Last Name 1

Case Study Exercise Program Exercise Prescription for John Doe

First Last Name Principles of Conditioning Professor Ni Bueno Date

Last Name 2

Client: John Doe John Doe is a 46 year old student at Cerritos College, measuring 5’10” and weighing 195 pounds. John has an overall good health history and does not have any current limiting conditions. He has a very busy schedule with work and school, and has not been able to maintain an exercise schedule. My first appointment with John was spent evaluating his postural deviations, going over his health history questionnaire, measuring his blood pressure, measuring his resting heart rate and discussing his SMART goals (Bryant and Green 48-50). According to his health history questionnaire John has torn his right ACL and both, left and right, medial minisci. He has had surgery on both knees. My client indicated he has low back pain on occasion involved with spinal extension and rotation. The questionnaire also showed a history of heart problems in immediate family; mother has had two heart attacks and he lost his uncle from a heart attack. John was told by a doctor that he has high blood cholesterol levels. Based on the health history questionnaire I required John to get a medical release form from his physician before beginning his training program. Using protocols from ACE Personal Trainer Manual (Bryant and Green 136-139), I performed a functional assessment of his static posture using a plumb line from the anterior, posterior, and sagittal views. John displayed thoracic kyphosis with a forward head position, rounded shoulders, medially rotated humerus and depression of the chest (Table-1 indicates weak muscles and tight muscles). He also showed lumbar lordosis with an anterior pelvic tilt. John’s beginning Body Mass Index (BMI) was 28 which classifies him as being overweight. Having a BMI greater than 25 puts him at an elevated health risk and increases his risk for cardiovascular disease, metabolic syndrome, hypertension, and type 2 diabetes (Bryant

Last Name 3 and Green 185-186). Using an electrical impedance device, his body composition yielded 26.7% body fat which categorizes him as overweight. John’s resting heart rate, RHR, is 54 beats per minute. Using Karvonen’s training zone formula, John’s target heart rate is between 126 bpm and 156 bpm during training. In addition, his blood pressure is 123 (systolic)/ 77 (diastolic) which classifies him as being in the prehypertension stage and can be reduced through lifestyle changes such as exercise, weight loss, and sodium restriction (Bryant and Green 128-129). John’s SMART goals are to lose ten pounds from 195 to 185 and to establish a healthy exercise program, accompanied by a balanced diet. Although John’s goal to lose ten pounds seems to be his target goal, I will not focus on the judgment of a scale because I want to keep track of John’s body composition as he might lose fat but not weight due to the fact that muscle is more dense than fat ("Is It Healthier To Be A Little Overweight?"). Decreasing his body fat percentage will help improve his cholesterol level (Gutfeld) in addition to implementing a balanced diet limiting his saturated fat intake. Following medical release from his physician, we will try to decrease John’s back pain by strengthening the proper postural muscles according to Table-1. As I prepare an exercise program for my client, I will be sure that the exercises and workouts are all low impact routines with the knee sensitivity in mind. John shows some interest in bicycling and swimming, which are great low impact cardiovascular exercises. After answering the Readiness to Change questionnaire (Bryant and Green 104), John appears to be ready to change but he might need some support from his friends and family. Due to the imbalances in flexibility, muscular strength and endurance, I will be starting John in a program focusing on stability and mobility. Phase 1, using the FITT strategy (Bryant and Green 374), will continue until he can display effective strength of core muscles and

Last Name 4 improved range of motion in the hips and shoulders. I will spend roughly 2-4 weeks in this phase (Table 2). Frequency: John will train two times per week with me and once on his own Intensity: Bodyweight Type: Exercises to improve core strength, and flexibility in hips Time: Each workout will be 60 minutes including warm-up, cool-down, and stretching

Cardiorespiratory training in phase 1 (Table 3) will consist of three aerobic training sessions per week. I will be using the Talk Test to monitor John’s intensity as I implement walking and light jogging (Bryant and Green 382). The first phase will only include low-impact exercises until he can perform 25-30 minutes of continuous walking and jogging with low intensity, below the Talk Test. Functional Movement and Resistance Training Phase 2: Movement Training will last until John can demonstrate the five basic movement patterns of squatting, lunging, pushing, pulling, and rotating (Table 4). We will spend roughly 4-6 weeks in phase 2. Frequency: John will train two times per week with me and once on his own Intensity: Bodyweight Type: Exercises to retain basic patterns of movement and muscle coordination Time: Each workout will be 60 minutes including warm-up and cool-down

Last Name 5 Cardiorespiratory Training Phase 2: Aerobic-efficiency Training will consist of interval walking for 25-30 minutes three times per week (Table 5). Since John indicated he enjoyed swimming and bicycling, he may include those activities in this phase. Phase 2 will last until he can demonstrate efficiency in the exercises, roughly 2-4 weeks. Functional Movement and Resistance Training Phase 3: Load Training will consist of bodyweight and load resistance exercise that create total body strength (Table 6). Once reaching this phase, I suggest John stay at this phase and use the exercises for maintaining overall total body strength. Frequency: John will train once a week with me and twice on his own Intensity: Intensity set to achieve strength and should fatigue by twelfth repetition Type: Exercises that promote total body strength Time: Each workout will be 60 minutes including warm-up and cool-down

