NASM STUDY
GUIDE
compiled by Kim @ fittinpretty.com
Stuff You Should Know…

This guide is based on the fourth edition of the NASM textbook. It was compiled in the fall of
2013.

This guide was created for my own personal use and has not been carefully edited for
publication. Please forgive any spelling/grammatical errors, etc. 

You are more than welcome to tell others about this guide. When you do, I ask that you please
direct them to my blog for the free download, rather than sending them a copy directly. (The
download will always be free.)

If you have questions about this guide or if you find errors, feel free to email me at
kimfittinpretty@gmail.com.

For more study tips, including lists of topics to focus on, check out the NASM study guide blog
posts from Julie @ Peanut Butter Fingers and Gina @ The Fitnessista.
Happy studying and GOOD LUCK!
-Kim
About this Guide
This guide is simply a compilation of information copied and pasted directly from the NASM textbook,
along with some supplementary information I found helpful for my understanding of the material.
This guide is not recognized by NASM in any way. Use at your own risk. 

The guide is organized by chapter, like the textbook. At the beginning of each chapter is a list of
the topics NASM called out as particularly important in their test prep guide (found in the online
e-learning materials).

Some charts and images were scanned directly from the textbook. Others (such as the 3 planes
of motion image) were found online.

Color coding and highlighting is for visual learning purposes.

You’re welcome to make changes to the guide for your own use, but please do not publically
distribute a modified version that originated from this guide.

This guide might include phrasing and extra details that helped me solidify my personal
understanding of the content, but that don’t make sense to you. In those cases, always default
to the textbook’s explanations and refer back to it as necessary.

Please do not use this guide as your only study tool! There might be questions on the test that
aren’t covered here. This is just a compilation of the topics and terms that stood out to me.
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2
Chapter 1
What to Know: Introduction to Integrated Training

Be familiar with all definitions throughout the chapter

Optimum Performance Training™ Model
o
Phase 1: Stabilization Endurance Training
o
Phase 2: Strength Endurance Training
o
Phase 3: Hypertrophy Training
o
Phase 4: Maximal Strength Training
o
Phase 5: Power Training
Escalation of obesity, diabetes, and chronic disease  increased demand for personal training
First fitness programs (1970’s) didn’t take into account new clients’ medical conditions, training risk
factors, muscle imbalances, and goals—they just mimicked fitness professionals’ own programs.
Chronic disease: incurable illness or health condition that persists for 1 yr+, resulting in functional
limitations and the need for ongoing medical care.
Obesity: BMI of 30 or greater, or at least 30 pounds overweight for their height.
Overweight: BMI of 25-29.9, or between 25 to 30 pounds overweight for their height.
BMI = 703 x (weight in pounds / height^2 in inches)
Diabetes: condition in which blood glucose (or blood sugar) is unable to enter cells, resulting in
hyperglycemia (high blood sugar).
Type 1: Pancreas doesn’t produce insulin
Type 2: There’s enough insulin, but cells are resistant ad do not allow insulin to bring adequate
amounts of blood sugar into cells
Deconditioned: a state of lost physical fitness, which may include muscle imbalances, decreased
flexibility, and a lack of core and joint stability.
Proprioception: The cumulative sensory input to the central nervous system from all
mechanoreceptors that sense body position and limb movement.
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Training the body’s proprioceptive abilities improves balance, coordination, and posture.
Past injuries can alter clients’ proprioceptive abilities.
Proprioceptively Enriched Environment: An unstable, yet controllable, physical situation in
which exercises are performed that cause the body to use its internal balance and stabilization
mechanisms.
Examples: stability ball dumbbell chest press or single-leg squat vs. bench press or barbell squat
OPT model – Optimum Performance Training Model, which takes into account each individual’s
goals, needs, and abilities in a safe and systematic fashion. This model was conceptualized for a society
that has more structural imbalances and susceptibility to injury than ever before. It can systematically
progress any client to any goal.
The OPT model includes 3 LEVELS of training: stabilization, strength, and power. Each level includes
one or more phases.
The 5 PHASES of training:
PHASE
(1)
Stabilization
Endurance
Training
(2)
Strength
Endurance
Training
(3)
Hypertrophy
Training
GOAL
DETAILS
TRAINING STRATEGIES
--Increase client’s ability
to stabilize joints and
maintain optimal posture
--Increase muscular
endurance while
developing optimal
neuromuscular efficiency
(coordination)
Neuromuscular efficiency relies
on the appropriate
combination of proper
alignment (posture) and the
stabilization needed to
maintain that alignment
--Proprioceptively challenging
environment (stability)
--Low loads, high repetitions
Improves: stabilization
endurance, prime mover
strength, overall work capacity,
joint stabilization, and lean
body mass
--Moderate loads and repetitions
(8-12)
--Perform two exercises in a
superset sequence (back-to-back
without rest): one traditional
strength exercise in a stable
environment (ie bench press) and
one stabilization exercise in a less
stable (but still controlled)
environment (ie stability ball
push-up)
--High volume, moderate to high
loads
--Moderate or low repetitions (612)
--Maintain stabilization
endurance while
increasing prime mover
strength
--Hypertrophy (increasing
muscle size) or maximal
strength (lifting heavy
loads)
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Designed for individuals who
have the goal of hypertrophy,
or maximal muscle growth (ie
bodybuilders)
4
(4)
Maximum
Strength
Training
(5)
Power
Training
--Develop speed and
power
--Enhance neuromuscular
efficiency, prime mover
strength, and rate of
force production
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Designed for those pursuing
maximal prime mover strength
by lifting heavy loads
--High loads, low repetitions (1-5)
--Longer rest breaks
Premise: execution of
traditional strength exercises
(with heavy loads) superset
with power exercises (light
load, fast). Ex of power
exercises: medicine ball chest
pass, soccer throw, squat jump.
--Superset: 1 strength and 1
power exercise during resistance
training
--Perform all power exercises as
fast as can be controlled
5
Chapter 2
What to Know: Basic Exercise Science

Know all definitions

Figure 2.34

Figure 2.38

Table 2.5 Muscle Fiber Types

Table 2.6 Muscle as Movers
Nervous System
Kinetic chain: The interaction of the 3 systems responsible for human movement (the nervous,
skeletal, and muscular systems)
Nervous system: A conglomeration of billions of cells specifically designed to provide a
communication network within the human body.
The nervous system is divided into two parts:
1)
2)
Central Nervous System: brain and spinal cord
Peripheral Nervous Systems: nerves (connects CNS to rest of body). 12 cranial
nerves, 31 pairs of spinal nerves, and sensory receptors.
The PNS is further divided into two systems:
a. Somatic Nervous System: Serves outer areas of body and skeletal muscles,
provide voluntary control of movement
b.
Autonomic Nervous System: Supplies neural input to involuntary systems of
the body (heart, digestive systems, and endocrine glands)
i. The autonomic system is further divided into the sympathetic nervous
system (increases activation in preparation for activity) and
parasympathetic nervous system (decreases activation during rest and
recovery)
(Helpful image of nervous system structure on pg. 21)
3 primary functions of the nervous system:
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1)
Sensory function: allows body to sense changes in internal/external environment (ie
walking on sand to walking on sidewalk)
2)
Integrative function: allows body to analyze and interpret sensory information to
allow for proper decision making
3)
Motor function: neuromuscular response to sensory information (ie changing walking
pattern to manage the sand to sidewalk switch)
The Neuron: functional unit of the nervous system; a specialized cell that processes and transmits
information through electrical and chemical signals.
Neurons are composed of three main parts (image on pg. 18):
1) Cell body, including: lysosomes, mitochondria, and a Golgi complex
2) Axon, which provides communication from the brain and spinal cord to the body
3) Dendrites, which gather information from other structures and transmit back to the neuron
3 kinds of neurons:
1) Sensory neurons respond to touch, sound, light, and other stimuli
2) Interneurons transmit nerve impulses between neurons
3) Motor neurons transmit nerve impulses from the brain/spinal cord to the effector sites
Sensory receptors convert environmental stimuli into sensory information that the brain/spinal
cord use to produce a response.
4 kinds of receptors:
1)
2)
3)
4)
Mechanoreceptors respond to mechanical force (touch/pressure)
Nociceptors respond to pain
Chemoreceptors respond to chemical interaction (smell/taste)
Photoreceptors respond to light
Muscle spindles are sensory receptors within muscles that run parallel to the muscle fibers and are
sensitive to changes in muscle length and rate of length of change. When muscles are stretched, the
spindles are also stretched, conveying information to the brain about muscle length. Muscle spindles
also help in regulating the contraction of muscles via the stretch reflex mechanism, which prevents
overstretching.
Golgi tendon organs (located where skeletal muscle fibers insert into the tendons of skeletal
muscle) are sensitive to changes in muscular tension and rate of tension change. Activation of the Golgi
tendon organ causes muscles to relax, preventing the muscle from excessive stress.
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Joint receptors are located in and around the joint capsule and signal extreme joint positions.
Skeletal System
206 bones in the skeletal system, 177 for voluntary movement. More than 300 joints.
2 divisions:
Axial—skull, rib cage, and the vertebral column
Appendicular—upper and lower extremities, shoulder and pelvic girdles
Bones have two jobs: 1) leverage (levers) 2) support (posture)
Bone is constantly renewed through a process called remodeling, during which old bone tissue is
broken down and removed by cells called osteoclasts and new bone tissue is laid down in its place by
osteoblasts.
Remodeling tends to follow the lines of stress placed on the bone, meaning that incorrect exercise
technique or poor alignment can lead to remodeling processes that reinforce bad posture. So bad
posture leads to more bad posture.
5 types of bones:
Long—Long cylindrical body with irregular or widened bony ends. Composed predominantly of
compact bone tissue to ensure strength and stiffness. Slight curvature good for force distribution. Ex:
humerus, femur
Components:
1.
2.
3.
4.
Epipyhsis: end of long bones—primary site for bone growth
Diaphysis: shaft portion of long bone—primary role is support
Epiphyseal plate: region connecting the diaphysis to the epiphysis
Periosteum: tough, fibrous membrane that coats the bone and plays a fundamental role
in movement by providing the point of attachment for tendons
5. Medullary cavity: space running down center of diaphysis, contains marrow that serves
as a useful energy reserve
6. Articular (hyaline) cartilage: hard, white, shiny tissue that covers ends of articulating
bones—reduces friction in joints
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Short—Similar in length/width, cubical in shape. Spongy bone tissue absorbs shock. Ex: carpals of
hands, tarsals of feet
Flat—Thin bones comprising two layers of compact bone tissue surrounding a layer of spongy bone
tissue. Protects internal structures and provides attachment sites for muscles. Ex: sternum, scapulae,
ribs, and cranial bones.
Irregular—Bones of unique shape and function that don’t fit other categories. Ex: vertebrae, pelvic
bones, and some facial bones
Sesamoid—Small bones embedded in a joint capsule or where a tendon passes over a joint. Develop
within particular tendons at a site of considerable friction or tension. They improve leverage and protect
joints from damage. Ex: patella
Bone Markings
Necessary for increasing stability in joints and providing attachment sites for muscles.
Two types of bone markings:
1.
Depressions: Flattened or indented portions of the bone. Examples include:
a. Fossa, an attachment site located on the scapulae (shoulder blades)
b. Sulcus, a groove in a bone that allows soft tissue (tendons) to pass through. Ex:
intertubercular sulcus located in humerus, known as groove for bicep tendon.
2.
Processes: Projections protruding from the bone, to which muscles, tendons, and ligaments
can attach. Ex: spinous processes (bones jutting out of the back of the neck)
Vertebral Column
The vertebral column (aka backbone, spinal column) consists of irregularly shaped bones called
vertebrae.
5 categories of vertebrae (based on location):
1. First 7 (C1-C7) starting from the top are called cervical vertebrae.
2. Next 12 (T1-T12) are located in the upper/middle back and are called the thoracic vertebrae.
3. Next 5 (L1-L5) are the largest, located in the lower back, and called the lumbar vertebrae. These
vertebrae support most of the body’s weight and are subject to the largest forces/stresses along
the spine.
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4. The sacrum is a triangular bone just below the lumbar vertebrae. Children have 4-5 sacral
vertebrae that fuse into one bone as adults.
5. The coccyx (tailbone) is at the bottom. Children have 3-5 bones that fuse into one as adults.
Jobs of the vertebral column: allowing humans to stand upright and maintain their balance, supporting
the head and arms while permitting freedom of movement, and acting as an attachment site for several
bodily components.
Neutral spine: the optimal arrangement of curves, representing a position in which the vertebrae
and associated structures are under the least amount of load.
3 major curvatures of the spine:
1. Posterior cervical curvature—posterior concavity of the cervical spine (upper spine curves in)
2. Anterior thoracic curvature—posterior convexity of the thoracic spine (middle spine curves out)
3. Posterior lumbar curvature—posterior concavity of the lumbar spine (lower spine curves in)
Joints
Joints are formed by one bone that articulates with another bone.
Arthrokinematics = joint motion
3 major types of joint motion:
1. Roll, as in a bike tire on a street. Ex: femoral condyles rolling over the tibial condyles during a
squat.
2. Slide, as in a bike tire skidding across the street. Ex: tibial condyles sliding across femoral
condyles during a knee extension.
3. Spin, like twisting off the lid of a jar. Ex: head of the radius (forearm bone) rotating on the end of
the humerus during pronation and supination of the forearm.
Kinds of Joints
1. Nonsynovial – no joint cavity or fibrous connective tissue, little or no movement. Ex: sutures
of the skull, pubic bones
2. Synovial (most common in the human body, representing 80% of joints) – produces synovial
fluid, has a joint cavity and fibrous connective tissue.
Kinds of synovial joints:
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





Gliding joints – no axis of rotation, moves by sliding side-to-side or back to forth
(simplest movement of all joints). Ex: carpals of hand
Condyloid joints – formed by the fitting of condyles of one bone into elliptical cavities of
another; moves predominantly in one plane. Ex: knee
Hinge joints – uniaxial; moves predominantly in one plane of motion (sagittal). Ex:
elbow
Saddle joints – one bone fits like a saddle on another bone; moves predominantly in
two planes (sagittal, joint of thumb frontal). Only ex: carpometacarpal
Pivot joints – only one axis; moves predominantly in one plane of motion (transverse).
Ex: radioulnar
Ball-and-socket joints – most mobile of joints; moves in all three planes of motion. Ex:
shoulder
Ligaments are fibrous connective tissues that connect bone to bone and provide static and dynamic
stability, input to the nervous system (proprioception), guidance, and limitation of improper joint
movement.



Ligaments are primarily made up of a protein called collagen, along with elastin.
Ligaments with higher collagen levels are better suited for resisting strong forces—ie the
stabilizing structures of the knee.
Ligaments are characterized by having poor vascularity (blood supply), meaning they don’t heal
or repair very well.
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Individuals who
exercise regularly generally achieve greater peak bone mass. The best kind of exercise for bones is
weight-bearing exercise (ex: resistance training, walking, body weight squats, push-ups, jogging—NOT
swimming or biking), since it forces bones to work against gravity.
Muscular System
3 major muscle types in the body:



Skeletal
Cardiac
Smooth
Muscles are multiple bundles of muscle fibers held together by connective tissue.

Bundle #1: The actual muscle surrounded by connective tissue called epimysium and then
wrapped in connective tissue called fascia.
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
Bundle #2: The fascicle. Made up of many individual muscle fibers wrapped by connective tissue
called endomysium, then wrapped in connective tissue called perimysium.
Connective tissues allow forces generated by the muscle to be transmitted from the contractile
components of the muscle to the bones, creating motion. Each layer of connective tissue extends the
length of the muscle and connects to bone to help form tendons.
Tendons attach muscles to bones and provide the anchor from which the muscle can exert force and
control the bone and joint.
Notable fact: Ligaments and tendons are both known for poor vascularity, leaving them susceptible to
slower repair and adaptation.
Muscle fibers:

Are encased by a plasma membrane called sarcolemma.

