Ex Assessment Test 2

passive straight leg raise

-the leg is raised to end ROM (may be necessary to put one hand on the contralateral thigh to prevent pelvic rotation) -although 80 degrees may be used as a criterion, 90 degrees is often used as a goal

the quadruped exercise

-this exercise emphasizes the low back musculature; also requires coordination -keeping the spine in neutral is critical; the only movement that should occur is in the extremities -initially, only one arm or leg is raised

roman chair

-this exercise strengthens the lumbar errector spinae muscles -although often used in therapeutic programs, it would not be recommended for all

mad cat stretch

-this is a good exercise to do as a warm up before placing any stress on the spine

advanced horizontal isometric side bridge

-this is a more difficult version of the side bridge exercise for quadratus lumborum and transversus abdominis development -also typically held isometrically for 30 to 60 seconds

horizontal isometric side bridge

-this is an exercise for quadratus lumborum and transversus abdominus development -typically held isometrically for 30 to 60 seconds

trunk extension exercise

-this passive ROM exercise can be used to maintain extension ROM in the lumbar spine

hip flexor stretch

-to stretch the hip flexors (ex. psoas) it is important to keep pelvic posture neutral

measuring ROM cont.

-trunk extension ROM hip joint ROM: -thomas test -active knee extension -passive straight leg raise -ober's test -piriformis combined tests of ROM in trunk and hip joint flexion: -finger tips to floor -sit and reach

modes of flexibility training

4 types: dynamic, static, ballistic, and proprioceptive neuromuscular facilitation (PNF) static stretching has 3 subcategories: -slow and constant stretch with a partner (passive) -slow and constant stretch without any assistance (self stretching) -slow and constant stretch against a stationary object (isometric)

contraindications to ROM and functional assessment

situations where ROM assessments are contraindicated include the following: -immediately after injury -after surgery that has disrupted tissue -while on pain meds -while taking muscle relaxants -regions of osteoporosis or bone fragility -joints with dislocation or unhealed fracture -any test that causes pain or discomfort

ROM and low back function

spine ROM: -lordotic curve (natural lumbar spine curve) -spinal flexion between the rib cage and the sacrum is limited to straightening of the normal lordotic curve -although ballistic extension movements of the spine are completely inappropriate, slow and controlled extension (not beyond normal lordosis) to maintain ROM and strengthen the low back is appropriate in exercise programs Scoliosis: an extreme lateral curvature -use Adam's test -it may or may not cause low back pain

flexibility program design

structured around the same underlying principles that all heath related fitness components utilize: -progressive overload -specificity of training -individual differences -reversibility

percent body fat methods

determining body composition, or percent body fat, helps the HFS: 1. identify individuals with high and low levels of body fat that are associated with increased health risks 2. design appropriate exercise prescriptions 3. formulate dietary recommendations 4. assess the progress of a client in response to a weight management program 5. estimate weight loss goals -a range of 10% to 22% for men and 20% to 33% for women is considered satisfactory for health

functional movement assessments cont.

quantitative functional movement screens may lead to: -reduced muscular imbalance and symmetries -determination of readiness to participate in weight training

ACSM risk classification

risk classification helps determine the following issues: -when a client should have a medical exam prior to exercise testing/training -when an exercise test is recommended prior to exercise training -when a physician or competent non physician health care professional needs to supervise the exercise test

weight management myths

#1: fat turns into muscle or vice versa #2: spot reducing #3: gaining weight at the start of an exercise program is from increased muscle

thomas test for tightness in hip flexors

-the leg is brought back until the low back is in contact with the mat; the contralateral leg should remain in contact with the mat -an understanding of anatomy + biomechanics is critical in the use of the test

anthropometrics

-a set of noninvasive, quantitative techniques for determining body size -measuring, recording, and analyzing specific dimensions of the body, such as height, weight, and body circumference -height and weight -BMI: body weight (kg)/height (m2) -circumference

measuring REE

-REE must first be measured or calculated using predictive equations -an activity factor is then used to calculate TEE for that individual -REE can be measured using indirect calorimetry which measures an individual's oxygen consumption -predictive equations take into account an individual's age, gender, height and weight or fat free mass

crunch: diagonal modifications

-a diagonal or twisting movement can be added to place more emphasis on the oblique musculature

weight management

-a healthy diet and regular PA are critical for attaining and/or maintaining a healthy weight -5 to 10% weight reduction results in improved overall health -knowing a person's body fat % and current body weight are needed to develop weight loss goals -safe and effective weight loss should occur at a rate of 1 to 2 lbs per week -depending on the weight loss goal multiple goals (ex 3 to 4) may need to be created until the person reaches the desired body fat % and weight

Adam's Test of Lateral Curvature of the Spine

-a lateral (side to side) curvature of the spine is called scoliosis -if scoliosis exists, it can usually be seen by assuming a position behind the individual as he bends forward

pre-exercise evaluation: blood pressure

-a resting BP measurement is a vital component of any prescreening evaluation BP is typically classified as follows: -normal BP: <120 systolic, <80 diastolic

flexibility training program

-a training program may be necessary to increase or maintain ROM relative to individual goals -in order to improve ROM, 2 to 3 training sessions per week for at least 3 to 4 weeks may be required -each exercise should include 2 to 4 repetitions in which the stretch is held between 10 and 30 seconds with a goals of accumulating 60 seconds of stretch across 2 to 4 reps -30 to 60 second holds in older individuals

atherosclerotic cardiovascular disease risk factors + defining criteria

-age -family history -cigarette smoking -physical inactivity -obesity -hypertension -dyslipidemia -diabetes

basic principles

-age and gender: w/ aging, there is a reduction in collagen solubility which may lead to an increase in tendon rigidity and therefore, reduction, in ROM -women have a more compliant Achilles tendon, resulting in greater ankle flexibility and lower muscle stiffness

trunk flexion exercise

-although these exercises can be used effectively to stretch the lumbar area, they are not recommended for people with disc problems

flexibility program design cont.

-assessment of ROM at specific joints helps to determine the need for a flexibility program -once adequate ROM is achieved, a maintenance program should be prescribed -the principle of overload for flexibility training may be applied by increasing frequency (sessions per day/week), intensity (point of stretch) and/or time for each sessions -principle of reversibility also shows that flexibility gains are lost within 4 to 8 weeks of ceasing flexibility exercises

bioelectrical impedance analysis (BIA)

-bioelectrical impedance analysis is a rapid, non invasive body comp assessment tool -a harmless electrical current is passed through the body, and the impedance to that current is measured -BIA estimates total body water and relies on regression equations to estimate % body fat -the accuracy of predicting the percentage of body fat from BIA ranges between +/- 2.7% and 6.3%

overweight and obesity

-characterized by high amounts of body fat in relation to overall lean body mass -linked to numerous chronic diseases -typically the result of excess caloric consumption and/or inadequate energy expenditure -obesity is associated with premature mortality from cardiorespiratory disease and other diseases such as cancer -central (abdominal) obesity is associated with metabolic syndrome and increased risk for cardiorespiratory disease

body mass index cont.

-children and adolescents can be classified using BMI + BMI for age growth chart -in children + adolescents, overweight is defined as the 85th to less than 95 percentile of BMI for age and sex -obesity is greater than/equal to the 95th percentile for age and sex -BMI isn't intended to differentiate between fat and fat free mass -a useful tool for population based assessments

fitness testing

-combining the HQ w/ fitness tests gives good insight to the current level of fitness common measurements obtained at rest include the following: -HR -blood pressure -body fat % -waist circumference -low back flexibility

exercises involving core stability muscles

-core stability training should be emphasized in low back training as well as rehab programs -many CS exercises also focus on coordination -lack of strength + endurance in back musculature is often tied to LBP -often, back musculature is weaker than abdominal musculature -often this is caused bc people neglect back extensor strengthening exercises -some exercises that help with the muscles of the spine also help with lateral abdominal muscles

cigarette smoking

-current smoker or those who quit within the previous 6 months or exposure to environmental tobacco smoke

basic principles

-defined as ROM of a joint or group of joints, as per the skeletal muscles and not any external forces -static flexibility can be achieved through the use of gravitational force, a partner, or specific exercise equipment -dynamic flexibility is the full ROM of a given joint achieved through the voluntary use of skeletal muscles in combination with external forces -ROM of one particular joint may not predict the ROM of other joints

