Team Boss

APT Manual
2021

harry sandhu
10/8/2021
Foreword
Dear student,
Whether you are starting your
journey in the Fitness Industry, or
here simply to upgrade your
knowledge, I would like to start by
thanking you for putting your trust in
us.
When I started Team Boss Fitness
Academy, I only had one goal; To
make it one of the premier Fitness
Education Providers in the World.
This Manual is your Introduction to
our Team Boss’ Advanced
Physique Transformation Certified
Personal Trainer Certification.
This Manual is “Evolutionary” in its
nature, meaning this a working draft
that we are sharing with you, and is
NOT FINAL in few of its key aspects.
However, it’s still 99% complete,
only needing an odd correction/edit.
Over the coming months, we will be
endeavouring to iron out any
shortcomings that there might be.
Along with the above, we will also be
looking to add more new content to
the current Manual, too.
For now, please keep the below
things in mind:
● This is NOT THE FINAL
COPY OF THE MANUAL,
BUT A WORKING DRAFT.
● This Manual does NOT
CONTAIN ANY OF THE KEY
TOPICS THAT ARE
COVERED IN THE LIVE
LECTURES, WHICH IS
WHAT MAKES THE Team
Boss’ Advanced Physique
Transformation Certified
Personal Trainer
Certification, truly unique
and 1 of the absolute BEST
OF ITS KIND, IN THE
WORLD.
● This Manual is to serve as
FOUNDATION to help you
clear some of the Basic to
Intermediate Level Concepts.
All your complex questions or
queries will always be
addressed in the Live
Lectures.
On that note, I hope you find this
manual to be helpful in clearing most
of your foundational concepts.
All the best in your future
endeavours.
Best wishes,
Harry Sandhu | Director |
Team Boss Fitness Academy
Index

1. ANATOMY & PHYSIOLOGY

1.1 Body Systems 8
1.1.1 Nervous System 8
1.1.2 Endocrine System 19
1.1.3 Digestive System 21
1.1.4 Cardiovascular System 26
1.1.5 Lymphatic System 35
1.1.6 Respiratory System 41
1.1.7 Skeletal System 46
1.1.7 Muscular & Connective Tissue System 56
1.2 Biomechanics 77
1.2.1 Exercise Performance Analysis Techniques 77
1.2.2 Muscular Force 78
1.2.3 Planes of Motion 78
1.2.4 Motion 78
1.2.5 Axis of Rotation 80
1.2.6 Levers 81
1.2.7 Muscle Movement Terminology 82
1.2.8 Muscle Location Terminology 83
1.3 Hormones 84
1.3.1 Insulin 84
1.3.2 Glucagon 85
1.3.3 Ghrelin 86
1.3.4 Leptin 88
1.3.5 Thyroid 90
1.3.6 Testosterone 90
1.3.7. Cortisol 93
1.3.8. Estrogen 96

2. ENERGY SYSTEMS &

METABOLISM
2.1 Metabolism 98
2.2 Energy Systems 105
2.2.1 Phosphagen System 107
2.2.2 Glycolytic System 107
2.2.3 Oxidative System 108
3. NUTRITION & SUPPLEMENTS
3.1 Nutritional Guidelines 113
3.2 Macronutrients 119
3.3 Role of Insulin 135
3.3 Importance of Leucine 142
3.4 Micronutrients 144
3.4.1 Vitamins 144
3.4.2 Minerals 150
3.5 Supplements 164

4. CLIENT PROFILING &

HEALTH SCREENING
4.1 Client Profiling Overview 176
4.2 Key Information to Gather 176
4.3 When to Profile 176
4.4 5 Pillars of Client Profiling and
Screening 177
4.5 Client Profiling & Health Screening Best
practices 180
4.5.1 PAR-Q 180
4.5.2 Needs Analysis 182
4.5.3 Movement Assessment &
Observation 185
4.5.4 Comparative Analysis 186

5. FITNESS & PHYSIQUE

TRANSFORMATION TESTING
PROTOCOLS 187
6. RISK MANAGEMENT, INJURY
PREVENTION & WORKPLACE
HEALTH AND SAFETY
6.1 What is a Risk 214
6.2 Risk Management and Preventative
Strategies 214

6.3 How to Assess, Identify and Minimise

Risks 216
6.4 Maintenance of Sports Equipment 219
6.5 Referrals 232
6.6 Occupational Health and Safety
Procedures 236
6.7 First Aid 241

7. EXERCISE PROGRAMMING &

PRINCIPLES 248

8. TRAINING
8.1 Types of equipment and their use 255
8.2 Types of training 258
8.3 Designing Training Programs 286
8.4 Exercise programs for long-term fitness and
competition goals 291
8.5 Personal training for functional health and movement
300
8.6 Exercise programs for Body Composition 333
8.7 Instructing Group Training Sessions 343
8.8 Bodybuilding 348
8.9 Power lifting 353

9. TRAINING SPECIAL POPULATIONS

361

10. REQUIRED READING

10.1 Muscle and Fat Structural Makeup 386
10.2 Macros 395
10.3 Digestion 415
10.4 Anti-nutrients 453
10.5 Diet Methods 474
10.6 Periodization 526
 Section 1:
Anatomy & Physiology

6
Why you need to understand anatomy
and physiology for physique
transformation:
To be able to help individuals undergo
physique transformation, and to educate
them about fitness and overall health, we
need to have a strong understanding of the
structure and functioning of human body.
Human movement is accomplished through
the functional integration of three systems:

→ Nervous System

→ Skeletal System

→ Muscular System

These three systems are also referred as

the ‘kinetic chain’. It is important to
understand that these systems must work
together to accomplish effective movement
quality and intensity for training for physique
transformation.

Understanding of fundamentals of anatomy

and physiology assists you in developing
training programs tailored towards the
specific needs of your clients.

Any trainer can prescribe exercises, but

you’re not going to be just any trainer.

Team Boss Physique Transformation

Specialists know the underlying whys
behind their clients training, so they can
create bodies that look at their peak.
Knowledge of anatomy and physiology will
give you the whys of superior physique
transformation results.

7

1.1 Body Systems
1.1.1 Nervous System
Basics of Brain: The Control
Centre of Physique
Transformation
If you thought, knowing your brain was
boring and doesn’t relate to your clients
busting out reps in the gym - think
again.
Although you don’t need to have a
degree like that of a brain surgeon, you
do need to know the basics of the way
brain works with rest of body.
Brain plays major role in your client's
motivation, movement quality, and risk
of injury. It is important that you know
basics of brain to ensure your training
supports your client's brain function.
Let’s cover the basics ...
2
1 5) Brain stem: Consider it as the
3 such as heartbeat and breathing.
6 abstract thought. It also plays a role
4 in the recognition of objects and
5
Key Areas of The Brain and Their
Roles:
There are six key areas of brain:
1) Frontal Lobe: It controls voluntary,
conscious movements of our motor
cortex, particularly those associated
with the control of our posture as
found by Loffe, Ustinova,
Chernikova, Kulikov, (2005).
2) Parietal Lobe: It is responsible for
assisting with interpretation of touch,
understanding of objects, shapes
and space. It helps us navigate
without dashing/hitting into things.
3) Occipital Lobe: It is associated with
our visual perception.
4) Cerebellum: It is vital for voluntary
motor unit control and balance
(coordination of movements without
getting injured) and muscle
recruitment.
connector of the brain to the body.
Brain can’t send and receive
messages without it. It also plays a
role in involuntary physical functions
6) Temporal Lobe: It is associated
with memory, judgement, and
visual memory.
8
How to Combine Brain Training with Nervous System: The Messenger of
Physique Transformation? Physique Transformation

Following are some exercise selection Transport yourself back to medieval

principles to support brain function during
physical training. At the end of the day, better
brain function leads to better movement, which
leads to better client results.
a) Use Balance for Better Muscular
Recruitment: Single sided / unilateral
exercises are a great tool to encourage
stabiliser development. This supports
symmetrical muscle development and
decreases the possibility of injury.
a) Use Touch to Give Exercise Feedback
and Cueing: With your client’s permission,
using touch to bring attention to certain
areas of their body can help enhance their
brain-body connection in these areas. This
can improve muscle recruitment, exercise
performance, and reduce injuries.
times and imagine you’re sending a
message to a friend, and the only way
to get it there is via a carrier pigeon.
Your nervous system is a bit like the
carrier pigeon; without it, it’s pretty
challenging to send a message from
point to point.
Our nervous system consists of
specialized cells called ‘neurons’ which
transmit and coordinate messages
throughout the body.
Our Nervous system can be divided
into two main areas:
• Central Nervous System (CNS)
which includes our brain and Spinal
Cord.
• Peripheral Nervous System (PNS)
which is composed of only neurons
outside the CNS. PNS connects our
CNS to the rest of our body.

a) Behavioural Feedback: You don’t need to

be a cheerleader, but giving your client
positive feedback when they do something
useful to support their results can assist with
their motivation to repeat the action.
Alternatively consider communicating with
your client when they behave in ways that
don’t align with their goal. This can help to
discourage repetition of undesired
behaviour. All this can help you to train your
clients’ frontal lobe, which helps them make
better choices towards their results.

9
How to Combine Brain Training with
Physique Transformation. Let’s take
a deeper look...
The Peripheral and Central Nervous
Systems (PNS & CNS)
The PNS has two functional
sub-divisions which are sensory or
afferent(which means to carry towards)
and motor efferent division(which
means to carry away).
Main role of PNS is to link CNS to limbs
and organs. Main role of CNS is to
connect spinal cord and brain.
PNS and CNS work together to form
two-way communication loop from
limbs, to organs, to spinal cord, to brain.
Sensory division consists of nerve fibers
which convey impulses from sensory
receptors which can be located
throughout your body, enabling them to
keep our CNS informed about all events
happening within and outside our
bodies.
Types of Sensory receptors:
• Chemo-receptors relaying
messages from chemical interactions
like smell and taste
• Mechano-receptors respond to
mechanical forces like touch, stretch
and pressure
• Nociceptors which respond to
feelings of pain
• Photoreceptors which respond to
light and our vision stimuli
These sensory fibres convey messages
(e.g., information about temperature)
from our skin, and from our skeletal
muscles and joints. These areas all
called somatic afferent fibres(Marieb &
Hoehn, p388).
Term ‘somatic’ means relating to the
body(‘Soma’, a word of Greek origin,
means ‘body’). The better your client
can feel their body and muscles (i.e.,
the better the connection between the
brain and the body), the better they can
build them.
In basic terms, PNS works to support
your client when they’re exercising to
send information to and from the CNS.
It’s like a sensory feedback device. If
PNS senses (through working with
CNS) that something may cause injury;
it can employ a reflexive muscular
response to stabilise and protect
vulnerable area.
10
Here is a visual example of
Central Nervous System
peripheral and central nervous
systems: Brain

Spinal cord

Peripheral Nervous System

Ganglion

Nerve

Image: PNS and

Don’t Over Stimulate PNS & CNS CNS

It’s important to know the right intensity

to apply to your client’s PNS and CNS
during training so that they perform
quality movements. Too much intensity
can overload PNS, CNS and
Autonomous Nervous System(ANS)
and lead to contraction and habitual
build-up of muscular tension in the
body, which over time can decrease
blood flow and yield adversely body
transformation results. We will discuss
the role of the ANS in next section.
So keeping all this in mind, you might
agree, understanding the nervous
system in context to Physique
Transformation is extremely useful to
deliver superior client results.
11
Autonomic Nervous System(ANS) What role does ANS play in Physical
Exercise?
ANS operates autonomously and it is
1. If we begin exercising at a high
designed to work with your PNS and
intensity, our sensory division(PNS)
CNS. Let’s dive a bit deeper:
takes in information from our
environment to inform our CNS of
1) Efferent/motor division(PNS)
what we are doing, so it can then
transmits impulses from our CNS to
relay messages back to our motor
muscles and glands(also known as
division(ANS) to respond to that
‘effector organs’).
environment or demand.
2) These impulses activate muscles to
2. As we exercise,
contract. This reaction is part of our
• our visceral afferent fibres
ANS, also known as our voluntary
communicate with our heart to
system because we can consciously
pump more blood to transport
control these impulses and
more oxygen
reactions.
• our efferent fibres prepare our
3) Other division of our motor division
skeletal muscles and joints
is impulses which impact our glands.
• and the information from our skin
This is part of our ANS that is also
can be then communicated back
known as our Involuntary nervous
through our motor fibres, so our
system.
glands can secrete sweat to cool
us down and our muscles can
react faster to these demands.
We have no conscious control of our
Involuntary nervous system. It regulates
our smooth muscles, cardiac muscles,
and glands which continue to function
till we die.

12
Here is a visual overview

Sympathetic Parasympathetic
Nervous system

Dilates
Contracts
pupil

Accelerates Slows
heartbeat heartbeat

inhibits Stimulates
digestive digestive
activity activity

Stimuates
glucose
release

Stimulates
secretion of
epinephrine and
norepinephrine

Image : Sympathetic Vs Parasympathetic

Our Sympathetic division reacts to

increase the activity of our body during
physical activity. The Parasympathetic
division serves our body during rest,
decreasing level of force and physical
activity, and allowing body to recover
and return to a balanced state.
A simple way to remember these two
states of the ANS is:

Parasympathetic = Rest and Digest

Sympathetic = Fight or Flight

13
 When designing the exercise
programs, it’s important to give
appropriate time for each of these parts
of the nervous system to recover, so the
body reaches homeostasis.
For example, if you ask your client to
train too intensely (sympathetic
exercise), without enough recovery
(para-sympathetic exercise), it’s likely
that he can overtrain and experience
fatigue, or injury.
What is Homeostasis?
This is the happy balance or steady
state of the human body, referring to “a
relatively constant internal environment
during unstressed conditions resulting
from many compensating regulatory
responses.” (Powers & Howley, p14).
Homeostasis and Thermoregulation
of the Body During Exercise
• In all that we do, whether exerting
energy, resting, walking from your living
room to the car (into the outside
environment), our bodies must adapt to
find equilibrium.
• The optimum core temperature our
bodies is about 37.6 degrees Celsius.
Any demand which moves this
temperature, higher or lower, is a kind
of stressor. The body operates for
survival and is always working to
achieve homeostasis or equilibrium(to
return the body’s operations to a
balanced/steady state).
• The regulatory centre of body
temperature is located in the
hypothalamus of the brain. Anterior
hypothalamus primarily deals with
increases in body heat and the posterior
hypothalamus deals with decreases in
body temperature.
For example, if you are exercising in
high temperature; your body’s
enviro-sensory receptors detect this
change and pass impulses to your CNS
where it then sends a message to our
effectors to correct this change by
responding/ by sending negative
feedback internally.
How to work with (not against) your
client's Nervous System during
physical exercise
Our Nervous System works as a filter
and as an organiser of all information
that we access through out our lifetime:
every sensation, every movement,
every interaction, every emotion.
Use it or Lose It (but don’t overuse it)
14
• Our brains store information in
categories and of importance. If we
don’t use a piece of information then
it moves down that storage hierarchy
and we may forget components of
that information.
• The more we practice complex
movements, the more receptive our
Nervous System becomes. This
speeds up the process of learning
new techniques, movements, and
sequences over time.

Repetition is the Mother of Skill

• When prescribing new exercises, it is
important that the learning happens
in a controlled environment without
too many distractions.
• When we first learn a new movement
or skill it is stored in our short-term
memory, but the more we do it, the
stronger the neural pathway
becomes- making it easier to
perform, and eventually it is stored as
a long-term memory and we can
perform it without too much
conscious effort.
E.g. Standing is one of these
skills that as a child we had to
learn with quite a lot of difficulty.
A child breaks up the task,
exploring where his centre of
mass is, how to distribute his
weight, how to position his
posture, and stand without falling
down.

Progressive Improvement
Just as a child learns a new
skill, you will need to gradually
teach your clients new and
diverse physical exercises which
will help them achieve their
respective fitness goals.

15
Nerve Tissue
The nerve tissue is the main component
of the nervous system made up of
neurons which allow us to communicate
both internally and with the outside
environment. They transport messages
(electro-chemically) all over the body
through ‘neural pathways’.
Neural pathways are like super
highways that connect locations to each
other.
The body continues to build new
branches and expands these highways
as and when required.
This can also work in an opposite
manner if a highway (neural pathway) is
not used for a prolonged period.
Each neural pathway is made up of
many neurons. A neuron has three
characteristic components:
1. A cell body
2. an axon
3. and dendrites
Here’s an image to illustrate this:
Dendrite
Soma
Myelin Sheath
Nucleus Cytoplasm (fluid)
Image : Neuron
Structure
Cell Body/ Soma
This contains the nucleus containing the
information and ability to sustain the
metabolic activities of the cell.
Axon
This is surrounded by a cell membrane
which transmits information away from
the cell body to other neurons.
Dendrites
Dendrites differ from an axon as they
can have many branches, where there
is only one axon for each neuron.
The Dendrites will differ depending on
the function of that neuron and gather
information from other structures to give
back to that neuron.
Magill, (8th edition) explains that
Neurons are covered by layers of
Myelin which works as a cellular
membrane that speeds up the
transmission of neural signals from one
neuron to the next via a ‘synapse’-
which is a junction between the axon
and next neuron.
Axon Terminal
Node of
Ranvier
Schwann Cell
16
Synaptic Transmission: Types of Neurons
By the process of Synaptic
transmission, a presynaptic neuron
(1) Sensory neurons
(the neuron which transmits information)
Most of these neurons are found in our
sends a chemical signal (i.e. releases a
PNS. They receive signals and then
chemical neuro-transmitter) through the
convert them into electrical signals and
synapse to the next neuron (post-
send the electrical signals along neural
synaptic neuron). In the target
pathways to the CNS. These neurons
(postsynaptic) neuron, it generates a
are unique in their structure as they
signal which carries information for the
have no dendrites and just one axon.
cell to take/not take a certain
(Magill, (8th edition).
action(Palay and Chan-Palay, 1976).
(2) Motor Neurons
There are two types of motor neurons:
Alpha Motor Neurons are found
predominantly in the spinal cord, they
have many dendrites and connect
directly to the skeletal muscle fibres
influencing our voluntary movement
responsible for the force of muscles
contractions.

Gamma Motor Neurons help control

the force of the contractions of our
muscles caused by the Alpha neurons.
Without the assistance of gamma motor
neurons, our movements would have a
lack of control.
The Gamma neurons are associated
Image: OIST with muscle spindles and golgi tendon
complexes, which control the tension in
our movements (Samsel, 2016).

Overuse of Alpha neurons can cause

tension and shortening in the muscle,
and hence it is important to stretch to
reduce the effects of this overuse and
restore balance to the muscle (Samsel,
2016).

(3) Interneurons
These neurons both originate and
terminate within the brain or spinal cord
and function as connections between
the motor neurons leaving the brain and
sensory neurons transmitting to the
brain. (Magill, 8th edition).
17
References:

• Furness, J. B. (2009). Parasympathetic Nervous System. Encyclopedia of Neuroscience, 445-446.

doi:10.1016/b978-008045046-9.01990-2
• Saladin S. Kenneth, Gan A. Christina, Kushman N. Heather, The Autonomic Nervous System and
Visceral Reflexes, Anatomy & Physiology - the unity of form and function, Ed. 9th Pub. McGrawHill,
2021.
• Strominger L. Norman, Demarest J. Robert, Laemle B. Lois, Noback’s Human Nervous System,
Ed. 7th, Pub. Humana press.2012.
• Henneman, E., G. Somjen, and D.O. Carpenter. 1965. Functional significance of cell size in spinal
motoneurons. Journal of Neurophysiology 28: 560-580.
• McArdle, William A., Katch, Frank L, Neuromotor System Organization, Exercise Physiology:
Energy, Nutrition, and Human Performance. Ed. 8th Walters Kluwer Pub. 2019.
• Hall, John E., Guyton, Arthur C., Unit IX, X, XI, The Nervous System, Guyton and Hall Textbook of
Medical Physiology,13th edition, Elsevier Pub. 2016.
• Saper CB. The central autonomic nervous system: conscious visceral perception and autonomic
pattern generation. Annu Rev Neurosci. 2002;25:433-69.
• Benarroch EE. The central autonomic network: functional organization, dysfunction, and
perspective. Mayo Clin Proc. 1993;68:988-1001.
• Oakes PC, Fisahn C, Iwanaga J, DiLorenzo D, Oskouian RJ, Tubbs RS. A history of the
autonomic nervous system: part II: from Reil to the modern era. Childs Nerv Syst. 2016;32:2309-
15.
• McDougall SJ, Munzberg H, Derbenev AV, Zsombok A. Central control of autonomic functions in
health and disease. Front Neurosci. 2014;8:440
• Aminoff Michael J., Boller O. Franc, Swaab Dick F., Handbook of Clinical Neurology 3rd Series,
Autonomic Nervous System Vol. 117, 2013.
• Cardinali Daniel P.,Ch.3 Peripheral Nervous System, Autonomic Nervous System, Ed.1, Pub.
Springer, 2018
• Mettler Fred A., Guiberteau Milton J., Ch. 3rd Central Nervous System, Essentials of Nuclear
Medicine & Molecular Imaging, Ed. 7th, Pub. Elsevier.2019
• Jaeger Dieter, Jung Ranu, Encyclopedia of Computational Neuroscience, Pub. Springer, 2015.
• Palay SL, Chan-Palay V. A guide to the synaptic analysis of the neuropil. Cold Spring Harb Symp
Quant Biol. 1976;40:1-16. doi: 10.1101/sqb.1976.040.01.003. PMID: 59655.

18
1.1.2 Endocrine System
Endocrine System: The Master
of Hormones and Body
Composition
If you’re wondering why your clients
are storing fat in some areas more than
others, or why they have trouble gaining
lean muscle, knowledge of endocrine
system can lead you to answers.
This system is a collection of glands
that secrete chemical messengers
known as ‘hormones’ which travel
through the blood-stream to their
specific target cells, which then relay
messages for the body to react.
Key Roles of The Endocrine System:
1. Regulate metabolism
2. Regulate growth and
development of tissues
3. Sleep regulation
4. Regulates Sexual functions
5. Regulates Mood
Image : Endocrine Glands
Endocrine Glands: The Worker Bees
Creating a Peak Physique
When referring to physical activity and
the body’s responses, we should focus
on the following key glands:
Hypothalamus
The hypothalamus(mentioned earlier
in ‘the nervous system’) controls and
regulates the working of body’s internal
processes. It also sends message to the
pituitary gland to release certain
hormones.
Pituitary Gland
The pituitary gland is vital to control
the amount of hormone released for
other glands such as the thyroid and
adrenal glands.
Thyroid Gland
It is vital to manage metabolism and
growth, therefore understanding it`s
functioning is crucial when training for
peak physique to regulate weight loss.
Adrenal Glands
Adrenal glands secrete cortisol, a
hormone associated with tissue
breakdown under stress. It is often
secreted if an individual has been
overtraining. Catecholamines-
epinephrine and norepinephrine
manage human excitation and stress
levels. This is what we rely on during
the flight or fight mode, the instinct
that’s hard-wired into us since we were
hunter-gatherers.
19
Pancreas: Governor of Blood Sugars &
Digestive Enzymes
The pancreas has two main functions within
our body :
• Exocrine function: It is important for our
digestion. The pancreas secrete enzymes
that regulate and break down macro-
nutrients that we eat: lipids, carbohydrates
and protein.
• Endocrine function: To secrete insulin to
breakdown glucose in the bloodstream to
prevent hyperglycaemia (which is the
cause Type 1 diabetes mellitus).
Glucagon is also secreted from the pancreas
which acts to raise blood sugar levels if
they’re too low, also known as
hypoglycaemia (Which is Type 2 diabetes)
Hormones Important for Physique
Transformation
Testosterone
Predominantly known as the ‘sex hormone’ in
males, it is secreted from the testes.
However, relatively small quantities of
testosterone are secreted into the female
bloodstream via the ovaries and adrenal
glands.
Testosterone works as an anabolic for
tissue build-up and so plays a vital role in
strength and hypertrophy gains, and that’s the
main reason why males tend to be more
muscularly built compared to females.
It promotes masculine (androgenic)
characteristics such as more of body hair.
Lastly, it is a steroid because it can
stimulate protein synthesis.
Because of its effect on muscular size, that
bodybuilding athletes widely abuse synthetic
drugs of testosterone.
However, this comes with great risks,
including a decrease in testicular functioning,
and for females, an increase in male
characteristics including beard growth and
deepening of the voice.
Estrogen
• This is the predominant sex hormone
secreted from the ovaries for female
characterization- stimulating breast
development, and fat deposition.
• Estrogen is also produced by the body's fat
tissue.
• While women generally have greater
estrogen levels than men; estrogen levels
are something to be aware of with your
male clients too.
Growth Hormone (GH)
• GH is secreted by the pituitary gland and is
regulated by the hypothalamus.
• GH levels go up during deep sleep,
vigorous exercise, and when blood glucose
levels are low. The levels peak during
puberty.
• GH levels go down during pregnancy or
when the brain senses that there is already
high level of GH in the blood.
• It plays a vital role in hypertrophy training
and peak physique transformation goals,
increasing bone development, muscle
tissue, protein synthesis and also
stimulating lipolysis for lipid breakdown(GH
is literally the fat blaster hormone of the
body).
Team Boss Tips
To stimulate higher levels of growth
hormone, to promote lean muscle gains,
ensure your client:
✔ Performs compound exercises involving
multiple muscle groups (deadlifts,
squats),
✔ Consumes appropriate amount of
calories
✔ Gets plenty of sleep / rest.
20
1.1.3 Digestive System

Digestive System: Fuelling

Lean Muscle Gains

Not many understand the importance of

the digestive system when it comes to
physique transformation. However, if
you can’t digest and absorb nutrients in
your digestive system, your body just
excretes them.
The nutrients we consume are essential
for our body to continue to function and
sustain life.
The nutrients travel through our
digestive tract to be broken down into
by products called substrates.
Substrates are then transported out of
the gut and into the bloodstream to
move through the body, and where they
are needed.

It is only when our food is in substrate

form that it can be utilized as energy for
daily activities and for exercise.
Digestive System

Why consumption of protein shakes

Does not guarantee that you build
muscle:
You can have all the protein shakes in
the world, but if your body can’t digest /
absorb the protein, you won’t get any
benefits. What you get is a very
expensive deposit in the toilet.

Next, let's dive deeper into the

macro-nutrients that your digestive
system utilises to fuel the body from
the calories we intake...

Macronutrients: The Building Blocks

of Nutrition for Leaner Body
Composition
When it comes to body functioning and
exercise we look at three key macro- 21
nutrients:
Carbohydrates : Carbohydrates are
broken down into glucose for all our
activities, whether it be endurance, or
our body’s daily calorific needs for bare
sustenance.
Fats : Fats are stored in the body as
triglycerides. It is the energy we need
ready and waiting for endurance based
activities when our carbohydrate stores
are depleted.
Proteins : This is the nutrient that you
hear a lot about when it comes to peak
physique and bodybuilding activities,
because protein which is broken down
into amino acids, assists in repairing the
structure of our muscle and body
tissues.
Proteins also assist in the synthesis
of hormones and enzymes. Protein is
not a key energy source and is the last
resort- i.e. it utilised as energy by the
body when we are starved of the other
two key macronutrient energy sources.
Physique Athletes and Protein
Consumption
Peak physique athletes will often reduce
their carbohydrate and fat intake and
increase the amount of protein
consumed during competition time to
achieve a negative energy balance using
a process called glycogenesis to reach
optimal lean body mass suitable to
compete.
Energy Systems and Macronutrient
Utilisation in Physical Exercise
Depending on the intensity of exercises
we perform, our bodies utilise different
energy systems. Each energy system
works primarily with a preferred
macronutrient source. Understanding
how energy systems work is vital in
creating effective exercise programs that
would sculpt lean, muscular bodies for
your clients.
Note: Detailed explanation of macro
nutrients and energy systems can be
found under ‘Nutrition’ section.
Energy Systems
Anaerobic System : This energy
system is then used when working
under the conditions of absence of
oxygen. Such conditions include high
intensity and very short duration
workouts like hypertrophy training or
sprint training. It predominantly uses the
energy from carbohydrate substrates.
Aerobic System : This energy system
uses oxygen and is the predominant
system working when we’re training for
longer periods of time such as
endurance training. In such cases,
when carbohydrate stores deplete early
on, fat stores work as the primary fuel
source.
What is Digestion?
Digestion breaks down the foods we
consume into its basic building blocks
(e.g., proteins into amino acids,
carbohydrates into glucose, and fats
into monoglycerides and fatty acids), so
that it can be easily absorbed and
utilized by the body as nutrients. The
food we eat is used for the body’s
current and future use (to an extent)
and the excess is excreted.
22
The Digestive System The Mouth :
(Gastrointestinal Tract) When you take a bite of food, the
process of digestion starts. When you
Salivary Glands chew the food, it is mixed with saliva to
start breaking down the food, turning it
into easy to swallow ‘bolus’- which is
Tongue easier to act on for digestive enzymes.
The process of chewing stimulates
Epiglottis secretion of digestive acids, enzymes,
mucus, and bile by stomach and other
Esophagus
organs involved in the process of
digestion. Lipid digestion starts in the
mouth by salivary lipase.
Liver
Carbohydrate digestion starts in the
mouth by salivary amylase by degrading
Stomach starch into smaller linked glucose
molecules and simpler disaccharides.

Gallbladder Pancreas The Oesophagus :

Duodenum
Next, when you swallow, the tongue
Ileum passes the food down the throat into the
(small
intestine) oesophagus(located near the windpipe).
Colon
Epiglottis is a small flap like structure,
which keeps the food from going down
the windpipe. In oesophagus, the
muscle walls squeeze the food
Caecum forward(peristaltic action) into the
stomach.
Appendix Rectum
The Stomach :
anus
Gastrointestinal Tract & function of In the stomach, hydrochloric acid
each section of the GI Tract for and enzymes, with the help of strong
digestion. muscles of the stomach wall (which
mechanically, makes further smaller
The digestive system is made up of pieces of the incoming bolus) continue
digestive or gastrointestinal (GI) tract the food mixture’s breakdown into a
and the pancreas, liver, and gall liquid like mixture. This mixture is then
bladder. GI tract consists of mouth, slowly emptied into small intestine.
oesophagus, stomach, small intestine, Gastric lipase further breaks down fat in
large intestine, and anus. These organs the stomach.
are hollow and form a long tubular
structure that passes the food we eat Pepsin attacks the peptide bonds of
forward. large protein molecules, breaking those
down into smaller chains of amino acids
(polypeptides)

23
The Small Intestine : To help with the
absorption, pancreas, gallbladder, and liver
send different juices to the first part of the
small intestine. The small intestine is a long,
hollow, tubular, winding structure packed
underneath the stomach. It is made up of 3
sections:
The Duodenum : Here, chemical digestion
and some nutrient absorption (mostly
minerals) happens. It receives secretions
from pancreas (pancreatic juice and other
enzymes) and liver (bile). Pancreatic juice
helps prevent ulcers and auto-digestion of GI
tract by neutralising ‘chyme’ that comes from
the stomach. Apart from pancreatic juices,
pancreas also secrete : Pancreatic Lipase,
Pancreatic amylase, and Pancreatic
protease.
Lipid breakdown in the duodenum : Major
part of lipid break down happens in the
duodenum. Bile salts (in Bile juice) breaks
down large flat globules into multiple smaller
droplets- that gives the fat more surface area
for further action of ‘lipase’ enzyme which
digests fats. Pancreatic lipase in the
presence of co-enzyme colipase (produced
by pancreas) acts on the smaller droplets.
The better the digestion of fats the better the
absorption of vitamins A, D, E and K which
are fat soluble. (Ross et al, 2013).
Starch Breakdown in the duodenum :
pancreatic amylase breaks down starch into
maltose.
Protein Breakdown in the duodenum:
pancreatic proteases called Trypsin,
chymotrypsin and elastase attack protein
generating of smaller chains of amino acids
called ‘peptide’
The Jejunum : Finishes chemical digestion,
and absorbs water, nutrients and Vitamins by
passive diffusion.
The Ileum : Finishes chemical digestion, and
absorbs water, nutrients and vitamins by
passive diffusion. The food moves slowly
through the small
Intestine, giving the small intestine sufficient
time to absorb most of the nutrients from the
food consumed and to let it into the
bloodstream. Having a large surface area in
the form of the winding, tubular form helps
this process. The rest of the portion that’s
non-liquefiable - is passed on to the large
intestine to be excreted.
The Large Intestine : The inside of the large
intestine has a lining called ‘mucosa’ which
helps in water, nutrients, and electrolyte
absorption. The large intestine also hosts the
most of the bacteria in our body. The good
bacteria here keep the large intestine healthy
by maintaining the balance i.e. preventing
multiplication of bad bacteria. It also helps
break down the fiber which promotes smooth
passage of feces.
Gastric emptying of carbohydrate drinks or
water moderately increases during light and
moderate physical activity (20-60% VO2
Max) compared with rest; it decreases at
intensities equal to 75% VO2Max or higher.
Things you should know
1) The brain exerts a powerful influence on
GI tract functions through diverse
neurochemical connections with digestive
organs.
2) Increases in gastric emptying during
moderate-intensity treadmill activity may
relate to increases in intra-gastric
pressure from abdominal muscle
contractile activity.
3) Frequent, high-intensity physical activity
can precipitate GI symptomatic self-
limited food poisoning, GERD, hiatal
hernia, IBS, and viral gastroenteritis in
the absence of proper nutrition &
recovery of the body.
4) The most common GI tract disorders
include constipation, diarrhoea,
diverticulosis, GERD, IBS, and excessive
gas production.
24
References:

• Smith, M. E., & Morton, D. G. (2010). The Digestive System, 1-18. doi:10.1016/b978-0-7020-3367-
4.00001-3
• Gerard P. Gut microbiome and obesity. How to prove causality? Ann Am Thorac Soc
2017;14(Suppl 5):S354.
• Patel C, et al. Transport, metabolism, and endosomal trafficking-dependent regulation of fructose
absorption. FASEB J 2015;29:4046.
• Chey WD, et al. Irritable bowel syndrome: a clinical revi;313:949.
• El-Salhy M, Gundersen D. Diet in irritable bowel syndrome. Nutr J 2015;14:36.
• Moorthy AS, et al. A spatially continuous model of carbohydrate digestion and transport processes
in the colon. PLoS One 2015;10:e0145309.
• Monda V, et al. Exercise Modifies the Gut Microbiota with Positive Health Effects. Oxid Med Cell
Longev 2017;2017:3831972.
• Hamasaki H. Exercise and gut microbiota: clinical implications for the feasibility of Tai. Chi J Integr
Med 2017l;15:270.
• Allen JM, et al. Exercise Alters Gut Microbiota Composition and Function in Lean and Obese
Humans. Med Sci Sports Exerc 2018;50:747.
• McArdle, William A., Katch, Frank L Exercise Physiology: Energy, Nutrition, and Human
Performance. Ed. 8th Walters Kluwer Pub. 2019
• McArdle, William A., Katch, Frank L Sports and Exercise Nutrition 5th Edition, Walters Kluwer Pub.
2019.
• L. Kathleen Mahan MS RD CDE, Sylvia Escott-Stump MA RD LDN Krause's Food & Nutrition
Therapy, Saunders Pub. 2007.
• Hall, John E., Guyton, Arthur C. Textbook of Medical Physiology,13th edition, Elsevier Pub. 2016.
• Ross LE et al (2013) Identification of amino acids in human colipase that mediate adsorption to
lipid emulsions and mixed micelles. Biochimica et Biophysica Acta; 1831:
• 6, 1052-1059.

25
1.1.4 Cardiovascular System
The Workhorse of a Peak Physique
The cardiovascular system is responsible to
send blood that contains nutrients, all around
the body.
It is made up of three key components:
Blood : Transports nutrients and cells
around the body.
Heart : The engine of the body that pumps
blood to all vital areas.
Veins and Arteries : The plumbing system
of the body, allowing the blood to flow in and
out of the heart, and around the body.
It is important to keep the cardiovascular and
circulatory system in peak condition to
ensure the health and safety of your client
and to support their physique transformation
goals.
In order to keep the cardiovascular system
healthy, it’s important to continue to give the
heart varied exercise stimuli. This means
don’t just focus on maximal strength training,
buy vary intensities too, to not only ensure
they look amazing, but their bodies also
function well.
The Heart: The Engine of the Body
Every beat of your heart is supporting blood
to flow around your body via the blood
vessels and arteries.
Image : Cardiovascular System
26
How does the Heart work? Heart Structure
The heart pumps out blood initiated The heart is made up of four chambers.
systolically through the arterial system There is a right and left atrium and right
(arteries) to the body and then carry it and left ventricle.
back via the venous system (veins) in • The Right side is known as the
a diastolically. pulmonic side because it receives blood
1) The amount of difference of blood from the body which is
that is pumped out of the left side deoxygenated(low in oxygen and high
(end diastolic volume) and the right in carbon dioxide), pumping this to the
side (end systolic volume) with each lungs to be oxygenated and then into
contraction is known as Stroke the left atria.
Volume (SV)
• The left side is known as the systemic
2) The total volume of blood which is
side because it pumps oxygenated
pumped out each minute is known
blood, (blood which is high in oxygen
as Cardiac Output (Q)
and low in carbon dioxide) around the
3) The rhythm of the heart and its beat
rest of the body.
is generated by the Sino-Atrial node
(SA node) in the right atrium of the
heart working autonomously. Let’s take a deeper look at the structure
However, this rhythm can be of the heart:
affected by the sympathetic nervous
system when the heart and body go
into stress, or deep relaxation.
4) The atrioventricular node (AV node)
will delay the impulse from the right
atrium to then be transported
through the ventricles.

The heart is one of the three muscles;

smooth, skeletal, and the heart being
the cardiac muscle. Similar to the
skeletal muscle, it contains microfibrils
and sarcomeres. This is discussed
further in the muscular system.

The Heart and Physical Exercise

• When exercising, the heart rate
increases with high intensity workouts
and relaxes when cooling down. Heart Structure
• We can exercise the heart and keep
it strong by practicing cardiovascular
exercises Blood : The River of Life
• Observing the difference between the The blood is like a river that transports
heart at rest and during exercise can life giving nutrients around the body.
be a good measurement and Improve the blood flow and you improve
indication of the intensity of work your overall health.
client is doing.
27
What is blood made of? Blood Vessels: How Blood Gets
The blood is made up of red blood cells Transported Around the Body
to carry oxygen, white blood cells to
fight infection and plasma to carry To assist in the regulation of blood
nutrients and hormones. transportation there are three main
blood vessels:
Why do we have blood?
The blood has three main functions #1. The Arteries
within the body:
Anterior Capillaries of
head and
# 1. Transportation vena cava
forelimbs
Blood rich in oxygen is transported
Pulmonary Pulmonary
from the lungs to the body and tissues. artery artery
Blood helps remove waste products. Aorta
Capillaries Capillaries
Blood carries nutrients and hormones of right lung of left lung
acting as chemical messengers from
the gastrointestinal tract to the bodies
tissues.
When we exercise, blood rushes from
our internal organs to our muscles to
assist their functioning for efficient Pulmonary Pulmonary
movement activities. vein vein
This is why blood doping is a popular Right atrium Left atrium
exercise stimulant for endurance Left ventricle
Right ventricle
activities, as it boosts the number of red
Posterior Aorta
blood cells in the body to carry oxygen vena cava
so the athlete can increase their VO2
max and exercise at a higher rate for Capillaries of
abdominal organs
longer periods of time. and hind limbs

# 2. Regulation
Blood helps regulate temperature,
transporting heat from our core to
extremities and out of our skin to cool
the body down. It also assists to heat up
our body depending on the
environment.
The blood regulates acidity(pH levels)
and water content of the cells.
# 3. Protection
The white blood cells help fight
infections & prevent diseases, illnesses.
The plasma also helps to produce
blood clots if there has been trauma or
injury to seal the damaged tissue until a
scar is formed.
Image : Arteries and Veins
The largest artery is known as the aorta
which transports the blood away from
the heart to the lungs for oxygenation.
The aorta is then made up of sub-
divisions or branches. The branches are
the arteries and then they branch into
even smaller branches known as
arterioles which are then again
subdivided into capillaries which is
where the exchange of waste products,
hormones and nutrients occurs.
28
#2. Veins
Methods to Prevent Cold Related
The veins are made up of subdivisions
Injuries :
called venules which collect the blood
If your client’s core temperature drops
from the capillaries to be transported
too much, serious injuries can occur.
back through veins from the body back
to the lungs for oxygenation to continue
Pay attention to these signs to be aware
the cycle yet again.
of if your clients core temperature is
dropping.
The Blood's Role in Environmental
Changes to Body Temperature
Signs of Decrease in Core
Changes in temperature are detected
Temperature :
by thermal receptors located in the skin.
Different physiological responses to the • Vasoconstriction where blood and
change in heat occur : oxygen are transported to the vital
organs for protection.
Increase in heat :
When we exercise, our core • Shivering to assist the body to keep
temperature increases, so to balance moving.
this heat-rise in our body must take on
certain adaptations to cool the body • Increase in energy expenditure to
down back to equilibrium. maintain core temperature levels.

Blood transport : How to Prevent Decreases in Core

Using blood to transport and store heat Temperature:
is one method used. If core
• Perform sufficient warm up.
temperatures rise, we tend to look
flushed when we exercise because • Layer clothing and decrease layers
blood is transported to the skin surface. as the client warms up, ensure
If core temperatures drop for example if clothing is put back on when cool-
we’re training in a colder environment, downs are commenced.
the body will transport the blood • Include more cardiovascular training
predominantly to our vital organs to to increase the heart rate and blood
prevent further loss of heat. transport to assist in heating up the
body
Methods to Prevent Heat Exhaustion:
If you’re working with clients in high
temperatures, certain measures should
be taken to avoid overheating such as:
• Drinking more water.
• Minimal clothing that can increase
surface temperature.
• Technical clothing that can increase
the surface area of heat movement
away from the body.
• Exercise in a cool and shaded or air
conditioned space.

29
Things you should know :

Blood-Pressure Facts :

• Blood-pressure (BP) is the pressure

of your blood flow on the walls of
arteries it flows through.

• Blood pressure is measured using

two numbers : ‘Systolic’ and
‘Diastolic’, and is measured in
‘millimeters of mercury’ (mmHg).

• If your BP reading is 130/90 mmHg,

your BP is said to be 130 over 90.
The first number (Systolic BP) is the
BLOOD SYSTOLIC DIASTOLIC
pressure in the arteries when the
PRESSURE mm Hg mm
heart contracts and empties itself out,
pushing the oxygenated blood out in
the arteries. The second number
(Diastolic BP) is the pressure in the
arteries when the heart relaxes and is
again filled with blood. (upper
CATEGORY Hg
number)
• According to American Heart
Association, following are the 5
stages of blood pressure.

(lower number)

NORMAL Less Than 120 AND Less Than 80

ELEVATED 120-129 AND Less Than 80

HIGH BP
130-139 OR 80-89
(Hypertension Stage 1)

HIGH BP
140 Or higher OR 90 Or Higher
(Hypertension Stage 2)

HYPERTENSIVE CRISIS
AND/O
(Emergency care Higher Than 180 Higher Than 120
R
needed!)

30
Hypertension Facts:
There are two hypertension types:
Essential and Secondary.
Essential / Primary Hypertension :
For 95% of hypertension patients, the
cause of it is unknown. It is called as
essential or primary hypertension.
Essential hypertension is diagnosed
when your BP readings are high on 3 or
more visits and all other probable
causes of hypertension have been ruled
out. Usually people with this type of
hypertension won’t have any symptoms,
but few can experience frequent
headaches, dizziness, nose bleeds etc.
Secondary Hypertension : Secondary
hypertension is a consequence of
another disease generally leading to
sodium retention and vasoconstriction
(constriction of blood vessels)
abnormalities. The most common
causes of secondary hypertension are :
abnormality in the arteries supplying
blood to the kidneys, airway obstruction
during sleep (sleep apnea), adrenal
gland disorders, hormone abnormalities,
thyroid disease, excessive salt intake,
or excessive alcohol intake. Certain
drugs can also be responsible for this
type of hypertension, such as :
ibuprofen and pseudoephedrine. The
good news is that if the cause is found,
Secondary hypertension can often be
managed to lead a normal and healthy
life.
Mechanism Causing Hypertension :
To understand what hypertension is,
we will firstly need to look at how the
body maintains its blood pressure under
normal circumstances and what are the
factors that cause the BP to rise, and
how.
Blood pressure is dependent upon two
variables : Cardiac Output (CO) and
Peripheral Vascular Resistance (PVR)
BP = CO * PVR
- Where, CO is the amount of blood the
heart pumps per minute and PVR is the
resistance to blood flow in arteries. So if
you look at the above equation, you can
see that, the more blood the heart
pumps AND/OR the narrower are the
arteries (i. e. the more the amount of
resistance to the blood flow in the
arteries) the higher is the BP.
In essential hypertension, the rise in
BP is mostly caused due to high PVR
(the CO is normal).
CO depends on Stroke Volume (SV,
i. e. the amount of blood the heart
pumps every beat) and Heart Rate (HR,
i. e. number of times the heart beats
every minute).
So, the equation now looks like :
BP = (SV*HR) * PVR
So now, increase in SV or HR or PVR
or any two or all three will cause the BP
to rise.
There are many reasons that can
raise the value of any of the above
variables.
31
Measures for Hypertensive
Bodybuilders : Bodybuilding is a strain
inducing activity (on the entire body,
especially on cardiovascular system).
As the heart needs to pump more blood
to increase the blood flow to the
muscles under strain to be able to
perform the exercise, it causes the BP
to rise temporarily. But with a good
exercise program, this is perfectly safe
and natural.
In fact, in long term, regular lifters will
have lower BP that can help them keep
hypertension at bay.
Studies show, weight training (guided
by doctors and trained individuals) can
help people who are already
hypertensive to bring their BP down in
long term.
1) If resting blood pressure is 180/110
mmHg or higher, resistance training
should not be performed.
1) Before you start : Hypertensive
individuals with systolic blood
pressures between 160-179 and
diastolic blood pressures between
100-109 mmHg should consult with
their physician (doctor) before
starting a resistance training
program.
1) Age : People who are over 45 or
have existing high blood pressure or
other heart problems should check
with a doctor before beginning a
weightlifting program.
1) Form : Learn proper exercise forms
to reduce the risk of injury.
5) Breathing technique : Certain
circumstances make raised blood
pressure from weightlifting more of a
risk. Some weightlifters use the
‘Valsalva maneuver’ as way to brace
themselves and increase the amount
of weight they can lift. This involves
forcefully exhaling against a closed
mouth and nose. It increases
pressure on the middle ears and
chest, and can cause highly raised
blood pressure. Proper breathing
technique keeps the airway open
throughout the lift, exhaling while the
weight is lifted and inhaling while the
weight is lowered.
5) Repetitions: The more the number
of repetitions performed, the higher
is the BP. BP is highest at the end
of exhaustion set. Hence, failure
sets even with light loads should
be avoided.
5) Lifting Speed : Controlled lifting
speed will help to maintain lower BP.
Too fast or too slow lifting will
elevate the BP.
5) Avoid lifting heavy : Hypertension
is a major cause of brain aneurysm
(strained arteries in brain) and lifting
very heavy can make the arteries
rupture if you have aneurism.
6) Avoid maximal / near maximal
lifts. Initially, you can get started
with 30-40% of 1 RM for upper body
and 50-60% of 1 RM for lower body
exercises.
5) Exercises with bigger muscles (leg
press, leg extension, chest press)
raise BP more than small muscle
exercises. When working big muscle
groups, instead of using both the
legs/arms together, do single
arm/leg exercises (as exercises
involving both limbs will increase BP
32
more than single limb exercises)
11)Start with lower weights: Even to
test 1 RM, wait for 6-8 weeks.

11) If muscle gain is the goal,

resistance can be upped till 70-
75% of 1 RM (If regular BP checkup
doesn’t show any abnormalities till
you slowly reach here).

11)Rest between sets : It is observed

that the rest period between the sets
affects the increase in BP. When the
rest between sets is 30 to 60
seconds, BP is seen to increase with
successive sets. However, if the rest
period is 90 seconds or more, BP
doesn’t show any significant rise.

11) Intensity : The easiest way to

make sure that you are using a safe
intensity to lift is to make sure that
you aren’t too exhausted or too out
of breath to talk.

11) Avoid sudden moves : Do not

move to seating or standing position
suddenly as sudden moves can
cause rapid BP drop leading to
dizziness.

11)Squats and deadlifts put the most

amount of strain on BP. If
attempting these, do these under
expert supervision.

11)High BP medication takes several

weeks to start working, so while
starting a resistance training
program, lift light weights.

11)To check BP increases during

exercising, BP readings during a
lower body seated resistance
training exercises will give the most
accurate readings.

33
References :

• Guyton AC, Jones CE, Coleman TG: Circulatory Physiology: Cardiac Output and Its Regulation,
2nd ed. Philadelphia: WB Saunders, 1973.
• Ibrahim M, Gorelik J, Yacoub MH, Terracciano CM: The structure and function of cardiac t-tubules
in health and disease. Proc Biol Sci 278:2714, 2011.
• Kho C, Lee A, Hajjar RJ: Altered sarcoplasmic reticulum calcium cycling—targets for heart failure
therapy. Nat Rev Cardiol 9:717, 2012.
• Parker, Steve, Cardiovascular system ch. 6th, The Concise Human Body, Ed.
• Korzick DH: From syncytium to regulated pump: a cardiac muscle cellular update. Adv Physiol
Educ 35:22, 2011.
• Hall, John E., Guyton, Arthur C. Textbook of Medical Physiology,13th edition, Elsevier Pub. 2016.
• McArdle, William A., Katch, Frank L Exercise Physiology: Energy, Nutrition, and Human
Performance. Ed. 8th Walters Kluwer Pub. 2019.
• Saghiv, Moran S., Sagiv Michael S., Basic Exercise Physiology, Pub. Springer
https://doi.org/10.1007/978-3-030-48806-2
• Mettler Jr.,Fred A., Guiberteau, Milton J., ch 5th Cardiovascular System, Essentials of Nuclear
Medicine and Molecular Imaging, Ed. 7th, Pub.
• Elsevier. Hall, John E., Guyton, Arthur C., UNIT III & IV, Textbook of Medical Physiology, Ed. 13th,
Elsevier Pub. 2016.
• https://www.heart.org/en/health-topics/consumer-healthcare/medication-information/how-do-beta-
blocker-drugs-affect-exercise
• http://www.bodvbuildingforvou.com/articles-submit/ioe-knight/high-blood-pressure.html
• https://www.livestrong.com/article/375471-raised-blood-pressure-bodybuilding/
• https://www.cooperinstitute.org/2012/02/hypertension-and-weight-training-secrets-for-success/
• https://www.evervdavhealth.com/hvpertension/understanding/tvpes-of-hvpertension.aspx
• https://barbend.com/maximal-lifting-causing-bleeding/

34
1.1.5 The Lymphatic System
The Cleaners of Your Body
Why a Healthy Lymphatic
System is Important for a Lean
Body :
Not many people consider the importance
of their lymphatic system when it comes
to having a lean and sculpted body, and
this is where a lot of people limit their
results.
When the lymphatic system isn’t working
correctly, your body is much more
susceptible to conditions like edema, or
fluid retention.
Image : Normal foot vs foot with
edema
You can have the best muscles in the
world, but if your lymphatic system isn’t
handling the excess fluids in your body,
they’ll be covered up by this fluid.
Get your lymphatic system working and
cleaning your body, and that lean look
isn’t too far away.
How the Lymphatic System Works :
The Lymphatic system works in a similar
manner to our cardiovascular system to carry
excess fluid through vessels away from the
tissues to boost the body's immunity and
cleansing of deep and superficial networks.
Lymphatic capillaries function within the
tissues of the body alongside the capillaries
which carry blood through the body.
What Does the Lymphatic System
Look Like?
Here’s a diagram to give you a visual
overview:
What Are the Main Functions of the
Lymphatic System?
• It removes excess fluids from the body’s
tissues, which prevents fluid build-up and
supports the appearance of a lean body.
• It absorbs fatty acids and subsequent
transport of fat to the circulatory system.
• It produces immune cells, which includes:
1) Monocytes
2) Lymphocytes
3) Antibody producing cells called
plasma cells.
35
There are five key components
that make up your Lymphatic
System:
1. Blood Vessels
2. Lymph Nodes
3. The Tonsils
4. The Thymus
5. The Spleen
How to Tell if Your Client’s
Lymphatic System Needs
Some Help?
• If your client has trouble getting
leaner then it may be a sign that their
lymph system isn’t functioning well.
Look for edema, or water retention
levels, especially around the lower
limbs. This can be a sign that the
lymph nodes are blocked, which can
prevent fluids to be excreted and
circulated.
• Gently massage around the spleen,
tonsils and check for inflammation or
pain.
Basics to Improve Lymphatic
Function:
If your client is experiencing lymphatic
challenges they may need to be
referred to a medical professional.
However there are some simple things
they can do to give their lymphatic
system a boost. Here are some
considerations:
Deep Breathing: Deep breathing is like
the pump that drives the lymphatic
system. Get your client to practice deep
breathing this for 5-20 minutes every
morning and evening for a month to
give their lymphatic system a boost.
Sweating:
Sweating helps the body clean itself and
can be supportive to the lymphatic
system. In cases of a challenged
lymphatic system, you don’t want to use
too much intensity to induce sweating.
Opt for walking, combined with deep
breathing whilst in warm clothing.
Infrared saunas are also supportive to
the lymphatic system.
Massage:
Massage treatments from a qualified
practitioner are a great way to stimulate
lymphatic flow.
Be Aware: It’s important to
communicate to your clients that
when their lymphatic system is
cleaning and releasing an excess
build up waste products, it may
produce uncomfortable symptoms
like, foul smelling stools, bad breath,
acne, mood swings, etc.
Lymph is a clear, transparent fluid, just
like blood plasma but with a slightly
lesser amount of protein content. It is
taken up by the lymphatic vessels as
tissue fluid. Its contents are also
different from two different locations of
the body & different times of the day.
Lymph is seen more transparent in a
fasted state as compared to the fed
state & similarly in a fed state the color
of Lymph in the small intestine is more
opaque & whitish as compared to the
fasted state.
Larger vessels known as Lymphatic
vessels are formed when the Lymph
drains into the capillary network in
tissue spaces.
Similar to the blood vessels, lymph also
flows through a system of Lymphatic
vessels and begins with microscopic
lymphatic capillaries, which penetrate
nearly each and every tissue of the
36
body.
Lymph nodes or Lymphatic nodes are
nodes that are placed along the length
of the lymphatics filter out & store the
lymph.
Lymphatic Capillaries look very much
similar to that of blood capillaries,
however, it is close-ended at one end. It
has a sack of thin endothelial cells
overlapping loosely over each other and
becoming larger and larger with
changing names as the lymphatic
vessels converge along their path. The
lymphatic capillaries converge to form
collecting vessels. These often travel
alongside veins and arteries and share
a common connective tissue sheath
with them. They empty into the Lymph
nodes at certain intervals and the
Lymph drips slowly through each node
where there are outside bacteria
present where the immune cells monitor
the fluid for foreign antigens, leaving it
from the other side of the node into
another collecting vessel.
Larger lymphatic vessels called
Lymphatic trunks are formed when the
collecting vessels converge. There are
11 Lymphatic trunks. The most
important part of the Lymphatic system
is the Lymphatic tissue which ranges
from loosely scattered cells to compact
cell populations encapsulated in
lymphatic organs where these cells are
may be from the mucous membranes of
the respiratory, digestive, urinary, or
reproductive tract.
The Lymphatic Tissues
The Lymphatic Tissue is made up of
various different types of lymphocytes
that take part in various activities of the
defense mechanism & immunity.
Neutrophils : These are anti-bacterial
Leukocytes and Leukocytes are
commonly known as White Blood Cells
where the number of Leukocytes
present in the blood shows if the body
has been attacked by a foreign bacteria
or virus.
N K Cells : Natural Killer : Natural
Killer cells are the kind of Leukocytes
that attack & destroy bacteria, rogue
tissues, or cells (cells of your own body
that get transplanted into cancerous
cells or get infected by a virus).
B Cells : Lymphocytes that are made
and found in Bone Marrow. These cells
differentiate between plasma cells,
connective tissue cells that secrete
antibodies.
T Cells : Lymphocytes that are made in
the Thymus are called T-Cells.
Macrophages: These are large cells
that display antigenic fragments and
process a foreign matter of it to some T
cells, thus altering the immune system
to the presence of an enemy.
37
Dendritic Cells : These are branched
& mobile antigen-presenting cells
(APCs) found in the epidermis,
mucous membranes & Lymphatic
Organs. It alerts the immune system
to pathogens that have entered the
body surfaces surrounding the
foreign intruder by receptor-
mediated endocytosis, otherwise it
works just like macrophages. After
reacting to the Antigen it migrates to
the next lymph node & triggers the
immune reaction.
Reticular Cells : These are branched
& stationary antigen-presenting cells
(APCs) that contribute to the
connective tissue framework of
Lymphatic Organs.
Lymphatic Organs
Lymphatic Organs contain the red bone
marrow, thymus, lymph nodes,
tonsils, and spleen.
Redbone marrow: It is soft, loosely
organized, highly vascular material,
separated from osseous tissue by
the endosteum of the bone
producing all classes of formed
elements of the blood; its red color
comes from the abundance of
erythrocytes.
Thymus: The thymus is a member of
the endocrine, lymphatic, and
immune systems. It secretes
hormones that regulate their later
activity along with developing
lymphocytes.
Tonsils : The tonsils are patches of
lymphatic tissue located at the entrance
to the pharynx, where they guard
against ingested and inhaled
pathogens.
Spleen : The spleen, the body’s largest
lymphatic organ, measures up to 12 cm
long and usually weighs about 150 g. It
is located in the left hypochondriac
region, just inferior to the diaphragm
and posterolateral to the stomach
What’s the Main Functions of the
Lymphatic System?
Provide Fluid Maintenance &
Recovery: The fluid is continuously
getting filtered from the blood capillaries
into the tissue as the blood circulates
through the body but only about 85% of
the fluid gets reabsorbed into the blood
capillaries again & only 15% of the fluid
that doesn’t get absorbed amounts to 2
to 4 liters of water & about half of the
protein in blood plasma in a course of
24 hrs.
If the excess water & protein doesn’t get
absorbed in the blood, the person can
die within hrs of circulatory failure.
So one of the most important functions
of the Lymphatic system is to absorb
this excess water & protein into the
bloodstream.
Immune function : The lymphatic
system also looks for foreign antigens &
chemicals from the tissues along with
the fluid & blood plasma. As the fluid
passes through lymph nodes before
submerging the fluid into the
bloodstream a lot of different lymphatic
cells sense the foreign antigens &
trigger reactive actions against them by
triggering an immune reaction.
38
Lipid Absorption: The excess lipid
which is left unabsorbed by the
capillaries gets absorbed in the Lacteals
(a type of Lymphatic Vessels) in the
small intestine.

39
References:

• Saharinen P, Tammela T, Karkkainen MJ et al 2004 Lymphatic vasculature: development,

molecular regulation and role in tumor metastasis and inflammation. Trends Immunol 25:387-95. A
comprehensive but concise review of the role, regulation and development of the lymphatic
system.
• wartz, M. (2001). The physiology of the lymphatic system. Advanced Drug Delivery Reviews, 50(1-
2), 3-20. doi:10.1016/s0169-409x(01)00150-8
• Loukas M. Bellary S.S. Kuklinski M. et al. The lymphatic system: A historical perspective. Clin
Anat. 2011; 24: 807-816
• Breslin, J. W., Yang, Y., Scallan, J. P., Sweat, R. S., Adderley, S. P., & Murfee, W. L. (2018).
Lymphatic Vessel Network Structure and Physiology. Comprehensive Physiology, 207-299.
doi:10.1002/cphy.c180015.
• Cueni, L. N., & Detmar, M. (2008). The Lymphatic System in Health and Disease. Lymphatic
Research and Biology, 6(3-4), 109-122. doi:10.1089/lrb.2008.1008
• Skandalakis, J. E., Skandalakis, L. J., & Skandalakis, P. N. (2007). Anatomy of the Lymphatics.
Surgical Oncology Clinics of North America, 16(1), 1-16. doi:10.1016/j.soc.2006.10.006.
• Saharinen P, Tammela T, Karkkainen MJ et al 2004 Lymphatic vasculature: development,
molecular regulation and role in tumor metastasis and inflammation. Trends Immunol 25:387-95. A
comprehensive but concise review of the role, regulation and development of the lymphatic
system.
• Loukas M, Abel N, Tubbs RS et al 2011 The cardiac lymphatic system. Clin Anat 24:684-91.
• Miller MJ, McDole JR, Newberry RD 2010 Microanatomy of the intestinal lymphatic system. Ann N
Y Acad Sci 1207 Suppl 1:E21-8.
• O’Morchoe CC 1997 Lymphatic system of the pancreas. Microsc Res Tech 37:456-77
• Nesselrod JP 1936 An anatomic restudy of the pelvic lymphatics. Ann Surg 104:905. An account
of the importance of the pelvic lymphatic system in tumour spread and treatment that provides an
accurate description of its component parts.
• Brierley J B, Field E J 1948 The connexions of the spinal subarachnoid space with the lymphatic
system. Journal of Anatomy 82: 153-166
• Jamieson J K, Dobson J F 1907 Lectures on the lymphatic system of the caecum and appendix.
Lancet I: 1061-1066
• Kampmeier O F 1969 Evolution and comparative morphology of the lymphatic system. Thomas:
Springfield, Illinois
• Kinmonth J B 1964 Some general aspects of the investigation and surgery of the lymphatic
system. J Cardiovasc Surg 5: 680-682
• MacGregor A 1936 An experimental investigation of the lymphatic system of the teeth and jaws.
Proc R Soc Med 29: 1237-1272
• Satiukova G S, Rassokhina-Volkova L J 1972 Compensatory-adaptive changes in the lymphatic
system of organs in experiment and disease. Bibl Anat 11: 481-487..

40
1.1.6 The Respiratory System
The Catalyst of Fat Burning
The respiratory system works closely
with the cardiovascular system to bring in
oxygen (O2) from the outside environment
and transport it into the lungs with the blood
to oxygenate the body and remove carbon
dioxide from (CO2) and waste from the
lungs and body. The respiratory system is
made up of airways, muscles and lungs.
These processes happen through various
mechanisms, all of which make use of
differences in pressure in the system.
Temperature Aspects of the Respiratory
System:
• Warming the inhaled air up to body
temperature 37 degrees Celsius
• Removing body heat by exhaling warm
gases
The more you improve your respiratory
function and breathing the better the body
can burn fat, through better functioning of
the metabolism.
Why Breathing is Important :
1) It helps to oxygenate the blood.
2) It nourishes the body at a cellular level.
3) It improves circulation and metabolic
function.
4) It helps release tension.
5) It can calm the mind and body.
Core Functions of Breathing :
Breathing is something we do
subconsciously. Along with our heartbeats,
it is our most continuous muscular action.
Breathing relies on the pressure differences
between the thorax and lungs to bring in air
and expel it from the body.
Breathing can be divided into 2 pathways :
Inspiration /Inhalation: Is an active
contraction where the thoracic cavity
volume is increased as air is
transported into the lungs for filtration.
Expiration /Exhalation: Can be active
or passive, to relax the inspiratory
muscles for air to be moved out of the
body.
• The inhaled air is 80% N2 and 16%
o2
• The exhaled air is 80% N2, 16% O2,
and 4% CO2
• That means, with every inhalation
and exhalation, 4% O2 is absorbed,
and 4% CO2 is thrown out
The Structure & Function of the
Respiratory System
We breathe in air through our noses
(nasal cavity to be more precise) and
this is where the majority of the larger
particles of dust or other pollutants in
the air are filtered out, resulting in it
saving the lungs from any kind of
infection from the pollutants in the air.
Phary
nx
Trach
ea
Left
main
bronch
us
Left
lung
Diaphra
gm
41
Image : Respiratory System
Through Nostrils, the air enters the The Pulmonary Capillaries carry blood
Pharynx, which is located just after the with max. Concentration of Carbon Di-
Nasal Cavity where the throat starts. In oxide and negligible amount of Oxygen
the pharynx, it is adjusted to the internal whereas the Alveoli air sacs contain
body temperature & is humidified. max. Concentration of Oxygen. This
creates a concentration gradient
After the Pharynx, the air comes to the
Larynx (Voice Box) where its main between the oxygen in the air sacs and
the oxygen present in the blood from
function is to allow air passage & stop
the capillaries.
food from entering the trachea
(windpipe). So because the concentration of
Oxygen from Alveoli is a lot higher than
The Trachea further filters the air we
the blood, the Oxygen from Alveoli
breathe & gets divided into 2 branches,
diffuses in the blood whereas the
each sending the supply of air to the left
Carbon Di-Oxide from the blood in the
& right lung. These branches are called
capillaries diffuses in the Alveoli
Bronchus (Right Bronchus & Left
(Alveolar air sacs). This Oxygen rich
Bronchus).
blood then enters the Cardiovascular
Each Bronchus connects to a Lung and system & provides oxygen-rich blood to
then further branches out into smaller each and every cell of the body.
branches called Bronchi or Secondary
Bronchus.
The Bronchi further branches out into
even smaller & 3rd order branches
called Bronchioles where it gets further
subdivided and branch out into sub-
bronchi.
Right from the Division of Trachea and
thereafter each division is termed as an
additional generation. There are
approximately 23 generations after
which the branches end at Alveolus
which has a tiny sac-like structure that
is covered with a spider-web kind of
sheet of Pulmonary Capillaries (tiniest
blood vessels) where the exchange of
gas Oxygen and Carbon Di-Oxide
happens. This gas exchange process is
known as Diffusion.
When Oxygen Concentration is high in
the Alveolar air Sacs known as Alveoli,
the walls of the Alveoli are moist and
thin and get thinner as air pressure rises
inside the Alveoli. The walls of the
Alveoli are attached to the Pulmonary
Capillaries.

42
The Role of the Diaphragm in
Breathing
The diaphragm works in response to
the pressure and volume. As the
pressure decreases and volume rises
within the chest cavity during inhalation,
the diaphragm will contract and flatten,
moving up during exhalation as the
pressure increases and volume
decreases, this increases the volume of
atmospheric pressure, it is this change
in atmospheric pressure compared the
thoracic cavity that stimulates the
process to continue and inhalation to
once again occur.
Inhalation Exhalation
Image: Role of Diaphragm in
Breathing
What Structures Support the
Respiratory System, So You Can
Breathe Better?
Muscles
• Breathing can occur at a resting state
which involves the movement of the
diaphragm, and the external
intercostal muscles.
• More forced breathing will occur if we
are under stress or undertaking a
physically demanding activity This
requires the use of the diaphragm,
external intercostal muscles,
scanlines and pectoralis minor.
• Our emotions also affect our quality
of breathing. If we are relaxed, the
breathing is calm and steady, if we
are scared, stressed, or excited, we
breathe faster. Therefore if we are in
a state of chronic stress, it prevents
our ability to breathe freely, which
can further lead to chronic tension,
poor posture and general health
issues.
43
Muscles used during inhalation:
1) Diaphragm
2) External intercostals
3) Scanlines
4) Pectoralis minor
5) Sternocleidomastoid
Muscles used during exhalation:
1) Abdominals
2) Internal Intercostals
Bones and Joints
These joints are involved during
breathing and the better they can move,
the better the respiratory system can
function.
1) Ribs
2) Sternum
3) Vertebrae
How Should My Clients Breathe
During Physical Activity?
Breathing is vital when cueing clients
while they exercise. Often clients can
forget to breathe properly if they’re
concentrating too much on the
movement.
Breathing can play a huge role on the
efficiency of a movement.
Breathing During Weight Training and
Peak Physique Transformation:
Many weight lifters perform a forced
inhalation and exhalation before holding
their breath before lifting a heavy
weight. This breath hold practice
(Valsalva manoeuvre) can be beneficial
to provide a pocket of pressure in the
abdominal and thoracic cavity, which
provides spinal support before exerting
a high amount of power to lift the load.
In the article by Hatzel & Lepley (2012)
they found that using this method for
short periods only have minimal effects
on BP and HR of the athlete.
Detrimental Effects of the Valsalva
manoeuvre:
• If the breath is held for too long, it
can cause dizziness, headaches and
spike in BP and elevate the HR
• If the client has a history of high
blood pressure or cardiac problems,
they should NOT use this method.
Controlled Breathing: The other form
of breathing that can be used is:
controlled breathing where the client
is encouraged to breathe normally.
• In this method there is no stress
added to the exercise.
• Encourage the client to breathe into
their whole body rather than just their
chest so they can expand the rib
cage and support the spine to assist
supporting good posture, exhaling
should happen the same way.
Some important Terms
• The maximum amount of air that can
be inhaled & exhaled is called the
Vital capacity of Lungs.
• The amount of air inhaled and
exhaled with each breathe is called
the Tidal capacity of Lungs.
• The number of inhalation &
exhalation per minute is called as the
Ventilation rate.
• The maximum amount of air one can
inhale in the lungs and hold is known
as the Total Lung capacity.
• The maximum amount of Oxygen
uptake by the lungs for a specific
period of time during an intense
cardiovascular exercise is termed as
the VO2Max.
44
References:

• Davies, A., & Moores, C. (2010). Structure of the Respiratory System. The Respiratory System,
11-28. doi:10.1016/b978-0-7020-3370-4.00002-5
• Carlson, B. M. (2019). The Respiratory System. The Human Body, 303-319. doi:10.1016/b978-0-
12-804254-0.00011-9
• Powell FL, Hopkins SR: Comparative physiology of lung complexity: implications for gas
exchange. News Physiol Sci 19:55, 2004.
• Hall, John E., Guyton, Arthur C. Textbook of Medical Physiology, Ed. 13th 2016
• Strohl KP, Butler JP, Malhotra A: Mechanical properties of the upper airway. Compr Physiol
2:1853, 2012.
• McArdle, William A., Katch, Frank L Exercise Physiology: Energy, Nutrition, and Human
Performance. Ed. 8th Walters Kluwer Pub. 2019
• Hall, John E., Guyton, Arthur C. Textbook of Medical Physiology,13th edition, Elsevier Pub. 2016.
• The John Hopkins University Center for Systems Science and Engineering (CSSE)
https://coronavirus.ihu.edu/map.html
• https://www3.nd.edu/~nsl/Lectures/mphvsics/Medical%20Phvsics/Part%20I.%20Physics
%20of%20the%20Bodv/Chapter%203.%20Pressure%20Svstem%20of%20the%20Bodv/
3.1%20Physics%20of%20breathing/Physics%20of%20breathing.pdf

45
1.1.7 The Skeleton System
The Foundation of a Strong
Athletic Physique
Role of The Skeletal System:
Support to the body’s Mass: Bones are
attached to other bones through
Ligaments & Tendons attach the
muscles to the Bones. Bones of our
limbs and vertebral column support the
body; the mandible and maxilla support
the teeth; and some viscera are
supported by nearby bones.
Protection for Organs: Bones enclose
and protect the brain, spinal cord, heart,
lungs, pelvic viscera, and bone marrow.
Movement of the Mass: Limb
movements, Axial Movements and other
movements are produced by the action
of muscles on the bones.
Electrolyte balance: The skeleton stores
calcium and phosphate ions and
releases them into the tissue fluid and
blood according to the body’s
physiological needs.
Acid base/ balance: Bone tissue buffers
the blood against excessive pH
changes by absorbing or releasing
alkaline phosphate and carbonate salts.
Blood formation: Red bone marrow is
the major producer of blood cells,
including cells of the immune system.
Think of a strong building. It’s built on a
strong foundation. Your skeletal system
is just like that. It provides a strong
structure to build a lean and muscular
body upon.
Participation in movement practices,
physical activity, and nutrition play a
vital role in the health of the skeletal
system.
For example:
• If you develop poor movement
patterns, e.g. sitting for long
periods of time at a stretch, it
changes your body’s alignment
and your posture.
• If you do not provide your body
with the nutrients it needs, the
skeletal system won't have the
fuel to sustain itself and thrive.
• If you do not challenge the skeletal
system enough, the bone
structure weakens and joints
related issues may develop.
How the Skeletal System
Supports a Strong Body:
The bones of the skeleton are
connected to muscles via
tendons.
The junctions bones form are known
as joints. These joints connect to
connective tissue known as
fascia.
It is at the joints where movement
occurs, so maintaining health of
the connective tissue is of great
importance.
46
Overview of the Skeletal System

Skeletal System:
Lateral view
Mandible

Scap Acromi
ula on

Humerus Clavi
cle

intervertebra
disk

iliac crest

Ilium

S.irru
m

ilium

Fem
ur
Cocc
yx

Fibul
a

Navicu Talu
lar s

Met.itars.il
nones

Phalange
s

The Two Key Parts of the Skeletal

System
The skeleton can be divided into two
groups to help us differentiate between
types of bones and their involvement in
the human body.
There are 206 bones in the human body
which is divided into 2 groups :

• The Axial Skeleton: Supporting and

protecting the most vulnerable parts-
you will find these 80 bones making
up your skull, vertebral column, and
rib cage. Marieb & Hoehn, (2007).
Image: Appendicular and Axial
• The Appendicular Skeleton: Skeleton
Supporting movement- these 126
bones consist of upper and lower
body limbs and girdles including the
shoulder and hip girdle. Marieb &
Hoehn, (2007).
47
The Axial Skeleton • The Skull may look like 1 unit but has
22 bones in the Cranium (a bone that
is located on top of your head that
covers & protects Brain) & 14 facial
bones which also covers the lower
jaw bone called Mandible.

Vertebral Column:
• The vertebral column is also referred
to as the spine or backbone of the
body, consisting of 33 irregular bones
arranged in the form of an “S” curve
called vertebrae that make up the
four regions of the back.
• (Here Flexion is shortening of
muscles attached to the Spine
Erector Spinae & Extension is
lengthening of muscles attached to
the spine Erector Spinae).
• Curvature of the Cervical & Lumbar is
Convex in nature from the Anterior
Side (Front Side) which is known as
the Lordotic Curve & the Curvature of
Thorasic & Sacrum & Cocyx together
is Concave in nature from the are
called the Kyphotic Curve.

48
The vertebrae of the backbone are grouped together in 5 groups starting from top:

Number of
Spine Region Role in the Spine
Vertebrae
Top- Cervical 7 (C1-C7) Support and motion of the Head
Upper/Middle- Move with the ribs provide an anchor for the rib
12 (T1-T12)
Thoracic cage.
Support most of the body weight and majority of
Lower back 5 (L1-L5)
force that will pass through the body.

The largest vertebrae of the Spine

Sacrum and coccyx 4-5 (fused) Sacrum: strengthens and stabilizes the pelvis.

coccyx (tail bone): slight support

to the pelvic organs, generally of little to no use

CERVICAL CERVICAL
VERTEBRAE VERTEBRAE

VERTEBRAE
PROMINENS

RIB
FACE
THORACIC THORACIC
VERTEBRAE VERTEBRAE
VERTEBRAE

INTERVERTEBRAE
DISKS

UMBAR INTERVERTEBRAE UMBAR

VERTEBRAE FORAMINA VERTEBRAE

SACRUM

PELVIC
CURVATURE COCCYX

Image: Front and side view of vertebral

column
49
In between the vertebrae are
intervertebral discs that are made of
fibrous cartilage that act as shock
absorbers, allowing the back to move.
Key Roles of the Vertebral Column:
• Maintains upright posture and
balance
• Serves as attachment point for many
muscles
• Supports the head and arms
• Protects the spinal cord
• Allows force, or kinetic energy to flow
through the body during dynamic
movements • The Thoracic Rib cage
has 25 bones including 12 Ribs on
both sides & 1 Sternum in the centre
Appendicular Skeleton
The Pectoral Girdle:
• •The Pectoral Girdle: Pectoral Girdle is a
series of bones connecting the arms to the
axial skeleton at the upper region of the
thoracic cavity. It consists of 2 Clavicle
Bones on either side of the sternum above
the rib cage where the clavicle bones
attach to the clavicular head of the chest
muscle (pectoralis major). Around 2 inches
away from the central axis on the posterior
of the thorax (backside of the thorax), you
would have 2 Scapulae bones.
• The clavicle (most commonly known as
collarbone) is an S-shaped bone located on
the anterior side of the shoulder where it is
attached on its medial end to the sternum
of the thoracic cage, which is part of the
axial skeleton. The lateral end of the
clavicle joins with the scapula just above
the shoulder joint. You can easily feel the
clavicle & can feel the length of it by
touching it with your fingers.
• The Upper Limbs have 2 Humerus (Bone
that supports your Upper arm muscles
Biceps, the Triceps & all the 3 heads of the
Deltoid, 2 Radius & Ulna to support your
forearm muscles & Elbow Flexors,
Metacarpal Bones support the Palm of your
hands & Phalanges to provide support for
your fingers.
• Pelvic Girdle has two hip bones, one on
either side of the axis.
• Lower Limbs contain 2 Femurs that
support the thigh muscles & gluteus
maximus & minimus attaching through the
hip joint with the help of the Pelvic Girdle.
The lower part of the Lower Limbs contains
2 Tibiae & Fibulae , 1 on either side of the
mid axis.Tibiae is the present in the
Anterior part where as fibulae provides
support from the back side & they attach to
the Metatarsal bones which then connect to
phalanges.
50
Now you’ve got an overview of the
skeletal system, let’s take a deeper look
at bones.
Bones: Internal Body Armour
“Bones are the strongest and stiffest
material in the musculoskeletal system.”
McGinnis, (1999).
They come in different shapes and
sizes, depending on their location and
function in the body.
(a) Long bone (c) Flat bone
What are the Different Types of (humerus of (stern
Bones? arm) um)
Here’s a visual overview of the
different types of bones:

(d) Irregular bone

(verte
bra)

(b) Short bone

(carpal of
wrist) Image: Types of
Bones

Bone Type Characteristic Example

Upper body: Humerus, clavicle,
radius, ulna, metacarpals,
Long, cylindrical shaft with irregular or
Long bone Phalanges
widened ends
Lower body: Femur, tibia, fibula,
metatarsals, phalanges
They are shorter in length and
somewhat cubical in shape. They
Carpals of the hands and tarsals of
Short bone consist of spongy bone tissue to
the feet
maximize shock
Absorption
Sternum, scapulae, ribs, ilium, and
Flat bone Thin and protective
cranial Bones
Irregular Vertebrae, pelvic bones, some
Have unique shapes and Function
bone facial bones
Sesamoid They are usually small and round Patella / Knee Cap
bone found in a joint capsule, or where a
tendon may pass over a joint
51
How do Bones Grow?
Like muscles, bones respond to
exercise, enabling their mineral density
and mass to grow, and the bone to
become stronger.
Performing weight bearing activities and
resistance training are ideal for this
adaptation to occur.
Throughout our lives bones can be
renewed using a process of resorption
and formation called remodeling.
• During resorption, old bones are
broken down and removed by cells
called osteoclasts.
• During new bone formation, new
bones are made using osteoblast
cells.
Age, exercise, and the amount of stress
placed on bones influence the speed
and rate of bone growth.
Bilateral Exercise: Less Stability
Exercise Considerations to Support
Healthy Bones:
Move with Correct Technique: This is
essential to be able to minimise uneven
bone wearing, so you can move and
maintain and develop well balanced
general alignment of your skeleton.
Balance Unilateral Stability with
Bilateral Strength: Consider exercises
that require stability to support the
joints.
• If you just focus on bilateral exercises
that cause you to be stable like bench
press and deadlifts, the body can
become rigid over time.
• Unilateral exercises, developing one
limb at a time- are a great compliment
to bilateral exercises. They not only
build better muscle symmetry, but also
support healthier bones and joints.
Unilateral Exercise: More Stability
52
Progressive Resistance: By adding
resistance to the muscle and bone
structures it creates a demand for
strength, so naturally the strength of the
bones improves.
Resistance can be added through
increasing weight being lifted for a given
exercise, or reducing mechanical
leverage to make the exercise more
difficult.
It’s important that the resistance being
applied isn’t too great, or the skeletal
structure can become compromised and
injured.
• It is recommended you begin an
exercise with enough resistance
so approximately 10-15 reps can
be completed.
• As your client’s skeletal system
adapts to this resistance, it may
be appropriate to decrease the
rep scheme (example - 5-7 rep
range), and increase the
resistance to work with this rep
scheme.
Bone Markings: How to Identify
Different Types of Bones
Different bones they generally have
different markings to identify
them by.
Surface markings will assist in
stability of joints and serve as
attachment points for muscles.
There are two categories of
surface markings:
#1. Depressions: These are
flattened parts of bone.
• One common example is a fossa
which can be found as an
attachment point for both the
infraspinatus and supraspinatus
muscle at the shoulder blade.
Sulcus:
Another form of depression is called a
sulcus which is a groove within the bone
to allow soft tissues like tendons to pass
through.
• An example of a sulcus is the
intertubercular sulcus which is
located between greater and
lesser tubercles of the humerus,
(upper arm bone) commonly
known as the groove for the
biceps tendon.
#2. Processes: Another form of
surface marking is a process
which will protrude from bones
so that muscles, tendons, and
ligaments can attach. Common
processes are called tubercle,
trochanter, process, condyle and
epicondyle.
• Examples can be found in the
vertebrae known as the spinous
process, and the coracoid, and
acromion process of the scapula.
Condyles:
• These can be found to form the
knee joint at the bottom of the
femur, (thigh bone) and top of
the tibia (shin bone).
• Epicondyles are commonly found at
the humerus to form the elbow joint.
Tubercles:
• These can be found at the
shoulder joint, with the common
greater and lesser tubercles
which are attachment sites for
the shoulder musculature.
Trochanters:
• These can be found at the femur
which attach to the hip
musculature, hence the greater
trochanter is often referred to as
the hip bone.
53
Joints: Linking Human Movement
Joints are formed by one bone articulating
with another. They can be both categorized
by appearance and function. Although one
joint may move across one plane, generally
the action of joint will affect the action or
response of another, linking human
movement by the kinetic chain and re-
establishing that human body will move
three dimensionally.
Importance of Joint Health in Physique
Transformation
The health of joints in not often considered
when it comes to creating an awe-inspiring
body, however it doesn’t negate its
importance.
If the joints aren’t moving well, it can be a
sign that neuromuscular signals aren’t
functioning well. If left unaddressed, joint
pains and injuries can result. So the better
you get your clients joints functioning, the
better and more frequently they can train.
This will dramatically enhance their results.
How to Classify Joints
#1. Gliding: Moving side to side or back to
front. E. g., Within the body they can be found
between the carpals of the hands and feet.
#2. Hinge: Predominantly within the sagittal
plane, and flexion and extension movements.
E.g. The elbow and knee joints.
#3. Pivot: Rotation usually within the
transverse plane. E.g. The base of the skull and
top of the neck
#4. Ball and Socket: These joints are the most
mobile, allowing movement in all three planes.
E.g. Hip and shoulder joints.
#5. Saddle: Allowing movement in two planes
of motion, the frontal and sagittal
(abduction/adduction, flexion/extension). E.g.
Carpometacarpal joint of the thumb.
#6. Plane/ Condyloid (condylar or
ellipsoidal): Usually can only move between
one plane at a time. E.g. Within the wrist or
metacarpophalangeal joint.

