Exercise Prescription Project:
An Approach to Decreasing a Client’s Risk of
Future Lower Back Problems
Tyler Burlingame
Client: Eric Sellitto
Health Promotion and Exercise Science:
Exercise Prescription
December 4, 2014
A. Introduction
According to Ehrlich (2012), a medical doctor and professor at the University of
Pennsylvania, “Low back pain is a leading cause of disability. It occurs in similar proportions in
all cultures, interferes with quality of life and work performance, and is the most common reason
for medical consultations.” Based on these facts, a person needs to begin early when it comes to
protecting their futures from lower back problems. Lower back problems are the leading cause of
medical leave in the work place and if a person does not begin to take precautions that prevent
lower back problems when they are young, they could potentially suffer the consequences when
they are older. My father is a maintenance mechanic for a company that makes and produces its
own sheet metal. This line of work is very intensive and demands long days of manual labor that
involve bending over and picking up machinery and parts that weigh fifty to one hundred pounds
regularly. Last fall at the age of 52, doctors performed a laminectomy on his lower back because
he was in such intense pain on a daily basis. “A laminectomy is the surgical uncovering of the
neural canal of the spine by excising one of more of the laminae of the vertebrae” (Chandler,
1951). A laminectomy is very common in his field and doctors even stated to him that sometimes
low back pain can be hereditary but it is a preventable injury.
In stating the above, my client, Eric Sellitto, has shown an interest in lowering his risk for
chronic low back pain in the near future. As we are all about to enter the working world within
the next few months, we will undergo changes throughout our daily lives that do not require us to
sit behind a desk and take notes any longer. We will be building careers and futures with
companies that may require us to perform manual labor on a daily basis. Eric is 22 years old and
plans to one day become a physical therapist and he understands that this is a hands on job and
will require him to be mobile daily and also require him to be able to teach clients certain
techniques that pertain to betting their health. Eric wants to practice what he preaches by
preventing low back pain in the near future and by avoiding having to undergo a laminectomy
like my father did last year.
In this department I have a lot of experience because ever since the doctor told my father
that low back pain is hereditary, I have been taking extra precautions to avoid these
circumstances in the future. Eric is a pretty physically fit kid and I will be prescribing a lot of
workouts that involve core strength training, flexibility exercises, upper back exercises, shoulder
exercises, neck exercises, and leg exercises. While prescribing this, I will be teaching Eric to use
proper form in all of these because bad form while exercising is another key reason as to why
lower back problems are so prevalent in today’s so society (Hoobler, 2013). Even things as
simple as picking something up off of the ground the proper way relates to low back pain. This
relates because if a person does not use proper form and continues to do this repeatedly, their
back is undergoing irregular movements that they are not used to and they could succumb to low
back pain over time.
B. Administer Tests
1. Demographics, BMI, % Body Fat, Skin Fold

Name: Eric Sellitto

Sports: Baseball at Rowan University

Age: 22

Gender: Male

Race: Caucasian

Height (in): 72 in

Height (cm): 183 cm

Weight (lb): 188 lb

Weight (kg): 85.3 kg

Resting Heart Rate: 64 Beats Per Minute

Blood Pressure (three tries):
o 120/81
o 120/79
o 120/80
o Average: 120/80

Skin Fold:
Location
Trial 1
Trial 2
Trial 3
Chest
12
12
11
Abdomen
13
11
12
Thigh
11
10
13
Average
12
11
12

Classification: Normal

% Body Fat: 11.7%

BMI:
o 188(703) / (72)(72)
o 132164 / 5184
o 25.5
o Classification: Slightly overweight according to the book

Client has large amount of muscle mass

At only 11.7% body fat, client is not overweight
Barriers to Physical Activity Collaboration
Eric scored fairly well on the barriers to being active quiz. The only score that was a
concern was the barrier pertaining to a lack of resources. When he and I spoke about this he
stated that getting to the gym was a problem for him. He lives twenty minutes from the closest
gym and he drives a truck that has a V8 in it that guzzles gas. He stated that between commuting
to college and work, he does not have the money to spend on gas that he wishes he had to get to
the gym. Then we spoke about utilizing Rowan’s gym during the days that he has to come to
classes. This way he would be killing two birds with one stone by only having to drive to school,
go to class, and then use the schools exercise facilities. He stated that it was a good idea.
All other barriers in this project were not a concern for Eric except the lack of time but he
stated he can always utilize his free time to become more active. I stated to him that it sounded
like a good idea.
2. Submaximal Cardiovascular Fitness Tests

