SD-SES 02
CA2
The client is an 18 year old student who does rock climbing actively. His goal is weight
loss, because he feels he is too heavy and that has affected his performance in rock
climbing.
Pre-exercise Test
The client’s Health History Questionnaire (Appendix B) indicates that he does not have
any past or present health problems or physical impairments. His family is also free from
health problems and therefore rules out the possibility of any hereditary health issues.
Considered together with his PAR-Q (Appendix A), the client is suitable for physical
activities without the prior need for a doctor’s assessment and approval.
His CVD Risk Stratification Questionnaire (Appendix C) however, categorizes the client
as having moderate risk level according to ACSM’s guidelines (Swain & Leutholtz,
2007). He has 2 risk factor as shown in Appendix C indicated by items with the “+” sign
in the last column. There is no information regarding the client’s cholesterol and fasting
glucose level and therefore left as non-contributing factors. The 2 risk factors are
smoking, and a BMI of 25.5 kg/m2. His BMI is considered of moderate risk if based on
the Asian’s recommendations (BMI Calculator, n.d.). Further body composition tests
using a body impedance analyzer indicates that his body fat percentage to be at 19.8%
which has exceeded the upper limit of 15% for adults who are physically active
(Heyward, 2006). This confirms that the client is overweight despite his stocky frame,
standing broad jump station during his yearly NAPFA test. His NAPFA record is
retrieved (Appendix D-1) and compared to the NAPFA standards (Appendix D-2). The
client passes all stations except the standing broad jump. His excellent pass in the shuttle
run station reduces the possibility that his failure in standing broad jump is caused by a
Goals
The client agreed to include an additional goal of improving his standing broad jump
results on top of his weight loss goal. The reasons for recommending an additional goal
were: firstly, the client has to serve national service and the standing broad jump is one of
the compulsory test stations in national service’s fitness test (IPPT). Secondly, standing
broad jump is an assessment of the muscular power of the legs (Hoffman, 2006).
Improving the client’s muscular power will help increase if not maintain his fat free mass
and therefore help to reduce his body fat percentage (Heyward, 2006).
Weight Loss
The exact amount of weight loss is calculated and detailed in the following table:
recommends that the rate of weight loss should be between approximately 0.5 to 0.9 kg
per week (Jakicic et al, 2001). Heyward (2006) recommends that weight loss should be
gradual. Therefore, based on the guidelines, the client should achieve his target weight in
about 4 to 7 weeks.
The client needs only 2cm more to pass in the NAPFA test. However a higher target of
performance grade “D” is set. For a “D” performance grade, the client needs to improve
his standing broad jump by 12cm or more. A resistance training program is prescribed to
Skeletal muscles of the lower body adapt to resistance training between 4 to 6 weeks
(Staron et al, 1994). However, the amount of improvements varies between individuals.
Goals Summary
Assessments
The client read and signed the Informed Consent Form for Physical Test (Appendix E)
considering he gets at least 30 min of physical activity most days of the week (based on
his CVD questionnaire, Appendix C) and achieved a performance grade of “D” for his
2.4km run-walk station in his NAPFA test (Appendix D), cardiovascular exercises will
nevertheless be prescribed in his weight loss program because the aerobics form of
exercise provides the best factors for maximizing caloric expenditure (Heyward, 2006).
Therefore there is a need to assess his cardiovascular fitness. Because of his moderate
risk level according to the CVD risk stratification, a submaximal test is administered to
determine his VO2max level (Heyward, 2006). The Bruce submaximal treadmill test is
selected because the client is familiar with the exercise (walking/running) he is required
The record of the client’s test can be found in appendix F-1. The following table is
bpm
HR2 121
HR3 152
km/h m/min %
S2 4 66.67 G1 12 0.12
S3 5.5 91.67 G2 14 0.14
mL/(kg.min)
SM2 24.56772
SM3 35.76784
b 0.361294194
mL/(kg.min)
VO2max 53.83254968 METS 15.38073
The client’s cardiovascular fitness is in the “Excellent” range when compared against the
closest age group in the norms table produced by The Physical Fitness Specialist Manual
(Appendix F-2). This supports the earlier stand that improving his cardiovascular fitness
is not priority and any aerobics exercise prescribed should focused on enhancing weight
loss.
