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Contents 1 Group #4 Members 2 Initial Client Consultation 3 Pre-Assessment: Part 1 3.1 Warm Up 3.2 Posture Assessment 3.3 Gait Assessment 3.4 Flexibility Assessment 3.5 Cardiovascular Endurance Assessment 3.6 Cool Down 3.7 Other Notes 4 Pre-Assessment: Part 2 4.1 Warm-Up 4.2 Muscle Strength and Endurance Testing 4.3 Cool-Down 4.4 Other Notes 5 SMART Goals 5.1 Cardiovascular Endurance 5.2 Flexibility 5.3 Strength 5.4 Psychological 5.5 Functional 6 First Training Session 6.1 Warm Up 6.2 Main Section 6.3 Cool Down 6.4 Other Notes 7 Second Training Session 7.1 Warm Up 7.2 Main Section 7.3 Cool Down 7.4 Other Notes 8 Third Training Session 8.1 Warm Up 8.2 Main Section 8.3 Cool Down 8.4 Other Notes 9 Fourth Training Session 9.1 Warm Up 9.2 Main Section 9.3 Cool Down 9.4 Other Notes 10 Fifth Training Session 10.1 Warm Up 10.2 Main Section 10.3 Cool Down 10.4 Other Notes 11 Sixth Training Session 11.1 Warm Up 11.2 Main Section 11.3 Cool Down 11.4 Other Notes 12 Seventh Training Session 12.1 Warm Up 12.2 Main Section 12.3 Cool Down 12.4 Other Notes 13 Eighth Training Session 13.1 Warm Up 13.2 Main Section 13.3 Cool Down 13.4 Other Notes 14 Ninth Training Session 14.1 Warm Up 14.2 Main Section 14.3 Cool Down 14.4 Other Notes 15 Tenth Training Session 15.1 Warm Up 15.2 Main Section 15.3 Cool Down 15.4 Other Notes 16 Eleventh Training Session 16.1 Warm Up 16.2 Main Section 16.3 Cool Down 16.4 Other Notes 17 Twelfth Training Session 17.1 Warm Up 17.2 Main Section 17.3 Cool Down 17.4 Other Notes 18 Thirteenth Training Session 18.1 Warm Up 18.2 Main Section 18.3 Cool Down 18.4 Other Notes 19 Post-Assessment: Part 1 19.1 Warm Up 19.2 Posture Assessment 19.3 Gait Assessment 19.4 Flexibility Assessment 19.5 Cardiovascular Endurance Assessment 19.6 Cool Down 20 Post-Assessment: Part 2 20.1 Warm-Up 20.2 Muscle Strength and Endurance Testing 20.3 Cool-Down 21 Final Client Consultation 22 SMART Goals Results 22.1 Cardiovascular Endurance 22.2 Flexibility 22.3 Strength 22.4 Psychological 22.5 Functional 23 Progression Summary Chart

[edit] Group #4 Members

Alex Giles, Ashley McNabb, Dan Hales, Leanne Smith, Tim VanderWeide

[edit] Initial Client Consultation

Group Members: Leanne, Alex, Ashley, Tim and Dan

Date: Friday January 24, 2014

Time: 12:30pm - 1:00pm

Location: Walker Complex Cafeteria

PAR-Q completed at the start of the meeting

Question 1: What is your past exercise experience?

Question 2: Is there anything in your past experience with exercise that worked well for you or did not work well for you?

Question 3: If ever, why did you stop exercising/participating in physical activity?

Question 4: What do you like to do and what do you not like to do in regards to exercise?

Question 5: What are your current interests/hobbies that include physical activity? (i.e. walking the dog)

Question 6: What is your availability? How many times per week would you like to meet?

Question 7: What time is most convenient for you to meet to perform your workout and for how long?

Question 8: Do you currently exercise? What does your typical exercise routine look like? (how do you see yourself in terms of your current fitness level)

Question 9: What is your age?

Question 10: Is there anything that may effect your ability to exercise? (i.e. medications, illness, injury)

Question 11: What is your occupation? (describe your workplace setting and the physical demands on your body)

Question 12: What are your current stress levels? (at work, home etc.)

Question 13: What is your present attitude towards exercise?

Question 14:Do you have any fears associated with exercising?

Question 15: What motivates you during a workout or how can we help to motivate you during a workout?

Question 16: Why are you enrolling in this program?

[edit] Pre-Assessment: Part 1

Group Members: Leanne and Alex

Date: Wednesday, January 29, 2014

Time: 7:15am - 8:00am

Location: The Zone

Purpose: To assess our client's posture, gait, flexibility and cardiovascular endurance

Equipment:

1) The track

2) Plumb line

3) Stop watch

4) Posture/gait assessment sheets

5) Measuring tape

6) Masking tape

[edit] Warm Up

Rockport Walking Test

• This test requires the individual to walk 1 mile. Therefore, since the indoor track at Brock University is 200m, the client walked 8 laps around the track.

[edit] Posture Assessment

For the posture assessment, Alex created a plumb line to evaluate the client's posture from both the frontal view and sagittal view. Alex held the plumb line while Leanne assessed the client's posture.

The findings on the frontal posture assessment were that the client's head and neck are noticeably forward. The client also has a slightly rounded upper back, slightly inclined trunk, slightly protruding abdomen and a slightly hollow back. Overall, the client's posture did not look as bad as we had originally anticipated. We were expecting the worst because she works at a desk all day.

The findings on the sagittal posture assessment were that the client's head and feet were typical, but that her left hip and shoulder were slightly higher than her right hip and shoulder. The client's spine is curved slightly laterally.

We shared the results of the posture assessment with the client once the assessment was completed. Following the posture assessment, the client informed us that she had forgotten to tell us at the initial consultation that she has some soft tissue damage on her upper right arm due to a seizure. This could explain why we found that her right shoulder was lower than her left.

[edit] Gait Assessment

For the gait assessment, both Alex and Leanne assessed the client's gait as she walked back and forth along the track in The Zone. The client's gait was assessed from all viewpoints, including the front, back and both sides.

The findings for the gait assessment showed that her head is flexed forward. We also found that the client takes short strides and has a small arm swing. When we had the client remove her running shoes, we also found that the client is flat footed.

[edit] Flexibility Assessment

YMCA Sit and Reach Test

For the sit and reach test, Alex and Leanne taped a measuring tape to the floor alongside the track and had the client sit with her feet at 15 inches.

The client performed the YMCA Sit and Reach Test. The client was unable to touch her toes. She struggled to get down onto the floor to perform the test. She also had difficulty getting back up off of the ground.

The client's sit and reach score of 6 inches when compared to Norms on p. 245 Table 11.27 is less than the 10th percentile.

[edit] Cardiovascular Endurance Assessment

Rockport Walking Test

The client used the indoor track at Brock University to complete the Rockport Walking Test. The track is 200m so the client walked eight laps of the track. The one mile walk took the client 17 minutes and 52 seconds. Her heart rate following the test was 120bpm.

Based on the norms for the Rockport Walking Test, the client's one mile walk time is poor compared to other individuals her age and gender.

Clients Body Weight (BW) = 235.6 lbs

Clients Age = 51 years old

Clients Gender = Female = 0

Clients Time = 17 minutes and 52 seconds (17.52)

Clients Heart Rate (HR) = 120 bpm (beats per minute)

Equation: VO₂ max (ml x kg^-1 x min^-1)

= 132.853 - (0.0769 x BW) - (0.3877 X age) + (6.315 x gender*) - (3.2649 x time) - (0.1565 x HR)

= 132.853 - (0.0769 x 235.6) - (0.3877 x 51) + (6.315 x 0) - (3.2649 x 17.52) - (0.1565 x 120)

= 18.98 (ml x kg^-1 x min^-1)

Our clients estimated VO₂ max of 18.98 (ml x kg^-1 x min^-1) when compared to Norms on p. 239 Table 11.14, is in the 10th percentile.

Our clients walk time of 17 minutes and 52 seconds when compared to Norms on p. 242 Table 11.20 is considered poor.

[edit] Cool Down

1 lap walk around track and static stretching

Static Stretches: Perform each stretch twice and hold each stretch for 30 seconds

• Neck Stretch

• Shoulder Stretch

• Side Bends

• Calf Stretch

• Hamstring Stretch

• Adductor Stretch

[edit] Other Notes

The client noted she had some soft tissue damage to her right upper arm due to a seizure.

The client has a hard time getting down to the ground and up off the ground (to and from a seated position).

The client cannot perform the quadriceps stretch. A modified stretch for this muscle group would be appropriate.

[edit] Pre-Assessment: Part 2

Group Members: Tim, Ashley and Dan

Date: Friday, January 31, 2014

Time: 7:00am - 7:45am

Location: The Zone

Purpose: To assess the client's muscle strength and endurance

Equipment:

1) Stop Watch

2) Chair with a back

3) Exercise Mat

4) Measuring Tape

5) Scale

[edit] Warm-Up

Walk 2 laps around the track

The stretches that will be performed during the warm up are listed below. An image corresponds with each stretch.

[edit] Muscle Strength and Endurance Testing

Lower Extremity: 30 second Chair-Stand Test

The client will sit in a chair with a back and fold her arms across her chest. Each hand will be on the opposite shoulder. The client will proceed to stand up and then sit back down again. She will repeat this as many times as she can within 30 seconds. The client cannot use her hands and her feet must stay flat on the floor.

