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Group 2: Rachel Gray, Melissa Petterson, Cody St.Germain & Ben Thompson

NOTE: For all images used, roll over for citation.

Contents

[edit] Consultation Questions

Initial meeting with client (J.W.) at 4:45pm on Monday, 23 September 13.

Present: Cody, Rachel, Melissa, Ben (arrived late with notice)

[edit] General background

1) Name: J.W.

2) What type of work do you do?

  • Academic Advisor
    • full time position
    • desk job (sitting at a computer all day)
  • working on a Masters degree, taking 1 class per semester

3) What are your interests/ hobbies?

  • volleyball, plays on Brock intramural team
  • being active
  • music

4) Do you have any previous exercise experience?

  • Had a YMCA membership until 1 month ago
    • stopped due to injury (see below for details of injury)
    • would attend strength training (free weights) classes 2-3 times per week
    • occasionally participate in a cardio class
  • volleyball

5) What exercises do you like best? Least?

  • Best:
    • everything and anything that works
    • prefer to work out with people, if left on her own she will tend to loose interest and motivation
  • Least:
    • Running, but will run with a partner

6) During our initial testing, we will like to collect data for comparison to documented normative tables to assist in designing a program for you. These tables are based on age groups, so may we ask you your age?

  • 26

[edit] Goals and expectations

7) What are your exercising goals?

  • "toning" - define musculature, but not bulk
  • no weight loss

8) What types of exercise would you like to focus on? (ex. Strength training, cardiovascular etc.)?

  • strength training, but will do cardio too

9) What are your expectations from the program?

  • education
    • learn about which exercises engage which muscles
    • how much is needed to see results
  • motivation to work out
  • become more "toned"

10) What are your expectations from us?

  • "To be there when I work out"
  • support

[edit] Scheduling flexibility

11) What time of day would you prefer to meet and exercise?

  • Around 4:45pm
  • for about an hour

12) How many times a week would you like to meet?

  • 2-3 times per week
    • Mondays and Thursdays, with some Tuesdays depending on volleyball schedule
    • start slow, just starting to become active again after 1 month recovery

[edit] Contact information

13) Preferred method of contact?

  • email - constant access all day
  • phone if needed

14) Emergency contact information?

  • Mother (info in file only to protect confidentiality)

[edit] Medical

15) Do you have any current injuries? If yes, please explain:

  • pulled muscle and connective tissue in ribs (intercostals) on right side
    • participated in Amazing Race Challenge 1 month ago
    • ran 18km with no work up training

16) Have you experienced any injuries in the past? If yes, please explain:

  • 'bucket-handle' tear and folding over of meniscus in left knee (2 and 3 years ago)
    • required surgery to repair both times
    • 1st time was landing a jump during a competitive dance competition
    • 2nd time was getting up into a truck and "twisted the wrong way"

17) Are you currently taking any medication(s)? If yes, please explain:

  • birth control

18) Do you have a medical condition we should be aware of? (example osteoarthritis, osteoporosis, pacemaker).

  • no

19) Do you have any allergies? If yes, please explain:

  • no

20) Do you carry an EpiPen?

  • no

21) Administer Par-Q

  • all 'no's' checked
  • signed 23 Sep 13

[edit] Fitness Assessment: 30 September 2013

Meeting with client (J.W.) at 4:45pm to perform the fitness assessments that follow.

Present: Ben, Rachel, & Cody

The session will begin with a warm-up and end with a cool-down.

