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Certificate IV in Fitness - Module 3Certificate IV in Fitness - Module 3

© Australian College of Sport & Fitness Page 1 of 170 Certificate IV ‐Module 3 ‐ Course Notes ‐ 1308B

CONTENTS

OVERVIEW OF THIS MODULE ................................................................................................................5

PART A ‐ LONG TERM EXERCISE PROGRAMMING .................................................................................5

COMPONENTS OF LONG TERM TRAINING PROGRAMS ........................................................................6

PART C – PLAN & DELIVER EXERCISE TO CHILDREN & ADOLESCENTS.................................................14

GROWTH STAGES OF CHILDREN ..........................................................................................................14

MAJOR INJURIES ..................................................................................................................................20

RISK FACTORS OF INJURY.....................................................................................................................23

HEALTH CONDITIONS SPECIFIC TO CHILDREN .....................................................................................25

GENERAL AND HEALTH BENEFITS OF EXERCISE...................................................................................29

PRE‐EXERCISE SCREENING AND TESTING ............................................................................................31

LEGALITIES OF WORKING WITH CHILDREN .........................................................................................37

WORKING WITH CHILDREN CHECK......................................................................................................38

PERSONAL RESPONSIBILITIES OF THE FITNESS PROFESSIONAL...........................................................40

INSTRUCTIONAL SKILLS AND CHILDREN ..............................................................................................42

COMMUNICATION SKILLS ....................................................................................................................43

PROGRAMMING...................................................................................................................................51

PLANNING THE PROGRAM...................................................................................................................52

STRENGTH ............................................................................................................................................55

CARDIOVASCULAR ENDURANCE..........................................................................................................57

CARDIOVASCULAR ACTIVITIES FOR 12 YEARS AND BELOW ................................................................58

CARDIOVASCULAR ACTIVITIES FOR 12 YEARS AND ABOVE.................................................................59

FLEXIBILITY ...........................................................................................................................................60

TYPES OF STRETCHING.........................................................................................................................61

ADDITIONAL PROGRAMMING FACTORS..............................................................................................62

CHECKLIST FOR PLANNING AND DELIVERING EXERCISE TO CHILDREN...............................................66

MOTIVATION........................................................................................................................................67

NUTRITION ...........................................................................................................................................70

SWAP IT, DON’T SPOT IT (HTTP://SWAPIT.GOV.AU) ...........................................................................75

REFERRALS AND ALLIED HEALTH PROFESSIONAL................................................................................75

EVALUATION AND MODIFICATION ......................................................................................................79


PART D ‐ PLAN AND DELIVER EXERCISE TO OLDER CLIENTS ...............................................................80

PROGRAMMING.................................................................................................................................122

STRENGTH ..........................................................................................................................................124

CARDIOVASCULAR ENDURANCE........................................................................................................129

TYPES OF STRETCHING.......................................................................................................................133

CERTIFICATE IV MODULE 3 ASSIGNMENT .........................................................................................160

ADDITIONAL READING ARTICLES .......................................................................................................170

ADDITIONAL RESOURCES

ADDITIONAL READING

Textbook Chapter 2, 8 & 9

Additional Reading Articles:

ACE Periodisation

Periodisation

Kids in Gyms

Government kids_Govt Recommendations 12‐18year

Government kids_Govt Recommendations 5‐12year

Child Trainer _Tanner Stages

Child Trainer _BMI for Children

Epilepsy fact sheet

Food allergies fact sheet

Asthma fact sheet

ADHD fact sheet

Kids resistance training_sample 1

Kids resistance training_sample 2

Example Childrens Training Advertisement

ACSM Older Adults and Exercise

Constucting an Older Adult exercise session

Tai_Chi_for_Arthritis

NSW Health and Older Adult Exercise

Healthy_ageing_stay_mentally_active

Ageing_muscles_bones_and_joints

Physical activity& Arthritis

Hypertension_means_high_blood_pressure


Osteoporosis Exercise Guide

Function follows Fitness and Older Adult

WEBSITES

Australian Association for Exercise and Sports Science www.aaess.com.au

The Australian Counselling Association www.theaca.net.au

Australian Medical Association www.ama.com.au

Australian Osteopathic Assoc www.osteopathic.com.au

Australian Physiotherapy Association www.physiotherapy.asn.au

The Australian Psychological Society www.psychology.org.au

Australasian Podiatry Council www.apodc.com.au

Children’s Hospital Institute of Sports Medicine www.chism.chw.edu.au

Chiropractors’ Association of Australia www.chiropractors.asn.au

Dieticians Association Australia www.daa.asn.au

National Training Information Service www.ntis.gov.au

The Royal Children’s Hospital Melbourne www.rch.org.au

WEB PAGES & SEARCHES

10 Steps Guides to Protecting Personal Information

http://www.privacy.gov.au/privacy_rights/steps/index.html

Australian Child Protection Legislation

http://www.aifs.gov.au/nch/resources/legislation/legislation.html

Dietary Guidelines for Children and Adolescents in Australia

http://www.nhmrc.gov.au

State and Territory Privacy Laws

http://www.privacy.gov.au/privacy_rights/laws/index.html

Web searches – ‘exercises for children’

Web searches – ‘exercises for older adults (or seniors)’

http://www.privacy.gov.au/privacy_rights/steps/index.html�

http://www.aifs.gov.au/nch/resources/legislation/legislation.html�

http://www.nhmrc.gov.au/�

http://www.privacy.gov.au/privacy_rights/laws/index.html�


Web searches – ‘fitness programs for children’

Web searches – ‘fitness programs for older adults (or seniors)’

PLEASE NOTE: Handouts can be found at the back of the module following page 71.


OVERVIEW OF THIS MODULE

This module initially addresses long term programming identifying the factors to consider when

planning these type programs.

Module 3 then moves on to focus on training special populations, specifically Children and Older

Adults. This module covers how to plan and delivery exercises for these individuals, as well as

identifying any special allied health professional that might be incorporated into developing these

programs.

PART A ‐ LONG TERM EXERCISE PROGRAMMING

REVIEWING HOW TO DEVELOP A TRAINING PROGRAM

In previous modules the basic concept of fitness programming was covered.

A fitness program is a planned schedule of training to meet the needs of the client.

The fitness goals of the program may be focused on increasing strength, flexibility, cardiovascular

endurance or even weight loss.

DEVELOPING A PROGRAM IN STAGES

As a personal trainer, the process of creating a training program to help develop a client reach their

specific fitness goal includes 6 stages:

Stage 1 ‐ gather details about the individual

Stage 2 ‐ identify the fitness components to develop

Stage 3 ‐ identify appropriate tests to monitor fitness status

Stage 4 ‐ conduct a gap analysis

Stage 5 ‐ compile the program

Stage 6 ‐ monitor progress and adjust program

You may have a client with a longer term fitness goal or commitment to their training program. In

which case you need to develop, plan and deliver a long term training program.

Consider a sportsman training for a certain event 12 months from now. As their trainer, your role

will be to plan a fitness program leading up to that event, not just for the next month or so.

Long range planning allows you to focus on the components of fitness in a much more strategic and

targeted way.

The following section looks at the specific components and additional considerations for developing

a long term program.


COMPONENTS OF LONG TERM TRAINING PROGRAMS

In addition to the normal stages of program design, additional considerations need to be made for

a long term fitness program.

TARGETED ADAPTATIONS

When your client first starts training there are some immediate benefits of fitness such as weight

loss or increased energy.

As they exercise regularly there will be long term adaptations of the body to fitness. These can

include:

o Faster Metabolism

o Lower Resting Heart Rate

o Reduced Body Fat

o Improved Oxygen Uptake

When planning a fitness program for long term training you can set target adaptations for your

client. Or in some cases you may anticipate the rate of client adaptation and estimate the point at

which you will increase the program intensity to reach a new adaptation target.

For example, you may target a 5% drop in body fat within the first phase of training. This is the

anticipated target adaptation. After this point is reached the fitness goal changes because the

planned program will change to building strength and the exercise choices and training program

will then change for that new goal.

PERIODISATION‐ PHASES AND SESSIONS

Periodisation is the method of organising the training year into phases where each phase has its

specific aims for the development of the client.

Normally, a simple fitness program will plan the “sessions” a client may undertake in the coming

month of training.

For example you may program your client to undertake 3 sessions per week over a 4 week period.

After this period the client may repeat the cycle of sessions and you may alter the program for

adaptations.

However, when you know your client has a long term fitness goal you can break down the entire

year (or period up to a certain goal or event) into training phases.

For example you may simply break the year into quarterly periods.


However, if your client is a sports person, you may organise the year into phases relating to the

sport season e.g. pre‐season, mid‐season, end of season, off‐season.

REST SESSIONS

It is the recovery after training that allows adaptation and improvement.

Training is a physical stress to the body. If you keep stressing the body then the client’s

performance will go backwards. If you do stress the body, then let it recover and performance will

improve. Without rest there is no improvement and if you keep stressing the body with no

recoveries then this will lead to over‐training.

For these reasons it is very important in a long term program to build sufficient rest period across

your phases of training. The general guideline is hard training sessions should be followed by easy

sessions, hard days by easy days, hard weeks by easy weeks.

PLANNING REVIEWS

Planning reviews during the long term program is essential.

This is your opportunity to benchmark your client's response to the program to date to see if they

are reaching the target adaptations and to then work out any modifications to the original fitness

program you need to make.

A review can be a combination of:

Reviewing results, fitness logs and compare to the goals set

Undertaking actual fitness tests and appraisals

Asking for client feedback

As a minimum you should review your client at the end of each period. However you can consider

smaller mid‐period reviews as well.

Reviews also help add motivation for a client. Reviews will show how the client is progressing and

motivate them to continue with the program.

LONG TERM GOAL SETTING

Helping your client set fitness goals is always important in any fitness program.

With long term fitness programs you need to also consider how to change and modify your goal

setting for your client.

Here are some steps and techniques to meet long term fitness goals:


1. Write down an overall fitness goal – setting one long term goal will give your client a sense of

where they would like to be and helps put things into perspective. For example, ‘I would like to

lose 20 kilograms’ or ‘I would like to lift 90kg on bench press’.

2. Set a few and frequent short term goals ‐ staying motivated for the long term means being able

to achieve short term goals. When you achieve short term goals, you will feel encouraged and

you will be more likely to stick to a fitness plan. So start your client with realistic goals that are

achievable. If you set the bar too high in the beginning, then your client will easily get

discouraged.

3. Build on small achievements ‐ if one of your short‐term goals is to lose five pounds within two

weeks and you achieve it, then build on your success. No matter how “small” your client’s

accomplishments may seem you can use them as building blocks for motivation. Focus on losing

an additional five pounds over the course of the next two weeks.

4. Revisit the long term goals ‐ once your client has achieved a few of your short‐term goals, take a

second look at your overall fitness goals. Those goals that seemed “out of reach” when you first

made them may now appear more achievable. In fact, these overall goals now become your

realistic long term fitness goals. The success in the short term is a platform for long term goals,

which is why building on your “small” achievements is so important.

5. Rewards. Don’t forget to give your client compliments for all of the hard work and dedication,

especially when you achieve short term goals. Your client can reward themselves for obtaining

these short term goals along the way.

PERIODISATION TRAINING EXPLAINED

Periodisation is the term for training

programs that schedule phases of training

throughout monthly or yearly schedules.

Periodisation is based on the principle that

the body can’t train everything well at once,

so it aims to break it down into “phases” that

focus on specific objectives.

WHAT ARE THE MAIN KINDS OF PERIODISATION?

There are 3 commonly held forms of organising periodisation:

Linear Periodisation

Linear periodisation is the easiest and simplest form of periodising your training. It generally means

concentrating almost solely on one motor ability per phase, for example, muscular endurance

followed by hypertrophy followed by strength followed by speed in a long linear progression.


Undulating Periodisation:

Undulating or ‘wave‐form’ periodisation refers to any program where you change training variables

to mildly emphasise one area of training.

Conjugate Periodisation

Conjugate means overlapping areas of periodised training to build interlocked areas of strength,

speed, fitness, size, stamina. It seeks to overcome the inherent weaknesses in a linear progression,

where areas can become neglected during all out emphasis on one motor ability.

All these forms of periodisation can be used to design a long term training program.

ADVANTAGES OF PERIODISATION

The advantages of periodisation are:

1. Maximal recovery is developed.

2. Maximal progress in each given area is developed at a specific time due to full attention being

placed on one aspect at a time.

3. Interest remains very high with frequently changing schedules and workouts.

4. Motivation and retention to the program remain high as usually a large time period has been

planned out to stick to.

5. Risk of injury is reduced due to variations in loading parameters as opposed to training heavy

at all times.

POSSIBLE DISADVANTAGES OF PERIODISATION

1. While dedicating time to one aspect of training others may become drawn down and

neglected.

2. Time consuming periods of high volume training are followed alternatively with very hard

periods of very intense difficult training.

3. There is a risk of losing confidence and esteem when, and if, things do not go according to the

yearly plan, causing disruptions and slowed progress.

4. 100% dedication to training is a must.

5. Confidence in training theory is required to assemble a sensible and efficient periodised

routine.


TRAINING PROGRESSION VARIABLES

Progression is an important part of periodisation.

Here are some examples of the ways you can introduce progression into a periodised programme:

Rep progression: Simply add a rep onto the same exercise performed in the previous workout. The

weight may be the same but an extra rep massively increases the workload completed. This tends

to conform to hypertrophy (muscle size growth) training.

Set progression: Simply add another entire set of the same movement you performed in the

previous workout. This will greatly increase the volume of a workout and again is geared somewhat

more to hypertrophy phases in periodisation.

Rest progression: Decrease the time taken between sets and exercises. If you normally take 60

seconds rest between sets, reduce this to 55 seconds next time. This type of progression involves

no greater workout load but does lend itself to hormonal changes that are useful for fat loss and

conditioning, and is especially useful in speed or strength‐endurance sports or competitive athletes

who are up against the clock.

Speed progression: Decrease the actual time taken to lift the weights in the set. In other words,

time each set and steadily lift the weights in a more and more explosive yet controlled manner in

order to complete the set in less and less time. This is especially geared towards explosive strength

athletes who require bursts of speed and power at various peaks.

Weight progression: This is the original and most obvious marker of improvement : lift more

weight. It is important to almost all athletes to be able to lift, push or pull more at some stage,

although overall strength levels may not be the prime requirement. Higher strength usually means

the ability to recruit more muscle and build more in the long run, so although not the be all and end

all of training parameters, its place is alongside those mentioned above.

EXERCISE SELECTION WITHIN PHASES

The selection of exercises is important in any long term training program.Between different training

phases, different exercises will be used to accomplish different fitness goals.

Consider the example of a runner where types of exercises will be used for different purposes.

Long distance training exercises will build up the runner's endurance, whereas hill sprints will build

up strength.

Periodisation will generally focus on all aspects of fitness at one point, depending upon your client's

goals. That is why the important of exercise selection can greatly alter the success of a particular

cycle.


DESIGNING A PERIODISATION PROGRAM

When designing a long term program based on

periodisation it requires longer planning than a

smaller weekly program.

First select the time period. If your client does

not have a specific goal or date to target choose

1 year as your overall periodisation time scale.

This can then be broken down into 12 month

cycles, each with an overall goal.

A one month cycle is a good block as many trainers notice they begin to stagnate in one scheme

after more than 6‐8 weeks.

For each month block you can choose one of the following goals:

Goal 1: Increase overall muscle mass (hypertrophy)

Methods: Rep and set progressions which increase volume are the most profound methods to see

overall size development.

Goal 2: Increase or maintain muscle mass but improve conditioning & lose fat

Methods: Set and rest progressions which keep necessary volume but increase overall calorie

output and hormonal changes needed to lose fat.

Goal 3: Increase speed strength and improve conditioning and lose fat

Methods: Speed and rest progressions are the most powerful tools for mastering explosive speed

and strength of neural recruitment whilst improving overall body health and losing fat.

Goal 4: Increase maximal strength and muscle power

Methods: Speed and set progressions mirror a blend of sheer explosive potential and with this

potential you develop the ability to rapidly grow and develop new functional weight.

Goal 5: Increase flexibility & maximum strength but with minimal size change

Methods: Load and speed progressions. A mixture of increasing weight trains neural recruitment

and power without much additional volume so size changes and exhaustion are less likely. Speed

progressions allow concentration on agility and explosiveness without wearing you out or

promoting overuse injuries.

These goals can be applied to each month and a variety of protocols used in each one.

In linear periodisation you would choose 2 months or so of each goal and stick to them.

In undulating you might have a beginning, middle and end phase of hypertrophy but with waves of

strength and conditioning training in between.


In conjugate periodisation you would often choose two goals and blend them over several months,

carefully backing off at the end of each section.

Periodisation can be applied to include many other training programmes and schemes and is best

thought of as a way of organising your long term training towards an eventual goal of improved

performance or hitting a peak goal.

CYCLES OF LONG TERM PLANNING

As explained in Certificate IV module 2, cycles of a long term program are referred to as:

Macro‐cylces

Meso‐cycles

Micro‐cycles

A macro‐cycle refers to an annual plan. There are three phases in the macro‐cycle: preparation,

competitive, and transition.

A meso‐cycle represents a phase of training with a duration of between 4 – 12 weeks or micro‐

cycles.

A micro‐cycle is typically a week because of the difficulty in developing a training plan that does not

align itself with the weekly calendar. Each micro‐cycle is planned based on where it is in the overall

macro‐cycle.

EXAMPLE – LONG TERM RUNNING PROGRAM

The following is an example of a long term program for a client attempting a ½ Marathon in 6

months time. The following program is designed for a client who can train 1½+ hours per week and

had already completed a earlier program of general strength training and endurance training .

(Marathon Training program – Copyright Brianmac.co.uk)

All figures in the table are minutes. R is for Rest day.

Sample Classical Periodisation (Macro‐cycle)

PHASE > General

Conditioning

Strength Power Maintenance Active Recovery

Sets 2‐3 2‐3 3‐4 1‐2 1

Reps 8‐12 6‐8 3‐5 6‐10 10‐12

Intensity moderate high high moderate low

Volume high moderate low moderate moderate


Week MON TUES WED THUR FRI SAT SUN

1 20 R 20 R 25 20 25

2 R 20 25 R 20 20 20

3 R 25 20 R 20 20 30

4 R 15 R 25 R 15 25

5 R 25 15 R 30 15 40

6 R 25 15 R 30 15 30

7 R 20 30 R 30 15 45

8 R 25 30 R 30 15 40

9 R 30 25 R 40 15 50

10 R 20 28 20 28 R 45

11 R 40 25 40 25 R 60

12 R 45 25 20 25 R 50

13 R 40 20 30 25 R 65

14 R 45 25 40 25 R 60

15 R 45 20 40 25 R 70

16 R 45 25 45 20 R 65

17 R 45 25 45 25 R 75

18 R 60 25 50 25 R 70

19 R 50 30 45 25 R 85

20 R 50 25 50 20 15 75

21 R 60 25 50 15 15 90

22 50 50 25 25 25 R 85

23 50 60 25 60 25 R 100

24 R 60 60 60 25 R 40

25 25 R 25 20 R 40 15

26 25 15 10 R R R Race


PART C – PLAN & DELIVER EXERCISE TO CHILDREN &

ADOLESCENTS

CHILD POPULATION CLASSIFICATION

Children can be simply defined by their age, and can be broken down into categories within the

children population. A child can refer to any individual that is between 0 and 16 years old before

they are classified as an adult.

For the purpose of this module, the child’s age will be split into categories, as different aspects may

be relevant to children of different ages. However, the categories may change slightly throughout

the module, as references have been gained from different sources that have their own categories.

GROWTH STAGES OF CHILDREN

Throughout the life of a child, continual growth and development occurs, however there are

specific developments related to the age of a child. This module will address the physical, cognitive

and emotional developments that a child will go through, and identified at different points of their

childhood, and therefore will be broken down into age categories. These categories are; 0 – 3, 4 – 5,

6 – 8, 9 – 12 and 13 – 16 years old.

The physical, cognitive and emotional developments are described as:

Physical development ‐ The physical aspect of the child is the growth and development of

their body and structures within their body

Cognitive development ‐ This refers to the growth of the brain and brain function

Emotional development ‐ Emotional aspect relates to the mood and relationship with other

CHILDREN AGED 0‐3

Known as the infant years, development occurs rapidly in the primary 3 years in all aspects. The

changes that occur are:

Physical development


o height is likely to double

o weight is likely to triple

o the ability to consume solids with the growth of teeth

o develop the majority of their brain

o develop large motor skills – running, walking

o develop balance and co‐ordination

o learn to control bodily function such as going to the toilet

Cognitive development

o develop the ability to communicate with full sentences

o creativity and imagination begin to evolve

o imitate the behaviour and actions of signification others

o begin to understand the differences between genders

o retain and process information in their immediate environment

o develop more understanding of their senses – smelling, touching, tasting, seeing and

hearing

Emotional development

o develop rapport with a parent/caregiver

o build relationships with family members

o begin to demonstrate feelings such as love, anger, happiness, sadness

o emotions are shown physically rather than verbally

CHILDREN AGED 4 ‐ 5

The next years following the infants are between 4 and 5 years old and usually involve the child

attending preschool classes, where they are exposed to a wider variety of aspects that can

encourage development in many ways. These include:


o continue to grow at a slower rate than the first 3 years

o usually reach around half their adult height and a fifth of their adult weight

o develop fine motor skills

o brain continues to grow reaching 90% of its size

o respiratory system strengthens

o their limbs grow, improving proportional ratio to their body causing their baby appearance


to disappear

o immune system begins to strength giving better resistance to illness


o learn through playing or experiences

o begin to develop a bit of independence as they experience time away from

parents/guardian

o start to understand and adhere to rules

o develop understanding of simple health tasks like washing hands and brushing teeth

o become inquisitive and question more


o physical contact decreases with parents

o Remains dependant and requires reinforcement from parents.

o continue to show emotions in a physical manner rather than verbally

o develop relationships with other children

o given opportunities to socialise and communicate with other children

CHILDREN AGED 6 ‐ 8

During the ages of 6 – 8 years old, the child is attending full time school, and therefore are exposed

further learning, social experiences and a range of different characters and personalities. Changes

during this age group consist of:


o growth and weight continue but slows, however may experience a growth spurt throughout

these years

o increase muscle mass and strength

o adult teeth begin to develop, but appear out of proportion with face

limbs become correctly proportioned with their body

refine their gross and fine motor skills to be more specific to sporting and other activities

requirements


develop understanding of more complex concepts involved with attending school

other adults become significant in terms of the information that is provided to them

increase the attention and detail give to tasks


begin to understand about the past, future and present

understand about differences, and concerned about not fitting in

develop as an individual and personality wise

think for themselves, especially as a result of broadening their scope of knowledge

social ability progresses


develop feelings for people outside their family

can control and hide feelings

require love and support, but decrease in the level they show physically

develop complex emotions like confusion and excitement

require or want more privacy

showing signs of empathy and helping behaviours

CHILDREN AGED 9 – 12

Referred to as the preteen’s years, these are the last few years prior to the student reaching their

teenage years. This stage usually involves a rapid growth spurt and the child reaching puberty. As a

result their body is experiencing vast changes, which include:


o growth spurt usually occurs between these years

o the body begins to develop, genital maturation, voice deepens for males, hips widen in girls

and shoulder widen in boys. This may be accompanied with growing aches

o enter puberty, usually occur earlier with girls, boy may not occur til slightly later


o become increasingly independent

o improve their decision making and

o influenced greatly by significant others (important people in their life) and friends

o responsibility increases

o become exposed to media and


o want to fit in and not stand out


CHILDREN AGED 13 – 16

The last age category involves the child entering their teens. This stage is just before they enter

adulthood, so most growth and development has occur already. Changes occurring throughout the

teenage years include:


o Complete puberty

o Generally reached the majority of their height, there may be some additional growth in the

twenties, but not much.


o reach a mature cognitive stage. All information can be processed and analysed

o take control of their own lives

o still gain information and learn from peers


o have the ability to develop long‐lasting relationships with the same and opposite sex

o develop the ability to read their own feelings and act on them to modify these

HEIGHT GROWTH OF CHILDREN

The height growth of a child can be identified on the following graphs which are sourced from WHO

website. They show the average height of a male and female child at different ages through their

childhood up until 19 years old. The graphs indicate 3 values above the mean and then 3 values

below the mean for each gender.

o become self‐conscious and self‐centred

o more orientated around establishing relationships with peers

o experience mood swings

o may begin emotional feelings for the opposite sex

o may try to become detached and independent from family


SO HOW COULD GROWTH SPURTS BE PROBLEMATIC WHEN TRAINING CHILDREN?

During a growth spurt, children may be more prone to injury

The children may be more fatigued during growth spurts

Those who grow early become used to beating other peers and when they catch up often

drop out.

Those who start late often feel they can never do any good and so don’t start or give up

early.

Long bones in limbs grow from epiphyseal plates and these can be damaged from overload

or severe stress before full growth is attained.


EXERCISE, GROWTH AND DEVELOPMENT

By performing physical activity or exercise, it can help the growth and development of a child. The

type and method of activity may differ throughout the ages, but the benefits remain very similar.

The specific benefits of exercise for children will be explained in more details later in this module,

however the benefit on exercise and growth and development are as follows:

o Build social skills and development of communication and interpersonal skills

o Promotes positive behaviour and attitude

o Creates health environment for body systems to grow and adapt

o Encourages development of leadership and self‐discipline

o Teaches them how to deal with winning and losing

o Help teach children to treat individuals equally

o Help develop the personality characteristics of a child

o Create a health environment for body growth

MAJOR INJURIES

Injuries occur to any individual performing physical activity or exercise, and this is no different for

children. However, differences occur with the type of injury, which is predominant in children.

The majority of injuries that affect children consist of abrasions, contusions (bruises) and cuts.

These can be related to clumsiness and activities that children participate in.

The following section address injuries and conditions, which can affect children, some of which are

general and others are more specific to children. All conditions should

SPRAINS

A sprain is an overstretching of the structures around a synovial joint. This usually involves a sudden

elongation or twisting to the structures that hold the joint together – the ligaments and tendons. As

a result, fibres within these structures become torn which can occur at different extents. This

determines the severity and can be classified into grades – Grade 1, 2 and 3. These mean:

Grade 1 – a slight stretching of fibres and small amount (<10%) of damage

Grade 2 – partial tearing where between 10 – 90% of fibres are damaged

Grade 3 – a complete rupture of the structure where the majority or all fibres are torn.

Sprains can affect all ages and genders the same; however recover can occur at a different rate for

children due to their body undergoing so much development and growth.


The symptoms that accompany a strain usually revolve around the tearing of fibres and an

inflammatory response that occurs, which may involve; pain, swelling, heat, redness and bruising.

The symptoms will worsen according with the grade; will increasing symptoms the higher the

grade.

SEVERS DISEASE

Also known as calcaneal apophyitis, Severs disease can simply be described as heel pain that affects

physically active children. It commonly develops just before puberty and involves the growth plate

of the calcaneal bone being damaged following excessive stress or force being place on this area.

During growth, bones can develop quicker than muscles and tendon, causing restriction, tightness

and inflexibility around a joint. When this occurs in the heel, weight‐bearing activities can place

further stress on these structures, causing pain and inflammation to develop. This can then

breakdown the structures and further inflame the area, developing a continual negative cycle.

A child is at most risk of developing this disease during the early part of the growth spurt in early

puberty. This is usually 8 – 10 years old in girls and 10 – 12 years old in boys. This is combined with

the weight‐bearing intense activities, which place increase stress on the heel.

To find more information about this condition visit:

http://www.betterhealth.vic.gov.au/ and search ‘Severs Disease’

PATELLOFEMORAL PAIN SYNDROME

Patellofemoral pain syndrome is a term given to pain associated with the joint between the patella

and the femur bone. It usually involves irritation of the underneath structure of the patella that

causes roughness.

The patella usually glides smoothly in the groove of the femur head, but the rough posterior

surface, can cause friction between the two structures, that develops into inflammation and pain if

it persists.

The syndrome can be a consequence of:

o wide hips

o knock knees

o increase Q‐angle (angle between

the femur and line perpendicular

to the ground),

o tibial torsion

o pronated feet

o weak inner thigh muscles

o previous need injury.

It is usually recommended that an individual who suffers from this injury rests and avoids high

impact exercise. There are specific exercises can be implemented to help reduce the friction and

improve this condition. Advice from an allied health profession is recommended.



o http://www.patellofemoral.org

OSGOOD‐SCHLATTER DISEASE

Osgood‐Schlatter disease consists of an inflammation of the tissues that attach to the tibial

tuberosity. At this point, all four quad muscles converge into the patella tendon and attach to the

superior end of the tibial bone.

This disease most commonly develops at the beginning of rapid growth stages, which occurs

between 8 and 13 years old for girls and 10 – 15 years old for boys.

Predominantly affecting boys, the development of this disease is significantly influenced by the

level and type of activity being performed. Activities such as running, twisting and jumping that

works the quadriceps muscles puts individual at a great risk during their growing stages.

Muscles, bones and tendons can all grow at different rates creating stress on each structure,

especially the bones which develop slowest. Then, the accumulation of quadriceps dominant

exercises, places addition stress on the growth plate located on the tibial tuberosity. The build up

of stress leads to pain and inflammation and even micro fractures can develop around this area.

LEGG‐CALVE‐PERTHES DISEASE

This is a disease affecting the head of the femur in children. The ball‐shaped head loses its blood

supply temporarily, causing it to fracture easily and then heal poorly. In addition, the area becomes

inflamed and extremely painful during hip related movements.

The cause is currently unknown.

Legg‐calve‐perthes disease commonly affects boys between the ages of four and eight who are

physically active, and can be undiagnosed, with the pain being related to growing or activities.

Symptoms include:

o Limping

o Stiffness and pain around the hip, groin, thigh or knee

o Restricted ROM around the hip joint

It is a temporary condition, where children usually recover without permanent damage, however

caution must be taken with the joint so permanent damage does not occur.

Physical activity can be incorporated to help maintain the range of movement and stability around

the joint therefore revolves around flexibility and strengthen in exercises of the muscles around the

hip joint.



o http://www.leggcalveperthesdisease.org/

JOINT HYPERMOBILITY

This is a condition in which the joints of a child move easily beyond their normal range, giving them

the hyper‐mobile (or loose, double jointed) characteristic. Joint hypermobility is usually inherited,

where a specific gene is passed on from parents predisposing the individual to this condition.

The symptoms of this condition usually only involve the increase ROM of the joint.

In the majority of cases this condition does not cause problems. However, fitness professionals

should be cautious with this condition, as it can prove problematic for some sporting performance

or exercises, due to unstable joints.

Exercise can be adopted to increase the strength of muscles around the joint, which therefore

enhances stability and reduces the ROM at the joint.

RISK FACTORS OF INJURY

OVERTRAINING

Overtraining or burnout is a syndrome that can occur with any client and involves a client

developing negative symptoms when participating in physical activity.

Children can be extremely vulnerable to this condition, as a result of physical activity whilst their

body is undergoing growth and changes. This places excessively stress on the body causing it to not

cope, creating the following possible symptoms:

o Fluctuating mood or changes in personality

o Elevated resting heart rate

o Constant or unusual fatigue

o Lack of enthusiasm or motivation

o Decreased appetite/weight loss

o Increase illness, injury or infections

o Sleeping patterns change

o Persistent muscle or joint pain

o Decreased performance

It is important to understand when a child is experiencing overtraining or burnout so modifications

can be made to their physical activity routine. Modification can be made relevant to the cause of


the syndrome therefore it is just as vital to establish the contributing factors to this condition.

These may be:

o Constant high level of physiological or emotional stress ‐ other stressors external to physical

activity might be contributing

o Quick growth period

o Fatigue – poor sleep or recovery

o Low immune system

o Insufficient recovery time – this could be due to participation in multiple sports which have

overlapping seasons, no periodisation phases

o Inadequate dietary consumption ‐ poor awareness of nutritional requirements with sport or

physical activity participation

o High performance intensity – this may be a result of pressure from parent, high ambition

and determination from the individual.

Being aware of these elements can help prevent overtraining, and then modifications based on

these can be implemented to treat this condition. Therefore avoidance can be attempted via:

o Periodising training programs – have periods of intense training and then periods of

recovery or low intensity

o Cross training – to give some muscles groups rest, perform varying activities

o Concentrating on technique

o Gradually intensity increase

o Allowing proper recovery from events and injury/illness

o Educating nutritional needs

o Emphasising fun and enjoyment in children

INADEQUATE SKILL AND PHYSICAL PREPARATION

Often when children participate in physical activity on their own, it involves unstructured activities

like running and jumping, performed whilst playing around with friends.

It’s not until the child become older do they refine their physical activities to specific sports or

exercise. At this point they are new to the whole performance and therefore require education

about skills and requirements of the sport or exercise to prevent injury and boost performance.

Therefore it becomes the fitness professional’s tasks to education and prepares the child for the

activity to reduce any risk of injury.


RECOVERY AND FATIGUE

Recovery and fatigue is another factor, which can increase the risk of injury for an individual.

Recovery will be explained in greater depth during the programming section, but it is important to

understand its influence on injury prevention.

By not allowing muscles enough time to recover, especially for children that are growing, it creates

a stressful environment for structures to cope with constant physical activities. This continual stress

will eventually lead to the breakdown of structures causing injury.

Due to growth, children require longer recovery periods following physical activity or exercise.

THERMOREGULATION

Thermoregulation is the ability of the body to control the level of body temperature. In adults the

body is very efficient at control the temperature; however a child’s body is usually not developed

enough too efficiently and effectively regulate temperature. The child’s body usually has an

immature cardiovascular system, sweat glands, increased metabolic cost for activities and

increased core temperature which means they are more at risk of overheating. Children also

acclimatise slower than adults, meaning they are more affected by hotter climates. Fitness

professionals should understand children’s sensitivity to exercise and hot temperatures and plan

for increased rests and hydration.

HEALTH CONDITIONS SPECIFIC TO CHILDREN

DIABETES

Diabetes is a condition in which the body cannot control the level of glucose within the blood

stream.

At times of high blood glucose, the body will release insulin, which tells the body to transport any

additional glucose in the blood into storage. At times of low blood glucose, the body will release

glucagon, which informs the body to release glucose into the body for energy. These are two

hormones work simultaneously to control the readily available glucose levels within the blood. In

diabetes, the production of insulin is affected reducing the body’s capacity to control the glucose

levels.

There are two types of diabetes; type I and type II.

Type I diabetes involves the destruction of insulin producing cells located in the pancreas; therefore

the body cannot produce any insulin. As a result the body cannot control the blood glucose levels

and they remain elevated.

Type II diabetes involves the specialised insulin producing cells becoming inefficient at producing

insulin. Insulin is still produced but not at the rate required by the body. This level of insulin is

therefore not enough to control the blood glucose levels efficiently.


Children are most commonly affected by type I diabetes, with this type affecting 90‐95% of child

suffers.

OVERWEIGHT AND OBESITY

Overweight and obesity consider the body fat percentage of an individual, and both consist of

higher than normal body fat.

The following table indicates the BMI values for children of different ages; it identifies the healthy

weight range (equivalent to 25 in adults) and overweight classification (equivalent to 30 in adults).

BMI equivalent to 25 in adult BMI equivalent to 30 in adults Age (years)

Males Females Males Females

2 18.41 18.02 20.09 19.81

2.5 18.13 17.76 19.80 19.55

3 17.89 17.56 19.57 19.36

3.5 17.69 17.40 19.39 19.23

4 17.55 17.28 19.29 19.15

4.5 17.47 17.19 19.26 19.12

5 17.42 17.15 19.30 19.17

5.5 17.45 17.20 19.47 19.34

6 17.55 17.34 19.78 19.65

6.5 17.71 17.53 20.23 20.08

7 17.92 17.75 20.63 20.51

7.5 18.16 18.03 21.09 21.01

8 18.44 18.35 21.60 21.57

8.5 18.76 18.69 22.17 22.18

9 19.10 19.07 22.77 22.81

9.5 19.46 19.45 23.39 23.46

10 19.84 19.86 24.00 24.11

10.5 20.20 20.29 24.57 24.77

11 20.55 20.74 25.10 25.42

11.5 20.89 21.20 25.58 26.05

12 21.22 21.68 26.02 26.67

12.5 21.56 22.14 26.43 27.24

13 21.91 22.58 26.84 27.76


13.5 22.27 22.98 27.25 28.20

14 22.62 23.34 27.63 28.57

14.5 22.96 23.66 27.98 28.87

15 23.29 23.94 28.30 29.11

15.5 23.60 24.17 28.60 29.29

16 23.90 24.37 28.88 29.43

Table 1: Classification of overweight and obesity for children and adolescents

Taken from the Australian Department of Health and Ageing (http://www.health.gov.au)

The Australian Department of Health and Ageing identifies the following issues affecting children

that are overweight or obese:

Immediate adverse health problems Psychological dysfunction

Social isolation

Body dissatisfaction possibly leading to

eating disorders

Asthma

Adverse health outcomes which may

develop in the short term Gastrointestinal disorders

Cardiovascular

Endocrine and orthopaedic problems

Reproductive system abnormalities

Menstrual abnormalities

High intra‐abdominal adipose tissue

Type 2 diabetes

Hypertension

High cholesterol

Adverse health outcomes which may

develop in the intermediate term High prevalence of cardiovascular disease

risk factors

Tracking of cardiovascular mortality and

morbidity into adulthood

High level of C‐reative protein (may lead to

coronary heart disease)

Australian Department for Health and Ageing http://www.health.gov.au


Physical activity and diet are the two main influencing factors for an individual’s weight or body

composition. Exercise and to a small extent diet can be addressed by the fitness professional,

suggesting their importance in controlling this condition.

ASTHMA

Asthma is a disorder within the respiratory condition, where the pathways into the lungs become

inflamed following a hyper responsive reaction after a trigger. The bronchus and bronchioles are

hypersensitive structures that response negatively to a range of triggers, by producing an

inflammatory response. The triggers include:

o Smoke

o Allergies (including fur, dust mites and plants)

o Exercise

o Strong smells

o Extreme weather conditions (cold conditions)

o Stressing the respiratory system

o Crying or laughing

Asthma in children can occur in two different forms; intermittent asthma and persistent asthma.

Intermittent asthma can be further broken down into infrequent and frequent intermittent asthma.

Infrequent intermittent asthma affects the majority of children and involves children having short

episodes of asthmas symptoms that can last from 1 day to 2 weeks. This type is usually a result of

an upper respiratory tract infection or an environmental allergy. Episodes are usually 6‐8 weeks

apart.

Frequent intermittent asthma involves the child suffering from asthma in 6‐8 week stages following

short periods of minimal symptoms.

Persistent asthma affects roughly 5‐10% of child asthma suffers and consists of daily symptoms of;

wheezing and coughing that affects sleep, early morning tightness, exercise intolerance.

Like any other individual with asthma, children with this condition can respond well to exercise;

however as exercise‐induced asthma is most common for children, some modifications are needed.

Exercise must be performed at a very low intensity, not to entice the respiratory system into an

inflammatory response. Fitness professionals must also be aware of the environmental conditions,

ensuring the weather conditions or any allergens are present to also cause a reaction.


http://www.nationalasthma.org.au


ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD) (ATTENTION DEFICIT DISORDER

(ADD))

ADHD and ADD are classified as the same condition, with ADD being the old terminology.

ADHD is a neurological disorder affecting the behaviour and development of a child. There are 3

aspects of behaviour that can be affected with this condition, and determine the type of ADHD that

a child suffers from. The different aspects include:

Inattention – the inability to devote sustained focus and attention to a given task

Impulsivity – behaviour is sudden without thought

Hyperactivity ‐ constant elevated activity, and inability to concentrate

These changes can be as a result dysfunction in specific areas within the bran, particularly the

frontal lobe and the cerebellum.

Exercise or physical activity has positive affects on the brain as well as the rest of the body;

therefore it can provide beneficial responses to this condition.

Exercise stimulates the release of chemicals in the brain that are involved in transmitting nervous

impulses, such dopamine. By improve the stimulation of nerves in the brain can help with brain

function and improve attention (and even shown to reduce impulsivity). Interestingly, this is the

same response that occurs with ADHD specific medication.

In addition to the release of neurotransmitters in the brain, exercise also has the following

responses:

o Increase blood flow (children with ADHD are shown to have less blood flow to areas of the

brain responsible for; thinking, planning, emotions and behaviour)

o Develops more blood vessels within the brain

o Stimulates the brain section related to behaviour and attention

GENERAL AND HEALTH BENEFITS OF EXERCISE

The physical activity recommendation for a child is to participate in at least 60 minutes of exercise

that is moderate to vigorous intensity on a daily basis. In addition to this, the recommendations

suggest that children should not spend more than two hours each day using electronic equipment

with screens.

Physical activity has several benefits for everyone who participates and this is no different for

children. The specific benefits that related to children involve:


GENERAL BENEFITS:

Interacting with friends/making new social bonds – participating in physical activity gives

children the opportunity to make friends and form new social bonds.

Improve balance and coordination – even without specific training, physical activity can

improve balance and coordination of children, which can help with daily tasks.

Develop social skills – physical activity usually involves teamwork, which enables children to

develop these skills as well as the opportunity to socialise with a range of different children.

Learning and productivity – physical activity can be linked to improved learning outcomes.

Increase blood flow to the brain enables more nutrients delivered to the brain and therefore

improved cognitive performance.

Positive school environment – it creates a less aggressive environment at school with fewer

discipline problems.

Reduction in anti‐social behaviour ‐ children who are active are less likely to be involved in

anti‐social behaviour.

Improve sleep – by participating in activities can result in better sleep and restful nights.

There are several elements, which can influence sleep negatively, such as growing pains; this

can help combat those elements.

Develop confidence and self‐esteem – physical activity can give a child the opportunity to

come out of his shell and build self‐confidence and self‐esteem.

HEALTH BENEFITS

In addition to the general benefits there are a huge amount of health benefits, which are a result of

exercise. They have been identified by WHO, and are as follows:

Develop healthy musculoskeletal tissues – exercise keeps tissues and structures within the

body health. This can be due to the stress placed on the structures as well as constant use

and increased blood circulation.

Develop a healthy cardiovascular system – the cardiovascular system is one of the most

affected systems within the body. As it becomes stressed, it adapts and becomes more

efficient.

Develop neuromuscular awareness ‐ children are still developing their prioprioceptive skills

of where the body is positioned. Physical activity can help encourage this development.

Maintain a healthy body weight – physical activity burns calories and therefore uses up

some of the energy that the body is storing, helping maintain or reduce fat levels.

Mental health ‐ improves mood as well as concentration skills and ability to manage anxiety

and stress. It also improves attention ability

Emotional wellbeing ‐ helps children feel more confident, happy, relaxed, improve self‐

esteem and self concept, sense of belonging, ability to sleep better, self expression and the

opportunity to achieve.


Develop healthy posture – physical activity can help develop muscles all over the body,

many of which are responsible for maintain posture, as a result posture can be improved.

More information on the benefits of exercise for children can be found:

http://www.healthykids.nsw.gov.au

PRE‐EXERCISE SCREENING AND TESTING

PRE‐EXERCISE SCREENING

As with all other clients the purposes of the pre‐exercise screening remain very similar for children

as they do any other client. These include:

o Identify contraindications

o Build rapport

o Understand likes and dislikes

o Initial assessment tool

o Measurement point

o Identify posture abnormalities

o Establish goals

o Tailor the exercise programme

Identifying contraindications still remains one of the most important elements, when completing

this with children; however emphasis during this process with children can be dedicated to building

rapport and understanding their likes and dislikes.

The process of the pre‐exercise screening is completed during an interview, where a questionnaire

gathers the following information:

Current medical conditions

Medical history

Medication

Lifestyle evaluation

Exercise history

Injury history

Fitness and health goals

Exercise likes and dislikes

Parent/guardian signature


Additional info – this process might be useful to be completed with a family member, this is so

the information gained is accurate. A child might not understand or know they suffer from a

specific health condition, which a parent or guardian will be able to provide details about.

WHAT TO DO WITH THE INFORMATION FROM A HEALTH SCREENING

Completing the pre‐exercise screening questionnaire is only part of the process; the next stage is to

understand how to use the information gathered. There is no point gaining this information and

then ignoring what the client has provided.

Use health and medical information to determine contraindications – the majority of the health

and medical information is used to determine any contraindications the child might have. It is

important to gain as much information regarding any health conditions the client possesses. Any

current conditions must be referred onto an allied health professional, so they can give permission

to client to participate in an exercise program.

If you are unsure whether a conditions is a contraindication or not, it is best to act on the side of

caution and recommend them to seek permission from an allied health professional.

The allied health professional will provide a letter to the fitness professional identifying whether

exercise is advisable and at what intensity.

Use client’s needs and the fitness tests to create training objectives and goals – once it has been

established that the client can participate in an exercise program (no contraindications), the

program can be created. This program should be designed around the needs and objectives of the

client. This element may be dependant on the age of the child and the activity that they perform.

For example, a child 4 years old might just want to perform exercise for fun, however a child aged

13 years old might be competing in tennis match and have need specific objectives.

Create an enjoyable and fun program – children often participate in exercise or physical activity for

enjoyment. By completing the pre‐exercise screening process, activity likes and dislikes can be

established and therefore the program can be orientated around these to help enjoyment and

ultimately adherence. This is particularly relevant for the lower end of the age category.

FITNESS TESTS

The next step in the overall pre‐exercise screening is Fitness testing. Fitness tests can be broken

into two categories; general fitness tests and component specific tests.

However, within this special population, children age can range from 3 years old up to 16 years old.

As a result, the tests can be adopted for this group can be very limiting due to development and

growth, especially in the lower spectrum.

It is suggested that the clients who are below the age of 12 years old that only the basic health

related fitness tests are performed. This is because:


o Fitness scores are unreliable under this age

o Children under this age have little understand of the meaning of component related fitness

tests

o Performance of these tests can range dramatically from day to day dependant on attention,

interest and motivation

o It is more important to base training on enjoyment and fun rather than weaknesses in

component specific fitness

Children who are above this age can participate in health related and component specific tests,

especially if they are competing in sports and are training to increase their sporting performance.

Like any other client, it can give the fitness professional some basis to create a program around.

The health related tests that can be used for all children are:

BMI or Body Mass Index

Heart Rate

Blood pressure

Specific component related fitness tests that are relevant to children in the higher end of the age

category are:

Beep Test (cardio‐respiratory)

Flexibility (sit and reach)

Illinois agility run (agility)

Balance test

Push‐up test (upper body strength)

Standing vertical jump (lower body power)

BMI OR BODY MASS INDEX

This is a test to determine whether the child is classified as underweight, healthy weight or

overweight and involves using the child’s height and weight. It is calculated by dividing the weight

in kilos by their height in meters squared:

BMI = Weight (kg)

Height (m2)

The value can then be applied to the following the World Health Organisation (WHO) charts (an

individual one for each gender), which identifies the status of the child BMI.


Taken from WHO (http://www.who.int/en/)

HEART RATE

The resting heart rate is a great indicator for cardiovascular health of an individual. It determines

how efficient the heart; lungs and vascular system are at delivering the required amount of oxygen

and nutrients to cells around the body. It can be used at rest, or throughout exercise to determine

how intense an individual is working.

The resting heart rate of a child varies according to their age; the following table shows the average

resting heart rate values for different children’s age and gender:


Ages years Resting HR Range (BMP)

Newborn (0 years) 70 – 190

1 – 2 80 – 130

3 – 4 80 – 120

5 – 6 75 – 110

7 – 9 70 – 110

10+ 60 – 100

This table gives an indication of the healthy range that children should fall within for specific ages.

The lower end of the spectrum can indicate a healthier and more efficient cardiovascular system,

and the higher end can indicate the opposite.

Blood pressure

Blood pressure is another health measurement that can also indicate the healthiness of the

cardiovascular system. It determines the pressure that is being exerted on the arteries during two

phases of the heartbeat – the systolic and the diastolic. The systolic measures the pressure on the

arterial walls during the contraction of the left ventricle (as the heart pumps blood out) and the

diastolic measures the pressure of the arterial walls during the rest of the left ventricle (as the heart

pumps blood into the left ventricle in preparation to be pumped out). The process of recording the

blood pressure is exactly the same for all clients; however, the results can be dependant on the age

of the individual. The following table indicates average blood pressure values according to age and

gender; further classification can be made according to the child’s height.

GIRLS BOYS Age Systolic (mmHg) Diastolic (mmHg) Systolic (mmHg) Diastolic (mmHg)

3 100 61 100 59 4 101 64 102 62 5 103 66 104 65 6 104 68 105 68 7 106 69 106 70 8 108 71 107 71 9 110 72 109 72 10 112 73 111 73 11 114 74 113 74 12 116 75 115 74 13 117 76 117 75 14 119 77 120 75 15 120 78 120 76 16 120 78 120 78


Reading

For a more details chart please see the extra reading sections – A Pocket Guide

to Blood Pressure Measurements in Children

Any readings, which are obtained outside the indicated values, can be classified as hypotension or

hypertension, depend on whether they are above or below and the amount they are different.

SPECIFIC COMPONENT RELATED FITNESS TESTS

Component related fitness tests can be used for a number of reasons which include:

o As a screening tool

o As an assessment tool

o A prediction tool

o Monitoring tool

BEEP TEST (MULTI‐STAGE FITNESS TEST)

The beep test measures the VO2 max without the use of high tech equipment. The test progresses

through stages, which are related to an estimate of VO2 max. VO2 max identifies the body’s ability

to take in and utilize oxygen

The purpose of the test is to run between markers 20m apart for as long as possible, within the pre‐

recorded beeps. The beeps indicate the point at which an individual should be at each marker and

goes from level 1, requiring 9 seconds between the markers, to level 21, which requires 3.89

seconds per markers. Level 1 requires a speed of approximately 8.5km per hour, where level 21 is

approximately 18.5 km per hour.

The beeps are pre‐recorded; therefore this test requires a CD player.

FLEXIBILITY (SIT AND REACH)

The sit and reach test measures the flexibility of the hamstrings and the lower back.

