1. Exercise Programming:
From Initial Screening(s) and
Baseline Assessments to the
Exercise Prescription

3. Fitness/Wellness Specialist Responsibilities
• Educate clients
• Conduct pretest health evaluationsConduct pretest health evaluations
• Select, administer, interpret tests to assessSelect, administer, interpret tests to assess
components of physical fitnesscomponents of physical fitness
• Design exercise prescriptionsDesign exercise prescriptions
• Lead classes/Give presentations
• Analyze client exercise performance and correct errors
• Motivate clients
• Reassess clients/athletes – be dynamic!

4. The Exercise “Science Artist”
“….exercise prescription is the
successful integration of exercise
science with behavioral techniques
that result in long term program
compliance and attainment of the
individual’s goals.”
ACSM Guidelines for Exercise Testing and
Prescription, 2000, pg 140

5. Exercise Programming and
Prescription
Definition:

6. Elements of Exercise Prescription
FITT-P

7. Exercise Prescription vs.
Health Related Fitness

8. Factors To Consider When Designing
An Exercise Prescription
• Health status
• Risk factor profile
• Medical evaluation
• Individual’s goals
• Baseline values
• Exercise preferences
• Program design principles
• Adherence factors

9. Why do we care about health
screening and risk stratification?

10. Health Screenings
• Par – Q
• Medical History
Questionnaire
• Coronary Risk factor
analysis
• Disease Risk Classification
• Informed Consent
• Physical Exam
• Lipid Panel and Glucose
Levels
• Blood Pressure
• 12-Lead ECG
• Graded Exercise Test
Clinical Tests

11. Self-Guided Screening
• PAR-Q and You
▫ Physical Activity Readiness Form
 Figure 2.1, p. 24 (ACSM)
 For pregnancy, p. 196 (ACSM)
• AHA/ACSM Health/Fitness Facility Pre-
participation Screening Questionnaire
▫ Figure 2.2, p. 25 (ACSM)

12. Professionally Guided Screening
• Health fitness/clinical assessment and activity
programming conducted and supervised by
appropriately trained personnel
• Professionally guided screening includes:
▫ Coronary Risk factor analysis
▫ Review more detailed health/medical hx info and
risk stratification
▫ Detailed recommendations for PA/exercise,
medical exam, exercise testing, physician
supervision

13. CVD Risk Factor Thresholds for
Use with ACSM Risk Stratification
•Positive and Negative Risk
Factors
(Table 2.2, p. 27, ACSM)

14. CVD Risk Factor Thresholds for Use with ACSM Risk
Stratification
Positive Risk Factors (Table 2.2, p. 27, ACSM)

16. CVD Risk Factor Thresholds for Use with ACSM Risk
Stratification
Positive Risk Factors (Table 2.2, p. 27, ACSM)

17. Calculating BMI
• BMI = weight in kg. / height in meters2
Weight: 180 lbs
Height 5 ft. 8 in.
What is the client’s BMI classification?
Weight: 257 lb
Height 5 ft. 9 in.
What is the client’s BMI classification?

18. BMI Classification

19. Hypertension

20. Cholesterol Classifications
ClassificationClassification TCTC LDL-CLDL-C TGTG
Optimal
Near/above
optimal
100-129
Borderline High
High >240 160-189 200-499
Very High >190 >500

21. HDL–C Classification
Classification HDL-C
Low
Normal
High (this is good!)

22. Fasting Blood Glucose
From 70 to 99 mg/dL
From 100 to 125 mg/dL
>126 mg/dL on more than one test

23. CVD Risk Factor Thresholds for Use with ACSM Risk
Stratification
Negative Risk Factors (Table 2.2, p. 27, ACSM)

24. How do I remember all of those risk
factors?

25. Case Study #1
• Bob Marley
▫ 54 year old male
▫ Cigarette smoker
▫ Brother died of MI age 55
▫ BP: 130/82
▫ HDL-C: 44 mg/dL
▫ TC: 188 mg/dl
▫ Fasting glucose: 112 mg/dl (verified 2x)
▫ Height: 5’7.5”; Weight: 160 lbs
▫ Light activity 3 days/week, 30 min (last 3 years)
▫ Medications: ACE-inhibitor, diuretic

26. • Jane is a 46 year old female. She has a family
history of breast cancer (mom was diagnosed at 47
and sister at 36). She quit smoking when she was 21.
She has been walking briskly (mod) for 45 minutes,
3 days per week, for the last 6 months. Her height is
5’2” and she is 130 lbs and her waist circumference
is 33”. Her cholesterol and glucose levels are all
within normal range, though her HDLs are 62mg/dl.
Her blood pressure is 126/88.