Contain cell components like a cellular plasma called sarcoplasm, nuclei, mitochondria
(which transform energy from food into cell energy), and myofibrils.
Myofibrils contain myofilaments, called actin (thin stringlike filaments) and myosin (thick filaments),
which are the actual contractile components of muscle tissue. The actin and myosin form repeating
sections, separated by Z lines, within a myofibril, and each section is called a sarcomere.
Sarcomere: the functional unit of the muscle, much like the neuron is for the nervous system.
Two other protein structures important to muscle contraction:

Tropomyosin, located on the actin filament, blocks myosin when the muscle is in a relaxed
state.

Troponin, also located on the actin filament, provides a binding site for both calcium and
tropomyosin when a muscle needs to contract.
Neural activation is the communication link between the nervous system and the muscular
system.
A motor unit = one motor neuron and the muscle fibers it innervates with.
Neurotransmitters are chemical messengers that cross the synapse between the neuron and
muscle fiber, transporting the electrical impulse from the nerve to the muscle. The neurotransmitter
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used by the neuromuscular system is acetylcholine (ACh), which, when attached, stimulates the muscle
fibers to go through a series of steps that initiates muscle contractions.
Sliding filament theory describes how thick and thin filaments within the sarcomere slide past
one another, shortening the entire length of the sarcomere and thus shortening muscle and producing
force. Steps are as follows:


A sarcomere shortens as a result of the Z lines moving closer together.
The Z lines converge as the result of myosin heads attaching to the actin filament and
asynchronously pulling the actin filament across the myosin, resulting in shortening of the
muscle fiber.
The excitation-contraction coupling process is what takes a muscle from neural stimulation
through muscle contraction.
The “All or Nothing Law”: motor units cannot vary the amount of force they generate; they
either contract maximally or not at all.
As a result of this law, the overall strength of a muscle contraction depends on the size of the motor
unit recruited and the number of motor units activated at a given time. (Large muscles handle large
movements, while small movements are made by greater quantities of smaller muscles.)
Two categories of muscle fibers:
1.
Type I (slow-twitch): contain MORE capillaries, mitochondria, and myoglobin. Often
referred to as red fibers since myoglobin appears red.
Other characteristics: increased oxygen delivery, smaller in size, less force produced,
slow to fatigue, long-term contractions (stabilization)
Example usage: sitting upright for a long period of time
2.
Type II (fast-twitch): white fibers, FEWER capillaries, mitochondria, and myoglobin.
Other characteristics: Decreased oxygen delivery, larger in size, more force produced,
quick to fatigue, short-term contractions (force and power)
Example usage: performing a sprint
Two subcategories of type II:
Type IIa: higher oxidative capacity, slower to fatigue. Called immediate fast-
twitch fibers, as they can use both aerobic and anaerobic metabolism almost equally
to create energy. (Therefore, kind of a combination of type I and type II muscle fibers)
Type IIx: low oxidative capacity, quicker to fatigue
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Muscles as Movers (page 42)
Muscle
Type
Agonist
Synergist
Stabilizer
Antagonist
Muscle Function
Exercise
Muscle(s) Used
Prime mover (muscles
most responsible for a
particular movement)
Hip extension
Gluteus maximus
Chest press
Pectoralis major
Overhead press
Deltoid
Row
Latissimus dorsi
Squat
Hip extension
Gluteus maximus, quadriceps
Hamstring complex/erector spinae
Chest press
Anterior deltoid/triceps
Overhead press
Triceps
Row
Posterior deltoid/biceps
Squat
Hip extension
Hamstring complex
Transversus abdominis, internal
oblique, and multifidus (deep
muscles in low back)
Chest press
Rotator cuff
Overhead press
Rotator cuff
Row
Rotator cuff
Squat
Hip extension
Transversus abdominis
Psoas (deep hip flexor)
Chest press
Posterior deltoid
Overhead press
Latissimus dorsi
Row
Pectoralis major
Squat
Psoas (deep hip flexor)
Assist prime mover
Stabilize while prime
mover and synergist
work
Oppose prime mover
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Endocrine System
The endocrine system is a system of glands that secrete hormones into the bloodstream to regulate a
variety of bodily functions, including mood, growth and development, tissue function, and metabolism.
(Similar to a thermostat.)
Consists of: host organs (glands), chemical messengers (hormones), and target cells (receptor cells).
Primary endocrine glands: hypothalamus, pituitary (the “master” gland—controls all others),
thyroid, and adrenal glands.
Carbohydrate (specifically glucose) is the body’s primary energy source during vigorous exercise.
Control of blood glucose is regulated by the pancreas, which produces two specific hormones:
insulin and glucagon.
Insulin: creates glucose stores immediately after meals.
Glucagon: Taps into glucose stores long after a meal, converting glycogen back into glucose so it can
be released into the bloodstream.
2 Catecholamines:

Epinephrine: adrenaline. Results in increased heart rate and stroke volume, elevated blood
glucose levels, opened airways, etc.

Norepinephrine: opposite of epinephrine, flight or fight response
Other key hormones:
Testosterone: present in both men and women (10x more in men). Plays a fundamental role in the
growth and repair of tissue. Raised levels are indicative of an anabolic (tissue-building) training status.
Cortisol: in contrast to testosterone, cortisol represents tissue breakdown. It’s released in times of
stress (such as exercise) to maintain energy through the breakdown of carbs, fat, and protein. Too
much cortisol (brought by overtraining, excessive stress, poor sleep, or inadequate nutrition) can lead to
significant breakdown of muscle tissue, and more.
Growth hormone: Responsible for growth and development during childhood up until puberty,
when sex hormones take over. Also increases the development of bone, muscle tissue, and protein
synthesis; increases fat burning; and strengthens the immune system.
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Thyroid: (Thyroid gland = Adam’s apple) Hormones primarily responsible for human metabolism.
Effects of exercise:
As activity increases, glucose uptake increases, insulin levels drop, and glucagon secretion by the
pancreas increases, helping maintain a steady supply of blood glucose.
Testosterone and growth hormone levels increase after strength training and moderate to vigorous
aerobic exercise. Same with cortisol levels.
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Chapter 3
What to Know: The Cardiorespiratory System

Figure 3.3 Atria and Ventricles know the functions of the right and left atrium and the right
and left ventricles

Table 3.1 Support Mechanisms of Blood

Table 3.2 Structures of the respiratory pump.
Cardiorespiratory system = cardiovascular system (heart, blood vessels, and blood) +
respiratory system (trachea, bronchi, alveoli, and lungs)
Cardiovascular System
The heart is contained in the area of the chest called the mediastinum.
3 types of muscle: cardiac (involuntary, striated in appearance), skeletal (voluntary, striated), and
smooth (not striated).
Intercalated discs between cardiac cells hold muscle cells together during contraction and create
electrical connections that allow the heart to contract as one functional unit.
Typical resting heart rate: 70-80 BPM.
Sinoatrial (SA) node: located in the right atrium, is called the pacemaker for the heart because it
initiates the electrical signal that causes the heart to beat.
Atrioventricular (AV) node: conducts impulses from the SA node to the ventricles.
Heart Structure/Process
1-RIGHT ATRIUM
4-LEFT ATRIUM
Deox pool
Gathers deoxygenated blood from the body,
ready to send to the RV
Ox pool
Gathers oxygenated blood from the lungs, ready
to send to the LV
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2-RIGHT VENTRICLE
5-LEFT VENTRICLE
Deox pump to lungs
Receives deoxygenated blood from the RA and
pumps it to the lungs to get oxygen
Ox pump to body
Receives oxygenated blood from the LA and
pumps it to the body
3-LUNGS (oxygenation)
6-BODY (blood goes into arteries and
comes back through veins)
Stroke volume: amount of blood pumped out of the heart with each contraction, or the difference
between the end-diastolic volume (EDV) and the end-systolic volume (ESV).
Typical heart stroke volume: 120 mL EDV and 50 mL ESV = SV of 70 mL.
Blood is life-sustaining fluid that supplies organs and cells with oxygen and nutrients, helps regulate
body temperature, fight infection, and remove waste products. Average adult has 4-6 L of blood.
3 Types of Blood:



Red – carry oxygen from lungs to body
White – fights infection
Platelets – clotting
Blood vessels form a closed circuit of hollow tubes that allow blood to be transported to and from the
heart.
3 Types of Blood Vessels:



Arteries – carry blood away from the heart
Capillaries – where water/chemicals are exchanged between blood and tissues
Veins – carry blood back to the heart
Respiratory System
Including: airways, lungs, and respiratory muscles.
Purpose: to bring oxygen into the lungs and remove carbon dioxide, ensuring proper cellular function.
Inspiration: activity contracting the inspiratory muscles to move air into the body.
Expiration: actively or passively relaxing the inspiratory muscles to move air out of the body.
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Normal breathing: uses primary respiratory muscles (diaphragm, external intercostals)
Heavy breathing: additional use of secondary respiratory muscles (scalenes, pectoralis minor)
Two respiratory airways:

Conducting airways consist of all the structures that air travels through before entering
the respiratory airways. (eg nasal/oral cavities, mouth, pharynx, etc.) The structures provide a
gathering station, allow the air to be purified, humidified, and warmed/cooled as necessary to
match body temp.

Respiratory airways collect channeled air from conducting airways and transport
oxygen/Co2 in/out of the bloodstream through a process called diffusion.
Best measure of cardiorespiratory fitness: maximal oxygen consumption (VO2max). Expensive
to test with accuracy, but often estimated through the Rockport Walk Test, Step Test, and YMCA bike
protocol test.
Results of abnormal breathing patterns:





Shallow, upper-chest breathing can become habitual, causing overuse to secondary respiratory
muscles.
Can affect posture and lead to lightheadedness, headaches, and dizziness.
Can lead to altered carbon dioxide and oxygen blood content, leading to feelings of anxiety that
further exacerbate the excessive breathing response.
Inadequate oxygen and retention of metabolic waste in muscles can create fatigued, stiff
muscles.
Inadequate joint motion from improper breathing can lead to restricted/stiff joints.
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Chapter 4
What to Know: Exercise Metabolism and Bioenergetics:
Be Familiar with all definitions throughout the chapter.
Substrates: Primary sources of chemical energy for most organisms, aka the middle product to which
all food must be converted to before it can be used as energy.
3 substrates: carbohydrates, fats, and proteins (in order of importance)
The energy stored in these substrates is chemically released in cells and stored in the form of a highenergy compound called adenosine triphosphate (ATP).
Energy metabolism or bioenergetics: the study of how energy is transformed through various
biochemical reactions. The ultimate source of energy is the sun.
Metabolism: all the chemical reactions that occur in the body to maintain itself.
Exercise metabolism: examination of bioenergetics as it relates to the unique physiological
changes and demands placed on the body during exercise.
Glucose: A simple sugar manufactured by the body from carbs, fat, and to a lesser extent, protein,
which serves as the body’s main source of fuel.
Glycogen: The storage form of carbohydrates. When carbohydrate energy is needed, glycogen is
converted into glucose for use by muscle cells.
Triglycerides: the chemical or substrate form in which most fat exists, both in food and in the body.
If fat calories consumed aren’t immediately needed, they’re converted into triglycerides for storage.
Protein is generally ignored as a significant fuel for energy metabolism, and only really comes into
play during starvation, when it’s required to participate in a special energy-producing process called
gluconeogenesis.
Cellular Metabolism
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When the chemical bonds of ATP are broken (by an enzyme), energy is released for cellular work and a
molecule called adenosine diphosphate (ADP) is dropped. Energy metabolism works to harness enough
free energy to reattach a phosphate group to an ADP, thereby turning it back into an ATP.
ATP = ADP + Pi (an inorganic phosphate molecule) + energy release
The body does not technically make energy—it transfers energy from the sun through food to cells
using energy metabolism processes. The specific process used depends on the intensity and duration of
the physical activity the body is performing at the time.
Energy is used to form the myosin-actin cross-bridges that facilitate muscle contraction. For one
cycle of a cross-bridge, two ATPs are needed.
3 different energy metabolism systems (ways to generate ATP):
ATP-PC System (immediate use)
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The simplest and fastest of the energy systems
Occurs without oxygen
Activated by the onset of activity, regardless of intensity, because of its ability to kick in
immediately
Provides energy for high-intensity, short-duration activity (as seen in power/strength training)
Works by transferring a phosphate (and its energy) from another high-energy molecule called
phosphocreatine (abbrev. PC) to an ADP molecule.
Glycolysis System (short-term use)
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Can produce a significantly greater amount of energy than ATP-PC
Limited to 30-50 seconds of duration (ideal for an 8-12 repetition exercise)
Works by chemically breaking down stored glucose. Before glucose can be used, it must be
converted to glucose-6-phosphate.
Can be aerobic or anaerobic (with or without oxygen)—process is the same, only the output is
different. Without oxygen, the result is lactic acid; with oxygen, the result is pyruvic acid, which
is converted into an important molecule used in the Krebs cycle.
Oxidative System (long-term use)
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The slowest, most complex system
Ability to produce energy for an indefinite period of time (since everyone has an ample storage
of fat)
Requires oxygen
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Happens via three sub-processes: Aerobic glycolysis (mentioned above), the Krebs cycle, and
the electron transport chain (ETC)
Metabolises carbs (via glucose), triglycerides aka fat (via fatty acids), and some proteins (via
amino acids). End results are water and carbon dioxide, both easily eliminated.
Note: the complete metabolism of a single glucose molecule produces between 35 and 40 ATP.
Summary: The amount of energy from stored ATP and phosphocreatine (the first system) is small.
The amount of energy from stored carbohydrates (the second system) is greater, but still limited. The
amount of available fuel for exercise from fats (the third system) is essentially limitless.
The body prefers aerobic or oxidative metabolism because carbon dioxide and water are more easily
eliminated.
Metabolism during exercise
One way to measure work output during exercise is by measuring oxygen consumption.
At the start of exercise, aerobic metabolic pathways are too slow to meet demand, so the body relies on
anaerobic processes. This oxygen deficit shows up in the sluggishness we feel at the beginning of a
workout. As aerobic processes kick in and less energy is derived from anaerobic sources, we begin to
feel better.
Excess Post-exercise Oxygen Consumption (EPOC): The state in which the body’s
metabolism is elevated for a time after exercise.
During intermittent exercise, the anaerobic-to-aerobic process occurs multiple times with each change
of work requirement.
Respiratory quotient (RQ) = the amount of carbon dioxide (CO2) expired divided by the amount
of oxygen (O2) consumed.
An RQ of 1.0 suggests that 100% of fuel is coming from carbohydrates, whereas an RQ of 0.7 suggests
that 100% of fuel is coming from fats. (Anything in the middle is a mix of carbs and fats.)
The “fat-burning zone” is a myth because working out at a higher intensity still results in a greater total
contribution from fat despite also generating a greater percentage contribution of fuel from
carbohydrates.
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Chapter 5
What to Know: Human Movement Science

Know definitions throughout the chapter in detail.