It is performed by the client sitting on the floor with one leg stretched out straight and the other

bent with the sole of the foot touching the inner thin. The outstretched leg is pressed against a

solid structure, and then the individual reaches as far down the leg towards the foot with both

hands. Either the distance from the fingertips to the foot or the overlap of the fingertips of the foot

is measured, producing a plus (+) or minus (‐) score. When the foot is not quite reached the score is

plus and if the fingertips go passed the foot the score become minus.


ILLINOIS AGILITY RUN

The Illinois agility test involves the client running round a course

marked out by cones, requiring quick reaction, sprinting and rapid

direction changes.

The cones are set up as indicated in the diagram. Once ready, the

individual lays prone by the start point, on the command ‘”go”

the individual jumps up and begins running round the cones as

shown in the diagram. The time taken for the individual to reach

the finish point is recorded.

PUSH‐UP TEST

The push‐up test involves the client performing as many push‐ups in a 30 second period. It can be

completed as a normal push‐up with hands and feet on the floor, or can be made slightly easier by

raising the level of the hands and complete it on a bench or chair.

STANDING VERTICAL JUMP

The standing vertical jump is used to measure the lower body power of a child.

This test is performed by the child standing with their dominant shoulder facing a wall. In this

position they reach up with the arm closest to the wall and mark with chalk the highest point

without raising any part of their foot off the floor. Then individual then jumps as high as possible

and marks another point on the wall at the highest point of their jump. The measurement between

the two markers is recorded, follow a couple of attempts.

LEGALITIES OF WORKING WITH CHILDREN

Working with children is slightly different for fitness professionals as it involves working with a

special population who are vulnerable. To ensure that the child is protected and their wellbeing is

put first there is elements that a trainer must be aware of.

YOUR RESPONSIBILITIES AS A TRAINER

A fitness professional who would begin to train children or young adolescents must:

Hold appropriate qualifications

Hold a current Senior First Aid/CPR Certificate

Have had a Working with Children Check

Hold Professional Indemnity and Public Liability Insurance

Have read and understood relevant child protection legislation pertinent to your

state/territory

I k f h // b i k


Have read and understood privacy of information legislation relevant to your state/territory

Have read and understood any Duty of Care policies related to your workplace

Hold appropriate Fitness Industry Professional Registration according to state & territory

Codes of Practice

Be able to evaluate and apply a pre‐exercise screening tool in relation to the provision of

physical activities for children and adolescents

Gain a basic understanding of a range of common Special Needs of children and young

adolescents.

Be able to select and apply fitness and assessment protocols

What qualifications and requirements will I need to instruct children?

o Certificate III and IV of Fitness with the special unit for training children

o A current CPR and first aid certificate

o Insurance

o Working with Children Check

WORKING WITH CHILDREN CHECK

There are some things that employers and self‐employed people must do by law to help keep

children safe and reduce the risk they are exposed to.

A Working with Children Check must be completed within the state the fitness professional works

within. This check is a background check investigating an individual’s criminal history ensuring they

are suitable to work with children. This can be completed may be processed by an employer or

directly by the fitness professional.

Self employed people, such as personal trainers, must get a Certificate for Self Employed People in

child‐related employment that proves they are not banned by law from working with children.

A certificate is still required if:

o An individual is self employed

o An individual works in one of the settings defined in the Commission for Children and Young

People Act 1998 as child‐related work settings

o An individuals work requires that you have direct unsupervised contact with children (under

18)

o The trainer is over 18

If you meet these criteria, the Commission for Children and Young People Act 1998 requires you to

obtain a Certificate for Self Employed People in Child‐Related Employment and either display it at


your workplace, or present it for inspection by people engaging you to work with children. You can

be fined $2,200 if you do not comply with this law.

The Working with Children Check consists of two elements:

Excluding people with convictions for serious sex and violence crimes against children.

Background checking for preferred applicants for primary child‐related employment,

ministers of religion and authorised carers.

A working with Children Check is specific to each state, where an individual check and legal

requirements are implemented. The following table explains the check for each state:

State/Territory Legal Requirements

Australian Capital

Territory

Under new rules in the ACT, people who work with children and vulnerable adults

must register with a Statutory Screening Unit.

New South Wales The NSW Commission for Children and Young People is responsible for the

Working with Children Check, which helps determine whether people are suitable

to work in child related employment.

In 2013 a new Working with Children Check started in NSW under the new check:

Workers and volunteers will apply for their own check once every five years

Employers will verify a child‐related worker's or volunteer's clearance

number

The same Working With Children Check will apply to everyone

Everyone with a clearance will be continuously monitored for serious sex or

violence offences.

Northern Territory In the NT it is mandatory for people who have contact or potential contact with

children to hold a Working with Children Clearance Notice and an Ochre Card.

SAFE NT administers the clearance procedure which involves an employment and

criminal history check. People who have previously had a Criminal History Check to

work with children will still be required to apply for the Working with Children


Clearance if they work certain specified areas of employment.

Queensland In Queensland people working or volunteering with children need to hold a Blue

Card.

South Australia Under the Children's Protection Act (Section 8B) people in SA who work in jobs

which require regular contact with children are required to obtain police clearance

before they commence employment.

Tasmania Currently there are no legal requirements for people working with children to

undertake a police check in Tasmania, however, organisations which require

employees and/or volunteers to work with children may have their own policies in

this regard.

Victoria The Victorian Government has a Working with Children Check, which is compulsory

for people who wish to work with or volunteer with children.

Western Australia In Western Australia a Working with Children Check is compulsory for people who

carry out child‐related work in Western Australia.

Care For Kids ‐ https://www.careforkids.com.au/articlesv2/article.asp?ID=82

PERSONAL RESPONSIBILITIES OF THE FITNESS

PROFESSIONAL

DUTY OF CARE

You, as an exercise professional, have a duty of care to children and young adolescents under your

supervision.

The main consideration is a duty of care to the child (and the parent/guardian/carer). Essentially

this is no different to the duty of care when training adults.

Duty of care would include consideration of the following: (this is not a definitive list)

Location

Activity type

Number of children in the session

Medical considerations for each child

Environmental conditions such as heat and humidity


Etcetera….

PRIVACY LEGISLATION

You must remember that it is your responsibility as a professional to use this information under the

relevant state and territory Acts.

An important Act to familiarise yourself with is the Privacy Act. The act for each state and territory

is different and each can be found at:

www.oaic.gov.au/privacy/privacy‐act/the‐privacy‐act

Or search privacy rights on the following website ‐ www.oaic.gov.au

This is an informative website which has all the relevant documents for your state or territory.

The National Privacy Act provides 10 privacy principles regarding the collection, handling and

storage of health information. It also provides a general right of access of individuals to their own

health records, and requires health service providers to clearly set out their policies on

management of personal information to the client/individual.

CHILD PROTECTION LEGISLATION

Before you begin training children or adolescents you will need to check and understand the Child

protection legislation in your state or territory.

Child protection legislation principles reflect the service goals to which governments aspire. They

also provide the legal framework according to which governments can intervene to protect

children. The legislation in each state and territory differs.

The Australian Government website has many helpful documents and links. The legislation comes

under the National Child Protection Clearing‐house.

It is important for you to be clear about how all these legislative requirements impact on your role

and responsibilities.

RISK & SAFETY

The recommended Staff/Child Ratios for structured or supervised programs in centres according to

the Fitness Australia/Children’s Hospital at Westmead “Kids in Gyms” document, 2003 are:

1:25 – That is, 1 instructor for every 25 children when conducting supervised or structured

group fitness classes. This includes weights and non‐ weights fitness classes and circuit

weight training classes. (This ratio may be exceeded on the proviso that for each increment

between 1 and 25 children over the initial class size of 25 students, there must be one

additional class instructor present).

1:8 ‐ 1 instructor for every 8 children when conducting supervised or structured resistance

training sessions.


For school groups a teacher must be present at all times in addition to the instructor.

Major factors associated with injury risk in children and adolescents include:

A biomechanics/exercise technique

Fatigue/recovery

Intrinsic factors of activities

Benefits of warm–up and cool–down for children not addressed

Inadequate skill

Inadequate physical preparation

Over‐training

Unrealistic expectations/pushy parents

INSTRUCTIONAL SKILLS AND CHILDREN

When considering instructional skills for children it is important to consider all these factors:

Class Structure

Psychological Benefits

Performance

Communication Skills

CLASS STRUCTURES

When designing classes for kids you need to think about the type and delivery of the following:

o Written class formats

o Sequence of exercises

o Importance of transitions between exercises or games

o Use of equipment

o Class structure variations

o Safety perimeters within the class structures

o General training principles and progression

PSYCHOLOGICAL DEVELOPMENTS

When training children you must always remember that psychological benefits are equally

important as health benefits. For example:

Changing the negative perception of exercise in both children and their parents


Exercise options available to families within the community

Improving self esteem and confidence through exercise

It is therefore necessary, that your training techniques should also incorporate aspects of

psychological development.

DELIVERY PERFORMANCE

Your performance skills can be the difference between a great training session and an average one.

Consider the areas of performance:

o Group activities

o Fun through movement

o Creating atmosphere

o The art of performance

o Use of themes

o Presenting and utilising instructor personality

o Appearance

COMMUNICATION SKILLS

Communication skills are vital for a good fitness professional training any individual. However,

training children can require more understanding of the child communication requirements.

Communication can come in two forms, verbal and non‐verbal communication.

Verbal communication ‐ the most basic and simplest form of communication and involve the voice

and speaking.

Non‐verbal communication – this involves all other communication that is not verbal, including

body language, tone, pitch and volume, facial expressions, eye contact, gestures, body movement

and posture.

Both these forms of communication need to be adjusted when training children, as a result of their

understanding varying according to their age. This is more important for non‐verbal

communication, which is often not recognised by a child in the lower end of the child age spectrum.

As a child progresses towards adulthood, they become more aware of this type of communication,

but still may misunderstand elements. This may result in poor understanding of requirements or

directions or loss of attention

Before looking at the specific requirements for different aged children, simple changes to

communication methods are identified:

o Use appropriate use of language


o Talk slowly so all children can understand

o Face the child/children when talking to them

o Communication should be positive and strength based

o Communication should address the needs and abilities of all

o Use the child’s name first

Communication must be specific to the age and development of the child; otherwise the likelihood

is that it will be ineffective or misunderstood. The different communication factors to consider for

children of different ages are as follows:

0 – 6 YEARS OLD REQUIRE:

o The use soft tones

o The use simple language

o Command to be repeated

o Tone, pitch and pace of voice to vary to maintain attention

o Question and answer interactions

o The use non‐stereotypical gender language

o The majority of reinforcement to be positive reinforcement

They also:

o Often mimic and adopt language from parents or significant others

7 – 10 YEARS OLD CHILDREN:

o Begin to understand complex words and sentences

o Can gauge the meaning of different tones, pitch and volume of voice

o Begin to respond to positive and negative reinforcement

o Use more advanced words following increased exposure

11 – 16 YEARS OLD CHILDREN:

o Begin to communicate like an adult

o Develop full appreciation for verbal and non‐verbal communication

o Respond fully to positive and negative reinforcement


INCLUSIVE LANGUAGE

It is important to use language that is inclusive and meaningful to children depending on their age,

developmental style and culture. Your language should never exclude a child. Some of the things

we should avoid are:

o Slang

o Sarcasm

o Jargon

o Stereotyping

o Gender typing

ASKING QUESTIONS

When asking questions of children, they will need time to form their responses and to express their

ideas and thoughts. They will also need differing levels of support and encouragement.

LISTENING

Listening to children is very important. They may feel unsettled or distrustful if you are not actively

listening to what they say. Ensure that your whole body and face are directed physically toward the

child. You may also need to sit or bend down so that you are at their eye level (or close to their eye

level).

There will be times when it is not appropriate for you to listen, for instance, in the middle of a

game. If a child attempts to interrupt you from a conversation you are already having with

someone else, you need to acknowledge them in some way, even though it is not appropriate for

them to interrupt.

In this situation, politely excuse yourself for a moment, and acknowledge that you have heard the

child and explain briefly that you will attend to them once you have finished your conversation. This

teaches a child to be patient and communication manners.

TIPS TO GET CHILDREN TO LISTEN TO YOU

1. Stay Brief

We use the one‐sentence rule: Put the main directive in the opening sentence. The longer

you ramble, the more likely a child is to become bored.

2. Stay Simple

Use short sentences with one‐syllable words. Listen to how kids communicate with each

other and take note. When a child shows that glazed, disinterested look, you are no longer

being understood.

3. Ask a Child to Repeat the Request Back to You


If he can't, it's too long or too complicated.

4. "When...Then."

"When you have your sunscreen on, then we can start the soccer match". "When," which

implies that you expect obedience, works better than "if," which suggests that the child has

a choice when you don't mean to give them one.

5. Give Choices

Would you like to play a game of volleyball or baseball?

6. Write It

Without saying a word you can communicate anything you need said. Draw a diagram of

how you would like the game to work. Use cartoons or funny stick figures to make it more

interesting.

GIVE CONSTRUCTIVE FEEDBACK

As the instructor for a session, there will be many times when you will give feedback to participants

and/or their parent/guardian/carer. When directing feedback to a child, it is good, to be very

positive and provide constructive feedback, so they remain upbeat about the activity. Non‐

constructive feedback can be detrimental to the rapport that you might have built with the client.

Timing is crucial when providing feedback. It is best if it is immediate as it will be more clearly

understood and have greater effect.

Here are some examples which identify the difference between constructive and non‐constructive

feedback:

Constructive feedback Non‐constructive feedback

“Johnny its best to stand with your feet

wider apart”

“Don’t do it like that Steve”

“Great job Anna, just to increase the pace a

little”

“Can’t you go any faster Lucy?”

“Your technique is brilliant Helen, don’t

forget to keep your back nice and straight”

“No, that’s wrong Chris, this is how you do it”

“Lovely posture Lisa. Just make sure your

knees are slightly bent. That’s it, well done.”

“Jan, I told you not to do it that way – it’s

dangerous”

“Well done Amy, you are using that

equipment correctly”

“Don’t hold the bar like that Ben”


“Follow my lead – watch how I bend my

knees”

“Everyone in this class is slack. You are not

trying your hardest”

“Fantastic effort everyone, lets take a 5

minute break to grab some water”

“Stop now everyone. Go and grab a drink”

“I would like everyone to have a chance to

use this equipment.”

“Don’t hog the equipment, let everyone have

a go!”

RESPECTING SIMILARITIES AND DIFFERENCES

It is important to always respect both the similarities and differences of children and to encourage

them to be respectful of these also.

Encourage children to talk about their likes and dislikes, hobbies, interests and anything else that

encourages them to communicate with you. This can also help you shape activities that they will

enjoy and be happy to participate in.

RESPECTING COMMUNICATION STYLES OF DIFFERENT CULTURES

Working in the fitness industry means that you will interact with children and adolescents from a

wide variety of cultures and backgrounds.

It is essential that you expand your awareness and understanding of different cultures in order to

form better relationships with the children you train. This will also help them feel included and

welcome.

In order to communicate effectively and respectfully with children, you must be mindful of the

language you use. Avoid potentially confusing language habits, such as the use of sarcasm or slang.

SUPPORTING CHILDREN WITH DECISION MAKING

It is important to provide opportunities for children to engage in decision making. This may involve

asking for input in designing a circuit, asking a child to think of a game for a warm up or even

leading the group in the performance of an activity.

A child’s age will affect their ability to make decisions. Listening to children and asking open

questions can assist them in the process of developing and ordering their thoughts and ideas.

While we need to provide opportunities for children to explore making decisions for themselves,

there are some important things we need to take into account:

o The child’s safety and that of others

o Whether we have the resources (equipment, time and staff) needed to act on the decision

o Whether we can budget for it if it is to cost money


o Whether we have the space or location that may be required

o Whether the decision complies with our ‘Duty of Care’ obligations

o Whether it is in accordance with centre policies and procedures

If we meet a hurdle in implementing what the child has decided they would like to do, then this is a

great opportunity to engage their problem solving skills and explore alternatives. We can ask

questions designed to direct and assist children to come up with a new, and hopefully more

appropriate, suggestion or decision.

Acknowledging what a great idea the child had, and then clearly explaining why we may not be able

to implement it will help the child feel heard and understood. They can then take ownership of

deciding how we can overcome the problem, which was encountered.

Once the child has a clear plan about what they would like to do, we can continue facilitating by

providing or directing them to materials and resources which will help them to execute their ideas.

It can be tempting for the adult to take over and control the project, but we must allow

opportunities for the child to be part of the process. The adult can provide input from their own

repertoire of ideas and suggestions to extend the children.

PROMOTING POSITIVE BEHAVIOUR

The key to promoting positive behaviour with any person and especially with children is to form

positive relationships with them.

There are many ways to do this, including communicating with respect and sincerity, and providing

activities to encourage positive interaction. Offering children a suggestion of what they should be

doing, rather than what they shouldn’t be doing, will give them a clear message of what you require

of their behaviour.

For example, instead of saying ‐ 'DON’T RUN INSIDE'

We could say ‐ 'PLEASE WALK INSIDE'

It is important to always convey clear expectations to children. It is much harder to have to deal

with negative behaviour once it arises than to foster positive behaviour through praise and positive

reinforcement.

Ensure that you encourage students by recognising their efforts and appreciating their

contributions. Some of the ways you can do this are:

Verbal praise and attention

Appropriate physical contact (e.g. pat on the back or high 5)

Providing opportunities to be involved (e.g. you did a great job collecting those skipping

ropes, could you be my helper next week?)


Rewards such as activities or games

Rewards such as stickers or certificates

LIMITS AND GUIDELINES

From time to time you will find that you need to impose limits and guidelines. These may include:

Rules (yours or those of a centre you might work in)

Out of bounds areas

Expectations about behaviour

Procedures for health and safety.

COLLABORATING WITH CHILDREN

Discussions about likes and dislikes, or similarities and differences can be a great help for children

to get involved and to learn to cope with situations that they don’t like.

Young children often give clues about what their interests are through their choices in play, so by

simply observing them we can find out lots about their individual preferences and interests.

With older children we may need to use different techniques such as:

o listening

o discussing/talking

o questioning/asking

o body language

o negotiations

When asking children questions, we can structure our questions to encourage them to express their

ideas, and to consider new ideas. Sometimes what interests children can be fairly obvious, at other

times more investigation, time and encouragement may be needed. We can make sure there is

time and opportunity for this by planning blocks of sufficient time in our sessions. For instance we

could conduct a group discussion at the start of training or use it at the end to help determine the

next session.

RESPECTING SIMILARITIES AND DIFFERENCES

It is important to always respect both the similarities and differences of children and to encourage

them to be respectful of these also.

Encourage children to talk about their likes and dislikes, hobbies, interests and anything else that

encourages them to communicate with you. This can also help you shape activities that they will

enjoy and be happy to participate in.


RESPECTING COMMUNICATION STYLES OF DIFFERENT CULTURES

Working in the fitness industry means that you will interact with children and adolescents from a

wide variety of cultures and backgrounds.

It is essential that you expand your awareness and understanding of different cultures in order to

form better relationships with the children you train. This will also help them feel included and

welcome.

In order to communicate effectively and respectfully with children, you must be mindful of the

language you use. Avoid potentially confusing language habits, such as the use of sarcasm or slang.

SUPPORTING CHILDREN WITH DECISION MAKING

It is important to provide opportunities for children to engage in decision making. This may involve

asking for input in designing a circuit, asking a child to think of a game for a warm up or even

leading the group in the performance of an activity.

A child’s age will affect their ability to make decisions. Listening to children and asking open

questions can assist them in the process of developing and ordering their thoughts and ideas.

While we need to provide opportunities for children to explore making decisions for themselves,

there are some important things we need to take into account:

o the child’s safety and that of others

o whether we have the resources (equipment, time and staff) needed to act on the decision

o whether we can budget for it if it is to cost money

o whether we have the space or location that may be required

o whether the decision complies with our ‘Duty of Care’ obligations

o whether it is in accordance with centre policies and procedures

o If we meet a hurdle in implementing what the child has decided they would like to do, then

this is a great opportunity to engage their problem solving skills and explore alternatives.

We can ask questions designed to direct and assist children to come up with a new, and

hopefully more appropriate, suggestion or decision.

Acknowledging what a great idea the child had, and then clearly explaining why we may not be able

to implement it will help the child feel heard and understood. They can then take ownership of

deciding how we can overcome the problem which was encountered.

Once the child has a clear plan about what they would like to do, we can continue facilitating by

providing or directing them to materials and resources which will help them to execute their ideas.

It can be tempting for the adult to take over and control the project, but we must allow


opportunities for the child to be part of the process. The adult can provide input from their own

repertoire of ideas and suggestions to extend the children.

PROGRAMMING

Creating a program specific to the child population can be different to that of an adult, and is

majorly dependent on the age of the child. As explained earlier, the age of a child can very from 3

years old up to 16 years old, so the physical activity requirements and needs vary dramatically

between these two ages. For the purpose of this section, children will be spilt into categories, which

are 3 – 5, 6 – 9 and 10 – 16.

The different reasons that children may participate in physical activity or exercises can be broken

down into the age categories and are as follows:

3 – 5 YEARS OLD

Fun and enjoyment playing

As a way of learning about their environment

6 – 9 YEARS OLD

Enjoy sporting activities

Make friends

Begin to participate due to competition

10 – 16 YEARS OLD

Improve sporting performance be competitive

Be social with friends

Improve physical appearance

Physical activity recommendations from the Australian Department of Health and Ageing for

children are given in slightly different age categories but are as follows:

Age group (yrs. old) Activity recommendations

3 – 5

The entire day should be punctuated with periods of rest and physical

activity. Aim for a total of 3 hours of activity throughout the day involving

activities such as walking, playing, as well as vigorous activities.

Inactive periods of more than 1‐hour duration should be avoided.

5 – 12 60 minutes of physical activity that includes moderate and vigorous

intensities.


12 – 18 At least 60 minutes of physical activity. Three to four times a week the 60

minutes activity should include 20 minutes of vigorous intensity activities.

Moderate activities –that enable the child to talk comfortably. This could include brisk walking,

casual cycling etc.

Vigorous activities – activities that make the respiratory system work creating the out of breath or

‘huffing and puffing’ feeling. These may include sporting activities such as football, netball,

swimming or running.

For more information, please visit the following website:

http://www.health.gov.au

PLANNING THE PROGRAM

Like all exercise programs, a program designed for children should still contain all the three

important components, which are:

o Warm up (preparation phase)

o Conditioning Component

o Cool Down (recovery phase)

However, when it comes to the finer details of each component, they can be different for a child

than any other client but will be dependant on age. The following sections will indicate how each

component is individually different when planning exercise for a child.

WARM‐UP

The purpose of a warm‐up is to prepare the body for the forthcoming activity, and this is no

different for children. Therefore the aim remains to:

Increasing the blood flow (to muscles);

Increase the delivery of oxygen and nutrients to the muscles for metabolism and

Improve lubrication around synovial joints.

Increase core temperature

Increase CNS activity

Older children who are involved in competition may use a warm up to prepare mentally.

A normal warm up usually contains components of aerobic activity, range of motion or flexibility

and then sport specific elements. This can still remain very similar for children, however, should


revolved around games that provide enjoyment. As a result, the child is likely to achieve the desired

affects and adhere to the activity rather then lose interest and get bored easily.

Although games can be implemented for the majority of children within this age group, it can differ

for older children that participate in sporting events. These children can be more focused on

performing the warm up to achieve the desired affect, rather than for enjoyment. Therefore they

can perform a normal warm‐up the same as an adult, this involves structured components

consisting of the 3 stages:

1. Aerobic exercise to raise heart rate (roughly 5 minutes)

2. Range of motion or Flexibility training (roughly 3‐5 minutes)

3. Program or exercise specific warm up (roughly 2 minutes)

For the younger children the warm‐up games can consist of an activity that encourages the children

to perform an aerobic activity.

Game #1 ‐ Fitness Bingo

This game is played just like regular Bingo but exercises are added.

First you need to designate each letter in the word B.I.N.G.O.

For example the letter “B” =10 Star jumps, “I” =5 high knees and “N” = 5 sit‐ups.

What happens is if when a BINGO number is called out and the player does NOT have that

number on his or her board then they have to do that designated exercise.

Game #2 ‐ Warm up Obstacle Course

This is something that can easily be done outside, inside or both.

Simply set up a fun course and run through it. It will be best to time the course to see if they

can improve with each attempt.

Game #3 ‐ Bowling Pin Relay

This is a game that involves a lot of running and some throwing skill as well.

Take some plastic toy bowling pins or some plastic cups will do the trick.

Place 5 or so in a row spread apart by about 3 feet.

Take a football or some other ball and run up to a designated spot about 15 feet from the

row of pins and attempt to knock one pin down at a time.

After each throw attempt the thrower must gather up ball and run it all the way back to a

starting line some 25‐35 feet behind the throw line.

This is a great game for a larger group but can work with even just one player against the

clock.


Game #4 ‐ Timer Games

Timer games can be a wide range of games.

When the timer goes off the one holding the ball is out.

In this case you can play by setting a timer and start by doing 10 star jumps.

Then it is the next persons turn to do the jumping jacks.

Go fast as you don’t want to be the one exercising while the timer goes off.

Think of any type of movement and this game will work.

Game #5 ‐ Builders and Bulldozers

You will need many plastic or paper cups for this game.

Take your cups and spread them out in an open surface.

Place half of the cups on their side and the other upside down.

Designate a time limit and break the players into two teams.

One team is the builders and will be setting the cups upright and the bulldozers will be

knocking them down with their hands only.

The object of the game is to be the team that has either built or knocked down the most

cups in the designated time.

Game #6 ‐ The knee Tap

Break up into pairs and face your partner.

Each person attempts to touch one of the knees of their partner without being touched on

the knee themselves.

Go for 30‐45 seconds.

Change partners and repeat.

CREATE A WARM‐UP ACTIVITY

Fitness trainers should have the ability to create their own warm up games for children. These

games should consist of a few simple concepts, which include; cardiovascular related activities, they

are fun, and they are age specific.

CONDITIONING COMPONENT

The conditioning components of a child are as follows, with the component followed with an

explanation of why a child may need to develop that aspect:

o Strength – cross the monkey bars

o Cardiovascular endurance – run away from the kid who is ‘it’


o Flexibility ‐ bend down to tie shoelace

There is no specific component that is more important for a child to develop; for a younger child it

is important to develop all areas before specialisation occurring for the older child as they refine

their activity or sport they wish to participate in.

STRENGTH

TO RECAP: Strength uses skeletal muscles to perform a movement and can be broken into two

types: muscular strength or strength endurance. Muscular strength is the ability to perform

maximal force against a resistance once, whereas muscular endurance is the ability to perform

repeated contractions against a resistance over a period of time.

Benefits of strength training in children:

Improve bone mineral density

Improved body composition

Increase motor fitness performance

Reduce injury risk

Improve self‐esteem, mental discipline

Of these benefits, the majority of them will not motivate a child to participate in exercise; the main

motivator is fun and enjoyment; however this will be addressed later in the module.

Strength training can generally be performed by children of any age generally above the age of 6

years old. The viewpoint of the Australian Strength and Conditioning Association is that if a child is

ready to participate in sporting activities such as cricket, football, soccer and AFL then they are

ready to performing strength training. However, this may vary according to their age and

development. Some children will not have developed enough to understand and follow clear

instructions to use the equipment, as well as have the ability to provide enough attention and

commitment to the training.

The Australian Strength and Condition Association (www.strengthandconditioning.org) has

produced the following training load and intensity recommendations for children:

Level Age Reps Resistance or load Equipment

1 6 – 9 15+ Body weight or light

resistance

None or resistance bands

2 9 – 12 10 – 15 reps Max load equivalent to

60% of max

Simple free weights and

machines


3 12 – 15 8 – 15 reps

Max load equivalent to

70% of max

Advanced free weight

exercises, but avoiding complex

lifts.

4 15 – 18 6 – 15 reps Max load equivalent to

80% of max

Moving towards advanced

adult program

Information taken from ‘Resistance Training for Children and Youth: A Position Stand from the

Australian Strength and Conditioning Association’ (ASCA, 2007)

(http://www.strengthandconditioning.org)

Program design can be classified according to the add group used in the intensity and load

recommendations, and therefore considers age groups 6 – 9, 9 – 12, 12 – 15 and 15 – 18. However,

not all children are at similar levels at the same age, and this is reflected slightly with the categories

overlapping age. I.e. a 12 year old may fall within the 9‐12 or the 12‐15 year olds.

In addition to the age the muscle and strength development is another factor, which will determine

which level they start within. For example, a beginner 13 year old might begin in level 2, due to a

Level 1

The child starting in this level is very new to strength training or training in general. They are usually

between the ages of 6‐9 but can also involve older individuals with no experience and poor muscle

development. This stage is used to introduce individuals into strength training, and build the basic

fitness components, techniques, motor skills and encourage correct posture. The level involves

basic, body weight or low resistance exercise where the individual can perform high repetitions.

Examples of exercise in this level, performed with good posture, include:

Body weight lunges on each side

Push‐ups (progress from knees to toes)

Step ups

It is important that a program including these exercises is performed in a safe and fun environment

to prevent injury and increase attention span and enjoyment.

Level 2

As the individual gets older or becomes more advanced in their strength ability (this is judged by

the fitness professional) the exercises become increasingly revolved around free weights and

weight machines, but still incorporate body weight. At this level strength training can be performed

up to 3 days per week, as long as they are non‐consecutive. The exercises are simple consisting of

basic movements that use either free weights or weight machines. Between 10 – 15 repetitions

with loads up to 60% of maximal repetition are used. Initially a program at this level will incorporate


1 – 2 minute rest between exercises, with the aim to progress from 1 set up to 3 sets. Exercises that

can be used during this stage include:

Machine leg press

Dumbbell arm curl

Dumbbell row

Level 3

By level 3, the children are between 12 – 15 years old or have appropriate muscle strength to

progress to exercises that mainly incorporate free weights. These exercises consist of simple

movements, with complex multi‐plane movements, such as lunge with a rotation, being avoided.

A program within this level will involve the child performing 8 – 15 reps using up to 70% of 1 RM,

for 2 sets initially with a 1 – 2 minute rest in between sets. Exercise could include:

Level 4

The final level usually involves children are close to full adult development, and therefore the

program can be based around similar principles of adult strength training.

Exercises can advanced to incorporate multi‐plane, multi‐joint movements, as long as correct

technique is being adopted (this should have been reinforced at lower levels). Repetitions range

between 6 – 15, using a maximal load of 80% of 1RM, with programs comprising of 3 days a week of

whole body routines, with a rest day following.

Some additional guidelines:

The children should master the technique using correct posture prior to increasing weight or

intensity

A strength training program for children should contain all the major muscle group

Advancement of the exercises and program should only occur once the child is ready

physically and mentally.

CARDIOVASCULAR ENDURANCE

TO RECAP: Cardiovascular endurance is the ability of the heart and lungs to provide oxygen rich

blood to tissues around the body, to be used for energy metabolism. This occurs via the lungs

inhaling oxygen (and exhaling carbon dioxide) and exchanging it into the blood vessels through

the cell walls. Once in the blood vessels, the heart is responsible for pumping this oxygenated

blood around the body to the cells.

The benefits of cardiovascular training for children consist of similar benefits to a young adult,

which include:

Reduce risk of obesity


Increase mood (can help with ADHD/ADD)

Reduce blood pressure

Reduce HDL cholesterol levels

Increased respiratory system (help with asthma symptoms)

Reduce risk of cardiovascular disease later in life

Improve co‐ordination

Like any other client, cardiovascular training for children mainly revolves around continuous or

prolonged performance of an aerobic (anaerobic can be used as well) activity. This may include

running, cycling, swimming or activities similar in nature.

Depending on the age of the child, these activities can be performed in various different structured

ways to achieve overloading of the cardiovascular system. This overloading is necessary to

encourage adaptations and improvements in the cardiovascular system.

There is generally a split at 12 years old, where children below this age perform aerobic activities as

part of a game or stimulate play. Individuals older than 12 years old are able to perform

cardiovascular activities in a similar structure to adults.

Although 12 years old is used as a divide, this age can be increased or decreased depending on the

development and maturity of the child. It is generally down to the fitness professional to decide

which type of training will be right for the child. The volume of activity for each age at the beginning

of this section can be used to identify the level of intensity and time spent performing a

cardiovascular exercise.

CARDIOVASCULAR ACTIVITIES FOR 12 YEARS AND

BELOW

TAG

A popular game for children in the lower end of the child population group, this game involves one

or a few individual being ‘it’. The child who is ‘it’ is then required to tag or touch other children so

they become ‘it’ as well. This game usually involves running, as it is hard to be performed using

other continuous activities likes swimming or cycling.

ASSAULT COURSE

Another method of performing a cardiovascular activity for children is to create an assault course

designed for children. This is a course, which involves tasks that must be completed throughout; for

example, it could include the child running through cones, hopping in a sack, throwing hops over a

cone, army crawl under a net. This can be performed in teams as a race to encourage performance.


SPORTING ACTIVITIES

Team sports can also be used to encourage cardiovascular activities, and can be fun for children.

This simple involves them playing soccer or tag rugby for a continual duration to gain cardiovascular

benefits.

CARDIOVASCULAR ACTIVITIES FOR 12 YEARS AND

ABOVE

Children aged around 12 can usually train using a similar structure to adults but with a decrease in

intensity levels. The types of training methods involve; continuous Fartlek or interval training

methods.

CONTINUOUS ACTIVITY

The simplest form of cardiovascular endurance training is continuous activity, where an aerobic

activity is performed continuously without breaks over a period of time. For a child these activities

are usually initiated with low intensity and short duration developing over time to further overload

the body.

An example for a child jogging for 20 minutes twice a week and then one 30 minute longer jog. This

can then be progressed by increasing the duration or the intensity.

FARTLEK TRAINING

Fartlek translates to ‘speed play’, and can be applied to all aerobic activities. It is an unstructured

method of cardiovascular endurance training, where the intensity is regularly changed throughout

an aerobic activity. The overall duration of the aerobic activity is set and then throughout duration,

the intensity is modified. It can be planned, where a change in intensity is pre‐set or unplanned,

where the intensity is randomly modified throughout the activity. This method encourages

adaptation at a faster rate, as the systems are constantly adjusting to the intensity.

An example of Fartlek is:

Duration Intensity (% of max capacity)

3 minutes Jog (50%)

1 minute 70%

2 minutes Gentle jog (40%)

200 metres Sprint (90%)

30 minutes Walk (30%)

2 minutes Medium pace jog (60%)

1 minute 70%

3 minutes Jog (50%)


During this training session, the different intensities will be constantly changed by the fitness

professional, and can be directed with whistle calls.

INTERVAL TRAINING

Interval training consists of bouts of aerobic activity (can be anaerobic, but for child is usually

aerobic) followed by a rest or reduced intensity. This composes one repetition and is then repeated

one or more times.

The purpose of interval training it to enable the cardiovascular system to work harder during the

aerobic activity, meaning the overall training intensity is higher. As a result this stresses the

cardiovascular system more than a continual aerobic activity creating quicker adaptations.

Interval training can consist any duration or distance repetitions which are repeated a number of

times; and a related recovery period. These repetitions and recoveries can be specific to the fitness

of the individual and the aim of the training as long as overload is occurring. Recovery can range

from 30 seconds to 5 minutes and can be active or static. It is important to relate the recovery to

the intensity of the activity with the longer recovery required for a higher intensity.

An example of interval training for a child:

Activity Duration Intensity (% of max capacity)

Aerobic activity 2 minutes Medium paced (60%)

Rest 1 minute Passive recovery







End of workout – perform cool down

FLEXIBILITY

RECAP: Flexibility is the ability of a joint to move through a full range of motion (ROM). It

considers the mobility of the joint and the length of the muscles which joint around the joint.

The purpose of flexibility training for young and older adults is mainly to increase the ROM of a joint

and the length of a muscle. However for young children the purpose is slightly different. Children’s

muscles are still growing and usually supple enough to have a good ROM around each synovial joint

within the body; therefore flexibility to increase muscle length and ROM becomes less

The ROM begins to become restricted for a child around the age of 12 years old whereas prior to

this, the child is usually supple and flexible enough to not require flexibility training to increase joint

ROM. Instead, the main purpose of flexibility is to prepare the child for a forthcoming activity.


A flexibility program for individuals who are over the age of 12 years old can generally be

performed similar to that of an adult. This includes using various types of stretching techniques,

which are as follows:

TYPES OF STRETCHING

STATIC STRETCHING

The most common and widely used type of stretching, static stretching involves hold a limb or body

position in an end position, so a group or individual muscle/s is elongated. This stretch should be

help up to 30 seconds, and aims at increasing the flexibility of a specific muscle or increases the

range of motion of a joint.

Static stretching is relatively safe, as long as the end position is not forced to an extreme and pain is

not felt.

It has been shown that long‐term flexibility gains have indicated that muscles stretched for around

30 seconds a day continue to produce improvements in their range of motion for up to around 6

weeks before reaching a plateau. If the stretches were only held for around 15 seconds then it

takes around 10 weeks to reach the same degree of range of motion.

DYNAMIC STRETCHING

Dynamic stretching involves a continuous movement or momentum to place a muscle in a

stretched position at each end point. This type of stretching can be used for sport or exercise

specific warm up, where it prepares the muscles and body for the specific movement that will be

used.

An example would be a walking lunge with the emphasis on the lunge to gain hip flexor stretching.

This type of exercise can pose some risks to an older adult; however, some specific forms of

dynamic stretching can be very advantageous for them. When planning this type of exercise for an

older adult, it is best to avoid any movement, which emphasises balance, bouncing, or uncontrolled

movements.

PNF STRETCHING

Proprioceptive Neuromuscular Facilitation (PNF) is another type of stretching, which takes

advantage of tension and muscle length receptors, to encourage muscular relaxation and flexibility.

The technique is performed with the use of a partner. The partner places the muscle in a

lengthened and slightly stretched position, by moving a limb. In this position, the client contracts

the stretched muscles against the resistance of the partner, holding the contraction for roughly 10

seconds. Following the contraction, the muscle will automatically relax, due to the response of the

golgi tendon organ. This then allows the partner to increase the stretch.


Performing this type of stretching can see great improvements in flexibility, but caution must be

taken when performing this for the older adult population. The muscles and tendons of the older

adult are more prone to tearing, and have less responsive muscle sensory receptors.

COOL DOWN

The cool‐down is the last element of the program and has the opposite effect to the warm‐up. It

aims to slowly return the body to a normal resting condition and achieved by performing a

cardiovascular activity. This cardiovascular activity is performed for around 5 – 10 minutes at a very

low intensity (much lower than the conditioning stage). Throughout the duration of the cool down

the intensity decrease further, to slowly reduce the heart rate.

The purpose of the cardiovascular activity is to keep breathing rate elevated for a short period of

time, helping the oxygen debt return to normal.

The final stage of the cool down is to perform some specific stretches to the muscles that have

been worked throughout the conditioning session.

For children, the aims of the cool down is similar to that of any other client, and like the warm up it

can be performed around games or fun activities. However, children usually exert themselves

maximally when playing games, so it will be important to use games that can lower the intensity/

ADDITIONAL PROGRAMMING FACTORS

INCREASED SUPERVISION

As explained earlier, where performing session it is important to have adequate amount of

supervision when training individuals to ensure their safety is considered.

Group training is recommended to have 1 supervisor for every 25 children. For children

younger than this, the ratio could even be 1:15 or 20.

Resistance training should involve 1 instructor for every 8 children.

For school groups a teacher must be present at all times in addition to the instructor.

TECHNIQUE

When training children, it is vital to perform the correct technique for all activities being completed.

For strength training this involves performing the exercises with lightweights to encourage

technique development prior to moving onto heavier weights. By ensuring this, the child will

gain the most benefits for the exercises and prevent any injuries occurring.

For cardiovascular exercises this involves performing the aerobic activities using the correct

form. This is often the stage in which children are learning the technique, so to encourage


the correct performance should be easier to implement than once they have been

performing the incorrect technique for a long period of time.

RECOVERY

Recovery is an important component of any individuals training program, however, for a child, it

become crucial in prevention of exercise intolerance and overtraining. A child’s body is undertaking

huge amount of changes and rapid growth, therefore it needs sufficient rest to allow these changes

and growth to occur. In addition, the growth may increase the vulnerability of the immune system;

therefore recovery is required to prevent illnesses.

Following an exercise session there are simple techniques, which can help a child recover, these

include:

o Replace fluid immediately following an exercise session

o Consume plenty of carbohydrate‐rich foods immediately after training

o Mix the type of training by cross training. This will avoid using the same muscles and

repetition.

o Encourage an active cool down with minimal resistance aids in the removal of waste

(lactic acid) produced during exercise

o Allow full recovery of an individual – seek advice from an allied health professional

o Ensure the child gets enough sleep

ORDER OF EXERCISES

Once you have selected the exercises you would like to use in your program, the next step is

decided what order to perform them in. Exercise order should be relative to the goal of the

program. Here are a few general rules for strength training exercises:

Exercises for bigger muscles should come before exercises for smaller muscles.

Examples: Chest or back before shoulders, biceps or triceps. Shoulders before biceps or

triceps. Quads or hamstrings before calves or abs.

Compound exercises should come before isolation exercises.

Examples: Bench press before dumbbell flies. Overhead press before lateral raises. Squats

before leg extensions. Romanian deadlifts before leg curls.

Free weight/body weight exercises should come before machines.

Squats or deadlifts before leg presses. Barbell bench press before incline machine press.

Pull‐ups before chest supported machine rows.


EXERCISE EQUIPMENT

Exercise equipment can vary when design a program for children. For younger children it can

include equipment items that can be used for games, with the advancement of equipment

occurring as the child moves towards the adolescent years and towards adulthood. Exercise

equipment may include:

EQUIPMENT HOW TO USE WITH CHILDREN

Ladder

Fast feet

Hop through one leg

Jump Through

Hop Scotch (hop, jump, hop,

jump)

Jump over beanbags

Side step in and out in

forward motion

Skipping ropes

Normal

Peppers (Fast)

1 leg

2 leg

Backwards

Cross overs

Aerobic Step

Step up (1 leg/2 leg)

Jump on/off or side to side

Push‐ups

Dips

Ezywalk

Hula Hoops

Normal twirl

Jump in and out

Use as skipping rope

Bean bag relay – use to hold

bags

Set up in a row to jump in

and out

Balls + Tennis balls

Soccer

Bounce 1 hand/2 hand

Throw and catch (partner)

Kick ball against a wall –

control

Bounce around body (figure

8) or twist around body

Bounce fast/slow – High/low

Bounce on air flow bats

Bean Bags

Balance

Run and replace (relay with

hula hoops)

Balance on head relay

Throw and catch (partner)

Use to balance on head while

doing any activity in circuit

(challenge)

Mini Trampoline

Jump

Hop on one leg /alternate

Bounce high/low, fast/slow

Run/jog on tramp

Markers (Dome &

Hats)

Station markers for circuit

activities

Straight line – weave/jump

Relay set up

Kick ball to markers/between


over

Use for group games to mark

out areas

markers

Set up formations – square,

triangle, circle

Games set up

Spike Balls

Co‐ordination – unusual

bouncing patters

Throw & Catch (feels strange)

Bounce 1 and / 2 hand

Roll or kicking against wall

Own Body

Star Jumps

Push – Ups

Sit – Ups

Triceps Dips

Squats

Running/jogging on the spot

Skipping

Jumping

Hopping

Walking

Cricket Bats and ball

Cricket

Bounce ball on bat (skill)

Batting practice – bowl tennis

balls to batters

Air Flow Bats

Tennis

Balance ball/bean bag on bat

Bounce ball on ground or on

bat

EXERCISE REPERTOIRE

Exercise repertoire considers the range of exercise knowledge that a fitness professional possesses.

This can be a general exercise repertoire, or specific to children, where exercises are modified to

encourage enjoyment and fun.

For a fitness professional training children, it is important for them to develop and wide range of

exercise which can be used for children of different ages. This can help with motivation and

adherence to the program or session.

Exercise repertoire can include:

Changes to level of exercise – allowing progression and regression

Elements of all fitness components and motor skills

Variation to intensities

Combining exercises

Creating games related to exercises

Using exercises as part of a competition


CHECKLIST FOR PLANNING AND DELIVERING EXERCISE

TO CHILDREN

Stage One: Plan the exercise

Apply appropriate pre‐exercise screening procedures prior to participation.

Identify the characteristics, needs and expectations of your client/s.

Consult with family members (where appropriate) to clarify any risk factors identified in pre‐

exercise assessment in order to recognise the sign and symptoms of injuries or conditions.

Recommend advice be sought from referral partners, if necessary.

Provide advice on alternative options for clients who are unsuitable for the planned exercise.

Select exercises from an appropriate exercise repertoire that match needs, abilities and goals.

Select and modify appropriate equipment.

Determine appropriate instructional techniques.

Select and apply appropriate baseline assessments.

STAGE TWO: INSTRUCT THE EXERCISE SESSION

Communicate the benefits of exercise.

Show sensitivity to cultural and social differences.

Communicate the general features of balanced nutrition and provide healthy eating information

to improve overall health and support exercise goals.

Explain and demonstrate the exercises and provide opportunities for questioning and

clarification.

Modify exercises to ensure they are safe and effective.

Demonstrate and instruct correct use of equipment.

Monitor exercise intensity, technique and safety during the session and modify as required.

Apply appropriate motivational techniques.

Facilitate activities to maximise individual participation.

STAGE THREE: EVALUATE THE EXERCISE SESSION

Evaluate the exercise session according to client and or caregiver feedback and personal

reflection.

Provide feedback to the client group on their progress and any changes recommended.

Identify modifications to the exercise plan where relevant.


MOTIVATION

Motivation is a method of using techniques to encourage an individual to perform a specific task.

All clients require motivation to help them achieve their goals. However, as each client will have

different motivations needs, each client should be addressed on an individual basis. Although this

may be the case, groups of individual can be categorised together as having similar motivation

needs.

Motivation can also be prevented by barriers that discourage participation in an activity or

behaviour. These barriers are also discussed in this section and can be specific to the older adult

population.

There are 2 main types of motivation that can affect a child:

Intrinsic – or internal motivation that comes from within

Extrinsic – motivation which comes from an outside source

You can use both of these motivation types to help increase the level of motivation a child has

before, during and after training.

Many people in fitness industry emphasise intrinsic motivation in children’s physical activity. The

theory of intrinsic motivation is that if participants are intrinsically motivated, they will be more

likely to have a quality experience and want to continue participation. They are performing the

activity or exercise because they internally want to rather than being enticed by external factors.

Extrinsic behaviour is dependant on another individual providing the motivation through physical

rewards (prizes) or psychological rewards (praise), but as soon as this is removed then motivation

declines. It is also evident that when a child feels their participation is being controlled by an

external force their intrinsic motivation to participate declines.

Therefore it suggests that an intrinsically motivated client truly loves to exercise, whereas an

extrinsically motivated client may stop exercising once the external motivation is taken away.

Examples of intrinsic motivation

Physical appearance – Child wants to look physically better

Health – the child understand the benefit of exercise on a condition they may suffer from.

I.e. diabetes.

Examples of extrinsic motivation

Authority ‐ “You have to do it”, “It's part of your class”

Rewards‐ i.e. trophies or prizes, “Do this and you will have finished”


As indicated earlier, it is a lot more effective if an individual is intrinsically motivated, therefore the

aim is to attempt to encourage the development of this. There are reasons which might be

preventing this and some solution are:

o The exercise might not be hard or challenging enough. Solution: This should be identified as

during the fitness tests.

o Child might not have found their niche or the right sport or activity. Solution: The child

should try as may different types until they find one they might enjoy and excel at.

o Child may not understand the benefit of the activity. Solution: education is needed.

ADDITIONAL DO'S AND DON’TS OF CHILD MOTIVATION

The dos and don’ts of child motivation and exercise (these can also be used for a fitness

professional to build ‘intrinsic’ motivation with their clients):

DO try to emphasise individual mastery of an exercise or activity

DON’T over‐emphasise peer comparisons of performance

DO promote perceptions of choice

DON’T undermine an intrinsic focus by misusing extrinsic ones

DO promote the intrinsic fun and excitement of exercise.

DON’T turn exercise into a bore or a chore

DO promote a sense of purpose by teaching the value of physical activity to health, optimal

function, and quality of life.

DON’T create a motivation by spreading fitness misinformation i.e. fad diets

ADDITIONAL MOTIVATIONAL FACTORS

In addition to the intrinsic and extrinsic motivation there are other ideas, which can be used to

encourage motivation for physical activity. There include:

o Educate children on the pros of physical activity and exercise

o Identify that physical activity doesn’t have to be hard work, it can be fun

o Encourage them to participate in a range of activities until they find on they enjoy

o Include physical activity in daily live – walk or cycle to school

o Join a team or club

o Put them in a social situation with other active children


BARRIERS

Barriers are factors, which can prevent a child from participating in physical activity. As a fitness

professional is it just as important to understand the barriers to physical activity, as what motivates

a child.

The barrier can include the following:

Physical barriers:

o Homework

o Computer games

o Internet use

o Television

Other barriers

o Not enough time

o Exercise is boring

o Environmental factors – too cold, too hot, raining

o Tiredness

o Lack of opportunity

o Limited physical activities offered

o Peer pressure

By understanding the barriers a fitness professional can address any issue that they can control and

come up with strategies to encourage motivation as well enhance adherence.

There are also theories and models, which help understand the behaviour of an individual and can

be applied to children. To understand behaviour in more detail, please research the following two

theories:

1. COGNITIVE BEHAVIOUR THEORY

2. THEORY OF PLANNED BEHAVIOUR


NUTRITION

Nutrition is an important component for

everyone; especially for a child that is growing,

and even more so if this is combined with

involvement of physical activity. Australian

recommendations suggest that all individuals,

including children, should include a range of

nutritious foods as part of their diet. The

components of the diet include:

Vegetables, legumes and fruit

Cereals – bread, rice, pasta couscous,

polenta, noodles, barley

Lean meat, fish and poultry and

alternatives

Milk, yoghurt, cheese and/or alternative

– low‐fat where possible

In addition to this range of foods, it is also

important to consume plenty of water, especially

if performing physical activity. This helps with the

function of all cells within the body.

