Chapter 11 - Exercise Programming

Question 1

Evidence Based Practice

Answer 1

Personalized exercise programming should be based on 3 things: 1) client attributes, goals and preferences, 2) PT experience and expertise, 3) the latest research finding
The 5 Steps
1. Formulating a question
2. Searching for health & fitness research that answers that question
3. Scrutinizing the quality of the research
4. Incorporating the research evidence into exercise program design & implementation
5. Evaluating outcomes and reevaluating research

Question 2

How to Interpret Scientific Research

Answer 2

1. Search for bias (ulterior motives)
2. Read the research
3. Evaluate for truth
4. Look for consensus

Question 3

Six Steps to Exercise Programming

Answer 3

1. Establish rapport and identify client goals
2. Administer an exercise preparticipation health screening (is medical clearance necessary?)
3. Identify barriers and collaborate on next steps (SMART goals, how will you move forward today?)
4. Determine if assessments are necessary (physiological or movement)
5. Determine which phase of ACE IFT model to begin
6. Prioritize program design and select exercise order

Question 4

Programming for Base Training

Answer 4

1. No assessment needed, this could demotivate client
2. Focus on moderate-intensity, RPE 3-4, emphasize enjoyment
3. Keep below VT1 (use talk test)
4. Increase duration and frequency
5. Client is ready for Fitness Training when can complete 20 min of cardio at below VT1
6. Add no more than 10% duration/week

Question 5

Programming for Fitness Training

Answer 5

1. Progress cardio based on clients goals and time available
2. Integrate vigorous intensities - work at, below and above VT1 (just below VT2)
3. Focus is on enhancing client’s aerobic efficiency by progressing duration, frequency, and intensity
4. Add intervals starting with a hard to easy ratio of 1:3 (1 min/3min) progressing to 1:2 and then 1:1 ratio
5. Increase load by no more than 10% weekly

Question 6

HIIT Considerations

Answer 6

May provide superior ability to improve cardio fitness and cardio metabolic health for a lesser weekly time commitment.
SIT - Sprint Interval Training (supramaximal sprints)
REHIT - Reduced Exertion High Intensity Interval Training (more time efficient, uses fewer and shorter sprints, still supramaximal)

Question 7

Performance Training

Answer 7

1. Goal to increase speed, power and endurance
2. Program sufficient volume to meet client goals
3. Integrate vigorous intensity (RPE 7-10) to improve aerobic capacity, speed and performance
4. Periodized training allows for appropriate time in each zone. 70-80% in Zone 1, 10% in Zone 2 and 10-20% in Zone 3
5. Increase volume up to 10%/week
6. Rule of threes - total weekly training volume = 3 times the event length client is training for.
7. Check for overtraining syndrome

Question 8

Functional Training

Answer 8

1. Focus on establishing/reestablishing postural stability, kinetic chain mobility - POSTURE, FLEXIBILITY, BALANCE
2. Exercises to improve muscular endurance, flexibility, core function and static & dynamic balance
3. Progress volume and challenge as function improves

Question 9

Movement Training

Answer 9

1. Focus on good movement patterns without compromising posture or joint stability
2. Include exercises for all 5 movement patterns in all planes
3. Integrate functional exercises to help maintain stability & mobility

Question 10

Load/Speed Training

Answer 10

1. Focus on adding loads to movements to create increased force production & meet client goals
2. Integrate 5 movement patterns with loads in different planes & combinations
3. Continue to integrate functional training
4. Add enough load to meet clients goals for strength, endurance, and hypertrophy
5. Add speed, quickness, agility, power, skill training for clients with such goals

Question 11

Elasticity Considerations

Answer 11

1. The property that allows tissue to return to its original shape when force is removed.
2. Ballistic & dynamic stretching are examples
3. No permanent lengthening but they do prepare muscles for activity.

Question 12

Static Stretching - Plastic Stretch

Answer 12

1. Improves tissue extensibility
2. When load is past elastic limit
3. Viscosity aids extensibility - warm up is important

Question 13

Autogenic Inhibition

Answer 13

1. Activation of the Golgi Tendon Organ (GTO) inhibits muscle spindle response allowing further stretching. Stress Relaxation.
2. 7-10 seconds of low force stretch activates GTO
3. Repeating stretch multiple times results in gradual lengthening of muscle

Question 14

Reciprocal Inhibition

Answer 14

The reflex inhibition of the motor neurons of antagonists when the agonists are contracted.

