Chapter 11 Integrated Exercise Programming: From Evidence to Practice

Client prerequisites and preparation for sport-related load/speed training

-a foundation of strength and joint integrity (joint mobility and stability) -adequate static balance and dynamic balance -effective core function -anaerobic efficiency (training of the anaerobic pathways) -athleticism (sufficient skills to perform advanced movements) -no contraindications for load-bearing, dynamic movements -no medical concerns that affect balance and motor skills

Passive vs. Active Recovery

-active recovery is more effective than passive recovery at maintaining endurance performance -active recovery is superior to passive recovery for sustaining power output -active recovery should be performed at a moderate intensity (80-90% of VT2, which is approx 55-60% of HRR) in order to sustain endurance performance and promote greater blood lactate removal. In contrast, when active recovery is performed at a vigorous intensity (at VT2, which corresponds to 75-85% of HRR), there is delayed blood lactate removal and a resultant decrease in endurance performance

jumping and hopping tips to ensure safety and effectiveness

-clients should land softly on the midfoot, and then roll forward to push off the ball of the foot. Landing on the heel or ball of the foot must be avoided, as these errors increase impact forces. Landing on the midfoot also shortens the time between the eccentric and concentric actions, thus increasing the potential for power development if another jump follows -ensure alignment of the hips, knees, and toes due to the potential for injury, especially in women -encourage clients to drop the hips to absorb the impact forces and develop gluteal dominance -clients must avoid locking out the knees upon landing, which leads to the development of quadriceps dominance. Poor landing technique can increase the risk of knee injuries. Proper hip mechanics during flexion and extension, along with the requisite muscular strength, is extremely important for developing lower-body power, which is why it is recommended that clients go through both the Functional and Movement Training phases before progressing to Load/Speed Training exercises -Instruct clients to engage the core musculature, which stiffens the torso, protects the spine during landing, and allows for increased force transfer during the subsequent concentric muscle action (or jump) -clients should land with the trunk inclined slightly forward, the head up, and the torso rigid. Personal trainers can cue clients to keep their "chests over their knees" and their "nose over their toes" during the landing phase of jumps

Load/Speed Training

-focus on application of external loads to movements to create increased force production to meet desired goals -integrate the five primary movement patterns through exercises that load them in different planes of motion and combinations -Integrate Functional Training exercises to enhance postural stability and kinetic chain mobility to support increased workloads -programs should focus on adequate resistance training loads to help clients reach muscular strength, endurance, and hypertrophy goals -clients with goals for athletic performance will integrate exercises and drills to build speed, agility, quickness, and power

Movement Training

-focus on developing good movement patterns without compromising postural or joint stability -programs should include exercises for all five primary movement patterns in varied planes of motion -integrate Functional Training exercises to help clients maintain and improve postural stability and kinetic chain mobility

Functional Training

-focus on establishing/reestablishing postural stability and kinetic chain mobility -exercise programs should improve muscular endurance, flexibility, core function, and static and dynamic balance -progress exercise volume and challenge as function improves

Base Training

-focus on moderate-intensity cardiorespiratory exercise (RPE = 3-4), while keeping an emphasis on enjoyment -keep intensities below the talk-test threshold (below VT1) -increase duration and frequency of exercise bouts -progress to Fitness Training when the client can complete at least 20 minutes of cardiorespiratory exercise below the talk test threshold

Signs of overtraining syndrome

-increased resting heart rate -disturbed sleep -decreased hunger on multiple days

