PERSONAL TRAINING QUARTERLY

PTQ VOLUME 3
ISSUE 1
ABOUT THIS PUBLICATION PERSONAL TRAINING QUARTERLY

PTQ
Personal Training Quarterly (PTQ)
publishes basic educational
information for Associate and
Professional Members of the
NSCA specifically focusing on
personal trainers and training
enthusiasts. As a quarterly
publication, this journal’s mission
is to publish peer-reviewed
VOLUME 3
articles that provide basic,
practical information that is
ISSUE 1
research-based and applicable to
personal trainers.

Copyright 2016 by the National EDITORIAL OFFICE EDITORIAL REVIEW PANEL

Strength and Conditioning
Association. All Rights Reserved.
Disclaimer: The statements
and comments in PTQ are
those of the individual authors
and contributors and not of
the National Strength and
Conditioning Association. The
appearance of advertising in this
journal does not constitute an
endorsement for the quality or
value of the product or service
advertised, or of the claims made
for it by its manufacturer or
provider.
NSCA MISSION
As the worldwide authority on
strength and conditioning, we
support and disseminate research-
based knowledge and its practical
application, to improve athletic
performance and fitness.
EDITOR: Mike Rickett, MS, CSCS
Bret Contreras, PHD, CSCS
Andy Khamoui, MS, CSCS
ASSISTANT EDITOR:
Britt Chandler, MS, CSCS,*D, Josh West, MA, CSCS
NSCA-CPT,*D
Scott Austin, MS, CSCS
PUBLICATIONS DIRECTOR:
Nate Mosher, DPT, PT, CSCS, NSCA-CPT
Keith Cinea, MA, CSCS,*D, NSCA-CPT,*D
Laura Kobar, MS
MANAGING EDITOR:
Matthew Sandstead, NSCA-CPT,*D Leonardo Vando, MD
PUBLICATIONS COORDINATOR: Kelli Clark, DPT, MS
Cody Urban
Daniel Fosselman
Liz Kampschroeder
Ron Snarr, MED, CSCS
Tony Poggiali, CSCS
Chris Kennedy, CSCS
John Mullen, DPT, CSCS

TALK TO US… Teresa Merrick, PHD, CSCS, NSCA-CPT

Share your questions and
Ramsey Nijem, MS, CSCS
comments. We want to hear
from you. Write to Personal Bojan Makivic, MSC
Training Quarterly (PTQ) at NSCA
Publications, 1885 Bob Johnson Justin Kompf, CSCS, NSCA-CPT
Drive, Colorado Springs, CO
80906, or send an email to
matthew.sandstead@nsca.com.

CONTACT
Personal Training Quarterly (PTQ)
1885 Bob Johnson Drive
Colorado Springs, CO 80906
phone: 800-815-6826
email: matthew.sandstead@
nsca.com

Reproduction without permission

is prohibited.

ISSN 2376-0850
PTQ 3.1 | NSCA.COM
TABLE OF CONTENTS

04 UTILIZING BATTLING ROPE EXERCISES

FOR HIIT AND SMIT
NICK TUMMINELLO

10 MANAGEMENT OF MUSCULOSKELETAL
INJURIES—A REVIEW FOR FITNESS
PROFESSIONALS
SCOTT CHEATHAM, DPT, PT, OCS, ATC, CSCS

14 PERSONAL TRAINERS AND NUTRITION

ADVICE—WHAT CAN I LEGALLY TELL
MY CLIENTS?
RICK COLLINS, JD, CSCS

16 DEVELOPING THE KNOWLEDGE

BASE FOR THE CERTIFIED
PERSONAL TRAINER
ROBERT LINKUL, MS, CSCS,*D, NSCA-CPT,*D

18 THE INTERACTION BETWEEN

METABOLIC DISORDERS AND
PERSONAL TRAINERS
ALEXIS BATRAKOULIS, MS, CSCS

22 CARNITINE—EFFECTIVE FAT-LOSS
SUPPLEMENT?
DYLAN KLEIN, PHD(C)

26 TRANSTHEORETICAL MODEL­­­­­­—
APPLICATIONS TO PERSONAL TRAINING
RYAN ECKERT, CSCS, NSCA-CPT

32 TOP WAYS TO DRIVE TRAFFIC TO

A FITNESS BUSINESS
JOSH LEVE

36 CONSIDERATIONS FOR UTILIZING

MANUAL RESISTANCE TRAINING
BOJAN MAKIVIC, MSC

PTQ 3.1 | NSCA.COM

UTILIZING BATTLING ROPE EXERCISES FOR HIIT
AND SMIT
NICK TUMMINELLO
B
attling rope exercises are increasingly popular amongst
strength and conditioning professionals. A common method
is to use battling rope exercises as a metabolic training
modality following a comprehensive resistance training workout,
which is referred to as a “metabolic finisher.” The main idea behind
using battling rope exercises in this manner is to increase the
client’s heart rate and help maximize the metabolic cost of the
training session.
A 2013 study demonstrated that exercises with battling ropes
elicited relatively higher acute metabolic demands than traditional
resistance exercises performed with moderately heavy loads (6).
Integrating battling rope exercises along with traditional resistance
training allows the client to reap the unique benefits that both
types of exercise offer, including making the workouts more
comprehensive, diverse, and interesting. This article provides three
scientifically founded, practical training strategies that can be
immediately implemented in order to help maximize the metabolic
cost of performing battling rope exercise.
1. INVOLVE AS MANY MUSCLES AS POSSIBLE
The metabolic cost of a given exercise relates directly to the
amount of muscle worked (3). For instance, when using battling
ropes, the client should allow the entire body to contribute to the
motion of rapidly moving the ropes back and forth in a manner
that is smooth and coordinated. Battling rope exercises can be
beneficial in a workout program because they involve many joints
moving simultaneously—not just the arms. Therefore, they require
the client to expend more energy because they require more
muscles to work.
Battling rope exercises can be performed as either a single- or
double-arm exercise. Although both single- and double- arm
exercises can be very effective for increasing the metabolic
demand of a workout, double-arm exercises may be more
effective. A recent study found that 30 s of the double-arm
wave using battling ropes yielded a larger metabolic response
4 PTQ 3.1 | NSCA.COM
than did the single-arm wave consisting of 15 s on each arm (7).
It makes sense that the double-arm wave provides a stronger
metabolic stimulus than does the single-arm wave, since the
single-arm wave involves less overall motion of the leg and hip
musculature. It is most likely that the increased involvement
of the lower body during the double-arm wave leads to the
greater metabolic response.
2. USE SHORTER REST PERIODS
Rather than using long rest periods between bouts of battling
rope exercises, it may be most beneficial to use shorter rest
periods. The cardiovascular and metabolic effects that battling
rope exercises create are increased by using one-minute rest
intervals compared to two minutes of rest (7).
3. USE SUPRAMAXIMAL INTERVALS
High-intensity interval training (HIIT) is currently a hot topic in
fitness and sports training. According to the American College of
Sports Medicine (ACSM) HIIT was identified as the most popular
fitness trend worldwide for 2014 (9). Unlike most fitness training
trends, HIIT has been shown in the research to provide improved
work capacity, glucose metabolism, and fat burning (4,5,8).
While most personal trainers and athletes are familiar with HIIT,
many are less familiar with supramaximal interval training (SMIT).
To better understand how to properly use SMIT and HIIT, one must
first understand the differences between the two. HIIT involves
interspersing high-intensity work intervals performed at 100%
VO2max with either low-intensity, active-recovery, or passive
recovery phases (e.g., standing or sitting fairly still). SMIT, on the
other hand, involves interspersing maximal-intensity bursts of
physical activity intervals performed at more than 100% VO2max
with the same rest interval.
Performing SMIT may even be a more effective method for
improving fitness and performance. A 2013 study published in the
European Journal of Sport Science looked at the endurance
and sprint benefits of high-intensity and supramaximal interval
training (2). The researchers found that “improvements in
3,000-m time trial performance were greater following SMIT
than continuous running, and improvements in 40-m sprint and
repeated sprint ability (RSA) performance were greater following
SMIT than HIIT and continuous running,” (2). Additionally, the
higher the intensity of the exercise, the greater the metabolic
impact (1).
The personal trainer can implement battling ropes as a HIIT or
SMIT method in their client’s strength and conditioning program.
There are several variations of exercises that can be performed
using battling ropes. Some examples of some double-arm
exercises include rope tidal waves (Figures 1 and 2), rope spirals
(Figures 3 – 6), rope press waves (Figures 7 and 8), and rope
rainbows (Figures 9 – 11).
CONCLUSION
In summary, if a personal trainer has a client who wishes to
maximize the metabolic impact of battling ropes exercises,
it is recommended that they emphasizes the performance of
double-arm battling rope exercises that involve the entire body
for supramaximal intervals. Additionally, evidence indicates that
shorter rest periods are an important factor to consider when
looking to maximize the metabolic cost of using battling ropes. In
addition to enhancing the metabolic cost of workouts, the battling
rope exercise applications provided in this article can serve as an
effective means of conditioning for the upper body. This can be
particularly useful in keeping a client’s program balanced since so
much of conditioning is lower body dominant (e.g., sprints, hills
runs, stairs, etc.). Given these factors, battling rope exercises and
metabolic training strategies can be a valuable tool in the strength
and conditioning professional’s training toolbox.
PTQ 3.1 | NSCA.COM
REFERENCES
1. Abboud, GJ, Greer, BK, Campbell, SC, and Panton, LB.
Effects of load-volume on EPOC after acute bouts of resistance
training in resistance-trained men. The Journal of Strength and
Conditioning Research 27(7): 1936-1941, 2013. 

2. Cicioni-Kolsky, D, Lorenzen, C, Williams, MD, and Kemp,
JG. Endurance and sprint benefits of high-intensity and
supramaximal interval training. European Journal of Sport
Science 13(3): 304-311, 2013.
3. Elliot, DL, Goldberg, L, and Kuehl, KS. Effect of resistance
training on excess post-exercise oxygen consumption. The
Journal of Strength and Conditioning Research 6(2): 77-81, 1992.
4. Laursen, PB, and Jenkins DG. The scientific basis for high-
intensity interval training: Optimising training programmes and
maximising performance in highly trained endurance athletes.
Sports Medicine 32(1): 53-73, 2002.
5. Perry, CG, Heigenhauser, GJ, Bonen, A, and Spriet, LL. High-
intensity aerobic interval training increases fat and carbohydrate
metabolic capacities in human skeletal muscle. Applied Physiology,
Nutrition, and Metabolism 33(6): 1112-1123, 2008.
6. Ratamess, NA, Rosenberg, JG, Klei, S, Dougherty, BM,
Kang, J, Smith, CR, et al. Comparison of the acute metabolic
responses to traditional resistance, body-weight, and battling
rope exercises. The Journal of Strength and Conditioning Research
29(1): 47-57, 2015.
7. Ratamess, NA, Smith, CR, Beller, NA, Kang, J, Faigenbaum,
AD, and Bush, JA. The effects of rest interval length on acute
battling rope exercise metabolism. The Journal of Strength and
Conditioning Research 29(9): 2375-2387, 2015.
8. Talanian, JL, Galloway, SDR, Heigenhauser, GJF, Bonen, A, and
Spriet, LL. Two weeks of high-intensity aerobic interval training
increases the capacity for fat oxidation during exercise in women.
Journal of Applied Physiology 102(4): 1439-1447, 2007.
9. Thompson, W. Now trending: Worldwide survey of fitness
trends for 2014. ACSM’S Health and Fitness Journal 17(6): 10-20.
ABOUT THE AUTHOR
Nick Tumminello is the owner of Performance University, which
provides practical fitness education for fitness professionals
worldwide, and is the author of the book “Strength Training
for Fat Loss.” Tumminello has worked with a variety of clients
from National Football League (NFL) athletes to professional
bodybuilders and figure models to exercise enthusiasts. He also
served as the conditioning coach for the Ground Control Mixed
Martial Arts (MMA) Fight Team and is a fitness expert for Reebok.
Tumminello has produced 15 DVDs, is a regular contributor to
several major fitness magazines and websites, and writes a very
popular blog at PerformanceU.net.
5
UTILIZING BATTLING ROPE EXERCISES FOR HIIT AND SMIT
EXERCISE DESCRIPTIONS
ROPE TIDAL WAVES (FIGURES 1 AND 2)
Anchor a heavy rope at its center away from where you are
standing and around a stable object. Stand facing the rope
with your feet hip-width apart, your knees slightly bent, and
one end of the rope in each hand with your arms extended in
front of your body.
Start swinging your arms up and down at the same time to create
a parallel wavelike motion with the rope. Extend your legs each
time you lift your arms slightly overhead, and allow your knees to
bend each time your arms come down.
Do not allow your back to round when you slam the ropes toward
the ground. Do not just use your arms; allow your entire body to
contribute to rapidly moving the ropes. Move as fast as possible
without pausing at any point until the set is completed.
FIGURE 1. ROPE TIDAL WAVE
FIGURE 3. ROPE SPIRAL
6 PTQ 3.1 | NSCA.COM
ROPE SPIRALS (FIGURES 3 – 6)
Anchor a heavy rope at its center away from where you are
standing and around a stable object. Stand facing the rope with
your feet hip-width apart, your knees slightly bent, and one end of
the rope in each hand with your arms in front of your body.
Keeping your elbows slightly bent, make outward circular motions
with both hands, moving your arms from your knees to above
your head to create a spiral pattern. Repeat this motion as fast as
possible without pausing at any point until the set is completed.
Do not just use your arms; allow your entire body to contribute to
the motion of rapidly moving the ropes.
FIGURE 2. ROPE TIDAL WAVE
FIGURE 4. ROPE SPIRAL
 NSCA.com

FIGURE 5. ROPE SPIRAL FIGURE 6. ROPE SPIRAL

ROPE PRESS WAVES (FIGURES 7 AND 8) set is completed. Do not just use your arms; allow your entire body
Anchor a heavy rope at its center away from where you are to contribute to the motion of rapidly moving the ropes. Since this
standing and around a stable object. Stand facing the rope with exercise uses the opposite grip than rope tidal waves, the emphasis
your feet hip-width apart, your knees slightly bent, and one end of this exercise is reversed. It emphasizes a pushing action—driving
of the rope in each hand with your arms in front of you at roughly the rope away from you—instead of a pulling action—driving the
waist height. 
 rope down into the ground—to create the waves.

