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FITNESSADVICE.NET

Fitness for Every Body

Brought to you by US Fitness Group
todd@usfitnessgroup.com
425-223-7169

2007 Fitness Trends

Trends related to children and seniors will take center stage in 2007. That’s just two of the fitness trends that the American Council on Exercise (ACE) is predicting for next year based on research and input from its network of certified fitness professionals. Here are the top 10 trends as predicted by the organization. 1. Expanded specialized fitness programming for older adults. A well-balanced fitness program offers many benefits for seniors. It conditions muscles, tendons, ligaments and bones to help fight osteoarthritis and osteoporosis, keeping the body more limber and stabilizing joints to lower the risk of everyday injury and enhance overall quality of life. 2. Small-group training for all age groups. Small-group personal training (usually less than five individuals) continues to grow. Couples, families and friends will look to this option as a way to receive the technical instruction and close supervision of personal training at a more economical cost. 3. A focus on youth programming. Fitness programs targeted toward children will grow as the impact of health status reports regarding the nation’s youth motivate community and program leaders, schools and parents to take action. 4. Personal trainers taking a team approach. Medical doctors, trainers and nutritionists will continue to make the connection that each member of the healthcare continuum can play a vital role in helping to prevent or reverse many of the disturbing health-related trends affecting society. 5. Simple, affordable options and alternatives for workouts. Participants are looking for variety in their workout regimens. Simple walking programs or a “back-to-basics” approach can fit those needs. Moderately intense, daily activity can help prevent illness and prolong life. Home gyms can also be a comfortable and inexpensive place to work out, especially since personal trainers can come directly to the home to offer guidance to inexperienced exercisers. 6. Functional fitness and balance training activities. Exercise programming and equipment aimed at improving individuals’ performance capabilities continue to be among the fastest growing and most popular exercise options. Health clubs are offering balance training programs and classes for virtually all levels and types of participants. 7. The mind and body connect for a complete health and fitness experience. Yoga, Pilates and Tai Chi continue to provide an opportunity and an alternative to higher impact activities. 8. The best in personal training from experts in the field have an accredited certification. Personal training is frequently cited as one of the fastest growing professions and consumers are demanding competent practitioners. 9. Accountability and measurement-focused programming. Technological advancements are making it possible to more precisely measure a wide variety of physiological responses and to document training program results. Such documentation will be necessary for insurance reimbursement for fitness services to become a reality in the near future. Consumers are also choosing to use downloadable programs to iPods, PDAs and other portable devices that offer fitness programming with illustrations and/or streaming video. 10. Time-efficient workouts for those with tight schedules. A greater demand exists for group fitness classes and training sessions that are 45 minutes or less. Workouts and exercise programs will continue to respond to the critical need for time-starved Americans to get an effective workout in a short time.

Todd Mayo
todd@usfitnessgroup.com
425-223-7169

Your Health as an Investment

When you reach a certain advanced age and you glance around at your peers you often conclude that the people who look and act the best are those who, over the years, have consistently eaten sensibly and exercised strenuously. It pays to invest in your good health. As the famous American poet and essayist Ralph Waldo Emerson remarked, "The first wealth is health." Keeping your body and mind in top condition not only benefits your quality of life, it also enhances your wallet. Most news accounts of rising obesity and poor health habits focus on the suffering and discomfort that people experience. But it may be just as effective to stress how much ill health costs. Compared with the rest of the population, sick people generally work (and earn) less, spend more on health care and have less energy and time to pursue their goals. In other words, it pays to invest in yourself first by maintaining your health. A major strategy is to not ignore small problems. Treat health challenges before they become serious, rather than afterwards. This means getting regular physical examinations with your doctor and not ignoring symptoms of what could be larger complications. Joining a gym or sports club may seem costly but usually pays for itself. Studies show that people who exercise regularly need to spend less than half as many nights in hospitals as people who don't. Physical activity also relieves stress so find something that keeps you moving and clears your mind. Monitor your eating habits. In our so-called "fast food nation" it's easy to become reliant on easy but unhealthy fast food, when rushing to and from work, meeting appointments, chauffeuring the kids and other life commitments. But by cooking your own meals, rather than eating out, you'll be better to your body and also save money.

Todd Mayo
todd@usfitnessgroup.com
425-223-7169

Personal Training on the Rise

Personal training still is the most successful program for retaining newcomers, according to a survey by IDEA Health & Fitness Association. The survey showed a growing trend toward putting people first before choosing the mode of exercise, which is reinforced by the variety of programs now available to meet a wide range of consumer needs regardless of age or physical condition, says Kathie Davis, co-founder and executive director of IDEA Health & Fitness Association "Fitness training is a choice that is open to people of all ages and capabilities,” says Davis. “This year's survey shows more attention than ever is being placed on finding the proper programs and equipment to remove all impediments to achieving a healthier lifestyle." More than three-quarters of respondents said they offer classes or programs specifically designed to reach inactive or new exercisers. Some of the significant trends and findings revealed in the 2006 survey include: • Personal training remains the most frequently offered program. One trainer working with one client is offered by 84 percent of the respondents. Optimism remains high that personal training will continue to grow, as expressed by 64 percent of those polled. • Personal training sessions with two to five clients are emerging as a popular option as people seek greater variety or value from their workouts. With 68 percent sharing sessions with two clients and 44 percent working out with three to five clients, it's clear multi-client personal training continues to climb. • While Pilates and yoga remain very popular (offered by 64 percent and 58 percent of the respondents, respectively), the survey revealed that after a brisk increase in availability over recent years, the number of these classes might be leveling out. • Pilates and yoga appear to remain independent activities. Only 32 percent reported a fusion of yoga and Pilates, 24 percent a fusion of Pilates and traditional strength training and 23 percent a blend of yoga and traditional strength training—numbers that have not changed over the past three years • Those who offer Gyrotonic® or Gyrokinesis® exercise feel it has significant growth potential. While presently only three percent of respondents said they offered these programs, 63 percent of those respondents expect this area to grow. • Fitness assessments, while a low-profile activity, maintain a role among the most offered options according to 84 percent of those surveyed. • Traditional "aerobics" classes continue to decline, with all types combined (high-, low- and mixed-impact) still being offered by roughly half of the respondents. • Boxing-based and kickboxing classes dropped nine percent over the past year and now are offered by only 39 percent of the respondents. As for data on exercise equipment, the 2006 survey revealed: • Barbells and/or dumbbells as well as resistance tubing and bands are the most frequently offered equipment, provided to clients by 90 percent of the respondents. The number of personal trainers and the prevalence of equipment-based classes likely heighten the usage of free-weights. • Stability balls were favored by 89 percent of respondents and 45 percent said they believed usage would continue on the upswing. • Two-thirds of respondents said they expected the use of Pilates' equipment to grow. • Over the past nine years, elliptical trainers have shown a 30 percent growth to where they now are close to the ubiquity of treadmills. Stair climbers and upright cycles, meanwhile, both have suffered 23 percent declines. • The popularity of many pieces of fitness equipment remains stable, if not growing. This is an indication that businesses are probably using the gear and experiencing an advantageous return on investment for their purchases. • Specialized balance equipment, foam rollers and small balls have continued to gain favor over the past three years, probably because more fitness professionals have learned how to use them and see applications for a wide variety of clients. Nearly 300 IDEA business and program directors across North America responded to this year's survey. These fitness professionals represent a blend of small and large health clubs, specialty studios, personal training facilities, colleges, corporate and hospital fitness centers as well as parks and recreation programs.

