HSE302 Master Reference

OVERVIEW & LEARNING OBJECTIVES

The evolution of sport and increased physical demands has made it essential for sports scientists and strength coaches to adopt multi-factorial approaches to screening and assessment. Within a sport, there may be common injuries or conditioning deficiencies, but there is still substantial variation between athletes — requiring a varied and adaptable repertoire of screening and assessment tools to inform programming decisions.

Learning Objectives:

Understand the purpose of musculoskeletal screening assessments
Critically analyse the literature regarding musculoskeletal screening and injury prediction
Identify and explain common processes and equipment required for accurate and safe assessments
Record, analyse and interpret information from a range of musculoskeletal screening assessments
Understand your responsibilities as an Accredited Exercise Scientist (AES) to maintain legal, ethical, and quality practice

PURPOSE OF MUSCULOSKELETAL (MSK) SCREENING

  Primary aim: To detect pre-determinants of poor musculoskeletal function and reduce the likelihood of injury — it is an injury prevention tool, NOT a diagnostic tool.

The body works as an integrative system — a deficiency in strength, mobility, or stability at one point in the kinetic chain can cause the whole system to falter or compensate (increasing injury risk)
Results inform corrective exercise prescription so programs can be tailored to a client's specific needs
Used at the start of sport participation and when returning to play after injury
Screenings are NOT for diagnosing medical conditions — serious issues should be referred to allied health professionals (physio, exercise physiologist)

Key Goals of MSK Screening Tools (Cook et al., 2014):

Identifying individuals at risk who are attempting to maintain or increase activity levels
Assisting in program design by using corrective exercise to normalise or improve fundamental movement patterns
Providing a systematic tool to monitor progress and movement pattern development across changing injury status or fitness levels
Creating a functional movement baseline for rating and ranking movement (statistical observation)
Determining readiness to return to sport after injury (key goal)

COMMON ASSESSMENT BATTERIES & TOOLS

Tool	Purpose	Key Feature
Postural Assessment	Identify resting alignment abnormalities	Assessed from anterior, lateral, and posterior views
FMS™ (Functional Movement Screen)	Assess fundamental movement patterns; identify deficiencies & imbalances	7 tests, scored 0–3, max total = 21
ROM Testing (Thomas, SLR, Ely's, Lateral Lift)	Assess joint range of motion and muscle tightness	Passive and active ROM variants
Muscle Activation Tests (Prone Hip Extension)	Assess whether specific muscles activate correctly	Palpate order and dominance of muscle activation
Beighton Scoring System	Assess generalised hypermobility	Score ≥4 indicates overall hypermobility
AMI (Athlete Movement Index)	Athlete-specific movements combining FMS + balance & dynamic stability	Designed to show how movement problems may lead to injury
USTA HPP (High Performance Profile)	Tennis-specific screening protocol across different ages/skill levels	Identifies weakness and inflexibility to optimise performance & prevent injury

Important: 3-RM strength tests are NOT commonly used in pre-screening — they assess physical performance, not movement quality. Pre-screening uses postural assessment, ROM testing, and muscle activation tests.

FMS™: DEEP SQUAT — SCORING & INTERPRETATION

  7 FMS tests: Deep Squat, Hurdle Step, In-Line Lunge, Shoulder Mobility, Active Straight Leg Raise, Trunk Stability Push-Up, Rotary Stability. Each scored 0–3. Max = 21.

Score	Meaning
3	Performs movement correctly without any compensation; meets all standard movement criteria
2	Completes the movement but must compensate in some way
1	No pain, but unable to complete the movement pattern or assume the position
0	Pain anywhere in the body during the test

Deep Squat — Client Video Analysis (from Learning Module):

Score Given	Reason
Score 2	Good technique overall — upper torso parallel with tibia or toward vertical; femur below horizontal; knees over feet; dowel aligned with feet. However: heels elevated on board (likely poor ankle or posterior chain mobility)
Score 1	Tibia and upper torso not parallel; femur not below horizontal; knees not aligned over feet; heels remain elevated

Score 3 Challenge: Even a "3" can be critiqued — watch foot position (should be shoulder-width, sagittal plane). Feet slightly turned out or stance too wide can technically breach criteria.

Upper torso limitation → poor glenohumeral, scapulothoracic, or thoracic spine mobility
Lower extremity limitation → poor ankle dorsiflexion or hip flexion mobility

ROM TESTS: THOMAS, SLR, ELY'S & LATERAL LIFT

Test	Assesses	Normal Result	Positive (Tight)
Thomas Test	Hip flexor tightness	Opposite thigh at table level; knee flexed >80°	Tight hip flexors: opposite thigh above table; knee <80° (extended). Tight TFL: opposite hip abducted/internally rotated
Straight Leg Raise (SLR)	Hamstring tightness	>80° hip flexion of raised leg	Tight hamstrings: <80° hip flexion of raised leg
Ely's Test	Quadricep tightness	Heel almost touches posterior thigh/glutes	Tight quads: heel far from touching; anterior or lateral pelvic tilt
Lateral Lift Test	Quadratus lumborum (QL) strength/tightness	Shoulders clearly lifted; straight body; brief hold at top	Weak QL: shoulders only slightly lifted; twisting; no pause at top

Video Analysis Results (from Learning Module):

Test	Side	Result	Interpretation
Thomas Test	Right	Negative	Normal
	Left	Positive	Hip contracture (tight hip flexors) — left leg only. Also positive for TFL contracture (hip abducted) — left leg
SLR – Client 1	Both	Negative	Good result (80+ degrees both legs)
SLR – Client 2	Both	Positive (bilateral)	Positive (<80°) on both legs; worse on left leg
Ely's – Attempt 1	Both	Negative	Good result; right leg slightly worse (borderline — general quad tightness)
Ely's – Attempt 2	Right	Positive	Anterior pelvic tilt indicates rectus femoris tightness on right side
Lateral Lift – Right	Right	Tight	Right side lift highlights tight QL on LEFT side
Lateral Lift – Left	Left	Weak	Left QL is weak AND tight — prescription should focus on strengthening AND lengthening to address the R-L difference

MUSCLE ACTIVATION TEST: PRONE HIP EXTENSION

Assessor palpates erector spinae, gluteus maximus, and hamstring simultaneously. Client slowly lifts leg straight off the table.

Normal pattern: Gluteus maximus should be the FIRST and MOST DOMINANT contraction. Order of erector spinae and hamstring activation varies and is less important, but their strength of contraction should be even.

Abnormal pattern: If glute max is NOT dominant → indicates poor activation/weakness in glutes. If any muscle cannot maintain continuous, consistent contraction → muscle activation needs to be addressed.

Video Analysis Results (from Learning Module):

Side	Result	Interpretation & Prescription Implication
Right	Glute first and most dominant; hamstrings and erector spinae follow	Good result — normal activation pattern
Left	Hamstrings and erector spinae activate first with more force than glute max	Poses risk of lower back pain and potential anterior pelvic tilt. Prescription: focus on LEFT glute max strength and LEFT erector spinae flexibility

BEIGHTON HYPERMOBILITY SCORING SYSTEM

Assesses generalised joint hypermobility across multiple joints
Score ≥4 out of 9 indicates overall hypermobility
If a client scores in a specific area → consider stability exercises for that specific area to reduce injury risk from excessive laxity

POSTURAL ASSESSMENT

Observational tool to identify abnormalities in resting body alignment. Assessed from three views:

View	What to Examine
Anterior (Front)	Position of feet, knees & legs; height of foot arch (pronation/supination); angle of femur via patella; rotation of head; prominence of ribs (flaring)
Lateral (Side)	Alignment of knees; position of pelvis; curves of the spine; head position; chest position
Posterior (Back)	Alignment of Achilles tendon; angles of femurs; height of PSIS; lateral pelvic tilt; spinal deviations; positions of shoulders & scapulae; angle of head

  Common postural faults: Kyphosis-lordosis, flat-back posture, posterior pelvic tilt; lower body — genu valgum, pes planus; upper body — rounded shoulders, forward head carriage, winging scapulae

PROFESSIONAL CONDUCT & ETHICS (ESSA)

Prescribed Reading: ESSA Code of Professional Conduct and Ethical Practice (pages 7–12)

As an AES collecting client data during screening, key obligations include:

Explain how client information and screening results will be collected, used, and stored
Store results in a secure location (locked filing cabinet or password-protected database)
Keep accurate and up-to-date records of client information
Obtain consent to record, store, and use client information where appropriate
Work within scope of practice — refer serious issues to allied health professionals
Maintain professional behaviour in all aspects of practice (handling sensitive health info, collaborating with health professionals, respecting privacy)

DO SCREENING TESTS PREDICT INJURY? (Bahr 2016 vs Hewett 2016)

Bahr (2016) — "Why screening tests to predict injury do not work — and probably never will": Three steps needed to validate a screening test for injury prediction:

A strong relationship between a marker from a screening test and injury risk
Evidence that an intervention given to 'at-risk' athletes is MORE beneficial than the same program given to all athletes
Tests need to be examined in relevant populations using appropriate statistical tools

Bahr argues current screening tests fail to meet all three steps — they cannot reliably predict individual injury.

Hewett (2016) — Response to Bahr: Even if screening tests cannot perfectly predict injury, they offer important positive side effects:

Athlete education and team awareness (key positive side effect)
Can still support injury prevention program design even without perfect predictive validity

  Controllable vs Uncontrollable injury risk factors:

  Controllable: Muscle strength imbalances, movement quality, training load, flexibility, fatigue

  Uncontrollable: Contact/collision from opposition, weather, playing surface, bad luck

PRACTICAL: MSK SCREENING ACTIVITIES

Working in groups of 4, rotating roles (Exercise Scientist ↔ Client) for each assessment:

Activity 1: Postural Assessment — anterior, lateral, and posterior views
Activity 2: FMS Deep Squat — score and justify (0, 1, 2, or 3)
Activity 3: ROM Tests — Thomas Test, SLR, Ely's Test, Lateral Lift Test
Activity 4: Muscle Activation Test — Prone Hip Extension (palpate order: glute max should be first and dominant)
Activity 5: Beighton Hypermobility Scoring

Record all results in Appendix 2 & 3 of the practical manual. Comment on results by providing preliminary goals or objectives for future exercise sessions.

SEMINAR MCQs WITH ANSWERS

Q1. Which describes the primary aim of a musculoskeletal screening assessment?
A. To assess the skills of an athlete ✔ B. To reduce the likelihood of injury C. To improve physical performance D. To improve mobility and stability
Justification: A = skill assessment; C = indirect outcome; D = screenings identify deficiencies in mobility/stability to then address. B = injury risk is related to movement deficits — primary aim.

Q2. Which of the following is NOT commonly used in pre-screening assessments?
A. Postural assessment B. Range of motion (ROM) testing ✔ C. 3-RM Strength tests D. Muscle activation tests
Justification: Maximal strength tests assess physical performance, not movement quality. Posture, ROM, and muscle activation are all standard screening components.

Q3. Which one of the following tests is included in the FMS™?
A. Prone Hip Extension B. Walking Lunge ✔ C. Trunk Stability Push Up D. Hop & Hold
Justification: A = not FMS (separate screening test); B = In-Line Lunge is FMS, not Walking Lunge; D = for ACL/knee injury return to play. C = FMS battery, assesses core/spine stability during upper body movement.

Q4. What is the total score possible for the FMS™?
A. 16 ✔ B. 21 C. 23 D. 25
Justification: 7 tests × 3 points each = 21 total.

Q5. Which most accurately describes a key goal of musculoskeletal screening tools?
✔ A. Determining readiness to return to sport after injury B. Programming to improve conditioning C. Determining skills required for a movement task D. Assessing strength and power
Justification: Screenings identify movement deficiencies that may exist in a previously-injured limb — directly supports return-to-play decisions.

Q6. Which result is 'Fair' for the External Rotation Strength test (USTA HPP)?
A. Inability to place arm in 90/90 position B. Inability to withstand any resistance ✔ C. Client can maintain 90/90 position with hand and forearm moving into internal rotation with resistance D. Arm does not 'break' the 90/90 position with resistance
Justification: Test assesses rotator cuff strength via manual force at 90° abduction / 90° ER. Rotator cuff strength is essential for preventing shoulder injuries in tennis athletes.

Q7. According to Bahr (2016), which step was NOT included as needed to validate a screening test for injury prediction?
A. Strong relationship between screening marker and injury risk B. Evidence intervention for 'at risk' athletes is more beneficial than universal program C. Tests examined in relevant populations using statistical tools ✔ D. Subjects from athletic population compared to non-athletic population
Justification: Bahr's three steps: (1) marker–injury relationship, (2) intervention superiority for at-risk vs all, (3) statistical validity in relevant populations. Comparing athletic vs non-athletic populations was NOT one of his criteria.

Q8. According to Hewett (2016), which is a positive side effect from screening?
✔ A. Athlete education and team awareness B. Prevention of injuries C. Prediction of athletic performance D. There are no positive side effects
Justification: Hewett acknowledges screening may not perfectly predict injury, but argues athlete education and team awareness are valuable positive side effects even so.

Q9. You've been approached for musculoskeletal screening of a swimmer. Which tests are most applicable?
A. Shoulder Mobility B. Trunk Stability Push Up C. Hop for Distance ✔ D. A & B
Justification: Swimming (esp. freestyle/butterfly) places the shoulder in compromising positions — both Shoulder Mobility and Trunk Stability Push Up assess shoulder/upper body function. Hop for Distance is for lower limb/return to play assessment.

Q10. A new gym member wants a program for middle-distance running. Which test would be most applicable?
A. Shoulder Mobility ✔ B. Single Leg Squat C. Hop for Distance D. Trunk Stability Push Up
Justification: Single leg squat measures unilateral mobility, stability, and strength — directly indicative of lower limb injury risk for distance runners. Hop for Distance = return from knee injury. Trunk Stability Push Up = upper body specific.

CASE STUDY: SINEAD (NETBALLER – ACL RETURN TO PLAY)

  Background: Sinead, 22, Melbourne Vixens — ACL repair last season. Returning to club netball only. Completed physio rehab (discharged). Feels unstable when turning/jumping. Hip pain and fatigue in opposite hip when jogging. Wants to feel match-ready.

Recommended Assessments & Expected Results:

Assessment	Expected Results	Programming Considerations
Single Leg Squat	↓ Depth (worse on repaired knee); ↑ knee instability (worse repaired knee); lateral pelvic tilt (repaired side as support leg)	Glute activation work (glute max + med, bilaterally) Progressive loading through increasing ROM (bilateral and unilateral) Dynamic and reactive balance work in multiple planes Very light load plyometrics for reactive power and confidence Address outstanding knee/hip/ankle ROM deficits not addressed by physio
Thomas Test + Ely's Test	Positive (tight hip flexors and very tight quads)
Straight Leg Raise	Average result (tending toward tightness)
Prone Hip Extension	↓↓ Glute activation; ↓ hamstring activation; hamstring (+ lumbar) activating first
Deep Squat	↓↓ Depth (<90°?); hip and overall rotation away from repaired side
Y-Balance Test (AMI)	Significantly lower stability on repaired knee (likely ≤1 or ≤89% symmetry between sides)

Privacy & Confidentiality:

Explain how information will be collected, used, and stored to Sinead upfront
Store results in secure location (locked filing cabinet or password-protected database)
Keep accurate and up-to-date records
Obtain consent to record, store, and use personal information

PRESCRIBED & RECOMMENDED READINGS

Prescribed Readings:

Bahr, R (2016). Why screening tests to predict injury do not work — and probably never will: a critical review. British Journal of Sports Medicine, 50(13): 776-780.
Hewett, TE (2016). Response to: 'Why screening tests to predict injury do not work — and probably never will: A critical review'. British Journal of Sports Medicine, 50(21): 1353.
ESSA Code of Professional Conduct and Ethical Practice (pages 7–12).

Cook, G. and Burton, L. (2014). Functional Movement Screening Part 1 & Part 2. International Journal of Sports Physical Therapy, 9(3): 396-409.
Chalmers, S., et al. (2018). Asymmetry during functional movement screening and injury risk: A replication study. Scandinavian Journal of Medicine and Science in Sports, 28: 1281-1287.
Athlete Movement Index (AMI) — PDF resource
USA Tennis High Performance Profile (HPP) — PDF resource

WEEK 2 – INJURY PREVENTION & CORRECTIVE EXERCISE W2

OVERVIEW & LEARNING OBJECTIVES

Injury prevention forms a fundamental part of strength and conditioning for athletes. Sports will have specific injuries known to have higher incidence (e.g. hamstring injuries in AFL, ACL injuries in netball), but not every athlete has the same risk. Injury prevention is about plugging the holes in an athlete's overall S&C so they are best physically positioned to handle the demands of their sport. (HSE302 Learning Module)

Learning Objectives:

Understand the critical characteristics that lead to injuries and implement strategies to prevent them
Employ tools and methods to monitor and evaluate exercise load and progress (mechanical and physiological assessments)
Understand the purpose and benefit of corrective exercises in addressing movement deficiencies

INJURY PREVENTION PRINCIPLES

  Key insight: Injury prevention should NOT be considered separate sessions — it must be formally integrated into all facets of the training program. (Burgess, 2014)

Sports injuries negatively affect performance; remaining injury-free maximises both athlete and team performance (Drew et al., 2016)
Team sports involve high-risk movements (accelerations, decelerations, jumping, landing, tackling, sprinting) — common injury contexts (Burgess, 2014)
Successful prevention strategies should begin at the start of preseason and continue throughout the season
Integrating S&C sessions with appropriate skill session loads during preseason prevents overtraining while preparing athletes for competition demands

Prehabilitation (Prehab)

Common technique used during preseason: regular prehab sessions with proprioception, balance, activation, dynamic and strength exercises (Burgess, 2014)
Can be delivered as team approach (circuit stations — all exposed to same exercises) or individualised (more precise, requires greater staff supervision)
High-risk activities (contact/tackling, high-speed running) must be gradually introduced with frequency and intensity carefully managed
Prehab sessions should be included before the team warm-up and counted within overall training load

ACUTE:CHRONIC WORKLOAD RATIO (ACWR)

  Training-Injury Prevention Paradox (Gabbett, 2016): Historically, high training loads were considered the primary cause of injuries. Recent research has shown that how quickly you reach a high training load is more important than the load itself. Athletes accustomed to high chronic loads actually have FEWER injuries than those training at lower loads.

Component	Definition	Implication
Acute Workload	Past week's training load	Represents current "fatigue"
Chronic Workload	Rolling average of the most recent 4 weeks of training	Represents developed "fitness"
ACWR	Acute ÷ Chronic	Ratio of fatigue to fitness

Safe Zone (0.85–1.35): High chronic workload (fitness) + low acute workload (fatigue) = well-prepared athlete, LOWER injury risk (Hulin et al., 2016)

Danger Zone (>1.5): Acute workload exceeds chronic workload = inadequate fitness base OR rapid workload increase = INCREASED injury risk (Gabbett, Hulin, Blanch & Whiteley, 2016)

Athlete is "underprepared" when acute load spikes above chronic baseline
Athlete is "well-prepared" when chronic load is high and acute load is moderate/lower
Higher intermittent aerobic fitness (assessed by Yo-Yo IR test) offers greater injury protection for soccer players exposed to rapid workload changes (Malone et al., 2017)

INJURY PREVENTION PROGRAMMING

When designing an injury prevention programme, the S&C coach can either target a specific injury or control injury risk factors. (Drew et al., 2016)

1. Specific-Injury Based Prevention

Type	Definition	Example
Primary Prevention	Removal or reduction of causal factors	Pre-season screening
Secondary Prevention	Early injury detection to prevent progression/worsening	Corrective exercise for minor issues
Tertiary Prevention	Reduction of complications and long-term injury burden	Rehabilitation programming

2. Risk Factor Based Prevention

Type	Definition	Example
Universal Prevention	Common risk factors to all (or most) sports	Sleep, nutrition, mental health, training loads
Selective Prevention	Risk modifiers displayed by asymptomatic individuals	Age, sex, sport, training age
Indicated Prevention	Selective + universal risk factors for athletes at higher injury risk	Previous injury history

Important: Training load management is a critical component of all injury prevention programmes. However, athlete load monitoring alone, without concurrent management of training loads, is NOT sports injury prevention. (Drew et al., 2016)

CORRECTIVE EXERCISE PRESCRIPTION

Corrective exercise is an integral part of injury prevention, particularly secondary prevention — preventing movement deficiencies and general weaknesses from progressing to more serious injuries requiring rehabilitation.

