Saulys, E.
Population Description:
According to the Centers for Disease Control and Prevention, childhood obesity has
increased from 7% to 20% and adolescents have increased from 5% to 18% since 1980. The
cause for obesity is due to their environmental factors, genetics, and behaviors. As the years
progress many children are becoming less active and childhood obesity is increasing. In the
future, working with children and childhood obesity is an ideal career path. The region to target
for an exercise program is Chicago suburbs. Evidently, Chicago has a high rate of obesity, but in
the suburbs many families have a lot of money which means kids are have access to all these
electronics to play with. Therefore, technology is taking over by attracting young kids instead of
participating in physical activity. Also, many communities are spread apart where stores or
entertainment are not within walking distance. However, this is slowly changing as the year’s
progress. Obesity is developing at a young age than it once was and these children need the care
and the attention to help them maintain a good healthy weight.
The age range will be between ages ten and fourteen in this population. At this age
children are experiencing puberty and going through life changes such as finding their circle of
friends, experiencing junior high school, and figuring out their likes and dislikes. Obese
adolescents have a higher rate of developing pre-diabetes, bone and joint problems, sleep apnea,
and social and psychological problems such as low self-esteem and depression. Statistics show
that more than 80% of children are overweight when diagnosed with diabetes. In the long term
these kids can develop heart problems, stroke, osteoarthritis, and other types of cancer. When a
child is obese at a young age, they have a higher risk of being obese when they are older.
1
Saulys, E.
Therefore, this population will be diverse because both boys and girls are at risk for these health
problems.
As stated before, obesity can cause a lot of health problems which means majority of this
population is considered inactive or exposed to very little physical activity. Many kids
experience physical activity only during school unless they participate in a sport. However, in the
state of Illinois it is required for schools to have a physical education program up until twelfth
grade. Most kids will go home and play video games or computer games instead of playing
outside. Also, adolescents are too young to make their own food so they eat what their parents
are eating. A lot of family households have both parents working which can result to having fast
food more than usual or quick, unhealthy meals. Since this population is mostly sedentary and
has an imbalanced diet there is an increase risk of injury involved with exercising. Some risks
may be muscle strains or stiffness due to lack of physical movement, high blood pressure and
cholesterol levels, or blisters on their feet from wearing the wrong shoe size. In order to have a
safe and effective program there needs to be a vast quantity of attention and care for these
children.
For this population to have an effective exercise program, one must take in consideration
that these children are not becoming physically active of their own free will. To help these
clients get treated, the best way is to control their cholesterol and blood pressure levels, a healthy
diet, and daily physical activity. Many of these kids are probably being required by a pediatrician
to begin exercising rather than on their own. Therefore, this population is use to a sedentary
lifestyle and adding exercise into their routine is a change for them which can cause them to be
unmotivated and stubborn.
2
Saulys, E.
For this population time availability is based on the family’s lifestyle. Young children
have to plan things around their family’s needs and when their parents are free to take them
places. On average, most kids go to school and then go home and relax by watching TV, doing
homework, or playing with electronics. Before entering junior high, kids got to have two chances
to be physically active which was during physical education class and recess, but at the junior
high level they only have physical education classes. Even with physical education classes many
children stand around and avoid participating because they are embarrassed or not socially
accepted. In a suburban area many kids are not within walking distance to a plaza or parks.
However, parks or playing games outside are not attractive to kids like they once were, instead
kids enjoyed walking to fast food places, going to movies, and watching TV with friends.
Finally, this population has some goals to be reached. First and foremost these children
need to increase their physical activity and fitness level. Another goal would be to improve their
self-esteem and body image. The last goal is to improve and maintain good health in order to
prevent pre-diabetes and other risk factors stated before.
3
Saulys, E.
Prescreening: Initial Meeting:
The purpose of the initial meeting is to open the lines of communication between the
programmer and the client. The meeting begins by providing the client and their family with
valuable information about the program and the background history of the programmer. A
background summary and area of interests will provide the client and their family with a better
overview and understanding of their programmer allowing them to ask any questions they may
have. Providing background information will help ease the stress and form a two way
conversation between the client, parents, and programmer discussing personal and medical
issues, the client’s interests, and any other important issues. Building the client and his or her
family’s trust in the initial meeting is very important to ensure the client knows that it is his or
her program and the programmer is here to help. Emphasizing past experience and providing a
comfortable environment will hopefully initiate a trusting relationship between the client, family,
and programmer.
Besides just discussing past background experience with my client, it is significant to
establish credibility by relaying information on current certifications from professional
organizations. Also, it is important to discuss the guidelines for exercise testing and treatment
according to ACSM for an adolescent population. Some certifications that would be important to
have are the ACSM exercise specialist certification or clinical exercise specialist certification
and personal trainer certification. The American Red Cross First Aid and CPR certification is a
mandatory certification for a programmer to have and making sure it is always up to date.
Another significant thing to do is to stress how important physical activity is for children and
adults. Presenting the clients with information on how exercise can assist weight management,
4
Saulys, E.
decrease blood and cholesterol levels, increase self-esteem, and other risks associated with non
physical activity is very important to help get a jump start on their motivation. These clients may
be uncertain or do not believe that exercise is good for them; therefore, educating the client and
their families will help increase motivation to start the exercise program.
Many of these clients are new to exercise or have not been practicing a physical activity
lifestyle for many years. To jump start their motivation and empower the client, it is best to ask
them what types of physical activity they have participated in the past whether it is cycling,
running, walking, or even playing catch. The clients should have a chance to state any other
types of physical activity that they would like to participate in or fit into during their program.
By taking inconsideration of the client’s likes and dislikes and incorporating in their types of
physical activity will give the client more autonomy which can increase their motivation and
enjoyment to start the program. The clients should feel comfortable to give suggestions or share
new ideas considering new or existing variations of physical activity to participate in throughout
this program. Some clients may be timid to suggest new ideas face-to-face, so it would be
beneficial to have them fill out a questionnaire or a survey on their program allowing them to
give thoughts and suggestions on paper. Setting small, reasonable goals and deadlines for these
goals to be reached and attained is another to empower the client. Having the client give
suggestions and setting small goals will help the client focus on health/fitness improvements
rather than comparing to peers or weight loss and stay motivated.
