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Group #8 Members: Chris Anderi, Rose Carey, Patrick Morris, Melissa Petterson & Justin Reay

NOTE: All image citations can be found by hovering over the image.

Contents

[edit] Initial Consultation Questions and Answers

Thursday October 10th, 2013 at 11:00 a.m. Members Present: Pat Morris, Justin Reay, Rose Carey, Chris Anderi


1. What are your interests/hobbies?

A: In the past our client fenced and was a long distance runner. Currently she is interested in educational activism and is currently pursuing a thesis in disability studies. Our client also has a dog that she enjoys walking daily.

2. What are your personal fitness goals?

A: She is interested in improving her overall general fitness.

3. What are your strengths and weaknesses?

A: Our client has a number of limitations of the upper body, as well as self perceived poor cardio. She feels her greatest strength lies in her lower body strength.

4. Have you ever taken part in a regular training program, if so when was the last time?

A: She last worked on strength training with a personal trainer about 6 years ago.

5. Do you have any training preferences?

A: She feels most comfortable completing cardiovascular activities. She has also done Tai Chi exercises in the past that she enjoyed.

6. Do you have any previous/current injuries?

A: Experiences lower back pain in the lumbar spine region due to a previous motor vehicle accident. Scoliosis of the upper spine in which she sees a chiropractor weekly. Carpel tunnel of the right wrist, as well as severe pain in her right shoulder and elbow. She believes her carpel tunnel stems from repetitive overuse of handling a mouse, and she wears a brace when the pain in her wrist is severe. The issues in the right arm have resulted in minimal strength and flexibility of the right arm, and gripping objects is an issue. She blew out her knee in the past when she used to run resulting in limited range of motion of the knee. Lastly, she has been diagnosed with a heart defect in which one of her heart valves only works at 75% capacity.

7. Are you currently on any medications?

A: No major medications, just Ibuprofen and Advil for pain fluctuations.

8. Do you have any allergies?

A: Allergic to cigarette smoke.

9. What is your availability and how often would you like to meet/week?

A: She is willing to meet 2 times a week, and is capable of meeting Tuesday-Thursday from 10am-12pm.

10. Do you have a zone pass?

A: Yes

11. Emergency contact info

A: She gave us her mothers and her information.

12. What is the best way to contact you? (email, cellphone, etc.)

A: She has no preference in mode of contact. Calling, texting, and email are all acceptable.

Note: Par-Q was filled out by client, however, unable to complete PARmed-X so a liability waver will be signed. Age will be acquired at initial fitness assessment for comparison of normative values of test.

[edit] Initial Assessments

Tuesday October 15th at 10 a.m. at the zone. Members present: Chris, Rose and Pat

[edit] 1. Resting Heart Rate

Taken by Rose at the wrist.

Resting Heart Rate = 60bpm.

[edit] 2. Warm up

Client warms up on the elliptical for 5 minutes.
Elliptical Trainer. Retrieved from: http://images.oneshotfitness.com/uploads/2010/04/Body-Solid-Elliptical.jpg

[edit] 3. Assessments

Balance Assessment: Stork Balance Test

This test is a simple way to assess balance.
Stork Balance Test. Retrieved from: http://www.runnersworldonline.com.au/site/_content/image/00003650-image.jpg

The client removes shoes and stands with hands on their hips. Next they place the sole of their non-standing foot against the inside of the calf of the other leg. The assessor times with a stopwatch the duration the client stays balanced. The test is then administered to the other leg.

Measurements:

  • Right leg = 2 minutes
  • Left leg = 2 minutes

Flexibility & Joint Range of Motion: Goniometry

Goniometry assessed the range of motion at several joints using a goniometer. Using this tool we will compare her left and right knee, wrist, elbow and shoulder to see if there is a difference between the joint range of motion per side. We are going to perform assessments on her wrist, asking her to perform pronation and supination as well as flexion extension and abduction and adduction to determine the extent of her injury. We will perform flexion and extension at the elbow and all movements of the shoulder.

Note: Initial Joint ROM chart can be found here.

Muscular Strength: Manual Muscle Screen (MMS)

This test will allow us to measure our clients muscular strength efficiently, and without the use of weights. The test requires muscles to be forced through their range of motion, against an externally applied resistance by the tester. The test will uncover any muscular imbalances in strength, either between agonists/antagonists or right/left side of the body. Special attention will be paid to the affected knee, wrist, elbow, shoulder, and lower back.

Great imbalances in strength were found between her left and right sides with the left being quite a bit stronger than her right.

Aerobic Capacity: Rockport Walking Test

This test is a submaximal field test to estimate V02 max in males and females age 20-69. The client is required to walk 1.6km (1mile) as fast as they can without running. After completion of the mile walk, heart rate must be calculated by the assessors. Next, the following equation is used to estimate V02 max.

132.853 -(0.0769 x weight lbs)-(0.3877 x age)+(6.315 x gender: men 1; women 0)- (3.2649 x time sec)-(0.1565 x heart rate)

Her calculated VO2max from the Rockport test is: 30.84.

[edit] SMART Goals

SMART GOALS (Specific, Measureable, Attainable, Realistic, and Time Restricted) Goals for our client:

Based on the initial physical assessment of our client, we have developed goals for different areas of fitness that we are interested in improving over the next term. Specifically, we are looking for improvements in cardiovascular endurance, strength, balance, and flexibility.

These goals have been established after composing the Rockport Test, Goniometry, Manual Muscle Screen Test and the Stork Balance Test.

We would like to see all of these goals met by the end of our six week program with out client.

Cardiovascular

Our client completed the Rockport test, walking one mile as fast as she could without running to estimate her VO2 max. Our client completed the test in 18:15 minutes and had an estimated VO2 max of 30.84. Our client appeared to be sweating, out of breath, and red in the face upon completion of this cardiovascular assessment test, which we can use to compare to her final assessment at the end of the term to note the physical demand of the assessment. Over the course of the semester, we hope to decrease the time it takes her to walk a mile down to 16 minutes to improve her cardiovascular endurance. In order to meet this goal, we plan on doing 20 minutes of cardiovascular exercise (using either the elliptical, track, or recumbent bicycles) twice a week when we meet with her. We are hoping to see this increase in cardiovascular endurance when we do a follow up test with our client at the end of the term.

Balance

Our client completed the Stork Stand Balance Test on both her right and left leg for assessment of balance. She completed two minutes on each leg, and only stopped because we capped the time frame for her to balance. Our client has a background in fencing, which she claims is the reason for her balance confidence and performance. Over the course of working with our client, we aim to maintain these results for her balance. In order to achieve this, we plan on practicing some weight transfer exercises (for example, step ups), as well as practice the stork stand on each leg approximately once a week.

Flexibility

To assess flexibility and range of motion with our client we used goniometry at several joints to compare the left and right side of the body. Upon completion of this assessment, it was obvious that her injured side (the right side) had a much lower range of motion value at several joints than her left side. Our group hopes to improve the balance between the range of motion between the left and right sides of the body at the elbow, wrist and shoulder joint. In order to achieve this we will be doing several stretches with our client every time that we meet with her in order to improve flexibility. We also plan to do several muscle strengthening exercises to the muscles that surround these joints in order to allow a further range of motion.

Strength

To assess strength of our client we performed a Manual Muscle Screen. After completion of this assessment the differences in muscle strength between our client’s right and left side of the body were clearly illustrated. Our client is predominantly stronger on the left side of her body due to all the injuries on the right side of her body. This test was a basic assessment of her overall strength and was used in order for us to assess and learn more about how we can further assess strength after receiving this baseline. We would like to see more of a balance between her left and right sides by the end of this program and we will work toward this by having her use resistance bands and free weights that will not allow her stronger left side to compensate for her weaker right side, therefore balancing her strength and ability.

Psychological

During the course of our initial exercise program with our client we found that there was a discrepancy between what she told us she was capable of and what we initially saw. It was apparent that she showed a lack of confidence when it came to exercising, likely due to the fact that she had become more sedentary than she had been in the past due to a number of factors ranging from her functional limitations to a lack of time. At this point we thought it would be crucial to address this lack of confidence in our program design in hopes to increase her exercise efficacy and potential to continue on with leading a healthy active lifestyle at the end of the term. Unfortunately, due to the fact that this goal was added later in our program we were not able to complete a pre-test assessment which makes completing an assessment of her confidence difficult. Ideally if we were to do this again we would have included an exercise confidence questionnaire that could have been completed at the beginning and end of the program.