The client completed a total of 7 chair stands in the 30 second timeframe.

Upper Extremity: Push-Up Test

The client will perform modified push-ups against a wall. The client will complete as many push-ups as possible within 30 seconds.

The client completed a total of 13 modified push-ups in the 30 second timeframe.

Core: Crunch Test

The client will try to complete as many crunches as possible within 30 seconds.

The client completed a total of 10 crunches in the 30 second timeframe.

Manual Muscle Test

A Manual Muscle Test was performed to determine the strength of the client's quadriceps.

The Manual Muscle Test was performed within functional limits and against gravity. There was a difference between left and right quadricep strength.

[edit] Cool-Down

1 lap walk around the track

During the cool down seziure protocol was discussed for safety precautions. Our Client was provided a handout of stretches performed during this session that can also be completed at home

[edit] Other Notes

These particular assessments were chosen because they can easily be incorporated into the SMART goals for the client. The results will provide us with a measure of self-improvement that can be compared to the post-test results at the end of the program.

The assessments were not difficult for the client to complete. In addition, the assessments did not require weights. We did not incorporate weights into her initial assessment because the client has no previous weight training experience.

Our client has started to walk on a regualr basis on the indoor track at Brock. This will help contribute to her progress.

The client's height and weight were acquired.

Height: 5'9

Weight: 235.6 lbs.

BMI = mass(kg) / (height (m))²

BMI = 106.866 kg / (1.75 m)² = 34.89 = 34.9

Our Client has a BMI of 34.9. Compared to Norms presented on p. 234 Table 11.5, the client is considered to be in the category, Class I Obesity.

Static Stretching: Hamstring

Quadriceps (lying on side)

Gastrocnemius

Piriformis (sitting or supine)

Levator Scapulae

Upper Trapezius

IT Band

Pectoralis Major

Rhomboids

All static stretches will be performed three times and held for 30 seconds each(3x30). 30 second breaks will be given between each repetition. All stretches will be performed bilaterally.

[edit] SMART Goals

[edit] Cardiovascular Endurance

Improve the client's walk time for the Rockport Walking Test from poor to fair. In addition, to improve the client's estimated VO₂ max from the 10th percentile to the 20th percentile.

In order to achieve this goal, the client will walk one mile five days a week. The client also performs a warm up prior to her session and a cool down following the session. The warm up is two and a half laps and the cool down is one lap. It takes our client roughly 20 minutes to perform one mile, which is the necessary prescription to improve VO²max.

We will perform a post-test to determine if she has improved using the same assessment.

We plan to achieve this goal in six weeks.

[edit] Flexibility

Improve the client's sit and reach by 1-2 inches (from 6 inches to 8 inches).

The client performs a flexibility training program while at work throughout the day. The client performs static stretches following her workouts that are specific to the muscle groups that were trained during the session. We will perform two sets of each stretch for 30 seconds.

The client also performs the stretches once daily while at home. She performs each stretch twice and holds the stretch for 30 seconds.

We will measure this by performing a post-test after six weeks using the same assessment (sit and reach).

[edit] Strength

We would like to improve the client's 3 strength and endurance test scores:

• Sit to Stand Chair Test - Increase from 7 to 10 in a 30 second time period.
• Modified Push-Ups - Increase from 13 wall push-ups to 18 wall push-ups or 10 modified kneeling push-ups in a 30 second time period.
• Crunches - Increase from 10 crunches to 15 crunches in a 30 second time period.

During the program, we would like to see our client progress from the very easy (yellow) bands to the medium (blue) bands.

We would like the client to progress her core workouts from 2 sets of 10 repetitions to 3 sets of 10 repetitions by the end of the program. Improving core strength will help the client to perform typical activities of daily living and minimize lower back discomfort that is due to osteoarthritis in the lumbar vertebrae.

[edit] Psychological

Improve the client's thoughts, feelings, and dedication towards exercise through continuous motivation and support. We will also continue to educate the client about the importance of exercise on health and the effects of exercise. This would include delayed onset muscle soreness and the significance of hydrating during a training session. We will measure this by performing an interview with the client at the end of the semester, following 6 weeks of training.

[edit] Functional

Improve the client's ability to get up off the floor and down to the floor via strengthening the lower body, upper body and core. In addition, we will incorporate flexibility exercises into her program in order to improve range of motion through her knees, hips and lower back. We will measure this by interviewing the client after 6 weeks of training. We will have the client compare the difficulty of getting up and down from the floor prior to the training program and following the training program.

[edit] First Training Session

Group Members: Leanne, Alex and Tim

Date: Wednesday, February 5, 2014

Time: 7:15am - 8:15 am

Location: The Zone

Purpose: To develop the client's upper body strength using resistance bands

Equipment:

1) Yellow resistance bands

2) Stability ball

3) The track

4) The ladder in the stretching area

[edit] Warm Up

Walk 2.5 laps of the track

Static stretching (hold each stretch for 30 seconds):

• Quadriceps
• Hamstrings
• Pectoralis
• Rhomboids
• Triceps
• Biceps

[edit] Main Section

Exercises #1-3 was 2 sets of 10 repetitions and exercise #4 was 2 sets of 5 repetitions. Each repetitions was held for 2-3 seconds. 1-3 minutes was given between each set and exercise to recover. We tied the resistance bands around a ladder in the stretching area at the track. Our client began with the light (yellow) resistance bands.

Exercise #1

Rhomboids

• Shoulder Retractions
  • 2 sets of 10 repetitions

1. Anchor resistance band to door handle, pole etc. (something sturdy).

2. Stand upright with feet shoulder-width apart.

3. Slightly bend your knees and extend arms in front of you (around mid-torso level) with an end of the resistance band in each hand (palms should be facing each other).

4. The further the ends of the resistance band are from the anchor, the more tension you will have.

5. Pull the resistance band towards you and squeeze your shoulder blades together. Keep elbows close to your sides. Hold it there for 2-3 seconds.

6. Return to starting position.

7. Perform 2 sets of 10 repetitions with 1-3 minutes recovery between each set.

• Extensions
  • 2 sets of 10 repetitions

1. Anchor resistance band to sturdy object at waist level.

2. Hold resistance band at each end.

3. Begin with arms at your sides. Keep your elbows straight.

4. Pull backwards.

5. Slowly return to starting position.

6. Perform 2 sets of 10 repetitions with green resistance band. 1-3 minutes recovery between each set.

Exercise #2

Biceps

• Resisted Biceps Curl
  • 2 sets of 10 repetitions

Starting Position:

1. Grasp the handles of the resistance band with a closed, supinated grip.

2. Position the feet shoulder-width apart with the arches of both feet on top of a middle section of the resistance band.

3. Stand erect (stand up straight) with the knees slightly bent.

4. Position the handles outside of the thighs with the arms at the sides and the palms facing forward.

5. In this position, the resistance band should be nearly taut (not stretched); if not, take up the slack by widening the stance or selecting a shorter band.

Upward Movement Phase:

1. Flex the elbows to move the handles in an upward arc toward the shoulders.

2. Keep the torso erect, the upper arms stationary, and the knees in the same slightly flexed position.

3. Flex the elbows until the hands are within 4-6 inches (10-15 cm) of the shoulders.

Downward Movement Phase:

1. Allow the elbows to slowly extend back to the starting position.

2. Keep the torso, upper arms, and knees in the same position.

Exercise #3

Triceps

• Pull Down
  • 2 sets of 10 repetitions

1. Anchor the band to a sturdy object.

2. Stand with feet shoulder-width apart.

3. Start by holding an end of the resistance band in each hand and bend the elbows to 90 degrees (make sure there is enough resistance in the band- the further the ends of the band are away from the anchor, the more resistance).

4. Keep your back straight, head forward and keep your elbows close to your body.

5. Extend both arms (straighten to 180 degrees).

6. Bring your arms back to the starting position (bent at 90 degrees).

7. Perform 2 sets of 10 repetitions with 1-3 minutes recovery between each set.

Exercise #4

Core

• Crunch on Stability Ball
  • 2 sets of 5 repetitions on stability ball
    • Hold each crunch for 2-3 seconds

1. Line supine (on back) on the stability ball with the lower-to-middle section of the back on the apex of the ball.

2. Place the feet flat on the floor about hip-width apart with the thighs, hips, and lower abdomen approximately parallel to the floor.

3. Place hands behind or at the sides of the head or fold the arms across the chest or abdomen.

4. Curl the torso to raise it 30 to 40 degrees from the starting position.

5. Keep the feet on the floor and the thighs and hips stationary.

6. After completing the crunch, allow the torso to uncurl back down to the starting position.

7. Perform 2 sets of 5 repetitions with a 2-3 second hold for each repetition. 1-3 minutes recovery between each set.

[edit] Cool Down

Walk 1 lap of the track

Static stretches: Perform two sets of each stretch and hold for 30 seconds.

• Triceps
• Rhomboids
• Shoulder rolls

[edit] Other Notes

Our client told us she doesn't want to hurt at all again. We told her about Delayed Onset Muscles Soreness (DOMS). She told us she knew about hurting after exercising, which is why she has never done it before and hopes that we can help motivate her to keep exercising even if she feels muscle soreness.