Who Are Fitness Professionals?

Fitness Professionals are coaches dedicated to helping you realize your potential. Great Fitness Professionals • Educate • Motivate • Inspire And like great coaches, the best Fitness Professionals know that the study of movement and nutrition can convey useful lessons of life – from increased confidence and self-esteem to improved discipline and focus. Your Fitness Goals: Weight Loss Management & Training The goal of our personal training program is to turn you into your own personal trainer. Only you are guaranteed to be with you for the rest of your life. We don’t teach you how to use a particular machine, we teach you how to exercise properly to achieve goals, rehabilitate injuries, and prevent future injuries. Nutrition is the basis. Learn how to eat properly based on your goals following two key principles: Eating strategies must be easy to follow (we don’t believe in diets) and they must include foods you already like to eat. Learn how to manage your fitness in a way that allows you to avoid all of the fad diet and exercise programs out there. Save thousands of dollars by learning about proper exercise and nutrition now and enjoy a lifetime of maintenance. Core Stability/Flexibility/Coordination. Consider hiring a Fitness Professional for 8 to 16 weeks — long enough to learn the nutritional strategies, various fitness principles, equipment technologies and exercise techniques required to become reasonably self-sufficient and to achieve noticeable results. Periodic sessions with a trainer will reinforce training habits and help you learn new techniques. Show your friends and family members that you have made the choice to be different from the 50-60% of Americans that choose to live their lives overweight. What Results Can You Expect from Your Personal Sessions? Create a nutritional plan based on your goals and on your personal profile. Learn how to turn your body into a “fat burning machine” - Lose up to 2 pounds per week of body fat per month and keep it off for life! Find out how to get the maximum results out of the least amount of exercise time. Learn how to burn fat while you sleep, watch tv, or sit at your desk at work. Have the body you’ve always wanted, be in better shape at 40 or 50 then you were at 20. Fit in that bikini you’ve always dreamed of, go down 4 dress sizes or change your waist from the 38 you’ve been for 5 years back to the 32 you were in high school. Get the motivation and inspiration you need to stick with your program. Learn how to adapt an exercise program Learn how to recover from an injury and how to prevent future injuries.

U S FITNESS GROUP Professional staff is there for you with a mix in: • Nutrition • Injury/Rehabilitation • Sports Training • Figure Modeling With knowledge in exercise science, nutrition, fitness assessment, exercise programming, and instructional and spotting techniques they are: • Professionals • Experienced and Committed •

US FITNESS GROUP Fitness Professionals hold certifications in important programs such as: ACSM (American College of Sports Medicine), NFPT (National Federation of Professional Trainers), NASM (National Academy of Sports Medicine), IFPA (International Fitness Professionals Association), NSCA (National Strength and Conditioning Association) ACE (American Council on Exercise), as well as other programs.

US FITNESS GROUP
TODD MAYO
todd@usfitnessgroup.com
425-223-7169

Health Benefits of Exercise and Physical Activity:

• Reduce the risk of premature death • Reduce the risk of developing and/or dying from heart disease • Reduce high blood pressure or the risk of developing high blood pressure • Reduce high cholesterol or the risk of developing high cholesterol • Reduce the risk of developing colon cancer and breast cancer • Reduce the risk of developing diabetes • Reduce or maintain body weight or body fat • Build and maintain healthy muscles, bones, and joints • Reduce depression and anxiety • Improve psychological well-being • Enhanced work, recreation, and sport performance Benefits of Aerobic Exercise: • Increased maximal oxygen consumption (VO2max) • Improvement in cardiovascular/cardiorespiratory function (heart and lungs) o Increased maximal cardiac output (amount of blood pumped every minute) o Increased maximal stroke volume (amount of blood pumped with each beat) o Increased blood volume and ability to carry oxygen o Reduced workload on the heart (myocardial oxygen consumption) for any given submaximal exercise intensity • Increased blood supply to muscles and ability to use oxygen • Lower heart rate and blood pressure at any level of submaximal exercise • Increased threshold for lactic acid accumulation • Lower resting systolic and diastolic blood pressure in people with high blood pressure • Increased HDL Cholesterol (the good cholesterol) • Decreased blood triglycerides • Reduced body fat and improved weight control • Improved glucose tolerance and reduced insulin resistance ________________________________________ Benefits of Strength Training: • Increased muscular strength • Increased strength of tendons and ligaments • Potentially improves flexibility (range of motion of joints) • Reduced body fat and increased lean body mass (muscle mass) • Potentially decreases resting systolic and diastolic blood pressure • Positive changes in blood cholesterol • Improved glucose tolerance and insulin sensitivity • Improved strength, balance, and functional ability in older adults Study:

Lifting Weights Attacks Belly Fat

By just lifting weights twice a week for an hour, women can battle the buildup of tummy fat that often takes hold with aging, a new study suggests. And they didn't even diet. The study focused on intra-abdominal fat, the deep fat that wraps itself around organs and is the most unhealthy because it's linked with heart disease. "One of the most common complaints in women, especially as we continue to age, especially as we go through menopause, the No. 1 complaint is abdominal growth," said Dr. Tracy Stevens, a cardiologist who directs the women's heart center at St. Luke's Hospital in Kansas City. "It's the apple-shaped person I'm most worried about," said Stevens, who was not involved in the study. "The more central the fat, the more it's laid down in the arteries." The study was funded by the National Institutes of Health and is being presented Friday at an American Heart Association conference in Phoenix. In it, 164 overweight and obese Minnesota women ages 24 to 44 were divided evenly into two groups. One group participated in a two-year weight-training program and the other was simply given a brochure recommending exercise of 30 minutes to an hour most days of the week. Both groups were told not to change their diets in a way that might lead to weight changes. Women who did the weight-training for two years had only a 7 percent increase in intra-abdominal fat, compared to a 21 percent increase in the group given exercise advice. The strength-training group also decreased body fat percentage by almost 4 percent, while the group just given advice remained the same. "I think we need to provide people with multiple possibilities, multiple roads to the same end. If this is what you're willing to do, I'll tell you what you can get out of it," said the lead author of the study, Kathryn Schmitz, an epidemiologist at the school of medicine at the University of Pennsylvania. Researchers reported only marginal effects from the training on total fat mass and the fat you can pinch under the skin. Using both free weights and machines, the women in the strength-training group worked out for about an hour and were encouraged to gradually increase the weights they lifted. "This is not a program you could do in your home, unless you can afford to have a full gym in your basement," Schmitz said. The women, who completed 70 percent of the advised exercise throughout the study, were in supervised strengthening classes for 16 weeks. Schmitz said the focus was on chest, back, shoulders, biceps, triceps, lower back, buttocks and thighs. She noted that adding muscle mass can help overweight women move faster so they burn more calories. Dr. Rita F. Redberg, a cardiologist at the University of California San Francisco, pointed out that since muscle burns more calories than fat, increasing muscle mass means losing more calories. "Certainly, any kind of exercise is better than not doing anything," Redberg said. But for "maximal benefit, cardio with weight training will get a lot more bang for your buck." "I think exercise is the fountain of youth," she said. "If it was a pill, everyone would be taking it."

Extra Weight, Higher Costs

As you snatch a couple more cookies or down another milk shake, you might be thinking about what those extra calories will do to your health. But have you considered what they will do to your wealth? The sugar and fat will add pounds, which can lead to heart disease, diabetes and a shortened life span. There is another consequence to packing on extra weight: being fat costs money — tens of thousands of dollars over a lifetime. Heavy people do not spend more than normal-size people on food, but their life insurance premiums are two to four times as large. They can expect higher medical expenses, and they tend to make less money and accumulate less wealth in their shortened lifetimes. They can have a harder time being hired, and then a harder time winning plum assignments and promotions. We’re not talking about people who are merely carrying a few extra pounds, or only those who are Jabba the Hutt in their dimensions, either. People carrying 30 to 40 pounds extra can be affected. “Being overweight can be dangerous to your wealth,” said Jay L. Zagorsky, an economist at Ohio State University who has looked at the relationship between various economic and sociological factors and a measure of obesity called the body mass index. Doctors use the index to determine whether a person is merely overweight or dangerously obese. You divide your weight in pounds by the square of your height in inches, which is then multiplied by 703, to adjust the English-system measurements to the metric system. (You could use kilograms and centimeters, but that would be too easy.) Or use a Web calculator like the one at www.nhlbisupport.com/bmi/ or www.halls.md/ideal-weight/body.htm. Anything under 25 is considered a normal reading of the index. From 25 to 30 is overweight, and above 30 is obese. People who rate above 40 are considered morbidly obese, meaning they are facing serious and sustained health problems. The index has been criticized for its inability to distinguish between a well-muscled person and a fat one. Nevertheless, it is by this measure that academics estimate that 97 million Americans, about a third of the population, are considered obese. Almost 10 million Americans could be considered morbidly obese. Academics have struggled to place a price tag on the cost of treating those carrying around too much weight. The obese suffer from heart disease, diabetes, depression, arthritis and joint problems, liver disease and sleep apnea. Complications from obesity, particularly diabetes, which afflicts 21 million Americans, push up the bill: $44,000 for a heart attack, $40,200 for a stroke or $37,000 for end-state kidney disease, estimates Judith A. O’Brien, the director of cost research at the Caro Research Institute, a health costs consulting firm. Amputating just a toe, a not uncommon consequence of untreated diabetes, averages $15,000, she estimates. Academics have not spent much time calculating what that care costs the overweight individual. Instead, they look at what obesity costs society or insurers. The sum usually arrived at is about $80 billion a year and