PE 3 Modules Students

Tertiary Physical Education Program
Rationale
A significant proportion of Filipinos are exposed to non-communicable disease

(NCD) risks which include tobacco and alcohol use, unhealthy diets, and physical inactivity.
In 2015, 68% of the total mortality rate in the Philippines is due to NCDs. The figures from
2015 show that every third Filipino (29%) can die before the age of 70 years from one of
the four main NCDs – cardiovascular diseases, diabetes, chronic respiratory disease and
cancer.
The increase in NCDs are affecting populations of low and middle income countries
like the Philippines, at a young age, reducing the productivity of the working age
population and stifling economic growth. Hence, government and private health
organizations have launched healthy lifestyle programs to help prevent and control NCDs
in the country, and one of these organizations is Southwestern University.
SWU utilizes the tertiary physical education (PE) curriculum as a conduit for
promoting fitness through physical activity among students, their family, friends and
community – the target population of this program. SWU believes that fitness born in the
psyche of students will transcend to people around them and those they get acquainted
with at present and in the future. Making these people fit will form part of their social
responsibility while in SWU, and in their organizations or communities after their
graduation; hence, the tagline – “Kung fit ako, fit din dapat sila.” The other
components – proper nutrition, prevention or cessation of smoking and alcohol
consumption and stress management will be integrated being co-existent under the
umbrella of wellness.
The tertiary physical education physical fitness program of Southwestern University

will produce living models of fitness who would manifest the following:
1. High quality of life which refers to becoming free from the discomfort of symptoms of
any form of illness, and functional in performing the activities of daily living and tasks
at home, in school, in the workplace and in the community. It does not simply refer to
living a liveable long life or adding years to life but life to years.
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2. Optimum productivity which means exhibiting highly efficient performances within the
set of standards defined by the organization or community to which the person
belongs to. The most common cause of absences and tardiness is health-related
resulting from non-healthy conforming lifestyle. It does not only lessen productivity
but entails high medical expenditures which all boils down to increasing the economic
burden on the person, the organization and the nation.
3. Social influence which refers to demonstration of sense of social responsibility in the

aspect of health awareness so that the effect of this program on them will also
transcend to members of one’s family, the organization and the community. By
mentoring them, their fitness practices can become contagious and will leave a
positive imprint in the lives of these people.
In becoming living models of fitness, the students will strive first to become fit and
competitive by working on their own under the supervision of a physical education
instructor. PE 1 comprises of modules on becoming fit which focuses on exercises that
improve cardiopulmonary capacity and musculoskeletal strength and endurance. PE 2
consists of modules on becoming competitive which prepares individuals to engage in
individual and team sports and other activities by meeting the required speed, agility,
flexibility, strength, and aerobic and anaerobic capacities.
Fit and competitive individuals cannot be considered living models of fitness when
no one will walk their path and become like them. They need to inspire people who will
become their trainees, and facilitate their training under PE 3 and 4 using what they
learned in PE 1 and 2. PE 3 covers PE 1 module where the role of the PE instructors will
be taken over by students who finished PE 1. This makes PE 1 a trainer’s training program
also. While the PE 1 graduates work on becoming contagious to their trainees, the latter
will aim at becoming fit. Same is true for PE 4 when PE 2 or PE 3 graduates will work on
becoming influential to a bigger group of people like a team, an organization or a
community who will toil toward becoming either fit or competitive whether with or
without medical comorbidities.
All the four PE programs are deemed project-based – PE 1 and 2 involve a project
of making one’s own self fit and competitive; and PE 3 and 4 make up a project involving
another individual or small group of individuals (PE 3) and the community or a team (PE
4). All modules in the four PE programs may all be delivered, accomplished, monitored
and assessed asynchronously depending on the progress of the training. However, final
assessment at the end of the semester may be done synchronously when public health
condition allows it.
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The contrast between the traditional and the new SWU tertiary PE curriculum
shows the superiority of the latter over the former as tabulated below:
Traditional SWU
Co-terminus with each semester Lifetime commitment
Thematic, stand alone Continuous progression
Cannot be applied/practiced to their Can be applied/practiced when they get to
future work unless if they become PE work; cuts across disciplines
teachers; no use in most professions
Teacher-centered, forces students to Student-centered, drives students to
execute teacher-made structured activities formulate and implement their preferred
activities
Will be considered by students just an Will be considered by students an integral
academic requirement part of their existence
Self-centered High sense of social responsibility
Based on lectures and demonstration Problem-based, research-oriented
Exam-based assessment Project-based assessment
A laboratory for PE majors A laboratory for sports science students
Conforms to CHED in detail Conforms to CHED in toto
Below is the summary of the tertiary physical education program showing the
scope of each semester, intended learning outcomes, expected derived skills, assessment
to be used and recognition rites at the end of each semester.
FIRST YEAR
st
1 Semester – PE 1 2nd Semester – PE 2
Title: Individualized Fitness Program Title: Sports Conditioning Program
Becoming Fit Becoming Competitive
Description: Application of the self- Description: Application of the self-
designed fitness program that comprises designed sports conditioning program for
of cardiopulmonary and musculoskeletal enhancement of speed, agility, flexibility,
strength and endurance training in the strength, and aerobic and anaerobic
context of Prochaska, DiClemente, and capacities to meet the demands of the
Norcross’ model of change. chosen sports or activity.
Outcomes: Physically fit to maintain Outcomes: Physically conditioned to take
healthy status and to engage in advanced part in the chosen sports or activity, and
conditioning and sports training, and readiness to transfer fitness and
readiness to make other individuals fit. conditioning skills to a group or
community.
Skills: Screening, Assessment, Exercise Skills: Screening, Assessment, Exercise
Prescription, Motivational Approaches Prescription, Motivational Approaches
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Assessment: Portfolio, anthropometric Assessment: Portfolio, speed, agility,
girth measurements, BMI, peak heart rate, flexibility, strength, and aerobic and
volume anaerobic capacity measurements
Celebration: Fitlympics (Fitness Fete) Celebration: Best Project Awards Rites
Certification: Fitness Training Certification: Conditioning Completion
Completion
SECOND YEAR
st
1 Semester – PE 3 2nd Semester – PE 4
Title: Peer/Group Fitness Program Title: Community Fitness/Sports Program
Becoming Contagious Becoming Influential
Description: Facilitation of designed Description: Facilitation of designed
fitness program to trainees for sports conditioning program for
optimization of their cardiopulmonary enhancement of speed, agility, flexibility,
and musculoskeletal strength and strength, and aerobic and anaerobic
endurance in the context of Prochaska, capacities to meet the demands of the
DiClemente, and Norcross’ model of chosen sports or activity, or a medical
change. condition.
Outcomes: Physically fit, healthy Outcomes: Physically conditioned
compliant trainees ready to engage in compliant members of the community
advanced conditioning and sports while trainer maintains one’s own physical
training while trainer maintains one’s own conditioning level
fitness level
Skills: Screening, Assessment, Exercise Skills: Screening, Assessment, Exercise
Prescription, Motivational Approaches, Prescription, Motivational Approaches,
Coaching Coaching, Organization and
Administration
Assessment: Portfolio, trainer and Assessment: Portfolio, trainer and
trainees’ anthropometric girth trainees’ speed, agility, flexibility, strength,
measurements, BMI, peak heart rate, and aerobic and anaerobic capacity
volume scores
Celebration: Fitlympics (Fitness Fete) Celebration: Best Project Awards Rites
Certification: Fitness Trainer’s Certification: Conditioning Trainer’s
PHYSICAL EDUCATION 3
Course Title: Peer/Group Fitness Program Tagline: Becoming

Contagious
Generic Course Title: Physical Activities towards Health and Fitness 1
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Course Number: PED 027 Credit: 2 units
Description: This deals with the facilitation of the designed fitness program to chosen
trainee or trainees through cardiopulmonary conditioning and musculoskeletal strength
and endurance training in the context of Prochaska, DiClemente, and Norcross’ model of
change.
Outcomes: Upon completion of this course, the student’s trainees shall have achieved
their physical fitness level in terms of cardiopulmonary conditioning and musculoskeletal
strength and endurance required to maintain healthy status and to engage in advanced
conditioning and sports training while maintaining the student’s fitness level.
Skills: The students will be honed on coaching their chosen trainees in screening their
readiness for physical activity, formulating exercise prescription, designing a fitness
program, assessing the progress of their training, and applying Prochaska, DiClemente,
and Norcross’ model of change by implicit self-motivation and explicit self-actualization.
Assessment: The students will compile their outputs and other documents in a portfolio
(print or electronic) including the accomplished forms that show records of their and their
trainees’ serial anthropometric girth measurements, body mass index, and peak heart rate.
Certification: The manifestation of the outcomes set for this course at the start of the
semester makes the students qualified to receive the Fitness Trainer’s Certificate.
General Instruction: The student chooses one or two other individuals, preferably from
their community as his trainees, and uses his platform in motivating the trainees as they
traverse from one stage of change to another. As much as possible, the student should
make sure that they would not be backsliding to the initial stages much so if they have
reached the maintenance stage and have kept the momentum to a higher level for so
long. The trainees may not see their student’s platform. However, the concepts needed in
becoming physically fit are given in their own platforms. The PE instructor monitors the
activities of both the student and his trainees, and compiles and evaluates the progress
of their training.
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Module 1 – Pre-contemplation Stage
Outcomes: Upon completion of this module, the trainees shall have achieved the
following while the student, the trainees’ coach motivates them and maintains or
progresses his own fitness level:
1. Defined their own life’s success and happiness.
2. Identified tangible and non-tangible things that make them happy.
3. Recognized stumbling blocks in the pursuit of their happiness and success.
4. Determined situations in their present lives that need to be changed.
5. Found ways to effect the changes.
6. Established readiness to apply ways to effect the changes.
Estimated Duration: Two weeks
Basic Concept on Motivational Approach: The student uses this concept in motivating the
trainees to engage in physical fitness program.
‘‘Motivation is a state of mind (characterized as an emotion, feeling, desire, idea, or

intellectual understanding; or a psychological, physiological, or health need mediated by
a mental process) which leads to the taking of one or more actions.’’ In other words,
‘‘motivation is a mental process that connects a thought or a feeling with an action.’’
Motivation is always potentially present in the mind, even if inactive, for it is essential
for self-preservation. Thus, ‘getting motivated’ is not a question of developing or
importing the mind-state. It is rather a matter of activating a presently quiescent process;
of mobilizing it; of removing barriers to its expression.
If a trainee is having a hard time getting motivated but seems ready to start, the
student’s task is to help the trainee locate these barriers and then help him mobilize the
mental process needed to remove them.
There are three phases in ‘‘finding’’ motivation:

1. Experiencing an emotional and/or intellectual thought process of the motivational
type
2. Establishing a clear mental pathway between those thoughts and the potential for
taking the related action
3. Taking the action as the result of being motivated
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To be effective, motivation must be inner-directed, e. g., ‘‘I want to do this for me, to
look better, feel better, and feel better about myself, for me, not for anyone else’’. External
motivation, e.g. ‘‘I’m doing this for my spouse/friend/children/parents or employer,
almost invariably leads to feelings of guilt, anxiety, anger and frustration.
With inner motivation your trainee will be able to take control of the way he exercises
and eats. With inner motivation, the chances are excellent that he will become a regular
exerciser, slowly, gradually, and carefully.
Students can guide their trainees through the processes of internal motivation-
mobilization and goal setting leading to self-discovery and action. In addition, students
can provide positive reinforcement and be role models for the trainees. Within limits, the
student can also help trainees locate their own motivation and mobilize it within
themselves by taking control of the process.
Taking control by the trainee is central to both starting a regular exercise program and
sticking with it. And there is much to take control of: whether to undertake a change
process at all; what goals to set; which sport and activity to engage in.
Stages of Change
In helping trainees to mobilize their motivation and then engage in behavioral change,
it is important for students to understand the stages of change. Prochaska, DiClemente,
and Norcross developed a model that is called ‘‘The Six Stages of Change’’ This
description and analysis of the change process is helpful in understanding how and why
motivation is successfully mobilized, as well the factors that lead to failure to do so.
The 6 stages of change are:

1. Pre contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination.
This module focuses on pre-contemplation where the trainee has not yet decided or
determined that he has a problem that requires a change. Therefore, he does not intend
to take any action within the upcoming six months. He may be unaware, or not fully aware,
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of the true benefits of making change or may be demoralized from past unsuccessful
attempts at change. Thus, he accepts his present state of being, either happily or
unhappily.
In pre-contemplative trainees, they are informed about the benefits of exercise in an

effort to move them toward at least contemplating regular physical activity. Trainees at
the other end of the spectrum (in the Action through the Permanent Maintenance phases)
and who are already regularly active are counselled to maintain or possibly increase their
exercise. They are also taught about injury prevention, rotation of exercise and ways to
remain active. The middle group (contemplative and planning students) who are not yet
active require mobilizing motivation, counselling and exercise prescription to initiate their
physical activity programs.
An important aspect of helping your trainee to mobilize his motivation, thereby

sending him successfully on his way through the six stages, is helping him to effectively
deal with ambivalence. Ambivalence is a state of mind characterized by coexisting but
conflicting feelings about a contemplated action, another person, or a situation in which
one finds oneself.
Feeling ambivalent about making a behavior change is perfectly normal. Virtually

everyone who even thinks about making a behavior change experiences it. Allowing
ambivalence to paralyze decision making, however, is a problem. Handled correctly, the
process of resolving ambivalent feelings can help your patient get started on the road to
success in regular exercise.
A key to success in dealing with ambivalence is to accept that it will always be present
to some extent. The ambivalent feelings will be weaker and sometimes stronger. The
trainee needs to be reminded occasionally that ambivalent feelings are perfectly normal.
It is how these feelings are handled, how they are responded to, that determines whether
they will trip one up or not get in one’s way. If ambivalence destroys commitment, that is
a problem.
If it simply questions commitment, if it does nothing more than taking your trainee on
a temporary detour, it can lead to a strengthening of resolve to proceed forward. The
person who is stuck with unresolved feelings of ambivalence is a person who, in many
cases, must look beyond or behind those feelings to determine why he has them in the
first place. Some people can resolve this on their own while others may need help.
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Below is the guide in interpreting the answers of trainees in the Physical Activity States
of Change questionnaire.
Stage Q1 Q2 Q3 Q4
Pre-contemplation No No - -
Contemplation No Yes - -
Preparation Yes - No -
Action Yes - Yes No
Maintenance Yes - Yes Yes
Teaching-Learning Activities:
For the Trainees: The student asks his trainees to perform the following and discusses the
outputs with them:
1. Interview two persons – one closed relative and one not related by blood line, both
should be suffering from any chronic or debilitating disease requiring maintenance
medications and limitations in the performance of his activities of daily living. A
written narrative report from this interview shall be submitted. The report shall
contain the answers to but not limited to the following questions:
a. How did you draw your road map to success in life? What did you consider as
essential factors that lead to the fruition of your life’s success? What did you
perceive as determinants of success that will make you happy? Had you made
your loved ones, your family collateral contributors of your success?
b. How does your present condition affect the road map you charted a long time
ago? Have you thought of attaining or not attaining anymore what you had
drawn before?
c. Can you narrate the history of your present medical condition from onset until
at present? Do you have family members or relatives who are also suffering
from, or somewhat similar or related to what you have right now? What are the
diseases common in your family?
d. Prior to the onset of the present condition, did you indulge in the use of illicit
drugs, excessive consumption of alcoholic beverages, chain smoking, skipping
adequate sleep over work, and spending time for too much worrying?
e. Prior to the onset of the present condition, had you been into any form of
physical activity like indoor and outdoor individual or team sports, fitness
exercise programs and recreational activities like trekking, leisure walking? If so,
at what age did you start and end your participation? How regular had you
done it? How many days a week? How much time you spent for this activity
every session? Less than or more than 30 minutes?
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f. What were your doctor’s advice now on dieting, compliance to medications,
and physical activity? What medications did your doctor prescribe? Can you tell
me what these are for? How long you have been taking all of these?
g. If you were to look back, what lifestyle practices you would have changed to
prevent the onset of your present medical condition, to reach the realm of
success and happiness in life you dreamt of way back then? Is physical inactivity
like lack of exercise one of those you would consider worth changing so as not
to succumb to what you have now?
2. Write an essay on the pursuit their success and happiness with emphasis on:
a. defining their own life’s success and happiness;
b. identifying tangible and non-tangible things that make them happy and
successful;
c. recognizing stumbling blocks in the pursuit of their happiness and success;
d. determining situations in their present lives that need to be changed;
e. finding ways to effect the changes
f. establishing readiness to apply ways to effect the changes.
3. Accomplish the table below. For each question below, please fill in the square Yes
or No. Please be sure to follow the instructions carefully. With the supervision of
your student coach, interpret your answer and draw conclusion.
Questions Yes No
1. I am currently physically active.
2. I intend to become more physically active in the next 6 months.
For activity to be regular, it must add up to a total of 30 or more
minutes per day and be done at least 5 days per week. For example,
you could take one 30-minute walk or three 10-minute walks each
day.
3. I currently engage in regular physical activity.
4. I have been regularly physically active for the past 6 months.
For the Student: Continue following the ongoing exercise prescription if you have not
progressed yet. Otherwise:
1. Record your new anthropometric measurements that include:
a. Weight in kilogram
b. Body mass index
c. Waist circumference in centimeter
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2. Revise your exercise prescription using the FITT format for both cardiovascular
conditioning and strengthening based on your progress at the end of the last
prescription. Use the format in Annex A.
3. Document randomly the activities by video or photograph the activities involved
in the implementation of your newly revised cardiovascular conditioning and
muscular resistance training program.
4. Tabulate the parameters obtained in each session as shown in Annexes B and C.
Basic Concept on Fitness: The student discusses these notes with their trainees after
completion of the three activities above.
Physical inactivity is a fast-growing public health problem and contributes to a variety

of chronic diseases and health complications, including obesity, heart disease, diabetes,
hypertension, cancer, depression and anxiety, arthritis, and osteoporosis. The 2008
National Nutrition Survey of the Food and Nutrition Research Institute (FNRI-DOST) found
very high prevalence of physical inactivity among adults. The prevalence of low physical
activity for work- and non-work-related physical activity was more than 85%, particularly
among females, while that of leisure-related physical activity was 83%. In fact the
prevalence of low physical activity increased significantly from 2003 to 2008, particularly
for work-related and travel-related physical activity.
In addition to improving a trainees’ overall health, increasing physical activity has

proven effective in the treatment and prevention of chronic diseases.
Regular physical activity at the correct intensity:
• Reduces the risk of death by 40%
• Lowers the risk of stroke by 27%
• Reduces the incidence of diabetes by almost 40%
• Reduces the incidence of high blood pressure by almost 50%
• Can reduce mortality and the risk of recurrent breast cancer by almost 50%
• Can lower the risk of colon cancer by 60%
• Can reduce the risk of developing of Alzheimer’s disease by one-third
• Can decrease depression as effectively as medications or behavioral therapy.
Exercise is indeed medicine!
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Benefits of Exercise
There is overwhelming scientific evidence to support the positive relationship between

regular physical activity and health. The overall health benefits of physical activity can be
summarized in the table below:
Over-all Benefits of Physical Activity

Strong Evidence Moderate to Strong Evidence Moderate Evidence
Lower risk of early death Better functional health for older Lower risk of hip fracture
adults
Lower risk of coronary heart Lower risk of lung cancer
disease Reduced abdominal obesity
Lower risk of endometrial cancer
Lower risk of stroke Weight maintenance after
weight loss Increased bone density
Lower risk of high blood
pressure Better cognitive function for Improved sleep quality
older adults
Lower risk of adverse lipid
profile
Lower risk of type 2 diabetes
Lower risk of metabolic

syndrome
Lower risk of colon cancer
Lower risk of breast cancer
Prevention of weight gain
Weight loss
Improved cardiorespiratory and

muscular fitness
Prevention of falls
Reduced depression
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Source: The evidence rating was reported based on the 2008 review by the Office of Disease Prevention and Health Promotion of US
Department of Health and Human Services. Over 8000 articles reporting the health benefits of exercise were reviewed in preparation
for the report. These evidence ratings were also adopted in the recently released 2011 National Physical Activity Guidelines by the
Health Promotion Board.
The following sections will elaborate further on the health benefits of exercise for
common chronic conditions and the optimum level of physical activity that is needed to
achieve them.
Premature death
• Individuals who are physically active for approximately 7 hours a week have a 40%
lower risk of dying early from leading cause of death than those who are active for less
than 30 minutes a week.
• The Risk of Dying Prematurely Declines as People Become Physically Active
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• High amounts of activity or vigorous-intensity activity are not necessary to reduce the
risk of premature death. Studies show substantially lower risk when people do 150
minutes of at least moderate-intensity aerobic physical activity a week.
• The most dramatic difference in risk is seen between those who are inactive (30
minutes a week) and those with low levels of activity 90 minutes or 1 hour and 30
minutes a week).
• The relative risk of dying prematurely continues to be lower with higher levels of
reported moderate or vigorous-intensity leisure-time physical activity.
Cardiorespiratory health
• Significant reductions in risk of cardiovascular disease occur at activity levels

equivalent to 150 minutes a week of moderate-intensity physical activity. Even greater
benefits are seen with 200 minutes (3 hours and 20 minutes) a week.
• In hypertension, blood pressure lowering effects of exercise are most pronounced in

people with hypertension who engage in moderate-intensity exercise 30 minutes on
most days; with systolic blood pressure decreasing approximately 5-7 mm Hg after an
isolated exercise session (acute) or following exercise training (chronic).
• It has been estimated that as little as 2 mm Hg reduction in population average systolic

BP can reduce mortality from coronary heart disease and stroke, and all causes by 6%
and 10% respectively (Lewington et al. 2002).
Metabolic health
• Regular physical activity strongly reduces the risk of developing type 2 Diabetes and
also aids in the control of blood sugar for those already with diabetes.
• The Da Qing study in China included an exercise only treatment arm and reported that
even modest changes in exercise (20 min of mild or moderate, 10 min of strenuous,
or 5 min of very strenuous exercise one to two times a day) reduced diabetes risk by
46% (compared with 42% for diet plus exercise and 31% for diet alone).
• The Finnish Diabetes Prevention Study and the US Diabetes Prevention Program (DPP)
included intensive, lifestyle modifications with both diet and increased physical
activity. In the former, 522 middle-aged, overweight adults with impaired glucose
tolerance (IGT) completed either lifestyle modifications of at least 30 min of daily,
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moderate physical activity, or no change in behaviour. The DPP randomized 3234 men
and women with IGT or impaired fasting glycemia (IFG) into control, medication
(metformin), or lifestyle modification groups, composed of dietary and weight loss
goals and 150 min of weekly aerobic activity. Lifestyle modification in both studies
reduced incident diabetes by 58% and, in the DPP, had a greater effect than metformin
(31%).
• Both aerobic and resistance training improve insulin action, blood glucose control and
fat oxidation and storage in muscle. Physical activity/exercise can result in acute
improvements in systemic insulin action lasting from 2 to 72 hours. Hence, the benefits
of regular exercise in clients with type 2 diabetes mellitus include improved glucose
tolerance, increased insulin sensitivity, decreased HbA1c and decreased insulin
requirements.
• Regular participation in aerobic physical activity and exercise results in beneficial