During the exercises, we had to remind our client to keep her head up and look straight ahead. We also had to remind her to keep breathing and explained proper breathing technique. We explained to breathe out during the difficult part of the exercise and to breathe in during the easy part of the exercise.

We had originally planned to do 2 sets of 10 reps for all the exercises. But our client was only able to do 2 sets of 5 reps for the core exercise (Exercise #4).

Our client completed her warm up (2.5 laps) in 5 minutes and 30 seconds.

[edit] Second Training Session

Group Members: Dan and Ashley

Date: Friday, February 7, 2014

Time: 7:00am - 7:45am

Location: The Zone

Purpose: To focus on our client's lower body muscular strength and endurance

Equipment:

1) Stop Watch

2) Resistance band (light)

3) Stability ball

4) 5 lb. dumbbell

5) The track

6) The ladder in the stretching area

[edit] Warm Up

Walk 2.5 laps around the track

Static Stretching (Holding each stretch for 30 seconds):

• Hamstring

• Quadriceps

• Gastrocnemius

• IT band

[edit] Main Section

Exercises #1-4 consisted of 2 sets of 10 repetitions. There was a 1-3 minute rest period between sets and exercises. The client used a light resistance band for exercise #2, which was tied to the ladder located in the stretching area at the track. Exercise #4 was performed holding a 5 lb. dumbbell.

Exercise #1

Quarter Squats

• Place stability ball behind client's back and against a wall
• 2 sets of 10 repetitions

1. Position feet shoulder-width apart with the toes pointed slightly outward.

2. Place your hands on your hips or extend them along the sides of your body or out in front of you.

3. Look straight ahead and lower into a partial squatting position.

4. Keep your back straight, hold your chest up and out and keep the shoulders back (avoid leaning forward).

5. Do not allow your knees to go past your toes.

6. Push through your heels to bring your body back to the starting position.

7. Perform 2 sets of 10 repetitions with 1-3 minutes recovery between each set.

Exercise #2

Hip Abduction/Adduction & Hip Flexion/Extension

• 2 sets of 10 repetitions

Hip Abduction (Figure 1):

1. Anchor resistance band to stable object.

2. Loop the other end around your right ankle so band crosses in front of you.

3. Stand with left leg slightly behind you, keep your right leg straight and slowly lift it out to the side. Slowly bring it back down to the starting position.

4. Repeat on the other leg.

5. Perform 2 sets of 10 repetitions on each leg with 1-3 minutes recovery between each set.

Hip Adduction (Figure 2):

1. Begin by making a loop at one end of the band and wrap it around your right ankle with the other end anchored to a steady object.

2. Your left leg will be your balancing leg. Keeping your back and both knees straight, slightly lift your right leg and slowly pull your right leg towards the midline of your body.

3. Slowly return the right leg back to the starting position.

4. Repeat this exercise on the opposite side (left leg).

5. Remember to keep abdominals tight, do not lean to the side as you perform the exercise and face forward.

6. Resistance is dependent on how close the balancing leg is to the working leg (loop end of the band).

7. Perform 2 sets of 10 repetitions on each leg with 1-3 minutes recovery between each set.

Hip Extension (Figure 3):

1. Anchor the resistance band to a steady object and wrap the resistance band around your right foot.

2. You should be facing the bands anchor with feet shoulder-width apart. Keep back straight.

3. Keeping your left leg straight, lift the right leg (should also be straight) backwards and release it back to the starting position.

4. Repeat this exercise on the other leg.

5. Perform 2 sets of 10 repetitions on each leg with 1-3 minutes recovery between each set.

Hip Flexion (Figure 4):

1. Put your right foot in the resistance band and turn so you are facing away from the band's anchor.

2. Stand erect (don't lean forward when performing this exercise).

3. Keeping your left leg straight, lift the right leg (should also be straight) forward slowly and then slowly release it back down to the starting position.

4. Repeat on the opposite leg.

5. Perform 2 sets of 10 repetitions on each leg with 1-3 minutes recovery between each set.

Exercise #3

Calf Raises

• Use body weight
• 2 sets of 10 repetitions

1. Stand on the floor with one hand at the side or on the hip.

2. Place the other hand on the wall or stair railing to assist in balance (if necessary).

3. The feet should be close together and flat on the floor.

4. Elevate up onto toes, then lower the heels through the full comfortable range of motion.

5. Perform 2 sets of 10 repetitions with 1-3 minutes recovery between each set.

Exercise #4

Oblique Side Bend

• Use 5 lb. dumbbell
• 2 sets of 10 repetitions

1. Stand erect with feet shoulder-width apart and hold a 5 lb. dumbbell in right hand. This is your starting position (you can keep your other hand on your hip).

2. Bend only at the waist to the right side (as far as you can).

3. Slowly raise back up to staring position.

4. During this exercise, maintain a tight core, keep your back straight and chest lifted.

5. Perform 2 sets of 10 repetitions on each side with 1-3 minutes recovery between each set.

[edit] Cool Down

Walked 1 lap around track

[edit] Other Notes

Our client told us that she was a smoker in the past and that after losing weight she underwent cosmetic surgery to remove excess skin. She claims that her core still feels "funny". This is something the group must keep in mind and future core exercises should be done with caution.

During the session, our client kept mentioning that she believed she would feel the workout in her legs tomorrow.

The client was given resistance bands to use at home for her own workouts and plans on doing the exercises on her own time as well.

We mentioned to the client that it would be a good idea to drink water during training sessions, but client stated that she does not like drinking water and that is why she does not bring it with her.

[edit] Third Training Session

Group Members: Dan, Tim and Leanne

Date: Monday, February 10, 2014

Time: 7:15am - 8:15am

Location: The Zone

Purpose: To develop the client's upper body strength using resistance bands.

Equipment:

1) Green resistance bands

2) Yellow resistance bands

3) The track

4) Stability ball

5) The ladder in the stretching area

[edit] Warm Up

• Walk 2.5 laps of the track

[edit] Main Section

Exercises #1-3 was 3 sets of 10 repetitions, exercises #4 and #5 was 2 sets of 10 repetitions. Each repetition was held for 2-3 seconds. There was a 1-3 minute rest period between each set and exercise. We tied the resistance bands around a ladder in the stretching area at the track. Our client began with the green resistance band for exercises #1-3 and with the yellow resistance band for exercise #5.

Exercise #1

Rhomboids

• Shoulder Retractions - 3 sets of 10 repetitions (green)
• Extensions - 3 sets of 10 repetitions (green)

Exercise #2

Biceps

• Resisted Biceps Curls - 3 sets of 10 repetitions (green)

Exercise #3

Triceps

• Pull Down - 3 sets of 10 repetitions (green)

Exercise #4

Core

• Crunches on a Stability Ball - 2 sets of 10 repetitions with 3 second hold

Exercise #5

D2 Bilateral Shoulder Flexion and Extension

• 2 sets of 10 repetitions (yellow)

Extension:

1. Anchor resistance band to a sturdy object just above head level.

2. Hold one end of the resistance band with palm facing forward. Arm should be above head and out to the side.

3. Pull the resistance band down and across body. Bring the end of the resistance band to opposite hip with palm facing inward.

4. Slowly return to starting position. Perform 2 sets of 10 repetitions on each side with 1-3 minutes recovery between each set.

Flexion:

1. Anchor resistance band to a sturdy object at floor level.

2. Begin with arm crossed over trunk, holding resistance band with palm inward at the opposite hip.

3. Raise arm up diagonally across trunk and end with palm facing forward (arm should be up and out).

4. Slowly return to start position. Perform 2 sets of 10 repetitions on each side with 1-3 minutes recovery between each set.

[edit] Cool Down

Walk 2.5 laps of the track

Static stretches (each stretch was performed twice and held for 15 seconds):

• Pectoralis Major
• Rhomboids
• Neck (Upper Trapezius and Levator Scapulae)

[edit] Other Notes

At the beginning of the session, our client informed us that she has noticed some muscle soreness in her upper right arm (across the top and back) while writing on the board in her seminar.

Our client brought a water bottle with her to our session.

Alex has put together a workout booklet for our client. She will e-mail the client a new version each time it is updated. The booklet will assist the client in learning the exercises that we have been doing in her training sessions and allow her to perform them on her own time.

We eliminated the warm up stretching due to time constraints. Our client is performing the stretches on her own on a daily basis and had already completed the designated stretches prior to coming to the session.

Our client performed 2.5 laps of the track in 5 minutes and 59 seconds for her warm up. It took her 29 seconds longer this week than the previous week.

Our client was able to perform the upper body exercises from last week with the stronger green resistance band.

Our client was able to perform double the number of repetitions for the crunch exercise. She improved from 5 repetitions last week to 10 repetitions this week. Before we began the exercise today, her goal was to perform 6 or 7 crunches. She was able to accomplish that and pushed herself to do more.

Our client was able to perform an additional set for all the exercises from last week.

Our client finished the 2.5 laps for the cool down in 6 minutes and 2 seconds.

[edit] Fourth Training Session

Group Members: Alex and Ashley

Date: Wednesday, February 12, 2014

Time: 7:15am - 8:30am

Location: The Zone

Purpose: To develop our client's lower body muscular strength and endurance and core strength.