[edit] Warm-Up

Ensure core is kept tight during the following dynamic exercises/stretches:

  • 20 jumping jacks (from standing, jump landing with hips and shoulders abducted, jump again returning to start position)
    Jumping Jacks. Taken from: https://www.google.ca/search?newwindow=1&hl=en&site=imghp&tbm=isch&source=hp&biw=1280&bih=681&q=jumping+jacks&oq=jumping+jacks&gs_l=img.3..0l10.1707.5288.0.5486.17.12.1.3.3.0.234.1596.5j5j2.12.0....0...1ac.1.28.img..2.15.1420.KGlxQpjItXs#facrc=_&imgdii=_&imgrc=B8cHNrgk-xVCwM%3A%3B57DwigQSxR_XNM%3Bhttp%253A%252F%252F1.bp.blogspot.com%252F-grbpVac9eVg%252FTitIHvzW-bI%252FAAAAAAAACsI%252F499_qKdxcCg%252Fs1600%252Fjumping-jacks.jpg%3Bhttp%253A%252F%252Fdougrun365.blogspot.com%252F2011%252F07%252Fjumping-jacks-seriously.html%3B300%3B300
  • cover 10m while performing each of the following:
    • high knees (jump back and forth from one leg to the other while flexing hip and knee to raise opposite knee as high as possible)
      High Knees. Taken from: http://www.womenshealthmag.com/files/images/0604_high_knees.jpg
    • butt kicks (jump back and forth from one leg to the other while flexing knee to raise opposite heel to touch buttocks)
      Butt Kicks. Taken from: http://www.fitstudio.com/system/images/361/print/030_Butt_Kicks.jpg?1366126933
    • walking lunges - unweighted (from standing, step forward into a lunge, step forward to standing, repeat with opposite leg)
      Walking Lunge. Taken from: http://www.kickstandfitness.com/wp-content/uploads/2012/11/lunge-nice-looking.jpg
    • grape vines (from standing, move to the right, alternate adducting left leg in front and behind right leg, repeat to the left adducting right leg in front and behind left leg)
      Grapevines. Taken from: http://static.oprah.com/images/health/201001/2010014-andrea-metcalf-cross-overs-290x218.jpg
  • 20 arm circles forward (while standing, abduct shoulders to 90 degrees and hold, supinate hands so palms face up, circumduct shoulders up and forward, start small and slowly increase diameter of circumduction through full range of motion)
  • 20 arm circles backward (while standing, abduct shoulders to 90 degrees and hold, pronate hands so thumbs point down, circumduct shoulders up and back, start small and slowly increase diameter of circumduction through full range of motion)
    Shoulder Circumduction. Taken from: http://content.answcdn.com/main/content/img/oxford/Oxford_Sports/0199210896.circumduction.1.jpg


[edit] Cool-Down

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

  • Standing quadriceps stretch (hold heel to butt and push hip forward)
    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 (feet slightly apart, keep knees straight, 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 (stand with toes of one foot against wall and heel on the floor, keep knee straight, lean toward the wall)
    Calf Stretch. Retrieved from: http://i1.ytimg.com/vi/f1HzSAuB-Vw/hqdefault.jpg
  • Standing chest stretch (clasp hands behind back, lift arms as high as possible, hold chest up and out)
    Chest Stretch. Retrieved from: http://zumewalk.com/wp-content/uploads/2009/03/40s-chest-stretch-400.jpg
  • Standing triceps stretch (reach one arm over shoulder and reach down back as far as possible, gently push elbow back with other hand, keep chest up and out)
    Triceps Stretch. Retrieved from: http://www.teachpe.com/images/jenny/triceps_stretch2.jpg
  • Ask client if she would like to stretch anything else

[edit] Strength:

Keep detailed notes of positions used for testing in order to repeat during post testing

[edit] Muscle Screen

Begin strength assessment with the Muscle Screen to quickly assess for overall muscle weakness or imbalance.

Muscle Screen 1
Muscle Screen 2

Cite: PEKN 4P22 Muscle Screen and Manual Muscle Testing Lab, Brock University

[edit] Sit-Up Test

Starting Position: Lie on a mat with your knees flexed to 90 degrees and feet flat on the ground. Hands should be resting on thighs.

Technique: Squeeze abdominals, push your back flat and raise high enough for hands to slide along thighs to touch the tops of the knees. Do not pull with neck or head and keep lower back on the floor. Return to the starting position.
Curl-up. Retrieved from: http://content.answcdn.com/main/content/img/oxford/Oxford_Food_Fitness/0198631472.curl-up.1.jpg

Time one minute and count how many curl-ups are performed. Compare to normative tables.