[edit] Session 1: 22 October 2013

[edit] Plan

Chris & Melissa will meet with client at 10am at The Zone.

Warm-Up

Elliptical Trainer - 5-10min (as needed)

Resistance Training

Aim for 2 sets of 15 repetitions (reps). The exercises that follow are to be performed as 3 super-sets:

  • Perform 1 set of 15 reps of the lower body exercise.
  • Perform 1 set of 15 reps of the upper body exercise.
  • Repeat

The rest period for the first exercise is filled with the second exercise. This will allow the muscle group involved to rest while making efficient use of time spent training.

  • Super-Set 1
  • Glute Bridge Hip Raises
  1. Begin laying supine with knees and hips flexed
  2. Begin the movement by driving through with heels, extending hips vertically
  3. Body weight should be supported by upper back and the heels of feet
  4. Extend as far as possible, then reverse the motion to return to starting position
  5. Repeat
    Glute Bridge Hip Raises. Retrieved from: http://3.bp.blogspot.com/-YECobjzh2pw/TynyammvCkI/AAAAAAAAAJc/TqhoMpR3CJE/s1600/glute%2Bbridge.jpg


  • Wall Push-Up
  1. Begin standing 2 feet from a sturdy wall
  2. Keeping body rigid in a straight line, lean toward the wall placing hands at shoulder level with elbows extended (starting position)
  3. Slowly lean toward the wall flexing elbows until upper arm is parallel with the wall
  4. Push against wall to return to starting position
  5. Repeat
    Wall Push-Up. Retrieved from: http://eatercise.com.au/wp-content/uploads/2012/10/wall-pushups.jpg


  • Super-Set 2
  • Step-Up
    • One step up with each leg = 1 rep
  1. Stand erect facing the step
  2. Step up onto the step with left leg
  3. Bring right leg onto step
  4. Step down backward with left leg
  5. Repeat with opposite leg
    Step Ups. Retrieved from: http://img.photobucket.com/albums/v62/zsazsa4ever/STEPUPS.jpg
  • Standing Row with resistance band
  1. Anchor resistance band well. Stand back far enough to take up slack
  2. Standing with feet shoulder width apart, a slight bend in the knees, and hands together at waist level
  3. Keeping body erect, core engaged and elbows in, pull hands back toward ribs
  4. Slowly return hands to starting position under control
  5. Repeat
    Standing Row. Retrieved from: http://www.ivillage.com/files/et/downloads/standing-row-636.jpg


  • Super-Set 3
  • Calf Raises
  1. Stand with balls of feet on edge of step, hold wall for balance if needed
  2. Dorsiflex at the ankles to lower body as far as possible (starting position)
  3. Plantarflex at the ankles to raise the body as high as possible
  4. Slowly dorsiflex at the ankles under control to return to starting position
  5. Repeat
    Calf Raises. Retrieved from: http://moltenwax.com/wp-content/uploads/2010/08/Standingcalveraisesexercise.jpg


  • Shoulder Press with resistance band
  1. Stand erect with middle of resistance band under both feet
  2. Flex elbows 90 degrees and abduct shoulders so hands are at the height of ears (starting position)
  3. Press hands up as far as possible, extending elbows and abducting shoulders
  4. Slowly flex elbows and adduct shoulders to return to starting position under control
  5. Repeat
    Shoulder Press. Retrieved from: hhttp://freshbodyfitness.com/wp-content/uploads/2011/11/shoulder-press.jpg

Core Stability

  • Russian Twists on Stability Ball with Medicine Ball

Note: This seems a bit advanced compared with the rest of the exercises included in this session, but our client's core stability and balance was found to be excellent during assessment and we are comfortable that this exercise can be performed well.

  1. Sit on stability ball with legs shoulder width apart and lean back slightly
  2. Hold medicine ball in front of and close to body (starting position)
  3. Rotate trunk to the left and right, keeping core engaged and moving the medicine ball to that side, keeping it close to the body (image illustrates a more progressed variation that we will work toward)
  4. One pass from starting position to the extreme left and right with return to starting position is one rep
  5. Repeat
    Stability Ball Twists with Med Ball. Retrieved from: http://www.howcast.com/videos/501008-How-to-Do-Seated-Twist-on-Exercise-Ball-Ab-Workout

Cardio

Client will perform a cardiovascular exercise for 20min and choose between:

  • Elliptical Trainer
  • Fast Walking on indoor track

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  1. Standing on one leg
  2. Hold heel to butt
  3. Push hip forward
  4. Repeat on opposite side
    Quad Stretch. Retrieved from: http://www.sportsinjuryclinic.net/image.php/?file=media/content/_master/164/images/quadstretch.jpg&width=440&height=275


  • Standing hamstrings stretch
  1. Stand with feet slightly apart, keep knees straight
  2. Reach down to touch toes
  • Rise from this position slowly in order to stretch back muscles
    Hamstring Stretch. Retrieved from: http://www.ibodz.com/files/exerciseimages/standing-hamstring-and-lower-back-stretch-1.JPG


  • Standing calf stretch
  1. Stand with toes of one foot against wall and heel on the floor
  2. Keeping knee straight, lean toward the wall
  3. Repeat on opposite side
    Calf Stretch. Retrieved from: http://i1.ytimg.com/vi/f1HzSAuB-Vw/hqdefault.jpg


  • Standing chest and biceps stretch
  1. Clasp hands behind back
  2. Lift arms as high as possible holding chest up and out
    Chest Stretch. Retrieved from: http://zumewalk.com/wp-content/uploads/2009/03/40s-chest-stretch-400.jpg


  • Standing triceps stretch
  1. Reach one arm over shoulder and reach hand down back as far as possible
  2. Gently push elbow back with other hand keeping chest up and out
  3. Repeat on opposite side
    Triceps Stretch. Retrieved from: http://www.teachpe.com/images/jenny/triceps_stretch2.jpg


  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Chris and Melissa were present for this session which lasted 1hr 15min.

Equipment needed:

  • Elliptical machine
  • Mat
  • Plyo box 12”
  • Resistance bands
    • Red, elastic
    • Green with handles
  • Stability ball
  • Medicine ball, 2lbs
  • Indoor track


Table 1: Observations and data from session 1 with client on 22 October 2013.

Session 1 Data
Session 1 Data


Impression:

Client was in good spirits and willing to do each exercise suggested.

She let us know immediately when any modifications were required and we accommodated these requests easily.

  • During the Russian Twists with the Medicine Ball we discussed the pain and numbness in her right wrist and hand in detail (reported above). She was unconcerned and familiar with the mechanism that induced it, saying that “it is just something I live with.” She was happy to continue the 1st set with the modifications made and to complete the 2nd set without the medicine ball. She seemed relieved when the pain lessened and went away completely by the end of the session, saying that we “must have caught [the cause of it] before it flared up too badly.”

During the cool-down we discussed then need to keep her right wrist in a neutral position when force is applied in any direction.

More research is needed here to find exercises that will begin to allow her to regain some strength and a greater range of motion in the right wrist.

  • This is something we will need to consider with each exercise we present.

Good effort was put forth, but she could easily be pushed for more next session.

Since we will not need to explain each exercise to the client, the next session should take less time.

[edit] Session 2: 24 October 2013

[edit] Plan

Justin & Pat will meet with client at 10am at The Zone.

Warm-Up

Elliptical Trainer - 5-10min (as needed)

Resistance Training

Aim for 2 sets of 15 repetitions (reps). The exercises that follow are to be performed as 3 super-sets:

  • Perform 1 set of 15 reps of the lower body exercise.
  • Perform 1 set of 15 reps of the upper body exercise.
  • Repeat

The rest period for the first exercise is filled with the second exercise. This will allow the muscle group involved to rest while making efficient use of time spent training.

