and duration for future workouts.

It seems that the widely held belief in warming up prior to training or competition needs to be carefully
considered before a specific warm-up program is adopted.

Cool-down

At the end of each exercise session, it is highly recommended that you cool down for five to ten minutes.
This is especially important after high-intensity exercise that contains an anaerobic component (for
example, very high-resistance training). Anaerobic exercise results in lactic acid accumulation in the
bloodstream and muscles. A cool-down period comprised of light aerobic activity will help remove the
lactic acid. Also, subsequent to a cool-down period, the muscle soreness that usually follows heavy
exercise (resulting not from lactic acid accumulation as was once believed, but rather from microtrauma at
the cellular level) is minimized or eliminated.

The least effective means of recovery is to simply fall to the ground. The rhythmic contractions of the
large muscles of the body help return blood to the heart. This important function of the muscular system
is most apparent following exercise, because many pints of blood are distributed to the extremities during
exercise. During exercise, blood flow patterns change. Through the action of the sympathetic nervous
system, blood is redirected away from areas where it is not essential to those areas that are active during
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exercise. Only 15% to 20% of resting cardiac output goes to muscle, but during exhaustive exercise our
muscles receive 80% to 85% of the cardiac output. This shift is accomplished by reducing blood flow to
the kidneys, liver, stomach and intestines, which causes the feelings of nausea associated with leg
workouts. A cool-down helps our body return to resting rates. Give your heart some help with light aerobic
cool-down activities. The cool-down should also contain stretching exercises specific to the preceding
exercise session.

Selected Exercises

Selected Chest Exercises

Few body parts can rival the attention-drawing power of the chest. A muscular, well-developed chest is
one of the distinguishing characteristics attributed to the ideals of the western image. The chest is
comprised of the pectoralis major and pectoralis minor. The pectoralis major muscle aids the serratus
anterior muscle in drawing the scapula forward as it moves the humerus in flexion and internal rotation.
The pectoralis minor muscle is used in true abduction (protraction) without rotation along with the
serratus anterior muscle. The pectoralis minor is most used in depressing and rotating the scapula
downward from an upwardly rotated position. This is best accomplished by raising the body a few inches
higher in the top position of bar dips. The pectoralis major is used powerfully in push-ups and pull-ups. It
works closely together with the anterior deltoid and as a helper of the latissimus dorsi muscle when
extending and adducting the humerus from a raised position. We will begin this section with chest
exercises.

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Muscle Origin Insertion Action Innervation
Pectoralis Clavicular: medial Clavicular: flat Clavicular: internal Clavicular:
Major half of anterior tendon 2 or 3 inches rotation horizontal lateral pectoral
surface of clavicle wide to the outer lip adduction flexion nerve (C5-7)
of intertubercular abduction and adduction
(when the arm is 90? of
abduction of the
glenohumeral joint)
Sternal: anterior Sternal: groove of Sternal: internal rotation Sternal:
surfaces of costal humerus horizontal adduction medial pectoral
cartilage of first 6 extension and adduction nerve (C8 T1)
ribs and adjacent of the glenohumeral joint
portion of sternum

Dumbbell Flat Bench Chest Press

Proper Position:
1. Lie on a flat bench in a supine position.
2. Plant your feet firmly on the floor.
3. Place the head shoulder blades and sacrum firmly on the bench.
4. Maintain a natural arch in the lower back.
5. Grasp the dumbbells with a pronated grip.
6. With the shoulders in 90? of flexion and the elbows extended hold the dumbbells
perpendicular to the body. This is the starting position.

Proper Technique:
1. Begin by slowly lowering the weight down and out initiating elbow flexion.
2. Continue to lower the dumbbells until the upper arms are parallel to the floor and
lateral at a 90? angle to the body.
3. The dumbbells should be directly over the hands.
4. In a controlled manner press the dumbbells up by contracting the pectoralis

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 major to the starting position.

Essential Tips to Avoid Common Mistakes:

• Place the head shoulder blades and sacrum on the bench while maintaining a
natural arch in the lower back.
• Keep the feet planted firmly during execution.
• Keep the wrists rigid.
• Do not bounce at the bottom of the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Dumbbell Incline Bench Chest Press

Proper Position:
1. Lie on an incline bench in a supine position.
2. Plant your feet firmly on the floor.
3. Place the head shoulder blades and sacrum firmly on the bench.
4. Maintain a natural arch in the lower back.
5. Grasp the bar with a pronated grip.
6. Place the hands approximately 6 inches wider than shoulder width. This is the
starting position.

Proper Technique:
1. Begin by slowly lowering the weight down and out initiating elbow flexion.
2. Continue to lower the bar until it reaches clavicle level and the upper arms are

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 parallel to the floor.
3. The barbell should be directly over the hands.
4. In a controlled manner press the bar up by contracting the pectoralis major to
the starting position.

Essential Tips to Avoid Common Mistakes:

1. Place the head shoulder blades and sacrum on the bench while maintaining a
natural arch in the lower back.
2. Keep the feet planted firmly during execution.
3. Keep the wrists rigid.
4. Do not bounce at the bottom of the movement.
5. Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Barbell Incline Bench Chest Press

Proper Position:
1. Lie on an incline bench in a supine position.
2. Plant your feet firmly on the floor.
3. Place the head shoulder blades and sacrum firmly on the bench.
4. Maintain a natural arch in the lower back.
5. Grasp the dumbbells with a pronated grip.
6. With the shoulders in 90? of flexion and the elbows extended hold the dumbbells

115
 perpendicular to the body. This is the starting position.

Proper Technique:
1. Begin by slowly lowering the weight down and out initiating elbow flexion.
2. Continue to lower the dumbbells until they reach clavicle level and the upper
arms are parallel to the floor.
3. The dumbbells should be directly over the hands.
4. In a controlled manner press the dumbbells up by contracting the pectoralis
major to the starting position.

Essential Tips to Avoid Common Mistakes:

• Place the head shoulder blades and sacrum on the bench while maintaining a
natural arch in the lower back.
• Keep the feet planted firmly during execution.
• Keep the wrists rigid.
• Do not bounce at the bottom of the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Barbell Flat Bench Chest Press

Proper Position:
1. Lie on a flat bench in a supine position.
2. Plant your feet firmly on the floor.
116
 3. Place the head shoulder blades and sacrum firmly on the bench.
4. Maintain a natural arch in the lower back.
5. Grasp the barbells with a pronated grip.
6. Place the hands approximately 6-inches wider than shoulder width. This is the
starting position.

Proper Technique:
1. Begin by slowly lowering the weight down and out initiating elbow flexion.
2. Continue to lower the bar until the upper arms are parallel to the floor and
lateral at a 90? angle to the body.
3. The bar should be directly over the hands.
4. In a controlled manner press the barbells up by contracting the pectoralis major
to the starting position.

Essential Tips to Avoid Common Mistakes:

• Place the head shoulder blades and sacrum on the bench while maintaining a
natural arch in the lower back.
• Keep the feet planted firmly during execution.
• Keep the wrists rigid.
• Do not bounce at the bottom of the movement.
• Always employ a competent spotter when performing a bench press.
• As you lower the bar progressively tighten all involved muscles as the bar
approaches your chest.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

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Bar Dips
Proper Position:
1. With the feet placed firmly on the supporting cross bars grasp the dip bars.
2. With the palms facing in and the elbows in extension (pointing directly back)
position the body directly between the bars so that the arms are holding the
body erect.
3. Once the arms are in full support of the body step off of the support bars.
4. (OPTIONAL) If needed flex the knees 90? to bring the lower legs to a position
that is parallel to the floor.
5. Keep your head in a natural position. This is the starting position.

Proper Technique:
1. Slowly lower the body in a controlled manner through elbow flexion.
2. Continue to lower the body to the point were your upper arms are at
approximately a 90? angle with your forearms and parallel with the dip bars.
3. Contract the triceps initiating elbow extension while keeping the elbows pointed
directly back and tucked into the sides of the body.
4. Continue to contract the triceps until returning to the starting position.

Essential Tips to Avoid Common Mistakes:

• Keep the elbows pointed back and tucked into the sides of the body.
• Keep the wrists in a flexed position.
• Lean forward (switch emphasis to pectoralis major).
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

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Dumbbell Chest Press on Ball
Proper Position:
1. Lay on a stability ball with your shoulders and head supported by the ball.
2. Shoulders hips and knees should all be in line with one another.

Proper Technique:
1. Press the dumbbells up towards the ceiling in an arc just short of lockout.
2. Slowly lower the dumbbells back to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Activate the transversus abdominis throughout the movement.
• Do not allow the hips to sink at any time during the exercise.
• Keep the feet planted firmly during execution.
• Do not bounce at the bottom of the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

119
Selected Lat Exercises

Although not as heralded as its anterior counterpart, the pectoralis major (chest), the latissimus dorsi is
synonymous with that elusive, highly sought after V-taper. Unfortunately, due to the inability to see the
back while training combined with the extreme volume of work performed for the pectoralis major, many
trainees neglect proper balance in their upper body training opting to prioritize chest development.

The latissimus dorsi has two main actions on the arm. It functions in adduction (pulling the arms to the
sides of the body from an out-to-the-side position) and extension (pulling the arms down from a
horizontal position straight out in front of the body). As we will see, knowing these two primary actions
will be a great tool for understanding the proper biomechanics for latissimus dorsi exercises.

As noted above, the latissimus dorsi muscle has a strong action in adduction of the humerus. Whenever
we have our hands above our head, as with seated pulldowns or while doing pull-ups, due to the upward
rotation of the scapula that accompanies glenohumeral abduction, the latissimus dorsi effectively
downwardly rotates the scapula by pulling the entire shoulder girdle downward in active glenohumeral
adduction. Since it is one of the most important extensor muscles of the humerus, it contracts powerfully
in chin-ups and supinated pulldowns. Any exercises in which the arms are pulled down bring the latissimus
dorsi into a full contraction. Basic rowing and pullover exercises with dumbbells or barbells are also good
for latissimus dorsi development.

Any discussion of the latissimus dorsi must include a mention of the teres major muscle. The teres major
is commonly referred to as the “lats’ little helper” because the two have the exact same action on the arm.
It is impossible to train one without the other. The origin of the teres major is on the lower edge of the
scapulae (shoulder blades) above the latissimus dorsi. The insertion is on the head of the humerus, in
virtually the same spot as the insertion of the latissimus dorsi. We will continue our section on exercise
selection with selected exercises for the latissimus dorsi muscle.

120
Muscle Origin Insertion Action Innervation
Latissimus Posterior crest of Medial side of Addition extension and Thoracodorsal
Dorsi ilium back of sacrum intertubercular internal rotation of nerve (C6-8)
and spinous process groove of glenohumeral joint also
of lumbar and lower humerus horizontal abduction of
T6-T12; slips from glenohumeral joint
lower 3 ribs

Overhead Pulldown
Proper Position:
1. Grasp the bar using a pronated grip approximately 6 inches wider than shoulder
width.
2. Grasp the bar with the arms slightly bent with the elbows pointed away from the
body.
3. Make sure that the knees are placed firmly under the support pads and that your
feet are planted firmly on the ground.
4. Lean back slightly (approximately 15 degrees) to allow the bar to travel in a
correct downward path.
5. Maintain a natural arch in the lower back. This is the starting position.

Proper Technique:
1. From the starting position pull the shoulder blades down and together. Begin to
contract the latissimus dorsi muscle by initiation contraction by bending the
elbows.
2. Pull the arms down and out until the bar touches your clavicle.
3. Keep the scapulae retracted and depressed.
4. Contract the latissimus dorsi while relaxing the hands and arms.

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 5. In a controlled manner return the bar back to its starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Concentrate on keeping the hands and arms relaxed while contracting the
latissimus dorsi.
• Maintain a natural arch in the spine at all times.
• Keep the head and neck in a neutral position throughout the exercise.
• Remember to inhale on the upward phase of the movement (eccentric) and
exhale on the downward phase (concentric).

Seated machine Row

Proper Position:
1. Plant your feet firmly against the foot platform.
2. Adjust the seat so that the handles in front of you are slightly lower than shoulder
height and the chest pad is positioned so that it will allow your body to stay erect.
3. Keep the elbows slightly bent and pointed down. This is the starting position.

Proper Technique:
1. From the starting position retract the scapula by pulling the shoulder blades down
and squeezing together.
2. Contract the latissimus dorsi by pulling the arms back until the elbows are
approximately beneath the shoulders.
3. Continue to contract the latissimus dorsi as well as the rhomboids and middle
trapezius.
4. In a controlled fashion return to the starting position.

122
Essential Tips to Avoid Common Mistakes:
• Avoid rotation of the shoulders during execution.
• Keep the elbows pointed down throughout the exercise.
• Maintain a natural arch in the lower back.
• Keep the head and neck in a neutral position.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

123
Chin-Up
Proper Position:
1. Grasp the bar using a supinated grip approximately shoulder width.
2. Grasp the bar with the arms slightly bent with the elbows pointed away from the
body.
3. Spine should be neutral and head should be pointed forward.

Proper Technique:
1. Retract and adduct the scapula.
2. With a slight bend at the elbow joint pull your upper body towards the bar.
3. Your thighs should be in line with your torso.
4. Pull up until your chin is elevated above the bar without moving your neck.

Essential Tips to Avoid Common Mistakes:

• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).
• Do not allow your body to swing – keep your legs stationary throughout the
whole movement.
• Pause for one second at the top of the movement and adduct the scapula and
contract the biceps.
• Return all the way to the starting position but do not allow your arms to lock out
at the bottom of the movement.

124
Pull-Up
Proper Position:
1. Grasp the bar using a pronated grip approximately 6 inches wider than shoulder
width.
2. Arms should be slightly bent with elbows pointed away from the body.
3. Spine should be neutral and head should be pointed forward. This is the starting
position.

Proper Technique:
1. Retract and adduct the scapula.
2. Bending at the elbow joint, pull your upper body towards the bar.
3. Your thighs should be in line with your torso.
4. Pull up until your chin is elevated above the bar without moving your neck.
5. Lower your body in a controlled manner to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Don not allow your body to swing - Keep your legs stationary throughout the
whole movement.
• Pause for one second at the top of the movement and adduct the scapula.
• Return all the way to the starting position, but do not allow your arms to lock
out at the bottom of the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

125
126
Bent-Over Row
Proper Position:
1. Plant your feet firmly on the ground in a stance slightly wider than shoulder
width apart with the knees slightly bent.
2. From the hips bend your upper body forward slightly above parallel to the floor.
3. Grasp the bar with a pronated grip slightly wider than shoulder width.
4. Allow the bar to hang with the elbows fully extended. This is the starting
position.

Proper Technique:
1. From the starting position retract the scapula by pulling the bar up toward your
chest.
2. Continue to contract the latissimus dorsi until the elbows are pointed directly up.
3. Continue to contract the latissimus dorsi as well as the middle trapezius and
rhomboids while trying to relax the hands and arms as much as possible.
4. In a controlled fashion return to the starting position.

Essential Tips to Avoid Common Mistakes:

• Avoid jerking the torso for assistance.
• Maintain a rigid upper body with the back flat.
• Keep the head and the neck in a neutral position (focus the eyes a short
distance ahead of the feet).
• Keep the torso and knees in the same position throughout the exercise.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

127
Supine Pullover on Ball
Proper Position:
1. Lay on the ball with head and shoulders in contact with the ball.
2. Keep shoulders hips and knees in alignment with one another.
3. Feet should be flat on the ground about shoulder width apart to start.

Proper Technique:
1. Start by holding a dumbbell in both hands so that the end of the dumbbell is
held with a triangular grip.
2. Press the dumbbell straight up in the air above the head.
3. Keeping the arms straight lower the dumbbell back over your head through a full
range of motion (this will differ from individual to individual) while making sure
to keep the arms straight.
4. At the end of the movement pause and slowly return to the starting position and
repeat.

Essential Tips to Avoid Common Mistakes:

• Activate the transversus abdominis throughout the movement.
• Keep the feet planted firmly during execution.
• Do not bounce at the bottom of the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

128
Selected Deltoid Exercises

Although the pectoralis major muscles of the chest and the biceps brachii muscles of the arms are
undoubtedly the areas that receive the most praise and adoration, symmetrical well-developed deltoid
muscles can undoubtedly differentiate a good physique from a great physique.

Whenever we engage in a lifting movement, we utilize the deltoid muscles. Generally, the larger trapezius
muscle stabilizes the scapula as the deltoid pulls on the humerus. The deltoid muscle is made up of three
heads: the anterior deltoid, the middle deltoid and the posterior deltoid. The fibers of the anterior deltoid
are involved in flexion, internal rotation and horizontal adduction of the glenohumeral joint. The fibers of
the middle deltoid are involved in abduction of the glenohumeral joint. The fibers of the posterior deltoid
are involved in abduction, extension, and horizontal abduction of the glenohumeral joint. We will continue
our section on exercise selection with selected exercises for the deltoids.

Muscle Origin Insertion Action Innervation

Anterior: anterior Anterior: deltoid Anterior: abduction Anterior: axillary
lateral third tuberosity on lateral flexion horizontal nerve (C5 C6)
of clavicle humerus adduction and
internal rotation of
glenohumeral joint
Deltoid
Middle: lateral Middle: deltoid Middle: abduction of the Middle: axillary
aspects of tuberosity on lateral glenohumeral joint nerve (C5 C6)
acromion humerus
Posterior: inferior Posterior: deltoid Posterior: abduction Posterior: axillary
edge of spine tuberosity on lateral extension horizontal nerve (C5 C6)

129
scapula humerus abduction and
external rotation of
glenohumeral joint

Seated Barbell Press (Military Press to the Front)

Proper Position:
1. Sit on a vertical shoulder press bench.
2. Place your feet firmly on the floor.
3. Press shoulder blades and sacrum firmly against the bench.
4. Grasp the bar with a pronated grip slightly wider than shoulder width apart while
still on the rack.
5. Press the bar overhead off of the support rack until the elbows are fully
extended. This is the starting position.

Proper Technique:
1. Lower the bar down slowly initiating elbow flexion.
2. Keep the wrists in a rigid position palms facing forward with the shoulders and
sacrum pressed firmly against the bench.
3. Continue to lower the bar until it descends to clavicle level.
4. Press the bar upward initiating elbow extension.
5. Do not arch the back while pressing up.
6. Continue to press up until you return to starting position.

Essential Tips to Avoid Common Mistakes:

• Do not rise out of the bench.
• Keep the elbows directly under the hands.
• Keep the wrist in a rigid position throughout the movement.
• Do not arch the back during execution.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

130
Barbell Upright Row
Proper Position:
1. Stand with feet slightly wider than shoulder width apart and with knees slightly
flexed.
2. Grasp the bar with a pronated grip and with the bar resting against the front of
your thighs.
3. The hands should be positioned approximately 6 inches apart.
4. The elbows should fully extend with the elbows pointed directly outward. This is
the starting position.

Proper Technique:
1. Begin by pulling the bar up along the body.
2. Keep the body erect with the knees slightly flexed.
3. Continue to pull the bar up until the bar reaches clavicle level.
4. The hands should be at clavicle level with the elbows pointed up and out at
approximately ear level.
5. Slowly allow the bar to travel along the body back to the starting position.

Essential Tips to Avoid Common Mistakes:

• Do not bounce the bar to initiate the upward movement.
• Do not swing the weight or rise on the toes.
• Do not assist the movement with the lower body.
• The wrist should stay in a rigid position throughout the movement.
131
 • Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Dumbbell Posterior Deltoid Raise

Proper Position:
1. Stand with the feet planted firmly on the ground approximately shoulder width
apart.
2. The knees should be slightly flexed.
3. With the palms facing in against the outer thighs grasp the dumbbells with a
natural grip.
4. The elbows should be pointed directly back.
5. Bend over at the hips so you are bent at about a 90? angle.
6. The dumbbells should be parallel with the legs. This is the starting position.

Proper Technique:
1. Begin by laterally raising the arms by contracting the posterior deltoids.
2. Continue to contract the posterior deltoids until the arms are approximately
parallel to the floor.
3. Slowly lower the arms back to the starting position.

Essential Tips to Avoid Common Mistakes:

132
• Do not swing the weight.
• Do not come up on toes to move the weight.
• Lead with the elbows not the hands.
• The hand position should have the pinky finger higher than the thumb (similar to
that of pouring a pitcher of water).
• Rest forehead on an incline bench in order to prevent swinging the body during
the concentric phase of the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

133
Dumbbell Medial Deltoid Lateral Raise
Proper Position:
1. Stand with the feet planted firmly on the ground approximately shoulder width
apart.
2. The knees should be slightly flexed.
3. Palms should be supinated to prevent shoulder impingement against the sides of
the legs.
4. The elbows should be pointed directly back. This is the starting position.

Proper Technique:
1. Begin by contracting the medial deltoids laterally raising the arms.
2. Continue to contract the medial deltoids until they are approximately parallel to
the floor.
3. Slowly lower the arms back to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Do not swing the weight.
• Do not come up on toes to move the weight.
• Lead with the elbows not the hands.
• The hands should not rise above shoulder level.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

134
Single Arm Cable Lateral Raise
Proper Position:
1. The legs should be placed in an athletic stance with the feet slightly wider than
shoulder width apart and knees slightly bent.
2. Face 90? to the right of the cable with your left shoulder approximately two feet
away from the base. There should be enough distance to allow for tension in the
starting position of the exercise.
3. The cable should be at the lower level with a single handle attached.
4. Hold the handle with the right hand just above the right thigh. This is the
starting position.

Proper Technique:
1. Retract the scapula and abduct the right arm until the elbow is parallel to the
floor but not higher than your shoulder.
2. The elbow should retain a slight bend throughout the exercise.
3. Slowly return the weight to the starting position.

Essential Tips to Avoid Common Mistakes:

• Do not swing the weight.
• Do not come up on toes to move the weight.
• Lead with the elbows not the hands.
• The hands should not rise above shoulder level.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

135
136
Seated Alternate Dumbbell Press on Stability Ball
Proper Position:
1. Sit on a stability ball with a neutral spine.
2. The weight should be in the hand with a supinated grip.
3. Arms form a 90% angle and are perpendicular to the floor.

Proper Technique:
1. Press one dumbbell towards the ceiling in a slow and controlled manner.
2. Stop just short of locking the elbow joint and slowly return to the starting
position.
3. Repeat steps 1 and 2 with the alternate arm — this is one repetition.

Essential Tips to Avoid Common Mistakes:

• Activate the transversus abdominis throughout the movement.
• Do not allow the lower back to cave in during extension.
• Keep the feet planted firmly during execution.
• Do not bounce at the bottom of the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

137
Selected Triceps Exercises

If stretching out your shirtsleeves or making sure that your arms look nice in a strapless dress is one of
your main training goals, then it would be advisable to incorporate triceps training into your program
design. Since the triceps make up two-thirds of the upper arm, it is logical that the bigger your triceps are
the more massive your arm will look.

The triceps are responsible for the movement of extension at the elbow. The muscles that act at the elbow
joint produce motion of the forearm. The ulnohumeral joint is a hinge joint that is a third class lever and
permits movement in the sagittal plane (also known as the medial plane). The triceps have three heads:
the long head (originates at the lower edge of the scapula), the lateral head (originates on the posterior
humerus), and the medial head (originates on the distal two thirds of the posterior humerus). All three
insert into the olecranon process of the ulna. We will continue our section on exercise selection with
selected exercises for the triceps

Muscle Origin Insertion Action Innervation

Triceps Long head: infraglenoid Olecranon process Long head: Radial nerve
brachii tubercle below inferior lip of the ulna adduction of the (C7 8)
of glenoid fossa of shoulder joint;
scapula extension of elbow
Lateral head: upper half All heads are
of posterior surface of involved in the
humerus extension of the
elbow
Medial head: distal 2/3
of posterior surface of
138
 humerus
Anconeus Posterior surface of Posterior surface of Extension of the Radial nerve
lateral condyle of the the olecranon elbow (C7 8)
humerus process of the ulna

One Arm Dumbbell Triceps Extension on Stability Ball

Proper Position:
1. Sit on a stability ball with feet planted firmly on the floor.
2. Place a dumbbell in one hand and rest the other arm across the stomach.
3. Extend the dumbbell over the head as in the end point of a dumbbell shoulder
press. This is the starting position.

Proper Technique:
1. Bending from the elbow bring the dumbbell down behind the head making sure
not to lean forward.
2. Contract the triceps muscles and return the weight to the starting position.

Essential Tips to Avoid Common Mistakes:

• Do not allow the upper arm to move during the exercise.
• Make sure to keep a natural arch in the spine and do not allow the lower back to
come off of the bench in order to move the weight.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

139
Skull Crushers
Proper Position:
1. Make sure that your feet are planted firmly on the ground while maintaining a
natural arch in your lower back.
2. Place your head sacrum and shoulder blades firmly on the bench.
3. Position your arms straight up with approximately 90? of flexion. This is the
starting position.

Proper Technique:
1. Slowly lower the forearms without moving your shoulders or upper arms.
2. Bring the forearms down until they form a 90? angle with your upper arms.
3. Pause for a second to build up the eccentric tension and then return to starting
position.

Essential Tips to Avoid Common Mistakes:

• Keep the wrist in neutral position because hyperextension of the wrist could

140
 cause pain similar to tennis elbow.
• Avoid twisting or rotating the shoulders or wrists.
• Emphasize form over the weight moved.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

141
French Press
Proper Position:
1. With the feet shoulder width apart and a natural arch in the lower back place
your hands at shoulder width on the bar with a pronated grip.
2. The head and shoulders point forward and the toes should be in an athletic
stance.

Proper Technique:
1. Press the bar overhead.
2. Keep the upper arms locked into position and slowly lower the bar behind the
head without allowing the back to arch or the upper arms to move.
3. Return the bar to the starting position just shy of locking out the elbows.

Essential Tips to Avoid Common Mistakes:

• Do not allow the back to arch or the head to drop forward.
• Contract the triceps at the top of the movement.
• Remember to inhale at the top of the movement (eccentric) and exhale on the
downward phase (concentric).

142
Triceps Cable Extension with Rope
Proper Position:
1. Stand with your feet slightly wider than shoulder width apart.
2. The knees should be slightly bent not locked.
3. Grab the rope attached to the high pullet with your hands in a neutral grip.
4. Keep your elbows pointed back and firmly held against the side of your body. This it the
starting position.

Proper Technique:
1. Contract the triceps and slowly lower your arms.
2. As you reach the end of the range of motion allow your arms to flare out towards the
sides and your wrists to pronate slightly.
3. Pause for one second “squeezing” the triceps muscles and return to the starting
position.

Essential Tips to Avoid Common Mistakes:

• Inhale during the eccentric phase and exhale during the concentric phase.
• Avoid bringing the forearms up to a point were tension from the cable is lost.
• Do not hyperextend the wrist; keep them in a neutral position.
• Keep the shoulders back and the elbows tucked firmly into your sides.
• Do not let the shoulder round forward — keep your scapula retracted throughout the
movement..

143
 • Remember to inhale on the downward phase or the movement (eccentric) and exhale
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.

Bar Dips
Proper Position:
1. Position yourself between the bars so that your arms hold you erect and you are able
to dip to a low position without having your feet touch the ground.
2. Hold your body erect with your elbows in to your sides.
3. Keep your elbows pointing directly behind you.
4. Keep your head in line with your spine – do not hyperextend the neck. This is the
starting position.

Proper Technique:
1. Slowly lower yourself to the point where your upper arms are at a 90? angle with your
forearms and approximately parallel with the dip bar.
2. Pause for a second to build up the muscular tension of the eccentric contraction and
then return to the starting position.
3. Do not go lower than parallel to insure that the tension remains on your triceps.
4. Keep the body erect; the further you lean forward the more emphasis will shift from
your triceps to your pectoralis major.

144
Essential Tips to Avoid Common Mistakes:
• Avoid having your elbows point out to the sides.
• Keep your wrists in a neutral position.
• Keep the shoulders back and your elbows tucked firmly into your sides.
• Remember to inhale on the downward phase of the movement (eccentric) and exhale
on the upward phase (concentric).

French Press on Ball

Proper Position:
1. Sit on ball with proper spinal alignment.
2. Plant your feet firmly on the floor.
3. Position the weight behind the head so that the base of the weight does not
touch the body.
4. Elbows should be pointed straight up.

Proper Technique:
1. Contract the triceps straightening the arms just short of locking them out.
2. Slowly lower the weight returning to the starting position.

145
 Essential Tips to Avoid Common Mistakes:
1. Activate the transversus abdominis throughout the movement.
2. Keep the feet planted firmly during execution.
3. Do not bounce at the bottom of the movement.
4. Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Selected Biceps Exercises

Muscular arms personify masculinity and can be very empowering. It is easily understandable that most
men are intrigued with developing their arms especially their biceps. Even if you are not interested in
bodybuilding, you are instantly drawn into its appeal whenever you flex your biceps in the mirror. The
phrase "show me your muscles" is usually followed by a single arm front bicep flex. No experience,
lessons or instructions are needed; we all instantly instinctively know what to do. The biceps have been
and will continue to be an indication of muscularity.

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With the intrigue regarding biceps, it seems as though everywhere you turn, you are inundated with
secrets to developing show-stopping, eye-turning, 21-inch arms. Not everyone has the genetic potential
or even the inclination to develop 21-inch arms but everyone has the potential to transform their arms
into eye-turning specimens. The flexors of the elbow are the biceps brachii, brachialis, and brachioradialis.
The muscles that act at the elbow joint produce the motion of flexion in the forearm. The ulnohumeral
(elbow) joint is a hinge joint, which allows motion to only occur in the sagittal (median) plane. The biceps
brachii is comprised of two heads, the long (outer head) and the short (inner head). The biceps brachii is
involved in flexion of the elbow as well as supination of the forearm. The long head originates on the
supraglenoid tuberosity of the scapulae. The short head originates on the coracoid process of the
scapulae. Both heads insert on the radial tuberosity and bicipital aponeurosis. The brachialis is also
involved in flexion at the elbow. It originates on the anterior humerus and inserts at the ulna tuberosity
and coronoid process of the ulna. The brachioradialis is also involved in flexion of the elbow. It originates
on the lateral condyle of the humerus and inserts at the styloid process of the radius. Now that we have
the basic functions of the muscles involved in elbow flexion we will discuss exercises that will optimize
your biceps size.

Depending on the position of the forearm and the rotation of the elbow, this will determine which portion
of the biceps group you challenge the most. The biceps brachii is a stronger elbow flexor when the
radioulnar joint is supinated (palms up). The biceps brachii is a stronger forearm supinator when the
elbow is flexed. When the forearm is neutral or pronated (palms down) the brachioradialis and brachialis
become more active. When the forearm is pronated, the brachioradialis tends to supinate as it flexes the
elbow. In a supinated position, it tends to pronate as it flexes. You can target whichever portion of the
biceps group you want to train with any of the aforementioned variations. Since dumbbells allow for full
supination or pronation of the forearm, we recommend their use to optimize your biceps potential. We will
continue our section on exercise selection with selected exercises for the biceps.

Muscle Origin Insertion Action Innervation

Biceps Long head: supraglenoid Tuberosity of Flexion of elbow Musculocutaneous
Brachii tubercle above the radius and bicipital supination of nerve (C5 C6)
147
 superior lip of glenoid aponeurosis forearm
fossa
Short head: coracoid Weak flexion of
process of scapula and shoulder joint
upper lip of glenoid fossa

Cable Biceps Curl

Proper Position:
1. Stand with your feet slightly wider than shoulder width apart.
2. The knees should be slightly bent not locked.
3. The arms should be at your sides holding onto the cable from a low pulley with a
supinated grip. This is the starting position.

Proper Technique:
1. Contract the biceps moving the forearm out and up through a natural range of
motion with your forearm in a supine position.
2. Isometrically contract the muscle at the end of the concentric contraction and
hold for a second.
3. Return to the starting position with the elbows aligned under the shoulders and
slightly bent.
4. Do not lock out the arms as this will place more stress on your ligaments and
tendons.

Essential Tips to Avoid Common Mistakes:

• Avoid any twisting or rotating of the shoulders or elbows during execution.
• Do not allow your elbows to come forward in order to lift the weight.
• Remember to inhale on the downward phase of the movement (eccentric) and

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 exhale on the upward phase (concentric).

Cable Rope Hammer Curl

Proper Position:
1. Stand with your feet slightly wider than shoulder width apart.
2. The knees should be slightly bent not locked.
3. The arms should be at your sides holding onto the cable from a low pulley with a
neutral grip. This is the starting position.

Proper Technique:
1. Contract the biceps moving the forearm out and up through a natural range of
motion with your forearm in a neutral position.
2. Isometrically contract the muscle at the end of the concentric contraction and hold
for a second.
3. Return to the starting position with the elbows aligned under the shoulders and
slightly bent.
4. Do not lock out the arms as this will place more stress on your ligaments and
tendons.

Essential Tips to Avoid Common Mistakes:

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 • Avoid any twisting or rotating of the shoulders or elbows during execution.
• Do not allow your elbows to come forward in order to lift the weight.
• Make sure not to lean back in order to pull the weight up.

• Remember to inhale on the downward phase of the movement (eccentric) and

exhale on the upward phase (concentric).

Dumbbell Biceps Curl

Proper Position:
1. Stand with your feet slightly wider than shoulder width apart.
2. The knees should be slightly bent not locked.
3. The arms should be at your sides holding onto the dumbbells with a supinated
grip. This is the starting position.

Proper Technique:
1. Contract the biceps moving the forearm out and up through a natural range of
motion with your forearm in a supine position.
2. Isometrically contract the muscle at the end of the concentric contraction and
hold for a second.
3. Return to the starting position with the elbows aligned under the shoulders and

150
 slightly bent.

Essential Tips to Avoid Common Mistakes:

• Avoid any twisting or rotating of the shoulders or elbows during execution.
• Do not allow your elbows to come forward in order to lift the weight.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).
• Do not lock out the arms as this will place more stress on your ligaments and
tendons.

Dumbbell Hammer Curl

Proper Position:
1. Stand with your feet slightly wider than shoulder width apart.
2. The knees should be slightly bent not locked.
3. The arms should be at your sides holding onto the dumbbells with a neutral grip.

Proper Technique:
1. Contract the biceps moving the forearm out and up through a natural range of
motion with your forearms in a neutral position.
151
 2. Isometrically contract the muscle at the end of the concentric contraction and
hold for a second.
3. Return to the starting position with the elbows aligned under the shoulders and
slightly bent.

Essential Tips to Avoid Common Mistakes:

• Do not lock out the arms as this will place more stress on your ligaments and
tendons.
• Avoid any twisting or rotating of the shoulders or elbows during execution.
• Do not allow your elbows to come forward in order to lift the weight.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Dumbbell Concentration Curl

Proper Position:
1. Sit on a bench.
2. Bend over from the hips.

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 3. Brace your working elbow along the interior of your thigh on the side being
worked.

Proper Technique:
1. With your biceps at a 70% angle to the floor beginning in a neutral position
contract the biceps.
2. As you contract the biceps begin to supinate your palm and pull the lower arm
out and up on a natural range of motion from the elbow as far as the forearm
will go without moving the upper arm.
3. Isometrically hold the contraction at the top of the movement for a full second
and then lower the weight to the starting position.

Essential Tips to Avoid Common Mistakes:

• Do not lock out the arm as this will place undue stress on the ligaments and
tendons.
• Avoid any twisting or rotating of the shoulders or elbows during execution.
• Do not allow your elbows to come forward in order to lift the weight.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

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Dumbbell Hammer Curl on Ball
Proper Position:
1. Sit on ball with proper spinal alignment.
2. Plant your feet firmly on the floor.
3. Start with the arms at your sides palms facing the body (neutral grip).

Proper Technique:
1. Contract the biceps and bring the arms towards the chest until they reach
slightly above the nipple line.
2. Make sure to keep the elbows slightly behind the shoulder joint in order to
insure isolation of the biceps.
3. Slowly lower the arms to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Activate the transversus abdominis throughout the movement.
• Keep the feet planted firmly during execution.
• Keep the wrists rigid.
• Do not bounce at the bottom of the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

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Selected Trapezius Exercises

Think back to last year when you were scurrying from the car to the hotel or from the taxi to the airport
frantically trying to keep on schedule so that you could start your hard earned vacation. Many of us will
recall the excruciating pain we experienced in our neck area while we struggled to carry our bags across
terminal and hotel floors. This pain we experienced stems from strain and, or a lack of muscular strength
and muscular endurance in the trapezius muscle. Therefore, in order to help prevent this potential
vacation scenario from repeating, we will delve into the correct training for the trapezius muscle.

While many of us associate the trapezius muscle with merely being the neck muscles that can be seen at
the base of the skull, the trapezius muscle actually consists of three fiber areas. While it is true that the
upper fibers of the trapezius muscle originate at the base of the skull, there are also middle and lower
fibers as well. The entire muscle looks like a kite, which starts at the base of the skull and extends down
and out to the posterior aspect of the lateral third of the scapulae and medial border of the acromion
process. It then continues down and inserts in a triangular space at the base of the scapular spine. The
upper fibers are a thin and relatively weak part of the muscle. This is the area in which we feel the most
pain while carrying luggage. The upper fibers provide some elevation of the clavicle and are of minor
importance in moving the head. The middle fibers are stronger and thicker and provide strong elevation,
upward rotation, and retraction of the scapula. The lower fibers assist in retraction and rotate the scapula
upward. Synergistically working together, the three parts tend to pull upward and adduct at the same
time. The muscle is always used in preventing the glenoid fossae from being pulled down during the lifting
of objects with the arms and as mentioned, is typically in action during the holding of an object (like
luggage). Strengthening of the upper and lower fibers can be accomplished through a variation of
shoulder-shrugging exercises. The lower and middle fibers can be strengthened through bent rowing in a
prone position and side arm shoulder joint abduction exercises. We will continue our section on exercise
selection with selected exercises for the trapezius muscle.

155
Muscle Origin Insertion Action Innervation
Trapezius Upper: base of skull Upper: posterior Upper: scapula Upper: accessory
occipital aspect of the lateral elevation and nerve (cranial
protuberance and clavicle extension of the nerve XI and
posterior ligaments head at neck branches of C3 C4)
of neck
Middle: spinous Middle: medial border Middle: elevation Middle: accessory
process of 7C and of the acromion upward rotation nerve (cranial
T1-T3 process and upper and adduction of nerve XI and
border of acromion scapula branches of C3 C4)
Lower: spinous Lower: base of Lower: Lower: accessory
process of T4-T12 scapular spine depression nerve (cranial
(triangular shape) adduction nerve XI and
Upper: scapula upward rotation branches of C3 C4)
elevation and of the scapula
extension of the head
at neck

Cable Bar Shrug

Proper Position:
1. Grasp the bar using a pronated grip approximately shoulder width.
2. Stand approximately 8 inches away from the cable pulley.
3. Make sure that you have a solid stance while standing upright.
4. The neck should be in a neutral position with the head facing forward. This is the
starting position.

Proper Technique:
1. From the starting position retract the scapula by squeezing your shoulder blades
together.
2. Simultaneously elevate and rotate the scapula upward attempting to bring your
shoulders as close to your ears as possible.
3. Hold the contraction for a second and then slowly return to the starting position.

Essential Tips to Avoid Common Mistakes:

• Concentrate on keeping the hands and arms relaxed while contracting the
trapezius muscle.
• Maintain a natural arch in the spine at all times.
• Keep the head and neck in a neutral position throughout the exercise.
• Keep in mind that this is a movement of the shoulder girdle not the shoulder
joint.
• Do not bend or bounce at the knees to assist with the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and

156
exhale on the upward phase (concentric).

157
Barbell Shrug
Proper Position:
1. Grasp the bar using a pronated grip with hands approximately shoulder width
apart.
2. Make sure that you have a solid stance while standing upright.
3. The neck should be in a neutral position with the head facing forward. This is the
starting position.

Proper Technique:
1. From the starting position retract the scapula by squeezing your shoulders
blades together.
2. Simultaneously elevate and rotate the scapula upward attempting to bring your
shoulder as close to your ears as possible.
3. Hold the contraction for a second and then slowly return to the starting position.

Essential Tips to Avoid Common Mistakes:

• Concentrate on keeping the hands and arms relaxed while contracting the
trapezius muscle.
• Maintain a natural arch in the spine at all times.
• Keep the head and neck in a neutral position throughout the exercise.
• Keep in mind that this is a movement of the shoulder girdle not the shoulder
joint.
• Do not bend and bounce at the knees to assist with the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

158
Dumbbell Shrug
Proper Position:
159
 1. Grasp each dumbbell using a pronated grip approximately shoulder width.
2. Make sure that you have a solid stance while standing upright.
3. The neck should be in a neutral position with the head facing forward. This is the
starting position.

Proper Technique:
1. From the starting position retract the scapula by squeezing your shoulder blades
together.
2. Simultaneously elevate and rotate the scapula upward attempting to bring your
shoulders as close to your ears as possible.
3. Hold the contraction for a second and then slowly return to the starting position.

Essential Tips to Avoid Common Mistakes:

• Concentrate on keeping the hands and arms relaxed while contracting the
trapezius muscle.
• Maintain a natural arch in the spine at all times.
• Keep the head and neck in a neutral position throughout the exercise.
• Keep in mind that this is a movement of the shoulder girdle not the shoulder
joint.
• Do not bend or bounce at the knees to assist the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

160
Seated Mid Row Retraction on a Machine
Proper Position:
1. Plant your feet firmly against the foot platform.
2. Adjust the seat so that the handles in front of you are slightly lower than
shoulder height and the chest pad is positioned so that it will allow your body to
stay erect.
3. Grasp the handles with a neutral grip. 4. Keep the elbows slightly bent and arms
parallel to the floor. This is the starting position.

Proper Technique:
1. From the starting position contract the scapular muscles.
2. Retract the scapula by pulling the shoulder blades down and squeezing together.
3. Hold for a count of one.
4. In a controlled fashion return to the starting position: protract the scapula
allowing the arms to come forward.

Essential Tips to Avoid Common Mistakes:

• Avoid rotating the shoulders during execution.
• Keep the arms in a semi-locked position throughout the exercise.
• Maintain a natural arch in the lower back.
• Keep the head and neck in a neutral position.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

161
162
Selected Abdominal Exercises

Turn the television on at any time of the day or night and you will most likely be inundated
with a number of infomercials for abdominal exercise machines that promise to strengthen
your abdominal muscles and trim your waist in no time. While the ab-craze seems to be the
new American pastime, the average person's midsection still looks more like an airbag than a
washboard.

Muscularity as it relates to visual appearance is dependent on having a relatively low body fat
percentage. In a relatively lean person, three distinct sets of lines or depressions are visible.
Aesthetically, these depressions create the visual appearance of the abdominals. Each
depression represents an area of connective tissue connecting the abdominal arrangement of
muscles. Running vertically from the xiphoid process to the pubis is the linea alba. Lateral to
each rectus abdominis is the linea semiulnaris. This represents the juncture (aponeurosis)
connecting the lateral border of the rectus abdominis and the medial border of the external
and internal obliques. Finally, the tendinous inscriptions are the horizontal depressions that
cross the rectus abdominis at three or more locations. These tendinous connections create
the visual appearance of the abdominals. Strengthening the abdominal group will not remove
fat from the waistline. There is no such thing as spot reduction, because muscles do not fuel
anaerobic exercise by using the fat that surrounds them. We will continue our section on
exercise selection with selected exercises for the abdominal muscle group.

Muscle Origin Insertion Action Innervation

Rectus Superior surface Inferior surfaces of costal Depresses ribs Thoracic spinal
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Abdominis of pubis around cartilages (ribs 5-7) and flexes vertebral nerves (T7-T12)
syphysis xiphoid process of column
sternum

Crunch
Proper Position:
1. Begin in a supine position lying on the floor or a floor mat.
2. Place your feet on a bench with your hips and knees flexed at 90?.
3. Rest your arms across your chest. This is the starting position.

Proper Technique:
1. Flex the neck to move the chin to the chest by contracting the abdominal muscles
and oblique muscles. Begin by pulling the rib cage up and over the pelvis.
2. While keeping the lower back flat continue to pull the rib cage up and over the
pelvis.
3. Slowly allow the trunk to uncurl then the neck to extend back to the starting position
while maintaining tension in the abdominal muscles.

Essential Tips to Avoid Common Mistakes:

• Always keep the lower back pressed firmly against the floor or floor mat.
• Do not place pressure on the neck by placing the hands behind the head.
• Work in a slow controlled manner concentrating on maintaining pressure on the
abdominal muscles.

164
Stability Ball Crunch
Proper Position:
1. Begin on a stability ball with the back slightly extended.
2. Your shoulders should be slightly higher than the hips.
3. Place your feet flat on the ground with your knees slightly wider than shoulder
width.
4. Flex the knees to form a 90? angle between the upper and lower legs.
5. Fold the arms across your chest forming a fist to support the chin. This is the
starting position.

Proper Technique:
1. Begin by contracting the abdominal muscles and pulling the rib cage toward the
pelvis.
2. While keeping the lower back pressed firmly against the stability ball continue to
pull the pelvis until the abdominal muscles are fully contracted.
3. Slowly allow the trunk to uncurl while maintaining tension in the abdominal
muscles.

Essential Tips to Avoid Common Mistakes:

165
 • Always keep the lower back pressed firmly against the stability ball.
• Work in a controlled manner concentrating on maintaining tension on the
abdominal muscles.
• Make sure that you maintain full contact with your feet on the floor.
• Keep your tongue at the roof of the mouth just behind the teeth to stabilize the
neck.
• Do not move the ball while performing the exercise.

Oblique Stability Ball Crunch

Proper Position:
• Begin on a stability ball with the back slightly extended.
• Your shoulders should be slightly higher than the hips.
• Your feet should be flat on the ground with your knees slightly wider than shoulder
width apart.
• Flex the knees to form a 90? angle between the upper and lower legs.
• Place one hand on the back of the head while the other rests softly across the
abdominal region. This is the starting position.
Proper Technique:
1. Begin by contracting the abdominal muscles and pulling the rib cage toward the
pelvis.
2. While keeping the lower back pressed firmly against the stability ball continue to
pull the left shoulder up and toward the right knee until the abdominal muscles
are fully contracted.

166
 3. Slowly allow the trunk to uncurl while maintaining tension in the abdominal
muscles.
4. Switch the hand placement and repeat with the right shoulder moving toward
the left knee.

Essential Tips to Avoid Common Mistakes:

• Always keep the lower back pressed firmly against the stability ball.
• Work in a controlled manner concentrating on maintaining tension on the
abdominal muscles.
• Make sure that your feet maintain full contact with the floor.
• Keep your tongue at the roof of the mouth just behind the teeth to stabilize the
neck.
• Do not move the ball while performing the exercise.

Kneeling Cable Crunch

Proper Position:
1. Secure a triceps rope attachment to a high cable pulley system.
2. Grasp the rope with a neutral grip.
3. Facing towards the cable machine kneel down on the floor with the upper body
erect.
4. The arms should serve as anchors and should not move during the exercise.

Proper Technique:
1. Draw the umbilicus inward thus engaging the transverse abdominis.
167
 2. Contract the abdominal muscles and slowly draw the rib cage closer to the
pelvis.
3. The cable should move with the body.
4. Slowly uncurl the trunk and return to the starting position.

Essential Tips to Avoid Common Mistakes:

• Do not allow the arms to move from the body during the exercise.
• Avoid rocking the body and using momentum to carry the body through the
exercise.

Hanging Leg Raise

Proper Position:
1. Grasp a pull-up bar with a pronated grip.
2. Allow the body to hang.

168
Proper Technique:
1. Bring the knees up towards the chest until they form a 90? angle with both the
hips and the lower leg.
2. With the back in a neutral position continue to pull the legs up contracting the
abdominal muscles until the thighs are parallel to the floor.
3. Slowly allow the legs to return to their starting position while maintaining
tension on the abdominal muscles.

Essential Tips to Avoid Common Mistakes:

• Keep the lower back from swaying.
• Keep the shoulder blades down and together throughout the movement.
• Keep the head and neck in a neutral position at all times.

169
Forward Stability Ball Roll
Proper Position:
1. Kneel behind the ball.
2. Place your forearms on the ball.
3. Inhale and draw your umbilicus inward.

Proper Technique:
1. Roll forwards on the ball with motion at the hip and shoulder joints.
2. Roll out as far as you can with proper spinal alignment.
3. Contract the abdominals and return to the starting position.

Essential Tips to Avoid Common Mistakes:

• Do not allow your back to drop at any time during the exercise.
• Do not allow your head to drop down.
• Remember to inhale at the starting phase and exhale as you roll back.

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Selected Rotator Cuff Exercises

Undoubtedly, you or someone you know may be hindered by rotator cuff impingement or tendinitis
problems. Activities that involve throwing, swimming and pitching are regular weekend activities for
many. These activities, which are relegated to the weekends, are often performed with poor technique,
muscle fatigue, inadequate conditioning, and inadequate warm-ups. Many of your future clients, friends or
family members may be weekend warriors. These weekend warriors may spend some time strengthening
the pectoralis muscles, bicep muscles, triceps muscles and the deltoid muscles but overlook the smaller
rotator cuff muscles. If any of the rotator cuff muscles fails to dynamically stabilize the humeral head in
the glenoid cavity, rotator cuff problems such as tendinitis and rotator cuff impingement may occur.

The rotator cuff muscles, which are better known by their acronym SITS (which represents the
supraspinatus - S, infraspinatus - I, teres minor - T, subscapularis - S), is a group of muscles that is most
important in maintaining the humeral head in its proper location within the glenoid cavity. The
supraspinatus is the most often-injured rotator cuff muscle. Injury often occurs from repetitious overhead
movements. The infraspinatus, which is the most powerful of the three external rotators, is vital to
maintaining the posterior stability of the glenohumeral joint. It is also the second most commonly injured
rotator cuff muscle. The teres minor works alongside with the infraspinatus. The subscapularis acts with
the latissimus dorsi and teres major muscles in extension of the glenohumeral joint, but due to its
proximity to the joint is less powerful. These muscles, which are not very large in comparison to the
pectoralis major, deltoids, and latissimus dorsi, MUST possess adequate strength and muscular endurance
to ensure their proper functioning or it is most likely that repetitive overhead movements will eventually
lead to acute or chronic problems. We will continue our section on exercise selection with selected
exercises for the rotator cuff muscles.

171
Muscle Origin Insertion Action Innervation
Teres minor Posteriorly on Posteriorly onExternal rotation Axillary nerve
middle upper greater horizontal abduction and (C5 C6)
aspect of lateral tubercle of extension of
border of scapula humerus glenohumeral joint;
stabilization of humeral
head in glenoid fossa
Subscapularis Entire anterior Lesser Internal rotation Upper and lower
surface of tubercle of adduction and extension subscapular
subscapular fossa humerus of glenohumeral joint; nerve (C5 C6)
stabilizes humeral head
in glenoid fossa
Supraspinatu Medial 2/3 of Superiorly on Weak abduction and Suprascapular
s supraspinatus greater stabilization of humeral nerve (C5)
fossa tubercle of head in glenoid fossa
humerus
Infraspinatus Medial aspect of Posteriorly on External rotation, Suprascapular
infraspinatus fossa greater horizontal abduction, and nerve (C5 C6)
172
 just below spine of tubercle of extension of the
scapula humerus glenohumeral joint;
stabilization of humeral
head in glenoid fossa
Dumbbell Horizontal Internal Rotation
Proper Position:
1. Either on a bench or floor mat lie on the side of your body
maintaining a natural arch in your lower back.
2. The shoulder you wish to work should be pressed against the bench
or floor mat.
3. Use a towel to brace the head to maintain a neutral position in the
head and neck.
4. Place the lower arm horizontal to the body at a 90? angle while
grasping a dumbbell (between 1-5 pounds).
5. The starting point of execution begins with the hand and dumbbell
slightly off of the floor.

Proper Technique:
1. Begin by rotating the lower arm up as far as possible by contracting
the internal rotators.
2. When the forearm is perpendicular to the ground hold the contraction
while keeping the arm and hand relaxed.
3. After a one-second isometric contraction slowly return to the starting
position slightly off the floor.
4. Repeat.

Essential Tips to Avoid Common Mistakes:

• Avoid twisting or rotating the trunk during execution of the exercise.
• Keep the head and neck in a neutral position.
• Avoid rotating the arm past the point where gravitational pull is lost
and contraction minimized.
• Remember to inhale on the downward phase of the movement
(eccentric) and exhale on the upward phase (concentric).

173
Dumbbell External Rotation
Proper Position:
1. Either on a bench or floor mat lie on the side of your body maintaining a natural
arch in your lower back.
2. The shoulder you wish to work should be farthest from the bench or floor mat.
3. Use a towel to brace the head to maintain a neutral position in the head and
neck.
4. Rest the bottom arm on the floor.
5. Grasp a dumbbell (between 1 to 5 pounds) in the top hand and hold the arm in a
90? angle braced against the side of the body.
6. The starting point is similar to the starting position of a dumbbell hammer curl
with the shoulder slightly internally rotated.

Proper Technique:
1. Begin by rotating the arm out and up from the body while keeping the elbow in
firm contact with the side of the body.
2. After a one-second isometric contraction slowly return to the starting position.
3. Repeat.

Essential Tips to Avoid Common Mistakes:

• Avoid twisting or rotating the trunk during execution of the exercise.
• Keep the head and neck in a neutral position.
• Keep the elbow pressed against the body or towel throughout the exercise.
• Avoid externally rotating the elbow past 80?.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

174
Seated Dumbbell Horizontal External Rotation
Proper Position:
1. Sit erect in a chair or bench while maintaining a natural arch in the lower back.
2. The upper arms should be level and parallel to the ground with the forearms
bent at a 90? angle.
3. The starting position looks like a scarecrow in a cornfield.

Proper Technique:
1. Begin by rotating the arms up as far as possible to a point where it looks as
though you are beginning a shoulder press.
2. After a one-second isometric contraction slowly return to the starting position.
3. Repeat.

Essential Tips to Avoid Common Mistakes:

• Keep your head in a neutral position.
• Avoid twisting or rotating the trunk during execution of the exercise
• Do not jerk the weight to get it past the sticking point.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

175
External Rotation at 90° Abduction
Proper Position:
1. Stand facing a low cable pulley with a single handle attached.
2. The humerus should be abducted 90? from the body and the elbow bent at 90?
with the forearm parallel to the floor.
3. Maintain proper spinal alignment.

Proper Technique:
1. Perform the drawing-in technique.
2. Keeping the arm at the same angle rotate the forearm so it is perpendicular to
the floor.
3. Pause for one second.
4. Slowly lower the weight back to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Activate the transversus abdominis throughout the movement.

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 • Keep the feet planted firmly during execution.
• Do not allow the arm to fall forward or backwards during the exercise.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Selected Leg Exercises

Many trainees have a tendency to focus on the beach muscles: chest, biceps and abdominal muscles.
Lower body development has taken a back seat to the aforementioned “show” muscles. Developing the
legs seems to be less and less of a priority as evidenced by legions of these pant covered, tank top
wearing wonders. Bench pressing and bicep curling fanatics cringe when they hear the words “leg
workout.” Nothing looks more ridiculous than an individual whose arms are bigger than his legs. Our legs
are the foundation of the body.

Functionally, the ability to jump, change pace and change direction is essential in nearly all sports. The
quadriceps muscles are involved in extension of the knee and are used in jumping type motions. In
addition, the quadriceps function as a decelerator for changing speed and direction and to prevent falling
when landing. The quadriceps muscles include the rectus femoris (which is involved in knee extension as
well as hip flexion) and the vastus medialis, vastus lateralis (the largest muscle of the quadriceps group)
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and vastus intermedius, which all attach to the patella. The quadriceps should be twenty-five to thirty-five
percent stronger than the hamstring muscles, the knee flexors.

The hamstring muscles are antagonist to the quadriceps muscles at the knee. This muscle group is highly
involved in activities involving acceleration and is commonly referred to as the running muscle. The group
consists of the biceps femoris, semimembranosus and semitendinosus, which all originate on the ischial
tuberosity of the pelvic bone. The semitendinosus and semimembranosus insert on the tibia while one
head of the biceps femoris inserts on the head of the fibula and lateral tibial condyle, with the other head
of the biceps femoris inserting on the femur. By knowing this difference we see that if we maintain
internal rotation throughout the range of motion we will bring the origin and insertion of the
semimembranosus and semitendinosus more in line with each other. Maintaining external rotation will
result in the emphasis being placed on the biceps femoris. We will continue our section on exercise
selection with selected exercises for the quadriceps muscles and the hamstring muscles.

Muscle Origin Insertion Action Innervation

Vastus Intertrochanteric line anterior Lateral border of Knee Femoral
Lateralis and inferior borders of greater patella and extension nerve (L2-4)
trochanter gluteal tuberosity patellar tendon to
upper half of the linea aspera tibial tuberosity
and entire lateral intermuscular
septum
Vastus Upper 2/3 of anterior surface of Upper border of Knee Femoral
Intermedius the femur patella and extension nerve (L2-4)
patellar tendon to
tibial tuberosity
Vastus Entire length of linea aspera and Medial half of Knee Femoral
Medialis the medial condyloid ridge upper border of extension nerve (L2-4)
patella and
patellar tendon to
tibial tuberosity
Rectus Anterior iliac spine of the ilium Superior aspect Flexion of Femoral
Femoris and groove (posterior) above the of patella and hip. nerve (L2-4)
acetabulum patellar tendon to Extension of
tibial tuberosity knee

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Muscle Origin Insertion Action Innervation
Biceps femoris Long head: Lateral condyle of Extension of hip Long head: sciatic
ischial tuberosity tibia and head of flexion of knee nerve- tibial
fibula internal rotation division (S1-3)
of hip and knee
Short head: Short head:
lower half of sciatic nerve-
linea aspera and peroneal division
lateral condyloid (L5 S1-2)
ridge
Semitendinosus Ischial tuberosity Upper anterior Extension of hip Sciatic nerve-
medial surface of flexion of knee tibial division (L5
tibia internal rotation S1-2)
of hip and knee
Semimembranosus Ischial tuberosity Posteromedial Extension of hip Sciatic nerve-
surface of medial flexion of knee tibial division (L5
tibial condyle internal rotation S1-2)
of hip and knee

Leg Press
Proper Position:
1. Place the feet in a stance slightly wider than shoulder width on the platform.
2. The pad should support the back neck and gluteal muscles.
3. The hips should be flexed at approximately 45?.
4. Grasp the handles at the sides or hold onto the sides of the seat if there are no
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 handles provided.

Proper Technique:
1. Contract the quadriceps and push against the platform with the feet.
2. Extend the legs until they are straight but just short of locking out the knees.
3. Slowly bend the knees and return the legs to the starting position.

Essential Tips to Avoid Common Mistakes:

• Adjust the machine as necessary to allow for the best angle of hip flexion.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).
• Be careful not to push your head into the pad especially during the concentric
phase of the exercise.
• Do not allow the knee to protrude past the toes.

Lunge (stationary with dumbbells)

Proper Position:
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 1. Stand erect with feet shoulder width apart.
2. Let your arms hang straight down holding weights at the sides of the body.
3. Keep your eyes focused straight ahead on a fixed point.

Proper Technique:
1. Take a large step forward.
2. Keep the torso erect.
3. Firmly plant the stepping foot but keep the planted foot in the fixed position.
4. Feet should be pointed straight ahead.
5. Slowly flex (lower) the lead hip and knee until the planted leg’s knee comes
within one to two inches from the floor.
6. Contract the quadriceps of the front leg and push back to the starting position.

Essential Tips to Avoid Common Mistakes:

• Make sure the lead leg’s knee does not protrude past the toes.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).
• Maintain an erect torso throughout the movement. • Do not allow the legs to
bow inward or outward during any phase of the exercise.
• Do not allow the dumbbells to swing at your sides more than 2 inches.

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Proper Position:
1. Sit on the machine so the pad supports your back.
2. Place the feet underneath the bottom roller so it is touching the front of the shin.
3. The knee joint should be in line with the axis point (lever) of the resistance.

Proper Technique:
1. Grasp the handles on the side of the seat if provided or grasp the sides of the
seat.
2. Contract your quadriceps as you extend the legs just short of locking them out.
3. Slowly lower the legs back to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Do not lock the knee joint out fully at the end of the concentric movement.
• Keep a neutral spine throughout the movement making sure not to allow the
head to fall forward or push hard against the pad.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

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Seated Leg Curl
Proper Position:
1. Sit in a leg curl machine and adjust the seat so the knee joint is in the middle of
the fulcrum point of the machine.
2. The lower pad should be on the back of the ankles.
3. Adjust the upper pad so that it is securely over the quadriceps.
4. Feet should be in a neutral position

Proper Technique:
1. Contract the hamstrings and draw the lower leg back towards the seat.
2. Make sure the thighs and hips are firmly against the pad.
3. Once you have reached a full range of motion of the concentric phase slowly
raise the roller to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Do not lock the knee joint forcefully at the top of the movement
• Remember to inhale on the upward phase of the movement (eccentric) and
exhale on the downward phase (concentric).

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Basic Squat
Proper Position:
1. In a ready position begin with the legs shoulder width apart with the feet pointed
out about 20? to 30?.
2. Flex the hips and knees keep the weight over the ankles and a slight forward
lean in the trunk.

Proper Technique:
1. Begin with the knees slightly bent and slowly begin to lower the body as far as
you can while maintaining a natural arch in the lower back.
2. Contract the gluteal muscles and hamstrings.
3. Slowly begin to straighten the legs while keeping your weight over your ankles.
4. Return to your original start position while maintaining proper spinal positioning.

Essential Tips to Avoid Common Mistakes:

• Avoid having your heels come off of the floor.
• Have the shoulders aligned with the knees and the feet.
• Keep the shoulders back with a natural arch in the lower back and the head and
neck in a neutral position.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

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Selected Calf Exercises

In bodybuilding the separation between winners and losers is often found in the neglected area of calf
development. Mike Mentzer and Arnold Schwarzenegger distinguished themselves as elite bodybuilders by
developing symmetry in their legs with diamond shaped calves. Many argue that genetics hold them back
from developing enviable calves. Do not use genetics as an excuse to neglect this important area of
overall development. Problems with poor calf development go far beyond genetics. Improper form will not
only create an environment where calves will not develop properly, it is also dangerous. Both experienced
and inexperienced lifters will often perform calf exercises too quickly while also limiting the range of
motion. This translates into lack of potential development. How often do you look over to the calf section
of the gym and see bouncing? As you lower your heel towards the floor, there is a great deal of force
placed on the Achilles tendon. It is critical that bouncing be avoided and control executed on the negative
portion of the lift to avoid potential injury to the Achilles tendon.

The tricep surae is the collective term for the gastrocnemius muscle and the soleus muscle. The
gastrocnemius is a biarticular muscle. When the knees are bent, the gastrocnemius muscle becomes an
ineffective plantar flexor. This means that when the knees are slightly flexed, the effectiveness of the
gatrocnemius is reduced, thereby placing more of the workload on the soleus. The soleus is used
whenever the ankle plantar flexes. Heel-raising exercises with the knees in full extension will work the
gastrocnemius, while heel-raising exercises with the knees slightly flexed will focus more on the soleus
muscles. We will continue our section on exercise selection with selected exercises for the calf muscles.

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Muscle Origin Insertion Action Innervation
Gastrocnemius Medial head: posterior Posterior surface of Plantar flexion Tibial nerves
surface of the medial the calcaneous of the ankle (S12)
femoral condyle (Achilles tendon) flexion of the
knee
Lateral head: posterior
surface of the lateral
femoral condyle
Soleus Posterior surface of the Posterior surface of Plantar flexion Tibial nerves
proximal fibula and the calcaneous of the ankle (S12)
proximal 2/3 of the (Achilles tendon)
posterior tibial surface

Seated Calf Raise

Proper Position:
1. Place the balls of your feet flat on the step with your feet and legs parallel to
each other.
2. Make sure the toes are pointed straight ahead.
3. Position the thighs securely underneath the pads.
4. Keep your upper body erect maintaining a neutral spine. This is the starting

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 position.

Proper Technique:
1. Begin by plantar flexing the ankles and removing the support lever.
2. Relax the ankles allowing the heels to drop off below the step (starting position).
3. Push up on your toes through a full range of motion.
4. Slowly lower your heels to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Make sure to keep the body in an erect position not allowing it to sway from
front to back.
• Do not allow the ankles to invert or evert during the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Standing Calf Raise

Proper Position:
1. Place the feet hip width apart with the balls of the feet on the edge of the step.
2. Position the shoulders directly under the pads and push up until the body is erect
maintaining a neutral spine.
3. The feet and knees should be pointed straight ahead. This is the starting
position.

Proper Technique:
1. Relax the ankles allowing the heels to drop off below the step (starting position).
2. Push up on your toes (plantar flex) through a full range of motion.
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 3. Slowly lower your heels to the starting position and repeat.

Essential Tips to Avoid Common Mistakes:

• Keep the knees extended but not locked throughout the movement.
• Do not allow the ankles to invert or evert during the movement.
• Remember to inhale on the downward phase of the movement (eccentric) and
exhale on the upward phase (concentric).

Unit Summary

I. Strength developed through resistance training helps to develop our musculoskeletal system.
A. Strength is our ability to contract our muscles with maximum force given constraints stemming from:
structural/anatomical factors, physiological/biochemical factors, psychoneural/psychosocial factors and
external/environmental factors.

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 1. Strength can be categorized as limit strength, absolute strength, speed strength, explosive
strength, anaerobic strength, linear strength endurance, non-linear strength endurance, and
aerobic strength.

a. The strength curve is the written attempt to analyze the components of strength production in all
human movement and is broken down into seven interrelated factors.

b. The seven factors of strength are: (1) the angle of “Q,” (2) the angle of “A,” (3) force, (4) time, (5) the
relationship between time and force, (6) the relationship between limit strength and Fmax and (7) the
amortization phase.

B. Both anaerobic and aerobic strength can be improved to levels far beyond the norm by training to
improve the seven factors of the strength curve.

C. The four basic forms of fitness equipment available on the market today to increase strength are:
constant resistance devices, variable resistance devices, accommodating resistance devices and static
resistance devices.

1. Calisthenic exercises are actually a special application of constant resistance technology.

Common forms are push-ups, pull-ups, jumping jacks and stretching exercises.

D. Different pieces of fitness equipment are designed for different purposes. Use the machine, free weight,
etc., that best meets your objectives and those of your clients’ strength goals.

E. Strength can be developed through dumbbells. There are several different kinds of dumbbells: kettle
bells, solid dumbbells, fixed plate dumbbells, oversized grip dumbbells, Olympic dumbbells, smart
dumbbells, and Powerblock dumbbells.

F. Most exercise machines are made to fit the theoretical average person. If you are of average build,
positioning on most machines should allow you to do the exercise in a relatively safe manner. However,
for short, tall and/or obese people, the exercise machines may be dangerous.

1. Factors to consider when working on machines are adjustability, ROM and balance.

G. Free weights and machines are not our only options in strength development. Other devices in training
are medicine balls and stability balls.

H. There are three basic grips used in weight training: supinated (palm up), pronated (palm down), and
the neutral grip (thumbs up).

I. New trainees should exhale through the sticking point and inhale during the less strenuous portion of
the lifts.

J. For experienced and well-trained athletes performing structural exercises (exercises that load the
vertebral column) with high loads, the Valsalva Maneuver can be helpful. It makes the exercises safer and
more effective. If you have high blood pressure or other circulatory system or heart problems, avoid
heavy resistance and breath holding.

K. The purpose of the general warm-up is to increase the functional potential of the body as a whole,
whereas the purpose of the specific warm-up is to establish the optimal relationship between the
forthcoming movements.

L. The cool-down serves to return the body to its resting state.

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M. Executing proper form, proper technique and essential tips to avoid common lifting mistakes is a great
way to ensure exercise effectiveness.

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 Section 3: Unit 9 Outline

Cardiovascular Training Theory

I. Cardiovascular Training
A. Understanding Common Aerobic Terms
B. Is Cardiovascular Work Necessary?

II. Cardiovascular Exercise Selection

A. Fact or Fiction
B. Look for a Better Way

1. Cycling
2. Rowing
3. Stair Climbing Machines
4. Treadmills
5. Cross Training

III. Conclusion

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Describe the benefits of aerobic exercise.

• Understand the physiological response aerobic exercise has on

the human body.

• Recommend proper aerobic conditioning guidelines based on

individual goals.

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Cardiovascular Training

Special section by James A. Peterson, Ph.D., ISSA Director of Aerobic Sciences and co-author of the ISSA
EFT Specialization Course

Despite the fact that the daily world of most serious exercisers is inexorably intertwined with fitness and
an intense commitment to maximizing their physicality, the simple fact remains that many individuals, as
a general rule, appear to have only a minimal appreciation or understanding of what constitutes sound
aerobic fitness. For many people, aerobic fitness is often perceived to be something associated with that
strange group of isolationists who spend countless hours pounding the highways and roadways in search
of the elusive “runner’s high.” Regrettably, such individuals tend to discount the possibility that aerobic
exercise is something on which they should spend a substantial amount of time and energy.
Unfortunately, they are mistaken.

Aerobic fitness is an important (most physicians would state categorically that it is the most
important) component of physical fitness. When your muscles need oxygen, your aerobic
(cardiovascular) system must be able to efficiently deliver it to them. When your body has waste products
that need to be expelled (e.g. carbon dioxide and metabolic waste products), your heart-lung complex
must be up to the task. These two tasks form the functional basis of aerobic fitness.

Aerobic exercise has another possible function, which is of substantial interest to almost every
individual who spends time working out. It burns body fat. Engaging in aerobic exercise can burn up
to one thousand calories an hour depending on the specific type and intensity of activity. As a result,
individuals who want to reduce their level of body fat sensibly, instead of starving the weight off, have a
positive, user-friendly option at their disposal. The potential health implications of adhering to sound
nutritional principles and practices, instead of primitive starvation techniques, are extensive and the
results are proven to be long term.

The value and impact of aerobic fitness to the exercise enthusiast extends beyond the boundaries of the
workout room. At the very least, engaging in aerobic exercise can increase your life span. Research
indicates that for every hour you spend exercising aerobically, you extend your life two hours. In anyone’s
value system, that’s an extremely good return on your investment. Aerobic exercise also can improve the
quality of your life, as well as the quantity of your life.

Aerobic exercise increases your level of available energy. The old adage, “Add life to your years, as
well as years to life, by exercise,” has considerable merit. A properly designed aerobic exercise program
will give you more energy to do the activities you enjoy.

Aerobic exercise aids in relieving depression. In her book Mental Skills for Physical People, Dr.
Dorothy V. Harris concluded that “exercise is nature’s best tranquilizer.” Researchers have found, for
example, that individuals suffering from moderate to light depression who engage in aerobic exercise
fifteen to thirty minutes at least every other day typically experience a dramatic improvement in their
condition.

Aerobic exercise aids in preventing certain types of cancer. Studies have found that men and
women who exercise are less likely to get colon cancer. Research has also suggested that women who do
not exercise have more than two and one-half times the risk of developing cancer of the reproductive
system and almost twice the chance of getting breast cancer.

Aerobic exercise enhances self-image. Research has documented the assertion that individuals who
exercise regularly feel better about themselves than sedentary individuals.
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Aerobic exercise relieves stress and anxiety. Exercise dissipates those hormones and other chemicals
that build up during periods of high stress. Exercise also generates a period of substantial emotional and
physical relaxation that sets in approximately an hour and a half after an intense workout.

Aerobic exercise reduces the risk of heart disease. Experts have found that non-exercisers have
twice the risk of developing heart disease than individuals who exercise aerobically on a regular basis.

Aerobic exercise can “slow” the aging process. By counterbalancing the age-related decrease in work
capacity and physical performance, aerobic exercise can help you maintain and sustain your ability to
perform work and to be independent.

Aerobic exercise increases the good (HDL) cholesterol. Exercise is one of the few voluntary
activities that is effective in raising your level of HDL, the type of cholesterol that lowers your risk of heart
disease.

Aerobic exercise improves the quality of sleep. Researchers have found that exercisers go to sleep
more quickly, sleep more soundly and are more refreshed than individuals who do not exercise.

Aerobic exercise improves mental sharpness. Numerous studies have shown that individuals who
exercise regularly have better memories, better reaction times and a better level of concentration than
non-exercisers. As an exercise enthusiast yourself, as well as the personal trainer for another, there are
certain rules to which you strictly adhere in your quest to “be the best you can be.” If you want to be
aerobically fit, and you should, you need to learn the “rules” for developing aerobic fitness and implement
them as an integral part of your regular conditioning routine. Similar to any of the critical tasks in your
life, you need to undertake the same systematic, ordered approach to ensuring that your heart-lung
complex is in optimal shape. Quite simply, your health demands it, and your body deserves it. Be smart,
heart smart!

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Understanding Common Aerobic Terms

Exercise scientists have often not made it easy for non-members of the scientific community to fully
understand aerobic fitness. Incomprehensible terms and phrases are frequently the rule, rather than the
exception, in the attempts to explain the procedures and the consequences of aerobic fitness.

Any listing of the terms and phrases used to discuss the major elements of aerobic training yields an
almost inexplicable, endless, mix of entries: maximal oxygen consumption, maximal oxygen uptake,
maximal aerobic power, cardiorespiratory function, cardiovascular efficiency, circulatory-respiratory
response, aerobic power output, anaerobic threshold, lactate threshold, submaximal exercise,
cardiorespiratory endurance, cardiac growth, aerobic work capacity, physical work capacity, cardiovascular
response, METs, watts, perceived exertion rate, lactic acid mechanism, cardiovascular adaptation, and so
forth.

Accordingly, before you undertake an aerobic training program for yourself, or before you attempt to help
others with their aerobic training, you need to develop a basic understanding of the most commonly used
aerobic terms. In each instance, you should attempt to comprehend the term in a context that will enable
you to make more informed decisions about your clients’ personal aerobic training goals and regimen.

Aerobic fitness is defined as the capacity to take in, transport, and utilize oxygen. Oxygen is the key
component. “Aerobic” means in the presence of oxygen. “Anaerobic,” on the other hand, means in the
absence of oxygen.

Aerobic exercise refers to moderate physical activity that places demands on the oxygen using pathways
that supply blood to your working muscles. Under all circumstances, your body strives to meet the energy
requirements placed on it in the most efficient manner possible.

Aerobic strength endurance involves the many factors that relate to cardiovascular efficiency (e.g.,
heart rate, stroke volume, ejection fraction, blood pressure, etc.) plus the maximum volume of oxygen
utilized by the working muscles (expressed in ml/kg/min), and efficiency of gas exchange (at the alveolar
level). In addition, research suggests that elite endurance athletes possess several attributes that
distinguish them from average performers (e.g., higher pain tolerance levels, better mechanical efficiency,
greater overall limit strength, etc.)

Aerobic training involves exercising aerobically in order to improve your level of aerobic fitness. Over
time as you overload your oxygen transport and utilization systems, your body adapts to the demands
that are placed upon it. Collectively, this process of overload and adaptation is called aerobic training.

Oxygen deficit, steady state and oxygen debt are terms that describe the relative quantity of oxygen
present during and after exercise. An “oxygen deficit” occurs as you begin to exercise when your intake of
oxygen does not immediately meet your demands. When your oxygen intake meets your demands, a
“steady state” is achieved. When you stop exercising and your need (demand) for oxygen slowly returns
to resting levels, whatever oxygen you inspire during this recovery phase that is excess of your resting
needs is called the “oxygen debt.”

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 Maximum oxygen consumption (also referred to as VO2 max and maximum oxygen uptake) is the
maximum amount of oxygen that can be transported to your body’s tissues from your lungs and as such
provides a quantifiable index of your capacity for aerobic energy transfer. It is most accurately measured
in a precisely conducted laboratory test.

Aerobic power is the most popular way to express aerobic fitness. To eliminate the influence of body
size, an individual’s maximum oxygen consumption score (in liters) is divided by the individual’s body
weight (in kilograms). The resulting value (expressed in milliliters of oxygen per kilogram of body weight
per minute) enables you to directly compare your level of aerobic fitness to someone else regardless of
how big either of you are.

Aerobic maintenance refers to the amount of aerobic exercise you must perform in order to sustain your
existing level of aerobic fitness. Most research suggests that you can maintain your level of aerobic fitness
by aerobically exercising two or three times weekly at the same level of intensity and duration used to
achieve your existing level of fitness.

Aerobic training threshold refers to the minimum level of intensity (heart rate) that must be exceeded
if significant changes in aerobic fitness are to result from the training. The more aerobically active you are,
the higher your training threshold.

Anaerobic threshold refers to the upper limit of training intensity beyond which additional training does
not have a positive effect on your aerobic fitness level. When your exercise becomes predominantly
anaerobic in nature, your aerobic system is no longer being overloaded, causing you to reach a point of
diminishing returns aerobically.

Aerobic training zone refers to the range of training intensity that will produce improvement in your
level of aerobic fitness. This range encompasses a point from your aerobic training threshold (minimum
level of intensity required) to your anaerobic threshold (maximum level of intensity possible before you no
longer improve aerobically). Your aerobic training zone is based on a percentage of your maximal heart
rate. As a general rule, your maximal heart rate is estimated by subtracting your age from 220.
Depending upon how physically fit you are, the lower and upper limits of your aerobic training zone are
then based on a percentage of that score, approximately 55% to 85%, respectively.

Aerobic training effect refers to the adjustments your body makes to the aerobic demands that are
placed upon it. Over a prolonged period of time, many of the adaptations that your body makes are
extremely significant. Your heart and lungs are perhaps affected the most. Your heart, for example,
enlarges in size. The walls between the chambers of your heart thicken, enabling more forceful
contractions. The stronger the contractions the greater the stroke volume will be. Thus, your resting heart
rate is lowered without any loss in cardiac output. In other words, aerobic exercise makes your heart into
a much more efficient pump. Your lungs are also affected in several positive ways by aerobic exercise.
During exercise, your respiratory muscles are continually overloaded, thereby increasing their level of
strength, endurance, and capacity for work. In addition, interior lung volume increases, creating a greater
surface area for gas exchange. As a result, more alveoli are utilized and the efficiency of exchange is
improved. This all translates into lowered breathing rates during periods of rest and smaller increases
during bouts of exercise.

Specificity of training refers to the fact that the effects of training are specific to the manner in which
the training is conducted and the activity employed as a training stimulus. In other words, you get what
you train for.

Aerobic over-training refers to the fact that more is NOT automatically better when it comes to
exercise. In some instances, you can, in fact, train too much. Excess training can lead to staleness, illness,
or injury.

Exercise intensity refers to how hard you are exercising. Aerobic intensity is critical for many reasons. It
determines the energy requirements of the exercise, the energy fuel or source to be used, the amount of
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 oxygen consumed, and the calories expended.

A MET is a unit of measurement that refers to the relative energy demands of an activity in comparison to
your energy demands in a resting state. A MET is a multiple of your resting metabolic rate. If you exercise
at a 6-MET level, you are exercising at a rate that is six times your resting state. A MET is assumed to be
equal to 3.5 milliliters of oxygen per kilogram of body weight per minute.

A watt is a measure of power (work performed per unit of time) involving a known force, distance and
time frame. Cardiorespiratory response is monitored in association with power outputs to determine
aerobic fitness. One watt equals 6.12 kgm per minute.

Relative work intensity refers to the fact that work (exercise) is rated by the ratio of the energy
required for the work to your resting (or basal) requirement. Moderate work is defined as that which elicits
an oxygen requirement up to three times the resting requirement (3 METs). Hard work is categorized as
that requiring three to eight times the resting metabolic rate (3 to 8 METs). Heavy work is considered to
be any exercise at a 9-MET level or greater.

Exercise duration refers to how long you exercise. Exercise duration can be recommended using several
parameters (time, distance or calories are the most commonly used). Exercise duration and exercise
intensity are integrally interrelated.

Exercise frequency refers to how often you exercise. Within limits, the more aerobically fit you are, the
more often you need to work out to improve your level of aerobic fitness. As a general rule, individuals
who are not very aerobically fit can achieve improvement by aerobically exercising a minimum of two or
three times per week. Individuals on the high end of the range of aerobic fitness, on the other hand, may
have to exercise as many as six times per week to achieve their aerobic fitness goals.

Aerobic exercise prescription refers to the fact that the fundamental precept for achieving optimal
aerobic improvement involves identifying the right amount of aerobic exercise necessary. Relative to your
physiological capabilities, you need to develop the aerobic exercise recipe (proper mixture of intensity,
duration and frequency) that is appropriate for your unique needs. When you or your clients are working
out, the success that you achieve (or the success that your clients achieve) is dependent in large part on
your working knowledge of the principles, practices, and programs attendant to developing whatever
fitness component you are addressing. The more you understand this information, the better prepared you
are to implement it into your workout regimen or your clients’ regimen. In the aerobics arena, the
situation is the same. Insight equals knowledge, and when knowledge is combined with your personal
commitment to excellence the end result is success in your training goals.

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Is Cardiovascular Work Necessary?

Some individuals with a well-defined interest in exercise — for example, bodybuilders — view the need for
and the benefits of aerobic training with a heightened sense of skepticism. To a degree, their misgivings
about whether to get seriously involved in aerobic training are rooted in the wealth of misinformation that
exists concerning aerobic fitness. There seem to be almost as many myths and misconceptions about the
“how’s” and “why’s” of training your heart-lung complex as there are individuals willing to advance an
opinion on the subject. Realistically, before most individuals will be able to make a firm personal
commitment to engage in a sound aerobic training program, they must be able to separate fact from
fiction regarding aerobic fitness. The following twelve beliefs relating to aerobic fitness appear to be
among the most common myths.

Aerobic fitness is not important for everyone.

Not true. Everyone needs to be able to efficiently take oxygen into their lungs and blood and pump it to
their working muscles where it is utilized to oxidize carbohydrates and fats to produce energy. If you are
concerned about your health, particularly the risk of heart disease, you need to accept the fact that
aerobic training can have a critical effect on the quantity and quality of your life.

All time spent exercising aerobically would be better used in the weight room.

Not true. Aerobic fitness is among the most preventative medicines available. How strong you are, how
well-sculpted your body is, and how good you feel about yourself will not be sufficient consolation to you if
you become seriously ill. While muscular fitness is certainly important, aerobic fitness is also essential. No
logical justification exists regarding why you should compromise your health. Make time for both
components of fitness.

Aerobic training improves only the heart-lung complex, not your muscles.

Not true. In fact, your muscles are the primary target organ of aerobic training. Aerobic training
increases the muscles’ ability to use fat as a source of energy. It also increases the size and number of the
cellular units (mitochondria) that produce energy aerobically. It also increases the levels of specific
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enzymes in your muscles that are required for the aerobic transformation of “fuels” into energy. When you
consider how aerobic training improves the condition and efficiency of your breathing muscles and your
heart (undoubtedly the most important muscle in your body), it is little wonder that relative to aerobic
fitness, “muscles do matter.”

More is better when it comes to aerobic training.

Not true. Research shows that an aerobic exercise program that exceeds more than four 45-minute
sessions per week has a limited effect on improving your aerobic capacity. You burn up more calories if
you aerobically exercise more, but you won’t necessarily wind up with a heightened level of aerobic
fitness. In addition, exercising aerobically more than 1.5 hours per week may be counterproductive, if
your goal is to maximize your level of muscle mass.

The best aerobic exercise is running.

Not true. The best aerobic exercise for you is one that you enjoy, one that is safe for you, and one that
you will perform on a regular basis. One person’s trash is another individual’s treasure. Pick an aerobic
activity that you personally like, stair climbing, treadmill, swimming, etc., and make it a regular part of
your workout regimen.

Aerobic exercise is expensive.

Not true. Your body, except for your feet, has little concern about what you wear when you train
aerobically. If you’re into running, you do need good shoes, which usually range in cost from $50 to $100.
Except for shoes, however, your financial outlay for aerobic training can be a relatively bare-bones payout.
Many aerobic activities (walking, running, etc.) require little or no equipment. You may, however, have to
become a member of a fitness club that has a pool or independent stair climbing machines if non-impact
aerobic exercise is your preferred mode of training.

Aerobic training is extremely time-consuming.

Not true. Compared to the time that you might usually spend lifting in the weight room, for example,
aerobic training is a virtual walk in the park. Most exercise scientists recommend exercising aerobically 20
to 30 minutes per workout. Some individuals exercise for longer periods of time, but such a time
commitment does not appear to be necessary.

Aerobic fitness is achieved by raising your heart rate.

Not true. Aerobic fitness is attained when you elevate the metabolic rate and oxygen consumption of
your muscles and you sustain the elevation sufficiently long enough to overload your aerobic enzyme
systems. Heart rate is only an external indication of oxygen consumption. Sustained metabolism is the
cause of aerobic fitness; heart rate is only a byproduct of the process.

Engaging in sports is a good way to develop aerobic fitness.

Not true. Playing sports (e.g. basketball, racquetball, etc.) does not provide the sustained level of
metabolism that you need to elicit the physiological responses in your body to develop aerobic fitness. For
the most part, you should already be sufficiently aerobically fit before you participate in sports.

The harder you exercise, the faster your level of aerobic fitness will improve.

Not true. Exercise scientists suggest that the best way to approach your goal of conditioning yourself
aerobically is “to make haste slowly.” Trying to do too much, too soon will usually result in you either
being injured or discouraged. Keep in mind that it takes time to elicit the stream of physiological
adaptations from your body that are both necessary and desirable. The ISSA recommends that you
exercise aerobically at an intensity level ranging from 55% to 85% of your maximum heart rate, with a
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suggestion that unless you are a serious athlete in tip-top aerobic condition, you train at the lower end of
the intensity range.

You have to sacrifice your joints for your heart.

Not true. Not all aerobic activities involve orthopedic trauma. Three of the most currently popular aerobic
activities are non-impact in nature: exercise cycling, rowing, and independent stair climbing. Compared to
cycling and rowing, independent stair climbing offers a critical advantage (beyond the fact that it controls
and eliminates the stress on your skeletal joints) in that it is a weight-bearing activity. Exercise scientists
have found that your bones respond in several positive ways (e.g. they become stronger) to weight-
bearing exercise.

It may be too late for you to begin an aerobic training program.

Not true. The benefits of aerobic fitness remain in effect regardless of how sedentary a lifestyle you have
previously led. While your initial level of fitness will influence your rate of aerobic improvement (not
surprisingly, the less active and fit you are, the faster you will improve aerobically), the health justification
for aerobic training is valid regardless of your exercise habits. In fact, for example, even a 70-year-old
individual can expect a substantial (10%) improvement in aerobic fitness from regular exercise. In short,
it is never too late.

CARDIOVASCULAR EXERCISE SELECTION

Addressing the issue of what type of aerobic exercise is most appropriate for you is, at best, easier said
than done. In reality, all forms of aerobic exercise do not offer the same features and benefits to you.
Some are safer than others. Some are more engaging (i.e., less boring). Some enhance more than one
component of fitness at a time. Some are more expensive. Some involve a slightly longer learning curve
(i.e., the time it takes you to master the skills involved in performing the exercise). Some aerobic exercise
products require more upkeep, a factor, which will come into play if you are planning on purchasing a
particular machine for home use. Some will withstand greater use.

Whatever the array of differences, the key point to remember is that in order to make your exercise
results more compatible with your overall exercise efforts, you need to make an informed decision about
what type of aerobic exercise is best for you. Such a decision involves diligently evaluating the advantages
and disadvantages of each of your exercise options and determining the relative impact of those
assessments on your interests and needs.

Fact or Fiction

One of the most substantial “roadblocks” you will encounter when attempting to identify what type of
aerobic exercise will best meet your interests and needs is the seemingly endless amount of
misinformation that exists concerning aerobic exercise modalities. Collectively, these faulty judgments can
complicate your search for the most appropriate way to exercise aerobically. Among the more common
misunderstandings concerning exercise modes are the following:

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 Walking is always the best exercise.

Not true. Except for severely deconditioned individuals, walking has a negligible effect on your level of
aerobic fitness. All factors considered, what will benefit you most is an exercise modality that stresses you
sufficiently so that you can achieve a training effect. It is recommended that you exercise at 55% to 85%
of your predicted maximum heart rate (220 minus your age). For the vast majority of people, walking
does not raise their heart rate into their “training zone.”

Treadmills offer the same benefits as stair-climbing machines.

Not true. While treadmills are certainly one of the most popular pieces of indoor aerobic exercise
equipment, they do not offer the same benefits as stair climbing machines. For one, exercising on a
treadmill exposes your musculoskeletal system to a certain amount of orthopedic stress, stress that is
much more substantially controlled on independent, step-action stair climbing machines. For example, it
has been estimated that the amount of trauma to your skeletal joints ranges from two to three times your
body weight each time your foot hits the treadmill’s belt during running. On the other hand, research has
shown that exercising on the StairMaster® 4000 PT® exercise system only places a load force of 1.2
times your body weight at any exercise speed. Exercising on a treadmill also includes an inherent
(however small) risk of falling off the back of the moving belt, if you do not keep up with the belt’s
preselected rate of speed. The only other fairly significant injury risk factor associated with treadmills
involves the problem of relatively high-speed restarts on AC-driven treadmills. On a few of the older
model treadmills, the user who steps onto a treadmill which has previously been stopped at a specific
speed has to immediately handle the same speed when the treadmill is restarted. Many newer model
treadmills (e.g., the Quinton® Club Trac 3.0) have an automatic speed reset feature that automatically
returns the speed to its lowest speed after the unit is stopped (for any reason). In addition to the
aforementioned safety factors, treadmills do not provide the strengthening effect on the user’s lower body
musculature that exercising on a stair-climbing machine does. Because users are forced to support their
body weight (however momentarily) each time they take a step on a stair climbing machine, the strength
level of their lower body musculature and the relative bone health level of the lower body skeletal system
are enhanced. Even when placed at their highest incline level, treadmills do not elicit comparable changes.

All exercise cycles are the same.

Not true. Statistics indicate that the stationary exercise cycle is the single most popular piece of home
exercise equipment in the United States and one of the more widely used aerobic exercise machines in
health and fitness facilities. A close examination of the major differences between the various types and
brands of exercise cycles does not, however, support the belief that most of these cycles are essentially
the same. First of all, they can be categorized into two broad groupings — those which have a mechanism
to calculate and show you how much work your body is doing while you are exercising (i.e., cycle
ergometers) and those which do not have such a mechanism (i.e., standard stationary bikes). More
importantly, exercise cycles have design features, which significantly impact on the user’s safety. Two of
the identifiable safety factors are particularly important. First, the basic geometry of the machine should
be such that the cycle’s pedals should be located as close as possible to the seat post (i.e., the armature
on which the seat rests), similar to an outdoor, road bicycle. The further away the pedals are from the
seat post, the higher the level of shear force on your knee joints. On one of the most well-known exercise
cycles, for example, the pedal crank is far forward from the seat post. The net result is that most people
who use this machine simply don’t exercise at high intensities in an attempt (conscious or subconscious)
to “protect” their knees. Those who pedal hard quickly fall prey to knee pain. Second, the load forces (i.e.,
resistance) that you must overcome while cycling should be relatively proportional to your cycling speed,
in other words, low resistance at low speeds and heavier resistance at higher speeds. At no time should
the converse be possible.

Exercising on a stair-climbing machine will expose your knees to the same level of stress as
climbing on actual stairs.

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Not true — provided you are exercising on an independent step-action stair-climbing machine. Most stair
climbing machines pose no undue risk of orthopedic injury. In fact, despite intuitive beliefs to the
contrary, exercising on a stair-climbing machine has been found to be as safe (and, in most instances,
safer) than actual walking. The contention that exercising on a mechanical stair-climbing machine might
be bad for you apparently stems from a concern over the forces generated at the knee during actual stair
climbing. The estimated load factor on the knee during actual stair climbing, for example, is purported to
be two times an individual’s body weight during the ascent phase and seven times an individual’s body
weight during the descent phase. On the other hand, recent research has shown that the orthopedic loads
on the body while exercising on an independent step-action stair-climbing machine (this particular study
employed the StairMaster 4000 PT) are equal to or less than the exerciser’s body weight.

All recumbent-type cycles are the same.

Not true. A very critical difference exists between recumbent-type cycles the place the user’s hips above
the exerciser’s feet and those machines which are designed in such a manner that a user’s feet and hips
are level with each other during the exercise bout. The former are commonly referred to as semi-
recumbent cycles because the exerciser is not in an entirely recumbent position. The latter constitute the
more traditional version of a recumbent cycle. Undesirably, the traditional version exposes the user’s
knees and hips to undue levels of stress. Because the user’s hips are blocked (i.e., figuratively, locked into
an unmovable position), the user’s quadriceps are forced to do all of the work that is performed during the
exercise bout. This exclusive reliance on your quadriceps results in undue stress being placed on the soft
tissues of your knees. By exercising on a machine that raises your hips above your feet, you “unblock”
your hips, thereby engaging additional muscles (i.e., hamstrings and gluteals) in the exercise bout. By
helping your quadriceps perform the work, you take the stress off your knee joints and avoid potentially
serious injury.

Performing both upper body and lower body exercise simultaneously will make you
substantially more aerobically fit.

Not true. Contrary to the endless array of unsubstantiated claims by one particular manufacturer of
cross-country ski machines, doing upper body and lower body work at the same time does not have a
noteworthy impact on your level of aerobic fitness. Research indicates that such a form of combined
exercise only improves your level of maximum oxygen output ( VO2max) by about six percent. If, on the
other hand, you are exercising at a percentage of your VO 2max (as all people do the vast majority of
time), the effect of combined exercise is actually less than five percent — not the wildly inflated affects
claimed by the manufacturer.

You cannot measurably improve both aerobic fitness and muscular fitness at the same time.

Not true. In fact, depending on your existing level of fitness and the intensity of your exercise bout,
several different types of machines may, to some degree, improve both components of fitness. Recently,
however, two machines were introduced to the marketplace which are specifically designed to dramatically
increase both aerobic fitness and muscular fitness regardless of your existing level of fitness — the
StairMaster Crossrobics® 1650 LE™ CardioSquat™ and the StairMaster Crossrobics 2650 UE™ Kayak™
conditioning systems. By independently and precisely allowing individuals to control both the speed of the
exercise movement and the resistance level that must be overcome while exercising, both machines
enable users to develop relatively high levels of aerobic fitness and muscular fitness simultaneously in a
single workout. The CardioSquat provides the aerobic conditioning benefits of exercising on a treadmill
and the strength training gains inherent in performing modified squat movements on a continuous basis.
The Kayak machine, on the other hand, enables users to achieve aerobic training comparable to that
provided by an exercise cycle and strength training benefits which exceed those possible on any other
device which involves the upper body (e.g., arm crank ergometers, rowers, etc.) An additional benefit
afforded by both machines is the fact that both offer a wide range of intensity levels that are appropriate
for a wide variety of fitness levels — 2.27 METs and 2 to 20 METs on the CardioSquat and Kayak
respectively.

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Look for a Better Way

Every person who wants to exercise aerobically usually has a choice of exercise options. For individuals
looking for a particular exercise experience, each type of exercise has a unique appeal. At best,
experience is a subjective matter. Ultimately, only you can determine the relative importance of exercise
safety, effectiveness, and efficiency to you personally. The more you know about what each exercise
alternative offers you with regard to each of these three factors, the more capable you will be of choosing
the “better way” for you. In the final analysis, what more could you hope for?

Cycling
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Cycling is an excellent form of aerobic exercise. It places a substantial demand on your heart and lungs. It
can burn up to 900 calories per hour while helping to condition your legs and cardiovascular system. All
factors considered, it is a very safe form of exercise since it imposes far less stress on the joints of your
body than many of the other means of exercising aerobically. Finally, and perhaps most importantly, it is a
very convenient form of exercise that almost everyone is familiar with. It would not be an over
exaggeration to conclude that almost everyone can ride a bicycle.

In order to get the most from your cycling efforts for aerobic fitness, you must first decide if you want to
exercise outdoors or indoors. Both forms of exercise, while somewhat similar in nature, offer distinct
advantages and disadvantages. Exercising outdoors has two major attractive features: variety and fresh
air. The fact that you can vary your routine and the intensity of your routine (e.g., include hills) is very
appealing to many people. Most individuals also like the idea of exercising in a fresh air atmosphere. On
the other hand, exercising outdoors, depending on where you live, may involve dealing with traffic,
polluted air, and inclement weather.

Exercising indoors is also very popular for a number of reasons, not least of which is the fact that you
don’t have to interrupt your training program just because the weather turns bad or respond to the
actions of individuals driving a vehicle considerably heavier (and potentially more dangerous) than your
bike. Cycling indoors involves working out on an exercise bike. All well-equipped health and fitness clubs
have exercise bicycles. Many individuals also have them at home. In fact, statistics show that the
stationary exercise bicycle is the single most popular piece of home exercise equipment in the United
States.

There are two basic kinds of exercise bikes: standard stationary bikes and ergometers. The primary
difference between the two is that ergometers have a feature that stationary bikes do not. This feature is
a mechanism for calculating (and showing you) how much work your body is doing while you are
exercising. In what form the ergometer indicates work output varies from bike to bike. Different
ergometers calculate your work output in one or more of the following: watts, KGM, pedal rate, calories
consumed, and relative distance pedaled. Knowing how much work you did enables you to better evaluate
the effectiveness of your training efforts, as well as serving as a yardstick for monitoring your progress
and for setting a quantifiable means for determining what to do in future workouts. The obvious downside
of ergometers is that they are more costly than standard exercise bicycles. An argument could be
advanced that this is an expense that many people probably don’t need. Fortunately, if you work out in a
health and fitness club, the facility assumes the cost since most such clubs tend to focus on providing their
members with the best “bells and whistles” that money can buy.

Both kinds of bikes have just one wheel, a relatively heavy metal or plastic flywheel at the front of the
bicycle that spins as you pedal. A resistive force that determines the workload is applied to the flywheel.
The resistance can be provided either by air (e.g., the Windracer exercise bicycle) or by mechanical or
electrical braking systems (e.g., the Lifecycle®, the Monarch® bicycle, the Tunturi® bicycle, etc.)