Movement Joint Example

Immovabl Joints of
Fibrous
e the teeth

Partially Cartilagin
Vertebrae
moveable ous

Shoulder
joint,
elbow
Moveable Synovial
joint, wrist
joint, knee
joint etc.

The 6 Types of Synovial Joints

Arthrokinematics refers to joints in motion.
There are six types of Synovial joints:
Image: Types of Synovial
Joints
54
References:

• Cramer GD, Darby SA: Basic and clinical anatomy of the spine, spinal cord, and ANS, St Louis,
1995, Mosby.
• Dail NW, Agnew TA, Floyd RT: Kinesiology for manual therapies, New York, 2011, McGraw Hill.
• Dimon Jr. T: Anatomy of the moving body: A basic course in bones, muscles, and joints, Berkeley,
CA, 2011, North Atlantic Books.
• Drake RL, Vogl AW, Mitchell AWM, et al: Gray’s atlas of anatomy, Philadelphia, 2008, Churchill
Livingstone Elsevier.
• Enoka RM: Neuromechanics of human movement, ed 3, Champaign, IL, 2002, Human Kinetics.
• Hall SJ: Basic biomechanics, ed 6, New York, 2012, McGraw Hill.
• Hamill J, Knutzen KM: Biomechanical basis of human movement, ed 12, Baltimore, 2003,
Lippincott Williams & Wilkins.
• Hamilton N, Weimar W, Luttgens K: Kinesiology: Scientific basis of human motion, ed 12, New
York, 2012, McGraw Hill.
• Kapandji TA: Th e physiology of the joints: Volume one: Upper limbs, ed 5, Edinburgh, 2002,
Churchill Livingstone.
• Levangie PK, Norkin CC: Joint structure and function: A comprehensive analysis, ed 5,
Philadelphia, 2001, FA Davis.
• McGinnis PM: Biomechanics of sport and exercise, ed 2, Champaign, IL, 2005, Human Kinetics.
• Muscolino JE: The muscular system manual: The skeletal muscles of the human body, ed 4, St.
Louis, 2017, Elsevier.
• Netter FH: Atlas of human anatomy, ed 3, Teterboro, 2003, Icon Learning Systems.
• Neumann DA: Kinesiology of the musculoskeletal system: Foundations for physical rehabilitation,
ed 3, St Louis, 2017, Elsevier.
• Oatic CA: Kinesiology: Th e mechanics and pathomechanics of human movement, Philadelphia,
2004, Lippincott Williams & Wilkins.
• Palastanga N, Field D, Soames R: Anatomy and human movement: Structure and function, ed 4,
Oxford, 2002, Butterworth-Heinmann.
• Patton KT, Th ibodeau GA: Anatomy & physiology, ed 9, St Louis, 2016, Elsevier.
• Smith LK, Weiss EL, Lehmkuhl LO: Brunstrom’s clinical kinesiology, ed 5,
• Philadelphia, 1996, FA Davis.
• Watkins J: Structure and function of the musculoskeletal system, Champaign, IL, 1999, Human
Kinetics.
• Werner R: A massage therapist’s guide to pathology, ed 4, Philadelphia, 2004, Lippincott Williams
& Wilkins.
• White TD, Folnens PA: Human osteology, ed 2, San Diego, 2000, Academic Press.

55
1.1.8 Muscular &
Connective Tissue System
Driver of Movement, Star of
Physique Transformation
Lean muscle gains, this is one of the
core focuses of Physique
Transformation. And to support this
goal, first you’ve got to understand how
your muscles work.
Did you know?
There are over 600 muscles in your
body.
Let’s first understand what the major
muscles are called. As you get to know
this, it becomes easier to communicate
muscle locations to your clients and to
medical practitioners.
Muscle Names: Anatomical Terms

So far you’ve learned about the other

systems of the body and how they
support your clients, to not only look at
their best - but also perform at their
best.

In this chapter we’ll cover the basics of

the muscular system and the other
important soft tissues that work with
your muscles. You can then apply this
fundamental knowledge to implement
powerful training and nutrition practices
as you progress through this course.

Muscular System Basics: Essential

Things You Need to Know to Create
Strong Healthy Muscles
Muscles play vital roles in the human
body:

1. Circulation of blood around your

body. Image: Muscle
2. Support movement and mobility, Names
so you can perform physical
exercise.
3. Help you digest the food.

56
Here’s a look at the main muscles you ’ll
need to know about as a Physique
Transformation Specialist:
Three Main Types of Muscles
These include three muscle types: smooth,
skeletal, and cardiac. And they have
different, yet interrelated roles to keep you
performing and looking at your best.
• Skeletal muscles are voluntary. This
means you can control them consciously.
• Smooth and cardiac muscles act
involuntarily.
Each muscle type in the muscular system
has a specific purpose.
Skeletal Muscle Tissue:
Skeletal muscle tissue
contractions move the body by
pulling on bones of the
skeleton, making it possible for
us to walk, dance, bite an
apple, or play the ukulele.
Cardiac Muscle Tissue:
Cardiac muscle tissue
contractions in the heart propel
blood through the blood
vessels.
Purpose of Cardiac Muscles
Your heart beats because of your
cardiac muscle, which helps blood and
other nutrients to be transported around
your body.
Purpose of Smooth Muscles
You can digest your lunch because of
your smooth muscles supporting your
digestive system. How These Types of
Muscle Work Together
The different muscle types also work
together to make the exercising (and
many more such activities) possible.
For example:
While you're performing physical
activities (walking, weight lifting,
playing), using skeletal muscles, your
heart pumps harder, due to the cardiac
muscle, and that causes you to breathe
faster and heavier, using smooth
muscles.
Vital Functions of the Muscular
System

Smooth Muscle Tissue:

Smooth muscle tissue Image: Functions of Muscular System
contractions move fluids and
solids along the digestive tract
1. Creating Movement
and regulate the diameters of
Through co-ordination of muscular
small arteries, among other
contraction and relaxation, movement is
functions.
possible; from simple movements like
drinking a cup of water to complex ones
Image: Types of Muscle Tissue Purpose of
like gymnastics and Olympic
Skeletal Muscles
weightlifting. When your movements are
correct; muscles keep your joints stable
You're able to move around throughout the
and prevent them from grinding and
day and perform physical exercise because
unevenly wearing.
of your skeletal muscles.

57
Alongside movement, your deep
skeletal muscles also keep your
skeleton upright as you walk, stand and
sit. These muscles support balanced
posture and allow joints to align better.
Great posture supports great looking
muscles, so support your clients to build
their big muscles that show on the
surface and their small muscles that
supports the movement of their joints.
2. Driving the Heart
As we mentioned before the cardiac
muscle plays a key role in the function
of your heart. Make sure you keep it as
strong as your biceps.
3. Breathing
Your diaphragm is one of the primary
muscles to support your breathing.
According to Benny Fergusson from
Movement Monk - “Diaphragm plays a
key role in your body that goes beyond
just breathing. As your diaphragm
contracts and relaxes is presses on
your organs (lungs and stomach) and if
the diaphragm is functioning well it acts
like your own internal masseuse.”
4. Digestion
6. Birthing Babies
You may associate the words “push,
push” with childbirth. Well there’s smooth
muscles in the uterus that support this
process.
7. Sight
In your eye socket there’s skeletal
muscles that help your eye to move.
Within your eyes, smooth muscles work to
help you focus and see the beauty around
you.
Sometimes stress, staring at a computer,
and excess training can cause these
muscles to strain, reducing your ability to
see.
Consider practicing some relaxation
techniques to support clarity returning to
your vision.
We will look at Skeletal Muscles in
Depth:
Skeletal Muscle:
Image: Structure of a skeletal muscle
Image

Smooth muscle that runs throughout

your digestive tract keeps food that’s
being digested moving along and helps
you to eliminate what the body doesn’t
need, or can’t absorb.
5. Passing Urine

Yep, every time you go to the toilet

you’re using smooth muscles that make
up your bladder. If you need to stop the
flow you use your PC (pelvic floor)
muscles.
(https://training.seer.cancer.gov/images/a
natomy/muscular/muscle_structure.jpg)

58
1. Structure:
A muscle is made up of thousands of
muscle fibres bundled together in a
connective tissue, and the bundle is
called a fosciculus. A bunch of fosciculi
makes a muscle.
Image Source:
https://training.seer.cancer.gov/anatomy
/muscular/structure.html
A muscle fibre is basically a muscle cell
which is cylindrical in shape and has
multiple nuclei. Each fiber has
cylindrical structures called myofibrils.
Myofibrils attach to the sarcolemma
(plasma membrane), at their ends, so
when myofibrils shorten, the muscle cell
contracts.

Image: Muscle Fibre

Image source:
http://www.opentextbooks.org.hk/syste
m/files/resource/34/34471/35200/media/
image23.png

One myofibril is made up of several

basic functional units called Sarcomere.
(1)

Actin & Myosin:

In a cell, myofibrils (the two filaments:
Actin & Myosin) run along the length
and through number of sarcomeres.

59
Image: Sliding Filament Theory

Image source:
https://opentexthc.ca/anatomyandphysi
ology/chapter/10-2-skeletal-muscle/

Myosin & Actin Differences:

Actin Myosin
• Thin & short • Thick & long
• Consists of actin, troponin, and • Consists of myosin and
tropomyosin meromyosin
• Present in A & I band • Present only in A band
• Less abundant (1 per 6 actin
• More abundant
filaments)
• One end is free, one is attached to Z
• Both ends are free
line
• Slides along Myosin • Doesn’t slide
• Smooth Surface • Rough Surface
• Cross bridges absent • Cross bridges present 60
Sliding Filament Theory: How 2. Muscle Tissue Growth and Body-
Muscles Contract Building

• Muscle tissue is made up of Hypertrophy is a scientific term to

sarcomeres which are the functional describe muscle growth. There are
units of myofibrils. different ways muscles can be trained
• Myofibrils will contain two primary that elicit different types of muscle
growth. It’s important you know them so
protein filaments whose interaction are
you can create an exercise program
responsible for our muscle contractions.
that’s the right fit for the performance
• These protein filaments are called
and appearance goals of your client.
Myosin (a thick filament) and Actin (a
thin filament). Schoenfeld, (2016).
There’s two key types of muscle growth;
• Two protein structures that are also
sarcoplasmic and sarcomere /
important to muscle contraction are
myofibrillar hypertrophy.
tropomyosin and troponin.
• Tropomyosin is located on the actin
filament, and blocks myosin binding
sites from attaching when the muscle is
in a relaxed state.
• Troponin is also located on the actin
filament, and plays a role in muscle
contraction by providing binding sites for
both calcium and tropomyosin when a
muscle needs to contract.
Image Types: Hypertrophy Types
It is the interaction of myosin and actin
that produce contractions. Signals to the Sarcoplasmic Hypertrophy:
skeletal muscle stimulated by the • Sarcoplasmic hypertrophy is an
nervous system begin this sliding increase in the volume of the non-
interaction of myosin and actin, cross contractile muscle cell fluid,
bridges are then formed and broken sarcoplasm.
several times during contraction to • This fluid accounts for 25-30% of the
produce tension to propel the thin muscle’s size. Although the cross
filaments towards the centre of the sectional area of the muscle
sarcomere. increases, the density of muscle
fibres per unit area decreases, and
It is this contact between the myosin there is no increase in muscular
cross bridges and the actin that produce strength.
force. Force can always be produced
but the level of intensity and amount This type of hypertrophy is mainly a
that is produced depends upon three result of high rep, high Volume,
primary factors as outlined by Powers “muscle size / bodybuilding type”
and Howley (2001). training.

(Tsatsouline, Pavel. Power to the

People. Dragon Door Publications,
Inc., 2000.)
61
How Different Types of Hypertrophy Training
Lead to Different Performance and Look

Sarcoplasmic Hypertrophy Sarcomere / Myofibrillar Hypertrophy

Training Methods to Promote Optimal Muscle

Growth
Perform training methods that stimulate both
sarcoplasmic and myofibril hypertrophy:
1. By practicing sarcoplasmic hypertrophy
methods you’ll stimulate growth in
sarcoplasmic fluid in the muscle cells.
2. By performing training methods that
induce sarcomere hypertrophy you’ll
stimulate greater growth in the number
of myofibrils, which increases density of
the muscle.

62
A useful training protocol to do this is:

Muscle Building Training Protocol

[Part 1]
Perform a set of:
low reps (2-5 reps)
x high load (70-90% of 1RM)
or x high force = mass x acceleration (50-60% of 1RM).

[Part 2]
Then for the same muscle group, follow with a set of:
high reps (10-15 reps)
x moderate load (50-60% of 1RM).

Repeat part 1 & 2 for 3-5 sets.

63
3. Muscle Fiber Types

Type I Type IIA Type IIB

Alternatively known as
Slow oxidative Fast oxidative Fast glycolytic

Presence of Mitochondria
High in number moderate in number Low in number

Number of capillaries High Moderate Low

Color Red Pink White

Diameter Small Medium Large

Size of Motor Neuron (bigger

motor neurons allow nerve Small Large Very Large
impulses to operate faster)
ATPase Concentration Low Medium High
Speed of Contraction Slow Medium Fast (10X of TypeI

Conduction Velocity Slow twitch Fast twitch Fast twitch

Activity aerobic Long term anaerobic Anaerobic

Duration of Contraction Long (Hours) Few minutes Short (<1 minute)

Fatigue resistant Fairly resistant Easily
Power of Contraction Intermediate (5-6 High (20 times of
Low
times of type I) type 1)
Storage Creatine
Creatine phosphate,
triglyceride Phosphate,
glycogen
glycogen
Lactate Removal Rate Highest High Slow
Oxidative Capacity High Medium Low
Glycolytic Capacity Low Medium High
Activities Performed Long term Short term
Long term anaerobic
aerobic anaerobic
Examples of Activities It Marathon
Engages In 400m-800m sprints Short sprints
running

64
4. Muscle Fibre Actions During Physical
Exercise
As you move or perform various training
activities, your muscle fibres adjust to your
activity and play different roles to
encourage better performance and prevent
injury.
Here are some of the roles muscle fibres
take during movement:
Synergists: The muscular system will
never just have just one muscle working,
there will always be another muscle or
group that work as synergists that support
the bone structure to limit the force or
oppose the action.
Stabilizers: Some muscles will work as
stabilizers during muscular action provide
stability during movement of prime movers
and synergist muscles.
Agonists /Prime Movers: The muscle
fibres which provides the bulk of the force
is known as the Agonists or prime movers.
Antagonists: The muscles which oppose
the force, or assist to regulate the action
are known as the Antagonists.
For example: when you contract your leg in
a leg extension, the hamstring will be
encouraged to relax to allow the movement
to occur.
Force Couple Relationships: This term
refers to the synergistic action of muscles
grouping together to produce force around
a joint. This creates the three dimensional
relationship of how the body's systems
work together to produce movement.
Common force couple relationships are:
• Internal and external obliques to produce
trunk rotation.
• Upper trapezius and lower part of the
scapula for upward rotation of the
scapula.
Muscle Contraction Types The three
main muscle actions are:
Eccentric Contractions:
• The lowering, or decelerating phase
of a movement.
• Tension is produced when the
muscle lengthens and the actin and
myosin cross-bridges are pulled apart
and reattached. It is often known as
the negative phase because it is
moving with the resistance rather
than against, it does this to
decelerate the force and movement.
Exercise Example: Lowering phase
of weight lifting / resistance
training, landing when jumping.
These types of contractions are
very effective at stimulating both
sarcoplasmic and myofibrillar
Concentric Contractions:
• The raising / lifting, or accelerating
phase of a movement.
• Tension is produced when the
muscle length shortens, and the actin
and myosin move together (sliding
filament theory) and the contractile
force is greater than the resistive
force.
Exercise Examples: Lifting phase of
weight lifting, jumping upward,
punching, kicking, throwing.
Team Boss Bodybuilding Tip::
To stimulate maximum muscle growth,
combine a powerful concentric
contraction (lift as fast as possible with
quality technique), with a slow and
controlled eccentric contraction (3-10
seconds).
65
Isometric Contractions:
• The pausing phase of a movement.
• This is when the force at contraction
and resistance is the same so there
is no change in muscle length.
• This type of contraction can be seen
when muscles stabilize to prevent
limb movements over stretching, or
shortening or moving in unwanted
directions.
Exercise Examples: Pausing phase
when weight lifting, rotator cuff
stabilization during the bench press.
Isokinetic contractions:
These type of contractions can only be
produced using specialized machines
which stimulate an ongoing
shortening and tension of the muscle
through full range of motion. It is
often used for muscular strength,
endurance and neuromuscular
benefits.
5. How is Muscular Force Produced?
1) The number of motor units recruited
2) The initial length of the muscle
3) The nature of the neural stimulation of
the motor units
McGinnis, (2005) defines force as a push or
pull movement, where objects are either
exerted upon or objects are exerted upon
others, force enables us to move in motion
and be accelerated, to be stopped or
decelerated and change direction.
Muscular Force = Mass (weight) x
Acceleration
6. Muscle Length tension relationship
This refers to the dependence of the
sarcomere length to produce tension and
maximal force.
• Active length tension relationship is
referring to the overlap of the myosin and
actin. If there is too much overlap then
there is no space to lengthen the
sarcomere and produce force. Think
about when your muscle has reached full
contraction, for instance, at the end of a
bicep curl, it is almost in a relaxed state
and the force available has been reduced
by the high level of tension and shortened
length of the sarcomere.
• Passive length tension relationship is
similar in the outcome but is referring
more to the resting state of a muscle
when it has reached full extension, looking
at the bicep curl once more at the end of
the movement when the arm reaches
extension the myosin and actin have been
stretched too far apart and so tension has
been reduced and muscular force is
minimal
• A happy medium is then needed to create
maximal levels of force and tension for
muscular growth. Both active and passive
tensions are needed to produce the
optimal levels of force. Multi joint
exercises allow this relationship a muscle
group to be in active tension as well as
passive tension, creating a positive force
couple relationships of more muscular
recruitment to work synergically for
greater levels of force and increase
muscular size.
7. Muscle Fatigue
Delayed Onset Muscle Fatigue (DOMS) is
the feeling of pain or discomfort which
occurs post training, usually in the first 72
hours of training (Santos R C et al, 2016).
It is an unfamiliar neuromuscular response
signaling the brain to not only learn new
movements, but also for the muscles to
adapt to new demands. The signal of pain is
executed to communicate with the individual
to rest the area, so that muscles can repair
and positive adaptations can occur.
66
http://slideplayer.com/slide/4428030/
Reflex Arc:
A reflex is a rapid response to a
stimulus occurring without our control or
premeditated thought.
As we develop, we are constantly
absorbing new information and forming
new patterns within our brain to control
our movement and reactions to certain
stimuli. These patterns can be simply to
stand still, something that is quite
difficult to do as a child but the more we
practice, the less we have to think about
the process of complex muscular
contractions and forces that occur within
our body.
Image: The Nervous System Reflexes
Stretch reflex
In this type of reflex the muscle spindles
are stretched when a muscle lengthens
this excites the motor neurons causing
the alpha motor neurons to send a
signal to inhibit the contraction to
prevent overstretching. At the same
time the opposing muscle will relax to
prevent injury.
Reciprocal inhibition
This process describes the relationship
and synchronicity of both the agonist
muscles and antagonist muscles
working together to prevent the muscles
from overacting and tearing.
Whilst one side of a muscle joint relaxes
the other will contracts. If you have two
muscles, both contracting and firing,
then there can be overpowering of the
stronger muscle causing the weaker to
tear.
67
Connective Tissue: Supporters
to the Muscular System
You can’t have great looking muscles
without a support team behind you. And
that support team consists of the fascia The fascia forms the largest system in the
system, ligaments and tendons, which body as it is the system that touches all the
we’ll discuss below. other systems.’
. \ >. - James L. Oschman, PhD

Fascia System: The Web That

Connects the Whole Body
With a focus on movement and
exercise, the fascia system acts like a
suspension system for the muscular
and skeletal system. It’s a springy, web
like structure that wraps around almost
every area of the body (muscles,
organs, bones, etc).

How Fascia Supports Strong

and Supple Muscles
Notice in the illustration below how the
fascia wraps around every layer of the
muscular system from the surface
layers to the deep layers.

Fascia binds muscle tissue and gives it

structure. It can support to create
movement and allow muscles to grow in
size when it is healthy, and it can
restrict movement and prevent muscle
growth when it’s not able to move freely.
Where each muscle group starts and Image: Fascia
ends at certain joints, the fascia keeps
going. Fascia webs wrap from your
head to your toes and assist you during
physical training via the expression of
myofascial lines.

68
What Are Myofascial Lines?
Fascia unites and connects every
system in your whole body. Consider
how your skin works to keep everything
in place and from falling out all over the
ground.
Your fascia behaves in a similar manner
towards your skin, and has other unique
qualities. It has no start and no end, and
forms a web like structure to support
your muscles during movement via
myofascial lines of stretch. In essence
myofascial lines are chains of
connective tissue that run throughout
and across lengths of your body.
Here’s how myofascial lines form during
physical activity:
Image: Myofascial Lines
How Releasing Fascia Can Support
Muscle Growth
Imagine for a moment you’re blowing up
a balloon, and it’s wrapped in another
balloon made of Kevlar. You keep
blowing and blowing, but your balloon
isn’t getting any bigger. It can be
because the Kevlar balloon that’s
wrapping your balloon is restricting it.
In this analogy the balloon you’re
attempting to blow up represents your
muscles and the Kevlar balloon that’s
restricting you represents the fascia.
Fascia is a much stronger and denser
tissue than muscle tissue, and it has
been found effective to apply various
fascia stretching methods to give
muscles more space to grow.
69
Team Boss Training Tip
You can stretch the fascia during your
resistance training exercises. Just use the
Hold at the End method.
For example; you’re performing a lying
dumbbell pec fly exercise. Don’t just stop at
the end of your designated reps, you ’re
leaving the fascia stretching and muscle
growth opportunities on the table.
At the end of the set, relax in the end
position of the exercise and allow the
weights to gently stretch your fascia tissue.
Breathe slowly and hold for 30-60 seconds
for best results.
This will create more space for blood to flow
into your muscle tissue and allow them to
grow more.:
Ongoing Research Recommendations
into Fascia
The topic of fascia alone with regards to
movement and physical performance could
fill this course alone. For further insights on
this topic it is recommended to research the
approach of Tom Myers of Anatomy Trains
for an anatomical overview of fascia.
To learn how to remodel the fascia system
and dramatically improve the way it moves, it
is recommended to look into the work of
Benny Fergusson from Movement Monk.
Ligaments: Connecting Bones to
Bones
Ligaments are the fibrous connective
tissue that connects bone to bone,
providing both static and dynamic
stability and feedback via proprioception
to the nervous system.
Here’s a visual of how ligaments work
around the knee joint:
Image: Knee Joint Ligaments
• Ligaments are made up of both
collagen to produce tension or strength,
and elastin to provide them with
flexibility. Ligaments within the body will
have a varied supply of both proteins
depending on their role stability and
movement within the body.
• Ligaments have a poor blood supply,
so their adaptability stress and exercise,
and their ability to recover can be slow.
70
Tendons: Connecting Muscles to
Bones
Tendons attach muscle to bone,
providing an anchor of where muscle
force can be controlled during
movement.
Image: tendons
Tendons attach muscle to bone,
providing an anchor of where muscle
force can be controlled during
movement.
Strong Muscles, Weak Tendons
Leads to Weak Joints.
While creating exercise programs, you
should include movements that develop
the strength of the tendons. This will
make your clients much more resistant
to injury, as tendons are the final
connection from the muscle to the bone.
How to Build Tendon Strength:
• To build tendon strength it’s useful to
feature heavy strength training into
your clients practice.
• Don’t rush into it though, as there is a
higher risk to injury. Gradually build
up your client's resistance training
intensity towards 80% of 1RM.
• Other more gentle practices like Tai
Chi are also very useful to improve
tendon strength, especially for the
lower body - from the low stances
and slow movements.
71
Muscles and Movements: How Muscles
Coordinate to Support Physical Activity
and Physique Transformation
By now you understand the names of the
major muscle groups, and how muscles
work and grow. In this lesson you’ll be
learning how the muscular system
coordinates to form movements around
major joints in the body. This is a core
component in designing physical training
programs that produce great physique
results and minimise injury.
Key Areas That you’ll learn about:
1. Shoulder Complex
2. Abdominal Complex
3. The Back
4. The Lower Limbs
The Shoulder Complex: Building
Shoulders Like Boulders
3 Key Parts of the Shoulder
Complex
The shoulder complex is made up of
the:
1. Shoulder girdle which is made up of
the scapula,
2. Clavicle (collar bones),
3. and the shoulder Glenohumeral joint
(shoulder socket).
4 Joints of the Shoulder Complex
The shoulder complex consists of four
joints:
1. Sternoclavicular: Connecting the
sternum to the collar-bones.
2. Acromioclavicular: Connecting the
shoulder blade to the collar bone.
3. Glenohumeral: Connecting the
shoulder socket to the humerus.
4. Scapulothoracic: Connecting the
shoulder blades to the thoracic spine.
Shoulder Movement and Muscle Gains
The girdle and joint are very mobile working
together to give the shoulder full range of
motion. If you improve the way the shoulder
moves whilst increasing the resistance this
area can bear, symmetrical muscle gains
can result.
Balance Mobility and Stability for Best
Shoulder Training Results
With more range and mobility comes a
decrease in stability, so when prescribing
exercise programs there should be an
emphasis on shoulder stabilization and
technique to protect this joint.
Common Shoulder Injuries
Common injuries that can occur are;
• Rotator cuff injuries,
• Postural issues which lead to poor
shoulder mechanics and neck tension.
When working with clients who may
be experience such injuries it is
important to recognize when it is
appropriate to refer to allied health
professional for rehabilitation, and
then personal training programming
can assist with strengthening post
rehabilitation.
72
 Strength training using slow and The Abdominal Complex: Muscles
controlled movements through circular and Movements of the Core
movements like circumduction can be
beneficial to stabilize and strengthen the Torso stability is a key requirement for
shoulder complex. This can be efficient movement and postural
supportive for general strength and protection and stability. The abdominals
mobility improvements and to will initiate this stabilization for any
rehabilitate injuries. movement, especially when it comes to
peak physique training and heavy lifting.
Muscles and Movements of the The abdominals are made up of layers:
shoulder joint
The superficial layer consists of: Rectus
Movement Muscles involved Movement Abdominus with fibres running vertically
example
Taking the arm Then we have the: External obliques
away from the with fibres on a 90 degree angle to the
Suprinatus body during a fly is
Abduction Initiated by the deeper internal Obliques The deepest
Deltoid supraspinatus layer is made up of:
before the deltoid
takes over The Transversus abdominis (TA) has
Bringing the arm fibres running horizontally. The TA also
Coracobrachialis back to the midline
Pectoralis major assists in expiration by decreasing the
Adduction Lattisumus Dorsi and holding and angle of the ribs and compressing the
Teres Major stabilising the
shoulder joint. internal viscera.
Pectoralis major
Deltoid (anterior
Flexion fibres)
Coracobrachialis
Biceps (long head) Moveme
Moveme
Lattisumus Dorsi Muscles involved nt
nt
Teres Major Downward stroke Example
Extension Pectoralis major motion when
Deltoid swimming
Triceps (long head) Rectus
Subscapularis Abdominus
Medial Teres major Trunk External Oblique
Lattisumus Dorsi flexion (bilaterally)
Rotation Pectoralis major
Deltoid Internal Oblique
Teres minor (bilaterally)
Lateral
Infraspinatus
Rotation Deltoid External Oblique
Lateral
(unilaterally)
Internal Oblique
Flexion
(unilaterally)
Stabilizat Transversus
ion Abdominus

73
Posterior abdominal wall:
These are not considered to be
abdominal muscles but they will work in
synchronicity to provide core stability
and improved posture.
These muscles are:
• The iliopsoas also with the psoas
major, psoas minor and iliacus
muscles
• Quadratus lumborum
The Back Muscles: Movements of the
Spine
The back consists of the Cervical
region, the thoracic, the lumbar and the
sacral. In this section we will focus on
the muscles and movements associated
with the lumbar and thoracic regions of
the spine.
Like the movement of the abdominals
the back muscles will also work either
simultaneously in pairs for contraction
(bilateral contraction) or one sided
(unilateral contraction).
Key Postural muscles of the back:

Movement Muscles involved Movement example

• Rhomboid minor
• Retraction • Rhomboid major • Drawing the shoulder blades back
• Trapezius
• Seratus Anterior
• Protraction • Rounding of the shoulders
• Pectoralis Minor
• Trapezius (upper
fibres)
• Elevation • Shrugging the shoulders
• Levator
• Scapulae
• Trapezius (lower
• Pec girdle is pulled downward, carrying
• Depression fibres)
a load in the hands
• Pec Minor
• Lateral • Trapezius
Rotation • Serratus anterior
• Rhomboid major
• Rhomboid minor • These muscles contract strongly when
• Medial
• Pectoralis minor moving the weight of the body on a bar
Rotation
• Levator to perform a chin up
• Scapulae

74
Additional information about muscle
attachments and movements can be
found in the text by Palastanga, Field, &
Somers, (2006). Anatomy and Human
Movement: Structure and Function.
Muscles and movements of lower
limbs
Postural Alignment and Balanced
Muscle Function
When looking to maintain or improve a
healthy postural alignment the above
movement’s with the pelvis, legs, back
and abdominals should be considered.

The key role of the lower body is to
provide stability and locomotion for the
body. Our bipedal way of of moving and
the size of our pelvis is a key
component of what makes us human.
So when training the lower body we are
often looking deeper into strength and
stability to assist in postural alignment
and locomotive functioning.
Exercises that support this mobility and
protection are advised including
contralateral movements that support
the mental awareness and connection
to how the body works from one side to
the other.
Balance exercises are a great way to
view any compensatory patterns or
postural abnormalities. Using the
guidelines within the Fitness appraisals
unit of this course are a great starting
and maintenance point to work with.

Movement Muscles involved Movement example

• Iliopsoas (psoas major and iliacus) is the
• Hip Flexion most powerful flexor, assisted by sartorius, • Squat
rectus femoris, and pectineus.
• Gluteus maximus is the most powerful hip
extensor, assisted by the hamstring • Bridge, barbell hip
• Hip extension
muscles (semitendinosus, Semimembranos thrust
us, biceps femoris)
• Gluteus medius and minimus arethe most
• Hip abduction powerful hip abductors, assisted by • Lateral band walk
piriformis and tensor fasciae latae.
• Adductor longus, adductor brevis, adductor
• Hip adduction magnus, and gracilis are the powerful hip
adductors, assisted by pectineus.
• Gluteus medius and minimus, and the
• Medial rotation • Leg circles
adductors (longus, brevis, magnus)
• Gluteus maximus is most powerful, assisted
by piriformis, obturator internus and
• Lateral rotation
externus, the gemelli, and quadratus
femoris.
• Hip • All muscles that move the quadricep
circumduction
75
References:

• SEER Training Modules, Structure of Skeletal Muscle. U. S. National Institutes of Health, National
Cancer Institute. https://training.seer.cancer.gov/anatomy/muscular/structure.html
• The Muscular System Manual The Skeletal Muscles of the Human Body by Joseph E. Muscolino.
• Dail NW, Agnew TA, Floyd RT: Kinesiology for manual therapies, New York, 2011, McGraw Hill.
• Watkins J: Structure and function of the musculoskeletal system, Champaign, IL, 1999, Human
Kinetics.
• Patton KT, Th ibodeau GA: Anatomy & physiology, ed 9, St Louis, 2016, Elsevier.
• Palastanga N, Field D, Soames R: Anatomy and human movement: Structure and function, ed 4,
Oxford, 2002, Butterworth-Heinmann.
• Netter FH: Atlas of human anatomy, ed 3, Teterboro, 2003, Icon Learning Systems.
• Dimon Jr. T: Anatomy of the moving body: A basic course in bones, muscles, and joints, Berkeley,
CA, 2011, North Atlantic Books.

76

1.2 Biomechanics
1.2.1 Exercise Performance Analysis
Techniques
1.2.2 Muscular Force
1.2.3 Planes of Motion
1.2.4 Motion
1.2.5 Axis of rotation
1.2.6 Levers
1.2.7 Muscle Movement Terminology
1.2.8 Muscle Location Terminology
The role of biomechanics in sport and training
is performance improvement and injury
prevention. Certain analysis techniques can
be used to observe performance, and offer
assisted evaluations for the trainer to better
coach and correct exercise performance.
Some of these analysis’s can only be used by
an Exercise Scientist or physiologist like the
use of force plates, or electromyography
(EMG) which record muscle activity or
inactivity.
Other analysis techniques that require special
equipment and that are readily available for
personal trainers which are given below.
1.2.1 Exercise Performance Analysis
Techniques
1. Qualitative anatomical analysis
‘How to perform a Qualitative anatomical
analysis’, as explained by McGinnis, (2005).
1)Breakdown the movement into temporal
phases of motion. E. g., Up phase and
down phase.
2)Identify the body segments and joint
motions involved in the movement.
3)What type of muscular contraction or force
is involved in the skill and what
muscle/muscle groups are involved.
4)Identify what muscles are involved in
performing the most effective technique
How to assess what muscles are involved:
How to assess what muscles are involved:
Look to see if superficial muscles are visibly
contracting. E. g., are biceps visibly working
when performing a bicep curl.
With permission from the client we can
palpate or touch to feel the superficial muscles
that should be contracting during the specific
movement. E. g. Can you feel the stomach
muscle actively tense when performing a
plank? if the muscle feels weak or soft then it
is a good indicator that the muscle is inactive
or potential compensations are existing
elsewhere.
2. Video recording for assessment and
analysis: Video recording can also be a
valuable assessment tool for both trainers and
instant feedback for clients to observe
technique. The footage can readily be viewed
more than once and can be a great tool to
observe change in performance and
progression for both the client and trainer.
77
1.2.2 How is Muscular Force
Produced?
McGinnis, (2005) defines force as a
push or pull movement, where objects
are either exerted upon or objects are
exerted upon others, force enables us
to move in motion and be accelerated,
to be stopped or decelerated and
change direction.
The maximum force that a muscle can
exert depends on its cross-sectional
area (perpendicular cut) and is inherent
to the structure of muscle filaments.
Muscular Force = Mass (weight) x
Acceleration
1.2.3 Planes of motion
When designing physical training
programs that make your clients
muscles look better it’s important you
also keep their movement balanced
across three key planes of motion, to
ensure both muscle symmetry and
reduce injury risk.
The body is split into different planes
which each cross through the centre of
mass of the body. The 3 key planes of
motion are: frontal, sagittal and
transverse.
When performing exercises, the movement
is performed on a plane running
perpendicular to an axis. Although there is
a more dominant plane the action is being
performed in. It is important to keep in mind
however that with each movement, there
will be a connection that links the body to
work integratively.
1.2.4 Motion:
Motion depends upon force acceleration
and mass. For example the if the human
body has excessive amounts of mass and
the person is overweight it will be more di
cult to create an accelerated force then it
would be for a person with less body mass,
Burkett, (2010)
The body can move in a Linear direction,
Angular or general motion. These motions
are affected by our centre of mass, the
force or velocity of the body or object. The
body can also be completely still or
resistant to motion which is known as
inertia.
Linear motion:
Linear motion is when all points of the body
move in the same direction at the same
time, McGinnis, (2005).
E. g., Generally this occurs more with
objects such as pushing an object in a
straight line, because our limbs and
muscles have to work together they’re
never really moving all in a straight line.
Linear motion may also be thought of as
motion along a line. If the line is straight,
the motion is rectilinear; if the line is curved,
the motion is curvilinear.
E. g., When you sit on the bike without
making any movement while the bike is in
motion can be termed as Rectilinear
Motion, whereas when you sit on the bike
drunk and you can’t ride the bike in a
straight line & you end up driving in a
curved fashion it becomes Curvilinear
motion.
78
Angular motion/Rotary motion:
This is when all points of the body move
in circles around a central imaginary line
known as the axis of rotation, which is
oriented perpendicular to the plane in
which the rotation occurs.
According to McGinnis (2005), we see
such motion all the time- almost every
time our limbs are isolated.
E. g., When we perform a twisting
movement.
General motion:
This is the most common form of motion
that we would see within the human
body, combining both linear and angular
motion.
E. g., When we extend the elbow and
horizontally adduct the shoulder we can
produce a linear motion at the hand,
McGinnis, (2005).
Newton's three laws of motion:
These three laws of motion will help you
to understand how change in force,
gravity and changing objects all affect
our motion in relation to exercise and
peak physique conditioning.
Newton’s second law:
The second law refers to acceleration.
We can use the equation Force= Mass x
Acceleration to help us explain.
The law explains that the amount of
force acting on the body in a given
direction is equal to the amount of force
multiplied by acceleration.
‘For example the more force that is
produced depending on the mass will
produce a higher acceleration.
Newton’s third law:
The final law of motion refers to
reaction, stating that for every force
applied there is always an equal and
opposite reaction force. This can be
explained by looking at ground reaction
forces in jumping or running, or the
impact or force our body applies to the
ground’s surface, as we land, according
to the law there will be an equal reaction
force that is applied back from the
grounds surface to the body. This is
why in training with plyometrics it is
important to cue bending the knees so
this reaction force can be absorbed over
a greater surface area, minimizing the
impact of the reaction.

Newton’s first law:

This first law of motion refers to the law

of inertia where movement will continue
in a straight line unless an external
force acts to change that straight line of
motion.
For example in weight training the
outside resistance of a weight on the
body will slow or alter the movement
compared to a lower weight or if we
were performing an exercise with just
body weight.
79
1.2.5 Axis of Rotation A. Motion occurring in the sagittal plane
The Earth revolves around its axis. So the around a mediolateral axis.
Axis of Earth becomes the Axis of Rotation. B. Motion occurring in the frontal plane
• An axis is an imaginary line around around an anteroposterior axis.
which a body part moves. If a body C. Motion occurring in the transverse
part moves in a circular path around plane around a supero-inferior axis, or
an axis, it is described as an axial more simply, a vertical axis.
motion. D. Motion occurring in an oblique plane;
• The non-axial motion is when the around an oblique axis.
body part moves in a straight line.
Both axial and non-axial motions of a Exercise
Plane Axis Movement
body part move within a plane. example
However, an axial motion moves Sagittal: Flexion/ Bicep curl
within a plane and around an axis. Divides Extension Squat
• The orientation of the axis for an axial the body
Coron
Front lunge
movement is always perpendicular to al
into left Running
the plane within which the movement and right. Walking
is occurring.
Frontal: Abduction/ Side lunge
• There are three fundamental axes as Divides adduction Side lateral
each plane has its own Anter
the body Lateral flexion raise
corresponding axes. ior/
into front Eversion/
poste
• The axis for sagittal plane and Inversion
rior
movements is oriented side to side back.
and described as the mediolateral
axis. Transvers Internal/ Trunk
• The axis for frontal plane movements e: Also external rotation
is oriented front to back and known as Rotation Cross
described as anteroposterior axis. the Horizontal punches
• The axis for transverse plane horizontal Long abduction Dumbbell
plane, itudin Horizontal chest flies
movements is oriented up and down divides al adduction
and described as supero-inferior or the body Left/right
simply vertical axis. into top rotation
and
bottom.

Image source: The Muscular System

Manual: The Skeletal Muscles of the
Human Body By Joseph E. Muscolino

80
1.2.6 Levers
Exercise machines have been made to
support the existing muscular
mechanics of the body. To exert
movement, force and stabilize the body
can be classed in 3 different types of
levers: Fulcrums or axis is the term
used to describe the joints of the body,
and the bones will act as levers or a
load, the muscles describe the e ort
used to move a load or resistance.
The Actions of levers in the human body
are described in the text by Marieb &
Hoehn, (7th edition).
First class levers:
First class levers are those where the
force or effort is applied at one end, the
fulcrum is in the middle and the load is
at the other end.
Flexion and extension movements, such
as, the movement of lifting the head to
neutral from the chest is an example of
this type of lever. The muscular effort
comes from the musculature in the
neck, the resistance is the weight of the
head over the chin.
Second class levers:
Second class levers are those where
muscular e ort is applied at one end of
the lever, and where the load was at
one end in a first-class lever, this time
the fulcrum or joint is at the opposing
end, leaving the resistance or load in
the middle.
These movements are rare within the
human body but an example of this
lever in action would be standing on the
tips of the toes where the
gastrocnemius and calf muscle work
strongly to pull the leg up from the
resistance of gravity and the heel back
to the ground.
Third class levers:
The final lever, the third class, which is
the most common lever for human
movement. The effort is in the middle of
the lever and load and fulcrum on either
end. These levers will work with more
speed than the other two with an
example being a bicep curl where the
bicep muscle works hard when lifting
the weight or load of that of a dumbbell
around the elbow joint as the fulcrum.
81
 1.2.7 Muscle Movement Terminology
Plantar / DorsiFlexion
The Building Blocks of a Well • Dorsiflexion: Flexing the ankle with
Balanced Training Program the foot moving upwards (toes
towards you).
It is essential for Physique Transformation ● Plantar flexion: Flexing the ankle
Specialist students to understand the with the foot moving downwards,
terminology used when describing the (away from the body).
body's position in relation to anatomical
structure and positioning when standing Eversion / Inversion
erect to the changes during exercise. • Eversion: Turning the sole of the foot
Muscles can only pull on bones to create laterally (outwards).
movement. Each of these movements • Inversion: Turning the sole of the
illustrate different ways to describe the foot medially (inwards).
contraction phase of a movement.
Each of these movements are paired, and Pronation / Supination
relate to each other, except for • Pronation: Rotating the forearm with
circumduction. the palm rolling inwards, or the
foot medially.
• Supination: Rotating the forearm
Flexion / Extension with
• Flexion: Decreasing the inner angle of the palm rolling outwards, or the foot
the joint. E. g., Spinal flexion is to laterally.
bend over.
• Extension: Increasing the inner angle Elevation / Depression
of the joint. E. g., Spinal extension is • Elevation: Lifting upwards, shrugging
to straighten up or stand up tall. the shoulders.
• Hyperextension: Extension beyond • Depression: Moving
normal range. E. g., Knee or elbow downward,returning the shoulders.

Abduction / Adduction Protraction / Retraction

• Abduction: Moving away from the • Protraction: Drawing forward moving
midline of the body. E. g., Performing anteriorly. E. g., Chin out.
a fly taking the arm away from the • Retraction: Drawing back/ moving
body. posteriorly. E. g., Chin in.
• Adduction: Moving towards the midline
of the body E. g., Returning the arm Combining Many Patterns
to the body. • Circumduction: circular or conical
movement.
Medial / Lateral Rotation
• Medial Rotation: Rotation of a limb
towards the midline. E. g., Turning
the leg inwards so that the toes point
towards the midline.
• Lateral Rotation: Rotation outwards
away from the midline.

82
1.2.8 Anatomical Terms to
Describe Muscle Location
Understanding anatomical terms are
important for communicating the
location of muscles, or the position of
movements with clients and medical
practitioners. Once again they have an
inverse relationship.
Anterior / Posterior
• Anterior: Towards the front of the
body. E. g., The patella lies
anterior tothe knee joint.
• Posterior: T owards the back of
the body. E. g., The gluteus
maximus lies posteriorly to the
hip joint.
Ventral / Dorsal
• Ventral: Towards the front of the
torso.
• Dorsal: Towards the back of the
torso.
Medial / Lateral
• Medial: Towards the centre or
midline.
• Lateral: Away from the midline or
away from centre.
Proximal / Distal
• Proximal: Towards the centre of
the body or another structure
• Distal: Away from the centre of the
body or another structure
Longitudinal / Transverse
• Longitudinal: Vertically
• Transverse: Horizontally
Axillary / Caudal
• Axillary: Toward the armpit
• Caudal: Toward the gluteals
(buttocks)
Cranial / Inguinal
• Cranial: Toward the head
• Inguinal: Toward the groin
Palmar / Dorsal
• Palmar: On or towards the palm of
the hand
• Dorsal: On or towards the back of
the hand or top of the foot
Supine / Prone
• Supine: Lying on your back
• Prone: Lying on your front

Superficial / Deep
• Peripheral / Superficial: Towards
the outer surface of the body.
• Deep: Towards the inner surface
of the body.

Inferior / Superior
• Inferior: Below or towards the
bottom. E. g., The knee is
inferior to the hip.
• Superior: Above or towards the
top. E. g., The head is superior
to the trunk.

83

1.3 Hormones
1.3.1 Insulin
What is insulin?
Insulin is a hormone produced by
pancreas and it helps us convert dietary
carbs into energy or into glucose for
further use.
Insulin is one of the hormones that are
required to regulate blood sugar level by
allowing cells in muscles, fat, and liver
to absorb it.
Harry’s Comment: ALL FOODS
TRIGGER INSULIN RESPONSE.
When we eat food, blood sugar rises,
and pancreas are signalled to release
insulin. Insulin then attaches to cells
where energy is needed (cells need
glucose but blood sugar can’t directly
enter cells) and now cells can absorb
sugar from blood.
If cells do not need energy, the sugar is
then converted into glycogen in liver for
further use.
If body doesn’t produce insulin (Type I
diabetes) or doesn’t produce in enough
quantities/is resistant to it (Type II
diabetes), blood sugar stays high
causing hyperglycemia.
Insulin Index (II)
II is how much the consumed food
elevates the concentration of Insulin in
blood in period of 2 hours consumption.
The II can be more useful than either
the glycemic index or the glycemic load
because certain foods (e. g., lean meats
and proteins) cause an insulin response
despite there being no carbohydrates
present, and some foods cause a
disproportionate insulin response
relative to their carbohydrate load.
Insulin Resistance (IR):
In order to understand IR, we need to
understand Insulin Sensitivity (IS) first.
IS refers to the body’s ability to
efficiently dispose of blood glucose.
Active individuals are more insulin
sensitive than those who have
sedentary lifestyles. When a person
consumes foods that keep the blood
sugar high for pretty much all the time,
for long periods, the insulin receptors in
cells stop responding to presence of
insulin in blood, and do not let the blood
glucose in. This is called as IR. So if
you are highly insulin sensitive, you
have lower chances of becoming insulin
resistant.
\
Image Sources:
https://www.healthypcos.com/blogs/pco
s/everything-you-need-to-know-about-
pcos-insulin-resistance
As sedentary individuals become more
and more insulin resistant, pancreas
cannot secrete sufficient insulin to
remove glucose from the blood after
food consumption. This is called as
Glucose Intolerance.
84
1.3.2 Glucagon
It is a catabolic hormone produced in
pancreas that raises the blood
concentration of glucose and fatty acids.
Its actions are opposite of that of
Insulin. When glucose concentration of
blood is too low, glucagon signals liver
to undergo gluconeogenesis and
glycogenolysis.
Insulin and glucagon are part of body’s
feedback loop to maintain steady
glucose levels.
Image source:
https://bio.libretexts.org/Bookshelves/An
cillary_Materials/Worksheets/Book%3A
_The_Biology_Corner_(Worksheets)/An
atomy_Worksheets/Feedback_Loops%
3A_Glucose_and_Glucagon
Glycogenolysis: Glucose is stored in
liver in the form of glycogen. When
glucagon binds to glucagon receptors in
the liver, liver converts glycogen into
glucose.
Gluconeogenesis: It is production of
glucose from amino acid molecules.
When those stores of glycogen are
depleted, glucagon turns off glycolysis
in liver, and signals liver and kidney to
produce glucose by Gluconeogenesis.
Regulation of Blood Glucose
85
1.3.3 Ghrelin
• Ghrelin is known as ‘hunger hormone’
and is released by stomach. It makes us
hungry, and also stimulates release of
growth hormone (GH). Small intestine,
pancreas, and brain too secrete ghrelin,
but in very small amounts.
• When we are hungry and ghrelin
levels rise, ghrelin slows oxidation of fat
to conserve energy. (1)
• Ghrelin levels are controlled by food
intake. Around usual meal times in
anticipation of food, and when hungry,
stomach releases blood and makes our
body ready for subsequent actions upon
ingestion of food.
• When we eat, it slows down ghrelin
release (carbohydrates and proteins
restrict ghrelin to a greater extent
compared to fats). Stomach distention
also acts as a signal to slow down its
release.
• Ghrelin is one of the hormones
responsible for weight regain after diet-
induced weight loss.
• Obese people are more sensitive to
ghrelin (rather than their bodies
producing more ghrelin).
• When we start dieting (as soon as 1
day), our ghrelin levels start dieting, and
in long durations, a study has reported
as much as 26% ghrelin levels rise.
• Recent studies suggest that ghrelin
also helps regulate glucose and insulin,
boost heart health, and protect bones
and muscle. (1)
Image:https://www.sciencedirect.com/science/artic
le/pii/B9780128031117000063
How to maintain optimal Ghrelin levels:
• As both obesity and anorexia increase
ghrelin levels, it is advisable to avoid
extreme weight loss or gain and maintain a
stable weight.
• Get enough sound sleep, as poor sleep
affects ghrelin levels causing weight gain.
• Higher the muscle mass = lower ghrelin
levels; so pack some more muscle on.
• As we all know high protein diet is useful in
feeling satiated- that is because protein
increases reduces ghrelin.
• Higher calorie intake periods placed
between diet duration can reduce ghrelin. A
study has reported 18% drop in ghrelin
levels when subjects were kept for weeks
on 29–45% more calories
Foods/Supplements to Maintain Optimum
Ghrelin Levels:
• Eggs
• High fibre foods (like Jerusalem artichoke)
• Leafy vegetables
• garlic
• onion
• leeks
• pre-biotics
• high insoluble fiber foods like oats
• Boiled AND chilled potatoes
86
References:

• Muller TD, Nogueiras R, Andermann ML, et al. (2015). Ghrelin. MolMetab.

https://doi.org/10.1016/i.molmet.2015.03.0Q5
• Mawer, R., (2016, June 24). Ghrelin: The "Hunger Hormone" Explained. Healthline.
https://www.healthline.com/nutrition/ghrelin
• Robertson, M., Henderson, R., Vist, G. et al. (2004) Plasma ghrelin response following a period of
acute overfeeding in normal weight men. Int JObes 28, 727-733.
https://doi.org/10.1038/si.iio.0802637

87
1.3.4 Leptin

• Leptin is called as satiety hormone

released from fat cells in adipose
tissue. It modulates the size of the
adipose tissues. It helps regulate body
weight (not only from meal to meal but
in the long run).
• • Leptin also impacts the onset of
puberty. E. g., undernourished women
with very low body fat take longer to
reach puberty than their counterparts
with more fat mass.
• • Leptin secretion amount is directly
related to amount of body fat. When
levels of the hormone fall, which
happens when an individual loses
weight, the lower levels can trigger
Image Source: https://thyroidadvisor.com/role-leptin-
huge increases in appetite and food thyroid/ •
cravings. This, in turn, can make weight
loss more difficult.
• • “When the body is functioning Leptin Resistance:
properly, excess fat cells will produce Unfortunately, when someone is obese, that
leptin, which will trigger the individual will have too much leptin in the blood.
hypothalamus to lower the appetite, This can cause a lack of sensitivity to the
allowing the body to dip into the fat hormone, a condition known as leptin
stores to feed itself.” (2) resistance. Because the individual keeps
• • Every individual has a leptin threshold eating, the fat cells produce more leptin to
which is predetermined by genetic signal the feeling of satiety, leading to
factors. When leptin level crosses that increased leptin levels.
threshold, our brain thinks that we are
not starving i. e. and we have enough What To Do to Reverse Leptin Resistance?
energy to carry out tasks that are costly • Avoid processed food
in terms of energy expenditure. (e. g., • Eat enough protein
pregnancy) • Consume enough soluble fibre (2)
• Make exercising a habit
• Lower your triglycerides (3,4)
• Get enough sleep

Congenial Leptin Deficiency:

In such cases, Body doesn’t produce leptin,
hence assumes there is no fat in the body, and
that leads to uncontrollable hunger.

Foods to maintain healthy leptin levels:

Fatty fish, Lean Protein (e.g. turkey, chicken),
Zinc, Leafy greens, Apples, Oatmeal, Green
tea, Almonds, Broccoli, Eggs 88
References:

• Hormone Health Network. "Leptin : Endocrine Society." Hormone.org, Endocrine Society, 12 July
2020, https://www.hormone.org/vour-health-and-hormones/glands-and-hormones-a-to-
z/hormones/leptin
• Salas-Salvado, J., Farres, X., Luque, X., Narejos, S., Borrell, M., Basora, J., Anguera, A., Torres,
F., Bullo, M., Balanza, R., & Fiber in Obesity-Study Group (2008). Effect of two doses of a mixture
of soluble fibres on body weight and metabolic variables in overweight or obese patients: a
randomised trial. The British journal of nutrition, 99(6), 1380-1387.
https://doi.org/10.1017/S0007114507868528
• Banks, W. A., Coon, A. B., Robinson, S. M., Moinuddin, A., Shultz, J. M., Nakaoke, R., & Morley, J.
• E. (2004). Triglycerides induce leptin resistance at the blood-brain barrier. Diabetes, 53(5), 1253-
1260. https://doi.org/10.2337/diabetes.53.5.1253
• Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano,
• C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica
Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D. (2003). A Low-Carbohydrate as
Compared with a Low-Fat Diet in Severe Obesity. The New England Journal of Medicine.
https://www.neim.org/doi/full/10.1056/NEJMoa022637

89
1.3.5 Thyroid 1.3.6 Testosterone
1. Thyroid: 1. Testosterone:
It is a butterfly shaped gland that sits in
the front of the windpipe in neck. The Testosterone is a primary male
thyroid secretes several hormones, sex hormone.
collectively called thyroid hormones. Predominantly known as the sex
Thyroxine (T4) is the main hormone. 1.1 hormone in males secreted from the
Thyroid hormones affect: testes gland. However relatively
• Metabolism small quantities of testosterone are
• growth and development secreted into the female
• Body temperature bloodstream via the ovaries and
• Brain development adrenal glands.
• Bone maintenance Testosterone works as an anabolic
• Normal sexual function for tissue buildup and so plays a
• Menstrual cycle vital role in strength and hypertrophy
• sleep gains, hence why males tend to be
1.2 Foods to improve thyroid function (if more muscular in build than
you are a healthy individual without any females.
thyroid issues): It is also an androgenic to promote
• Garlic masculinity characteristics such as
• Radish increased amount of body hair.
• Seafood Lastly it is a steroid because it can
• Mushroom stimulate protein synthesis.
• Egg yolk It is because of it’s effects on
• Low fat yogurt muscular size and that bodybuilding
• Seaweed athletes can choose to abuse
synthetic drugs of testosterone,
however this comes with great risks,
including a decrease in testicular
functioning and for females an
increase in male characteristics
including beard growth and
deepening of the voice.

In men it is responsible for:

• Development of male sex organs
• Deepening of voice during puberty
• Appearance of facial hair
• Balding in later stages of life
• Muscle size and strength
• Sex drive
• Sperm production

90
Image source:
https://www.researchgate.net/publication/221
740685_Testosterone_and_its_metabolites_-
_modulators_of_brain_functions
Testosterone is secreted primarily by
the testicles of males and, to a lesser
extent, the ovaries of females. It is one
of the androgens in females and in
females it is important for:
• Ovarian function
• Bone strength
• Sexual behavior
After the age of 40, the concentration of
circulating testosterone falls by about
1.6 percent every year for most men.
(24).
Foods that help maintain optimum
testosterone levels:
Low fat milk, Cruciferous vegetables
(broccoli, cauliflower, Brussel sprouts,
turnips, kale, cabbage), Egg yolks,
Pomegranates, Beans, Tuna, Oysters,
Spinach, beef
91
References:

• 24. Tsujimura A. (2013). The Relationship between Testosterone Deficiency and Men's Health.
The world journal of men's health, 31(2), 126-135.
https://wjmh.org/DQIx.php?id=10.5534/wimh.2013.31.2.126

92
1.3.7 Cortisol
Cortisol (stress hormone) is secreted by
adrenal gland. It controls our mood and
fear, and hence is responsible for ‘fight
or flight’ response.
When we are about to wake up in the
morning, our body prepares itself by
increasing cortisol levels. Cortisol levels
rise when we undergo physical or
emotional stress.
Most cells in our body have receptors
for cortisol.
The following diagram lists functions of
cortisol.

Image source:
httys://i1.wy.com/rhvositive.co/wy-
content/uyloads/2018/12/IMG
0434.yng?resize=1024%2C1024&ssl=1

93
Role of Cortisol in Muscle Building
(or more accurately, in Muscle
Protein Breakdown):
Cortisol, being a catabolic hormone, is
often villainized as there is a belief that
cortisol spike due to workout (esp
resistance training) leads to MPB and
hampers muscle growth. Many athletes
try to keep the workout periods short
and intensities low, fearing MPB due to
post workout cortisol spike.
Is That True though?
No. Studies show that acute cortisol rise
after workout is nothing to be feared of.
Implication for athletes, Coaches,
and Trainers
Findings of a study by in 2006 by Bird
et.al. (25) can be simplified as:
• If your daily protein intake and carb
timing is not on point, you can
expect up to 50% cortisol rise post
exercising
• Meeting daily protein needs will result
in almost no cortisol spike.
• If your carb intake is timed so that
during exercising your glycogen
levels do not deplete (resulting in
gluconeogenesis - which leads to
MPB), and if your daily protein
intake is also met, you can actually
expect a DROP IN CORTISOL
LEVELS (23-27%) POST
TRAINING.
• Carb timing around exercise session
and daily protein intake- if these two
things are addressed, you can
expect more muscle gain fat loss
compared to when either of the two
or both the conditions are not met.
NOTE: The above studies are about
short term cortisol rise.
What Happens in the long run:
In the long run (12 weeks onward), body
adapts and releases less and less
cortisol.
Also, in the long run, cortisol doesn’t
affect muscle gain or fat loss. A
study even reported positive
correlation between post workout
cortisol rise and long term muscle
gain (26). Even though I would
prefer to wait for more evidence for
that correlation, the key takeaway
would be that you do not need to
worry about exercise induced
cortisol rise!
That does not mean long term cortisol
rise due to poor sleep and stress is
to be disregarded. Manage stress in
other areas of your life (rather than
cutting down workout time and
intensity) to avoid cardiovascular
and hypertension risks.
Foods that can help maintain
Optimum Cortisol Levels:
• Dark chocolate
• Bananas (esp during a long endurance
session)
• Probiotics like yogurt, kimchi,
sauerkraut, kefir
• Water (as dehydration increases
cortisol)
• Fish oil
• Black tea
• Fruits with Vit C
• Ashwagandha
• Broccoli (has vitamin C which lowers
cortisol)
• Red pepper
94
References:

• 25. Bird, S. P., Tarpenning, K. M., & Marino, F. E. (2006). Independent and combined effects of
liquid carbohydrate/essential amino acid ingestion on hormonal and muscular adaptations
following resistance training in untrained men. European journal of applied physiology, 97(2), 225-
238. https://doi.org/10.1007/s00421-005-0127-z
• 26. West, D. W., & Phillips, S. M. (2012). Associations of exercise-induced hormone profiles and
gains in strength and hypertrophy in a large cohort after weight training. European journal of
applied physiology, 112(7), 2693-2702. https://doi.org/10.1007/s00421-011-2246-z

95
1.3.8 Estrogen
• This is the predominant sex hormone
secreted from the female ovaries
characterization, stimulating breast
development, and fat deposition.
• Estrogen is also produced by the
body's fat tissue.
• While women generally have greater
estrogen levels than men; estrogen
levels are something to be aware of with
your male clients too.

Hormones and food consumption:

Please refer to ‘hormones and food
consumption’ in Nutrition section.

96
 Section 2:
Metabolism & Energy Systems

97
2.1 METABOLISM 3. How to Speed up Metabolism:
●Eat enough protein to preserve
1.Definitions: muscle as muscle burns more
●Definition 1: It is Body’s ability to burn calories at rest. (2-2.2g/kg body
calories. weight/day) for average population.
●Definition 2: It is sum of chemical ●Build more muscle through resistant
processes that convert energy from training and optimal protein intake.
indirect sources (nutrients) to sources ●Incorporating HIIT into exercise
that can directly perform muscular regimen is a good way to burn
activities. calories during and even after it. (1)
●Definition 3:Metabolism comprises of ●Studies have shown that
following 3 activities: the caffeine in coffee can boost
●Conversion of food into energy for metabolism by 3–11%. (2)
body’s activities. ●body needs water to process
●Conversion of food to building blocks calories. If you are even mildly
of protein, fats, and carbs dehydrated, your metabolism may
●Elimination nitrogenous waste. slow down
●Definition 4: Central role of metabolism ●Unlike other saturated fats, coconut
is to guarantee cells are properly oil is relatively high in medium-chain
charged (low energy charge of cell = low fats. In one study, researchers found
ATP concentration) by the process of that medium-chain fats increased
conversion of energy nutrients into ATP metabolism by 12% compared to
(i.e. phosphorylation). long-chain fats, which raised it by
just 4% (3)
2. What Affects Metabolism?
Note: Eating enough protein, preserving
●TOTAL CALORIE INTAKE
and adding more muscle is the only
●MACRO RATIO
PROVEN way to build metabolism.
●Age
Rests of the ways mentioned above
●Gender
either cause negligible impact or are
●Food Choices
temporary or have weak evidence
●Hormone Levels
behind.
●Exercise Choices
●Stress & Environmental Factors

98
What is BMR? Factors affecting BMR:
Basal metabolic rate (BMR) is the rate • Age
of energy expenditure by the body • Gender
during complete physical, mental, and • Body composition
digestive rest (4). • Hormones
It is the largest contributor to energy • Diseases/Illness
expenditure (50-55% !!) (5) • Environmental factors (e. g., low
“The word “basal” in basal metabolic tempratures)
rate refers to the absence of Interesting fact: After the age of 20,
physiological and pathological BMR decreases by 1-2% per decade.
conditions like exercise, stress, disease,
etc.” (6)

Difference between BMR & RMR

BMR RMR
Basal Metabolic Rate Resting Metabolic Rate
It is the amount of energy expended
Minimum amount of energy required to
when the individual is awake, in a post-
sustain life (vital organ functioning like
absorptive, thermos-neutral state while
heart, brain, circulation, respiration).
having not exercised for typically 12 h
Less restrictive measurement
More restrictive measurement conditions:
conditions
●Subject has to fast for 12 hours
●Measured in post absorptive state
●Subject has to at least sleep for 8
(i.e. 4 hours after meal)
hours
●No specific sleep requirements
BMR is usually measured in the morning,
RMR has been measured either in the
after an overnight fast, no exercise for the
sitting or supine positions, with a
previous 24 h, free from emotional stress,
minimum of 15 min of rest, sometimes
familiar with the apparatus, and the subject
up to an overnight rest.
completely rested
More accurate Less accurate, but more convenient.

99
How to Measure BMR (Direct &
Indirect Method):
“The BMR measurement should be
done in an isolated room ensuring the
removal of all psychological and
physiological factors that can cause
excitement. The subject must be on 12–
14 h of caloric fasting and after a night
of restful sleep. No strenuous activity
must be allowed 1 h before the test and
during the test.
Thermoneutrality of the subject should
be maintained by keeping the
temperature of the room between 68 °F
and 80 °F.” (6)
Methods to Measure BMR
Calorimetry (direct and indirect), heart-
rate monitoring, and doubly labelled
water are the methods used for the
calculation of BMR.
These methods are out of the scope of
this paper.
Also, Calorimetry is the most accurate
way of measuring BMR. But as it
requires specific lab setting and is quite
expensive. Therefore, a few predictive
equations are used to roughly estimate
calculate BMR
1. BMR Calculation Using Predictive
Equations:
There are three common equations for
estimating RMR: (1) the Harris-Benedict
equation, (2) the Mifflin equation, and
(3) the Cunningham equation:
a. Revised Harris-Benedict Equation
(widely used, relatively accurate for
average person):
Males: BMR (cal/day) = 88.4 +
(13.4 x Weight in kg) + (5.68 x
Height in cm) - (5.68 x Age in
yrs)
Females: BMR (cal/day) = 447.6
+ (9.25 x Weight in kg) + (3.10 x
Height in cm) - (4.33 x Age in
yrs)
b. Mifflin Equation:
Males: BMR (cal/day) = (10 x
Weight in kg) + (6.25 x Height in
cm) - (5 x Age in yrs) + 5
Females: RMR (cal/day) = (10 x
Weight kg) + (6.25 x Height cm)
- (5 x Age in yrs) - 161
c. Cunningham Equation (uses fat-
free mass, suggested for athletes):
It uses LBM as the main predictor of
BMR.
For males and females: BMR
(cal/day) = 500 + 22 x FFM (kg)
Note: FFM= Fat Free Mass
100
Issues with BMR Calculation and its
Implications for Trainers and
Coaches:
As the equations do not take into
consideration the duration in which
weight loss of a person has happened-
(If the duration of limited calorie intake
has been long, the subject would have
sustained low BMR ), that might cause
an error in your prediction of how the
weight loss/gain will progress in future
with your diet and exercise plan based
on current BMR predicted by one of
these equations. (7)
A meta study has revealed that BMR
calculations overestimate by approx.
10% in men and 15% in women, and
can be as high as 20-30% depending
on body composition due to problems in
parameters used or in study designs
(8).
Renau et al., (10) found predictive BMR
equations based on height, weight, age,
and gender overestimate and hence
predict higher calorific requirements in
African American population
(overestimation of average 144 cal/day).
Relevance of predictive BMR equations
such as Harris-Benedict equation,
Owen, Mifflin, Bernstein, World Health
Organization (WHO), Muller, and
Schofield, in today’s prosperous and
modern societies, and their validity in
populations other than those originally
investigated in these studies is unclear
(11).

For example, “The FAO/WHO/UNU

equations to predict BMR were
developed using a database that
contained a disproportionate number
(3388 out of 7173 i.e. 47%) of Italian
subjects. These Italian subjects had a
higher BMR per kilogram than any other
group in the Schofield database. The
numerical dominance of Italians in the
Schofield database and their apparent
elevated BMR recorded may largely
explain why the Schofield equations
overestimate BMR in most populations
today.” (9)

101
So, which BMR equation is suitable
for me?

Brandon Roberts has created this

flowchart quite useful to decide which of
the numerous BMR equations will suit
your purpose the best. (12).

Image source: Brandon Robert’s (@brob_21) Instagram post dated July 5, 2020

102
Is there anything such as NO WEIGHT
LOSS?

There is no such thing as ‘no weight

loss’. If a person says that he has been
dieting as well as exercising but hasn’t
been able to lose weight, there is a
very high possibility that he has
overestimated his own metabolic rate
and/or underestimated total daily
caloric intake and/or overestimated his
energy expended per exercise session.

A study with obese subjects by

Litchman et.al. (13) states: “The failure
of some obese subjects to lose weight
while eating a diet they report as low in
calories is due to an energy intake
substantially higher than reported and
an overestimation of physical activity,
not to an abnormality in
thermogenesis.”.

Many other studies with healthy

subjects too state underreporting of
calories consumed to be a fact,
however, obese people have significant
bias in reporting. (14).

If you are in in deficit of 7700 calories,

YOU WILL LOSE WEIGHT. But out of
that 1kg how much is fat and how much
is muscle will depend upon your
choices related to: exercises, food, and
sleep.

103
References:

• 1. Hazell, T. J., Olver, T. D., Hamilton, C. D., & Lemon P, W. R. (2012). Two minutes of sprint-
interval exercise elicits 24-hr oxygen consumption similar to that of 30 min of continuous
endurance exercise. International journal of sport nutrition and exercise metabolism, 22(4), 276-
283. https://doi.org/10.1123/iisnem,22.4.276
• 2. Dulloo, A. G., Geissler, C. A., Horton, T., Collins, A., & Miller, D. S. (1989). Normal caffeine
consumption: influence on thermogenesis and daily energy expenditure in lean and postobese
human volunteers. The American journal of clinical nutrition, 49(1), 44-50.
https://doi.org/10.1093/aicn/49.1.44
• 3. Seaton, T. B., Welle, S. L., Warenko, M. K., & Campbell, R. G. (1986). Thermic effect of
medium-chain and long-chain triglycerides in man. The American journal of clinical nutrition, 44(5),
630634. https://doi.org/10.1093/aicn/44.5.630
• 4. Anthanont, P., Levine, J. A., McCrady-Spitzer, S. K., & Jensen, M. D. (2017). Lack of Seasonal
Differences in Basal Metabolic Rate in Humans: A Cross-Sectional Study. Hormone and metabolic
research. 49(1), 30-35. https://doi.org/10.1055/s-0042-107793
• 5. van Marken Lichtenbelt, W. D., & Schrauwen, P. (2011). Implications of non-shivering
thermogenesis for energy balance regulation in humans. American journal of physiology.
Regulatory, integrative and comparative physiology, 301(2), R285-R296.
https://doi.org/10.1152/aipregu.00652.2010
• 6. Pethusamy K., Gupta A., Yadav R. (2019) Basal Metabolic Rate (BMR). In: Vonk J., Shackelford
T. (eds) Encyclopedia of Animal Cognition and Behavior.
• https://link.springer.com/referenceworkentry/10.1007%2F978-3-319-47829-6 1429-1#howtocite
• 7. Johannsen, D. L., Knuth, N. D., Huizenga, R., Rood, J. C., Ravussin, E., & Hall, K. D. (2012).
Metabolic slowing with massive weight loss despite preservation of fat-free mass. The Journal of
clinical endocrinology and metabolism, 97(7), 2489-2496. https://doi.org/10.1210/ic.2012-1444
• 8. McMurray, R. G., Soares, J., Caspersen, C. J., & McCurdy, T. (2014). Examining variations of
resting metabolic rate of adults: a public health perspective. Medicine and science in sports and
exercise, 46(7), 1352-1358. https://doi.org/10.1249/MSS.0000000000000232
• 9. Henry, Jeya. (2005). Basal metabolic rate studies in humans: Measurement and development of
new equations. Public Health Nutrition, 8(7A), 1133-1152. 10.1079/PHN2005801.
• https://www.researchgate.net/publication/7490153 Basal metabolic rate studies in humans Measur
ement and development of new equations
• 10. Reneau, J., etal. Do we need race-specific resting metabolic rate prediction equations?. Nutr.
• Diabetes 9, 21 (2019). https://doi.org/10.1038/s41387-019-0087-8
• 11. Almajwal A. M., & Abulmeaty M. A. (2019). New Predictive Equations for Resting Energy
Expenditure in Normal to Overweight and Obese Population. International Journal of
Endocrinology. https://doi.org/10.1155/2019/5727496
• 12. Brandon, Roberts.[@brob-21] (2020, July 5). Over the last week you’ve likely come to realize
that resting energy expenditure equations are population specific. [Photograph]. Instagram.
• 13. Lichtman, S. W., Pisarska, K., Berman, E. R., Pestone, M., Dowling, H., Offenbacher, E.,
Weisel, H., Heshka, S., Matthews, D. E., & Heymsfield, S. B. (1992). Discrepancy between self-
reported and actual caloric intake and exercise in obese subjects. The New England journal of
medicine, 327(27), 1893-1898. https://doi.org/10.1056/NEJM199212313272701
• 14. Wehling, H., & Lusher, J. (2019). People with a body mass index >30 under-report their dietary
intake: A systematic review. Journal of health psychology, 24(14), 2042-2059.
https://doi.org/10.1177/1359105317714318

104
2.2 Energy Systems
What is energy and how do we
source it?
Depending on the intensity and duration
of exercises we perform our bodies will
utilise different energy systems. Each
energy system works primarily with a
preferred macronutrient source.
Understanding how to train certain
energy systems is vital in creating
exercise programs, those illicit training
effects to promote a lean, muscular
body with your clients.
Adenosine triphosphate (ATP) is the
energy currency of human body. It fulfils
all energy needs of our body. ATP
captures and stores chemical energy
released from breakdown of food. That
energy is later released whenever body
needs energy for various cellular and
muscular functions (such as training).
In strength training or endurance
training- every movement is fuelled by
energy that’s released when ATP is
broken down by breaking one of the
phosphate bonds. This is called as ATP Image Source:
Hydrolysis. This happens when the https://www.ptdirect.com/images/person
muscle receives a signal (in the form of al-training-atp-
electrical impulse), asking the muscle to breakdown/@@images/cd16f4a2-29b4-
perform contraction. 485b-a7f2-50dca2763596.ipeg

105
Energy and muscle contractions:
Energy is needed to form the actin and
myosin cross bridges that produce muscle
contractions. ATP is separated and then
used as energy to move the actin filament
towards the centre of the sarcomere,
another ATP is then needed to release the
cross bridges to produce a contraction.
Now ATP is broken down into ADP
(Adenosine diphosphate) and a single
phosphate.
At any given point of time, body holds only
very small amount of ATP. And that’s why; it
again needs to convert ADP to ATP! The two
by-products (ADP & P) come together and
make ATP when they gain energy (from
the reaction that breaks down
ingestedfood OR from Creatine
Phosphate) and this process is called as
PHOSPHORYLATION.
106
If phosphorylation occurs when oxygen is
available, it is called ‘Aerobic Metabolism’ /
‘Oxidative Phosphorylation’. If not, it is called as
‘Anaerobic Metabolism’.
Image Source: https://www.ptdirect.com/images/personal-
training-atp-and-adp/@@images/84f64747-31c0-49a1-
b911-cc3b4bc9db24.jpeg
Creatine Phosphate is stored in muscles- so
when muscles need energy- for say, exercise
when you are lifting weights- that’s the fastest
way to produce ATP (one of the ready ATP is
exhausted).
But just as body doesn’t store a lot of ATP, it
doesn’t store a lot of Creatine Phospate either.
So when Creatine Phosphate is exhausted, the
energy from other sources- which are in
abundance in the body- are used for energy
that’s needed to build ATP. Those sources are:
Carbs, Proteins, and Fats.
“It is estimated that there is only about 100g of
ATP and about 120g of phosphocreatine stored
in the body, mostly within the muscle cells.” (1)
There are systems through which ATP can be
generated:
• ATP-PC system (also known as the
Phosphagen System)
• Anaerobic Glycolytic System (also known
as the Lactate System)
• Aerobic System (also known as Slow
Glycolysis or Oxidative Phosphorylation)
When exercising, our body operates on a
continuum of these three systems. Intensity and
Duration of any activity decides which system
dominates.
2.2.1 Phosphagen System:
• As mentioned above, because of the really
low amount of ATP being available in the
body at any given time, when one starts
exercising, the available ATP can provide
energy only for 3 to 4 seconds.
• This process takes place within the muscle.
• After that, ATP generation happens with the
help of creatine phosphate (which too is in
really low quantities in muscle).
• This can sustain for 8 to 10 seconds.
• It requires rest to replenish ATP stores or we
can use another process called glycolysis.
• Exercise examples: (1) 100m sprint (2)
Hypertrophy session of 6-12 reps at a high
load
2.2.2 Glycogen Lactic Acid System
• It predominantly steps in when exercise
goes past the duration of PC breakdown and
needs ATP via the breakdown of glucose or
glycogen.
• This process takes place within the
sarcoplasm of a muscle cell.
• Muscles have glycogen stores (some
amount of glucose is stored in the form of
glycogen in muscles). When glycogen is
converted into glucose, that reaction doesn’t
need oxygen- and it releases energy. That
energy is utilized to form ATP.
• Lactic Acid is a by-product of this process.
• Exercise examples: (1) 200m sprint; (2)
Weight training of 8-12 repetitions
This process can be explained in two steps:
• Phase 1 of glycolysis is energy investment: 1
glucose + 2 ATP
• Phase 2 energy generation: 4 ATP produced
+ 2 NADH (Nicotinamide adenine
dinucleotide + 1 Hydrogen atom) = ATP If
O2 is not present NADH the hydrogen is
accepted by pyruvic acid to form lactic acid
and NADH can be restored to NAD to
continue glycolysis.
107
The presence of lactic acid and hydrogen
ions together without oxygen can cause
fatiguing effects of the muscle as they pool
in the blood. Therefore, it is important to
perform an active cool down for these short
bursts of activity to utilize oxygen to assist
with the removal of these by products.
• This system is slower than phosphagen
system, but faster than aerobic system.
• It can supply energy for activities up to
90 seconds.
Image: Anaerobic and Aerobic Systems
2.2.3 Aerobic Respiration:
• This system is the slowest of all, but
can provide almost infinite amount of
energy for hours together.
• A couple of minutes into exercising,
this system takes over, and muscles
in action are provided with oxygen.
• Oxygen breaks down glucose (from
remaining glycogen in muscles, from
liver, from intestine) under this
system. (2) o This system can use
fats and proteins too. o The order of
preference of these for this system is:
1. Carbs
2. Fats
3. Proteins (extreme cases like
starvation)
• It uses three processes to produce
ATP and energy production.
i. Aerobic glycolysis
ii. Krebs cycle where food can be
converted into energy
iii. Electron Transport Chain
• Within the mitochondria and with the
presence of oxygen pyruvic acid is
converted to form the two-carbon
molecule of Acetyl-CoA, this can then
be metabolised to form substrates
contributing to oxidative production of
ATP.
• As hydrogen ions are released during
the Krebs cycle and glycolysis we
enter the third process where they
are joined with other enzymes to
complete the phosphorylation of ADP
to ATP.
108
• Beta oxidation: Carbohydrates are
the preferred nutrient for energy,
however, once these stores have
been depleted, for instance if an
athlete was competing in a marathon,
then they can reach a point where
they “hit a wall” and the body has to
then use fat stores to continue to be
energized, again through the Krebs
Cycle.