changes in lipid profile of patients with dyslipidaemia. These changes include
reductions in triglyceride levels and an increase in HDL (good cholesterol)
concentrations. The reductions in LDL levels in clinical trials have been inconsistent.
• Good evidence exists that physical activity reduces the risk of metabolic syndrome.
Lower rates of these conditions are seen with 120 to 150 minutes (2 hours to 2 hours
and 30 minutes) a week of at least moderate-intensity aerobic activity.
Overweight and obesity
• A minimum of 150 minutes per week of moderate intensity physical activity for
overweight and obese adults improve health; however, greater amounts of physical
activity of > 250 minutes per week is necessary to achieve clinically significant weight
loss.
• There is strong evidence that regular physical activity between 150 and 250 minutes
per week reduces the risk of weight gain and is most effective when combined with a
balanced diet.
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Musculoskeletal health
• Regular physical activity slows the decline in bone density especially in individuals
participating in weight bearing aerobic and resistance programs using moderate or
vigorous intensity. These changes are significant when exercising at 90 minutes a week
and continue up to 300 minutes a week.
• Physically active individuals, especially females, have lowered risk of hip fracture than
do inactive individuals. There is moderate evidence that 120-300 minutes per week of
regular physical activity at moderate intensity is associated with a reduced risk of hip
fractures.
Module 2 – Contemplation Stage
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following while the student, the trainees’ coach motivates them to go through the
contemplation stage of change and maintains or progresses his own fitness level:
1. Assessed their readiness to indulge in regular physical activity particularly, exercise.
2. Defined the success of their engagement in exercise with set goals and established
priorities.
3. Identified ways of controlling their lives for the success of their exercise
engagement.
4. Screened themselves with the end goal of classifying themselves according to the
risk stratification for participation in exercise.
Basic Concept on Motivational Approach: The student uses this concept in transitioning
their trainees from pre-contemplation to contemplation stage of change.
The trainee has recognized that he is engaging in a behavior, such as sedentary

lifestyle, that actually constitutes a problem. In this stage, he seriously intends to take
action within the next six months or so but is not prepared to do it just yet.
Mobilizing Motivation for Regular Exercise
When mobilizing a trainee’s motivation for regular exercise, two important points to
keep in mind are:
1. ‘‘Taking small steps’’
Gradual change is another helpful guiding concept for the person who is becoming a
regular exerciser. When starting a program from scratch, it is highly recommended that a
previously sedentary person start just with ordinary walking for 10 minutes or so, three
times a week. After a couple of weeks, he can increase the time spent, and perhaps the
frequency; and after a couple more weeks, perhaps the speed. ‘‘Too much, too soon’’, is
bound to lead to muscle pain, perhaps injury and a greater likelihood of quitting early. A
gradual increase in time spent, distance covered, and speed are the proven formula for
sticking with it.
2. Goal Setting
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The key to mobilizing motivation and to keep it going is goal setting. It is the central
element in the five-step process known as the Wellness Motivational Pathway for Healthy
Living (which will be discussed below). The exercise prescription most usefully negotiated
with the student provides Specific, Measurable, Achievable, Realistic, and Timely (SMART)
goals for the student to pursue, and a SMART pathway for reaching them. It is what makes
all efforts at behavior change work.
The Wellness Motivational Pathway for Healthy Living
No single approach to helping trainees become regular exercisers will work for
everyone. In this segment, The Wellness Motivational Pathway (WMP) approach, which is
recommended by ACSM, will be discussed.
The WMP provides your trainee with the details of the bridge they need to cross in
order to advance from the Planning Stage (III) to the Action Stage (IV). The WMP has been
developed over time from observation, anecdotal interviews and experience. While it has
not been tested experimentally, it appears to be a logical approach to how to cross the
bridge from Stage III to Stage IV and also appears to have no potential negative side-
effects.
The WMP has five steps:
1. The first step is assessment, both self and professional.
2. The second step is defining success, for the person, by the person. To be effective
for each individual, ‘‘success’’ has to be defined within his or her specific context.
It has to be realistic for the person and its achievement has to be within the realm
of possibility for him.
3. The third step is goal setting. This is the central element of the Wellness
Motivational Pathway.
4. The fourth is establishing priorities among the various sectors of a person’s life.
This is particularly important for achieving success if the person decides to become
a regular exerciser by engaging in a planned leisure time activity or sport.
5. The fifth is taking control of the whole process. This final step itself has eight
elements.
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Step 1: Assessment
Assessment has two components, assessment by oneself and assessment by others,

usually health professionals. Self-assessment is closely connected to goal setting. Letting
trainees answer questions is important in helping to define your trainee’s long term goals
and in mobilizing his motivation to achieve them. This is their first activity in this module.
Step 2: Defining Success for Oneself
How you approach the subject of success can be either helpful or rather harmful, to
your trainees and to the process of setting and achieving their goals. Whether it concerns
how to stop smoking, lose weight, or become a regular exerciser, just how your trainee
defines success for himself will have a major impact on the outcome. To be helpful and
facilitating for health-promoting behavior change, success must be defined in terms that
make sense for each trainee and must be realistically achievable for him. If success is
defined in terms that are objectively either impossible or difficult to achieve, then striving
to achieve it becomes frustrating, inhibiting, and anger provoking, and will eventually lead
to quitting. Thus, for your students, the concept of success should be facilitating, not
inhibiting.
For example, if someone is naturally slow of foot but decides to take up running,
success should not be defined in terms of absolute speed, e. g., ‘‘I will consider myself
successful when I can run a mile in eight minutes.’’ Success in this person’s case might be
better defined in terms of endurance, e. g., ‘‘As my first objective, I want to be able to run
for 20 minutes without stopping, at a comfortable pace.’’ Once that objective is achieved,
another can be set if the person wishes to do so; for success must also be defined with
the recognition that its meaning for any one person can change over time. In fact, for
most people who experience success in regular exercise, it will change over time. However,
at the beginning of the process, there is no way of knowing just how far an individual will
get.
Step 3: Goal Setting
Goal setting is the central element of the WMP. This is the single most important
undertaking in developing a successful program of regular exercise. The initial goals set
must be reasonable at the time they are set. Recognizing that what is considered to be
realistic is likely to change over time, nothing can kill a change process faster than the
setting of unrealistic, unachievable goals. The goals set should be SMART, that is, Specific,
Measurable, Achievable, Realistic, and Timely.
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The establishment of goals creates the mind-set, the mental environment, which will
permit and then facilitate what for most people is a major change in the way they live. It
is the thinking that gets one going and keeps one going, whether in purposefully walking
for 30 minutes five times per week, or using the stairs instead of the elevator and getting
off the bus ten blocks from work every day, or training for six months to run a marathon
or an Olympic distance triathlon.
Step 4: Establishing Priorities
Establishing priorities among the various possible health promoting behaviours and
between the planned personal health promotion program and the rest of one’s life is the
next step. Creating balance among the set of behaviour change goals, and between the
new goals and the rest of one’s life is central to making the whole process work. If the
person has set more than one goal, what is their ranking? Which is considered to be the
most important to achieve? Which the least? In addition, what about priorities between
the new goal(s) (in the case of athletics and other leisure time activities) and other
important things that are going on in other parts of the patient’s life, like relationships
with family and friends, and employment? If juggling needs to be done, it will be very
helpful to set priorities.
• Making the Time. Becoming a regular exerciser intrudes on one’s time for the rest
of one’s life. This aspect of the enterprise should not be swept under the rug. It
needs to be examined carefully. How is time being spent now? Can your trainee
give up four hours of television a week? Can your trainee get up 45 minutes earlier
four days a week (including the two weekend days) and cut down on dawdling time
by 15 minutes on each of those days?
Step 5: Taking Control
There are eight elements in Taking Control of the behavior that following through on
the Wellness Motivational Process is intended to lead to. Taking control of your life means
‘‘running your life instead of letting it run you.’’
The eight elements are:
1. Understanding that motivation is not a thing, but a process that links a thought to
a feeling with an action.
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2. Following the first four steps of the Wellness Motivational Process for Healthy
Living from the beginning.
3. Examining what one already does well; health- promoting behavioral changes
already made.
4. Recognizing that gradual change leads to permanent changes.
5. Dealing with the fear both of failure and of success. There are many reasons for
failure in becoming a regular exerciser, and it should be stressed that none of them
have moral content. One is not a “Bad” person if one doesn’t make it this time
around. One can always try again, and if one never makes it, well, one just does not
and that should be the end of it, unless you and the trainees are open to referral
to another health professional who may be able, by taking a different approach, to
ultimately achieve success. The necessity of dealing with the ‘‘fear of success’’ may
come as a surprise, but this is a documented problem for certain persons, especially
in the realm of weight loss.
6. The readiness to explore one’s limits while recognizing one’s limitations. It is very
important for you to be able to help trainees recognize and accept their limitations.
Speed, strength, muscular bulk, flexibility, gracefulness, are in part achieved
through training and practice. But, as noted, they are in significant part achieved
also as a result of genetic makeup. Exactly what proportion of each achievement is
determined by one’s genetic endowment and the proportion by one’s own effort
is of course not yet as known.
7. Appreciating the process of psychological immediate gratification. It’s a mental

immediate gratification, not a physically measured one like scale weight. It is the
immediate gratification that comes from taking control, taking responsibility,
realizing self- empowerment realizing self-efficacy, and doing something new and
different.
8. Achieving balance, in the process of gradual change.
After the trainees have assessed their readiness to indulge in regular physical activity
particularly, exercise, defined the success of their engagement in exercise with set goals
and established priorities, and identified ways of controlling their lives for the success of
21
their exercise engagement, they will screened themselves with the end goal of classifying
themselves according to the risk stratification for participation in exercise. This is done by
answering the Physical Activity Readiness Questionnaire.
When beginning an exercise prescription process, the question of safety to exercise

arises. There are documented risks associated with physical activity; the major concern
being the increased risk of sudden cardiac deaths as well as myocardial infarction
associated with vigorous physical exertion.
In this module, you are provided with a systematic method of assessing your trainee’s
medical status to reduce the chance that your trainee may risk injury or illness (particularly
to his or her heart) by exercising. Almost all students will benefit from exercise, but some,
especially those trainees with known disease, signs and symptoms, or risk factors for
cardio-vascular, pulmonary, or metabolic disease, may need to have certain modifications
or restrictions placed on their exercise program. With a systematic approach, the
screening process should not present a burden to the student or prevent trainees from
initiating light- or moderate-intensity
Considerations in Pre-participation Screening
As the student coach, the algorithms presented in this module will help to identify
factors that may (1) require pre-participation medical screening or exercise testing; (2)
warrant a clinically or professionally supervised program or limitations on the intensity at
which a trainee is safe to exercise, and (3) in a small number of trainees) may exclude your
trainee from participation.
Your responsibility is to follow a logical and practical sequence to acquire health
information, assess risk, and provide the exercise prescription with appropriate
precautions to your trainee.
For the Trainees: The student asks his trainees to accomplish the following and discusses
the outputs with them:
1. Answer the following questions:
a. Where am I now in my life? How did I get here?
b. What do I like about myself, my body? What do I not like?
c. What is it about my body and mind that I am unhappy with that could be
positively affected by exercising regularly?
d. What would I like to change, if anything, and why?
e. What is going on in my life that would facilitate behavior change? Inhibit it?
f. Where am I now in my physical activity level?
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g. Have I tried regular exercise before and failed to stick with it?
h. Currently, what do I estimate my potential to stick with an exercise program to
be?
i. What unmet personal needs am I thinking of attempting to meet?
j. Am I ready, really ready, to try it? Would I really like to change, even if it means
giving up something I am accustomed to?
k. Do I think that I can mobilize the mental strength if that is what I want or need
to do?
l. What has my previous experience with personal health behaviour change been?
Good? Bad? Some success? None? Will that help me this time around?
m. What can I learn from experience that will help this time? Am I being realistic
about this?
n. What is my self- image?
o. Do I think of myself as good-looking? Attractive? Not attractive? Healthy?
Unhealthy?
p. What do I see when I look in the mirror?
q. What kinds of feelings do those images elicit?
r. If I am planning to exercise to help in weight loss or simply to shape up a
currently out of shape body, will I be able to use the facts that smaller size
clothing now fits and that my waist is getting smaller as measures of success,
rather than scale weight (which might or might not change much, even as I am
redistributing body mass)?
s. And further, if I am going to exercise primarily for weight loss, is my true goal
to become really ‘‘thin,’’ rather than somewhat thinner?
2. Based on your answers to the questions above, write an essay about your readiness
to engage in exercises indicating the following:
a. SMART (Specific, Measurable, Achievable, Realistic, and Timely) Goals
b. Daily or weekly prioritized activities including its schedule
c. Ways to control factors that hamper your goals
3. Accomplish the Physical Activity Readiness Questionnaire below. The student
coach will help the trainee interpret the answers to the questions below.
b. Body mass index
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24
25
26
27
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Basic Concept on Fitness: The student discusses with the trainee these notes prior to
accomplishing the PAR-Q form by the latter.
Risks of exercising -- Putting it in perspective
Before discussing the risk of exercising, it is important to begin by asking the question,
’’Is the person safe to remain sedentary?’’ Physical inactivity has been identified by the
World Health Organization as the fourth leading risk factor for global mortality (6% of
deaths globally).
The risks of participation in exercise range from the most common – muscle soreness
and musculoskeletal injury to the most serious – myocardial infarctions and sudden
cardiac death, which will be discussed here. Vigorous physical activity has been shown to
transiently increase the risk of sudden cardiac death and myocardial infarction (heart
attack) among individuals with both diagnosed and occult cardiac conditions. The
absolute risk of sudden cardiac death during vigorous physical activity has been estimated
at one per year for every 15,000 - 18,000 people. Although these rates are low, the risk is
relatively higher in sedentary unscreened individuals who engage in unaccustomed
vigorous activity. As such, sedentary individuals who intend to exercise should begin with
low to moderate intensity exercises. For these individuals, an appropriate pre-
participation screening process should be administered to further lower the risk.
The important points on risk of exercising can be summarized below:

• Exercise generally does not provoke cardiovascular events in healthy individuals
with normal cardiovascular systems.
• Risk of sudden cardiac arrest or myocardial infarction is very low in healthy
individuals performing moderate intensity activities.
• Risk of sudden cardiac death and/or myocardial infarction increases transiently and
acutely in individuals performing vigorous exercise with diagnosed or occult
cardiovascular disease.
Even in patients with known cardiac disease undergoing a supervised rehabilitation

programs, the incidence of adverse cardiac events are rare: cardiac arrest = 1 in 117,000;
non-fatal myocardial infarction = 1 in 220,000; and death = 1 in 750,000 patient-hours of
participation.
Considering the overwhelming benefits of physical activity, the risk of inactivity and
the relatively rare serious side effects of exercise, almost all patients will benefit from
29
physical activity; with some of them needing modifications or restrictions on their exercise
program. For patients with chronic diseases, it is important that the clinician performs a
risk stratification and exercise screening prior to initiating an exercise prescription.
Aims of Pre-Participation Health Screening
• Identify individuals with medical contraindications for exclusion from exercise

programs until these conditions have been addressed and optimized.
• Identify individuals with clinically significant disease(s) who should participate in a
medically supervised exercise programs.
• Identify individuals who are at increased risk for disease because of age, symptoms
and risk factors who should undergo further medical evaluation and exercise testing
before initiating an exercise program or increasing the frequency, intensity or the
duration of the current program.
• Identify individuals with special needs e.g. Elderly or disabled population etc. that may
affect exercise testing and programming.
A self-guided questionnaire such as the Physical Activity Readiness Questionnaire is

the recommended entry level for screening. This self-guided question screening tool is
able to quickly identify conditions or risk factors that require further assessment before
commencing exercise. If the trainee answers no to all 7 questions, he is at a LOW RISK for
health complications, and is generally safe to begin an exercise program without
supervision at any intensity. The student coach can expect to receive the New PAR-Q from
trainees that require exercise clearance.
However, for most patients with chronic disease, the PAR-Q typically produces a
positive response for at least one of the questions. With that in mind, the algorithm
presented in the figure below outlines the screening process that the student coach and
the trainee can go through to determine the student’s risk level. This is called risk
stratification. This assessment process is based on ACSM’s recommendation available in
the eighth edition of ACSM’s Guidelines for Exercise Testing and Prescription.
Risk Stratification
The process of risk stratification is based on:

• Identifying the presence or absence of known cardiovascular, pulmonary and/or
metabolic disease.
• Identifying the presence or absence of signs and symptoms suggestive of
cardiovascular, pulmonary and/or metabolic disease. (see Table 1.1) for definition
of major signs and symptoms)
30
• Identifying the presence or absence of cardiovascular risk factors. (see Table 1.2 for
Cardiovascular Risk Factors Threshold)
ACSM Risk Stratification Categories
Low risk:
• No signs/symptoms of or no diagnosed cardiovascular, pulmonary and/or
metabolic disease.
• No more than one cardiovascular risk factor.
• Low risk of acute cardiovascular event.
Physical activity/exercise program may be pursued safely without the necessity of
medical examination and clearance
Moderate risk:
• No signs/symptoms of or no diagnosed cardiovascular, pulmonary and/or
metabolic disease.
• Two or more cardiovascular risk factors.
• Increased risk of acute cardiovascular event.
• Individuals at moderate risk may safely engage in low to moderate intensity
physical activities while awaiting medical clearance.
• Medical clearance and exercise testing prior to participation in vigorous intensity
exercise is recommended.
High risk:
• One or more signs and symptoms of or diagnosed cardiovascular, pulmonary
and/or metabolic disease.
• High risk of acute cardiovascular event.
• Thorough medical examination and clearance must be sought prior to initiation of
physical activity or exercise at any intensity.
Placement of your trainee in the HIGH, MODERATE, or LOW RISK categories helps the
student coach determine the need for further testing and supervision during exercise.
HIGH RISK: Trainees should undergo further medical testing before starting an
exercise program. Clinical supervision is recommended during exercise and stress testing.
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* Clinical supervision = under the direct supervision of a health/fitness professional
possessing a combination of advanced college training and certification equivalent to the
ACSM Registered Clinical Exercise Physiologist and Exercise Specialist or above
MODERATE RISK: The trainee is safe to begin light- or moderate-intensity exercise

(should undergo further medical assessment before partaking in vigorous-intensity
exercise) Supervision by a fitness professional during exercise is often recommended
(depends on the reason for falling into this category)
* Professional supervision = under the supervision of a health/fitness Professional possessing

a combination of academic training and certification equivalent to the EIMP Clinical Fitness
Professional or above.
LOW RISK: The trainee is safe to begin exercising without further assessment. Exercise
supervision is not necessary.
It is also important to note that trainees may require supervision for reasons other
than a medical condition. These may include learning to use the exercise equipment,
familiarization with exercise technique and if either the student coach or the trainee feels
that exercising under supervision will motivate trainee to continue regular exercise.
Algorithm for the screening process:
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33
34
35
36
37
Important considerations for risk stratification
The algorithm serves as a guide that may be modified at the discretion of the student
coach. Some of the information may not be available to the student coach at the screening
to assess the risk level accurately. Under these circumstances, student coaches are
encouraged to use existing information and make a conservative estimate of the trainee’s
risk level.
• If the trainee’s disease is well controlled e.g. metabolic or pulmonary disease such
as thyroid and asthma and other stable chronic diseases or conditions) the trainee
will remain at HIGH RISK; however, the intensity of his exercise may be increased
at the discretion of the relevant specialist or cardiologist.
• A trainee in the moderate risk category based on cardiac risk factors may be
progressed to LOW RISK if the risk factors resolve (e. g. quitting smoking, losing
weight, or no longer sedentary).
• Hypertensive trainees with resting SBP ≥ 200 mm Hg or DBP ≥ 110 mm Hg should

not undergo exercise testing nor be allowed to exercise. It is important to establish
blood pressure control and assess for presence of end organ disease before
initiating exercise. For asymptomatic hypertensive trainees with BP < 180/110 mm
Hg and no evidence of end organ disease, they may begin low to moderate
intensity aerobic exercises without the need for exercise testing.
• For individuals with type 2 Diabetes (T2DM) desiring to participate in low-intensity

physical activity like walking, physicians should use clinical judgment in deciding
whether to recommend pre exercise testing. Conducting exercise stress testing
before walking is unnecessary. No evidence suggests that it is routinely necessary
and requiring it may create barriers to participation.
• To avoid automatic inclusion of lower-risk individuals with T2DM, exercise stress

testing is recommended primarily for previously sedentary T2DM trainees who
want to undertake activity more intense than brisk walking. The goal is to more
effectively target individuals at higher risk for underlying cardiovascular disease. In
general, ECG stress testing may be indicated for individuals matching one or more
of these criteria in the Table 1.3 below.
For a more in-depth look at pre-participation screening, please see the National Sports
Safety Committee’s report 2007 which can be downloaded from the website below:
38
http://www.ssc.gov.sg/publish/etc/medialib/sports_web_uploads/gc/media_releases_enc
losures/sports_safety_committee.Par.0005.File.tmp/Sports_Safety
_Committee_26SEPO7.pdf
In this module, we have outlined both the health risks that trainees face if they remain
inactive, as well as the risks of exercising. Although most trainee s will benefit from
participating in regular exercise, trainees should be screened prior to initiating an exercise
program. For many, this will consist of the short PAR-Q, in which they are able to answer
NO to each of the questions. These trainees are safe to begin an exercise program of any
intensity without supervision.
For trainees who answer YES to at least one of the New PAR-Q questions, the screening
process needs to continue to assess their level of risk. The risk level (low, moderate, or
high) that the trainee is assessed at will determine:
a. Whether he needs further medical assessment prior to beginning an exercise
program.
b. The intensity at which he is safe to exercise.
c. Whether he needs supervision during his physical activity.
39
Module 3 – Preparation/Planning Stage
following while the student, the trainees’ coach motivates them to go through the
planning stage of change and maintains or progresses his own fitness level:
1. Been cleared medically to engage in physical activity particularly, exercise.
2. Designed for themselves an exercise program for strengthening and cardiovascular
conditioning.
Basic Concept on Motivational Approach: The student coach uses this concept in giving
their trainees confidence and guarantee that it is safe to engage in the exercise they
designed based on the algorithm of the ACSM. They will also be guided in the design of
their personalized strengthening and cardiovascular conditioning program.
In this stage, the trainee is seriously planning to engage in behavior change within the
next month or so. Upon entering this stage, the person has become motivated. One has
found those thoughts that will activate him, that will overcome his or her ambivalent
feelings and his doubts that he can, in fact, succeed. He consciously chooses to engage
in a new set of behaviours and believes that positive change will indeed be possible.
40
For the Trainees: The student asks his trainees to do the following and discusses the
outputs with them:
1. Write an essay explaining their risk stratification and the exercise intensity that fits
their classification.
2. Record their baseline anthropometric measurements that include:
b. Height in meter
c. Body mass index = weight in kg divided by the square of the height in meter
d. Waist circumference in centimeter
3. Make an exercise prescription using the FITT format for both cardiovascular
conditioning and strengthening. The format is found at the end of this module.
b. Body mass index
Basic Concept on Fitness: The notes on the basic concepts of exercise prescription shall
be discussed by both the student coach with his trainees before the latter accomplish the
second and third activities for trainees above.
Every exercise prescription should be tailored to meet individual health and