Figure 5.3 Planes of Motion
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Table 5.1 Examples of Planes, Motions, and Axes

Figure 5.4 Joint Motions

Figure 5.5 Joint Motions
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Figure 5.6 Joint Motions

Figure 5.7 Joint Motions

Table 5.2 Muscle Action Spectrum

5.3 Common force couples

Figure 5.15 Levers
Biomechanics: the science concerned with the internal and external forces acting on the human
body and the effects produced by these forces.
Anatomic Locations
Superior: above the point of reference
Inferior: below the point of reference
Proximal: nearest the center of the body or point of reference
Distal: away from the center of the body or point of reference
Anterior: on or toward the front of the body
Posterior: on or toward the back of the body
Medial: relatively closer to the midline of the body
Lateral: relatively farther away from the midline or toward the outside of the body
Contralateral: opposite side of the body
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Ipsilateral: same side of the body
Planes of Motion
Although motions can be one-plane dominant, remember that no motion occurs strictly in one plane of
motion.
Joint motion: movement in a plane that occurs on an axis running perpendicular to that plane, like
the axle that a car wheel revolves around.
Frontal=Front/back, Sagittal=Sides, Transverse=Top/bottom
Sagittal Plane
Bisects the body into right and left sides. Movements go forward/backward and up/down.
Movements include:

Flexion: a bending movement in which the relative angle between two adjacent segments
decreases.
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
Extension: a straightening movement in which the relative angle between two adjacent
segments increases.
Examples of sagittal plane movements: bicep curls, tricep pushdowns, squats, front lunges, calf raises,
walking, running vertical jump, climbing stairs, and shooting a basketball.
Hyperextension is the extension of a joint beyond the normal limit or range of motion, often
resulting in injury.
Frontal Plane
Bisects the body into front and back halves. Movements go side-to-side.
Movements include:

Adduction: a movement of the segment toward the midline of the body (or similar to
flexion, a decrease in the angle between two adjoining segments, but in the frontal plane)

Abduction: a movement away from the midline of the body (or similar to extension, an
increase in the angle between two adjoining segments, but in the frontal plane)
Examples of frontal plane movements: side lateral raises, side lunges, and side shuffling.
Transverse Plane
Bisects the body into upper and lower halves. Movements are rotations.
Movements include:

Internal rotation: rotation of a joint toward the middle of the body.

External rotation: rotation of a joint away from the middle of the body.

Horizontal abduction: movement of the arm or thigh in the transverse plane from an
anterior position to a lateral position.

Horizontal adduction: movement of the arm or thigh in the transverse plane from a
lateral position to an anterior position.
Examples of transverse plane movements: cable trunk rotations, dumbbell chest fly, throwing a
ball/Frisbee, golfing, swinging a bat.
Scapular Motion
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Motion of the shoulder blades.
Movements include:

Retraction (“adduction”): Shoulder blades come close together.  

Protraction (“abduction”): Shoulder blades move farther away from each other.  

Elevation: Should blades move upward toward ears.

Depression: Shoulder blades move downward.
Muscle Actions
Isotonic (iso = equal, tonic = tension): constant muscle tension
Eccentric: deceleration (lowering a weight)
Concentric: acceleration (lifting a weight)
Isometric (iso = equal, metric = length): constant muscle length
Isokinetic (iso = equal, kinetic = motion): constant velocity of motion
Isotonic:
Force is produced, muscle tension developed, and movement occurs through range of motion.
Two phases of isotonic movement:
1.
Eccentric: A muscle develops tension while lengthening (actin and myosin cross-bridges are
pulled apart and reattached). Lengthening happens because the contractile force is less than the
resistive force.
Moving in the same direction as the resistance, decelerates/reduces force
Examples: landing from a jump, lowering a weight
2.
Concentric: The contractile force is greater than the resistive force, resulting in shortening of
the muscle and visible joint movement (actin and myosin cross-bridges move together, known
as sliding-filament theory).
Moving in opposite direction of force, accelerates/produces force
Examples: jumping upward, lifting a weight
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Isometric:
No visible movement with or against resistance, dynamically stabilizing force.
Contractile force is equal to resistive force, leading to no visible change in muscle length.
Examples:
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
Pausing between lifting and lowering in resistance training.
Adductors and abductors of the thigh during a squat dynamically stabilize the leg from moving
too much in the frontal and transverse planes.
During a ball crunch, the transversus abdominis and multifidus muscles stabilize the lumbar
spine.
Isokinetic:
Muscle shortens at a constant speed over the full range of motion.
Speed of movement is fixed, resistance varies with the force exerted. Ie the harder an individual pushes
or pulls, the more resistance they feel. Muscle tension is at its maximum throughout the whole range of
motion.
Requires sophisticated training equipment.
Examples of Muscle Actions:
Bicep Curl
1. Lift dumbbell. Concentric action, muscle shortening.
2. Hold dumbbell at shoulder. Isometric action, muscle length unchanged.
3. Lower dumbbell. Eccentric action, muscle lengthening.
Squat
1. Squat down. Lowering movement = eccentric action.
2. Pause at bottom. Isometric action.
3. Return to standing. Lifting movement = concentric action.
Force: the interaction between two entities or bodies that results in either the acceleration or
deceleration of an object. Characterized by magnitude (how much) and direction.
Muscle Relationships
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Length-tension relationships: the resting length of a muscle and the tension the muscle can
produce at this resting length.
Optimal muscle length = actin and myosin filaments in the sarcomere have the greatest degree of
overlap, allowing for the max amount of connections between the two and max force production.
Lengthening a muscle beyond this optimal length reduces overlap and force production.
If muscle lengths are altered (ie misaligned joints—poor posture), they will not generate the needed
force to allow for efficient movement.
Force-velocity curve: the relationship of muscle’s ability to produce tension at differing
shortening velocities. As the velocity of a concentric muscle action increases, its ability to produce force
decreases. Aka the faster you lift, the harder it gets. (Reverse is true for eccentric actions: as velocity
increases, force production increases.)
Force-couple relationships: muscle groups working together to produce movement around a
joint. Muscles in a force-couple provide divergent pulls on the bone or bones they connect with.
All muscles working in unison to produce a desired movement are said to be working in a force-couple.
Proper force-couple relationships rely on proper length-tension relationships and joint motion.
Common Force-Couples
Muscles
Movement
Internal/external obliques
Upper trapezius and lower portion of serratus
anterior
Gluteus maximus, quads, and calf muscles
Trunk rotation
Upward rotation of scapula
Gastrocnemius, peroneus longus, and tibialis
posterior
Deltoid and rotator cuff
Hip and knee extension during walking, running,
etc.
Performing plantarflexion at the foot and ankle
complex
Performing shoulder abduction
Muscle Levers
Joint motion is caused by muscles pulling on bones; muscles cannot actively push.
A lever consists of a rigid “bar” that pivots around a stationary fulcrum (pivot point). In the body, the
fulcrum is the joint axis, bones are the levers, muscles create the motion, and resistance can be body
weight or object weight.
3 kinds of levers:
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

First-class: Fulcrum in the middle, like a seesaw. Example: nodding the head.
Second-class: Resistance in the middle (with fulcrum and effort on either side), like a load in
a wheelbarrow. Examples: full-body push-ups or calf raises.

Third-class: Effort in the middle (between resistance and fulcrum). Most limbs of the
human body are third-class levers. Examples: human forearm during bicep curl (fulcrum =
elbow, effort = bicep, load = dumbbell).
Rotary motion: movement around an axis.
Torque: a force that produces rotation, measured in newton-meters or Nms.
The difference between the distance a weight is from the center of a joint and the muscle’s attachment
and line of pull (direction through which tension is applied through the tendon) is from the joint will
determine the efficiency with which the muscles manipulate the movement. Ie: the closer a weight is to
the point of rotation (the joint), the less torque it creates (and the easier the movement becomes).
Motor Behavior
Motor behavior: the HMS response to internal and external environmental stimuli. The collective
study of 3 things:
1.
Motor control: how the central nervous system integrates internal and external
sensory information with previous experiences to produce a motor response.
2.
Motor learning: utilization of motor control through practice and experience, leading
to skilled movement. (Examples: riding a bike, playing the piano)
3.
Motor development: the change in motor behavior over time, throughout a lifespan.
Muscle synergies: groups of muscles that are recruited by the central nervous system to provide
movement. With proper technique, synergies become increasingly fluent and automated.
Sensorimotor integration: the ability of the nervous system to gather and interpret sensory
information and to select and execute proper motor responses. This process works as long as incoming
sensory information is good. Individuals training using improper form will develop improper sensory
information, leading to movement compensations and potential injury.
Feedback: the use of sensory information and sensorimotor integration to help the human
movement system in motor learning.
2 kinds:
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1.
Internal Feedback (sensory feedback): the process whereby sensory information is
used by the body to reactively monitor movement and the environment.
2.
External Feedback: information provided by an external source, such as a trainer or
mirror, to supplement internal feedback.
2 Forms of external feedback:
a. Knowledge of results: telling a client how they did after performing a move.
b. Knowledge of performance: providing feedback during a movement.
It is important that clients do not become dependent on external feedback, as this may detract from
their responsiveness to internal sensory input. Clients should be encouraged to pay attention to how
their body feels when they are performing a movement correctly.
REVIEW TIPS FROM NASM – Chapter 5
The planes of motion can be a bit tricky, so here is a little bit of clarification:
Frontal Plane
NOT front to back movements
Side to side movements
Exercises involving abduction and/or adduction of the limbs
Example: side lunge, lateral dumbbell raise, ice skater
Imagine a wall in front and in back of you. The ONLY movement this would allow is along that planesideways movements.
Sagittal Plane
Forward and backwards movements
Movements involving pushing and/or pulling
Movements involving flexion and/or extension at joints
Example: bicep curl, front lunge, bench press, and rows
Imagine a wall on your right and left side. The ONLY movement this would allow is along that plane-or
front and back movements.
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Transverse Plane
Rotational movements
Diagonal movements
Example: rotation, wood-chop throw, medicine ball rotation chest pass
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Chapter 6
What to Know: Fitness Assessments
This is going to be a very important chapter to know as a lot of test question will be taken from this
chapter.
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Table 6.1 Guidelines for Health and Fitness Professionals
Figure 6.1 Subjective vs. Objective information
Figure 6.2 Sample Physical Activity Readiness Questionnaire
Figure 6.3 Sample questions: client occupation
Figure 6.4 Sample questions: client lifestyle
Figure 6.5 Sample questions: client medical history
Table 6.2 Common medications by classification
Table 6.3 Effects of medication on heart rate and blood pressure
Heart rate and blood pressure assessments
Table 6.4 Target heart rate training zones
Max Heart Rate formula (straight percentage method) for each zone
Body Composition Assessments
Circumference measurements
Body Mass Index
YMCA 3-minute step test
Rockport Walk Test
Table 6.9 Pronation Distortion Syndrome
Table 6.10Lower Crossed Syndrome
Table 6.11Upper Crossed Syndrome
Be familiar with all of the assessment protocols and for the posture assessments all
compensations
NASM endorses a “start low and go slow” approach to exercise.
Fitness assessments allow PTs to continually monitor a client’s needs, functional capabilities, and
physiologic effects of exercise, enabling the client to realize the full benefit of an individualized training
program.


NOT designed to diagnose medical/health conditions or prescribe treatment of any kind.
Designed to serve as a way of observing/documenting clients’ structural/functional status.
Fitness assessments include:

Pre-participation health screening
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Resting physiologic measurements (heart rate, blood pressure, height, weight)
Measurements to help determine fitness level
Subjective information: general and medical history (occupation, lifestyle, personal info)
Objective information: physiologic assessments, body composition testing, cardiorespiratory
assessments, static and dynamic postural assessments, performance assessments
The Physical Activity Readiness Questionnaire (PAR-Q) has been designed to determine
the safety or possible risk of exercising for a client based on the answers to specific health history
questions. Primarily aimed at identifying individuals at risk of cardiovascular disease (CVD) who would
need further evaluation from a doctor before proceeding.
Common Movement Patterns and Potential Impacts

Extended periods of sitting  tight hip flexors, postural imbalances, potentially poor
cardiorespiratory conditioning



Repetitive movements  pattern overload to muscles and joints, leading to tissue
trauma and kinetic chain dysfunction. Working with arms overhead may lead to
shoulder/neck soreness, tightness in lats and weakness in rotator cuff.
Dress shoes  decreased dorsiflexion and overpronation at the foot and ankle
complex, resulting in flattening of the arch of the foot
Mental stress  elevated resting heart rate, blood pressure, and ventilation at rest
and exercise.
(Review effects of medication on heart rate and blood pressure chart on page 108)
Heart rate assessment
Resting heart rate is a fairly good indicator of overall cardiorespiratory fitness, whereas
exercise HR is a strong indicator.
7 pulse points—most common: radial and carotid arteries
Resting heart rate should be determined by having the client record it 3 mornings in a row and take the
average
Typical resting heart rate = 70-80 BPM (Average for men =70, average for women = 75)
Estimated maximal heart rate = 220 – age
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Heart Rate Training Zones
Zone
One
Two
Three
Purpose
Build aerobic base/aid in
recovery
Increase aerobic and anaerobic
endurance
Build high-end work capacity
Intensity
65-75%
76-85%
86-95%
Heart rate reserve (HRR) aka the Karvonen method is a method of establishing training intensity
on the basis of the difference between a client’s predicted maximal heart rate and their resting heart
rate.
Target heart rate (THR) = [(HRmax – HRrest) x desired intensity] + HRrest
Blood pressure assessment
Systolic (pressure within the arterial system after the heart contracts) / Diastolic (pressure within
the arterial system when the heart is resting and filling with blood)
Acceptable blood pressure = 120/80 mm Hg or less
Body composition: the relative percentage of body weight that is fat versus fat-free tissue, aka
“percent body fat”
Percent Fat Standards
Essential
Athletic
Recommended (34 years or less)
Recommended (35-55)
Recommended (56 and up)
Men
3-5%
5-13%
8-22%
10-25%
10-25%
Women
8-12%
12-22%
20-35%
23-38%
25-38%
Body Composition Assessments:
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
Skinfold measurement w/calipers
Bioelectical impedance w/an electrical current
Underwater weighing (aka hydrostatic weighing)
Body Fat Percentage
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Calculate with the Durnin formula
Measure 4 skinfolds: biceps, triceps, subscapular (back fat), and iliac crest (love handles), then plug into
chart with sex and age

Body fat % x scale weight = fat mass

Scale weight – fat mass = lean body mass
Circumference Measurements

Can be used on obese clients

Good for comparisons/progressions

Good for assessing fat pattern/distribution

Inexpensive

Easy to record
The 7 measurements include: neck, chest, waist, hips, thighs, calves, and biceps
Waist-to-hip ratio (divide waist by hip)—should be no higher than 0.8 for women and 0.95 for men.
BMI = Weight (kg) / Height (m^2)
OR
BMI = [Weight (lbs) / Height (inch ^2)] x 703
BMI with lowest risk of disease = 22-24.9
Cardiorespiratory Assessments
Most valid measurement: cardiopulmonary exercise testing (CPET) or maximal oxygen
uptake. Often not practical due to cost, time involved, and willingness of client to perform at max
physical capacity.
Submaximal testing allows for the prediction or estimation of VO2max (maximal oxygen uptake).

YMCA 3-Minute Step Test: 96 steps/minute on a 12-inch step. Measure heart rate afterwards
for 60 seconds. Compare to chart.
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
Rockport Walk Test: Record the client’s weight. Have the client walk 1 mile as fast as possible
on a treadmill. Record the time. Record the client’s HR. Use the formula to calculate oxygen
consumption.
Posture and Movement Assessments
Proper posture:

Ensures that the muscles of the body are optimally aligned at the proper length-tension
relationships necessary for efficient functioning of force-couples. This in turn ensures proper
joint motion, maximal force production, and reduced risk of injury.