• Protein Synthesis for energy: Protein

can also be used for energy but only
in extreme cases, such as starvation
when the body is completely depleted
of other energy stores of
carbohydrates and fats.

• Exercise examples: This process

requires a lot of energy so it is suited
to more endurance activities such
weight training with high repetitions
and low resistance or endurance
running event

Image: Kreb’s Cycle

• Energy during exercise

Predominant
Exercise Duration Energy System Type of Rest Type of Exercise
• 100m Sprint
• ATP-PC • Hypertrophy weight
• Fast 3-30 seconds System • Passive training

• Anaerobic • 200m sprint

• Fast 30-50 seconds • Active
Glycolysis • Weight training 8-12 reps

• Active/ • Marathon
• Slow endurance • Aerobic
Passive • Muscular endurance

109
When any activity happens, it uses one
of the above mechanisms for its energy
requirements. As energy load or speed
with which it is needed changes, body
shifts from one mechanism to another.
Most exercises fall somewhere on the
‘Metabolic & Hemodynamic Continua’
but hardly to either extreme. E. g.,
football players require aerobic as well
as anaerobic exercises to be
incorporated in their regimen.
Knowledge of both these continua and
where various physical activities fall, is
a very useful piece of information to
design training program specific for
each athlete’s goal.

Metabolic & Hemodynamic Continua:

Any physical activity lies on a specific
point on metabolic continuum (what kind
of energy is utilized by that activity) and
on Hemodynamic continuum (if it
imposes more of a volume load or
pressure load on heart). Each specific
point correlates to a point on time axis-
how much time that activity takes.
Looking at this information, we can
determine if an activity is power (power
lifting), speed (100m sprint), or
endurance (marathon) activity.
Following diagram summarizes this
relationship:

Where does your exercise regimen fall

on the Metabolic Continuum?
The answer to that should be directed
by your training goals as “physiological
adaptations produced from exercise
training are highly specific to the nature
of training activity”, says a study by
Brown (3).

110
References:

• (n.d.) ATP - Energy's Ultimate Form!. PTDirect. https://www.ptdirect.com/training-design/anatomv-

and-phvsiologv/atp-2013-the-ultimate-form-of-human-energy
• (n.d.) Cellular Respiration. BBC Bitesize.
https://www.bbc.co.Uk/bitesize/guides/z2vbb9q/revision/1
• Brown, S. (2016). Exercise Physiology. In Fundamentals of Kinesiology.
https://he.kendallhunt.com/sites/default/files/heupload/Brown Kinesiology 2e Chapter8 0.p df

111
 Section 3:
Nutrition & Supplementation

112

3.1 NUTRITIONAL GUIDELINES
Internationally Recognised Healthy
Eating Guidelines
According to the World Health
Organisation (WHO)
“What constitutes a healthy diet may
differ depending on the needs of the
individual, locally available foods,
dietary customs, cultural norms and
other considerations. However, the
basic principles of healthy eating remain
the same for everyone. The nature of
access to food requires broader
solutions at the societal level to promote
healthy and safe food options.
Broadly speaking, a healthy diet means
there should be a balance between
energy intake (calories) and energy
expenditure. WHO also recommends
limiting sodium intake to less than 2
grams per day (equivalent to 5 grams of
salt), reducing free sugars to less than
10% (ideally 5%) of total energy intake,
and shifting fat intake away from
industrial trans fats. ”
httvs://www.who.int/health-
toyics/healthv-diet#tab=tab 2
Indian dietary guidelines are designed
to provide up-to-date advice about food
and nutrient uptake required for health
and wellbeing.
These guidelines apply to all healthy
individuals, including those with
common diet-related risk factors, such
as being overweight. Those who need
special dietary advice for a medical
condition, or the frail elderly, should see
a specialist for their nutrition
recommendations.
Indian Dietary Guidelines:
1. “Eat variety of foods to ensure a
balanced diet.
2. Ensure provision of extra food
and healthcare to pregnant and
lactating women.
3. Promote exclusive breastfeeding
for six months and encourage
breastfeeding till two years or as
long as one can.
4. Feed home based semi solid foods
to the infant after six months.
5. Ensure adequate and appropriate
diets for children and adolescents,
both in health and sickness.
6. Eat plenty of vegetables and fruits.
7. Ensure moderate use of edible oils
and animal foods and very less use
of ghee/ butter/ vanaspati.
8. Avoid overeating to prevent
overweight and obesity.
9. Exercise regularly and be physically
active to maintain ideal body weight.
10. Restrict salt intake to minimum.
11. Ensure the use of safe and clean
foods.
12. Adopt right pre-cooking processes
and appropriate cooking methods.
13. Drink plenty of water and take
beverages in moderation.
14. Minimize the use of processed
foods rich in salt, sugar and fats.
15. Include micronutrient-rich foods
in the diets of elderly people to enable
them to be fit and active. ” Source:
National Institute of Nutrition,
Hyderabad
https://vikaspedia.in/health/nutrition/diet
arv-guidelines-1/dietary-goals-and-
guidelines
113
Recommended dietary allowance (RDA) Reference man is between 20-39
is defined as the nutrient present in the years of age, height 163 cm and
diet which satisfies the daily weight of 60kg. Reference woman is
requirement of nearly all individuals in a between 20-39 years of age, height
population. It is influenced by 151 cm and weight 50 kg. For a
taller and heavier person the RDA
• Sex - In general requirement is
values have to be more than what is
more for men than women.
given here.
• Age- Adult men and women
require nutrients for maintenance https://vikaspedia.in/health/nutrition/
where as infants and children dietarv-guidelines-1/recommended-
require it for growth and dietary-allowance
maintenance. Nutrient
requirements during childhood Consumption Recommendations
are proportional to growth rate. • Access information for appropriate
• Body weight: Among adults foods for body composition and
requirements are related to body consumption recommendations for,
weight and size. weight loss and
• Physiological states- During In order to gauge how much food an
menstruation, pregnancy and individual should be consuming, we
lactation women require some need to get an indication of how
nutrients more than the normal much energy their body requires to
times. perform their daily tasks. This is
• Requirements of sports persons achieved by combining the energy
and athletes who perform high required for their Basal Metabolic
levels of extreme activity are Rate (the energy required to keep
high some times 2-3 times the your body alive at rest), and their
normal times. daily activity levels.
• Physical activity- Sedentary
person needs much less
nutrients than a moderate to
severely active person.
• Environment- Extremes of climate or
high altitude alters the need for
certain nutrients.
RDA suggested for Indian population is
based on the reference man and
reference woman .
Reference man and Reference woman
are defined on the basis of body
weights of well nourished healthy
adults who have satisfactory growth
during their child hood and are
currently leading a healthy and
moderately active life living under
normal comfortable conditions.

114
From: Short report of nutrient requirements for Indians, A report of the expert group,
ICMR, 2020

115
Culture and Food Eating patterns can extend beyond
religious beliefs. Some individuals may
As technology has increased
choose a lifestyle, or an eating habit
globalisation, it has enabled the
that varies based purely on their own
population around the world to travel
personal values. Some of these
and settle in different countries with
common lifestyle eating habits include:
different languages, customs and
• Vegetarianism: Does not eat any
beliefs. A part of this transition is living
meat, poultry, game, fish, shellfish or
in areas where the population eat a
by-products of slaughter
different cuisine to what you are used
• Veganism: Does not eat dairy, eggs or
to, and also, people with different diets
any other animal product
and beliefs living near you. These
• Pescetarian: Does eat fish, but does
individuals may very well become your
not eat any meat, poultry, game, or by-
clients, and your ability to accept,
products of slaughter.
understand and evaluate the nutritional
It is important to understand the role of
differences of different cultures will go a
food in cultural and religious practice,
long way to ensuring a long sustainable
and to be mindful of the nutritional
relationship with your clients.
effects of their particular eating habits.
Food is an important part of religious
observance and spiritual ritual for many
Recording Nutritional Information
faiths including Hinduism, Islam,
During the health screening is the
Christianity, Sikhism and Buddhism. For
perfect opportunity to get an idea of
example, some religions insist that
your clients’ nutritional information.
certain foods are restricted at particular
There are a variety of ways that you can
times, while other foods are eaten at
identify your clients eating habits
festivals and celebrations. The role of
including:
food practices is complex and varies
among individuals and communities. Kitchen Audit:
Culture and cultural tradition also A kitchen audit is a brief questioning or
influences our expectations regarding: checklist of all the foods that are
• The ways in which food and drinks are contained in your client's’ kitchen at
prepared and served home. This includes healthy and
• When food and drinks are consumed unhealthy foods. A kitchen audit is a
• The types of food and drinks that are quick and easy way to get an insight
consumed into the foods that your client and their
• The behaviors acceptable while eating family consumes, however it does not
and drinking give a lot of detail.

Nutritional Questionnaire:
A nutritional questionnaire is a
document that enables you to ask your
client how many servings of each food
group they consume per day. It is
relatively quick and provides the trainer
with more detail of the clients eating
habits. From this, the trainer can give
more specific advice according to eating
habits.
116
 Food Diary:

A Food Diary is a very specific outline of

each food your client has consumed,
how much they and the time they had it.
It requires a lot more effort to complete,
but the advantage is that it provides a
lot more detail. A trainer can quickly
review a food diary and evaluate energy
density of meals, nutritional density, and
the effect of meal timing amongst a host
of other details. For a client wanting to
undergo a body transformation, a Food
Diary as encouraged as a very
important step to reaching their goals. A
sample food diary is provided below.

Food Diary

Time / Meal Food/Beverage Quantity Protein Fat Carbs Calories Notes

Breakfast

Snack

Lunch

Snack

Dinner

Total

117
A regular food diary, and a weekly
check in with a PT, works as a fantastic
source of extrinsic motivation.
Extrinsic motivation refers to
motivation that comes from an external
source, such as a reward, a friend’s
encouragement or a Trainers
instruction.
Intrinsic motivation refers an
individual’s ability to self-motivate and
encourage themselves to perform a
task, it is that little voice inside your
head that tells you to keep going!
Extrinsic forms of motivation can often
increase an individual’s intrinsic
motivation.
Some methods you can use to
encourage your client to adhere to their
training regime and increase their
healthy eating habits can include:
• Weekly checks of a Food Diary
• Motivational messages
• Inspiration stories
• Quotes to put up at home
•Surrounding themselves with like
minded people
As trainers it is important to support
clients to adopt healthy behaviors.
Unfortunately striving to have a body
you feel comfortable in can lead to
unhealthy behaviors and conditions. As
trainers, it is important to understand
and be wary of these conditions.
These can include:
Anorexia Nervosa: An eating disorder
characterized by a l ow weight, fear of
gaining weight, a strong desire to be
thin, and food restriction
Bulimia: A serious psychiatric illness
characterised by recurrent binge-eating
episodes (the consumption of
abnormally large amounts of food in a
relatively short period of time). Binge
episodes are associated with a sense of
loss of control and immediately followed
by feelings of guilt and shame, which
then leads the person to compensatory
behaviors such as self-induced
vomiting, fasting, over exercising and/or
the misuse of laxatives, enemas or
diuretics.
Body Dysmorphia : A psychiatric
illness characterized by an insatiable
desire to increase muscle size and
muscle mass leading to a lack of
confidence and unhealthy practices and
thought processes.
118
3.2 MACRONUTRIENTS
Nutrition for Body Composition
The general rule weight management is
to follow “the energy in/energy out”
formula.
If:
Energy In (Food) is > Energy Out
(metabolism + exercise) = Weight Gain
Energy In (Food) is < Energy Out
(metabolism + exercise) = Weight Loss
Energy In (Food) is = Energy Out
(metabolism + exercise) = No Change
in Weight
Building muscle is an anabolic process.
This means that the body is building
new tissue. To build this new tissue, the
fuel supply needs to be greater than
what is being used.
Weight Loss and Fat Loss are both
catabolic processes. This means that
they are metabolising (converting fuel to
energy) energy stores within the body.
For this process to occur, the fuel
supply needs to be less than the total
energy expenditure.
If in an individual is happy with their
weight, and wishes to maintain. Then
the energy consumed should equal the
total energy used throughout the day.
This would suit individuals and athletes
who want to maximise performance
and/or lead a healthy life without any
change to their body composition.
3.2.1 Protein
What are Proteins?
Proteins are building blocks of our
muscles. We get the protein our body
needs from sources available around us
(vegetarian and non-vegetarian).
Essentially, every protein is made up of
basic units called Amino Acids (AA).
There are 20 AA in nature, out of which
9 are essential amino acids (EAA) (i.e.
human body can’t make those and we
have to get those from food sources).
The numerous proteins found in nature
are just different permutations and
combinations of the 20 AA. But the
protein we eat/find around us is different
than what we need in our body to build
muscle. So our body breaks it down
(catabolic action) into its basic units
(AA) and puts those back together
(anabolic action) in required sequences
as and when needed.
These newly configured proteins are
now used wherever required:
• To replace and regenerate cells and
tissues.
• To make antibodies.
• DNA synthesis
• Chemical reactions etc.
119
OUR BODY CANT STORE PROTEINS
IN THE FORM OF AA!
So when we have provided protein for
all the functions that need it, and if we
have some extra AA, we can’t store it
for a rainy day!
Body just breaks those excess AA down
into alpha keto acids (nitrogen is
removed from AA and disposed through
urine.).
Those alpha keto acids are turned into
triglycerides and stored in fat tissues.
Alpha-keto acids can be used as fuel
when body isn’t supplied with enough
calories from fat or carbs- but this hardly
happens as carbs is the most preferred
fuel of our body, and fats after that. This
is because our body tries hard to not
use those alpha keto acids as much as
possible, saving those to build tissues-
as no other macro nutrient can do that.
(0)
Complete and Incomplete Proteins:
When a protein source provides all 9
EAA, it is called as a complete protein.
Most non vegetarian protein sources
are complete or CLASS A.
An incomplete protein is one that is
lacking in any of EAA. Most plant based
protein sources are incomplete (except
soybean).
Functions of Protein:
• Skeletal muscle stores AA for other
tissues.
• Maintain body structure and posture
(e. g., collagen)
• Mobility (contractile proteins)
• Hormones & Enzymes
• Cell signaling pathways
• Immunity (antibodies)
• Repairing of damaged muscles
during exercise
• Plays part in protein turnover
• Metabolic adaptation in long term
exercise
• Remodelling
• Provide AA substrates to promote MPS
• In absence of glucose, it’s a primary
substrate for gluconeogenesis
Net Muscle Protein Balance (NBAL)
NBAL is the difference between Muscle
Protein Synthesis (MPS) i. e., the process
of building muscle mass and Muscle
Protein Breakdown (MPB) i. e., the
process of breaking down of muscles.
When one talks about MPS or MPB, it can
be particular to a type of protein e. g.,
myofibrillar or mitochondrial.
Type of training and its effect on
corresponding type of protein (myofibrillar
or mitochondrial) is evident only in trained
individuals. In untrained individuals, a
single bout of resistance training leads to
MPS of both types of proteins (1).
When muscle size and strength of a
bodybuilder increase as protein intake
post training repairs of damaged muscle
cells and tissue and promotes muscle
growth, he has a total positive NBAL i. e.,
his MPS of myofibrillar proteins > MPB of
myofibrillar proteins. o When an
endurance athlete pairs his sessions with
a diet that provides enough daily protein,
muscle repair and adaptations lead to
enhanced aerobic power and endurance
performance from enhanced anabolic
processes. I. e. MPS of proteins
responsible of enhancing aerobic power >
MPB of those proteins.
One has NBAL=0 when he is maintaining
muscle mass.
120
Protein needs for aerobic exercises:
• Carbohydrate (enhances glycogen re-
synthesis) and protein (remodels
skeletal muscle protein) intake post
endurance exercise is important to
restore performance and for abilities of
muscles to work efficiently.
• A sport drink with additional protein
may extend time to fatigue for
endurance athletes when enough carbs
aren’t consumed, leading to suboptimal
performance. But, extra protein (if
enough glycogen stores are available)
doesn’t enhance endurance
performance. (16).
• Though endurance athletes do not
need as much protein as bodybuilders
do, they need it more than non-active
individuals to repair the muscle damage
caused due to endurance training. (17)
• “On a metabolic level, a single bout of
endurance training stimulates the
oxidation of several amino acids.
Although the amount of amino acids as
part of total energy expenditure during
exercise is relatively low compared to
other substrates (e. g., carbohydrates
and fat), it may depress the rates of
skeletal MPS, and thereby have a
negative effect on training adaptation.
• A low supply of amino acids relative to
that of carbohydrates may also have
negative effects on the synthesis of
capillaries, synthesis and turn-over of
mitochondrial proteins and proteins
involved in oxygen transport including
hemoglobin and myoglobin.”(18)
b) Insulin
Many resistance athletes take simple
carbs with protein post training as it
is believed to speed up the recovery.
But, is there any truth to that?
The possible explanation behind this
popular belief could be misinterpretation
of a fact that insulin acts as a stimulant
for MPS as it increases plasma and
intramuscular leucine as stated in a
paper ‘Physiologic hyperinsulinemia
stimulates protein synthesis and
enhances transport of selected amino
acids in human skeletal muscle’ by
Biolo et. al. (19).
But that does NOT mean we need carbs
for that! The amount of insulin needed
for this purpose is very less (i. e., 10-15
IU/ml), that is 2-3 times basal resting
levels for healthy individual. And that
much insulin spike can happen with the
protein that you are consuming. So
there is NO NEED OF CARBS to
stimulate MPS post training if you
are consuming adequate protein!
• Okay, so carbs don’t play a part
in MPS. So is it possible that
carbs reduce MPB and hence
are responsible and important
for positive NBAL?
A study by Glynn et. al. (20)
concludes: “the enhanced
muscle protein anabolic
response detected when (EAA +
Carbs) are ingested post
resistance exercise is primarily
due to an increase in MPS with
minor changes in MPB,
regardless of carbohydrate
dose or circulating insulin
level.”
So, the answer is; NO.
High protein foods help maintain
optimum levels of insulin
121
References:

• https://www.self.com/story/what-protein-does-in-vour-bodv
• 1. Wilkinson SB, Phillips SM, Atherton PJ, Patel R, Yarasheski KE, Tarnopolsky MA & Rennie MJ (2008).
Differential effects of resistance and endurance exercise in the fed state on signalling molecule phosphorylation
and protein synthesis in human muscle. J Physiol.
• https://phvsoc.onlinelibrarv.wilev.com/servlet/linkout?suffix=null&dbid=8&doi=10.1113%2Fiphvsiol.2
• 011.211888&key=18556367
• 2. Proud, C.G. (2007). Signaling to translation: How signal transduction pathways control the protein synthetic
machinery. Biochem J. https://pubmed.ncbi.nlm.nih.gov/17376031/
• 3. Morton R., McGlory C., Phillips S. (2015). Nutritional interventions to augment resistance training-induced
skeletal muscle hypertrophy. Frontiers in Physiology.
• https://www.frontiersin.org/article/10.3389/fphys.2015.00245
• 4. Kumar, V., Atherton, P., Smith, K., & Rennie, M. J. (2009). Human muscle protein synthesis and breakdown
during and after exercise. Journal of applied physiology.
https://journals.physiology.org/doi/full/10.1152/japplphysiol.91481.2008
• 5. Leal, D. (July 24, 2020). Is Muscle Protein Synthesis the Same as Growth? Very Well Lift.
https://www.vervwellfit.com/muscle-protein-svnthesis-and-muscle-growth-4148337
• 6. Phillips SM, Tipton KD, Aarsland A, Wolf SE, Wolfe RR. (1997). Mixed muscle protein synthesis and breakdown
after resistance exercise in humans. Am J Physiol. 273(1):99-107. https://doi.org/10.1152/aipendo.1997.273.1.E99
• 7. Tipton, K. (2017). Branched-chain amino acid supplementation to support muscle anabolism following exercise.
Gatorate Sports Science Institute. https://www.gssiweb.org/sports-science-exchange/article/branched-chain-amino-
acid-supplementation-to-support-muscle-anabolism-following-exercise
• 8. Phillips, B. E., Hill, D. S., & Atherton, P. J. (2012). Regulation of muscle protein synthesis in humans. Current
opinion in clinical nutrition and metabolic care, 75(1), 58-63. https://doi.org/10.1097/MCO.0b013e32834d19bc
• 9. Aragon, A. A., & Schoenfeld, B. J. (2013). Nutrient timing revisited: is there a post-exercise anabolic window?.
Journal of the International Society of Sports Nutrition, 10(1), 5. https://doi.org/10.1186/1550-2783-10-5
• 10. Oliver C Witard, Sarah R Jackman, Leigh Breen, Kenneth Smith, Anna Selby, Kevin D Tipton. (2014)
Myofibrillar muscle protein synthesis rates subsequent to a meal in response to increasing doses of whey protein at
rest and after resistance exercise. The American Journal of Clinical Nutrition.
https://doi.org/10.3945/aicn.112.055517
• 11. Moore, D.R., Camera, D.M., Areta, J.L., and Hawley, J.A. (2014). Beyond muscle hypertrophy: why dietary
protein is important for endurance athletes. Appl. Physiol. Nutr. Metab.
https://csep.ca/KnowledgeTranslations.asp?a=view&id=14
• 12. Kimball, S. R., & Jefferson, L. S. (2006). Signaling pathways and molecular mechanisms through which
branched-chain amino acids mediate translational control of protein synthesis. The Journal of nutrition.
https://doi.org/10.1093/in/136.1.227S
• 13. Churchward-Venne, T. A., Breen, L., Di Donato, D. M., Hector, A. J., Mitchell, C. J., Moore, D. R., et al. (2014).
Leucine supplementation of a low-protein mixed macronutrient beverage enhances myofibrillar protein synthesis in
young men: a double-blind, randomized trial1-3. Am. J. Clin. Nutr. https://academi c
.oup.com/aicn/article/99/2/276/4571468
• 14. Morifuji, M., Sakai, K., Sanbongi, C., & Sugiura, K. (2005). Dietary whey protein downregulates fatty acid
synthesis in the liver, but upregulates it in skeletal muscle of exercise-trained rats. Nutrition (Burbank, Los Angeles
County, Calif.), 21(10), 1052-1058. https://doi.org/10.1016/i.nut.2005.01.010
• 15. Phillips SM, Moore DR, Tang JE. A critical examination of dietary protein requirements, benefits, and excesses
in athletes. (2007). Int J Sport Nutr Exerc Metab. https://www.ncbi.nlm.nih.gov/pubmed/18577776
• 16. Hawley, John & Gibala, Martin & Bermon, Stephane. (2007). Innovations in athletic preparation: Role of
substrate availability to modify training adaptation and performance. Journal of sports sciences.
https://www.researchgate.net/publication/51392732_Innovations_in_athletic_preparation_Role_of_subs
trate_availability_to_modify_training_adaptation_and_performance
• 17. Ivy J. L. (2004). Regulation of muscle glycogen repletion, muscle protein synthesis and repair following
exercise. Journal of sports science & medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905295/
• 18. Knuiman, P., Hopman, M., Verbruggen, C., & Mensink, M. (2018). Protein and the Adaptive Response With
Endurance Training: Wishful Thinking or a Competitive Edge?. Frontiers in physiology, 9, 598.
https://doi.org/10.3389/fphys.2018.00598
• 19. Biolo, G., Declan Fleming, R. Y., & Wolfe, R. R. (1995). Physiologic hyperinsulinemia stimulates protein
synthesis and enhances transport of selected amino acids in human skeletal muscle. The Journal of clinical
investigation. https://doi.org/10.1172/JCI117731
• 20. Glynn, E. L., Fry, C. S., Drummond, M. J., Dreyer, H. C., Dhanani, S., Volpi, E., & Rasmussen, B. B. (2010).
Muscle protein breakdown has a minor role in the protein anabolic response to essential amino acid and
carbohydrate intake following resistance exercise. American journal of physiology. Regulatory, integrative and
comparative physiology, 299(2), R533-R540. https://doi.org/10.1152/aipregu.00077.2010 122
3.2.2 Carbohydrates
What are Carbohydrates?
Carbohydrates are the sugars, starches
and fibers found in fruits, grains,
vegetables and milk products. 1 gram of
carbohydrate has 4 calories.
Body breaks carbs down into its smaller
units (glucose, fructose) which are
absorbed by the small intestine. These are
then absorbed into bloodstream and reach
liver- where all sugars are converted into
glucose. Glucose and insulin are carried by
blood and converted into energy for basic
functions of body as well as for physical
activities. If it is not required right away, it
is stored in liver and in muscles as
glycogen. Body can store up to 2000
calories in the form of glycogen.
Once that 2000 calorie limit is reached,
excess carbs are stored as fat.
What are functions of carbohydrates?
ofuel for the central nervous system
oenergy for working muscles prevent
protein from being used as an
energy source enable fat
metabolism fuel for brain function
‘Essential’ is not the same as ‘Optimal’.
‘Carbs aren’t essential’ is usually
misinterpreted as carbs aren’t needed.
That’s far from the truth, as we need carbs
for optimum health, and that’s the goal of
most people when they want to change
their dietary habits and start training.
Essential in the above statement only
means that its unavailability doesn’t lead to
cell death. But very low or no carb intake is
still is detrimental to health!
Also, in scientific literature, ‘essential’
means something that CANNOT be
produced by the body. And by that
definition, if we do not consume ANY carbs
at all, body will go through
gluconeogenesis to produce required
amount of glucose, essential for
SURVIVAL, but not enough to THRIVE!
Daily Carbohydrate
Recommendations
Endogenous glycogen stores are fully
replenished by a high-carbohydrate diet
(8-12 g of carbohydrate/kg/day ).
Image source:
https://www.coursehero.com/file/505869
15/gssi-carbohydrates-101pptx/
Carbs & Training:
For most activities, carbohydrate is the
major energy source.
Why carbs are important for training?
(Strength as well as endurance)
• Maintain high rates of carbohydrate
oxidation
• Reduce ratings of perceived exertion
• Increase endurance capacity
• Delay the onset of fatigue
• Prevent hypoglycemia
HIIT exercise capacity is consistently
improved with adequate carbohydrate
intake.
Why carbs are a superior fuel for
athletic performance?
Carbohydrate provides a metabolic
advantage (high carb oxidation, spare
liver glycogen). When we choose types
of carbs, want to choose those that
result in high rates of oxidation.
123
Carb recommendation Endurance Pre-Workout Nutrition: if your tank is
Athletes for Peak performance: (1) already filled with glycogen, and protein,
o 3-4 Hours Before : 1-4 pre-workout nutrition isn’t really
g/kg (find the amount and timing that is important.
best for your stomach) Post-Workout Nutrition: after a
o In the hour before: try a training session (which burns approx
small amount of easily digested 150-180g glycogen), you don’t need to
carbohydrates, ~25 g. This can help rush home to have carbs as you won’t
meeting your “during” needs need any more till your next workout!
o During Note: importance of both protein and
practice/Competition: 30-60 g/h (when carbs in pre and post workout nutrition
going for 60 min or longer) is covered in detailed under ‘proteins’
o After practice/Competition: section.
1.0-1.2 g/kg to refill glycogen stores.
This is especially important if the athlete Carb Timing For Non-Athletes:
has a short time to recover (<8 hours) ● For average population not
chasing any athletic goals,
Carbs are important for different frequency of meals has no effect
team sports for different reasons: on weight loss and body
composition.
Sport Why Carbs are ● But meal frequency does affect
important satiety and hence can possibly
Strength + Power To Maintain short reduce the probability of
Field Sports energy bursts occurrences of binge eating
leading to better adherence to diet
Endurance Field To maintain in some cases.
Sports glycogen stores
Battling Sports To maintain blood Harry’s Note: Carbs aren’t
glucose for responsible for Metabolic
attention & Syndrome and Insulin Resistance.
decision making But, it’s a different story if you are
already insulin resistant or have
Court Sports To maintain metabolic syndrome.
glycogen
Source: Table is made over
from information
from a study (2) time

124
References:

• Rodriguez, Nancy & Dimarco, Nancy & Langley, Susie. (20091. Nutrition and athletic performance
Med Sci Sports Exerc.
• https://www.researchgate.net/publication/24023338 American College of Sports Medicine position
stand Nutrition and athletic performance Med Sci Sports Exerc 2009 41 709 731 101249MSS0b
013e31890eb86
• 2. Francis E. Holway & Lawrence L. Spriet (2011): Sport-specific nutrition: Practical strategies for
team sports. Journal of Sports Sciences. http://dx.doi.org/10.1080/02640414.2011.605459

125
3.2.3 FATS
1. Why include sufficient fat in daily
diet?
• Extremely low fat diets are liked to
increased triglycerides and
reduced good cholesterol levels
which may lead to cardiovascular
diseases. (26)
• Optimal fat intake maintains healthy
levels of testosterone (27)
• Improves insulin sensitivity.
• Optimal amount of dietary fat
consumption increases activation
of the mTOR pathway which
triggers MPS. (28).
2. So, More Fat = More Benefits?
• “The data has shown that
consuming a higher percentage
of calories from fat does not lead
to greater net fat loss, and that
very high fat eating plans such
as a ketogenic diet do not
produce any unique metabolic
advantages.” (29)
• Chronic high fat diets (>35%)
should be avoided because they
may reduce carbohydrate and
protein consumption, decrease
long-term performance, reduce
fat-soluble vitamin intake, and
potentially increase the risk for
cardiovascular complications
(24).
3. Is fat intake important for building
muscle?
• “No sports performance-related
benefits are associated with fat
intakes below 15% (and health
concerns would exist), experts
do not recommend fat intakes
below 15% of the total energy
requirement” (24)
• Fat being the most energy dense
macro, it’s the primary choice to
increase caloric intake to pack
muscle on.
• Some studies report benefits of fat
(esp. Omega 3 Polyunsaturated
Fatty Acids) intake in terms of
minimizing effects of
overtraining. (30).
• For the average lifter out there,
deriving about 25% of your total
daily calories from fat will be a
good figure to aim for. This
percentage should ideally come
from various different types of
fats. Make sure you consume
omega-3 fatty acids (roughly 1.5-
1.8 grams per day) - specifically
EPA and DHA. (31)
• If you're having trouble meeting
this through your diet, you may
want to consider
supplementation with around 0.5-
1.8 grams per day of an omega-
3 supplement containing EPA
and DHA. (32)
• Try to keep saturated fats around
10% and eliminate trans fat from
your diet as best you can.
• Quality sources of fat come from
fish, nuts, vegetable and coconut
oils, avocados, flax seeds, and
cheeses.
• Let your fat intake be dictated by
how much carbs you are
consuming (keeping protein
amount unchanged) if you are
carb cycling. On high carb days,
reduce the calories fat and do
the opposite on low carb days.
126
References:

• 26. Parks, E., Krauss, R., Christiansen, M., Neese, R., & Hellerstein, M. (1999). Effects of a low-
fat, high-carbohydrate diet on VLDL-triglyceride assembly, production, and clearance. Journal Of
Clinical Investigation. https://www.ici.org/articles/view/6572
• 27. Hamalainen, E. K., Adlercreutz, H., Puska, P., & Pietinen, P. (1983). Decrease of serum total
and free testosterone during a low-fat high-fibre diet. Journal of steroid biochemistry.
https://doi.org/10.1016/0022-4731(83)90117-6
• 28. Smith, G. I., Atherton, P., Reeds, D. N., Mohammed, B. S., Rankin, D., Rennie, M. J., &
Mittendorfer,
• B. (2011). Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to
hyperinsulinaemia-hyperaminoacidaemia in healthy young and middle-aged men and women.
Clinical science.
• https://doi.org/10.1042/CS20100597
• 29. Hall, K. D., Chen, K. Y., Guo, J., Lam, Y. Y., Leibel, R. L., Mayer, L. E., Reitman, M. L.,
Rosenbaum, M., Smith, S. R., Walsh, B. T., & Ravussin, E. (2016). Energy expenditure and body
composition changes after an isocaloric ketogenic diet in overweight and obese men. The
American journal of clinical nutrition. https://doi.org/10.3945/aicn.116.133561
• 30. Venkatraman JT, Pendergast DR. (2002). Effect of Dietary Intake on Immune Function in
Athletes.
• Sports Medicine.
• https://www.researchgate.net/publication/11436836 Effect of Dietary Intake on Immune Function in
A thletes
• 31. Nalewanyj, sean. (n.d.). Bodybuilding And Fat Intake: Your Complete Guide.
https://seannal.com/articles/nutrition/bodybuilding-fat-intake.php
• 32. Kris-Etherton, P. M., Harris, W. S., & Appel, L. J. (2003). Fish consumption, fish oil, omega-3
fatty acids, and cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology,
https://www.ahaiournals.org/doi/full/10.1161/01.atv.0000038493.65177.94

127
Hormones and food consumption
It does this by taking the stored
When Carbohydrates are consumed,
Glycogen molecules and transporting
they are broken down into
them to the bloodstream where they are
monosaccharides (simple sugars) and
utilised by the Lactate (Anaerobic
absorbed as glucose into the
Glycolytic) and Aerobic energy systems.
bloodstream. If the food is low GI
This is a catabolic process as it breaks
(meaning the glucose is absorbed into
down body tissue for energy.
the bloodstream slowly), then the
carbohydrate meal will provide the
If Glucagon levels are high, it means
individual with a steady supply of
that a lot of tissue is being metabolized.
energy over the next 1 to 3 hours.
The main focus of the body is to stay
alive, so the breakdown of body tissue
If the food is high GI (meaning the
is a warning signal to the body that it
glucose is absorbed faster into the
must consume more fuel. So when
bloodstream), then there will be a great
Glucagon levels are high, and the body
influx of glucose into the bloodstream.
is in need of fuel, the Stomach produces
When glucose is present in the
Ghrelin, which makes you feel hungry
bloodstream, the Pancreas secretes a
and propels you to consume food. You
hormone called I nsulin into the blood.
then eat your food, digest it, absorb it
Insulin plays two very important roles.
into the bloodstream, release insulin to
Insulin activates the binding site on the
metabolise, and if necessary, store it.
glucose molecule, so that it can be
metabolised, its other role is to transport
Once insulin levels reach a certain level,
any excess glucose from the
the body will produce Leptin , which is
bloodstream, so that it can be converted
the hormone that decreases hunger and
to glycogen and stored in the muscle
makes you feel full.
and the liver.
The process of hunger and blood
Once muscle (approx 0.015g/kg of Body
glucose regulation then continues to
Weight) and Liver (approx 1kg)
play out continuously between the
Glycogen stores are maximised and
hormones of Insulin, Glucagon, Ghrelin,
excess glucose is converted in the Liver
and Leptin. All of which have a major
to Triglycerides and stored as Fat! This
impact on how you feel about eating
is why it is important to have
and when you want to eat, which all
incremental increases in energy
directly affect body composition
consumption.
nutrition.
If an individual goes an extended period
of time without consuming any fuel, their
blood plasma and blood Free Fatty
Acids will run low and the body will need
to tap into its stored energy sources.
Glucagon is the hormone that works
alongside Insulin to help regulate blood
sugar levels.

128
Hormonal Imbalances: How They Can Relate to
Body Fat % in Specific Sites

Hormonal imbalances can lead to less or more fat

storage in specific sites of the body. This however
is a highly complex issue with many layers to it,
due to the body operating as an interconnected
system. This table outlines a general consideration
for common skin fold sites and how fat
accumulation in these areas can indicate
imbalances in certain hormones within the body.
Note that there are differences in fat distribution
patterns between men and women:

General Subcutaneous Fat

Hormones Imbalance Description
Storage Sites
Decentralizes fat distribution in men,
Can affect fat storage on the
Testosterone conditional on cortisol concentration;
chest and triceps
mild centralization in women
Can affect fat storage on the Suppresses testosterone in men;
Estrogen
hips and thighs decentralizes fat distribution in women
Can affect fat storage on the
Cortisol Centralizes fat distribution
stomach
Growth Can affect fat storage on the
Decentralizes fat distribution
hormone knees and calves
Progesteron N/A Decentralizes fat storage, conditional
e on estrogen and cortisol concentrations
Thyroid Can affect fat storage on the Doesn’t affect fat distribution
hormone ribcage
Insulin Can affect fat storage on love Reinforces the effect of cortisol
handles and back

Nutrition, supplementation and exercise programs

can be delivered to great effect to address these
hormonal imbalances, leading to improved
physique transformation results. If there is a
genuine cause to believe your client has a
hormonal imbalance, it is recommended you have
blood work done. These topics will be discussed in
greater detail in the Certificate 4 course and
specialized courses delivered by Team Boss
Fitness Academy.

129
Nutrition Advice for Building Muscle:
Increasing Muscle size can be an
important performance or aesthetic goal
in the development of an athlete.
Commonly, athletes will desire muscle
mass and strength gains; with few
wanting an increase in body fat. It is
always a good idea to liaise with an
Accredited Sports Dietician when
considering nutritional advice for
athletes. General nutritional rules for
building muscle include:
Increase Energy In: To increase
weight, energy in must be greater than
energy out. All individuals are different,
but a
general rule is an increase of 10% of
your total energy expenditure
(calories/kilojoules). This can be done
by:
- Increasing portion sizes
- Increasing the number of meals per
day
- Increasing the energy
(calories/kilojoules) density of foods
- Increasing the frequency of your meals
and snacks
- Carbohydrates are the primary fuel
source during high intensity exercise,
therefore a lot of the increase of energy
should be in the form of carbohydrates.
- Consume energy dense
drinks/shakes
Remain in an anabolic state: The
average meal takes approximately 1-
3 hours to digest (broken down) and
for the nutrients
to be absorbed. If a food is more
processed, higher in sugar, more
liquid, the faster it will be absorbed.
The more complex, raw, lower in
sugar, or less processed the food,
the slower it will be absorbed.
The friend of the anabolic trainer is Low
GI and slow metabolising foods. This
will supply the athlete with a steady drip
of energy over a longer period of time.
This is important because it means the
fuel required is coming from a food
source, and not from a fuel source
within the body (muscle glycogen or
muscle triglycerides).
It is important to remain anabolic so that
the muscle itself isn’t diminished to be
used as a fuel source, as this will
decrease muscle size and strength, and
training ability. When Ghrelin is
released, you start to feel hungry, which
means that your body is already in a
catabolic state and you are utilising
body tissue for fuel. So you should aim
to never be hungry if you are trying to
build muscle. You can achieve this
through:
- Preparing your food beforehand, and
having it with you
- Planning your meal times in advance
- Carrying liquid meals with you
- Consuming Low GI meals throughout
the day
130
Fruits and Vegetable contain a high
volume of Vitamins and Minerals that
the body requires to
function optimally. You should be
consuming at least 7-8 servings of fruit
and vegetables daily
to fuel your body with the nutrients it
needs to improve:
- Cognitive function (Mental focus to
push through a session)
- Acid/Base regulation (ensure your
stomach is processing fuel optimally,
and assisting
recovery between sets)
- Cellular function (including increasing
repair and regeneration of muscles)
Diets such as “If It Fits Your Macros”
(IIFYM), will work superficially, as it
follows the rules of
energy in verse energy out. However
the body is far more complex than that.
There are billions
of chemical reactions that occur
continuously throughout your body
during the day. Each of
these reactions requires molecules that
you can only obtain from your food.
Eating food that is
not energy dense will result in a faster
ageing and poorer-functioning body,
neither of which are beneficial to
optimizing muscle growth and feeling
healthy.
Good Fats Post Training: During
resistance training sessions,
inflammation increases around the
body, due to the increase in blood flow
through the body, and tension around
the joints and tendons. This
inflammation can slow the
transportation of macro and
micronutrients to the muscles after
training, which is when it is most critical.
Having a diet that includes Good Fats
such as Omega 3, which has anti-
inflammatory properties, will see the
body recovering and growing at a
quicker rate.
Appropriate Supplementation: There
are a range of supplements in the
marketplace that claim to achieve great
results in short amounts of time. Any
supplementation choices should be
considered with the assistance of an
accredited Dietitian or Sports Dietician.
There are several supplements that can
assist the process of muscle building in
a safe and natural way. These will be
discussed in more depth in the
Supplements chapter.
131
3.3 Role of Insulin
What is insulin?
Insulin is a hormone produced by
pancreas and it helps us convert dietary
carbs into energy or into glucose for
further use.
Insulin is one of the hormones that are
required to regulate blood sugar level by
allowing cells in muscles, fat, and liver
to absorb it.
Harry’s Comment: ALL FOODS TRIGGER
INSULIN RESPONSE.
It would make more sense to call Insulin as
anti-catabolic rather than anabolic, as insulin
controls the energy flow from storage to
bloodstream when diet provides enough
glucose. (15)
Image source:
https://www.endocrineweb.com/sites/default/files/imagecache/gallerv-
large/wvsiwvg_imageupload/37373/2019/02/26/HowInsulinWorks_3956
3672_M.jpg
When we eat food, blood sugar rises,
and pancreas are signaled to release
insulin. Insulin then attaches to cells
where energy is needed (cells need
glucose but blood sugar can’t directly
enter cells) and now cells can absorb
sugar from blood.
If cells do not need energy, the sugar is
then converted into glycogen in liver for
further use.
If body doesn’t produce insulin (Type I
diabetes) or doesn’t produce in enough
quantities/is resistant to it (Type II
diabetes), blood sugar stays high
causing hyperglycemia.
132
Insulin Index (II)

II is how much the consumed food

elevates the concentration of Insulin in Insulin Index Glycaemic Index
blood in period of 2 hours consumption. Blood glucose levels are
The II can be more useful than either measured Blood glucose
the glycemic index or the glycemic load raising potential of
Blood insulin levels
because certain foods (e. g., lean meats carbohydrate content of a
are measured
and proteins) cause an insulin response food compared to a
despite there being no carbohydrates reference food (pure
present, and some foods cause a glucose)
disproportionate insulin response Compares food
relative to their carbohydrate load. Compares portions with
portions with equal
equal digestible
overall caloric
carbohydrate content
content (250 kcal
Difference between II and GI: (typically 50 g)
or 1000 kJ)
The limitation of the GI approach is that
we can eat a diet full of low GI
carbohydrates and protein, and still
produce a large amount of insulin. Even
though those are slow to digest and do
not raise blood sugar significantly, low
GI foods still require substantial
amounts of insulin.
We should focus on amount of insulin, and
not on carb quantity or blood sugar rise.

133
Insulin Index of common foods:
Inulin Insulin
Food Food Food Insulin
Index
Index Index
Butter 2 Low fat milk 34 Honeysmacks 49
Reduced fat potato
Olive Oil 3 Beef lasagne 34 51
chips
White tortilla
Avocado 4 36 Sustain 52
(ccorn)
Walnuts 5 Snickers Bar 37 Soy-lin grain bread 52
Honey resin bran Low fat cottage
Bacon 9 37 52
muffin cheese
Yellow cake with
Peanut Butter 11 Beef steak 37 53
chocolate
Peaches canned
Bologna 11 Popcorn 39 54
with juice
French fries
Peanuts 15 Frozen corn 39 54
(McCain)
Reduced fat Fat free raisin
Tuna in Oil 16 40 54
cottage cheese oatmeal cookie
Tomato pasta
Hot dog 16 41 Donut 54
sauce
Roast chicken
17 Granola 41 Battered fish fillet 54
without skin
Cream cheese 18 Grain bread 41 Orange juice 55
Chicken with skin 19 Carrot juice 41 Great grains 57
Coleslaw 20 Pastry 42 French fries 57
93% fat free 20 Low fat cheese 42 Pan cakes 58
Cheddar Cheese
Tofu 21 Lentils in tomato 42 Croissant 58
sauce
Prawns 21 White fish 42 Whole grain puff 59
Navy beans 23 Apple 43 Banana 59
Egg 23 Orange 44 Skim milk 60
Full cream milk 24 Coca-cola 44 Chocolate brownie 60
Beef taco 24 Potato chips 45 Black grapes 60
Tuna in water 26 Jatz cracker 45 Honey bunches of 61
oats
Whole meal 29 Corn chips 45 Cheerios 63
pasta

White pasta 29 Brown rice 45 Water crackers 64

Porridge 29 Pizza 47 White bread 100
Resins 31 Apple pie 47 Baked beans 120
Chocolate chip 33 Apple juice 47 Potatoes 121
cookies
Muesli bar 34 Oat bran 48 Mars Bar 122
Milk chocolate 34 Reduced fat 49 Jelly beans 160
chocolate chip 134
cookie
Limitations of Insulin Index: As sedentary individuals become more and
Looking at the above chart if you want to help more insulin resistant, pancreas cannot
yourself with extra spoonful of butter, we secrete sufficient insulin to remove glucose
should remember that II of a food measures from the blood after food consumption.
insulin in blood only for 2 hours post This is called as Glucose Intolerance.
consumption. This approach will lead to Role of Carbs in Insulin Resistance
underestimating insulin response from foods
that invoke rise in insulin quite late (e.g. “One cannot simply look at the fact that
protein spikes insulin approx. 8 hours after carbohydrate ingestion will suppress fat
consumption, and fats take even longer). burning during the time that carbohydrate
is metabolized. Unfortunately, proponents
“We can’t simply assume that because the of the "carbohydrates drive insulin which
insulin rise after meals is low that our total drives fat storage" mantra do exactly that.
insulin secreted across the day will also be You have to consider the big picture and
lower.” (15) what is happening over a 24 hour period. ”
(16)
Insulin Resistance (IR):
In order to understand IR, we need to
understand Insulin Sensitivity (IS) first.
IS refers to the body’s ability to efficiently
dispose of blood glucose.
Active individuals are more insulin sensitive
than those who have sedentary lifestyles.
When a person consumes foods that keep the
blood sugar high for pretty much all the time,
for long periods, the insulin receptors in cells
stop responding to presence of insulin in
blood, and do not let the blood glucose in. This
is called as IR. So if you are highly insulin
sensitive, you have lower chances of
becoming insulin resistant.

Image Sources:
https://www.healthvpcos.com/blogs/pcos/evervthing-
vou-need-to-know-about-pcos-insulin-resistance
135
Role of exercise (Endurance &
Resistance) in preventing insulin
resistance:
• As we saw above- improved insulin
sensitivity drastically lowers the
chances of one becoming insulin
resistant. Exercise induced weight
loss seems to be one of the major
reasons for improved insulin
sensitivity. It is important to know
that weight loss due to dieting alone
and exercise induced weight loss
have noticeable difference in
improvement in insulin sensitivity.
• “Additionally, exercise-induced weight
loss stimulates mitochondrial
oxidative capacity and impacts
endogenous glucose production by
significantly suppressing
unnecessary gluconeogenesis. The
efficacy of sustained improvements
in glucose metabolism may be
influenced by exercise intensity as it
relates to changes in body
composition. Dietary weight loss
effectively lowers adipose tissue
considerably, but does not influence
muscle metabolism similar to
exercise training. However, both
interventions may be used together
as a powerful weight reduction
technique as well as a weight
management tool and a mechanism
proven effective to improve glucose
metabolism.” (17)
•
Image Source:
https://www.crossfit.com/essentials/metabolic-svndrome-
and-insulm-resistance-underlvmg-
causes-and-modification-by-exercise-training
“An increase in the quantity of FFM
from resistance training contributes
to increased glucose disposal,
probably from a mass effect, without
altering the intrinsic capacity of the
muscle to respond to insulin. On the
other hand, endurance training
enhances glucose disposal
independent of changes in FFM, fat
mass, or VO2max, suggestive of an
intrinsic change in the ability of the
muscle to metabolize glucose.” (18).
Note: This study was conducted on
young, non-obese females.
• Endurance training increases insulin
sensitivity (25% to 50%), in a variety
of age and population groups
(healthy, obese, females, males,
young, adults, older population, and
people with Type II diabetes); many
studies have noted insulin sensitivity
related benefits independent of
changes in body weight and/or body
composition.
• Intensity matters: HIIT is more
affective at avoiding metabolic
syndrome than moderate intensity
aerobic training. (19)
136
Implications for Trainers & Coaches: Foods and Supplements to maintain
o People respond differently to optimum Insulin levels:
efforts of increasing insulin • Non starchy vegetables
sensitivity esp. through aerobic • Cacao
exercise (because of genetic • Whole grain foods
variation), and hence • High protein foods
individualized programs are • Foods with soluble fiber (legumes,
recommended. o HIIT has oatmeal, flaxseeds, oranges,
greater benefits with respect to Brussel sprouts)
metabolic syndrome than low or
moderate intensity aerobic
training.
o Endurance as well as
resistance training both help
increase insulin sensitivity
through different mechanisms
but the comparison with
respect to the degree of
increase in insulin sensitivity
is not clear.
o Weight loss is NOT an
indicator of increased insulin
sensitivity when following an
exercise protocol. Exercise
will still lead to insulin
sensitivity benefits even
though there are no weight
loss/BMI changes.
o Insulin sensitivity benefits of
aerobic training are rapidly
lost according to a study that
examined effect of detraining on
trained athletes for 10 days.
(May last longer in non-
diabetic population) (20)

137
References:

• Kendall, M. (2015). Making sense of the Food Insulin Index (with recipes and food lists to stabilise
insulin and blood sugars and help you to lose weight). Optimising Nutrition.
https://optimisingnutrition.com/food-insulin-index-2/
• 2. Krieger, J. (n.d.). Insulin, an Undeserved Bad Reputation: The Finale. Weightology: The
Science of Metamorphosis. https://weightologv.net/insulin-an-undeserved-bad-reputation-the-
fmale/
• 3. Keshel, T. E., & Coker, R. H. (2015). Exercise Training and Insulin Resistance: A Current
Review. Journal of obesity & weight loss therapy, 5(Suppl 5), S5-003.
https://doi.org/10.4172/2165-7904.S5-003
• 4. Eric T. Poehlman, Roman V. Dvorak, Walter F. DeNino, Martin Brochu, Philip A. Ades, Effects
of Resistance Training and Endurance Training on Insulin Sensitivity in Nonobese, Young Women:
A Controlled Randomized Trial, The Journal of Clinical Endocrinology & Metabolism, Volume 85,
Issue 7, 1 July 2000, Pages 2463-2468, https://doi.org/10.1210/icem.85.7.6692
• 5. Tjonna, A. E., Lee, S. J., Rognmo, 0., Stolen, T. O., Bye, A., Haram, P. M., Loennechen, J. P.,
Al-Share, Q. Y., Skogvoll, E., Slordahl, S. A., Kemi, O. J., Najjar, S. M., & Wisloff, U. (2008).
Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic
syndrome: a pilot study. Circulation, 118(4), 346-354.
https://doi.org/10.1161/CIRCULATIONAHA.108.772822
• 6. Roberts, C. K., Hevener, A. L., & Barnard, R. J. (2013). Metabolic syndrome and insulin
resistance: underlying causes and modification by exercise training. Comprehensive Physiology,
3(1), 1-58. https://doi.org/10.1002/cphy.c110062

138
3.5 MICRONUTRIENTS
A balanced diet should contain
micronutrients (vitamins and minerals) as
humans cannot produce (most of) these.
They are also referred to as essential
nutrients for the same reason. When we
eat plant and animal based foods, we get
the vitamins that plants and animals
created or the minerals they absorbed.
Vitamins:
‘vita’ = life, ‘amine’ = a nitrogenous
substance essential for life. Casimir Funk,
a biochemist, coined the term ‘vitamin’ in
1912. (1) Funk is known to be the father
of vitamin therapy. He studied diseases
caused due to deficiency (scurvy, beri-
beri, pellagra, rickets) and identified
components that were missing that
caused these deficiencies. All vitamins
were discovered by 1948, and around
1950, most micronutrients were available
to public. (2)
Vitamins are organic, made by plants and
animals which can be broken down by
heat, acid or air.
Vitamins are divided in two categories:
Fat-soluble (vitamin A, vitamin D, vitamin
E, and vitamin K) and Water soluble
(vitamin C and the B-complex vitamins,
such as vitamin B6, vitamin B12, and
folate). Water soluble vitamins are to be
dissolved in water for absorption by the
body. Excess of these are lost through
urine. Unlike water soluble vitamins, fat
soluble vitamins aren’t thrown out of the
body, and hence accumulate.
References:
• 1.https://www.karger.com/Article/Abstract/319165
• 2.https://www.hsph.harvard.edu/nutritionsource/vitamins/
• 3.https://www.sciencedirect.com/science/article/abs/pii/S0891584915001409?via%3Dihub
• 4.https://www.medicalnewstoday.com/articles/324308#trout
• 5.https://www.muscleandfitness.com/nutrition/gain-mass/vitamin-e-stacked/
• 1. Vitamin E
● It is an essential vitamin, as body
can’t produce it. It is fat-soluble, and is
found in cell membrane.
● Benefits:
O Essential for repairing plasma call
membrane (very important for muscle
cells as they undergo more wear and
tear due to exercising). (3)
O It’s a powerful anti-oxidant
O It is known for its anti-aging
properties
O In treatment of inflammatory
disorders such as rheumatoid arthritis to
lessen the severity of pain
O It helps prevent atherosclerosis as
Vitamin E can protect bad cholesterol
from depositing in arteries.
● Food Sources: sunflower seeds,
almonds, peanuts, avocados, spinach,
trout (4)
● Recommended intake:
O 200-400 IUs of vitamin E
O Vitamin E vs. synthetic forms. While
synthetic and natural vitamin E- both
are absorbed to the same degree,
natural form almost twice as bioactive
when consumed. I.e., Only 50% of
synthetic Vitamin E is absorbed, and the
rest is thrown out.
O “If the source is listed as dl-alpha
tocopheryl acetate or dl-alpha
tocopherol, it’s synthetic. If it reads d-
alpha tocopherol (no “l” after the “d”), it’s
a natural form likely derived from
vegetable oils.” (5)
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2. VITAMIN B
Vitamin B complex is a group of following
water soluble vitamins: niacin, thiamin,
riboflavin, folate, B12, B6, pantothenic
acid, and biotin.
• Vitamin B Complex converts nutrients
into energy.
• Cobalamin (Vitamin B-12):
o It metabolizes protein and fats. o It is
essential for red blood cell
generation.
o It ensures optimal neurological
function necessary for muscle
control.
• Niacin (Vitamin B-3):
o It helps grow muscles.
o Lowers bad cholesterol and increases
good cholesterol o Promotes
glucose metabolism o Necessary for
optimal levels of hormone
production.
o It also increases HGH (Human
Growth Hormone) production and
hence aids fat loss. o Food
Sources: pork, cereals, tuna, turkey,
peanuts, and liver.
• Pyridoxine (Vitamin B-6):
o Promotes red blood cell generation o
Important for protein metabolism
o Maintains healthy levels of Nitric
Oxide (responsible for athletic
performance). o Food Sources: fatty
fish, chickpeas, bananas.
• Riboflavin (Vitamin B-2):
o Important for energy production.
o Helps reduce post-exercise muscle
soreness which leads to lesser
recovery time. o Food Sources:
trout, beef, lamb, dairy.
References:
• 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2294088/
• 2. https://www.hsph.harvard.edu/nutritionsource/vitamins/vitamin-b/
• 3. https://onlinelibrary.wilev.com/doi/full/10.1111/cns.13207
• 4. https://lpi.oregonstate.edu/mic/vitamins/vitamin-B6
• Biotin (Vitamin B-7):
o It is required for fat and carbs
metabolism
o Food Sources: Yeast, eggs,
salmon, and cheese are good
dietary sources.
• Folate/Folic Acid (Vitamin B-9):
o Folic acid is the synthetic version
of B-9 that naturally occurs in food.
o Energy production, muscle repair,
and muscle building happens when
B-9 works together with B-12.
o Food Sources: avocado, spinach.
o But to fulfill the daily
requirements, folic acid
supplements are advised.
•
Recommended intake:
o B-12: 2.4mg/day. Has low
toxicity level. If you aren’t
deficient, having it in excess
doesn’t provide any benefits.
Vegetarians are at a risk of it’s
deficiency as its primary food
sources are
o Niacin (B-3): 14-16mg/day is a
normal dose. Bodybuilders take
between 300-500mg for desired
results. Start with a low dose.
o Folic acid (B-9): 400mcg/day
for both men and women.
o Biotin (B-7): 30mcg/day for
both.
o Riboflavin (B-2): 1.1mg/day for
women, 1.3mg/day for men
o Thiamin (B-1): 1.1.mg/day for
women, 1.2mg/day for men
140
3. Vitamin C
●It is a water soluble essential vitamin
that our body can’t synthesize (i.e.
diet/supplements is the only source).

●Benefits:
oVitamin C is a powerful anti-oxidant.
(1)
oSupports your immune system’s
cellular function (2)
o“Although regular vitamin C intake
likely won’t prevent you from
catching a cold, it may reduce the
duration or severity of cold
symptoms.” (3)
oIndividuals with iron deficiency
might benefit from increasing their
vitamin C intake as it increases iron
absorption (4)
oEssential for cognitive development
of infants during pregnancy
oHas antidepressant effects.
oSupport carnitine and collagen
biosynthesis in skeletal muscle
tissue
oVitamin C at 500mg/day, twice, in
combination with 400 IU vitamin E
may result in insulin-sensitivity-
increasing effects of exercise in both
trained anduntrained individuals. (5)

●Recommended intake: ~60-120mg/

day (depending on age & sex) is easily
attained through diet.

●Higher doses of vitamin C, up to

2000mg/day are used to support the
immune system (for athletes) or reduce
the duration of the common cold.

References:

• 1. https://www.ncbi.nlm.nih.gov/pubmed/30789800
• 2. https://www.ncbi.nlm.nih.gov/pubmed/29099763
• 3. https://www.ncbi.nlm.nih.gov/pubmed/23440782
• 4. https://www.ncbi.nlm.nih.gov/pubmed/30666502 141
• 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425865/
4. Vitamin K ●Vitamin K1
●Vitamin K is fat soluble, and is oIt is the primary dietary form of
essential for blood coagulation. vitamin K.
●Optimal levels of vitamin K are oDietary Sources: green leafy
associated with: vegetables and vegetable oils
oImproved bone circumference (soybean, canola, etc).
and diameter. ●Vitamin K2:
oReduction in risk of oMK-7, a subtype of Vitamin K2 is
cardiovascular-related mortality found in animal and fermented
(by reducing calcification and foods.
stiffening of arteries). (1) oNatto- a traditional Japanese
oFaster recovery from intense food made from fermented
workouts soybean is the most important
oImproved episodic memory in source of MK 7.
older adults. (2) oIts 10 times more readily
●Microwaving plant-based sources of available than vitamin K1.
vitamin K will increase the absorption oMK-7 is helpful in maintaining
rate of the vitamin. bone health
●Vitamin K has two types: K1 oK2 is used by anabolics users to
(phylloquinone) that naturally occurs control the damage to heart.
in plants and K2 (menaquinone-n or ●Recommended Dosage: (4)
MK-n)- range of K2, synthesized by o~1 microgram/kg body
bacteria. These are collectively weight/day
referred to as K2. (3)

References:

• 1. https://examine.com/supplements/vitamin-k/
• 2. https://www.medicalnewstoday.com/articles/219867#benefits
• 3. https://www.muscleandstrength.com/supplements/ingredients/vitamin-k.html
• 4. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-k/

142
5. Vitamin D
●It is one of the 24 micronutrients
necessary for our survival.
●Vitamin D is synthesized by our skin
from cholesterol when exposed to
UV light from the sun.
●Vitamin D is also found in fish, eggs,
and dairy products.
●It regulates calcium and phosphorus
in the body.
●It is important to maintain proper
bone structure.
●Vitamin D supplements to correct a
deficiency may improve athletic
performance.
●Low levels of vitamin D3 are linked
to erectile dysfunction, low
testosterone levels
●People with insufficient levels of
Vitamin D are likely to have fatty
muscles.
References:
• 1. https://www.eurekalert.org/pub releases/2018-05/esoe-lwa051718.php
• 2. https://examine.com/supplements/vitamin-k/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821095/
●“In women, both total and abdominal
fat were associated with lower
vitamin D levels, but that abdominal
fat had the greatest impact. In men,
however, lower vitamin D levels were
significantly linked with fat in the liver
and abdomen.” (1)
●“Vitamin K is often supplemented
alongside vitamin D, since vitamin D
also supports bone health. In fact,
taking both together will improve the
effects of each, since they are
known to work synergistically.
Excessive vitamin D can lead to
arterial calcification, but vitamin K
reduces this buildup.” (2)
●Recommended Dosage: (3)
o1000–4000 IU (25–100
micrograms)/day for average
population.
oTo treat deficiency, 50,000 IU per
week for 6-12 weeks could be
used.
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https://www.fssai.gov.in/upload/advisories/2020/01/5e159e0a809bbLetter_RDA_08_01_
2020.pdf

144
MINERALS
Minerals exist in soil or water, are
inorganic, and cannot be broken down.
Minerals are divided into: macro-
mineral (calcium, phosphorus,
magnesium, sodium, chloride, sulphur,
and potassium) and trace/micro (iron,
manganese, copper, zinc, cobalt,
selenium, fluoride, and iodine), and as
the name suggests, trace/micro
minerals are needed in smaller amounts
than macro-minerals.
Functions of Minerals:
Macro-Minerals:
1.Calcium
• 99% of it is stored in bones. If body
doesn’t get enough calcium from
food, it removes it from the bones.
• For normal functioning, body
maintains a steady level of Ca in
blood and tissues. Parathyroid
hormone (PTH) and calcitonin play
important roles in it. When calcium
levels drop, PTH signals the bones to
release calcium into the bloodstream.
In the intestines, PTH also activates
vitamin D for improved absorption of
calcium. Simultaneously, the kidneys
are signalled to excrete less calcium.
When the body has enough calcium,
calcitonin controls release of calcium
from bones, and signals kidneys to
excrete more calcium.(1)
• It is important for:
• Blood clotting
• Muscle Contraction
• Heart rhythm regulation
• Nerve functions
• Bone and teeth health
•Deficiency:
• Bones release calcium into the blood
if blood levels of Ca drop. Serious
deficiency of calcium (hypocalcemia),
can be a result of kidney failure,
surgeries like gastric bypass, or
medications like diuretics that
interfere with absorption.
• Some foods/medications can result in
increased Ca intake need (they either
slow the absorption of Ca or increase
its rate of excretion) such as
corticosteroids, excess sodium in the
diet, phosphoric (found in dark
sodas), excess alcohol, and some
anti-nutrients.
• Signs of Deficiency:
• Muscle cramps or weakness
• Numbness or tingling in fingers
• Abnormal heart rate
• Poor appetite
• People at the risk of Ca deficiency:
• Postmenopausal women:
menopause lowers estrogen
(which helps calcium
absorption and mineral
retention)
• Amenorrhea (where menstrual
periods stop early/disrupted,
often seen in younger women
with anorexia nervosa or
athletes who train very
intensely)
• lactose intolerance
145
• Dietary Sources (1): • Dosage:
• Dairy (cow, goat, sheep) and • Recommended Dietary
fortified plant-based milks Allowance (RDA) (2):
(almond, soy, rice) • Women (19-50): 1000 mg/day
• Cheese • Men (19-70): 1000 mg/day
• Yogurt • Women (51+): 1200 mg/day
• Calcium-fortified orange juice • Men (71+): 1200 mg/day
• Winter squash • Pregnant & Lactating Women:
• Edamame (young green 1000 mg/day
soybeans); Tofu, made with • The Tolerable Upper Intake
calcium sulfate Level (TL): 2,000-2,500
• Canned sardines, salmon (with mg/day (3)
bones) • Overdose:
• Almonds • Some research has shown
• Leafy greens such as collard, that in certain people, calcium
mustard, turnip, kale, bok can accumulate in blood
choy, but NOT spinach or vessels with long-term high
swiss chard which lessen the doses and cause heart
absorption. problems.
• can block the absorption of
other minerals like iron and
zinc.
• People above 50, if take more
than 2000 mg a day, esp from
supplements, can be at
increased risk of kidney
stones, prostate cancer, and
constipation.

References:

• https://www.hsph.harvard.edu/nutritionsource/calcium/
• https://www.ncbi.nlm.nih.gov/books/NBK56056/
• https://www.acpjournals.org/doi/full/10.7326/M16-1743

146
.
2. Phosphorus Symptoms:
• Muscle weakness
• Phosphorus is an essential structural • Appetite loss
component of cell membranes and • Weak bones
nucleic acids • Rickets
• Numbness in digits
• 85% it in our body is found in teeth • Dietary Sources: dairy, meat, fish,
and bones. (1) poultry, eggs, liver, green peas,
broccoli, potatoes, almonds (2)
• Helps the body to store and use
energy. Dosage:
• Recommended Dietary Allowance
• Works with calcium in the formation (RDA):
of strong, healthy bones and teeth. • 700 mg/day for males as well
as females
• It is important for (2): • The Tolerable Upper Intake Level
• Bone mineralization (TL) (2):
• Energy production • Men and women (31-70yrs):
• Cell signalling through 4000 mg/day
phosphorylation • Men and women (71+ yrs):
• Regulation of acid-base 3000mg/day
homeostasis
Supplements:
• It is also part of phospholipids (which • Use in cases of phosphorus wasting
carry fats in blood to help transport by body (eg due to kidney
nutrients to and from cells) malfunction) needs to be medically
supervised. It is used in the form of
Deficiency: calcium phosphate and potassium
• Is uncommon and can occur only in phosphate salts.
cases of:
• near starvation. Overdose & Toxicity:
• genetic renal phosphorus • High serum levels pf phosphorus can
wastage disorder lead to cardiovascular diseases
• “A low calcium-to-phosphorus intake
ratio may be detrimental to bone
health, especially in women at
increased risk for osteoporosis”. (1)

References:

• https://lpi.oregonstate.edu/mic/minerals/phosphorus

• List of vitamins, Harvard health publishing school.

147
.
3. Magnesium
• Needed for chemical reaction in the
body
• Plays role in muscle contraction
along with calcium.
• More than 50% is stored in bones.
• It is important for: (1)
• Blood clotting
• Regulation of blood pressure
• Regulation of blood sugar
• Nerve functions
• Development of teeth and
bones
• According to evidence so far, Mg
supplements DO NOT help with
muscle cramps (2).
Deficiency: (2)
• Body tries to hold on to magnesium
when its stores are low.
• Long term low magnesium diets,
alcohol abuse and inability to absorb
magnesium can cause real
deficiency.
• Elderly have the risk of deficiency as
the intake through food is low, body
doesn’t absorb it as much, and a lot
of it is lost through urine.
• Diseases associated with digestion
(e. g., Celiac, crohn’s disease) can
lead to magnesium deficiency
• Uncontrolled diabetes, insulin
resistance can lead to Mg deficiency
as in such cases body creates a lot of
urine, and Mg is flushed out with
urine
References:
• List of vitamins, Harvard health publishing school
• https://www.hsph.harvard.edu/nutritionsource/magnesium/
• Dietary Sources: cooked Spinach, Swiss
chard, banana salmon, white potatoes
with skin, broccoli, legumes, sunflower &
other seeds, milk, whole-wheat bread,
cashews, soy milk, soybean, dark
chocolate (at least 70%) (1,2)
Dosage:
• Recommended Dietary Allowance
(RDA):
• Men (18+): 420 mg/day
• Women (18+): 320 mg/day
• Pregnant women: 350-360 mg/day
• Lactating women: 310-320 mg/day
• The Tolerable Upper Intake Level (TL)
(2):
• Men and women (31-70yrs): 350
mg/day (not applicable to dietary
Mg, but to medicine, supplements)
Supplements:
• Used if body has a problem absorbing
magnesium.
• OTC: liquid form (magnecium citrate or
chloride), solid tablet (magnesium oxide
and sulphate)
• Liquid form is absorbed better
Overdose:
• Is rare, as body excretes excess
magnesium.
• People with kidney diseases are at risk-
as kidneys cant flush out excess
magnesium.
• Can happen only from more than TL
intake through supplement. Can lead to
nausea, diarrhea, cramps. Has laxative
effect.
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.
4. Sodium
• Impacts blood pressure
• It is important for:
• Maintaining fluid balance
OUTSIDE cells
• Nerve impulse transmission
• Muscle contractions
• Deficiency: very rare, happens only
in cases of patients who take
medicines that depletes the body of
sodium.
• Dietary Sources: Salt, Soy sauce,
processed foods, vegetables
Dosage:
• Recommended Dietary Allowance
(RDA):
• Men & Women: 2300 mg/day,
staying below this lowers risk
of high blood pressure and
high blood pressure
• The Tolerable Upper Intake Level
(TL):
• Not determined
• Overdose:
• Puts pressure on kidneys.
• Body holds on to water to
dilute sodium, that means
increased blood volume, that
means increased pressure on
heart and blood vessels. And
hence, can cause high blood
pressure, stroke, and heart
disease.
• Can cause calcium loss
References:
• List of vitamins, Harvard health publishing school.
• https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/
Toxicity:
• Excess sodium in life is called
‘hypernatremia’ which can happen in
people who don’t have enough water
intake or are severely dehydrated.
• “When sodium accumulates in the
blood, water is transferred out of cells
and into the blood to dilute it. This
fluid shift and a build-up of fluid in the
brain can cause seizures, coma, or
even death. Extra fluid collecting in
the lungs can cause difficulty
breathing.” (2)
• Symptoms: loss of appetite, nausea,
confusion, weakness, excess thirst.
Note: Natural salts aren’t healthier than
table salt. The amount of minerals they
have (in addition to sodium
chloride/table salt) is so small, that it
almost makes no difference.
5. Chloride
• It’s a part of stomach acid
• It is important for:
• Digestion
• Fluid balance
• Deficiency:
• Dietary Sources: Salt, processed
foods, soy sauce
Dosage:
-Recommended Dietary Allowance
(RDA):
• Men & Women (14-50 yrs): 2.3 g/day
• Men & Women (51-70 yrs): 2 g/day
• Men & Women (71+ yrs): 1.8 g/day
-The Tolerable Upper Intake Level (TL):
Not known
-Overdose & Toxicity: Rare in healthy
individuals
149
.
6. Sulphur
• Sulphur helps these amino acids
maintain their shapes so that they
can perform their roles in the human
body. (1)
• Is a component of vitamin B1. Insulin,
and some amino acids
• It is important for:
• Stabilizing protein structures
• Healthy skin, hair, & nails
(makes cells rigid)
• Deficiency: rare, possible only in
cases of extreme protein deprivation.
• Dietary Sources: meat, poultry,
legumes, fish, cabbage, garlic, nuts,
onions, wheat germ, soft water,
raspberries (2)
Dosage:
• Recommended Dietary
Allowance (RDA): Unknown as
its abundant in food supply.
• The Tolerable Upper Intake
Level (TL): Unknown
• Overdose: Can occur only in case of
excessive consumption of protein
supplements with Sulfur.
• Toxicity: Depressed growth (2)
References:
• List of vitamins, Harvard health publishing school.
• https://www.sciencedirect.com/science/article/pii/B9780123918826000078
• https://www.hsph.harvard.edu/nutritionsource/potassium/
• National Academy of Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington
(DC): National Academies Press (US); 2019 Mar.
7. Potassium
• As it carries a small electrical charge at
times, it is called as electrolyte which
stimulates cell and nerve functions. (1)
• Functions of sodium and potassium are
usually closely related, and hence, are
studied together.
• “High salt intake increases blood
pressure, which can lead to heart
disease, while high potassium intake
can help relax blood vessels and
excrete sodium while decreasing blood
pressure. Our bodies need far more
potassium than sodium each day.” (1)
• It is important for:
• Fluid balance INSIDE cells
• Maintaining normal blood
pressure
• Muscle contraction
Deficiency:
• Excess Potassium is flushed everyday
through urine, that’s why it is needed to
be replenished daily from food.
• Deficiency is rare (other than in
situations such at diarrhoea, vomiting,
excess fluid loss through urine/sweat)
as its available in wide variety of food
items.
• Magnesium deficiency can also lead to
potassium deficiency as Mg helps
kidneys reabsorb potassium to maintain
a healthy balance.
• Symptoms:
• Muscle cramps
• Fatigue
• Weakness
• Muscle paralysis
• Irregular heartbeats
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.
• Dietary Sources: Dairy, spinach, …
salmon, broccoli, beans, avocado,
raisins, cashews, almonds, yogurt,
coconut water, orange, almond milk,
soy milk, chicken.
• Dosage:
• Recommended Dietary Allowance
(RDA):
• Not Available
• Adequate Intake (AI) established by
National Academy of Medicine, USA
(2):
• Men (14-18 yrs): 3000 mg/day
• Men (19+ yrs): 3400 mg/day
• Women (14-18 yrs): 2300
mg/day
• Women (19+ yrs): 2600
mg/day
• Pregnant & Lactating Women:
2500-2900 mg/day depending
on age
• The Tolerable Upper Intake Level
(TL): Unknown

Overdose:
• As excess Potassium is flushed
everyday through urine, in healthy
individuals, overdose and toxicity is
extremely rare.
• Excess of potassium causes
‘hyperkalemia’ in conditions where
body holds on to excess potassium.
• Possible in people who use
potassium based salt substitute.

References:

• List of vitamins, Harvard health publishing school.

• https://www.sciencedirect.com/science/article/pii/B9780123918826000078
• https://www.hsph.harvard.edu/nutritionsource/potassium/
• National Academy of Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington
(DC): National Academies Press (US); 2019 Mar.
151
Trace-Minerals:
1. Iron
• Component of haemoglobin & myoglobin
• Aids oxygen transport throughout the body
with the help of haemoglobin (present in red
blood cells) and myoglobin (present in
muscle cells)
• Stored in liver, spleen, bone marrow,
muscle tissue as ‘ferritin’; and carried all
over the body by a protein that bind to iron,
called ‘transferrin’.
• It is important for:
• For making AA
• Maintaining healthy blood
• For making collagen
• Brain development and growth in
children
• Normal functioning of cells and
hormones
Deficiency:
• is called ‘anaemia’ and is very common in
pregnant and menstruating women,
children, and those who consume iron-
deficient food.
• Vegetarians, endurance athletes, people
with chronic kidney diseases, and elderly
are also at risk
• To avoid iron deficiency, vegetarians should
eat food sources that have iron along with
foods that have vitamin C, and should avoid
calcium rich foods and tea (it contains tannin,
which lowers absorption of iron from vegetarian
sources).
• It causes:
▪ Extreme fatigue
▪ Light headedness
Dietary Sources: Heme iron:
▪ poultry, red meat, eggs, mussels, oysters,
canned tuna
▪ Heme iron is better absorbed by body.
References:
• https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
• https://www.hsph.harvard.edu/nutritionsource/iron/
Non-heme iron:
• fruits, green vegetables, fortified grain products,
beans, dark chocolate (at least 45%), lentils
• heme iron and vitamin c taken with non-heme iron
can improve absorption of non-heme iron
• phytates, tanins, and Ca supplements (in large
doses) can inhibit its absorption.
Dosage:
Recommended Dietary Allowance (RDA):
▪ Boys (14-18 yrs): 11 mg/day
▪ Girls (14-18 yrs): 15 mg/day
▪ Men (19-50 yrs): 8 mg/day
▪ Women (19-50 yrs): 18 mg/day
▪ Pregnant women: 27 mg/day
▪ Lactating women: 10 mg/day
▪ Men (51+ yrs): 8 mg/day
▪ Women (51+ yrs or after menopause): 8 mg/day
The Tolerable Upper Intake Level (TL):
▪ Males & females >14+ yrs: 45 mg/day
▪ Boys & Girls below 14 yrs: 40 mg/day
Supplements:
• Some of the available multivitamin and mineral
supplements and fortified cereals have 100% of
the RDA for women, and others, aimed at treating
anemia, can have a lot more than RDA.
• Available in various forms: ferrous gluconate
(liquid form, better absorbed, but contains less
elemental iron), ferrous sulphate, ferrous
fumarate etc and differ in amounts of elemental
iron (the amount of iron that’s available for the
body to absorb in that supplement)
Overdose:
• Toxicity is rare as body simply starts absorbing
less iron from food if it has enough
• Can happen only from intake of very high doses
of iron supplements when not needed.
• Can cause nausea, constipation, upset stomach.
152
 2. Manganese
∙ Is a cofactor (a compound that
acts a s a catalyst for an enzyme)
for many enzymes that metabolize
AA, carbs, cholesterol, and
glucose.
∙ Plays a role in blood clotting.
∙ Human body has 10-20 mg of it,
25-40% stored in bones. (1)
∙ It is important for:
o Metabolizing AA, cholesterol
and carbs
o Bone formation
∙ Deficiency: Very rare
∙ Dietary Sources: Nuts, seeds,
tea, legumes, leafy green
vegetables, whole grains (2)
● Dosage:
o Recommended Dietary
Allowance (RDA): can’t be
determined
o Adequate Intake (AI): (3)
▪ Women: 1.8 mg/day
▪ Men: 2.3 mg/day
o The Tolerable Upper Intake
Level (TL):
▪ Men & Women: 11
mg/day
● Supplements:
o Oral or Intravenous (IV)
o Useful in treating
manganese deficiency.
● Overdose:
o Doesn’t happen from dietary
intake
o Toxicity can occur in people
exposed to high amount of
manganese (welding,
mining)
3. Copper
∙ Found in all body tissues.
∙ With iron, it helps make red blood cells.
∙ Helps collagen formation, energy
production, and iron absorption
∙ Found in brain, kidneys, liver, heart,
skeletal muscles
∙ Deficiency:
o Rare.
o Can impair immune function,
nerve signalling, increases
chances of infection, and
increases risk of osteoporosis.
o High intake of Zinc (150 mg/day
or above) and/or Vitamin C (1500
mg/day or above) increases the
chances of Cu deficiency. (1)
∙ Dietary Sources: seafood, fortified
cereals, vegetables, fruits, nuts, black
pepper, beans, cocoa,
● Dosage:
o Recommended Dietary Allowance
(RDA): (2)
▪ Men: 900 mcg/day
▪ Women: 900 mcg/day
o The Tolerable Upper Intake
Level (TL): 10000 mcg/day
● Supplements:
o Not necessary, very few need it
o Should be taken only if advised
by a medical professional
● Overdose: Rare
● Note: Supplements can interact
(reduce or increase Cu levels in blood)
with contraceptive pills, hormone
therapy, non-steroidal anti-
inflammatories (NSAIDS), Zinc
supplements, gastric ulcer
medications. (1)

References:

• https://ods.od.nih.gov/factsheets/Manganese-HealthProfessional/
• https://www.webmd.com/vitamins/ai/ingredientmono-182/manganese
• List of vitamins, Harvard health publishing school.
• https://www.medicalnewstoday.com/articles/288165#risks
• List of vitamins, Harvard health publishing school. 153
 4. Cobalt
∙ Part of Vitamin B-12
∙ Acts as cofactor for several enzyme
actions
∙ Is a part of biotin-dependent Kreb’s
cycle (1)
∙ Helps make RBC to carry oxygen
around, when oxygen levels in the body
are low.
∙ Deficiency:
o Anaemia is the main cause of
Cobalt deficiency
o Symptoms:
▪ Fatigue
▪ Tingling in hands and feet
▪ Numbness
∙ Dietary Sources: Foods high in
Vitamin B-12
● Dosage:
o Recommended Dietary Allowance
(RDA):
▪ Not Determined
o The Tolerable Upper Intake
Level (TL): Not determined
● Supplements:
o Enough information isn’t available
to decide if it is safe for pregnant
and lactating women.
● Overdose:
o Unsafe to take cobalt
supplements in large amounts
o Unsafe to take cobalt
supplements for more than 90
days (1mg/day) (2)
o Might lead to vision and hearing
impairments and heart issues.
o Can reduce activity of thyroid

References:

• https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=19&contentid=cobalt

• https://www.webmd.com/vitamins/ai/ingredientmono-1613/cobalt

• List of vitamins, Harvard health publishing school.