The poster is taken from the Australian Governments website which provides information of

Healthy Eating.

SPECIFIC RECOMMENDATIONS FOR CHILDREN

In addition to the Australian Healthy eating guidelines, there are specific volumes of each

component that children should concentrate on consume for them to achieve the right amount of

nutrients, vitamins and minerals to help with growth and development.

FRUIT AND VEGETABLES

Fruit and vegetables are one of the most important components of the diet and are usually not

consumed enough by the young generation. They contain vast amount of vitamins and minerals as

well as antioxidants and phytochemicals.

Consuming fruit and vegetables are helps by:

o Maintain vitamin levels within the body

o Prevent obesity


o Improve the bowel movements – preventing constipation or other bowel disorders

o Reduce blood pressure

o Reduce cholesterol

o Improve insulin sensitivity

o Reduce risk of cardiovascular disease

o Help prevent development or growth of cancer

o Reduce risk of type II diabetes

The recommended servings for children can be classified by their age group and are as follows:

Age of child (years) Fruit (serves) Vegetables (serves)

4‐7 1‐2 2‐4

8‐11 1‐2 3‐5

12‐18 3‐4 4‐9

Data taken from Department of Health and Ageing (http://www.health.gov.au)

An example of a serve of fruit is 1 medium piece (apple, orange) 2 small pieces (kiwifruit,

apricot) 1 cup of diced or canned fruit and 1.5 tablespoons of dried fruit.

An example of a serve of vegetables includes a half a cup of cooked vegetables or legumes, 1

cup of salad, 1 medium potato.

CEREALS

Cereals are foods, which contain fibre, carbohydrates, protein and various vitamins and minerals.

The majority of individuals consume this component as their main source of energy

(carbohydrates). This component should be increased if intense physical activity is being

performed.

Age of child (years) Breads and Cereals (serves)

4‐7 3‐7

8‐11 4‐9

12‐18 4‐11


A serve of cereals includes two slices of bread, one medium bread roll, 1 cup of cooked pasta or

rice, 1 cup of oats (porridge), half a cup of muesli.


LEAN MEAT, FISH AND POULTRY, NUTS AND EGGS

This food category contains high levels of protein, iron, zinc and Vitamin B group. These

components are all vital for growth and repair, so are extremely important for children to consume

enough quantities of these. The recommendations are:

Age of child (years) Meats and Alternatives (serves)

4‐7 ½ ‐ 1

8‐11 1 ‐ 1 ½

12‐18 1‐2


A serving meats and fish include 65‐100g cooked meat, 80‐120g fish fillets, 2 small eggs,

handful of nuts, half a cup of beans.

MILK, YOGHURT, CHEESE AND/OR ALTERNATIVE

Usually revolved around dairy, this food group provides calcium, an important nutrient to help build

bones, protein and vitamin B group. The quantities that children are advised to consume per day is:

Age of child (years) Dairy Foods (serves)

4‐7 2‐3

8‐11 2‐3

12‐18 3‐5


Examples of the food serves are 1 cup of milk, 40g of cheese and 200g of yoghurt.

WATER

Water is an essential component of any individual’s diet as it is involved in every process and a

component of each cell within the body. It also has an important role in regulating body

temperature.

Water can be gain through any fluids that are drunk, but tap water is the best fluid due to it

containing fluoride, which helps build strong teeth.

Recommended water consumption for children is:

Age of child (years) Water (serves)


4‐8 1‐1.2L (about 5 glasses)

9‐13 1.4‐1.6L (about 5‐6 glasses)

14 + 1.6‐2L (about 5‐8 glasses)


N.B: A glass is 250mL

Fluid intake may vary slightly according to activities complete and environment. An individual

participating in physical activity should increase the amount of serves they consume, likewise, in a

hot environment the same should occur.

In addition to the above food groups, there are also some additional components that can be

consumed in very small volumes, as a result of their negative affects on the body and health. The

extra foods include:

o Margarines, oils and fats

o Biscuits, cakes and pastries

o Soft drinks and confectionaries

o Take away food

As indicated on the ‘Australian Guide to Healthy Eating’ these foods should be consumed only

occasionally in small amounts; and this is no different for children.

ADDITIONAL COMPONENTS

Recommended level of calcium for children:

Age of child (years) Calcium

Babies 300 mg per day (if breast fed)

500 mg per day (if bottle fed)

Young Children up to 11 years old 700 – 900 mg per day

Recommended level of salt for children:

Age of child (years) Salt

1 – 3 2 g salt a day (0.8g sodium)

4 – 6 3g salt per day (1.2g sodium)

7 – 10 5g salt per day (2g sodium)


11+ 6g salt per day (2.4g sodium)

Data taken from National Health Service website (www.nhs.uk)

READING A FOOD LABEL

Food labels are an important part of

helping kids learn to make healthy choices.

Food labels provide basic information

about the nutrition inside foods so that we

can begin to see how foods are different.

Food labels contain a variety of

information including:

Nutrition Information Panel – this

provides information on the amount of energy, protein, fat (total and saturated), carbohydrates

(total and sugar) and sodium (this is an indication of the amount of salt). This information will help

you to make an informed decision about what food to buy. Choose foods that are low in fat

(especially saturated fat), sugar and sodium. By using the “per 100g” column of the nutrition

information panel you can compare and choose the healthier option of two similar foods.

Ingredient list – all of the ingredients contained in the food are listed in order of weight. You can use

this to see how much sugar is

contained in a product relative to other

ingredients by how high it is in the ingredient list. Try to avoid choosing foods where sugar is one of

the first few ingredients in the list.

Percentage labelling – this tells you how much of the characterising ingredients are in your product.

For example, percentage labelling will tell you what percentage of the strawberry yoghurt is made

up of strawberries.

Food Additives – food additives, including colours, flavours and preservatives will be included in the

ingredient list in the form of numbers. If you are sensitive to a particular additive, and know its

identifying number, this will help you to avoid foods containing the offending additive.

Country of Origin – in Australia, the label of any packaged food must state the country that the food

was made or produced in.

Directions for use and storage – these include specific instructions such as “refrigerate after use”.

When followed, these instructions help to maintain the safety and quality of the food.

Information for allergy sufferers – products containing the major allergens, peanuts, tree nuts (e.g.

almonds, cashews, walnuts), shellfish, milk, eggs, sesame, soybeans and gluten, are labelled as

“may contain ….”. If you have an allergy to any of these foods or food components, it is strongly

recommended that you avoid all foods containing these products.


Date marking ‐ do not buy or consume foods after their “use‐by” date. However, food is still safe for

consumption after its “best before” date.

The previous excerpt is taken directly from The Australian Governments Measure up website

(http://www.measureup.gov.au).

SWAP IT, DON’T SPOT IT (HTTP://SWAPIT.GOV.AU)

‘Swap it, Don’t Spot it’ is a government initiative that encourages children or families to swap an

unhealthy option or behaviour with a healthier one. This can be related to exchanging an unhealthy

food option with a healthy food option or swap an unhealthy behaviour with a healthy behaviour.

Examples of these are:

Unhealthy option Healthy option

Fried food SWAP Fresh food

Fizzy drink SWAP Water

Drive to the local shops SWAP Cycle or walk to the local shops

Watch sport on TV SWAP Participate in Sport

Movie SWAP Bowling

Examples taken from (http://swapit.gov.au/ways‐to‐swap)

The reasons why the government have produced this initiative it to improve the well‐being of

individuals, helping to

o Reduce the risk of chronic diseases

o Reduce intra‐abdominal fat and therefore the risk of serious health problems

o Reduce health problems

To find out more information, and how this can be used when training children, log onto

http://swapit.gov.au.

REFERRALS AND ALLIED HEALTH PROFESSIONAL

When working with any client it is good to have an understanding of the types of allied health

professionals, whom you could gain advice from or assist you with the service that you offer.

Very similar allied health professionals can be used when training children, with the exception of

Child specific health professionals.

As a fitness professional your knowledge of these conditions or disease is very limited, and

therefore advice from an allied health professional should be gained to limit or eliminate any risk.

http://www.measureup.gov.au/�


With a huge range of potential allied health professionals it is important to understand the role of

each one especially relating to the older adult population. An Allied health professional includes:

General Practitioner

Paediatrician

Physiotherapist (Paediatric Physiotherapist)

Exercise Physiologist

Occupational Therapist

Accredited Practising Dietician

Osteopaths

Additional allied health professionals:

Podiatrist

Chiropractor

Psychologist

GENERAL PRACTITIONER (GP)

A GP is one of the most used allied health professional that fitness professional refer to, or gain

permission for a client to participate. They identify the overall health of an individual, and deal with

acute injury/illnesses to chronic injuries/illnesses. They are interest in the physical and mental

wellbeing of the individual, and provide medication or advice regarding actions to take to return to

normal wellbeing.

With regards to children, they are involved in immunisation from diseases, acute illnesses as well as

chronic conditions treatment and prevention. Therefore a GP is usually the primary point of call for

any child who presents with a medical condition and potential or current contraindications during

the screening process. The GP can provide advice on whether exercise or physical activity can be

performed by the client.

PAEDIATRICIAN

A paediatrician is a medical doctor that is specifically skilled to understand the well‐being of babies

and children’s, educated in child related conditions. They are also involved with the development

and behaviour of children. Paediatrician can specialise into a specific topic or complete general

training to cover a broad range of areas. Therefore some GP’s will refer onto a paediatrician for a

better understanding of a child related illness or disease.

Similar to that of a GP, a fitness professional can seek advice regarding child related conditions or

illnesses, to gain permission to perform physical activity or advice.

PHYSIOTHERAPIST (PAEDIATRIC PHYSIOTHERAPIST)


The role of a physiotherapist, as explained by the Chartered Society of Physiotherapy, is to restore

an individual’s body back to normal function following an injury, illness or disability.

Physiotherapists administer a range of treatment methods, on a holistic approach to improve the

wellbeing and lifestyle of an individual. A paediatric physiotherapist specialises in injuries or

chronic conditions that are related to children.

Physiotherapists can work with children to restore their body’s function back to normal state,

usually following an injury, illness or change in physical wellbeing.

A fitness professional can work closely with physiotherapists to restore the full physical capacity of

an individual, using a combination of treatment methods, one of which is usually exercise. They

may also provide advice to the fitness professional as to the recommended or allowed exercises,

intensity and durations.

ACCREDITED EXERCISE PHYSIOLOGIST

An accredited exercise physiologist is an allied health professional at the top end of the fitness

professional ladder. They specialises in understanding the responses and adaptations of exercise on

the body; as well as achieving physical and mental wellbeing for special populations, through the

prescription of physical activity, lifestyle and behaviours changes.

Children are considered a special population; and therefore an area covered by an exercise

physiologist. They are educated in the specific medical or chronic conditions that relate to children

and adolescents, and understand the requirements or limitations of performing physical activity or

exercise for these young individuals.

An exercise physiologist is an expert in understanding how to train a children suffering from a

chronic condition. This provides a referral or advice point for fitness professional. Referral can help

the child or their parent develop an understanding and how to deal with the condition. As a result

this can help improve their overall well‐being.

OCCUPATIONAL THERAPIST (OT)

An occupational therapist deals with clients to work towards an independent or fulfilled life. For

children, an OT will usually work with individuals that have a disability, chronic disease or injuries

that affects their daily living, development and learning. They will use various methods to help

improve the child’s cognitive, physical and motor skills with the overall goal to achieve a better life.

A fitness professional can work with an OT to understanding the specific components or areas to

address, and how the use of exercise can improve their condition or overall well‐being.

ACCREDITED PRACTICING DIETICIAN (APD)

Specialising in nutritional and dietary advice, a Dietician understand the specific requirements for

all individuals. When dealing with children, an APD can implement a specific nutritional plan to help

with the growth and development, as well as their physical activity needs.


An APD can understand dietary related diseases that children may be subject to; and how to create

a nutritional plan that caters for these. They also understand child specific allergies or intolerances.

Working with an APD, a fitness professional can help achieve their client goals with the additional

of nutritional advice or plans to their program. These may be related to body composition goals or

general high intensity training. They may also refer to this individual if the client is concerned about

dietary conditions.

OSTEOPATH

Osteopathy is a form of manual medicine that emphasises a holistic approach to diagnose, prevent

and treat many health issues affecting the physical body. Osteopaths are trained to recognise

conditions that require medical referral. They are also trained to perform standard medical

examinations of the musculoskeletal, cardiovascular, respiratory and nervous systems.

Osteopaths can work with all individuals, including children. They can help children have a smooth

transition into adult life, improving structural problems that may affect the mobility and function of

the body that lead to other problems. Structural problems may develop from:

Problems during pregnancy or birth

Accidents or falls during childhood

Infection or inflammatory conditions

Genetic disorders

THE ESSENTIAL COMPONENTS OF A COMPETENT REFERRAL

Fitness professionals, from time to time will be required to refer a client to an allied health

professional. This is to gain permission for the client to participate in exercise or to refer them onto

another professional who has greater understanding and training in specific conditions, diseases or

specialised training.

This can be done in the form of a letter that provides the allied health professional with all the

information that they require. The letter from a fitness professional to an allied health professional

should include the following:

1. Your professional details – the information should include the name of the person making

the request for the referral:

Address (essential)

Telephone number (desirable)

Email address (optional)

2. Name of the person to whom you are referring the patient. This may be a specific person or

a department without specifying the individual.

3. Patient’s details must include name, address, telephone number and date of birth.


4. Presenting complaint: It is important to record the client’s own perception of the problem

for which they are being referred.

5. Medical history: Comment on whether there is any relevant medical history and whether or

not the client is on any drugs or medication that you are aware of.

6. Social history: A client’s social habits such as smoking, alcohol consumption (particularly if it

is felt that this may be excessive).

KNOW THE LIMITATIONS OF A FITNESS PROFESSIONAL

A fitness professional’s expertise exists with prescribing, instructing and delivery fitness to a range

of different clients; however there are certain topics which can cross between this subject that a

fitness professional cannot provide detailed information.

When training an individual, a trainer will often come across nutritional, injury and chronic

condition elements, that clients are requesting information. Although there has been some training

along these subjects, it is important to understand the limitation of the fitness professional and

know when to refer or gain advice from another individual.

EVALUATION AND MODIFICATION

The last element to think about when designing a program is when and how to evaluate the

program. With the information gathered in this process it can then be used modify the program

accordingly.

The evaluation will identify:

o How the training has gone

o Are goals being achieved?

o Likes and dislikes

o Problematic exercises

o Progression/regression

It is important to establish at what point within the program this stage should be performed. There

are many different views on when to do this, some individual monitor on a short term basis, every

two weeks; while others monitor less often around 6‐8 weeks.

Although there is no specific right or wrong answer, ideally monitoring should be performed when

a program is likely to need changing or adaptation.

Performing this evaluation stage within a short timeframe may result in little or no change in the

client’s physical fitness and therefore no adaptations to the program needed. This is likely to place

doubt in the clients mind about the program efficiency and effectiveness and may affect

adherence.


In contrast waiting too long to monitor the program, may result in the client adapting before this

re‐test and then missing an opportunity to adapt the program.

PART D ‐ PLAN AND DELIVER EXERCISE TO OLDER

CLIENTS

OLDER ADULT CLASSIFICATION

There are many different classifications of how old an individual has to be for them to fall within

the ‘older adult’ category. For the purpose of this course, and generally with the fitness industry,

the term ‘older adult’ is generally defined as women and men over 55 years old. However, other

individuals can also fall in the same category when they are below this age, but have a decreased

physical capacity (I.e. A de‐conditioned man over 45 years old). It is important to keep in mind that

a man of 45 or a woman of 55 would not necessarily perceive themselves the same way.

DEMOGRAPHICS

Between 30 June 1989 and 30 June 2009, the proportion of Australia's population aged 15‐64 years

has remained relatively stable, increasing from 66.9% to 67.5% of the total population. The

proportion of people aged 65 years and over has increased from 11% to 13.3%. During the same

period, the proportion of population aged 85 years and over has more than doubled from 0.9% at

30 June 1989 to 1.8% at 30 June 2009. The proportion aged under 15 years decreased from 22.2%

to 19.1%.

In the 12 months leading to 30 June 2009, the number of people aged 65 years and over in Australia

increased by 85,800 people, representing a 3.0% increase. The proportion of the population aged

65 years and over increased from 11.0% to 13.3% between 30 June 1989 and 30 June 2009.


All states and territories experienced growth in their populations aged 65 years and over in the year

ended 30 June 2009. The Northern Territory (7.0%), the Australian Capital Territory (4.0%), Western

Australia and Queensland (3.7%) experienced the greatest increase in the numbers of persons aged

65 years and over.

AGED 85 YEARS AND OVER

In the 12 months to 30 June 2009, the number of people aged 85 years and over increased by

21,000 people (5.8%) to reach 383,400. Over the past two decades, the number of elderly people

increased by 167.8%, compared with a total population growth of 30.1% over the same period.

Increased life expectancy for both males and females has contributed to this rise. There were

almost twice as many females (251,800) than males (131,600) in this age group at 30 June 2009.

In the year ended June 2009, the largest increases in the number of people aged 85 years and over

occurred in the Australian Capital Territory (8.0%), followed by Victoria (6.0%), New South Wales

and Western Australia (both 5.9%), the Northern Territory (5.6%) and South Australia (5.4%),

Queensland (5.3%), and Tasmania (4.4%).

AGED 100 YEARS AND OVER

In the 12 months to 30 June 2009, the number of people aged 100 years and over increased by 610

people (19.5%) to reach 3,700. Over the past two decades, the number of centenarians (those over

100 years old) increased by 206%, compared with a total population growth of 30.1% over the same

period. Increased life expectancy for both males and females has contributed to this rise. There

were more than three times as many females (2,900) than males (800) in this age group as of the 30

June 2009, which reflects the higher life expectancy at birth for females compared with males.


CHARACTERISTICS AND NEEDS

CHARACTERISTICS

The characteristics of an individual are continually changing throughout their life, from a baby to a

child, to an adolescent, to a young adult, and then finally to an older adult. The changes that will be

explained here are the changes that occur as we become an older adult. Remember that these

changes are the typical aspects that change and may be dependant on factors that include lifestyle

choices, genetic make up and exposure to certain environments.

We have classified the characteristic changes that occur in the following categories:

o Structural change

o Physical activity change

o Risk of chronic disease

STRUCTURAL CHANGE

There are several structural changes to the human body which occur to the older adult as a result

of ageing. The National Institutes of Health suggests there are 8 areas of age‐related change:

- Brain: The brain can undergo various changes as we age. There is loss

of cell structure and function which can result in loss of memory,

confusion and overall function.

- Muscles, bone and joints: Bones and muscle mass decreases as we age, and the body also

goes through a lot of wear and tear throughout life. The

implications of the changes are briefly explained here:

- Reduced bone mass leads to a higher risk of fractures due

to osteoporosis.

- Reduced muscle mass leads to a decrease in strength and

functional capacity.

- Wear and tear can result in reduced ROM and result in

the condition arthritis or osteoarthritis.

- Eyes and Ears: Both these senses decline as we age, with eyesight weakening

around the age of 40. There are decreases in depth perception,

colour perception and peripheral vision. Hearing will deteriorate,

with less sensitivity to high pitch sounds and lower volumes.

- Digestive and Metabolic: The prevalence of gastrointestinal disorders increases as we age,

especially gastroesophageal reflux disease (GERD), heartburn


and pre‐diabetes.

- Urogenital: Conditions such as incontinence and prostate cancer become

more prevalent.

- Dental: Dental problems may be dependant on the care given to your

teeth and gums. However, common problems which exist as we

age are tooth decay and gum disease.

- Skin: Skin changes as we get older – wrinkles, dryness and age spots

can all occur.

- Functional abilities: Daily tasks become more difficult, mainly due to reduced

physical ability, balance and restricted ROM. This can then lead

to falls or reduce standard of living.

(Sourced from http://www.nlm.nih.gov/medlineplus/magazine/issues/winter07/articles/winter07pg10‐13.html)

PHYSICAL ACTIVITY CHANGE

Physical activity is defined as ‘any bodily movement produce by skeletal muscles that require

energy expenditure’ (WHO, 2013). The level of physical activity can be dependant on several factors

including, lifestyle, job and hobbies, however it is suggested that the level of physical activity

decreases significantly in the older adult population. The peak physical age of an individual is

around 30 years old, so the decline in activity is suggested to develop following this age.

In addition to the reduction in activity level for older adults, the type of physical activity has also

changed to a lower form of intensity in activities such as; walking, gardening and golf. This means

that not only are older individuals performing a shorter duration of physical activity, but the

reduced intensity results in the body being overloaded less.

Overloading the body can help the systems within the body function more efficiently, therefore a

reduction in physical activity (that causes overload) can directly relate to a decrease in an

individuals health and well being as well as increase the risk of developing a chronic condition.

RISK IN CHRONIC DISEASE

The risk of being affected by a chronic disease or condition advances as we age, and as explained in

the previous section can be related to a reduction in physical activity. However, this is not the single

factor that will influence the risks of developing a chronic disease; it can also be attributed to the

ageing processes that occur to the body and other factors. Other factors may consist of:

demographic, lifestyle choices, genetics and environmental factors. Chronic disease will be

expanded in greater detail later in this module.

NEEDS


Needs can be classified as components which are necessary for an individual to live a long healthy

life, and can be subject to an individual’s stage of life, quality of life expectations, and additional

personal requirements. However this section will address the basic requirements for an older adult

to achieve a high standard of living in a stable physical and mental state.

For the purpose of this module, the health, social and functional needs of an older adult will be

explained.

HEALTH NEEDS

A key requirement to achieving a high standard of living is health. Health is made up of the physical

and mental wellbeing of an individual, who is free of illness, injury or pain. Health is a component

that the older adult place high up on their priorities, and understand how it affects their overall

wellbeing. This is something which can be very useful to understand when motivating a client.

Poor health occurs as a result of the development of illness, injury or pain. This becomes more

predominant as an individual reaches the older adult category with characteristic changes and

deterioration of some systems within the body occurring. These changes involves natural physical

and mental changes, and can include the deterioration to the older adult’s sight, hearing, memory,

mobility, motor sensory skills, and balance. This then places greater risk for the development of

chronic conditions.

As a result, this provides an indication that improvement of an individual’s well‐being can be

addressed by prolonging characteristic changes or system deterioration usually seen in the older

population. Although these changes are inevitable, modification to lifestyle choices and behaviour

can have an impact and delay the onset. This can therefore help limit the chronic condition risk and

extend the well‐being of the individual.

The government of South Australia (2009) reports that an older person who maintains a healthy

condition is usually the result of healthy genes, favourable socioeconomic, cultural and

environmental circumstances, healthy lifestyles and good access to health care services. This

suggests that there are actions that can be taken which can help maintain the health status of an

older adult.

As a result of the above information, the aim is to encourage behaviours that can improve or

maintain a stable health condition of an older adult.

SOCIAL NEEDS

The elderly have been described as being at risk to social isolation. Social isolation can be described

as having a lack or no communication with society and individuals within that society. It involves

the individual staying at home for days, even weeks at a time without communicating with anyone,

and significantly this often includes family or friends. As a result of this solitary life loneliness and

perceived lack of support can develop along with health problems.


Although, attempts at social interaction may be successful, often the superficial feeling of this

communication does not meet their social needs, until contact comes from a signification other

that can provide emotional support along with communication.

Social isolation can affect all ages, however the combination of other factors such as; stressful life

transition, health problems and disabilities can result in more severe effect for the older adults. It

has even been identified as having the same implications on health as smoking and obesity, in that

it can attribute to higher rates of morbidity, mortality, depression, infection and cognitive decline.

There are multiple reasons why social isolation may occur; however, interestingly physical changes

that occur with age are considered one of the most relevant contributing factors. Physical change

can result in reduced mobility meaning individuals are less able to travel away from their home and

visit friends and family, or even to a public place for any social interaction.

FUNCTIONAL NEEDS

Functional tasks are activities that occur on a daily basis that are part of life. The need for functional

tasks to be performed is vital for someone to live a self‐dependent and high standard of living.

Without being able to execute tasks that are performed on a daily basis means dependability on

someone to help carry out these tasks.

As we age, simple daily tasks may become difficult to perform as a result of changes to the physical

characteristics of the older adult. Throughout life these tasks are taken for granted by the majority

of the population, and neglect the increasing difficulty that arises as we age.

Simple tasks range from walking up stairs, going to the toilet, cooking a meal and even putting on

clothes are a few functional tasks used every day that could become difficult as a result of some or

all of the changes as we age discussed earlier, and therefore support personnel is required for some

of these tasks to be completed.

The common problems which can lead to difficulty performing these tasks usually revolve around a

reduction in physical ability, but more specifically are:

o Reduced strength

o Reduced ROM or flexibility

o Poor balance or stability

o Poor posture

COMMONLY HELD MYTHS ABOUT OLDER ADULTS

MYTH: FACT:

Most older people are pretty much alike. They are a very diverse age group.

They are generally alone and lonely. Most older adults maintain close contact with

family.


They are sick, frail, and dependent on others. Most older people live independently.

They are often cognitively impaired. For most older adults, if there is decline in some

intellectual abilities, it is not severe enough to

cause problems in daily living.

They are depressed. Community dwelling older adults have lower rates

of diagnosable depression than younger adults.

They become more difficult and rigid with

advancing years.

Personality remains relatively consistent

throughout the lifespan.

They barely cope with the inevitable declines

associated with ageing.

The majority of older people successfully adjust to

the challenges of ageing.

Sourced from The American Psychological Association (www.apa.org)

PROCESS OF AGEING

Getting older is a natural part of life. How an individual ages or how they feels during this process

may depends on many things, including the health problems run in their family and the life choices

they make. By taking good care of their body and learning positive ways to deal with stress, an

individual can slow down or even prevent problems that often come with getting older. However,

this section will address normal processes which may occur with ageing.

It is generally considered that the body’s physical peak age is around 30 years old. Up until this

point, physical capacity and performance increases before a gradual declines following.

A brief recap will be provided for system before the changes which occur during the ageing process

is explained.

SKELETAL SYSTEM

BRIEF RECAP: Function of the skeletal system is to protect soft

tissue, act as structural support, store minerals and produce blood

cells.

Protective bones include the skull and ribs, which protect the

brain and lungs respectively. All bone within the system provides

rigidity to support the body. The skeletal system stores fats and

essential minerals and the bone marrow found in long bones

produces red and white blood cells.

The most common change that occurs to the skeletal system, as

individual ages, is a reduction in bone density. Bone density refers

to the thickness and volume of nutrients a long bone is composed

of.


This change is most predominant in women, where they can lose up to 8% of bone density per year,

whereas men can lose up to 3% per year.

There are several processes that can contribute to this reduction in density. The two primary

mechanisms that affect the bone density are:

o A change in the bone remodelling process, where the cells involved become less efficient

o A change in the production of specific hormones

First, the remodelling process will be addressed. This process is a continual function that occurs

throughout life. Initially it provides bone growth for children and then once bones are fully

developed, it is responsible for maintaining bone homeostasis. Bone homeostasis can be described

as a process of maintaining bone nutrient equilibrium.

The remodelling process involves specialised

cells called osteoclast cells and osteoblast

cells. Osteoclasts are responsible for

breaking down bone tissue (bone

resorption), and osteoblasts are responsible

for building bone. In a normal functioning

process these two cells work at equal rates

and therefore remain a stable and healthy

density of bone tissue.

However, as we age the volume of osteoblast cells reduces, but the osteoclasts cells remain at the

same level. This results in more bone tissue being broken down than can be replaced and rebuilt by

the osteoblasts and therefore reducing the density of the bone.

The second element that can contribute to a reduced bone density is the levels of specific

hormones produced by the body. These hormones consist of testosterone in males and oestrogen

in females where fewer quantities are produced as we age.

The function of testosterone within the skeletal system is to inhibit bone resorption (stop the role

of the osteoclasts) and maintain bone mass. The reduction in testosterone causes an imbalance in

the bone maintenance process eventually causing a reduction in bone density.

Oestrogen has a similar role within the skeletal system, regulating the remodelling process. It

ensures the bone tissue remains at a healthy and constant density. Similar to testosterone, the

reduction of oestrogen also reduces the bone maintenance process decreasing the density.

Oestrogen is believed to more impact on this process, which is why this ageing process

predominantly affects females.

In addition to these two factors other elements that can contribute to the reduction in bone

density, these are:


Use of steroids

Alcoholism

Prolonged immobilisation

Gastrointestinal disorders

Some types of cancers

Cigarette smoking

Other changes that occur within this system are the decline of blood cell production and a decrease

in mineral storage.

The decline in blood production occurs as a result of fewer stem cells, the blood producing cell,

being present within the bone marrow. This can result in a decrease in white and red blood cells

being circulated around the body. As these two cells are component of other systems they will be

explain in more detail further in the module, so a brief explanation of the implication will be given.

White blood cells are responsible for fighting foreign invaders, and work within the immune

system, so will be explained in more detail further in this section. Red blood cells are gas carriers,

transporting oxygen and carbon dioxide around the body. With less oxygen being delivered to cells

and carbon dioxide being removed; fatigue becomes more predominant in muscles and tissues.

Another change that occurs is a decrease in minerals storage within long bones. One of the roles of

the skeletal system is to store vital minerals for the body, and due to the density being reduced,

this also causes a reduction in mineral storage. As a result, the body is less accessible to these

minerals, and often become mineral insufficient.

MUSCULAR SYSTEM

BRIEF RECAP: The muscular system’s main role is movement. Skeletal muscles contract to perform

a movement and also provide support and produce heat. (This section is only considering skeletal

muscles)

Ageing can have a substantial affect on the

muscular system by reducing the overall

function of skeletal muscles. This can be seen

with a decline in muscle strength, reduction in

fatigue resistance, meaning muscles tire more

rapidly, and an increase in the time taken for

muscles to recover in the elderly population.

This decrease in function can be attributed to a

decline in the overall skeletal muscle mass.

To understand more about the process of a

decrease in muscle mass, a muscle fibre is made

up of two proteins called actin and myosin.

These are responsible creating the diameter of


the muscle fibre. When stimulated and overloaded these muscles undergo a process where they

increase in diameter (hypertrophy).

However, in the opposite circumstance, a lack of stimulation and overloading results in these

proteins decreasing their diameter, causing muscle atrophy. A thinner muscle will generally

produce less strength.

Muscle atrophy is a result of a process called sacropenia, the degenerative reduction in muscle size

and power. This process can be due to several age‐related factors:

Reduced level of physical activity

Change in central and peripheral nervous stimulation

Decrease in number of motor neurones

Reduced rate of muscle protein synthesis

Reduction in hormones being produced – which stimulate muscle development and growth

Other factors which contribute, and may not be age‐related:

Reduced dietary protein intake

The American academy of Health and Fitness (2008) indicates that the difference in body

composition between a normal healthy young person and a 75 year old adult is as follows:

Healthy young individual 75 year old adult

Muscle 30% 15%

Adipose tissue 20% 40%

Bone 10% 8%

Although muscle atrophy is an ultimate affect of ageing, there are factors, which may determine

whether it occurs, or the rate of its occurrence. The main factors which can reduce or even reverse

this process is exercise, specifically resistance training. Evidence has shown that muscles that are

stimulated regularly can maintain or increase their mass.

Interestingly, the type of muscle fibre may also influence how the muscles age. Fast twitch type II

muscle fibres decrease at a greater rate than the slow twitch type I counterparts. This enables the

individual to remain performing endurance‐based tasks and maintain posture, but produces an

overall decrease in maximal strength. However, slow twitch fibres still undergo a decline, as

indicated earlier the muscles ability to resist fatigue is reduced resulting in muscles tiring quicker.

The development of fatigue at a quicker rate can be partly contributed to another effect of ageing

to this system, which is the inability to expel heat from the contracting muscles. As the muscle

works, heat is produced as a by‐product and must be transported away by the blood. With a

reduction in the efficiency of this process, the muscle begins to overheat and therefore diminish its

ability to work.


The body does not specifically build new muscle fibres; growth of muscles consists of enlargement

of existing muscle fibres. Instead, muscles contain specialised cells called satellite cells. These cells

have the capacity to rebuild or replace aged and worn out muscle fibres. During the ageing process

the volume of these satellite cells decrease; meaning the muscle capacity to rebuild or replace cells

is compromised.

As we get older, the decline in heart function converts to a reduction in blood flow towards

muscles, and therefore less nutrients, including oxygen, is delivered. This can result in prolonged

recover from activities or injury.

In addition, the some other factors which alter within the muscular system as we age are:

Reduction in collagen production

Reduction in elasticity

CARDIOVASCULAR SYSTEM

BRIEF RECAP: The function of the cardiovascular system is to circulate and deliver blood carrying

nutrients, hormones, waste and gases to target cells.

The age related changes all contribute to reducing the

function of the cardiovascular system and can be categorised

into the following sections:

THE BLOOD – RED BLOOD CELLS

The significant change within the blood is the reduction in

the volume of red blood cells. These cells have a life span of

roughly 120 days; therefore a continuous production of

blood cells is required.

As explained in the skeletal system, red blood cells are

produced during a process called erythropoiesis (erythrocyte

being a red blood cell and poiesis means to make) in the

bone marrow of long bones. This process is stimulated by

erythropoietin (EPO), a hormone released by the kidneys.

The role of the red blood cells is to transport oxygen from the

lungs through the blood vessels to target cells within the

body for metabolism. Once at these target cells oxygen will be dropped off and carbon dioxide

(metabolic waste product) is picked up to be transported to the lungs to be expelled. A decline in

circulating red blood cells reduces the blood capacity to transport oxygen to cells and carbon

dioxide away from cells. As the requirements of oxygen remains the same, an increase in the

ventilation rate, heart rate or both must occur.


THE HEART

The heart undergoes several changes, reducing its function. This reduced function ultimately

reduces the cardiac output, the amount of blood which is pumped out of the heart in one minute.

These consist of:

Progressive development of atherosclerosis – the build up of fatty deposits blocking of the

coronary blood vessels

Decrease in elasticity of heart tissue

Development of scar tissue over damaged cells

Decrease stroke volume

Increased Heart rate

BLOOD VESSELS

Blood vessels are the pathways for blood to be transported from the heart to the lungs and the rest

of the body. The main change that occurs within these vessels is the build up of fatty deposits along

the walls – this is known as atherosclerosis. As a result of this condition, the effects that occur are:

o Reduced lumen space (area for blood to travel through)

o Toughening of vessel walls which reduced their elasticity

o High risk of blocking vessels

These can all contribute to a reduction in blood being passed through vessels, and therefore

limiting the amount of nutrients that are being delivered to areas beyond the restriction or

blockage. Consequently, these tissues can become fatigued, take a long time to repair following an

injury or even die as seen during a stroke.

This condition generally can develop as we age, however there are external factors which can

influence its development, these include diet, exercise and smoking habits.

NERVOUS SYSTEM

BRIEF RECAP: The nervous system monitors and coordinates internal organ function and responds

to changes to the external environment by sending signal through a nerve network. Each signal is

sent from the brain via a nerve to a target cell, for a response to occur.

The nervous system is like any other tissue throughout the body reaching it physical peak at around

30 years old, before its function begins to decrease and cells start to deteriorate. The changes can

have the following affects:

o Mild decline in accuracy

o Senses decay rapidly

o Long term memory suffers (older adults find difficulty in retrieving names for example)


o Spinal reflex arc reduce – body become less efficient at protecting itself

This is commonly seen by a reduction in brain and spinal column cells; reducing the size and weight

of the structures. This deterioration decreases the number of neurones present, causing fewer

pathways throughout the body reducing the ability to communicate.

The changes that occur within other systems can contribute to this decline in nervous tissue,

especially that seen in the cardiovascular system. As explained earlier, there is a build up of fatty

deposits that gradually accumulate within the blood vessels around the body. This can also occur

with the blood vessels of the brain. As a result, the volume of blood accessing the brain tissue

becomes limited, supplying fewer nutrients that might be required to function adequately or even

survive. With fewer nutrients to provide energy, the brain tissue struggles to work, stimulating

atrophy to this tissue. In addition to this, it also increases the chances of suffering a stroke.

Structural changes to nerve cells also occur as we age. These changes consist of a decrease in

dendrite branches, the component of the nerve cell that receives messages; a reduction in

neurotransmitter production, the chemical that send messages between cells; and the

development of deposits or plaque, which interfere with the transmission. These changes

contribute to the decrease in transporting nerve impulses throughout the body, and therefore a

decline in neural function. This can be visibly noticed with poorer memory, reduced senses

(hearing, vision, smell and balance), slower motion control and reaction time.

ENDOCRINE SYSTEM

BRIEF RECAP: The endocrine system is made up of many glands throughout the body, which

produce and secrete chemicals known as hormones. A hormone is a chemical messenger that

provides a slow, longer‐term change within the body. Each hormone has a specialised role and

targets a specific organ or tissue, stimulating a response. Hormones work together to maintain

homeostasis within the human body.

The major change that occurs in the endocrine system is the decline in production of certain

hormones; these involve the reproduction hormone, oestrogen, testosterone, growth hormone,

vitamin D, and melatonin.

Reproduction Hormones – There are several hormones responsible for reproduction, all of which

decline with age. As a result of this reproduction is less likely to occur.

Oestrogen – oestrogen is produced by the ovaries in women and usually decreases at menopause.

A decrease of this hormone has been identified in other systems and contributes to a decrease in

bone density.

Testosterone – this hormone is specifically produced by the testes in men and is said to reduce in

5% of men aged 50 and 70% in men aged 70. The affect of this hormone is also related to other

systems, but generally causes reduced muscle mass and strength reduced bone density and reduce

some cognitive function.


Growth hormone ‐ GH is produced by the pituitary gland of the brain and starts to reduce around

the age of 40. It decreased production leads to loss of muscle mass, increased fat, and loss of

energy.

Vitamin D – classified as prohormone, due to its role in calcium and bone metabolism. It is gained

from a select few foods, but mainly synthesised by the skin following sunlight exposure. The lack of

this prohormone can result in a decline in bone density. As vitamin D is gained from sunlight

exposure, older adults are often restricted to being inside, and therefore may not exposure to

sunlight.

Melatonin – produced by the pineal gland, it is mainly present in early childhood and almost non‐

existent in the older adult population. Melatonin’s function helps the secretion of other hormones

as well as to promote sleep by regulating the bodies 24 hour body clock. As well as protect against

some free radical damage.

Although no directly relevant to the endocrine system, other systems may fail to respond to

stimulus of hormones produced by the endocrine gland.

RESPIRATORY SYSTEM

BRIEF RECAP: The function of the respiratory system is to create an environment where gases can

be exchanged; these include oxygen and carbon dioxide. This occurs during the process of

inhalation and exhalation.

Ageing has a negative affect on the function of the respiratory system; however, this system works

directly in conjunction with the cardiovascular system. Their role together is to deliver body cells

with oxygen and expelling carbon dioxide. Therefore a decline in ability of one of these has a knock

on affect to the other.

The structures within the lungs develop gradual reduction in elasticity and begin to deteriorate, a

character seen in a condition known as emphysema. Emphysema is the extremist case; however a

change in this structure affects the exchange surface that oxygen and carbon dioxide transfer

through, reducing the ability of diffusion to occur.

In addition to the specific respiratory components deteriorating, other the structures around the

thoracic become restricted and less mobile, specifically the muscles around the ribcage. By

restricting movement, can reflect on the capacity of the lungs to expand and limits how much they

can inhale.


LYMPHATIC SYSTEM

BRIEF RECAP: The lymphatic system can also be classified as the immune system, where its

function is to protect the body against disease and infection.

As a result of age, the lymphatic system,

become less efficient at fighting infections

and disease. Specialised cells (B and T

cells), that responds to invasions of

foreign pathogen, become less responsive

and effective. Briefly, T cells detect and

stimulate a response to an invasion and B

cells are responsible for creating anti‐

bodies.

Therefore, as these cells are less capable,

the body reacts slower to an invasion and

fewer antibodies are produced to fight an

invasion. In addition, the antibodies

available fight the invasion for a shorter

duration than they do in a younger adult.

In some cases, older adults may even

produce auto antibodies, which are cells

that attack the bodies own cells rather than foreign invaders. This situation will further diminish the

efficiency of the antibodies, adding to the struggle to fight infections and foreign invaders.

It is also identified that other some external factors may help with the deterioration of the immune

system, these being radiation, chemical exposure and exposure to certain diseases.

DIGESTIVE SYSTEM

BRIEF RECAP: The digestive system processes the consumed food and liquid, breaking it down to

enable absorption. This provides the body with the needed nutrients for metabolism.

The digestive is composed of multiple structures that can all function properly for an older adult,

however as we age the ability to repair tissue begins to diminish and any damage, due to abrasion,

acids or enzymes, is often present. The slow rate of new tissue being made means this damaged

tissue struggles to repair itself, reducing its function.

The digestion of food become extended for an elderly individual, as a result of reduced enzymes

and atrophy to smooth muscles of the alimentary canal. The body produces and releases less

enzymes and acids that perform chemical digestion, meaning the break down process takes longer

than in a young adult. This can cause problems with the digestive system, such as constipation.


The muscles are the second factor responsible for delaying digestion; a decreased muscle tone in

smooth muscles means they are less effective at pushing the food through the system. As a result

the food takes longer to travel through each structure.

In addition, older adult are more vulnerable to dehydrated due to reduced thirst mechanics.

CONDITIONS

MUSCULOSKELETAL

ARTHRITIS

Arthritis is an umbrella term used to describe more than 100 medical conditions that specifically

affect the synovial joints within the musculoskeletal system. As arthritis covers such a wide range of

conditions, it is hard to pin‐point the exact symptom; however, it usually results in weakness,

instability and deformity of the joint.

Osteoarthritis, rheumatoid arthritis and gout are the most common conditions under the arthritis

umbrella and are accountable for 95% of the conditions. (Arthritis Australia, 2013

http://www.arthritisaustralia.com.au)

OSTEOARTHRITIS

Osteoarthritis, also called degenerative joint disease, is the most common type of arthritis. It

consists of a gradual loss of synovial joint function as a result of deterioration of structures within

the joint.

A synovial joint, consists of structures that encapsulate two or more bones connecting together to

allow movement. At the end of each connection bone there is an articulating surface covered with

thick cartilage to prevent the bones from rubbing together, as well as to absorb any impact.

Over time, wear and tear takes place; especially in weight bearing synovial joint; causing the

cartilage to break down or become brittle and therefore less efficient at performing its role. At the

same time, other structures of the synovial joint become less capable at performing their role and

contribute to the joints reduced capacity. Continual use of this worn joint creates irritation that

leads into pain and an inflammatory response.

This condition can be broken down into two categories; primary and secondary osteoarthritis;

which are determined by the cause of the breakdown in joint structures.

Primary arthritis is a result of the natural ageing process, where the breakdown of cartilage

develops over years of use and a natural break down of structures occur with age.


Secondary osteoarthritis is directly related to another condition or disease and the reason for the

breakdown of the joint structures. Examples of conditions are; obesity, diabetes, repeated trauma,

surgery, hormone disorders or gout.

Osteoarthritis is a chronic condition which occurs gradually over time, however, there are risk

factors which include:

Being overweight

Getting older

Joint injury

Joints that are not properly formed

A genetic defect in joint cartilage

Stresses on the joints from certain jobs and playing sports

Taken from Arthritis Research UK (http://www.arthritisresearchuk.org/)

To find out more information about arthritis, please view the following websites:

http://www.arthritisresearchuk.org/

RHEUMATOID ARTHRITIS

Rheumatoid arthritis (RA) is an autoimmune disease which also falls under the arthritis umbrella.

Like osteoarthritis, this condition is a chronic and progressive disease; however it is a result of the

body’s own immune system which attacks healthy tissue within the body, especially joints.

During this autoimmune disease, the specialised cells that destroy foreign invaders within the body

struggle to differential between the body’s own cells and foreign cells. This results in the bodies

own structures or tissues being attacked and broken down.

RA is referred to as an autoimmune disease due to structures within a synovial joint being attached

by the immune system, resulting in a breakdown of within and around a joint. This can have an


inflammatory response causing swelling, pain, stiffness and redness and can ultimately lead to

irreversible joint destruction and disability. This most commonly occurs in the hands, wrists, knees

or feet of an individual who suffers from this condition.

As RA is an autoimmune disease there may also be damage to organs in the body, from the body

attacking some of these cells.

Symptoms include; fatigue, low‐grade fever, stiffness, loss or energy, muscle and joint aches.

The peak age of onset of RA is considered to be 35‐45 years ‐ a time when people are most active in

their workplace or taking care of their family.

EXERCISE AND ARTHRITIS

Exercise has been shown to benefit individuals who suffer from arthritis, and should be included as

a treatment plan. The benefits that have been reported by incorporating exercise as a treatment

plan have been:

Reduce joint pain and stiffness

Increased mobility and flexibility

Provide greater support and stability for joints but strengthening muscles

Strengthen bones

Decrease muscle tension

Improve overall wellbeing

The exercise program should involve low impact exercises containing elements of; mobility,

strengthening, and endurance exercises. These are shown to be the most beneficial type of activity

without damaging the structures further. A specific type of training that would be ideal for arthritis

suffers is aqua‐aerobics.

However, it is recommended for the older adult speaks with an allied health professional prior to

commencing an exercise program.

To find out more information about arthritis, please view the following websites:

http://www.arthritisaustralia.com.au/

http://arthritisnsw.org.au/

Restricted Range of Motion (ROM)

Synovial joints are structures that offer a varying amount of movement which is dependant on the

type of joint. Each joint classification (hinge, ball and socket, pivot, saddle, condyloid) has a normal

range of motion however over time this normal range of motion can be restricted.

http://www.arthritisaustralia.com.au/�

http://arthritisnsw.org.au/�


During the ageing process and wear and tear through use, structures begin to deteriorate and a

build up of collagen fibres occurs. In addition, muscles and supporting structures like ligaments

become tight and less elastic. Coupled together these developments can lead to stiffness in the

joint, and ultimately limits the movement around that joint. This is classified as a restricted range of

movement (ROM).

Exercise and Restricted ROM

Similar to the benefits of exercise on arthritis, exercise can benefit the structures around a joint,

encouraging suppleness and flexibility, especially if mobility exercises are performed. Increasing the

flexibility and mobility of the structures of the joint will improve the range of motion of a joint.

OSTEOPOROSIS

As explained in the ageing process section; bones are continually undergoing a natural remodelling

process. To recap again on this function, osteoclasts are constantly breaking down old bone tissue

for the osteoblasts to resynthesis and lay down new bone tissue to maintain healthy bone tissue.

As aforementioned, a change in the function of these remodelling cells causes a reduction in bone

density. This is therefore the development of osteoporosis, which can be classified as a skeletal

condition where the body cannot replace bone minerals at the same rate at which they are being

removed. This then leads to a reduced mass or density of bone.

Osteoporosis has a literal meaning of porous bone ‐ meaning that the bone has become less dense.

Osteoporosis is a chronic condition that evolves naturally along with the ageing process; however

there are factors which can encourage the development of the condition. These include:

Heredity – family history of osteoporosis puts individuals at higher risk

Hormones – testosterone and oestrogen are responsible at controlling bone density

Lifestyle – smoking and excessive caffeine, alcohol and salt

There are also factors which can help in the prevention of osteoporosis. These include diet, exercise

and/ or physical activity.

Bones are composed of composed of calcium, which is the compound being broken down and

reformed during the remodelling process. By limiting the amount of calcium in the body may

restrict the remodelling process, suggesting a diet should contain adequate amount of diet. The

influence of exercise is described in more detail in the below section.


Exercise and Osteoporosis

Research has shown that regular exercise can help maintain health bone density and even reverse

the affect of osteoporosis. Exercise places stress on bones stimulating osteoblasts into action, and

increasing the rate of new bone tissue being produced.

The specific type of exercise has been show to have a direct relationship to the amount of

osteoblast stimulation. The most efficient activity is weight bearing activities, due to an increased

stress being placed on the bones.

In addition, other factors can be responsible for receiving the greatest bone building affect. These

include; dynamic movements, high magnitude movements, and weight bearing with

multidirectional loads.

Dynamic movements – this involves motion or active exercises rather than static.

High magnitude – wide range of motion, i.e. sprinting will stimulate a greater response than

jogging.

Weight bearing – exercises should included movements or activities which places stress or a

force through the bones, this can be seen as weight bearing.

Multidirectional – the exercises should contain multiple planes of movement of movement

to cause a various degree stress from different angles.


To find out more information about osteoporosis, please view the following website:

http://www.osteoporosis.org.au/

CARDIOVASCULAR

HYPERTENSION

Hypertension means the pressure of blood within the arteries is above the normal level. This is

identified during two phases of the cardiac cycle. As the left ventricle of the heart contracts, it

pumps blood out into the main artery (the aorta) to the rest of the body. During this process the

pressure the blood exerts on the walls of the arteries, is known as the systolic pressure. The left

ventricle then relaxes and no blood is actively pumped out into the aorta, the pressure of the blood

on the arteries is classified as diastolic pressure. Measuring an individual’s blood pressure involves

both the systolic and diastolic pressures.

Normal pressure blood pressure is considered to be around 120 mmHg for systolic pressure and

around 80 mmHg for diastolic pressure. Values above these figures can be considered high blood

pressure; however, there are ranges which establish the severity of the high pressure.

Blood pressure category Systolic Diastolic

Normal 120 80

Pre‐hypertension 120‐139 80‐89

Hypertension stage 1 140‐159 90‐99

Hypertension stage 2 160+ 100+

Hypertensive crisis 180+ 110+

The American Heart Foundation (2013, http://www.heart.org/)

HYPOTENSION

Hypotension is the opposite of

hypertension which is known as low

blood pressure. This condition is where

the pressure within the arteries is lower

than the suggested normal level, as

indicated above.

Exercise and Hypertension

Exercise is considered by many health

organisations including the World

Health Organisation (WHO), the

National Heart Foundation and the


International Society of Hypertension as the primary intervention in prevention and treatment of

pre‐hypertension and hypertension.