Question 15

Static Stretching

Answer 15

1. Moving joints to put muscle in and end-range position and hold for up to 30 seconds
2. Most commonly practiced flexibility training. easy, doesn’t require partner.
3. Can be passive or actively (partner)

Question 16

Proprioceptive Neuromuscular Facilitation (PNF)

Answer 16

Capitalizes the Autogenic and Reciprocal inhibition - combines stretch/relax. Three different types but all begin with a partner providing a 10 sec passive pre-stretch
1. Hold-Relax - 1) 10 sec passive pre-stretch by trainer, 2) 6 sec client holds while trainer tries to stretch, 3) client relaxes for 30 sec stretch by trainer
2. Contract-Relax - 1) 10 sec passive pre-stretch by trainer, 2) Client moves joint through ROM with resistance from trainer, 3) client relaxes for 30 sec stretch by trainer
3. Hold-Relax-Agonist Contraction - 1) 10 sec passive pre-stretch by trainer, 2) 6 sec client holds while trainer tries to stretch, 3) client relaxes for 30 sec stretch by trainer then adds concentric action of muscle at end.
Most effective as it uses both autogenic & reciprocal inhibition

Question 17

Dynamic Stretching

Answer 17

Mimics the movement patterns of the upcoming workout. Increases sports related flexibility.

Question 18

Ballistic Stretching

Answer 18

Bouncing type movements. Triggers stretch reflex and may be associated with increased risk for injury. May be appropriate if the sport a client is training for requires ballistic movement.

Question 19

Flexibility Training Considerations

Answer 19

Should focus on major tendon units including ankles, anterior & posterior legs, chest, hips, lower back, neck shoulder girdle and trunk

Question 20

FITT Recommendations for Flexibility

Answer 20

Frequency - >=2 x/wk, daily most effective
Intensity - to discomfort but not pain
Time - 10-30 sec holds for most adults, 30-60 sec for older adults, PNF 3-6 sec followed by 10-30 sec
Type - a series for all major muscle tendon groups
Volume - 60 seconds for each exercise, repeat 2-4 times

Question 21

Self Myofascial Release

Answer 21

Applies pressure to tight, restricted areas of fascia and underlying muscle in an attempt to relieve tension and improve flexibility. Small, continuous movements on a foam roller for 30-60 seconds. Stay current on research.

Question 22

Balance Exercise

Answer 22

Research has not shown optimal frequency, duration and type of balance exercises but it has been recommended that balance exercises be performed three days per week for 10 - 15 minutes each session. These can be incorporated into any part of a workout.
Progressions include: Arm positioning, surface, visual, tasking

Question 23

FITT Recommendations for Neuromotor Exercise (Balance)

Answer 23

Frequency - >=2-3 days/week
Intensity - not determined
Time - 20-30 min per day
Type - motor skills for balance, agility, coordination, gait, proprioceptive training

Question 24

Movement Training

Answer 24

Exercises that are based on the 5 movement patterns, emphasizing movement efficiency in all planes.

Question 25

FITT Recommendations for Resistance Training

Answer 25

Frequency - each major muscle group 2-3 times/wk Intensity - 20-50% for older for power, <50% for endurance, 40-50% for strength for older & sedentary novices, 60-70% for novice to intermed, >=80% for experienced for strength (1-RM) Time - unknown Type - all muscle groups, multi joint exercises recommended, variety Repetitions - 8-12 for strength & power, 10-15 for strength in older beginners, 15-25 for endurance Sets - 2-4 sets for strength & power, 1 set is effective for older or novices, 1-2 sets for endurance

Question 26

Load/Speed Training

Answer 26

Primary Focus is adding external loads to movements to produce increased force and/or speed for specific objectives. Training objectives may include: increased muscular endurance, strength, hypertrophy, improved body composition, movement, function, health & performance. Continue to incorporate functional & movement training. Exercises can include: Olympic lifting, plyometrics, speed work, agility, coordination and quickness drills

Question 27

Prerequisites for Load/Speed Training

Answer 27

Clients need movement proficiency and control during loading and against reactive forces - they must be able to accelerate, decelerate, stabilize, during powerful movements. Prerequisites are: 1. Joint mobility and stability (strength) 2. Adequate static and dynamic balance 3. effective core function 4. Anaerobic efficiency 5. Athleticism (skill for the movements) 6. No contraindications for load bearing, dynamic movements 7. No medical concerns that affect balance and motor skills

Question 28

Importance of warm up & cool down

Answer 28

The more power necessary for a given activity, the more important the warm up and cool down.

