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

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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 between evidence-based practices and fitness fads and myths.
• Know the scope of practice 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 related 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 training field 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 see this doubling at a faster rate of around every few months.

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 personal trainers need to stay current on these topics and continue to learn about them.

Evidence-Based Practice

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

Understanding 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 is for trainers to focus on evidence-based practice to attain the highest levels of success.

Evidence-based practices are the conscientious use 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 paying attention to what the scientific research says, not the current trends 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.

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

Integrated Training and the OPT Model

The NASM uses the proprietary exercise training approach, the Optimum Performance Training model.

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 holistically. 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 complex subject 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 have a ton of control over their health and well-being.

Choosing actually to 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 developing and promoting 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 to internal and external situations, changing environments, and changes in physiology.

A disease is generally defined as any abnormal condition that negatively affects the structure or function of a body part. We usually break the 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 from 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. 

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. Both of these result in the person carrying more body fat than normal and may negatively impact their health. Obesity is more severe and has major health risks associated with it. 

We generally use BMI to compare 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 the process of plaque forming 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 improving overall blood flow. 

Hypertension

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

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

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 rests or 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 systolic of 140 or more and/or a diastolic of 90 or higher.

Cholesterol

High cholesterol is a major cause of 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. 

Diabetes

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

In type 2 diabetes, the body produces insulin, but its cells do not use it correctly. This state creates insulin resistance.

Cancer

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 are very important for ensuring optimal health and well-being along the lifespan. 

Skeletal muscle makes up much of the overall body mass and supports freedom of movement in the environment. 

Foot and Ankle Dysfunction

Foot and ankle injuries will severely limit and impact 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, resulting in the 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 comprises the lumbar spine, pelvis, abdomen, and hip musculatures, commonly called 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 head and neck posture over a long time will often cause this. 

Forward head posture is the 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

In many cases, fitness professionals are the bridge between licensed healthcare providers and 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 clients 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 everything 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 certified personal trainers to understand their scope of practice and fully understand the scope of practice for allied health professionals.

Certified Personal Trainer’s Scope of Practice

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

Fitness professionals guide to help 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.