Addresses: mobility deficits, stability deficits, muscle imbalances, proprioceptive deficits
Tools such as VALD Digital Health Platform provide exercise databases for prescribing mobility, stability, general strength, and balance/proprioception exercises
Exercise prescription is informed by thorough musculoskeletal screening outcomes

FMS (Functional Movement Screen) — Key Tests & Corrective Strategies

Screening Test	Identified Issue	Possible Deficiency	Corrective Exercises
Deep Squat	Significant anterior translation of arms (in front of line of torso)	Poor glenohumeral and thoracic mobility; Overactive: Pecs, Lats, Anterior Delts; Weak: Scapular Retractors	Wall Slide; Kneeling Thoracic Extension & Lat Stretch; Seated Row
Deep Squat	Marked lumbar flexion and posterior pelvic tilting	Tight: hip flexors, ankle dorsiflexors, hamstrings; Weak: Core (esp. posterior), Glutes	Hip mobility exercises; Ankle dorsiflexion stretches; Core stability (Anti-Flexion); Hip Thrust
Hurdle Step	Marked lateral trunk flexion and significant hip hitching (stepping side)	Poor stance leg stability; Poor step leg strength/mobility (ankle, hips); Poor lateral trunk control	Arabesque/Single Leg RDL; Step Ups/Hip Flexor Stretch; Suitcase Carries
Shoulder Mobility	Unable to get hands within 3 hand lengths bilaterally	Poor glenohumeral and thoracic mobility; likely Rotator Cuff involvement	Wall Slides; Rotator Cuff exercises (IR/ER); T-spine rotation with reach
Postural Assessment	Knees & feet both pointing outwards (~45°); Slight posterior pelvic tilt	Weak: Hip flexors, hip IRs, lumbar extensors; Tight: Glutes, Abdominals, hip ERs, TFL, Hamstrings	Hip internal rotation exercises; Hanging leg raise w/ med ball (adductors); Squat/Deadlift/Back Extension; Hip myofascial release for glutes, TFL, hamstrings; Cobra stretch
Postural Assessment	Excessive kyphosis with forward head carriage; Scapulae excessively protracted (>10cm bilaterally)	Poor T-spine mobility; Tight: Pecs, Anterior Delt, Lats, Neck Flexors; Weak: Scapular retractors	T-spine foam rolling; T-spine rotation with reach; Seated Row; Face Pull; Chest-Supported Row
Ely's Test + Thomas Test	Ely's: heel ~15cm from posterior leg, slight anterior pelvic tilt. Thomas: thigh above table bilaterally; right hip abduction when left leg raised	Tight quads (Ely's); Tight hip flexors (Thomas); Tight TFL (hip abduction); Weak hamstrings & glutes	Knee Flexion exercises (Hamstring Curl, Swiss Ball Hamstring Roll Out); Glute exercises; Hip Extension (RDL, KB Swings)
Prone Hip Extension	Right: significant sustained glute contraction. Left: delayed, weak glute activation; Erector spinae dominant on left	Weak/underactive: Left glute; Tight/overactive: Left erector spinae	Hip Thrust; Clam Shell; Erector spinae myofascial release; Standing forward fold (soft knees)
Y-Balance Test	Movement symmetry <90% bilaterally; notable compensation during lateral reaches (poor balance)	Weak: intrinsic ankle muscles, hip stabilisers (glute med., glute min., piriformis), core	Proprioceptive exercises (foam mat balance); Glute med wall lean; Clamshell with hip extension; Arabesque; Lateral Lunge
Box Drop (Landing)	Marked internal rotation and valgus translation on landing (knees cave in); minimal hip flexion (stiff landing)	Weak: hip abductors and ERs; Tight: hip adductors and IRs; Restricted ankle mobility; Poor landing motor control/eccentric control	RB Glute Bridge/Squat; Clams; Hip mobility circuit; Heel hang stretch; Landing practice exercises; Eccentric-focused squat/good mornings

REHABILITATION PHASES

  Rehabilitation follows injury — exacerbates existing physical limitations and creates new ones that need tracking. Regular assessments targeting injury-influenced areas are critical.

Phase	Focus	Who Manages
Phase 1	Controlling acute symptoms — managing pain and swelling	First response medical staff, athlete, other health professionals
Phase 2	Increasing ROM, basic muscular endurance and strength of affected areas (as tolerated); may include aerobic fitness	Exercise Scientists & S&C Coaches (primary role)
Phase 3	Fully restore ROM, increase strength and endurance, proprioception, aerobic fitness, sport-specific requirements. Re-integrates injured area into whole functional chain.	Exercise Scientists & S&C Coaches (primary role)

Scope of Practice note: Accredited Exercise Scientists (AES) can deliver and supervise (but NOT prescribe) exercise programs for clients with pathology/injury that have been prescribed by an accredited exercise physiologist or physiotherapist.

TELEHEALTH IN EXERCISE DELIVERY

VALD Digital Health is one example of technology used for exercise assessment, prescription, and delivery in-person and online. Telehealth has become popular for clients unable to attend in-person (rural/remote areas, disability, health conditions).

Benefits of Telehealth:

Improved accessibility and convenience
Comfort — clients guided through individualised programs in their own home
Cost-effective
Reduced time-burden

Barriers and Challenges:

Client equipment availability
Technological difficulties (internet access, competency with technology)
Difficulties performing comprehensive physical examinations (e.g. musculoskeletal screening battery)
Security breaches and client privacy concerns

PRACTICAL: MUSCULOSKELETAL SCREENING & CORRECTIVE PRESCRIPTION

Part 1: In pairs, identify TWO appropriate corrective exercises + a progression and regression for each issue identified in screening (Table 1). Alternate roles: Exercise Scientist and Client. Deliver exercises as in a real-world session.

Part 2: Deliver a rehabilitation session. View the physiotherapist's consultation letter for a football player with a right hamstring strain. Choose two exercises from the prescribed program and deliver to partner. Record coaching notes in Table 2 to pass back to the physio.

Example Rehab Notes (Table 2):

Pallof Press: Completed with no hamstring pain/tightness; 2×10 easily completed — consider progressing soon
BB Box Squat: Hamstring tightness/symptoms noted during exercise (5/10 VAS) — regressed to BW Box Squat which reduced symptoms

SEMINAR MCQs WITH ANSWERS

Q1. Which of the following conditions is typically a consequence of overuse/over-training?
A. Bone Fracture during contact B. ✔ Stress Fracture C. Joint Sprain D. Concussion
Justification: Fractures during contact, joint sprains and concussions are acute injuries. Stress fractures result from consistent repetitive loading over time — the hallmark of chronic overuse/overtraining.

Q2. Removal or reduction of causal factors (e.g. pre-season screening) is what type of injury prevention?
✔ A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Quaternary prevention
Justification: Secondary = early detection to prevent worsening. Tertiary = reduce long-term burden. Quaternary prevention is not a defined strategy.

Q3. According to Voskanian (2013), when should an ACL prevention program be initiated?
A. When athlete starts senior sport B. When athlete trains >3 times/week ✔ C. At or prior to onset of puberty D. 2 years after onset of puberty
Justification: Prevents maladaptive neuromuscular and biomechanical patterns from developing in the first place. 2 years post-puberty is too late.

Q4. According to Voskanian (2013), what should an ACL prevention program emphasise?
A. Neuromuscular training B. Plyometrics C. Muscle strengthening ✔ D. All of the above

Q5. All of the following are symptoms commonly related to overtraining, EXCEPT for?
✔ A. Increased hunger and thirst B. Poor quality and/or quantity of sleep C. Persistent flu-like symptoms D. Performance plateau or reduction
Justification: Increased hunger and thirst relate to symptoms after 1–2 sessions in a day. The others reflect negative physiological changes from overtraining.

Q6. According to Gabbett (2016), what does the training-injury prevention paradox refer to?
A. Athletes at high loads have more injuries ✔ B. Athletes accustomed to high training loads have FEWER injuries than athletes at lower workloads C. High loads = greater injury risk D. Low loads = lower injury risk
Justification: Higher chronic training loads have been shown to PROTECT athletes from injury.

Q7. How is the chronic training load defined in the acute:chronic ratio?
A. Rolling average of most recent 6 weeks ✔ B. Rolling average of the most recent 4 weeks of training C. Total load of most recent 6 weeks D. Total load of most recent 4 weeks

Q8. Which definition describes Universal Prevention in risk-factor based injury prevention?
A. Risk modifiers displayed by asymptomatic individuals B. Removal or reduction of causal factors ✔ C. Common risk factors to all or most sports D. Injury detection early to prevent progression

Q9. According to Hulin et al. (2016), which ACWR range was shown to make players more resistant to injury?
A. 0.50–0.75 ✔ B. 0.85–1.35 C. 1.40–1.70 D. >2

Q10. According to Malone et al. (2017), which of the following reduced injury risk of soccer players?
✔ A. Higher intermittent aerobic fitness B. Lower body fat C. Higher anaerobic fitness D. Low chronic training loads
Justification: Higher intermittent-aerobic capacity (Yo-Yo IR test) offers greater injury protection when exposed to rapid workload changes. Injury risk is phase-dependent — lower in-season vs pre-season at similar loads.

CASE STUDY: BLAKE (BASKETBALLER)

  Background: Blake, 17, plays SEABL basketball (AIS scholarship). 6'7", 85kg. Agile but lacks strength. Developing lower back pain and anterior hip tightness/cramping with increased workload, repeated jumping, or "suicide" drills.

Screening Findings:

Assessment	Findings
Postural – Spine & Hips	Excessive lumbar lordosis and thoracic kyphosis with forward head carriage; hips level; no lateral spinal curvature
Postural – Feet & Knees	Low-to-flat arch; kneecaps facing forwards; slight genu valgum; hyperextended knees on standing
Postural – Shoulders	Internally rotated; winging scapulae
Prone Hip Extension	Bilateral glute weakness with inconsistent contraction (worse left); lumbar extensors dominant
Thomas Test	Positive for bilateral hip contractures
Box Drop (Landing)	Excessive pronation and valgus on ground contact; subsequent excessive lumbar lordosis
Running Gait	Very rigid upper body; bilateral pelvic dropping/hitching (coronal plane); low leg clearance with minimal knee height; occasional knee knocks

Issue Interpretation & Corrective Strategy:

Issue Identified	Interpretation/Implication	Corrective Exercises
Excessive lumbar lordosis and thoracic kyphosis	Poor core/spinal stability; tight hip flexors; weak glutes causing anterior pelvic tilt	Prone glute activation; Hip extensions; Glute bridging; Kneeling hip flexor stretch; Open Book Rotations
Slightly knock-kneed (genu valgum); hyperextending knees	Weak glutes/external rotators; tight quadriceps	Calf Raises/Heel hang stretch; Clam shells; Glute bridging; Quad stretch/Hamstring curl
Internally rotated shoulders; winging scapulae	Weak peri-scapular muscles	Rowing; Scapula setting; Y.T.W.L. exercises; Seated Unilateral Banded Row; Banded Pull Apart
Bilateral glute weakness (hip extension pattern)	Weak, poorly activating glutes likely causing the back pain; lumbar extensors compensating	Prone glute activation; Hip extensions; Glute bridging with focus on glute activation dominance; Bird Dog
Bilateral hip contractures (Thomas Test +ve)	Tight hip flexors causing anterior pelvic tilt; contributing to LBP and anterior hip tightness	Kneeling hip flexor stretch; Hip mobility circuit
Box drop: excessive pronation & valgus on landing	Poor lower limb strength and stability to deal with landing force	Assisted Single Leg Squat; Kneeling Banded Chop; Proprioception work (after glute strength and quad flexibility improve)
Running gait: pelvic drop/hitching; rigid upper body	Poor core strength, spinal mobility, hip stability, substantial lower limb weakness	Hip hitching/Standing leg abduction; Assisted single leg squats

Example S&C Session (from Seminar Answer Key):

Exercise	Sets	Reps	Load	Rest	Tempo	Notes
Assisted Single Leg Squat	3	10	BW	60s	2:1:2	Hold sturdy object; can regress to BW squat if needed
Seated Unilateral Banded Row	3	12	—	60s	2:1:2	Upright posture; drive hips to hands; focus on squeezing shoulder blades together
Banded Pull Apart	3	12	—	60s	2:1:2	Reset shoulder blades; keep chest up
Kneeling Banded Chop	3	12	—	60s	Slow/Controlled	Steady breathing; pull belly button into spine/brace core as if expecting impact
Open Book Rotations	3	12	—	60s	Slow/Controlled	Complete ROM that is comfortable
Glute Bridge	3	12	—	60s	2:3:2	Focus on glute contraction; 3-second pause to maximise glute engagement
Clam Shells	3	12	—	60s	2:1:2	Complete ROM that is comfortable; can progress with resistance band above knees
Bird Dog	3	12	—	60s	2:1:2	Slow and controlled; avoid excessive arching of the spine

Programming Notes: Start at higher volume, low intensity (build endurance). Future programs: transition to low volume, moderate intensity, very slow tempo (time under tension for strength). Emphasise technique, correct activation, and postural setting.

PRESCRIBED & RECOMMENDED READINGS

Prescribed Reading:
Voskanian, N (2013). ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Current Reviews in Musculoskeletal Medicine, 6(2): 158-163.

Gabbett, TJ (2016). The training-injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine, 50(5): 273-280.
Hulin, BT., Gabbett, TJ., Lawson, DW., Caputi, P and Sampson, JA (2016). The acute:chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. British Journal of Sports Medicine, 50(4): 231-236.
Malone, SM., Owen, A., Newton, M., Mendes, B., Collins, KD and Gabbett, TJ (2017). The acute:chronic workload ratio in relation to injury risk in professional soccer. Journal of Science and Medicine in Sport, 20(6): 561-565.

WEEK 3 – EXERCISE PRESCRIPTION FOR SPORT W3

OVERVIEW & LEARNING OBJECTIVES

  Topic: Sport specificity in exercise training and assessment; ACSM progression models for resistance training; the coach–athlete relationship.

Sport specific training is achieved by designing sessions that replicate similar movement patterns or activate the same muscle groups required for specific sport skills, ensuring that adaptations (strength, power) directly influence performance and general athlete preparedness. Sport specificity also applies to assessment — testing should reflect the demands of the sport.

Learning Objectives:

Understand the importance of sport specificity in programming and exercise assessments for sport
Understand how a sport specific approach to exercise training and testing can be implemented to benefit elite and sub-elite athletes
Understand how to build and develop a coach–client relationship

SPORT SPECIFICITY IN TRAINING & TESTING

The principle of specificity states that the greatest adaptations occur when resistance training programs are specific to the task or activity. (ACSM, 2009)

Sport-Specific Performance Attributes:

Attribute	Key Evidence
Vertical Jump	Highly correlated with force production during isokinetic and dynamic exercises. Closed-chain exercises (squats) correlate more strongly (r = 0.72 VJ; r = 0.65 standing long jump) than open-chain. Olympic lifts (total-body multi-joint) more effective for VJ improvement than traditional strength training. Best approach: combine heavy + light-to-moderate loading with fast rep velocity, moderate-to-high volume (4–6 days/week) + plyometric training. (Evidence category B, ACSM 2009)
Sprint Speed	Correlates with force production (especially isokinetic velocities >180°/sec). Relative strength (relative to body mass) strongly correlates with sprint velocity, acceleration, jump squat height and power (r = 0.88). Maximal strength alone does not significantly reduce sprint time; hip flexor strength training can help. Combining strength + sprint training yields the greatest improvements. (Evidence category B, ACSM 2009)
Agility	Muscular strength important for quick direction changes. Lower-body multi-joint exercises correlate with agility tests. Peak eccentric hamstring force (90°/sec) correlates with agility. Agility-specific training more effective than RT alone; RT alone produces mixed results.
Sport-Specific Activities	Soccer: kicking limb strength correlates with ball velocity. Baseball/Handball: RT improves throwing velocity 2.0–4.1%. Shot put, golf, swimming, tennis: RT improves performance across all.

Absolute vs Relative Strength:

Type	Definition	When to Prioritise
Absolute strength	Maximal force that can be produced (or load lifted) irrespective of body mass	Athletes where body mass is not a concern; contact sports requiring maximal force output
Relative strength	Amount of force/load lifted relative to body mass	Weight-restricted sports (wrestling, boxing, powerlifting); running-based sports where extra mass (even muscle) may be disadvantageous. Achieved via high-intensity, low-volume (non-hypertrophic / neural) training.

ACSM PROGRESSION MODELS – RESISTANCE TRAINING FOR HEALTHY ADULTS

Source: Ratamess et al. (2009). ACSM Position Stand. Medicine and Science in Sports and Exercise, 41(3): 687–708.

Three Core Progression Principles:

Progressive Overload – gradual increase of stress placed upon the body. Variables that can be manipulated: exercise intensity (load), total repetitions at current intensity, repetition speed/tempo, rest period length, or training volume (total reps × resistance)
Specificity – adaptations are specific to the stimulus applied, determined by: muscle actions involved, speed of movement, range of motion, muscle groups trained, energy systems involved, intensity and volume
Variation (Periodisation) – systematic process of altering program variables over time to keep the stimulus challenging and effective

Load Progression Rule: A 2–10% increase in load is recommended when the individual can perform the current workload for 1–2 repetitions over the desired number on two consecutive training sessions. (ACSM, 2009 – Evidence Category A)

Exercise Sequence Recommendations:

Large muscle groups before small muscle groups
Multiple-joint exercises before single-joint exercises
Higher-intensity before lower-intensity exercises

MUSCLE ACTIONS: ECCENTRIC VS CONCENTRIC VS ISOMETRIC

Action	Description	Key Properties
Concentric (CON)	Muscle shortening under load	Most common in traditional RT; dynamic
Eccentric (ECC)	Muscle lengthening under load	Produces greater force per unit of muscle size than CON or ISOM Less metabolically demanding than CON (requires less motor unit activation per load) More conducive to hypertrophic adaptations Results in more pronounced DOMS compared to CON ECC isokinetic training produces greater muscle action-specific strength gains than CON training
Isometric (ISOM)	No net change in muscle length	Secondary role (stabilisation, core, grip, pauses in movement); beneficial for low back health and spinal stabilisation musculature

Common MCQ trap: Eccentric actions are less metabolically demanding (not more), produce more force per unit of muscle size, and result in more pronounced DOMS — the opposite of what might seem intuitive.

ACSM PRESCRIPTION SUMMARY – BY TRAINING GOAL

Goal	Novice	Intermediate	Advanced
Muscular Strength	8–12 RM; 1–3 sets; 2–3 days/week; moderate velocity (1–2s CON, 1–2s ECC)	Wider range 1–12 RM (periodised); 3–4 days/week	Emphasise heavy loading 1–6 RM; 3–5 min rest; 4–5 days/week; continuum of velocities (unintentionally slow to fast)
Muscle Hypertrophy	Similar to strength; multiple-set programs recommended for maximising hypertrophy	1–12 RM periodised; emphasis on 6–12 RM zone; 1–2 min rest; moderate velocity	Higher volume, multiple-set programs; 6–12 RM; 1–2 min rest
Muscular Power	Strength training foundation first	Light loads (0–60% 1RM lower body; 30–60% 1RM upper body) at fast contraction velocity; 3–5 min rest; 3–5 sets; multiple-joint total-body exercises	3–6 sets; 2–3 min rest; 30–60% 1RM (upper body); 0–60% 1RM (lower body); 4–5 days/week
Local Muscular Endurance	Light to moderate loads (40–60% 1RM); high repetitions (9–15+); short rest (<90 sec)

Training Frequency Summary:

Training Status	Recommended Frequency
Novice (no RT experience or not trained for years)	2–3 days/week
Intermediate (~6 months consistent RT experience)	3–4 days/week
Advanced (years of RT experience)	4–5 days/week (advanced athletes may use split routines up to 4–6 sessions/week)

Strength–RM Relationship: To improve maximal strength, heavier loads (lower RM) are required as athletes advance. For a 3–5 RM prescription = advanced strength/power development. 10–12 RM = hypertrophy/beginner strength.

PERIODISATION MODELS

Model	Description	Best Used For
Classical / Linear	Starts with high volume + low intensity; progressively volume decreases and intensity increases. Peak performance narrow window at end.	General population; beginner to intermediate; most sports off-season development
Reverse Linear	Inverse of classical — intensity highest initially, volume lowest; then intensity decreases and volume increases over time.	Local muscular endurance goals (shown superior for LME)
Undulating (Non-linear / Daily Undulating Periodisation – DUP)	Rotates heavy, moderate and light loads (e.g., 3–5 RM, 8–10 RM, 12–15 RM) within a training week or cycle. Enables variation in intensity AND volume within the same mesocycle.	Intermediate to advanced athletes; superior strength increases over 12 weeks vs classical; shown effective across multiple fitness objectives

Typical Periodised Phases (for sport):

Phase	Focus
Preparatory Phase 1	Hypertrophy, muscular endurance; moderate intensity, moderate-to-high volume
Preparatory Phase 2	Basic and maximal strength; high intensity, low-to-moderate volume
Preparatory Phase 3	Strength and power; high intensity, low volume; explosive and dynamic movements
Competition Phase	Structured around competition; incremental and undulating loading; maintenance
Transition Phase	Reducing volume and intensity to promote recovery, rest and rehabilitation

SPORT-SPECIFIC APPLICATIONS

Soccer (Yu et al. 2021):

Strength is a main component of power, muscular endurance, and agility — but NOT flexibility
In-season strength and power training is important for maintaining physical qualities through a congested schedule
Sport-specific sessions prioritise multi-joint movements that replicate soccer demands (acceleration, deceleration, kicking, contact)

American Football (Jalilvand et al. 2019):

Physical demands vary significantly by position (e.g., linemen need maximal strength/mass; running backs need speed-strength; receivers need power and agility)
Pre-season microcycles integrate multiple biomotor qualities; session structure differs substantially from soccer due to position-specific needs

Endurance Running (Karp 2010):

Strength training for distance runners should focus on muscular endurance and power-type training rather than maximal strength/hypertrophy (which adds body mass)
Power-type strength training (plyometrics, explosive movements) improves running economy
Sample program uses moderate loads and higher repetitions; prioritises running-specific muscle groups

TESTING STRENGTH & POWER IN SOCCER (Paul & Nassis, 2015)

Source: Paul, DJ & Nassis, GP (2015). Testing strength and power in soccer players. Journal of Strength and Conditioning Research, 29(6): 1748–1758.

1RM Testing in Soccer:

Free barbell tests better reflect functional strength compared to isokinetic dynamometry
1RM should be achieved within 4 consecutive attempts to ensure validity and reduce fatigue effects
Regular re-evaluations needed as strength increases; new equations required when changing facilities/modalities
Barriers to 1RM testing in soccer: time constraints, logistics, skill requirement, injury apprehension during season
Submaximal repetitions can predict 1RM (high correlation) but errors may occur for players with limited strength training experience
In semi-professional players: moderate correlation (r ≈ 0.50) between 1RM and CMJ (countermovement jump)
Isometric knee extensor force showed better correlation with CMJ and isokinetic peak torque

Power Testing (CMJ) in Soccer:

Countermovement jump (CMJ) is the most commonly used power test — high familiarity, match relevance
Intraday reliability is stable; test-retest over consecutive days more variable (same-day retest may not be independent)
Vertical jump and isokinetic dynamometry show moderate correlation (r = 0.51) but are independent measures
Bilateral asymmetry may result from strength differences, muscle imbalances, or technique — may be statistically significant but not always clinically meaningful
Running and agility generate unilateral forces; may not correlate strongly with bilateral VJ performance
Large strength increases do not always immediately translate to improved match performance

  Key exam point: The moderate relationship (r = 0.50) reported between 1RM and CMJ in semi-professional soccer players (Paul & Nassis, 2015) is a frequently tested fact.

COACH–ATHLETE RELATIONSHIP IN STRENGTH & CONDITIONING

Source: Foulds, SJ., Hoffmann, SM., Hinck, K., and Carson, F (2019). The Coach–Athlete Relationship in Strength and Conditioning: High Performance Athletes' Perceptions. Sports, 7(12): 244–255.

The 3+1 C's Model (Jowett, 2007):

A framework for understanding quality coach–athlete relationships. Higher quality = greater athletic outcomes.