Flexibility Exercise Evidence-Based Recommendations

-programming for flexibility exercises should focus on the major tendon unity, including ankles, anterior and posterior legs, chest, hips, lower back, neck, shoulder girdle, and trunk -frequency: >/= 2-3 days/week with daily being most effective -intensity: holding a static stretch for 10-30 seconds is recommended for most adults; in older individuals, holding a stretch for 30-60 seconds may confer greater benefits; for PNF stretching, a 3-6 second light-to-moderate contraction (20-75% of maximum voluntary contraction) followed by a 10-30 second assisted stretch is desirable -type: a series of flexibility exercises for each of the major muscle-tendon units is recommended; static flexibility, dynamic flexibility, ballistic flexibility, and PNF are each effective -volume: a reasonable target is to perform 60 seconds of total stretching time for each flexibility exercise -pattern: repetition of each flexibility exercise 2-4 times is recommended; flexibility exercise is most effective when the muscle is warmed through light-to-moderate aerobic activity or passively through external methods such as moist heat packs or hot baths -progression: methods for optimal progression are not known

Fitness Training

-progress cardiorespiratory exercise duration and frequency based on the client's goals and available time -integrate vigorous-intensity (RPPE = 5-6) cardiorespiratory exercise intervals with segments performed at intensities below, at, and above VT1 to just below VT2

Performance Training

-progress moderate- and vigorous-intensity cardiorespiratory exercise -program sufficient volume for the client to achieve goals -integrate near-maximal and maximal intensity (RPE = 7-10) intervals performed at and above VT2 to increase aerobic capacity, speed, and performance - periodized training plans can be used to incorporate adequate training time below VT1, from VT1 to just below VT2, and at or above VT2

Periodization

-refers to planned progression of exercise that intentionally varies the training stimuli, especially with respect to intensity and volume. Systematically changing the exercise variables (resistance, reps, and sets) appears to be more effective for attaining both strength development and peak performance that standardized muscular-training protocols -The advantage of periodized over non-periodized exercise programs is the frequently changing demands on the neuromuscular system that require progressively high levels of stress adaptation -Divided into macrocycles, mesocycles, and microcycles

sport-specific considerations

-which movement patterns and activities (aerobic vs. anaerobic) are required for the client to be successful in reaching their performance goals? -what are the athletic skills and abilities the client currently lacks? -what are the common injuries associated with the activity?

4 ways to increase difficulty in exercises

1. arm progressions 2. surface progressions 3. visual progressions 4. tasking progressions

All aspects of personalized exercise programming should be based on a combination of three factors:

1. client attributes, goals, and preferences 2. personal trainer experience and expertise 3. the latest research findings in health and fitness

6 steps for client-centered exercise programming

1. establish rapport and identify client goals 2. administer an exercise preparticipation health screening 3. identify barriers and collaborate on next steps 4. determine if physiological or movement assessments are necessary 5. determine in which phase(s) of the ACE IFT Model to begin 6. Prioritize program design and select exercise order

5 steps of Evidence-based practice

1. formulating a question 2. searching for health and fitness research evidence that best answers the formulated question 3. scrutinizing the quality of the research evidence 4. incorporating the research evidence into exercise program design and implementation 5. evaluating exercise program outcomes and periodically reevaluating the research evidence

Basic Concepts for interpreting scientific research

1. search for bias 2. read the research 3. evaluate for truth 4. look for consensus

Ballistic stretching

A stretch that incorporates bouncing-type movements is a ballistic stretch. Ballistic stretch has been used in athletic drills and in pre-training warm-ups. The bouncing movements associated with ballistic stretching usually trigger the stretch reflex and thus may be associated with an increased risk for injury. As a result, the use of ballistic stretching has not been widely advocated. However, the absolute exclusion of ballistic stretching from flexibility programs has been questioned, particularly in the case of athletes whose functional demands include ballistic-type movements

Contract-relax technique

After a passive 10-second pre-stretch, the contract-relax technique requires the individual to push against the force provided by the personal trainer so that a concentric muscle action occurs throughout the full ROM of the muscle group targeted for the stretch. In other words, the personal trainer provides enough resistance to slightly counteract the individual's force of contraction, but not so much that he or she cannot move the joint through its ROM. Then, similar to the hold-relax method, the individual relaxes the muscle group and allows a passive stretch force from the personal trainer (held for 30 seconds) to increase the ROM in the muscle group that was previously concentrically active. This final stretch should be of greater magnitude due to autogenic inhibition

Hold-relax technique

After the passive 10-second pre-stretch, the hold-relax technique requires the individual to hold and resist the force provided by the personal trainer so that an isometric muscle action occurs for six seconds in the muscle group targeted for the stretch. Then, the individual relaxes the muscle group and allows a passive stretch force from the personal trainer (held for 30 seconds) to increase the ROM in the target muscle group. This final stretch should be of greater magnitude due to autogenic inhibition.