Air resistance is derived from pedaling when the flywheel is pushed (driven) by the air. The faster you
pedal, the greater the level of air. The more air you have, the greater the resistance. As the flywheel turns
faster, you work harder because the flywheel is “resisting” against the air. The primary advantages of an
air-driven system are that the exercise is very smooth and that the exercise does not cause local muscle
fatigue (of the quadriceps) while you exercise. In other words, you can do your heavy leg training and
your aerobic workout on the same day if you prefer. The major disadvantage of an air-driven system is
that you can’t mechanically preset the resistance level. The only way you can reach a certain intensity
level is to pedal fast enough.

Mechanical and electrical systems provide resistance either by means of a tension belt (mechanical) or an
alternator (electrical). The tension belt usually a strip of nylon-like material, is tightened or loosened
against the flywheel to adjust your workload. An alternator, on the other hand, creates resistance by
electronically establishing resistive force that must be overcome as you pedal. The wide popularity of
these two types of resistance systems is due to the fact that you can preset and adjust the workload prior
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 to or as you work out. The main disadvantages of such systems arise from the fact that mechanical and
electrical-induced resistance is more likely to cause severe local muscular fatigue (primarily your
quadriceps) and the fact that once mechanical and electrical systems reach a certain point of usage, the
resulting wear and tear make accurate calibration (or physiological feedback) impossible. Local muscular
fatigue is undesirable because of two factors. In the first place, you want to stop exercising because you
sufficiently stressed your aerobic system, not because your quads are tired. In addition, as a bodybuilder,
you do not want your aerobic workout somehow impeding your leg work in the weight room.

When you work out on an exercise bicycle, a few guidelines should be followed to make your efforts as
enjoyable and effective as possible. The seat of the bicycle should be adjusted to a height where when you
are sitting on it, your leg should be slightly bent with your foot on the pedal. If you can lock your leg
(knees), the seat is too high. While exercising, you should adopt a body position that is comfortable for
you. There are almost as many different suggestions on how to position yourself as there are people
willing to offer a suggestion on what to do. Regardless of what anyone claims, if it is not comfortable, it is
highly unlikely that you will either enjoy it or will stick with it. In addition, you should exercise at a level of
intensity that enables you to reach (but not exceed) your target heart rate. If you work out too hard, you
will not be able to sustain your training for the required minimum period of at least twenty minutes.
Finally, as a general rule, you should wear lightweight, absorbent clothing when you exercise. While heavy
clothes or airtight rubber suits may make you sweat more while exercising, any water weight loss is both
temporary and illusionary. More importantly, the wearing of such clothes may subject you to the
undesirable risks of thermal stress (overheating internally).

Ultimately, the decision of what method you should use to exercise aerobically is a personal one. The
decision should generally be based on how well the exercise form works for you, how safe it is, and how
likely you are to stick with it. Provided you like cycling, without question it would be in your best interests
to pump pedals, as well as iron.

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Updated Technologies

The use of magnetic resistance in both home and commercial exercise cycles is growing tremendously.
This system uses two magnets against the flywheel of the bike. As the tension is increased the magnets
are moved closer to the flywheel, thus creating more resistance. What may be the most favorable quality
of this system is that no moving parts touch at the flywheel and therefore the bikes stay calibrated and
free from wear and tear for long periods of time.

Rowing

As a means for developing aerobic fitness, rowing can be an excellent choice. Not only do rowing
machines enable exercisers to develop their cardiovascular system, they also place a considerable demand
on the muscular system. Unlike treadmills, exercise cycles, and stair climbing machines, a rowing machine
works your upper body, as well as your lower body.

When properly performed, rowing exercise involves most of the major muscle groups in your body. For
example, the rowing stroke is composed of 65% to 75% leg work and 25% to 35% arm work. During the
driving movement, rowers work your ankle extensors (calves), knee extensors (quadriceps), hip extensors
(hamstrings and gluteals), back extensors (lower back), shoulder extensors (lats, posterior deltoids,
trapezius, and rhomboids) and elbow flexors (biceps and forearms). During the return phase of the rowing
movement (which is not nearly as demanding as the driving action), rowers work the ankle flexors (shins),
hip flexors (quadriceps and iliopsoas), and trunk flexors (abdominals).

The question that bodybuilders face is whether or not rowing would be an appropriate aerobic training
modality for them. Except on an intuitive basis, such a decision can best be made after examining the
fundamental advantages and disadvantages of rowing machines (in general) and the two basic types of
rowers (more specifically).

Without question, continuous rowing provides an excellent stimulus to your cardiovascular system.
Research shows that properly performed rowing offers a fantastic aerobic workout. It conditions your
heart and lungs without the orthopedic trauma attendant to jogging outdoors or on a treadmill, or working
out on a dependent-action stair-climbing machine. For individuals wanting and needing to train their upper
body musculature, rowers provide a convenient option for attaining an overall body workout while
simultaneously developing aerobic fitness. Finally, rowers also afford exercisers with the means for
burning calories at a rate that is as high as any known type of exercise.

Before deciding that rowing is the appropriate alternative for meeting your aerobic training needs, the
possible negative factors attendant to exercising on a rowing machine should be considered. Whether or
not these factors redirect your interest in rowing to another form of training is entirely an individual
matter.

One point you certainly need to consider is the fact that for most people, rowing is not a very natural
movement. The rowing motion is typically not something, which will be second nature to most individuals.
It takes time to master the rowing motion in order to perform the rowing stroke properly. As such, rowing
machines may not be an appropriate entry-level modality for individuals who want to initiate an aerobic
training regimen.

Another potential downside to exercising on a rowing machine involves the fact that individuals who use
poor form while rowing often develop lower back pain. Either because they are unfamiliar with the proper
techniques for rowing or because they become too fatigued while exercising to maintain proper form, such
people overly stress their lumbar region because of the biomechanically disadvantageous position in which
they exercise.

An argument can also be advanced that exercising on a rowing machine does not provide a training

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environment in which the body is afforded the optimal opportunity to develop synergistically and
proprioceptively. In other words, because the weight of the exerciser is supported by their posterior (rear
end), as opposed to the feet or hands, the systems of the body don’t develop in a functional (natural)
way. When you exercise in a standing, weight-bearing position, each part of your body is forced to
respond to the physiological loads being imposed upon it while you are exercising. Functional (natural)
motion involves forces being applied in all three of the body’s primary cardinal (axial) planes. Exercising
on a rowing machine, on the other hand, involves forces being applied in a single plane. Possibly the
easiest way to understand the possible implications of the differences between a functional exercise
environment and the non-functional environment afforded by a rowing machine is to consider the fact that
rowing does not place an appropriate demand on the skeletal system of the body. As a result of not
overcoming “gravity stress,” the bones of the individual exerciser do not respond by becoming more dense
and stronger (as they would in a weight-bearing activity, such as independent-action stair climbing).

After you review the possible pluses and minuses concerning rowing, your next step is to consider what
type of rowing machine to use. If you belong to a health-fitness club and do all of your training in that
facility, the decision on what kind of rower to use is pretty much a done deal. You are going to use
whatever type (if any) the club has. If the facility has more than one type of rower or if you are
considering purchasing a rower for your home, then you have a choice.

Basically, two categories of rowing machines are marketed: those that are driven by a cylinder, and those
that are powered by fan-blade flywheels. In the cylinder-type rowing machines, the resistance (tension) is
controlled by the amount of air or fluid that is compressed within the cylinder. In the fan-blade, flywheel
type of rowing machine, the pulling movement turns a flywheel with fan blades, which offer resistance to
the wind. The harder you pull, the faster the flywheel spins and the greater the wind resistance from the
fan blades.

Cylinder-type rowers typically feature a pneumatic (air) resistance mechanism more often than a hydraulic
(fluid) mechanism for controlling user tension. Compared to flywheel rowers, they carry a much lower
price. Unfortunately, the majority of cylinder rowers require that you be put in an exercise position that
does not enable you to engage in a natural rowing motion. You are not able to pull in a straight plane like
you do on a flywheel rower. As a result, on a cylinder rower you are unable to naturally synchronize your
arm and leg movements with each other. The tension adjustment is only for your arms. You can only
move your legs faster, not harder.

Flywheel rowers, on the other hand, provide a more natural “feel.” The flywheel generates a much more
continuous, smooth rowing stroke. The stroke feels harder to the exerciser, but it is actually much easier
to maintain a sense of cadence since each stroke flows from the previous one. Flywheel rowers also have
the advantage of having a single handle to pull instead of two separate handles on the cylinder rowers. In
addition, many flywheel rowers have electronic displays — a feature which their lower-priced counterparts
do not offer. Such displays not only provide the exerciser with useful feedback concerning selected
physiological and performance measures, they also can have a positive effect on the exercise adherence
level of the participant. Some individuals find the various “bells and whistles” to be quite motivating while
they are exercising. Exercise adherence is a key goal.

If you decide to exercise on a rowing machine, read and adhere to the manufacturer’s usage instructions
for the machine. In general, the following basic guidelines and techniques for rowing machines are
recommended:

• If possible, train on a flywheel-type rowing machine.

• To get started, select an exercise program or intensity level.

• If mandated by the design of the machine, input required information into the computer console.

• Place your feet on the platform and secure the foot straps. Leave the foot straps sufficiently loose
so that you can lift your heels when you slide forward at the beginning of the stroke.

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 • Begin the rowing stroke with your arms extended.

• Push with your legs; keep your arms straight.

• Finish the stroke by pulling the handle(s) into your abdomen; extend your legs.

• Recover to the starting position by first extending your arms and then bending your legs.

• Exercise for at least 20 minutes at a level of intensity that is 55% to 85% of your maximum heart
rate (220 minus your age).

Like any aerobic training regimen, the choice of what to do involves considerable individual discretion.
Only you can decide what you like and what form of training you will stick with. Fortunately, most quality
health-fitness clubs often offer you several options. If your goal is a healthy heart, rowers offer a good
choice. If you have difficulty deciding whether rowing is for you, consider the advice of rowing
enthusiasts: “those in the know, go with the row.”

Updated Technologies:

For avid rowers the use of machines has never quite been the same: no drag and no water. The fitness
industry’s answer to those problems is the Water Rower. The Water Rower is made of wood for home use
and the commercial models also have industrial gripping to help make them last a little longer. The
machines use a water flywheel that creates resistance using the water itself. If you want a more intense
workout you just go faster, much like you would with traditional open water rowing. An advantage of the
water rower for independent contractors is that the water rower is virtually silent; all you hear is the
swishing of water and the panting of the user.

Stair Climbing Machines

Aerobic exercise can take many forms, both with and without equipment. For those individuals who
exercise aerobically in a gym or a fitness club using equipment, there are four widely used types of
equipment: exercise cycles, treadmills, rowing machines and stair climbing machines. Of the four, the
most popular method appears to be stair-climbing.

An examination of the fundamental basis of the popularity of stair climbing on machines can help explain
why this particular means of exercise is the chosen form of aerobic training by many bodybuilders.
Generally speaking, stair climbing has three basic features that should appeal to bodybuilders: It is safe,
time efficient, and functional.

Stair climbing is safe. A number of methods exist for enabling you to achieve an aerobic training effect.
Unfortunately, many of them are not safe because of the stress they create in the joints of the exerciser.
All things being equal, the larger the person, the greater the stress. Obviously, as an individual with an
intense interest in developing yourself physically, you need a form of aerobic exercise with little or no
orthopedic trauma. Some stair climbing machines have been proven to be safe, while others have not.

Just as there are significant differences between models in a technically complex and patented machine
such as an automobile (for example, a Ford versus a Mercedes), a few critical mechanical differences exist
between the various stair-climbing machines. The primary one involves the basis of the stepping action.
Some machines offer independent stepping action, each step operates independently of the other step.
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 Other machines feature dependent stepping action, where the force and the resultant movement of one
step produces a counter-force and movement of a similar nature in the other step (creating what is, in
essence, the same general effect as cycling in a standing position).

As a general rule, most independent-action, stair-climbing machines do not place stress on your joints.
Dependent-action stair climbing machines, by the very nature of their non-functional design, expose your
knees, hips and low back to undue levels of orthopedic trauma. This variance in skeletal stress is the
fundamental reason why independent-action, stair-climbing machines (primarily the StairMaster® 4000
PT®) are used in more than 1700 therapeutic medical facilities.

The contention that climbing stairs might be bad for you apparently stems from a concern over the forces
generated at the knee during actual stair climbing. (The estimated load factor on the knee during actual
stair climbing is purported to be four to six times an individual’s body weight). While research has shown
that orthopedic trauma to the major joints of the body remains a serious problem with exercising on a
dependent-action, stair climbing machine, independent-action, stair climbing machines have design
features that greatly minimize orthopedic trauma while exercising.

In addition to being safe, exercising on an independent-action, stair-climbing machine is time efficient.

Several studies have been conducted which show that you can produce a substantial increase in aerobic
fitness by exercising on a stair climbing machine for as little as 15 minutes a day, three times a week.
Given the demands placed on your time by your regular weight workout, stair climbing offers a real
logistical and convenience advantage to bodybuilders. Most of the stair climbing machines typically found
in health and fitness clubs have software capabilities which enable you to vary the intensity level at which
you exercise to accommodate to your particular needs, interests, and time constraints.

Stair climbing is functional. Other than selecting a form of aerobic exercise that you enjoy and in which
you will continue to participate, you want to choose (all other factors considered) a method of exercising
which involves functional movements. Functional movement is important because directly and indirectly it
requires your body (joints, muscles, neurological system) to “conduct” itself as it does naturally. As you
exercise, your joints, muscles, and neurological system are required to react to each other as they do in
real life. Muscles vary the degree to which they support and oppose each other depending on which (axial)
cardinal plane they happen to be in at any specific moment in time. In functional movement, joints incur
different natural stresses, depending on the plane of movement, the velocity of the movement, and the
type of loading to which they are exposed. Finally, functional movement facilitates normal proprioceptive
feedback. Your neurological system innervates your musculoskeletal system in a movement pattern that is
both safe and natural.

Stair climbing offers a particularly desirable form of functional movement. Stair climbing on a machine
with independent action is weight-bearing exercise without the orthopedic trauma that usually
accompanies such a stressful form of exercise (e.g., running, exercising on a treadmill, etc.) In other
words, you can enable your neurological and musculoskeletal systems to synergistically react to the
demands of the exercise without over-stressing your skeletal joints. You can achieve the “upside” benefits,
without having to deal with the “downside” consequences.

How to Use a Stair Climbing Machine

Like most physical tasks to which you are exposed for the first time, exercising on a stair-climbing
machine requires some (neurological) learning and adjustment. Other than avoiding dependent action
machines (which I strongly believe are very unsafe for all users), you can get the most out of your stair
climbing efforts by adhering to the following guidelines:

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 • Do not let the pedals (steps) contact either the floor or the upper stop levels. Such contact can
cause trauma to your joints and can also result in a jerky, uncomfortable motion.
• Select a range of intensity that allows you to stay in the middle of the range of motion for the
pedals. The key is to select a climbing speed that enables you to achieve a training effect and
enjoy the activity. Faster may not be better. Work out at a level that is consistent with your
capabilities, needs and interests. If you want to increase the difficulty of your workout, one step is
to not use your hands to hold on while exercising even for balance.
• Exercise for at least 15 minutes. Take a brief break if you have to while you’re exercising, but
make sure that you exercise collectively for a minimum of 15 minutes. Once you become more
comfortable on the machine, gradually extend the amount of time you exercise to twenty minutes
or more.
• Do not lean on the console or the handrails of the machine. Partially supporting yourself on the
machine will decrease the work level at which you’re exercising by lowering the amount of weight
you have to lift during each step, thereby decreasing the number of calories you burn up while
exercising. Leaning forward on a machine while exercising can also put your back in a possibly
injurious (flexed) position.
• Relax as much as possible while stair climbing. Stand erect and let your arms hang naturally (if
possible).

Stepping Up

Given the wealth of documented information about the positive consequences of simulated stair climbing,
little doubt exists about whether or not exercise on an independent-action, stair-climbing machine can be
a terrific conditioning and therapeutic tool. Stair climbing is certainly a task you can master. If you enjoy it
as well, you should strongly consider incorporating it into your overall workout program. It would be
among the more advantageous “steps” you could take for your heart.

Treadmills

One of the most popular pieces of aerobic equipment in many health and fitness clubs is the treadmill.
Basically, a treadmill is an indoor platform that has a motor-driven revolving belt (tread) on which an
individual exercises. The user controls how fast the motor moves the belt. The upper level for speed on
most commercial models of treadmills ranges up to 15 miles per hour, which translates to 4-minute miles.
Over an extended period of time, such a speed is much faster than anyone but a world-class athlete would
need. Depending on the speed of the belt, the exerciser either walks, power walks, jogs or runs to keep
pace with the revolving belt. Failure to do so results in the exerciser being forced off the belt.

In addition to speed controls, most treadmills also have a feature that permits the user to adjust the angle
of elevation of the belt and platform on which the user exercises. Such an adjustment enables the user to
substantially increase the workload (level of intensity) of the exercise. Some treadmills allow you to
increase the angle of elevation at which you exercise up to a grade of 25%. If you’ve ever attempted to
run up a relatively steep hill, you can appreciate the potential effect of such an adjustment.

The requirements for achieving an aerobic training effect while exercising on a treadmill are the same for
other aerobic tools (e.g., bicycle ergometer, independent stair climber, cross-country ski machine, etc.)
You have to exercise for 20 to 60 minutes, at least three times a week, at a level of intensity between
55% to 85% of your maximum heart rate (MHR = 220 - your age).

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As an exercise modality, treadmills have several unique features and advantages. The main types of
exercise on a treadmill — walking, power walking, jogging and running — are among the most natural
forms of human locomotion. If you like to walk, jog or run, a treadmill provides you with a very safe
environment in which to exercise. No uneven surfaces. No exhaust fumes. No traffic. No contentious
animals to deal with. No limiting environmental factors (e.g., cold, heat, wind, altitude, dust, etc.)

The capability of most treadmills to provide you with on-going performance and physiological feedback
(e.g., speed, distance covered, elapsed time, calories expended, elevation, METs, etc.) is also a desirable
feature. Such feedback enables you to monitor your progress, make necessary adjustments in your
training protocol, and contributes to your overall level of enjoyment (and subsequent level of exercise
adherence) of your exercise bout.
Treadmills also have a few features which, comparatively speaking, are less desirable than those on other
aerobic tools. Unlike exercising on an independent stair climbing machine or a bicycle ergometer, working
out on a treadmill exposes your musculoskeletal system to a certain amount of orthopedic stress. It has
been estimated that the amount of trauma to your joints ranges from 1.5 to 3 times your body weight
each time your foot hits the belt during running.

Using a Treadmill the First Time

Like any other exercise tool, using a treadmill safely and effectively requires that you follow certain steps
and precautions. Regardless of whether or not your client is an experienced treadmill user, all should
adhere to the following guidelines:

• Get on the treadmill and straddle the belt by standing on the platform.

• Never turn the belt on while you are standing on it.

• Turn the belt on and look down at the belt to see how fast it is moving. Make sure it is going at a
relatively slow speed before you step on to it.

• Hold on to either the side or front handrails (depending on which the treadmill you’re using has)
before you step on to the moving belt.

• Start out walking slowly to get the feeling of exercising on that particular surface. Your body has to
get acclimated to a different sense of balance on the treadmill.

• Warmup for a few minutes at a relatively slow speed and get accustomed to exercising on the
treadmill. Then, gradually increase your speed to the rate you prefer. In the last few minutes of
your workout, gradually decrease your rate of speed as a warm-down.

• While exercising, always look forward. Never look behind you because it tends to throw your
balance off. If you must turn and talk to someone, hold on to a handrail.

• As a general rule, do not walk or run backwards on a treadmill.

• If while you are exercising you start to lose your balance, hold on to a handrail and step off. Don’t
try to stop the treadmill while you are off balance.

• Do not make major, sudden changes in speed while you are exercising. Get acclimated to a speed
before you increase your speed.

• If you increase the level of elevation at which you are exercising, do it gradually. A higher grade is
often much more difficult than the average individual believes it’s going to be.

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 • When you decide it is time to stop exercising, press the stop button and continue to walk until the
treadmill comes to a complete stop.

Stay on the treadmill and hold on to the handrails for 30 to 60 seconds before you actually get off in order
to restore your sense of equilibrium, balance, and stability.

Using a Treadmill to Test Your Client's Fitness Level

Treadmills are used extensively for both clinical and personal reasons to help individuals assess their
aerobic fitness level. Although exercise scientists and physicians generally state that the best measure of
aerobic endurance or physical working capacity is the direct measurement of oxygen uptake during
maximal (you reach a point where you cannot continue to exercise at a higher level of intensity) exercise,
equations exist for estimating your VO2 max which are based on how long you are able to exercise on the
treadmill while adhering to a specific testing protocol.

The two most common aerobic capacity testing protocols are named after their developers, Robert Bruce
and Bruno Balke. Bruce’s protocol is considered the more aggressive method because he requires
individuals to raise their level of exercise intensity every three minutes by increasing both the speed and
the grade at which they exercise. Balke, on the other hand, recommends two-minute exercise bouts, after
which only the grade at which an individual is exercising is increased. The intensity of the workload at
which an individual is required to exercise is increased by approximately 2.5 and 1.0 METs for the Bruce
and Balke protocols respectively at each new stage. When you reach a point where you cannot continue to
exercise at the new level of intensity, the total time you have exercised to that particular point is then
compared to baseline VO2 max normative values to see how aerobically fit you are. The longer you are
able to exercise, the higher your estimated level of VO2 max.

Home Treadmill Considerations

Here are some parameters to follow when purchasing a treadmill for your home. Look for a machine with
at least a 400 pound capacity, fat burn program, cardiovascular, and possibly a heart rate interactive
program: this means the running deck will incline and decline in response to the level of your HR. A
running deck size of fifty-five to sixty inches long by approximately twenty inches wide is a good size. The
frame should be sturdy and allow for full range of motion. The treadmill should have a large and clear LED
display. Also, if space is a consideration you may want a treadmill that can fold up. The motor should be
at least 2.5 continuous HP and the rollers should be approximately 2.5 inches in diameter. With regard to
the warranty, eventually you will need service on the machine, and a manufacturer will only honor the
warranty for a home treadmill in a home setting.

Treadmill or Not to Treadmill

No one but you can say for sure whether or not the treadmill is your best option for developing aerobic
fitness. What can be stated unequivocally, however, is that you need to pick an exercise tool that meets
your interests and needs. For millions of people, the treadmill is that tool. If you concur, put “pride in
stride” and start exercising today.

Cross Training
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In the past decade, considerable research has shown that the effects of training are specific to the manner
and the means in which the training is conducted. A given activity, performed daily, recruits the same
muscle fibers and metabolic pathways over and over, giving rise to an adaptive response referred to as
the “training effect.” With regard to its effect on muscle fibers, this training effect is generally very specific
to the activity. For example, the effects of cycling on muscle fibers will not transfer to jogging. On the
other hand, the effects of training do transfer from one mode of activity to another with regard to your
body’s supply and support systems.

Research has shown that training effects on your respiratory and cardiovascular systems resulting from
one type of aerobic activity tend to transfer to other types of aerobic exercise. The reasons for this are
fairly simple. In the early stages of your training regimen, the inability of your muscle fibers to use oxygen
limits your ability to perform a specific task. As your muscle fibers adapt to the stimulus provided by the
training, the demand on your cardiovascular system increases. Your muscles, having become better able
to use the existing oxygen, figuratively are limited in their performance by the inability of your heart,
blood vessels, and blood to deliver oxygen to them. Over time, your cardiovascular system becomes more
efficient, and more oxygen is delivered to the working muscles. This increased efficiency has potential
benefits for all of your muscles, not just the fibers used in a specific activity. Your ability to deliver oxygen
to all of your working muscles is enhanced.

Table 9-1

Sample Aerobic Cross Training Workout Schedule, One Activity per Day

Monday Independent stair climbing (StairMaster 4000 PT), 20 minutes

Wednesday Jog, 30 minutes

Friday Independent stair climbing (StairMaster 4000 PT), 20 minutes

In the continuing, eternal search for an optimal training program, several fitness enthusiasts decided that
the concept of “cross training” was the answer. Depending on how you define the term and perceive its
effects, cross training may indeed be a very positive training approach for those individuals who want to
maximize their fitness level, while minimizing their risk of being injured.

The literature suggests that the original genesis for cross training was provided by triathletes, who
mistakenly believed that running and cycling could improve their swim performance, and vice versa.
Unfortunately, the effects of one form of training are specific to the muscle fibers involved in that activity.
Running does not directly enhance swimming, for example. With regard to simply being a better swimmer,
nothing will have a more positive effect on the muscle fibers involved in swimming than swimming itself.

As an individual who devotes a considerable amount of time and effort to becoming more physically fit and
capable, the primary dilemma you face is not how to become a better swimmer, a better cyclist, or a
better runner but rather how to become a better you. Does the concept of cross training have implications
and applications to your quest to become more physically fit? In a word, yes.

Cross training means using several modes of training to develop a specific component of fitness. A sound
argument can be advanced to support the premise that using two or more types of exercise in your
training regimen is in your best interest.

While no evidence exists to support the often stated claim that cross training somehow induces a higher
(a.k.a. better) aerobic response, using several modes of training does provide you with a very positive
orthopedic benefit. By combining exercise modes, you do not stress the same bones and muscle groups
over and over. The repetition of a given activity (over an extended period of time) can lead to minor or

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even major orthopedic problems. In other words, cross training will reduce the likelihood of your being
injured by diminishing the likelihood of you over-training (over-stressing) a given bone or muscle.

Table 9-2

Sample Aerobic Cross Training Workout Schedule, Multiple Activities per Day

StairMaster 4000 PT
Monday
StairMaster Spinaker exercise cycle

StairMaster Crossrobics 1650 LE

Wednesday
StairMaster Kayak

StairMaster 4000 PT
Friday
Jog or swim

Almost as important, cross training has been shown to have a very positive effect on long-term adherence
to a specific type of activity. Your aerobic training program needs to enhance not only your level of aerobic
power, but also your long-term adherence to your efforts to become aerobically fit. This latter goal, at
best, is a difficult task (particularly for anyone who tends to feel that any minute spent away from the
weight room is a wasted 60 seconds). Among the factors that researchers have identified as being
important reasons why individuals drop out of an exercise program are: the exercise regimen was not
effective, the protocol was not safe, and the effort was not fun (enjoyable).

Making your aerobic exercise program effective is basically a function of adhering to established guidelines
for developing aerobic fitness. If you engage in aerobic exercise three days a week for 20 to 60 minutes
each time at a level of intensity approximately 55% to 85% of your maximum heart rate (220 minus your
age), you will become aerobically fit.

Cross training can make your developmental efforts more safe and fun. You will be safer because of the
decreased likelihood that you will incur an overuse injury, a point that was discussed earlier. Your aerobic
program will be more fun because of the fact that cross training incorporates variety into your workout
regimen. Instead of performing the same activity week after week, you can mix and match your choice of
activities according to what you personally like to do. The basic criteria for selecting an aerobic activity is
that it must be an activity that stimulates the need for oxygen by the large muscle groups of your body.
Tables 9-1 and 9-2 offer two sample aerobic cross training workout schedules. As you can see in both
examples, at no time do you have consecutive aerobic workouts that involve impact activities (e.g.,
jogging). Although both examples emphasize exercising on the StairMaster 4000 PT, a mechanical stair
climbing machine, you can select whatever aerobic activity you personally enjoy . . . just as long as it
does not result in orthopedic stress to your joints. Over the years, you have undoubtedly varied your
strength training workouts in an effort to find the right “mix” for your personal needs and genetic skills.
The same basic concept should apply to your aerobic training efforts.

Conclusion

If you have hesitated to take the necessary steps to implement a regular program of aerobic training into
either your workout schedule or your clients’ schedules because you (for whatever reason) were perplexed
over the deluge of contradictory and misleading information regarding aerobic fitness, you need to
reconsider your inaction. You need to separate fact from fiction. You need to make sense out of aerobic
nonsense. It is utterly nonsensical to believe that aerobic training is something for which you just do not

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have enough time. You need to make the time to take care of your health. Your clients are counting on
your knowledge!

Unit Summary

Aerobic fitness is defined as the capacity to take in, transport, and utilize oxygen. Oxygen is the key
component. “Aerobic” means in the presence of oxygen. “Anaerobic,” on the other hand, means in the
absence of oxygen.

I. Aerobic training involves exercising aerobically in order to improve your level of aerobic fitness. Over
time as you overload your oxygen transport and utilization systems, your body adapts to the demands
that are placed upon it. Collectively, this process of overload and adaptation is called aerobic training.

A. Commonly used aerobic terms:

1. VO2 max (maximum oxygen uptake) is the maximum amount of oxygen that can be
transported to your body’s tissues from your lungs.

2. Maximal heart rate is estimated by subtracting your age from 220.

3. Aerobic training zone: Depending upon how physically fit you are, the lower and upper
limits of your aerobic training zone are approximately 55% to 85 % of your MHR.

4. A MET is a unit of measurement that refers to the relative energy demands of an activity in
comparison to your energy demands in a resting state.

5. A watt is a measure of power (work performed per unit of time) involving a known force,
distance and time frame.

B. For individuals looking for a particular exercise “experience,” each type of exercise has a unique appeal.
At best, “experience” is a subjective matter. Ultimately, only you can determine the relative importance of
exercise safety, effectiveness, and efficiency.

1. Cycling is an excellent form of aerobic exercise. It places a substantial demand on your

heart and lungs. It can burn up to 900 calories per hour.

2. The rowing machine works your upper body, as well as your lower body.
a. The rowing stroke is composed of 65% to 75% lower-body work and 25% to 35% upper-
body work.

3. Stair climbing is safe, time efficient, and functional and the most popular method of gym
aerobic work.

4. If you like to walk, jog or run, a treadmill provides you with a very safe environment in
which to exercise.

5. Cross training means using several modes of training to develop a specific component of
fitness.

C. Aerobics, whether it be aerobic endurance training or some form of cardiovascular work on a treadmill,
stepper, or bike, has numerous benefits from fat burning to cardiovascular health to improved recovery
abilities.

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Section 3: Unit 10 Outline

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 Cardiovascular Training Theory

I. Flexibility

A. Flexibility Defined

B. Anatomical and Physiological Basis of Stretching

C. Assessing Range of Motion (ROM)

D. Constraining Factors

E. Inflexibility and Injury Potential

F. Specificity and Flexibility

1. How Much Flexibility is Enough?

G. The Effects of Body Temperature on Flexibility

H. Tension Magnitude during Stretching

I. Duration

J. Breathing and Relaxation

K. Stretching as a Means of Preventing Delayed Onset of Muscle Soreness

(DOMS)

L. Programming and Periodicity of Stretching

M. Methods of Increasing Joint Flexibility

1. Static Stretching
2. Dynamic Stretching
3. PNF Method
4. Contract-Relax (CR) Method
5. Contract Antagonist-Relax (CA) Method
6. Fascial Stretching

N. Flexibility Exercise Descriptions: Static-Active Stretches

II. Weight Training and Flexibility

A. Dangerous Stretches

B. Passive and Active Flexibility

Self-Quiz (8 questions)

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Flexibility

Special section by Charles Staley, B.S., M.S.S

Everyone, even the most sedentary folks, needs a certain level of flexibility and mobility. The question is,
“How much?” Many individuals have been led to think that the extreme flexibility of an Olympic gymnast is
a component of fitness. The fact is, however, that the vast majority of individuals already have an
adequate level of flexibility. That is, they have ample flexibility to meet the exigencies of their daily
activities with ease, and room to spare for life’s little emergencies (e.g., falling on ice, tripping, etc.)

Flexibility Defined

The term flexibility refers only to joints’ mobility and how muscles, ligaments, tendons or other soft
tissues affect it. The terms “loose,” “supple,” “stretched,” “extended” and “elongated” are appropriate
descriptions for soft tissues, while a more befitting description of “flexibility” is the ability to flex, extend
or circumduct the joints through their full intended range of motion. While the definitions of the word
flexibility abound, they are not always consistent.

Kurz: “...the ability to perform movements of any amplitude in a joint or series of joints.”

Costill: “...refers to the range of motion, or to the looseness or suppleness of the body or specific joints,
and reflects the interrelationships between muscles, tendons, ligaments, skin, and the joint itself.”

Most fitness enthusiasts typically tend to overemphasize flexibility training, to the neglect of developing
functional strength while in the stretched position. Significantly improving your joints’ range of motion
without also improving the strength of your surrounding musculature (especially at its new range of
motion) can be an invitation for injury.

For example, when you improve your flexibility (in a given joint or group of joints) to the point where an
additional five degrees of motion exists, the affected muscles now have a reduced amount of overlap
between the actin and myosin filaments, resulting in a substantial reduction in force output ability. For this
reason, strength and flexibility training programs must occur concurrently.

Whenever human movement is discussed, terms such as “strength,” “flexibility,” “endurance” and “speed”
are used for the purpose of identifying and describing various qualities of that movement. These qualities
are isolated only for conceptual purposes, and you should realize that any human movement reflects
various degrees of strength, flexibility, endurance and speed simultaneously.

Anatomical and Physiological Basis of Stretching

Understanding flexibility starts with a basic knowledge of cellular muscle anatomy and physiology. Of
particular importance is the basic unit of the muscle cell — the sarcomere — and the three primary
inhibitory proprioceptors — the Golgi tendon organ (GTO), the muscle spindle and the Pacinian corpuscles.

The sarcomere: Myofibrils have the ability to change length, because they are constructed of overlapping
strands of protein polymers called actin (the thin strands) and myosin (the thicker strands). The
“boundaries” of the sarcomere are called “Z lines,” to which the actin filaments are attached. In the center
of the sarcomere are the myosin strands which, during contraction, can pull the Z lines closer together by
attaching to the actin filaments with specialized heads called “cross bridges.” These cross bridges function

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much like boat oars as they reach out attach and pull on the actin filaments, causing the Z lines to move
toward one another.

When you stretch a muscle, the opposite occurs. During the stretch, the fibers elongate as each
sarcomere extends to the point where no overlap between the thick and thin filaments exists at all
(specialized elastic filaments comprised of titin keep the sarcomere together in the absence of overlap). At
this point, the remaining stress is taken up by the surrounding connective tissue (sarcoplasmic reticulum,
sarcolemma and endomysium). If the stretch tension escalates beyond this point, microscopic tears
develop both in the connective tissues and within the sarcomere itself. Such microtraumatic injuries
eventually heal, but at the cost of scarification and micro-adhesions that may leave the muscle fiber less
capable of contraction and extension.

Research conducted at the University of London by Drs. Pamela Williams and Geoffrey Goldspink suggests
that during periods of prolonged muscle elongation, the body detects a reduction in the overlap between
actin and myosin, and synthesizes new sarcomeres at the ends of the myofilament in order to reestablish
proper overlap. Greater overlap means improved force production potential, so this may be an important
reason for anyone to include stretching in their training programs.

The Proprioceptors: The neuromuscular system has built in safeguards against severe muscular injury.
These safeguards take the form of proprioceptors that can sense changes in muscle tension. When these
changes are too sudden, too intense or both, the proprioceptors act to inhibit the nervous impulse sent to
the muscle. There are three primary proprioceptors involved in stretch inhibition: the Golgi tendon organ
(GTO), the Pacinian corpuscle and the muscle spindle.

• The Golgi tendon organ is located at the musculo-tendonous junction, and detects the magnitude
of mechanical stress at this location. When excessive tension develops, the GTO causes the motor
cortex of the brain to “shut off” muscle contraction. The GTO is not sensitive to the rate of force
development, only to the absolute value of tension that develops within the muscle.
• Pacinian corpuscles are small, elliptical bodies, which lie in the deep layers of the skin, in close
proximity to the GTOs. They are sensitive to quick movement and deep pressure. As compared to
the GTO and muscle spindle, the inhibitory role of this organ is not well understood.
• The muscle spindle is actually a specialized muscle fiber, which detects excessive stretch within
the muscle. Muscles responsible for fine movements contain more muscle spindles than do muscles
responsible for gross movements. Unlike the GTO, the muscle spindle does not relay signals
through the motor cortex; as such, it is not considered a feedback loop, but rather an inhibitory
knob. Resetting the muscle spindle is the mechanism of PNF and contract-relax stretching
methods.

How should you improve joint mobility? Rather than short, intense bouts of stretching (which tend
to trigger the proprioceptors), opt for longer, frequent periods of stretching where less tension is
used. Soreness after a stretching session is a sign that hydroxyproline (an amino acid found in
connective tissue) and other biochemicals have been released into the muscle fiber to help repair
damaged tissues. It is probably a sign that you are stretching too hard.

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Assessing Range of Motion (ROM)

Specific joint range of motion (ROM) is measured with a goniometer, a specialized protractor with two
arms, which rotate about one another. A calibrated scale at the vortex of the arms is used to determine
ROM in millimeters (mm). While a goniometer is normally reserved for therapeutic applications, you may
nevertheless make use of several standardized tests with which to assess ROM in your clients:

1. Sit and Reach: Used to assess trunk flexion, a function of hip and spine flexibility on the sagittal
plane. The primary muscles limiting trunk flexion are the hamstrings. Sit on the floor, legs together
and extended. Lean forward with outstretched arms, attempting to touch your toes (or, if possible,
to go beyond the toes) by flexing the trunk. Hamstring length can be assessed by lying on your
back with both legs together and extended. Next, lift one leg (keeping it extended) on the sagittal
plane until significant tension develops. If the leg being tested can be brought to a vertical position
prior to significant tension developing, hamstring flexibility is adequate. This test can also be used
as a static-active stretch for the hamstrings.
2. Hip Flexors: Rest on one knee and one foot, similar to holding a football for a place kick. Your front
heel and rear knee should be approximately 12 to 18 inches apart. Push the rear hip down toward
the floor. Viewed from the side, you should easily be able to align your pelvis between both knees,
such that all three are in a straight line, as indicated in the photograph. This test can also be used
as a static-active stretch for the hip flexors.
3. Shoulder Flexibility: Lie faceup on a table, such that your lower legs hang off the end. Next, extend
your arms overhead, keeping them extended and hands close together. You should be capable of
resting your entire arm against the table, without excessive arching of the back.
4. Trunk Extension: Lie facedown on the floor, in the start of a push-up position. Attempt to raise
your trunk off the floor by extending your arms, while keeping your pelvis against the floor. You
should be able to completely extend your arms while keeping your pelvis against the floor. This
test can also be used as a static-active stretch for the anterior trunk muscles.

Constraining Factors

As with all other motor abilities, the potential to increase joint flexibility to an extreme degree is to a
certain extent genetically predetermined. Younger individuals are generally more flexible than older
people, and women are usually more flexible than men. Flexibility is affected by past injuries, if any,
strength levels, core temperature, time of day, and even mood, stress levels and personality type. There
is a fairly strong anecdotal association between inflexible personalities and physical inflexibility.

On a structural level, flexibility is most often limited by the structure and shape of the joint, the ligaments
and tendons that cross the joint, adhesions from past injuries or surgery, too much muscle around a joint,
too much fat around a joint, highly toned but shortened muscles, fascial binding and shortened muscles
due to inactivity. Contrary to popular gym mythology, muscle length is not the primary limiting factor in
developing great ROM. In fact, normal, healthy muscle tissue can be stretched to about twice its resting
length.

The above mentioned constraining factors can be categorized into those that are beyond the individual’s
control (adhesive scarification, joint shape, etc.), and those factors which can be influenced through
training. Some factors, particularly joint shape, can be altered through intensive training during childhood,
which is commonly seen in the training of gymnasts and dancers.

Inflexibility and Injury Potential

Sometimes repetitive, limited ROM activities performed over a prolonged time period can create shortened
muscles. The hip flexors (psoas and iliacus) can become shortened due to long periods of sitting and
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bicycling — activities where the hip flexors contract repeatedly, but over a reduced range of motion.
Weight training exercises, if habitually performed in a shortened range of motion (i.e., without full
extension and/or flexion) can also lead to shortening.

Chronically shortened muscles can be the first step in a series of events leading to injury. Over time,
shortened hip flexors can lead to a reduction of the normal lordotic curve of the lumbar spine, which can
in turn impair the spine’s load-bearing and shock-absorption capacity. When the spine cannot function
normally, a wide range of injuries (from chronic to acute) can result. Overtight hamstrings have the same
effect on the lumbar spine.
Overtight quadriceps can pull the patella upward (proximally), causing it to track abnormally high on the
femoral groove. Such a condition can potentially result in a roughening of the underside of the patella
(chrondromalacia patellae), leading to pain, inflammation and eventually, debilitation.

Specificity and Flexibility

In keeping with the SAID and specificity principles of training, joint flexibility is optimized if the training
methods are specific to the desired results. Flexibility is specific to three criteria:

1. Joint Specificity: A flexibility training program for the hips (for example) will not improve flexibility
in any other joint. The joint-specific nature of flexibility training does not necessarily mean that all
joints must be targeted with flexibility exercises. Flexibility training can be prioritized toward joints
that are most in need, as a way of maximizing training efficiency.
2. Position and Speed Specificity: For maximum effectiveness, stretching exercises must be very
similar in form and speed to the skill you are trying to improve. Slow, static stretching, for
example, will not improve high and fast kicking movements nearly as well as dynamic stretching
movements. Conversely, dynamic stretching methods have limited ability to improve a static skill,
such as a split on the floor.
3. Resistance Training Contributes to Increased Joint Flexibility: Properly conceived resistance training
programs can have a beneficial effect on your flexibility levels. In fact, whatever your level of
flexibility, the primary concern is that there is adequate strength throughout the joint’s full range of
motion. Two key points are to perform resistance exercises through the involved joint’s full range
of motion and to work antagonistic pairs of muscles equally.

How Much Flexibility is Enough?

This of course varies from individual to individual, but it can safely be said that you need enough flexibility
for any situation that you will normally encounter in day to day life, plus a little bit more. This “little bit
more” is called the flexibility reserve. Conversely, if adequate flexibility is lacking the difference between
what you have and what you need is called your flexibility deficit. Of all the bio-motor abilities, joint
flexibility is perhaps the easiest to develop. The methods involved are simple and require little time, effort
or specialized equipment.

The Effects of Body Temperature on Flexibility

Body temperature is an important consideration when attempting to improve joint flexibility. Increased
temperature helps to facilitate increases in ROM, while decreased temperature tends to preserve
decreases in muscle length. Prior to performing stretching exercises, body temperature must be elevated.
The warmup can be passive, meaning a hot bath or shower, or active, meaning a brief session of muscular
activity. The latter is preferred, because it raises your core temperature, whereas the former may only
elevate surface temperature.
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Although you may use stretching as a warmup, such a practice is often counterproductive. Warming up
before stretching is important in two regards. First, core body temperature is elevated. Second, muscles
are subject to thixotropy, which is the tendency of gels (e.g., body fluids) to become less viscous,
following a period of being shaken or otherwise disturbed by outside forces. This explains why periods of
inactivity tend to cause muscular stiffness, and why muscular viscosity is reduced when muscles are
active. The most appropriate time to stretch a muscle (from the perspective of body temperature and the
thixotropic effect) is after training. In this way, the target muscle tissues are warm and less viscous, which
facilitates lengthening; but in the process of cooling down, muscles tend to become less elastic than they
are immediately after training (when stretching tends to preserve long-term improvements in length).

Humidity also plays a factor in stretching and flexibility development. A given temperature has a varying
quality depending on the humidity. In other words, you will have an easier time warming up in 70-degree
temperatures at 90 percent humidity than in 70 degrees at 70 percent humidity. Although it is not fully
understood why this happens, many experts acknowledge that increased humidity has the effect of
intensifying the effect of temperature.

Tension Magnitude During Stretching

Muscle tension is another important consideration when stretching. Stretching methods can range from
intuitive “cat nap” limbering (which is useful for releasing adhesions and microscopic tissue bonding after
periods of inactivity) to aggressive stretching regimens designed to radically increase a joint’s range of
motion (as performed by dancers, martial artists, and gymnasts). Of course, discomfort and pain are
subjective experiences, and everyone has varying tolerances to both. We recommend stretching to the
point of mild to moderate discomfort if the goal is to improve range of motion, but short of discomfort if
the primary objective is to speed up the removal of waste products during or after a workout.

Duration

Ideal stretching duration can vary depending on many factors, primarily the type of stretching method
being used (described subsequently). Dynamic stretching, for instance, involves several “swings” that last
only a moment or so each. Static-active and contract-relax methods involve longer periods lasting 20
seconds to 1 minute. A static stretch should be held for at least 20 seconds, in order to overcome the
stretch reflex. Stretching sessions rarely last more than 20 minutes, with each muscle normally taking two
to three minutes at most. The agonizing stretching sessions used by martial artists, gymnasts and dancers
are probably no more effective (and may actually result in scarification) than longer sessions of lesser
intensities.

Breathing and Relaxation

Much has been made of proper breathing patterns while stretching. However, there is no reason to
overanalyze a function that should come naturally and instinctively. Breathe normally, and visualize the
muscles, tendons and ligaments lengthening during the stretch. Avoid holding your breath since this
increases blood pressure and general muscular tension. Correct breathing should enhance relaxation while
stretching, particularly when exhalation is timed to coincide with the elongation phase of the stretch.

Stretching as a Means of Preventing Delayed Onset of Muscle Soreness (DOMS)

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Although research is still inconclusive, low to moderate intensity stretching exercises may be effective in
reducing post-exercise muscle soreness (perhaps the best reason to stretch regularly). Stretching or
massaging the muscle serves to help rid your muscles of hydroxyproline and other waste products that
result from exercise-induced microtrauma. Aggressive stretching may actually cause microtrauma. If your
goal is to increase joint ROM, microtrauma is an unfortunate but unavoidable side effect. If, on the other
hand, your objective is reduction of DOMS, stretching must be performed with reduced tension.

Programming and Periodicity

Like all training components, stretching exercises should be periodized throughout the training cycle.
Fortunately, unless you participate in dance, martial arts, gymnastics or other activities requiring great
flexibility, you don’t need to spend significant time or energy on stretching programs. If you do require
high levels of ROM, consider the following when designing your training schedule:

• If flexibility is critical, the bulk of your flexibility training should occur late in the preparatory period
and be maintained through the competitive period. Problem joints should receive priority attention
throughout the preparatory period.
• Excessive flexibility can be detrimental if you are involved in strength and power activities. For
example, too much hip flexibility can weaken the stability of the low position in the squat. Also,
track and field throwers often report that a certain level of “tightness” in the pectoral region can
facilitate elastic energy in the final stages of the throw.
• If your objective is to increase ROM, intensive stretching should not be performed every day, as
your muscle and connective tissues need time to heal. A schedule where adaptive tension
stretching occurs every other day, interspersed with days of light tension stretching, is more
appropriate.
• If reduction of DOMS is your objective, stretching exercises can be performed every day, or nearly
every day. The most effective method involves stretching your muscles immediately after they
have been trained. If you wish to plan static stretching on a day where no resistance training
occurs, perform a low-intensity 10 to 15 minute cardiovascular session (active warmup) or take a
hot shower, steambath, or Jacuzzi prior to stretching.

Increasing Joint Flexibility

Static Stretching

This is the most common form of stretching. While effective for recovery purposes, the static method is
not as effective as contract-relax method (to be discussed shortly) in terms of achieving long-term
increases in ROM. Static stretching is contraindicated prior to resistance training, as it can temporarily
lower your strength levels. There are two types of static stretching. In static-active stretching, you move
slowly toward your extreme range of motion for the joint you are stretching, and upon reaching the
desired level of tension, hold for 20 to 60 seconds. In static-passive stretching, you have a partner move
you toward your maximum range of motion (ROM), as you relax during the stretch. Although you should
never bounce or jerk while performing static stretches, it is sometimes effective to “pulse” rhythmically
several times, as long as you are well within your present range of motion. During the pulsing rhythm,
your nervous system will be able to anticipate and accommodate your movements, resulting in an
effective stretch.

Dynamic Stretching

Dynamic stretching involves swinging the arm and/or legs in a controlled manner. Various patterns can be
utilized. When stretching dynamically, you should not exceed the present range of motion of the joints in
question. There are several methods you can use to ensure the safety of this type of stretching. First, an
even, controlled rhythm must be established, with swinging movements initially well within the current
range of motion, and then gradually increase the amplitude of the movement, until you are at the desired
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level of tension at the endpoint of the movement. Second, the stretch reflex can be averted by stopping
the moving limb prior to the target joint reaching the end of its range of motion. As an example, during a
standing dynamic hamstring stretch, you can swing (kick) your leg into an outstretched hand, which stops
your foot at the end of each swing, prior to the extreme range of the hip joints. The nervous system will
anticipate this, and as a result, the stretch reflex will be minimized or even eliminated. Please bear in
mind that these are specialized movements, and care must be taken with their use.

PNF Method

Originally developed by Dr. Herman Kabat, and then later refined by physical therapists Dorothy Voss and
Margaret Knott, PNF (proprio-neuromuscular facilitation) is defined as “methods of promoting or hastening
the response of the neuromuscular mechanism through stimulation of the proprioceptors.” True PNF
requires specialized training, and is normally used only in a clinical setting. Although there are many
different PNF methods, most forms involve dynamic, rotational, and angular movements done in
accordance with verbal cues from a registered physical therapist.

Contract-Relax (CR) Method

Individuals within the fitness industry commonly refer to this method of stretching as PNF; however, we
use the term “contract-relax” to distinguish it from true PNF. The contract-relax method is performed with
a partner who carefully provides resistance for the muscle being stretched, prior to actually stretching it.
The rationale behind this method is that when you contract a muscle before stretching it, you inhibit the
stretch reflex. This built-in safety mechanism is set very conservatively, however, and “fooling” the
muscle through this type of stretching is quite safe and effective when done properly. The contract-relax
method is particularly effective during the latter part of the warmup, as the muscular exertions promote
an increase in body temperature.

One benefit of contract-relax stretching is that the targeted muscles become stronger in their extreme
ranges of motion. Keep in mind that the moment a joint reaches a new (higher) level of flexibility, the
associated muscles now have a small region that has never experienced contraction. For this reason, gains
in flexibility should be coupled with strength gains in the extreme ranges of motion.

Contract-relax stretching may be contraindicated in hypertensive individuals. Recent research conducted

by William Cornelius at the University of North Texas showed an increase of 20mm/Hg in systolic blood
pressure and 13mm/Hg in diastolic when three repetitions of PNF hip flexion were performed.
Interestingly, Jensen reported that ROM increased after one repetition, but did not further increase after
repeated repetitions. With this in mind, you should monitor gains in ROM after each repetition of contract-
relax stretching and discontinue stretching when the ROM reaches a plateau.

Contract Antagonist-Relax (CA) Method

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Very similar to the contract-relax method, CA stretching facilitates an increase in muscle length through a
maximum isometric contraction of the antagonist, immediately prior to a static stretch of the agonist. If
the latissimus dorsi muscle contracts as the agonist during a set, then the pectoralis major will lengthen
as the antagonist. Antagonist muscle groups must relax and lengthen when the agonist muscle group
contracts. This is known as reciprocal innervation and occurs through reciprocal inhibition of the
antagonist. When motor units are activated in the agonist, a reciprocal neural inhibition of the antagonist
motor units occurs. This reduction in neural activity of the antagonist allows them to subsequently
lengthen under less tension. So during your sets for back work, your pectoralis major acts as the
antagonist and is lengthened while the latissimus dorsi muscle contracts. Because the antagonist is
momentarily fatigued from the isometric exertion, it becomes less able to oppose the lengthening of the
agonist. Due to the inherent similarities to contract-relax stretching, this method may also involve risk to
you if you have hypertension; the aforementioned precautions should be observed.

Fascial Stretching

As mentioned earlier, fascia (the elastic, membranous “sheath” which encases muscles and muscle
groups) can bind and constrict the muscles that surround a joint. Dr. Ida P. Rolf was largely responsible
for raising awareness of this phenomenon by developing “structural integration” (or Rolfing, as it is
commonly known). This method of improving the body’s natural alignment with gravity happens by
“releasing” fascial restrictions to efficient, natural movement.

Fascial stretching involves deep-tissue manipulation, and should only be performed by a competent
physical therapist. Although fascial stretching is still a new and evolving practice, it holds great promise
for those who wish to achieve a permanent increase in their range of motion.

Weight Training and Flexibility

Weight training can result in an increase in joint flexibility or it can have the opposite effect, a decrease in
flexibility. It depends not only on how the exercise is done but also on how much weight is used and the
ROM. Also, adaptations to weight training with beginners is different from more experienced trainees who
use more weight.

If you use relatively light loads so that you go through a full ROM, you will be able to increase your
flexibility. In exercises such as lateral arm raises when you go through a full ROM so that the arms end up
directly overhead you can increase shoulder flexibility. You can do the same in front arm raises, lateral
prone raises, back raises, etc. Exercises such as reverse trunk twists are excellent for increasing rotational
flexibility of the spine, as well as strengthening the internal and external obliques. To increase the ROM in
supination and pronation, use a Strength Bar at full length. Many other examples of exercises that can be
done through a maximum ROM are possible.

As you increase repetitions, sets and/or use greater resistance, your weight training will result in a loss of
flexibility. There are two reasons for this:

1. When you handle very heavy weights you rarely fully extend the limbs because of the loss in
mechanical advantage of the muscles.
2. The use of heavy weights brings about residual tonus in the muscles, which, when sufficiently
strong, keeps the muscles in a shortened state after the workout.

When you use a greater number of repetitions and/or sets, you will invariably find that as you approach
the last repetitions or sets, ROM will be decreased. This typically occurs when fatigue begins to set in or
when the muscles begin to tighten from the amount of work being done. The more work you do, the
greater will be the likelihood of a decrease in flexibility in the joints affected.

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Because of this, all heavy or intense weight training programs should be supplemented with stretching,
preferably after the workout and active in nature. This is especially important when the spine is involved
in weight bearing and may become compacted, as for example when holding weights on the shoulders or
overhead. Active stretching at this time can be done to regain the normal ROM in the involved joints.

For example, if you do multiple sets of the biceps curl, you can do a straight arm hang on a high bar to
regain the straight-arm position. For the lower back, hanging is also very beneficial, whether it be on a
high bar to get a full equal stretch of the spinal vertebrae, or on the Yessis Back Machine in which you
hang from the hips with the trunk vertical. Keep in mind that the stretching at this time is not for an
increase in flexibility; it is merely to regain the normal ROM in the joints that you had prior to the
exercise.

Dangerous Stretches

It is important to understand that some stretching exercises such as the straight leg toe touch can
severely weaken the spine. When you bend over maximally from the waist (and hip) you stretch mostly
the ligaments of the spine, not the muscles. Thus most of the stretching in straight leg toe touches is of
the spinal ligaments, not the hamstrings. This can easily be proven if you maintain the spine in an arched
position and then bend over from the hips. Most often you will not be able to reach the horizontal trunk
position because of tight hamstrings. The same applies to the seated toe touch and the hurdler stretch in
which there is excessive stretching of the spinal ligaments and not very much of the hamstrings (unless
you keep the spine locked in an arched position when you bend forward). In this case the ROM is limited.

Adequate strength in extreme joint positions is necessary to prevent structural damage by outside forces.
Keep in mind that in active movements it is muscle strength that moves the limb through the necessary
range of motion. Passive flexibility has very little correlation to your active range of motion. Thus, the
greater your active flexibility, the better able you are to perform the necessary actions but only when you
have adequate levels of strength through the entire ROM. Also, as you increase your ROM it is important
to develop adequate strength in your new range of motion. Flexibility without strength can be dangerous.

ROM may be limited by four factors:

1. Connective tissue restrictions.

2. Bony conf igurations at the joint.
3. Contact of muscle masses of adjacent segments.
4. Strength of the muscles over the full ROM. Physical contact of the muscles of adjacent limbs cannot
be changed (unless there is also unnecessary fat). The same is true when you have contact of the
bones forming the joint.

When you do not use the total ROM at a particular joint for a long time, the connective tissues crossing
the joint become shortened and adapt to the usual ROM. If an exercise demands a large ROM at one or
more joints and you do it regularly, the tissues become lengthened and you maintain the needed
flexibility. The areas of the body that receive little movement show the greatest decrease in ROM.

Passive and Active Flexibility

Passive flexibility refers to the ROM available when an outside force (i.e., gravity, momentum, another
body part or another person) is the causative force. Active flexibility is the ROM produced when muscle
force (or gravity) creates the movement range. If the muscles are weak the ROM will be less than it
should be. Because a passive ROM shows little correlation to an active ROM and you exhibit a great ROM
in a static position, it does not mean that it relates to what you do when performing actively. The two are
hardly related! If you desire an active range of motion, you must do active stretching. If you desire a
static or passive range of motion, then you should do static stretching.

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In active stretching, the muscles that are actively involved do so primarily in the eccentric contraction. For
example, when you raise your arms overhead as in the lateral arm raise, you are eccentrically stretching
the latissimus dorsi and teres major. These muscles undergo an eccentric contraction as you raise the
arms to not only control the movement but also to stop the arms from going beyond the capability of the
joint. Another example is to lie on your back and then raise one leg as high as possible. Then lower and
raise the other leg and repeat in an alternating manner. Every time you raise the leg, you are using the
hip flexor muscles to eccentrically stretch the hamstrings.

You can also use gravity as the force to produce active stretching. For example, if you do a good morning
exercise keeping the lower back in its normal slightly arched position as you bend over from the hips, you
will elicit an eccentric contraction in the hamstrings. You then rise up and, each time you go down, you
experience a slightly greater ROM. Note that these stretches are more natural since they duplicate what
occurs in everyday and sports activities.

Always Warmup before doing Flexibility Exercises.

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 1. Front Shoulder Stretch: In a seated 2. Serratus Anterior and Latissimus
position on the ground or mat, with knees Stretch: Reach arm up and over, bending
bent, place your hands behind you with at the elbow. The arm is now positioned
fingers pointing backwards. Slowly slide behind the head as if stretching the triceps.
your hands farther and farther backwards While bending at the waist laterally, add a
until you feel your front deltoids being slight amount of pressure to the elbow with
stretched. Stop and hold that stretched the opposite hand. Take deep breaths, and
position for about one minute. Remember relax into the stretch.
to relax in the stretched position. Avoid
being tense.

3. Forearm and Wrist Stretch: Start on 4. Elongation Stretch: This is a great

all fours with a neutral spine. Support exercise for maintenance of your whole
yourself on your hands and knees. Thumbs body. Lying on the floor or a mat, stretch
are pointed to the outside of the body with your arms over your head and point your
fingers pointed toward knees. Keep palms toes. Reach as far as possible with both
flat as you lean back to stretch the inside your arms and your feet, elongating the
part of your forearms. body. Hold for 5 seconds and repeat.

Figure 10-1a: Flexibility exercise descriptions. Static-active stretches: front shoulder

stretch, serratus anterior and latissimus stretch, forearm and wrist stretch, and elongation
stretch.

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 6. Forward Torso Stretch: While holding
5. Shoulder, Arms, and Latissimus
on to a bar with hands shoulder-width
Stretch: With legs bent under you, reach
apart, bend forward at the waist. Make
forward with arms on floor. You can also do
sure to be far enough away from the bar to
this one arm at a time. Stretch the sides,
elongate the torso. The focus should be on
upper back and lower back by slightly
the upper back, shoulders, and arms during
moving your hips in either direction.
the stretch.

7. Hamstring Stretch: Lie in a supine 8. Shoulder Joint Stretch: Holding a stick

position with one leg bent, foot flat on the or towel in both hands, slowly raise it over
floor. Grab the back of the opposite leg just your head until the stick or towel is behind
below the knee and pull towards the chest. you. As your shoulder flexibility improves,
Keep the stretched leg straight, but not you will be able to perform this “dislocate”
locked at the knee joint. movement with your hands closer and
closer together. Holding the same stick or
towel behind your back, with one hand
over and the other hand under, bring your
hands closer and closer together. Repeat
this movement by reversing your hand
position. Remember to hold your stretched
positions for a minute or so, relaxing into
the stretched positions

Figure 10-1b: Flexibility exercise descriptions. Static-active stretches: shoulder, arms, and
latissimus stretch; forward torso stretch; hamstring stretch; and shoulder joint stretch.

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 9. Low-Back Stretch: As you lie flat on 10. Groin Stretch: In a sitting position,
your back, bend one knee. Allow that knee bring the soles of your feet together. Sit up
to fall over the opposite leg, as the hip straight, and gently press knees toward the
rises off the floor. Be sure to keep floor. By leaning forward slightly, you will
shoulders and upper torso on the mat. You feel a deep groin, glute, hamstring, and
should feel this stretch through the lower low-back stretch.
back muscles. Take deep breaths and relax
into the stretch.

11. Quadriceps Stretch: Lie on your side 12. Neck and Upper Back Stretch: Lie
on the mat or floor. Support your head on your back with both knees bent to
with your arm. With your free hand, pull alleviate pressure on the low back. Clasp
back on the foot of the top leg with your hands behind head. Gently raise head off
knee flexed. Hold the stretched position for the mat and bring your chin to chest. Be
about one minute, remembering to relax in extremely careful not to pull too hard on
the stretched position. the head and neck. Hold this stretch for 30
seconds.

Figure 10-1c: Flexibility exercise descriptions. Static-active stretches: low-back stretch,

groin stretch, quadriceps stretch, and neck and upper back stretch.

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 13. Ankle and Calf Stretch: Bring the 14. Piriformis and Glute Stretch: From a
toes of one foot almost even or parallel to supine position on the floor with knees bent
the knee of the other leg. Let the heel of and feet flat on the floor, cross the left leg
the bent leg come off the ground one-half over the right, just below the knee. Grab
inch or so. Lower heel toward ground, the back of the right leg and pull towards
while pushing forward on your thigh (just the chest. The lower portion of the right leg
above the knee) with your chest and should be parallel to the floor and the left
shoulder. leg should be perpendicular to the right
leg. Hold the stretch for 30 seconds, switch
legs, and repeat.

15. Quads, Knees, Back, Ankles, 16. Calf Stretch: Stand with one foot in
Achilles, and Groin Stretch: From a front of the other. Bend one leg, and put
standing position, squat down with your your foot on the ground in front of you,
feet flat and toes pointed out at with the other leg straight behind. Slowly
approximately 15º angles. Keep your heels move your hips forward, keeping your
4-12 inches apart. lower back flat. Keep your heel of the
straight leg on the ground with toes
pointed straight ahead or slightly turned in.

Figure 10-1d: Flexibility exercise descriptions. Static-active stretches: ankle and calf
stretch; piriformis and glute stretch; quads, knees, back, ankles, achilles and groin stretch;
and calf stretch.

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17. Chest and Anterior Deltoid Stretch: 18. Back Stretch: Do this on a mat or
Clasp hands together behind your back. rug. In a sitting position, hold your lower
Gently raise arms until you feel a stretch hamstrings behind your knees with your
throughout the chest and shoulder region. hands and pull them to your chest. Gently
roll up and down your spine, keeping your
chin down toward your chest.

19. Front Straddle Stretch: Lunge 20. Hamstring Stretch: Too many
forward with one foot, dropping the hips as athletes get pulled (torn) hamstrings,
if you were performing a lunge. Hold this because they are not flexible enough in
position for 20 seconds and then repeat their hip joints. Their hamstrings are too
with the other leg. You can do this stretch tight. To lengthen the hamstrings a little
either in one place, or while walking (to improve hip joint flexibility), sit down
forward. Doing it in one place will stretch with your legs spread apart in the shape of
the hamstrings of the front leg, the a “V” and try putting your chest against
quadriceps of the back leg and the groin. your right leg; hold for 30 seconds and
Doing it while walking — sinking into the repeat for the left leg and then between
stretched position with each stride forward both legs. Remember to relax into the
— adds the benefits of strengthening the stretch.

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 quadriceps of the front leg. You may even
want to hold a dumbbell in each hand while
straddle-walking for added difficulty.

Figure 10-1e: Flexibility exercise descriptions. Static-active stretches: chest and anterior
deltoid stretch, back stretch, front straddle stretch, and hamstring stretch.

Unit Summary

I. Flexibility is the ability to flex, extend or circumduct the joints through their full intended range of
motion.

A. The anatomical and physiological basis of stretching revolves around the sarcomere and the three
primary inhibitory proprioceptors: the Golgi tendon organ (GTO), the muscle spindle and the Pacinian
corpuscles.

1. The Golgi tendon organ is located at the musculo-tendonous junction and it detects the
magnitude of mechanical stress at this location.
2. Pacinian corpuscles are small, elliptical bodies, which lie in the deep layers of the skin in
close proximity to the GTOs.
3. The muscle spindle is actually a specialized muscle fiber, which detects excessive stretch
within the muscle. Muscles responsible for fine movements contain more muscle spindles
than do muscles responsible for gross movements.

B. Myofibrils have the ability to change length because they are constructed of overlapping strands of
protein polymers called actin (the thin strands) and myosin (the thicker strands). During the stretch, the
fibers elongate as each sarcomere extends to the point where no overlap between the thick and thin
filaments exists at all.

C. Specific joint range of motion (ROM) is measured with a goniometer, a specialized protractor with two
arms, which rotate about one another.

1. While a goniometer is normally reserved for therapeutic applications, several standardized

tests can be used: sit and reach, hip flexor, shoulder flexibility and trunk extension tests.

D. As with all other motor abilities, the potential to increase joint flexibility to an extreme degree is to a
certain extent genetically predetermined with flexibility being limited by the structure and shape of the
joint.

1. Healthy muscle tissue can be stretched to about twice its resting length.

E. Chronically shortened muscles can be the first step in a series of events leading to injury.

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F. Flexibility with regard to training specificity is specific to three criteria: joint specificity, position and
speed specificity and training specificity.

G. Increased temperature helps to facilitate increases in ROM, while decreased temperature tends to
preserve decreases in muscle length.

H. Stretch to the point of mild to moderate discomfort if the goal is to improve range of motion, but short
of discomfort if the primary objective is to speed up the removal of waste products during or after a
workout.

I. Correct breathing should enhance relaxation while stretching, particularly when exhalation is timed to
coincide with the elongation phase of the stretch.

J. Stretching exercises should be periodized throughout the training cycle.

K. The most common methods of increasing joint flexibility are: static stretching, dynamic stretching, PNF
method, contract-relax (CR) method, contract antagonist-relax (CA) method and fascial stretching.

1. There are two types of static stretching: active and passive.

a. In static-active stretching, you move slowly toward your extreme range of motion for the joint you are
stretching. Upon reaching the desired level of tension, hold for 20 to 60 seconds.

b. In static-passive stretching, you have a partner move you toward your maximum range of motion
(ROM), as you relax during the stretch.

2. Dynamic stretching involves swinging the arm and/or legs in a controlled manner.

3. The contract-relax method is performed with a partner who carefully provides resistance for the
muscle being stretched, prior to actually stretching it.

4. CA stretching facilitates an increase in muscle length through a maximum isometric contraction

of the antagonist, immediately prior to a static stretch of the agonist.

5. Fascial stretching involves deep-tissue manipulation.

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 Section 3: Unit 11 Outline

Body Composition

I. Understanding Body Composition

A. Body Types

B. Body Mass Index

C. Waist Circumference

1. Waist Circumference Measurements

D. Components of the Human Body

1. Body Fat

a. Measuring Body Fat

b. Using Calipers
c. Generalized Adult Body Fat Equations

E. Goal Setting using Body Composition Statistics

II. Conclusion
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 Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Determine and analyze an individual's body composition.

• Understand the importance of the mind/body link.

Understanding Body Composition

The incidence of obesity is growing in the United States . Obesity is 5 to 8 times more common among
Americans today than it was at the start of the twentieth century. Thirty-four million Americans are
overweight (approximately 15 million men and 19 million women).

As stated in an earlier unit, personal trainers have more time with the apparently healthy population than
do physicians. They have a tremendous influence on shaping the health attitudes and practices of those
around them. Therefore they must possess a solid foundation of scientific principles - such as
understanding body composition assessment - and be able to apply these principles.

In order to assist your clients in reaching their fitness related goals, we need to know more information on
the current standards for body composition categorization and assessment. We will begin by discussing
body types, BMI, waist circumference and conclude with methods for body fat determination.

Body Types (Somatotype)

The way your body looks is a result of your genetics and environmental factors (such as training and
nutrition). The genetic factor has a dominant influence on your body structure, both inside and out.
Scientist W. H. Sheldon devised a system of classifying different human body types. He called this system
"somatotype." Using this system, humans can be classified in three body types:

• Mesomorphic or muscular body type.

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 • Ectomorphic or slim, linear body type.
• Endomorphic or fat, round type.

Figure 11-1: Somatotypes

Sheldon's system uses a somatotype number with three digits on a scale of 1 to 7. The first digit refers to
the degree of endomorphy, the second digit refers to the degree of mesomorphy, and the third digit refers
to the degree of ecotmorphy. An extreme endomorph has the somatotype 711, an extreme mesomorph
has the somatotype 171 and an extreme ectomorph has the somatotype 117.

Most individuals have a dominant somatotype and also display some characteristics of the other two. An
average person may fall somewhere around a 333 or a 444 rating. This system is useful because it helps
understand genetic predisposition. For example, on a pound-for-pound bodyweight basis, ectomorphs
usually require more calories. Mesomorphs are next in line, and endomorphs require the fewest calories.
Determined, competitive athletes should have their somatotypes determined by trained individuals. Elite,
world-class athletes usually have a mesomorphic rating of 5 to 7 , endomorphic of 1 to 3 and ectomorphic
rating of 4 to 1. This indicates that being predominantly mesomorphic is a common trait of elite athletes.
This makes sense, as mesomorphs have a higher body composition of muscle mass, which is the primary
tissue responsible for athletic performance. This does not mean that ectomorphs or endomorphs cannot
become superior athletes; however, they should use training and nutrition methods to build more muscle
mass and keep percent body fat within desirable levels for their sex and sport.

While it is good to know Sheldon's system for academic purposes, we do not feel that it should be used as
a factor or reference for program development. Genetic categorization deminishes the personal
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empowerment that is necessary for success. It is not possible to establish the relative portion of an
individual's health or fitness that is determined through heredity; therefore, genetic background neither
dooms nor guarantees success in achieving and maintaining total fitness.

Body Mass Index

Body Mass Index (BMI) describes relative weight for height. BMI is often used as a predictor of future
disease risk. However, one can be overweight and not be obese. Overweight refers to an excess of
amount of weight that includes all tissues: bone, muscle, water and fat. Obesity refers specifically to body
fat. The National Heart Lung and Blood Institute (NHLBI) recommends that BMI be used to assess
overweight and obesity and not to monitor changes in bodyweight. According to an expert panel formed in
1998 by the NHLBI, BMI is the key preferred measure to be used in clinical guidelines for the
identification, evaluation and treatment of overweight and obesity in adults.

BMI FACT SHEET

BMI Calculation

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 STEP ONE: Calculate height in inches. 1 foot = 12 inches

Example: Female client is 5'6" tall, 125 lbs.

5 X 12 = 60; 60 + 6 = 66 inches

STEP TWO: Calculate BMI, applying height in inches to the equation below. Start by
multiplying height in inches.

Example: Female client is 66" tall, 125 lbs

BMI STANDARDS

Underweight < 18.5

Normal 18.5 - 2.49

Overweight 25.0 - 29.9

Obesity, Class I 30.0 - 34.9

Obesity, Class II 35.0 - 39.9

Extreme Obesity, Class III > 40

Source: The National Institutes of Health

Waist Circumference

Evaluating fat in the abdominal region is important in determining an individual’s health risk. Fat in the
abdominal region, known as visceral fat, is associated with greater risk of Type II diabetes, dyslipidemia
(elevated levels of free fatty acids in the blood), hypertension and cardiovascular disease. Evidence from
epidemiological studies shows that waist circumference is the best predictor of abdominal-fat content.

Waist Circumference Measurements

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Locate the upper hipbone and top of the iliac crest. Place the measuring tape in a horizontal plane around
the abdomen at level with the iliac crest. Before reading the tape measure, make sure that the tape is
snug, the skin is not compressed and that the tape measure is parallel to the floor. Measure at the end of
an expiration (after the client exhales).

Waist circumference cut-offs for increased health risk:

Men: >40 inches (102 cm)

Women: >35 inches (88 cm)

While BMI and waist circumference measurements may be appropriate as predicators of future health risk,
they are not as effective in gauging overall body mass and body composition changes. ISSA takes the
position that body composition assessment should play a prominent role when assisting clients.

When determining a client's ideal weight, it is misleading to focus only on the scale. Scales do not account
for the proportion of fat to lean tissue. The real health concern is the portion of fat as compared to overall
weight.

Components of the Human Body

The three major structural components of the human body include muscle, bone and fat. We categorize
these components as lean body mass, or LBM, and total body fat. Muscle and bone comprise the body's
LBM while different types of fat account for total body fat.

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Body Fat

Total body fat is deposited in different sections of the body and is classified as essential fat and storage
fat. Essential fat is the fat required for normal physiological functioning. It is stored in the heart, lungs,
liver, spleen, kidneys, intestines, muscles, bone marrow, and lipid-rich tissues throughout the central
nervous system. Females hold additional essential fat in the mammary glands and pelvic region. Storage
fat is stored in adipose tissue. This reserve includes fatty tissues that protect the various internal organs
as well as the larger subcutaneous (beneath the skin surface) fat. Subcutaneous fat is what we normally
think of when we mention body fat.

Click here to enlarge Click here to enlarge

Table 11-2
Average Body Fat Ranges for Males and Females

Gender Male Female Male Female Male Female

Age 18 - 39 40 - 59 60 - 79

Essential 10% to 10% to 10% to

2% to 4% 2% to 4% 2% to 4%
Fat 13% 13% 13%

14% to 14% to 14% to

Underfat 5% to 7%
20%
5% to 10%
22%
5% to 12%
23%

21% to 11% to 23% to 13% to 24% to

Healthy 8% to 19%
32% 21% 33% 24% 35%

Obese 20% + 33% + 22% + 34% + 25% + 36% +

Measuring Body Fat

There are numerous methods used to determine body composition. Body composition measurement is an
important part of the initial assessment procedure for new clients and an important ongoing evaluative
test for existing clients. (Excessive levels of body fat are associated with cardiovascular disease, cancer,
and other maladies.) Body composition assessment is also an important source of motivation for clients,
as it demonstrates (hopefully) positive changes in overall fitness levels. The fat and lean compartments of
the human body can be determined through the following methods.

Dual Energy X-Ray Absorptiometry (DEXA): A single X-ray source is used to determine whole body
and regional estimates of lean tissue, bone, mineral and fat. The software required for this process
continues to be refined. DEXA is expected to play a major role in the future of body composition analysis.

Underwater Weighing: Another widely used technique is underwater, or hydrostatic, weighing.

Underwater weighing compares the weight of the subject in air to the weight of the subject completely
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submerged in water. Because fat is less dense than water, a person with a high amount of fat will weigh
less underwater than a person of similar weight who has less fat. Measurements must consider the
amount of air in the lungs during measurement (i.e., corrected for residual volume—the amount of air left
in the lungs after complete exhalation) and for gastrointestinal air. Underwater weighing, in the hands of
skilled technicians and subjects who are comfortable underwater, provides a good estimate of the density
of the body, which can then be converted to an estimate of fat percentage. This technique is accurate and
fairly inexpensive. Unfortunately, it is not portable.

Potassium Ion: Another technique is to determine the amount of a naturally occurring isotope,
potassium. Potassium is the chief ion within the cells of active tissue. From the amount of total potassium
it is possible to estimate the mass of lean tissue. However, the equipment necessary for this procedure is
not universally available and is very expensive.

Bioelectrical impedance: BIA devices were developed on the basis that water conducts electricity better
then fat. Because muscle has a high water content and fat has a very low water content, the rate at which
your body conducts electricity can be used to estimate body fat analysis. A small portable instrument
applies an electrical current to an extremity and resistance to that current is measured. Total body water
is calculated and the value can be used to estimate percent body fatness. Many bioelectrical impedance
devices have been developed—there are even hand-held versions. Many are extremely expensive. Keep in
mind that BIA devices were developed mostly for the population at large and use calculations and norms
for the average person. In addition, recent scientific reviews of these methods indicate that they are
unreliable.

Nuclear Magnetic Resonance (NMR): Electromagnetic waves are transmitted through tissues and are
absorbed by selected nuclei, which then release energy at a particular frequency (or resonance). The
frequency characteristics are related to the type of tissue. Computer analysis of the signal can provide
detailed images and the volumes of specific tissues can be calculated.

Ultrasound: Sound waves are transmitted through tissues and the echoes are received and analyzed.
This technique has been used to measure the thickness of subcutaneous fat. Present technology allows for
whole-body scans and the determination of the volumes of various organs.

Near Infrared Interactance (NIR): A fiber-optic probe is placed over the bicep and an infrared light
beam is emitted. The light passes through subcutaneous fat and muscle and is reflected by bone back to
the probe. Although NIR devices are becoming more common in gyms and clubs world wide, recent
studies suggest that this technology needs continued work to merit use.

Skinfold Thickness: An estimate of total body fatness is made from a measure of subcutaneous fat. As
approximately 50% of the body fat is subcutaneous (under the skin), it follows that the thicker the
skinfolds (a fold of skin and fat, but not the underlying muscles), the greater the amount of fat a person is
carrying. Specially designed calipers measure the thickness of representative sites throughout the body.
These measurements are applied to mathematical equations to estimate the body's density. The
measurements are then converted into a body fat percentage. This technique of measuring skinfolds is
inexpensive, portable, and appropriate in both laboratory and field settings when used by experienced and
skilled individuals.

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Using Calipers

If you are right handed grasp the caliper in your right hand and with your left hand, pull out the fold of
skin with its underlying layer of fat. Grasp the skin and the underlying layer of fat between the thumb and
fingers of your left hand. Pull it out in the appropriate direction and continue to hold the skinfold as you
apply the caliper. Place the teeth of the caliper onto the skinfold. The teeth should be about 1/4” (quarter
of an inch) from the fingers of your left hand, which continues to hold the fold of the skin. Completely
release

the trigger of the calipers so the entire force of the jaws is on the skinfold. Do NOT release the fingers of
the left hand while taking the readings. The teeth will move a little to a lower reading then when first
applied. This occurs because of subcutaneous water and will cease after a few seconds. This is when the
reading should be taken. (Reverse the process if you are left-handed)

Figures 11-3a and 11-3b show the anatomic location of the eight most frequently measured skinfold sites.

1. Triceps: Measure at the bottom of the 2. Subscapular: Locate the middle of the
inside (long head) of the triceps. Pull the scapula (shoulder blade) and measure
skinfold in a vertical direction. about one inch from the spine. Pull the
skinfold in a vertical direction.

3. Pectoral: Measure about one inch below 4. Mid-axillary: Measure the fold in a

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the collar bone and two to three inches out horizontal line at a level with the bottom of
from the inside edge of the pectoral muscle. the sternum. Pull the skinfold in a vertical
Be sure to stay on the pectorals and avoid directionl.
breast tissue if you are measuring a
female. Pull the skinfold in a horizontal
direction.

Figure 11-3a Skinfold sites and descriptions: Triceps, Subscapular, Pectoral, and Mid-axillary.

Skinfold Measurement tips

1. When taking measurements, do so directly on the skin, not through the clothes. Readings should
be taken in a standing position and on one side of the body—normally the right side.
2. Take readings in triplicate and use the average of the two closest readings for use in the
appropriate formula.
3. Finally, we cannot overemphasize the importance of practice.

Generalized Adult Equations

Numerous investigations have produced various equations for use on the general population as well as on
specific subgroups, such as athletes. These equations, though, have high correlations only with the
populations upon which they were developed; many of these equations are not universal. There is a set of
prediction equations, however, that is generalized for males and females. Pages 354 and 355 provide a
step-by-step guide for body fat calculation that incorporates the Jackson and Pollock body density
equation and the Brozek body fat equation.

5. Abdominal: Measure about one inch to 6. Suprailiac: Measure about halfway

the left of and one inch down from the navel between the navel and the top of the
(belly button). Pull the skinfold in a vertical hipbone. This should be at or near the area
direction. where the oblique and abdominals meet.
Pull the skinfold in a horizontal direction.

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7. Quadriceps: Measure in the middle of 8. Calf: Measure the middle of the inside
the quadriceps. If the area is too tight, you head. Pull the skinfold in a vertical direction.
may need to go up one to two inches. Pull
the skinfold in a vertical direction.

Figure 11-3b Skinfold sites and descriptions: Abdominal, Suprailiac, Quadriceps, and Calf.

Click here to enlarge Click here to enlarge

Goal Setting Using Body Composition Statistics

You can use the information obtained through body composition analysis to help you design
an appropriate time frame for expected results. A few steps can take you from body fat
percentage to the number of weeks required to reach a specific goal.

Remember that the body is composed of lean body mass (muscle and bone) and total body
fat. If a client's initial statistics reveal that he is 40% body fat, you can conclude that 60%
of his weight is attributed to lean body mass.

Ideal weight loss involves loosing body fat while maintaining lean body mass. A good goal
for our example client is a 5% reduction in body fat. With a few simple calculations, we can
figure out how this goal translates in pounds, and can then map out a timeline to reach this
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goal.

To begin, calculate the number of pounds the client carries as body fat as well as the
number of pounds allotted to LBM. Let's say that our client weighs 240 pounds. Multiply the
total number of pounds by body fat percentage (40% in our example) to reveal the number
of pounds the client carries as fat. 240 x 0.40 = 96 pounds of fat. To find the number of
pounds due to LBM, you can either subtract “fat” pounds from total weight (240 – 96 =
144) or multiply total weight by 60% (240 x 0.60 = 144).

To calculate a “goal weight,” take your clients current LBM in pounds and divide it by 1.00
minus the body fat percentage goal. (1.00 represents 100% of body weight expressed as a
decimal number — just as 0.40 represents 40% expressed as a decimal number.) In our
example, the client's LBM is 144 pounds. The body fat percentage goal is 35% (5% body fat
reduction). 1.00 – 0.35 = 0.65. To calculate goal weight, divide 144 by 0.65. 144 ÷ 0.65 =
222 pounds. With a goal of 35% body fat, the client's goal weight would be 222 pounds.
Comparing this number to the starting weight of 240 pounds reveals an 18-pound body fat
reduction. Loosing one pound per week, it would take 18 weeks to go from 240 pounds at
40% body fat to 222 pounds at 35% body fat while maintaining the 144-pound LBM.

As body composition information is obtained and documented, it should be used in

conjunction with your clients training goals to assess their progress (or lack-there-of). If
goals are not being achieved, you must review the current training and nutritional plan and
adjust accordingly. (Section 5 describes nutritional programming in greater detail.)
Consistent monitoring of body composition alerts you to when a change is needed.

Conclusion

Body composition measurement is an important part of the initial assessment procedure for
new clients and an important ongoing evaluative test for existing clients. (Excessive levels
of body fat are associated with cardiovascular disease, cancer, and other maladies.)
Assessment is also an important source of motivation as it demonstrates (hopefully)
positive changes in overall fitness levels. At the ISSA, we believe so strongly in our role as
fitness educators and health promoters, that we want all of our certified trainers to make
sure that body composition assessment becomes an integral part of workout and training
regimens.

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Unit Summary

I. Body composition testing is the determination of the fat and lean

compartments of the human body through various methods.

A. Body composition assessment is an important part of your initial assessment

procedure with new clients and an important ongoing evaluative test with existing
clients.

B. The somatotype system classifies the human body into three body types:
mesomorphic, ectomorphic, and endomorphic.

1. Mesomorphs are classified as muscular body types.

2. Ectomorphs are classified as slim or linear body types.

3. Endomorphs are classified as round types.

a. While it is good to know Sheldon's somatotype system for academic

purposes, it is not possible to establish the relative portion of an individuals'
health or fitness that is determined through heredity, therefore your genetic
background neither dooms or guarantees success in achieving total fitness.

C. Body Mass Index (BMI) describes relative weight for height. BMI is often used as
a predictor of future disease risk.

D. Evaluating fat in the abdominal region through waist circumference

measurements is important in determining an individual's health risk.

E. The body's three major structural components include muscle, fat, and bone.

1. Total body fat is deposited in different sections of the body, essential fat and
storage fat. Essential fat refers to fat stored in the marrow of bones, the heart,
lungs, liver, spleen, kidneys, intestines, muscles, and lipid-rich tissues
throughout the central nervous system. Storage fat consists of fat that
accumulates in adipose tissue.

2. Most experts in the field of body composition research agree that the average

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 body fat for young men is 15% of body weight and 25% of body weight for
women.

F. Scales, BMI and waist measurements do not account for the proportion of fat to
lean tissue. The real health concern is the portion of fat as compared to overall
weight.

1. The fat and lean compartments of the human body can be determined through
numerous methods including: DEXA, hydrostatic weighing, NMR, ultrasound, Bod
Pod, BIA, NIR and skinfold-measurements.

G. The eight most frequently measured skinfold sites are the triceps, subscapular,
pectoral, mid-axillary, abdominal, suprailiac, quadriceps, and calf.

H. Insert the skinfold-scores into mathematical equations designed to predict body

density or percent body fat.

I. Goal weight = lean body mass weight ÷ (1.0 – desired body fat percentage)

J. At the ISSA, we believe so strongly in our role as fitness educators and

health promoters, that we want all of our certified trainers to make sure that
body composition assessments becomes an integral part of workout and
training regimens.

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 Section 4: Unit 12 Outline

Program Development

I. The Stages of Program Development

A. Drawing-in Phase

1. Stage One: Establish Yourself as a professional

a. Establishing a Relationship
b. Key Characteristics in Establishing a Relationship

i. Client Rapport
ii. Know Your Craft
iii. Sincerity
iv. Integrity
vi. Enthusiasm
vii. Ethics

2. Stage Two: Data Collection

3. Stage Three: Guided Discovery

4. Stage Four: Fell the Water Before Jumping In

5. Stage Five: Establish an Integrated Fitness Lifestyle

a. Goals and Objectives

b. Goal Orientation

c. Client Motivation

Self-Quiz (8 questions)

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 LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand the five stages of the drawing-in process and how

to incorporate them into your fitness business.

The Stages of Program development

As future ISSA fitness professionals we must first seek to understand before we make recommendations.
It is the mark of all true professionals, whether they are physicians, lawyers, chiropractors or personal
trainers. You would not have confidence in a doctor’s prescription unless you had confidence in the
diagnosis. The same will hold true with regard to your clients’ confidence in your recommendations.
Consider the following:

Imagine you are having problems with your feet and decide to visit a podiatrist. After he briefly listens to
your complaint, he takes off his shoes and takes out his insoles and hands them to you. He tells you to
put his insoles on because they have worked great for him and they should work great for you. You put
them on and walk around but it simply makes your problem worse. He tells you that they work for him so
try harder to make them work for you. You try again with no success. He tells you that it is your attitude
and that you need to be positive, but still no success. The podiatrist becomes angry and says that he has
done so much to help you but you simply cannot be helped. What are the chances in another visit? We do
not have confidence in someone who does not diagnose before he or she makes a prescription. The same
is true for your future clients. As ISSA trainers we must listen first, then make our recommendations.

What fitness means for one person is not necessarily the same for another. If you try to force a certain
program on your client, rather than develop a program that is commensurate with his or her personal
preferences, current schedule and available resources, you will usually be unsuccessful in drawing that
client into a fitness lifestyle.

Referring back to the podiatrist scenario, before the podiatrist can recommend insoles that a client will be
able to live with on a daily basis, the podiatrist will have to take into account some basic information. A
mold can be made and then fitted for size. The patient can then try it on the insoles, walk and live in them
for a while. If the insoles fit and alleviate the pain, then the podiatrist has done his job. Similarly, before
you put a person on a training and nutrition program, you have to know a lot about that person. An
appropriate fit can ensure future success for your client.

At that point, you will have succeeded in “drawing” your client into a fitness lifestyle. This is what we call
the “drawing-in process.” Over the years we at the ISSA have taught this process, and it has proven to be
highly successful and popular. The process consists of five distinct and often overlapping steps.

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Drawing-in Phase

The ISSA has developed a system known as “the drawing-in phase,” which should be used when
developing a fitness training regimen for all beginning clients and in order to analyze their needs. When
consistently used, the ISSA drawing-in phase ensures a high level of client motivation, while distinguishing
you as a professional trainer. The ISSA drawing-in phase consists of the following five stages.

Stage One: Establish Yourself as a Professional

Establishing a Relationship

Perhaps the most sensitive moment in your relationship with new clients occur when they first call or visit
to find out about being trained by you. Often we are at a loss as to what to say. The best approach is to
ask a series of detailed questions. Find out who they are and what they’re about. Are they single or
married? What are their family responsibilities? What are their occupations? What hours do they work?
How physically active or sedentary are their lifestyles? By gaining a better understanding of your clients,
you will be able to later construct fitness programs that are compatible with their needs, responsibilities,
and preferences — ones that they are able to stick with.

Key Characteristics in Establishing a Relationship

Client Rapport
Developing a rapport with your clients is an essential first step in gaining their trust and confidence.
Rapport implies a relationship based on common experiences, interests or outlook. This relationship
creates a bond between you and your clients, which will decidedly improve your effectiveness as a trainer.
Try to find common interests. You will learn something about them, and the time that you spend together
can be more productive. Avoid judging your clients or setting yourself up as superior just because you are
more fit. Focus on their strengths and get them to feel good about themselves.

Know Your Craft

Knowing your craft inside and out enables you to project an authoritative aura, which will inspire
confidence in your clients. This confidence ultimately leads to trust, and when a client trusts his/her
trainer, he/she will work much harder than she/he otherwise would. That is motivation! A good trainer
literally inspires her or his charges into action. If your clients have even the slightest doubt about your
expertise, you are doomed in terms of what you can accomplish with them. Incidentally, your own
physical condition is a billboard for your level of expertise — make sure it speaks well of you! Ben Franklin
once said, “The best sermon is a good example.”

Sincerity
Sincerity is a reflection of your commitment to your clients. Like knowledge, sincerity also generates trust
that you have a genuine interest in your client’s progress and well-being. Show some interest in other
aspects of your clients’ lives, not just their fitness development. Get to know them as individuals — doing
so will not only make your sincerity evident to your clients, but it will also allow you to gain valuable
insights into what makes them “tick,” which will in turn help you to motivate them by tuning in to their
emotive “trigger points.” Note: there is a fine line over which you must not tread, in terms of getting too
personal with your clients. Always come back to the task at hand — your clients’ fitness objectives.

Integrity
Integrity reflects a committed, sincere and consistent set of principles and practices by which you operate.
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It enables your clients to practice both what you teach and what you do. Your actions, speech and
behavior should reflect your total commitment to the progress of your clients. Always conduct yourself as
a professional!

Enthusiasm
Enthusiasm in all aspects of your life is your passport to success. Enthusiasm is the by-product of
expertise and sincerity, as well as your genuine excitement about the results you know you can obtain for
your clients. Since you have experienced these results yourself, and since you can provide many
“shortcuts” for your clients due to your expertise and experience, you will naturally project enthusiasm for
your work. Generously share success stories of your own or your clients, observing that, “If I (or they)
could do it, so can you!”
Enthusiasm is also a reflection of your love for your profession. If you do not enjoy your work, it will come
across loudly to your clients. “Burnout” is sometimes a problem among trainers who expend significant
emotional energy with their clients, so self- motivation is imperative. You simply cannot allow yourself to
become a “clip-board holder,” mindlessly counting out repetitions with no real interest in the task at hand.
If you do, you will be looking for another career — one that does not require emotional commitment on an
ongoing basis.

Ethics
Personal trainers are not licensed, and the industry is not yet regulated. However, in the event of legal
problems, a judge will expect you to behave at a level consistent with other professionals. Be a
professional and do not get involved with your clients. Even a false accusation can ruin your life and end
your personal training career. You must protect yourself. While the benefit of the doubt will go to you,
being unjustly accused of impropriety is little better than actually doing something wrong. Psychologists
describe the phenomenon of transference between trainers and clients, teachers and students, and
coaches and clients as physical attraction developed by working closely with each other. You can minimize
problems by always maintaining a professional demeanor, not becoming overly friendly with clients,
particularly of the opposite sex, and documenting training sessions, evaluations and training programs.
We cannot overemphasize this point: Be a professional and do not get intimately involved with your
clients!

Stage Two: Data Collection

Data collection is an ongoing obligation starting from the very first day. You will need to collect accurate,
up-to-date information regarding your clients’ health status, training progress, and so forth. This text
contains examples of relevant forms you can use with your clients. In addition, if you are working out of a
club, it will have liability and physician consent forms, which your clients will have to fill out as well.

Stage Three: Guided Discovery

Now it is time to orient your clients through a “guided tour” of the fitness facility you work out of. This
aspect of the drawing-in phase can last 2 to 3 weeks, or as little as a few workouts, and is designed to: a)
reverse the effects of disuse; b) get the clients oriented to all available technologies; c) allow the clients to
learn what their options are and which exercises they likes best (never cram your own likes and dislikes
down your clients’ throat!); d) learn more about your clients; and e) to allow your clients to gradually
develop the discipline to maintain a more fitness-oriented lifestyle. The idea is not to force people into
immediate and massive change, but to gently guide them into gradual, long-lasting changes.

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Stage Four: Feel the Water Before Jumping In

The principle reason to try a fitness program is to Figure12-1

check for client compliance, ability and discipline to
continue with the program. Choose from the myriad
of training protocols one that you and your clients
feel will provide the easiest route toward living a
fitness (disciplined) lifestyle. This protocol will always
incorporate the exercises, training schedule, foods
and other factors that you have jointly “discovered”
during the guided discovery process. Never assume
that your favorite training protocol, your favorite
nutritional supplements or your personal fitness diet
schedule is best for your clients! All too often they
will not be! Once your clients have tested the waters Click above to enlarge image
of discipline, you can make fine adjustments to
maximize compliance.

Your clients will comply for one of two reasons:

1. Public compliance pressure.

2. Private acceptance of the regimen you and they decide upon.
The second reason is the only acceptable one. The other will surely lead to failure!

Stage Five: Establish an Integrated Fitness Lifestyle

Once you establish a relationship, collect data, go through a guided discovery, and assess your client’s
compliance, you can then use this information to establish a basic fitness program for an integrated
fitness lifestyle. Please refer to Figure 12-1.

Goals and Objectives

Now it is time to ask the question “What are your objectives?” and then develop the most scientifically
sophisticated and complete program possible within the bounds of your clients’ interest levels, monetary
restrictions and lifestyles. Never ask your clients what their objectives are until they fully understand what
their options are!

An interesting survey published in “IDEA Personal Trainer” indicated the following as reasons why people
seek personal trainers:

Goal Orientation

Goal orientation is a key element in establishing strong motivation. Goal-orientation not only shows you
where you are going, it also shows you how to get there. Beware, however, of allowing your goals to
impose limits on your clients’ performance by making them “final destinations.” Instead, look at your
goals as “stepping-stones” that will put you in position to access your next stepping-stone! In other words,
the goal is not an end, but a means to another goal. Excellence is an ongoing process for the passionate,
committed trainer.

A goal can be seen as the bridge between wanting to achieve something and actually achieving it. The
following conditions must be present in order for a sincere desire to be considered a goal.

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• A goal must be well
defined. Vague wishes or
desires, such as “I want to
be a great baseball player”
or “I want to become % of Respondents to
thinner” just don’t cut it. Client Goals*
Survey
Instead, “I want to make
the little league team this Body Shaping, (82%)
year” or “I want to weigh
165” are better defined, Weight
and as such, are more Management, (77%)
attainable.
• A goal must be stated in
writing. Busy schedules Muscular Strength, (72%)
and the various
complexities of life have a Improve Health, (72%)
way of turning sincere
desires into distant Exercise Adherence, (72%)
memories. Goals must be
written down and put in a Improve Lifestyle, (56%)
place where they will be
seen often. Improve Diet, (55%)
• A goal must be stated in
the positive. The Improve Self-Image, (52%)
subconscious mind does
not understand negatively Aerobic
(51%)
stated goals, so always Improvement,
use a positive frame of
reference in constructing Psychological
(36%)
your goals. Not “I won’t Health,
eat junk food any more”
but “I will eat healthy Meet Social Needs, (23%)
foods each day.” Better
yet, “I enjoy eating *Please understand that these are not truly
healthy foods each day.” goals but merely reasons to go to a personal
Now the goal is an trainer. A goal is a specific objective to be
affirmation, which can be achieved at a specific point in time.
used to precipitate action.

• A goal must have a deadline for its completion. In order to get really excited about a goal, there
must be an expected time of completion. Otherwise, there will be no sense of urgency, and before
you know it, you are right back where you started, no closer to your goal. Of course, unexpected
problems and circumstances often arise, and when this happens, simply adjust the completion date
accordingly.
• A goal must have sincere emotional appeal. If it does not, there will be no urgency or passion.
Learn to prioritize the most important goals, and make the distinction between a mere wish and an
important objective.
• A goal must be difficult, yet realistic. If the goal is too easy, e.g., “I will go to the gym tomorrow,”
it will be very unlikely that enough attention will be focused on it to get it done. Conversely, if it is
too difficult, the confidence of knowing it can be done will be lacking. Set goals in such a way that
with a sustained, concentrated effort, you know you can get the job done.

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Client Motivation

As leaders of the fitness lifestyle, it is essential to realize that most clients do not care how much we know
until they know how much we care. Therefore, it is imperative that we learn to listen so that we can
effectively communicate, educate and create situations that allows clients to reach their full potential. In
order to reach their potential, desire must be nurtured through recognition and praise. Recognition and
praise will keep clients moving smoothly toward their goals.