The specific physiology of the benefit of exercise is under debate, but can be contributed towards

exercise improving the overall function as well as specific components within the cardiovascular

system. One specific benefit that has been determined to improve this condition is related to the

function of endothelial tissues within blood vessels. Blood vessels consist of an inner layer called

the endothelium, a dynamic tissue responsible for many active functions within the vasculature,

including secretion and modification of blood vessel constriction or dilation and contraction and

relation of smooth muscles that lines vessels.

By exercising, this endothelial tissue remains supple and fully functional; maintaining or improving

its ability to perform it role. As a result this will increase the cardiovascular function and then help

reduce the blood pressure within the body.

OTHER CONDITIONS WHICH COULD PRESENT THEMSELVES WITHIN THE CARDIOVASCULAR

SYSTEM ARE:

Heart attack

A heart attack happens when there is a sudden blockage to an artery that supplies blood to

an area of your heart.

Coronary heart disease

Coronary heart disease is the most common cause of death in Australia. It is also a major

cause of disability, with many people reporting problems or needing assistance with daily

activities.

Deep vein thrombosis

Deep vein thrombosis (DVT) is a blood clot in one of the deep veins of your body, usually in

your leg.

Atrial fibrillation

Atrial fibrillation is one of a number of disorders commonly referred to as 'arrhythmias',

where your heart does not beat normally.

Familial hypercholesterolaemia

Familial hypercholesterolaemia is an inherited condition in which your body doesn't remove

enough cholesterol from the blood. This causes high total blood cholesterol levels and early

onset of coronary heart disease in some families

High cholesterol

Cholesterol is a fatty substance produced naturally by your body and found in your blood.

Heart failure


Heart failure occurs when the heart muscle has become too weak to pump blood through

the body as effectively as normal.

Palpitations

Heart palpitations are an awareness of your heartbeat.

Angina

Angina is chest pain or discomfort caused by insufficient blood flow and oxygen to the

muscle of the heart.

Coronary artery spasm

Coronary artery spasm is a temporary discomfort or pain that is caused by a temporary

spasm in one or more of your coronary arteries.

NEUROLOGICAL

PARKINSON’S DISEASE

Parkinson’s disease is a neurological condition affecting the control of muscular movements,

especially fine motor skills. It is a common condition that affects individuals as the progress into the

later years of their life.

Parkinson’s is a progressive and degenerative disease affecting particular nerve cells within the

brain (specifically the Substantia Nigra area of the brain), that become impaired or die. These cells

are responsible for stimulating the release of dopamine, a hormone that controls the co‐ordination

and smoothness of movement. A reduction of this hormone within the brain results in interrupted

jerky movements.

The symptoms of this disease only present themselves once 70% of nerves cells in the Substantia

Nigra are damage or non‐functional, therefore the disease can go unnoticed for a long period of

time. Once present, the symptoms include the following:

Shaking/trembling The most well known symptom. Usually starting in one limb, it consists of

small shaking or trembling.

Rigidity or stiffness

Muscles become unable to relax and are constantly in a contracted and

tight

Bradykinesia This is slowness of movement, occurring due to the brain not being able

to control smooth and fine motor movements.

Parkinson Australia (2013, http://www.parkinsons.org.au)


Parkinson’s is a disease that can eventually turn into a debilitating condition. The implications that

it can have on an individual is:

1. Physical capacity – simple functional tasks and mobility become increasingly more difficult

to perform reducing the independence of the sufferer.

2. Bodily functions – automatic functions of the body begin to become problematic. This

involves; temperature regulation, digestion of food and fluid, elimination of unwanted

waste, sexual relationships and sleep.

3. Emotional – Parkinson’s can interfere with the psychological well‐being of the individual,

where development of anxiety and depression can occur.

4. Social – socialising become increasing difficult with the development of; diminishing voice

volume and non‐verbal gestures, indiscernible hand‐writing.

5. Cognitive – in some cases, Parkinson’s can be accompanied by dementia. This reduced the

cognitive capacity of an individual.

EXERCISE AND PARKINSON’S DISEASE

Exercise can benefit individual who suffer from Parkinson’s disease in two important ways. Firstly,

exercise can be used to maintain muscle strength, cardiovascular endurance, balance and

coordination and therefore combat the decline in physical capacity associated with this disease. An

increase in physical capacity can encourage independence and improve life style.

The second benefit involves slowing down the progression of the disease. Parkinson’s is responsible

for reduction the dopamine productions cells and reduced levels of dopamine within the brain.

Although damage or destruction of these cells cannot be reversed, exercise can increase the

efficiency of how the brain uses this hormone by modifying the areas of the brain that receive

dopamine signals.

As suggested, improving all components of fitness can be extremely beneficial to this disease, so all

types of exercise should be adopted. However, a program should be based around functional

capacity and mobility. The National Parkinson Foundation recommends the following types of

exercise for Parkinson’s sufferers:

o Treadmill training with body weight support

o Resistance training

o Aerobic exercise

o Alternative forms of exercise (Yoga)

o Home‐based exercise (workout tapes)

o Practice of movement strategies

To find out more information on Parkinson’s Disease, please view the following website:


http://www.parkinson.org/

http://www.parkinsons.org.au/

STROKE

Stroke occurs when the supply of blood to the brain is suddenly disrupted. Blood is carried to the

brain by blood vessels called arteries. Blood may stop moving through an artery because the artery

is blocked by a blood clot or plaque, or because the artery breaks or bursts.

A stroke can occur in two main ways:

1. Blocked Artery (Ischemic stroke)

An ischemic stroke is caused when there is a blockage of blood to the brain. In everyday life,

blood clotting is beneficial. When you are bleeding from a wound, blood clots work to slow and

eventually stop the bleeding. In the case of stroke, however, blood clots are dangerous because

they can block arteries and cut off blood flow.

There are 2 types of ischemic stroke:

o Embolic ‐ when a blood clot travels to the brain causing a blockage

o Thrombotic – when cholesterol laden ‘plaque’ causes a blockage to the blood flow to

the brain

2. Bleed in the brain (haemorrhagic)

Strokes caused by a break in the wall of a blood vessel in the brain are called haemorrhagic

strokes. This causes blood to leak into the brain, again stopping the delivery of oxygen and

nutrients. Haemorrhagic stroke can be caused by a number of disorders, which affect the blood

vessels, including long‐standing high blood pressure and cerebral aneurysms.

An aneurysm is a weak or thin spot on a blood vessel wall. The weak spots that cause aneurysms

are usually present at birth. Aneurysms develop over a number of years and usually don't cause

detectable problems until they break.

STROKE AND EXERCISE

Exercise can be beneficial in preventing the risk of a stroke and as treatment following a stroke.

Stroke prevention involves mainly the incorporation of aerobic activities. This activity improves the

efficiency of the cardiovascular system and reduces any other vascular related conditions such as

high blood pressure. High blood pressure is considered a high risk factor for strokes, so by reducing

this, the risk of a stroke is also reduced. The aerobic activities may be dependent on the fitness

capacity of individual, but can involve continuous activities like walking, swimming or cycling.

Exercise can be a valuable treatment method, once an individual has suffered a stroke. A stroke

commonly leads to reduced mobility and physical capacity. Exercise can be employed to return the


individual back to normal physical capacity, improving their life and wellbeing as well as reducing

the reoccurrence risk.

It is also suggested that activities should be based on functional activities, but important to include

aerobic activities on a regular basis (2‐3 times a week), will help the cardiovascular system function

more efficiently. This will reduce the risk chronic conditions such as diabetes or cardiovascular

diseases.

To find out more information on Stroke’s, please view the following website:

http://strokefoundation.com.au/

PSYCHOLOGICAL

DEPRESSION

Depression is a condition of prolonged feeling of sadness, emptiness and helplessness. There is also

a loss of interest in all activities, poor concentration, altered sleeping and eating habits.

Depression can develop from a number of factors which may include:

o Social isolation and loneliness

o Reduced sense of worth or purpose

o Fears

o Recent bereavement

o Health problems

It affects all ages and is not limited to the older adult; however it is a common problem for older

adults. This can go unnoticed or is related to getting older rather than a psychological condition.

Signs of depression in an older adult:

o Unexplained aches and pains

o Feelings of hopelessness or helplessness

o Anxiety and worries

o Memory problems

o Slowed movement and speech

o Irritability

o Loss of interest in socialising and hobbies

o Neglect of personal care

DEPRESSION AND EXERCISE

Exercise has multiple effects on the body which have a positive effect on combating depression.

These positive effects stem from the physiological:

Reduced stress

Boost self‐esteem

Improve sleep


Improved mood

DEMENTIA OR EARLY STAGE

Dementia is the umbrella name given to collection of symptoms which result in the reduction of

brain function affecting a multitude of areas, including:

Language

Memory

Perception

Personality

Cognitive skills

The nature of dementia often gradually progresses and is irreversible. It is often seen in individuals

who fall within the older adult category, however effect younger adults and is then described as

‘Younger Onset of Dementia’. (The Department of Health and Ageing (2013,

http://www.health.gov.au/dementia).

Being a group of symptoms, there are often several conditions that are responsible for the

development of dementia, these can include:

Alzheimer’s disease

Circulatory problems within the brain

Degeneration of the frontal or temporal lobe

Alcohol,

Huntington’s disease

AIDS related

DEMENTIA AND EXERCISE

Individuals who suffer from dementia are recommended to participate in exercise. The benefits are

generally to improve the overall wellbeing of the individual, rather than specifically beneficial for

condition.

DEPRESSION AND DEMENTIA

Depression and dementia are psychological conditions which can be mistaken for each other due to

there common symptoms.

To help distinguish between the see the following table:

Symptoms of depression Symptoms of Dementia

Mental decline is relatively rapid Mental decline occurs slowly

Know Can be confused


Difficulty concentrating Short‐term memory declines

Normal motor and language skills Impaired motor skills, language and writing

Notices and worries about memory problems Doesn’t

To find out more information on Dementia and Alzheimer’s, please view the following

website:

http://www.fightdementia.org.au/

RESPIRATORY

ASTHMA

Asthma is an inflammatory disorder causing the restriction of the airways that lead into the lungs.

The bronchus and bronchioles within the lungs become hypersensitive and hyper responsive to a

range of triggers. These can range from:

Airborne allergy triggers, e.g. house dust mites, pollens, pets and moulds

Cigarette smoke

Viral infections

Extreme weather conditions

Work‐related triggers, e.g. wood dust, chemicals, metal salts

Some medicines

As a result of these structures coming in contact with a trigger, the hyper responsive reaction

restricts the airways of the lungs causing wheezing, breathlessness, chest tightness and coughing.

Asthma is a condition affecting all ages, but can be misdiagnosed in the older adult population,

being attributed to ageing or other diseases. Of the above triggers, the most common to affect

older adults are airborne allergy triggers and viral infections.

EXERCISE AND ASTHMA

Exercise is considered to be a secondary role in the treatment of asthma following administration of

pharmaceutical medicines. Its role consists of improving the efficiency of the respiratory and

increases the aerobic fitness of the individual.

To achieve this benefit, training must consist of aerobic activities which begin at a low level of

intensity gradually increasing as the fitness level of the individual improves. The Australian

Association for Exercise and Sport Science (2011) recommends that the activities involve large

muscle groups in a rhythmic action like; walking, jogging, running, cycling and swimming.

To find out more information on Asthma, please view the following website:


http://www.nationalasthma.org.au/

EMPHYSEMA

Emphysema is a lung disease, which causes a shortness of breath. It occurs as a result of damage to

the alveoli sacs within the lungs. Over time of abuse, usually by smoke, the alveoli sacs lose their

elasticity limiting their ability to exchange gases.

In a normal functional alveoli, oxygen and carbon dioxide efficient diffuses through a single cell wall

to This then prevents the exchange of oxygen and carbon dioxide between the cell walls and

capillaries; resulting in a reduced amount of oxygen being transported around the body.

The damage to alveoli is considered to be long‐term exposure to cigarette smoke or industrial

pollutants.

Emphysema can create breathlessness during simple tasks, which then creates the desire to rest.

This can cause a negative cycle of inactivity and reduced physical capacity for the older individual

and therefore become detrimental to their physical capacity.

EXERCISE AND EMPHYSEMA

Exercise can be seen as difficult tasks when even simple daily activities may become a struggle,

however, gentle aerobic activities can be very beneficial to the respiratory and cardiovascular

system.

To find out more information on Emphysema, please view the following website:

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Emphysema?open

PNEUMONIA

Pneumonia is an infection of the alveoli sacs within the lungs. It can be caused by many kinds of

both bacteria and viruses. Tissue fluids accumulate in the alveoli reducing the surface area exposed

to air. If enough alveoli are affected, the patient may need supplemental oxygen.

ENDOCRINE

HYPERTHYROIDISM

This condition is where the thyroid gland is too active, resulting in too much thyroid hormone being

produced.

The thyroid gland regulates growth and metabolism via two hormones; thyroxine (also called T4)

and triodothyronine (also called T3).


Therefore when the thyroid gland produces too many hormones, these speeds up the body’s

metabolism, and makes all functions and organs work a lot faster than required. The symptoms that

are present with hyperthyroidism may include:

feeling nervous, irritable or emotional

tremors(shaking)

sleeping poorly

intolerance of heat and sweating more than usual

losing weight despite having an increased appetite

feeling tired

muscle weakness

increased heart rate or palpitations

having infrequent periods or problems getting pregnant

having more frequent bowel movements or diarrhoea

shortness of breath, especially when exercising

swelling of your thyroid gland

HYPOTHYROIDISM

This condition is the opposite of hyperthyroidism, where the thyroid gland produces too little of the

T3 and T4 hormones which are required for body functions and therefore metabolism slows down.

Fatigue and low energy levels

Depression

Slow heart rate

Unexplained weight gain

Intolerance to cold temperatures

Fatigued and aching muscles

Dry, coarse skin

Puffy face

Hair loss

Constipation

Problems with concentration

Goitre (enlarged thyroid gland)


EXERCISE AND THYROID PROBLEMS

Exercise does not have any directly relating benefits for thyroid problems, however is can improve

the overall wellbeing of an individual.

Caution must be taken when exercising with these conditions. Both thyroid conditions can cause

fatigue and weakness which can affect the ability to perform exercise. In addition, the some of the

other symptoms indication previously may also influence an individual’s ability to participate, these

include, changes in heart rate, intolerance of heat and muscle weakness.

DIABETES

Diabetes is a condition affecting the pancreas’ ability to produce and secrete insulin. It can occur at

two different levels, where it cannot produce any insulin or, it struggles to produce enough to meet

the body’s demands. Insulin is a vital hormone that controls the level of glucose within the blood.

The pancreas secretes insulin and glucagon on demand according to the blood glucose levels.

During a period of high blood glucose the pancreas will secrete insulin to reduce this level. When

secreted, insulin will signal to the liver and other areas of the body to absorb glucose lowering the

blood glucose level. In the event of low blood glucose, glucagon is secreted to signal the liver to

release glucose to increase the blood level.

Diabetes involves specifically the production and secretion of insulin, but can be affected in two

slightly different ways, producing the two types: Type I diabetes and Type II diabetes.

TYPE I DIABETES

Type I diabetes involves the destruction of insulin producing cells located in the pancreas;

eliminating the production and secretion of any insulin. As a result the body cannot control the

blood glucose levels and they remain elevated, which is potentially extremely dangerous for the

individual.

Once pancreas cells have been damaged, they cannot be reversed, so within this condition insulin

must be administered by the individual via injections. The volume of insulin injected must be

relative to the blood glucose levels so this must be tested prior to each injection.

The onset of type I diabetes usually occurs in those under 30 years of age but can occur at any age.

About 10‐15% of all cases of diabetes are type I.

TYPE II DIABETES

This is the most common type of diabetes affecting 85‐90% of diabetic suffers and is especially

common in older adult population. Type II diabetes is a result of genetics and environmental factors

that causes the pancreas to struggle to meet the demands of insulin requirements. Insulin must be

released to help other organs absorb glucose from the blood, and the volume released is

dependent on the level glucose within the blood. In Type II diabetes, there is usually a continuously

high level of glucose in the blood (due to poor diet) which the pancreas cannot keep up and


produce enough insulin to control this elevated level. As a result the blood sugar remains raised

causing problems.

Although there is a strong genetic predisposition, the risk is greatly increased when associated with

lifestyle factors such as high blood pressure, overweight or obesity, insufficient physical activity,

poor diet and the classic ‘apple shape’ body where extra weight is carried around the waist.

Type 2 diabetes can often initially be managed with healthy eating and regular physical activity.

However, over time most people with type 2 diabetes will also need tablets and many will also

need insulin. It is important to note that this is just the natural progression of the disease, and

taking tablets or insulin as soon as they are required can result in fewer complications in the long‐

term.

EXERCISE AND DIABETES

Exercise is strongly recommended for all diabetes suffers as long as their condition in controlled

with no additional complications.

Exercise and Sports Science Australia (ESSA) recommends to following exercise for individual with

diabetes:

o Cardiovascular exercise – 150 moderate intensity or 90 high intensity cardiovascular

exercises per week. This should be spread out over at least three days, without training

consecutively more than twice. Cardiovascular exercise consists of continuous repetitive

activities such as walking, running, swimming or cycling.

o Resistance exercise – Specifically aim at Type II diabetic suffers, resistance exercise should

be performed three times a week. The resistance exercises should focus on major muscle

groups and involve 8 – 10 repetitions.

Although, some individuals with type II diabetes may not be able to meet the recommendations the

aim to be to slowly build up and to achieve as close to these guidelines as possible.

GENERAL AND HEALTH BENEFITS OF EXERCISE

There are many benefitting factors for elderly individuals to participate in exercises. These benefits

range from a huge amount of health benefits, to social and recreational benefits and are specific to

the needs of the ageing adult, as explained earlier. These include:

GENERAL BENEFITS:

Interacting with friends/Making new social bonds/Social benefits – as explained earlier,

the lack of older adults socialising can have detrimental effects on an individual’s health.

Therefore, incorporating an older adult into an exercise program will reduce the feeling of

loneliness and isolation thus, help improve or maintain an individual’s mental and physical

health.


Developing a sense of community – similar to social needs, for older adults to perform

exercise in group within their community, helps provide them a sense of support in their

local area. This can also be related to loneliness and can help prevent this from occurring,

and therefore may reduce health problems.

Better sleep patterns – sleeping problems are increasingly common with age. However,

there is positive effect of exercise or physical activity on these sleeping problems. Therefore

performing exercise is likely to improve the sleeping patterns of the older adults.

Higher functional health – The World Health Organisation (WHO) states that an individual,

who participates in exercise or physical activity, is more likely to have a higher level of

functional health. This will increase cognitive function, reduce the risk of falling and as well

as reduce the risk of moderate and severe functional limitations.

Improve balance and coordination – Exercise can improve the balance and coordination of

individuals helping reduce the risk of falls, and improve daily functions that require these

components.

Enhancement of bone health – as we age bones naturally reduce their density. Exercise

helps

HEALTH BENEFITS

In addition to the general benefits there are a huge amount of health benefits, which are a result of

exercise. They have been identified by WHO (2013), and are as follows:

Lower rates of all‐cause mortality:

o coronary heart disease

o high blood pressure

o stroke

o type 2 diabetes

o colon cancer

o breast cancer

Higher level of cardio‐respiratory and muscular fitness

Maintenance of strong immune system

Healthier body mass and composition

A biomarker profile (measurable characteristic that helps determine the severity or

presence of some disease states) that is more favourable for the prevention of

cardiovascular disease, type 2 diabetes

Metabolic Effects – improves body’s ability to control glycemic levels are rest

Improve bone condition


PRE‐EXERCISE SCREENING AND TESTING

PRE‐EXERCISE SCREENING

As with all other clients the purposes of the pre‐exercise screening remains the same for Older

Adults. The purpose of the pre‐exercise screening is as follows:

o Identify contraindications

o Build rapport

o Initial assessment tool

o Measurement point

o Tailor the exercise programme

o Identify posture abnormalities

However, due to the ageing processes that have been explained earlier, the older adult’s body is

slowly deteriorating and may develop conditions (may be dependant on lifestyle and other factors);

the screening process of an older adult should place more emphasis on identifying any

contraindications or conditions. The reason for this is that contraindications or conditions could

place the client under risk, and therefore may restrict the individual from participating in a fitness

program.

The process of the pre‐exercise screening is completed during an interview, where a questionnaire

gathers the following information:

Current medical conditions

Medical history

Medication

Lifestyle evaluation

Exercise history

Injury history

Fitness and health goals

Additional info – this process might be useful to be completed with a family member, this is so

the information gained is accurate. An older individual may forget, or withhold some important

information that a family member can provide.

What to do with the information from a health screening?

Completing the pre‐exercise screening questionnaire is only part of the process; the next stage is to

understand how to use the information gathered. There is no point gaining this information and

then ignoring what the client has provided.


Use health and medical information to determine contraindications – the majority of the health

and medical information is used to determine any contraindications the older adult might have. It is

important to gain as much information regarding any health conditions the client possesses. Any

current conditions must be referred onto an allied health professional, so they can give permission

to client to participate in an exercise program.

If you are unsure whether a conditions is a contraindication or not, it is best to act on the side of

caution and recommend them to seek permission from an allied health professional.

The allied health professional will provide a letter to the fitness professional identifying whether

exercise is advisable and at what intensity.

Use client’s needs and the fitness tests to create training objectives and goals – once it has been

established that the client can participate in an exercise program, the program can be designed.

This program should be designed around the needs and objectives of the client. For example, a

client may want to improve their daily living; therefore the exercises would be orientated around

functional exercises.

FITNESS TESTS

The next step in the overall pre‐exercise screening is Fitness testing. These are activities that are

performed to evaluate a client’s health and fitness level. They can be general fitness tests such as

heart rate or blood pressure or very specific fitness tests that directly relate to a component of

fitness.

Similar to pre‐exercise screening questionnaire, the fitness tests are implemented for an older adult

the same as all other clients, however emphasis may be placed on specific fitness tests. These are:

Blood pressure

BMI

Specific fitness tests catered for older adults

Posture

Functional movement


The American Academy of Health and Fitness (2008) recommends six fitness tests for older adults,

these are:

30 second chair stand

30 second arm curl

Two minute marching step or 6 minute walk test

Chair sit and reach

Back scratch

Eight foot up and go

Single leg stand

30 SECOND CHAIR STAND (muscular strength and strength endurance)

This test measures lower body strength and consists of the client standing from a seated position

and then returning to the seated position. This is completed as many times as possible within a 30

second period. To orientate this around strength endurance, complete the same movement, but

record the number of repetitions to failure.

The results table below shows the recommended values for each older adult age group:


Age Below average Average Above average

Men 60‐64 < 14 14‐19 > 19

Women 60‐64 < 12 12‐17 > 17

Men 65‐69 < 12 12‐18 > 18

Women 65‐69 < 11 11‐16 > 16

Men 70‐74 < 12 12‐17 > 17

Women 70‐74 < 10 10‐15 > 15

Men 75‐79 < 11 11‐17 > 17

Women 75‐79 < 10 10‐15 >15

Men 80‐84 < 10 10‐15 > 15

Women 80‐84 < 9 9‐14 > 14

Men 85‐89 < 8 8‐14 > 14

Women 85‐89 < 8 8‐13 > 13

Men 90‐94 < 7 7‐12 > 12

Women 90‐94 < 4 4‐11 > 11

(Sourced from http://www.topendsports.com)

30 SECOND ARM CURL (muscular strength and strength endurance)

This test measures upper body strength, specially the bicep strength. It consists of the client

performing as many arm curls as possible in a 30 second period. This is performed in a seated

position with women using a 5lb weight and men using an 8lb weight. To orientate this around

strength endurance, complete the same movement, but record the number of repetitions to

failure.

TWO MINUTE MARCHING STEP

Designed to measure the functional fitness of an older adult, this consists of the client marching on

the spot for 2 minutes. The marching involves the client raising the leg up so the femur is parallel to

the ground. The number of steps is counted, with 1 repetition raising both legs. This test is usually

performed next to a wall to provide support if they have trouble balancing.

6 MINUTE WALK TEST

This test is an adaption of the Cooper 12 minute run for elderly individuals. It involves the individual

walking as far a possible in a 6 minute duration. The distance walked is recorded during this test.

CHAIR SIT AND REACH (lower body flexibility)

Measuring the clients lower body flexibility, this test is very similar to the standard sit and reach

test, however the older adult is seated in a chair to provide stability and ease of performance. In

the seated position, they reach both hands (or one hand with the other holding onto the chair for

stability) down towards one of the feet which is outstretched. The other foot is grounded to create


stability. Measurements from the hand and foot position (minus or plus) are taken and then

repeated on the opposing side.



Men 60‐64 < ‐2.5 ‐2.5 – 4‐ > 4

Women 60‐64 < ‐0.5 ‐0.5 – 5 > 5

Men 65‐69 < ‐3.0 ‐3 – 3 > 3

Women 65‐69 < ‐0.5 ‐0.5 – 4.5 > 4.5

Men 70‐74 < ‐3.5 ‐3.5 – 2.5 > 2.5

Women 70‐74 < ‐1 ‐1 – 4 > 4

Men 75‐79 < ‐4 ‐4 – 2 > 2

Women 75‐79 < ‐1.5 ‐1.5 – 3.5 > 3.5

Men 80‐84 < ‐5.5 ‐5.5 – 1.5 > 1.5

Women 80‐84 < ‐2 ‐2 – 3 > 3

Men 85‐89 < ‐5.5 ‐5.5 – 0.5 > 0.5

Women 85‐89 < ‐2.5 ‐2.5 – 2.5 > 2.5

Men 90‐94 < ‐6.5 ‐6.5 – 0.5 > ‐0.5

Women 90‐94 < ‐4.5 ‐4.5 – 1 > 1


BACK SCRATCH (upper body flexibility)

This measures the flexibility of the client’s upper body. It is performed by the individual reaching

both hands behind their back, attempting to have them touch. One hand reaches over the shoulder

and the other hand reaches from the lower back. Ideally the hands should meet and touch

comfortably; however in the older adult population this is quite a hard task. The distance between

the two hands is measured and recorded.



Men 60‐64 < 6.5 6.5 – 0 > 0

Women 60‐64 < 3 3 – 1.5 > 1.5

Men 65‐69 < 7.5 7.5 – ‐1 > ‐1

Women 65‐69 < 3.5 3.5 – 1.5 > 1.5

Men 70‐74 < 8 8 – ‐1 > ‐1

Women 70‐74 < 4 4 – 1 > 1

Men 75‐79 < 9 9 – ‐2 > ‐2

Women 75‐79 < 5 5 – 0.5 > 0.5

Men 80‐84 < 9.5 9.5 – ‐2 > ‐2

Women 80‐84 < 5.5 5.5 – 0 > 0

Men 85‐89 < 10 ‐10 – ‐3 > ‐3


Women 85‐89 < 7 7 – ‐1 > ‐1

Men 90‐94 < 10.5 10.5 – ‐4 > ‐4

Women 90‐94 < 8 8 – ‐1 > ‐1


EIGHT FOOT UP AND GO (coordination and agility)

This test measure coordination and agility in older adults and involves the client standing from a

chair, walking 8 feet in front of the chair round a cone and then back to the chair to a seated

position. This should be done as quickly as possible and is timed.

SINGLE LEG STAND (BALANCE)

To measure the proprioceptive and balance ability of the older adult, this test involves standing on

one leg (next to a wall for support) for a duration of 30 seconds or until they need to use the wall or

support leg. The length of time they can balance for is recorded (up to 30 seconds). If 30 seconds is

reached this indicates good balance, however this test can be progressed if completed with ease.

To do this, the individual can close one eye or stand on a pillow to create an unstable surface.

Ensure the safety of any individual performing the progression exercise by standing in an

appropriate position to provide help if they below unbalanced.

Once complete the fitness tests can be used as a gauge to identify the fitness level of the client, but

they can also be used in several other ways:

o Used for education and motivation

o Goal setting and program planning

o Monitoring progress and re‐evaluation

POSTURAL CHANGES AS WE AGE

As we age there are several changes which occur to our posture. This can be due to the postural

muscles becoming weak and unable to combat the effects of gravity on the body, as well as other

factors which may involve injury, poor biomechanics, illness, poor footwear or clothing and stress/.

The changes to posture usually include malfunctioning spine or torso and can include the following:

o Lumbar spine flattens – losing it lordotic curve

o Forward bend of the hips – extended sitting can shorten the hip flexors cause the torso to

lean forward

o Thoracic spine increases its curvature – the upper back begins to develop kyphosis (hunch

back)

These alterations in posture can have a detrimental effect on the vertebrae and vertebral discs,

usually causing degeneration of the cartilage (vertebral discs) or the spinal bones, leading to

arthritis or osteoporosis (explained in more detail further on in the module)


As we age, we get a forward bend at the point where the thoracic spine (the spine of the chest)

meets the lumbar spine (the spine of the lower back). This makes the stomach protrude.

The lumbar spine flattens, losing its normal curvature and resulting in further protrusion of the

stomach.

Finally, the convex curve of the upper back worsens resulting in a hunch back. Not only does the

lack of posture make us look old but the compression of the vertebrae that result from those

postures may accelerate degenerative disk disease and degenerative arthritis.

Ultimately, this may lead to vertebral compression fractures, if you happen to have weakness of the

bones (osteoporosis).

Even without compression fractures, the chronic constriction of the lungs and guts contribute to

the decreased good function of those organs.

POSTURAL APPRAISAL

A postural appraisal involves assessing an individual’s posture and comparing it to ideal posture,

and identifying:

o any abnormality

o the degree of deviation

o the origin of deviation

o any contraindications

o postural risk factors associated with exercise


Features

A postural assessment can help the trainer identify muscle imbalances at a joint and the

working relationships of the muscles around a joint such as over‐facilitated agonist and

inhibited antagonists.

A personal trainer will observe the client’s posture in all three planes relative to a vertical

plumbline, allowing the trainer to identify any muscle imbalances at the major load‐bearing

joints: the feet, knees, hips or shoulders.

A personalized assessment based on a client’s posture will allow the trainer to develop a

personalized workout based on the client’s current musculoskeletal structure.

ADVANTAGES

Poor posture and poor structural alignment of the load‐bearing joints could lead to overuse

injuries of the muscular system. A trainer can use the postural assessment to identify

specific muscles which will need to be lengthened or strengthened to help the client achieve

their specific goals.

A postural assessment takes the guesswork out of choosing which exercises to use for a

particular client and allows a trainer to select the best exercises for each client’s individual

needs.

THE STANDING POSTURAL ASSESSMENT

One tool commonly used by fitness and health professionals is the standing postural assessment.

The purpose of this assessment is to observe a person standing at normal, relaxed posture from the

front, side, and often rear view, and then determine how his or her alignment compares to a

predetermined standard as indicated by a vertical “plumb line.”


The points of reference you’ll be observing are your earlobe, top of your shoulder, the dent on the

side of your elbow, the side seam of your pants or shorts at the fullest part of your hips, the outside

of your knee (just slightly closer to the front of your knee than the back), and your ankle bone.

If any of these points fall in front of or behind the line you’ve drawn from the ankle bone up, this is

an indicator that your posture is misaligned.

From the front view, you want to make sure the centre of your chin, the dent between your

collarbones, your sternum, your belly button, and the rise of your pants all line up vertically. Also,

you might draw two horizontal lines across the tops of your shoulders and hipbones to ensure that

both are level.

WHAT TO LOOK FOR IN A POSTURAL ASSESSMENT ‐ REVIEW

POSTERIOR VIEW

1) Head/neck tilt

2) Head rotation

3) Shoulder level

4) Shoulder bulk

5) Scapula distance from spine

6) Spinal curvatures

7) Arm distance from the body

8) Skin creases. Are they same on both sides

9) Elbow position.

10) Thigh/calf bulk. Is this equal?

11) Calf midline.

12) Genu varum/valgus (knock knee or bowed legs)

13) Foot position.

SIDE VIEW

1) Forward head position.

2) Are the shoulders protracted?

3) Is there noticeable kyphosis?

4) Lumbar spine. Is this lordotic or flat?

5) Knee position. Are the knees normal, flexed or hyper extended?

HOW DO YOU SHARE THE RESULTS WITH YOUR CLIENT?

When conducting the assessment simply make notes of which muscles might be over‐facilitated or

tight and which might be inhibited or weak. When sharing results from a postural assessment, focus


on the positive aspects and how the observations can be used to help the client move closer to

their individual fitness goals. Avoid using negative language such as: “wrong,” “bad” or “poor.”

Keep scope of practice in mind as personal trainers never diagnose a condition or prescribe a

solution, they merely make observations that are used in designing an effective and efficient

exercise program. Make simple statements that link back to your client’s goals such as “it seems as

though you might have tight hip flexors so it will be important to take the time to thoroughly

stretch the muscles to reach your fitness goals in a timelier manner”.

Taking the time to do a postural assessment on a client is like a mechanic driving a car before taking

the time to make the necessary repairs. Just like the mechanic needs to drive the car to identify the

specific issue, a trainer needs to take the time to observe a client’s body structure relative to a

plumbline to identify any potential muscle imbalances and create a proper stretching and

strengthening exercise program.

PROGRAMMING

The purpose of this section is to apply the training principles to the older adult population, as a

fitness professional all specific knowledge of fitness programming will have been learnt in previous

qualifications.

Like any client the aim of a program is to achieve the goals of the client, however, the needs of the

older adult are altered due to the ageing processes.

There are five physical activity recommendations for older Australians.

1. Older people should do some form of physical activity, no matter what their age, weight, health

problems or abilities.

2. Older people should be active every day in as many ways as possible, doing a range of physical

activities that incorporate fitness, strength, balance and flexibility.

3. Older people should accumulate at least 30 minutes of moderate intensity physical activity on

most, preferably all, days.

4. Older people who have stopped physical activity, or who are starting a new physical activity,

should start at a level that is easily manageable and gradually build up the recommended

amount, type and frequency of activity.

5. Older people who continue to enjoy a lifetime of vigorous physical activity should carry on

doing so in a manner suited to their capability into later life, provided recommended safety

procedures and guidelines are adhered to.

As explained earlier, there are several reasons for an older adult to perform an exercise program,

and of these a selection can be used to determine the structure and components of the program.

The following reasons may determine the programming for an older adult:

o Improve functional capacity


o Improved physical and mental wellbeing

o Prevention of chronic conditions

o Reduction or management of a condition

o Improved sport or activity performance

When designing a program for an older adult, it should contain the same structure used for any

client, therefore should consist of 3 components:

o Warm up (preparation phase)

o Conditioning Component

o Cool Down (recovery phase)

WARM UP

Warm‐ups prepare the body for the forthcoming activities both mentally and physically and

therefore should not change that much between an older adult and young adult.

The physiological changes that occur following a warm up consist of; increasing the blood flow (to

muscles); increase the delivery of oxygen and nutrients to the muscles for metabolism and improve

lubrication around synovial joints. It can also help the client prepare mentally.

As any other client, to prepare the client for the conditioning component of the program, the warm

up should consist of 3 stages:

1. Aerobic exercise to raise heart rate

2. Flexibility and mobility training

3. Program or exercise specific warm up

The first stage consists of a general aerobic exercise which aims to stimulate the cardiovascular

system. Due to an older adult’s body responding at a slower rate than a young adult, this stage is

often extended in duration, and can last up to 10 minutes. Aerobic exercises can consist of

treadmill walking or jogging, stationary bicycle, cross‐trainer, or stepper machines.

Stage 2 consists of flexibility and mobility exercises, usually involving light stretches (mainly

dynamic during the warm‐up), which focus on the muscle of body part, which is being trained.

The final stage consists of a program or exercise specific warm‐up so the body can efficiently

prepare for the specific muscles and movements being used. The intensity of these exercises must

be very low, so the individual is not worked too hard. Therefore for an older adult, the exercises are

regressed to their simplest form, or in some cases the specific muscle used in the session is

stimulated by contracting it.


CONDITIONING COMPONENT

The conditioning component is where the program aims to meet the goals of the client and

generally revolves around the following components of fitness:

o Strength

o Cardiovascular endurance

o Flexibility

o Balance

STRENGTH

TO RECAP: Strength uses skeletal muscles to perform a movement and can be broken into two

types: muscular strength or strength endurance. Muscular strength is the ability to perform

maximal force against a resistance once, whereas muscular endurance is the ability to perform

repeated contractions against a resistance over a period of time.

Strength is usually considered the primary component that an older adult should address when

initiating an exercise program. It will provide the foundation for all other fitness components to

build upon and therefore is vital to establish a base strength prior progressing onto other

components.

Strength can be developed in many different forms, all of which consist of some sort of resistance

that stresses the muscles and creates adaptation. For the older adult, this module will address

strength in general and identify in brief how it can be adapted for muscle strength and muscle

endurance.

Improving the strength of an older adult can see the following benefits (many of which are related

to each other):

Improved overall quality of life

Increased strength and muscle mass (improve metabolic rate)

Reduced body fat

Reduced blood pressure

Increased bone density

Increased glucose metabolism

Increased gastrointestinal transit

Reduced low back pain

Reduced arthritic pain

Reduced depression


CREATING A STRENGTH PROGRAM

Preparing a strength or resistance program for an older adult is very similar to that of any other

client, and should include all the same program elements. However, it may differ by requiring

modifications to each program element. These modifications are relevant to the needs of an

individual who may be affected by the ageing processes or a chronic condition. The following

section identifies the elements contained within a strength program, and how they can be adapted

for an older adult:

Exercises selection

The selection of exercises contained within an older adult’s strength program is crucial for obtaining

the needs and goals of that client. Often the older adult will have a general overall strength goal;

however other specific goals may revolve around function capacity or sport specific performance.

Functional capacity considers the movements that are continually used throughout the day, such as

standing from a seated position or walking up stairs. Sport specific performance is less likely to be

the goal of an older adult, but programs directed towards this goal should be specific to the

movements used within the sport.

To begin designing a program, it is recommended that to achieve an overall strength goal, the

program should contain at least one exercise for each of the main muscle groups. This can then be

refined to include function movements or sport specific exercises in accordance with their goals.

Frequency of program and adaptation phase

Frequency identifies how often a strength program should be preformed for gains to occur. Like a

young adult, it is recommended for an older adult to perform strength training 2 ‐3 times per week

for gains to occur.

The recovery time between these sessions is extended for the older adult population with

recommendations of 72 ‐ 96 hours recovery before exercising the same muscle group.

Repetitions and Sets

The repetitions of a strength workout are very specific. You can achieve different types of strength

gains in a young adult through repetition training ranging between 4 – 20+ reps. However, older

adults usually target muscular strength or strength endurance and therefore the repetitions range

is between 8 – 15 repetitions. Muscular strength will be achieved at the lower end and muscular

endurance will be achieved at the higher end of the spectrum.

Sets are related to the capabilities of an older adults ranging between 1 – 3 sets. For a beginner

program they should begin with one set of exercises and progress up to three sets as they become

more capable.

Load (intensity)

The load varies between 60 – 80% of an individual’s 1 repetition maximum. The lower load is more

likely to target strength endurance and higher load target muscle strength; however beginners


should start with the lower range. The key element is that the load is producing enough muscle

fatigue for adaptations to occur.

Progression

Progression sees gradual improvement in strength due to muscle adaptation. For this to take place

the muscle must be continually overloaded and stressed, so an ongoing progression must be

applied. This can be done via the FITT principle which modifies the program according with the

following:

o Frequency – how often you perform the exercise or program

o Intensity – the load used for each exercise

o Time – the duration spent training

o Type – the type of exercises (individual muscle or compound exercises)

OTHER ELEMENTS TO CONSIDER WHEN STRENGTH TRAINING OLDER ADULTS:

Speed of exercise

Older adults should perform the exercise at a slower rate than a young adult, spending up to 6

seconds to execute one repetition. Broken down into the concentric and eccentric phases the

exercise should be performed; 2 seconds for concentric phase and 4 seconds for eccentric phase.

Technique

Technique consists of performing an exercise correctly using its intended actions and muscles. This

is just as vital for older adults as any other client, to prevent injuries and achieve the desired

outcome. However, many older adults do not have much experience with exercising and therefore

have a poor awareness of technique. This highlights the importance of demonstrating and focusing

on the correct technique to be performed.

Monitoring training load

The training load of the individual should be monitor on an ongoing basis, to ensure the client is

being overloaded enough for adaptations to occur or not being overloaded too much and show

signs of exercise intolerance.

Demonstration

As some older adults are new to exercise and physical activity it is important to ensure the client

understands the requirements each exercise within the program. As with any client, an older adult

may learn more effectively in either of 3 different. These are:

o Auditory – learn by hearing

o Visual – learn by watching

o Kinaesthetic – learn by doing

To train your clients efficiently it is important to understand how each of them learns and then

target this method. However, for an older adult, applying more than one of these methods can


reinforce the instruction of the exercise and ensure full understanding and requirements. This may

involve talking through AND demonstrating each exercise thoroughly.

STRENGTH TRAINING MODIFICATIONS:

The simplest form of strength training may be too challenging for some individuals within the older

adult population, as a result of poor stability, ROM, or strength. This means the training needs to be

modified to enable performance.

To provide the correct modification, an evaluation needs to be made to understand why the

program is too advanced.

A common modification that is implemented for poor stability is the use of a chair to create a

seated resistance program (this is also explained within the balance component). Other

modification may involve improving ROM and muscle contraction prior to developing a strength

program.

SEATED RESISTANCE TRAINING

As explained earlier, the physical capacity of an elderly individual reduces, meaning they may find it

hard to perform strength or mobility exercises whilst balancing simultaneously. As a result, one of

these components needs to be removed. Therefore, as the aim of this program is to increase

strength, the balance or stability element needs to be removed. To do this, the exercise can

incorporate a chair, producing a seated strength‐training program. This enables the individual to

focus on strength, which can then progressed into developing other components, like balance,

when appropriate.

Seated shoulder raises (with our without weight)

1. You can do this exercise while standing or sitting in a sturdy, armless chair.

2. Keep feet flat on the floor, even and a shoulder‐width apart.

3. Hold hand weights straight down at your sides with palms facing

inward.

4. Slowly breathe out as you raise both arms to the side, shoulder

height.

5. Hold the position for 1 second.

6. Breathe in as you slowly lower arms to the sides.

7. Repeat 10 to 15 times.

8. Rest; then repeat 10 to 15 more times.


Chair dips

1. Sit in a sturdy chair with armrests with your feet flat on the floor,

shoulder‐width apart.

2. Lean slightly forward; keep your back and shoulders straight.

3. Grasp arms of chair with your hands next to you. Breathe in

slowly.

4. Breathe out and use your arms to push your body slowly off the

chair.

5. Hold position for 1 second.

6. Breathe in as you slowly lower yourself back down.



Seated row with a resistance band

1. Sit in a sturdy, armless chair with your feet flat on the floor,

shoulder‐width apart.

2. Place the centre of the resistance band under both feet. Hold each end of the band with palms facing inward.

3. Relax your shoulders and extend your arms beside your legs.

Breathe in slowly.

4. Breathe out slowly and pull both elbows back until your hands are at your hips.


6. Breathe in as you slowly return your hands to the starting position.



Back leg raises holding chair

1. Stand behind a sturdy chair, holding on for balance. Breathe in

slowly.

2. Breathe out and slowly lift one leg straight back without bending

your knee or pointing your toes. Try not to lean forward. The leg

you are standing on should be slightly bent.


4. Breathe in as you slowly lower your leg.



6. Repeat 10 to 15 times with other leg.

7. Repeat 10 to 15 more times with each leg.

Leg straightening exercises

1. Sit in a sturdy chair with your back supported by the chair. Only

the balls of your feet and your toes should rest on the floor. Put

a rolled bath towel at the edge of the chair under thighs for

support. Breathe in slowly.

2. Breathe out and slowly extend one leg in front of you as straight

as possible, but don't lock your knee.

3. Flex foot to point toes toward the ceiling. Hold position for 1

second.

4. Breathe in as you slowly lower leg back down.


6. Repeat 10 to 15 times with other leg.

7. Repeat 10 to 15 more times with each leg.

Toe stands

1. Stand behind a sturdy chair, feet shoulder‐width apart, holding on for balance. Breathe in slowly.

2. Breathe out and slowly stand on tiptoes, as high as possible.


4. Breathe in as you slowly lower heels to the floor.



CARDIOVASCULAR ENDURANCE

TO RECAP: Cardiovascular endurance is the ability of the heart and lungs to provide oxygen rich

blood to tissues around the body, to be used for energy metabolism. This occurs via the lungs

inhaling oxygen (and exhaling carbon dioxide) and exchanging it into the blood vessels through

the cell walls. Once in the blood vessels, the heart is responsible for pumping this oxygenated

blood around the body to the cells.

The benefits that result from older adults participating in cardiovascular endurance are:

o Improved VO2 max


o Reduced risk of cardiovascular disease

o Lower Blood pressure

o Increased HDL (good cholesterol)

o Lower LDL (bad cholesterol) and Fat

o Improved body composition

o Improved quality and quantity of life

o Reduced rate of age‐related deteriorating in physiological functions.

A cardiovascular endurance program consists of an aerobic activity that is continuous and repetitive

in nature. These are activities performed over a longer duration which stresses the heart and lungs

creating adaptation and improvements in their functions. The types of activities include walking,

running, cycling, swimming, step exercises, elliptical machine, low impact aerobics and aqua‐

aerobics.

There are several different types of cardiovascular endurance training that can be incorporated into

an older adult program. They are generally the same as a young adult, with the duration and

intensity being lower. The American College of Sports Medicine recommends an older adult

performs cardiovascular endurance exercise for duration of 20‐60 minutes 3 – 5 times a week at a

55 – 90% of VO2 max.

The methods of performing these cardiovascular activities are:

CONTINUOUS ACTIVITY

The simplest form of cardiovascular endurance training is continuous activity, where an aerobic

activity is performed continuously without breaks over a period of time. For an older adult these

activities are usually initiated with low intensity and short duration developing over time to further

overload the body.

An example for an older adult would be walking for 20 minutes twice a week and then one 30

minute longer walk. This can then be progressed by increasing the duration or the intensity.

FARTLEK TRAINING

Fartlek translates to ‘speed play’, and can be applied to all aerobic activities. It is an unstructured

method of cardiovascular endurance training, where the intensity is regularly changed throughout

an aerobic activity. The overall duration of the aerobic activity is set and then throughout duration,

the intensity is modified. It can be planned, where a change in intensity is pre‐set or unplanned,

where the intensity is randomly modified throughout the activity. This method encourages

adaptation at a faster rate, as the systems are constantly adjusting to the intensity.


An example of Fatlek is:

Duration Intensity

5 minutes Gentle walk (50%)

1 minute Power walk (80%)


1.5 minutes Fast walk (70%)


2 minutes Medium walk (60%)

30 second Power walk (80%)


INTERVAL TRAINING

Interval training consists of bouts of aerobic activity (can be anaerobic, but for older adults is

usually aerobic) followed by a rest or reduced intensity; this is then repeated one or more times.

The duration of the aerobic activity can vary according to the fitness of the individual and the aim of

the training. Likewise the rest period can also vary, but should provide recovery from the aerobic

activity

This type of training enables the cardiovascular system to work harder for the aerobic activity reps

with the recover, meaning the overall training is at a higher intensity.

An example of interval training for an older adult:

Activity Duration Intensity

Aerobic activity 2 minutes Light Jog








End of workout

FLEXIBILITY

RECAP: Flexibility is the ability of a joint to move through a full range of motion (ROM). It

considers the mobility of the joint and the length of the muscles which joint around the joint.

As we age, our muscles normally become shorter and lose their elasticity. Bone structure can also

be affected, causing decreased range of motion in the shoulders, spine, and hips. These changes

can sometimes be painful. It becomes important for seniors to maintain the range of motion of

their bodies, and to continue moving joints normally.


Flexibility is usually trained via stretching which involves attempting to elongate or increase the

elasticity a muscle. Most workout routines focus on cardio exercises getting the heart rate up and

strength training, which develops muscle. However, stretching is just as important, especially for

older adults, who routinely suffer from loss of joint flexibility as they age.

The specific benefits of stretching are:

Increases flexibility

The most obvious role of stretching is to improve flexibility. This increases the length of muscles

and the range of motion around a joint. Although it can be seen as a single benefit, it usually

contributes to many of the other benefits seen in stretching such as improved physical capacity,

functional tasks and posture.

Emotional Benefits

Often overlooked, stretching can be used as a relaxant to reduce stress and anxiety. This is

especially seen in specific types of stretching like yoga and tai chi, which can be seen as activities,

which incorporate flexibility as a component.

Stretching can help relax muscles that become tight due to stress or depression. This can then

improve the psychological wellbeing of the individual. In addition to this, stretching or exercise in

general releases endorphins, a chemical in the brain which improves mood.

Improves circulation and creates healthier muscles

Tight muscles often have a restricted blood flow; by stretching the blood flow to a muscle can be

increased. This leads to more nutrients being provided and more waste being removed from

muscles. This can result in more efficient muscles, quicker recovery and reduced injury risks.

Improves balance and coordination

Increasing the flexibility of muscles can also improve their function. Therefore, muscles that are

involved in balance and coordination can now perform the role more efficiently. This is especially

important for the older adult as it helps to prevent falls and improve functional tasks.

Helps alleviate lower back pain

Pain and stiffness in the lower back can be directly related to tight muscles in that region.

Stretching these muscles can alleviate pain.

Helps improve cardiovascular health

Yoga, a form of stretching, can have beneficial effects on the cardiovascular system, by improving

the muscles, which attach to the lungs and are involved in ventilation. Stretching can also help

improve artery function and lower blood pressure.


TYPES OF STRETCHING

Static Stretching

The most common and widely used type of stretching, static stretching involves hold a limb or body

position in an end position, so a group or individual muscle/s is elongated. This stretch should be

help up to 30 seconds, and aims at increasing the flexibility of a specific muscle or increases the

range of motion of a joint.

Static stretching is relatively safe, as long as the end position is not forced to an extreme and pain is

not felt.

It has been shown that long‐term flexibility gains have indicated that muscles stretched for around

30 seconds a day continue to produce improvements in their range of motion for up to around 6

weeks before reaching a plateau. If the stretches were only held for around 15 seconds then it

takes around 10 weeks to reach the same degree of range of motion.