Curl-up

[edit] Push-Up Test

Have JW do modified push-ups, with her knees bent and feet off the floor. Have her keep her body in a straight line and lower it until her upper arms are parallel to the floor. Encourage her to keep her abdominals tight to prevent her back from sagging.
Push-up. Retrieved from: http://www.womenshealthmag.com/files/images/0812-wm-knee-push-up.jpg
Push-up

[edit] Wall-Sit Test

Procedure: Stand comfortably with feet approximately shoulder width apart, with back against a smooth vertical wall. Slowly slide back down the wall to assume a position with both your knees and hips at a 90° angle. The timing starts when this position is obtained and is stopped when the subject cannot maintain the position.
Wall sit. Retrieved form: http://4.bp.blogspot.com/-aBqlVWR4fXA/USUDKs8nS_I/AAAAAAAAAOk/bIJqSrwo2E4/s320/wall+sit+with+break.jpg

Scoring: the total time in seconds that the position was held is recorded. The table below gives a general guideline to expected scores.

Wall sit

[edit] Flexibility & Balance: Functional Movement Screen (FMS)

We decided to use the Functional Movement Screen to gauge our clients flexibility, strength, and balance. The FMS consists of 7 exercises that highlight the individuals strengths and weaknesses so that we can properly tailor their exercise routine to achieve their exercise related goals. Each test is performed ~3 times (per side if the movement isolates only one side at a time), each performance will be noted and graded on a scale of 0-3.

Test 1: DEEP SQUAT

The Deep Squat is performed to assess shoulder & lower-body mobility (hips, knees & ankles) as well as ensuring our client has the necessary strength to perform several unassisted deep squats. This can also be used to assess the individuals readiness for weighted squats and other lower body strength exercises.
FMS Deep Squat. Retrieved from: http://charlieweingroff.com/wp-content/uploads/DEEP-Squat.jpg

Test 2: HURDLE STEP

The Hurdle Step is used to assess mobility and stability on both sides of the hips, knees and ankles. This can isolate one side that might be lacking in flexibility, strength and balance in comparison to their strong/dominant side.
FMS Hurdle Step. Retrieved from: http://i49.tinypic.com/357kf85.jpg

Test 3: IN-LINE LUNGE

The In-Line Lunge demonstrates the individuals hip, knee & ankle strength and balance. Poor hip mobility often results in a poor performance of this exercise.
FMS In-Line Lunge. Retrieved from: http://advancedsjc.com/wp-content/uploads/2011/10/FMS-Inline-lunge.jpg

Test 4: SHOULDER MOBILITY

The Shoulder Mobility test displays shoulder flexibility on both sides of her body. Any limitations will be noted as an area that the client can aim to improve their flexibility.
FMS Shoulder Mobility. Retrieved from: http://hakafitness.net/site/wp-content/uploads/2012/06/shoulderMobililtySM-150x150.jpg

Test 5: ACTIVE STRAIGHT LEG RAISE

This exercise aims to demonstrate the flexibility of the hamstrings and the hip. Each side is held until the observer has noted the score of that test.
FMS Active Straeght Leg Raise. Retrieved from: http://davidlasnier.com/wp-content/uploads/2012/09/active-straight-leg-raise.jpg

Test 6: TRUNK STABILITY PUSH-UP

An emphasis on the individuals core stability is the focus of the Trunk Stability Push-Up exercise. The core connects movements within the upper and lower limbs and should be maintained.
FMS Trunk Stability Push-Up. Retrieved from: http://hakafitness.net/site/wp-content/uploads/2012/06/trunkStabilityPushSM-150x150.jpg

Test 7: ROTATIONAL STABILITY

The Rotational Stability test can be used to determine the balance of the individual. Many basic activities and movements require correct and efficient energy transfer between the upper and lower limbs achieved by rotational stability and balance.
FMS Rotational Stability. Retrieved from: http://www.humankinetics.com/excerpts/excerpts/assess-trunk-stability-with-rotational-test

GRADING SYSTEM:

0 points: If the client reports any pain resulting from this test.