Motivation is a complex subject. Motive is defined as an impulse or physiological need acting as incitement
to action. This inner drive compels people to make an initial action. This initial action may take the form of
diet pills, buying exercise equipment off of an infomercial, joining a gym, experimenting with a new diet,
opting for surgery or acquiring the services of a personal trainer. This internal drive usually stems from
the basic need of acceptance or the need of recognition.

Successful trainers understand that recognition is about thanking people, listening and treating people
with dignity. The importance of trainers’ interactions cannot be overemphasized. It does not matter what
we say; it matters what our clients hear. Trainers should be aware of the types of interactions that foster
participants’ learning, motivation to exercise and attendance. The following section describes instructional
strategies in the visual, auditory and kinesthetic/tactile domains. If a participant has a weak sensory
channel (visual, auditory or kinesthetic/tactile), then a multi-sensory approach is warranted. This
approach makes use of all of the senses to promote and reinforce the learning of knowledge and skills. If
we become better listeners, then we can become more effective trainers.

Visual Domain

• Demonstrate a skill whenever possible.

• Tell the participants what to look for in your demonstrations.
• Be sure everyone in the group can see you.
• Maintain eye contact when speaking to participants.
• Use diagrams if necessary.
• Use visual cues to enhance body awareness and coordinated movement (e.g., footprints placed on
the floor; stickers placed on the body or equipment; pointing to a body part; arrows or lines on the
floor).

Auditory Domain

• Whenever possible, provide participants with facts or background information regarding exercises
and procedures.
• If needed, verbally direct a participant to perform a task.
• Allow participants with hearing impairments to see your mouth and hand gestures. Do not over
exaggerate mouth movements.
• Provide corrective skill feedback: information regarding how to correct an inadequate performance.
Knowledge of results leads to increased learning.
• Provide positive skill feedback: Tell participants what they did correctly to reinforce the likelihood of
the skill being correctly performed again.
• Ask questions regarding discomfort during exercises (e.g., pain during passive range-of motion,
pain during cardiovascular training). This information alerts the trainer to signs of exercise distress
and provides feedback regarding his/her technique. The trainer should also ask questions regarding
exercises and procedures for the purpose of testing the participants’ knowledge.
• Listen to the participants’ questions, responses and attempts at conversation.
• Utilize praise, vocal intonation, claps, gestures and expressions to activate or intensify motor
performances and foster appropriate behavior.
• Use simple verbal cues to assist the participants in better visualizing the movements.

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Kinesthetic/Tactile Domain

• Manually guide a participant with a visual impairment or apraxia through the desired motions.
• Physically assist a participant whenever needed (e.g., manual assistance that enables a participant
to reach full range of motion).
• Tap the body part to facilitate movement in the correct direction.

Once you are communicating effectively, never underestimate the power of kindness. Kindness is
the ultimate form of recognition. Mary Kay Ash the founder of Mary Kay Cosmetics once said,
“There are two things people want more than sex and money. Recognition and praise.” Kindness
can be offered by anyone. It honors human dignity, it sincerely listens, and it radiates compassion,
love and respect. Successful trainers use these simple gestures everyday:

• A heartfelt verbal thank you or congratulations.

• An unexpected voice mail or e-mail to show your appreciation.
• A handwritten note, birthday card or message.
• Listening: You can convey no greater honor than to sincerely listen to what your clients have to
say.

To be a more effective trainer, utilize this information while teaching your client, new skills. Your attention
to detail will be rewarded in the form of attentive clients and a reputation for genuine care regarding the
progress of your clientele.

Unit Summary

I. As future ISSA fitness professionals, we must seek first to understand our clients before we make
recommendations.

A. The ISSA drawing-in phase ensures a high level of client motivation, distinguishes you as a professional
and consists of the following five steps: (1) establishing yourself as a professional; (2) data collection; (3)
guided discovery; (4) feeling the water before jumping in; and (5) establishing an integrated training
process.

1. Stage one: Establish yourself as a professional through client rapport, knowing your craft,
sincerity, integrity, enthusiasm and business ethics.
2. Stage two: Data collection
3. Stage three: Guided discovery
4. Stage four: Feel the water before jumping in
5. Stage five: Establish an integrated fitness lifestyle based on your client’s (informed)
objectives.

B. Goal orientation is a key element in establishing strong motivation.

1. A goal must be well defined.

2. A goal must be stated in writing.
3. A goal must be stated in the positive.
4. A goal must have a deadline for its completion.
5. A goal must have sincere emotional appeal.
6. A goal must be difficult, yet realistic.

C. Motive is defined as an impulse or physiological need acting as incitement to action.

1. Trainers should be aware of the types of interactions that foster the participant’s learning,
motivation to exercise and attendance.
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a. Communication occurs through the visual, auditory and kinesthetic/tactile domains.
2. If we become better listeners, then we can become more effective trainers.

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 Section 4: Unit 13 Outline

Basic Assessment of Fitness Participants

I. Basic Assessment

A. What a GXT Involves

1. Who Should Have a Stress Test?

2. How Safe is a GXT?
3. What Information Does a GXT Provide?
4. After the GXT
5. Blood Pressure Basics

B. How Hard Should Your Clients Train?

1.Using THR
a. Karvonen Formula

2. Using RPE
a. Borg RPE Scale

3. Using the MET Equivalents

a. No Pain, No Gain...No Way!

4. Assessment for Cardiovascular Endurance

a. 12-Minute Run-Walk Test
b. 12-Minute Swimming Test
c. 12-Minute Cycling Test
d. Step Test

5. Assesment for Muscular Strength

a. Upper Body Test
b. Lower Body Test
c. Advanced 1RM Testing

6. Assessments for Flexibility

a. Simple Client Pre- and Post-Test Assessment

7. Muscular Endurance Assessment

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

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 • Develop the proper client assessment for your clients’ individual needs.
• Implement tests in order to determine target heart rate, cardiovascular endurance,
flexibility, muscular strength, body composition and girth measurements.

Basic Assessment

Every exercise program should begin with an assessment of your client’s physical fitness; unfortunately
this process is often neglected. Each physical assessment should at least include the parameters of
muscular strength and endurance, flexibility and cardiovascular endurance. Assessments provide a
baseline from which to evaluate your progress. Assessments allow you to note the areas that need
improvement, and from that information, develop a personalized program based on what is best for your
client. Assessments also give you an opportunity to discuss what the results mean with your client. This is
a great time to reiterate the importance of physical fitness and how improvements in test scores reflect on
improvements in health.

Assessment is the first step in developing an exercise program, but be aware that not all assessment tools
are suitable for all clients. Assessment should be done during the course of your initial consultation. You
should discuss in depth any medical or chronic conditions that your client presents. This is also the
appropriate time to request medical clearance from the client’s physician and, if necessary, inquire about
parameters to work within for more serious conditions. If it is impossible for you to speak directly with the
physician regarding your client’s medical condition, send a form to the doctor to complete and send back
to you, or have the client take it to the doctor and bring it back to you. You may create your own or use
the example provided. The form should include the doctor’s recommendation for exercise, any activities or
exercises that would be contraindicated (and the reason why), and any other pertinent information
relevant to designing a safe and effective training program. This form should be completed in addition to
the medical clearance release form.

Once the client returns the form to you, be sure to go over it with him/her thoroughly. This will ensure
that you are very familiar with the medical/health history of the client and also give you a chance to
discuss options. These forms are available for download on the ISSA website located at
www.FitnessEducation.com.

Once you reach the decision to have your client start exercising, his / her physician may recommend a
graded exercise test (GXT) before you have him/her exercising. This procedure commonly referred to as
an exercise stress test. Such a recommendation from one’s physician may raise a number of questions in
your mind regarding a GXT: What does a GXT involve? Why should your client undergo a GXT? Is it safe?
What information does it provide? Understanding the answers to such questions and other relevant issues
concerning graded exercise testing may help to alleviate much of the confusion and mystery that
frequently exists concerning this increasingly utilized evaluative procedure. Certainly if your client has
never engaged in an aerobic exercise program before, a better understanding of what an exercise stress
test involves may lessen the likelihood of your client experiencing undue anxiety.

What a GXT Involves

A GXT can be administered in a variety of locations, including a physician's office, a hospital, and a health
and fitness facility. Regardless of where a GXT is administered, special equipment to handle any medical
emergency that may arise and a sufficient number of appropriately trained professionals must be present.
According to the guidelines established by the American Heart Association (AHA) and adopted by ISSA, all
individuals who administer GXTs should be trained in cardiopulmonary resuscitation (CPR), and at least
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one of the technicians in the testing area should also be trained and certified in advanced cardiac life
support. Also, in accordance with AHA guidelines, a physician should be on the premises (e.g., in the
building) at all times.

Prior to the start of a GXT, a resting electrocardiogram (ECG) is performed to check for cardiac
abnormalities that exist in the absence of “stress” and to provide a basis for comparison with your
physiological responses during the exercise session. Both resting blood pressure and heart rate are
assessed and monitored throughout a GXT. Electrodes (sensors) are placed on the chest during a resting
ECG. These sensors remain in place during a GXT so that the rhythm and electrical activity of the heart
can be monitored continuously throughout the GXT. At rest, an ECG may indicate that the heart is
receiving adequate amounts of blood and oxygen, but when the body is stressed (i.e., during exercise), an
ECG may reveal signs that your heart is receiving insufficient amounts of blood and oxygen.

A variety of modalities (e.g., treadmill, stationary cycle, stair climbing machine, etc.) can be used to
provide the exercise stress. The motor-driven treadmill is the device most commonly used in the United
States for graded exercise testing. In general, a GXT initially involves placing a relatively low level of
exercise-induced stress on the cardiovascular system. Subsequent increases in work demand are then
gradually incorporated into the exercise protocol the client is required to perform by raising either the
speed or grade (incline) of the treadmill. Because the goal of a GXT is simply to determine the capability
limits of the cardiovascular system, you need not worry about the treadmill reaching “warp” speed or
being raised to a grade that simulates Mount Everest.

Two different types of GXTs can be administered. One is referred to as a symptom-limited maximal GXT
and the other as a submaximal GXT. The symptom-limited maximal GXT is the more common of the two
types of GXTs and involves progressively increasing the intensity of the exercise until signs or symptoms
of exertion intolerance are displayed. The submaximal GXT, on the other hand, progressively increases the
level of exercise intensity a predetermined end point (e.g., 85% of your maximum heart rate) is reached
or until a sign or symptom of exertion intolerance occurs (before the end point has been reached).

Who should have a Stress Test?

The current guidelines of the AHA (for both male and female) indicate that individuals under age 40 who
undergo a normal physical examination, which indicates no symptoms of cardiovascular disease, no
coronary risk factors, no physical findings (including murmurs and hypertension), they can be considered
free of disease and do not require a GXT before undertaking a new exercise regimen. On the other hand, if
you have a client 40 years of age or older with an abnormal physical examination (murmur, etc.) or two or
more coronary risk factors, he/she should have a GXT before embarking on a vigorous exercise program.

In guidelines recently revised by the American College of Sports Medicine (and subsequently adopted by
ISSA), a GXT is not recommended prior to initiating an exercise program if your client is an asymptomatic
male 40 years or younger or female 50 years or younger. If your client is an older asymptomatic adult
(males 40-plus, females 50-plus), you may have him/her begin a moderate exercise regimen (intensity
40% to 60% maximum oxygen uptake capacity, or VO 2max) without a GXT. A GXT is recommended for all
clients for whom you are planning a vigorous exercise program (intensity greater than 60% VO2max).

The ACSM and ISSA use the same criteria of two or more primary risk factors as the basis for
recommending a GXT prior to an individual beginning an exercise program. Moderate exercise is, however,
permitted without a GXT for individuals without coronary artery disease (CAD) symptoms but with two or
more CAD risk factors. Individuals with two or more risk factors, but without symptoms, must undergo a
GXT only before vigorous exercise.

How Safe is a GXT?

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Like most medical procedures, a GXT is not without some risk. The risk can be minimized by proper
screening and by having the test administered by properly trained personnel. As stated previously,
personnel involved in conducting a GXT should be familiar with the equipment and trained to handle
emergency situations should they arise. Although unfavorable events (e.g., heart attacks) are well
publicized, they are extremely rare (less than one per every 500 symptom-limited maximal GXTs). The
risk of dying is much lower (less than 1 in 10,000).

What Information Does a

GXT Provide?

In the early stages of CAD, individuals usually do not exhibit symptoms of coronary insufficiency while
either at rest or during non-strenuous activity. During exercise, however, signs or symptoms of CAD often
become evident, as the demands for oxygen increase beyond what the diseased arteries can deliver. If the
oxygen demand and supply imbalance is relatively large, it can cause anginal chest pain — a hallmark sign
of CAD. Smaller oxygen imbalances can cause changes in heart rate, blood pressure and heart rhythm and
may elicit changes on the ECG. An abnormal ECG during a GXT is only suggestive that a cardiac problem
is present since the results of such tests are not always accurate. Approximately 10% to 20% of GXTs
result in false positives (i.e., the test erroneously indicates that an individual has heart disease).
Unfortunately, a higher proportion (20% to 40%) of false negative (i.e., the test incorrectly indicates that
an individual is free of heart disease) GXT results occur. Accordingly, when evaluating test results, the
physician must consider all of the following: how long and through what stage the individual exercised,
what your heart rate and blood pressure responses, whether any rhythm disturbances of heart occurred
and when they occurred, whether any ECG abnormalities appeared, and how he/she looked and felt.

After the GXT

Once your client has taken a GXT, you should discuss the results with his or her doctor. If no problems are
discovered, the information provided by the GXT should then be used to design an appropriate exercise
program for your client’s specific goals, needs, interests and fitness level. Should your client’s physician
feel that his/her stress test was not accurate or was inconclusive, he or she may recommend a thallium
exercise stress test in order to improve the diagnostic accuracy of the evaluative procedure.

Remember, it is impossible to “flunk” a GXT. If a problem is detected, it is much better to identify it in the
controlled setting of a physician's office, a hospital, an exercise science laboratory or a health and fitness
club than in your client’s own home. Finally, no matter who you are, or who your client is, both of you can
benefit from participating in an exercise program based on the information obtained from a properly
conducted GXT.

Blood Pressure Basics

Pulse

When you place your finger over an artery near the skin surface you can feel the pulse. The number of
pulses that can be counted per minute indicates the number of heartbeats per minute. Every time the
heart contracts a pulse wave is initiated. When the left ventricle pumps blood into the aorta, the wall of
the aorta stretches. The expansion or pulse wave moves faster than the blood itself. As soon as the wave
has passed, the elastic wall of the artery snaps back to normal size. This alternating expansion and recoil
of the artery is known as the arterial pulse. As the left ventricle forces a large volume of blood into the
aorta during systole, the aorta expands to accommodate this blood. As the walls of the aorta recoil to
normal size, during diastole, the blood is kept flowing into the capillaries. Without this mechanism, the
blood would rush through the arteries and into the arterioles and capillaries damaging the delicate walls of
the capillaries.

Blood Pressure
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Blood pressure is the force exerted by the blood against the inner walls of the blood vessels. It is
determined by the flow of the blood and by resistance to that flow. Blood pressure is expressed as systolic
pressure over diastolic pressure. In arteries, blood pressure rises during systole and falls during diastole.
A blood pressure reading is expressed as systolic pressure over diastolic pressure. Assessing blood
pressure can be part of your normal assessment process. The following chart demonstrates the proper
way to take blood pressure.

How to take blood pressure

Blood pressure is taken using a

medical-grade
sphygmomanometer and
stethoscope.

1. Seat client in a quiet room

with upper arm exposed.
(For best results, do not
pull a tight sleeve up, which
may create pressure on the
upper arm. Have client
wear a tank top or loose T-
shirt.)
2. The cuff should be
smoothly and firmly
wrapped around the upper
arm at heart level with its
lower margin about an inch
above the antecubital
space.
3. Locate the brachial artery
on the inner side of the
upper arm (approximately
1 inch above the bend in
the elbow) and place
stethoscope over the artery
applying minimal pressure.
The stethoscope should not
touch the cuff or its tubing.
4. The arm should be relaxed
and supported by you at an
angle of 10 to 45 degrees.
5. Make sure the air-release
switch remains closed (turn
knob clockwise).
6. Rapidly inflate the cuff with
quick, even pumps to 180
to 200 mm Hg.
7. Gradually release the cuff
pressure (about 3 to 5 mm
per second) by slowly
opening the air release Blood Pressure Levels
knob (counterclockwise
turn) noting the first sound. Systolic (mm Diastolic
Category
The systolic pressure is the Hg) (mm Hg)
result of turbulence from
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 the rush of blood as the Optimal Less than 120 Less than 80
formerly closed artery
briefly opens during the Normal Less than 130 Less than 85
highest pressure in the
cardiac cycle. High Normal 130-139 85-89
8. Continue to release
pressure, noting when the Hypertension
sound becomes muffled
(4th phase diastolic Stage 1,
pressure) and when the 140-159 90-99
sound disappears (5th
stage diastolic pressure). Stage 2, 160-179 100-109
Clinicians usually record the
5th phase as diastolic blood Stage 3, 180 or higher 110 or higher
pressure.
Adapted from “Heart and Stroke Guide,” American
NOTE: If blood pressure Heart Association
reading needs repeating,
allow 30 to 60 seconds
between trials. If the
reading exceeds 140/90
mm, allow a 10 minute
rest before repeating.

How Hard Should Your Clients Train?

Perhaps the most important component of a sound exercise recommendation for fitness is the level of
exercise intensity. The prescribed level of intensity must be sufficient to overload the cardiovascular
system, but not so severe that it overtaxes any of the systems of the body. For the apparently healthy
individual who wants to develop and maintain an adequate level of cardiorespiratory fitness, the ISSA, as
does the ACSM, recommends that the intensity level of the exercise be 55% to 85% of the person's
VO2max. For most participants, exercise intensities between 60% to 80% of VO2max are prescribed. It is
generally believed, however, that the appropriate intensity threshold to elicit a training effect is at the low
end of the recommended continuum for those who have been relatively sedentary, and at the high end of
the scale for those who are physically active.

Unfortunately, many adults — particularly those just starting an exercise program — have difficulty
estimating the intensity of exercise needed to produce improvements in their aerobic fitness levels. This
difficulty in properly gauging exercise intensity often results in a lack of improvement or, worse,
overexertion which, in turn, leads to excessive muscle soreness and/or injury. The key you want to
remember is that to maximize the benefits from your client’s aerobic workouts, he/she need to exercise
within an appropriate intensity range. In order to identify what intensity range is appropriate for your
client, use one or more of the several techniques, which exist for monitoring acceptable levels of exercise
intensity. The most widely used methods are target heart rate (THR), ratings of perceived exertion (RPE)
and metabolic equivalent units (METs).

Using THR to Measure Exercise Intensity

When an individual exercises, the heart beats faster to meet the demands of the muscles for more blood
and oxygen. The more intense the exercise bout, the faster the heart beats. Thus, all factors considered,
monitoring heart rate during exercise provides a very accurate reflection of the metabolic intensity of the
exercise. Several techniques can be used to determine an appropriate target heart rate.

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Exercise intensity can be prescribed in terms of heart rate (HR) by using specific heart rate values that are
equal approximately to 60% to 80% of VO 2max. One method involves monitoring HR at each stage of a
maximal graded exercise test (GXT). Heart Rate is plotted on a graph against the VO 2max equivalents
(METS) of each stage of the test to define the slope of the heart rate response to exercise. From this
relationship, the exercise heart rate associated with a given percent of VO 2max can be obtained. While
this method is generally the most accurate approach for determining what constitutes an appropriate level
of exercise intensity, it is often times impractical since it requires you to complete a maximal GXT — with
its associated logistical and safety considerations.

Another method for assessing exercise intensity is based on the observation that 70% and 85% of
maximal heart rate is equal to approximately 60% and 80% of functional capacity VO2max. For example:

THR range = maximal HR x 0.70 and 0.85

where:

THR = target heart rate

maximal HR = 220 – age (low estimate)
or
210 – (0.5 x age) (high estimate)

The third method for determining the exercise heart rate is to calculate the heart rate reserve (HRR).
Developed by Dr. M. Karvonen, the HRR method of determining training or target heart rate range,
requires a few simple calculations:

Karvonen Formula

Example

220 220

–____ ,Subtract age – 30

____,Predicted, age-adjusted maximum 190

–____,Subtract resting heart rate – 70

____,Heart rate reserve 120

x____,Multiply by exercise intensity of 60-80% x 0.70

____, 84

+____,Add resting heart rate back in + 70

____,Target heart rate (beats/minute) 154

Whenever possible, use an accurate measurement of maximal heart rate rather than a predicted or
estimated one. Estimated maximal heart rates have a distinct disadvantage in that they are based on
population averages, and, as a result, have a relatively large standard deviation of plus or minus 10 to 12
bpm.

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The HRR or Karvonen method adjusts THR so that a given percentage of THR calculated by using the
Karvonen method is the same as the HR equivalent of that specific percentage of VO 2max. In other words,
a THR calculated at 70% of maximal heart rate is roughly the same as the heart rate corresponding to
70% of VO2max.

Using RPE to Measure Exercise Intensity

Another method for prescribing and monitoring exercise intensity involves using ratings of perceived
exertion (RPE). Perceived exertion refers to the physical strain individuals believe they are experiencing
while exercising. Perceived exertion feedback is important because it provides a practical means for
individuals to become sensitive to what constitutes appropriate exercise intensity. During exercise,
perception of effort is influenced by a variety of cues — some local in nature (e.g., sensations of muscular
discomfort or strain) and some central in nature (e.g., heart rate, breathing rate, etc.).

The most common BORG RPE SCALE

measurement tool for assessing
perceived exertion is a ratings Perceived Exertion During
scale named after its developer, Rating
Exercise
Swedish psychologist Gunnar
Borg. Borg's pioneering 6
concepts involving perceived
exertion have evolved 7 Very, very light
dramatically over the years.
Originally, Borg proposed a 8
scale (also referred to as the
RPE Scale) that utilized 15 9
categories (6 to 20) of Very light
sensations — seven of which 10
were identified by descriptors.
11
Borg's original efforts were Fairly light
based on the premise that his 12
numbering system closely
correlated to heart rate. When a 13
"0" was added to each category Somewhat light
number, a range of numbers 14
quite comparable to the heart
rate range in young, trained 15
individuals (60 to 200 bpm) was Hard
created. Borg's initial RPE scale 16
followed the patterns of heart
rate and oxygen consumption 17
during incremental aerobic Very hard
exercise. As exercise intensity 18
increased, heart rate, oxygen
consumption and RPE increased. 19
Subsequently, however, Borg Very, very hard
and other exercise scientists 20
recognized that perceived
exertion is extensively Source: ACSM Guidelines for Exercise Testing and
influenced by additional Prescription
variables, some of which have a
nonlinear relationship to
exercise intensity (e.g., lactic
acid production, ventilatory
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responses, etc.).

In the more than 20-year period since Borg introduced his original work on perceived exertion, RPE scales
have been found to have a wide range of applications. In using RPE to monitor exercise intensity, the
individual who is exercising provides a verbal description of how (relatively) difficult the exercise is based
on categories assigned to each of the numbers. For example, a perceived exertion rating of 4 of the
Category/Ratio RPE scale has been observed to correspond to approximately 60% of VO 2max. On the
other hand, a rating of 6 corresponds to approximately 80% to 85% of VO 2max. Therefore, an RPE range
of 14 (somewhat hard) to 16 (hard) is recommended for most healthy adults.

Monitoring exercise intensity with the RPE scale is beneficial because:

• It serves as a cross-check on THR, especially if estimations of maximal HR are based on age.

• Unlike manual HR monitoring (counting each heart beat by placing two fingers on a main artery),
you are not required to stop exercising to check it.
• It requires no special equipment to accurately describe your perception of intensity, whereas
relatively expensive HR monitors are needed for accurate HR determinations.

A number of studies have shown that participants skilled at using RPE as an indicator of overall feeling of
exertion can use it to easily and effectively specify an RPE level to achieve a particular level of
conditioning. It can also be used in conjunction with a THR prescription. In addition, RPE can be used to

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assess (and modify, if necessary) the effectiveness of a specific exercise prescription. RPE, for example, is
often one of the first readily recognizable measures of (positive) changes in aerobic fitness.

Using MET Equivalents to Measure Exercise Intensity

All physical activities can be classified on the basis of their oxygen requirements. The amount of oxygen
your body consumes is directly proportional to the energy you expend during the activity. At rest, your
body consumes approximately 3.5 ml of oxygen per kilogram of body weight per minute. The resting level
of oxygen consumption is referred to as l.0 MET. Thus, an eight-MET level would equal eight times the
amount of oxygen you use at rest.

Although the MET method can be used for prescribing exercise intensity, it has two serious limitations.
First, various environmental factors such as heat, humidity, cold, wind, altitude, pollution, differences in
terrain, etc., can change the way your cardiovascular system responds to a given MET level. As a result,
your cardiovascular system may be working harder at the same MET level. Also, as your level of fitness
improves, different MET levels are required to ensure that the training stimulus is sufficient to produce
continued improvements. For these reasons, compared to MET equivalents, both THR and RPE are more
commonly used to indicate exercise intensity.

Table 13-1: Leisure Activities In Mets

Activity Mean Range Activity Mean Range

Archery 3.9 3-4 Hunting (bow or gun)

Small game (walking,

Backpacking --- 5-11 ---- 3-7
carrying light load)

Big Game (dragging carcas,

Badminton 5.8 4-9+ ---- 3-14
walking)

Basketball Judo 13.5 ----

Gameplay 8.3 7-12+ Mountain Climbing ---- 5-10+

Non-game ---- 3-9 Music Playing ---- 2-3

Billiards 2.5 ---- Paddleball, Racquetball 9 8-12

Bowling ---- 2-4 Rope Jumping 11 ----

Boxing 60-80 skips/min 9 ---

In-ring 13.3 ---- 120-140 skips/min ---- 11-12

Sparing 8.3 ---- Running

Canoeing,
---- 3-8 12 min per mile 8.7 ----
rowing and

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kayaking

Conditioning
---- 3-8+ 11 min per mile 9.4 ----
Exercise

Climbing Hills, 7.2 5-10+ 10 min per mile, 10.2 ----

Cricket 5.2 4-8 9 min per mile, 11.2 ----

Croquet 3.5 ---- 8 min per mile 12.5 ----

Cycling 7 min per mile 14.1 ----

Pleasure or to
---- 3-8 6 min per mile 16.3 ----
Work

10 mph 7.0 ---- Sailing ---- 2-5

Dancing (social,
---- 3-8 Scuba Diving ---- 5-10
square, tap)

Dancing
---- 6-9 Shuffleboard ---- 2-3
(aerobic)

Fencing ---- 6-10+ Skating, ice and roller ---- 5-8

Field hockey 8.0 ---- Skiing, Snow

Fishing Downhill ---- 5-8

From Bank 3.7 2-4 Cross-country ---- 6-12+

Wading in Stream ---- 5-6 Skiing, Water ---- 5-7

Football (touch) 7.9 6-10 Sledding, Tobagganing ---- 4-8

Golf Snowshoeing 9.9 7-14

Power Cart ---- 2-3 Squash ---- 8-12+

Walking (carrying
5.1 4-7 Soccer ---- 5-12+
bag)

Stair Climbing (machine

Handball ---- 8-12+ ---- 3-17
based)

Hiking (cross
---- 3-7 Swimming ---- 4-8+
country)

Horseback Riding Table Tennis 4.1 3-5

Galloping 8.2 ---- Tennis 6.5 4-9+

Trotting 6.6 ---- Volleyball ---- 3-6

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 Walking 2.4 ----
Adapted from ACSM’s Guidelines for Exercise
Testing and Prescription, 5th Ed. Philadelphia, PA:
Horseshoe
---- 2-3 Lea & Febiger, 1995.
Pitching

No Pain, No Gain . . . No Way!

The old adage — “no pain, no gain” — when applied to exercise — has often led more than one
unsuspecting individual to attempt to do too much. In fact, a strong argument could be made that
“no pain equals no gain equals no sense.” It is in your best interest to keep in mind that exercise
does not have to “hurt” to produce improvements in fitness level. Whether someone is new to the
“joys” of exercise or a profound fitness enthusiast, using the THR or RPE methods will make workouts
more effective and more enjoyable.

Assessment for Cardiovascular Endurance

Testing for cardiovascular endurance includes a variety of methods and equipment, reflecting the
wide differences in capabilities found among clients. This section will provide protocols for
submaximal tests in swimming, leg cycle ergometry and walking/running. There are several simple
methods used to assess cardiovascular endurance in older persons. The two most common methods
are the 12-minute run-walk and the step test, both of which are included in this unit.

12-Minute Run-Walk Test

The goal of this test is to have the participant cover as much distance as possible in 12 minutes. It is
best to perform the test on a track for ease of calculations. It is useful to place cones every 100
yards to facilitate measurement of distance. This test can be used to compare pre-training and post-
training levels of aerobic fitness. Some older people will not perform well and may receive a poor
classification. It is more important to focus on the progress they achieve through training than the
classification they might receive; remember to focus on the positive!

12-Minute Running/Walking Assessment

Classification Under 30 yr. 30-39 yr. 40-49 yr. 50+ yr.

Very Poor Under 1.0 mi. Under .95mi. Under .85 mi. Under .80 mi.

Poor 1.00-1.24 .95-1.14 .85-1.04 .80-.99

Fair 1.25-1.49 1.15-1.39 1.05-1.29 1.00-1.24

Good 1.50-1.74 1.40-1.64 1.30-1.54 1.25-1.49

Excellent Over 1.74 Over 1.64 Over 1.54 Over 1.49

Source: Cooper, K., The New Aerobics

12-Minute Swimming Test

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This test can be used to assess cardiovascular endurance in people who are not able to run or walk
comfortably enough to complete the run/walk test. This is also an excellent assessment for
asthmatics who seem to experience fewer incidents while performing water exercise. Be sure to find
out the length of the lap lanes of the pool that you use for the testing site. Although most pool lanes
measure 25 yards or meters, you need to be sure of the distance in order to obtain accurate results.

12-Minute Swimming Assessment

Classification Under 30 yr. 30-39 yr. 40-49 yr. 50+ yr.

Under 418 Under 374 Under 352

Very Poor Under 440 yd.
yd. yd. yd.

Poor 440-545 418-502 374-458 352-435

Fair 546-655 503-612 459-568 436-545

Good 656-765 613-722 569-678 546-655

Excellent Over 765 Over 722 Over 678 Over 655

Source: Cooper, K., The New Aerobics

12-Minute Cycling Test

This test can be used to assess cardiovascular endurance in the client that prefers
cycling to the other previous assessments listed. This test can be done outside (using
appropriate distance markers) or inside on a stationary cycle.
Step Test
Another practical test that requires very little equipment is the Step Test. This test,
along with the bicycle ergometer, is excellent for assessing visually impaired students.
This test is also appropriate for all ages and both sexes. Because the test lasts only
three minutes, only extremely unfit individuals would find this test too vigorous. This
test should only be performed if a physician has given the participant medical
clearance.
Equipment:

1. 12” bench step (with at least a 24” x 16” stepping area)

2. Clock with a sweep hand (seconds) or a stopwatch
3. Stethoscope (not necessary but useful)
4. Metronome

Procedure:

1. Set the metronome to 96 beats per minute.

2. Stepping cadence (96 bpm) is 24 steps per minute. The rhythm of the steps will
be a 4 count: up, up, down, down. Step up with the right foot, then left, followed
by right foot down then left foot down.
3. Demonstrate the pattern to your client.
4. Allow 15 seconds of practice with the metronome.
5. Begin the test; time client for 3 minutes.
6. After 3 minutes, terminate the test and have the client sit down.
7. Five seconds after the 3-minute termination mark, take the client’s pulse for one

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 complete minute.
8. Record this one-minute post exercise rate.
9. Compare to the standards below.

Kasch- Pulse Recovery Step Test

Below
Excellent Very Good Average Poor
Average

71 - 78 bmp 79 - 83 bmp 84 - 99 bmp 100 - 107 bmp 108 - 118 bmp

Muscular Strength Assessment
The participant’s posture, range of motion and starting position for selected activities
should be considered in the following strength assessment. It is also important to note
any compensatory mechanisms or muscle substitutions that occur during a movement.
Prior to engaging in any physical assessments, be sure to have your client warm up.
Stretching or challenging the muscle without a proper warm up is a surefire way to
injure your client. Let him/her warm up thoroughly, and be sure to explain the
procedures you are about to perform. Scores on the following tests, which gauge arm
and leg strength, reliably reflect strength throughout the upper and lower body,
respectively. Remember, all client information is confidential!

Upper-Body Test

Have the client lie on a flat bench and with the barbell racked. When you are ready to begin, instruct the
client to place his/her hands on the bar slightly wider than shoulder width. After lifting the bar off the
rack, instruct the client to lower the bar to chest level and then push it back up to the starting position. Be
sure to stress the importance of breathing properly and keeping the low back pressed into the pad of the
bench.

When attempting to determine a client’s one repetition maximum (1RM), a good starting place is the
client’s body weight multiplied by the minimum value listed in the “fair” or “average” category found under
the appropriate age-group heading. This will give you a good idea of the amount of weight to start with
when testing for 1RM.

For example, say your client is a very sedentary 58-year-old man who weighs 170 pounds. To estimate a
weight to begin testing his 1RM, multiply 170 (his weight) by .65 (minimum value for fair in his age
group) to arrive at 110.5. The number 110.5 represents the amount of weight in pounds that your client
should be able to bench press for a 1RM, taking into consideration his age and assuming that he is in fair
condition.

Additional testing of this client shows that he can actually perform a 1RM bench press with 130 lbs. You
would determine his rating by dividing 130 lbs. by his body weight of 170lbs to arrive at .76. When you
look on the chart in the 50 to 59 age group, you will see that 0.76 would give this client a rating of
average.

Values for Bench Press Strength in 1RM/body weight in pounds

Rating Age in Years

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Men 20-29 30-39 40-49 50-59 60+

Excellent >1.26 >1.08 >.97 >.86 >.78

Good 1.17-1.25 1.01-1.07 .91-.96 .81-.85 .74-.77

Average .97-1.16 .86-1.00 .78-.90 .70-.80 .64-.73

Fair .88-.96 .79-.85 .72-.77 .65-.69 .60-.63

Poor <.87 <.78 <.71 <.64 <.59

Women 20-29 30-39 40-49 50-59 60+

Excellent >.78 >.66 >.61 >.54 >.55

Good .72-.77 .62-.65 .57-.60 .53-.59 .51-.54

Average .59-.71 .53-.61 .48-.56 .43-.50 .41.50

Fair .53-.58 .49-.52 .44-.47 .40-.42 .37-.40

Source: The Institute for Aerobic Research. 1985 Fitness Norms.

Calculations:

170 (weight in lbs.) x .65 (fair rating, 50-59 age group) = 110.5 lbs. (est. 1RM)

This upper body test will not be appropriate for all your clients. Some may have limitations that prevent
them from being able to perform the test safely and accurately. If this test cannot be performed safely,
then use your best judgment when determining the appropriate weight. Always err on the side of caution,
and remember that communication with your client can be the most effective assessment tool you have!

Lower Body Test

A 1RM seated leg press can be used to assess your client’s leg strength. Through a process of trial and
error you will estimate a 1RM max for your client and then divide that value by the client’s body weight to
come up with a number. Locate the number you came up with on the chart below to rate your client’s leg
strength.

Values for Seated Leg Press in 1RM/body weight in pounds

Rating Age in Years

Men 20-29 30-39 40-49 50-59 60+

Excellent >2.08 >1.88 >1.76 >1.66 >1.56

Good 2.00-2.07 1.80-1.87 1.70-1.75 1.60-1.65 1.50-1.55

Average 1.83-1.99 1.63-1.79 1.56-1.69 1.46-1.59 1.37-1.49

Fair 1.65-1.82 1.55-1.62 1.50-1.55 1.40-1.45 1.31-1.36

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Poor <1.64 <1.54 <1.49 <1.39 <1.30

Women 20-29 30-39 40-49 50-59 60+

Excellent >1.63 >1.42 >1.32 >1.26 >1.15

Good 1.54-1.62 1.35-1.41 1.26-1.31 1.13-1.25 1.08-1.14

Average 1.35-1.53 1.20-1.34 1.12-1.25 .99-1.12 .92-1.07

Fair 1.25-1.34 1.13-1.19 1.06-1.11 .86-.98 .85-.91

Source: The Institute for Aerobic Research. 1985 Fitness Norms.

Calculations:

1RM/client weight = Value to compare on the chart

If your client has any knee or hip problems that would prevent him/her from doing this assessment test,
consult with his/her physician to determine how the physician would like you to proceed with your client’s
leg strengthening program.

Advanced 1RM Testing

If your client has prior experience training, then an advanced 1RM test may be more appropriate. First,
select an exercise, for example the bench press, and ask your client how much weight he or she can
successfully lift for 10 repetitions. Load the bar and then count the actual repetitions completed. If your
client claimed that he or she could do 135 pounds for 10 repetitions and in reality only completed seven
repetitions, then you would check the chart for the accompanying percentage that relates to seven
repetitions. As you will see, seven repetitions correlate to 82.5% in the chart.

Estimating Your One Repetition Maximum

Number of Repetitions Percent of Maximum (96)

1 100.0

2 95.0

3 92.5

4 90.0

5 87.5

6 85.0

7 82.5

8 80.0

9 77.5

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 10 75.0

Adapted from landers, 1986

Take the weight lifted: in this example it was 135 pounds, and divide it by 82.5% to arrive at the
estimated 1RM. In this example, if your client successfully completed seven repetitions at 135 pounds
then his/her 1RM would be 135/0.825 =164 pounds.

Assessments for Flexibility

Both active and passive range of motion (ROM) tests should be utilized when determining limitations in
flexibility. Active ROM tests are performed with the participant actively contracting muscles to take the
joint through the full range of motion. Passive ROM testing utilizes an assistant to take the joint through
the range and is conducted when the participant has difficulty completing the movement due to lack of
strength and/or coordination. In general, if a participant can move a particular joint through the normal
range of motion actively, then a passive ROM test is not required (Hoppenfield, 1976). Passive ROM is
typically greater than active ROM.

Simple Client Pre- and

Post-Test Assessment

The following tests can be used to define a starting point. Any progress made through exercise and
healthy behavior changes can be measured against the starting point. This is a great way to show your
clients that they are making progress without “classifying” their current fitness level. Though it is
important that they realize the need to facilitate changes due to negative conditions, it is equally as
important to demonstrate the “fruits of their labor.” By charting your clients’ progress, they see that
exercise is working and that fosters motivation to continue training.

Zipper Stretch — measures shoulder flexibility. Directions: Take right hand over right shoulder and bring
left hand up the back. Measure the distance between the two hands. Switch arms and repeat the test with
the left hand over the left shoulder and the right hand up the back.

Sit and Reach — measures flexibility of the lower back and hamstrings. Directions: This test involves
sitting on the floor with legs out straight. Feet (shoes off) are placed flat against a box with both knees
held flat against the floor by the tester. The client leans forward slowly as far as possible and holds the
greatest stretch for two seconds. Make sure there are no jerky movements and that the fingertips remain
level and the legs flat.

Muscular Endurance Assessment

Push-ups — measures upper-body strength and endurance.

Directions: Men should use the standard “military style” push-up position with only the hands and the
toes touching the floor. Women have the option of using the bent-knee position. With knees on the floor,
hands on either side of the chest and back straight. Do as many push-ups as possible with good form until
exhaustion. Count the total number of push-ups performed.

Push-Up Norms (Men) Push-Up Norms (Women)

Age Age

276
 20- 30- 40- 50- 20- 30- 40- 50-
% 60+ % 60+
29 39 49 59 29 39 49 59

> >
99 >86 >64 >51 >39 99 >56 >60 >31 >20
100 70

95 62 52 40 39 28 s 95 45 39 33 28 20 S

90 57 46 36 30 26 90 42 36 28 25 17

85 51 41 34 28 24 85 39 33 26 23 15

80 47 39 30 25 23 E 80 36 31 24 21 15 E

75 44 36 29 24 22 75
34 29 21 20 15
70 41 34 26 21 21
70 32 28 20 19 14
65
39 31 25 20 20
65 31 26 19 18 13

60 37 30 24 19 18 G 60 30 24 18 17 12 G

55 35 29 22 17 16 55 29 23 17 15 12

50 33 27 21 15 15 50 26 21 15 13 8

45 31 25 19 14 12 45 25 20 14 13 6

40 29 24 18 13 10 F 40 23 19 13 12 5 F

35 27 21 16 11 9 35 22 17 11 10 4

30 26 20 15 10 8 30 20 15 10 9 3

25 24 19 13 9.5 7 25 19 14 9 8 2

20 22 17 11 9 6 P 20 17 11 6 6 2 P

15 19 15 10 7 5 15 15 6 4 4 1

10 18 13 9 6 4 10 12 8 2 1 0

5 < 13 <9 <5 <3 <2 VP 5 <9 <4 1 0 0 VP

N= 1045 790 364 172 26 N= 579 411 246 105 12

Total N= 2397 Total N=1353

S, Superior; E, Excellent; G, Good; F, Fair; P, S, Superior; E, Excellent; G, Good; F, Fair; P,

Poor; VP, Very Poor. Data provided by the Poor; VP, Very Poor. Data provided by the
Institute for Aerobics Research, Dallas, TX Institute for Aerobics Research, Dallas, TX
(1994). (1994).

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Sit Ups — measures overall muscular strength and endurance.

Directions: Have the client lie on the floor with knees bent, feet flat and hands resting on his/her thighs.
Have the client contract the abdominals (squeeze the abdominals and him/her raise high enough for
his/her hands to touch the tops of his/her knees. Do not allow the client to pull at the neck or head, and
instruct him/her to keep the lower back flat on the floor. If the client has back problems this test should
be avoided.

1 Minute Sit-Up : Number (men) 1 Minute Sit-Up : Number (women)

Age Age

20- 30- 40- 50- 20- 30- 40- 50-

% <20 60+ % <20 60+
29 39 49 59 29 39 49 59

99> >62 >55 >51 >47 >43 >39 99 >55 >51 >42 >38 >30 >28

95 62 55 51 47 43 39 S 95 55 51 42 38 30 28 S

90 55 52 48 43 39 35 90 54 49 40 34 29 26

85 53 49 45 40 36 31 85 49 45 38 32 25 20

80 51 47 43 39 35 30 E 80 46 44 35 29 24 17 E

75 50 46 42 37 33 28 75 40 42 33 28 22 15

70 48 45 47 36 31 26 70 38 41 32 27 22 12

65 48 44 40 35 30 24 65 37 39 30 25 21 12

60 47 42 39 34 28 22 G 60 36 38 29 24 20 11 G

55 46 41 37 32 27 21 55 35 37 28 23 19 10

50 45 40 36 31 26 20 50 34 35 27 22 17 8

45 42 39 36 30 25 19 45 34 34 26 21 16 8

40 41 38 35 29 24 19 F 40 32 32 25 20 14 6 F

35 39 37 33 28 22 18 35 30 31 24 19 12 5

30 38 35 32 27 21 17 30 29 30 22 17 12 4

25 37 35 31 26 20 16 25 29 28 21 16 11 4

20 36 33 30 24 19 15 P 20 28 27 20 14 10 3

15 34 32 28 22 17 13 15 27 24 18 13 7 2

10 33 30 26 20 15 10 10 25 23 15 10 6 1

5 27 27 23 17 12 7 VP 5 25 18 11 7 5 0 VP

278
 1 <27 >27 <23 <17 <12 <7 1 <25 <18 <11 <7 <5 <0

N= 46 312 1431 1558 919 205 N= 15 144 289 249 137 26

Total N=4471 Total N=860

S, Superior; E, Excellent; G, Good; F, Fair; P, S, Superior; E, Excellent; G, Good; F, Fair; P,

Poor; VP, Very Poor. Data provided by the Poor; VP, Very Poor. Data provided by the
Institute for Aerobics Research, Dallas, TX Institute for Aerobics Research, Dallas, TX
(1994). (1994).

Walk Test — measures cardiovascular fitness.

Directions: Either on a treadmill or a marked area such as a track, have the client walk as fast as
possible for one mile. Immediately upon completion, take the individual’s heart rate for 15 seconds.

Rockport Walking Test Equation (One-Mile Walk)

VO2max (in ml.kg-1.min-1)

132.853 – (0.0769 x body weight)
=
– (0.3877 x age) + (6.315 x gender)
male = 1 female = 0
– (3.2649 x time) – (0.1565 x heart rate)

From Kline, GM et al.: Med Sci Sports Exrc 19:253-259, 1987.

Unit Summary

I. Every exercise program should begin with an assessment of your client’s physical fitness level.
Assessment should be done during the course of your initial consultation to review in depth any medical or
chronic conditions that your client presents. Request medical clearance if necessary and inquire about
work parameters for more serious conditions.

A. Once you reach a decision to have your client start exercising, his/her physician may recommend that
he/she undergo a graded exercise test (GXT) before beginning an exercise regimen.

1. There are two types of GXTs: symptom-limited maximal GXT and submaximal GXT.

279
a. The symptom-limited maximal GXT involves the progressive increase in exercise intensity until signs or
symptoms of exertion intolerance occur.

b. The submaximal GXT involves the progressive increase of exercise intensity until a predetermined end
point (e.g., 85% of maximum heart rate) is reached or until a sign or symptom of exertion intolerance
occurs before the end point is reached.

B. The ISSA recommends that the intensity level of exercise be 55% to 85% of your client’s maximum
oxygen uptake capacity (VO2 max).

C. Several techniques exist for the monitoring of acceptable levels of exercise intensity. The most widely
used methods are: target heart rate (THR), rating of perceived exertion (RPE) and metabolic equivalent
units (METS).

1. THR range = maximal HR x 0.70 and 0.85

a. 70% and 85% of maximal heart rate is equal to approximately 60% and 80% of functional capacity
VO2 max.
2. The HRR or Karvonen method adjusts your THR so that a given percentage of your THR
calculated (using the Karvonen method) is the same as your HR equivalent of that specific
percentage of VO2 max. In other words, when HR is calculated using the Karvonen method, the
percentage of the THR zone directly correlates with the percentage of VO2 max.

3. Rating of perceived exertion (RPE) refers to the physical strain individuals believe they are
experiencing while exercising.

a. RPE is often one of the first readily recognizable measures of (positive) changes in aerobic fitness.
4. The resting level of oxygen consumption is referred to as l.0 MET.
a. At rest, your body consumes approximately 3.5 ml of oxygen per kilogram of body weight per minute.
D. There are several simple methods to assess cardiovascular endurance: 12-minute run-walk test, 12-
minute swim test, 12-minute cycle test and Kasch pulse recovery step test are some of the more common
methods.

E. There are several simple methods to assess muscular strength: the upper-body bench press test,
lower-body leg press test and an advanced 1 RM test are some of the more common methods.

F. There are several simple methods to assess flexibility: the zipper stretch and the sit and reach test are
two of the more common methods.

G. There are several simple methods to assess muscular endurance: the push-up test, sit-up test, squat-
test, and the walk test are some of the more common methods.

Section 4: Unit 14 Outline

Training Principles

I. Laws of Training Introduction

280
 A. The Seven "Granddaddy" Laws
1. Principles of Individual Differences
2. Overcompensation Principle
3. Overload Principle
4. SAID Principle
5. Use/Disuse Principle
6. Specificity Principle
7. GAS Principle
8. Are There Other Principles

B. The Popular Systems in the Fitness Marketplace Today

1. Positions of Flexion (POF)
2. High Intensity Training (HIT), Heavy Duty Training
(HDT), and Superslow Training.
3. Body Contract Training (BCT)
4. Bulgarian Power Burst Training
5. Hard Gainers System
6. The Super Squats Routine
7. Bigger, Faster, Stronger (BFS)
8. Is There Hope?

C. The Weider System

1. Principles to Help You Plan Your Training Cycle
2. Principles to Help You Arrange Your Workout
3. Principles to Help You Perform Each Exercise

D. Some Popular Sub-Principles of Fitness Training

1. The FITT Principle

2. Five Rs Principle

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Gain a thorough insight into training systems, how they

variably effect the underlying factors (those effecting
strength) and other fitness components, and how each
compares on the “good-better-best” scale.

Laws of Training Introduction

281
There are numerous training philosophies in the fitness industry. From books and magazines to videos and
the Internet, the information can be overwhelming. Some work best for strength, others for size. Some for
cuts, some for speed. Some for sports, some for fitness. Some for hard gainers, some for beginners. Even
if you have time to peruse all of them and adequate knowledge of training science to make informed
choices, uncertainty as to which is best can still paralyze you. Science, then, must guide you. After all
there is really only one science. But all too frequently, science is misinterpreted, which leads to confusion.

There are well-documented training principles that are important in judging the merits of any training
system. There are at least seven overlapping principles upon which all systems must rely if optimum
effectiveness in training outcomes is to be expected. Most (but not all) of the training systems popular in
current muscle magazines adhere only in part to The Seven “Granddaddy” Laws. What determines
whether a training system is more or less effective than another lies in how these laws are implemented,
how they are used to the best advantage of the trainee and whether or not they are even considered.

The Seven “Granddaddy” Laws

1. Principle of Individual Differences

This principle is an acknowledgment that we all have different genetic blueprints. David Q. Thomas, Ph.D.
stated, “We all will have similar responses and adaptations to the stimulus of exercise, but the rate and
magnitude of these changes will be limited by our differing genetics. Some are fast responders and others
are slow responders. Some have the capacity to reach elite status and some do not. If we have everyone
perform the same exercise program, they will all not receive the same benefits at the same rate or to the
same extent. This is an important principle to teach to people wishing to start an exercise program or to
youngsters just coming into sports. There are two reasons: 1) so they can set realistic goals, and 2) so
they do not get frustrated when they do not see miraculous changes in their bodies or performance.”

2. Overcompensation Principle

Calluses build up on your hands as an adaptive response to friction. Muscle fibers grow in size and
strength in response to training. Lacerated tissue develops scar tissue. All involve Mother Nature’s law of
overcompensation for a stress response. In other words, it is nothing more than a survival mechanism
built into the genetic code of the species.

3. Overload Principle

Related to the Overcompensation principle is the principle that states that in order to gain in strength,
muscle size or endurance from any training, you must exercise against a resistance greater than that
“normally” encountered. If you use the same amount of resistance for the same number of repetitions
every workout, there will be no continued improvement beyond the point to which your body has already
adapted.

There is a built-in problem with this principle. Your body is wonderfully adaptable to stresses imposed
during training. As you get stronger and stronger, the stress levels required to force added adaptation rise
to such a height that your recuperative powers simply cannot keep up. The solution? It is very simple. At
this point you must go to a split system of training. Then, perhaps later, a double or even triple split. The
only other solution will be for your training progress to plateau (or worse, you will enter a state of
overtraining), as you are not affording your body ample time for recovery — and further adaptation — to
occur. This solution begs the question of how to “periodize” your training, which is discussed later in this
unit.

4. SAID Principle

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Your muscles and their respective subcellular components will adapt in highly specific ways to the
demands (adaptive stress) you impose upon them in your training. This applies as well to various bodily
systems and tissues other than your muscles. This is the SAID Principle, the acronym for “Specific
Adaptation to Imposed Demands.” If your training objectives include becoming more explosive, then you
have to train explosively. If you desire greater limit strength (primarily from an increase in the cross
section of myofibrils), you must use heavier weights than if you were training, for example, local muscular
endurance (capillarization and mitochondrial adaptations). If your objectives include deriving
cardiovascular benefits, then you must tax the heart muscle as well as the oxygen-using abilities of the
working muscles.

In fact, the SAID principle is so uncompromising in its highly researched tenet of training “specifically”
that problems frequently arise if one possesses more than one training objective at a time. The specific
training required for one will frequently detract from the expected gains in the other. For example,
training for aerobic strength endurance (aerobic power) will severely limit the level of limit strength one
can attain. Similarly, stressing one’s ATP/CP energy system calls for different training methods than does
training one’s glycolytic (lactic acid) or aerobic (oxidative) energy systems.

Your specific adaptive responses to exercise can change dramatically over time. This is particularly true as
you age. But it is also true if you have successfully improved your body’s recovery abilities. Clearly, this
can be accomplished through the use of (illegal and often dangerous) drugs or through the use of certain
nutritional supplements. Simply, with improved recovery ability, your body has become a different body,
so the adaptation mechanisms have changed.

5. Use/Disuse Principle

The principle of use/disuse applies to both training and cessation of training. Putting it another way, “use
it or lose it.” If you stress your body and its systems enough, it will adapt to meet the stress. For
example, in a bodybuilding program, hypertrophy, or increase in size, occurs in the trained muscle. If you
stop stressing it (disuse or detraining), it will adapt to meet the lowered stress. In other words, when you
stop your bodybuilding training program, atrophy (decrease in size) occurs in the previously trained
muscle.

Unfortunately, it takes much less time to become detrained than it does to become trained. The
“detraining” effect is known as the “law of reversibility.” Fortunately, some training-related changes in
your neuromuscular system remain over long periods (muscle memory), which allow you to regain your
strength or size more quickly than starting from scratch. (The presence of muscle memory is at this point
a hypothesis based upon voluminous anecdotal evidence.)

6. Specificity Principle

The Specificity Principle states that you must move from general (or foundational) training to specific and
highly specialized training as your final objective (whether it be optimum fitness or athletic competition)
draws closer.

This principle relates to factors involved in both neuromuscular adaptation as well as technique
“functionality.” Neuromuscular changes will occur over time as an adaptation to repeating a specific
movement pattern. For example, you will get stronger in squats by doing squats as opposed to leg
presses, and you will achieve greater endurance for the marathon by running long distances than you will
by cycling long distances.

7. GAS Principle

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GAS is the acronym for General Adaptation Syndrome. The GAS is comprised of three stages according to
its originator, Dr. Hans Seyle: 1) the “alarm stage” caused by the application of intense training stress
(the overload principle), 2) the “resistance stage,” when our muscles adapt in order to resist stressful
weights more efficiently (The Overcompensation, SAID and Use/Disuse Principles), and 3) the “exhaustion
stage” where, if we persist in applying stress we will exhaust our reserves and then be forced to stop
training.

In gym lingo, the GAS law states that there must be a period of low-intensity training or complete rest
following periods of high-intensity training. The reason for this is that the stress you have applied is
traumatic, forcing your “injured” muscles to heal and then adapt. The recovery and overcompensation
time must be taken so that further stress does not continue the downward spiral caused by repetitive
bouts of trauma.

Confusion frequently arises in applying this principle. Some tissues and cellular components may have
been stressed very little or not at all, and are therefore in need of little or no rest. In fact, if you do not
work these tissues, owing to the “law of reversibility,” some atrophy will occur. For example, when heavy
negative training is performed, much rest is needed because this form of training is highly traumatic to
muscles. On the other hand, if the same exercise is performed with the same resistance and speed but the
eccentric stress is removed, the rest period needed would be far less. The most frequent misuse of this
principle is seen among those who insist on training each body part once weekly (for example) just
because “it works.” This is generally not advised, as it is far too infrequent and too much rest. Inevitably,
either precious time is wasted or detraining results in some systems’ tissues or cellular elements.

Are There Other Principles?

Dr. Mel Siff and Yuri Verkoshansky discussed many of the important principles of strength training in their
book, Supertraining: Special Strength Training for Sporting Excellence (1996). In addition to the ones
listed above, they talked about another principle, “The Principle of Central Nervous Control,” which posits
that all patterned activity and computerized instructions to the nervous and endocrine systems come from
the highest command and integrating center in humans. “Far too many fitness professionals focus on
training the muscles as if they are an independent entity,” said Siff in a recent communication.

Patrick Neary, Ph.D., of Malaspina University-College in Nanaimo, B.C. Canada would include what he
refers to as the “Taper Principle:”

“This principle is one in which the physiological adaptations of training are maintained with a reduction in
the training volume (intensity and duration) and frequency. This reduction occurs prior to competition. The
overall reduction allows the body adequate rest to perform maximally. There appears to be a fine balance
between the amount of rest and the amount of exercise performed. If you rest too much, you lose the
physiological adaptations of training; if you exercise too much, you overtrain.

“Swimmers typically have been the biggest proponents of tapering. However, the literature has a number
of published studies that include runners (Houmard et al., 1990, 1992, 1994; Shepley et al., 1992; Johns
et al., 1992) and cyclists (Neary et al., 1992,1993). This list is not complete by any means but those that
come to mind immediately. David Costill (Ball State) has also done a lot of work on taper.”

He concluded by stressing, “It is not detraining, but a separate principle of training. To me, it does not
sound too dissimilar from the Specificity and GAS principles, except that it is restricted to the short time
span immediately before sports competition.”

Charles I. Staley, B.Sc., MSS, states, “I would also add the Principle of Variability to this list. Even if the
training load is specific to the desired outcome and progresses over time, the organism eventually
accommodates to the stress. Various studies, as well as in the trenches observations show that varying

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various aspects of the training load (character, volume, intensity, density, etc.) tend to allow the client to
make more progress before accommodation sets in.

“However, it seems to me that this is part of the precepts outlined in the Overload Principle, wherein it is
said that one must constantly add greater stress than theretofore accommodated. Certainly, this could
mean changing the nature of the stress, not just the amount.”

There are many differing points of view when it comes to training principles. Nelio Alfano Moura, Brazil’s
track and field trainer, states that in most reference sources only three training principles are listed:
overload, specificity and reversibility. “Everything else,” said he, “seems to be concepts that can be
subordinated to them, and no matter how important these concepts are (and they are really very
important), we should not call them ‘principles.’”

The principles covered in this chapter are well supported in research literature, and they have worked well
for many in the “trench.” Despite this, you should not be close-minded about rejecting any of them or
embracing others for that matter, if sufficient scientific evidence warrants the change.

Popular Systems in the Fitness Marketplace Today

We will now evaluate some of the popular systems in use today using the seven laws of training as our
criteria. The systems we will examine are:

I. Positions of Flexion (POF)

II. High Intensity Training (HIT)

A. Superslow Training

B. Heavy Duty Training (HDT)

III. Body Contract Training (BCT)

IV. Bulgarian Power Burst Training

V. Hardgainers System

VI. Supersquats Training

VII. Bigger, Faster, Stronger (BFS)

Let us not forget the ever-growing series of training systems and techniques incorporated in the
hierarchically arranged ladder of intensity that Joe Weider has preached in all of his magazines since the
1940s. Add to that myriad sport-specific systems out there, and you have nothing short of physical, not to
mention mental and emotional, gridlock.

A big problem persists among pundits for each of the listed systems with how these training principles are
employed: how The Granddaddy Seven are interpreted or whether they should be employed at all. When
are laws holy? When is each affected by other rules? More importantly, when does a training system that
follows one rule but is in violation of another (which sometimes seems to be the case in many of the
above-listed popular systems), become so important that it is okay to be in violation of latter? We must
uncover, once and for all, how you can easily create the ultimate system for your unique client.

Positions of Flexion (POF)

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POF is a training method (not a system) propounded by Steve Holman, editor-in-chief at IronMan
magazine. This is what he said in a communication on the Internet:

“Positions of Flexion (POF) is hitting each muscle from three positions so that you train the full range of
motion. For example, to train your biceps with POF you do the following:

• barbell curls
• incline dumbbell curls
• concentration curls

The arc of flexion of the biceps is from back behind your torso to up next to your head. In other words,
you can curl anywhere along this arc, and POF has you training the biceps in three positions along that
arc. Notice that the incline dumbbell curls train the stretch position (bottom of the arc), barbell curls the
mid-range position (middle of the arc) and concentration curls the contracted position (top of the arc).
This full-range-of-motion training makes for better results. You also get the added benefit of synergy, or
muscle teamwork, in the mid-range position (deltoids helping biceps contract), activation of the stretch
reflex in the stretch position (which can recruit reserve muscle fibers) and resistance in the peak
contracted position. Do two warm-up sets at 50 and 70 percent of the first exercise (standing barbell
curls) and one to two work sets of the other two movements (incline dumbbell curls and concentration
curls), and you will get some unique muscle stimulation.”

Principle Does POF Obey?

Principle of Individual Differences No

Principle of Overcompensation Yes

Principle of Overload Yes

SAID Principle No

Use/Disuse Principle Yes

The Specificity Principle No

GAS Principle No; not addressed

The notions that POF “is hitting each muscle from three ranges of motion” and that of “muscle teamwork”
are not supported by science. POF advocates full range of motion during exercise, which is good. However,
almost any other method or system will allow the same results based on this tenet, as long as the
exercises are properly done. POF does not prescribe a specific number of sets, repetitions, weight or
recovery time. However, POF advocates do make some suggestions. These suggestions (the biceps
routine, for example) clearly do not follow the Principle of Individual Differences. Some of us will need
more than six sets, some of us less. The notion of “attacking” the muscle from different angles does not
allow for specific adaptations, and therefore is violating the SAID and Specificity Principles. Proper use of
POF will indeed follow the Overload and Use/Disuse principles, however.

Popular Systems in the Fitness Marketplace Today

We will now evaluate some of the popular systems in use today using the seven laws of training as our
criteria. The systems we will examine are:

286
I. Positions of Flexion (POF)

II. High Intensity Training (HIT)

A. Superslow Training

B. Heavy Duty Training (HDT)

III. Body Contract Training (BCT)

IV. Bulgarian Power Burst Training

V. Hardgainers System

VI. Supersquats Training

VII. Bigger, Faster, Stronger (BFS)

Let us not forget the ever-growing series of training systems and techniques incorporated in the
hierarchically arranged ladder of intensity that Joe Weider has preached in all of his magazines since the
1940s. Add to that myriad sport-specific systems out there, and you have nothing short of physical, not to
mention mental and emotional, gridlock.

A big problem persists among pundits for each of the listed systems with how these training principles are
employed: how The Granddaddy Seven are interpreted or whether they should be employed at all. When
are laws holy? When is each affected by other rules? More importantly, when does a training system that
follows one rule but is in violation of another (which sometimes seems to be the case in many of the
above-listed popular systems), become so important that it is okay to be in violation of latter? We must
uncover, once and for all, how you can easily create the ultimate system for your unique client.

Positions of Flexion (POF)

POF is a training method (not a system) propounded by Steve Holman, editor-in-chief at IronMan
magazine. This is what he said in a communication on the Internet:

“Positions of Flexion (POF) is hitting each muscle from three positions so that you train the full range of
motion. For example, to train your biceps with POF you do the following:

• barbell curls
• incline dumbbell curls
• concentration curls

The arc of flexion of the biceps is from back behind your torso to up next to your head. In other words,
you can curl anywhere along this arc, and POF has you training the biceps in three positions along that
arc. Notice that the incline dumbbell curls train the stretch position (bottom of the arc), barbell curls the
mid-range position (middle of the arc) and concentration curls the contracted position (top of the arc).
This full-range-of-motion training makes for better results. You also get the added benefit of synergy, or
muscle teamwork, in the mid-range position (deltoids helping biceps contract), activation of the stretch
reflex in the stretch position (which can recruit reserve muscle fibers) and resistance in the peak
contracted position. Do two warm-up sets at 50 and 70 percent of the first exercise (standing barbell
curls) and one to two work sets of the other two movements (incline dumbbell curls and concentration
curls), and you will get some unique muscle stimulation.”

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 Principle Does POF Obey?

Principle of Individual Differences No

Principle of Overcompensation Yes

Principle of Overload Yes

SAID Principle No

Use/Disuse Principle Yes

The Specificity Principle No

GAS Principle No; not addressed

The notions that POF “is hitting each muscle from three ranges of motion” and that of “muscle teamwork”
are not supported by science. POF advocates full range of motion during exercise, which is good. However,
almost any other method or system will allow the same results based on this tenet, as long as the
exercises are properly done. POF does not prescribe a specific number of sets, repetitions, weight or
recovery time. However, POF advocates do make some suggestions. These suggestions (the biceps
routine, for example) clearly do not follow the Principle of Individual Differences. Some of us will need
more than six sets, some of us less. The notion of “attacking” the muscle from different angles does not
allow for specific adaptations, and therefore is violating the SAID and Specificity Principles. Proper use of
POF will indeed follow the Overload and Use/Disuse principles, however.

Bulgarian Power Burst Training

Leo Costa and Russell Horine D.C. developed the Power Burst system in 1989 after Leo attended a series
of lectures on strength training in the Soviet Union, East Germany and Bulgaria. Actually, this system had
been well known by the former Soviet, East German and Bulgarian weightlifters for many years. While it is
suitable for weightlifters, it is clearly not always suitable for newcomers into the world of fitness,
bodybuilding,and other athletics as it is presented by Costa. On the other hand, it could be made to apply
to clients and fitness trainers other than weightlifters with a few minor adjustments (particularly insofar as
the frequency of training each body part is concerned).

Bulgarian Power Burst Training involves 35- to 40-minute workouts performed three times daily. If the
exercises are cycled correctly, this notion will not violate any principles, even if it does seem somewhat
impractical at times. Intensity is varied throughout the week (called microcyclic periodization), with the
focus of the intensity level and volume of each exercise on the specific sports-related objective. Power
Burst Training also states that you should not waste adaptive energy on nonproductive intensity levels,
which may violate the GAS principle (periods of high intensity must be followed by periods of low or no
intensity).

Principle Does Power Burst Training Obey?

Principle of Individual Differences No

Principle of Overcompensation Yes

Principle of Overload Yes

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SAID Principle No

Use/Disuse Principle No

The Specificity Principle Yes

GAS Principle No

Finally, Power Burst Training suggests working each body part three times weekly, which clearly violates
the Principle of Individual Differences, as well as the SAID and GAS principles.

Hard Gainers System

In his book BRAWN (1991) Stuart McRobert defines a hard gainer as “someone who finds making gains in
size and strength hard to come by.” It is a broad category encompassing almost all bodybuilders and
lifters. Who does not find gains difficult? The “bedrock” of the Hard Gainer System is progression,
performance and persistence. McRobert notes that progression is gained by adding another rep or a little
more weight (even if it is increments of as little as a half pound) during each set or workout. Performance
in a Hard Gainers routine involves strict form during exercise. Persistence in the Hard Gainers routine
relies on the fact that workouts must be performed time and time again over long periods of time.

The Hard Gainers System encourages the user to adapt routines to fit his or her personal needs. The
recommended set and rep scheme (as a “general recommendation”) is 1 to 3 sets of 6 to 9 repetitions for
upper body and 1 to 3 sets of 10 to 20 repetitions lower body. However, McRobert claims the Hard
Gainers philosophy can be applied to other systems of training as well.

Principle Does Power Burst Training Obey?

Principle of Individual Differences No

Principle of Overcompensation Yes

Principle of Overload Yes

SAID Principle No

Use/Disuse Principle Possibl

The Specificity Principle No

GAS Principle No

Still, the notion that progression must be continuous during all workouts (whether it be adding extra
repetitions or weight) is in violation of the GAS Principle. Periods of low or no intensity are not allowed.
SAID and the Specificity principles may be violated as well if the routine is not adapted to the specific
needs of the trainee. Moreover, the general guideline of 1 to 3 sets of 6 to 9 repetitions and 10 to 20
repetitions (for upper and lower body respectively) violates the Principle of Individual Differences, SAID
Principle and Specificity Principle.

The Super Squats Routine

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With no surprise, this routine focuses on a single lift: the squat. The general guideline, as outlined by
Randall J. Strossen, Ph.D., in his book Super Squats (1989) is to perform 1 set of 20 squats and to add 5
pounds to the bar every workout. After each set of squats, the trainee is advised to perform a light set of
pullovers to “expand the ribcage.”

While the program focuses on the squat, it does include other exercises. Here is the basic
program as outlined by Strossen in his book. Training frequency is 1 to 2 times per week.

Seated Behind the neck press 3 sets of 10 reps

Bench press
3 sets of 12 reps

Bent-over row 2 sets of 15 reps

Standing biceps curl 2 sets of 10 reps

Parallel squat 1 set of 20 reps

Radar chest pull 1 set of 20 reps

Stiff-legged deadlift 1 set of 15 reps

Radar chest pull 1 set of 20 reps

Toe raise 3 sets of 20 reps

Crunch 1 set of 25 reps

While Strossen advocates other routines, his focus is on one set of 20 repetitions in the squat. This is in
violation of the Principle of Individual Differences — some of us will do better on 4 sets of 6 repetitions
with heavier weight! Because it is encouraged to add 5 pounds every workout, it is in violation of the GAS
Principle, in that there are not periods of low or no intensity, and there may not be enough recovery time
between workouts.

The Specificity and SAID principles are violated, in that it will not be specific to all scenarios — it will do
very little to increase limit strength, for example. The basic program lists several other exercises (granted,
it is listed as a “basic” program and other programs are given), but the choice of exercises is in violation
of the Principle of Individual Differences, as well as the SAID Principle and Specificity Principle. As for the
idea of “expanding the ribcage” by doing pullovers, it is unsupported by scientific literature.

Principle Does Super Squat Training Obey?

Principle of Individual Differences No

Principle of Overcompensation Yes

Principle of Overload Yes

SAID Principle No

Use/Disuse Principle No

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The Specificity Principle No

GAS Principle No

Bigger, Faster, Stronger (BFS)

Bigger, Faster, Stronger (BFS) is a company that sells exercise equipment and various other training aids
and publishes a magazine by the same name. Its main focus is training for athletics. The program consists
of training for agility, flexibility and sport-specific technique five days per week and weight training three
days per week (twice per week in-season). Here is a basic outline of the BFS program:

Monday box squat, towel bench, auxiliary lifts, flexibility and agility training

Tuesday sprints, plyometrics, flexibility, agility and sports-specific technique

Wednesday power clean, deadlift, auxiliary lifts, flexibility and agility training

Thursday sprints, plyometrics, flexibility, agility and sports-specific technique

Friday parallel squat, bench press, auxiliary lifts, flexibility and agility training

BFS encourages the trainee to use a weight that allows correct form and technique yet is challenging.
Repetitions and sets are as follows:

Week 1 3 sets of 3 repetitions

Week 2 5 sets of 5 repetitions

Week 3 1 set of 5 repetitions, 4 repetitions, 3 repetitions, 2 repetitions and 1 rep

1 set of 10 repetitions, 8 repetitions, 6 repetitions (if the back is not

Week 4 involved)
or 2 sets of 4 repetitions and 1 set of 2 repetitions (if the back is involved)

While this program is specifically meant for athletes and not your average fitness client, it still does not
adhere to the Principle of Individual Differences. No precise weight or percentage of 1RM is given, but it is
possible that this program could violate the GAS Principle in that BFS encourages always trying to increase
the weight being used. The SAID and Specificity principles may also be violated, in that different weights,
repetitions and sets must be used depending on the nature of the athletic event. Furthermore, proper
foundational training — a point not made by the representatives of BFS in our communication — must
precede the use of plyometrics and agility drills.

Principle Does BFS Training Obey?

Principle of Individual Differences No

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Principle of Overcompensation Yes

Principle of Overload Yes

SAID Principle Possible

Use/Disuse Principle Yes

The Specificity Principle Possible

GAS Principle No

Is There Hope?

Are all these programs worthless? Can anyone make gains with any of these programs? At some time or
another, all of these programs may prove beneficial to your clients. It is with a careful eye and
consideration that you choose a program that best suits your clients. Better yet, borrow the strong points
of programs, and tailor them to suit your clients! That will be the only system that obeys all seven
principles and will provide optimum gains!

The Weider System

No book on weight training in general — or bodybuilding in particular — would be complete without

mentioning the immense contributions of Joe Weider. Much of the lingo of gyms and fitness clubs
worldwide came from his magazines. Many of the techniques of training, dieting and the use of nutritional
supplements came into prominence largely through his dedicated efforts over the past 60 years.

The Weider System has been in existence for over 50 years and has grown to incorporate other great
training ideas as they came along. It is a system in the strict definition of the term, but also a guide to aid
you in developing your own personal system based on your unique recuperative ability, experience, goals,
strengths, weaknesses and guts to go the distance.

The Weider System guidelines come in the form of a series of training methods collected (and in many
instances named) by Joe Weider personally over many years, which became widely known as the Weider
Principles. In fact, of the Weider Principles that were developed by Joe personally, one in particular had a
major impact on the world of bodybuilding. That was the concept of splitting workouts to train specific
body parts. The split system, double split system and triple split system, as they became known, are Joe’s
unique contribution to bodybuilding science.

There are three broad categories of Weider Principles:

1) principles to help you plan your training cycle

2) principles to help you arrange your exercises in each workout

3) principles to help you perform each exercise

It is easy to discern whether or not this orderly collection of training methods, both in the aggregate and
individually, adhere to The Seven Granddaddy Principles (laws). The simple truth is that individually they

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do not. But when you look at them in the aggregate, and the guidelines as to when and how to apply
them in the Weider System, they most certainly do!

Here is why:

The fact that you are training at all assumes that you know: 1) you are going to grow (Overcompensation
Principle), 2) you are going to train regularly (The Use/Disuse Principle), and 3) weight training is the
most efficient method of doing aforementioned points one and two.

• Both the type and amount of adaptive stress each of the Weider Principles delivers to the organism
can be manipulated very efficiently and effectively (SAID and Overload principles respectively).
• Each method listed in the Weider System has its strengths and weaknesses in regards to the
specific muscle components it targets (SAID Principle), so you must use your instinct and
experience in discerning when to apply each, or whether to apply it at all (Individual Differences
Principle).
• The list of methods is totally flexible.

Within the instructions for each are listed guidelines to aid you in discerning whether to use it and how
often to employ it in your day-to-day training microcycles (GAS and Individual Differences Principles).

The three categories of principles discussed in the Weider System are listed in the next few pages along
with brief explanations of each. One of the principles appears in all three categories: the Instinctive
Training Principle. It is simple. Use your own training experience and knowledge of how your body
responds to exercise stress when planning and carrying out a training program! This must take place on a
cycle-to-cycle, day-to-day and, quite literally, minute-to-minute basis!

Principles to Help You Plan Your Training Cycle

1. Cycle Training Principle (Breaking your training year into cycles for strength, mass or contest
preparation helps you avoid injury and keeps your body responsive to adaptation).
2. Split System Training Principle (Breaking your workout week into upper- versus lower-body
training, for example, results in more intense training sessions).
3. Double or Triple-Split Training Principle (Breaking down your workout into two or three shorter,
more intense training sessions per day).
4. Muscle Confusion Principle (Muscles adapt to a specific type of stress — habituate or plateau —
when you continually apply the same stress to your muscles over time, so you must constantly
vary exercises, sets, repetitions and weight to avoid accommodation.)
5. Progressive Overload Principle (The basis of increasing any parameter of fitness is to make your
muscles work harder than they are accustomed to.)
6. Holistic Training Principle (Cellular organelles respond differently to different forms of stress, so
using a variety of rep/set schemes, intensity and frequency will maximize muscle mass.)
7. Eclectic Training Principle (Combining mass, strength or isolation-refinement training techniques,
as your instincts dictate, into your program often helps you achieve greater progress.)
8. Instinctive Training Principle (Bodybuilders instinctively attain the ability to construct diets,
routines, cycles, intensity levels, repetitions and sets that work b est for them.)

Principles to Help You Arrange Your Workout

1. Set System Training Principle (Performing one set per body part was the old way; the Set System
calls for multiple sets for each exercise in order to apply maximum adaptive stress.)
2. Superset Training Principle (Alternating opposing muscle group exercises with little rest between
sets.)
3. Compound Sets Training Principle (Alternating two exercises for one body part with little rest
between sets.)

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 4. Tri-Sets Training Principle (Doing 3 exercises for one muscle group with little rest between sets.)
5. Giant Sets Training Principle (Doing 4 to 6 exercises for one muscle group with little rest between
sets.)
6. Staggered Sets Principle (Injecting 10 sets of forearm, abdominal or calf work in between sets for,
say, chest or legs.)
7. Rest-Pause Principle (Using 85 to 90 percent of your max, do 2 to 3 repetitions, then put the
weight down. Next do 2 to 3 more, rest, 2 to 3 more and rest for a total of 3 to 4 rest-pauses. The
short rest-pauses allow enough time for ATP to be re-synthesized, and permit further repetitions
with the heavy weight.)
8. Muscle Priority Principle (Working weaker body parts first in any given workout. Alternatively, work
larger muscle groups first, while energy levels are high.)
9. Pre-Exhaustion Principle (Examples: superset flyes, a chest isolation exercise, with bench presses;
a compound exercise involving triceps and chest, in order to maximize chest development by pre-
exhausting the triceps.)
10. Pyramid Training Principle (Starting a body part session with higher-rep/lower-weight and gradually
adding weight — commensurably reducing reps — ending with a weight that can be lifted for 5
reps.)
11. Descending Sets Principle (Lighter weights from set to set as fatigue sets in; known as ”stripping.”)
12. Staggered Sets Training Principle (Staggering smaller, slow-developing body parts in between sets
with larger muscle groups.)
13. Instinctive Training Principle (Instinctively attaining the ability to construct diets, routines, cycles,
intensity levels, repetitions and sets that work best.)

Principles to Help You Perform Each Exercise

1. Isolation Principle (All muscles act as stabilizers, synergists, antagonist or agonists. By making one
particular muscle the prime mover in any given exercise you have isolated it as much as possible,
and therefore the stress applied to it.)
2. Quality Training Principle (Gradually reduce the rest between sets while maintaining or increasing
the number of repetitions performed.)
3. Cheating Training Principle (Swing the weight past the sticking point at the end of a set in order to
add stress.)
4. Continuous Tension Principle (Maintain slow, continuous tension on muscles to maximize red fiber
involvement.)
5. Forced Repetitions Training Principle (Partner-assisted repetitions at the end of a set.)

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 6. Flushing Training Principle (Do 3 to 4 exercises for a bodypart before moving to another.)
7. Burns Training Principle (2 to 3-inch, quick movements at the end of a set.)
8. Partial Repetitions Training Principle (Because of leverage changes throughout any given exercise,
it is sometimes helpful to do partial movements with varying weight in order to derive maximum
overload stress for that bodypart.)
9. Retro-Gravity Principle (Negatives, or eccentrics as they are called, make it possible to get more
muscle cells to respond, because you can lower about 30 to 40 percent more weight than you can
successfully lift concentrically.)
10. Peak Contraction Principle (Holding the weight through maximum contraction at the completion of
a movement.)
11. Superspeed Principle (Compensatory acceleration of movements used to stimulate hard-to-reach
fast-twitch fibers.)
12. Iso-Tension Principle (This is a method of practicing posing, tensing each muscle maximally for 6
to10 seconds up to a total of 30 to 44 flexes in a variety of posing positions.)
13. Instinctive Training Principle (Bodybuilders instinctively attain the ability to construct diets,
routines, cycles, intensity levels, repetitions and sets that work best for them.)

Some Popular Sub-Principles of Fitness Training*

*Portions of this section have been adapted from: The Keiser Manual: A Guide To The Fundamentals of
Resistive Training with KEISER Air-Powered Exercise Machines, Paul O. Davis, Ph.D., FASCM, 1989

There are several collections of sub-principles that have been espoused by various fitness authors over the
years. Two popular and very good collections for beginners and intermediates just getting involved in
fitness training are the “FITT Principle” and the “Five R’s Principle.”

The FITT Principle

The FITT Principle applies to any type of resistance training, whether it be for limit strength, speed
strength, anaerobic or aerobic strength. It is especially suited to beginners’ efforts because it spells out
exactly what they should do to get started. Applying the FITT Principle will ensure the training effort is
reasonably effective. There are four components to this principle:

1. Frequency of exercise: How often should your client exercise each week? Answer: twice for
maintenance, 3 times for beginners, 5 times for serious fitness enthusiasts and up to 14 or more
times for elite clients.
2. Intensity of exercise: How hard should your client exercise? Answer: If training 2 or 3 times
weekly, train with high intensity; if training 5 or more times weekly, “periodize” the program into
macrocycles, mesocycles and microcycles, with microcyclic intensity variations built in to avoid
undertraining and overtraining.
3. Time to Exercise: How long should your client exercise each session? Answer: For anaerobic
objectives, train less than an hour each workout; for aerobic objectives, train for up to two hours
each session.
4. Type of exercise: What exercises should your client do? Answer: Beginners training 2 or 3 times
weekly should choose an array of exercises and methods to reverse the processes of disuse in all
major muscle groups and bodily systems; Athletes do likewise, but only during their off-season.
Pre- and in-season training must be highly specific to the tasks/skills of their respective sports.

Five Rs Principle

The Five Rs are important elements for any beginners’ or intermediates’ fitness training programs. Similar
in scope to the FITT Principle, this principle keys on slightly different elements of training technique. The
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reasonable answer as to which is best is that both are necessary, and both should be applied to your
client’s training programs. These “R” principles do not always apply to elite clients because of their often
severe and highly specialized techniques.

Range of Motion When we speak of range of motion, we mean the complete movement capability of a
joint. Every exercise must be performed through the complete range of motion, from a fully stretched
position of the targeted muscle(s) to a fully contracted position. Equally important, each and every muscle
spanning (or acting upon) a given joint must be exercised in order to maintain or improve that joint’s
range of movement.

Resistance The resistance (that is, the weight moved) must be small enough that the exercise can be
performed through full range of motion without “cheating,” or using body swing. Yet the resistance must
be such that it taxes the muscles for the desired number of repetitions.

Repetitions When choosing the number of repetitions (how many times the exercise is to be done in a
set), you must first decide what results you want from the program. Generally, low repetitions (3 to 8)
produce absolute strength. Medium repetitions (10 to 20) produce anaerobic strength endurance. High
repetitions (20 to 40) produce aerobic strength endurance. The bodybuilder, who is training for increased
bulk, does many sets of many different weights, speeds and repetitions to get as many elements of his
muscles to adapt for maximum size increases. Yet, despite his extreme muscular size, this individual will
not have the same absolute or limit strength as the client who trains strictly for absolute or limit strength.
So, this “R” relates to the fact that your training efforts will yield highly specific results, according to how
and what stress is applied. (See above.)

Repetition Ranges

Benefits
Repetitions
Produced

3 7 10 12 16 20 30

Very
Strength/Power High Med. Med. Med./Low Low Low
High

Muscular Very
Med/Low High High Med. Low Low
Hypertrophy High

Anaerobic
Low Med/Low Med High/Med High High/Med Med/Low
Strength
Endurance

Aerobic
Very
Strength Low Low Low Med High/Med High
Low
Endurance

Note: To achieve the above benefits at a given repetition range, the final repetition must be
performed at or near maximum effort. For example, to achieve the benefits listed at 10
repetitions, the resistance load must be at or near the lifter’s 10 repetition-maximum for each
set performed.

Rest A working muscle needs about 2 to 4 minutes rest between each set of repetitions before it is ready
to function near full capacity again. For example, several repetitions of the curl would constitute one set of
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curls. A second set of repetitions should begin after two to four minutes of rest. The first set will have
depleted the cell’s adenosine triphosphate (ATP) and phosphocreatine (PC), your muscles’ energy for
contraction. ATP and PC cannot be replenished in less than about two minutes.

Recovery The last R, recovery, is very important. Adequate time must be allowed between one workout
and the next, so the exercised muscles can complete their recovery processes. As a general rule, you
should not exercise the same muscle group two days in a row, and usually not more than three times a
week. Otherwise, your body will eventually become fatigued and reach a stale, or overtrained, state. If
you do not give your muscles a rest, they will take one on their own — you will get overtrained or (worse)
injured. In sports medicine circles, this phenomenon is commonly called the overuse syndrome, and
results from “cumulative microtrauma.”

Unit Summary

I. There are at least seven overlapping principles upon which all systems must rely if optimum
effectiveness in training outcomes is to be expected.

A. These seven principles are known as the Seven Granddaddy Laws.

1. The Principle of Individual Differences states that while we all will have similar responses
and adaptations to the stimulus of exercise, the rate and magnitude of these changes will
be limited by our differing genetics.
2. The Overcompensation Principle states our bodies will compensate to handle any repeated
stress that our system faces.
3. The Overload Principle states in order for gains to continue, the intensity of the stress
imposed must be progressively increased.
4. The SAID Principle states that our bodies will physiologically adapt according to whether we
are training aerobically or anaerobically.
5. The Use/Disuse Principle states that our bodies will adapt to current exercise or lack there
of. Simply stated, “use it or lose it.”
6. The Specificity Principle states that we must move from general training to specific and
highly specialized training as it relates to our intended goals.
7. The GAS Principle states that we undergo stress in three stages: shock, compensation and
exhaustion. Therefore we must train in cycles to account for these various stages.

B. Resistance training high in intensity (utilizing 8-10 repetitions), heavy in resistance and with a
maximum of one minute rest between sets will maximize serum testosterone and growth hormone levels,
thus allowing for successful recovery, adaptation and muscular growth.

C. Some popular systems in the fitness market place today include: Positions of Flexion (POF), High
Intensity Training (HIT), Heavy Duty Training (HDT), Body Contract Training (BCT), Bigger, Faster,
Stronger (BFS), Bulgarian Power Burst Training, Hardgainers System, Supersquats Training and Superslow
Training.

D. The Weider System has been in existence for over 50 years, and has grown over time to incorporate
other great training ideas as they came along.

1. There are three broad categories of Weider Principles: (1) principles to help you plan your
training cycle, (2) principles to help you arrange your exercises in each workout, and (3)
principles to help you perform each exercise.

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a. There are several principles to help you plan your training cycle: split training, double or triple split
training, progressive overload training, holistic training, eclectic training and instinctive training.

b. There are several principles to help you arrange your workout: set system, superset system, compound
set system, tri-set system, giant set system, staggered set principle, rest-pause principle, pre-exhaustion
principle, pyramid set system and staggered set system.

c. There are several principles to help you perform each exercise: isolation principle, cheating principle,
continuous tension principle, forced repetitions principle, flushing principle, burn principle, partial
repetition principle, super speed principle, peak contraction principle, iso-tension principle, retro-gravity
principle.

E. The FITT Principle is an excellent way to organize any training and is comprised of four components:
frequency, intensity, time and type of exercise.

F. The Five R’s principle is an important part of any training program and includes five components: range
of motion, resistance, repetitions, rest and recovery.

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 Section 4: Unit 15 Outline

Periodization

I. Periodized Training

A. The Need for Periodization

B. The Relationship and Practical Applications of Periodization and the Laws of Training

1. The Law of Individual Differences

2. The Law of Overcompensation and Overload
3. The SAID Principle and the Law of Specificity
4. The GAS Principle and the Law of Use/Disuse

II. Overtraining and Overreaching

A. Interrelated Stressors

B. Physiological Markers of Overtraining

C. Excessive Training

III. Muscle Soreness

A. Avoiding Overtraining and Overreaching

B. An Integrated Approach for Recuperation

1. Sleep Requirements

C. Creating a Periodized Program

1. Age and Experience-Related Factors

2. Macrocycles, Mesocycles and Microcycles
3. Order of Exercises, Drills and Flexibility Training
4. Foundational Training
5. Functional Training (Sport-Specific Training)
6. Pre-Season Training
7. In-Season Training
8. Active Rest

IV. Conclusion

Self-Quiz (8 questions)

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 LEARNING OBJECTIVES

After completing this unit you will be able to:

• Design and implement a comprehensive periodized program for your clients.

• Understand the differences between overtraining and overreaching and how to curtail each of
them in your training.

Periodized Training

The concept of periodized training is becoming increasingly popular. Periodization refers to how one’s
training is broken down into discreet time periods called “macrocycles”, “mesocycles” and “microcycles.”
Even though any program must be periodized if it is to be successful — making periodization a foregone
conclusion — it has become more of a buzzword in the world of strength training. More and more books,
magazine articles and Internet information now addresses the concept of periodization.

The Need for Periodization

Is periodization necessary for athletic performance to improve? Why? Why not just train hard all the time
and practice skills all the time? A seemingly logical question, let’s have a look at what noted sports
scientists have to say.

“The need for different phases of training is influenced by physiology because neuromuscular and
cardiorespiratory development and perfection ... are achieved progressively over a long period of time.
One also has to consider the client’s physiological and psychological potential, and that athletic shape
cannot be maintained throughout the year at a high level.”

~ Tudor O. Bompa (Theory and Methodology of Training, 1983)

“Peaking at just the right time — obviously of key importance to the bodybuilder and clients — is far from
the only benefit of periodized training. You will also gain strength, power and muscle size. Training with a
periodized plan also helps to keep your regimen from becoming boring. Another major reason to switch to
periodized training is to prevent injuries.”

~ Fleck and Kraemer (Periodization Breakthrough! 1996)

“... periodization has been established to prevent overtraining and optimize peak performance through
training.”

~ Dan Wathen (Essentials of Strength Training and Conditioning, 1997)

While these statements are true, the fact is, the Seven Laws of Training simply demand a periodized plan.

The Relationship and Practical Applications of Periodization and the Laws of Training

The Law of Individual Differences

This law states that not everyone can train in the same manner. It is relevant to periodization when you
consider the fact that individual client differences will change with training. Each will become an entirely
different individual after a year of proper training. Certainly, a beginner will not keep the same physical
and psychological characteristics after training — he or she will literally become a different individual in
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that he or she will be stronger, faster, recover more quickly and have a different perspective on training
than when he or she began.

The Laws of Overcompensation and Overload

Simply put, training must progressively increase in intensity over a period of time. Using the same
repetitions, sets, frequency, training loads and methods of training time after time will not result in
improvement in performance.

The SAID Principle and the Law of Specificity

The body will adapt in a highly specific manner to the stress it receives. Simply put, you must train like
you play! However, the rigors of athletic competition are too extreme to jump right into. Many sports are
ballistic in nature — a stress too intense to engage in without sufficient limit strength and conditioning
methods.

The GAS Principle and the Law of Use/Disuse

Periods of high intensity must be followed by periods of low or no intensity. If you only complete one hard
workout, adaptation for larger muscles will take weeks. Too long not to train! Therefore, there must be
frequent periods of low intensity between periods of high intensity. Again, the adaptation process will
allow quicker recovery as you develop physically. What used to demand a week’s worth of recovery will
eventually only require a couple of days. Therefore, changes in training variables must take place.

Overtraining and Overreaching

Hans Selye’s General Adaptation Syndrome Principle has demonstrated that the body will go through three
predictable stages in response to stress: shock, compensation and exhaustion. Therefore cycling your
training to account for these stages is imperative for program success. If we exceed our bodies’ rates of
adaptation we will most likely spend most of our training in the exhaustion phase.

Overreaching is an accumulation of training and/or non-training stress resulting in a short-term decrement

in performance capacity with or without related physiological and psychological signs and symptoms of
overtraining in which restoration of performance capacity may take from several days to several weeks.

Overtraining is an accumulation of training and/or non-training stress resulting in a long term decrement
in performance capacity with or without related physiological and psychological signs and symptoms of
overtraining in which restoration of performance capacity may take from several weeks to several months.

Interrelated Stressors

We are all bombarded daily with a variety of stressors. More often than not, these stressors are of low
enough “intensity” or so subtle that they don’t affect us negatively in the athletic training term. But most
take their toll over time. What’s worse, of those that do have a more immediate negative effect, their
intensity is often compounded by the mere presence of the many other stressors. For example, any
number of environmental stressors can have physical or physiological consequences. And one’s
psychological state is inextricably intertwined with one’s biochemistry.

Consider some of the more common stressors (Table 15-1), with an eye toward how they interact to aid
or hinder training efforts and especially how they can affect overreaching and overtraining.

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Table 15-1 Stressors and Contributing Factors

• Poor training • Excessively

• Excessive heat or facilities high or low
cold humidity
• Ultraviolet
• Challenging terrain irradiation • Excessive
Enviornmental altitude (above
Stressors • Environmental • Poorly designed or below
pollution clothing sealevel)

• Poorly designed • Airborne pollen

equipment and other
allergens

• Job problems • Depression • Mental illness

• Neurological • Pain • Aging

disorders
• Fear or anxiety • Academic
• Anger considerations
Psychological • Family problems
and • Financial status • Sex problems
Psychosocial • Schedule
Stressors • Personality conflicts conflicts • Boredom

• Lack of • Psyching up too • Pressure to

encouragement frequently perform

• Lack of adequate
training

• Environmental stress • Psychological stress • Too much training

frequency
• Anatomical/structural • Aging
stress • Too much training
Physiological
• Exertional stress intensity
and
• Overuse stress
Biochemical
• Too much training • Too much training
Stressors
• Poor exercise technique duration volume

• Ill-conceived
training program

As a rule of thumb, attempt to eliminate (or at least minimize the ill effects of) all stressors except
exertion, training duration, training frequency, training intensity, and training volume. These, you want!
But only if you can control them. In a previous chapter, we explored the Seven Laws of Training that must
be obeyed if training efforts are to pay maximum dividends. Of particular importance is the General
Adaptation Syndrome (GAS) Law. The third stage of the GAS Law infers the notion that you must rest
between severe bouts of training to allow both recovery and supercompensation to occur. In the short run

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(days or weeks), failing to do so causes an overreaching syndrome, and, in the long run (months), causes
an overtraining syndrome.

If you do not go that far, the low-level overreaching may be regarded as just another term for “adaptive
overload.” It is what is needed to initiate an adaptive response in the body. But once you have
overreached, you must pay attention to the GAS Law! Continued overreaching — indiscriminate and
continued overload over time — causes cumulative microtrauma, which is the primary cause of
overtraining.

Physiological Markers of Overtraining

Several physiological markers of overtraining have been identified. More important than
recognizing these markers, however, is denying their evolution. By the time you have
observed such markers, it is too late. Consider these common examples. Is it better to treat
the excess storage fat associated with obesity or prevent its accumulation? Is it better to
allow your insulin levels to fluctuate wildly by disregarding sound dietary and
supplementation techniques (thereby predisposing you to increased catabolic activity and
thus overreaching/overtraining) or to eat and supplement carefully to prevent catabolism
and overreaching/overtraining? Obviously, the best approach is prevention.

If overtraining and overreaching are not prevented, several markers (symptoms) will alert
you to their presence. It is important that you know what to do if these markers surface.
First, you should be aware that most scientists are in agreement that overtraining and
overreaching markers are generally different for anaerobic and aerobic clients. Anaerobic
clients usually experience sympathetic overtraining symptoms, whereas aerobic clients are
more susceptible to parasympathetic overtraining. Briefly, the sympathetic nervous system
speeds up bodily functions thereby increasing energy needs, and the parasympathetic
system slows down bodily functions thereby conserving energy. Together they comprise the
autonomic nervous system, which acts on blood vessels, glands and internal organs. The
somatic nervous system, on the other hand, primarily innervates your skeletal muscles.

Sympathetic overtraining can lead to increased resting heart rate, increased blood pressure,
loss of appetite, decreased body mass, sleep disturbances, emotional instability and
elevated basal metabolic rate. Parasympathetic overtraining signs include early onset of
fatigue, increased resting heart rate, decreased heart rate recovery after exercise and
increased resting blood pressure. Of the two condi tions, symptoms of sympathetic
overtraining are the most frequently observed. Nilson et al., (1999) have proposed that
young clients are more prone to symptoms of sympathetic overtraining, while older clients
are more likely to show signs of parasympathetic overtraining.

The body’s hormonal responses are also altered as a result of overtraining. The ratio of
testosterone to cortisol is thought to regulate anabolic processes in recovery, so a change in
this ratio is an important indicator, and perhaps the cause, of overtraining. A decrease in
testosterone coupled with increased cortisol might lead to more protein catabolism than
anabolism in the cells. Overtrained clients often have higher blood levels of urea, and
because urea is produced by the breakdown of protein, this indicates increased protein
catabolism. This mechanism is thought to be responsible for the loss in the body mass seen
in the overtrained clients.

Excessive Training

Excessive training refers to the training in which the volume, the intensity, or both are
increased too quickly, and without proper progression. Training with too high a volume or
intensity produces no additional improvement in conditioning or performance and can lead
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 to a chronic state of fatigue that is associated with muscle glycogen depletion. Research
shows that training 3 to 4 hours per day, 5 or 6 days each week, provides no greater
benefits than when training is limited to only 1 to 1.5 hours per day. In addition such
excessive training has been shown to significantly decrease muscle strength. Therefore,
trainers and trainees should make sure that their programs are periodized and slowly
progressive. Finally, the concept of training specificity implies that several hours of daily
training will not provide the adaptations needed for clients who participate in events of short
duration. So if the training volume and intensity are implemented with a steady
progression, and specific to that sport, then what should be the intensity of training?

The level of training intensity relates to both the force of muscle action and the stress
placed on the cardiovascular system. With regard to muscle action, intensity is highest
when the muscles exert maximal tension. Training intensity can determine the specific
adaptations that occur in response to the training stimulus. High-intensity, low-volume
training can be tolerated only for brief periods. Although it does increase muscle strength,
aerobic capacity will not be improved. Conversely, low-intensity, high-volume training
stresses the oxygen transport and oxidative metabolism systems, causing greater gains in
aerobic capacity. Attempts to perform large amounts of high-intensity training or trying to
imitate the training programs of elite clients can have negative effects on adaptation. The
energy needs of high-intensity exercise place greater demands on the glycolytic system,
rapidly depleting muscle glycogen. If training is attempted too often, such as daily, the
muscles can become chronically depleted of their energy reserves and the person might
demonstrate signs of chronic fatigue or overtraining. The body undergoes inflammation in
response to this training and should progress into repair and remodeling.

If you are constantly in the catabolic state of metabolism through repeated training, your
body cannot produce the chemical substances and parts needed for repair, remodeling and
ultimately growth of the body. This is called overtraining. The stress of excessive training
can exceed the body’s ability to recover and adapt, which results in more catabolism
(breakdown) than anabolism (buildup). Once again, clients experience varied levels of
fatigue during repeated days and weeks of training, so not all situations can be classified as
overtraining. Fatigue that often follows one or more exhaustive training sessions is usually
corrected by a few days of rest coupled with a carbohydrate-rich diet. Overtraining on the
other hand is characterized by a sudden decline in performance that cannot be remedied by
a few days of rest and dietary manipulation.