Equipment:

1) Stop Watch

2) Resistance band (green)

3) Stability ball

4) 8 lb. dumbbell

5) 5 lb. dumbbell

6) 3 lb. dumbbell

7) Chair

8) Step

[edit] Warm Up

Walk 2.5 laps around the track

[edit] Main Section

Exercises #1-4: 3 sets of 10 repetitions with a 1-3 minute recovery between sets

Exercise #5: 2 sets of 10 repetitions with 1-3 minutes recovery between sets

Exercise #6: 2 sets of 8 repetitions with 1-3 minutes recovery between sets

Have client use green resistance band for exercise #2.

Exercise #1 performed using 3 lb. dumbbell, exercise #3 performed holding a 5 lb. dumbbell and exercise #4 using an 8 lb. dumbbell.

Exercise #1

Quarter Squats

• With stability ball on back and against a wall
• 3 sets of 10 repetitions
• Holding a 3 lb. weight in each hand

Exercise #2

Hip Abduction/Adduction & Hip Flexion/Extension

• 3 sets of 10 repetitions
• Use green resistance band

Exercise #3

Calf Raises

• 3 sets of 10 repetitions
• 5 lb. weight in each hand

Exercise #4

Oblique Side Bends

• With 8 lb. dumbbell
• 3 sets of 10 repetitions

Exercise #5

Step Up

• 2 sets of 10 repetitions on each side

1. Stand facing chair/bench etc.

2. Height of object should be such that when you place your foot on the object your knee is at about hip height.

3. Place right foot on the object (make sure entire foot is on object).

4. Use right leg to lift you, step up on object so you are standing both legs on top of the object.

5. Leaving your left foot on the object, step down with your right foot.

6. Step back up with your right foot.

7. Can progress this exercise by increasing height of the object (starting low and getting higher or adding dumbbells).

8. Make sure entire foot is on object and they are pushing off with foot on object (not foot on the floor).

Exercise #6

Resistance Band Push Through Crunch

• 2 sets of 8 repetitions

1. Attach the band to a higher object (we used the ladder on the track for instance) and lay down in a supine position, grabbing each side of the band. Extend the elbows out at shoulder-level, engage your abdominals, and crunch down toward your hips while contracting your abs. Slowly return to starting position and repeat for 8.

2. Reminder not to pull down with body weight but with abdominals.

[edit] Cool Down

Walked 1 lap around track

Static stretches (for lower body - perform 2 sets of each stretch on both legs, hold each stretch for 30 seconds)

• Hamstring
• Calf (against wall with straight leg and bent leg)
• Modified Quadriceps Stretch
  • Place foot on ledge/chair behind you, make sure have something to balance with (i.e. another chair in front)
• Modified Piriformis Stretch
  • Performed while sitting. Cross your right ankle onto your left knee. Gently press down on your knee until you feel a stretch
  • If you are unable to bring your leg onto your knee, cross your feet at the ankles and press the knee down and to the side

[edit] Other Notes

During exercise #4 we noticed that the client has restricted range of motion during lateral flexion on both the left and right sides of the body. It was recognized during this exercise because the client cannot reach very far duirng the side bends when working on the obliques duirng the core portion of the session.

During exercise #6 the client experienced slight pain in her knees from kneeling for a few minutes at a time. The exercise was modified to a crunch while laying on her back, on a mat and pulling the resistance band down that is tied to a higher object. This released the pressure from her knees and still focused on engaging the core.

The session was extended an extra 45 minutes because the client was able to go into work later and cut her lunch break shorter that day. This gave us the opportunity to complete all the exercises we had and the recommended number of sets and repetitions. We were also able to complete a cool down and static stretching after the exercises were completed. We did not have any other obligations that morning so we were happy to stay.

[edit] Fifth Training Session

Group Members: Alex and Tim

Date: Wednesday, February 19, 2014

Time: 7:15am - 8:30am

Location: The Zone

Purpose: To develop our client's lower body muscular strength and endurance and core strength.

Equipment:

1) Stop Watch

2) Resistance band (green)

3) Stability ball

4) 8 lb. dumbbell

5) 5 lb. dumbbell

7) Chair

8) Step

[edit] Warm Up

Walk 2.5 laps around the track

[edit] Main Section

Exercises #1-5 & #7: 3 sets of 10 repetitions with a 1-3 minute recovery between sets

Exercise #6: 3 sets of 8 repetitions with 1-3 minutes recovery between sets

Have client use green resistance band for exercises #2, #4 and #6.

Exercise #1 performed using 5 lb. dumbbell, exercise #3 performed holding a 8 lb. dumbbell and exercise #7 using an 8 lb. dumbbell.

Exercise #1

Quarter Squats

• With stability ball on back and against a wall
• 3 sets of 10 repetitions
• Holding a 5 lb. weight in each hand

Exercise #2

Hip Abduction/Adduction & Hip Flexion/Extension

• 3 sets of 10 repetitions
• Use green resistance band

Exercise #3

Calf Raises

• 3 sets of 10 repetitions
• 8 lb. weight in each hand

Exercise #4

Resisted Dorsiflexion

• 3 sets of 10 repetitions with green resistance band

1. Anchor the resistance band to a sturdy object low on the floor or have someone hold one end of the resistance band.

2. Wrap the other end of the resistance band around the top of the foot.

3. Sit on bosu ball or on the floor with legs straight and heels on the floor.

4. Pull your ankle up so toes are facing the ceiling (you should feel the resistance while pulling your toes up- called dorsiflexion).

5. Let your ankle relax and go back down (toes will be slightly pointed).

6. Perform 3 sets of 10 repetitions on each foot (your recovery will occur while performing a set on the opposite foot).

Exercise #5

Step Up

• 3 sets of 10 repetitions on each side

Exercise #6

Resistance Band Push Through Crunch

• 3 sets of 8 repetitions (with green resistance band)

Exercise #7

Oblique Side Bends

• 3 sets of 10 repetitions on each side with 8 lb. weight

[edit] Cool Down

Walk 1.5 laps around track

Light lower extremity stretching- Performed 3 sets of each stretch and held each stretch for 30 seconds

• Quadriceps
• Hip Flexor
• Gastrocnemius
• Soleus

Plantar Fascia Stretch

[edit] Other Notes

Quadriceps strength and range of motion through the client's knees is improving. She is performing more than a quarter squat now. When she performs a squat her knees are getting closer to 90 degrees (able to get deeper into her squat than she previously could).

The client is having a much easier time getting up and down from the floor.

The client has a lot of inner motivation and is always willing to try and perform that extra set. For example, performed 3 sets of 8 repetitions of the resistance band push through crunch (only performed 2 last week) and performed a third set of step ups (only performed 2 sets last week).

We should add a stretch to her flexibility program to improve her lateral flexion (still noticeably limited).

Client mentioned she is having some heel pain (sounds like heel spurs). We spent extra time stretching her calves and the bottom of her feet today. We are hoping the pain is due to tightness and that this will relieve some pain. We should continue to monitor this.

[edit] Sixth Training Session

Group Members: Alex and Leanne

Date: Monday, February 24, 2014

Time: 7:15am - 8:15am

Location: The Zone

Purpose: To develop out client's upper body muscular strength and endurance and core strength using body weight, resistance bands and dumbbells.

Equipment:

1) Green resistance bands

2) Stability ball

3) Yellow resistance bands

4) The track

5) The ladder in the stretching area

6) Stop watch

[edit] Warm Up

Walk 2.5 laps of the track

[edit] Main Section

Exercises #1-3: 3 sets of 12 repetitions

Exercise #4: 3 sets of 10 repetitions

Exercises #5 & #6: 2 sets of 10 repetitions

Green resistance band used for exercises 1-3,5 and yellow resistance band for exercise 6.

1-3 minutes recovery between each set and exercise.

Exercise #1

Rhomboids

• Shoulder Retractions - 3 sets of 12 repetitions (green)

• Extensions - 3 sets of 12 repetitions (green)

Exercise #2

Resisted Biceps Curls

• 3 sets of 12 repetitions (green)

Exercise #3

Triceps Pull Down

• 3 sets of 12 repetitions (green)

Exercise #4

Core Crunches on a Stability Ball

• 3 sets of 10 repetitions with a 3 second hold

Exercise #5

D2 Bilateral Shoulder Flexion and Extension

• 2 sets of 10 repetitions (green)

Exercise #6

Standing Chest Fly with Resistance Band

• 2 sets of 10 repetitions (yellow resistance band)

1. Anchor resistance band to a sturdy object at chest height.

2. Each hand will hold an end of the resistance band.

3. Start the exercise with your arms open. Arms should be straight, but not locked. Do not let hands go behind shoulder line (should be right in line with shoulder).

4. Pull arms together towards the midline. Arms should still be straight (not locked). The angle between the arm and the body should be 90 degrees.

5. Slowly return to starting position.

6. Perform 2 sets of 10 repetitions. Recovery is 1-3 minutes between each set.

[edit] Cool Down

Walk 1.5 laps of the track

Static stretching (perform each stretch twice and hold each stretch for 30 seconds):

• Pectoralis Major

• Rhomboids

• Neck (Upper Trapezius and Levator Scapulae)

[edit] Other Notes

At the beginning of todays session, our client informed us that the other day she was doing calf raises in the Tim Hortons line.

For the first exercise (rhomboids), our client is finding that the green resistance bands are becoming easier. We should now have our client move back further to increase the resistance or move the client up to the blue resistance band to increase the resistance.