Dynamic stretching

Dynamic stretching involves a continuous movement or momentum to place a muscle in a

stretched position at each end point. This type of stretching can be used for sport or exercise

specific warm up, where it prepares the muscles and body for the specific movement that will be

used.

An example would be a walking lunge with the emphasis on the lunge to gain hip flexor stretching.

This type of exercise can pose some risks to an older adult; however, some specific forms of

dynamic stretching can be very advantageous for them. When planning this type of exercise for an

older adult, it is best to avoid any movement which emphasises balance, bouncing, or uncontrolled

movements.

PNF stretching

Proprioceptive Neuromuscular Facilitation (PNF) is another type of stretching which takes

advantage of tension and muscle length receptors, to encourage muscular relaxation and flexibility.

The technique is performed with the use of a partner. The partner places the muscle in a

lengthened and slightly stretched position, by moving a limb. In this position, the client contracts

the stretched muscles against the resistance of the partner, holding the contraction for roughly 10

seconds. Following the contraction, the muscle will automatically relax, due to the response of the

golgi tendon organ. This then allows the partner to increase the stretch.

Performing this type of stretching can see great improvements in flexibility, but caution must be

taken when performing this for the older adult population. The muscles and tendons of the older

adult are more prone to tearing, and have less responsive muscle sensory receptors.

PNF has varying other benefits which include:


Can improve muscle tone – increase muscle strength

Can improve balance – therefore preventing falls

Can benefit daily functions

Example: To perform a hamstring PNF stretch, lie flat and raise a leg until you feel a slight

discomfort in your hamstring muscle. With a partner holding the leg in this position, contract the

hamstring isotonically against the partner’s resistance (this can be done isometrically if there is no

partner to help) for 6‐10 sec. Then relax the muscle and allow the partner to gently and slowly

deepen the stretch (this can be done using your quadriceps if completed individually). Repeat the

cycle 3‐4 times.

REMEMBER TO BE CAUTIOUS WITH THE OLDER ADULT AND ONLY GENTLY INCREASE THE

STRENGTH WHILST GAINING FEEDBACK FROM THE INDIVIDUAL.

BALANCE

RECAP: Balance is the ability to maintain a stable body position over its centre of gravity whilst

being stationary or moving.

Balance can be seen as one of the most important component for an older adult as it allows them

to stand, walk, and even run in an upright position without falling. Falls in the elderly population are

a common occurrence that can reduce the independence of an individual as it is usually

accompanied with a fracture or injury. Therefore to prevent this from happening becomes vital to

help and improve physical wellbeing.

There are several things that can be done to reduce the risk of a fall, which include; have an

occupational therapist review the home environment, provide awareness about risks, improve sight

with glasses and improve balance and lower body strength. The last element is where the fitness

professional can help and develop a program to improve this vital component of fitness.

Balance can simply be improved by developing the lower body strength of an individual; however

there are specific balance exercises or methods to incorporate into a strength program, which will

further encourage the development of balance.

Specific balance exercises are very basic and involve performing activities that put the client in an

unstable situation, which usually involve the client standing on one leg. This can be easily regressed

or progressed to make it versatile for all abilities. It is important to start at the right level for your

older adult client and then progress this for improvements to continually occur.


This exercise can be regressed and progressed as follows:

REGRESSION PROGRESSION

Stand with other foot touching the floor

but without placing any weight on the

foot

Stand close to a wall for support initially

using the whole hand for support then

progressing to one finger touching the

wall for support

Close one eye

Stand on a cushion, then progress to

stability ball

Perform an activity like catching and

throwing a ball

Perform the initial stages of a squat –

bending leg 20 %

Moving on to the tiptoes

This balance exercise can also be incorporated into a daily routine, where the individual practices

balancing on one leg whilst performing activities such as brushing teeth or waiting for the kettle to

boil.

PLEASE NOTE: If these balance exercises are integrated into a daily routine, ensure the older

adults safety by emphasising and explaining how to support themselves during this activity to

prevent a fall.

The second method that can be adopted to improve balance is to incorporate it within a strength‐

training program. This would usually be implemented after the client begins to show improvements

with the balance exercises, or could be developed gradually with the strength‐training program.

To have the most benefit on balance the strength program should consist of exercises, which

include; foot plantar‐flexion, lateral leg raise, hip flexion and knee flexion. These movements

develop the muscles used during balance and are functional movements used on a daily basis.

Examples of exercises that incorporate balance:

Heel raises – with feet shoulder width apart the individual raising onto tiptoes (hold momentarily at

the end point) and then lowering back so the foot is planted on the ground. This can be performed

with support initially (two hands holding the back of a chair), and then the level of support can

slowly be reduced as the individual progresses. For example the client can remove one hand, then

remove both hands, and then finally complete it with eyes closed.

Side leg raise – the client stands with feet slightly wider than shoulder width apart, whilst holding

onto a chair with two hands. One leg is raised laterally as high as possible. Initially this can be

completed without resistance, then resistance bands can be slowly incorporated to progress the

strength element. To develop balance with this exercise, similar to the heel raise, the level of

support can be gradually reduced as necessary.


Knee Flexion – in a similar position as the two previous exercises, the client raise the knee in the

sagittal plane raising the knee towards the chest whilst holding the chair for support. This is

completed without resistance and then resistance can be added for progression.

The above exercises are instances of combining balance and strength exercises; however the

principle of combining the two can be easily accommodated to any exercise which requires the

individual to perform in a standing position.

COOL DOWN

The cool‐down is the last element of the program and has the opposite effect to the warm‐up. It

aims to slowly return the body to a normal resting condition and achieved by performing a

cardiovascular activity. This cardiovascular activity is performed for around 5 – 10 minutes at a very

low intensity (much lower than the conditioning stage). Throughout the duration of the cool down

the intensity will further decrease to slowly reduce the heart rate back to resting levels.

The purpose of the cardiovascular activity is to keep breathing rate elevated for a short period of

time, helping the oxygen debt return to normal.

The final stage of the cool down is to perform some specific stretches to the muscles that have

been worked throughout the conditioning session.

SPECIFIC EXERCISES THAT CAN BE TAILORED FOR THE OLDER ADULT:

AQUA‐AEROBIC FOR OLDER ADULTS

Water aerobics provides a workout combining the components cardiovascular endurance and

strength through continuous resistant activities in the water.

It also offers a low impact from of exercise, which can help protect the joint and required for

specific conditions like arthritis. Aqua aerobics protects your joints in two ways:

o Buoyancy of the water supports a portion of weight, reducing the load on joints during

movement.

o Resistance of the water prevents the body from moving too quickly, which can prevent mild

hyperextension and repetitive‐stress injuries.

Falling is a major concern for many seniors, owing to a combination of reduced balance and

growing fragility of bones. This can make many exercise options too risky, however, in the water,

natural buoyancy helps to keep them upright.

Aqua‐aerobics classes for seniors can take on many forms. There are classes that are designed by

the Arthritis Foundation that are done in pools heated to approximately 85 degrees, which involve

low‐ to no‐impact aerobic and strengthening exercises. Aqua aerobics classes can consist of brisk


walking in the shallow end and/or performing traditional aerobic type movements such as jogging,

marching, kicking and jumping jacks.

Aqua aerobics classes for older adults can also involve working out in the deep end of the pool. In

these types of classes a special flotation vest is worn that holds you upright and keeps your feet

from touching the bottom of the pool. In a deep water aerobics class you mimic the actions of

walking, jogging or running with your arms and legs as you attempt to travel around the pool.

Equipment used can include water bottles, kickboards, noodles, hand webs or buoys to create

resistance and tone the abdominal muscles as well as the arms and legs. A well‐designed water

aerobics class can meet the client's cardiovascular exercise and muscular tone goals.

WHICH TYPE OF CLIENTS SHOULD AVOID AQUA EXERCISES?

Cardiovascular Concerns

People with coronary artery problems or any history of heart disease should definitely get medical

clearance before signing up for an aqua step program. Heart rates are as much as 17 beats slower

per minute in water than they are when exercising on land. Water temperature and depth also

have an effect on heart rate.

You can't gauge the intensity of a workout by the numbers as you can in the gym; you have to

continually evaluate how you feel. The dramatically increased resistance of the water can aggravate

conditions like arrhythmia or high blood pressure during strenuous exercise.

Osteoporosis and Balance Problems

Exercise has a number of benefits for older people. It improves mobility, flexibility, endurance,

balance, strength and overall quality of life. Seniors can stay independent longer if they continue a

regular exercise program.

While pool time is ideal for many cardio and stretching activities, water step aerobics might not be

one of them. Pool step helps to protect bones and joints from sudden impact, a blessing for those

concerned about osteoporosis. It may be too tough for older adults at risk for fractures or those

elderly exercisers who suffer from poor balance.

The water creates high‐intensity, constant resistance and posture in the water is inherently

unstable. It might be advisable to build up more core strength and stronger leg muscles before

attempting step aerobics in the pool, or switching to a gentler, more fluid aqua exercise.

TAI CHI FOR OLDER ADULTS

Derived from an ancient Chinese martial art, tai chi exercises offer numerous health benefits. Tai

chi for seniors is particularly attractive due to the slow, low impact movements that reduce the

possibility of injury. Benefits of tai chi include both physical and emotional health.


The benefits of tai chi are the strengthening of leg and hip joints, as well as the core muscles of the

back and abdominals. This may be why tai chi exercises improve balance in older adults while

walking. The ability to counter and change footing if you begin to slip can make the difference from

landing on a hip or regaining control. The movements of a tai chi form are deliberate and precise,

toning muscles. In addition, tai chi is a weight‐bearing exercise, which helps prevent bone loss.

A qualified Tai Chi instructor will teach a class a series of movements that collectively make up a tai

chi form. Tai chi movements mimic those that we see among other animals, putting us in touch

with nature. Before class begins, however, they will typically spend 15 to 20 minutes stretching as a

warm‐up. Flexibility is another health benefit derived from tai chi for older adults. Although the

movements are slow, tai chi is an aerobic exercise.

The philosophy that your mind, body and spirit must be in alignment is one basis for tai chi. The qi

(pronounced "chee") is the life force that runs through everyone, and its ability to flow freely is

necessary for health. Tai chi movements focus on a point just below your naval, which is where the

qi originates. The focus is a meditative state while breathing deeply. Research shows that this kind

of calm state can lower blood pressure

PILATES FOR OLDER ADULTS

Many older adults are attracted to Pilates as they see it as a “softer” option aimed at back care and

posture. However, many traditional Pilates exercises would be inappropriate for the older adult,

specifically if we look at flexion exercises such as the single leg stretch or rolling like a ball.

When working with clients of retirement age and beyond some may have osteoporosis. Classes

should accommodate this. Exercises such as rolling like a ball do have some bone‐loading effects

but would carry a high risk of crush fractures if taught generally to the older adult.

YOGA FOR OLDER ADULTS

The Yoga Health Foundation explains yoga as ‘a scientific system designed to generate greater

clarity and harmony in life’.

A concern to the older adult population is the lack of balance, which stems, in part, from sitting

rather than standing and from not challenging one’s balance in various positions. Complications

resulting from falls among people over the age of 65 frequently lead to a multitude of serious

problems.

Yoga is considered by many to be a great tool for combating the concerns of an ageing society, and

have shown to have multiple benefits. The health benefits of yoga for older adults are:

o Improved sleep

o Improve balance – reducing falls

o Improved mood

o Reduced chronic pain


o Decrease in blood pressure

o Improved lung capacity and breathing

o Lower cholesterol

ZUMBA FOR OLDER ADULTS

The term "Zumba" means to move swiftly with grace. Zumba is a program of Latin dance moves

which incorporates interval and resistance exercise. The moves are performed to zesty Latin

rhythms, and other lively international music. The party experience is contagious and nothing short

of exhilarating.

Zumba dance moves are fun, easy to follow, and the routines keep the entire body moving. Zumba

fitness exercise is a revolutionary new and exciting program that doesn't feel like exercise at all.

Zumba for older adults has the same party flair as the original program.

A special Zumba program has been developed just for beginners and elderly participants, called

"Zumba Gold". During this program or any other Zumba class older adults don't have to worry

about trying to keep pace with the original program that may be too intense for some.

Older Adults can improve cardiovascular circulation, breathing, stamina and even cognitive thinking

with Zumba. This is achieved via improved cardiovascular system and an increase in oxygenated

blood being circulated around the body and to the brain.

Learning something new and exciting is a great way to stimulate the mind, and may even slow the

progression of Alzheimer's disease and memory loss associated with dementia.

OTHER THINGS TO THINK ABOUT WHEN CREATING EXERCISE PROGRAMS

MEDICATIONS

Medication becomes an increasingly common aspect to consider when planning exercise programs

for an older adult. This is due to the increase in prescribed medicine for this population following an

increased rate of chronic conditions.

The administration of prescription medication is usually accompanied with internal and external

effects to the body. Some common symptoms include, flushing (become markedly red in the face),

raised body temperature, raised blood pressure, increased fatigue, dizziness, dry mouth, cold hands

and feet and depression.

As a fitness professional it is vitally important a client identifies any medication they are taking and

the purpose and common side affects of this medication is understood. In some cases, extra advice

or information may be required from an allied health professional to create safe and efficient

programs.


WATER CONSUMPTION AND DEHYDRATION

The importance of water is often undervalued in normal life let a lone when physical activity is

performed. Consuming fluids should be emphasised by the fitness professional for all clients,

especially the older adult. Dehydration is a common condition, which can occur on different scales.

The human body is composed of between 50 – 65% of water, so by lowering the level of water that

is available to the body can have detrimental effects to system and structures within the body.

It is important an older adult consumes at least 2 litres of water per day. During physical activity,

this volume needs to increase, due to water being lost within sweat and increased respiration.

TIPS TO KEEP YOUR OLDER ADULTS ENGAGED

EDUCATE BENEFITS

It is important for the older adult to understand the benefits of performing physical activity and

what they might expect to experience following a program. This also involves identifying that there

may be slight soreness for following the session, but this is normal and to be expected. HOWEVER,

it is important for them to understand the difference between pain from an injury OR soreness

from overload.

INDIVIDUALISTIC

Each client should be provided with a program that focuses on their specific goals, weaknesses and

ability. It is especially important to begin the program at the right level for the client and the

progression is made as the client advances. If this is not performed then the client might not adhere

to the program.

GOAL‐SETTING

One of the most important elements of training for anyone is goal‐setting. Goals can be both short

and long and provide the overall aim of a program and can also be used to evaluation and identify

progression. It is important to develop the goals according with SMART goals setting.

o Specific

o Measurable

o Attainable

o Realistic

o Time‐frame

ENCOURAGEMENT AND MOTIVATION

Clients are motivated by different stimulus, so to ensure adherence it is important to provide

specific encouragement that appeals to the individual you are training. Getting to know the older

adult client will allow the fitness profession to indentify the motivational factors for each individual.


For an older adult, it was identified, earlier that they place high importance on their health and

well‐being. This is an important element that can be adopted to motivation and individual, by

educating the benefits to their health when performing physical activity.

SOCIAL SUPPORT

Another element identified in the older adults needs is the requirement of social support. Physical

activity and exercise can be used as a basis to form this social support and interaction. Therefore, to

help engage and encourage adherence, a fitness professional can involve friends and families within

a program to support their actions. It can also give, an older adult the opportunity to meet

individuals in the same situation as them when group training is organised.

SELF‐MANAGEMENT

Clients should be encouraged to be their own behaviour therapist. They should practice self‐

reinforcement by focusing on increased self‐esteem, enjoyment of the exercise itself, and the

anticipated health and fitness benefits.

EXERCISE INTOLERANCE AND OVERTRAINING

Exercise intolerance is where an individual is unable to participate with an exercise program due to

negative symptoms presenting themselves. This may be due to an advanced program being set,

radical exercise progression, too high exertion or a contraindication/condition. The degree of

exercise intolerance can vary from individual to individual and includes a range for symptoms that

may include:

UNUSUAL FATIGUE

For an individual performing exercises there is usually some sort of fatigue which exists, however,

in the case of exercise intolerance, an excessive and unusual level of fatigue is experience.

Fatigue that prevents the performance of normal daily tasks; is prolonged, or exists prior to a

workout is usually a sign that an individual is not coping well with an exercise program, or are

additional elements are preventing them from recovering adequately.

In some cases even simple tasks such as eating or walk can be a hard task to perform as a result of

fatigue.

MUSCLE CRAMPS

Muscle cramps are involuntary muscle contractions and can occur to any individual that exercises.

However, for an individual who is continually suffering muscle cramps that last a long duration can

be a sign of exercise intolerance. They can also indicate a muscle is exerting too much force and

cannot tolerate this exertion.


SHORTNESS OF BREATH

Shortness of breath is a normal component of training, however when this occurs outside the

training program, it can indicate the bodies need to provide additional oxygen to tissues. This can

suggest the body is not coping well with an exercise program, and is not recovering effectively.

PROLONGED JOINT OR MUSCLE PAIN

An exercise program usually overloads the body or systems within the body (cardiovascular or

muscular system) and therefore creates some sort of muscle pain. When this pain is prolonged and

does not improve, it can suggest the body is not recovering from the training session. This is a good

indication that the individual is experiencing exercise intolerance and modification is required.

CHEST PAIN

Chest pain can be a symptom of heart attacks, or can be a sign that the heart is working too hard

for its ability. This is a good indication of exercise intolerance and should be taken serious.

Recommendations to an allied health professional would be recommended.

CYANOSIS

Discoloration of the extremities and face, appearing as a bluish pallor, can indicate abnormally

oxygenated blood. This is a very visible sign of exercise intolerance but also a serious call for

intervention. Sufferers should seek medical attention in the event of a serious blood‐flow

disruption.

DEPRESSION

Heightened activity can produce mental and emotional problems in those afflicted with exercise

intolerance. The depression can rob them of more energy, creating a vicious cycle. Facing physically

debilitating limitations takes a toll on the psyche, manifesting itself in anxiety, despondence,

disorientation and irritability. Taken together with other symptoms, depression is a common

characteristic of exercise intolerance.

INSTRUCTING OLDER ADULTS

Instruction of older adults can be particularly challenging. The ability to process and follow

directions deteriorates as we age. This means that you will need to allow more time, and provide

more demonstration, more explanation and more practice of skills than you might with younger

clients. Older clients may not be aware that they are performing a skill incorrectly and therefore

will not be able to correct it independently. Your role in correction will be greater than you may

usually expect.

In addition, you will need to provide more functional exercise than you might otherwise. Specific

exercises should be as close as possible to those that older adults might deal with during their usual

day to day activities. When screening, it is essential that you ask what day to day activities are

usually performed and identify those where difficulty is experienced. For instance, some older


adults may have trouble climbing stairs or stepping up the kerb. This presents a danger of falling

and is an area that could easily be focussed on in training sessions.

Older people often experience trepidation when participating in new things. Make sure that you

always have sufficient time to prepare and deliver the session. If you are rushing, the older client

will often become very nervous. It is more important that you reduce the number of exercises that

you intended, than to rush the client and lose their confidence. Here is some advice:

Ensure that you arrive and set up early

Greet clients individually and ask how they are

Be positive and optimistic

Explain the purpose of the lesson

Explain the types of exercises and why you have included them

Demonstrate the exercises

Make time for clients to practice exercises and get them right

Correct mistakes in a positive manner

Encourage clients to ask questions

Foster a friendly and positive environment

Use positive enforcement

Ask for feedback

Older clients will generally have different expectations than younger clients. This includes their

expectations in terms of the way you interact with them. A fitness professional will need to choose

words carefully and avoid slang.

Things to remember:

Beginners will learn at different rates. Older beginners will often learn at a much slower

rate.

Emphasise small achievements with positive feedback.

Expect performance to be inconsistent.

Focus correction on the errors that will cause the most risk. Minor errors should never be

corrected until all major ones are overcome.

Practice, demonstrate and explain constantly.

Practice skills that are more likely to transfer to daily life.

Vary situations over time to improve your client’s ability to adapt to new situations in daily

life.

Don’t rush ‐ transition between exercises should occur in a timely but not a hasty manner.

Always be respectful and listen intently.


CHECKLIST FOR PLANNING AND DELIVERING EXERCISE TO OLDER ADULTS

STAGE ONE: PLAN THE EXERCISE

Apply appropriate pre‐exercise screening procedures prior to participation.

Identify the characteristics, needs and expectations of your client/s.

Consult with family members (where appropriate) to clarify any risk factors identified in pre‐

exercise assessment in order to recognise the sign and symptoms of injuries or conditions.

Obtain client's permission to seek advice from a medical or allied health professional to

clarify health, medical or injury concerns.

Provide advice on alternative options for clients who are unsuitable for the planned

exercise.

Select exercises from an appropriate exercise repertoire that match needs, abilities and

goals.

Select and modify appropriate equipment.

Determine appropriate instructional techniques.

Select and apply appropriate baseline assessments.

STAGE TWO: INSTRUCT THE EXERCISE SESSION

Inform older clients about the physical changes that occur with the ageing process and

communicate benefits of exercise.

Show sensitivity to cultural and social differences.

Communicate the general features of balanced nutrition and provide healthy eating

information to improve overall health and support exercise goals.

Explain and demonstrate the exercises and provide opportunities for questioning and

clarification.

Modify exercises to ensure they are safe and effective.

Demonstrate and instruct correct use of equipment.

Monitor exercise intensity, technique and safety during the session and modify as required.

Apply appropriate motivational techniques.

STAGE THREE: EVALUATE THE EXERCISE SESSION

Evaluate the exercise session according to client and or caregiver feedback and personal

reflection.

Provide feedback to the client group on their progress and any changes recommended.

Identify modifications to the exercise plan where relevant.


MOTIVATION

Motivation is a method of using techniques to encourage an individual to perform a specific task.

All clients require motivation to help them achieve their goals. However, as each client will have

different motivations needs, each client should be addressed on an individual basis. Although this

may be the case, groups of individual can be categorised together as having similar motivation

needs.

Older adult can be categorised as a group, all having specific motivation factors that may influence

their decision or motivation for a behaviour. In this instance the behaviour is performing an

exercise program.

Motivation can also be prevented by barriers that discourage participation in an activity or

behaviour. These barriers are also discussed in this section and can be specific to the older adult

population.

MOTIVATIONAL FACTORS

NEEDS – the needs of an older adult were explained earlier in this module, and these can reflect

the motivation of a client. To meet some of the needs of older adults might provide some internal

motivation to participate in exercise. For example, an individual may need to improve their

functional capacity to remain independent therefore this would give them motivation to reach this

level by exercising.

PAST EXPERIENCE – the past experience of an individual can have an impact on the current

motivation of participation into exercise. If the experience was an enjoyable and led to positive

outcomes then the motivation is likely to be high. However this can also work in the opposite

manner, if an older adults experience was negative it would perhaps prevent them from

participating or adhering to a program.

AGEISM ‐ some individuals believe the ageing process should accompany a reduction in exercise

and physical activity. This mind set involves the individual believing that they should not be or

capable of performing as much physical activity or the same level of intensity. As a result this can

influence the way the older adult participate in exercise and therefore can have an implication on

the results achieved.

INTERNAL FACTORS – There are several internal factors that will influence the level of

motivation a individual has, these can range from; education, mood, pain, fatigue, awareness,

cognitive stability. The most influential factor considers a few of the internal factors and revolves

around the way the older adult feels either prior to or following an exercise session. If the individual

is in a fatigued state with some pain from a chronic condition they might be less likely to participate

than an individual who is full of energy.


EXTERNAL FACTORS ‐ The environment in which the client performs the exercise as well as the

support group or participants can also determine motivation. The direct environment offers a

change from the individual’s home setting and therefore the more appealing the environment is

the more motivation the individual may have. I.e. a walk in a picturesque setting will provide more

motivation than around an urban area.

As explained at the beginning of this module, the social needs of an older adult become

fundamental for preventing social isolation and providing social support. However, the opportunity

for socialising become less available and therefore any opportunity will most likely be taken.

COMMON BARRIERS TO THE OLDER ADULT

ATTITUDE: As explained in the motivation section, age is huge factor that can deter people

participating in a physical activity or an exercise program. Many older adults believe reduced

activity should occur along with the ageing process and therefore do not consider performing more

activities.

AWARENESS: Many older adults have never exercised before and not aware of the benefits to

their health or wellbeing. Without understanding how exercise can improve their daily living, they

may have no reason to perform physical activities.

TIME: Limited time is a common barrier that all individuals can use. There is often a belief that

physical activity or exercise can be very time consuming.

DISCOMFORT: Exercise has been given bad press, suggesting that it should be painful for benefit

to be achieved. In addition to this, potential injury, rapid fatigue and physical aliments can all

contribute to this barrier, discouraging individuals to participate.

MISUNDERSTOOD ADVICE FROM ALLIED HEALTH PROFESSIONALS: Occasionally, older

adults are provided with the advice regarding physical activity that they misunderstand or belief

ACCESSIBILITY: As individual progress through into older adult population, their physical capacity

and independence reduces. This can prevent them from being able to access exercise facilities or

exercise groups. Many individual do not understand that physical activity can be completed at

home or in their neighbourhood, and therefore are not educated at the type of activity they can

perform on their own.

CLIMATE: Especially during an Australian summer, the heat is often a deterrent for participating

physical activity. The heat can usually leave individual feeling lethargic, reducing the motivation, as

well as performance.

BEHAVIOUR CHANGE


An individual’s change in behaviour is believed to involve 5 stages, according to the Behaviour

Change model. These stages involve; pre‐contemplation, contemplation, preparation, action and

maintenance.

These stages can be applied to an older adult and their participation in an exercise program,

determining the stage they are in and what strategies can be implemented to encourage them into

the next stage.

PRE‐CONTEMPLATION

An individual has no plan to participate in physical activity or an exercise program and do not

believe they should change their behaviour. They may be unaware that their well‐being or

physical/functional capacity could be improved by incorporating exercise into their life. The

individual is often classified in being unmotivated.

Strategy to encourage progression

Provide educational information about benefits of exercise

Identify other in same age group performing exercise

Identify barriers to exercise

CONTEMPLATION

During the contemplation stage, the individual may have been informed about the benefits and

developed the understanding that exercise can improve their well‐being or standard of living. They

begin to understand that a condition, ageing or other factors are affecting their well‐being, which

can be reverse or prevented. As a result the individual is thinking about exercising, however they

can remain in this stage for a long period.


Find motivation relevant for individual

Provide support ‐ involve family member

PREPARATION

The individual is preparing themselves to performing exercise or increase the amount of physical

activity that is performed. This may involve finding a PT trainer to provide sessions and locating an

exercise group (like walking or swimming group).


Identify goals and make them SMART (specific, measureable, attainable, realistic and time‐

frame)

Create a plan


ACTION (TRYING)

This stage involves the older adult participating in an exercise program or increasing the level of

physical activity they perform. Although a new behaviour has been made, there is a strong chance

of relapse


Create program according to goals

Identify any changes in well‐being in the short time of participation

Ensure likes and dislike are implemented in program

MAINTENANCE

The last stage of the change in behaviour is maintenance of the new behaviour, so this would be

orientated around the individual continuing in the exercise program. Once at this stage, the

individual should be happy with the new behaviour and ho


Reassess goals and progress program

Review likes and dislikes of exercise

Review coping strategies

NUTRITION

Nutrition is an important component for everyone; however it can become increasingly important

when performing physical activity. An individual in the older adult population requires even more

emphasis placed on their diet and nutrition consumption. This is due their body being more

vulnerable and

For anyone performing physical activity there is an increase in burnt calories, which need replacing,

therefore it is vital to ensure that energy is being replaced.

GENERAL FOOD ADVICE

The Australian Government produced a guide stating that individuals should include a range of

nutritious food as part of their diet. The suggestions are individuals consume the following in:

Vegetables, legumes and fruit

Cereals

Lean meat, fish and poultry

Milk, yoghurt, cheese and/or alternative – low‐fat where possible

Water is another essential component of an older adults dietary needs.

S d f f h l h / id li / li id h l h i


The poster is taken from the Australian Governments website which provides information of

Healthy Eating.

ADVICE FOR THE OLDER ADULT POPULATION

The Australian Government recommends that there are small changes that could be made to

improve the health of the older adult. These include:

o The requirement for protein increases as the individual ages, therefore it is important to

consume food rich in protein.

o Calcium has been shown to prevent or slow the risk of osteoporosis, therefore consume

foods that are high in calcium.

o Vitamin D also help with maintain healthy bones. Vitamin D is mainly gained from sunlight,

but small doses can be found in dairy products, oily fish, cheese and eggs.

o Limit total fat intake especially saturated fat.

o Limit the use of salt in your diet

o Older adults become less efficient at breaking down lactase, which means they become

intolerant.

The ability of the older adult’s body to produce thirst signals reduces; therefore the body may need

water without giving this signal. It is important for the older adult to consume regular drinks, which

consist mainly of water, but may include soda water, milk, and fruit juice. Occasionally, tea of

coffee can be included as well.

IMPORTANT VITAMINS, MINERALS AND FOOD GROUPS FOR THE OLDER ADULT:

CALCIUM

Calcium is an essential component for the maintenance of healthy bones. As people progress into

the older adult population their requirements for calcium increases as a result of the body

reabsorbing them from bones. This re‐absorption causes a condition known as osteoporosis,

explained earlier. In order to reduce the risk of osteoporosis and to keep the bones healthy,

individuals can obtain calcium from milk and dairy foods such as yogurt and cheese, leafy green

vegetables and calcium fortified cereals.

FAT

Older people who are fit, well and within a healthy weight range should minimise saturated fat

intake to improve heart health. However, elderly adults who are above the age of 75 may find that

fat restriction is not beneficial, especially if a person is frail, below a healthy weight or has a small

appetite. In some cases extra fat may actually be required to increase the number of calories

consumed and to aid weight gain. Elderly adults wishing to gain weight should always consult their

healthcare provider or a qualified nutritionist before making any significant changes to their diet.


FIBRE

Fibre is an important element for the digestive system helping it to function efficiently. Also known

as roughage, fibre helps clean the passage way through the final parts of the alimentary canal. With

the slowing and reduction in efficiency of the digestive system, older adults require an increase in

their fibre consumption.

Good sources of fibre include wholegrain cereal, porridge, wholegrain bread, brown pasta and rice,

fresh fruit and vegetables and pulses. Also remember to drink plenty of fluids as this will help the

gut to function properly.

FLUID

As we get older the body's ability to conserve water gradually decreases and the perception of

thirst becomes less sensitive. However, dehydration can result in drowsiness and confusion among

other side effects so it is important to keep hydrated throughout the day even if we don't feel

thirsty. Fluid intake does not necessarily mean just water and can also include hot drinks such as

tea and coffee, fruit juice or squash.

Older adults should also avoid caffeine drinks because it’s dehydrating the bowels, causes

constipation and increases calcium leakage from bones. That includes coffee and black tea. Green

tea has caffeine in it but is high in antioxidants so it’s good to drink but not more than a cup per

day.

IRON

Iron is a vital element in the body, and is involve in the transportation of oxygen and carbon dioxide

to cells around the body. Haemoglobin the gas binding structure of red blood cells is composed of

iron, and therefore without it gas transportation does not occur. This would lead to fatigue and

poor tissue repairing.

Iron can be found in meat, some vegetables and dried fruit.

VITAMIN C

This vitamin is essential for healing wounds and repair bones and teeth, due to it assisting the

formation of collagen in the body. It is important in the formation of other collagen rich structures

which include skin, ligaments, tendons and blood vessels.

Vitamin C is also an important nutrient for the immune system – help the functioning of

macrophages (white blood cells).

It is also thought to be important in preventing heart disease and cancer due to its antioxidant

properties.

Vitamin C and Iron are linked together with Iron requiring vitamin C for it to be efficiently absorbed.


VITAMIN D

Vitamin D helps the body to absorb calcium and therefore slows the rate of calcium re‐absorption

from bones. It is vital for older adults to ensure they have enough Vitamin D in their body to help

prevent osteoporosis and maintain healthy bone density.

Vitamin D is gained usually through exposure to sunlight, however to ensure enough vitamin D is

present in the body supplements can be taken. It is recommended by the Australian Health

Department that adults over 65 should take 10 micrograms of Vitamin D per day.

ZINC

Zinc is required for the maintenance of a healthy immune system and is most commonly found in

meat, shellfish, wholemeal bread and pulses.

OMEGA 3 FATTY ACIDS

Omega 3 is an important element for brain function, memory, coherence and nervous system

function. These oils our body cannot make by itself and is reliant on our nutritional intake. They

coat every cell in our body and especially important for the CNS function. Resources: oily fish like

salmon, sardines, mackerel, herring, nut and seeds unspoiled (especially walnut). Supplementation

is also popularly available (important to make sure it is free of heavy metals and had vitamin E for

proper absorption).

SOME HELPFUL TIPS FOR YOUR OLDER ADULT CLIENTS

APPETITE CHANGES

An Individual’s appetite can change as they get older. The change usually causes a reduction in

appetite as a result of decreased physical activity energy usage. Often older adult do not place

much important on food or calorie intake and therefore might not replace the energy they have

burnt. However, it is important to education an older adult that, when performing physical activity,

they need to increase their calorie intake to replace energy expenditure.

To encourage food consumption, a fitness professional can recommend the follow ideas:

SNACKING

Many older adults find it difficult to create and eat three meals a day and therefore often go

without. To encourage food consumption a fitness professional can promote healthy snacks, which

can include fruit, vegetables and wholegrain cereals.

Some nutritious and easy snack ideas include porridge (which can be bought in boxes of single

serving sachets), sardines on toast (as tinned sardines can be stored for a long time) and beans on

toast or soup (as again the key components are long life).


FREEZING PORTIONS

Cooking for one can be a de‐motivating for many elderly adults and can also result in food wastage.

Instead of buying ready meals for one why not cook a large meal such as a stew, shepherds pie or

lasagne, spilt into individual portions and freeze for future meals. You can freeze a huge array of

foods nowadays, from quiches through to fresh soups, meat and fish so check the guidelines and

really utilise your freezer

VARY DIET

It is important to vary the diet of an older adult ‐ don’t go for the same fruits and vegetables week

after week. Eat seasonal fruits and vegetables from markets or order seasonal boxes online. If

possible – go organic, because pesticides and chemicals have a long term effect on our nervous,

immune and hormonal systems. Try different grains besides wheat and rice – like rye bread instead

of white bread, instead of rice – try quinoa (the only grain that is rich in proteins and not just

sugars!). Get excited about food, be creative and try new things.

IN ADDITION…

The elderly population can suffer from low stomach acids and enzymatic activity which can cause

poor absorption of nutrients and malnutrition.

Elderly people with poor digestive function should make sure their diet is easily digested – steamed

vegetables and soups rather than cold salads, fresh vegetable and fruit juices, cooking and

preparing pulses, nuts and seeds properly.

Making sure an older adult drinks 20 min before or after eating but not during a meal as the fluid

can wash the digestive enzymes needed.

REFERRALS AND ALLIED HEALTH PROFESSIONAL

When working with any client it is good to have an understanding of the types of allied health

professionals, whom you could gain advice from or assist you with the service that you offer.

The same allied health professionals can be used when training older adults. In fact, some allied

health professionals are critical to refer to with individuals who are categorised in the high‐risk

group – this is the older adult. As explained earlier, this group of the population have a higher risk

for chronic condition or disease and contraindications to physical activity. Therefore need to be

thoroughly screened to prevent putting them at any risk.

As a fitness professional your knowledge of these conditions or disease is very limited, and

therefore advice from an allied health professional should be gained to limit or eliminate any risk.

With a huge range of potential allied health professionals it is important to understand the role of

each one especially relating to the older adult population. An Allied health professional includes:


General Practitioner

Physiotherapist

Exercise Physiologist

Occupational Therapist

Massage Therapist

Accredited Practising Dietician

Osteopaths

Additional allied health professionals:

Podiatrist

Chiropractor

Psychologist

GENERAL PRACTITIONER (GP)

A GP looks at the overall health of an individual throughout their life by managing and preventing

illness and poor physical or mental wellbeing. They generally cover a broad spectrum of ages and

conditions or illnesses, however some chose to specialise in an area, system of the body or

condition.

As a fitness professional, a GP should be the primary point of call for any client who presents with a

medical condition and potential or current contraindications during the screening process. The GP

can provide advice on whether exercise or physical activity can be performed by the client.

PHYSIOTHERAPIST

The role of a physiotherapist, as explained by the Chartered Society of Physiotherapy, is to restore

an individual’s body back to normal function following an injury, illness or disability.

Physiotherapists administer a range of treatment methods, on a holistic approach to improve the

wellbeing and lifestyle of an individual.

For the older adult client, physiotherapy aims at returning the individuals lifestyle back to normal

following an injury, illness or disability, however, this changes slightly as we age. As explained

earlier, there are specific age related conditions, which require management rather than treatment.

Therefore the physiotherapist’s focal point becomes the maintenance of the condition with the

outcome being to maintain a healthy wellbeing.

An example of management being required is Parkinson’s disease or arthritis.

In addition, physiotherapy can also have other benefits that include:

Maintaining Mobility and Independence


o Physiotherapy can help older adults remain healthy and active for as long as

possible. It is the key to restoring and maintaining a high level of physical function so

that you can live and maintain a fully independent life at home.

Decreasing pain

o By increasing strength and mobility

o By improving coordination

o By improving cardiorespiratory function

Improving basic functions such as standing, walking, and grasping

ACCREDITED EXERCISE PHYSIOLOGIST

An accredited exercise physiologist is an allied health professional at the top end of the fitness

professional ladder. They specialises in understanding the responses and adaptations of exercise on

the body; as well as achieving physical and mental wellbeing for special populations, through the

prescription of physical activity, lifestyle and behaviours changes.

Older adults are one of many specialised areas exercise physiologist are trained in, and use exercise

to prevent and treat chronic conditions or injuries to assist and improve the older adult’s wellbeing.

The conditions range from cardiovascular diseases to cancer to physiological conditions. This allied

health professional gives fitness professionals a point for advice or referral for the training of

special population with chronic conditions. Referral to an exercise physiologist could provide an

older adult with education, time management, physical activity and exercise prescription guidance

helping achieve a healthier life.

OCCUPATIONAL THERAPIST (OT)

An occupational therapist works with individuals to overcome various problems so they can achieve

a fulfilled, self reliant and independent life. These problems vary according to the demographic of

the individual, but considering the older adult, they focus around chronic diseases, rehabilitation of

injuries and decreased physical capacity.

OT’s use a variation of exercise, education and rehabilitation techniques as well as the use of

specific equipment to encourage an independent life. In addition, the older adult’s home is

assessed to ensure a risk free environment and all vital functional tasks can be performed with

ease.

The OT role concentrates on improving the life of an individual, which often revolves around

management of chronic conditions. However in the case of rehabilitation and reduced physical

capacity, this can be improve by developing the strength, balance, fine motor skill and dexterity of

the individual so functional tasks can be performed.


An occupational therapist can help an older adult:

o Prevent falls

o Improve daily functional tasks

o Improve independence

o Improve confidence

o Help individual return to home or work

REMEDIAL MASSAGE THERAPIST

A remedial therapist is an allied health professional who administers massage to seek the return of

normal health following and injury or muscular disorder.

Massage therapy is particularly valuable for the aches and pains associated with growing older.

Currently, with the drastic rise in the number of ageing baby‐boomers, many massage therapists

are opting to learn massage techniques that are specifically designed to help the elderly achieve

mind‐body harmony. This age‐specific massage is either called older adults massage or geriatric

massage.

Older Adults massage technique is similar to massage for younger adults. The techniques used must

keep in mind that an ageing body requires a little extra tender loving care. Specially trained

massage therapists are aware that an elderly body must be positioned carefully on a massage table,

compared to a healthy 30‐year‐old body. Great care is taken in the positioning of an elderly client,

and once positioned on the massage table, a senior will rarely ever be asked to move, as is so

typical with other types of massage.

Older Adults massage sessions will typically range from 30‐mintues to an hour. However, when

mobility is an issue for example the client is wheelchair‐bound the massage therapist will be forced

to adapt and the massage can take longer. Massage practitioners will often spend more time on the

hands and feet of their clients ‐ especially if the client doesn’t walk or doesn’t have full use of their

hands. In cases such as these, a hand or foot massage can enhance body awareness, sensation and

circulation in certain parts of an ageing body.

The benefits of older adults massage are circulation, decreasing muscular stiffness, and helping to

decrease inflammation that may rest in the joints. However, it also treats so many of the typical

conditions that arise with age ‐ such as muscular stiffness, arthritis, skin discoloration, muscle and

bone deterioration, tendonitis, bursitis, and respiratory problems such as asthma and emphysema.

ACCREDITED PRACTISING DIETICIAN (APD)

Providing expert nutritional and dietary advice, an accredited practising dietician caters for the

individual nutritional needs of each individual.

Their expertise encompasses specific dietary related diseases, including diabetes, osteoporosis,

heart disease, food allergies and intolerances as well as bulimia, anorexia and obesity.


The nutritional needs and dietary requirements of older adults are quite different to that of young

and middle‐aged adults, and require a different approach. Whilst many older and elderly adults

attempt to keep as fit and active as their bodies will allow, others may be frail and will require

additional care and support from family, friends and health initiatives.

Further problems may involve a low food budget meaning there is little choice in terms of food

variety, and single adults may feel unmotivated to cook for one or may lack cooking skills. In

extreme cases elderly individuals could become malnourished, resulting in the prevention of

recovery from illness and an increased likelihood of developing more health problems. Additional

adverse side effects may include fatigue and psychological problems such as anxiety and

depression.

Elderly adults who are struggling to maintain a healthy and balanced diet may find they could

benefit from the guidance and support of a nutritionist.

An APD can specifically cater for the needs of the older adult and will be able to identify any specific

deficiencies in the body. These will be corrected within a specific nutritional plan that addresses the

individual needs of the older adult. In addition to the nutritional needs, the APD is fully aware of

the challenges older and elderly adults face such as difficulty getting to the shops and a loss of

appetite and will take these into account when designing the program.

OSTEOPATH

Osteopathy is a form of manual medicine that emphasises a holistic approach to diagnose, prevent

and treat many health issues affecting the physical body. Osteopaths are trained to recognise

conditions that require medical referral. They are also trained to perform standard medical

examinations of the musculoskeletal, cardiovascular, respiratory and nervous systems.

Osteopathic treatment can be adapted to any body type, and can be particularly gentle and useful

for the elderly. Ageing is a natural life process and greatly impacts on the musculoskeletal system,

often reducing mobility and causing stiffness and pain.

Osteopathy can assist in reducing the pain and dysfunction associated with particular conditions

(such as osteoarthritis) and the effects of general ageing and wear on the body. It can help to

improve overall quality of life.

Osteopathy may help with:

Rehabilitation after hip or knee replacement/surgery

Improve neck motion for important tasks such as driving

Keep hands and wrists mobile for writing, cooking

Avoid or delaying the need for surgery

Low back pain and stiffness

Hip and knee pain

Neck, shoulder and arm or hand pain


Arthritic pain and joint swelling

THE ESSENTIAL COMPONENTS OF A COMPETENT REFERRAL

Fitness professionals, from time to time will be required to refer a client to an allied health

professional. This is to gain permission for the client to participate in exercise or to refer them onto

another professional who has greater understanding and training in specific conditions, diseases or

specialised training.

This can be done in the form of a letter that provides the allied health professional with all the

information that they require. The letter from a fitness professional to an allied health professional

should include the following:

1. Your professional details – the information should include the name of the person making

the request for the referral:

Address (essential)

Telephone number (desirable)

Email address (optional)

2. Name of the person to whom you are referring the patient. This may be a specific person or

a department without specifying the individual.

3. Patient’s details must include name, address, telephone number and date of birth.

4. Presenting complaint: It is important to record the client’s own perception of the problem

for which they are being referred.

5. Medical history: Comment on whether there is any relevant medical history and whether or

not the client is on any drugs or medication that you are aware of.

6. Social history: A client’s social habits such as smoking, alcohol consumption (particularly if it

is felt that this may be excessive).

KNOW THE LIMITATIONS OF A FITNESS PROFESSIONAL

A fitness professional’s expertise exists with prescribing, instructing and delivery fitness to a range

of different clients; however there are certain topics which can cross between this subject that a

fitness professional cannot provide detailed information.

When training an individual, a trainer will often come across nutritional, injury and chronic

condition elements, that clients are requesting information. Although there has been some training

along these subjects, it is important to understand the limitation of the fitness professional and

know when to refer or gain advice from another individual.

EVALUATION AND MODIFICATION

The last element to think about when designing a program is when and how to evaluate the

program. With the information gathered in this process it can then be used modify the program

accordingly.


The evaluation will identify:

o How the training has gone

o Are goals being achieved?

o Likes and dislikes

o Problematic exercises

o Progression/regression

It is important to establish at what point within the program this stage should be performed. There

are many different views on when to do this, some individual monitor on a short term basis, every

two weeks; while others monitor less often around 6‐8 weeks.

Although there is no specific right or wrong answer, ideally monitoring should be performed when

a program is likely to need changing or adaptation.

Performing this evaluation stage within a short timeframe may result in little or no change in the

client’s physical fitness and therefore no adaptations to the program needed. This is likely to place

doubt in the clients mind about the program efficiency and effectiveness and may affect

adherence.

In contrast waiting too long to monitor the program, may result in the client adapting before this

re‐test and then missing an opportunity to adapt the program.

As a result, 4 weeks seems a good timeframe to perform this monitor stage.

USEFUL READINGS

Australian Government, Department of Health and Ageing

http://www.health.gov.au/internet/main/publishing.nsf/Content/Nutrition+and+Physical+A

ctivity‐1

Australian Government, National Health and Medical Research Council

http://www.nhmrc.gov.au/guidelines/publications/n23

Exercise is medicine

http://exerciseismedicine.org.au/public/factsheets

World Health Organisation

http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/

NSW Government, Office of Sport and Recreation


http://www.dsr.nsw.gov.au/active/tips_older.asp

Nutrition Australia

http://www.nutritionaustralia.org/national/resource/physical‐activity‐older‐adults

State Government of Victoria, Department of Health

http://www.health.vic.gov.au/agedcare/publications/wellforlife_nutrition.htm

http://www.health.vic.gov.au/agedcare/publications/wellforlife_booklet.htm

The Better Health Channel

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Healthy_ageing_stay_phy

sically_active

National Ageing Research Institute

http://www.mednwh.unimelb.edu.au/nari_research/pdf_docs/pp_activity/participation_in

_physical_activity.pdf

http://www.mednwh.unimelb.edu.au/nari_research/pdf_docs/pp_activity/participation_in_physical_activity.pdf�

http://www.mednwh.unimelb.edu.au/nari_research/pdf_docs/pp_activity/participation_in_physical_activity.pdf�


CERTIFICATE IV MODULE 3

ASSIGNMENT Please note assignments are subject to change. The most up‐to‐date version will be

downloadable from the Student Online Learning Centre (www.acsf.com.au/fitnesscourse)


CERTIFICATE IV IN FITNESS

MODULE 3 – ADVANCED FITNESS PROGRAMMING

ASSIGNMENT TASK

GENERAL INSTRUCTIONS

The assignment is in 4 sections, each with a number of parts. Please ensure that you submit

complete assignments including all 4 sections and all parts.

You may use your Cert IV Module 3 course notes and any other resources available to you. We

advise you to use as many research strategies as possible to acquire a good understanding of the

subject matter. Although you may use various sources, you must always ensure that your work is in

your own words, plagarism is strictly not allowed. You may use references, as long as you identify

the source.

Please submit your assignment based on the submission instructions in the course overview

information.

If you have any questions how to complete assignment question please email or contact your tutor.

COMPETENCIES BEING ASSESSED

For this assessment task you need to demonstrate the ability to:

Section 1 – Interact Effectively with Children

Identify appropriate language Communicate positively

Identify key words of meaning

Use appropriate non verbal communication

Use non gender and not stereotypical language

Interact frequently

Promote positive behaviour Use methods to promote positive behaviour

Collaboration Collaborate about interests

Respect Respect similarities and differences

Decision making Support children in decision making

Section 2 – Plan and Deliver Programs for children and Older Adults

Part A: Planning exercise Pre‐exercise screening

Identify needs, expectations and characteristics

Consult with parent/caregiver

Recognise signs and symptoms of major injuries

Recommend advice from a health professional

Identify the special needs of children

Outline stages of growth and development

Describe age variation

Identify injury risks


Select appropriate exercises

Determine appropriate equipment

Determine appropriate instructional techniques

Part B: Instruct Communicate benefits of exercise

Provide advice on healthy eating and dietary guidelines

Explain and demonstrates exercise and equipment

Explain motivational techniques

Part C: Evaluate Explain importance of evaluation

Identify feedback sources

Section 3 – Working with Allied Health Professionals

Part A: Monitor Respond to poor exercise tolerance

Describe signs and symptoms of instability

Identify associated conditions

Part B: Maintain case management

file Identify information contained in a case management file

Identify information that should be shared

Maintain client records

SECTION 1 – INTERACT EFFECTIVELY WITH CHILDREN

1. In less than 100 words for each, explain how the following points would apply when interacting with children

in a fitness setting.

a) Use language that is appropriate for age, developmental stage and culture

b) Use key words of meaning to a child

c) Ensure non verbal communication is relevant and appropriate

d) Ensure interactions are frequent, respectful and caring

e) Use non gender and non stereotypical language.

2. Briefly describe how you see the types of communication changing for children who are 3‐5,

5‐9 and 9‐16 years old.

3. When training children, how would you promote positive behaviour for the different age

groups 3‐5, 5‐9 and 9‐16 years old? In your answer, consider the following:

Communication

Positive and realistic expectations

Examples of positive behaviour

Acknowledging positive behaviour

Applying limits that are appropriate to the child

4. When training children, why is it important to collaborate with children about their

interests?