Muscle Soreness

Our bodies will undergo the processes of inflammation, repair and remodeling in response to the stress
imposed by training. A certain degree of muscle soreness or pain may be experienced after a workout.
Muscle soreness that occurs directly after a workout is known as acute muscle soreness. Muscle soreness
that appears 12 to 48 hours after exercise is known as delayed onset muscle soreness (DOMS) or post
exercise muscle soreness (PEMS). Acute soreness may last up to one hour following exercise and dissipate
thereafter. The cause of acute soreness or inflammation may be due to a reduction in blood flow to the
muscle and an accumulation of metabolic byproducts like hydrogen ions or lactic acid. The physiological
mechanisms that cause DOMS or PEMS are not completely understood but the leading hypotheses are: (1)
the Connective Tissue Damage Hypothesis, (2) Skeletal Muscle Damage Hypothesis, and (3) The Spasm
Hypothesis.

1. Connective Tissue Damage Hypothesis. In a 1997 study, Brown, Child, Day and Donnelly
reaffirmed an early study done by Abraham that demonstrated that the excretion of
hydroxyproline, a metabolic product of connective tissue damage was higher in the urine of
individuals who experienced muscle soreness than those who did not. This hypothesis suggests

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 that DOMS or PEMS is due to a disruption in the connective tissue of the muscle and tendinous
attachments.
2. Skeletal Muscle Damage Hypothesis. In a 1986 study, Clarkson et al found that serum creatine
kinase concentration was elevated with concentric, eccentric and isometric contractions, with
greater perceived muscle soreness associated with the eccentric contraction. In a 2000 article
entitled “Effects of Plyometric Exercise on Muscle Soreness and Plasma Creatine Kinase Levels and
its Comparison with Eccentric and Concentric Exercise” (The Journal of Strength and Conditioning
Research: Vol. 14, No. 1, pp. 68–74), the authors found Clarkson’s study not only proved to be
true but also concluded that plyometric activities had incurred perceived muscle soreness than
concentric contractions.
3. Spasm Hypothesis. In a 1980 study, Devries proposed that DOMS or PEMS is due to ischemia
during exercise, which results in the accumulation of pain-causing substances in the muscle, which
in turn stimulates reflex muscular spasms that produce more ischemia. This theory was further
proven by work done in 2000 by Barlas, Walsh, Baxter, and Allen.

Avoiding Overtraining and Overreaching

As stated earlier, cumulative microtrauma (cellular damage from an overreaching episode that gets worse
and worse over time) is the cause of overtraining. There are two ways to cope with cumulative
microtrauma. You can avoid it and you can treat it. If you have to treat it, it is too late! You avoid it not by
avoiding training or by avoiding a small amount of (normal) cellular destruction, but instead by not letting
microtrauma accumulate. This is done by:

• Incorporating sensible, scientific weight training and light resistance systems of training that
employ a carefully devised “periodicity” or “cycle” method.
• Varying your training methods.
• Taking advantage of, scientific application of the many therapeutic modalities at your disposal.
• Following sensible, scientific nutritional practices and supplementation.
• Using good lifting techniques.
• Getting proper sleep and rest.
• Taking advantage of various psychological techniques that promote restoration (for example,
meditation, visualization and hypnotherapy techniques).
• Avoiding all other stressors in your life that can become problematic to your training efforts
(whether environmental, psychological, sociological, biochemical, physiological or anatomical in
nature).

The best predictors of overtraining syndrome appear to be heart rate, oxygen uptake and blood lactate
responses to a standardized bout of work. Performance decrements are also good indicators. The best way
to minimize the risk of overtraining is to follow cyclic training procedures, alternating easy, moderate and
hard periods of training, also known as periodization. As a general rule, 1 or 2 days of intense training
should be followed by an equal number of easy aerobic training days.

Repeated days of hard training cause a gradual reduction of muscle glycogen. On average, the body has
the ability to store 500 grams of glycogen — 400 are in muscle glycogen, 95 in liver glycogen and 5 grams
in blood-borne glucose. Unless clients consume extra carbohydrates during these periods, muscle and liver
glycogen reserves can be depleted. As a consequence, the most heavily recruited muscle fibers will not be
able to generate needed energy for exercise.

Keeping a journal of daily training programs and charting sets, repetitions, exercises, rest between sets
and most importantly target heart rate during particular lifts, can help you analyze your clients’
progression. If all these factors are constant, then carbohydrate intake should increase by an extra 360
calories per day. The extra calories add up to an additional 2500 calories a week, which corresponds to
the calories needed to gain a pound in muscle. If you continue to lose muscle mass, analyze all the
emotional stress in your life to identify any possible contributing factors. Allow for adequate periods of
sleep a night; men typically eight hours a night and women seven hours a night. A comprehensive
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program that is periodized and progressive will always yield the best gains. Adjust your programs and
keep training.

Figure 15-1: Symptoms of overtraining.

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An Integrated Approach for Recuperation

Left to its own resources, the body will in time recover fully from most training sessions. The problem is
that, the body is in no particular hurry to do this. So the key is to administer a comprehensive
recuperation plan to speed up this process. Soviet researchers recommend, “cycling” your recuperative
efforts. This means that as the difficulty of your training increases, you must pay even more attention to
recuperation. Here, then, is a three-phase recuperation procedure that has been perfected “in the
trenches” on many elite-level throwers and power lifters. This procedure is integrative; that is to say, all
aspects function synergistically, with the end result being a more speedy and complete recovery from the
most difficult training sessions.

Phase 1: Pre-Training Recovery

The application of pre-training recuperative techniques will ensure not only better training performance,
but more effective post-training recovery as well. Sports medicine specialists employ the following to
favorably affect their clients’ recuperative abilities:

Salicylate (Aspirin)
Before we discuss aspirin, we must stress: In all cases, NEVER recommend over-the-counter medication
without first obtaining medical clearance.

Aspirin operates on a variety of levels. First, aspirin improves blood flow by reducing the body’s output of
thromboxane, a natural chemical, which causes blood platelets to become “stickier.” Even as little as 30
mgs (about a tenth of a normal tablet) of aspirin prior to training can thin the blood to the point where
muscle tissue is exposed to greater amounts of nutrient-carrying blood, thus speeding up recovery
between reps and sets. Second, lactic acid and other waste products — the result of heavy training efforts
— will be flushed from your muscle cells with greater speed and efficiency. Aspirin also reduces edema
(swelling), another result of hard training. Tissue swelling and inflammation is universally regarded by
experts as the enemy of healing. Recovery simply does not begin until edema has subsided. Third, aspirin
reduces pain associated with training. While there is no benefit in masking pain resulting from injury,
aspirin can often make the difference between a “ho-hum” workout and a really supercharged effort
which, when coupled with an effective recovery regimen, will lead to increased progress.

Research has proven that low doses of aspirin work just as well as large doses, with less possibility of
stomach irritation. Instead of assuming that “more is better,” it is a wise practice to seek the smallest
possible dose that will assist your recuperative efforts. To protect your stomach lining even further, try
crushing the aspirin tablets between two spoons and mixing them into a glass of milk. Since the body
eventually develops a tolerance to it, use aspirin judiciously; perhaps only prior to your most difficult
training sessions. Once again, never recommend over-the-counter medications without first obtaining
medical clearance.

Leg Elevation
Many of us either sit or stand while at work for eight or more hours before going to the gym. During this
time, the legs can often become edematous and swollen. Training with your legs in this condition will
handicap your training efforts right from the start. To help remedy this condition, spend 20 to 30 minutes
(both during the work day, and prior to your leg and/or low back training) with your back on the floor,
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legs up against the wall or up against the side of a couch. Positioning your legs in this way will allow
gravity to assist your body in returning blood back up to the heart, restoring optimum circulation.
Incidentally, while on your back, take the opportunity to listen to some relaxing music or take a light nap.
Doing so will promote an important physical and psychological transition between work and training.

Phase 2: Recovery During Training

The recovery process starts every time you cease work — that means between the positive and negative
portion of each rep, between reps, between exercises and between workouts. In the larger sense,
recovery is needed between heavy training cycles, which sometimes last months. The following aspects of
recovery during the training session must be addressed.

Time between sets

Time is, in fact, the most elemental unit of recovery. The amount of time you spend between sets has a
significant effect on your performance during succeeding sets and on future training sessions. In fact, you
can raise the overall difficulty of the workout, simply by decreasing the time between sets. You can
employ either objective or subjective methods of monitoring time between sets. Objectively, the pulse
rate is commonly used to determine when to begin the next set. Most commonly, the trainee waits until
the heart rate has fallen below 60% of maximum. Another objective method, albeit less accurate, is to use
the clock. In other words, for example, you would do a set every three minutes. The problem with this
method is that your body’s functioning varies from workout to workout, depending on how well you
recovered from previous training efforts. Therefore, using a standard time unit can be a hit-or-miss
proposition at best.

Most people use a subjective assessment to determine time between sets. In other words, they resume
the next set when they “feel ready.” While there is merit in trusting and listening to your body, we
recommend the heart-rate method, perhaps tempered with subjective assessment, to determine the
proper time between sets.

Movement between sets

Many individuals mistakenly sit down and move as little as possible between sets. While this
feels like the thing to do from an intuitive perspective, a faster recovery can be realized by
moving around a bit between sets. Why? Well, if you will consider the importance of the
warm-up and cool-down in the context of a workout, and then think of moving between sets
as both a cool-down from the previous set and a warm-up for the next set, you will see the
logic in this approach. Movement serves as a “transition” between all-out effort during the
set and relative inactivity between sets. This practice aids circulation and helps to reduce
swelling of muscular tissues.

Peripheral Heart Action Training (PHAT)

PHA is simply the practice of structuring your workouts so that upper- and lower-body
exercises are alternated with one another, instead of first training legs, then back, and so
on. The effectiveness of PHAT is that it keeps the blood moving between major areas of the
body, which accelerates recovery of each bodypart.

The “Light Day”

Instead of performing each and every leg workout at gut-busting intensity, incorporate
planned, easier workouts about every third session. An example of such a session would be
4 sets of 15 reps at 50% to 55% of maximum. This type of moderate-intensity training is
quite effective in “feeding” sore muscles with fresh blood, reducing scar formation on the
micro-level and flushing waste products from affected tissues. Planning light days into your
training schedule not only accelerates recovery times it also adds variety to the training
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schedule, which in itself assists in the recovery process.

Phase 3: Post-Training Recovery

Post-training recovery methods complete the integrated recuperation plan. These methods
are designed to assist the body in rapidly accelerating the recovery process when it is
needed most – directly after training. Two techniques in particular give the most “bang for
the buck” in terms of immediate results.

Contrast Showers
Done immediately after training (use your gym’s shower if possible), expose your lumbar
area to alternating bursts of hot and cold water – as hot as you can reasonably stand for
two minutes, followed by two minutes of progressively colder water up to the point of
discomfort. This procedure is then repeated 4 to 6 times. Since hot water is a vasodilator
and cold water a vasoconstrictor, the net effect of contrast showers is vastly improved
circulation to the affected areas.

The effectiveness of contrast showers is markedly increased when combined with trunk
stretching. Facing away from the shower nozzle, slowly bend forward at the waist, rounding
the spine as you do so (forward flexion). Then return to an upright position and slightly
backward to extend your spine. Finally, flex your spine laterally by bending to each side at
the waist. Use a handrail and non-slip rubber skids for safety. All four stretches are
repeated for each contrasting cycle.

Cryokinetics
Immediately after leaving the shower, construct an ice pack by placing crushed ice in a Zip-
lock bag. Lie down on the floor with your feet propped over your bed or couch and place the
ice pack under your lumbar spine. Now, to improve the effect of this procedure threefold,
try stretching your spine while on the ice. Gently perform lateral (side to side) flexions
alternated with pulling your knees to your chest. Mobilizing your spine in this way will
counteract the stiffening effect that you may have experienced while icing your back in the
past. Cryo-kinetic therapy is very beneficial in reducing contracted, tightened muscle tissue,
as well as pumping these tissues free of accumulated training-induced waste products.
Spend at least 15 but no longer than 20 minutes on the ice.

Ongoing Professional Assistance

Many forms of therapy, including various types of “bodywork,” are available at moderate
cost, and are highly recommended. Chiropractic adjustments, massage, whirlpool, sauna
and acupressure are among the most readily available and effective of these therapeutic
modalities.

The integrated recuperative strategy just described is not theoretical. It has been
successfully used by scores of high-level athletes from various disciplines. It requires a
minimum investment of time and money, and requires no specialized equipment or
facilities. For many individuals, integrating a recuperative scheme into their personal
training schedule means the start of new progress, even after long periods of stagnation.

It all boils down to a simple plan. Many trainers will tell you that the single biggest problem
with their clients is not that they do not train enough, but that they train too much. This is
not necessarily true. Perhaps they have “under-recovered,” but they are not necessarily
training too much. In fact, it may very well be that clients can tolerate much more training
and benefit commensurably from it. First, you must periodize your training adequately. All
progress must be gradual and orderly. What you do must be predicated upon what you have
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 just accomplished. No system of training is a silver bullet. None will give you immediate
success at your sport. Indeed, sticking to one program can actually hamper your progress.
Take your time, be scientific and thorough, and plan for sufficient sleep in your week.

Sleep Requirements

The amount of sleep needed is contingent on the individual’s current schedule, personal preferences and
level of daily stress. Extensive evidence points to a need for at least eight hours of sleep per night and
often as much as nine or more hours in times of elevated stress. You can get by on less, but it catches up
with you eventually. Try it for yourself. Go to bed earlier and get an extra hour in every night for a week.
You will be quite surprised at how your alertness and vitality improve.

The midday nap, although not part of our Western cultural norms, is a widely practiced custom around the
world. Your circadian rhythm begs for sleep at that time, and it is not only attributable to poor diet as is so
often claimed. While poor diet can indeed exacerbate midday drowsiness, it is not the only factor.

Therefore, if possible and your schedule permits, take a brief 20- to 30-minute rest in the afternoon. It
will make you sharper, more alert and promote faster recuperation from intense exercise. However, avoid
going into the deep sleep that comes with longer rest. Short periods of rest are more productive.

Creating a Periodized Program

Now that the need for a periodized program has been reviewed, it is time to begin exploring how such
training can be organized in a logical manner. It is not as clear-cut as it seems. There are many factors
involved in creating a periodized program.

Age- and Experience-Related Factors

Knowing that the Law of Individual Differences does exist, the ages and the experience levels of your
particular clients must be taken into consideration. Remember the following points:

• Younger clients will recover more quickly than older clients.

• Younger clients are also usually less experienced than older clients.
• Clients will change in experience levels and recovery abilities during their training. Over a lifetime
of training the body will decrease in recovery ability, but during that lifetime it will also undergo
certain training effects that allow for harder and more frequent training.

With these points in mind, younger clients, who are less skilled both in conditioning techniques as well as
in their given sports, will need a more vigorous, foundational regimen. As your clients progress and
mature, more sport-specific training will be needed, and the foundational period, while remaining
important, can be shortened. Aged clients may need more recovery time, and individual differences may
require more of a foundational period of training.

Macrocycles, Mesocycles and Microcycles

Periodization is the discreet breakdown of training goals through cycles. Training cycles can be categorized
as macrocycles, mesocycles and microcycles. In simple terms, periodization is a way to organize training
goals. Metaphorically speaking, a macrocycle can be likened to a dollar bill. A mesocycle would then be
considered a quarter and a microcycle would be like a penny. Keep in mind that these terms are simply
used for training organization.

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Macrocycle
A macrocycle can be thought of as an entire training period. While it is generally thought of as a year, it is
not always the case. Most sports have one season per year; however, others, such as track and field and
weightlifting, may have two or more “seasons” per year.

Mesocycle
A mesocycle is a periodical breakdown in a macrocycle. While the overall focus in a mesocycle is changed,
it should be noted that mesocycles “blend” together. Foundational training does not end in the
“foundational” period. Nor does sport-specific training begin in the “sport-specific training” period. Pre-
training for sport-specific movements and exercises will begin in the foundational period, and foundational
training may extend well into the sport-specific period (however, with less emphasis).

Microcycle
A microcycle is described as one cycle in intensity. Recall that periods of high intensity must be followed
by periods of low intensity before another period of high intensity can occur. For certain muscles, this
could take as little as five days and as much as three weeks! So, while a microcycle is often thought of as
“one week,” this is not always the case. Imagine that you have your client on a certain program for the
next three weeks and he or she is progressing in a positive manner. However, midway through the cycle a
work related problem occurs, which limits your client’s normal sleep patterns. He or she is unable to
continue with the program as planned. In this instance a one-day deviation in the program’s intensity to
account for this deviation can be implemented. This one-day deviation is an example of a training
microcycle.

Order of Exercises, Drills and Flexibility Training

One dilemma that often plagues the trainer and client: What should the client do first? All components are
important, but which ones should be done first? Because speed, explosive movements and agility require
much of the body’s resources, they hold precedence in order of training. Because bigger muscles require
more energy and effort than smaller muscles, they should be done first. Multiple-joint movements also
require more energy and effort than smaller muscles, they, too, should be exercised first. As for flexibility
training, the rule is, it should never be done when the body is not fully warmed up as injury may occur.

Training is not limited to the weight room or the field. During training, psychological techniques and
therapeutic modalities must also be applied. With these points in mind, here are some general guidelines
for proper order of exercises, drills and flexibility training:

I. Psychological training (visualization,

concentration, etc.)

II. Warm up

III. Flexibility training

IV. Non-linear speed-strength training

A. Plyometric training

B. Agility training

V. Linear speed training

VI. Explosive training (Olympic movements)

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VII. Multiple-joint movements

A. Squat

B. Bench Press

C. Dip, overhead press, etc.

VIII. Single-joint movements

A. Larger muscles

B. Smaller muscles

IX. Flexibility training

X. Cool down

XI. Application of appropriate therapy (ice treatment, TENS, etc.)

Foundational Training

The main purpose of foundational training is to strengthen weaknesses, recover from any injuries, and
develop a “foundation” of strength in all muscles, tendons, ligaments and health and fitness. Usually this
involves training for limit strength, but it can also include the most nonspecific components of fitness
involved in your sport. Because limit strength is not a major component of any sport other than
powerlifting (although important), it is usually the main focus of this period. For this reason, we are
providing a powerlifter’s “peaking cycle” as a basic plan for developing limit strength. For clients other
than powerlifters, slight modifications should be made, as they have no reason to perform one-repetition
maximum lifts.

For a beginning client, this period may also serve as a “learning” period for technique and general strength
training. In future mesocycles, a beginner may be required to engage in movements that are foreign to
him and cannot be done properly or efficiently unless he or she has been exposed to such movements in
the foundational period.

This period has been given several names by practitioners (general preparatory period and anatomical
adaptation phase to name two). Regardless of what it is called, the main focus remains the same: to
prepare clients for future training and peak performance by developing a strong foundation of health and
fitness.

Functional Training
(Sport-Specific Training)

This mesocycle is dedicated to further and more focused development of those attributes needed by your
client. Training will be done increasingly closer to the energy pathway needed for the particular sport.
Furthermore, the bodyparts (muscles, tendons and ligaments) that are more directly involved will receive
heavier focus. For example, a sprinter, who would have been focusing on cardiovascular strength as well
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as limit strength in all muscles of the body in the foundational period, will now focus on explosive leg
strength and strength in the ATP/CP or glycolytic pathway in this mesocycle (depending on the length of
the race).

More advanced training techniques, such as the Olympic movements or compensatory acceleration
training, will be used in this period for many clients without worry of proper technique (which should have
been developed in the foundational period). The functional training period will also serve as a foundation
for more advanced training, such as plyometrics and ballistic training in the pre-seasonal mesocycle for
many clients.

Pre-Season Training

This mesocycle is designed to bring all aspects of past training together to optimally condition a client for
peak performance. With the proper foundation and skills in place, it is time to focus on extremely specific
skills needed for your client’s sport. No components of fitness that are not highly specific to your client’s
sport is to be practiced in this mesocycle — they should already be in place!

Many of the drills and exercises in this mesocycle will be extremely advanced and cannot be done by
anyone who is not a high-level client. For example, for some clients, ballistic movements and overspeed
training will be used. Such movements would be too intense for an unconditioned client. Furthermore,
your client should start practicing the movements and patterns needed for his or her sport. Football
players should start looking at their play-books more, pitchers should be throwing harder, long-distance
clients should run longer distances, and hockey, soccer, lacrosse players should be practicing ball or puck
handling. In any sense, before the focus was on gaining the necessary “tools” to optimize performance.
Now is the time to refine their skills with their new “tools.”

In-Season Training

Even in the pre-season training mesocycle, your client is still developing. However, now gameday soon
approaches! Seasonal training should be viewed as the first day of organized practice. The reason is, these
practices are often the most intense of the year, and it’s time to start backing off in training and allowing
the head coach do his job.

While conditioning will be seriously decreased, the term “maintenance phase” is a misguided and illogical
term. It does not mean physical fitness will not be increased and merely maintained. In fact, it will be
increased. In-season training is the ultimate in “sport-specific” training. Your client, with the proper
periodized routine, should become stronger — both in the game and in overall conditioning — as the
season progresses. The secret is to properly schedule training sessions to allow such growth without
disturbing the head coach’s practices. The goal of this mesocycle is to win! Nothing you do in this
mesocycle should impede this goal!

Active Rest

Now that the season is over, your client has achieved championship status (nothing less is acceptable!)
and he or she has left everything he or she had on the play ing field, it is time to realize the GAS Principle
and allow a period of low intensity. Peak performance is both physically and psychologically draining and
it’s time to “get away”.

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While the term “active rest” may seem like a contradiction in terms, it is not. Knowing that various
therapeutic modalities increase recovery time and that even exhausted bodies will recover more quickly
from actively moving the body, this is still a time for physical activity, much less intense activity — but
activity nonetheless.

Tell your clients to enjoy those things they have been meaning to do. Play some pick up basketball. Go for
a daily, long walk with your significant other. Put good use to those golf clubs. Emphasize that they are
not to sit around and do nothing!

Conclusion

As noted, perhaps names amongst practitioners may differ, the goals and progression remain the same. It
is a discreet and gradual movement toward optimal fitness in regard to the specific demands of your
client’s sport. It must be reemphasized that the goals of each mesocycle are not clear-cut, but blend
together. In the foundational mesocycle you are developing the skills for sport-specific training. In the
sport-specific training mesocycle you are still developing a foundation as well as setting the stage for in
season training. In pre- and in-season training, you are still developing sport-specific strength. Although
your client may not be involved in a traditional sport, he/she will have a goal and the plan on how to best
achieve the goal can be periodized as well.

Unit Summary

I. Periodization refers to how a training program is broken down into discreet time periods called
macrocycles, mesocycles and microcycles. In simple terms, periodization is a way to organize training
goals.

A. Metaphorically speaking, imagine a macrocycle is a dollar bill. A mesocycle would then be considered a
quarter and a microcycle would be like a penny. Keep in mind that these terms are simply used for
training organization.

II. Hans Selye’s General Adaptation Syndrome Principle has demonstrated that the body will go through
three predictable stages in response to stress: shock, compensation and exhaustion. Therefore, cycling
your training to account for these stages is imperative for program success. Not doing so can lead to
overtraining.

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III. Though there are several physiological markers of overtraining, the most common are sympathetic
and parasympathetic nervous system overtraining.

IV. Excessive training refers to the training in which the volume, intensity or both are increased too
quickly without proper progression.

V. Muscle soreness that occurs directly after a workout is known as acute muscle soreness. The
physiological mechanisms causing DOMS or PEMS is not completely understood, but the leading
hypotheses are 1) The Connective Tissue Damage Hypothesis, 2) Skeletal Muscle Damage Hypothesis and
3) The Spasm Hypothesis.

A. The best way to minimize the risk of overtraining is to follow cyclic training procedures. This is done by
alternating easy, moderate and hard periods of training; also known as periodization. As a general rule,
one or two days of intense training should be followed by an equal number of easy aerobic training days.

B. Integrating a recuperative scheme into training schedule can mean the start of new progress, even
after long periods of stagnation.

C. The ISSA recommends taking a brief 20- to 30-minute rest in the afternoon.

VI. Periodization is a gradual process with the goals of each mesocycle oftentimes blending together.

A. In the foundational mesocycle skills for sport-specific training are developed.

B. In the sport-specific training mesocycle a foundation is still developing as well as the stage being set for
in-season training. In pre- and in-season training, sport-specific strength is still developing.

C. Even if your client is not involved in a sport, his or her training program should still be periodized.

Section 4: Unit 16 Outline

Determining Training Loads

I. Training Loads

A. Determing Repetitions, Sets, and Frequency

1. Repetitions, Sets, Frequency, and Hormones

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 2. Training Load Pregression

B. ISSA's Integrated Approach to Sports Training

1. Matching Training Technologies to Fitness Objectives

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand when and why you should use certain repetitions,

sets and frequency for particular weight training goals.
• Understand and apply ISSA’s Integrated Approach to Sports
Training to exercise programs.

Training Loads

It is imperative as a future trainer that you are able to determine the appropriate loads and
repetitions necessary to bring about the desired goals of your clients. An inappropriate
recommendation can lead to excessive training, which will undoubtedly lead to overtraining

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and, inevitably, failure for your client.

Maximum power will occur somewhere

between 55% and 85% of the one-
Table 16-1: One Rep Maximum* repetition maximum. Therefore, the
training load (how much weight is used)
should be somewhere between 55% and
Number of Percent of
85%. This is considered the appropriate
Repetitions Maximum (%)
training zone to facilitate a training effect in
resistance training. Remember that in order
1 100.0
to determine your own or your client’s one
repetition maximum, the following protocol
2 95.0
should be used. Select an exercise, for
example the bench press, and ask your
3 92.5
client how much weight he or she can
successfully lift for 10 repetitions. Load the
4 90.0
bar and then count the actual repetitions
completed. If your client claimed that he or
5 87.5
she could do 135 pounds for 10 repetitions
and in reality only completed seven
6 85.0
repetitions, then you would check Table 16-
1 for the percentage that relates to seven
7 82.5 repetitions. As you can see, seven
repetitions correlates to 82.5%. Take the
weight lifted (in this example it was 135
8 80.0 pounds) and divide it by 82.5% to arrive at
the estimated 1RM. If your client
successfully completed seven repetitions at
9 77.5
135 pounds then his or her 1RM would be
135 ÷ 0.825 = 164 pounds. Keep in mind
10 75.0 that a standard deviation of plus or minus
25% will be evident from one client to
another.

Determining Repetitions, Sets and Frequency

Remember the Principle of Individual Differences? Each of us has differences that eventually
dictate how many repetitions and sets we can perform, how often we can train, and how
much weight we should be using while training. Consider the following:

• Large muscle groups recover more slowly than smaller muscle groups.
• Fast-twitch (white) muscle fibers recover more slowly than slow-twitch (red) muscle
fibers.
• Recovery from fast movements takes longer than does recovery from slow
movements.
• Men recover more quickly than women.
• Young clients recover more quickly than older clients.
• Using heavy weights requires more recovery time than using lighter weights.
• More repetitions, sets and frequency require longer recovery periods than do fewer
repetitions, sets and frequency.

All of these points need to be taken into consideration; however, let us focus on the second
point: muscle fiber types. If you could figure the fiber makeup of each person on this planet,
you would have a bell shaped curve — something similar to that of Figure 16.1 on the
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opposite page. Twenty five percent of the population will have predominately white muscle
fiber, 25% will have predominately red muscle fiber and 50% will be somewhere in the
middle. Of course, there are a few exceptions. Postural muscles are usually mostly red fiber,
as are calves (they have to be, otherwise you’d tire too easily while standing and walking!)

Once you have determined whether you are fast twitch, slow twitch or somewhere in
between, you then can determine your optimal repetitions, sets, weight and training
frequency. (We have provided some guidelines; however, even these are subject to
individual differences.) Training zones note that if you are predominately white fiber, it does
not mean you always train with heavy weight and low repetitions and sets. Most of your
training will be at this end of the spectrum; however there will be periods where lower
weights and higher frequency are needed (as noted by the GAS Principle and Specificity
Principle). However, the SAID Principle states that the body will adapt in a highly specific
way to your training.

As well, in an ideal world, you will have the “genetic gift” of matching muscle fiber
composition that is best suited for your sport. In higher levels of competition, this is almost
always true. Not so in lower levels of competition. Through research, you may discover that
you are predominately a red fiber individual, yet you want to play football! This is not such a
bad scenario (you will just do a few more repetitions and sets). If you have to go from one
extreme to the other, you are in poor shape! But the SAID Principle says you must train that
way regardless of your genetics. It is not possible to establish the relative portion of an
individuals’ health or fitness that is determined through heredity, therefore your genetic
background neither dooms or guarantees success in achieving total fitness.

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Repetitions, Sets, Frequency and Hormones

Many training programs have been developed over the years in an attempt to modify and manipulate the
natural process of hormonal releases, each with varying degrees of success. The truth is, the success of a
program is often determined by its ability to elicit a specific hormonal response, and little else.

Hormones circulating during and after workouts directly affect muscle adaptation. Unfortunately, this is
one of the most misunderstood aspects of resistance training. If we as trainers understood the natural
anabolic activity in our clients resulting from specific styles of strength training, we could surely design
more effective programs that would enable our clients to recover faster, adapt and grow more effectively.
Let us look at the factors of muscle fiber recruitment and manipulating serum testosterone and growth
hormone levels through resistance training.

The average beginning trainee knows that high Figure 16-1

repetitions (15 repetitions or more at 55% to 65% of
1RM) is best for muscular endurance and is not
conducive to gaining muscular mass. The lighter weights
used in high-repetition work are not enough to
innervate the higher-threshold motor units in a muscle.
The key is that only muscle fibers activated by the
resistance training will respond to increased levels of
anabolic hormones. When heavier weights (lower
repetitions) are used in resistance training, more muscle Click above to enlarge
fibers are recruited. The more muscle fibers recruited image
for an exercise, the greater the extent of remodeling in
the entire muscle.

There is another reason that light weight and high repetitions are not optimal for stimulating muscular
hypertrophy. The majority of the work done in high-repetition sets is accomplished by slow-twitch type I
muscle fibers. Type I muscle fibers have a limited ability to hypertrophy. Type IIB fibers are activated
when more force is required, which allows for the greatest potential for growth. Heavier weights
accomplish more complete activation of the type IIB muscle fibers.

According to the size principle, motor units are recruited in order according to their thresholds and firing
rates. Since most muscles contain a range of type I and type II fibers, force production can be very low or
very high. Therefore, to get to a high-threshold motor unit, all of the motor units below it must be
sequentially recruited. Heavy resistance training recruits these high-threshold motor units; therefore all
the units below it can undergo hormonal adaptations to the stress of the heavy loads.

An increase in serum testosterone levels is one result of heavy resistance training. Since testosterone is
the primary hormone that interacts with skeletal muscle tissue, it has both direct and indirect effects on
muscle tissue. Resistance training exercises utilizing large muscle groups of the lower body (squats,
deadlifts) can increase serum testosterone concentrations more than other types of exercises. Using a
resistance of 85% to 95% of 1RM will also increase testosterone levels more than other resistance loads.
Many aspiring novices will attempt to lift near 1RM loads for one or two repetitions in the hopes of gaining
muscle size. Although heavy resistance does innervate high threshold motor units, serum testosterone
levels are increased through moderate to high volume of exercises. This is achieved through multiple sets,
exercises and a moderate repetition range (around 10 repetitions) with short rest intervals (30 to 60
seconds).

For gains in muscular size, smaller motor units need to be recruited first in each set of exercise. As the set
progresses in intensity, larger units will then be recruited. If the low-threshold motor units are inhibited to

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recruit the high-threshold motor units for explosive movements (as in powerlifting), the low-threshold
units that are not activated will not undergo hormonal adaptations. This is because of the size principle of
muscle fiber recruitment. Since motor units are recruited in an orderly fashion (from low threshold to
high) and can span a range of muscle fiber types (type I and type II), then a moderate range of
repetitions must be used to recruit the entire spectrum of fibers. This recruitment pattern allows the full
spectrum of fibers to adapt to the training by increasing sensitivity to circulating anabolic hormones.

Table 16-2: Training Sets and Reps

Training Application Repetition Guidelines Working Sets

Endurance Training 12 or more 2 to 3

Hypertrophy 6 to 12 3 to 6*

Strength 6 or fewer 2 to 6

Power 1 to 2 3 to 5

* Bodybuilding sets may vary dramatically depending on program design.

After a muscle has been subjected to intense stress through maximal force contractions over a moderate
repetition range, hormones begin the growth process and muscle remodeling. Growth hormone plays a
vital role in adapting to the stress of resistance training. Growth hormone levels can be increased through
resistance training of high intensity (10 repetitions at 75% of 1RM) with three sets of each exercise (high
total workload) and short, one-minute rest periods. Once the levels are elevated, a cascade of events
occur: decreased glucose utilization, increased amino acid transport across cell membranes, increased
protein synthesis, increased utilization of fatty acids, increased lipolysis (fat breakdown), enhanced
immune functions and a promotion of compensatory renal hypertrophy. An understanding of natural
anabolic activity, which occurs in the human body is essential to muscular adaptation, successful recovery,
training progression and ultimately muscular gains.

Training Load Progression

Once you determine an appropriate load and repetition plan that is commensurate with your clients’ goals,
a strategy for progression is imperative because your clients will inevitably adapt to the initial plans.
Without progression, the need to adapt is reduced resulting in stagnant training.

If you are not making gains with your clients’ current programs, then you are not doing all you can to
assist them in achieving their goals. Unfortunately, a big mistake many trainers make is that they
faithfully stick to a program that is not producing results. As obvious as it may seem, if you continue to do
the same thing, you will continue to get the same results. Many trainers continue to follow programs that
are not producing results with an erroneous belief that results are inevitable. If you are not seeing results
on a monthly basis, you need to reassess the training protocol.

As with most endeavors, you cannot achieve success haphazardly. You need to have specific, objective
goals that are recorded to check for progress. Monitoring your client’s training and charting his or her
response to your recommended program allows you to know when and to what extent the loads should be
progressed. As stated earlier, you need to formulate specific goals, keep a training journal and periodically
check the client’s body composition. If you do not set specific goals, and if you do not monitor the client’s
progress toward those goals, then how can you assess if the clients are making progress?

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Make a concentrated effort to progressively increase the intensity to meet the overall goals. This is where
having a specific goal with a specific timetable is important. The training style has to be conducive to the
intended goal, whether it is muscle hypertrophy or strength gains. You cannot train the same way for an
extended period of time and hope for gains.

According to Graves and Baechle, a simple method to assess when progression is necessary is known as
the 2-for-2 rule. If your client can successfully complete two or more repetitions in the last set in two
consecutive workouts for any given exercise the load should be increased. The ISSA recommends a load
increase of 2% to 5% percent for advanced trainees and 5% to 10% percent for new and intermediate
trainees. Keep in mind that seasoned athletes and intermediate trainees are at or beyond the national
averages in their strength capacities and therefore load increases will not be as large as their new
counterparts who have much more room for improvement.

Another reason for this is that initial strength increases in beginners are partially due to neural factors
rather than muscle hypertrophy. Neural adaptations like improved synchronization of motor units firing
and improved ability to recruit motor units account for a faster rate of progression. Initial strength
increases due to neural adaptations will not always result in hypertrophy, which is why many new trainees
will improve in strength more rapidly a their muscles will increase in size.

Figure 16-2: Heavy resistance training, light resistance training, psychological techniques, therapeutic
modalities, medical support, biomechanics, dietary manipulation and nutritional supplementation each
play a significant role in integrated sports training.

ISSA’s Integrated Approach to Sports Training

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The act of lifting weights is not in itself training. While it is certainly an integral part of training, training is
part of the process of a fitness lifestyle. This process of training includes key technologies. The ISSA has
outlined eight critical components or technologies that comprise an effective process of integrating fitness
into clients’ training and lives. Collectively these factors have been organized into the International Sports
Sciences Association’s Integrated Approach to Training.

Consider these eight technologies as “spokes” in a wheel (Figure 16.2). Not having one or two of these
spokes will make for a wheel that will still run, but it will not be as sturdy. The more spokes you take out,
the less efficient and safe the wheel becomes. Likewise, the fewer technologies you use the less efficient
your training will be.

1. Heavy Resistance Training: Dumbbells, barbells, fluids, pressurized air, elastic devices, springs and
a host of devices designed to provide “heavy” external resistance to one’s musculoskeletal effort all
constitute “resistance training.” Tradition has it that exercises designed to be performed with
dumbbells and barbells (and the technologies designed to simulate traditional dumbbell and barbell
movements) constitute “weight training.” The existing categories of weight training technologies
are: 1) constant resistance devices, 2) variable resistance devices, 3) accommodating resistance
devices, and 4) static resistance devices. New technologies will be developed in time.
2. Light Resistance Training: Running, swimming, calisthenics, aerobic dance, plyometrics and many
more — are all special forms of “light” resistance training. When bodyweight alone is the source of
resistance, tradition and reasons of clarity dictate that the exercises be referred to by their
individual names. Cycling, rowing, stair climbers and similar forms of training that utilize “light”
external resistance collectively constitute a second category of light resistance training, which are
also referred to by their respective names.
3. Psychological Techniques: Self-hypnosis, mental imagery training, transcendental meditation and a
lot of other “mind games” can help improve strength output capabilities in sports and training.
4. Therapeutic Modalities: Whirlpools, electrical muscle stimulation, massage, ultrasound, music,
intense light and a host of other therapies can have a very positive effect on strength training
efforts, both indirectly (how quickly you can recover from your previous workout), and directly
(greater force output).
5. Medical Support: Periodic checkups, exercising preventive care, chiropractic adjustments, and even
clinical use of prescription drugs are sometimes recommended for those in heavy training when
medical problems arise. Only qualified sports medicine specialists are able to prescribe such
support.
6. Biomechanics (Skill Training): Performing your skill perfectly will almost always result in greater
force being applied, whether it is applied to an object, opponent or the ground. Good skills
execution involves the efficient sequencing of activation/inhibition of prime mover, stabilizer and
synergistic muscles. Sequencing efforts involve factors of position, direction, timing, rate, speed
and effect of force application.
7. Dietary Manipulation: You do not eat only to stay alive and healthy, you eat to excel at your sport
or fitness activity. Eating is designed to assist in achieving specific sports/training objectives. There
are many nutritional techniques that will ensure greater force output capabilities both immediately
as well as over time, thereby improving training and competition efforts. Despite your most
dedicated efforts, however, you will not be able to gain ample nutritional support from food alone,
a point that has been supported time and time again in sports nutrition research.
8. Nutritional Supplementation: Most often, eating is not sufficient to give you all the nutrients you
need in order to achieve your sports/training objectives. This point is widely disputed among sports
scientists and nutritionists alike, who would have us believe that eating “three square meals” per
day is ample fare for clients in heavy training. They overlook at least three important points: 1)
Many state-of-the-art supplements are designed to take your body beyond normal biochemical
functioning, 2) No one on earth consistently eats “square meals,” and 3) Myriad research reports
clearly show that deficiencies most often exist in clients’ diets due to many well-documented
reasons.

Matching Training Technologies to Fitness Objectives

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In your quest for excellence, your job is always going to be to identify — and apply — those technologies
that best augment each of the factors that effect fitness and arrange them into a coherent, integrated
training program. Clearly, some factors are not alterable (e.g., fiber arrangement and insertion points of
muscles). That doesn’t mean you can’t make use of your knowledge of these limitations in structuring
your clients’ training, by avoiding less than fruitful practices or in some way manipulating them to your
advantage.

Bear in mind that many of the factors effecting program design are inextricably interrelated and may be
directly or indirectly, positively or negatively, affected by your attempts to augment or in some way
manipulate any of them, regardless of which technologies are employed in training. For example, long,
slow distance running (aerobic) will invariably hamper efforts to achieve maximum starting strength.
There are many, many similar scenarios, and the wise fitness trainer will learn to avoid this often costly
kind of mistake.

Remember that there are only so many hours in the day, so you must choose the methods of training that
will yield the greatest returns. Zero in on the most important training objectives, and integrate the
training methods that will get your clients to their goals safely, quickly and fully.

Table 16-3a: Sample Training Program (Beginner/Female)

Client: Mrs. Smith Age: 42 Level: Beginner

Goal: Firm legs, butt, and get rid of flab under her arms (10% bodyfat reduction)

Activity Level: Moderate; walks occasioally with friends (4-mile walks twice a week)

Medical conditions: None

Frequency: 3 times per week (Monday, Wednesday and Friday)

Warm-Up: 10- minute treadmill walk Flexibility: 5 minutes of light stretching

Resistance training exercise Reps Sets

Saftey Squat 15-17 1

Flat Bench Dumbbell Press 12-15 1

Lying Leg Curl 10-12 1

Seated Cable Row 12-15 1

Forward Lunge (alternating leg each rep) 15 each leg 1

Shoulder Press (neutral grip) 12-15 1

Alternate Seated Dumbbell Curl 12-15 1

Triceps Cable Pressdown 12-15 1

Seated Calf Raise 30 1

Incline Bench Dumbell Press 12-15 1

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Side Lunge 15 each leg 1

Step Up 15 each leg 1

Assisted Machine Pull-Up 12-15 1

Seated Lateral Raise 12-15 1

Seated Leg Curl 10-12 1

Dumbbell Hammer Curl 12-15 1

Incline Dumbbell Triceps Extension 12-15 1

Standing Calf Raise 12-15 1

Reverse Pec-Dec 12-15 1

Back Extension 20-25 2

Reverse Crunch 20-25 2

Oblique Crunch 20-25 2

Straight Crunch 20-25 2

Superman 20-25 2

Cardio: 60% to 70% of maximum heart rate Flexibility: 5 minutes of light stretching

Table 16-3b: Sample Training Program (Beginner/Male)

Client: Mr. Smith Age: 36 Level: Beginner

Goal: Get bigger (increase LBM)

Activity Level: Job entails lifting boxes for two hours per day, 5 days per week

Medical conditions: None

Frequency: 3 times per week (Monday, Wednesday and Friday)

Warm-Up: 10- minute treadmill walk Flexibility: 5 minutes of light stretching

Resistance training exercise Reps Sets

Squat 10-12 2

Flat Bench Dumbbell Press 10-12 2

Semi-stiff Legged Deadlift 10-12 2

Seated Row 10-12 2

Leg Press 8-10 2

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Incline Bench Dumbbell Press 8-10 2

Lying Leg Curl 8-10 2

Lat Pulldown 8-10 2

Dumbbell Shoulder Press 8-10 2

Lateral Raise 8-10 2

Barbell Curl 8-10 2

Triceps Press Down 8-10 2

Hammer Curl 8-10 2

Lying Dumbbell Triceps Extension 8-10 2

Seated Calf Raise 30-35 2

Standing Calf Raise 10-12 2

Hyperextension 16-20 2

Back Extension 16-20 2

Reverse Crunch 20-25 2

Oblique Crunch 20-25 2

Straight Crunch 20-25 2

Cardio: 3 times per week for 30 minutes at 60% to 70% of maximum heart rate

Flexibility: 5 minutes of light stretching

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Table 16-4a: Sample Training Program (Intermediate/Female)

Client: Ms. Johnson Age: 23 Level: Intermediate

Goal: Get ready for her wedding coming up in 6 months (Increase LBM by 3 pounds and
lose 5 pounds of body fat).

Activity Level: Intermediate; she is very active on the weekends and has moderate
activity with her job as a daycare assistant. Ms. Johnson also enjoys playing golf with her
fiancé on the weekends

Medical conditions: None

Frequency: 3 times per week (Ms. Smith can only make it to the gym Monday, Tuesday
and Thursday)

Monday: Lower Body

Warm-Up: 10- minutes on machine of her Flexibility: 5 minutes of dynamic

choice stretching

Resistance training
Reps Sets Rest
exercise

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1. Deadlift 8-10 3 90

2. Walking Lunge with

20-22 2 60
Loaded Trunk Rotation

3. Hamstring Curl* 10-12 2 60

4a. Multi-Plane Lunges

(Front, 45°, side and 40 each leg 2 30
transverse)

4b. Step-up with Hip

40 each leg 2 90
Flexion

5. Standing One-leg Calf

10-12 2 90
Raise

6. Weighted Russian Twist

30-35 2 30
from Floor*

7. Back Extension 25-30 3 60

8. Straight Crunch Sland

25-30 2 30
Board (with weight)*

Cardio: 30 minutes of interval training on machine of her choice

Flexibility: 5 minutes of light stretching

3.Hamstring Curl done on a stability ball

*More functional exercise
6.Weighted Russian twist with legs on a stability ball
options
8.Straight Crunch on a stability ball

Tuesday: Upper Body

Warm-Up: 10- minutes on machine of her Flexibility: 5 minutes of dynamic

choice stretching

Resistance training
Reps Sets Rest
exercise

1a. Seated One-arm Cable

6-8 4 90
Row with Rotation

1b. Dumbbell Flye on Flat

6-8 4 90
Bench*

2. Push/Pull with Cables 10-12 4 60

3. Cable Rope Pulls to

10-12 3 90
Neck*

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4. Unilateral Shoulder
10-12 2 60
Press*

5. L-Lateral Raise 10-12 2 60

6. Bent-over Lateral
10-12 2 60
Dumbbell Raise

7. Alternate Dumbbell
10-12 3 90
Hammer Curl*

8. High Pulley Triceps

10-12 3 90
Extension with Rope

Cardio: 30 minutes of interval training on machine of her choice

Flexibility: 5 minutes of light stretching

1b. Dumbbell Flies on Stability Ball

3. Cable Rope Pulls to Neck on Stability Ball

*More functional exercise
options 4. Unilateral Shoulder Press on Stability Ball

7. Alternate Dumbbell Hammer Curl on Stability Disk or

Wobble Board

Sample Training Program (Intermediate/Female), continued

Wednesday: Off

Thursday: Full Body

Warm-Up: 10- minutes on machine of her Flexibility: 5 minutes of dynamic

choice stretching

Resistance training exercise Reps Sets Rest

1a. Push Press 8-10 4 0

1b. Squat 8-10 4 0

1c. Push-up 8-10 4 0

1d. Deadlift 8-10 4 180

2. Back Extension * 15-20 2 60

3. Alternate Superman * 20-25 2 60

4. Plank Hold* 15 sec. 3 60

5. Wood Chop 20-25 3 90

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 Cardio: 30 minutes of interval training on machine of her choice

Flexibility: 5 minutes of light stretching

2. Reverse hyperextension on stability ball

*More functional exercise
3. Alternate Superman on stability ball
options
4. Supine lateral stability ball roll

Friday: Off

Saturday: Active Rest

Sunday: Active Rest

Table 16-4b: Sample Training Program (Intermediate/Male)

Client: Mr. Jones Age:18 Level: Intermediate

Goal: Make his collegiate soccer team (hoping for a defensive position)

Activity level: plays soccer 3 times per week, plays basketball a few times as well

Medical conditions: none

Frequency: 4 times per week (Upper Body / Lower Body Split)

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Day 1: Lower Body Workout

Warm-Up: 10-minute treadmill jog

Plyometrics: split squat, lateral jump

Flexibility: 5 minutes of dynamic stretching
over barrier

Resistance training
exercise:(2 times per week Reps Sets Rest
(Monday and Thursday)

1. Squat with Calf Raise 12-15 4 120

2. Semi-Stiff-Legged
Deadlift 10-12 4 120

3a. Multi Plane Lunges

40 each
(Front, 45°, side and 2 30
leg
transverse)

40 each
3b. Step-up with Hip Flexion 2 90
leg

4. Weighted Russian Twist

30-35 2 30
(Floor*)

5. Back Extension* 25-30 3 60

6. Oblique Crunch on Slant

25-30 2 30
Board (with weight)*

7. Straight Crunch on Slant

25-30 2 30
Board (with weight)*

Cardio: 20 minutes of jogging on a track with five-yard sprints every 50

yards.,,Flexibility: 15 minutes of assisted stretching,

Flexibility: 15 minutes of assisted stretching

4. Weighted swiss ball russian twist from floor<

5. Back extension on stability ball

*More functional exercise
options
6. Oblique crunch on swiss ball (with weight)

7. Straight crunch on swiss ball (with weight)

Day 2: Upper Body Workout

Warm-Up: 10- minutes on machine of her Flexibility: 5 minutes of dynamic

choice stretching

Resistance training
Reps Sets Rest
exercise:2 days per week

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(Tuesday and Friday)

1. Flat Bench Alternate

8-10 4 120
Dumbbell Press*

2. Pull-up 8-10 4 120

3. Cable Cross-over with

10-12 2 60
Trunk Rotation

4. Pull-Over 6-8 2 90

5. Unilateral Shoulder
10-12 2 60
Press*

6. Lateral Raise 10-12 2 60

7. Unilateral Posterior Delt

10-12 2 60
Raise

8. Alternate Dumbbell Curl* 10-12 3 90

9. Decline Dumbbell Triceps

10-12 3 90
Extension

Flexibility: 15 minutes of assisted stretching

1. Alternate dumbbell chest press on stability ball

*More functional exercise 5. Unilateral shoulder press on stability ball

options
8. Alternate dumbbell curl on stability disk or wobble
board

Day 3 (Wed): Active Rest Day 4 (Thurs):Lower Body Workout

Day 5 (Fri): Upper Body

Day 6 (Sat): Active Rest Day 7 (Sun): Off
Workout

Table 16-5a: Sample Training Program (Advanced/Female)

Client: Miss Hersbro Age:28 Level: Advanced

Goal: Be in bikini shape for the summer (3-pound body fat reduction)

Activity level: Moderate

Medical conditions: none

Frequency: 4 days per week

Day 1: Full Body Workout #1

Warm-Up: 10 minutes on machine of her Flexibility: 5 minutes of dynamic

choice stretching

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Resistance training exercise: Reps Sets Rest

1a. Dumbbell Walking Lunge 15-20 4 30

1b. Seated Cable Row 10-12 4 30

1c. Standing Hamstring Curl 10-12 4 30

1d. Push-up 10-12 4 60

2. Incline Reverse Curl 20-25 3 60

3. Decline Oblique Crunch with

20-25 3 60
Medicine Ball

Cardio: 30 minutes of interval training machine of her choice

Flexibility: 15 minutes of assisted stretching

Day 2: Full Body Workout #2

Warm-Up: 10- minutes on machine of her Flexibility: 5 minutes of dynamic

choice stretching

Resistance training exercise: Reps Sets Rest

1a. Pull-up 10-12 4 30

1b. Semi-stiff Legged

10-12 4 30
Deadlift

1c. Dip 10-12 4 30

1d. Hammer Curl 10-12 4 60

2. Calf Raise 10-12 3 60

3. Bent-over Lateral Raise 10-12 3 60

4. Four-Point Alternate
20-26 3 60
Arm/Leg Raise

Cardio: 30 minutes of interval training machine of her choice

Flexibility: 15 minutes of light stretching

Day 3: Off Day 4: Full Body Workout #1

Day 5: Full Body Workout #2 Day 6: Active Rest Day 7: Active Rest

Table 16-5b: Sample Training Program (Advanced/Male)

Client: Mr. Hisbro Age:26 Level: Advanced

Goal: Increase LBM and shoulder-joint integrity; also plays in advanced men’s soccer

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league on weekends

Activity level: Moderate, active when not at work

Medical conditions: Previous shoulder injury

Frequency: 4 days per week

Monday: Chest and External Rotators

Flexibility: 5 minutes of dynamic

Warm-Up: 10 minutes on machine of his choice
stretching

Resistance training exercise: Reps Sets Rest

1. Flat Bench Dumbbell Press* 8-10 4 90

2. Incline Bench Dumbbell Press *

8-10 4 90

3. Flat Bench Fly* 10-12 3 90

4. Decline Bench Dumbbell Press 10-12 2 90

12-15
5. External Rotation with Low Pulley
(each 3 90
(arm abducted 30 degrees from torso)
side)

12-15
6. External Rotation with Low Pulley
(each 3 90
(arm abducted 90 degrees from torso)
side)

Cardio: 30 minutes of interval training machine of his choice

Flexibility: 15 minutes of light stretching

1. Flat Dumbbell Press on Stability Ball

*More functional exercise options 2. Incline Dumbbell Press on Stability Ball

3. Flat Dumbbell Chest Flye on Stability Ball

Tuesday: Legs

Flexibility: 5 minutes of dynamic

Warm-Up: 10- minutes on machine of his choice
stretching

Resistance training exercise: Reps Sets Rest

1. Squat or Power Squat Machine

6-8 4 90

2. Semi-stiff Legged Deadlift 6-8 4 90

3a. Multi Planner Lunges (Front, 45°, 40 3 45

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side and transverse)

3b. Step-up with Hip Flexion 20-25 3 90

4. Hamstring Curl* 8-10 3 60

5. Donkey Calf Raise 10-12 4

6. Hanging Leg Raise 10-12 3 60

7. Incline Reverse Crunch 10-12 2 60

8. Back Extension 10-12 3 90

9. Oblique Crunch* 10-12 3 90

10. Straight Crunch on Slant board* 20-25 3 90

Flexibility: 15 minutes of light stretching

4. Hamstring curl on a stability ball

*More functional exercise options 9. Prone Russian twist on stability ball

10. Straight crunch on stability ball

Unit Summary

I. As a trainer it is imperative that you are able to determine the appropriate loads and repetitions
necessary to bring about the desired goals of your clients.

A. Maximum power will occur somewhere between 55% and 85% of the one repetition maximum (1RM).
Therefore, the training load should be somewhere between 55% and 85% to facilitate a training effect.

1. High-repetition resistance training (15 repetitions or more utilizing less than 55% to 65% of
1RM) does not innervate high-threshold motor units and therefore limits the potential for
type II muscle fiber hypertrophy.
2. Powerlifting (2 to 6 repetitions at 85% to 95% of 1RM) does not allow for sufficient time to
activate all motor units in an orderly fashion. This diminishes the hormonal adaptations to
the entire span of muscle fibers in any given motor unit.
3. Utilizing (8 to10 repetitions at least 75% of 1RM) with three sets of each exercise and a
maximum of one minute rest between sets will maximize serum testosterone levels and
growth hormone levels thus allowing for successful recovery, adaptation and muscular
growth.

B. If your client can successfully complete two or more repetitions above the desired repetition range in
the last set in two consecutive workouts for any given exercise, the load should be increased by 2% to
10% depending on your client’s current physical abilities.

C. The ISSA Integrated Training Approach includes: heavy resistance training, light resistance training,
psychological techniques, therapeutic modalities, biomechanics, dietary manipulation and nutritional
supplementation.

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1. Ultimately as fitness educators our goal is to utilize the eight technologies to develop a
process for our clients to draw into the fitness lifestyle while being commensurate with their
current physical abilities, schedules and available resources.

Section 5: Unit 18 Outline

The Basics of Sound Nutrition

I. Sound Nutrition
II. The Five Rules of Performance Nutrition
III. Substances to Avoid
A. Alcohol
B. Nicotine
IV. Scheduling of Meals
V. What to Eat
A. Carbohydrates

1. The Glycemic Index

2. Fiber

B. Protein

1. Make up of Protein
2. Whey Protein and Anabolism
3. Casein and Anti-Catabolism
4. Putting All the Pieces Together

C. Fats

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 1. Medium Chain Triglycerides
2. Cholesterol

D. Vitamins

E. Minerals

F. Water

1. Dehydration Dangers

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand the basics of sound nutrition and how each of the

macronutrients works to fuel the body.
• Analyze any dietary plan for its ability to support strenuous training and
produce the desired results.
• Identify substances to avoid that may hinder performance.

Sound Nutrition

The core of the ISSA Dynamic Nutrition Approach is based on thermodynamics.

Thermodynamics is the branch of physiochemical science concerned with heat and energy
and their conversions, one into the other, through mechanical work. Considerable data
indicates that the safest and most effective way to accomplish this objective is to combine
sensible eating habits with a program of sound exercise, including both aerobic training and
weight training.

The Five Rules of Performance Nutrition

There are some simple truths about eating and exercise that seem to have been overlooked.
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 The ISSA proposes the following five rules. They apply to everyone: sedentary or active,
young or old, in or out of shape.

Rule One: Always eat at least 5 times a day. Two or three meals are simply not enough. It
is permissible to regard two of these meals as "snacks," provided they contain sufficient
calories to get you to your next meal, and they are comprised of the appropriate ratio of
macronutrients as described in Rule Two. Your blood sugar and insulin levels will be
controlled (and thus your energy level), you will get protein in small amounts throughout
the day to support growth and recovery, and (most important) body fat will not be stored,
but instead mobilized as an energy source. By providing your body with a consistent and
frequent supply of just the right number of calories, its need to store fat is reduced.
Conversely, when you eat infrequently, your body recognizes a "famine" situation and your
entire endocrine system (powerful hormones produced inside your body that control how
you grow, recover, and produce energy) is thrown for a loop. Then, too much of the food
you consume is stored as body fat in preparation for the "famine" to come.

Rule Two: In planning each of your daily meals (or snacks), a caloric ratio of approximately
1 part fat, 2 parts protein, and 3 parts carbohydrate is a good place to begin. However, as
you will see in Rule Three (below), this is merely an estimate for average people. Depending
on the severity of your daily work routine and training protocol, you may need more or less
carbohydrates for energy. Fat is essential for maintaining good health and it is needed to
manufacture many important hormones in your body, so do not attempt to eliminate fat
from your diet! Just try to ensure that saturated fat (from animal sources) is kept low, and
that the unsaturated fats (e.g., canola oil or olive oil) predominate. Also, you must consume
enough protein to support growth and recovery and consume carbohydrates. For the most
part, choose low glycemic index carbohydrates, which are converted to blood sugar slowly
so you can control your insulin levels. Remember, carbohydrates are your body's preferred
energy fuel source, although fats work well too, particularly during aerobic training
(provided the ratio of fats, protein and carbohydrates is kept within the recommended
"zone"). Remember that protein and carbohydrates both have 4 calories per gram, while fat
has 9 calories per gram.

Rule Three: Rule Three: When you sit down to eat, ask yourself, "What am I going to be
doing for the next three hours of my life?" If you nap, eat fewer carbohydrate foods; if you
plan to train, eat more carbohydrates. In other words, adjust your carbohydrates up or
down depending upon anticipated energy output. Remember, your pre-workout
carbohydrates should be low glycemic.

Rule Four: You cannot lose fat quickly and efficiently unless you are in a negative calorie balance: taking
in fewer calories than you are burning. Neither can you gain muscle tissue quickly and efficiently unless
you are in a positive calorie balance: taking in more calories than you would need to maintain your current
weight. So, how can you gain muscle and lose fat at the same time? This paradox is easily explained.
Clearly, you cannot lose fat and gain muscle at the same time, so you must alternate periods of negative
calorie balance with periods of positive calorie balance. It does not matter if you are trying to lose total
body weight, stay at the same weight or gain weight. This alteration will 1) readjust your BMR upward,

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making it easier to keep fat off, and 2) support recovery and lean tissue building through insulin and
glucagon control.

Rule Five: It is almost impossible to get all of the nutrients your body needs to remain healthy and active
from food alone, particularly if you are on a diet. Therefore, it is important to supplement your diet with
vitamins, minerals and other carefully selected substances to ensure maximum progress toward your
fitness, health, muscle-building and fat-loss goals. Also, no matter how hard you try, no matter how good
a cook you are, or where you buy your food:

• You cannot always eat 5 or 6 times daily;

• There are many instances when your body either requires or can make good use of certain
micronutrients in greater amounts than what can be derived from food alone;
• Soil depletion, toxins in the food chain, over-processing, overcooking, free-radical formation in the
body, and a host of other (sometimes medically related) factors can all interact to make food less
than totally nutritious.
• Periods of high-stress training require a higher intake of many nutrients without a commensurable
increase in caloric needs;
• Periods of high-stress training create a situation in which various benefits can be derived from
substances not normally found in food or biosynthesized in the body in sufficient quantities, but
which are easily derived from botanical sources;
• Humankind's genius has allowed us to improve Mother Nature's original work in many of life's
arenas. One such arena is in the nutritional supplement industry;
• There are some great supplements for serious sports competition training or fitness training that
are not available in nature. But remember: Always consult your doctor before and while you
are on a supplement program.

Additional Tips on Sound Nutrition:

• Eliminate junk food. Most fast food, along with most pastries and processed foods, contain high
amounts of fat, sodium and sugar (usually simple sugars). None of these qualities is beneficial to
any athlete. Consuming these foods does little for your energy, except promote a rise and then
subsequent drop in your blood sugar levels.
• Drink eight to ten glasses of water each day. This will ensure you're replacing fluids lost
during exercise. You need not wait until you are thirsty. By then you are already dehydrated. Drink
these glasses of water throughout the day, not all at once.
• Determine your daily protein requirements. As you already know, small amounts of protein
should be available to your muscle tissue throughout the day for optimum growth and recovery.
Proteins that include the essential amino acids (those that your body does not manufacture) are of
utmost importance. Protein powder provides a great means of obtaining additional quality protein.
The Hatfield Estimate Procedure for Determining Daily Protein Requirements will help you
determine how much protein your body needs.
• Consume high-fiber foods. Not only does a fiber-rich diet help reduce cholesterol, it also lowers
the glycemic response of your meals and promotes efficient digestion. Fiber will be discussed later
in this unit.
• Increase your lean body weight through resistance training. The more lean weight you
have, the more efficient your body moves and the higher your metabolism becomes. Your bones
become denser and your muscles, tendons, and ligaments strengthen. The great side effect is that
it is easier to avoid gaining excess body fat. Remember, bigger muscles burn more calories than
little ones.

Substances to Avoid

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The following substances should not be part of anyone's lifestyle. As trainers we are role models for the
fitness lifestyle, and as Ralph Waldo Emerson once said, "Your actions speak so loudly that I cannot hear
what you say." Be a good role model and practice what you preach.

The ISSA does not condone the use of these substances. This is not intended as medical advice and
should not replace the advice of a qualified physician.

Alcohol

Although small amounts of alcohol have been shown to increase muscular endurance and strength output,
these benefits are very short-lived. After approximately twenty minutes, problems begin to occur.

The numerous negative side effects of alcohol outweigh its possible benefits to anyone. Since alcohol is a
toxin (poison), a host of physical abnormalities can arise. These abnormalities can reduce your strength,
endurance, recovery capabilities, aerobic capacity, ability to metabolize fat, and muscle growth.

Alcohol can also affect your nervous system and brain. With long-term alcohol use, a severe deterioration
of your central nervous system is possible. With short-term use, nerve-muscle interaction can be reduced,
resulting in a loss of strength. Other dangerous effects include reduced eye-hand coordination and
balance, delayed recovery, and less efficient healing of injuries. Alcohol has been responsible for a number
of sexual dysfunctions including loss of libido, reduced sperm formation, menstrual irregularities, and
shrinkage of sexual organs.

Alcohol can damage muscle cells. Some of these damaged cells can die from prolonged exposure to
alcohol, resulting in less functional muscle contractions. Alcohol will also result in increased muscle
soreness following training, thereby requiring additional time for recuperation.

Alcohol's effects on the heart and circulatory systems are numerous. You can experience a reduction in
your endurance capacities when you drink alcohol, especially in large quantities. When consuming
alcoholic beverages your heat loss increases, because alcohol stimulates your blood vessels to dilate. This
heat loss can cause your muscles to get cold and, as a result, become slower and weaker during
contractions.

In addition, alcohol can cause several gastric, digestive and nutritional irregularities. This drug causes a
release of insulin that will in turn increase the metabolism of glycogen, thereby sparing fat, resulting in
more difficult fat loss. Since alcohol consumption can interfere with the absorption of many nutrients, it is
possible to become anemic and deficient in the B vitamins.

Because your liver is the organ that detoxifies alcohol, the more alcohol you consume, the harder your
liver has to work. This additional stress on your liver can damage and even destroy some liver cells.

Since alcohol acts as a diuretic, large amounts of alcohol can place undue stress on your kidneys. With
alcohol's diuretic action, large amounts of antidiuretic hormone (ADH) are secreted. This can result in
elevated water retention, something no athlete wants.

Alcohol's effects on strength, reaction time, skill and heart function are less than desirable. In fact, alcohol
is not a nutritional source of energy, even though it contains seven calories per gram. Alcohol's potential
for causing mental deterioration is great, with numerous physiological abnormalities very possible.

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Substances to Avoid Cont..

Nicotine

People who smoke may not realize the harmful effects of their habit. In fact, smoking can
seriously inhibit your chances of success in any athletic endeavor. The active ingredient in
tobacco is nicotine. Although this substance stimulates the adrenal glands for increased
energy, the long-term negative side effects far outweigh any possible benefits. When you
inhale smoke into the lungs, the heart has to work harder. You can see this by monitoring
the pulse of a smoker after they puff on a cigarette. The heart actually beats faster and
harder. In many who smoke, this effect causes irregular heart contractions that can persist
for thirty to forty-five minutes. Besides increased heart rate, smoking elevates blood
pressure and increases resistance in the airway. It then becomes more difficult to breathe.
The arteries constrict, thus increasing blood pressure. These effects also occur in the
arteries of the heart, reducing blood flow to the heart muscles. One by-product of smoking
is carbon monoxide. This substance easily attaches to oxygen and leaves less oxygen
available for the working muscles, thus reducing your endurance tremendously. The oxygen
in your lungs also decreases with smoking, by nearly half. The numerous toxic by-products
of smoking have been associated with cancer, heart disease and other degenerative
illnesses. Skin temperature can drop due to smoking, causing a person to feel cold and
function at low levels during training and competition. Other forms of tobacco include snuff
and chewing tobacco, which also have dangerous side effects. In addition to the nicotine
that ends up in your saliva and down your throat, many forms of mouth cancer are caused
from these practices.

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 The ISSA does not condone the use of these substances. This is not intended as
medical advice and should not replace the advice of a qualified physician.

Meal Scheduling

The ISSA Dynamic Nutrition Approach enables you to fit your nutrition to your training and competition.
This can best be done through the consumption of five or six meals each day, rather than the more
conservative approach of two or three a day as outlined in the First Rule of Performance Nutrition.

Pay attention to your blood sugar level. Following a meal, your blood sugar will be elevated. This will allow
you to perform physical activity without the loss of energy. Of course the more intense your activity, the
more you will reduce these levels. But when your blood sugar level gets low, you will feel tired and weak.

If you learn to listen to your body, you will realize that your blood sugar is low and replenishment is
needed. This is the time to eat again. A meal every three or so hours is now recommended.

Rather than eat by the clock or simply when you are hungry, you should attempt to consume all five daily
meals in a 15 to 18 hour period. This is usually the time that we are awake. The content and size of your
next meal is what is important. Simply ask yourself, "What am I going to do in the next three hours?" By
carefully evaluating your next three hours of activity, you can determine approximately how many calories
to consume at the present meal.

For instance, your daily caloric requirement might be 3,000 calories. Broken down into five meals, you can
calculate that you would need 600 calories in each meal. But since each three-hour period is not identical
in energy expenditure, you must act accordingly.

When you wake, ask yourself what you will do for the next three hours. If you are going to drive to work,
read the paper and sit down to a casual meeting, your caloric expenditure will be slight. The calories you
consume at breakfast should also be slight - say 400 to 500 calories for example. Following that three-
hour period, you must ask yourself the same question and evaluate your caloric expenditure. Perhaps you
are going to perform some type of moderate intensity work at your job. This second meal should then
provide additional calories, perhaps 600 to 700.

At the next three-hour period you find yourself preparing to sit at a desk. Your caloric intake might then
be 400 to 500 calories. The next period could then precede your training period. This time you might
consume between 800 and 1,200 calories to ensure adequate energy for your training. Also, this is the
time to choose foods with a low-glycemic index rating. This simply means that the foods you choose (like
fruits or beans) will stabilize your blood sugar levels for a longer time, sufficient for your entire training
period.

Meal number five might then precede sleep (by about an hour or so) and would therefore require a lower
number of calories, say 400 to 500. The total number of calories would equal the 3,000 calories required
per day, but would be scheduled in a way that you would consume a greater number of calories prior to
the physical and mental demands of your day.

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What to Eat

The word "food" is generally restricted to the things we eat that contain macronutrients (protein,
carbohydrates and fat) and micronutrients (vitamins, minerals and trace elements). These macronutrients
and micronutrients have potent "drug-like" actions in our bodies. They exert a profound influence on
powerful hormones and enzymes we need to survive, grow, and perform optimally. There are six major
nutrients (carbohydrates, proteins, fats, vitamins, minerals and water) necessary for a healthy body. A
deficiency in any one of these nutrients can reduce your chances of success in reaching your fitness goals.

Carbohydrates

Everyone needs energy, and the best source of energy comes from carbohydrates. Ultimately, your
nutrition program should contain anywhere from 50 percent to 80 percent of caloric intake from
carbohydrates.

First let us classify carbohydrates. Carbohydrates can be classified three ways: Monosaccharides,
disaccharides and polysaccharides. Simple sugars like glucose and fructose fall into the monosaccharide
category. These simple sugars can be found in honey and fruits.

Making up the second class of carbohydrates are di-saccharides like table sugar (sucrose) and lactose.
Lactose is a sugar found in milk.

The third class, or polysaccharides, are those sugars often referred to as complex carbohydrates. These
starches and starch-like sugars (dextrins, cellulose, pectin and glycogen) can be found in whole grains,
vegetables, nuts, some fruits and legumes.

Our bodies can only absorb monosaccharides (glucose, galactose, or fructose) the single units of sugars
and starches. Once absorbed through the small intestines into the portal vein and then circulated into the
bloodstream through the liver as blood glucose, our bodies can put glucose to work in three ways:

It can burn the glucose immediately for energy if blood glucose levels are not at a stable level of 20 grams
blood borne glucose circulating every hour. If it is not needed for energy immediately, then it is converted
into glycogen in the liver or muscles. The liver has the capacity to store between 80 to 100 grams of
glycogen. The muscles have the capacity to store between 300 to 600 grams of glycogen, depending on
muscle mass. Liver glycogen supplies energy for the entire body. Muscle glycogen only supplies energy to
muscles. If the body has an excess of glucose, and all of the glycogen stores are full, the surplus glucose
is converted to fat by the liver and stored as adipose tissue (body fat) around the body. If needed, fatty
acids can be burned as fuel (BUT the fat can not be converted back to glucose).

Since muscles have a specific purpose of contraction, they have a limited number of enzymes for glycogen
synthesis. Muscle only has the necessary enzymes to convert glucose into glycogen. Muscle glycogen,

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which is similar in structure to starch is an amylopectin (branched chained polymer containing hundreds of
glucose units). Unlike muscles, which only supply energy to muscles, through the stored 300 to 600 grams
of glycogen, the liver is responsible for supplying energy to the entire body, with 80 to 100 grams of
stored glycogen. The liver is able to make glycogen from fructose, lactate, glycerol, alanine, and other
three-carbon metabolites. The liver allows glucose to enter the bloodstream to be utilized by muscles to
synthesize glycogen, due to the liver's more versatile use of the aforementioned substrates.

Table 18-1: Carbohydrate Fact Sheet

Any of a group of chemical compounds including sugars starches and

Definition fiber containing carbon hydrogen and oxygen with a 2:1 hydrogen-
to-oxygen atom ratio.

Chemical Constituent
Carbon•Hydrogen•Oxygen
(Elements)

Energy Yield 4 calories per 1 gram

Monosaccharide(mono = one saccharide = sugar) (simple

carbohydrate)

• glucose - commonly referred to as “blood sugar”

• galactose - sugar in milk fructose - sugar in fruit Disaccharide
(di = two saccharide = sugar) (simple carbohydrate) sucrose
- table sugar; combination of glucose + fructose lactose -
milk sugar; combination of glucose + galactose
• Polysaccharide (poly = many saccharide = sugar) (complex
carbohydrate) starch fiber

Classifications Disaccharide(di = two, saccharide = sugar) (simple carbohydrate)

• sucrose - table sugar; cobination of glucose + fructose

• lactose - milk sugar; combination of glucose + galactose

Polyscaccharide(poly = many, saccharide = sugar) (complex

carbohydrate)

• starch
• fiber

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 Our bodies can only absorb monosaccharides (glucose galactose or
fructose — single units of sugars and starches). Once absorbed
through the small intestines into the portal vein and then circulated
into the bloodstream through the liver as blood glucose our bodies
can put glucose to work in three ways:

1. It can burn the glucose immediately for energy if blood

glucose levels are not at a stable level of 20 grams blood
borne glucose circulating every hour.
2. If it is not needed for energy immediately then it is converted
into glycogen in the liver or muscles. The liver has the
Primary Function
capacity to store 80 to 100 grams of glycogen. The muscles
have the capacity to store between 300 to 600 grams of
glycogen depending on muscle mass. Liver glycogen supplies
energy for the entire body. Muscle glycogen only supplies
energy to muscles.
3. If the body has an excess of glucose and all of the glycogen
stores are full the surplus glucose is converted to fat by the
liver and stored as adipose tissue (body fat) around the body.
If needed fatty acids can be burned as fuel (BUT the fat can
not be converted back to glucose)

The Glycemic Index

The glycemic index refers to the relative degree to which blood sugar increases after the
consumption of food. A food is always measured relative to the effect of pure glucose. High-glycemic
index foods can raise blood glucose levels very quickly, as well as insulin levels. In contrast, low-
glycemic index foods do not significantly raise blood glucose levels and insulin levels after eating.
Pure glucose is given a value of 100, while other foods are given an index number representing their
relative effect on blood glucose levels. For example, sweet corn is assigned an index number of 55,
which means sweet corn raises blood glucose levels 55 percent as much as pure glucose. In general,
foods below 55 are considered low-glycemic index foods, 55 to 70 represents mid-glycemic index
foods and foods over 70 are considered high glycemic. In the past, it was widely believed that simple
sugars dramatically increased blood glucose levels while starches such as potatoes and bread were
digested slowly. The results from numerous studies show this is definitely not the case. In fact, one
of the biggest surprise comes from baked potatoes, which reported an average index of 85, making
it one of the higher glycemic foods available. Here is a look at how a high-, mid- and low-glycemic
value food can alter one's blood glucose response.

While there are many ways to utilize the index to benefit our varied client base, remember that
different people can have different results and there are many factors that can influence the index of
foods like food preparation, age of food, fiber content, protein and fat content, as well as other
variables. It is not a perfect science and not all testing results been consistent.

However, as fitness professionals, the glycemic index provides us with yet another tool to help our
clients meet their individual goals. By offering our knowledge and assistance on this subject, it is
possible to fine tune our clients' training and nutrition programs to more closely match their energy
requirements throughout the various stages of training. Many athletes and dieters have reported
marked differences in weight loss and performance results by manipulating their balance of foods to
meet their goals. Specific athletes may see a direct benefit from using the glycemic index in their
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 food selection. However, there is insufficient evidence to suggest that all athletes will see equal
benefits. All trainers, coaches and serious athletes should know the difference between high, mid,
and low-glycemic value foods and when their consumption and appropriate mix will best serve their
intended purpose.

Table 18-2: The Glycemic Index of Common Foods

Glucose 100

Breads Cereal Grains

Mixed grain
28 Barley pearled 25
bread

Oat Bran
48 Rice, instant,boiled 1 min 46
bread

Pita Bread,
57 Sweet Corn 55
white

Wheat
bread, 69 Rice, brown 55
wholemeal

White bread 71 Rice, White 55

Bagel 71 Couscous 65

Breakfast
Rice, instant, boiled 6 min. 90
Cereals

Rice Bran 19 Dairy Foods

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All-Bran 42, Yogurt, low fat, artificially sweetened 14

Oatmeal 49 Milk, skim 32

Special K 54 Legumes

Muesli 56 Lentils, red 25

Life 66 Kidney beans 29

Grapenuts 67 Butter beans 31

Cream of
70 Pinto beans 39
Wheat

Cheerios 74 Baked beans, canned 48

Total 76 Kidney beans, canned 52

Team 82 Pasta

Cornflakes 83 Fettucine 27

Crispix 87 Spaghetti, protein enriched 27

Fruit and
Fruit Vermicelli 35
Products

Pear, fresh 37 Spaghetti, white 41

Apple 38 Macaroni 45

Orange 44 Linguine 46

Grapes 46 Tortellini, cheese 50

Banana 54 Soups

Raisins 64 Tomato soup 38

Watermelon 72 Black bean soup 64

Snack
Split pea soup 60
Food

Peanuts 15 Vegatables

Popcorn 55 Carrots, cooked 39

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Pretzels 81 Yam 51

Dates 103 Sweet potato 54

Sugars Potato, new 54

Fructose 22 Potato, white, boiled 56

Honey 58 Beets 64

Sucrose 64 Potato, mashed 70

Maltodextrin 105 Potato, baked 85

Maltose 105

Fiber

Fiber is a compound that only plants contain (i.e., grains, oats, fruits, etc.); it is never in animal foods
(i.e., meats). The fiber we consume is called dietary fiber. Fibers are mainly the indigestible complex
carbohydrates (polysaccharides) that make up plant cell walls and include cellulose, hemicellulose, pectin
and a variety of gums, mucilages and algal polysaccharides. Fibers do not provide any energy, but they do
play an important role in the diet as the main contributor to the dietary fiber (roughage) content. Among
its other protective qualities, this indigestible bulk helps promote efficient intestinal function and helps
regulate the even absorption of sugars into the bloodstream. Dietary fiber can be broken down into two
forms: soluble and insoluble. On average, most Americans consume only 12 grams of fiber a day.
According to the American Heart Association (AHA), fiber is important for the health of our digestive
system as well as for lowering cholesterol. Both the AHA and the National Cancer Institute recommend
that we consume 25 to 30 grams of fiber a day. An easy way to include the needed 25 to 30 grams is to
add 3 choices from Table 18-3 to the diet. Each choice provides 10 grams of fiber.

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Table 18-3: The Fiber "10" Chart: Food Portions that Provide 10 Grams fo Fiber

Grains Vegetables Fruits

1/2 cup All Bran 1/2 cup mixed beans 3 pears

1 cup Rolled Oats 1/2 cup peas lentils 3 bananas

1 cup whole-grain cereal 1 cup peanuts 4 peaches

2 cobs sweet corn 2 cups soybeans 4 oz. blackberries

3 slices whole-rye bread 3 cups steamed veg. 5 apples

3 cups Puffed Wheat 4 servings mixed salad 6 oranges

4 slices whole-wheat bread 4 large carrots 6 dried pear halves

4 large pieces of Shredded

4 cups sunflower seeds 10 dried figs
Wheat

4 oz. bag of popcorn 5 cups raw cauliflower 20 prunes

As the name implies, soluble fiber dissolves in water. These fibers bind to bile acids and excrete them
from the small intestine. Surplus cholesterol is disposed of in the liver as bile acids. Bile acids are then
transported to the small intestine where they aid in lipid digestion. Bile acids are also essential for the
absorption of these digested products. This binding of bile acids can help to decrease the cholesterol levels
in the blood.

Insoluble fiber, again as the name implies, does not dissolve in water. This type of fiber is known as
roughage. Though it is not dissolvable in water, it does absorb it, causing an increase in fiber bulk. Bulking
agents help to clear the gastrointestinal track of all its waste. By regularly consuming these fibers, the
amount of time digested food sits in the intestine is decreased. This helps keep the body from absorbing
starch and sugars in the intestine.

Insoluble fiber is responsible for the full feeling you get after eating certain foods. Foods rich in insoluble
fiber can help dieters by allowing them to eat fewer calories without feeling hungry . Insoluble fibers are
hard to digest, so when they finally get to a point where they can be released into the intestine, they are
still slightly intact. It is this reason that they make up the bulk of your stool. Since the insoluble fibers are
only partially digested, it is hard for the undigested calories to be taken up by the intestine. By reducing
calories and decreasing the amount of cholesterol in the blood, one could potentially lose weight/fat.

The best source of fiber is from dietary foods, which also provide other minerals and nutrients your body
needs. If you are consuming enough fiber rich-foods, there is no point in taking a fiber supplement.

Fiber supplements do not offer the same benefits that dietary fibers do. In 1991, the FDA banned many
over-the-counter diet aids with fiber-containing substances, because they did not show any evidence of
being safe and effective weight loss agents. Some fiber supplements have also been found to have
negative interactions with many heart, diabetic, and psychological medications. Before taking any kind of
fiber supplement, it is best to check with your physician.

Fiber is a good, natural way of helping to reduce body fat. It does not metabolize fat quicker or more
efficiently, but it will help you by decreasing the intake of calories. It will also reduce the amount of free

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cholesterol in the blood. Fiber may also help prevent colon cancer, heart disease and diabetes. Fiber is
something that everyone should be consuming more of - there are too many reasons for you not to.

A word of caution: When increasing the fiber content of your diet, it is best to take it slow. Add just a
few grams at a time to allow the intestinal tract to adjust; otherwise, abdominal cramps, gas, bloating,
and diarrhea or constipation may result. Another way to help minimize these effects is by drinking at least
2 liters (8 cups) of fluid daily.

Protein

Protein is an organic compound composed of carbon, hydrogen, oxygen, and nitrogen. One of the main
functions of protein is to synthesize structural proteins like muscle. Protein is also responsible for
synthesizing structural hormones like insulin, growth hormone and Insulin Growth Factor I. These are
anabolic hormones that can influence many functions in the body, including muscle growth, recovery,

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strength and absorption of nutrients into your muscle cells. Your body uses protein to make structural and
biochemical reactions that are required for muscle contraction, cardiovascular function, and immunity
from disease, just to name a few.

Make Up of Protein

The ultimate value of a food protein

or a protein supplement is in its
amino acid composition. Amino acids Table 18-4: Protein Sources
are the building blocks of protein and
muscle tissue. Many physiological Incomplete
Complete Protein
processes relating to bodybuilding Protein
Sources
(including energy, recovery, muscle Sources
hypertrophy, fat loss, and strength
gains) are linked to amino acids. Whey Vegetables
Protein is made up of 21 amino acids,
which are known as the building Casein Fruits
blocks of life. From these building
blocks protein molecules are created. Milk Rice
Amino acids are categorized as
essential (8), conditionally-essential Eggs Grains
(7), and nonessential (6). Essential
amino acids cannot be manufactured Beef Oats
in sufficient amounts to meet the
demands of the human body; Cheese Pasta
therefore, essential amino acids must
be obtained from food. Conditionally- Chicken Nuts (some)
essential amino acids cannot be
produced by the human body in Fish Bread
adequate amounts during periods of
illness, injury or extreme emotional Yogurt Sunflower Seeds
stress. Nonessential amino acids can
be synthesised by the human body in Cottage Cheese
sufficient amounts and are thus not
required in the diet. It has been
Turkey
proven that amino acids play a major
role in both performance and
recovery.

There are two types of protein: complete and incomplete. Complete proteins contain all of the essential
amino acids, while incomplete proteins are deficient in one or more. If incomplete proteins are consumed
the body will not fully utilize them during protein synthesis. It is possible to mix two incomplete proteins
to make a complete protein. An example of this is mixing rice with beans.

Whey Protein and Anabolism

Whey was once a by-product that was discarded by dairy farmers. For the last decade, though, whey has
been the number-one protein of choice. Whey is very important for any athlete attempting to enhance
their strength. To understand whey's importance, turn to the Biological Value Scale, which was developed
to measure the quality of specific proteins. It rates just how efficiently your body uses a specific protein
source. The higher the biological value, the more amino acids and nitrogen your body is retaining from the
food you eat - this translates into the potential for quality muscle growth and strength. Egg whites used to
be at the top of the biological chain with a rated score of 100. Whey rates at 106 to 159. Not only is more
nitrogen retained in the body with whey, it also enters the bloodstream much faster than other sources.
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Thus, the body can receive nutrients as fast as possible after strenuous training for full recovery and
growth potential to be achieved. Immediately following a workout your muscles with valuable amino acids
to increase anabolism and prevent muscle breakdown. Whey protein is also high in branched-chain amino
acids as well as glutamine.

Whey is known as the anabolic protein since it increases protein synthesis with a greater efficiency than
other sources. There are three different types of whey proteins: whey concentrate, whey isolate, and
whey hydrolysate. Concentrate is between 50% and 80% proteins. The isolated version separates whey
from lactose, ash, fats and carbohydrates so that you receive 90% to 97% protein. The best types are
either ion-exchange or cross-flow micro-filtered whey isolate. The isolate is the most expensive, but you
are getting more protein per gram of powder. The hydrolysate is partially digested and is already broken
down into di- and tri- peptides before it hits your stomach. It will then enter the bloodstream quickly.
Whey hydro is most responsible for producing the anabolic effect when ingested immediately after your
workout. The best type would be hydrolysate 520. This stands for a molecular weight of 520 Daltons.

Table 18-5: Protein Fact sheet

Any of a group of complex nitrogenous organic compounds that

have amino acids as their basic structural units that are found in
Definition
ALL living matter and are REQUIRED for the growth and repair of all
animal tissue.

Chemical
Constituent Carbon•Hydrogen•Oxygen•Nitrogen
(Elements)

Energy Yield 4 calories per 1 gram

Amino Acids: unit needed by the body to form various tissues,

enzymes, blood proteins, etc

Conditionally-
Essential Nonessential
Essential
Amino Acids Amino Acids
Amino Acids

Valine*
Tyrosine Serine

Methionine Taurine Glycine

Tryptophan Proline Glutamic acid

Classifications
Theronine Glutamine Aspartic acid

Phenylalanine Cystine Asparagine

Lysine Arginine Alanine

Leucine* Histidine**

Isoleucine*

*Branched-chain amino acids (BCAAs)

** Histidine is an essential amino acid for infants and athletes on

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 Peptides: small number of amino acids linked together

Protein: large chains of amino acids linked together

• Protein is essential for growth and recovery;

• Branched-chain amino acids are required to spare muscle

breakdown during exercise;

• Glutamic acid and Glutamine are important amino acids for

growth of muscle tissue;
Significance

• Individual amino acids can elicit targeted events, like growth

hormone increase;

• Collagen — connective tissue — makes up one third of total body

protein content, making it one of the most common proteins in the
body.

Casein and Anti-Catabolism

Casein and whey are both derived from milk. Casein has a lesser value of nitrogen retention than whey.
Casein also has a lower glutamine proportion and does not have whey's strong amino-acid profile. But
casein does release more slowly into the bloodstream, and and it is a good protein for late evening
consumption. Studies have shown that casein clumps when exposed to stomach acid. This causes a slower
release and prolonged duration of amino acids into the bloodstream. It is ideal to take at bedtime because
it continuously releases amino acids into the bloodstream while you sleep, preventing you from entering a
catabolic state during the overnight fast. This makes casein the ideal anti-catabolic protein.

Putting all the Pieces Together

The minimum amount of protein a serious weight lifter should consume is 1 gram of protein per pound of
body weight. This should be a combination of whole foods and protein supplements. When you are training
at a higher level or preparing for competition, you will need to consume a greater amount - even 1.5 to 2
grams per pound of body weight. Research has conclusively proven that exercise increases protein needs.
Dr. Peter Lemon is the world's leading researcher on protein requirements and athletes. In the Journal of
Medicine and Science in Sports and Exercise (19:5, S179-S190, 1986) Dr. Lemon writes, "Several types of
evidence indicate that exercise causes substantial changes in protein metabolism. In fact, recent data
suggests that the protein recommended dietary allowance might actually be 100% higher for individuals
who exercise on a regular basis. Optimal intakes, although unknown, may be even higher, especially for
individuals attempting to increase muscle mass and strength."

His most recent research, published in Nutrition Reviews, (54:S169-175, 1996), indicates that strength
athletes need up to 1.8 grams of protein per kilogram of body weight to maintain positive nitrogen
balance. That is 0.8 grams per pound of bodyweight or almost 140 grams a day for someone who weighs
172 pounds. In one study of Polish weightlifters (Nutr. Metabolism 12:259-274), 5 of 10 athletes were still
in negative nitrogen balance even while consuming 250% of the RDA.

The amount of protein you should consume at each meal depends on your body weight. You should
consume several small meals per day to keep your blood sugar levels stabile in a positive anabolic state.
When you go several hours without consuming protein you enter into a catabolic muscle-wasting state.
This means that the body is eating itself to attain the amino acids it requires for proper function. Your
hard-fought muscle will then disappear and body fat will reappear. You should consume 40 grams per
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meal five times a day if you weigh 200 pounds spaced out every 3 hours. It was once thought that you
could ingest only 30 grams of protein per meal. For those over 200 pounds, 50 to 70 grams is optimal.
Use both whey and casein to mix and match your protein sources.

The debate over how much dietary protein is necessary will continue. From the research, we have
concluded that the RDA's recommendation of 0.36 grams per pound of bodyweight does not account for
outside stresses like exercise; further, fanatical recommendations of 300 to 500 grams a day are
unfounded. According to the research, 0.8 grams a day per pound of bodyweight is a good range in which
to maintain positive nitrogen balance, and enable the trainee to continue to make muscular gains. So, as
your training increases in volume, duration or intensity, your protein requirements increase accordingly.
And with the increased need for quality protein, you should consume foods that have a high protein
efficiency ratio. Such foods are eggs, milk, meat and fish. When consuming this much protein you must
drink more fluids, as the increase in protein requires more hydration for digestion.

As with any nutrient, consuming more protein than your body can utilize can result in an increase in fat
storage. Your liver virtually converts the excess protein into fat. Another problem can arise with over-
consumption of protein. When a person maintains an extremely high protein intake for a long period of
time, a highly toxic form of ammonia (called urea) may develop. Since the urea in your body is excreted,
an overabundance of urea places a strain on your liver and kidneys. This excess urea is often responsible
for a form of arthritis known as gout.

Fats

You should realize the importance of fat in your diet. Fat is not always a villain, responsible for clogging
arteries and packing on pounds. To an athlete, fat acts as a secondary source of energy during training or
competition. Fat-based energy becomes available soon after carbohydrate stores in the muscles deplete.

Fats can be found in solid or liquid form and are often referred to as lipids. Even though carbohydrates are
your body's major source of energy, fats are the most highly concentrated source of energy - over
carbohydrates and proteins. Fats have nine calories per gram while carbohydrates and proteins contain
only four, so it is easy to see why foods high in fat are also high in calories.

There are a host of reasons why our bodies need fat. Fat acts as the storage system for excess calories
that you consume, whether from dietary fat, carbohydrates or proteins. Fat is an essential ingredient for
healthy skin and hair, and acts as a carrying agent in the transportation of the fat-soluble vitamins A, D, E
and K. Dietary fat provides us with essential fatty acids, which the body does not manufacture. Essential
fatty acids aid in many bodily functions, including the regulation of blood pressure. Fats also help regulate
cholesterol in your blood. In addition, fats provide satiety because they increase the time needed to empty
food from your stomach.

While fat is necessary and essential for proper health, some types of fats can damage the cardiovascular
system. Artery-clogging fats that increase blood cholesterol include saturated fat and trans fat. Saturated
fat comes mainly from animal sources like meat and dairy products, but it can also be found in coconut
and palm oils. Trans fat comes from hydrogenated vegetable oils like margarine and vegetable shortening.
Both saturated fats and trans fats stay solid at room temperature.

A more heart-healthy fat is unsaturated fat, generally found in vegetables. This type of fat includes both
monounsaturated and polyunsaturated. Monounsaturated fat is found in olive, canola and peanut oils.
These oils are liquid at room temperature but start to thicken when refrigerated. This type of fat is
considered the healthiest for your heart and body. Avocados and nuts also contain monounsaturated fat.
Polyunsaturated fat is found in soybean, corn, safflower and sunflower oils. These oils are liquid at room
temperature and in the refrigerator. This type of fat is considered the next healthiest fat that does not clog
arteries.

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When unsaturated vegetable oils are manufactured into solid form, they turn into trans fats. This type of
fat is commonly called fully or partially hydrogenated vegetable oil in a food's list of ingredients. Trans fats
are found in hundreds of processed foods, usually to protect against spoiling and to enhance flavor.
Restaurants tend to use a lot of trans fat (hydrogenated vegetable oil), especially for frying.

Trans fats are even worse for the cardiovascular system than saturated fats. Researchers have
conservatively calculated that trans fats alone account for at least 30,000 premature deaths from heart
disease every year in the United States. Recent studies indicate that trans fats drive up the body's LDL,
the bad cholesterol, even faster than saturated fats. High levels of cholesterol have been linked to heart
disease and stroke.

Diets high in fat, particularly saturated fat, may also promote breast, colon, endometrial, lung, prostate,
and rectal cancers. Therefore, saturated fats and trans fats are the only fats that we should strive to
eliminate from our diet. Replace these fats with monounsaturated and polyunsaturated fats. The American
Heart Association recommends that daily fat intake should be less than 30 percent of total calories;
saturated fat intake less than 8 to 10 percent of total calories, and cholesterol less than 300 milligrams
per day. Always read the Nutrition Facts label and list of ingredients to find out the amount of, and the
type of, fat contained in any particular food.

Table 18-7: Fat Fact Sheet

Any of various soft, solid, or semisolid organic compounds

comprising the glyceride esters, ketones, and related
Definition
compounds of fatty acids and associated sterols, alcohols,
hydrocarbons, ketones, and related compounds.

Chemical
Constituent Carbon•Hydrogen•Oxygen
(Elements)

Energy Yield 9 calories per 1 gram

• Free fatty acids: Used as energy substrate by muscles

and other tissues
• Triglycerides: (glycerol (sugar alcohol) + 3 free fatty
acids) Accounts for 95% of dietary fat and fat in the body
(for a fuel source and for storage)
Classifications: • Phospholipids: (1 phosphate group + 2 fatty acids)
Functions in cell membrane and dissolving fats
• Cholesterol: (complex 4-ringed structure) Functions in
cell membranes and provides starting material for bile
salts vitamin D and steroids .

Functions of Fats

Source of storage and fuel

Padding Vital organs and skeleton

In The Body
Insulation of nerve fibers and tissue to speed up nervous
impulses

Part of all cell membranes

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 Starting material for other molecules — cholesterol made into
vitamin D steroid hormones bile acids and some fatty acids
made into prostaglandins

Reduces rate of stomach emptying — necessary for absorption

of fat soluble vitamins
In The Body
Source of essential fatty acids

Medium Chain Triglycerides (MCTs)

Consumed fat requires a long complicated process to become usable energy. If we could find a fat that we
could eat, have it absorb quickly and be used as an energy source efficiently, then the consumption of
that fat would be more beneficial. Recent research tells us that medium-chain triglycerides (MCTs) might
fit this bill. MCTs are fatty acids produced from coconut oil and palm kernels (among others). These fatty
acids are more rapidly absorbed than long-chain triglycerides. They can be used as energy much faster
than glucose and have over two times the calories. This means that they would be an excellent source of
energy for long, intense workouts or competitions.

Since MCTs are absorbed so quickly, they seldom get stored as fat. They spare protein by being more
easily used for energy. In fact, the MCT molecules act as "carriers" of amino acids into your muscles,
thereby improving your body's ability to assimilate dietary protein.

Excess intake of MCTs can lead to diarrhea, and possibly complicate liver problems in some people with
liver disease. MCT oil can be used on salads and in baking but not frying, and does not provide any of the
essential fatty acids. However, MCTs provide a healthy alternative to saturated fat by providing high
calorie intake for energy without many of the dangerous side effects of dietary saturated fat.

Cholesterol

Special Section by Monique N. Gilbert B.Sc. Author of Virtues of Soy: A Practical Health Guide and
Cookbook (Universal Publishers, 2001).

The American Heart Association (AHA) states that cholesterol is a substance found in all animal-based
foods and fats. (Plant-based foods do not contain cholesterol.) They also say that the human body
constantly makes cholesterol, mostly in the liver and kidneys. In our body, cholesterol is most common in
the blood, brain tissue, liver, kidneys, adrenal glands, and the fatty covers around nerve fibers. It helps
absorb and move fatty acids.

Cholesterol is necessary to form cell membranes, for the making of vitamin D on the surface of the skin
and the making of various hormones, including the sex hormones. It sometimes hardens in the gallbladder
and forms into gallstones. High amounts of cholesterol in the blood have been linked to the development
of cholesterol deposits in the blood vessels, known as atherosclerosis.

355
Cholesterol, and other fats, cannot dissolve in the blood. They have to be transported to and from the
cells by special carriers of lipids and proteins called lipoproteins. There are several kinds of lipoproteins,
but the ones to be most concerned about are low density and high-density lipoproteins.

Low-density lipoprotein (LDL) carries the bulk of the cholesterol in the blood and has a central role in the
atherosclerotic process. LDL penetrates the walls of blood vessels and arteries feeding the heart and
brain; where they are oxidized by free radicals and accumulate as a gruel-like material that blocks the
blood vessels. When this plaque-like material leaks into the blood vessel, it can cause a blood clot
(thrombosis). Thrombosis can lead to a stroke if the clot goes to the brain, or heart attack if the clot
blocks a coronary artery. A high level of LDL cholesterol reflects an increased risk of heart disease and
stroke, which is why LDL cholesterol is often called the bad cholesterol.

High-density lipoprotein (HDL) only carries approximately one-third to one-fourth of the blood cholesterol
in our body. HDL cholesterol has a protective effect, preventing LDL oxidation and removing cholesterol
that accumulates in the blood vessel walls. Medical experts believe HDL carries cholesterol away from the
arteries and back to the liver, where it is eliminated from the body. They also suspect HDL removes
excess cholesterol from atherosclerotic plaques and slows their growth. A high level of HDL seems to
protect against heart attack and stroke, which is why HDL is known as the good cholesterol.

Cholesterol is measured in milligrams per deciliter of blood (mg/dL). Total blood cholesterol is the most
common measurement of cholesterol. It is the number you normally receive as test results. Knowing your
total blood cholesterol level is an important first step in determining your risk for heart disease and stroke.
An important second step is to know your level of good HDL cholesterol in relation to total cholesterol.
Some doctors use the ratio of total cholesterol to HDL cholesterol. The goal is to keep the ratio below 5 to
1, with the optimum ratio at 3.5 to 1.