physical fitness goals. The principles of exercise prescription are based on the
psychological, physiological and health benefits of exercise training, and are generally
intended for a healthy adult. Modifications are however, necessary to accommodate the
individual characteristics such as health status, physical ability, age or athletic and
performance goals.
Components of Exercise Training Sessions
41
• Warm up
➢ Transitional phase that allows the body to adjust to the changing physiological,
biomechanical and bioenergetic demands during the conditioning phase of the
exercise session.
➢ Minimum of 5-10 minutes of low to moderate intensity cardiovascular and
muscular endurance activities.
➢ Increases body temperature.
➢ Decreases the potential for post-exercise muscle soreness.
• Conditioning
➢ 20-60 minutes of aerobic, resistance, neuromuscular and/or sports activities
(exercise bouts of 10 minutes are acceptable if the individual accumulates at
least 20-60 minutes each day of daily exercise).
• Cool down
➢ Allows gradual recovery of heart rate and blood pressure, and removal of
metabolic end-products from the muscles used during the more intense
conditioning phase.
➢ Minimum of 5-10 minutes of low to moderate intensity cardiovascular and
muscular endurance activities.
• Stretching
➢ Minimum of 10 minutes of stretching performed after the warm up or cool
down phases.
Components of an Exercise Prescription
The components of a prescription for medication include the name of the medication,
strength or dose, frequency of administration, route, refills, and precautions. The
components of an exercise prescription follow a similar format, using the FITT principle:
Frequency, Intensity, Time (or duration) and Type. An important element to consider in
exercise prescription is exercise progression.
Frequency refers to the number of times the activity is performed each week. There is
a positive dose-response relationship between the amounts of exercise performed -- as
the amount (frequency and time or duration) of exercise performed increases, so do the
benefits received.
Intensity of the physical activity is the level of vigour at which the activity is performed.
There are a number of ways in which intensity can be measured. Some methods are easier
42
to use but are generally less objective, while others are more objective but may require
additional equipment or simple calculations. The Table 2.1 provides an overview of some
ways to measure exercise intensity.
In general, we recommend using a simple, though less objective, measure of intensity,

such as the talk test or the Rating of Perceived Exertion (RPE). Objective measures of
intensity are more accurate and often used in formal exercise testing.
• Subjective Measures of Intensity
The least objective but easiest measure of intensity is the ‘‘talk test.’’ When
performing physical activity at a low intensity, an individual should be able to talk or sing
while exercising. At a moderate intensity, talking is comfortable, but singing, which
requires a longer breath, becomes more difficult. At vigorous intensity, neither singing
nor prolonged talking is possible. A similarly easy but more robust measure of intensity is
‘perceived exertion.’
The original perceived exertion scale, the Borg Rate of Perceived Exertion (RPE)
Scale ran from a minimum of 6 to a maximum of 20. This scale has been simplified to a10-
point scale in which intensity increases from a minimum (level 0) to a maximum (level 10).
Both are shown below. The talk test and RPE Scale are practical measures for sedentary
patients without significant cardiovascular risk factors.
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• Physiological/ Relative Physiological/Relative Measures of Intensity
Other more objective measures include percentages of maximal oxygen

consumption (VO2 max), oxygen consumption reserve (VO2 R), heart rate reserve (HRR)
and maximal heart rate (HRmax). Some of these more objective measures are used in
formal exercise testing. Perhaps the easiest but not the most accurate measure is
calculated using a percentage of the patient’s HRmax.
For example, exercising at a moderate intensity would be quantified as 64%-76%

of HRmax. You estimate your trainee’s HRmax using the formula 220 minus the trainee’s
age (220 - age).
Although this method is simple, it has a high degree of variability and tends to
underestimate HRmax in persons under the age of 40 and overestimate it in individuals
44
over the age of 40. This is generally true for both genders. A more accurate but more
complicated formula is 206.9 - (0.67 ◊ age). Depending on the situation, the clinician will
need to decide whether ease or accuracy is more important.
• Absolute Measures of Intensity Metabolic Equivalents
METs represent the absolute expenditure of energy needed to accomplish a given

task such as walking up two flights of stairs. One MET is defined as 1 kcal/kg/hour and
is roughly equivalent to the energy cost of sitting quietly. A MET is also defined as
oxygen uptake in ml/kg/min with one MET equal to the oxygen cost of sitting
quietly, equivalent to 3.5 ml/kg/min. METs are a useful and convenient way to describe
the intensity of a variety of physical activities and are helpful in describing the work of
different tasks; however, the intensity of the exercise needed to achieve that task is relative
to the individual’s reserve. A simple way of converting METs to calorie cost of physical
activity makes use of the following equation:
Calories expended/hr = *METs Rating X BW (kg)
* 2000 Compendium:?Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL,
Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS. Compendium of Physical Activities: An
update of activity codes and MET intensities. Medicine and Science in Sports and Exercise, 2000;32
(Suppl):S498-S516.1993 Compendium:?Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis
JF, Paffenbarger RS Jr. Compendium of physical activities: Classification of energy costs of human physical
activities. Medicine and Science in Sports and Exercise, 1993; 25:71-80.
For example, a healthy, active person may report that climbing the two flights of
stairs as light-intensity, while an inactive, chronically ill person may report that the same
task requires vigorous effort. Light physical activity is defined as requiring less than 3
METs, moderate activities 3-6 METs, and vigorous activities greater than 6 METs. Table
2.2 illustrates common physical activities with the associated intensity in METs.
As with other aspects of this module, you and the trainee are offered choices. Here,
again, the choice of measure for intensity is used is up to the trainee and you. For persons
at risk for cardiac events, more objective measures may be necessary; while for otherwise
healthy, sedentary individuals, the easier, more subjective measures will likely suffice.
Table 2.2. Common physical activities with the associated intensity in METs
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Time, or duration of the activity, refers to the length of time that the activity is
performed. Generally, bouts of exercise that last for at least 10 minutes are added
together to give a total time or duration for a given day. For example, a trainee who brisk
walks 10 minutes in the morning, and 10 minutes in the evening, can count a total time
or duration of 20 minutes for the day. Note that the exercise recommendations are dosed
in terms of minutes of activity.
Type of physical activity: Walking is the most common form of physical activity that
sedentary individuals can begin. Walking is a very familiar activity, and one that can easily
be incorporated into daily life. The main types of exercise are:
• Cardiovascular / Aerobic exercise

• Resistance Exercise Aerobic (Cardiovascular) Exercise
• Aerobic (cardiovascular) exercise: Continuous rhythmic exercise that uses a large
amount of muscle mass; require aerobic metabolic pathways to sustain activity.
• Use of large amount of muscle? Sufficient? In total body oxygen consumption?
Central cardiopulmonary adaptations
e.g.: Walking, jogging, cycling, swimming, rowing, dancing, in-line skating
The quantity or volume of exercise is a function of the frequency (F), intensity (I) and
the duration/time (T) as well as the type of the exercise performed (T). The exact
composition of FITT varies depending on the characteristics and goals of the individual.
The FITT exercise prescription will need to be revised according to the individual’s
response, need, limitation and adaptation to exercise as well as the evolution of goals and
objectives of the exercise program.
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Frequency
➢ 3-5 days a week of a combination of moderate and vigorous aerobic exercise.
Intensity
➢ Relative (physiologic) difficulty of the exercise (how hard the exertion feels).
➢ Exercise of at least moderate intensity that noticeably increases heart rate and
breathing is recommended as the minimum exercise intensity for adults to achieve
health benefits.
➢ A combination of moderate and vigorous intensity exercises that substantially

increases heart rate and breathing is recommended and ideal for attainment of
health improvements in most adults.
➢ The risk of exercise, which includes cardiac and musculoskeletal complications,

increases with higher intensity.
➢ Higher intensity interval training is time-efficient, especially for individuals who

have less time available for physical activity.
➢ Intensity and duration interact and are inversely related.
➢ Improvements in aerobic fitness from low intensity, longer duration exercise (easy
run for 90 min) are similar to those with higher intensity interval training (various
quantities of intervals between 30 sec and 4 min)
➢ Exercise intensity may be estimated by various methods, the easiest objective

measure being Peak HR method:
Target HR = HRmax x % intensity desired

where predicted maximal heart rate (HRmax): 220 - age
➢ Less objective but practical methods for sedentary subjects like the talk test and
RPE have been discussed above.
Other methods are:
➢ HR reserve (HRR) method:
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Target HR = [(HRmax - HRrest) x % intensity desired] + HRrest
(HRmax is calculated by prediction equation).
➢ VO2 reserve method:

Target VO2 R = [(VO2 max - VO2 rest) x % intensity desired] + VO2 rest (VO2 max
is estimated by maximal or submaximal testing).
➢ Peak VO2 method:

Target VO2 = VO2 max x % intensity desired.
➢ Peak METs x (% METs) method:

Target METs = [(VO2 max)/3.5ml/kg/min] x % intensity desired. (Activities at the
target VO2 and METs can be determined using a compendium of physical activity
or metabolic equations).
HR reserve and VO2 reserve reflect the rate of energy expenditure during physical
activity more accurately than other exercise intensity prescription methods but
require more complex calculations and exercise testing.
Exercise quantity and duration (Time)
➢ Measure of amount of time physical activity is performed i.e. per session, day or
week, or by the total caloric expenditure.
➢ The quantity of physical activity may be performed continuously or intermittently

and accumulated over the course of a day through one or more sessions of physical
activity of at least 10 minutes in duration.
➢ A total of 150 minutes of moderate intensity aerobic exercise or vigorous intensity

aerobic exercise done for a total of 75 minutes is recommended for most adults.
Both moderate and vigorous intensity exercises can be accumulated over a week
with 1 minute of vigorous intensity aerobic exercise equivalent to 2 minutes of
moderate intensity aerobic exercise.
➢ To promote or maintain weight loss, 50-60 minutes a day (to total 300 minutes per
week of moderate exercise), or 150 minutes per week of vigorous exercise (or an
equivalent combination of daily exercise) is recommended.
➢ Performing intermittent sessions of 10 minutes of exercise to accumulate the

minimum duration recommendations is an effective alternative to continuous
exercise.
48
➢ Total caloric expenditure and step counts may be used as surrogate measures of
exercise duration.
➢ A minimum caloric expenditure of 1000 kcal a week through physical activity and
exercise, as well as 3000-4000 steps per day of walking at moderate to vigorous
intensity is recommended.
Aerobic (Cardiovascular) exercise mode (Type)
➢ Rhythmic, aerobic type exercises of at least moderate intensity involving large

muscle groups and requiring little skill to perform are recommended for improving
cardiovascular fitness.
➢ Other exercise and sports requiring skill to perform or higher levels of fitness are
recommended only for individuals with adequate skill and fitness to perform the
activity.
➢ Exercise can be classified into different groups according to exercise intensity and
energy expenditure (see Table 2.3)
49
➢ Group A & B - useful to regulate and maintain intensity of effort
➢ Provide predictable levels of energy expenditure - not affected by sex, age, skill
➢ As individuals progress to higher fitness levels, group C & D exercises provide more
variation. Rely on heart rate response or subjective RPE
➢ Cardiovascular exercises can also be classified by body-weight dependency
Southwestern University will follow the FITT format using the training design of the
European Association of Preventive Cardiology, European Society of Cardiology as shown
50
below. In the absence of the results of the cardiopulmonary exercise test, the intensity
discussed above will be used: <64% for light intensity, 64 – 76% for moderate intensity,
and >74% for high intensity. The Karvonen’s formula will be used to determine the target
heart rate: [(HRmax - HRrest) x % intensity desired] + HRrest; HRmax is 220 – age.
Muscular Fitness and Resistance Training
Resistance training is an essential component of any exercise training program. It