After discussing with the clients and their families about the program and sharing ideas,
the first step is to have them sign two forms including the assent form and the informed consent
(Appendices A and A-1) with their parent’s or legal guardian’s signature on it since this
5
Saulys, E.
population is under the age of eighteen years old. The assent form will be geared towards the
child’s cognitive level so he or she can understand what is going on at their level. An informed
consent will geared towards the parent’s cognitive level and provide full detail description of the
program. Both forms will guarantee full understanding of the types of physiological tests that
may be given and the structured of the program. Presented in the document are all the tests and
procedures that will be taken place and receive a verbal description of these tests at both
cognitive levels before signing the documents. An informed consent and assent form are
important because many clients do not know the health risks involved with various testing no
matter how little the risk may be. It is essential to have the informed consent and assent form
improved by an attorney before hand to make sure all necessary information is noted and
anything inappropriate is removed. The informed consent and assent form are to protect the legal
rights of the client and the exercise programmer providing both sides of full awareness of the
procedures and expectations before beginning the exercise program.
After the client and the parent or legal guardian have signed the informed consent and
assent form the second form that needs to be completed is the Par-Q also known as the Physical
Activity Readiness Questionnaire (Appendix B). Within in this population it is most likely that
the parent or the legal guardian will help the client fill this out. The Par-Q is a short, one page
questionnaire with “yes” or “no” answers covering the client’s past or current health from a wide
standpoint. According to the requirements of the Par-Q, if a client shows a “yes” to one or more
questions he or she must seek medical clearance before participating in the program. The Par-Q
is beneficial for the exercise programmer because it shows if the client may have any health
issues that should be brought to the trainer’s attention regardless if it is diagnosed or not. It is a
6
Saulys, E.
fast and simple way to point out any health issues that may need to be brought to a physician’s
attention during the medical clearance examination.
Once the Par-Q is filled out the client will need to complete a family health history form
(Appendix C) including their family history and their personal medical history questionnaire
(Appendix C-1) using ACSM risk stratification guidelines. The parent or guardian of the client
will help the child fill this out in order to get accurate answers. Based on the risk stratification
guidelines if these children are obese they are automatically classified as high risk because there
is the assumption of pre-diabetes involved. Therefore, many of these clients will fall in the obese
category and will have to get a medical clearance form from a physician (Appendix D) before
starting the exercise program regardless if they answered “yes” or “no” on any of the questions
listed in the Par-Q. It is important to know the family healthy history because genetically it can
put the client at even greater risk of a heart attack or any cardiovascular diseases.
After the informed consent, the Par-Q, and the family health history form is completed, it
is important to take note on any immediate family problems or complications with the parents
like a sudden death, myocardial infarction, or coronary diseases. These factors can relate to the
client by causing limitations on what the client can participate regarding physical activity.
The next step is to have the client fill out a medical health form (Appendix E) which will
give more in dept information on possible cardiovascular risks. As an exercise scientist and
programmer it is important to know any allergies, medical conditions, past/present injuries or
surgeries, and past/present medications that are being taken. Knowing this information is
important whether it pertains to a cardiovascular risk increase during exercise or not, it can be
beneficial for any accident or emergency during exercise.
7
Saulys, E.
Another form the client needs to fill out is an activity/lifestyle assessment form
(Appendix F). This document asks the client to describe their habits due to smoking, alcohol
consumption, physical activity, and nutrition. It is very important that these children maintain a
healthy diet and do not partake in alcohol and drugs at this very young age. A brief overview of
the client’s current physical activity level will give the programmer a brief idea on where the
client stands and what type of activities that he or she is currently participating in, if any at all.
This assessment can be beneficial to encourage further communication between the programmer
and the client to discuss what he or she likes and what they would like to add into their program.
Another strong point of this assessment is evaluating their strengths and weaknesses. These
factors can give a baseline for encouragement and motivation in areas that they are lacking.
Once the client is evaluated and there are no risk factors involved the next step is to find
out the client’s objectives for this program. The client will write down three short-term goals and
three long-term goals (Appendix G). These goals will help construct an effective exercise
program for this population. After setting these goals both the client and the programmer will
discuss how to obtain these goals and allow the client to provide ideas to accomplish these goals.
The programmer will also give some input on different exercise or physical activities that he or
she may not be able to think of. This discussion will ensure the client and the programmer that
they are both on the same page. Both the client and the programmer will work together to come
up with a compromise and design an effective, fun workout that he or she can enjoy. The
programmer would advise the client to bring music to listen to help motivate them during the
exercise if he or she does not want to talk. In addition, the client will have some homework to do
to educate them on health and fitness.
8
Saulys, E.
The last part of this meeting will be to find out if the client and his or her family will need
help in controlling their weight. If the client says yes, he or she along with their family will have
to sign a pledge (Appendix G-1) in order to schedule a session. The programmer, the client, and
the client’s family will discuss times that are available to meet once a week and discuss any
issues that are going on and what to do to meet their goals. A schedule will be made and the
client will know where to meet for these meetings. All information gathered during the initial
meeting will be put away into the client’s personal folder that will be looked out throughout
program designing process and during the program itself.
After all forms have been completed, filled out, and the goals have been established, the
next step after the initial meeting is to do a physical fitness assessment. The client needs to have
their medical release form and to be dressed appropriately for body composition assessment and
exercise testing.
9
Saulys, E.