  • Super-Set 1
    • Glute Bridge Hip Raises
    • Wall Push-Up
  • Super-Set 2
    • Step-Up
      • One step up with each leg = 1 rep
    • Standing Row with resistance band
  • Super-Set 3
    • Calf Raises
    • Shoulder Press with resistance band


Core Stability

  • Russian Twists on Stability Ball


Cardio

Client will perform a cardiovascular exercise for 20min and choose between:

  • Elliptical Trainer
  • Fast Walking on indoor track


Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
    • Rise from this position slowly in order to stretch back muscles
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Pat and Justin were present for this session which lasted 1hr.

Equipment needed:

  • Elliptical machine
  • Mat
  • Plyo box 12”
  • Resistance bands
    • Red, elastic
    • Green with handles
  • Stability ball
  • Indoor track


Table 2: Observations and data from session 2 with client on 24 October 2013.

Session 2 Data
Session 2 Data


Impression:

The client seemed very happy with her last exercise session and was in good spirits for our session to follow. Because she had already completed all the exercises, any adjustments that had to be made for her had already been completed so our focus was on encouraging an increase in intensity. We were able to modify the wall push-up and shoulder press, which was well received by the client. When asked if she wished to improve the intensity of other exercises she seemed quite confident in what her capabilities were and wasn’t afraid to express her opinion. When she was experiencing pain she was quick to let us know so we could make some needed adjustments. During the session she seemed very willing to do all the exercises and completed everything with vigour. After the session we discussed any changes she may want to see up to this point or exercises she may want to try, and she responded that she was happy with what we had come up with thus far and was interested in doing whatever we come up with for her.

Important Note:

Our client reported a mild, constant pain in her right knee following her exercise session on October 22, that had remained up to our session. She reported the pain to be directly at the medial portion of the knee joint. During the exercise session she had to stop before intended while using the elliptical because of knee pain, although she had no problems when walking afterwards. We informed or client to email us if the pain increased or continued following the second session.

[edit] Session 3: 29 October 2013

[edit] Plan

Chris & Melissa will meet with client at 9:30am at The Zone.

Because client needed to adjust her availability this week, we will perform a lower body work out this session, and an upper body work out tomorrow. The schedule is expected to return to allowing 48hrs recovery time between sessions and we will resume performing 2 full body work outs per week.

Warm-Up

Client will perform a light cardio exercise for 5-10min as needed and choose between fast walking around the track, the elliptical trainer or the stair climber in the Zone.

Stair Climber. Retrieved from: http://www.fitnessblowout.com/images/Products/Enlarge/7000ptsilverconsole.jpg

Resistance Training

Aim for 2 sets of 15 repetitions (reps). The exercises that follow are to be performed as 3 super-sets:

  • Perform 1 set of 15 reps of each exercise.
  • Rest 60 seconds.
  • Repeat
  • After 2 sets of each super-set move to the next one.

The rest period for the first exercise is filled with the second exercise. This will allow the muscle group involved to rest while making efficient use of time spent training.

  • Super-Set 1
  • Hip Extension
  1. Take position on mat
  2. Tighten glutes and hamstrings and concentrate on flexing these muscle groups during the exercise
  3. Perform extension at the hip to lift weight
  4. Slowly return to start position
  5. Repeat
    Hip Extension. Retrieved from: http://www.self.com/blogs/flash/ResistanceBandHipExtension-595.jpg
  • Lateral Step-up
  1. Stand with feet together with the plyo-box on the right side
  2. Step up onto box with right foot using a lateral step
  3. Bring left foot onto top of box and transfer weight to it
  4. Step down off the other side of the box with right foot using a lateral step
  5. Bring left foot down beside right
  6. Repeat using left foot first moving to the left
    Lateral Step-Up. Retrieved from: http://www.womenshealthmag.com/files/images/mv-lateral-stepup.jpg


  • Super-Set 2
  • Hip Adduction
  1. Take position in machine
  2. Move legs together (adduction) to lift weight
  3. Slowly return to starting position under control
  4. Repeat
    Hip Adduction. Retrieved from: http://fit-geek.com/wp-content/uploads/2011/06/hipadductor.jpg
  • Hip Abduction
  1. Take position in machine
  2. Move legs apart (abduction) to lift weight
  3. Slowly return to starting position under control
  4. Repeat
    Hip Abduction. Retrieved from: http://www.fitnessthings.com/exercise-equipment/ProdImages/VR3_HipAbduction.jpg


  • Super-Set 3
  • Leg Extension
  1. Take position in machine ensuring starting position hold knee at around 90 degrees
  2. Extend knees to lift weight ensuring not to lock the knee
  3. Slowly return to starting position under control
  4. Repeat
    Leg Extension. Retrieved from: http://www.treadmillfactory.ca/product_images/1305835208-1_body-solid-cam-series-seated-leg-extension-seated-leg-curl.jpg
  • Lying Leg Curl
  1. Take position in machine ensuring starting position does not hyper-extend the knees
  2. Flex the knees to lift weight
  3. Slowly return to starting position under control
  4. Repeat
    Lying Leg Curl. Retrieved from: http://www.t-nation.com/img/photos/07-171-training/image027.jpg


Core Stability

  • Russian Twist on Stability Ball
  • Single Leg Glute Bridge
  1. Lay supine with hips and knees flexed
  2. Extend right knee fully
  3. Lift hips off floor so back, thighs, and extended right leg form a straight line
  4. Hold this position for 30 seconds
  5. Relax and rest for 30-60 seconds as needed
  6. Repeat with left leg extended
    Lying Leg Curl. Retrieved from: http://www.ecofitwomen.com/wp-content/uploads/2011/08/single-leg-bridge5.jpg

Cardio

Client will perform a cardiovascular exercise for 20min and choose between:

  • Stair Machine
  • Fast Walking on indoor track

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
    • Rise from this position slowly in order to stretch back muscles
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Chris, Rose & Melissa met with client at 9:30am at the Zone. The session lasted 1hr 20min.

Equipment Needed

  • Elliptical machine
  • Resistance band, green
  • Ankle weights, 3lbs
  • Stability ball
  • Plyo box, 12"
  • Resistance machines
    • Hip adduction
    • Hip abduction
    • Leg extension
    • Leg curl
  • Indoor track


Table 3: Observations and data from session 3 with client on 29 October 2013.

Session 3 Data


Impression

Client performed all exercises requested with enthusiasm. She was happy to be using the resistance machines for this lower body workout, and mentioned that the weight was just challenging enough. She needed coaching to not allow the weight stack hit the bottom during each rep, and said when she paid attention to that she could feel her muscles working harder.

The session went well, progression through the exercises was smooth, conversation was light and easy, and the client was in better spirits at the end of the session than she was at the beginning.

[edit] Session 4: 30 October 2013

[edit] Plan

Pat & Justin will meet with client at 1:00pm at The Zone.

Warm-Up

Client will perform a light cardio exercise for 5-10min as needed and choose between fast walking around the track, the elliptical trainer or the stair climber in the Zone.

Resistance Training

Aim for 2 sets of 15 repetitions (reps). The exercises that follow are to be performed as 3 super-sets:

  • Perform 1 set of 15 reps of each exercise.
  • Rest 60 seconds.
  • Repeat
  • After 2 sets of each super-set move to the next one.

The rest period for the first exercise is filled with the second exercise. This will allow the muscle group involved to rest while making efficient use of time spent training.