For the second exercise (biceps), our client stated that her wrists were feeling weak today and that it may have been from knitting all weekend. We also had to remind our client to keep the movements controlled and to slow down.

For the third exercise (triceps), our client struggled a bit to maintain her form and we had to remind her to breathe properly.

For the fourth exercise (core), our client was taking quite a bit of time between each repetition before moving on to the next repetition. The time between each repetition increased towards the end of the set. The time between each repetition was the longest during the third set. Our client was holding each crunch for 2 seconds instead of 3.

For the fifth exercise (D2), our client mentioned that she could really feel it in her right arm due to the soft tissue damage she has. We noticed that when she performed the exercise on the right side, she was using her whole body to pull down and across instead of using just her arm. We added an extra set of 5 repetitions.

The sixth exercise (chest) was a new exercise. At the end of each set, our client was not bringing her arms back up to 90 degrees, nor was she performing the exercise in a straight line. This was especially noticeable on the right side.

For the cool down, we did each stretch twice and added a hip stretch because she had mentioned it was bothering her from sitting in the car for 8 hours yesterday. More specifically, she noted it was her left hip.

We noted that we should add a new exercise each week for variety and possibly start adding in dynamic stretches as well.

[edit] Seventh Training Session

Group Members: Tim, Ashley and Dan

Date: Wednesday, February 26, 2014

Time: 7:00am - 7:45am

Location: The Zone

Purpose: To develop our client's lower body muscular strength and endurance and core strength.

Equipment:

1) Stop Watch

2) Resistance band (green)

3) Stability ball

4) 8 lb. dumbbell

5) Chair

6) Elliptical

7) Step

[edit] Warm Up

Elliptical for 5 minutes (if available) on level 1

[edit] Main Section

Exercises #1-3: 3 sets of 12 repetitions with a 1 minute recovery between sets

Exercises #4, 6 & 7: 3 sets of 10 repetitions with a 1 minutes recovery between sets

Exercise #5: 2 sets of 10 repetitions

Exercises #1,2 & 6 performed using 8 lb. dumbbell.

Exercise #3 performed holding a 8 lb. dumbbell and exercises #3 & 7 using resistance band.

Exercise #1

Quarter Squats

• With stability ball on back and against a wall
• 3 sets of 12 repetitions
• Holding an 8 lb. weight in each hand

Exercise #2

Calf Raises

• With 8 lb. dumbbell in each hand
• 3 sets of 12 repetitions

Exercise #3

Resisted Dorsiflexion

• 3 sets of 12 repetitions with green resistance band

Exercise #4

Step Up

• 3 sets of 10 repetitions on each side

Exercise #5

Walking Forward Lunge

• 2 sets of 10 repetitions

1. Begin standing with your feet shoulder-width apart and your hands on your hips.

2. Step forward with your right leg, bending both knees. Lower your body until your back knee nearly touches the ground (or as far as you can go). Both knees should be at approximately 90 degrees. Front knee should not pass the front foot (knee should be in line with ankle).

3. Back should remain straight and upright and toes should remain pointing forward during the entire movement.

4. Do not step out too far. There should be about 2-2.5 feet between your feet.

5. From this position, push up and drive through the heel of your lead foot, bring the back leg forward until you return to the starting position.

6. Step forward with the opposite leg (left) and repeat. Walk forward for all repetitions.

7. Perform 2 sets of 10 repetitions on each leg.

NOTE: Can use a wall for balance or modify exercise to a static lunge if having difficulty performing the walking lunge.

Exercise #6

Oblique Side Bends

• 3 sets of 10 repetitions on each side with 8 lb dumbbell

Exercise #6

Resistance Band Push Through Crunch

• 3 sets of 10 repetitions (with green resistance band)

[edit] Cool Down

Walk 1.5 laps walked around track

Lower extremity stretching: Perform each stretch three times and hold each stretch for 30 seconds

• Quadriceps
• Hip flexor
• Gastrocnemius
• Soleus

[edit] Other Notes

Client was unable to complete 5 minutes on the elliptical. Instead, she completed 3 minutes on level one.

Client was able to complete the walking lunges. We provided the client with modifications, but she did not need to use them. Modifications included using the wall for balance or static lunges.

Walking lunges were a new exercise, so only 10 repetitions were completed. The resistance band push through crunch was no longer a new exercise, so we increased the repetitions from 8 to 10 this week.

[edit] Eighth Training Session

Group Members: Alex, Ashley and Leanne

Date: Wednesday, March 5, 2014

Time: 7:15am - 8:15am

Location: The Zone

Purpose: To develop our client's lower body muscular strength and endurance and core strength.

Equipment:

1) Stop Watch

2) Resistance band (green)

3) Stability ball

4) 8 lb. dumbbell

5) Chair

6) Elliptical

7) Step

8) Bosu ball

[edit] Warm Up

Elliptical for at least 3 minutes on level 1 (try to have client go longer than 3 minutes)

[edit] Main Section

Exercise #1

Quarter Squats

• 3 sets of 12 repetitions

• Have client extend arms out in front (no weights for this session)

• Place stability ball between the client's back and the wall

Exercise #2

Resisted Dorsiflexion

• With green resistance band
• 3 sets of 12 repetitions

Exercise #3

Side Steps

• With green resistance band
• 3 sets of 10 repetitions on each leg

1. Wrap the resistance band around both legs. Place the resistance band just above each ankle.

2. Begin the exercise with your feet shoulder width apart. The band should be taut, but not stretched. Knees should be slightly bent (half-squat position).

3. Keep feet, trunk and head facing forward. Back should remain erect (do not bend forward).

4. Shift weight to left leg and take a step out to the side with the right leg.

5. Keep hips level during the movement. It may help to place hands on hips (can feel if hips are dropping or remaining level).

6. Slowly shift your weight to the right leg (moved leg) and bring the other leg (left leg) back to the starting position.

7. After performing the appropriate number of sets and repetitions you will change direction. Instead, you will shift weight to right leg and take a step out to the side with the left leg.

8. Perform 3 sets of 10 repetitions in each direction. 1-3 minutes recovery between each set.

Exercise #4

Hip Flexion/Extension

• With green resistance band
• 3 sets of 12 repetitions

Exercise #5

Oblique Side Bends

• 3 sets of 12 repetitions on each side
• With an 8 lb. dumbbell

Exercise #6

Resistance Band Push Through Crunch

• 3 sets of 10 repetitions using the green resistance band

Exercise #7

Back Extensions over Bosu Ball

• 3 sets of 10 repetitions

1. Place bosu ball on the ground with the inflated side facing upwards.

2. Lay face down on the bosu ball. Position yourself so you abdomen is directly in the middle of the bosu ball.

3. Spread your legs slightly apart. For extra support, your knees can be slightly bent and touching the ground.

4. Rest your hands behind your head.

5. Lift your trunk as high as your comfortably can. Hold this position for 1-3 seconds and then slowly lower your trunk back down. Head should remain in a neutral position throughout the entire exercise (not flexed or extended).

6. Perform 3 sets of 10 repetitions with 1-3 minutes recovery between each set.

Exercise #8

Step Up

• 3 sets of 12 repetitions

[edit] Cool Down

Walk 1.5 laps of the track

Lower extremity stretching: Perform one set of each stretch and hold the stretch for 30 seconds

• Quadriceps
• Gastrocnemius
• Soleus
• Hamstrings

[edit] Other Notes

The client's quarter squats have improved and she is almost performing full squats.

The client mentioned that she experiences lower leg pain (shin splits) after walking for a long period of time. She says she tries to walk 6 laps per day, but begins to experience shin pain when she performs 8 laps. This may be the result of a muscle imbalance. Therefore, we are going to continue to perform the resisted dorsiflexion exercise. The client also mentioned that she is going to try and start walking on her heels in the morning to strengthen the other side of her leg (tibialis anterior).

The client has also noticed it is getting easier to get down to the floor and up off the floor.

The client mentioned that the step ups are becoming easier. She noticed that she is not as out of breath as she was in previous sessions and that they are not as challenging to complete anymore. Next week we will increase the height of the step. The client notices that pushing off with her left leg first is harder than the right. Therefore, it is important to remind the client to push off the left leg when starting with her left leg. The client mentioned she will try and be more aware of this when she is climbing stairs at home and to push off with her left leg.

Side steps were a new exercise this week. The side steps were very controlled and targeted muscles that the client could not previously feel.

The client struggled at the end of each set during the resistance band push through crunch exercise. We will keep working on this exercise to improve her core.

The new exercise this week was the back extension. The new exercise went well, but the client used her hands for support. We will keep working on this exercise to strengthen her lower back muscles.

During the oblique side bends, we noticed that the right side has better lateral flexion than the left. The client informed us that there is more pain on the left side, especially in the spine (could be due to the arthritis). Therefore, she cannot bend as far on that side. We will find a new exercise to target the obliques.

The client made great progress with her stretches. The client can now reach and grab her foot during the quadriceps stretch and is able to hold this position throughout the duration of the stretch.

[edit] Ninth Training Session

Group Members: Tim and Dan

Date: Friday, March 7, 2014

Time: 7:00am - 7:45am

Location: The Zone

Purpose: To develop our client's upper body muscular strength and endurance and core strength using body weight, resistance bands and dumbbells. In addition, to improve our clients posture through stretching and strengthening.

