NASM CPT Podcast

NASM-CPT Podcast: NASM-CPT 7 Program Designs – Special Populations

National Academy of Sports Medicine
National Academy of Sports Medicine
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In this NASM-CPT Podcast, Rick Richey continues his discussion in Domain IV with an emphasis on special populations.
Rick focuses on a myriad of topics including youth training, specifically how often and for how long, as well as tips for working with obese clients, an in-depth look at hypertension and coronary heart disease, and much more.
Whether you’re studying for the exam, or just looking to refresh your knowledge base, this is the episode for you!

Rick Richey is a NASM-CPT, CES, PES, and Master Trainer.

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Rick Richey:

Hello, and welcome to the NSM CPT podcast. My name is Rick Richey. And today, we are continuing with our study guide our guided study for the CPT seven. And again, these are things that you can follow along with especially if you're studying for the NSM CPT seven exam. If you are already an NSM certified personal trainer, this is really just some good content for you to listen to, again, as a refresher, and I think it'll come in handy. Today, we're going to be talking about special populations. So this is the part two and have to in our domain for of program design. And 20% of your exam will be taken from program design. Our previous episode, we talked about the OP t model. And in this episode, we're going to be talking about special populations. And for those of you who are following along in the chapters, section six, this is these are chapters 2122 and 23. So get into it, special populations. First thing we're going to talk about is youth training. So when working with youth, here's what we're going to do, I'm going to go through frequency intensity duration, the fitness assessments that you can do, the flexibility programs that you might put in place, and then the types of resistance training that may be beneficial to the youth training client. Now, with that said, progression should be based on postural control and physical capabilities. And that's true for any group. But the neuromuscular inefficiencies are oftentimes seen in youth, as they start to add the weight and resistance particularly for the first time, then that it's hard to control those degrees of freedom. So make sure we're basing this on what they can do. And not focused on having them do things that they can't do, or at least Well, we're going to emphasis on less load, and less weight, and more on how fun. These physical activities are. Why? Because this isn't just about personal training. This isn't about coming in and lifting weights necessarily. It is about movement in what you should be doing. So here's our frequency. How often should you be working out exercising or engaging in physical activity, and the truth is five to seven days a week, five to seven days a week for 60 minutes for 60 minutes every day, five to seven days a week, moderate to vigorous cardiovascular exercise training, that should be the focus for our youth. Now, if you're saying hey, Rick, I'm I'm a coach for a volleyball team or I'm a coach for a little league peewee football baseball team. Is there a different way that we should be training? Well, you should be doing skill training. That skill training comes in very handy as you are teaching them skills to go along with their sports. But in general, we're looking at youth five to seven days a week with a moderate to vigorous cardio respiratory exercise intensity, which for them is called playing. And they should be doing that for 60 minutes a day. Physical assessments, you can do overhead squat assessment, push up assessments, and then different cardiovascular assessments like the YMCA step test would be notable for them. And then flexibility self myofascial techniques, static stretching, active stretching, dynamic, stretching, the whole flexibility continuum can fit within the youth training, and then resistance training one to two sets, eight to 12 repetitions of 40 to 70% intensity. doing that for two to three days a week.

Alright, that's for our youth training. Let's now move into obese clients. So we have clients that may be coming into the gym, working that are obese, but they might also not be coming into the gym with some of the programming for physical activity that we should be working with and teaching and coaching and a lot of us are doing more These days, then we are doing one on one training. So it's not about necessarily what's the workout like inside the gym. But what are the protocols for working with clients that are obese? First of all, we want to make sure our clients are comfortable. Again, goes for any clients. We're talking about that specifically for our clients here in obesity, make sure they're comfortable. So foam rolling, having them get down on the floor and use a foam roller that might not be something that's very comfortable, or exercises that are floor based might not make them feel comfortable. So being aware of your clients comfort level, and how do you know, ask them, ask your clients how comfortable they are, while doing some of the things and waiting you know what we're talking about. They know what we're talking about when we clarify this. I'm not talking about is it difficult or simple. I'm talking about your comfort level with doing the physical activity that we're doing exercises, if needed should be performed in a standing or seated position. And clients may have other underlying health issues. So a medical release may be necessary for our clients that are obese. Now let's get into the protocols. So these are general protocols for physical activity for obese clients. frequency, how often are they working out the answer at least five days a week. intensity, how intense is the workout for this this special population, the intensity should between be between 60 and 80% of the max heart rate. So the intensity 60 to 80% of Max heart rate and duration 40 to 60 minutes per day, or a 20 to 30 minute session twice each day. See, because you don't have to do it all at one go. You can break up exercises. And what we're trying to do is accumulate minutes, how many minutes 40 to 60 minutes, or 20 to 30 minutes two times a day, at least five days a week at the intensity of 60 to 80% of the max heart rate. Fitness assessments may include an overhead squat assessment, pushing and pulling assessments, and then your flexibility, what flexibility that you can utilize with your clients. And then the resistance training can move into the PT model and follow some of those constructs.