  • Super-Set 1
  • Lying Chest Press
  1. Lie on the bench, a dumbbell in each hand
  2. Place feet flat on the floor (knees at about 90 degrees flexion)
  3. Engage core and squeeze shoulder blades together
  4. Press dumbbells up keeping arms directly over shoulders with strong wrists, do not lock elbows
  5. Lower the dumbbells under control until elbows are slightly below shoulders.
  6. Repeat
    Lying Chest Press. Retrieved from: http://well-girl.com/wp-content/uploads/2013/01/860.png
  • Standing Row


  • Super-Set 2
  • Lateral Raises
  1. Place resistance band under arch of each foot
  2. Stand up straight, feet shoulder width apart
  3. Ensure feet are lined up parallel on the ground
  4. Start with arms at sides, gripping handles of resistance bands
  5. Raise straight arms to shoulders laterally (create a 90 degree angle)
  6. Lower arms to sides under control
  7. Repeat
    Lateral Raise. Retrieved from: http://www.womansday.com/cm/womansday/images/QH/01H-walk-it-off-1.jpg
  • Biceps Curl
  1. Stand tall, place feet about shoulder width apart
  2. Engage core
  3. With hands gripping weights (or resistance bands) face palms forward
  4. Keep elbows against sides flex elbows to bring arms toward chest
  5. Extend elbows under control returning to start position
  6. Repeat
    Biceps Curl. Retrieved from: http://freshbodyfitness.com/wp-content/uploads/2011/11/bicep.jpg
  • Super-Set 3
  • Triceps Kickback
  1. Stand with feet hip width apart, flex knees slightly, flex at the waist
  2. Pull arm into a position so it is parallel with body
  3. Keep elbow stabilized as they are extended
  4. Slowly return to beginning position under control
  5. Repeat
    Triceps Kickback. Retrieved from: http://www.alive.com/site_22/367-ex-triceps.jpg
  • Shrugs
  1. Stand tall with feet shoulder width apart, place band under arch of both feet
  2. Engage core
  3. Grip the handles keeping hands in handshake position
  4. Flex knees slightly
  5. Keeping arms straight, elevate shoulders as far as possible
  6. Hold briefly
  7. Slowly depress shoulders as far as possible
  8. Repeat
    Shoulder Shrugs. Retrieved from: http://www.medhelp.org/Images/articles/Band_Workouts_shurg.png

Core Stability

  • Resistance Band Woodchopper
  1. Stand with feet shoulder width apart, knees slightly flexed
  2. Attach one end of band to stationary object above shoulder height, grasp other end with both hands
  3. Start with arms up above the shoulder closest to where band is anchored
  4. Engage core
  5. Keeping elbows straight pull hands down across body to opposite knee
  6. Concentrate on engaging the core to twist from one side to the other
  7. Slowly return to the starting position
  8. Repeat
    Resistance Band Woodchopper. Retrieved from: www.womenshealthmag.com/files/images/1107-wood-chop-resistance.jpg
  • Plank
  1. Start in prone position with toes and forearms supporting body weight
  2. Engage core and keep body in straight line from shoulders to heels
  3. Look up slightly and keep neck relaxed
  4. Hold position for desired length of time (30sec)
    Plank. Retrieved from: http://www.erinchapmanfitness.com/wp-content/uploads/2013/04/Bridge-Plank-on-Elbows.jpg

Cardio

Client will perform a cardiovascular exercise for 20min and choose between:

  • Stair Machine
  • Fast Walking on indoor track

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
    • Rise from this position slowly in order to stretch back muscles
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Justin & Pat met with client at 1:00pm in the Zone. The session lasted 1hr 20min.

Equipment Needed

  • Elliptical machine
  • Mat
  • 3lbs ankle weights
  • Resistance band, red, elastic
  • Indoor track


Table 4: Observations and data from session 4 with client on 30 October 2013.

Session 4 Data


Impression

Client was in good spirits for this session. She didn't mention of any pains from the previous workout but was concerned with her knee and because of this she didn't want to perform the elliptical and we chose instead to walk for 25 minutes. Adding an extra 5 minutes was the start of a progression to work on her cardio for the next session and increase her intensity. She was able to perform the exercises with ease, she mentioned that the weight was a little light for the bicep curl with the ankle weights on her wrist and said she could easily move up weights for this. Her form was slightly off near the end of the triceps kickback and mentioned that she felt this one but enjoyed it.

[edit] Session 5: 5 November 2013

[edit] Plan

Chris, Justin & Melissa will meet with client at 9:30am at The Zone.

Warm-Up

5min on the elliptical machine at level 2.

Resistance Training

This session with have two circuits of five exercises. The first circuit will be performed back to back. A 3 min water/rest break will follow. The first circuit will be repeated. Another 3 min water/rest break. The second circuit will then follow the same pattern.

  • Circuit 1
  1. Lunge pulses (feet spread & stationary)
    1. Step left leg forward and bend your knees to lower your body into a lunge
    2. Lunge until both knees are bent at 45 degrees
    3. Slowly pulse into a half lunge and out of the lunge
    4. Push through your left heel to return to standing
    5. Repeat with the right leg
      Lunge Pulses. Retrieved from:http://boropulse.com/wp-content/uploads/2012/07/Lunge.jpg
  2. Lying chest press
  3. Leg press
    1. Sit down on the machine and place your feet on the platform located near the ground
    2. Place your feet about shoulder width apart and select appropriate weight
    3. Grip the hand grips
    4. Lower yourself so that your knees are bent from 45-60degrees as you inhale
    5. Push through your heels to go back to the starting point as you exhale, but make sure not to lock the knees
    6. Repeat
      Leg Press. Retrieved from:http://www.fitness-weetjes.nl/wp-content/uploads/2013/01/Leg-Press.jpg
  4. Lateral raise
  5. Woodchopper
  • Cricuit 2
  1. Lat pull-down
    1. Sit down in machine and make sure the knee pad is adjusted to your height (it should fit snug against your quadriceps)
    2. Select the appropriate weight
    3. Grasp the bar with the palms facing forward, hands greater than shoulder width apart.
    4. When both arms are extended, sit up tall with a strong posture, and the back slightly angled backward (about 15degrees)
    5. As you exhale, lower the bar down until it reaches your chest (draw the shoulders and the upper arms down and back)
    6. The torso should remain stationary and only the arms should move
    7. Inhale and slowly raise the bar back to the starting position where your arms are fully extended
    8. Repeat
      Lat Pull-down. Retrieved from:http://www.sprint2thetable.com/wp-content/uploads/2012/03/lat-pull-down.jpg
  2. Calf raises
  3. Triceps kickback w/ resistance band
  4. Hip extension w/ resistance band
  5. Plank on bosu or stability ball

Cardio

Client will perform a cardiovascular exercise for 20min. We will walk around the indoor track performing intervals (laps) of different intensity which will be determined by heart rate (HR). One lap performed at around lower target HR pace followed by a lap at around upper target HR pace.

Target HR:

  • 220 - age = max HR
    • 220 - 40 = 180bpm
  • max HR - resting HR = HR reserve
    • 180bpm - 60bpm = 120bpm
  • (HR reserve x 60%) + resting HR = lower target HR
    • (120bpm x 60%) + 60bpm = 132bpm
  • (HR reserve x 80%) + resting HR = upper target HR
    • (120bpm x 80%) + 60bpm = 156bpm

Target HR zone for 60-80% max HR is 132-156bpm for our client.

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
    • Rise from this position slowly in order to stretch back muscles
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Chris & Justin met with client at 9:30am in the Zone. The session lasted 1hr 20min. Melissa was not able to attend due to sickness and she let the other team members know before the session.

Equipment Needed

  • Elliptical machine
  • Free weights
    • 7.5lbs
    • 3lbs ankle weights
  • Resistance machines
    • Leg press
    • Lat pull-down
  • Resistance band
    • Light, green
    • Medium, red
  • Indoor track
  • Heart rate monitor


Table 5: Observations and data from session 5 with client on 5 November 2013.

Session 5a Data
Session 5b Data

Impression

Rating of Perceived Exertion chart. Retrieved from:http://www.askdoctornat.com/wp-content/uploads/2013/02/borg-img-docstoccdn-com.png
We planned to do lunges and were concerned for her knee when she mentioned she is pigeon-toed. We watched her knee tracking closely and observed no problems. She asked to increase weight for lat pull-down from 20 to 30lbs after the first set. She completed this exercise with good form and no shaking. We were not able to obtain a HR monitor, so used the Rate of Perceived Exertion scale to judge the intensity with which our client was walking around the track for the 20min cardio part of the session.

[edit] Session 6: 7 November 2013

[edit] Plan

Rose & Pat will meet with client at 10am at The Zone.

Warm-Up

5min on the elliptical machine at level 2.

Resistance Training

This session with have two circuits of five exercises. The first circuit will be performed back to back. A 3 min water/rest break will follow. The first circuit will be repeated. Another 3 min water/rest break. The second circuit will then follow the same pattern.