Cardiorespiratory Training Phase 2 Progression is devised to maintain aerobic endurance for 30 or more minutes continuously by means of swimming, bicycling, or using an elliptical machine (Table 7). He will remain in this phase to avoid any injuries that could occur in the anaerobic phase. According to the Transtheoretical Model of Behavior Change (Bryant and Green 67), John is in the preparation stage since he is considering changing his lifestyle to be more active but has not been consistent with his workouts. This unique program is designed to guide John into developing and maintaining an exercise program based on his specific goals and needs. It is an easy to follow program and I’m sure John will be successful in following it.

Last Name 6

John Doe: Health-risk Appraisal Age

46

Height/Weight

5’10”/ 195 lbs

Exercise history

Has exercised occasionally but has not been able to maintain a exercise routine. Previously participated in recreational sports. Wants to lose ten pounds and be healthier

Medical history

Reconstructive surgery on both knees. Tore his ACL in his right knee, and tore medial minisci in both, left and right, knees in 2011. Some low-back pain involved with spinal extension and rotation No serious health issues Currently taken no medication

Risk factors

Resting heart rate: 54 bpm Blood pressure: 123/77 Doctor indicated high Cholesterol Mother suffered two heart attacks, uncle passed away from heart attack

Table 1: Assessment Notes Assessment

Results

Observations

Functional Assessment: Plumb Line Analysis

Thoracic Kyphosis

Protracted shoulders, medially rotated humerus, depressed chest, and forward head position

Functional Assessment: Plumb Line Analysis

Excessive Lordosis

Anterior pelvic tilt

Last Name 7

Functional Assessment: Shoulder FlexionExtension Test

Inability to flex shoulders 170 degrees

Tightness in Pectoralis major and minor, serratus anterior, Kyphosis of thoracic spine

Functional Assessment: Thomas Test

Both left and right knees remain in flexion

When attempting to go into knee extension, lumbar spine goes into extension

Anthropometri c Measures: Body Composition

26.7% Body Fat

Bioelectrical Impedance Device. Categorized as obese

Anthropometri c Measures: Body Mass Index

BMI 28

BMI indicates overweight

Cardiorespirat ory Fitness Assessment: Resting Heart Rate

Resting Heart Rate: 54 bpm Training Zone: 126-156 bpm

Karvonen’s training zone between 126156 beats per minute.

The kyphosis of the thoracic spine indicates tight muscles in pectoralis major and minor, serratus anterior, upper trapezius, levator scapulae, cervical spine extensors, and latissimus dorsi. Muscles suspected to be weak are the middle trapezius, lower trapezius, rhomboid major and rhomboid minor. Excessive lordosis indicates tight muscles in iliopsoas, erector spinae, and quadratus lumborum. Suspected weak muscles are rectus abdominis, external oblique, internal oblique, gluteus maximus, and hamstrings. Hip flexors will be a concentration of stretches and

Last Name 8 exercises. Shoulder flexion is limited due to tightness in serratus anterior, anterior scapulohumeral muscles and upper trapezius. Table 2: Functional Movement and Resistance Training Phase 1: Stability and Mobility Exercise Selection

Intensity

Repetitions

Rest interval

Sets

Supine 90-90 Neutral Back

Bodyweight

3-10 Minutes

Lying Hip Flexor Stretch

Bodyweight

15 second hold

30 seconds

2-4

Anterior Capsule Stretch

Bodyweight

15 second hold

30 seconds

2-4

Table-top kneeling lat stretch

Bodyweight

15 second hold

30 seconds

2-4

Half Kneeling Triplanar Stretch

Bodyweight

15 second hold

30 seconds

2-4

Shoulder bridge (glute bridge)

Bodyweight

5-10 (hold for 1-2 seconds)

30 seconds

1-2

T-Spine Spinal Extension

Bodyweight

5

30 seconds

2-4

T-Spine Prisoner Rotations

Bodyweight

2-4 (15 second hold)

30 seconds

2-4

Rocking Quadrupeds

Bodyweight

10

30 seconds

1-2

Prone arm lifts

Bodyweight

2-4 (10 second hold in formations :I,Y, W, O)

30 seconds

2-4

1

Last Name 9 The stretches and exercises included in the table target John’s weak and tight muscles according to his postural deviations. The stretches included in the table will remain a part of his training program although they will not be repeated in the tables for the next phases. Table 3: Cardiorespiratory Training Phase 1: Aerobic-base Training Warm-up Fast walk for 5 minutes

Workout Frequency: 3 days per week Intensity: Below the talk-test threshold Type: Walking Time: 25-30 minutes continuous exercise

Cool-down Walk for 5 minutes

All cardiorespiratory training will be low-impact in precaution of knee injuries. Table 4: Functional Movement and Resistance Training Phase 2: Movement Training Exercise selection