Extend your legs and explosively drive your arms out in front
of your body at roughly a 45-degree angle. Quickly reverse the
motion, pulling your arms back down and returning to the starting
position. Continue this total-body action, whipping the ropes up
and down as fast as possible without pausing at any point until the

FIGURE 7. ROPE PRESS WAVE FIGURE 8. ROPE PRESS WAVE

PTQ 3.1 | NSCA.COM 7

UTILIZING BATTLING ROPE EXERCISES FOR HIIT AND SMIT

ROPE RAINBOWS (FIGURES 9 – 11)
Anchor a heavy rope at its center away from where you are
standing and around a stable object. Stand facing the rope with
your feet hip-width apart while holding one end of the rope in
each hand above your head with your elbows bent and your hands
underneath the rope.
Move the ropes back and forth in a manner that is fast but smooth
and coordinated; do not use a jerking, stop-and-start motion. Use
your legs by allowing your knees to bend as your arms lower to
each side and by extending your legs each time your arms are
overhead when you go back to center. 

Explosively pivot your body while flipping the ropes over as if

throwing them from the floor to one side of your body and then
the other. Move your arms explosively in an arching, rainbow-like
motion. This movement should create a rhythmic, wavelike motion
in the ropes.

FIGURE 9. ROPE RAINBOW FIGURE 10. ROPE RAINBOW

FIGURE 11. ROPE RAINBOW

8 PTQ 3.1 | NSCA.COM

WHAT MAKES US NSCA.com

• Expert staff to
help with product
selection and
application
• Commercial grade,
high quality products
• Cutting edge seminars
with some of the
best educators in the
industry
• Top notch service
with 100% satisfaction
guaranteed

Call for
our new
2016
catalog

800-556-7464 • PERFORMBETTER.com
PTQ 3.1 | NSCA.COM 9
FEATURE ARTICLE
MANAGEMENT OF MUSCULOSKELETAL INJURIES—
A REVIEW FOR FITNESS PROFESSIONALS
SCOTT CHEATHAM, DPT, PT, OCS, ATC, CSCS
M
ost fitness professionals commonly encounter individuals
with musculoskeletal injuries (MSI). Injuries to the
musculoskeletal system are common in active individuals
who participate in fitness and sport-related activities. Hootman et
al. surveyed 6,313 active adults aged 20 – 85 years old and found
that 83% reported exercise-related musculoskeletal injury with
more than 66% of injuries occurring to the lower extremities (6).
Kaplan et al. reported that one in four women who are physically
active experience an exercise-related MSI (7). Having a basic
understanding of how to manage MSIs is important for fitness
professionals in order to train these clients safely. This article will
provide a basic review of three common musculoskeletal injuries,
the tissue healing process, monitoring post-injury pain, signs of
overtraining, and reducing injury risk.
COMMON MUSCULOSKELETAL INJURIES
As individuals participate in physical activity, it is possible that
they will sustain an MSI. Three common types of MSIs include
muscle strains, ligament sprains, and bone fractures. All present
distinct signs and symptoms that fitness professionals need to be
able to recognize in order to properly manage.
MUSCLE STRAINS
Muscle strains often occur as an acute traumatic event that
results in a loss of function. When the muscle cannot meet the
activity demands and works beyond its physiological capacity,
an injury often occurs. With mild strains, the client may report
a “pulling sensation” with pain. In more severe cases, the
client may report feeling a “pop” followed by pain, swelling,
and discoloration (1). Loss of function typically occurs with
10 PTQ 3.1 | NSCA.COM
more severe strains. Table 1 provides a description of the three
different grades of muscle strains (1).
LIGAMENT SPRAINS
Ligament sprains often occur with trauma such as a fall or collision
during contact sports (e.g., a soccer player collides with another
player, spraining their knee ligaments). The most common joints
for sprains include the ankle, knee, thumb/fingers, and shoulder
(1). If a sprain occurs, the client often reports hearing a “popping”
sound followed by immediate pain, swelling, instability, decreased
range of motion (ROM), and loss of function. Table 2 provides a
three-level grading system for ligament sprains (1).
BONE FRACTURES
A fracture is a break in the bone, which is typically caused by
some type of trauma or overuse. For example, fractures can
occur from a simple fall onto the ground that can cause a minor
break, or from a high speed motor vehicle accident that can
cause multiple, severe fractures (1). Fitness professionals should
understand that fractures usually do not occur in isolation but
rather, are accompanied by damage to the skin, muscles, vessels,
and organs, which can all affect the healing process (1).
Of particular interest to fitness professionals are stress fractures.
A stress fracture is a small crack in the bone that is caused by
overuse. With overuse, the muscles may become fatigued and
unable to absorb the repetitive forces which eventually transfer
straight to the bone. If the bone cannot repair itself fast enough,
it may result in a stress fracture (11). The majority of stress
fractures occur in the weight bearing bones of the foot (e.g.,
2nd and 3rd metatarsal) and the lower leg (e.g., tibia) (11). Stress
fractures are most prevalent in high impact sports such as distance
running, dance, and gymnastics, as well as in military recruits (11).
Possible causes include overtraining, poor conditioning, improper
equipment, and training mistakes. Low bone mineral density has
also been linked to stress fractures (1,11). Signs and symptoms of
stress fractures are localized and may include the following: local
pain that increases with weight-bearing activity and diminishes
with rest, point tenderness at the site of the fracture, and local
swelling and possible discoloration (1,11).
THE TISSUE HEALING PROCESS
After an injury, the body will go through a systematic reparative
process in order to recover from the injury. This process is a
continuum that begins immediately after injury and ends once
the tissues (e.g., bones, ligaments, and muscle) have healed;
this process can take up to two years to complete (5). Illustrated
in Figure 1, the tissue healing process consists of three distinct
phases, which are inflammatory, fibroblastic/proliferation, and
maturation/remodeling (7,8).
FIGURE 1. PHASES OF TISSUE HEALING
INFLAMMATORY PHASE
The inflammatory phase begins immediately after an injury.
The local blood vessels constrict at the injury site to control
bleeding. Special cells called platelets rush to the area to control
bleeding and signal other important cells such as neutrophils and
macrophages to the area (7,8). Neutrophils fight infection while
macrophages begin to clean up the damaged tissue. This phase
can last up to six days as the body attempts to protect the injured
area, remove damaged tissue, and start the healing process.
This phase of healing is often characterized by redness, warmth,
swelling, pain, and dysfunction (1,7).
FIBROBLASTIC/PROLIFERATION PHASE
The fibroblastic/proliferation phase begins as the inflammatory
phase comes to an end. Scar formations begin as the fibroblast
cells enter the area and produce large amounts of collagen
and proteoglycans, which are key components to the scar
formation process (1,7,8). The scar can resist normal stresses
within 2 – 3 weeks and will continue to strengthen for several
months. This phase typically lasts from three days to six weeks.
During this phase, the body is filling in the injured area with a
scar and restoring function to the tissues. This phase is typically
characterized by a slow return to function, decreased pain, and
swelling with activity (1,7).
PTQ 3.1 | NSCA.COM
MATURATION/REMODELING
As the fibroblastic phase comes to an end, the maturation/
remodeling phase begins. During this phase, the fibroblasts
have filled the wound with collagen and the wound begins to
remodel into a more organized scar matrix (8). This creates
more tensile strength in the scar, which can regain up to 70 –
80% of the tissue’s original strength. Healing in this phase can
last anywhere from 21 days to two years (1,7). The goal of
this phase is to complete the healing process and regain fully
functioning tissue. This phase is characterized by an advancement
of functional activity with little-to-no symptoms when the tissue
is stressed (1,7).
Whether it is muscle, ligament, or bone, each tissue has a specific
healing time. It is important for fitness professionals to remember
that even if the individual is cleared to resume physical activity,
the tissue may still be healing. Caution is advised when returning
to activity after an injury due to the individual being at a higher
risk of reinjuring the tissue if overloaded too quickly. Factors that
can influence the healing process timeline include age, nutrition,
compliance, and comorbidities (2,8).
MONITORING POST-INJURY PAIN
Some post-injury clients may have a difficult time returning to
physical activity. As the healing tissue is being stressed, clients
may experience an array of sensations, such as tightness, muscle
guarding, and pain. Fitness professionals need to be aware of
these sensations in order to safely progress the client through their
exercise program. Most important is pain because the sensation
of “pain” is the body’s way of saying that some form of harm or
irritation is occurring. Below are some definitions of the types of
pain that can be experienced.
ACUTE PAIN
Acute or immediate pain often signals tissue damage and elicits
a “fight or flight” response. Symptoms often include anxiety,
increased blood pressure, increased muscle tension, and guarding of
the injured area (1,9). A good example would be a basketball player
who lands on an opponent’s foot and sprains an ankle.
CHRONIC PAIN
Chronic pain is considered pain that lasts longer than three
months (1,9). This often results in depression, a preoccupation with
symptoms, and trouble sleeping and eating. An example would be a
client with multiple low-back surgeries who has not fully recovered
and is experiencing chronic pain.
REFERRED PAIN
Referred pain is pain that is transferred to an area away from the
site of the injury. The pain may have a specific pathway or may be
diffused to several areas. Numbness and tingling may accompany
the pain if nerve involvement is present (1,9). For example, a
pinched nerve from a damaged lumbar disc can result in referred
pain in the leg. Table 3 provides examples of some of the different
types of pain elicited by various tissues of the body.
Using an 11-point numerical pain rating scale to measure pain, where
“0” means no pain and “10” equates to the worst pain imaginable,
is a great way for the client to communicate what they are feeling
before, during, and after activity (3). Using a pain scale may
enhance the safety of the training sessions and offer a simple way
for clients to communicate to the fitness professional.
11
MANAGEMENT OF MUSCULOSKELETAL INJURIES—
A REVIEW FOR FITNESS PROFESSIONALS

SIGNS OF OVERTRAINING 8. Hunt, TK, Hopf, H, and Hussain, Z. Physiology of wound

As clients begin to increase the intensity of their exercises once healing. Advanced Skin and Wound Care 13(suppl 2): 6-11, 2000.
they start feeling better, the risk of overtraining increases. Besides 9. Jones, BH, Cowan, DN, and Knapik, JJ. Exercise, training and
the type of pain, there are six signs and symptoms that may injuries. Sports Medicine 18(3): 202-214, 1994.
indicate overtraining in the healing tissues: soreness that lasts
10. Kaplan, RM, Herrmann, AK, Morrison, JT, DeFina, LF, and
more than four hours; soreness or pain that occurs earlier or is
Morrow, JR, Jr. Costs associated with women’s physical activity
increased from prior session; increased stiffness or decreased ROM
musculoskeletal injuries: The women’s injury study. Journal of
over several sessions; swelling, redness, and warmth in the healing
Physical Activity and Health 11(6): 1149-1155, 2014.
tissue; progressive weakness over several sessions; and decreased
functional usage (1). 11. Mayer, SW, Joyner, PW, Almekinders, LC, and Parekh, SG.
Stress fractures of the foot and ankle in athletes. Sports Health
REDUCING THE RISKS OF INJURY 6(6): 481-491, 2014.
Fitness professionals should also attempt to reduce the risk
12. Morrow, JR, Jr., Defina, LF, Leonard, D, Trudelle-Jackson,
of future injury. Injury risks increase as the amount of training
E, and Custodio, MA. Meeting physical activity guidelines and
increases (12). This risk can be lowered by adjusting the client’s
musculoskeletal injury: The WIN study. Medicine and Science in
exercise parameters (e.g., frequency, intensity, and duration)
Sports and Exercise 44(10): 1986-1992, 2012.
(4). Other risk factors to consider include age, flexibility, as
well as whether or not they smoke and have a sedentary job
or lifestyle (9).
ABOUT THE AUTHOR
SUMMARY Scott Cheatham is an Assistant Professor in the Division of
The tissue healing process is a key concept that every fitness Kinesiology at California State University, Dominguez Hills. He is
professional should understand. Because a client’s functional also the owner of the National Institute of Restorative Exercise,
abilities will change in each of the tissue healing phases, the which provides continuing education to medical and fitness
fitness professional must understand the time it takes to heal and professionals. Cheatham received his Doctor of Physical Therapy
the science behind each phase in order to prescribe safe exercises degree from Chapman University and is currently a PhD candidate
for clients in those phases. Additionally, being able to monitor in physical therapy at Nova Southeastern University. Cheatham is
post-injury pain and recognize signs of overtraining are important a Certified Athletic Trainer (ATC) and a Board Certified Specialist
to ensure safe program design for these clients. in Orthopedics (OCS). He also holds several fitness certifications
and is a certified ergonomic specialist. He is a national presenter
REFERENCES for various organizations and has authored over 50 peer reviewed
1. Anderson, MK, and Parr, GP. Foundations of Athletic Training: publications, textbook chapters, and home study courses on the
Prevention, Assessment, and Management. Lippincott, Williams topics of health and fitness and sports medicine.
and Wilkins; 2012.
2. Campos, AC, Groth, AK, and Branco, AB. Assessment and
nutritional aspects of wound healing. Current Opinion in Clinical
Nutrition and Metabolic Care 11(3): 281-288, 2008.
3. Cleland, JA, Childs, JD, and Whitman, JM. Psychometric
properties of the Neck Disability Index and Numeric Pain Rating
Scale in patients with mechanical neck pain. Archives of Physical
Medicine and Rehabilitation 89(1): 69-74, 2008.
4. Gilchrist, J, Jones, BH, Sleet, DA, and Kimsey, CD. Exercise-
related injuries among women: Strategies for prevention from
civilian and military studies. Morbidity and Mortality Weekly Report
49(12): 15-33, 2000.
5. Hertling, D, and Kessler, RM. Management of Common
Musculoskeletal Disorders: Physical Thereapy Principles and
Methods (3rd ed.), Lippincott, Williams and Wilkins; 1996.
6. Hootman, JM, Macera, CA, Ainsworth, BE, Addy, CL, Martin,
M, and Blair, SN. Epidmeiology of musculoskelatal injuries among
sedentary and physically active adults. Medicine and Science in
Sports and Exercise 34(5): 838-844, 2002.
7. Hu, MS, Maan, ZN, Wu, JC, Rennert, RC, Hong, WX, Lai, TS, et
al. Tissue engineering and regenerative repair in wound healing.
Annuals of Biomedical Engineering 42(7): 1494-1507, 2014.