Alright, what about people with diabetes? So there are two types of diabetes primarily one that you will engage with will be folks with type two diabetes, which is about 95% of the diabetes cases in our population. One thing you want to ensure is that your diabetic patients have the appropriate footwear. You want to ensure that there is a snack, a quick source of carbohydrate. Why? Well because their blood sugar tends to get elevated. Why am I keeping sugars around? Well, majority of people are also on medications that are keeping their blood sugar's down. Well, exercise is very good for that, keeping their blood sugar down bringing it down. But if you've got medications that are doing that and you start exercising, then people can get quite shaky, and low blood sugar can lead to fainting and worse, especially especially for those who are insulin dependent. So be aware of that and keep a quick source of carbohydrate close by avoid excessive plyometrics and other forms of high intensity training doesn't mean that they can't do that. But it's all dependent on the client. And everything's based off of assessments but something that you might want to avoid excessive plyometrics and high intensity training. And then self myofascial techniques may be contra indicated, and may be something rolling on their legs where they may have a peripheral vascular disease and peripheral neuropathy. Self myofascial techniques may be contra indicated for people with diabetes. No, right. hypertension and coronary artery disease. Oh, by the way, we're looking at frequency of the diabetes and exercise we're going to have the same workouts that we might see here in the hypertension and coronary heart disease. So let's talk about hypertension and coronary heart disease. First of all, avoid heavy lifting. Clients should be breathing normally. So avoid heavy lifting, avoid clenching fists while training and modify tempo to avoid extended isometric contractions and muscle actions. Why? Because that high blood pressure is if you put your thumb together and your fingertips together and make a circle with your hands. Every time your heart beats, and it contracts, it pushes pressure out against that hands. So you're making this tube as if blood is going to be flowing through it. So when the heart pumps, you'll see a little boop, boop. And that's where a pulse comes from. So you have a systolic and diastolic pressure, as your heart beats, it pushes out on the arterial wall, when you have hypertension, that pulse, it doesn't have as much give to it, the the arteries are, are tighter. They're not as flexible or malleable, and they don't expand as much as they used to could. There's a I've spent some time down in Alabama recently. So you're being left with an Alabama ism there. It can't do what it used to good. So now what can it do? Well, it's a little bit tighter, it's a little bit more locked down. And so hypertension, increased tension pushing against a blood flow. So when you tighten your muscles and contract your muscles, it also adds more tension against the artery. Same thing for people who don't have hypertension. But when you add that compression onto an already hypertensive artery, then it can lead to potential issues. So avoiding the heavy lifting, avoiding clenching fist, modified tempos, minimizing isometric contractions and concentric muscle actions. exercises for hypertension and coronary coronary artery disease should be performed in a standing or seated position. You can use circuit training and peripheral heart action system. So lower body, upper body, lower body upper body as a weight training option, as long as you're adding in some appropriate rest intervals, and that those rest intervals that are appropriate are based on how well our clients are responding. And then finally, make sure that you progress your client slowly what are we looking at for frequency three to seven days per week at 50 to 85% of the max heart rate, our duration should be 30 to 60 minutes. Fitness assessments might include single leg squat overhead, squat, pushing and pulling assessments, flexibility, you can do static, you can do active stretching, you could do it standard or seated and then resistance training one to three sets of 10 to 20 repetitions, two to three days per week.