Helps the body produce high levels of functional strength. Without it, the body may degenerate
or experience altered movement patterns and muscle imbalances.
The use of a static postural assessment (assessment of resting posture) is the basis for
identifying muscle imbalances.
3 primary postural distortion patterns:

Pronation distortion syndrome: flat feet, knock knees

Lower crossed syndrome: arched lower back

Upper crossed syndrome: forward head, rounded shoulders
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Static Postural Assessment
Check for: neutral alignment, symmetry, balanced muscle tone, and specific postural deformities.
Focus on the kinetic chain checkpoints: Foot and ankle, knee, lumbo-pelvic-hip complex (LPHC),
shoulders, head and cervical spine
Anterior View (from the front)
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Foot/ankles: Straight and parallel, NOT flattened/externally rotated
Knees: In line with toes, NOT adducted or abducted
LPHC: Pelvis level with both anterior superior iliac spines in same transverse plane
Shoulders: Level, NOT elevated or rounded
Head: Neutral position, NOT tilted or rotated
Lateral View (side)
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Foot/ankles: Neutral position, leg vertical at right angle to sole of foot
Knees: Neutral position, NOT flexed nor hyperextended
LPHC: Pelvis neutral position, NOT anteriorly (lumbar extension) or posteriorly (lumbar flexion)
rotated
Shoulders: Normal kyphotic curve, NOT excessively rounded
Head: Neutral position, NOT in excessive extension (jutting forward)
Posterior View (side)
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
Foot/ankles: Heels straight and parallel, NOT overly pronated
Knees: Neutral position, NOT adducted or abducted
LPHC: Pelvis level, as above
Shoulders: Level, NOT elevated or protracted
Head: Neutral, NOT tilted or rotated
Dynamic Postural Assessments
1) Overhead Squat
Assesses dynamic flexibility, core strength, balance, and overall neuromuscular control. (Same as singleleg squat.)
Look for these 5 compensations:
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2) Single Leg Squat
Assesses dynamic flexibility, core strength, balance, and overall neuromuscular control. (Same as
overhead squat.)
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3) Pushing Assessment
Assesses: movement efficiency and potential muscle imbalances during pushing movements.
4) Pulling Assessment
Assesses: movement efficiency and potential muscle imbalances during pulling movements.
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Performance Assessments
1) Push-up Test
Measures muscular endurance of the upper body, primarily the pushing muscles.
Process: Perform push-ups for 60 seconds or to exhaustion without compensating. Must touch chest to
floor. PT records number of touches.
2) Davies Test
Assesses upper extremity agility and stabilization.
Process: In push-up position, client switches off touching two points 36 inches apart with the opposite
hand. PT records number of touches in 15 seconds.
3) Shark Skill Test
Assesses lower extremity agility and neuromuscular control.
Process: Client stands on a 9-square grid, hands on hips, standing on one leg. Follows directions to hop
from box to box in a certain pattern, always returning to center.
Deductions recorded for: non-hopping leg touching ground, hands coming off hips, foot going into
wrong square, foot not returning to center square.
4) Upper Extremity Strength Assessment (Bench Press)
Estimates one-rep maximum on overall upper body strength of the pressing musculature. Considered
an advanced assessment for strength-specific goals only.
Process: Warm up with light resistance for 8-10 reps. Take a 1 min rest. Add 10-20 lbs. for 3-5 reps. Take
a 2 min rest. Repeat last two steps until failure between 2-10 reps. Use chart to estimate one-rep max.
5) Lower Extremity Strength Assessment (Squat)
Estimates one-rep maximum for squats and overall lower body strength. Considered an advanced
assessment for strength-specific goals only.
Process: Warm up with light resistance for 8-10 reps. Take a 1 min rest. Add 30-40 lbs. for 3-5 reps. Take
a 2 min rest. Repeat last two steps until failure between 2-10 reps. Use chart to estimate one-rep max.
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Chapter 7
What to Know: Flexibility Training Concepts:
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Know all definitions throughout the chapter
Figure 7.10 Integrated flexibility Continuum
Table 7.2 Examples of stretching within the Flexibility Continuum
Myofascial Release
Table 7.3 Static Stretching Summary
Table 7.4 Active-Isolated Stretching summary
Table 7.5 Dynamic Stretching summary
Mechanoreceptors = a Golgi tendon organ (GTO) and muscle spindle fibers
GTO
Muscle Spindle Fibers
Senses muscle tension
Senses muscle lengthening
Relaxes the muscle in response
Contracts the muscle in response
Normal reaction to avoid injury
Normal reaction to avoid injury
Focus on page 183!!
Look at each overactive muscle and refer back to Appendix D (pages 575-596). Look at each muscle's
"Isolated Function". Some muscles will over-do their "Isolated Function". Other muscles tend to be
"victims of association". This means that they may become synergistically dominant because a muscle
nearby becomes underactive/lengthened/weak.
In addition, by having a general idea of what each muscle's "Isolated Function" is, you will be able to
figure out exercises that directly work those muscles.
Think of muscles in terms of antagonistic (one is an agonist while the other is an antagonist) actions.
When an agonist contracts, the antagonist will relax. Also keep in mind that several muscles may have
similar actions and that the exact movement of a bone will be the result of a coordinated effort
involving many muscles (force couples). Muscles function in integrated groups to allow for
neuromuscular control during movement. A muscle's integrated muscle function is the action it
naturally tends to perform when it works in conjunction with other muscles. By isolating each muscle
on the other hand, and tracing them from their point of origin to their insertion, one can gain a better
understanding of that muscle's main function. A muscle's isolated function is what that individual
muscle is meant to do, alone, and isolated from all other muscles.
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An advanced knowledge in anatomy is required to identify muscle functions such as agonists,
antagonists, synergists, and stabilizers. For example, most stabilizers are proximal to the joint they
stabilize, but it is dependent on the movement that is occurring. Stabilizers are generally smaller in size,
made up of type I muscle fibers (slow twitch), and they are prone to weakness.
Some examples of stabilizers include (1) rotator cuff – shoulder (2) core inner unit – multifidus,
transverse abdominus, pelvic floor muscles, internal oblique – stabilize pelvis and spine (3) kneeVMO, popliteus – knee. For the exam you only need an understanding of this concept to the degree the
textbook discusses.
Flexibility: the ability to move a joint through its complete range of motion. ROM is dictated by the
normal extensibility of all soft tissues surrounding the joint. Soft tissue will only achieve efficient
extensibility if optimal control of movement is maintained throughout the entire ROM.
Dynamic range of motion: the optimal control of movement throughout a joint’s entire ROM. It
is the combination of flexibility and the nervous system’s ability to control ROM efficiently.
Neuromuscular efficiency: the ability of the nervous system to recruit the correct muscles to
produce force (concentrically), reduce force (eccentrically), and dynamically stabilize (isometrically) the
body.
Flexibility requires extensibility, which requires dynamic range of motion, which
requires neuromuscular efficiency.
Postural distortion pattern: predictable patterns of dysfunction that develop when the HMS is
misaligned and not functioning properly over time. Muscle imbalance  poor posture  improper
movement  injury.
Relative flexibility: altered movement patterns, or the tendency of the body to seek the path of
least resistance during functional movement patterns. (Ex: squatting with feet externally rotated due to
tight calf muscles.)
Muscles imbalances: alterations in the lengths of muscles surrounding a given joint, in which
some are overactive and others underactive.
Reciprocal inhibition: the simultaneous relaxation of one muscle and the contraction of its
antagonist to allow movement to take place. (A naturally occurring, healthy phenomenon.)
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Altered reciprocal inhibition: a muscle inhibition, caused by a tight antagonist, which inhibits
its functional antagonist. (Ex: a tight psoas, hip flexor, decreases neural drive of the glutes, hip
extensors.)
Synergistic dominance: a neuromuscular phenomenon that occurs when synergists take over
function for a weak or inhibited prime mover.
Arthrokinematics: the motions of joints in the body.
Arthrokinetic dysfunction: a biomechanical and neuromuscular dysfunction leading to altered
joint motion.
Muscle spindles help prevent muscles from stretching too far or too fast. However, when a muscle
on one side of a joint is lengthened (because of a shortened muscle on the opposite side), the spindles
of the lengthened muscle are stretched. This info is transmitted to the brain and spinal cord, exciting the
muscle spindle and causing the muscle fibers of the lengthened muscle to contract. This often results in
micro spasms or a feeling of tightness. When a lengthened muscle is stretched, it increases the
excitement of the muscle spindles and further creates a contraction (spasm) response.
Autogenic inhibition: The process by which neural impulses that sense tension are greater than
the impulses that cause muscles to contract, providing an inhibitory effect to the muscle spindles.
(Called autogenic because the muscle is being inhibited by its own receptors.)
Stretches should be held long enough for the Golgi tendon organ to override the signal from the
muscle spindle (approx. 30 seconds).
Pattern overload: consistently repeating the same pattern of motion, which may place abnormal
stresses on the body.
Cumulative injury cycle: Tissue trauma  inflammation  muscle spasm  adhesions  altered
neuromuscular control  muscle imbalance.
Any trauma to the tissue of the body creates inflammation. Inflammation, in turn, activates the body’s
pain receptors and initiates a protective mechanism, increasing muscle tension or causing muscle
spasm.
Davis’s law states that soft tissue models along the lines of stress.
3 phases of flexibility training:
1. Corrective
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Designed to increase joint ROM, improve muscle imbalances, and correct altered joint motion.
Includes: self-myofascial release and static stretching.
Appropriate for: phase 1 of OPT.
2. Active
Designed to improve extensibility of soft tissue and increase neuromuscular efficiency using
reciprocal inhibition.
Includes: self-myofascial release and active-isolated stretching. A-I stretching allows for
agonists and synergist muscles to move a limb through a full ROM while the functional
antagonists are being stretched.
Appropriate for: phases 2, 3, and 4 phases of OPT.
3. Functional
Includes: self-myofascial release and dynamic stretching. Dynamic stretching requires
integrated, multiplanar soft tissue extensibility, with optimal neuromuscular control, through
full ROM, or movement without compensation.
Appropriate for: phase 5 of OPT.
Stretching Techniques
Myofascial Release focuses on the neural system and fascial system in the body (fibrous tissue
that surrounds and separates muscle tissue). By applying gentle force to a knot, the elastic muscle fibers
are altered from a bundled position into a straighter alignment. Gentle pressure stimulates the Golgi
tendon organ and creates autogenic inhibition, decreasing muscle spindle excitation and releasing the
hypertonicity (tension) of the underlying muscles. Must sustain pressure on a spot for 30 seconds.
Examples: Foam roll calves (leaning back, ankles crossed), IT band (outer thigh, other leg
draped over that leg), adductors (inner thighs, on elbows), piriformis (butt, ankle on
knee), latissimus dorsi (upper side, arm extended overhead)
Static Stretching is the process of passively taking a muscle to the point of tension and holding the
stretch for 30 seconds min. It combines low force with longer duration. The Golgi tendon organ is
stimulated and an inhibitory effect is produces (autogenic inhibition). Contracting the antagonistic
muscle while holding the stretch can reciprocally inhibit the muscle being stretched, enhancing the
stretch.
Examples: Static gastrocnemius stretch (press wall, back heel on ground), static standing
TFL stretch (raise arm up and over), static kneeling hip flexor stretch (kneel forward on
knee, arm raised), static standing adductor stretch (side lunge), static latissimus dorsi
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ball stretch (reach arm straight by rolling ball), static pectoral stretch (press forward into
shoulder), static upper trapezius/scalene stretch (pull head to side)
Active-Isolated Stretching is the process of using agonists and synergists to dynamically move
the joint into a range of motion. Increases motorneuron excitability, creating reciprocal inhibition of
the muscle being stretched. Recommended for warm-up.
Examples: Active supine biceps femoris stretch (lay on back, draw knee over opposite leg),
active standing adductor stretch (side lunges to each side).
Dynamic Stretching uses the force production of a muscle and the body’s momentum to take a
joint through the full available range of motion. Uses reciprocal inhibition to improve soft tissue
extensibility. Perform 10 reps using 3-10 dynamic stretches.
Examples: Hip swings, medicine ball rotations, walking lunges, prisoner squat, tube
walking side to side.
Controversial stretches: inverted hurdler’s stretch, plow, shoulder stand, straight-leg toe touch,
arching quadriceps
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Chapter 8
What to Know: Cardiorespiratory Fitness Training
Know all definitions throughout the chapter:






Overtraining page
General vs. Specific Warm-up
Cool down Phase
Figure 8.1 FITTE factors
Table 8.9 Training Zones
Circuit Training
Cardiorespiratory fitness: the ability of the circulatory and respiratory systems to supply oxygenrich blood to skeletal muscles during sustained physical activity. One of 5 components of physical
fitness, along with muscular strength, muscular endurance, flexibility, and body
composition.
Cardio is a top priority from the standpoint of preventing chronic disease and improving health and
quality of life.
Integrated cardiorespiratory training: systematically progressing clients through various
stages to achieve optimal levels of physiological, physical, and performance adaptions by placing stress
on the cardiorespiratory system.
Each cardio session should include a warm-up, conditioning phase, and cool-down.
General warm-up (movement not related to actual activity) vs. specific warm-up (movement
related to activity, aka dynamic stretches, such as squats and push-ups before weight training)
Purpose of warm-up: increase heart and respiratory rates, increase tissue temperature, and
psychologically prepare the individual for higher intensity.
Warm-up guidelines: 5-10 minutes of low-to-moderate intensity
Goal of cool-down: reduce heart and breathing rates, gradually cool body temperature, return
muscles to their optimal length-tension rates, prevent venous pooling of blood in lower extremities,
and restore physiological systems to baseline.
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At rest, only 15-20% of circulating blood reaches skeletal muscle, but during intense vigorous exercise
it increases to as much as 80-85% of cardiac output. During intense exercise, plasma volume can
decrease by as much as 10-20%.
Static stretching guidelines: During warm-up, static stretching should only be used on areas
assessed as tight/overactive. Hold stretches for 20-30 seconds. During cool-down, it should be used on
the major muscles used during the workout, to return them to normal resting lengths.
Suggested Warm-Up Activities



Stabilization clients: self-myofascial release (30 sec/muscle), static stretching (30 sec/muscle),
cardio (5-10 min)
Strength clients: self-myofascial release (30 sec/muscle), active-isolated stretching (1-2 sec, 510 reps/muscle), cardio (5-10 min)
Power clients: self-myofascial release (30 sec/muscle) and dynamic stretching (10 reps/side)
FITTE principle: Frequency (# training sessions in a time period), intensity (level of demand on the
body), time (length of time engaged in activity), type (mode or type of activity selected), and
enjoyment.
Frequency: for general health, need small quantities of activity every day. For improved fitness,
higher intensity work 3-5 days/week.
Intensity: calculated via heart rate, power output (watts), or % maximal oxygen consumption
(Vo2max) or oxygen uptake reserve (Vo2R). Moderate intensity = less than 60% Vo2R or passable talktest range. (Intensities greater than that are required to improve fitness.) Recommended intensity = 4085% (40% being the threshold for deconditioned individuals).
Ways to measure Vo2:
1.
2.
Peak Vo2 Method: best, but not realistic.
Vo2 Reserve Method: simple and preferred. Target Vo2R = [(Vo2max – Vo2rest) x
intensity desired] + Vo2rest
3.
Peak Metabolic Equivalent (MET) Method: METs used to describe the energy cost of
physical activity as multiples of resting metabolic rate. 1 MET = 3.5 mL O2 kg min or the
equivalent of the average resting metabolic rate (RMR) for adults.
4.
Peak Maximal Heart Rate (MHR) Method: 220-age. Not intended to be used to
guide training.
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5.
HR Reserve (HRR) Method: Aka Karvonen method, the difference between the client’s
predicted max heart rate and their resting heart rate. THR = [(HRmax – Hrrest) x desired
intensity] + HRrest
6.
Ratings of Perceived Exertion Method: Moderate intensity is equal to “somewhat
hard” (12-14) on the 6-20 Borg scale.
7.
Talk Test Method: Work until you can’t speak comfortably.
Ventilatory threshold: the point during graded exercise in which ventilation increases
disproportionately to oxygen uptake, signifying a switch from predominately aerobic energy
production to anaerobic energy production.
Time recommendations:



2 hours and 30 minutes (150 min) of moderate-intensity aerobic activity (aka brisk walking)
every week
OR
1 hour 15 minutes (75 min) of vigorous-intensity aerobic activity (jogging or running)
OR
A mix of intensities
Type:
For an activity to be considered aerobic, it must: be rhythmic in nature, use large muscle groups, and be
continuous.
Principle of specificity:
the body will adapt to the level of stress placed on it and will then require
more or varied amounts of stress to produce a higher level of adaptation in the future.
Overtraining: Excessive frequency, volume, or intensity of training, resulting in fatigue (which is also
caused by a lack of proper rest and recovery)
3 Stages of Cardio Training:

Stage 1: Target heart rate of 65-75%, or 12/13 on the perceived exertion scale. Start slowly
and work up to 30-60 minutes continuous exercise. When they can maintain zone one heart
rate for 30 minutes 2-3 times a week, ready for stage 2.