12 PTQ 3.1 | NSCA.COM


TABLE 1. MUSCLE STRAIN GRADES
GRADE
Grade I (mild strain)
Grade II (moderate strain)
Grade III (severe strain)
TABLE 2. LIGAMENT SPRAIN GRADES
GRADE
Grade I (mild sprain)
Grade II (moderate sprain)
Grade III (severe sprain)
TABLE 3. EXAMPLES OF VARIOUS TYPES OF PAIN
TYPE OF PAIN
Cramping, dull, and aching
Dull and aching
Sharp and shooting
Sharp, bright, and lightning
Throbbing and diffused
Burning, stinging, and aching
Deep, nagging, and dull
Sharp, severe, and intolerable
NSCA.com
DESCRIPTION
Result: few muscle fibers damaged
Symptoms: mild or moderate pain
Functional ability: normal strength
Result: greater number of muscle fibers involved
Symptoms: moderate or severe pain, mild
swelling, and possible discoloration
Functional ability: noticeable weakness
Result: complete tear of muscle fibers
Symptoms: “pop” or “ripping” sensation, severe pain, swelling, and discoloration
Functional ability: loss of muscle function
DESCRIPTION
Result: few muscle fibers damaged
Signs: minimal tenderness and minimal swelling
Symptoms: mild or moderate pain
Functional ability: normal strength
Result: greater number of muscle fibers involved
Signs: moderate tenderness, moderate swelling,
decreased ROM, and possible discoloration and instability
Symptoms: moderate or severe pain
Functional ability: noticeable weakness
Result: complete tear of muscle fibers
Signs: significant tenderness, significant swelling,
discoloration, inability to bear weight, and instability
Symptoms: “pop” or “ripping” sensation,
severe pain, swelling, and discoloration
Functional ability: loss of muscle function
STRUCTURE
Muscle
Ligament or joint capsule
Nerve root
Nerve
Vascular
Nerve (sympathetic)
Bone
Fracture
PTQ 3.1 | NSCA.COM 13
FEATURE ARTICLE
PERSONAL TRAINERS AND NUTRITION ADVICE—
WHAT CAN I LEGALLY TELL MY CLIENTS?
RICK COLLINS, JD, CSCS
L
et’s take this scenario: You are a personal trainer, certified
by the National Strength and Conditioning Association
(NSCA) as a Certified Personal Trainer (NSCA-CPT®). You
are thoroughly knowledgeable about the latest research and
theories on healthy eating. One of your clients, Bob, asks you
what and how to eat in order to lose his spare tire and build
strength and muscle. You tell Bob to reduce his calories, eat
more protein and less sugary cereal, and cut back on the six-
pack of beer he drinks twice a week. Maybe you even write
him up a custom diet plan, meal by meal. Everything you offer
Bob is sound advice and complies with accepted nutritional
principles. How, then, could anyone accuse you of doing anything
wrong? It depends upon the state in which you are located.
What is legal and what is not when it comes to giving nutrition
recommendations is based on individual state laws, not federal
law. Moreover, these laws may change from year to year.
No matter how wonderful your recommendations were, in 16
states as of writing this article—Alabama, Georgia, Iowa, Kansas,
Maine, Mississippi, Missouri, Montana, Nebraska, North Carolina,
North Dakota, Ohio, Rhode Island, South Dakota, Tennessee, and
Wyoming—your advice to Bob may have run afoul of the law.
In these restrictive states there are laws that make it illegal to
provide individualized nutrition counseling without a license, and
licenses are limited almost exclusively to Registered Dietitians
(RDs) with the Academy of Nutrition and Dietetics (1). In effect,
non-RD nutritionists and personal trainers in these states are
generally barred from providing individualized nutritional
counseling regardless of their knowledge or expertise. Some
14 PTQ 3.1 | NSCA.COM
states offer certain limited exemptions. Virtually all states offer
an exemption of some kind for retailers and others who sell
supplements or food, allowing them to make explanations as to
their preparation or use (4).
But not all states are quite so limiting. Currently, in six states—
Delaware, Florida, Illinois, Maryland, Minnesota, and New Mexico—
and the District of Columbia, it is illegal to provide individualized
nutrition counseling without a license or exemption. However, RDs
are not the only ones eligible for licensing. While the specifics
vary by state, these states offer greater flexibility in permitting
certain non-RDs to become licensed.
Yet another 15 states—Arkansas, California, Hawaii, Idaho, Indiana,
Kentucky, Nevada, New Hampshire, Oklahoma, South Carolina,
Texas, Utah, Vermont, West Virginia, and Wisconsin—focus not on
giving the advice itself, but on what you call yourself (3). These
states make it legal for all to provide individualized nutrition
counseling as long as you are not using a protected title. Only
RDs can use the title—meaning that others cannot call themselves
a “dietitian” or even a “nutritionist,” depending on the state
(5,6). So, while you can provide the counseling to Bob, not being
able to use the title may deprive you of certain advantages (e.g.,
insurance reimbursement eligibility).
In nine other states—Alaska, Connecticut, Massachusetts,
Minnesota, New York, Oregon, Pennsylvania, Virginia, and
Washington—you can provide nutrition counseling to Bob as long
as you do not use the protected title. However, the title is offered
not only to RDs but also to some non-RDs, such as nutritionists.
The remaining four states—Arizona, Colorado, Michigan, and New
Jersey—have no laws restricting nutritional counseling. In these
states, it is legal for everyone to provide individualized nutrition
counseling without licensing and there are no limits on title use.
Obviously, you want to comply with your state’s law in advising
clients like Bob. That is not always so easy. As in many legal
areas, definitive answers can be elusive, definitions may be vague
or confusing, and the boundaries between the safe zone and
the danger zone can be murky. Further, a lot depends on the
interpretation of the applicable law by the regulatory boards in
each state. The best we can do is to explore some of the general
principles of relevance to the question of legality, including but not
limited to: is there an individual assessment, and to what degree?
How formal is the setting? Is the advice customized? Is it for a fee?
INDIVIDUAL ASSESSMENT
While state laws vary, nutritional counseling generally requires
an assessment of a person’s individualized health and nutritional
status. While the extent of the assessment need not necessarily be
to the degree of a medical intake consultation, it generally must
precede the recommendations for nutritional counseling to exist.
In other words, giving a lecture about healthy eating or writing an
article about nutrient timing would generally not be considered
illegal even in restrictive states. The extent to which the assessment
and recommendations delve into medical issues will also be a
factor to consider in whether nutritional counseling has occurred
in a restrictive state. The deeper into medical history and disease
issues the assessment delves, with consequent recommendations,
the more likely a transgression will be seen as having occurred in a
state that reserves this type of counseling strictly for RDs.
FORMAL SETTING
The formality of the setting is also a factor in determining whether
nutritional counseling has been provided. So, for example, telling
your participants after a spin, or cycling, class to “grab some water
because hydration is important” would likely be acceptable in
all states. Even if the group instructor directed his comment to a
particular individual, as in “Everyone be sure to hydrate. Especially
you, Bob, and grab some carbs as well,” it is unlikely that the
comment would be problematic as the setting was informal and
there was no substantive individual assessment. If the consultation
took place at a desk in the trainer’s private office, the formality of
the setting might suggest that nutritional counseling was being
provided. If you took Bob in your office and asked him a litany of
questions about his eating habits and then gave him nutritional
recommendations based on his answers, this would most likely
violate the laws in the restrictive states.
CUSTOMIZED ADVICE
The customization of recommendations is an important factor.
Generic advice about healthy eating—such as telling a client
to substitute fruit for doughnuts—would be far less likely to be
problematic than providing a customized meal plan, particularly
if provided after a formal assessment. It is generally not illegal for
personal trainers to provide peer-reviewed research on various
popular diets and eating styles so that clients can make up their
own minds about what is right for them. But advising a client
on which diet to follow, based on the data acquired from the
individualized assessment, would generally violate the law in a
restrictive state. Gray areas may exist with respect to sample
PTQ 3.1 | NSCA.COM
diets, and may depend on the exact wording of the law and the
extent to which the choice of the sample diet was based upon an
individualized assessment.
CHARGING A FEE
Charging a fee for nutritional advice is a red flag in restrictive
states. While some exemptions may exist for providing nutritional
counseling to family members for no fee, non-licensed trainers
who charge for nutritional services generally violate the law in
restrictive states. Advertising “for fee” programs mentioning
“weight loss,” “fat loss,” “body transformation,” “diet plans,” or the
like will invite investigation by the local board. Some trainers have
suggested accepting payment for nutritional services as part of a
“comprehensive fitness or lifestyle program.” In restrictive states,
this would likely be a violation of the law as the components—
individualized assessment and recommendations, etc.—are present.
Florida, for example, is one of the states that allows non-RDs to
conduct classes or seminars, or give speeches related to nutrition,
under the rationale that the information given in a group setting is
broad and not individualized (2). Although the speaker could charge
a fee even without being an RD, such classes might be scrutinized
by the appropriate regulating agency.
The purpose behind limiting individualized nutrition counseling
to RDs is ostensibly based on concern for consumers—protecting
people like Bob from unknowledgeable and misinformed
practitioners. Regardless of the true intent, personal trainers are
responsible to be familiar with the sometimes fluid landscape of
the nutritional counseling laws in their state and to abide by them.
While laws may change, personal trainers can begin reviewing their
state’s laws are by visiting http://NutritionAdvocacy.org/.
REFERENCES
1. Academy of Nutrition and Dietetics. Accessed February 2016
from http://www.eatright.org/.
2. FL ST § 468.505.
3. FL ST § 468.509.
4. GA ST §43-11A-18 (Georgia’s “exceptions”) and OH ST §
4759.10(H) ORC (Ohio’s “exemptions”).
5. KRS § 310.070.
6. TEX OCC § 701.251.
ABOUT THE AUTHOR
Rick Collins is a lawyer dedicated to the health and fitness
community. His law firm represents companies in the sports
nutrition industry as well as amateur and professional athletes. He
is recognized as a legal authority in the field of dietary supplements
and performance-enhancing substances. He serves as a legal
counselor to the International Society of Sports Nutrition and
the International Federation of Bodybuilding and Fitness, has
contributed chapters to two textbooks on sports nutrition, and
writes a monthly column for the internationally circulated Muscular
Development magazine. Collins was interviewed as a legal authority
in the film “Bigger, Stronger, Faster*” (2008). He is also a Certified
Strength and Conditioning Specialist® (CSCS®) through the National
Strength and Conditioning Association (NSCA), as well as a former
personal trainer and competitive bodybuilder. To learn more about
Collins and his practice, please go to www.supplementcounsel.com.
15
DEVELOPING THE KNOWLEDGE BASE FOR
THE CERTIFIED PERSONAL TRAINER
ROBERT LINKUL, MS, CSCS,*D, NSCA-CPT,*D
T
he base level of education developed by a certified personal
trainer can be acquired in many different ways. Some earn
four-year degrees in kinesiology, others attend specialty
schools, and some implement a self-study plan featuring a
textbook and study materials on their own. Collectively, their
first focus is to prepare and earn an accredited certification.
Once certified, they begin the process of building a clientele (1).
To accomplish this task, the trainer must focus on continuing
their work experience, developing their education, and expanding
their knowledge base to work with a larger and more diverse
range of clientele.
All personal trainers start in the fitness industry at an entry level
position in which the majority, if not all, of their knowledge is
theoretical. Gradually, their knowledge base increases through
hands-on experience and exposure to clients during shadowing
sessions, internships, or mentorships. From this point on, the
trainer must troubleshoot new challenges that arise as clients’
goals change, physical limitations occur, and the number of clients
increases.
Every personal trainer has a professional scope of practice in
which their current clientele can be categorized (2). The personal
training industry is made up of many different clienteles with
different fitness goals, physical limitations, and diseases in which
they want to pursue, improve, or defeat. It is the trainer’s task to
obtain this information through the initial interview, consultation,
and evaluation of a client (2). Based on the information acquired
during that process, the trainer must decide if their knowledge
base and experience can safely and efficiently train the client
appropriately (4). If the trainer feels that they are unable to meet
the requirements of the client, it is their professional responsibility
to refer the client to an individual with a scope of practice that
does meet the requirements (i.e., physical therapist, medical
doctor, registered dietitian, etc.).
16 PTQ 3.1 | NSCA.COM
Over time, a rookie trainer can increase the reach of their clientele
by utilizing three avenues. The first avenue is the commitment
to continue their education through scientific and evidence-
based research (1). The personal training industry is growing
at a rapid rate with a large amount of research studies being
conducted. These studies produce a massive amount of content
which a trainer can use to build more efficient program designs,
learn appropriate cues, and develop progressions that are more
productive for their clientele.
Second, through hands-on education in a practical format.
Attending and participating in conferences, clinics, seminars,
mentorships, internships, certification programs, and certificate
programs provides a trainer the opportunity to connect with their
peers and learn from some of the best teachers and researchers
in the industry. A trainer can participate and learn to perform
movements correctly through hands-on practical experience
and earn secondary certifications or certificates to add to their
credibility and expertise.
As a personal trainer continues to grow their clientele they will
be presented with a variety of new goals, physical limitations,
and diseases. These challenges can range from fat loss, sports
performance, muscle gain (hypertrophy), nutritional guidance,
lower back pain, frozen shoulder, tissue and joint repairs, joint
replacements, cosmetic surgery, cancer surgery/treatment,
scoliosis, diabetes, and arthritis just to name a few (1). All of these
physical limitations can be intimidating for a personal trainer to
take on, however, with a network of health and fitness professionals
to pull information from, a trainer can progress a client accordingly.
It is considered a responsible step for a personal trainer to consult
with a colleague, mentor, or associate (or with the professional in
which their client was referred) to confirm that the progressions for
their client are safe, efficient, and appropriate (5).
Referring to and/or teaming up with other more experienced
professionals (e.g., personal trainers, strength coaches, physical
therapists, registered dietitians, general healthcare providers,
etc.) is a great way for a trainer to progress a client accordingly.
Through a team approach, the client can be progressed safely
and successfully while the trainer can then add that experience to
their repertoire. The client will be guided accordingly and by the
appropriate professional while the trainer is able to learn and gain
experience working with a physical limitation or goal in which they
were previously lacking (3).
Third is the process of developing a knowledge base over time
and through experience. In the beginning of their career a trainer
has a solid understanding of theoretical content and has practiced
practical application in mock-training settings; however, their
experience in a real-life setting is often minimal. It is drastically
different implementing a program design, teaching cues, and
coaching progressions to a real client and thus, with every
experience in doing so the trainer adds to their knowledge base
(see Table 1 for suggested areas of focus). With more opportunity
comes the ability for the trainer to hone the skills needed to be a
well-rounded fitness professional.
A committed personal trainer can gradually grow their knowledge
base by utilizing these three avenues on a consistent basis. The
personal trainer must stay up-to-date on the fitness industry that
is performing research at an all-time high. The trainer should
process and use that information as well as consult with their
mentors, peers, or colleagues as they pursue working with new
demographics of clientele. With each experience of training a
new client comes an opportunity to research, consult, and learn
about something new. The career-driven personal trainer will learn
from their mistakes, build on their successes, and utilize their
knowledge base with each new client they encounter.
REFERENCES
1. Clayton, N, Drake, J, Larking, S, Linkul, R, Martino, M, Nutting,
M, and Tumminello, N. Foundations of Fitness Programming. NSCA
Publication. 6-8, 2015.
2. Coburn, J, and Malek, MH. NSCA’s Essentials of Personal
Training. (2nd ed.) Champaign, IL: Human Kinetics; 147-149, 2012.
3. Eckert, R, and Snarr, R. Scope of practice - Nutrition and the
personal trainer. NSCA Personal Training Quarterly 1(3): 10-14, 2014.
4. Kompf, J, Nadolsky, S, and Tumminello, N. The scope of
practice for personal trainers. NSCA Personal Training Quarterly
1(4): 4-9, 2014.
5. Mikeska, D. A SWOT analysis of the scope of practice
for personal trainers. NSCA Personal Training Quarterly 2(1):
22-27, 2014.
ABOUT THE AUTHOR
Robert Linkul was the National Strength and Conditioning
Association’s (NSCA) Personal Trainer of the Year in 2012. He is
currently a volunteer with the NSCA as the Southwest Regional
Coordinator and Committee Chairman for the Personal Trainers
Special Interest Group (SIG). Linkul is the Career Development
columnist for the NSCA’s Personal Training Quarterly (PTQ)
publication and speaks internationally on career development
techniques for personal trainers. Linkul mentors personal training
students and rookie trainers entering the industry on business
strategies, client retention, and professional longevity. Linkul has
been in the industry since 1999, and owns and operates his own
personal training studio in Sacramento, CA. 