154
5. Selenium ● Dosage:
∙ Is an essential component of various o Recommended Dietary
enzymes Allowance (RDA):
∙ Is a part of a protein called ▪ Men & Women (19+
selenoprotein (selenoproteins have yrs): 55 mcg/day
antioxidant properties. They are a ▪ Pregnant Women: 60
part of DNA, protect and repair cell mcg/day
damage, and help metabolizing ▪ Lactating women: 70
thyroid hormone) mcg/day
∙ Stored in muscles and thyroid gland o The Tolerable Upper Intake
∙ Deficiency: Level (TL):
o Difficult to diagnose ▪ Men & Women (19+
o Depends on the soil content of yrs): 400 mcg/day
the region you live in. ▪ Pregnant & Lactating
o Groups at the risk of selenium Women: 400 mcg/day
deficiency: ● Supplements:
▪ HIV o You don’t get additional
▪ Dialysis benefits from selenium
▪ Digestive diseases such supplements if you are not
as Crohn’s disease deficient
▪ Vegetarians, vegans in o Usually have 100-400 mcg
areas with low selenium selenium per dose
content soil ● Overdose & Toxicity:
∙ Dietary Sources: o People who eat too many
o Selenium content of food brazil nuts on daily basis can
depends on the selenium have toxic levels of selenium
content of the soil it is grown in. o Overdose can lead to:
It also affects the selenium muscle tremors, dizziness,
content of animal foods- as upset stomach, kidney
animals eat those plants. failure, heart attack,
o Generally, animal protein is a respiratory problems etc.
good source
o Seafood, brazil nuts, fortified
cereals, beans, lentils
o “Brazil nuts are exceptionally
high in selenium even when
grown in low-selenium soil, with
even one nut containing more
than the RDA.” (1)

References:

• https://www.hsph.harvard.edu/nutritionsource/selenium/

• List of vitamins, Harvard health publishing school.

155
6. Fluoride
∙ Prevents and reverses tooth decay to
some extent (1)
∙ Stimulates formation of bones
∙ Prevents growth of harmful mouth
bacteria
∙ In healthy adults, 50% of fluoride
absorbed from food is excreted by
kidneys, and in chidren, upto 80% of the
intake is retained.
∙ Rate of absorption is reduced if it is taken
with food.
∙ Dietary Sources:
o Brewed Tea- depending on type and
source (has higher Fluoride levels than
most foods)
o Only trace amount is naturally present in
food (before preparing it with water
containing fluoride)
Dosage:
o Recommended Dietary Allowance
(RDA):
▪ Women: 3 mg/day
▪ Men: 4 mg/day
o The Tolerable Upper Intake Level
(TL): 10 mg/day
● Supplements:
o Very few contain fluoride- that too in
multivitamins and in trace amounts
o Somme supplements, meant for children,
are in the form of drops
● Overdose: (2)
o Long term excess fluoride ingestion in
infancy and childhood can lead to dental
fluorosis
o Overdose from supplements can lead to:
nausea, stomach pain, vomiting,
diarrhoea, skeletal fluorosis, and even
death in rare cases.
References:
• https://www.ncbi.nlm.nih.gov/books/NBK109832/
• https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional/#en1
• List of vitamins, Harvard health publishing school.
• https://www.hsph.harvard.edu/nutritionsource/iodine/
7. Iodine
∙ Essential to make hormones thyroxine and
triiodothyronine
∙ Regulates metabolism
Deficiency:
o Can prevent normal growth
o In pregnant women, can cause: miscarriage,
stunted growth, still birth etc.
o In adults, intake of less than 10-20 mcg/day
can lead to hypothyroidism which can result in
o People who are at risk of iodine deficiency are:
▪ Who don’t use iodized salt or other iodine
supplements
▪ Pregnant women
▪ Vegans
▪ People living in areas with low iodine in
soil
∙ Dietary Sources:
o It is found in soil and ocean and that affects its
amount in food
o Animal food, sea vegetables (eg kelp), seafood,
iodized table salt, eggs, dairy, fortified infant
formula
Dosage:
o Recommended Dietary Allowance (RDA):
▪ Men & Women (19+ yrs): 150 mcg/day
▪ Pregnant Women: 220 mcg/day
▪ Lactating Women: 290 mcg/day
o The Tolerable Upper Intake Level (TL):
▪ All adults, pregnant, and lactating women: 1100
mcg/day
● Supplements:
o Can interact with diuretics and blood
pressure medication, leading to
hyperkalemia
● Overdose:
o Rare
o Can lead to hyperthyroidism
156
8. Zinc o Zinc deficiency is a common in low and
● Though Zinc is ‘essential trace element’ middle-income countries esp. in children
(human body needs it very small amounts), causing stunting of growth, diarrhea,
its needed for a lot of enzymes to be able pneumonia, and malaria. (2)
to function. o In case of deficiency, depression and
● Zinc supplementation is important for acne can benefit from Zinc
athletes as Zinc is lost through sweat. supplementation.
o Signs of Deficiency (3):
Zinc is important for: (1) ▪ Loss of taste or smell
• Brain function (alertness and learning) ▪ Poor appetite
• Protection of free radicals ▪ Depressed mood
• DNA creation ▪ Decreased immunity
• Maintenance of proper immune function ▪ Delayed wound healing
• Prostate health ▪ Diarrhea
• Wound healing. ▪ Hair loss
• Bone strength. ● Dietary Sources: Meat, poultry,
• Controls the functioning of the sense organs oysters, crabs, lobsters, nuts, seeds.
in the nervous system. Though legumes and whole grains are
• Cell division and reproduction. good sources of zinc, they also contain
● Because of its role in cell division and phytic acid (an anti-nutrient), that lowers
reproduction, zinc is required during absorption of zinc by the body. (2)
growth, and pregnancy. ● Dosage:
● Zinc is important for the senses of smell Zinc is more efficiently absorbed when taken
and taste. in smaller doses
Deficiency: o Recommended Dietary Allowance
• Apart from inadequate intake, other reasons (RDA):
can be: Excessive or prolonged diarrhea, ▪ For adults (19+ years): 11 mg a day for
chronic liver or kidney diseases, and inability men and 8 mg for women. (2)
to absorb zinc due to digestive disorders. ▪ Pregnancy: 11 mg/day (3)
• High amounts of calcium & phosphorus in ▪ Lactation: 12 mg/day (3)
cow’s milk can lower zinc absorption. o The Tolerable Upper Intake Level
• People with increase zinc needs are at the (TL): 40 mg/day for adults
risk of Zinc deficiency: ● Supplements:
▪ People with severe conditions: eg o Available as lozenges and pills
burns and sepsis o To be taken only if deficiency is
▪ Pregnant women confirmed
▪ Lactating women ● Overdose:
o Zinc deficiency can cause: o Can almost never happen from intake
▪ Short stature through food (4)
▪ Reduced ability to taste food o Can hamper iron & copper absorption
▪ Problems in proper functioning of o Can cause nausea, vomiting, poor
testes and ovaries. appetite, abdominal pain, headaches,
diarrhea

References:
• https://www.muscleandfitness.com/flexonline/flex-nutrition/importance-zinc-bodybuilders/
• https://examine.com/supplements/zinc/
• https://www.hsph.harvard.edu/nutritionsource/zinc/ 157
• https://www.ncbi.nlm.nih.gov/books/NBK222317/
References:
https://www.fssai.gov.in/upload/advisories/2020/01/5e159e0a809bbLetter_RDA_08_01_2020.pdf

158
3.5 SUPPLEMENTS

Supplementation
A healthy eating plan that is rich in
nutrient dense foods, and with a sound
balance of macronutrients, is the
preferred and encouraged option for
nutritional choices. For individuals who
are deficient in a nutrient, it is essential
to seek advice from your GP, or an
Accredited Dietician. In cases where a
Vitamin of Mineral is lacking, they may
prescribe a supplement to help achieve
optimal health.

Prescribing supplements is outside the

scope of practice for a Personal Trainer,
however it is best practice to familiarise
yourself with the more common
supplements found in the industry, to be
able to provide advice and assistance to
your clients.

There are many supplements that claim

to provide a quick answer to a training
goal. A Personal Trainer should be
stringent with their research and ensure
they make informed decisions and give
informed advice. It is important to note
that Nutrition, Training and Lifestyle
make up 95% of your health and fitness,
supplementation may be able to provide
an extra boost to health and
performance, but they should not be
relied upon as a major method to
success.

159
The Australian Institute of Sport and
Google Scholar are two fantastic
databases to refer to for reliable
information on supplements. The AIS
has a well-developed classification
(ABCD) system for supplements that it
applies to its athletes. It can be found by
searching this link:
https://www.ausport.gov.au/ais/nutrition/
supplements/classification
The ABCD Supplement Classification
System
Group A:
These supplements are supported for
use in specific sports. They are
provided or permitted for use. Examples
include: Sports drinks, Whey Protein,
Electrolyte replacements,
Iron/Calcium/Multivitamin /Vitamin D
supplements, Caffeine, Probiotics,
Beetroot juice, Beta-alanine and
Creatine. AIS Fact sheets are provided
for all group A supplements.
Group B:
These supplements are deserving of
further research and could be
considered for provision to athletes
under a research protocol. They are
approved for use by WADA (World Anti-
Doping Authority). Examples include
Carnitine, Acai/Goji Berries, Glutamine,
Fish Oils, Glucosamine)
Group C:
These supplements have little
meaningful proof of beneficial effects.
They are not provided to athletes,
however may be permitted with specific
approval. They are approved for use by
WADA. Examples include supplements
that are not found in either Group A or
B.
Group D:
These supplements are banned or are
at high risk of contamination with
substances that are banned, and should
not be used by athletes. Examples
include stimulants (such as Ephedrine,
Phenylalanine and DMAA),
Testosterone Boosters, Growth
Hormone releasers and Peptides, and
Beta-2-agonists.
Some of the supplements you may
come across in the fitness industry
include:
• Whey Protein Isolate
• Whey Protein Concentrate
• Branch Chain Amino Acids (BCAA’s)
• Multivitamins
• Fish Oils
• Glucosamine
• Creatine
• Beta Alanine
• Caffeine
• L-Carnitine
• Arginine Alphaketogluterate (AAKG)
• Gamma Aminobutyric Acid (GABA)
• Peptides
• Steroids
160
WHEY PROTEIN CONCENTRATE VS WHEY PROTEIN ISOLATE - HEAD TO
HAD COMPARISON

Q1: What is it used for?

WPC
Used to increase dietary protein intake, aids in protein synthesis, helps
muscle recovery and size and strength gains.

WPI
Used to increase dietary protein intake, aids in protein synthesis, helps
muscle recovery and size and strength gains.

Q2: Suitable for Vegetarians?

WPC
Yes

WPI
Yes.

Q3: Suitable for Vegans?

WPC
No (Plant based protein powders like Soy, Pea, Rice and Hemp, can
serve as potential alternatives).

161
 WPI
No (Plant based protein powders like Soy, Pea, Rice and Hemp, can serve as
potential alternatives).

Q4: What is the Key Difference between the two?

WPC
• Usually, 70% to 80% Protein Content and 20% to 30% is Sugar and Fats,
Per 100 Grams.
• Undergoes 1 (some companies claim to filter their WPI’s more than once
vs WPC) lesser filtration process.
• Is usually creamier
• Generally, has a better taste
• Sometimes can be difficult to mix without a blender. However, this
problem is not very common anymore.
• Slightly slower absorption rate Vs WPI. Can vary between 1 to 3 Hours.
This variance comes from the processing, quality and percentage of the
actual protein per 100 grams content.
• Usually, cheaper by 20% to 40% than WPI.

WPI
• Usually, 90% Protein Content and 10% is Sugar and Fats, Per 100 Grams.
• Undergoes 1 (some companies claim to filter their WPI’s more than once
vs WPC) additional filtration process.

• Is usually closer to water like consistency

• Generally, has a slightly sour tinge to it. This is usually due to the naturally
higher protein and lesser sugar and fat content.
• Generally, mixes pretty well.
• Usually, faster absorption than WPC.
• Usually, more expensive by 20% to 40% than WPC.
•
162
 Q5: How is each consumed?
WPC
Usually with water. However, it can be taken with milk or can even be added
to other foods like Oats, Cream of rice, muffins etc.
Note: One of the primary reasons why, most people avoid taking it with Milk
is due to increased Calories, coming from Milk.

WPI
Usually with water. However, it can be taken with milk or can even be added
to other foods like Oats, Cream of rice, muffins etc.
Note: One of the primary reasons why, most people avoid taking it with Milk
is due to increased Calories, coming from Milk.

Q6: What is the usual serving size of each?

WPC
Usually 20 to 40 Grams (protein content) per serve.
Note 1: As an informed consumer, you must look for, what is the actual
“amount” of protein you are getting per serve. For example, if comparing
2 products, Product A has a serving size of 30 Grams, but the actual
“protein content” in that 30 Gram Serve is only 15 Grams, and then you
have Product B, and it’s serving size is 40 Grams, but the actual protein in
that 40 Grams Serve is 36 Grams, Product B, becomes far more superior,
because it represents far greater “value” Per 100 Grams.
50% Protein Per Serve in Product A vs 90% Protein Per Serve, to be precise.
Note 2: Serving size will often vary due to below factors:
• Size of Individual
• Type of Physical Activities
• Total Daily Protein Requirement
• How much of the Total Daily Protein is being consumed from other
sources.
• Individual Tolerance.

163
 WPI
Usually 20 to 40 Grams (protein content) per serve.
Note 1: As an informed consumer, you must look for, what is the actual “amount” of
protein you are getting per serve. For example, if comparing 2 products, Product A
has a serving size of 30 Grams, but the actual “protein content” in that 30 Gram
Serve is only 15 Grams, and then you have Product B, and it’s serving size is 40
Grams, but the actual protein in that 40 Grams Serve is 36 Grams, Product B,
becomes far more superior, because it represents far greater “value” Per 100
Grams.
50% Protein Per Serve in Product A vs 90% Protein Per Serve, to be precise.
Note 2: Serving size will often vary due to below factors:
• Size of Individual
• Type of Physical Activities
• Total Daily Protein Requirement
• How much of the Total Daily Protein is being consumed from other sources.
• Individual Tolerance.

Q7: Potential side effects of each?

WPC
In high doses (or if you have some sort of intolerance), it can lead to:
• Increased bowel movement.
• Nausea.
• Bloating.
• Cramping
• Diarrhoea
• Constipation
WPI
In high doses (or if you have some sort of intolerance), it can lead to:
• Increased bowel movement.
• Nausea.
• Bloating.
• Cramping
• Diarrhoea
• Constipation

Q8: Which is more expensive?

WPI is usually more expensive.
164
Q9: Suitable for Vegans?
WPC
No (Plant based protein powders like Soy, Pea, Rice and Hemp, can serve as potential
alternatives).

WPI
No (Plant based protein powders like Soy, Pea, Rice and Hemp, can serve as potential
alternatives).

Q10: Can each be consumed by General Population?

WPC
Yes absolutely. Suitable for all ages from 5 and upwards. However, please check with your
Healthcare Professional to get 100% Clearance.

WPI
Yes absolutely. Suitable for all ages from 5 and upwards. However, please check with your
Healthcare Professional to get 100% Clearance.

Q9: Suitable for Vegans?

WPC
No (Plant based protein powders like Soy, Pea, Rice and Hemp, can serve as potential
alternatives).

WPI
No (Plant based protein powders like Soy, Pea, Rice and Hemp, can serve as potential
alternatives).

Q10: Can each be consumed by General Population?

WPC
Yes absolutely. Suitable for all ages from 5 and upwards. However, please check with your
Healthcare Professional to get 100% Clearance.

WPI
Yes absolutely. Suitable for all ages from 5 and upwards. However, please check with your
Healthcare Professional to get 100% Clearance.
165
 Q11: When would you recommend each?
• Anytime you believe, you are your client is not going to meet his/her
Daily Requirement of Protein from food, you can consider plugging that
gap from Supplemental Protein.
• For faster protein delivery to the muscles – usually, use in pre or post
workout scenarios.
• Above 2 points, apply to both, WPC & WPI.

Q12: Are both suitable for Drug Tested Sports?

• Yes, both are approved by WADA (World Anti – Doping Agency).
• Both are suitable for school going children too. However, if in doubt,
please check with your Healthcare Professional.

Q13: Which is better?

• Both are almost equally good at building muscle
• For general population (including most gym goers/bodybuilders) WPC, is
more than adequate and a good quality WPC will do an excellent job, for
the most part.
• WPI should only be considered by absolute Elite Athletes, who are
looking for, even the smallest advantage.

166
Supplement: Multivitamins

Inadequate intake of vitamins and minerals leading to

a body or tissue deficiency, will impair the athlete’s
What is it used for? health and performance. Multivitamins can restore
these deficiencies. Will not improve performance,
unless a deficiency already exists.
What AIS category is it? Group A

Can become reliant on supplement for vitamin and

nutrient intake. They do not contain the
phytochemicals found in fruits and vegetables.
What are the side effects?
Large doses of antioxidant vitamin supplements may
be counterproductive if they upset the balance of the
body’s complex antioxidant system

How do you take it? Orally, as a tablet

Doses can vary depending on vitamins and minerals
How much do you take?
included
Approved by WADA? Yes
Are generally a synthetic version, however some
Is it a natural product? natural supplements of a particular vitamin or mineral
can be produced

167
 Supplement Fish/Krill/Cod Liver Oil:

High levels of Omega 3,6,9. CL oil>Krill>Fish. Anti-inflammatory

roles, can help decrease macular degeneration. Will only work, if
What is it used for?
diet already includes omega 3.
Lower cholesterol

What AIS category is it? Group B

What are the side effects?
How do you take it?
How much do you take?
Approved by WADA?
Is it a natural product?
Bad breath, heartburn, fishy taste, upset stomach, nausea, and
loose stools.
Orally, as a capsule
All three oils are generally consumed once daily at a dosage of
1000mg, though this can be higher.
Yes
Yes
Fish Oil: Fatty Fish such as Salmon, Tuna, Mackerel Krill Oil:
Small Crustaceans Cod Liver Oil:

Supplement: Glucosamine

What is it used for? Anti-inflammatory, used to improve function and ease pain. studies
have shown both results and no result. Generally, only found to work
on people that suffer from osteoarthritis

What AIS category is

it? Group B
What are the side
Use cautiously in women who are, or plan to become, pregnant, or
effects?
are breastfeeding. The most common side effects occur that have
been reportedare gastrointestinal in nature, such as upset stomach,
nausea, heartburn, and diarrhea
How do you take it? Orally as a tablet or powder
How much do you
take? Up to 1500mg daily
Approved by WADA? Yes
Is it a natural Yes, through edible cartilage, shells of selfish, some Glucosamine
product? supplements are produced from natural sources

Supplement: Creatine
Can increase energy output in the ATP system
Increases water into the cell and increases protein
What is it used for?
synthesis, allows for a quicker recovery time
between efforts when working in the ATP system 168
What AIS category is it? Category B, under supervision
Supplement: Creatine

Can increase energy output in the ATP system

What is it used for?
What AIS category is it?
What are the side effects?
Increases water into the cell and increases protein
synthesis, allows for a quicker recovery time
between efforts when working in the ATP system
Category B, under supervision
Diarrhea, nausea and stomach cramps.Can damage
kidneys in high doses.
Produces creatinine which can have a toxic effect

How do you take it? Through powder and capsules

How much do you take?
Approved by WADA?
Is it a natural product?
Can you find in food
Will creatine work for everyone
Did research find any differences for male
and female.
Would it help aerobic athletes?
2-3g per day for general pop (mens health) up to 20g
per day
Yes
Can be both, you can purchase pharmaceutically
made and naturally occurring
Yes, red meat
No, depending on kidney issues, current creatine
levels and blood type.
No research found
Minimally, used to assist the ATP-PC system

169
Supplement: Beta Alanine
What is it used for?
What AIS category is it?
What are the side effects?
How do you take it?
How much do you take?
Approved by WADA?
Is it a natural product?
How does it work?
Tingles begin at what level?
What energy system is it best for?
Naturally occurring amino acid It is essential, needed
from foods or supplement
Triggers an acute stimulant response, found in pre
workouts, decreases fatigue in the muscles.
Category B, now changed to Category A
Burning, itching, tingliness, flush, canincrease
HR when taking on an empty
stomach
Can be purchased on its own, as a powder, orally,
mixed with water, found in red meat. Take 30min
before workout
800-1200mg every 3-4 hours
Yes
Can be both found in food and made
pharmaceutically.
Helps to neutralize Hydrogen Ion and lactic acid
build up
10mg per kg BW
Lactate system
170
Supplement: Caffeine
What is it used for? Stimulant
Increase mental alertness Increases stamina
Increases blood flow Can help
What AIS category is it? Category A
What are the side effects? Insomnia, nervousness, restlessness, vomiting,
nausea. If taken in high doses AND for long periods
of time, these side effects can be present
How do you take it? Tablets, food, drink
How much do you take? Tiredness -600g
2-10mg per kg BW, do not exceed 800mg
Approved by WADA? Yes
Is it a natural product? Yes, can be both
Would you recommend to a client? Would consult with a nutritionist on a case by case
basis
Is there any link between high stimulant None that were found
level and depression
Does it speed up your metabolism Yes, increased
What energy system would benefit most. Aerobic system and aerobic athletes

Supplement: Levocarnitine

What is it used for? Fat loss

Muscle recovery
An amino acid, helps increase mobilisation of fats to
the mitochondria
What AIS category is it? Category B
What are the side effects? Nausea, vomiting, seizures, fishy urine
How do you take it? Tablet form of from foods, eg dairy, meat, oats, rye
How much do you take? 2-4g per day
Approved by WADA? Yes
Is it a natural product? Yes
Would you recommend to a client? Only if they had muscle problems, due to the fact
that you can get it from foods
Who is the recommended dosage For General population

When do you take it As a morning supplement

171
Supplement: Arginine Alphaketogluterate

What is it used for? Used to treat kidney disease, Increases sexual

energy, In
athletics, can exercise longer
Can increase aerobic capacity, vasodilator
What AIS category is it? Category A
What side effects? Vomiting, nausea in high doses
How do you take it? Tablets and powder, mornings or 30min before
workout. Not to be used for more than 60 days
How much do you take? 2-10g per day
Approved by WADA? Yes
Is it a natural product? Yes
What foods is it found in Red Meat, large amounts
Main benefit Is to increase aerobic output
When do you take Morning supplement for

Supplement: GABA - Gamma Aminobutyric Acid

What is it used for? It is a neurotransmitter that helps to increase REM

sleep patterns and increases muscle repair and
regeneration through sleep hours 5-8.
Can increase Growth Hormone production
What AIS category is it? Category C
What are the side effects? Can cause depressive effects in high doses
How do you take it? Orally, as a powder mixed with water
How much do you take? 3 - 3 grams, once daily
Approved by WADA? Yes
Is it a natural product? No, it is a synthetically produced compound

172
 Section 4:
Client Profiling & Health Screening

173
You cannot manage that which you do
not measure.
This saying sets the scene for why
health professionals need a quality
health screening process.
When a potential client approaches you
looking for a training program, there are
certain things
that need to be accounted for first, to
ensure specificity of training to the
client’s needs and
health.
The way in which you communicate with
the potential client is essential to gain
the necessary
information to design a program but
also to establish two way trust with the
client.
This trust, between the trainer and client
is imperative for clients to reach their
goals.
Therefore, initial client profiling and
health screening holds great value to
the process of training
and getting desired outcomes.
Key Information You Need to Gather
for a Quality Client Profile
1. The needs and goals of the client.
2. Both current and past exercise /
movement practices.
3. Any existing or past health conditions
of the client.
4. Their family history (health) and /or
past / present injuries
5. Assessment of general movement
abilities.
The above information can be gathered
verbally, and / or using detailed
questionnaires. No
matter what method you choose, your
intention must be to gain a deeper
understanding of your
client.
When to Profile Your Clients’ Health and
Fitness
∙ Before Commencing Group Training
Health screening should be initiated before
any commencement of exercise or training.
In a
group setting there are often clients that will
come and go or just come in for one
session, a
questionnaire can be too time consuming for
this client so a verbal screening, is most
appropriate, key information should also be
noted for future reference.
Group Training Client Question
Examples:
o Personal details: E. g., Name, living
location, age
o What has motivated them to come to a
group personal training session?
o What activities/exercises are they
currently doing? What do they
like/dislike about those?
o Do they have any current or previous
injuries?
o Do they have any other health
concerns? E.g. Pregnancy, heart
problems.
By asking these key questions you can
assess whether your session will be
suitable for their needs, or whether a
more private session would be
appropriate. You can also assess
whether they should be referred to an
allied health professional or medical
practitioner.
Once you make an educated decision as to
whether your session will be suitable
for this client, ensure they also
understand that they should be
conscious of their own body throughout
the session and if they feel
uncomfortable with any of the
exercises, they should communicate
these concerns with you as their
trainer, so technique or the exercise
can be adjusted.
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∙ Before Commencing Personal
Training
When a potential client approaches you
and is looking for a more one-on-one
customized training experience, then
our health screening can be more
thorough and in more detail.
It is important to make the client feel as
safe as possible during this
conversation, asking questions
mentioned above for group clients, to
allow you to explore their needs and
goals with the intent to improve their
health, fitness and physique.
Cross checking the detailed
questionnaire with the client and their
answer should also be done to ensure a
mutual understanding of the client’s
needs.
5 Pillars of Successful Client
Profiling and Screening:
This information provides a framework
to cater to the specific needs of the
individual when designing and
implementing programs. Within this
initial contact and health screening you
will need to adhere to any restrictions
that may exist to your client’s current
level of training / qualification(s), and
whether a referral to an allied health
professional may be advised.
1. Gather Quality Information:
Medical information should always be
gathered before every encounter with a
new client, whether in a group or
individual situation. By documenting this
information, the trainer is following legal
requirements under their duty of care
and policies and procedures of their
gym or area of training setting.
Information can be gathered via
questionnaires or interviews with the
client. The more information we collect,
the more knowledge we can gain about
the potential client for a more client
specific approach to his program.
Here’s some considerations to support
you gathering quality information for
your health screening:
∙ Verbal Communication:
Throughout conversations you should
record the information being given by the
client to review after and use to assist with
further assessment and program planning.
Methods of recording client
information:
oDocumenting screening information
can be done either by writing or
recording on your phone.
oAll information should then be filed
away safely and labeled for future
referencing during the duration of your
client/trainer relationship.
∙ Questionnaires:
Questionnaires should be clear and
concise, and the value should be
explained to the client so they know why
they need to fill it out and how it will be
utilized to assist them.
2. Refer to an Allied Health
Professional When Necessary:
∙ Know When to Refer:
It is important for health professionals to
understand their boundaries, skills, and
qualifications when working with clients
and to be aware of allied health
practitioners and refer clients when the
need arises.
After communication with the client, a
decision as to whether a referral is needed
prior to commencing training should be
made. In some client circumstances a
personal decision needs to be made by
you as a health and fitness professional, to
see if you’re prepared or have the
qualifications required to take on the client.
∙ Build Your Network
It is recommended you build a network of
trusted allied health professionals. This will
help you to better support the needs of
your client, and can provide business
building opportunities.
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Every client will be unique in how not only
they move and respond to exercise and
training, but
also their psychological and emotional well-
being.
It is then important to have good relationships
with other allied health practitioners who you
can work with to better the experience for
your client and chances of them achieving
their
health and fitness goals.
∙ Test and Assess Your Client’s
Benchmark:
As part of a high quality screening process,
you will learn different tests of assessment for
new
clients both anatomically, physiologically, and
in performance to decide how best to design a
training program.
This is further expanded under ‘Performance
Measurement’ section.

∙ Conduct Clear Client Communication:

∙ Build Two Way Relationships
Clear communication between your client and
As much as trainers can refer clients to an yourself is a key factor to support great results
allied health practitioner, it can also work the
and develop fruitful relationships.
other way round if a client’s needs are to
increase their level of physical activity.
This relationship between the trainer and
physician should continue with regular
updates and an exchange of knowledge and
information for the client by recording regular
fitness appraisals.

Allied health professionals to consider

when training clients:

Mental General Health and

Physical Therapy Nutrition
Health Wellbeing
General practitioner
Massage therapist Psychologist Nutritionist
(GP)
Physiotherapist Psychiatrist Dietician Kineasiologist
Exercise
Acupuncturist
physiologist
Mind-body
practitioners;

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∙ Test and Assess Your Client’s
Benchmark:
As part of a high quality screening
process, you will learn different tests of
assessment for new
clients both anatomically,
physiologically, and in performance to
decide how best to design a
training program.
This is further expanded under
‘Performance Measurement’ section.
∙ Conduct Clear Client
Communication:
Clear communication between your
client and yourself is a key factor to
support great results
and develop fruitful relationships.
The role of the trainer is to act as a
guide to assist the client to achieve their
health and training
goals.
The trainer should be:
o Approachable : The client should
feel comfortable and supported by
their trainer.
o Professional : The trainer should
be educated to the needs of the
client, and if they do not feel their
knowledge and qualifications are
adequate to benefit the client then
they should refer the client to allied
health practitioner better suited.
o Motivational: The trainer should
mentor the client and assist them
to be their best person, speaking
positively and honestly. The trainer
should reinforce the client’s original
goals and keep them informed
about their progress through
regular fitness appraisals and
fitness testing.
Here’s some key elements for more
effective communication:
o Build Trust: Speaking to your potential
/ current client in a manner that
promotes trust is important. It’s
important your client feels they are
being understood, and you are
genuinely wanting to help them achieve
their goals. Coming to a gym or seeking
out professional assistance for your
health is a big step for people so as
trainers we need to be as approachable
as possible
o Share the Why’s: Appropriate
protocols will need to be adhered to
depending on the area / environment
training will take place. The trainer
should outline to the client the
reasoning behind exercise prescription
choices and relate them back to their
physical needs and individual goals.
Descriptions of why particular equipment
is used and the intentions behind tests
and training should also be
communicated with the client.
o Listen More Than You Speak: Ensure
that the client’s ongoing needs are
being heard and that the training
program can be adapted to suit the
individual(s). If the goals of the client
cannot be met due to current levels of
fitness, then this will also need to be
communicated and a progressive
training program should be designed to
assist them in achieving these goals
over time.
∙ Ongoing Assessment and
Measurement:
To support client motivation and to assess
the effectiveness of their current physical
training,
nutritional and lifestyle habits, it's important
to schedule ongoing measurement of their
results.
It is useful to keep this consistent with the
initial health screening you have conducted.
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Next up, we’ll dive deeper into the
process of health and fitness screening
… What is a PAR-Q?
Client Profiling & Health Screening:
A Process for Best Practice
So far you’ve learned an overview of
what a quality health screening
involves, and why it’s
important in delivering excellent client
results. Now we’re going to dive deeper
into best
practices for your health screening.
There are many ways to screen and test
your clients; to ensure your exercise
programs are safe
and tailored to their needs.
Here are four important foundations to
get started with your client.
4 Foundations to Test and Screen
Your Clients Safely:
1. PAR-Q (physical activity readiness
questionnaire)
2. Needs Analysis
3. Movement Assessment / Observation
4. Comparative Analysis
PAR-Q: How to Determine if Your
Client is Ready for Training
PAR-Q stands for ‘Physical Activity
Readiness Questionnaire’. It’s one of
the most fundamental parts of designing
a safe and effective exercise program,
that supports their goals. Before
participating in any fitness activity the
client should be asked to do a PAR-Q.
This test will determine the readiness to
increase your client’s current physical
activity.
If they answer Yes to any of the
questions on the questionnaire, it is
advised that the client consult with their
personal medical practitioner to go over
the questions they answered yes to.
With the physician, the client can then
determine what type of training will be
best suited for them at this stage of their
health and fitness.
If your client has honestly answered No
to all the questions, this offers
reassurance that the client is now ready
to increase their current level of physical
activity and can gradually move forward
now undertaking further fitness tests
and eventually progressively
challenging and improving their fitness
with an organized training program with
a trainer.
Example Questions for the PAR-Q
Test:
178
Example Questions for the PAR-Q Test:

Yes No Has your doctor ever said you have heart trouble?

Yes No Do you frequently have pains in your heart or chest?

Yes No Do you often feel faint or have spells of severe dizziness?

Yes No Has a doctor ever said your Blood Pressure is too high?

Has your doctor ever told you that you have a bone or joint problem,
Yes No such as arthritis that has been aggravated by exercise, or might be
made worse with exercise?

Is there a good physical reason not mentioned here why you should
Yes No
not follow an activity program even if you wanted to?

Yes No Are you over the age of 65 and not accustomed to vigorous exercise?

This PAR-Q & YOU TEST of Physical readiness was sourced

from the British Columbia Ministry of Health and critiqued by the
Multidisciplinary Advisory Board on Exercise (MABE). Reference
_AR-Q & YOU Validation Report, British Columbia Ministry
ofHealth, May 1978. Produced by the British Columbia Ministry of
Health and Department of National Health and Welfare.

179
Needs Analysis: Ensuring safe and
effective exercise programs
Needs Analysis Overview
This detailed analysis enables us to
establish the personal goals and
desired outcomes of the client, how they
move, what their strengths are, what
movements they enjoy, where their
weaknesses are and what their
concerns or barriers are.
What information does the analysis
provide?
∙ It assesses the anatomy and
structure of the client
∙ Their physiological responses and
how their body responds to
changes in fitness demands.
∙ The information of the client profile
and their exercise performance
allows us to recognize the
hierarchy of importance when
considering what is the best
method of training for the client.
∙ Considering the expectations of a
training program for the client,
whether it be sport performance,
body composition, general fitness
etc. Considerations of any past or
current injuries, where prevention
techniques can then be enforced.
Needs Analysis Key Components
Part 1: Identification
Identify the specific needs of the sport
or training type the client is needing to
train in, with
respect to their outlined goals of
achieving peak physique
transformation, anatomical, and
physiological needs.
Part 2: Perform and assess
Using the client profile to assess their
training history, perform and assess
relevant anthropometric data and body
composition results, and physical tests
related to the previously
identified training goal of peak physique
transformation.
This is expanded further upon in the
Assessment and Performance
Measurement section.
Part 3: Review / evaluate and
exercise selection
Review and evaluate the results of the
needs analysis identifying any
weaknesses, strengths to
maintain, or opportunities for further
physiological enhancement. These
results will assist to
determine the most appropriate type of
exercise prescription to program for the
client.
This is expanded further upon in the
Exercise Programming section.
180
Principles for Performing a Quality
Needs Analysis
# 1. Tailor to Your Clients Specific
Needs, Don’t Provide Cookie Cutter
Training
By performing a needs analysis we can
then start to focus on the specific needs
of the client, (are they looking for bulk,
endurance, rehabilitation etc.), this
information helps us to develop a fitness
program that is right for them instead of
simply prescribing exercises with no
connection to that client’s particular
body type which in time could cause
more harm to them than good.
# 2. Observe and Document Your
Clients Results
You will be required to observe and
document these results and preferences
of the client for their physical and health
progress, referring back with the client
to their original goals to maintain
alignment with the program.
# 3. Keep it Simple, Don’t Overload
Your Clients
People are overloaded with information
about health and there are trainers who
will often put out free exercise programs
on the internet that potential clients can
easily access. However, it is this
information overload that can often
make people who are uneducated in
fitness more confused, and more
disconnected from their bodies and
farther from their goals for their health.
It is our job as educated trainers to
educate and inspire clients about the
importance of health and fitness, and
the importance of specificity when
designing and implementing a fitness
program.
How to Clearly Identify Client Needs:
Goal Setting Fundamentals: Set Up
Your Client For Success
Setting clear, measurable and achievable
goals is a key component of a quality
health screening
process.
Determining the goals of the client is
important to not only keep them
accountable throughout the training
program and engaged within the sessions
but it is also important to help you as a
trainer to plan and customize each
session.
Goals of the client should be referred to
and communicated with the client
throughout the needs analysis to ensure
specificity to the expectations of both the
client and you as a trainer .
Effective Goal Setting Framework:
SMART Goals
‘SMART’ is a simple and effective process
that can be used to set goals with your
client.
SMART goals are:
1. Specific
2. Measurable
3. Achievable
4. Relevant
5. Time Bound
An example of process and questions you
can take your client through is outlined
below:
1. Specific
∙ What do you want to accomplish with
your health and fitness?
∙ Who needs to be included?
∙ When do you want to do this?
∙ Why is this goal important?
2. Measurable
∙ How can you measure progress and
know if you’ve successfully met your
goal?
∙ Measure physical performance
∙ Measure body composition
∙ Measure the body
181
3. Achievable Common Obstacles to Health and
∙ Do you have the skills required to Fitness Goals
achieve the goal? ∙ Lack of time
∙ If not, how can you obtain them? ∙ Transport
∙ Are you prepared to dedicate the ∙ Lack of motivation
effort required to achieve your ∙ Age
goals? ∙ Cost
4. Relevant ∙ Health restrictions
∙ Why am I setting this goal now?
∙ What is the motivation for this Motivations and Drivers for
goal? Participating in Physical Activity
∙ Is it aligned with overall objectives? ∙ Improved self-esteem and feeling
5. Time-bound confident
∙ How much time do I need to ∙ Sex appeal
commit each day / week / month, ∙ Pain relief
to achieve this goal? ∙ Enjoyment
∙ What’s the deadline and is it ∙ Weight loss
realistic? ∙ To help others
To support the success of the SMART ∙ Increased physical ability / skill
goals you set with your client, it's also ∙ Improved health and wellbeing and
important to consider what can get in feeling of vitality
the way of, and also encourage their ∙ A sense of achievement through
success. competition / overcoming
challenge

Client Health Profiling Tests

Within this section of the needs analysis
we should look at the biological data of
the client, including their age, height
and weight, their health history and
current injury or health concerns,
anatomical structure and posture, their
current level of fitness and physical
activity background.

Tests for profiling can include:

∙ Resting Heart Rate
∙ Resting Blood Pressure
∙ Body Composition
∙ Waist circumference
∙ Hip to waist ratio
∙ Skin folds
∙ Body mass index (BMI)
These tests are further expanded upon
in the Assessment and Performance
Measurement Section.

182
Further Questions You Can Ask Your
Client in Their Needs Analysis:
These example key questions were
outlined by Fleck & Kraemer (1997)
include:
∙ Are there any health/injury
concerns which may limit the
exercises performed or the
exercise intensity?
∙ What type of equipment (e. g., free
weights, machines, bands/tubing,
medicine balls, functional) is
available and preferred?
∙ What is the targeted training
frequency and are there any time
constraints that may affect workout
duration?
∙ What muscle groups need to be
trained (generally all major muscle
groups are trained, but some may
require prioritization based upon
strengths/weaknesses or the
demands of the sport or activity)?
∙ What are the targeted energy
systems (e. g., aerobic or
anaerobic)?
∙ What types of muscle actions (e.g.,
concentric [CON], eccentric [ECC],
isometric [ISOM]) are needed?
∙ If the individual is training for a
sport or activity, what are the most
common sites of injury?
3. Movement Assessment &
Observation:
Your client may be ready to transform
their health fitness and physique, but if
they have poor
movement quality they may be
vulnerable to injury. This is why it’s so
important to assess and
observe your clients movement quality.
The analysis of your client's movement
is conducted through observing their
ability to confidently execute
foundational movements that will be
required to be performed in an exercise
training program. I. e. Squat, crawl,
walk, run, jump, grip, throw, catch, push
pull.
This is also important in physique
transformation to predict the likelihood
of injury, which can have dramatic
impacts on long term results.
The movements you test should be
specific to the performance outcomes of
the individual and/or the sport. Your job
as a trainer is to look for any
compensations that may be occurring
from anatomical imbalance or injuries,
to find where the client may be
experiencing weaknesses and where
their strengths are in their physical
performance.
These observations allow the program
to have focus on strengthening
weaknesses or challenging strengths,
as a trainer you should continually refer
to the client’s original goals and
communicate results with the client so
they can review their own feelings
during exercises and difficulties and
progressions, the client’s own personal
observations should also be considered.
183
Within the needs analysis the client will be
assessed on the following:
Foundation Movement Assessment Example:

Exercise Squat
Start Position • Standing with feet hip width apart, toes straight ahead.
Down Phase:
• Inhale: Lower the tailbone, bending from the knees
tracking the toes, as if sitting into a chair, maintaining a
neutral spine keeping the chest lifted and eye gaze
Exercise forward.
Description Up phase:
• Exhale: Push through the feet, keeping the knees in the
same position and not going over the toes or too far
back to the heels to lose balance, lifting through the
pelvic floor and the spine back to standing
Movement Focus • Hips, knees, ankles, glutes
• To strengthen the legs, glutes, maintain hip mobility,
Movement Goals
improve flexibility and ROM in the achilles
• Keep the eye gaze forward and chest up to avoid
straightening of the legs and rounding through the spine
when client looks at their feet. This also assists to open
Cueing the airways and activate through the core stabilising
through the spine
• Keep the tailbone low
• Rounding of the spine, Valgus knee (knees come in/
Common errors
knock knees)

Variations: • Release through hips before attempting the movement

Modifications/Pro • Reduce range
gressions • Progressions: Weighted squats, power squats

How to Use the Movement Assessment to 4. Comparative Analysis

Improve Client Results and Minimize Injury:
Note where the client has weaknesses and needs
improvement in their movement quality. There is
no point including a high intense program of
sprints, if the client is experiencing imbalances
with their standing and walking posture. In a case
like this they would need to begin with improving
the strength and support of their structure and
lower body before progressing into a speed
program
This final section of the Needs Analysis will
compare the results of the client profile and
physical and physiological testing to the goals
of the client and where they want to be with
their fitness.
We can now implement realistic timelines and
safety guidelines of load, volume, frequency
and intensity of the training program to achieve
these desired goals.
184
 Section 5:
Fitness & Physique Transformation
Testing Protocols

185
Fitness & Physique Transformation
Testing Protocols
Fitness and physique testing is an
important aspect of providing a quality
service to your clients. Measuring
results builds motivation and self-
confidence in the process you’re taking
your client through. Based on the
results you’ve measured you can then
customize ongoing training and
nutritional protocols and to further your
clients ongoing progression.
Remember you cannot manage that
which you do not measure.
Why should I perform fitness tests
and appraisals for peak physique
transformation?
∙ Having a visible change, or value
for clients gives them something to
work towards and helps them to
self-motivate in and outside of the
structured sessions.
∙ Testing for planning and
professionalism that sets you apart
from other trainers, gives feedback
to the client.
∙ Documented client results are a
powerful business building tool, as
it illustrates what a potential client
can expect through working with
you.
What to Consider Before You Conduct
a Fitness / Performance Appraisal?
∙ Fitness appraisals should be
executed after a risk assessment
(see Risk Management unit) is
completed.
∙ The student / instructor should only
conduct appraisals to their own skills
and training and seek supervision of
more expert guidance when needed
and follow up with referrals when
needed.
∙ Performance appraisals should be
performed within a controlled and
safe environment for more accurate
results to be recorded.
∙ Any recommendations from allied
health professionals or consent
letters from medical practitioners
should be included before
undertaking fitness testing.
How to Choose the Right Environment
for Your Client Results` Testing?
The environment of which fitness testing is
to be assessed should be considered with
respect to each individual test and it’s
intended performance outcomes.
There are two types of environments in
which training can be undertaken:
1. Closed spaces, which are
environments that are generally more
desired when assessing fitness levels,
with external influences that could affect
the reliability of the results being limited.
They are generally performed in a lab or
gym setting where the spaces can be
more easily controlled.
2. Open spaces, In comparison open
spaces cannot be controlled. For example,
an outdoor setting where many external
factors could change or influence how
fitness tests and appraisals are performed
and measured. These can include; the
weather, the terrain, other people etc.
186
Tailoring Your Testing for Cultural
and Social Differences
It is important to recognize that each
individual will be unique when
conducting fitness tests and their
personal values, and wishes should be
respected.
Some examples of situations where
special consideration to testing
protocol should be addressed:
1. Religious beliefs
2. Body consciousness
3. Past trauma
Examples of measures to address
special considerations:
1. Respect client preference of a gender
specific trainer or practitioner
2. Respect privacy of client by
undertaking testing in a private space
3. Ask permission and communicate
clearly before you begin testing
How to Record Information Required
for Fitness Testing and Appraisals?
Keeping a clear record of your clients`
progress is a critical part of the testing
process. You don’t want to try to
remember your client`s results.
Document them!
Here are some considerations when
documenting your clients results:
∙ Each client should have their own
client profile made, recording
personal information obtained from
their pre-exercise screening
test(s), (.i.e. Goals, Needs
analysis, body composition tests)
and then their performance
appraisal tests discussed in this
unit.
∙ These profiles should be stored in
a secure and safe environment out
of reach of any external parties
that have not been discussed with
the client.
• The storing and the recording of
this information should be done with
respect to the legislative and
workplace privacy laws and
regulations, duty of care and
professional client relationship.
∙ Information should be stored as a
hard copy and online copy that can
be shared with the client for
personal observation to assist with
adherence and motivation to the
program and their personal goals.
∙ Tests results should be recorded
and then tested again at
incremental, clearly defined
periods, to observe changes and
improvements.
Performance and General Health
Results
What Types of Tests Can I do to
Measure My Clients Results?
There are many ways you can measure
your clients` progress towards their
goals. Here are a few benchmark tests
to consider.
1. Body Composition Analysis &
Physique Transformation Tests
a. Body Mass Index (BMI)
b. Anthropometric Girth Measurements
c. Body Fat % Testing
2. Cardiovascular Health & Fitness
Tests
a. Cardiovascular testing
b. Resting Heart Rate (RHR)
c. Blood pressure
3. Movement & Biomechanics Tests
a. Postural analysis and skeletal
alignment
b. Range of movement and mobility
c. Strength abilities
187
1. Body Composition Analysis &
Physique Transformation Tests
a. Body Mass Index (BMI)
Why Test BMI?
This assessment is helpful to identify
whether the client could be of chronic
health diseases due to excess weight
being carried. It is most useful for
testing clients who have higher levels of
body fat than muscle mass.
For clients with a goal of peak physique
transformations the BMI assessment
tool may not be favorable to clients
looking to build muscle as their weight
will increase with muscle mass and the
results do not take into account muscle
mass.
What is Body Mass Index (BMI) and
How Do I Test it?
This test describes whether the client is
in a healthy weight range with relation to
their height. The assessment is based
on the concept that weight should be
proportional to height, using the
calculation:
● BMI = Weight (kg) / Height (meters).
The following chart describes where
your calculated score then sits on the
chart. The chart is categorized from a
Normal weight, Overweight, Obese, and
Extreme obesity.
From the recorded findings you can
then determine whether a referral
should be made to an allied health
practitioner. If the client is at risk of a
chronic health disease their heart rate
and blood pressure may need to be
monitored when training, and their
general practitioner may recommend
certain exercises or training volumes
should be avoided.
188
How to interpret BMI Measurements for
Males and Females?

For more information about the interpretation

of BMI charts and calculating your own go to
the HeartFoundation.org.au

b. Anthropometric Girth Measurements

Waist Circumference
∙ This assessment is done using a tape
measure to identify the measurement
around a person’s waist or middle.
∙ This assessment helps to screen those
carrying excess fat around their middle
putting them at risk of possible health
diseases associated with being
overweight or obese.
∙ When screening your client, if the
measure as obese then you should refer
them to a healthcare practitioner before
commencing training to avoid any
contraindications that may arise in
undertaking an exercise program.

189
How to Measure Your Clients Waist
Circumference?
∙ A tape measure is used to measure around the
individuals waistline just above their hips,
roughly in line with their belly button.
∙ The tape measure should be placed on their
skin or no more than one layer of clothing.
∙ The measurement can be taken with the
individual standing and just after they take a
normal exhale.
∙ Ensure you measure the same area of your
clients waist each time, and that they have not
eaten for at least an hour prior, to ensure a
more accurate and consistent measurement.
∙ It’s more accurate to measure your client`s
waistline at the end of a relaxed, not forced
exhale.
Hip Circumference
∙ This assessment is done similarly to the waist
circumference. The hip circumference is taken
as well as the waist circumference to take into
account people’s different body shapes and
how they hold their weight.
∙ For example; Women tend to carry more
weight on their hips as opposed to men who
carry more weight around their abdomen.
How to Measure Your Clients Hip
Circumference?
∙ Have the client stand with an even weight
distribution across their feet at hip width apart ?
∙ Place the tape measure around their hips and
widest part of the glutes and take
measurement
Waist to Hip Ratio
∙ Similar to the how the BMI is based on the
weight and height in this assessment we divide
the waist circumference by the hip
circumference.
Waist to hip ratio = Waist circumference / Hip
circumference
Considerations While Taking Girth
Measurements
∙ Communicate Clearly
For girth measurements with tape measure; be
mindful of vulnerable parts of the body, and
explain to the client exactly what you’re going to
do and where.
∙ Use When Appropriate
These measurements are more suited to clients
whose goal is `to lose weight` rather than peak
physique clients whose aim is to build muscle.
This is especially important to consider while
measuring the client’s hip circumference, as for
them who are doing excessive loading and
weight resistance, their glutes in particular will
gain muscle and therefore measure higher.
∙ Be Consistent
For most accurate results measurement ensure
you measure at a similar time in the day at the
same location.
Measure with the regular intervals and pay
attention to trends and patterns over time, more
than over focusing on an individual
measurement.
c. Body Fat % Testing
Skin Fold Calipers: Why Use Them to Test
Your Client's Body Fat Levels
This method of measuring body composition, is
one of the most accurate, inexpensive and
accessible. The calipers will measure the client’s
percentage of subcutaneous fat, which is the fat
between the skin and the muscle wall. Using the
recorded measurements and an equation the
body fat percentage can be found.
It involves pinching the skin at specific sites
around the body and measuring the width of
these skin folds with skinfold calipers. The fat
you’re measuring resides between the skin and
the muscle wall and is called subcutaneous fat.
190
Pro’s Here’s some visual examples of
1. Relatively inexpensive. skinfolds being measured :
2. Relatively easy to learn.
3. Can be completed in minutes, any
time or place.
Cons
1. Margin for error can vary
depending on the experience and
knowledge of the technician. It is
advised to learn from someone
highly experienced.
2. Body fat distribution can factor into
the accuracy level. Some people
may hold more fat outside of the
common test sites, which can
affect the accuracy of the test.

How to Use Skin Fold Calipers for

Accurate Body Fat % Measurement?
Accurately performing a skin fold test is
an art form , due to the variable nature
of how hard to pinch the skin and how The 3 Site Skinfold Method: Location
to find the location of the skinfold site. Differences for Men & Women
The more you practice the better you Men and women tend to hold their body
will get. fat in different places, which is why it’s
1. To perform the skin fold test, pinch important to measure their skin folds in
the skin at the chosen location, then use slightly different places. The below
the skin caliper device to measure the images provide locations to consider
thickness of the skin fold for each site. when testing the skinfolds of male and
2. An assessment of skinfolds can be female clients.
accurately performed using 3, 4, 7 or 14
skinfold sites. Each method has specific
sites for testing spread across the body
commonly including the chest, arm,
abdominals and thigh.
3. After your skinfold test performance,
simply plug the numbers into a formula
(available in many online applications),
and this gives you deeper insights to
your clients body composition.

191
2. Cardiovascular Health & Fitness
Tests
a. Cardiovascular Testing
The human heart is vital for pumping
blood and nutrients to where your
clients body needs it during their
training. Let’s discuss some useful
methods to test your clients
cardiovascular fitness, and why it’s
important in the context of physique
transformation.
Why Cardiovascular Testing is
Important for Peak Physique
Training?
When training for Peak physique, the
cardio respiratory response is not the
most primary source to measure
strength gains. It is the strength of this
system however that will determine the
client’s ability to transport sufficient
oxygen throughout their body for
maximal performance, especially
endurance performance, and optimal
recovery of tissues and cells.
How Test Your Clients
Cardiovascular Fitness?
VO2max Testing
The VO2max test is the most reliable
test used for the measurement of
Oxygen supply, demand and use.
The VO2max test is used to determine
the maximal amount of Oxygen that can
be consumed and transported
throughout the body before being
expelled again.
2 Types of VO2Max Testing: Maximal
vs Submaximal
For fitness trainer’s the sub-maximal
VO2 test is preferred over a maximal
test due to the safety of the test, the
clientele and environmental access for
the test to be performed.
How to Test Your Clients Sub-
maximal O2 Levels?
The test is performed by estimating the
client’s maximal heart rate (using the
calculation 220- client age) and
performing fitness tests (often by bike,
treadmill, rower) to 85% of this
estimated maximal heart rate,
determining the oxygen consumption in
sub maximal working conditions. To
measure the oxygen consumption levels
specialized equipment is required.
Considerations when performing this
test:
The max HR test should be viewed as
an estimation and client responses and
intolerance should be monitored in the
case that the HR estimation is not
accurate to the individual. Intolerances
can also be monitored using the Borg
RPE scale discussed in this unit.
Environmental and psychological
factors should also be considered when
conducting this test to avoid over
training.
The test should be conducted in a
controlled and supervised environment.
The protocol of the assessment and it’s
benefits to the client and their
performance outcomes should be
discussed.
Physical intolerances to training and
risks of overtraining.
The client’s previous exercise for the
day or potential psychological stressors
should be taken into account before
commencing the testing.
192
Graded Exercise Testing (GXT) for
Cardiac Health
As mentioned above the most
accessible and reliable test for testing
cardiovascular fitness is the Vo2 max or
Sub maximal test.
When deciding what exercise to perform
to measure this performance it’s
important to take into consideration:
1. The level of fitness of the client
2. The age of the client
3. The specificity of the testing to
their intentions and goals with
respect to the client’s level of
fitness and training goals cardiac
health can be measured doing
different exercises such as:
o Cycle ergometer test
o Step test
o Rower ergometer test
o Treadmill test (discussed)
How to Perform the Treadmill Test
This GXT test accommodates all levels
of fitness and can be used for both
adults and children. The test can also
be relatable to people as it requires the
movements specifics of walking and
running which are a daily necessity for
the majority of people.
Considerations when testing :
∙ The grade and speed of the
treadmill
∙ The number of stages appropriate
for the fitness level to adjust the
speed or incline if needed and
grade. For peak physique training
athletes adjusting the incline can
be a good way to increase the
work efforts and leg strength.
∙ The intensity or metabolic
equivalents (MET) of the test to be
performed
Testing protocol:
1. Measure resting heart rate and BP
2. Perform light 5 min warm up
3. Begin the test gently and then
slowly increase the MET, incline
and or speed with each stage
4. Finish by retesting HR and using
the Sub-max O2 testing equation
193
b. Resting Heart Rate (RHR) Assessment
This test can provide the trainer with a good
baseline of the clients cardiovascular fitness
and health. As training progresses the RHR
can be beneficial to observe using Heart
rate monitors or resting manual tests how
hard the client is working and their intensity
level.
When to perform a RHR Test
∙ The best time to record the RHR is in
a supine position upon awakening in
the morning.
∙ During exercise HR can be measured
using a HR monitor.
∙ Post exercise we will use the preferred
radial measurement
How to perform a RHR assessment
1. To find the RHR we need to record the
pulse-rate of the client.
2. The pulse is created by the amount of
blood pulsating through the arteries
with each contraction of the heart.
3. The pulse can be found at 7 surface
points of the body, but the carotid
(neck) and radial (wrist) locations
usually the easiest points to observe
this.
How to Conduct a Radial Measurement :
1. Placing two fingers on the right wrist in
line with the thumb. The thumb has its
own pulse so it is recommended to
use the pointer and middle finger.
2. A pulse should be able to be felt from
here and we can record the number of
beats/pulses in 60 seconds/1 minute.
Considerations and communication
process with client:
∙ The process should be explained to
the client and permission should be
granted before beginning the test.
∙ The touch should be gentle
∙ The test should be conducted during
resting periods between exercise
and/or before commencing exercise
and after.
How to Conduct a Carotid
Measurement:
This method of measuring RHR is not
recommended for trainers to use as it
can be invasive to the client, instead the
trainer should teach the client how to do
this method for themselves and record
the number of pulses.
How to perform the test:
1. To perform this test the client
should again place two fingers on
their neck along the
sternocleidomastoid muscle, or to
the side of the larynx.
2. The number of beats should again
be recorded for one minute.
Considerations and communication
process with the client
∙ The test should be performed by
the client and results recorded by
the trainer.
∙ The touch should be gentle.
How to Manage Client
Cardiovascular Training Intensity
For safety purposes when testing your
clients` cardiovascular fitness it’s very
important to manage the intensity of
their output during the tests.
∙ You can use Target Heart Rate
(THR) testing for a more formulaic
approach,
∙ Or the Rating of Perceived
Exertion (RPE) to get feedback
from your client. Both methods are
discussed further below.
Target Heart rate THR Testing
The THR is used as a baseline during
cardiovascular physical activity and can
be found using the direct measure of
maximal heart rate recorded or the
indirect measure of the heart rate
reserve (Karvonen method). Powers, &
Howley, (2001).
194
Direct method: Borg Rating of Perceived Exertion
The client’s max HR can be found using (RPE) Scale:
the equation: This test uses a scale rating method to
Max HR = 220-Age determine the intensity and feelings of
Once the predicted max HR is physical exertion the client is feeling in
determined you can multiply this result response to the exercise demands.
by the proposed working intensity, to ∙ The scale can be used to assess
find the THR the client should aim to how well the client’s body is
work in during that intensity. adapting and responding to
For example: physical demands.
∙ They should be encouraged to
Zone one: answer honestly.
Max HR X 0.65 (65% intensity)
Max HR X 0.75 (75% intensity) An example of the scale is as
follows:
Zone two:
Max HR X 0.76 Level of
Max HR X 0.85 #
Exertion
Zone three: No exertion at
Max HR X 0.86 6
Max HR X 0.95 all

7
Indirect method:
This method uses the equation:
THR= [Max HR - Resting HR ( X the 7.5 Extremely light
desired intensity)] + resting HR
8
Both methods should be used as
guidelines to obtain the desired HR for 9 Very light
exercise intensities.
10
For further guidance and feedback to
the perceived exertion of the client we 11 Light
can use Borg RPE scale.
12

13 Somewhat hard

14

15 Hard (heavy)

16

17 Very hard

18

19 Extremely hard

Maximal
20 195
exertion
c. Blood Pressure Testing
Why Testing Blood Pressure is
Important for Peak Physique
Athletes:
∙ As trainers / sport physicians
testing client’s / athletes blood
pressure is important to see how
hard the heart is being worked
when under stress, how long it
takes to recover and when it is
relaxed.
∙ Measuring your client's blood
pressure at regular intervals
provides a great indicator to the
health of their heart and the way it
is adapting to the training you’re
undertaking with them. A healthy
heart provides a solid base for
physique transformation.
∙ To understand why we should test
blood pressure we have to
understand a little bit more about
the heart.
Basic Heart Functioning
The heart is split into two sides our left
and right.
∙ The right side of the heart will
pump blood from the arteries to the
lungs to pick up oxygen.
∙ The left side will then transport
the oxygenated rich blood to the
rest of the body where it is needed
most.
Each time the blood that heart contracts
is pushed into the arteries placing
pressure on the artery walls. It is this
pressure on the artery wall that is the
measurement of blood pressure.
How to Measure Blood Pressure
When we measure blood pressure we
look at two values.
# 1. Systolic value:
The systolic value is the amount of
blood pressure in your vessels against
the artery wall when the heart muscle is
contracting and working it’s hardest.
If you’re testing a client straight after a
training session/workout then it is likely
that this value could be higher than their
normal BP, because their heart has
been working harder.
# 2. Diastolic value:
Measures the blood in the vessels when
the heart muscle relaxes between beats
and refills with blood this is the diastolic
value.
Even if the client is tested after a
training session this value should not
change too much.
We display this measurement in a
fraction with the systole value at the top
and the diastole value at the bottom.
196
What’s a Healthy Blood Pressure
Range?
An example of a normal blood pressure
(as recommended by medical
practitioners) result is:
Systolic: 120 mmHG
Diastolic: 80 mmHG
What is high blood pressure?
High blood pressure (HBP) can also be
known as hyper-tension and is when
the systolic pressure and diastolic
pressure is too high. Generally (140/90)
is considered to a value of risk.
Naturally, blood pressure will increase
when we exercise but it is the resting
value (the diastolic pressure) should not
fluctuate more than a couple of mmHG.
If the pressure if too high then it means
our heart muscle is working too hard
and we can be at risk of cardiac
problems or disease.
There are some ways to improve or
lower blood pressure depending on the
situation and person including:
∙ Adopting a lower sodium diet
∙ Increasing the amount of
cardiovascular exercise
∙ Lowering stress levels through
relaxation techniques
In some cases medication may be
advised for some individuals
What is low blood pressure?
Also known as hypotension is when
the systolic value falls below 110
mmHG and diastolic value falls below
60 mmHG.
Low blood pressure can be dangerous
and often there is an insufficient amount
of blood being transported to the brain
which brings on symptoms of:
∙ Dizziness
∙ Increased HR
∙ Blurred vision
∙ Nausea
∙ Fainting
∙ Special considerations to women
who are pregnant should be made
as their blood pressure can
naturally lower during this time.
One of the most common cases if
blood pressure lowering is a
feeling of being light-headed if we
move from a seated position to
upright position too quickly.
Therefore when lifting weights this
should be a consideration to be
observant of.
Quick Tip:
∙ To minimize, or prevent your client
feeling light-headed as they move
from sitting to standing.
∙ Advise them to inhale and retain
their breath.
∙ This will raise their blood pressure
and can allow more blood to pump
to the brain, reducing the potential
of light headedness occurring.
197
How to Test Blood Pressure:
Equipment and Process
The most widely used and accessible
process of measuring blood pressure is
to use a cuff and a sphygmomanometer
( pronounced: svig-mo-man-om-eter ).
Here’s what a sphygmomanometer
looks like:
Blood Pressure Testing
Considerations:
1. The client should be in an upright
seated position for at least 5
minuts before commencing the
test, allowing the client to relax and
find a comfortable position.
2. A cuff is then generally placed
around the bare skin of the left
bicep as it is in a bent flexed
position. The cord of the
sphygmomanometer facing in a
downward direction towards the
hand on the inside of the arm.
3. The cuff should then be inflated to
180 mmHG
4. Slowly then release the air
pressure of the cuff listening with a
stethoscope simultaneously
watching the sphygmomanometer.
5. The first thud of a heartbeat that is
heard is the systole reading.
6. When the thudding stops, it is the
diastolic reading.
Risks associated with Blood
pressure and Weight Training
Blood pressure can fluctuate and
change through day to day activities as
well as exercise and can be easily
influenced by things like stress, food,
lifestyle, body composition and the
environment.
If we’re doing more cardio training there
are multiple muscles being used and
therefore the blood distribution and
pressure is spread out across the body.
When we are weight training, specific
muscles are often isolated, especially
when doing more static isometric
movements and working at a high
intensity, which will naturally elevate
blood pressure.
When the exercise is stopped, because
there is not as many muscle groups
being used the blood and oxygen will
rush to these specific areas and can
sometimes put the athlete/client at a risk
of blood pooling.
Blood pressure should be monitored,
especially for those already
experiencing common changes, and
training should then be modified or an
allied health professional should be
liaised with.
198
3. Movement & Biomechanics Tests Common Postural Imbalances
As a Team Boss physique
Here’s an overview of some common
transformation specialist you’ll be
postural challenges that your clients
renowned in supporting your clients to
may be experiencing.
look in peak condition. To support them
getting, and staying there - without
injury, it’s important you also consider
the function of the skeletal structure
that’s supporting their sculpted muscles.
That’s why testing movement and
biomechanics is important.
a. Postural Analysis and Alignment
Testing
The better your clients body can align
then the better muscular recruitment
that can occur in any exercise, or
movement they perform.
Better Postural Alignment During
Exercise = Better Muscle Building

If you don’t consider the posture your

client brings to their training, you can Kyphosis / Lordosis
add muscle to a structure that’s already
out of balance, which can decrease the Head Forward
longevity and results of their training.
Cervical
Let’s discuss some common postural Hyperextended
imbalances that you should look out for spine
and work towards addressing with your
clients. Scapula Abducted

Thoracic Increased flexion (posterior to the

Spine plumbline)

Lumbar Hyperextended (anterior to the

spine plumbline)

Pelvis Anterior tilt

Hip Joint Flexed

Knee joint Slightly hyperextended

Slightly plantar flexed due to the

Ankle joint
backwards inclination of the leg

Hip flexors Short and strong 199

“Text Neck” / Fatigue Posture

Head Forward

Cervical Slightly extended

spine

Thoracic Long kyphosis (increased flexion) with posterior

Spine displacement of the trunk

Lumbar Flattened and low lumbar

spine

Pelvis Posterior tilt

Hip Joint Hyperextended with anterior displacement of the pelvis

Knee joint Hyperextended

Ankle joint Slightly plantar flexed due to the backwards inclination of the
leg

Hip flexors Short and strong

200
Flat Back

Head Forward

Cervical Slightly extended

spine

Thoracic Upper-increased flexion, lower straight

Spine

Lumbar (flexed) straight

spine

Pelvis Posterior tilt

Hip Joint Extended

Knee joint Extended

Ankle joint Slightly plantar flexed

Hip flexors Weak and Elongated

Flat Back

Head Neutral

Cervical Normal, possibly slightly

spine anterior to the plumbline

Thoracic Normal, possibly slightly

Spine posterior to the plumbline

Lumbar Lordosis
spine

Pelvis Anterior tilt

Knee joint Slightly hyperextended

Ankle joint Slightly plantar flexed

Abdominals Long and weak (anterior

201
Lumbar Short and strong
Other Postural Habits That Can
Affect Your Client Results
Knock Knees (Genu Valgus)
∙ Femur is rotating externally
∙ Knee adduction
Bow Legs (Genu Varus)
∙ Femur rotates internally
∙ Knee abduction
Asymmetry
Dominant sided (differs to Scoliosis
which is a condition of the spine C-
curving or S-curving
Pronation / Eversion
∙ When the ankle joint/foot rolls in
∙ The medial part of the foot is often
lengthened and weak
∙ Often causing the peroneals to be
short and tense
Supination / Inversion
∙ The ankle joint/foot rolls out
∙ The peroneals are weak and
lengthened
Hyperextension of the knees
∙ Lengthened hamstrings
∙ Shortened quadriceps
Scoliosis
∙ Excessive anterior/posterior pelvic
tilt
How to Assess Your Client's Posture
Now you know some common postural
imbalances to look for with your clients.
Next we’ll cover how to dive deeper into
assessing your client's posture.
Static, Standing Postural
Assessment
Posture is essentially the position of the
body in space. An upright posture is
maintained by a series of muscles
running up and down the body to
produce an equal amount of force
across the body which oppose the
downward force of gravity to maintain
an erect position.
Correct postural alignment is essential
for a balanced force and distribution of
joints and muscular activation across
the body, the equilibrium of the body
and systems should provide minimal
stress to the structure of the body.
To assess the most ideal posture we
refer to the plumbline (lateral view) and
the anatomical position (frontal view)
seeking these structures to coincide
with this line reference.
202
Using the location of this line where the
body and main points outlined in the
analysis, we can locate whether there is
anatomical deviance of the line and
body.
Points of Reference:
1. Ear lobe
2. Top of the shoulder
3. Dent on the side of the elbow
4. Hips/ iliac crest bony part
5. Lateral side of the knee
6. Ankle bone/lateral malleolus
These points of potential deviance of
the plumbline should then be recorded
to outline any misalignment and
potential compensations.
What to look for in the posterior
(back) view:
1. Head/neck tilt: If the cervical
vertebrae are laterally tilted then
this could indicate tension or
tightness in the neck, and shoulder
musculature
2. Head rotation: can indicate
tightness in the
sternocleidomastoid
3. Depression or elevation: of the
shoulders
4. Overall spinal alignment: any
abnormal curvatures or favoring to
one side
5. Distance between the arms to
the body : indicating potential
tightness in agonist abductors
6. Genu varum/valgus: Is the client
bow legged or do they have knock
knees? This may explain knee pain
as joints wear differently in these
conditions.
7. Foot position: This can tell you
about hip rotation as people with
tight lateral rotators may have
more pronation, whereas those of
us with tight medial rotators stand
pigeon toed.
If compensations are visible then there
could strong muscles that are being
overactivated whilst other muscles
become weak, joints could lack mobility
or be hypermobile.
These problems can then cause
damage to surrounding tissues and
unwanted stress on the body, knowing
that if there is a weakness or problem
somewhere then another part of the
body can be affected as our body is all
interconnected.
What to look for in the side or lateral
view ?
1. Is the head positioned more
forward suggesting Lordosis and
potential tightness in the neck
extensors ?
2. Are the shoulders protracted,
suggesting potential tightness in
the pectoralis muscles or weak
rhomboids ?
3. Is there kyphosis of the thoracic
spine, suggesting potential
breathing difficulties and tightness
of the pectoral muscles ?
4. Is there any deviations of the
lower/lumbar spine ?
5. What is the knee position?
Hyperextended, flat or flexed,
suggesting possible tension in the
legs?
203
b. Range of Movement (ROM) and
Mobility Testing
The quality in which your client
moves will have a profound influence on
the exercise and weight prescription
during training sessions.
If a person doesn’t have good
flexibility and mobility than their ability to
perform exercises and in particular
weight training will be affected with their
range of motion being limited.
Why Range of Movement is
Important for Physique
Transformation
It’s as simple as 1, 2, 3:
1. Better range of movement leads to
better structural alignment during
exercise.
2. Better alignment during exercise
leads to, less chance of injury and
better muscular recruitment.
3. Better muscular recruitment leads
to better symmetry and muscle
building results.
How to Test Your Client's Range of
Motion ?
The following tests give a basic
understanding of the client’s ROM and
mobility and serve as an indicator for
you to prescribe further mobility training,
to support better results from their
physique transformation training.
Sit and Reach Test
∙ This test is utilized to assess the
flexibility of the posterior line of the
body, including common tight
areas around the lower back and
hamstrings.
∙ Good ROM with these areas is
important for peak physique clients
to be able to effectively lift weights
with proper technique.
∙ If these areas are restricted with
mobility then compensations can
be recruited leading to potential
injury, particularly to the back.
Equipment required to perform the
test:
1. Box
2. Ruler
How to perform this test ?
1. A sufficient dynamic warm up should
be done first to increase the oxygen and
blood supply to the movement about to
be tested.
2. The client should then be seated
upright on the floor with legs out
straight, and toes dorsiflexed against
the box.
3. The client should then be asked to
hinge forward from the hip slowly
reaching their arms out across the box
towards their toes with their palms
facing down, holding the position.
4. The measurement can then be taken
with a ruler/tape measure from their
toes to their fingertips, ensuring that the
fingertips are at the same level.
5. Further testing can be conducted on
each leg individually to test for
differences, as illustrated in the images
below.
204
Overhead Squat Test
The overhead squat test is important to
include in the initial fitness appraisals,
as it is a fundamental movement that
should be performed correctly if clients
are to train further with any overhead
lifting and weight training for peak
physique performance outcomes.
The test will allow the trainer to observe
client`s dynamic flexibility, core
strength, balance and overall neuro-
muscular control.
How to Test the Over-head Squat :
1. Have the client stand with their feet
hip width apart and toes facing
directly forward
2. Instruct the client to extend and lift
their arms overhead.
3. Client should then squat as if
they’re about to sit in a chair, and
return to a standing position
4. Perform squat to be viewed in all
four planes of movement
5. It can also be useful to stand your
client in front of a wall during this
test to minimize compensations
and cheating with their form.
Common Imbalances to Look For
During the Overhead Squat Test
Here are some considerations and
checkpoints to be aware of when
performing this test:
What to look for at the feet:
∙ Test should be performed with
shoes off so a better judgement of
ankle strength, feet arches and
position can be observed, all of
which can influence the movement
and position of the knees, hips and
overall posture.
∙ Observe the heel and achilles
mobility and positioning, and
whether the client favors more
weight distributed over their toes
with heel lifting or the opposite and
toes are lifting slightly.
∙ Observe whether the feet are flat
and facing straight ahead, or if the
feet are turned out.
What to look for at the knees:
Observe the knees when squatting to
see if they’re prone to rolling in or out
(genu valgus/genu varus).
What to look for at the hips:
Observe if there is a lack of mobility in
the hips and any excessive hip flexion
or extension
What to look for at the back:
Observe if there is any lumbar arch
when squatting
What to look for at the arms:
∙ Observe the positioning of the
arms overhead and watch that
shoulders don’t lift up to the ears
(shrug shoulders) as they do this.
∙ Do the arms fall forward.
205
c. Strength Testing
Strength is a great indicator of your
client`s structural integrity / alignment
and their level of muscular recruitment
in a given movement.
Why Strength Testing is Valuable to
Physique Transformation
It is very complimentary to test your
client's strength levels to gauge
performance improvements during their
physique transformation journey.
Strength levels over a given period of
time can give deeper insights to the
health and recovery levels of your
clients’ nervous system.
For example; if your clients’ strength
testing is declining over time, it could
indicate that they are not recovering
appropriately. This could give further
insights to make adjustments to their
nutritional intake, training intensity, or
volume.
Remember: It’s difficult to manage what
you don’t measure.
Consider this equation to understand
the importance of testing strength for
the purpose of physique transformation:
(Strength Output x Volume) +
(Appropriate Recovery & Nutrition) =
Lean Muscle Gains
Here’s some useful way to test your
client's strength levels.
i. Repetition Max (1RM) Testing
This is the maximum amount of weight
that can be lifted during one complete
movement repetition.
*This type of test is not recommended
for clients who are starting out with a
strength training program, as the risk of
injury is higher with minimal training and
technique perfecting.
How to Test Your Clients 1RM
Preparation:
∙ Select an appropriate movement, and
prepare equipment to test your client's
strength levels, that aligns with their
goals.
∙ Equipment that can be used to test
should be easily able to be adjusted
and record measurements. This could
include, barbells, machines, and
dumbbells.
Warm Up:
∙ The client should warm up for at least
10 minutes doing low intensity exercise
specific to the movement being tested,
before any maximal lifts.
∙ Start the client on low weights for 3-5
reps to assess technique and warm up
the muscle group to be used.
∙ The trainer should then start them at
about 50-70% of their estimated 1 rep
max capacity, to avoid any risk of injury
if the predicted weight is too heavy.
Lift Testing:
∙ The client should then lift the weight
decided upon with 4 attempts. After
each attempt the client should have 3-5
minutes rest after each attempt to
replenish energy stores.
Progressive Loading:
∙ Each time the client successfully lifts
the weight then the trainer should
progressively increase the load by
about 2.5kg - 5kg depending on how
easily they can successfully lift and
control the movement.
∙ The closer the client gets to their
predicted maximal capacity the smaller
the load progression should be, again
to avoid any potential risk of injury at
this stage.
Determine 1 Rep Max:
∙ When the client is unable to complete 1
repetition of the load then the trainer
should take the number of the load
lifted previously as their 1RM Max.
206
Examples of Exercise for 1RM
Testing

As strength differs throughout the body,

different exercises should be used to
assess strength for those body parts and
muscle groups. (e.g. bench press, leg
press, bicep curl, triceps extension)

Muscle / Area Specific 1RM Test

Examples

207
ii. Submaximal Strength Testing
In the case for novice or beginner
clients looking to build their strength and
optimize their physique a sub max
repetition test is recommended.
How to Test Submaximal Strength?
This test should begin in the same
manner as 1RM test with a 5-10 minute
warm up and the client sharing their
estimated maximal load.
1. 50-70% of the predicted
maximum load should then
be lifted by the client to
assess technique and trainer
should correct any errors
before commencing further.
2. The client should this time
complete 4-10 repetitions of
the 50-70% load capacity to
their predicted maximum.
3. The client should then rest
for 3-5 minutes
4. Once they have rested the
weight can be progressed by
small increments depending
on how easily and controlled
they could lift the last weight
5. When the client cannot
complete 10 reps but stop
past 4 then that weight will
be recorded.
6. Like the 1RM test this test
should be performed again
with the same protocol for
different muscle groups to
record specific sub max
results for different exercise.
Refer to the 1RM testing
exercise examples.
iii. Strength Endurance Testing
Muscle endurance testing is a great
complement to 1RM and submaximal
strength testing. It measures not just your
client's ability to lift something once, but to
keep lifting over a given period of time, or
repetitions.
Strength endurance using the appropriate
methods is useful to speed up fat loss and
blood flow around the body.
If you client's strength endurance is
increasing as well as their maximal strength,
it’s likely that they’ll be on track for great
improvements in lean muscle gain. Provided
that their nutrition is appropriate to their body
composition goals.
How to Test Strength Endurance ?
Strength Endurance Testing Principles
∙ Choose Appropriate Exercises
o Many movements can be tested
to demonstrate your client`s
strength endurance levels.
o It is recommend you choose
movements that are relevant to
your clients` goals, that you’re
able to measure with accuracy
and consistency.
o Exercises that work well and
relatively safe are body weight
movements, including; squats,
push ups, rows / pull ups, etc.
∙ Test Within Appropriate Intensity
Levels
o As a general recommendation: if one
rep of the movement can be completed
per second over a 60 second period
(e.g. 60 squats per minute), it is
recommended to increase exercise
intensity. This can be done by adding
resistance, reducing leverage, or
progressing from a bilateral to a
unilateral exercise.
o If the exercise is too easy it will test
more cardiovascular endurance than
muscular endurance.
208
 Exercise Push up
Begin in a plank position, shoulders in
Start line with wrists, feet slightly parted.
Position Eye Gaze between the hands and
neutral spine

Down Phase: Inhale and slowly

bending at the elbows lower the body
to the ground until you are touching
Exercise the ground with your chest and body.
description
Up phase: Exhale and push down
through the hands lifting the body
back to the starting plank position