Dimension	Definition	Key Higher-Order Themes (from Foulds et al. 2019)
Closeness	Depth of connection — how trust, like, respect, and appreciation are expressed	Trust (built over time, via 1-on-1 time and seeing positive results); Like (mateship with acknowledged boundaries); Respect (active listening, time management, showing care for athlete's improvement); Appreciation (acknowledging effort, social media recognition, conversations beyond sport); Care (individualised programming, holistic awareness)
Commitment	Desire to maintain the relationship over time	Positive outlook (mutual goal setting, future planning); Shared experience (support, availability, "above and beyond"); Athlete-centred focus (adjusting loads based on feedback, training variations)
Complementarity	Interaction perceived as cooperative and effective	Adaptability (adjusting approach to athlete needs); Autonomy-supportive motivational climate; Role model traits (coach credibility via past achievements and reputation)
Co-orientation	Degree to which coach and athlete can accurately infer each other's feelings, thinking, and behaviours (reciprocal understanding)	Teamwork; Personality traits; Effective communication

Key Findings from Foulds et al. (2019):

56 raw data themes identified across the 3+1 C's framework from 12 high-performance athletes
Trust was built over time, particularly in one-on-one scenarios (especially during return-to-play from injury)
Athletes desired a mateship with coaches but acknowledged the importance of professionalism and boundaries
Coach credibility (past achievements, who they work with, results achieved) was important, particularly when athletes did not select the coach themselves
S&C coaches have more opportunity than general sports coaches to create 1-on-1 situations, set mutual goals, and have conversations beyond sport (especially during rehab/return-to-play)
Athletes valued acknowledgement of effort, follow-up contact outside of sessions, and a coach's ability to recognise the whole person (holistic awareness)
The S&C coach–athlete relationship is dyadic (both parties influence it), not unidirectional

Building rapport in practice: Mutual goal setting; individual attention; demonstrating genuine care beyond training outcomes; consistent communication; acknowledging athlete's effort and results; adapting programming based on athlete feedback and readiness.

PRACTICAL: CORE COMPOUND EXERCISES, ASSESSMENT & PROGRESSIONS

1RM Assessment Considerations:

Explain the assessment and its purpose clearly to the client beforehand
Ensure client is proficient with the lift before 1RM testing to reduce injury risk and improve reliability
1RM should ideally be achieved within 3–5 attempts to minimise fatigue effects
Maintain privacy and confidentiality of results and programming notes
Note technique observations for programming (e.g., sticking points, compensation patterns)

Core Compound Exercise Technique Cues:

Exercise	Key Setup	Key Cues
Back Squat	Bar on upper traps; hands just outside shoulder-width; feet shoulder-width, slightly turned out (10pm/2pm position)	"Push the floor away" \| "Knees in line with toes" \| "Chest up, stay tight"
Deadlift	Hip-width stance; shoelaces under bar; set the lats ("squeeze oranges in armpits"); inhale and brace before pull	"Set your lats" \| "Drive hips forward, squeeze glutes" \| "Push the floor away"
Bench Press	3 points of contact (head, glutes on bench, feet on floor); eyes under bar; slight back arch; overhand grip slightly wider than shoulder-width	"Breathe in on way down, snap the bar in half" \| "Breathe out on way up, punch the ceiling"
Military Press	Feet hip-width, slight knee bend; elbows stacked under wrists at ~45°; proud chest, neutral spine; core set	"Punch the sky" \| "Bar up and back" \| "Keep back straight"
Pull Up (overhand)	Overhand grip just outside shoulder-width; arms extended, lats set, proud chest	"Elbows into pockets" \| "Squeeze shoulders down" \| "Chest to bar"

Progressions & Regressions Table:

Regressions = reduce balance, ROM, coordination, or mobility demands. Progressions = increase them.

Core Exercise	Regression 2	Regression 1	Progression 1	Progression 2
Squat	Sit to stand / Assisted squat (TRX)	Goblet squat / Box squat	Front squat / Split squat	Overhead squat / Pistol squat
Deadlift	Hip hinge / Elevated deadlift	Romanian deadlift (RDL) / Rack pull / Trap bar deadlift	Snatch grip deadlift / Deficit deadlift	Single-leg RDL / B-stance RDL
Bench Press	Wall push-up / Machine chest press	Push up / Floor press / Pin press (reduced ROM)	Close grip bench press / Pause bench press	Single-arm DB bench / Ring push-up
Military Press	Wall slide / Machine overhead press	Seated DB press / Landmine press	Push press / Standing DB press	Split jerk / Push jerk
Pull Up (overhand)	Lat pulldown / Dead hangs	Band assisted pull up / Negative pull up	Weighted pull up / Chest to bar pull up	Muscle up / One-arm pull up

MCQ trap (squat progressions): Leg Press and Goblet Squat are regressions (reduce stability demand). Squat Jumps are the progression (add explosive/power element). Rack Pull works a different movement pattern entirely (hip extension, posterior chain).

3 Stages of Communication & Skill Delivery (from Practical):

Stage	Objective	Coach Behaviours	Example Cues (Squat)
Stage 1: Establish coordination pattern	Introduce exercise; build basic movement understanding	Explain purpose ("why"); keep instructions simple; demonstrate clearly (2–3 times); 2–3 key focus points; allow practice with minimal complexity; basic feedback on safety & gross technique	"Push your hips back." \| "Keep your chest tall." \| "Push through your heels."
Stage 2: Gaining control of coordination pattern	Perform consistently with good control; slightly more demanding conditions	Reinforce learned cues; correct major movement errors; improve control via tempo/pauses; introduce simple progressions; build confidence under greater demands	"Control the way down." \| "Keep your knees tracking over toes." \| "Stay balanced through mid-foot."
Stage 3: Optimising the coordination pattern	Refine technique for efficiency, performance, and individual goals	More detailed and individualised feedback; progress load/complexity/training intent; introduce goal-specific progressions (strength, hypertrophy, power, endurance); challenge learner while maintaining quality	"Drive hard out of the bottom." \| "Push the floor away faster." \| "Stay tight before you descend."

SEMINAR MCQs WITH ANSWERS – WEEK 3

1. Which most accurately describes a recommended method for progression when training to improve muscular strength?
A. Decrease sets from multiple-set to single-set programs
B. Increase frequency from 1 day/week (beginner) to 6 days/week (intermediate)
C. ✓ C. A 2–10% load increase when the individual can perform 1–2 reps over desired number on two consecutive sessions
D. Decrease movement velocity from explosive (beginner) to unintentionally slow (advanced)
ACSM guidelines: progress from 1–3 sets (novice) to multiple sets (advanced); frequency: 2–3 (novice) → 3–4 (intermediate) → 4–6 (advanced) days/week; advanced training uses a continuum of velocities including fast concentric; 2–10% load increase is the evidence-based rule for progression.

2. Which statement is correct regarding eccentric muscle actions compared to concentric and isometric contractions?
A. They are less conducive to promoting hypertrophic adaptations
B. ✓ B. They produce greater force per unit of muscle size
C. They are more metabolically demanding
D. They result in less pronounced DOMS
Eccentric: produce MORE force per unit of muscle size; LESS metabolically demanding (fewer motor units per load); MORE conducive to hypertrophy; MORE pronounced DOMS. All opposite to common assumptions.

3. A moderate relationship (r = 0.50) is reported between which two performance tests in semi-professional soccer players? (Paul & Nassis, 2015)
A. 1RM and vertical jump B. ✓ B. 1RM and CMJ C. Vertical jump and 15m sprint time D. 1RM and VO2max
Paul & Nassis (2015) specifically report moderate correlation (r ≈ 0.50) between 1RM and CMJ (countermovement jump) in semi-professional players.

4. RT prescription for improving maximal strength when progressing from beginner to intermediate/advanced should include:
A. ✓ A. Fewer repetitions per set, heavier loads
B. More repetitions, lighter loads
C. Fewer repetitions, lighter loads
D. More repetitions, heavier loads
Load is inversely proportional to rep range. Heavier loads (lower reps) are required for maximal strength development, especially in more advanced athletes where lighter loads no longer provide sufficient stimulus.

5. According to Yu et al. 2021, strength is NOT considered a main component for which biomotor ability?
A. Power B. Muscular endurance C. Agility D. ✓ D. Flexibility
Strength contributes to power, muscular endurance, and agility. Flexibility is predominantly determined by structural properties of connective tissue and is not a primary strength component.

6. You are writing a program for an athlete (e.g., sprinter) looking to improve strength without adding much muscle mass. What should the program focus on?
A. Strength via increase in muscle mass
B. ✓ B. Relative strength
C. Only absolute strength
D. Strength via high-volume training
Relative strength = force relative to body mass. Achieved via high-intensity, low-volume (non-hypertrophic) training that emphasises neural adaptations. Adding muscle mass (even via absolute strength training) may disadvantage locomotor performance in running-based sports.

7. Which is an appropriate prescription for an advanced athlete looking for further development in strength or power?
A. 10–12 RM B. 8–10 RM C. 15–20 RM D. ✓ D. 3–5 RM
Advanced athletes require higher training intensities (lower RM ranges) to continue making strength/power gains. Higher RM ranges are insufficient for advanced individuals who have already adapted to moderate loads.

8. According to ACSM, which combination is most suitable for training muscular power in advanced individuals?
A. 1–2 sets, 5–6 min rest, 0–60% 1RM, 2 days/week
B. ✓ B. 3–6 sets, 2–3 min rest, 30–60% 1RM, 4–5 days/week
C. 3–6 sets, 30 sec rest, 85–100% 1RM, 2 days/week
D. 1–2 sets, 2–3 min rest, 0–60% 1RM, 3–4 days/week
Advanced power: 3–6 sets; 2–3 min rest (5–6 min is excessive; 30 sec insufficient); 30–60% 1RM upper body, 0–60% 1RM lower body; 4–5 days/week. 2 days/week = novice frequency; 3–4 days/week = intermediate.

9. According to ACSM, how can training volume be altered in resistance training?
A. ✓ A. Changing the number of exercises, reps or sets performed
B. Reducing rest period duration
C. Changing the type of exercises performed
D. Changing exercise tempo, reps or sets
Volume = total reps × resistance. Changing the number of exercises, reps, or sets directly changes the amount of work completed. Rest periods, exercise type, and tempo affect intensity/stimulus but not volume per se (volume is defined as total work).

10. Which exercise is a suitable progression for a barbell back squat?
A. Leg Press B. ✓ B. Squat Jumps C. Goblet Squat D. Rack Pull
Squat Jumps introduce an explosive/power element as a progression. Leg Press = regression (removes stability). Goblet Squat = regression (load more anterior, less spinal loading). Rack Pull = different movement pattern (hip extension/posterior chain, not a squat variant).

CASE STUDY: GEORGE (RUGBY UNION)

  Context: George, 17 years old, elite junior half-back. Height 172cm, Weight 74kg. Undersized for position and below average in conditioning. Limited RT experience. Needs strength/power development to transition to elite level.

Assessment Results:

Test	George's Result	Age Average	Assessment
Vertical Jump	30 cm	37.8–42.2 cm	Below average
40m Sprint	7.90 sec	6.35–6.89 sec	Below average
1RM Leg Press	120 kg	—	(Used instead of squat — uncomfortable with 1RM squat)
1RM Bench Press	80 kg	—	Limited upper body strength
Max Pull Ups	4 (kipping)	—	Poor technique, limited pulling strength

Building Rapport (applying Foulds et al. 2019):

Establish trust through 1-on-1 time; show consistent interest in George as a whole person (not just athlete)
Set mutual goals with George; explain the rationale behind every exercise and program decision
Acknowledge effort and results; provide regular positive feedback
Be adaptable — adjust loads/approach based on George's daily readiness and feedback
Maintain appropriate boundaries while building a mateship
Demonstrate credibility through professional behaviour and knowledge; be present and attentive during sessions

Prescribed S&C Session (addressing weaknesses, sport-specific):

Exercise	Sets / Reps / Load / Tempo	Rationale
Kettlebell Swing	3 × 8 @ 12–15 RM – 1:0:X (explosive concentric)	Develop lower-body power and hip extension capacity to improve acceleration, sprint speed, and vertical jump (key identified weaknesses)
Goblet Squat	3 × 10 @ ~12 RM – 2:1:2	Build foundational lower body strength to address undersized physique and improve force production for sprinting, tackling, and contact situations. Goblet squat chosen as a regression from back squat — appropriate for novice.
Barbell Bench Press	3 × 10 @ ~60–70% 1RM – 2:1:2	Develop upper body strength for contact, tackling, and physical competitiveness against larger opponents
Romanian Deadlift (RDL)	3 × 10 @ ~12 RM – 2:1:2	Improve posterior chain strength (hamstrings, glutes) for sprint speed, acceleration, and hamstring injury prevention in a developing rugby athlete
Bent-Over Row	3 × 10 @ ~12 RM – 2:1:2	Develop upper back strength to address pulling strength deficit (poor pull-up performance) and enhance contact stability and injury resilience
Sled Pushes	3 × 10 metres @ RPE 7–8/10	Develop horizontal force production and conditioning specific to rugby acceleration, repeated efforts, and contact situations

Programming rationale: As a novice lifter, George uses moderate loads (12–15 RM) and controlled tempos (2:1:2) to develop technique and foundational strength before progressing to heavier loads. The goblet squat and RDL are appropriate regressions/introductory exercises. Explosive movements (kettlebell swing, sled pushes) address George's power and sprint deficits which are the most critical weaknesses for his rugby position.

PRESCRIBED & RECOMMENDED READINGS – WEEK 3

Prescribed Readings (Examinable):

Reference	Key Sections	Topic
Ratamess, NA et al. (2009). ACSM Position Stand: Progression Models in Resistance Training for Healthy Adults. Medicine and Science in Sports and Exercise, 41(3): 687–708.	Relevance to Sports Applications (pp. 11–12); Table 2 — summary of prescription recommendations (p. 13)	Evidence-based RT prescription for strength, power, hypertrophy, and endurance; sport applications (VJ, sprint, agility); progression principles; eccentric vs concentric; periodisation models
Foulds, SJ., Hoffmann, SM., Hinck, K., and Carson, F (2019). The Coach–Athlete Relationship in Strength and Conditioning: High Performance Athletes' Perceptions. Sports, 7(12): 244–255.	Results, Discussion and Conclusion sections	3+1 C's model (closeness, commitment, complementarity, co-orientation); 14 higher-order themes; building trust, rapport, and effective relationships in S&C contexts

Reference	Key Sections	Topic
Paul, DJ & Nassis, GP (2015). Testing strength and power in soccer players: The application of conventional and traditional methods of assessment. Journal of Strength and Conditioning Research, 29(6): 1748–1758.	'Repetition Maximum' and 'Power' headings	1RM testing in soccer (validity, reliability, practicality); CMJ for power assessment; bilateral asymmetry; correlations between tests (r = 0.50, 1RM vs CMJ)
Yu, L., Altieri, C., Bird, SP., Corcoran, G and Gao, J (2021). The importance of in-season strength and power training in football athletes. IJSC, 1(1).	'Performance Attributes for Football' and 'Strength and Power Training' sections; example session (p. 5)	Sport-specific training recommendations for soccer; biomotor abilities; in-season programming
Jalilvand, F., Chapman, DW and Lockie, RG (2019). Strength and conditioning considerations for collegiate American football. Journal of Australian Strength and Conditioning, 27(2): 72–85.	Table 1 (p. 5) — typical roles and physical qualities by position; Table 7 (p. 15) — pre-season microcycle for advanced running back	Position-specific physical demands; sport-specific S&C programming; comparison to soccer demands
Karp, JR (2010). Strength training for distance running: A scientific perspective. Strength and Conditioning Journal, 32(3): 83–86.	Table 1 (p. 2) — sample strength training program; 'Power-Type Strength Training' heading	Strength training for endurance runners; power-type training to improve running economy; contrast with team sport demands

OVERVIEW & LEARNING OBJECTIVES

  Topic: Group Training – circuit training design, skill instruction, group management, and reflective practice.

Compared with individual training, group training imposes physical, intellectual, and social challenges on participants. Key benefits of group training include (Bailey, 2013):

Encourages co-operation and enables participants to learn from one another
Removes the stigma of failure and encourages involvement of everyone
Enables participants to respect others' strengths and weaknesses
Focuses on processes required to complete exercises and drills
Particularly effective for problem-solving activities and small-sided games

Learning Objectives:

Recognise the potential benefits and challenges of conducting group training sessions
Understand key considerations when conducting group training sessions, including the organisation, instruction, and supervision of groups to ensure sessions are conducted in a safe and effective manner
Apply this knowledge to design group-based exercise sessions for distinct groups of clients with various health, fitness and sports performance goals

CIRCUIT TRAINING: TYPES & DESIGN

Circuit training is a common, versatile form of group training involving a series of carefully selected exercises. It can be used to develop a specific component of fitness, skills for a sport, or for specialist populations, and can be adapted to suit a wide range of fitness levels. (Lawrence & Hope, 2011)

Two Main Circuit Types:

Type	Description	Example
Time-controlled circuit	Time dictates work-to-rest ratio. All participants move on together; no queues between stations.	45 sec work : 15 sec rest (total 1 min per station)
Repetition-controlled circuit	Coach sets the number of repetitions for each exercise before moving on. Can lead to queues if abilities differ — use a control exercise in the middle to manage this.	12 or 14 reps per exercise

Methods of Controlling Work Time (Lawrence & Hope, 2011):

Stopwatch-timed – same work/rest for all; coach may watch clock rather than participants
Exercise station-timed – a set station (e.g., shuttle runs) dictates pace; gives coach freedom to observe
Music tape-timed – work/rest dictated by music; frees coach to observe; cannot easily increase duration as participants progress
Lighting system-timed – traffic light system signals start/change
Split group (pairs) – one partner does circuit station, other does control exercise; excellent for combining cardiovascular and strength endurance
Repetition-prescribed by teacher – one set rep number (e.g., 20 reps); different intensities can be offered
Repetition-selected by participant – participant chooses from a range (e.g., 8, 12, 16 or 20 reps)

Progressive Circuit Training Formats:

Format	Description
Work, rest & play	Alternates work stations with active rest or game-based activities
Competition circuit	Participants in pairs of similar ability compete against each other; rep counts recorded to allow self-comparison
Colour circuit	Exercise cards colour-coded by difficulty (e.g., green = easy, blue = moderate, red = hard) to allow simultaneous multi-level training
Giant sets circuit	Four body parts/muscle groups; 3–4 exercises per group; stay at one station and complete all exercises before moving on
Super sets circuit	Similar to giant sets but uses opposing muscle groups at each station (e.g., abs + erector spinae; triceps + biceps)
Stage/Sets circuit	Visit the same station 2–4 times before moving on; allows specific muscle loading; intermediate step between circuit and weight training. Training reps = 50% of maximum reps achieved in testing.
Individual circuit	Three phases: Teaching → Testing (find max reps per station) → Timing (complete 3 laps at full speed, record time, set target). Highly individualised.

Circuit Layout & Arrangement:

The layout should accommodate the number of participants and cater for different abilities. Factors influencing format choice: fitness level, age, ability, class numbers, space, environment, and equipment available. (Lawrence & Hope, 2011)

STAGES OF LEARNING A SKILL

According to the ASCA (2017), based on Fitts & Posner (1967), there are 3 stages of learning a skill:

Stage	Name	Description	Duration
Stage 1	Early / Cognitive	Athlete has to think about how to perform the skill. Uses visual depiction + 2–3 verbal cues to attempt to replicate the master performance.	A few sets up to several weeks
Stage 2	Intermediate / Associative	Athlete has some control over the skill but it is not yet reflex-based. Uses internal (kinaesthetic) control + visual processes.	A few sets up to several weeks
Stage 3	Advanced / Final / Autonomous	Skill is reflex-based within the athlete's neural circuitry — becomes automatic.	Weeks to months for a novice

Memory Aid: Stages in order = Cognitive → Associative → Autonomous (CAA). Think "Can't Always Automate."

5-Step Approach for Introducing a New Exercise (Cognitive Stage):

Name the skill to be learnt
Demonstrate the skill two or three times
Identify two or three points for the athlete to focus on
Demonstrate the skill a number of times again so the athlete can look for key points stressed by the coach
Get the athlete/client to practice the skill

Common MCQ trap: "Avoid letting the client practice the movement to avoid injury" is the INCORRECT step — practice is essential and IS part of the 5-step approach.

Learning Styles:

Visual – by watching ("show me that again coach")
Kinesthetic – by feel ("let me try that again coach")
Audio – by listening ("explain that again coach")

COACHING NOVICE VS ADVANCED ATHLETES

Aspect	Novice Athletes	Advanced Athletes
Instruction approach	Avoid lengthy verbal descriptions; use visual demonstration + 2–3 verbal cues; don't overload with information	5-step approach not needed — already mastered fundamentals; new exercises are extensions/variations of prior skills
Practice conditions	Allow plenty of practice in low-stress situations (e.g., very light loads for strength, slow speeds for speed drills) — helps grasp kinaesthetic feel	New skills taught via "chaining" (linking previously learnt parts) and "shaping" (refining into final complex skill); part-whole method
Feedback priority	Knowledge of Results (the outcome) > Knowledge of Performance (how they did it) — specifics of execution less important at this stage	Both types of feedback appropriate; can incorporate knowledge of performance more readily
Feedback timing	Only at completion of the skill or set	During a repetition (if necessary)

Feedback Timing by Stage:

Stage	When to Provide Feedback
Cognitive (novice)	Only at the completion of the skill or set
Associative (intermediate)	Between repetitions, during a set (if necessary)
Autonomous (advanced)	During a repetition (if necessary)

COMMUNICATION, FEEDBACK & CUES

3-Step Feedback Procedure (to reinforce good technique at any stage):

Simple, positive praise (e.g., "good rep", "well done", "excellent")
Positive reinforcer (e.g., "good chest position", "great knee lift")
Corrective reinforcer if needed (e.g., "keep your chest up more", "need to lift knee higher")

Characteristics of Effective Feedback (ASCA, 2017):

Quality	Description
Specific	Relates to the athlete's performance relative to the components of the task they were asked to perform
Constructive	If identifying an error, provides reasons and possible solutions
Immediate	An athlete retains memory of their performance briefly — quick feedback is important
Clear	Athletes must understand exactly what is required
Positive	Should be positive and encouraging; avoid negative feedback to prevent discouragement

  Coaching Cues: Key words or phrases used prior to/during an exercise to reinforce key technical points. Using 2–3 single-word cues is typically sufficient. E.g., for a squat: "Chest up | Knees out | Sit deep"

Avoid: Extensive feedback (overloads novices), delayed feedback (athlete loses memory of execution), and negative feedback (undermines confidence and motivation).