1 point: The client results in a poor performance in the test.

2 points: The client is able to provide a good performance in the test.

3 points: The client yields great performances from the test.

Here is a link to a PDF of the protocol we will follow: Functional Movement Screen

[edit] Cardiovascular: Rockport Walking Test

Purpose:

The purpose of this test is to determine JW's VO2 max.

Equipment:

Stop watch and a 400 meter track (we will use the 200m track at Brock and adjust our calculations).

Procedure:

  1. Have the client walk as briskly as possible for 1.6 km (1600 meters or 8 times around the Brock University walking track).
  2. As soon as the client stops walking, measure their heart rate (use the 15 second heart rate count) In order to calculate heart rate per minute, multiply the numbers of beats (in 15 seconds) x 4.
  3. Convert seconds to minutes- Number of seconds divided by 60.
  4. Use the following formula to calculate an estimated VO2 max: 132.853 - (0.0769 × Weight) - (0.3877 × Age) + (6.315 × Gender*) - (3.2649 × Time) - (0.1565 × Heart rate)* Substitute 1 for males and 0 for females.
  5. Observe VO2 max normative values.
  6. Observe 1.6 km walking times normative values.

Adapted from NSCA’s Essentials of Personal Training, pg 223-224


General data from the test:

Image:Data_4.PNG

Table 11.20 Norms for the Rockport Walk Test

Clients aged 18-30 years (min:s)

Image:Data_2.PNG

Taken from NSCA’s Essentials of Personal Training, pg 242

Table 11.14: Percentile Values for Maximal Aerobic Power (VO2 max; ml.kg-1.min-1)

Image:Data_3.PNG

Taken from NSCA’s Essentials of Personal Training, pg 239

[edit] Findings

Manual Muscle Test

The following discrepancies were observed:

  • Slight hyperextension in both elbows
  • Stability problems in left knee during the quadriceps test
  • Noticeable weakness in left quadriceps muscle compared to right quadriceps muscle

Sit-Up Test

J.W performed 63 sit-ups in 60 seconds

Push-Up Test

J.W performed 40 in 60 seconds. She became fatigued, so during the 60 seconds, she stopped and then continued.

Wall-Sit Test

J.W held the position for 65 seconds

FMS

1. Deep Squat:_____________|3

2. Hurdle Step: ____________|3

3. In-Line Lunge:___________|2 (Left side & right side both scored 2) - slight movement of dowel off of lumbar

4. Shoulder Mobility:________|3 (Left side & right side both scored 3) -no shoulder impingement

5. Active Stragiht Leg Raise:__|3

6. Push Up:_______________|2

7. Rotary Stability:__________|2 - only contralateral reach/kick was completed

Rockport Test:

JW's VO2max was found to be 46.39mL/kg/min

  • Body Weight: 103 lbs or 46.72kg
  • Age: 26
  • Gender: Female
  • Heart Rate(bpm):
    • Before= 76
    • After= 88
  • Time(min): 16:45 or 16.75
    • Walked around the Brock indoor track 8 times.

Calculations:

VO2max = 132.853 - (0.0769 × Weight) - (0.3877 × Age) + (6.315 × Gender*) - (3.2649 × Time) - (0.1565 × Heart rate)

  • Substitute 1 for males and 0 for females.

VO2max = 132.853 - (0.0769 × 103) - (0.3877 × 26) + (6.315 × 0) - (3.2649 × 16.75) - (0.1565 × 88) = 46.39

[edit] Smart Goals

Upon completion of the fitness assessment with JW a list of Smart Goals was determined.


Cardiovascular:

(To follow)

Strength:

(To follow)

Flexibility:

(To follow)

Core & Balance:

(To follow)

[edit] Initial Strength Training Assessment: 3 October 2013

Rachel and Melissa met with JW at 4:45pm at the Cage.

The session took place in the Zone and the stretching area beside the track and lasted approximately 1 hour.

The purpose of this session was to carry out an assessment of the weight that JW should use for strength training.