Movement
Let’s diver deeper into strength endurance Shoulder, back and core
focus
testing using the push up as an example.
Pushing Assessments (Push Up Test) To develop shoulder mobility, back
Aim: To measure the upper body’s strength Movement
and core strength and upper body
and endurance, through a pushing pattern. goals
muscular endurance
Test preparation:
∙ The instructor should lead a warm up for Avoid arching or rounding of the
approximately 5-10 minutes of low spine, keep the eye gaze between the
intensity aerobic exercise followed by skill Cueing hands to assist the maintenance of a
specific movement focusing on releasing neutral spine. Control the movement
tension in the upper body and preparing
and go to full Range of motion (ROM)
the body for the physical demands of the
exercise.
Common
∙ An example warm up could be arm Rounding of the spine, dipping of the
errors and
rotations, arm swings, plank to pike flow, lower back and raised hips, pulsing of
and bear crawls. signs of
the chest.
Demonstration: fatigue
∙ The instructor should introduce the Regression : Perform push-up from
client(s) to the test, going over how to knees rather than toes. Adjust the
correctly perform a pushup, any angle of the decline, either using a
alterations/variations that can be made, Variations: bench, or wall.
as well as common faults to look out for.
Modifications Progressions : Adjust the angle of the
∙ Work in pairs if in a group setting, so the
/Progression decline by raising the feet either using
partner or instructor can count how many
push-ups are being performed. s a bench or wall, adjust the ankle of the
The Test: hands, eg, wide, diamond etc. Add
∙ The client(s) will have 1-2 minutes to resistance and progress to bench
perform as many correct push up press.
repetitions possible (either on knees or Easier Push Up Harder Push Up
toes).
∙ When the client breaks form or can no
longer continue with the exercise due to
fatigue then that number correctly
209
completed should be recorded.
Extra Strength Endurance
Assessments
It is useful to divide your testing
categories into movement patterns.
Here’s some examples:
1. Pushing Patterns: Push Up,
Bench Press, Shoulder Press
2. Pulling Patterns: Pull Up, Row,
Pull Over
3. Squatting Patterns: Squat, Single
Leg Squat, Lunge
4. Hinging Patterns: Romanian
Deadlift, Single Leg Deadlift, Hip
Raises
Adherence and Motivation
In order for the client to successfully
achieve their goals and progress in their
training, motivation is a key! And an
excellent way to keep their motivation
flowing is to measure their results to
show them how they’re improving and
progressing.
Sometimes fat loss and muscle gain
goals can take time to show externally,
so testing and measuring other
performance variables that contribute to
physical transformation is very useful.
Any time your clients motivation needs
a boost, you can show them how their
performance is improving, or where they
have opportunities to improve further.
This can support adherence and
longevity to their training with you.
So you can have clients that keep
coming back, and continue training
outside of your sessions it’s important to
know that basics about the inner
workings of motivation.
Types of Motivation
There are two types of motivation that
trainers should be aware of to assist
clients to stay on track.
#1. Intrinsic Motivation:
Intrinsic motivation comes from the
individual/client to be able to self
motivate without any external influence
or reward, just simply their own drive
and determination.
An example of intrinsic motivation
could be If a client is training not for any
personal or external gains but simply
because they enjoy what they’re doing,
and it makes them happy.
Some ways to assist your client feel
intrinsically motivated are:
1. To programs sessions to be
enjoyable and specific to the
personality and drive of the client.
2. Keep training sessions interesting,
so the client doesn’t grow bored.
3. Knowledge of progress can inspire
positive feelings. Test regularly
and demonstrate their results, to
ignite their inner drive/instinct.
#2. Extrinsic Motivation:
This type of motivation required in
external cues arising from outside the
client or individuals personal
motivational behaviors.
Some ways to assist your client with
extrinsic motivation are:
1. Using a reward system to keep
them motivated.
2. Sometimes individuals are seeking
praise so provide them with
positive feedback.
Motivate them by introducing a
challenge or competition they can work
towards.
210
 Section 6:
Risk Management, Injury Prevention,
Workplace Health
& Safety, and Referrals

211
Risk Management
To avoid negligence or risk of injury to
the client, the ability to identify potential
or existing risks
is of great importance.
What is a Hazard / Risk?
A hazard can be anything that could
cause potential physical, emotional, or
psychological harm
to someone. Working in the fitness
industry, you are working human beings
who all have different health histories
and will move differently to one another
so it your duty of care to try to provide a
safe experience for all clients and other
employees within the workplace.
Creating a Safe Environment for the
Client
To mitigate risk of injury; As part of
health screening you should provide
your client(s) with an
introduction to the training space and
facilities available.
∙ Within the workplace trainers
should educate new clients about
the equipment accessible within
the exercise environment including
suitable equipment and techniques
for that particular client to maintain
individualization when prescribing
exercise.
∙ The trainer should not only
demonstrate the proper use and
technique of exercises and
equipment use but they should
also then observe the clients form
to instantaneously correct any
errors and prevent bad habits and
patterns from occurring.
What to include when introducing
clients to training space and facilities
:
∙ You should be clear with them
about any potential risks or
hazards: e.g. Informing them if the
weights that are too heavy.
∙ Correct use of equipment
∙ How to navigate the training area
(Where to train, emergency exits,
bathroom facilities)
∙ Have an approachable mannerism,
and introduce client to other
trainers so they feel comfortable to
seek professional advice and
guidance when needed.
Risk Management and Preventative
Strategies
∙ Safety of client(s)
You will need to ensure the safety of
the client, assessing risks and
referring to the maintenance of
equipment procedures and OHS
laws.
∙ Demonstrate knowledge with
reference in programs to the
bodies anatomical and
physiological functioning
You will need a deep understanding
of the anatomy and physiology
functions of the body and movement
networks.
∙ Reference to Pre- exercise
health screening and
assessments:
After performing a Pre- Exercise
Health Screen, we can then look at
designing the fitness program. Refer
to the physical tests performed in the
Health Screening and performance
appraisal process to identify the
most appropriate exercises,
equipment and training type for the
client in relation to their needs, and
goals.
212
To avoid risks when working in a fitness
context is to work within the fitness
industry and
legislative guidelines to avoid potential
harm to the client, yourself or other
persons within the
area you are operating from.
One key way we can avoid risks is to
perform an adequate health screening
of the client, to
understand weaknesses in their body,
related to past injuries, or health risks.
The results from
the AFIRM (2006) research found that
the most common risks and concerns
by professionals in
the fitness industry are as follows:
Rahi’s note: To make it relevant to
India, can we add a line “which we
believe is pretty much the case india
too.”
1. The competency of fitness
professionals.
2. The effectiveness of pre-exercise
screening and management of de-
conditioned clients.
3. Poor supervision of fitness service
users and incorrect use of equipment.
4. Fitness trainers failing to remain
within their scope of practice.
5. Equipment misuse (as distinct from
incorrect use).
6. Poor fitness training environments.
1. The competency of fitness
professionals
It is important to understand that
information in regards to physical
training and health is continually being
challenged in the scientific communities
and therefore changing. To stay up-to-
date with the most current knowledge in
the fitness industry we should always be
seeking to develop our professional
competence, by staying educated,
enrolling in courses, and reading
new research.
If at any time you do not feel
comfortable in working with a particular
client, or you are unable to assist them
with their performance outcomes, it is
important then to refer the individual to
an allied health professional, or another
trainer whose expertise would be more
suited.
2. The effectiveness of pre-exercise
screening and management of
deconditioned clients
Placing the principles of the Client
Profiling & Health Screening unit of this
course will be key to regaining client
confidence in the care and
professionalism of you as a trainer.
Having the ability to acknowledge
barriers to physical activity including
past injury compensations, and to then
prescribe alternative exercises to suit
the needs and develop strength and
confidence back to the client.
Simply sitting out for an exercise,
especially in a group situation should
not be an option, as a trainer you should
be able to prescribe an alternative
exercise to suit the client’s level of
fitness and ability.
213
3. Poor supervision of fitness service
users and incorrect use of equipment
This manual will outline guidelines with a
variety of exercises and correct
techniques.
4. Fitness trainers failing to remain
within their scope of practice
Trainers should only be working within
their areas of expertise to avoid risks and
harm for the client. If the client’s needs
are outside the line of qualifications or
confidence then the client should be
referred to an allied health professional or
another trainer who is more suited to
assist their requirements.
5. Equipment misuse
Trainers should adhere to the OHS
regulations, laws and regulations in
relation to the correct maintenance and
checks of equipment to follow safety
guidelines and guidelines recommended
by equipment makers. Implementation
and adherance to an organized protocol to
check the safety of equipment and
maintenance of cleanliness and hygiene
of the facilities within the workplace
should be made sure of.
6. Poor fitness training environments.
- Trainers should follow the OHS
guidelines and regulations to
minimize and risk of human harm.
- Administering cleanliness routines
and practices to follow for both the
employees/trainers and clients to
maintain organization of equipment.
- Following appropriate clothing
protocols that is best suited when
training, such as closed toed shoes
to avoid injury.
- Cleaning after use of equipment, and
booking systems to avoid
overcrowding of spaces should also
be advised.
How to Assess, Identify and Minimize
Risks
When identifying, and assessing risks
and the potential probability of risks this
hierarchical method can be used:
1. Identify the injury or consequence
that could result from the identified
hazard
● What is the potential worst case
scenario?
● Prevention is better than cure, every
time.
2. Determine the likelihood of the
event occurring from the hazard
● Fatality: May cause one more
fatalities
● Critical: May cause severe injury and
weeks of lost time
● Minor injury: May cause a few days
of lost time
● Negligible : First aid is required but
no lost of time
● Very likely: Exposure to the risk
could happen frequently (daily-weekly)
● Likely: Exposure to the risk could
happen, but not as frequently (weekly-
monthly)
● Unlikely: Exposure to the risk could
happen, but rarely (monthly- yearly)
● Very unlikely: Exposure to the risk
could happen, but the likelihood is
minimal (yearly-two
yearly)
3. Determine the overall risk
associated with the hazard
● Cross-reference the probability and
the severity the risk poses
4. Determine the risk rating.
● The higher the rating the greater the
need to implement a control measure,
or to eliminate the risk completely.
214
 Example of risk client risk assessment
and preventative measures:

Risk Causes Preventative measures

• Screen patient before prescribing exercises.
Chou, Quaseem, Snow, Casey, Cross,Shekelle,
& Douglas (2007) impose that an inquiry of the
• Inappropriate choice of exercise location of pain, frequency of symptoms, and
Causing
• Loads too high duration of pain, as well as previous history and
further damage
• Inappropriate technique treatment of back pain should be recorded.
to back
• Insufficient rest • Perform %RM test to find appropriate weight to
be lifted.
• Supervise technique and give guidelines and
advice.
• Build up of lactic acid, (Powers & • Begin exercise program gradually, avoiding
Howley 2010) intense eccentric exercise during the first 5-
• Beginning training session too 10minutes of the training session. (Powers, &
intense and not giving muscles time Howley 2001).
Delayed onset to adapt to the physical • Active recovery to assist in the removal of lactic
muscle requirements (Powers & Howley acid and other byproducts, (Quinn 2010)
soreness 2010) • Educate client about possible risk of DOMS
• Increasing weights or intensity before commencement of program and
before client has become reassurance that it is a normal aftereffect.
comfortable with current exercise • Massage post exercise to reduce discomfort and
prescription. swelling (Quinn 2010)
• Pain can cause sufferers to avoid
• Encourage correct movement techniques despite
Overcompensa working stabilizer muscles to
pain and reassure that pain will subside.
tion of muscles compensate for restrictions to back
• Do not disregard the importance of general
to compensate muscles.
exercises to improve fitness and assist in
for trunk • Classic movements can be
minimising back pain, as well as performing
stabilizer performed incorrectly as a form of
stabilizer exercises, Koumantakis, Watson, &
muscles recovery for painful areas of
Oldham (2005)
concern.
• Inform client of all aspects of the program goals
and strategies, so they are aware of intentions
Psychological and possible risks and side effects.
problems • Initiating client into program too fast • Ask client to keep a log of feelings during
including so they become overwhelmed. program as a guide to see if any of the exercises
depression • Not taking into account their or frequency of training is too much and causing
and low self personal feelings and fears detrimental effects.
efficacy • Trainer should be supportive and encouraging
throughout the duration of the rehabilitation
program.
Blisters, ulcers • Give client barriers to hold to for support with
or falls due to • Exercises that go for too long balancing problems.
proprioception • Inadequate supervision • Regularly check feet for occurring blisters
problems and • Not taking appropriate risk • Deter away from long duration activities
numbness of management procedures to avoid • Provide significant amounts of rest
feet from nerve falls • Check with client how well they feel regularly
damage during program.
215
How to Minimize Risk if Your Client
Has a Pre-Existing Injury
Injuries can often be caused by lifestyle
choices and routines that could involve
prolonged periods of being sedentary
(under use related injuries), hard labor
(overuse related injuries) or jobs or
home life that are stressful (mental /
emotional related injuries). These will all
impact on how we move our bodies and
could lead to increased severity of
injury, or additional injuries if not
considered when planning a training
program.
Observe Your Clients Like a Hawk
Beyond your initial detailed assessment
of your client, it is important to continue
ongoing observation of the way your
client performs exercises in your
training program. This gives you an
opportunity to adjust their training
technique in the moment and improve it
over time. This is a very useful practice
to work with and minimize injury
occurrence.
Balance Internal with External
It’s very common that your clients
are eager to improve the way they look,
which can often overly draw their focus
to the outside of their body (what they
look like). To support the outside
looking good, you need to make sure
the inside of their bodies function well.
Any past injuries that may have
happened could have left lasting muscle
recruitment compensations. Ensure
these are addressed as well as your
clients physique focused goals.
- Continue to observe your client during
draining.
- If you notice over / under use of
certain muscle groups during their
physical training consider changing the
intensity of the exercise, or the method
in which it is practiced.
- When muscular imbalances are
addressed, likelihood of injury is
minimized, and better overall
recruitment of muscles is achieved,
which will ultimately support your client
in their physique goals.
Select Exercises Wisely
Some exercises are better than others if
your client has a current injury, or has a
history of injury. For example;
- Let’s say you’d like to strengthen your
client's legs, but they have a history of
challenges with their back. This would
potentially limit the ability to bear weight
on their back to strengthen their legs. In
this case you may choose unilateral
(single leg) exercises, instead of
bilateral leg exercises. This increases
the weight on your client's legs and
minimizes load on their spine.
If your client is injured, or at risk of
injury, it doesn’t mean their training
needs to stop. Clever exercise selection
can support the rehabilitation of injuries,
whilst helping them achieve their
physique goals at the same time.
216
Maintenance of Sports Equipment
To ensure that workplace risk
management procedures are met and
that full duty of care to
users of facilities and equipment are
adhered to regular maintenance is
required. Implementing regular
workplace procedures that include
documentation and supervision of
sporting equipment maintenance
checks are advised. This routine
participation in reviewing and
addressing these procedures ensure
the open communication between those
across facility and equipment faults
and/or repair needs are being
addressed on a day to day basis.
1. Equipment Maintenance Log
Books
Gyms and studios should maintain an
operations logbook for easy tracking of
the daily and routinely jobs that need to
be done to ensure the safety and risk
management guidelines of the
workplace. Some of the things that
should be included within the logbook
and checked off are:
∙ Equipment should be checked for
any faults and tested before use
∙ Equipment should always be
stored in a safe and secure place
∙ Specific maintenance for
equipment should be implemented
checking with manufacturer's
specific steps to clean and
manage the longevity of the
product Equipment should be
clearly labeled Equipment should
be cleaned regularly as per the
rules and regulations of the
workplace and specific instruction
labelled with the product.
∙ Checking that emergency
equipment is within a functioning
date, and replace ahead of expiry
if need be.
This log book should be stored in a
general place such as the office, and
clearly marked for all
instructors and employees to be aware
of it and its use known.
2. A monthly logbook checking
should be initiated to go over:
∙ # The regularity of instructors/
employees logging activities
∙ # Check whether equipment has
been maintained.
∙ # Check any repairs that need to
be done and report to supervisors
and staff
217
3. Daily Maintenance Routine for Fitness
Training Equipment
All equipments and fitness machinery should
be checked prior to any personnel use.
Note about equipment, starting weights on
machines:
Checking the starting load is important before
public use, as it could be a potential hazard for
clients coming in, and the weight being too
heavy for them to change or beginning to lift
without checking putting them at risk of
potential injury.
Equipment Checklist:
Check placement and order of free
weights / dumbbells / kettlebells etc.
Equipment should be organized and weight
resistance should be clearly marked and
stored appropriately per load and difficulty. If
heavier weights are not put away correctly
this could put a client at risk who are
unfamiliar with the size and could potentially
try and lift something that is beyond their
limits.
Equipment should be cleaned at the
beginning of the day, after each use, and
at the end of the day:
With different people picking up weights and
equipment, there is risk of contamination
through sweat and other potential skin
disorders. Clients should be educated to
clean all equipment after using it and
cleaning products should be stored in a
visible and accessible place.

Week Week Week Week

Date & initial
1 2 3 4
Barbells
Check weights

Check springs for wear and tightness

Dumbbells
Check order
Check for wear and tear
Machines
Check wires
Check resistance
Check for wear tear
Check hinges
Check attachments

218
Personal Hygiene and Cleaning Equipment Repair:
Equipment:
- If equipment needs repairing then
To avoid potential infection or skin it should be clearly labelled and
irritation it is important for gyms and removed from public accessibility.
trainers to implement methods of - Relevant and expert repair
personal hygiene including: services should be notified and
communicated with to ensure
- Wearing gloves if providing first aid
correct care and servicing is done.
- Wearing inners/gloves if boxing
- If it is within your abilities to repair
- Regularly wiping down and
and isn’t outline to be repaired by
cleaning equipment after use
the manufacturer or professional
- Ensuring the environment, you are
then do so, ensuring that the
working in is cleaned and
workplace management is notified
maintained, using materials like a
and safety precautions are
checklist and job designation to
adhered to.
ensure the important tasks are
being done.
Considerations for cleaning
products: When cleaning equipment,
there are several products available, but
considerations should be made when
choosing the right product:
- Product should be eco-friendly
- Should not include ingredients that
are common allergens. Ingredients
should be labelled and visible for
clients and trainers to ensure risks
are being considered.
- Products should be non-toxic
- Non-corrosive (not ruin equipment
or surfaces) Check equipment
maintenance instructions.
- Easy to rinse or dry off
- Alkaline neutral
- Biodegradable

219
Injury Prevention
This unit will outline the skills and
knowledge required to incorporate an
understanding of injury prevention in a
fitness training context.

Trainers should incorporate their

foundational knowledge of human
anatomy, and physiology to implement
strategies to address injury patterns,
recovery techniques and correct
exercise technique to promote healthy
posture and movement efficiency.

This unit requires the ability to screen

individuals, using skills obtained from
pre-exercise and client history
information, incorporating risk
assessments and client referrals if
needed.

Fitness advice and programming

administered should reflect the results
from health screening information to
prevent further injury for clients who
have had past or reoccurring injury
patterns.

Injuring prevention protocols should

include correspondence with allied
health professionals, and work should
be in conjunction with legislation and
organization policies and procedures.

220
Personal trainers should respect the
experience and specialist practitioners
who will assist in the treatment of
injuries, but can implement strategies to
prevent common injuries from occurring
and assist in the post rehabilitative
process to strengthen the injured body,
to realign the body and smooth out any
compensatory movements and work
with allied health professionals post
rehabilitation to prevent recurring
injuries.
Personal trainers are often sought out to
assist in the post rehabilitation services
to strengthen and align the body of
clients who have experienced injuries.
Trainers will work with allied health
professionals to identify movements or
exercises that should be avoided to
prevent injury recurrence but assist to
maintain movement and rehabilitate the
body back to health.
Allied health professionals may
prescribe specific exercises for the
client to do with a trainer or in their own
time. These exercise prescriptions and
time schedules to do them should be
shared with you as a trainer so when
planning programming, you’re not
fatiguing the client, especially in an
injury sensitive area by repeating the
movements.
Some problems that can arise from
injuries include:
● Decreased stability and mobility
● Scar tissue
● Muscle atrophy
● Chain- link effect or imbalance
● Post injury trauma and tension
● Clients may feel less motivated to
train from psychological and physical
draw backs associated with injury
Terminology:
● Cumulative Injury Cycle:
This term is used to describe recurring
injuries, another term used is Repetitive
Stress Injuries
(RSI)
Common recurring injuries include:
● Low back pain
● Knee pain
● Ankle sprain
● Shoulder injuries
● Neck and shoulder pain
221
These recurring injuries can be caused by
habitual compensations that cause
weakening in other muscular structures.
They can also occur from repetitive
movements or overuse of a particular muscle.
Lack of physical activity and mobility can be
another cause such as sitting for prolonged
periods.
They can occur through training, if there is a
focus on one exercise, if the program is not
varied to alternate muscle groups, or if
insufficient rest and recovery techniques are
prescribed.
There is also complaints of these injuries
occurring in the workplace, with one study
claiming that 50% of workplace injuries are
due to RSI, Nainzadeh, Malantic-Lin, Alvarez,
Loeserl, (1999).
Types of Repetitive stress injuries:
Tissue Trauma:
This is a common injury that can occur
through excessive strength training often
stimulated from a muscle strain. Micro
traumas to the muscle proteins myosin and
actin are a healthy adaptation to muscle
anabolism especially beginning a new
exercise, it is the response predominantly
during the eccentric phase of motion, this
change is referred to as DOMS.
However, without sufficient rest the muscle
fibres do not have time to repair and muscle
proteins cannot be replenished and so the
tissue trauma remains, or grows if the
exercise continues to be repeated.
Acute injuries:
Refers to the immediate period following
an injury where the tissues have been
damaged, and initial protective response
of the body is to bleed and swell.
Acute injuries will generally be short-term
lasting 24-48 hours.
Characteristics of acute injuries can
include:
● Pain
● Swelling
● Immobility
● Heat
● Change in colour, such as; Redness
Treatment:
R est
I ce
C ompression
E levation
R est
S eek further medical advice and
assistance
Chronic injuries:
Without proper care of acute injuries, they
can progress to chronic injuries, they can
also be injuries that occur over time rather
than from a direct trauma. Chronic injuries
can cause ongoing paying for the sufferer
causing them to go into protective mode of
the area, and develop compensatory
patterns to avoid use of the injured area.
These injuries will generally be present
more than 6 months.
222
Sprain:
Sprains occur when a ligament is
stretched or torn usually due to
instability causing a twist or shock to the
area.
Sprains occur to a ligament and can be
divided into three grades.
Common sprains for bodybuilder can be
back sprains, which can occur from
overuse, incorrect form, lifting too heavy
or incorrect muscle patterning due to
weakness in the core or glutes.
Grade 1: These sprains will involve
several ligament fibres being stretched,
but ROM is normal and does not
produce stress on the ligament affected.
Grade 2: These sprains will have a
significant number of ligament fibres
damaged, and that a joint stretched will
show considerable laxity.
Grade 3: This is a complete ligament
tear, with excessive laxity, but may
appear to be pain free and therefore
can sometimes not be treated
appropriately.
Strain:
Like a sprain, and can also be divided
into three grades, but these injuries
relate to the muscle or tendon. They
can be partial or complete tears, caused
by being overstretched or shear force
where force is pulling adjacent to the
fibres.
A common example in body-building
training is when performing shoulder
shrugs and neck strains can occur.
Grade 1: The strain involves several
muscle fibres, there is localized pain but
no loss of strength can be seen.
Grade 2: There is a significant amount
of muscle fibres damaged, and there
will be pain and swelling, which will
cause a loss of strength from immobility
responding to the pain and discomfort.
Grade 3: A complete muscle tear will
occur.
223
Inflammation:
Inflammation is the body’s natural
response to acute or chronic injury to
the tissues, and it can be visible or
internal. It is a protective mechanism of
the body and communication of pain
receptors to the brain.
Responses can include:
Dilation of the blood vessels, increasing
blood flow and the number of white
blood cells to enter the tissue to assist
with repair and removal of dead and
damaged cells.
● Increase in heat to the area, possible
redness
● Muscle Spindles will contract to
immobilize the area, causing a
tightening of crossbridges and tension
in the muscle.
The term “itis” will indicate there has
been inflammation. Eg. Tendo nitis,
burs itis.
Scar tissue: The formation of scar
tissue is a vital part of the early stages
of healing, as it binds the damaged
fibres together, however without
sufficient treatment and recovery, soft
tissue injuries will create large amounts
of scar tissue which can be problematic
when resuming usual movement and
functionality. When scar tissue is
excessive it will bind adjacent fibres and
structures together, known as adhesion
limiting function of the tissue and
surrounding structures.
Joint injuries:
Dislocation: This is the forced
displacement from the normal bone
position meeting at the joint. Occurring
when a force will stretch the ligament
surrounding a joint to a point where the
bone must compromise and are pushed
out of their normal contact with each
other.
Sublaxation: This is not as extreme as
dislocation, occurring when the joint
capsule and ligament is stretched
beyond a normal point, but the bones
do not displace excessively.
Bone injuries:
Fracture: This is the partial or complete
break of a bone.
Stress fracture: These are common in
repetitive stress injuries, where a
hairline crack in the bone is caused.
Common injuries experienced in peak
physique training
Injuries to the upper back and cervical
spine
- Injuries to this area can occur if
posture is out of alignment or if the
client has slight or excessive kyphosis,
from hunching or working at a
computer.
- Injuries can also occur if the client is
bracing or is not breathing three
dimensional
224
How to avoid the injury:
- Correct posture coaching
- Stabilization training
- Core stability training
- Mobility training
- Correct breathing techniques for
movements
Shoulder joint injuries:
Peak physique training, and overhead heavy
lifting can be a common cause of injury to
the shoulder joint. As mentioned in the
Anatomy unit of the Certificate 3 in fitness,
the shoulder joint is freely movable
allowing it to move in a number of
directions, providing clients with a
range of opportunity to train around the joint,
but with movability comes a lack of stability
which could lead to potential injury.
● Without proper movement mechanics and
technique execution around the shoulder,
injuries can occur to not just the shoulder
but also the neck, jaw and back.
● Although hypertrophy programs can be
beneficial to strengthen the shoulder joint
and muscles surrounding, overuse injuries
can also occur if repetitive movements are
being executed.
● Varied training days
● Muscle group coupling and changing
exercises should then be considered when
planning hypertrophy programs to prevent
overuse injuries from occurring.
● Clients performance should be recorded
and progressions should be incremented
slowly using progressive overload principles,
so the client is not lifting beyond their
abilities
Impingement syndrome:
This is one of the most common
shoulder problems, where the arm is
abducted past 90 degrees. When this
happens the greater tuberosity of the
humerus will compress the rotator cuff
to the acromion process causing a pain
response and decrease in shoulder
mobility and ROM.
Rotator cuff tear:
This is when the tendons primarily
responsible for the motion around the
shoulder joint experience trauma or a
chronic impingement. In this type of
injury, surgical repair is often necessary
and it is a lengthy recovery.
Neck pain and headaches:
Neck pain and headaches are often the
response to tension and tightness in
shoulders.
Relief can be found by the following:
● Encouraging correct full body
breathing techniques
● Building stability in the shoulder
complex can often be more beneficial
than directly
stretching the neck, Cools, A, et.al.,
(2013).
● Improving strength and ROM
● Correcting movement mechanics and
alignment.
225
Injuries to the hip:
Degeneration:
Often the hip succumbs to ageing
degeneration, such as osteoarthritis. If the
hip is experiencing degeneration, then
mobility can decrease which can often lead
to back problems from compensatory
patterns being used to attempt to reduce
pain and use of the area affected.
Some symptoms of degeneration can
include:
● Groin pain, sometimes reaching to the
outside of the thigh and down to the knee
● Back pain
Popping and snapping:
Some clients will question popping sounds
around the hip joint, this can often indicate
that further strengthening and stabilizing
around the joint should be done. It can be
a sign of hypermobility or instability of the
joint, or perhaps that there is a need to
stretch if the psoas muscle is overactive.
Lifestyle choices and injury prevention in
peak physique training. Even if you live an
active lifestyle in the gym or in your
workouts, your choices outside this
space can have an impact on movement
mechanics, alignment and increase the
risk of injury.
Some common examples are:
● Sitting for long periods of the day can
increase tightness in the hips, decrease
the
activation of glutes, and impact on posture
and core stability and strength to correctly
and safely execute exercises.
● Excessive technology use can lead to
injuries of the distal parts of the arm, often
presenting tightness in the forearm flexors
which can affect a client’s lifting technique
and mechanics.
Prevention strategies:
Educating clients on positive lifestyle
changes can assist in the prevention of
lifestyle injuries.
These could include:
Sitting:
● Providing clients with alternative
recovery strategies in between sets to
sitting such as performing an Asian
squat or walking around to increase
blood flow and oxygen to the area.
● If the client is sitting for long periods
due to work, provide them with
resources that support varied working
positions, such as, standing desks, or
using a Swiss ball.
● Promote taking regular moving work
breaks to walk around, or stretch
Overusing technology:
● Educate the clients to plan technology
periods to avoid overuse
● Provide clients with wrist, finger and
shoulder exercises and stretches to
relieve tension.
● Bring in hanging periods on
programming, to hang from a pull up bar
to decompress
the wrists from being in excessive
compression.
226
Injury Preventative strategies:
Risk Management:
Performing regular and detailed risk
assessments, (using strategies outlined
in the Certificate 3 Risk management
unit) will assist to identify risks specific
to the training space and goals of
clientele. Trainers and workplaces
should then implement risk
management strategies to avoid injuries
from occurring.
Health Screening:
Your health screening, (outlined in
Certificate 3 Manual, Health Screening
unit) will prove to be an efficient strategy
to avoid injuries once training
commences. By gathering information
about
your client and their injury history you’re
already able to identify areas of
potential weakness or concern and
begin planning strengthening strategies.
Within this communication, the need to
refer or communicate with an allied
health professional or clients existing
expert or GP can also be established.
Communication with an allied health
professional can continue throughout
training, sharing assessments and
progressions to be
able to work together to implement the
most efficient and safe program for the
client.
Performance and fitness appraisals:
Relevant tests and appraisal strategies
are outlined in the Certificate 3 Manual
in the fitness appraisal unit.
These tests allow us to see the client’s
body in motion and performance and
when static observing both the physical
and physiological responses. These
tests allow the trainer to identify existing
weakness and limiting factors that may
present as potential risks for injury, so
strategies can be implemented and
exercises can be modified and used to
realign and
strengthen the client’s body and
systems.
Posture and injury prevention:
One of the key tests when assessing a
client’s anatomical structure is the
postural analysis, which is used to
identify any misalignments that may
exist from past injury, or lifestyle factors
that can influence posture.
One of the things trainers are looking
out for when assessing posture is if
there is any muscle imbalance that
could affect the client’s equilibrium
when functioning and performing
exercises.
227
Muscle Imbalance:
Muscle imbalance can occur from both
physical stress through activity, injury or
sedentary lifestyles, occurring around
the joints where excessive load or strain
can influence the body’s structure.
If a muscle imbalance is present then
there is dysfunction in the body, where
a includes stretching and fascial release
muscle or group may be weaker than
the other, because the body is all
connected if one muscle is not doing its
job properly then this can have profound
effects on the rest of the bodies
movement and functional abilities.
Causes of muscle imbalance:
● Postural adaptations in response to
mechanical changes which can alter the
perceived centre of gravity.
● Responses to painful stimuli, where
the pain can upset motor control and
the body will go into protection mode,
avoiding the painful area
● Response to physical demands,
where the body may feel fatigue and
substitute
patterns or inhibition due to muscle
overload
● A lack of varied movement, leading to
muscle overuse
Correcting muscle imbalances:
To correct muscular imbalance, you will
need to include the following into
programs.
● Include proprioception training to
correct sensory motor feedback of the
bodies
positioning.
● Include a good warm up which
of tension or
holding due to trauma or pain
● Re-educate muscle activation for
correct movement patterns, preventing
any
overactivation, or muscle substitution.
● Depending on the complexity of the
imbalance, referring clients, and liaising
with a neurokinetic Therapist could be a
positive strategy to change these habits.
● Quality vs Quantity. Always
encourage quality movement over
quantity, if the client is performing an
exercise with incorrect technique, due to
possible fatiguing then encourage them
to stop before an injury or imbalance
can occur.
● Stretching or strengthening?
Injury can be avoided by releasing tight
muscles, or strengthening weaker
muscles. If untreated then both can lead
to muscular imbalances and potential
injury.
Working with the body unified network,
it is often best to use both techniques,
as a tight muscle may be causing
another muscle to over activate and
weaken another.
Once the muscle is released then
strengthening of the weaker inactive
muscle would need to
occur.
228
Depending on the degree of imbalance
an allied health professional or
● Good warm up and cool down:
manipulation expert may need to be
● Training steps to prevent injuries:
liaised with. Using techniques such as
massage, cupping and acupuncture
- Ensure the client has a good
may assist in the release of muscles
understanding of the exercise and start
that may be holding due to past injury
them off performing the movement
traumas.
slowly with control before progressing
the speed or load.
A neurokinetic therapist could also be
worth liaising with to assist the
- Use the FIIT principle to assess and
neuromuscular patterning, before as a
adapt the training sessions
trainer you can work to maintain these
techniques and use exercises to
- Monitor the and report the client’s
retrain and strengthen the muscle(s)
performance and ability, noting both
involved.
strengths and weaknesses to action any
changes needed
By promoting good muscle balance and
posture, the client’s ability to produce
- Ensure the client is using proper
force and respond to shock, moving
technique and movement mechanics for
with efficiency and full ROM will
each exercise
increase their performance abilities and
prevention of injury.
- Educate the client and provide
resources about good recovery and rest
techniques

- Encourage clients to stay focused on

the task and movement, often clients
can get caught up in conversation and
stop paying attention to what they need
to do. As mentioned throughout this
course, peak performance is not just
about the muscular ability, the mind is
always needed to correct the
movements and respond to the
demand.

229
Referrals: Collaborate with allied
health professionals
Referrals and collaborations:
Referrals are the process where a client
is sent from one practitioner to another
within the healthcare and fitness
industry to better service and respond to
the clients specific needs.
Depending on the nature of the situation
this could be for treatment or diagnosis
or perhaps reaching out to someone
within the same field as you with higher
knowledge or experience in a particular
area of interest.
As personal trainers we should respect
our own qualifications, our knowledge,
and duty of care to our clients, therefore
respecting those in their chosen fields
collaborating and referring clients when
the need is there.
Assessing risks and identifying the
need to refer:
● Your client may need diagnosis or
clearance from a medical practitioner
before commencing with a training
program. These details can be gathered
within the initial health screening of the
client
● Your client’s needs maybe outside the
scope of practice of your personal
training qualification
● Your client may need counselling or
mental health attention beyond your
level of skill or area of service
● Your client may disclose personal
information outside your area of skill or
service
Communicating the need to refer:
Because some client’s needs can be
sensitive you will need to harness good
and professional communication skills
to address the need to refer or seek
external advice or guidance with
another health care professional.
To effectively communicate with your
client here are some points to consider:
● Think before you speak and consider
your tones
● Choose an appropriate time and place
● Keep it simple and to the point
● Use appropriate language
● Make sure the client understands and
seek clearance through additional
feedback
Arranging a referral:
Referrals should be made professionally
via letters or emails so they can be held
on record, phone calls can also be
made but notes should always be taken.
Including the following points within a
letter referral should be considered:
● Your personal (professional) contact
details
● Contact details of the practitioner of
whom you are referring to
● The date of the referral
● The reason of the referral
● The relevant health history gathered
within the health screening
● Details regarding the condition for
which you are referring to as
communicated by the client
● Your approach and applications taken
so far
● Any other relevant information worth
noting
230

Information given should be factual
rather than subjective or opinionated
and should be known by the client
before given elsewhere.
The client must agree with the
information being given and give
consent to be disclosed and client and
trainer confidentiality maintained.
Allied health professionals and
practitioners that you may refer to or
collaborate with:
● General practitioner/doctor
● Physiotherapist
● Osteotherapist
● Professional counselor or
psychologist
● Social or health workers
● Mental health units or hospitals
● Psychiatrists
● Law officers
● Dieticians
● Nutritionists
● Other complementary health services
Roles of Allied health professionals and
Personal trainer:
Do Not Do
- Refer client to allied health
professional
- Obtain guidelines from clients allied
health care professional
-Follow guidelines for exercise
prescription and medical conditions
Diagnose
(some are covered in the special
medical
population unit of certificate three)
conditions
- Identify potential risk factors
associated with medical condition
through health screening and risk
assessment procedures
- Screen clients for exercise
intolerance
- Refer client to an allied health
professional for exercise prescription
Prescribe guidelines
treatment - Design individualized progressive
programs for specific longevity health
needs and performance goals
- Refer client to a general practitioner,
dietician or nutritionist expert
- Support client with healthy eating
and peak physique transformation
Prescribe
comp prep goals
diets
- Provide client with resources or
information in regards to general
healthy eating and peak physique
body composition training goals
- Refer client to an allied health
professional for treatment of any
injury or disease
Provide
- Use exercises to assist clients health
treatment
and performance goals
for injuries
- Assist client to maintain and follow
or diseases
medical advice and guidance for
injury or disease from physical
therapist or physician
- Provide post rehabilitation services
Provide and exercise programming
rehabilitatio - Provide exercise prescription that
n services supports the advice and
for clients maintenance of rehabilitation
services
- Focus on physical performance
goals
Provide - Act as a coach and motivator for
counselling client
services for - Provide general information and
clients advice for mental health wellbeing 231
- Refer client to a qualified counsellor
or therapist if required
Understanding terminology used
within the health and fitness industry

Within the healthcare and fitness

industry medical terminology is used to
describe the human body and
functioning therefore it is important to
have a strong understanding and be
able to interpret common exercise
science and anatomical terminology
used.
This terminology will be needed within a
variety of health industry contexts within
referrals and collaborations such as ;

- Personal Training programming

language

- Client medical history and health

history records

- Potential medications being used

or prescribed to the client

- Medical conditions or diseases

- Health insurance

- Work cover

Referrals to Personal Trainers from

allied health professionals
It is common that an individual may be
referred from their allied health
practitioner to seek out a
professional personal training
program.
Examples of reasons for referrals are:
● Injury rehabilitation
● Guidance in competition prep
● Cardiovascular risks
● Weight risk
● Suffering or on the border of
diabetes diagnosis

232
Abbreviations commonly used by other health care professionals:

LX Lumbar spine

LM Lateral meniscus (knee)

Thx Thoracic Spine

PFJ Patellofemoral joint (knee)

Cx Cervical Spine

TCJ Talocrural joint (ankle)

# Trauma, damage or fracture site
STI Soft tissue injury
STJ Subtalar joint (ankle)
GHJ Glenohumeral joint (shoulder
complex)
OA Osteoarthritis

ACJ Acromioclavicular joint (shoulder

complex) RA Rheumatoid arthritis

ITB Iliotibial band (muscle)

SCJ Sternoclavicular joint (shoulder
complex)
TFL Tensor Fascia Latae (muscle)

RC Rotator cuff (Shoulder complex)

VMO Vastus medialis oblique (muscle)

SIJ Sacroiliac joint

SCM Sternocleidomastoid (muscle)

LBP Lower back pain

THR Total hip replacement

ACL Anterior cruciate ligament (knee)

PF Pelvic floor
PCL Posterior cruciate ligament
(knee)
TA Transverse abdominus

MM Medial meniscus (knee)

In these cases the trainer should keep regular notes on the clients results and performance to report back
to their allied health professional, checking in with progress and potential changes to the programs.
233
Occupational Health and Safety
Procedures
You need to be aware of the general
standards for occupational health and
safety (OHS) required within a fitness
industry context. This could be
addressed by implementing regulations
for clothing, first aid equipment, and
emergency exit procedures.
Occupational Workplace Health and
Safety (OHS) Standards
∙ The OHS standards should have
the intent to promote and operate
work in a secure and safe
environment, and aim to protect
and the health of people within that
workplace.
∙ It is the ability to identify potential
hazards and safely remove or
control those risks within the
workplace.
∙ To create a health and safe
working environment within the
fitness industry, trainers, and
employers should aim and promote
to secure the safety and health of
their clients and people
∙ they work with by reducing,
controlling or eliminating hazards.
∙ Each country and state will have
their own legislative laws to abide
by when considering their
workplace laws and codes of
conduct within the fitness industry,
and it is important that you
∙ become familiar with the laws in
not only your place of business,
but also your region and country.
∙ By enforcing Workplace Safety
laws and regulations you
contribute to the safety and
prevention of injury or death of
yourself, other employees and
clients accessing the area. By
minimizing risks, the workplace is
also improving their operations and
productivity by reducing
absenteeism from workplace
related accidents.
How to Implement OHS Strategies
∙ Acknowledging your duty of care to
your client(s) employers,
colleagues and any other patrons
of the training environment.
∙ Consultation by means of
meetings with work colleagues to
discuss the safety of the workplace
and think of and implement ways
to resolve health and safety
issues.
∙ Fill out clear risk management
analyses to identify potential
hazards and continue to update
them depending on the situation,
environment and client you are
working with Ensure that all
injuries, fatalities, and near misses
are reported to prevent future
incidents
∙ Implement systems to regularly
review and evaluate health, safety
and welfare
234
Health and Safety Laws and
Legislations
As well as workplace safety procedures
and rules, trainers should also abide by
the laws and legislations implemented
and regulated by their local councils,
state, national and fitness industry
groups.
Hierarchy of OHS Laws
This hierarchy enables a clear view of
the people and organizations that we
would go to in the case of an
emergency or to decide upon the key
laws and regulations that should be
implemented within the workplace.
1. We begin with the fitness industry
standards and guidance notes
2. What are the industry, local or
state standards of health and safety
requirements?
3. What are the legislative codes of
conduct?
4. What are the laws and
regulations?
5. What are the national and
international acts?
Manual Handling Hazards
Personal Trainers are expected to
provide not only an instructional service
but also a more hands on approach and
so physical stress from repetitive
movements or tasks can often be
causes of injury.
It is therefore important to:
1. Learn correct and safe manual
handling techniques when lifting or
moving heavy equipment.
2. This technique, especially working
with heavy weight is important to be
able to pass on to clients as well when
independently choosing to train.
3. Physical stress injuries can occur
from not just working with heavy
equipment but also from repetitive
movement strain, or over exerting
oneself.
Prevention of manual handling and
physical stress injuries
1. Have a clear risk assessment
outlining and identifying potential risks
and how to control these arising
activities.
2. Conduct clear and regular
documentation of risk assessments and
consultations with other trainers and
employees.
3. Control risks by suggesting or
introducing mechanical lifting aids.
4. Reach out to another trained person
for support and spotting when planning
to handle heavy equipment.
5. Workplaces should encourage
training and educating regarding manual
handling specific to the fitness industry.
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Duty of Care
As personal trainers we take on a moral
duty of care to our clients to anticipate
and do all that is in our knowledge and
practicable power to prevent injury or
harm to them. As soon as a client
comes to you for a service then you can
then be held accountable for any action
taken within a session, or guidance and
advice exchanged.
It should be communicated with the
client that their safety should also be
their own and should therefore be
conscious of the decisions they make or
exercises they do during sessions,
communicating with you as a trainer if at
any time they feel any discomfort or
uncertainty of what is expected within
the session, so that you as a trainer can
adapt programs to suit.
Confidentiality and Privacy
Each organization will have a clear
policy outlining the confidentiality and
privacy relationship between the client
and trainer.
When we work with clients they are
entrusting you as a trainer with
potentially some vulnerable issues and
detailed personal information, and the
well-being of their bodies therefore it is
critical
that as a trainer there is confidentiality
and trust between you both.
The practice of confidentiality ensures
that personal information of the client is
not disclosed without the client’s
permission to anyone including to other
trainers/employees.
OH&S Records
When identifying hazards, or if an
incident occurs, appropriate reports
should be made and records kept.
Legislative requirements: Reports
that involve legislation will include
information needed to report hazards,
near misses and incidents. These
reports are contained within State levels
OH&S Acts and the Workers
Rehabilitation Compensation Act if work
cover is required from injuries sustained
by employees within the workplace.
Keeping records: To meet compliance
with OH&S standards workplaces must
keep a history of their records no matter
how small or serious the incident. A
small sprain one day could turn into
someone potentially suing years later
from that same injury not healing
properly, this is why reports should be
clearly written and detailed and every
action taken under the employee or
workplaces duty of care has been met
and outlined.
Records will also assist the workplace
to comply with updating and reviewing
safety standards.
Reviewing records also allows
organizations to identify areas where
improvements can be made and should
seek feedback from coworkers and
clients to provide a high quality of
service and safety. Policies and
procedures can then be implemented to
reduce and prevent risks occurring
or recurring.
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Records that should be kept by
organizations:
● Emergency procedures and
evacuation plans
● Fire equipment and maintenance
procedures
● Hazardous substances
● Safety audits, including hazardous
events and near misses
● First aid procedures, assessments,
treatment and equipment
● Work permits and licenses
● Hazard/risk assessments,
preventative and corrective action
● Job descriptions and responsibilities
● OH&S meetings and notes taken
● Workplace training offered and taken
● Workers compensation records
Working with Children
It is important that when working with
children you work within the laws and
legislations of your national child
protection laws. Under Australian
legislation a current Working with
Children’s check and Police check is
required before commencing any
training or work. Trainers should take
into consideration the different growth
development stage of their client and
their specific and individual health
needs to commence a fitness program.
Communication with Clients for OH
&S
The way you communicate with clients
is an important element to consider in
your OH & S
procedures. If we fail to communicate
effectively with our clients it can be
detrimental to the psychological and
emotional well-being, which can
become a risk factor contributing to
physical well-being.
Here’s some considerations when
communicating with your clients to
support OH&S standards:
● Be respectful to diversity and cultural
differences
● Be empathetic to the client’s needs
● Be motivational and supportive
● Respect the client’s rights, including
privacy and confidentiality policies
● Listen openly
● Accept the client’s freedom of choice
to express what they do and don’t like
and be adaptive to change
● Be professional, establish personal
boundaries between you and the client
with regards to client and trainer
expectations
Instructor Care and Maintenance
Group and personal training can be
demanding profession, which can
involve long work hours.
This can present challenges both at a
physical and mental level.
Common issues faced:
Physical Level:
● Repetitive muscular strain if
demonstrating movements over
extended periods, or if in constant
flexion (bending over to adjust clients in
certain techniques)
● Manual handling stress if lifting heavy
equipment, pushing or pulling
237
Mental Level:
● Listening and dealing with client’s
injuries, challenges, and problems
● Understanding and being empathetic
to injuries/issues the client maybe
facing each session
● Assessing when it is appropriate to
discuss emotional issues of the client
● Seeking professional assistance or
counseling for the client or personally if
required
● Dealing with varying personalities
● Taking client(s) problems and issues
on personally
Personal Safety
The working environment you work in
should feel safe always, and the
organization should take
precautions to ensure this safety via:
● Equality right and social inclusion
● Developing policies and procedures
that prevent and deal with violent
behavior
● Developing policies and procedures
that prevent social isolation and bullying
● Training in conflict management
● Training in how to manage violent
behavior
● Provision of appropriate counseling
services following traumatic incidents
Ways to Monitor Staff to Prevent OH
& S Issues
Your workplace should implement
strategies ensure personal safety
measures and standards are being met.
● Checking hazard and hazard reports
● Observation of staff and work
colleagues
● Encourage open feedback and
communication amongst staff and
employees
Dealing with Inadequacies of OH&S
Standards
If health and safety regulations are not
being adhered to then the appropriate
supervisor or manager needs to
communicate these inadequacies with the
person(s) responsible. Depending on the
situation communication can be expressed
both formally and informally.
Formal communication:
● Reports
● Notices
● Policies
● Further training can be offered
● Informal communication:
● Face to face verbal communication
● Verbal reports
Incident Report procedure:
When reporting an incident, here’s some
guidelines to consider:
1. The report should be clearly written and
able to be understood
2. Report the name(s) of people involved
including the position(s) of those involved.
● Witness(s)
● Supervisor in charge at the incident
● Victim(s)
3. Date and time of the incident
4. Exact location of the incident
5. The task/activity being undertaken
and the time of the incident
6. Description of the incident
7. Nature of injury sustained
8. Clear description or image of the body
area affected
9. Description of first or medical
treatment and actions taken
10. Were expert services, such as
ambulance called?
11. Did the victim have to be transported
12. Was the supervisor contacted?
13. Possible causes of the incident
14. Actions taken to prevent any
reoccurring incident
15. Is further investigation required for
this incident
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First Aid
It should be noted that requirements to
gain a first aid and CPR qualification will
not be sufficient within this unit, only the
basic understanding to prevent and
manage potential injuries
within a fitness and programming
context will be outlined.
An external course will be required to be
undertaken to complete the
requirements of a First aid CPR
certificate.
First aid procedures will be specific to
sports training and fitness industry
common situations
and injuries.
First Aid Management in Physical
Training Workplace
There are many facets to effective
management of first aid in your
workplace as a fitness professional.
Here’s some key foundational areas:
1. Assess and Manage Immediate
Hazards
∙ To avoid a potential incident, it is
important to perform regular risk
assessments and action on high
rating hazards as per the Risk
management unit in this course.
∙ Regular training should be offered
to employees to identify and
manage potential incidents that
could happen within your place of
work.
2. First Aid Kit
Within the workplace to avoid or
manage risks and potential incidents of
injury it is important to
always have fully stocked and usable
first aid kit readily available.
∙ The location of the workplace first
aid kit should be available and
known to all trainers and staff
members
∙ As well as first aid certification
training, a workplace training of
injury prevention strategies and
emergency induction training
should be implemented.
∙ An emergency plan should be
available with relevant contacts
and locations of hospitals or
medical practitioners if needed
within the area.
∙ Reporting of incidents is
mandatory and records should be
kept and readily available.
3. Incident / Emergency plan
Emergency procedures will differ
depending on the situation, however a
basic plan can be followed.
∙ Know your specific responsibilities
within an emergency
∙ How can you keep yourself and
others safe
∙ Where the emergency exits
∙ Where is the emergency
evacuation point
∙ Where is the relevant emergency
equipment. E. g., First aid kit, fire
extinguisher
∙ Know how to use the emergency
equipment if needed
First Aider Emergency Response
Guidelines for an Unconscious
Person
These guidelines are from the
Australian Resuscitation council in
response to an unconscious person.
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Potential Causes of
Unconsciousness and How to
Prevent Those
Unconsciousness can occur to a person
in a number of ways, so it is important
that as trainers we are monitoring
clients during training to avoid this and
referring back to pre-health
assessments and recommendations of
allied health practitioners.
Some ways in which someone could fall
unconscious are:
1. A decrease in oxygen to the brain
2. Heart and circulatory problems,
(fainting, abnormal heart rhythms,
high/low blood pressure). Within the
client health screening and fitness
appraisals, are they susceptible to rapid
changes within heart rate or blood
pressure, do they need to wear a heart
rate monitor for observation and
prevention of risks.
3. Metabolic problems, (low blood sugar
levels, intoxication). So check in with
your clients about their nutrition and diet
prior to training.
4. Brain problems (from head trauma,
stroke). Has your client been in an
accident, or has something happened
within the session where a head injury
may have occurred.
It is important to recognize that all of
these causes do have the potential to
occur within a fitness training session,
and so should be included within a
workplace risk management plan for
monitoring and a fast response.
Responding to an Emergency
Incident
If you are a witness to an emergency
incident and you choose to go and
assist, then it is important to understand
that an automatic duty of care is then
assumed between you and that person,
and so you can be liable if negligence
occurs.
When responding to an emergency
situation the acronym DRSABCD is
used to assist navigate your steps to
approach the incident.
Let’s dive deeper into what DRSABCD
means:
1. Danger
In this first step before approaching the
patient you should first assess if there is
any potential danger to yourself, then to
any bystanders, and finally to the
patient. Potential dangers could be any
chemicals, aggressive people in the
area, etc. If the danger was too high for
you to go in and assist the patient the
emergency services should be called.
You should check 360 degrees around
the area and patient for potential
danger.
Guidelines when approaching a
patient:
∙ Be sure to put on gloves to avoid
potential cross infection if it is safe
to approach the patient.
∙ Never stand over the patient, as
this could inflict fear if they are
conscious and an automatic
defense reaction which could be
harmful to yourself.
∙ Approach the patient from their
head.
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2. Response
If it is safe to approach the person then
you should then be checking for any
conscious responses.
When approaching the patient use the
acronym COWS to assist:
● “Can you hear me”
● “ Open your eyes”
● “ What’s your name”
● “ Squeeze my hands”
When performing this last one take hold
of both hands when asking as
sometimes if the patient has had a
stroke they may not have functioning in
one side of their body.
3. Send for Help
If there is no response from the patient
then emergency assistance should be
sent for. If you were on your own you
would make the phone call or ask a
bystander to do this, informing them of
the “ 4 P’s.”
∙ Position: What is your location?
∙ People: How many casualties?
∙ Problem: What’s happened?
∙ Progress: What have you done so
far? Keep emergency services on
the line so they can assist and you
can talk through your actions
4. Airways
If the patient has given no response then
the next step is to check their airways.
● They should be placed in a recovery
position.
● You should then open their mouth if
possible with a pistol grip and check for
any blockages to their airways, including
their tongue, if a blockage is found, such
as vomit, then use the patient's hand to
clean out the blockage to avoid any cross
infection. (you should already have gloves
on).
● The airways should then be rechecked
by Looking and feeling for any signs of
breathing, including a rise and fall of the
chest or any breath expelled to your ear as
you listen.
Contraindications of checking airways
● If there is a suspected spinal injury,
you/first aider should take on the “ life
over limb” rule, if the patient is not
breathing and unresponsive then there is a
patient assumed permission to save their
life takes priority.
● Cross infection is also a risk so it is
important to use and have access to
gloves or as mentioned use the patient’s
own hand to remove any blockages
5. Breathing
The airways should then be rechecked and
the patient should be observed to see if
they’re breathing.
● Use a pistol grip again to open the
mouth and tilt the head back slightly to
open the airway.
● Then by Looking at and feeling for any
signs of breathing, including a rise and fall
of the chest or any breath expelled to your
ear as you listen.
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6. Cardiopulmonary Resuscitation
(CPR)
If no signs of life (breathing, verbal or
physical response) can be detected
then CPR should be
commenced.
● Turn the patient carefully back to their
back and commence ARC CPR
recommendations of 30 compressions,
if you are trained in giving recovery
breaths then the compressions should
be followed by two recovery breaths if
signs of life don’t change.
● Continue this ratio of 30:2 until signs
of life return, emergency services arrive
and take over, or if you can physically
no longer continue.
Compression guidelines
● Chest compressions should be
provided at a rate of approximately 100
– 120 /min with minimal to no
interruptions
● The compressions should be made at
the sternum in the centre of the chest.
● The depth of compressions should be
5 cm/2 inches for an adult.
Compression depth for a child is at least
⅓ the depth of the chest size, or 5 cm
for a child and 4 cm for an infant.
Contraindications of performing CPR
There can sometimes be a risk of
breaking ribs if compressions are
performed for a long duration or with a
lot of force. Again there is a “life over
limb” rule.
7. Defibrillator / Automated External
Defibrillator (AED)
Here’s some considerations in the event
you need to use a defibrillator.
● The defibrillator should be used in
conjunction with the compressions and
operated if the patient is unresponsive
and not breathing.
● The defibrillator has been designed
and made to be accessible and
understandable for even someone
without training to be able to operate.
● The role of the AED is to scan for
abnormal heart rhythms and send a
shock through the body to assist in
returning the heart back to a normal
rhythm, increasing the chances of
survival of patients suffering from
cardiac arrest.
● The AED won’t send a shock if the
patient isn’t experiencing a cardiac
arrest.
Operating the AED
● The AED is an automated device that
if possible all gym should have access
to in case of emergency.
● After switching the device on, it will
then give verbal step by step prompts.
● Provided are two electrode pads
which should be placed on clean dry
skin of the chest. If the patient has too
much hair a shaver should be used to
remove the hair, any sweat should also
be wiped down.
● One electrode pad should be placed
slightly below the collarbone on the
person’s right chest and one pad on the
person’s left side below the armpit. This
placement can change if the patient is
an infant, or if the patient has large
breasts the pad can be placed further
lateral to the left to avoid excess breast
tissue.
● The AED will then prompt for
compressions to stop and all person’s to
step away from the patient so a shock
can be administered.
● Once the shock has finished, the pads
should stay on the patient and
compressions should resume until the
AED will prompt another scan and
shock.
242
Post CPR and Emergency Response
It is common that after experiencing a
traumatic event both the patient or the first
aider can experience shock.
Shock symptoms include:
● Dizziness/fainting
● Pale clammy skin
● Rapid breathing and increase in heart rate
● Nausea
● Changes in mental state and increase in
anxiousness
● Inability to make conscious decisions
Treatment of Shock
In the event that the first aider goes into
shock they should be encouraged to stop
and will also need treatment mentioned
above. It is common that after traumatic
events shock can occur later and so those
involved in the event should be referred to
an allied health professional specializing in
counseling and psychology as well as be
monitored by a medical practitioner.
3 key considerations to treating someone in
shock:
1. Rest and reassure the patient
2. Encourage them to lie down with legs
elevated (only if injuries are not aggravated)
to help lower their heart rate and regulate
breathing
3. Keep person warm and comfortable
Administration After an Emergency
Response
It is important to keep accurate records and
have appropriate follow up procedures
following an emergency event.
Following an emergency response:
1. Refer to workplace policies and
procedures in regards to making reports and
the storing of this sensitive information
2. Respect to the patient’s privacy and family
should be made
3. Refer to workplace policies and
procedures that can provide counseling if
needed
Injuries and How to Perform
Immediate First Aid
As a fitness professional; if an incident
occurs under our supervision immediate
first aid response measures should be
taken.
The most common injuries can happen
in sport and exercise are soft tissue
injuries.
Soft tissue refers to the muscles,
tendons, ligaments, fascia, nerves,
fibrous tissues, fat, blood vessels, and
synovial membranes.
Common Immediate Treatment for
Acute Tissue Injuries
For most acute injuries the simplest
form of immediate treatment is to use
the acronym RICER:
1. Rest
2. Ice
3. Elevation
4. Referral
Another useful first aid procedure
acronym is NO HARM:
1. No Heat
2. No Alcohol
3. No Running
4. No Massage
All of these will increase the blood flow
to the injured area resulting in an
increase to the natural inflammation
process to restrict the area from being
used.

243
Common Injury Types and Treatment
Considerations

Injury Potential causes SIgns/symptoms Treatment

Bruise Direct force from contact with a Swelling, Ice, if bleeding
hard surface discolouration clean the area
and cover
Muscle Occurs when the joint is stretched Swelling, loss of RICER
Sprain or forced past its normal range of power or ability to bear
motion, resulting in overstretching weight, possible
or a tear to the ligament that discolouration and
supports the joint bruising and/or
sudden onset of pain.
Muscle Occurs when the muscle/ligament Pain, swelling, RICER
Strain is overstretched or contracted too possible
quickly, resulting a tear of the discolouration/bruisin
muscle/tendon fibers g, loss of
movement/mobility to
the area
Overuse This can occur by continuing to Pain, swelling, Rest, exercise
Injury train if an acute injury has restricted mobility prescription of
occurred and not having sufficient flexibility or
rest. They can also result from strengthening
compensatory
patterns

244
First Aid Treatment: How to Write an
Incident Report
An incident report is important to ensure
clear communication of an event that
requires first aid.
1. It should be known that an incident
report is legal binding information, and
should be filled out honestly, in detail.
2. The information should remain
confidential and be stored safely by the
workplace. When writing an incident
report the following information should
be documented:

1. Patient's full name

2. Description of Injury

3. Description of incident

4. Treatment/measures taken

5. Emergency services involved

6. Actions taken to prevent injury or incident including

risk management protocol and procedures already in
place

7. Location

8. Person(s) involved including first aider’s, patients

and witnesses including occupation titles and who is in
charge at the time

9. Contact details of the person filling out the report for

future or immediate contact

10. Signatures of those involved and making the report

245
 Section 7:
Exercise Programming & Principles

246
Progressive overload
Training programs should follow the
principles of progressive overload.
When prescribing, progressing or
regressing exercise, we can use the
FITTE principle.
FITTE Principal
What’s it used for?
The trainer should observe and record
changes in training and either change
the frequency, intensity, type of
exercise, the time or duration and add in
specific styles of training that allow the
client to enjoy and connect with the
movements they’re doing.
These five variables offer you as a
trainer a guide to adjust as client’s
performance improves to assist the
client to progress.
If the client is having difficulty with the
program set then these principles can
be adjusted to regress what has been
set.
Using the Progressive overload method
helps to prevent risk of overtraining for
clients, or alternatively if the client
reaches a steady state and training
benefits and returns are diminished
the program should then be progressed
to introduce further challenge for
training adaptations and health gains.
1. Frequency:
∙ It is recommended to engage in
movement as much as possible
and to avoid sedentary behaviors.
According to Powers & Howley,
(2001) to achieve weight loss goals
and prevent NCD risks, one should
engage in physical activity (PA) 3-
4 days per week.
∙ When planning and instructing fitness
programs, the frequency of PA should
also take into account the extra
training or active behaviors clients
may have outside of their session with
you as trainer to avoid risk of injury
from programs of high intensities and
frequency of training.
2. Intensity:
∙ Depending on the desired
performance outcomes of the client(s)
and the existing fitness level, intensity
should vary depending on the
individual.
∙ If the client is untrained and learning a
new skill then the intensity of the
exercise should be low, as the
individual becomes more comfortable
with the exercise/ training then the
intensity can be altered and
increased.
∙ Describing the load of the
cardiovascular system, Powers &
Howley, (2001) state that training
between 50-85% V02 max will
produce training adaptations when
coupled with the right duration and
frequency.
∙ Training intensity should consider the
training goal of energy expenditure for
that session and the duration.
∙ Intensity can be progressed or
regressed by adjusting the following.
Consideration of the overall intention
and training type however should be
taken into account, as well as the
specific needs and fitness level of the
client.
∙ Intensity can be adjusted by changing
the repetitions, tempo, rest intervals
and load of the exercise.
247
Methods of assessing intensity
∙ Talk Test/Borg RPE: The test
looks the ability to be able to have
a conversation whilst training and
how it alters depending on the
level of intensity.
∙ Low intensity exercise:
Individuals are able to have a
conversation.
∙ Submaximal intensity: The client
has difficulty holding a
conversation.
∙ Vigorous intensity: The client will
“huff and puff” and be unable to
have a conversation.
o Vo2 Max test for cardio vascular
training assessments
o 1 RM Test for strength and
resistance assessments
Repetitions:
∙ This is the number of times an
exercise is repeated. A full
repetition will generally move
through the key muscle actions of
eccentric, concentric, and
isometric phases to reach full
range of motion and one repetition.
∙ Training at specific repetitions can
improve muscular adaptations and
therefore a different repetition max
should be used depending on the
type of exercise and training
performance goals.
∙ Trainers should be aware that
different variables as well as type
of exercise will influence the
number of repetitions being able to
be achieved, including the load,
muscle fatigue and intensity of the
exercise.
∙ Generally a higher repetition
program should be included when
beginning and learning new
exercises as it enable the muscles,
and connective tissue and brain to
learn new patterns of movement
developing muscular endurance
and the body’s ability to maintain
and control movements over a
period of time.
∙ Repetitions should be adjusted via
progressive overload respectively
to the training intensity to prevent
the risk of overtraining.
Sets:
∙ Sets are when repetitions are
grouped for specific adaptation
goals.
∙ The number of sets should
consider the training intensity, the
load, training goals and number of
repetitions being performed. If the
client is performing many
repetitions at a low intensity then
generally the number of sets is
reduced, e. g., Muscular
endurance training, if training goal
is to improve muscular strength
and power then the number of
repetitions would generally be
lower but with multiple sets at a
high intensity or load.
248
Tempo:
∙ The tempo is the rate of how the
exercise should be performed.
Depending on the intention of the
exercise and the level of
experience the client may have in
performing the given exercise the
tempo will differ.
∙ If the client is learning a new
movement/exercise then the
tempo of performance should be
slow so that the movement can be
corrected and the client can learn
correct technique and feeling to
understand how it should be done.
∙ As the client becomes more
familiar with the exercise tempo
can be something that can be
increased depending on the
performance outcomes.
∙ If the performance outcomes were
for maximal strength or
hypertrophy a high tempo may not
be advised, as you would first be
looking to change the resistance,
reps or sets.
∙ If the performance outcome was
more for speed then this is when
tempo can be increased.
3. Type of exercise/session:
∙ When considering what exercises
to choose and the sessions to be
done, it should be focused upon
the optimal selections for the
physical adaptation.
∙ Variables and considerations of
exercise type and session
planning: There are certain
variables that should be
considered in this component:
∙ The type of exercise(s) chosen will
depend on the performance
outcomes and goals of the client(s)
and their long/short program
design
∙ Performance outcomes;
Cardiovascular fitness, Peak
physique training, Strength
training, Hypertrophy training,
Flexibility, Endurance, Power.
∙ The individual preferences to
training and what they enjoy to do
∙ Is the exercise selection and
session suitable for the
progressions of the client(s)
∙ Is it appropriate to the client’s age,
anatomical and physiological,
fitness level and specific needs
∙ Is it safe and comply with the
workplace and industry standards
and risk management plan
∙ Is it suitable to the training
environment being utilized
∙ Is it suitable to the client’s training
lifestyle/what other training are
they doing? Competitions times
etc.
4. Time/Duration:
∙ The time and duration of the
workouts will depend on the
intensity and type of workout.
∙ For clients who are overweight,
programs that are longer in
duration working at more of a
moderate intensity and adding high
intensity bouts can be beneficial to
their goals of weight loss.
Workouts that are high impact
could potentially add risk to their
bones which are not as strong and
developed as someone who has
been active for longer and carrying
less body fat.
249
5. Enjoyment:
∙ Training sessions should include
exercises that complement the
client’s lifestyle and compliment
the movements they enjoy as well
as focus on physique
transformations.
∙ Exercises should still be specific to
the clients’ needs and are often
good to include towards the end of
a session.
∙ In the case of strength training
some examples could be to cross
train with strength training in the
form of rock climbing to continue
the strength transformation and
development of the client.
∙ Games can also be a good way to
bring more enjoyment to workouts.
∙ These adaptations to sessions can
help to boost the client’s motivation
to training and also open their eyes
to accessibility of movement and
potential gains outside of their
planned workouts and routine.
Training for Adaptation:
Using progressive overload and the
FITTE methods to assist the planning of
programs we can then assess how to
prescribe the exercises to clients
depending on their fitness testing
results and performance.
We can adjust exercises to suit the
needs of the client and adaptation
outcomes in the following ways:
Regressions:
Regressions refer to taking a “step
back,” if the exercise is too complex, or
if the client cannot safely perform the
movement correctly then the exercise
should be altered.
The regression exercise should remain
as close to the original exercise
prescribed to continue to train the
desired muscular groups and
movement. If training remains too
complex then the client could be at risk
of injury and overtraining.
Exercises can be regressed by
adjusting any of the FITTE methods.
E. g., Changing the intensity
● Changing the load
● Breaking down the skill or using
isolation
Progressions:
This is the opposite to regression, in this
training change we are taking a “step
forward,” like a graduation of the
movement we can adjust it to make the
exercise more complex. Progressions
are important for clients to be able to
continually grow and develop with their
training. If the training stays the same
the client will reach a steady state
where no change or adaptation can be
observed. To achieve progress and to
continually evolve and learn the body
needs to be challenged.
Again the FITTE principle can be used
to change, and continually requesting
client feedback into
their changing goals and training
experience.
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Variation:
There are many approaches and
executions of exercises that will train
the same area, however it is important
to understand that no matter what the
client’s fitness level or ability is there is
always a variation to that exercise. This
is especially important when conducting
group training.
When planning exercise programs there
should always be a regression option
and progression option for clients to
choose from depending on their level.
This ensures inclusion throughout
training and allows the client to stay
motivated knowing that there are always
options for them to stay active in all
situations.
SAID Principle
This principle refers to the ‘Specific
Adaptation to Imposed Demands’.
Introducing a person to a new
environment and new activity, their
bodies will need to adapt to the
requirements of the
exercise to improve performance in
skills and general fitness.
The adaptation process depends on:
∙ The stimulus magnitude: Type of
exercise, equipment used
(type/load)
∙ Accommodation: When the
individual reaches a plateau or
becomes comfortable with the
stimulus
∙ Specificity: Are the requirements
of the stimulus complementary to
the physical requirements/needs of
the individual.
∙ Individualization: Whether in a
group training session or personal
training exercises and training
programs should be designed to
cater to the physical and
anatomical needs of the client(s)
involved.
∙ Training Load/Overload:
Determine the load to be used
dependent on initial health
screening. Load can be defined by
the Intensity (%RM) Frequency,
Duration, or Volume load of the
exercise. To measure this change
and training prescription strategy
we can use the principle of
progressive overload.
∙ Diminishing returns: This
principle refers to how we train and
adapt to the demands of exercise
and training. When we first start a
new program we experience a
greater change in the body, doing
weight training we see a rapid gain
of muscle hypertrophy. The more
we train though the more our
bodies and muscles adapt and
even at higher volumes and
intensity the gains will be less than
those gained when we first start a
new program.
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 Section 8:
Physical Training

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8.1 Types of equipment and use
1. Kettlebells:
Kettlebells are a traditional Russian
training tool that has been used for over
100 years to develop total body
conditioning & functional strength.
A Kettlebell derives its name, as it
basically resembles a cast iron kettle
without a spout. It can also be described
as a cannonball with a handle
(Tsatsouline, 2001).
There are two distinct types of
Kettlebells:
∙ Competition pro grade kettlebells
designed specifically for the
competition Girevoy and are
uniformly sized and shaped to be
able to lift repeatedly over a course
of time, with only the weight
changing.
∙ The traditional kettlebell will
change in shape as the weight
changes, the lightest weight will be
smaller than a heavier weight.
Kettlebell use:
Kettlebells are mostly adopted by those
looking for an all rounded workout,
embraced in such
sports as Mixed Martial Arts, NBA, NFL,
Cycling, etc due to its ability to
strengthen the cardiovascular system,
muscles & joints as a complete &
unified system.
How this is important for physique
transformations:
Because Kettlebells offer a great
workout to strengthen the body both
functionally and for optimal physique,
they can offer a fun and sport specific
option to strength and conditioning
programs aimed at building muscle
mass, and fine tuning the body's
movement patterns for
functional fitness.
Kettlebell use and safety
considerations:
The following points must be taken into
account before handling Kettlebells for the
first time:
- Never engage in strenuous exercise
before Kettlebell lifting, ensure you are
mentally
alert & physically prepared to avoid injury.
- Always train somewhere you will be able
to safely drop the Kettlebell if you get in
trouble and are too fatigued to continue
the exercise.
- If you become too fatigued to safely and
securely hold the Kettlebell/s in your
grip…STOP!
- Ensure hands and Kettlebells are dry
& free from oiliness to avoid dropping.
- Always wear proper flat training shoes or
train barefoot if confident enough using
the
Kettlebell. Typical running shoes have an
elevated heel; limiting correct Kettlebell
form, which requires loading weight into
the heels.
- When using ballistic Kettlebell moves,
always train in an open space free of
others walking near you.
- Use proper breathing to pressurize your
abdomen whenever using Kettlebells
(refer to exercise skills section).
- Build up to heavier weights gradually, do
not overload too fast. Earn your passage
to
increase load.
- Always pay attention to your form. Stop
lifting whenever your form deteriorates.
This is when most injuries occur in all
sports. You should always strive for form
perfection.
- Avoid pain. Pain not only causes
inhibition in the nervous system and
weakens any
muscle crossing the weight-bearing joint,
but it also immediately results in
production of compensatory movement
patterns. This in-turn leads to poor
postural alignment. If you feel
253
pain…STOP and seek professional
advice!
Essential Kettlebell Holding
Positions:
During the majority of Kettlebell
exercises the bell can be caught at two
major holding positions. At these
positions the Kettlebell is stabilised then
redirected to continue the exercise.
These holding positions are vital to
master Kettlebell training.
The Rack Position:
Important Points:
Here are the elements for a proper rack
position:
- Stand with legs shoulder width apart or
slightly wider.
- Hip is pushed to the side underneath
the weight.
- The glutes, quads & core complex are
flexed.
- The belly of the Kettlebell rests on the
‘V’ formed by the biceps and forearm.
- The shoulder is pressed down.
- The bicep, upper arm & elbow rest
against the torso.
- The Kettlebell handle rests on the
base of your palm & should follow a
diagonal line from your thumb.
- Wrist is perfectly flat, should be an
extension of the forearm.
- Eyes forward, head in a neutral
position facing straight ahead.
Whilst in the rack position walk around
for 1 min, swap arms & repeat. This will
teach you to relax in the rack position.
Overhead Lockout Position:
Important Points:
- Ensure you have perfected the rack
position as previously mentioned.
- Stand with legs shoulder width apart or
slightly wider.
- The glutes, quads & core complex are
flexed.
- Knees & elbow supporting the
Kettlebell should be locked out, to
create a stable base
to support the bell.
- The shoulder should be sitting in its
socket, with the shoulder blade (of the
supporting
arm) pulled down by contracting the lat.
- The bicep of the supporting arm
should be kissing/beside the ear.
Whilst in the overhead lockout position
walk around for 30 seconds, swap arms
& repeat. This
will teach you to relax in the rack
position.
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Key differences between Kettlebells
& Dumbbells:
Kettlebells
The handle of the Kettlebell is distanced from
the weight giving it a displaced centre of mass.
Unique design allows for unique ‘circular
motion’ movements like swings & juggling.
Kettlebells require the body’s muscles & joints
to work as a single unit to perform many of the
exercises effectively.
Ballistic Kettlebell exercises are free flowing
causing the body to produce, resist & redirect
force.
Kettlebells allow for a range of fitness qualities
to be satisfied with as little as one exercise.
Recruit the deep stabilising muscles of the
abdominals, shoulders, hips, back, etc more
effectively.
More ideally suited for strength endurance
training requiring higher repetitions.
Improves resistance to injury due to diverse
planes of movement used whilst training.
Training requires mental focus to avoid injury,
but also makes it more enjoyable due to mental
stimulation.
2. Machine weights:
- Machines are great to build awareness
and control in lifting technique
- Great as a starting weight training tool
for beginners, special populations,
clients
recovering from injuries and elderly
programs
- Offer opportunities for clients to learn
and isolate specific target muscles,
which is great to use when building
strength in specific weak areas if
imbalances are present, or improve
muscular definition and size for a
specific muscle when peak physique
conditioning
- Machine weights are easy to progress
and monitor performance
Dumbbells
Balanced centre of mass, meaning less
nervous system & stabilising
musculature recruitment.
More ideally suited to maximal strength
& hypertrophy development. Less
diverse applications for complete fitness
development.
Easier to progress load as dumbbells
generally have smaller weight
increments.
Lower skill required to train effectively at
a beginner level.
Can sometimes be seen as monotonous
due to the repetitive nature of exercises.
Safety considerations:
- Machines need regular maintenance
and safety checks following
manufacturer
guidelines and workplace equipment
maintenance guidelines
- Variation in muscle group training
should be considered to avoid repetitive
movements and the risk of overuse
injuries
- Trainers should encourage correct
technique and client mind and body
focus to avoid incorrect form or cheats
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3. Dumbbells/Free weights:
- Dumbbells encourage the client to move
through a range of movement planes and
range of motion allowing more variation to
movement possibility then machine weights
- They come in a range of sizes and can be
progressed or regressed by small amounts
and adjustment to the loads
- They require more core stability then
machine weights, as the client is unable to
use the machine for assistance, and need to
stabilize and control the movement with their
body alone.
- Dumbbells generally will use multiple
muscle groups and so strengthen the body
for multifunctional use
- Dumbbells are generally easily accessible
to and cheap to purchase
Safety considerations:
- Movement can be more free using
dumbbells which can pose for potential injury
risk if the muscle is stretched beyond point of
control
- Trainers should take note of technique
and correct execution to avoid injury
8.2 Types of training
1.Cardiovascular fitness training:
Training for cardiovascular fitness exercises
the key muscles and muscle groups and
in particular the muscle of the heart. All
training essentially will exercise the heart,
and regular movement will assist in the
strengthening of the heart muscle. By
strengthening the heart we can then
improve its functioning and reduce the
risks of developing cardiovascular
diseases as we age.
Cardiovascular Exercise
Walking
Running
Cycling
Fitness testing:
Generally exercises that relate to “cardio”
fitness will refer to HR so initial screening tests
will be based around the resting, max and VO2
max HR results to identify the most optimal
training area to work from.
How often should we include cardio fitness
for body composition changes:
As mentioned in the activity guidelines adults
should be accumulating at least 150 minutes of
moderate fitness activity 5 days or more a
week. At this frequency cardiac fitness benefits
will be able to be observed, however for any
weight loss and body composition goals the
intensity
will need to be increased to more a vigorous
state accumulating at least 75 minutes 3 days
per week.
Cardiovascular fitness for Peak Physique
and training:
∙ Cardiovascular training can prove to be
ideal for body composition goals and
weight loss when training for peak
physique competitions and goals.
∙ They can assist to add variation to the
workouts. On rest days for strength
training then clients can be encouraged to
do more cardio training to continue to
exercise their heart and achieve health
goals.
∙ Cardio training can also be good to include
in part of the warm up process to help the
efficiency of oxygenating the blood, and
warming up the muscles.
Some examples of cardio (cardiovascular)
exercise can include:
Progression
Stair or hill climbing
Increase distance or intensity into a sprint
Add in hills, change location, increase tempo
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2. Core training and stability
What is Core Strength?
Despite many misconceptions to the
contrary “Your core is not just your
“abs”. Anatomically your core is made
up of the deep abdominal muscles,
including multifidus, it wraps around to
the back including your erector spinae,
pelvic floor muscles, muscles of the
diaphragm to assist the breath and
glutes. Your core is then everything
that is not your arms and legs and is
designed to connect your limbs, so they
can work together more effectively.
Core Strength Principles:
These principles should serve as the
foundation for your training, or what I
call movement practice. Without solid
principles upon which to build, the
exercises lose impact.
● Principle 1:
Your core initiates whole body
connection. Your core strength is
defined by the level at which you can
synergistically co-ordinate the parts of
your body to harmoniously work
together.
The key parts that often determine core
strength are the shoulders, hips, spine,
even feet and
their ability to work together with your
torso and energy system, including your
mind to regulate
the connection and intensity.
● Principle 2: Core strength will be
limited to the weakest link in the chain.
Any weak link can end up being your
downfall when it comes to core strength.
Like a strong chain, high levels of core
strength rely on connection, not strong
individual links. You might have strong
abs, but if you’ve got weak scapulae
(shoulder blades), poor breathing
habits, etc., say goodbye to deep levels
of core strength. With your core at the
center of everything you do, it is
interrelated with everything that
surrounds it. The way you move your
big toe, breathe and even think can
have dramatic effects on your core
strength in a particular position. These
subtleties will separate the strong and
the super strong when it comes to core
strength.
● Principal 3: Core strength comes
from the inside out, not the outside in.
Many people love six pack abs, and
sure they may look great, but they are
not a defining factor of your overall core
strength. Indeed, it’s possible to have
great abs and a strong core, but they’re
not really related when it comes to
martial arts. Core strength is all about
mindful movement, not aesthetics.
Mindful movement involves everything
from the way you position yourself to
the way you breathe. When training for
peak physique competitions the
aesthetic six pack is important and will
demonstrate strength, but for longevity
of movement the six pack should be the
result of a quality movement practice
and living a disciplined lifestyle.
Developing this internal strength as well
as gaining the abdominal definition will
benefit the client in all aspects of their
training and body control during
movement.
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Role of the core:
The predominant role of the core
muscles is to assist in stabilization of
the spine and postural support.
Maintaining good core strength should
be a goal for everyone as it will assist in
the conditioning for all sports. Core
training has become popular for people
suffering from back pain, as it helps to
strengthen the muscles which support
the back. If the core is weak then the
back muscles must work harder to
compensate for this loss so can become
strained.
Control and Stability:
Can the client control and stabilize their
structure, muscles, and joints when
performing a movement. Before
prescribing any additional weight
resistance the client should be able to
support their own bodies structure with
non-weight bearing exercises first. Core
stability is vital for building foundational
strength and progressing in sports
performance and peak physique goals.
It assists in the execution of exercises
and reducing the risk of injury.
Core Strength Patterns:
∙ Compression: Compression is
probably the most commonly used
method when training the
abdominal section of the core
these days. A basic example of
compression is involved in the
classic crunch / sit up. Sadly this
commonly used method can
promote bad habits of sitting
patterns by flexing the spine and
shortening the abdominals, if
overused it can lead to injuries and
poor performance in your practice,
∙ Extension: This is the opposite of
compression. Extension essentially
involves the spinal muscles
contracting and the abdominal
muscles relaxing. Imagine the bridge
or back bend and you get a visual of
what extension looks like. Extension
doesn't often get associated with
being a 'core' exercise, because it's
not just about abs, but remember your
core is far more than your abs.
∙ Twisting: Twisting is one of the most
essential patterns and involves
generating rotation around the spine.
Developing strength through the
twisting pattern improves the way your
hips, spine and shoulders work
together. Think powerful, punches,
kicks, and throws
∙ Bracing: Bracing is training your core
to contract like a brick wall and is the
opposite to twisting. Bracing
effectively involves resisting rotation of
the spine whilst an opposing external
force is challenging you to twist.
Effective bracing makes your core like
a bridge, connecting your hips,
shoulders and spine together in one
line. The objective of bracing is to
engage the core musculature and
keep the hips and shoulders inline
without moving. An example of
bracing is used in the traditional push-
up. To perform this movement, you
must brace your core while bending
your arms. If you do this well, your
hips and shoulders will remain in a
line during the movement.
∙ Breathing: How and when you
breathe dramatically affects your core
strength in any given moment.
Breathing well is a worthwhile practice
in your pursuits to a stronger core.
During the movements outlined focus
on breathing deeply into your belly
button.
258
Core Strength exercise examples:

Exercise V sit
Begin seated, lifting from the pelvic floor to have a tall
Start Position posture. Lift one leg to a 90 degree angle, then the other
leg, and extend the arms from the shoulder joint.
Inhale and pulse the arms, whilst maintaining a tall posture
Exercise Description and leg position, continue to hold the position and exhale.
Perform for 15 seconds, and repeat for 3-5 sets.
Movement Focus Abdominals
Movement Goals Abdominal strength and torso control
● Use back extensors to lengthen the spine and torso
Cueing
● Maintain leg position
Spine rounding or dropping
Common errors
Bracing abdominals instead of full breaths

Regressions:
Single leg lifts, and planks to build core and abdominal
strength and support
Variations: Roll downs Progressions:
Modifications/ Change arm position to a “T” position outstretched wide.
Progression s Extend legs straight,
Extend legs wide
Hold dumbbells to add resistance to the torso.
Roll ups

259
Further Stability examples:

Exercise Plank/Prone hover

Start Position Start in a pushup position, shoulders in line with wrists and
a neutral spine.
Exercise Description Hold the isometric position for a duration of approximately 1
minute and build the duration time the stronger the client
gets.
Movement Focus Abdominals
Movement Goals Abdominal strength, torso stabilisation, shoulder stability
Cueing ● Avoid letting the pelvis sink or lift too high
● Create one long line from the tailbone to the tip of the
head
● Eye gaze between the hands
Common errors Pelvis dropping or lifting
Bracing the abdominals instead of full breaths
Flexing the neck to look to the feet which causes a
rounding of the spine
Variations: Regressions:
Modifications/ Can be done on forearms if the client experiences
Progression s weakness in their wrists
Decrease time Progressions:
Side Plank Variations
Add instability and plank on swiss ball or bosu ball will feet
up Add weight belt
Increase time to perform in. Hill climbers in plank

260
Further Stability examples:
Exercise Single leg standing
Begin in a tall standing position, maintaining pelvis
Start Position
alignment lift one leg
Exercise Description Hold the leg lift, or adjust the height of the leg or location
Movement Focus Abdominals, glutes
Movement Goals Abdominal strength, leg strength, ankle stability
● Use back extensors to lengthen the spine and torso
Cueing
● Maintain leg position
Spine rounding or dropping
Common errors
Bracing abdominals instead of full breaths
Regressions:
Single leg lifts, and planks to build core and abdominal
strength and support
Variations:
Progressions:
Modifications/Progres
Change arm position to a “T” position outstretched wide.
sions
Extend legs straight,
Extend legs wide
Hold dumbbells to add resistance to the torso.
Exercise Hanging leg raise
Begin taking hold of a bar with a wide overhand grip slightly
Start Position
wider than shoulder width
Exercise Description Raise your knees towards the chest, and hang.
Movement Focus Abdominals, Tensor Fascia Latae
Movement Goals Abdominal strength, decompression of wrists
● Keep the shoulders and neck muscles relaxed
Cueing
● Continue to breathe
Bracing abdominals or neck muscles Elevating the
Common errors
shoulders towards the ears
Regressions: Supine leg lifts (single) Supine leg lifts
(double) hanging
Progressions:
Variations: Extend knees for straight legs
Modifications/Progres Raise and lower legs whilst holding hang position Pull up
sions with leg raise.
Add in twists by bringing the knees or legs across the body
to
target obliques more.