Plyometric Experience

Beginner (no experience): 80-100 Intermediate (some experience): 100-120 Advanced (considerable experience): 120-140

Small-group Traiing

Benefits: semiprivate training provides advantages in the areas of finance, time management, and referals. For the client, benefits include a lower cost per session, enhanced camaraderie among workout partners, and an opportunity to receive instruction in a small-group setting from a qualified exercise professional Group Homogeneity: PT should ensure that the individuals are somewhat homgenous in characteristics such as level of physical conditioning, fitness goals, training experience, and even physique Personal Attention: Have an upfront, honest conversation with clients about the level of personal interaction they can expect during a semiprivate training session.

Training Strategy #4

Combined cardiorespiratory and muscular training is an antidote to detraining While the best option is to consistently avoid inactivity and sedentary behaviors altogether, some degree of physical inactivity and sedentary behavior is inevitable. With this in mind, try to design clients' exercise training programs in advance of interruptions to regular activity in a manner that attenuates the rate of detraining. Combined cardiorespiratory and muscular training results in numerous favorable effects (body composition, muscular strength, and lipid profile) that persisted for longer following training cessation when compared with either cardiorespiratory or muscular training

Intensity of Recovery

For a client performing an interval session that consists of four repetitions of 4 minutes at 60-89% of HRR interspersed with 2 minutes of active recovery bouts, personal trainers need to program a specific intensity (40-59% of HRR, or HR <VT1) to be performed for the active recovery bouts. The intensity of recovery may also extend to the overall intensity of a daily session of exercise dedicated to recovery (a moderate-intensity, 60-minute bicycle ride at 40-59% of HRR or HR <VT1)

Precautionary guidelines associated with plyometric drills

Given the ballistic nature of plyometric-training drills, appropriate strength, flexibility, and postural mechanics are required to avoid injury. The following recommendations are provided to reduce the potential for injury and increase the likelihood of performance-related goal achievements for clients -plyometric drills should be performed at the beginning of a training session after the completion of a dynamic warm-up (while clients are not fatigued) to reduce the risk of injury -proper technique is crucial. Clients should not jump unless they know how to land. Ensure that clients are capable of landing correctly by initially teaching small, low-intensity jumps and using appropriate landing techniques

Training Strategy #3

Integrate a single long training session into the biweekly training routine More than one-third of U.S. adults have prediabetes. People with prediabetes have a two- to sixfold increased risk of developing type 2 diabetes in their lifetimes. Moreover, individuals with type 2 diabetes have a life expectancy, on average, that is 10 years shorter than their counterparts without type 2 diabetes. Prediabetes is underpinned by impaired blood glucose and poor insulin sensitivity. Both of these physicological markers worsen considerably with even brief periods of inactivity (less than one week). Arguably the single best workout to augment insulin sensitivity and improve blood glucose control is a prolonged bout of exercise that decreases muscle glycogen stores.

Training Strategy #2

Low-dose HIIT (12 minutes/week) improves cardiometabolic health -HIIT involves alternating brief bouts (30 seconds to 5 minutes) of higher-intensity exercise with either rest or lower-intensity workloads throughout an exercise routine. HIIT exercises have a reported ability to improve health outcomes for a lesser weekly time commitment relative to the current exercise guidelines for moderate-intensity continuous training. A very low dose of HIIT, consisting of a single four-minute interval bout at 85-95% of MHR performed three times per week, was sufficient to significantly improve VO2 max and lower BP in a group of individuals with MetS. Each HIT session was preceded by a 10-minute warm-up and concluded with a three-minute cool-down. Both the warm-up and cool-down were performed at an intensity of 60-70% of MHR