  • Circuit 1
  1. Lunge pulses (feet spread & stationary)
  2. Lying chest press
  3. Leg press
  4. Lateral raise
  5. Woodchopper
  • Cricuit 2
  1. Lat pulldown
  2. Calf raises
  3. Triceps kickback w/ resistance band
  4. Hip extension w/ resistance band
  5. Plank on bosu or stability ball

Cardio

Client will perform a cardiovascular exercise for 20min. We will walk around the indoor track performing intervals (laps) of different intensity determined by monitoring RPE. One lap at normal pace followed by a lap at a faster pace.

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
    • Rise from this position slowly in order to stretch back muscles
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Rose & Pat met with client at 10am in the Zone. The session lasted 1hr 10min.

Equipment Needed

  • Elliptical machine
  • Free weights (7.5lbs)
  • Resistance machines
    • Leg press
    • Lat pull-down
  • Resistance band
    • Light, green
    • Medium, red
  • Indoor track


Table 6: Observations and data from session 6 with client on 7 November 2013.

Session 6 Data 1
Session 6 Data 2

Impression Client was in good spirits to perform workouts. She is able to do all workouts with generally good form except for the partial lunges that she performed for the lunge pulses. We moved up the weight for the lat pull down because she said it was too easy and even at 40lbs she said she could go up more the next time. We had to wait a long time for the leg press machines so for the second set we moved to the upstairs machine that is slightly a different angle but still working the same muscles. Due to the waiting we changed the order of the exercises to perform the lat raises and the woodchopper until a leg machine was available.

[edit] Session 7: 11 November 2013

This session was originally planned for 12 November at 9:30am with Chris & Melissa, but last minute schedule changes from the client forced us to adjust this.

[edit] Plan

Rose & Pat will meet with client at 10am at The Zone.

Warm-Up

5min on the elliptical machine at level 2.

Resistance Training

This session with have two circuits of five exercises. The first circuit will be performed back to back. A 3 min water/rest break will follow. This will happen twice more for a total of 3 sets of all circuit 1 exercises. The second circuit will then follow the same pattern.

  • Circuit 1
  1. Seated row
    1. Sit in machine, make any adjustments needed
    2. Grip handles while keeping chest against pad, feet flat on floor and knees flexed to 90deg
    3. Engage core
    4. Extend the shoulders and flex the elbows to bring hands to chest, keeping elbows tight to sides
    5. Return to starting position slowly and under control
    6. Repeat
      Seated Row. Retrieved from: http://3.bp.blogspot.com/-3bihGP_JImI/TZ8NWxnNzSI/AAAAAAAAARA/97Up0ZnJ5y0/s1600/back+row.jpg
  2. Sit to stand (modified squat)
    1. Stand about 30 cm from bench
    2. Ensure feet are shoulder width apart, toes point straight and spine is erect
    3. Engage core
    4. Flex hips and knees to lower bum to bench, ensuring back stays straight and knees do not pass in front of toes (squat action)
    5. Briefly take a seat on the bench
    6. Push through the feet and return to standing position
    7. Keep the rocking of momentum to a minimum
    8. Repeat
      Sit to Stand. Retrieved from: http://www.google.com/imgres?hl=en&biw=1280&bih=681&tbm=isch&tbnid=EQKqJK4rskKmTM:&imgrefurl=http://www.bodyandsoul.com.au/fitness/workouts/new%2Byears%2Bday%2Brecovery%2Bworkout,16183&docid=SSQ1OQVL4LaY4M&imgurl=http://cdn.vogue.com.au/media/article-steps/2/7/3/0/27399-1_asl.jpg&w=420&h=316&ei=PfmQUqDPDIizrQGYzYCYAg&zoom=1&ved=1t:3588,r:20,s:0,i:147&iact=rc&page=2&tbnh=154&tbnw=209&start=18&ndsp=22&tx=141&ty=123
  3. Incline push-ups
  4. Supine leg kick-out
    1. Lying supine, put the middle of the resistance band around the ball of one foot
    2. Point the toes toward the ceiling
    3. Leg with resistance band should start with knee and hip flexed to 90 degrees.
    4. Opposite leg should be straight and rested on the mat
    5. Grip the handles of the resistance band with both hands
    6. Extend the hip and knee to provide a “kick” motion with the resisted leg (this should cause the leg to straighten)
    7. Slowly return the hip and knee to the starting position at 90 degree flexion
    8. Repeat
      Supine Leg Kick-out. Retrieved from: http://www.ncpad.org/contentimages/406.gif
  5. Leg raises
    1. Lying supine, put your hands underneath your bottom
    2. Extend the legs straight with toes pointing to the ceiling
    3. Raise the legs off of the ground to about 90 degree hip flexion, while keeping knees straight and neck relaxed
    4. Return the legs towards the floor while keeping them straight
    5. Do not let the feet touch the ground before raising them to the ceiling again
    6. Repeat
      Lying Leg Raises. Retrieved from: http://www.menshealth.co.uk/cm/menshealthuk/images/eQ/lyinglegdrop.jpg


  • Cricuit 2
  1. Pec deck fly’s
    1. Position seat so knees are flexed to 90 degrees.
    2. Sitting tall with engaged core, grab the handles
    3. Push medially so the hands and elbows move towards one another (horizontal shoulder adduction)
    4. Return the arms slowly to the starting position under control
    5. Repeat
      Chest Fly on Pec Deck. Retrieved from: http://www.trainbodyandmind.com/wp-content/uploads/2011/02/Chest-Fly-Workout-1.jpg
  2. Shoulder press
  3. Lying leg curl
  4. Heel walks
    1. Standing straight, holding free weights, engage the core
    2. Point toes toward ceiling, and stabilize on heels
    3. Walk 10m only on the heels
    4. Repeat
      Heel Walk. Retrieved from: http://25.media.tumblr.com/tumblr_mduhecTakV1roqxplo1_500.gif
  5. Plank on bosu or stability ball

Cardio

Client will perform a cardiovascular exercise for 20min. We will walk around the indoor track performing intervals (laps) of different intensity determined by estimating RPE. One lap at normal pace followed by a lap at a faster pace.

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Anterior chest and shoulder stretch using wall
  1. Extend shoulder as far as possible
  2. Press arm against wall
  3. Lean in to feel stretch
  4. Repeat on opposite side
    Wall Chest Stretch. Retrieved from: http://www.massagestudyguide.net/wp-content/uploads/2012/09/straightarm-wall-chest-stretch.jpg
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Rose & Pat met with client at the Zone at 10am for 1hr 10min.

Equipment Needed

  • Elliptical machine
  • Resistance band, red
  • Mat
  • Free weights (7.5lbs)
  • Bench
  • Resistance machines
    • Seated row
    • Pec deck
    • Leg curl


Table 7: Data from session 7 with client on 11 November 2013

Session 7 Data 1
Session 7 Data 2

Impression

We changed a few things during this session because of equipment and her needs. She had to jog to her office and back because she forgot her student card so she was warm when she got there. She needed to leave before 11:10 to get back for a meeting so we decided to do the cardio first for 10mins so that we had some cardio and if we had time at the end we were going to go back for the other 10mins, but she needed to get back. In order to compensate we gave her less rest during the sets in order to boost her cardio. She had difficulty with the leg raises but she was able to complete all of them. She was very breathless after the first set and was sweating throughout. She didn’t talk as much because we worked her much harder this session. We changed the tip toe walk to the heel walk because she has had plenty of work on her plantar flexors so we wanted to work on her dorsi flexors. She was unable to do the incline push ups because of her wrist so we worked on the standing wall push ups with her hands in a fist with wrists neutral. The plank we needed to change because of back issues but we decided to work on her back for supermans in order to strength her back muscles since we haven’t focused on this yet.

Supermans

  1. Lie prone on a mat
  2. Arms should be straight and fully extended above head, ensure neck remains neutral (look at the ground) and relaxed
  3. Engage core
  4. At the same time, raise legs, arms and chest off floor as far as possible
  5. Hold briefly
  6. Return the arms, legs and chest to the ground
  7. Repeat
    Supermans. Retrieved from: http://www.barstarzz.com/wp-content/uploads/2013/01/superman-exercise.jpg

[edit] Session 8: 12 November 2013

This session was originally planned for 14 November at 10:00am with Justin, Rose & Pat, but last minute schedule changes from the client forced us to adjust this.

