NASM CPT 7th Edition Chapter 1: The Modern State of Health and Fitness
NASM CPT 7th Edition Chapter 1: The Modern State of Health and Fitness 1

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Chapter Goals:

  • Be able to distinguish between a fitness professional’s role in the allied health industry.
  • Find the most prevalent chronic health conditions affecting modern society.
  • Know the differences in evidence-based practices and fitness fads and myths.
  • Know what the scope of practice is for a personal trainer certified through NASM.

Welcome to NASM!

Our society is increasingly automated and requires less and less physical activity.

This has led to increases in the number of sedentary lifestyles and convenience-focused diets, which fuel the fire of obesity and the relating chronic health conditions.

Certified professional trainers are here to be a powerful force for change and help clients to improve their fitness for long-term health and happiness.

The NASM Certified Personal Trainer

The NASM certified personal trainer, or CPT, provides the scientific foundation required to start a career as a fitness professional.

This is also just the beginning of the careers in fitness, as successful careers require ongoing and continued growth since the fitness industry is always evolving.

The state of information and knowledge in the field of training is always growing and at a rapid rate.

Overall, we consider human knowledge to be doubling every century. But, when it comes to the medical field, we actually see this doubling at a faster rate of around every few months currently.

This also leads to the fitness industry being full of misinformation and poor trends that people get hooked on and try. 

Staying physically fit and eating healthy is one of the best forms of preventive medicine, and it is essential for personal trainers to stay current on these topics and continue to learn about them.

Evidence-Based Practice

The focus for the systems and methodologies that NASM uses are in line with scientific principles, and they are proved to be safe and effective for any client that is working toward a fitness goal.

Understanding of these principles will require a solid knowledge base of human anatomy and physiology, kinesiology, fitness assessments, fitness program design, and coaching techniques to help change behaviors.

The recommendation NASM puts out there is for trainers to focus on evidence-based practice for attaining the highest levels of success.

Evidence-based practices are the conscientious uses of the current best evidence in making decisions about client care.

We define this as any practice relying on scientific evidence for guidance and decision making, which means to pay attention to what the scientific research says, not whatever the trends are currently on social media. 

For the fitness professionals here, applying the best external evidence means they are using the most relevant research that has been done using sound research methods.

The other thing that plays a role here are the client expectations and values, which vary greatly person to person.

Integrated Training and the OPT Model

The NASM uses the proprietary approach for exercise training, and it is known as the Optimum Performance Training model.

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The model is backed by scientific research and has been quite successful for many types of clients.

It is very important for all programs to be rooted in science and to address the needs of the client in a holistic manner. The personal training industry is growing rather rapidly.

An integrated approach to exercise represents the inclusion of these forms of training:

  • Flexibility and mobility
  • Core strength and stability
  • Cardiorespiratory 
  • Balance
  • Plyometrics
  • Speed, agility, and quickness
  • Resistance

The Global State of Health

This is a very complex subject that has many moving pieces like the factors the individual can’t control, such as genetics, access to health care, preventive medicine, natural disasters, socioeconomic status, and already built environments.

Even though there are many challenges to getting good health, people do have a ton of control over their own health and well-being.

Choosing to actually engage in healthy habits is a personal decision to be made.

Defining Health and Disease

The WHO functions as the international public health agency of the United Nations that focuses on the development and promotion of public health and well-being efforts internationally. 

The WHO defines health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.”

Health is not static and is always changing due to the body’s need to adjust internal and external situations, changing environments, and changes in physiology.

Disease is generally defined as any abnormal condition that negatively affects the structure or function of a body part. We usually break disease down into two types. These are chronic and noncommunicable diseases.

The current leading cause of death in the world is actually the presence of chronic diseases and conditions. 

Physical Inactivity and Its Relationship to Chronic Disease

The global impact of chronic disease is staggering when looking at both economic and human standpoints.

People that keep their cardiovascular fitness levels across their whole lifespan are two to four times less likely to develop heart disease or die prematurely from it. 

The chronic diseases are among the most prevalent and costly of conditions in the US and globally. 

Overweight and Obesity

The terms overweight and obesity both refer to a body weight that is bigger than normal or healthy. For both of these, it results in the person carrying more body fat than normal and may negatively impact their health. For obesity, it is more severe and has major health risks associated with it. 

We generally use BMI as a basic comparison of a person’s height to their weight. 

The BMI classifications are as follows:

  • Underweight is a BMI of less than 18.5
  • Healthy is a BMI of 18.5 – 24.9
  • Overweight is a BMI of 25 – 29.9 
  • Obese is a BMI of 30 – 34.9
  • Obesity 2 is a BMI of 35 – 39.9
  • Obesity 3 is a BMI of 40 or greater

Heart Disease

Cardiovascular disease is a broader term that we use to describe many problems in the heart and blood vessels and includes conditions like strokes, heart attacks, heart failure, heart valve problems, and arrhythmias.

Atherosclerosis is defined as the process where the plaque is formed in the arteries, leading to reductions in blood flow to the heart and brain.

Exercise promotes many positive physiological changes like encouraging the heart’s arteries to dilate more easily, and this improves overall blood flow. 


This is one of the main risk factors for both heart disease and stroke.