Submaximal Treadmill Test
o Age: 22
o Gender: Male
o Stage 1: Pretest- RHR- 60, BP- 120/79, RPE-0
0:45: HR- 72, BP- 125/81, RPE- 6
1:30: HR- 80, BP- 131/83, RPE- 8
2:15: HR-84, BP- 133/83, RPE- 10\
3:00: HR- 88, BP- 134/82, RPE- 11
4:00: HR- 96, BP- 137/85, RPE- 13
o Stage 2: 4:45: HR- 100, BP- 140/88, RPE-15
5:30: HR- 120, BP- 143/90, RPE- 15
6:15: HR- 136, BP- 146/89, RPE- 16
7:00: HR- 152, BP- 149/91, RPE- 16
8:00: HR- 160, BP- 151/92, RPE- 17

VO2MAX= 15.5 + (21.8 x speed MPH) – (.327 x HR) – (.263 x speed
MPH x Age) + (.00504 x HR x Age) + (5.98 x gender)

VO2MAX= 15.5 + (21.8 x 3.5) – (.327 x 160) – (.236 x 3.5 x 22) +
(.00504 x 160 x 22) + (5.98 x 1)

VO2MAX= 15.5 + 76.3 – 52.32 – 18.172 + 17.74 + 5.98

VO2MAX= 45.03

Classification: Good

Astrand Submaximal Cycle Test
o Age: 22
o Gender: Male
o Pretest-
RHR- 60, BP- 120/81, RPE-0
1:00: HR- 74, BP- 127/81, RPE- 7
2:00: HR- 84, BP- 135/83, RPE- 8
3:00: HR- 87, BP- 136/81, RPE- 9
4:00: HR- 92, BP- 139/86, RPE- 12
5:00 HR- 102, BP- 144/93, RPE- 14
6:00 HR- 116, BP- 146/91, RPE- 15
7:00: HR- 124, BP- 144/90, RPE-15
8:00: HR- 136, BP- 153/91, RPE- 16
9:00: HR- 142, BP- 162/89, RPE- 17
10:00: HR- 152, BP- 168/95, RPE- 17
11:00: HR- 160, BP- 175/96, RPE- 18
12:00: HR- 162, BP- 178/92, RPE- 18
STAGES
POWER
HEART RATE
BLOOD PRESSURE
Stage 1
50
87
136/81
Stage 2
100
116
146/91
Stage 3
150
142
162/89
Stage 4
200
162
178/92
o Pmax (W): 200
o VO2MAX= (10.6 x Pmax / Weight) +7
o VO2MAX= (20.6 x 200 / 85.3) + 7
o VO2MAX= 55.3
o Classification: Excellent

One Mile Walk Test
o Male
o 188 lbs
o 15:36 Minutes (.26 of hour)
o HR: 152

VO2MAX= 132.853 - (0.0769 × Weight) - (0.3877 × Age) + (6.315 ×
Gender) - (3.2649 × Time) - (0.1565 × Heart rate)

VO2MAX= 132.853 - (0.0769 × 188) - (0.3877 × 22) + (6.315 × 1) (3.2649 × 15.36) - (0.1565 × 140)


VO2MAX= 132.853 – 14.46 – 8.53 + 6.315 – 50.15 – 23.788

VO2MAX= 42.24

Classification: Good
Aerobic Step Test
o Male
o 24 Steps per minute
o Metronome Setting: 96
o HR at end: 136 BPM
o 3 Minutes

VO2MAX= 111.33 – (.42 x HR)

VO2MAX= 111.33 – (.42 x 136)

