Cert III in Fitness

SISFFIT303A Develop & apply an awareness of specific

populations to exercise delivery

Principles of exercise prescription

Mode The type of exercise that will stimulate the desired outcome e.g. Aerobic, resistance, hydrotherapy

etc.

Frequency The number of sessions per week or per day.

Duration The total time for each session, measured in minutes.

Intensity The effort required, measured as a percent of maximal capacity e.g. 70-89% of max HR or 60-85%

of VO2 R.

Precautions The modifications in prescription required for specific populations to make exercise safe e.g.

Individuals with diabetes should be given set times to exercise around timing of meals, insulin

injections and BSL monitoring.

Progression Gradual increase of the mode, frequency, duration and intensity of exercise guided by the

individual’s abilities and goals. Most exercise programs have an initiation stage, improvement

stage and maintenance stage.

Why undertake a health screen?

To assist with development of safe and effective program design

Identify individuals with medical contraindications to exercise, individuals at increased risk of

chronic disease because of age, symptoms and/or risk factors.

Determine the need for medical evaluation and clearance prior to starting an exercise program and Identification of individuals who should participate in a medically

supervised exercise program.

SOAP Technique

• Subject assessment•Objective assessment•Assessment•Plan

Common screening form

used to determine the

need for medical clearance.

PAR-Q

Subjective information

Medical history

Symptoms

Level of pain

Medications

Objective information

Blood pressure

Heart Rate

Weight/Height

Range of motion

Gait pattern

Modifiable risk factors

Factors we can change

such as exercise, lifestyle

behaviours

Non-modifiable risk factors

Factors we cannot change

or eliminate

such as family history and age.

ASSESSMENT 2 (NO. 6)Match the Case Studies

LOW• no medical clearance required.

MODERATE

• no medical clearance required.

HIGH

• Medical clearance required and appropriately qualified professional to develop exercise program.

Absolute contraindications

Should not participate in exercise until their condition has been

treated and stabilised

Where the risk of participating

outweighs any perceived benefits.

Relative contraindications

Are flexible

May act as a warning sign.

Contraindications to exercise

Blood pressure

>140/90

Head injury/ concussion

Diabetes

Recent surgery Pregnancy

Use of alcohol/

drugs (within 24hrs)

Acute injuries

Contraindications to exercise

Unstable angina

Recent heart attack

Stroke

Prescribed medication

(e.g. beta blockers)Open

wounds/Infections

Epilepsy

Heart conditions

Spinal conditions

Poor exercise

tolerance.

If any signs of poor exercise tolerance are experienced the exercise

must be stopped

immediately and client is to be assessed by

a medical or allied health

professional.

Nausea or vomiting

Pallor (signs of poor perfusion)

Redness

Fatigue

Shortness of breath

Leg cramps

Claudication

Poor exercise

tolerance.

If any signs of poor exercise tolerance

are experienced the exercise must be

stopped immediately and

client is to be assessed by a

medical or allied health professional.

Unusual heart rate response

Chest pain

Dizziness or light headedness

Swelling of ankles

Loss of coordination

Lega

l lim

itatio

ns

A fitness instructor is qualified to prescribe and deliver exercise programs for the relatively healthy population

The relatively healthy population are individuals who are free from injury, illness and risk factors for chronic disease.

If a client is identified as not relatively healthy the fitness instructor must inform the client they do not have the

appropriate qualifications to develop their exercise program and for legal reasons they are required to refer them to an appropriately qualified allied health professional, who

specialises in prescribing exercise for individuals suffering from the specific condition.

Referring to medical professional

Documentation

A referral letter

signed authority to

release information

form

any progress notes

developed from sessions with the client

Information

should state all relevant information clearly

including clients medical history, exercise history, reasons for referral and

expected outcomes.

Appropriate referring options

General

Practitioner

A 50 year old male, BP 150/90, sedentary lifestyle, not on any

medication. Wanting to start an exercise program at the local gym.

Occupational

Therapist

A female who has been training with you at the gym has recently been

involved in a car accident and as a result fractured her right wrist. The

client is finding it difficult to undertake activities of daily living due to

her inability to use her right hand.

Accredited

Exercise

Physiologist

A female aged 55 years, suffering from type 2 diabetes and

hypertension, had 2 stents inserted after heart attack 3 years ago. A

doctor has advised her to undertake regular exercise to assist with the

management of her chronic disease.

