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PEKN 4P22 Group 1

Kevin, Matt, Thomas and Jason


Contents

[edit] Client Initial Questionnaire:

Km08te 10:37, 17 October 2011 (EDT)

Age:

56

Gender

Female

Goals:

Flexibility of her right hip, she sees a chiropractor every 3 weeks but they are unable to adjust her hip (believed due to lack of flexibility) she has degenerative disc damage in her spine from what she believes was from lifting children etc (she relates it to her hip).

Notes

She also has weakness in her right knee; causes her pain sometimes if worked hard, she used to work out every day about 2 years ago and during that time she did not experience knee pain as the muscle had been strengthened.

She exercises currently twice a week at Brock during the noon fitness classes which are either step or ball classes at medium-low intensity

She walks her dogs every day for about a kilometer or 2 and walks from zone 2 every day to get to work

She finds workouts such as swimming, yoga, stationary bike can get boring.. (I thought maybe yogalates for her as it is more up-pace yoga; flexibility)

She has high blood cholesterol but she believes she is beating or beaten it. Takes no medication.

The days she is free to use the gym or meet with us is Wednesday or Thursday afternoon, she will also go home and do homework (our exercises) upon our prescription

Par-Q

Client Par-Q hard copy

[edit] Client Assessment Rationale

We wanted to pick a few low intensity, easy to conduct, valid and reliable tests. We wanted to target as many major muscle groups, and differentiate between energy systems if possible. We accomplished this all while keeping in mind our clients goals, attributes (motivation, efficacy) and physical characteristics (age, gender, training status)

[edit] Client Assessment Protocol:

Km08te 10:09, 17 October 2011 (EDT)

Push-Up Test

Some muscular endurance tests may involve resistance exercises heavy enough to permit only a limited number of repetitions ti be performed by untrained clients. For example: clients with weak or small upper body muscles (young or elderly) may not be able to complete many repetitions. The fact that not many repetitions can be performed by the client indicates that the test becomes a function of strength. Therefore the test becomes one that can be used to assess muscular strength.

Equipment

Foam Roller Yoga Mat

Procedure

1. Have the Client assume the standard push-up position. For women, modify the position by having the Client perform in a kneeling position, with the knees flexed at 90 degrees and ankles crossed.[1]

2. Use the foam roller, and instruct the female client to lower her torso until she lightly touches it. The body should be raised to full arms length.

3. Record the maximum number of complete repetitions until postural fatigue.

4. Compare Clients data to norm values (add table) KM

Image:4P22 Modify Pushup.PNG

References

- NCSA's Essentials of Personal Training p 237 - NCSA's Essentials of Personal Training p 259 for 'norm values'



Sit and Reach

There is no single test that can measure whole body flexibility. Many believe that sit and reach test is a measure of hip and low back flexibility. However, it may not be an adequate measure of low back and hip function because it only measures the distance reached by the client. It is important to note that, a lack of hip and low back flexibility, along with poor muscular strength of the abdominal, is believed to be predictive of low back pain.

Equipment

Meter stick Tape Measuring tape Yoga Mat

Procedure

1. Have the client perform a light warm-up involving dynamic active movements. Make sure the client has removed shoes prior to test and that the test be conducted via slow controlled stretches.

2. For the YMCA sit and reach test, place the meter stick on the floor and place tape perpendicular across the meter stick at the 38 (15 in) cm mark. The client then sits on the yoga mat with heels lined up with the 38 cm (15 in) mark. Feet should be 25-30 cm apart.

3. The client is then instructed to reach forward slowly with both hands, moving as far possible and holding terminal position. The fingers should overlap and be in contact with the meter stick.[2]

4. The score is at the most distant point reached. Use the best of three trials to score. The knees must stay extended throughout the test, without the assistance of the tester.

5. Compare the results to 'norm values'

Image:4P22_Sit_and_Reach.PNG

References

-NCSA's Essentials of Personal Training p 238 -NCSA's Essentials of Personal Training p 260 for 'norm values'



Wall Squat Test

The wall squat test will primarily measure how strong your quadriceps are, however the hamstring and gluteal muscles will also come into play. It is a good assessment to do with our client because it is easy to conduct, requires little equipment and can help monitor our clients progress and results. Most importantly it gives us an accurate reading as to the capability of our clients lower body functional limitations, an area our client is interested in improving.