ORGANISATION OF GROUPS

Group Size Considerations:

Larger groups: Greater social and strategic challenge
Smaller groups: Greater opportunity for participation and physical activity
Useful strategy: practise skills initially alone or in pairs, then progress to larger groups

Bases for Forming Sub-Groups (Bailey, 2013):

Ability | Gender | Developmental stage | Friendship | Random

NOT recommended: Appointing "captains" who then select players — this leaves less-skilled individuals last, leading to feelings of rejection and humiliation.

ASCA (2017) Recommendations for Group Organisation:

Coach-to-athlete/client ratio: 1:15 or less for the most effective coaching
Sub-groups of 2–4 athletes/clients of similar capabilities help organisation
Precise programming (exact work:rest periods, start times) also aids effective organisation

Strategies for Large Groups (Space/Equipment Limitations):

Strategy	Example
Split training with skill/specialist coach	In soccer: skill coach takes 8 players for 4v4 small-sided game, fitness coach takes 8 for speed/conditioning for 15 min, then groups swap
Stagger start times	One group starts in gym at 4:00 PM, next group starts at 4:30 PM
Stagger exercise order	Half group starts with lower body exercises, other half starts with upper body — switch for next session

Effective Planning Considerations:

Time – available to run the session
People – number and characteristics of those involved
Equipment – available (including space)
Interaction of all these factors in a dynamic atmosphere

PROMOTING ENGAGEMENT IN GROUP ACTIVITIES

Greater time engaged in activities = greater learning. Principles for maintaining engagement (Bailey, 2013):

Establish and reinforce efficient routines
Be clear about expectations of behaviour, supported by workable control strategies
Delegate tasks: use athletes/clients to help set up/pack away apparatus, distribute/collect equipment
Be brief and to-the-point with verbal instructions
Identify possible causes of disruption and plan strategies to address them (transitions between phases, queuing, waiting)
Include expected time allocations for different activities in the lesson plan
Evaluate the appropriateness of your timings after each session

Reflective Practice:

Reflective practice enables improvement by examining what worked well and what could be done better next time. Key steps:

Description: What has happened?
Feeling: What were you thinking and feeling?
Evaluation: What was good and bad about the experience?
Analysis: What sense can you make out of the situation?
Conclusion: What else could you have done?

SESSION STRUCTURE & PROGRESSION

Structure of a Circuit Training Session (Lawrence & Hope, 2011):

Phase	Components
Warm-up	Mobility and pulse-raising activities → Preparatory stretches → Re-warming / specific warm-up (increasing intensity toward circuit level; introduce activities to be used in main workout)
Main Workout	Option A: Specific exercises targeting all major muscle groups (muscular S&E focus) Option B: Range of exercises for cardiovascular fitness only Option C: Combined muscular + cardiovascular exercises (most common) — when combining, alternate strength exercises with cardiovascular exercises to maintain intensity
Cool-down	Warm-down exercises (lower intensity from circuit level) → Post-workout stretches (developmental and maintenance) → Optional relaxation → Remobilise. NB: If circuit exercises have a cooling effect on the body, re-warm before stretching.

Adapting for Different Fitness Levels (Lawrence & Hope, 2011):

Variable	Less fit / Specialist	Intermediate / General	Advanced / Sport-specific
Overall duration	~45 min	45–60 min	60–90 min
Overall intensity	Low	Moderate	Higher
Movement speed	Relatively slow	Moderate	Relatively quick
Warm-up	Lower intensity, longer duration	Moderate intensity & duration	Higher intensity, generally shorter

Ways to Adapt Intensity of Individual Stations:

Resistance – use longer levers, add weights
Rate – speed of exercise
Range of motion
Repetitions
Rest – rest time between stations / intensity of activity during rest

Ways to Adapt Overall Circuit Intensity:

Number of stations
Intensity of exercises at each station
Time working at each station
Number of times the circuit is performed (rounds)
Rest time between each circuit/round

PRACTICAL: AT2 PREPARATION – GROUP TRAINING

Week 4 practical is dedicated to planning and rehearsing the AT2 group training session (to be delivered in Week 6 or 7). Key tasks:

Participate in a component of a demonstrator-led group training session (to understand AT2 delivery requirements)
With your AT2 partner, develop a clear session structure and goals
Select exercises/activities that directly relate to your session goals
Develop simple instructions to be communicated during delivery
Decide on roles for each group member during session delivery
Plan progressions, regressions, and alternatives to account for equipment constraints and individual differences

Exercise Selection Principles for Group Training:

Select exercises requiring little or no equipment (common in larger groups / non-gym settings)
Resistance training remains effective with bodyweight only
To progress bodyweight exercises (since external load cannot be increased easily):
- Increase repetitions
- Increase movement velocity (e.g., squat → jump squat)
- Use more challenging exercise variations

Teamwork & Collaborative Practice:

AT2 requires intraprofessional collaboration (multiple team members of the same profession). Reflects real-world practice as an Accredited Exercise Scientist working in:

Intraprofessional teams (same profession, e.g., two exercise scientists)
Interprofessional teams (two different professions)
Multidisciplinary teams (three or more different professions)

SEMINAR MCQs WITH ANSWERS – WEEK 4

1. Which of the following shows the correct order of the stages of learning a skill?
A. Cognitive, Autonomous, Associative
B. ✓ B. Cognitive, Associative, Autonomous
C. Associative, Cognitive, Autonomous
D. Autonomous, Associative, Cognitive
Stage 1 = Cognitive (must think about skill); Stage 2 = Associative (some control, not yet reflex); Stage 3 = Autonomous (skill is automatic/reflex-based).

2. Which of the following steps is NOT part of the five-step approach to introducing a new exercise to clients in the cognitive stage of learning?
A. Name and briefly explain the exercise
B. Identify two or three key points for the client to focus on
C. Demonstrate the exercise at least two or three times so the client can look for the key points
D. ✓ D. Avoid letting the client practice the movement to avoid injury
Practice IS essential — it gives the coach an opportunity to provide feedback and technique adjustments. Avoiding practice is the WRONG option; it is the opposite of what the 5-step approach requires.

3. To reinforce good technique irrespective of the stage of learning, the following 3-step procedure is recommended:
A. ✓ A. Provide positive praise, positive reinforcement, corrective reinforcement
B. Provide constructive feedback, highlight incorrect execution, corrective reinforcement
C. Provide negative feedback, highlight incorrect execution, corrective reinforcement
D. Provide critical feedback, negative reinforcement, incorrect reinforcement
Step 1: Positive praise ("good rep"). Step 2: Positive reinforcer ("great knee lift"). Step 3: Corrective reinforcer if needed ("keep chest up more").

4. You have decided to split a large group into smaller groups. What is a recommended method to form groups?
A. Appoint captains to select players
B. ✓ B. Create groups based on ability
C. Randomly create groups of unequal numbers
D. Always let the athletes decide their groups
Appointing captains is NOT recommended (leads to humiliation of less-skilled). Unequal numbers make work:rest management harder. Athlete-decided groups can create very uneven ability pairings. Ability-based grouping is most effective for organisation.

5. According to ASCA (2017), which approach should coaches follow when training novice athletes?
A. Provide lengthy descriptions so athletes have all the information
B. ✓ B. Provide practice opportunities in low-stress situations
C. Provide feedback on 'knowledge of performance' because it is more important
D. Provide minimal feedback following a set to avoid confusing the athlete
Lengthy descriptions overload novices. Knowledge of Results (outcome) > Knowledge of Performance for novices. Feedback following a set is appropriate. Low-stress practice helps novices grasp the kinaesthetics of the exercise.

6. According to ASCA (2017), what should the coach-to-client ratio be in group training?
A. 1:20 B. 1:40 C. 1:25 D. ✓ D. 1:15
1:15 or less is most optimal — allows coach to observe technique, provide specific feedback, and implement progressions/regressions where needed.

7. When planning a group training session, which consideration should be made?
A. Limit equipment so clients try variations
B. Prescribe the same exercises to all members regardless of age or experience
C. ✓ C. Consider the number of exercises, sets or rounds so the session doesn't run too long
D. Demonstrate some (but not all) exercises so clients can start sooner
Time, people, and equipment must all be considered. Demonstrating ALL exercises is essential. Prescribing the same program regardless of individual differences is poor practice.

8. At what stage of learning is it appropriate to provide feedback to a client DURING their repetitions?
A. Cognitive stage B. Associative stage C. ✓ C. Autonomous stage D. Intermediate stage
Cognitive: feedback only at end of set (intra-rep feedback overloads/confuses). Associative: between reps/during a set. Autonomous: during a rep — athletes have greater understanding and can apply feedback immediately.

9. According to ASCA (2017), feedback to novice/intermediate clients should comprise which attributes?
A. ✓ A. Specific, constructive, immediate, clear, and positive
B. Specific, constructive, delayed, extensive, and positive
C. Non-specific, encouraging, immediate, simple, and positive
D. Specific, constructive, immediate, clear, and negative
Negative feedback is avoided. Extensive feedback should be avoided (overloads client). Delayed feedback is less effective. Specific and clear feedback helps the client understand what to improve.

10. You arrive at the park and there aren't enough bench seats for everyone to do step-ups at the same time. What action is best?
A. Encourage clients to wait their turn
B. Create a capacity limit so some participants leave
C. Use a progression of the step-up (no equipment needed)
D. ✓ D. Stagger the order so half the group does lower body and the other half does upper body, then switch
Waiting = inactivity beyond prescribed rest, session objectives not met. Capacity limit is impractical. The progression may be too hard for all participants. Staggering the order lets all clients complete all exercises while minimising further session changes.

CASE STUDY: PEAK PERFORMANCE – GROUP CIRCUIT SESSION

  Context: 10 participants (6 = weight loss goal, 2 = aerobic fitness, 2 = supplement gym program/social). Mix of novice and intermediate exercisers, low-to-moderate fitness. 45-min session outdoors (back of facility), groups of 6–12, any portable equipment.

Session Objectives:

Improve general fitness and strength endurance
Improve muscle mass (also contributes to energy expenditure long-term)
Increase energy expenditure to assist weight loss

Session Structure: Circuit Resistance Training

Rationale: Circuit training can improve aerobic fitness and strength endurance due to high continuity and moderate resistance (ACSM).

#	Exercise	Prescription	Rest
1	Static Lunges or Walking Lunges	Circuit training: 30 sec interval — as many reps as possible while maintaining proper technique (extra rest if technique decays). Repeat circuit twice through in total. RPE: 15–17/20	30 sec rest inclusive of station changeover time
2	(Assisted) Chin Ups or Powerband Lat Pulldowns
3	Sit-to-stand or Bodyweight Squats
4	Overhead Medicine Ball Presses
5	Medicine Ball Crunch with Legs Elevated
6	Bench/Box Step Ups
7	Battle Ropes (single or double; rest when needed)
8	Farmer Carries (15 m lane)

Key design principles applied: Exercises alternate upper/lower body to maintain cardiovascular intensity; progressions/regressions provided (e.g., sit-to-stand → squat); 30 sec intervals allow self-pacing across novice/intermediate participants; RPE 15–17 targets vigorous intensity appropriate for weight loss and fitness goals.

PRESCRIBED & RECOMMENDED READINGS – WEEK 4

Reference	Key Sections	Topic
Lawrence, D & Hope, R (2011). Complete Guide to Circuit Training. Bloomsbury Publishing.	Chapter 4: Approaches to Designing and Managing a Circuit Training Session	Time-controlled vs repetition-controlled circuits; layout and arrangement; progressive circuit formats (competition, colour, giant sets, super sets, stage training, individual circuit)
Lawrence, D & Hope, R (2011). Complete Guide to Circuit Training. Bloomsbury Publishing.	Chapter 5: Structure and Progression for a Circuit Training Session	Session structure (warm-up, main workout, cool-down); adapting for different fitness levels; methods to vary intensity

Secondary Source (module-referenced):

Reference	Key Content
ASCA (2017). Level 1 S&C Coach Accreditation Manual (Module 3: Coaching Theory and Coaching Practical). ASCA, Melbourne.	3 stages of learning; 5-step approach; coaching novice vs advanced athletes; 3-step feedback procedure; characteristics of effective feedback; group size recommendations (1:15 ratio); organisation strategies for large groups
Bailey, R (2013). (as cited in module)	Benefits of group training; group size trade-offs; principles for forming sub-groups; promoting engagement; avoiding "captain selection" method

WEEK 5 – WOMEN IN SPORT & EXERCISE W5

OVERVIEW & LEARNING OBJECTIVES

  Topic: Women in Sport and Exercise — unique considerations for exercise programming with female athletes and clients, including sex differences, pregnancy, postpartum, Female Athlete Triad, RED-S, and early sport specialisation.

Learning Objectives:

Evidence-based practice related to Women in Sport, including the ability to compile, critically evaluate, and communicate the scientific rationale for exercise programming and service delivery
Understand exercise and programming considerations for women in sport and exercise, specifically related to pregnancy, the Female Athlete Triad, and the general population
Identify the need for guidance or further information from an appropriate health professional in relation to complex issues regarding Female Athletes

SEX DIFFERENCES & EXERCISE PROGRAMMING CONSIDERATIONS

Source: Faigenbaum (2008); Linnamo et al. (2005); Knowles et al. (2019)

Pre-Puberty vs Post-Puberty:

Before puberty: Essentially minimal physiological differences between males and females
During puberty: Oestrogen ↑ in females → ↑ fat deposits; Testosterone ↑ in males → ↑ protein synthesis
Result: Adult women tend to have more body fat and less muscle mass on average than men

Strength Differences:

Women tend to have ~2/3 the absolute strength of men, due to lower muscle quantity (particularly above the waist)
Women can increase relative strength at the same rate as men during resistance training
Absolute strength gains are often greater for men
Conclusion: No justification for designing resistance training programs for women differently from men — programs should be designed to improve sports performance regardless of sex (Faigenbaum, 2008)

Hormonal Responses to Resistance Training:

Both males and females show significant ↑ in Growth Hormone (GH) after heavy resistance training
GH increase is greater in females than males
Testosterone increase is only observed in males (not females)
Implication: Since GH and testosterone are anabolic (hypertrophy and max strength), females may need higher training frequency than males to maximise genetic potential in strength and power (Linnamo et al., 2005)

Menstrual Cycle & Resistance Training – Knowles et al. (2019):

Source: Knowles OE et al. (2019). Resistance training and skeletal muscle protein metabolism in eumenorrheic females: Implications for researchers and practitioners. Sports Medicine, 49: 1637–1650.

Key finding: Some studies suggest greater strength and hypertrophy improvements when training frequency is emphasised in the follicular phase (early phase, oestrogen dominant).

Hypothesised to relate to the oestrogen-to-progesterone ratio and possible anabolic signalling effects
More recent research suggests menstrual cycle phase likely has minimal influence on resistance training adaptations overall
Current recommendations: emphasise consistent training and individual symptom responses rather than strict phase-based programming

EXERCISE DURING PREGNANCY

Sources: SMA Position Stand (2016); ACSM (2013/2014); ACOG (2020)

Physiological Changes During Pregnancy:

↑ Cardiac output, stroke volume, heart rate, blood glucose
↓ Blood pressure (reduced peripheral resistance); limited venous return
Weight gain, altered centre of gravity, increased joint laxity, increased water retention
Higher O2 consumption during exercise (foetal demands + altered skeletal muscle stabilisation)
HR higher at lower intensities; HR at high intensities is lower than non-pregnant state

Benefits of Exercise During Pregnancy:

Improves circulation; decreases oedema
Mitigates risk of pre-eclampsia (high BP + protein in urine) and gestational diabetes
Reduces weight gain
Same general benefits as exercise for the general population

General Exercise Recommendations (ACSM, 2014):

Women with a normal pregnancy can start or continue exercising without fear of harm to herself or her foetus
30 minutes of moderate-intensity exercise (RPE 12–14 on Borg 6–20 scale) on all or most days of the week
Activities should be dynamic and involve large whole-body movements (e.g., cycling, walking)

Contraindications to Exercise During Pregnancy:

Relative Contraindications	Absolute Contraindications
Severe anaemia Unevaluated maternal cardiac arrhythmia Chronic bronchitis Poorly controlled Type 1 diabetes Extreme morbid obesity or extreme underweight History of extremely sedentary lifestyle Intrauterine growth restriction Poorly controlled hypertension Orthopaedic limitations Poorly controlled seizure disorder or hyperthyroidism Heavy smoker	Haemodynamically significant heart disease Restrictive lung disease Incompetent cervix/cerclage Multiple gestation at risk for premature labour Persistent 2nd or 3rd trimester bleeding Placenta Praevia after 26 weeks gestation Premature labour during current pregnancy Ruptured membranes Pre-eclampsia/pregnancy-induced hypertension

Activities to AVOID During Pregnancy:

Exercises with abdominal trauma or pressure (e.g., heavy weight lifting)
Excessive range of motion exercises (↑ joint laxity)
Contact/collision sports (e.g., soccer, ice hockey, martial arts)
Hard projectile objects or striking implements (e.g., hockey, cricket)
High falling risk activities (e.g., judo, skiing, skating, horse riding)
Extreme balance/coordination/agility (e.g., gymnastics, water skiing)
Significant pressure changes (e.g., scuba diving, skydiving)
Heavy (greater than submaximal) lifting
High-intensity training at altitudes >2000m
Supine position (lying on back) — risk of hypotension, particularly after 28 weeks' gestation
Activities with increased fall risk (e.g., horse riding)
Scuba diving (risk of fetal malformations)

Stop Exercise Immediately If (Warning Signs):

Vaginal bleeding
Abdominal pain
Regular painful contractions
Amniotic fluid leakage
Dyspnoea before exertion
Dizziness or headache
Chest pain
Muscle weakness affecting balance
Calf pain or swelling

SMA Position Stand – Resistance Training During Pregnancy (Exercise Prescription):

Resistance Training (for previously-active, uncomplicated pregnancy):
2 sessions/week | 1 set of 12–15 reps per exercise | 8–10 exercises per session | RPE/intensity: moderate (12–14 Borg)

Aerobic Exercise Prescription (SMA):

Previously sedentary: RPE 12–14 (moderate) on Borg scale
Previously active: RPE 15–17 (somewhat hard to hard) on Borg scale
Talk test: if client can maintain conversation, not overexerting

Pelvic Floor Exercises (SMA Position Stand):

Prescription: At least 8–12 contractions, three times per day

Pre-Exercise Screening for Pregnancy (ESSA PSS-Pregnancy):

Assesses pregnancy-specific conditions and risk factors prior to commencing exercise
Differs from ESSA-APSS (adult screening) in targeting: pregnancy-specific absolute contraindications (pre-eclampsia, placenta praevia, ruptured membranes, etc.)
Clearance from GP/obstetrician required if any absolute contraindications are present
Collaborative approach recommended: exercise physiologist + medical professional

EXERCISE IN THE POSTPARTUM PERIOD

Source: Mottola MF (2002). Exercise in the postpartum period: Practical applications. Current Sports Medicine Reports, 1(1): 362–368.

  Key Points:
  Medical clearance from a GP must be obtained before any exercise prescription resumes following pregnancy
Many physiological adaptations to pregnancy can continue following birth — conservative, common-sense approach is advised
Altered cardiovascular response to aerobic exercise due to pregnancy can persist up to 4 weeks postpartum (Mottola, 2002)
Pregnancy exercise routines can be slowly reintroduced during the postpartum period

Focus: gradual reintroduction of exercise; pelvic floor recovery is a priority
Consider: physical activity level prior to pregnancy, mode of delivery, and presence of any complications
Pages 366–367 of Mottola (2002) cover specific programming considerations and guidelines

FEMALE ATHLETE TRIAD & RED-S

Sources: Sherman & Thompson (2004); Nazem & Ackerman (2012); De Souza et al. (2022)

  Female Athlete Triad — 3 interrelated clinical entities:
  Eating disorder / energy deficiency (e.g., anorexia nervosa, bulimia nervosa)
Amenorrhea (menstrual dysfunction)
Osteoporosis (low bone mineral density)

  Caused by: insufficient dietary caloric intake relative to training load → hormonal changes → menstrual disruption → bone loss

Definitions:

Anorexia athletica: Disordered eating in female athletes characterised by intense fear of gaining weight even while underweight
Amenorrhea: Absence of at least three consecutive menstrual cycles; may be due to overtraining; can be the first sign of the Triad (Sherman & Thompson, 2004)
Osteoporosis: Low bone mass and deterioration of bone tissue → bone fragility → increased fracture risk

Sports at Highest Risk (aesthetics/leanness emphasis):

Gymnastics, diving, ballet, athletics, figure skating
Amenorrhea prevalence in these sports: up to 69% (vs 2–5% in general population) (Nazem & Ackerman, 2012)
Clinical eating disorder prevalence in female elite athletes: 16–47% (vs 0.5–10% in general population)
Osteoporosis prevalence in female elite athletes: up to 13% (vs 2.3% general population)

Complications of the Triad:

Menstrual disturbances → possible infertility
Amenorrhoeic athletes with low bone density: 2–4× greater risk of stress fractures

RED-S – Relative Energy Deficiency in Sport:

RED-S expands on the Female Athlete Triad; underpinned by low energy availability (imbalance between dietary intake and energy expenditure).
  Source: De Souza MJ et al. (2022). The path towards progress: A critical review to advance the science of the female and male athlete triad and relative energy deficiency in sport. Sports Medicine, 52: 13–23.
RED-S affects both male and female athletes
Consequences: reproductive health impairment, impaired tissue synthesis, poor bone health, GI complications (e.g., irritable bowel syndrome), immunological disorders, psychological conditions (e.g., depression)
Research (Rogers et al., 2021): ~80% of athletes suffer from RED-S; GI and immunological disorders most prevalent (>30%)
Despite high prevalence, only ~3% of athletes show physiological indicators of energy deficiency

LEAF Questionnaire (Low Energy Availability in Females Questionnaire):

Purpose: Identify female athletes at risk of the Triad/RED-S through self-reported physiological symptoms of persistent energy deficiency (not eating disorder diagnosis).