Triglycerides are also often measured when testing for cholesterol levels. Triglycerides are the chemical
form in which most fat exists in food as well as in the body. Calories ingested in a meal and not used
immediately are converted to triglycerides and transported to fat cells to be stored. Hormones regulate
the release of triglycerides from fat tissue so they meet the body's needs for energy between meals.
Elevated triglycerides are linked to the occurrence of coronary artery disease and may be a consequence
of other diseases, such as untreated diabetes mellitus. Saturated fats and trans fats (trans fatty acids) are
the chief culprits in raising blood cholesterol and triglyceride levels. Ingesting animal-based products and
hydrogenated fats can significantly increase both of these levels. This is why it is important to understand
how cholesterol affects our body, and why we should try to keep it under control.

Vitamins

Vitamins are any of various relatively complex organic substances found in plant and animal tissue and
required in small quantities for controlling metabolic processes. Everyone needs vitamins, and active
people need more vitamins than sedentary people. If you want to be successful in achieving peak
performance capabilities, you need to provide your body with everything it needs. Vitamins are
undoubtedly essential to physical performance. Each of the vitamins has a specific responsibility in your
body. Below are the most important vitamins essential to successful physical performance.

• Vitamin A: Helps to maintain your skin and mucous membranes and contributes to the function of
night vision. Excess vitamin A intake can be toxic, since this vitamin is fat-soluble. Vitamin A can
be found in carrots and yellow vegetables.
• Vitamin B1 (Thiamin): Responsible for carbohydrate metabolism along with the function of your
nervous system. More than 1,000 milligrams of B1 might cause increased urination and possible
dehydration. Because this vitamin is water-soluble, daily replacement is necessary. Whole grains
are the best source of B1.
• Vitamin B2 (Riboflavin): An active agent in the metabolism of energy and cell maintenance. It
also is an essential ingredient in the repair of all cells following injury. Milk and eggs are excellent
sources of vitamin B2.
356
 • Vitamin B3 (Niacin): Has numerous responsibilities in various bodily functions and is present in
every cell in your body. This vitamin can cause hot flashes, but you can build a tolerance to this
vitamin and find it helpful in the reduction of high cholesterol. Peanuts and poultry are fine sources
of B3.
• Vitamin B5 (Pantothenic Acid): Essential in the formation of the chemical acetylcholine, which is
involved in nerve transmission, memory, and crucial in the metabolism of energy. Poultry, fish, and
whole grains provide you with ample levels of this vitamin.
• Vitamin B6 (Pyridoxine): Involved in the metabolism of sugar, fat and protein. A limit of 300 mg
per day will be adequate for any athlete. It can be found in foods like wheat germ, fish and
walnuts.
• Vitamin B12 (Cobalamin): Refers to substances containing the mineral cobalt, which is important
in the metabolism of protein and fat and aid in red blood cell production. Sources include liver,
oysters and clams.
• Vitamin B15 (Pangamate or Pangamic Acid): A coenzyme involved in respiration, protein
synthesis, and regulation of steroid hormones. Its principal effect is to increase blood and oxygen
supplies to tissue. Deficiency states produce no apparent negative effects, which leads some
conservative nutritionists to the conclusion that it is not a "true" vitamin. B15 is found principally in
Brewer's Yeast, organ meats and whole grains.
• Folic Acid (Folacin): Helper substance of the B complex group, especially in red blood cell
formation. Five milligrams a day is recommended for athletes.
• Biotin: Helps to metabolize carbohydrates and fats. Best sources are brown rice and soybeans.
• Choline: An agent helpful in the use of the B complex vitamins. It is crucial in normal brain
function (notably memory) and acts as a factor in metabolizing fat and cholesterol. The best food
sources are eggs and lecithin.
• Inositol: Helpful in the use of B complex vitamins. It acts with choline in metabolizing fat and
cholesterol. In addition, it plays an important role in the transmission of nerve impulses. Lecithin
and wheat germ are good sources of inositol.
• Para-amino-benzoic acid (PABA): Essential for normal skin and hair growth. Sources include
whole grains and wheat germ. It is (at least partially) synthesized in the intestinal flora, a fact that
has led conservative nutritionists to deny a need for it in the diet.
• Vitamin C (Ascorbic Acid): A water-soluble vitamin similar to the B complex vitamins. It is
involved in various bodily functions and may produce diarrhea and mild diuretic effects in some
people. Citrus fruits provide a good source of C.
• Bioflavonoids: Chemicals that contribute to the strength of your capillaries and help to protect
vitamin C stores in your body. These vitamins can be found in fresh raw vegetables and fruits.
• Vitamin D (Calciferol): A fat-soluble vitamin that regulates calcium and phosphate metabolism in
your body. This vitamin is actually formed on your skin via ultraviolet rays from light, when they
react with cholesterol in your skin. Sunlight serves as the best source of vitamin D, but this vitamin
is also added to milk.
• Vitamin E (d-alpha tocopherol succinate): Another fat-soluble vitamin that has numerous
responsibilities in your body. Recent research clearly shows the importance of Vitamin E in fighting
the ravages of free radical damage inside your body. If ever there were an "anti-aging" elixir, this
is it. (See the section on anti-oxidants later in this manual.) Food sources available are wheat
germ, green leafy vegetables, whole grains, and vegetable oils.
• Vitamin K ("K" stands for "Koagulation"): This vitamin is implicated in proper blood clotting. It is
synthesized in the intestinal flora. Because it is fat-soluble, it has the potential for toxicity if taken
in large doses. There is no established RDA.

Vitamins Cont...

It is well established that all physically active people need an abundance of vitamins for optimal
performance. The physical demands of training use up these substances and make it more critical for
replenishment. It is quite possible that eating 5 or so carefully balanced meals (and the increased caloric
intake that may normally accompany such an eating schedule) every day will make supplementation with
vitamins unnecessary. However - and this is a very important "however" - who does that? In the interest

357
of "insurance," it is probably wise to take a low- to moderate-dosage multivitamin/mineral supplement
two or three times daily. Caution must be taken however, when fat-soluble vitamins (A, D, E, and K) are
consumed in large quantities because of the possibility of toxicity stemming from bodily storage of these
fat-soluble vitamins.

Minerals

Until recently, vitamins were thought to be a more important concern in peak performance than minerals.
Through vast research, it is now believed that minerals play a very significant role in various bodily
functions essential to physical movement. A deficiency in any mineral can be disastrous to peak
performance. Minerals are naturally occurring homogenous inorganic substances with a specific chemical
composition and characteristic crystalline structure. For example, failure to consume adequate levels of
calcium and iron can result in fatigue, weakness and injury. Women tend to be more likely to experience
such deficiencies then men.

Minerals are found in plants and animal foods along with your drinking water. Many times the quantities of
minerals found in these sources are too small. Since the stresses associated with sport activity promote
the loss of various minerals, it becomes more important to increase your mineral intake. Below are some
of the minerals important to physical performance.

• Calcium: The most abundant mineral in your body. It helps to make up your teeth and bones and
is needed for muscle contractions. Only about ten percent of the calcium in dairy products is
absorbed in your body. No wonder many people are deficient in this mineral. An athlete deficient in
calcium may experience stress fractures. Good sources of calcium are dairy products and calcium
carbonate supplements.
• Magnesium: Another mineral essential to muscle contraction, notably in the relaxation phase. A
lack of magnesium produces fatigue, spasms, muscle twitching, and muscle weakness. Foods that
provide quality magnesium are soybeans, leafy vegetables, brown rice, whole wheat, apples,
seeds, and nuts.
• Phosphorus: The second most abundant mineral in your body. It is involved in muscle
contractions and helps in the utilization of foodstuffs. By consuming large quantities of phosphorus
you might experience a depletion of calcium and magnesium in your bones, muscles and organs,
and have weakness. Fish and poultry contain quality phosphorus.
• Iron: Essential in making hemoglobin or oxygen in your blood and crucial in the transportation of
oxygen during endurance activities. An intake of more than 50 milligrams a day for prolonged
periods can be toxic. Interestingly, coffee and tea consumption can limit the absorption of iron. The
best source of iron is meat. Even cooking in an iron skillet can increase the iron content in your
food.
• Copper: Helps to convert iron to hemoglobin and promotes the use of vitamin C. Most foods have
copper in them.
• Zinc: Responsible for cell growth by acting as an agent in protein synthesis. Also aids in the use of
vitamin A and B-complex vitamins. It prolongs muscle contractions and therefore increases your
endurance. Sources include eggs, whole grains, and oysters.
• Manganese: A mineral essential in numerous functions including glandular secretions, the
metabolism of protein and brain function. Too much manganese can inhibit the absorption of iron.
Food sources are tea, leafy green vegetables and whole grains.
• Sodium and Potassium: Minerals that need to have a balance for maximal muscular power.
These minerals are needed in the transmission of nerves impulses. Deficiencies will produce
cramping and weakness. Good sources are green leafy vegetables, bananas, citrus and dried fruits.
Incidentally, salt tablets for sodium intake are a no-no!

Active people vary in the amounts of extra minerals needed. Much depends on your age, sex, genetics,
medical history, and your training. In practical terms, estimates provide guidelines rather than concrete
recommendations.

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 Table of Performance Daily Intakes (PDI)

Nutrient Forms Found In Supplements PDI

Vitamin A Acetate, Beta Carotrne, 5,000 IU to

Vitamin A
Vitamin A Palmitate 25,000 IU

15,000 IU to
Beta Carotene Beta Carotene
80,000 IU

400 IU to 1,000
Vitamin D (D2) Ergocalciferol, (D3) Cholecalciferol
IU

Mixed Tocopherois, D-alpha Tocopherol Succinate, 200 IU to 1,000

Vitamin E
DL-Tocopherois IU

80 mcg to 180
Vitamin K (K1) Phyloquinone, (K2) Menadione
mcg

800 mg to
Vitamin C Ascorbic Acid, Rose Hips
3,000 mg

30 mg to 300
Vitamin B1 Thiamine Hydrochloride (HCI)
mg

30 mg to 300
Vitamin B2 Riboflavin
mg

20 mg to 100
Vitamin B3 Niacinamide, Niacin
mg

20 mg to 100
Vitamin B6 Pyridoxine, Hydrochloride (HCI)
mg

400 mcg to
Folate Folic Acid
1,200 mcg

12 mcg to 200
Vitamin B12 Cyanocobalamin
mcg

125 mcg to 300

Biotin Biotin
mcg

25 mg to 200
Pantothenic Acid d-calcium pantothenate
mg

Calcium carbonate, calcium citrate, calcium 1,200 mg to

Calcium
malate, calcium glycinate 2,600 mg

800 mg to
Phosphorus Phosphorus
1,600 mg

400 mg to 800
Magnesium Magnesium oxide, magnesium glycinate
mg

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 25 mg to 60
Iron Ferrous (iron) fumarate, iron glycinate
mg

15 mg to 60
Zinc Zinc citrate, zinc arginate
mg

200 mcg to 400

Iodine Iodine from kelp
mcg

100 mcg to 300

Selenium Selenomethionine
mcg

Copper Copper lysinate, copper gluconate 3 mg to 6 mg

Manganese arginatem, manganese glycinate, 15 mg to 45

Manganese
manganese gluconate mg

Chromium dinicotinate glycinate, chromium 200 mcg to 600

Chromium
picolinate, chromium polynicotinate mcg

100 mcg to 300

Molybdenum Molybdenum chelate
mcg

1,500 mg to
Sodium Sodium chloride*
4,500 mg

1,500 mg to
Chloride Sodium chloride*
4,500 mg

2,500 mg to
Potassium Potassium chloride
4,000 mg

Boron Boron tri chelate, boron glycinate, boron citrate 6 mg to 12 mg

Choline bitartrate, choline dihydrogen citrate, 600 mg to

Choline
phosphatidyl choline 1,200 mg

800 mg to
Inositol Myo-inositol
1,200 mg

200 mg to
Bioflavonoids Citrus, rutin, hesperidin bioflavonoids
2,000 mg

IU= International Units, mg= milligrams, mcg= micrograms

*Sodium and Chloride are derived predominantly from food sources, not dietary
supplements. Note: Refer to the specific chapters for details on these nutrients and special
considerations. Guidelines for other nutrients like amino acids, carbohydrates, lipids, fiber,
herbs, and metabolics (such as, creatine, inosine, Coenzyme Q-10, and L-carnitine) are
covered in their respective chapters because their use is more involved than can be
summarized in this table.

360
WATER: Its Dietary Importance

Water is the most abundant substance in your body. All of your cells are soaked in water. Water makes up
55 to 75 percent of your total body weight. The food you eat contains about seventy percent water. A ten
percent reduction of water in your body can make you sick and a loss of twenty percent can mean death.
Although you can survive for weeks without food, you can survive only a few days without water. If you
happen to be in a hot environment, you might be limited to only a few hours.

Drinking five glasses of water a day can lower the risk of deadly heart disease, according to a study
released in April, 2002. Researchers at Loma Linda University said that people who drank five eight-ounce
glasses of water daily were about half as likely to die of coronary heart disease as those who drank two
glasses or less. The benefit was greater than that conferred from drinking a moderate amount of alcohol
or taking aspirin, the study said. In fact, drinking water appears to confer as much a benefit to heart
health "as stopping smoking or lowering cholesterol," said Dr. Jacqueline Chan, the study's lead author.

"This is a really simple method" of preventing coronary heart disease, she said.

Coffee, soda, milk, and caffeinated sodas did not show any statistically significant heart benefits. Chan
said more research is needed to confirm the findings, but researchers already adjusted the figures to
account for other potential factors in heart disease fatalities such as smoking, calorie intake, exercise,
blood pressure, and socioeconomic status.

The study, which was to be published in the American Journal of Epidemiology, did not specifically explain
how increased water drinking might lower the risk of heart disease. But it noted that dehydration could
elevate risk factors such as blood viscosity.

This amazing substance is involved in every bodily function known to man. Your vital fluid blood is
comprised of ninety percent water. And we all know that our blood is responsible for transporting nutrients
and energy to working muscles and then transporting metabolic waste away from tissues.

A reduction in water means more concentrated blood. A loss of only five percent body water results in a
ten percent loss of water from your blood. The thicker the blood, the more susceptible your body is to
clotting, and the less efficient it becomes at delivering oxygen to your brain and muscles. It also becomes
harder to transport substances to and from your various tissues.

Temperature regulation is controlled by water. If you do not have sufficient amounts of water in your
body, cooling cannot take place. Water lubricates joints and helps your digestive system. Water is also
responsible for the actions involved in energy production. If your kidneys do not have adequate water
available to them, your liver is forced to detoxify toxins. And when your liver is called upon to do this,
other functions performed by your liver are less effective, including the metabolism of food products.

Water helps you recover from your workouts, aids in fat-based fueling of muscles and provides for storage
of water inside your cells. When you become dehydrated, all of these functions become less effective and
your performance levels lower.

Water contributes to energy storage by being stored alongside glycogen. If you do not drink enough water
to facilitate this, extra glucose remains in your bloodstream until it reaches your liver. Then the glucose is
stored as fat. You can actually get fatter when you do not consume adequate amounts of water.

If you are dieting, drink plenty of water so your liver can effectively metabolize body fat. And when you
are carbohydrate loading, drink water often so glucose can become stored as glycogen.

Active people need more water than inactive people do. A reduction in as little four to five percent body
water can result in a drop in physical performance as great as twenty to thirty percent. It is recommended
361
that you consume plenty of water on a daily basis, twenty minutes before any athletic event and following
high carbohydrate meals. Do not wait until you are thirsty to drink water. By the time your body reaches
that point, you are already deficient in this vital fluid.

When you consider that our muscles are made up of nearly 70% to 80% water, it is easy to see why fluid
replacement is so important! Dehydration upsets the natural balance of fluids in the body and can lead to
serious problems, including difficulties associated with heart function and temperature-regulation.

Fluid replacement is as important for the average fitness enthusiast as it is for the well-trained athlete.
With so much riding on balanced body fluids, researchers are always seeking the most effective way to
keep our bodies well-hydrated and functioning at peak condition.

Table 18-8: Major Nutrient Fact Sheet

Carbohydrates Fat Protein Vitamins Minerals Water

Starches Sugars Triglycerides Complex and Trace
Cholesterol molecules elements
Phospholipids

Chemical C,H,O C,H,O C,H,O,N C,H,O,N Many H, O

Constituents (mainly) (mainly) and some elements
(Elements) other
elements
depending
on vitamin

Starting and Starts in In the small Starts in No major No major

ending mouth; ends in Intestine stomach; digestion digestion
points of small intestine ends in occurs occurs
Digestion small
intestine

Factors Digestive Bile digestive Acid

involved in enzymes enzymes digestive
digestion enzymes

Effect of Breakdown of Breakdown Breakdown Little or Little or

digestion starches and to fatty acids to none none
table sugar to and some constituent
simple sugars other amino
substances acids

Absorption Absorption in Absorption in Absorption Absorption Absorption

and small intestine; small in small in small in small
distribution distribution via intestines intestines intestines intestines
in the body blood and main and and and
distribution distribution distribution distribution
via lymph via blood via blood via blood

Primary Utilization as Utilization as Used to Are Most are

metabolism energy source; energy form own enzyme enzyme
storage as source; proteins “helpers” “helpers”
glycogen; storage of and
excess as body excess as enzymes;

362
 fat triglyceride excess as
in fat tissues body fat
(AKA body
fat)

Ultimate Breakdown to Breaks down Breakdown Slight Little No

fate water and to water and to carbon chemical change change
(excretion carbon dioxide carbon dioxide change
products) dioxide water and and
mainly urea excretion
in urine

Table 18-9: Recommended Water Intake

Step 1 Select an appropriate need factor.

0.5 — Sedentary no sports or training

0.6 — Jogger or light fitness training

0.7 — Sports participation or moderate training 3 times a week

Need
Factors 0.8 — Moderate daily weight training or aerobic training

0.9 — Heavy weight training daily

1.0 — Heavy weight training daily plus sports training or “2-a-day”

training

Multiply weight (in pounds) by the appropriate need factor to arrive at the
Step 2
recommended water intake in ounces per day.

Example 1 120 pounds x 0.6 = 72 ounces per day

Example 2 200 pounds x 0.7 =140 ounces per day

We recommend that you drink water eight to twelve times per day.

Example 1 72 ounces per day divided by 10 glasses = 7.2 ounces per glass

Example 2 140 ounces per day divided by 12 glasses = 11.7 ounces per glass

Dehydration Dangers

Dehydration is the loss of water from the body, and a depletion of electrolyte levels (sodium and
potassium). When you become dehydrated even slightly, your body fights back by slowing down the
elimination of water. In the event that this occurs, you retain excess amounts of water. A restriction of
fluids virtually stimulates your body to retain more water. Dehydration is treated by replacing the water
the body is lacking and by restoring electrolyte levels to normal. Dehydration may be caused by
inadequate water intake or by excessive water loss, but the most common cause of dehydration is a
simple failure to drink liquids. By the time you feel thirsty, you are already dehydrated.

363
The average person loses approximately 2.5 percent of total body water per day. When you participate in
events above and beyond normal activities, like exercise, sporting events, or yard work, the risk of
dehydration is even greater. Any activity that causes you to sweat depletes your body fluid levels.
Strenuous activity will have an even greater effect and quickly dehydrate the system. In addition to the
ISSA recommended daily water intake, we recommend that you drink 16 ounces of water for every pound
of weight lost during strenuous exercise. We also recommend that you consume the needed amount in
fifteen-minute intervals, rather than all at once.

Table 18-10: Water Purification Systems

Ion
Exchan Granul Solid
Ion
ge ar Block Rever Activat
Exchan
Water (Catio Activat and se Distillat ed Aerati Disinfect
ge
Contaminants n) ed Precoat Osmo ion Alumin on ion
(Anion
Water Carbo Absorpt sis a
)
Soften n ion
ers

Arsenic (0.05 • • • •
mg/L)

Asbestos (7 ml • • •
fibers >10pm/L)

Atrazine
(Herbicides/Pesti • • •
cides-0.003
mg/L)

Benzene (VOC- • • •
0.005 mg/L)

Flouride (4.0 • • •
mg/L)

Lead (0.015
• • • •
mg/L Action
Level)

Mercury (0.002 • • • • •
mg/L)

Nitrate (10.0 • • •
mg/L)

Tetrachloroethyl
• • • •
ene (PCE,VOC-
0.005 mg/L)

Total
• • • •
Trihalomethenes
(TTHMs-0.10

364
 mg/L)

Radium (20 • • •
pCl/L Proposal)

Radon (300 • •
pCl/L Proposal)

Coliform
• •
Bacteria (zero in
95% of samples)

Different contaminants require different solutions. The chart matches contaminants and their national Safe
Drinking Water standards with equipment that can help reduce or resolve the problem. When treating for
health contaminants, a consumer must be absolutely certain that the product chosen will solve the water
quality problem. Have water tested by a state certified laboratory before deciding which solution is best.
Source: Water Quality Association (manufacturers’ trade group)

Summary

1. The core of the ISSA Dynamic Nutrition Approach is based on thermodynamics. Thermodynamics is
the branch of physiochemical science concerned with heat and energy and the conversion of one
into the other involving mechanical work.
A. The ISSA proposes the following five rules as they apply to everyone, sedentary or active,
young or old, in or out of shape:
1. Rule One: Always eat at least 5 times a day.
2. Rule Two: In planning each of your daily meals (or snacks), a caloric ratio of
approximately 1 part fat, 2 parts protein, and 3 parts carbohydrate is a good place to
begin.
3. Rule Three: Eat for what you plan to do.
4. Rule Four: You cannot lose fat quickly and efficiently unless you follow a negative
calorie balance diet- taking in fewer calories than you would need to stay the same
weight.
5. Rule Five: Supplementation is necessary for optimal performance.
B. The following substances are not conducive to the fitness lifestyle: alcohol, nicotine,
clenbuterol, HCG, aldactone, cytomel, thybon and triacana, to name a few.
C. The ISSA Dynamic Nutrition Approach is virtually the means to which you fit your nutrition
to your training and competition. This is best accomplished through the consumption of five
or six meals each day, rather than the more conservative approach of two or three a day as
outlined in the First Rule of Performance Nutrition.
D. There are six major nutrients (carbohydrates, proteins, fats, vitamins, minerals and water)
necessary for a healthy body. A deficiency in any one of these nutrients can reduce chances
of success in reaching fitness goals.
1. Carbohydrates are any of a group of chemical compounds including sugars, starches,
fiber, and containing carbon, hydrogen, and oxygen with a 2:1 hydrogen-to-oxygen
atom ratio.
a. The glycemic index refers to the relative degree to which blood sugar
increases after the consumption of food.
b. Fiber is a compound that only plants contain. Dietary fiber only comes from
plant foods (i.e., grains, oats, fruits, etc.); it is never in animal foods (i.e.,
meats, dairy).

365
2. Proteins are any of a group of complex nitrogenous organic compounds that have amino acids as
their basic structural units. Proteins are found in ALL living matter and are required for the growth
and repair of all animal tissue. Protein is an organic compound composed of carbon, hydrogen,
oxygen and nitrogen.
1. Whey is known as the anabolic protein because it increases protein synthesis with a greater
efficiency than other sources. There are three different types of whey proteins, whey
concentrate, whey isolate, and whey hydrolysate.
2. Casein and whey are both derived from milk. Casein has a lesser value of nitrogen retention
than whey but it does release more slowly into the bloodstream. Casein's value as a protein
of choice for late evening consumption is its strong point.
3. According to the research, 0.8 grams a day per pound of bodyweight is a good range in
which to maintain positive nitrogen balance and enable the trainee to continue to make
muscular gains.
3. Fats are any of various soft, solid, or semisolid organic compounds comprising the glyceride esters,
ketones, and related compounds of fatty acids and associated sterols, alcohols, hydrocarbons.
4. Fats are classified as free fatty acids, triglycerides, phospholipids and cholesterol.
. MCTs are fatty acids produced from coconut oil and palm kernels (among others). These
fatty acids are more rapidly absorbed than long-chain triglycerides.
a. Cholesterol (complex 4-ringed structure) functions in cell membranes and is the starting
material for building bile salts, vitamin D, and steroids.
5. Vitamins are relatively complex organic substances found in plant and animal tissue, which are
required in small quantities for controlling metabolic processes.
. Water-soluble vitamins include B and C.
a. Fat-soluble vitamins include A, D, E, and K.
6. Minerals are naturally occurring homogenous inorganic substances with a specific chemical
composition and characteristic crystalline structure.
7. Water is the most abundant substance in your body. All of your cells are soaked in water. Water
makes up 55 to 75 percent of your total bodyweight.
. The ISSA recommends eight to twelve glasses of water per day.
a. Dehydration is a depletion of electrolyte levels (sodium and potassium) and the loss of
water from the body.
b. ISSA recommends that you drink 16 ounces of water for every pound of weight lost during
exercise. (It takes your body 15 to 20 minutes to absorb 16 ounces of water.)

366
 Section 5: Unit 19 Outline

Estimating Caloric Needs

I. Caloric Needs

A. Estimating your Caloric Needs

1. BMR and Daily Caloric Expenditure, Step-by-step

B. Determining an Appropriate Nutrient Ratio

1. ISSA's 1-2-3 Nutritional Rule-of-Thumb

a. Method 1
b. Method 2

2. Putting it all together

II. Conclusion

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Estimate an individual’s daily caloric needs based on his or

her activity level.
• Determine minimum protein requirements for people of all
activity levels.

367
Caloric Needs

We have discussed the Five Rules of Performance Nutrition and the roles of the 6 major nutrients in our
bodies in Unit 18. We will now cover the importance of estimating caloric needs. How many times has
someone asked you, "How many calories should I eat?" or, "How can I lose weight?" or, "What should I
eat?" The key to answering these questions always involves calculating the number of calories a person
needs. This chapter discusses effective methods for determining how many calories we should eat.

While we are on the subject of calories, just what are they? A calorie is the quantity of heat required to
raise the temperature of 1 gram of water 1 degree Celsius. This small unit is used in physics and
chemistry. The Calorie (with a big "C"), or kilocalorie, is the terminology used to represent how much
heat-yielding potential there is in food. One kilocalorie is the amount of heat needed to raise the
temperature of 1000 grams of water 1 degree Celsius. This unit is what most people mean when they talk
about "calories;" that is, the "calorie" used when discussing nutrition and diet. Confusingly, many books
use the three terms interchangeably: calorie = Calorie = Kilocalorie. Not to worry; with a little insight, it is
easy to discern which "calorie" is being discussed. Daily caloric requirements are in the thousands. For
example, an active, 200-pound male with 15% body fat requires 3,420 calories per day. If authors are
using the smaller calorie convention, this daily caloric requirement is 1000 times larger or 3,420,000
calories. (You can see why the kilocalorie is used instead; kilocaloric measurements are easier to work
with.)

There is another measure of energy used by scientists and internationally called the kilojoule (kJ). You will
commonly encounter the kJ in the scientific literature and on food packaging from foreign countries. To
convert kilojoules to nutritional calories, simply divide the number of kilojoules by 4.2.

Traditional methods of science for measuring the total daily caloric expenditure of the body, or metabolic
rate, analyze oxygen consumption. The amount of oxygen used and carbon dioxide exhaled is a direct
result of the amount of energy expended. This measurement indirectly reflects metabolism. These
laboratory techniques employ sophisticated technology, normally out of most personal trainers' areas of
expertise. Instead, personal trainers can rely on calculations and charts (found on the following pages) as
practical methods for estimating daily caloric requirements and assessing metabolic rate.

Just as with the determination of body composition, energy expenditure techniques have a margin of
error. Keep this in mind, because even the most sophisticated methods may yield daily caloric rates that
are too high or too low. In order to fine tune caloric intake based on the individual's metabolic rate, it is
important to keep track of body composition changes.

Everybody expends a different amount of energy each day, which depends on many factors such as
physical activity and the composition of the diet. However, the basal metabolism, or basal metabolic rate
(BMR) remains somewhat constant. Your BMR is the rate at which the body expends energy for
368
maintenance activities, such as keeping the body alive, organ function, etc. Your BMR is lowest when
sleeping; however, most methods measure your BMR when awake, but under controlled conditions of
resting and constant room temperature. Your BMR is therefore an estimate of the number of calories you
would burn over 24 hours while lying down, but not sleeping. Your actual metabolic rate is estimated by
adding the caloric cost of all the activities in which you engage throughout the day to your BMR.

The ISSA’s method for determining daily caloric requirements has been around for many years. We have
modified the process into an easy-to-follow, three-step process. You will need to know the client’s sex,
percent body fat (which can be determined through one of the methods outlined in the Body Composition
Section), weight and average approximate daily activity level. Remember, BMR is the number of calories
one would expend if he or she did NO activity all day.

The formulas for BMR and daily caloric intake are reasonably accurate for people with average levels of
body fat (i.e., 20% and 28% for men and women, respectively). The higher the body fat percentage, the
fewer calories the body burns. (Limited activity and less muscle require fewer calories). The lower the
body fat percentage, the more calories the body burns. (Large muscles require more calories.) Energy
requirements above the BMR depend on activity level. Requirements can be as low as 130% percent of
BMR and as high as 200% of BMR. The following pages explore practical methods for determining BMR
and daily energy expenditure.

Getting rid of fat permanently is made easier by increasing metabolic rate. Increasing both muscle mass
and activity level increases the body's metabolic rate. It is possible to gain muscle mass and lose fat at
the same time. Never sacrifice muscle tissue during the fat loss process. Instead, build more muscle to
burn more calories. You will lose fat more quickly and be more successful at keeping it off.

Estimating Your Caloric Needs

To review, your basal metabolic rate (BMR) is the number of calories you would burn over 24 hours while
lying down, but not sleeping. Your actual metabolic rate is estimated by adding the caloric cost of all the
activities in which you engage throughout the day to your BMR.

There are four steps to determining your BMR. Two additional steps allow you to calculate your daily
caloric expenditure. Read an overview of the steps below, then follow along as we break down BMR and
daily caloric expenditure calculation step-by-step, using an example.

First, convert your weight from pounds to kilograms using Equation 19-1. Second, use your weight in
kilograms to complete Equation 19-2. (Use the appropriate equation for your gender). Next, find the
proper lean factor multiplier that corresponds to your gender and body fat percentage. Finally, use this
lean factor multiplier and the number of calories calculated in step 2 to complete Equation 19-3. This is
the number of calories you burn at rest each day, or your BMR.

BMR and Daily Caloric Expenditure, Step-by-step

Step 1: Convert bodyweight from pounds to kilograms.

1 kilogram (kg) = 2.2 pounds (lbs). To find your weight in kilograms, divide your bodyweight in pounds by
2.2.

Eq. 19-1

bodyweight in pounds ÷ 2.2 = bodyweight in kilograms

EXAMPLE: Male, 200 pounds
200 lbs ÷ 2.2 = 90.9 kg
369
Step 2: Calculate equation 19-2.

Choose the equation that corresponds to your gender. Then, using bodyweight in kilograms, perform the
calculation. The resulting number will be used in the final calculation of BMR (Step 4).

Eq. 19-2a

Men: 1.0 x bodyweight (kg) x 24

Eq. 19-2b

Women: 0.9 x bodyweight (kg) x 24

EXAMPLE: Male, 200 pounds
1.0 x 90.9 kg x 24 = 2182

Step 3: Determine lean factor multiplier.

Based on your gender and body fat percentage, determine your lean factor multiplier using table 19-1.

EXAMPLE: Male, 200 pounds, 15% body fat

lean factor: 2; multiplier: .95

Step 4: Calculate BMR.

To calculate your BMR, multiply the number obtained in step two by your lean factor multiplier.

Eq. 19-3

number from step 2 x lean factor multiplier

EXAMPLE: Male, 200 pounds
2182 x 0.95 = 2073

BMR = 2073 calories

Now that you know your BMR you can determine your daily caloric expenditure by factoring in your daily
activity. Obviously, activity means you are going to burn more calories. To find your daily caloric
expenditure, locate your activity range in Table 19-2 and multiply your daily BMR (or your hourly BMR if
you want to calculate hourly caloric expenditure) by the multiplier listed.

Step 5: Determine daily activity multiplier.

EXAMPLE: Male, 200 pounds, 15% body fat, ski instructor, tennis player, weight
lifter, jogger
Range: Fitness Buff, moderate; multiplier: 1.65

Step 6: Calculate daily caloric expenditure.

To calculate your daily caloric expenditure, multiply your BMR (number obtained in step 4) by your daily
activity multiplier.

370
Eq. 19-4

BMR x daily activity multiplier

EXAMPLE: Male, 200 pounds, 15% body fat, ski instructor, tennis player, weight
lifter, jogger
2073 x 1.65 = 3420

Total daily caloric expenditure = 3420 calories

Table 19-1

Lean Factor Percent Body Fat (%) Multiplier

1 10 to 14 1.0

2 15 to 20 .95
Men
3 21 to 28 .90

4 Over 28 .85

1 14 to 18 1.0

2 19 to 28 .95
Women
3 29 to 38 .90

4 Over 38 .85

Table 19-2

Average Daily Activity Levels

1.30 = Very Light

Sitting, studying, talking, little walking or other activities through
Couch Potato out the day
Range
1.55 = Light
Typing, teaching, lab/shop work, some walking throughout the day

1.55 = Light
Typing, teaching, lab/shop work, some walking throughout the day
Fitness Buff Range
1.65 = Moderate
Walking, jogging, gardening type job with activities such as
cycling, tennis, dancing, skiing or weight training 1-2 hours per day

Athlete or Hard 1.80 = Heavy

Daily Trainer Heavy manual labor such as digging, tree felling, climbing, with

371
Range activities such as football, soccer or body building 2 to 4 hours per
day

2.00 = Very Heavy

A combination of moderate and heavy activity 8 or more hours per
day, plus 2-4 hours of intense training per day

Table 19-3: Calculation Review

BMR and daily caloric expenditure calculations

Step 1: Convert bodyweight from pounds to to kilograms.

bodyweight (lbs) ÷ 2.2 = bodyweight (kg)

Step 2: Calculate the appropriate equation below using bodyweight in kilograms.

Men 1.0 x bodyweight (kg) x 24

Women 0.9 x bodyweight (kg) x 24

Step 3: Determine lean factor multiplier

Lean Factor Percent Body Fat (%) Multiplier

1 10 to 14 1.0

2 15 to 20 .95
Men
3 21 to 28 .90

4 Over 28 .85

1 14 to 18 1.0

2 19 to 28 .95
Women
3 29 to 38 .90

4 Over 38 .85

Step 4: Multiply the number obtained in Step 2 by the lean factor multiplier to determine
BMR

number from Step 2 x lean factor multiplier = BMR

Step 5: Determine daily activity multiplier.

1.30 = Very Light

Couch Potato
Sitting, studying, talking, little walking or other activities through
Range
out the day

372
 1.55 = Light
Typing, teaching, lab/shop work, some walking throughout the
day

1.55 = Light
Typing, teaching, lab/shop work, some walking throughout the
day
Fitness Buff Range
1.65 = Moderate
Walking, jogging, gardening type job with activities such as
cycling, tennis, dancing, skiing or weight training 1-2 hours per
day

1.80 = Heavy
Heavy manual labor such as digging, tree felling, climbing, with
activities such as football, soccer or body building 2 to 4 hours
Athlete or Hard
per day
Daily Trainer
Range
2.00 = Very Heavy
A combination of moderate and heavy activity 8 or more hours
per day, plus 2-4 hours of intense training per day

Step 6: Multiply BMR by lean factor multiplier to obtain daily caloric expenditure.

BMR x daily activity multiplier

Our 200-pound male at 15% body fat and a BMR of 2,073 calories per day uses a total of 3,420 calories
on an average day. When planning a zig-zag diet program for this client, this would be your starting daily
caloric mark, and you would zig-zag up and down from this number.

Table 19-4 provides a means to the same end, but may be considered more user-friendly than the
previous method. Simply find your client’s bodyweight (in pounds) in the left column. Then, using his or
her body composition (lean factor) and activity level, locate his or her daily caloric expenditure.

Determining an Appropriate Nutrient Ratio

ISSA’s 1-2-3 Nutritional Rule-of-Thumb

Once we calculate the appropriate daily caloric intake (expenditure), we can determine the appropriate
nutrient ratios. As the Second Rule of Performance Nutrition states, the ISSA recommends the 1-2-3
nutritional rule-of-thumb. This general nutritional intake guideline of approximately 1 part fat, 2 parts
protein, and 3 parts carbohydrates is valid for most people who are weight training and exercising to lose
weight. If you follow this simple rule, you and your clients will maintain a diet that is low in fat, moderate
in protein, and high in carbohydrates. The 1-2-3 nutritional rule-of-thumb makes it easy to prioritize your
nutritional thinking when purchasing food, preparing meals, and eating out. The following discusses two
methods for determining nutrient ratios based on the 1-2-3 rule.

Table 19-4: Estimating Your Daily Caloric Requirements

Total Your
Average Daily Caloric Requirements
Weight Lean

373
(pounds) Factor

1.30 1.55 1.65 2.00 2.30

M F M F M F M F M F

100 1 1418 1277 1691 1522 1800 1620 2182 1964 2509 2259

2 1347 1213 1606 1446 1710 1539 2073 1866 2384 2146

3 1276 1149 1521 1370 1620 1458 1964 1768 2258 2033

4 1205 1085 1437 1294 1530 1377 1858 1669 2133 1920

110 1 1560 1404 1860 1674 1980 1782 2400 2160 2760 2484

2 1482 1334 1767 1590 1881 1693 2280 2052 2622 2360

3 1404 1264 1674 1501 1782 1604 2160 1944 2484 2236

4 1326 1193 1581 1423 1683 1515 2040 1836 2346 2111

120 1 1701 1531 2029 1826 2160 1944 2618 2356 3010 2709

2 1616 1454 1928 1735 2052 1847 2487 2238 2860 2574

3 1531 1378 1826 1643 1944 1750 2356 2120 2709 2438

4 1446 1301 1725 1552 1836 1652 2225 2003 2559 2305

130 1 1843 1659 2198 1978 2340 2105 2836 2552 3261 2935

2 1751 1576 2088 1879 2223 2000 2694 2424 3098 2788

3 1659 1493 1978 1780 2106 1895 2552 2297 2935 2641

4 1567 1410 1868 1681 1989 1789 2411 2169 2772 2495

140 1 1985 1788 2367 2131 2520 2269 3054 2750 3512 3163

2 1886 1699 2249 2024 2394 2156 2901 2613 3336 3005

3 1787 1608 2130 1917 2268 2041 2749 2472 3161 2847

4 1687 1520 2012 1811 2142 1929 2596 2338 2985 2689

150 1 2127 1915 2536 2283 2699 2430 3272 2946 3763 3388

2 2021 1819 2409 2169 2564 2309 3108 2799 3575 3219

3 1914 1724 2282 2055 2429 2187 2945 2651 3387 3049

4 1808 1628 2156 1941 2294 2066 2781 2504 3199 2880

374
160 1 2269 2042 2705 2435 2879 2592 3490 3142 4014 3613

2 2156 1940 2570 2313 2735 2462 3316 2985 3813 3432

3 2042 1838 2435 2191 2591 2332 3141 2827 3613 3251

4 1929 1736 2299 2070 2447 2203 2967 2671 3412 3071

Table 19-4: Estimating Your Daily Caloric Requirements Continued

Total Your
Weight Lean Average Daily Caloric Requirements
(pounds) Factor

1.30 1.55 1.65 2.00 2.30

M F M F M F M F M F

383
170 1 2170 2170 2875 2587 3061 2754 3710 3338 4267
9

364
2 2291 2062 2731 2458 2908 2616 3525 3171 4054
7

345
3 2171 1953 2588 2329 2655 2479 3339 3005 3840
6

326
4 2050 1845 2444 2199 2602 2341 3154 2837 3627
3

406
180 1 2297 2297 3044 2739 3241 2916 3928 3534 4517
1

386
2 2425 2182 2892 2602 3079 2770 3732 3357 4291
1

365
3 2298 2068 2740 2466 2917 2625 3535 3182 4065
9

345
4 2170 1952 2587 2328 2755 2479 3339 3004 3839
4

429
190 1 2694 2425 3213 2891 3420 3077 4146 3730 4768
0

407
2 2559 2304 3052 2746 3249 2923 3939 3544 4530
6

386
3 2424 2183 2892 2603 3078 2770 3731 3358 4291
2

364
4 2290 2061 2731 2457 2907 2615 3524 3171 4053
7

375
 451
200 1 2837 2553 3382 3044 3600 3241 4364 3928 5019
7

429
2 2695 2425 3213 2892 3420 3079 4146 3732 4768
1

406
3 2553 2298 3044 2739 3240 2916 3928 3535 4517
5

383
4 2411 2170 2875 2587 3060 2755 3709 3339 4266
9

474
210 1 2978 2861 3551 3196 3780 3402 4582 4124 5269
3

450
2 2829 2547 3373 3036 3591 3232 4353 3918 5006
6

426
3 2680 2412 3196 2876 3402 3062 4124 3711 4742
9

403
4 2531 2279 3018 2717 3213 2892 3895 3505 4479
2

3120 496
220 1 2808 3720 3348 3960 3564 4800 4320 5520
8

472
2 2964 2668 3534 2668 3762 2668 4560 4104 5244
0

447
3 2808 2527 3348 3023 3564 3207 4320 3888 4968
1

422
4 2652 2387 3162 2846 3366 3029 4080 3672 4692
3

3262 519
230 1 2935 3889 3500 4140 3726 5018 4516 5771
3

493
2 3099 2788 3695 3325 3933 3540 4767 4290 5482
3

467
3 2936 2642 3500 3150 3726 3353 4516 4065 5193
4

441
4 2603 2495 3306 2975 3519 3167 4265 3839 4905
4

Table 19-4: Estimating Your Daily Caloric Requirements Continued

Total Your Average Daily Caloric Requirements

376
 Weight Lean
(pounds) Factor

1.30 1.55 1.65 2.00 2.30

M F M F M F M F M F

240 1 3403 3063 4058 3652 4320 3887 5236 4712 6021 5419

2 3232 2910 3855 3469 4104 3693 4974 4476 5720 5148

3 3063 2756 3652 3287 3888 3499 4712 4241 5419 4877

4 2893 2604 3449 3104 3672 3304 4451 4005 5118 4606

250 1 3545 3192 4227 3805 4500 4051 5454 4910 6272 5647

3368
2 3032 4016 3615 4275 4285 5181 4665 5958 5365

3 3191 2971 3804 3424 4050 3645 4090 4418 5645 5080

4 3013 2713 3593 3234 3825 3443 4636 4174 5331 4800

260 1 3687 3319 4396 3957 4679 4212 5672 5106 6523 5872

2 3503 3153 4176 3759 4445 4001 5388 4851 6197 5578

3 3318 2986 3956 3561 4211 3790 5105 4594 5871 5284

4 3134 2821 3737 3363 3977 3580 4821 4340 5545 4991

270 1 3829 3446 4565 4109 4859 4374 5890 5302 6774 6097

2 3638 3274 4337 3904 4616 4155 5596 5037 6435 5792

3 3446 3101 4109 3698 4373 3936 5301 4771 6097 5487

4 3255 2929 3880 3493 4130 3718 5007 4507 5758 5182

*All values based on the conventional method of estimating caloric requirements and may vary
between individuals. Also slight rounding error may occur.

377
METHOD 1

Expanding the 1-2-3 ratio of nutrients, we see that 1 part fat plus 2 parts protein plus 3 parts
carbohydrates equals 6 total parts. Dividing the overall 3,420 calories (from our original example) into 6
parts yields 570 calories per part (3420 ÷ 6 = 570). Knowing that one part equals 570 calories, we can
calculate the number of calories allotted for daily intake for each nutrient.

From the caloric density chart on the left, we know that there are 9 calories in 1 gram of fat, 4 calories in
1 gram of protein, and 4 calories in 1 gram of carbohydrates. In order to determine the number of grams
per nutrient we simply take the number of calories allotted for each nutrient and divide that number by
the nutrient’s caloric density.

Fat: 1 part x 570 = 570 calories allotted to fat intake

Protein: 2 parts x 570 = 1,140 calories allotted to protein intake

Carbs: 3 parts x 570 = 1,710 calories allotted to carb intake

Caloric Density of Some Major Nutrients

Nutrients Calories/Gram

Carbohydrates 4

Protein 4

Fat 9

Alcohol* 7

Water 0

Vitamins 0

Minerals 0

* Alcohol is often considered a nutrient because it provides calories in the diet.

Fat Calories: 570 ÷ 9 = 63 grams of fat

Protein Calories: 1140 ÷ 4 = 285 grams of protein

Carbohydrate Calories: 1710 ÷ 4 = 428 grams of carbohydrates

METHOD 2

A modified 1-2-3 nutritional rule-of-thumb is based on protein intake and subsequent fat and
carbohydrate percentages.

We have concluded that the RDA’s recommendation of 0.36 grams per pound of bodyweight does not
account for outside stresses (exercise) and that recommendations of 300-500 grams a day are excessive.
378
0.8 grams a day per pound of bodyweight is a good ratio to maintain positive nitrogen balance and enable
muscular gains. Table 19-6 is an easy-to-follow chart developed by Dr. Hatfield that is based on this ratio.

While Table 19-6 addresses daily protein intake, it should be noted that it estimates minimum protein
intake. Evidence from current research validates a higher protein intake for heavy resistance training.
Table 19-7 reflects this research.

Table 19-5: 1-2-3 Nutrient Ratio

One part fat would be

1 x 570 = approximately 570
calories
from fat.

Two parts protein would be

2 x 570 = approximately 1140
calories
from protein

Three parts carbohydrates would

be
3 x 570 = approximately 1710
calories
from carbohydrates.

Table 19-6: Hatfield Estimate Procedure for Determining Minimum Daily Protein
Requirements

Formula:
Lean Bodyweight (in pounds) x Need Factor = Minimum Daily Protein
Requirement (in grams)

NEED FACTORS

0.5 — Sedentary, no sports or training

0.6 — Jogger or light fitness training

0.7 — Sports participation or moderate training 3X week

0.8 — Moderate daily weight training or aerobic training

0.9 — Heavy weight training daily

1.0 — Heavy weight training daily plus sports training, or “2-a-day” training

Protein requirements (according to need factor) expressed in grams per day

379
 LBW (lbs.)* 0.5 0.6 0.7 0.8 0.9 1.0

90 45 54 63 72 81 90

100 50 60 70 80 90 100

110 55 66 77 88 99 110

120 60 72 84 96 108 120

130 65 78 91 104 117 130

140 70 84 98 112 126 140

150 75 90 105 120 135 150

160 80 96 112 128 144 160

170 85 102 119 136 153 170

180 90 108 126 144 162 180

190 95 114 133 152 171 190

200 100 120 140 160 180 200

210 105 126 147 168 189 210

220 110 132 154 176 198 220

230 115 138 161 184 207 230

240 120 144 168 192 216 240

Table 19-7

Protein Requirements in Grams per Pound of bodyweight per Day

Sedentary adult (RDA) 0.36

Adult recreational exerciser 0.95

Adult competitive athlete 1.40

Adult, building muscle mass 2.00

Dieting athlete 1.00

Growing teenage athlete 1.00

Putting it All Together

Protein

Let us continue with our sample athlete from the daily caloric expenditure section. Let us say our 200-
380
pound male is an adult competitive athlete. He will need 1.40 grams of protein per pound of bodyweight
per day. Recalling from the caloric density table that there are 4 calories per gram of protein, we multiply
the grams of protein per day by 4 to get the number of calories from protein.

Example: Male, 200 lbs, 15% body fat, competitive athlete

1.40 x 200 = 280 grams of protein per day

280 grams x 4 calories per gram = 1120 calories from protein

To determine the percentage of calories that come from protein, divide the number of
protein calories by the number of overall calories.

1120 protein calories ÷ 3420 overall calories = 33%

33% of the overall calories are derived from protein.

Fat

Percentage of calories from fat can vary quite a bit, depending on whom you talk to. The RDA, for
example, says that fat calories should consist of no more than 30% of the diet. This number is good for
general health, but is considered too high for individuals seeking peak performance and physical
condition. The ISSA recommends that fat be 1 part of your overall calories. If there are six total parts in
the 1-2-3 approach (remember 1+2+3=6 total parts) then one part of 100% would be 100% divided by
6. This equals 16.6%, which if rounded up would be 17%. In this example one part fat is equal to 17% of
the total calories.

Example: Male, 200 lbs, 15% body fat, competitive athlete

To determine the amount of calories from a diet with 17% of the total calories derived from
fat, simply multiply the total daily calories by the percentage of calories coming from fat.

0.17 (17%) x 3420 total daily calories = 581 calories from fat

581 fat calories ÷ 9 calories per gram of fat = 65 fat grams per day

Please keep in mind that many people, especially in the US, are accustomed to diets high in fat. Often
clients will come to you with a diet consisting of 50% of calories from fat! It may be necessary to wean
these clients off of fat slowly, or they may lose interest in the fitness lifestyle. It is best to start clients
accustomed to diets high in fat at a percent of fat you feel they can tolerate (30% to 35% of calories
from fat, for example), and then slowly reduce the amount over time.

Carbohydrates

Now that we have determined calories from protein and fat, the remainder of the calories can only come
from one source: carbohydrates. As we have discussed carbohydrates are the body’s preferred source of
calories, and should make up the largest calorie supply of any nutrient in the diet. To determine the
amount of calories needed from carbohydrates, simply subtract the calories from fat and protein from the
total daily calories.

381
 Example: Male, 200 lbs, 15% body fat, competitive athlete

3420 daily calories – 581 fat calories – 1120 protein calories = 1719 carbohydrate
calories

1719 carbohydrate calories ÷ 4 calories per gram (as indicated on the caloric density
chart) = 430 grams of carbohydrates per day

To determine the percentage of calories that come from carbohydrates simply divide the
number of carbohydrate calories by the number of overall calories

1719 carbohydrate calories ÷ 3420 overall calories = 50%

50% of the overall calories are derived from carbohydrates.

Our 200-pound adult male athlete is eating a caloric ratio of 17% fat, 33% protein, and 50%
carbohydrates.

Nutrient Calories Grams Percentage Parts

Fat 581 65 581/3420 =17% 1

Protein 1120 280 1120/3420=33% 2

Carbohydrates 1719 430 1719/3420=50% 3

Conclusion

Whether you use Method One or Method Two of the 1-2-3 nutritional rule-of-thumb, this general
nutritional intake guideline, of approximately 1 part fat, 2 parts protein, and 3 parts carbohydrates is
valid for most people who are weight training and exercising to lose weight. If you follow this simple rule
you and your clients will maintain a diet that is low in fat, moderate in protein, and high in carbohydrates.
The 1-2-3 nutritional rule-of-thumb makes it easy to prioritize your nutritional thinking when purchasing
food, preparing meals, and eating out. To accommodate muscle gain or fat loss, this rule can be modified.
We will discuss these modifications in the next unit.

Table 19-8a: Sample Menu A

Gender: Male Weight: 183 Body fat percentage: 15%

Activity level:Moderate: Light typing, but one hour of heavy weight training per day

Step 2
Step 1
Lean Factor: 2 (Men 14% to 20% body fat)
183 pounds ÷ 2.2 = 91.5 kg
2196 x 0.95 (lean factor 2 multiplier) = 2,086.2
For Men:
1 x 91.5 (bodyweight in kg) x 24 = 2,196
BMR = 2,086.2 calories per day

382
 Step 4
Step 3
Average Daily Activity Level: 1.65
3 parts carbohydrates
1.65 x 2,086.2 = 3,442.23
2 parts protein
or
1 part fat
3,442 calories per day
3,442 ÷ 6 = 574 calories per part

Carbohydrates:
= 1,722 calories,
3 x 574

Protein: 2 x
= 1,148 calories,
574

Fat: 1 x 574 = 574 calories,

Total Calories: = 3,444

Table 19-8b: Sample Menu A

Carbs
Meal # Food Serving Size Fat (g) Protein (g) Calories
(g)

Meal 1 Oatmeal 2 Cup 116 0 12 512

Egg
6 large 0 0 24 96
White

Egg, fried 3 large 3 21 18 273

Orange 2 32 0 2 136

Graham
Meal 2 6 30 6 3 186
Crackers

Milk,
5 cups 60 0 40 400
skim

Apple 1 21 0 084

Meal 3 Chicken 6 ounces 0 4 48 228

383
 Breast,
baked

Bread,
whole 2 slices 22 2 4 122
wheat

Lettuce,
Romaine, 1 cup 2 0 0 8
raw

Tomato,
1 6 0 1 28
raw

Rice,
Meal 4 brown, 16 ounces 104 4 12 500
cooked

Whitefish,
6 ounces 0 12 42 256
baked

Broccoli,
chopped, 1 cup 10 0 6 48
cooked

Cottage
Meal 5 cheese, 3 cup 18 18 84 570
lowfat

Totals 424 g 67 g 296 g 3447

Macronutrients have been rounded in order to make the calculations easier to understand. Students
will find that most nutrition books and calorie-counting guides follow the same procedure. You should
note that the caloric values of the foods represented do not match the macronutrient profiles
accurately, but serve as an approximation to their value.

Table 19-9a: Sample Menu B

Gender: Female Weight: 150 Body fat percentage: 25%

Activity level: Light: Typing and some walking throughout the day

Step 2
Step 1 Lean Factor: 2 (Women 18% to 28% body
150 pounds ÷ 2.2 =68.2 kg fat)

For Women: 1,473 x 0.95 (lean factor 2 multiplier) =

0.9 x 68.2(bodyweight in kg) x 24 1,399.4
= 1,473
BMR = 1,399.4 calories per day

Step 3 Step 4
Average Daily Activity Level: 1.55

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 1.55 x 1,399.4 = 2169 3 parts carbohydrates

or 2 parts protein

2,169 calories per day 1 part fat

2,169 ÷ 6 = 361.5 calories per part

Carbohydrates: 3 x = 1,084.5
361.5 calories

Protein: 2 x 361.5 = 723 calories

= 361.5
Fat:1 x 361.5
calories

= 2,169
Total Calories:
calories

Table 19-9b: Sample Menu B

Serving Carbs Protein

Meal # Food Fat (g) Calories
Size (g) (g)

Meal 1 Bagel 1 medium 31 6 1 157

Egg white 5 large 0 20 0 80

Egg, fried 1 large 1 6 7 91

Meal 2 Crackers, saltine 16 36 4 4 196

Milk, Skim 4 cups 48 32 0 320

Raisins, seedless 3/4 cup 88 4.5 0 369

Ground Beef,
Meal 3 3.5 ounces 0 28 16 256
extra lean

385
 Hamburger Roll 1 20 3 2 110

Lettuce,
1 cup 2 0 0 8
Romaine, raw

Meal 4 Pasta 8 oz. 58 11 2 318

Shrimp, broiled 6 ounces 0 36 2 162

Broccoli,
1/2 cup 5 3 0 32
chopped, cooked

Cottage cheese,
Meal 5 1/2 cup 3 14 3 95
lowfat

Totals 292 g 167.5 g 37 g 2,194

Macronutrients have been rounded in order to make the calculations easier to understand.
Students will find that most nutrition books and calorie-counting guides follow the same
procedure. You should note that the caloric values of the foods represented do not match
the macronutrient profiles accurately, but serve as an approximation to their value.

Starch Group

Starch Group

386
Vegetable Group

387
388
Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts

389
Dairy Group

390
Fruit Group

391
Unit Summary

I. The rate of the body’s energy expenditure is referred to as the “metabolic rate.” This is the total daily
caloric expenditure.

A. BMR is an estimate of the number of calories you would burn over 24 hours while lying down, but not
sleeping. Your actual metabolic rate is estimated by adding the caloric cost of all the activities in which
you engage throughout the day to your BMR.

B. The ISSA recommends the 1-2-3 nutritional rule-of-thumb. This general nutritional intake guideline of
approximately 1 part fats, 2 parts protein, and 3 parts carbohydrates is valid for most people who are
weight training and exercising to lose weight. The Hatfield procedure for determining minimum daily
protein requirements is as follows:

1. 1. Formula: Lean Bodyweight (in pounds) x Need Factor = Minimum Daily Protein
Requirement (in grams)
2. While Dr. Hatfield’s estimate takes into account necessary daily protein intake, it should be
noted that these are minimum protein estimates. Evidence from current research validates
a higher protein intake for heavy resistance training.

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 Section 5: Unit 20 Outline

The ISSA Zig-Zag Approach to Muscle Gain and Fat Loss

I. The Zig-Zag Approach

A. Validation of the ZIG-ZAG Approach

B. Targeted Fat Loss Approach for Everybody: The ZIG-ZAG

Approach

C. The ZIG-ZAG Approach in Action

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• •Master the nutritional techniques of putting on muscle mass

without putting on fat, and taking off fat without also taking
off muscle.

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The ZIG-ZAG Approach

Losing weight has become an American pastime. When determining the the most favorable fat loss
approach for your clients, a review of traditional methods will help shed some light on how to best
approach this task. Surprisingly, when researching the facts, it became evident that most traditional fat
loss approaches vary and are not appropriate for a fitness lifestyle. These methods are primarily
developed for people who need to lose weight fast for health reasons or for the would-be dieter who wants
to trim down to look better.

There are three main ways your body loses weight: (1) dehydration, (2) lean weight loss (from muscle),
and (3) fat loss.

Dehydration is not a recommended type of weight loss. However, wrestlers and other athletes who need
to “make weight” will unavoidably turn to this method as a last-minute resort. Losing a couple pounds
during the last few hours prior to competition to make it into a specific weight division may not be
harmful, as long as the athlete is in a good state of hydration to begin with. In most cases, the athlete can
rehydrate after the weigh-in. However, do not rely on dehydration to lose more than a few pounds
(usually less than 3% to 4% of your total bodyweight), and do not stay dehydrated for more than several
hours or become dehydrated under circumstances of heat stress. Ideally, dehydration to make weight
should be avoided at all costs.

Lean weight loss can result from an excessive reduction in caloric intake, losing weight too fast, not
eating the proper proportions of macronutrients, and not exercising properly. Lean weight loss comes
primarily from the breakdown of muscle tissue; however, bone and connective tissue can also be reduced
in size. This is a very detrimental type of weight loss for the athlete, or anybody for that matter. Loss of
lean body mass also reduces BMR (basal metabolic rate) and jeopardizes body structure and function.

Targeted fat loss together with increased lean mass is the ISSA recommended mode of weight loss and
the core of the ZIG-ZAG approach, which is the focus of this unit. Increases in lean body mass percentage
will also accompany a proper fat loss program as a result of losing fat and keeping lean bodyweight the
same, which in turn, will result in a lower percent bodyfat and higher percent lean body mass. Or, a lower
bodyfat percentage may be the result of actually increasing the weight of lean body mass, which will result
in an increase of lean body mass percentage. The key to adjusting body composition should not be

394
dictated by reaching some arbitrary weight goal. It should be determined by attaining a bodyfat goal that
is realistic and can be reached given your current physical abilities, schedule and personal preferences.

Anyone who has been around the fitness world for any length of time has most likely heard one of these
complaints:

“I eat like a bird, and I still gain weight!”

“No matter what I do, I get fatter and fatter!”

“All I have to do is smell food and I put on weight!”

Scientists have long known that stringent dieting causes a corresponding drop in our resting metabolic
rate (BMR), making it very difficult, often impossible, to continue the fat loss process.

The rate of fat loss will be determined by individual genetics, body type, metabolism, nutrition and
exercise program. However, remember that it is not possible to establish the relative portion of an
individual’s health or fitness that is determined through heredity; therefore genetic background neither
dooms or guarantees success in achieving total fitness. Ectomorphs (naturally lean people) will have the
easiest time losing fat but find it hard to gain muscle. Mesomorphs will also be able to lose fat easily and
can put on muscle mass the easiest. Endomorphs, who tend to carry more bodyfat, can lose fat at a good
rate but need to make sure to stick to a low-fat nutrition program, keep up on strength and aerobic
exercise, and follow the fat loss tips, as they will probably benefit from them the most. Endomorphs may
also find it beneficial to raise their protein levels up to 25% to 30% of total daily calories to encourage an
increase in lean mass levels. Men tend to lose fat and gain muscle more easily than women because of
their hormonal differences, particularly higher testosterone, which give men the ability to maintain a
higher proportion of muscle mass and a higher metabolic rate then women. A woman’s hormonal system
resists changes in body composition as a protective mechanism to conserve energy stores while pregnant.
Women, therefore, will tend to lose fat at a slower rate and find it hard to maintain bodyfat levels below
16%. As we age, bodyfat reduction occurs at a slower rate. This should not discourage anyone but should
rather underscore the importance of establishing realistic, lifelong goals. These include following a
balanced nutrition plan and keeping up with a daily exercise program, including muscle-building exercises.

Validation of the ZIG-ZAG Approach

Scientists at the University of Pennsylvania performed a 48-week research study, which explored this
phenomenon. They came up with some intriguing findings that both elite athlete and the couch potato can
definitely benefit from. The study involved 18 women weighing an average of 216 pounds at the beginning
of the research period. Half consumed 1,200 calories per day, and the other half received 16 weeks of a
common liquid meal replacement followed by a conventional weight-reducing diet. All of the overweight
women walked to increase their caloric burn.

While the BMRs of both groups fell after five weeks, it fell significantly more in those taking the meal
replacement supplement (the more stringent of the two experimental treatments). Their BMRs quickly
returned to a level considered normal for their new (lower) bodyweight. After the 48 weeks, the BMRs of
both groups had dipped an average of 9%, and their percentages of bodyfat had dropped an average of
16% to 19%.

Now, what is interesting about this study’s findings (other than the relatively predictable outcome that the
crash dieters were not any better off than the moderate dieters after 48 weeks) is that scientists had
previously assumed that any drop in weight triggered a permanent, corresponding drop in BMR. A
permanently lowered BMR would mean that a dieter would not burn calories as rapidly and might
therefore regain the lost pounds or have real problems shedding more pounds.

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Of course, the mechanism responsible for this highly undesirable turn of events is the loss in lean muscle.
It is simple: Bigger muscles burn more calories than little muscles. And if you are losing weight from both
fat and muscle, your ability to continue losing fat — and keep it off — is literally sacrificed.

Scientists are finally beginning to garner some hard data supporting what we of Irondom have known for a
long, long time. There is a way to lose fat and still maintain a reasonably high BMR so your fat loss
process can continue smoothly. It’s called the “Zig-Zag” method of fat loss, and it works better than any
fat loss method there is. Why? It’s permanent. Permanent, that is, if you continue to eat five or six
smaller meals per day and exercise regularly. It also allows you to maintain (or improve) your lean muscle
mass.

Refer to tables 20-1 and 20-2. You will notice that as caloric intake is decreased and caloric burn
increases, bodyfat percentage drops correspondingly. But so does BMR. Then, to force BMR back to a
normal level, you begin eating normally again for a brief period of time.

What happens is that your bodyfat level again begins to climb, but not so high as it was at the beginning.
Then you lower your caloric intake again; down goes your bodyfat. Eat normally again, and up the bodyfat
goes — again, not so high as it was before. This process continues until your bodyfat percentage is at
healthful levels.

By zig-zagging your caloric intake like this, you ultimately allow periodic BMR adjustments to take place,
bringing it back to a level corresponding to your new (lower) bodyweight. Then it is easier to begin losing
fat again — and again. If you simply try going down, down, down in bodyfat, your BMR never has a
chance to adjust, and your fat loss efforts become harder and harder until, in thorough frustration, you
binge out and get fat again — forever. The Zig-Zag method also will help you get over or avoid the
phenomenon of plateauing, in which you lose several pounds of fat then stop losing. When most people hit
a plateau, what do they do? They reduce caloric intake, which is wrong. You now know that this just adds
to the problem, by further dropping your BMR. Zig-Zag your calories up, and your BMR will be readjusted
higher to burn more calories.

An important key to the entire process is weight training. Without the weight training, your lost weight will
be from lean tissue, not only fat! Do not try to do it too quickly! Even with weight training, starvation diets
will cause too much muscle loss rather than sheer fat reduction. Walking is okay for those considered
“chronically” fat. However, for those who are only slightly overweight, other forms of aerobic exercise are
excellent for maintaining great cardiovascular fitness. Weight training stands out as the single best
method there is for ensuring that gradually lost weight will come from fat stores and not hard-won muscle
tissue. Why? Because aerobic training simply does not build muscle to the extent that weight training can.
In fact, aerobic training alone will reduce your lean body mass and drop your BMR. This means you need
to exercise to burn more calories. But, on the other hand, if you gain 5 or 10 pounds of muscle, you are
burning more calories all the time, even when you are sleeping. Further, when you couple the Zig-Zag
method and weight training with moderate aerobic exercise and a careful diet and supplement program,
you will be amazed at how easy it is to lose fat, and how utterly enjoyable it is to keep it off forever.

This individual actually

lost 21 pounds of
muscle and only nine
pounds of fat! He’ll
yo-yo back up to 200 Table 20-1
in no time (within one
to two years,
according to
information compiled

396
during the
Congressional
investigation into the
fat-loss industry).
However, in doing so,
he will be 35% body
fat instead of his
original 30%. Why?
He will never regain
all of the lean tissue
he lost as a result of
his crash-dieting
earlier. This same
scenario happens over
and over to men and
women alike.

This individual actually

Table 20-2
lost 21 pounds of
muscle and only nine
pounds of fat! He’ll
yo-yo back up to 200
in no time (within one
to two years,
according to
information compiled
during the
Congressional
investigation into the
fat-loss industry).
However, in doing so,
he will be 35% body
fat instead of his
original 30%. Why?
He will never regain
all of the lean tissue
he lost as a result of
his crash-dieting
earlier. This same
scenario happens over
and over to men and
women alike.

By following the five

rules of performance
nutrition, this client
gained 14 pounds of
quality muscle (and a
greatly amplified
397
metabolic rate and
immune competence).
An effective nutritional
strategy allowed him
to lose 44 pounds of
body fat!

Targeted Fat Loss Approach for Everybody:

The Zig-Zag Approach

When you plan a fat-loss program, there are certain measures that you can take to help you achieve your
goal. They are:

1. Taste: If you like the way your food tastes, you will be more inclined to eat it. You should learn
how to prepare foods that are good for you, in ways that taste good to you.
2. Satiety: Foods that satisfy your hunger and blood sugar levels will leave you less likely to snack.
These foods should be of a low glycemic index (under 50). Eating five meals each day keeps your
blood sugar levels elevated, and keeps you from getting hungry. And by consuming your highest
calorie meal nearly two hours before you train, you will have the greatest energy levels during
training, and the smallest prior to inactive periods.
3. Calorie control: By regulating your diet so that you are not consuming high calorie foods that
consist primarily of fat, you can control how many calories go to your mouth. Do not forget that
exercise contributes to an elevated metabolism, which helps you burn more calories at rest and
during training.
4. For health: When you reduce your fat intake, you significantly reduce your chances of clogged
arteries, heart disease and stroke. You also reduce the risk of obesity and diabetes. (Both
conditions can be aggravated through the consumption of high-fat diets.) Add nutritional
supplements to your daily eating to better replenish the nutritional requirements lost during
training and to reduce the chances of nutrient deficiencies.
5. Lifestyle: When you lose weight (fat), you must make a conscious effort to make it a lifelong
commitment. Engaging in brief periods of weight loss followed by weight gain is not a healthy
lifestyle. Living healthy takes effort, but it should not be so difficult that you cannot stick with it. Do
not try to do too much too soon. Find a pace you can maintain.

By following these measures, dieting can be eliminated and eating healthfully will become a much easier
lifelong commitment. Other suggestions for improving eating habits include: curbing your appetite by
consuming caffeine before your meals, eating high fiber foods and supplementing your meals with low-
calorie protein powder. Staying cool so your metabolism remains higher for heat production, training
regularly and incorporating aerobic and anaerobic exercise into your weekly routine.

When attempting to lose fat, never try to lose more than 1 to 2 pounds per week. Weight loss faster than
this will greatly increase the likelihood of losing lean body mass (which we now know will slow
metabolism), along with the fat. This makes it easier to gain the weight back in the future . You will
undoubtedly get clients who want results more quickly than this. As a trainer, never lose sight of the
lifestyle approach. Permanent fat reduction takes time, but they will get there! Encourage your clients to
look at the long-term benefits. This rate of fat reduction equates to 52 to 104 pounds of fat lost in one
year.

Fat loss should be undertaken at a slow rate. Do this by reducing total daily calories by only
two calories per pound of lean body mass. This will result in a slower rate of fat loss but

398
should not have the adverse effects on performance that would result from a higher rate of
fat loss.

When reducing intake, calorie reduction should come from dietary fats and simple
carbohydrates, rather then complex carbohydrates, in that order. These calorie sources are
the fat-causing culprits. Cut back on high-fat foods, spreads, deserts, pastries, fruit, soda and
other sources of fat, sugar and alcohol. Follow the fat loss tips and guidelines for suggestions
on how to reduce consumption of these calorie sources. Studies continue to confirm that
when people eat a high-fat diets, compared to low-fat diets, the people on high fat-diet tend
to put on body fat and have a hard time taking it off, while the people on the low-fat diets
lose fat more easily.

• For example, if you weight 195 pounds with 20% body fat, your lean body mass is
about 156 pounds. Therefore, 156 pounds lean body mass X 4 calories = 624 calories
per day. If you are following a weight maintenance plan of 3,500 calorie per day,
subtract 624 calories, which gives you 2,876 calories per day.

A pound of fat contains 3,500 calories, and it will take about six days to lose it in the above
example. Losing fat at a faster rate will certainly result in a loss of muscle mass — definitely
not what athletes want. This moderate fat loss approach will result in about five pounds of fat
lost per month. Subtract the calories evenly from each meal. If your sport-specific nutrition
plan has a daily menu that consists of 5 meals/snacks per day, then reduce each meal/snack
by 125 calories (-625 calories/ 5 meals = -125 calories per meal) in the above example. It is
very important to keep up with your daily meal schedule.

Calorie reduction should not come from protein and only minimally from complex
carbohydrates. Protein consumption should stay at the level recommended for each
individual, and you can use the protein chart in Unit 20 to more specifically determine protein
needs during fat loss/muscle building cycles. Protein has an added bonus of stimulating the
thermogenic effect (refer back to Section 1, Unit 1 on metabolism), meaning that it takes the
body more calories to process protein than it can derive from the breakdown of protein.

There are approximately 2,500 calories in a pound of muscle. Additionally, protein contributes
less than 2% of the substrate used during sessions, which last less than one hour. Although
protein does play a minor role as a substrate during exercise, contributions can rise as high
as 15% to 18% in activities lasting longer than 90 minutes in duration. The majority of
energy is derived from the branched chain amino acids, leucine, valine and isoleucine. Several
factors, including diet, exercise intensity and exercise duration, will determine whether fat or
carbohydrate is the primary substrate preference during work.

Complex carbohydrates are very important to maintain blood sugar levels and provide a
constant source of energy. Studies also show that fat burns better when carbohydrates are
present in the diet. Also, maintain your supplement intake as recommended. If you are
having trouble controlling your appetite or feel you need to boost your metabolism, there are
several other nutrients, herbs and supplements that you can add to your daily regimen.

Table 20-3:

Weeks Required to Lose Fat Using the Zig-Zag Method of Dieting Together with a
Periodized Training Program

When you're 10% to 15% bodyfat, it will take a bit longer to lose fat because you have

399
very little fat left to lose; and only continuing to lose slowly will ensure that only fat is lost,
not muscle! Chronically obese people take longer to lose fat also. Their very low metabolic
rates and their inability to engage in strenuous (calorie-burning) exercise are the reasons.
By "stuttering" your caloric intake and engaging in muscle-building (or muscle-preserving)
exercises, metabolic rate adjustments take place and the fat-loss process continues
uninterrupted.

Tabled Numbers = Weeks to lose desired pounds of fat to bring you down to a 10% to
15% bodyfat level. *(Going below 10% is only recommended for athletes under medical
supervision.)

Lbs of fat Your Starting Bodyfat Percentage

to lose
without *5% *10% 15% 20% 25% 30% 35% 40%
loosing
muscle WEEKS TO LOSE BODY FAT

5 lbs. 20 15 10 5 5 5 6 7

10 lbs. 25 20 10 10 10 12 14

15 lbs. 30 15 15 15 18 21

20 lbs. 40 20 20 20 24 28

25 lbs. 25 25 25 30 35

30 lbs. 30 30 30 36 42

35 lbs. 35 35 35 42 49

40 lbs. 40 40 48 56

45 lbs. 45 45 54 63

50 lbs. 50 50 60 70

55 lbs. 55 66 77

60 lbs. 60 72 84

The Zig-Zag Approach In Action

To Increase Total bodyweight By Losing Fat And Gaining Muscle:

• For 4 to 5 days each week (including your training days), add two calories per pound
of lean bodyweight to your normal daily caloric intake. Spread these added calories
among five meals per day. For example, a 170-pound person who is around 12% body
fat should add approximately 300 calories per day to his or her diet. Over five meals,
that equals a 60-calorie increase per meal on the average. Then, on the remaining 2
to 3 days each week (including off-days or light training days), reduce your caloric
intake by two calories per pound of lean bodyweight. Reduce each of your five meals
per day according to rules above. For example, a 170-pound person who is around
12% body fat should subtract approximately 300 calories per day from his or her diet;
over five meals, that equals a 60-calorie decrease per meal on the average. Do not
forget to adjust your calories upward monthly to reflect the new caloric needs of your
400
 increased muscle mass.

To Decrease Total bodyweight By Losing Fat And Gaining Muscle:

• For 4 to 5 days each week (especially on off-days and light-training days), reduce your
caloric intake by two calories per pound of lean bodyweight as described above. Then,
on the remaining 2 to 3 days each week (including heavy-training days), add two
calories per pound of lean bodyweight to your normal daily caloric intake. Do not
forget to adjust your calories upward monthly to reflect the new caloric needs of your
increased muscle mass.

To Stay The Same Total bodyweight But Lose Fat And Gain Muscle:

• For 3 to 4 days each week, especially on off-days or light-training days, reduce your
caloric intake, and increase your caloric intake for the other 3 or 4 days each week
(especially on heavy training days) by two calories per pound of lean bodyweight as
described above. Do not forget to adjust your calories upward monthly to reflect the
new caloric needs of your increased muscle mass.

By following an eating schedule like this, you will store less fat while providing carbohydrates,
proteins, vitamins and minerals to your body tissues as they need them. These guidelines are
the most effective approach for increasing muscle mass and reducing body fat.

401
Unit Summary

I. Targeted fat loss together with increased lean mass is the ISSA’s recommended mode of weight loss
and the core of the Zig-Zag Approach.

A. The Zig-Zag Approach can be used in three ways:

1. 1. to increase total bodyweight by losing fat and gaining muscle.

2. to decrease total bodyweight by losing fat and gaining muscle.
3. to stay the same total bodyweight but lose fat and gain muscle.

B. Scientists at the University of Pennsylvania performed a 48-week research study, which explored the
Zig-Zag Approach.

1. Fat loss should be undertaken at a slow rate. Do this by reducing your total daily calories by
only two calories per pound of lean body mass.
2. Calorie reduction should not come from protein and should only minimally from complex
carbohydrates.
3. A pound of fat contains approximately 3,500 calories.
4. A pound of muscle contains approximately 2,500 calories.

402
 Section 5: Unit 21 Outline

Fad Diets and Nutrition

I. Diets

A. Carbohydrate-Restricted Dites
B. Protein-Restricted Diets
C. Fat-Restricted Diets
D. Calorie-Restricted Diets
E. Common Fad Diets

1. Should You Enter "The Zone?"

2. A Final Word about Fad Diets: Avoid Them!

II. Conclusion

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Distinguish between fad diets and diets with sound nutritional

macronutrient structure.

403
Diets

Many people want something for nothing. This attitude also applies to those wishing to lose body fat, gain
muscle, and improve their physical fitness or sports performance. There is no miracle means to good
nutritional practices. With thousands of foods to choose from, you can easily see how many diets can exist
using different food combinations and dieting angles. However, upon close examination, many of these
trendy diets may be deficient in important macro- and -micronutrients. Most of these diets do not provide
adequate nutrition and therefore are not meant for individuals who are on a fitness or athletic training
program. Fad weight-loss diets can be too low in protein or carbohydrates, and some of them are too high
in fat. They can also leave the dieter in a poor state of health, with a damaged metabolism. Typically, the
weight lost from fad dieting consists of water weight, fat, and muscle mass. This loss of muscle mass is
where the problem exists, because it reduces the body's ability to burn calories. When the fad dieter has
lost weight, their body has a lower capacity to burn calories. As most dieters soon return to their old
eating habits, they tend to gain more weight as body fat and can end up having a higher percentage of
body fat, even if they do not return to their previous high weight.

Carbohydrate-Restricted Diets

Fad diets almost always severely cut carbohydrate foods from their lists of recommended consumption.
Not only does this sap your energy, it can also harm athletic performance. The fact is, you need
carbohydrates for your brain, heart, and muscles, among other vital organs. The main fuel of the brain
and central nervous system is glucose, which is most easily obtained from carbohydrates. If carbohydrates
remain unavailable for several days the body attempts to conserve essential protein by producing an
alternative fuel source known as ketones, made from the partial burning of fatty acids. As the breakdown
continues, these ketones build in the blood causing an abnormal condition called ketosis. Initial weight
loss is NOT fat but water, as the kidneys attempt to rid the body of excess ketones. Ketogenic diets make
the blood more acidic, upsetting the body's chemical balance and causing potentially serious and
unpleasant side effects like headaches, bad breath, dizziness, fatigue, and nausea. In addition, fat can
only be metabolized via Krebs cycle oxidation. It is essential to recognize that a reduction in Krebs cycle
intermediates due to low- or no-carbohydrate diets will result in a diminished rate of ATP production from
fat metabolism. When carbohydrate stores are depleted in the body, the rate at which fat is metabolized is
reduced. Carbohydrates are therefore essential in the ability to metabolize fat. It is only the free fatty
acids that are metabolized via the Krebs cycle that are used in ATP production, that go toward reducing
body fat levels during exercise.

It is true that a large volume of weight will be lost as glycogen (stored carbohydrate) depletes in the
muscles and liver, but this weight is from water loss. This will not help body composition or overall health.
It is also true that the body will rely more on free fatty acids for fuel when muscle glycogen is depleted,
but the body will rely much more on amino acids (protein) supplied from the breakdown of lean tissue. So
while you may burn fat, you will also burn more muscle. In addition to this, individuals on a carbohydrate-
restricted diet have lower energy levels and experience shorter time to fatigue during exercise. This
means that workouts will likely be shorter and lower in intensity.

Protein-Restricted Diets

404
Diets that drastically cut protein are another culprit in unhealthy eating. Active athletes and fitness
enthusiast, you are simply asking for trouble. Muscle soreness, general fatigue and overall weakness
accompany low protein consumption.

Although your body appears to be unchanging, it is always in a constant state of flux. Body protein is
constantly being turned over as old cells die and new cells replace them. Science has proven that 98% of
the atoms in your body are replaced within one year. In three months, your body produces an entirely
new skeleton. Every six weeks, all the cells have been replaced in your liver. You have a new stomach
lining every five days. Every month you produce an entirely new skin as dead cells are shed and new cells
grow underneath. The proteins in your muscles are continually turned over as muscle is broken down and
new tissue is synthesized. Every cell in your body is constantly being recycled. Where do all these new
cells come from? These new cells come from the protein you consume every day.

The fate of an amino acid after it is transported to the liver is highly dependent on the body's immediate
needs. Some amino acids enter the bloodstream, where they join amino acids that have been liberated
during the constant breakdown and synthesis of our body's tissues. Each cell, directed by its own DNA
blueprint, draws from the common pool of available amino acids to synthesize all the numerous proteins
required for its functions.

In order for protein synthesis to occur, an adequate supply of both essential and non-essential amino
acids is vital. If one of the essential amino acids is missing, synthesis is halted. Any amino acids that are
not used within a short time cannot be stored for future use. Restriction in protein intake will result in
protein degradation and muscle breakdown (catabolism).

Fat-Restricted Diets

Although diets that notably cut fat intake are usually healthy, is unhealthy to drastically reduce levels of
unsaturated fat. Fat acts as a carrier for the four fat-soluble vitamins (A, D, E and K) and it helps to
cushion your kidneys, liver and nerves. Research has shown that an extremely limited intake of
unsaturated fat can result in elevated cholesterol, a condition that can lead to a heart attack or stroke.

Calorie-Restricted Diets

Since most diets have a limited number of calories per day, it is highly unlikely that full vitamin and
mineral replenishment will take place. Even well-balanced diets may not effectively replenish all the
vitamins, minerals and foodstuffs used up by athletes in training and competition.

The body's number-one priority is to obtain sufficient energy to carry on vital functions such as circulation,
respiration and digestion. Therefore, in the absence of adequate dietary carbohydrates, protein and fat
calories, the body will break down not only dietary protein but protein in the blood, liver, pancreas,
muscles, and other tissues in order to maintain vital organs and functions.

Without sufficient energy, the human body has the innate ability to break down muscle tissue for use as
an energy source during heavy exercise. This process is known as gluconeogenesis, which is the
production of glucose from non-carbohydrate sources. The part of the reaction that pertains to our
discussion is known as the glucose-alanine cycle. During this cycle, BCAAs (three of the essential amino
acids: leucine, isoleucine, and valine) are stripped from the muscle tissue and are converted to the amino
acid alanine, which is transported to the liver and converted to glucose. Branched-chained amino acids are
metabolized directly in the muscle and can be converted into energy to prevent muscle catabolism.

In addition, low-calorie programs cause side effects similar to ketogenic diets, but with decreased calories
medical consequences are more severe. Low-calorie diets should only be administered under careful
medical supervision. We do not condone any plans that contain fewer than 1,200 calories.

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Common Fad Diets

We are continually barraged with new diet books and programs marketed weekly. Anyone can be
successful at weight loss if they eat fewer calories than their bodies need. Since we as future fitness
educators cannot rely on the accuracy of claims made by advertisements, key questions should be asked
for any given nutritional program.

• Does the program integrate physical activity?

• Does the program account for personal preferences based on lifestyle and career?
• How fast does the program encourage weight loss or muscle gain?
• Does the program help change negative behaviors into positive behaviors?
• What kind of professional support is provided?
• What kind of maintenance program is provided?

We will summarize some of the top selling programs available on the market today and briefly discuss
their effectiveness and safety.

The Zone, written by Barry Sears, PhD, (Harper Collins 1995) and Mastering the Zone, released in 1997,
are low-carbohydrate, high-protein eating programs. Foods stressed are lean meat, chicken, fish, non-
starch vegetables and certain fruits. According to Sears, clients should select food combinations known as
blocks that balance fat and protein due to our body's hormonal balance. The premise of the plan is that
the majority of Americans have a genetic defect that leads to an overproduction of insulin and that
carbohydrates trigger insulin release. This defect produces bad eicosanoids, which are responsible for
virtually every disease state. Stanford endocrinologist, Gerald Reaven, whose work is cited in Sears' book,
states that there is not evidence that changes in insulin affect eicosanoids or that eating equal amounts of
protein and carbohydrates lowers insulin levels. The Zone falls into the category of a low-carbohydrate
diet plan.

Should You Enter "The Zone?"

You already know that a "40% carbohydrate, 30% protein and 30% fat structure" nutrition plan will not
work for everybody. Just like other fad diets, if you follow the plan and eat the prescribed amount of
foods, you will probably lose weight. This diet has no place in sports nutrition. Many scientists have
written scientific reports, denouncing its use.

The Atkins' New Diet Revolution is a slightly revised version of Dr. Atkins' Diet Revolution. The book,
written by Robert C. Atkins MD, claims that overweight people do not overeat but have a disturbance in
carbohydrate metabolism. Atkins claims that when carbohydrates are severely limited, the body burns its
own fat and hunger is suppressed. During a minimum of a 14-day period at the onset of the program,
carbohydrates are restricted to 20 grams per day. The nutrient breakdown is 5% carbohydrates, 35% fat
and 60% protein. Average caloric intake is between 1700 to 2300 calories. This plan falls under low-
carbohydrate plans and is not recommended for the reasons listed above.

The Fat Blocker Diet, written by Arnold Fox, MD, and Brenda Aderly, MHA, claims that one gram of
chitosan will block the absorption of 3 to 6 grams of fat. The positively charged chitosan will attract and
bind to negatively charged fat, thereby reducing blood fat, total cholesterol and bad LDL cholesterol while
increasing the good HDL cholesterol. The book does provide reliable information based on the Food Guide
Pyramid and encourages dieters to exercise. We do not recommend this plan due to the core of the
program being based on animal studies.

Fit for Life, written by Marilyn and Harvey Diamond, claims that the body cannot digest more than one
concentrated food at a time. The program claims that you cannot eat protein and carbohydrates together
because the necessary enzymes for digestion counteract one another, resulting in the food putrefying in
your system.You consequently become fat because you cannot break this food down. The program only

406
allows for 20 grams of protein per day and does not allow followers to drink water with meals. Fit for Life
falls under a low-protein diet. We do not recommend this plan due to the aforementioned reasons listed in
low-protein diets. In addition, diets of this nature can lead to eating disorders because they suppress your
metabolism and can lead to food obsessions.

The New Pritkin Diet, written by Robert Pritkin, is based on the low-fat diet developed by his father Nathan
Pritkin. The calorie intake for men ranges from 1300 to 1600 calories and, for women, 1200 to 1400. The
plan emphasizes a fat intake of 10 percent or less, five to six small meals a day and exercise. This plan
falls under low-fat and low-calorie diets and is not recommended for the reasons cited above.

The New Beverly Hills Diet, written by Judy Mazel, is a 35-day plan to lose weight through consuming low-
calorie produce and eating food in specified combinations. Followers are required to only eat protein with
protein, carbohydrates with carbohydrates and fat with either (but not combined.) Followers consume
about 1500 calories daily. This program falls under low-calorie diets, is low in nutrients and protein and
can cause bloating, diarrhea and fluid loss.

A Final Word about Fad Diets: Avoid Them!

Avoid fad dieting. You now know that fad diets are counterproductive, and may harm you. You also know
that a performance-nutrition plan must be designed to meet specific energetic and metabolic requirements
of athletic individuals. For example, a marathon runner requires much less protein then a powerlifter does.
By knowing this little bit of nutrition science, it is easy for you to understand that some of the common fad
diets have absolutely no use for athletes. Do not get caught up in the myth that surrounds the marketing
of various gimmick diets. If you need to lose weight, see your doctor, follow the guidelines in Units 19
through 21, or follow another plan your doctor may prescribe. Recent scientific studies report that the
most important factors for losing and maintaining weight include not overeating; eating a low-fat diet (less
than 25% of your daily calories) with high fiber, moderate protein and high carbohydrates (mostly from
low-glycemic index foods that are also high in fiber); eating whole foods; eating 5 or more smaller
meals/snacks per day; and regular exercise.

Under a doctor's supervision, however, some obese people may be put on a very low-calorie diets (less
than 1000 calories per day). Most obese people have a hard time losing weight because they have
developed a condition known as "insulin resistance," and they may not be able to exercise. When insulin is
not working properly, low-carbohydrate diets, are sometimes indicated until the patient begins to lose
weight, at which point they return to a low-fat, balanced diet. In some cases, doctors have to use drugs to
facilitate weight loss. This extreme dieting depletes glycogen stores and causes adverse effects on
physical and mental performance.

In addition to extreme, medically-supervised diets, a new procedure known as stomach stapling has
become an option for some clinically obese clients. Stomach stapling, known clinically as gastric (relating
to the stomach) bypass surgery, is a type of surgery in which the stomach is reduced in size by one of
several methods. The smaller stomach is then reconnected to the small intestine, bypassing the
duodenum and other segments of the small intestine, thus decreasing the patient's ability to absorb
nutrients from food.

After a gastric bypass surgery, the stomach is reduced from approximately one quart to one ounce (a
mere two tablespoons!) This limited stomach capacity can help speed weight loss by making it difficult to
eat too much food at one time and to feel satisfied after a very small meal. Because the body strives to
maintain a steady state, it adapts to this new, limited capacity. Over time, the stomach pouch will stretch
until it can hold between five and eight ounces, or approximately one cup at a time. Gastric bypass
surgery is usually performed only after many other alternatives have failed. Remember, these clinical
weight loss approaches have no applications for fitness and athletics. So avoid them, unless otherwise
advised by your healthcare practitioner.

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Summary

I. There are over 30,000 diets available today, but there is no miracle means to good nutritional practices.

A. In order for protein synthesis to occur, an adequate supply of both essential and non-essential
amino acids is vital. If one of the essential amino acids is missing, synthesis is halted. Restriction in
protein intake will therefore result in protein degradation and muscle breakdown (catabolism).

B. Although diets that notably cut fat intake are usually healthy diets, those who reduce their levels of
unsaturated fat are also at risk.

C. Low-calorie diets should only be administered under careful medical supervision. ISSA does not
condone any meal plans that contain fewer than 1,200 calories for men and women in one day.

D. Some of the top selling programs available on the market today are: The Zone Diet, Atkins Diet,
Fat Blocker Diet, Fit for Life, New Pritkin Diet and The New Beverly Hills Diet.

E. Under doctor’s supervision there is a rationale for following some drastic weight loss diets in certain
cases of obesity.

1. In addition to these extreme medically supervised diets, there is a branch of medicine

concerned with the management of obesity known as Bariatrics.

a. A new procedure known as stomach stapling has become an option for some
clinically obese clients.

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 A final word on fad diets: AVOID THEM!

Section 5: Unit 22 Outline

Supplementation

I. Supplementation

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 A. 24 Good Reasons Why You May Need Vitamin and Mineral Supplements

B. Herbs: Nature's Sport Pharmacy

C. Newer Ergogenic Aids

D. Supplement Review

1. Creatine
2. Caffine
3. Ephedrine
4. Synephrine
5. Coleus Forskohlii
6. Prohormones
7. DHEA
8. Androstendione
9. Ribose
10. Yohimbine
11. Carnitine
12. SAMe
13. Glucosamine
14. Whey Protein
15. Glutamine
16. Branch Chain Amino Acids
17. Myostatin
18. Thymus Extract
19. Soy Isaflavones
20. Antioxidants
21. Common Antioxidant Supplements

a. Green Tea
b. Bilberry
c. Ginkgo Biloba
d. Maria Thistle

E. Reliable Resources for Research

F. Reccomendations on Supplement Use for Specific Goals

G. Statutory Regulations

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Designate which supplements may be useful in a training program based on clients’ use and needs.

Supplementation

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Sports supplements are part of the Dynamic Nutrition Approach. Scientific studies show that in addition to
well-known benefits of maintaining proper health, physical and mental performance can be enhanced with
sports nutrition supplements. Protein supplements offer a convenient and economical way to get daily
high-quality protein intake. For strength athletes, several supplements can be helpful for optimum muscle
growth and repair. For maximum aerobic energy, which is of interest to long-distance athletes, special
energy drinks can be used, in addition to special metabolites, such as carnitine. Recent research also
supports the use of supplement nutrition therapy to help reduce pain and inflammation and heal injuries.
These therapeutic supplement agents include different herbs, amino acids (such as DL-glutamine),
bioflavonoids, antioxidants and a special metabolite called glucosamine that has been shown to repair
connective tissues.

The supplement market seems to have a product for a slew of intended goals: muscle growth, longevity,
disease prevention, etc. Given the influx of supplements on the market today, it is no wonder why many
may find it difficult to make a distinction between sports supplements, performance supplements,
bodybuilding supplements and/or natural supplements; terms synonymous with the word dietary
supplement. In 1994 a law entitled the Dietary Supplement Health and Education Act or DSHEA provided
the FDA’s definition of a “dietary supplement;”

Vitamins, minerals, herbs or other botanicals (except tobacco), amino acids, any dietary substance for use
by man to supplement the diet by increasing the total dietary intake and a concentration, metabolite,
constituent, extract or combination of any of the above-listed ingredients.

QUESTION: Why do some supplements have wording (a disclaimer) that says: “This statement has not
been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease”?

ANSWER: This statement or “disclaimer” is required by law (DSHEA) when a manufacturer makes a
structure/function claim on a dietary supplement label. In general, these claims describe the role of a
nutrient or dietary ingredient intended to affect the structure or function of the body. The manufacturer is
responsible for ensuring the accuracy and truthfulness of these claims; they are not approved by FDA. For
this reason, the law says that if a dietary supplement label includes such a claim, it must state in a
“disclaimer” that FDA has not evaluated this claim. The disclaimer must also state that this product is not
intended to “diagnose, treat, cure or prevent any disease,” because only a drug can legally make such a
claim.

In the United States, we can purchase anything classified as a supplement without a prescription. The
broad definition of a dietary supplement has spurred the recent influx of new products like DHEA and
androstenedione, pro-hormones that in the past would not have been classified as supplements. The
safety of supplements is always going to be dependent upon an individual’s specific state of health and
level of physical activity. It is also contingent upon following the product’s directions and not over-dosing
any of the supplements being taken. Vitamins and minerals have been sold and used for many decades
and have an excellent safety record when taken as directed. For many of the essential vitamins and
minerals you will find recommended daily values (DV) on the labels. In some instances, certain vitamins
and minerals will need to be taken in at least 100% of the daily values, and sometimes in higher amounts.

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24 Good Reasons Why You May Need Vitamin and Mineral Supplements

1. Poor digestion. Even when food intake is adequate, inefficient digestion can limit your body’s uptake
of vitamins. Some common causes of inefficient digestion are not chewing well enough and eating too
fast. Both of these result in larger than normal food particle size, too large to allow complete action of
digestive enzymes. Many people with dentures are unable to chew as efficiently as those with a full set of
original teeth.

2. Hot coffee, tea, and spices. Habitual drinking of liquids that are too hot and consuming an excess of
irritants such as coffee, tea, pickles and spices can cause inflammation of the digestive linings, resulting in
a drop in secretion of digestive fluids and poorer extraction of vitamins and minerals from food.

3. Alcohol. Drinking too much alcohol can damage the liver and pancreas, which are vital to digestion and
metabolism. It can also damage the lining of the intestinal tract and adversely affect the absorption of
nutrients, leading to sub-clinical malnutrition. Regular use of alcohol increases the body’s need for B-
group vitamins, particularly thiamine, niacin, pyridoxine, folic acid, vitamins B12, A and C as well as the
minerals zinc, magnesium and calcium. Alcohol affects availability, absorption and metabolism of
nutrients.

4. Smoking. Smoking is also an irritant to the digestive tract and increases the metabolic requirements of
Vitamin C, all else being equal, by at least 30 mg per cigarette over and above the requirements of a
nonsmoker. Vitamin C, which is normally present in such foods as cabbage, onions, oranges and
grapefruit, oxidizes rapidly once these fruits are cut, juiced, cooked or stored in direct light or near heat.
Vitamin C is important to the immune function.

5. Laxatives. Overuse of laxatives can result in poor absorption of vitamins and minerals from food, by
hastening the intestinal transit time. Paraffin and other mineral oils increase losses of fat-soluble vitamins
A, E and K. Other laxatives used to excessively can cause large losses of minerals such as potassium,
sodium and magnesium.

6. Fad diets. Discarding whole groups of foods can cause a serious lack in vitamin intake. Popular low-fat
diets, if taken to an extreme, can be deficient in vitamins A, D and E. Vegetarian diets, which exclude
meat and other animal sources, must be very skillfully planned to avoid Vitamin B12 deficiency, which
may lead to anemia.

7. Overcooking. Lengthy cooking or reheating meat and vegetables oxidizes and destroys heat-
susceptible vitamins such as the B-group, C and E. Boiling vegetables removes water-soluble vitamins,
such as B-group, C and many minerals. Light steaming is preferable. Some vitamins, such as vitamin B6,
can be destroyed by microwave irradiation.

8. Food processing. Freezing food containing Vitamin E can significantly reduce its levels once defrosted.
Foods containing Vitamin E exposed to heat and air can turn rancid. Many common sources of Vitamin E,
such as bread and oils are highly processed, so that the Vitamin E content is significantly reduced or
missing, which increases storage life but can lower nutrient levels. Vitamin E is an antioxidant, which
defensively inhibits oxidative damage to all tissues. Other vitamin losses from food processing include
vitamins B1 and C.

9. Convenience. A diet dependent on highly refined carbohydrates, such as sugar, white flour and white
rice, place greater demand on additional sources of B-group vitamins to process these carbohydrates. An
unbalanced diet contributes to such conditions as irritability, lethargy and sleep disorders.

412
10. Antibiotics. Some antibiotics, although valuable in fighting infection, also fight off friendly bacteria in
the gut, which normally allows B-group vitamins to be absorbed through the intestinal walls. Such
deficiencies can result in a variety of nervous conditions, and therefore it may be advisable to supplement
with B-group vitamins when on a lengthy course of antibiotics.

11. Food allergies. The omission of whole food groups from the diet, as in the case of individuals allergic
to gluten or lactose, can mean the loss of significant dietary sources of nutrients such as thiamine,
riboflavin or calcium.

12. Crop nutrient losses. Some agricultural soils are deficient in trace elements. Decades
of intensive agriculture can overwork and deplete soils, unless all the soil nutrients,
including trace elements, are regularly replaced. Food crops can be depleted of nutrients
due to poor soil management.

13. Accidents and illness. Burns lead to a loss of protein and essential trace nutrients.
Surgery increases the need for zinc, Vitamin E and other nutrients involved in the cellular
repair mechanism. The repair of broken bones will be retarded by an inadequate supply of
calcium and Vitamin C and conversely enhanced by a full dietary supply. The challenge of
infection places high demand on the nutritional resources of zinc, magnesium and vitamins
B5, and B6.

