ACSM CPT Chapter 13: Comprehensive Program Design
ACSM CPT Chapter 13: Comprehensive Program Design

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Chapter Objectives:

  • Discuss the physiological benefits of comprehensive exercise programs.
  • Know the comprehensive exercise program components.
  • Learn about the options for advanced training.
  • Know the anatomy of the exercise session.

Benefits of a Comprehensive Exercise Program

Physiological Benefits

Improvement in Cardiovascular and Respiratory Function

When we do aerobic activities that utilize our large muscle groups over longer periods of time, we put a demand on the cardiovascular and the respiratory systems, along with partially the skeletal muscle system. When we put this stress on them, our cardiorespiratory fitness may improve. This leads to reductions in death from all causes. With lowered CRF we see more premature death risk, specifically from CVD.

Reduction in Coronary Artery Disease Risk Factors

Preventing risk and treating risk factors are important to consider due to the high prevalence of heart disease in our society these days. We cannot change some of the primordial risk factors, but we can change our physical activity factors. 

Decreased Morbidity and Mortality

Being physically active is a known prevention of several life-threatening diseases like premature death. Both morbidity and mortality rates are directly affected by how much and how well populations exercise. 

Morbidity is the amount of disease that is present in a population. 

Mortality is the amount of death in a population.

Decreased Risk of Falls

One out of every four older adults will have a fall that leads to a moderate or even severe injury. We classify an older adults as people that are over the age of 65.

Falls are oftentimes linked to lacking muscular strength, endurance, coordination, and balance. By doing exercises to improve these, we see improved daily functioning and decreased risk of these falls. Neuromotor training should be a focus of training for these older adults.

Increased Metabolic Rate

The metabolism is the rate at that your body tissues will break down and use energy that you have consumed. Our metabolic rates decrease as we age. If we don’t use the energy at the time, it will be stored as fat cells in the body. As people age, they are less active and lose muscle mass, which contributes to the decline in metabolic rate. With exercise, we can slow this and increase our metabolism.

Improvement in Bone Health

Exercise causes increases in bone mass and also slows the decrease in bone mass that occurs with age. Engaging in impact and weight-bearing activity is important to promote the best adaptation to the bone.

Weight Loss and Reduced Obesity

Obesity relates to many of the chronic diseases that we see. Physical activity is part of the way we can manage obesity and overcome it. By doing so, we can reduce these risks for chronic disease.

Psychological

Decreased Anxiety and Depression

Depression is defined as feeling sad and unhappy, being very self-critical, and having low self-esteem. It impairs daily function and possibly creates difficulties for life at home and work. Heart disease is a major health risk from depression. 

Exercise is helpful and is known to treat mild and moderate depression.

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Anxiety is the emotional state shown by excessive worry and constant tension. Exercise has been shown to reduce both trait and state anxieties.

Enhanced Feelings of Well-Being

Exercise has been shown to enhance our self-esteem, give more restful sleep, and give faster recovery from psychosocial stresses. It gives us enhancements in our feelings of energy and quality of life.

Positive Effect on Stress

Exercise and all physical activity potentially have positive effects and stress. This includes reducing depression, overall stress, and hostility.

Better Cognitive Function for Older Adults

Being regularly physically active relates to reduced risks for dementia and decline of cognitive function for older adults.

Components of a Comprehensive Exercise Program

The optimal exercise program will address health related physical fitness components of CRF, muscular strength, endurance, flexibility, body composition, and neuromotor fitness.

We use the FITT-VP and apply it to our fitness categories.

Cardiorespiratory Fitness

This is the ability of the blood vessels, lungs, and heart to give oxygen to the body during long physical activity.

Frequency

Doing 3 – 5 days per week of cardio is recommended, but some are always better than none. 

When the intensity of this exercise increases, we see the number of days and the time needed decrease. 

Injury risk increases when doing vigorous intensity on 5 or more days per week.

Intensity

Intensity for cardio is shown in many different ways. We have heart rate reserve, percent of age predicted max heart rate, perceived exertion, and oxygen uptake reserve. The recommendations depend entirely on the person’s fitness level and their habitual activity. 

Time or Duration

For moderate exercise, getting 30 minutes per day for a total of 150 minutes per week of activity is recommended.

For vigorous intensity activity, it is recommended to get 20 – 25 minutes per day on 3 days per week for about 75 minutes per week.

When combining these two, you should shoot for 20 – 30 minutes on 2 – 4 days a week.

For people who are already regular with their exercise program, they should shoot for 300 minutes per week of moderate activity and 150 minutes per week of vigorous intensity.

Type or Mode

Some examples of the type of activity are things like: walking, jogging, swimming, cycling, and running. Some things are low skill, but others require the person to learn the skill and be able to do it efficiently first.

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Volume or Amount

This plays an important role in the outcome of health and fitness, especially regarding your body composition and weight management. We should use the exercise volume to estimate our total energy expenditure for prescribing exercise.

Progression Rate

Progression depends on the health status, response to training, fitness level, and goals that a person has. Progressing allows for improvements in CRF while avoiding stagnation in their training.

Muscular Fitness 

This category includes both muscular strength and muscular endurance. Strength is a muscle or group of muscles’ ability to produce force. Endurance is the ability to continue to perform without fatiguing. 

Overload must occur for muscular fitness to improve. The muscles that adapt to training stimuli must be increased to keep gaining.

Frequency

The frequency of resistance training depends on clients’ goals, but for general fitness and the training of the major muscle groups, it is recommended that you exercise 2 – 3 days per week. The recommendation is for 48 hours of time between working for the same muscle group.

Intensity

This intensity is inversely related to the number of reps. With higher resistance, the reps are going to be fewer. For improvements in muscular fitness, we see 8 – 12 reps per set at an intensity of 60 – 80% of 1RM. 

When you have older clients or some that are very deconditioned, it is recommended to do 10 – 20 reps at 40 – 50% 1RM. And reps should allow for fatigue but not failure.

Time or Duration

The total time varies, especially with a whole body approach or a split program style. Regarding rest between sets, doing 2 – 4 sets with 2 – 3 minutes between the sets for every muscle group trained is recommended. 

Type or Mode

This resistance training can be done with various modes: free weights, machines, and body weight exercises.

Exercises can be separated into single and multi joint exercises.

Volume

Muscle groups need to be trained for a minimum of 2 – 4 sets, which can be from the same exercise or a combination of exercises that affects the same group.

Progression

Progressive overload is the principle used for making continuous gains in resistance training. This is done by increasing the resistance lifted, the number of reps, the number of sets, or several days exercised per week. If the client wishes to maintain their current level, then the program does not need changes.

Flexibility       

These exercises can improve our range of motion in the joints and overall physical function.

Frequency

Stretching is needed 2 – 3 days per week, and daily flexibility is recommended in some small way.

Intensity

Stretches don’t need to be uncomfortable, and if so, then the client should release that stretch slightly. Trainers need to use cues to guide the clients to stretch properly.

Time or Duration

10 minutes is the recommended time per session, allowing all major groups to get targeted with four reps of each stretch.

Type or Mode

This can be done with static stretching, which can be either passive or active, dynamic, and proprioceptive neuromuscular facilitation. 

Volume

Every exercise per joint needs to be held to the point of tightness occurring for 10 – 30 seconds. Time needs to add up t about 60 seconds per joint. 

Neuromotor Exercise

These exercises involve the use of motor skills, proprioceptive training, agility, coordination, and balance. We also term these as functional fitness.

Frequency

This is recommended to be done for 2 – 3 days per week for 20 – 30 minutes at a time.

Intensity

Three aspects can be manipulated to increase intensity:

  • The base of support.
  • The center of mass.
  • Peripheral cues.

Time or Duration

The minimum dose that is effective for balance training hasn’t ever been defined. Often there are improvements when utilizing 20 – 30 minutes per day for a total of 60 minutes every week. 

Type or Mode

This can be activities like yoga, tai chi, and Pilates.

Advanced Training Options

Advanced training options can raise an exercise program’s challenge by manipulating current exercises with the FITT-VP principles or by prescribing new and additional exercises focusing on physical fitness skill components.

These are the skill related fitness components:

  • Speed is the ability for us to do a movement in a short time period.
  • Agility is the ability to change the body’s position in space quickly and accurately.
  • Coordination is the ability to use your senses, like sight and hearing, to perform tasks with other body parts smoothly and accurately.
  • Balance is the maintenance of the body’s equilibrium when you are either stationary or moving.
  • Power is the rate at that someone can do work. More powerful work is done in less time.
  • Reaction time is the time that elapses between your response to something and the stimulation from that thing.

Power, Agility, and Speed

Plyometric exercises are often used for training these skills and they link strength with the speed of movement to produce power. This is also often called jump training. 

These plyometrics start with some quick stretch of the fibers of a muscle and then a fast shortening of those same fibers. This can also be achieved with power resistance training.

Reaction Time, Coordination, and Balance

There are many drills and exercises used to emphasize the use of these skills. These three skills involve muscle activation with sensory integration to do exercise related tasks in a highly skilled way.

Anatomy of an Exercise Session

Warm-up

Warm up is typically a minimum of 5 – 10 minutes of low and moderate activity and is used to warm our muscles up and prepare for the conditioning phase. It takes the body from rest and into workout mode.

Conditioning Phase

This is the main focus of the session and I usually include at least one of the following: cardio, sport specific activity, resistance training, and neuromotor activity.

Cool-Down

The cool down is like the warmup but in reverse. It is meant to take the body from this conditioning phase and into a relaxed phase. Like the warmup also, it is 5 – 10 minutes.

Stretching

This phase is outside of things done in the warmup and cool down. It is important to be warmed up when you are stretching. This follows the flexibility protocols mentioned earlier.

ACSM CPT Chapter 13: Comprehensive Program Design 1
ACSM CPT Chapter 13: Comprehensive Program Design 2
ACSM CPT Chapter 13: Comprehensive Program Design 3

Tyler Read

Tyler Read, BSc, CPT. Tyler holds a B.S. in Kinesiology from Sonoma State University and is a certified personal trainer (CPT) with NASM (National Academy of sports medicine), and has over 15 years of experience working as a personal trainer. He is a published author of running start, and a frequent contributing author on Healthline and Eat this, not that.

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