Equipment:

1) Stability ball

2) Elliptical

3) 5 lb. dumbbell

4) Green resistance bands

[edit] Warm Up

4 minutes on elliptical machine at level one

[edit] Main Section

1 minute recovery between each set and exercise

Exercise #1

Shoulder L-Raise over Stability Ball

• 2 sets of 10 repetitions
• Dumbbells not required for this session

1. Lay face down on the ball. Legs should be extended with feet slightly apart (so it is comfortable). Use feet to stabilize yourself over the ball so shoulders can be used freely.

2. Ball should be placed around the hip area.

3. Place a dumbbell in each hand (grip: palms facing down). Rest dumbbells on the ground in front of you with arms extended.

4. First, retract the shoulders lifting the dumbbells towards the chest. Focus on squeezing the shoulder blades together (shoulders should be abducted and elbows should be bent at a 90 degree angle).

5. Once retracted, laterally rotate shoulders so dumbbells are in line with shoulders (rotating lower arms backwards).

6. Slowly reverse the movements back to the starting position.

7. Perform 3 sets of 10 repetitions.

NOTE: Client did not use dumbbells for this exercise during this session. Body weight was sufficient. Wanted to ensure the client was performing the exercise correctly before adding resistance.

Exercise #2

Biceps Curls

• With 5 lbs.
• 3 sets of 12 repetitions

Exercise #3

Triceps Kickback

• With 5 lbs.
• 3 sets of 12 repetitions

1. Stand to the right of the weight bench, holding a dumbbell in your right hand with your palm facing in (towards your body).

2. Place your left lower leg and your left hand on top of the bench (knee will be bent).

3. Lean forward at the hips (upper body should be parallel with the floor).

4. Right leg can be slightly bent.

5. Bend your right elbow so your upper arm is parallel to the floor. Your forearm will be perpendicular to it.

6. Keep elbow close to body.

7. Maintain a straight back throughout the entire exercise.

8. Keeping the upper arm still, straighten your arm behind you until your entire arm is parallel to the floor and one end of the dumbbell points toward the floor.

9. Slowly bend arm back to starting position.

10. Perform 3 sets of 12 repetitions on both sides (left and right arm).

NOTE: Use a 5 lb. dumbbell for this exercise.

Exercise #4

Core Crunches on a Stability Ball

• 3 sets of 12 repetitions with a 3 second hold

Exercise #5

D2 Bilateral Shoulder Flexion and Extension

• 3 sets of 12 repetitions (green)

Exercise #6

Standing Chest Fly with Resistance Band

• 3 sets of 12 repetitions (green band)

[edit] Cool Down

Walk 1.5 laps of the track

Static stretching (hold each stretch for 30 seconds, perform each stretch twice)

• Pectoralis Major

• Rhomboids

• Triceps

• Neck (Upper Trapezius and Levator Scapulae)

[edit] Other Notes

Client had to be pushed really hard to get to 4 minutes on the elliptical. She reported that it was not painful, but her legs felt like jelly.

After 2 sets of 10 repetitions of the L-Raises, client reported feeling some 'crunching' in her left shoulder due to arthritis. She did not feel any pain though.

During triceps kickbacks, left arm struggled due to soft tissue damage in biceps muscle. Did get through both sets with no complaints though.

Form started to suffer for last three crunches on the stability ball. 3 sets of 12 repetitions may be too much for now.

D2 Flexion and Extension seem relatively easy for client. We can progress to light dumbbells soon.

[edit] Tenth Training Session

Group Members: Alex, Ashley and Leanne

Date: Wednesday, March 12, 2014

Time: 7:15am - 8:15am

Location: The Zone

Purpose: To develop our client's lower body muscular strength, endurance and core strength.

Equipment:

1) Stop Watch

2) Resistance Band (green)

3) Stability Ball

4) Chair

5) Elliptical

6) Step

7) Bosu ball

8) Dumbbell (3 lbs.)

9) Ankle weight/pulley system (cable machine)

[edit] Warm Up

Elliptical for 4-5 minutes at level 1 (depending on how client is feeling)

[edit] Main Section

Exercise #1

Squats

• 3 sets of 12 repetitions

• Extend arms out in front while holding 2-3 lb. medicine ball or dumbbell

• Place stability ball between the client's back and the wall

Exercise #2

Walking on Heels

• 3 sets of 12 repetitions (12 repetitions on each side)

1. Stand in an upright position (do not lean forward or flex neck).

2. Lift your toes from the floor and walk on heels.

3. Avoid flattening your feet (do not let toes touch the floor).

4. Perform 3 sets of 12 repetitions (12 reps on each side) with 1-3 minutes recovery between each set.

Exercise #3

Side Steps with Resistance Band

• 3 sets of 10 repetitions on each leg with green resistance band

Exercise #4

Hip Flexion/Extension using pulley system at cable machine

• 3 sets of 12 repetitions (10 lbs. when using cables)

NOTE: Follows the same guidelines as before, but client will be using a cable with weight instead of a resistance band for extra resistance.

Exercise #5

Twisting Toe Touches

• 3 sets of 10 repetitions

1. Stand upright with feet slightly wider than shoulder-width apart, keep knees straight and place arms at your sides (this is your starting position).

2. Bend over at the waist and twist your trunk. Touch your right fingers to your left toes (it is okay if you can only reach your knee- go as far as you can without inflicting pain).

3. Return to starting position.

4. Bend over at the waist and twist your trunk. This time touch your left fingers to your right toes.

5. Remember to activate your oblique's when performing this exercise.

6. Perform 3 sets of 10 repetitions on each side with 1-3 minutes recovery between each set.

Exercise #6

Resistance Band Push Through Crunch

• 3 sets of 10 repetitions using the green resistance band

Exercise #7

Back Extension over Bosu Ball

• 3 sets of 10 repetitions

Exercise #8

Step Ups (increasing height of the step this week)

• 3 sets of 12 repetitions

[edit] Cool Down

Walk 400m on the treadmill at 2.5 MPH

Lower Extremity Stretching: Perform two sets of each stretch and hold each stretch for 30 seconds

• Quadriceps
• Gastrocnemius
• Soleus
• Hamstrings
• Lateral Flexors of Trunk

[edit] Other Notes

As we were walking over to the stretching area on the track, we asked our client how she has been feeling after her workouts. At our initial consultation, the client mention she did not want to feel any pain. Our client told us that the most she has felt after her workouts is stiffness. She commented that it was nothing that she had dreaded that she would feel and that we have been treating her well.

During squats, our client mentioned her right arm was tender while holding the 3 lb. weight in front of her. We had to remind her to keep her head up.

During the side steps, our client was told in the third set to keep control and take a wider stance. It looked much better afterwards.

The client mentioned that she has sore heels. Therefore, heel walking is not the best suited exercise for her. She wanted to try it this week, but we will change it to a new exercise next week or go back to performing resisted dorsiflexion.

The client used 10 lbs. during the hip flexion/extension exercise on the cable machine.

During the step ups, we noticed that the client's left side is much weaker than the right side. The client mentioned that she notices her right leg trying to make up for the imbalance (right leg helps to push off).

During the twisting toe touches exercise, the client was reaching roughly to the knee. She mentioned that her right arm, near her biceps was tender. We modified the exercise by getting her to put her arms down during the exercise instead of holding them up. This provided both arms with time to rest and reduced pain and fatigue.

The client had a fall in the mud last week and her knee was bruised. As a result, getting down to the ground was more difficult today. While the client performed back extensions on the bosu ball, we made sure to cue the client to keep her knees off the ground and to stay up on her toes. For the last set, we had our client place her hands behind her head because she was using her hands to help her perform the exercise. She stated that it was more difficult. We also suggested that she ice her knee to reduce any swelling and that the swelling could be causing the pain.

During the resistance band push through crunch, we reminded our client to keep her head back. We told her to focus on a point on the ceiling to help keep her head back. We noticed that the client was not straining her neck as much and was lifting her shoulders slightly off the ground. This was an improvement.

The client completed 4 minutes and 30 seconds on the elliptical. This is a 30 second increase from last session.

The client was shown how to use new equipment properly. Two new pieces of equipment were introduced including the treadmill and the cable machine. This is so she is able to use it on her own in the future.

[edit] Eleventh Training Session

Group Members: Tim and Dan

Date: Friday, March 14, 2014

Time: 7:00am - 7:45am

Location: The Zone

Purpose: To develop our client's upper body muscular strength and endurance and core strength using body weight, resistance bands and dumbbells. In addition, to improve our clients posture through stretching and strengthening.

Equipment:

1) Elliptical

2) Stability ball

3) 8 lb. dumbbell

4) Blue resistance bands

5) 2 lb. dumbbell

6) Green resistance bands

7) Track

[edit] Warm Up

4 minutes 30 seconds on elliptical machine at level 1

[edit] Main Section

Exercise #1

Shoulder L-Raise over Stability Ball

• 3 sets of 10 repetitions

Exercise #2

Biceps Curls

• With 8 lb. dumbbell
• 3 sets of 12 repetitions

Exercise #3

Triceps Kickback

• with 8 lb. dumbbell
• 3 sets of 12 repetitions

Exercise #4

Core Crunches with Twist on a Stability Ball

• 3 sets of 12 repetitions with a 3 second hold

Exercise #5

D2 Bilateral Shoulder Flexion and Extension

• 3 sets of 12 repetitions
• First two sets performed with blue resistance band
• Last set performed with green resistance band

Exercise #6

Chest Flies on Stability Ball

• With 2 lb. dumbbells on stability ball
• 3 sets of 12 repetitions

1. Hold one 2 lb. dumbbell in each hand. Sit on the stability ball and walk your feet out in front of you until your head, neck and shoulders/upper back are resting comfortably on the ball.