Prescreening: Fitness Assessment:
In order to conduct a fitness assessment, all paperwork and forms must be signed,
completed, and evaluated before the client continues with the prescreening process. Prior to the
fitness assessment the client will be notified to wear comfortable, loose-fitting clothing, athletic
shoes, and drink plenty of fluids. It is important the client drinks a lot of fluids during the twentyfour hour period before the test to make sure the body will be at normal hydration. The client
will also be advised not to do any strenuous or extreme exercising within twenty-four hours prior
to testing. It is important that the client does not eat, smoke, and consume alcohol or caffeine at
least three hours prior to the fitness assessment. By following these rules will not only protect the
client, but it will also help give a more accurate measure of their fitness level.
It is important to perform a fitness assessment before starting the program because it
gives the programmer and the client a better understanding of the client’s current fitness level
while demonstrating the client’s strengths and weaknesses. The fitness assessment will reassure
the client that their program will be made specific to them according to their needs.
The fitness assessment will measure the five components of fitness which includes
measuring and assessing body composition, cardiovascular endurance, muscular endurance,
muscular strength, and flexibility. These five components of fitness will give a valid indication
of where the client stands and what needs to go into the program in order to improve these areas
for the client. Body composition assessment will take place first to prevent any decrease in body
water and electrolytes. Next, the cardiovascular assessment will be performed so that he or she
will not have worn out any large muscle groups that are essential to the aerobic fitness test. After
the cardiovascular assessment the client will participate in the muscular strength and muscular
10
Saulys, E.
endurance testing using the large muscle groups. Finally, the client will be tested on their
flexibility. Flexibility is important at the end because the client’s ligaments and muscles will be
loosened up from all the activities that he or she has performed beforehand. The order of these
assessments is set up to achieve optimal results from all fitness components.
Body Composition:
To begin the fitness assessment testing, the client will start off with body composition.
Body composition is an important part of the client’s health and physical fitness profile. It
consist of two components that make up the body which are fat mass and fat free mass, usually
expressed in a percentage of body fat. Performing a body composition assessment on the client
will help both the client and the programmer to set reasonably goals that are specific for the
individual to reach. ACSM has set guidelines that distinguish between what is normal body
mass, what is too little, and what is too much according to the individual’s height, weight, and
age. By doing this assessment, the programmer can see if the client is at risk for developing any
other type of diseases, such as coronary heart disease, pulmonary disease, etc.
Since this population is so young, the client’s body composition will be tested by taking
his or her BMI. BMI stands for body mass index. This is an easy and non-expensive way to
assess the client without any complications. It is very rare for someone to take a skinfold
measurement on young kids because it will make them more self conscious and it is
unprofessional. However, BMI is the ratio of body weight to body height squared and can be
inaccurate due to the child’s body structure. For example, a child can be very tall and carry less
fat, but their height can be higher than the classified norms. It does not account for the
composition of body weight, age, ethnicity, body build, or frame size. These factors will be
11
Saulys, E.
discussed with the client to ensure he or she understanding of the test. The client’s measurements
will be recorded on a BMI recording sheet (Appendix H-1).
At a young age it will very common for these clients to feel uncomfortable and self
conscious about their bodies during this process. To help ease the tension and the feeling of self
consciousness it is good to have a relaxed conversation with the client and discuss what he or she
values mean and why. This will help make the client feel comfortable and will ensure them that
they are not being judged on the excess fat on their body. This assessment should be measured
once every few months because it takes a while for the body to adapt and change. It is not the
goal of the program to have the client become obsessive over body fat percentage because it can
lead to unhealthy behaviors. Also, fat loss is caused by diet and exercise which tends to be nonlinear, so measuring every week or two weeks would be ineffective and can cause frustration
with the client.
The correct protocol for these measurements is to have the client remove any extra
clothing such as sweatshirts, sweat pants, and shoes. When measuring the height, the client will
be asked to stand up straight with shoes off and heels together while taking in a deep breath and
looking straight forward. The headboard of the vertical ruler will indicate the client’s height by
making contact with the highest part of the client. Next, the scale will be checked to make sure it
is leveled before the client gets his or her weight measurement. At this point the client will have
all excess clothing off, including shoes, which will help provide an accurate weight for the client
without removing the last layer of clothing. The client has a preference to do either a blind
weight or not and will be reassured that the average weight varies between four to five pounds a
day. If the client is self conscious or will be discouraged by the number on the scale, it is
12
Saulys, E.
beneficial to do a blind weight to prevent the client from being discouraged. To assure accuracy,
when the client is retested he or she will be tested on the same scale at the same time of day. The
client has the responsibility to follow all of the protocols each time. These procedures and
classifications for the body mass index test may be found in Appendix H. All parts of the fitness
will be confidential and will only be discuss between the programmer, the client, and the family.
Cardiovascular Endurance:
Following the body composition assessment is the cardiovascular endurance assessment
which happens to be the most important element of physical fitness. Cardiovascular endurance
consists of using large muscles groups in a dynamic, moderate-to-high intensity exercise for an
extended period of time. The purpose of this test is to measure the current functional state of the
skeletal muscle, respiratory, and cardiovascular systems. Due to this population of young,
overweight adolescents the best method to use to test their cardiovascular endurance will be the
Rockport 1-mile walk test (Appendix I). This test is more practical than a submaximal test or a
maximal test on the treadmill or cycle ergometer since these clients have inexperience with those
machines.
The Rockport 1-mile walk test is beneficial to obese individuals because this population
may have limitations due to their health status. Predicting a person’s VO2max can be a better
indicator because many individuals quit during a maximal test before they have exerted all their
air. The Rockport 1-mile walk test targets sedentary individuals because it is just fast pace
walking rather than exerting all their air out in a short period of time. For most of these children,
walking at a fast pace will be hard for them. Therefore, the Rockport 1-mile walk test fits for
them and will provide an accurate measurement of VO2max.
13
Saulys, E.
Before the test is given, the client will have their resting heart rate and blood pressure
taken and recorded. The client will be provided with a heart rate monitor and will be informed on
how to use it. The client will wear the heart rate monitor throughout the entire test. During the
test if the client experiences any angina, shortness of breath, dizziness, or any other
complications presented by ACSM guidelines (Appendix I-1) the test must be terminated with a
passive cool-down. The client is encouraged to speak up if they feel any of these complications
and must stop to prevent any further harm to their body.