Brief, practical questionnaire for routine screening
Focuses on physiological symptoms, with or without the presence of an eating disorder
Facilitates early detection and treatment

(Melin et al., 2014)

EARLY SPORT SPECIALISATION RISKS IN ADOLESCENT FEMALES

Source: Blagrove RC, Bruinvels G & Read P (2017). Early sport specialization and intensive training in adolescent female athletes: Risks and recommendations. Strength and Conditioning Journal, 39(5): 14–23.

  Early specialisation defined as: 3 components present simultaneously:
  Year-round training for >8 months
Focusing on a single main sport
Quitting all other sports to pursue a single sport

  (Jayanthi & Dugas, 2017)

Key Risks of Early Specialisation in Females:

Female Athlete Triad / RED-S risk
Overuse injuries (higher risk in single-sport athletes vs multi-sport)
Burnout and dropout
Depression and loss of training time
High injury likelihood increases substantially when organised sport participation > athlete's age in years per week

Key Recommendations from Blagrove et al. (2017):

Children should avoid single-sport specialisation before age 12
Total weekly training volume should not exceed the athlete's age in years (e.g., a 15-year-old should not train >15 hours/week); >16 hr/wk substantially increases injury risk
A balanced lifestyle should be promoted: variety of social, academic, sport, and leisure activities
An interdisciplinary approach should be adopted to manage young female athlete health, fitness and wellbeing
Education and guidance should be provided to young female athletes AND their parents
Athletes themselves should be given the opportunity to make their own decisions about sport participation (not parents alone) — key MCQ trap!

PRACTICAL 5 – RESISTANCE TRAINING DURING PREGNANCY

Practical Aims:

Understand relative and absolute contraindications for pregnant women
Identify how traditional exercises may create contraindicated situations and need modification
Develop safe alternative exercise options with appropriate pregnancy-specific cueing

Contraindicated Exercises & Safe Alternatives (2nd Trimester onwards):

Original Exercise	Reason Contraindicated	Alternative 1	Alternative 2
Deep Squat (full ROM)	Increased joint laxity → injury risk with full ROM exercises	Reduced ROM dumbbell squat	Swiss ball squat
Prone Hip Extension	Prone (face-down) position contraindicated beyond first trimester	Bird dog	Donkey kick
Arabesques	Single-leg balance challenges → risk of falling	Resistance band kickback	Standing glute kickback
Romanian Deadlift	Potential to overload posturally compromised joints (lumbar-pelvic girdle)	Kettlebell deadlift (reduced ROM)	Prisoner deadlift
Bench Press	Supine position → risk of hypotension and nausea	Wall push-up	Standing chest press
Medicine Ball Chest Pass to Trampoline	Risk of contact with hard projectile object	Seated (with back support) medicine ball chest pass to partner (no catching)	—
Military Press	Emphasises lumbar lordosis → overloads posturally compromised lumbar-pelvic girdle	Seated DB shoulder press	Seated DB lateral raise
Plank / Prone Hold	Prone position contraindicated beyond first trimester	Incline shoulder taps	Cat-cow
Crunches	Supine position → risk of hypotension	Pelvic floor exercises	Seated marching/knee lifts
Russian Twists	Excessive ROM around abdominal region	Seated side crunches	Seated ball stability hold

  Key pregnancy-specific cueing principles:
  Avoid supine (lying on back) positions — risk of hypotension due to inferior vena cava compression
Avoid prone positions from second trimester onwards
Cue abdominal/core engagement before movement: "gently draw your lower belly in and up"
Pelvic floor engagement: "imagine stopping the flow of urine — gently squeeze and hold"
Use talk test: if client can maintain a conversation, intensity is appropriate
Avoid Valsalva (breath holding) — breathe out on exertion phase
Ensure adequate hydration before and during sessions
Prioritise stability; use chairs/walls/support for balance exercises
Emphasise controlled, reduced ROM for exercises that stress the lumbar-pelvic region

SEMINAR MCQs WITH ANSWERS & JUSTIFICATIONS

Q1. The Female Athlete Triad includes which of the following disorders?
✓ A. Amenorrhea, bone mineral loss, and eating disorders
B. Eating disorders, bulimia, and normenorrhea C. Amenorrhea, dysmenorrhea, and normenorrhea D. Bone mineral loss, dysmenorrhea, and eating disorders
The Triad = (1) Eating disorder/energy deficiency + (2) Amenorrhea (menstrual dysfunction) + (3) Osteoporosis (bone mineral loss). Caused by insufficient caloric intake relative to training load. Normenorrhea = normal menstruation — not part of the Triad.

Q2. According to SMA, which prescription scheme is most appropriate for resistance training during pregnancy?
A. 4 sessions/week, 2 sets 8–10 reps, 8–10 exercises B. 2 sessions/week, 2 sets 15–20 reps, 8–12 exercises ✓ C. 2 sessions/week, 1 set 12–15 reps, 8–10 exercises D. 1 session/week, 3 sets 12–15 reps, 8–12 exercises
SMA Position Stand: 2 sessions/week, 1 set of 12–15 reps, 8–10 exercises per session (for previously-active women with uncomplicated pregnancy).

Q3. Which of the following is NOT a general recommendation to minimise risks of sport specialisation in adolescent females?
A. Promote balanced lifestyle ✓ B. Decisions concerning participation should only involve the athlete's parents C. Adopt an interdisciplinary approach D. Provide education and guidance to athletes and parents
Young female athletes should be given the opportunity to make their own decisions about sport participation — it should not rest solely with parents. All other options (A, C, D) are genuine Blagrove et al. (2017) recommendations.

Q4. According to SMA, at what Borg Scale intensity can previously-active pregnant women safely participate in aerobic activity?
A. 12–14 ✓ B. 15–17 C. 17–19 D. Greater than 19
Previously-active pregnant women: RPE 15–17 (somewhat hard to hard). Previously sedentary: start at RPE 12–14 (moderate). RPE >17–19 = too vigorous for pregnancy.

Q5. According to the SMA Position Stand, what is the recommendation for pelvic floor exercises during pregnancy?
A. At least six times per week B. At least 4 sets daily ✓ C. At least 8–12 contractions, three times per day D. As many times as is comfortable
SMA Position Stand: pelvic floor exercises = at least 8–12 contractions, performed three times per day.

Q6. In females who participate in sports such as diving and gymnastics, amenorrhea can be as high as:
A. 29% B. 39% C. 49% ✓ D. 69%
Sports emphasising aesthetics/leanness (gymnastics, diving) → amenorrhea prevalence up to 69% vs 2–5% in general population (Nazem & Ackerman, 2012). These sports create pressure for low body weight → disordered eating → hormonal changes → amenorrhea.

Q7. According to Knowles et al. (2021), females may achieve greater strength/hypertrophy gains by training with high frequency during which menstrual phase?
A. Luteal phase ✓ B. Follicular phase C. Menstrual phase D. Ovulation phase
Some studies suggest greater gains when training frequency emphasised in the follicular phase (oestrogen dominant, early phase). Hypothesised mechanism: oestrogen-to-progesterone ratio and anabolic signalling effects. However, current evidence suggests menstrual cycle phase has minimal overall influence — individual response and consistent training are prioritised.

Q8. According to Blagrove et al. (2017), children should avoid single-sport specialisation before what age?
A. 10 B. 11 ✓ C. 12 D. 13
Blagrove et al. (2017): avoid single-sport specialisation before age 12. Early specialisation (particularly <12 years) is associated with Female Athlete Triad, overuse injuries, burnout, and dropout.

Q9. According to Blagrove et al. (2017), total weekly training volume for adolescent females should not exceed:
✓ A. Their age in years B. Depends on training age C. 12 hours D. 10 hours
Athletes should not participate in more hours of organised sport than their age in years (or more than 16 hr/wk) — greater participation substantially increases injury risk. A 14-year-old should not exceed 14 hours/week of organised training.

Q10. According to Mottola (2002), an altered cardiovascular response to aerobic exercise due to pregnancy can persist up to how many weeks postpartum?
A. 12 weeks B. 10 weeks C. 8 weeks ✓ D. 4 weeks
Mottola (2002): altered CV response to aerobic exercise persists up to 4 weeks postpartum. This is key for programming — conservative return to exercise, medical clearance required, gradually reintroduce intensity.

CASE STUDY 1: LORETTA (Track & Field Athlete – Female Athlete Triad)

  Client Profile: Loretta, 17 years old, national age champion (800m & 1500m). Under sports science team care for 4 years. Lost 5kg off already slight 56kg frame over last 12 months; denies dietary changes but never eats post-training nutrition. Fainted at competition → suffered hairline fractures (distal femoral shaft and anterior tibia) despite a small fall. Currently 8 weeks away from returning to normal training. Frustrated with modified programme and disinterested in rehabilitation discussion.

Part A – Concerns to Discuss:

Area	Specific Concerns
Energy availability & nutrition	Inadequate energy intake relative to training load; skipping post-training nutrition; possible restrictive eating behaviours; possible RED-S risk; hydration status
Health indicators	Menstrual history (possible amenorrhea); fatigue or dizziness; bone health (stress fracture risk — 2–4× higher with amenorrhea + low BMD); illness frequency
Psychological factors	Body image concerns; performance pressure; attitudes toward food; athlete identity issues during injury period
Training load & recovery	Training volume vs recovery balance; sleep quality; academic + sport stress

Part B – Strategies & Support Network:

Strategy	Actions
Education	Educate athlete and parents on energy availability; explain relationship between fuelling, injury risk, and performance; normalise fuelling as a performance strategy
Nutrition support	Refer to sports dietitian; develop structured fuelling plan (pre/post training); gradual weight restoration if needed
Medical screening	RED-S/Triad screening; menstrual function assessment; bone health monitoring (DEXA scan); possible GP/sports physician referral
Training modifications	Temporary training load reduction; emphasise rehabilitation adherence; maintain strength training for bone health
Psychological support	Referral if disordered eating suspected; support motivation and identity during rehabilitation period
Monitoring plan	Regular follow-up discussions; monitor weight, wellbeing, training tolerance; repeat LEAF-Q if indicated

CASE STUDY 2: BIANCA (Pregnant Client – Session Redesign)

  Client Profile: Bianca, regularly-active client, approaching later stages of 2nd trimester. Has been training 3×/week for 3 months. Wants to continue same exercises and frequency. Original session: full-body strength circuit (RPE 8/10, 3 rounds × 15 reps, 20s rest between exercises, including floor press, goblet box squat, seated overhead press, RDL, seated bicep curls, mountain climbers, med ball slams, KB swings, burpees, glute bridges, calf raises, tricep kickbacks).

Part A – Redesigned In-Clinic Session (later 2nd Trimester):

Session Objectives: Maintain full-body strength via conservative prescription. Promote core and pelvic floor control.
Session Structure: Resistance training incorporating fewer sets, fewer exercises, increased rest period duration.

Exercise	Sets	Reps	Intensity	Rest	Key Notes
Goblet Box Squats	1	12	RPE 4–6/10	90s	Box improves safety as balance changes; control depth to comfortable ROM
Machine Chest Press	1	12	RPE 4–6/10	90s	Upright position avoids supine hypotension risk; breathe out on up phase
Rack Pull	1	12	RPE 4–6/10	90s	Reduced ROM limits lumbar stress vs RDL; maintain neutral spine; posterior chain strength
Seated Cable Row	1	12	RPE 4–6/10	90s	Stable pulling exercise, low injury risk; emphasise controlled scapular movement; upper back posture support
Calf Raises	1	12	RPE 4–6/10	90s	Use support for balance if needed; may help manage pregnancy-related swelling
Bird Dog	1	12	RPE 4–6/10	60s	Promotes lumbo-pelvic stability; maintain level hips and controlled movement

Part B – Telepractice Session (home, 3kg dumbbells only):

Original Exercise	Home Modification	Key Notes
Goblet Box Squats	Sit to Stand (from chair)	Chair improves safety; control depth; upright position avoids supine hypotension; can use pillow for height
Machine Chest Press	Wall Push-up	Stable pressing option; breathe out on up phase; adjustable by distance from wall
Rack Pull	Standing Glute Kickbacks	Stand upright holding sturdy object (wall/chair); emphasise breathing, stability and glute contraction
Seated Cable Row	Resistance Band Row	Anchor band to feet or door; emphasise controlled scapular movement
Calf Raises	Calf Raises (same)	Use wall/chair support for balance; may help manage pregnancy swelling
Bird Dog	Bird Dog (same)	Promotes lumbo-pelvic stability; maintain level hips and controlled movement

Sets/reps/intensity/rest: same as Part A (1 set × 12 reps, RPE 4–6/10, 90s rest)

PRESCRIBED & RECOMMENDED READINGS – WEEK 5

Prescribed Readings (Examinable):

Reference	Key Pages/Sections	Topic
Knowles, OE et al. (2019). Resistance training and skeletal muscle protein metabolism in eumenorrheic females: Implications for researchers and practitioners. Sports Medicine, 49: 1637–1650.	Full article	Sex differences in hormonal response to resistance training; menstrual cycle phases and training; follicular phase advantage hypothesis; programming implications
Sports Medicine Australia (2016). Position Statement: Exercise in Pregnancy and the Postpartum Period.	Full document	Relative and absolute contraindications; aerobic and resistance exercise prescription during pregnancy; pelvic floor exercises; postpartum return to exercise
Mottola, MF (2002). Exercise in the postpartum period: Practical applications. Current Sports Medicine Reports, 1(1): 362–368.	Pages 366–367 (exercise guidelines/considerations for postpartum)	Physiological changes postpartum; CV response persistence (up to 4 weeks); conservative programming approach; medical clearance requirements

OVERVIEW & LEARNING OBJECTIVES

  Topic: Exercise Programming for Children (6–12 years) and Adolescents/Youth (13–18 years)

The suitability of resistance training in children and youth has been controversial for 30+ years, largely due to misconceptions such as "lifting weights stunts growth." This has driven a significant body of research, leading to position stands from major organisations including ASCA, IOC, NSCA, and BASES.

Learning Objectives:

Understand key considerations when exercise programming for children and adolescents, including assessing motor impairment, determining a suitable age to begin strength training, and how to safely progress training programs.
Identify different models of athletic development (e.g., LTAD, FTEM, ASF) and how to apply them.
Apply this knowledge to design exercise programs for children and adolescents of different ages and levels of physical development.

Key Definitions:

Children: 6–12 years of age
Youth/Adolescents: 13–18 years of age

ASCA POSITION STAND – RESISTANCE TRAINING FOR CHILDREN & YOUTH (2017)

Source: ASCA (2017). Resistance Training for Children & Youth: A Position Stand from the Australian Strength & Conditioning Association.

  Purpose: Provide clarity and guidance to assist coaches designing resistance training programs for children and youth at various developmental stages. Addresses 7 sections including appropriate age, training intensity, program design, injuries, legal cases, nutrition, and overall summary.

Minimum Age to Commence Resistance Training:

According to ASCA, the youngest age a child should commence resistance training is 6 years of age, provided proper coaching and supervision are in place.

Key consideration: readiness is determined more by maturation level and ability to follow instruction than by chronological age alone.
Children must be able to accept and follow coaching instructions, understand and appreciate safety requirements, and maintain concentration throughout a session.

ASCA Resistance Training Prescription by Age Group (Training Levels):

Level / Age Group	Rep Range / Intensity	Key Guidance
Level 1: 6–9 years	≥15 reps or 45s hold; body weight & light resistance only (brooms, bands etc.)	No external loading; focus on movement patterns, technique, fun
Level 2: 9–12 years	10–15 RM; ~60% 1RM max	Simple free weights + age-appropriate machines; no complex lifts
Level 3: 12–15 years	8–15 RM; ~70% 1RM max	More free weights but avoid complex lifts (cleans, snatches, deadlifts, squats) unless Level 2 ASCA coach is present
Level 4: 15–18 years	6–15 RM; ~80% 1RM max	Progress toward advanced adult programs; split routines if appropriate; complex multi-joint movements with sound technique and Level 2 ASCA coach oversight

Memory aid for ASCA rep ranges: 6–9 yrs = 15+ reps | 9–12 yrs = 10–15 RM | 12–15 yrs = 8–15 RM | 15–18 yrs = 6–15 RM

LONG TERM ATHLETE DEVELOPMENT (LTAD) MODEL

Source: Balyi et al. (2013); Canadian Sport for Life

  Purpose: A planned, systematic framework for young athletes providing effective long-term development beyond short-term gains. Designed to improve the quality of sport programs for ALL participants and help them reach their potential throughout life.

Created in recognition of: high rates of childhood obesity AND record numbers of children pushed into early sport specialisation
The LTAD consists of 7 stages from infancy through to adulthood

The 7 Stages of LTAD:

Stage	Age (Males)	Age (Females)	Focus
1. Active Start	0–6 years	0–6 years	Physical literacy foundation; movement, play, fun
2. FUNdamentals	6–9 years	6–8 years	ABCs of athleticism: Agility, Balance, Coordination; fundamental movement skills; overall physical capacity
3. Learn to Train	9–12 years	8–11 years	Consolidate fundamental sport skills; introduce sport-specific skills; physical literacy stage
4. Train to Train	12–16 years	11–15 years	Build aerobic base; strength development; begin sport specialisation
5. Train to Compete	16–23 years	15–21 years	Optimise fitness; sport-specific preparation; high-volume/intensity training
6. Train to Win	19+ years	18+ years	Maximise performance; peak athletic preparation
7. Active for Life	Enter at any age		Recreational and competitive sport throughout life

  Physical Literacy stages (LTAD): Built through Active Start + Fundamentals + Learn to Train — these three foundational stages develop the movement competency needed for lifelong sport participation.

MCQ-ready: LTAD = 7 stages | Train to Compete = Males 16–23 / Females 15–21 | Train to Win = Males 19+ / Females 18+ | FUNdamentals (6–9 yrs) = agility, balance, coordination (ABCs)

AIS FTEM FRAMEWORK – Foundation, Talent, Elite, Mastery

Source: Gulbin et al. (2013)

  Purpose: Developed by the Australian Institute of Sport (AIS) to overcome limitations of the LTAD model. Key improvement: incorporates technical and tactical skills (not just physical skills as per LTAD).

4 macro stages: Foundations (F) → Talent (T) → Elite (E) → Mastery (M)
Further divided into 10 micro phases

Macro Stage	Micro Phases	Description
Foundations	F1, F2, F3	Building physical literacy, movement skills, love of sport/activity
Talent	T1, T2, T3, T4	Demonstration of potential through to talent verification, practising and achieving, breakthrough & reward
Elite	E1, E2	Senior elite representation; senior elite success
Mastery	M1	Sustained elite success

AUSTRALIAN SWIMMING FRAMEWORK (ASF)

Developed by Swimming Australia (SAL) in collaboration with the AIS. Based on the FTEM model; captures different athlete development pathways across three broad levels: Non-Elite, Pre-Elite, and Elite.

ASF Key Levels and Training Emphasis:

Level	Sub-levels	Training Emphasis
Non-Elite	Foundation 1–3	Learning & acquisition of basic movement; extension & refinement; commitment to sport/active lifestyle
Pre-Elite	Talent 1–4	Demonstration of potential → Talent Verification → Practising & Achieving → Breakthrough & Reward
Elite	Elite 1–2, Mastery	Senior elite representation → success → sustained elite success

ASF Pre-Elite Talent Verification (Talent 2) – Training Recommendations:

Training Emphasis: Technique + Speed + Aerobic Development (AEC)
Training Purpose: Training Foundations

Pool	Land
Continuation of technique across all strokes Development of aerobic capacity Further development of racing skills Greater variety of training methods	Increase strength-to-bodyweight ratio Even development of all muscle groups Development of 'core' body alignment Maintain flexibility

NSCA POSITION STATEMENT ON LTAD – 10 PILLARS (LLOYD ET AL., 2016)

Source: Lloyd RS et al. (2016). NSCA Position Statement on Long Term Athlete Development. Journal of Strength and Conditioning Research, 30(6): 1491–1509.

  Key Aim: Promote the benefits of a lifetime of healthy physical activity; foster a unified, holistic approach to youth athletic development.

The NSCA believes these 10 pillars can:

Foster a more unified and holistic approach to long-term athletic development
Promote the benefits of a lifetime of healthy physical activity
Prevent and/or minimise injuries from sports participation for all boys and girls

The 10 Pillars of Successful LTAD (NSCA, 2016):

Long-term athletic development pathways should accommodate the highly individualised and non-linear nature of the growth and development of youth
Youth of all ages, abilities and aspirations should engage in long-term athletic development programs that promote both physical fitness and psychosocial wellbeing
All youth should be encouraged to enhance physical fitness from early childhood, with a primary focus on motor skill and muscular strength development
Long-term athletic development pathways should encourage an early sampling approach for youth that promotes and enhances a broad range of motor skills
Health and wellbeing of the child should always be the central tenet of long-term athletic development programs
Youth should participate in physical conditioning that helps reduce the risk of injury to ensure their on-going participation in long-term athletic development programs
Long-term athletic development programs should provide all youth with a range of training modes to enhance both health- and skill-related components of fitness
Practitioners should use relevant monitoring and assessment tools as part of a long-term physical development strategy
Practitioners working with youth should systematically progress and individualise training programs for successful long-term athletic development
Qualified professionals and sound pedagogical approaches are fundamental to the success of long-term athletic development programs

IOC CONSENSUS STATEMENT ON YOUTH ATHLETIC DEVELOPMENT – BERGERON ET AL. (2015)

Source: Bergeron MF et al. (2015). International Olympic Committee consensus statement on youth athletic development. British Journal of Sports Medicine, 49: 843–851.

  Purpose: Develop a more unified, evidence-based approach to youth athlete development; evaluate science and practice; present recommendations for developing healthy, resilient, capable youth athletes while providing opportunities for all levels of sport participation.

IOC Recommendations – Conditioning, Testing & Injury Prevention:

Design youth athlete development programmes comprising diversity and variability of athletic exposure, to mitigate the risk of overuse injuries (NOT minimise diversity)
Encourage regular participation in strength and conditioning programmes that are suitably age-based
Maintain an ethical approach to, and effectively translate, laboratory and field testing to optimise youth sports participation
Promote evidence-informed injury prevention programmes

MCQ trap: The IOC recommends programmes comprising diversity and variability of athletic exposure (to REDUCE overuse injury). A statement saying "minimise diversity and variability" is the INCORRECT option (it is NOT a recommendation).