Accredited

Practising

Dietician

A male client comes to you for help, he is overweight and wishes to loss

the weight; he has been going to the gym for 2 years and trailing

different diets but has not yet lost weight. Upon questioning you

identify he is undertaking the appropriate amount of exercise.

Medical professionals

Any condition affecting muscles, joints or nerves can be treated

by a physiotherapist

Osteopaths use evaluation, diagnosis and a wide range of

hands-on techniques to identify dysfunctions in your body.

A sports doctor does NOT treat acute and chronic illnesses nor provides preventative care and health education to males and

females of all ages.

Psychologists work with individuals to develop

management strategies to better deal with their emotional state, prevent ongoing problems and

improve their function.

Common medical

conditions in children

Growth plate

fractures

Osgood schlatters disease

AsthmaCystic Fibrosis

Epilespy

Common medical

conditions in older clients

Incontinence

Menopause

Osteoporosis

Osteoarthritis

• is a degenerative condition which can affect one or numerous joints. • In normal joints the ends of bones are covered by cartilage which

cushions the ends of the bones and helps a joint move smoothly BUT, in OA the cartilage breaks down from wear and tear and becomes thin leaving bones unprotected.

Osteoarthritis (OA)

• is an autoimmune disease that causes chronic inflammation of the joints. • has potential to cause joint destruction and functional disability.

Rheumatoid arthritis

(RA)

• is a condition where the bones become fragile and brittle, causing them to fracture easily.

• occurs when bones lose minerals such as calcium more quickly than the body can replace, leading to a loss of bone thickness (bone density).

Osteoporosis

Hypertension

Is a constant elevation in arterial blood

pressure equal to or exceeding a systolic blood pressure of 140mmHg and/ or

diastolic blood pressure of 90mmHg.

Chol

este

rol

is produced by the liver and made by most cells in the body.

It is transported around the blood by lipoproteins.

Too much cholesterol in the bloodstream leads to fatty deposits that develop in the arteries and form into

calcium plaques, which causes the vessels to narrow and eventually block.

Most common causes of lower

back pain

Lumbar strain to the ligaments, muscles or

tendons

caused from overuse, improper use or trauma.

Most common causes of lower

back pain

Nerve irritation & damage to the discs

caused from wear and tear or traumatic injury, bony encroachment and bone or joint conditions.

Injuries

The most common causes of neck pain are ‘whiplash’, ‘acute

wry neck’, mechanical neck pain, and osteoarthritis.

Wryneck is not an acute acceleration/deceleration injury.

ACL (anterior cruciate ligament) injuries are caused from large forces e.g. landing, twisting,

hyperextension and deceleration e.g. hill runs.

PCL (posterior cruciate ligament) is the strongest ligament in the

knee (primary stabiliser); it controls backward movement of the tibia and excessive external

rotation.

Injuries cont./

LCL (lateral collateral ligament) attaches from femur to the fibular and stabilises

the knee laterally.

Menisci aids in joint lubrication, assists in distributing weight bearing forces and

increases joint stability. Menisci injuries are caused by rotation with weight

bearing whilst flexing/extending the knee, a significant valgus/varus force and

deep squatting.

Osgood-schlatter’s disease is thought to be caused from over use injuries before

the structure of the knee has fully developed.

Symptoms of patellofemoral pain may be aggravated by stairs (down worse than

up) and returning from a squatting position.

Diabetes Mellitus is a metabolic disorder resulting in inability to properly metabolise carbohydrates and control blood glucose levels

due to ineffective insulin mechanism. The pancreas either stops producing insulin or its supply of insulin is limited.

• Type 1• Is thought to be an inherited autoimmune disease in which antibodies are

produced against the beta cells of the pancreas. Which results in the absence of endogenous insulin production. Type 1 Diabetes mostly occurs in childhood and adolescence but can onset at any age.

Insulin dependent diabetes mellitus

(IDDM)

• Type 2• is charaterised by diminished insulin secretion relative to serum glucose

levels in conjunction with peripheral insulin resistance which results in chronic hyperglycemia. Type 2 more commonly has a later onset and is linked to both genetic and poor lifestyle factors.

Non insulin dependent Diabetes Mellitus

(NIDDM)

• Inability to maintain normal glucose or any degree of glucose intolerance during pregnancy, despite treatments with diet or insulin. Risk factors for developing Gestational Diabetes are obesity, personal or family history of GD and age.