14. Stress. Chemical, physical and emotional stress can increase the body’s requirements
for vitamins B2, B5, B6 and C. Air pollution increases the requirements for Vitamin E.

15. P.M.S.. Research has demonstrated that up to 60% of women suffering from symptoms
of premenstrual tension, such as headaches, irritability, bloating breast tenderness, lethargy
and depression can benefit from supplementation with Vitamin B6.

16. the Teen years. Rapid growth spurts that occur in the teenage years, particularly in
girls, place high demands on nutritional resources to underwrite the accelerated physical,
biochemical and emotional development in this age group.

17. Pregnancy. Pregnancy creates higher than average demands for nutrients to ensure
healthy growth of the baby and comfortable confinement for the mother. The nutrients that
should be increased during pregnancy are the B-group, especially B1, B2, B3, B6, folic acid
and B12, A, D, E, and the minerals calcium, iron, magnesium, zinc and phosphorous.
Professional assessment of nutrient requirements during pregnancy is recommended.

18. Oral contraceptives. Oral contraceptives can decrease absorption of folic acid and
increase the need for Vitamin B6 and possibly Vitamin C, zinc and riboflavin.

19. Light eating. Some people eat very sparingly, even without weight reduction goals.
U.S. Dietary surveys have shown that an average woman maintains her weight on 800
calories per day, at which level her diet is likely to be low in thiamine, calcium and iron.

20. Aging. The aged generally have a low intake of vitamins and minerals, particularly iron,
calcium and zinc. Folic acid deficiency is often found, in conjunction with Vitamin C
deficiency. Fiber intake is often low as well. Riboflavin (B2) and pyridoxine (B6) deficiencies
have also been observed. Possible causes include impaired sense of taste and smell,
reduced secretion of digestive enzymes, chronic disease and possibly physical impairment.

21. Lack of sunlight. Invalids, shift workers and people with minimal exposure to sunlight
can suffer from insufficient amounts of Vitamin D, which is required for calcium metabolism

413
and without which rickets and osteoporosis (bone thinning) have been observed. Ultraviolet
light is the stimulus to Vitamin D formation via the skin. Often the sun is blocked by cloud,
fog, smog, smoke, ordinary window glass, curtains and clothing. The maximum
recommended daily supplemental intake of Vitamin D is 400 i.u.

22. Bio-individuality. Wide fluctuations in individual nutrient requirements from the

official recommended average vitamin and mineral intakes are common, particularly for
those in high physical demand vocations, such as athletics and manual labor, taking into
account bodyweight and physical type. Protein intake influences the need for Vitamin B6
and Vitamin B1 and is linked to caloric intake.

23. Low body reserves. Although the body is able to store reserves of certain vitamins
such as A and E, Canadian autopsy data has shown that up to 30% of the population has
reserves of Vitamin A so low as to be judged “at risk.” Vitamin A is important to healthy skin
and mucous membranes (including the sinus and lungs) and eyesight.

24. Athletics. Athletes consume much food and experience considerable stress. These
factors affect their needs for B-group vitamins, Vitamin C, and iron in particular. Australian
Olympic athletes and A-grade football players, for example, have shown wide-ranging
vitamin deficiencies.

HERBS:
Nature’s Sport Pharmacy

In addition to vitamins and minerals, the term “herb” falls under the DSHEA of 1994. An often used
definition of herbs is any part of a plant, which can be used as a medical treatment, nutrient, food
seasoning or dye. However, this definition is too shortsighted to be relevant to the needs of an otherwise
healthy athlete, whose major objective in life is to excel in his or her respective sport. Herbs are used to
enhance performance in many ways:

• Herbs can cleanse your body. Many herbs contain powerful antioxidants, whose ability to slow the
aging process as well as aid in recovery have been well documented.
• Herbs can have a normalizing effect, allowing the body to both recuperate from and adapt to the
intense stresses of workouts and competition.
• Herbs can have great nutritional value. Many herbs are high in vitamins and minerals, which an
athlete needs at higher levels, due to an extremely active lifestyle or dietary limitations.
• Herbs can raise energy levels.
• Herbs can stimulate the immune system.
• Herbs can also stimulate other systems, such as the endocrine system, which plays a part in all
bodily functions, including muscle tissue repair an growth.
• Herbs can add seasoning to bland, low-fat food.

While the list of herbs is far too extensive to include in this glossary of training and nutrition terms (only a
few of the more popular herbs are mentioned), we will cover a few of the categories that may be of
interest to you and your clients.

Diuretics

• By increasing the production and removal of urine,

Diuretics: Substances
diuretics also eliminate toxins and waste from the body.
that tend to increase
Ancient herbal tradition has it that diuretics include any
the output of urine,
herb that is beneficial to the urinary system. Many herbs,
thus decreasing the
including parsley root, uva ursi, corn silk, alfalfa, juniper
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 berries, artichokes, asparagus, astragalus, buchu, burdock,
amount of water in the
celery, chaparral, dandelion, kava kava and sarsaparilla
body.
are known to have diuretic properties. Diuretics should not
be used long-term and definitely not during intense
exercise, as they can rob the body of several minerals, as
well as bodily fluids (especially from the blood), both of
which are vital during exercise.

Laxatives

• Laxatives are a multimillion-dollar business for the

pharmaceutical industry. Many herbs also serve as
laxatives and are much gentler on the body than
commercial brands. They are also a lot less expensive. By
stimulating bowel movement, wastes and toxins are Laxatives: Substances
removed from the body. With them, however, bodily fluids that stimulate the
and vital minerals are also lost. So, as with diuretics, evacuation of the
caution should be taken when using laxative herbs. Do not bowels.
prolong your use of laxatives. Some natural laxatives
include cascara sagrada, dandelion root, psyllium seeds,
aloe vera, boneset and damiana.

Newer Ergogenic Aids

When it comes to the newer, more novel products that fall under the banner of ergogenic aids, some of
these supplements do not have a long history of use or are not well researched. Keep in mind that most of
the research studies on supplements are only performed over short periods of time — a few weeks or a
few months. This means that the long-term effects of using some supplements have not been determined.
As a general rule, it is always important to follow the usage directions provided on the bottles of dietary
supplements. Although, these newer metabolite supplements found on the market contain nutrients that
are either found naturally in some foods or are made and used by the body, more research is needed.
There are many excellent supplements that have solid research support. Educate yourself on those, and
determine which fit your needs. Remember, use only those supplements that are supportive of your health
and fitness goals, are known to be effective and are free from side effects. It is wise to be under the
supervision of your doctor, team physician or other health professional to ensure that your sports nutrition
and supplement program will work for you, not against you.

While supplementation is an integral part of the ISSA Dynamic Nutrition Approach, let us not forget the
fourth common myth source: supplement manufactures. The supplement industry is continually growing.
The industry thrives on individual hopes and dreams for life-altering changes. Desperation to fill the mold
of the perfect body places many in a vulnerable position. This vulnerability manifests itself as trust and
purchasing power for the varying manufacturers and marketers. Unfortunately these “easy” results rarely
seem to be delivered. Nonetheless, each year Americans spend billions on the health and fitness industry
in search of these easy results. Ploys and gimmicks will most likely continue, as consumers , we must arm
ourselves with knowledge. As future ISSA fitness educators, we must educate our clients, family members
and friends, as knowledge is the best protection against fraudulent claims. Four easy rules to remember
are:
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Caveat Emptor or Let the Buyer Beware

1. You do not need all of them all the time.

2. You do not have enough room in your belly for all of them all the time.
3. You cannot afford to buy all of them all the time.
4. Most are not capable of delivering all the benefits they claim to be able to anyway; an integrated,
scientific approach is the only way to ensure optimal use of nutritional supplements.

Do not take the advertising hype you see in all of the bodybuilding magazines as gospel. There are a few
excellent books and a lot of great scientific journal articles written on the subject of nutritional
supplements. Be sure the books you choose are not those written by an author hired by a supplement
company so dubious claims can be made to sound safe. Of course, a small handful of the larger
supplement companies are hiding behind our constitutional right of free speech. Remember, making
medical claims in advertisements for food supplements is against the law. In addition, supplements should
not be prescribed or sold to children under 21 years of age or women who are pregnant or are trying to
become pregnant. As a means to protect yourself against fraudulent claims, we recommend that you visit
www.FDA.gov.

Table 22-1

Calories
Name Protein Vitamins/Minerals
Flavor (serving Fat Carbs
Manufacturer (type) (% daily value)
amt)

Protein Powders

Advanced
125 (32g 24g,
Whey Chocolate 2g 3g 2% Iron
scoop) (whey)
Prolab

Atkins Shake 30% Vitamin A

170
Atkins Chocolate 20g, 30% Vitamin C
(11oz 9g 5g
Nutritionals, Delight (whey) 30% Vitamin D
can)
Inc. 30% Vitamin E

Carbolite 96 (28g 24g, (

Vanilla 0g 0g N/A
Morico Foods scoop) soy)

20g,
Carbsolutions 120 150% Vitamin E
(soy
Richardson Vanilla (32g, 2 3g 2g 100% Vitamin C
and
Labs scoops) 90% Vitamin A
whey)

Complete
Double 100% Vitamin C
Protein 200 (50g 35,
Rich 5g 3g 60% Vitamin E
Optimum packet) (whey)
Chocolate 40% Vitamin D
Nutrition

Cross Flow Dutch

130 (32g 24g,
Whey Protein Dark 2g 4g N/A
scoop) (whey)
Formula One Chocolate

Designer 90 (24g 17.5g, 88% Vitamin B6

Vanilla 1.5g 2g
Protein Next scoop) (whey) 75% Vitamin B1

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Proteins 75% Vitamin B12
International

Vanilla
Eggalbumen 110 (31g 22g,
Orange 0g 4g N/A
Formula One scoop) (egg)
Cream

Keto Soy 202 100% Vitamin E

24g, (
Shake Life Chocolate (42g, 2 10g 4g 100% Vitamin C
soy)
Services scoops) 100% Folic Acid

Natural Brand 108 (30g 11g,

Chocolate 0g 16g 8% Phosphorous
GNC scoop) (soy)

525% Vitamin B6
Nitrotech 110 (28g 20g,
Strawberry 1.5g 3g 100% Vitamin E
Muscletech scoop) (whey)
100% Folic Acid

50g,
230 (whey,
Prom3 ISS
Vanilla (62g, 3 egg and 2g 3g N/A
Research
scoops) casein
blend)

Pro Whey
136 (31g 24g,
Protein Vanilla 1.5g 2.5g 2% Iron
scoop) (whey)
ProPower, Inc.

Table 22-1

Calories
Name Protein Vitamins/Minerals
Flavor (serving Fat Carbs
Manufacturer (type) (% daily value)
amt)

Meal Replacements

100% Vitamin E
300
Fuel Plex Strawberry 45g, 60% Riboflavin
(84g, 1.5g 25g
Twinlab Smoothie (whey) 50% Vitamin C
packet)
50% Vitamin D

100% Vitamin E
Fuel Plex French 300 (83g 45g,
1.5g 25g 60% Riboflavin
Twinlab Vanilla packet) (whey)
50% Vitamin C

Genisoy 120 (39g 14g,

Chocolate 0g 16g 15% Iron
Genisoy scoop) (soy)

50% Vitamin B12

Meso-Tech Vanilla 340 (89g 52g,
3.5g 24g 50% Vitamin C
Muscletech Cream packet) (whey)
50% Vitamin E

Chocolate 38g, 150% Vitamin E

Met-Rx 240 (72g
Peanut (whey, 3g 17g 100% Vitamin C
Met-Rx packet)
Butter egg and 100% Folate

417
 casein 60% Vitamin D
blend)

100% Vitamin E
Myoplex Chocolate 280 (76g 42g,
3g 21g 50% Vitamin C
EAS Mint packet) (whey)
50% Vitamin D

50% Vitamin C
140
Total Soy Bavarian 17g, 50% Vitamin D
(36g, 2 2g 14g
Naturade Chocolate (soy) 50% Vitamin E
scoops)
50% Folate

100% Vitamin C
Ultra Slim- Soy 170 100% Vitamin E
15g,
Fast Slim- Chocolate (48g, 2 2g 25g 35% Iron
(soy)
Fast Delite scoops) 35% Vitamin D
25% Vitamin A

Ultramet 100% Vitamin E

280 (76g 42g,
Champion Strawberry 12g 24g 50% Vitamin C
packet) (whey)
Nutrition 50% Vitamin D

Energy Shakes

Boost 100% Vitamin C

240 (8oz 15g,
Mead Johnson Chocolate 6g 33g 100% Vitamin E
can) (milk)
Nutritionals 40% Vitamin D

Ensure 9g, (soy 50% Vitamin C

250 (8oz
Abbot Vanilla and 6g 40g 25% Vitamin D
can)
Laboratories whey) 25% Vitamin E

Metabolife 220 100% Vitamin C

Vanilla 12g,
Metabolife (11oz 3g 41g 100% Vitamin E
Voyage (milk)
International can) 85% Chromium

Table 22-1

Name
Flavor Calories Protein (type) Fat Carbs
Manufacturer

Energy Bars

Advantage Bar
,20g, (soy, whey,
Atkins Nutritionals Almond Brownie 230 10g 2.6g
and casein blend)
Inc

BuzBar 18g, (soy, whey

Chocolate Crunch 200 6g 18g
SmartFuel and casein blend)

Clif Energy Bar Carrot Cake 240 9g, (soy) 4g 42g

418
Clif Bar

Clif Energy Bar

Apricot 220 8g, (soy) 2.5g 43g
Clif Bar

Meso-Tech Chunky Chocolate 25g,(whey, soy,

340 8g 38g
Muscletech Chip and casein blend)

PowerBar
Banana 222 10g, (milk) 2g 42g
PowerBar

Promax Bar 20g, (whey and

Rocky Road 290 4g 44g
SportPharma casein blend)

Promax Bar Chocolate 20g, (whey and

290 5g 40g
SportPharma Caramel Crunch casein blend)

Results Energy Bar 11g, (soy, whey,

Berry 200 6g 28g
EAS and casein blend)

WarpBar Oatmeal
180 8g, (soy and whey) 3.5g 31g
SmartFuel Raspberry

Protein Bars

Designer Whey
Next Proteins Perfect ABSberry 270 31g, (whey) 6g 23g
International

Designer Whey
Double
Next Proteins 270 30g, (whey) 7g 23g
ChocoLATS
International

HI Protein Bar Chocolate 33g, (whey and

296 6g 7g
Universal Nutrition Brownie soy)

Lean Body Bar Strawberry 30g, (Casein, whey

300 9g 3g
Labrada Nutrition Cheesecake and soy blend)

Lean Protein Bar Chocolate Banana 31g, (Casein, whey

290 9g 26g
SportPharma Nut and soy blend)

Nitro-Tech Crunchy
290 35g, (whey) 6g 9g
Muscletech Chocolate Crisp

Nitro-Tech Peanut Butter

290 35g, (whey) 8g 6g
Muscletech Chocolate Chip

PowerBar Protein
16.5g, (whey and
Plus Chocolate 183 3.8g 17g
milk)
PowerBar

Premier Eight Bar Chocolate 30g, (soy, casein,

250 6g 23g
Premier Nutrition Strawberry and whey blend)

419
 Mousse

Premier Protein Double Chocolate 30g, (soy, casein,

280 8g 14g
Premier Nutrition Crunch and whey blend)

Protein Plus Bar 34g, (casein, whey

Malted Milk Ball 310 8g 25g
Met-Rx and soy blend)

Solid Protein
Chocolate 250 32g, (whey) 6g 18g
Nature’s Best, Inc.

SoyOne
Caramel Crunch 241 18g, (soy) 6.8g 27g
Interactive Nutrition

Ultraprotein Bar Chocolate Fudge 32g,(casein whey

300 4.5g 7g
Champion Nutrition Brownie and soy blend)

Table 22-1

Name Manufacturer Flavor Calories Protein (type) Fat Carbs

Other Bars

14g, (soy,
Balance + Yogurt Berry +
200 casein, and 6g 22g
Balance Bar antioxidants
whey blend)

14g, (soy,
Balance Bar
Almond Brownie 200 casein, and 6g 23g
Balance Bar
whey blend)

15g, (casein,
Balance Gold
Carmel Nut Blast 210 whey, milkand 7g 23g
Balance Bar
soy blend)

15g, (soy,
Balance Gold Crunch
S’mores 210 casein, whey, 7g 23g
Balance Bar
and milk blend)

Balance Outdoor 15g, (soy and

Chocolate Crisp 200 6g 21g
Balance Bar whey)

Endulge Bar
Chocolate Crunch 150 3g, (soy), 12g 2g
Atkins

Ensure Nutrition and Chewy Chocolate 9g, (soy and

230 6g 35g
Energy Bar Abbot Peanut Milk)

420
Laboratories

15g, (soy,
FixBar Apple Crisp 200 casein, and 6g 22g
SmartFuel whey blend)

Luna Bars Chocolate Pecan

180 10g, (soy) 4.5g 24g
Clif Bar Pie

Mojo Bars Honey BBQ

200 9g, (soy) 9g 25g
Clif Bar Almond

Myoplex Delux Nutrition 24g, (casein,

Bar Chocolate Fudge 340 whey and milk 7g 44g
EAS blend)

Myoplex Lite Nutrition 24g, (soy,

Bar Toffee Crunch 190 casein, whey, 3.5g 28g
EAS and milk blend)

24g, (soy,
Myoplex Low Carb
Strawberry 250 casein, whey, 7g 20g
Nutrition Bar EAS
and milk blend)

Oasis Bar Chocolate Peanut

190 9g, (soy) 5g 25g
Balance Bar Crisp

Pria Double Chocolate

110 5g, (soy) 3g 16g
PowerBar Cookie

12g, (casein,
Snac Bar
Chocolate 180 whey and milk 3g 24g
Champion Nutrition
blend)

Nutri-Grain Cereal Bar

Apple Cinnamon 140 1.5g (soy, milk) 2.8g 27g
Kellogg’s

Chocolate,
Snickers
Caramel and 280 4g (milk, egg) 14g 30g
Mars
Peanut

Supplement Review

More and more people are using sports supplements to improve athletic performance, body build and to
increase the overall quality of life. As the research accumulates, the boundaries, which divide the
beneficial from the useless, will become evident. While the list of supplements available today is
overwhelming, we will cover a few of the top supplements currently on the market. For more details on
sports nutrition and supplementation, we highly recommend the Specialist in Performance Nutrition
Course written by the ISSA Director of Nutrition Sciences, Daniel Gastelu, M.S., MFS.

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This upcoming section is for information purposes only and is not intended to replace the advice or
practice of your doctor or other health professional. Always consult your doctor before and while on a
supplement program and before using drug treatment for any reason.

The following is a special section by ISSA Director of Nutrition Sciences Daniel Gastelu, M.S., MFS

Creatine

What is New in Creatine Research?

For about a decade now, use of creatine supplements has continued to increase on the athletic scene.
Dozens of studies have confirmed that for some athletes under certain conditions, taking creatine
supplements can improve strength performance. Some studies even report an increase in lean body mass.
So while the research studies confirm that creatine supplements can enhance short-duration, high-
intensity athletic activities, the optimum dosage is yet to be determined.

To add a piece to the creatine dosage puzzle, a research team examined the effects of taking an average
of 7.7 grams per day (0.1 gram per kilogram of lean body mass) of creatine supplement for 21 days on
resistance training on force output, power output, duration of mean peak power output and total work
performed until fatigue. Forty-one male athletes took part in the study about half took creatine and the
other half took an inactive placebo preparation. Various performance measurements were taken while the
subjects performed the bench press until exhaustion. At the end of the 21-day study, the results revealed
that the individuals who were taking the creatine supplements were able to perform more work until
fatigue set in than the control group. They also experienced improvements in force and power output,
which they were able to sustain for longer periods of time.

But there is more news about creatine, which is especially interesting for females. To figure out if there is
a creatine gender gap, 12 males and 12 females were given either supplements containing creatine
monohydrate five grams four times per day (a total of 20 grams per day) or a creatine-free drink, for four
days. The results indicated that there are no gender-specific responses to creatine administration, and
men and women both experienced the expected benefits from taking creatine supplements. These benefits
included increasing high-intensity exercise performance ability.

And there is still more news about the benefits of taking creatine supplements for females interested in
boosting upper-body anaerobic strength. In this study three strength-trained females involved in overhand
sports were given either an inactive placebo or 25 grams of creatine monohydrate supplements per day
for seven days. Improvement in upper-extremity ability to perform strenuous exercise was a result of
taking the creatine supplements. These and other research studies all indicate that for short-term, high-
intensity athletic events and weight lifting, creatine supplementation is proven to increase performance.
This makes creatine a sort of nitro fuel for the strength athlete. For additional information on creatine,
please check out our CEU on creatine and exercise available in our CEU library at
www.fitnesseducation.com.

Caffeine

Caffeine is a drug that is frequently used all over the world, usually for its stimulant effects. Caffeine
increases alertness, lowers the perceived exertion of exercise and decreases reaction time. Caffeine has
another effect on the body that few people know about. It also acts as a fat-burner!

Caffeine works by increasing the rate of fatty acid metabolism and decreasing the rate of carbohydrate
(glucose) metabolism during aerobic exercise. Every study done on the effects of caffeine during aerobic
exercise that has measured muscle glycogen levels, has found that glycogen is spared after ingestion of
only 150 to 250 mg of caffeine. An increased reliance on fat and decreased reliance on glucose and
glycogen translates into increased aerobic exercise endurance and increased time to exhaustion. In
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addition to this, for a given amount of calories used during exercise, more calories will come from body fat
if caffeine is consumed prior to exercise.

Caffeine does have side effects as well. At high doses (more than 15 mg/kg bodyweight), caffeine can
produce slowed heart rate, hypertension, nervousness, irritability, insomnia and gastrointestinal distress.
In addition to this, it is a diuretic that blocks the release of antidiuretic hormone. This causes the kidneys
to excrete more fluid than normal, which can dehydrate the body.

Caffeine is one of the least marketed but most effective fat-burners available. It will not help you lose
weight on its own, but when taken before aerobic exercise, can increase fat-burning and help you exercise
longer by delaying the onset of fatigue. Caffeine will not have any beneficial effect on anaerobic exercise.
If you use caffeine, use it sparingly and in small doses.

New research reveals that caffeine can boost performance in short-term athletic events as well. Using a
rowing ergometer exercise machine, it was determined that one hour after athletes took 6 or 9 milligrams
of caffeine per kilogram of body mass, exercise performance time significantly improved. This occurred in
particular during the first 500-meter segment of the simulated rowing test. Keep in mind that when using
caffeine to boost performance, it may be banned by some athletic organizations at certain blood levels,
and caffeine also can have a dehydrating effect. Also, because caffeine can deplete calcium from your
body, studies show that prolonged high intake should be avoided, and that extra calcium intake is needed
to avoid the risk of calcium depletion.

Ephedrine

The drug ephedrine, which is the main constituent of the herb ma huang, is a major ingredient in many
weight loss nutritional supplements on the market today. Ephedrine speeds up the metabolism by
stimulating the release of adrenaline in the body. Adrenaline stimulates the release of glucose from the
liver and free fatty acids from the body’s fat stores, increasing the availability and use of both glucose and
fat for ATP production. Unfortunately, adrenaline can also have very negative effects on the body.

Several studies have shown that ephedrine, when combined with caffeine, can aid in overall weight loss in
obese people due to its adrenal effects. These conclusions are somewhat limited because all subjects used
were obese, and measurements of body composition were not used at any time. Only overall bodyweight
and body mass index (BMI) were used as measures. What does this conclusion mean for those who are
not currently considered obese? The answer is not known. It is likely that an ephedrine/caffeine
combination (all research has shown that ephedrine must be taken with caffeine to have any weight loss
effect) will result in overall weight loss, but more research is needed to determine if lean body mass is
spared with its use.

More research is not needed to verify that ephedrine use has horrible, often deadly, side effects. The FDA
has received over 1,400 reports of adverse side effects associated with ephedrine use. Medical problems
have ranged from high blood pressure, irregular heart rate, insomnia, nervousness, tremors and
headaches, to seizures, heart attacks, strokes and death.

December 30, 2003, the FDA issued a consumer alert on the safety of dietary supplements containing
ephedra. The alert advised consumers to immediately stop buying and using ephedra products. Also on
December 30, the FDA notified manufacturers that it intends to publish a final rule stating that dietary
supplements containing ephedrine alkaloids present an unreasonable risk of illness or injury. The rule
would have the effect of banning the sale of these products as soon as it becomes effective, 60 days after
publication. The FDA highly recommends that products containing ephedrine be avoided because of
possible side effects and questionable results.

Synephrine

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Synephrine is the main “active” compound found in the fruit of a plant called Citrus aurantium. The fruit is
also known as zhi shi (in traditional Chinese medicine), and as green orange, sour orange and bitter
orange in other parts of the world. Synephrine is chemically very similar to the ephedrine and pseudo-
ephedrine found in many OTC cold/allergy medications and in a number of weight loss and energy
supplements, which contain ma huang. Its purported ergogenic benefits are to increase the metabolic
rate, increase caloric expenditure, promote weight loss and increase energy levels. A recent study
conducted in dogs suggests that synephrine and octopamine can increase the metabolic rate in a specific
type of fat tissue known as brown adipose tissue (BAT). This effect would be expected to increase fat loss
in humans, with the exception of one small detail: Adult humans do not have brown adipose tissue.

Coleus Forskohlii

Coleus forskohlii has been added to thermogenic formulas as a thermogenic enhancer. It can raise the
levels of the enzyme adenylate cyclase, which increases the conversion rate of ATP to cAMP. Cyclic
adeniosinemonophosphate (cAMP) is a key regulator of the metabolic rate. cAMP has been clinically
proven to increase the force at which your heart contracts, and it lowers arterial blood pressure. This can
help counteract the raising of blood pressure from caffeine and ephedrine.

Prohormones

One category of dietary supplements that continues to experience controversy is the so-called
prohormones or testosterone precursors. For purported muscle-building enhancement these products
typically contain DHEA (dehydroepiandrosterone) and andro (androstenedione). Controversy aside, both
andro and DHEA are actually hormones made by the body. They are also the precursors of testosterone
and estrogens.

In general there are two groups of males who are interested in increasing their testosterone levels: 1)
young athletic adults, and 2) older adults. This interest in increasing testosterone levels is based on the
fact that testosterone is the primary male hormone responsible for building and maintaining big muscles
and masculinizing effects. Young males who seek these testosterone boosters are driven by the “more is
better” mindset, while older males seek to restore normal youthful testosterone levels. Among females,
testosterone is found in much lower levels but also exerts anabolic and masculinizing effects if the levels
are artificially increased. A review of the medical research will be helpful in leading to an objective
viewpoint on the usefulness of these prohormone testosterone-boosting supplements for sports nutrition
applications, sorting gym hype from scientific evidence.

DHEA

DHEA is a steroid hormone produced mainly by the adrenal glands. In men, it is also produced in the
testes as an intermediate in testosterone production, and in women, it is also produced in the ovaries as
an intermediate in estrogen production. DHEA is a weak androgen (a steroid hormone that promotes
masculine characteristics) and it has been reported to induce growth of body hair in men and women. In a
pilot study using men between the ages of 20 and 25, supplemental DHEA did not increase testosterone
levels but did appear to help decrease body fat and increase lean body mass. However, when this study
was duplicated, no significant changes in body composition were observed. Conversely, in another study,
an increase in androgen levels was reported in postmenopausal women given supplemental DHEA, as was
an increase in body hair growth during the study period. Another study this using both men and women
did not report any significant changes in lean body mass or body fat but did report an overall
improvement in the feeling of well being. This last study also reported a possible anabolic effect: an
increase in the IGF-I level. IGF-I is an important growth promoter in muscles, especially in individuals
undergoing intensive training.

Major studies with athletes taking DHEA supplements have not yet been reported. However, a small study
done with young men who lift weights (average age 23 years old), taking 50 mg of DHEA per day, did not

424
report any improvements in strength and lean body mass when compared to the placebo group. Going by
the results of the studies just mentioned and other studies, medically unsupervised DHEA use by young
male athletes will probably not increase testosterone levels significantly enough to stimulate benefits
greater then those experienced by natural testosterone production. However, careful use by female
athletes and male athletes over age 40 may provide some beneficial physical and physiological effects.
Other reported benefits of DHEA include immune-system enhancement, antidepressant action,
enhancement of mental functioning and longevity in laboratory animals. The amounts used in studies have
varied, but benefits have been reported in the 25 to 100 mg per day range, with 50 milligrams per day
being reported safe for short-term use of several months. A word of caution: Do not take supplemental
DHEA if you are a man who may have prostate cancer or a woman who may have breast cancer, a
reproductive cancer or a reproductive disorder, and use only under doctor’s supervision.

Androstendione

The use of testosterone precursors supplements, such as androstenedione, is spreading like wildfire
through gyms. But the benefits are still unproven for strength athletes. This is especially true for young
individuals, whose hormone levels are already naturally soaring. The idea behind taking androstenedione
is that because the body uses it to make testosterone, some extra from supplements may increase
testosterone even more.

While millions of andro tablets are consumed per day by iron-pumping athletes, new research adds to the
disappointing news of previous studies. A new study looked at the effects that an androstenedione
complex formula had on weight-lifting males. The complex formula contained a daily dosage of 300 mg of
androstenedione, plus 150 mg of DHEA, 750 mg of tribulus terrestris, 625 mg of chrysin, 300 mg of
indole-3-carbinol and 540 mg of saw palmetto. Blood levels of androstenedione concentrations did
increase in the supplement group when compared to the placebo group.

During the 8-week study period, muscle strength was increased in both the groups, but the differences
were not significant. The researchers also observed that the use of the androstenedione complex formula
did not result in increased serum testosterone concentrations. The increased production of estrogen
caused by the androstenedione supplement was not reduced by the addition of chrysin. All told, the andro
supplement did not cause additional benefits to resistance-training young adults.

Androstenedione has an equally dubious origin as it applies to sports nutrition. You will commonly
encounter reference to a study conducted by V.B. Mahesh and R.B. Greenblatt used by andro supplement
companies to substantiate that andro supplements are effective at boosting testosterone levels and
promoting larger muscles and strength. You may be surprised to learn that the 1962 Mahesh study used
only four nonathletic women. Furthermore the results of the study were based on one dose of either 100
mg of DHEA taken by two of the women or 100 mg of androstenedione taken by the other two women,
lasting only several hours. Based on blood samples taken shortly after ingesting the DHEA and andro
supplements, both DHEA and andro caused a temporary rise in the women’s serum testosterone levels
with andro causing about double the rise in testosterone. Amazingly, during the 1990s, tales of this one-
day research study on two women taking Andro prompted androstenedione being marketed as a muscle-
building supplement for male athletes, while no real proof existed that men would actually benefit from
taking andro. You will commonly encounter this scientific reference in promotional literature as
substantiation for taking andro supplements. (Mahesh, V.B. and R. B. Greenblatt. The in vivo conversion
of dehydroepiandrosterone and androstenedione to testosterone in the human, Acta Endocrinology, Vol.
41 (1962), pp. 400–406.) You now know that the study substantiates nothing as far as sports nutrition is
concerned. Some Andro studies later conducted using males did not show a significant rise in testosterone
levels or significant improvements in muscle size or strength.

One group of researchers, lead by Gregory Brown, recently reported in the Journal of Applied Physiology
that the effectiveness of orally ingested androstenediol in raising serum testosterone concentrations might
be limited because of liver breakdown. Brown and colleagues conducted a study where men experienced
in strength training ingested either a 20 mg androstenediol in a sublingual tablet or a placebo. The
425
sublingual androstenediol tablets did cause a significant increase in these young men (average age 22.9
years old) in serum androstenedione, free testosterone, total testosterone and estradiol concentrations.
The practical benefits of the results of this study need to be determined in future studies.

As far as safety is concerned, the FDA currently permits the sale of andro and DHEA supplements. On the
practical side, as these supplements act as hormones in the body, it is reasonable to use only under
medical supervision just in case an adverse hormonal imbalance or other adverse event occurs. The
medical community notes that until more studies are performed using these supplements, safety should
not be assumed, and side effects (too numerous to list here) common to anabolic-androgenic steroids and
estrogens are expected when using these testosterone precursor prohormones. Competitive athletes
should note that both DHEA and andro are banned by most sporting organizations. Concerning the issue
of potency, the best way to confirm this is by requesting an independent laboratory analysis from the
manufacturer.

I always advocate having people spend their money on healthy foods and sports supplements that
naturally boost testosterone levels and function before turning to prohormones, as well as follow a healthy
lifestyle. In fact, the most recent research confirms that the simple act of living a healthy lifestyle
consisting of regular exercise and good nutrition is the best way to maximize testosterone levels. While it
is well known that strength training increases testosterone levels, a recent study reported that in middle-
aged men, being in good health was associated with highest testosterone levels. Good health was defined
as the absence of chronic illness, prescription medication, obesity and excessive drinking of alcoholic
beverages.

Ribose

Ribose is used in the body as a precursor for making ATP molecules, as well as proteins, DNA, RNA and
other nucleotides. Ribose can contribute to the pool of energy substrates, in particular through the
conversion of pyruvate. Therefore, the primary benefit of taking ribose is to maintain and replenish ATP
molecule levels in the body, and a secondary benefit of ribose is its direct contribution to energy
production as an energy substrate.

Like with other developments in sports nutrition, the story of ribose began with its use in animal research
and medicine. In 1983, H.G. Zimmer looked at the effects of ribose on rats with reduced heart function
due to poor blood supply and reductions in adenosine triphosphate and total adenine nucleotide tissue
levels. After 24 hours of ribose administration, biosynthesis of cardiac adenine nucleotides was stimulated
and ATP levels were improved. This resulted in improved heart function of the research animals. In 1984,
H.G. Zimmer reported again that administration of ribose, via intravenous infusion, lead to restoration of
cardiac ATP levels within 12 hours during recovery from a 15-minute period of myocardial ischemia. This
was compared to the 72-hour recovery for ATP normalization in animals without the benefit of ribose
administration. To further this research, after concluding that ribose is cardioprotective in rats and
stimulates the production of ATP and other adenine nucleotides, H.G. Zimmer’s attention was turned to
verifying these effects in other animals. In the 1984 February issue of Science, H.G. Zimmer reported that
ribose had a similar myocardial ATP stimulating effect in other animal species.

In 1987 John St. Cyr and colleagues reported the results of ribose use on dogs. They found that ATP levels
dropped significantly following global ischemia in dogs, which required several days to fully recover. They
found that after ribose administration, ATP levels rebounded significantly within 24 hours. Researchers
concluded that ribose infusion significantly enhanced the recovery of energy levels in the postischemic
myocardium in the experimental dogs.

Similar to the experimental animals, researchers found comparable results when examining ATP dynamics
in human subjects. In 1986 M.E. Cheetham reported that after 30 seconds of maximal sprinting, upon
biopsy examination, female subjects had decreased muscle glycogen, phosphocreatine and ATP levels. N.
McCarthy reported similar findings based on research using male human subjects. After performing four
30-second bouts of maximal isokinetic cycling at 100 rpm, with four-minute recovery intervals, ATP,
426
glycogen and phosphocreatine muscle tissue levels were greatly reduced. In 1993, Y. Hellsten-Westing, et
al., reported that in human male subjects, intermittent exercise caused a reduction in ATP tissue levels.

So, ATP tissue levels can be reduced from poor blood flow or from exercise. The next step in ribose
research lead to examine what happens to patients with medical conditions that cause ATP tissue
depletion when given ribose. M. Grose and coworkers investigated what giving ribose, orally or
intravenously, did to healthy volunteers and patients with myoadenylate deaminase deficiency. Both
groups well tolerated ribose administration. Although no ATP tissue levels or exercise performance
parameters were measured, this study was a stepping-stone in demonstrating the ribose dynamics in
human studies. The researchers observed a reduction in serum glucose levels during ribose
administration, although ribose administration was well tolerated. In 1991 D.R. Wagner and coworkers
looked at the effects of oral ribose administration of three patients with AMP deaminase deficiency. Three
grams of ribose was given to subjects orally, every 10 minutes, beginning one hour before exercise until
the end of the exercise periods. Exercise was performed on a bicycle ergometer. The researchers found
that ribose administration did not improve maximum exercise capacity in these three patients, but found
that post-exercise muscle stiffness and cramps disappeared almost completely in two of the three patients
tested. Researchers concluded that ribose may both serve as an energy source and enhance the synthesis
of ATP.

Two key studies have verified the safety and effectiveness of ribose in human subjects. In 1986, N.
Zollner found that taking D-ribose improved tolerance to exercise in a 55-year-old patient suffering from
exercise-induced muscle pain and stiffness due to primary myoadenylate deaminase deficiency. The
patient was taking four grams of D-ribose before exercising to prevent the symptoms over a two-year
period. This dosage, taken every 10 to 30 minutes of exercise, with a total dose of 50 to 60 grams per
day, was well tolerated without side-effects.

In 1992, W. Pliml and coworkers reported the results of their research on the effects of ribose on exercise-
induced ischaemia in stable coronary artery disease, in the Lancet. They were trying to develop a strategy
aimed at protecting or restoring cardiac energy metabolism, which was greatly impaired by ischaemia. The
existing scientific evidence suggestion that ribose stimulates ATP synthesis and improves cardiac function
led them to test the notion that ribose increases tolerance to myocardial ischaemia in male patients with
documented severe coronary artery disease. The researchers gave male subjects either 60 grams of D-
ribose daily divided in four dosages per day for 3 days, or a placebo. They found that the ribose group
better tolerated treadmill walking exercise, which improved the heart’s tolerance to exercise induced
ischaemia.

The company that makes RiboCell, a D-ribose raw materials sold to supplement companies, Nutratech,
has a study underway to examine the performance and recovery effects of athletes taking D-ribose. No
one can say, however, that taking ribose will definitely boost energy. Nor can anyone say that athletic
performance will improve. The scientific evidence is clear, however, that ribose will help heart and
skeletal-muscle cells maintain their energy charge and normal function, and that taking ribose before,
during and after periods of high-intensity exercise will increase exercise effectiveness.

The research does show that for individuals with heart and circulatory system problems, ribose can in
some instances help increase exercise performance and tolerance. Ribose supplement use may also help
the beginner exerciser, as well as have beneficial effects for serious competitors and hard-charging
weekend athletes. Athletes’ hearts and skeletal muscles use energy faster than it can be replaced, and
ribose is effective at rebuilding these critical energy stores to keep the heart and skeletal muscles at their
peak. Consuming drinks containing ribose, before, during and after exercise may be worth a try for these
exercising individuals.

Using Ribose

Research has shown that about 3 to 5 grams of ribose taken every day should put enough in the
bloodstream to ensure that the heart and skeletal muscle cells have an adequate supply. Serious athletes
427
and people concerned about their circulation may want to take more. In fact, these people may require 10
to 20 grams or more per day. A good course of action would be to start out with about five grams of
ribose per day. If you feel you need more, increase your dosage by about 3 to 5 grams per day. However,
do not take more than 15 to 20 grams per day. People with heart or circulatory system problems who
want to use ribose to increase exercise tolerance or reduce post-exercise soreness or stiffness should do
so under medical supervision.

Safety of Ribose

Scientific research on ribose has been ongoing the past two decades and in some of these studies, very
high doses of ribose have been administered. In one study on patients with severe coronary artery
disease, doses of 60 grams per day for three days were given. In these patients, there were no lasting
side effects. In still another study, ribose was given in 60gr doses for seven days. Some of the patients
taking these very high doses developed minor cases of diarrhea, while others had occasional mild and
asymptomatic hypoglycemia. It should be noted that these studies were only a few days long. The study
mentioned above with the 55-year-old using ribose was over a year period, but under a doctor’s
supervision. Ribose is currently sold as a dietary supplement. It is best to follow the directions that come
with the specific product, keeping the reports of the studies reviewed in this article in mind, as to not
overdo it. At this time there is a lack of scientific evidence to state with certainty that ribose is safe for
long-term use by all people. Its use should therefore be restricted to adults and for short-term periods.
Discontinue use if any side effects occur. It is always best to consult your physician before taking
supplement products or if a disease or health condition exists.

Yohimbine

The use of yohimbine for weight loss is inconclusive, and I do not recommend it due to the
potential side effects. Research has been conducted, and some of the key studies will be
reviewed below. Keep in mind though, that just because investigators have conducted
research on the use of this supplement does not mean that such studies should be used to
endorse its safety.

Alpha-2 receptors are common in sites of the body that tend to accumulate fat: abdomen,
breasts, buttocks and thighs. When exposed to circulating catecholamines, such as
norepinephrine and epinephrine, alpha-2 receptor sites inhibit lipolysis (the release of fatty
acids) while the beta receptors stimulate lipolysis. Generally speaking, epinephrine,
norepinephrine, glucagon, adrenocorticotropic hormone (ACTH) and growth hormone
stimulate the release of fatty acids from adipose tissue into the blood stream. Once in the
blood stream, fatty acids are usually rapidly oxidized if the fatty acid blood concentration is
not elevated from fatty acid input resulting from a meal. Generally, when fatty acid blood
concentration is high, it favors fat storage, which results from over-eating and inactivity.
Although, keeping in mind that fatty acids are always used for energy, it is the balance
between the amount of fatty acids ingested versus their use for energy that determines how
much ends up stored as fat. Of course, this is a rather simplistic explanation of fatty acid
metabolism. There is much more involved in these fat storage/utilization dynamics, and
those who want more insight on these dynamics should investigate ISSA’s SPN course. In
that course, I delve into these dynamics in much more detail.

Hypothetically speaking, blocking the alpha-2 receptors might be useful during weight loss
to free up the catecholamines such as norepinephrine, making more available to stimulate
beta receptor sites, resulting in a higher rate of lipolysis. Yohimbine, through its alpha 2-
adrenergic receptor antagonist activity, has been shown to increase levels of norepinephrine
in the blood stream. Galitzky and coworkers observed during their 14-day study of
yohimbine treatment that lipid-mobilizing effects were sustained during this study period.
This research collaborated their earlier observations as well as the research of Lafontan and

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 coworkers.

But the question still remains — is yohimbine an effective weight loss aid?

Kucio and coworkers conducted research looking for answers to this very question. In their
research report titled, “Does yohimbine act as a slimming drug?” they found an interesting
answer. In this study, 20 obese female outpatients were first limited to 1,000 calories per
day for three weeks. After this three-week period, 10 subjects were given yohimbine and
the other 10 were given a placebo for three additional weeks, which all continued to
consume 1,000 calories per day. Researchers found that the yohimbine treatment
significantly increased weight loss: 3.55 kilograms bodyweight lost in the yohimbine group
versus 2.21 kilograms bodyweight lost in the placebo group. However, there was not a
significant effect on lipolysis observed, nor did treatment with yohimbine delay the gastric
emptying rate. Keep in mind that while over two pounds more weight was lost by the
yohimbine group, there were no measurements of what type of weight was lost — body fat
or muscle — and these results were observed in sedentary obese females, who ate only
1,000 Calories per day. Also, there are other nutritional aids that can result in greater
weight loss with fewer or no side effects. The study concluded that further research is
warranted to determine the applicability of using alpha 2-receptor inhibitory drugs as
supplementary management in the treatment of obesity.

Waluga and coworkers went on to examine what the combined effects of ephedrine, caffeine
and yohimbine were on cardiovascular function and rate of weight loss. To do this they
divided 27 obese but otherwise healthy women into three groups of nine. The first group
received only a very low-calorie diet (400 calories per day) and a placebo. The second group
received the same diet along with ephedrine and caffeine drug treatment. The third group
received the same diet, the ephedrine/caffeine treatment used in group two, plus
yohimbine. The treatment lasted for 10 days. At the end of the study the researchers
observed a significant reduction in body mass in all groups, with no statistical difference
between the groups: Group one lost 3.3 kilograms of bodyweight, group two lost 3.5
kilograms of bodyweight, and group three lost 3.4 kilograms of bodyweight. Although no
significant results were seen between the groups, the researchers pointed out that this
study was only 10 days long and that the subjects were on a very low-calorie diets, which
may have distorted any weight loss effects of the drugs or have been too short to
distinguish the real effects reported by other researchers. However, the main aim of the
study was to determine adverse effects of the drug treatment on the cardiovascular system,
and in fact, the researchers did determine that the inclusion of yohimbine along with the
ephedrine and caffeine did evoke some potentially dangerous changes in the cardiovascular
system. They concluded that the addition of yohimbine should be treated with caution and
must be excluded in particular obese individuals with cardiovascular complications.

While yohimbine may be useful in losing weight in some clinical settings, it should not be
used by non-obese people. That is, over-weight and lean people who want to get leaner and
have the expectation that yohimbine is safe and effective in promoting greater fat loss
results are advised not to take this supplement.

Carnitine

These days, carnitine’s many benefits are getting a lot of media attention, yet most people are still unsure
how taking carnitine will improve their health or how much carnitine their bodies need. Whether you are
one of those people or a veteran carnitine user who wants updated information, read on. This section will
start you off on your quest for knowledge about this remarkable supplement.

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The beneficial effects that carnitine can have on cardiovascular health should be of interest to everyone,
but especially to those who are at risk of coronary heart disease. Carnitine is a vital substance needed by
your body to keep your heart pumping. Medical researchers have discovered an association between low
levels of carnitine in heart muscle and heart failure. It is therefore suspected that low carnitine production
or intake is a risk factor for heart attacks in some people. Among its many “heart healthy” benefits,
carnitine can improve blood flow and raise the “good” HDL-cholesterol levels, while lowering the “bad”
LDL-cholesterol levels. This reduces your risk of coronary heart disease.

Carnitine for Weight Loss

Losing and maintaining weight is a lifelong battle for millions of people in their quest for leaner bodies and
better health. Experts estimate that almost 30 million American adults are dieting to lose weight at any
given time, and an equal number are gaining it back. Research indicates that leading a lifestyle that
boosts your body’s usage of fat is the first step to lifelong weight management. Due to carnitine’s
essential role in fat metabolism, it is a prime nutrient for boosting your fat-burning capabilities.

There is much more to losing and controlling your weight than just taking a dietary supplement. People
with weight problems need to adopt a lifestyle of proper dietary habits and a program of regular physical
activity to help with lifelong weight control. Carnitine’s role in fatty-acid metabolism can help with weight
loss efforts and can be an important part of your “lean-lifestyle” program. However, it is not meant to
solve all of your weight problems on its own.

Carnitine’s role in fatty-acid transport into cells’ mitochondria for energy production helps in weight
management by enhancing the rate at which your body uses fatty acids for energy production. This, in
turn, increases the fat calories your body uses each day and decreases the amount being stored on your
hips, waist and other bodyparts. Carnitine ingestion can also increase your metabolic rate — the amount
of energy you produce and the calories you use to produce it — which means you will burn more calories
each day.

In 1997, researchers reported the results of a study that examined the effects of carnitine on weight loss
in obese adolescent students aged 13 to 17. The subjects were divided into two groups. Both groups
received nutritional education, physical training and controlled diet plans. The experimental group also
took 2 g of L-carnitine per day and the control group took a placebo. At the end of the three-month study,
both groups of students lost weight, demonstrating that food control and exercise can result in weight
loss. However, the group taking 2 g of L-carnitine per day lost an average of over 11 pounds of weight,
while the group taking the placebo lost an average of about 1.5 pounds. This study clearly demonstrated
that L-carnitine supplementation caused a greater rate and total amount of weight loss. The L-carnitine
treatment was well tolerated by the study subjects, with no side effects being observed.

In 1992, Gilbert Kaats and coworkers reported the results of their weight-loss study, which included the
use of carnitine and other nutrients. A total of thirty women and 10 men, ages 19 to 65, were recruited for
the study. The study was designed to evaluate changes occurring in lean body mass, blood cholesterol
levels and resting metabolic rate, while subjects followed a program of moderate calorie restriction of
1,000 to 2,000 calories a day.

During the eight weeks of phase I, dietary guidelines were followed by the subjects but no supplements
were given. Not many changes were detected in bodyweight, blood serum cholesterol levels or resting
metabolic rate during this period. During the eight weeks of phase II, subjects were given two fiber
cookies and supplements containing 200 mg of L-carnitine and other nutrients, including 200 mcg of
chromium per day to their diets. At the end of phase II, researchers discovered an average loss of body
fat of over 11 pounds and an 11% reduction in total serum cholesterol levels. Furthermore, they saw a
9% reduction in the blood serum levels of LDL-cholesterol, no loss of lean body mass, and maintenance,
or increase in resting metabolic rate.

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Interviews with subjects after the study revealed that the addition of the fiber cookies and carnitine
supplement helped them stick to their diets. Moreover, they found the increase in the rate of fat loss
encouraging. It is interesting to note that three of the subjects doubled their metabolic rates during phase
II. One of these subjects followed a vegetarian diet and lost only 3.6 pounds of body fat during the first
eight weeks and a substantial 16.5 pounds of body fat during the second eight weeks of the study. (Since
almost exclusively animal proteins supply dietary carnitine, vegetarians typically have low carnitine
intakes from dietary sources.) It appears that the supplemental carnitine increased the vegetarian’s rate
of fat metabolism, resulting in an increased reduction in body fat. These studies demonstrate carnitine’s
powerful metabolic and fat-burning enhancing effects.

SAMe

Understanding what SAMe Is and Does

Short for its chemical name, S-adenosyl-L-methionine (can also be spelled s-adenosylmethionine), SAMe
is produced by your body and takes part in many biochemical processes that help keep you healthy. SAMe
is made from the amino acid methionine, using the body’s primary energy molecule, ATP (adenosine
triphosphate). It is also involved in an important biochemical process known as methylation. In this
capacity it acts as a methyl donor, which is used by other molecules to make even more molecules. Methyl
groups are part of organic compounds and can be transferred from SAMe to another biochemical to create
entirely new compounds your body needs. Technically, methyl groups consist of one carbon atom with
three hydrogen atoms attached. When the body is not making SAMe efficiently, it adversely effects
production of other essential substances your body needs to survive and thrive. As you will soon learn, not
producing adequate amounts of SAMe often results in horrible degenerative diseases. The good news is
that simply taking a SAMe supplement will safely and effectively correct these related disorders.

Overview of the Health Benefits of SAMe

SAMe’s role in methylation is involved in a wide range of biochemical processes and important to a wide
variety of biological functions. Some of these include: DNA (deoxyribonucleic acid) function; manufacture
of proteins; liver function; fat metabolism; the production of nervous system and brain biochemicals, such
as ephedrine and dopamine; fetal development; hormone regulation; cell membrane integrity; cell
reproduction; and brain and nervous system function.

Once SAMe has donated its methyl group in the process of methylation, it becomes a new substance
called S-adenosyl-L-homocysteine, which goes on to manufacture an important sulfur-containing amino
acid, L-cysteine. In turn, this amino acid is involved in creating one of the body’s most potent
antioxidants, glutathione. Glutathione and the amino acid taurine are important for liver detoxification.
SAMe donates methyl groups to molecules like norepinephrine, making epinephrine into molecules such as
phosphatidylethanolamine, which eventually form phosphatidylcholine, used to make cell membranes.
SAMe’s methylation role is involved with RNA and DNA, thereby becoming active in the genetic copying
and duplication processes.

SAMe is involved in other important metabolic pathways that are required to produce a variety of
important biochemicals. For example, SAMe is needed in the production of two compounds called
spermidine and spermine. These two substances are involved in cell and tissue growth, gene expression
and the formation of yet another compound called MTA (methylthioadenosine). MTA helps to control pain
and inflammation. In this way, SAMe indirectly controls levels of pain and inflammation in the body, giving
it clinically proven analgesic and anti-inflammatory effects with few, if any, minor side effects.

SAMe is also involved in homocysteine metabolism, and new studies indicate that it can play a role in
maintaining normal levels of homocysteine, which when elevated, can have adverse effects on the
cardiovascular system. High homocysteine, or hyperhomocysteinemia, is linked to a variety of diseases,
including atherosclerosis, which can lead to heart attack and stroke; blood clots and other vascular

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diseases; neural tube defects and spontaneous abortion; depression and other cognitive dysfunction; and
Alzheimer’s disease. Therefore, SAMe may be important in promoting and maintaining cardiovascular
health, as well as other benefits, which will be explained below.

SAMe Health Benefits in Detail

Due to its diversified roles in the body, research conducted over the past five decades has found that
taking SAMe can be beneficial for treating primarily three common degenerative conditions:

• Osteoarthritis
• Fibromyalgia
• Depression

Keep in mind that treatment of medical conditions requires medical supervision, and people should not
stop taking their medication without the approval of their doctors. In many cases, SAMe can be taken
safely along with other medications, as determined by their doctor. As people start to see improvements,
they can decide with their doctors whether or not to reduce the drugs they are taking. In this way, think
of SAMe as part of a nutritional therapy program to complement a drug therapy program. The following is,
therefore, for information purposes only and will serve to acquaint you with some of the main benefits of
SAMe on the medical conditions listed above.

SAMe and Arthritis

Although the term literally means joint inflammation, arthritis really refers to a group of more than 100
rheumatic diseases and conditions that can cause pain, stiffness and swelling in the joints. Certain
conditions may affect other parts of the body, such as the muscles, bones and some internal organs and
can result in debilitating and sometimes life-threatening complications. If left untreated, arthritis can
cause irreversible damage to the joints.

The two most common forms of arthritis are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis
is an autoimmune disease that occurs when the body’s own immune system mistakenly attacks the
synovium (cell lining the inside of joints). This chronic disabling disease causes pain, stiffness, swelling
and loss of function in the joints.

Osteoarthritis (also referred to as degenerative joint disease) results from the wear and tear of life, which
causes physical damage to the joints and surrounding tissues leading to pain, tenderness, swelling and
decreased function. Initially, osteoarthritis is non-inflammatory, and its onset is subtle and gradual,
usually involving one or only a few joints. The joints most often affected are the knee, hip and those of
the hand. Pain is the earliest symptom, usually made worse by repetitive use. Other risk factors include
joint trauma, obesity and repetitive joint use. Osteoarthritis can also be a byproduct of aging with its
associated decrease in the body’s ability to renew normal collagen.

SAMe Scores High in Combating Osteoarthritis

The role of SAMe in alleviating some of the symptoms of osteoarthritis is verified in several medical
studies performed on humans. In fact, SAMe’s role in the promotion of joint health became apparent
during initial research on depression, which led to studies on SAMe’s effects on treating osteoarthritis and
other conditions. SAMe has been used in over a dozen studies conducted on more than 22,000 people to
determine its effects on people suffering from osteoarthritis. For example, in 1985 a team of researchers
lead by S. Glorioso published the results from a randomized double-blind, multi-center clinical trial that
examined the effects of SAMe versus ibuprofen. The study examined the effects of SAMe in 150 patients
with hip and/or knee osteoarthritis. For 30 days both compounds were administered by mouth at the rate
of 400 mg taken three times per day. There were many more complaints in the ibuprofen group when

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compared to the group of patients taking SAMe. The researchers concluded that SAMe was slightly
superior to ibuprofen in the management of pain in these subjects.

SAMe Beats Out Naproxen

In a medical study, SAMe demonstrated that it is superior to the non-steroidal, anti-inflammatory drug,
(NSAID) known as naproxen. This double-blind, placebo-controlled study using 734 subjects examined the
benefits of these compounds for people suffering from osteoarthritis of the hip, knee, spine and hands. In
a double-blind, placebo-controlled study neither the patients nor the clinicians providing the medication
were aware if they are administering SAMe or a placebo. Using a double-blind, placebo-controlled study
eliminates psychological bias that might occur if the patients or experimenters knew whether the patients
were taking SAMe, naproxen or placebo.)

The oral dose of SAMe was 1,200 mg per day: two 200 milligram tablets taken three times per day. The
naproxen group took 750 mg daily, 250 mg, three times per day. Both compounds proved more effective
than the placebo in reducing pain; however, SAMe was better tolerated by the study subjects than was
naproxen. There was no difference between SAMe and the placebo in the number of side effects, gastric
complaints being the most common of side effects. Some of the benefits observed from the SAMe group
include: improved ability to stand up from a seat, improved walking, improved walking up stairs, reduced
day pain and overall improvements in functionality. The researchers concluded that because of SAMe’s
analgesic properties and lack of major side effects, it deserved to be ranked among the most adequate
treatments for the medical management of osteoarthritis.

One study, conducted by B. Konig and colleagues in Germany, examined the long-term effects of taking
SAMe on patients with osteoarthritis. This study lasted for two years. Patients received 600 mg of SAMe
daily, taken as 200 mg tablets, three times per day. Researchers noted changes in symptoms relating to
abnormalities of the knee, hip, cervical spine and dorsal/lumbar spine. The severity of morning stiffness,
pain at rest and pain on movement was assessed throughout the study period. Improvements in all the
symptoms related to osteoarthritis were improved significantly. SAMe also improved the depressive
feelings associated with osteoarthritis and was well tolerated. Most side effects disappeared during the
course of therapy, and no adverse effects were recorded during the last six months of the treatment
period. The researchers concluded that SAMe is an innovative alternative to the drugs currently used in
the treatment of patients with osteoarthritis.

These are just a few of the many studies reporting the beneficial effects taking SAMe has for people with
osteoarthritis. Studies have been conducted with as many as 20,641 subjects. In this large-scale study,
SAMe was effective in reducing symptoms of osteoarthritis in about 95% of the patients tested. Side
effects were few, and when they did occur were mostly related to gastrointestinal upset. The researchers
used different dosages of SAMe during the eight-week study period: 1,200 mg per day during week one,
800 mg per day during week two, and 400 mg per day during weeks 3 to 8.

Most People With Arthritis Need to Take SAMe

For people with osteoarthritis taking SAMe is a must. In addition to taking SAMe there are a number of
other supplement products and botanicals that have been shown to reduce the pain and immobility
induced by osteoarthritis. Glucosamine sulfate and chondroitin sulfate have received international acclaim
for their clinically proven beneficial effects. Botanical extracts such as St. John’s wort, boswellia serrata,
devil’s claw and curcumin have also been shown to help reduce the pain and/or depression associated with
osteoarthritis. A newcomer, methyl-sulfonyl-methane (MSM) is also showing promise for osteoarthritis
sufferers. There is no reason to try only one approach. SAMe can be safely taken along with any one of
these supplements. You can consider starting a joint health promotion supplement plan by taking SAMe
along with glucosamine. Then, include some of the other products on an as-needed basis, depending on
how improvements are progressing. This is why it is important to work closely with a doctor who will help

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monitor how someone responds to this nutritional course of treatment and offer guidance regarding other
products as determined by the specific medical condition.

Glucosamine

Recalling from Unit 3, cartilage, tendons, and ligaments are comprised of dense connective tissue.
Evidence is mounting that glucosamine supplementation aids in dense connective tissue synthesis. This is
important to athletes because the repair and growth of this type of connective tissue is never-ending. In
addition, because athletes endure so much collagenous tissue damage, it is possible for them to develop
osteoarthritis in later years.

Dense connective tissue is made up of collagen and proteoglycans (PGs). PGs form the “framework” and,
in a sense, collagen “fills in the spaces.” PGs are comprised mainly of glycosaminoglycans (GAGs) — long
chains of modified sugars. The principal sugar in PGs is called hyaluronic acid, of which 50 percent is
comprised of glucosamine.

Collagen and PGs must somehow “get together” during the production of new connective tissue. Of the
multitude of biochemical reactions that must take place during the synthesis of connective tissue, there is
one critical “rate-limiting” step that once reached, guarantees that tissue is successfully synthesized. That
rate-limiting step is the conversion of glucose to glucosamine. Glucosamine is the single most important
substance in the synthesis of connective tissue.

Over thirty years of research has gone into understanding the benefits of glucosamine as an oral
supplement. Some of the findings are listed below.

• In a study appearing in the British Journal of Sports Medicine, researchers found that general
mobility improved more quickly among subjects with knee pain who were treated with 2000 mg of
glucosamine per day, starting after about four to eight weeks of treatment. By the end of the 12-
week study, 88% of those that took glucosamine said their knee pain had improved compared to
only 17% among those who took the placebo. (Participants did not know which pill they were
taking.)
• A study conducted from the University of Liege, Belgium found that glucosamine significantly
reduced symptoms such as pain, stiffness, physical functioning, and joint mobility in subjects
suffering from osteoarthrits of the knee. In addition, taking at least 1,500 mg of oral glucosamine
sulfate for at least three years was most effective in slowing the degenerative process of
osteoarthritis.
• A report in The Journal of Pharmacology and Experimental Therapeutics suggests that glucosamine
seems to boost the pain relief from ibuprofen for arthritis sufferers. Researchers hope that arthritis
sufferers can reduce the amount of ibuprofen they take by also taking glucosamine.
• Of greater concern to athletes, glucosamine aids in feeding injured connective tissues because it is
the most critical precursor for rebuilding the collagenous matrix that forms connective tissue.
• Glucosamine is the preferred substance in synthesizing the framework of dense connective tissue.
• In vitro research demonstrated that glucosamine increases the production of GAGs (the most
important molecules in your PGs) by 170%

The sulfate form of glucosamine (e.g., glucosamine sulfate) may be better absorbed by your body. Also,
glucosamine is often combined with chondroitin in the treatment of the symptoms of arthritis.
Glucosamine is available in different forms such as tablets and powder. It is not recommended that
different forms of glucosamine be taken at the same time. Using more than one form increases the risk of
overdose. As with any supplement, it is important for your clients to discuss glucosamine supplementation
with their doctors.

Whey Protein

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Imagine a nutritional ingredient that has been clinically proven to help build muscle, improve physical
performance, sharpen your mind, help your body ward off disease, enhance circulatory system function,
improve overall health and, to top it all off, has potent anti-aging effects. The secret is high-quality whey
protein, and its special building blocks that your body needs most. Protein is the one nutrient we cannot
live without; however, researchers are discovering that most of us are not getting enough of it.

Protein is essential for all living things, especially humans. Our bodies are mostly made up of various
proteins. But not all of the proteins we eat are created equal. What proteins are made of has an impact on
whether or not they work well in your body. Your body’s activity level, and the type of activity you
perform will dictate what type of protein you need. Whey protein has gotten the reputation of being the
“king” of all proteins, especially as a supplement. Its reputation is well-deserved, as the benefits of whey
protein are confirmed in medical research, including sports performance scientific studies by some of the
world’s leading researchers, universities and medical centers, from Shanxi Medical College in China to
Harvard University.

But how do scientists know that whey protein is the best? During the mid 1900s, when researchers were
experimenting with proteins from plant and animal sources, they discovered that some proteins have all
the essential amino acids to support growth and health while others do not. After years of testing and
retesting, they determined that whey protein not only scored the highest in amino acid composition, but
more importantly it also had a high biological value, or BV, a measure of how much of a protein is actually
used by the body. As scientists continued researching proteins, they started to focus on protein building
blocks, the individual amino acids. As they tested each amino acid separately, researchers were amazed to
learn that individual amino acids exerted profound beneficial effects on the body. In fact, most amino
acids have multiple benefits.

Below are some of the functions of the main amino acids in high-quality whey protein that occur in
significant amounts to promote beneficial effects. These functions are not only important to your good
health, they are also of particular interest to the fitness-minded.

Benefits of Whey Protein’s Key Amino Acids

BCAAs (Branched-Chain Amino Acids)

• Increases endurance
• Prevents fatigue
• Improves mental performance
• Increases energy level

Phenylalanine

• Maintains nervous system health

• Relieves depression
• Elevates mood
• Decreases pain
• Boosts memory
• Suppresses appetite

Tryptophan

• Relieves mild to moderate depression

• Relieves insomnia and promotes restful sleep
• Promotes weight loss by suppressing appetite
• Reduces overall sensation of pain (i.e. migraine headaches, fibromyalgia, general muscle pain)

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Arginine

• Increases growth hormone levels

• Protects against heart disease
• Lowers blood pressure
• Improves poor circulation
• Aids in the production of creatine, an important source of energy
• Lowers ammonia levels, which can be increased in athletes due to frequent exercise

Glutamine

• Boosts immune system function

• Maintains muscle mass
• Prevents muscle catabolism (breakdown)
• Enhances glycogen storage
• Aids recovery from exercise
• Promotes healing
• Increases growth hormone levels

Proline

• Rebuilds cartilage and bones

• Speeds injury repair
• Promotes tissue recovery following exercise
• Protects against overuse injuries (sprains, strains, tendonitis)
• Whey Protein Gets Results:
It Is Money Well Spent
• While high-quality whey is the most expensive of the primary protein sources used in protein
products, it has some distinct nutritional advantages. It enhances the production of glutathione,
one of the body’s most powerful natural antioxidants. It also has the highest levels of BCAAs and
has been shown to boost immune system functioning. Another advantage of whey is that it
dissolves easily in water, allowing you to mix your protein drink on the go without excessive
clumping. Lastly, whey protein exits the stomach much faster than other proteins and it is
absorbed through the intestines more quickly. As a result, you get a large, quick rise in amino
acids, which is important during exercise and recovery.
• In addition, whey protein has been clinically proven to build muscle and improve athletic
performance. It has also been shown to help reduce body fat, while at the same time increase lean
muscle mass when taken as part of an exercise program. Another important benefit of the protein
is its ability to raise levels of IGF-1, a muscle-building chemical, and decrease levels of cortisol, a
muscle-depleting substance.
• Whey protein concentrate raises the glutathione level in animals and humans, which may be a
mechanism for modulating immunity. Although the exact mechanism by which whey protein
concentrate affects immunity has not been fully elucidated, whey protein concentrate is known to
be rich in glutathione precursors, substances that support optimum immune function. Medical
researchers also report that the glutathione-boosting effect of whey protein can also be important
in preventing and even treating certain cancers and other diseases.

Whey Protein, Glutamine and the Athlete

• About 60% of the total free amino acid content of the body is glutamine. During stress, major
changes occur in glutamine levels. The muscle concentration decreases sharply, whereas the
immune and gut cells show an increase in demand. The plasma glutamine level may drop below
the physiological level, resulting in a situation of imbalance and increased vulnerability to
infections. In this condition, the body needs an extra supply of glutamine from the diet.
• Dr. Eric Newsholme and his associates at Oxford University in the United Kingdom were among the
first to hypothesize that an amino acid imbalance may result from strenuous exercise and, as a
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 consequence, induce a number of phenomena that are collectively referred to as the “overtraining
syndrome.” Decreased performance, depressed mood and increased incidence of infections are
among the many symptoms that are related to the syndrome, which has been experienced by
runners, cyclists, swimmers, skiers, ballet dancers, rowers and even race horses. Dietary glutamine
plays a role in counteracting these phenomena because, as has been shown repeatedly, endurance
exercise decreases the plasma glutamine level, suggesting that the muscles cannot provide enough
of the nutrient.
• Inadequate amounts of circulating glutamine may lead to impaired immune function and increased
susceptibility to infection among athletes suffering from overtraining syndrome. In addition,
glutamine consumption by the small intestine has been found to occur at a very high rate.
Observations of gastrointestinal disorders, particularly of diarrhea and food allergies, may be due,
at least in part, to low concentrations of circulating glutamine. Recently, it was also shown that
glycogen storage in the muscles occurred significantly faster when study subjects consumed
protein together with carbohydrates as compared to carbohydrates alone. One of the responsible
dietary factors for this faster glycogen recovery is thought to be glutamine.
• Whey Protein Glutamine Fights Infection During Training and Exercise
• There is evidence that moderate regular exercise helps reduce the level of infection in normal
individuals, according to an article published in the British Journal of Sports Medicine. However,
intensive exercise increases the incidence of infection. Risk of upper respiratory tract infections
climbs with higher training mileage and after a marathon. A number of factors probably contribute
to this apparent immuno-suppression. These include raised cortisol levels, reduced salivary
immunoglobulin levels and low glutamine levels. There is some evidence that the incidence of
infection after prolonged exercise in endurance athletes taking glutamine is lower than in
endurance athletes taking a placebo.
• Glutamine
• Glutamine is 1 of the 11 nonessential amino acids. Nonessential does not mean that glutamine is
not important, but rather the body can produce this substance itself. 60% of our glutamine is found
in the skeletal muscle, with the remainder residing in the lung, liver, brain and stomach tissue.
More than sixty percent of our free amino acids come in the form of glutamine, and under normal
conditions, our bodies are able to produce more than enough to handle the load. But during times
of stress, glutamine reserves are depleted and need to be replenished through supplementation.
• Research is showing that glutamine depletion caused by stress can be activated by something as
minor as a common cold and the level of depletion increases with the severity of the disease.
Patients undergoing surgery, burn victims, those suffering acute trauma, as well as HIV and cancer
patients will all find their glutamine levels severely depleted by their conditions. As fitness
enthusiasts, the important thing to remember is that stress-related glutamine depletion does not
only occur with illness, but due to stress caused by exercise.
• Intensive exercise will disrupt immune function, increase lactic acid and ammonium levels. High
levels of ammonia can effect muscle function. Within the first five minutes of exercise, glutamine
levels rise and catabolic hormones are released. At the conclusion of the exercise session the
muscles will continue to release glutamine, causing a severe depletion situation. And the harder
you train, the higher the rates of depletion.
• Glutamine increases the hydration state of the muscle cells. Hydration of the muscle cells can
change rapidly, and once the cells are dehydrated they enter a catabolic state. During times of
catabolic stress, research has shown that glutamine levels can drop by as much as 50%.
Overtraining will result in fewer gains, but also higher disease rates, infections and a poor immune
system, due to the heavy demands placed on the energy reserves of the body. Higher levels of
training result in higher stress demands on the body, which lead to a reduction in plasma
glutamine levels.
• Catabolic states, muscle loss, depletion, cell dehydration and muscle atrophy are phrases that
weaken the knees of even the most seasoned of weightlifters or bodybuilders. How can one little
supplement produced in abundance by the body be responsible for so many concerns? According to
Ronald Klatz, MD, President of the Academy of Anti-Aging Medicine in Chicago, “Glutamine
promotes the assimilation of nutrients, regulates protein synthesis, stimulates growth-hormone
production and enhances the immune system.”

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• Weightlifters and bodybuilders need to realize that glutamine is critical for muscle-building because
it is a nitrogen donor, meaning that it moves nitrogen around in the body to where it is needed.
Anyone who pumps iron understands that a positive nitrogen balance is necessary in the effort to
gain muscle mass. Entering the Krebs cycle as a non-carbohydrate source of energy, glutamine
converts to glutamate and produces ATP, which is an energy molecule. With adequate amounts of
glutamine in the body through diet and/or supplementation, little or no muscle is broken down to
provide glucose. And remember, too little glutamine results in muscle atrophy.
• The typical American diet provides 3.5 to 7 gr of glutamine daily, which is found in animal and
plant proteins. Many people choose to supplement daily due to the long and growing list of
benefits. Research shows levels of supplementation from 2 to 40 grams daily. Two to three grams
have been found to help symptoms of queasiness. This 2 to 3 gr dosage used post workout builds
protein, repairs and builds muscle, and can induce levels of growth hormone found in the body.
High levels of glutamine supplementation have been used in hospital settings with doses of 20 gr
per day to treat colitis, Crohn’s disease and diarrhea. Forty gr per day of glutamine are used with
HIV, cancer patients undergoing chemotherapy and burn victims. Today, hospitals are beginning to
study the effects of glutamine on reducing the number of days required for a hospital stay and are
showing their confidence in the safety of glutamine by supplementing the nutritional needs of low
birth-weight babies with glutamine.
• Current research shows that diabetics should use caution when supplementing with glutamine
because they metabolize glutamine abnormally. Also, supplementation with cancer patients is
controversial because of the reaction of glutamine on rapidly dividing cells, which is characteristic
of a tumor. But the latest research shows that glutamine prolongs survival of cancer patients by
slowing down catabolic wasting and helps the depleted immune system. As the chief source of
energy for the intestines, glutamine aids in fighting diseases that affect the lining of the intestines.
In addition, it can reverse some of the intestinal damage caused by non-steroidal anti-
inflammatories, such as ibuprofen. And in its capacity to protect the brain from ammonia toxicity,
glutamine is being researched with regard to its positive effects on neurodegenerative diseases. As
an energy provider to the brain, glutamine is a mood elevator, improves mental performance and
helps with long- and short-term memory.
• Glutamine research continues to produce additional benefits of this supplement on a daily basis.
With the apparent lack of side effects, it is a supplement that all in the fitness industry should give
serious consideration to.
• Branch Chain Amino Acids
• The three BCAA’s, leucine, isoleucine, and valine make up about 35% of the amino content of the
muscle and have been found to be utilized more for energy during heavy resistance training,
therefore they require a little more supplementation than the other amino acids. Also, leucine is
used at double the rate of the other two BCAA’s, which is why you will find a higher leucine amount
in BCAA supplements. It is suggested that due to their importance, they be taken on an empty
stomach before and after your workout. BCAA’s are not so much supplemented for protein
synthesis as they are to retain a positive nitrogen balance and replace the BCAA’s that are lost
through energy expenditure.
• A study reported in the journal Medicina Dello Sport looked at the effect of taking supplemental
BCAAs on bodybuilding progress. The study involved 31 male bodybuilders between the ages of 18
and 34, all of whom were drug-free or “natural,” bodybuilders. The subjects were divided into two
groups: 16 took a placebo and 15 took a BCAA supplement. The results showed that while both
groups experienced increases in bodyweight, the BCAA group had greater weight gains. An analysis
of the weight gain in the BCAA group showed increases in the lean body mass in both the legs and
arms, with no changes in the trunk area of the body. In contrast, the group taking the placebo
showed no lean mass gains in these areas. The BCAA group also showed strength gains in both the
squat and bench press exercises, while the placebo group gained strength only in the squat
exercise. In addition, the BCAA group showed improvements in measures of exercise intensity.
• Myostatin
• Myostatin, previously known as growth and differentiation factor 8 (GDF-8), is a recently
discovered growth factor that is a potent inhibitor of muscle growth. The more myostatin a person
has, the smaller and weaker he (or she) is likely to be. Myozap CSP3 contains a marine vegetable

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 extract named cystoseira canariensis that has been shown to help scavenge myostatin in the body
safely and effectively. CSP3 is an acronym for cystoseria canariensis. Data from research teams at
Johns Hopkins University, UCLA and Purdue have linked myostatin to changes in muscle mass and
have sequenced the myostatin gene in humans, chickens, pigs, turkeys, sheep, baboons, zebra,
fish and rats. Since myostatin is thought to be one of the main reasons why aging, lack of exercise
and decreased anabolic hormone levels result in muscle loss. A myostatin inhibitor should prevent
any of its deleterious effects on muscle growth. While there is convincing evidence that myostatin
is a potent inhibitor of muscle growth, the data to support the efficacy of CSP3 to scavenge the
myostatin still needs further investigation in peer reviewed clinical research.
• Thymus Extract
• Thymus extracts are currently being studied with an interest in their utility as a life extension
medicine. This is being expanded upon due to the observation that, as we age, thymus gland
activity diminishes. The thymus gland lies in the upper part of the mediastinum behind the sternum
and extends upward into the root of the neck. It weighs about 10 to 15 g, (about half an ounce) at
birth and begins to grow until puberty when it begins to atrophy. Its maximum weight is around 30
to 40 g, (1 to 1.5 ounces) and by the age of 40, it has returned to its weight at birth. The thymus
consists of two lobes connected by areola tissue. The lobes are enclosed in a fibrous capsule, which
dips into their substance, dividing them into lobules that consist of an irregular branching
framework of epithelial cells and lymphocytes.
• Enhancing and stabilizing that activity through an oral thymus supplement might be of significant
use. More will be determined on that particular possibility as broader information becomes
available through clinical studies. Thymus extracts have been shown to prevent recurrent upper
respiratory infections (especially in children and in adults prone to chronic bronchitis). It has been
purported to normalize T-cell immune system function and immune cell function in human beings
(especially those who are HIV-positive), as well as treat acute hepatitis C and other types of
hepatitis infections. Clinically, it has been shown to restore blood cell counts in cancer patients
undergoing chemotherapy and improve symptoms of asthma, hay fever and food allergies
(especially in children). In addition, thymus extract has also been shown to help regulate
physiologic function in people with autoimmune disorders (especially rheumatoid arthritis and
lupus).
• Soy Isaflavones
• The following is a special section by Monique N. Gilbert BS, health advocate, CFT and author of
Virtues of Soy: A Practical Health Guide and Cookbook (Universal Publishers, 2001).
• With much attention on how soy can help women, many men wonder if it can help them too. The
answer is an overwhelming yes. Besides helping reduce the risk of heart disease, stroke, high
blood pressure and diabetes, soy appears to have a positive effect on male hormone-related
cancers, such as prostate cancer. In fact, a recent study of Seventh Day Adventists in California
found that men who regularly drank at least one cup of soy milk a day reduced their risk for
prostate cancer by 70%.
• The prostate is one of the male sex glands located just below the bladder and partially surrounding
the urethra. It makes fluid that becomes part of the semen. Cancer of the prostate is found mainly
in older men. As men age, the prostate may get bigger and block the urethra or bladder, causing
difficulty in urination or sexual functioning. This condition can be a result of benign prostate
enlargement or prostate cancer. The symptoms for both are similar. General symptoms include a
weak or interrupted flow of urine; painful, burning or frequent urination, especially at night; blood
in the urine; or nagging pain in the back, hips or pelvis.
• According to the American Cancer Society, prostate cancer is the most common cancer among men
in the United States, besides cancers of the skin. Prostate cancer is listed as the second biggest
cancer killer of older American men, after lung cancer. Doctors usually determine a man’s prostate
health by rectal examination and PSA testing. The PSA test is a diagnostic blood test that measures
the amount of prostate specific antigen the prostate gland is producing. This antigen is a small
protein molecule that normally combines the seminal fluid. It is almost nonexistent in the blood
stream of men without prostate cancer, but becomes persistently elevated in men with prostate
cancer. The higher the PSA level, the greater the likelihood of cancer. A recent study suggested

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 that men with rising PSA levels might benefit from ingesting soy-based products on a regular basis.
During a six-month trial, soy appeared to decrease PSA levels, compared with a placebo group.
• American men are almost five times as likely to die of prostate cancer than Japanese men.
According to the American Prostate Society, population studies show that Japanese men do get
small prostate tumors. However, their high consumption of soy-based products, such as tofu and
soy milk, apparently delays the onset of cancer and slows the growth of their tumors. While they
may have a relatively high incidence of latent prostate cancer, their mortality rate from this disease
is infinitesimal compared to American men. The exception is when they immigrate to the United
States and adapt to an American diet. Then Japanese men end up having the same death rate from
prostate cancer as their American counterparts.
• An examination of prostate cancer deaths in 59 countries shows that diet is strongly linked to
mortality from this disease. This international study concluded that death from prostate cancer is
positively associated with the affluent Western diet, which is high in animal-based products, fat and
alcohol. Conversely, intakes of cereals, nuts, seeds, fish, soybeans and soy-based products are
negatively associated with prostate cancer mortality. Researchers did not determine whether fish
had a protective effect, because the men who ate the most fish also ate the most soy. Both fish
and soy contain omega-3 fatty acids, which have been shown to inhibit the growth of tumors. What
this international study did determine was that the men who ate the most soy products were the
least likely to die of prostate cancer.
• Researchers found that the ingestion of animal fat (saturated fat) may increase the risk for
prostate cancer, and other hormone-sensitive cancers, by raising sex hormone levels. Prostate
cancer is linked with testosterone levels and is often treated by cutting the production of this
hormone, either surgically or chemically. Clinical evidence points to the beneficial role of soy in
reducing hormonal levels.
• Researchers attribute isoflavones with soy’s cancer-protective effects because they influence cell
growth and regulation. Soy isoflavones tend to concentrate in prostate tissue and may prevent
prostate cancer by inhibiting its growth during the initial phase of the disease. Results from a study
at Harvard University Medical School indicate that soy can drastically reduce tumor growth and its
spread to other organs. The substances found in soybeans appear to block the development of
blood vessels (angiogenesis) needed by the tumors, causing them to starve to death.
• Antioxidants
• Antioxidants are compounds that prevent and repair damage to cells caused by pollution, sunlight
and normal body processes. These elements cause oxidation in our body, which produce dangerous
chemical compounds called free radicals. These compounds are highly reactive and have the
potential to damage DNA, causing mutations that can result in the malignant transformation of
cells. Free radicals can easily cause harm to the immune system, whose cells divide often. They
may also be responsible for some of the changes of aging.
• We can help the body in its ability to scavenge and destroy free radicals before they cause harm by
supplying it with natural substances that act as antioxidants. These substances block the chemical
reactions that generate free radicals in the first place and destroy the ones that have already
formed.
• Conditions of normal metabolism, radiation, exercise, ozone exposure, carcinogens and other
environmental toxins cause oxygen molecules inside our bodies to break down. Loss of one of its
electrons to another molecule during such processes causes the oxygen molecule to become highly
reactive, capable of combining with other molecules in its quest for another electron to take the
place of the one lost. In this volatile state, it becomes known as a “free radical.”
• When the renegade molecule finds an electron mate, it bonds with it, giving it an extra electron.
This new electron makes that molecule highly reactive and a self-perpetuating vicious cycle begins.
Cell membranes are destroyed, immune system integrity is compromised and DNA — a cell’s
master regulators — is altered or destroyed.
• Free radicals are highly reactive molecules, which target your tissues’ protein bonds, the DNA in
cells’ nuclei and the important polyunsaturated fatty acids within cells’ membranes. Once initiated,
a chain reaction begins that ultimately results in the total destruction of that cell. Scientists have
determined that over 60 age-related maladies are a direct result of long-term damage resulting
from free radical activity. There are seven different “species” of free radicals.

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 • By far, prevention is the most important course of action against the ravages of free radicals. Some
preventive measures are: 1) abstaining from smoking; 2) strict adherence to a carefully
constructed — integrated — training program (including your diet); and 3) avoidance of pollutants
and other toxic substances that are known to cause free radical formation. It has, over the past
few years, become scientific dogma these antioxidants indeed make a difference in the body’s
ability to recover more quickly and to aid in preventing many of the maladies associated with
premature aging.
• Dr. William Pryor, professor of biochemistry at Louisiana State University, confirms, “There has
been a renaissance in free radical biology in the past decade. Within the next 10 or so years, [our
greater knowledge of how best to fight free radical damage] will promote a modest extension in life
span — perhaps 5 to 8 years.” Professor Pryor is not alone in this belief. Working in the USC-based
Institute for Toxicology, Dr. Paul Hochstein and Dr. Kelvin Davies and their colleagues have
dedicated their time and resources to understanding free radicals, the damage they cause and how
to combat them and prevent their formation. According to their research, your body’s built-in
repair mechanisms — certain enzymatic free radical scavenging and salvage systems — are not
capable of handling the onslaught. The cumulative effect of [free radical] damage over time may
diminish the cell’s ability to make these repairs. This may be what causes some of the physical
degeneration of aging, explained Davies.
• There is no doubt that repair-limiting free radicals decrease an athlete’s ability to recover from
training. Below are short descriptions of substances from Mother Nature’s sports pharmacy, which
may prove to be powerful alternatives for you in your quest for bodybuilding excellence.

Common Antioxidant Table 22-7

Supplements
Species of Free Corresponding
Green Tea Radicals Antioxidants
Green tea, also known as GTA
(green tea antioxidant) or GTE Green Tea (GTA)
(green tea extract), has been
clinically shown to be as much as Vitamin C
200 times more effective than
Vitamin E at scavenging hydrogen Superoxide Anion Glutathione (GSH)
peroxide and superoxide anion Radical
radicals. As such, it is perhaps the Maria Thistle
most potent antioxidant known to (assists GSH)
man in its ability to reduce: 1)
antibacterial and antiviral activity, Ginkgo Biloba
2) anti-platelet and hypo-
cholesterolemic activity, 3) risk of Green Tea (GTA)
lung cancer due to smoking, 4) risk
of skin damage and skin cancer due Glutathione (GSH)
to radiation, and 5) a host of other
age-related maladies. The active Hydrogen Peroxide
Maria Thistle
ingredients of green tea are called (assists GSH)
polyphenol catechins, with (-)-
Epigallocatechin Gallate (EGCg) Ginkgo Biloba
being by far the most important.
Green tea is unprocessed; black tea Vitamin C
is the same plant but highly Hydroxyl Radical
processed (oxidized); oolong tea, Ginkgo Biloba
also from the same plant, is
partially processed tea. Do not pour Dehydroepiandrosterone DHEA
boiling water on green tea, as that
destroys it is beneficial effects. Singlet Oxygen Vitamin A (beta

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Instead use water heated to 180°F. carotene)

Bilberry Vitamin E
The active component of bilberries (succinate)
is the anthocyanosides. During
WWII, bilberry jam became very Glutathione (GSH)
popular among the allied forces
pilots because it promoted superior Maria Thistle
visual acuity, especially while flying (assists GSH)
at night. Both folklore and studies
show that bilberry extract: 1) Selenium and
protects blood capillaries, 2) Bilberry (assists
protects the heart, 3) shows Vitamin. E)
excellent anti-inflammatory action,
4) inhibits cholesterol-induced Ginkgo Biloba
atherosclerosis, and 5) inhibits
serum platelet aggregation Vitamin A (beta
(clotting). Its chief action as an carotene)
antioxidant is its powerful synergy
with Vitamin E. Vitamin E
(succinate)
Ginkgo Biloba
Native to China and Japan, the Nordihydroguaiaretic
Polyunsaturated Fatty
ginkgo tree lives over 1000 years! acid (NDGA)
Acid Radical
The active components of ginkgo
leaves are quercetin and the Selenium and
flavoglycosides. Ginkgo extract is Bilberry (assists
shown to: 1) reduce clots and Vitamin. E)
thrombi formation in the veins and
arteries, 2) increase cellular energy Maria Thistle
by increasing cellular glucose and (assists GSH)
ATP, 3) scavenge free radicals, 4)
prevent the formation of free Glutathione (GSH)
radicals, 5) reduce high blood
pressure, 6) promote peripheral Nordihydroguaiaretic
blood flow (especially to the brain), acid (NDGA)
and 7) ameliorate inner ear Organic/Fatty Acid (fromchapparal)
problems. Ginkgo also has been Hydroperoxides
shown to improve alertness, short- Maria Thistle
term memory and various other (assists GSH)
cognitive disorders.
Ginkgo Biloba
Maria Thistle
The active compound in maria Glutathione (GSH)
thistle is silymarin. It is known to:
1) be a potent hepatoprotector and Maria Thistle
Oxidized Protein
antihepatotoxic agent, thereby (assists GSH)
restoring normal metabolic function
to the liver, 2) promote cellular Ginkgo Biloba
regeneration via increased protein
synthesis, 3) aid in protecting the
kidneys, and 4) act as a powerful
antioxidant principally through its
sparing effects on glutathione

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(which also probably accounts for
its potency in improving liver
function).

Reliable Resources for Research

Remember, when you are in doubt about the truth, do the research yourself and make up your own mind.
The following online scientific journals contain great information about nutritional supplements (among
other things), and are highly recommended as places to begin your search. Both of these websites allow
free viewing of their back issues and have searchable databases. In the business of health, the Internet is
your friend!

• The Physician and Sportsmedicine Online www.physsportsmed.com

• The American Journal of Clinical Nutrition www.ajcn.org

Recommendations on Supplement Use for specific goals

Now that we have reviewed some of the supplements on the market today, we will cover the 10 most
common reasons why your client may want to use supplements and the recommended supplements for
each of their intended goals. For a more details on performance nutrition and supplementation, please
refer to our Specialist in Performance Nutrition course.

(1) To Lose Fat (4) For Anaerobic Energy

• Energy drinks (short- and medium-chain

• DHEA
glucose polymers)

• Energy drinks (long-chain glucose

polymers) • Medium-chain triglycerides (MCT oil)

• Meal replacement drinks with balanced

• Creatine monohydrate
micro- and macronutrients from high
grade sources

• Herbal Formulas (xaio pangmei, brindall

• Lactic acid buffers (e.g., baking soda)
berry, qing herb formulas)

• Coffee (caffeine)* • Pyridoxine alphaketoglutarate (PAK)

• Yerba mate (stereo-isomer of caffeine)* • Inosine

• Bifidobacteria • Herbal formulas

• Alpha ketoisocaproate (KIC) • Flaxseed oil

• Other lipotropic substances (5) For Aerobic Energy

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 • Energy drinks (long-chain glucose
(2) Get Stronger
polymers)

• Protein drinks with egg or whey

• Lactic acid buffers (e.g., baking soda)

• Coenzyme Q-10 (CoQ10)

• Ornithine alphaketoglutarate (OKG)

• Branched chain amino acids (BCAAs) • Octacosanol

• Insulin-like growth factors (Colostrum) • Ammonia scavengers

• L-Glutamine • Dimethylglycine (DMG)

• Herbal formulas • Inosine

• Alpha ketoisocaproate (KIC) • Herbal formulas

(6) For More Rapid Post-Experience

(3) To Builld Muscle Mass
Recovery

• Creatine monohydrate
• Creatine monohydrate

• Protein drinks with egg or whey • Branched Chain Amino Acids (BCAAs)

• Ornithine alphaketoglutarate (OKG) • L-Glutamine

• Branched chain amino acids (BCAAs) • Immune boosters (mumie)

• Medium-chain triglycerides (MCT oil) • White willow bark

• Insulin-like growth factors (colostrum) • Adaptogens (Siberian ginseng)

• L-Glutamine • Herbal insulinomimetic formulas

• Herbal formulas • Bifidobacteria

• Flaxseed oil
• Mumie
• Arginine

7) To Reduce Pain or Inflamation (10) For General Health

• Aspirin • Vitamin and mineral complex

• Antioxidants (vitamins A, C and E,

• Glutamin glutathione, selenium, green tea, ginkgo
biloba.

• White willow bark • Trace elements

• Aloe Vera • Immune boosters (colostrum, mumie,

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 echinacea, DHEA)

• Individual amino acids (many have specific

• DLPA (dl-Phenylalanine)
applications to health)

(8) For More Rapid Tissue Healing • Chaparral, maria thistle, anthocyanadins

• Cardiovascular tonics (garlic, onion, ginger,

• Vitamin C (1000 mg.) cayenne, skullcap, black cohash, goldenseal,
valerian, hawthorn berries)

• Insulin-like growth factors (colostrum) • Bifidobacteria

• Ornithine alphaketoglutarate (OKG)

*Supplements containing substances
• Glucosamines
banned by most sports governing bodies,
including the International Olympic Committee.
(9) For Better Mental Focus or
Arousal

• Phosphateidylserine (500 mg.)

• Careful meal balance and meal

scheduling will ensure that blood sugar
levels are kept stable.

The Preceeding Section was for information purposes only and is not intended to replace
the advice or practice of your doctor or other health professional. Always consult your
doctor before and while on a supplement program and before using drug treatment for any
reason.

Statutory Regulations

Every state has specific regulations regarding the legality of practicing the profession of a nutritionist and
offering recommendations on supplementation. The following are the Updated State Professional
Regulations as of September 2003.

• Licensing: Statutes include an explicitly defined scope of practice and performance of the
profession as illegal without first obtaining a license from the state.
• Statutory Certification: Limits the use of particular titles to persons meeting predetermined
requirements, while persons not certified could still practice the occupation or profession. (The
ISSA SPN course meets these requirements.)
• Registration: This is the least restrictive form of state regulation. As with certification,
unregistered persons may be permitted to practice the profession if they do not use the state
recognized title. Typically examinations are not given and enforcement of the registration
requirement is minimal.

For a complete listing of state regulations please visit the American Dietetic Association at:

www.eatright.org/Public/ContinuingEducation/100_9046.cfm

Unit Summary

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I. Sports supplements are part of the Dynamic Nutrition Approach. Scientific studies show that in addition
to well-known benefits of maintaining proper health, physical and mental performance may be enhanced
with sports nutrition supplements.

A. The FDA defines dietary supplements as:

1. Vitamins, minerals, herbs and other botanicals (except tobacco), amino acids, any dietary
substance for use by man to supplement the diet by increasing the total dietary intake and
a concentration, metabolite, constituent, extract or combination of any of the above-listed
ingredients.
2. Herbs are any part of a plant, which can be used as a medical treatment, nutrient, food
seasoning or dye and include diuretics and laxatives.

B. While Supplementation is an integral part of the ISSA Dynamic Nutrition Approach, each year
Americans spend billions on the health and fitness industry. Ploys and gimmicks will most likely continue,
however, knowledge is the best protection against fraudulent claims. Four easy rules to remember
regarding supplements are:

1. You don’t need all of them all the time.

2. You don’t have enough room in your belly for all of them all the time.
3. You can’t afford to buy all of them all the time.
4. Most are not capable of delivering all the benefits they claim to be able to; an integrated,
scientific approach is the only way to ensure optimal use of nutritional supplements.

C. A final point to consider is that every state has specific regulations that dictate the legality of offering
recommendations on supplementation.

Section 6: Unit 23 Outline

Exercise and Older Adults

Introduction

I. Exercise and Older Adults

A. Being Sedentary can be Hazardous to your Health

B. Age is No Excuse for Infirmity

C. Training Considerations

D. Contraindications

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 Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand your role as a Certified Fitness Trainer when

training older adults.
• Understand how to design an exercise program for older
adults.

Section 6: Injury and Disease

Introduction

As exercise principles move from the athletic realm to the medical setting, it is important for
you as a future ISSA fitness educator not only to have a good working knowledge of many
types of conditioning programs, but also to be able to apply them to situations other than
athletic populations. Strength training research has grown and will continue to grow rapidly.
Scientists are applying progressive resistance techniques to larger treatment groups and are

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 increasing the overall body of knowledge in this area of sports medicine.

In recent years, many health experts have concluded that medical science has (for many
chronic health problems) achieved about as much as can be expected in the battle against
sickness and premature death. Furthermore, based upon an increasing amount of evidence,
many experts have surmised that additional expenditures for health care cannot and will not
produce the financial benefits that could be achieved if every American adopted better
health practices — particularly a physically active lifestyle. In the past three decades,
several major epidemiological studies have demonstrated that regular physical activity is
associated with an improved quality of life and longevity. Several chronic health problems
and conditions exist that are still treated solely with conventional medical therapy. For
whatever reason, many members of the medical community are unaware of the therapeutic
— as opposed to preventative — role that exercise can have in health care.

The concept of exercise prescription is thought to be reserved for health care professionals.
Exercise prescription is the application of fitness principles to persons with medical
conditions. Although no ISSA trainer should EVER diagnose a disease or attempt to treat
diseases in a medical fashion — this would be unethical as well as illegal — it is imperative
for all future ISSA trainers to have a working knowledge of the many common medical
conditions that afflict clients today. Periodically, research the most recent medical and
sports literature and develop relationships with physicians, physical therapists, occupational
therapists, clinical counselors, dietitians and other allied health professionals; this will serve
as the foundation in which to design effective programs for those clients with special
medical conditions. In terms of exercise, a special population may be defined as a group
with a special medical condition who may require expertise and supervision to overcome
that medical situation.

As we have repeated on numerous occasions throughout the text, we as future personal

trainers have a tremendous influence on shaping the health attitudes and practices of those
around us. This section of the text is devoted to educating our future trainers on the
importance of exercises in the prevention of disease and injury for the benefit of your
friends, family members, co-workers, and clients.

Exercise and older adults

Special Section by Karl Knopf Ed.D

Clinically speaking, we begin to age from the moment of conception. As we approach our middle years, if
our bodies are not well cared for, the effects of normal aging begin to become apparent. Various organs
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and systems begin to display deterioration. The effects of this deterioration present themselves as heart
disease, arthritis, elevated blood pressure and low back problems to name a few. Other changes that
occur include decreases in hormone production and elasticity begins to diminish in muscles, skin and blood
vessels. Many of these adverse effects of aging can be reversed or slowed with the intervention of a
proper and regular exercise routine. No matter how well one maintains oneself, the physiological process
of aging will take its toll. Exercise does not stop the biological clock, but it can slow it considerably. Proper
exercise is imperative in maximizing physiological capacity.

Most researchers believe that the maximum life span in humans is slightly over 110 years. This life span
has remained unchanged for 300 years in spite of tremendous advances in public health. Scientists
suggest that we should not experience a steady decline in health starting in our 30s, but rather live
successfully into our 80s before bodily systems start to break down.

Average life expectancy in the United States has increased dramatically in this century, from about 47
years in 1900 to about 75 years in 1990. This increase is mostly due to improvements in sanitation, the
discovery of antibiotics, and advancements in medical care; but as scientists make headway against
chronic diseases such as cancer and heart disease, some think it can be extended even further.

Maximum human life span seems to be another matter. There is no evidence that it has changed in
thousands of years despite fabled fountains of youth and biblical tales of long-lived patriarchs. However,
the dream of extending life span has shifted from legend to laboratory in recent years as more
gerontologists than ever are exploring the genes, cells and organs involved in the aging process. With
each passing day they uncover more secrets to healthy living and longevity. Physical activity is one of
them.

According to a study done at Stanford University, longtime runners live longer lives and have less pain,
disability and disease than their sedentary peers. The longtime runners in this study were leaner, needed
less medication and had fewer joint problems than non-runners of the same age. This evidence is proof
positive that living an active life is beneficial.

The past surgeon general has estimated that close to 85% of our most dreaded diseases could be
prevented with appropriate lifestyle changes, including a good diet and regular exercise. Healthy lifestyles
behaviors and sensible exercise would not only prevent disease and untimely death but would improve the
quality of one’s life! No one wants to just survive; everyone wants to live fully. Regular exercise will foster
that goal!

Being Sedentary Can Be Hazardous To Your Health

The following list includes information and facts regarding the adverse effects associated with physical
inactivity.

• Inactivity and poor diet cause at least 300,000 deaths a year in the United States.
• Adults who are less active are at greater risk of dying of heart disease and developing diabetes,
colon cancer and high blood pressure.
• More than 60% of U.S. adults do not engage in the recommended amount of physical activity.
• Approximately 40% of U.S. adults are not active at all.
• Physical inactivity is more common among women than men, African American and Hispanic adults
than whites, older than younger adults, and the less affluent than more affluent individuals.
• Social support from family and friends is consistently and positively related to regular physical
activity.
• Inactivity increases with age. By age 75, about one in three men and one in two women engage in
no physical activity.