2. Keep hips and glutes raised (body should be in a straight line from the shoulders to the knees). Knees should be bent at 90 degrees.

3. Begin by extending the arms out to the side. Palms should be facing the sky and elbows should be pointed toward the ground (arms should have a slight bend to them).

4. Bring dumbbells in your hands together (over the body's midline- center of the chest).

5. Arms will be extended out in front of you with palms facing each other (a slight bend at the elbow will remain).

6. Slowly lower the dumbbells back to the starting position.

7. Perform 3 sets of 12 repetitions with 1-3 minutes recovery between each set.

[edit] Cool Down

Walk 1.5 laps of the track

Static Stretching: Perform each stretch twice and hold each stretch for 30 seconds

• Pectoralis Major

• Rhomboids

• Triceps

• Neck (Upper Trapezius and Levator Scapulae)

[edit] Other Notes

The warm up was originally 4 minutes and 30 seconds on the elliptical (a 30 second increase from previous week). However, without us asking, the client pushed herself to complete 5 minutes on the elliptical.

We noticed that the client's right arm was dominant during exercises 3 & 5, which is thought to be due to soft tissue damage in her left arm. As a result, the right arm has more strength.

Today was the first day using the blue resistance band. The client reported that it felt much harder, but it felt 'good'. Said she wants to keep using it.

[edit] Twelfth Training Session

Group Members: Tim and Dan

Date: Monday, March 17, 2014

Time: 7:00am - 7:45am

Location: The Zone

Purpose: To develop our client's upper body muscular strength and endurance and core strength using body weight, resistance bands and dumbbells. In addition, to improve our clients posture through stretching and strengthening.

Equipment:

1) Elliptical

2) Stability ball

3) 8 lb. dumbbells

4) Blue resistance band

5) Green resistance band

6) 2 lb. dumbbells

7) Track

[edit] Warm Up

5 minutes on elliptical machine at level 1

[edit] Main Section

Exercise #1

Shoulder L-Raise over Stability Ball

• 3 sets of 10 repetitions

Exercise #2

Biceps Curls

• With 8 lb. dumbbells
• 3 sets of 12 repetitions

Exercise #3

Triceps Kickback

• With 8 lb. dumbbells
• 3 sets of 12 repetitions

Exercise #4

Core Crunches with Twist on a Stability Ball

• 3 sets of 12 repetitions with a 3 second hold

Exercise #5

D2 Bilateral Shoulder Flexion and Extension

• 3 sets of 12 repetitions
• First two sets performed with blue resistance band
• Last set performed with green resistance band

Exercise #6

Chest Flies

• With 2 lb. dumbbells on stability ball
• 3 sets of 12 repetitions

Exercise #7

Overhead Shoulder Press

• 3 sets of 12 repetitions
• With 8 lb. dumbbells

1. Sit on top of the stability ball with feet firmly planted on the ground. Engage abdominal muscles to remain stable on the ball. Keep back straight and head up (looking forward) throughout the entire exercise. Hold one dumbbell in each hand.

2. Begin by raising dumbbells to the side of your head. Forearm should be perpendicular with the floor and upper arm should be parallel with the floor (elbow at 90 degrees). Palms should be facing forward (away from your body).

3. Push dumbbells upward until the ends of each dumbbell touch. Arms should be as straight as possible (without locking elbows).

4. Slowly lower the weights back down to the starting position.

5. Perform 3 sets of 12 repetitions with 1-3 minutes recovery between each set.

6. Use 8 lb. dumbbells (hold one in each hand).

[edit] Cool Down

Walk 1.5 laps of the track

Static Stretching: Hold each stretch for 30 seconds and perform each stretch twice

• Pectoralis Major

• Rhomboids

• Triceps

• Neck (Upper Trapezius and Levator Scapulae)

[edit] Other Notes

It was noted that the client's strength had increased, so we increased the weight of the dumbbells from 5 lbs. to 8 lbs. this week.

During exercise #5, the client used the blue resistance band for all 3 sets. This is an improvement from last week, where she had to use the lighter (green) resistance band for the final set of the exercise.

The session went quicker than expected. This left additional time after the client had performed all of the pre-planned exercises. We decided to add an extra exercise at the end of the session. It should be noted that this was the first time that we had extra time at the end of the session.

The client's self confidence and dedication to the program has improved. Compared to previous sessions, the client was pushing herself more than usual today.

[edit] Thirteenth Training Session

Group Members: Alex, Ashley and Leanne

Date: Wednesday, March 19, 2014

Time: 7:15am - 8:30am

Location: The Zone

Purpose: To develop our client's lower body muscular strength, endurance and core strength.

Equipment:

1) Stop Watch

2) Resistance Band (blue)

3) Stability Ball

4) Chair

5) Elliptical

6) Step

7) Bosu ball

8) Dumbbell (3 lbs.)

9) Cables

[edit] Warm Up

Elliptical for 5-6 minutes at level 1 (depending on how client is feeling)

[edit] Main Section

CIRCUIT ONE (perform each exercise once before performing the next set)

Exercise #1

Squats

• 3 sets of 12 repetitions

• 3 lb. dumbbell in each hand above head

• Place stability ball between the client's back and the wall

Exercise #2

Resisted Dorsiflexion

• 3 sets of 12 repetitions (12 repetitions on each side) using blue resistance band

Exercise #3

Side Steps with Resistance Band

• 3 sets of 12 repetitions on each leg with blue resistance band

Exercise #4

Back Extension over Bosu Ball

• 3 sets of 10 repetitions

Exercise #5

Resistance Band Push Through Crunch

• 3 sets of 10 repetitions using the blue resistance band

CIRCUIT TWO (perform each exercise once before performing the next set)

Exercise #6

Step Ups

• 3 sets of 12 repetitions

Exercise #7

Standing Oblique Twist with Cables

• 3 sets of 10 repetitions

1. Begin by standing with left side towards the cable machine. Reach across your body with your right arm to grip handle with both hands.

2. Arms should be fully extended (straight) and at shoulder level. Stand with feet approximately shoulder-width apart and knees slightly bent.

3. Rotate to the right (away from the pulley) as far as you can without rotating your hips. Isolate and rotate your waist and upper body without involving your lower body. Remember to engage your abdominals.

4. Hold this rotated position for 2 seconds and slowly return to starting position. Arms should remain straight and parallel to the floor.

5. Repeat on the left side (right side towards cable machine, left arm reaching across body and rotate to left- away from pulley).

6. Perform 3 sets of 10 repetitions on each side with 1-3 minutes recovery between sets.

Exercise #8

Hip Flexion/Extension using cable machine

• 3 sets of 12 repetitions (10 lbs. when using cables)

[edit] Cool Down

Walk 400m on the treadmill at 2.5 MPH

Lower Extremity Stretching: Perform each stretch twice and hold each stretch for 30 seconds

• Quadriceps
• Gastrocnemius
• Soleus
• Hamstrings
• Lateral Flexors of Trunk

[edit] Other Notes

The weight on the cable machine for exercises #7 and #8 was increased from 10 lbs. to 15 lbs. during the second and third circuit.

The client mentioned that she has not been doing as much walking the past couple of weeks because she has been too busy. When she has time, she claims to walk 3-4 days a week and performs 6-8 laps of the track each time. The lack of walking could affect her cardiovascular endurance and as a result, may negatively impact her post-assessments.

The client is not renewing her Zone membership for the spring and summer. She plans on performing the workouts at home until fall.

During the cool down on the treadmill, we noticed that the client's left foot points slightly inward compared to the right foot. The left foot is also scraping the ground more than the right foot. This may be due to fatigue because we were at the end of the session. This was not recognized during the gait assessment in the initial assessment.

[edit] Post-Assessment: Part 1

Group Members: Leanne and Alex

Date: Monday, March 24, 2014

Time: 7:15am - 8:00am

Location: The Zone

[edit] Warm Up

Rockport Walking Test

[edit] Posture Assessment

The findings of our frontal posture assessment were similar to the pre-test. The client's head and neck remain noticeably forward. The client has a slightly rounded upper back, slightly protruding abdomen and slightly hollow back. Overall, the client's posture did not change much over the past six weeks. She continues to work at a desk all day, five days per week.

However, we did find that the client's trunk looked more erect in the post-assessment. The trunk was slightly inclined to the rear in the pre-assessment.

The findings of our sagittal posture assessment were similar to the pre-test. The client's head and feet were typical, but her left shoulder was slightly higher than her right shoulder.

However, we did find that her spine was straight in the post-assessment. The spine was slightly curved laterally in the pre-assessment. In the pre-assessment, the client's hips were uneven. Her left hip was slightly higher than her right hip. However, in the post-assessment we did not notice any unevenness. Two tests were performed and her hips seemed to be level. We asked the client to place her thumb on each hip bone in order to better observe the level of her hips. Leanne and Alex also took turns palpating the client's hip bones to feel for any unevenness.