We have a few more to go through we're going to go with older adults. Older Adults progression should be slow monitored and based on postural control. Exercise, if needed, should be focused on movement without support, like sitting or standing. And when we say exercise if needed. Remember, our goal for many populations is physical activity, get people moving. Self myofascial techniques can be replaced with slow and controlled active and dynamic stretching. So let's go through frequency three to five days per week. Intensity moderate to vigorous cardio respiratory training for 30 to 60 minutes per day, the fitness assessments you can do our overhead squat assessment, pushing and pulling assessments. Flexibility can be used self myofascial techniques, static, active and dynamic as long as you're focused and slow and controlled with your movements, resistance training one to three sets of eight to 20 repetitions at 40 to 80% of that intensity level three to five days per week for older adults. What about folks that have arthritis, arthritis is good to avoid heavy lifting and high repetitions. However, high repetitions with a low load may be appropriate. Well, as long as that is a pain free range of motion. Our goal for our clients is to be pain free. So if they're arthritic, then we pain free ranges of motion. Working through pain and arthritis is not going to help anybody reach their goals. It's going to make them want to avoid exercise, it creates pain, it can create a spike in inflammation or oftentimes referred to in arthritis as a flare up. So we want to minimize that don't work through joint pain, work through ranges of motion that are pain free, and then start slowly and progress. You know, increase follow a system a progression, and depending on the severity of the conditions will limit how far you progress your client so with that being said three to five days per week is the frequency intensity and low to moderate intensity 40 to 65% of your heart rate Max, and progress as tolerated and it all depends on the client's capabilities, fitness assessments over Squat assessment pushing and pulling assessments. Flexibility you can do static and active and controlled dynamic stretches, your resistance training with arthritis, one to three sets 10 to 12 repetitions two to three days per week, or you can lighten that load and bump those repetitions up a little bit higher. Alright, what about osteoporosis, and progression should be slow, it's got to be well monitored based on what people can control. So our postural control, it focuses exercises around the hips, thighs, back and arms, avoid excessive spinal loading. osteoporosis is the wearing down of the density that are that makes up our bones. So we want to limit that osteo means bones. pyrosis means porous.

So the holes that are in our bones, as they start to that structure starts to fade away, we want to be very careful with the spinal loading, make sure the client is breathing in normal manner, and avoid holding breath. with osteoporosis frequency two to five days per week intensity cardio respiratory training should start at a moderate intensity level. And then it can go from 40 to 65%. And their heart rate max for 20 to 60 minutes per day. Or you can do eight to 10 minute bouts. And you can just add those bouts up to meet that 20 to 60 minute per day goal. Fitness assessments overhead squat assessment, pushing and pulling assessments are feasible flexibility, static and active minimizing that application of dynamic stretching, and then resistance training one to three sets eight to 20 repetitions two to three days per week. And as they progress, we can load those bones a little bit more because resistance training does help to strengthen those bones. And if nothing else helps to minimize the speed at which osteoporosis and bone loss bone mineral density is being lost. So exercise is highly indicated resistance training is highly indicated for those with osteoporosis. Alright, cancer. With cancers, yes, there are many different types. So as a general overview, we're looking at cancer to avoid heavy lifting in the initial stages of training, allow for adequate rest and progress your clients slowly start slow and progressively increased depending on the severity of the conditions, frequency three to five days a week intensity, your cardiovascular training should be should start out moderate level and then you can go 40 to 70% of your heart rate Max and progress as tolerated duration, how long should they be doing that exercise? Well 15 to 30 minutes per session, and maybe only start with five minutes. And we keep going back to this Do what you can not what you can't and if you can do five minutes, and that's what you can do. That's what you do. And that doesn't mean that how long is our training sessions five minutes? Well, that that may be the case. But again, this is about you coaching your clients. So maybe you have a client that you've been training for a long time they have cancer, and when they work out on their own, you're just encouraging them, Hey, get five minutes in, right work create some physical activity and the benefits that come from physical activity, certainly, through conversation with their physician, fitness assessments, overhead squat assessment, pushing and pulling assessments. You can do static and active flexibility training and resistance training one to three sets 10 to 15 repetitions two to three days per week. Now, we're going to move into pregnancy. And here are some general rules for pregnancy avoid exercise and prone, which is on the stomach or supine positions on your back after 12 weeks of pregnancy. So lying down in your stomach or your back. It's just not what we're going for, particularly after the 12 week mark for pregnancy. Avoid the self myofascial techniques on varicose veins and areas of swelling, and then play plyometric training doing glyos they're not really advised in the second and third trimesters, so be aware of that. Alright, so let's talk about frequency intensity duration. Here we go frequency three to five days per week. intensity, moderate intensity cardio respiratory exercise, 40 to 70% of Max heart rate, and you can increase that as it's tolerated or based on physician's advice. Now, one of the things we look at with pregnancy is that pregnancy is probably not the best time to start working out if you've never worked out before. But if you work out regularly leading up to your pregnancy, you don't really have to make a lot of adjustments you can continue to work out You were just to be aware of the changes and tolerances and don't get frustrated with yourself that you're not able to do what again, you used to could, as you are now, pumping blood and feeding nutrients to a being inside of you, so you don't get all of those nutrients and your lifts may change your cycling classes, whatever you do. while pregnant, you may notice a little downturn and your ability to produce and it's okay, that's okay. it's to be expected. So here we are. Let's look at duration 15 to 30 minutes per day and then progress. As you feel you need fitness assessments overhead squat assessments pushing and pulling assessments flexibility, self myofascial techniques are okay, just remember not on swollen areas and be aware of any varicosities in the veins, you can add in static and active stretching. Also note that your clients may not want to do foam rolling, especially that 12 week mark where we don't want them prone or supine, the self myofascial techniques will be a bit more challenging resistance training two to three days per week using light loads at 12 to 15 repetitions. And moderate to high intensity resistance exercises may be used in the first trimester if the client is accustomed to exercise However, in the second or third trimesters lower intensity exercise programs are advised. Moving on to lung disease, chronic lung disease, here's some things to be aware of upper body exercises cause increased dipsea and it may be monitored. So just allow for it for that and then also allow for sufficient rest between exercises. So for chronic lung disease, we're looking at a frequency three to five days a week 40 to 60% of your peak work capacity, duration, work up to 20 to 45 minutes.