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• People with disabilities are less likely to engage in regular moderate physical activity than people
with no physical disabilities, yet they have similar needs to promote health and prevent lifestyle-
related diseases.
• Age Is No Excuse for Infirmity
• Dr. DeVries of USC has shown that men and women in their 70s and 80s can achieve levels of
vigor associated with people 30 years younger. This means that assuming there are no underlying
disorders, exercise can make an 85-year-old as strong as a 55-year-old person. Regular
participation in physical activity can raise the fitness level of an active 64-year-old to that of an
average, sedentary 30-year-old. Dr. Alex Lief of Harvard Medical School believes that exercise is
the closest thing we have to an anti-aging pill. He states, “Regular daily physical activity has been
a way of life for virtually every person who has reached the age of 100 in sound condition.” By the
year 2050, the expected life span will be 82 years of age. Nowadays, it is not surprising to hear of
people celebrating their 70th birthdays, but that was not the case 40 years ago.
• In 1980, the number of Americans older than 65 years of age was approximately 25 million.
Researchers predict that by the year 2030 that number will grow to over 63 million. Currently the
fastest growing segment of the population in the United States is the age group of 85 years and
over. With regular exercise there is no reason for this increasingly large group of older adults to
experience a significant decline in health.
• In 1984, Dr. Bortz, co-chairman of the American Medical Association’s Task Force on Aging and
past president of the American Geriatrics Society, took all the information he had gathered over
many years and compiled them in a review paper titled “Disuse and Aging” for the Journal of the
American Medical Association. Bortz concluded that if you recorded a list of all the changes in the
human body that are attributed to aging and then compiled a similar list of changes due to physical
inactivity, you would notice a striking similarity between the two lists. For example, changes
associated with both aging and inactivity include changes in muscles, bones, brain, cholesterol,
blood pressure, sleep habits, sexual performance, psychological inventory and so forth. The near
duplication of the lists demonstrates that many of the bodily changes we have always ascribed to
the normal aging process may really be caused by disuse. It is imperative that older adults
understand the significance of this information and are educated as to how to prevent many of
these changes with activity.
• The founder of the American Running and Fitness Association, Richard Bohannon, MD, says that
more than half of all older adults believe they get enough exercise through minimal walking and
routine activities. In truth, more strenuous activities provide greater fitness gains and more
preventative benefits; with proper supervision, older adults are perfectly capable of training at
higher intensities. Gerontologists tell us that once we reach the age of 50 the need for fitness is
even more crucial due to the many physiological changes that occur with age.
• Another myth of aging is that as you get older, you naturally become more fragile. However, when
we look at the bones of older runners, like the runners mentioned previously, we see minimal loss
of bone due to the continual force applied to the bones over many years of running. Wolf’s Law,
named for the German pathologist who first proclaimed it, states: “The robustness of a bone is in
direct proportion to the physical forces applied to that bone.” In short, if we remain active our
bones will remain strong. Participation in vigorous exercise and recreational activities regularly over
a lifetime can yield rewards garnered well into the later years of life. Adults who lead a sedentary
existence lose bone density and increase their risk of fracturing bones in accidents in their homes
or of becoming unable to perform daily living activities. People who continue to lead healthy, active
lives into their later years are at less risk for such serious and debilitating injuries. Researchers at
UCLA performed a study on 4,300 people. Of that population, only 12% who exhibited few or no
unhealthy habits became disabled over the next decade. Nineteen percent of those who had many
bad habits paid the price by way of illness, disability and death.
• Life involves a continuing series of choices. While advances in medical technology clearly contribute
to the decline of many diseases, it is generally accepted that changes in lifestyle and environment
have a great impact upon the prevalence and incidence of the major diseases of adulthood. Even
the subtlest of changes can result in significant benefit.
• Compelling information published in the American Academy of Physical Education Papers (1993),
revealed just how much impact the aging process can have on carrying out basic life functions and
quality of life. Of those adults 60 to 64 years of age, approximately 19% of men and 40% of
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 women studied were unable to or found it difficult to lift/carry 25 pounds. The information indicated
that 25% of men and 24% of women were unable to walk a quarter of a mile and 10% of men and
22% of women had difficulty doing heavy housework. These percentages increased drastically after
age 65.
• Extending life would not mean much if it simply meant living more years with disease and
disability. The same steps that add years to your life can add life to your years. Healthy habits not
only reduce the risk of fatal heart attacks and cancer, but also reduce other chronic ailments that
can be physically, psychologically and financially debilitating. The bottom line is this: The more
exercise has been a constant in your life the better your chances are of living long and well.
• Older adults who want to maintain physical and emotional independence must engage in regular
exercise. Most older adults fear losing their independence more than they fear death. Proper
exercise can help older adults prolong their independence. Unfortunately, many older adults believe
they are too old to start exercising. In fact, we are never too old to start an exercise program if it
is done prudently and with a physician’s input. Many of the deleterious effects associated with
aging are now being found to be the end result of the effects of hypo-kinetic disease (AKA: couch
potato syndrome). Unfit people will experience a decline in physiological performance of
approximately 2% per year while fit people will only decline by about 0.5% per year. Over a
lifetime that makes a significant difference!
• Experts on aging revealed through research that total bed rest for 21 days shows the same effects
seen in 30 years of aging. Scientists suggest that for every one hour of exercise performed, a
person will increase his/her life span by one hour. Very few of us die of old age; we die from the
result of diseases such as cancer and heart disease often seen in older, unhealthy persons. Many
health experts believe we die as a result of making poor health choices. Today we have knowledge
and resources available to make healthy choices. It was not too long ago that older adults were
discouraged from exercise and told to just sit in their rocking chairs. Today, experts agree that
exercise is one of those healthy choices that each of us can make, no matter what our physical
condition. Experts are continually discovering that health-related issues ranging from childbirth to
heart disease can be improved by the intervention of exercise. Study after study demonstrates that
proper exercise, in addition to making us look and feel better, actually lengthens and improves the
quality of our lives. Exercise = living longer.
• Aging affects the function of all body systems. In the book, We Live Too Short and Die Too Long,
Dr. Bortz said, “Almost everything we have been taught about aging is wrong. We now know that a
very fit body of 70 can be the same as a moderately fit body of 30.” We are now entering an
exciting time, when medical doctors, exercise physiologists and gerontologists are all redefining
what aging is. No longer should we expect to get sick, get heart disease, get Alzheimer’s disease or
any of the other maladies commonly associated with the passage of time.
• Think of an 80-year-old person and what comes to mind? Most of us, when we think of “aging,”
imagine becoming more and more disabled. This concept of aging is not what is programmed into
our bodies, but rather what has been projected by society. With exercise and proper care, people
can and are living longer and more active lives. The next 10 years of scientific breakthroughs will
lead to breathtaking increases in human longevity. The sunset years are beginning to see the light
of a new day.
• The stigma of slow decline associated with aging is no longer an issue for those who show interest
in fitness and health. In fact, athletically and nutritionally fit individuals can measure out at 10 to
20 years biologically younger than their chronological age. For decades we have accepted frail and
non-energetic persons among the older segment as the norm. Wrinkled skin, stooped shoulders
and halting steps have been expected characteristics with each year we grow older. Those
expectations are beginning to shift. Those professionals actively involved in exercise programming
for older adults strongly believe that stooped shoulders, halting steps and other so-called age
related conditions could be prevented or even corrected with proper exercise. Studies done on
older athletes have found that their metabolisms do not slow down as much as first thought, nor
does their muscle mass decrease as much. Scientists are proving in study after study that when
such deterioration does occur, it is not the result of old age, but again, disuse. Increasing research
supports the claim that chronological age is no big deal. We now have evidence that a fountain of
youth does exist. It exists in the form of your local fitness center, pool, and exercise class.

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 • Until a few years ago, most medical authorities would not have recommended that any of their
elderly patients be put on a strength training program. However, with current research showing the
ability to increase in muscle strength in persons over 80 years old, some other findings showing an
increase in bone density with strength training, increases in leg strength in patients over 90 years
old, reductions in cardiovascular risk factors, and a maintenance of strength even after many
programs were completed, it is now acceptable to have older adults, even past 90 years old
pumping iron. There are experts who speculate that a properly performed strength program may
actually inhibit many of the aging-related phenomena that are present in many persons in our
society, such as back kyphosis and scoliosis, muscle wasting, glucose intolerance and even weight
management problems.

Training Considerations

For our purposes, older adults will be divided into three categories:

Category 1: 55-to 60-years-of-age. May participate in most moderate weight training routines, with only
slight modifications (for joint problems, decreased ROM, any cardiovascular abnormalities).

Category 2: 65-to 80-years-of-age. Modify programs based on medical recommendations, ROM

limitations, signs of fatigue, muscle weakness, and joint pain.

Category 3: 80-years-of-age and above. Closely monitor, set low-exertion levels, emphasize individual
muscle group strength, overall posture, strength enhancement and avoiding injury.

As a group in general, older adults have been exposed to many years of inactivity. This may predispose
them to metabolic abnormalities, coronary risk factors, hyperlipidemia, hypertension and other problems.
Physically they may suffer from decreased range of motion (ROM), muscle strength and function, and
elasticity of connective tissue. Orthopedic problems such as kyphosis and arthritis also are prevalent in
this group.

A medical clearance is a must for all groups. They should have resting measures performed, such as blood
panels, EKGs and neurological assessments. These assessments will help evaluate chronological versus
fitness age in participants who, at 75, may be able to participate in the 50 to 65 classes, and vice versa.

Contraindications

Absolute

Severe coronary heart disease, arrhythmia (ventricular, atrial), uncontrolled hypertension 200/105, acute
myocarditis and or thrombosis.

Relative

Valvular heart disease, permanent pacemaker, cyanotic congestive heart disease, Marfan Syndrome,
chronic obstructive pulmonary disease (COPD), electrolyte imbalance (hypokalemia), uncontrolled
myxedema, uncontrolled diabetes, thyrotoxicosis, long Q-T syndrome of the EKG. Strength instructors
should understand which conditions may be aggravated by strength training before designing individual
programs. Consultation with a physician may be necessary in some instances.

Guidelines

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 • Strength Programs: Low to moderate intensity with higher amounts of repetitions, and you can
substitute any free weight exercise routines, which are difficult to perform with machine or partner-
assisted routines, until they reach a good base level of strength.
• Frequency: Two to three times per week, in conjunction with a cardiovascular program.
• Duration: Approximately 60 minutes total (30 minutes CV, 30 minutes of resistance training,
depending on the state of fitness of each participant. Build up to this duration gradually.
• Intensity: Low to moderate. Should be at approximately 50% to 80% of estimated VO2, or 60%
to 75% of maximum heart rate. RPE = somewhat hard.
• Flexibility after each session

The ISSA understands the tremendous amount of information necessary to be effective in assisting older
adults. While we have briefly covered some of the basic issues with regard to fitness and older adults, we
have merely scratched the surface. Therefore to contend with this need, the ISSA has a specialization
course that focuses on fitness for older adults. The course is written by Karl Knopf Ed.D and incorporates
the work of Dr. William Evans of Tufts University, who conducted some of the most comprehensive
published medical research on weight training and longevity for older adults. We urge you to consider
working with this wonderful group of people. As Dr. William Evans and Dr. Irwin Rosenburg stated in their
book Biomarkers, “Exercise is the prime mover in the drive to preserve vitality.” While exercise may be
merely an option for the young, it is imperative for older adults.

Unit Summary

I. The past surgeon general has estimated that close to 85% of our most dreaded diseases could be
prevented with appropriate lifestyle changes, including a good diet and regular exercise. Proper healthy
life style behaviors and sensible exercise would not only prevent disease and untimely death but would
improve the quality of one’s life!

A. Dr. DeVries of USC has shown that men and women in their 70s and 80s can achieve levels of vigor
associated with people 30 years younger. This means that assuming there are no underlying disorders,
exercise can make an 85-year-old as strong as a 55-year-old person.

B Older adults who want to maintain physical and emotional independence must engage in regular
exercise. Most older adults fear losing their independence more than they fear death. Proper exercise can
help older adults prolong their independence.

C. A medical clearance is a must for older adults. They should have resting measures performed, such as
blood panels, EKGs and neurological assessments. These assessments will help evaluate chronological
versus fitness age in participants who, at 75, may be able to participate in the classes geared toward
people ages 50 to 65 and vice versa.

D. Guidelines

1. Strength Programs: Low to moderate intensity with a greater number of repetitions. You can
substitute any free weight exercise that is difficult to perform with a machine or partner-assisted
exercise until the client reaches a good base level of strength.
2. Frequency: 2 to 3 times per week in conjunction with a cardiovascular program.
3. Duration: Approximately 60 minutes total (30 minutes CV, 30 minutes of resistance training,
depending on the state of fitness of each participant). This duration needs to be built up to.
4. Intensity: Low to moderate at approximately 50% to 80% of estimated VO2, or 60% to 75% of
maximum heart rate. RPE = somewhat hard.
5. Flexibility training after each session

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 Section 6: Unit 24 Outline

Exercise and Adaptive Fitness

I. Adaptive Fitness

A. Benefits of Increased Physical Activity

B. Changing Attitudes Toward Disabled Persons

C. Taking the "Dis" Out of Disability

D. Role of Exercise for the Disabled

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand what is necessary when dealing with clients’

special needs.
• Understand how to design an exercise program for clients
with special needs.

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Adaptive Fitness

Special Section by Karl Knopf, Ed.D.

True physical education implies the full involvement of the client’s mind and body in concert. From time to
time the idea arises that one can educate the mind and ignore the body. Dr. Claudine Sherrill stated, “To
develop the mind and neglect the body is analogous to developing a powerful jet engine without a
fuselage to carry it.” Yet, many times well-meaning rehabilitation counselors and special education
teachers tell the disabled to develop their cerebral qualities at the expense of their physical potential. By
neglecting the body, the deleterious effects of a sedentary lifestyle will manifest themselves.

Education through the “physical” has become a principle of both education and rehabilitation. One of the
many encouraging developments of recent years has been the realization that physical activity for the
disabled can make a major contribution to the quality of their lives. Being physically competent enhances
a person’s self-image and confidence, which are critical to social and intellectual growth. Julian Stein said
about the disabled, “Give me pride; give me substance; give me a life of my own and I will stop feeding
off of yours.”

Prior to the late 20th century the attitude toward the disabled was that of pity or sympathy. Today,
fortunately, attitudes toward the disabled are improving. As one of my students said, “I can think of ways
to deal with architectural barriers, but attitudinal barriers are far more difficult.” As teachers who work
with the disabled, we must remember that such a person is, first, a unique individual, and second,
happens to have a disability.

The 20th century saw much progress in attaining rights for the disabled. Within the past 30 years, vast
improvements have been made in enhancing the services and programs for the disabled within our
society. Many laws have been enacted to assist the disabled. Some of this legislation provides the impetus
for the physical educator and special educator to work together to assure quality education for the
disabled. The general theme of these and other laws is that education for the disabled should be free and
appropriate into the 21st century.

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Adaptive Physical Fitness (APF) is a diversified psychomotor and educational approach in which the
teaching styles and activities are modified to ensure success for each individual. In addition, it should
provide the opportunity for interactions that develop appropriate social skills. APF differs from typical
physical fitness in that it features individualized programs of instruction. APF may range from clinical
programs to post-rehabilitation. APF programs should focus on developing and maintaining muscular
strength and endurance, cardiovascular fitness, flexibility, posture, balance, perceptual-motor skills, and
gross and fine motor skills. The APF program should always be designed in conjunction with medical
consultation and recommendations from physical therapists and physicians.

Adaptive Physical Fitness professionals work with, not on, the disabled individuals. Typically, clients
involved in an APF program at the post-rehab level have acquired disabilities such as spinal cord injuries,
visual impairment and neuromuscular diseases. The focus of an APF program for these types of individuals
should be to develop and maintain health-related fitness and posture, along with continuing the skills they
acquired in therapy.

Adaptive Physical Fitness is designed to be therapeutic as well as educational. APF uses many of the tools
of physical medicine in an educational environment. The focus of APF is to increase the psychomotor skills
of disabled individuals and allow them the opportunity to achieve their greatest potential.

Benefits of Increased Physical Activity

• Maintains optimal health and decreases incidence of secondary health problems related to disuse
syndrome
• Increases muscular strength and endurance
• Increases flexibility
• Improves cardiovascular function and blood lipid management
• Reduces risk factors responsible for cardiovascular disease
• Reduces obesity and glucose intolerance
• Lessens or eliminates depression
• Improves sleep
• Enhances self-esteem and a feeling of control
• Improves basic motor skills
• Makes activities of daily living easier
• Turns handicaps into disabilities

Key Points

A sound APF program should address the major components of physical and motor fitness. These
components are:

• Agility
• Balance
• Body composition
• Cardiovascular endurance
• Flexibility
• Muscular endurance
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 • Muscular strength
• Neuromuscular coordination
• Power
• Speed

Changing Attitudes toward Disabled Persons

Attitudes toward persons with disabilities are often reflected in the labels used to identify and group them.
Medical labels do have some benefit, but incorrect or improper use of labels can stigmatize individuals and
groups. Stigmatization generates sympathy or fear toward persons with disabilities and, of course, is not
desirable.

Another problem with labels is that they tend to segregate people. Stigmatization and stereotyping may
lead to prejudice and discrimination in social, educational and vocational settings. Persons with disabilities
are often externally limited much more by society’s attitudes regarding the disability than by the actual
disability itself. The familiar social-psychological axiom states that, “What you think of me, I will think of
me, and what I think of me, I will become.”

Terms that influence attitudes, and therefore warrant differentiation from each other, are handicap,
disability and impairment. These terms are not synonymous. Handicap is generally defined as anything
that prevents the attainment of one’s goals (Sherrill, 5th ed. 1998). A person is handicapped if he/she
encounters impediments or disadvantages that limit success in a given situation. Thus, being handicapped
is situation-specific; i.e., a person may be handicapped in one situation but not in others. In contrast, the
term disability refers to the presence of a medical condition. Participants in an adaptive fitness program
may have either congenital or acquired disabilities. A person may have a disability because of a spinal
cord injury to the thoracic vertebra, leaving the individual disabled or paralyzed in the leg muscles. This
person is handicapped if stairs are the only means to get to the second floor. If an elevator is provided,
however, then no handicap exists because the individual is able to accomplish the objective of getting to
the second floor. This same person may not be handicapped at all in regard, say, to archery, if upper body
strength was not affected by the disability. Unfortunately, the word handicapped is still used
interchangeably with disability in many legislative, educational and administrative circles. Even federal
legislation—e.g., Public Law 93-112, Public Law 94-142 (the Americans with Disabilities Act)—has utilized
words such as “handicapped” and “disabled” synonymously.

Professionals who work in adaptive fitness programs must remember that the participants are individuals
first and disabled second. It is less desirable to use the term epileptic than the phrase, “person with
epilepsy.” The former defines the person in terms of his/her limitations while the latter places individuality
first. It is valid to assume that, taken as a total human being, a person with a disability can do more than
he/she cannot do. Terms currently in vogue in reference to persons with physical disabilities are physically
challenged and differently abled. The bottom line is to be sensitive to word choices that have negative
connotations (which include cripple, victim, invalid, abnormal, wheelchair-bound or -confined and gimp).
These words have negative connotations because they define the individual in reference to his/her
limitations. Our purpose and goal is to take the “dis” out of disability until we find only ability!

Taking the “Dis” Out of Disability

There is virtually no chronic condition that cannot be positively influenced by proper exercise and a caring
instructor. If you desire to be an effective teacher of the physically limited, you must be willing to adapt,
modify and create until your client is successful.

The way a society cares for its less fortunate is a reflection of the level of that society. As our society
ages, more and more individuals are acquiring disabling conditions. Demographics show that soon a large
percentage of the population will manifest some type of chronic condition. Unfortunately, many fitness
professionals are unprepared to effectively train this important segment of the population. With the

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adoption of the Americans with Disabilities Act, all public facilities must be accessible to persons with
disabilities. Without properly trained instructors to implement exercise programs, persons with disabilities
will be programmatically excluded from gyms and health clubs. It is imperative that fitness professionals
be trained to work with this important segment of the population and work with management to remove
attitudinal and physical barriers to make the gym accessible to all.

Individualizing an exercise program for a person with special needs can be extremely challenging for even
the most seasoned professional. To be a respected member of the disabled person’s treatment team, it is
critical to always solicit input from your client’s physician and therapist regarding exercise protocols.
Improper exercise programs can be just as harmful as no exercise at all. The current evidence suggests
that people with disabilities can benefit from sensible exercise routines. More than four out of five people
over the age of 65 have at least one chronic condition. A recent study revealed that the six most prevalent
chronic conditions seen in older people are: arthritis, hypertension, hearing impairments, heart disease,
vision loss, and assorted orthopedic conditions.

Exercise is especially appropriate for clients with disabling conditions for myriad reasons. Today it is
common to see healthcare professionals recommend exercise for rehabilitative purposes to almost
everyone.

Role of Exercise for the Disabled

The role of exercise intervention for chronic conditions is to increase functional fitness without
exacerbating existing conditions. An adaptive program is designed to provide a disabled client the
opportunity to participate in fitness activities that are not otherwise easily performed. The goal of an
adaptive fitness session for a client with a disability is improved fitness, mobility, and self-efficacy.

The adaptive fitness program can be enjoyed by virtually anyone with a disability, but it is especially
appropriate for people with orthopedic and joint dysfunctions. Persons with obesity, ambulatory
limitations, and low-back syndrome conditions do extremely well within an adaptive aquatic setting. In
fact, there are only a few conditions where the implementation of an exercise program would be
contraindicated.

Physical activity for all is our goal!

Summary

I. Adaptive Physical Fitness (APF) is a diversified psychomotor and educational approach in which teaching
styles and activities are modified to ensure success for each individual.

A. The focus of APF is to increase the psychomotor skills of disabled individuals and allow them the
opportunity to achieve their greatest potential.

B. APF programs address the major components of physical and motor fitness including: agility, balance,
body composition, cardiovascular endurance, flexibility, muscular endurance, muscular strength,
neuromuscular coordination, power and speed.

C. There is virtually no chronic condition that cannot be positively influenced by proper exercise and a
caring instructor. If you desire to be an effective teacher of the physically limited, you must be willing to
adapt, modify and create until your client is successful.

D. The role of an exercise intervention for chronic conditions is to increase functional fitness without
exacerbating existing conditions.
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E. The goal of an adaptive fitness session for a client with a disability is improved fitness, mobility and
self-efficacy.

Section 6: Unit 25 Outline

Exercise and Our Youth

I. Exercise and Our Youth

A. Training Considerations
B. Contraindictations
C. Recommendations

Self-Quiz (7 questions)

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 LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand what training considerations and

contraindications to make when training youth.
• Understand how to design an exercise program for youth
clientele.

Exercise and our youth

Portions of this section have been adapted from ISSAs Youth Fitness Trainier course by Thomas D. Fahey,
Ph.D.

America is faced with an obesity epidemic that extends to our youth. Physical education programs in the
schools are under-funded and often administered by teachers with little training or practical experience in
sports, training and exercise physiology. Special youth populations are also potential clients. Children with

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diabetes, asthma, spinal cord injury, amputation, mental retardation, and cerebral palsy could benefit
from the services of a knowledgeable trainer. Families of these children may have discretionary income
that could pay for your services. You could help these young people improve their physical capacities for
sport or health and well being.

Children are not miniature adults. You cannot use the same training methods or motivational techniques
on growing children as you do with mature adults. Children are different from adults anatomically,
physiologically, and emotionally.

Children have immature skeletons. Their bones do not mature until somewhere between the ages 14 and
22 years — depending on gender and maturational levels. In girls, exercises during childhood can have a
critical effect on bone health that can last a lifetime. Children and adolescents sustain different types of
athletic injuries than adults and are particularly vulnerable to growth-related overuse injuries (e.g.,
Osgood Schlatter’s disease).

Children have immature temperature regulation systems. They have a large surface area in comparison to
their muscle mass, which makes them more susceptible to cold injuries. Also, children do not sweat as
much as adults do, so they are more susceptible to heat exhaustion and heat stroke. Their relatively low
muscle mass and immature hormone systems makes it more difficult to develop speed and power.
Breathing and heart responses during exercise are much different than in adults, which also affects their
capacity for exercise.

Growth and development also influences the capacity to learn motor skills. For example, rapid growth
during puberty makes it difficult to achieve stability in basic sports skills. Those who mature at an earlier
age will out perform late-bloomers — initially. The late-maturing athlete will often out perform the early
maturing athlete in high school, college or beyond.

Sports skill development in children depends on maturation of the brain and nervous system, muscles,
temperature regulation and endocrine systems. The personal trainer should know developmentally
appropriate training techniques that increase fitness for sports without causing injury.

Since 1963, there has been a relationship between lack of activity and increases in body fat levels for
children in the USA, as reported in the Physician and Sports Medicine in 1999. However, in the recent
past, several leading sports and fitness organizations have set guidelines for strength training for children.
Along with recommendations from the ACSM (2002), there is now a wide body of evidence concerning the
current state of fitness and optimum routines for children that enhance fitness and wellness. The task at
hand is to promote fitness, make it appealing to kids at different age levels, and help children maintain
active lifestyles beyond their youth.

Training Considerations

Category 1

Younger (5 to 12): Children have a lower tolerance to the demands of exercise. Strength training routines
should focus on learning basic lifting techniques, and not on lifting heavy weights. Beginners should
become familiar with the basics of exercise, such as heart rate monitoring, proper body alignment,
benefits of warm-up, etc. This age group should not perform high-resistance exercises. Repetitions of 10
to 15 should be used at all times.

Category 2

Older (12 to 17): Lifetime sports and activities should be emphasized with this group of adolescents and
young adults. Isolating activities that they enjoy (and are willing to participate in on a regular basis) is an
important key to developing a regular curriculum. Body image, peer acceptance, self-esteem, goal-setting
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and personal achievements are part of this group’s concerns. Strength training may be a prime motivator
for adolescents who may have a distorted body image. Toning and sculpting muscles, improving posture
and mastering difficult weight training techniques is important for self-esteem. Parents and faculty
members should therefore be encouraged to keep kids engaged in resistance training as part of overall
fitness. Heavy weight and maximum lifts may still be contraindicated in the younger end of this age
group. Always recommend a physical exam by a trained healthcare provider prior to beginning a training
program for all youths.

Contraindications

Category 1

Younger (5 to 12): Training at too high of an intensity and duration. Training in hotter and more humid
environments, as thermoregulatory mechanisms are not fully developed. Sports injuries to the long bones
(epiphyseal plates), low back (L-4, L-5), and muscle injuries are problematic in this group.

Category 2

Older (12 to 17): Tendinous injuries (Osgood Schlatter’s), low initial fitness levels, excess bodyweight and
musculoskeletal disorders may all prohibit children from participating without permission from a physician.

Recommendations

Properly supervised strength training for children should be included in physical education classes, as well
as in community fitness programs and private fitness organizations. Teaching of resistance training
principles and their benefit to overall fitness will be important in maintaining children’s health. Boys and
girls can participate together in drills that improve speed, agility, strength, endurance, reaction time and
coordination.

Category 1

Younger (5 to12): Learn skills and coordination first. Examples include proper range of motion in lifting,
bilateral symmetry, handling free weights and power drills versus strength drills.

Category 2

Older (12 to 17): Increase in training intensity, preparation for sports competition, body toning and
general conditioning, increase of range of motion, enhancement of posture. Make it fun. Get feedback
from all students.

Boys and girls can indeed significantly improve their strength with resistance training. However, unlike
adults, neurological factors, as opposed to hypertrophic factors, are primarily responsible for these gains.
Once adolescents occur, testosterone levels in boy's increases from 20-60-ng/100 ml to 300- 600
ng/100ml. Girls' testosterone levels stay at 20-60 ng/100ml.

General Guidelines

• Warm-up and stretching should be performed before resistance training.

• Begin with light loads to allow for appropriate adjustments to be made. Increase loads gradually (5
to 10%) as strength improves.
• Workouts should not occur in succession but allow 1 to 2 full days between workouts.

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 • Two to three non-consecutive workouts are recommended.
• Multiple joint exercises can be used but the focus should be on form and technique rather than
weight lifted.
• Finally, encourage the kids to drink plenty of water before, during and after exercise.

Children and adolescents are natural markets for personal trainers. Many young people participate in
competitive athletics. They and their parents want health, fitness and athletic success. Children can
benefit from the services of a personal trainer, who has specific knowledge of youth fitness and
performance as well as more general knowledge of anatomy, physiology, exercise physiology,
performance measurement, training, sports psychology and sports nutrition. Personal trainers have an
impressive array of training, nutritional and psychological tools to help young athletes excel. At the same
time, coaches in high school and sports clubs are often poorly trained because of the sorry state of
coaching education in American colleges and universities. This presents opportunities for personal trainers
to fill the gap and help motivated young athletes to “be the best that they can be” on the playing field.
Understanding these opportunities, the ISSA has developed a specialization course, which focuses on
Youth Fitness Training, written by world-renowned exercise physiologist, Dr. Thomas Fahey.

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Unit Summary

I.Children are not miniature adults. You can’t use the same training methods or motivational techniques
on growing children as you do with mature adults. Children are different from adults anatomically,
physiologically and emotionally.
A. America is faced with an obesity epidemic that extends to our youth.

B. The task at hand is to promote fitness, make it appealing to kids at different age levels, and help
children to maintain active lifestyles beyond their youth.

C. Guidelines

1. Warm-up and stretching should be performed before resistance training.

2. Begin with light loads to allow for appropriate adjustments to be made. Increase loads
gradually (5% to 10%) as strength improves.
3. Workouts should not occur in succession but allow 1 to 2 full days between workouts.
4. Two to three non-consecutive workouts are recommended.
5. Multiple-joint exercises can be used, but the focus should be on form and technique rather
than weight lifted.
6. Finally, encourage the kids to drink plenty of water before, during and after exercise.

D. Teaching of resistance training principles and their benefit to overall fitness will be important in
maintaining children’s health.

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 Section 6: Unit 26 Outline

Exercise and Hypertension

I. Hypertension

A. Why You Should be Concerned about Hypertension

B. How You can Prevent Hypertension

C. How to Design an Exercise Program for a Hypertensive Individual

D. Dealing with the Reality of Hypertension

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand the role of exercise in controlling and preventing

hypertension.
• Understand how to design an exercise program for
hypertensive clients.

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Hypertension

Statistics indicate that an estimated 60 million Americans suffer from chronically elevated levels of arterial
blood pressure, a medical condition known as hypertension. In the vast majority of instances, high blood
pressure has no identifiable specific cause. Among the factors known to contribute to hypertension are
age, heredity, ethnic background, gender, obesity, sodium sensitivity, alcohol consumption, use of oral
contraceptives and sedentary lifestyle.

To determine the presence of hypertension, blood pressure must be taken by someone specifically trained
to conduct such a procedure. Almost all medical professionals (physicians, nurses, etc.) and many health
and fitness professionals are qualified to measure your blood pressure.

Blood pressure is the variable force of blood against the walls of arteries and veins created by the heart as
it pumps blood to every part of the body. As the heart beats each time, blood is ejected into the arterial
system, thereby raising pressure against the walls of the circulatory system. As the blood subsequently
flows into the veins, the pressure drops gradually.

The flow of blood through the body is regulated by a complex system of hormones, nerve signals and
other factors, which either widen or constrict small blood vessels called arterioles. Under normal
circumstances, the level of blood pressure fluctuates not only each time the heart beats but also according
to other factors, such as the level of physically activity, time of day and stress level.

A problem arises when the regulatory system for controlling blood pressure fails to function properly. The
arterioles in the body stay constricted, driving the pressure in larger blood vessels up. When this occurs,
the heart has to pump harder to keep blood flowing through the constricted vessels. When this occurs for
a sustained period of time, chronic hypertension results.

There are two critical issues associated with high blood pressure: Why there is cause for concern and what
should be done. An appropriate response to these inquiries can greatly lower the risk of developing this
potentially debilitating medical condition.

Why You Should be Concerned about Hypertension

Not surprisingly, because high blood pressure adds to the workload of the heart and arteries, hypertension
is a primary risk factor for coronary heart disease (the leading cause of adult deaths in the United States).
When the heart is forced to operate at a higher workload than normal for an extended period of time, it
tends to enlarge. Past a certain point, a very enlarged heart has a relatively difficult time meeting the
demands placed upon it.

An individual may have high blood pressure for years and never know it because often no outward signs
or symptoms exist. Eventually, if it remains undiscovered and nothing is done to treat it, artery walls can

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be damaged, leading to hardening (less elastic) and narrowing (scarring) of arteries and arterioles (a
condition known as atherosclerosis). In turn, this condition results in a reduction of blood flow to several
organs, including the heart, kidneys and eyes. In addition, the added demands on the heart may cause its
left ventricle wall to thicken, thereby decreasing the its efficiency. Collectively, untreated hypertension
increases the risk of both stroke and heart disease.

Preventing Hypertension

Since the specific cause of hypertension is generally unknown in almost 90% of cases, the measures
recommended to prevent high blood pressure cover a broad spectrum. Considerable research suggests
that the following steps can be effective in both preventing and treating high blood pressure:

• Maintain an appropriate bodyweight. Obese individuals are more than twice as likely to have high
blood pressure than others. If body fat is too high, even a small decrease in fat level can
significantly lower blood pressure.
• Limit alcohol intake to no more than two drinks a day. The bad news: Too much alcohol raises
blood pressure. The good news: Its effects are completely reversible.
• Do not smoke. Nicotine has been shown to constrict small blood vessels and raise blood pressure.
In addition, smoking increases the risk of heart attack in other ways.
• Moderate the amount of salt in the diet. Although diverse opinions exist regarding the relationship
between high blood pressure and salt intake, salt does appear to increase blood pressure levels in
sodium-sensitive individuals. (About half of hypertension sufferers are sodium-sensitive.)
• Consume adequate amounts of calcium, magnesium and potassium. A few studies suggest that
these minerals can have a positive impact on blood pressure.
• Exercise on a regular basis. Exercise has been found to have several interrelated benefits with
regard to blood pressure, including maintenance of a desirable bodyweight, reduction of the risk of
heart disease and strengthening the cardiovascular system.

Exercise Programs for Hypertensive Individuals

While drug therapy is traditionally considered to be the most effective form of treating high blood
pressure, regular exercise has been found to be a valuable and safe adjunct therapy for many
hypertensive individuals. In fact, a sound exercise program may serve as an effective non-drug alternative
for some hypertensives. In the past decade, substantial information has emerged concerning what
constitutes an appropriate exercise prescription for an individual suffering from high blood pressure.
Among the key factors that should be considered when designing an exercise program for a hypertensive
individual are the following:

• Non-weight-bearing or low-impact aerobic activities (e.g., walking, stair climbing, cycling,

swimming, etc.) should be emphasized, since a significant portion of hypertensives are obese or
elderly — both groups frequently suffer from a variety of lower-extremity orthopaedic problems.
• Exercise intensity should be kept at the low end of the intensity range (i.e., 40% to 65% of
VO2max or 50% to 75% of MHR). It should be noted that strong evidence exists regarding the fact
that high-intensity (greater than 70% of VO2max or 80% of MHR) aerobic exercise does not
produce beneficial effects on blood pressure.
• Rating of perceived exertion (RPE) should be used to monitor exercise intensity for individuals
taking antihypertensive medications (e.g., beta-blockers), which influence heart rate response. The
recommended RPE range for these individuals would be 10 to 13 (light to somewhat hard).
• Exercise duration should begin at 20 to 30 minutes of activity per session and progress to 30 to 60
minutes as adaptation occurs. Such a time frame for exercise duration should help to promote
weight loss, which has been consistently associated with reductions in blood pressure.
• Hypertensive individuals should be encouraged to exercise at least four times per week — although
exercising on a daily basis is preferable. A well-established effect of an acute bout of aerobic
exercise is a temporary reduction in blood pressure, which can last for several hours.

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 • A prolonged warm-up period (more than five minutes) is advised to ensure that the hypertensive
individual’s cardiovascular system is prepared for the upcoming physical activity. An adequate
warm-up reduces the hypertensive’s chances of experiencing a sharp and sudden rise in blood
pressure.
• An extended cool-down period (more than five minutes) is recommended so that a gradual
transition can be made from the conditioning activity back to the resting state. Cooling down helps
to prevent dizziness, light-headedness and fainting (all frequently associated with an abrupt
cessation of exercise, especially in hypertensive individuals taking vasodilating agents).

Dealing With the Reality of Hypertension

It follows that since little is known about the precise causal factors in the vast majority of hypertensive
cases, very few individuals can be certain about why they have been afflicted with this potentially
dangerous medical condition. What is known, however, is that common sense (in the form of adhering to
certain lifestyle guidelines) and regular exercise can have a positive effect on both preventing and treating
chronic high blood pressure. Proper lifestyle adjustments allow for effective blood pressure management.

Unit Summary

I. Statistics indicate that an estimated 60 million Americans suffer from a chronically elevated level of
arterial blood pressure, a medical condition known as hypertension. In the vast majority of instances, high
blood pressure has no identifiable specific cause.

A. Hypertension is a primary risk factor for coronary heart disease (the leading cause of adult deaths in
the United States). This is not surprising because high blood pressure adds to the workload of your heart
and arteries.

B. Considerable research suggests that the following steps can be effective in the prevention and
treatment of high blood pressure.

1. Maintain a desirable bodyweight.

2. Limit alcohol intake to no more than two drinks per day.
3. Do not smoke. Nicotine has been shown to constrict the small blood vessels and raise blood
pressure.
4. Moderate the amount of salt in the diet.
5. Consume adequate amounts of calcium, magnesium and potassium.
6. Exercise on a regular basis.

C. While drug therapy is traditionally considered to be the most effective form of treating high blood
pressure, regular exercise has been found to be a valuable and safe adjunct therapy for many
hypertensive individuals.

D. The following are key factors that should be considered when designing an exercise program for a
hypertensive individual.

1. Non-weight bearing or low-impact aerobic activities (e.g., walking, stair climbing, cycling,
swimming, etc.) should be emphasized.
2. Exercise intensity should be kept at the low end of the intensity range (i.e., 40% to 65% of
VO2 max or 55% to 85% of MHR).

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 3. The recommended RPE range for these individuals would be 10 to 13 (light to somewhat
hard).
4. Exercise duration should begin at 20 to 30 minutes of activity per session and progress to
30 to 60 minutes as adaptation occurs.
5. Hypertensive individuals should be encouraged to exercise at least four times per week —
although exercising on a daily basis is preferable.
6. A prolonged (>5 minutes) warm-up period is advised to ensure that the hypertensive
individual’s cardiovascular system is prepared for the upcoming physical activity.
7. An extended (>5 minutes) cool-down period is recommended so that a gradual transition
can be made from the conditioning activity back to the resting state.

E. By managing your life in an appropriate way, you increase the likelihood that you’ll be able to manage
your blood pressure in an acceptable, life-sustaining manner.

Section 6: Unit 27 Outline

Exercise and Diabetes

I. Exercise and Diabetes

A. Exercise Can Help

B. Choosing the Right Kind of Exercise

C. Moderation is the Key

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand the role of exercise for clients who have diabetes.

• Understand how to design an exercise program for diabetic
clientele.

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Exercise and Diabetes

The human body is a smoothly functioning food processor, transforming sugars, starches and other
components of your diet into energy — the energy you need to perform the daily tasks of life (sitting,
walking, lifting, etc.) For those who suffer from diabetes, the transformation of foodstuffs into energy does
not occur in as nearly an effective manner due to problems with insulin. Insulin is a hormone, which is
produced by the pancreas. Insulin plays an essential role in helping transport glucose (blood sugar) into
the cells where it can be changed into energy.

Although the exact cause of diabetes is unknown, what is known is that the body of a diabetic either does
not produce enough insulin or it cannot properly use the insulin it does make. These two circumstances
constitute the two major forms of diabetes — Type I (insulin-dependent) diabetes and Type II (non-
insulin-dependent) diabetes. Type I, also referred to as juvenile diabetes, occurs most often in children
and young adults. Type II, sometimes referred to as maturity-onset diabetes, usually occurs in adults over
40 years of age who are overweight. Of the two forms of diabetes, Type II is far more common —
accounting for about 90% of all of the victims of this chronic disease.

Because their bodies cannot properly handle glucose, all diabetics suffer from an elevated level of blood
sugar (hyperglycemia) — a condition that occurs when glucose levels in the blood build up and sugar spills
over into the bloodstream and the urine. The potential repercussions are enormous. More than 150,000
Americans die annually from diabetes and its complications. Not surprisingly, diabetes has also been
shown to increase the likelihood of suffering from heart disease, stroke, gangrene, kidney disease and a
serious eye disorder called retinopathy. Diabetes, for example, increases the risk of heart disease by a
factor of 2 to 4 and your chances of suffering a stroke by a factor of 2 to 6. In addition, diabetes is the

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number one cause of adult blindness in the United States — resulting in more than 5,000 new cases of
blindness annually.

Exercise Can Help

Exercise can have a significant effect not only in helping diabetics control their disease and reducing their
risk to its life-threatening complications, but also in greatly decreasing an individual’s chances of
developing the disease in the first place. In fact, research shows that exercise reduces an individual’s
likelihood of developing diabetes by more than half — including people who either are obese or are
genetically predisposed to the disease. Furthermore, in a major study at the University of California,
Berkeley, researchers found that expending an additional 500 calories per week through exercise can
reduce the risk of developing diabetes by 6%.

Exercise also can help those individuals who contract diabetes. Among the beneficial aspects of exercise
that are either directly or indirectly related to diabetes are: lowering excess blood sugar levels (by helping
transport glucose out of the bloodstream and into the cells where it can be used), strengthening the
muscles and the heart, improving circulation (thereby increasing blood flow to the body’s organs), and
reducing stress. Research indicates that collectively the aforementioned benefits of exercise can have a
positive impact on the risk of developing primary complications associated with diabetes — heart disease,
kidney disease, high blood pressure, nerve damage, blindness and impotence. In addition, exercise can
also help reduce the necessity for the circulatory-related amputations, which are related to the disease.
Finally, exercise helps individuals reduce excess weight — the reason many of them may have developed
Type II diabetes in the first place.

Choosing the Right Kind Of Exercise

Regular exercise has been shown to be an effective means to help control diabetes. Any exercise program
for a diabetic, however, should be designed in accordance with the type of diabetes and its severity.
Although some controversy exists regarding how exercise can best be incorporated into the “total”
treatment program for diabetes, certain guidelines have been identified to minimize potential exercise
hazards and maximize exercise benefits. Among those guidelines are the following:

• Diabetic individuals should undergo a complete medical evaluation before starting an exercise
program. Exercise is contraindicated for individuals with poor blood sugar control (i.e., their fasting
blood sugar levels exceed 250 mg/dl).
• Diabetics should be encouraged to monitor their blood sugar levels before, during and after
exercise. This step will allow individuals, along with their physician to assess the effects of exercise
on blood sugar levels and make any needed adjustments in food intake or the dosage of
medication. Available clinical data suggest that it is safe to exercise if a diabetic’s blood sugar level
is between 100 and 250 mg/dl.
• Unless limited by complications of the disease, diabetics can engage in the same types of activities
as non-diabetics. Obese diabetics (common for Type II) and those with eye or nerve damage
(typically seen in Type I) should avoid high-impact exercise activities and select non-weight

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 bearing or low-impact alternatives. (Note: Stair-climbing on an independent step-action machine
would offer the best combination of weight bearing and non-impact activity.)
• The intensity of exercise for diabetics should be very similar to what’s prescribed for healthy adults
(55% to 85% of MHR). Type II diabetics should, however, be advised to exercise at the low end of
the range since their prescribed duration and frequency of exercise tend to be high.
• Type I diabetics should be advised to exercise 20 to 30 minutes per session. In contrast, Type II
diabetics should be encouraged to exercise for a longer duration (40 to 60 minutes per session) to
promote weight loss.
• Both types of diabetics should be encouraged to exercise daily. A regular, consistent exercise
pattern helps diabetics to more effectively balance their training with their diets and medications,
and thus maintain blood sugar control.
• Diabetics should be encouraged to exercise within one to three hours after a meal or snack, when
blood sugar levels are still relatively high.
• Because of the insulin-like effect of exercise, diabetics who engage in physical activity without
adequate food ingestion (especially carbohydrate) are at high risk for experiencing hypoglycemia
(low blood sugar).
• Type I diabetics should be instructed to: 1) avoid exercising during periods of peak insulin activity
or take special precautions (e.g., consume a light meal or carbohydrate snack), and 2) alter the
insulin injection site to an area not primarily involved in the exercise (the abdomen tends to be an
effective location) to prevent exercise-induced hypoglycemia.
• Diabetics should be instructed to always carry a form of fast-acting carbohydrate (e.g., juice, soft
drinks, candy, glucose tablets, etc.) in case of a hypoglycemic emergency.
• Diabetics should be encouraged to exercise with a partner who is aware of the signs, symptoms
and treatment of hypoglycemia. If diabetic individuals choose to exercise alone, they should be
instructed to wear diabetic identification tags — this will help to ensure that they receive proper
treatment in the event they become ill while exercising.
• Diabetics (especially Type I) should be advised to avoid exercising in extreme heat due to their
increased susceptibility for anhidrosis (failure of the sweating mechanism). As a general rule,
diabetics should curtail exercise when the ambient temperature is above 90 degrees Fahrenheit
and, concurrently, the relative humidity is above 60%.
• Diabetics should be instructed to check their feet carefully before and after exercise, because they
have an increased susceptibility to infection. They should watch for skin lesions, blisters,
discoloration or swelling, and consult their physician if any of these appear.
• Strength training at a low-to-moderate intensity level (12 to 20 repetitions per set) can be
incorporated into the total fitness program for diabetics. Recent evidence suggests that strength
training, like aerobic training, can improve glucose uptake by exercising the skeletal muscles.
(Note: Given the fact that individuals with diabetes are prone to high blood pressure, they should
avoid high-intensity, maximum effort lifting.)

Moderation is the Key

Regular exercise can certainly be sound medicine for diabetic sufferers. They should keep in mind,
however, that for them, more is not better. Experts warn that they should not overdo it. If physical
activity is too intense, blood sugar levels may actually rise, not fall. As a result, a moderate step-by-step
exercise program is recommended. Reasonable efforts yield maximum benefits. Nothing could be sweeter,
particularly for the diabetic.

Unit Summary

I. More than 150,000 Americans die annually from diabetes and its complications. Diabetes has also been
shown to increase the likelihood of suffering from heart disease, stroke, gangrene, kidney disease and a
serious eye disorder called retinopathy.

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A. Exercise can have a significant effect not only in helping diabetics control their disease and reducing
risks of its life-threatening complications, but also in greatly decreasing an individual’s chances of
incurring the disease in the first place.

B. Among the beneficial aspects of exercise that are directly or indirectly related to diabetes are:

1. Lowering excess blood sugar levels (by helping transport glucose out of the bloodstream
and into the cells where it can be used).
2. Strengthening the muscles and the heart, improving circulation (thereby increasing blood
flow to the body’s organs).

a. Reducing stress.

C. Regular exercise has been shown to be an effective means to help control diabetes. Any exercise
program for a diabetic should be designed in accordance with the type of diabetes and its severity.

D. Guidelines

1. 1. Diabetic individuals should undergo complete medical evaluations before starting an

exercise program.
2. Diabetics should be encouraged to monitor their blood sugar levels before, during and after
exercise.
3. Unless limited by complications of the disease, diabetics can engage in the same types of
activities as non-diabetics.
4. The intensity of exercise for diabetics should be very similar to what is prescribed for
healthy adults (55% to 85% of MHR).
5. Diabetics should be instructed to always carry a form of fast-acting carbohydrate (e.g.,
juice, soft drinks, candy, glucose tablets, etc.) in case of a hypoglycemic emergency.
6. Diabetics should be encouraged to exercise with a partner who is aware of the signs,
symptoms and treatment of hypoglycemia.
7. Diabetics should be instructed to check their feet carefully before and after exercise (for
swelling), because of their increased susceptibility to infection.
8. . Strength training at a low/moderate intensity level (a range of 12 to 20 repetitions per
set) can be incorporated into the total fitness program for diabetics.

E. Regular exercise can certainly be sound medicine for diabetic sufferers. A moderate step-by-step
exercise program is recommended.

Section 6: Unit 28 Outline

Exercise and Arthritis

I. Exercise and Arthritis

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 A. Keep those Joints Moving

B. Impact on Your Health

C. Protect Yourself

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand the role of exercise for clients who have arthritis

and what steps to take to allow them to maintain a fitness
lifestyle.
• Understand how to design an exercise program for diabetic
clientele

Exercise and Arthritis

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In general terms, arthritis refers to a disease that causes pain or stiffness in skeletal joints. Collectively
representing more than (100) different types of arthritis, the term “arthritis” refers to a debilitating
medical condition that affects more than 37 million Americans at any given time. Over and above the
human toll imposed by arthritis (i.e., the disease partially disables 1.5 million Americans and completely
disables another 1.5 million), the cost of arthritis is substantial. The Arthritis Foundation states that
arthritis has a cost that goes beyond pain — medical care, lost wages, insurance, lost income taxes,
homecare services, etc. Conservative estimates of the annual cost of arthritis place the total at
approximately $15 billion per year (and rising).

Pain and cost notwithstanding, one of the most dismaying aspects of arthritis is the fact that no known
cure exists for the disease. In some instances, the cause of arthritis is known — an injury to the joints,
the result of an infection such as lyme disease, the by-product of medication, etc. In other cases,
physicians can only hypothesize about the causal factors. Age is often cited as a leading cause of arthritis.
Almost half the cases of arthritis involve osteoarthritis — an age-related condition. To date, however, no
one has been able to identify why an individual’s joints wear out. Other noted causes of arthritis include
food allergies, heredity, nervous system malfunction, and attack on the body’s immune system by
unidentified microbes.

Whatever the cause, arthritis has seven basic major warning signals: swelling in one or more joints, early-
morning stiffness, recurring joint pain or tenderness, lack of normal range of motion in a joint, obvious
redness and warmth in a joint, unexplained substantial weight loss, fever or weakness in conjunction with
joint pain, and any symptoms similar to the aforementioned that last for at least two weeks. Once the
onset of arthritis has been identified, a key question that every arthritis sufferer must address is: What
can be done to treat or control this painful condition?

Keep Those Joints Moving

While physicians exhibit some degree of diversity in their approach to arthritis treatment, many firmly
ascribe to the belief that regular exercise is an essential part of any arthritis-treatment prescription. This
proactive philosophy is in direct contradiction to the traditionally held myth that people with arthritis
should avoid exercise because of pain and possible joint damage. Unfortunately, doctors used to advise
arthritis sufferers to get plenty of rest — up to 12 hours a day. Over time, the medical community has
come to realize that too much rest ultimately makes arthritis symptoms worse, not better.

The effects of a sedentary lifestyle on arthritis sufferers can be substantial. Their joints stiffen up and
become even more painful. Their muscles become weaker. They lose stamina. Eventually, the ability to go
about even the most basic activities of daily life diminishes, causing some of life’s most fundamental tasks
(e.g., climbing stairs, playing with kids, etc.) to turn into exhausting chores. In addition, as people lose
the ability to perform simple every day tasks, they also tend to lose some sense of self worth — which in
turn often leads to myriad psychological problems (e.g., depression, hopelessness, fear, etc.).

Fortunately, exercise can help individuals who suffer from arthritis. Numerous studies have been
conducted in the last decade, which show that properly performed exercise can have several benefits for
arthritis sufferers. For example, medically sound exercise can improve strength, build stamina and
increase the capacity of joints to move freely through a full range of motion with less pain and swelling.
Proper exercise also enables some arthritis sufferers to reduce their intake of anti-inflammatory drugs.
Finally, exercise can also have a positive effect on the mindset of individuals who have arthritis. By
providing renewed levels of energy and a sense of hope and control over their condition, exercise can help
diminish and put to rest feelings of fatigue and hopelessness.

The value of exercise is not limited to one specific type of arthritis or to any one particular age group. For
arthritis sufferers, exercise reinforces the credibility of the dictum: “Use it or lose it.” Exercise has been
found to help those people with severe cases of arthritis (i.e., cannot walk or use their hands), as well as
individuals with mild or moderate arthritis. In addition, exercise has also been shown to help relieve the

475
arthritic symptoms of individuals with joint replacements and individuals who are relatively advanced in
age.

Impact on Your Health

Once an arthritis sufferer has made a commitment to exercise, the basic questions that must be
addressed are the same as when developing any kind of exercise program: What kind of exercise? How
much? How hard? How often? The Arthritis Foundation offers six basic guidelines for helping individuals
with arthritis exercise safely and effectively:

• Consult with a physician to develop an appropriate exercise program.

• Begin the exercise program at a safe (i.e., comfortable) intensity level, and gradually increase it as
the body responds to the demands placed upon it.
• Get sufficient rest between exercise bouts. Rest (i.e., sleep and nap) as much as needed.
• Exercise at least twice a day.
• Develop a structured plan for exercising daily (i.e., time and place) and stick with the plan as much
as possible.
• All other factors being equal, exercise during a time when the individual has the least amount of
pain, stiffness and fatigue.

Arthritis sufferers should include three basic types of exercise in their workouts: full range-of-motion
exercises (flexibility); strength training exercises (muscular fitness); and aerobic training (aerobic fitness).
Flexibility exercises are essential to joint health. Moving a joint (hopefully through a full range of motion)
helps keep it relatively healthy in a number of ways. For example, moving a joint increases lubrication by
inducing the manufacture of synovial fluid, which is then distributed over the cartilage and circulated
throughout the entire joint space. Moving a joint also increases the circulation of blood and lymph fluid
into and out of joint structures and adjacent soft tissues. This process aids in reducing joint swelling,
removing waste products, and delivering nutrients and oxygen to the joint tissues (which facilitates
healing).

Performing strength training exercises on a regular basis also has considerable benefits for people with
arthritis. Since most individuals with arthritis tend to suffer from strength deficits, proper strength training
can raise their levels of muscular fitness to a point where they are more capable of being able to handle
the physical demands of daily living. Getting back to normal levels of strength (or close to it) can make a
major difference in the world of someone who lacks the functional capacity attendant to an acceptable
level of personal independence and a sense of personal dignity. Most strength training programs for
arthritis sufferers tend to focus on exercises that work the major muscles surrounding the body’s joints,
which are most likely to be affected by arthritis, such as those of the hips, shoulders and knees.

The third major component of an exercise program for arthritis sufferers is aerobic training. The value of a
sound aerobic exercise regimen for individuals with arthritis is even higher than for those without malady.
All other factors being equal, aerobically fit individuals have more energy throughout the day for all kinds
of activities. For arthritis sufferers, the ability to exert themselves without undue fatigue can have a major
impact on the quality of their lives. The main criterion for selecting a modality for aerobic training is that it
does not subject the exerciser to undue levels of orthopedic stress. Among the more appropriate low-
impact modalities commonly used by arthritis sufferers are water exercise, exercise cycles and
independent stair-climbing machines.

Protect Yourself

The potential value of regular exercise extends beyond the benefits of being able to treat and control
arthritis once it strikes. Recent evidence also indicates that proper exercise can help reduce the likelihood
that arthritis will develop. Take a proactive approach to health. Exercise regularly. Jump-start your joints.

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Unit Summary

I. In general terms, arthritis refers to a disease that causes pain or stiffness in skeletal joints. The Arthritis
Foundation states that arthritis has a cost that goes beyond pain—medical care, lost wages, insurance,
lost income taxes, homecare services, etc. Conservative estimates of the annual cost of arthritis place the
total at approximately $15 billion per year (and rising).
A. Exercise can help individuals who suffer from arthritis. Numerous studies have been conducted in the
last decade showing that properly performed exercise can have several benefits for arthritis sufferers.

B. The Arthritis Foundation offers six basic guidelines for helping individuals with arthritis exercise safely
and effectively:

1. Consult with a physician to develop an appropriate exercise program.

2. Begin the exercise program at a safe (i.e., comfortable) intensity level and gradually
increase it as the body responds to new demands.
3. Allow sufficient rest between exercise bouts. Rest (i.e., sleep and nap) as much as needed.
4. Exercise at least twice a day.
5. Develop a structured plan for exercising daily (i.e., time and place) and stick with it as much
as possible.
6. All other factors being equal, exercise during a time when the individual has the least
amount of pain, stiffness and fatigue.

C. Arthritis sufferers should include three basic types of exercise in their workouts: full range-of-motion
exercises (flexibility), strength training exercises (muscular fitness) and aerobic training (aerobic fitness).

D. Recent evidence indicates that proper exercise can help reduce the likelihood of developing arthritis.
Take a proactive approach to health. Exercise regularly. Jump-start your joints.

477
 Section 6: Unit 29 Outline

Exercise and Coronary Heart Disease

I. Coronary Heart Disease

A. Coronary Artery Disease Risk Factors

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand how to properly train a client who has had

coronary heart disease.
• Understand how to design an exercise program for clientele
with coronary heart disease.

478
Coronary Heart Disease

Heart disease is the leading cause of death in the United States. According to the Center for Disease
Control, nearly 950,000 Americans die from heart disease and stroke every year — that’s one every 33
seconds. The enormity of this catastrophic total can perhaps be better understood when compared to the
fact that since Acquired Immune Deficiency Syndrome (AIDS) was first diagnosed, the cumulative number
of reported deaths due to AIDS is slightly more 450,000.

Fortunately, exercise can help prevent you or your client from becoming victims of heart disease. Contrary
to the misconception that heart disease is the inevitable consequence of aging, research has shown that
lifestyle — too much saturated fat, too much sodium, too much alcohol, smoking, too much body fat and
not enough exercise — are the predominate contributing factors of heart disease.

In other words, by ignoring the single muscle that may matter most in your body — your heart — and
catering to some of the muscles that need the least attention — those involved with ingesting foodstuffs —
you expose yourself to the deadly risks of a condition that may be best characterized as “heart roulette.”
Just as serious and even more deadly than its Russian counterpart, “heart roulette” involves more than 20
different diseases of the heart and its vessels. The more you abuse your body through diet and the more
you ignore the need to have a healthy heart, the greater the likelihood that you will suffer from heart
disease.

The most serious form of heart disease is coronary heart disease (CHD). Nearly one-third of all non-
accidental deaths that occur in the United States each year are the result of CHD. Essentially, CHD
involves the obstruction of the blood supply to the heart through the three coronary arteries. The
narrowing, hardening and blocking of these arteries through the buildup of lipids in the inner layers of
these arteries leads to CHD. In turn, when part of the heart muscle does not get enough blood (oxygen
and nutrients), it begins to die. Eventually, the coronary artery is occluded to a point where the individual
suffers a heart attack. The serious nature of heart attacks is reflected in the fact that more than one out of
three individuals die from their first heart attack, and that more than 300,000 Americans annually die
from heart attacks before reaching the hospital.

A number of extensive clinical studies have identified the major risk factors for heart disease. Although not
an inclusive list, the factors that account for most of the heart disease in the United States are listed in
Table 30-1. The danger of getting heart disease and suffering a heart attack increases with the number of
risk factors.

479
Considerable research has left no doubt that a strong inverse relationship exists between physical exercise
and coronary heart disease risk. Regular exercise is integrally linked to decreased cigarette smoking,
lower prevalence of high blood pressure and a more desirable blood lipoprotein profile. In addition,
exercise has been shown to help control obesity and stress, which are also confirmed risk factors for CHD.

Of the known modifiable factors for CHD in the United States, cigarette smoking is perhaps the most
important. More than 10 million Americans suffer from some degree of debilitating and chronic disease
caused by smoking. The number of deaths annually in the United States that can be directly attributed to
smoking exceeds 350,000. Fortunately, exercise appears to have a positive effect on smokers. One study
reported that more than 75% of the adult male and female smokers who had taken up regular
recreational running stopped smoking. Another study found that increased physical activity resulted in
fewer cigarettes smoked per day. Yet another investigation produced evidence suggesting that aerobic
exercise reduces a smoker’s desire for cigarettes. While more scientifically controlled studies are needed
to precisely define the relationship between exercise and smoking, one fact is clear: Very few physically
active people smoke.

The findings of several studies suggest that regular exercise — particularly when combined with sound
dietary practices — will reduce the risk of developing either hypertension or hypercholesterolemia.
Research has shown that the beneficial effects of exercise for hypertensives include lowering of blood
pressure by suppressing the sympathetic nervous system, normalizing kidney function, decreasing insulin
secretion, and altering the sensitivity of blood vessel receptors. Exercise also produces favorable changes
in blood lipid and lipoprotein profiles. Total cholesterol, triglycerides and low-density lipoprotein
cholesterol all decrease, while high-density lipoprotein cholesterol increases. Exercise also helps to control
obesity, which is another risk factor.

You can do something about “heart roulette.” Exercise your heart. While it’s not 100% foolproof, it does
offer you the best opportunity for a healthy, long life. Surely, you deserve no less.

Table 29-1: Coronary

Artery Disease Risk
Factors

Positive Risk Factors Defininf Criteria

Men >45 years; Women >55 years or premature

1. Age
menopause without estrogen replacement therapy.

MI or sudden death before 55 years of age in father or other

2. Family History
first-degree male relative.

Blood pressure =140/90 mm hg, confirmed by

3. Current Cigarette
measurements on at least tow separate occasions or on
Smoking or Hypertension
antihypertensive medication.

Total serum cholesterol >200 mg/dL (5.2 mmol/L) (if

4. Hypercholesterolemia lipoprotein profile is unavailable) or HDL < 35 mg/dL (0.9
mmol/L).

Persons with insulin-dependent diabetes mellitus (IDDM)

who are >30 years of age, or have had IDDM for >15 years,
5. Diabetes Mellitus and persons with noninsulin dependent diabetes mellitus
(NIDDM) who are >35 years of age should be classified as
patients with disease.

480
 Persons comprising of 25% of the population, as defined by
6. Sedentary Lifestyle/ the combination of sedentary jobs involving sitting for a
Physical Inactivity large part of the day and no regular exercise or active
recreational pursuits.

Negative Risk Factors Defining Criteria

1. High Serum HDL

>60 mg/dL (1.6 mmol/L).
Cholesterol

NOTES: It is common to sum risk factors in making clinical judgements. If HDL is high,
subtract one risk factor from the sum of positive risk factors, since high HDL decreases CAD
risk. Obesity is not listed as an independent positive risk factor because its effects are
exerted through other risk factors (e.g., hypertension, hyperlipidemia, diabetes). Obesity
should be considered as an independent target for intervention. * Adapted in part from the
Journal of the American Medical Association 269:3015-3023, 1993.

Summary

I. Heart disease is the leading cause of death in the United States. In 2000 alone, according to the
American Heart Association, almost 950,000 Americans died from heart disease.

A. Contrary to the misconception that heart disease is the inevitable consequence of aging, research has
shown that lifestyle — too much saturated fat, too much sodium, too much alcohol, smoking, too much
body fat and not enough exercise — are the predominate contributing factors to heart disease.

B. The most serious form of heart disease is coronary heart disease (CHD). Nearly one-third of all of the
non-accidental deaths that occur in the United States each year are the result of CHD. Essentially, CHD
involves the obstruction of the blood supply to the heart through the three coronary arteries.

C. Of the known modifiable factors for CHD in the United States, cigarette smoking is perhaps the most
important.

1. More than 10 million Americans suffer from some degree of debilitating and chronic disease
caused by smoking. The number of deaths annually in the United States that can be directly
attributed to smoking exceeds 350,000.

D. Risk Factors

1. Age: Men >45 years; women >55

2. Family history: Ml or sudden death before 55 years of age in father or other first-degree
male relative or before 65 years of age in mother or other female first-degree relative.

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 3. Smoking/Hypertension: Blood pressure is 140/90 mm hg, confirmed by measurements on
at least two separate occasions or on anti-hypertensive medication.
4. Hypercholesterolemia: Total serum cholesterol > 200 mg/dL (5.2 mmol/L) (if lipoprotein
profile is unavailable) or HDL < 35 mg/dL (0.9 mmol/L)
5. Diabetes mellitus
6. Sedentary lifestyle: jobs involving sitting for a large part of the day and no regular exercise
or active recreational pursuits

E. Research has shown that the beneficial effects of exercise for hypertensives include:

1. Lower blood pressure due to suppression of the sympathetic nervous system

a. Normalization of kidney function

2. Decreased insulin secretion

3. Altered sensitivity of blood vessel receptors

4. Positive changes in blood lipid and lipoprotein profiles

5. Decreased total cholesterol, triglycerides, and low-density lipoprotein cholesterol (LDL)

6. Increased high-density lipoprotein cholesterol (HDL)

Section 6: Unit 30 Outline

Exercise and Pregnancy

I. Pregnancy

A. Contraindications for Exercise During Pregnancy

B. The Aerobic Exercise Prescription for a Pregnant Woman

C. Precautionary Measures for Exercising While Pregnant

1. A Celebration of Life

Self-Quiz (8 questions)

LEARNING OBJECTIVES

482
 After completing this unit you will be able to:

• Understand the precautions to take when training a pregnant

client and how to ensure that she maintains her fitness
lifestyle.
• Understand how to design an exercise program for pregnant
clientele.

Pregnancy

Sensible exercise can be a safe and productive undertaking for both a pregnant woman and her fetus.
Unfortunately, not a single medical school in the entire United States offers a required course in prenatal
exercise physiology for its graduates, and therefore, relatively few obstetricians have a working knowledge
of what constitutes sound exercise advice. As a result, misinformation and misunderstanding abound
regarding whether pregnant women should exercise during their pregnancies and, if they should, what
kinds of exercise prescriptions and exercise modalities are appropriate for them.

Fortunately, a growing body of evidence exists to support the belief that a pregnant woman can benefit in
numerous ways from sound exercise. Exercise can reduce the severity and frequency of back pain;
enhance prenatal weight management efforts; improve coping mechanisms and reduce levels of stress,
anxiety and depression; improve digestion and reduce constipation; enhance levels of energy to facilitate
the ability to perform the activities of daily living (ADLs); and reduce postpartum belly.

483
The key to achieving the aforementioned benefits of exercising during pregnancy is to ensure that no
contraindications exist for a pregnant woman to exercise and that her exercise regimen is medically
sound. Simply stated, an exercise program must not — under any circumstances — subject either the
expectant mother or her fetus to undue risk of injury or harm. Adhering to a few basic guidelines will keep
the focus of a pregnant woman who wants to exercise where it belongs — on safety.

Contraindications for Exercise during Pregnancy

Before a pregnant woman initiates an exercise program, she should be closely evaluated by her physician
to determine if any possible reason exists regarding why she could not safely participate in a medically
sound exercise program. Within the medical and exercise science communities, these reasons are
collectively termed as “contraindications.” The preeminent professional organization representing
obstetricians and gynecologists — the American College of Obstetricians and Gynecologists (ACOG) — has
developed a list of absolute and relative contraindications for aerobic exercise during training. Pregnant
women possessing absolute contraindications should not exercise, while those with relative
contraindications should be allowed to exercise only with the approval of their physicians. (Even with such
approval, these women should be closely supervised while exercising.)

Absolute Contraindications

Among the conditions that should preclude a pregnant woman from exercising are coronary heart disease,
ruptured membranes, incompetent cervix, premature labor, multiple gestation, vaginal bleeding, placenta
previa and a history of three or more spontaneous abortions or miscarriages. If, for any reason, any of the
aforementioned conditions arise after a pregnant woman has begun an exercise program, the fundamental
guideline remains unchanged: She should refrain from further exercise.

Relative Contraindications

A list of the factors that should be carefully evaluated before a pregnant woman initiates an exercise
program includes high blood pressure (hypertension), anemia or other blood disorders, thyroid disorders,
diabetes, palpitations or irregular heart rhythms, extreme weight fluctuations (high or low), a history of
precipitous labor, a history of intrauterine growth retardation, a history of bleeding during the current
pregnancy and an extremely sedentary lifestyle. Depending upon the results of the examination (which
must be performed by a physician), the expectant mother may or may not be allowed to participate in an
exercise regimen.

Table 30-1:

Exercise Recommendations for Pregnancy and Postpartum

1. During pregnancy, women can continue to exercise and derive health benefits even
from mild to moderate exercise routines. Regular exercise (at least three times per week)
is preferable to intermittent activity.

484
 2. Women should avoid exercise in the supine position after the first trimester. Such a
position is associated with decreased cardiac output in most pregnant women; because
the remaining cardiac output will be preferentially distributed away from splanchnic beds
(including the uterus) during vigorous exercise, such regimens are best avoided during
pregnancy. Prolonged periods of motionless standing should also be avoided.

3. Women should be aware of the decreased oxygen available for aerobic exercise during
pregnancy. They should be encouraged to modify the intensity of their exercise according
to maternal symptoms. Pregnant women should stop exercising when fatigued and
should not exercise to exhaustion. Weight-bearing exercises may under some
circumstances be continued at intensities similar to those prior to pregnancy. Non-
weight-bearing exercises, such as cycling and swimming, will minimize the risk of injury
and facilitate the continuation of exercise during pregnancy.

4. Morphologic changes in pregnancy should serve as a relative contraindication to the

types of exercise in which loss of balance could be detrimental to maternal or fetal well
being, especially in the third trimester. Further, any type of exercise involving the
potential for even mild abdominal trauma should be avoided.

5. Pregnancy requires an additional 300 kcal/d in order to maintain metabolic

homeostasis. Thus, women who exercise during pregnancy should be particularly careful
to ensure adequate caloric intake.

6. Pregnant women who exercise during the first trimester should augment heat
dissipation by ensuring adequate hydration, appropriate clothing and optimal
environmental surroundings during exercise.

7. Many of the physiologic and morphologic changes of pregnancy persist 4 to 6 weeks

postpartum. Thus, pre-pregnancy exercise routines should be resumed gradually based
upon a woman’s physical capability.

American College of Obstetricians and Gynecologists: Exercise During Pregnancy and the
Postpartum Period (Technical Bulletin # 189). Washington, DC: ACOG, 1994.

The Aerobic Exercise Prescription for a Pregnant Woman

485
Once the decision has been made that it is appropriate and safe for a pregnant woman to exercise, every
effort possible must be undertaken to ensure that her exercise regimen adheres to medically sound
guidelines. At a minimum, a comprehensive exercise program includes two major developmental focuses
— muscular fitness and aerobic fitness.

Decisions concerning the type, intensity, duration and frequency of aerobic exercise should be
individualized according to each pregnant woman’s particular needs. Accordingly, the most appropriate
aerobic exercise prescription is one that considers a woman’s current fitness level, the stage of her
pregnancy and her personal interests. As a starting point, the ACOG has published guidelines (refer to
Table 30-1) for aerobic exercise during pregnancy and the postpartum period.

All factors considered, some exercise modalities appear to be more suitable than others for a pregnant
woman. As a general rule, the most appropriate aerobic activities are those which offer little or low
orthopaedic trauma to their musculoskeletal systems, such as swimming, cycling, walking and
independent step-action mechanical stair-climbing. Women involved in running programs before the
advent of their current pregnancies can usually continue their running efforts provided they reduce the
intensity at which they run (i.e., by decreasing their running speed, by running only on level terrain and
by incorporating periodic walk-run breaks into their workouts).

Since the basic purpose of exercising during pregnancy is to allow a woman to maintain her level of fitness
and to be better able to handle the stresses involved in labor and delivery — as opposed to improving her
fitness level or her athletic performance abilities — the intensity, frequency and duration of an exercise
regimen for a pregnant woman is usually somewhat reduced. For example, the recommended exercise
intensity level for a pregnant woman is 50% of maximal oxygen uptake, as opposed to at least 60% for
her non-pregnant counterpart. Similarly, it is suggested that a healthy pregnant woman engage in aerobic
training approximately three times per week (on non-consecutive days) for 20 to 30 minutes per session.
The typical aerobic exercise prescription for non-pregnant women often involves more days of exercising
and considerably longer bouts of aerobic training.

A pregnant woman should:

Table 30-2:

Reasons to Discontinue Exercise and

Seek Medical Advice • Stay adequately hydrated.
• Keep the intensity level of her
1. Any vaginal discharge exercise at a moderate level.
• Avoid wearing clothing that is
2. Sudden swelling of the ankles, hands, and impermeable to water.
face • Be acutely sensitive to the
environmental conditions that
3. Persistent, severe headaches and/or visual exist at the time of the exercise
disturbance; unexplained spells of faintness or session (particularly the ambient
dizziness temperature and relative
humidity levels).
4. Swelling, pain and redness in the calf of • Keep the duration of her
one leg (phlebitis) exercise session to thirty
minutes or less to avoid
5. Elevation of pulse rate or blood pressure impairing blood flow to the
that persists after exercise exerciser’s uterus.
• Avoid prolonged (i.e., longer
6. Excessive fatigue, palpitations, chest pain than five minutes) bouts of
exercise in the supine (lying on
7. Persistent contractions (more than 6 to 8 her back) position.
per hour) that may suggest onset of • Eat a nutritionally sound diet
premature labor (i.e., consume sufficient

486
 8. Unexplained abdominal pain amounts of carbohydrates) to
ensure adequate levels of
9. Insufficient weight gain (<2.2 pounds per glucose are available.
month during last two trimesters)

Adapted from Wolfe, et al. ”Prescription of aerobic

exercise during pregnancy.” Sports Med 8:273-
301, 1989.

Precautionary Measures for Exercising while Pregnant

Exercise regimens for pregnant women must always be designed to avoid placing either the mother or her
fetus at risk. In response to the numerous physiological changes that occur during pregnancy, certain
precautionary measures should be undertaken.

A Celebration of Life

For many women, the act of bringing a new life into the world is one of the most fulfilling experiences of
their lives. In a time of physical and emotional stress, proper exercise can contribute in positive ways to
this experience by enhancing the health and well being of pregnant women. A good indicator of an
appropriate dose of exercise is that a pregnant woman be fully recovered within 15 to 20 minutes after
completion of the exercise bout. Table 31-2 provides a listing of signs and symptoms that should prompt a
pregnant woman to stop exercising and consult the physician who is monitoring her pregnancy. The key
for a pregnant woman is to engage in an exercise regimen that is based on sensible guidelines.

487
Summary

I. Sensible exercise can be a safe and productive undertaking for both a pregnant woman and her fetus.

A. A growing body of evidence exists to support the belief that a pregnant woman can benefit in
numerous ways from sound exercise. Exercise can :

1. Reduce the severity and frequency of back pain;

2. Enhance prenatal weight management efforts;
3. Help pregnant women counteract the feelings of stress or anxiety;
4. Improve digestion and reduce constipation;
5. Help provide an enhanced level of energy to facilitate the ability to perform the activities of daily
living; and
6. Help reduce postpartum belly.

B. An exercise program must not under any circumstance subject either the expectant mother or her
fetus to undue risk of injury or harm.

C. Adhering to a few basic guidlines will keep the focus of a pregnant women who wants to exercise
where it belongs - on safety. During exercise, a pregnant women should:

1. Stay adequately hydrated

2. Keep the intensity level of the exercise at a moderate level;
3. Avoid wearing clothing that is impermeable to water while exercising;
4. Be acutely sensitive to the enviornmental conditions that exist at the time of the exercise session
(particularly the ambient temperature and relative humidity levels);
5. Kepp the duration of the exercise session to thirty minutes or less to avoid impairing blood flow to
her uterus;
6. Avoid prolonged (i.e., longer than five minutes) bouts of exercise in the supine (lying on her back )
position;
7. Avoid overstretching while exercising or performing exercises in a ballistic (i.e., jerky or bouncy)
fashion;
8. Eat a nutritionally sound diet (i.e., consume sufficient amounts of carbohydrates) to ensure
adequate levels of glucose are available.

488
 Section 6: Unit 31 Outline

Exercise and Asthma

I. Asthma

A. What Occurs During an Asthma Attack

B. Managing Asthma

C. Enjoying an Asthma-Free Workout

D. Breathing Easier

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand how to manage asthma in exercise and work with

clients who have asthmatic conditions.
• Understand how to design an exercise program for asthmatic
clientele.

489
Asthma

If you are one of the 25-million plus Americans who suffer from some form of asthma, the fear of having
an asthmatic attack that leaves you breathless any time you physically exert yourself may cause you to
avoid aerobic exercise at all costs. Who can reasonably argue that facing bouts of shortness of breath,
coughing, wheezing, a tightness or burning sensation in your chest, abdominal pain, headaches and undue
fatigue every time you work out is not sufficient cause to drive you to become an “exercise dropout.” In
reality, however, despite the fact that exercise can trigger an attack of asthma, sensible exercise may
actually help asthmatics to be better able to deal with their debilitating medical condition.

Unfortunately, asthma is a very serious problem in the United States for individuals of all ages. At some
time in their lives, at least five percent of all Americans will experience the symptoms of asthma (a term
which is derived from the Greek word that means “to pant”). In literal terms, asthma is a tightening of the
airways of the lungs that results from either undue inflammation of the lining of the airways or specific
triggering factors. Among the most common triggers for asthma are respiratory infections; exercise
(which dries the airways in your lungs); allergies (which stimulate a hypersensitive immune system
thereby causing the release of chemicals that find their way to the lungs resulting in swelling of the
airways and the overproduction of mucus); emotional stress; cold air; sudden changes in either humidity
or temperature; air pollution (e.g., dust, tobacco smoke, paint or household cleaner fumes, perfume,
etc.); and certain medicines, such as aspirin.

What Occurs During an Asthma Attack

While the causes of an asthma attack often vary from one person to the next, the process of an asthma
attack is relatively straightforward. During an attack, the bronchioles (small branches of the airways that
distribute air throughout the lungs) narrow because the muscles surrounding them have gone into spasm.
In turn, this narrowing (collectively referred to as “bronchospasm”) restricts the level of airflow to the
alveoli, (minute air sacs deep in the lugs which serve as the terminal branches of the respiratory tract
where oxygen and carbon dioxide are exchanged). When bronchospasm occurs, individuals experience the
symptoms of an asthmatic attack to varying degrees. Once bronchospasm has occurred, it generally takes
between 30 and 60 minutes to resolve itself without treatment. In a very limited number of instances, the
asthmatic may have to be hospitalized. In most cases, however, asthma can be managed properly to
preclude undue discomfort or complications.

Managing Asthma

Asthma sufferers have numerous treatment options available. As a general rule, the primary method for
controlling asthma involves the taking of drugs — both inhaled and orally. Because they reach the airways
directly and more quickly, inhaled drugs are the preferred option in most instances. These drugs are

490
designed to relax the bronchial muscles. In addition to bronchodilator therapy, many physicians also
prescribe drugs to suppress the persistent inflammation, which is often present in the lining of the airways
of asthmatics (Note: Frequently, this step involves using inhaled steroids.)

Although drugs are often helpful, asthma sufferers should remember that they can take additional specific
steps to help alleviate the condition. At the least, they should avoid those factors (as much as possible)
that cause asthmatic symptoms to occur. They should also consider adhering to the following tips:

• Use a peak flow meter. A relatively inexpensive device, this apparatus measures how fast air can
be expelled from the lungs. A precipitous drop (e.g., more than 10%) may be the signal of an
increased level of airflow resistance.
• Use a spacer to ensure that inhaled medicine reaches the lungs and does not land on the roof of
or the back of the throat. Attached to an inhaler, a spacer provides for better, more efficient
medicine inhalation by suspending medicine. Suspension increases the opportunity to inhale.
• Adhere to the recommended dosage of medicine. Excessive medication can produce unwanted
side effects (e.g., rapid heart rate, dizziness, etc.)
• Drink water after you use your inhaler to clear the back of your throat of medicine.
• Check air quality daily. Know what to do about various pollutants and pollens.
• Use a mask or scarf to cover the nose and throat in cold weather. Wherever necessary,
reduce the impact of cold air on air pathways.
• Stay well hydrated. Mucus plugging can result from a poor level of fluid intake.
• Be sensitive to food-related asthma problems. Foodstuffs (e.g., celery, carrots, peanuts, egg
whites, bananas, shrimp, etc.) have been known to increase the likelihood and severity of
asthmatic attacks in certain individuals.
• In an emergency, use over-the-counter inhaled asthma medications when your regular
medication is not available.

Enjoying an Asthma-Free Workout

In recent years, many individuals have found that regular exercise can also be a positive means for
asthma therapy. The key to exercise effectiveness as a therapeutic option for asthma sufferers is that it
makes breathing more efficient. Some evidence also exists to suggest that proper exercise also makes the
airways of the lungs less sensitive to those factors, which are conducive to bronchospasm.

Because exercise (as was mentioned earlier) can in some instances trigger an asthmatic attack, it is
extremely important that your client and his or her physician work together to develop a comprehensive
exercise and medication plan to deal with this medical condition. Keep in mind that one individual’s
specific response to exercise may vary from another’s. If you develop an appropriate and sensible exercise
program, your client has much to gain from regular physical activity, including an increase in overall
wellness.

Most physicians suggest that the first step for being able to safely combine asthma and exercise is to find
out how an individual’s body reacts during exercise and identifying what should be done in certain
situations. The next step is to develop an exercise regimen that meets your client’s needs and interests.
Heed the following guidelines to ensure that your client’s exercise program is both productive and safe.

• Select an exercise, such as swimming, that raises the heart rate, increases respiratory rate and is
relatively easy on the lungs.
• Avoid asthma triggers as much as possible. For example, if your client is allergic to pollen, exercise
indoors. Avoid outdoor exercise on polluted, cold, and dry days. Advise your client to wear a mask
or a scarf if he or she must exercise outside on a cold day. (This warms and moistens the inhaled
air.) If possible, exercise in warm, humid air.
• Perform specific breathing exercises to strengthen the lungs.
• Medicate prior to exercising (30 minutes before engaging in activity).
• Have your client keep his or her inhaler close by during exercise.
491
 • Perform warm-up (under control) exercises prior to working out.
• Avoid very intense exercise for prolonged periods of time.
• Advise your client to breathe through the nose as much as possible while exercising.
• Control breathing rate to prevent hyperventilation.

Breathing Easier

The benefits and joys of exercise are well within the reach of most asthma sufferers. In order to offer the
most to your training clients, plan accordingly. Such planning requires input from the client’s physician,
sensitivity to his or her particular needs, and the courage to embark on a reward-filled journey. By
proceeding sensibly and purposefully, you can give your client’s lungs a much-needed breath of fresh air.

Summary

I. Asthma is a tightening of the airways of the lungs that results from either undue inflammation of the
lining of the airways or specific triggering factors.

A. Asthma afflicts 25-million Americans of all ages, making it a very serious problem in the United States.

B. Asthma sufferers have numerous treatment options available. As a general rule, the primary method
for controlling asthma involves the taking of drugs, both inhaled and orally.

C. In recent years, many individuals have found that regular exercise can also be a positive means for
asthma therapy.

1. The key to exercise effectiveness as a therapeutic option for asthma sufferers is that it
makes breathing more efficient.
2. Heed the following guidelines to ensure that your client’s exercise program is both
productive and safe.

a. Select an exercise, such as swimming, which raises the heart rate, increases respiratory
rate, and is relatively easy on the lungs.

b. Avoid asthma triggers as much as possible. For example, if your client is allergic to
pollen, exercise indoors. Avoid outdoor exercise on high-pollution, cold, and dry days.
Encourage your client to wear a mask or a scarf if he or she must exercise outside on a cold
day. (This warms and moistens the inhaled air.) If possible, exercise in warm, humid air.

c. Perform specific breathing exercises to strengthen the lungs.

d. Medicate prior to exercising (30 minutes before engaging in activity).

e. Have your client keep an inhaler close by during exercise.

492
f. Perform warm-up (under control) exercises prior to working out.

g. Avoid very intense exercise for prolonged periods of time.

h. Advise your client to breathe through the nose as much as possible while exercising.

i. Control breathing rate to prevent hyperventilation.

Section 6: Unit 32 Outline

493
 Exercise and Sports Medicine in the Trenches

I. An Introduction To Sports Medicine

A. General Principles of Injury Prevention

1. Intrinsic Factors (Mental and Physical preparedness)

2. Extrinsic Factors (factors which impinge externally on performance)

B. Therapeutic Modalities Used In Sports Medicine

II. Common Orthopedic Problems

A. Low Back Pain

1. Chiropractic
2. Chiropractic vs. Medical Management of Low Back Pain

B. Shoulder Pain
C. Elbow Pain
D. Knee Pain

III. Symptoms and Treatment of Minor Athletic Injuries and Illnesses

A. Weakness, Fatigue and Exhaustion

B. Dizziness, Vertigo or a Sudden Loss of Consciousness
C. Fever with or without Chills
D. Cough or Shortness of Breath
E. Generalized Joint and Bone Pain
F. Abdominal Pain
G. Bleeding
H. Hip Pain
I. Leg Pain
J. Ankle Pain
K. Foot Pain
L. Shin Splints

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Understand the basics of sports medicine that is applied “in the trenches” and know your
role as a Certified Fitness Trainer when encountering these problems.
• Understand common orthopedic problems with exercise and how they are treated.
• Recognize symptoms of minor athletic injuries and illnesses.

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An Introduction to Sports Medicine

Special Section by Sal Arria, D.C., Co-Founder I.S.S.A. & Charles Staley, BSc, MSS

Sports Medicine is concerned with the diagnosis, treatment, rehabilitation, and prevention of athletic
injuries, as well as dealing with the effects of exercise on the human body for the enhancement of athletic
performance. Sports medicine is not restricted to the medical field: athletic trainers, coaches and personal
trainers are also involved. While most sports medicine books are written by doctors or researchers for the
benefit of their fellow colleagues it’s unfortunate and unnecessary that this information never reaches the
fitness consumer. Personal trainers and health-care professionals have typically had an adversarial
relationship, the result being that trainers are left to their own resources when it comes to information
regarding injury prevention and care. Again, the consumer loses.

A unique aspect of this unit is that it represents not only a doctor’s perspective, but coaches’ and athletes’
perspectives as well. The authors have extensive backgrounds in their fields, and realize that you want to
continue to train! Although risk is omnipresent in most sports, far too many athletes suffer from avoidable
injuries, which continue to plague them long after their sport careers are over. By following the principles
outlined in this unit, you will be able to greatly reduce the likelihood of injury. If you are already suffering
from injury, we will show you the best course of action to take. Charlie Francis, Ben Johnson’s sprint
coach, and coach to many other internationally elite athletes, illustrates an enlightened (yet rare)
approach to injury prevention in his book, The Charlie Francis Speed Training System: “If there was ever
any doubt about whether or not to take another rep, we would stop for that session.” After all is said and
done, use your common sense. As cliché as this may sound it has done more to prevent injury than all the
immense wealth of medical science and technology we have available to us today. We wish you success
and fulfillment in your training!

General Principles of Injury Prevention

In his book, The Sports Medicine Bible, renowned orthopedic surgeon Lyle Michelle identified two
classifications of factors leading to sports injuries; Intrinsic and Extrinsic factors

Intrinsic Factors (mental and physical preparedness)

• Activity should be consistent with age, somatype, and capabilities.

• Pre-participation screening is critical, esp. if over 35, smoker, obese.
• Skills should be adequate for activity (i.e., lifting properly).
• Muscle tightness can lead to injury.
• A rational approach to competition must be employed (you can injure not only yourself, but others
also). Be process oriented!

Extrinsic Factors (factors which impinge externally on performance)

• Other personnel: Trainers and coaches must beware of over stimulating the athlete into a
performance, which is beyond his or her capabilities.
• Training program design: Adequate fitness is critical (fatigue leads to injuries). Make sure you
warm-up and cool-down!
• Environment: Investigate equipment, flooring and venue in general. Thermal injuries: Hydrate,
wear appropriate clothing, and acclimatize prior to activity or competition.
• Clothing, footwear, etc: Proper fit and function.

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 • Other equipment: mouth-guards, helmets, padding, belts, wraps
• Fluids, nutrition and supplements: Dehydration can cause injury through performance impairment.
• Fitness after injury: Rehab should address muscle wasting and joint stiffness.

Therapeutic Modalities Used In Sports Medicine

The following section is an introduction to the use of therapeutic modalities in the prevention,
management, and treatment of common athletic injuries and related problems. Many of these modalities
also play a role in enhanced recuperation after training sessions, which obviously leads to improved
performances. Some of the therapeutic modalities discussed are strictly the domain of the sports medicine
physician, licensed physical therapist, or certified athletic trainer. However, others may be safely applied
by coaches and fitness trainers or even by the athletes themselves.

Any athlete or fitness trainer who hopes to achieve elite performances in sport must be aware and make
use of these means throughout his or her athletic career. Eastern European nations have known this for
years, yet here in the U.S. we are just beginning to realize the significance of integrating therapeutic
techniques into the training plan.

1. Diathermy: A professional therapeutic modality, diathermy is a form of high-frequency heat that

penetrates injured tissues deeper and more effectively than other forms of heat therapy (e.g.,
hydroculator packs, moist-heat packs, etc.) Where other modalities penetrate between one-eighth to one-
fourth inch at best, diathermy reaches 1-1/2 to 2-1/2 inches into the injured tissues. Diathermy increases
vasodilation (blood supply) needed for both carrying nutrients to and waste products away from injured
tissues. Unlike other forms of heat therapy, diathermy’s circulating heat does not produce static swelling
at the treatment site. Note: all forms of heat therapy should be followed by cryotherapy, or cold
treatment.

2. Electrostimulation: Typical use involves electrodes that create a contraction of the surrounding
musculature, reducing edema by pumping fluid out of the affected tissue. An atypical application (but a
very effective method of reducing edema), pioneered by former Eastern Block sports medicine specialists,
involves placing the electrodes not on the muscles, but directly on the joint. Moderate to intense amounts
of intermittent stimulation are applied for 10 to 15 minutes per session. This type of transarticular
electrostimulation is most effective when implemented immediately after diathermy, and followed by
cryotherapy and elevation.

3. Cryotherapy: The application of cold (usually in the form of ice or “chemical ice”) to body tissues, for
the purpose of pain relief and decreased swelling (via vasodilation). Typical use involves hourly
applications of 10 to 15 minutes in duration. Ice is simple, inexpensive and effective, and can be applied
without professional assistance.

4. Heat Therapy: Heating pads or hot showers are best when followed with ice, because heat alone
causes static swelling. Leaving a heating pad on all night is the worst treatment possible, because it
creates static edema. Never use heat sooner than 48 to 72 hours after an injury. When it is used, it should
be used for only 10 to 15 minutes, along with active stretching of the body part being heated, followed by
10 to 15 minutes of ice and stretching of the affected area. Hot showers are great in the morning and
after workouts to bring blood into the tissue, but the shower should be turned progressively cooler to cold
in order to dissipate any swelling caused by heat.

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5. Ultrasound: High-frequency sound waves, which oscillate to penetrate 1 to 2-1/2 inches into muscle
tissue. Ultrasound loosens or breaks up scar tissue and tight fibrous adhesions due to injury. Frequently
used in most musculoskeletal ailments.

6. Hydrotherapy: The use of water as a therapeutic/recuperative means. The most common forms are
listed below:

• Contrast Showers: Alternate between hot and cold bursts of water for 2-minute periods directly
following your workout. The contrasting temperatures taken to a reasonable point of discomfort.
Repeat this alternating 2-minute sequence 4 to 6 times. Since hot water is a vasodilator, and cold
water is a vasoconstrictor, the net effect is vastly improved circulation to the effected areas.
• Contrast Baths: Applied in the same manner, and for the same purpose as contrast showers.
Contrast baths, however, are more convenient for localized use (e.g., treating a limb instead of the
entire body).
• Whirlpool: This form of therapy improves circulation, and renders a relaxation effect. Can be used
for general or localized purposes. Water temperature should stay between 102 and103º F (28 to
35º C). Limit immersion to 15 minutes or less. Avoid whirlpool if there is a swollen joint or joints.

7. Cryokinetics for Low Back and Leg Recuperation: An ice pack can be constructed by placing
crushed ice in a “zip-lock” bag. Immediately after leaving the shower, the individual should lie down on
the floor with feet propped over a bed or couch, and the ice pack under the lumbar spine. To improve the
effect of this procedure threefold, stretch the spine while on ice, and gently perform lateral (side to side)
flexions alternated with pulling knees to chest. Mobilizing the spine in this way will counteract any
stiffening effects from icing the back. Cryokinetic therapy is very beneficial in reducing contracted,
tightened muscle tissue, as well as pumping these tissues free of accumulated, training-induced waste
products. We recommend at least 15, but no longer than 20 minutes should be spent on the ice. This is
most effective when done immediately after contrast showers.

8. Leg Elevation: Used as a means to reverse hydrostatic or columnar pressure after a long day standing
or training. Leg elevation is particularly effective prior to training, and the effects are improved at least
twofold when used concurrent with cryotherapy on the knees. For greatest effectiveness, elevate the legs
for about 20 minutes, keeping them perpendicular to the floor while lying on the back.

9. Ongoing Professional Assistance: Many forms of therapy, including various types of “bodywork,” are
available to athletes at moderate cost, and are highly recommended. The most commonly used forms of
professional assistance are as follows:

• Chiropractic • Neuromuscular Reeducation

• Massage Therapy • Trager Mentastics
• Physical Therapy • Acupuncture/pressure
• Rolfing • Alexander Technique

Common Orthopedic Problems

Low Back Pain*

* * Note: This section was adapted from “The 5 Step Back Solution,” a self-help, Award Winning video
produced by The American Institute of Health Education. The ISSA has created an invaluable CEU based
on this Award Winning Video. For more information on “The 5 Step Back Solution” CEU please visit
www.fitnesseducation.com.

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Low back pain is the most frequent cause of missed work after the common cold — it is been estimated
that over 20 million people suffer with this debilitating condition. This is unfortunate because, with all the
knowledge and diagnostic tools that we have available today, there is no reason back pain should continue
to plague so many people.

The key to managing low back pain starts with the decision to take an informed, active role in maintaining
your health. Your back needs a little maintenance every day, even when you do not have pain. When you
visit with your doctor, you will only spend 15 minutes (if you are lucky) in an office visit, but you spend 24
hours a day, 7 days a week living with your back. Treatment and therapy are important, but it is what you
do for yourself when you are not having treatment that is most important to help you live free from
recurring back pain.

Start with an accurate diagnosis from your chiropractor or physician. Make sure you ask for an explanation
of what is wrong, and then listen carefully to all recommendations. Learn as much as you can about your
condition.

The AIHE has identified five steps which, when followed sequentially and consistently, can significantly
reduce the incidence and severity of symptoms stemming from low back pain:

Five Steps to a Better Back

Step 1: Reduce The Inflammation

The first step in addressing back pain is to “put out the fire.” Inflammation is often the result of the joints,
nerves or soft tissues of your back becoming irritated, raw and swollen. According to a recent government
study (AHCPR), the recommended initial medical treatment of choice is usually an oral anti-inflammatory
and ice. Exercise caution however, because some people can’t tolerate any type of anti-inflammatory
medication. Check with your physician before using any drug.

While using an internal anti-inflammatory, you should also use an external anti-inflammatory — namely
ice. Flexible gel packs are best, but crushed ice in a “zip-lock” bag works well also. Crushed ice works
particularly well for people who weigh over 200 pounds. Make sure that if you use crushed ice it is really
smashed up into fine pieces; otherwise it is like lying on rocks. Do not cover it with a towel, because it will
not penetrate deep enough to work. Instead, use only a zip-lock bag.

Ice is cold, and after a minute or so, people usually want it off! Remember that the immediate pain of the
ice is worth the long-term relief you’ll get from the reduction of inflammation and swelling. Ice has to be
cold, really cold, to be effective, and needs to be applied for at least 15 to 20 minutes. Imagine the
thickness of a t-bone steak, and how much cold you would need to feel the effect through the other side.
That is about the thickness of your back.

The key to using ice is staying mobile and flexible. One side effect of cold is that it tends to make you a
little stiff, so stretch! Try doing knee-to-chest and pelvic-rock stretching while lying on the ice. This is
called cryokinetics, or “movement on ice.” Not only does it keep you from stiffening up, it literally pumps
swelling or inflammatory edema out of the low back as you stretch.

Step 2: Improve Segmental Alignment and Mobility

The two most common mechanical problems that cause back pain are misalignment and fixation. A
misalignment can occur as a result of an injury, such as slipping or falling. If one vertebra moves out of its
normal position, even just a little, it can create pain. Almost everyone at one time or another has
experienced an injury or trauma, and can relate to the pain associated with a malalignment.

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It is equally important to understand and recognize that when two or more vertebrae get stuck together
and stiffen up, or fixate, this interferes with the normal biomechanics (or movement) of the spine.
Remember that each individual vertebra is ideally designed to move freely and independently of each
other. This distributes the load and leverage of normal motion between all five lumbar vertebrae. The two
main causes of fixation of vertebral joints are trauma, or remaining in a static position for prolonged
periods of time:

Traumatic Fixation: Take, for example, jamming a finger while catching a baseball. Your finger is
jammed or sprained, not broken, but boy does it hurt, and get stiff and swollen. Now try to bend that
finger. It may bend at one joint; however, the rest of the joints remain fixated or immobile.

The same principal applies to the spine. When the back is traumatized or injured, there are four joints or
facets on each vertebrae held together by tiny ligaments. Multiply that times five vertebrae in the low
back or lumbar spine, and you would find that is 20 joints to sprain or fixate! If three vertebrae are fixated
above and two below, that puts the strain or load of the entire body on just one level while you’re
bending, lifting or twisting. The muscles and little ligaments that hold that level together just cannot take
that type of load, so they strain, sprain or tear.

Micro (small) tears of the ligaments that hold the spine together eventually heal, but they heal with scar
tissue that is not as flexible, and thus the next time you lift something heavy, guess which level or area
gives way!