improves all components of muscular fitness including strength, endurance and power.
The aims of resistance training include reducing the physiological stress during activities
of daily living, preventing muscular deconditioning, and for effective management and
prevention of chronic diseases.
• Frequency
➢ For general muscular fitness, and for adults who are untrained or recreationally
trained, resistance training of each major muscle group is recommended for 2 or
more days a week with at least 48 hours separating the exercise training sessions
for the same muscle group.
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➢ All muscle groups to be trained may be done so in the same session, or each
session may focus on selected muscle groups so that only a few of them are trained
in any one session. (split routine)
• Type
➢ Multi joint or compound exercises affecting more than one muscle group and
focusing on agonist and antagonist muscle groups are recommended for all adults,
to avoid creating muscle imbalances that may lead to injury.
➢ Single joint exercises targeting major muscle groups may also be included in a
resistance training program.
• Volume of resistance exercise (Repetitions and sets)
➢ Adults are encouraged to train each muscle group for a total of 2-4 sets, derived
from the same exercise or from a combination of exercises affecting the same
muscle group, with 8-12 repetitions per set i.e. 60-80% of one-repetition maximum
(1-RM), with a rest interval of 2-3 minutes between sets to improve muscular
fitness. 1-RM is the maximum amount of weight one can lift in a single repetition
for a given exercise.
➢ Having different exercises training the same muscle group adds variety and
improves adherence to the training program.
➢ Resistance training intensity and number of repetitions performed each set are
inversely related.
➢ A higher number of repetitions with lower intensity not exceeding 50% 1-RM
should be performed per set along with shorter rest intervals and fewer sets if the
objective of the resistance training program is mainly to improve muscular
endurance.
➢ For older adults and deconditioned individuals who are more susceptible to
musculotendinous injuries, 1 or more sets of 10-15 repetitions of moderate
intensity i.e. 60-70% 1-RM resistance exercises are recommended.
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• Technique
➢ Each exercise should be performed with proper technique and include both lifting
(concentric contractions) and lowering (eccentric contractions) phases of the
repetition. Each repetition should be completed in a controlled deliberate fashion
throughout the full range of motion.
➢ Maintain a regular breathing pattern i.e. exhaling during lifting phase and inhaling
during the lowering phase.
Flexibility Exercises (Stretching)
➢ Stretching exercise is recommended in any exercise training program for all adults.
➢ Stretching exercise is most effective when the muscles are warm and should be
performed before and/or after the conditioning phase.
➢ Stretching should be performed to the limits of discomfort within the range of

motion, perceived as the point of mild tightness without discomfort.
➢ Stretching following exercise may be more preferable for sport activities where
muscular strength, power and endurance are important for performance, rather
than during the warm up period.
➢ Stretching following warm up is still recommended for adults exercising for overall
physical fitness or athletes performing activities in which flexibility is important.
➢ There is minimal scientific evidence to demonstrate the efficacy of stretching for

injury prevention though limited evidence seems to suggest that it may be
beneficial in sports in which flexibility is an important part of performance.
53
➢ Stretching exercises improve the joint range of motion and physical function,
especially in the elderly.
➢ Stretching should be performed at least 2-3 times a week, for at least 10 minutes
in duration.
➢ Stretching exercises should involve the major muscle tendon groups of the body.
➢ Four or more repetitions per group are recommended.
➢ Static stretches should be held for 20-30 seconds.
Neuromuscular Exercise
➢ Neuromuscular exercise is recommended for the elderly population who are

frequent fallers or with mobility impairment, and suggested for all adults.
➢ Frequency: 2-3 days a week.
➢ Examples include core conditioning, balance & gait exercises, and taijiquan.
SWU Exercise Prescription Format (See Annex A for Tabular Format)
• Cardiovascular Conditioning
Warm-up:
Static Stretch 1: _______________ Duration: _____ sec Reps: ______ Set: ____
Conditioning:
Frequency: _____ x a week
Intensity: Target Heart Rate (THR) = ______ beats/min %HRR + _______ RHR = _______
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For Light Intensity Interval Training:
30 30 30 30 30
sec sec sec sec sec
THR Borg 11-12
60s 60s 60s 60s

5 min sec sec sec sec 3 min
n n n n ½ HRR
For Moderate Intensity Continuous Exercise:
20 - 30 min
THR Borg 11-14
5 min 3 min ½ HRR
For High Intensity Interval Training:

4 4 4 4
min min min min
THR Borg >15
3 3 3 3
5 min min min min min ½ HRR
Time: ______ min/session _______ min/week

Type (check): _____ Jogging _____ Treadmill _____ Ergo bike
_____ Rope skipping _____ Swimming _____ Rowing
_____ Stair climbing _____ Star jumps _____ Walking
Others: _______________________________________________________
Cool Down:
• Muscular Resistance Training
Frequency: _____ x a week
Type: ___ compound exercises ___ single joint exercises
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Target muscles or class/Type of Exercise: For split routine, group the exercises.
_____________________________ ______________________________
_____________________________ ______________________________
_____________________________ ______________________________
_____________________________ ______________________________
Volume (for each exercise above):
1 RM: ___ Load: ___ (kg) %1RM: ___ Reps: ___ Sets: ___
Module 4 – Action Stage
following while the student, the trainees’ coach motivates them to go through the action
stage of change and maintains or progresses his own fitness level:
1. Implemented regularly upon themselves the cardiovascular conditioning and
muscular resistance training program they designed.
2. Demonstrated improvement in the parameters or achieved the target parameters
of the cardiovascular conditioning and muscular resistance training.
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Estimated Duration: Four to six weeks
Basic Concept on Motivational Approach: The student coach uses this concept in insuring
regularity of exercise sessions and accurate execution of the exercises by his trainees.
This step of the change process is taking the action itself. Weekly monitoring of the
progress of the training is imperative to obtain the desired outcomes for both the student
coach – a motivated trainee, and the trainee – enthusiasm to become fit with
improvement in the parameters or achievement of the targeted parameters of the
cardiovascular conditioning and muscular resistance training.
For the Trainees: The student asks his trainees to perform the following and discusses the
outputs with them:
in the implementation of their designed cardiovascular conditioning and muscular
resistance training program.
b. Body mass index
Basic Concept on Fitness: The notes on the basic concepts of this module shall be shared
and discussed again by the student coach with his trainees.
Prerequisites:
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▪ Exercise is better performed early in the morning or in the evening.
▪ It should not be done on a full stomach.
▪ People who have followed a sedentary or quiet lifestyle should begin an exercise
program slowly.
▪ It is not important how quickly one advances to a higher level of fitness. Becoming
fit eventually and maintaining that fitness is what matters.
▪ A slow and easy start can avoid musculoskeletal injuries. Be sure to thoroughly
warm up before beginning and cool down gradually by stretching, appropriate to
the exercise. This is very important to prevent cramping and other discomforts.
▪ Choose activities that you like.
▪ Be realistic about what you can do.
▪ Exercising in a group is better than doing it alone because it makes it a social event
and encourages continuous participation.
▪ One has to consult a doctor before starting an exercise program. Also stop and
check with your doctor right away if you develop sudden pain, shortness of breath,
or feel ill.
▪ Choose your method of exercise carefully! Make sure it is suitable for your body
type. Avoid high-impact events. Certain exercises should not be performed when
people have certain diseases.
▪ People with diabetic retinopathy should not perform exercises that involve
bending forward too much or standing on their head.
▪ People with weak heart should not perform strenuous exercise. Those who have
had a heart attack cannot perform any exercise other than walking for a certain
period after recovery.
▪ Be very certain to remain hydrated by continuously drinking water supplemented
with vitamin C and electrolytes while exercising.
▪ Even those confined to bed should have some kind of physical activity or at least
physiotherapy to avoid bedsores, chest infection, and loss of strength of bones,
constipation and depression.
▪ Observe physical distancing, proper donning and doffing of mask and hand
washing when exercising in areas at risk for droplet or airborne infection.
▪ The mask does not compromise breathing. It is an effective way to prevent viral
transmission in a community context, provided that compliance is high.
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Equipment, Gear and Environmental Considerations:
• Wear light clothing and sports shoes with medial arch support.
• Avoid exercising under the heat of the sun or in a humid environment.
• Exercise on even ground of floor.
• Be mindful of the surrounding when exercising in the park while listening to music
on your head phone or earphone as you may hit or may be hit by others.
• Exercise with somebody so he can call for help when necessary.
• If equipment is needed for cardiovascular conditioning:
- Set the speed of motorized treadmill that stimulates your heart to beat within
the target heart rate. Maintain such a speed for your designed duration.
- Observe the speed of manual treadmill or ergo bike that corresponds to your
target heart rate. Maintain such a speed for your designed duration.
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- Set the resistance of your ergo bike that would give you the target heart rate
and maintain it for your designed duration.
• If you are not using an equipment but instead running, jogging, hopping and other
aerobic exercises, maintain the intensity of your activity that would give you the
target heart rate within the designed duration.
• Bottle filled with water and your body weight can be used for your muscular
resistance training. Other elastic materials at home may be used.
• Your heart rate can be monitored while exercising by:

- Counting your radial pulse (https://www.youtube.com/watch?v=m8tzO_nreb0)
- Hooking a pulse oximeter to your finger
- Holding the pulse counter on the treadmill or ergo bike
- Downloading the measurement of HR application to your android phone
Normal Response to Exercise:

• Increased heart rate
• Increased breathing rate
• Mild to moderate sweating, depending on your exercise level
• Feeling or hearing your heart beat
• Muscle aches and tenderness that might last a day or two as you get started
Abnormal Response
• Severe shortness of breath
• Wheezing, coughing, or other difficulty in breathing
• Cramps, severe pain or muscle aches
• Excessive perspiration
• Chest discomfort, pain, pressure or tightness felt in the chest and possibly
extending to your left arm or neck
• Light-headedness, dizziness, fainting
• Severe, prolonged fatigue, or exhaustion after exercise
• Nausea
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Module 5 – Maintenance Stage
following while the student, the trainees’ coach motivates them to sustain what they have
gained and maintains or progresses his own fitness level:
1. Progressed their cardiovascular conditioning and muscular resistance training in a
new exercise prescription.
2. Achieved the target parameters of the new cardiovascular conditioning and
muscular resistance training program that requires progression to much higher
levels.
Basic Concept on Motivational Approach:
This is the step that all people who have commenced an action want to reach. Once
they have become regular exercisers, there are three different possible departures:
• Lapse
• Relapse
• Termination/Permanent Maintenance
Lapse
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Lapse is a temporary abandonment of the positive behavior, followed by a quick return
to it. Lapse does not produce any significant alteration in progress towards established
goals or, having achieved them, any significant modification in fitness or body
configuration. Lapse is fine, can be fun for a limited time, and is perfectly normal.
Worrisome is what is called relapse.
Relapse
Relapse is abandonment of the positive behavior that has produced the desired
outcome, to the extent that the outcome disappears. The program of regular exercise is
given up indefinitely, the good feelings, changes in body shape, and increased strength
and endurance gained from doing it vanishes.
To reverse relapse requires first figuring out what happened, why the relapse occurred.
Then, it requires going back to the planning, or possibly even the contemplation stage,
recommencing the change process and remobilizing motivation.
1. Write an essay about their experience in implementing their designed fitness
program in the past 4-6 weeks citing the reinforcing factors and the stumbling
blocks.
2. Record their new anthropometric measurements that include:
b. Body mass index
3. Revise their exercise prescription using the FITT format for both cardiovascular
conditioning and strengthening. Use the same format in Annex A.
in the implementation of their newly revised cardiovascular conditioning and
b. Body mass index
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Basic Concept on Fitness: The notes on the basic concept of exercise progression shall be
shared and discussed again by the student coach with his trainees.
Rate of Progression in Cardiovascular Conditioning
The recommended rate of progression depends on the individual’s health status,

exercise tolerance and exercise program goals. Progression involves increasing any of the
FITT components.
• Frequency, intensity and duration of exercise are gradually adjusted over the next
4-8 months or longer for the elderly and deconditioned patients.
• Progression in the FITT components of the exercise prescription should be made