To begin the test, the client will walk for five minutes as a warm-up to get the body loose
and begin blood flow throughout the body before performing the actual test. Then the client will
perform the test by walking as fast as they can around the track or on the treadmill for one mile.
Immediately after they perform the test, the client will have their heart rate and blood pressure
taken and recorded again (Appendix I). The client will be given instructions to walk for five to
ten minutes on the treadmill or around the track at a slow pace to cool down the body and get rid
of any lactic acid. This procedure can be found in Appendix I. In order to predict the client’s
VO2max, there will be an equation (Appendix I) given which includes heart rate, age, height,
weight, sex, and walk time and then the client will be classified according to the .
For this test, the VO2max score will provide valid information which can be used to
classify their cardiovascular endurance level. This will give the programmer an idea where the
client stands and will keep all scores confidential between the client.
Muscular Endurance:
Muscular endurance is the ability to exert a submaximal force by using a muscle group
for an extended period of time. This test is used to see how many reps someone can do in a
14
Saulys, E.
period of time. With this population the clients will be tested by doing a push-up test for upper
body muscular endurance and a partial curl-up test for abdominal muscular endurance. These
two exercises will target major muscle groups that are beneficial to the human body. For these
tests the procedures can be found in Appendix J.
The client will first participate in the push-up assessment. To prepare for this test the
client will be given a five minute warm-up either using a light weight of dumbbells or an arm
ergometer set at a low resistance between 1 to 4 pounds. A warm-up is crucial because it creates
blood flow throughout the body and protects the client from injuries. Once the warm-up is
completed the client will be asked to perform as many push-ups as possible with proper form
according to their gender-specific form (Appendix J) without rest or until fatigue. The client will
be notified if they have an arch in the back or using improper form and will be asked to fix it.
After the client has performed the test, he or she will be classified into a norm percentile ranking
based on his or her gender (Appendix J-1). This is a fast and straightforward test with a
familiarized exercise targeting the major muscle groups and providing adequate results.
After the push-up test is completed the client will move on to the partial curl-up test that
will test their abdominal muscular endurance. The client will be asked to do a five minute warmup which consists of low intensity sit-ups or curl-ups before the actual test. Once the warm-up is
finished the client will be positioned on the mat in accordance to the ACSM guidelines
(Appendix J) with their arms to their side. There will be a piece of masking tape place 12
centimeters away from the other piece of tape at the tip of their fingers since this population is
under the age of 45. A metronome will be set at 40 beats per minute and the client will be asked
to do partial curl-ups by having their shoulder blades lifted off the mat. This form of curl ups will
15
Saulys, E.
allow the client to only use their abdominal muscles and not their back which in the long run will
protect them. The client will be notified that the rate of their curl-ups goes to the metronome
until fatigue or until they have performed 25 curl-ups. At any time during the test the client feels
uncomfortable they are encouraged to stop. The programmer will pay close attention to the neck
and lower back in order to prevent injury. If the client has an arch back, it will be fixed by
placing a pillow underneath the designated area. This number of curl ups will be used to classify
the client’s norm percentile according to the ACSM classification (Appendix J-2). This test is
very common and many of these clients know what a curl-up is. It is easy and inexpensive, but
can accurately test the abdominal muscular endurance.
Muscular Strength:
Muscular strength is the ability of a muscle group to exert maximal, contractile force
against a resistance in a single contraction. This test is used to see how much power one can
exert within one rep. In order to test a client’s muscular strength, the client will be given two
tests which consist of a bench press and a leg press. The protocols for these tests can be found in
Appendix K.
The first test given will be the submaximal bench press test which is testing the client’s
upper body muscular strength using an equation to estimate their maximal 1-RM weight
(Appendix K). The client will not be performing a maximal 1-RM test due to safety issues and
lack of inactivity. The client will be given an in-depth directions and a demonstration on how to
perform a bench press lift because many of these children have never used this type of machine
or performed this type of exercise. The client is encouraged to ask any questions or concerns that
they may have before performing this exercise. After the demonstration, the client will be
16
Saulys, E.
instructed to lie on the bench and perform six repetitions of a bench press lift with just the bar or
a light weight as warm-up and to make them feel comfortable before the test.
In order to distinguish the correct weight for the client to be tested at is to figure out what
is 45% of the client’s body weight. To receive an accurate result, client should not be able to
perform more than ten lifts at the tested weight, but should be able to perform more than one lift
which is less than his or her 1-RM max. If at 45% of the client’s body weight is lifted for more
than ten repetitions, then increase the weight incrementally until the client is able to lift more
than one, but less than ten repetitions. In this case the testing volume is greater for the predicted
1-RM test than the 1-RM max test, so fatigue will be the factor for these clients’ outcome. It is
important to spot the client and maintain communication with the client throughout the
assessment. The client should be given about 2 minutes of rest between sets. Follow the
procedure until the child fails to complete the full ROM of the exercise for at least two attempts.
If fatigue becomes a big factor in preventing the client to perform well, it is best to retest the
client after a 24-hour period. The 1-RM is usually achieved within 7 to 11 trials. The client’s
measurements will be recorded and kept confidential between the programmer, the client, and
the parents (Appendix K).
After the upper body assessment, the client will be tested on their lower body muscular
strength by performing a submaximal leg press test and will have his or her results recorded
(Appendix K-1). The client will go through the same procedure that they did for the bench press
lift which includes an instructional demonstration, warm-up, and the actual test. The only
difference is the client will be performing this exercise on a leg press machine rather than a free
weight bench. Once again the client will have a predicted 1-RM rather than a max 1-RM due to
17
Saulys, E.
lack of inactivity and safety for these children. This will prevent unnecessary stress on the
client’s heart and body.