demonstrating exercises

-demonstrating exercises to client is a critical element to program implementation -allows the client to see what has been verbally explained and also allows key aspects of the exercise to be highlighted -some equipment has a max weight limit or the person may not be fit or be comfortable while exercising on the equipment -all these aspects should be considered when designing an exercise program for an overweight/obese client

pre-exercise evaluation: patient participation

-detailed instructions should be provided to participants prior to exercise testing instructions should include the following: -avoid eating/smoking 3 hours prior to testing -wear comfortable footwear and loose fitting clothing -directions for medication usage prior to testing -avoid unusual physical efforts for 12 hours prior to testing -preparticipation screening + physical exam should be completed -contraindications to exercise testing should be determined -informed consent should be reviewed/signed

contraindication to PA

-determined when the risk outweighs the benefit -most are related to CVD and are determined in the presence of a physician contraindications should be followed to further reduce the risk of PA: -absolute: nonnegotiable -relative: based upon the individuals risk level -take into account all other factors when assessing relative contraindications bc each situation is unique

abdominal curl

-the crunch or curl emphasizes the rectus abdominis -the lateral abdominals are also used if done on a therapeutic ball

circumferential measurements

-easily understood by clients -can be used with extremely obese individuals -determines fat distribution as a risk of obesity -central obesity (android) is linked to a greater risk of cardiovascular disease than gynoid obesity (hip + thigh region) -measurement accuracy ranges from 2.5 to 4%

evaluating progress

-fitness tests should be periodically repeated and an HQ should be re-administered to monitor the participant's contemporary health status -a follow up test may be conducted 3 months after the participant has been regularly exercising w/ biannual testing after -make sure all evaluations are documented

flexibility intro

-flexibility is a component of health related fitness -poor flexibility in children evidenced in the presidential physical fitness assessment -recommendations for flexibility were made in 1998 by the ACSM -adequate ROM is necessary to perform ADL

summary

-flexibility is an important component of fitness that can sometimes be neglected -although there are various types of flexibility programs, selecting the appropriate type should be based on the client's needs -proper assessment techniques will help determine ROM imbalances -there are parameters for program design, but research has still not provided clear evidence for the best program available

measuring ROM of the spine and at the hip joint

-good ROM at the hip joint is important for good biomechanics of the spine -although tightness in the hip flexors isn't seen as often as tightness in the hip extensors, both are important factors for a healthy spine -tightness in the muscles crossing the hip joint may predispose a person to low back problems

obesity

-having a high BMI

sit and reach tests cont.

-if a person with tight hamstrings practices the sit and reach maneuver with both legs extended, the soft tissue structures of the spine can be damaged -in administering the sit and reach test, the fitness professional should consider the quality of the movement, it can be more important than the distance actually reached

cailliet stretch

-in a sit-and-reach stretch, it is recommended that each leg be stretched individually, thus, the symmetry of hamstring length can be determined. -if the hamstrings in one leg are in more of a shortened state than those of the other, stretching to achieve symmetry may be the first goal

active and passive knee extension

-in active knee extension, the subject extends the leg to end ROM -in passive knee extension, the examiner extends the leg -in recent years these two tests have become more popular than the straight leg raise test

physical activity factor

-in determining an individual's energy needs, a PA factor needs to be included in the prediction equation the institute of medicine (IOM) has developed a PA level (PAL) that takes into account TEE and REE, independent of gender: -low active -active -very active

flexibility program benefits

-increasing the duration of each repetition beyond 30 to 60 seconds appears to have limited benefit -flexibility should be performed when a muscle is warm -5 minute aerobic warm up and general flexibility exercises -post exercise flexibility training may be more beneficial than pre exercise -generally, increased ROM has been demonstrated in all modes of flexibility

ober's test for iliotibial (IT) band tightness

-individual being tested lies on their side with the hips stacked -the knee should drop to the table

ballistic flexibility

-involves rapid + bouncing like movements in which the resultant momentum of the body or body segments is used to extend the affected joint through the full ROM -no longer recommended as much -creates higher risk for injury

resting energy expenditure

-largest component of TEE and is the energy required to maintain normal regulatory balance and body functions at rest -can also be described as the amount of calories a person uses if he/she was to do no activity throughout the day -lean mass, body tissues, age, gender, and ethnicity all affect REE -the thermic effect of food must also be taken into consideration when accounting for the energy requiring act of eating and digesting food