VO2MAX= 54.21

Classification: Excellent
Comparison of Results
Test
VO2MAX
Classification
Submaximal Treadmill Test
45.03
Good
Astrand Submaximal Cycle Test
55.3
Superior
One Mile Walk Test
42.24
Good
Aerobic Step Test
54.21
Superior
I was extremely surprised with how physically fit Eric appeared to be when comparing
these test results. In the Submaximal Treadmill testing as well as the One Mile Walk Test, Eric
was in the category of Good when it came to comparing his results. In the Aerobic Step Test and
the Astrand Cycle Test, Eric scored even better with the categorization of Superior. I believe that
he scored Superior in these two categories because Eric stated that he does a lot of bike riding as
well as Plyometric workouts, which explains why he would do so well on the Aerobic Step Test.
3. Exercise Heart Rate for 60% and 85%

220-Age = MHR

220-22 = 198

MHR= 198

MHR x % of HR= THR

198 x .60= 60% of MHR

119 = 60% of MHR

MHR x % of HR= THR

198 x .85= 85% of MHR

168 = 85% of MHR
60 % of MHR
85% of MHR
119 BPM
168 BPM
Eric has a max heart rate of 198 beats per minute. If his target heart rate is 60% he will be
at 119 beats per minute and if it is 85% he will be at 168 beats per minute.
4. Functional Needs Assessment
During the Overhead Squat Impairments test, Eric did very well. As I assessed him from
all three views, I only noticed one impairment and that was during the lateral view of the
assessment. The impairment that I noticed was excessive lordosis of the spine, which causes the
Erector Spinae, Hip Flexor Complex, and Latissimus Dorsi to be overactive and the Anterior
Core, Hamstrings, and Gluteus Maximus to be underactive (Biren & Biren, 2011).
In this instance, I would have Eric really focus on his form while squatting as well as
focusing on his core as well. Excessive Lordosis could mean that Eric has not been focusing on
training his Core, Hamstrings, and Gluteus Maximus enough and these will be places that we
need to start strengthening. Low back problems have a lot to do with posture and judging by
Eric’s other portions of the Squat Assessment he is in good shape. Some sample exercises that
we will use to fix this problem will be a lot of lower back extensions and crunches as well as
squats and leg press to focus on his Hamstrings and Gluteus Maximus.
5. Muscular Strength
Bench Press 1 RM
215 x 10 reps

1 RM= (weight lifted x reps x 0.033) + weight lifted

1 RM= (215 x 10 x 0.033) + 215

1 RM= 70.95 + 215

1 RM= 286
Leg Press 1 RM
325 x 10 reps

1 RM= (weight lifted x reps x 0.033) + weight lifted

1 RM= (325 x 10 x 0.033) + 325

1 RM= 107 + 325

1 RM= 432
In both categories, Eric scored above average for his muscular strength for a male that is 72
inches tall and 188 pounds. He showed excellent for and also showed a lot of drive and power
when doing these reps. One thing he needs to work on is keeping his butt down when he bench
presses during his final couple of repetitions. This is where he needs to call me in and utilize his
spotter so that we can avoid injury.
6. Muscular Endurance
Classification
Push Ups (1 minute)
Crunches (1 minute)
46
56
Good
Good
After evaluating Eric’s results, he scored in the category of Good in the Muscular
Endurance testing. During his push up and crunch test he displayed really nice form and also
placed in the second highest category.
7. Flexibility

Sit and Reach Test (3 tries)
Trial 1
Trial 2
Trial 3
30 cm
32 cm
31 cm
o Classification: Average

Apley’s Scratch Test
o Eric displayed normal shoulder internal rotation and external rotation during this
assessment and also could touch his fingertips together on both sides.

Straight Leg Raise Test
o Eric showed excellent flexibility during the straight leg raise assessment with not
much limitation.

Thomas Test
o Eric did not show any contralateral leg rises or any moves laterally; excellent.
8. Balance Tests

Stork Balance Tests
o Left Leg:

22 seconds

26 seconds

33 seconds
o Right Leg:

35 seconds

34 seconds

36 seconds
Left Leg
22 sec.
26 sec.
Right Leg
33 sec
35 sec.
34 sec.
36 sec.
I gave Eric three tires on each foot to complete the balance testing. Ultimately, Eric
scored within the 50th percentile in this area. This is average, but the stork test isn’t an easy task
to do regardless of the classification of the grades. Eric’s dominant side of his body is his right
side so naturally his right side did better than his left.
9. Muscular Power