TABLE 1. SUGGESTED AREAS OF FOCUS FOR THE PERSONAL TRAINER

TWELVE AREAS OF FOCUS FOR PERSONAL TRAINING CLIENTS

Low Back/Hip Injury:

Strength Gain and Hypertrophy:
Disease/Special Populations: Chronic or Acute Back Pain,
Increasing Muscular Strength and/or
Arthritis, Multiple Sclerosis, Disc Injury, Sciatica , etc.
Muscular Size, Power Lifts, Strongman,
Diabetes, Cancer, etc. Chronic or Acute Hip Pain
Foundational Strength Lifts, etc.
Impingement, Weakness, etc.

Fat Loss and Weight Management:

Youth Development/Special Populations:
Movement Preparation, Agility, Stability,
Balance, Reaction Time, Coordination, etc.
Elbow Injury:
Nutritional Guidelines and Suggestions,
Chronic or Acute Elbow Pain, Tennis
Exercise Frequency, Program Design,
Elbow, Golfer’s Elbow, Tendonitis, etc.
Rest and Recovery Periods, etc.

Shoulder Injury:
Speed and Power Production:
Special Populations: Older Adults Chronic or Acute Shoulder Pain,
Olympic Lifts, Plyometrics,
Daily Life Activities and Injury Prevention Frozen Shoulder, Bursitis,
Agility and Speed Drills, etc.
Tendonitis, Rotator Cuff Injury, etc.

Knee Injury: Endurance and Cardiovascular Training:

Special Populations: Pregnancy
Chronic or Acute Knee Pain, Fun Runs, 5-K and 10-K Runs, Half and
Pregnancy Preparation,
Patellar Tendonitis, Meniscus Full Marathons, Extreme Races,
Prenatal, Postpartum Care
Injury, Ligament Injury, etc. Hiking and Mountaineering, etc.

PTQ 3.1 | NSCA.COM 17

FEATURE ARTICLE
THE INTERACTION BETWEEN METABOLIC DISORDERS
AND PERSONAL TRAINERS
ALEXIS BATRAKOULIS, MS, CSCS
I
t is well known that epidemics of obesity and diabetes
have grown at an alarming rate among adults and children,
throughout the entire world (15,21). It is likely that the health
and fitness industry will play a major role regarding the prevention
and rehabilitation of these widespread issues (14). The modern
way of living has, in some cases, eliminated or reduced the
amount of regular physical activity as a fundamental stimuli from
many people’s daily lives. The growth of obesity and diabetes
suggests that there is an imbalance between the modern lifestyle
and physical requirements. Physical inactivity has become a major
risk factor for chronic non-communicable diseases in certain
populations (5). In fact, opportunities to be physically active tend
to decrease at the onset of adulthood and recent lifestyle changes
(e.g., cell phones, advanced computers, and high resolution
televisions) have reinforced this phenomenon (11). According
to the European Commission, 40 – 60% of the European Union
population can be categorized as living a sedentary lifestyle,
while roughly 31% are able to complete the European Union
guidelines of 30 min of moderate physical activity per day (12).
Unfortunately, similar statistics can be found in the United States,
Canada, and Australia, where approximately only about 48%, 54%,
and 33% of the population is physically active, respectively (8,10).
EPIDEMIOLOGICAL OVERVIEW
In Europe, a startling 35% of people over the age of 15 did not
reach the minimum recommended levels of regular physical
activity (26). The latest research findings clearly show that
regularly engaging in exercise and activity are two key
18 PTQ 3.1 | NSCA.COM
components for obtaining and maintaining a healthy lifestyle (7).
The World Health Organization (WHO) defines overweight and
obese people as having abnormal or excessive fat accumulation
that presents a risk to health based on the body mass index (BMI)
(27). A person who is overweight has a BMI greater than or equal
to 25 and obesity is categorized as someone with a BMI greater
than or equal to 30 (27). On the other hand, diabetes mellitus
is a metabolic disorder that is characterized by abnormal levels
of fasting blood glucose in the context of insulin resistance and
relative insulin deficiency (2). People who are overweight or
obese, or have diabetes mellitus type 2 are at a major risk for a
number of chronic diseases, including cardiovascular disease,
metabolic syndrome, and cancer (2). Once considered a problem
only in high income populations, overweight/obesity and diabetes
are now dramatically on the rise in low and middle income
populations, particularly in urban settings (14). Additionally, recent
statistics indicate that approximately 1.5 billion adults 20 years and
older are overweight, and of these individuals, approximately 500
million are obese (14). Based on the latest available data, more
than half (52%) of the adult population in the European Union is
overweight or obese (14). On average, across the European Union,
17% of the adult population is obese, with more than one-third
(35%) of United States adults considered obese (25). In addition,
the global prevalence of diabetes is estimated to be 9% among
adults aged 18 years or older and the WHO projects that diabetes
will be the 7th leading cause of death in 2030 as the rates of
type 2 diabetes have increased markedly over the last 50 years in
parallel with obesity (25).
THE RATIONALE FOR SPECIALIZED EXERCISE
PROFESSIONALS
In 2013, the American Medical Association officially recognized
obesity as a disease, a move that could induce physicians to pay
more attention to this condition and develop an environment
of intensive readiness (14). This progress may help change the
way the medical community tackles this complex issue that
affects so many people worldwide. Strength and conditioning
professionals should be actively involved in order to help people
live healthier lifestyles and avoid non-communicable diseases.
Therefore, instructing and supervising exercise to overweight,
obese, prediabetic, and diabetic individuals likely requires the
development of specific credentials which focus exclusively on
these types of special populations. The unhealthy bodyweight
and unstable glycemic control can be associated with rapid
increases in many other chronic diseases (2). There is evidence
from population-based studies with long-term follow-up that
suggests that age-related weight gain is attenuated in physically
active adults compared to sedentary adults (21). Lifestyle
interventions have also been shown to be more effective than
the most commonly recommended drugs and can play a key role
regarding the treatment of these chronic conditions (21). Generally,
a systematic healthy diet, customized physical exercise to maintain
a healthy bodyweight, and adhering to behavioral changes are the
primary mainstays of treatment for obesity and diabetes.
According to a recent survey by the American College of Sports
Medicine (ACSM), childhood obesity and exercise for weight loss
consist of two of the top 20 worldwide fitness trends, and have
been very popular for the last eight years (23). Additionally, the
number one stated reason for people to become members at
fitness facilities is to exercise for weight loss (17). Therefore, it is in
the personal trainer’s best interest to be well-versed and qualified
to assist in cases of overweight, obese, prediabetic, and diabetic
individuals. Following this approach may allow the personal
trainer to be more successful with their clientele, as well as open
more opportunities to broaden their client base. Personal trainers
should focus on specific special populations in order to provide
customized services to these individuals who are in dire need of
structured and supervised exercise protocols (2).
THE ROLE OF EXERCISE SPECIALIST
Personal trainers should be able to apply an individualized
approach and assess and motivate clients to achieve and maintain
an active and healthy lifestyle. They should also focus their
efforts on behavior changes within this population by using
optimal communication skills and empathy (1). Furthermore, an
appropriate bridge that could unite and develop closer relations
between the personal training and healthcare sector seems to
be one way to ensure safe and thorough treatment for clients.
While there has been progress in this direction, the gap between
personal training and healthcare professionals is visible and
especially prevalent in developing countries (22).
Under these circumstances it seems realistic that the future of the
strength and conditioning field is associated with the existence of
a multidisciplinary task force that consists of four or five members
(i.e., general practitioner-pathologist, nutritionist-dietician,
physiotherapist, psychologist, and exercise specialist) in order to
provide the most safe and credible guidance to these populations.
Specifically, the occupations of weight management exercise
PTQ 3.1 | NSCA.COM
specialist and prediabetes exercise specialist seem to be two of
the most popular specializations for personal trainers at vocational
levels in Europe (3).
THE EVOLUTION OF PERSONAL TRAINING
It is up to us as personal trainers to take action and have the
opportunity to obtain integral, multidimensional, and evidence-
based knowledge regarding these cases. The interaction among
metabolic diseases and personal trainers could provide an
opportunity for the expansion and progress of the personal
training industry. This has been shown in the United States where
the attractiveness of the occupation of fitness professional is rising
more and more during recent years. According to the latest data
from the United States Bureau of Labor Statistics in 2014, this
field is experiencing an employment boom and the profession is
expected to grow by 24% in the next decade (6). In addition, the
occupation of personal trainer was recently named the 18th best
job in America by CNN Money due to its growth opportunities,
pay, and benefit to society (9). Additionally, personal trainers can
also work in a variety of settings beyond the gym or fitness facility,
including hospitals, corporate wellness departments, clients’
homes, and outdoor boot camps.
CONCLUSION
Active living is an optimal way of life for wellbeing and is
considered one of the most important elements in avoiding and
treating non-communicable diseases (4). With the current rise in
overweight individuals, obesity, prediabetes, and diabetes, the role
of qualified personal trainers is absolutely crucial for creating a
more active and healthy society. It is obvious that there is a need
for personal trainers who have optimal education, training, and
certifications, and who have excellent communication skills to
inspire and motivate. This is especially important for these special
populations because they may need specialized and focused
attention to exercise safely.
REFERENCES
1. Adelman, AM, and Graybill, M. Integrating a health coach into
primary care: Reflections from Penn State ambulatory research
network. Annals of Family Medicine 3(2): 33-35, 2005.
2. American College of Sports Medicine. ACSM’s Guidelines
for Exercise Testing and Prescription. (9th ed.) Philadelphia, PA:
Lippincott Williams and Wilkins; 2013.
3. Batrakoulis, A, and Rieger, T. European barometer on the top
future trends in fitness education, training and certification of the
exercise professionals. Journal for Physical Education and Sport
Science 1(1): 10-26, 2014.
4. Blair, SN, Dunn, AL, Marcus, BH, Carpenter, RA, and Jaret, P.
Active Living Every Day (2nd ed.) Champaign, IL: Human Kinetics;
2010.
5. Blair, SN. Physical inactivity: The biggest public health
problem of the 21st century. British Journal of Sports Medicine 43:
1-2, 2009.
6. Bureau of Labor Statistics, United States Department of
Labor. Occupational outlook handbook: Fitness trainers and
instructors. Retrieved from http://www.bls.gov/ooh/personal-care-
and-service/fitness-trainers-and-instructors.htm.
7. Centers for Disease Control and Prevention. Obesity
19
THE INTERACTION BETWEEN METABOLIC DISORDERS AND PERSONAL TRAINERS
prevention and control. Retrieved from http://www.cdc.gov/
workplacehealthpromotion/implementation/topics/obesity.html.
8. Centers for Disease Control and Prevention. State indicator
report on physical activity. Atlanta, GA: U.S. Department of Health
and Human Services, 2010. Retrieved from http://www.cdc.gov/
physicalactivity/downloads/PA_State_Indicator_Report_2010.pdf.
9. CNN Money. Best jobs in America: 18. personal trainer.
2012. Retrieved from http://money.cnn.com/pf/best-jobs/2012/
snapshots/18.html.
10. Colley, RC, Garriguet, D, Janssen, I, Craig, CL, Clarke, J, and
Tremblay, MS. Physical activity of Canadian adults: Accelerometer
results from the 2007 to 2009 Canadian Health Measures Survey.
Health Reports 22(1): 7-14, 2011.
11. Donnelly, JE, Blair, SN, Jakicic, JM, Manore, MM, Rankin, JW,
and Smith, BK. American College of Sports Medicine. American
College of Sports Medicine position stand: Appropriate physical
activity intervention strategies for weight loss and prevention
of weight regain for adults. Medicine and Science in Sports and
Exercise 41(2): 459-471, 2009.
12. European Commission. Sport and physical activity. Special
Eurobarometer. 2014. Retrieved from http://ec.europa.eu/public_
opinion/archives/ebs/ebs_412_fact_uk_en.pdf.
13. European Union. Physical activity guidelines: Recommended
policy actions in support of health-enhancing physical activity.
European Commission. 2008. Retrieved from http://ec.europa.eu/
sport/library/documents/c1/eu-physical-activity-guidelines-2008_
en.pdf.
14. Flegal, KM, Kit, BK, Orpana, H, and Graubard, BI. Association
of all-cause mortality with overweight and obesity using standard
body mass index categories: A systematic review and meta-
analysis. Journal of the American Medical Association 309(1): 71-82,
2013.
15. Hallal, PC, Andersen, LB, Bull, FC, Guthold, R, Haskell, W, and
Ekelund, WU. Global physical activity levels: Surveillance progress,
pitfalls, and prospects. The Lancet 380(9838): 247-257, 2012.
16. Hossain, P, Kawar, B, and El Nahas, M. Obesity and diabetes in
the developing world – A growing challenge. New England Journal
of Medicine 356(3): 213-215, 2007.
17. International Health, Racquet and SportsClub Association.
The 2013 IHRSA Global Report: The state of the health and club
industry. Boston, MA; 14-16, 2013.
18. LaMonte, MJ, Barlow, CE, Jurca, R, Kampert, JB, Church, TS,
and Blair, SN. Cardiorespiratory fitness is inversely associated with
the incidence of metabolic syndrome: a prospective study of men
and women. Circulation 112(4): 505-512, 2005.
19. National Center for Chronic Disease Prevention and Health
Promotion. The Power of Prevention: Chronic disease… the public
health challenge of the 21st century. 2009. Retrieved from http://
www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf.
20. Organisation for Economic Co-operation and Development.
Health at a glance 2013. OECD Publishing; 48-59, 2013.
21. Saris, WH, Blair, SN, van Baak, MA, Eaton, SB, Davies, PS, Di
20 PTQ 3.1 | NSCA.COM
Pietro, L, et al. How much physical activity is enough to prevent
unhealthy weight gain? Outcome of the IASO 1st Stock Conference
and consensus statement. Obesity Reviews 4: 101-114, 2003.
22. Thompson, WR. Worldwide survey reveals fitness trends for
2012. ACSM’s Health Fitness Journal 15(6): 9-18, 2011.
23. Thompson, WR. Worldwide survey reveals fitness trends for
2015. ACSM’s Health Fitness Journal 18(6): 8-17, 2014.
24. Ward, BW, and Schiller, JS. Prevalence of multiple chronic
conditions among US adults: Estimates from the National Health
Interview Survey, 2010. Preventing Chronic Disease 10, 2013.
25. World Health Organization. Global status report on non-
communicable diseases 2014. WHO Publishing: Geneva (CH); 208-
271, 2012. Retrieved from http://www.who.int/nmh/publications/
ncd-status-report-2014/en/.
26. World Health Organization. Obesity and overweight. Media
Centre. 2015. Retrieved from http://www.who.int/mediacentre/
factsheets/fs311/en/.
27. World Health Organization. Physical activity and health in
Europe: Evidence for action. WHO Publishing: Copenhagen (DK);
8-10, 2006. Retrieved from http://www.euro.who.int/__data/
assets/pdf_file/0011/87545/E89490.pdf.
ABOUT THE AUTHOR
Alexis Batrakoulis holds a Bachelor of Science degree in Physical
Education and Sport Science with specialization in fitness
and a Master of Science degree in Exercise and Health with
specialization in chronic diseases. He also holds 13 primary and
specialty certifications through National Strength and Conditioning
Association (NSCA), American College of Sports Medicine (ACSM),
National Academy of Sports Medicine (NASM), American Council on
Exercises (ACE), and Aerobics and Fitness Association of America
(AFAA). He is a member of the Standards Council of EuropeActive
(formerly the European Health and Fitness Association [EHFA])
and has served as a member or leader of technical experts groups
for the development of educational standards regarding the Pre-
Diabetes Exercise Specialist and Weight Management Exercise
Specialist at the vocational level in Europe. He has 21 years of
experience in commercial fitness clubs, personal training, athletic
preparation, and fitness education. Additionally, he is the Education
Director of Personal Training Certification at Greek Aerobics and
Fitness Training School (GRAFTS), which is the largest training
provider in Greece and Cyprus.
 COACH
NSCA.com