Importance to our client?

In every day life you are constantly moving in and out of this the squatted position, such as when you sit down in a chair or walk up a staircase. Increased strength in the active muscles will be very beneficial as to the proficiency of this activity.

Equipment

A wall Stopwatch

Procedure

1) To start the wall squat test first stand with your back flat against a wall, your feet about a foot away and shoulder width apart.

2) Begin to squat down, keeping the small of your back pressed firmly into the wall and ensuring that your knees are tracking properly over your toes.

3) Go down until the knee joint angle is approximately 90 degrees, or the point at which the thigh is parallel with the ground. Try and then hold this position until you can no longer maintain proper form.

Analysis

Compare your scores with the following standards (measured in seconds). For every 10 year block past age of 35, reduce raw score by 5.

Our client: (Reduce 10 seconds)

Women: Excellent: >39 (29) Good: 36 (26) Above Average: 31 (21) Average: 26 (16) Below Average: 23 (13) Poor: <20 (10)

Image:4P22_Wall_Sit.PNG


References

http://www.thefitmap.co.uk/exercise/tests/strength/lower/wall.htm



Midsection Strength Assessment

The trunk curl is a simple exercise that involves the abdominal muscles. When performed correctly, the trunk curl test provides an excellent evaluation of midsection, or core, muscle strength and endurance.

Procedure

Trunk Curl Starting Position

1) In a supine position with your head, upper back, arms, and hips on the floor, your hands next to hips, your knees bent approximately 90 degrees, and your feet flat on the floor.

Trunk Curl Exercise Execution

2) Contract your abdominal muscles to lift your upper back and head off the floor as far as possible (10 to 15 centimeters from shoulder to ground. Your lower back should remain in contact with the floor as your hands slide forward. Take one full second for the upward movement.

3) Lower your upper back and head to the floor, resuming the starting position. Take one full second for the downward movement.

4)Do not drop down quickly to the floor or bounce up from it. Perform as many trunk curls as possible. Record raw score

5) Interpret raw score to 'norms'

Midsection Strength Index- Women

Low 0-19 Moderate 20-39 High 40+

Image:4P22 Trunk Curl.PNG

References

http://www.humankinetics.com/mediasvr/MarketingPDFs/Westcott%206-7.pdf "Assessing Current Strength"



1 mile walk

Walking tests can predict VO2 max with reasonable accuracy. The following equation can predict VO2 max in ml/min-1 from walking speed, heart rate, body weight, age and gender in men and women.

VO2 max = 132.853 - (0.0769 x Wt) - (0.3877 x Age) + (0.5955(6.315 x Gender) - (3.2649 x T1) - (0.1565 x HR1-4)

The multiple correlation is r= 0.92. Using 1 mile walk performance in time (expressed in minutes and hundredth of minutes) for T1. The group studied ranged from 30-69 year old individuals. Therefore the method applies to a large segment of the adult population

Procedure

1) measure out a 1 mile (1609 meters) route. For our client 8.05 laps of the indoor track.

2) with assistance, enable the use of a heart rate monitor (Garmin Forerunner 210).

3) perform walk, obtain time (T1), body weight in kg (Wt), age in years, gender (female), Heart rate immediately at the end of trial (HR1-4).

4) Compute, obtain raw score

5) Compare to 'norms' (add table) KM

Image:4P22_200m_Track.PNG

References

-McArdle, W.D., Katch, F.I., & Katch, V.K. (2010). Exercise physiology: nutrition, energy, and human performance. (7th ed). Baltimore, MD: Lippincott Williams & Wilkins.

-NCSA's Essentials of Personal Training p 260 for 'norm values'

[edit] Group 1 Client Assessment Results

Km08te 21:08, 4 December 2011 (EST)


1 mile walk: 85 bpm

Sit & Reach: 18 cm

Push Up: 17 reps

Wall Sit: 60 seconds

Partial Curl-Up: 34 reps


Notes:

-No medicine for high cholesterol

-Often gets bored with exercise programs; looking for variety

-Good leg endurance and strength

-stabilization of core appeared to be easier

-dynamic movements of core more difficult, not smooth

[edit] Assessment Interpretation

Km08te 21:08, 4 December 2011 (EST)

1 mile walk: 85 bpm

Image:vo2_calc_pic.jpg

Her performance indicates she is 'fair'. In addition, from table 11.17 on page 249 from NSCA text: our client scores in the 20th percentile, below average.