261

3. Strength training
Choosing exercises and how to train the
individual for strength gains and peak
physique:
Types of Exercises:
● Total body (auxiliary) workouts
● Large muscle groups to small muscle
groups
● Compound/ Multi joint to single joint
● Push exercises to pull exercises
∙ Total body (auxiliary) workout
This type of workout offers a more
functional training approach to unite the
body through motion. A selection that
can be beneficial for general fitness,
functional performance and Olympic
weightlifting. Total body workouts often
require more skill so a usually
prescribed to individuals at the end of a
session after their muscles have been
prepared and the movements have
been perfected, they are also
prescribed to individuals with more
experience.
Exercise example:
Exercise Front Squat
Position the feet slightly wider than
hip width and slightly on an angle.
Pick up barbell from rack or ground
Start bending from the knees and
Position grasping with an overhand open
grip, slightly wider than shoulder
width. Place the bar in front of
shoulders with the elbows lifted.
Take a breath and lower the
tailbone, bending from the knees,
keeping the heels down and
travelling over the toes to a range
Exercise
where the upper legs and calves
Descriptio
are in almost a 90 degree angle, (or
n
as far as your range can take you.
Take a breath to hold and then
exhale and push through the feet to
lift back to standing
Hip flexion and extension, knee
Movement extension, ankle plantar flexion,
Focus back extension, shoulder flexion
and scapular elevation
Improving leg strength.
Agonists: Quadricep muscle, soleus
Stabilizer: Hamstrings
Movement Postural stability, ankle and hip
Goals flexibility
Stabilizers: Erector spinae, rectus
abdominus, obliques,
gastrocnemius, glutes
Stay strong through the core to
maintain stability through the back,
avoid slouching and keep the head
Cueing
lifted. Keep lowering the tail bone
and avoid pushing the butt out.
Keep feet flat on the ground
Common Slouching through the back Lifting
errors up the heels, place a
Regression: Squat without
Variations: resistance Progression: Increase
Modificatio resistance
ns/Progres SLow the movement down on the
sions descent and increase the dempo
back to standing
262

∙ Large muscle groups to small
muscle groups:
This type of training can be good to
isolate key muscle groups the individual
is looking to strengthen or improve. In
terms of resistance training it is a
popular choice for muscle hypertrophy,
maximal strength goals and peak
physique in bodybuilding. You can do
this in the same session or split the
workout training large muscle groups
one day and small another.
Generally you would train large muscle
groups before training the smaller
groups, as you need
the small group to assist and stabilize
when exercising larger muscle groups.
When the larger muscle groups fatigue
you can still optimally train the smaller
muscle groups
Exercise example:
Exercise Barbell Bench press
Start Begin in a supine position on a bench
Position with a neutral spine, with an overhand
wide grip of the bar slightly wider than
shoulder width. Fett should be flat on
the ground, if the feet cannot reach
the ground then the us of a step or
elevated surface to place the feet is
recommended.
Exercise Breath in to prepare the body and then
Description lift the barbell from the chest straight
up to lock the elbows, before exhaling
and returning the barbell about 4-6cm
above the chest as recommended by
Haupt, (2001) to minimize injury risks.
This counts as one rep the spotter
should assist to lift the weight back to
the rack.
Movement Shoulder flexion
Focus
Movement Antagonist: Developing strength
Goals through the chest musculature in the
sternal head of the pectoralis major.
Synergists: Clavicular head of the pec
major Anterior deltoid
Triceps Brachii
Dynamic Stabilizer: Biceps brachii
short head
Cueing ● Retract the shoulder blades
● Use the breath to assist the
movement, inhaling on the push
and exhaling on the descent.
● Keep the elbows at 45 degrees
● Keep the eye gaze looking
straight up to avoid unnecessary
tension through the neck
Common ● Inability to reach full ROM
errors ● Lifting of the feet and back
● Tensing through the neck
● Pulsing or bouncing of the barbell
off the chest
(often these errors occur if the 263
weight is too heavy)
∙ Small muscle group exercise
example
Complementing the bench press
exercise, we will now work to develop
one of the major smaller muscles which
assist in the pec major through
transverse flexion. The triceps brachii
was a major synergist and so
developing this muscle assists to
develop the overall strength in the
muscle group network, it helps to avoid
injury and reduces the risk of over
training to the larger muscle of the
pectoralis major by equaling the
strength gains for further optimal
movement performance and muscular
physique.
Exercise Tricep extension
Start Begin in a seated position by holding
Position the dumbbells overhead, with the
elbows locked, a neutral spine and
eye gaze straight ahead.
Exercise From the starting position, bend the
Description elbows so the weight lowers down the
back, flex the wrists at the bottom to
avoid the weight touching the back,
and then extend the elbows to lift the
weight back to the starting position
Movement Elbow flexion and extension
Focus
Movement Agonist/prime mover is the triceps
Goals brachii
Stabilizers: This time pec major works
to stabilize the movement with the
anterior deltoid and wrist flexors
Cueing ● Inhale to prepare at the top
before exhaling to lower.
● Keep the elbows in
● Keep feet flat and firm on the
ground
Common ● Lifting of the feet
errors ● Pelvis tilting forward and arching
of the spine if hips are tight. ( use
a back support if needed, release
through the hips before
commencing, sit slightly forward).
Variations: Regressions: Tricep dips, decrease
Modificatio weight Progression: Increase load,
ns/Progres decline tricep extension
sions
264

● Multi joint (compound) to single
joint (isolated):
Multi joint exercises should generally be
done by clients who are familiar with the
exercise, as they can often be complex
in skill. Kraemer, and Ratamess, (2004)
found that multidimensional exercises
can produce great force gains and are
often recommended for hypertrophy and
power training goals. Due to the high
skill level and fatiguing factors that
occur when performing multi-
dimensional exercises, single joint
exercises should be prescribed after as
they’re less fatiguing so can be done
longer, they also assist to develop the
overall strength of the particular group
being exercised.
Compound/Multi-dimensional
exercise example:
Exercise Shoulder press BB
Start Either begin seated, grasping the barbell
Position with hands slightly wider than shoulder
width to lift from the rack.
Standing option 1: Begin with feet slightly
more than shoulder width apart and bend at
the knees to squat and lift the bar from the
ground to the shoulders.
Standing option 2: Begin under the rack to
lift the barbell off and onto the shoulders,
walk forward away from the rack to begin
the exercise. Knees, hips and shoulders
should be in line.
Exercise With your head and chest lifted, eye gaze
Description straight ahead, keeping the knees slightly
bent and a wide stance (if standing) inhale
to prepare then exhale to press the bar
straight up with wrists inline with the
shoulders. Hold and then inhale to return to
bring the bar to chest height.
Movement Upward phase:
Focus Shoulder abduction, Scapular outward
rotation and elevation, elbow extension
Downward phase:
Shoulder adduction, scapula inward rotation
and depression, elbow flexion
Movement Agonist/Prime mover: Anterior and medial
Goals Deltoid Antagonist/Synergists: Middle
Trapezius, levator Scapula, triceps brachii
Cueing ● Stabilize through the core muscles to
support the spine
● Push the bar to full ROM and slowly
control down
Common Back arching or pelvic anterior tilt (Mostly
errors due to weakness in core muscles)
No reaching full ROM from elbow joint
Shoulders lifting to the ears
Variations: Regressions: Seated press, reduce load
Modificatio Progression: Increase load, power clean
ns/Progres Can be performed with dumbbells or cable
sions
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Exercise Bent over row BB
Start Position Begin with knees slightly bent and hinge forward with the hips to a mid way point,
almost parallel to the floor with a neutral spine. Pick up the barbell with a wide
overhand grip
Exercise Maintaining a neutral spine, exhale and pull the bar up towards the waist by
Description bending the elbows without adjusting the hip flexion position. At the top position
hold for a moment bring the shoulder blades together. Return the barbell by
extending the arms.
Movement Focus Back strengthening.
Exhale to engage through core stabilisers to support the back. Shoulder joint
extension. Scapula retraction and downward rotation.
Movement Goals Agonist/Prime mover: Back muscles- middle and lower trapezius, rhomboids,
latissimus dorsi, teres major, posterior deltoid and the infraspinatus and teres
minor
Antagonist:Rectus abdominus, obliques
Cueing ● Maintain a neutral spine
● Head lifted
Common errors - Moving the back or hunching
- Placing strain on the neck by looking back
Variations: - Can be done with an underhand grip as well.
Modifications/ - Progress to single arm row
Progressions - Progress/regress by adjusting weight, reps, sets

Isolation/Single joint exercise example:

Exercise Bicep curl (with barbell)

Start Position Begin standing erect with feet shoulder width apart and knees slightly bent.
Holding the barbell with an underhand supinated grip.
Exercise Starting with elbows extended, flex the elbows and lift the bar. Hold and then lower
Description the arms back to elbow extension.
Movement Focus Upward phase: Elbow flexion Downward phase: Elbow extension

Movement Goals Agonist: Biceps brachii, Synergist: Biceps brachialis, Biceps brachioradialis
Stabilizers: Anterior deltoid, upper and middle trapezius, levator scapula, wrist
flexors

Cueing ● Control the movement

● Breathe to support the spine and posture
● Reach full extension when returning to the start for full ROM
Common errors Swinging momentum driven from the lower back to assist the movement, often
done if the weight is too heavy.
Clenching of the jaw, often again done if the weight is too heavy or the client is not
breathing through the movement.

Variations: Regression: Decrease the resistance Progression: Increase the resistance

Modifications/ ● Alternate arms and use dumbbells 266
Progressions ● Underhand Chin Ups (bodyweight, or with a weighted belt)
Exercise Lateral raise/Fly (DB)
Start Position Standing position with knees and elbows slightly bent grasping dumbbells with an
overhand grip
Exercise Exhale to abduct and lift the dumbbells away from the body up to shoulder height,
Description with shoulder to wrist alignment. Hold then return dumbbells back to the bodies
sides.
Movement Focus Agonist: Lateral Deltoid
Antagonist: Deltoid, Anterior, Supraspinatus, Trapezius, Middle, Trapezius, Lower,
Serratus Anterior, Inferior Digitations
Movement Goals Upward phase: Lateral abduction Downward phase: Adduction

Cueing ● Maintain good posture

● Support the spine activating through core muscles pelvic floor
Common errors Avoid swinging of the torso Neck protraction
Lifting weights too high/Don’t go past shoulder height
Variations: ● Can be done sitting
Modifications/ ● Front/Lateral raise
Progressions ● Adjust weight, reps, sets

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● Upper body/ lower body split
workouts:
Training by splitting the major muscles
group of the upper and lower body
enable adequate rest and performance
gains for muscle groups, when training
one group, the other can rest and
vice versa. In terms of total body gains,
Schoenfeld, (2016) states that when
training was compared between split
and total body workouts, total body
workouts showed greater strength gains
in both the upper and lower extremities.
However athletes who are looking for
bodybuilding and hypertrophy gains
found that if they had time, performing
double workouts, (Two workouts in the
same day splitting the groups per
session) they were able to train at a
greater volume and frequency and
could see a greater increase in muscle
cross sectional area.
Exercise Latissimus Dorsi Pull Down (Lat
Pull Down)
Start Position Begin seated with an upright posture,
locking the knees under the pads.
With an underhand wide grip
(approximately shoulder width) take
hold of the cable bar.
Exercise Pull the bar down to the chest in front
Description of the head (to avoid excessive head
protraction) and inline with the nipples.
Retract the shoulder blades, then
control the cable back releasing the
biceps to full elbow extension to finish
the repetition.
Movement Downward phase:
Focus Shoulder extension, scapula retraction
and depression, elbow flexion Upward
phase:
Shoulder flexion, scapula protraction
and elevation, elbow extension
Movement Downward phase:
Goals Agonist: Latissimus Dorsi
Synergist:Posterior Deltoid, Biceps
brachii, middle and lower Trapezius,
Rhomboids
Dynamic stabilisers: Triceps long head
Upward phase:
Agonist Latissimus dorsi
Synergist: Posterior Deltoid,
Trapezius, Rhomboids, Biceps brachii
Cueing ● Relax the head and neck
● Pull the shoulder blades down on
the descent
● Keep the chest proud and eye
gaze straight ahead.
Common ● Performing the exercise behind
errors the neck
● Pulling the bar too far down
(mostly happens if the weight is
too heavy)
Variations: ● Changing the grip to overhand or
Modifications/ adjusting the width
Progression s ● Perform standing with a split
stance
● Perform using a TRX
● Decrease or increase the 268
resistance
Lower body exercise example:

Exercise Straight leg Deadlift (barbell)

Start Position Begin with the barbell on the floor and squat deep, lowering the tailbone and
keeping the chest lifted.
Grasp the barbell in a mixed grip position (with one hand supinated and the
other pronated) slightly wider than shoulder width, just outside the knees.
Breathe to support the spine and stand up.
Exercise From the standing position, hinge from the hips, keeping the legs straight
Description reaching the barbell towards the feet.
Keeping the bar as close to the body as possible extend from the waist and
hips back to standing.
Movement Focus Upward phase:
Hip extension, knee extension, ankle plantar flexion Downward phase:
Hip flexion, knee flexion, ankle dorsi flexion

Movement Goals Agonist: Hamstrings

Synergist: Gluteus maximus, erector spinae, adductor magnus Stabilisers:
Trapezius muscles, Rhomboids, lat dorsi, levator scapula Antagonist
stabiliser: Rectus abdominus, obliques
Cueing ● Hinge forward from the hips
● Keep the bar close to the body
● Eye gaze should follow the bar
● Maintain connection with abdominals to avoid arching through the spine
● Keep the arms and knees straight
Common errors ● Arching the lower spine (can be due to a weak core, tightness through
the hips or hamstrings)
Variations: ● Adjust the load
Modifications/Prog ● Adjust stance
ressions Regression: Hip hinge exercises (body weight) Progression: Sumo deadlift,
Romanian deadlift

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● Push/pull exercises:
Similar to the split programs that you
can do when changing between upper
body and lower body exercises, we can
do this with push and pull workouts.
Focusing on exercises like the Leg
Press, and the seated row..
Push exercise example:

Exercise Seated Leg press (machine)

Start Position Begin in an upright seated position and place feet in the centre of the platform
(medium stance) at a hip width distance and toes facing straight up.
Exercise Inhale and press or push the platform away from the body, but keeping the knees
Description slightly bent. Then exhale and slowly lower the bar back towards you, keeping a
slight resistance (not taking the weight all the way down).
Movement Upward phase: Knee extension, hip extension Downward phase (return) Knee
Focus flexion and hip flexion
Movement Agonist: Quadriceps
Goals Antagonist/Synergist Gluteus maximus, adductor magnus Dynamic Stabilisers:
hamstrings, gastrocnemius :
Cueing ● Push through the forefoot and heel
● Relax the arms by your side
● Keep feet planted on the platform
● Watch that the knees don’t fall in or out to the side
● Maintain tall posture and avoid hunching
Common ● Feet moving or heels lifting
errors ● Knees collapsing
Variations: Variations: Adjust foot placement Regression: Body resistance squats
Modifications Regressions/progressions: Adjust the resistance/load
/Progression
s

270
● Pull exercise example:

Exercise Seated row (cable)

Start Position Sitting slightly forward place your feet on the platform and take hold of the cable.
Move the hips back and keep the knees slightly bent.
Exercise Keep the elbow joint at a 90 degree angle to the wrist and shoulder and pull the
Description cable towards your waist.Pull the shoulder blades together and open the chest.
Slowly return the cable back to extend and outstretch the arms. Repeat,
Movement Pull phase: Elbow flexion, back extension
Focus
Return phase: Elbow extension, back flexion
Movement Agonist: This is a big compound exercise so there are multiple muscles in the
Goals back that contribute to the execution including, lat dorsi, and rhomboids
Antagonist muscles: Erector Spinae, Trapezius muscles,Posterior deltoid, pec
major, brachialis, brachioradialis
Dynamic stabilisers:
Biceps brachii, triceps long head Stabilisers: Rectus abdominus, obliques
Cueing ● Pull shoulder blades together

Common ● Too much weight and then moving into excessive back extension
errors
● Shoulder elevation to ears, and rounding of the back
Variations: Variations: Adjust grip (wide, overhand, underhand) Dumbbell or barbell row
Modifications
Regression/progression: Adjust the load
/Progression
s

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Types of Strength Training Programs
1. Maximal Strength
To be able to produce and develop
muscular strength we’re looking to train
the body from
neuromuscular level to be able to
internally strengthen not just the
muscles but the bones,
joints and tissues so that they can
create tension to withstand external
forces and be able to
exert force of their own.
∙ We again would uses principles of
progressive overload to adjust the
training intensity and type of
training for optimal and specific
adaptations.
∙ It is important to observe that the
body will develop strength in all
planes of motion and
so training should look to challenge
the body within these planes.
2. Muscular endurance:
Once control of the movement is
established, the muscle can be
trained to exert force over a longer
duration by increasing the number of
repetitions or duration of time.
∙ Muscular endurance is important
for all programs as it enables the
body to develop core strength and
joint stabilization through
movements overtime.
∙ It can also be an efficient way to
reduce body fat percentage for
body composition goals, and train
the muscles slow twitch fibers.
∙ Muscular endurance training will
assist you to continue training and
competing for peak physique goals
for longer.
More information can be found in the
Endurance training unit.
3. Power/speed-strength:
∙ Power and speed of an individual
can be determined by how quickly
their muscles can respond to a
stimulus.
∙ The speed of force will be
determined by the number of fast
twitch fibers and the sensory
response of the muscle to react
and perform the movement.
∙ Muscular power training will build
on the foundations of training
gained through stabilization and
maximal strength training to be
able to produce maximal force and
maintain the ability to correct
posture and stabilize the joints
preventing overexertion.
∙ Generally powerlifting is performed
a lot faster than hypertrophy or
muscular strength training so
would be done with a lower load
but with more repetitions.
∙ These exercises can be quite
complex in execution so should
only be performed once the
foundations of strength and
conditioning techniques have been
clearly explained and then
performed by the client.
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 Progressive weight training and grip types:
When choosing exercises and adjusting
programs another consideration to change is
how the client is gripping the weight being used.
By adjusting the grip, the client will be able to
achieve slight changes in their muscular
alignment to perform the exercise change the
dominant muscle groups being activated or
enable them to perform more repetitions or lift
heavier loads.
Here is a list of grip types and some examples of
how they can be utilized in a workout design.

Grip Type Application Exercise example

Overhand The overhand grip refers to the palm of the hand facing down with the fingers ● Lat pull down
coming over the bar and thumb underneath. Predominantly working the wrist ● Chin up
extensors in this grip. ● Reverse curls
Underhan The opposite to the overhand grip. The palms are facing up gripping the bar or ● Bicep curls
d grip dumbbell with fingers underneath and thumbs on top. ● Reverse grip chin
Predominantly working wrist flexors and used when performing bicep dominant ups
exercises
Hammer This when the palms of the nads are facing inward to one another. ● Chin up
grip Predominantly working the wrist extensors again. ● Dumbbell bench
This grip cannot be achieved using a barbell so weights with a dumbbell are press
chosen ● Dumbbell Tricep
extension
Wide grip When using a barbell the hands grip slightly wider than shoulder width. This ● Bench press
grip allows the muscular focus to change doing the same movement. For ● Chin up
example in a bench press by widening the grip there is an increase in pectoral ● Lat pull down
activation. ● Bicep curls
Closed In comparison with a wide grip the hands are closer together placed slightly Can be used in the
grip inward of the shoulder width. Similar to the wide grip the intention is to bring a same way as above
slightly changed muscular focus when performing the same exercise. Using
the same example with the bench press, by closing the grip the client would
experience less chest and pec involvement and an increase in tricep activation

Alternate This is when one hand is in an overhand position and the other is in an ● Deadlift
grip underhand position. ● Chin up
This is more commonly used if one side is stronger than the other allowing the
client to lift a heavier weight.
Preferably you would want to form equilibrium with the body and develop the
weaker side so it can lift the same.
Hook grip This grip is predominantly use in more olympic lifting, placing the hands around ● Snatch
the bar with the thumb secured under the fingers. Placing more pressure on ● Clean and jerk
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the thumb but securing the load and bar more strongly.
Resistance training programs:
When focusing our intention on types of
strength outlined in this unit, (Stabilization,
Hypertrophy, muscular endurance, muscular
power), there are training programs that we
can
integrate to work the key variables that make
up that training type and best assist the client
to
achieving those intended performance
outcomes.
The following can help build a framework in
your program design:
1. Single Set program:
As the name describes, this program will
have the client performing one set of
each exercise prescribed in a training
session. When a client is still a novice in
strength training this single set system
can be a good way to introduce them to a
variety of resistance exercises. This type
of training is generally used for more
maximal strength and hypertrophy gains.
Benefits:
o The client is more inclined to work at
their maximal capacity/ %1RM to lift
heavier if they’re only doing one set.
o Time efficiency, if there is minimal time
to train then this program can still
achieve positive strength results in less
time
o With only one set being performed the
client has the opportunity to learn and
correct the movement, allowing for
more neural adaptations as well as
control and stabilization of the
movement.
o Less inclined to push past their limits, if
untrained, reducing the risk of
overtraining
Considerations:
It can be argued that with a reduction in
training volume the strength adaptations
may not be as much as a multiple set
program
2. Multiple Set:
In comparison to the single set
program, this training option
increases the volume of training to
perform exercise repetitions over
multiple sets.
Benefits:
o Increase in volume of training
places the body under more
tension to achieve more anabolic
effects for hypertrophy outcomes
o Can be adapted to train for
muscular endurance as well as
hypertrophy strength gains
Considerations:
Due to the workload and energy
involved for this extra volume, the
trainer would need to address the
performance goals, the existing
fitness level of the client to
progressively increase and adapt the
training variables. (Frequency,
intensity, tempo).
3. Pyramid
This type of program can be adapted
to progress or regress the load or
number of repetitions being
performed in each set. Depending
on the intention of the workout
repetitions can be higher or lower.
As the client is warming up they can
begin with a low load over 10-12
repetitions, then increase the load as
they move back down starting from
10-12 repetitions to 1-2 repetitions.
The pyramid system can work from
a high to low load as well, as long as
the client’s body has been warmed
up enough to be able to start with a
high load and high repetitions.
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Benefits:
o This program can be adapted to
suit a number of training types by
adjusting the intensity and volume.
o A great way to build muscle and
endurance over time.
Considerations:
o The pyramid system should be
based upon their fitness testing
%RM results, being considerate to
not go past a level or load the
client cannot control.
o If the client cannot continue with
good technique and control then
the load or number of repetitions is
too high and the intensity should
be lowered.
o Appropriate rest intervals should
be included with a pyramid system.
4. Super Set
This program can be done in a few
different ways.
o Training the same muscle groups
with two or more different
exercises. E.g. Bench press
followed by push-ups. This way of
training can be used to increase
muscular endurance and
hypertrophy strength gains by
training the same muscle groups to
their maximal capacity. It’s also a
good way to motivate the client
using different exercises to
achieve the same result.
o Another way this type of training
can be used is to train the
agonist/prime mover in one set
and then the agonist in the next
set.
E. g., Bicep curls followed by tricep
extensions
o This can also be used training
push/pull exercises performing a
set of a push exercise like Bench
press followed a seated row.
Considerations:
o Trainers should look out for
compensatory patterns and weak
links in performing movements.
o Muscular fatigue and overtraining
should also be considered.
o Potential compensatory patterns can
also occur if the muscular groups
being targeted are getting fatigued.
5. Drop Set
This type of training is popular amongst
experienced bodybuilders, requiring them
to perform a
set to failure, when they reach that point
the load is reduced so they can push
another set out. It should only be done for
2-3 sets to avoid risks of overtraining and
placing too much stress on the body.
Considerations:
o Clients are not advised to push past
the point of controlling good
technique.
o A trainer/spotter must be present.
o It should be performed by
experienced lifters only.
o Progressively adjust the load
according to fitness testing results
and performance appraisals
6. Circuit training
∙ This type of workout is great for group
style training and individuals who are
looking to improve body composition
and muscular endurance in a short
amount of time. Performing multiple
repetitions of an exercise in a short
amount of time, before moving on to
another exercise.
∙ Generally low sets are involved with
moderate to high repetitions and
minimal rest periods getting as much
done in the time frame given.
∙ One of the most popular circuit style
training programs is the rise in cross
training.
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7. Split body workouts
This workout involves splitting the body
up into parts to isolate select muscle
groups to train on
a particular day. A favorite workout style
among body builders to enable them to
train harder
over more days whilst still allowing their
muscular groups to recover sufficiently
on the off
training days.
This type of workout is discussed in
more depth in the body building unit
of this course
manual.
8. Vertical Loading
∙ This type of workout is a good one
to use in a circuit style of training,
performing repetitions prescribed
from the top of the body, and then
moving down the body. Exercises
can be prescribed to include a total
body workout, then back and
shoulders, finishing at the lower
body and legs.
∙ Once repetitions have been
completed per body part, then
another set can be completed,
continue with the loading until the
duration of the workout is complete.
∙ Adopting a split body style, this
method can also be popular for
bodybuilders to build muscle
as well as muscular endurance
depending on the amount of rest in
between sets. Allowing
body parts to have a rest as the
client loads down the body, when
they reach back to the
starting total body or upper body
workout this area would have
received a sufficient amount of rest
to replenish ATP-PC stores.
9. Horizontal Loading
∙ This type of workout requires the
client to complete the total amount of
repetition and sets of a muscular
group before moving on to complete
the total amount of repetitions and
sets for another muscular group.
∙ The workout can be adapted to suit
the training type of power, or
strength by manipulating the rest
periods and exercise loads.
10. Training for females
∙ It was once believed that females
should be trained differently to
males, that certain sports
could not be played by females, and it
was not until the 1970’s that females
were accepted into the world of
bodybuilding and physique
competitions.
∙ These days when programming, we
can train both males and females
together. Like all programs, the
individual’s genetic makeup, current
health, current physical activity
Participation, and body composition,
all need to be considered and whether
male or female,
exercises should be specific to the
needs and goals of that person.
∙ Keeping in mind these
considerations, the training level will
be different for all individuals and
unconditioned athlete will always see
a greater and adaptation to training
than those who are more conditioned
and require different training
challenges.
∙ Genetics and athletic inheritance will
also play a role in training
adaptations for both females and
males, those who are born into an
existing athletic family will inherit
specific muscular fibers, and
behaviors that assist in their physical
capabilities.
276
Female Strength training:
∙ When comparing an untrained male
to an untrained female, research has
shown that men typically exhibit more
force and total strength than women,
especially in the upper body where
Morrow and Hosler, (1981) saw a
50% difference when comparing
absolute strength.
∙ Once training commences, research
from Wilmore, (1974) saw no
difference between genders in
building muscle. This research shows
that males and females can develop
strength simultaneously however, due
to the existing muscle mass males
naturally have, females will not be as
strong when compared on the same
programs.
Genetic makeup:
∙ Testosterone difference:
Testosterone is a naturally produced
hormone that is produced naturally in
the body, however this hormone is a
distinct difference in the male and
female bodies with males showing
amounts approximately 10 times higher
than females, Schoenfeld, (2016).
∙ Effects of testosterone in training:
Research looking at training and the
effects of testosterone on muscle
growth shows that the hormone is
highly anabolic, increasing the
myofibrillar protein synthesis and
increasing the release of human growth
hormone (GH) and Insulin-like growth
factor 1 (IGF-1) which when combined
with resistance training both have
shown a positive influence to muscular
growth. Schoenfeld, (2016).
This research explains the earlier
studies done mentioned above as to
why males will naturally have more
muscle mass than females, with this
hormone difference, making it easier
for males muscles to hypertrophy.
Menstruation and training:
∙ Another key difference in the male
body and the female body is
menstruation, although many
studies show that females can
continue training during this period,
it is important to recognize that
every female will respond
differently during their cycle and
that during this period they this
time can be more sensitive for
some females in both emotional
and physical capabilities.
∙ Open communication and
adaptability to training should be
adopted to cater to these needs.
∙ Some athletes have reported
irregularities with their menstrual
cycles, or amenorrhea which is
defined by Powers and Howley,
(2001) as less than four menses a
year, which in time can affect their
estrogen levels causing potential
deficiencies in bone mineral
density (BMD). It is unclear of
exactly what can cause
amenorrhea, but some studies
have linked it to excessive training
loads affecting the blood
concentrations of some hormones
or psychological stresses. If a
client is experiencing amenorrhea,
then they should be referred to a
general health practitioner.
∙ If a female client is experiencing
difficulties with PMS then training
loads should be reduced to avoid
the risk of amenorrhea.
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Body alignment:
∙ Knees:
o The alignment of females can
affect training, with females often
being more susceptible to knee
injuries than males. Hewitt, (2000)
explains that females knees can
be affected by their wider hips
placement, and hormones,
especially during their menstrual
cycle when relaxing levels can be
higher causing higher ligamentous
laxity and can decrease their
neuromuscular performance.
o Strength programs that focus on
knee stabilization and joint stability
can therefore be effective to
prevent the risk of knee injuries in
female athletes, and trainees.
o Coaching in correct movement
technique to absorb shock when
landing if programming any
jumping or running activities should
also be advised.
∙ Breasts:
o It’s unfortunate that female
anatomy has not evolved over time
to compensate for and support the
natural weights attached to a
female's chest, that is their
breasts.
o We know the effects to the body
when excess load is added to the
body, and if the body cannot
support this load then the body has
to learn to compensate for this
weight.
o In female cases this is often done
by the back, the arms and neck,
which can lead to tension in these
areas.
o Including exercises that strengthen
the back and core stabilization is
essential to help support females
in training.
o With respect to the female being
trained, proper bra support should
also be a recommendation.
∙ Pelvic floor:
Due to the wideness of the pelvis, in
some weight training like CrossFit
some female athletes demonstrate
incontinence due to pelvic floor
weakness, therefore there should be
emphasis in training programs on
education and strengthening of
these areas to prevent injury and
further issues.
278
4. Flexibility Training
∙ Flexibility enables joints to reach full
range of motion, if the connective
tissue loses elasticity then this can
affect muscular movement efficiency.
∙ To perform any exercise or lift with
correct technique requires the
achievement of full range of motion.
∙ Strength and flexibility should work
hand in hand, with strength gains
comes control and stability to avoid
over stretching, with improved
flexibility comes the ability to
efficiently complete strength exercises
in fluidity and without risk of injury and
a buildup of tension.
Stretching benefits:
∙ To stretch a muscle is to encourage
oxygen rich blood into that area.
∙ Stretching is not about being an
acrobat, it’s about functionality and
mobility.
o If you can’t reach to the highest shelf
of your cupboard then your tight
muscles are restricting you from a
daily activity.
o If you’re struggling to walk due to calf
or hip tightness, then this is restricting
you and could potentially lead to
compensation and learning a new
pattern that puts your natural
functioning at risk for injury.
∙ If you are injured from trauma
however, that area needs to recover
and stretching could potentially cause
more harm than good.
∙ Stretching enables the muscles and
connective tissue to rejuvenate
∙ Improves flexibility and mobility of the
joints.
∙ Relieves muscle tension
∙ Improves neuromuscular functionality
∙ Relieves joint stress
When should we stretch:
∙ Daily stretching of at least 30
minutes of static stretching twice a
week to improve flexibility, is
recommended by Powers and
Howley, (2001).
∙ The basic principle of listening to
your body, and doing what you
can, when you can should be
considered. Start to notice where
you feel tension and start here.
Inhale to prepare the muscle, and
relax the body then exhale to move
deeper into the stretch.
∙ When the muscles are tense, the
mind is then tense and you’re
more likely to feel stress and
fatigue. As soon as we start to
breathe and stretch this
oxygenation and lengthening can
relax and energize the body.
Warm Up/Prior to exercise:
∙ Active stretching or dynamic
stretching can be effective to
lengthen and warm up the body.
∙ The activity/program purpose
you're about to do will determine
what stretch is best.
Cool down/Post exercise:
∙ Static stretches can be performed
to slow the heart rate and relax the
body and muscles, which are
warmed up and can move more
freely into the range of motion.
∙ Stretching assists your range of
motion to perform a movement
with correct technique, and prevent
injury.
∙ To relax, to be mindful of your
body. Knowing how your body
feels and being able to assess its
level of pain.
279

Types of stretching:
Static:
∙ To hold a stretch for a prolonged
duration of about 12 seconds,
however they can be held
longer if desired. E. g., Calf stretch
∙ Stretches should be repeated
about 3-5 times progressively
increasing the flexibility range each
time.
Ballistic/ Dynamic:
∙ Active stretching without holding.
E. g., Walking calf stretch
Proprioceptive neuromuscular
facilitation (PNF):
This involves a partner or trainer to
assist the stretch. The partner should
move the target limb through its full
range of motion, one ROM has been
reached the limb is then contracted
against the partner for 10-12 seconds,
the target muscle is then fully relaxed
before repeating the exercise 3-5 times.
Stretching examples for key muscle
groups
Stretch Standing calf stretch
Type of stretch Static
Begin standing and step one foot
forward just past the centre of
Start position
gravity or in front of the other foot
that is supporting you.
● Dorsiflex the foot that is out in
front, to bring the toes towards
you.
● Hinge forward from the hips and
bend the supporting knee of the
other leg.
● Keep the target leg straight and
as you exhale and deepen the
Stretch/
Exercise range feel into calf muscle
description being stretched, all the way up
to the hamstring and gluteals.
● Continue to breath with each
exhale attempting to deepen the
stretch further
● After about 20 seconds slowly
come back to standing and
move on to the next leg.
● Stretching and releasing tension
through the legs from the calf
What is it good muscle up the leg.
for
● It also adds as a balancing
exercise if done with no support
● If balance is an issue this
stretch can be done against a
wall for support and pressing
the foot up against the wall.
● It can also be done seated on
the floor bending one knee out
to the side and extending the
Variations
target leg out in front and
repeating the steps above.
● Progress to more of a dynamic
stretch by taking a step each
time the leg changes, holding
for about 3-5 breaths each leg
and walking forward as you go.280
Stretch Hamstring stretch
Type of
Static
stretch
Begin standing with feet slightly wider than hip width apart. Toes facing
Start position straight ahead.
Hands on hips
● Hinge forward from the hips keeping the back straight.
● Begin to feel a stretch move into the hamstring muscle and potentially
lower back the further you go.
Stretch/ ● Hands can leave the hips and move down towards the ground
Exercise depending on your ROM.
description
● ● Continue to breath moving deeper into the stretch with each
exhale and the muscle lengthens and releases.
● ● Slowly extend up from the hips back standing
What is it ● Stretching the hamstrings
good for ● Lower back
● Can be done seated, similar to the seated calf stretch. Extend both
legs, dorsi flex the feet and hinge forward from the hips.
Variations
● You can also adjust the angle of the feet to change the stretch to the
sides of the legs into the soleus muscle and peroneus longus.

Stretch Lying Glute Stretch

Type of Static
stretch
Start position ● Begin lying down supine.
● Bend knees feet flat on the ground.
● Cross one leg over the thigh of the other leg, aiming for a 90 degree
angle from hip, knee and ankle of the leg that is crossed.
● Feed your hand through the gap of the two legs and grasp onto the
hamstring of the lower leg and pull back towards the torso
Stretch/ ● Keep the head resting on the ground as you pull the leg back
Exercise ● Attempt to draw the crossed legs knee down to bring about a hip
description opening stretch at the same time.
● Continue to breathe deeply throughout the exercise, with each exhale
moving more deeply into the stretch if the body permits
What is it ● Getting a deep glute stretch, predominantly the glute max
good for ● Opens the hips
Variations ● If the client does not have the range to reach the hands to the lower
leg to pull back then it can done without the extra pull, or a theraband
can used, or the stretch can be a PNF stretch and the trainer can
assist the stretch

281
Stretch Kneeling lunge

Type of stretch Static

Start position Begin by lunge forward, dropping the back knee to the floor (use a pad or mat to support the
knee).
Stretch/ Exercise ● Place hands on hips, maintain a tall posture and slowly lunge into the front leg,
description stretching and opening the back legs hip.
● Ensure the posture stays tall and you don’t fall over the front leg with the torso.
What is it good ● Targeting the illiopsoas muscle, it’s a good one to release the hips if you’ve been sitting
for for long periods.
Variations ● Change the positioning of the feet to adjust the stretch
● Change to a more dynamic stretch by performing walking lunges and pausing to stretch
and hold and then continue.
Stretch Supine spinal twist
Type of stretch Static

Start position ● Begin lying down supine on the floor/mat.

● Bend knees and keep feet flat on the ground with knees and ankles together.
● Hands can be outstretched in “T” Position with wrists in line with shoulders

Stretch/ Exercise ● Inhale and move the knees over to one side of the body keeping the connection
description between the knees and ankles
● Keep the shoulder blades firmly on the floor
● Exhale and pull the legs back to centre and then repeat to the other side

What is it good ● Stretching the oblique muscles

for ● Stretching the erector Spinae
Variations ● To progress this stretch into a more of an abdominal workout at the same time and a
dynamic stretch the legs can be lifted into a “table top” position and the exercise is
completed the same way.
● Therabands or a towel can also be used to assist the movement
Stretch Spinal stretch
Type of stretch Dynamic

Start position ● Begin in a quadruped ( four point kneeling position) with wrists in line with shoulders
and knees in line with hips, and neck stretched as an elongation of the spine

Stretch/ Exercise ● Inhale and drop the tailbone, and belly causing an arch to the spine, and lift the head
description
● Exhale and tuck the tailbone, round the spine and tuck the chin

What is it good ● Articulating the vertebral column

for ● Releasing tension in the back muscles
Variations ● Can also be done using a wall or seat as support by placing hands on the support and
continuing the movement outlined. 282
Stretch Triceps stretch
Type of Static
stretch
Start position ● Begin with both arms lifted straight above the head.
● Bend one elbow and reach the hand to the scapula
● Place the other arms hand onto the bent elbow
Stretch/ ● Taking deep breaths guide elbow back to open the chest and feel a gentle
Exercise pull on the Triceps
description
What is it ● Stretching the long head of the tricep muscle
good for ● A good chest opener to correct rounded shoulders and posture
Variations ● If ROM does not permit the reach of the hand to the elbow then a cable can
be used or thera band to pull down, resting the tricep against a wall can also
be an option

● The trainer can also assist this stretch changing it to a PNF stretch
● Watch that there is not arching through the back.

Stretch Doorway stretch

Type of Static
stretch
Start position ● Begin placing the closest forearms and hand to the wall
● Take a step forward with one leg
● Press into the wall
Stretch/ ● Pressing into the wall you feel a stretch through the trapezius and
Exercise pectoral muscles
description
● Repeat on the other side
What is it ● Pectoral muscles
good for ● Trapezius muscles
Variations ● Adjust the height of the hand/arm on the wall to feel the stretch into
different parts of the back, and chest
● Extend the arm and just press the hand into the wall and feel the
stretch now reach the deltoids as well
● Step and twist away from the wall to adjust the targeting and deepen
the stretch

283
8.3 Designing Training Programs
Health risks from Inactivity:
Client’s should be made aware of
potential risks associated with inactivity
such as:
∙ Health risks
∙ Physical risks
∙ Mental health risks
Health scares or avoidance of Non-
communicable diseases (NCD’s) can be
a key factor for
some to begin fitness training.
According to the World Health
Organization, (2015) The most
common Non-communicable diseases
(NCD’s) are:
- Cardiovascular Disease
- Cancers
- Chronic Respiratory Disease
- Diabetes
They also state that 3.2 million NCD
deaths can be attributed to
insufficient Physical Activity.
With a growing fitness industry there is
now more than ever a demand for
expert personal training guidance and
health education. Powers & Howley,
(2001) recommend that to prevent
NCD’s and achieving weight loss
goals the general population should
be exercising 3-5 times a week, for
20-60 minutes, at an intensity of
55/65% to 90% of their MHR.
They should also be educated on ways
to avoid these risks such as:
∙ Regular and safe physical activity
∙ Healthy eating to complement
training demands
∙ Recovery strategies
∙ Social strategies to communicate
and workout with friends to help
maintain motivation and
accountability
∙ Record achievable goals and put
them somewhere visible for a
constant reminder of their
intentions
Potential barriers to participation in
fitness programs:
Potential barriers should be explored in
pre-exercise health screening and
monitored throughout, the trainer
should use motivational techniques
and keep the client(s) accountable
to their original goals and
intentions to avoid these potential
barriers from preventing the client
to continue.
Some key barriers can be:
- Individual fears from past injury or
experience
- Time barriers and life obligations
- Financial barriers and difficulties
- Lack of self-motivation
284
Working with allied health
professionals
Depending on the needs and
performance goals of the individual they
could be in contact with several other
practitioners to assist with their goals so
being aware of these relationships is
important to be able to take them into
consideration when planning programs.
∙ For clients who may be
experiencing risks associated with
a sedentary lifestyle such as
obesity than regular communication
and reports should be shared with
their general
practitioner to avoid exercises that
could pose potential harm.

Examples of allied health Developing fitness Programs

professional relationships: Physical Activity (PA)
∙ The client could be receiving Recommendations:
regular massage therapy that can These fitness guidelines were
then affect their joints and developed to give people of all ages
recovery. Some massage therapy an idea of the type of movement
can cause some soreness post they should be doing each week. It
treatment or changes to blood acts as a guide to enforce personal
circulation that should be goals to try and reach.
considered. Australian government: Department
of Health (2014).

Who Intensity Duration Type

Children Moderate -
60 minutes (or more) PA Cardiovascular fitness Strength
aged 5- vigorous
everyday (3 days a week)
12 intensity
Adolesc Moderate-
60 minutes (or more) PA Aerobic activities Strength (3
ent s vigorous
every day days a week)
(13-17) intensity
Accumulate 150 minutes
● Moderate and vigorous
(or more) of Moderate
Aerobic PA throughout the
intensity PA 5 days + per
Adults Moderate- week
week Accumulate 75
(18-64) Vigorous activity ● Strength training involving
minutes (or more) of
major muscle groups at
vigorous PA 3 days a
least 2-3 days per week
week
● Incidental exercise (eg.
gardening, household
Moderate- chores)
Accumulate 150 minutes
Older Vigorous activity ● Moderate and vigorous
(or more) of Moderate
age Or as physically aerobic PA
intensity PA
adults mobile as their ● Balance activities for
Accumulate 75 minutes
(65+) bodies abilities prevention of falls 3+ days
(or more) of vigorous PA
allow per week
● Strength training 2 days
+ per week
285
Programming
Communication with client:
∙ It is essential that within personal
training programming that the
relationship between
the trainer and client is positive and
clear
∙ Use open and honest
communication so that the client
feels comfortable to express
their feelings throughout the training.
∙ Provide clear and easy to
understand feedback suited to the
client’s understanding.
∙ Whether this be verbal, providing
reports of training progress or
video and imagery
feedback
∙ Motivation and encouragement
throughout sessions should be
implemented to keep
the client enthused about training
and keep them working towards their
goals.
∙ Be adaptable in coaching styles
choosing the appropriate style that
works for your
client and the appropriate style for
situations.
Seek regular and in the moment
feedback with the client about their
feelings towards programming and
potential frustrations or difficulties,
where further time could be spent on
a movement or modifications may
have to be made
Adopt the appropriate coaching
styles
Autocratic: This style of coaching is
used when the trainer is “telling” the
client what to do,
they have decided on the session, and
will then tell the client what they’re to
and how they’re
going to do it. An example could be
more a boot camp style of training.
Democratic: This is more a sharing
style of coaching where the trainer
invites the client to
share their opinions, and feelings. The
trainer can then adapt the session to fit
the client’s
suggestions and explain what is to be
done and why they’re doing it.
Designing the program
∙ Perform a Par-Q test to get to
know your client and their
readiness to exercise prescription
and training.
∙ Perform a Needs analysis
identifying the goals, needs and
single muscles and groups
predominantly needed for the
activity.
∙ Perform a metabolic analysis to
identify the current body
composition and recording specific
goals for peak physique
transformations.
∙ What is the optimal program that
will meet the needs of this
analysis? Use FITT to identify
the specific considerations to
observe and implement for the
program.
∙ Determine the objective and
training type.
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Working towards training objectives
Are they looking for short term goals
and training?
∙ For short term training, we can use
micro cycles for a week to week
training plan. This style of training
could be more suited for general
fitness goals for the individual. A
circuit plan could be adopted to
introduce them to a variety of
exercises and training. Sessions
could include strength days,
endurance days, functional days,
muscular power days, or core
strength days.
For clients looking to lengthen their
training to more of a monthly period
or 12 week period we would use
mesocycles. In this style the goal
could be to work towards a specific
goal or competition. Training would
begin introducing the client to
training utilizing performance
appraisals and progressive overload
to adapt and progress the sessions
for physical performance outcomes
and physiological adaptations.
∙ Macrocycle training will then be
focused on longevity training or
seasonal training for specific
sports and goals. The sessions
would include progressive phases
as well as tapering or deloading
phases where the training
demands would reduce to allow for
appropriate rest periods and
recovery. Sessions would then
change again continually staying
focused to original intent of the
client and providing variation to
maintain adherence and training
motivation.
Control and Stability:
Can the client control and stabilize their
structure and posture, muscles, and
joints when performing a movement?
Before prescribing any additional weight
resistance the client should be able to
support their own bodies structure with
non-weight bearing exercises first. We
can develop the body’s ability to
stabilize through a range of motions and
changes in force by challenging the
body and core with unstable surface
and repeated training to increase
neuromuscular learning and
adaptations.
Preparatory Initial training:
For an unconditioned individual
sessions should begin with the intention
to develop their bodies posture and
stabilization through body weight
training.
Including:
∙ Single leg stance exercises,
observing any differences or
compensations of either side
∙ Isolation of weak muscles or
groups
∙ Contralateral movements to
engage the brain and body's ability
to control movements and for the
body to work as one
Progression:
Training should progress as they client
becomes stronger and more conscious
of the their body and proprioception.
To progress their training:
∙ Adapt the environment by including
more unstable surfaces. E. g.,
balance beams, Swiss ball training.
∙ Add in weight training and
instability for further growth and
progression 287
Conducting exercise sessions
∙ Communication between
trainers and clients:
When conducting exercise sessions the
trainer needs to consider how the client
learns and how best to communicate
how to perform and exercise for
maximal results.
∙ Cueing:
Cueing is as essential part of coaching
the client and assisting them to move
with correct form, and maintain focus to
their body and what it is doing. It assists
in the client’s understanding of what is
intended and what they should feel and
experience to achieve the desired
result. It is important to consider that
everyone learns differently and so the
trainer should be adaptable to the
needs and learning of the client when
selecting the appropriate cueing
technique.
Types of Cueing:
1. Verbal
2. Visual
3. Imagery
4. Hands on
∙ Verbal: This type of cueing
involves the articulation of direction
to the client. Instruction should be
positive and/or constructive to help
motivate and assist the client’s
understanding of what is expected.
∙ Visual: This involves the trainer
demonstrating the
movement/exercise with correct
form and technique. It provides the
client with a visual image of what
the goal movement is. The
exercise should be broken down,
as well as completed in “real time”
creating the foundation and the
desired outcome. Verbal cueing
should also be used to compliment
this technique.
∙ Imagery: Creating an image of
something the client is relatable to
can assist them to enhance their
ability to recruit the appropriate
muscles for the given exercise or
movement. Imagery can create a
frame of reference for the body to
follow. By asking the mind to
create images, the innate signaling
system of the body is triggered.
The use of imagery should be
specific to the client and the goal
of the exercise. Choose your
words wisely to be as direct and
realistic with the desired
movement you are wanting the
client to achieve.
E. g., “Lengthen the spine”,
“Tuck the tailbone”,
“Expand the rib cage as you
inhale.”
∙ Hands on approach:
Hands on cueing involves a the use of
touch to guide the client’s position and
technique. The use of touch can assist
in the neuromuscular connection for the
client to feel what muscle should be
working, it can sometimes assist to
release tension, similar to the effects of
a massage.
Cautions with hands on approach:
o Always request permission from
the client before proceeding with
this approach. Explain to the client
the purpose and where you intend
to touch them.
o If a client has reached full
extension or are in an extreme
position, such as holding a weight
overhead then touching should be
avoided in case of shock or
causing the client to lose focus.
o When using this approach
remember that the intention is to
guide the client NOT push or press
them into a position or movement.
o Monitor the load or effect through
feedback and through sense 288
8.4 Exercise programs for long-term
fitness and competition goals
Monitoring Long-term goals:
Long-term exercise programs are used
for clients’ with long term health goals,
these can be:
∙ Fitness and health longevity, to
feel physically able to do the daily
tasks and exercises they wish to
partake in without fear of being
physically unfit.
∙ Competition training clients need a
long term program outlining peak
training periods, rest periods etc.
∙ Clients looking to lose weight and
maintain this weight loss also use
a longer term program.
When training clients for a long term
fitness program, it is important to
understand the varying goals and levels
of motivation and behaviors each will be
going through.
This is when this model for change can
be used:
Trans-theoretical model:
This model will assist the trainer to
outline common experiences and
behaviors that he can Potentially come
across when adopting a new training
program.
It consists of 5 stages which include:
1. The Pre-contemplation stage:
In this stage the person is usually not
ready to take action with their fitness.
They have nothing that is driving them
to change, and they’re yet to set a goal.
To move from this stage the person
usually needs a reason, sometimes a
health scare can spark some motivation
to change, or guidance from social
connections.
2. Contemplation stage:
Here the individual starts to be more
aware of the benefits that can come
from making a change, and they start
thinking about taking action in the next 6
months. They tend to weigh the pros
and cons to change, going through not
only the reason to take action but also
the excuses that can prevent them from
moving forward into the next stage.
3. Preparation stage:
The individual is finally starting to take a
more positive move into changing their
health. They start to look at the options,
maybe even make contact with a gym
or trainer. As a personal trainer you
have a very influential role for people at
this stage to help motivate them to take
that next step into their health
transformation. Communicating the
benefits and going through an intended
immediate and long-term timeline and
program with the client can be a great
way to get him started and transitioning
to the action stage.
4. Action stage:
The individual is moving more regularly
and has taken part in a regular fitness
program. However, it is important to
monitor adherence at this stage, as the
client can still be vulnerable to regress
back to their old ways and barriers.
5. Maintenance stage
In this final change the individual has
established a regular fitness routine and
is self-motivated to continue. He’s less
likely to relapse to the beginning of this
process and will generally find his way
back a lot faster if he does regress.
289
Exercise programming safety
guidelines to consider:
● Get clear on the needs and goals of
the client in initial screening information
● Educate client on equipment, space,
and technique
● Train for anatomical conditioning and
injury prevention before adding
complexities and challenges
● Use progressive overload principles to
change and adapt programs as needed
● Evaluate and reevaluate sessions
from regular recording of performance
and results
● Re- test using fitness appraisals for
measurable fitness improvements
The recording of session observations
and results will assist the trainer and
client to continue to be specific to the
client’s needs and adaptations to
training. As stated by Chieu and
Barnes, (2003) for an unconditioned
client, physiological changes can be
observed within the first two weeks of
training before the client reaches
homeostasis or a plateau with their
training gains.
The body will enter stages of adaptation
that can be outlined utilizing the
General Adaptation Syndrome model.
Performance appraisal and
Assessment measures for long-term
planning goals
∙ The trainer should be recording
and communicating with the client
throughout and after each session,
checking in with how the client is
responding physically and mentally
to the training demands.
The trainer should be able to adapt the
program to suit the needs of the client.
∙ Initial fitness testing should be
revisited to measure changes in
performance and client training
progress. Testing should be
performed at the interval of 3-4
weeks.
∙ Body composition testing should
be done to assess adaptations to
fitness and training. Testing should
be performed at the interval of 3-4
weeks.
Planning Long-Term programs:
Periodization:
When planning for long-term fitness
transformations, to simplify the splitting
of sessions we can
use the concept of Periodization.
Depending on what the client is working
towards, different
approaches can be used.
Cycles:
∙ Macrocycles are categorized for
long-term training, usually of 6
months to years.
∙ Mesocycles are split sections of
macrocycles lasting for a several
weeks to months.
290
When planning for an extended goal we
can break it down into realistic timelines
and prescribe the exercises, testing and
evaluation periods within the
mesocycles to reach the overall goal, all
the while being adaptable to the
sessions depending on how the
individual is performing.
Exercise volume and intensity can
change through the daily and weekly
training variations but continue to be
aligned with the bigger picture and
performance outcome.
At the end of the mesocycles, the client
should reach a period of peak
performance and ability as their bodies
adapt to the training.
Peak training: Prior to competition the
athlete should increase the level of
training reaching for their maximal
performance goals. If training for peak
physique bodybuilding competition then
this is where they’re looking to lift that
personal best, and to be the strongest
they’ve been through the training
program.
Tapering:
To avoid overtraining or just after their
peak training phase, and usually the
week just prior to the competition we
prescribe a tapering period. This is
where the athlete should begin to
decrease the volume of their training
and the frequency of training, but still
include some high levels of intensity
sessions in those training days. This
tapering phase allows the client to
maintain their performance gains but
will also give them time to rest and
recover before the big competition.
Testing and performance appraisals:
At the beginning of each block,
performance appraisal testing should be
done, to observe the fitness levels of
the client’s cardiovascular system, his
strength level and progressive
adaptations, balance, and flexibility.
Sessions can progress according to
these results.
4 Adaptation factors affecting
performance and programming
When training for long periods, the
individual's body will be experiencing a
series of changes. These changes will
reflect how the client responds to stress
in training sessions, his recovery
periods and his body’s ability to adapt
and change to the demands.
1. General Adaptation Syndrome
(GAS):
∙ New stimulus:
Whether you’re a conditioned athlete or
novice, beginning any new program will
introduce new exercises and
physiological demands. Programming
should then begin with an introductory
stage of stimulus, technique and time
for the individual to learn and time for
the trainer to observe and record the
response.
291
∙ Alarm phase:
New training programs will be a shock
to the client's body and they will most
likely enter a period of stress, because
they won’t be used to these demands.
The body's sensory system sends off an
alarm that triggers a physiological
response to protect itself, raising the
heart rate, increased perspiration or the
onset of DOMS (Delayed onset muscle
syndrome). This alarm then encourages
the individual to slow down entering
them into the more positive period.
∙ The Adaptation phase:
This stage is where positive adaptations
can occur, where the muscle and
tissues repair and grow, and where the
nervous system learns new movement
patterns.
∙ Plateau/Steady State:
The individual will then reach a stage of
steady state or homeostasis where the
physiological adaptations and bodies
recovery rate is equal to the volume and
demands and no change can be seen.
∙ Exhaustion phase:
If the individual continues to train at high
volumes without responding to the first
alarm of change and receiving adequate
rest, then the body can enter a stage
where the demands and stress is
greater than the body's adaptive
mechanisms. The body reaches
exhaustion which can trigger symptoms
of overtraining.
∙ Deloading Phase:
Just like any operating or living
organism, it cannot sustain a constant
high level of training or work without
burning out. With constant progression
and high volumes of training with
insufficient recovery periods the
individual will reach exhaustion or an
over trained state, (i. e., GAS phase). In
this deloading period the client could be
continuing to train as normal and find
that they’re no longer progressing by
detraining, feeling more exhausted and
not building in fitness and gains.
Schoenfield, (2016) states that, “chronic
resistance training can suppress the
phosphorylation of intracellular anabolic
signaling.”
To avoid reaching this detrimental state,
deloading or detraining periods can be
prescribed, where the individual can
continue to train but at a lower intensity
and/or volume to promote the
restoration and rejuvenation of the
bodies systems and tissues, additional
rest should also be prescribed.
The client should continue to be
monitored however, especially if they’re
new to training their bodies recovery
ability will not be as fast so longer rest
periods may be needed.
∙ Recovery Phase:
Rest can take many shapes, generally
the individual should not complete stop,
and take on a sedentary lifestyle for
days or weeks.
292
2. Steady State/Homeostasis:
At some point during training the body
will become accustomed to the training
load and reach a state where the body
will not progress or regress. It is at this
point when the individual is at ease with
the training and is performing correctly
that training variables can be adjusted.
When the client reaches a steady state
with their training, the program can then
be adapted.
Using the principles of FITT (frequency,
intensity, time, and type) these can be
adapted to progress the training to
continue to develop the client, working
towards and progressing with their
performance outcomes.
3. Variation of training days:
Using Cross-training is a helpful way to
motivate clients to adhere to programs,
prescribing exercises that are aligned
with their goals but offer a change to
their usual training routine. To continue
the progression of training performance,
avoid exhaustion and overtraining and
keep the client motivated for the longer
term outlook the trainer should have an
awareness of the dynamics of training
and influences that one training day will
have on the next. Gaining information
from the client in their initial screening of
any other training they may do outside
of these sessions will also affect their
performance as will the variation of
exercise and volume prescription.
For example, you wouldn’t prescribe a
high intense upper body workout on
consecutive days because the body
does not have enough time to repair.
Therefore, you can split workouts from
upper to lower body or total body
workouts, to more unidimensional
workouts, balancing them with adequate
amounts of cardio and recovery
sessions to optimize results,
adaptations and adaptability.
Long-term fitness program example:
This program's overall goal is general
fitness, focused on an unconditioned
individual for body composition
transformation, and health and fitness
intervention.
The macrocycle is then broken down
into 4 week blocked mesocycles.
Core and Stability
- The week begins with core and
stability focused training to prepare
the body for the changing
demands and core loading through
the week.
- With the unconditioned individual,
they should begin with body
resistance exercises to develop
the nervous system’s motor
patterning, and reduce the risk of
muscular compensations and
negative habits from poor initial
conditioning.
- The session should also include
flexibility training to balance the
body’s ability to lengthen and
release tension whilst also
developing stabilization through
the core strength training.
- This preparatory training will then
serve as an educational basis of
muscle memory for further training,
and recovery.
293
Maximal Strength training
- The total body maximal strength
training can focus on
multidimensional exercises and/or
functional training that develop the
neural motor functioning.
- Total body workouts can assist to
avoid developing any potential
imbalances in the body from some
parts of the body being stronger
than others etc.
- Total body workouts and
specifically functional workouts can
also be good to work as a
challenge or varied training option
at the end of a session.
Cardiovascular fitness training
- The Cardio section assists
capillarization and oxidation of
cells to strengthen the heart
muscle and cardiovascular health.
- Training will begin with Sub-max
endurance training to condition the
system and train the aerobic
system.
- As cardiovascular fitness
improves, the individual will be
able sustain heavier workloads and
recover and at a faster rate to the
demands.
- Cardio workouts can also be a
good warm up option for the
individual to assist in the blood
circulation and redistribution of
blood flow to skeletal muscle
where it is needed most.
Split body workouts
- The split upper body and lower
body workout can alternate
exercises of multidimensional and
unilateral to isolate specific areas.
Observations from the previous
days training should assist in the
exercise selection and prescription
for these workouts.
- Identifying skills/techniques or
areas of the body that need a more
specialized focus or iron out any
imbalances noticed.
Interval training
- The HIIT interval workout can
include a mix of around 4-5
exercises covered in the previous
week’s session. It is ideal as a
technique as it helps the body and
mind to memorize those exercises
and then they can develop the
muscular and cardiovascular
adaptations in this workout.
- Sessions in the 4-8 and 8-12 week
periods should reflect the client’s
progressions. Exercises should
then progress accordingly. As the
body develops, the exercises can
progress and be varied, or if the
client is looking to perfect a
particular exercise, prescription
can stay the same to perfect the
skill and just change the
reps/sets/load as required.
294
 Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Core and
Maximal Strength Cardio HIIT
stability Upper
1-4
Body/Lowe r Rest Rest
week s body training
Total body 20-30 minutes 20 mins
+

Flexibility

Progression of
core and
Progress by
Stability (add
adding intervals of
potential further
sprint training or
imbalances, add
higher intensities
weights, use Specify the of the chosen
variations) maximal strength exercise(s) Increase
Monitor training to goals
repetitions,
of hypertrophy, With higher
flexibility/ ROM Use exercise change rest
power or intensities bouts,
4-8 progression to
should be shorter
progression s periods.
functional gains
assist in and the FITT
with long rest
weeks programming for
intervals
more complex principle
weight training. Progress as
Use variations
you see fit.
and progressions
of exercises If work intervals
are long and at a
Look for any
high intensity, then
patterns of
rest should also
tension and
be long.
possible
compensations

Progression of
8-12
core and
Progress by
Stability (add
weeks adding intervals of
potential further
sprint training or
imbalances, add
higher intensities
weights, use Specify the of the chosen
variations) maximal strength exercise(s) Increase
Monitor training to goals
repetitions,
of hypertrophy, With higher
flexibility/ ROM Use exercise change rest
power or intensities bouts,
progression to progression s periods.
functional gains should be shorter
assist in and the FITT
with long rest
programming for
intervals principle
more complex
weight training. Progress as
Use variations
you see fit
and progressions
of exercises If work intervals
are long and at a
Look for any
high intensity, then
patterns of
rest should also
tension and
be long.
possible
compensations

295
Long term training for Peak Physique
bodybuilding competition prep
● Strength gains:
The first 1-4 weeks should begin
introducing the individual to this style of
training. Beginning to establish
muscular strength gains, to support the
body's structure and be able to progress
to heavy loads during more hypertrophy
phases of training.
- Load is moderate with reps of about
10-12 and Sets of 5.
- Exercises should be focused on Total
body conditioning and strength. Include
multi joint exercises that establish
greater gains over multiple muscle
groups.
● Body composition and
cardiovascular fitness
The next 4-8 weeks should be about
slimming down and improving body
composition.
- Include Cardiovascular training, using
HIIT intervals for metabolic changes
and power training.
- Muscular endurance training can also
be used to improve cardiovascular
health and body resilience when lifting.
This where CrossFit training can come
into action using lower loads over a
longer period of time.
● Hypertrophy gains
Weeks 8-11 prior to competition should
be about muscular gains and
hypertrophy training.
Training the body in isolation using
single joint exercises to build bulk and
that aesthetic visual
of mass strength. Low Repetitions with
maximal load is recommended, with
longer rest
intervals.
● Tapering
Week 11-12 Volume of training should
decrease, reducing the number of
training days. Include sessions of
maximal strength and hypertrophy, but
with sufficient rest periods to avoid risks
of overtraining.
296
Example Program for peak physique
gains through periodization:

Set
Microcycle 3 weeks Training goal Reps Rest
s
● Begin with health screening
● Performance appraisal testing
Functional training 3 12-15 3 minutes
● Observe and record change in performance
● Observe and record change in anatomical structure and function
● Increase number of repetitions to learn technique and skill
● Train for injury prevention
Mesocycle 12 weeks Strength training 3 4-5 3 minutes
Get more specific with training goals
Build structure and support through heavier loading
Build resilience of bodies structure for training adaptations to occur Educate on timing of sessions
and rest periods

Use split programs and rest days

Even out body structures and observe and respond to any compensatory movements

Deloading phase Allow for adaptations

Reduce number of training days Add variations and cross training Adjust intensity of session
Re-evaluate goals and changing body composition and functioning

Reduce body fat /

Metabolic phase 3 15-25 30-60 seconds
muscular endurance
Increase training intensity
Train body and energy systems for hormonal adaptations of stress and recovery

Reduce fat by increasing the duration of performance or number of repetitions to be able to sustain
the load and expectations of the movement with control over time
Deloading phase

Reduce number of training days Add variations and cross training Adjust intensity of session
Re-evaluate goals and changing body composition and functioning

Macro cycle phase Hypertrophy 3-4 6-12 2 minutes

Clear on goals and condition individual for hypertrophy gains
Train body evenly/ focus on muscular groups that need additional training

297
8.5 Personal training for functional
health and movement
What is Functional Training?
The simple definition of functional
training / fitness is; training that
engages the body to move more
effectively as a synergistic unit. The
purpose of functional training is to train
the body as a whole structure – the way
it’s desired to be used.
Safety Guidelines:
∙ Always pay attention to your form
when performing exercises. Stop
any exercise when your technique
breaks down. This will dramatically
reduce the chance of injury.
∙ Always build load and intensity
progressively when using
functional equipment.
∙ If any given exercises induces
pain… STOP! This will only cause
your body to move in a
compensatory way, which will
negatively impact long-term
movement and performance. Seek
professional advice if pain
continues.
∙ Execute correct breathing
technique to pressurize your
diaphragm whenever your core
complex is loaded, or about to be
loaded.
∙ In the event when functional
equipment is used for training
outdoors, do not train whilst facing
the sun.
∙ Pay close attention to your
surroundings. Ensure the surface
is not slippery or uneven.
∙ Always wear appropriate footwear
when training.
Functional Equipment:
∙ This unit covers the basic functional
movement patterns to develop
balanced training programs, and
describes how to apply them with
different functional equipment. This
will allow you to select the most
appropriate piece of equipment for
each movement to more effectively
deliver your clients training goal.
∙ In this unit you’ll learn how to
effectively use the following functional
training equipments :
o Aquabags
o Slosh Balls
o Wall and Dead Balls
o Ropes
o Torsonators
● The basic movement patterns that will be
covered are:
o Squat
o Dead-lift
o Push
o Pull
o Twist
When using functional training as a training
method you should be looking at the whole
body structure and how it works together to
complete a movement. Each of the
movements mentioned above use a
number of muscles and joints. Even if you
use a simple version of the squat there is a
lot going on, there is dorsi / plantar flexion
at the ankle, flexion / extension of the knee
and hip, while the core and back need to
stabilize the spine and tool being used.
Use the legend below to help choose the
best exercise and tool for your desired
training effect.
● XXX = Very Effective
● X = Effective
● N/A = Not Applicable
298
Who is Functional Equipment
Suitable For? Portability:

The functional equipment outlined is As functional equipment takes up very

effectively used to improve acceleration little space, it gives you the ability to
and power among a wide range of train anywhere, anytime, any movement
training programs. The use of functional and at any intensity.
equipment is becoming increasingly
popular due to their adaptability
throughout a range of unconventional Types of functional equipment:
movement patterns. Using the
∙ Aqua-bags:
functional equipment for strength gains
o The Aqua Bag is a fun, easy to
can also offer clientele working towards
use, versatile and portable piece of
bodybuilding and physique
equipment, making it perfect for
transformation an alternative style of
home gyms, personal trainers, and
training to promote interest and
those who travel a lot.
maintenance of programs, and assist in
o As the name suggests, the Aqua
total body conditioning and functioning
Bag is filled with water. This
for longevity health.
means that when you lift the Aqua
Bag, the water moves making the
Aqua Bag unstable and
Functional equipment is also suitable for deceptively difficult to control. The
use among the general population when instability of the Aqua Bag forces
specific attention is paid towards tempo all of your stabilizing muscles,
and technique. including core and rotator cuff, to
work overtime.
o The design of the Aqua Bag also
Diverse Applications of functional makes it great for performing great
training equipment: movements such as Olympic lifts
- The Functional equipment outlined to develop explosive power, but is
is very effective, due to their ability much easier, safer, and more
to manipulate force and maximize common for the average person.
the potential of many traditional
movements.
- They are also very adaptable to be
used effectively across a variety of
planes of motion, which are difficult
to train with other equipment.
There are almost limitless options
to implement the outlined
functional equipment into your
training regime(s).
- Functional equipment builds
functional strength throughout your
whole body, conditioning for peak
physique transformation goals, and
can help improve resilience to
injury. 299
o Benefits:
- In an Aqua Bag the water is
always moving and it becomes
unpredictable causing a chain
reaction through your body that
randomly stimulates different
muscles to help stabilize the bag
during each movement. Small
changes in how you move the bag
can result in drastic changes of
force that go through your body.
- This provides unique benefits:
▪ When used correctly the Aqua Bag
is a great injury prevention tool.
▪ The unstable nature of the Aqua
Bag helps strengthen your body in
planes of movement that are not
commonly stimulated with
traditional resistance equipment.
The Aqua Bag will therefore
strengthen your weak links.
▪ The Aqua Bag is a great tool to
improve stability as it acts upon
you rather than you upon it
(meaning it reacts harmoniously to
your movement).
▪ You can use it on its own for
conventional exercises, or in
contrast with conventional
exercises. Contrast training is a
great way to develop multiple
attributes (attributes such as
strength, power and stability).
∙ Dead Balls:
o Dead Balls are rubber balls filled
with iron sand. The flexibility of the
rubber outer combined with the
iron sand means that the Dead
Ball is readily deformed and
doesn’t bounce easily – it’s like a
cross between a medicine ball and
a sandbag.
o Benefits:
- Dead Balls lend themselves to a
range of unconventional movement
patterns. This allows the user to
strengthen and train the body to
move more athletically.
- The unique benefits of using Dead
Balls includes:
▪ Power and speed development,
through unique exercises such as
slams.
▪ Cardiovascular and muscular
endurance through all planes of
movement.
▪ Can be used to train the body to
absorb force imposed by an
external object more effectively.
This is very effective for athletes
engaging in team sports such as
Rugby, AFL, etc.
300
How to Apply Functional Equipment
to Specific Movement Split training Functional exercises

Patterns: Lower Body Exercises:

∙ Training Isolation VS Movement The following section outlines how the

Patterns: following key lower body movement
patterns can be applied to various
There are times when it’s important to functional implements.
go back to the basics and isolate
muscles such as for rehab purposes
and to detail particular muscles and bulk ∙ Squatting / Knee Dominant
for peak physique competitions. To Movements:
promote more effective movement and
balanced training however there is more Squatting movements are sometime
benefit to performing movement referred to as lower body push or knee-
patterns and compound exercises dominant exercises. Squatting is a great
rather than isolation exercises. movement for your whole body. Squats
not only strengthen the legs and hip,
For example the leg extension versus a they also effectively train the core and
squat: upper body in an isometric manner.
During the squat the hip and knee
changes angles at a similar rate. If you
The leg extension (leg/hip extension have the mobility this should result in
isolation): works your quadriceps hard the hips and knees being parallel, or the
in a manner that doesn’t apply to hips below the knees.
movement required for sports of day-to-
day activities.
The sandbag front squat (squatting
movement pattern): engages
quadriceps more powerfully, whilst
training the body to more effectively
integrate the hips and knees. In addition
to the hips being more effectively
engaged, all core and upper body
muscles are forced to stabilize while
holding the sandbag.
Long story short… Training functional
movement patterns delivers a better
training outcome, teaches more
integrated movement, with less
exercises in less time.

301
 Squat + Variations
Purpose • Builds lower body and core strength
• Overhead squat build whole body mobility
• Jump squats are a great power exercise
Muscle Groups T • Quads
argeted • Glutes
• Hamstrings
• Calves
• Core complex
Exercise Variations / Aqua bag/ sand bag Slosh ball Wall/ dead ball
Tools
1 Front squat XXX XXX XXX
2 Back squat XXX N/A N/A
3 Jump squat XXX X X
4 Zercher squat XXX XXX XXX

5 Dead squat XXX X

6 Shouldered squat XXX X X

7 Overhead XXX X X
Exercise Find your optimal squat stance: you can squat down as low as you can, then shuffle your feet
Preparation around until both heels are on the floor.
Stand up with neutral spine and eyes forward.
1. Hold tool at the front of the body with elbows up - refer to Image.
2. Place tool on the traps not on neck, extend the mid back to bring chest up - refer to Image
back squat.
3. Cradle the tool in your arms by flexing your elbows.
4. Starting from the ground, pull the tool into your body and pick your chest up.
5. Place tool over one shoulder and control it with your arms.
6. Lock out arms overhead and ensure the tool is under control at the top.

Execution • Inhale and begin the squat by hinging at the hips, pushing your butt back
• Continue to pull yourself down into a deep squat using your hip flexors
• Make sure you keep your chest up and eyes forward at all times to maintain good
posture throughout the movement
• Stand back up, pushing through your heels and exhale through the top part of the
upwards movement
• 3 Drive hard through your heels as you stand up coming onto your toes and leaving the
ground
Cueing • Only go through a range of motion that is comfortable for you
• Make sure that your knees track in line with your toes throughout the movement
• Really push through the heels on the way up to activate glutes and quads

Common Mistakes • Flexing through the spine. To correct this cue to keep the chest forward and imagine a broomstick along the
length of the spine.
/Corrections • Knees bowing in. To correct this cue to push the knees out in line with the toes (if this doesn’t help glute and VMO
activation exercises may be required before squatting)
• Coming up onto the toes. To correct this ensure you have found the optimal foot position and cue to keep the
weight in the heels.

Other Variations • Single legged squat

• Zercher squat throws
302
Progression Jump squat: Good squat strength and perfect technique must be established.
Overhead squat: Good squat strength, good overhead strength mobility and perfect technique must be established.
• Deadlift / Hip Dominant Movements:
The dead-lift can sometimes be referred to as a lower body pull or hip dominant exercise. The deadlift is another
fantastic exercise to engage the whole body. Teaching someone good lumbo-pelvic control and lift mechanics is
a great skill for life and will help them avoid injuries. A hip dominant exercise requires a larger range of motion at
the hip compared to the knee and ankle.
Deadlift + Variations
Purpose ●To build posterior chain strength, including the hips and back.
●To train the dead-lift movement in a way that is technically easier than using a bar.
●Legged Dead-lift help promote hip stability
●Good morning and Rumanian dead-lifts help improve hamstring flexibility
Muscle ●Hamstrings
G ●Quadriceps
roups Targeted ●Adductors
●Glutes
●Lower back
●Core complex

Exercise Aqua bag/ Sand bag Slosh Ball Wall/ Dead Ball
Variations/ Tools
1. Conventional XXX X X
2. Rumanian XXX XXX XXX
3. Sumo XXX XXX XXX
4. Good morning XXX N/A N/A
5. Back throws N/A N/A XXX
6. 1legged Dead- XXX X XXX
lift
Exercise ●For #’s 1, 2, 4 and 5: Stand with feet roughly shoulder width, with the tool over or
preparation between your feet.
●For #’s 2 and 5: the movement starts from standing.
●Look forward, push your butt back, bend your knees and ensure thoracic and lumbar
spine are neutral.
●For # 5: Place the tool on your middle traps.
Execution ●For #’s 1,3,4 and 6: Take a deep breath into your abdomen, tighten the core complex to
pressurize your abdomen and support your spine.
Begin by pulling with your chest. Drive your chest towards the roof.
Drive with the hips and stand up, exhaling through the last part of the upward movement.
Lock legs and hips, squeezing your glutes.
Inhale and lower the tool to the start position, exhale at the bottom then inhale and reset.
●For #’s 2, and 5: Hinge at the hips and soften the knees keeping a neutral spine until
your torso is close to parallel to the floor
●For #’s 2, 5 and 6: Ensure shins are as vertical as possible Soften the knee of the
stabilising leg, keeping the shin as vertical as possible.
●For # 6: Pushing the hip back, whilst bringing the free foot back in a pendulum motion.
●For # 6: Keep a straight line between head and heel, until your body is close to parallel
to the floor.