steadily growing. The government or insurers pay about 85 percent of that. In other words, the fit and the fat pay for it indirectly through taxes or higher health insurance premiums. This year, two nutritional scientists at the University of Wisconsin-Madison, Rachel N. Close and Dale A. Schoeller, took a unique twist on the calculations to determine what “supersizing” a fast-food meal costs society. Paying 67 cents to supersize an order — 73 percent more calories for 17 percent more money — adds an average of 36 grams of adipose tissue. The future medical costs for that bargain would be $6.64 for an obese man and $3.46 for an obese woman. “The hidden financial costs associated with weight gain from upsizing a value meal may help convince people it is not a bargain,” Mr. Schoeller said. Even routine care can put a dent in a family’s finances. Office visits and prescriptions for medicines to manage diabetes, high cholesterol, back pain and depression can reach $7,000 in annual out-of-pocket expenses for someone — admittedly one with nearly every problem associated with obesity — covered by an employer’s health insurance, according to an online health care cost estimator United HealthGroup provides to its customers. While the health problems ravage savings, an overweight person may have difficulty accumulating a nest egg in the first place. One of the earliest sociological studies of the overweight, in 1966, found that the heaviest students had a harder time getting into top colleges. More recent studies have found that the obese, particularly white women, are paid less. A study by John H. Cawley, an associate professor of human ecology at Cornell University, found that a weight increase of 64 pounds above the average for white women was associated with 9 percent lower wages. Evidence from decades of discrimination studies has led Mark V. Roehling, an associate professor at the School of Labor and Industrial Relations at Michigan State University, to the conclusion that there is “consistent evidence of weight discrimination.” One factor is that some employers do not want to be burdened with higher health insurance costs. Other times it is a matter of appearances or a belief that “people of size,” as Mr. Roehling terms the obese, are lazy, weak-willed or considered too unattractive to interact with customers. He has found that some employers are upfront about it, even in Michigan, which is the only state that outlaws weight discrimination. While conducting research, he said, he was told by a personnel manager, who himself was overweight, that the company would not hire overweight people, even after Mr. Roehling told him that was illegal. The bias is more pronounced toward white women than white men, Mr. Roehling said: “Blacks are more accepting of large people and whites are more accepting of overweight black females.” Mr. Roehling is convinced that weight bias is stronger than bias stemming from race. You can test that thesis yourself with the Implicit Association Test, at implicit.harvard.edu/implicit. It was created by researchers at Harvard, the University of Virginia and the University of Washington to plumb an individual’s attitude toward race, ethnicity and religion. Take the test for prejudice against overweight people and compare your result against the similar test for race. Brian A. Nosek, a psychology professor at the University of Virginia who helped develop it, said that test results showed that bias against blacks and the overweight was about equal, but that while people rarely admit to race bias, they freely admit to weight bias. “There is no social sanction against saying you don’t like fat people,” Mr. Nosek said. The weight penalties come in other forms as well. Sociologists have long noted that in developed countries, the higher-status people tend to be thin and the lower- status ones are fat. “That heavier people have a harder time getting married is pretty well supported,” said Jeffery Sobal, a professor at Cornell University who has studied obesity. Marriage can be crucial in wealth creation, especially when a person “marries up” to someone with money or a higher education. That may be a rarer occurrence for the obese. “There is a stigma against the overweight that plays out in the social class world,” he said. The end result? The obese accumulate only about half the assets of the normal-size American, said Mr. Zagorsky, the Ohio State University research scientist. He matched B.M.I. and wealth data in the National Longitudinal Survey of Youth, a multiyear sampling done by the Bureau of Labor Statistics, and found that for every one-point increase in the index, net worth dropped by $1,000. The typical female baby boomer, he said, earned $313.70 less annually for every one-point increase in her B.M.I., while the typical male earned $161.30 less for every point. A chicken-or-egg question invariably pops up. Are people fat because they are poor or poor because they are fat? “We can never prove causality in social science,” Mr. Zagorsky said. “As an experiment, I can’t force people to eat or force them not to eat.” But he said that if wealth causes the change in weight, then people who receive inheritances should show a corresponding drop in their B.M.I. That does not happen, so he asserts that weight drives the lack of wealth. Mr. Zagorsky’s data revealed an odd finding about inheritances. Thin people tend to receive bigger inheritances. He is not sure why, but he thought it could be because people with low B.M.I.’s live longer and their parents tend to live longer, so wealth has a longer time to accumulate before it is transferred. What happens to a person who loses weight? Mr. Zagorsky said a drastic drop in weight corresponds to an increase in wealth. A baby boomer whose B.M.I. drops from 27.5, the middle of the overweight category, to 21.7, the middle of the normal category, sees an increase in wealth of $4,085. The impact of weight loss on wealth was considerably less for black women and it appeared to make no difference for black men. But a B.M.I. decrease of 10 points corresponds to a wealth increase of $12,720 for white men and slightly less for white women. But it has to be a big loss in weight. “You can’t just drop 10 pounds and change your wealth,” he said.