gradually to avoid muscle soreness and injury.
• All individuals should be monitored for any adverse effects of the increased
volume, and downward adjustments should be made if the exercise is not well
tolerated.
Progression to National Physical Activity Recommendations
For sedentary trainees initiating an exercise program, a lower dose of exercise may be
initially recommended. It is assumed that your trainee will eventually set a goal to reach
the recommended levels of 150 minutes a week of moderate- intensity exercise or 75
minutes a week of vigorous-intensity exercise, or some combination thereof. He might do
this at the outset, or he might do it only after conquering the ‘‘regular’’.
This progression can occur by increasing the duration, the frequency, the intensity, or
a combination of these. There is no single correct order to progress these components,
and the best option will vary depending on each trainee’s preferences, health status, and
lifestyle. We will describe two different paths that your patients can choose to follow, each
focusing on a different component: duration and frequency.
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In each case, it is assumed that your trainee is beginning his program for a duration
that he is confident of maintaining at least 3 times per week (frequency) at a low to
moderate intensity. For example, over a course of one month, he may go from walking
five minutes a day three times each week, up to 20 or even 30 minutes a day three times
each week. Once a duration of 30 minutes is reached, your trainee can then increase the
frequency of the exercise from three times each week ( see Figure 2.1, this occurs at the
end of level 6), to four, and then five times each week.
An alternative method is to progressively increase the frequency of activity. Your

trainee can begin their progression by first increasing the frequency of activity up to at
least five days each week, while maintaining the same duration for each session. Some
trainees will be able to increase their frequency directly from three to five times per week;
others will want to progress more slowly first, to four times per week, and then up to five.
This option has the advantage of helping your trainee establish a more regular habit
of incorporating exercise into his daily routine. The hardest part of regular exercise is the
regular, not the exercise. Following this progression pathway focusing on frequency, your
trainee establishes the pattern of regular exercise for a duration that is not intimidating
or overwhelming. Once your trainee has reached a frequency of at least five times each
week, he can then consider increasing the intensity of the exercise to a moderate level,
i.e. an RPE of 3-4 out of 10, or a level at which he is able to talk but not sing. Your trainee
can also consider increasing the duration of the exercise sessions by 5-10 minutes per
week, while still maintaining the good habit of exercising five days each week. The order
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in which the intensity and duration are increased is not important, and will depend on
your trainee’s preference and health/fitness/age status. Figure 2.2 illustrates this
progression path.
Figure 2.2. Progression along the frequency path
Progression in Muscular Resistance Training
• If continued gains in muscular fitness and mass are desired, the individual will have
to progressively overload the muscles to present a greater training stimulus, by
using a higher resistance or more weights, performing more repetitions but not
exceeding 12 repetitions, or training muscle groups more frequently.
• If the individual is satisfied with the muscular fitness improvements made, a
maintenance program is adopted where the same regimen of sets, repetitions,
resistance and frequency is performed without the need for overloading. Muscular
fitness may be maintained by training muscle groups only 1 day each week
provided the intensity remains the same.
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Module 6 – Termination Stage
following while the student, the trainees’ coach motivates them to sustain or progress
what they have gained as he maintains or progresses his own fitness level:
1. Regularized their cardiovascular conditioning and muscular resistance training
using the revised prescription.
2. Achieved the target parameters of the new cardiovascular conditioning and
muscular resistance training program that requires progression to much higher
levels.
Basic Concept on Motivational Approach:
In this stage which is also called as permanent maintenance stage, lapses can still
happen but often do not last for long. This is because most regular exercisers find that if
they stop for too long, they just do not feel well and are almost impelled to take up their
activity again. There are, in fact, some regular exercisers who, because of this
phenomenon, find it difficult to take the occasional break for recharging that is beneficial
for most.
The following flow chart describes the rate of progression of the fitness level of your
trainees throughout the semester. This evidence of success has to be shared with your
trainees.
66
1. Write an essay about:
a. Their experience derived from the implementation of your revised fitness
program in the past 4-6 weeks citing the reinforcing factors and the stumbling
blocks.
b. Their experience with the motivational approach of their student coach from
the start of the semester until at present, and how this approach would
motivate also other people to follow their footstep in this endeavour.
c. The effect of their physical education experience this semester to their pursuit
for happiness and success in life.
2. Record their new anthropometric measurements that include:
b. Body mass index
3. Revise their exercise prescription using the FITT format for both cardiovascular
conditioning and strengthening based on theirr progress at the end of Module 5.
Use the same format in Annex A.
in the implementation of their newly revised cardiovascular conditioning and
b. Body mass index
Basic Concept on Fitness: The principle of progression in Module 5 still applies here. On
the other hand, your tendency to progress further may it be within the physiological
bounds or not, may fire back at you. Here are some guides in avoiding over exercising.
67
Health experts recommend moderate-intensity exercise on most days of the week.
So, you may be surprised to learn that you can get too much exercise. If you exercise often
and find that you are often tired, or your performance suffers, it may be time to back off
for a bit. Learn the signs that you may be exercising too much. Find out how to keep your
competitive edge without overdoing it.
How too much exercise can hurt
To get stronger and faster, you need to push your body. But you also need to rest.
Rest is an important part of training. It allows your body to recover for your next workout.
When you do not get enough rest, it can lead to poor performance and health problems.
Pushing too hard for too long can backfire. Here are some symptoms of too much
exercise:
• Being unable to perform at the same level

• Needing longer periods of rest
• Feeling tired
• Being depressed
• Having mood swings or irritability
• Having trouble sleeping
• Feeling sore muscles or heavy limbs
• Getting overuse injuries
• Losing motivation
• Getting more colds
• Losing weight
• Feeling anxiety
If you have been exercising a lot and have any of these symptoms, cut back on exercise
or rest completely for 1 or 2 weeks. Often, this is all it takes to recover. If you are still tired
after 1 or 2 weeks of rest, contact or see your student coach. You may need to keep resting
or dial back your workouts for a month or longer. Your student coach can help you decide
how and when it is safe to start exercising again.
How to avoid overtraining
You can avoid overdoing it by listening to your body and getting enough rest. Here
are some other ways to make sure you are not overdoing it:
• Eat enough calories for your level of exercise.
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• Decrease your workouts before a competition.
• Drink enough water when you exercise.
• Aim to get at least 8 hours of sleep each night.
• DO NOT exercise in extreme heat or cold.
• Cut back or stop exercising when you don't feel well or are under a lot of stress.
• Rest for at least 6 hours in between periods of exercise. Take a full day off every
week.
Compulsive exercising
For some people, exercise can become a compulsion. This is when exercise is no longer
something you choose to do, but something you feel like you have to do. Here are some
signs to look for:
• You feel guilty or anxious if you do not exercise.
• You continue to exercise, even if you are injured or sick.
• Friends, family, or your provider are worried about how much you exercise.
• Exercise is no longer fun.
• You skip work, school, or social events to exercise.
• You stop having periods (women).
Compulsive exercise may be associated with eating disorders, such as anorexia and
bulimia. It can cause problems with your heart, bones, muscles, and nervous system.
When to call a medical professional
Call your student coach who will refer you a medical professional once you:
• Have signs of overtraining after 1 or 2 weeks of rest
• Have signs of being a compulsive exerciser
• Feel out of control about how much you exercise
• Feel out of control about how much you eat
Your medical provider may recommend that you see a counselor who treats
compulsive exercise or eating disorders. Your provider or counselor may use cognitive-
behavioral therapy (CBT), antidepressant medicines and support groups as treatments.
ASSESSMENT
At the end of the semester, the following will be evaluated: (File folder may be
submitted to Cloud, or mailed to SWU or, when health crisis is gone, hand carried to SWU)
69
A. Portfolio must contain as shown in the table below. Absence of any of the outputs
would mean a grade of INCOMPLETE.
Module Outputs Check

1 Trainee/s
Interview Report* (Relative)
Interview Report* (Non-Relative)
Essay* on Pursuit of Happiness and Success in life
Accomplished Table Physical Activity States of Change
Questionnaire
Interpretation of the Table
Student
New Anthropometric Measurements
Progressed Exercise Prescription for Cardiovascular Conditioning
Progressed Exercise Prescription for Muscular Resistance Training
Compilation of videos or photos each session
Cardiovascular Conditioning Monitoring Chart
Muscular Resistance Training Monitoring Chart
2 Trainee/s
Answers to Self-Assessment Questions
Essay* on Readiness for Exercise, Goals Setting, Prioritizing,
Controlling
Accomplished 2020 PAR-Q
Interpretation of 2020 PAR-Q
Student
3 Trainee/s
Essay* on Risk Stratification and Exercise Intensity
Baseline Anthropometric Measurements
Exercise Prescription for Cardiovascular Conditioning
Exercise Prescription for Muscular Resistance Training
Student
70
Module Outputs Check

4 Trainee/s
Student
5 Trainee/s
Essay* on experience derived from training using the first
prescription
Student/Trainee/s
6 Trainee/s
Essay* on experience derived from training using the 2nd
prescription
Essay* on the motivational approach of the PE instructor
Essay* on effects of PE 1 to the pursuit of one’s happiness/success
Student/Trainee/s
71
*Minimum for all essay and narrative reports = 1,500 words
B. Progression in Cardiovascular Conditioning and Muscular Strength and Endurance:

The rating for these outcomes will be based on the mean of the target and the
baseline. The mean is the passing mark.
Cardiovascular Conditioning (Separate tables for Student and Trainee)
Parameters Baseline 2nd 4th week 6th week 8th week nth week
week
Waist Circumference
Weight
BMI
Target Heart Rate
Peak Exercise Heart
Rate
Borg RPE
Muscular Strength and Endurance (Separate tables for Student and Trainee)
Parameters Baseline 2nd 4th week 6th week 8th week nth week
week
Volume
Load, % 1RM
Exercise 1
Exercise 2
Exercise 3
Exercise 4
RPE
Exercise 1
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Exercise 2
Exercise 3
Exercise 4
REFERENCES
A. Most of the content of these modules were lifted from the Exercise is Medicine,
Philippines Pre-Course Book 2017 with the following references:
➢ ACSM’s Guidelines for Exercise Testing and Prescription 8th Edition
➢ ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription Sixth
Edition
➢ ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities;
J. Larry Dustine, Geoffrey E. Moore, Patricia L. Painter and Scott O. Roberts
➢ ACSM’s Exercise is Medicine; A Clinician’s Guide to Exercise Prescription by Steven
Jonas and Edward Phillips
➢ ACSM’s Exercise is Medicine; A quick guide to Exercise Prescription by Technogym
Medical Scientific Department
➢ 2011 National Physical Activity Guidelines Health Promotion Board Singapore
➢ Exercise and Type 2 Diabetes: American College of Sports Medicine and the
American Diabetes Association: Joint Position Statement by the American College
of Sports Medicine and the American Diabetes Association; approved by Executive
Committee of the American Diabetes Association Medicine & Science in Sports &
ExerciseR and Diabetes Care; July 2010
73
➢ Appropriate Physical Activity Intervention Strategies for Weight Loss and
Prevention of Weight Regain for Adults; ACSM Position Stand ; Donnelly, Joseph E.
Ed.D (Chair); Blair, Steven N. Ped; Jakicic, John M. Ph.D.; Manore, Melinda M. Ph.D.,
R.D.; Rankin, Janet W. Ph.D.; Smith, Bryan K. Ph.D.; Med Sci Sports Exerc. 2009;
41(2):459-71
➢ Exercise and Hypertension; ACSM Position Stand by; Pescatello, Linda S. Ph.D.,
FACSM, (Co-Chair); Franklin, Barry A. Ph.D., FACSM, (Co-Chair); Fagard, Robert
M.D., Ph.D. FACSM; Farquhar, William B. Ph.D.; Kelley, George A. D.A., FACSM; Ray,
Chester A. Ph.D., FACSM; Medicine & Science in Sports & Exercise: March 2004 -
Volume 36 - Issue 3 - pp 533-553
➢ Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the
International Diabetes Federation Task Force on Epidemiology and Prevention;
National Heart, Lung, and Blood Institute; American Heart Association; World Heart
Federation; International Atherosclerosis Society; and International Association for
the Study of Obesity; K.G.M.M. Alberti, FRCP; Robert H. Eckel, MD, FAHA; Scott M.
Grundy, MD, PhD, FAHA; Paul Z. Zimmet, MD, PhD, FRACP; James I. Cleeman, MD;
Karen A. Donato, SM; Jean-Charles Fruchart, PharmD, PhD; W. Philip T. James, MD;
Catherine M. Loria, PhD, MS, MA, FAHA; Sidney C. Smith, Jr, MD, FAHA; Circulation
2009, 120:1640-1645
➢ National Physical Activity Guidelines for Americans 2008: Office of Disease
Prevention and Health Promotion of US Department of Health and Human Services
➢ Ministry of Health Clinical Practice Guidelines, Management of Asthma 1/2008
➢ Australian Association for Exercise and Sports Science position statement on
exercise and asthma Alan R. Morton, Kenneth D. Fitch Journal of Science and
Medicine in Sport 14 (2011) 312-316
➢ Department of Health (2010, March-April). Philippine National Guidelines on
Physical Activity: Galaw-galaw baka pumanaw. Healthbeat, 58, 6-8 Retrieved from:
http://www. doh.gov.ph/node/1025.html
➢ Department of Health, National Epidemiological Center. (2009). ‘‘The 2009
Philippine Health Statistics’’. Retrieved from
http://www.doh.gov.ph/sites/default/files/ PHILIPPINE%20HEALTH
%20STATISTICS%202009_0.pdf
➢ Department of Health (2013, April 26). ‘‘Leading causes of Mortality.’’ Retrieved
from http://www.doh.gov.ph/node/198.html
➢ Masoli, M., Fabian, D.; Holt , S. , Richard, B. (2004, May) ‘‘Global Burden of Asthma’’.
Retrieved from:
http://www.ginasthma.org/local/uploads/files/GINABurdenReport_1. Pdf
➢ National Statistics Office & ICF Macro. (2009, December) ìPhilippines -National
Demographic and Health Survey 2008î. Retrieved from: http://dhsprogram.com
/pubs/pdf/FR224/FR224.pdf
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➢ Philippine Statistics Authority (2012, August 30). The Age and Sex Structure of the
Philippine Population: (Facts from the 2010 Census). Retrieved from
http://www.census.gov.ph/content/age-and-sex-structure-philippine-population-
facts-2010-census
➢ The Problem of Mental Health in the Philippines (n.d.) Retrieved on May 15, 2014)
from wikispaces:
http://mentalhealthph.wikispaces.com/2.%09The+Problem+of+Mental+
Health+in+the+Philippines
B. American Council on Exercise website. 9 signs of overtraining. www.acefitness.org/