BETTER

GET THE GEAR THAT IS PROVEN TO MAKE A DIFFERENCE

The TRX® Suspension Trainer has been scientifically validated to increase core activation with every
TM

exercise. Its uniquely patented design enables hundreds of exercises that can be scaled to meet the
needs of athletes and PT clients at any fitness level. Used by professional, collegiate and high school
coaches, TRX is the perfect tool to get athletes moving better, feeling better and performing better.

For optimal results, learn how to integrate the Foundational Movement Standards
into your training with the TRX education journey.

YOUR JOURNEY STARTS HERE, CARVE YOUR PATH NOW GIVE THE GIFT
S TA RT EXP AND MASTER
OF EDUCATION
15% OFF 30% OFF
SUSPENSION FUNCTIONAL GROUP RIP®

A TRX 2 or more TRX

TRAINING
®
TRAINING®
TRAINING ®
TRAINING ®

Education Gift Card Education Gift Cards

COURSE COURSE COURSE COURSE
Equivalent of one education course
Never expires • Any open course • Any location

TRXTRAINING.COM PTQ 3.1 | NSCA.COM USE CODE: NSCA AT CHECKOUT

21
CARNITINE—EFFECTIVE FAT-LOSS SUPPLEMENT?
DYLAN KLEIN, PHD(C)
INTRODUCTION
B
odybuilders, fitness enthusiasts, and even scientific
researchers are constantly trying to discover new ways
to improve fat loss and overall health. A very popular
supplement believed to aid in this process is carnitine. Carnitine
is a nutrient found in meat, dairy, and eggs, and is intimately
involved in fat metabolism. In theory, if one can transport more fat
into the mitochondria, then more fat can be broken down, thereby
decreasing body fat. While this may seem logical on the surface,
the truth is that there is more to the story than is commonly stated
when hearing about carnitine to improve fat loss. This article will
review the literature to see if carnitine truly has a role in fat loss, or
if it is ineffective as a fat-loss supplement.
A BRIEF OVERVIEW OF CARNITINE
Carnitine is a vitamin-like, water-soluble amine obtained through
dietary intake or by synthesis in both the liver and kidneys.
Almost all (about 95 – 98%) of the bodily stores of carnitine are
in skeletal muscle and the heart, with the remaining 2 – 5% in the
liver, kidneys, and blood (11). Carnitine plays a pivotal role in fat
metabolism by transporting fatty acids within the mitochondria to
be oxidized and generate ATP (11). Without carnitine, this process
could not take place and fat oxidation in skeletal muscle would be
greatly hindered (6).
The theory behind carnitine supplementation is that more
intramuscular carnitine equates to greater fatty acid transport
and oxidation, leading to improvements in fat loss. This theory,
however, operates under some assumptions: that carnitine
translocation is the rate-limiting step in fatty acid oxidation,
meaning that increasing free carnitine levels will equate to greater
transport of fatty acids into the mitochondria and more fat
oxidation; and, that you can increase muscle levels of carnitine
through dietary means. If all these assumptions are true, there
may be a reasonable case for carnitine supplementation.
INTRAMUSCULAR CARNITINE AND FATTY ACID
TRANSPORT AND OXIDATION
It is assumed that carnitine translocation is the rate-limiting step
in fat oxidation. However data suggest that fat oxidation actually
occurs when carnitine levels are well below resting levels (10).
22 PTQ 3.1 | NSCA.COM
Further, when fat availability in the blood is artificially increased
during exercise (at 80% VO2max), with no concomitant increases
in skeletal muscle carnitine, the muscle still oxidizes more fat (4).
This evidence suggests that carnitine translocation may not be
the rate-limiting step during fat oxidation. Therefore, increasing
muscle carnitine levels may not amount to further increases in fat
oxidation. This is because maximal rates may already be achieved
with lower levels of muscle carnitine and that artificially high levels
of fatty acids in the blood are easily handled without additional
carnitine. Nevertheless, is there still a role for increasing muscle
levels of carnitine, and if so, is it even possible?
CARNITINE INGESTION
Many studies show that chronic ingestion of carnitine does very
little to augment intramuscular stores. In 1994, Barnett and
colleagues showed that two weeks of carnitine supplementation
at 4 g per day did not significantly affect muscle levels of carnitine
(1). Similarly, Vukovich et al. investigated the effects of carnitine
supplementation on muscle carnitine concentrations and glycogen
content during submaximal exercise, in which subjects ingested
6 g per day of carnitine and still did not show any increases
in muscle levels of carnitine (12). Using a longer study design,
Wächter et al. gave subjects 4 g of carnitine per day for three
months and still did not see any increases in muscle levels of
carnitine (13). Based on these findings, oral ingestion of carnitine
alone appears to have virtually no effect on intramuscular levels.
Even direct intravenous infusion of carnitine has been shown
to be unsuccessful (2,7). In addition, performance parameters
such as perceived exertion, exercise performance, VO2max, and
markers of muscle substrate usage such as respiratory exchange
ratio, fatty acid turnover across the leg, and post-exercise muscle
glycogen content were all shown to be unaffected by the ingestion
of 2 – 5 g of carnitine per day (anywhere from one week up to
three months) (6). The majority of evidence shows that intake of
carnitine alone fails to increase intramuscular levels and therefore
will not likely increase fat burning.
INSULIN, CARBOHYDRATES, AND CHOLINE
While intake of carnitine alone has proved unsuccessful at increasing
intramuscular levels, combining carnitine with other substances has
been shown to increase the level of skeletal muscle carnitine.
It has been shown by Stephens and colleagues that oral ingestion of
carnitine alongside a rather large dose of carbohydrate (CHO) (~80
– 94 g) is able to effectively stimulate the uptake of carnitine
(as measured indirectly via blood levels and urinary excretion)
(8,14). While 80 – 94 g of carbohydrate may not seem unusual
for a bodybuilder or weightlifter to consume in one sitting, the
off-season, or even in the earlier stages of dieting, the dosage
may come into conflict during the later stages of prep (when
carbs are being reduced), or for those who have lower CHO
requirements. Moreover, even replacing some of the carbohydrate
with whey protein (40 g CHO + 40 g whey) has shown to actually
have an antagonistic effect on muscle carnitine uptake despite
resulting in similar blood levels of insulin and in the face of
enhanced carnitine absorption in the gut compared to carbohydrate
alone (5). Therefore, some practical limitations may come into
play, especially when it means eating relatively high amounts of
carbohydrate to gain what may be a trivial fat-burning effect from
carnitine.
Indeed, when subjects were given oral carnitine (2.7 g per day)
alongside large doses of carbohydrate (80 g CHO twice daily),
their carnitine stores increased by 21% and their bodyweight
remained relatively unchanged (9). In contrast, those who were
not given the carnitine supplement had no change in carnitine
stores and actually increased their bodyweight and increased their
fat mass by 4.5 lb (9).
Another effective way to increase muscle carnitine stores is in
combination with choline. The combination of carnitine and choline
has not only shown to increase muscle levels of carnitine, but has
also been shown to reduce body fat compared to placebo (1 –
1.5% reduction in body fat) (3). These results, however, should be
interpreted with caution as the measurements done to ascertain
body fat levels were skin calipers and bioelectrical impedance
analysis, two methods that are highly inaccurate and prone to
error by the measurer. Thus, even when carnitine stores are
increased, the effect on reducing body fat is likely negligible.
Moreover, none of these studies incorporated long-term resistance
training programs with controls on dietary intakes during a well-
planned weight-loss diet.
CONCLUSIONS
Although it may be possible to increase skeletal muscle levels
of carnitine by combining it with relatively large amounts of
carbohydrate repeatedly throughout the day, or by taking it
with choline, there is limited data that shows that carnitine is
a potent fat-burner that will result in significant reductions in
fat mass. Furthermore, the practical limitations of consuming
carbohydrate that equates to 640 kcals each day make the
usefulness of carnitine as a fat-burner questionable, especially
compared to well-known effects of a sufficient caloric deficit
combined with increased physical activity. Thus, currently, carnitine
seems to have a limited role when trying to reduce body fat.
More research is needed in randomized, placebo-controlled trials
alongside rigorously controlled diets and well-structured exercise
programs to determine whether carnitine could be an effective
additive to a weight-loss program.
PTQ 3.1 | NSCA.COM
REFERENCES
1. Barnett, C, Costill, DL, Vukovich, MD, Cole, KJ, Goodpaster, BH,
Trappe, SW, and Fink, WJ. Effect of L-carnitine supplementation
on muscle and blood carnitine content and lactate accumulation
during high-intensity sprint cycling. International Journal of Sport
Nutrition 4: 280-288, 1994.
2. Brass, EP, Hoppel, CL, Hiatt, and WR. Effect of intravenous
L-carnitine on carnitine homeostasis and fuel metabolism during
exercise in humans. Clinical Pharmacology and Therapeutics 55:
681-692, 1994.
3. Hongu, N, and Sachan, DS. Carnitine and choline
supplementation with exercise alter carnitine profiles, biochemical
markers of fat metabolism, and serum leptin concentration in
healthy women. Journal of Nutrition 133: 84-89, 2003.
4. Romijn, JA, Coyle, EF, Sidossis, LS, Zhang, XJ, and Wolfe, RR.
Relationship between fatty acid delivery and fatty acid oxidation
during strenuous exercise. Journal of Applied Physiology 79: 1939-
1945, 1995.
5. Shannon, CE, Nixon, AV, Greenhaff, PL, and Stephens, FB.
Protein ingestion acutely inhibits insulin-stimulated muscle
carnitine uptake in healthy young men. American Journal of
Clinical Nutrition 103: 276-282, 2016.
6. Stephens, FB, Constantin-Teodosiu, D, and Greenhaff, PL. New
insights concerning the role of carnitine in the regulation of fuel
metabolism in skeletal muscle. Journal of Physiology 581: 431-444,
2007.
7. Stephens, FB, Constantin-Teodosiu, D, Laithwaite, D, Simpson,
EJ, and Greenhaff, PL. Insulin stimulates L-carnitine accumulation
in human skeletal muscle. FASEB Journal 20: 377-379, 2006.
8. Stephens, FB, Evans, CE, Constantin-Teodosiu, D, and
Greenhaff, PL. Carbohydrate ingestion augments L-carnitine
retention in humans. Journal of Applied Physiology 102: 1065-1070,
2007.
9. Stephens, FB, Wall, BT, Marimuthu, K, Shannon, CE,
Constantin-Teodosiu, D, Macdonald, IA, and Greenhaff, PL.
Skeletal muscle carnitine loading increases energy expenditure,
modulates fuel metabolism gene networks and prevents body fat
accumulation in humans. Journal of Physiology 591: 4655-4666,
2013.
10. Spriet, LL. Metabolic regulation of fat use during exercise
and in recovery. In: Maughan, RJ, and Burke, LM (Eds.), Sports
Nutrition: More Than Just Calories – Triggers for Adaptation. Kona,
HI: Nestlé Nutrition Institute Workshop; 69: 39-58, 2011.
11. Stipanuk, MH and Caudill, MA. Biochemical, Physiological, and
Molecular Aspects of Human Nutrition. (2nd ed.) St. Louis, MO:
Elsevier; 2006.
12. Vukovich, MD, Costill, DL, and Fink, WJ. Carnitine
supplementation: Effect on muscle carnitine and glycogen content
during exercise. Medicine and Science in Sports Exercise 26: 1122-
1129, 1994.
23
CARNITINE—EFFECTIVE FAT-LOSS SUPPLEMENT?
13. Wachter, S, Vogt, M, Kreis, R, Boesch, C, Bigler, P, Hoppeler,
H, and Krahenbuhl, S. Long-term administration of L-carnitine to
humans: Effect on skeletal muscle carnitine content and physical
performance. Clininca Chimica Acta 318: 51-61, 2002.
14. Wall, BT, Stephens, FB, Constantin-Teodosiu, D, Marimuthu,
K, Macdonald, IA, and Greenhaff, PL. Chronic oral ingestion of
L-carnitine and carbohydrate increases muscle carnitine content
and alters muscle fuel metabolism during exercise in humans.
Journal of Physiology 589: 963-973, 2011.
NSCA 2016
TACTICAL
STRENGTH AND CONDITIONING
FIT TO SERVE. STRENGTH TO PERFORM.
REGISTER NOW | NSCA.COM/TSAC2016
ABOUT THE AUTHOR
Dylan Klein earned his Bachelor of Science degree in Nutritional
Sciences, Dietetics from Rutgers University, where he is currently
pursuing a Doctorate in Nutritional Biochemistry and Physiology.
His research currently focuses on the molecular adaptations of
skeletal muscle to exercise. In addition, Klein was also the Head
Nutritionist for the Rutgers University football team for the 2012
– 2013 season and the Assistant Nutritionist for the 2011 – 2012
season. In addition, Klein was the Head Nutritionist for the Rutgers’
Army Reserve Officers’ Training Corps (ROTC) program from 2011
– 2013. Outside of his role as a nutritionist on campus, Klein also
works with the lay public, both in person and via email/phone
correspondence where he specializes in fat loss, muscle gain, and
body recomposition. He also provides more information on a blog
called “Calories in Context.” 
ANNUAL TRAINING
APRIL 25 – 28, 2016
SAN DIEGO, CA
SAN DIEGO MARRIOTT
MISSION VALLEY
The 39th Annual NSCA National Conference
is bringing together the best of the best from
all reaches of the strength and conditioning
industry to bridge the gap between innovative
science and power-packed applications in
exercise and athletic performance. From
cutting-edge presentations to dynamic
hands-on sessions by renowned professors,
researchers, strength coaches, and personal