27. Medications
• Blood pressure control **
▫ Diuretics
▫ Beta-blockers
▫ ACE Inhibitors
▫ Angiotensin II receptor
blockers
▫ Calcium channel blockers
▫ Vasodilators
▫ Nitrates
• Asthma **
▫ Oral or inhaled
bronchodilators
• Glycemic control
▫ Biguanides (Metformin,
Glucophage)
▫ Alpha-glucosidase inhibitors
(Precose, Glyset)
▫ Sulfonylureas (Glucotrol,
Amaryl)
• Cholesterol lowering
▫ Statins (Lipitor, Zocor,
Provachol)
▫ Nicotinic acid (Niacin)
▫ Fibrates
• Thyroid **
▫ Thyroid hormone medicine,
levothyroxine sodium
(Synthroid, Levoxyl, or
Levothroid)

28. Medications
• Beta blocker (BP)
▫ Decrease force of
contraction
▫ Decrease cardiac workload
▫ Decrease demand for O2 in
myocardium
• Nitrates (BP)
▫ Vasodilator
▫ Decrease preload and
cardiac workload
• Ca2+ channel blockers (BP)
▫ Prevent vasoconstriction
▫ Prevent coronary artery
spasm
▫ Increase O2 supply to
myocardium
• Diuretic (BP)
▫ Increase H2O excretion
▫ Decrease blood volume
• Ace inhibitor (BP)
▫ Prevent vasoconstriction
▫ Prevent H20 retention
▫ Decrease blood volume

29. Medications
Meds HR BP
Beta Blocker
Nitrate
Calcium Channel Blocker
Diuretics
Ace Inhibitors
Bronchodilators
Thyroid meds
Nicotine

30. Table 2.1 ACSM Risk Stratification Categories for
Atherosclerotic CVD (Figure 2.4 ACSM p. 28)

31. • CVD, pulmonary, or metabolic disease
▫ CVD: Coronary, peripheral vascular, or
cerebrovascular disease
▫ Pulmonary: COPD, asthma, interstitial lung
disease, cystic fibrosis
▫ Metabolic: diabetes (I or II), thyroid disorders,
renal, or liver disease
Cardiovascular, Pulmonary, and
Metabolic Disease - - HIGH RISK!

32. Major symptoms or signs suggestive of cardiopulmonary or metabolic
disease.*
___________________________________________________
1. Pain, discomfort (or other anginal equivalent) in the chest, neck, jaw,
arms, or other areas that may be ischemic in nature
2. Shortness of breath at rest or with mild exertion
3. Dizziness or syncope (fainting)
4. Orthopnea/paroxysmal nocturnal dyspnea (labored breathing;
discomfort in breathing in any but erect position)
5. Ankle edema
6. Palpitations or tachycardia
7. Intermittent claudication
8. Known heart murmur
9. Unusual fatigue or shortness of breath with usual activities
___________________________________________________
*These symptoms must be interpreted in the clinical context in which they
appear, since they are not all specific for cardiopulmonary or metabolic
disease. See description of each in ACSM Guidelines.
___________________________________________________
Figure 2.3 ACSM p. 26

33. ACSM Figure 2.3

34. Case Study
• Lolo Jones
▫ 26 years old, non-smoker
▫ BMI: 24.6 kg/m2
▫ Asthmatic, normal cholesterol and BP
▫ Fasting glucose: 85 mg/dl
▫ Sprint athlete – works out 6 days/week 2+ hours per
day (vigorous activity) for last 2 years
▫ No family history of heart disease
▫ Sister, 22, has Type 2 diabetes

35. Exercise Testing and Participation
Recommendation Based on Risk
• Once risk classification established,
appropriate recommendations may be made
regarding:

38. Maximal Graded Exercise Test (GXT),
Reasons for Max. Testing in the Clinical Setting:
 To find the true max. HR for exercise prescription
 To measure or estimate VO2 max.
 To determine baseline aerobic fitness level
 To help plan a safe and effective exercise program
 To aid in the diagnosis of CVD in the mod. risk or in
those who are symptomatic (*with ECG*)
 To follow the progress of known disease (*with ECG)

39. Submaximal Exercise Tests

40. • Sheri is a low risk client. She was told by her
previous trainer that she should not have a GXT
done because according to ACSM GXTs are only
for moderate to high risk clients.
• Do you agree or disagree with her previous
trainer? Why?