Sit & Reach: 18 cm

18 centimeters is equal to 7.086614 inches.

According to table 11.31 on page 260 from the NSCA text: our client scores in the 10th percentile. Well below average.

Push Up: 17 reps

According to table 11.30 on page 259 in NSCA text: our client scores in the 80th percentile. Above average.

Wall Sit: 60 seconds

Image:SitAssessmentTABLE.jpg

After age corrected factor:

Women: Excellent: >39 (29) Good: 36 (26) Above Average: 31 (21) Average: 26 (16) Below Average: 23 (13) Poor: <20 (10)

Therefore our client's performance indicates that she is excellent in the wall sit test.

Partial Curl-Up: 34 reps

Based on table 11.28 page 257 from NSCA text: a score of 30 puts our client in the 80th percentile. This indicates that our client is above average for her age and gender.

References

Earle, Roger W., and Thomas R. Baechle. NSCA's essentials of personal training. Champaign, IL: Human Kinetics, 2004. Print.

[edit] Client Program Rationale

Km08te 12:49, 21 October 2011 (EDT)

http://www.legs-exercises.com/exercises/gym/ good website

The main goal with our program is to improve our client’s functional weaknesses. Interpreting the results of our client assessment indicated that she had

Frequency:

-3 days per week, 2 with group, 1 on own time.

Intensity

~15 RM, using body weight and/or light resistance, shown to increase muscle strength via neurological adaptations to muscle motor activation.

Time

~45 minutes/session. Shown to reduce chance of drop out.

Type

-mainly closed kinetic chain exercises

-mixture of dynamic and stabilizing strengthening

-flexibility component both dynamic and static

-warmup and cool-down

Progression:

utilize levers, neuromuscular challenge, repetitions, rest, resistance

Rest Interval

Between sets, 1:00. Allows for majority of ATP/CP to be regenerated. Appropriate for slow speed of performance and low-moderate loads (30-60%). This is shown in Bompa (1998) however, we found that 1:00 rest was too much, so we reduced it to 30 seconds mid-way through the program. This change allowed for an increased intensity as an increased response was demonstrated.

References

Bompa, Tudor O., and Lorenzo Cornacchia. Serious strength training. Champaign, IL: Human Kinetics, 1998. Print.

Bompa, Tudor O.. Periodization training for sports. Champaign, IL: Human Kinetics, 1999. Print.

ASCM Position Stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults

Earle, Roger W., and Thomas R. Baechle. NSCA's essentials of personal training. Champaign, IL: Human Kinetics, 2004. Print.

[edit] Client Program

Km08te 15:43, 12 November 2011 (EST)

Warmup

Five laps of 200m indoor track at a brisk walking pace. Group considered doing some more intensive dynamic flexibility exercises.

  • Meeting 5: changed to 2 lap speed walk and included a dynamic warmup including:

Knee to chest

Dosage: 15 x each leg

- smooth motion

- flex toe to shin

- up on your toe

- gentle pull

Image:Knee_to_chest.png

Heel to Butt

Dosage: 15 x each leg

- flex toe to shin

- smooth gentle motion

- hips forward

- stand tall

- up on toes

Image:MP_Heel_to_Butt.gif

Hurdler

Dosage: 15 x each leg

- imagine a hurdle just above your knee

- complete movement (full ROM)

- slow and controlled

Image:Hurdler.png

Reverse Hurdler

Dosage: 15 x each leg

- imagine hurdle just above your knee, behind you

- complete movement

- balance

- slow and controlled

Image:Reverse_hurdler.png


Main Section

1) Squat

For the first workout we chose a dynamic, closed chain kinetic exercise to strengthen the lower body of our client.

Initially we used a exercise ball for support, and performed against a wall. After 3 sets of 15 with 1:00 rest interval we noticed and after inquiry noted that it was quite easy for her to complete. We concluded that perhaps for the next workout we can make it more difficult.