Executive Survey: Physical Fitness is Key to Corporate Career Success

Seventy five percent of executives surveyed by TheLadders.com said good physical fitness is critical for success at the executive level and being overweight is a serious career impediment. The majority of the respondents stated that corporations should help their employees get fit. Seventy five percent of the executives said companies should provide on-site fitness centers or subsidize gym memberships, and 12 percent said companies should offer cash incentives to regular exercisers. "Physical fitness is a critical issue for employers these days as rising health-care costs and increased knowledge about the health risks associated with obesity-related conditions have companies thinking seriously about the long-term health of their employees," said Marc Cendella, president and CEO of the Ladders.com.

Pre-participation Health and Fitness Assessments

Exercise testing, according to ACSM standards, should be part of all members' initial assessments upon joining your facility. By Michael Nordvall, Ed.D., and Michelle Walters-Edwards, Ph.D. WITH THE RELEASE of the new 7th edition of ACSM's Guidelines for Exercise Testing and Prescription, it is timely and important to review the steps to perform a complete health and fitness assessment. Many in the health/fitness industry may have moved away from incorporating the assessment process when assimilating new members; however, to ensure members' safety and well-being, and to improve member retention and programming, assessments must be performed. Further, assessments provide both the members and facility personnel with the means to document improvements attained through participation in an individualized, well-designed, regular exercise program. Following is a step-by-step review of the health assessment procedure according to American College of Sports Medicine (ACSM) standards, along with how to interpret test results and strategies for more effectively incorporating the health assessment process into your facility. A couple of notes: Web listings have been included as a quick reference for testing procedures and interpretation; however, the most timely information is published in ACSM's Guidelines. Also, the assessments described here are comprehensive for whom ACSM terms a "low risk" individual. Members who are at moderate to high risk for cardiovascular disease, also described by ACSM, may require additional medical evaluation prior to engaging in physical activity. Pre-test instructions and the test environment Members should be instructed to arrive for their fitness assessments wearing the proper clothing, having avoided significant exertion or exercise on the day of the test, and having abstained from food, alcohol, tobacco and caffeine for three hours prior to testing. They also should have been given some information regarding the assessment so they have reasonable expectations and can plan the rest of their day accordingly. When possible, testing should be conducted in a quiet, private area to reduce anxiety and improve concentration. Practically speaking, it may be feasible to only complete the questionnaires, and height, weight, resting heart rate, blood pressure and body composition assessments in such a place. The remaining tests, including cardiorespiratory endurance, muscular fitness and flexibility assessments, will most likely occur on the facility floor. The staff member conducting the tests should be relaxed, yet confident, to ease the member through the screening process. Testing procedures should be explained clearly, and ample time should be allowed to answer any questions. The process should be conducted in an organized fashion. Sometimes it may be necessary for members and staff to perform the entire screening process in the span of two days; the resting assessments on day one, followed by the active assessments on day two. Components of the health screening For individuals seeking a professionally guided exercise regimen, the general components of the health assessment process are broad in nature, and range from evaluating the many components of physical fitness to protecting your facility from liability. The tests and components should be performed in a specific order, and include the following: 1. Complete ACSM/American Heart Association (AHA) Preparticipation Screening Questionnaire or Physical Activity Readiness Questionnaire (PAR-Q), lifestyle and medical history inventories, and the informed consent form 2. Resting heart rate and blood pressure 3. Body composition 4. Cardiorespiratory endurance 5. Muscular fitness (includes both strength and endurance) 6. Flexibility As noted, these tests may be divided into resting assessments (tests one, two and three) and active assessments (tests four, five and six). For certain individuals, however, the risks of exercise testing may outweigh the benefits associated with exercise. Exercise testing without a physician present may be contraindicated for a person with conditions such as acute infections or unstable chest pain (angina). A complete list can be found in ACSM's Guidelines. If defined by the ACSM/AHA Questionnaire, have your member obtain a physical examination and medical clearance (www.exrx.net/Testing/PhysicianLetter.html) prior to testing. The initial steps in the assessment process are aimed at obtaining a comprehensive understanding of your new member's health and lifestyle. Central to this information is completion of all necessary health/facility forms, and the determination of resting heart rate and blood pressure. Members should complete the forms (e.g., ACSM/AHA Questionnaire or PAR-Q, questions regarding past and existing health conditions and risk factors for cardiovascular disease, informed consent, etc.) that will provide information regarding whether it is safe to test them in your facility prior to scheduling a fitness assessment appointment. If a red flag, such as frequent chest pain, arises in your pre-test evaluation, now is the time to recommend physician intervention. Following is where you can obtain examples of these forms: PAR-Q (www.csep.ca/pdfs/par-q.pdf); informed consent (www.exrx.net/Testing/InformedConsent.html); CAD risk factor analysis (ACSM's Guidelines). The informed consent should be approved by your legal counsel to determine the appropriate language and consent process for your facility. Forms to evaluate medical history and lifestyle behaviors should also be considered, and can easily be developed. Resting heart rate and blood pressure Determination of resting heart rate (RHR) and resting blood pressure (RBP) should, ideally, be conducted after the member has been allowed to sit quietly for five minutes. Practically speaking, members may complete health/fitness assessment forms during that time, if they haven't already. The most common method for determining RHR is the radial palpation technique. While the subject is seated, palpate the radial artery at the base of the thumb (lateral to the mass of wrist tendons) using your index and middle fingers. Count the pulse for a period of 10 seconds and multiply by six. Record the results in beats per minute (bpm). To determine RBP, wrap the cuff firmly around the upper arm at heart level, aligning the cuff with the brachial artery. The appropriate cuff size will be ensured when the bladder within the cuff encircles at least 80 percent of the member's upper arm (most adults will use a large cuff size). The stethoscope bell is placed below the antecubital space over the brachial artery, with the bevel on the earpieces facing toward the front. Rapidly inflate the cuff 20 mmHg above the first Korotkoff sound, and then slowly release pressure at a rate not exceeding 5 mmHg per second. The first sound heard represents systolic blood pressure (SBP). Continue to release pressure and note when the sound becomes muffled and then finally disappears. Just