Gestational Diabetes

Obesity is the major risk factor for

these chronic diseases

CAD

hypertension

stroke

diabetes

Obe

sity

is defined as excessive body fat >25% for males and >30-32% for females or BMI >27-30+.

Obesity results from hypothalamic, endocrine, genetic disorders (e.g. hyperlipidemia), poor diet and inactivity.

The key causes are increased consumption of energy dense foods high in saturated fats and sugars and

reduced physical activity.

Triggers of the

asthma

Upper respiratory

tract infection

Cigarette smoke

Exercise

Inhaled allergens

(dust mites, pollens)

Emotional triggers (stress,

laughter) Environmental factors

(dust, smoke, pollution)

Changes in temperature

and the weather

Genetic predisposition

Dep

ress

ion

is an illness where individuals experience low mood, feelings of worthlessness and fatigue for prolonged periods of time.

Individuals with depression find it difficult to function everyday and may be reluctant to participate in activities they would

normally enjoy.

In people with depression the mood regulating neurotransmitters in the brain fail to transmit properly and

levels of serotonin is reduced resulting in a lowering of mood.

Functions of the musculoskeletal system

Support Bones create the framework and muscles contract to hold the

body in position.

Movement Muscles contract and pull on bones they are attached to which

causes the bone to act as a lever and move the body.

Protection protects the bodies vital organs from injury e.g. skull protects

brain, vertebral column protects spinal cord, ribs protect heart

and lungs and pelvis protects the reproductive organs.

The skeletal system is the main storage system for the main minerals such as calcium and phosphorus and the production of blood cells.

The digestive system converts foods into raw

materials that build and fuel our body cells.

The digestive system takes in

food,

breaks it down into nutrient

molecules

absorbs these molecules into

the bloodstream

and then rids the body of the indigestible

remains

Examples are protein into amino acids, carbohydrates into glucose, fat’s into fatty

acids.

The nervous system is made up of the brain,

spinal cord and nerves.

There are two parts to the nervous

system;

Central nervous system (CNS): Made up of the brain and spinal cord.

Peripheral nervous system (PNS):

Nerves connect the brain and spinal cord to the

peripheral nervous system. It is also made up

of two parts;

Autonomic nervous system (ANS): Regulates glands and organs without

effort from our conscious mind. Made up of two parts the

sympathetic and parasympathetic.

Somatic nervous system (SNS): It relays information from the eyes,

ears, skin and muscle to the CNS. Receives commands from CNS and

makes muscles contract or relax allowing the body to move.

Experienced clients

people who may have never been to a gym or undertaken any form of resistance

training. Also includes people who have ceased exercise for a period of time greater

than 6 months.

For inexperienced clients start off with lower exercise intensity and frequency and gradually increase as they process.

Resistance exercises should begin with machine based multiple muscle group

exercises such as leg press, chest press, lat pull down or seated row.

This is recommended to develop a basic level of strength, overall joint and core

stability before processing to free weights.

Inexperienced clients

people who have previously exercised in a gym setting, are currently undertaking

regular exercise and have been for a period of time.

the exercise program may start at a higher intensity, use combination of

free weights, cable machines and incorporate plyometric training or

sports specific exercises.

Children have different physiological responses to exercise

than adults.

Children have a higher VO2 and heart rate

Stroke volume and cardiac output are lower in children at

sub-maximal exercise.

Considerations before prescribing exercise to children

PAR-Q form should be completed and signed by a parent or guardian giving authorisation and consent for their child or adolescent to participate.

Periods of development such as growth spurts need to be identified in order to prevent over loading weak growth plates possibly resulting in future damage.

Size of the exercise equipment should correspond to the size of the child.

Proper technique needs to be preformed before intensity is increased.

No heavy resistance

Exercise recommendations for healthy active older clients

Flexibility and balance exercises are critical for maintaining functional capacity, balance and agility to prevent falls and injuries.

Walking, stationary bike and aquatic exercise are recommended modes of aerobic exercise.

Participating in group environments allow for social interaction and increases adherence.

Exercise should be of moderate intensity and can be broken into smaller bouts throughout the day if more achievable (e.g. 10 minute bouts).

Exercises should be functional to activities of daily living, starting off with a low resistance.

Initially increase duration and frequency before increasing the intensity of exercise

Incontinence.

one activity which is contraindicated

High impact activities such as jumping and skipping

a form of exercise which is very important to include in the

program is Pelvic floor exercises.