To increase the difficulty we could implement various stresses:

a) add resistance (resistance bands/tubing, plate or free weight

Image:4P22_wall_squat_with_free.JPG

b) slow movement during motion, for example: 2:2 vs 1:1 concentric/eccentric contraction time

c) increase time held at point of maximal effort, for example: hold knees at 90' flexion for 2-3 seconds then concentrically return to starting position.

d) decrease base of support by adding knee extension when knees reach 90' flexion.

Dosage: 3 sets of 15, 1 minute rest between sets.

Image:4P22_ballsquatsingleleg.jpg

  • Meeting 5: added a medicine ball (10lbs), kept the swiss ball

Image:Rotational_Medicine_Ball_Squat.jpg

  • Meeting 6: added a medicine ball (15lbs), reduced rest to 30 seconds, kept swiss ball
  • Meeting 7: no change
  • Meeting 8: modified to single leg walking lunge with two 10lb dumbbell in each hand
  • Meeting 9: added weight to the single leg walking lunge with two 15 lb dumbbells in each hand
  • Meeting 10: unchanged, emphasized foot placement, slow controlled movement
  • Meeting 11: unchanged

Image:Walking-lunge.jpg

2) Modified Pushup

Since our clients initial pushup score was quite low, we decided to implement that very exercise. Knowing specificity of training, we hope to train the pushup ability and see improvements in that test post program. In addition the functional benefits of improved upper body strength.

Dosage: Maintaining the 3 sets of 15 principle, with 1:00 rest between sets. We proceeded. However knowing that her maximum performing in one set is 17, we decided to modify the repetitions per set to 10.

Image:Modified-Pushups.gif

  • Meeting 5: corrected technique to isolate correct muscles
  • Meeting 6: reduced rest between sets to 30 seconds
  • Meeting 7: no change
  • Meeting 8: no change
  • Meeting 10: add 2 reps on each set
  • Meeting 11: maintained 12 reps per set.

3) Hip abduction

Since hip stability and flexibility was an area of interest for our client, we decided to choose an exercise that worked the hip abductors and certain fibers that assist with hip extension.

Our client really liked this exercise, and seemed to be challenged.

Dosage: 3 sets of 15, 1 minute rest between sets.

  • Meeting 5: modified technique: isolated correct muscles, slowed movement down, held for 2 seconds at full abduction

Image:4P22_HipAbductionSide_Program.jpg

  • Meeting 6: added resistance band for monster walk, reduced rest to 30 seconds between each set (time during opposite stretch, resting unused limb)

Image:Monster_walk_ankle_bands.jpg

  • Meeting 7: eliminated the resistance band as it was awkward for the client. Modified hip abduction while stomach on ball, slightly rotated trunk.

Image:Modifiedhipabduction.jpg

  • Meeting 8: fixed technique, isolated movement
  • Meeting 10: Had an idea to try a new technique, decided not to and maintained previous exercise.

Image:Hipabductionwall.png

  • Meeting 11: went back to original hip abduction, 3 sets of 20, maintained slow controlled held for moment at raised position.


4) McGill Curlup

We chose this exercise because it allows for maximal abdominal activation, whilst limiting ROM that promotes faulty technique. For example: traditional crunches promote neck flexion, and compensation dismissing the isolation of the abdominals. After proper technique was shown, and cues given, the client performed well, felt challenged and we will continue to use this version.

Dosage: 3 sets of 15, 1 minute rest between sets.

Image:McGill_curl_up2.jpg

  • Meeting 5: changed technique to hands flexed, elbows to sky, hands on shoulder blades

Image:Modified_McGill.jpg

  • Meeting 6: reduce rest to 30 sec
  • Meeting 7: no change
  • Meeting 8: no change
  • Meeting 10: hold for 2 seconds at flexion
  • Meeting 11: slow controlled maintain at flexion.

5) Cat & Camel

Adapted from McGill (2002): "We recommend that the routine begin with the cat-camel motion exercise (spine flexionextension cycles) to reduce spine viscosity (internal resistance and friction) and “floss” the nerve roots as they outlet at each lumbar level, followed by hip and knee mobility exercises. Note that the cat-camel is intended as a motion exercise - not a stretch, so the emphasis is on motion rather than “pushing” at the end ranges of flexion and extension. We have found that 5-8 cycles is often sufficient to reduce most viscous-frictional stresses."