[edit] Gait Assessment

Our findings for the gait assessment were similar to the pre-assessment. The client continues to walk with her head flexed forward. Once again, our client displayed a short stride length and a small arm swing. Our client remains flat footed.

An additional finding of the gait assessment included that the client's left foot turns slightly inward while walking. Her trunk is also slightly flexed forward.

[edit] Flexibility Assessment

YMCA Sit and Reach Test

The client was warmed up from the Rockport Walking Test and performed a few static stretches before performing the YMCA Sit and Reach Test.

The client was still unable to touch her toes. However, she had a much easier time getting down to the floor and up from the floor to perform the test. The client pushed herself to go farther on trial two after hearing her score for trial one. She made a big improvement from trial one to trial two.

The client's sit and reach score of 10 inches when compared to Norms on p. 245 Table 11.27 is in the 10th percentile. This is a 4 inch increase from the pre-test. The client's pre-test score was 6 inches. This score did not place her in a percentile when comparing norms. Scores from both trial one and trial two in the post-test were farther than her best score in the pre-test.

[edit] Cardiovascular Endurance Assessment

Rockport Walking Test

The client used the indoor track at Brock University to perform the Rockport Walking Test. The track is 200m and therefore, the client walked eight laps of the track. The one mile walk took the client 17 minutes and 12 seconds to complete. Her heart rate following the test was 108bpm.

Based on the norms for the Rockport Walking Test, the client's one mile walk time is fair compared to other individuals her age and gender.

Clients Body Weight (BW) = 240.6 lbs

Clients Age = 51 years old

Clients Gender = Female = 0

Clients Time = 17 minutes and 12 seconds

Clients Heart Rate (HR) = 108bpm (beats per minute)

Equation: VO2 max (ml x kg-1 x min-1)

= 132.853 - (0.0769 x BW) - (0.3877 X age) + (6.315 x gender*) - (3.2649 x time) - (0.1565 x HR)

= 132.853 - (0.0769 x 240.6) - (0.3877 x 51) + (6.315 x 0) - (3.2649 x 17.12) - (0.1565 x 108)

= 21.78 (ml x kg-1 x min-1)

The client's estimated VO2 max of 21.78(ml x kg-1 x min-1) when compared to Norms on p. 239 Table 11.14, placed her in the 10th percentile. She improved from 18.98 (ml x kg-1 x min-1) to 21.78 (ml x kg-1 x min-1). However, this still places her in the 10th percentile. She did not achieve our SMART goal for cardiovascular endurance because we wanted her to be in the 20th percentile. We are happy with this improvement because our training program did not concentrate on developing her cardiovascular endurance.

The client's walk time of 17 minutes 12 seconds when compared to Norms on p. 242 Table 11.20 is fair. She improved her walk time from poor to fair and achieved our SMART goal for cardiovascular endurance. Her original walk time was 17 minutes and 52 seconds.

[edit] Cool Down

Walk 2 laps around track and perform static stretching

Static Stretches: Performed each stretch once and held each stretch for 30 seconds

• Neck Stretch
• Shoulder Stretch
• Lateral Flexors of the Trunk Stretch
• Calf Stretch
• Hamstring Stretch
• Quadriceps Stretch

[edit] Post-Assessment: Part 2

Group Members: Tim, Ashley and Dan

Date: Wednesday, March 26, 2014

Time: 7:15am - 8:00am

Location: The Zone

[edit] Warm-Up

Walk 2 laps around the track

[edit] Muscle Strength and Endurance Testing

Lower Extremity: 30 second Chair-Stand Test

The client will sit in a chair with a back and fold her arms across her chest. Each hand will be on an opposite shoulder. Our client will proceed to stand up and then sit back down again. She will repeat this as many times as she can within a 30 second time period. Our client will be instructed not to use her hands and her feet must stay flat on the floor.

The client completed a total of 7 chair stands in the 30 second time period during the pre-test. The client completed a total of 10 chair stands in the 30 second time period during the post-test.

Upper Extremity: Push-Up Test

The client will perform modified push-ups against a wall. The client will complete as many push-ups as possible within a 30 second time period.

The client completed a total of 13 modified push-ups in the 30 second timeframe during the pre-assessment. During the post-test, the client completed a total of 16 modified push-ups in the 30 second timeframe.

Core: Crunch Test

The client will complete as many crunches as possible within a 30 second time period.

The client completed a total of 10 crunches in the 30 second timeframe during the pre-assessment. During the post-test, the client completed a total of 18 crunches in the 30 second time period.

Manual Muscle Test (MMT)

The MMT was performed within functional limits and against gravity during the pre-assessment. There was a difference in left and right quadriceps strength during the pre-assessment.

During the post-test, the MMT was performed within functional limits and against gravity. There was no noticeable difference between left and right quadriceps strength during the post-assessment.

[edit] Cool-Down

Walk 1 lap around the track

Stretching lower and upper extremity: Perform each stretch once and hold each stretch for 30 seconds

• Hamstring
• Quadriceps
• Hip flexor
• Rhomboid
• Pectoralis Major
• Upper Trapezius
• Levator Scapula
• Calf
• Tibialis Anterior

[edit] Final Client Consultation

Group Members: Leanne, Alex, Ashley, Tim and Dan

Date: Wednesday, April 2, 2014

Time: 7:00am-8:15am

Location: Four Points Sheraton

Purpose: To meet with our client one last time and go over her pre-test and post-test results after six weeks of training. In addition, we will provide our client with material that will allow her to continue training without us.

Materials:

We provided the client with an exercise booklet during the final consultation. Each page was dedicated to one exercise. Each page included the name of the exercise and a description of how to perform the exercise. The description was specifically written for our client in order to ensure proper form when we were no longer with her. For example, we did not use "supine" to describe body positioning. Each page also included a picture to correspond with the description. The booklet only includes exercises that were performed during the program. The booklet was separated into two sections. The first section was made up of the client's upper body exercises and the second section was made up of the client's lower body exercises. Each section also included some core exercises. This was labeled clearly in the booklet. The number of sets and repetitions for each exercise are provided at the end of the exercise description. The number of sets and repetitions were continuously updated throughout the semester. Therefore, the booklet given to the client is up to date regarding the sets and repetitions she is currently performing for each exercise. This booklet will provide the client with enough information to continue on with her training routine.

At the beginning of the semester, we provided our client with resistance bands to keep. She was given a blue resistance band towards the end of the semester when the yellow and green bands became too easy. The resistance bands will allow her to perform the majority of her exercises in the comfort of her home.

[edit] SMART Goals Results

[edit] Cardiovascular Endurance

The client's initial estimated VO2 max was 18.98 (ml x kg-1 x min-1). When we compared her score to Norms on p. 239 Table 11.14, she was in the 10th percentile. We wanted to improve her VO2 max from the 10th to 20th percentile. The client's estimated VO2 max did IMPROVE from 18.98 to 21.78, but it was not enough to move our client from the 10th to 20th percentile.

The client's initial one mile walk time for the Rockport Walking Test was 17 minutes and 52 seconds. When we compared her score to Norms on p. 242 Table 11.20, it was considered poor. We wanted to improve her walk time from poor to fair. Our client IMPROVED her walk time from 17 minutes 52 seconds to 17 minutes 12 seconds. This moved the client into the fair category based on her age and gender when compared to norms.

[edit] Flexibility

The client's initial sit and reach score was 6 inches. When compared to Norms on p. 245 Table 11.27, she was less than the 10th percentile. We wanted to improve the client's sit and reach by 1-2 inches or from 6 to 8 inches. Our client IMPROVED her sit and reach score by 4 inches or from 6 to 10 inches! This moved our client into the 10th percentile.

[edit] Strength

We wanted to improve the client's 3 strength and endurance test scores:

• Sit to Stand Chair Test - Goal was to increase from 7 to 10 in a 30 second time period. Our client IMPROVED from 7 to 10 and therefore, she achieved our goal.
• Modified Push-Ups - Goal was to increase from 13 wall push-ups to 18 wall push-ups or 10 modified kneeling push-ups in a 30 second time period. Our client did IMPROVE from 13 to 16, but did not achieve our goal.
• Crunches - Goal was to increase from 10 crunches to 15 crunches in a 30 second time period. Our client IMPROVED from 10 to 18 crunches.

 Our client also progressed from yellow to blue resistance bands. The client achieved the goal of performing 3 sets of 10 repetitions for all exercises. She was also able to go beyond that and perform 3 sets of 12 repetitions for some exercises.

[edit] Psychological

We wanted to improve the client's thoughts, feelings, and dedication towards exercise through continuous motivation and support.

Our client has IMPROVED because:

• Takes time out of her lunch break to go and walk on the track (goes alone)
• Was surprised that she is able to exercise without pain
• The client asked us to make her a booklet, so she could do the exercises at home
• Excited that she is able to perform the majority of the exercises at home
• Wants to come back in the fall with a new group

[edit] Functional

We wanted to improve the client's ability of getting up from the floor and down to the floor.

Our client has IMPROVED because:

• We have seen a large improvement in both the speed and quality of the movement.
• The client told us she has noticed an improvement. She told us it much easier and quicker to perform the movement.

[edit] Progression Summary Chart

Progression Summary Chart