Stage 2:
Focus on increasing workload (speed, incline, level). Target heart rate of 76-85% or
14-16 perceived exertion. Alternate with stage 1 within the workouts and between days at first.
Progress from a work-to-rest ratio of 1:3 to 1:1.

Stage 3: Target heart rate of 86-95% or 17-19 perceived exertion.
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Circuit training allows for comparable fitness results without spending extended periods of time to
achieve them. It’s proven to provide higher post-exercise metabolic rates as well as strength levels.
Postural consideration for clients with anteriorly rotated pelvis and arched lower back (lower
crossed syndrome): initial use of bicycles or steppers might not be warranted, as the hips are placed in
a constant state of flexion, adding to a shortened hip flexor complex. Also, treadmill speed should be
kept to a controllable pace to avoid overstriding.
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Chapter 9
What to Know: Core Training Concepts

Know all definitions throughout the chapter

Local Stabilization System

Global Stabilization System

Table 9.1 Muscles of the Core

It is your responsibility to learn how to categorize, progress, and regress body position while
performing certain types of exercises.

The OPT model is divided into three different blocks of training and each building block
contains specific phases of training that systematically advances the student in a safe and
progressive manner. Exercises can be categorized by adaptation and by type of exercise:

OPT Level (adaptation): Stabilization, Strength, or Power (be familiar with all exercises
listed, as well as how to regress and progress the exercises listed)

Type of Exercise: Core

Table 9.3 Core training program design
A weak core is a fundamental problem inherent to inefficient movement that may lead to predictable
patterns of injury.
Core: the structures that make up the lumbo-pelvic-hip complex (LPH), including the lumbar spine, the
pelvic girdle, abdomen, and the hip joint. Where the body’s center of gravity (COG) is located and where
all movement originates.
Local stabilization system: muscles that attach directly to the vertebrae.



Consist primarily of type I (slow twitch) muscle fibers with a high density of muscle spindles.
Primarily responsible for intervertebral and intersegmental stability; work to limit excessive
compressive, shear, and rotational forces between spinal segments.
Primary muscles: transverse abdominis, internal obliques, multifidus, pelvic floor musculature,
and diaphragm.
Global stabilization system: muscles that attach from the pelvis to the spine.

Act to transfer loads between the upper extremity and lower extremity
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

Provide stability between the pelvis and spine, provide stabilization and eccentric control of the
core during functional movements.
Primary muscles: quadratus lumborum, psoas major, external obliques, portions of the internal
oblique, rectus abdominis, gluteus medius, and adductor complex.
Movement system: muscles that attach the spine and/or pelvis to the extremities.


Primarily responsible for concentric force production and eccentric deceleration during dynamic
activities.
Primary muscles: latissimus dorsi, hip flexors, hamstring complex, and quadriceps
Train muscles from the inside out (local  global  movement)
Drawing-in maneuver: used to recruit the local core stabilizers by drawing the navel in toward the
spine.
Bracing: contracting the abdominal, lower back, and buttock muscles at the same time.
Exercises performed in an unstable environment have been demonstrated to increase activation of the
local and global stabilization system when compared to traditional trunk exercises.
Goal of core training: develop optimal levels of neuromuscular efficiency, stability (intervertebral
and lumbopelvic stability—local and global stabilization systems), and functional strength (movement
system). Neural adaptions become the focus of the program instead of striving for strength gains.
1. Intervertebral stability
2. Lumbopelvic stability
3. Movement efficiency
Clients begin at the highest level at which he can maintain stability and optimal neuromuscular control.
3 levels of core training:
1.
Core-stabilization training (Phase 1): designed to improve neuromuscular efficiency and
intervertebral stability, focusing on drawing in and bracing during exercises.

2.
Examples: marching, floor bridge, floor prone cobra, prone is-abs
(plank)
Core strength (Phase 2, 3, 4): Designed to improve dynamic stabilization, concentric
strength, eccentric strength, and neuromuscular efficiency of the entire kinetic chain. More
dynamic eccentric and concentric movements of the spine throughout a full ROM, while still
drawing in and bracing.
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
3.
Examples: ball crunch, back extensions, reverse crunch, cable
rotations
Core power (Phase 5): Designed to improve the rate of force production of the core
musculature and prepare an individual to dynamically stabilize and generate force at more
functionally applicable speeds.

Examples: rotation chest pass, ball medicine ball pullover throw, front
MB oblique throw, soccer throw
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Chapter 10
What to Know: Balance Training Concepts:

Figure 10.2 Effects of joint dysfunction

Table 10.1 Balance training parameters

OPT Level (adaptation): Stabilization, Strength, or Power
o
Be familiar with all exercises listed, as well as how to regress and progress the
exercises listed

Type of Exercise: Balance

Table 10.2 Balance training program design
Balance: when the body is in equilibrium and stationary, meaning no linear or angular movement.
Requires optimal muscular balance (length-tension relationships and force-couple relationships), joint
dynamics (arthrokinematics), and neuromuscular efficiency, using visual, vestibular (inner ear) and
proprioceptive inputs.
Dynamic balance: the ability to move and change directions under various conditions (ie running
on uneven surfaces) without falling.
Limit of stability: the distance outside of the base of support that an individual can move into
without losing control of his or her center of gravity.
Balance training programs that are performed for at least 10 minutes a day, 3 times a week for 4 weeks
appear to improve both static and dynamic balance ability.
Goal of balance training: to increase the client’s awareness of his or her limit of stability (or
kinesthetic awareness) by creating controlled instability. Balance and neuromuscular efficiency are
improved through repetitive exposure to a variety of multisensory conditions.
Balance progressions: easy to hard, simple to complex, stable to unstable, static to dynamic, slow
to fast, two arms/legs to single-arm/leg, eyes open to eyes closed, known to unknown (cognitive task)
Progression tools: floor, balance beam, half foam roll, foam pad, balance disc, wobble board, bosu
ball
3 levels of balance training:
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1.
Balance-stabilization (Phase 1): Designed to improve reflexive (automatic) joint
stabilization contractions to increase joint stability. Involve little joint motion. Body is placed in
unstable environments so it learns how to react.

2.
Examples: single-leg…balance, balance reach, hip internal/external
rotation, lift and chop, throw and catch
Balance-strength (Phase 2, 3, 4): Designed to improve neuromuscular efficiency. Involve
dynamic eccentric and concentric movement of the balance leg, through full ROM. Movements
require dynamic control in mid-range of motion, with isometric stabilization at the end-range of
motion.

3.
Examples: single-leg squat, single-leg squat touchdown, single-leg
Romanian deadlift, multiplanar step-up to balance, multiplanar lunge
to balance
Balance-power (Phase 5): Designed to develop proper deceleration ability to move the
body from a dynamic state to a controlled stationary position, as well as high levels of eccentric
strength, dynamic neuromuscular efficiency, and reactive joint stabilization.

Examples: multiplanar…hop with stabilization, single-leg box hop-
up/down with stabilization
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Chapter 11
What to Know: Plyometric Training Concepts:

Know all definitions throughout the chapter

Integrated performance paradigm

The phases of Plyometric Exercise

Figure 11.2 Program design parameters for reactive training

OPT™ Level (adaptation): Stabilization, Strength, or Power (be familiar with all exercises
listed, as well as how to regress and progress the exercises listed)

Type of Exercise: Balance

Table 11.1 Plyometric training program design
Rate of Force Production: Ability of muscles to exert maximal force output in a minimal amount
of time.
Plyometric (reactive training): Exercises that generate quick, powerful movements involving an
explosive concentric muscle contraction preceded by an eccentric muscle action. Individuals react to
the ground surface to develop larger than normal ground forces that can be used to project the body
with greater velocity or speed of movement.
Reaction stimulus: the opposing objects clients encounter during plyometric training (the ground,
typically)
Integrated performance paradigm: To move with efficiency, forces must be dampened
(eccentrically), stabilized (isometrically), and then accelerated (concentrically)
3 phases of plyometric exercise:
1.
Eccentric phase: cocking/loading phase, as in squatting before shooting a basket. Potential
energy is stored like stretching a rubber band.
2.
Amortization phase: dynamic stabilization, transition phase, muscle switches from
overcoming force to imparting force in the intended direction. The fast this transition happens,
the more powerful the final movement.
3.
Concentric phase:
unloading phase, concentric action resulting in enhanced muscular
performance.
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Purpose of plyometric exercise: Enhances the excitability, sensitivity, and reactivity of the
neuromuscular system, increases the rate of force production (power), motor unit recruitment, firing
frequency, and motor unit synchronization. Only to be incorporated once client has achieved strength
base, proper core strength, and balance. Provides the ability to train specific movement patterns at a
more functionally appropriate speed.
Goal of plyometric training: decrease the reaction time of the muscle action spectrum
(eccentric deceleration, isometric stabilization, and concentric acceleration)
Stretch-shortening cycles: eccentric and concentric contractions repeated as a series.
Speed of muscular exertion is limited by neuromuscular coordination. Ie: the body will only
move within a range of speed that the nervous system has been programmed to allow.
3 levels of plyometric training:
4.
Plyometric stabilization (Phase 1): Designed to establish optimal landing mechanics,
postural alignment, and reactive neuromuscular efficiency (coordination during dynamic
movement). Involve little joint motion.

5.
Examples: squat jump, box jump-up/down, and multiplanar jump, all
with stabilization at the end
Plyometric strength (Phase 2, 3, 4): Involve more dynamic eccentric and concentric
movement through a full ROM. Progressed specificity, speed, and neural demand. Designed to
improve dynamic joint stabilization, eccentric strength, rate of force production, and
neuromuscular efficiency. Exercises performed in a repetitive fashion, with short periods of
time on the ground between actions.

6.
Examples: squat jump, tuck jump, butt kick, power step-up
Plyometric power (Phase 5): Designed to further improve rate of force production,
reactive strength, dynamic neuromuscular efficiency, and optimal force production. Involve
entire muscle action spectrum and contraction-velocity spectrum used during integrated,
functional movements. To be performed as fast and explosively as possible.

Examples: ice skaters, single-leg power step-up, proprioceptive
plyometrics
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Chapter 12
What to Know: Speed, Agility, and Quickness Training:

Know all definitions throughout the chapter

Table 12.1 Kinetic Chain checkpoints during running movements- pay attention to the
foot/ankle complex

Table 12.2 SAQ Program Design
Speed: Ability to move the body in one intended direction as fast as possible. Product of stride rate
and stride length. (Referring to straight ahead speed, or distance covered divided by time.)
Stride rate: # strides taken in a given amount of time (or distance)
Stride length: distance covered in one stride, while running
Agility: Ability to start, stop, or change direction quickly while maintaining proper posture. Referring
to short bursts of movement that involve a change in movement direction, cadence, or speed.
Quickness: ability to react to a stimulus and appropriately change the motion of the body with
maximal rate of force production.
Frontside mechanics: Triple flexion of the ankle, knee, and hip in appropriate synchrony. Proper
alignment of the lead leg and pelvis during sprinting, which includes ankle dorsiflexion, knee flexion,
hip flexion, and neutral pelvis. Associated with better stability, less braking forces, and increased
forward driving forces.
Backside mechanics: triple extension of the ankle, knee, and hip in appropriate synchrony. Proper
alignment of the rear leg and pelvis, including ankle plantarflexion, knee extension, hip extension, and
neutral pelvis. Associated with stronger push phase, including hip-knee extension, gluteal contraction,
and backside arm drive.
SAQ training benefits: weight loss, coordination, movement proficiency, and injury prevention.
Fun and invigorating, increasing exercise compliance, adherence, and effectiveness. When using SAQ for
weight loss, clients’ heart rate must be kept appropriate elevated.
Examples of SAQ exercises for…
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Youths: Red light, green light and follow the snake (follow the pattern of a rope, one foot on
each side, forward and backward)
Weight-loss population: jump rope, cone shuffles, ladder drills, box drill, partner
mirror drill
Seniors: cone/hurdle step-overs, stand-up to figure 8
3 levels of SAQ training
1.
Stabilization (Phase 1): 4-6 drills with limited horizontal inertia and unpredictability.
 Examples: cone shuffles, agility ladder drills
2.
Strength (Phase 2, 3, 4): 6-8 drills with greater horizontal inertia but limited unpredictability.
 Examples: T-drill, box drill, stand up to figure 8
3.
Power (Phase 5): 6-10 drills with max horizontal inertia and unpredictability.
 Examples: modified box drill, partner mirror drill, timed drills
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Chapter 13
What to Know: Resistance Training Concepts:

General Adaptation Syndrome

Table 13.1 Adaptive benefits of resistance training

Table 13.2 The general adaptation syndrome

SAID Principle

Adaptations for resistance training

Table 13.3 Resistance training systems

Table 13.4 Peripheral heart action system
On the exam, some questions may ask about how to properly progress body position during an
exercise. You need to be able to progress (make more difficult), or regress (make easier) a client's body
position. Below, progressions are listed from easy to difficult and you can see that two-legs on a stable
surface (the floor) is easier than standing on one leg (single-leg), on the floor. With the arms, start a
client with two arms, before progressing on to an alternating arm, and then to a single arm exercise. For
example:
What would be the immediate progression of a “Single-Leg Dumbbell Curl”?
a. single-leg, alternating arm, stable
b. single-leg, single-arm, stable
c. two-leg, alternating arm, unstable
d. two-leg, single-arm, unstable
General Adaption Syndrome (GAS): Describes how the body responds and adapts to stress.
3 Stages of Response to Stress:
1.
Alarm reaction—initial reaction to stressor such as increased oxygen and blood supply to
necessary areas of the body
2.
Resistance Development—increased functional capacity to adapt to stressor such as
increasing motor unit recruitment
3.
Exhaustion—a prolonged intolerable stressor produces fatigue and leads to a breakdown in
the system or injury (such as stress fractures, muscle strains, joint pain, or emotional fatigue)
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Delayed-Onset Muscle Soreness: Pain or discomfort often felt 24 to 72 hours after intense
exercise or unaccustomed physical activity
SAID (Principle of Specificity or Specific Adaption to Imposed Demands): Principle
that states that the body will adapt to the specific demands that are placed on it.