Passive stretching

Occurs when a partner or assistive device provides added force for the stretch For example: an individual performing a lying hamstrings stretch with the leg propped against a sturdy structure, such as a vertical equipment stanchion or a door jamb For example: when a personal trainer applies a slight force to the back of the person's leg to allow the client to reach the point of resistance in their ROM

Hold-relax with agonist contraction technique

The hold-relax with agonist contraction technique is identical to the hold-relax technique, except a concentric action of the opposing muscle group is added during the final passive stretch to add to the stretch force. With this technique, the final stretch should be of greater magnitude primarily due to reciprocal inhibition and, secondarily, to autogenic inhibition. This PNF technique is considered the most effective since it utilizes both reciprocal and autogenic inhibition

Training Strategy #1

The minimum dose of activity to maintain weight and cardiometabolic health equates to 1 mile per day -researchers have demonstrated that a minimal level of physical activity is required to maintain body weight and cardiometabolic health. Minimal physical-activity level for weight maintenance occurred at approximately 8 miles of walking per week (or an equivalent energy expenditure). Body-weight changes are a good proxy of the dose of physical-activity levels required to maintain cardiometabolic health. An increase in body weight can be interpreted to mean that additional physical activity is required to maintain weight and cardiometabolic health

Frequency of Recovery

This component of training recovery refers to the number of days/week specifically devoted to recovery. For instance, if a client is simply recovering from a somewhat hard training session, the frequency of recovery may be a single day. Conversely, a client recovering from a 10K run may require several days of recovery

Type of Recovery between Bouts

This component refers to the type of recovery and may refer to either active recovery or passive recovery. Active recovery involves continued exercise at a substantially lower intensity or workload, while passive recovery consists of resting completely. The type of recovery to be performed is a consideration for both the time between interval bouts and daily recovery sessions. In terms of an active recovery, the mode of exercise to be performed is an additional variable to be contemplated. It is common for clients who normally run to cross train; for example, an active recovery day for a runner may consist of swimming or exercising on an elliptical trainer

Self-myofascial release

a technique that applies pressure to tight, restricted areas of fascia and underlying muscle in an attempt to relieve tension and improve flexibility. It is thought that applying direct sustained pressure to a tight area can inhibit the tension in a muscle. Tightness in soft tissue may be diminished through the application of pressure (self-myofascial release) followed by static stretching

Components of Agility Training

acceleration, deceleration, and balance, and requires the client to control the center of mass (COM) over the base of support (BOS) while rapidly changing body position -progress drills by increasing the speed of movement, complexity of tasks, and direction of movement, and by introducing resistance (bands and ankle weights) -drills can be predetermined (the client is informed of the expected task) or reactive (the client reacts to unexpected verbal or visual cues) -aim to progressively narrow the BOS to improve agility

How to add load to bend-and-lift (squat)

external loading may be applied with various types of resistance equipment. A client may begin by holding a medicine ball while doing squats. Another resistance option is placing an elastic band under the feet and holding each end of the band while performing squats. A third resistance option is free weights, beginning with dumbbells and progressing to a light barbell. An alternative exercise to the barbell squat is the leg press, which trains the same pattern of movement without the influence of gravity, while strengthening the quadriceps, hamstrings, and gluteus maximus muscles

How to add load to rotational movements

external resistance may be applied to rotation movements by using resistance bands or cables in a standing position, by using machines from a seated position, or by lifting medicine balls from a variety of positions (standing, seated, and lying). Dumbbells can be used in movement that directly oppose gravity's line of pull

Purpose of Base Training

intended to help people move more consistently to establish basic cardiorespiratory endurance. This, in turn, will lead to improved overall health, energy, and mood, and increased caloric expenditure. Encouragement and exercise activities that can be successfully completed in each workout are crucial for building client self-efficacy in this phase

Movement-pattern progression

linear-forward --> lateral --> backpedal --> rotational --> crossover cutting curving