trainers, you’ll gain the tools to elevate your
strength and conditioning skillset and help
your athletes achieve their greatest potential.
FEATURE ARTICLE
TRANSTHEORETICAL MODEL­­­­­­—
APPLICATIONS TO PERSONAL TRAINING
RYAN ECKERT, CSCS, NSCA-CPT
T
he certified personal trainer (CPT), as defined by the
National Strength and Conditioning Association (NSCA),
is an individual who assesses, motivates, and educates
clients regarding their health/fitness needs (1). The CPT uses
an individualized approach, designs safe and effective exercise
programs, responds appropriately in emergency situations, and
refers clients to other healthcare professionals when necessary
(1). A CPT may also provide general nutritional advice and
facilitate healthy behavior changes. Among the many aspects
of the CPT’s duties, facilitating behavior change may perhaps
be the most crucial element in promoting overall client success.
Long-term client progress is dependent on a variety of factors,
but healthy behavior change provides the foundation upon which
success is realized.
In order to facilitate healthy behavior change, models and theories
are often used as guiding frameworks from which to develop an
evidence-based intervention. There are a variety of such models
to choose from when attempting to change a client’s behavior,
and some models might be better suited for certain behaviors. The
most common behaviors that CPTs will be working with include
diet and exercise. This article will deal specifically with exercise-
related change.
Many different theories and models have been successfully used to
facilitate exercise behavior change, including the transtheoretical
model (TTM), social cognitive theory (SCT), and social ecological
model (4). The SCT model identifies a variety of factors that
influence behaviors, with self-efficacy being the key concept
26 PTQ 3.1 | NSCA.COM
characterizing this theory (4). The social ecological model
describes the many different variables that influence behavior,
ranging from the intrapersonal level to the public policy level
(4). The TTM, on the other hand, proposes stages of change
that individuals progress through as behaviors are modified
(4). While all three of these models and theories have been
successfully utilized within exercise interventions, the purpose
of this brief review will be to discuss the application of the TTM
and its constructs in modifying exercise behavior in the personal
training setting. The TTM was chosen for this review as it is a well-
established model for facilitating exercise behavior change (4).
Therefore, a summary of the model and its application to personal
training can be useful for the fitness professional.
THE TRANSTHEORETICAL MODEL
The TTM was introduced in the early 1980s and has been applied
to many health behaviors since its conception (6). The model
was originally applied to smoking cessation, but its application
has expanded to address many other health behaviors, including
exercise. As stated previously, this model proposes stages of
change that individuals progress through as they attempt to
change a specific behavior (4). However, these stages are only
one construct within the model. Other constructs included within
the TTM include processes of change, decisional balance, and
self-efficacy (2). All of the constructs that characterize the TTM
have been applied to exercise behavior (6). This review will focus
mainly on the “stages of change” model and how it relates to
exercise behavior. The other constructs and their application to
exercise behavior will be discussed briefly.
STAGES OF CHANGE
The five stages of change model include: (a) precontemplation, (b)
contemplation, (c) preparation, (d) action, and (e) maintenance
(4). Table 1 outlines the different stages of change and their
associated behaviors (see Table 1). When applying this model
to exercise, each stage is characterized by a unique readiness
to engage in exercise behavior. As individuals progress from
precontemplation onwards, their readiness and willingness to
engage in exercise increases (4,5,6). This can be seen in a review
of the literature as conducted by Spencer et al., in which they
found that exercise stage-matched interventions resulted in
participants moving to a higher stage of change and typically an
improvement in fitness level (6). This review also demonstrated
positive correlations between a variety of predictors of exercise
behavior (e.g., self-efficacy, stress level, social support, dietary
habits, and attitude towards exercise) and stage of change,
suggesting that as individuals progress through the stages of
change, the likelihood of engaging in exercise increases alongside
an increase in positive predictors of exercise (6). Other studies
have also concluded that the TTM is efficacious in improving
exercise behaviors and progressing individuals through the stages
of change (3,5,8).
OTHER CONSTRUCTS
The TTM also includes processes of change, decisional balance,
and self-efficacy within its conceptual framework (2). There are
10 processes of change, including both cognitive and behavioral
processes (2). Decisional balance is simply defined as the
weighing of the pros and cons to making a behavior change. Self-
efficacy is characterized by the confidence an individual has in his/
her ability to engage in a specific behavior (2). Table 2 provides a
general description of each of these constructs (see Table 2).
Implementing a TTM-based exercise prescription has been
shown to result in improvements in the other constructs that
were mentioned above (4,5). The use of the TTM appears to
improve an individual’s exercise-related behavioral strategies,
cognitive processes, decisional balance (i.e., weighing the pros
and cons of becoming more physically active), and self-efficacy
(4,5). Improvements in these components of the TTM may result
in increases in exercise adherence, changes in exercise-related
processes (i.e., cognitive and behavioral processes of change
related to exercise), and/or forward progression through each
stage of change (4,5).
APPLICATIONS OF THE TRANSTHEORETICAL MODEL
The TTM has been successfully applied in the modification
of exercise behaviors in a variety of populations and settings
(3,4,5,6,8). This is important as the CPT will potentially work
with a variety of individuals, each with unique characteristics
and backgrounds. While different behavior change theories and
models can be utilized when prescribing an exercise program
to a client, the TTM can provide an individualized and effective
framework from which to attempt to modify exercise behavior.
IDENTIFYING A CLIENT’S STAGE OF CHANGE
When using the TTM to develop a specific behavioral approach, it
is important to identify the client’s stage of change. This can be
accomplished during the initial consultation and interview process
(see Table 3). Many of the questions in Table 3 will be answered
without the CPT even having to ask them. For example, if the
PTQ 3.1 | NSCA.COM
CPT is meeting a new client for the first time, it can be assumed
that this client is in at least the contemplation or preparation
stage since they have made an attempt to seek help (i.e., hiring a
trainer to develop an individualized program) and is more likely
to see the benefits of making a change. If, when talking to the
client during the interview process, the CPT finds out that the
client has been consistently exercising for the past year at a level
that meets the recommended physical activity guidelines (i.e.,
150 min per week of moderate-intensity activity and two sessions
per week of resistance exercises), this individual would be in the
action stage (7). As can be seen from these examples, some of
the information that is needed to assess a client’s stage of change
accurately can simply be obtained through the normal interview
process. However, if all the information needed is not obtained, the
questions in Table 3 can be useful in identifying a client’s stage of
change (see Table 3).
After identifying a client’s stage of change, a specific and targeted
behavioral approach can be utilized when prescribing an exercise
program. Ideally, this approach will promote progression through
the stages of change so that the likelihood of the client’s long-
term exercise adherence is increased. Table 4 outlines the different
stages of change as they relate to exercise behavior, provides
examples of what client behaviors and attitudes might look like for
each stage, and lists specific behavioral approaches that can be
taken for each of the individual stages (see Table 4).
While it is beyond the scope of this article to provide a
comprehensive discussion of the other constructs within the
TTM (i.e., processes of change, decisional balance, and self-
efficacy), the importance of these constructs and their application
should not be overlooked by the CPT. These constructs may
be appropriately used based on the client’s stage of change.
More specifically, the processes of change targeted through
individualized exercise programming depends on the client’s
readiness for change (2). The cognitive processes of change are
often targeted for those in the precontemplation, contemplation,
and preparation stages of change (2). Individuals in these stages
often need encouragement regarding the perceived benefits
of exercise as well as an evaluation of their lifestyle with and
without regular exercise. This may be best accomplished through
an intervention targeting the cognitive processes of change. The
behavioral processes of change are often the focus for clients
that are in the action and maintenance stages, as these processes
focus on specific client rewards for achievement of goals, social
support for behavior maintenance, and altering the individual’s
environment so that it better promotes the intended behavior (2).
As individuals progress through the stages of change (e.g., from
precontemplation to maintenance), the pros of engaging in
exercise typically increase while the cons decrease (2). Also it is
often assumed that once an individual is successfully engaging
in the intended behavior (i.e., in the action stage) that the pros
of engaging in that behavior outweigh the cons (2). Self-efficacy
typically increases naturally as an individual progresses through
the stages (2). While continually targeting both decisional balance
and self-efficacy is important throughout all stages of change, an
increased focus on these constructs in earlier stages of change
(i.e., precontemplation, contemplation, and preparation) may be
necessary. Individuals in these early stages may have cons that
outweigh the pros and low exercise-related self-efficacy.
27
TRANSTHEORETICAL MODEL—APPLICATIONS TO PERSONAL TRAINING

CONCLUSION 5. Marshall, SJ, Biddle, SJ. The transtheoretical model of

The CPT, being in a prime position to encourage healthy behavior
change with clients, can benefit from utilizing the TTM in their
practice. The use of the TTM helps in providing an individualized
exercise prescription for each client while promoting long-term
success and exercise adherence. The first step for the CPT would
be to determine a client’s stage of change. Once the stage of
change is established, an individualized approach to exercise is
made through a targeted focus on the other constructs within the
TTM. While there are a variety of behavior change theories and
models to choose from when developing a targeted behavioral
approach for a client, the TTM provides a relatively simple and
easy to follow model from which to apply this approach.
REFERENCES
1. Coburn, J, and Malek, M. (Eds.) NSCA’s Essentials of Personal
Training. (2nd ed.) Champaign, IL: Human Kinetics; 107-123, 2012.
2. Glanz, K, Rimer, BK, and Viswanath, K. (Eds.). Health Behavior:
Theory, Research and Practice. San Francisco, CA: Jossey-Bass;
125-148, 2015.
3. Johnson, SS, Paiva, AL, Cummins, CO, Johnson, JL, Dyment,
SJ, Wright, JA, Prochaska, JO, Prochaska, JM, and Sherman, K.
Transtheoretical model-based multiple behavior intervention
for weight management: Effectiveness on a population basis.
Preventative Medicine 46: 238-246, 2008.
4. Ligouri, G, Dwyer, G, Fitts, T, and Lewis, B. (Eds.). ACSM’s
resources for the health fitness specialist. Philadelphia, PA:
Lippincott Williams & Wilkins; 235-239, 2014.
behavior change: A meta-analysis of applications to physical
activity and exercise. Annals of Behavioral Medicine 23(4): 229-
246, 2001.
6. Spencer, L, Adams, T, Malone, S, Roy, L, and Yost, E. Applying
the transtheoretical model to exercise: A systematic and
comprehensive review of the literature. Health Promotion Practice
7(4): 428-443, 2006.
7. U.S. Department of Health and Human Services. 2008 Physical
Activity Guidelines for Americans. Accessed October 13, 2015 from
http://health.gov/paguidelines/guidelines/.
8. Zhu, L, Ho, S, Sit, JWH, and He, H. The effects of a
transtheoretical model-based exercise stage-matched intervention
on exercise behavior in patients with coronary heart disease: A
randomized controlled trial. Patient Education and Counseling 95:
384-392, 2014.
ABOUT THE AUTHOR
Ryan Eckert is currently working on his Master’s degree in Exercise
and Wellness at Arizona State University. He holds a Bachelor’s
degree in Exercise and Wellness from Arizona State University
and is a Certified Strength and Conditioning Specialist® (CSCS®)as
well as a National Strength and Conditioning Association (NSCA)
Certified Personal Trainer® (NSCA-CPT®)through the NSCA. He
is working as a Graduate Research Assistant at Arizona State
University and as a personal trainer for Core Concepts Personal
Training in Phoenix, AZ. Eckert has over four years of experience
in personal training, working with athletes and the general
population.