Teaching Points ●Imagine you are trying to push the ground away with your feet when you stand up.
●Twist the band to increase resistance.
Common Mistakes ●Flexing through the spine. To correct this; imagine a broomstick along the length of the
spine.
/ Corrections
●Extending the knees first and then the hips. Cue to pull with the chest and drive through
the hips.
Progression Should be able to perform the exercise with perfect technique before adding external load.
303
∙ Lunge Movements:
The lunge is an excellent exercise that
trains each leg in an independent
manner. The lunge can also be referred
to as a unilateral exercise. Correct
lunge technique combined with
appropriate equipment selection will
help address imbalances and build a
functional lower body. The lunge is
generally considered a knee dominant
exercise. However the demands of will
differ with each type and the step
length. For example shorter steps
require more quadriceps recruitment
compared with longer steps that
required more hamstring recruitment.
Other programming considerations are
that a back lunge requires more glute
recruitment than a forwards lunge and
the lateral lunge recruits more
adductors.

Lunge + Variations

Builds unilateral lower body strength, whilst minimizing tension on the spine
Purpose
in the deepest position of the lunge.

Helps to even out strength imbalances.

Muscle Groups Glutes

Quads

Hamstrings

Calves
Targeted
Adductors

Abductors

Core Complex

Variations/ Tool Slosh ball Wall/ dead ball

1. Split XXX X 304

2. Back XXX XXX X

3. Side XXX XXX X

4. Forward XXX XXX X

5. Walking XXX XXX X

6. Overhead XXX X X
Exercise 1- step back lunge distance and bring hip in the middle
preparation 2- 6- Stand up with feet shoulder width apart, neutral spine and
eyes forward.
Lock out tool overhead

Execution • Inhale deeply to pressurize your diaphragm.

• Step Forward/backwards/side in a controlled manner
• As you step, push the hip backwards whilst bending the knee
to descend into the lunge.
• Throughout the lunge, ensure the spine is kept in neutral
alignment and weight is distributed over the heel and
midfoot.
• Stand up by driving the heel into the ground, whilst engaging
the glutes and gripping the floor with your toes.
Teaching Points • Focus on a point on the horizon if balance is an issue.
• To further improve stability, step slightly to the side as you
step. This will widen your base of support.
• A shorter back step will have a greater quad focus. A longer
step back will have a greater emphasis on the hips.
• Emphasize driving the front leg into the ground during the
concentric phase of the movement. The front leg should
be the prime mover.
• During the lunge the torso should predominantly move in an
up and down pattern, similar to a split squat.
Common • Allowing the torso to laterally tilt, losing abdominal tension
Mistakes / and correct spinal alignment. To correct this; ensure the
Corrections diaphragm is pressurized with air.
• Using the back foot too much to engage the movement.
Correct this by cueing to drive the heel into the ground,
whilst engaging the glutes and gripping the floor with your
toes.
Progression • Client must have good Lunge technique before performing
walking and overhead lunge.
• Good overhead strength is need before performing overhead
variations.

305
Upper Body Exercises:
The following section outlines how the
following key upper body movement
patterns can be applied to various
functional implements. Balanced
program design for a given training
session would involve an even balance
of pushing and pulling movements. It is
recommended that the pulling and
pushing movements are in the same
plane (e. g., horizontal pushing works
with horizontal pulling). This will ensure
muscles around the shoulder remain
balanced, helping to prevent future
injury. In the case where the client is
over/under developed in a particular
movement, the ratio of 2:1 in exercise
programming is an effective method to
address imbalances.
∙ Vertical + Horizontal Pulling
Movements:
Upper body pulling exercises involve
movement of the object towards your
body. These can be broken down into
vertical or horizontal pulling movement
patterns.
Examples of vertical pulling exercises
are the upright row or a chin up.
An example of a horizontal pulling
movement is a bent over row.
∙ Full Body Pulling Movements:
Full body pulling movements generally
involve upper body pulling and hip
dominant exercises working together as
a combined unit, and deliver many
powerful training benefits. Full body
pulling exercises can be made to
essentially train the whole body when a
full body pressing movement is added –
A great example of this is a clean and
jerk. Full body pulling exercises provide
unique benefits such as increased
power output for pulling and jumping,
increased demands on the core and
increased neuromuscular and
cardiovascular demands. These are
great for mixed martial artists, and other
athletes who require a mix of power and
endurance. They should be only used
after basic strength and coordination
through hip-dominant and
vertical/horizontal pulling movements is
developed.
∙ Vertical + Horizontal Pressing
Movements:
Upper body pressing exercises involve
movement of the object away from your
body. Upper body pressing exercises
can be broken down into vertical or
horizontal pressing movement patterns.
Examples of vertical pressing exercises
are the overhead press or shoulder-
shoulder press. An example of a
horizontal pressing movement is a
push-up.
306
∙ Full Body Pressing Movements :
∙ Vertical Pulling Movements :
Full body pressing movements
generally involve upper body pressing Upper body pulling exercises involve
and knee dominant exercises working movement of the object towards your body.
together as a combined unit, and deliver Vertical pulling exercises such as rope
many powerful training benefits. climbing strengthen all muscles involved in
elbow flexion, shoulder extension, scapular
You may choose to use them for their retraction and core stabilisation. An
increased power output, increased alternative take on a vertical pulling
demands on the core or for their time exercise is the wall/dead ball slam.
saving effect, due to training a large
amount of musculature with one
exercise. ∙ Rope Climbing Progressions :
They should only be implemented after Climbing ropes are one of the best ways to
full range and correct technique is improve upper body pulling and grip
developed with both pressing and knee strength; however few can naturally climb a
dominant movements. rope competently. To progress a beginner
to climbing a rope more competently a
series of progressions (outlined below) are
necessary.
Progression 1 : Scoop and Stomp
● To build confidence when working with the unstable nature of climbing ropes.
Purpose: ● To allow a beginner to build base level strength and neural adaptation for more advanced
rope climbing exercises.
Muscle Groups All muscles involved in elbow flexion, shoulder extension, scapular retraction and core
Targeted: stabilisation.
● Place a sturdy box / chair (approximately knee height) beside the rope.
● Sit on the box / chair with the right side of the rope hanging next to the outside of your left
Set Up: foot.
● Grab the rope with both hands at approximately eye level.
● Lift your left foot off the ground, whilst still sitting on the box / chair.
1. Scoop your right foot under your left foot and pinch your feet together jamming the rope.
Your left foot should be standing on the rope, which should now be in the shape of a ‘U.’ This
will anchor you to the rope, allowing it to take some of the load of your body.
1. Grip the rope tightly and stand.
You should now be off the ground with most of your weight being supported by your left foot.
The right foot pinching the rope holds it in place.
Execution: 1. Release the rope from your feet. Using your abdominals, bring your knees up to your
chest. Re-secure your feet on the rope by following step 1.
2. Stand up with your legs, and re-reach as high as possible with your arms.
3. Repeat the inchworm process until the top of the rope has been reached.
4. Loosen the grip of your feet on the rope when coming down. Support your weight evenly
between your feet and hands, slide your feet down and place hand-over-hand on the way
down.
● Ensure you keep your scapular / shoulder blades engaged throughout the entire rope
climb, as climbing places great tension on the musculature revolving around the shoulder.
● To avoid potential strain to the bicep tendon, ensure a slight bend is always kept in the
Teaching Points:
elbow
● Count every pull up the rope as 1 rep and progress only when correct technique can be
exhibited for a minimum of 5-8 repetitions.
Common ● Allowing your body to pull away from the rope: 307
Mistakes/Correcti ● To correct this, pull your chest close to the rope at all times, and prevent yourself from
ons: leaning back.
Progression 2: Crimping
● To progress upper body strength levels so that the Upper Body only climbing
progression may be attained.
Purpose:
● To allow an intermediate to build strength, skill and neural adaptation for more
advanced rope climbing exercises.
Muscle ● All muscles involved in elbow flexion, shoulder extension, scapular retraction and
Groups core stabilisation.
Targeted: ● Adductors are involved to varying degrees when crimping the rope.
● Place a sturdy box / chair (approximately knee height) beside the rope.
● Sit on the box / chair with the rope hanging between the knees.
Set Up:
● Grab the rope with both hands at approximately eye level.
● Lift both feet off the ground, whilst still sitting on the box / chair.
1. Pinch your feet together crimping the rope.
- One foot should be higher than the other allowing you to effectively
crimp the rope. It should resemble an ‘S.’ This will anchor you to the rope,
allowing it to take some of the load of your body.
- As your upper body strength levels improve crimp the rope with your feet
less tightly.
2. Grip the rope tightly and stand.
- You should now be off the ground with most of your weight being
Execution: supported by your left foot. The right foot pinching the rope holds it in
place.
3. Release the rope from your feet. Using your abdominals, bring your knees up to
your chest. Re-secure your feet on the rope by following steps.
4. Stand up with your legs, and re-reach as high as possible with your arms.
5. Repeat the inchworm process until the top of the rope has been reached.
6. Loosen the grip of your feet on the rope when coming down.
Support your weight evenly between your feet and hands, slide your feet down
and place hand-over-hand on the way down.
● Ensure you keep your scapular / shoulder blades engaged throughout the entire
rope climb, as climbing places great tension on the musculature revolving around
the shoulder.
Teaching
● To avoid potential strain to the bicep
Points:
tendon, ensure a slight bend is always kept in the elbow.
● Count every pull up the rope as 1 rep and progress only when correct technique
can be exhibited for a minimum of 5-8 repetitions.

Common Allowing your body to pull away from the rope:

Mistakes/ To correct this pull your chest close to the rope at all times, and prevent yourself
Corrections: from leaning back.

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Progression 3: Upper Body only

Purpose: ● Builds upper body tendon, ligament and muscular strength levels through a
vertical pulling plane.
● Simultaneously strengthens 3 major components of grip – pinch, finger and crush
grip.
Muscle All muscles involved in elbow flexion, shoulder extension, scapular retraction and core
Groups stabilisation.
Targeted:
Set Up: ● Grab the rope with both hands at approximately eye level.
● Grip the rope tightly.
● Lift both feet off the ground.
Execution: 1. Pull your whole body up (as you would with a pull up) powerfully with both
arms.
· If this is too difficult: powerfully drive your knees towards your chest as you pull. This
is called a kipping action and will periodically lighten the load of your upper body. Kipp
less powerfully as your pulling strength levels improve.
2. As your head passes your hands, reach your right hand higher up the rope and
re-grip.
3. Pull your left hand to meet you right.
4. Repeat steps 1-3.
5. When coming down the rope. Support your weight evenly between your feet and
hands, slide your feet down and place hand-over-hand on the way down.
● As your strength improves apply less tension on the rope with your feet
and legs until you are descending one arm at a time.
Teaching ● Ensure you keep your scapular / shoulder blades engaged throughout the entire
Points: rope climb, as climbing places great tension on the musculature revolving around
the shoulder.
● To avoid potential strain to the bicep tendon, ensure a slight bend is always kept
in the elbow.
● Count every pull up the rope as 1 rep and progress only when correct technique
can be exhibited for a minimum of 5-8 repetitions.
Common Allowing your body to pull away from the rope:
Mistakes/ To correct this pull your chest close to the rope at all times, and prevent yourself from
Corrections: leaning back.

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Progression 4: L-Sit Climb
Purpose: ● Builds upper body tendon, ligament and muscular strength levels through a vertical
pulling plane.
● Simultaneously strengthens 3 major components of grip – pinch, finger and crush
grip.
● Builds hip and abdominal strength through the anterior plane.
● Promotes active / dynamic flexibility of the posterior muscles of the legs and hips.
Muscle ● All muscles involved in elbow flexion, shoulder extension, scapular retraction, core
Groups stabilisation and hip flexion.
Targeted:
Set Up: ● Grab the rope with both hands at approximately eye level.
● Grip the rope tightly.
● Lift both feet off the ground.
● Lift your legs out straight in front of your body, so it forms the shape of an ‘L.’
Execution: 1. Pull your whole body up (as you would with a pull up) powerfully with both arms.
- If maintaining the ‘L’ position is too difficult: bend your knees until strength
levels progress.
2. As your head passes your hands, reach your right hand higher up the rope and re-
grip.
3. Pull your left hand to meet you right.
4. Repeat steps 1-3.
5. When coming down the rope. Support your weight evenly between your feet and
hands, slide your feet down and place hand-over-hand on the way down.
- As your strength improves apply less tension on the rope with your feet and
legs until you are descending one arm at a time.
- If you become very advanced lower yourself down the rope with arms only
while maintaining the L-sit position.
Teaching ● Ensure you keep your scapular / shoulder blades engaged throughout the entire rope
Points: climb, as climbing places great tension on the musculature revolving around the
shoulder.
● To avoid potential strain to the bicep tendon, ensure a slight bend is always kept in
the elbow.
● Count every pull up the rope as 1 rep and progress only when correct technique can
be exhibited for a minimum of 5-8 repetitions.
● Work up to at least 20 straight leg raises with sound technique before attempting this
progression.
Common ● Allowing your body to pull away from the rope:
Mistakes/Cor
- To correct this - Pull your chest close to the rope at all times, and prevent yourself
rections: from leaning back.
● Not maintaining a full L-sit position.
- To correct this - Perform myofascial release on calves, hamstrings and glutes with
rollers, and stick work to ease improve dynamic flexibility. Static hamstring / calf
stretching will also be beneficial to maintain the L-sit position.

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∙ • Rope Rowing

311
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∙ Full Body Pulling Movements:
Full body pulling movements generally
involve upper body pulling and hip
dominant exercises working together as
a combined unit, and deliver many
powerful training benefits.
Full body pulling exercises can be made
to essentially train the whole body when
a full body pressing movement is added
– A great example of this is a clean and
jerk.
Full body pulling exercises provide
unique benefits such as increased
power output for pulling and jumping,
increased demands on the core and
increased neuromuscular and
cardiovascular demands. These are
great for mixed martial artists, and other
athletes who require a mix of power and
endurance.
They should be only used after basic
strength and coordination through hip-
dominant and vertical/horizontal pulling
movements is developed.
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314
315
∙ Vertical Pressing Movements:
Upper body pressing exercises involve
movement of the object away from your
body. Examples of vertical pressing
exercises are the overhead press or
shoulder-shoulder press. When
executed a full range of motion vertical
pressing movements effectively
strengthen all muscles involving the
shoulder, whilst teaching stabilization of
the rotator cuff.

316
∙ Horizontal Pressing Movements:
Upper body pressing exercises involve movement of the object away from your body. Examples of vertical
pressing exercises are floor presses and shoulder weighted push-ups. Horizontal pressing movements
like the weighted push-ups effectively teach horizontal pushing whilst stabilizing the whole body.

317
∙ Full Body Pressing Movements:
Full body pressing movements
generally involve upper body pressing
and knee dominant exercises working
together as a combined unit, and deliver
many powerful training benefits.
You may choose to use them for their
increased power output, increased
demands on the core or for their time
saving effect, due to training a large
amount of musculature with one
exercise. They should only be
implemented after full range and correct
technique is developed with both
pressing and knee dominant
movements.

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319
320
321
Full Body Exercises:
∙ Twisting Movements:
Twisting movements are often the
missing link in most people’s training
programs. Twisting movements
integrate all muscles in the body to work
in a synergistic manner. They require
the muscles that involve hips, spine and
shoulders to work together and engage
in the correct sequence. Programming
twisting movements effectively can take
your training programs to new levels,
particularly for specific sporting
applications.

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323
324
∙ Carrying Drills / Gait
Movements:
Carrying drills are great functional full
body exercises; they strengthen your
feet and lower body while developing
core strength and upper body isometric
strength. They’re best suited for
developing strength endurance,
conditioning and work well in circuits
with teams of people.

325
Power Ropes:
∙ Rope Exercises:
Rope exercise can have a number of
different movement patterns happening
at any one time, but few of the
movements fit perfectly into any one
group. The rope drills would be the
exception because of its heavy pulling
involvement. Rope exercises have a
reduced eccentric component which
them a great choice for conditioning
exercises. Most rope exercises are
performed quickly so they work well in
timed circuits or high reps.

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∙ Functional Equipment
Programs:
Movements are half of the equation in
an effective functional training program.
The programming methods in which
movements are applied is a very
important factor to develop a specific
and intended training outcome.
∙ Conditioning programs
Outlined below are a number of training
circuits and intervals. The circuits and
intervals can be mixed and matched for
a conditioning program or can be add to
strength training as a warm ups or
finishers.
Complexes are also outlined below.
They are a type of circuit performed with
the one object without rest during the
set. They can be very challenging and
allow you to perform a large amount of
work in a short period of time.
327
∙ Circuits
Circuit Programming Options
1. Perform as many rounds as you can in 10-
15 minutes
2. Time how long it takes to perform X
rounds
3. Perform X exercise for time then rest for
the same amount of time before moving to
the next one
4. Record your results and try and beat it
next time. So for option 1 and increase the
number of rounds/reps and for option 2 you
should try to reduce your time.
* When combining circuits and complexes for
a conditioning session, the session should
last no longer than 60 minutes, with 30-40
minutes being optimal.
3 Exercise Circuit examples:
1. Aqua bag Clean/ Thruster – 10 reps or
30sec on/ 30 sec off
2. Rope wave of choice – 20 reps or 30sec
on/ 30 sec off
3. Dead ball whop chop throw and return - 5
each side reps or 30sec on/ 30 sec off
∙ Complexes
Complexes are a number of specific
movement patterns chained together in a
coordinated sequence. They deliver potent
training outcomes for fat loss, whole body
muscular and cardiovascular endurance.
Complex programming options:
1. Perform as many rounds as you can in 10-
15 minutes
2. No rest between a-e, then repeat 3- 5
times
3. Time how long it takes to perform X
rounds
Record your results and try and beat it next
time. So for option 1 and increase the
number of rounds/reps and for option 2/3 you
should try to reduce your time.
* When combining circuits and complexes for
a conditioning session. The session should
last no longer than 60 minutes with 30-40
minutes being optimal.
Complex programming examples:
Aqua bag / sandbag Complexes 1
1. Back lunge side swings - 5 reps each
leg
2. Clean - 5 reps
3. Thrusters - 5 reps
4. Jump squats (bag on back) - 5 reps
5. Bent over row - 5 reps
Aqua bag / sand bag Complexes 2
1. Upright row 5 reps
2. Snatch 5 reps
3. Back lunge 5 reps (each leg)
4. Back squat jumps 5 reps
5. Thrusters 5 reps
6. Press 5 reps
Slosh Ball Carry Complex
1. Front lunge
2. Walk 5 meters
3. Squat
4. Walk 5 meters
5. Slosh ball good mornings
6. Walk back 10 meters
7. Max push-ups on the ball
Power Ropes Programs:
Ropes are best programmed using
timed interval based training methods.
Interval training involves an intense
work bout followed by recovery bout.
The recovery bout can be performed
two ways:
1. Complete rest (passive recovery):
Passive recovery is commonly used
when the intensity is very high or with
people at a beginner level of training
experience and conditioning.
2. Active recovery: Active recovery is
used to help blood return to the heart
and to help maintain your heart rate. It
is best applied with a participant who
has a more intermediate to advanced
training level / conditioning base.
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Aerobic Conditioning: Work to rest
ratios of 1:1 or 2:1 are outlined below.
These will target the aerobic system.
2. Anaerobic Conditioning: If you wish
to target the anaerobic system you
could perform intervals of 1:3, e.g. 30
sec on 90 sec off.
Interval training protocols are outlined
with the power ropes. However you may
wish to use other tools, all you need to
do is swap or add an exercise in to the
program.
Power Rope Intervals:
1. Alternating
2. Spiral
3. Twist
4. Two arm wave
5. Side to side
Perform one of the following intervals:
Level 1: 15 on 15 off 3 rounds rest 2
mins x 2-4 times
Level 2: 30 on 30 off 2 rounds rest 2
mins x 2-4 times
Level 3: 20 on 10 off 3 rounds rest 3
mins x 3-5 times
Level 4: 30 on 15 off 2 rounds rest 2
mins x 3-5 times
Strength Programs:
The programs below are full-body
strength and power programs. Perform
2-3 of these workouts a week and
change them every 3-4 weeks. Or
perform 1 a week with your normal
programs for a different training effect.
Suggested sets and reps and have
been given, however, see programming
options for other sets and reps to suit
your desired training outcome.
Sandbag Strength and Power
program
1a) Sand-Bag Clean 3x 3-5 sets
1b) Military press 3-5x 3-5 sets
2a ) Zercher squats sand bag
2b) Sandbag weighted push up
3a) Sandbag TGU 4 x 3-5 sets
3b) Sandbag Bent over Row
All in Power program
1a) Dead ball Back thruster 5 x 3 sets
(walk and throw back)
1b) Wall Ball wood chops 5x 3 sets
(each side)
2 ) Sandbag shouldering 4 x 3-5 sets
3a ) Aqua bag Push press 5x3-5 sets
3b ) slosh ball good mornings 5x3-5
sets
Three way General Strength
1. Slosh ball
1a. Slosh ball Floor press 5-10 x 3-5
sets
1b. Push up on Slosh ball 10+ x 3-5
sets
1c. Dead slosh ball Squat 5-10 x 3-5
sets
2. Aqua-bag
2a. Deadlift (bag in between feet/ inter
lock fingers) 5-10 x 3-5 sets
2b. Up right row 5-10 x 3-5 sets
2c. Bent over Row 10+ x 3-5 sets
3. Aqua-bag
3a. Aqua bag Side Lunge 5-10 each leg
x 3-5 sets
2b. T.G.U 3-5 each side x 3-5 sets
2c. Floor Fly 10+ x 3-5 sets
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Strength Programming Options:
General set and rep guidelines to
effectively train a range of strength
qualities are outlined below:
Strength Focus: 5 reps x 3-5 sets,
Rest 2-5 minutes between sets
Power Focus: 3 reps x 3-6 sets, Rest
3-6 minutes between sets
General strength/ size gains: 6-12
reps x 3-5 sets, Rest 1-2 minutes
between sets
Programming Considerations:
Designing Your Training: When
combining strength and conditioning
programs try to keep the
session no longer than 60 minutes. The
strength section should be performed
before the conditioning. The session
break down could look like this:
a. Balanced Strength + Conditioning:
30 minutes strength (using a specific /
mixed focus), 30 minutes of conditioning
work.
b. Strength focus: 40 minutes of
strength/ 20 conditioning.
c. Conditioning focus: 20 minutes
strength/ 35 minutes of conditioning.
Putting it all together:
Perform these programs for 21-28 days
then have a light week and change the
program. Below are some weekly plans
that combine strength and conditioning
programs.
3 days a week
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8.6 Exercise programs for body
composition goals
This is unit describes and outlines
knowledge to be able to plan and
execute safe and comprehensive
programs for individuals looking to
change and maintain body composition
goals.
This unit does not outline the effects
and complementary effects of changing
and maintaining healthy eating goals,
however it will outline the appropriate
training methodologies that work in
conjunction with a healthy diet, in
relation to energy in and energy
expenditure.
This unit will look at the training that is
recommended when looking to reduce
body fat for both healthy living goals, as
well as training and competition
preparation for peak physique bodies.
Energy and body composition goals:
Weight gain occurs when the energy
expenditure is less than energy intake.
When the goal is to lose weight, it is
important to encourage the client to
work with a dietician or nutritionist at the
same time. Powers & Howley, (2001)
state that exercise is not the key
component to achieving weight loss; it is
predominantly recommended that the
calorie/kilojoule is reduced.
Motivating the client to complement
their training with healthy eating is
essential if they are to achieve their
body composition goals. It is important
to recognize your qualifications and
knowledge to be able to provide the
most effective advice.
As a trainer, we can provide guidance to
good nutrition, however working with a
general practitioner, dietician and/or
nutritionist will optimize the results for
the client and provide them with an
individualized experience to achieve
their goals.
Weight gain is often due to a
combination of large quantities of food
intake as well as
immobility and therefore it is essential to
include an exercise program into the
weight loss program.
Some of the effects of increasing
physical exercise is an increased
amount of hunger, so the client should
be educated about this and guided to
making healthier food choices to
improve their energy, and optimize
training and recovery strategies.
331
Risks associated with Immobility
∙ Increase in the risk of
cardiovascular diseases; the heart
is like any muscle in the body, and
if it is not being trained through
physical activity that the size can
decrease, causing the heart to
work a lot harder to circulate blood
throughout the body, affecting
blood pressure.
∙ Weight gain
∙ Decrease in BMD and therefore
higher risks of developing
Osteoarthritis
∙ Higher risks of depression
∙ Lowers self-esteem
∙ Metabolic Syndrome
Barriers to PA adherence
Often client’s whose goal is to lose
weight are carrying with them past
emotional traumas, or disappointment
and judgment from past weight loss
failures. Clients then need to be
monitored and communicated with
cautiously to balance the level of
motivation, and challenging them and
their preexisting beliefs or barriers.
It is also important to recognize your
level of training and expertise and refer
clients who are experiencing
psychological difficulty to a professional
in this area.
There are two behavior health models
which will assist trainers and clients
through common barriers or behavior of
starting up a new fitness program.
Behavior health models are:
● Health belief model
● Trans-theoretical model of behavioral
change
Health belief model
This model predicts that the
client/individual will enroll in physical
activity and health and
wellness changes based on:
Perceived health threats: The client
may have had a health scare, or have
been warned by a health practitioner
about risks that could be developed if
their health behaviors don’t change. It is
important to not scare the client by
mentioning health risks from sedentary
behaviors or obesity, however the client
should be educated and provided with
options and resources that outline the
accessibility of health improvements.
The client should feel supported
throughout
the process of adopting change.
Trans-theoretical model
This model will assist the trainer to
outline common experiences and
behaviors that can happen when
adopting a new training program.
For more information refer to the long-
term programming unit in this course.
332
Initiatives to promote healthy
lifestyle changes:
Example: 10,000 steps a day
This is a great initiative to motivate
clients outside of training and
encourage self-motivation.
It also will encourage clients to look for
opportunities to be active outside of
planned training sessions.
Examples of everyday opportunities to
increase number of steps:
● Take the stairs
● Walk to locations which are in close
proximity instead of driving
● Social walking catch ups or meeting
The step challenge does not specify
intensity, so it should be encouraged to
add in 10 min bout high intense
intervals to progress weight loss goals
for the client.
The trainer should check in with the
client to keep them accountable for their
step challenge.
Somatotype and training for body
type:
This term refers to the characterization
of three body type categories. When
training clients for body composition
goals it is important to understand that
humans will all have different body
types depending on their genetics,
environmental upbringing etc. So these
three categories can be considered and
helpful but should not be a main focus
of training. Somatotypes referencing
simply guides us to observe that the
client’s body will develop differently
depending on which one they are or
simply their genetics and upbringing
history.
This definition falls under the belief that
our genetic makeup will determine our
body shape. Body shape does not
define health and we cannot train to
look like someone else, therefore our
shape reflects our unique selves.
Body shapes can be influenced by:
● Genes
● Culture
● Habitat
● Social influences.
333
Endomorphy: This shape represents
someone who is more round in
appearance. They will have a large
digestive viscera. The word endo
relates to the endodermal embryonic
layers from which the digestive tract is
derived. Powers & Howley, (2001).
Generally speaking this body type looks
in appearance more “chubby” so
training for weight loss could be a
common goal.
Mesomorphy: This shape has a more
relative amount of muscle, bone, and
connective tissue.
The word meso derived from the
mesodermal embryonic layer. Powers &
Howley, (2001). They are generally
more of a medium shape and a
common goal could be to gain more
muscle.
Ectomorph: This shape is
predominantly linear so a more straight
and minimal curved body. It can be
fragile with greater surface area to mass
ratio giving it a greater sensory
exposure to the external environment.
The nervous system is derived from the
ectodermal embryonic layer, therefore
giving its name. Powers & Howley,
(2001). Being more of a fragile body
type, more hypertrophy gains can be a
common goal to build muscle and
protect and support their structure.
334
Aerobic exercise for body
composition goals:
The Heart:
The inclusion of aerobic exercises will
assist to train and strengthen the heart
muscle. If the client is obese or
overweight their bones can be weak
and therefore it is recommended when
first initiating programming for the client
to begin with low impact exercises, such
as cycling on a stationary bike, rowing,
boxing or fast walking to increase the
Heart Rate.
Clients who are at risk of heart disease
should be monitored closely to avoid
exceeding their Max HR which could
place too much stress on their heart and
body. Monitoring tools can include
wearing a HR monitor, the Borgs test
and observing the client’s performance
and breath, and asking the client for
feedback as to how they are feeling.
The respiratory system and posture:
The respiratory system is also affected
with the chest muscles weakening,
resulting in a decrease in lung
expansion and more chest breathing, if
the breath cannot move efficiently
through the body then this will place
more pressure onto the heart. Emphasis
on posture and correct breathing is
therefore an important factor to
introduce to the weight loss program as
a starting and staple inclusion.
People tend to brace or hold their
breath, when exercising but it is
important to continue to circulate the
oxygen, to maintain good posture, so
the breath can assist in executing
movements. The trainer should assist
the client by cueing correct timing for
breathing when executing exercises.
As the client eccentrically moves,
(lengthening) or effort phase the inhale
breath will assist to reach full range of
motion in the given exercise, as the
muscle concentrically moves the exhale
breath should be promoted.
Exercise examples and breathing:
E. g., During the bench press you
should exhale slowly to press the load
to full range and then inhale to stabilize
and hold before exhaling to return to the
beginning.
Types of Cardiovascular training
Interval training:
Interval training is a great option to
include in training schedules to improve
cardiovascular fitness and lose weight.
The training can be customized to suit
the conditioning of both endurance
training and anaerobic fitness. It
enables the client to challenge
themselves with repeated exercise
bouts of low to high intensities
depending on the desired training
outcomes.
Studies outlined by Powers and Howely
(2001) suggest that adding high
intensity bouts to endurance training will
actually develop the clients VO2max
more than working at steady state
intensity levels for longer periods of
time, hence interval training is effective
and time efficient for optimizing results.
more specific to endurance gains.
Working at higher intensities for a
shorter duration will be more specific to
the anaerobic system, recruiting a
higher number of fast twitch fibres can
improve the individual's metabolic
health.
Interval training sessions are
programmed using the following 335
variables:
∙ Duration/length of the interval:
Referring to the duration of work in
each set. Powers and Howley (2001)
state that work efforts over 60
seconds are generally improve
aerobic power and under 60
seconds is more anaerobic.
∙ Intensity of the effort:
Use the max HR test to determine
the intensity of work. High intensity
is generally above 80% MHR.
∙ Rest interval:
Longer rest intervals allow the
individual to work at higher
intensities for longer, rest duration
should generally be equal to the
work duration. Extending the rest
intervals will give the individual a
longer opportunity to lower their HR,
shorter rest periods encourage work
efforts above the individual's comfort
zone and should be monitored for
overtraining symptoms. It should be
noted that when including a HIIT
program for weight loss goals, the
clients especially those who are
classed as overweight or obese
should also be including workouts of
lower intensities and lower weight
bearing, and restorative strength
training. Working at higher
intensities repetitively or for long
duration can place excessive stress
on the bodies muscles bones, joints
and nervous system and so
adequate amounts of rest or at least
48 hours between sessions to allow
muscles and tissues to repair.
∙ Number of sets and repetitions:
The sets and reps will be depend
upon the purpose of the training and
fitness levels of the client(s).
HIIT programs
These programs are a form of interval
training and can include a variety of
exercises depending on the
performance goals worked at high
intensities for a number of short bursts.
HIIT programs also known as Fartlek
training have become increasingly
popular for clients to achieve weight
loss goals fast. When the heart is
introduced to a high work level from
high intensity workouts we secrete our
adrenal hormones also known as our
fight or flight hormones epinephrine and
norepinephrine. These two hormones
work to catalyse lipolysis which is the
breakdown of fat and predominantly
target subcutaneous and visceral fat
stores of the abdomen, Kravitz (2014).
Physiological Benefits of HIIT
programs as found by; Boutcher,
(2011)
∙ Improved VO2 Max and Cardiac
health
∙ Increased secretion of adrenal
hormones epinephrine and
norepinephrine for lipolysis and fat
burning
∙ Improved HDL (High density
lipoproteins) to transport
cholesterol from the artery walls to
the liver for removal
∙ Decreased BP (blood pressure)
∙ Increased HGH (Human growth
hormone)
∙ Increased tolerance to lactate
threshold
∙ Elevated Sympathetic nervous
system
∙ Decreased parasympathetic
nervous system
∙ Improved venous blood return and
increased stroke volume
∙ Increased testosterone levels
∙ Example Strength Gains workouts
336
using Interval training
Body Complex workouts
Strength and body composition
This type of interval workout focuses on
splitting upper body muscular Exercise will assist to support the
complexes and lower body muscular excessive weight gain and strengthen
complexes. It’s a great workout to the body; Inactivity will cause
include as a challenger at the end of a degeneration of bones and mineral
session moving through 4-5 exercises density increasing the risk of
performing as many as you can in the osteoporosis, muscle catabolism. If the
designated time-frame. As the client body cannot support its structure
improves rest intervals can be shorter through movement then the client’s risk
and work intervals and/or load can be of falls, bone breaks and muscle strains
increased. is heightened. Weight training is then a
very important component to a weight
Workouts can also be more power loss program to increase BMD,
focused to work the Total Body, with or including exercises that challenge core
without resistance. E. g., Burpees, stability, which will then assist the
followed by sled drags repeated for individuals balance control, and ability
approximately 10 min. to support their body, and posture
through a range of both everyday
challenges and activities and to support
Lower body complex interval session the execution of exercises.
example:
Resistance training should include
In this workout, the focus is on multi-joint training that target larger
compound muscles of the lower body, muscle groups of the back, chest,
individuals should aim to complete the shoulders, hips and legs.
session in 8-10 minutes. An active rest
should then be about 10 minutes of Single joint exercises are also
walking or active stretching. recommended to target abdominal
muscles, biceps, triceps, hamstrings,
quadriceps, lumbar extensors and calf
muscles.
Sets/ For weight loss goals it is recommended
Exercise Load
Reps that deconditioned individuals should
70-80% begin with a lower resistance, and low
Barbell squat 1 5-8
RM intensity and higher repetitions of about
10-15 this will develop the client for
Good 70-80%
1 5-8 more endurance strength training, but
morning RM
with a higher number of repetitions the
Dummbell 70-80% client can then become more
1 5-8
lunges RM accustomed to the training, and learn
Seated Leg 70-80% the correct technique more effectively.
1 5-8
Press RM As the client improves, the training can
Barbell 70-80% then be progressed by increasing the
1 5-8
Deadlift RM intensity, the load, and then decreasing
the rest. The rest should be about 2-3
minutes depending on the fitness level
and goals of the individual. 337
For more power strength training, rest
time can be shorter, for more Weight loss program:
hypertrophy strength gains, rest time Clients are already carrying weight so it
can longer. is not recommended to not prescribe
It is recommended that clients should high impact weight bearing activities,
have at least 48 hours of rest between such as box jumps, or running for long
strength training to allow the muscles to periods of time.
recover and muscular and neural Due to the excess weight being carried
muscular benefits to take shape. usually on the front of the body, the
If the client is wanting to train at a client often experiences back pain or
higher frequency then the trainer should strain so beginning with exercises which
take be mindful of the exercises being promote stabilising through the core to
prescribed and muscle groups used, support the posture and spine can be
muscle groups should then be changed effective.
to allow rest for those already trained. Weight loss can be achieved at any
E. g., Single leg dead lift intensity, however if you’re wanting to
train for longer periods then a lower
- Stand with feet hip-width apart. intensity (25% Vo2 max) is preferred for
Depending on the client’s strength weight loss as it can be sustained for
this can be done with a dumbbell longer periods of time. Monitor the
or begin initially with body client’s performance and fitness level
resistance to correct the with evaluations every 4 weeks.
movement first.
- Hinge forward from the hip at
90bmi degrees, as you lift the
extended leg behind you so that
the body is parallel to the floor,
with arms hanging down from
shoulder to wrist.
- Return to beginning.
- 15-20 reps
- 2-3 sets each side
- 50-70% 1 RM load
- Target muscles: Glutes and
hamstrings
If glutes and hamstrings are tight, this
will restrict the range of the movement,
so some stretching before commencing
this exercise is recommended. Eg,
walking forward kicks.
Look out for arching of the lower back to
compensate for weak core strength.

338
 Monday Tuesday Wednesday Thursday Friday Saturday

Upper body
Workout
Lower body Cardio
Core workout workout training
8-12 Reps Total Body
20-30 mins
Functional Rest
(Body 8-12 Reps + HIIT
3-5 sets Training
resistance) 20
3-5 sets Mins
Low-mod
load

Week 4
Upper body
Cardio 30
Core Total body mins
Progressions training Lower body
Total body (Add further Strength
(Strength) HIIT 20
Functional instability training Rest
Progress lifts mins
Training challenge of
to more multi (increase
swiss ball or 6-8 reps
dimensional power
weights)
exercises)
2-3 sets
Mod- high
+ loads for
increasing
Flexibility strength and
hypertrophy

Information for clients using this

program:
∙ This program is to be conducted
three times a week.
∙ This program should be re-
evaluated after 4 weeks to keep
specific to client
∙ This program is designed for an
overweight adult looking to lose
weight
∙ The client must obtain a Medical
clearance before commencing this
program from a doctor/physician
∙ Any exercise undertaken that
results in problems for the client
should be ceased immediately
∙ For load levels: client must work
with trainer to determine 1RM for
each exercise in a separate
session before commencing
program
∙ Load for exercises should be
performed at 75-85% of 1RM
Body Composition for Peak
Physique aesthetic transformation
Training the body to perform it’s best is
definitely a priority in training programs,
but when it comes to peak physique
training and competition, looking your
best and strongest on stage without
equipment props is what’s going to get
your client the glorious outcome they’re
looking for.
6 Keys to getting the a gold medal
strong body:
1. Periodization training
2. Train Symmetrically
3. Train for stamina and muscular
endurance for fat loss and lean muscle
4. Train for maximal anabolic
conditioning
5. Nutrition 339
6. Rest
Body composition training for
females: Weight loss
Weight loss is a common goal among
females and an ongoing practice, due to
habitual patterns that are developed.
Training then should focus both on
psychological pattern changes and
encourage healthy choices.
Healthy choices could include:
● Portion control
● Walk more when possible/choose
stairs
● Active social interactions, or finding a
workout buddy

Exercise programming should be

focused on assisting the client to feel
motivated to adopt these conditioning
patterns, both in training and in their
lifestyles, therefore programs should
include functional training and a variety
of exercises that are specific to the
clients likes and needs alike.
The American physiological Society,
(2016) found that women rely more on
human growth hormone than men for
weight loss and muscle and bone
anabolism so long-term workouts
should include moderate to heaving
loading cycles

340
8.7 Instructing group training
sessions
This unit takes on the key foundations
established in the Instructing fitness
programs unit and uses them to dive
deeper into key components needed to
plan and conduct fitness sessions
specific for groups. Groups training
sessions can be made up of a range of
different clients all with their own
personal goals and needs to careful
consideration to risk management and
safety should be applied as well
ensuring programs are looking at
maximal benefits in that time
frame.
Risk management of group training
1. Perform and refer to pre-exercise
health screening
Clients should all provide prehealth
screening information about any
preexisting or current injuries, goals,
health considerations or concerns so
that any potential risks of harm or injury
can be avoided.
2. Individualization and Specificity
When working in a group fitness
environment it is important to still
maintain a high level of specificity and
consciousness of the individual needs
of your clients.
3. Be aware of potential limitations
and needs of the client
Clients should be informed to be aware
of their own needs and bodies
communication if exercises are difficult,
or if they feel discomfort throughout the
session.
4.Refer to risk management analysis
prior to each session
A thorough identification of risks and
management procedures should be
done, with regular reviews of its
success.
5. Work under the ratio laws and
regulations by the fitness industry
Working under the recommended ratio
guidelines of your national, state and
local laws with relevant qualifications
and confidence in your skills should also
be considered. Training sessions should
always be readily adaptable depending
on the client’s, environments etc.
Ratios will also depend on:
- The experience and qualifications of
the trainer
- The fitness level and health conditions
of the clients
- The intensity and type of exercises
- Insurance restrictions
- Intention/aim of the session
6. Sessions should be able to be
adaptable:
- Providing exercises that are not
complex, and that are suitable to a wide
range of needs
- Utilizing a more controlled space so a
high level of observation, instruction and
correction can be provided.
- Monitor different levels of fitness
ensuring you’re catering by providing
progressions, regressions or further
assistance to those who require further
attention. In the case that an individual
may need more specialized attention it
is important that referrals for more
private
training are being made.
341
Client motivation
Self Motivation
● Many clients that are looking for groups
based workouts are also looking for more of
a “kick-start” back into a healthy movement
routine. Therefore, it is important to develop
a strong rapport with each client to be able
to continually motivate them and maintain a
fun and engaging training environment.
Look for feedback from clients individually
and as a group to ensure the sessions are
meeting their needs and they are enjoying
and understanding the reasoning and
intentions behind the workouts.
Social Motivation
● Many clients are looking to meet like-
minded people whom share an interest in
improving their health, providing
opportunities for team building or
socialization within session can also be
rewarding and beneficial for both physical,
mental and social health benefits.
Competitive motivation
Monitor the group dynamics and try to
ensure all clients goals are being met.
Friendly competitions can be great to
encourage clients to engage with their
natural competitive instincts and challenge
themselves.
Benefits of Group training:
- Social inclusion and motivation from
others as well as the trainer
- Sessions are usually aimed at general
fitness so can be accessible for most
people’s needs
- Sessions offer an introduction to a variety
of training types and exercises to keep
clientele engaged which can increase their
adherence to physical activity
- Affordability, generally group training is a
lower cost than personal training so this can
be attractive to individuals looking to get
back into fitness.
Circuit Training for groups
● Using a circuit style of training is a
great way to introduce a range of
exercises to a group of clients, allowing
for varied fitness levels.
● Exercises can easily be progressed or
regressed to suit each station.
● Exercises can work a range of
systems, training for cardiovascular
fitness, strength, power etc. all in one
session as the client moves through
each station
● The varied exercises provide
enjoyment for the client’s as they can
always change
● Clients can grow familiar with
exercises technique by repeating
throughout the circuit.
● Usually the duration that the client will
spend on each exercise station will be
timed so intensity criteria, (Resistance,
tempo etc.) can be adjusted to suit
maximal results within that time frame.
● Circuit training sessions are usually
planned with a variety of exercises and
minima rest in between, preparing for
maximal results in a limited time frame
Prior to commencing training the trainer
should refer to pre-exercise screening
information about the clients who are
participating in the session.
If a client is participating casually to the
session and has not yet done a formal
screening, then key information
discussed in the health screening unit of
this course should be found. This
information ensures the trainer is aware
of any limitations the client(s) may have
to training.
Exercises can then be modified if need
be to ensure safety of the client. An
organized easy to follow approach can
be taken when planning the circuit
session using the
following guidelines:
342
Periodization phases of a circuit
training program
1. Preparation/Warm Up phase
● Warm ups should be specific to the
intention of the proposed workout and
training session, they serve as an
opportunity for the client to become fully
conscious of their body and it’s
movements noticing any restrictions or
abnormalities that may need to be
addressed or voiced to the trainer
before commencement of the session.
● Purpose of the chosen
exercises/stretches should be
communicated the client and
demonstrated for visual feedback.
● Depending on what lifestyle and work
the individual is involved in, these
movement patterns and habits will need
to be addressed, as well as the
psychological focus of the client as
these can all affect the training
performance and results.
For example; If the client spends a lot of
time sitting over a computer then a
warm up focus on postural alignment,
hip flexor release and glute awakening
will need to be included.
● The warm up should be about 10
minutes long, at a low intensity to
prepare the individual for the session
ahead.
Coaching/Trainer Observations in
the preparation phase:
● Observe any difficulties, shortening of
range, possible compensation or strain
from the client to perform the exercise
and make adjustments if needed.
● Adjustments could include breaking
down the exercise further to perfect the
skill, or changing the resistance or
intensity.
2. Conditioning
This phase refers to the exercise
selection for the program.
● The exercises should reflect the goal
of the session/program. If the plan is for
strength then more strength resistance
exercises should be included. If the
session is for cardiovascular fitness or
muscular endurance then the exercises
should reflect this.
● The circuit session is conditioning the
client to perform better, specific to their
goals and perceived fitness outcomes.
● Exercise purpose and technique
should be communicated with clients
including demonstration and
regression/progression options to
ensure safety and individualization of
their performance.
● Communicating the effects of each
exercise on the body and health
benefits will also help to motivate the
client through the session
3. Recovery
The cool down phase should allow the
body to relax and return to its normal
rhythm. Including more static stretches
to assist breath direction and tension
release of muscles used.
● Cooling the muscles down will also
assist in returning them to their normal
length tension relationship, taking them
out of stress mode for gains.
● Myofascial release techniques,
assisting the connective tissue to
release can also be used.
343
4. Adaptation
How the body feels and looks after a
training session- this is what the clients
are all looking for…. The results!
Depending on the goal of the program
varied results can be achieved, e.g:
- Improved strength
- Improved mobility/flexibility
- Weight loss
● Often when clients are doing a new
exercises or style of training they will
experience a brief duration of Delayed
Onset Muscle Soreness (DOMS)
This is a period where the nervous
system is taking on the benefits and
learning’s of the session, so muscle
patterns can be formed. The muscles
are also taking on adaptations of growth
and change in response. This effect
should only last 2-3 days.
● The client should be monitored for
overtraining, if the body has been
placed under too much stress and if
recovery is taking an abnormal amount
of time, e. g., DOMS effect lasting past
the 3 day period. Precautions of rest or
possible referrals to allied health
professionals should then be taken.
Resistance training and group
training
CrossFit:
There has been an increase in the
popularity of resistance training among
individuals recognizing the benefits of
weight training. The introduction of
CrossFit has had a rapid influence on
lifting communities and training offering
workouts that introduce the individual to
a variety of lifting, as well as power
lifting, and functional training.
CrossFit for Peak physique training
CrossFit should be used as a variation
to hypertrophy training, it is designed to
be more about improving muscular
power and endurance rather than for
muscular isolation and aesthetic gains.
Using functional strength goals to
develop strength, CrossFit sessions are
usually based around high intense
interval training to improve
cardiovascular fitness as well as
strength.
Benefits of CrossFit training:
● Physiological improvements:
- Improved body composition and
lean body mass goals
- Improved muscular endurance
and resilience
- Improved functional health and
fitness
- Improved metabolic rate
● Exercise adherence and
motivation:
- Use of time to motivate clients
to complete the most out of work
in that time-frame
- Recording results can also
motivate clients each session to
continually be looking to improve
their performance and progress
faster
- Done in a group setting the
comradery within CrossFit
communities can be a
motivational contributor to
continue.
- CrossFit is appealing to
competitive individuals so perfect
for those competing in peak
physique training looking to
better themselves and compete
against others. The rise of
CrossFit games adds another
avenue to work towards for peak
performance and training
344
CrossFit training and considerations:
● When starting CrossFit a prehealth
screening should be done
● Fitness assessment should be done
including testing to establish current
level of fitness and lifting capacity and
technique.
● Begin with low resistance and high
repetitions to improve muscular
endurance, cardiovascular fitness and
smooth out lifting technique.
● Progressively increase load as fitness
and technique improve, monitoring
performance and avoiding overtraining.
● Progressively introduce different lifting
techniques, like Olympic lifting, once
foundation movements have been
established and assessed for good
execution and control
● Training should include mobility and
flexibility training to improve ROM and
control
● Warm ups should prepare the body
for the session and cool downs
assisting the commencement of
recovery and muscle rejuvenation and
adaptation

345
8.8 BodyBuilding training
Training Programs
In this unit we will look that the training
involved specific for bodybuilding 1. Periodization
outcomes. Like the name describes Training programs should use the
bodybuilders are looking to build the periodization model for fitness
growth of their muscles, showing their programming and competition
strength off in high definition growth and
muscular shape with minimal planning. More on the periodization
percentage of fat in body composition. model of planning can be found in
In this section we will look at how we the long-term planning unit of this
would train a client looking for this manual.
result.
2. Body control and stabilization
Depending on the experience and
Risk management considerations fitness level of the client, training should
prior to training first focus on the control, and
stabilization of the body.
When training for stage performance as
a bodybuilder this can place the client’s 3. Cardiovascular fitness
body under a lot of stress requiring
They should also focus on
them to be strict on their diet and
cardiovascular fitness to reduce body
planning as well as their body to get to
fat. More on body composition and
an optimum winning level.
training can be found in the body
● Detailed health screening and fitness composition unit of this course
testing will need to be completed to manual.
assess the fitness level and health of
4. Hypertrophy training
the client
Once mobility, stability and
● Regular fitness appraisals and testing
cardiovascular fitness is established the
will need to be completed when training
client can focus more intently on
the client for competition
muscular growth and definition through
● Consideration to the client's hypertrophy training.
psychological state will then be very
important requiring clearance from a
medical practitioner not just in physical
health to prepare them for the training
load but also for their mental health.
● When planning and training programs
the client should also be referred to
work with a qualified sports nutritionist
or dietician to assist in individualized
meal plans that complement their
training.

346
Hypertrophy training:
Frequency of Hypertrophy training:
Hypertrophy is the growth of muscle
size. As muscles get larger there is an Increase in training volume, allows for
increase in sarcomeres and cross more neuromuscular adaptations for the
sectional area of the muscle unit. brain and body to learn, recover and for
muscle anabolism to occur.
Benefits of hypertrophy training:
In a study looking at the effects of
● The more “bulk” our muscles have the training volume, and protein synthesis
stronger we are to protect our skeleton, by increasing weekly
for example we are armored for any
collision activities in sport. training volumes and the number of sets
completed within a session; Schoenfeld,
● Larger muscle size also enables us to (2016) found
prevent any unwanted movement of our
muscles and joints at a given time. that when muscle biopsies were taken
there was an increase in key proteins
● Adaptations for muscle hypertrophy needed for increasing the speed of
are visible overtime as progressive protein synthesis and increasing
overload is implemented to increase muscular hypertrophy.
intensity and resistance overtime with
low repetitions and multiple sets It is important to recognize the risk of
detraining and overtraining if training
volume is not managed correctly.
Hypertrophy training principles: Trainers should use the principles of
progressive overload and perform
Bodybuilders need to be heavily
conscious about their nutrition and regular fitness appraisals to check in
macronutrient intake to complement with the training effects for the client.
their training for muscle gain, muscle
repair and fat reduction.
Diets should be:
● Balanced for energy as discussed in
the nutrition units of this course.
Balancing training and energy output
with energy intake from macronutrients
and potential supplementation to
promote muscle anabolism, fat
reduction and muscle repair.
● Training and meal timing is then also
essential to promote good health,
digestion and adaptiveness to training
and muscle anabolism.
More on nutrition and training can be
found in the nutrition unis of this
manual.

347
Split Routines:
If we’re wanting clients to work at high
intensity over a high volume of training
days then we need a workout that will
allow the client to do this without
fatiguing too quickly and putting them at
risk of overtraining.
● Split routines allow the training
volume to be distributed among body
parts. The client would perform multiple
sets per muscle group allowing already
these muscle groups to work at a high
volume and intensity. Muscle groups
that are not the primary focus of a
particular workout and can be
sufficiently rested, and once trained an
increase in muscle repair, metabolic
stress, and muscular anabolism;
Schoenfeld, (2016).
● For example: Begin a workout week
with Core strength and stability, moving
into a back day, followed by chest and
finishing the week with glutes and legs.
This allows client to train all week whilst
still providing enough rest for the
muscle groups worked before training
them again. Generally each muscular
group should have at least 2 days rest
before training again to allow for DOMS
symptoms to be relieved and muscular
and neural adaptations to take place.
Split Workout routine example:

Training day Training Focus Example exercises

Monday+ Core stability Swiss ball knee tucks V sit
Wednesday
Planks
Tuesday + Back + chest + Chest Press Pull ups
Thursday arms
Lat pull down
Wednesday & Legs + glutes Dead lift Squats Split lunges
Friday
Saturday Cross training Rock climbing Cross fit
Sunday Recovery Yoga/Stretching
348
Intensity of hypertrophy training:
For maximal muscular growth, clients
working towards bodybuilding and
hypertrophy goals are recommended to
work at a high intensity 75-85% max
1RM for muscular adaptations and
growth to occur at a faster rate.
● Schoenfeld, (2016) outlines that to
gain higher amounts of neural activity
and metabolic stress to enhance
muscular size training intensity should
be high, with low repetitions and as
discussed previously over multiple sets
● Because there is maximal force
needed to lift heavy loads at a high
intensity the client is recruiting more
Type 2 muscle fibres for high energy
output and greater cross sectional area
for muscular anabolism.
● Repetitions should be between 6-12
and Sets of 3-5 rest intervals depending
on fitness level should remain short to
promote the client working in the ATP-
PC range for high force and muscular
growth.
Tempo:
Adjusting the tempo when training for
bodybuilding outcomes and competition
is a great way to trick the mind into
thinking a load you have lifted before at
a faster tempo is heavier. By slowing
down the movement tempo or repetition
speed you increase the muscle length
tension
relationship and therefore increase the
amount of force to execute the exercise.
One way this can be demonstrated is by
manipulating the length of time the
muscle is contracted or lengthened
when performing a loaded exercise:
Eccentric Training:
Referring to the lengthening of the muscle,
Komi, Kaneko, & Aura found that eccentric
conditioning is greatly important to the
performance outcomes of hypertrophy
training, where there is a greater force per
unit of muscle size being produced.
Application:
● Eccentric training is when you
predominantly train in an eccentric phase.
● A training partner or professional trainer is
advised to support the movement. The client
would perform the eccentric part of the
exercise whilst the trainer would assist with
the concentric.
● Another way to train eccentrically is to
perform the movement as normal, including
the concentric action but performing the
eccentric action more slowly to emphasize
that action more intensely and the muscles
working
● It requires the client to work at a higher
intensity to push a lot harder, and past your
point of failure then when you would perform
exercises concentrically as well.
● Loads can be increased and reps would
be increased to get that extra repetition in.
Benefits:
● Training at this level can be very beneficial
to increase muscular fiber size and number
increasing the load tolerance.
● Increase number of fast twitch fibers
recruited for muscular hypertrophy gains
● Improved muscle coordination
● Improved strength across movement
speeds
349
Safety guidelines for eccentric
training:
∙ Clients should not be encourage to
do this style of training without the
guidance of a trained and qualified
trainer.
∙ The trainer should assist with the
concentric phase so that full force
can be used by the client in the
eccentric phase.
∙ Appropriate rest is then required to
repair muscle fiber damage.
∙ Due to the overtraining risks
associated with training to failure, it
is not recommended to do a whole
workout of eccentric training,
Locke, (2013).
Exercises examples:
Bench Press
Can we then train Concentrically
only?:
The concentric action is the shortening
phase of the muscle, and considered to
be more the recovery phase of the
movement. When the muscle is
lengthened in the eccentric phase this
where the muscle tissue is placed under
stress to develop further strength and
gains.
If we were to train only concentrically
you would not be strengthening the
muscle, however you’re still bringing
blood flow and nutrients to the area, so
this style of training would be preferred
for more rehabilitative training where the
eccentric loading and stress is removed.
Benefits:
● Increase frequency of exercise
● Rehabilitation training
Example exercise:
Sled pulls
Exercise Selection:
After assessing the client, their goals
and utilizing the points mentioned above
exercise selection is the fun part of
designing a good hypertrophy program.
1. Develop the weak links: Ideally we
would start by selecting muscle groups
that are weaker first and developing
them, to avoid comments like “chicken
legs” when the training focus has been
over dominating the upper body.
2. Varying the target musculature:
Selecting exercises that are not going to
over-train and fatigue certain body parts
is also important. We mentioned the
benefits of including split workout
routines to develop hypertrophy gains
for bodybuilding competitions to enable
the client to work at a greater intensity
and volume and maintain a high level of
frequency. So choosing exercises that
develop the back and chest on one day,
then the legs on the next is often a good
way to plan for a periodized program.
3. Training in all planes of motion:
When targeting muscle groups in a
session exercise selection should
develop the muscle groups in all planes
of possible motion. This also adds more
enjoyment to the training, providing the
client with opportunity to move their
body in different ways, whilst still
supporting the growth of the same
muscle group.
∙ Example movement plane
training for the back
musculature:
o Frontal plane: Training the back
in the frontal plane performing a lat
pull down
o Sagittal plane: Barbell squats
o Transverse plane: Cable machine
wood chops
350
8.9 Powerlifting Methodologies
Power lifting can elevate your
knowledge as a personal trainer in
strength and conditioning, as well as
boost your client's strength
performance. Power lifting is becoming
more and more popular among athletes
looking to build total body strength and
adaptability through sports.
Differences between Powerlifting and
Bodybuilding
CrossFit is among many training styles
adopting the foundations and basics of
Olympic lifting and giving them a face lift
that is taking the world by storm with,
global competitions and workouts that
are encouraging all levels of fitness and
training to take part.
The use of power exercises in strength
building would generally be used for
clients or athletes who are more
advanced in their training and already
have a preexisting knowledge about
how their body responds to strength
training and the correct technique to be
used.

Power lifters Bodybuilders

● High frequency and volume of training for

● Frequency of training is less due to the
maximal adaptation to muscular size and
intensity of their workout bouts, so longer
body composition.
rest to replenish energy stores and
muscle regeneration is needed ● Maximal level of intensity, lifting loads
that are 80-100%Max RM, with a lower
● Intensity of lifting is high requiring
number of sets
maximal effort but lifting more
● Exercise selection can be total body
65-75% Max RM
compound movements but more
● Exercise selection is targeted more to
predominantly the client would isolate
muscle recruitment of the whole body
muscle groups so that aesthetically each
working as one
muscle group shows more definition
● Train for explosiveness
● Train for muscular hypertrophy and
● Tempo increased of exercise execution
maximal strength

Moving from a bodybuilder to a

power lifter:
● Client’s cannot reach goals of
powerlifting without first establishing the
foundations of strength.
● The lifts required for powerlifting or
Olympic weightlifting are based upon
the foundations of maximal strength and
hypertrophy resistance training
exercises.
● Strength training should be used to
Stabilize the body's joints to avoid injury 351
when movements are executed in
greater speed.
Powerlifting training
Being an explosive style of training the
body will predominantly use fast twitch
type II fibers for rapid muscular stretch
and contraction to produce a greater
force of strength.
● Training should include exercises that
train this fast reaction time
● Training should include Strength and
stabilization training to avoid shock and
over stretching when performing
exercises.
● Flexibility training should also be
encouraged so full ROM can be
achieved.
Key Olympic lifts and skill
breakdown
Plyometrics
∙ To build maximal muscular
strength, along with strength
training the clients should also
adopt a plyometrics program.
∙ Plyometrics is mostly done with
body resistance to teach the client
how to move their bodies rapidly
without risk of injury.
∙ Plyometrics training will teach
teach the body movement patterns
for explosive actions, training the
CNS to receive sensory
information, respond and action
with fast reaction times.
∙ Exercise examples:
o Plyometrics training can include
jumping to build leg power and
strength. Beginning on a level
surface to smooth out technical
errors and then progressing to
varied heights as power improves.
o Burpees have been a long time
favorite in plyometrics training,
encouraging the client to jump and
build leg power as well as upper
body strength when adding a push
up, and encouraging a smooth
transition between movements,
which is a skill needed when
progressing power lifting exercises.
3 core exercises of Olympic
weightlifting:
Power lifting is made up of explosive
total body movements but there are
three exercises that the foundations of
this sport and competitive olympic
weightlifting.
Just like any exercise we should always
begin with the foundations of the
movement before jumping into a
complicated lift and skills. This skill
breakdown and observation allows the
trainer to correct technical errors,
potential compensations, and avoid
injury risks.
1. Power clean and skill breakdown
Front Squat: An exercise familiar among
bodybuilders and the primary skill that
will make up the skill of a power clean.
352
Exercise Bodybuilder FrontFSquat Power lifter front squat

Start Position Position the feet slightly wider than hip width Power lifting front squat is performed
and slightly on an angle. Pick up barbell from with bar sitting at the front the of the
rack or ground bending from the knees and chest held shoulder width apart, with an
grasping with an overhand

open grip, slightly wider than shoulder width. overhand grip and the elbows pointing
Place the barbell behind the shoulders. out.

Elbows should aim toward being near

shoulder level.
Exercise Take a breath and lower the tailbone, Similar execution as the body builder
Description bending from the knees, keeping the heels front squat, except that powerlifters
down and travelling over the toes to a range want to move under that bar quickly
where the upper legs and calves are in almost
when performing the clean so a full
a 90 degree angle, (or as far as your range can
take you. Take a breath to hold and then depth squat is ideal.
exhale and push through the feet to lift back
to standing
Movement Focus Hip flexion and extension, knee extension,
ankle plantar flexion, back extension,
shoulder flexion and scapular elevation

Movement Goals Improving leg strength.

Agonists: Quadricep muscle, soleus Stabilizer:
Hamstrings
Postural stability, ankle and hip flexibility
Stabilizers: Erector spinae, rectus abdominus,
obliques, gastrocnemius, glutes
Cueing Stay strong through the core to maintain Lengthen the spine and keep the
stability through the back, avoid slouching shoulders relaxed.
and keep the head lifted. Keep lowering the
tail bone and avoid pushing the butt out. Avoid rounding through the back
Keep feet flat on the ground
Common errors Slouching through the back Lifting up the Rounding the spine. Lack of mobility
heels, place a

Variations: Regression: Squat without resistance

Modifications/ Progression: Increase resistance
Progressions Slow the movement down on the descent and
increase the dempo back to standing

353
Exercise Bodybuilder Straight leg Deadlift Power lifter clean pull
(barbell)
Start Position Begin with the barbell on the floor and squat Begin with the barbell on the floor and
deep, lowering the tailbone and keeping the squat deep, lowering the tailbone and
chest lifted. keeping the chest lifted.
Grasp the barbell in a mixed grip position Grasp the barbell with an overhand grip
(with one hand supinated and the other slightly wider than shoulder width.
pronated) slightly wider than shoulder width,
Breath and pull the bar up transferring
just outside the knees.
power from your feet and ankles to the
Breathe to support the spine and stand up. hips (triple extension)
Keep the bar as close to the body as
possible and lift up to the hips,
extending the elbows so the arms are
straight and straightening the body be
up on your toes.
Exercise From the standing position, hinge from the
Description hips, keeping the legs straight reaching the
barbell towards the feet. Keeping the bar as
close to the body as possible extend from the
waist and hips back to standing.
Movement Focus Upward phase:
Hip extension, knee extension, ankle plantar
flexion
Downward phase:
Hip flexion, knee flexion, ankle dorsi flexion
Movement Goals Agonist: Hamstrings
Synergist: Gluteus maximus, erector spinae,
adductor magnus Stabilisers: Trapezius
muscles,
Rhomboids, lat dorsi, levator scapula
Antagonist stabiliser: Rectus abdominus,
obliques
Cueing ● Hinge forward from the hips From starting position engage through
● Keep the bar close to the body Lats and hamstrings initiating the
● Eye gaze should follow the bar movement
● Maintain connection with abdominals to Keep the chest lifted.
avoid arching through the spine
● Keep the arms and knees straight
Common errors ● Arching the lower spine (can be due to a Imbalance when standing Weight too
weak core, tightness through the hips or heavy and technique
hamstrings) faults
Variations: ● Adjust the load
Modifications/ ● Adjust stance
Progressions
Regression: Hip hinge exercises (body weight)
Progression: Sumo deadlift, Romanian
deadlift

354
Power clean
Read on to see how we put these two
foundational strength exercises together
to make the power clean movement

Exercise Power clean altogether

Start Position Begin by positioning yourself over the barbell, gripping with an
overhand grip slightly wider than shoulder width in a deep squat,
lowering the tailbone to lengthen the spine and positioning the
shoulders over the bar to initiate a slight spinal arch and keeping the
chest lifted.
Exercise Description Keeping the bar close to the body pull the bar up past the knees,
shrugging the shoulders to help build momentum to lift the bar up
touching the thighs and thrusting through the hips as they extend.
As the body extends pull the bar up with the arms, flex the elbows and
allow the body to come underneath the bar.
Rotate the elbows under the bar to catch the bar under the shoulders
to finish in a front squat power lifting position with the elbows pointed
out nearing the shoulders and in a deep squat, stand up immediately
holding the bar at the shoulders once the squat is reached.

Either slowly lower the bar back to starting position reducing the
muscular effort or drop the bar from the finished standing position.
Movement Focus Hip extension Knee extension
Ankle plantar flexion
Shoulder abduction, flexion, external rotation Scapula and clavicle
elevation and upward rotation Elbow flexion

Movement Goals Agonist: Gluteus maximus, Deltoids, Trapezius Synergist: hamstrings,

quadriceps, calves Stabilisers: hamstrings, quadriceps

Cueing ● Hinge forward from the hips

● Keep the bar close to the body
● Eye gaze should follow the bar
● Maintain connection with abdominals to avoid arching through the
spine
● Keep the arms and knees straight
Common errors ● Arching the lower spine (can be due to a weak core, tightness
through the hips or hamstrings)

Variations: ● Adjust the load

Modifications/Progression ● Adjust stance
s
Regression: Hip hinge exercises (body weight) Progression: Sumo
deadlift, Romanian deadlift

355
 2. Split Jerk and skill breakdown
The complexity of this exercise requires first a skill breakdown and developed strength and mobility
to ensure the client can first perform the fundamentals of this movement.
Exercise Shoulder press BB
Either begin seated, grasping the barbell with
hands slightly wider than shoulder width to
lift from the rack.
Standing option 1: Begin with feet slightly
more than shoulder width apart and bend at
Start Position the knees to squat and lift the bar from the
ground to the shoulders. Standing option 2:
Begin under the rack to lift the barbell off
and onto the shoulders, walk forward away
from the rack to begin the exercise. Knees,
hips and shoulders should be in line.
With your head and chest lifted, eye gaze
straight ahead, keeping the knees slightly
bent and a wide stance (if standing) inhale to
Exercise
prepare then exhale to press the bar straight
Description
up with wrists inline with the shoulders. Hold
and then inhale to return to bring the bar to
chest height.
Upward phase:
Shoulder abduction, Scapular outward
Movement rotation and elevation, elbow extension
Focus Downward phase:
Shoulder adduction, scapula inward rotation
and depression, elbow flexion
Agonist/Prime mover: Anterior and medial
Movement Deltoid
Goals Antagonist/Synergists: Middle Trapezius,
levator Scapula, triceps brachii
Powerlifting Push Press
Begin in a squat position with tailbone down,
chest lifted and eyes straight ahead. Gripping
the bar with an overhand grip slightly wider
than shoulder width.
Similar to the movement of the power clean.
From the starting position you should
progressively lift the barbell to the shoulders,
centering the weight over the feet and
extending through the knees and hips as the
weight transfers up.
When the barbell reaches the shoulders the
elbows should be under the wrists pointing
forward. Take a breath in to stabilize the
back and then dip down quickly bending from
the knees to build momentum to lift the BB
overhead and project the hips slightly
forward as they extend, maintain a neutral
spine and transfer the weight from the
ground up to the arms and hands.
Return the bar back to the ground starting
position by either slowly dropping back to the
hips and then squatting down to return it to
the ground.
Hip extension Hip flexion Knee extension
Ankle plantar flexion Shoulder abduction,
flexion Scapula upward rotation Elbow
extension
Agonist: Shoulders/ Anterior deltoids
Antagonist: Quadriceps, Gluteals, Hamstrings.
Deltoids, Pectorals Triceps, Latissumus dorsi,
Abdominals

● Stabilize through the core muscles to

support the spine
Utilize leg power Maintain a neutral spine
Cueing
● Push the bar to full ROM and Stabilize the back Breathe

slowly control down

Back arching or pelvic anterior tilt (Mostly
due to weakness in core muscles) Arching the back and pushing the butt out,
Common errors using the arms too much and not enough leg
No reaching full ROM from elbow joint strength.
Shoulders lifting to the ears
Variations: Regressions: Seated press, reduce load Push Jerk
Modifications/ Progression: Increase load, power clean Can 356
be performed with dumbbells or cable Split Jerk
Progressions
Exercise Powerlifting Push Jerk
Begin this exercise with the barbell racked from
Start the shoulders instead of the ground.
Hold the bar with the elbows under the wrists
Position
and slightly wider than shoulder width.
Once positioned with the barbell on the
shoulders, the client should dip down and
Exercise
extend through the knees. When the legs reach
Descriptio
extension, building the momentum and power to
n dip down bending from the knees
be transferred to the arms to push the barbell
up into a locked out overhead position.
Simultaneously the client should dip back down
into a partial squat, (hips just above the thigh
height) to absorb some of the resistance from
the overhead lifting position.
Movement
Finish back in standing.
Focus
Hip extension Hip flexion Knee extension
Ankle plantar flexion Shoulder abduction, flexion
Scapula upward rotation Elbow extension
Agonist: Shoulders/ Anterior deltoids
Antagonist: Quadriceps, Gluteals, Hamstrings.
Movement
Goals Deltoids, Pectorals
Triceps, Latissumus dorsi, Abdominals
Utilize leg power Maintain a neutral spine
Cueing
Stabilize the back Breathe
Common
errors
Variations
: Power Jerk
Modificati
ons/Progr Split Jerk
ession s
Exercise Split Jerk
Begin this exercise with the barbell
positioned in front of the chest,
hands slightly wider than shoulder
width or begin with a clean from
Start Position
the ground.
Hold the bar with the elbows under
the wrists and slightly wider than
shoulder width.
Once in an even standing position
before explosively pressing the bar
back up overhead, locking out the
elbows and extending through the
knees and hips.
As the bar goes overhead absorb
the force by splitting the legs, with
Exercise one in front of the other and
lunging down. Maintain lifting the
Description
bar overhead with head slightly
forward and neutral posture. Hold
for a moment in the lunge before
inhaling and stepping the feet back
together into standing.
Once in a balanced standing
position gradually lower the
barbell back to the rack or ground.
Hip extension Hip flexion Knee
extension
Movement
Ankle plantar flexion Shoulder
Focus
abduction, flexion Scapula upward
rotation Elbow extension
Agonist: Shoulders/ Anterior
deltoids Antagonist: Quadriceps,
Gluteals, Hamstrings. Deltoids,
Movement Goals Pectorals
Triceps, Latissumus dorsi,
Abdominals
Utilize leg power Maintain a
neutral spine Stabilize the back
Cueing Breathe
Ensure toes are facing forward and
hips are level in the lunge position
Weakness in legs in lunge causing
imbalance Knee Valgus
Common errors
Holding in positions rather than
one full motion
Variations:
Modifications/
Progression s
357
3. Snatch and skill breakdown

Exercise Overhead squat Exercise Snatch

Retrieve the bar with a wide overhand grip. Feet
Start should be in a wide stance.
Position In an upright position hold the barbell overhead
with locked elbows.
Keeping the bar lifted overhead inhale and then
exhale to squat down deep lowering from the
Exercise
tailbone and maintaining an upright chest
Descriptio
position. Return to the starting position by
n
driving through the knees to extend back to
standing.
Hip extension Hip flexion
Movemen Knee extension Ankle plantar flexion
t Focus Thoracic, Lumbar extension Shoulder abduction
Scapula elevation and upward rotation
Agonist: Quadriceps, Gluteals, Hamstrings
Movemen Antagonist:. Triceps, Seatus anterior, Latissumus
t Goals dorsi, Trapezius, deltoids, lower back, Teres
muscles, calves, Abdominals, adductors
Start Begin in a squat position, feet
Position slightly wider than hip width.
Shoulders positioned over the bar
holding overhead with a wide grip
and straight arms, keeping the chest
lifted.
Exercise Pull the bar off the floor transferring
Descriptio the weight upward.
n As the knees extend and the bar
passes the knees, lift the shoulders
allowing the bar to move and tough
the thighs.
Jump upward allowing the feet to
slightly leave the ground building
momentum and extending the hips.
Shrug the shoulders and pull the bar
upward with the arms allowing the
body to come underneath the bar.
Holding in an overhead locked elbow
position simultaneously move into a
squat position to absorb some of the
resistance keeping the arms
overhead. Breathe and return to
standing from the squat position.
Gradually return the bar to the rack
or too the floor.

Stabilize the back Breathe Movement Hip extension

Focus
Cueing Keep an upright neutral spine Hip flexion Knee extension
Bend from the knees and keep the butt low Ankle plantar flexion Thoracic,
Lumbar extension Elbow extension
Scapula elevation and upward
rotation
Glutes lifting when returning to standing.
Common Movement Agonist: Gluteals, Deltoids,
errors Watch for hypermobile elbows in overhead Goals Trapezius Stabilizers: Hamstrings,
position Quadriceps, calves
Cueing Stabilize the back

Variations Engage through the core muscles

: Breathe
Modificati Snatch Keep an upright neutral spine
ons/Progr
ession s Bed from the knees and keep the
butt low
Common Glutes lifting when returning to
errors standing.
Watch for hypermobile elbows in
overhead position
Variations Change to a hook grip
:
Modificati 358
ons/Progr
essions
 Section 9:
Training Special Populations

359
Exercise programming for special
population groups
We have discussed so far key aspects
and principles needed to train generally
healthy adults.
In this unit we will discuss how to cater
and program to the needs of individuals
who are limited in their training ability in
some way.
This unit applies to instructors who work
within a controlled work environment.
Work should be performed under
current legislation when working with
children and/or vulnerable people, under
the policies and procedures of the
organization and educational
competence.
Special populations to be considered
are:
● Children and adolescents
● Older adults
● Pregnancy
● Clients with a disability
Considerations when preparing to
work with a special population
group/individual
When working with special population
groups the workplace risk management
protocol and legislative requirements
can be slightly more extreme or different
so attention should be given here.
Changes in risk management
procedures could be:
∙ Regulations about age and
participation in some activities
∙ Additional qualifications could be
needed, for instance if you’re
looking to work with children, a
working with children’s check is
mandatory under Australian law.
∙ In some circumstances an allied
health professional, or carer may need
to be present within a training session
∙ An allied health professional may also
place limitations on certain exercises,
e.g. If there has been an injury, heart
problems.
∙ Further study and resources can also
be undertaken to ensure a level of
high knowledge and confidence when
working with these groups
∙ Changes to group training ratios to
account for higher needs in specific
individuals
1. Children and adolescents (Aged 13-17
years of age)
Training teenagers:
From birth to adulthood our bodies and
minds learn and develop via the movement
experiences we have. From learning the
very fundamentals of grasping, standing
and walking this is the beginning of any
performance program. Beginning regular
movement practices at a young age can
promote healthier living choices as we age
as well.
The international physical activity guidelines
recommend that adolescents between the
ages of 13-17 should be active for at least
60 minutes per day with a mix of both
moderate and vigorous intensity training
and adding resistance or strength training
at least 3 days per week.
Exercises should be focused on the level of
the individual’s body development and as
they establish foundations skills and more
progressive training can be implemented.
Training should include training in all
movement planes. Training styles should
include: aerobic fitness, coordination and
stability, flexibility, plyometrics, and
resistance training for increasing muscular
strength.
360
Barriers to participation in regular
physical activity:
∙ School and academic
commitments and expectations:
During childhood, physical activity
is more accessible and promoted,
but as academic demands
increase and team sports become
less popular, (more so for young
girls) the level of participation
declines. The Australian bureau of
statistics, (2007) stated that as
work and study demands
increased the level of Physical
Activity decreases. (Need to
change to fit indian context- find an
indian source or see if this one is a
study that’s applicable to global
scenario)
∙ Social influences and self-
esteem: Our social groups at this
age can play a vital role in the
motivation towards participation in
physical activity.
∙ Family/parental influences and
participation in sport: Upbringing
will also influence the level of
participation in PA, if parents don’t
have a connection to their bodies
and being active then their children
won’t have that role model
motivation to be involved either.
Risk management:
Educate adolescents about
overtraining risks It is important to
understand that a fitness program is
usually an addition to existing school
sports and team activities outside of
school, so education about physical
stress and overtraining symptoms
should be communicated with
individuals to ensure the understanding
of their bodies response to these
demands. Incorporating appropriate
recovery strategies should also be
implemented into programs.
Physiological considerations to training
adolescents:
∙ Glycolysis: Adolescents tend to have
a lower number of glycolytic enzymes
than adults so they will fatigue faster
working at higher intensities, Boisseau,
& Delamarche, (2000).
∙ Heat regulation: Adolescents tend to
have more immature thermoregulation
functioning so in extreme environments
their bodies response can be delayed,
Brokenshire, Armstrong, & Williams,
(2009).
Potential Risks to resistance training in
young adolescents:
∙ Growth plate injuries: Growth plates
develop at each end of long bones. I.e.
Tibia and Fibula. Injuries to growth
plates are usually the result of high
impact falls, excessive loading and/or
contributing and being the result of
overtraining. Growth plate injuries can
also be caused by technique errors in
exercise execution, so small group
sizes and close expert supervision
should be implemented in these
training sessions.
∙ Micro traumas: Even for adults
repeated exercises especially those
done with a loaded weight will cause
small micro traumas in the skeletal
muscle. For sports, which require
repetitive use of limbs, there is a higher
risk of micro trauma and injury which
as Powers and Howley, (2001) state
can lead to premature closure of the
growth plate. Clinical studies also
outlined by Powers and Howley, (2001)
state that the risk of micro traumas and
growth plate damage is less for
unstructured play then it is for
adolescents training and competing in
more organized sports.
361
∙ Tendonitis: This is inflammation
of the tendon and can be caused
by insufficient recovery periods
and a failure to effectively treat
acute injuries, and so the
inflammation builds. They can also
occur if training programs are
progressed too quickly in a short
amount of time, putting the body
into a shock state. Increasing the
volume of the training, or the
intensity can be one of the causes.
Safety guidelines to avoid injury:
∙ Trainers should emphasize
education of training and potential
risks that can occur as well as the
potential and existing benefits that
can be experienced.
∙ Safety checks for equipment to be
used and educate on proper use.
Powers, and Howley (2001) state
that in one study from the
American College of Sports
Medicine, “up to 50% of injuries in
organized sport could have been
avoided by attention to proper
training technique, safety
procedures and use of safety
equipment.”
∙ Trainers should complete thorough
demonstrations of exercises with
correct technique as well as verbal
explanations so the individuals
understand. Because adolescents
have trouble focusing or
concentrating for long periods of
time the demonstrations should be
short and sweet but covering the
main points to consider.
∙ Following the completion of the
demonstration the participant(s)
should then be questioned of their
understanding and potentially
repeat what was said or shown to
provide proof.
∙ If children are observed performing
exercises incorrectly then they
should be pulled up and corrected
with an explanation of what was
wrong, and how to correct it.
Decreasing the load or simplifying
the exercise should be the next
step if technique continues to be a
problem.
∙ Trainers should be aware of the
other organized sports and school
activities children are involved in to
reduce the risk of repetitive
movement and strain which as
mentioned can lead to
microtrauma and potential stunted
growth.
Exercise programming for
adolescents:
∙ Programming considerations
When taking into consideration growth
changes and the number of hours’
adolescents spend studying and sitting,
exercise programs should focus on
correcting posture deterioration and
include physical activity that is
enjoyable with these being a main factor
to maintain participation in physical
activity.
∙ Programs that promote and
complement the individual’s
development and functional growth
∙ Include activities that develop skills
that assist in bone health
development.
362
∙ Programs should be fun to keep
individuals engaged.
∙ Plan and take into consideration
external training within school and
sporting groups
∙ When taking into consideration the
number of hours’ adolescents
spend studying and sitting,
exercise programs should focus on
correcting posture deterioration.
∙ Progressive overload and
programming
Use progressive overload methodology
of the FITTE principle of progressing
and regressing programs. This will allow
you to slowly increase the intensity of
programs. DiFiori, (2002) recommends
the 10% rule to adjust programs as
individuals meet a steady state with the
force or energy requirements. Only
adding 10% each week, or when
needed will help to monitor the
progressions and keep the participants
working at safe work levels.
Resistance exercise programming
Resistance training can positively
influence the neuromuscular growth as
much as physical for young adults
preparing their bodies with the healthy
foundations of health and fitness and
positive outlook in their adulthood.
Benefits of implementing resistance
training programs:
o Supports motor skill functioning
and acquisition
o Reduce risks of sustaining injuries
in sport
o Increase bone mass
o Improves physical health and well-
being
o Improves self-esteem
Type of resistance training:
o Resistance training programs
should support where the
individual is at in their growth and
development.
o Begin with body resistance training
building the foundations and
fundamentals of resistance
training.
o Encourage the joy of training,
make sessions fun! E. g., Rope
climbing, or partner work.
o As the child/adolescent
progresses in their training and
abilities
o As the individual ages and again
progresses with their strength and
movement ability then they can
progress further with resistance
training and becoming more
competitive or skilful in their
sessions.
o Exercises can include more
eccentric loading, and an increase
in loading including:
- Hypertrophy training and the use
of free weights Plyometrics training
can also progress, with landing
mechanics and muscular support
being previously established and
developed.
Types of load recommendations:
o It is recommended by
Granacher,et.al, (2016) that free
weights should be used over
machine weights as machines
were designed for adult use and
setup can be complicated.
o Free weights offer a more
simplistic way to adjust the load,
they also develop coordination,
stability, accessible for all planes
of movement.
o The individual should be able to
support their own body weight and
363
perfect technique before adding
any external resistance or force.
∙ Intensity and frequency:
o Behm, et al., (2008) recommends
beginning a resistance training program
with one to two sets of 8-15 repetitions
and a light to moderate load (30-60%
1RM) 2-3 days per week.
o The high repetitions and low to
moderate load enable faster learning of
the skill and technique with reduced risk
of injury.
o As the individual progresses resistance
training sessions can then become
more intense and specific to achieving
training objectives.
Resistance training example for
beginners/ early age

Exercise Wheel barrow races

- Begin with person number one on all fours on the ground.
- The partner (person number two) will then squat to pick up one leg at a
Start Position
time of person number one so they’re then supporting their weight with
their core and shoulder stability.