This may include

Kegals (drawing the pelvic floor muscles in and holding for 5-10

seconds and repeating 10 times). Undertake while lying,

sitting, standing.

Lie on back, draw in pelvic floor muscles and hold contraction while lifting one leg slightly off

the floor.

Kneel on all fours, draw in pelvic floor muscles and hold contraction while extending

opposite arm and leg out at the same time.

Assessment 6 (no. 6)

TYPE FREQUENCY DURATION INTENSITY

Aerobic

(low impact)

3-5days/week 30-40mins Moderate/

RPE 11-

13

Resistance

(experienced

clients)

2 days/week High

repetitions

Low weights

Flexibility

(relaxation)

3-5

days/week

10-30mins Gentle

exercises

Examples of exercises may include; swimming, walking, cycling on a stationary bike, exercises in the water, low impact aerobics, pelvic floor exercises and yoga. Jogging may be continued as the client has been jogging regularly prior to the pregnancy and the distance should be decreased throughout the pregnancy.

Exercising while pregnant

Minimal increase in core temperature – Modify the intensity and duration of exercise, wear appropriate clothing, exercise in a cool environment and stay hydrated to prevent hyperthermia and associated risks to the fetus.

Avoid exercise in the supine position after first trimester

Avoid high contact sports or activities that cause risk to abdominal trauma.

Avoid scuba diving

Do not exercise at altitude greater than 6000 feet

Exercises & injury

Weight bearing exercises are important for osteoarthritis, rheumatoid arthritis and osteoporosis to nourish cartilage, bone

and strengthen joints.

Exercises should be functional, mimicking the individual’s activities of daily living (ADL’s) and targeting the major muscle

groups for osteoarthritis, rheumatoid arthritis and osteoporosis.

Balance exercises should be incorporated in an exercise program for individuals suffering from osteoarthritis,

rheumatoid arthritis or osteoporosis.

Exercises & injuryCont./

Exercises involving forward flexion of the trunk with resistance is not recommended for individuals with lower back pain.

Rowing, skipping and bouncing are all exercises not beneficial for individuals with neck issues. False

Circuit training is the best form of strength training for clients with hypertension, incorporating high repetitions and low resistance.

Once medically cleared clients with high cholesterol can undertake an exercise program in a gym facility under supervision of a fitness instructor.

Exercise Guidelines/Precautions for Diabetes Mellitus – with complications.

Complication Precaution Recommendation

Autonomic

neuropathy

Likelihood of hypoglycemia,

abnormal BP, increased resting

HR, decreased max HR. Prone

to dehydration and

hypothermia.

Lower intensity, keep

hydrated, use RPE scale.

Physician approval

required.

Peripheral

neuropathy

Avoid activity that will cause

trauma to feet. No aquatics if

ulcers present. Avoid balance

activities.

Non weight bearing exercise

e.g. Cycling, chair

exercises, swimming.

Regular assessment of

feet, keep clean and dry,

use supportive shoes.

Nephropathy Avoid exercise that increases BP

(e.g. Heavy weights and high

intensity aerobic exercise), do

not hold breath.

Low to moderate intensity

aerobic and resistance

exercise. Keep hydrated.

Retinopathy Avoid high intensity weight lifting

or overhead lifting, avoid

activities that lower or jar head

(e.g. gymnastics, yoga)

Use RPE scale

Exercise guideline for an obese person.

TYPE FREQUENCY DURATION

Aerobic

(large muscle groups,

dynamic activity)

5-7days/week 40-60mins or 2

sessions per day of

20-30mins

Resistance

(8-10 exercises, major

muscle groups)

2-3 days/week 1 set of 12-15 reps

Flexibility

(static stretch all major

muscle groups)

5-7 days/week 2-4 sets per stretch

15-30secs

Benefits of exercise for clients who suffer from depression.

Decreases feelings of

depression and anxiety

Reduces the serum cortisol

levels – a stress hormone

Increases energy levels

Increases social interaction

Creates a distraction

from worries and anxiety

Benefits of exercise for clients who suffer from depression.

Decreases stress

Release of endorphins in central

nervous system, leads to feeling good and life satisfaction.

Improved self esteem

Improved overall physical health

Motivational techniques

Motivational interviewing

Behaviour modification

Reinforcements

Cognitive/Behavioural

Decision making

Social support

Intrinsic approaches

Motivating a client who suffers from depression

Firstly use rewards for attendance because sometimes it is very difficult getting out of the house for a client with depression let alone attending a gym with large crowds of people.