prior to when the sound disappears is used for classification of diastolic blood pressure (DBP). A minimum of two measurements, separated by one minute, should be taken, with the results and goals explained to your member. The following classifications of RBP are adapted from a publication of the National Institute of Health: Values < 120 mmHg for SBP and < 80 mmHg for DBP are considered normal Values between 120 and 139 mmHg for SBP or 80 and 89 mmHg for DBP are categorized as prehypertension SBP values between 140 and 159 mmHg or DBP values between 90 and 99 mmHg is stage 1 hypertension SBP values 160 mmHg or values 100 mmHg for DBP places an adult in stage 2 hypertension Body composition Body composition describes the relative proportion of fat to fat-free mass. Excess body fat places an individual at increased risk for development of diseases such as type 2 diabetes, stroke and hypertension. A number of laboratory and field techniques have been developed to assess this important component of physical fitness. A common and reliable field method, which correlates well to hydrostatic weighing, is to estimate body composition from skinfold measurements. The skinfold technique is based on the fact that subcutaneous fat is proportional to the total amount of body fat. It provides a reliable estimate of your member's body density, which is used to determine percent body fat. This relationship, however, depends considerably on your member's age, gender and ethnicity. Population-specific equations to convert body density to percent fat reflect these variables. General procedures for skinfold measurements are the following: * Measurements should be taken on the member's right side while standing. * The caliper should be placed 1cm away from the thumb and finger, perpendicular and halfway between the base and crest of the fold. * Maintain the pinch while reading the caliper. * Obtain your reading in one to two seconds. * Take duplicate measurements at each site, retesting if not within 1 to 2 mm. * Rotate through measurement sites to ensure the skin has time to return to normal. A standardized description of skinfold sites can be found in ACSM's Guidelines or at www.exrx.net/Testing/BodyCompSites.html. The skinfold sites used are dependent on the generalized skinfold equation that converts skinfolds into body density. Such equations to convert skinfolds into body density can be found in ACSM's Guidelines. A common equation includes the chest, abdomen and thigh (men), and triceps, suprailiac and thigh (women) skinfolds. As noted, population-specific equations are then used to convert body density into percent body fat. Computer programs (www.exrx.net/Calculators/BodyComp.html) have made the task of converting skinfold measurements to percent body fat much easier, or consult ACSM's Guidelines for the manual process. The average body fat for men and women varies, dependent on age (see ACSM's Guidelines or consult www.exrx.net/Calculators/BodyComp.html). ACSM also recommends measurement of waist circumference, since body fat distribution, particularly in the abdomen, is an important predictor of a number of health risks. Measurements should be made with a flexible yet inelastic tape measure placed lightly (avoid compressing the skin) at the narrowest part of the torso above the umbilicus and below the xiphoid process. This process should be repeated until duplicate measures are within 5 mm. Waist circumferences <70 cm in women and <80 cm in men are considered low risk for associated health risks (CAD, hypertension, type 2 diabetes, etc.). See ACSM's Guidelines for a complete list of waist circumference classifications. Cardiorespiratory endurance Cardiorespiratory endurance is the ability to sustain dynamic, vigorous-intensity exercise using large muscle groups. This type of exercise depends on the ability to consume (respiratory system), transport (cardiovascular system) and use (skeletal muscle) oxygen efficiently. The greater the efficiency of these systems, the higher the VO2max. Generally, a person with higher cardiorespiratory fitness has a reduced chance of death from all causes. Most often, it is more practical to perform a submaximal exercise test and predict VO2max, rather than a maximal exercise test, which requires increased management and supervision. Stationary cycle ergometers and motor-driven treadmills are common modes to test aerobic capacity, as numerous protocols exist for each. If your member has not been classified as contraindicated to exercise, follow these general procedures for submaximal testing of cardiorespiratory endurance: * Obtain RHR and RBP information in the exercise position prior to the test. * After properly positioning your client on the ergometer (slight bend in knee for cycling or straddling the treadmill belt prior to starting test), begin the test with a two- to three-minute warm-up at an intensity not higher than the first stage of the exercise test. * The exercise protocol should consist of approximately two- to three-minute stages. * Heart rate (HR) should be monitored at least twice during each stage, preferably at the second and third minutes. * If HR difference between the second and third minute of the stage is greater than five bpm, extend the stage until steady state is reached (two HRs within five beats). * Blood pressure (BP) should be monitored near the end of each stage. * Member's rating of perceived exertion level (RPE) should be monitored at the conclusion of each stage. As the member's stated RPE enters a range that would be appropriate for subsequent workouts, the member should be asked to pay close attention to this feeling (e.g., "somewhat hard"), and aim for the same feeling during regular workouts. It may also be useful at this time to describe the rule of thumb, commonly called the "talk test," which can later be used to prescribe exercise training intensity. * Terminate the test when members achieve 85 percent of their maximal heart rate (MHR), or 70 percent of heart rate reserve. MHR may be estimated, in lieu of a maximal test, using the standard 220 ¬ age or a newer formula of 208 ¬ (0.7 x age). * Additional criteria have been established by ACSM to clarify significant abnormal responses to exercise that may warrant stopping the test. Such indications (signs/symptoms) may be found on page 78 of ACSM's Guidelines. * After the test, have members cool down by performing exercise at an intensity not exceeding the first stage, or use a passive recovery if members experience signs or symptoms of discomfort. * Monitor HR, BP, RPE, and signs and symptoms at least five minutes post-exercise, or longer if abnormal responses were noted. * Conclude the test when HR and BP stabilize, although not necessarily to resting levels. As mentioned, numerous protocols exist to determine cardiorespiratory endurance. Refer to pages 70 to 74, or 100 to 101 in ACSM's Guidelines for a comprehensive review of cycle ergometer and treadmill tests. Also, the YMCA cycle ergometer protocol can be found online at www.exrx.net/Testing/YMCACycleTest.html, and the popular Bruce treadmill protocol can be found at www.exrx.net/Testing/CardioTests.html. Once the test is completed, it is appropriate to determine members' VO2max using prediction equations. Consult Appendix D of ACSM's Guidelines for information on how to calculate treadmill VO2max, or refer to www.exrx.net/Calculators/YMCACycle.html for computer-generated results of the YMCA cycle test. Your members may now be ranked into a percentile value of the appropriate population (age) based on their VO2max value. Such information also provides a baseline to monitor improvements upon retesting after cardiorespiratory endurance training. Percentile values for VO2max can be found on page 79 of ACSM's Guidelines, or at the above Internet sites. Muscular fitness Muscular fitness is an important component of physical fitness