5. How would you ensure that you encourage children to respect their differences?\

6. Explain with examples how you would support children wit decision making in a fitness

environment. In your answer, make reference to the following:


a. Sharing ideas

b. Discussing limitations

c. Exploring alternatives

d. Assisting with implementation of ideas

e. Acknowledging suggestions that can’t be used

SECTION 2 – PLAN AND DELIVER PROGRAMS FOR CHILDREN AND OLDER ADULTS

Part A – Planning Exercise For Children

Pre‐exercise screening for all clients is essential.

1. List the elements that should be included in a pre‐exercise screening for children, young

adolescents and older adults.

2. Explain the purpose of conducting a pre‐exercise screening for children and older adult prior to

exercising.

Before you begin working with children or young adolescents, it is imperative that you have a very

good understanding of the legislation that affects you. Child Trainers must have a firm grasp of the

legislation and regulatory requirements and also the organisational policies and procedures which

enable safe and appropriate conduct of exercise for children and adolescents.

3. Research the following legislation with relation to children and explain how it applies to a child

trainer:

a. OHS

b. Duty of Care

c. Privacy

d. Anti‐discrimination

e. Child protection

4. Compare and explain how the needs and expectations of exercise differs between children,

adults and older adults.

5. Why is it important to consult with parents or family members and not solely rely on the

information provided by the child and/or older adult?

6. Research the list of major injuries and conditions below.

Sprains

Osteochondroses

o Severs

o Patellofemoral pain syndrome


Joint hypermobility

Osgood Schlatters syndrome

Arthritis

Osteoporosis

Hyper/hypotension

Dementia

Obesity

Asthma

ADD/ADHD (attention deficit disorder)

a. Provide a brief description of each injury or condition.

b. Explain the signs and symptoms of these injuries or conditions.

c. List and explain the exercises that are contraindicated to each condition.

d. Describe, for each condition, how you would modify your exercise program to

accommodate an individual with that condition.

7. When working with children and/or older adults you will be required to refer to and consult

with a number of medical and allied health professionals.

a. Research the following list of professionals

b. Summarise their roles with regards to children

c. Outline each of the allied health practitioners role in helping a fitness professional

produce a program for a client with a specific condition.

i. General Practitioner

ii. Paediatrician

iii. Accredited Exercise Physiologist

iv. Physiotherapist

v. Occupational therapist

vi. Accredited Practising Dietician

vii. Osteopath

viii. Chiropractor

ix. Diabetes educator

x. Podiatrist

8. Describe how age variation will affect the fitness programming (3‐5, 5‐9, 9‐16 and 55+)?

9. Identify 5 exercises and 5 pieces of equipment specifically suitbale for the age groups below:


AGE 3 – 5 yrs 5 – 9 yrs 9 – 16 yrs 55+ yrs

Exercises

Equipment

10. You have been asked to design an outdoor circuit for over 55’s. (Ensure that you consider

strength, flexibility and cardio exercises)

a. Identify appropriate equipment/exercises for 6 exercise stations

b. Explain why each is appropriate.

c. Provide 2 modifications for each exercise based on a less skilled/conditioned and a

more skilled/conditioned older adult

Complete the following case studies, paying careful attention to the specific needs of the

individuals listed.

Your answer to each of the Case Study questions should be no more than 200 words.

Case Study 1:

You have been asked to help a Physical Education teacher at a local High School with their in school

fitness programs. You want to develop a program that is fun, interactive and safe for all students.

John is a 14 year old boy who has been experiencing shin splints as he is training for the City to Surf.

He saw a medical practitioner who provided him with the following letter:

‘John may resume physical activity but should avoid weight bearing exercises, especially those that

involve prolonged periods of repetitive springing and landing’.

a) How would you advise the PE teacher to structure their physical education classes in order

to include John as much as possible.

b) What advice would you give John in order to manage his condition?

c) Which exercises must John avoid until the condition is resolved?

d) Explain the different types of instruction techniques and which one would be appropriate to

this group of adolescents?

Case Study 2:

You have been asked to write a 40min circuit lesson plan for a group 15‐16yr old boys and girls.

Include information on the set‐up, safety, warm‐up, conditioning/aerobic, fundamental motor

skills, cool‐down, and relaxation. Also include the circuit stations and activities at each.

Case Study 3:


You have been asked to help with a group of older adults with arthritis who have a specific request

to improve functional mobility:

a) How would you structure this class in order to meet the needs of this group of older adults?

b) What advice would you give these clients in order to manage their condition?

c) Which exercises should you avoid?

d) Which instructional techniques will be appropriate to this group of older adults?

Case Study 4:

You have been asked by your local aged care facility to design an exercise class for older adults with

no apparent special conditions. The facility manager has asked you to design a class with the

following requirements:

An indoor functional exercise class

65‐90 year old woman and men

20 participants

a. Provide a suitable name for your class

b. Provide a brief description of your class which outlines the class type

c. Identify the equipment list

d. Outline the fitness outcomes (aims and objectives) for this class

e. Allocate the stages of the class

f. Select an appropriate and varied range of exercises and allocate appropriate timing to

the program

g. Outline modifications for those with special needs

h. List appropriate pre‐class instructions for the group

i. Complete a pre‐class checklist

Part B – Instruct The Session

1. Explain the benefits of exercise for children and older adults (4 benefits each) and explain

why it is important to communicate these benefits before they commence exercise?

2. Research healthy eating for children, adolescents and older adults:

a. What are the general features of healthy eating?

b. Provide basic dietary advice to improve overall health for these clients.

3. Explain the 3 teaching methods and explain why it is important to use more than one

method when showing children and/or older adults the use of equipment.


4. Distinguish between the motivational techniques that would be appropriate for 5, 9 and 14

year and 55+ participants.

AGE 3 – 5 yrs 5 – 9 yrs 9 – 16 yrs 55+ yrs

Motivational

Techniques

5. Explain why training groups of children require specific planning, extra supervision and

exercise modification.

6. Outline the major changes that occur with age in the following areas:

i. Physiological

ii. Postural

iii. Psychological

iv. Behavioural

7. Describe how social needs will also change as we age.

8. Describe the healthy eating information for older adults paying particular attention to the

following:

Energy balance

Dietary guidelines

Fuel for exercise

Fuel for minimising post exercise fatigue and maximising recovery

Hydration

Special dietary needs requiring referrals.

9. What problems/risks can you envisage with instructing older adults and why is it essential to

monitory exercise intensity, technique and safety (100‐200 words)?

Part C – Evaluate The Session

1. Why is it important to evaluate the session, explaining how the evaluation might be

different for children and older adults?

2. When training children and older adults who can you get feedback from and why?

3. How would you identify modification are required for an exercise plan, and what

modification could be implemented for a children’s or older adults exercise plan?


SECTION 4 – ALLIED HEALTH PROFESSIONALS

Part A – Monitor Client Responses

1. Your client is exhibiting signs of poor exercise tolerance to your exercise program. You are

concerned that they are displaying contraindications to exercise. Outline the advice that you

should give your client.

2. The following is a list of signs and symptoms of instability:

Unusual fatigue and weakness

Pain or discomfort in the neck, chest, jaw or arms

Breathlessness

Oedema

Palpitations, tachycardia or bradycardia

Claudication pain

Dizziness or light headedness

Musculo‐skeletal pain.

a. Provide a brief description of the terms listed above

b. Provide 2 examples of conditions that might cause these symptoms or signs to occur

Part B – Case Management File

1. Identify the type of information you would expect to keep in a case management file.

2. What type of information should be shared with other health professionals?

3. Explain why it is important to maintain accurate, current, relevant and complete client

records


ADDITIONAL READING

ARTICLES The following articles and additional reading will support your learning for this module.

rthritisAUSTRALIA

For your local Arthritis Office:

1800 011 041

www.arthritisaustralia.com.au

ARTHRITIS INFORMATION SHEET

rthritisAUSTRALIA

For your local Arthritis Office:

1800 011 041

www.arthritisaustralia.com.au

ARTHRITIS INFORMATION SHEET

Is physical activity good for arthritis? Research has found that regular exercise is one of the most effective treatments for arthritis. It can help to:Improve: mobility and flexibility of joints, muscle strength, posture and balance. Decrease: pain, fatigue (tiredness), muscle tension and stress.

Just as importantly, physical activity will improve your overall health. It can improve the fitness of your heart and lungs, increase bone strength, reduce body weight and reduce the risk of conditions such as diabetes. It also improves your sleep, energy levels and mental wellbeing.

Who should exercise? Everyone with or without arthritis should be doing regular, appropriate exercise. The important thing is to choose the activities that best suit your condition, health and lifestyle.

What types of exercise should I do? Before you start to exercise it is important to ask your doctor and healthcare team to help you develop a suitable program and choose the best activities for you. Everyone’s fitness level and limitations will be different so start with activities that suit you. While some people with arthritis will find a five kilometre walk comfortable, others may find walking around the block difficult enough when starting. Generally you will need to do a mix of:• flexibility: to maintain or improve the mobility of

your joints and muscles. Examples include moving the joint as far as it can, muscle stretches and yoga.

• muscle strengthening: to support and take pressure off sore joints, strengthen bones and improve balance. An example is using weights or resistance bands.

• fitness: to improve the health of your heart and lungs. These activities usually use the larger muscles in the body, rather than exercising a specific area, and may make you ‘puff’ a little. Examples include brisk walking, cycling and swimming.

There isn’t just one particular exercise or activity that is recommended for all people with arthritis. Choose an activity that you enjoy and that is convenient for you to do. Low-impact exercises, with less weight or force going through your joints, are usually most comfortable. Examples of low-impact activities include:• walking• exercising in water, such as hydrotherapy

(with a physiotherapist), swimming or water exercise classes (see the Water exercise information sheet)

• strength training• tai chi • yoga and pilates• cycling• dancing.

How much should I do? All Australian adults should be aiming to do at least 30 minutes of activity on most days of the week. You can do 30 minutes continuously or combine several 10 to 15 minute sessions throughout the day. If you have arthritis and you have not exercised for a while, you may need to start with shorter sessions then build slowly. Talk to your doctor or a physiotherapist about getting started to help you avoid an injury or over-doing it. Don’t forget that activities such as gardening, playing with pets or taking the stairs rather than the lift can also count as exercise.

Australian Rheumatology

Association

Physical activityThis sheet has been written to provide general information about exercise for people with arthritis. It also includes guidelines as to what types and how much exercise to do and general safety tips. This sheet does not provide individual exercises or specific advice for each type of arthritis.

For more information:

Disclaimer: This sheet is published by Arthritis Australia for information purposes only and should not be used in place of medical advice. © Copyright Arthritis Australia 2007.

rthritisAUSTRALIA

Your local Arthritis Office has information, education and support for people with arthritis Freecall 1800 011 041 www.arthritisaustralia.com.au

For more information:

Disclaimer: This sheet is published by Arthritis Australia for information purposes only and should not be used in place of medical advice. © Copyright Arthritis Australia 2007.

rthritisAUSTRALIA

Your local Arthritis Office has information, education and support for people with arthritis Freecall 1800 011 041 www.arthritisaustralia.com.au

Exercise is one of the best treatments for arthritis. Talk to your healthcare team before you get started.

© Copyright Arthitis Australia 2008. Reviewed December 2008. Source: A full list of the references used to compile this sheet is available from your local Arthritis Office

The Australian General Practice Network, Australian Physiotherapy Association, Australian Practice Nurses Association, Pharmaceutical Society of Australia and Royal Australian College of General Practitioners contributed to the development of this information sheet. The Australian Government has provided funding to support this project.

To find a physiotherapist, talk to your doctor, see the Australian Physiotherapy Association website at www.physiotherapy.asn.au or look under ‘Physiotherapist’ in the Yellow Pages.To find an exercise physiologist, talk to your doctor, contact the Australian Association for Exercise and Sports Science on (07) 3856 5622 or use the ‘find an exercise physiologist’ feature at www.aaess.com.auBooks Millar, A Lynn 2003, Action plan for arthritis: Your guide to pain free movement, Human Kinetics, Champaign, IL.

Nelson, Miriam E et al 2002, Strong women and men beat arthritis, Lothian, Port Melbourne.Walk with ease: Your guide to walking for better health, improved fitness and less pain 2003, Arthritis Foundation of America, Atlanta, GA.Websites Australian Government’s National Physical Activity Guidelines are available at www.health.gov.au (look under the ‘For consumers’ section)

How will I know if I’ve done too much? It can be hard to predict how your body will cope with a new activity. The most important thing to do is to listen to your body. A general guide is the ‘two hour pain rule’ – if you have extra or unusual pain for more than two hours after exercising, you’ve done too much. Next time you exercise, slow down or do less.

Should I exercise through pain? You should stop exercising if it is causing you unusual pain or increases your pain beyond what is normal for you. Exercising through this type of pain may lead to injury or worsening of your arthritis symptoms. (Note, many people with arthritis have some amount of pain all the time. This is not a reason to avoid exercise. You should only stop if you notice extra or unusual pain while you are exercising).

When is the best time to exercise? It doesn’t matter when you exercise, as long as you do. If possible, try to exercise when:• you have least pain• you are least stiff• you are least tired, and• your medicines are having the most effect (ask

your doctor or pharmacist about how to time your

medicines with exercise if possible. This may help to make your exercise session more comfortable).

Safety tips • Talk to your doctor and/or health professional before

starting an exercise program. A physiotherapist or exercise physiologist can suggest safe exercises and make sure you are doing your exercises correctly to prevent an injury.

• You may need more rest and less exercise during a ‘flare’, a period of increased pain and stiffness. Do not vigorously exercise a joint that is red, hot, swollen or painful.

• Always build slowly. When you first start, do less than you think you will be able to manage. If you cope well, do a little bit more next time and keep building gradually.

• Always start your exercise with some gentle movements to warm up your body and your joints. This can help prevent pain and injury during exercise.

• Cool down at the end of your session with some gentle movements and stretches. This can help prevent muscle pain and stiffness the next day.

CONTACT YOuR LOCAL ARTHRITIS OFFICE FOR MORE INFORMATION SHEETS ON ARTHRITIS.

Image description. Better Health Channel logo End of image description.

Imagedescrip

Blood pressure (high) - hypertension

The heart pumps blood around the body through the blood vessels. Blood pressure is the amountof force exerted on the artery walls by the pumping blood. High blood pressure (hypertension)means that your blood is pumping with more force than normal through your arteries. The addedstress on the arteries can accelerate the silting of arteries with fatty plaques (atherosclerosis).Atherosclerosis contributes to many illnesses, such as heart attack and stroke. Other risk factorsfor atherosclerosis include cigarette smoking and high blood cholesterol.

Hypertension is a common disorder of the circulatory system, affecting around one in seven adultAustralians and becoming more common with age. Older people may experience a change in theirblood pressure pattern due to their arteries becoming more rigid (less elastic).

Hypertension usually produces no symptoms. This means most people don’t even realise they haveit. Experts recommend that everyone should have their blood pressure checked regularly.

How blood pressure is controlledWhen the heart contracts, the blood inside the left ventricle is forced out into the aorta andarteries. The blood then enters small vessels with muscular walls, called arterioles. The tone in themuscular walls of the arterioles determines how relaxed or constricted they are. If narrowed, theyresist flow. Reduced flow of blood is detected in the brain, the kidneys and elsewhere. Nervereflexes are stimulated and hormones are then produced. The heart is induced to beat moreforcefully so that the blood pressure is maintained at a higher level, to overcome the restricted flowthrough the arterioles. The achievement of good flow (now at high pressure) eases possibleproblems for function of the brain and kidneys.

These adjustments occur normally. However, in some people the adjustments become fixed andhigh blood pressure persists. These people have developed hypertension.

How blood pressure is measuredHypertension can be mild, moderate or severe. Your blood pressure is naturally higher when youare exerting yourself, such as during physical exercise. It is only a concern if your blood pressure ishigh when you are at rest, because this means your heart is overworked and your arteries haveextra stress in their walls.

Blood pressure is measured in two ways:

• Systolic – the highest pressure against the arteries as the heart pumps. The normalsystolic pressure is usually between 110 and 130mmHg.

• Diastolic – the pressure against the arteries as the heart relaxes and fills with blood. Thenormal diastolic pressure is usually between 70 and 80mmHg.

A sphygmomanometer takes blood pressureBlood pressure is measured using a pressure-measuring instrument called a sphygmomanometer.

• An inflatable pressure bag is wrapped around the upper arm. The bag is connected to thesphygmomanometer. The operator manually pumps up the bag with air until the circulationof the arm’s main artery is interrupted.

• The pressure in the bag is then slowly released until it equals the systolic pressure in theartery, indicated by blood once again moving through the vessel. This makes a ‘thumping’sound. The systolic pressure is indicated on the sphygmomanometer and recorded.

• The blood pressure in the arm’s main artery drops to equal the lowest pressure, which isthe diastolic pressure. This is the pressure at which the thumping sound is no longer heard.This figure is also recorded.

Blood pressure (high) - hypertension Page 1 of 3

• The operator may take numerous readings to get the true picture. This is because manypeople tend to ‘tense up’ during the procedure and nervous tension may temporarily boostthe blood pressure.

Most people with hypertension feel okayHypertension usually does not produce any symptoms, because the organs of the body can resisthigh blood pressure for a long time. That’s why it’s important to have regular medical examinationsto make sure your blood pressure isn’t creeping up as you grow older. High blood pressure over aperiod of time can contribute to many illnesses, including:

• Heart attack• Heart failure• Kidney disease• Stroke.

An unhealthy lifestyle can cause hypertensionSome of the factors which can contribute to high blood pressure include:

• Hereditary factors• Obesity• Lack of exercise• A diet high in salt• Heavy drinking• Kidney disease.

The effects of high blood pressure on the arteries are worsened by:

• Cigarette smoking• High levels of saturated fat in the diet• High blood cholesterol• Diabetes.

Responses to some types of stress may affect both blood pressure and changes in the arteries, butthis remains scientifically uncertain.

Some drugs may cause hypertensionCertain drugs can cause hypertension or make controlling hypertension more difficult. Check withyour doctor or pharmacist for alternatives. These drugs include:

• The combined contraceptive pill• Non-steroidal anti-inflammatories• Some nasal drops and sprays• Some cough medicines, eye drops and appetite suppressants.

Blood pressure and ageingWith advancing years, the arteries tend to become more rigid (less elastic). This may change aperson’s blood pressure pattern, with a higher systolic pressure and a lower diastolic pressure. Thehigher systolic pressure is important because it can further accelerate the rigidity of the arteries.This state is referred to as ‘isolated systolic hypertension’. Although these changes are due toageing, this is not a normal state and may need medication to control the systolic pressures.

Making healthier choicesTwo out of five people can successfully lower their blood pressure by making adjustments to theirlifestyle. For example, a low fat diet and giving up cigarette smoking will reduce the damagingeffects of hypertension on the arteries. Some healthy lifestyle choices include:

• Maintain your weight within the healthy range.• Eat a high fibre, low fat and low salt diet.• Give up smoking.• Limit alcohol consumption.• Exercise regularly.


See your doctor before you start any new exercise program.

Antihypertensive medicationsIn most cases, it is necessary to take antihypertensive medication as well. Usually hypertensivemedications are introduced at low doses. The dose may be gradually increased if needed. Asecond, even a third drug may be added to achieve good blood pressure control. Not many peopleexperience unpleasant side effects.

Any drug treatment for hypertension needs to be monitored carefully by your doctor. You shouldnever alter the dose of your hypertension medication or stop taking it without consulting with yourdoctor. Medications don’t cure the condition and most of the people who need to takeantihypertensive drugs will do so for the rest of their lives.

Where to get help

• Your doctor• Your local pharmacist

Things to remember

• Hypertension, or high blood pressure, is a risk factor in many diseases, such as heartattack, kidney failure and stroke.

• Hypertension often doesn’t show any symptoms, so regular check-ups are important.• Leading a healthy lifestyle is one of the best ways to both treat and prevent hypertension.

This page has been produced in consultation with, and approved by: Heart Research Centre

Copyight © 1999/2009 State of Victoria. Reproduced from the Better Health Channel (www.betterhealth.vic.gov.au) atno cost with permission of the Victorian Minister for Health. Unauthorised reproduction and other uses comprised in thecopyright are prohibited without permission.• This Better Health Channel fact sheet has passed through a rigorous approval process. For the latest updates and moreinformation visit www.betterhealth.vic.gov.au.



Imagedescrip

Healthy ageing - stay mentally active

Growing older does not mean that your mental abilities will necessarily be reduced. There's a lotyou can do to keep your mind sharp and alert. Researchers believe that many of the supposed age-related changes that affect the mind, such as memory loss, are actually lifestyle related. Just asmuscles get flabby from sitting around and doing nothing, so does the brain.

A marked decline in mental abilities may be due to factors like prescription medications or disease.Older people are more likely to take a range of medications for chronic conditions than youngerpeople. In some cases, a drug (or a combination of drugs) can affect mental abilities.

Certain diseases that are more common to old age, such as Alzheimer's disease, can also be theunderlying cause of declining mental abilities. It is worth checking with your doctor to make sureany cognitive changes, such as memory loss, aren't associated with drugs or illness.

Age-related changes to the brainSome of the normal age-related changes to the brain include:

• Fat and other deposits accumulate within brain cells (neurones), which hinders theirfunctioning.

• Neurones that die from 'old age' are not replaced.• Loss of neurones means the brain gets smaller with age.• Messages between neurones are sent at a slower speed.

The brain can adaptA brain that gets smaller and lighter with age can still function as effectively as a younger brain.For example, an older brain can create new connections between neurones if given theopportunity. There is evidence to suggest that mental abilities are 'shared' by various parts of thebrain so, as some neurones die, their roles are taken up by others.

Physical fitness is importantSome conditions that can affect the brain's ability to function, such as stroke, are associated withdiet, obesity and sedentary lifestyle choices. Keeping an active body is crucial if you want an activemind. Suggestions include:

• At least 30 minutes of moderate exercise every day delivers an oxygen boost to the brain.• Exercising in three 10-minute blocks is enough to deliver significant health benefits.• Regular exercise can improve your brain's memory, reasoning abilities and reaction times.• Avoid the complications of obesity (such as diabetes and heart disease) by maintaining a

healthy weight for your height.• Avoid smoking and drinking to excess.

Eat a healthy dietGood nutrition helps to keep your brain in optimum condition. Suggestions include:

• Make sure your diet contains sufficient B group vitamins.• Glucose is the brain's sole energy source, so eat a balanced diet and avoid extreme low

carbohydrate diets.• Narrowed arteries (atherosclerosis) can reduce blood flow to the brain, so make sure you

eat a low fat, low cholesterol diet.

Improve your mental fitnessResearchers at Stanford University (USA) found that memory loss can be improved by 30 to 50 percent simply by doing mental exercises. The brain is like a muscle - if you don't give it regularworkouts, its functions will decline. Suggestions include:

Healthy ageing - stay mentally active Page 1 of 3

• Keep up your social life and engage in plenty of stimulating conversations.• Read newspapers, magazines and books.• Play 'thinking' games like Scrabble, cards and Trivial Pursuit.• Take a course on a subject that interests you.• Cultivate a new hobby.• Learn a language.• Do crossword puzzles and word games.• Play games that challenge the intellect and memory, such as chess.• Watch 'question and answer' game shows on television, and play along with the

contestants.• Hobbies such as woodwork can improve the brain's spatial awareness.• Keep stress under control with meditation and regular relaxation, since an excess of stress

hormones like cortisol can be harmful to neurones.

Boost your memoryGood recall is a learned skill. There are ways to improve a failing memory no matter what yourage. Suggestions include:

• Make sure you're paying attention to whatever it is you want to remember. For example, ifyou're busy thinking about something else, you mightn't notice where you're putting thehouse keys.

• Use memory triggers, like association or visualisation techniques. For example, link a nameyou want to remember with a mental picture.

• Practice using your memory. For example, try to remember short lists, such as a grocerylist. Use memory triggers to help you 'jump' from one item to the next. One type ofmemory trigger is a walking route that you know well. Mentally attach each item on yourlist to a landmark along the route. For example, imagine putting the bread at the letterbox,the apples at the next-door neighbour's house and the meat at the bus stop. To rememberthe list, you just have to 'walk' the route in your mind.

Conditions and events that can impair brain functionGetting older doesn't necessarily mean that the mind stops working as well as it once did.However, some of the conditions and events more common to older age that affect brain functioninclude:

• Atherosclerosis.• Dehydration.• Dementia, such as Alzheimer's disease.• Depression.• Diabetes mellitus.• Heart disease.• Medications - prescribed medicines should be regularly reviewed so that unwanted side

effects are avoided, and drugs should be discontinued if they are no longer required.• Poor nutrition, vitamin deficiency.• Parkinson's disease.• Stroke.

Many conditions can be managedMany of the conditions that may affect brain function can be managed effectively. The followingfactors have all proved to be important:

• Lifestyle and diet changes• Monitoring tests for hypertension, cholesterol and diabetes• Medications.

Where to get help

• Your doctor• Gerontologist• Neurologist.


Things to remember

• Researchers believe that many of the supposed age-related changes which affect the mind,such as memory loss, are actually lifestyle related.

• Keeping an active body is crucial if you want an active mind.• Some of the conditions and events more common to old age that may hinder brain function

include dementia, Parkinson's disease and atherosclerosis.

This page has been produced in consultation with, and approved by: North East Valley Division of General Practice



WA Anaphylaxis Factsheet

Meeting the challenge for Western Australian Children

What are allergies?

Allergies occur when the immune system produces antibodies against substances in the environment (allergens) that are usually harmless. Once allergy has developed, exposure to the particular allergen can result in symptoms that vary from mild to life threatening (anaphylaxis).

What is anaphylaxis?

Anaphylaxis is a severe, rapidly progressive allergic reaction that is potentially life threatening. Although there has been an increase in the number of children diagnosed as at risk of anaphylaxis, deaths are still rare. However, deaths have occurred and anaphylaxis must therefore be regarded as a medical emergency.

What causes anaphylaxis?

Food allergies are the most common triggers for an anaphylactic reaction. Nine foods cause 90% of food allergic reactions in Australia and can be common causes of anaphylaxis. These are:

peanuts

tree nuts (e.g. hazelnuts, cashews, almonds)

egg

cow’s milk

wheat

soybean

fish

shellfish

sesame

Other triggers include:

insect stings, particularly bee stings

medications

latex

anaesthesia.

Signs and symptoms of anaphylaxis

The symptoms of a mild to moderate allergic reaction can include: • tingling in the mouth • swelling of the lips, face and eyes • hives or welts • abdominal pain and/or vomiting. Symptoms of anaphylaxis - a severe allergic reaction can include: • difficulty breathing or noisy breathing • swelling of the tongue • swelling/tightness in the throat • difficulty talking and/or a hoarse voice • wheezing or persistent coughing • loss of consciousness and/or collapse • young children may appear pale and floppy.

Why is it important to know about anaphylaxis?

The most important aspect of the management of children with anaphylaxis is avoidance of any known triggers. Schools and child care services need to work with parents and children to ensure that certain foods or items are kept away from the child, to prevent exposure to known triggers. Knowledge of severe allergies will assist staff to better understand how to help children who have this problem.

How can anaphylaxis be treated?

Adrenaline given as an injection into the muscle of the outer mid-thigh is the most effective first aid treatment for anaphylaxis. Children at risk of recurrent anaphylaxis are advised by their medical practitioners to carry adrenaline in an auto-injector, e.g. EpiPen®, for use in an emergency. Children between 10 - 20kg are prescribed an EpiPen® Junior, which has a smaller dosage of adrenaline. Parents should provide schools or child care services with the child’s EpiPen®, which should be kept in an accessible, unlocked location. If a child is treated with adrenaline (an EpiPen®) for anaphylaxis, an ambulance must be called and the child should be taken immediately to a hospital.

How can anaphylaxis be prevented?

The key to prevention of anaphylaxis is knowledge of those children who are at risk, awareness of triggers (allergens) and prevention of exposure to these triggers. Some children wear a medical warning bracelet to indicate allergies.

Anaphylaxis at school or child care service

When a child is at school or child care and is at risk of anaphylaxis, parents must:

inform staff of the diagnosis and its cause

discuss prevention strategies with staff

work with staff to develop an Anaphylaxis Management Plan

provide the school or child care service with an ASCIA Action Plan, or copies of the plan, that is signed by the child’s medical practitioner and has an up-to-date photograph

supply the child’s EpiPen® and ensure it has not expired

attend a training session, where possible.

It is recommended that staff involved:

know the identity of children who are at risk of anaphylaxis

liaise regularly with parents

follow information contained in the child’s anaphylaxis management plan

obtain training in how to recognise and respond to an anaphylactic reaction, including administering an EpiPen®

ensure the EpiPen® is stored correctly (at room temperature and away from light) in an unlocked, easily accessible place

know where the EpiPen® is located

in the event of a reaction, follow the procedures in the child’s ASCIA Action Plan.

Summary of important points

Anaphylaxis is a medical emergency that requires a rapid response.

Certain foods and insect stings are the most common causes of anaphylaxis.

The key to prevention of anaphylaxis is identification of triggers and preventing exposure. Schools and child care services need to develop prevention strategies in consultation with the child and the child’s parents.

Adrenaline given through an autoinjector (EpiPen®) is the first line treatment for anaphylaxis. The EpiPen® is designed so anyone can use it in an emergency.

Staff who are responsible for the care of children at risk of anaphylaxis must obtain training in how to recognise and respond to an anaphylactic reaction, including administering an EpiPen®.

Further information

Australasian Society of Clinical Immunology and Allergy: www.allergy.org.au Anaphylaxis Australia www.allergyfacts.org.au

Teaching Children who have Epilepsy

Seizure Smart

TEACHING CHILDREN WHO HAVE EPILEPSY Serving Australians with Seizures

The need to know about Epilepsy Teachers have an important role in determining the future of all children, especially those with epilepsy. To ensure each child with epilepsy has the opportunity to develop to their full potential, teachers need to understand:

The diverse manifestations of epilepsy The specific nature of each individual child’s epilepsy and treatment How epilepsy may affect the child academically, emotionally and socially.

What is Epilepsy? Epilepsy occurs when there are recurrent seizures due to a discharge of abnormal electrical activity in the brain cells. Not all seizures are convulsive. Non-convulsive seizures are more difficult to recognise and are frequently misinterpreted. Daydreaming and unresponsiveness, confused or inappropriate behaviour and/or temporary speech impairment, may all be signs of seizures.

The Epilepsies There are numerous types of epilepsy or epilepsy syndromes. Individual children may develop an epilepsy syndrome:

With one or more type of seizure/s. With known cause OR no apparent cause. With or without other neurological problems. Which responds in varying degrees of success to medication. Which they may or may not outgrow.

Once the type of epilepsy has been correctly diagnosed, the aim is to prescribe a medication most effective for the seizure type, but causes the least possible side effects.

Epilepsy and learning difficulties Learning disabilities are not an automatic consequence of epilepsy. Many children with epilepsy will achieve both academically and socially. Some children will, however, experience varying degrees of learning disability, and their individual needs must be met. Learning and cognitive difficulties may be directly related to:

The epilepsy syndrome Type of seizure(s) The duration and frequency of seizures The time absent from school because of seizures

1300 EPILEPSY (37 45 37) © Epilepsy Association May 2002 (Revised Mar 2006)

1 The time it takes to recover from seizures


Seizures and/or medication can affect:

Attention and alertness Cognitive functioning Memory Motor skills.

Some children with epilepsy may experience difficulties with:

Visual and/or verbal learning– reading, spelling, rote learning, speech and language, perceptual problems, numeracy, problem solving and memory recall Motor ability – handwriting may be poor and performance slower Psycho-social problems – low self-esteem frustration, anxiety, and poor motivation Maintaining consistency in learning Inappropriate behaviour – attention seeking or withdrawal behaviour Change in mood

Further difficulties can be created by:

Unrealistic expectations (above or below the child’s abilities) by parents, friends, teachers and peers Socio-economic factors and differing family backgrounds.

Suggested teaching strategies 1. Co-Operative Learning: group work develops listening and talking skills, encourages

interaction with peers in problem solving and allows children to ask questions and learn from each other.

2. Task Analysis: the breaking down of specific tasks into their most basic steps establishes teaching and learning stages that will need to be achieved if the child is to succeed. Task analysis can be applied to any learning or social situation activity.

3. Cueing: proves effective especially with listening activities. Warn the child, ahead of time, of the purpose of the activity. Give a quick summary of the passage and ask comprehension questions before reading the passage. Knowing the purpose of the activity will help keep the student on task.

4. Reviewing: a review of the processes used in solving a complex task can be very helpful for the child.

5. Repetition: leads to the consolidation of skills learnt in mastering a task. Unconsolidated skills are not likely to be generalised to other learning tasks.

6. Mnemonics: uses verbal, visual and symbolic techniques as memory aids. The acquisition of facts and procedural knowledge is governed by memory and the most effective measures for memory development are rehearsal related.


27. Regular evaluation of the above strategies.


What teachers can do Seek information from the doctor or Epilepsy Action about the various types of epilepsy, how

to recognise and administer first aid for different types of seizures and the possible effects of treatment.

Obtain detailed information about the specific nature, treatment and possible effects of each

child’s epilepsy on their educational, physical and emotional development. Primarily such information should be sought from the parents. If needed consent should be obtained to talk to the child’s doctor/specialist.

Observe seizures. Apart from the parents, the teacher is the adult who sees the child more than

anyone else and can be an important source of seizure description. Such observations and documentation can greatly assist the doctor.

Observe and monitor the pattern of each child’s behaviour and learning processes. Share

information and observations with the child’s parents and educational support staff to develop a consistent team approach.

In conjunction with relevant others, develop an individual epilepsy management care plan to be

used at school and for school activities. Utilise resources available through Epilepsy Action’s educational support services, to develop

individual student programs. Help the child cope with their epilepsy and encourage active participation in all school activities

in accordance with parental and medical advice. Help other children, teachers and parents understand epilepsy and encourage social acceptance.

Further information can be obtained from Epilepsy Action including the pamphlet Practical Management Of The Student With Epilepsy.


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Asthma facts

Asthma is a disease of the airways in the lungs that causes inflammation (redness) and swelling.The exact cause is not known and there is currently no cure. Asthma is the most widespreadchronic (ongoing) health problem in Australia. A range of programs and services are available tosupport people with asthma.

Asthma rates in AustraliaAsthma rates in Australia are high compared to other countries, with over two million peopleaffected. This includes one in nine adults and one in eight teenagers and one in seven primaryschool age children. Evidence suggests that the proportion of people in Australia with asthma hasnot increased in recent years, after rising steadily throughout the 1980s and 1990s.

More facts about asthma in AustraliaSome other facts about asthma in Australia include:

• Asthma is one of the most common reasons for admission to hospital for children.• Around one-third to one-half of adults with asthma have moderate or severe asthma

effects.• Asthma is more common among boys than among girls in primary school age children.

However, after the teenage years, more women have asthma than men.• Asthma is more common among Indigenous Australians, particularly adults, than among

other Australians.• Asthma is less common among Australians who were born in non-English-speaking

countries than among other Australians.• More than eight in 10 people with asthma are affected by allergy.

Asthma management strategiesAustralian governments (federal, state and territory) have made asthma a national health priority.Strategies to monitor and manage asthma in Australia include:

• Asthma Cycle of Care – support for GPs to provide best practice asthma care to theirpatients, including the use of written Asthma Action Plans.

• First Aid for Asthma – information about how to obtain prompt medical assistance in anemergency.

• Asthma Friendly Schools Program – promotes a safe and supportive schoolenvironment for students with asthma.

• Asthma Foundations of Australia – an association of state-based Asthma Foundationsproviding a range of asthma-related programs and activities.

• Australian Centre for Asthma Monitoring – monitors and reports on asthma rates andimpacts in Australia.

• National Asthma Council Australia – works with health professionals to improve healthoutcomes for people with asthma.

• Community education – a variety of community information activities to encouragebetter management of asthma within the community.

Where to get help

• Your doctor• Your pharmacist• Your local community health centre• Asthma Foundation of Victoria Tel. 1800 645 130• National Asthma Council Australia Tel. 1800 032 495

Things to remember

Asthma facts Page 1 of 2

• Asthma is a big health problem in Australia.• The exact cause is not known and there is currently no cure, but relief is possible with

medication and good management.• A range of programs and services are available to support Australians with asthma.

This page has been produced in consultation with, and approved by: National Asthma Council Australia

This Better Health Channel fact sheet has passed through a rigorous approval process. Theinformation provided was accurate at the time of publication and is not intended to take the placeof medical advice. Please seek advice from a qualified health care professional.

For the latest updates and more information, visit www.betterhealth.vic.gov.au

Copyight © 1999/2010 State of Victoria. Reproduced from the Better Health Channel(www.betterhealth.vic.gov.au) at no cost with permission of the Victorian Minister for Health.Unauthorised reproduction and other uses comprised in the copyright are prohibited withoutpermission.

Asthma facts Page 2 of 2

Child and Youth Mental Health Information Series Attention Deficit Hyperactive Disorder (ADHD)

What is the issue?ADHD causes problems with children’s behaviour. Usually children with ADHD: � Can’t pay attention for long; � Do things without thinking; and � Are too active. The behaviours happen more often and are worse than those usually seen in a child of the same age. The problems happen in a number of different places, like school, home and social settings. Every child is different so ADHD looks different in every child. It can be very complicated.

Between 3 and 9 children in every 100 seen by health workers are diagnosed with ADHD. Research suggests that ADHD may be � Inherited from a family member – this appears to be

the largest contributing factor; and/or � Due to other influences on individual and body

chemistry.

What are the signs of ADHD? Families and teachers say that children with ADHD have difficulty: � Concentrating and paying attention. Children with

ADHD are easily distracted, particularly when there are lots of things going on around them. Some children may daydream.

� Sitting still. Children with ADHD often squirm, fidget, get out of their seats a lot in the classroom, run around and climb. They’re always on the go and are unable to sit quietly and play.

� Humming, fast talking, or making noises. � Acting without thinking or understanding the

consequences. They may be risk takers. � Difficulty waiting for rewards. � Difficulty waiting. Children with ADHD may appear to

be rude, interrupt or talk over others. They may blurt out answers and have trouble waiting their turn.

� Following instructions or rules

Other problems that may go with ADHD Some children with ADHD have problems with: � School work: learning problems and/or poor school

achievements; � Thinking skills: trouble with organising and complex

problem solving; � Emotional problems: Anxiety, depression, low self

esteem and anger are common; � Social problems: Difficulty making and keeping friends;

� Behavioural problems: Tantrums, not doing as they are asked, defiant, touchy or easily annoyed, aggressive and argumentative with others; and

� Language problems: Difficulty understanding and organising language.

These problems are more likely to go along with ADHD but are not part of ADHD. If these other problems are present, more specialised treatment may be needed.

Assessment of ADHD For general practitioners, careful assessment is needed to diagnose ADHD. Paediatricians, child mental health professionals or child psychiatrists are trained to make this assessment. Assessment should cover: � The child’s behaviour at school or work, home and in

social settings; � History of the child’s problem; � Vision and hearing checks; � What is happening at home; and � How the child gets on with other young people. It is important to remember that behaviour that may indicate a diagnosis must be occurring in more than one setting.

Managing ADHD ADHD is usually diagnosed in childhood. As children grow up their problems may become less obvious but ADHD does not disappear altogether. Proper treatment means that in most cases symptoms of ADHD can be managed and a child’s behaviour and life improves

Research suggests that a mix of education, learning new behaviours and medication may be helpful. Medication helps about 80% of children who have ADHD. A doctor, usually a specialist, is the best person to look after ADHD medication treatment. A doctor makes sure your child is getting the right dose and checks for any side-effects. Often medications can help control the basic problems of ADHD, such as poor attention, over activity and acting without thinking. Other treatments may be helpful to manage problems with emotions, behaviour and school. Health and education workers can help families to manage ADHD.

Things to try Parents and carers can help children with ADHD manage their behaviour by: � Being positive about your child. Show them the good

things about themselves. Even some parts of ADHD can be seen as positive e.g. lots of energy, willing to try new things, ready to talk, spontaneous, happy enthusiastic, imaginative, and so on;

� Demonstrating your own positive communication and problem solving skills.

� Noticing and using lots of rewards and praise for good behaviour. Often rewards or consequences mean less to children with ADHD so use special rewards your child likes. Rewards encourage children to work eg. little toys or things they want, particular privileges or special activities;

� Making sure children have clear and consistent routines at home and school;

� Gaining their attention by starting a request or instruction with their name;

� Using short, to the point, instructions. Children with ADHD often have difficulty understanding spoken information. The more words you use, the less they understand;

� Breaking down jobs into smaller steps. Praise and encourage the child for trying as well as for finishing the job. Praise helps children learn to manage their behaviours and builds confidence;

� Giving children a quiet place to study. Turn off radio and TV. Make sure the space is clear and s/he only has the things needed to do the work;

� Telling children straight away about how they are going. Children with ADHD need quicker feedback for their behaviour because their attention is often shorter than other children;

� Being confident, consistent and quick to respond when your child misbehaves. Children with ADHD usually act without thinking about consequences. Giving consistent and immediate consequences assists children to learn self-control;

� Having a good understanding of your child’s ability to control their behaviours. Keep in mind what is realistic for your child. This helps guide your reactions to your child’s behaviour; and

� Seeking counselling if you and your partner are having relationship difficulties, as constant fighting between parents can make things worse. Sorting out relationship problems may help your child.

How to get help� Your child’s general practitioner, teacher, guidance

officer, school counsellor or school health nurse may be able to assist your child.

� A General Practitioner can refer you to a Paediatrician if your child needs a more specialised assessment or treatment.

� Your general practitioner may refer you to other specialists who work with children and adolescents such as a private psychologist, psychiatrist or other health worker.

� Your local Community Health Centre � Triple P Positive Parenting Program. The program

assists in reducing disruptive behaviours in children and young people by providing information and counselling to promote parenting skills. See www.triplep.net.

The Brisbane North Youth Service Provider Directory has details of many services, and can be accessed at www.health.qld.gov.au/rch/professionals/BNYSPD.pdfor you could also consider one of the following.

ServicesAssociation of Relatives and Friends of the Mentally Ill Support and information for significant other/s of those affected by mental illness. Call their head office on (07) 3254 1881 or see www.arafmi.qld.gov.au for local support groups.

Health Information Service For general health information and referral. Now includes the Child Health Line. Call 13 HEALTH (13 43 25 84).

Kids Help Line Free national telephone counselling for children and young people 24 hours a day, 7 days a week. Phone 1800 55 1800.

LifelineFree counselling and support, available 24 hours a day, 7 days a week. Phone 13 11 14.

ParentlineCounselling and support for parents, available 8am – 10pm, seven days a week. Phone 1300 30 1300.

Queensland Transcultural Mental Health Service Provides mental health assistance and information to people from culturally diverse backgrounds. Phone (07) 3167 8333 during business hours.

SANE Australia National charity aimed at enhancing mental health through campaigning, education and research. Phone 1800 187 263.

Websiteswww.addaq.org.au: The Attention Deficit Disorder Association Queensland provides information and services on ADHD.www.headspace.org.au: Website for the National Youth Mental Health Foundation, which aims to support Australian young people with mental health and related problems. www.health.qld.gov.au/mhcarer: Queensland Health website for information and support for those caring for someone with a mental illness. www.kidshelp.com.au: Kids Help Line online counseling available for young people. www.livingisforeveryone: Australian government suicide prevention strategy website. www.raisingchildren.net.au: Practical, expert child health and parenting information and activities www.reachout.com.au: Interactive forum for young people to access support and assistance. www.somazone.com.au: Information for young people about health and well-being issues.

This fact-sheet was updated in April 2009 by the Child and Youth Mental Health Service of the Royal Children’s Hospital, Brisbane, to raise awareness and provide information to families, young people and community members. This and others fact sheets in the series can be downloaded from: www.health.qld.gov.au/rch/families/cymhs.asp

Disclaimer: Information in this fact sheet is intended as a guide only. Although every effort was made at the time of printing to ensure the accuracy of information, Queensland Health does not accept responsibility for change in service details. Queensland Health accepts no responsibility for the way in which this fact sheet is used. In addition, quality of service provision is the responsibility of individual service providers.

GO FOR IT !Here’s an example of a strength-training program for kids 11-13

MondayExercises Sets Reps Weight

Warm-ups/Stretch 5 minutesBench Press 3 10 5-10 lbs

Crunch 3 30 BodyLunges 3 10 Body

Calf Raises 3 30 BodyWrist Curls/Extensions 3 12 Soup Can

Cool Down/Stretch 5 minutesWednesday

Exercises Sets Reps WeightWarm-ups/Stretch 5 minutes

Bicep Curls 3 10 5-10lbsTricep Extensions 3 10 5-10lbs

Seated shoulder Press 3 10 5-10lbsCrunch w/twist oblique 3 30 Body

Squat 3 12 5-10lbsCool-Down/Stretch 5 minutes

FridayExercise Sets Reps Weight

Warm-ups/Stretch 5 minutesBench Press 3 10 5-10lbs

Crunch 3 30 BodyLunges 3 10 Body

Calf Raises 3 30 BodyWrist Curls/Extensions 3 12 Soup Can

Cool –Down/Stretch 5 minutes

SAFETY FIRSTSo you have the home gym, the free weights and that old poster of Arnold in the basement.Now all you have to do is establish some safety guidelines. Here are some starting points.

_ Ensure proper instruction and supervision at all times _Use a spotter _Increase weight in small increments (2-5 pounds) _Use no or low weight and high repetitions

_No maximum lifting _Lift on non-consecutive days to allow for rest and recovery_ Ensure total body exercises, one lift per muscle _Always warm-up, stretch and cool-down

GETTING STARTEDHere’s an example of a strength-training program for kids 8-10

MondayExercises Sets Reps Weight

Warm-ups/Stretch 5 minutesModified push-ups 1 8-10 Body

Crunch 1 20-25 BodyLunges 1 8-10 Body

Calf Raises 1 20-25 BodyWrist Curls/Extensions 1 10-15 Soup Can

Cool-Down/Stretch 5 minutesWednesday

Exercises Sets Reps WeightWarm-ups/Stretch 5 minutes

Bicep Curls 1 8-10 Soup CanTricep Extensions 1 8-10 Soup Can

Seated Shoulder Press 1 8-10 Soup CanCrunch w/twist oblique 1 8-10 Body

Squat 1 8-10 BodyCool-Down/Stretch 5 minutes

FridayExercise Sets Reps Weight

Warm-ups/Stretch 5 minutesModified push-ups 1 8-10 Body

Crunch 1 20-25 BodyLunges 1 8-10 Body

Calf Raises 1 20-25 BodyWrist Curls/Extensions 1 10-15 Soup Can

Cool –Down/Stretch 5 minutes

SAFETY FIRSTSo you have the home gym, the free weights and that old poster of Arnold in the basement.Now all you have to do is establish some safety guidelines. Here are some starting points.

_ Ensure proper instruction and supervision at all times _Use a spotter _Increase weight in small increments (2-5 pounds) _Use no or low weight and high repetitions

_No maximum lifting _Lift on non-consecutive days to allow for rest and recovery_ Ensure total body exercises, one lift per muscle _Always warm-up, stretch and cool-down

NSW Department of Tourism, Sport and Recreation

Kids in gyms

Guidelines for running physical activity programs for

young people in fitness and leisure centres in NSW

www.dsr.nsw.gov.au

© Fitness NSW and The Children’s Hospital at Westmead 2003

All rights reserved.

ISBN 0-7347-6135-X

Acknowledgements

Appreciation is expressed to those agencies and theirrepresentatives who contributed to the development ofthese guidelines. Special acknowledgment is given tomembers of the Fitness NSW advisory panel:

Dr Robert Parker - ChairpersonChildren’s Hospital Institute of Sports Medicine

Ali ConstantinoFitness NSW

Gordon AllenPolice and Citizens Youth Clubs

Sheena BarnesNSW Department of Tourism, Sport and Recreation

Nicole ChambersLeichhardt Park Aquatic Centre

Arthur ChapmanStretch-n-Grow

Rosemary DavisNSW Department of Education and Training

Jason FountainFitness NSW

Cathy Gorman-BrownNSW Department of Tourism, Sport and Recreation

Ian GraingerFitness NSW/Fitness Australia, Fitness NSW BoardMember

Peter HickeyPrairiewood Leisure Centre

Liz JonesFitness First

George JoukadorSutherland Leisure Centre

Susan KingsmillHiscoes Fitness Centre, Fitness NSW Board Member

Regina McLeanBody Health Fitness Centre

Gina StuartCentral Coast Health

Niki TaylorNSW Department of Tourism, Sport and Recreation

Liz WellsFitkid, Fitness NSW Board Member

Author

Dr Robert J ParkerThe Children’s Hospital Institute of Sports Medicine(CHISM), The Children’s Hospital at WestmeadLocked Bag 4001Westmead NSW 2145tel (02) 9845 0761fax (02) 9845 0432website www.chism.chw.edu.au

Photographs

Julie Howard PhotographyReprinted with permission from Australian FitnessNetwork

Published by

NSW Department of Tourism, Sport and Recreation6 Figtree DriveSydney Olympic Park NSW 2127Locked Bag 1422Silverwater NSW 2128tel (02) 9006 3700 or 13 13 02fax (02) 9006 3800email [email protected] www.dsr.nsw.gov.au

Additional copies are available from

Fitness NSW23 Chandos Street, Suite 3St Leonards NSW 2065PO Box 1311Crows Nest NSW 1585tel (02) 9460 6200fax (02) 9460 6211email [email protected] www.fitnessnsw.com.au

and

NSW Department of Tourism, Sport and Recreation

3Kids in gyms

Contents

Minister’s foreword: A message from the Minister for Tourism and Sport and Recreation 2

A message from the Chief Executive, The Children’s Hospital at Westmead 3

A message from the Chief Executive Officer, Fitness NSW/Fitness Australia 4

Overview of guidelines 5

Introduction 6

Purpose 6

Background 7

The guidelines 8

Risk management plan 8

Pre-exercise screening and consent procedures 10

Privacy 10

Age of entry and centre membership 10

Staff supervision ratio 12

Insurance 13

Role of the fitness professional 13

Selected references 15

Published documents 15

Websites 17

Attachment one: Working with Children check requirements 18

Attachment two: Exercise and Physical Activity Readiness 19Assessment of Children and Young Adolescents (ExPARA)

Attachment three: Summary of eligibility requirements 25and staff:child/adolescent ratios

Table 1 Eligibility requirements by age 25

Table 2 Recommended staff/child ratios for structured or 26supervised programs conducted in centres

7Kids in gyms

Overview of guidelines

These guidelines aim to:

assist commercial community fitness and leisure centres to provide a wide range of safe and high-quality physicalactivity programs for healthy children and young adolescents aged five to 16 years

increase opportunities for children and young adolescents to participate in physical activity programs

increase the participation rate of children and young adolescents in a wide range of physical activities in safeenvironments

enhance business opportunities

support the Charter of Physical Activity and Sport for Children and Youth.