education-and-resources/lifestyle/blog/6466/9-signs-of-overtraining?pageID=634.
Accessed August 8, 2018.
C. Carfagno DG, Hendrix JC 3rd. Overtraining syndrome in the athlete: current clinical
practice. Curr Sports Med Rep. 2014;13(1):45-51. PMID: 24412891
www.ncbi.nlm.nih.gov/ pubmed/24412891.
D. Meeusen R, Duclos M, Foster C, et al. Prevention, diagnosis, and treatment of the

overtraining syndrome: joint consensus statement of the European College of Sport
Science and the American College of Sports Medicine. Med Sci Sports Exerc.
2013;45(1):186-205. PMID: 23247672 www.ncbi.nlm.nih.gov/pubmed/23247672.
E. Rothmier JD, Harmon KG, O'Kane JW. Sports medicine. In: Rakel RE, Rakel DP, eds.
Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap
29.
F. Preventive Cardiology, Cardiac Rehabilitation and Sports Cardiology Course: From Set-
up to Frontiers, European Society of Cardiology and European Association of Sports
Cardiology, Inselspital Bern University Hospital, Switzerland.
75
ANNEX A
EXERCISE PRESCRIPTION
Cardiovascular Conditioning Prescription
Name of Student or Trainee: _________________________________________ Age: _________

Date of 1st Day of Training: _________________ Initial Prescription/No. of Progression: _______
Components Target
Frequency
Intensity
Resting Heart Rate
Heart Rate Reserve
Target Heart Rate
HR @ High Interval
HR @ Low Interval
Borg Rate of Perceived Exertion
Time
Warm up
Stimulus
Cool down
Number of cycles
Type
For Light Intensity Interval Training:

30 30 30 30 30
sec sec sec sec sec
THR Borg 11-12
60s 60s 60s 60s

5 min sec sec sec sec 3 min
n n n n ½ HRR
For Moderate Intensity Continuous Exercise:
20 - 30 min
THR Borg 11-14
5 min 3 min ½ HRR
76
4 4 4 4
min min min min
THR Borg >15
3 3 3 3
5 min min min min min ½ HRR
Example: A 25 year-old male medically cleared to engage in high intensity interval

training.
Components Target
Frequency 5 x a week
Intensity
Resting Heart Rate 88 beats/min
Heart Rate Reserve 76%
Target Heart Rate (220-25-88)0.76 + 88 = 169
HR @ High Interval 169 beats/min
HR @ Low Interval (220-25-88)0.38 + 88 = 128 beats/min
Borg Rate of Perceived Exertion 15
Time
Warm up 5 min @ low interval
Stimulus 23 min
Cool down 3 min @ low interval
Number of cycles 4
Type HIIT on Motorized Treadmill
4 4 4 4
min min min min
THR = 169 beats/min Borg >15
3 3 3 3
5 min min min min min
½ HRR = 128 beats/min
77
Muscular Resistance Training Prescription
Name of Student or Trainee: ______________________________________________ Age: ____

Date of 1st Day of Training: _________________ Initial Prescription/No. of Progression: _______
Training Age
Goal
Volume
Frequency
Session/Duration
Warm up Stretch Duration Sets Reps
Exercise Sets Reps Rest Load RPE
Cool down Duration Sets Reps

Stretch
78
Name of PE Instructor: ___________________________________________________________
Name of Student Coach: _________________________________________________________
Date Submitted/Finished: ________________________________________________________
Example:
Training Age 28
Goal Increase strength
Volume Moderate
Frequency 2x week
Session/Duration 80 min including warm up and cool down
Warm up Stretch Duration Sets Reps
Arms across chest 30 sec 2 1
Prone quad 30 sec 2 1
stretch
Hams stretch 30 sec 2 1
Exercise Sets Reps Rest Load RPE
Squat 5 4 2-3 min 85% 1RM 17
Bench press 3 5 2-3 min 80% 1 RM 17
Power clean 3 4 2-3 min 70% 1 RM 15
Deadlift 5 4 2-3 min 85% 1RM 17
Bench pull 3 8 1-2 min 75% 1RM 14
79
DB Split squat 3 8 1-2 min 75% 1RM 14
Military Press 3 8 1-2 min 75% 1RM 14
Cool down Duration Sets Reps
Stretch
Arms across chest 30 sec 2 1
Prone quad 30 sec 2 1
stretch
Hams stretch 30 sec 2 1
80
ANNEX B
CARDIOVASCULAR CONDITIONING MONITORING CHART
Name of Student or Trainee: ____________________________________________________________________________ Age: ____
Name of Student Coach: _______________________________________________________________________________________
PE Instructor: ________________________________________________________________________ Section: _________________
Parameters Baseline Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8
Date Measured
Initial or Progression
No.
Waist Circumference,
cm
Height, m
Weight, kg
BMI
Target Heart Rate
Peak Exercise Heart
Rate
Borg RPE
*5 days a week
Parameters Day 9 Day 10 Day 11 Day 12 Day 13 Day 5 Day 14 Day 15 Day 16
Date Measured
81
Initial or Progression
No.
Waist Circumference,
cm
Height, m
Weight, kg
BMI
Target Heart Rate
Peak Exercise Heart
Rate
Borg RPE
*at least 5 days a week
ANNEX C
MUSCULAR RESISTANCE TRAINING MONITORING CHART
Name of Student or Trainee: ___________________________________________________________________________ Age: _____
Name of Student Coach: _______________________________________________________________________________________
PE Instructor: ________________________________________________________________________ Section: _________________
Parameters Baseline Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8
Date Measured
Volume/Intensity
Load, % 1RM
Exercise 1
Exercise 2
Exercise 3
RPE
82
Exercise 1
Exercise 2
Exercise 3
Parameters Day 9 Day 10 Day 11 Day 12 Day 13 Day 14 Day 15 Day 16 Day 17
Date Measured
Volume/Intensity
Load, % 1RM
Exercise 1
Exercise 2
Exercise 3
RPE
Exercise 1
Exercise 2
Exercise 3
*With 48 hours interval
83

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Tertiary Physical Education Program

A significant proportion of Filipinos are exposed to non-communicable disease

The tertiary physical education physical fitness program of Southwestern University

3. Social influence which refers to demonstration of sense of social responsibility in the

Course Title: Peer/Group Fitness Program Tagline: Becoming

Generic Course Title: Physical Activities towards Health and Fitness 1

Estimated Duration: Two weeks

‘‘Motivation is a state of mind (characterized as an emotion, feeling, desire, idea, or

There are three phases in ‘‘finding’’ motivation:

The 6 stages of change are:

In pre-contemplative trainees, they are informed about the benefits of exercise in an

An important aspect of helping your trainee to mobilize his motivation, thereby

Feeling ambivalent about making a behavior change is perfectly normal. Virtually

Physical inactivity is a fast-growing public health problem and contributes to a variety

In addition to improving a trainees’ overall health, increasing physical activity has

Exercise is indeed medicine!

There is overwhelming scientific evidence to support the positive relationship between

Over-all Benefits of Physical Activity

Lower risk of type 2 diabetes

Lower risk of metabolic

Lower risk of colon cancer

Lower risk of breast cancer

Prevention of weight gain

Improved cardiorespiratory and

• The Risk of Dying Prematurely Declines as People Become Physically Active

• Significant reductions in risk of cardiovascular disease occur at activity levels

• In hypertension, blood pressure lowering effects of exercise are most pronounced in

• It has been estimated that as little as 2 mm Hg reduction in population average systolic

• Regular participation in aerobic physical activity and exercise results in beneficial

Overweight and obesity

Module 2 – Contemplation Stage

Estimated Duration: Two weeks

The trainee has recognized that he is engaging in a behavior, such as sedentary

Mobilizing Motivation for Regular Exercise

1. ‘‘Taking small steps’’

The Wellness Motivational Pathway for Healthy Living

The WMP has five steps:

1. The first step is assessment, both self and professional.

Assessment has two components, assessment by oneself and assessment by others,

Step 2: Defining Success for Oneself

Step 3: Goal Setting

Step 4: Establishing Priorities

Step 5: Taking Control

The eight elements are:

4. Recognizing that gradual change leads to permanent changes.

7. Appreciating the process of psychological immediate gratification. It’s a mental

8. Achieving balance, in the process of gradual change.

When beginning an exercise prescription process, the question of safety to exercise

Considerations in Pre-participation Screening

Risks of exercising -- Putting it in perspective

The important points on risk of exercising can be summarized below:

Even in patients with known cardiac disease undergoing a supervised rehabilitation

Aims of Pre-Participation Health Screening

• Identify individuals with medical contraindications for exclusion from exercise

A self-guided questionnaire such as the Physical Activity Readiness Questionnaire is

The process of risk stratification is based on:

ACSM Risk Stratification Categories

MODERATE RISK: The trainee is safe to begin light- or moderate-intensity exercise

* Professional supervision = under the supervision of a health/fitness Professional possessing

Algorithm for the screening process:

• Hypertensive trainees with resting SBP ≥ 200 mm Hg or DBP ≥ 110 mm Hg should

• For individuals with type 2 Diabetes (T2DM) desiring to participate in low-intensity

• To avoid automatic inclusion of lower-risk individuals with T2DM, exercise stress

Time: min/session _ min/week

Type: _ compound exercises _ single joint exercises