Hypertension is a blood pressure that is greater than 120/80. 

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The top number is the systolic blood pressure. This is the pressure in the arteries and other blood vessels when the heart is contracting.

The bottom number is the diastolic blood pressure. This is the pressure in the arteries and blood vessels when the heart is at rest or in between the beats.

Normal blood pressure is one below 120/80

Elevated blood pressure is between 120 – 129 and diastolic under 80.

Stage one hypertension is between 130 – 139 over 80 – 89.

Stage two hypertension is a systolic of 140 or more and/or a diastolic of 90 or higher.


High cholesterol is a major cause for disease globally. We consider LDLs to be the bad cholesterol and HDLs to be the good cholesterol.

LDL levels should be lower than 100 mg per deciliter. 


This is a disease that impacts the body’s ability to properly metabolize carbs, especially glucose, which is the simplest form of carb that is used to produce energy.

We have two forms of diabetes. 

Type 1 diabetes is when the pancreas doesn’t make enough insulin. Without insulin, glucose in the blood will rise to dangerous levels.

Type 2 diabetes, the body produces insulin, but it is not used right by the cells of the body. This state creates insulin resistance.


This is a disease where cells in the body grow abnormally. This can lead to things like tumors growing aggressively and then damaging the body. 

Cancer can occur in almost any part of the body, and we have almost 100 different types of cancer found.

Exercise plays an important role in the prevention of many forms of cancer.

Respiratory Disease

Chronic obstructive pulmonary disease is an umbrella term for many chronic respiratory dysfunctions shown by the presence of breathlessness, limitations in airflow, and accelerated declines in the function of the lungs.

Evidence of Muscular Dysfunction and Increased Injury

Skeletal muscle development and maintenance is very important for ensuring optimal health and well-being along the lifespan. 

Skeletal muscle makes up a large amount of the overall body mass and it supports freedom of movement in the environment. 

Foot and Ankle Dysfunction

Foot and ankle injuries will severely limit and impact the everyday activities. 

The two most common issues are ankle sprains and plantar fasciitis. An ankle sprain happens when someone twists, rolls, or turns their ankle and it results in stretching or tearing of ligaments holding the bones of the ankle together and connecting the foot and lower leg.

Plantar fasciitis is inflammation of the tissue on the bottom of the foot connecting the heel bone to the toes and it often has related chronic heel pain.

Knee Dysfunction

This type of pain is common and affects people regardless of their age or activity level.

The three most common forms of knee injury are patellar tendonitis, anterior cruciate ligament tears, and medial cruciate ligament tears. 

Many of these common injuries can be prevented with proper techniques, supportive footwear, and modifications to exercise and physical activity when necessary.

Lumbo-Pelvic-Hip Complex Dysfunction

This is made up of the lumbar spine, pelvis, abdomen, and the hip musculatures, and we commonly refer to it as the core. 

The LPHC connects the upper and lower halves of the body. 

Shoulder Dysfunction

Shoulder pain is actually the most common occurrence, especially when the body ages. 

Shoulder problems are often due to instability in the shoulder joint or impingement of the soft tissues or bony structures of the shoulder. This is known as shoulder impingement syndrome.

Regularly done shoulder strengthening and flexibility of the upper body can help reduce the risk of these injuries.

Head and Neck Dysfunction

These are common ailments and poor posture of the head and neck over a long time will often be the cause of this. 

Forward head posture is a main cause of these pains. It is seen often with the increase in office work and mobile phone use.

The Healthcare Continuum

This represents a systematic way to view the healthcare industry in various entry points, types of care provided, and the intended outcomes.

Allied Health Professionals

For many cases, the fitness professionals are the bridge between licensed healthcare providers and the clients. 

Certified personal trainers will usually have these networked allied health professionals:

  • Physical therapists
  • Athletic trainers
  • Chiropractors
  • Registered dietitian nutritionists
  • Licensed massage therapists

Certified Fitness Professionals

Fitness professionals include certified trainers, group fitness instructors, and strength and conditioning coaches

The role of the certified personal trainer:

  • Entry-level certified personal trainers are fitness professionals who work with apparently healthy clients. With additional training, the certified trainers may work with many types of clients that are medically cleared to exercise. 
  • Personal trainers should recognize their own areas of expertise and tailor their practice to that accordingly. 

Scope of Practice and Code of Conduct

The scope of practice represents all of the things a given professional can do within the legal boundaries of their job. 

These sets of rules will vary based on the country and even regions and states sometimes. 

It is vitally important for the certified personal trainers to not just understand their scope of practice, but also to fully understand the scopes of practice for the allied health professionals.

Certified Personal Trainer’s Scope of Practice

CPTs are fitness professionals who will perform individualized assessments and design the safe, effective, and scientifically based. The programs will also be individualized in order to fit the clients best.

Fitness professionals provide guidance to help the clients with their personal, health, fitness, and performance goals.

The NASM Code of Conduct has some large sections to know for professionalism, confidentiality, legal and ethical requirements, and business practice regulations.

NASM CPT 7th Edition Chapter 1: The Modern State of Health and Fitness 2
NASM 6th Edition Chapter 1: The Scientific Rationale for Integrated Training 2

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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