In order to achieve these aims, these guidelines address issues associated with:

the vulnerability of children and young adolescents

providing safe environments for conducting physical activities for children and young adolescents

conducting supervised and unsupervised age-appropriate physical activity programs for children and young adolescents

providing a wide range of safe and effective physical activity programs for children and young adolescents

providing appropriate staff supervision of different physical activity programs and centre facilities

providing appropriate pre-exercise screening procedures for children and young adolescents

providing centre and staff insurance protection

providing suitably qualified centre staff to conduct physical activity programs for children and young adolescents.

8 Kids in gyms

Regular participation in physical activity by children and young adolescents is essential for their optimum growth,development and ongoing health and well being.

Physical activity provides multiple health benefits to children and young adolescents, including psychological well being,reduced symptoms of depression and anxiety and enhanced self-esteem.

When combined with appropriate dietary modifications, physical activity is effective in modifying factors associated withthe metabolic syndrome (hypertension, obesity, insulin resistance and impaired blood fat profiles). Weight bearing andstrength training activities also promote the skeletal health of young people.

Physical inactivity is the second largest cause of illness in our country and contributes to a wide range of seriousdiseases including cardiovascular disease, diabetes, overweight and obesity.

These diseases are beginning to appear among children, with childhood overweight and obesity affecting one in fourAustralian children. In the 10-year period from 1985 to 1995 the level of combined overweight/obesity in Australianchildren more than doubled, while the level of obesity tripled in all age groups for both boys and girls. The rate ofincrease in overweight and obesity in Australia appears to be accelerating sharply accompanied by a similar increase insedentary leisure-time pursuits.

Three major factors are thought to have contributed to the epidemic of childhood overweight and obesity. These are:

an increase in sedentary behaviours

a decline in spontaneous and organised physical activity, and

an increase in the consumption of energy-dense foods and sugary drinks.

Increasing participation in physical activity among children and young adolescents is one strategy that may help curbthe predicted increase in childhood overweight and obesity.

Commercial fitness providers are well placed to offer children and young adolescents safe and enjoyable physicalactivity opportunities. However, because of the vulnerability of young people, specific guidelines are required tomaximise their safety and wellbeing while they are attending physical activity programs.

PurposeThese guidelines are to help commercial and community fitness and leisure centres provide a range of safe and high-quality physical activity programs for healthy children and young adolescents aged between five and 16 years. Implicit inthis is the intention that centres will increase opportunities for children and young adolescents to participate in physicalactivity programs, and that more children and young adolescents will participate in such programs as a result.

These guidelines outline the minimum requirements for commercial providers of physical activity programs for childrenand young adolescents, and are designed to supplement the existing Fitness NSW Code of Practice for FitnessCentres and support the Fitness NSW initiative of One-Million-Members-by-2010.

The guidelines also support the Charter of Physical Activity and Sport for Children and Youth, an initiative developedby The Children’s Hospital at Westmead in consultation with over 60 parent and community groups, sporting, fitnessand recreational clubs and organisations, professional associations, schools, local and state government organisationsand national sporting bodies.

A number of specialised activities for children and young adolescents currently conducted in some fitness and leisurecentres are not covered in these guidelines. These include boxing, martial arts, abseiling, climbing, wrestling, ballet anddance classes, yoga and pilates.

Introduction

9Kids in gyms

BackgroundAn initial draft of the guidelines was developed following a systematic review of the electronic databases, data madeavailable to Fitness NSW and results from a survey of all Fitness NSW members.

Of those who responded to the survey, 74 per cent confirmed that they conducted physical activity programs forchildren or young adolescents. These programs included general fitness activities; group fitness classes, includingcircuit weights-based classes; resistance training; dance classes and swim classes. There are currently no industryguidelines about the establishment of such programs.

The survey identified several areas of concern, including the need to:

establish the minimum age of membership and entry requirements

define appropriate qualifications for staff involved in physical activity programs for children and young adolescents

provide a pre-exercise health screening questionnaire for children and young adolescents

establish safety criteria for the use of equipment by children and young adolescents

establish appropriate staff to student supervision ratios for different types of exercise programs for children andyoung adolescents.

The draft guidelines were refined with additional consultation and advice provided by the following groups andorganisations: Fitness NSW, the NSW Department of Tourism, Sport and Recreation, NSW Department of Health,Central Coast Health, NSW Department of Education and Training, The Commission for Children and Young People, theChildren’s Hospital Institute of Sports Medicine, The Children’s Hospital at Westmead, Police and Citizens Youth Clubs,NSW Heart Foundation, NSW fitness and leisure centres, training course providers and Recognised TrainingOrganisations, and independent NSW fitness industry representatives.

10 Kids in gyms

Risk management planAll community fitness and leisure centres (hereafter called centres) should have a risk management plan in place thatencompasses the safe provision of programs involving children and young adolescents. In adopting these guidelines,those centres that currently have risk management plans should review and update them.

Fitness NSW members can obtain a copy of the Fitness NSW risk management plan from the website atwww.fitnessnsw.com.au. Alternatively, centres may find useful information in the manual It’s Your Business: a Guide forDirectors of Sport and Recreation Organisations, produced by the NSW Department of Tourism, Sport and Recreation,which is available at the website at www.dsr.nsw.gov.au.

All members of staff should be aware of the centre’s risk management plan and the procedures for implementing theplan. All staff must have read and signed a statement to show that they understand the risk management plan. Thisstatement should then be kept in their personnel folder.

In addition to what is contained in the Fitness NSW risk management plan, a centre’s risk management plan forchildren and young adolescents should include additional sections related to:

duty of care

the Working with Children check

the centre’s facility environment

fitness equipment and children.

Duty of care

Centres have a duty of care to any child or young adolescent who participates in a physical activity program wwiitthhiinn tthhaatt cceennttrree..

Where a centre conducts physical activity programs for children or young adolescents, it is the responsibility of thatcentre to provide:

safe and well-maintained facilities and equipment

qualified fitness professionals to conduct physical activity classes

supervision in all areas of the centre

protection against physical, sexual and emotional abuse and neglect from other centre members, participants and staff

a policy of safe supervision for change rooms for children and adolescents under the age of 18 years.

The centre must have a written policy outlining its duty of care responsibilities. All staff must have read this policy and signed a statement showing that they understand this duty of care. This statement must be kept in theirpersonnel folder.

Centres engaging people in child-related employment have a range of legal responsibilities which are outlined below.

The guidelines

11Kids in gyms

Working with Children check

In centres where child-related activities or services are provided, employers have a range of responsibilities under theWorking with Children check. The check helps to reduce the likelihood that unsuitable people will be engaged to workin paid or unpaid roles with children or young adolescents.

Under NSW legislation, it is an offence for a person convicted of particular kinds of offences to apply for, remain in, orundertake paid or unpaid child-related employment. All people entering paid child-related employment must alsoundergo a series of background checks before they begin their employment.

NSW Department of Tourism, Sport and Recreation administers the Working with Children check on behalf of the NSWfitness industry. All centres and child-related employees (paid, unpaid and volunteers) must meet the relevantrequirements of the Working with Children check.

These requirements can be found in Attachment one.

The centre’s facility environment

All centres must meet minimum quality standards to ensure the safety of their users. By law, every centre in NSW mustcomply with the Occupational Health and Safety Act 2000 (NSW). It is also recommended that all centres comply withthe voluntary NSW Fitness Industry Code of Practice (NSW Department of Fair Trading, 1998). Clause 39 of the coderequires that centres ensure that all exercise areas contain safe working spaces, and that the number of people usingany given space does not hinder the safe and effective use of the training equipment used in that space.

Where classes are conducted for children or young adolescents, the exercise environment should be inviting andappropriate, which might be achieved by the use of colour and other appropriate visual stimuli.

Fitness equipment and children

Most resistance training equipment used in centres is designed for adults. Because children’s limbs and bodies aresubstantially shorter than those of adults, the lever systems of such equipment often do not suit children. In addition,machines designed for adults, while offering some level of adjustment, simply do not offer the level of adjustmentrequired to accommodate a child or an adolescent. Children and young adolescents should not use equipment thatcannot be suitably adjusted for them, as this could lead to injury.

The use of free weights may also lead to injury in children and young adolescents through improper lifting techniquesand lack of adult supervision. Close adult supervision by appropriately qualified staff (see Role of the fitnessprofessional, page 13) is therefore essential when free weights are used by children and/or young adolescents.

Some resistance training equipment specifically designed for use by children may be recommended. Centres that offerphysical activity classes for children and young adolescents using resistance weight training or electronic cardiovascularequipment should ensure that all equipment can accommodate the physiological and biomechanical differencesbetween children, adolescents and adults.

12 Kids in gyms

Pre-exercise screening and consent procedures Parents or guardians of children or adolescents under the age of 16 years must complete a pre-exercise questionnaireif their children want to participate in a centre’s physical activity program. (Clause 24 of the NSW Fitness Industry Codeof Practice indicates that it is compulsory for all consumers who participate in any physical activity program within acentre to complete a pre-exercise screening questionnaire.) All questionnaires completed by parents or guardians onbehalf of children and young adolescents must be assessed by a qualified fitness professional (see Role of the fitnessprofessional, page 13) before any type of physical activity program begins at the centre.

The pre-exercise screening questionnaire for children and adolescents under the age of 16 years must include:

emergency contact details

medical/health history — if any serious risk factors are identified there must be provision for a medical practitionerto authorise further participation in the relevant activity

physical activity history — listing type of activity, frequency and intensity

a disclaimer

a parent or guardian signature giving authorisation and consent

a countersignature by the fitness professional or centre official indicating approval.

Attachment two is an example of an Exercise and Physical Activity Readiness Assessment (ExPARA) questionnairedeveloped by the Children’s Hospital Institute of Sports Medicine (CHISM) in association with Fitness NSW.

PrivacyIn December 2001, the National Privacy Act 2001 was introduced in Australia. Under the act, centres are included inthe definition of a ‘health service provider’. In respect of health service providers and through its 10 national privacyprinciples, the legislation promotes greater openness between health service providers and consumers regarding thecollection, handling and storage of health information.

This includes a general right of access for consumers to their own health records. The act requires health serviceproviders to have documentation available that clearly sets out their policies for the management of personalinformation. All centres and outsourced contractors must conform to these national privacy principles.

Age of entry and centre membershipThe ages at which children and young adolescents may enter or become members of centres will depend on the typeof classes or programs available at each centre. Classes or programs are divided into the following categories:

non-weights-based group fitness classes and use of cardiovascular equipment

weights-based group fitness classes

unsupervised resistance training

other structured or supervised programs.

13Kids in gyms

Non-weights-based group fitness classes and use of cardiovascular equipment

For the purposes of centre membership and the use of centre facilities and services as a centre member, it isrecommended that the minimum age of entry to centres be 14 years of age for participation in general non-weights-based group fitness exercise classes, including water-based activities and use of cardiovascular equipment. A pre-exercise screen should be assessed by a qualified member of staff (see Role of the fitness professional, page 13)before the individual concerned begins any exercise program.

Weights-based group fitness classes

For the purposes of centre membership and the use of centre facilities and services as a centre member, it isrecommended that the minimum age of entry be 16 years of age for participation in weights-based group fitnessclasses, including weights-based circuit classes and classes that incorporate boxing type exercises. A pre-exercisescreen should be assessed by a qualified member of staff (see Role of the fitness professional, page 13) before theindividual concerned begins any exercise program.

Unsupervised resistance training

For the purposes of centre membership and the use of centre facilities and services as a centre member, it isrecommended that the minimum age of entry be 16 years of age for participation in unsupervised resistance training.An unsupervised resistance training program should only occur after a pre-exercise screen has been assessed by aqualified member of staff (see Role of the fitness professional, page 13), and an initial resistance training program hasbeen developed and supervised by a suitably qualified member of staff.

Where a centre staff member is placed in a position of one-on-one supervision, or supervises a group fitness classbehind closed doors with children or young adolescents, that person is subject to all laws and requirements under theChild Protection (Prohibited Employment) Act 1998 (NSW) and the Child Protection (Offenders Registration) Act2000 (NSW).

Other structured or supervised programs

For participation in other structured or supervised physical activity programs by groups such as those of schools, sportsteams, swim classes or junior elite athlete training squads, or other special physical activity programs conducted by acentre and instructed by qualified centre staff or other outsourced qualified fitness professionals (see Role of thefitness professional, page 13), the minimum age of entry to a centre should be at the discretion of the centre. Allchildren and young adolescents under the age of 18 years and participating in other structured or supervised programs(including all school groups) should have a pre-exercise screen assessed by a qualified member of staff beforebeginning the exercise program.

Restrictions that apply to the minimum age of entry to a centre when a person wishes to participate in other structuredor supervised physical activity programs may be influenced by such factors as:

staff qualifications and availability

the type and range of physical activity programs that can be offered (such as programs for sporting teams, juniorathlete squads, school groups, water-based activities and swim classes)

space and equipment availability.

Centres must clearly define and display the minimum age of entry for children. Once the minimum age of entryrequirement has been defined, the centre must follow these limits strictly for legal liability reasons.

14 Kids in gyms

Membership contracts

Normally, it is recommended that parents or guardians sign centre membership contracts entered into by children oryoung adolescents under the age of 18 years. However, centres may, at their discretion, sign a membership contractdirectly with an adolescent between 16 and 18 years old. Membership contracts entered into by a child or youngadolescent under the age of 16 years must be signed by a parent or guardian.

Casual use of facilities by children and young adolescents

No children or adolescents under the age of 14 years should be admitted into a centre unless they are part of ascheduled program or are participants in:

a sporting team

a junior athletic squad

a school group

a special physical activity program conducted by the centre

a water-based or swim class

other supervised or structured activities.

See Table 1 in Attachment three for a summary of this information.

Staff supervision ratioStaff to child/adolescent ratios will depend on the type of classes or programs available at each centre and whethercentres provide structured programs for outside groups (see Casual use of facilities by children and young adolescents,above). In such cases, staff supervision is categorised as either:

supervised or structured group fitness classes or

supervised or structured resistance training programs.

Supervised or structured group fitness classes

For supervised or structured group fitness classes, including weights-based group fitness and circuit weight trainingclasses, it is recommended that the staff to child/adolescent ratio is no more than one centre staff member to 25students (1:25).

Where supervised or structured group fitness classes are conducted for school-aged groups, a teacher from the schoolmust also be present at all times during the class. The staff to child/adolescent ratio may exceed 1:25 on the provisothat, for each increment of between 1 and 25 school students over the initial class size of 25 students, there is anadditional supervising teacher present.

15Kids in gyms

Supervised or structured resistance training programs

For supervised or structured resistance training programs, it is recommended that the staff to child/adolescent ratio notexceed 1:8. Where supervised or structured resistance training is being supervised as part of a school group’s activities,a teacher from the school must also be present at all times during the training program.

During supervised or structured physical activity programs for school-aged groups, the role of the fitness professional isto conduct safe exercise programs and the role of the teacher is to maintain general class discipline and control. SeeTable 2 in Attachment three for a summary of this information.

InsuranceWhere a centre is to conduct physical activity programs for children or young adolescents, it must have an insurancepackage that provides coverage for this special population. Major considerations should be the level of the centre’spublic liability and professional indemnity insurance cover.

Children and young adolescents who attend a centre as part of a school-based organised activity are covered underthe Supplementary Sporting Injuries Benefits Scheme (1984) on the proviso that there is a teacher present at all timesduring the physical activity session. This scheme covers accidents or injuries that occur during any official schoolsporting activity or Department of Tourism, Sport and Recreation organised program. This cover includes transportationto and from the centre.

It is recommended that all centres confirm in writing with their respective insurance companies that their public liabilityand professional indemnity insurance includes cover for physical activity programs for children and young adolescents.

Role of the fitness professionalFitness professionals who are responsible for conducting physical activity programs for children and young adolescents must:

obtain the skills and qualifications necessary to lead children’s physical activity programs (see below)

hold current cardiopulmonary resuscitation (CPR) and first aid qualifications

have had a Working with Children check

have appropriate insurance.

Staff requirements

Fitness professionals providing a fitness service for children and young adolescents under the age of 16 years in acentre are required to meet the minimum requirements of the NSW fitness industry. These include all of the following:

a current Fitness Australia registration

a current CPR and first aid certificate

successful completion of a relevant Fitness NSW/Fitness Australia-approved course or Unit of Competence atCertificate IV level or its equivalent, and specialising in the area of exercise prescription for special populations —children and young adolescents.

16 Kids in gyms

Outsourced contractor organisations

Outsourced contractor organisations that conduct physical activity programs for children and young adolescents incentres should conform to all aspects of these guidelines, particularly in relation to:

insurance

pre-exercise screening and consent procedures

staff supervision

staff qualifications

the National Privacy Act

their duty of care, including child protection legislation

knowledge of the centre’s risk management policy and plan.

17Kids in gyms

Published documentsAmerican Academy of Pediatrics (1990) Strength training, weight and power lifting, and body building by children andadolescents. Pediatrics 86(5): 801–03.

American College of Sports Medicine (1995) ASCM’s Guidelines for Exercise Testing and Prescription (5th edn).Baltimore: Williams and Wilkins.

American College of Sports Medicine (1997) Exercise prescription: recommendations for children. Certified News 7(1): 1–6.

American College of Sports Medicine (1998) Joint statement: recommendations for cardiovascular screening, staffing,and emergency policies at health/fitness facilities. Medicine Science in Sports & Exercise 30(6): 1009–1018.

Australian Sports Commission (1998) Codes of Behaviour. Canberra: Australian Sports Commission.

Australian Sports Medicine Federation (1990) Guidelines for Safety in Children’s Sport-Gymnastics. Canberra: Australian Sports Medicine Federation.

Australian Sports Medicine Federation (1990) Guidelines for Safety in Children’s Sport-Weight Training. Canberra: Australian Sports Medicine Federation.

Bar-Or O. (1994) Childhood and adolescent physical activity and fitness and adult risk profile. Chapter 63 in BouchardC. (Ed) Physical Activity, Fitness and Health. Springfield, Il: Human Kinetics.

Bauman A, Bellew B, Vita P, Brown W, Owen N. (2002) Getting Australia Active. Melbourne: National Public Health Partnership.

Bauman A, Wright C, Brown W, Abernathy P, Atkinson R, Bull F, Naughton G, Oldenberg B, Purtell J, Shilton T. (2000)National Heart Foundation Physical Activity Policy. Canberra: National Heart Foundation.

Blimkie CJR. (1993) Resistance training during preadolescence: issues and controversies. Sports Medicine 5(6): 389–407.

Blimkie CJR. (1993) Benefits and risks of resistance training in children. In Cahill, B and Pearl, A (1993) (eds),Intensive Participation in Children’s Sport. Champaign, Illinios: Human Kinetics.

Booth ML, Macaskill P, McLellan L, Phongsavan P, Oately T, Patterson J, Wright J, Bauman A, Baur L. (1997)NSW Schools Fitness and Physical Activity Survey. Sydney: NSW Department of Education and Training.

Booth ML, Chey T, Wake M, Norton K, Hesketh K, Dollman J, Robertson I. (2003) Change in the prevalence ofoverweight and obesity among young Australians, 1969–1997 American Journal of Clinical Nutrition 77: 29-36.

Commission for Children and Young People (2000) Working With Children Check - Guidelines for Employers Sydney:Commission for Children and Young People.

Cavill N, Biddle S, Sallis J. (2001) Consensus statement: health enhancing physical activity for young people: statementof the United Kingdom expert consensus conference. Pediatric Exercise Science 13: 12–25.

Egger G, Donovan R, Corti B, Bush F, Swinburn B. (1999) National Physical Activity Guidelines: Scientific BackgroundReport. Canberra: Commonwealth Department of Health Population Studies Group.

Faigenbaum AD, Kraemer WJ, Cahill B, Chandler J, Dziados J, Elfrink L, Forman E, Gaudiose M, Michelli L, Nitka M,Roberts S. (1996) Youth resistance training: position statement paper and literature review. Strength and Conditioning 10(2): 109–14.

Selected references

18 Kids in gyms

Fitness NSW (2001) One-Million-Members-by-2010. An initiative for the growth of the NSW Fitness Industry. Sydney: Fitness NSW.

Health Education Authority (1998) Young and Active: Policy Framework for Young People and Health EnhancingActivity. London: Health Education Authority.

NSW Childhood Obesity Secretariat (2002) Childhood Obesity: Background Paper. Sydney: NSW Health Department.

NSW Department of Education and Training (1999) Guidelines for the Safe Conduct of Sport and Physical Activity inSchools. Sydney: NSW Department of Education and Training.

NSW Department of Fair Trading (1998) NSW Fitness Industry Code of Practice. Sydney: NSW Department of Fair Trading.

NSW Department of Sport and Recreation (2002) It’s Your Business: a Guide for Directors of Sport and RecreationOrganisations. Sydney: NSW Department of Sport and Recreation.

NSW Department of Sport and Recreation (2002) Child Protection: a Simple Guide for Sport and RecreationOrganisations. Sydney: NSW Department of Sport and Recreation.

NSW Health Department (2002) NSW Childhood Obesity Summit: Communique. Sydney: NSW Health Department.

NSW Physical Activity Taskforce (1998) Simply Active Every day: a Plan to Promote Physical Activity in NSW1998–2002. Sydney: NSW Health Department, Public Health Division.

New Zealand Sports Medicine Federation (1994) Guidelines for the Safe Use of Weights by Children and Adolescents.Dunedin: New Zealand Sports Medicine Federation.

O’Connor HT, Eden BD. (2000) (eds) Recommendations for nutrition and physical activity for Australian children.Medical Journal of Australia 173(7): S1–S16.

Parker RJ, Elliott E, Georga A, Booth ML. (2003) Charter of physical activity and sport for children and youth Australiaand New Zealand Journal of Public Health (accepted for publication).

Sallis, JF, and Patrick, K. (1994) Physical activity guidelines for adolescence: consensus statement. Pediatric Exercise Science 6: 302–14.

Sports Medicine Australia (1997) Safety Guidelines for Children in Sport and Recreation. Canberra: Sports MedicineAustralia.

Shilton T, Naughton G. (2001) Physical Activity and Children: a Statement of Importance and Call to Action from theHeart Foundation. Canberra: National Heart Foundation of Australia.

Suter and Associates Leisure and Tourism Planners (2000) Physical Activity Guidelines for Local Councils: PreliminaryDraft Guidelines. Canberra: Local Government Association.

Twisk JWR. (2001) Physical activity guidelines for children and adolescents: a critical review. Sports Medicine 31(8): 617–27.

United States Department of Health and Human Services (1996) Physical Activity and Health: a Report of the SurgeonGeneral. Atlanta, GA: US Department of Health and Human Services, Centre for Disease Control and Prevention,National Centre for Chronic Disease Prevention and Health Promotion.

19Kids in gyms

WebsitesChildren’s Hospital Institute of Sports Medicine (CHISM)www.chism.chw.edu.au

Fitness NSWwww.fitnessnsw.com.au

NSW Commission for Children and Young Peoplewww.kids.nsw.gov.au/check

NSW Department of Tourism, Sport and Recreationwww.dsr.nsw.gov.au

Play by the Rules (a South Australian government initiative)www.playbytherules.net.au

The Office of the Federal Privacy Commissionerwww.privacy.gov.au

20 Kids in gyms

Working with Children check requirements(Commission for Children and Young People 2000)

All centres and child-related employees (paid, unpaid and volunteers) must meet the relevant requirements of theWorking with Children check. The Working with Children check Guidelines for Employers are available on theCommission for Children and Young People’s website at www.kids.nsw.gov.au/check or on NSW Sport and Recreation’swebsite at www.dsr.nsw.gov.au.

The following is a brief summary of the requirements of the Working with Children check. Centres are encouraged toread the guidelines when establishing their responsibilities.

1. It is an offence under the Child Protection (Prohibited Employment) Act 1998 for a person who has been convictedof a serious sex offence or a registrable offence under the Child Protection (Offenders Registration) Act 2000, to applyfor, undertake or remain in child-related employment. It is also an offence for a centre or employer to employ a personwithout first asking him or her to declare whether or not they are a prohibited person. Making a false declaration is alsoan offence.

All existing employees and preferred applicants for paid and unpaid employment (including volunteers) who are workingin or seeking child-related employment must sign a prohibited employment declaration to declare their status. Thisrequirement includes employees and volunteers from interstate while they are involved in child-related employment inNew South Wales. Centres must securely file declarations.

If an applicant discloses that he or she is a prohibited person, that person cannot be employed in child-relatedemployment. If an existing employee discloses that she or he is a prohibited person, that person must be removed fromchild-related employment. Centres are encouraged to find alternative employment for these people where possible.

2. It is mandatory for preferred applicants for paid child-related employment to have background checks conducted onthem before they commence employment. These background checks, or employment screening, include checkingrelevant criminal records, and records of apprehended violence orders and disciplinary proceedings. The checks areconducted through the Working with Children check. This process involves:

the centre registering with NSW Sport and Recreation to obtain an employer ID number by completing aregistration form

the preferred applicant signing a Working with Children check consent form to enable the screening process.Preferred applicants’ records cannot be checked without their consent. Centres must retain signed consent formsand file them securely.

the centre completing the Working with Children check request form and forwarding this to NSW Sport andRecreation, the approved screening agency for fitness and leisure centres in NSW

the centre informing the Commission for Children and Young People if it decides not to employ someone as aresult of the findings of the Working with Children check by completing a standard form available on thecommission’s website.

Note: All Working with Children Check forms are available on the websites of the Commission for Children and YoungPeople at www.kids.nsw.gov.au/check and NSW Department of Tourism, Sport and Recreation at www.dsr.nsw.gov.au.

3. The centre must undertake probity checks (for example, by contacting referees) for all applicants. The Working withChildren check Guidelines for Employers provide information which will assist organisations conducting referee checks.

Attachment oneAttachment oneAttachment one

21Kids in gyms

Exercise and Physical Activity Readiness Assessment of Children andYoung Adolescents (ExPARA)*

Important information for parents/guardians

The purpose of this form is to ensure we provide every child and/or adolescent with the highest level of care.

For most children, physical activity provides an opportunity for children and adolescents to have fun and promotes thebasis for good health and an enhanced quality of life for the future.

However, there are a small number of children or adolescents who may be at risk when participating in anexercise/physical activity program. We ask therefore that you read and complete this questionnaire carefully and return itto the appropriate staff member in charge. The information contained in this form is confidential and is subject to thelaws and regulations contained in the privacy laws enacted in December 2001.

Personal details

Name: DOB: M/F:

Height (cm): Weight (kg): BMI:

How old was your child as at 1 January this year?

Name/s of parent/s or guardian/s:

Home Address:

Private home contact ph: Work ph: Mobile:

Has a GP or specialist referred your child?

Doctor’s name: Contact ph:

If there is an emergency, specify the person who should be contacted and their emergency phone number:

Name: Contact ph:

After hours emergency contact ph:

PPlleeaassee nnoottee:: In case of a medical emergency, an ambulance may be used to transport your child to the nearest medicaltreatment service.

Attachment two

22 Kids in gyms

Heart-Lung-Other systems

1. Does your child have, or has your child had:

a heart condition (please specify)

Cystic Fibrosis

Diabetes (Type I or Type II — please specify)

High blood pressure (specify when last taken)

High cholesterol

Unexplained coughing during or after exercise

Breathing problems or shortness of breath (for example, asthma, emphysema)

2. Does your child experience or has your child ever experienced:

epilepsy or seizures/convulsions

If yes, is it at rest or during exercise?

fainting

dizzy spells

heat stroke/heat-related illness

increased bleeding tendency/haemophilia

other (please specify)

3. Does your child have, or has your child had, an eating disorder?

Yes No

4. Does your child take any medications for (please name):

heart problem epilepsy

diabetes Attention Deficit Disorder (ADD)

asthma, breathing problems allergies

blood pressure

other (please specify)

4.1 If your child is taking any medication, please state if there are any side effects experienced as a result of taking thismedication:

23Kids in gyms

Muscle-Bone system1. In the last six months, has your child had any muscular pain while exercising?

Yes No

If yes, please explain and indicate where the pain has occurred (eg. ‘pain in the back of the right heel’ or ‘pain on theinside of the right elbow’:

1.1 Has a doctor treated this pain?

Yes No

2. In the last six months, has your child experienced joint pain, or pain in the bones?

Yes No

If yes, please explain and indicate where the pain has occurred (eg. ‘front of right leg’ or ‘behind my knee bone’:

2.1 Has this joint pain, or pain in the bone been treated by a doctor?

Yes No

2.2 Has your child broken any bones or suffered injury to their bones in the last 12 months?

Yes No

If yes, please explain where and how the break/injury occurred.

Brain-Muscle system 1. Does your child have, or has your child had difficulty/problems with any of the following?

vision motor sensory skills

hearing poor balance/instability

speech/language sleep apnoea

2. Has your child ever experienced a brain or spinal injury?

Yes No

3. Does your child experience difficulty in the skill of:

climbing up stairs walking down stairs none of the above

24 Kids in gyms

Special conditions1. Does your child use a ‘puffer’ or ‘ventilator’ for asthma?

Yes No Not applicable

2. Does your child self-administer insulin for Diabetes?

Yes No Not applicable

3. Does your child have any chronic disability or chronic illness?

Yes No

If yes, please indicate the condition:

Cerebral Palsy Hypermobility

ADHD Obesity

Downs Syndrome Intellectual impairment

Other (please specify):

4. Is your child allergic to food, medications, pollens or other allergens or specific environments?

Yes No

If yes, please explain what causes have been identified with this/these allergy/ies:

5. Does your child follow a special diet?

Yes No

6. Has your child ever been diagnosed with a nutritional deficiency (such as non-iron deficiency)?

Yes No

If yes, please specify the nutritional deficiency :

25Kids in gyms

General health1. Has your child had surgery in the previous 12 months?

Yes No

2. Are you aware of any medical reason/condition which might prevent your child from participating in an exercise program?

Yes No

If yes, please explain:

3. What are your child’s favourite hobbies and interests?

Informed consentI hereby acknowledge that:

The information provided above regarding my child’s health is, to the best of my knowledge, correct.

I will inform you immediately if there are any changes to the information provided above.

I give permission for my child to commence your physical activity program.

Parent/Guardian signature: Date:

*The copyright on this questionnaire belongs to the Children’s Hospital Institute of Sports Medicine and the documentis reproduced with the Institute’s permission.

26 Kids in gyms

Administration only: Referral to Medical Practitioner

Child/adolescent has no risk factors >> cleared to participate in physical activity program

Child/adolescent has one or more Heart-Lung-Other risks >> refer to Medical Practitioner

Child/adolescent has one or more risks from Muscle-Bone >> Possibly refer to a Medical Practitionerand/or Brain-Muscle systems or Special conditions and or appropriate allied health professional**General health sections.

**Name and title of allied health professional child/adolescent is referred to:

Signatures

Parent/Guardian: Fitness professional:

Date: Date:

27Kids in gyms

Summary of eligibility requirements and staff:child/adolescent ratios

Table 1 Eligibility requirements by age

AAggee ooff cchhiilldd//yyoouunngg aaddoolleesscceenntt EElliiggiibbiilliittyy rreeqquuiirreemmeennttss

1166––1177 yyeeaarrss Eligible for centre membership

Normally parent/guardian signature on membership contract required butmay be left to discretion of centre

Must complete pre-exercise screen questionnaire prior to commencement ofany program

Parent/guardian signature on questionnaire left to discretion of centre

Can use centre facilities as casual member (where appropriate)

Eligible to participate in:

– non-weights-based group fitness classes– water-based classes– weights-based group fitness classes (including circuits and boxing

type exercises)Eligible to participate in unsupervised resistance training on provisos that:

– pre-exercise screen has been assessed by qualified staff member– an initial resistance training program has been written and is to be

supervised by a qualified member of staff.Eligible to use cardiovascular equipment unsupervised

1144––1155 yyeeaarrss Eligible for centre membership

Parent/guardian must sign membership contract


Parent/guardian must sign questionnaire on behalf of young adolescent

Can use centre facilities as casual member (where appropriate) withoutparent/guardian supervision

Eligible to participate in:

– non-weights-based group fitness classes– water-based classesEligible to use cardiovascular equipment unsupervised

May participate in structured or supervised group activities determined atdiscretion of centre

Not eligible to participate in unsupervised resistance training or weights-based group fitness classes (including circuits and boxing type exercises)

Attachment three

1122––1133 yyeeaarrss Not eligible for centre membership

Must complete pre-exercise screen questionnaire prior to commencement of any program

Parent/guardian must sign questionnaire on behalf of child/youngadolescent



Not eligible to use cardiovascular equipment unsupervised

UUnnddeerr 1122 yyeeaarrss Not eligible for centre membership


Parent/guardian must sign questionnaire on behalf of child/youngadolescent



Not eligible to use cardiovascular equipment unsupervised

Table 2 Recommended staff/child ratios for structured or supervised programs conducted in centres

SSttaaffff//cchhiilldd rraattiioo SSttrruuccttuurreedd//ssuuppeerrvviisseedd pprrooggrraammss

1:25*† Conducting structured or supervised group fitness classes (including non-weights-based and weights-based group fitness classes and circuit weight training classes).

1:8* Conducting supervised or structured resistance training.

*For school groups, a teacher must be present at all times in addition to the instructor.

†Ratio may exceed 1:25 on proviso that foreach increment of between 1 and 25students, there must be one (1) additionalclass teacher present.

28 Kids in gyms

* Did you know that if you’re between 12 and 18 years old, you need to be doing at least 60 minutes of moderate to vigorous physical activity every day to keep healthy?

* And you shouldn’t spend more than two hours a day surfing the net, watching TV or playing video games? (Unless of course it’s educational!)

Walking, skateboarding, playing sport and heaps of other activities are not only good for you, they give you a chance to spend time with friends and make new ones.

So get active, enjoy life and have fun!

Great reasons to be activeBeing active is good for you in so many ways. It can provide a huge range of fun experiences, make you feel good, improve your health, and is a great way to relax and enjoy the company of your friends.

Some of the benefits of being active include:

* It’s a great way to have fun with friends and make new ones.

* It’s an opportunity for new skills and challenges.

* It can boost your confidence.

* It can improve your fitness.

* It can make your bones and muscles stronger.

* It can improve your posture.

* It can help you maintain a healthy weight.

* It improves the health of your heart.

* It can help you relax.

* It reduces stress.

* It can help you maintain healthy growth and development.

How much?You need to do at least 60 minutes of physical activity every day. But don’t stress, you can build this up throughout the day with a variety of activities. And remember, you can always do more if you want to!

How hard?It’s not hard! Your physical activity should be done at a moderate to vigorous intensity. There are heaps of fun ways to do it.

* Moderate activities like brisk walking, bike riding with friends, skateboarding and dancing.

* Vigorous activities such as football, netball, soccer, running, swimming laps or training for sport.

Vigorous activities are those that make you “huff and puff”. For additional health benefits, try to include 20 minutes or more of vigorous activity three to four days a week.

What is the best activity to do?Any physical activity is good for you. Try to be active in as many ways as you can. Variety is important in providing a range of fun experiences and challenges and gives you an opportunity to learn new skills.

There are easy things you can do out of habit that will be good for you. For example, you can walk the dog and replace short car trips with a walk or a bike ride.

Physical activity can be part of:

* games

* sports

* having fun with friends

* getting to places (walking, cycling and skateboarding)

* dancing

* school or family activities.

Get out and get active.AUSTRALIA’S PHYSICAL ACTIVITY

RECOMMENDATIONS FOR 12-18 YEAR OLDS.

What about TV and computer games?Watching TV, videos or DVDs, surfing the net and playing computer games can occupy a lot of your spare time. And while these may be fun, they usually involve sitting still for long periods.

Research has shown that watching TV for more than two hours a day when you are young is associated with being overweight, having poor fitness, smoking and raised cholesterol in adulthood.

So try to limit the amount of time you spend watching TV, videos or DVDs, surfing the net or playing computer games during your leisure time (homework doesn’t count, sorry...), especially during the day, and on weekends, when you could be out doing something fun and active!

What if I’m not very active?If you are not currently doing much physical activity, try and build up to 30 minutes a day with moderate activity such as walking or bike riding. Then steadily increase the time spent being active until you reach the goal of one hour or more each day.

Here are some ideas for getting active

* Choose a range of activities you like or think you might like to try.

* Be active with your friends. You are more likely to keep active if it’s fun and you have people to enjoy it with.

* Walk more: to school, to visit friends, to shops, or other places in your neighbourhood.

* Try to limit time spent watching TV, videos or DVDs, surfing the net or playing computer games, especially during the day and on weekends.

* Take your dog or a neighbour’s dog for a walk.

* Try new challenges – skate, ride, surf, cycle or snorkel.

* Be active with family members – in the yard and on family outings.

* Encourage and support younger brothers and sisters to be active.

* Try a new sport or go back to one you have played before.

* Take a class to learn a new skill such as yoga, kick boxing, dancing or diving.

* Check out the activities at your local recreation centre, clubs or youth centre.

* Put on some music and dance.

And remember to always take precautions to avoid injury.

Get a boost by combining activity with healthy eatingHealthy eating goes hand-in-hand with being active.

As a teenager, you are growing at a rapid rate. An eating pattern that contains a healthy variety of foods such as vegetables (including legumes i.e. peas, beans and lentils), fruit and cereals, and is low in fat, salt and sugar, will help you to be at your healthy best.

A healthy diet will make sure you have the energy, strength and good health to try new active challenges. If you combine healthy eating and physical activity, it will also help you maintain a healthy weight.

For more information www.healthyactive.gov.au

Other resources that you may find useful include:

Everyone wants to be more active. The problem is getting Started.

National Physical Activity Guidelines for Adults

Food for Health, Australian Dietary Guidelines for Adults, Children and Adolescents

Australian Guide to Healthy Eating

Each of these can be obtained by calling 1800 020 103 and asking for the PHD publications request line.

GET HEALTHY. GET ACTIVE.Building a healthy, active Australia.

© Commonwealth of Australia, December 2004.

Department of Health and Ageing (2004), Australia’s Physical Activity

Recommendations for 12-18 year olds, Canberra.

Active kids are healthy

kids.AUSTRALIA’S PHYSICAL ACTIVITY


Active and healthy.Kids love to be active. Making physical activity a part of their daily routine is not only fun, but also healthy.

Physical activity is important for healthy growth and development. It is also a great way for kids to make friends and learn physical and social skills.

Encouraging kids to be active when they are young also establishes a routine that could stay with them throughout their life.

If you are a parent or carer of a young child, the two points to remember are:

* Children need at least 60 minutes (and up to several hours) of moderate to vigorous physical activity every day.

* Children should not spend more than two hours a day using electronic media for entertainment (e.g. computer games,TV, Internet), particularly during daylight hours.

Why is physical activity important?Children between 5 and 12 years of age greatly benefit from being physically active. It can:

* Promote healthy growth and development.

* Build strong bones and muscles.

* Improve balance and develop skills.

* Maintain and develop flexibility.

* Help achieve and maintain a healthy weight.

* Improve cardiovascular fitness.

* Help relaxation.

* Improve posture.

* Provide opportunities to make friends.

* Improve self-esteem.

How much is enough?Kids need to do a minimum of 60 minutes of physical activity every day. But remember, more is better – even up to several hours! This can be built up throughout the day with a combination of moderate to vigorous activities.

What type of activity is recommended?A combination of moderate and vigorous activities is recommended.

A moderate activity will be about equal in intensity to a brisk walk, and could include a whole range of activities such as a bike ride or any sort of active play.

More vigorous activities will make kids “huff and puff” and include organised sports such as football and netball, as well as activities such as ballet, running and swimming laps. Children typically accumulate activity in intermittent bursts ranging from a few seconds to several minutes, so any sort of active play will usually include some vigorous activity.

Most importantly, kids need the opportunity to participate in a variety of activities that are fun and suit their interests, skills and abilities. Variety will also offer your child a range of health benefits, experiences and challenges.

Remember, any activity that sees your child expend energy is good!

What about skill learning?Kids gain valuable experience and can learn skills such as running, throwing, jumping, catching and kicking, by participating in a variety of physical activities. Active play and informal games, as well as organised sport, provide opportunities to develop these skills, which help to build their confidence and gives them more options to take part in a wide range of activities as they get older.

Cycling and walking on neighbourhood streets and paths also provide kids with skills that make them more street-smart and aware of their surroundings. Swimming is another activity that is not only healthy, but will teach kids about safety when they are at the beach or the pool.

What about TV and computer games?Television viewing of more than two hours a day in childhood and adolescence is associated with poor fitness, smoking, raised cholesterol and being overweight in adulthood.

If they get the chance, kids may often choose surfing the net, watching TV and playing computer games over other activities. And while these activities can be educational they involve sitting still, often for long periods of time.

Ideally, your child shouldn’t spend more than two hours a day doing these things, particularly at times when they could be enjoying more active pursuits.

Pre-schoolers should be encouraged to take part in active play and their exposure to TV and video limited.

What about inactive children?Kids who are inactive need to be encouraged. Perhaps organised sport is not their thing. That’s fine. Talk to them and find out what is and see if there is something you can do together.

If your child is just starting to get active, begin with moderate intensity activity - say 30 minutes a day - and steadily increase.

What about pre-school children?Physical activity is important for all children, and infants and toddlers should be given plenty of opportunity to move throughout the day. Children should not be inactive for prolonged periods, except when they’re asleep!

Daily movement helps to develop a child’s sensory and motor systems. It helps them gain an understanding of the surrounding world and become confident moving within it.

In a space that is safe and hazard-free, let infants spend time lying on their front, back and sides; let them roll over, creep and crawl. And give pre-school children plenty of chances to enjoy active play.

Try to limit the time your child is inactive and encourage their natural instinct to move.

Take time to have fun playing with your child and enjoy watching them develop.

How can I help?We can all play a vital role in supporting and encouraging kids to be active and healthy.

By offering kids a range of physical activities, you can help them develop an active approach to life that may stay with them for the rest of their lives.

And don’t forget that along with plenty of activity, children also need good foods for healthy growth and development. Children need the goodness that comes from eating a wide variety of nutritious foods as outlined in the Dietary Guidelines for Children and Adolescents in Australia and the Australian Guide to Healthy Eating.

What can I do now?

* Be a role model - be active when you’re with children.

* Include physical activity in family outings.

* Support active play, recreation and participation in sport.

* Encourage and support walking and cycling to school.

* Think of active alternatives when you hear “I’m bored”.

* Be prepared – have a box at home and in the car with balls, a frisbee or a kite etc, and you will be always ready for action.

* Encourage children to replace time spent surfing the net, watching TV and playing computer games with more active pursuits.

* Negotiate a limit on time spent surfing the net, watching TV and playing computer games.

* Work with your child’s school to increase physical activity opportunities.

* Work with Local Government to support walking, cycling and physical activity in your neighbourhood and community.

* Walk and talk – practice spelling, multiplication or other homework with your child while walking.

* Give gifts or toys that promote physical activity such as bats, balls, skipping ropes, skates or bikes.

Adapted from Shilton TR & Naughton G. “Children and physical activity. A statement of importance and call to action.” National Heart Foundation of Australia, April 2001.

For more informationwww.healthyactive.gov.au


Everyone wants to be more active. The problem is getting started.

Australia’s Physical Activity Recommendations for 12-18 year olds







Department of Health and Ageing (2004) Australia’s Physical Activity


* Did you know that if you’re between 12 and 18 years old, you need to be doing at least 60 minutes of moderate to vigorous physical activity every day to keep healthy?

* And you shouldn’t spend more than two hours a day surfing the net, watching TV or playing video games? (Unless of course it’s educational!)

Walking, skateboarding, playing sport and heaps of other activities are not only good for you, they give you a chance to spend time with friends and make new ones.

So get active, enjoy life and have fun!

Great reasons to be activeBeing active is good for you in so many ways. It can provide a huge range of fun experiences, make you feel good, improve your health, and is a great way to relax and enjoy the company of your friends.

Some of the benefits of being active include:

* It’s a great way to have fun with friends and make new ones.

* It’s an opportunity for new skills and challenges.

* It can boost your confidence.

* It can improve your fitness.

* It can make your bones and muscles stronger.

* It can improve your posture.

* It can help you maintain a healthy weight.

* It improves the health of your heart.

* It can help you relax.

* It reduces stress.

* It can help you maintain healthy growth and development.

How much?You need to do at least 60 minutes of physical activity every day. But don’t stress, you can build this up throughout the day with a variety of activities. And remember, you can always do more if you want to!

How hard?It’s not hard! Your physical activity should be done at a moderate to vigorous intensity. There are heaps of fun ways to do it.

* Moderate activities like brisk walking, bike riding with friends, skateboarding and dancing.

* Vigorous activities such as football, netball, soccer, running, swimming laps or training for sport.

Vigorous activities are those that make you “huff and puff”. For additional health benefits, try to include 20 minutes or more of vigorous activity three to four days a week.

What is the best activity to do?Any physical activity is good for you. Try to be active in as many ways as you can. Variety is important in providing a range of fun experiences and challenges and gives you an opportunity to learn new skills.

There are easy things you can do out of habit that will be good for you. For example, you can walk the dog and replace short car trips with a walk or a bike ride.

Physical activity can be part of:

* games

* sports

* having fun with friends

* getting to places (walking, cycling and skateboarding)

* dancing

* school or family activities.

Get out and get active.AUSTRALIA’S PHYSICAL ACTIVITY


What about TV and computer games?Watching TV, videos or DVDs, surfing the net and playing computer games can occupy a lot of your spare time. And while these may be fun, they usually involve sitting still for long periods.

Research has shown that watching TV for more than two hours a day when you are young is associated with being overweight, having poor fitness, smoking and raised cholesterol in adulthood.

So try to limit the amount of time you spend watching TV, videos or DVDs, surfing the net or playing computer games during your leisure time (homework doesn’t count, sorry...), especially during the day, and on weekends, when you could be out doing something fun and active!

What if I’m not very active?If you are not currently doing much physical activity, try and build up to 30 minutes a day with moderate activity such as walking or bike riding. Then steadily increase the time spent being active until you reach the goal of one hour or more each day.

Here are some ideas for getting active

* Choose a range of activities you like or think you might like to try.

* Be active with your friends. You are more likely to keep active if it’s fun and you have people to enjoy it with.

* Walk more: to school, to visit friends, to shops, or other places in your neighbourhood.

* Try to limit time spent watching TV, videos or DVDs, surfing the net or playing computer games, especially during the day and on weekends.

* Take your dog or a neighbour’s dog for a walk.

* Try new challenges – skate, ride, surf, cycle or snorkel.

* Be active with family members – in the yard and on family outings.

* Encourage and support younger brothers and sisters to be active.

* Try a new sport or go back to one you have played before.

* Take a class to learn a new skill such as yoga, kick boxing, dancing or diving.

* Check out the activities at your local recreation centre, clubs or youth centre.

* Put on some music and dance.

And remember to always take precautions to avoid injury.

Get a boost by combining activity with healthy eatingHealthy eating goes hand-in-hand with being active.

As a teenager, you are growing at a rapid rate. An eating pattern that contains a healthy variety of foods such as vegetables (including legumes i.e. peas, beans and lentils), fruit and cereals, and is low in fat, salt and sugar, will help you to be at your healthy best.

A healthy diet will make sure you have the energy, strength and good health to try new active challenges. If you combine healthy eating and physical activity, it will also help you maintain a healthy weight.

For more information www.healthyactive.gov.au


Everyone wants to be more active. The problem is getting Started.







Department of Health and Ageing (2004), Australia’s Physical Activity


Active kids are healthy

kids.AUSTRALIA’S PHYSICAL ACTIVITY


Active and healthy.Kids love to be active. Making physical activity a part of their daily routine is not only fun, but also healthy.

Physical activity is important for healthy growth and development. It is also a great way for kids to make friends and learn physical and social skills.

Encouraging kids to be active when they are young also establishes a routine that could stay with them throughout their life.

If you are a parent or carer of a young child, the two points to remember are:

* Children need at least 60 minutes (and up to several hours) of moderate to vigorous physical activity every day.

* Children should not spend more than two hours a day using electronic media for entertainment (e.g. computer games,TV, Internet), particularly during daylight hours.

Why is physical activity important?Children between 5 and 12 years of age greatly benefit from being physically active. It can:

* Promote healthy growth and development.

* Build strong bones and muscles.

* Improve balance and develop skills.

* Maintain and develop flexibility.

* Help achieve and maintain a healthy weight.

* Improve cardiovascular fitness.

* Help relaxation.

* Improve posture.

* Provide opportunities to make friends.

* Improve self-esteem.

How much is enough?Kids need to do a minimum of 60 minutes of physical activity every day. But remember, more is better – even up to several hours! This can be built up throughout the day with a combination of moderate to vigorous activities.

What type of activity is recommended?A combination of moderate and vigorous activities is recommended.

A moderate activity will be about equal in intensity to a brisk walk, and could include a whole range of activities such as a bike ride or any sort of active play.

More vigorous activities will make kids “huff and puff” and include organised sports such as football and netball, as well as activities such as ballet, running and swimming laps. Children typically accumulate activity in intermittent bursts ranging from a few seconds to several minutes, so any sort of active play will usually include some vigorous activity.

Most importantly, kids need the opportunity to participate in a variety of activities that are fun and suit their interests, skills and abilities. Variety will also offer your child a range of health benefits, experiences and challenges.

Remember, any activity that sees your child expend energy is good!