dyslipidemia

-low density lipoprotein (LDL) cholesterol greater than or equal to 130 mg x dL-1 (too high) -high density lipoprotein (HDL) cholesterol less than 40 mg x dL-1 (too low) -lipid lowering medication

enhancing low-back function

-maintenance of good hip joint ROM is essential for a healthy spine -need a good combination of flexibility exercises for back and hip as well as strength exercises for the whole core including abs, hips, and low back musculature -don't exceed the normal lordotic curve when doing back extension exercises -isometric exercises can supplement regular crunches + diagonal crunches

getting started

-moderate risk individuals can start in a low to moderate intensity program (less than 60% of functional capacity) prior to medical exam -non diagnostic testing can be performed in a non clinical setting -submaximal tests are included in this category and are helpful in determining exercise prescription -diagnostic testing is used to assess the presence or impact of CVD -the HFS can supervise tests conducted on individuals at low to moderate risk

static flexibility

-most common: slow + constant motion that is held in the final position, or point of mild discomfort, for 15 to 30 seconds -the advantage of using this method involves both relaxing + concurrent elongation of the stretched muscle without stimulation of a stretch reflex -since static stretching is slow and controlled, it does not provide an increase in muscle temp and blood flow redistribution that is needed before and after exercise

sit and reach tests

-most commonly used assessment for flexibility in the low back and hip joint -it should be noted that sit and reach testing may need to be modified for various subpopulations including the young, old, and the pregnant although specific procedures/norms are lacking

family history

-myocardial infarction -coronary revascularization (bypass) -sudden death before 55 years in father or other male first degree relative or before 65 yr in mother/female first degree relative

fitness testing cont.

-next a submaximal graded exercise test is conducted common measurements obtained while the participant is exercising include the following: -HR -blood pressure -rating of perceived exhaustion -VO2 max

hydrostatic weighing guidelines

-no eating within 4 hours of the test -go to the bathroom right before -wear as little clothing as possible -person needs to exhale completely before going underwater -remain motionless as long as possible -perform 5 to 10 trials -it is the gold standard, but its costly, takes times, and needs technical expertise

air displacement plethysmography

-non invasive and can be performed on all ages

physical inactivity

-not participating in at least 30 min of moderate intensity PA (40-50% VO2R) on at least 3 days of the week for at least 3 months

major signs/symptoms of CVD, metabolic + renal disease

-pain/discomfort in the chest, neck, jaw, arms, or other areas that may result from myocardial ischemia (reduced blood flow to heart; decreased O2 to the body) -shortness of breath at rest or w/ mild exertion -dizziness or syncope (loss of consciousness) -orthopnea (shortness of breath when lying flat) or paroxysmal nocturnal dyspnea (attack of severe shortness of breath at night) -ankle edema -palpitations or tachycardia -intermittent claudication (cramping in the leg w/ exercise from obstructed arteries) -known heart murmur -unusual fatigue or shortness of breath with usual activities

passive and active back extension

-person is pushing the torso up while keeping the pelvis in contact with the mat -the person is actively lifting the torso with the back musculature -measurement can be made to either the chin or suprasternal notch

summary

-pre participation screening is used to identify individuals who are at risk to experience an adverse exercise related event the new screening algorithm is based on: -low risk of CV events with the adoption of new exercise program -risk associated w/ vigorous exercise can be mitigated if the individual begins at lower intensities and progresses over time -in addition to pre participation screening, the exercise professional should administer a medical history and CVD risk factor assessment -once through the process, an appropriate exercise mode + protocol should be chosen to assess any or all of the health related components

body composition and weight management background

-recent estimates indicate that approximately 65-70% of the US population are classified as overweight or obese (BMI greater than or equal to 25 kg m-2) -obesity rates among children have tripled since the 1980s and now are at 17% -6% as severely obese (BMI greater/equal to 40)

ACSM position stand

-regarding weight loss, the combination of diet and MVPA (greater than/equal to 150 min/week) produces the largest weight loss compared to diet or PA only -it is well established that regular MVPA (moderate to vigorous physical activity) is necessary to prevent weight regain after weight loss has occurred -the ACSM position stand indicates that engaging in more than 250 min per week of MVPA would result in better weight maintenance

lab methods for measuring body comp

-require more expensive and specialized equipment -ultrasound

hypertension

-systolic blood pressure greater than or equal to 140 mmHg and/or diastolic greater than or equal to 90 mmHg -confirmed by measurements on at least 2 separate occassions, or any antihypertensive medication