Mechanical specificity: weight and movements placed on the body.
Neuromuscular specificity: speed of contraction and exercise selection.
Metabolic specificity: the energy demand placed on the body.
Mechanically, the body burns more calories when movements are performed while standing and using
moderate weights.
Neuromuscularly, the body burns more calories when more muscles are being used for longer periods
in controlled, unstable environments.
Metabolically, the body burns more calories when rest periods are short to minimize full recuperation.
Weight loss programs: apply all 3!
Adaptions from Resistance Training
Stabilization: the body’s ability to provide optimal dynamic joint support to maintain correct
posture during all movements. Requires high levels of muscular endurance. Improved by training in
controlled, unstable environments.
Total
Body
STABILIZATION
EXERCISE
EXAMPLES
Chest
Back
Shoulder Biceps
Ball
squat,
curl to
press
Ball
dumbbell
chest
press
Standing
cable
row
Single-leg
dumbbell
scaption
Step-up
balance,
curl, to
overhead
press
Push-up
Ball
dumbbell
row
Seated
stability
ball
military
press
Triceps
Single-leg Supine
dumbbell ball
curl
dumbbell
triceps
extension
Single-leg Prone
barbell
ball
curl
dumbbell
triceps
extension
Legs
Ball
squat
Multiplanar
step-up
to
balance
Muscular endurance: the ability to produce and maintain force production for prolonged periods
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of time. Helps to increase core and joint stabilization, which is the foundation on which hypertrophy,
strength, and power are build.
Muscular hypertrophy: the enlargement of skeletal muscle fibers (resulting from an increase in
myofibril proteins or myofilaments) in response to being recruited to develop increased levels of
tension, as seen in resistance training. Hypertrophy can be achieved through low to intermediate
repetition ranges with progressively higher loads.
Strength: the ability of the neuromuscular system to produce internal tension to overcome an
external force. Needs to be thought of not as a function of muscle, but as a result of activating the
neuromuscular system.
STRENGTH
EXERCISE
EXAMPLES
Total
Body
Chest
Back
Shoulder Biceps
Triceps
Legs
Lunge to
two-arm
dumbbell
press
Flat
dumbbell
chest
press
Seated
cable row
Seated
dumbbell
shoulder
press
Cable
pushdown
Leg
press
Squat,
curl, to
two-arm
press
Barbell
bench
press
Seated
lat
pulldown
Seated
shoulder
press
machine
Supine
bench
barbell
triceps
extension
Barbell
squat
Seated
two-arm
dumbbell
biceps
curl
Biceps
curl
machine
Stabilization training is designed with the characteristics of type I slow-twitch muscle fibers in mind
(slow-contracting, low tension output, and resistance to fatigue), strength training is designed to match
the characteristics of type II muscle fibers (quick-contracting, high tension output, prone to fatigue).
Majority of strength increases occur during the first 12 weeks of training, from increased neural
recruitment and muscle hypertrophy.
Power: the ability of the neuromuscular system to produce the greatest possible force in the shortest
possible time (force X velocity). Focus: getting the neuromuscular system to generate force as quickly as
possible (rate of force production). Increase in power achieved by increasing force (weight) or velocity
(speed). To maximize training, heavy and light weights should be used.
Modern training programs: emphasis on appropriate exercise selection, all muscle actions, multiple
plains of motion, and repetition tempos.
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POWER
EXERCISE
EXAMPLES
Total
Body
Chest
Back
Shoulder Biceps
Two-arm
push
press
Two-arm
medicine
ball chest
pass
Medicine
ball
pullover
throw
Barbell
clean
Rotation
chest pass
Soccer
throw
Front
medicine
ball
oblique
throw
Overhead
medicine
ball throw
Triceps
Legs
Squat
jump
__
__
__
__
Tuck
jump
Resistance Training Systems
Single-Set System: 1 set per exercise. Beneficial for beginning clients or maintenance.
Multiple Set: multiple sets for each exercise. Superior to single-set for advanced clients.
Pyramid: progressive or regressive step approach that either increases or decreases weight with each
set. 10-12 reps light to 1-2 reps heavy.
Superset: two exercises performed in rapid succession. 8-12 reps with no rest.
Variations:
A) Two exercises for the same muscle group back to back. (Ex: bench press to push-ups.) This
method improves muscular endurance and hypertrophy.
B) Two exercises back to back that involve antagonist muscle groups. (Ex: Chest and back or
quads and hamstring.)
Drop-sets: performing a set to failure, then removing a small percentage of the load, and continuing
with the set, completing a small number of reps (2-4).
Triple drop: a set to failure followed by 3 successive load decrements performed with no
rest.
Circuit-training System: a series of exercises performed one after another, with minimal rest
between each exercise. Typically low to moderate number of sets (1-3) with moderate to high reps (820) and short rest periods (15-60 sec). Great for those with limited time who want to change their
bodies quickly.
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Peripheral Heart Action System: Alternates upper and lower body exercises throughout the
circuit. Distributes blood flow between extremities, potentially improving circulation.
Split-routine System: breaking the body into parts to be trained on separate days. (Ex: 3-day—M:
chest, shoulders, triceps—W: Legs—F: back, biceps)
Vertical Loading: progressing a workout vertically down the template by alternating body parts
trained from set to set. Allows for maximal recovery for each body part. Order:
1.
2.
3.
4.
5.
6.
7.
Total body exercise
Chest
Back
Shoulders
Biceps
Triceps
Legs
Horizontal Loading: performing all sets of an exercise or body part before moving on to the next
exercise or body part. (Ex: 3 sets of chest, then 3 sets of back, etc. following the order above.)
Appropriate for maximal strength and power training. Longer rest periods between sets (takes longer
overall).
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Chapter 14
What to Know: Integrated Program Design and the Optimum Performance
Training (OPT) Model
Know all definitions throughout the chapter.
Tempo controls the amount of time that the muscle is active or producing tension – concentrically,
isometrically, and/or eccentrically.
NASM writes tempos this way: “a/b/c” and tempo is always written in this way:
a = eccentric
b = isometric
c = concentric
Therefore, assuming the above, a 4/2/1 tempo on a one repetition of a bench press would be:
4 counts, controlled, eccentric deceleration, bringing the weight back down (before the push)
2 counts on the isometric stabilization at the bottom of the exercise
1 count on the push (upward)
Another example: a 2/0/2 tempo on one repetition of a bench press would be:
2 counts, controlled, eccentric deceleration, bring the weight down (into position, before the push upward)
0 no counts of isometric stabilization at the bottom
2 counts of concentric pushing (upward)
Focus on the following tables from Chapter 14:
Table 14.2 Training volume adaptations
Table 14.7 Phase 1: Stabilization Endurance Training
(all of the resistance training acute variable and tempo for core)
Table 14.8 Phase 2: Strength Endurance Training
(all of the resistance training acute variable and tempo for core)
Table 14.9 Phase 3: Hypertrophy Training
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(all of the resistance training acute variable and tempo for core)
Table 14.10 Phase 4: Maximal Strength Training
(all of the resistance training acute variable and tempo for core)
Table 14.11 Phase 5: Power
(all of the resistance training acute variable and tempo for core)
Program design: creating a purposeful system or plan to achieve a specific goal.
Acute variables: important components that specify how each exercise is to be performed. They
include:

Repetition: one complete movement of a particular exercise. Most involve three muscle
actions: concentric (against resistance), isometric, and eccentric (with resistance).


Set: group of consecutive repetitions.
Training intensity: an individual’s level of effort compared with their max effort.
Intensity can be increased in a number of ways, such as adding instability.

Repetition tempo: speed with which each repetition is performed, from slow to
fast/explosive.


Training volume: total amount of work performed within a specified time.
Rest interval: Time to recuperate between sets. The shorter the rest intervals, the less
ATP and PC will be replenished and consequently less energy available for the next set.

Training frequency: number of training sessions in a given period. Optimal: 35X/week.

Training duration: timeframe from start to end of workout, OR length of time (in
weeks) spent in a phase of training.

Exercise selection: process of choosing exercises that allow for optimal achievement of
desired adaption.
There is an inverse relationship between sets, repetitions, and intensity.
General Rep, Set, Intensity, and Rest Recommendations:
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3 kinds of exercises:

Single joint: focus on isolating one major muscle group or joint (ex: bicep curls, tricep
pushdowns, calf raises)


Multijoint: involve two or three joints (ex: squats, lunges, step-ups, chest presses, rows)
Total body: include multiple joint movements (ex: step-up balance to overhead press, squat
to two-arm press, barbell clean)
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Exercises can and should be progressed to increasingly unstable environments to improve stabilization
and training of core stabilization muscles.
All exercises can be progressed or regressed in a systematic fashion.



Stabilization phase: increase/decrease proprioception
Strength phase: increase/decrease volume/load
Power phase: increase/decrease speed/load
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Undulating periodization: allowing client to train at varying intensities during the course of a
week. Ex: stabilization workout on Monday, strength workout on Wednesday, and power workout on
Friday.
Macrocycle: the largest training cycle, which covers a year of training (aka an annual plan).
Mesocycles: 1-3 month periods within a macrocycle.
Microcycles: 1-week plans within mesocycles.
The OPT Model
Stabilization (Phase 1): Designed to create optimal levels of stabilization strength and postural
control. Can be progressed by increasing proprioception, volume, and intensity, and by decreasing rest
periods. Usually lasts 4 weeks (as with all phases.)
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Strength Endurance (Phase 2): Increase stabilization endurance, hypertrophy, and strength.
Includes use of superset techniques in which a more-stable exercise (such as a bench press) is
immediately followed with a stabilization exercise with similar motions (such as a stability ball pushup).
Hypertrophy Training (Phase 3): Focus on maximal muscle growth. High levels of volume with
minimal rest periods.
Maximal Strength Training (Phase 4): Focus on increasing the load placed on the tissues of
the body. Improves recruitment of more motor units, rate of force production, and motor unit
synchronization. Rest periods may need to increase as clients train with heavier loads.
Power (Phase 5): Designed to increase the rate of force production (or speed of muscle
contraction). Power = force X velocity. Therefore, an increase in either F or V results in an increase in
power. Individuals should train with both heavy and light loads for best results. Training involves
combining a strength exercise with a power exercise for each body part (ex: barbell bench press
superset with a medicine ball chest pass).
OPT Model Applications
Body Fat Reduction: Alternate between phases 1 and 2, one phase per month. Workouts 3x week.
Increasing Lean Body Mass (Hypertrophy): Alternate between phases as follows: 1-2-3, 2-34, 1-2-3-4, 3-2-1. Workouts 3x week.
Improving General Sports Performance: Power + Strength Endurance constant, plus
alternate on and off Stabilization each month.
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Chapter 15
What to Know: Introduction to Exercise Modalities:
There are no specific study tips for chapter 15, but be sure to be familiar with the different modalities
such as:









Machines
Free weights
Bands and rubber tubing
Cable Machines
Medicine Ball
Kettlebell
Body weight training
TRX suspension training
BOSU
You will not see very much on the exam for this chapter but it will help you with categorizing exercise
for resistance, core, and reactive training.
Strength-Training Machines
Pros:
Less intimidating—safer substitute for free weights
Can emphasize certain muscle groups for rehab/bodybuilding purposes
Various intensities (load) provided in one weight stack
Does not require spotter
Provides extra support for special-needs clients (great for elderly)
Keeps individual in a fixed plane of motion, which may limit excessive ROMs
Cons:
Do not allow total-body exercises
Movements primarily in one plane, fail to accommodate multijoint movements
Do not challenge core stabilization system much
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May not be ideal for improving athletic performance
Machines do not fit all body types
Expensive (comparably)
Inferior to free weights for improving core stability/neuromuscular efficiency
Free Weights
Pros:
Can be used to emphasize certain muscle groups
Can improve athletic performance
Can challenge core stabilization system
May improve dynamic joint stabilization and proprioception
Allows individuals to move in multiple planes of motion and use multijoint (complex) movements
Cons:
May require a spotter
May be too difficult for beginning clients
Requires multiple dumbbells or barbells to change load
Potentially more dangerous
Intimidating for some
*Should try to progress clients to a proprioceptively challenging environment, like bench press on a
stability ball or standing with barbell/weights. Also, can regress from free weights to machines if
necessary.
Cable Machines
Allow similar freedom of movement as free weights, yet do not require a spotter
Offer resistance for all body parts
Effective for developing stability, muscular endurance, hypertrophy, strength, and power
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Important to align the line of pull of the cable with the line of pull of the muscle being worked
Can be effectively used in all phases
Can challenge the core
Prefer exercises to be done in a standing position
Elastic Resistance (Rubber Tubing/Bands)
Inexpensive alternative to training with resistance
Not ideal for maximal strength training, but helpful for improving muscular strength and endurance
Allows movement in multiple planes and often greater ROM compared to machines
Allow clients to perform resisted exercises that mimic sports-like movements
Can use two bands together as a form of progression, vs. moving to a higher resistance band
Problem: the tension changes as the bands are stretched, and stretch properties vary according to
thickness, age of the band, and how often they’re used
Versatile, cheap, and portable
Medicine Balls
Oldest means of resistance training
Dynamic power opportunities
Allows explosive movement without eccentric deceleration
Weigh between 1-30 pounds (high-velocity movements require lighter balls)
Best for rebound activities such as bouncing/throwing against a wall
Kettlebell Training
Differs from dumbbells in that center of mass is away from the handle, requiring more strength and
coordination
Transform dynamic force reduction into powerful force production for a fun, challenging, effective
workout
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Leads to enhanced athleticism, coordination, and balance, increased mental focus and physical
stamina, increased oxygen uptake, and increased total body conditioning (etc.)
Emphasis on posterior chain, working from the ground up and keeping perfect form throughout
Particularly appropriate in phases 1, 2, and 5
Body Weight Training
Often used for core, balance, and plyometric training
Teach clients to train in all planes of motion for greater kinesthetic awareness
Most are closed-chain exercises, which lead to greater motor unit activation and synchronization
compared to open-chain
Portable
*Closed-chain Exercises: Distal extremities (hands or feet) are in a fixed position and the force
applied by an individual is not enough to overcome resistance (such as the ground or an immovable
object). Examples: push-ups, pull-ups, squats.
*Open-chain Exercises: Distal extremities (hands or feet) are not in a fixed position and the force
applied is great enough to overcome resistance (such as barbells or dumbbells). Examples: bench
press, lat pulldown, leg extension machine.
Suspension Body-Weight Training
Can be easily modified for any client
Allow trainers to manipulate body position and stability to provide multiplanar, multijoint exercises in
a proprioceptively enriched environment
Benefits: increased muscle activation, low compressive loads on spine, increased performance,
potential increase in caloric expenditure, improvements in cardio fitness
Ideal in phases 1 and 2 of OPT.
Proprioceptive Modalities
Stability Balls
Primarily used to increase demand for stability
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Can also be used to reinforce proper posture during squatting movements
Can introduce greater ROMs during certain movements, like crunches
Novices with poor balance should master stable exercises first
Not recommended for use with max force building exercises
Bosu Balls
Can be used with either side up (Examples: squat while standing on rounded side, or do
push-ups with hands on flat side)
Increases demand for stability
Safe to stand on
Ideal for phases 1, 2, and 5
Vibration Training
Beneficial effects on stimulating greater muscle fiber involvement during exercise, leading to greater
increases in lean body mass, weight loss, and changes in body composition
Performed on a platform that generates vertical sinusoidal vibrations (a smooth repetitive oscillation)
that stimulate muscle contractions comparable to the tonic vibration reflex
Some benefits: improved circulation, alleviates muscle soreness, increased bone density, potentially
reduces symptoms of Parkinsons, etc.
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Chapter 16
What to Know: Chronic Health Conditions and Physical or Functional
Limitations
For this chapter, read through the text and highlight the training guidelines and have a general idea on
how to design a program for the special populations mentioned in this particular chapter. Don't worry
too much about the acute variables (reps, sets, tempo, etc.) but rather on contraindications and more
appropriate techniques for these populations.
Kids
How children differ from adults in terms of exercise:





Children do not typically exhibit a plateau in oxygen uptake at maximal exercise
Children are less efficient and tend to exercise at a higher percentage of their peak oxygen
uptake
Children do not produce sufficient levels of glycolytic enzymes to be able to sustain bouts of
high-intensity exercise
Immature thermoregulatory systems mean delayed and limited sweating ability
Relatively high peak oxygen uptake levels allow children to perform endurance activities well
Program recommendations: 60 min/day
Seniors
Blood pressure tends to be higher.
Arteriosclerosis: normal physiological process of aging that results in arteries that are less elastic,
leading to greater resistance to blood flow
Atheroscleroris: caused by poor lifestyle choices, restricts blood flow as a result of plaque buildup
Peripheral Vascular Disease: plaques that form in any peripheral artery, typically lower leg
Blood pressure guidelines:



Normal: <120/80
Prehypertensive: 120/80 to 139/89
At risk: 140/90+
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Recommendations:






Use of self-myofascial release and static stretching
Stage 1 and II cardio
Emphasis on stabilization training
Choose exercise modalities that safeguard against falls and foot problems
30-60 min/day or 8-10 min. bouts
Progress to free sitting or standing exercises when possible
Obesity
Currently, 66% of Americans over 20 are overweight. 72 million Americans are obese (34%).
Obese people exhibit: worse balance, slower gait velocity, shorter steps
Recommendations:








Focus on energy expenditure, balance, and proprioceptive training
Burn 200-300 calories per workout
Use caution in supine and prone positions, due to potential hypotensive/hypertensive
responses
Standing position might be most comfortable
Phases 1 and 2 of OPT most appropriate
Emphasize appropriate breathing
Dumbbells, cables, and tubing work well over machines
40-60 min/day, 5 days a week
Diabetes
Diabetes is a metabolic disorder in which the body does not produce enough insulin (type 1) or the body
cannot respond normally to the insulin that is made (type 2).
Recommendations:







Take care when recommending walking to prevent blisters and foot microtrauma
Careful about carbohydrate intake and insulin use, before and after exercise
Guidelines similar to those for obese people
Careful with self-myofascial release, since some have peripheral neuropathy (loss of protective
sensation in feet/legs)
Phases 1 and 2 of OPT most appropriate
Weight-bearing activities may need to be avoided at least initially
Be cognizant of signs and symptoms of hypoglycemia
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
Intensity no greater than 50-90% in beginning
Hypertension
Defined as blood pressure over 140/90.
Common contributors: smoking, a diet high in fat, and excess weight
Plan to reduce blood pressure should include diet, exercise, weight loss, and medication
Body position can have an impact on blood pressure—supine and prone positions can increase BP
Both hypotensive and hypertensive responses are possible
Recommendations:







Use static and active stretching
Foam rolling might be contraindicated since it involves laying down
Core exercises in a standing position preferred over supine core exercises
Use plyometric training with care
Resistance training in seated or standing positions
Use circuit-style or Peripheral Heart Action (PHA) training system to keep blood flow moving
Breathe normally

Avoid Valsalva maneuver (overgripping)
Coronary Heart Disease
CHD is caused by atherosclerosis (plaque formation), leading to narrowing of coronary arteries
Treatment involves aggressive multidisciplinary lifestyle intervention, including diet, exercise, and
stress reduction
Cardiovascular complication rate is low
Recommendations:






Obtain upper safe limit for exercise (heart rate)
Clients must be able to monitor own heart rate
Use rate of perceived exertion (0-11)/Talk Test to measure intensity
Aerobic low-intensity exercise is recommended
Do not start resistance training unless client has been exercising for at least 3 months
Use circuit-style or Peripheral Heart Action (PHA) training system to keep blood flow moving
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Osteoporosis
Osteopenia: a condition in which bone mineral density (BMD) is lower than normal and considered
a precursor to osteoporosis
Osteoporosis: a disease of bones in which BMD is reduced, bone microstructure is disrupted, a the
actual proteins in bone are altered. Commonly affects the neck of the femur and the lumbar vertebrae,
placing the core in a weakened state and more susceptible to injury (ie a fracture).


Primary osteoporosis: associated with normal aging, attributable to lower production
of estrogen/progesterone (involved in regulating bone loss)
Secondary: caused by certain medical conditions that disrupt normal bone reformation
(alcohol abuse, smoking, certain disease or meds)
Peak bone mass: the highest amount of bone mass a person is able to achieve during his lifetime.
People must remain active enough to ensure adequate stress is being placed on their bodies to maintain
consistent bone remodeling.
Individual who participate in resistance training have a higher bone mineral density than those who do
not. However, it improves density by no more than 5% (not high enough to prevent fractures).
Recommendations:










Focus on prevention of falls, rather than strength, for elderly
Combine resistance training with flexibility, core, and balance training
50-90% max heart rate
Focus exercises on hips, thighs, back, and arms
If client cannot get around well, use stable, machine-based equipment
Some degenerative postural changes cannot be corrected
Take care with crunches or movements with a lot of spinal flexion
Plyometric training not recommended
Higher intensities (75-85%) needed to stimulate bone formation
Min. 6 months of consistent training required to have an effect on bone mass
Arthritis
Arthritis: an inflammatory condition that mainly affects the joints. An estimates 21.6% of the adult
population have arthritis.
Osteoarthritis: caused by degeneration of cartilage within joints
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Rheumatoid arthritis: degenerative joint disease in which body’s immune system mistakenly
attacks its own tissue. Characterized by morning stiffness and eventual loss of joint integrity.
Recommendations:






Pain persisting for more than 1 hour is an indication that exercise needs to be modified or
eliminated
Avoid exercises involving high intensity or high repetitions to avoid joint aggravation
Low-volume circuit program or multiple session format is best
Steroids can increase fracture risk
Individuals have decreased strength/proprioception, decreased ability to balance while
standing, loss of knee-extensor strength
Symptoms are heightened through inactivity as a result of muscle atrophy and lack of tissue
flexibility
Cancer
Probability for American men is 44%, 38% for women.
Benefits of exercise: less fatigue, increased quality of life, positive effects on mood/self-concept,
retention of lean body mass
Recommendations:





Exercise at low to moderate intensities for moderate durations
Slowly progress cardio training (5 minutes up to 30)
Core and balance exercises essential
Plyometrics not recommended until client has progressed to three phase I workouts per week
Phase 1 and 2 for resistance training
Pregnancy
Most recreational pursuits are appropriate.
Flexibility and core training are important to maintain posture. Core-stabilization exercises improve
strength of pelvic floor.
Not advised in 2nd or 3rd trimesters: supine or prone positions, torso twisting movements
Pregnant clients prone to dizziness, nausea, fainting.
Recommendations:
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



Static and active stretching, self-myofascial release as tolerated (esp. on varicose veins or
swollen calves)
Cardio: stage I (stage II only on doctor’s advice)
Plyometric training not recommended beyond first trimester
Postpartum women should be encouraged to: reeducate posture, joint alignment, muscle
imbalances, stability, motor skills, and recruitment of deep core stabilizers
Chronic Lung Disease
One of the leading preventable causes of death.
Restrictive Lung Disease: the condition of a fibrous lung tissue, which results in a decreased
ability to expand the lungs.
Chronic Obstructive Lung Disease: condition of altered airflow through the lungs, generally
caused by airway obstruction as a result of mucus production.
Problems: decreased ventilation and decreased gas exchange ability (leading to decreased aerobic
capacity and endurance and in oxygen desaturation). Fatigue, shortness of breath, muscle wasting,
hypertrophied neck muscles.
Recommendations:




Use of lower body cardiorespiratory and resistance training
Use Peripheral Heart Action training system
40-60% of peak work capacity, work up to 20-45 min.
Maintain adequate rest intervals
Intermittent Claudication/Peripheral Arterial Disease
Intermittent claudication: manifestation of symptoms caused by peripheral arterial disease
(PAD), characterized by limping, lameness, or pain in lower leg
Peripheral arterial disease: characterized by narrowing of major arteries that are responsible for
supplying blood to the lower extremities
Recommendations:




Intermittent format of exercise, with rest as necessary.
Do not exceed established heart rate upper limit.
Focus on aerobics, emphasis on walking, with resistance exercise as complementary
Self-myofascial release not recommended
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


Phase 1 and 2 suggested
Primary limiting factor: leg pain
Exercise should induce symptoms, causing a stimulus that increases local circulation
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Chapter 17
What to Know: Nutrition

Know all Definitions throughout the chapter

Table 17.4 Know all of the Essential Amino Acids

Table 17.6 Recommended Protein Intake

Daily recommendations for fiber

Specific recommendations for endurance athletes

Fatty acids

Lipids in the body

Daily recommendations and importance of water

Table 17.11The effects of dehydration

Be familiar with guidelines for altering body composition

Risks of very low calorie diets

Calorie count for proteins, carbohydrates, fats
Nutrition: sum of the processes by which an animal or plant takes in and uses food substances for
growth and repair of tissues.
Calorie: a unit of energy defined as the amount of heat energy required to raise the temperature of 1
gram of water 1 degree Celsius.
1 g of carbohydrates = 4 calories
1 g of fat = 9 calories
1 g protein = 4 calories
Total Energy Expenditure (TEE): the amount of energy (calories) spent, on average, in a typical
day.
Resting Metabolic Rate (RMR): the amount of energy expended while at rest (to sustain bodily
functions such as blood circulation, respiration, and temperature regulation). 70% of TEE.

Affected by multiple factors, including age, sex, genetics, hormonal changes, body size, body
composition, temperature, illness, medication, etc.
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
Avoid declines in resting metabolism by avoiding starvation diets.
Thermic Effect of Food (TEF): amount of energy expended above RMR as a result of the
processing of food (digestion) for storage and use. 6-10% of TEE.
Energy expended during physical activity: above RMR and TEF. 20% of TEE.
Estimating TEE:
1. Weight (lbs) x 10 = RMR
2. RMR x activity factor (1.2-2.1) = TEE
Protein
Proteins are primarily responsible for building and repairing body tissues and structures. They are
made up of amino acids linked by peptide bonds.
Amino acids: 8 essential (needs to come from food), 10 nonessential (created by the body), and 2
semi-essential
3 uses of amino acids (broken down from proteins): protein synthesis (building/repairing tissue),
immediate energy, or potential energy (fat storage).
Complete proteins: foods that supply all of the essential amino acids in appropriate ratios.
Limiting factor of a protein: the essential amino acid that is missing or present in the smallest
amount. Synthesis works on an all-or-none principle, and is reduced to the point at which the cell runs
out of the limiting amino acid.
Biologic value (BV): Term used to rate protein quality.
Protein notes:





Consuming protein above requirements will not reveal previously untapped muscle-building
capacity.
Consuming higher quality proteins could lead to needing less protein overall.
Incomplete proteins can be combined to create complete proteins.
Anaerobic and aerobic exercise affect protein requirements in different ways.
Protein intake may be adjusted to aid in satiety.
Complete proteins: animal sources, dairy and meats.
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Incomplete proteins: grains, legumes, nuts, seeds, and vegetables.
Factors affecting protein requirements: daily exercise and physical activity levels, daily
caloric consumption, body composition goals, and sports-performance goals.
The goal is to satisfy energy needs with carbohydrates and fat, saving protein for tissue repair and
growth. This is why carbs are often referred to as protein sparing.
Gluconeogenesis: when amino acids are used to assist in energy production during a negative
energy balance. Exercise depletes glycogen, increasing gluconeogenesis.
Protein and Bodybuilders





Competitive levels of body fat are generally unhealthy and impossible to maintain.
Because the body’s survival mode kicks in, continual reductions of calorie intake are necessary
to continue to achieve change.
Because of its anabolic requirements, protein intake cannot be lowered. Often, protein is
increased in the final weeks before a competition.
Normal eating habits enable greater muscular gains than year-round high-protein intake.
Carbohydrates consumed within an hour after exercise inhibits muscle-protein breakdown.
Protein Requirements
Skeletal muscle = 72% water, 22% protein, and 6% fat, glycogen, and minerals.
1 lb. of muscle = 100g protein.
To build muscle, consume:


An additional 200 to 400 calories daily (1.5 to 2.5 calories per pound) above maintenance
requirements.
AND
A little extra protein (2 ounces).
General protein recommendations:
Sedentary adults
0.8 g (0.4/lb.)
Strength athletes
1.2 - 1.7 g (0.5-0.8 g/lb.)
Endurance athletes
1.2 - 1.4 g (0.5-0.6 g/lb.)
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Chronic consumption of a high-protein diet is generally associated with a higher intake in saturated fat
ad low fiber (risk factors for heart disease). Kidneys have to work harder to eliminate increased urea
produced, so be careful with anyone with kidney problems. Also, more protein requires more fluid
consumption. Protein requires 7x more water than carbs or fat to metabolize. Main concern with highprotein diets is dehydration.
Recommended Dietary Allowance for protein: 0.8 g/kg/day. 10-35% total caloric intake.
Carbohydrates
Carbohydrates: a chief source of energy for all body functions and muscular exertion, carbs are
compounds containing carbon, hydrogen, and oxygen. Generally classified as sugars (simple), starches
(complex), and fiber.
Carbs provide the body with nutrition fat and protein cannot, satiety, proper cellular fluid balance,
blood sugar levels, and spare protein for building muscles. They are the perfect and preferred form of
energy. Parts of the central nervous system rely exclusively on carbohydrate.
Sugar: any monosaccharide or disaccharide. Simple sugars (such as honey and fruit) are easily
digested, double sugars (table sugar) less so, and starches (like whole grain) require the most digestive
action.
Monosaccharide: single sugar unit. Includes glucose (blood sugar), fructose (fruit sugar), and
galactose.
Disaccharides: two sugar units. Includes sucrose (common sugar), lactose (milk sugar), and maltose.
Starch: the storage form of carbohydrates in plants, comprised of connected monosaccharides. Must
be broken down into glucose (simple sugar) for utilization.
Glycogen: the storage form of carbohydrates in humans, comprised of connected monosaccharides.
Polysaccharides: long chains of monosaccharide units linked together and found in foods that
contain starch and fiber. These foods are called complex carbohydrates and include starch found in
plants, seeds, and roots.
Glycemic index (GI): the rate at which ingested carbohydrate raises blood sugar and its
accompanying effect on insulin release.


High: > 70
Moderate: 56-69
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
Low: < 55
Foods lower on the GI are good sources of complex carbohydrates, as well as being high in fiber and
overall nutritional value.
Fiber
Fiber is an indigestible carbohydrate. It provides bulk in the diet, increasing satiety, delays emptying
of the stomach, prevents constipation, lowers blood cholesterol, regulates the body’s absorption of
glucose, and regulates blood glucose levels. Two types: soluble and insoluble.
Soluble fiber: moderates blood glucose levels, lowers cholesterol. Examples: oats, legumes,
barley, many uncooked fruits/veggies.
Insoluble fiber: passes through the digestive system in its original form. Helps reduce risk of
colorectal cancer, hemorrhoids, and constipation.
Daily diet should include 25 to 38 g of fiber.
As duration of exercise increases, available glucose and glycogen diminish, increasing the reliance on
fat as a fuel source.
“Fat burns in a carbohydrate flame.” Maximal fat utilization cannot occur without sufficient
carbohydrate to continue Krebs cycle activity.
Carbohydrate intake recommendations


General: 6-10 g/kg/day, 45-65% of total caloric intake
Before exercise: Consume a high-carb meal 2 to 4 hours before exercising for more than
an hour.


During exercise: Consume 30-60g of carbohydrate every hour.
After exercise: Consume 1.5g per kg of carbohydrate within 30 minutes of completing
exercise.