What about skill learning?Kids gain valuable experience and can learn skills such as running, throwing, jumping, catching and kicking, by participating in a variety of physical activities. Active play and informal games, as well as organised sport, provide opportunities to develop these skills, which help to build their confidence and gives them more options to take part in a wide range of activities as they get older.

Cycling and walking on neighbourhood streets and paths also provide kids with skills that make them more street-smart and aware of their surroundings. Swimming is another activity that is not only healthy, but will teach kids about safety when they are at the beach or the pool.

What about TV and computer games?Television viewing of more than two hours a day in childhood and adolescence is associated with poor fitness, smoking, raised cholesterol and being overweight in adulthood.

If they get the chance, kids may often choose surfing the net, watching TV and playing computer games over other activities. And while these activities can be educational they involve sitting still, often for long periods of time.

Ideally, your child shouldn’t spend more than two hours a day doing these things, particularly at times when they could be enjoying more active pursuits.

Pre-schoolers should be encouraged to take part in active play and their exposure to TV and video limited.

What about inactive children?Kids who are inactive need to be encouraged. Perhaps organised sport is not their thing. That’s fine. Talk to them and find out what is and see if there is something you can do together.

If your child is just starting to get active, begin with moderate intensity activity - say 30 minutes a day - and steadily increase.

What about pre-school children?Physical activity is important for all children, and infants and toddlers should be given plenty of opportunity to move throughout the day. Children should not be inactive for prolonged periods, except when they’re asleep!

Daily movement helps to develop a child’s sensory and motor systems. It helps them gain an understanding of the surrounding world and become confident moving within it.

In a space that is safe and hazard-free, let infants spend time lying on their front, back and sides; let them roll over, creep and crawl. And give pre-school children plenty of chances to enjoy active play.

Try to limit the time your child is inactive and encourage their natural instinct to move.

Take time to have fun playing with your child and enjoy watching them develop.

How can I help?We can all play a vital role in supporting and encouraging kids to be active and healthy.

By offering kids a range of physical activities, you can help them develop an active approach to life that may stay with them for the rest of their lives.

And don’t forget that along with plenty of activity, children also need good foods for healthy growth and development. Children need the goodness that comes from eating a wide variety of nutritious foods as outlined in the Dietary Guidelines for Children and Adolescents in Australia and the Australian Guide to Healthy Eating.

What can I do now?

* Be a role model - be active when you’re with children.

* Include physical activity in family outings.

* Support active play, recreation and participation in sport.

* Encourage and support walking and cycling to school.

* Think of active alternatives when you hear “I’m bored”.

* Be prepared – have a box at home and in the car with balls, a frisbee or a kite etc, and you will be always ready for action.

* Encourage children to replace time spent surfing the net, watching TV and playing computer games with more active pursuits.

* Negotiate a limit on time spent surfing the net, watching TV and playing computer games.

* Work with your child’s school to increase physical activity opportunities.

* Work with Local Government to support walking, cycling and physical activity in your neighbourhood and community.

* Walk and talk – practice spelling, multiplication or other homework with your child while walking.

* Give gifts or toys that promote physical activity such as bats, balls, skipping ropes, skates or bikes.

Adapted from Shilton TR & Naughton G. “Children and physical activity. A statement of importance and call to action.” National Heart Foundation of Australia, April 2001.

For more informationwww.healthyactive.gov.au


Everyone wants to be more active. The problem is getting started.

Australia’s Physical Activity Recommendations for 12-18 year olds







Department of Health and Ageing (2004) Australia’s Physical Activity


VDH 10/99

Because the onset and progression of puberty are so variable, Tanner has proposed a scale,now uniformly accepted, to describe the onset and progression of pubertal changes (Fig. 9-24). Boys and girls are rated on a 5 point scale. Boys are rated for genital development andpubic hair growth, and girls are rated for breast development and pubic hair growth.

Pubic hair growth in females is staged as follows (Fig 9-24, B):

• Stage I (Preadolescent) - Vellos hair develops over the pubes in a manner not greater than that overthe anterior wall. There is no sexual hair.

• Stage II - Sparse, long, pigmented, downy hair, which is straight or only slightly curled, appears. Thesehairs are seen mainly along the labia. This stage is difficult to quantitate on black and whitephotographs, particularly when pictures are of fair-haired subjects.

• Stage III - Considerably darker, coarser, and curlier sexual hair appears. The hair has now spreadsparsely over the junction of the pubes.

• Stage IV - The hair distribution is adult in type but decreased in total quantity. There is no spread tothe medial surface of the thighs.

• Stage V - Hair is adult in quantity and type and appears to have an inverse triangle of the classicallyfeminine type. There is spread to the medial surface of the thighs but not above the base of theinverse triangle.

The stages in male pubic hair development are as follows (Fig. 9-24, B):

• Stage I (Preadolescent) - Vellos hair appears over the pubes with a degree of development similar tothat over the abdominal wall. There is no androgen-sensitive pubic hair.

• Stage II - There is sparse development of long pigmented downy hair, which is only slightly curled orstraight. The hair is seen chiefly at the base of penis. This stage may be difficult to evaluate on aphotograph, especially if the subject has fair hair.

• Stage III - The pubic hair is considerably darker, coarser, and curlier. The distribution is now spread over the junction of the pubes, and at this point thathair may be recognized easily on black and white photographs.

• Stage IV - The hair distribution is now adult in type but still is considerably less that seen in adults. There is no spread to the medial surface of the thighs.

• Stage V - Hair distribution is adult in quantity and type and is described in the inverse triangle. There can be spread to the medial surface of the thighs.

Vermont Department of Health

Health Screening Recommendations for Children & Adolescents

The Tanner Stages

IPreadolescentno sexual hair

IISparse, pigmented,

long, straight,mainly along labia

and atbase of penis

IIIDarker, coarser,

curlier

IVAdult, butdecreased

distribution

VAdult in quantity

and type withspread to medial

thighs

Fig. 9-24, B

Vermont Department of Health

Health Screening Recommendations for Children & Adolescents

In young women, the Tanner stages for breastdevelopment are as follows (Fig. 9-24, C):

• Stage I (Preadolescent) - Only the papilla is elevated abovethe level of the chest wall.

• Stage II - (Breast Budding) - Elevation of the breasts andpapillae may occur as small mounds along with someincreased diameter of the areolae.

• Stage III - The breasts and areolae continue to enlarge,although they show no separation of contour.

• Stage IV - The areolae and papillae elevate above the levelof the breasts and form secondary mounds with furtherdevelopment of the overall breast tissue.

• Stage V - Mature female breasts have developed. Thepapillae may extend slightly above the contour of thebreasts as the result of the recession of the aerolae.

The stages for male genitalia development are asfollows: (Fig. 9-24, A):

• Stage I (Preadolescent)- The testes, scrotal sac, and penishave a size and proportion similar to those seen in earlychildhood.

• Stage II - There is enlargement of the scrotum and testesand a change in the texture of the scrotal skin. The scrotalskin may also be reddened, a finding not obvious whenviewed on a black and white photograph.

• Stage III - Further growth of the penis has occurred, initiallyin length, although with some increase in circumference. There also is increased growth of the testes and scrotum.

• Stage IV - The penis is significantly enlarged in length and circumference, with further development of the glans penis. The testes and scrotumcontinue to enlarge, and there is distinct darkening of the scrotal skin. This is difficult to evaluate on a black-and-white photograph.

• Stage V - The genitalia are adult with regard to size and shape.

Source:Reprinted with permission from Feingold, David. “Pediatric Endocrinology” In Atlas of Pediatric Physical Diagnosis, Second Edition, Philadelphia. W.B. Saunders,1992, 9.16-19

VDH 10/99

IPreadolescent

IIBreast budding

IIIContinued Enlargement

IVAreola and papillaform secondary mound

VMature female breasts

IPreadolescent

IIEnlargement,change in texture

IIIGrowth in length andcircumference

IVFurther development ofglans penis, darkeningof scrotal skin

VAdult genitalia

Fig. 9-24, AFig. 9-24, C


Imagedescrip

Body Mass Index (BMI)

Body mass index (BMI) is used to estimate your total amount of body fat. It is calculated bydividing your weight in kilograms by your height in metres squared (m2).

Differences in BMI between people of the same age and sex are usually due to body fat. Howeverthere are exceptions to this rule, which means a BMI figure may not be accurate.

BMI calculations will overestimate the amount of body fat for:

• Body builders• Some high performance athletes• Pregnant women.

BMI calculations will underestimate the amount of body fat for:

• The elderly• People with a physical disability who are unable to walk and may have muscle wasting.

BMI is also not an accurate indicator for people with eating disorders like anorexia nervosa orpeople with extreme obesity.

BMI is not the best measure of weight and health risk. A person’s waist circumference is a betterpredictor of health risk than BMI.

BMI and childrenThe healthy weight range for adults of a BMI of 20 to 25 is not a suitable measure for children.

For adults who have stopped growing, an increase in BMI is usually caused by an increase in bodyfat. But as children grow, their amount of body fat changes and so will their BMI. For example, BMIusually decreases during the preschool years and then increases into adulthood.

For this reason a BMI calculation for a child or an adolescent must be compared against age andgender percentile charts.

In 2005, Victoria introduced new BMI-for-age percentile charts specifically for children aged fromtwo years to 18 years, in addition to the regular range of updated weight and height growth charts.

The new BMI charts for children have been developed by the US Centre for Disease Control.

The charts are useful for the assessment of overweight and obesity in children aged over two.However they should be used only as a guide to indicate when make small lifestyle changes, andwhen to seek further guidance from a doctor or an Accredited Practising Dietitian (APD).

Calculating your BMIBMI is an approximate measure of the best weight for health only. To calculate your BMI, you needto know:

• Your weight in kilograms• Your height in metres.

Now you can use our handy BMI calculator.

What your BMI means

Body Mass Index (BMI) Page 1 of 3

http://210.247.186.34/bhcv2/bhcsite.nsf/pages/health_tools?opendocument

Once you have measured your BMI, you can determine your healthy weight range.

If you have a BMI of:

• Under 18 – you are very underweight and possibly malnourished.• Under 20 – you are underweight and could afford to gain a little weight.• 20 to 25 – you have a healthy weight range for young and middle-aged adults.• 26 to 30 – you are overweight.• Over 30 – you are obese.

For older Australians over the age of 74 years, general health status may be more important thanbeing mildly overweight. Some researchers have suggested that a BMI range of 22-26 isacceptable for older Australians.

Some exceptions to the ruleBMI does not differentiate between body fat and muscle mass. This means there are someexceptions to the BMI guidelines.

• Muscles – body builders and people who have a lot of muscle bulk will have a high BMI butare not overweight.

• Physical disabilities – people who have a physical disability and are unable to walk mayhave muscle wasting. Their BMI may be slightly lower but this does not necessarily meanthey are underweight. In these instances, it is important to consult a dietitian who willprovide helpful advice.

• Height – for people who are shorter (for example Asian populations), the cut-offs foroverweight and obesity may need to be lower. This is because there is an increased risk ofdiabetes and cardiovascular disease, which begins at a BMI as low as 23 in Asianpopulations.

Being overweight or underweight can affect your healthThe link between being overweight or obese and the chance you will become ill is not definite. Theresearch is ongoing. However, when data from large groups of people are analysed, statisticallythere is a greater chance of developing various diseases if you are overweight. For example, therisk of death rises slightly (by 20–30 per cent) as BMI rises from 25 to 27. As BMI rises above 27,the risk of death rises more steeply (by 60 per cent).

Risks of being overweight and physically inactiveIf you are overweight (BMI over 25) and physically inactive, you may develop:

• Cardiovascular (heart and blood circulation) disease• Gall bladder disease• High blood pressure (hypertension)• Diabetes• Osteoarthritis• Certain types of cancer, such as colon and breast cancer.

Risks of being underweightIf you are underweight (BMI less than 20), you may be malnourished and develop:

• Compromised immune function• Respiratory disease• Digestive disease• Cancer• Osteoporosis• Increased risk of falls and fractures.

Body fat distribution and health riskA person’s waist circumference is a better predictor of health risk than BMI. Having fat around theabdomen or a ‘pot belly’, regardless of your body size, means you are more likely to developcertain obesity-related health conditions. Fat predominantly deposited around the hips andbuttocks doesn’t appear to have the same risk. Men, in particular, often deposit weight in the waistregion.


Studies have shown that the distribution of body fat is associated with an increased prevalence ofdiabetes, hypertension, high cholesterol and cardiovascular disease. Generally, the associationbetween health risks and body fat distribution is as follows:

• Least risk – slim (no pot belly)• Moderate risk – overweight with no pot belly• Moderate to high risk – slim with pot belly• High risk – overweight with pot belly.

Waist circumference and health risksWaist circumference can be used to indicate health risk.For men:

• 94cm or more – increased risk• 102cm or more – substantially increased risk.

For women:

• 80cm or more – increased risk• 88cm or more – substantially increased risk.

Genetic factorsThe tendency to deposit fat around the middle is influenced by a person’s genes. However, you cantake this genetic tendency into account and do something about it.

Being physically active, avoiding smoking and eating unsaturated fat instead of saturated fat havebeen shown to decrease the risk of developing abdominal obesity.

Where to get help

• Your doctor• Maternal & Child Health nurse• An accredited practising dietitian, contact the Dietitians Association of Australia

Things to remember

• BMI is an approximate measure of your total body fat.• Being underweight or overweight can cause health problems, especially if you are also

inactive.• Your waist circumference is a better predictor of health risk than BMI.

This page has been produced in consultation with, and approved by: Deakin University - School of Exercise and Nutrition Sciences



©2009 American Council on Exercise®

To obtain reprint permission contact the American Council on Exercise®

M09-025 39

TM

American Councilon Exercise®

Periodized Training and Why iT is iMPorTanT

You have the best intentions regarding your workout, but find that your motivation has been sapped.

Lately, no matter how hard or how often you work out, you just can’t seem to progress any further. You’re stuck on a plateau.

training program can produce better results than a non-periodized program. The purpose of the study, which was published in the journal Medicine & Science in Sports & Exercise in 2001, was to determine the long-term training adapta-tions associated with low-volume, circuit-type training vs. periodized, high-volume resistance training in women (volume = total amount of weight lifted during each session).

The 34 women in the study were divided into those two groups, along with a non-exer-cising control group. Group 1 performed one set of eight to 12 repetitions to muscle failure three days per week for 12 weeks. Group 2 performed two to four sets of three to 15 rep-etitions, with periodized volume and intensity, four days per week during the 12- week period.

As the chart shows, the periodized group showed more substantial gains in lean muscle, greater reductions in body fat and more sub-stantial strength gains than the non-periodized group after 12 weeks.

Periodizing your Cardiovascular Workout

You should also periodize your cardiovas-cular training for the same reasons—to further challenge your body while still allowing for adequate recovery time.

If, for example, you’re a recreational runner, running for fitness, fun and the occasional short race, you’ll want to allow for flat, easy runs, as well as some that incorporate hills and others that focus on speed and strength.

What you don’t want to do is complete the same run every time. If you run too easily, and don’t push yourself, you won’t progress. And chances are you’ll get bored. Conversely, too much speed or high-intensity training will lead to injury or burnout, and most likely, disap-

It turns out that the exercise you’ve been doing has worked so well that your body has adapted to it. You need to “shock” or “sur-prise” your body a bit. You need to give it a new challenge periodically if you’re going to continue to make gains.

That goes for both strength and cardiovascular training. “Periodizing” your training is the key. Instead of doing the same routine month after month, you change your training program at regular intervals or “periods” to keep your body working harder, while still giving it adequate rest.

For example, you can alter your strength-train-ing program by adjusting the following variables:

• The number of repetitions per set, or the number of sets of each exercise

• The amount of resistance used • The rest period between sets, exercises or

training sessions • The order of the exercises, or the types of

exercises • The speed at which you complete each

exercise • There are many different types of periodized

strength-training programs, and many are geared to the strength, power and demands of specific sports. The most commonly used program is one that will move you from low resistance and a high number of repetitions to high resistance and a lower number of repetitions.

• Such a program will allow your muscles to strengthen gradually and is appropriate for anyone interested in general fitness.

research shows Better results

A frequently cited study conducted at the Human Performance Laboratory at Ball State University has shown that a periodized strength-

pointing race results.If you are serious about improving your time

in a 10K or completing a half marathon or even a full marathon, you’ll need a periodized program geared to each type of race. Many such programs are available from local running clubs, in running books and magazines, from some health clubs, as well as on running websites.

Specially designed periodized training pro-grams are also available for cycling and many other sports.

Periodized training will ensure that you con-tinue to make measurable progress, which will keep you energized and interested in reaching your goals.

additional resourcesMarx, J.O et al. (2001). Low-volume circuit versus high-volume periodized resistance training in women. Medicine & Science in Sports & Exercise, 33, 635–643.

American College of Sports Medicine Position Stand—Progression Models in Resistance Training for Healthy Adults: www.acsm-msse.org/pt/ pt-core/template-journal/msse/media/0202.pdf

American College of Sports Medicine—The Team Physician and Conditioning of Athletes for Sports: A Consensus Statement: www.acsm.org/AM/Template.cfm?Section=Search&section=Team_Physician_Consensus_Statements&template=/CM/ContentDisplay.cfm&ContentFileID=353

If you are interested in information on other health and fitness topics, contact: American Council on Exercise, 4851 Paramount Drive, San Diego, CA 92123, 800-825-3636; or, go online at www.acefitness.org/GetFit and access the com-plete list of ACE Fit Facts.TM

Marker Periodized Non-periodized

Lean muscle +4.6 lb (2.1 kg) +2.2 lb (1 kg)

Body fat% –4% –1.8%

Leg press +44 lb (20 kg) +18 lb (8.2 kg)

Youth Personal Training

Lincoln Park1320 West FullertonChicago, IL 60614773 477-9888

Benefits of Exercise

The top ten reasons Youth should work out with a Personal Trainer:

# 10: Safe and Effective

# 9: Reinforce Healthy Lifestyle

# 8: Get youth off the couch

# 7: Improve eating habits

# 6: Meet others

# 5: Have fun

# 4: Learn proper lifting technique

# 3: Loss weight

# 2: Perform better in sports

and the # 1 reason you should work out with a Personal Trainer is…

RESULTS!

Lincoln Park1320 W

est FullertonChicago, IL 60614773-477-9888

WelcomeLakeshore Athletic Clubs has been committed to member satisfaction since we opened our doors in 1972. In fact, we measure our very success by the number of members we can touch, motivate, support, help and listen to. This approach has helped us to become one of the premier health and fitness facilities in the country.

The International Health Racquet Sports Association (IHRSA) recognizes Lake Shore Athletic Club as one of the most distinguished fitness associations in the country. This organization is just one resource we utilize to bring our members the most innovative, creative and educationally based programs found anywhere in the fitness industry.

Youth Personal Training

Our staff of Personal Trainers for youth is highly knowledgeable in fitness, weight loss and sport specific training. In fact, many of our trainers not only hold degrees in Exercise Science and a nationally accredited certification, but also have specific expertise in training youth.

Why do youth need Personal Training?

Assure safe training•

Rise of unhealthy habits•

Increasing cost of health care•

Schools decreasing P.E. requirements•

Personal Training will help youth:

Develop an active lifestyle•

Develop healthy eating habits•

Learn proper lifting techniques•

Perform better in athletics•

Lose weight•

Improve self-esteem•

Kids GymKids Gym is a free service offered for all Lakeshore members. Kids 8 - 14 years old can come and hang out in a fun and safe atmosphere. Kids can participate in a number of entertaining activities including Ping-Pong, Billiards, Wii Sports, Dance Dance Revolution, as well as access to our one of a kind Kids Circuit Training room (While our attendants can give limited instruction, kids are not allowed to work-out alone. Parents must be present for extended workouts. Please consider taking one of our Youth Circuit Training classes for more comprehensive instruction).

HoursMonday - Friday 3:00pm - 8:00pm Saturday - Sunday 8:30am - 4:00pm

Youth Circuit TrainingIntroducing the newest program at Lakeshore, Youth Circuit Training. Kids 8 - 14 years old will be introduced to our one-of-a-kind Kids Gym through professionally designed and supervised circuit training. Kids will learn basic weight training principles and technique in a fun and safe environment. Lifting weights will help kids improve strength and endurance, build strong bones, prevent injuries, and loss weight. Youth Circuit Training will incorporate fun, active games that get kids moving, as well as basic nutrition education.

We also offer Short Sports I & II for children ages 3-6 years old and Junior Jocks for children ages 7-9 years old. Please call for days and times. For more information and class times please contact coach Jesse at 773-477-9888 x116.

Pricing

Private 1-session $60 6-sessions $50 ($300)

Semi-Private 1-session $70 ($35pp) 6-sessions $360 ($180pp)

Group (3 or 4) 6-sessions $120/child

Programs

Every Personal Training session will be individualized. These are a sample of specific training goals.

Weight loss•

Individualized programming•

Nutrition evaluation•

Sport specific training•

Increased performance•

Basketball, soccer, tennis, etc.•

Weight Training 101•

Weight Orientation•

Aerobic Training•

Please contact Jesse Kleinjan at 773-477-9888 x116 for more information.

Cancellation PolicyA 24-hour notice is required to cancel any scheduled service. In the event a scheduled appointment is canceled with less than 24-hours notice or you miss the appointment, you will be charged. No refunds will be given on pre-paid services after 30 days from the date of purchase; pre-payments expire in six months.

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Live Well, Live Long: Steps to Better Health Health Promotion and Disease Prevention for Older Adults

Physical Activity for Older Adults: Exercise for Life!

Chapter 4. Exercise for Life! A Physical Activity Program for Older Adults and Facilitator’s Guide to Exercise for Life! A Physical Activity Program for Older Adults

Part 1: Exercise for Life! A Physical Activity Program for Older Adults Part 2: Facilitator’s Guide to Exercise for Life! A Physical Activity Program for

Older Adults Part 1: Exercise for Life! A Physical Activity Program for Older Adults

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Exercise for Life! is a complete physical activity program that includes:

• Chair-based strength exercises for the upper and lower body • Chair-based stretching exercises for the upper and lower body • Balance exercises • Easy-to-understand, step-by-step instructions for each exercise • Illustrations of a multicultural cast of real-life older adults who demonstrate

the exercises • Tips on how to build endurance for 30 minutes a day, 5 days a week • Information on exercising safely • Guidelines on when older adults should see their healthcare provider before

exercising • Information on the benefits of physical activity • General exercise tips

To view or download the Exercise for Life! Physical Activity Program for Older Adults, see Chapter 6. Part 2: Facilitator’s Guide to Exercise for Life! A Physical Activity Program for Older Adults Table of Contents Welcome to Exercise for Life! A Physical Activity Program for Older Adults Are You the Facilitator? Getting Started Before the First Session… To Start the First Session… Step 1: Doing the Warm Up Step 2: Good Sitting Position Step 3: Breathing Step 4: Strength Exercises Step 5: Stretching Exercises Step 6: Balance Exercises Step 7: Talk for a Few Minutes about Building Endurance Step 8: Congratulations! Step 9: How Does Everyone Feel? After the First Session… What to Do if Exercisers Ask You If It’s Safe for Them to Exercise Tips for Working with Older Adults in Physical Activity Programs

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Welcome to Exercise for Life! A Physical Activity Program for Older Adults Exercise for Life! was created for older adults to learn more about physical activity and have a fun, easy-to-follow program that can be done at home. You can also do the exercises with other older adults at someone’s home or at a senior center or other group setting.

• Exercise for Life! has strength and stretching exercises with easy step-by-step instructions

• Exercise for Life! is written so that anyone can follow it, and does not need a leader

Are You the Facilitator? If you are getting a group together to use Exercise for Life!, you are the facilitator. Congratulations! Exercise has many physical, mental and social benefits, and we hope your efforts to encourage others to exercise are rewarding for you and for them.

Here’s what some older adults have to say about moving their bodies:1

“Exercising and walking gives you energy. That’s how you strengthen your

body. Your weakness disappears when you walk a lot.”

“Dancing makes you feel young and you never give up hope.”

“Exercise makes people happy and stop thinking about anything meaningless.”

This Facilitator’s Guide will give you special tips for:

• How to use Exercise for Life! • How to work with older adults in a physical activity setting • How to set up the physical activity area so that it is safe and welcoming

1 Belza, B., Walwick, J., Shiu-Thornton, S., Schwartz, S., Taylor, M. and LoGerfo, J. (2004) “Older Adult Perspectives on Physical Activity and Exercise: Voices from Multiple Cultures.” Preventing Chronic Disease [online serial]. Available at CDC on the World Wide Web: http://www.cdc.gov/pcd/issues/2004/oct/04_0028.htm.

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Getting Started You’ve already taken the first step: getting a group together to Exercise for Life! Before the First Session…

• Look at the room you will be using for the strength and stretching exercises • Make sure you have a chair for each person

o Chairs should be sturdy with no arms and a high back • Put the chairs in a big circle • Bring some music

o It should be lively enough to get everyone moving for the warmup o It should be not too fast for the strength and stretching exercises

• Be prepared to get ideas from the participants • Tell everyone to:

o Wear comfortable clothing and shoes with good support o Not eat for 1–2 hours before doing physical activity o Drink lots of water before they come o Be prepared to learn new things and have fun!

To Start the First Session…

• Greet everyone and have everyone introduce themselves • Explain that you are the facilitator and you will be coordinating the group • Explain that the group will be doing strength and stretching exercises for the

upper and lower body • Plan to do strength and stretching twice a week • Make sure everyone understands that muscles need to rest for 2 days between

strength routines Step 1: Doing the Warm Up

• Tell the participants that the first step is a 5–10 minute warm up • Explain that the body needs to warm up before doing physical activity • Put on the music • Have participants walk around the room or march in place • Encourage everyone to participate • Make eye contact with everyone to include them • At the end of the warm-up period, ask everyone to sit in a chair • Check in with everyone to make sure they feel okay

o If someone doesn’t feel okay, he or she should not continue

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Step 2: Good Sitting Position

• Explain that they need to have good sitting posture when doing the exercises to support the body

• By practicing a good sitting position, they can develop good posture • Go through the good sitting position checklist (page 9) item by item • Demonstrate each step as you read it

o Show each step again if needed Step 3: Breathing

• Explain that breathing right is also a part of exercising and will help them do the exercises

• Go through the practice breathing checklist (page 10) item by item • Demonstrate each step as you read it

o Show each step again if needed Step 4: Strength Exercises Starting with Basic Level 1

• Review the “tips when you do level 1 strength exercises” on page 10 with the participants

o Make sure everyone understands how to use a slow, steady motion and stay in a good sitting position

• Explain that GOOD FORM IS EVERYTHING! o It’s better to do an exercise just 1 time with good form than to do it

many times incorrectly o Good form means:

Using the muscles the exercise is supposed to use Doing the exercise safely

• Have everyone start with basic level 1 by doing each strength exercise 8–

12 times (this is one “set”) o Show each exercise again o Slowly over time they can work up to 2 sets (8–12 times in each set

with a 1-minute rest between sets)

• Encourage the participants to LISTEN TO THEIR OWN BODY and DO WHAT FEELS RIGHT FOR THEM

o Tell the participants:

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You are the best judge of what you can do safely on any day Everyone has their own pace, stick with your own and don’t try

to do someone else’s It’s okay if you need to rest for more than 1 minute between

sets Exercise is not a competition! Be patient and don’t compare

yourself to anyone Over time everyone can improve

Moving Up to a More Challenging Workout

• Over time (which may be different for each person), the participants will be able to do 2 sets of a level 1 strength exercise in good form

• When participants can do 2 sets of level 1 in good form, they may be

ready for a more challenging workout by moving to level 2 or using weights

• Level 2

o Some exercises have directions for how to do a more challenging workout by moving to level 2

o Follow the directions for the more challenging way to do the basic exercise (not all exercises have this)

o Show it again

• Using hand or ankle cuff weights o Tip: Look for hand weights with or without handles and ankle weight

cuffs at sporting good stores, discount stores, garage sales or flea markets

o To do strength exercises with weights: Start by using 1-pound weights and do the level 1 exercise 8

times (1 set) Build up to doing the level 1 exercise 12 times using 1-pound

weights Build up to doing 2 sets of the level 1 exercise (12 times each)

using 1-pound weights (with a 1-minute rest between sets)

• When a participant can do 2 sets of the level 1 exercise using 1-pound weights IN GOOD FORM, the next challenge is to switch to 2-pound weights

o Tips: Only increase your weights if it feels right to you Increase your weights by 1 pound only, don’t skip a pound

o Encourage everyone to be patient! You will get stronger over time Using the 2-pound weights, do 1 set of 8 times Build up again to 12 times, then 2 sets of 12 times each

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• Participants can continue to increase their weights gradually using the steps above

Step 5: Stretch Exercises

• Review the “tips when you do stretch exercises” on page 15 with the participants

o Make sure everyone understands: Start the stretch slowly Stretch until they feel a MILD pull on the muscle Keep a steady, gentle stretch while they keep breathing Keep their joints “soft” and not “lock” the knee or elbow by

straightening them too much when they stretch Relax into the stretch (don’t bounce!) Back off a little if the stretch hurts End the stretch by slowly going back to the starting position How long to hold each stretch:

• When you start this program, hold each stretch and slowly count to 5 (to count 5 seconds, say “one one-thousand, two one-thousand…”)

• After a few weeks, count to 10 or 15 (10–15 seconds) • After a few months, work up to a count of 20 – 30 (20–30

seconds) • Hold neck stretches for 5 seconds only

o Do each stretch 1–2 times Show how to do each stretch twice

o After a few weeks, participants can slowly increase to 3–5 times if they want

• Explain that GOOD FORM IS IMPORTANT WITH STRETCHING,

TOO! o Tips:

Take your time, breathe and relax Don’t try to stretch too hard. Go at your own pace. Over time

you will become more flexible

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Step 6: Balance Exercises

• Explain that they need to have good standing posture when doing the balance exercises to support the body

• By practicing a good standing position, they can develop good posture • Go through the good standing position checklist (page 40) item by item • Demonstrate each step as you read it

o Show each step again if needed • Do the 3 balance exercises on pages 41, 42 and 43

o The participants can do the heel-to-toe walk together against a wall o Be sure to have enough room between people

Step 7: Talk for a Few Minutes about Building Endurance

• Explain that building endurance will make your heart and lungs stronger • Tell the participants that just 30 minutes a day of moderate intensity physical

activity —about the same as briskly walking a mile in 15–20 minutes—will give them many health benefits

• Suggest that they do endurance activities on 3 to 5 days of every week o They don’t have to do all 30 minutes at one time o They can do endurance exercise for 10 minutes, 3 times a day o Tip: Start slowly with 5–10 minutes if you haven’t been active, and

slowly build up to 30 minutes o Give them the suggestions on page 44 for endurance activities o Ask them what they like to do for endurance exercise o See if anyone wants to be buddies and do endurance exercise together

• After the first session, you might want to check in every week about how the endurance activities are going

Step 8: Congratulations! Give yourselves a big hand! You did a great job! Step 9: How Does Everyone Feel?

• Check in with everyone o Do they feel okay? o How were the exercises for them? o What did they like or not like? o Will they come back next time? o Will they bring someone new with them?

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o Would someone else like to bring music? o Does the group want to have a snack after exercising?

• Encourage sharing about the experience • Make a phone list or phone tree so you (or someone else) can call and remind

people to come to the next session • Can they share rides? Find out who needs a ride and who has a ride to share

After the First Session…

• Whew! That was a lot of things to remember and talk about—GOOD FOR YOU!

• Use this Facilitator’s Guide to help you get through all these steps each session

• Find out if someone else would like to share the role of facilitator with you

What to Do if Participants Ask You If It’s Safe for Them to Be Physically Active Participants may ask you if it is safe for them to exercise because they have a health condition or they have not been physically active. Do NOT give them medical advice on this question. You can share with them the following information, which may help them make the decision. If in doubt, it is always best for older adults to check with a healthcare provider.

• Physical activity is good, and not harmful, for most older adults. Not being active is much less safe

• If an older adult hasn’t been physically active, it is best to start slowly:

o Do each strength exercise 1–3 times, and build up slowly o Do endurance activity (brisk walking, for example) for 5–10 minutes

each day and slowly build up to 30 minutes o If you are out of breath and it is hard to talk, slow down or do less o Stretch slowly and you will become more flexible after a while

• If an older adult has a chronic condition: o Most older adults who have arthritis, diabetes or osteoporosis (bone

loss) and other chronic conditions can safely be active to improve their health and fitness. Physical activity will make their joints work better and can reduce the pain of arthritis.

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o Older adults should see their doctor before starting if they have a heart condition, high blood pressure, chest pain, arthritis, diabetes or other chronic conditions

Participants with a chronic condition can probably be active safely as long as the condition is currently being controlled

For example, it is probably safe to be physically active: • If you have diabetes and your blood sugar readings are okay • If you have osteoarthritis and your joints are not painful and

swollen Moderate activity may help control the condition and relieve symptoms By staying in touch with a healthcare provider they can:

• Monitor the effect physical activity is having on their symptoms and overall condition

• Learn to recognize when the condition is stable (activity is okay) and when it is in an unstable flare-up period (stop physical activity until stable again)

If a chronic condition changes from being stable to a flare-up, they should stop physical activity and consult a healthcare provider.

• The provider may determine that gentle stretching is all right to do even during a flare-up

• Gentle stretching may feel good and help lower stress If they have had a hip or knee replacement, they should check with their doctor before doing lower-body exercises.

Tip to Participants: Show your healthcare provider the Exercise for Life! Physical Activity Program for Older Adults so you can work together to build your strength, flexibility, stamina and balance.

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Tips for Working with Older Adults in Physical Activity Programs

By Chaya Gordon, MPH 1. Older adults are not a homogeneous group A room full of older adults may include a wide range of ages, encompassing several generations. There may be big differences in functional or cognitive capacity. There may also be big differences between individuals based on culture, race, religion, language, sexual orientation, income, education, gender, physical ability, size, or other factors. Each elder is a unique individual. Learn as much as you can about the cultural environment of the elders you are working with. 2. Be aware of ageist attitudes Watch out for ageist attitudes that you may be expressing inadvertently. Society’s ageist attitudes negatively represent aging as a time characterized chiefly by loss—loss of physical ability, loss of loved ones, loss of social status. While it is important to acknowledge loss, use this opportunity to promote the positive side of aging. 3. Older adult? Senior? Elderly? Little old lady? Address elders formally (using Mrs./Miss/Ms./Mr.) unless they invite you to call them by their first names. “Elder” and “older adult” seem neutral and respectful, but remember that people of varying cultural backgrounds may not be comfortable with the same descriptors. An underlying respect for the elders you’re working with will speak volumes. 4. Be inclusive and nonjudgmental Use eye contact and other techniques to engage and include everyone in a physical activity group or class. In a group setting, some elders may need or want more of your attention than others, which can be very challenging. Try to acknowledge and validate the needs of an individual while immediately refocusing attention back on the whole group. Base your Use eye contact and other techniques to engage and include everyone in a group or class. In a group setting some elders may need or want more of your attention than others, which can be very challenging. Try to acknowledge and validate the needs of an individual while immediately refocusing attention back on the whole group. Base your expectations of an individual on their ability, not their age. Establish a positive, nonjudgmental tone that supports everyone. 5. Be aware of communication difficulties due to vision or hearing impairments or low literacy Many elders have vision and hearing impairments. Others may have low literacy in their primary language (whether it’s English or another language), which makes it difficult for them to use written materials. Still others may have cognitive impairment. However, it may be hard to determine the specific reason for any communication difficulties you and the elder may be experiencing. Older adults may feel embarrassed or ashamed and may mask these problems. For example, an older woman who doesn’t know how to read may say she forgot her reading glasses.

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Make sure everyone in the group can see and hear you. Use a microphone if possible. Print materials for older adults should be in a font that’s at least 14-point size, should not use italics or script, and should have high contrast and a clear, simple layout. Large-size visual aids can be very helpful. They don’t require that someone knows how to read—a problem that affects one third of older adults—or understands health terminology. Lighthouse International has two excellent free pamphlets, Making Text Legible: Designing for People with Partial Sight and Effective Color Contrast: Designing for People with Partial Sight and Color Deficiencies (call 1-800-829-0500 to request). The Harvard School of Public Health website is an excellent health literacy resource (www.hsph.harvard.edu/healthliteracy). 6. Be aware of fears and concerns that older adults may have

Elders may have many fears and concerns such as losing independence, being isolated, falling, getting injured, feeling mixed about participating, not being accustomed to doing physical activity, or feeling that it is inappropriate to do physical activity. Acknowledge that societal attitudes toward physical activity for elders have changed over time. Listen to their concerns, validate their reality, and appreciate that you are in a position to help them make positive changes in their lives. 7. Pay attention to learning and teaching style

Older adults can learn new complex motor skills, but may learn at a different rate or need different instructional techniques than younger adults. Be prepared for a wide range of abilities among participants. Break down components into small parts and show more than once. Give clear explanations, both verbally and visually. Give participants a lot of positive reinforcement and positive feedback. Pay close attention to proper form and alignment, but encourage individual expression and variation wherever appropriate. And remember, every elder can improve the level of physical fitness. Be sure to celebrate progress with the participants! 8. Encourage social interaction among participants

For elders, one of the benefits of participating in physical activity in a group setting is the opportunity to engage in social interaction. Encourage peer education, sharing and interaction among participants both in and out of class. For example, include a 5–10-minute informal warm-up before a class during which participants can talk with each other while walking or doing other warm-up activities, or use partner activities during a class. 9. Learn from elders—They’re the experts!

Familiarize yourself with language and examples that relate to the older adults you work with. Ask about popular activities, and take a look at the physical activity opportunities in their neighborhoods and what these places offer. Appreciate that you are contributing to the empowerment and quality of life of elders in your program, and embrace and value the life experience they bring.

Source: Copyright © 2004 American Society on Aging, San Francisco, California. www.asaging.org. Reproduction does not require written permission. However, proper credit must be given in the following form: Tips for Working with Older Adults in Physical Activity Programs. American Society on Aging. 2004.

ACE FitnessMatters • July/August 2007 7

News Flash: You’re not getting any younger.And you’re not alone. As a population, the number ofolder adults in the United States has grown to more than36 million—that means one in every eight people is overthe age of 65. By 2010, that number is expected to jumpto more than 40 million. Couple that with the fact thatAmericans are more sedentary than ever before and we’vegot a problem. A big one.

As inactive people grow older they lose strength,mobility and balance, and it becomes tougher for themto accomplish what exercise scientists call activities ofdaily living or ADL. These seemingly simple things likegetting up from a chair, carrying groceries or puttingaway dishes are obviously essential for good physical—and mental—health for all people.

Within the last five years or so, many fitness professionals have been promotingfunctional fitness programs as a way for older adults to remain active and inde-pendent as they age. Although anecdotally many are convinced these programs areeffective, very little scientific research has been conducted to prove it. “There havebeen a number of studies that look at traditional weight training and the carryoverto activities of daily living, but only a couple small studies have looked at function-al training specifically,” notes John Porcari, Ph.D., of the University of Wisconsin,La Crosse. “Our goal was to find out if older adults see improvements from func-tional fitness programs in a short period of time.”

The inspiration behind this American Council on Exercise–sponsored study wasthe hope that if researchers could prove that functional fitness works, and that mostwill see real-world benefits relatively quickly, then more older adults would be willingto try functional exercise programs and be more likely to stick with them.

The StudyLed by Porcari and Denise Milton, M.S., a physical therapist with the U.S. mili-

tary, a team of exercise scientists at the University of Wisconsin, La Crosse Exerciseand Health Program recruited 24 male and female volunteers, ages 58 to 78 years.Each of the test subjects had some form of cardiac, metabolic or orthopedic

• Unilateral balance: standing on one leg• Golfer’s lift: like picking up a golf ball• Squat with arms forward• Wall push-ups• Lateral squats• Forward/backward leans• Squat with diagonal reach• Walk-around obstacle• Overhead press• Rotation lunges• Lunge and chop• Stairclimb

ACE-SPONSOREDRESEARCH

STUDY

New ACE research

that shows older

adults can expect

quick benefits

from functional

fitness programs

Function Follows

Fitness B Y M A R K A N D E R S

Table 1.Functional exercises used by the experimental group.

Continued on page 8

8 July/August 2007 • ACE FitnessMatters

condition and all were already actively participating in the university’sLa Crosse Exercise and Health Program.

“A lot of [the subjects] have been in our program for a longtime, doing pretty traditional exercise, things like walking and aero-bic dance, but we’re seeing people getting older and they’re havingmore and more trouble doing things in everyday life,” says Porcari,illustrating that the study participants were prime candidates fortesting the validity of functional fitness. Each subject was randomlyassigned to either the experimental group (which would do func-tional exercises) or a control group (which would stick with a tradi-tional exercise program). Before the training period began, bothgroups were given the Functional Fitness Test for Older Adults,which consists of six components designed to evaluate things likestrength, endurance, flexibility, balance and agility.

Once a baseline was established, it was time to start the exerciseprogram. The experimental group participated in functional exercisesessions three times weekly for four consecutive weeks. Each sessionconsisted of a five-minute warm-up, a circuit of 12 functional exer-cises, including moves like the wall push-ups, lunge and chop, andsquat with diagonal reach (Table 1), followed by a 10-minute cool-down. Subjects were instructed to work at a moderate-intensity levelwhile performing each of the exercises, one minute per move with a15-second transition between each.

Researchers used sand-filled milk jugs (from 0.5 to 10 pounds) tosimulate the weights of common household items. Similarly, thereaching and bending exercises mimicked the postures used in manycommon ADL. As the exercises became easier for the subjects, resist-ance was added and modifications were made to ensure that theexercisers maintained a moderate level of intensity throughout thetest period.

After four weeks of exercise training, the research team onceagain administered the Functional Fitness Test for Older Adults togauge the physical improvements of both the experimental groupand the control group.

The Results The experimental group, which underwent the functional fitness

training, showed greater physical improvements than the controlgroup (Table 2). In particular, improvements were seen in lower-bodystrength (13% improvement), upper-body strength (14%), cardiores-piratory endurance (7%), agility/dynamic balance (13%) and shoul-der flexibility (43%). The researchers concluded that the functionalfitness program was superior to conventional exercise for improvingthe subjects’ abilities to complete most ADL.

Though the efficacy of functional training was no surprise to theresearchers, Porcari finds it encouraging that the test subjects showedsignificant improvements in as little as four weeks. What makesthese findings even more significant is that researchers weren’t sim-ply starting with totally inactive subjects and seeing big benefits—allsubjects in the study were already regular exercisers.

Beyond the ScienceObviously the take-home message here is: Functional fitness really

works. Even the simplest exercise regimen, like the one employed byour researchers using inexpensive equipment like sand-filled plasticjugs, is effective enough for older adults to reap significant benefitsin less than a month.

Though this study did not assess the psychological consequencesof the increase in functional fitness, anecdotal comments from sub-jects in the experimental group suggested they were encouraged bythe subsequent benefits they experienced while performing everydaytasks. Researchers asked each of the subjects if they noticed anyimprovement in their ADL. The responses were generally positive,but Porcari recalls one woman in particular:

“At first she said, ‘No.’ Then she called me back and said,‘When I reach for stuff in the cupboards it’s a lot easier than itused to be. Or when I’m in my car, it’s a lot easier for me to turnaround and look behind me when I’m backing up,’” says Porcari.“It just brings a smile to my face to hear the anecdotal commentsthat it does work in everyday life. Sure, it’s nice to do this kind ofbench research, but it’s much more gratifying when you see peopleactually getting benefits.”

VARIABLE PRE-TESTING POST-TESTING CHANGEGROUP

Chair Sit-to-Stand (reps)Control 15.0+3.7 14.9+3.4 -0.1Experimental 13.8+3.1 15.6+2.6* 1.8

Biceps Curls (reps)Control 15.1+2.7 14.6+3.4 -0.5Experimental 13.8+2.6 15.7+3.1* 1.9

6-Minute Walk (yds)Control 641+79.1 643+83.9 2.0Experimental 618+62.4 661+67.1* 43.0

Chair Sit-and-Reach (in)Control -4.8+3.5 -4.4+3.9 0.4Experimental -5.3+4.8 -4.1+3.9 1.2

Back Scratch (in)Control -2.6+3.4 -2.7+3.6 0.1Experimental -3.7+5.8 -2.1+4.9* 1.6

8 Foot Up-and-Go (sec)Control 5.1+0.53 5.1+0.75 0.0Experimental 5.5+0.77 4.8+0.50* -0.7

* Significantly different than pretesting (p<0.5)

This study was funded solely by the American Council on Exercise (ACE)and conducted by John P. Porcari, Ph.D., and Denise Milton, M.S., at theLa Crosse Exercise and Health Program of the University of Wisconsin,La Crosse.

AC E - S P O N S O R E D R E S E A R C H S T U DY

Table 2.

Changes in FFT scores over the course of the study.


The WWorkoutFabio Comana, ACE consultant and exercise physiologist, created the following functional fitness circuit workoutbased on the findings of this research. This 30-minute circuit requires no special equipment and can be done justabout anywhere. Do it two or more times per week and you’ll improve your balance, agility and cardiovascular fitness,as well as flexibility and strength in your lower and upper body. For best results, complete each exercise as shownhere and then repeat the circuit a second time.

Station 1: Standing BalanceWeek 1: Stand with feet hip-widthapart, eyes closed and attempt tomaintain balance for 15 seconds(use supports as necessary). Dofour reps of 15 seconds each. Week 2: Progress the exercise byextending your arms out in frontand then out to your sides whilereaching 6 inches in each direc-tion without losing balance ormoving your feet (eyes open orclosed). Do five reps in eachdirection (forward, left and right).Week 3: Progress the exerciseagain by standing on one legwhile lifting the opposite leg ashigh as possible. Attempt to main-tain balance for 15 seconds.Relax and repeat three moretimes with each leg.

Station 2: Step OversWeek 1: Place a 6-inch-tall vegetable can (or cone) on the floor and standapproximately 6 inches behind it with both feet facing forward. Slowly liftyour right leg and—while maintaining your balance—step over the can. Shiftyour weight to balance on your front leg and lift your left leg up and over.Return to the starting position by stepping back over the item. Do 10 reps.Week 2: Progress the exercise by adding a stepping motion in a sidewaysdirection. Do 10 reps.Week 3: Progress the exercise again by gradually increasing the height ofthe item to 10 to 12 inches. Do 10 reps.

Station 3: Figure 8 Cone DrillPlace one cone (cone A) 10 feet in frontof a chair and a second cone (cone B)10 feet to the right of cone A. Begin thedrill seated in the chair. Next, stand upand walk as quickly as possible to theleft side of cone A. Turn to the rightaround it and walk toward the right sideof Cone B. Walk completely around thatcone and proceed back toward the leftside of Cone A. Circle around that oneas well and head back to your chair. Dothree reps with 30 seconds restbetween reps.

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10 July/August 2007 • ACE FitnessMatters

Station 4: Chair Stands with Chest StretchSit in a chair holding your torsoupright off the backrest with feetflat on the floor, hip-width apart,and hands placed in your lap.Slowly rise to a stand. Try topush through your heels whileextending your arms out to yoursides at chest height withthumbs turned to point towardthe ceiling. Squeeze your shoul-der blades together and hold forone to two seconds. Next, bringyour arms back to your sides andslowly sit back down. Start bydoing the exercise continuouslyfor 30 seconds, and graduallybuild up to 60 seconds as yourstrength and endurance improve.

Station 5: Standing Push-presses Stand with feet hip-width apart holding weights (2- to 10-pound dumbbells or cans of vegetables) at shoulder height,palms facing forward with your weight on your heels. Slightlydip the knees to start the exercise, then straighten yourknees and simultaneously push the weights overhead untilyour arms are fully extended. Avoid arching your lower back.Slowly return your arms to shoulder-level and repeat. Do thisexercise continuously for 30 seconds.

Station 6: Seated Leg Extension Sit in a chair holding your torso upright off the back-rest with feet flat on the floor and hip-width apart, andhands placed in your lap. Without moving your hips orback, slowly extend your right leg, attempting to raiseit until it’s parallel to the floor. Hold for two seconds.Relax and return to the starting position. Do this exer-cise continuously for 30 seconds, then repeat with theopposite leg. If you can’t quite get your leg parallel,use the backrest for support or just attempt to lift it ashigh as possible.

Station 7: Penny Pick UpStart three steps awayfrom a penny placed onthe floor. Slowly walktoward the penny. Stopto lunge or squat down,pick the penny up, thenstand back up and con-tinue walking anotherthree steps. Do five reps.

AC E - S P O N S O R E D R E S E A R C H S T U DY

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Station 9: Treadmill WalkWalk for a half-mileon a treadmill at aspeed setting that ismoderately difficult,yet slow enough thatyou feel confidentwalking. If you don’thave access to atreadmill, simply takea brisk half-mile walk.

Station 8: Biceps and TricepsStand with your feet hip-widthapart holding a 4- to 10-pounddumbbell (or can of vegetables)in your left hand. Place the oppo-site hand on a table edge orback of a chair for support.Standing upright, slowly do abiceps curl. Keep your elbow byyour side and avoid arching yourlower back. Slowly return your

arm to your side, bend your torso for-ward 45 degrees while supportingyourself using the opposite arm. Allowyour left arm to bend at the elbow asyou lean forward and slowly extend itback behind your body. Hold for one totwo seconds before relaxing your armat your side. Finally, return to anupright standing position. That’s onerep. Do this exercise continuously for30 seconds and then repeat withopposite arm.

Station 10: Standing Hamstring and Hip-flexor Stretch Using a chair, step up with your right leg andplace your foot firmly and flat on the seat. Usethe backrest of the chair as a support if needed.Slowly shift your weight forward while maintain-ing a slight backward lean with your torso.Simultaneously extend your arm overhead (orarms, if not using the support). Hold for one totwo seconds. You should feel the stretch in yourgroin area. Relax and slowly shift your weightbackward. While bending forward at the hips,straighten your leg on the chair and reach yourarms forward toward your straightened leg. Holdfor one to two seconds. You should feel thestretch in your hamstrings. Slowly return to start-ing position. That’s one rep. Do a total of threereps with each leg.

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