PNF

-techniques combining passive stretch with isometric and concentric muscle actions designed to utilize the autogenic and reciprocal inhibition responses of the golgi tendon organs (GTO) 3 techniques: - hold-relax - contract-relax - hold-relax w/ agonist contraction

metabolic equations

-the ACSM metabolic equations can be used to estimate the amount of calories that will be expended during a workout or to estimate the length of time an individual has to exercise to expend a certain amount of calories -a calorie, aka a kilocalorie (kcal) is an expression of energy intake -it takes about 3500 cals to make and store 1 pound of weight

weight loss and the FITT principle

-types of exercise activities that work well for the overweight and obese include walking, swimming, water aerobics, jogging/walking in water, biking and elliptical/rowing machines -the FITT principle can be adjusted to meet the needs of the client -for extremely obese or sedentary individuals initially doing exercise in 10 min bouts at least 3x a day may be necessary

skin fold measurements

-used to determine the amount of subcutaneous fat based on the following assumptions: 1. approximately 1/3 of total body fat is located subcutaneously 2. the amount of subcutaneous fat is proportional to total body fat -the accuracy of predicting the % body fat from skin folds is +/- 3.5% assuming proper technique

hydrostatic weighing

-uses land and water measurements -% fat calculated through water displacement

dynamic flexibility

-utilizes slow + controlled, sport specific movements which are designed to increase core temp and enhance activity related to flexibility + balance -no comprehensive list of movements is available; up to coaches knowledge/experience -eccentric training was recently introduced as a new technique that is designed to reduce the occurrence of injuries and improve flexibility and performance

DEXA

-very low current x-rays at 2 energy levels -measures bone mineral content, body fat, and lean soft tissue mass

medical history + CVD risk factor assessment

CVD risk factors should be identified and controlled to/for: -aid in development of individual's ExRx -lifestyle modification -disease prevention + management the following steps should be followed: 1. determine if the patient meets any positive risk factors from table 3.2 -if the patient doesn't know if he/she meets the criteria for a risk factor, it should be counted 2. sum the positive risk factors 3. if client meets negative risk factors from table 3.2, subtract 1 from the total positive risk factors

FITT principles for flexibility

F: 2 to 3 training sessions/week for 3-4 weeks; 2 to 4 reps I: low intensity to improve ROM T: 10-30s, 60 sec across 2-4 sets T: static, dynamic, ballistic, PNF

example TEE prediction

REE (kcal/day) = 66.47 + 13.75 (wt in kg) + 5 (ht in cm) - 6.8 (age in yr) = (66.47 + 13.75 (81.82) + 5 (182.9) - 6.8 (35) = 1869 kcal/day TEE = (REE) × (PAL) = (1869) × (1.5) = 2803 kcal = 2803 kcal For maintenance: 2,800 calories needed For weight loss: 2,300 calories needed (500 cal daily deficit)

exercise prescription

an appropriate exercise prescription should be designed in consideration of the following: -individual's health status -fitness test results -personal goals (which can change)

PNF cont.

each technique has 3 phases: -passive prestretch -passive stretch -contractions -for PNF stretching to be effective, a partner must be properly trained in the technique -however, data is inconclusive to determine if PNF is better than other stretching methods

weight loss and the FITT principle cont.

frequency: -greater than/equal to 5 days a week to maximize caloric expenditure intensity: -progression from moderate (ex 40-60% or HRR) to vigorous (ex greater than/equal to 60% or HRR) may result in greater health benefits time: -a minimum of 30 min per day (ex 150 min a week) progressing to 60 min a day (ex 300 min per week) of moderate intensity aerobic activity type: -the primary mode of exercise should be aerobic PA that involve the large muscle groups -as part of a balanced ex program, resistance training and flexibility should be incorporated

functional movement assessments

functional movement assessments are used by clinicians and practitioners to determine: -movement proficiency -potential for injury -design for appropriate training and rehab programs

functional strength assessments

functional movement screen: -identifies functional movement deficits and asymmetries/imbalances that may be predictive of musculoskeletal conditions + potential injuries -consists of 7 functional movement tests graded on a 0-3 scale, with the composite score range from 0 to 21, 14 is considered the minimum