The muscular strength tests are not made for the client to become sore. It is used to see
where the client stands and what needs to be improved during their exercise programming. For
children it is not safe to load the body with heavy weights. Since children are anatomically and
physiologically immature, loading the body with heavy weights can cause damage to the
developing bones and joints. Therefore, a predicted 1-RM test is more applicable because it
prevents loading of the body and delay onset muscle soreness.
Flexibility:
Lastly, the client will participate in a flexibility test that will evaluate number of ways to
assess various joints in the body. Flexibility is important to help prevent low back pain problems
and helps with functional daily movement. A sedentary child will most likely be inflexible and
lack full range of motion with various joints. Therefore, testing for this will provide the
programmer with valid information that can be used to increase flexibility and range of motion
for these children.
The first test to assess will be the modified sit and reach test or the modified back-saver
sit and reach test depending upon the client’s health and which he or she prefers to measure
hamstring flexibility. Both methods can be found in Appendix L. Both test are very similar with
each other, however, the back-saver version allows the untested knee to be bent at 90 degrees
flexion. This test is for individuals who have low flexibility and lower back problems because it
decreases the lower back pain and boost comfort. Regardless which test the client participates in,
there will be a 12-inch sit and reach box. To prepare for the test, the client will warm-up with a
18
Saulys, E.
few stretches and then the client will take the test. For the test, the client will reach forward as far
as possible and hold it for a second. The programmer will measure the distance between the ends
of the box to their finger tips which will be used to test their flexibility. This test is called the
finger to box distance and the client’s measurement will be recorded and compared to the
YMCA norm percentile rankings for classification (Appendix L-1).
Another method that the client will be asked to participate in is the goniometer to
measure range of motion (ROM) in various joints. The range of motion will be measured in
degrees and compared to ACSM’s norm of motion values for a healthy individual. Goniometer
must be used properly in order to get an accurate measurement (Appendix L-2) of a wide variety
of joints. The focus will be on the client’s shoulders, hips, knees, and elbows to ensure that the
whole body was tested. This method is quick and right to the point to assess flexibility in a
multitude of joints, which is crucial when working with inactive adolescence. During this
procedure the client will be comfortable at all cost and will rely on the programmer to do the
work. There will be a light conversation throughout this procedure to provide trust between the
client and the programmer and avoid awkwardness.
After the client as has gone through these flexibility tests, the client will be done with the
prescreening fitness assessment. The programmer will analyze all measurements and scores
before creating a program. Once the scores are analyzed the next step is to create a personalized,
safe, and effective program that is based on the client’s goals, interests, and current health status.
19
Saulys, E.
Sample Program:
All the information gathered from the initial meeting and the fitness assessment will be
used to create an exercise program that will meet the client’s needs. The individual will have the
program implemented into a daily schedule to guarantee the excuse of “lack of time” has been
prevented. The program will include the client’s likes, dislikes, wants, and gains from this
program.
The client’s program will include cardiovascular fitness, flexibility, resistive training, and
basic nutrition. For fat loss and fat-free mass gain it takes a minimum of eight weeks for this to
develop along with muscle hypertrophy. Therefore, the client’s program will undergo a sixteen
week exercise program divided into three phases. It is going to take time to make this program
part of a sedentary child’s lifestyle. The main focus of this program is to have the child become
physically active, reduce adiposity, and gain fat-free mass. Frequency will be the main variable
that is manipulated. The individual will start the program out at three times a week and will alter
in duration, slightly increasing as the individual gets familiar with physical activity. Over time
the frequency will increase and the duration will depend on the intensity level and remain
consistent. Intensity will increase depending on the client’s progress with the program. Since the
client is under the age of sixteen, the client will need transportation to the facility. The client will
come prepared to the program by wearing proper attire including shoes and comfortable clothing
along with a positive, motivated attitude.
Cardiovascular and Flexibility:
Cardiovascular exercise is aerobic exercise. Aerobic exercise is necessary and maintains
and increase cardiovascular endurance and fitness. Cardiovascular exercises provide many
20
Saulys, E.
benefits to the human health such as improving health status like bone and muscle mass and
reducing disease risks. Specifically, cardiovascular exercises help reduce the risks of
osteoporosis, reduce blood pressure, and prevent depression and anxiety along with other
negative emotional states. Aerobic exercise training should include a warm-up, endurance
conditioning, and a cool-down session.
Phase I: 4 Weeks:
To begin the program, the client will perform a warm-up. The importance of a warm-up
is to increase core temperature, range of motion, and blood flow to the working muscles to
produce energy. Participating in a warm-up will prevent the client from risk of injury due to
increase of muscle contraction and range of motion within the joints and prevent abnormal
cardiac rhythm. The client will perform one minute of jumping jacks following a minute and half
of walking at a low intensity (<40% of age predicted heart rate max – APHRM). The client will
repeat this twice in order to have a proper five minute warm-up. In order to find age predicted
max heart rate, the programmer will use the equation 208 minus .7 times age and then record it.
Exercise intensity will be based off of heart rate measurements. The client will be instructed on
how to take his or her heart rate through demonstration and verbal instruction. The client will
place his or her index and middle finger on his or her brachial place and count the beats for six
seconds. Then the client will take that number and multiply by ten to figure out how many beats
per minute. The value will determine if the individual needs to increase or decrease his or her
exercise intensity levels.
After the warm-up the client will take a few minutes to grab a drink of water and shake
out his or her muscles to loosen up large muscle groups. The client will take a couple of minutes
21
Saulys, E.
and participate in dynamic stretching. Dynamic stretching are active movements that bring out a
stretch, but not held in the end position (Appendix M). Therefore, this type of stretching will
ensure that the muscles are loose and prepared for the cardiovascular fitness conditioning.