because it positively influences body composition, bone mass, self-esteem, musculotendinous integrity (related to low-back pain) and glucose tolerance (related to type 2 diabetes). Muscular fitness describes both muscular strength (the maximal force a muscle can produce) and muscular endurance (the ability of a muscle to resist fatigue). There are a few considerations to recognize before performing common tests to measure muscular fitness: * Strength and endurance are specific to the muscle group, the speed of movement, the type of contraction and the joint angle being tested. * Members should be familiarized with the equipment, and instructed on the proper movements of all exercises used in the test. * Appropriate spotters should be used, and all safety measures should be reviewed with members prior to the assessments. * Absolute measures of strength should be used to monitor improvements in strength-training programs. * When comparing a member's strength assessments to other individuals, results should be expressed as the weight lifted per unit of body weight (e.g., kg/kg). Dynamic muscular strength (upper and lower body) is frequently assessed using the one-repetition maximum (1-RM), or the heaviest weight that can be lifted one time. However, performing a battery of 1-RM tests may prove to be impractical and/or increase associated risks. Tests of muscular fitness may be substituted by choosing a submaximal level of resistance, and counting the maximal number of repetitions before fatigue. The appropriate weight (and exercise) may be based on a percentage of 1-RM (estimated 6-RM or 10-RM) or body weight (e.g., 70 percent). After strength training, the same initial weight would be used to reassess muscular fitness of a particular muscle. Additionally, push-ups and sit-ups are frequently used as tests of muscular endurance, as population norms exist for each. The push-up test of upper-body strength has men use the standard position (hands pointing forward, shoulder-width apart, back straight, head up and using the toes as a pivot). Women should assume a similar position, except the legs are together, with the lower legs in contact with the mat or floor (ankle is plantar flexed), while using the knees as the pivot point. The following procedures for the push-up test may be used for both men and women: 1. Your member should lower his or her body until the chin touches the floor (preferably a mat is used) while the stomach remains elevated above the floor. 2. With a straight back, all members should push up to a straight-arm position, repetitiously without rest. 3. Record the maximal number of push-ups performed as that person's score. For the curl-up (crunch) test of abdominal strength, all members assume a supine position, with a 90 degree bend in the knees. The arms are placed at the side with the fingertips in contact with tape placed on the floor. A second piece of tape is placed 10 cm distant from the first. Members should do the following: 1. Perform controlled curl-ups by lifting the shoulder blades off the mat at a rate of 25 curl-ups per minute. Use a metronome set at 50 beats per minute to achieve this rate (with each beat of the metronome, your client should move either up or down). 2. The lower back should remain flat during curl-ups, as the fingers touch both pieces of tape throughout the duration of testing. The test lasts for one minute. 3. Your member's score reflects the total number of curl-ups performed without losing pace with the metronome up to a maximum of 25. Variations do exist on how to perform the curl-up test, and may be found in ACSM's Guidelines. Norms for the push-up and curl-up tests may also be found in ACSM's Guidelines. Also, refer to www.exrx.net/Calculators/PushUps.html or www.exrx.net/Calculators/ SitUps.html for an easy method of determining a member's population ratings. Flexibility Flexibility is the ability to move a joint through a full range of motion. It depends, in part, on the muscles, ligaments and tendons surrounding the joint, the degree of warm-up and the type of joint in question. Flexibility is an often-neglected component of physical fitness, and those who are inflexible may be at higher risk for injury during activity, and/or lower-back pain. There are numerous methods to measure flexibility at various joints throughout the body. Common tests incorporate the use of goniometers, inclinometers, flexometers and tape measures. A simple and effective field test is the sit-and-reach test of low-back and hamstring flexibility. In lieu of a sit-and-reach box, the YMCA protocol, requiring only a tape and yardstick, may be used to assess trunk flexion: 1. Make sure your members have completed a warm-up; the submaximal aerobic test plus some stretching (avoid bouncing at all times, as this increases the risk of injury) would accomplish this. 2. Place the yardstick on the floor with a 20-inch piece of tape placed perpendicularly at the 15-inch mark. 3. Have your members sit with the yardstick between their legs, placing the heels of their feet (without shoes) on the edge of the tape, about 12 inches apart. 4. Members should slowly reach forward as far as possible, exhaling during the reach, with both hands briefly holding the final position. Ensure that members don't lead with one hand, that their knees remain extended without being forced to the floor, and that both hands remain in contact with the yardstick for the entire movement. 5. Record the most distant of two trials (in inches or centimeters) as the score. Percentiles for the standard test are based on gender and age, and can be found on page 90 of ACSM's Guidelines. Also, refer to www.exrx.net/Calculators/SitReach.html to determine your member's population rating for the YMCA Sit-and-Reach Test. Conclusions Exercise testing is not an end in itself, but, rather, should be integrated into the assimilation of new members and their overall exercise program design. Assessments can be performed in a time-efficient manner that is safe and practical. There are numerous ways to use the testing experience to help educate your members, as in determining, for example, a member's 10 RM as part of an effort to design a circuit-training program. Through testing, you can maximize your ability to tailor a safe, effective program for each individual member. Further, by establishing a performance baseline, tangible evidence is gathered that can later be used to document fitness improvements attained through training. Such individual attention to your members' initial fitness level will not only aid in exercise programming, but, perhaps, will standardize the industry assimilation process, and increase overall member retention and fitness center profitability. FM REFERENCES American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription (7th ed.). Lippincott, Williams & Wilkins: Philadelphia, Pa., 2005. Black, S.A. Advanced cardio training. Fitness Management 20(8): 30-34, July 2004. Exercise Prescription on the Net (www.exrx.net/index.html). Heyward, V.H. Advanced Fitness Assessment & Exercise Prescription (4th ed.). Human Kinetics: Champaign, Ill., 2002. Howley, E.T., and B.D. Franks. Health Fitness Instructor's Handbook (4th ed.). Human Kinetics: Champaign, Ill., 2003. Porcari, J.P., C. Foster, M. Dehart-Beverly, N. Shafer, P. Recalde and S. Voelker. Prescribing exercise using the talk test. Fitness Management 17(9): 46-49, August 2001. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. NIH Publication No. 04-5230, August 2004. Tanaka, H., K.D. Monahan and D.R. Seals. Age-predicted maximal heart rate revisited. Journal of the American College of Cardiology 37(1): 153-156, 2001. Michael Nordvall, Ed.D., is an associate professor and chair, and Michelle Walters-Edwards is an assistant professor, in the Health and Human Performance Department at Marymount University in Arlington, Va. ©Copyright 2007. Fitness Management