[edit] Plan

Chris & Melissa will meet with client at 9:30am at The Zone.

Warm-Up

5min on the elliptical machine at level 2.

Resistance Training

This session with have two circuits of five exercises. The first circuit will be performed back to back. A 3 min water/rest break will follow. This will happen twice more for a total of 3 sets of all circuit 1 exercises. The second circuit will then follow the same pattern.

  • Circuit 1
  1. Seated row
  2. Sit to stand
  3. Wall push-ups
  4. Supine leg kick-out
  5. Leg raises
  • Circuit 2
  1. Pec deck fly’s
  2. Shoulder press
  3. Lying leg curl
  4. Heel walks
  5. Supermans

Cardio

Client will perform a cardiovascular exercise for 20min. We will walk around the indoor track performing intervals (laps) of different intensity determined by estimating RPE. One lap at normal pace followed by a lap at a faster pace.

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Anterior chest and shoulder stretch using wall
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Chris & Melissa met with client at the Zone at 9:30am for 1hr.

Equipment Needed

  • Elliptical machine
  • Resistance band, red
  • Mat
  • Free weights (5 & 7.5lbs)
  • Bench
  • Resistance machines
    • Seated row
    • Pec deck
    • Leg curl


Table 8: Data from session 8 with client on 12 November 2013

Session 8 Data 1
Session 8 Data 2

Impression

Client arrived in good spirits and reported feeling “sore in a good way” after yesterday’s session. We suspect this is DOMS. She attempted each exercise with vigor and really put a good effort in today, despite feeling sore. We asked if she has been noticing any changed in her body or her stamina in her everyday life. She told us that her right wrist is bothering her less often than it had been, and when it does it is less painful for a shorter amount of time. We were very encouraged to hear this report from her as this is the focus of one of our SMART Goals. She said that she hadn’t noticed any other changes, but admitted that she is very busy, sits most of the day, and hasn’t been paying attention for any changes yet since she didn’t think they could occur so quickly. During the stretching portion of the session she mentioned that during the standing hamstring stretch she can tell that she is reaching closer to the floor. We agreed with this assessment and as an afterthought wished we had included a measurement in our initial testing for later comparison. We also added an extra stretch for the dorsiflexors.

Dorsiflexor stretch

  1. Stand on right leg, hold the wall for balance if needed
  2. Move left foot behind right heel pointing toe into the floor
  3. Keeping toe on floor push left ankle forward and toward the floor
  4. Should feel stretch along top of left foot and up anterior aspect of left leg
  5. Hold 30sec then repeat on right side
Dorsiflexor Stretch. Retrieved from: http://www.athletestreatingathletes.com/wordpress/wp-content/uploads/2010/12/topoffoot2.jpg

[edit] Session 9: 19 November 2013

[edit] Plan

Chris, Melissa & Rose will meet with client at 9:30am at The Zone.

Warm-Up

5min on the elliptical machine at level 2.

Resistance Training

This session with have two circuits of five exercises. The first circuit will be performed back to back. A 3 min water/rest break will follow. This will happen twice more for a total of 3 sets of all circuit 1 exercises. The second circuit will then follow the same pattern.

  • Circuit 1
  1. Standing row
  2. Step-up with press-up
    1. Have the client stand in front of a box and ask them to step up onto the box with one foot
    2. The client should be holding dumbbells in each hand and have their arms abducted to level with the shoulders
    3. The trailing leg of the second foot should be brought up until the client's plant foot is fully extended
    4. When the leg is fully extend have them press the dumbbells upwards over their head and hold
    5. Have them return the weights to level with the shoulders and lower their feet back onto the floor
    6. Repeat
      Step-up Press-up (free weights). Retrieved from: http://www.google.com/imgres?authuser=0&hl=en&biw=1280&bih=681&tbm=isch&tbnid=8TzkI-ETxOox5M:&imgrefurl=http://www.oprah.com/health/Exercises-to-Get-in-Shape_1/4&docid=heg1pDu7AwSJ8M&imgurl=http://static.oprah.com/images/201004/omag/201004-omag-fit-exercise-press-600x411.jpg&w=600&h=411&ei=4NGQUvfsLJSargHNroGQDg&zoom=1&ved=1t:3588,r:4,s:0,i:91&iact=rc&page=1&tbnh=186&tbnw=260&start=0&ndsp=18&tx=246&ty=147
  3. Triceps kickback
  4. Tip-toe walk
  5. Supermans
  • Circuit 2
  1. Squat with biceps curl
    1. Have the client in the anatomical position with dumbbells in each hand
    2. Have the client perform a squat by bending the knees and lowering the hips.
    3. When the client returns to a normal position from the squat have them perform a bicep curl, bring the weights close to humerus reducing the angle at the elbow
    4. Repeat
      Squat with Biceps Curl. Retrieved from: http://www.google.com/imgres?authuser=0&hl=en&biw=1280&bih=681&tbm=isch&tbnid=I67PocZUh4-s1M:&imgrefurl=http://getfityou.com/how-to-get-bigger-biceps-with-squats&docid=3F8n5h48hktizM&imgurl=http://getfityou.com/wp-content/uploads/2012/03/Squats-to-Biceps.jpg&w=400&h=400&ei=GNOQUoTCFcjgrAG3p4CoDw&zoom=1&ved=1t:3588,r:2,s:0,i:85&iact=rc&page=1&tbnh=178&tbnw=184&start=0&ndsp=20&tx=123&ty=96
  2. Wall push-up
  3. Single-leg glute bridge
  4. Leg raise - draw numbers
    1. As described above, but trace numbers in air with feet

Cardio

Client will perform a cardiovascular exercise for 20min. We will walk around the indoor track at a constant intensity determined by heart rate (determined above) as measured with a HR monitor and by estimating RPE.

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Anterior chest and shoulder stretch using wall
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Chris, Melissa & Rose met with client at the Zone at 9:30am for 1hr.

Equipment Needed

  • Elliptical machine
  • Resistance band, red handles & blue handles
  • Mat
  • Free weights (2x 10lbs)
  • Medicine ball, 3lbs
  • Plyo step, 12"
  • HR monitor


Table 9: Data from session 9 with client on 19 November 2013

Session 9 Data

Impression

Client arrived in good spirits, said hello and went straight to the elliptical without waiting for us. We followed and one of us went to set up for the first circuit. After the warm up we got right into the exercises which she put good effort into performing. She was sweating lightly throughout. The cardio portion was performed at a constant intensity at a HR that fell within our target zone, but client could have easily pushed harder, in fact we had to get her to slow down to stay within the target range. We will need to adjust the target HR we calculated in order to elicit a training response and keep the client happy with the amount of effort we are asking of her.

[edit] Session 10: 21 November 2013

[edit] Plan

Justin & Pat will meet with client at 10:00am at The Zone.

Warm-Up

5min on the elliptical machine at level 2.

Resistance Training

This session with have two circuits of five exercises. The first circuit will be performed back to back. A 3 min water/rest break will follow. This will happen twice more for a total of 3 sets of all circuit 1 exercises. The second circuit will then follow the same pattern.

  • Circuit 1
  1. Standing row
  2. Step-up with press-up
  3. Triceps kickback
  4. Tip-toe walk
  5. Supermans
  • Circuit 2
  1. Squat with biceps curl
  2. Wall push-up
  3. Single-leg glute bridge
  4. Leg raise - draw numbers

Cardio

Client will perform a cardiovascular exercise for 20min. We will walk around the indoor track at a constant intensity determined by heart rate as measured with a HR monitor and by estimating RPE.

Cool-Down & Flexibility Training

Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching.

Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Anterior chest and shoulder stretch using wall
  • Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Justin & Pat met with client at the Zone at 10:00am for 1hr.