When choosing an idea for setting up an aerobic exercise to reduce adiposity, it is best to
incorporate type 1 and type 2 activities. Type 1 activities involve minimal skill or physical
fitness such as walking, cycling, and aquatics aerobics. Type 2 activities require minimal skill,
but average physical fitness levels and involve more vigorous-intensity exercises such as
jogging, step aerobics, and spinning. A majority of this population comes from sedentary
lifestyles and has low physical fitness levels. It would be beneficial to start these clients out with
Type 1 aerobic exercises and work their way up to Type 2 aerobic exercises.
The endurance conditioning in phase I will start off by walking on a treadmill at a small
incline to allow the client to get comfortable and re-familiarize themselves with physical activity
and equipment. Walking involves minimal skill and low-intensity which makes it an easy
transition. Also, the client will incorporate jump rope during this phase. Jumping is easy and it is
a great way to increase bone mass. This population is at the ages of peak bone mass and as he or
she continues to grow his or her bone mass content will decrease. Therefore, involving jumping
into he or she’s program will help optimize bone mass content and help prevent early stages of
osteoporosis. The aerobic exercise is performed according to the aerobic prescription following
the FITT principle during the endurance conditioning phase. The duration of this phase is
dependent on the intensity (40-60% APHRM), but on average will be about 20-30 minutes long.
The client will participate in a 6 minute walking on an incline followed by 3 minutes of jump
rope with a minute and half rest. The client will repeat this two to three times depending on he or
22
Saulys, E.
she’s individualized program two times a week which will be on Monday and Wednesday. Since
the client is participating in a high mechanical load, it is important to involve a rest break
between the sets. The duration will increase as well as the frequency as the individual progress
through the phase to 20-30 minutes to three times a week going Monday, Wednesday, and Friday
by the end of phase I. Since the client wants to achieve basic health benefits, walking and
jumping will be a great way to burn adipose tissue while enhancing the cardiovascular system
and increasing he or she’s bone mass content. Most importantly, the cardiovascular exercise
prescription is to build up and maintain fitness. As a result, exploiting large muscle groups in a
continuous flow like walking and jumping will be best fit for the client. Also, walking and
jumping with a break in between the sets will allow the client to maintain constant exercise
intensity and not have to rely just on their skill. It is important for the client to participate in an
exercise that fits their needs. At the end of the phase the client will record his or her frequency,
intensity, time, and specificity in a chart found in Appendix M-1. This chart will be used for all
three phases so the client can see how he or she improved throughout this section.
Phase II: 8 weeks:
In phase II, the warm-up will consist of a minute in a half of jumping jacks followed by
two minutes of walking on the treadmill at the same intensity as phase I (<40% APHRM) and
will repeat two times. The same dynamic stretching routine from phase I will carry over to phase
II (Appendix M). During phase II, the client will continue to participate in walking and jump
rope, but the intensity, duration, and frequency will be changing. The client will walk on an
incline for 8 minutes followed by 5 minutes of jump rope with a 2 minute rest period and repeat
twice. By the end of phase I the client has walked for 20-30 minutes for three times a week at 4023
Saulys, E.
60% APHRM. Phase II will be focusing on changing the intensity to 45-65% APHRM
exercising for 30 minutes, three times a week during the first four weeks of phase II. Once the
first four weeks have past, the client will maintain the intensity at 45-65% APHRM, and increase
the duration up to 35 minutes along with adding another day per week which will result to four
days per week for the second half phase II. Adding another day will increase basic health
benefits and help the client reach optimal health benefits.
To measure intensity of endurance conditioning, a Rating of Perceived Exertion will be
used (Appendix M-2). By multiplying the rating of perceived exertion by ten will give a good
indication of heart rate since RPE and heart rate correspond with each other. For example, a
rating of 11 should predict a heart rate around 110 beats per minute. The main goal for phase II is
to have the client between 12-13 RPE. This will reassure the client and the programmer that the
client is working out at an appropriate and desired intensity. Another way to ensure the client is
working out at a significant intensity is the talk test. The client should not be able to carry on a
full conversation with the programmer at ease, but be able to speak no more than a sentence or
two. Once again, the client will record his or her FITS on the recording sheet (Appendix M-1).
Phase III: 4 weeks:
In phase III the client will continue to do jumping jacks followed by walking on the
treadmill for he or she’s warm-up, but the intensity will be bumped up to >45% APHRM and the
duration will be eight to ten minutes. Therefore, the client will participate in two minutes of
jumping jacks and three minutes of walking on the treadmill and repeat twice. The client should
feel comfortable with a slight increase because he or she have been performing just below that
24
Saulys, E.
for twelve weeks now. Following the warm-up, the client will continue to perform the same
dynamic stretching that was in phases I and II (Appendix M).
In phase III, the client has more variety on cardiovascular exercises. The client can
continue using the treadmill or use the elliptical machines, stair climbers, or stationary bikes
during their aerobic session. Within phase III, the intensity will be moved up to 50-70% APHRM
and the duration will be 35-40 minutes depending on which intensity level is chosen. The client
will participate in 10 minutes of walking on the treadmill or use of other aerobic machines
followed by 7 minutes of jump rope with two and half minute rest period between sets. The
client will repeat these two times to complete a 40 minute aerobic exercise session. However, the
frequency will stay the same at four days per week going Monday, Tuesday, Wednesday, and
Friday. It is good to have one day off between the four workout days instead of going four days
in a row to give the body rest from the mechanical load. By the end of this phase the client will
be able to see how he or she improved by looking at his or her chart that he or she has been
recording on at the end of each phase (Appendix M-1).
Cool Down:
After the cardiovascular conditioning has been finished, the client will undergo a cooldown immediately to prevent the risk of cardiovascular complications due to stopping exercise
suddenly. During the cool-down phase the client will continue exercising at a low intensity for
about five to 10 minutes. Performing a light activity after conditioning will result in lowering the
heart rate and blood pressure to return to near baseline levels. This will avoid the pooling of
blood in the extremities and the possibility of fainting. Cooling down is important because it
speeds up the recovery process for the individual.
25
Saulys, E.