pre-participation health screening

goals for pre-participation screening: -to identify those who should receive medical clearance prior to initiating exercise program -to identify those w/ clinically significant disease -to identify those w/ medical conditions who should be restricted from exercise participation

flexibility assessment protocols

goniometers: -similar to a protractor and is used to measure a joint's ROM expressed in degrees -consists of 2 arms: a stabilization arm that is fixed to the proximal body segment, and the other, a movement arm that follows the distal body segment as it is moved through its range of motion -axis is placed at a predetermined anatomical landmark, generally at the joint of axis of rotation they are portable, relatively easy to use and inexpensive, however, disadvantages include: -difficulty stabilizing moving segments -visually determining a vertical axis

ACSM risk classification cont.

low risk: asymptomatic individuals w/ 1 or no risk factors moderate risk: asymptomatic individuals w/ 2 or more risk factors high risk: individuals w/ diagnosed cardiovascular, pulmonary or metabolic disease OR signs/symptoms of cardiovascular, pulmonary, or metabolic disease

age

men: 45 years or older women: 55 years or older

factors affecting flexibility

muscle properties: -the inherent properties of muscle tissue play a major role in the ROM of a given joint PA and exercise: -PA can lead to greater flexibility of the affected joints, primarily by moving joints through a fuller ROM during exercise than would normally occur anatomical structures: -the ROM of a given joint is influenced by its structure and the anatomical structures surrounding it

factors affecting ROM

nature and nurture: -can increase ROM w/ a flexibility program but only so much due to genetics posture: -poor posture leads to decreased ROM -tendinous tissue can shorten and impede motion disease: -arthritis -osteoporosis

recommendations for diagnostic testing

persons with: -end stage renal disease -pulmonary disease -previously diagnosed CVD -new or changing symptoms suggestive of CVD

pre-participation screening intro

previous pre-participation screening guidelines focused on risk classification based on the following: -CVD factors -signs and/or symptoms of CVD, metabolic disease + pulmonary disease -recent evidence suggests this type of screening may wrongly over-refer individuals to seek medical clearance prior to exercise -a new paradigm has been created to encourage PA, while minimizing barriers, and still ensuring client safety

ACSM pre-participation screening algorithm

the algorithm follows these steps to determine if an individual should seek medical clearance prior to exercise: 1. Identify if the individual currently participates in exercise -exercising at least 30 min on 3 or more days/week at a moderate intensity for at least 3 months 2. Identify if the individual has been diagnosed w/ CVD, metabolic, or renal disease 3. Identify if the individual has any signs or symptoms suggestive of the same diseases 4. Identify the individual's desired exercise program intensity **look at chart

informed consent

the informed consent should include the following: -comprehensive explanation of the risks -indication that the participant is free to withdraw without consequence -statement that "emergency procedures + equipment are available" -the form should be explained verbally -the individual should be given a time to ask questions -if the participant is a minor, the parent or legal guardian provides consent, whereas the minor provides assent

energy balance

the management of body weight is dependent on energy balance: -energy intake (the amount of cals consumed) and energy expenditure (the amount of cals expended) total energy expenditure (TEE) is the total # of cals expended each day and reflects the amount of energy required to carry out all metabolic processes within the body: -resting energy expenditure (REE or RMR) 60 to 70% TEE -thermic effect of food 10% TEE -physical activity expenditure 20-30% TEE

self-guided methods

the most common self-guided screening form is the physical activity readiness questionnaire for everyone (PAR-Q+): -a recent update to the traditional PAR-Q, which now includes several follow up questions -the updated form was created to reduce barriers to exercise and the # of false positive screenings -it will also allow the exercise presription (ExRx) based on the individual's medical history

pre-participation health screening cont.

this will be accomplished by collecting: -individual's current PA level -individuals w/ signs + symptoms of CVD, metabolic disease + renal disease -individuals diagnosed w/ medical conditions who should be restricted from exercise -individual's desired exercise program intensity

overall recommendations

when determining the appropriate program design: -differentiate between flexibility training with the sole purpose of increased ROM (often using static stretching) OR -flexibility exercises with the primary purpose of preparing for fitness training or sport specific training pre-exercise static stretching isn't recommended. Instead: -pre activity ROM should be dynamic -flexibility programming should occur during or immediately after activity