Equipment Needed

  • Elliptical machine
  • Resistance band, red handles & blue handles
  • Mat
  • Free weights (2x 10lbs)
  • Medicine ball, 3lbs
  • Plyo step, 12"
  • HR monitor


Table 10: Data from session 10 with client on 22 November 2013

Session 10 Data 1
Session 10 Data 2

Note

The client said that she thought that the individual exercises during the super-sets and the super-sets themselves were a good challenge. The target heart rate zone that was being used for the cardio component of the exercise was a lower intensity than that being used during perceived exertion and the client thinks that she could work at a higher intensity. We had to cut the session a little bit short so we instructed the client to complete the stretching component later in the day. She informed us that she typically completes a full circuit at least once on her own daily, especially a biceps and shoulder stretch done by putting the arm against the wall that a group member showed her. She said that it really helps to make her right arm feel better.

Impression

We feel as though the workout was a success and our goals were accomplished. We think it is important that we look at increasing her target HR zone for the next cardio sessions to better reflect the intensity that she feels she could be working at. In addition, she seemed confident and motivated throughout the entire session. Lastly, it may be important for us to think about exercises with a greater mind for the client’s confidence when deciding on what to do, most specifically in regards to the toe walk which she thought she felt “silly” doing.

[edit] Session 11: 28 November 2013

[edit] Plan

Chris & Pat will meet client at the Zone at 10:00am.

Warm-Up 5min on the elliptical machine at level 2.

Resistance Training This session with have two circuits of four exercises. The first circuit will be performed back to back. The client will perform 12 repetitions of each exercise. A 3 min water/rest break will follow. This will happen twice more for a total of 3 sets of all circuit 1 exercises. The second circuit will then follow the same pattern.

  • Circuit 1
  1. Hip Extension
  2. Hip Adduction
  3. Hip Abduction
  4. Russian Twist on ball
  • Circuit 2
  1. Leg Extension
  2. Lying Leg Curl
  3. Lateral Step Up with Dumbbells
  4. Single Leg Glute Bridge


Cardio Client will perform a cardiovascular exercise for 20min. We will walk around the indoor track at an intermittent intensity and we will record heart rate as measured with a HR monitor.

Cool-Down & Flexibility Training Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching. Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Anterior chest and shoulder stretch using wall

Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Chris & Pat met with client at the Zone at 10:00am for 1hr.

Equipment Needed

  • Elliptical machine
  • Heart Rate Monitor
  • 12” Plyo Box
  • Resistance Bands:
    • red
  • Free Weights:
    • 7.5 lbs
  • Resistance Machines:
    • Hip Adduction
    • Hip Abduction
    • Leg Extension
    • Lying Leg Curl


Table 11: Data from session 11 with client on 28 November 2013

Session 11


Impression

The client complained of being tired when she arrived due to travelling back and forth from Toronto the past few days, however she was still in good spirits and happy to workout and get away from her office for a bit. For the second circuit we had to break it down to the leg extension and lateral step up completed together back to back for 3 set due to the machines being busy. Once completed those two we went downstairs to the lying leg curl machine and completed the lying leg curl and the single leg glute bridge together for 2 sets back to back. We had to take a set out because she was visibly tired and wouldn’t have been able to complete the last set effectively. For the leg extension we had to lower the weight from 50lbs down to 40lbs due to fatigue.

[edit] Session 12: 29 November 2013

[edit] Plan

Justin, Rose & Melissa will meet client at the Zone at 10:00am.

Warm-Up 5min on the elliptical machine at level 2.

Resistance Training This session with have two circuits of four exercises. The first circuit will be performed back to back. The client will perform 12 repetitions of each exercise. A 3 min water/rest break will follow. This will happen twice more for a total of 3 sets of all circuit 1 exercises. The second circuit will then follow the same pattern.

  • Circuit 1
  1. Lying Chest Press
  2. Biceps Curl
  3. Shrugs
  4. Resistance Band Woodchopper
  • Circuit 2
  1. Lat Pulldown
  2. Lateral Raises with dumbbells
  3. Triceps kickback
  4. Plank


Cardio Client will perform a cardiovascular exercise for 20min. We will walk around the indoor track at an intermittent intensity and we will record heart rate as measured with a HR monitor.

Cool-Down & Flexibility Training Client will perform a cool-down period of 5 min of cardio exercise of choice followed by static stretching. Instruct client to focus on breathing deeply and hold each stretch for 30 seconds. Deepen each stretch after 10 seconds.

  • Standing quadriceps stretch
  • Standing hamstrings stretch
  • Standing calf stretch
  • Standing chest and biceps stretch
  • Standing triceps stretch
  • Anterior chest and shoulder stretch using wall

Ask client if she would like to stretch anything else, make note of any other stretches performed.

[edit] Data

Justin, Melissa & Rose met with client at the Zone at 10:00am for 1hr.

Equipment Needed

  • Elliptical machine
  • Resistance band, red handles
  • Mat
  • Free weights (2x 12.5lbs, 2x 5lbs)
  • Stability ball
  • Lat pull-down machine
  • HR monitor


Table 12: Data from session 12 with client on 29 November 2013

Session 12 Data

Impression

Client arrived in good spirits and said she was not sore from yesterday's session when asked. We noticed she was beginning to fatigue around rep 9 for each set of the biceps curl,and almost right away for the shoulder shrugs, but she was determined to push through and refused to go to a lighter weight - her confidence is really showing! During the woodchopper, near the end of each set she wasn't moving through as large a ROM as at the beginning. We could have held a hand out to give her a target to reach to with every rep - we'll remember to make a note of this in her take home workout (to pick a spot to try to always get her hands to). We added an extra stretch, shoulder rolls, to ensure her shoulders were stretched after performing shrugs.

Shoulder rolls

  1. Elevate shoulders
  2. Roll shoulders back and around through full ROM slowly for 30sec to feel stretch
  3. Repeat in a forward direction, 30sec
    Shoulder Roll Stretch. Retrieved from: http://www.uofmhealth.org/sites/default/files/healthwise/media/medical/hw/h9991861_002.jpg

[edit] Post Program Assessment Testing: 3 December 2013

Chris, Justin, Melissa & Rose met our client at the desk in the Zone at 9:30am.

[edit] 1. Resting Heart Rate

We had our client take her pulse at the carotid artery when she arrived for the session. It was found to be 120bpm. We expect this is reasonable since she had just arrived from her office and walked up a flight of stairs.

Upon reflection of this we should have taken a resting pulse after letting her sit still for 5 minutes, but considering our time restraints we were forced to work with 120bpm as a baseline.

After we found this value we discussed how an error may have been made when we took her resting heart rate at the initial assessment. It was found to be 60bpm at that time, and upon reflection that seems very low for having walked across campus to meet us in the Zone.

[edit] 2. Warm up

We went over to the elliptical machine so our client could warm up for 5 minutes.

[edit] 3. Assessments

Balance: Stork Stand

We started with the Stork Stand balance test where our client again performed very well reaching 2 min on each leg.

Joint ROM: Goniometry

Upon completion of goniometry measurements we found improvements in our client's ROM at almost every joint we measured, both on her right (injured) and left sides. The greatest improvements were seen in radioulnar supination on the right (+50 deg), lateral rotation at the left shoulder (+40 deg), and flexion and extension at the right wrist (+25 deg each), with improvements of +5 deg or more in most other movements except adduction at the left wrist which saw -5 deg change in ROM.

Table 13: ROM changes on the left and right sides of client's body

ROM Improvements

Initial Joint ROM chart can be found here.

Final Joint ROM chart can be found here.

Strength: Manual Muscle Screen

Throughout this assessment no strength imbalances were found between the right and left sides of the client's body.

Cardiovascular: Rockport Walking Test

The client completed 8 laps around the Brock track in 14:26min with a heart rate of 156bpm. Using the calculation listed above her estimated VO2max was found to be 31.97ml/kg/min.

Table 14: Assessment data comparison chart

Assessment Comparison Chart

[edit] SMART Goal Discussion

We set a time frame of six weeks to meet our SMART Goals with our client. Overall we feel each of them has been met or exceeded.