So that's challenging to do with chronic lung disease, but build up that fitness, assessment overhead squat pushing and pulling assessments. You can do self myofascial techniques for flexibility, static and active stretching resistance during one set of eight to 15 repetitions two to three days per week. And the peripheral heart action system is recommended that lower body upper body lower body upper body circuit so that you are practicing pumping blood to different locations in the body as you work through a brief circuit. All right, and then the last one we're going to talk a bit today about is intermittent claudication and peripheral artery disease. So intermittent claudication could be pain that is based on usually based off of limited blood flow. So how do we work with these clients that have peripheral artery disease will allow for sufficient rest between exercises and workouts may start with five to 10 minutes of just build up activity. And we slowly progress the client frequency three to five days per week. You know as you work up to this every single day is also indicated but three to five days per week. Intensity 50 to 85% of your heart rate max duration work up to 20 to 30 minutes, fitness assessment overhead squat pushing and pulling flexibility static and active stretching SMT is not listed on here. resistance training a circuit training format is recommended. So eight to 10 exercises one to three sets of eight to 12 repetitions progressing up to 12 to 20 repetitions. So getting them doing this engagement of exercise for prolonged period of time. And we are getting their heart to work a little bit more those arteries to accept more blood flow as we continue to challenge them. And that wraps up domain for domain for program design. That was our special populations. And remember to review the OPT model which was the other portion of the program design that we talked about.

Alright, so I'm done today. Thank you so much for your time. I appreciate you joining me and and i really do encourage you to continue going with your studies for those of you who are working on your CPT seven. Congratulations. I hope that you find this very helpful, and that it can help to support you in your study process. If you have questions for me reach out to me on Instagram at Dr. dot Rick Richey or you can email me directly Rick dot This has been the NASM CPT podcast.


The Author

National Academy of Sports Medicine

National Academy of Sports Medicine

Since 1987 the National Academy of Sports Medicine (NASM) has been the global leader in delivering evidence-based certifications and advanced specializations to health and fitness professionals. Our products and services are scientifically and clinically proven. They are revered and utilized by leading brands and programs around the world and have launched thousands of successful careers.


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