Vertical Jump Test
Trial 1
Trial 2
Trial 3
Average
53 cm
56 cm
57 cm*
55.3
*Best Score (used for power and rating)
o Peak Power (W) = [51.9 x ht (cm)] + [48.9 x BM (kg)] – 2007
o Peak Power (W) = [51.9 x 57] + [48.9 x 85.3] -2007
o Peak Power (W) = 2958.3 + 4171.17 – 2007
o Peak Power (W) = 5122.47
o Peak Power Rating: Above Average
o Vertical Jump Height Rating: Average
Eric did very well for a kid that has played baseball his whole life without ever playing a
sport such as basketball that involves a lot of explosive movements. Granted, baseball does
involve a lot of explosive movements but he states that he was a pitcher, and also did not do
much when it came to power training. He scored in the Above average range in the peak power
rating and average in the height (cm) rating. His peak power was above average because of his
weight in correspondence with his height.
10. Anaerobic Stepping Test

Anaerobic Stepping Test
o Bench height: 15.75 in
o Steps until failure; each leg.
Right Leg
43 steps
Left Leg
39 steps
Eric did each leg for this step test until failure. His right leg, or dominant leg, did four
more steps than his left leg. He finished at 43 steps with his right and 39 steps with his left. This
is a fairly high amount of steps for both legs but the classification chart was not attainable for me
during this test. He began fatiguing on his right leg at around 26 steps and began fatiguing on his
left leg at around 30 steps which was odd because he finished stronger with his right leg. I then
began to think that this was like this because his right leg is dominant and also can activate type
II muscle fibers faster and more abundantly than his left leg because it is more active.
11. Agility Test

Semo Agility Test
o I explained this test to Eric and then had him perform it two times at a slow speed
and then three times at max speed with three minute rest in between each set.
o Results
Trial 1
Trial 2
Trial 3
12.5 seconds
10.9 seconds*
11.5 seconds
*Best Time
Eric performed this test three times and I was impressed. He stated that they used to do
this for baseball during the off season so he knew what he was doing and had really good
mechanics when performing this. His best time was 10.9 seconds and this places him in about the
80th percentile. This was pretty impressive and he did everything up to correctly.
C.Conclusion
In conclusion of my paper, Eric is ready to begin in training program. Eric is extremely
healthy and as a former athlete he is ready to train and high intensity levels if need be but more
importantly he is ready to begin preparing for his future by practicing exercises that will allow
him to grow old without having to worry about back pain.
In summarizing Eric’s results, he is a 22 year old Caucasian male that weighs 188
pounds. After having him fill out my informed consent form, medical history review, and other
various tests, I began doing his demographical assessment as well his other assessments
pertaining to his fat percentage and body mass index. He has played baseball his whole life and
even went on to play at the collegiate level at both Gloucester County College and Rowan
University. He has a body mass index of 25.5, which equals out to be overweight but we are also
failing to recognize that he is muscular and one pound of muscle is heavier than one pound of fat
as we all know. He has a resting blood pressure of 120/80 and also has a resting heart rate of
sixty four beats per minute while only having 11.7% body fat as indicated by administrating a
skin fold test on him.
Aside from the demographics, Eric scored very well on all of the submaximal
cardiovascular fitness tests. During the Submaximal treadmill test and one mile walk test he was
categorized as good for his age group and for the Astrand submaximal cycle test and the aerobic
step test Eric scored in the Superior category. This was shocking because I didn’t think that he
would be in this good of shape being out of baseball for almost a full year now (played for years
of collegiate baseball and is no longer eligible. After adding all of his scores up and averaging
them together Eric has a VO2MAX of 49.2 which places him in the Excellent category overall.
This tells me that Eric practices cardiovascular fitness regularly and that is why his results do not
surprise me that much. Also, Eric’s heart rate at 60% of his max heart rate is 119 beats per
minutes and at 85% is 168 beats per minute.
During Eric’s functional needs assessment I noticed that he had excessive lordosis during
the overhead squat assessment. After figuring out which muscles were overactive and
underactive I began a plan to begin developing these muscles to make them stronger for the
future. Eric also scored above average on his one repetition maximum tests. During these tests,
we found out that he has a maximum bench press of 286 and a maximum squat of 432. In regards
to his muscles, he also scored well in the muscular endurance category; he scored “good” in both
of these and also helped me to have an understanding of what types of exercises I would like to
begin him with when we began our training program.
The next assessments were balance and flexibility. I performed the stork balance test on
Eric and he did not do too badly but it is also an area that could use some work. Eric scored in
the 50th percentile during this assessment and his right leg (dominant leg) was able to maintain
balance longer than his right leg almost every time. Flexibility may be one thing that Eric lacks
and could be something that will overall one day lead to him having lower back problems. This
is something we will need to focus on during our sessions together. His upper body flexibility
was pretty good but he struggled a bit during the sit and reach assessment and fell into the
average category. Though this is not bad, it very well can be better and he explained that he
knows flexibility is something that he lacks.
The last tests we did dealt with muscular power, anaerobic power, and agility. Eric did
well with all of these assessments and allowed me to perform all of them on him with no
limitations. During the vertical jump test, we found that his peak power was ranked above
average and his jump height (cm) was ranked just average. This was found out by comparing his
weight and the height he jumped in a scientific formula. The next assessment was the anaerobic
stepping test in which Eric did 43 steps with his right leg and 39 with his left leg. This was a fair
scoring and he did better with his dominant leg which was expected. The last assessment I
performed was the Semo Agility Test in which Eric did really well on because he has done and
practiced this before. His best score was a 10.9 seconds which put him in the 80th percentile. He
was pleased in finding this out.
Overall Eric was a very easy client to work with because there was not much that he
couldn’t do and also there were not any restraints on the tests that we could do. In prescribing
Eric a workout plan that would overall help him avoid lower back problems in the future, I began
by giving him proper instructions and form on some of his favorite exercises. I have a buddy
who is only twenty six years old and has back problems because he was lifting heavy weight
without using proper form. This is the primary thing that I want Eric to focus on and it will also
help him in the long run. As well as emphasizing proper form, I also taught Eric the proper way
to pick up things on a daily basis whether they are heavy or not. I taught him not to bend down
with your lower back but to lower your level by bending your knees. This may not seem like
much but in the long run can help a lot.
Exercises that I prescribed Eric pertain to flexibility, core training, and cardiovascular
training. A lot of people believe that cardiovascular training is just good for a person’s heart but
in reality it is really good for a person’s core as well. I would prescribe him a running program
that involved cardiovascular fitness four to five days a week (based on his test results) for at least
an hour a day. I would then prescribe to him a serious of core exercises such as planks, sit ups,
cable crunches, reverse crunches, etc. I would ask that he did these three days a week with at
least twenty four hours of rest in between each. I would ask that he would super set 5 core
exercises of his choice and do it for five sets. The twenty four hours of rest is crucial for this as
well because people do not understand that your core is a muscle just like any other one and a
person needs to rest their core just as much as any other muscle group. I would then prescribe to
Eric a series of static stretches for him to do at the end of each workout. He stated that he rarely
stretches after a workout and that is why I am guessing that his flexibility is poor. I would utilize
stretches that utilized his hip flexors, hamstrings, gluteus maximus, and gluteus medius but
would also prescribe some upper body exercises as well do that they do not offset each other by
one being loser than the other.
Eric was a great client to work with throughout this project and he is a very athletic
person. We both as a whole learned a lot about ourselves during this project and also a lot about
how good of shape we are in and how well we can both utilize our exercise capabilities. It made
me happy to see him excited at the end of each test to see what his results would be. I for one
was not expecting him to be in as good of shape as he was because I always looked at baseball
(even though I played my whole life) as a sport that required too much physical activity. This
could also be because I wrestled for four years at Paulsboro High School and nothing compared
to the beating that we got at practice every day. Overall, this was a very interesting project and I
enjoyed doing it for the most part.
References
Biren, G., & Biren, B. (2011). Exercise Prescription. Deer Park, NY: Linus Publications
Chandler, F. A. (1951). Laminectomy. The American Journal of Nursing. 51(3), 156-157.
Ehrlich, G. E. (2012). Low back pain. World Health Organization.Bulletin of the World Health
Organization, 81(9), 671-6.
Hoobler, C. (2013, Mar 27). Proper form crucial in exercise therapy. The Oregonian
Katch, V. L., McArdle, W. D., Katch, F. I., & McArdle, W. D. (2011). Essentials of exercise
physiology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.