Equipment Needed

Strength Assessment

  • dumbbells (5, 7.5, 8, 10, 12.5, 15, and 17.5lbs)
  • weight machines

Stability

  • stop watch
  • Bosu ball

[edit] Warm Up

  • 20 jumping jacks
  • cover 10m while performing each of the following:
    • high knees
    • butt kicks
    • walking lunges - unweighted
    • grape vines
  • 20 arm circles forward
  • 20 arm circles backward

[edit] Assessment

The % Body Weight Testing method will be used to obtain a starting weight at which to train JW. The protocol used and data found follow:

  • IF AT ANY TIME THE CLIENT EXPERIENCES PAIN STOP IMMEDIATELY
  • Ensure client uses proper form at all times. She has expressed the desire to be educated about strength training and will be receptive to any adjustments and/or explanations.
  • Be aware of client’s previous injuries and watch for signs that she may be hiding pain in order to participate. If any concerns arise explain that the program can be adjusted to accommodate her strengths and weaknesses in order to facilitate her greatest benefit from this experience.

Procedure:

  1. In The Zone, use client’s body weight (BW) to multiply by the factor (Table 1) for each exercise. Round down to the nearest 5lb increment to determine trial load. Perform one exercise for each muscle group, preferably with free weights (exercises in grey on Table 1).
    1. If client is comfortable, use free weights (FW) only for each body area. Use machines only if client is not comfortable with FWs.
    2. If machines are used, ensure to note the type (either cam-based or pivot-based, use the correct exercise, and choose the nearest weight option available).
  2. Demonstrate and explain the exercise before allowing client to practice with very low weight. Observe form and make any corrections needed.
  3. When form is good have client warm up with 50% of the trail load for 10 reps.
  4. Allow 1-2min rest. Change weight to trial load and have client perform as many reps as possible. If form deteriorates or client cannot finish a rep, stop assessment for the current exercise.
  5. Record number of reps completed successfully.
  6. After all exercises are complete, determine training load using Table 2. This will be the basis of the strength training aspect of our program with this client.

Table 1: Protocol for %BW strength assessments for women

Table 1: Protocol for %BW strength assessments for women

Table 2: Adjusting trial load to allow goal number of repetitions

Table 2: Adjusting trial load to allow goal number of repetitions

[edit] Stability

The following stability exercises were performed:

  • Bosu Ball (bubble up)
    • stand on two feet and turn in circles, clockwise and counter clockwise
      • good form, balance maintained throughout
        Bosu circles. Taken from: http://d3vs5ss8iow0ry.cloudfront.net/video-library/thumbnail/bosu-ball-squats-with-ball-up_-_step_1.max.v1.png
    • turn in circles while flexing hip and knee to 90deg with each step, clockwise and counter clockwise
      • good form, balance lost requiring step off 2 times
        Bosu circles & leg raises. Taken from: http://www.beginnertriathlete.com/cms/articleimages/1282/Bosu-Ball-Leg-raise-bent-knee-in-front-alternating3.jpg
    • balance on one leg for as long as possible
      • right was easier to maintain than left. Left required more compensatory arm and trunk movements to maintain one-footed stance.
        Bosu One Leg Balance. Taken from: http://davidlasnier.com/wp-content/uploads/2011/07/bosu1.jpg
  • Plank (on elbows and toes)
    • held for 1:00
    • upper back was quite rounded, verbal instruction to modify this was unsuccessful
      Plank on Elbows. Taken from: http://www.erinchapmanfitness.com/wp-content/uploads/2013/04/Bridge-Plank-on-Elbows.jpg

[edit] Cool-Down

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

  • Standing quadriceps stretch (hold heel to butt and push hip forward)
  • Standing hamstrings stretch (feet slightly apart, keep knees straight, reach down to touch toes)
    • Rise from this position slowly in order to stretch back muscles
  • Standing calf stretch (stand with toes of one foot against wall and heel on the floor, keep knee straight, lean toward the wall)
  • Standing chest stretch (clasp hands behind back, lift arms as high as possible, hold chest up and out)
  • Standing triceps stretch (reach one arm over shoulder and reach down back as far as possible, gently push elbow back with other hand, keep chest up and out)
  • Ask client if she would like to stretch anything else

[edit] Second Strength Assessment: 10 October 2013

Rachel and Cody met JW at 4:45 at the Cage.