TABLE 1. TRANSTHEORETICAL MODEL – STAGES OF CHANGE (4,6)

STAGE OF CHANGE STAGE CHARACTERIZATION
Individual(s) not intending to take action within the next 6 months; either uninterested in making behavior
Precontemplation
change or lacks knowledge of the benefits of making behavior change
Individual(s) intending to make behavior change within the next 6 months; may be becoming more aware
Contemplation
of the benefits of the specific change; the costs associated with the change may still outweigh the benefits
Individual(s) planning on making behavior change within the next 30 days (1 month); may
Preparation
have a plan for making the change, but might also be seeking help or assistance
Individual(s) have made the behavior change within the past 6 months; working
Action
towards making the behavior change to become a habit
Individual(s) have successfully maintained behavior
Maintenance
change for more than 6 months; working to avoid relapse

28 PTQ 3.1 | NSCA.COM

 NSCA.com

TABLE 2. ADDITIONAL TRANSTHEORETICAL MODEL CONSTRUCTS (2)

CONSTRUCT DESCRIPTION
Processes of Change (Cognitive)
Increasing awareness about the causes, consequences, and cures/treatments for a problem
Consciousness raising
behavior (e.g., sedentary lifestyle)
Dramatic relief Increasing positive or negative emotions in order to motivate action (e.g., personal testimonials)
Self-reevaluation Assessment of one’s image with and without the problem behavior (e.g., sedentary lifestyle)
Environmental Assessment of how the problem behavior affects one’s social environment (e.g., friends,
reevaluation family, peers, co-workers, etc.)
The belief that one can take action and make a positive change in their behavior; also includes
Self-liberation
the commitment to the belief that one can make a change
Processes of Change (Behavioral)
Helping relationships Social support that promotes healthy behavior change
Increase in healthy opportunities within one’s social environment (e.g., presence of a personal
Social liberation
trainer or presence of a workout partner)
Removing cues for unhealthy habits and adding prompts that promote healthy behavior change
Stimulus control
(e.g., leaving gym bag by the front door)
Substituting healthy behaviors for unhealthy, counterproductive behaviors (e.g., replacing 1
Counterconditioning
hour of television viewing time with walking)
Reinforcement Rewarding oneself for the attainment of small goals that promote healthy behavior
management change (e.g., incentives)
Decisional Balance
Pros Benefits of making change or taking action
Cons Negatives of making change or taking action
Self-Efficacy
Confidence Confidence that one can successfully engage in healthy behavior change
Temptation Temptation to return to old, unproductive habits or behaviors

TABLE 3. QUESTIONS TO DETERMINE A CLIENT’S STAGE OF CHANGE (3)

1. Are you currently physically active (i.e., accumulating 150 minutes or more of moderate-intensity activity or 75 minutes or more of
vigorous-intensity activity each week)? If yes, in action or maintenance stage and go to question 2; if no, go to question 3.

2. Have you been regularly physically active for at least the past 6 months? If yes, in maintenance stage and stop questions; if no, go
to question 3.

3. Are you doing any physical activity? If yes, in action stage and stop questions; if no, go to question 4.

4. Have you made any actions and/or concrete plans to increase your physical activity (e.g., gym membership, purchase exercise
equipment, hire a personal trainer)? If yes, in preparation stage and stop questions; if no, go to question 5.

5. Do you plan on becoming more physically active within the next 6 months? If yes, in contemplation stage; if no, in
precontemplation stage.

PTQ 3.1 | NSCA.COM 29

TRANSTHEORETICAL MODEL—APPLICATIONS TO PERSONAL TRAINING
TABLE 4. APPLYING THE TRANSTHEORETICAL MODEL TO EXERCISE ADHERENCE
STAGE OF CHANGE TYPICAL CLIENT BEHAVIORS/ATTITUDES
- inactive and not planning on increasing activity
- may be uninformed about benefits of
physical activity and the deleterious
effects of a sedentary lifestyle
Precontemplation - may have made several failed attempts in the past
and are discouraged to begin exercising again
- may have low exercise-related
self-esteem and/or self-confidence
- inactive, but intending on increasing
their activity within 6 months
- may be becoming more aware of
Contemplation
benefits of increasing physical activity
- costs of increasing activity may
still outweigh the benefits
- inactive, but intending on increasing physical
activity within the next month (30 days)
- may have a specific plan in place
Preparation - may be seeking resources for assistance
(i.e., hiring a personal trainer)
- may waiver in their exercise-related
self-esteem and/or self-confidence
- active, but for less than 6 months
- may be struggling to make physical activity a habit
- goal achievement may increase exercise-related
self-esteem and/or self-confidence
Action
- active, and have maintained a physically
active lifestyle for at least 6 months
- maintaining activity level may be easier
for client once in this stage
Maintenance
- exercise-related self-esteem and/or
self-confidence may increase with successful
maintenance of physical activity level
30 PTQ 3.1 | NSCA.COM
SPECIFIC BEHAVIORAL APPROACH
- educate on health benefits of
living physically active lifestyle
- educate on negative consequences
of sedentary lifestyle
- provide motivation to consider
increasing physical activity level
through positive encouragement
- discuss the pros and cons of
starting a regular exercise program
- continue to educate about health benefits
of physical activity and health
consequences of being sedentary
- begin discussing resources that are
available to help in increasing exercise levels
- provide individualized exercise prescription
that works with client’s lifestyle and goals
- discuss potential barriers to engaging
in regular physical activity
- promote increases in self-esteem and confidence
through support and positive encouragement
- monitor on a regular basis in
order to assess progress
- discuss barriers as they arise and
develop a plan to overcome them
- modify exercise prescription as needed to
accommodate changes in lifestyle and/or goals
- provide positive reinforcement by
celebrating achievement of goals
- educate on skills needed for long-term
maintenance of physical activity
- monitor on a less regular basis
in order to monitor progress
- develop plan to overcome
new barriers as they arise
- allow more autonomy and responsibility
for physical activity over time
 Elevate your hockey strength and
conditioning game. Join elite strength
coaches from hockey teams across
the U.S. and Canada at the 3rd annual
NSCA Training for Hockey Clinic,
June 10-11 in Colorado Springs. Learn
the essentials of training up close
and personal from leaders in hockey
strength and conditioning as they
come prepped to give you the tools to
apply research-based knowledge back
in the weight room.

Whether you’re training youth,

professionals or somewhere in
between, Training for Hockey is an
unmatched opportunity to learn the
tricks of the trade for preparing your
athletes to excel on the ice.

Register through May 23 to save!

Don’t miss out on power-packed sessions and elite speakers including:

Nelson Ayotte, St. Louis Blues | Energy System Program Design

Maria Mountain, Revolution Sport Conditioning | The Essential Eight for Goalie Health and Performance

Brijesh Patel, Quinnipiac University | Understanding and Implementing Special Strength Training Exercises

Don’t miss these cutting-edge topics in hockey training!

Register today at NSCA.com/hockey2016
Space is limited to the first 120 registrants.
800.815.6826 | NSCA.com/hockey2016

sponsored by
TOP WAYS TO DRIVE TRAFFIC TO A FITNESS
BUSINESS
JOSH LEVE
M
arketing, when dissected to its most basic element, is
nothing more than storytelling. When telling a story,
information is shared that the storyteller believes will be
entertaining, important, interesting, or relevant to the listener. For
fitness business owners, marketing is understanding the audience
and being able to craft stories that capture their attention.
WHAT IS MARKETING?
It is important to not confuse marketing with sales. A useful way
to think of the difference between marketing and sales is that
marketing makes the phone ring, whereas, sales is answering the
phone call. Regardless of the type of marketing effort chosen, the
following recommendations should be carefully considered:
• Keep it precise and simple: consumers want you to get
directly to the point.
• Make it pop: consumers’ mailboxes, both physical and
virtual, are constantly inundated with promotions. The
goal is to grab their attention immediately, before the
message gets moved to the trash.
• Make it personal: nothing shows you care more than
making it personal. Hand written notes and using the
person’s name in a message can go a long way.
• Extend an offer and have a deadline: for example, if the
offer is a complimentary 30-min training session, indicate
how long the offer is good for before it expires. There is
nothing like a deadline to get people to respond, usually
on the last day of the offer.
One aspect of marketing is to give information to an audience
who otherwise has not heard of the business before, but another
part of a successful marketing campaign is to keep the name and
reputation in high esteem to those who are already members or
consumers. The following are some recommendations of ways to
get current clients/members more engaged:
• Throw a party: there are many types of events that can be
put together that, when done well, can drive the necessary
traffic to see a return on investment. Parties can be
32 PTQ 3.1 | NSCA.COM
thrown for almost any occasion, including welcome to the
neighborhood parties, baby-showers, anniversary parties,
and holiday parties. It is a good idea to always have an
offer at these events, especially one that is appropriate
for the event and that can tie in with the theme. The offer
should also make sense in that moment and in the bigger
picture. For instance, the offer could be an upcoming
bootcamp and one person could win a free six-week long
bootcamp.
• Raffle prizes: raffle prizes can be used as a way to drive
sales. For example, giving away a 30-day upgrade to
an “unlimited sessions” option or a free nutritional
consultation can expose non-using clients to new services.
It may also be nice to make sure that everyone wins some
sort of prize.
• Simple and sincere gestures are sometimes the best:
practice random acts of kindness such as bringing cold
water into a cycling class, providing fresh towels to a
yoga session, passing out smoothie samples after training
sessions, or putting refreshments and snacks in the lobby.
Quiet expressions of gratitude are noticed, appreciated,
and can go a long way, especially to potential clients.
• Do not underestimate the social aspect of fitness:
celebrate client successes, culminate challenges, and
acknowledge milestones. For example, if a client reaches a
certain goal or milestone, then they receive a free t-shirt.
People are more apt to provide positive feedback or
referrals when they are in a heightened emotional state.
For instance, right after becoming a client or reaching a
specific goal may be an ideal time to ask them to refer
their friends.
• Have a wall of fame: most people love to see themselves
or others having fun. Using event photographs can be
a great way to reinforce the positive experiences and
encourage more participation. Ideally, the pictures can
be posted in high-traffic areas as well as on social media
websites. They can create more interaction as clients are
 reminded of the fun they had, or might be inspired by
seeing others having fun. Plus, these events can be alluded
to in order to show prospective clients the care and
support they would also receive as clients. Additionally,
a wall of fame could be used to highlight special feats or
goals achieved by clients.
GET INVOLVED IN THE COMMUNITY
Known in some circles as public relations, marketing a business is
about developing and managing the brand image. Some examples
of how to get involved in the community and therefore enhance
the image and reputation of the brand include:
• Sponsor community activities: a fitness business can get
involved with community activities by serving as a host or
sponsor for local events. Some examples might include a
youth football league or local fitness and health activities
for young adults.
• Create a press kit and send out press releases: every
fitness business should create an attractive and compelling
press kit. The press kit should include a background
statement about the fitness business, a fact sheet, and
a biography of the owner or staff. This press kit could
be forwarded to the local media, maybe even with a
human-interest story as well. Another way to be involved
in the community is to invite the press to special events
conducted at the fitness facility and get the media actively
involved in promoting the occasion.  pursuing cross-promotional relationships. These partnerships
• Become the health and fitness expert in your community:
attend local chamber of commerce events and get to know
local business owners. If services can be complimentary
to another business, then offer to do a presentation for
their customers or make a partnership. Attending or
hosting open houses to network with clients or local
business owners may lead to new opportunities presenting
themselves. Finding ways to leverage expertise to new
audiences can enhance the company’s and personal
trainer’s reputation as the fitness expert in the community.  to gain their trust. The goal is to prove to them that if they refer
• Team up to volunteer: the fitness industry is an ideal fit
with giving back. Those that lead healthy, active lifestyles
often desire to share their good fortune by contributing
to the community in some way. One way to do this is to
align the fitness business with local charities and host or
participate in fundraisers throughout the year.
The common saying “failure to plan is planning to fail,” may seem
cliché, but it is true. In order to reap the benefits of hard work, it
is necessary to ensure that the company is set up for success. The
following are some tips on how to set up a successful business in
the personal training field:
• Develop a budget and determine your spending: as a
rule, allocating 6 – 7% of the gross revenue to marketing
(10% for a big initiative) can be a great way to ensure that
marketing goals can be accomplished.
• Identify the target market: figure out who the target
audience is and build the marketing strategy around that.
Also it is important to keep in mind that marketing efforts
PTQ 3.1 | NSCA.COM
are best utilized at places people spend a lot of time. For
instance, in book stores, coffee houses, schools, etc.
• Determine the campaigns and offers: the offer is very
important, it should give people a way to try out the
services in a way that they feel comfortable and in control.
For example, offering a trial membership or discounted
sessions can create a low-risk options that allow
prospective clients to try the services without making
a long-term commitment. Keep in mind, giving away
services for free is not always the best method. Rather,
a reasonable price should be selected based on current
pricing and what the offer contains.
• Leverage social media: make sure to choose the right
social media avenues. Important questions to ask before
deciding what social media website to use include what
kind of content is being used/produced? Do potential
members/clients spend time on the social media network?
Does the network fit the targeted demographic?
• Do not try to tackle all social channels at once: come
up with a plan that focuses on one or two social media
networks. It is better to be an expert on one platform
rather than mediocre on several platforms.
DEVELOP STRATEGIC PARTNERSHIPS
One of the best ways to drive traffic to a fitness business involves
involve establishing a synergistic relationship between the fitness
business and another business that benefit both parties. One
way to do this is by leveraging services offered with neighboring
physical therapists, massage therapists, and chiropractors, for
example. Oftentimes these businesses are looking for qualified
fitness businesses and professionals to refer their patients to
when necessary. One method for starting such a relationship is
by visiting them and providing them with professional looking
handouts about the fitness business and staff. Providing them with
a highly discounted or even complimentary session is a great way
their clients to the fitness business, then they will be taken care of
in a professional and effective manner. After gaining their trust, it
is important to leave them with plenty of contact information (e.g.,
business cards, fliers, etc.). It is also prudent to keep the lines of
communication open to grow the relationship and to remind them
to continue referring clients.
LEVERAGE WORD-OF-MOUTH AND
REFERRAL MARKETING
Perhaps the greatest marketing tool of all is word-of-mouth.
Nothing has a greater impact on an individual’s interest in a
product or intent to purchase than a recommendation made
by a trusted associate or friend. One way to leverage this is by
providing incentives to existing clients, members, and even to the
individual who was referred. For example, a client could earn a
free t-shirt upon providing the names of three friends who would
be interested in the services.
33
TOP WAYS TO DRIVE TRAFFIC TO A FITNESS BUSINESS

CONCLUSION
It is important to remember that setting up and maintaining
a successful fitness business is a long process. Marketing, like
ABOUT THE AUTHOR
As Co-Founder and President of the Association of Fitness
branding, does not have a starting point and an ending point.
Studios (AFS), Josh Leve is responsible for strategic business
Rather, marketing is an ongoing process of seeking to understand
operations of AFS. Leve has over 10 years of sales, consulting,
the audience and focusing on creating and sending messages that
advertising, marketing, operations, and retail fitness experience.
encourage people to try the business’s services.
Prior to AFS, Leve successfully turned around the financial
performance of three different big box facilities in Chicago, IL
while providing consultative services for smaller fitness studios.
Prior to his health club experience, Leve worked with Corbett
Accel—the largest healthcare communications/advertising
company in the United States—where he launched products for
major pharmaceutical companies such as Merck, Bristol Myers
Squibb, and Sanofi-Aventis. Leve holds a Bachelor of Arts degree in
Journalism from the University of Kansas. 