Key Physiological Changes Across Maturation (Bergeron et al.):

Growth spurts affect trainability; PHV (Peak Height Velocity) is a key landmark
Aerobic capacity, strength and power all increase during adolescence
Early specialisation is linked to burnout, overuse injuries, and dropout
A sampling approach (exposure to multiple sports) in early years is recommended

PRE-EXERCISE SCREENING SYSTEM FOR YOUNG PEOPLE (PSS-YP) – ESSA

  Two versions:
  PSS-YP (5–15 years): Completed by parent/guardian on behalf of the child
PSS-YP (16–17 years): Completed by the young person themselves

How PSS-YP (16–17 years) differs from ESSA-APSS (adults) and PSS Pregnancy:

Feature	ESSA-APSS (Adult)	PSS-YP (16–17 yrs)	PSS Pregnancy
Who completes it	Individual adult	Young person (16–17) + parent/guardian consent required if ≤15	Pregnant individual
Stage 1 questions	9 chronic disease/risk factor questions	Focuses on: heart conditions, family history of sudden cardiac death <50yrs, epilepsy/seizures, fainting/dizziness, diabetes, asthma attack in last 12 months, anaphylaxis, recent surgery	Pregnancy-specific conditions (pre-eclampsia, placenta praevia etc.)
Parent/guardian consent	Not required	Required if ≤15 years	Not required
Physical activity question	Includes PA level question	Includes PA level (days physically active ≥60 min)	Pregnancy-specific PA questions

How PSS-YP informs exercise prescription (16–17 years):

Stage 1 "Yes/Don't Know" responses → discuss with exercise leader or medical provider before commencing; may require GP clearance
Physical activity data (days per week active) → baseline for programming volume/frequency
Age-appropriate: allows young person to self-report, fostering responsibility; requires parental consent if ≤15 yrs
Helps identify absolute contraindications to exercise (e.g., uncontrolled cardiac condition) vs. conditions requiring modified approach

SEMINAR MCQs WITH ANSWERS & JUSTIFICATIONS

Q1. The LTAD model was introduced to improve the quality of sports programs. The LTAD model consists of how many stages?
A. 5 B. 6 ✓ C. 7 D. 8
The LTAD model has 7 stages: Active Start, FUNdamentals, Learn to Train, Train to Train, Train to Compete, Train to Win, Active for Life.

Q2. In the LTAD model, the Train to Compete stage refers to which age group?
A. Males 19+ / females 18+ B. Males 12–16 / females 11–15 C. Enter at any age ✓ D. Males 16–23 / females 15–21
Train to Compete = Males 16–23 and Females 15–21. Train to Win = Males 19+ / Females 18+. Train to Train = Males 12–16 / Females 11–15. Active for Life = enter at any age.

Q3. According to the LTAD model, which components are needed to build physical literacy?
A. Active Start, Train to Train, Train to Win B. Train to Train, Train to Compete, Train to Win ✓ C. Active Start, Fundamentals, Learn to Train D. Active Start, Learn to Train, Train to Win
Physical literacy = the foundational three stages: Active Start (0–6) + FUNdamentals (6–9) + Learn to Train (9–12). These sit in the 'Physical Literacy' base of the LTAD pyramid.

Q4. According to the ASCA, the youngest age a child should commence resistance training is:
A. 5 years ✓ B. 6 years C. 8 years D. 12 years
ASCA Position Stand: minimum recommended age = 6 years, contingent on ability to follow coaching instructions and maintain concentration. Class discussion: is this appropriate? The rationale centres on neural readiness rather than a purely arbitrary age cutoff.

Q5. According to the ASCA, which training load intensity should be used with adolescents aged 15–18 years?
A. 1–3 RM B. 3–5 RM ✓ C. 6–15 RM D. >16 RM
ASCA Level 4 (15–18 yrs): 6–15 RM (~80% 1RM max). Level 3 (12–15): 8–15 RM. Level 2 (9–12): 10–15 RM. Level 1 (6–9): ≥15 reps, body weight/light resistance only.

Q6. According to the ASF's Pre-Elite Talent Verification guidelines, pool and land training should emphasise which of the following?
A. VO2max, race pace ✓ B. Technique, speed, aerobic development C. Technique, enjoyment, anaerobic development D. Aerobic speed, anaerobic speed, core strength
ASF Talent Verification (Pre-Elite level) emphasises: Technique + Speed + Aerobic Development (AEC). Pool: technique continuation, aerobic capacity, racing skills. Land: strength-to-bodyweight ratio, all muscle groups, core alignment, flexibility.

Q7. According to Bergeron et al. (2015), which of the following is NOT a recommendation for conditioning, testing and injury prevention for youth athletic development?
✓ A. Youth athlete development programmes should minimise diversity and variability in athletic exposure to minimise overuse injury risk
B. Encourage regular participation in age-appropriate S&C programmes C. Maintain an ethical approach to field/lab testing D. Promote evidence-informed injury prevention programmes
The IOC actually recommends programmes comprising diversity and variability of athletic exposure (to REDUCE overuse injuries) — the opposite of what Option A states. Options B, C, and D are all genuine IOC recommendations.

Q8. Which of the following is a key aim of the NSCA's (2016) position statement on LTAD?
A. Promote benefits of playing competitive sport as early as possible ✓ B. Promote the benefits of a lifetime of healthy physical activity C. Promote early specialisation in sport D. Advise parents on risks of sport
NSCA (Lloyd et al., 2016): key aim = promote a lifetime of healthy physical activity. Youth are often ill-prepared for the rigors of sport; all youth should be viewed as "athletes" and afforded the opportunity to enhance their athleticism.

Q9. You have been asked to run a gym-based strength training session for netball athletes aged 12–15 years. What is the ASCA recommendation for an appropriate repetition range?
A. 3–5 RM B. 5–8 RM ✓ C. 8–15 RM D. >15 RM
ASCA Level 3 (12–15 years): 8–15 RM (~70% 1RM). More free weight exercises used but complex lifts (cleans, snatches, deadlifts, squats) avoided unless a Level 2 ASCA coach is present.

Q10. A school asks you to develop an athletic development program for students aged 6–9 years. Your program should emphasise which of the following aspects?
✓ A. Development of agility, balance, and coordination B. Sport-specific skills C. Competition-based skills and games D. Plyometrics and jumping
LTAD FUNdamentals stage (6–9 years): emphasises the ABC's of athleticism — Agility, Balance, Coordination — alongside fundamental movement skills and overall physical capacity development. Sport-specific skills come later (Learn to Train stage).

CASE STUDY: WETPOOL WAVES SWIMMING CLUB

  Client Profile: Wetpool Waves Swimming Club (Melbourne, north-eastern region). Heavy recruitment of swimmers to develop a high-performance pathway. You are hired as High Performance Manager. Two key squads: (1) Learn-to-Swim squad (7–10 years old; refining strokes; trains 2×/week) and (2) Elite National Squad (12–18 years; state/national qualifying times; trains up to 10×/week).

Part A – ASF Training Recommendations (Learn-to-Swim vs Elite National Squads):

	Learn-to-Swim Squad (7–10 years)	Elite National Squad (12–18 years)
ASF Level	Foundation 1 (Learning & Acquisition of Basic Movement) / transitioning to Foundation 2	Pre-Elite: Talent 2 (Talent Verification) or Talent 3 (Practising & Achieving)
Training Emphasis	Enjoyment, Technique, Simple Speed	Technique + Aerobic Development (AEC); Speed + Anaerobic Development; VO2max
Training Purpose	Transition from LTS; Skill Development	Enhanced Training and Competition exposure
Pool	Simple training & games; introduction to technique across all strokes; introduction to racing skills & sculling drills; simple speed (15m/6 secs); starts/turns/relays	Begin increasing training volume and intensity; implement holistic SSSM training methodology; consider event specialisation; develop aerobic capacity; develop racing skills; greater variety of training methods
Land	Group/team activities; overall physical literacy; flexibility; movement coordination	Implement musculoskeletal assessment; periodised strength program; maintain flexibility; maintain 'core' body alignment
Recovery & Regeneration	10–16 weeks per season	8–12 weeks per season

Part B – Dry-Land Session Plan: Learn-to-Swim Squad (7–10 years old) [EXAMPLE]:

Section	Exercises	Details
Warm-up	Tag game (e.g., sharks & fish); animal movements (bear crawl, frog jumps, crab walk)	Purpose: Raise HR, coordination, enjoyment Time: ~8–10 min Cues: Stay light on your feet, move in different directions
Main session	Bear crawl relays; wheelbarrow walks (partners); medicine ball passes (light); wall sit challenge (partners); "Streamline" holds (on floor)	Purpose: Whole-body strength, coordination, basic swimming positions Format: Circuit, 3–4 rounds, 30s per station; partner exercises 15s each (30s between stations) Cues: Bear crawl: "Back flat like a table" \| Wheelbarrow: "Strong arms, don't let hips drop" \| Passes: "Quick hands" \| Wall sit: "Back flat, knees bent, stay still like a statue" \| Streamline: "Long and straight like in the water"
Cool-down	Arm circles; cat–cow (spine movement); overhead reach + side bend	Purpose: Mobility (shoulders, spine), bring HR down Time: ~3–5 min Cues: Move slowly, full range

Part C – Dry-Land Session Plan: Elite National Squad (12–18 years old) [EXAMPLE]:

Section	Exercises	Details
Warm-up	Skipping or light jog; walking lunges; band pull-aparts; plank hold	Purpose: Increase HR, activate key muscle groups (shoulders, trunk) Time: ~10–12 min Cue: Controlled movement, good posture
Main session	Strength + control circuit: Split squats (BW or band), push-ups, banded rows, med ball slams/chest passes, plank shoulder taps Swimming-specific core: Streamline holds (prone/supine); hollow holds with flutter kicks	Purpose: Strength, trunk control; transfer to swimming positions and propulsion Format: 5 stations, 30s work, 15s rotate, 3–4 rounds Cues: Split squat: "Front knee stable, chest tall" \| Push-up: "Body straight, control down" \| Row: "Pull elbows back, squeeze shoulders" \| Plank: "Stay tight, minimal movement" \| Streamline: "Long and rigid like in the water"
Cool-down	Shoulder mobility (band or BW); hip flexor stretch; thoracic rotation	Purpose: Maintain mobility, support recovery Time: ~5–8 min Cues: Controlled breathing, full range

Note: Elite national squad athletes often already have a full resistance program. This dry-land session should complement (not duplicate) that program — focusing on swimming-specific movements, trunk control, and injury prevention rather than maximal strength development.

PRESCRIBED & RECOMMENDED READINGS – WEEK 7

Prescribed Readings (Examinable):

Reference	Key Pages/Sections	Topic
ASCA (2017). Resistance Training for Children & Youth: A Position Stand from the Australian Strength & Conditioning Association.	Page 4, Section 2.2 (appropriate training age); Pages 28–29, Section 7.0 (summary)	Minimum training age (6 yrs); LTAD training levels; rep ranges by age group; injury risk; nutrition
Bergeron, MF et al. (2015). International Olympic Committee consensus statement on youth athletic development. British Journal of Sports Medicine, 49: 843–851.	Pages 2–3 (physiological/performance changes across maturation); Page 3 (specialisation challenges); Page 7 (fitness/athleticism/functional foundation); Pages 8–9 (IOC recommendations: general principles & conditioning/testing/injury prevention)	IOC recommendations for youth development; diversity of athletic exposure; injury prevention; conditioning guidelines
Movement ABC-2 – Movement Assessment Battery for Children aged 3–16 years.	Full document (assessment tool)	Motor impairment screening; 8 tasks across manual dexterity, ball skills, and static/dynamic balance
ESSA: Pre-Exercise Screening System for Young People (PSS-YP) – 16–17 years version.	Full document	Pre-exercise screening for youth; Stage 1 (compulsory) health questions; parent/guardian consent requirements

SCOPE OF PRACTICE – AES vs AEP vs S&C COACH vs AEP

Accredited Exercise Scientist (AES) – ESSA Scope of Practice

AES Definition: Applies the science of exercise to design and deliver physical activity and exercise-based interventions to improve health, fitness, well-being, performance and assist in the prevention of injury and chronic conditions.

AES CAN do

AES CANNOT do

Screen and assess health, movement, exercise and performance capacity
Design and deliver exercise interventions to prevent injury and manage risk factors for chronic conditions
Educate and promote physical activity for a healthy life at individual, community or population level
Deliver exercise programs that have been prescribed by a qualified health professional (e.g. AEP) for people with medical conditions, injuries or disabilities
Provide general nutritional advice (national guidelines only)
Support goal setting and behaviour change

Prescribe exercise for the treatment and/or management of a clinical condition or injury
Diagnose injury or disease
Perform manual therapy
Adjust a clinical client's exercise program without consultation with a qualified health professional

  Key AES Principle (ESSA Code of Professional Conduct):
  Must not make false/misleading claims about qualifications, competencies or scope of practice
Must recognise limitations and refer to other accredited professionals where appropriate
Must communicate scope of practice accurately to clients

  AES Annual Accreditation Requirements (ESSA):
  20 CPD points (min. 15 in Further Education) | Professional Indemnity Insurance | Declare criminal/ethical history | 1,000 hours practice every 5 years | First Aid + CPR certificate (renewed yearly)

ASCA Accredited Strength & Conditioning (S&C) Coach – Scope of Practice

S&C Coach Definition: An accredited ASCA coach who develops the physical capabilities of competitive athlete populations.

S&C Coach CAN do

S&C Coach CANNOT do

Work with athletic populations (youth to veterans)
Screen athletes for injury risk and performance limitations
Design periodised, integrated athletic development programs (resistance, conditioning, speed, agility, flexibility)
Develop strength, power and movement testing protocols
Monitor and assess progress (HR, GPS, performance testing)
Provide general information on healthy eating, supplement basics (per ASADA/AIS/WADA guidelines)
Work in conjunction with sports medicine staff and physios to design rehab plans
Provide basic First Aid and CPR

Diagnose injury or illness
Prescribe medications
Treat injuries through manual therapy or joint manipulation
Rehabilitate injury or directly oversee rehabilitation
Provide specific diets or recommend specific supplements
Work with the general population or clients with health concerns (cardiac dysfunction, diabetes, etc.) — unless they also hold AES/AEP qualifications

  ASCA Levels: Level 1 = Community/Club | Level 2 = State/National | Level 3 = Elite/International

  Professional Scheme Levels: Intern (PSI) → Professional (PSP) → Elite (PSE) → Master (PSM)

  University degree NOT required for ASCA accreditation but most roles require undergrad in Human Movement/Sport Science.

  Important: Dual Qualification – An AES who is ALSO an ASCA accredited S&C coach can work with BOTH general and athletic populations. They can also prescribe exercise for general purposes and conditioning for some chronic diseases (not for direct treatment).

Accredited Exercise Physiologist (AEP) vs AES – Key Difference

Role	AES	AEP
Prescribe exercise for clinical conditions	❌ No	✓ Yes
Deliver exercise programs prescribed by AEP	✓ Yes	✓ Yes
Design prevention/fitness programs	✓ Yes	✓ Yes
Work with diagnosed disease patients	Only under AEP/health professional guidance	✓ Yes (primary role)

AES Risk-Based Decision Framework for Chronic Disease Clients:

Risk Level	AES Role
Low risk (no co-morbidities)	Can prescribe general fitness and conditioning independently
Moderate risk	AEP consultation or guidance recommended
High risk	Always outside AES scope – refer to AEP/clinical team

INTERDISCIPLINARY TEAM & RETURN TO SPORT

Kraemer et al. (2009) – Return to Play Process

Source: Kraemer W, Denegar C, Flanagan S (2009). Recovery from injury in sport: Considerations in the transition from medical care to performance care. Sports Physical Therapy, 1(5): 392–395.

Stage	Primary Providers	Role
Medical Treatment (initial)	Physicians	Examine, re-evaluate, diagnose, surgical correction
Early Rehabilitation	Physicians, Physios, Athletic Trainers	Manage pain, limit swelling, protect injured tissues
Rehabilitation	Athletic Trainers, Physical Therapists	Restore motion, neuromuscular control of individual muscles
End-stage Rehabilitation	Athletic Trainers, Physios, S&C Specialists	Restore balance, reflex control, strength, endurance
Generic-specific Development	S&C Specialists	Restore most basic physical performance functions
Sport-specific Development	Sports Coaches + S&C Specialists	Restore competitive performance functions

Key Principles (Kraemer et al.):

Communication is vital – lack of communication between medical providers, S&C specialists and coaches can slow recovery and increase re-injury risk
Until full medical clearance is provided, the injured athlete remains a patient regardless of who is supervising their program
Rehabilitation is NOT linear – positives and negatives occur daily; constant feedback from the athlete is required
Athletes must be psychologically ready, not just physically, before returning to play
Progression: Open kinetic chain (unilateral) → Weight-bearing closed kinetic chain → Bilateral closed kinetic chain movements
Monitor for overtraining: athletes may try to over-train to return to play sooner, which is a major threat to successful recovery

Return to Sport (RTS) Consensus – Ardern et al. (2016)

  Key RTS considerations:
  Consider biological, psychological AND social factors in RTS decision
Composition of and roles within the decision-making team should be determined early
Regular information-sharing among all relevant stakeholders
Regular assessments and review of goals scheduled
Workload considerations: too low (under-prepared) OR too high (too much, too soon) both increase re-injury risk
Stage of the season should NOT influence RTS decision – only recovery timeline matters

"One Athlete – One Programme" Philosophy:

All members of the interdisciplinary team unified in plan and outcome measures
Clarity regarding roles and responsibilities is essential
Client/athlete is always at the centre of the team
Interdisciplinary team may include: athlete, coach, doctor/specialist, physio/athletic trainer/chiro, S&C coach, nutritionist, psychologist

Effective Interdisciplinary Collaboration Requires:

Frequent, clear and effective communication between all team members
Client-centred care
Respect for each professional's contributions
Client consent before sharing information with other practitioners

HYPERTENSION – ESSA POSITION STAND (SHARMAN ET AL., 2019)

Source: Sharman JE, Smart NA, Coombes JS, Stowasser M (2019). Exercise and sport science Australia position stand update on exercise and hypertension. Journal of Human Hypertension, 33: 837–843.

  BP Classification (Heart Foundation / Australian Guidelines):
  
    CategorySystolic (mmHg)Diastolic (mmHg)
Optimal<120AND <80
Normal120–129AND/OR 80–84
High-normal130–139AND/OR 85–89
Grade 1 (mild) hypertension140–159AND/OR 90–99
Grade 2 (moderate)160–179AND/OR 100–109
Grade 3 (severe)≥180AND/OR ≥110
Isolated systolic hypertension>140AND <90

  When systolic and diastolic fall in different categories → use the HIGHER diagnostic category.

  Key Facts:
  Hypertension = most common circulatory system condition; accounts for >40% of CVD burden
1 in 3 Australians aged >18 years have hypertension; 68% of these are uncontrolled
Accounts for 6% of all GP consults in Australia
Aerobic exercise training reduces resting BP by ~7/6 mmHg (population average, hypertensive patients)
A 5 mmHg drop in SBP → 7% reduction in all-cause mortality, 14% reduction in stroke death, 9% reduction in CHD death

Exercise Prescription for Hypertension – ESSA 2019 (Table 2):

Type	Intensity	Duration	Frequency
Warm-up / Cool-down	RPE 10–12 (Borg)	5–10 min	Before AND after all sessions
Aerobic – Moderate (walking, cycling, jogging, running)	Moderate: 40–59% VO2R or HRR; RPE 11–13	30 min	5 days/week
Aerobic – Vigorous	Vigorous: 60–84% VO2R or HRR; RPE 14–16	20 min	3 days/week
HIIT	4×4 min @ 85–95% HRpeak; 3 min recovery @ 50–70% HRpeak	~25 min	3 days/week
Resistance (major muscle groups)	8–12 reps to substantial fatigue	1 set of 8–10 exercises (multiple sets if time allows)	≥2 non-consecutive days/week
Isometric Resistance Training (IRT)	2 min @ 30% MVC (arms or legs)	4 sets with 2–3 min rest between sets	3 non-consecutive days/week

Isometric Resistance Training (IRT): NEW modality. Evidence shows SBP reduction of −5 to −11 mmHg, DBP −4 to −6 mmHg. Protocol: 4×2 min handgrip or leg at 30% MVC with 2–3 min rest. Single limb appears more effective than alternating.

Special Considerations – Hypertension:

Postpone training if: Resting BP ≥180 mmHg SBP OR ≥110 mmHg DBP → refer to doctor as priority.

Stop exercise if during session: SBP >250 mmHg AND/OR DBP >115 mmHg; also stop if SBP drops >10 mmHg below resting despite increasing workload.

Beta-blockers: reduce maximal HR and aerobic power → use RPE or target HR from exercise test at usual medication dose; may impair thermoregulation in heat → advise limiting intensity in hot weather + hydration
Diuretics: reduce plasma volume → ensure hydration especially in first weeks of treatment
Abrupt exercise cessation: avoid – may cause sudden SBP drop (venous pooling). Instead, reduce to ~30% peak capacity for 3–5 min cool-down
Older adults (>65 years): extended cool-down; hydration before/during/after; watch for hypotension, syncope, arrhythmias post-exercise
Automotive pollution: exercise away from busy roadways (pollutants can increase BP)
Hypertensive response to exercise: SBP ≥210 mmHg (men) or ≥190 mmHg (women) at maximal exercise = beyond upper normal; advise regular medical screening
Vigorous aerobic exercise (<90% HRmax or <85% VO2peak) is safe and well-tolerated by most people with hypertension

Resistance Training for Hypertension:

Dynamic resistance exercise reduces BP by ~3/3 mmHg
Must be performed rhythmically, through full ROM, at moderate-to-slow speed; emphasise eccentric contractions; maintain normal breathing (NO breath holding)
Heavy isometric lifting WITH breath holding = pronounced pressor (BP raising) effect → AVOID

OSTEOPOROSIS – ESSA POSITION STATEMENT (BECK ET AL., 2016)

Source: Beck BR, Daly RM, Fiatarone Singh MA, Taaffe DR (2016). ESSA position statement on exercise prescription for the prevention and management of osteoporosis. JSAMS.