The session will begin with a warm-up and end with a cool-down. Although we already did a strength fitness assessment of JW (using free weights), we also wanted to do a strength fitness assessment using machines because she expressed the desire to use them on her own, but didn't know how. For the purpose of time, we decided to break the strength assessment into two session (free weights on October 3rd and machines on October 10th).

[edit] Warm-Up

Ensure core is kept tight during the following dynamic exercises/stretches

  • 10 jumping jacks
  • 20 high knees
  • 20 butt kicks
  • 20 arm circles in both forward and backward direction (start small, grow larger)
  • 2 laps around the Brock Zone track

[edit] Strength: % Body Weight Testing

  • IF AT ANY TIME THE CLIENT EXPERIENCES PAIN STOP IMMEDIATELY
  • Ensure client uses proper form at all times. She has expressed the desire to be educated about strength training and will be receptive to any adjustments and/or explanations.
  • Be aware of client’s previous injuries and watch for signs that she may be hiding pain in order to participate. If any concerns arise explain that the program can be adjusted to accommodate her strengths and weaknesses in order to facilitate her greatest benefit from this experience.

Procedure:

  1. In The Zone, use client’s body weight (BW) to multiply by the factor (Table 1) for each exercise. Round down to the nearest 5lb increment to determine trial load. Perform one exercise for each muscle group.
  2. Where machines are used, ensure to note the type (either cam-based or pivot-based, use the correct exercise, and choose the nearest weight option available.
  3. Demonstrate and explain the exercise before allowing client to practice with very low weight. Observe form and make any corrections needed.
  4. When form is good have client warm up with 50% of the trail load for 10 reps.
  5. Allow 1-2min rest. Change weight to trial load and have client perform as many reps as possible. If form deteriorates or client cannot finish a rep, stop assessment for the current exercise.
  6. Record number of reps completed successfully.
  7. After all exercises are complete, determine training load using Table 2. This will be the basis of the strength training aspect of our program with this client

Client’s BW: 103 lbs (Check on way up to the Zone)

Table 1: Protocol for %BW strength assessments for women

  • weights difficult to be rounded to a weight the gym had. For example, the gym does not have 27.81 lbs for the chest press, so our client performed the exercise using 30 lbs

Image:Training_load_principle_oct_10th.PNG

Trial load is designed to allow 12-15 reps. BW = body weight; FW = free weight; CM = cam-based machine; PM = pivot-based machine. Taken from NSCA’s essentials of Personal Training, pg364.

Table 2: Adjusting trial load to allow goal number of repetitions

Image:Training_prin_2_oct_10th.PNG

NA = no adjustment; Load increase (+) or decrease (-). Taken from NSCA’s essentials of Personal Training, pg366.

[edit] Cool-Down

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

  • Standing quadriceps stretch (hold heel to butt and push hip forward)
  • Standing hamstrings stretch (feet slightly apart, keep knees straight, reach down to touch toes)Rise from this position slowly in order to stretch back muscles
  • Standing calf stretch (stand with toes of one foot against wall and heel on the floor, keep knee straight, lean toward the wall)
  • Standing biceps and chest stretch (clasp hands behind back, palms facing away from body, hold chest up and out)
  • Standing triceps stretch (hold one arm across chest with thumb pointed down, cradle with opposite arm and gently pull, look toward shoulder of are being stretched)
  • Roll the ankles clockwise, roll the ankles counter clockwise
    Ankle circles. Retrieved from: http://gymnasticsinjuries.files.wordpress.com/2012/10/ankle-circles1.jpg
  • Roll the wrists clockwise, roll the wrists counter clockwise
Wrist circles. Retrieved from: http://farm5.static.flickr.com/4045/4383287662_d92185846f_o.gif
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