Set short term goals for each session using SMART principle and be careful not to worsen depressive symptoms if client is unable to meet expectations

Educate the clients on the benefits of exercise and inform them on how good they will feel once the endorphins start releasing.

Term Motivational technique

Motivational interviewing Client identifies their plan

Behaviour modification Prompts for exercise

Reinforcements Rewards for participation

Cognitive/Behavioural SMART goals

Decision making Benefits and costs of exercise

Social support Exercise in a group

Intrinsic approaches Engage in purposeful and meaningful activity

Managing back to back appointments

Arrive at work 15minutes early to gather information on the new clients and have ready for them to arrive. Set up equipment in the consultation room such as BP machine, scales and tape measure.

Use time management skills to plan sessions allocate time frames and stick to them e.g. 5min warm up, 20mins of exercises, 5min warm down and stretches.

Keep your elderly client on track and if she continues to talk politely stop her and remind her you only have 30minutes which you need to get the most out of the session.

Use a stop watch to alert you when you have 5-10 minutes left in an appointment so you can start finishing up.

If one of the new clients needs more time book another appointment to continue the session rather than rushing and leaving them uncertain of how to use the equipment.

ORALASSESSMENT

Client Actions

Over 40 years of age Type 2 Diabetes three

years ago Not certain if her

condition is stable Does not measure her

BSL. BP is a little high but is

not sure. She often gets dizzy and

light headed. Takes medication for

diabetes, but is not sure what it is called.

She is slightly overweight.

Has a family history of heart disease.

Measure and record BP.

Explain that a fitness instructor is qualified to prescribe and deliver exercise programs for the relatively healthy population. The relatively healthy population are individuals who are free from injury, illness and risk factors for chronic disease. Has diabetes and high BP for legal reasons I am required to refer to a GP to gain medical clearance prior to participating in any form of exercise.

And then refer to an appropriately qualified allied health professional such as exercise physiologist, who specialises in prescribing exercise for individuals suffering from diabetes.

Write the referral letter, offer to book an appointment with their GP and terminate the initial consultation.

Write notes on their file outlining your actions and restricting access to the gym until medical clearance is provided.

Diabetes & hypertension

Undertaking regular exercise is very important in managing diabetes and hypertension. Exercise can improve both conditions and prevent associated complications from occurring. Benefits are:

• Increase insulin sensitivity• Increase glycemic control• Decrease insulin requirements and medication dosage• Decrease blood pressure• Decrease risk of CV disease• Decrease body fat • Increase psychological well-being• Increase HDL’s• Decrease LDL’s• Decrease stress• Increase oxygen update• Decreases mortality from heart attacks.• Decreases risk of atherosclerosis.• Improves cardio-respiratory function.

Between 6-14 mmol/L

Range a diabetic’s blood

sugar levels (BSL) must be

to exercise

Clients with diabetes should always

complete exercise under

supervision.

signs and symptoms are

you as the instructor

observing for during exercise

Shaking

excessive sweating

clumsiness

increased heart rate

tiredness

acting aggressive

signs of blurred vision

complaining of hunger or headaches.

Modifications to program of asthmatic

Undertake adequate warm up and warm down

The warm up should consist of rhythmic low level exercise (e.g.

walking progressing to jogging) and flexibility exercises for major muscle

groups

The warm down period should continue until the HR returns to

within 20 beats per minute of pre-exercise level and may include slow

walking and flexibility exercises.

Include activities that utilise large muscle groups in a rhythmic

pattern such as walking, jogging, running, cycling, swimming and

endurance game activities.

Importance of not exercising in an

environment with potential triggers (e.g. dust, blossom,

smoke).

Do not exercise in early mornings and late evenings, mid to late morning ideal time and avoid

extreme temperatures and humidity.

Nasal breathing is recommended while exercising as it enhances

breath warming and humidification which in turn lowers the incidence of EIA.

Educate client to increase duration of activity before

intensity as they progress with their exercise

Client with lower back pain

Forms of exercise include

stretching

range of motion

strengthening

stability

Base exercises around

core stability

posture

be functional to activities of daily living.

Most common muscles that

are associated to the lower

back

Erector spinae

Psoas

Iliotibial band

Hip external rotators Hamstrings

Rectus femoris

Gastrocnemius.

Gluteal and hamstring muscle strength is very

important for pelvic stability.