Exercise Guidelines - ACSM

Applying the ACSM Guidelines Research shows that the ACSM exercise guidelines are effective for improving body composition and blood pressure in previously sedentary adults. BY WAYNE L. WESTCOTT, PH.D., AND RICHARD A. WINETT, PH.D. DURING THE LAST two decades, numerous studies have examined the effects of strength training on various health indicators in adults. Resistance exercise has produced beneficial outcomes for bone mineral density,27 glucose utilization,26 back pain,31 arthritis,24 gastrointestinal transit,20 blood pressure,17 blood lipids,7 post coronary performance,14 depression,32 resting metabolism29 and body composition.11 Comprehensive reviews12,34 have noted the potential of strength training for producing a myriad of health benefits, and recent studies have shown that regular resistance exercise reduces the risk for metabolic syndrome19 and premature all-cause mortality.18 While all of the reported studies showed favorable outcomes for improving strength and body composition, there was little consensus regarding a standard training protocol. For example, important strength-training studies conducted at Tufts University typically featured five or fewer exercises, performed two or three days a week, for three sets of eight repetitions each.9,13,21,11 On the other hand, equally important studies conducted by University of Maryland investigators29,28,25,23 typically featured seven to 14 exercises, performed three days per week, for one to two sets of 15 repetitions each. During this same time period, researchers at the University of Florida examined the comparative effects of various strength-training protocols, especially the number of exercise sets30,15,33 and the number of weekly training sessions.30,8,16,22 ACSM guidelines As reported by Faigenbaum and Pollock,10 the findings from these and other studies on resistance-training protocols were instrumental in the development of the strength-training recommendations published in the 1995 American College of Sports Medicine Guidelines for Exercise Testing and Prescription, 5th edition.2 The 1995 ACSM exercise guidelines essentially restated and reinforced the 1990 ACSM Position Stand3 with respect to the recommended training protocols for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Both of these ACSM publications advised previously sedentary but otherwise healthy men and women to perform one set (eight to 12 repetitions) of eight to 10 resistance exercises for the major muscle groups at least two days a week. These guidelines also recommended a minimum of 20 minutes of aerobic activity, three days a week, at sufficient intensity to attain 60 to 90 percent of maximum heart rate. The South Shore YMCA, Quincy, Mass., decided to apply the 1995 ACSM minimum requirement exercise guidelines to previously sedentary adults who enrolled in a 10-week introductory fitness program for the primary purposes of improving body composition and reducing resting blood pressure. Because exercise class participants typically perform both muscular strength and cardiovascular endurance activities during the same session, we offered a two-time-per-week training program (consistent with ACSM's minimum strength-training guidelines), and a three-times-per-week training program (consistent with ACSM's minimum endurance exercise guidelines). Exercise classes were scheduled mornings, afternoons and evenings on a Tuesday/Thursday sequence (twice per week) and on a Monday/Wednesday/Friday sequence (three times a week). All training sessions were completed within one-hour class periods, and included approximately 20 minutes of resistance exercise and 20 minutes of aerobic activity. Participants with low initial fitness levels required more time to complete the strength-training circuit, and began with shorter bouts of aerobic activity. All exercise classes were carefully instructed and closely supervised (maximum of six participants with two instructors) to ensure compliance with the ACSM exercise guidelines. To provide a controlled training environment, a separate exercise facility was outfitted with 10 standard weightstack machines (leg extension, leg curl, double chest, pullover, lateral raise, biceps curl, triceps extension, abdominal curl, low-back extension and neck flexion/extension) and three common cardiovascular tools (two treadmills and a recumbent cycle). Program protocol Body weight, body composition and resting blood pressure were assessed during the first and the last week of the 10-week training program. The order of exercise was randomly assigned during the first training day, so that three participants performed resistance training followed by aerobic training, and three participants performed aerobic training followed by resistance training. Strength training consisted of one set of each resistance exercise, from larger to smaller muscle groups, with a weightload that could be lifted between eight and 12 repetitions. When a trainee completed 12 repetitions, the resistance was increased by 5 percent (or less). Each exercise repetition was performed in approximately six seconds, with about two seconds for the concentric muscle action and about four seconds for the eccentric muscle action. Aerobic training bouts began and ended with three-minute warm-up and cool-down periods, during which participants performed the same aerobic activity at a lower training intensity (slower treadmill speed or reduced cycle resistance). The steady-state aerobic training segment was performed at an exercise heart rate approximately 70 to 80 percent of the participant's age-predicted maximum. However, participants were not allowed to train above level 15 (hard effort) on the Borg (6 to 20) rating scale of perceived physical exertion,5 regardless of their exercise heart rate. Participants also performed a 20-second static stretch for the prime-mover muscle group immediately following each resistance-training exercise. For example, upon completing the leg extension exercise, participants performed a 20-second quadriceps stretch; after completing the leg curl exercise, they performed a 20-second hamstrings stretch, and so on, for all 10 strength exercises. Program participants Participants in the 10-week introductory fitness program were 1,644 adults between the ages of 21 and 80 years old from the greater Boston area. Each participant completed a medical history questionnaire, and anyone with possible exercise contraindications was required to provide written physician permission before beginning the program. The mean age for the 892 participants who trained twice a week was 56.2 years, and the mean age for the 752 participants who trained three times a week was 51 years. Program results Pre-training and post-training assessment data were collected over an eight-year period from 1996 through 2004, including nine spring, eight summer, eight fall and eight winter exercise sessions of 10 weeks in duration. Ninety-two percent of the previously sedentary adults who enrolled in the exercise program completed all 10 weeks of training. Data for these 1,644 introductory exercise program participants were analyzed by training frequency, gender and age. Beginning values for body weight, body composition and blood pressure are presented in Table 1. Training frequency. The mean exercise adherence rates (percentage of scheduled training sessions attended) were 83.2 percent for twice-per-week trainees and 79.6 percent for three-times-per-week trainees. Both training frequencies were effective for improving body composition and resting blood pressure in previously sedentary adults (Table 2). Participants who trained three times per week had significantly greater decreases in percent fat (¬2.2 vs. ¬1.9 percent) and fat weight (¬4.4 vs. ¬3.2 pounds) than those who trained twice a week, which makes sense because three-day trainees performed 50 percent more exercise. However, both training frequencies produced identical increases in lean weight (+3.1 pounds), indicating that two weekly resistance workouts may be as effective as three weekly strength-training sessions for stimulating muscle development in beginning exercisers. Reductions in resting systolic and diastolic blood pressure were statistically similar for participants who trained three times a week and twice a week. Based on these findings, it would appear that three exercise sessions a week may be more beneficial overall, but two weekly workouts are effective for improving body composition and reducing resting blood pressure in previously sedentary adults. Gender. Our program participants included 1,258 women and 386 men, showing a stronger response from women than men to supervised exercise classes (3:1 ratio). The men experienced significantly greater decreases in percent fat (¬2.8 vs. ¬1.8 percent) and fat weight (¬5.9 vs. ¬3.0 pounds) than the women. Men also added significantly more lean weight (+4.6 vs. + 2.6 pounds) than women (Table 3). The greater changes in body composition components attained by the men may be due in part to their higher bodyweight (204.7 vs. 171.9 pounds) and lean weight (156.1 vs. 119.2 pounds), compared to the women. Men and women trainees had statistically similar reductions in resting systolic and diastolic blood pressure. Age. The data were also divided into age groups: 1) 21 to 30 years; 2) 31 to 50 years; 3) 51 to 65 years; and 4) 66 to 80 years. The analyses showed no significant differences among the four age groups in body weight, body composition or blood pressure changes. These findings indicate that the ACSM minimum requirement exercise guidelines produce similar improvements in these health/fitness factors for young, middle-aged and older adults. Summary and practical application Based on the results attained by 1,644 adults who completed our 10-week introductory exercise program, the 1995 ACSM minimum requirement exercise guidelines are effective for improving body composition and resting blood pressure in previously sedentary men and women between 21 and 80 years of age. On average, 10 weeks of combined strength and endurance training produced a 2 percent reduction in percent fat, a 3.7-pound loss in fat weight, a 3.1-pound gain in lean weight, a 3.8 mmHg-decrease in resting systolic blood pressure and a 1.8 mmHg-decrease in resting diastolic blood pressure (see sidebar). The basic and brief 1995 ACSM exercise protocol was apparently well-received by these formerly inactive adults. More than 90 percent of those who enrolled in the fitness program completed it, attending more than 80 percent of their scheduled classes. According to written, anonymous questionnaires administered at the completion of each 10-week training session, more than 95 percent of the participants reported high levels of satisfaction with the overall exercise program, and committed to continuing their training. Research indicates that both genetic and psychological factors can influence tolerance for and responsiveness to physical training.6,4 In addition, it would appear that relatively simple and time-efficient exercise protocols may be advantageous for previously inactive adults from an acceptance and compliance perspective. Based on our experiences with beginning exercisers, the 1995 ACSM basic strength and endurance training guidelines provide both a practical and effective approach for improving body composition and resting blood pressure in previously sedentary adults. Finally, the recently released 7th edition of ACSM's Guidelines for Exercise Testing and Prescription1 presents essentially the same strength-training recommendations used in this study. The key resistance exercise guidelines in the latest ACSM certification textbook call for the following: * Eight to 10 exercises for the major muscles. * One set of each exercise. * Eight to 12 repetitions per exercise set. * Two to three nonconsecutive training days per week. * Moderate movement speed: approximately six seconds per repetition. * Full range of pain-free movement. Clearly, these guidelines are consistent with our research findings, and we agree that new exercisers should begin strength training in this manner. FM