After the cool-down, the client will perform static stretching to stretch their muscles
(Appendix M-3). Stretching is important because it increases flexibility. Flexibility is the ability
to move joints freely through range of motion without injury. Flexibility should be performed
every day. Static stretching will be used after the cool down because it involves stretching to the
farthest point and holding the stretch for 30 seconds to a minute each time. Static stretching has a
low risk of injury, pain, and resistance to stretch. This type of stretching is good to increase
flexibility and range of motion with the muscles already warmed up previously from the
endurance conditioning.
Resistive Training:
To begin, the client will perform a warm-up following a short session of dynamic
stretching. Once that is done, the client will participate in a basic resistive training program. Two
important components of resistive training are muscular endurance and muscular strength.
Muscular fitness is important to execute activities of daily living, to maintain functional
independence, and to par-take in leisure time activity without undue stress and fatigue. About
80% of Americans suffer lower back pain problems. Increasing muscular fitness levels will
prevent children from developing lower back problems, osteoporotic fractures, and
musculoskeletal injuries when they get older. Resistive training will help increase bone and
muscle mass. However, the client must perform proper technique to prevent the client from
injury. During the session, the client will have every exercise demonstrated before performing
the exercise his or her self.
26
Saulys, E.
Phase I: 4 weeks:
The resistive training program will have basic movements with pictures and instructions
following a recording sheet for the client to write down their progress at the end of each phase
(Appendix N-N1). Since this population is young and their bodies are immature it is important to
focus on the major muscle groups and multi joint exercises. For ages 10 through 14 it is
important to have 12 exercise sets per training session which can vary depending on the
individual. First the client will participate in a five minute walking warm-up on the treadmill to
get the blood flowing and warm up the body that will be exercised. A short warm-up will
improve the muscle’s ability to exert force during successive training sets. It is important to have
a warm-up before performing a high intensity work out and it is dangerous to not prepare the
body physiologically before a training session.
The client will participate in resistive training starting off twice a week on Tuesdays and
Thursdays. Since this population is not use to resistive training or any physical activity this type
of training will lead to muscle soreness. Therefore, it is important to have days of rests so the
body can relax and give the client time to adjust to the program. The program will include two
sets of six basic lifts focusing on the major muscle groups. The client will use dumbbells,
resistive machines, and their own bodily resistance. Since this population is young, most of the
lifting will be done using their own bodily resistance and resistive machines. It is important the
client lifts with full range of motion from a position of comfortable muscle stretch to a position
of complete muscle contraction. However, over the course of time they will be using low weights
of dumbbells. Using the resistive machines will allow the client to learn the motions of proper
lifting without coordination to stabilize body parts and maintain balance during free weights. The
27
Saulys, E.
machine will be adjusted to the individual’s body size. Prior to any lifting the client will perform
1 set of 8 repetitions with low weight as a warm-up. This is important because the body will go
through range of motion and develop the neuromuscular connections of how to perform the lift.
Then the client will perform 2 sets of 10 repetitions of a heavier load (50% 1-RM) for each of the
six exercises. Ten repetitions will allow the client build up muscular strength and muscular
hypertrophy. The client will spend two seconds in the concentric phase and three seconds in the
eccentric phase. Between each set the client will take a two minute rest break.
Phase II: 8 weeks:
In phase II of resistive training, the client will go from two days per week to three days
per week on Mondays, Wednesdays, and Fridays including endurance conditioning. A warm-up
will not be necessary because the client will finish up the endurance training prior to the resistive
training. Therefore, the muscles are warmed up and ready for training. During phase II, the client
will develop muscular gains and focus on overloading the body. Just like in phase I, the client
will perform 1 set of 8 repetitions of a light weight before each lift. The intensity for the
beginning of phase II will be the same as phase I which is 50% of 1-RM for the first two weeks
or until the client can do 15 repetitions at ease before increasing the intensity. At this rate, the
client will still use mostly machines and their body resistance. When the two weeks have pasts,
the client will increase the intensity by adding a weight load of 1 to 3 pounds of he or she’s
previous weight depending on their work ethic. The lasts four weeks of the program the client
will bump the intensity up to 55 to 60% 1-RM by adding another 1 to 3 pounds on he or she’s
previous weight load. Intensity will increase once the client can perform 15 repetitions easily
before adding on more weight. However, the client will still remain the frequency of three times
28
Saulys, E.
per week. The percentages are a basic idea, but every client is different so intensity may vary
depending on the individual. The goal for phase II is to progressively overload the body.
Phase III: 4 weeks:
The main focus in phase III will be increasing the intensity not the frequency. It is
important that the client stays committed and participates in resistive training three times per
week without skipping a day. It is important to have a day of rest between each session to
prevent injury and give the body a day to relax. The resistive training will take place on the same
days as the cardiovascular endurance training. This is to provide an efficient workout and the
client only has to stay after endurance training three times a week.
If at any time the client does not feel ready to increase the intensity, they can maintain at
the same intensity level in phase II until they feel ready to increase. Once the clients can perform
15 repetitions with proper form and at ease the intensity will increase to 65-70% of 1-RM. Since
this population consists of adolescents it is important to not exceed 70% of 1-RM to prevent any
damage of bone and joint development. Due to this population’s lifestyle, this is a beginner
program so the warm-up and lift will remain the same as in the two previous phases. However,
the client can suggests changes according to their wants and needs. On Tuesdays, there will be a
circuit training that will take place after endurance training if the client wishes to do so or feels
comfortable. Circuit training is a useful way to decrease boredom and give the clients a variety to
stay motivated. An information sheet will be given to the client to read over the significance of
circuit training and what types of movements are involved (Appendix N-2). During phase III, if
the client decides to participate in circuit training, Tuesdays will then consist of endurance
training and circuit training.
29
Saulys, E.