Question 29

Amortization Phase

Answer 29

The time between the concentric and eccentric actions. This should be kept to a minimum to produce the maximum amount of muscular force.

Question 30

Plyometric Exercise Definition

Answer 30

1. Improves the production of muscular force and power 2. Quick powerful movements involving eccentric contractions (stretch shortening cycle - active stretch) followed by concentric contractions of the same muscle.

Question 31

Plyometric Exercises

Answer 31

1. Linear Forward, Lateral, Backpedal, Rotational, Crossover Cutting Curving 2. Jumps in place, Single linear jumps or hops, multiple linear jumps or hops, multidirectional jumps or hops, hops & bounds, depth jumps or hops 3. power push up, medicine ball push up, chest pass, vertical chest toss

Question 32

Plyometric Cautions

Answer 32

1. Perform plyometrics at the beginning of training before a client is too fatigued (after warm up) 2. Ensure client has proper technique (land on mid foot, proper alignment of body, drop hips to absorb impact, don't lock knees, engage core, land with "chest over knees"

Question 33

FITT Recommendations for Plyometrics

Answer 33

Frequency - 1-3 workouts/wk, recover for 48-72 hrs Intensity - progress from light to moderate to vigorous intensity Time - type - quick powerful movements of lower or upper body Volume - measured by foot contacts - beginner 80-100, intermediate 100-120, advanced 120-140. Decrease volume as intensity increases

Question 34

Speed, Agility, Reactivity Considerations

Answer 34

1. Speed-Strength is the ability to develop force at high velocities and relies on a person's reactive ability. 2. Speed Endurance refers to the ability of an individual to maintain maximal velocity over an extended time period. 3. Speed Drills - head neutral position, body leaning forward, drive from shoulders, short strokes for accelerating/decelerating, long strokes for top speed, relax hands

Question 35

FITT Recommendations for Speed & Agility Drills

Answer 35

Frequency - 1-3 workouts/wk, recover for 48-72 hrs Intensity - high intensity, perform early in a workout Time - Beginner: 15-30 sec (glycolic), intermediate: <10 sec (phosphagen), advanced: 10-60 sec (glycolic & phosphagen). 2-3 min rest periods type - explosive drills Volume - 1-3 sets

Question 36

Speed Drill Exercises

Answer 36

Arm squeeze and rear arm drive, Arm squeeze and forward arm drive, high knees, high marches, butt kicks, agility ladder, hurdle drills, lateral shuffle

Question 37

Periodization

Answer 37

Planned progression of exercises that intentionally varies the training stimuli especially with respect to intensity and volume. Changing these variables seems to be more effective for strength development and peak performance. Three segments: macrocycles (overall time period, 6-12 months), mesocycles (smaller segments), microcycles (2-4 weeks long). May be linear or undulating.

Question 38

Fading Fitness Statistic

Answer 38

In a one month period, all training adaptations were lost for people in a study who had done 13 weeks of training before cessation. The losses were measured in systolic blood pressure, HDL cholesterol, triglycerides

Question 39

Program Maintenance Strategies

Answer 39

1. The minimum dose of activity to maintain weight and cardiometabolic health equates to 1 mile/day 2. Low dose HIIT (12min/week) improves cardiometabolic health (add a warm up & cool down) 3. Integrate a single long training session into the biweekly training routine. Long routines benefit diabetes & pre-diabetes conditions by decreasing the muscle glycogen stores. (90 min) 4. Combine cardio and resistance training as an antidote to detraining.

Question 40

FITT Recommendations for Recovery

Answer 40

If rate of recovery is appropriate, higher levels of training can be achieved. Frequency - time between workouts, at least 1 day Intensity - lower intensity for the intervals in HIIT Time - recovery time in HIIT or overall recovery (days), more time in recovery than in exercise Type - active (continued activity at lower level or different mode of activity) or passive recovery. Active recovery is superior to passive

Question 41

Recovery Considerations

Answer 41

Active recovery of less than 50% of MHR are best for decreasing protons and lactate levels. Don't workout too hard when recovering. 10 min is an ideal time for cool down after an intense workout. Others say 60-70% of MHR is okay for active recovery workouts. HIIT workouts benefit recovery process. Increase monocarboxylate transport (MCT) which aids removal of lactate and protons. HIIT durations of 2min/1 min rest and 3-12 bouts per session