41. Metabolic Syndrome

42. >100

43. Factors To Consider When Designing
An Exercise Prescription
• Health status
• Risk factor profile
• Medical Evaluation
• Individual’s goals
• Baseline Values
• Exercise preferences
• Program Design Principles
• Adherence factors

44. Purpose of Health Related Fitness
Testing
• Educate participants about present health-
related fitness status relative to standards and
age and gender norms
• Provide data helpful in development of exercise
prescriptions
▫ Address all fitness components
▫ Baseline data and follow – up
▫ Motivate participants
▫ Stratify risk

45. Components of Health Related Fitness
1. Body weight and body composition
2. Cardiorespiratory Endurance (Fitness)
3. Muscular Endurance
4. Muscular Strength
5. Flexibility

46. Measures of Weight or Body Comp.
Anthropometric measures:

48. Cardiorespiratory Endurance (CRE) /
Cardiorespiratory Fitness (CRF)
• Ability of heart, lungs, and circulatory system to
supply O2 and nutrients effectively to working
muscles
• Typically expressed as VO2max
• Clinical submaximal and maximal tests
▫ Field tests

49. Musculoskeletal Fitness
• Ability of skeletal muscle systems to perform work
• Muscle strength
• Muscle endurance

50. Muscular Strength Testing
 Grip Strength
 One Repetition Max.
 4, 5, or 6 Rep Max
•
Muscular Endurance Testing
 Curl Up
 Push Up

51. Flexibility
• “Sit and Reach” test

52. Components of Health Related Fitness
1. Body weight and body composition
2. Cardiorespiratory Endurance (Fitness)
3. Muscular Endurance
4. Muscular Strength
5. Flexibility

53. Test Validity, Reliability, and Objectivity
• Validity
• Reliability
• Objectivity

54. Prediction equations
• To whom is equation applicable?
▫ Population specific vs. general
• How were variables measured by the researchers
who developed equation?

55. Feasibility
Efficacy
Health history
Goals
Things to keep inThings to keep in
mind:mind:

56. Preparing to Test Your
Client/Athlete

57. What should be the
proper order of testing?
• Flexibility
• Body composition
• Muscular fitness
• HHQ/Risk stratification
• CRE / CRF
• Resting BP and HR

58. Give client specific instructions as
to what to wear, what to bring, and
what to expect on testing day!

59. Always have your supplies
and equipment ready
before the client arrives!

60. Make the client as
comfortable as possible!

61. Be professional, be confident,
be yourself!

62. Test Interpretation
• Calculate necessary values
• Classify client results by comparing to
established norms or percentile rank
• Discuss results with clients
▫ Provide hard copy of results to client
▫ Keep a copy for your records!

63. Factors To Consider When Designing
An Exercise Prescription
• Health status
• Risk factor profile
• Medical Evaluation
• Individual’s goals
• Baseline Values
• Program Design Principles
• Exercise preferences
• Adherence factors

64. Characteristics of Exercise Program Dropouts &
Factors Related to “Dropping Out”

65. Reinforcing Factors for Exercising
(Promoting Adherence)

66. Exercise Program Design
Principles

67. Exercise Program Design Principles
• Specificity of Training
• Overload training
• Progression
• Initial values
• Inter-individual variability
• Diminishing returns
• Reversibility

68. Principle of Specificity
The training effects from any exercise are specific
to the activity and the muscles involved.

69. Overload Training
Progression

70. Inter-individual variability
• Responses to a training stimulus vary amongst
individuals
• What are some factors that vary amongst
individuals?

71. Initial Values
Diminishing Returns
Reversibility

72. Genetic
Ceiling

73. Clinical Tests
• Physical Exam
• Lipid Panel and Glucose Levels
• Blood Pressure
• 12-Lead ECG
• Graded Exercise Test

74. Case Study
• Height: 5’5”
• Weight: 138lbs

75. Case Study
• Sonia Sotomayor
▫ 44 year old female with BMI of 23 kg/m2;
▫ WC = 35inches
▫ BP: 134/82; does not smoke
▫ HDL-C: 42 mg/dl
▫ Father had MI age 42, Sister MI age 50
▫ Brother has T2DM, diagnosed age 35
▫ Fasting glucose: 95 mg/dl
▫ Mod exercises 5 days per week, 30 min (last 2 months)
▫ Meds: aspirin for knee pain from a sporting injury

76. Case Study
• Mike Magiske
▫ 62 year old, sedentary male
▫ Quit smoking 5 months ago
▫ Impaired fasting glucose (Pre-diabetes/insulin
resistance)
▫ Obese --Low HDLs
▫ Normal Triglycerides
▫ Mother died of CVD age 57

77. • You have determined that Spencer is a high risk
client. Spencer wants to begin a moderate
walking program.