Cool Down:
Just like cardiovascular training, a cool-down will take place immediate afterwards. A
cool-down period after a workout will help the body recovery and bounce back. It will prevent
the client from delay onset muscle soreness. A cool down is important is to keep the body active
to help the flow of oxygen content throughout the body. Having the client do a cool-down will
help clear the lactic acid back into the blood when oxygen is converted back to pyruvic acid in
the muscle. By doing this will help the muscles recover more quickly. During the cool-down
phase, the client will continue to work out, but at a low intensity for about five to ten minutes.
This is important because it allows the heart rate and blood pressure to return to near baseline
levels, prevents the pooling of blood in the extremities, and prevents the risk of fainting. After
the cool-down the client will stretch his or her muscles by performing static stretching (Appendix
N-3). These types of stretches will relate to the major muscle groups that were performed in the
resistive training. For example, the client will perform a quadriceps, hamstring, chest, back,
abdominal, and shoulder stretches. Static stretching after a workout is important because it
increases flexibility and allows the client to reach as far as they can and hold the stretch. Static
stretching prevents lower back problems, risk of injury, and increase flexibility.
Nutrition:
For many of these children the diet transformation will have to come from both the
parents and the child. In this case, the parent’s are the major instigators on what their children
eat. Therefore, the parents need to be 100% committed to help their child succeed and get on
track. This transformation will take time just like exercise, but it takes dedication and
commitment in order to succeed. An exercise programmer can only provide the basics of
30
Saulys, E.
nutrition (Appendix O). If the client wishes to receive more in depth information, they will be
recommended to a certified dietician. It will be the child and the parent’s responsibility to contact
the dietician and follow the dietician’s food plan. Following up with a dietician will help the
family and the child to stay on track and follow a meal plan that is suitable to his or her needs in
order to accomplish their goals. The important thing is that the child sticks with their meal plan
after the exercise programming ends to reach the goal of a lifelong change and a transformation
into a healthy lifestyle.
The program that the client and the programmer have designed together includes all the
components of fitness which are body composition, cardiovascular endurance, muscular
endurance, muscular strength, and flexibility. The primary goal for this program is to help the
client reduce adipose tissue, increase fat-free mass, and become physically active in their daily
lives. Even though the program is complete, it is important to have a continuous follow up to
make sure the client is sticking with the program.
Additionally the client will be asked to change some of he or she behaviors by
incorporating incidental physical activity. For instance, instead of sitting on the couch and
changing channels the client will be advised to change the channels on the actual TV. Another
way to improve incidental activity will be to advise the parents to park further from the store and
take the stairs more than the elevator or escalator forcing the child to walk and do physical
activity without feeling pressured. Incidental physical activity is important because majority of
Americans live a sedentary life and do not even try to do some to minimal labor throughout a
normal day. By increasing incidental physical activity will help motivate the child and increase
basic health benefits.
31
Saulys, E.
Follow Up:
The program has finished and the client has received all valuable information to continue
exercising and have a healthy lifestyle. It is the client’s responsibility to be committed to the
program and work to their best ability. If at any given time the client is bored or wants to change
anything about the program, the client has the right to bring it up with the programmer and
discuss their wants and needs. The client will be encouraged to be self-motivated and turn the
exercise into a daily routine and a part of their life. The programmer will provide the client with
a lot of support during the exercises and throughout this journey of change in their lifestyle.
A meeting will be held at the beginning of each week on a Monday to go over the
previous week. At this meeting the client will discuss their strengths and weaknesses, likes and
dislikes, and their short term goals for the week. Together the client and the programmer will
look over the client’s recording sheet for cardiovascular endurance and resistive training to
discuss his or her progress (Appendices M-1 and N-1). This meeting is important to gain a trust
bond between the client and the programmer and also to maintain on the same page.
To ensure progress throughout the exercise program, each prescreening assessment that
was used to assess current fitness levels will be completed again at a four week increment to
keep track of progress in cardiovascular endurance, muscular endurance, muscular strength,
flexibility, and body composition. If there are any declines or lack of improvements with a
particular component of fitness, modifications will be made accordingly to the client’s
preference and needs in order to improve that area. For safety and effectiveness of the program,
there will be progress checks made for each component of fitness. The programmer will
supervise the client for the first month of the training to prevent or correct any bad technique and
32
Saulys, E.
then supervise upon request of the client. It is better to make something efficient earlier rather
than later because it will be dangerous for the client to get use to doing the wrong exercises
rather than doing the correct exercises. If the client is struggling with certain types of exercises,
there will be modifications made upon request of the client or if the programmer sees or feels
that is too much for the client. Progress checks will also be an indicator of increasing intensity,
frequency, and duration of specific parts of the program. However, to increase the intensity,
frequency, and duration is also dependent about the client and their readiness to improve. For
example, the frequency for lifting will increase to three days with more intensity added to each
of the exercises that are being performed. Throughout the whole training the client is encouraged
to ask questions, ask for supervision after the first month, and ask for any modifications if they
are struggling. It is important to have made sure the program is safe, effective, and pertains to the
client’s individual needs.
For the conclusion of the program, the client will have a final meeting with the
programmer. During this meeting the client will participate in their final prescreening fitness
assessment to check progress and compare results from when they first started the program.
Throughout this meeting, all the goals and objectives that the client completed during the entire
program will be discussed. The client will be asked to critique the program that was developed
together and the sessions. If by the end of the program the client does not feel comfortable
working out without guidance or with a partner, the programmer will continue to work with the
client for two to three weeks until the client is ready to take on the responsibility. Eventually, the
client will have to take on full responsibility for the workout. Recommendations will be made for
33
Saulys, E.
a personal trainer if the client insists. Also, the client will be asked to make a recommendation
for future clients for the programmer.
The main goal for this program is to provide a client with a new healthy lifestyle and
hopefully he or she will maintain these goals and lifestyle. The client will have all the
programmer’s information and full permission to contact the programmer with any questions
they might have in the near future. If the client does not call within in six to eight weeks after the
program, I will contact the client personally myself. If the client is doing well and maintains a
healthy lifestyle, there is no need for further contact unless the client has any questions or feels
necessary to contact the programmer.
34