Cardiovascular

After completing the Rockport test in 18:15 we decided that by having our client perform 20 minutes of cardio twice a week we could decrease her time to 16 minutes. We were all excited to find after six weeks she was able to complete the Rockport in 14:26 - a full 1:36 faster than we had hoped for! The client was sweating, but still able to carry on conversation throughout the test. Her heart rate upon completion was found to be 156bpm, which allowed us to estimate her VO2max at 31.97ml/kg/min - an improvement of +1.13ml/kg/min from initial testing. We feel this goal was very successfully met and suspect that had she not been talking the whole way through the test, she may have finished even faster.

Balance

While we failed to incorporate practice of the Stork Stand test into our program, we did include many exercises that required weight transfer from one part of the body to another (heel and toe walking, step-ups, sit-to-stand). We met our balance goal of maintaining our client's ability to perform this test on both legs for 2 minutes. In the future it would be ideal to allow the client to balance for as long as possible rather than limiting the test to 2 minutes.

Flexibility

Even though we did not quantify this goal, having our client stretch for 5 to 10 minutes at the end of each session allowed us to see exciting results in this area. Almost every ROM movement measured increased by at least +5 degrees on both the right and left sides, and most increased by 10 to 20 degrees. She reported that her activities of daily living (specifically using a manual can opener) were noticeably easier, and that the amount and frequency of pain she felt in her right wrist was drastically reduced. Also, the balance in ROM between her left and right sides has increase so that the contralateral difference for any given movement is 10 degrees or less, when initially there was up to a 35 degree difference.

Strength

After repeating the Manual Muscle Screen at the end of the program we found no contralateral strength imbalances in our client. We feel this is a great improvement from our initial test when we found imbalances of varying degrees in both her upper and lower limbs. Our plan to use methods of strength training that would not allow her stronger left side to compensate for her weaker right side seems to have been successful. We feel that our client should continue to use resistance bands during strength training to maintain and continue to develop balanced strength throughout her body.

Psychological

Since this goal was added later in the program we did not get an initial base line for it other than reflective opinion from the group members. As mentioned above, we would add an exercise confidence questionnaire to the program. Despite the lack of ability to quantifiably compare our client's attitude and self-confidence between the beginning and end of the program we feel there has been improvements made. Specifically, her attitude toward what she is capable of doing has shown great change. At the beginning of the program she was very concerned that the pain in her wrist would be aggravated when trying new exercises. After two weeks when she saw the care we took to ensure that she would not be in pain and the concern we exhibited when she did report pain to us, she began to trust not only in us, but also in herself and her own ability. Every one of us agreed this new outlook allowed her self-efficacy to noticeably increase over the course of the program.

[edit] Psychological Program Progression

Week 1:

Recognized and issues and decided to add this to our already existing smart goals. At this point, and for the remainder of the exercise program, a member from the group that was working with the client that day would complete any exercises they could with the client or demonstrate the exercises to be completed in advance. Doing this served a number of purposes being that it informed the client about proper technique, increased her comfort level, and most importantly increased her awareness. Awareness in this case specifically meant that by completing the exercise with another and watching them struggle, she could recognize that perhaps the exercises weren't just hard because of her functional limitations, but instead some of that difficulty could be attributed to exercise in itself. In addition, we wanted to try and constantly introduce the client to new exercise formats, modes, and types of exercises to increase her exercise knowledge. Similarly, while we wanted to be constantly be teaching her new things we also wanted to recycle already learned exercises as well, most specifically ones that she enjoyed in order to keep her confident and motivated.

Week 2:

As discussed before we did as many exercises as possible with the client, as well as tried to actively participate in the sessions in other ways by constantly providing feedback, counting, and motivating. We introduced her to a few new exercises, some examples being the resistance band hip extension, and resistance band wood chop. Lastly, we introduced her to a new mode of exercise being the resistance machines to build her confidence with equipment that would be available to her in a gym setting.

Week 3:

In this week we switched our exercise format being that we moved from super sets to circuits. While this change was largely due to the physical goals of the program, it also complemented the mental goals in that it allowed us to inform her of other program styles that are available to her and continue to build her knowledge and preference. In addition we added some new exercises, some of which were lunge pulses and a stability ball plank.

Week 4:

During this week we reused a wall-pushup exercise which hadn’t been attempted since the first week of the program. This exercise in particular was one that stuck out to us as being very telling of her functional limitations as a result of her carpal tunnel, specifically because she seemed very protective of her wrist and exhibited a lot of shakiness and instability. Doing this exercise again therefore served in providing the client and ourselves tangible evidence that she is improving and that she does have the potential for progress. In addition, we introduced her to supermans and stability ball planks.

Week 5:

In this week we demonstrated to the client how a heart rate monitor can be used to monitor cardiovascular exercise, specifically through the use of a target heart rate zone. In addition, we included multi-faceted exercises into the program, specifically a squat-and-curl, and step-and-press. The purpose of this was to show the client new exercise types that can be done with limited amounts of time, that are potentially more cognitively engaging, and simply to once again increase her exercise knowledge.

Week 6:

Because this was our last week of exercise sessions we wanted to try and build up the clients confidence as much as possible not introducing her to anything new, but rather having here complete a number of exercises that she had already performed often and well. In addition we tried to step back a little and let her set her own pace and push herself to better mimic what things would be like after this program ends and she is continuing on her own. Of course we still provided ample feedback and encouragement but we allowed her to ultimately control the progression of the exercise sessions.

[edit] Take Home Material for Client

The program we put together for our client to continue with on her own is structured as the sessions we had with her were. Each begins with a warm-up, moves onto strength training, continues with cardio, and wraps up with a cool-down and stretching.

We provided her with two sample templates that she can choose from, a super-set workout and a circuit training workout.

A list of all the exercises we had our client perform was included. It is broken down into upper-body, lower-body and core exercises and contains pictures with descriptions of each.

We explained to our client that she can select exercises to fit into the template for each workout depending on what she would like to focus on that day, and how she can use the templates to keep track of her improvements over time.

We also made sure to emphasize the importance of using resistance bands during her workouts to maintain strength balances between her right and left sides. We also discussed ways she can modify other exercises she might like to try to accommodate her wrist.

We invited her to contact any of us in the future with any questions or concerns she may have about the information we provided her with.

Find the resources we presented to our client:

Super-set Workout Training Template here.

Circuit Training Workout Template here.

Take Home Exercise List (with illustrations and descriptions) here.

Cardio Exercise and Materials Description here.

[edit] Training Program Outline and Progression

Training Program Outline

  • 2 full body workouts/week focusing on all major muscle groups
  • Each session:
    • 5 minute warm up
    • 30 minutes of resistance training
    • 20 minutes cardiovascular training
    • 10 minute cool down

Resistance Training Styles

  • Super-sets
    • Antagonistic muscles or upper/lower body muscle groups
  • Circuits
    • Upper body: push & pull
    • Lower body: anterior & posterior chain
    • Core

Training Program Progression and Overload

  • Body weight & light resistance bands → Body weight, medium/heavy resistance bands, free weights
  • Overload induced each week in different ways:
    • Increased volume at week two
    • Increased volume and intensity at week three
    • Increased volume at week four
    • Increased intensity at week five
    • Increased volume at week six

Training Program Week by Week

Week 1

  • 7 exercises → 3 super-sets + 1 core
    • Upper/lower body exercises (Ex. Step-up super-set with bent over row)
    • 2 x 15
  • 20 min cardio, self selected pace

Week 2

  • 8 exercises → 3 super sets + 2 core
    • Session 1: Lower body
    • Session 2: Upper body
    • Antagonistic muscles (Ex. Leg extension super set with lying leg curl)
    • 2 x 15
  • 20 min cardio, self selected pace

Week 3

  • 10 exercises → 2 circuits
    • 2 x 15
    • Free weights
  • 20 min cardio - intervals

Week 4

  • 10 exercises → 2 circuits
    • 3 x 10
  • 20 min cardio - intervals

Week 5

  • 10 exercises → 2 circuits
    • 3 x 10
  • 20 min cardio
    • target heart rate zone (65-80% MHR)

Week 6

  • 8 exercises → 2 circuits
    • 3 x 12
  • 20 min cardio - self-selected pace & track HR

Table 15: Program progression summary chart

Program Summary Chart part 1
Program Summary Chart part 2
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