The exercises selected for assessments are squats and calf-raises. The squat with barbell
exercise is selected because there is a strong correlation between 1-RM squat strength
and the performance of standing broad jump (Koch et al, 2003). The calf-raise with
barbell exercise is selected because the contributions to a standing broad jump propulsion
by the muscles moving the hip, knee, and ankle joints are 45.9%, 3.9%, and 50.2%
respectively (Robertson & Fleming, 1987). This shows that the calf muscle plays an
important part in the performance of standing broad jump since the calf muscles move the
ankle joints.
The submaximal muscle endurance test method is employed to estimate the client’s 1-
employed because the client has little experience in both lifting exercises and may be
uncomfortable in performing the 1-RM maximal test, where he would be required to lift
very heavy loads (Heyward, 2006). The record of the client’s squat and calf-raise lifts
The Wathan formula is used to estimate the client’s 1-RM because it yields the most
accurate prediction for squats (LeSuer et al, 1997). His 1-RM for squats is predicted to be
approximately 87kg, whereas his calf-raises 92kg (1-RM Calculator, n.d.). Expressed as
1-RM to body mass ratio, the client scores 1.35 for squats and 1.43 for calf-raises.
The client’s 1-RM to body mass ratio for squats is considered poor when compared
against the closest age group in the norms table for relative squat strength shown in
appendix G-2 (Hoffman, 2006). No norms data could be found for calf-raise. Regardless,
the resistance program designed to improve the client’s standing broad jump results
The most recommended weight loss program is based on the simple concept of caloric
intake vs. caloric expenditure (Heyward, 2006) and will therefore be employed for this
client. To calculate the client’s caloric intake, the client needs to keep a record of his food
consumption for the past 3 to 7 days (Heyward, 2006). To calculate his caloric
expenditure, it is necessary to estimate the activity level based on the activities the client
Caloric Intake
The client’s food intake record can be found in appendix H. Based on the record, the
client takes 4 meals a day and has quite a normal food selection with a slight aversion to
vegetables. He takes his meals on regular timing and does not skip meals. The only
problem is his habit of taking sandwiches with mayonnaise and cheese for supper.
Mayonnaise has very high fat content. In fact, 99% of its calorie comes from fat.
Using the data recorded by the client, his average caloric intake per day is calculated to
be approximately 2817 kcal (Energy and Nutrient Composition of Foods, n.d.; Nutrition
Data, n.d.).
Caloric Expenditure
There are many different formulas to calculate the daily caloric expenditure or TEE
(Total Energy Expenditure). Most of them require the estimation of the client’s PAL
(Physical Activity Level). The following table template (Gerrior et al, 2006) calculates an
estimate of the client’s PAL and TEE by filling in the daily activities and their
The client’s daily activities and their estimated durations are recorded through a client
interview. The METs value for each activity is referenced from Appendix E.4 in
Heyward (2006). Two TEE values were calculated: one for a day the client has rock
climbing training and another for a day that he does not. The average daily energy
expenditure of the client over 1 week is approximately (3334 * 3 + 2407 * 4)/7 = 2804
kcal.
BEE indicates basal energy expenditure; METs, metabolic equivalents; PAL, physical activity level; PA, physical activity coefficient; TEE, total energy expenditure.
1
Activity: activities performed in the past 24 hours
2
Duration: length of each activity performed
3
ΔPAL: physical activity impacts on energy expenditure
The PAL average over 1 week is estimated at ((2.46 * 3) + (1.38 *4)) / 7 = 1.84. This
PAL average is used in another TEE estimation formula provided by the Institute of
Medicine (Heyward, 2006) and yields a TEE of 2953 kcal per day. The table below is
created to calculate the TEE using the formula provided by the Institute of Medicine.
TEE Calculation
Age (yr) 18
Ht (m) 1.59
Wt (kg) 64.5
PAL 1.8 PA 1.26
TEE (kcal/day) 2953.28
Institute of Medicine Formula (Heyward, 2006)
The TEE values estimated using the 2 formulas do not differ by much and therefore
acceptable to assume the average of these 2 values (2878 kcal) to be the client’s daily
TEE.
Energy Balance
The estimated TEE differs very little from the average daily caloric intake. Given that
these values are estimates, it is safe to regard that the client experiences energy balance
provided he engages in rock climbing activities 3 times a week. This implies that any
additional physical activities that the client performs will lead to a negative energy
Type
Running is selected for the following reasons: firstly, the client is familiar with the
exercise. Secondly, the client already engages in rock climbing, which is primarily
anaerobic, for 3 days per week. The client will furthermore, participate in an additional
resistance program designed to improve his standing broad jump. Introducing aerobics
exercise will add variety into his weekly physical activities. Thirdly, aerobic exercise of
light to moderate intensities allows one to perform it for a long duration of time and as a
result, expend more energy to achieve a negative energy balance necessary for weight
loss (Heyward, 2006). And fourthly, the introduction of aerobic exercises will help
Frequency
The frequency of exercise in this program is 3 days/week and does not seem to fulfill the
(Jakicic et al, 2001). However, the client has rock climbing training on 3 other days
(Mon, Wed, Fri) of the week. If a higher frequency is prescribed, the client may
Intensity
The translation of intensity classification to % VO2R is based on data from Pollock et al,
1998 (Heyward, 2006). Basically, light intensity translates to 20-39% VO2R whereas
runs without a heart rate monitor, as the client does not own one. These RPE values are
derived by referencing the target HR values in the training log against the HR and
corresponding RPE the client experiences when performing the Bruce Submaximal
Duration
Duration of each run is calculated based on the target VO2R level, which directly affects
the speed of the run, and the distance of the route. The distance of the route is determined
by a number of rounds around the school campus or a park near the client’s home. The
route starts and ends at the same point, which makes the effective grade of the route 0%.
Energy Expenditure
As this is a weight loss program training log, the estimated average energy expenditure
per session is also included in the training log to facilitate the calculation of energy
deficit and the timeline for the completion of this program. The total energy expenditure
Diet
A weight loss program is more effective if suitable dieting is included (Heyward, 2006).
The supper component of bread with mayonnaise and cheese is removed from the client’s
diet, especially since mayonnaise is 99% fat. As a result, his average daily calorie
consumption reduces by 462 kcal (Nutrition Data, n.d.). Over a week, his calorie
~0.64 kg/week
As shown in the table above, the client should be able to achieve his target weight in 7
weeks by exercising according to the training log and revising his diet as recommended
above. This weight loss program follows the recommendation made by ACSM (Jakicic et
Evaluation
After the program is completed after 7 weeks, the client will be assessed again on his
body weight and body composition using the same tests mentioned above in the
Assessment section. If the target weight loss is achieved, the client will move on to the
However, if the target weight loss is not achieved, the client will be interviewed again to
find out if he has followed the training log and diet revision correctly, or if he has
encountered any problems in following the program. If there are no problems with these
factors, the whole process of assessment shall be repeated and another weight loss
In order to correctly advise the client on maintaining his weight loss, his TEE needs to be
recalculated again because his body weight and fat free mass will now be different after
the loss of weight. Generally, the client can choose to reduce the frequency of the runs, or
resume taking supper but on healthier food choices, or a combination of both. The most
important factor is that energy balance must be met using his new TEE.
ACSM also recommends a weekly energy expenditure of 2000 kcal for effective weight
maintenance (Jakicic et al, 2001). However, the client meets this recommendation easily
even if he stops the running sessions altogether because of his regular engagement in rock
Warm up and Cool down
The client is instructed on how to perform the warm up and cool down exercises before
and after a run. Warm up exercises consist of dynamic and light static stretches on the
muscles used during running. These include, and not restricted to, the calves, hamstrings,
quadriceps, gluteals, transversus abdominis and deltoids. Cool down exercises consist of
A resistance training that comprises of squat and calf-raise exercises with barbell is
employed to improve the lower body muscular strength and power of the client in order
Training Log
Type
As mentioned earlier, the squat exercise is selected because there is a strong correlation
between 1-RM squat strength and the performance of standing broad jump (Koch et al,
2003). The calf-raise exercise is selected because calf muscles contribute the most during
the propulsion phase of standing broad jump (Robertson & Fleming, 1987). Applying the
principle of specificity, improving the muscular strength and power of these 2 muscle
The squat exercise is selected over seated leg extension because it is closed kinetic chain,
whereas the seated leg extension is open kinetic chain. Close kinetic chain exercises have
joint movements (Closed kinetic chain exercises, n.d.). The calf-raise exercise is also
Free weights are preferred over machine weights as it provides the added advantage of
excising the minor stabilizer muscles which are required during standing broad jump and
The squats should be done first before the calf-raises because the quadriceps is bigger
than the calf muscles. Moreover, the squats exercise is a multi-joint exercise, whereas the
Frequency
The frequency of exercise is twice a week as recommended by Heyward (2006) for the
prevent injury from overtraining. The exercises are therefore scheduled on Tuesdays and
Thursdays. Furthermore, they are rest days in the client’s rock climbing schedule
therefore ensuring there will be no clashes between the 2 training schedules. Tuesdays
and Thursdays are also school days, meaning he will have access to the school’s gym
Intensity
Since the standing broad jump is an assessment of muscular power (Hoffman, 2006), the
program work on the power improvement of the involved muscles. Heyward (2006)
recommends resistance intensities of over 80% 1-RM for power gains. Of the 3
microcycles prescribed for both exercises in this program, two of them have intensities
above 80% 1-RM. The third microcycle has a lower resistance intensity of 70% 1-RM to
provide some rest to the worked muscles and to reduce the risk of injury.
In fact, the training program employs the undulating periodization model to maximize
response of the neuromuscular system (in this case, strength and power gains) and to
minimize overtraining and injury (Heyward, 2006). The undulating periodization model
developing strength gains in young men who train under duration and frequency similar
Volume
The volume varies in inverse correlation with the resistance intensities following
periodization principles. Lower volume is prescribed for higher intensity and vice-versa.
Data from Baechle, Earle and Wathen (2000) is used to provide some gauge on the
absolute number of reps that can be prescribed to each of the microcycle intensities since
they are all above 75% 1-RM in this training program. However, the volume still needs to
be adjusted according to the client’s ability to perform the exercises in correct form and
posture. For example, only 2 sets are prescribed for squats using intensity of 80 kg as it is
general, 3-6 reps for sets devised for power gains, and 8-12 reps for sets devised for
strength gains.
Rest Period
The rest period between sets lasts 5 minutes for sets of intensities above 80% 1-RM, 3
minutes for sets of intensities 70% 1-RM. Longer rests are required for heavier intensities
Progression
Upon the completion of the above 12-week program, the client is assessed again on his
standing broad jump. If the goal of “D” performance grade is achieved, the client can
move on to the maintenance phase. If the goal is not achieved but improvement is
witnessed, the client will be assessed on his squat and calf-raise 1-RM again. Using the
new 1-RM values, which should be better than the previous ones, a new 12-week training
log will be devised. The absolute intensities of each microcycle in the new training log
should be higher, but the other factors (periodization, frequency, etc) will be kept the
Maintenance
Based on the reversibility principle, the client may lose the muscular improvements if
detraining is experienced. If the client stays physically active and participates regularly in
sports or games that require jumping or sprinting, it should take a long time for detraining
to occur. If detraining does occur, the client will just need to devise a new training
program following the same principles described above. However, faster improvements
would be expected because of the muscle memory principle (Muscle Memory, n.d.).
Warm up and Cool down
The client is instructed on how to perform the warm up and cool down exercises before
and after performing the resistance exercises. Warm up exercises consist of dynamic
stretches of the muscles involved in the resistance exercise. It is important to move the
joints involved through their full range of movements. A set or two of the same resistance
exercise with zero intensity is recommended. Cool down exercises consist of static
Conclusion
The client is prescribed an exercise program designed to achieve weight loss and another
to improve his standing broad jump performance. Both programs are devised such that
they can fit into his existing schedules with as little clashes as possible. For the weight
loss program, running at low to moderate intensities is selected to maximize his energy
expenditure on days that the client does not have rock climbing training. His diet is also
adjusted as effective weight loss programs consist of both dieting and exercise
components.
As for the resistance program, multi-joint and closed kinetic chain exercises using free
weights are employed. The focus is on power and strength gain as standing broad jump is
reduce the likelihood of injuries. However, periodization makes the training program
complicated. Therefore the training log is important and the client should adhere closely
to its schedule.
Educating the client on the purpose and principles behind the training programs is
important so that the client can understand better the need to adhere to the training logs
and not to modify the logs himself. Educating the client on the importance of warm-up
and cool-down exercise will also help him to reduce the likelihood of injuries.
On the whole, devising an effective exercise prescription can be a complex process that
trainer should consult a physician or nutritionist if he/she has any doubts, if the case is
complex, or if the client does not meet the risk stratification/health history requirements.
Robertson, D.G., Fleming, D. (1987). Kinetics of standing broad and vertical jumping.
Can J Sport Sci., 12(1):19-23.
Koch, A.J., O'Bryant, H.S., Stone, M.E., Sanborn, K., Proulx, C., Hruby, J.,
Shannonhouse, E., Boros, R., Stone, M.H. (2003). Effect of warm-up on the standing
broad jump in trained and untrained men and women. J Strength Cond Res., 17(4):710-4.
LeSuer, D.A., McCormick, J.H., Mayhew, J.L., Wasserstein, R.L., Arnold, M.D. (1997).
The Accuracy of Prediction Equations for Esitmating 1-RM Performance in the Bench
Press, Squat, and Deadlift. Journal of Strength and Conditioning Research, (4), 211-213
Swain, D. P., & Leutholtz, B. C. (2007). Exercise prescription: a case study approach to
the ACSM guidelines. USA: Human Kinetics.
Jakicic, J.M., Clark, K., Coleman, E., Donnelly, J.E., Foreyt, J., Melanson, E., Volek, J.,
Volpe, S.L. (2001). ACSM Position Stand on the Appropriate Intervention Strategies for
Weight Loss and Prevention of Weight Regain for Adults. Med. Sci. Sports Exerc., Vol.
33, No. 12, 2001, pp. 2145–2156.
Staron, R.S., Karapondo, D.L., Kraemer, W.J., Fry, A.C., Gordon, S.E., Falkel, J.E.,
Hagerman, F.C., Hikida, R.S. (1994). Skeletal muscle adaptations during early phase of
heavy-resistance training in men and women. Journal of Applied Physiology, Vol 76,
Issue 3 1247-1255
Hoffman, J. (2006). Norms for fitness, performance, and health. Human Kinetics: USA
Gerrior, S., Juan, W.Y., Peter, B. (2006). An Easy Approach to Calculating Estimated
Energy Requirements. Prev Chronic Dis. 3(4): A129. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784117/
Closed kinetic chain exercises (n.d.) Retrieved March 23, 2010 from
http://en.wikipedia.org/wiki/Closed_kinetic_chain_exercises
Heyward, V.H. (2006). Advanced fitness assessment and exercise prescription. USA:
Human Kinetics
1-RM Calculator. (n.d.) Retreived March 23, 2010 from
http://www.shapesense.com/fitness-exercise/calculators/1rm-calculator.aspx
Appendix A (PAR-Q)
PAR-Q &
Physical Activity Readiness
Questionnaire - PAR-Q
(revised 2002)
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day.
Being more active is very safe for most people. However, some people should check with their doctor before they start
becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in
the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before
you start.
YES NOIf you are over 69 years of age, and you are not used to being very active, check with your doctor.
1. Has your doctor ever said that you have a heart condition and that you
should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not
4. Do you have a bone or joint problem (for example, back, knee or hip) that
could be made worse by a change in your physical activity?
5.
Is your doctor currently prescribing drugs (for example, water pills) for your
blood pressure or heart condition?
NO to all questions DELAY BECOMING MUCH MORE ACTIVE:
• if you are not feeling well because of a temporary illness such as a
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can: cold or a fever wait until you feel better; or
• if you are or may be pregnant talk to your doctor before you
• start becoming much more physically active begin slowly and build up gradually. This is the
start becoming more active.
safest and easiest way to go.
• take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that
you can plan the best way for you to live actively. It is also highly recommended that you have PLEASE NOTE: If your health changes so that you then answer YES to
your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you any of the above questions, tell your fitness or health professional.
start becoming much more physically active. Ask whether you should change your physical activity plan.
Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who
undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity.
No changes permitted. You are encouraged to photocopy the PAR-Q but only if you use the entire
form.
NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may
be used for legal or administrative purposes.
"I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction."
.. .
, Note: This physical activity clearance is valid for a maximum of 12 months from the date it is
completed and becomes invalid if your condition changes so that you would answer YES to any of
the seven questions.
Appendix B (Health History Questionnaire)
Date: 23 / 2 / 2010
HEALTH HISTORY QUESTIONNAIRE
All questions contained in this questionnaire are strictly confidential and will become part of your medical record.
Have you ever been diagnosed with any of the following illness or medical problems? If yes, include approximate date or year.
MEDICATIONS
Please list your prescribed drugs and over-the-counter drugs, such as vitamins and nutritional supplement including
approximate start date.
Name of Drug Strength Frequency Taken Start Date/Yr.
ALLERGIES
Please list all drug allergies including type of reaction.
Drug Type Reaction
REVIEW OF SYSTEMS
General □ Anorexia □ Chills □ Fatigue □ Fever
□ Malaise □ Sweats □ Weight Loss
Ear, Nose, Throat □ Decreased Hearing □ Hoarseness □ Ringing in Ears □ Pain with Swallowing
□ Ear Pain □ Nose Bleeds
Cardiovascular □ Chest Pain □ Palpitations □ Peripheral Edema
CERTIFICATION
The above information is true to the best of my knowledge.
NAPFA Standards
* taken from Hoffman, 2006. Norms for fitness, performance, and health. Human
Kinetics: USA.
Appendix H (Food Intake Record)