For weight loss: there is no need to reduce carbohydrate intake for weight loss.
High-carb diets increase the use of glycogen as fuel, whereas a high-fat diet increases the use of fat as
fuel. Carb-rich diets will build glycogen stores and aid in performance/recovery.
Carbohydrate loading can nearly double muscle glycogen stores, increasing endurance potential.
Week-long program includes 4 days of carb depletion (10% of calories) followed by 3 days of rest and a
high-carb diet (90% of calories).
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Fatty Acids
Lipids: a group of compounds that include triglycerides (fats and oils), phospholipids, and sterols. 95%
are fats and oils. Lipids are three fatty acids attached to a glycerol backbone.
 Monounsaturated fat: Olive oil, canola oil, peanut oil, avocados
 Polyunsaturated fat: vegetable oils, omega-3 fatty acids (fish), most nuts and seeds
 Saturated fat: meat, poultry, lard, butter, cheese, cream, eggs, whole milk, tropical oils
  Trans-fat: stick margarine, shortening, fried foods, fast food, many baked goods
Fats are carriers of fat-soluble vitamins A, D, E, and K.
Fat intake recommendations:



Adults: 20-35% of daily calories
Athletes: 20-25% of daily calories
No health benefits in consuming less than 15% daily
It is metabolically inexpensive to convert dietary fat to body-fat stores. Fat has a lower thermic effect
than other macronutrients.
Dietary fats stimulate the release of CCK, a hormone that signals satiety.
Low-volume, high-calorie diets might not satisfy peripheral satiation mechanisms (chewing,
swallowing, stomach distention), leading to hyperphagia (overeating).
Fat is digested and absorbed slowly. The body needs fat for energy, structure/membrane function,
precursors to hormones, cellular signals, and regulation of uptake/excretion of nutrients in cells.
Metabolic syndrome (syndrome X): a cluster of symptoms characterized by obesity, insulin
resistance, hypertension, and dyslipidemia. Associated with obesity, high-fat diets, and sedentary
lifestyle.
In the presence of higher fat levels, the body decreases glycogen synthesis, leading to chronically
elevated levels of blood sugar.
Water
Water constitutes 60% of the adult human body.
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Sedentary men/women should consume 3.0 L (13 cups)/2.2 L (9 cups) per day.
Those who want to lose weight should drink an additional 8 ounces of water per 25 pounds above ideal
weight.
The body cannot adapt to dehydration.
Effects of dehydration:



Decreased blood volume, blood pressure, sweat rate, performance, cardiac output, and blood
flow to skin
Increased core temperature, heart rate, perceived exertion, and use of muscle glycogen
Water and sodium retention
Fluid replacement guidelines:





14-22 oz. of fluid 2 hours before exercise
5-12 oz. of fluid for every 15-20 minutes of exercise
16-24 oz. for every pound of body weight lost after exercise
Fluids should be cold for more rapid gastric emptying
If exercise exceeds 60 minutes, a sports drink (containing up to 8% carbs) should be used
Altering Body Composition
For fat loss:






Eat less/exercise more
Distribute protein, carbs, and fat throughout the day
Consume less than 10% of calories from saturated fat
4-6 meals/day
9-13 cups water
Weight and measure food for at least first week
For lean body mass gain:




4-6 meals/day
Spread protein intake throughout the day
Ingest protein and carbs within 90 minutes of a workout
Do not neglect important of carbs and fat
Risks of very low calorie diets:
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(Lower than 1200 calories)




Increased risk of malnutrition
Poor energy and inability to complete essential fitness
A behavioral pendulum swing—inability to reintroduce forbidden foods in a moderate manner
Fatigue, constipation, nausea, diarrhea.
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Chapter 18
What to Know: Supplementation

Table 18.2 Dietary reference intake terminology

Units of measure used on dietary supplement labels

Adverse effects of excess for specific vitamins & minerals

Be familiar with the ergogenic aids and dosage
Dietary supplements: products intended to supplement the diet. Contain some nutrient property,
intended for ingestion, labeled as a dietary supplement, and cannot be represented for use as
conventional food or approved as a drug.
Almost anything that is not already classified as a drug can be put into a pill, capsule, or powder and sold
as a dietary supplement.
Scientific studies pertaining to the health consequences of multivitamin-mineral supplementation are
limited in quantity and quality.
Dietary reference intake (DRI) values for nutrients provide good guidelines for what constitutes
an adequate intake of a nutrient.

Estimated Average Requirement (EAR): Average daily nutrient intake level that is
estimated to meet the requirement of half the healthy individuals who are in a particular life
stage and gender group.

Recommended Dietary Allowance (RDA): Average daily nutrient intake level that is
sufficient to meet the nutrient requirement of nearly all (97-98%) of healthy individuals.

Adequate Intake (AI): Recommended average daily nutrient intake level, based on
observed approximations or estimates of nutrient intake that are assumed to be adequate for
a group (or groups) of healthy people. Used when RDA cannot be determined.

Tolerable Upper Intake Level (UL): Highest average daily nutrient intake level likely to
pose no risk of adverse health effects to almost all individuals. As intake increases above UL,
the potential risk of adverse health effects increases.
o
Safe Upper Limits (SUL): UK version of UL
Even essential nutrients are potentially toxic at some level of intake. (Example: excess vitamin A during
conception/early pregnancy can lead to birth defects, vitamin D excess can result in the calcification of
blood vessels, excessive vitamin B6 intake can cause permanent damage to sensory nerves.)
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Nutrient levels that are appropriate for healthy people can be life-threatening for those with certain
conditions. For example, supplementation with vitamins E and K are complicate conditions for people
on anticoagulation therapy.
Whether optimal is closer to the RDA and AI or the UI for a nutrient is unknown and likely differs for
the various nutrients and also may differ from one person to another.
Units of measure:
Protein, carbs, and fat expressed in grams.
Vitamins, minerals, amino acids, and fatty acids expressed in milligrams or micrograms.
% DVs for vitamins/minerals are based on the 1968 RDAs for adults (using the higher of two
recommended amounts, when there are differences between males and females).

DV problem: iron RDA is 18 mg/day, based on a menstruating woman’s requirement. Men’s RDA
is 8 mg/day. When a pill provides 100% of DV for iron, it provides more than twice the RDA for a
man.
International units (UIs): expression for amounts of vitamin A, D, and E on supplement labels.
Vitamin and mineral supplements
Levels in multivitamins should be 100%, except for:

Vitamin A (when indicated as retinol) should be less than 100% DV--high intake of retinol has
been linked to hip fracture in older women and birth defects during pregnancy


B-carotene: high levels linked to lung cancer in smokers.
Calcium: should be at low levels or absent, since amount required would make pill too big to
swallow. For best absorption, daily calcium requirements should be spaced throughout the day.
Deficiencies and effects:

Deficiencies of vitamins/minerals can impair the ability to perform physical activity, and/or
mental/emotional problems.

Vitamin B12 deficiency is often mistaken for Alzheimer’s disease.
It’s not unusual to find supplements with nutrient levels that exceed the UL or SUL values.
It is possible to consume excessive amounts of some nutrients without taking a dietary supplement.
Nutrients with Greatest Potential for Excess Dosage
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A supplement that contains 100% DV…
Vitamin A
Contains more than twice the RDA for women, only half the UL and the right
amount according to the Guidance Level.
Vitamin D
Contains twice the AI value. The UL is 5 times the DV, and the SUL is 2.5 times the
DV.
Iron
Contains the RDA for women, more than twice the RDA for men. The UL is only a
little over twice the DV, and the Guidance Level is 1 milligram less than the DV.
Zinc
Contains an amount of zinc that is almost twice the RDA for women. The UL is just a
little over twice the DV, and the SUL is a little less than twice the DV.
The general population could benefit from the use of a multivitamin. Manufacturing methods and
ingredients used could affect results. No one should use multivitamins for medicinal purposes.
Ergogenic: work generating. Often used in associated with supplements that enhance athletic
performance.
Non-nutrient Ergogenic Aids
Creatine: synthesized naturally in the body from amino acids, glycine, and arginine. Plays a critical role
in normal brain function. Can enhance certain types of brief high-intensity efforts.



Typical dosing: 5 to 7 days of supplementation at 20 g per day, followed by a maintenance
phase of 2 to 5 g per day.
Potentially not safe for those with kidney problems.
Creatine loading should be considered no different than carb-loading.
Stimulants (caffeine)
Caffeine is the most widely used drug in the world. It primarily affects the central nervous system, heart,
and skeletal muscles. Caffeine does not seem to help with sprint-type efforts lasting 90 seconds or less.
Most effective ergogenic response: 3-6 mg per kg body weight, to be ingested about 1 hour before
exercise.
Potential negative effects: insomnia, nervousness, nausea, rapid heart and breathing rates, headache,
chest pain, and irregular heart rhythm.
Banned Stimulants
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50 different stimulants are prohibited in sports.
Prohormones: show a lack of benefit and significant risk potential in young to middle-aged
athletes. DHEA is produced naturally in the body for most. Some older adults might benefit from DHEA
supplementation, although very high levels lead to cancer risk.
Androstenedione: a compound that the body can concert to testosterone or estrogen, widely used
to boost testosterone levels in men.
Androgenic anabolic steroids: drugs designed to mimic the effects of testosterone. Promote the
building of muscle mass, strength, and loss of body fat (at the risk of adverse side effects). One
particular concern is the early closure of growth plates in bones in youth and stunted development of
normal height.
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Chapter 19
What to Know: Lifestyle Modification and Behavioral Coaching:

Figure 19.1 Stages of Change Model

Know the stages of Change

Be familiar with the initial session

Effective Communication skills

Goal setting- SMART Goals

Cognitive Strategies

Positive Self talk

Exercise Imagery
Client Expectations




Numerous options
Supportive, nurturing environment
Convenient locations
Affordable cost
PTs have 20 seconds to make a good first impression.
Stages of Change
Stage 1: Precontemplation
Clients have no intentions of changing.
Strategy: Best strategy is education with attractive, easy-to-read materials. Cannot force clients to form
intentions.
Stage 2: Contemplation
Clients thinking about becoming more active in the next 6 months. Aware of some of the costs/benefits
of exercise, but misconceptions might still be present. PTs can have huge influence on this group.
Strategy: More education. Discuss ways to deal with perceived cons of exercise. Develop long-term
motivational programs.
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Stage 3: Preparation
Planning to begin exercising regularly in the next month. Believers in the health benefits of exercise.
Unrealistic expectations for change, high risk of disappointment and early dropout.
Strategy:







Clarify realistic goals/expectations
Maintain beliefs in importance of exercise
Discuss programs that might work best
Consider clients’ schedules, preferences, health concerns
Ask about previous successful experiences
Avoid exercise that could lead to discomfort or injury
Discuss building a social support network
Stage 4: Action
Clients have started to exercise, but have not yet maintained behavior for 6 months.
Strategy: Continue to provide education to strengthen belief in pros of exercise, discuss barriers to
exercise, anticipate upcoming disruptions, develop actions for overcoming barriers/disruptions.
Stage 5: Maintenance
Clients have maintained changes for 6 months or more. Still tempted to return to old habits of less
exercise.
Strategy: Have a maintenance check-in plan. Give suggestions tailored to personal preference.
Assessing Stage
What experiences has the client had with physical activity in the past?
What worked best/least? What contributed to them quitting?
What has kept them from exercising in the past 6 months?
What did they do when disruptions (holidays, travel) occurred?
Initial Session
20 seconds to make first impression.
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Initial session is for building a relationship—spend at least 30 minutes just talking. Determine client’s
readiness to exercise and decide what stage of change he or she is in. Both parties are testing the other,
determining whether they want the relationship to continue.
Initial conversation points (in addition to assessing the client’s stage): daily activities, importance of
physical activity for good health, health concerns (use as a motivator), stress levels, fitness goals,
input about what they want included in their exercise program.
Important to understand what fitness improvements the client hopes to achieve and to clarify what
clients mean by “feeling better, being stronger, looking better, being fit,” etc.
SMART goals: specific, measurable (quantifiable), attainable (challenging but not extreme),
realistic (client is willing and able), and timely (set goals that can be both attained tomorrow and in 3
months).
Break goals down into smaller goals that can be achieved relatively quickly—this is very motivating for
clients.
2 types of goals: process and product. Have clients focus on process goals, since they have
more control over them.
Social facilitation: people increase their effort and performance when others are watching them.
Communication
It is more important to communicate understanding than to provide the right information.
4 different interpretations of communication: what speaker means, what speaker says,
what listener hears, what listener thinks speaker means.
Tips:






Use open-ended questions to build collaborative relationships with clients.
Use reflections, summaries, and affirmations in communication.
Genuinely affirm something the client personally values—thoughts, plans, or skills (instead of,
say, workout clothes).
Change I statements to you statements.
Ask permission to give advice to soften the trainer’s role as an authority figure and support a
partnership in decision-making.
Provide information by giving examples of work with other clients.
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Kinds of support: instrumental (practical factors like childcare), emotional (encouragement),
informational (directions, advice), companionship (accountability and camaraderie)
Common barriers to exercise: time, unrealistic goals, lack of social support, social physique
anxiety, convenience.
Positive Self Talk



Help clients become aware of negative thought processes by listing any negative thoughts they
have around exercise.
Come up with a list of positive thoughts they might use in regard to exercise.
Train clients to notice negative thoughts, stop them, and replace them with positive ones.
Alternatively: generate a list of positive, motivating key words clients can use as awareness tools in pace
of negative thoughts.
Psyching Up
Have clients use techniques they use to get psyched up for other things in life. Positive thoughts,
keywords, imagery, specific food, music, etc.
Keep a running conversation about whether client is getting psyched up.
Exercise Imagery: the process created to produce internalized experiences to support or enhance
exercise participation. Have clients visualize themselves performing at the level they desire. Rehearse
performances with positive feelings and outcomes. Best to use client’s previous positive experience if
one exists. If not, develop one using role models or media influences.
Psychological benefits of exercise: promotes positive mood, reduces stress (and related
physical symptoms such as headaches and stomachaches), improves sleep, reduces depression/anxiety.
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Chapter 20
What to Know: Developing a Successful Personal Training Business:

Providing uncompromising customer service

Know who your customers are

Ten steps to success
4 P’s of Marketing:




Product. Product is the result trying to be achieved.
Price. Inevitably, a small percentage of clients will be unable to afford your services.
Place (distribution)—channels product/service will go through to reach clients. Examples: online
coaching, after school programs, boot camps at parks, corporate wellness programs, sport
training centers, senior centers.
Promotion—communication of information about product/service. Categorized into push or
pull. Advertising pulls consumers in by building awareness, incentives push consumers to
purchase in volume.
Uncompromising customer service: being unwavering in providing an experience and level of
assistance that is rarely, if ever, experienced anywhere else. Develop an obsession for becoming
artistic in your approach to helping people. Clients choose PTs based on how they feel when working
with them.
Guidelines:






Take every opportunity to meet/get to know clients.
Represent a positive image and high level of professionalism.
Never give the impression that a question is inconvenient, unnecessary, or unintelligent.
Express ideas well.
Obsess on opportunities to create moments that strengthen professional relationships.
Take ownership of complaints.
Everybody is a potential client.
10 Steps to Success
1. What is the desired annual income?
2. How much must be earned each week to achieve the annual goal?
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3.
4.
5.
6.
7.
8.
9.
10.
To earn the weekly goal, how many sessions need to be performed?
What is the closing percentage? (Of clients approached, how many sign up?)
In what timeframe will new clients be acquired?
How many potential clients need to be interacted with overall to gain clients within the
timeframe? (Desired number of new clients divided by closing percentage.)
How many potential clients need to be contacted each day?
How many potential clients need to be contacted each hour of the day?
Ask each member spoken to for his/her contact information.
Follow up.
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FINAL Test Prep
(from NASM)
On the actual exam, you will be tested in the following subject areas (exam breakdown):
Basic and Applied Sciences
15 Questions
Assessment
15 questions
Exercise Technique and Training Instruction
20 questions
Program Design
20 questions
Nutrition
12 questions
Client Relations Behavioral Coaching
10 questions
Professional Development, Practice and Responsibility
8 questions
Other Important Materials:

National Academy of Sports Medicine Code of Ethics (In the
beginning of your book pages V-Vi)
Be sure to read all the sections as there will be test questions on this. You may see something
like how long should a personal trainer keep client records for? The correct answer would 4
years. (Page Vi located under Business Practice)

Appendix D
Understand the “isolated function” of the muscles, which is the same as the muscles concentric
muscle action. You will not be tested on the origin, insertion, or the integrated function.

The BOC Candidate Handbook (located in your eLearning center
under CPT4 Online)
Make sure to review this before the exam, it contains important information on how the test
was developed and other relevant information.
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