Intensity

Repetitions

Rest interval

Sets

Dynamic warm-up: ● Plank ● Side plank ● Glute bridge ● Crunches

Bodyweight

12-15 (Planks Held for 30-60 seconds)

90 seconds after all four exercises

3

Hip hinge

Bodyweight

12-15

30 seconds

2-3

Bodyweight squats

Bodyweight

12-15

30 seconds

2-3

Half-kneeling lunge rise

Bodyweight

12-15

30 seconds

1-3

Lunges

Bodyweight

12-15

30 seconds

2-3

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Seated Bilateral cable press

65% 1RM

12-15

30 seconds

2-3

Thoracic Matrix

Bodyweight

12-15

10-15 seconds

1-2

Bilateral Cable Rows

65% 1RM

12-15

30 seconds

2-3

Assisted Pull Ups

Bodyweight

12-15

30 seconds

2-3

Half kneeling Wood-chop

Bodyweight

12-15

30 seconds

2-3

Half kneeling Hay-bailers

Bodyweight

12-15

30 seconds

2-3

Phase 2 targets movement training of the five basic movement patterns of squatting, bending, pushing, pulling, and rotating. Training with these exercises in all three planes will help increase John’s ability to perform ADL’s (Bryant and Green 330).

Table 5: Cardiorespiratory Training Phase 2: Aerobic-Efficiency Training Warm-up Fast walk/bicycling for 5 minutes

Workout Frequency: 3 days per week Intensity: Comfortable to hold a conversation 10 minutes Difficult to hold a conversation 5 minutes Comfortable to hold a conversation 10 minutes Type: Walking, stationary bicycling Time: 25-30 minutes continuous exercise

Cool-down Walk/bicycling for 5 minutes

Phase 2 of cardiorespiratory training focuses on beginning interval training. John may walk or use a stationary bicycle in efforts to create a low-impact routine.

Last Name 11 Table 6: Functional Movement and Resistance Training Phase 3: Load Training Exercise selection

Intensity

Repetitions

Rest interval

Sets

Bodyweight Medicine Ball

12-15 (Planks Held for 30-60 seconds)

2 minutes after circuit exercises

2-3

Dumbbell squats

65% 1RM

12-16

30-60 seconds

2-3

Dumbbell side lunges

65% 1RM

12-16

30-60 seconds

2-3

Bent-over barbell rows

65% 1RM

12-16

30-60 seconds

2-3

Upright dumbbell rows

65% 1RM

12-16

30-60 seconds

2-3

Standing unilateral cable press

65% 1RM

12-16

30-60 seconds

2-3

Dumbbell incline chest flys

65% 1RM

12-16

30-60 seconds

2-2

Standing unilateral cable rows

65% 1RM

12-16

30-60 seconds

2-3

Bodyweight

To fatigue

30-60 seconds

2-3

Cable triceps pushdowns

65% 1RM

12-16

30-60 seconds

2-3

Dumbbell biceps curls

65% 1RM

12-16

30-60 seconds

2-3

Reverse dumbbell flys with hip hinge

65% 1RM

12-16

30-60 seconds

2-3

Dumbbell shrugs

65% 1RM

12-16

30-60 seconds

2-3

Dynamic warm-up ● Plank ● Side plank ● Glute bridge ● Crunches on ball ● Prone arm lifts (W,I,T,Y)

Assisted Pull Ups

Last Name 12 This phase is an overall total-body workout that targets the five basic movement patterns. Sets of 12-16 repetitions at 60-70% 1RM are specific for those who want to improve muscular endurance, fitness, and health (Bryant and Green 333). This phase will be used to maintain good health and wellness for John. Table 7: Cardiorespiratory Training Phase 2 Progression: Aerobic-Efficiency Training Warm-up Elliptical, bicycling, or fast walk for 5 minutes

Workout Frequency: 3 days per week Intensity: Comfortable to hold a conversation 10 minutes Difficult to hold a conversation 5 minutes Comfortable to hold a conversation 10 minutes Type: Walking, stationary bicycling, swimming laps Time: 25-30 minutes continuous exercise

Cool-down Walk/bicycling/swimming for 5 minutes

This is a progression of phase 2 because I do not want to compromise John’s knees. This phase will be used as maintenance for his cardiorespiratory endurance and will help promote a healthier lifestyle. This is a 10-12 week program that is designed uniquely for John’s goals. Following the training program will guide him to improve his postural deviations, lose ten pounds, gain muscular endurance, gain cardiorespiratory endurance, improve body fat composition, and help him become a healthier person. Once John agrees to the training program we will start promptly to begin his lifestyle change.

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Works Cited Bryant, Cedric X., and Daniel J. Green. ACE Personal Trainer Manual: The Ultimate Resource for Fitness Professionals. San Diego, CA: American Council on Exercise, 2010. Print. Gutfeld, G. "Muscle Up Your Metabolism." Prevention 43.8 (1991): 60. Academic Search Premier. Web. 30 Apr. 2013. "Is It Healthier To Be A Little Overweight?." Consumer Reports On Health 17.10 (2005): 8-9. Academic Search Premier. Web. 29 Apr. 2013.