Dosage: 5-8 cycles as pointed out above, emphasizing motion, not peak curvature.

Image:CatCamel.png

  • Meeting 5, 6, 7, 8: no change
  • Meeting 10: no change
  • Meeting 11: no change

6) Plank

Initially we attempted a basic plank whereby the client 'planked' with palm of hands planted on the ground, arms extended and body prone with the trunk flat and feet about shoulder width apart, feet perpendicular to ground for support on toes.

Image:HP_209_Plank_248.jpg


This was considered too easy, therefore we progressed the exercise by changing the orientation and adding neuromuscluar challenge.

  • Meeting 5: changed technique: decrease base of support, extended resistance arm (shoulder extension)

Image:4P22_PlankBall_Program.JPG

  • Meeting 6: reduced rest to 30 seconds between sets.
  • Meeting 7: no change
  • Meeting 8: added 15 seconds to hold
  • Meeting 10: performed one set of 45sec, two at 60 sec hold time
  • Meeting 11: performed all three sets at 60 seconds


7) Kneeling Trunk Extension

To increase trunk flexibility, we chose a modality that used the exercise ball already present in wall squats. The client enters a kneeling position on a yoga mat present, places hands on the fitted swiss ball, then rolls the ball away from themselves, extending the trunk.

Dosage: 3 sets of 3-5 second holds each leg until tension is felt. Progressing each set to extend the point of tension.

  • Meeting 5, 6, 7, 8: no change
  • Meeting 10-11: performed 5 sets

Image:4P22_TrunkStretch1_Program.jpg


8) Hug Knee/Pretzel

Our clients lower back and hip flexibility is well below average, as shown by the results of our assessments above. Therefore a gluteal stretch was chosen. As of the first workout, our client really enjoyed and felt challenged on this stretch.

Dosage: 3 sets of 3-5 second holds each leg until tension is felt. Progressing each set to extend the point of tension.

Image:Image_76.jpg

  • Meeting 5: worked on technique
  • Meeting 6: changed rest length to switch (time during opposite stretch, resting unused limb)
  • Meeting 7: participated with client to demonstrate better technique
  • Meeting 8: held stretch for > 5 seconds
  • Meeting 10: held stretch for > 5 seconds and performed 5 sets
  • Meeting 11: held longer, performed 5 sets

9) Hamstring Stretch

To improve our clients sit and reach score in the future, another muscle group that will need work is the hamstring group. Therefore a single leg hamstring stretch was chosen. Technique emphasized: neutral spine, sit tall, imagine the trunk as an immovable plank whereby the only axis of rotation is at the hip.

Dosage: 3 sets of 3-5 second holds each leg until tension is felt. Progressing each set to extend the point of tension.

  • Meeting 5: worked on technique
  • Meeting 6: changed rest length to switch (time during opposite stretch, resting unused limb)
  • Meeting 7: no change
  • Meeting 8: held stretch longer > 5 seconds.
  • Meeting 10-11: held stretch for > 5 seconds and performed 5 sets.

Image:4P22_SeatedSingleLegHamstring_Program.jpg

  • Meeting 6: attempt few band stretches

10a) Band Stretches-Hamstring

Dosage: 3 x 3-5 s/leg / switch

- back flat

- head relaxed

- straight leg

- hold at point of tension

  • Meeting 7: stretches were success from Meeting 6, continued to impliment
  • Meeting 8: worked on technique (straight leg, breathing, where to pull from and to)
  • Meeting 10: held for > 5 seconds and performed 5 sets
  • Meeting 11: held for > 5 seconds and performed 5 sets

Image:BandHamstring.png

10b) Band Stretches- Adductor

Dosage: 3 x 3-5 s/ leg/ switch

- gentle stretch

- opposite leg flexed and planted

- trunk, head relaxed

  • Meeting 7: stretches were success from Meeting 6, continued to implement
  • Meeting 8: worked on technique (always start down, pull abduction, hold)
  • Meeting 10: held for > 5 seconds and performed 5 sets
  • Meeting 11: held for > 5 seconds and performed 5 sets