  Definitions:
  Osteoporosis: BMD T-score ≤ −2.5 SD below mean for young adult Caucasian women (WHO); skeletal disorder characterised by compromised bone strength predisposing to increased fracture risk
Osteopenia: BMD T-score between −1.0 and −2.5 SD
Normal: T-score above −1.0 SD
>50% of women and 70% of men who sustain a low-trauma fragility fracture have osteopenia (not osteoporosis)
Nearly 2/3 of Australians over 50 have low bone mass; ~400 osteoporotic fractures per day in Australia in 2013
>95% of hip fractures occur as a consequence of a fall

What makes exercise osteogenic (bone-stimulating):

Must be dynamic (not static/continuous)
Must induce relatively high bone strains (deformations)
Must be applied rapidly
Relatively few loading cycles required IF adequate intensity achieved
Short bouts with rest periods more effective than same number performed all at once (bone cells desensitise to repetitive loading)
Diversified loading (multidirectional) required – bone adapts to habitual patterns

NOT osteogenic: Walking alone, swimming, cycling – these have minimal or no effect on BMD in peri/postmenopausal women. Walking in isolation is insufficient for bone health.

Exercise Prescription for Osteoporosis (ESSA 2016 – Table 1):

Risk Level	Definition	Impact Loading	PRT (Progressive Resistance)	Balance Training
Low-risk	Normal BMD (T > −1.0), no risk factors	High impact (>4× BW); 4–7 d/wk; 50 jumps/session (3–5 sets × 10–20 reps, 1–2 min rest)	High–very high (80–85% 1RM; RPE ≥16); 2 d/wk; 2–3 sets × 8 reps	Incorporate into strength/impact elements; challenging tasks
Moderate-risk	T-score −1.0 to −2.5, or some risk factors	Moderate-to-high (>2× BW); 4–7 d/wk; 50 jumps/session (3–5 sets × 10–20 reps)	High–very high (80–85% 1RM); 2 d/wk; 2–3 sets × 8 reps	4 sessions/wk; 30 min variety/session; ≥10s per exercise
High-risk	T-score < −2.5 (osteoporosis) OR multiple risk factors/previous fracture	Moderate (2–3× BW), within pain limits; 4–7 d/wk; aim for 50 reps over time; SUPERVISE near railing	High–very high (80–85% 1RM); 2 d/wk; 2–3 sets × 8 reps; SUPERVISE essential	4 sessions/wk; 30 min/session; SUPERVISE to prevent falls

  PRT Target Muscles (for spine and hip benefit): Weighted lunges, hip abduction/adduction, knee extension/flexion, plantar/dorsiflexion, back extension, reverse chest flys, abdominal exercises; OR compound movements (squats, deadlifts). Rate of progression for novice: 50% → 60% → 70% → 80% 1RM over first 4 sessions.

Contraindications & Special Considerations – Osteoporosis:

AVOID in vertebral osteoporosis:

Deep forward spine flexion (especially loaded) – rowing, lifting with flexed spine, yoga, Pilates, bowling, sit-ups, gardening, vacuuming
Rapid and/or loaded twisting, explosive or abrupt actions (golf, racquet sports) if high risk
Bend knees, not spine to pick up or reach low objects

Calcium and vitamin D are essential to complement exercise for musculoskeletal health
High load PRT + moderate impact loading = safe and well-tolerated even in adults with low bone mass (LIFTMOR trial evidence)
For frail individuals: prescription order = PRT first → balance training → weight-bearing activity
OA modification: use low-to-moderate impact activities + high-intensity PRT (replace jumps with heel drops)
Cardiovascular disease modification: keep intensity below ischaemia level; avoid Valsalva/breath holding; avoid isometric contractions >5–10 s
Balance exercises with eyes closed = always near a railing or secure support

OBESITY – ESSA POSITION STATEMENT (JOHNSON ET AL., 2021)

Source: Johnson NA et al. (2021). Physical activity in the management of obesity in adults: A position statement from ESSA. JSAMS, 24: 1245–1254.

  Definitions:
  Overweight: BMI 25–29.9 kg/m²
Obese: BMI ≥30 kg/m²
Australia 2017/18: 35.7% overweight + 31.3% obese = ~2/3 of adults above healthy weight
Obesity = 2nd leading contributor to preventable morbidity/mortality in Australia
Obesity causes: metabolic changes (inflammatory agents), ectopic fat storage, mechanical stress on musculoskeletal system

ESSA Obesity Exercise Prescription (Table 1):

Goal	Type	Intensity	Frequency	Volume/Duration
Weight Loss	Aerobic (brisk walking, jogging, cycling, swimming, dancing, ball games)	Moderate or Vigorous	5–7 days/week	Minimum 300–420 min/week (≈1 hour on 5+ days)
Prevention of Weight Gain	Aerobic	Moderate or Vigorous	5–7 days/week	>150 min, preferably 300 min/week (45–60 min most days)
Prevention of Weight Regain	Aerobic	Moderate or Vigorous	5–7 days/week	At least 60 min on most (preferably all) days = upper level of prevention of weight gain
Reduction in Central Adiposity	Aerobic ± Resistance (high-load: >75% 1-RM)	Moderate, Vigorous, or Higher	3–7 days/week	Insufficient evidence – may be LESS than 300 min/week
Reduction in Ectopic Fat	Aerobic and/or HIIT	Moderate, Vigorous, or HIIT	3–5 days/week	May be possible with ~500–600 MET-min/wk (≈60 min/wk vigorous/HIIT)

  Key Evidence Points:
  Exercise alone (without diet): produces only 0–1 kg weight loss
Diet + exercise combined: greatest and most sustained weight loss
Volume is the key determinant of weight loss extent – intensity alone is less important
HIIT: similar cardiorespiratory fitness benefits to MICT; limited evidence for weight management superiority
Resistance training: improves body composition, preserves lean mass during weight loss; does NOT contribute to aerobic volume targets
Resistance training (3×/week, progressing to 8–12 reps at 85% 1RM) attenuates lean mass reduction during weight loss
Modest weight loss (5–10%) → clinically significant health improvements
Benefits of PA on health (e.g. reducing visceral fat) can occur WITHOUT significant weight loss

Special Considerations – Obesity:

Comorbidity	Approach
Hypertension / T2D / CVD	Prioritise BP/glycaemic control first; use HTN/T2D aerobic volumes before increasing to weight management volumes; weight loss will assist CVD/T2D goals
Morbid obesity	Start with seated/habitual PA; progress toward weight management prescriptions; prioritise comorbid CVD management
OA / musculoskeletal limitation	Prioritise musculoskeletal health first; OA exercises (strengthening) do NOT count toward weight management aerobic volumes; aquatic exercise may be below MVPA threshold – monitor intensity
Elderly	Significant weight loss may not be primary goal; resistance exercise imperative for lean mass; improved nutrition + PA improves function and QoL
Post-bariatric surgery	PA integral to pre/post-surgical care; resistance exercise to limit fat-free mass loss; monitor for nutritional deficiencies (iron) and hypoglycaemia

  Intensity Definitions (for Table 1 above):

  Moderate: 40–60% VO2R or HRR; RPE 12–13 | Vigorous: 60–84% VO2R or HRR; RPE 14–16 | Higher: ≥60–84% VO2R/HRR or ≥14–16 RPE

ESSA STRATEGIC PLAN 2024–2026

  4 Strategic Objectives:
  Strong Workforce – strengthen capacity and capability of accredited professionals
Bold Advocacy and Promotion – raise profile nationally and internationally
Embrace Technology and Innovation – leverage tech for transformative impact
Leverage Green and Gold – showcase expertise via Brisbane 2032 Olympic and Paralympic Games

  Enablers: Strong Culture | Operational Excellence | Sustainable Growth

  Core Functions: ESSA Members | Robust Self-Regulation | Industry Leadership

WEEK 8 SEMINAR MCQs WITH ANSWERS

Q1. Which of the following roles falls within the Scope of Practice for an AES (no other qualifications)?
✓ B. Design and delivery of exercise programs to improve wellbeing and prevent chronic conditions
AES can screen and assess capacity (not diagnose), prevent injury (not treat/manage), manage risk factors for chronic disease (not treat already-diagnosed conditions).

Q2. In an athlete's rehab journey from a knee injury, which phase most likely involved transition from physio → S&C coach involvement?
✓ C. Week 8–9 which involved strength work, swimming and cycling
Per Kraemer et al.: Week 2–3 = medical/physio; Week 7 = physio; Week 8–9 = end-stage rehab (some physio + S&C); Week 11 = all S&C (restore basic physical performance).

Q3. Which is outside the scope of an S&C Coach (without other qualifications)?
✓ B. Recommending specific supplements to enhance recovery/performance
S&C coaches can provide GENERAL supplement information per ASADA/AIS/WADA guidelines only; they CANNOT recommend specific supplements. They CAN work with youth to veterans (C) and provide general healthy eating info (D).

Q4. Which interdisciplinary team is best suited for chronic disease management?
✓ A. Accredited Exercise Physiologist, General Practitioner and Dietician
AEP (not AES) manages chronic disease exercise prescription; S&C coach works with athletic populations (not chronic disease); AES can only deliver programs prescribed by AEP in this context.

Q5. What role is an AES permitted to play for clients with medical conditions/injuries/disabilities?
✓ C. Delivery of exercise programs that have been prescribed by an appropriate health professional (e.g. AEP or Physiotherapist)
AES can DELIVER (not design) programs for clinical populations when those programs have been prescribed by a qualified health professional. AES can also screen and assess capacity.

Q6. Which correctly describes minimum hypertension exercise prescription recommendations?
✓ D. Moderate or vigorous intensity (or combination) or HIIT (3–5 days/week) for endurance, AND resistance exercise (2+ days/week)
ESSA 2019: Aerobic (moderate 30 min 5d/wk OR vigorous 20 min 3d/wk OR HIIT 4×4 min 3d/wk) AND resistance (8–12 reps, 8–10 exercises, ≥2 non-consecutive days) AND IRT (4×2 min @ 30% MVC, 3 non-consecutive days).

Q7. When should an exercise session for a hypertensive client be postponed?
✓ A. If resting BP is poorly controlled (SBP ≥180 mmHg OR DBP ≥110 mmHg)
ESSA 2019: Postpone session and refer to doctor as priority if resting SBP ≥180 or DBP ≥110. Note: stop during session if SBP >250 or DBP >115.

Q8. During which stage do S&C specialists assist athletic trainers and physios (Kraemer et al.)?
✓ B. End-stage rehabilitation
End-stage rehab: Athletic Trainers + Physical Therapists + S&C Specialists work together to restore balance, reflex control, strength, endurance. Generic-specific development = primarily S&C specialists.

Q9. Which component is included within the Return to Sport consensus statement (Ardern et al., 2016)?
✓ D. Workload considerations due to possible link with re-injury
Previous injury history and stage of season NOT in the RTS consensus. Workload (too low or too high) is a key factor as both increase re-injury risk.

Q10. Injury management and clinical rehabilitation should incorporate which of the following (Ardern et al., 2016)?
✓ A. Shared decision making whereby key stakeholders communicate effectively and have clearly defined roles
One Athlete – One Programme philosophy. Communication, clear roles, regular information sharing, and regular review of goals are all essential. Minimising communication (D) increases risk of poor outcomes.

CASE STUDY: MICHELLE (Collaborative Prescription)

  Client Profile: Michelle – has overweight/obesity and hypertension. Also has a shoulder injury/pain. Goal = weight management. AES is primary practitioner.

Part A – AES Role (within scope):

Weight management: monitor BMI and waist circumference
Discuss weight history and health issues
Assess other health risk factors (medications, smoking, social situation, life stresses)
Design exercise program following prescription guidelines for weight management: aerobic exercise (strongest evidence for weight loss, prevention of weight regain, and BP regulation) AND resistance exercise (may improve lean muscle mass and assist BP regulation)

Part B – Other Health Professional Involvement:

Professional	Role
Dietitian	Nutritional strategies to facilitate weight loss
Physiotherapist or AEP	Shoulder injury and pain management
Psychiatrist/Psychologist	If chronic pain becomes an overarching issue
General Practitioner (GP)	Primary point of contact and hub of case information for all health professionals

Building the team: gather consent from Michelle → explain what is shared → contact other professionals → establish clarity on what each member can and cannot provide.

Part C – Exercise Program (Weight Management + Hypertension):

Section	Exercise	Variables
Warm-up	Cycling (recumbent bike)	10 min; Moderate (60% HRmax)
Main Session	Sit-to-stands	3 × 10; body weight; 1 min rest; shorten range if needed (elevated box)
	Treadmill walking	10 min; Moderate (60% HRmax); add incline rather than speed to increase intensity
	Single leg press (horizontal)	3 × 10 each leg; body weight; 1 min rest; progress to static/walking lunges
	Standing hip extension/abduction	3 × 10 each leg; non-resisted; rest while opposite side works; add Theraband if easy
	Cycling	10 min; Moderate-to-hard (60–75% HRmax); short bursts of higher intensity
Cool-down	Stretching	Standing quad stretch (chair); standing hamstring stretch (chair); calf stretch off step; QL stretch

Part D – Supporting Orthopaedic Surgeon's Recommendations:

Forward correspondence to GP if unsure whether they have been included
Confirm whether Michelle has physio or AEP involvement – surgeons/GPs often don't distinguish between types of exercise professionals
If no physio/AEP involved: recommend one, or ask Michelle to contact GP for a direct referral
DO NOT rehabilitate the diagnosed shoulder injury – acute care and rehabilitation is NOT within AES scope (unless under direct guidance from physio/AEP)
DO NOT attempt manual therapy – hands-on treatment is not within AES/S&C scope
Ensure weight loss exercise does NOT compromise quality of shoulder treatment or place shoulder at risk of further aggravation

WEEK 9 – OLDER ADULTS W9

DEFINITIONS & OVERVIEW

  Older Adults defined as: Healthy individuals ≥65 years of age, OR individuals aged 50–64 years with disabilities, chronic disease, and/or functional impairments. (ACSM, 2014)

Sarcopenia: Age-related progressive loss of skeletal muscle mass and physical capacity
Osteopenia: Low bone density (less severe)
Osteoporosis: Severe bone density loss with high fracture risk
Fat tends to redistribute from subcutaneous → visceral (surrounding organs) with age → associated with CVD & T2D
Only 11% of individuals ≥65 years engage in aerobic or resistance training that meets national guidelines (ACSM, 2014)
~81% of adults aged 57–85 years use ≥1 prescription medication which may alter physiological response to exercise

Common Age-Related Co-morbidities (all modifiable via exercise):

Cardiovascular disease, Type 2 diabetes, Cancer, Obesity, Hypertension, Osteoporosis, Osteoarthritis, Depression, Sarcopenia

BENEFITS OF EXERCISE IN OLDER ADULTS

Evidence supports regular physical activity and enhanced fitness capacity for: (ACSM, 2014)

Slowing physiological changes of aging that impair exercise and functional capacity
Optimising age-related changes in body composition
Promoting psychological and cognitive well-being
Managing chronic diseases
Reducing the risks of physical impairment and disability
Increasing quality of life years
Decreasing the risk of T2D and osteoporosis
Reducing medical costs and prescription medication dependence
Improvements in sleep duration and quality

Regular aerobic AND resistance training specifically:

↑ Cardiorespiratory & muscular fitness
↑ Health and functional activity
↑ Insulin sensitivity & glucose tolerance
↓ Body fat / ↑ lean muscle mass (improved body composition)
↑ Energy metabolism
↓ Sarcopenia
↑ Hormone regulation
↑ Bone mineral density

EXERCISE PRESCRIPTION GUIDELINES (FITT) – OLDER ADULTS

Source: ESSA (2009) & ACSM (2014)

Mode	Frequency	Intensity	Time/Volume	Notes
Aerobic (Moderate)	≥5 days/week	55–70% HRmax RPE 11–13 (moderate)	30–60 min/session	Walking, cycling, swimming
Aerobic (Vigorous)	3–5 days/week	70–90% HRmax	20–30 min/session	Vigorous alternatives to moderate
Resistance (Light)	≥2 days/week	40–50% 1-RM	8–10 exercises, major muscle groups; 1–3 sets × 8–12 reps	For deconditioned/beginners
Resistance (Moderate-Vigorous)	≥2 days/week	60–80% 1-RM	8–10 exercises, major muscle groups; 1–3 sets × 8–12 reps	After base established
Power Training	≥2 days/week	30–60% 1-RM	1–3 sets × 6–10 reps	Multi-joint, large muscle groups; important for falls prevention
Balance Training	No specific guideline	RPE 9–12	Use strength guideline as guide (~10–15 reps)	Critical for falls prevention; challenge progressively
Flexibility	Daily (short-term); 3–5/week (long-term)	To point of resistance	1 stretch (5–15s initially) → 3–5 stretches × 20–30s	American Geriatrics Society (for OA)

  ACSM/AHA Summary for ≥65 years:
  Moderate aerobic 30 min/day × 5 days/week OR Vigorous 20 min/day × 3 days/week
8–10 strength exercises, 10–15 reps each, 2–3 × per week
If at risk of falling → balance exercises
Have a physical activity plan

  (Nelson et al., 2007 / ACSM-AHA)

  Largest VO2max improvements in sedentary older adults: achieved with training intensities of 65–75% HRR

EXERCISE RISKS & STOP CRITERIA

Stop exercise immediately if ANY of the following occur:

Dizziness
Angina (chest pain)
Shortness of breath NOT related to exercise
Systolic BP ≥ 220 mmHg and/or Diastolic BP ≥ 105 mmHg

Most common adverse events = minor musculoskeletal problems (joint pain, bruising, sprains) (McPhee et al., 2016)
Absolute risk of exercise-related cardiovascular event = ~0.01% in those accustomed to mod-vigorous activity (Stathokostas & Jones, 2015)
Measure BP before session (baseline) and after cool-down

  Pre-exercise screening (ACSM):
  Apparently healthy + wants to start moderate exercise → medical screening NOT necessary
Apparently healthy + wants to start vigorous exercise → medical screening RECOMMENDED
Known cardiac, pulmonary, or metabolic disease → screening before any exercise program

  (Tiedemann et al., 2011 – ESSA Falls Prevention)

SPECIAL CONSIDERATIONS FOR OLDER ADULTS

Focus: Functional capacity > performance (ADLs don't require large aerobic capacity but do need strength, power, flexibility)
Deconditioned/sedentary: Start at light intensity (RPE 9–11, Borg 6–20 scale); progress conservatively
Power training: Important for falls prevention. Power declines faster than strength with age; needed to 'correct' balance loss. Commence after base strength/movement control is established.
Sarcopenia: May need to build strength BEFORE aerobic training is physically possible
Hydration: More susceptible to dehydration; impaired water/electrolyte balance → individualise fluid replacement
Medications: ~81% of adults 57–85 years use ≥1 prescription med that alters physiological response to exercise
Cool-down: Extended cool-down required → reduces risk of hypotension, syncope (fainting), arrhythmias post-exercise; also reduces chance of dehydration post-exercise
Environment: Free of tripping/falling hazards; appropriate footwear; correct technique

OSTEOARTHRITIS (HIP & KNEE) – BENNELL & HINMAN (2011)

Source: Bennell KL & Hinman RS (2011). A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. JSAMS, 14: 4–9.

  OA Background:
  Chronic joint disease; hip and knee most commonly affected lower limb sites
Causes: pain, stiffness, swelling, joint instability, muscle weakness → impaired function, reduced QoL
2007: 7.8% of Australians had OA → projected 11% by 2050 (ageing + obesity)
Severity of pain ≠ severity of X-ray changes (not well correlated)
Commonly co-exists with heart disease, hypertension, diabetes; most OA patients don't meet PA guidelines
No cure; treatment = non-pharmacological / pharmacological / surgical

Exercise Modes for OA (all beneficial for pain & function):

Mode	Evidence	Notes
Aerobic (land-based)	Strong – reduces pain, improves function	Walking, cycling, seated stepper
Resistance/Strengthening	Strong – cornerstone of OA management	Quadriceps, hip abductors, hip extensors, hamstrings, calves
Aquatic/Hydrotherapy	Moderate – small-moderate benefit	Good for obese/severe disease in early phase; no improvement in walking ability or ROM noted
Tai Chi	Moderate – beneficial for pain, function, balance, flexibility	Lower methodological quality than strength/aerobic studies
Combination (aerobic + resistance)	Optimal for most patients	Evidence: walking = strength training over 18 months (Messier et al.)

Key principle: Exercise effect sizes are HIGHER for land-based > aquatic, and aerobic > strengthening (from meta-analyses)

American Geriatrics Society – OA Exercise Guidelines (Table 2, Bennell & Hinman 2011):

Type	Intensity	Volume	Frequency
Flexibility – static (initial)	To subjective resistance	1 stretch/muscle group; hold 5–15s	Once daily
Flexibility – long-term goal	Full ROM	3–5 stretches/muscle group; hold 20–30s	3–5×/week
Strengthening – isometric	Low-mod: 40–60% MVC	1–10 submax contractions; hold 1–6s	Daily
Strengthening – isotonic (low)	40% 1-RM	10–15 reps	2–3×/week
Strengthening – isotonic (mod)	40–60% 1-RM	8–10 reps	2–3×/week
Strengthening – isotonic (high)	>60% 1-RM	6–8 reps	2–3×/week
Aerobic	Low-mod: 40–60% VO2max/HRmax; RPE 12–14	Accumulate 20–30 min/day	2–5×/week

Special Considerations – OA:

Exercise IS safe and well-tolerated for most, including severe OA
Some joint discomfort during exercise is NORMAL – do NOT adopt pain-contingent approach
STOP/modify if: substantial increases in pain/swelling lasting more than several hours after exercise
HIGH-impact exercise should be avoided (high joint load → potentially deleterious)
Obese or severe disease: consider aquatic exercise first; seated strength training tolerated better than weight-bearing aerobic
Weight loss >5% → significant improvement in disability and knee load (relevant for knee OA)
Adherence is the key predictor of long-term outcome; supervised sessions + home program = optimal
>12 directly supervised sessions → moderate treatment effect; <12 → small effect
No current evidence that exercise is disease-modifying (can reduce symptoms, not structural progression)

  ESSA/Roddy et al. Evidence-Based Recommendations (OA):
  Both strengthening AND aerobic exercise reduce pain and improve function
Few contraindications to exercise in OA
Exercise should be individualised and patient-centred (age, co-morbidity, mobility)
Group and home exercise are equally effective → patient preference determines mode
Adherence = principal predictor of long-term outcome
Effectiveness is independent of X-ray severity
Exercise programs should include education to promote lifestyle change

FALLS PREVENTION IN OLDER ADULTS – TIEDEMANN ET AL. (2011)

Source: Tiedemann A et al. (2011). ESSA Position Statement on exercise and falls prevention in older people. JSAMS, 14: 489–495.