To visualize a sprain or strain, picture a nylon rope being pulled to its maximum tensile strength. Just
before it breaks, it begins to fray. Ligaments and muscles under stress loads fray also. Keep in mind that
muscles strain and ligaments sprain. Unlike a nylon rope, you will eventually heal, but your pain can last
for up to six to eight weeks, or even more!

Static Fixation: This is stiffness created by being in one position for prolonged periods of time. Take your
finger for example. If you hold it back for one hour while you drive or sit at a computer, then let it go, it
becomes stiff. It was not traumatized in the same way as catching a baseball (which caused traumatic
fixation), but it sure stiffened up. Another example is if we put a healthy, uninjured elbow in a cast for
four weeks. When we take the cast off, the elbow is locked or fixated, even though there was not an
injury. The elbow joint was just fixated in one position for prolonged periods of time, like sitting all day!

The same thing can happen to your back. If you sit for prolonged periods of time without moving, your
spine stiffens up and fixates. When you bend over to pick up a piece of paper after eight hours of sitting,
you blow your back out, and cannot figure out why! Remember, the leverage on that one poor vertebrae
that is doing all the moving just cannot take that type of stress, so the muscles and ligaments that
surround and support it sprain, strain or tear.

According to the most recent government study on back pain, chiropractic adjustments or manipulation
are the best method of mobilizing the spine, reducing the fixations, and creating normalized alignment.
Gentle, manual manipulation frees the fixated vertebral segments, and creates normalization of mobility
and alignment.

But the fixations or stiffness between the vertebrae will recur within hours of your adjustment, if you
return to 3 to 6 hours of straight sitting. There is no substitute for maintaining the mobility on your own
after your treatment. Start each morning by gently pulling one knee toward your chest, and relax your
back muscles as you pull. Hold for 3 to 5 seconds, pull the opposite knee toward the chest, and hold it for
3 to 5 seconds. Then, clasp your hands at the top of both shins, and gently pull your knees toward your
chest. Hold for 3 to 5 seconds. Repeat this stretch five to ten times before you get up in the morning. It is
the best way to stretch the muscles before you start your day.

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The effectiveness of this exercise is dependent on how much you can relax your back while you are
stretching.

Decompression mobilization in a non-weight-bearing position (stretching when lying on your back, or on

your hands and knees) when done carefully is great! Our backs need a break from gravity! Gravity is
constantly compressing our vertebrae together. Add to that carrying a child or groceries, and by the end
of the day you have a reason to hurt! So, take quick breaks, lie down just for 2 to 3 minutes a few times a
day — especially at night, instead of sitting on a couch. As simple as it sounds, it really works! Think
about how much time you spend sitting, compressing your back all day. Do not forget that sitting
increases the pressure in the low back up to eleven times normal, and running down hill increases the low
back pressure up to four times your bodyweight. So, give your back a rest from the constant compression
several times during the day.

Step 3: Increase Muscular Flexibility

Once the vertebrae have been specifically mobilized, it is time to stretch the muscles of the
low back and hamstrings. The best time to start is first thing in the morning, before you get
up. Do a few knees-to-chest and pelvic-rock stretches before your feet hit the floor. Then,
take a hot shower and stretch. As simple as it sounds, this technique has helped hundreds
of patients who have suffered for years with recurring back pain.

Professional and Olympic athletes realize the importance of stretching and flexibility, so use
the techniques they use to stretch and loosen up first thing in the morning, and then several
times during the day, to prevent unnecessary pain or injury. We recommend five two-
minute stretches during the day, rather than one 10-minute session, because you usually
stiffen up throughout the day from prolonged sitting or standing.

Knee-to-chest stretches specifically stretch the muscles of the low and mid back, buttocks
and hamstrings. The key to knee-to-chest stretching is to relax before beginning to pull.
Gently clasp your hands just below your knees, and pull with your arms, relaxing your low
back. Hold for 3 to 5 seconds, then release. Remember, start and end this stretch with your
knees bent. It takes the stress off the low back.

Hamstring stretching is a critical factor in reducing low back pain. The hamstrings (muscles
in the back of the leg) connect to the bottom of the pelvis. If they are tight, it will inhibit
your ability to flex or bend forward, thus putting most of the load of bending on the low
back, rather than dispersing the load and leverage between the hamstrings, glutes, hips and
low back.

Cat stretches really stretch the muscles and joints of the low back, so start off easy at first.
Again, relax, start on your hands and knees with the elbows locked, and then gently allow
the low back to sag into an arch (like an old horse). Hold for just 2 to 3 seconds, and then
press your low back upward (like an angry cat), and hold for 2 to 3 seconds. Then sit back
on your legs and stretch, reaching your arms forward, again really relaxing the muscles of
the back, butt and legs. Hold for about 5 seconds, then return to the starting position on
your hands and knees, and repeat several times.

Step 4: Pay Attention to Your Posture

We spend most of our lives with our bodies in the three basic positions — sitting, standing
and sleeping. Let us cover them one at a time.

Sitting: If you were to take a survey of people that suffer with back pain, you would find

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that nearly everyone sits far too much. Sitting increases the pressure in the back nearly two
times your bodyweight. So, if you are a 120 lb. secretary, you have about 240 lbs. of
pressure on your low back. Then, after sitting all day at work, you sit while driving home
and then sit once again for dinner. Now your back is hurting badly, so you sit in front of the
TV, slouched. Do that 7 days a week, and you wonder why you still have back problems —
even after you saw your chiropractor for an adjustment, your massage therapist for a
massage, your physical therapist for ultrasound and heat, and finally, your physician for
pills. It could not be more obvious. Do not sit so much without moving. If you can, at work
take a few short breaks on the floor — lie down and stretch; then hit the floor at night when
you come home, instead of the couch.

Standing: As we stand during the day, the muscles of our back become fatigued or tired.
Especially by the end of the day, we have a tendency to round or hunch forward. This poor
posture puts an unnecessary load on the low back, because the weight and leverage of the
upper body rounding forward puts a constant stress on the low back.

When you are standing, do not lock your knees and round forward. Instead, spread your
legs, and press forward with an arch in your low back. Lean on an arm if you can. It helps
take some weight off the muscles of the back.

When you are lifting, it is important to bend your knees, but it is equally important to keep
the weight that you’re lifting as close to your body as possible. Do not rotate or twist.
Square off toward what you are going to lift. It does not take much weight to cause an
injury.

Never reach out, lift and rotate. It is the easiest way to tear or rupture a disk, because of
the forces and leverage on the small support ligaments of the spine. They just cannot take
it.

Prolonged standing with your weight shifted on one leg or another creates an uneven,
lateral or side bending of the spine. This loads the tiny joints of the back on one side.

An example of this concept is a new mother. It is tough carrying a baby around without
putting it on one hip, but try to switch sides often, keeping the baby close to you. Do not
exaggerate the sway of your back by letting your tummy hang forward.

If you stand on a hard surface like concrete all day, the cumulative effect of compression
and the constant pounding and jarring of your spine when you walk with hard shoes is just
another variable that can contribute to back pain.

Assess the surface and work place where you stand all day. If you can get away with
wearing tennis or hiking shoes, do so. Nike Air shoes do an incredible job stabilizing the
foot, and cushioning the impact on heel strike. Nike has a wide variety of air sole shoes
worth trying. They are specifically designed to take the shock out of each step.

Sleeping: Do not sleep on your belly. Prolonged hyperextension from sleeping on your
stomach causes the low back joints to jam together, and it’s definitely a reason for waking
with back pain. Try to sleep on your back with you knees bent; or if you sleep on your side
and have a small waist, use a pillow under your waist to keep the plane of the spine
horizontal with the bed. Do not be afraid to use lots of pillows around you — not to prop you
up, but to support you in an oblique or almost-on-your-side position.

Select a mattress that is not too firm but not too soft. Rotate and turn your mattress every
couple of months; and if you cannot afford a new mattress, use a piece of plywood between
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 the mattress and the box spring for added support. We spend almost one third of our lives
in bed, so if you wake up with pain, the first thing to do is to replace your existing mattress!

Step 5: Strengthen Your Back and Abdomen

The back is supported on the outside by muscles, and on the inside by ligaments and tendons. They must
be exercised to strengthen them, but make sure you follow the previous four steps before attempting to
strengthen your back. Check with your doctor, and ask which exercises you should or should not do.

If you try to strengthen your back or abdomen without becoming flexible first, you stand a chance of
straining your back. If your back muscles are tight, and you try to do an abdominal exercise, which
requires forward flexion or bending of the trunk, you will strain or sprain your back.

Now comes the work. Do not let anyone fool you; if you have back pain, you must eventually work on
strengthening the surrounding muscles and ligaments that support your back and trunk, in order to keep
your symptoms from recurring. Just a few minutes a day will make a big difference.

The abdominal muscles provide approximately fifty percent of the support for the back.

The area between the rib cage and the pelvis is called the trunk. You’ll never see a giant redwood tree
standing with one half of a trunk! Your trunk is composed of two major muscle groups; the abdominal
muscles and the back muscles. Consistent training, good form and good technique can enhance the
effectiveness of abdominal exercises.

Exercise the abdomen a few times a day — morning, noon and evening. Lie on the floor instead of sitting
on the couch at night watching TV. Then, during every commercial, do a few knee-to-chest stretches and
abdominal crunches. It really works! Consistent, moderate training is the key to great success without a
lot of effort or time. Statistics tell us the average person watches two to three hours of TV a day. So do
not make any excuses. Hit the floor at night, and start to strengthen those abdominal muscles while you
are watching the tube, talking on the phone, or reading to your kids.

Try to remember to tighten your abdomen throughout the day, as you stand, work or drive. A simple thing
like keeping your abdominal muscles tight really does make a big difference, because it helps take the
load off the back during the day.

In the case of women — especially after having a baby — the abdominal muscles are weak. It took nine
months to get out of shape; it will take a few months to get back into shape. If you just let them go, you
will be prone to back pain. For men, the “beer belly” sets them up for developing back pain. The extra
weight pulls the spine into a sway position, and offers no support for the back.

Until your abdominal muscles or stomach muscles become strong enough to support your back, use a belt
or support. Belts increase the abdominal support by providing support from the front of the spine.

If you have to lift for a living, or if your job necessitates loading, bending, carrying, standing or reaching
all day — use a belt. You have probably seen workers wearing them. Over the years, we’ve recommended
belts with great success. However, the soft elastic type does not offer the support that the Bollinger belt
offers.

Remember, using a belt will never replace your abdominal-strengthening program, but rather serve as
support until your abdominal muscles get strong enough to carry the load themselves.

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Even when your abdominal muscles do get strong, it is okay to use a belt if you have a job that requires
prolonged heavy lifting. After all, football players, powerlifters, bodybuilders and weightlifters have used
them for many years to protect their backs during heavy training or competition, and they usually have
very strong abdominal muscles. Just keep the belt loose when you are not lifting, then cinch it down tight
when you have to carry or lift heavy objects.

During the acute phase (the first week or so) of back pain, I recommend the use of a belt or support most
of the time, except when sleeping or lying on ice. While you are driving, sitting at work, or if you have to
return to work when you are still in pain, it is okay to use a belt most of the day. The constant
aggravation created by not having abdominal support is a big reason for an unnecessarily prolonged
recovery after an injury.

Chiropractic

One of the most valuable ergogenic aids for the athlete is proper chiropractic care. Chiropractic is a
natural (that is, not employing drugs or surgery) healing system that treats the whole person, rather than
just the particular symptoms of a disorder. In chiropractic, a licensed practitioner corrects structural
imbalances of the body, called subluxations, with adjustments and manipulations of the spine and
articulations (joints), through prescription of various exercises (e.g., stretching or weight training), and
through the employment of various therapeutic modalities (e.g., electrical stimulation).

Subluxation refers to improper biomechanical motion between two vertebrae, which produces irritation of
a spinal nerve, leading to back and neck pain, muscle spasm, and potential for further injury. Tight
muscles, incorrect training techniques, scoliosis (curved spine), poor posture, high hip or shoulder, or
misaligned spine — all can predispose a person to a subluxation.

By restoring proper alignment to the spinal column and the joints, the doctor of chiropractic can help the
athlete operate at optimum biomechanical efficiency. Chiropractic care can help the athlete to strengthen
muscles, improve coordination and balance, extend range of motion, restore proper biomechanical
function, achieve greater mental focus, and have more energy.

One valuable healing aid which chiropractic emphasizes is time — letting the body heal itself after the
structural imbalances have been corrected. Many chiropractors take seriously their responsibility as
educators, by explaining to the patients what they can do to enhance their own rehabilitation, and that
this takes time.

A good chiropractor specializing in sports should explain how to modify training techniques to prevent
future injuries. For example, a runner might need to change his or her stride length, shoes, running
surface, training schedule, or stretching and strength routines.

The chiropractic profession in the past has suffered from much criticism from the medical establishment
regarding the fundamental philosophy that chiropractic can “cure” most health problems, from allergies
and migraine headaches, to bed-wetting and heart problems.

While the chiropractic profession was built on this philosophy, science has not proven these claims, and
not all chiropractors agree with them anyway. What can be proven, however, is that chiropractic
adjustments can aid in restoring proper skeletal biomechanics, allowing the body to do the work it was
designed to do.

There are many types of chiropractors, and they employ a wide variety of techniques. At one extreme, it
must be admitted, is the “rack ‘em and crack ‘em” breed, which has given the entire profession a bad
reputation. This type of chiropractor uses the same general spinal manipulations on each patient, without
spending time evaluating each individual’s problems, or educating each patient on rehabilitation and
preventive programs.
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At the other end of the spectrum are those who spend time figuring out the proper corrections for each
problem, employ manipulative or therapeutic techniques specific to each individual misalignment, and take
the time to explain rehabilitation, prevention, and training improvements to the patient.

Serious athletes and fitness enthusiasts alike are advised to seek out (by asking fellow athletes) a
competent sports chiropractor that emphasizes the biomechanical aspect of treatment and injury
prevention. Biomechanical aspects of treatment include testing for muscle strength and flexibility, gait
analysis, and correction of weight training techniques, as well as evaluation for skeletal alignment. As
adjuncts to the manipulations, many chiropractors use physical therapy modalities, including ultrasound,
diathermy, ice, heat and electrical muscle stimulation.

A typical sports chiropractic treatment program consists of two or three visits a week of 15 to 30 minutes
each. The patient sits or lies on a treatment table, and the practitioner makes biomechanical evaluations
using a variety of techniques, including AK (applied kinesiology). Some chiropractors employ computer
analysis of posture, gait or nutrition to aid them in their evaluation, diagnosis and treatment procedures.

Sports chiropractors have valuable viewpoints on athletic training and injury treatment methods. One
leading sports chiropractor, Dr. Sal Arria, director of the Santa Barbara Chiropractic and Sports Medicine
Clinic in Santa Barbara, CA, and team doctor for the 1984 U.S. Olympic track and field team, believes in
keeping an injured joint mobile whenever possible for speedier healing.

“New research proves that it is most important to stimulate injured joints into gentle movement, as this
increases circulation,” said Dr. Arria. “Misaligned vertebral joints have a tendency to fixate and lose
mobility between the vertebral segments, leading to biomechanical changes.”

This research is contrary to traditional theory, which held that an injured joint should be immobilized in a
cast. These days, a cast is put on when the injured joint is unstable, with torn connective tissue that
needs a healing scar.

“But the longer a joint is immobilized, the greater the deterioration,” said Dr. Arria. “When there is no
stress on an injured area, re-absorption occurs; the body begins reabsorbing muscle, and even bone
calcium. The result is atrophy and osteoporosis, or demineralization of the bones.”

If any certainty can be derived from the array of choices you have in regards to selection of sports medical
care, you should generally opt for the conservative approach. The non-invasive techniques of chiropractic
are an excellent place to start.

Chiropractic vs. Medical Management of Low Back Pain

Canadian Study Yields Surprising Results. Low back pain is not finicky when it comes to choosing its
victims — athletes, non-athletes, young, old, male, female, strong, weak — over 66% of all people
between the ages of 18 and 55 have experienced some form of low back pain. Additionally, low back pain
(LBP) is estimated to affect over 80% of all people at some time in their lives. This debilitating and
ubiquitous condition is so prevalent that it might be seen as indigenous to the human species!

Although management of LBP was, in years past, handled primarily by medical doctors, more and more
people are turning to chiropractic care as the treatment of choice for this life-altering malady. Although
enthusiastically received by LBP sufferers, chiropractic has had difficulty getting its fair share of respect
from the medical establishment. That is, until now.

Thanks to a 1993 study sponsored by the Ontario Ministry of Health, chiropractic no longer has to rely on
anecdotal evidence to support its safety and effectiveness in treating LBP. Known as “The Manga Report,”
after its principle researcher, the study focused on the effectiveness, as well as the cost effectiveness (to
society) of chiropractic management (as compared to medical management) of LBP. While the study was
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based in Canada, its implications are important for anyone suffering from LBP. Four primary aspects of
chiropractic care for LBP were studied: efficacy, patient satisfaction, safety and cost effectiveness.

Dr. Manga, quoted in an article in USA TODAY, was asked if he had any personal interest in giving
chiropractic a boost. He responded by saying, “My interest is serving the public interest,” adding, “the
evidence is overpowering.” One thing is certainly clear — the Manga Report will go a long way in relieving
the hesitancy of LBP sufferers in seeking chiropractic treatment for their condition. The Manga Report is
available from the Foundation for Chiropractic Education and Research at 1-(800)-622-6309.

Shoulder Pain

It is probably safe to say that virtually anyone who has worked out for more than two or three years has
experienced shoulder pain at one time or another. More than any other joint, the shoulder seems
particularly prone to injury, both chronic and acute. Once shoulder pain has set in, even routine daily
tasks, such as putting on a shirt overhead or shampooing in the shower, become burdensome. Training
seems beyond the bounds of possibility, since nearly all movements involve the shoulder in varying
degrees. Even squatting and calf raises involve, and can aggravate, shoulder problems.

The glenohumeral joint (where the head of the humerus attaches to the shoulder complex) is a ball-and-
socket type joint, but unlike the hip, the G/H joint is quite shallow — so much so that the bones contribute
little to the joint’s stability. That role falls onto the surrounding muscles and their tenuous attachments, as
well as the capsular ligaments. Always remember that the shoulder’s forte is mobility, not stability. The
second structural factor leading to shoulder dysfunction is the enormous leverage that can be applied to
the shallow G/H joint by the arm. Consider that for a person of average arm length, a ten-pound dumbbell
in the hand equates to over 45 pounds of force at the shoulder joint when held out at arm’s length, such
as in a lateral raise.

Sports-Related Shoulder Injuries:

Falling: In many sports, including skating, soccer, football, wrestling and baseball, falling is inevitable.
During a fall, the hand instinctively reaches out to break the fall, decelerating the body’s downward
movement with the arm outstretched. This instinctive reaction creates a long lever, which results in
tremendous mechanical forces on the G/H joint-fulcrum, often leading to injuries ranging from strains and
sprains of the surrounding muscles and ligaments to subluxation (less than a full dislocation) or, in the
worst-case scenarios, dislocation of the joint.

Throwing: Not just in the sense of throwing a ball, but also any hitting or swinging (such as a tennis serve
or hitting a baseball) movement is essentially an attempt to separate the G/H joint, in biomechanical
terms. During any throwing movement, the rotator cuff muscle group is responsible for decelerating the
arm after the object has been released. Since many individuals have very weak rotator cuffs and posterior
deltoids as compared to the anterior shoulder muscles, the deceleration aspect of the throw often results
in strains and sprains of the shoulder’s soft tissues, especially those of the rotator cuff.

Impact: Football, boxing, wrestling, soccer, basketball and various other sports involve direct, and often
violent, impact to the shoulder and arm. Direct blows to the upper arm in particular can “pry” the G/H
joint apart, creating injuries ranging from microtraumatic soft tissue injuries to shoulder separations.
Additionally, multiple shoulder injuries stemming from years of athletic participation often result in
adhesions, loss of range of motion, calcium deposits, and degenerative changes to the joint itself. With
each new injury, the shoulder becomes both more prone to, as well as less capable of, withstanding
further injuries.

Training-Related Shoulder Injuries:

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Bench Pressing: The most popular chest exercise this movement also results in legions of shoulder
injuries. Besides contributing to the imbalance between the anterior and posterior muscles of the
shoulders, the bench press has an almost mystical allure for many trainees, making it more of a
demonstration event than a training exercise for many. The bench is the vehicle for more forced reps,
heavy negatives, missed attempts, and bad training form than any other exercise. Over 90% of all
shoulder injuries from bench pressing occur during the transition or amortization phase between the
negative and positive portions of the movement. Specifically, a rapid lowering of the bar prior to pressing
upward results in large linear momentum forces, which must then be quickly reversed by the shoulder
musculature before the bar can be raised. When these forces exceed the strength of the joint mechanism,
the shoulder may not be capable of reversing the accumulated momentum, which means that the lifter
will miss the lift, suffer a muscle tear, or both. For this reason, always lower the bar with complete control
this does not mean a full pause, however! Unless you are a competitive powerlifter, a controlled “touch-
and-go” movement is best.

Muscle Imbalance: As noted earlier, most people neglect the posterior shoulder musculature in their
training. Most popular gym exercises — bench presses, seated presses, lat pulldowns, and so on — involve
external rotation of the humerus at the shoulder joint. The movements that work the internal rotators or
rotator cuff (bent laterals, etc.) have little or no cosmetic value, so few people do them, that is, until they
suffer a shoulder injury. Eventually, the weaker rotator cuff becomes virtually useless in performing its
intended role in stabilizing the shoulder.

Over training: Not in the traditional sense (i.e., performing deltoid exercises too frequently), but in the
sense that whenever you have a bar or dumbbell in your hand, there is stress on the shoulder joint. So
from this perspective, even exercises for the back, biceps or triceps can significantly aggravate existing
chronic shoulder symptoms. Avoiding this type of overuse demands that you take a purposeful, conscious
approach to nearly every movement you make — both in and out of the gym! Some of the most common
movements, such as getting up off of the floor after doing crunches, opening a car door, or putting on a
sweater, can add stress to a malfunctioning shoulder.

Conservative Solutions

1. Strengthen the arms! This may seem like odd advice, but the fact remains that your arms are
the conduits through which forces are transmitted to the shoulder. If your arms are weak, the
shoulders must pick up the slack. If you find that during dumbbell benches or inclines, you have a
harder time picking the dumbbells up and getting into position than doing the exercise itself, you
need to strengthen your arms. Heavy dumbbell curls, hammer curls (i.e., with thumbs up) and
dumbbell triceps extensions will go a long way in strengthening your biceps, triceps and
brachioradialis muscles, as well as indirectly fortifying the shoulder girdle itself. Get yourself to the
point where you can handle heavy dumbbells with ease. Machines are okay, but they do not
challenge the synergistic and stabilizing muscles nearly as well as dumbbells.
2. Circumvent Problematic Exercises. If military presses (for example) cause you shoulder pain,
do not do them, even if every shoulder-training article you have ever read says that military
presses are the best shoulder exercise going. For you, they might aggravate prior or existing
injuries, or it may simply be that your particular shoulder structure is not well suited to the
exercise(s) in question. In either case, make modifications (such as grip, range of motion, or slight
deviations from the usual movement pattern), or use another exercise altogether.
3. Bench press technique. As noted earlier, a controlled descent of the bar is essential. Another fine
point; most benches are 11” wide. This is necessary to allow proper range of motion during the lift,
but it creates a very narrow support for the scapulae. To keep your shoulder blades supported
during bench presses, shrug them together as is if “pinching a quarter” between them, and also
tighten the upper back just prior to un-racking the bar. In this way, the scapulae will remain
supported by the bench during the lift. Your shoulder joints will thank you! A final note on
benching. The authors have observed everything from trainees putting both feet up on the bench
(better “isolation,” supposedly) to keeping one foot on the bench and one on the floor, to pinching
the knees together during the lift. All of these technique deformities create an unstable base, which
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 can lead to injury. Keep both feet flat on the floor, a bit wider than shoulder width, and keep them
there during the lift. Use your feet like the extended pods of a backhoe, for support and stability
during the lift. If you cannot keep your feet from “fidgeting” during the lift, you are using too much
weight!

Elbow Pain

Considering the incredible and constant strain that it is subjected to, the elbow is a stoic joint indeed. The
elbow is a ginglymus, or hinge-type joint, formed by the humerus bone of the upper arm, and the radius
and ulna bones of the lower arm. Although only flexion and extension occur around the elbow itself, the
joint also permits rotation of the radius around the ulna. Like the knee, the elbow is encased within an
extensive synovial membrane, which synthesizes synovial fluid for the purpose of lubricating the joint. The
elbow is quite stable, owing to the numerous tendons and ligaments that contribute to its integrity. In
fact, many people are amazed to learn that over a dozen muscles cross the elbow joint — not just the
biceps and triceps!

Causes and Preconditions for Elbow Problems

Acute traumatic elbow injuries are thankfully rare. Those that do occur are almost always the result of
extreme stress in power and explosion events, such as Olympic weightlifting and throwing. Falls (such as
in skating, football, rugby and equestrian events) and impact (as in football, combat sports and hockey)
also sometimes result in sudden traumatic elbow injury. Traumatic injuries of any type must receive
immediate medical attention by a qualified sports medicine physician.

Chronic injuries in the elbow are usually a result of overuse. Boxers often suffer from such conditions. Of
great importance is the fact that most people fail to consider the cumulative impact of all stressful events
on the elbow, limiting their attention to training-related stress only. On the job, mechanics (constant work
with wrenches, screwdrivers, etc.), secretaries and office workers (constant typing, and writing) and
health professionals (massage, physiotherapy, and other forms of physical manipulations) are at risk for
repetitive overuse syndrome (R.O.S.) to the elbow, due to constant and excessive contracting of the
gripping muscles, all of which cross the elbow joint. Most R.O.S. of the elbow is seen in the dominant side,
so “handedness” becomes an additional factor to consider in these types of injuries.

Categories of Joint Injury

Inflammatory: The body’s first response to joint injury is inflammation, or a “bleeding” of serum into the
joint capsule. Anyone who has ever experienced a rollover type ankle injury playing basketball can attest
to the amazing speed of this process, as the ankle quickly takes on baseball-like proportions. In the
shoulder, however, such inflammatory events are not as visible. Therefore, assume the presence of
inflammation after any significant joint injury, and immediately apply ice packs to the area (for 10-15
minutes, three times per hour), until you can get to a sports medicine physician for diagnosis and
treatment.

Impingement: In the shoulder the head of the humerus, routinely impinges joint, the acromium process,
or the “roof” of the shoulder, during chest and shoulder exercises. The pain that many people experience
at the top portion of upright rows is an example of this type of impingement. Do not advise your clients to
“work through” this type of pain! Instead, circumvent it by offering alternative exercise form or selection.

Strains and Sprains: A strain is a muscle pull or tear, while a sprain indicates tendon or ligament
damage. Strains and sprains are categorized by severity — a Grade I strain involves a cramp or pull of the
muscle fibers, a Grade II strain is characterized by a small to moderate amount of muscle tearing, while a
Grade III strain involves tearing of large numbers of muscle fiber. In tendons and ligaments, a Grade I
sprain involves minor fraying, a Grade II sprain indicates moderate damage, and a Grade III sprain
involves massive or total tearing of the connective tissue.
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Adhesive Capsulitis: Adhesive capsulitis is a network of adhesive fibers throughout a joint. This
phenomenon is the body’s response to the immobilization that results after an injury. Immediate and
aggressive physical therapy is warranted to prevent the formation of these adhesions, which, if left
untreated, can permanently reduce the joint’s range of motion.

Among athletes, throwing, particularly in baseball and the javelin event, is the leading cause of R.O.S. of
the elbow. Boxers are also susceptible (from the high volume of punches thrown in training and
competition), as are tennis players and golfers. Bodybuilders, fitness enthusiasts and recreational athletes
are not, by any means, immune to R.O.S.

A Closer Look at the Problem

The biggest problem with the elbow is the tiny size of the tendinous attachment sites, of which there are
many. Both impact and the dynamic forces of leverage can progressively weaken these sites. This
leverage means that 10 pounds in the hand equals approximately 45 pounds at the shoulder joint, for a
person with average arm length. Another way to view this phenomenon is to compare the force you get by
turning a bolt with a long handled wrench, as opposed to a short handled wrench. Now consider that a
tennis player, for instance, makes this already long lever even longer by putting a racquet in the hand.
The impact of repetitively hitting the ball, compounded by the very long lever arm created by the racquet,
results in cumulative microtrauma to the tendinous attachment sites at the elbow.

Over time, if not treated, these tendons actually begin to fray, much like a nylon rope would if stretched
beyond its tensile strength. Eventually, the tendon can detach from its attachment site at the elbow,
requiring surgical repair.

Treatment Options: From Conservative to Radical

• Rest: The most effective, yet overlooked, aspect of post-injury recovery is simply to become more
aware of, and markedly limit, activities that cause pain and swelling to the affected area. In light of
the elbow’s ubiquitous role in almost all human activity, this is no easy task.
• Forearm Strap: Used by tennis players, golfers and other athletes with elbow problems, the strap
acts like a “shunt,” absorbing impact and vibrational forces before they reach the tendinous
attachment at the elbow. One of the best straps is the Interceptor™, by Weider.
• Aspirin Therapy
• Diathermy
• Electro-stimulation: Moderate to intense amounts of intermittent electrostimulation is applied
directly to the injured tendinous area for 10 to 15 minutes per session. This form of
electrostimulation is most effective when it follows diathermy, and is followed up with cryo-
therapy.
• Cryotherapy
• Corticosteroids: Administered by injection to the injury site, corticosteroids help to reduce
inflammation and pain. The drawback, however, is that these agents cause a breakdown of
collagenous and ligamentous tissue after repeated injections.
• Proliferate-injection Therapy: This is injected directly into the injury site, causing an “artificial
injury,” which then provokes the collagenous cells to begin restructuring themselves more quickly.
• Surgery: In the most extreme cases, a torn or avulsed tendon or ligament may require surgical
reattachment. This is the “final straw” when it comes to solutions for joint problems. Many methods
are used, including tendon grafts and stapling.

Prevention is the Key

Fortunately, most serious elbow problems can be completely prevented with good training and work
habits, and immediate intervention upon the onset of trouble. Never train through elbow pain; instead,
seek the immediate guidance of a qualified sports medicine physician or chiropractor.

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Knee pain

Chondromalacia: Degenerative changes (roughening) of the underside of the kneecap. Causes pain when
rising out of a chair, or when climbing stairs. Think about getting a grain of sand under your eyelid. The
synovial fluid acts the same way. Tight quads are responsible for 80% of chondromalacia. Other causes
include repetitive overuse, genu valgum (“knock-knees”), and a shallow lateral femoral condyle.

Patellofemoral Pain Syndrome (PFPS): Figure 32-1

Exemplified by pain in front of patella, which
intensifies during activity. Also, pain during extended
sitting, and/or walking up stairs. PFPS is further
characterized by crepitus (noise), without instability.
PFPS is considered to be a tracking problem of the
patella, caused by an imbalance between the medial
and lateral quadriceps. The damage to the underside
of the patella is not unlike uneven tread wear in a car
that needs the tires rotated.
Click above to enlarge image
Unstable Knee Joint: Knee suddenly gives out. This
is often caused by old injuries, which have
overstretched the knee ligaments.

Locked Knee: The usual cause of locked knees is a torn meniscus, or a loose body within the joint
capsule.

Swelling/Tightness: Nearly always indicates an internal injury. See physician immediately.

Crepitus: Noisy knees are no reason for concern unless accompanied by pain and/or swelling.

How to Use Knee Wraps

Knee wraps have long been a mainstay for competitive powerlifters, and for good reason. When properly
used, wraps can dramatically improve knee safety during heavy squatting and leg training sessions.
Whenever you contract your quadriceps muscles, the patellar ligament wants to pull away from its
attachment at the upper front aspect of the tibia. During squatting, for example, the heavier you go, the
lower you go, and the faster you descend, the more this tendency is compounded.

Wrapping your knees with “superwraps,” or other highly binding types of bandages is something all
powerlifters must do when squatting with extremely heavy weights in training and competition. However,
there is a question as to whether anyone else should. One theory has it that constantly wrapping one’s
knees during training robs that person of the very stress that is critical to promote positive adaptive tissue
growth, including connective tissue. Reasons for wearing knee wraps during squatting, therefore, are as
follows:

1. Keeping your knees warm (wrapped loosely), which improves blood flow and tissue elasticity.
2. If the weight you are using is greater than 80 percent of your maximum
3. If you have knee problems that require wearing wraps
4. If you use them, do so with the following information in mind. Knee wraps are only effective if used
properly.

Sit on a chair or bench. Begin with the wrap completely rolled up (this makes the process much easier
than fighting with a six-foot tangle of cloth). With your leg straight, start applying the wrap on the upper
portion of your shin. Wrapping from “in” to “out,” (counterclockwise for the left leg, clockwise for the
right), anchor the wrap by applying 2 to 3 layers on the upper shin, then move upward, overlapping each
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previous layer by one-halve the width of the wrap. When wrapping around the patella, make sure the
wrap is a bit loose to avoid excessive pressure on the kneecap. Apply the wrap tightly again as you move
past the knee, stopping somewhere on the lower third of the thigh. Tuck the end of the wrap under the
previous layer to secure it. Repeat for the other leg.

You will notice that the wrap is tightly wound in a cylindrical fashion around the upper shin (where the
patellar ligament attaches), then more loosely wound over the kneecap itself (this is important to avoid
grinding the patella into the femoral condyle, creating a case of chondromalacia for yourself), then tightly
wound over the lower quarter of the thigh. The rationale for wrapping the knees prior to heavy squatting
is that it reduces the pulling forces on the patellar ligament at its attachment to the shin. This translates
to significantly reduced chances of avulsing (detaching) your patellar ligament during heavy leg
movements.

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 Figure 32-2: Four views of knee joint

Symptoms and Treatment of Minor Athletic Injuries and Illnesses

The following section is a compendium of injuries and conditions common to lifters and athletes. It was
adapted by Dr. Fred Hatfield from the curriculum developed for Morinaga Co., Ltd. School for Sports and
Fitness Coaches, Tokyo (1989). It is arranged with the following useful features: 1) Description of the
injury or condition, 2) Probable Treatment, 3) Cause for Concern, and 4) When to Call Your Physician.

Weakness, Fatigue and Exhaustion

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Most of you probably feel tired when you say you are fatigued and exhausted, but what do you mean
when you say you feel weak? It is important to understand the differences, since each symptom may have
a completely separate cause. Fatigue and exhaustion are often the results of emotional upset, unusual
stress, or just plain boredom. Since the cause is generally psychological, it often goes away with a rest
and a change of mood.

Prolonged feelings of fatigue, however, may be an early sign of depression. Many other symptoms often
accompany this kind of fatigue, including trouble sleeping (insomnia), headaches and irritability. On the
other hand, chronic fatigue could be an early sign of heart or lung disease.

While fatigue and exhaustion have to do with feeling tired, true weakness means an actual loss of muscle
strength. We usually associate the three symptoms, because they often occur together. Many times these
symptoms are associated with common illnesses such as colds and flu. On the other hand, they may
accompany more serious diseases such as mononucleosis, hepatitis, various disorders of your endocrine
glands such as diabetes or thyroid disease, certain nutritional deficiencies, and some disease of the
nervous system. Sometimes, fatigue or weakness may be associated with actual dizziness or fainting.

When you feel tired all the time, it is important first to try to distinguish between chronic fatigue and
actual muscle weakness. Fatigue is much more common. Once you determined that fatigue is your
problem, carefully analyze your lifestyle. Are you eating properly, and getting enough rest and exercise?
Are you exercising too much? Have you maintained your weight?

If your answer to these questions is yes, you must then analyze your psychological lifestyle. Is your family
life happy? Are you satisfied with your job? Do you have regular activities that you enjoy? Are you
generally relaxed? Remember that one of the most common causes of fatigue is stress.

Probable Treatment

Treatment of your fatigue or muscle weakness is aimed at treating the underlying cause. If you are feeling
tired, and know it is because you are just not eating or sleeping properly, try to correct the situation.
Follow a regular exercise program. If the fatigue persists with or without other symptoms, your doctor will
need to evaluate the problem.

Cause for Concern

Whenever you experience prolonged fatigue that is not relieved by normal diet and rest, you should seek
medical advice. When your fatigue is accompanied by other symptoms, such as chest discomfort or
shortness of breath, you should see your doctor immediately. The same is true if you develop weakness in
your muscles.

Call Your Physician When

1. Your fatigue is not relieved by normal diet and sleep.

2. Your fatigue is chronic, and persists over several weeks.
3. Your fatigue is associated with loss or gain of more than a few pounds.
4. Your fatigue is associated with other symptoms, such as heart palpitations shortness of breath,
dizziness, fainting, severe headaches or fever.
5. Your fatigue is accompanied by severe depressions.
6. You experience true muscle weakness.

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Dizziness, Vertigo or A Sudden Loss of Consciousness

You probably have experienced the symptoms of dizziness. It can best be described as a sensation of
unsteadiness or light-headedness. In some cases, it may be associated with a feeling of faintness.
However, with dizziness, you do not actually faint or lose consciousness. You may feel dizzy after having
one drink too many, or immediately after getting off an amusement park ride. Emotional upset and stress
may also sometimes produce this symptom.

Vertigo is often confused with simple dizziness, but it is generally a more serious medical symptom.
Vertigo can best be described as an actual sense of movement. With vertigo, you perceive that either you
or your surroundings are actually moving or spinning. When you try to walk, you may veer to one side.

Vertigo is usually the result of a disturbance in either the inner portion of your ear, or certain areas of the
brain responsible for maintaining your balance. Any acute or chronic disorder that affects the nerves
leading to these areas can also cause vertigo. One of the most common causes is a mild viral illness
associated with head and ear stuffiness. Sometimes the symptoms of vertigo do not even appear until
after the infection has cleared up. Typically, the symptoms are worse when you turn your head or change
positions. More serious causes include head injury, drug overdose and brain tumors.

A sudden loss of consciousness is called fainting. Fainting is usually a result of a sudden decrease in the
blood supply to the brain. Many mechanisms can affect the blood flow to your brain, and some of these
are part of your body’s natural reaction to anxiety, particularly stress. The very act of fainting and falling
down often increases the blood supply to the brain. Fatigue, hunger and emotional stress are common
causes of fainting.

Probable Treatment

The treatment of dizziness, vertigo or loss of consciousness depends on the cause of the symptoms. If you
have become dizzy because of emotional upset or stress, often a brief period of rest, and an attempt to
eliminate the underlying cause will solve your problem. Vertigo that is a result of a mild viral illness will
generally go away within a few days without treatment. If you become faint, lie down right away, and
elevate your legs and feet above the level of the body. This forces more blood to the head. For recurrent
dizziness, vertigo or fainting episodes, your physician will need to do a complete evaluation in order to
prescribe appropriate therapy. He or she will need to determine the underlying cause, and to be certain
that there has been no head trauma or other injury if you have lost consciousness.

Cause for Concern

Although dizziness is generally nothing to worry about, it may be a clue to something more serious, such
as hypoglycemia (low blood sugar), anemia, and high or low blood pressure, drug overdose or heart
disease. Anytime you experience dizziness that does not go away within a fairly short time, consult your
doctor. An occasional episode of vertigo that is short-lived should not be a cause for alarm. However,
recurrent, frequent, severe attacks of vertigo require medical attention. Likewise, vertigo associated with
head injury or accompanied by fainting requires immediate medical attention.

Most often, fainting is harmless except for the risk of head injury. Recovery from an uncomplicated
episode of fainting should occur within minutes. Loss of consciousness may also accompany heart disease,
severe anemia, diabetes, hypoglycemia, drug overdoses and epilepsy. Any time someone loses
consciousness and cannot be aroused (coma), consider this a medical emergency, and call for an
ambulance at once.
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Call Your Physician When

1. You experience dizziness that does not go away within a short time.
2. You experience recurrent episodes of dizziness or vertigo.
3. You experience dizziness, vertigo or fainting associated with a head injury or convulsions. Call for
medical help immediately.
4. You experience recurrent fainting episodes.
5. You are unable to arouse someone who is unconscious. Call for an ambulance at once.

Fever With or Without Chills

Fever is probably the single most important symptom of illness. It is also one of the main ways in which
your body defends itself against disease. Normally, oral body temperature ranges between 96.8 and 99.3
degrees Fahrenheit. Like a built-in thermostat, a center in the brain keeps your temperature within this
normal range, in spite of conditions outside your body.

When you become sick, especially with a serious infection, the invading germs cause your body to produce
substances that circulate to the brain center, and reset this thermostat. As your body works to keep this
higher temperature in order to help fight the infection, you feel feverish. Your fever may begin either with
a sensation of flushing and warmth, or with chills. Soon your pulse rate will increase, and you may
experience aches and pains in your muscles.

Although infections are the most common cause of fever, anything that interferes with the thermostat in
your brain can produce an elevated temperature, including stroke, cancer, heart attack, and an overactive
thyroid gland (hyperthyroidism).

Probable Treatment

Because fever is simply a symptom and not a disease itself, treatment depends on the cause. If you have
a low-grade fever with symptoms of cold or flu, home treatment with aspirin (provided you are not
allergic) or acetaminophen taken every six hours may relieve muscle aches, as well as lower your
temperature. However, any drug treatment should be discussed with your doctor. Aspirin should not be
used if your child has a fever, since its use has been linked to a serious complication of a certain viral
illness called Reye’s Syndrome.

As part of the evaluation of any prolonged or unusual fever, your physician will ask you if you have
traveled recently, taken any drugs, or have been exposed to any infections. After a careful physical
examination, certain X-rays and laboratory tests may be necessary in order to make a diagnosis, and
prescribe appropriate treatment.

Cause for Concern

An increased temperature is a clue that you may be ill. However, the number does not necessarily tell you
how sick you are. In general, children tend to have higher fevers than adults, while elderly people do not
have high fevers when they are quite ill. So how do you know Cause for Concern? A low-grade fever —
under 102 degrees Fahrenheit orally — associated with the symptoms of cold or flu is generally no cause
for alarm. However, if your fever increases beyond a low grade, or there are other symptoms associated
with severe shaking chills, unusually severe headaches or neck stiffness, consult your doctor. A prolonged
low-grade fever, even without other symptoms, or a fever that comes and goes over a period of several
weeks, should also receive medical attention. Extremely high fevers, particularly in infants or young
children, will occasionally cause convulsions. This should be considered a medical emergency requiring
immediate medical care.

Call Your Physician When

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 1. You have prolonged low-grade fever (under 102 degrees Fahrenheit).
2. Your fever comes and goes over a period of time.
3. You have a fever associated with neck stiffness, shaking chills, wet coughs, convulsions, or severe
headache — call immediately.
4. You have an extremely high fever — over 103 degrees Fahrenheit — for twelve to twenty-four
hours.

Cough or Shortness of Breath

A cough is one way your body prevents irritating particles that enter your airways from invading your
lungs. Viruses and bacteria that cause infection, as well as dust, smoke and pollen, are trapped in the tiny
hairs (cilia) that line your air passages, and act as protective barriers. Irritation of these cilia stimulates
your cough reflexes.

Whenever you develop a cough, you should determine its cause. For example, a cough at work when
inhaling certain noxious chemicals may indicate an allergy to these substances. A cough during pollen
season may also suggest allergy. Sometimes drinking hot or cold liquids or getting food “down the wrong
pipe” can irritate the sensitive airways and provoke a cough.

Whether your cough is “dry” or “wet” will also be a clue to its cause. Irritants such as smoke, dust or
allergies can trigger a dry cough. Certain infections such as cold, measles, or flu also commonly cause a
dry cough. This type of cough should go away when the infections clears up. If it does not, there may be
another cause, and you should consult your doctor.

A wet cough means that you are coughing up fluid. In this case, your cough is likely from an infection in
your lungs such as bronchitis or pneumonia. Once bacteria get past the protective barrier in the airways
and actually invade the lungs, your body produces large amounts of sticky fluid (mucus) as a defense
measure. This fluid irritates the lungs, causing you to cough it out. If this mucus is green, yellow, or
reddish-brown, you probably have a lung infection and should seek medical advice. Whenever you cough
up bright red blood, see your physician immediately.

If you are a smoker, you may cough every morning. This smoker’s cough could be a symptom of chronic
bronchitis. Consult your physician. Heavy smokers are much more likely to develop lung infections
because nicotine in cigarettes destroys the cilia in the airways, leaving nothing to prevent viruses and
bacteria from entering the lungs.

Shortness of breath is a symptom that may occur with or without a cough. Sometimes it comes on so
gradually that you notice it only during strenuous activity. Regardless of when it occurs, this symptom
requires your doctor’s immediate attention since it means that you are unable to get enough oxygen into
your system. You may have a feeling of breathlessness. Shortness of breath can be a symptom of
bronchitis, asthma, emphysema, cancer, or heart disease.

Probable Treatment

Because coughing is an important defense mechanism, you should generally avoid suppressing it. This is
especially true of a wet cough. Before taking any cough suppressant, check with your doctor. On the other
hand, an expectorant will help you cough up the fluid and possibly shorten your illness. Expectorants are
sold over the counter without a prescription. If your cough persists or is associated with shortness of
breath, have your doctor determine the cause and suggest appropriate treatment. As part of an
evaluation, the physician may order X-rays, examine and culture the fluid, and/or perform special
breathing tests.

Cause for Concern

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Anytime you have dry cough persisting for longer than a week without other symptoms of a cold or flu,
seek a doctor’s advice. A wet cough suggests a possible lung infection and may require treatment with
antibiotics. Although a cough is the most common symptom of respiratory disease, it may also be caused
by other problems, such as heart disease. Shortness of breath with or without a cough requires a doctor’s
immediate attention.

Call Your Physician When

1. Your dry cough persists for longer than a week and is not associated with a cold or flu.
2. You are coughing up green, yellow, or reddish-brown mucus.
3. You cough up bright red blood — call immediately.
4. You are a smoker and you cough every day.
5. You are short of breath with or without a cough — call immediately.

Generalized Joint and Bone Pain

Most people do not realize that the bone is actually living tissue. Any injury or infection of bone is usually
quite painful. A bone may be bruised from any blunt injury. If severe, such bruises may take several
weeks to heal. Persistent pain, localized in a particular bone or area of a bone, may also be a symptom of
something more serious, such as a bone infection (osteomyelitis) or even a tumor in the bone.

Most people tend to confuse bone pain with joint pain. Generalized bone pain is often a vague symptom
that accompanies viral infections such as the flu. You may also have a low-grade fever and muscle aches
and pains. The union of two or more bones forms yours joints. Most of your joints are supported by tough
fibrous bands (ligaments) and enclosed in capsules (bursa) that protect and lubricate them.

Localized joint pain is a symptom that usually follows an injury to a ligament or cartilage or an
inflammation of a bursa. Another cause of localized joint pain is a condition called gout. If you have gout,
you have probably had attacks before. The pain is usually localized in one joint, which is often red and
swollen.

Generalized joint pain is usually not a serious symptom unless it persists for more than several days or
comes and goes. Usually it is one symptom of a viral illness, along with fever and muscle aches. When
joint pains do persist, they may be a symptom of a generalized infection, arthritis, or other serious illness.

Probable Treatment

Home treatment for a bruise consists of cold packs to relieve the swelling. Avoid further injury to a bruised
area. If your physician suspects an infection or a tumor, he will order X-rays to confirm his diagnosis.

Bone infections may require hospitalization and intravenous antibiotics. Localized joint pain due to trauma
usually requires splinting of the injured joint. Avoid putting weight or further strain on the joint. Cold
packs may help reduce the swelling. Your doctor will check the injured joint and order X-rays if he
suspects a fracture or dislocation. If your pain is severe, he may prescribe pain medication and possibly an
anti-inflammatory drug. If your joint is infected or you have gout your doctor will diagnose and treat the
underlying disease.

For generalized joint pain associated with a viral illness like a cold or flu, aspirin — if not allergic — or
acetaminophen, bed rest, and plenty of fluids should relieve your symptoms. (Do not give children aspirin
for any viral infection) If your joint pain persists for over a week or is intermittent, your doctor may need
special tests to make the diagnosis.

Cause for Concern

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If you have localized bone pain that did not result from a bruise, and it persists for more than a week, see
your doctor. When you also have symptoms of fever, weight loss, or redness and swelling over the bone,
immediate care is required. Generalized bone pain that persists or is associated with fever and weight loss
should be reported to your doctor.

Sudden severe pain in a single joint following an injury or strenuous activity should be checked. Sudden
pain with redness and swelling (particularly in your big toe) should make you suspect gout. Your doctor
will do special tests to confirm this diagnosis.

Generalized joint pain of a few days’ duration as one symptom of a cold or flu is usually nothing to worry
about. If it persists, suspect a form of arthritis or a more serious condition. Fever, chest pain, and
shortness of breath associated with generalized joint pains likewise require prompt medical evaluation and
treatment.

Call Your Physician When

1. You have localized pain in a particular bone.

2. You have generalized bone pain lasting more than a week.
3. You have either localized or generalized bone pain associated with fever, weight loss, or redness or
swelling over any bone.

Abdominal Pain

While most people do not understand the anatomy of their digestive systems, almost everyone has
experienced abdominal pain, nausea, vomiting, or diarrhea at some time. In evaluating what seem to be
digestive symptoms, your doctor must suspect diseases of other systems as well. For example, sometimes
a heart attack may cause symptoms identical to heartburn or indigestion. Similarly, a brain tumor can
cause symptoms of nausea and vomiting. Because of these confusing patterns, it is especially important
that you give your doctor a careful medical history when you describe any of these symptoms so that the
real cause of the problem can be discovered.

If you have frequent, repeated, or lasting severe abdominal pain, you should see a physician. Try to
describe the onset of the pain. If it came on suddenly over several minutes, it is likely due to a perforated
ulcer or a blockage in the blood supply to your intestine. If your pain came on gradually over several
hours, a diagnosis of appendicitis, gallstones, or even a pelvic infection are possibilities.

The character of your abdominal pain is also a clue to the underlying cause. Colic or spasm of a portion of
your intestine is the most common cause of abdominal pain. This type of pain is usually caused by a
blockage somewhere in your intestinal tract, which stretches the intestine behind the blockage. A burning
or aching type of pain is more characteristic of an ulcer.

The location of your abdominal pain is likewise very important in helping to determine its cause. Pain
caused by appendicitis, for example, almost always settles in your right lower abdomen. Pain from
bleeding of infection in your abdomen usually is widespread. Remember, when you complain of abdominal
pain, your stomach is not always where the pain really begins.
Other symptoms, such as nausea and vomiting, when associated with abdominal pain, may give your
doctor further clues to your diagnosis. Although nausea and vomiting are usually not symptoms of serious
illness, they should not be taken lightly. The first sign of pregnancy will often be nausea and vomiting
known as “morning sickness.”

Diarrhea is also a symptom that is usually not serious. The most common cause is probably a viral
infection in your colon. However, the cause may be bacterial. Although your colon normally contains a
heavy growth of bacteria, a shift in the type, as occurs in “traveler’s diarrhea” or following the use of
antibiotics, can sometimes cause severe diarrhea.
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If your diarrhea persists or is associated with severe cramps, bloody stools, or fever and chills, get prompt
medical attention. Your physician’s first question will almost always be “Have you traveled recently?”

If your symptoms are persistent and are associated with weight loss, your doctor will look for more
serious causes. Be prepared to discuss your diet, the character of your stool, the amount of your weight
loss, any medications you are taking, or any other medical problems that you have. It is important to
realize that any change in your bowel habits may be a very important symptom of a serious underlying
condition.

Probable Treatment

Treat any of these symptoms yourself only when they are mild and of short duration. Generally, home
treatment consists of avoiding any offending substance that you suspect has caused your nausea,
vomiting, cramps, or diarrhea. Stay on a clear liquid diet until your symptoms go away in a day or two.
Your doctor will want to know how long you have had this symptom and how often you vomit. He/she will
ask about the character of your vomit and many doctors will want to see a sample and possibly test it for
blood or other substances. Your doctor’s treatment of more severe or prolonged symptoms will depend on
diagnosis of the underlying cause.

Many very sophisticated diagnostic tools are now available that actually permit a specialist to look directly
at large portions of your digestive system and diagnose any abnormalities. In addition to direct
observation, your doctor will have many other laboratory and X-ray studies available if they are deemed
necessary to find the cause of the symptoms.

Cause for Concern

Any persistent abdominal pain, nausea, vomiting, or diarrhea can be a clue to a serious medical problem.
These symptoms may not only suggest a problem with your digestive system, but they can also be a clue
to other conditions as well. Remember that whenever any of these symptoms are associated with
intestinal bleeding, fever, chills, weight loss, or severe abdominal pain, you should seek medical
evaluation as soon as possible.

Call Your Physician When

1. You have any severe abdominal pain, nausea, vomiting, or diarrhea.

2. You have any of these symptoms associated with bleeding, fever, chills, or weight loss.

Bleeding

Everyone has had a cut, a nosebleed, or a tooth pulled. Whatever the reason, anytime a blood vessel is
torn, blood leaks into the tissue. Usually, this bleeding stops within minutes. Certain substances (factors)
in your blood together with special blood cells (platelets) react quickly to make your blood clot, problem
with your platelets, your blood will not clot properly and you will continue to bleed even after minor
injuries. In either case, bleeding may occur anywhere in your body with possible serious blood loss.
Abnormal clotting, or the lack of clotting, may be caused by malnutrition, infections, drug reactions,
anemia, leukemia, or inherited disorders like hemophilia.

If your blood vessels are weakened or damaged for any reason, you may bruise easily. The bruises that
some women notice on their thighs or hips called “devils pinches” are usually not serious but should
always be evaluated by a doctor. Elderly people with very thin skin may also bruise easily, especially on
the backs of their hands and on their forearms. This is usually not a cause for concern.

Probable Treatment

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If you are bleeding heavily (hemorrhaging), the first step is obviously to stop the blood loss and determine
the cause. If possible apply direct pressure to the bleeding site. If the bleeding is from an arm or leg
injury, you may use a tourniquet but loosen it every few minutes. If your gums are bleeding, try packing
with cotton gauze temporarily. For nosebleeds, lean forward and pinch your nostrils. Never bend your
head back; avoid swallowing the blood.

If your bleeding is caused by a clotting abnormality, you may need tests to determine the exact problem.
Severe internal bleeding may require emergency surgery to prevent significant blood loss or damage to an
organ. Know your blood type and carry adequate identification with you at all times in case you require an
emergency blood transfusion.

Call Your Physician When

1. 1. You are bruising with no apparent reason.

2. You notice bleeding that does not stop after a few minutes — call immediately.
3. You have excessive or abnormal bleeding — call immediately.
4. You have blood in your urine, stool, vomitus, or sputum — call immediately.

Hip Pain

Even though your femur is the largest and strongest bone in your body, it may be subjected to pain and
stiffness as a result of arthritis, dislocation, fracture or other injury.

Arthritis most commonly causes symptoms of hip pain, especially when there has been no injury. As you
get older, routine wear and tear may cause the cartilage on the surfaces of your joints to become
roughened. This degenerative arthritis (osteoarthritis) is common in older people and often affects the hip
joints. The symptoms are gradual stiffening that becomes painful when you stand or walk for any length of
time. The pain usually will worsen after prolonged activity and improve somewhat with rest.

A hip fracture is another common cause of pain and other symptoms. This usually results from a fall. Hip
fractures are especially serious in the elderly. Hip fractures often lead to serious complications such as
strokes and pneumonia as well as poor and slow healing. A rare cause of hip pain and stiffness is a
dislocation. The thighbone fits into a socket in your pelvis, forming the hip joint. Surprisingly, hip
dislocation is usually caused by a fall on your foot or your knee. This serious injury is unusual because it
takes great force to damage the strong ligaments that hold the end of your thighbone in its socket.

Probable Treatment

If your hip pain comes on gradually, your doctor will carefully evaluate your symptoms and probably
suggest X-rays to be certain that they are due to arthritis. If this is the cause, your most important
treatment will be plenty of rest. Try to avoid strenuous or weight-bearing activities such as prolonged
standing, climbing, or walking up and down a lot of steps. If you’re overweight, lose weight to decrease
the stress on your joints. Physical therapy may relieve some of your symptoms.

Your medical treatment will be similar to that described for arthritis. If you are otherwise active, and your
arthritis is severe or painful and fails to respond to conservative treatment, your doctor may suggest a
surgical hip replacement.

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Although there is no cure for arthritis of the hip, adequate treatment may relieve your symptoms and
enable you to enjoy a full and active life. If your arthritis shows only on an X-ray, but if you feel fine, do
not worry. We are all bound to suffer some wear and tear as we get older.

If you suspect a hip dislocation, never attempt to replace the thighbone in its socket. Get medical
attention immediately. If ambulance care is not available, carefully place the victim on a firm board with a
pillow under the knees and take him to an emergency room. Firmly support the leg and thigh during
transport. Careful X-ray studies will be necessary, and anesthesia is almost always used in correcting the
dislocation.

In treating a suspected hip fracture, turn the victim onto his back and gently place him on a long board.
Carefully secure his body firmly to the board to steady the hip, pelvis, and spine. Transport him to an
emergency room immediately. If a large board is not available, the victim’s legs should be padded and
bandaged tightly together. Move the injured leg as little as possible to avoid any further damage to nerves
or blood vessels near the fracture. Your doctor will generally want to order X-rays whenever a hip fracture
is suspected since some fractures are difficult to detect.

Cause for Concern

Hip soreness from a new activity like skiing will usually go away by itself. But, if you gradually develop hip
pain without an injury, and the pain continues for longer than a week or two, you should see your doctor.

Any fall by an elderly person that results in hip pain requires medical evaluation to rule out a fracture. If
an injured person lying on his back is unable to lift his leg, suspect a hip fracture. Often the foot and leg
on the injured side will be turned outward. A bruise over the hip, following a fall, is one clue to a likely
fracture and should not be ignored. If a fracture is mistaken for a bruise, and the victim continues to
hobble about in this condition, the bone will heal poorly and fail to provide adequate support. This often
leads to another fall.

Call Your Physician When

1. You experience the gradual onset of hip pain or stiffness that persists for longer than a week
2. You have hip pain after a fall on your foot or knee.
3. You have hip pain, a limp, or a bruise over your hip after a fall.
4. You suspect a dislocation.

Leg Pain

Most leg pain and other leg symptoms are due to cramps that originate in the muscles of your thigh and
calf. Usually, there is no serious underlying cause. Occasionally, other more serious conditions (such as
varicose veins or phlebitis) can cause similar symptoms of cramping or aching in your thigh and especially
in your calf.

Muscle cramps are sudden, painful spasms that most often result from overexertion. A loss of body salts
and/or a pulling or stretching of your leg muscles during exertion may be the reason for your cramps. Any
strain on your leg muscles, such as wearing high-heeled shoes all day, can produce spasms. Chronic
anxiety and stress may tighten your muscles and result in similar symptoms. Still another common cause
is sciatica resulting from a low back injury. Leg cramps may also accompany infections that cause high
fever, chills, and sweating.

Varicose veins can give you both a cosmetic and actual pain in your legs. The veins near the surface are
usually involved and may become enlarged, bluish, twisted, and lumpy. These veins rarely cause severe
symptoms, but in some cases you may experience increased soreness and fatigue. This condition is more

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common in women than in men and often occurs in families. It may be aggravated by pregnancy or
obesity.

The most serious cause of thigh and calf pain is the formation of blood clots in the veins of the legs. While
these may appear in the surface veins, they are more serious when they occur in the deep veins. Small
clots (emboli) sometimes break loose and travel through the bloodstream to the lungs or brain, where
they can cause a fatal blockage. If you have recently had pelvic or abdominal surgery, or you have injured
or broken a lower limb, you are at high risk. Also, if you are taking birth control pills or have been
bedridden for a prolonged period of time, you are prone to develop a blood clot.

Probable Treatment

Most ordinary leg cramps can be treated at home. Moist heat packs, massages, and rest are the
mainstays. Physical therapy and exercise also may be helpful. If your pain persists or is severe, see your
doctor. He/she will check you thoroughly and possibly order some blood tests. He may prescribe
medication for pain and muscle relaxants to relieve the spasms.

For most varicose veins that are mild to moderately severe, avoid prolonged standing and wear support
hose. Also avoid tight clothing such as garter and girdles. Varicose veins that bleed or ulcerate require
prompt medical attention. If your condition gets worse or complications develop, your doctor may
recommend surgery or local injections to remove the affected veins.

You can prevent blood clots in your leg by reducing certain risk factors. If you have poor circulation, are
pregnant, or have just had major surgery, take particular care to exercise your legs and keep them
elevated. If bedridden for more than two or three days, use special support stockings to improve the
circulation in your legs. If you suspect a blood clot, there is no home treatment. Get medical attention
immediately. The treatment for an early or mild blood clot will include bed rest with your feet elevated and
aspirin or another anti-inflammatory medication. More serious cases may require hospitalization and drugs
to thin your blood.

Cause for Concern

Almost everyone gets an occasional leg cramp. If your cramps are unrelated to a particular activity,
appear repeatedly in the same spot, or follow a recent injury, you should see your doctor. If you have
varicose veins, be concerned when a vein ruptures and bleeds after an injury or when an ulceration
develops. Your doctor should check severe varicose veins.

Most important, if you are at risk for blood clots, and you gradually develop severe pain, swelling,
redness, or heaviness in your leg, get immediate medical attention. Be especially concerned if these
symptoms are associated with shortness of breath, chest pain, fever, or coughing blood.

If leg swelling and pain develop after an injury or after being in bed for several days, you should suspect a
blood clot.

Call Your Physician When

1. You have cramps in the same location that persists for several days without any apparent cause.
2. You have varicose veins that are extremely painful or that bleed or ulcerate.
3. You have any swelling, redness, or tenderness in your thigh or calf, especially if you are at risk of
developing blood clots.

Ankle Pain

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Like any other joint in your body, your ankle may gradually become painful from any of the causes of
arthritis mentioned earlier. Most sudden, severe ankle pain results from an acute injury such as a strain or
sprain. A strain is a mild stress on a muscle or tendon; a sprain is the stretching or actual tearing of a
ligament.

Some orthopedists consider a severe ankle sprain to be worse than an outright fracture. Severely torn
ligaments heal slowly and often poorly, which may lead to repeated ankle sprains.

It is extremely rare for your ankle to become dislocated without an accompanying fracture. Most fractures
are actually caused indirectly by a force applied to your foot and transmitted to your ankle. Usually, this
force turns your foot either inward or outward, each causing a different type of fracture.

Your ankle joint is very complicated and involves the union of several bones and ligaments. Because of
this, in severe ankle injuries, more than one bone is often fractured.

Probable Treatment

Your doctor will check your ankle and lower leg and suggest X-rays to determine the extent of the injury
to the bones and ligaments. Mild ankle strains and sprains without torn ligaments do not require a cast.
More severe sprains often require a cast to steady the ankle joint while the ligaments heal. A completely
torn ligament usually requires a walking cast for at least six weeks to promote healing and to prevent a
recurrence. Avoid putting any stress on your ankle for several weeks afterward.

Occasionally, when X-rays show that a ligament is completely torn, your doctor may advise surgery to
repair the tear. This is especially true if you are young and extremely active in sports. Follow your doctor’s
advice carefully to prevent long-term weakness and repeated ankle sprains. It may take as long as three
to four months until your ankle has completely returned to normal.

If you suspect an ankle fracture, seek medical attention Ankle Figure

as soon as possible. Avoid bearing weight on it, apply
cold packs, and splint and elevate the ankle during
transport to an emergency room. Most experts
recommend that you splint the injured ankle with the
shoe on and wrap the lower part of your leg with an
elastic bandage. Ankle fractures almost always require
some type of cast, with the period of time depending on
the extent of your injury. Severe fractures that impair
the blood supply to your foot or where the bone
fragments are sufficiently dislocated to prevent normal Click above to enlarge
healing may require surgery. image

After your cast is on for about 24 hours, you will need to return to the doctor to be sure that there is good
circulation to your foot and toes.

Cause for Concern

You cannot always judge the severity of an injury by your pain. Sometimes a mild ankle sprain, with a
partially torn ligament, is more painful than a completely torn ligament. See your doctor if you have any
significant pain or swelling or cannot support your weigh. Splint or tape the ankle with an elastic bandage
and avoid bearing weight on it. You may apply cold packs to relieve the swelling. Basically, any sudden
twisting injury causing severe pain and swelling should suggest a fracture until proven otherwise.

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Compare your injured ankle to your normal ankle. Any deformity or displacement of the bone is a clue to a
likely ankle fracture and requires prompt medical evaluation.

Call Your Physician When

1. You have severe ankle swelling and pain following a sudden injury.
2. You are unable to walk comfortably or have any numbness or tingling in your foot several hours
after an injury.
3. You gradually develop pain, redness, or swelling in your ankle that persists for more than two days,
even without an injury.

Foot Pain

Most people overlook the importance of their feet. Anything that causes foot problems will likely put a
crimp in your lifestyle. Corns, calluses, bunions, diseases of the joints of the feet (such as gout), fungal
infections such as athlete’s foot (tinea pedis), and ingrown toenails are all capable of producing enough
pain to keep you from walking. Your feet, and especially your toes, may also be accidentally injured. A
“stubbed toe” is usually nothing to worry about, but untreated fracture of the small bones of the foot and
toes can lead to permanent disability.

If you have bunions, you probably got them because you are genetically predisposed, or wear shoes that
are too tight. Over time, pressure from tight shoes produces redness and irritations (inflammation) near
the joint of the big toe. Continued friction over the joint causes the bone to harden and become inflexible.
A large, bony growth develops, usually on the inner side of the big toe. Women get bunions more often
than men and generally develop them in both feet. Once you have bunions, you may have difficulty
finding shoes that fit. Your worst symptom, however, will be pain.

Areas of hard, thickened skin are called either corns or calluses. They develop on an area where there is
repeated or prolonged pressure or friction. Corns tend to be pea-sized or slightly larger. They are usually
tender and typically occur on your feet either between the toes (soft corns) or over the bony areas (hard
corns).

Calluses are less tender and usually have less definite margins than corns. The palms of your hands and
the soles of your feet are the most common sites, but they can develop anyplace where there is pressure.
For example, guitarists have calluses on their fingers, and violinists get them under their chins.

Gout typically occurs as a sudden attack, causing pain, redness, and swelling of the joint of the big toe.
The wrist, ankle, knee, and even your thumb may be involved. Later attacks may be less intense but often
last longer. After time, the disease can cause crystals of uric acid to deposit in tissue around your joints,
causing stiffness and deformity. Gout is inherited, with 90 percent of the sufferers male, usually over the
age of 30.

Fungal infections can affect either the skin of your feet, causing athlete’s foot, or the toenails. Both
infections are actually a form of ringworm. Athlete’s foot is a common problem that causes itching and
burning between the toes and on the soles of your feet. After a long time, it is not unusual for your
toenails to become infected as well. Athlete’s foot is highly contagious and can be spread by direct contact
or by using an infected person’s towel or shoes.

Most people get ingrown toenails from either chronic irritation or manicuring too closely to the nail edge.
Once the nail becomes ingrown, there is a danger of infection. The area around the toenail becomes red,
swollen, and tender to touch.

Probable Treatment

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Wearing proper shoes for each activity can prevent most foot injuries. If your doctor determines that you
have fractured your foot he will recommend a cast or special shoe to aid in healing. Taping it to the
adjacent toe until it has healed is the best way to continue activity with a broken toe.

You can prevent bunions, corns, and calluses on your feet by wearing shoes that fit properly. If you
already have bunions, you can relieve the pain by enlarging or cutting your shoes. This will eliminate
pressure on your bunions. Some specialized shoe stores sell “bunion last” shoes with a wide forefoot
section. Or you may want to have shoes custom-made. Whenever possible, avoid wearing high-heeled,
narrow-toed shoes. If your pain is not relieved by these techniques, consult your doctor. You may be a
candidate for surgery. However, before you decide on surgery, you should get a second opinion and make
sure you understand the risks.

Once you have a corn or callus, try soaking the area in hot water. Or you may apply a softening agent
such as salicylic acid. Purchase this at your pharmacy and carefully follow the enclosed directions (do not
apply the agent to normal skin). A few days after applying this preparation, use an emery board to
remove the thickened dead skin. If your callus or corn is on a weight-bearing area, ask your pharmacist
for a metatarsal bar or foam pad to help relieve the pressure.

The aim of the treatment for gout is to minimize the formation of uric acid crystals; your doctor may
prescribe any of several different drugs to do so once he has made the diagnosis. A high liquid intake will
help to increase your daily urine output. Special diets have not been shown to affect attacks.

Good foot hygiene is essential for the prevention of fungal infections. Keep your feet clean and dry,
especially in warm weather. In warm weather, wear light shoes such as sandals that allow air to circulate
between your toes. Over-the-counter medications specifically labeled for athlete’s foot may be helpful in
mild cases, but they usually do not work on your toenails. Check with your doctor if you have a severe or
chronic case of athlete’s foot or the nails are involved. He may examine a skin scraping and prescribe an
oral anti-fungal drug.

If you have an ingrown toenail that does not appear to be infected, try soaking your toe in hot water.
However, if there is redness, swelling, and severe pain with or without pus, consult your physician. He
may need to open the area near the toenail surgically to drain the infection. It is also likely that he will
prescribe antibiotics.

Cause for Concern

Any persistent pain following a foot injury should receive prompt medical attention. If a bunion becomes
so painful that you are unable to walk, see your doctor. If you suffer from diabetes or poor circulation, you
should never remove corns or calluses on your own because of the increased risk of infection. Although
most cases of athlete’s foot tend to be mild and self-limited, a diabetic who develops a foot infection
(fungal infection or ingrown toenail) should seek prompt medical attention. Rarely, a severely infected
ingrown toenail will spread more deeply into the tissue of the toe, affecting the tendons and even the
bone.

The most serious complication of gout is kidney failure. Chronic arthritis is another complication. Although
no one really knows why, people with gout have an increased incidence of high blood pressure
(hypertension), kidney disease, diabetes, high fats (triglycerides) in the blood, and hardening of the
arteries (atherosclerosis).

Call Your Physician When

1. You have any persistent pain following a foot injury.

2. You have a bunion that is so painful that it interferes with your walking.

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3. You have a painful corn or callus, an ingrown toenail, or a fungal infection of your feet and you
have diabetes or poor circulation.
4. You have an infected ingrown toenail.
5. You notice a sudden painful swelling and redness of any of your joints, especially the big toe.
6. Shin Splints
7. Special Section by James Dustin Parsons BS, CFT, FT
8. You know that annoying pain in your lower legs that never seems to get better? This leg pain
always seems to slow your training just when you are starting to make some real gains. This group
of lower leg injuries commonly referred to as “shin splints”, is one of the most commonly occurring
injuries in active people.
9. Unfortunately, the advice people get on the prevention and treatment of these injuries when
shopping for athletic shoes is far from science. Most people end up with shoes that are not helping
their condition, or are even causing it.
10. The good news is that with the proper shoe selection, shin splints can be prevented or reduced.
The trick is to know the characteristics of your feet, and to be able to match them with the key
characteristics of an athletic shoe.
11. It all begins with knowing your feet. Many of us have heard before that we have flat feet, or an
abnormally high arch. Knowing this information is crucial because the truth is, most of what we
need in an athletic shoe revolves around our arch type.
12. Foot Types
13. A flat foot, commonly referred to as a pronated foot, is characterized by excessive motion. That
means the foot is loose and “gives” too much under the weight of the body, thus appearing flat
when bearing weight. A high arch foot, commonly called a supinated foot, has its own associated
problems. A supinated foot is a rigid foot, and a poor shock absorber. As such, excess forces of
movement get transferred up the leg to be absorbed by some other body part, in this case the
bones of the lower leg.
14. A neutral (normal) foot is a middle ground between the pronated and supinated foot. This foot type
is the biomechanically correct foot and is not prone to either type of shin splint specifically, but
symptoms may persist. Chances are, if you have never heard one way or the other which foot type
you have, you are neutral.
15. So, how do these foot types tend to cause shin splints? First we will investigate the pronating or
flat foot. The tibialis posterior is the primary muscle responsible for maintaining the arch of the foot
when you bear weight on the feet.
16. The pronating arch tends to collapse under load. A tug-of-war between the collapsing arch and the
tibialis posterior occurs with each step. Over time, the collapsing arch wins the war. Due to the
excessive forces in the tibialis posterior, the muscle’s origin begins to be pulled away from its
attachment on the tibia.
17. Obviously very painful, a person experiencing this condition will generally feel discomfort on the
distal medial (lower inside) aspect of the leg felt near the border of the tibia and the soleus muscle,
near the midpoint of the leg. Keep in mind that the pain may not be isolated to one spot because
the origin of the tibialis posterior covers a large area.
18. Now we will turn our attention to the supinating (high arch) foot. Recall that this is a rigid foot and
does not absorb shock well. As stated, this foot transfers more of the forces of impact up the leg.
The tibia is the bone that suffers the most in this condition. Hairline fractures may begin to form in
the bone. A person with this type of shin splint will feel pain in the anterior distal (lower front) of
the leg, somewhere on the bottom half the shin.
19. One can distinguish this condition from the flat foot shin splints because this type will be most
tender to touch directly on the tibia (shin), usually anterior (in front of) the tibialis posterior
muscle. This condition can further be identified by visible swelling (lumps) on the shins. In either
type of shin splint, the pain will be the worse during and immediately after exercise.
20. Selecting Proper Footwear
21. Now that the kinesiology is out of the way, we will review footwear. If you are flat-footed, you want
a shoe that controls the motion of your foot. Remember that a flat foot undergoes excessive
motion. To combat this problem, you look for a shoe sole that is rigid from the base of the toes

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 (usually the widest part of the sole) to the heel. You also want a good, solid heel cup. This is the
region of the shoe the cups and stabilizes the heel above the sole.
22. This combination acts as a brace for the foot, holding it in the neutral position and preventing
pronation. How do you check a shoe for these characteristics? You have to get your hands on it!
Squeeze the heel cup area above the sole. Is it firm or spongy? With one hand, hold the rear of the
sole and place the other on the widest part of the sole near the base of the toes. Give it a good
twist! Bend it! Did it feel solid or spongy?
23. Now compare it to other shoes in the store. I have found that Asics shoes with the motion control
bar typically fare the best in this category.
24. If you have flat feet, you want the shoe to be firm in these key areas, but still flexible in the toes.
This will maintain the integrity of the arch of the foot, thus reducing the forces on the tibialis
posterior muscle during exercise. This will relieve the tendency for the tibialis posterior to begin
tearing away from its tibial attachment, saving a lot of pain and lost training.
25.

What if you have a high arch? Figure 32-3: Foot print diagram
You already have a rigid foot, so
you have no need for motion
control. What you need is shock
absorption. If your tendency is
for hairline fractures of the tibia
because of excessive force
transferred through the foot,
then you need to absorb some of
that impact force with your shoe.

Try on some shoes! Jump around

a little! You are looking for a
shoe that cushions your impact
with the ground. I have found
that Saucony athletic shoes are
usually the best in this category.
You may further benefit from an
added athletic sole insert
designed for shock absorption.

26. What if you have a neutral or middle of the road foot? In your case, you are not specifically prone
to either type of shin splint discussed in this article, although symptoms of either may still occur.
Shoe selection is not as crucial for you. You want to look for a shoe that is a trade off between the
two technologies discussed above. Look for a fair shock absorber, with descent stability in the sole
(from the base of the toes back), and heel cup.
27. The one characteristic that ALL athletic shoes should possess is a flexible toe region. This prevents
overworking the Gastro-soleus complex (the calf) during activity and opening yourself up to a
whole different category of athletic injury.
28. So how can you find out what type of foot you have? Here is one of the easiest ways to find out.
With no shoes or socks on, get your feet wet. Now take a few steps, and take a look at your
footprints. Compare your footprint to the diagram given. Understand that most people are
somewhere in between the two extremes. Use your best judgement to gauge where you fall on the
bell curve.
29. It is important to keep in mind that this information is useful for ALL active people, and not just
those who commonly experience shin splints. Following these principles of shoe selection will help
prevent, not just cure these lower leg injuries to you or your clients.

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Summary

I. Sports Medicine is concerned with the diagnosis, treatment, rehabilitation, and prevention of athletic
injuries, as well as dealing with the effects of exercise on the human body for the enhancement of athletic
performance. Sports medicine is not restricted to the medical field; athletic trainers, coaches and personal
trainers are also involved.

A. There are two classifications of factors, which lead to sports injuries: intrinsic factors (mental & physical
preparedness) and extrinsic factors (those factors which impinge externally on performance).

B. Therapeutic modalities used in sports medicine

1. Diathermy is a form of high-frequency heat that penetrates injured tissues deeper and more
effectively than other forms of heat therapy (e.g., hydroculator packs, moist-heat packs,
etc.).
2. Electrostimulation involves electrodes that create a contraction of the surrounding
musculature, reducing edema by pumping fluid out of the affected tissue.
3. Cryotherapy is the application of cold (usually in the form of ice or “chemical ice”) to body
tissues, for the purpose of pain relief and decreased swelling (via vasodilation).
4. Heat Therapy is the use of heating pads or hot showers which are best when followed with
ice, because heat alone causes static swelling.
5. Ultrasound is high-frequency sound waves, which oscillate to penetrate 1 to 2-1/2 inches
into muscle tissue.
6. Hydrotherapy is the use of water as a therapeutic/recuperative means.
7. Cryokinetic therapy is very beneficial in reducing contracted, tightened muscle tissue, as
well as pumping these tissues free of accumulated, training-induced waste products.
8. Leg Elevation is used as a means to reverse hydrostatic or columnar pressure after a long
day standing or training.
9. Ongoing professional assistance: Many forms of therapy, including various types of
“bodywork,” are available to athletes at moderate cost, and are highly recommended.

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 Section 6: Unit 33 Outline

Basic First Aid

I. First Aid

A. Emergency: Order of Priority

1. The Primary Survey

2. Good Samaritan Law

B. Airway Obstruction
C. Bleeding

1. How to Control Bleeding

D. Nose Injuries
E. Fractures, Sprains, Strains, & Dislocations
F. Diabetic Emergencies

1. Insulin Reaction (or Insulin Shock)

2. Diabetic Coma
3. First Aid for Insulin Reaction and Diabetic Coma.

G. Stroke
H. Seizure

1. Signs and Symptoms

2. First Aid

II. Keep A First Aid Kit Checklist

Self-Quiz (8 questions)

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Identify and properly deal with basic first aid situations in

order to protect those around you.

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First Aid

Special Section by Darin Rell BS, CFT, AHA BLS Instructor

As fitness specialists, we are a very diverse group. While we may specialize in certain groups we will all be
out of our specialty at one time or another. When clients come to see a trainer it usually means they
either need help in making themselves better at whatever they do, they are medically at risk of a
preventable cardiovascular disease, or they just want to get healthy. They are entrusting you to lead them
to meet their goals. What if something were to go wrong while you are in a training session? Such as they
start choking on a piece of bubble gum, or your geriatric clients’ pacemaker stops working. Do you have
the skills to try to save that persons life? Do you know how to identify a stroke? Do you know the
difference between cardiac arrest and a heart attack? These are all questions that you need to be able to
answer.

While it is a requirement to earn your Basic Adult Cardiopulmonary Resuscitation certification, I am

challenging you all to become as proficient in CPR as you are in fitness training. You never know when an
emergency will strike.

The circumstances that lead to the use of CPR are varied. Think of all the times you have been on long
bike rides far away from other people. Or out hiking, or even at your child’s little league game. A common
problem with CPR is that if it is not performed within the first 5 minutes of cardiac arrest, the survival rate
is very low. If rescuers delay in any way it could be a matter of life and death.

The American Heart Association has devised four very important factors that greatly increase success
rates. They refer to it as the “Chain of Survival.”

1. Early Access
2. Early CPR
3. Early Defibrillation
4. Early Advanced Care

Not all CPR certifications are equal. They vary from basic 2-hour instructional to 8-hour healthcare
provider courses with examinations at the end. While it is not required of you to have the healthcare
provider status, would you not feel better knowing you have that extra knowledge? Imagine if the ISSA
offered a simple course that took very little, if any, knowledge to pass. Would you still have pursued the
program? I hope not! It is a matter of being respected within the profession. This is one more way to
represent to others that ISSA trainers are leaders when it comes to competence and ability.

You can contact the American Heart Association at www.americanheart.org to find a CPR class in your
area that will meet your needs. In addition you can also visit the Red Cross at www.redcross.org.

DISCLAIMER: Under no conditions does the ISSA accept responsibility regarding any consequences that
stem from the use of the following information in any First Aid application. This following section is
provided as a study aid, not a first aid manual. The following section is intended as information for safety
awareness and is in NO way to be used as a substitute for first aid training, OSHA compliance, job
training, or for proper equipment use. While First Aid is not a requirement, the ISSA highly recommends
that all students take a Basic First Aid course.

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EMERGENCY:
Order of Priority

In every emergency situation, there is a logical order to be followed. First, it is important to carefully
assess the scene of an emergency before any further steps are taken. The purpose of this assessment is
to assure it is safe to provide first aid care. For example, an unconscious victim might be lying on a live
power line. If a rescuer were to touch the victim before the power could be shut off, the rescuer would
become a victim as well! Always be sure it is safe before you attempt to help a victim!

Once you determine it is safe for you to help a victim, you should immediately determine if the victim has
any life threatening conditions.

Begin by checking to see if the victim is responsive. Kneel and ask, “ ARE YOU OK?” If there is no
response, you must immediately summon an ambulance! Recent studies have conclusively shown that
victims who are not breathing and do not have a heartbeat have a substantially greater chance for
survival if they receive prompt advanced medical care in a hospital or by trained paramedics.

Only after a call is placed for emergency medical services should a volunteer attempt to further help an
unconscious victim.

If there are bystanders on the scene, summon someone to your side to provide assistance.

If the victim is on his stomach, first place the victim's arm closest to you above his head. Then turn him
over by placing one hand on the victim's hip and the other hand at the victim's shoulder. Turn the body in
a smooth, even straight line so as to not cause further injury in the event of existing spinal cord injury.

With the victim now on his back, open the victim's airway by placing the heel of your hand on the victim's
forehead and the tips of your fingers under the bony part of the jaw.

Push down on the forehead while lifting up the chin until the jaw is pointing straight up. Now place your
ear over the victim's mouth and LOOK, LISTEN & FEEL for breathing for 3 to 5 seconds. LOOK at the chest
to see if it is rising, LISTEN for sounds of breathing and FEEL for air coming from the victim.

If the victim is not breathing, rescue breathing is required immediately! (Refer to what you learned in your
CPR class)

Rescue breathing will provide vital oxygen to a victim who cannot breath on his or her own. After giving a
victim two breaths, the pulse is checked at the Carotid Artery to ascertain if the victim has a heartbeat.
This artery is located on the side of the neck and is found by first positioning the fingers on the victim's
Adam's Apple, then sliding the fingers down into the soft groove on the side of the neck. The pulse is
checked for 5 to 10 seconds.

531
If the victim has a heartbeat, but is not breathing, Rescue Breathing is required. If the victim is not
breathing and does not have a heartbeat, CPR is required without delay!

The Primary Survey

Remembering the necessary steps of the primary survey is as easy as remembering your A, B, Cs. These
initial steps of checking the (A) airway, (B) breathing, and (C) circulation (pulse), together with a check
for major bleeding, constitute the primary survey, which looks for life-threatening conditions!

In every instance where first aid is to be provided, it is important to always ask a conscious victim for
permission to help them. If a victim is unconscious, it is presumed they have provided consent for you to
assist them.

Good Samaritan Law

The Good Samaritan Law has been adopted by many states in America. The general approach of this kind
of statute is to exempt an individual from liability who is helping another in an emergency situation. Under
these statutes the helping person cannot be sued for additional injuries caused during the rescue attempt
even if it is less than perfect. This policy is in place to encourage people to help one another in emergency
situations. This is not intended as legal advice and should not replace the advice of a qualified lawyer.

Airway Obstruction

NOTE: Emergency treatment of airway obstructions is taught as part of CPR training and only through
classroom practice can the necessary skills be mastered. The mechanics of handling airway obstructions
are presented in this tutorial for background insight only.

If an individual is choking, but can speak or cough forcibly, there is an exchange of air (although it might
be diminished) and you should encourage the victim to continue coughing while you just stand by! On the
other hand, if a victim is choking, but cannot speak or cough, an airway obstruction exists which must be
treated immediately!

The treatment for an obstructed airway in a conscious victim involves the use of abdominal thrusts,
performed as follows:

1. Stand behind the victim.

2. Wrap your arms around the victim's waist.
3. Make a fist with one hand and place the thumb side of the fist against the victim's abdomen just
above the navel and well below the lower tip of the breastbone.

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 4. Grasp your fist with your other hand, with elbows out, and press your fist into the victim's
abdomen with quick, upward thrusts. Each thrust is a distinct, separate attempt to dislodge the
foreign object. Repeat thrusts until foreign object is cleared or the victim becomes unconscious.

Emergency treatment of airway obstructions in an unconscious victim is taught in CPR classes.

Bleeding

Major bleeding may be a life-threatening condition requiring immediate attention. Bleeding may be
external or internal. Bleeding may be from an artery, a major blood vessel, which carries oxygen-rich
blood from the heart throughout the body. It may be from a vein, which carries blood back to the heart to
be oxygenated or bleeding may be from a capillary, the smallest of our body's blood vessels.

Arterial bleeding is characterized by spurts with each beat of the heart, is bright red in color (although
blood darkens when it meets the air) and is usually severe and hard to control. Arterial bleeding requires
immediate attention!

Venus bleeding is characterized by a steady flow and the blood is dark, almost maroon in shade. Venus
bleeding is easier to control than arterial bleeding.

Capillary bleeding is usually slow, oozing in nature and this type of bleeding usually has a higher risk of
infection than other types of bleeding.

First Aid for bleeding is intended to:

• Stop the bleeding

• Prevent infection
• Prevent shock

How to Control Bleeding

Apply DIRECT PRESSURE on the wound. Use a dressing, if available. If a dressing is not available, use a
rag, towel, piece of clothing or your hand alone.

IMPORTANT:

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Once pressure is applied, keep it in place. If dressings become soaked with blood, apply new dressings
over the old dressings. The less a bleeding wound is disturbed, the easier it will be to stop the bleeding.

If bleeding continues, and you do not suspect a fracture, ELEVATE the wound above the level of the heart
and continue to apply direct pressure.

If the bleeding still cannot be controlled, the next step is to apply pressure at a pressure point. For
wounds of the arms or hands, pressure points are located on the inside of the wrist (radial artery-where a
pulse is checked) or on the inside of the upper arm (brachial artery). For wounds of the legs, the pressure
point is at the crease in the groin (femoral artery). Steps 1 and 2 should be continued with use of the
pressure points.

The final step to control bleeding is to apply a pressure bandage over the wound. Note the distinction
between a dressing and a bandage. A dressing may be a gauze square applied directly to a wound, while a
bandage, such as roll gauze, is used to hold a dressing in place. Pressure should be used in applying the
bandage. After the bandage is in place, it is important to check the pulse to make sure circulation is not
interrupted. When faced with the need to control major bleeding, it is not important that the dressings you
will use are sterile! Use whatever you have at hand and work fast.

A slow pulse rate, or bluish fingertips or toes are signs that the bandage may be impeding circulation.

Signs and symptoms of internal bleeding are:

• bruised, swollen, tender or rigid abdomen

• bruises on chest or signs of fractured ribs
• blood in vomit
• wounds that have penetrated the chest or abdomen
• bleeding from the rectum or vagina
• abnormal pulse and difficulty breathing
• cool, moist skin

First aid in the field for internal bleeding is limited. If the injury appears to be a simple bruise, apply cold
packs to slow bleeding, relieve pain and reduce swelling. If you suspect more severe internal bleeding,
carefully monitor the patient and be prepared to administer CPR if required (and you are trained to do so).
You should also reassure the victim, control external bleeding, care for shock (covered in next section),
loosen tight-fitting clothing and place victim on side so fluids can drain from the mouth.

Nose Injuries

Severe nosebleeds can be frightening and lead to shock if enough blood is lost. If you have
your client sit down, pinch the nostrils shut, and lean forward, this can control many cases
of nosebleed (to prevent blood from running into the throat).

Once the bleeding has been stopped, talking, walking and blowing the nose may disturb
blood clots and allow the bleeding to resume. The victim should rest quietly until it appears
the bleeding remains stopped.

If it is suspected that the victim has suffered head, neck or back injuries DO NOT attempt to
control the blood flow as they may cause increased pressure on injured tissue. All
uncontrolled nosebleeds require prompt medical attention!

Fractures, Sprains, Strains, and Dislocations

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 Fractures, sprains, strains, and dislocations may be hard for the trainer or coach to tell
apart. For this reason, first aid treatment of any of these conditions is handled as though
the injury was a fracture.
Signs and symptoms of the above conditions may include a “grating” sensation of bones
rubbing together, pain, tenderness, swelling, bruising, and an inability to move the injured
part.

First Aid for any of these conditions consists of:

• Control bleeding if present.

• Care for shock.

Splint affected area to prevent further movement, but do so only if possible without causing
further pain to victim. Cold packs may help reduce pain and swelling.

Only trained rescue workers should move victims with traumatic injuries. Head, neck and
back injuries are serious and require special care for movement and transport of victims
with these conditions. In exceptional circumstances, such as when a victim is at risk of
further injury unless moved, the victim's head and neck should be stabilized and the body
moved with minimal flexing of the head, neck or spinal cord.

All victims with fractures, dislocations, sprains and strains require professional medical
attention. However, if your client cannot receive medical treatment until the following day,
we recommend the RICE principle.

The RICE principle is what emergency medicine professionals use to reduce the pain and
inflammation associated with an athletic injury. It goes like this:

R: REST: make sure the person is in a safe location, keeping any movement to a minimum.

I: ICE: apply ice or cold pack to the injured area. This is usually done in 20-minute intervals
for several hours following the injury or until medical attention can be received.

C: COMPRESSION: wrap the injured area with clothing or bandage applying a fair amount
of tension to the affected body part.

E: ELEVATION: elevate the injured body part above the level of the heart. In the case of
an ankle, have the person lie on their back and rest their foot up on a chair or table.

Diabetic Emergencies

Sugar is required in the body for nourishment. Insulin is a hormone that helps the body use the sugar.
When the body does not produce enough Insulin, body cells do not get the needed nourishment and
diabetes results. People with this condition take Insulin to keep their diabetes controlled. Diabetics are
subject to two very different types of emergencies:

Insulin Reaction
(or Insulin Shock)

This condition occurs when there is too much insulin in the body. This condition rapidly reduces the level
of sugar in the blood and brain cells suffer. Insulin reaction can be caused by taking too much medication,
by failing to eat, by heavy exercise and by emotional factors.

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Signs and Symptoms: Fast breathing, fast pulse, dizziness, weakness, change in the level of
consciousness, vision difficulties, sweating, headache, numb hands or feet, and hunger.

Diabetic Coma

This condition occurs when there is too much sugar and too little insulin in the blood and body cells do not
get enough nourishment. Diabetic coma can be caused by eating too much sugar, by not taking prescribed
medications, by stress and by infection.

Signs and Symptoms: Diabetic coma develops more slowly than Insulin shock, sometimes over a period
of days. Signs and symptoms include drowsiness, confusion, deep and fast breathing, thirst, dehydration,
fever, a change in the level of consciousness and a peculiar sweet or fruity-smelling breath.

First Aid for Insulin Reaction and Diabetic Coma

Looking for the signs and symptoms listed above will help to distinguish the two diabetic emergencies. In
addition, if the patient is conscious, you can ask two very important questions, which will help determine
the nature of the problem:

Ask the client: “Have you eaten today?”

Someone who has eaten, but has not taken prescribed medication may be in a diabetic coma.

Ask the client “Have you taken your medication today?”

Someone who has not eaten, but did take his or her medication, may be having an insulin reaction.

(Always look for an identifying bracelet, which may reveal a person's condition)

Of the two conditions, insulin shock is a true emergency, which requires prompt action!

A person in insulin shock needs sugar, quickly! If the person is conscious, give sugar in any form; candy,
fruit juice or a soft drink! Sugar given to a person in insulin shock can be lifesaving! If the person is
suffering from diabetic coma, the sugar is not required but will not cause them further harm. Monitor
victims carefully. Seek professional help.

Stroke

Stroke occurs when the blood flow to the brain is interrupted long enough to cause damage. This may be
caused by a clot formed in an artery in the brain or carried to the brain in the bloodstream, a ruptured
artery in the brain, or by compression of an artery in the brain, as found with brain tumors.

First aid consists primarily of recognizing signs and symptoms and seeking professional attention.

Signs and symptoms of a stroke include:

• Weakness and numbness of the face, arm or leg that is often on one side of the body only.
• Dizziness
• Confusion
• Headache
• Ringing in the ears
• A change of mood
• Difficulty speaking
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 • Unconsciousness
• Pupils of uneven size
• Difficulty in breathing and swallowing
• Loss of bowel and bladder control

If you suspect a person is having a stroke, have them stop whatever they are doing and rest. Promptly
obtain professional help. Reassure the victim and keep them comfortable. Do not give anything by mouth.
If the victim vomits, allow for fluids to drain from the mouth. Observe carefully while awaiting professional
help and, if trained to do so, monitor the airway, breathing and circulation and be prepared to administer
rescue breathing or CPR if required!

Seizure

Seizures are fairly common, but are very misunderstood! Seizures, per se, are not a specific condition.
Rather, many different types of conditions such as insulin shock, high fevers, viral infections of the brain,
head injuries, or drug reactions may cause them. When seizures recur with no identifiable cause, the
person is said to have epilepsy.

Signs and Symptoms

Many individuals have a warming sensation before the onset of a seizure. Many times, a person about to
have a seizure will physically move themselves from danger (as from the edge of a train platform) before
the seizure begins. Seizures can range from mild to severe. Mild seizures may take place and end in a
matter of seconds. Severe seizures may involve uncontrollable muscle spasms, rigidity, loss of
consciousness, loss of bladder and bowel control, and in some cases, breathing that stops temporarily.
Many epileptics carry cards or bracelets, which identify their condition.

First Aid

The following steps should be taken immediately in the event of a seziure.

• Summon professional help. Prevent the person from injuring himself/herself by moving furniture or
equipment.
• Do not attempt to restrain a person suffering a seizure and do not put anything in their mouth!
• Loosen clothing. If they vomit, turn on their side to allow fluids to drain. Stay with the person until
they are fully conscious. If trained, administer rescue breathing or CPR, if required.

First Aid Kit Checklist

In order to administer effective first aid, it is important to maintain adequate supplies in each first aid kit.
First aid kits can be purchased commercially already stocked with the necessary supplies, or you can
create your own including the following list of items.

• Adhesive bandages: available in a large range of sizes for minor cuts, abrasions and puncture
wounds.
• Butterfly closures: these hold wound edges firmly together.
• Rolled gauze: these allow freedom of movement and are recommended for securing the dressing
and/or pads. These are especially good for hard-to-bandage wounds.
• Nonstick Sterile Pads: these are soft, super absorbent pads that provide a good environment for
wound healing. These are recommended for bleeding and draining wounds, burns and infections.
• First Aid Tapes: Various types of tapes should be included in each kit. These include adhesive,
which is waterproof and extra strong for times when rigid strapping is needed; clear, which
stretches with the body's movement, good for visible wounds; cloth, recommended for most first

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 aid taping needs, including taping heavy dressings (less irritating than adhesive); and paper, which
is recommended for sensitive skin and is used for light and frequently changed dressings.
• You can also include tweezers, first aid cream, thermometer, an analgesic or equivalent, and
an ice pack.

Summary

I. The ISSA requires all certified trainers to have a current Basic Adult CPR certification.

A. CPR is an acronym for Cardio Pulmonary Resuscitation.

1. You can contact the American Heart Association at www.americanheart.org to find a CPR
class in your area that will meet your needs. In addition you can also visit the Red Cross at
www.redcross.org.

B. Remembering the necessary steps of the primary survey is as easy as remembering your A, B, Cs.
These initial steps of checking the (A) airway, (B) breathing and (C) circulation (pulse), together with a
check for major bleeding, constitute the primary survey, which looks for life-threatening conditions!

1. If the victim is not breathing, rescue breathing is required immediately! (Refer to what you
learned in your CPR class)

C. The Good Samaritan Law states that the helping person cannot be sued for additional injuries caused
during the rescue attempt even if it is less than perfect.

D. The treatment for an obstructed airway in a conscious victim involves use of the Heimlich Maneuver.

E. The RICE principle is what emergency medicine professionals use to reduce the pain and inflammation
associated with an athletic injury. It goes like this:

1. REST - make sure the person is in a safe location, keeping any movement to a minimum.
2. ICE - apply ice or cold pack to the injured area. This is usually done in 20-minute intervals for several
hours following the injury or until medical attention can be received.
3. COMPRESSION - wrap the injured area with clothing or bandage applying a fair amount of tension to
the affected body part.
4. ELEVATION - elevate the injured body part above the level of the heart. In the case of an ankle, have
the person lie on their back and rest their foot up on a chair or table.

F. Insulin shock is a true emergency, which requires prompt action!

1. A person in insulin shock needs sugar, quickly! If the person is conscious, give sugar in any form:
candy, fruit juice or a soft drink! Sugar given to a person in insulin shock can be lifesaving! If you
suspect a person is having a stroke, have them stop whatever they are doing and rest. Promptly obtain
professional help.

G. Do not attempt to restrain a person suffering a seizure and do not put anything in their mouth!

H. In order to administer effective first aid, it is important to maintain adequate supplies in each first aid
kit. First aid kits can be purchased commercially already stocked with the necessary supplies.

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