Image:BandAdductor.png

11) Lying Cross-Over

Dosage: 3 x 3-5 s/ leg / switch

- gentle stretch

- until point of tension

- overpressure can be applied to bent kne

- relax low back, head

  • Meeting 7: stretches were success from Meeting 6, continued to implement

Image:LyingCrossOver.png

  • Meeting 8: worked on technique (foot reaches to feel stretch)

Image:LyingCrossover.jpg

  • Meeting 10: peformed 3 sets held for 5 seconds and switched
  • Meeting 11: peformed 3 sets held for 5 seconds and switched

References

http://cajunchiro.net/Documents/McGill%20Curl%20Up.pdf "Spinal Stabilization"

http://www.ahs.uwaterloo.ca/~mcgill/fitnessleadersguide.pdf "Enhancing Low Back Health through stabilization exercise"

Voight, Michael L., Barbara J. Hoogenboom, and William E. Prentice. Musculoskeletal interventions: techniques for therapeutic exercise. New York: McGraw-Hill, Medical Pub. Division, 2007.

http://professionalmassagetherapist.org/stretches/stretches_Results.php "The Stretching Post"

[edit] Final Assessment Interpretation

Km08te 21:08, 4 December 2011 (EST)

1 mile run: 140 bpm

Image:Vo2_run_test.png

Her performance indicates she is 'fair'. In addition, from table 11.17 on page 249 from NSCA text: our client scores in the 20th percentile, below average.

Image:Vo2_walk_test_post.png

This is her performance using the Rockport Walk formula, even though she ran, the results for estimated Vo2 are similar.

Sit & Reach: 20 cm

20 centimeters is equal to 7.9 inches.

According to table 11.31 on page 260 from the NSCA text: our client still scores in the 10th percentile. Well below average.

Push Up: 24 reps

According to table 11.30 on page 259 in NSCA text: our client scores in the 90th percentile. Above average.

Wall Sit: 90 seconds

Image:SitAssessmentTABLE.jpg

After age corrected factor:

Women: Excellent: >39 (29) Good: 36 (26) Above Average: 31 (21) Average: 26 (16) Below Average: 23 (13) Poor: <20 (10)

Therefore our client's performance indicates that she is well above excellent in the wall sit test.

Partial Curl-Up: 40 reps

Based on table 11.28 page 257 from NSCA text: a score of 40 puts our client just under the 90th percentile. This indicates that our client is above average for her age and gender.

References

Earle, Roger W., and Thomas R. Baechle. NSCA's essentials of personal training. Champaign, IL: Human Kinetics, 2004. Print.

[edit] Program Summary

Km08te 21:09, 4 December 2011 (EST)

Image:Final_Summary.jpg

  • First 1 mile followed Rockport Walk Protocol, Second 1 mile run followed Brian Mac protocol.

References

GEORGE, J.D. et al. (1993) VO2max estimation from a submaximal 1-mile track jog for fit college-age individuals, Med Sci Sports Exerc., 25 (3), p. 401-406

[edit] Meetings & Attendance

Km08te 13:15, 4 November 2011 (EDT)

Meeting # 1: Jason, Brendan (dropped course)

October 18:

Meeting # 2: Assessment: Kevin, Matt

October 25:

Meeting # 3: Workout 1 Kevin, Matt, Jason, Thomas

October 28:

Meeting # 4: Workout 2 Jason, Matt

November 1:

Meeting # 5: Workout 3 Kevin

November 4:

Meeting # 6: Workout 4 Kevin, Jason,

November 8:

Meeting # 7: Workout 5 Kevin

November 10

Meeting # 8: Workout 6 Kevin, Matt, Thomas

November 15

Meeting # 9: She came and cancelled Kevin, Jason, Matt

November 17

Meeting # 10: Workout 7 Kevin, Matt

November 22

Meeting # 11: Workout 8 Kevin, Thomas

November 24

Meeting # 12: Only one of us available, therefore cancelled

November 29

Meeting # 13: Final assessment Kevin, Matt, Thomas

[edit] Presentation

Km08te 21:09, 4 December 2011 (EST)

Group 1 Presentation

Client Handout for personal use

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