How to add load to single-leg (lunge)

lunge movements (in any direction) may be performed with external loads by holding a medicine ball or dumbbells

Dynamic stretching

mimics a movement pattern to be used in the upcoming workout or sporting event. It is commonly used to help athletes prepare for competition by allowing them to increase sport-specific flexibility. An example of an athlete preparing for an event using dynamic stretches would be a track sprinter performing long walking strides that emphasize hip extension while maintaining a posterior pelvic tilt. This type of activity-specific movement enhances the flexibility of the hip joints and prepares the tissues for the upcoming physical exertion

active stretching

occurs when the individual applies added force to increase the intensity of the stretch For example: leaning further to the side during a side bend stretch increases the intensity of the stretch to the lateral flexors on the opposite side of the torso. Since the side-bending action is performed by the person stretching, they are "actively" involved in the exercise

Proprioceptive neuromuscular facilitation (PNF)

originally developed and used to treat increased tissue tonicity in the rehabilitation setting, PNF capitalizes on the principles of autogenic inhibition and reciprocal inhibition. There are 3 basic types of PNF stretching techniques: hold-relax, contract-relax, and hold-relax with agonist contraction. For each of the 3 techniques, a partner provides a passive pre-stretch of 10 seconds as the initial step. The actions that follow the passive pre-stretch are different for each technique.

Static stretching

performed by moving the joints to place the targeted muscle group in an end-range position and holding that position for up to 30 seconds -one of the most commonly practiced forms of flexibility training because it is easily performed without the requirement of a partner and it does not elicit the stretch reflex (a reflexive muscle contraction that occurs in response to rapid stretching of the muscle) reducing the likelihood of injury -static stretching can be performed actively or passively

Macrocycle

program timeframe -may cover a training period of 6-12 months. The long range goal to be attained by the end of the macrocycle is divided into shorter-term goals that are addressed in time segments of less duration -ex: a 6 months macrocycle may consist of two 3-month mesocycles

Microcycle

progressive training segments for each mesocycle -typically 2-4 weeks in length and provide regular reinforcement for making small steps towards the larger goals

Linear periodization

provides a consistent training protocol within each microcycle and changes the training variables after each microcycle

Undulating periodization

provides different training protocols during the microcycles in addition to changing the training variables after each microcycle

How to add load to pulling movements

pulling movements may be performed with external loads by using resistance bands or cables in a standing position, by performing machine rows and pull-down from a seated position, and by lifting dumbbells from a bent-over standing position with the torso parallel to the floor and supported by one arm (bent-over row exercise)

How to add load to pushing movements

pushing movements may be performed with added resistance by using resistance bands or cables in a standing position, by performing machine chest presses from a seated position, or by lifting free weights (dumbbells or a light barbell) from a lying (supine) position

Mesocycle

specific training goals -each mesocycle would provide sequential goals leading to the ultimate goal of the six-month macrocycle -because even three-month mesocycles represent a relatively long period for goal attainment, these are divided into more manageable microcycles.

Components of Speed training

speed training incorporates moving rapidly from one point to another in the shortest timeframe possible body position or lean -maintain a slightly forward lean during the acceleration phase -transition to a more vertical position with top speed to facilitate hip and knee extension for stride head position -assume a relaxed, neutral position arm action -drive from the shoulders, not the elbows -short strokes (or pumping actions) are utilized during the acceleration and deceleration phases -long strokes are utilized during top speed and sustained speed phases -relax the hands and maintain an open hand position leg action -at toe-off, kick upward explosively and directly under the buttocks while simultaneously driving the knee forward and upward until the thigh is parallel to the ground -the foot then swings below the knee, moving to a fully extended knee position while maintaining a dorsiflexed ankle position

Reciprocal inhibition

the principle stating that activation of a muscle on one side of a joint (the agonist) coincides with neural inhibition of the opposing muscle on the other side of the joint (the antagonist) to facilitate movement

Time (Duration) of Recovery

this component can refer to either the recovery time between interval bouts or the duration of an entire recovery session