  Falls Statistics:
  >1/3 of community-dwelling Australians ≥65 years fall at least once per year
Falls account for 14% of emergency admissions and are the leading cause of injury-related deaths in older adults
Cost of treating a single fall: $1,600–$5,688 (AUD)
Fall rates and risk of multiple falls increases significantly with age
People aged ≥85 years and those with chronic disease (Parkinson's, previous stroke) are at substantially increased risk

Falls Prevention – Exercise Evidence:

Exercise can reduce risk and rate of falls by 17–34% (Cochrane review)
Optimal exercise program (meta-analysis, 44 RCTs): Programs with (1) HIGH balance challenge + (2) HIGH dose + (3) NO walking program → 42% reduction in fall rate
Programs including balance-challenging exercises are MORE effective than those that don't challenge balance
Exercise must be progressively challenging, ongoing, and of sufficient dose
Dose: >50 hours total (e.g., 2 × 1hr/week for 6 months) → needed for lasting effect

What balance-challenging exercises look like:

(a) Stand with feet closer together or on one leg
(b) Minimise use of hands for balance
(c) Practice controlled movements of body's centre of mass

Progressions for Balance (Tiedemann Table 2):

Exercise	Progressions
Graded reaching in standing	Narrower foot placement; reach further/different directions; reach down; heavier objects; foam mat; stepping while reaching
Stepping in different directions	Longer/faster steps; step over obstacle; pivot on non-stepping foot
Walking practice	Tandem walk; increase step length/speed; different surfaces; different directions; heel and toe walking; around/over obstacles
Sit to stand	No hands; lower chair; softer chair; add weight vest/belt
Heel raises	Decrease hand support; hold longer; one leg at a time; add weight
Step ups	Decrease hand support; increase step height; add weight
Half squats (wall)	Decrease hand support; hold longer; move away from wall; add weight; one leg

  Evidence-based programs for falls prevention:
  Otago Exercise Programme – home-based strength & balance; includes walking if safe; uses ankle cuff weights with progression
Tai Chi – group-based; effective for falls prevention
FaME (Falls Management Exercise) – group-based balance and strengthening

Walking programs: Walking alone is NOT the best falls prevention strategy (may increase exposure to falls; takes time from balance training). Include walking only if it doesn't replace balance training. HIGH RISK individuals → do NOT prescribe brisk walking.

Special Considerations – Falls Prevention:

People with OA may require analgesia; people with asthma/heart disease may need medication; people with diabetes may need extra carbohydrate before/during exercise
Extended cool-down required (reduce hypotension, syncope, arrhythmias)
Dehydration more likely in older adults taking diuretics → fluid before, during, and after exercise
"Circuit" design useful for group programs (participants take turns at challenging exercises)
Adherence increased by: high self-efficacy, past exercise history, good health, exercise accessibility/convenience, social emphasis, strong leadership, individually tailored exercise
Use positive health messaging rather than "falls prevention" as sole aim → higher acceptance

EXERCISE INTENSITY TERMINOLOGY – ESSA/NORTON ET AL. (2009/2010)

Source: Norton K, Norton L, Sadgrove D (2010). Position statement on physical activity and exercise intensity terminology. JSAMS, 13: 496–502.

Intensity Category	METs (absolute)	%HRmax	%HRR	%VO2max	RPE (Borg 6–20)	RPE (C-R 0–10)	Descriptive
SEDENTARY	<1.6 METs	<40% HRmax	<20% HRR	<20% VO2max	<8 (RPE C: <8)	<1	Sitting/lying; little movement; low energy
LIGHT	1.6–<3 METs	40–<55% HRmax	20–<40% HRR	20–<40% VO2max	8–10	1–2	No noticeable change in breathing; sustainable ≥60 min
MODERATE	3–<6 METs	55–<70% HRmax	40–<60% HRR	40–<60% VO2max	11–13	3–4	Can maintain conversation; lasts 30–60 min
VIGOROUS	6–<9 METs	70–<85% HRmax	60–<85% HRR	60–<85% VO2max	14–16	5–6	Conversation generally cannot be maintained; lasts ~30 min
HIGH	≥9 METs	≥85% HRmax (≥90% in some)	≥85% HRR	≥85% VO2max	≥17	≥7	Cannot be sustained for >~10 min

  Key points from ESSA 2009 Intensity Position Statement:
  MET values most appropriate for healthy adults ≤30 years; must be adjusted for older adults or those with co-morbidities
Aerobic fitness decreases ~8–10% per decade beyond 30 years
Relative intensity measures are preferred when working with individuals (especially older adults)
1 MET = 3.5 mL O2/kg/min (resting metabolic rate)
HRmax (when unknown) = estimated as 220 – age
HRR = HRmax – resting HR (used for Karvonen method)
Vigorous activity: counted as 2× the minutes of moderate activity for population health targets (e.g., 150 min moderate/week)
National PA guideline (Australia/ACSM/AHA): ≥150 min moderate intensity/week OR ≥75 min vigorous intensity/week

Example Activities by Category:

Category	Example Activities
Sedentary	Sleeping, quiet sitting, watching TV, riding in a car, sitting reading (1.0–1.5 METs)
Light	Washing dishes, ironing, cooking, computer work, standing reading (1.6–2.9 METs)
Moderate	Walking (10+ min), gentle swimming, social tennis, golf, water aerobics, mowing lawn (3–5.9 METs)
Vigorous	Jogging, cycling fast, aerobics high-impact, stationary rowing @ 100W (6–8.9 METs)
High	Running @17.5km/h, stationary bicycling @ 200W, rowing @ 200W (≥9 METs)

MILD COGNITIVE IMPAIRMENT (MCI) & AEROBIC EXERCISE – ZHENG ET AL. (2016)

Source: Zheng G et al. (2016). Aerobic exercise ameliorates cognitive function in older adults with mild cognitive impairment: A systematic review and meta-analysis of RCTs. BJSM, 50: 1443–1450.

  MCI Definition: Cognitive decline greater than expected for age that does NOT notably interfere with daily activities. Intermediate stage from normal ageing → dementia/Alzheimer's Disease (AD).
  Prevalence in adults ≥65 years: 3–19%
20–46% of MCI cases develop AD/dementia within 3–5 years
Up to 22% of MCI cases can return to normal cognitive function with early appropriate intervention

Key Findings (11 RCTs, n=1497 participants, mean age 74.1 years):

Outcome	Result	Statistical Finding
Global cognitive function (MMSE)	Significant improvement ✓	MD=0.98 (95% CI 0.5–1.45, p<0.0001)
Global cognitive function (MoCA)	Significant improvement ✓	MD=2.7 (95% CI 1.11–4.29, p=0.0009)
Memory – immediate recall	Weak significant improvement ✓	SMD=0.26–0.29
Memory – delayed recall	Weak significant improvement ✓	SMD=0.22–0.25
Executive ability (clock drawing)	Potentially positive ✓	One study: MD=0.98
Attention	No significant improvement ✗	p=0.76
Verbal fluency	No significant improvement ✗	p=0.84
Visuospatial function	No significant improvement ✗

Aerobic Exercise Prescription used in studies:

Frequency: 2–5 sessions/week
Duration: 30–60 min/session (most studies 6 months–1 year)
Intensity: 40–60% HRR, 60–80% HRmax, or "moderate intensity"
Minimum duration for benefits: ≥6 months recommended
Modes: Walking, Tai Chi, jogging, cycling, dance-based aerobics, handball training

Clinical Implication: Aerobic exercise with low-to-moderate intensity is feasible, produces virtually no adverse effects, and improves global cognitive function and memory in MCI patients.

ASSESSMENT TOOLS FOR OLDER ADULTS

Assessment	What it measures	Use case/Notes
Progressive Balance Test	Reactive balance – graduated difficulty (standing positions reducing base of support)	Identifies severity of balance issues; suitable for ambulant older adults
Timed Up and Go (TUG)	Dynamic balance during ambulation; functional mobility	Stand, walk 3m, turn, return, sit; used for fall risk; similar to real-world walking
Fast Walk Speed Test	Gait speed; walking ability at good pace	Poor performance associated with falls, mobility decline, disability, hospitalisation, mortality
30-second Sit-to-Stand	Lower limb strength and strength endurance	Established measure; relevant if client reports leg weakness or difficulty with stairs
6-Minute Walk Test	Cardiovascular endurance / aerobic capacity	Sub-maximal aerobic assessment; common in older adults and cardiac populations
Grip Strength (dynamometer)	General upper limb strength; proxy for overall muscle function	Associated with sarcopenia; useful general older adult function screen
MMSE (Mini-Mental State Exam)	Global cognitive function screening	Score /30; used in MCI/dementia screening
MoCA (Montreal Cognitive Assessment)	Global cognitive function (more sensitive than MMSE)	Score /30; detects mild cognitive impairment

PRACTICAL EXERCISES & PRESCRIPTION – OLDER ADULTS (W9 Practical)

Exercise	Sets × Reps/Duration	Intensity (RPE)	Rest	Key Technique Cues	Progressions
Marching	3 × 10	RPE 9–12	30–60s	Drive knees up high & fast; upright posture; breathe out on knee drive; handrails for safety	Lateral marching; marching over obstacles; foam surface
Tandem Walk	3 × 7 metres	RPE 9–12	30–60s	Heel in front of toes; comfortable pace; eyes forward; handrails for safety	Foam surface; line path on ground
One-Leg Stand	3 × 30s holds	RPE 9–12	30–60s	Upright posture; weight even; hips level; eyes forward; wall for safety	Foam surface; gradually decrease hand support
Grapevine Steps	3 × 5 per leg	RPE 9–12	30–60s	Right foot crosses over left; upright posture; eyes forward; hips level; wall support	Foam surface; slower movement
Sit to Stand	3 × 10	RPE 9–12	60–90s	Drive through heels; knees in line with toes; use hands if needed; breathe out going up	Lower chair; remove hand push; goblet box squat
Step Ups	3 × 5 per leg	RPE 9–12	60–90s	Foot firmly on box; knees in line with toes; upright posture; handrails for safety	Decrease hand support; increase step height
Heel Raise	3 × 10	RPE 9–12	60–90s	Upright posture; eyes forward; push through big toe; breathe out on up phase	Decrease hand support; isometric hold at top; single leg

  Warm-up exercises for older adult balance sessions:

  10 sit-to-stands | 10 calf raises (chair support) | 10 hip abductions per side | 10 hip extensions per side

  Cool-down: 5 min walk (decreasing speed) + static stretching

  Stretches: Standing quad stretch (chair) | Standing hamstring stretch (chair) | Calf stretch off step | QL stretch (lateral trunk flexion)

SEMINAR MCQs WITH ANSWERS & JUSTIFICATIONS

Q1. The term 'sarcopenia' refers to the progressive loss of which tissue with aging?
✓ B. Muscle
Sarcopenia = loss of muscle. Bone loss = osteopenia/osteoporosis. Fat tends to accumulate.

Q2. A common co-morbidity occurring with aging, typically associated with joint pain and inflammation, is known as:
✓ C. Osteoarthritis
OA is a chronic joint disease (hip and knee most common); causes pain, stiffness, swelling, instability, muscle weakness.

Q3. According to ACSM, what is the minimum recommended aerobic training frequency for older adults?
✓ C. 5 days/week at moderate intensity OR 3 days/week at vigorous intensity
ESSA (2009) & ACSM (2014): ≥5 d/wk moderate OR 3–5 d/wk vigorous.

Q4. According to the American Geriatrics Society, which exercise guideline is recommended for people with osteoarthritis pain?
✓ D. Isotonic strength training at low-moderate intensities 2–3 times per week
AGS: isotonic low (40% 1-RM, 10–15 reps), mod (40–60% 1-RM, 8–10 reps), high (>60%, 6–8 reps), all 2–3×/week.

Q5. For previously sedentary or highly de-conditioned older adults, what should initial exercise intensity (RPE 6–20 scale) be?
✓ B. 9–11
Light intensity = RPE 9–11 on Borg 6–20 scale; conservative approach initially, then progress individually.

Q6. What types of exercise training are especially important for falls prevention in older adults?
✓ C. Balance and power training
Sensorimotor systems decline with age. Power declines faster than strength. Power needed to 'correct' balance loss. Balance training is the cornerstone of falls prevention exercise.

Q7. At what blood pressure level should exercise be stopped with an older adult?
✓ C. Systolic BP ≥220 mmHg, diastolic BP ≥105 mmHg
Also stop for: dizziness, chest pain (angina), shortness of breath unrelated to exercise.

Q8. If an apparently healthy older adult wants to begin an exercise program, medical clearance is recommended for what intensity?
✓ B. Vigorous
ACSM: moderate exercise in apparently healthy older adult = no clearance required; vigorous = clearance recommended. Known disease = clearance required for any intensity.

Q9. According to ESSA, what should be performed after a training session with an older adult?
✓ A. Extended cool-down
Reduces risk of hypotension, syncope (fainting), arrhythmias post-exercise. Also addresses dehydration risk.

Q10. Training recommendations for improving power in older adults are:
✓ B. 1–3 sets of 6–10 repetitions (30–60% 1-RM)
Lighter loads allow faster movement velocity → optimises power development. Complete AFTER base strength/movement control established. Strength improvements also lead to power improvements.

CASE STUDY: LORNA (Older Adult – Balance Focus)

  Client Profile: Lorna – older adult, somewhat regularly active, has experienced 2 falls and 2 near-falls, states "muscles are not what they used to be," reports difficulty walking up stairs. Clear balance issues but still ambulant.

Part A – Assessment Choices & Justifications:

Assessment	Justification
Progressive Balance Test	Has clear balance issues but is ambulant and active. Enables gradual increases in difficulty to gauge severity of balance problems.
Timed Up and Go	Assesses dynamic balance during ambulation – similar to real-world walking she does regularly. Complements static balance testing.
Fast Walk Speed Test	She walks regularly; poor gait speed strongly associated with falls, mobility decline, disability, hospitalisation, mortality.
30-Second Sit-to-Stand	Reports muscle weakness and difficulty with stairs → lower limb strength concern. Established measure of strength and strength endurance.

Part B – In-Clinic Session Program:

Session Objectives: Develop balance, strength and stability

Section	Exercise	Details
Warm-up	Sit-to-stands, calf raises (chair), hip abductions, hip extensions	10 reps each – prepares/strengthens hip/ankle muscles important for balance
Main Session	Balance Circuit	Obstacle course style: low balance beams, uneven surfaces, soft/malleable surfaces, dual-task (heel-toe walking + balloon tapping)
	Reactive Coordination	Ball passing with Lorna (challenge reach within safe limits); progress: single leg balance or foam mat
	Clocks	Single leg stance, opposing leg taps markers like clock face positions
	Multi-directional High Knee Marching	Slow or fast or alternating, all directions; eyes closed option with hand on wall for safety
Cool-down	5 min walk (decreasing speed) + standing quad, hamstring, calf, QL stretches

Part C – Telehealth Session Program (home-based):

Section	Exercise	Modifications for Home
Warm-up	Same as Part B	Chair or sturdy object for stability
Main	Balance Circuit	Couch cushions/pillows as uneven surface; heel-toe walking, tandem walking
	Clocks	Same as in-clinic
	Multi-directional High Knee Marching	Same; hand lightly on wall for safety if eyes closed
	Stand and Reach	Against wall, narrow foot placement, single arm reaching; progress to single leg if confident
Cool-down	5 min walk + quad (chair), hamstring (chair), calf (wall), QL stretches

Note on Balance Training Prescription: No specific guidelines exist for balance training prescription. Use general strength guidelines as a guide (approx. 10–15 reps) when appropriate.

Reference	Topic
Blagrove, RC., Bruinvels, G and Read, P (2017). Early sport specialization and intensive training in adolescent female athletes: Risks and recommendations. Strength and Conditioning Journal, 39(5): 14–23.	Early specialisation risks; minimum age 12 before single-sport focus; weekly training volume caps; recommendations for balanced development
De Souza, MJ et al. (2022). The path towards progress: A critical review to advance the science of the female and male athlete triad and relative energy deficiency in sport. Sports Medicine, 52: 13–23.	RED-S framework; consequences of low energy availability; GI, immunological, reproductive, psychological effects; ~80% athlete prevalence (Rogers et al., 2021)
Nazem, TG & Ackerman, KE (2012). The female athlete triad.	Triad definitions, prevalence statistics (amenorrhea 69% in aesthetic sports), bone health complications
Sherman, C & Thompson, RA (2004). The female athlete triad.	Amenorrhea as first sign of Triad; definitions; osteoporosis in athletes

Reference	Key Sections	Topic
ASCA (2017). Resistance Training for Children & Youth (same document as above).	Page 8, Section 3.3 (training intensity); Page 9, Section 4.2 (LTAD); Pages 10–15, Section 4.3 (model programs – sample sessions for Levels 1–4)	Practical program design across age groups; intensity progression
Ford, P et al. (2011). The Long-Term Athlete Development model: Physiological evidence and application. Journal of Sports Sciences, 29(4): 389–402.	Full article	Physiological basis of the LTAD model; evidence for staged development
Lloyd, RS et al. (2016). National Strength & Conditioning Association Position Statement on Long Term Athlete Development. Journal of Strength and Conditioning Research, 30(6): 1491–1509.	Full article (10 pillars)	NSCA LTAD position statement; 10 pillars; sampling approach; long-term health promotion

Category	Systolic (mmHg)	Diastolic (mmHg)
Optimal	<120	AND <80
Normal	120–129	AND/OR 80–84
High-normal	130–139	AND/OR 85–89
Grade 1 (mild) hypertension	140–159	AND/OR 90–99
Grade 2 (moderate)	160–179	AND/OR 100–109
Grade 3 (severe)	≥180	AND/OR ≥110
Isolated systolic hypertension	>140	AND <90

HSE302 – Exercise Programming | Master Reference Document

WEEK 1 – MUSCULOSKELETAL SCREENING W1

OVERVIEW & LEARNING OBJECTIVES

PURPOSE OF MUSCULOSKELETAL (MSK) SCREENING

Key Goals of MSK Screening Tools (Cook et al., 2014):

COMMON ASSESSMENT BATTERIES & TOOLS

FMS™: DEEP SQUAT — SCORING & INTERPRETATION

Deep Squat — Client Video Analysis (from Learning Module):

ROM TESTS: THOMAS, SLR, ELY'S & LATERAL LIFT

Video Analysis Results (from Learning Module):

MUSCLE ACTIVATION TEST: PRONE HIP EXTENSION

Video Analysis Results (from Learning Module):

BEIGHTON HYPERMOBILITY SCORING SYSTEM

POSTURAL ASSESSMENT

PROFESSIONAL CONDUCT & ETHICS (ESSA)

DO SCREENING TESTS PREDICT INJURY? (Bahr 2016 vs Hewett 2016)

PRACTICAL: MSK SCREENING ACTIVITIES

SEMINAR MCQs WITH ANSWERS

CASE STUDY: SINEAD (NETBALLER – ACL RETURN TO PLAY)

Recommended Assessments & Expected Results:

Privacy & Confidentiality:

PRESCRIBED & RECOMMENDED READINGS

WEEK 2 – INJURY PREVENTION & CORRECTIVE EXERCISE W2

OVERVIEW & LEARNING OBJECTIVES

INJURY PREVENTION PRINCIPLES

Prehabilitation (Prehab)

ACUTE:CHRONIC WORKLOAD RATIO (ACWR)

INJURY PREVENTION PROGRAMMING

1. Specific-Injury Based Prevention

2. Risk Factor Based Prevention

CORRECTIVE EXERCISE PRESCRIPTION

FMS (Functional Movement Screen) — Key Tests & Corrective Strategies

REHABILITATION PHASES

TELEHEALTH IN EXERCISE DELIVERY

Benefits of Telehealth:

Barriers and Challenges:

PRACTICAL: MUSCULOSKELETAL SCREENING & CORRECTIVE PRESCRIPTION

SEMINAR MCQs WITH ANSWERS

CASE STUDY: BLAKE (BASKETBALLER)

Screening Findings:

Issue Interpretation & Corrective Strategy:

Example S&C Session (from Seminar Answer Key):

PRESCRIBED & RECOMMENDED READINGS

WEEK 3 – EXERCISE PRESCRIPTION FOR SPORT W3

OVERVIEW & LEARNING OBJECTIVES

Learning Objectives:

SPORT SPECIFICITY IN TRAINING & TESTING

Sport-Specific Performance Attributes:

Absolute vs Relative Strength:

ACSM PROGRESSION MODELS – RESISTANCE TRAINING FOR HEALTHY ADULTS

Three Core Progression Principles:

Exercise Sequence Recommendations:

MUSCLE ACTIONS: ECCENTRIC VS CONCENTRIC VS ISOMETRIC

ACSM PRESCRIPTION SUMMARY – BY TRAINING GOAL

Training Frequency Summary:

PERIODISATION MODELS

Typical Periodised Phases (for sport):

SPORT-SPECIFIC APPLICATIONS

Soccer (Yu et al. 2021):

American Football (Jalilvand et al. 2019):

Endurance Running (Karp 2010):

TESTING STRENGTH & POWER IN SOCCER (Paul & Nassis, 2015)

1RM Testing in Soccer:

Power Testing (CMJ) in Soccer:

COACH–ATHLETE RELATIONSHIP IN STRENGTH & CONDITIONING

The 3+1 C's Model (Jowett, 2007):

Key Findings from Foulds et al. (2019):

PRACTICAL: CORE COMPOUND EXERCISES, ASSESSMENT & PROGRESSIONS

1RM Assessment Considerations:

Core Compound Exercise Technique Cues:

Progressions & Regressions Table:

3 Stages of Communication & Skill Delivery (from Practical):

SEMINAR MCQs WITH ANSWERS – WEEK 3

CASE STUDY: GEORGE (RUGBY UNION)

Assessment Results:

Building Rapport (applying Foulds et al. 2019):

Prescribed S&C Session (addressing weaknesses, sport-specific):

PRESCRIBED & RECOMMENDED READINGS – WEEK 3

Prescribed Readings (Examinable):

Recommended Readings: