ACSM CPT Chapter 13: Comprehensive Program Design

ACSM CPT Chapter 13: Comprehensive Program Design

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    Chapter Objectives:

    • Discuss the physiological benefits for comprehensive exercise programs.
    • Know the comprehensive exercise program components.
    • Learn about the options for advanced training.
    • Know the anatomy of 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 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 is 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 both important things 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 preventor 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 a severe injury. We classify older adult 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 the risk for these falls decreasing. Neuromotor training should be a focus of training for these older adults.

    Increased Metabolic Rate

    The metabolism is the rate 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, they lose muscle mass, and this 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. It is important to engage in impact and weight-bearing activity to promote the best adaptation to 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.


    Decreased Anxiety and Depression

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

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

    Anxiety is the emotional state shown by being excessively worried and having 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 the quality of life.

    Positive Effect on Stress

    Exercise and all physical activity potentially gives positive effects n 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.


    It is recommended to do 3 – 5 days per week of cardio, but some is always better than none. 

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

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


    Intensity for cardio is shown through 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 it is recommended to get 30 minutes per day for a total of 150 minutes per week of activity.

    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.

    Volume or Amount

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

    Progression Rate

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

    Muscular Fitness 

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

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


    The frequency of resistance training depends on the goals that clients have, 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 the same muscle group.


    This intensity is inversely related with the number of reps. With higher resistance, the reps are going to be less. 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 when you have a whole body approach or a split program style. As far as rest between sets, it is recommended to do 2 – 4 sets with 2 – 3 minutes between the sets for every muscle group trained. 

    Type or Mode

    This resistance training can be done with a variety of modes: free weights, machines, ands, and also body weight exercise.

    Exercises can be separated by single and muti joint exercises.


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


    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, or the number of sets, or number of days exercised per week. If the client wishes to just maintain their current level, then changes are not needed in the program.


    These exercises have the ability to improve our range of motion in the joints and overall physical function.

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


    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 properly stretch.

    Time or Duration

    10 minutes is the recommended time per session, and that will allow 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 ether passive or active, dynamic, and proprioceptive neuromuscular facilitation. 


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


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


    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

    Advance training options can raise an exercise program’s challenge through the manipulation of current exercises with the FITT-VP principles or also through the prescription of new and additional exercises that put focus on skill components of physical fitness.

    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 with both speed and accuracy.
    • Coordination is the ability to use your senses like sight and hearing in order to perform tasks with other body parts smoothly and with accuracy.
    • Balance is the maintenance of the body’s equilibrium when you are either stationary or moving.
    • Power is the rate that someone can do work. More powerful work is done in less time.
    • Reaction time is the time that elapses between the response you have to something and the stimulation from that thing.

    Power, Agility, and Speed

    Plyometric exercises ae often used for training these skills and they link strength with 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 is typically a minimum of 5 – 10 minutes of low and moderate activity and is use so that we can 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 includes at least one of the following: cardio, sport specific activity, resistance training, and neuromotor activity.


    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.


    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.

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