34 PTQ 3.1 | NSCA.COM

FEATURE ARTICLE
CONSIDERATIONS FOR UTILIZING MANUAL
RESISTANCE TRAINING
BOJAN MAKIVIC, MSC
D
ifferent terms exist to define a training method where
a partner provides manual resistance during strength
training. Some of the most common terms for this
are assisted training, partner-resistance training, and manual
resistance training (MRT). In the last decade, MRT methods have
become more commonly accepted in the research literature as
well as among strength and conditioning professionals. Although
some sort of equipment can be helpful during MRT (e.g., sticks,
towels, benches, bars, etc.), this training modality is generally
considered as training without equipment, contrary to traditional
resistance trainings that involve equipment such as free weights,
exercise machines, resistance bands, and tubes (3). Some of the
most common stated advantages of utilizing MRT methods are low
cost, minimal equipment, and small space requirements (4).
APPLICATION
Even though MRT is mostly used for single-joint movements,
there are also several multi-joint exercises in which the MRT
modality can be employed (e.g., push-ups, lat pulldowns, row
pulls, military presses, bench presses, etc.). All three types of
contraction (i.e., concentric, eccentric, and isometric) can be
accentuated separately or at the same time during MRT training,
whereas this may not always be possible with other strength
training modalities. This is particularly true if maximal force is a
main emphasis during each phase of the movement. For example,
isometric contraction can be performed at any joint angle during
different exercises (e.g., abduction, adduction, elbow flexion/
extension, shoulder/pectoralis flies, etc.). The same is true if
performing only the concentric or eccentric components of a
36 PTQ 3.1 | NSCA.COM
movement for any exercise. Jerky movement performance and
range of motion (ROM) can be easily monitored and corrected
during the performance.
PHYSIOLOGICAL ASPECTS OF MRT
It is well established that free weight resistance training cannot
provide equal muscular torque and force throughout the full ROM
due to changes in the moment arm of the external resistance
during the movement (2). Compared to free weights or exercise
machines, where the external resistance is constant (not including
machines with accommodating resistance technology), during
MRT the external resistance can be variable and adjusted at
each joint position. This allows for maximal effort of the muscle
through the entire ROM. For example, a person can perform
bench press with 80 kg (176 lb) for 10 repetitions. The first
few repetitions they perform will be relatively easy but as the
person approaches the 10th repetition, they are likely to become
more fatigued, making each repetition harder than the last.
The size principle of muscle fiber recruitment states that the
last repetitions of a set are important due to motor unit (MU)
exhaustion and activation of additional MUs (7). As fatigue of
the muscle fibers advances, only the last repetitions can be
considered to be performed with maximal muscular effort (7).
Performing MRT with controlled, low speed movement can
provoke maximum effort of the muscle throughout the entire
ROM for each single repetition (5). As muscle fatigue is increased,
the partner can adjust the external resistance in order to preserve
maximal contraction in each repetition and consequently maximal
exertion in each set. If performed properly, the result is maximal
muscular effort during the entire set of the exercise. Studies
have demonstrated that training with maximal muscle effort
implemented throughout full ROM, such as during MRT, may
achieve similar or even greater strength improvement compared
to other resistance training modalities (2,3).
The most frequently used equipment in resistance training
demonstrate different mechanical properties such as (7):
• Elasticity: The level of resistance force is defined by the
extent of the elastic band displacement. The maximal
external resistance and, in most cases, the maximum
muscle tension are elicited at the end of the movement.
• Resistance: Depends on the weight and inertia of the
moving object (e.g., barbell, dumbbell, exercise machines,
etc.). The weight of the object is constant, but as the
acceleration of the moving object increases (i.e., higher
speed of movement), the amount of required muscular
force is less (force-velocity relationship) and can be
compensated with higher levels of MU activation to
continue accelerating the load (compensatory acceleration
training) (6).
• Compound Resistance: An example of this type of
exercise is combining resistance bands with barbells or
dumbbells. These exercises require three components
being overcome at the same time: object weight
(constant), inertia (equivalent to acceleration), and elastic
force, which increases with the displacement of the
moving object (7).
All the above mentioned mechanical properties of external
resistance can also be accomplished using MRT. Controlling the
performance of movement and the equal distribution of resistance
or load can be achieved throughout full ROM with MRT. Muscles
do not recognize the form of resistance or load, but are stimulated
by distribution of load (they can recognize the positions where the
external torque is greater or lesser).
ADVANTAGES AND DISADVANTAGES OF MRT
MRT, like all other resistance training methods, has its own
strengths and weaknesses. Therefore, it can be not considered
as superior or inferior to other training methods in terms of
performance or body composition improvement. Table 1 provides
several advantages and disadvantages of MRT.
PRACTICAL APPROACH TO MRT
Utilizing correct technique and avoiding jerky movements are
the fundamental prerequisites which each lifter has to be familiar
with in order to start proper MRT training. While performing
MRT, the focus should be on exercise intensity, full ROM, exercise
progression (e.g., simple to complex exercises, multi-joint to
single-joint, and large muscle groups to small muscle group
exercises), and movement speed.
While performing MRT, the lifter should maintain continuous
muscle tension by not allowing relaxation during the set. Different
tempos can be used to emphasize the concentric, isometric,
or eccentric phase of contraction. It has been suggested that
concentric components should be performed at a moderate tempo
while eccentric should be performed slowly. For example, it is
PTQ 3.1 | NSCA.COM
suggested that eccentric components be performed approximately
twice as slow as concentric components (1). Persistent feedback
and good communication between the partner and lifter is
essential in order to achieve optimal results of MRT (1).
The methodology of MRT can mimic the methodology of general
resistance training. The first 3 – 4 repetitions can be performed at
a submaximal level and serve as a warm-up to prepare the muscle
for maximal effort (5). Table 2 provides some basic guidelines for
implementing MRT into a strength and conditioning program.
One issue that may present itself is if the partner is not able
to apply the necessary force. If this occurs, the following
recommendations may be useful:
1. Additional resistance (e.g., barbell, dumbbells, resistance
bands, etc.) can be given to the lifter to lessen the load for
the partner.
2. Focus more on prolonged concentric phase of contraction
(4 – 6 s).
3. Utilization of unilateral exercises (e.g., single-arm, single-
leg, or one side of the body).
4. Emphasizing the weakest points of muscular torque. For
example, using more resistance or even static/prolonged
contraction in the weakest area of ROM.
CONCLUSION
MRT can be an effective, low-cost, and easy to perform training
modality. It can be performed in many situations regardless of
space, equipment availability, and performance level. Moreover,
during MRT, the attention should be directed toward optimal
technique performance as well as on proper communication
between the partner and lifter.
REFERENCES
1. Adamovich, DR, and Seidman, SR. Special resistance
exercises: Strength training using MARES (manual accommodating
resistance exercises). National Strength and Conditioning
Association Journal 9(3): 57-59, 1987.
2. Dorgo, S, King, GA, and Rice, CA. The effects of manual
resistance training on improving muscular strength and endurance.
The Journal of Strength and Conditioning Research 23(1): 293-303,
2009.
3. Dorgo, S, King, GA, Candelaria, N, Bader, JO, Brickey, GD, and
Adams, CE. The effects of manual resistance training on fitness in
adolescents. The Journal of Strength and Conditioning Research
23(8): 2287-2294, 2009.
4. Dorgo, S. The effectiveness of manual resistance versus
weight training on fitness test achievement scores in adolescents.
The Journal of Strength and Conditioning Research 24: 1, 2010.
5. Hedrick, A. Manual resistance training for football athletes at
the U.S. Air Force Academy. Strength and Conditioning Journal
21(1): 6, 1999.
6. Verkhoshansky, Y, and Siff, MC. Supertraining (6th ed.)
Verkhoshansky; 2009.
7. Zatsiorsky, VM, and Kraemer, WJ. Science and Practice of
Strength Training. Champaign, IL: Human Kinetics; 2006.
37
CONSIDERATIONS FOR UTILIZING MANUAL RESISTANCE TRAINING

ABOUT THE AUTHOR

Bojan Makivic completed his Bachelor of Science and Master of
Science degrees in Sport Science at the University of Belgrade,
Serbia and University of Vienna, Austria, respectively. Currently,
he is pursuing a second Master of Science degree in Digital Health
Care at the University of Applied Science in St. Pölten, Austria.
Makivic works as a sport therapist at a rehabilitation clinic in
Austria. His job responsibilities include preparing and conducting
strength and endurance trainings as well as performing gait
analysis for patients with different health issues. Previously, Makivic
was a co-owner and co-founder of PROFEX Institute for Health
and Sport. He has also instructed courses covering biomechanics,
exercise physiology, and training methodology at different
educational institutes in Austria and abroad. Additionally, Makivic
has published peer-reviewed research as well as articles for sport
and fitness magazines. Currently he is participating in a research
group that is conducting research on post-activation potentiation.

FIGURE 1. HIP ABDUCTIONS FIGURE 2. HIP ABDUCTIONS

38 PTQ 3.1 | NSCA.COM

 NSCA.com

FIGURE 3. LATERAL HIP ABDUCTIONS FIGURE 4. LATERAL HIP ABDUCTIONS

FIGURE 5. SIT-UPS FIGURE 6. SIT-UPS

PTQ 3.1 | NSCA.COM 39

CONSIDERATIONS FOR UTILIZING MANUAL RESISTANCE TRAINING

FIGURE 7. ECCENTRIC SIT-UPS FIGURE 8. ECCENTRIC SIT-UPS

FIGURE 9. LATERAL SIT-UPS FIGURE 10. LATERAL SIT-UPS

40 PTQ 3.1 | NSCA.COM

 NSCA.com

FIGURE 11. HIP ADDUCTIONS FIGURE 12. HIP ADDUCTIONS

FIGURE 13. BICEPS CURLS FIGURE 14. BICEPS CURLS

PTQ 3.1 | NSCA.COM 41

CONSIDERATIONS FOR UTILIZING MANUAL RESISTANCE TRAINING

FIGURE 15. BICEPS CURLS WITH BAR FIGURE 16. BICEPS CURLS WITH BAR

FIGURE 17. SITTING SIDE BICEPS CURLS FIGURE 18. SITTING SIDE BICEPS CURLS

42 PTQ 3.1 | NSCA.COM

 NSCA.com

FIGURE 19. SITTING LEG CURLS FIGURE 20. SITTING LEG CURLS

FIGURE 21. LYING LEG CURLS FIGURE 22. LYING LEG CURLS

PTQ 3.1 | NSCA.COM 43

CONSIDERATIONS FOR UTILIZING MANUAL RESISTANCE TRAINING

FIGURE 23. HIP THRUSTS FIGURE 24. HIP THRUSTS

FIGURE 25. LAT PULLDOWNS FIGURE 26. LAT PULLDOWNS

44 PTQ 3.1 | NSCA.COM

 NSCA.com

FIGURE 27. PECTORAL FLIES FIGURE 28. PECTORAL FLIES

FIGURE 29. SITTING LEG EXTENSIONS FIGURE 30. SITTING LEG EXTENSIONS

PTQ 3.1 | NSCA.COM 45

CONSIDERATIONS FOR UTILIZING MANUAL RESISTANCE TRAINING

FIGURE 31. LYING LEG EXTENSIONS FIGURE 32. LYING LEG EXTENSIONS

FIGURE 33. LATERAL LEG EXTENSIONS FIGURE 34. LATERAL LEG EXTENSIONS

46 PTQ 3.1 | NSCA.COM

 NSCA.com

FIGURE 35. LATERAL SHOULDER FLIES FIGURE 36. LATERAL SHOULDER FLIES

FIGURE 37. TRICEPS EXTENSIONS FIGURE 38. TRICEPS EXTENSIONS

PTQ 3.1 | NSCA.COM 47

CONSIDERATIONS FOR UTILIZING MANUAL RESISTANCE TRAINING

FIGURE 39. SITTING SIDE TRICEPS EXTENSIONS FIGURE 40. SITTING SIDE TRICEPS EXTENSIONS

48 PTQ 3.1 | NSCA.COM

 NSCA.com

TABLE 1. ADVANTAGES AND DISADVANTAGES OF MRT

ADVANTAGES
No or minimal equipment required
Large number of individuals can exercise at the same time
Eccentric contraction can be performed (and accentuated) in
nearly every single joint
Closely control movement speed and form
Maximal or nearly maximal muscular effort during each repetition
Accommodating and variable resistance
It can be used in all age groups and at all performance levels
Distribution of load can be equal throughout full ROM
Pure concentric or pure eccentric contractions can be performed
DISADVANTAGES
Two persons are needed to perform MRT
Inability to quantify components of resistance training
(e.g., intensity and training volume)
The improvement in strength is difficult to evaluate
Novice spotters need more time to master
proper spotting technique
Not all multi-joint exercises can be performed optimally
It can be exhausting for spotter if they lack adequate strength
Some individuals are not comfortable with the
close contact involved in MRT

TABLE 2. BASIC GUIDELINES FOR OPTIMAL MRT

The strength and conditioning program should include 1 – 3 MRT training sessions per week.
There should be 6 – 8 MRT exercises per training session.
2 – 4 muscles groups should be trained per session. Targeting two major muscle groups
(e.g., gluteals, quadriceps, hamstrings, latissimus dorsi, etc.) combined with two smaller
muscle groups (e.g., forearm, calves, biceps, triceps, etc.) is ideal. The core area should
be trained during every training session.
Using a split routine (e.g., agonist/antagonist muscle groups) is recommended.
3 – 5 sets should be performed per exercise: three sets for smaller muscle groups
and up to five sets for bigger muscle groups.
8 – 12 repetitions should be performed per set. For exercises including only eccentric
components, it is recommended to perform 6 – 8 repetitions in order to avoid delayed
onset muscle soreness syndrome.
Static contractions should be held for 4 – 6 s during each repetition.

PTQ 3.1 | NSCA.COM 49

1885 BOB JOHNSON DRIVE | COLORADO SPRINGS, CO 80906
PH: 719 632-6722 | TF: 800 815-6826 | FX: 719 632-6367
NSCA.com