- Person number two should keep their shoulders relaxed and initiate to
walk forwards.
Exercise
- Person number one walks forward on their two hands whilst person
Description
number two walks forward in a bipedal form.
place the feet is recommended.

Person number one:

- Develop core strength
- Develop shoulder stability
- Improve wrist strength
Movement Goals
- Improve contralateral movement
Person number two:
- Develop back and core strength
- Gait and postural stability

Person number one:

● Look straight through to the hands to avoid neck flexion and tension in this
area
● Keep the elbows locked and shoulders relaxed
● Continue to breathe and use the abdominals and glutes to support the
Cueing
back
Person number two:
● Keep the shoulders and arms relaxed
● Maintain and a strong connection with the breath moving into the back to
support the spine

● Person number two may dip the lower back if weak through the core or
Common errors
lacks the arms strength
Regression: Establish a strong isometric plank first
- Begin crawling on all fours
Variations: - Person number two should begin with lower resistance such as a ball to
Modifications/Pro walk with
gressions - Begin stationary before moving forward Progressions:
- Person number one can add a push up whilst person number two would 364
squat or lunge
Example exercise programming and
progressions
Exercise Exercise Goal
To develop leg strength and
body alignment. This is also
Body resistance squats
a key skill in conditioning
for more progressive skills.
To develop stability, and
Lunges
postural control
To develop core stability
Planks
Begin holding for 30 seconds
- Decompression of
wrists using computers
and phones
Monkey bars (hanging) Teaches coordination
- -
Play and whole body
integration
- Improves strength.
Promotes changes in
Agility practice/running
direction and speed and
with cones
play
Plyometrics Training:
∙ Plyometrics training link both
strength and speed improving
muscular power.
∙ Training includes more ballistic and
forceful movements, where the
muscle is eccentrically stretched
rapidly and then shortened at
ground contact.
Progressions/Variations
- Add dumbbells or resistance bands to add
resistance
- Increase leg power by adding jumps and
developing squat landing technique to avoid
jarring of the knees
- Use pole to encourage posture technique
- Add dumbbells to increase resistance
- Add jumps to develop leg power
- Add balance beam to challenge stability and
potential alignment compensations
- Side planks
- Progress from forearm holds to hands
- Increase duration of hold length
- Progress again to push ups
- Progress distance
Add pull ups
- Alternate from hands to legs and inversions
- Progress with distance
- Reduce rest periods
- Add inclines
∙ Because of the higher forces
involved it is essential that
muscular strength based
resistance training is also being
done to strengthen the bones and
muscular tissue to be able to
sustain the forces accompanied.
∙ Teaching foundations of proper
landing techniques to jumping
should then be included.
∙ Stability training will also assist this
style of training to improve posture
and strengthening of the smaller
muscle groups, particularly those
of the ankle joints.
365
Examples of plyometrics training
could include: ∙ Coordination and stability
training examples:
skipping as a foundational skill and then o Balance beam training
progressing into more depth and box o Trail running or moving over
jump training. unstable surfaces.
∙ Equipment and exercise
Progressions example to promote
Exerci
Exercise Goal / coordination and stability can
se
Variations include;
Bosu balls: Standing on these provide
Foundation an unstable surface for the individual.
skill to teach Increase depth They can also progress their exercises
Skippin
landing of jumps, eg.
g by adding squats, lunges or medicine
technique and Box jumps
ball throws whilst maintaining a
power
balanced position.

Skill acquisition training:

Coordination and stability:
This style of training will develop the
∙ This type of training will help individual’s neural and physical
adolescents develop their postural patterning for coordination. It
stability and alignment of their implements principles of key skills for
body. human movement and how to perform
∙ Training should include instability them. They can include:
which will assist to develop the
∙ Kicking
individual’s visual system and
∙ Throwing
proprioception. This is the
∙ Catching
consciousness of their own body in
∙ Climbing
relation to the environment/space
∙ Running
or force against them.
∙ Jumping.
∙ Including training that promotes
Skill based training can also encourage
the use of all the individual’s
individuals to be involved in more team
senses will promote focus, and
based sports or
improved cognition. McGuine and
Keene, (2006) recommend that specialized training if they enjoy a
stability training should be included specific style or skill.
prior and post to all strength based
training sessions to optimize
athletic performance and
technique. Chaoauchi, et al. (2014)
found that implementing balance
training prior to a plyometrics
training session, it initiated greater
training improvements in reactive
strength. 366
Flexibility Training:
∙ Flexibility training will assist to
lubricate and release tension in
tight joints and muscles. This is
especially important for individuals
who are spending prolonged times
studying or sitting, as their bodies
take on more stress.
∙ Weaver, (2014) writes that mental
stress can cause our muscular
body to tense up, along with the
secretion of adrenal hormones that
can affect our heart rate and blood
flow moving into the muscles,
usually the body should feel this
stress and then can relax and
stress surpasses. If the stress is
chronic however, the body will hold
onto this tension and cause
tightness and discomfort in the
body.
∙ Relaxation techniques, like
breathing and stretching can assist
to relieve the effects of stress and
muscular tension.
Cardiovascular fitness:
∙ Adolescents hearts and lungs are
still growing and therefore
cardiovascular fitness will improve
their VO2 max and respiratory
system.
∙ This can assist in immune defence
and recovery from training.
∙ Cardiovascular fitness should
continue to develop the individual
both physically and neural
including agility sessions that
develop both speed and reaction
time to adapt to environmental
changes.
They can also be more skill based
including cycling or rowing for
endurance Performance.
2. Physical training and
programming for older adults
No matter what age we are our bodies
need to be continually conditioned and
used to avoid both physical and mental
health risks. International health
guidelines recommend that older adults
should be accumulating at least 150
minutes of moderate-vigorous physical
activity per day to their own ability.
Benefits of Physical Activity (PA):
∙ Improved Cardiovascular health
∙ Reduce risk of cardiovascular
disease
∙ Reduce BP
Social benefits of PA for older
adults:
∙ Social support can influence
positive behavioral change and
self-efficacy motivations for older
adults. Resnick, et al, (2002)
outlines key influences in social
behaviors that can affect
adherence and self-motivation to
enroll in physical exercise and
programs.
∙ Classes and group activities can
then be a great way to attract older
adults to motivate and hold each
other accountable whilst also
stimulating emotional and physical
well-being.
∙ Exercises should attract the
individual through educational
benefits and fun.
∙ Examples can include dancing and
team based workouts that promote
a supportive environment.
367
Barriers to PA as we age:
∙ Lack of time
∙ Fear of injury
∙ Self-confidence or embarrassment
to participate in PA
∙ Lack of knowledge of benefits of
PA
∙ Accessibility to facilities to engage
in a controlled exercise routine
Initiatives to encourage regular PA in
the elderly community:
∙ Socialization and group training,
training with a friend or meeting
people who share common
interests can be a great initiative to
increase PA participation in the
elderly community
∙ Introduce realistic goals and
challenges
∙ Positive motivation and
encouragement of progressions
and performance improvements
∙ Explain benefits of incidental
training, such as cleaning,
gardening, walking for transport
∙ Incidental exercise, such as using
the body as transport and walking
or cycling more, gardening or
doing housework are all incidental
ways to bring in more exercise into
our daily routines.
∙ Educating individuals about the
benefits to engaging regular
physical exercise can be a
positive influence to adopt a
healthier routine for older adults.
Risks for older adults due to inactivity:
∙ Increased risk of Osteoporosis due to
loss of bone mass
∙ Increased risk of Cardiovascular
disease
∙ Cognitive impairments
∙ Metabolic syndrome
∙ Mental health issues, including low
self-efficacy, and depression
Safety guidelines and considerations:
∙ Perform a thorough health screening
including the PAR-Q readiness
questionnaire to understand the
physical and mental barriers and/or
risks the individual may experience.
∙ Fitness appraisals and initial exercise
testing should also be done to
identify potential weaknesses or
areas of concern to focus
programming on initially.
∙ Ensure regular fitness appraisals,
reporting and open feedback is
utilised.
∙ Observe and list potential risks to the
individual ensuring all safety
precautions are taken including an
incremental 10% progression of the
prescribed training program
∙ Encourage individuals to know their
abilities and communicate any
concerns or discomfort
∙ Include functional exercises that
assist in everyday living
∙ Take into consideration weakness in
joints such as wrists and grips
strength using equipment for short
periods or that is easier to hold
∙ Encourage clients to drink plenty of
water during the session to reduce
risks of cramping or dehydration and
hydrate the bodies systems
∙ Take into consideration and liaise
with medical practitioners about
potential medications that could
affect training and performance.
368
Working with allied health
professionals:
With the prevalence of potential health
risks rising in older populations it is
important that along with a normal
health screening check there should
also be some communication and
potential
regular liaising with the client’s general
practitioners to outline specific
exercises to be avoided or limitations in
training that should be considered.
∙ This can be done by asking the
client to get a written clearance or
report before commencing training
from their general practitioner.
∙ Clients should then be monitored
with these recommendations and
limitations taken into consideration
with training programs.
∙ Any abnormalities to training
performance or concerns should
be alerted to health care
professionals in regular reports
and documentation
∙ Within a group training context
variations and modifications to
exercises should be prescribed
and outlined within or before the
session with clients of concern.
Training for neurogenesis and
reducing risks of dementia and
neural disorders:
∙ Just as it is important to continually
train the mind throughout our
lifetime using things like Sudoku or
trivia to prevent cognitive decline it
is important to include physical
activity and regular exercise.
∙ It is argued that physical activity for
lifestyle improvements will protect
us against development of
dementia, Hertzog, et al., (2008).
∙ Further studies have found that the
hippocampus which plays a major
role in memory formation will begin
to shrink annually from the age of
26 by approximately 1.18% in
volume, Raz, et al., (2010).
Exercise can slow the effects of
hippocampus volume reductions
by keeping the brain active in
processing sensory information
from the environment to react and
adapt to changing demands.
∙ Including exercises which promote
the mental and emotional
connection is then important.
A study that looked how you could
stimulate neurogenesis further was
done by Lista and Sorrentino, (2010)
finding that physical exercise can
increase the production of insulin- like
growth factor 1 which plays a vital role
in this process, demonstrating that, “an
old dog really can learn new tricks and
the brain can continue to grow if
stimulated both mentally and physically.
Exercise examples for neurogenesis:
∙ Obstacle style training to promote
balance, proprioception and mental
stimulation.
∙ Exercises with moving objects,
such as balloons for visual
stimulation and physical reaction
increase could be a good way to
begin a program and awaken the
body and senses.
∙ Progressing then to further
sensory stimulation through boxing
or martial arts, however physical
contact contraindications should be
taken into consideration for wrist
and joint weakness.
369

∙ Checking in with clients as to how
they are feeling during exercises
can all assist this neural
improvement, asking them what
they just did, or what muscles were
being used are all positive
inclusions for mental health
improvements.
Types of training for older
populations:
Cardiovascular fitness
∙ Powers and Howley, (2001) state
that, “aerobic power decreases in
the average population after the
age of twenty at a rate of 1% per
year.” For those who maintain
regular aerobic physical activity
and a healthy weight, the risk is
then reduced. With rising risks
associated with cardiovascular
health as we age it is then
important to introduce exercise
programming which encourage
aerobic and endurance based
activities.
∙ With bone mineral density
declining with cardiovascular
health it is recommended that
older adults should engage in low
weight bearing activities to protect
and minimize risk to their joints,
improve hip mineral density and
alignment.
∙ Activities can include water based
aerobic activity, cycling, walking
and use of the cross trainer for
aerobic performance gains.
∙ Interval training can a good way to
progress VO2max and cardiac
functioning, keeping endurance
activities to minimal risk to start but
adding burst of higher intensity
movements, such as hill climbing,
or speed walking or cycling.
∙ Cardiovascular activities with
low weight bearing risk
o Walking
o Water based training and aerobic
o Cycling
Resistance Training
∙ Benefits of Resistance training
o Improve Bone mineral Density:
With bone mineral density (BMD)
and balance declining as we age,
this places older adults at a higher
risk of falls, and injury; It is then
important to also maintain and
include resistance training to help
support and strengthen the body's
structure.
o Improve cognitive functioning
and memory: As well as physical
benefits resistance training, has
also shown to improve memory
and cognitive functioning for older
adults, Cassilhas, et al., (2007)
found that by engaging in a
moderate to high intensity
resistance training program three
times a week for six months,
participants showed performance
improvements in both memory and
verbal concept formation.
o Build strength and resilience for
the body: There is a
misconception that when we age
we will all become “weak” or frail, a
study done by Helbostad, Sletvold,
and Moe-Nilssen, (2004) showed
that resistance training programs
that promote balance,
coordination, functional and
strength training even just twice a
week cannot only avoid this frailty
but for those already suffering it
can dramatically improve
psychological well-being and
physical functioning.
370
Older female adults and training
∙ The risk of Osteoporosis is more
prevalent in women over the age
of fifty, one of the effects of
menopause is the reduction of
estrogen which can lead to bone
loss, Powers and Howley, (2001).
∙ To prevent this risk or reduce the
effects females are encouraged to
maintain a healthy exercise routine
through their lifetime especially in
their twenty’s. Introducing regular
weight training for muscular
strength and hypertrophy will
increase muscle mass, bone
growth and BMD so engaging in
resistance training from an early
age and can prove to be beneficial
for physical health and longevity as
we age.
Exercise programming for older
adults
FITT Principles
∙ Frequency: The frequency of
workouts should be dependent
upon the tolerance of the
individual; recovery time can take
longer with age so appropriate rest
time should be prescribed to
ensure appropriate rejuvenation of
muscles and tissues.
∙ Intensity: The Intensity of
workouts should also begin at an
achievable and minimal level to
avoid over exerting the body past
it’s limits. Slowly increasing the
intensity as the individual become
accustomed to the demands is
then recommended.
The ACSM recommends, “a repetition
range for individuals older than age 50-
60 years of age or frail persons is 10 to
15 repetitions, although more advanced
and healthy older adults can perform
lower repetition ranges with heavier
weight (80% of 1RM or higher) for
greater strength gains.”
∙ Type: The type of training should
be focused on the physiological
needs based on the following:
o Peak performance for general day
to day living
o Injury prevention and reducing pain
or discomfort.
Once these core needs have been
addressed the training can then be
more specialized on the goals of the
individual. Keeping workouts simple
is recommended, focusing on the
main muscle groups, i. e., Back,
chest, arms, legs, abdominal.
∙ Time/Duration: Time/Duration of
workouts will again depend upon
the individual tolerance to the
physical demands. Longevity of
mobility is the prime focus so
sessions can include high intensity
challenges but the majority of the
session should be kept at a low to
moderate intensity for muscular
endurance gains.
Equipment choices: Machines or
Dumbbells?
Due to the reduction in control of
movements for older adults it is
recommended that a more controlled
training environment should be adopted,
therefore machines are preferred over
dumbbells for their assisted
development of muscular control and
strengthening.
371
Training focus:
One of the effects of immobility is the
deterioration of leg strength to be able
to assist in stabilizing the body, this can
often lead to adults needing to use
wheelchairs or walking sticks to help
support them. This means that
maintaining and improving leg strength
is of great importance, some exercise
can include:
∙ Lower body
o Leg curls
o Good mornings
o Calf raises
∙ Upper body
o Cable seated Fly’s for postural
development, chest and back
strength promoting full breathing
o Shoulder press
o Cable twist strengthening for
transverse plane back, arm and
abdominal strengthening
Functional resistance training
∙ Sit for functional training and leg
strengthening
∙ Dumbbell walking lunges which
can mimic the action of walking
holding groceries or heavy objects.
∙ The client should be encouraged to
keep the shoulders relaxed and
use the strength in the glutes and
legs for power in lowering and
lifting.
∙ The chest should be lifted and
back lifted tall, avoiding any hip
flexion that can sometimes happen
if the glutes are weak.
Postural training and core stability
∙ For years, older adults have
formed a positive relationship
towards low impact exercises like
tai chi, Qigong, yoga and pilates
that promote core strength,
flexibility and stability.
These exercises allow the
individuals mind to calm and
maintain focus on the exercise at
hand, they teach control and
integration of the whole body and
mind to work as one.
∙ Balance training can include
exercises which involve swiss ball
training to promote both posture
and pelvic floor strengthening.
A weak pelvic floor can lead to
incontinence in both men and
women and should then be cued in
exercise programming. Naturally
when we stand upright the pelvis
has posterior anterior tilt, so this
position should be encouraged in
both sitting upright and standing
exercises.
Flexibility Training:
∙ Sessions should include both a
warm up and cool down which
includes stretching to reduce risks
of muscular strain or cramping.
∙ Gentle stretching without pulsing is
recommended so the muscle is not
aggravated, and more dynamic
stretches which warm up and
lengthen at the same time.
372
Bodybuilding:
Although muscle mass declines with
age it is possible for even the oldest of
individuals to still have significant
strength gains and with regular training
increase the number of fast twitch fibres
for muscular power improvements,
McComa, (2005).
Resistance training considerations:
∙ If the individual has bodybuilding
goals then an extensive report and
health screening should be
performed with the guidance and
recommendations of their health
care practitioner to safely outline
the risks associated and to be
clear with what exercises are most
appropriate for not just their
physiological goals but also their
bodies structure and needs.
∙ Regular monitoring and reports
should then be noted and shared
with the client and health care
practitioner before progressing
further with training.
∙ Sessions should be short however
and the client would need longer
rest between sets and training
days to maximize hypertrophy
gains and cell rejuvenation.
∙ The trainer should take into
consideration both HR and BP be
mindful of intensity. BP can also be
affected with overhead exercises
or exercises which involve quick
changes in direction or from low to
high.
∙ Trainers should also discourage
and look out for them, “valsalva
maneuver,” of holding the breath
which can be observed during
heavy lifting. Holding the breath or
bracing can lead to increase of BP
placing pressure on the
cardiovascular and respiratory
systems. This can be avoided if
the trainer educated the client and
coaches them through correct
breathing sequences when training
and especially lifting.
373
3. Prenatal
Many changes can occur to the
woman's body during pregnancy so it is
important to be aware of some of the
common changes, have a
communication relationship with your
client and with their allied health
professional(s) during this sensitive and
extraordinary period.
∙ What to be aware of during each
pregnancy trimester
First trimester
Symptoms to be aware of Possible recommendations

● Nausea (morning sickness)

● Increase in fatigue
● Hormonal changes
● Potential immediate release of relaxin (hormone
released to prepare the mother for childbirth
increasing flexibility in the ligaments and in
particular around the pelvis).
● Increase in rest intervals
● Increase hydration
● Increase in strength and mobility training
● Increase in caloric intake

Second trimester
Symptoms to be aware of Possible recommendations

● Changes in centre of gravity

● Prone positions may be uncomfortable
● Increase in relaxin
● Increase fatigue
● Thermo-regulatory system increase (more heat in
the body)
● Postural changes (Breast enlargement, increase
lordosis and thoracic kyphosis)
● Increase stability training
● Increase rest intervals
● Mobility and strength training
● Increase hydration
● Be aware of temperature in training
environments
● Increase in pelvic floor training

Third trimester
Symptoms to be aware of Possible recommendations

● Changes in centre of gravity ● Ensure plenty of rest intervals

● Prone positions should be avoided in training
● Increase relaxin
● Increase fatigue
● Thermo-regulatory system increase (more heat in
the body)
● Postural changes (Breast enlargement, increase
lordosis and thoracic kyphosis)
● Increase in baby weight to carry
● Increase in stability, strength training
● Increase in pelvic floor exercises
● Increase hydration
● Increase in caloric intake
● Keep HR to sub-max
● Reduce intensity and duration of workouts
● Beware of Diastastasis rect (spreading of
the Rectus abdominus along the mid line of
the fascia)

374
∙ Equipment options for
pregnancy:
As pregnancy progresses the amount of
training that requires the client to be on
her feet should be reduced. Some of the
equipment that is recommended are:
o Machine weights:
- Using Machine weights is a good
option, as they are controlled and
things like the Lat Pulldown allow
the client to be in a seated position
promoting postural alignment,
building strength through her back
to relieve any tension from excess
baby weight and take the pressure
off her feet.
o Swiss Ball:
- Using a swiss ball is brilliant to
relieve that pressure from the
client’s legs and feet.
- It’s also a great way to promote
pelvic floor exercises, and core
stability.
∙ Physical Training During
Pregnancy
o Women should continue to
maintain their fitness and training
during pregnancy.
o If the woman has been training at
a good level prior to pregnancy
then training can generally
continue.
o If the woman does not already
have a good general fitness and
perhaps is only just beginning a
regular training program then the
approach to her training would be
a lot more lower impact.
o Training should not commence
without a written medical clearance
and potential recommendations
from the client’s medical
practitioner
∙ Benefits of physical training
during pregnancy:
o Improved strength to support
postural changes during pregnancy
o Potential improved recovery post
pregnancy
o Improved well-being
o Improved self-confidence and self
esteem
o Reduced muscular pain
o Preparation for childbirth
o Improved energy levels
∙ Training focus:
o Core stability and abdominal
strength
- Training sessions should have a
strong focus in the early stages of
pregnancy (and prior
if planned) to develop abdominal
strength and core stability to help
support the carrying of the baby
and postural changes.
- Training core stability including
abdominal strength and pelvic floor
in all ranges of motion is
recommended to prepare and
assist the changes in centre of
gravity and postural adaptations
when extra baby weight is gained.
- Exercises that spend too much
time spent in a prone position
should be avoided and more
supported positions such as
seated, or quadruped exercises
should be included, like those used
in pilates.
- As pregnancy progresses focus on
more the pelvic floor rather than
abdominals should be advised,
especially when risks of diastasis
recti increase.
375

o Back strengthening and
postural alignment
- No matter what the client’s fitness
was prior to pregnancy they’re
going to experience an excessive
increase in weight in their belly, so
exercises that support both
postural alignment, stability and
back strength should be
recommended.
- Exercises that increase back
strength should be included, as
well as leg strength to support the
increase in weight.
- Depending on their fitness level
and technique weighted squats
can be included, as well as lat pull
downs.
∙ Example training program for
strength
Warm up:
- Should include exercise specific
dynamic stretches, pay careful
attention to hypermobility from
increases in relaxin.
- As pregnancy progresses the bike
or rower machine should be used
to increase cardiovascular fitness
and prepare the body for the
session.
Cool down:
Breathing exercises, stretching focusing
on areas of tension especially the back.

Rest
Reps/
Exercise Intensity interv Goal
Sets
als

To improve
Mod
posture and
Lat Pull Sub- rest, 2
6-8/3 increase
down maximal mins
back
per set
strength

leg strength,
improve
10- pelvic floor
Squat
12/3-4 control, and
hip/pelvic
stability

Improve
Hold core
for 10 stability,
V sit
second increase
s /3 abdominal
strength
Improve
balance, hip
alignment
10-
Lunges and pelvic
12/3
stability,
improve leg
strength 376
Post Natal
Many of the prenatal changes that the
client would have experienced will
continue into the first few weeks
postpartum. The client should allow for
appropriate recovery after birth and
follow the recommendations of the
medical practitioner.
Trainers should seek a new medical
clearance with new exercise
recommendations and avoidance from
the client’s medical practitioner.
Exercise recommendations if the
client was not training during
prenatal:
o The client should begin slow and
progressively.
o Abdominal exercises may need to
be avoided in the beginning weeks
of post natal training and more
attention to strengthening the joints
and stabilising the body should be
made.
∙ Exercise recommendation if the
client is was active during
prenatal stages:
o Recovery of postpartum symptoms
can often be a lot faster if the client
was active and had a good level of
fitness prior to giving birth. If this is
the case then training can resume,
but slowly and progressively, with
attention to new fitness testing
results.
o Building arm and back strength is
a good place to start with training
to prepare the body for extra
carrying demands of their child.
Ensuring the contralateral
movements are being included to
avoid any compensatory patterns
from favoring sides.
4. Clients with a disability:
A disability can be defined as a
restriction physically or mentally to a
person. In this section of the unit we will
discuss two of the most common
physical disabilities among humans
which
affects their ability to move and function
at their optimum level.
∙ Back pain
∙ Osteoporosis
Back Pain
It is estimated that 70-95% of people
will experience back pain some time
during their lives, (Powers, Beneck,
Kulig, Landel & Fredericson, 2008). At
that statistic it is likely that in your
training careers you will work with a
client suffering from acute or chronic
back pain.
Acute Back pain: Acute back pain is
when the sufferer will experience pain
for a short period of time. If not
managed at the time this pain can often
come back or worsen to chronic pain in
their lifetime.
Chronic back pain: Chronic back pain
is a constant suffering which can
debilitate and affect the sufferers well-
being and quality of life.
Prior to training process:
o Perform a thorough health
screening and movement analysis,
including communication,
recommendations and clearance
for training with the client’s medical
practitioners and physical
therapists.
o Perform or refer to workplace risk
management and prevention
strategies and process ensuring 377
safety and monitoring of the client.
∙ Exercise Programming process
for Back Pain clients:
Programs should focus on prevention
and cause of pain rather than simply
focusing on the pain itself.
o Prevention and Cause of pain
- Research has shown that in most
cases of chronic lower back pain,
the muscles multifidus and
transverse abdominis that stabilize
the spine are reflexively inhibited
and need to be strengthened
(Koftolis, & Kellis, 2006).
- Transverse abdominus is part of
the core stabilisers, many existing
programs have a strong focus on
this core network, but as Rainville,
Hartigan, Martinez, Limke, Jouve,
& Finno (2006) have found.
- The inability to activate the core
muscles could be a form of
neurological miscommunication
and compensation to avoid further
pain. It is then important to look out
for any failures in activation and
not bring a sole focus to just the
core muscles.
- Program should also include a
focus on proprioception to assist in
consciousness of the client’s body
and its actions and responses.
Koftolis, & Kellis, (2006) support
this addition of proprioception
focus with their study observing
links in the relationship between
disturbances of the lumbar spine
and mechanoreceptors due to
impairments of the superior
proprioception centers.
- Flexibility of the spine’s range
should also be considered.
- Improving cardiovascular fitness,
which should include a focus
exercising the diaphragm and
correct breathing techniques to
assist the spine and rib cage to
move freely with each breath.
- Regaining muscle strength to help
repair injured tissue should also be
included.
Osteoporosis
As well as good nutrition physical
activity has had and continues to be
recommended for prevention of
Osteoporosis, to increase bone mineral
density and assist in the recovery
process from exercise and longevity of
health.
∙ Cardiovascular exercise:
o Nelson & Layne, (1999) showed
that in the past 10 years prior to
their own study there had been a
direct positive relationship between
resistance training and aerobic
activities and increases in bone
density.
o Maintaining a healthy balance of
movement and mobility throughout
your life is of course the healthiest
and most recommended
preventative of disease and
degeneration of bone health in
later years.
378
∙ Resistance training:
o Turner & Robling, (2003)
Recommend a more dynamic
resistance training to static
exercises, because dynamic
exercises have been found to
initiate Osteogenesis (bone
formation).
o Examples of more dynamic
resistance training could include
Tai Chi and yoga for body weight
training, if the client however has
developed the mobility to lift weight
dynamically then their training
could progress into more power
lifts.
o To avoid stress related injuries
when working with clients with
Osteoporosis, sufficient rest, and
variation with exercise choice and
training type should be advised to
avoid overloading to specific bones
and muscles affected.
5. Diabetes:
Diabetes is a metabolic disorder where
people cannot naturally produce enough
insulin in the
body to control blood glucose levels
(Type 1) or the body is unable to
respond normally to insulin that is
made, (Type 2).
Exercise and living a healthy lifestyle
plays a vital role in the prevention of
diabetes, and in the
control and maintenance.
∙ Types of diabetes:
o Type 1:
In this type the beta cells within the
pancreas have been damaged so
insulin can no longer be produced to
filter and transport the blood glucose
into the tissues.
People with Type 1 diabetes will need to
inject insulin into their body to
compensate for the pancreas
dysfunction.
This type of diabetes can be passed on
genetically, and certain precautions
when training should be advised such
as:
- Performing an extensive pre-
exercise screening test
- Corresponding with allied health
professionals about the client’s
current level of health and
seriousness of their diabetes, that
could affect their sight, or heart.
- Clients will need to inject insulin
and/or eat a carbohydrate rich
meal before training, or they can
be at risk of hypoglycemia (low
blood sugar)
379
o Type 2:
People with this type of diabetes can
usually self-produce insulin however
their cells can become resistant to it
which can lead to abnormal levels of
blood glucose, often leading to
hyperglycemia (high blood glucose
levels).
This type of diabetes usually occurs
more slowly than type 1 and later in life
commonly due to unhealthy lifestyle
choices and abdominal obesity.
Treatment of this type of diabetes is
often to improve diet choices and
increase participation in regular fitness
and exercise training.
∙ Risks of diabetes during
exercise:
o Hypoglycemia (low blood sugar)
symptoms include:
- Dizziness and risk of fainting
- Body weakness
o Hyperglycemia (high blood
sugar): If not managed, condition
can lead to more chronic
symptoms which can affect:
- The functioning of the kidneys
- The circulatory system,
affecting the heart
- The nerves and sensitivity in
the feet and legs
- And eyes
∙ Considerations for exercise
training:
o Medical clearance from allied
health professional
o Pre-exercise health screening and
fitness testing
o Clients should be confident in
administering insulin if needed and
monitoring their blood glucose
levels
o Consultation with a dietician &
nutritionist is advised when
developing meal plans for training
o Depending on the severity of
diabetes the feet and legs can be
affected so precautions should be
advised when training the lower
body and performing any self
myofascial release
o Clients should be monitored for
symptoms associated with either
hypoglycemia or hyperglycemia
o Appropriate footwear should be
advised for the client to wear
∙ Benefits of exercise and
diabetes control:
o Improved glucose tolerance
o Weight loss and weight control
o Potential decrease in insulin
injection requirements
∙ Cardiovascular training:
o Cardiovascular training is
encouraged for people with
diabetes to include in their
workouts to promote circulatory
system, heart health and blood
transport.
380
o Weight loss can often be a main
priority for both types of diabetes,
and aerobic training can help
reduce lipid levels to assist in this
goal.
o Colberg, Yardley, Riddell, et al,
(2016) promote the idea of
including high intensity interval
training (HIIT) to; “improve the
skeletal muscle oxidative capacity,
insulin sensitivity and glycemic
control for adults with Type 2
diabetes.” A HIIT session is often a
favorite for clients with limited time
and looking for maximal results.
o Depending on age, ability and
cardiovascular health certain
precautions should be taken to
monitor Heart rate of the individual.
For those who are at risk of
cardiovascular disease more
prolonged aerobic training can be
recommended, to train at a lower
intensity for a longer duration.
o Clients should be including regular
intervals of cardiovascular training
into their weeks for faster results to
their health and well-being
o Example HIIT cardiovascular
training session:
Sprint 10 seconds
Squat 20 seconds
Rower sprint 20 seconds
Push up 10 seconds
Rest 1 minute
Repeat X 3
∙ Resistance Training:
o The primary goal for someone with
diabetes is usually weight loss and
maintenance of diabetes. Usually a
symptom of obesity is associated
with Type 2 diabetes is muscular
weakness, so beginning training
with a goal to improve foundation
levels of strength should be
advised. Including both resistance
and cardiovascular training can
help to establish a lean body mass
and improve glycemic control and
maintenance.
o Once the foundation level of
strength and technique in
exercises is established this is
when clients can progress in their
training. Peak physique body
building can be an excellent goal
for clients to reduce their weight
and improve strength.
o When beginning resistance training
regular rest intervals should be
advised to avoid overuse injuries
or overtraining, and including
variation in exercise to train and
assist in muscular adaptations for
the whole body
o Include ROM flexibility training and
core stability to assist in lifting
control and improved performance
and alignment.
381
6. Obesity
Obesity is a complex disease which places
is associated with chronic health diseases
and mental health issues. The primary
cause of obesity to the balance of energy
in, compared to energy expenditure.
∙ Measuring body mass and obesity:
Body composition measurements have
been outlined in the health screening unit
of this certification. They assist trainers
and allied health professional to measure
the fat content of the individual in relation
to their body type. These tests can show
whether an individual is overweight, obese
or underweight. They include BMI testing,
and skin folds.
∙ Working with allied health
professionals:
Due to the high risks involved with
individuals who are obese it is important to
collaborate and work closely with allied
health professionals, including general
practitioner to assess the use of certain
medications and effects of physical
activity, or physiological risks that could
affect performance.
Because obesity is largely the result of
poor dietary choices it should be
recommended that clients also work with a
certified dietician to compliment and assist
the progressions and motivation of
physical training.
∙ Risks associated with obesity
- Cardiovascular disease
- Respiratory problems
- Back pain
- Degeneration of bone mineral density
- Self- confidence reductions
- Impairments to quality of life
∙ Exercise programming for
obese adults
o With an increase in weight needing
to be carried by a person who is
obese common instabilities in
cardiovascular health, and stability
can be an issue. Sessions should
then have a focus on
proprioception, core strength and
stability, this will also assist to
reduce the symptoms and prevent
back pain that can arise from
excess mass being carried often in
the belly.
o Due to the cardiovascular and
respiratory problems associated
with obesity programming should
also include low weight bearing
aerobic training.
o Resistance training will be
important to strengthen the body’s
structure and help to increase lean
body mass which will help to
increase metabolic rate and
improve body composition goals.
For more information on body
composition and weight loss
can be found under ‘Body
Composition’ unit.
382
 Section 10:
Required Reading

1. Muscle & Fat Structural Make-up

2. Macros

3. Digestion

4. Anti-Nutrients

5. Comparative Analysis of Various Diet

Methodologies

6. Periodization

383
10.1Muscle & Fat Structure

1. Muscle Structure:
Muscles play a vital role in every
function of the human body, from;

1. The circulation of blood around

your body.
2.
support movement and mobility,
so you can perform physical
exercise.
3.
help you digest the food.

Did you know?

Let’s first understand what the
major muscles are called. As you
get to know this it becomes easier
to communicate muscle locations
to your clients and to medical
practitioners.

Three Main Types of Muscles

These include three muscle types:
smooth, skeletal, and cardiac. And
they have di erent, yet interrelated
roles to keep you performing and
looking at your best.
∙ Skeletal muscles are voluntary.
This means you can control them
consciously.

∙ Smooth and cardiac

muscles act involuntarily
and are governed by
unconscious physical
functions.
Each muscle type in the muscular
system has a specific purpose.

Purpose of Skeletal Muscles

You're able to move around throughout
your day and perform physical exercise
because of your skeletal muscles.

384
Purpose of Cardiac Muscles
Your heart beats because of your
cardiac muscle, which helps blood and
other nutrients to be transported around
your body..
Purpose of Smooth Muscles
You can digest your lunch because
of your smooth muscles supporting
your digestive system.
How These Types of Muscle Work
Together
The different muscle types also work
together to make these functions
possible.
For example:
• While you're performing physical
activities (walking, weight lifting,
playing), using skeletal muscles,
• •your heart pumps harder, due to the
cardiac muscle, that causes you to
breathe faster and heavier, using
smooth muscles.
Muscle Tissue Growth and Body-
Building
Hypertrophy is a scientific term to
describe muscle growth. There’s
different ways muscles can be trained
that will elicit different types of muscle
growth. It’s important you know them so
you can tailor the right look and
performance for your client.
There’s two key types of muscle growth;
sarcoplasmic and sarcomere /
myofibrillar hypertrophy.
Sarcoplasmic Hypertrophy:
∙ Sarcoplasmic hypertrophy is an
increase in the volume of the
non-contractile muscle cell fluid,
sarcoplasm.
∙ This fluid accounts for 25-30% of
the muscle’s size. Although the
cross sectional area of the muscle
increases, the density of muscle
fibres per unit area decreases,
and there is no increase in
muscular strength.
(Tsatsouline, Pavel. Power to
the People. Dragon Door
Publications, Inc., 2000.)
Sarcomere / Myofibrillar
Hypertrophy:
∙ Sarcomere or Myofibrillar
hypertrophy, on the other
hand, is an enlargement of
the muscle fibre as it gains
more myofibrils, which
contract and generate
tension in the muscle.
∙ With this type of hypertrophy,
the area density of myofibrils
increases and there is a
significantly greater ability to
exert muscular strength.
(Tsatsouline, Pavel. Power to the
People. Dragon Door Publications, Inc.,
2000.)
385
How Different Types of Hypertrophy
Training Lead to Different
Performance and Look

Sarcoplasmic Hypertrophy Sarcomere / Myofibrillar Hypertrophy

386
Skeletal Muscle:

It is a voluntary muscle, responsible for

body part movements.

1. Structure:
A muscle is made up of thousands of
muscle fibres bundled together in a
connective tissue, and the bundle is
called a fosciculus. A bunch of fosciculi
makes a muscle.

Image Source:
https://training.seer.cancer.gov/anatomy
/muscular/structure.html

A muscle fibre is basically a muscle cell

which is cylindrical in shape and has
multiple nuclei. Each fiber has
cylindrical structures called myofibrils.
Myofibrils attach to the sarcolemma
(plasma membrane), at their ends, so
when myofibrils shorten, the muscle cell
contracts.

Image source:
http://www.opentextbooks.org.hk/syste
m/files/resource/34/34471/35200/media/
image23.png

One myofibril is made up of several

basic functional units called Sarcomere.
(1)

Actin & Myosin:

In a cell, myofibrils (the two filaments:

Actin & Myosin) run along the length
and through number of sarcomeres.

Image source:
https://opentextbc.ca/anatomyandphysi
ology/chapter/10-2-skeletal-muscle/

387
Myosin & Actin Differences:
Actin
Thin & short
Consists of actin, troponin, and
tropomyosin
Present in A & I band
More abundant
One end is free, one is attached to Z
line
Slides along Myosin
Smooth Surface
Cross bridges absent
Sliding Filament Theory: How
Muscles Contract
∙ Muscle tissue is made up of
sarcomeres which are the
functional units of myofibrils.
∙ Myofibrils will contain two
primary protein filaments whose
interaction are responsible for our
muscle contractions.
∙ These protein filaments are
called Myosin (a thick filament)
and Actin (a thin filament).
Schoenfeld, (2016).
∙ Two protein structures that are
also important to muscle
contraction are tropomyosin
and troponin.
∙ Tropomyosin is located on the
actin filament, and blocks
myosin binding sites from
attaching when the muscle is
in a relaxed state.
∙ • Troponin is also
located on the actin filament,
and plays a role in muscle
contraction by providing
binding sites for both calcium
and tropomyosin when a
muscle needs to contract.
Myosin
Thick & long
Consists of myosin and meromyosin
Present only in A band
Less abundant (1 per 6 actin
filaments)
Both ends are free
Doesn’t slide
Rough Surface
Cross bridges present
It is the interaction of myosin and
actin that produce contractions.
Signals to the skeletal muscle
stimulated by the nervous system
begin this sliding interaction of
myosin and actin, cross bridges are
then formed and broken several
times during contraction to produce
tension to propel the thin filaments
towards the centre of the sarcomere.
It is this contact between the myosin
cross bridges and the actin that
produce force. Force can always be
produced but the level of intensity
and amount that is produced
depends upon three primary factors
as outlined by Powers and Howley
(2001).
388
2. Muscle Fiber Types

Instead of summarizing in paragraphs, I

am using a table so that it is easier to
see the differences at a glance.
Type I Type IIA Type IIB
Alternatively Slow oxidative Fast oxidative Fast glycolytic
known as
Presence of High in number moderate in number Low in number
Mitochondria
Number of high moderate low
capillaries
Color Red Pink white
Diameter small medium large
Size of Motor Small Large Very Large
Neuron
(bigger motor
neurons allow
nerve impulses to
operate faster)
ATPase low medium high
Concentration
Speed of Slow medium Fast (10X of Type I)
Contraction
Conduction Slow twitch Fast twitch Fast twitch
Velocity
Activity aerobic Long term anaerobic anaerobic
Duration of Long (Hours) Few minutes Short (<1 minute)
Contraction
Fatigue resistant Fairly resistant easily
Power of low Intermediate (5-6 High (20 times of
Contraction times of type I) type I)
Storage triglyceride Creatine phosphate, Creatine Phosphate,
glycogen glycogen
Lactate Removal Highest High Slow
Rate
Oxidative Capacity high medium low
Glycolytic Capacity low medium high
Activities Long term aerobic Long term anaerobic Short term anaerobic
Performed
Examples of Marathon running 400m-800m sprints Short sprints
Activities It
Engages In

389
b. Fat Structure:
Body fat or adipose tissue is a type of
connective tissue in human body.
Fat cells do not die; they can shrink and
grow in size (to store less or more fat
depending upon individual body fat %).
Fat cells undergo hyperplasia, i.e.
multiply in numbers after a certain size
threshold. That means if you lose
weight, you can never go back to the
lower number of fat cells that you had
previously, and hence, when you gain
weight AGAIN, it is easier for your
body to put on fat as fat cells are
already there, and the body just
needs to stash the fat away in it.
Functions of Body Fat:
1. Protection of vital organs
2. Storage of energy
3. Maintenance of body temperature
Types of Fats:
Based on where the fats are stored,
they can be classified as
1. Intramuscular Triglycerides
(IMTG):
It is present in muscle fibers near
mitochondria (the energy production
site).
Carbohydrate intake plays a role in
determining whether body will use IMTG
during exercise. If sufficient carb
reserves are present, glycogen is the
preferred fuel for exercising. When
glycogen stores are low, IMTG is used
as fuel during exercise. The post-
exercise pump is partly attributed to
IMTG as it spares glycogen in muscles,
as it is a preferred fuel source for body
during anaerobic (weight training)
exercises to glycogen.
Average person has 3 times more IMTG
than muscle glycogen.
Unlike glycogen, IMTG is NOT stored in
equal amounts in type I and type II
fibers. IMTG is stored in larger
quantities (2.8 times more) in type I
(endurance) fibers than in type II
(anaerobic) fibers. (7)
1. Visceral fat:
It is present around internal organs and
in healthy amounts, it’s necessary to
protect these organs.
Men have a tendency to store more
visceral fat (around the midsection) and
women have a tendency to put on more
subcutaneous fat (in thighs, buttocks,
arms).
Steroids, smoking, and alcohol are a
few reasons that can cause higher
visceral fat %.
Higher visceral fat % leads to higher
stress and higher risk of cardiovascular
diseases.
While losing weight, when a person
loses visceral fat, often see higher
cholesterol levels, because it is
metabolized in liver.
2. Subcutaneous fat:
It is the so called ‘unsightly fat’ that we
can see on our bodies. It is usually
WAT. Though, we think if we get rid of
subcutaneous fat, we will become
healthier, we cannot be more wrong. In
terms of cardiovascular fitness, lower
visceral fat % matters more. I.e. a
person who doesn’t have as much
‘visible’ (subcutaneous) fat but has more
% of visceral fat than a person with
more ‘ugly’ (subcutaneous) fat and
lower visceral fat % is more likely to be
at risk.
390
Genetics is one of the reasons
behind how quickly one puts on
subcutaneous fat.
This fat is quite stubborn, i.e. very
difficult to burn as it is difficult to get
these lipid deposits into bloodstream.
1. Essential fat:
As the name suggests is required for
healthy functioning of our body. This
type of fat is found in brain, bone
marrow, nerves, and organ
membranes.
And based on type of cells, it is
classified as:
1. White Adipose Tissue (WAT):
It is made up of large white cells
(usually stored under the skin, hence
subcutaneous) in hips, abdomen,
thighs, arms. Body stores energy in the
form of triglycerides in these cells. It has
a single, large droplet, with few
mitochondria. WAT has low vascularity.
It doesn’t use any energy itself to
function.
“WAT maintains energy homeostasis by
storing extra energy in the form of
triacylglycerols and by breaking down
this stored energy into FFA and glycerol
to generate energy in the form of
adenosine triphosphate when energy
demands increase.” (8)
2. Brown Adipose Tissue (BAT):
BAT forms during development of
embryo before other fat depots. BAT is
present in newborns in much larger
quantities than in adults. before other fat
depots and is assumed to contain a
uniform population of adipocytes.
It is made up of small multiple droplets.
It has more number of mitochondria and
has high vascularity. BAT promotes
energy expenditure as it is thermogenic
i.e. creates heat by burning fatty acids
and helps maintain body temperature.
BAT has higher capillary density that
provides it with oxygen and nutrients
and distributes heat to the rest of the
body.
“The amount of active BAT in humans is
heterogeneous, but the exact mass has
never been measured precisely.
Estimates suggest that healthy humans
have about 50 g of active BAT
(approximately 0.1% of body mass).” (9)
And that much of fully activated BAT
contributes to approximately 2% to 5%
of BMR in an average human. (10)
The figure below shows the location of
WAT and BAT:
Img src:
https://www.google.com/url?sa=i&url=https%3A%2F%2Fthi
nksharplivesmart.com%2F2015%2F10%2F08%2Fwhite-fat-
v-brown-fat%2F&psig=AOvVaw2zQhuMbX4HzENQ-
n314KQq&ust=1593359350402000&source=images&cd=vf
e&ved=0CAIQjRxqFwoTCMiW0KKsouoCFQAAAAAdAAAA
ABA0
391
 1. Beige Adipose Tissue (Being
studied for concrete
implications):
Clusters of brown adipocytes also
develop in WAT and that is called as
Beige Adipose Tissue or iBAT (induced
BAT) or recruitable BAT or wBAT (white
adipose BAT). iBAT also undergoes
thermogenesis. But the difference
between BAT and iBAT is BAT can
undergo thermogenesis under resting
conditions, but iBAT can do that only via
the action of specific activators. (11)
Difference between WAT & BAT:
(Answer to Assignment Q2)
So, Can BAT Upregulation be a Possible
Solution To the Obesity Pandemic?
A paper (8) examines available information
to explore such a possibility, and the
answer is, ‘Not really!’ The reasons for that
are:
∙ Mechanism of how WAT converts into
iBAT is inconclusive at this point.
∙ BAT can’t significantly contribute to
total daily energy expenditure,
because, as mentioned before, it can
contribute only 2-5% of BMR that too
when fully activated.
∙ Obese people have lesser BAT mass

WAT BAT
Function ∙ Insulation, Heat generation
∙ excess energy
storage
∙ endocrine function
Amount in human body 12-35kg approx. 50g approx.
Location ∙ Under the skin ∙ Shoulder
∙ around organs blades
∙ under the skin
Color Ivory/yellowish white brown
Adipose Cells Uni-locular Multi-locular
Vasculature Poor Dense
Increase with age Decrease with age
No of mitochondria low high
present
Size Large Small
Formation Post birth In embryonic stage

• Watt, et.al. (2002). Intramuscular triacylglycerol utilization in human skeletal muscle during exercise:
is there a controversy? Journal of Applied Physiology . 93:4, 1185-1195.
https://journals.physiology.org/doi/full/10.1152/japplphysiol.00197.2002
• Mulya, A., & Kirwan, J. P. (2016). Brown and Beige Adipose Tissue: Therapy for Obesity and Its
Comorbidities?. Endocrinology and metabolism clinics of North America, 45(3), 605–621.
https://doi.org/10.1016/j.ecl.2016.04.010
• Rothwell, N. J., & Stock, M. J. (1979). A role for brown adipose tissue in diet-induced
thermogenesis. Nature. https://www.nature.com/articles/289699a0.pdf
• van Marken Lichtenbelt, W. D., & Schrauwen, P. (2011). Implications of non-shivering thermogenesis
for energy balance regulation in humans. American journal of physiology. Regulatory, integrative and
comparative physiology, 301(2), R285–R296. https://doi.org/10.1152/ajpregu.00652.2010
• Harms, M. & Seale, P. (2013). Brown and beige fat: development, function and therapeutic potential.
Nature Medicine. https://www.nature.com/articles/nm.3361 392
10.2 MACROS
1. Proteins
What are Proteins?
Proteins are building blocks of our
muscles. We get the protein our body
needs from sources available around us
(vegetarian and non-vegetarian).
Essentially, every protein is made up of
basic units called Amino Acids (AA).
There are 20 AA in nature, out of which
9 are essential amino acids (EAA) (i.e.
human body can’t make those and we
have to get those from food sources).
The numerous proteins found in nature
are just different permutations and
combinations of the 20 AA. But the
protein we eat/find around us is different
than what we need in our body to build
muscle. So our body breaks it down
(catabolic action) into its basic units
(AA) and puts those back together
(anabolic action) in required sequences
as and when needed.
These newly configured proteins are
now used wherever required:
• To replace and regenerate
cells and tissues.
• To make antibodies.
• DNA synthesis
• Chemical reactions etc.
OUR BODY CAN'T STORE PROTEINS IN
THE FORM OF AA!
So when we have provided protein for all the
functions that need it, and if we have some
extra AA, we can’t store it for a rainy day!
Body just breaks those excess AA down into
alpha keto acids (nitrogen is removed from
AA and disposed through urine.).
Those alpha keto acids are turned into
triglycerides and stored in fat tissues.
Alpha-keto acids can be used as fuel when
body isn’t supplied with enough calories from
fat or carbs- but this hardly happens as
carbs is the most preferred fuel of our body,
and fats after that. This is because our body
tries hard to not use those alpha keto acids
as much as possible, saving those to build
tissues- as no other macro nutrient can do
that. (0)
Complete and Incomplete Proteins:
When a protein source provides all 9 EAA, it
is called as a complete protein. Most non
vegetarian protein sources are complete or
CLASS A.
An incomplete protein is one that is lacking
in any of EAA. Most plant based protein
sources are incomplete (except soybean).
1.Functions of Protein:
∙ Skeletal muscle stores AA for other
tissues.
∙ Maintain body structure and posture (e.g.
collagen)
∙ Mobility (contractile proteins)
∙ Hormones & Enzymes
∙ Cell signaling pathways
∙ Immunity (antibodies)
∙ Repairing of damaged muscles during
exercise
∙ Plays part in protein turnover
∙ Metabolic adaptation in long term
exercise
∙ Re-modelling
∙ Provide AA substrates to promote MPS
∙ In absence of glucose, it’s a primary
substrate for gluconeogenesis
393
Insulin:
1. Many resistance athletes take
simple carbs with protein post
training as it is believed to
speed up the recovery. But, is
there any truth to that?
The possible explanation behind this
popular belief could be misinterpretation
of a fact that insulin acts as a stimulant
for MPS as it increases plasma and
intramuscular leucine as stated in a
paper ‘Physiologic hyperinsulinemia
stimulates protein synthesis and
enhances transport of selected amino
acids in human skeletal muscle’ by Biolo
et. al. (19).
But that does NOT mean we need carbs
for that! The amount of insulin needed
for this purpose is very less (i.e., 10–15
IU/ml), that is 2–3 times basal resting
levels for healthy individual. And that
much insulin spike can happen with the
protein that you are consuming. So
there is NO NEED OF CARBS to
stimulate MPS post training if you are
consuming adequate protein!
2. Okay, so carbs don’t play a part
in MPS. So is it possible that
carbs reduce MPB and hence
are responsible and important
for positive NBAL?
A study by Glynn et. al. (20) concludes:
“the enhanced muscle protein anabolic
response detected when (EAA + Carbs)
are ingested post resistance exercise is
primarily due to an increase in MPS
with minor changes in MPB,
regardless of carbohydrate dose or
circulating insulin level.”
So, the answer is; NO.
High protein foods help maintain
optimum levels of insulin
Vegetarian Diet & Protein Needs
∙ To get enough protein through
vegetarian options, it’s a little
difficult to be able to stay within the
caloric limit, as most vegetarian
protein sources have quite low
amount of protein compared to
non-vegetarian class A sources-
and to hit daily protein quota, one
has to eat considerably more food
volume.
∙ So, to get enough protein and a
diverse profile of AA, when making
Vegetarian Diet Plans - always use
Whey for at least 30 to 40% as
part of overall daily protein content.
∙ You can increase the protein from
whey as high as 80% when you
the competition date- end of
extreme dieting is approaching.
∙ Why Whey is a good option for
vegetarians to bridge the protein
gap?
∙ Vegetarian protein sources lack
complete amino acid profile.
∙ Plant based proteins are very low
in EAA
∙ Add 10-20g whey to each meal
assuming 4-5 meals per day.
∙ You can add EAA but whey is
preferred to plug the AA diversity
gap as:
o Whey has EAA + Extra
nutrients
o Whey is more satiating
∙ For vegans - use a combination
of Pea & Rice Protein.
394
References:

• Todd, C. (2019). Here's What Actually Happens in Your Body When You Eat
Protein. Self. https://www.self.com/story/what-protein-does-in-your-body
• Wilkinson SB, Phillips SM, Atherton PJ, Patel R, Yarasheski KE, Tarnopolsky MA &
Rennie MJ (2008). Differential effects of resistance and endurance exercise in the
fed state on signalling molecule phosphorylation and protein synthesis in human
muscle. J Physiol.
https://physoc.onlinelibrary.wiley.com/servlet/linkout?suffix=null&dbid=8&doi=10.11
13%2Fjphysiol.2011.211888&key=18556367
• Proud, C.G. (2007). Signaling to translation: How signal transduction pathways
control the protein synthetic machinery. Biochem J.
https://pubmed.ncbi.nlm.nih.gov/17376031/
• Morton R., McGlory C., Phillips S. (2015). Nutritional interventions to augment
resistance training-induced skeletal muscle hypertrophy. Frontiers in Physiology.
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• Kumar, V., Atherton, P., Smith, K., & Rennie, M. J. (2009). Human muscle protein
synthesis and breakdown during and after exercise. Journal of applied physiology.
https://journals.physiology.org/doi/full/10.1152/japplphysiol.91481.2008
• Leal, D. (July 24, 2020). Is Muscle Protein Synthesis the Same as Growth? Very
Well Lift. https://www.verywellfit.com/muscle-protein-synthesis-and-muscle-growth-
4148337
• Phillips SM, Tipton KD, Aarsland A, Wolf SE, Wolfe RR. (1997). Mixed muscle
protein synthesis and breakdown after resistance exercise in humans. Am J
Physiol. 273(1):99–107. https://doi.org/10.1152/ajpendo.1997.273.1.E99
• Tipton, K. (2017). Branched-chain amino acid supplementation to support muscle
anabolism following exercise. Gatorate Sports Science Institute.
https://www.gssiweb.org/sports-science-exchange/article/branched-chain-amino-
acid-supplementation-to-support-muscle-anabolism-following-exercise
• Phillips, B. E., Hill, D. S., & Atherton, P. J. (2012). Regulation of muscle protein
synthesis in humans. Current opinion in clinical nutrition and metabolic care, 15(1),
58–63. https://doi.org/10.1097/MCO.0b013e32834d19bc
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exercise anabolic window?. Journal of the International Society of Sports
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• Oliver C Witard, Sarah R Jackman, Leigh Breen, Kenneth Smith, Anna Selby, Kevin
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• Moore, D.R., Camera, D.M., Areta, J.L., and Hawley, J.A. (2014). Beyond muscle
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mechanisms through which branched-chain amino acids mediate translational
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• Churchward-Venne, T. A., Breen, L., Di Donato, D. M., Hector, A. J., Mitchell, C. J.,
Moore, D. R., et al. (2014). Leucine supplementation of a low-protein mixed
macronutrient beverage enhances myofibrillar protein synthesis in young men: a
double-blind, randomized trial1-3. Am. J. Clin. Nutr.
https://academic.oup.com/ajcn/article/99/2/276/4571468
• Morifuji, M., Sakai, K., Sanbongi, C., & Sugiura, K. (2005). Dietary whey protein
downregulates fatty acid synthesis in the liver, but upregulates it in skeletal muscle
of exercise-trained rats. Nutrition (Burbank, Los Angeles County, Calif.), 21(10),
1052–1058. https://doi.org/10.1016/j.nut.2005.01.010
• Phillips SM, Moore DR, Tang JE. A critical examination of dietary protein
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396
b. Carbohydrates
What are Carbohydrates?
Carbohydrates are the sugars, starches and
fibers found in fruits, grains, vegetables and
milk products. 1 gram of carbohydrate has 4
calories.
Body breaks carbs down into its smaller
units (glucose, fructose) which are absorbed
by the small intestine. These are then
absorbed into bloodstream and reach liver-
where all sugars are converted into glucose.
Glucose and insulin are carried by blood
and converted into energy for basic
functions of body as well as for physical
activities. If it is not required right away, it is
stored in liver and in muscles as glycogen.
Body can store up to 2000 calories in the
form of glycogen.
Once that 2000 calorie limit is reached,
excess carbs are stored as fat.
What are functions of carbohydrates?
∙ fuel for the central nervous system
∙ energy for working muscles
∙ prevent protein from being used as an
energy source
∙ enable fat metabolism
∙ fuel for brain function
‘Essential’ is not the same as ‘Optimal’.
‘Carbs aren’t essential’ is usually
misinterpreted as carbs aren’t needed.
That’s far from the truth, as we need carbs
for optimum health, and that’s the goal of
most people when they want to change their
dietary habits and start training.
Essential in the above statement only
means that its unavailability doesn’t lead to
cell death. But very low or no carb intake is
still is detrimental to health!
Also, in scientific literature, ‘essential’
means something that CANNOT be
produced by the body. And by that
definition, if we do not consume ANY carbs
at all, body will go through
gluconeogenesis to produce required
amount of glucose, essential for SURVIVAL,
but not enough to THRIVE!
Daily Carbohydrate Recommendations:
Endogenous glycogen stores are fully
replenished by a high-carbohydrate diet (8-
12 g of carbohydrate/kg/day ).
Image source:
https://www.coursehero.com/file/50586915/
gssi-carbohydrates-101pptx/
397
Carbs & Training:
For most activities, carbohydrate is the
major energy source.
Why carbs are important for training?
(Strength as well as endurance)
∙ Maintain high rates of
carbohydrate oxidation
∙ Reduce ratings of perceived
exertion
∙ Increase endurance capacity
∙ Delay the onset of fatigue
∙ Prevent hypoglycemia
HIIT exercise capacity is consistently
improved with adequate carbohydrate
intake.
Why carbs are a superior fuel for
athletic performance?
Carbohydrate provides a metabolic
advantage (high carb oxidation, spare
liver glycogen). When we choose types
of carbs, want to choose those that
result in high rates of oxidation.
Carb recommendation Endurance
Athletes for Peak performance: (1)
∙ 3-4 Hours Before : 1-4 g/kg (find
the amount and timing that is best
for your stomach)
∙ In the hour before: try a small
amount of easily digested
carbohydrates, ~25 g. This can
help meeting your “during” needs
∙ During practice/Competition: 30-
60 g/h (when going for 60 min or
longer)
After practice/Competition: 1.0-1.2 g/kg
to refill glycogen stores. This is
especially important if the athlete has a
short time to recover (<8 hours)

Carbs are important for different team

sports for different reasons:

Sport Why Carbs are important

Strength + Power Field To Maintain short energy
Sports bursts
Endurance Field Sports To maintain glycogen stores
Battling Sports To maintain blood glucose
for attention & decision
making
Court Sports To maintain glycogen over
time

Source: Table is made from information

from a study (2)

398
Pre-Workout Nutrition: if your tank is
already filled with glycogen, and protein,
pre-workout nutrition isn’t really
important.
Post-Workout Nutrition: after a
training session (which burns approx
150-180g glycogen), you don’t need to
rush home to have carbs as you won’t
need any more till your next workout!
Note: importance of both protein and
carbs in pre and post workout nutrition
is covered in detailed under ‘proteins’
section.
Carb Timing For Non-Athletes:
∙ For average population not
chasing any athletic goals,
frequency of meals has no effect
on weight loss and body
composition.
∙ But meal frequency does affect
satiety and hence can possibly
reduce the probability of
occurrences of binge eating
leading to better adherence to diet
in some cases.
Harry’s Note: Carbs aren’t responsible
for Metabolic Syndrome and Insulin
Resistance. But, it’s a different story if
you are already insulin resistant or have
metabolic syndrome.
HOW DOES BODY STORE CARBS?
Carbohydrates are the sugars,
starches and fibers found in fruits,
grains, vegetables and milk
products. Body breaks carbs down
into its smaller units (glucose,
fructose) which are absorbed by the
small intestine. These are then
absorbed into bloodstream and
reach liver- where all sugars are
converted into glucose.
Glucose and insulin are carried by
blood and converted into energy for
basic functions of body as well as for
physical activities. If it is not required
right away, it is stored in liver and in
muscles as glycogen. Body can
store up to 2000 calories in the form
of glycogen.
Once that 2000 calorie limit is
reached, excess carbs are stored as
fat.
399
Role of Insulin
What is insulin?
Insulin is a hormone produced by
pancreas and it helps us convert dietary
carbs into energy or into glucose for
further use.
Insulin is one of the hormones that are
required to regulate blood sugar level by
allowing cells in muscles, fat, and liver
to absorb it.
Harry’s Comment: ALL FOODS
TRIGGER INSULIN RESPONSE.
It would make more sense to call Insulin
as anti-catabolic rather than anabolic,
as insulin controls the energy flow from
storage to bloodstream when diet
provides enough glucose. (3)
Image source:
https://www.endocrineweb.com/sites/def
ault/files/imagecache/gallery-
large/wysiwyg_imageupload/37373/201
9/02/26/HowInsulinWorks_39563672_M
.jpg
When we eat food, blood sugar rises,
and pancreas are signaled to release
insulin. Insulin then attaches to cells
where energy is needed (cells need
glucose but blood sugar can’t directly
enter cells) and now cells can absorb
sugar from blood.
If cells do not need energy, the sugar is
then converted into glycogen in liver for
further use.
If body doesn’t produce insulin (Type I
diabetes) or doesn’t produce in enough
quantities/is resistant to it (Type II
diabetes), blood sugar stays high
causing hyperglycemia.
400
Insulin Index (II)
II is how much the consumed food
elevates the concentration of Insulin in
blood in period of 2 hours
consumption.
The II can be more useful than either
the glycemic index or the glycemic load
because certain foods (e.g., lean
meats and proteins) cause an insulin
response despite there being no
carbohydrates present, and some
foods cause a disproportionate insulin
response relative to their carbohydrate
load.
Difference between II and GI:
The limitation of the GI approach is that
we can eat a diet full of low GI
carbohydrates and protein, and still
produce a large amount of insulin. Even
though those are slow to digest and do
not raise blood sugar significantly, low
GI foods still require substantial
amounts of insulin.
We should focus on amount of
insulin, and not on carb quantity or
blood sugar rise.
401
 We should focus on amount of insulin, and not on carb quantity or blood sugar rise.

Insulin Index Glycemic Index

Blood insulin levels are measured
Compares food portions with equal overall
caloric content (250 kcal or 1000 kJ)
Blood glucose levels are measured
Blood glucose raising potential of carbohydrate
content of a food compared to a reference food
(pure glucose)
Compares portions with equal digestible
carbohydrate content (typically 50 g)

Insulin Index of common foods:

Food Inuli Food Insu Food Ins

n lin ulin
Inde Inde Ind
x x ex
Butter 2 Low fat milk 34 Honeysmacks 49
Olive Oil 3 Beef lasagna 34 Reduced fat potato chips 51
Avocado 4 White tortilla (ccorn) 36 Sustain 52
Walnuts 5 Snickers Bar 37 Soy-lin grain bread 52
Bacon 9 Honey resin bran muffin 37 Low fat cottage cheese 52

Peanut Butter 11 Beef steak 37 Yellow cake with chocolate 53

Bologna 11 Popcorn 39 Peaches canned with juice 54

Peanuts 15 Frozen corn 39 French fries (McCain) 54
Tuna in Oil 16 Reduced fat cottage cheese 40 Fat free raisin oatmeal cookie 54

Hot dog 16 Tomato pasta sauce 41 Donut 54

Roast chicken 17 Granola 41 Battered fish fillet 54
without skin
Cream cheese 18 Grain bread 41 Orange juice 55
Chicken with skin 19 Carrot juice 41 Great grains 57

Coleslaw 20 Pastry 42 French fries (McD) 57

93% fat free Cheddar 20 Low fat cheese 42 Panjacks 58
Cheese
Tofu 21 Lentils in tomato sauce 42 Croissant 58

Prawns 21 White fish 42 Whole grain puff 59

Navy beans 23 Apple 43 Banana 59
Egg 23 Orange 44 Skim milk 60
Full cream milk 24 Coca-cola 44 Chocolate brownie 60
Beef taco 24 Potato chips 45 Black grapes 60
Tuna in water 26 Jatz cracker 45 Honey bunches of oats 61
Wholemeal pasta 29 Corn chips 45 Cheerios 63
White pasta 29 Brown rice 45 Water crackers 64
Porridge 29 Pizza 47 White bread 100
Resins 31 Apple pie 47 Baked beans 120
Chocolate chip 33 Apple juice 47 Potatoes 121
cookies
Muesli bar 34 Oat bran 48 Mars Bar 122
402
Milk chocolate 34 Reduced fat chocolate chip 49 Jelly beans 160
cookie
Limitations of Insulin Index:
Looking at the above chart if you want
to help yourself with extra spoonful of
butter, we should remember that II of a
food measures insulin in blood only for 2
hours post consumption. This approach
will lead to underestimating insulin
response from foods that invoke rise in
insulin quite late (e.g. protein spikes
insulin approx. 8 hours after
consumption, and fats take even
longer).
“We can’t simply assume that because
the insulin rise after meals is low that
our total insulin secreted across the day
will also be lower.” (15)
Insulin Resistance (IR):
In order to understand IR, we need to
understand Insulin Sensitivity (IS) first.
IS refers to the body’s ability to
efficiently dispose of blood glucose.
Active individuals are more insulin
sensitive than those who have
sedentary lifestyles. When a person
consumes foods that keep the blood
sugar high for pretty much all the time,
for long periods, the insulin receptors in
cells stop responding to presence of
insulin in blood, and do not let the blood
glucose in. This is called as IR. So if
you are highly insulin sensitive, you
have lower chances of becoming
insulin resistant.
Image Sources:
https://www.healthypcos.com/blogs/pco
s/everything-you-need-to-know-about-
pcos-insulin-resistance
As sedentary individuals become more
and more insulin resistant, pancreas
cannot secrete sufficient insulin to
remove glucose from the blood after
food consumption. This is called as
Glucose Intolerance.
Role of Carbs in Insulin Resistance
“One cannot simply look at the fact that
carbohydrate ingestion will suppress fat
burning during the time that
carbohydrate is
metabolized. Unfortunately, proponents
of the "carbohydrates drive insulin which
drives fat storage" mantra do exactly
that. You have to consider the big
picture and what is happening over a 24
hour period.” (4)
403
Role of exercise (Endurance &
Resistance) in preventing insulin
resistance:
∙ As we saw above- improved insulin
sensitivity drastically lowers the
chances of one becoming insulin
resistant. Exercise induced weight
loss seems to be one of the major
reasons for improved insulin
sensitivity. It is important to know
that weight loss due to dieting
alone and exercise induced
weight loss have noticeable
difference in improvement in
insulin sensitivity.
∙ “Additionally, exercise-induced
weight loss stimulates
mitochondrial oxidative capacity
and impacts endogenous glucose
production by significantly
suppressing unnecessary
gluconeogenesis. The efficacy of
sustained improvements in glucose
metabolism may be influenced by
exercise intensity as it relates to
changes in body composition.
Dietary weight loss effectively
lowers adipose tissue
considerably, but does not
influence muscle metabolism
similar to exercise training.
However, both interventions may
be used together as a powerful
weight reduction technique as well
as a weight management tool and
a mechanism proven effective to
improve glucose metabolism.” (5)
∙ Image Source:
https://www.crossfit.com/essentials
/metabolic-syndrome-and-insulin-
resistance-underlying-causes-and-
modification-by-exercise-training
∙ “An increase in the quantity of FFM
from resistance training contributes
to increased glucose disposal,
probably from a mass effect,
without altering the intrinsic
capacity of the muscle to respond
to insulin. On the other hand,
endurance training enhances
glucose disposal independent of
changes in FFM, fat mass, or
VO2max, suggestive of an intrinsic
change in the ability of the muscle
to metabolize glucose.” (6). Note:
This study was conducted on
young, non-obese females.
∙ Endurance training increases
insulin sensitivity (25% to 50%), in
a variety of age and population
groups (healthy, obese, females,
males, young, adults, older
population, and people with Type II
diabetes); many studies have
noted insulin sensitivity related
benefits independent of changes in
body weight and/or body
composition.
∙ Intensity matters: HIIT is more
affective at avoiding metabolic
syndrome than moderate intensity 404
aerobic training. (7)
∙ Implications for Trainers &
Coaches:
o People respond differently to
efforts of increasing insulin
sensitivity esp. through
aerobic exercise (because of
genetic variation), and hence
individualized programs are
recommended.
o HIIT has greater benefits
with respect to metabolic
syndrome than low or
moderate intensity aerobic
training.
o Endurance as well as
resistance training both help
increase insulin sensitivity
through different
mechanisms but the
comparison with respect to
the degree of increase in
insulin sensitivity is not clear.
o Weight loss is NOT an
indicator of increased insulin
sensitivity when following an
exercise protocol. Exercise
will still lead to insulin
sensitivity benefits even
though there are no weight
loss/BMI changes.
o Insulin sensitivity benefits of
aerobic training are rapidly
lost according to a study that
examined effect of detraining
on trained athletes for 10
days. (May last longer in
non-diabetic population) (8)
Foods and Supplements to maintain
optimum Insulin levels:
∙ Non starchy vegetables
∙ Cacao
∙ Whole grain foods
∙ High protein foods
Foods with soluble fiber (legumes,
oatmeal, flaxseeds, oranges, Brussel
sprouts)

405
References:

• Rodriguez, Nancy & Dimarco, Nancy & Langley, Susie. (2009). Nutrition and athletic
performance Med Sci Sports Exerc.
https://www.researchgate.net/publication/24023338_American_College_of_Sports_
Medicine_position_stand_Nutrition_and_athletic_performance_Med_Sci_Sports_Ex
erc_2009_41_709_731_101249MSS0b013e31890eb86
• Francis E. Holway & Lawrence L. Spriet (2011): Sport-specific nutrition: Practical
strategies for team sports. Journal of Sports Sciences.
http://dx.doi.org/10.1080/02640414.2011.605459
• Kendall, M. (2015). Making sense of the Food Insulin Index (with recipes and food
lists to stabilise insulin and blood sugars and help you to lose weight). Optimising
Nutrition. https://optimisingnutrition.com/food-insulin-index-2/
• Krieger, J. (n.d.). Insulin, an Undeserved Bad Reputation: The Finale. Weightology:
The Science of Metamorphosis. https://weightology.net/insulin-an-undeserved-bad-
reputation-the-finale/
• Keshel, T. E., & Coker, R. H. (2015). Exercise Training and Insulin Resistance: A
Current Review. Journal of obesity & weight loss therapy, 5(Suppl 5), S5-003.
https://doi.org/10.4172/2165-7904.S5-003
• Eric T. Poehlman, Roman V. Dvorak, Walter F. DeNino, Martin Brochu, Philip A.
Ades, Effects of Resistance Training and Endurance Training on Insulin Sensitivity
in Nonobese, Young Women: A Controlled Randomized Trial, The Journal of
Clinical Endocrinology & Metabolism, Volume 85, Issue 7, 1 July 2000, Pages
2463–2468, https://doi.org/10.1210/jcem.85.7.6692
• Tjønna, A. E., Lee, S. J., Rognmo, Ø., Stølen, T. O., Bye, A., Haram, P. M.,
Loennechen, J. P., Al-Share, Q. Y., Skogvoll, E., Slørdahl, S. A., Kemi, O. J.,
Najjar, S. M., & Wisløff, U. (2008). Aerobic interval training versus continuous
moderate exercise as a treatment for the metabolic syndrome: a pilot
study. Circulation, 118(4), 346–354.
https://doi.org/10.1161/CIRCULATIONAHA.108.772822
• Roberts, C. K., Hevener, A. L., & Barnard, R. J. (2013). Metabolic syndrome and
insulin resistance: underlying causes and modification by exercise
training. Comprehensive Physiology, 3(1), 1–58.
https://doi.org/10.1002/cphy.c110062

406
C. Fats 3. Is fat intake important for
building muscle?
∙ “No sports performance-related
1. Why include sufficient fat in
benefits are associated with fat
daily diet?
intakes below 15% (and health
∙ Extremely low fat diets are liked to
concerns would exist), experts do
increased triglycerides and
not recommend fat intakes below
reduced good cholesterol levels
15% of the total energy
which may lead to cardiovascular
requirement” (24)
diseases. (1)
∙ Fat being the most energy dense
∙ Optimal fat intake maintains
macro, it’s the primary choice to
healthy levels of testosterone (2)
increase caloric intake to pack
∙ Improves insulin sensitivity.
muscle on.
∙ Optimal amount of dietary fat
∙ Some studies report benefits of fat
consumption increases activation
(esp. Omega 3 Polyunsaturated
of the mTOR pathway which
Fatty Acids) intake in terms of
triggers MPS. (3).
minimizing effects of overtraining.
(5).
∙ For the average lifter out there,
2. So, More Fat = More Benefits?
deriving about 25% of your total
∙ “The data has shown that
daily calories from fat will be a
consuming a higher percentage of
good figure to aim for. This
calories from fat does not lead to
percentage should ideally come
greater net fat loss, and that very
from various different types of fats.
high fat eating plans such as a
Make sure you consume omega-3
ketogenic diet do not produce any
fatty acids (roughly 1.5-1.8 grams
unique metabolic advantages.” (4)
per day) - specifically EPA and
∙ Chronic high fat diets (>35%)
DHA. (6)
should be avoided because they
∙ If you're having trouble meeting
may reduce carbohydrate and
this through your diet, you may
protein consumption, decrease
want to consider supplementation
long-term performance, reduce fat-
with around 0.5-1.8 grams per day
soluble vitamin intake, and
of an omega-3 supplement
potentially increase the risk for
containing EPA and DHA. (7)
cardiovascular complications (8).
∙ Try to keep saturated fats around
10% and eliminate trans fat from
your diet as best you can.
∙ Quality sources of fat come from
fish, nuts, vegetable and coconut
oils, avocados, flax seeds, and
cheeses.
∙ Let your fat intake be dictated by
how much carbs you are
consuming (keeping protein
amount unchanged) if you are carb
cycling. On high carb days, reduce
the calories fat and do the opposite
on low carb days. 407
References:

Parks, E., Krauss, R., Christiansen, M., Neese, R., & Hellerstein, M. (1999). Effects of a
low-fat, high-carbohydrate diet on VLDL-triglyceride assembly, production, and
clearance. Journal Of Clinical Investigation. https://www.jci.org/articles/view/6572
2. Hämäläinen, E. K., Adlercreutz, H., Puska, P., & Pietinen, P. (1983). Decrease of
serum total and free testosterone during a low-fat high-fibre diet. Journal of steroid
biochemistry. https://doi.org/10.1016/0022-4731(83)90117-6
3. Smith, G. I., Atherton, P., Reeds, D. N., Mohammed, B. S., Rankin, D., Rennie, M. J.,
& Mittendorfer, B. (2011). Omega-3 polyunsaturated fatty acids augment the muscle
protein anabolic response to hyperinsulinaemia-hyperaminoacidaemia in healthy young
and middle-aged men and women. Clinical science.
https://doi.org/10.1042/CS20100597

4. Hall, K. D., Chen, K. Y., Guo, J., Lam, Y. Y., Leibel, R. L., Mayer, L. E., Reitman, M.
L., Rosenbaum, M., Smith, S. R., Walsh, B. T., & Ravussin, E. (2016). Energy
expenditure and body composition changes after an isocaloric ketogenic diet in
overweight and obese men. The American journal of clinical nutrition.
https://doi.org/10.3945/ajcn.116.133561

5.Venkatraman JT, Pendergast DR. (2002). Effect of Dietary Intake on Immune Function
in Athletes. Sports Medicine.
https://www.researchgate.net/publication/11436836_Effect_of_Dietary_Intake_on_Immu
ne_Function_in_Athletes

6. Nalewanyj, sean. (n.d.). Bodybuilding And Fat Intake: Your Complete Guide.
https://seannal.com/articles/nutrition/bodybuilding-fat-intake.php

7. Kris-Etherton, P. M., Harris, W. S., & Appel, L. J. (2003). Fish consumption, fish oil,
omega-3 fatty acids, and cardiovascular disease. Arteriosclerosis, Thrombosis, and
Vascular
Biology, https://www.ahajournals.org/doi/full/10.1161/01.atv.0000038493.65177.94

8. https://www.unm.edu/~lkravitz/Article%20folder/NutrientPeriod.html

408
Macros Breakdown of all common Non Veg & Veg Proteins, common Dietary Fats &
common Carbs
In the breakdown, you need to cover: Total Calories, Proteins, Fats and Carbs per 100g
Food Calories/100 Protein(g)/100 Fat(g)/ Carbs(g)/100g
g g 100g
Bacon 215 16.5 16.5 0
Chicken breast 110 23.1 0 0
mutton 109 20.6 2.3 0
Egg white 52 10.9 0.2 0.7
Whole egg 143 12.6 9.5 0.7
Salmon 183 19.9 10.9 0
Lobster 90 18.8 0.9 0.5
Soybean 416 36.5 19.9 30.2
shrimp 106 20.3 1.7 0.9
lentils 353 25.8 1.1 60.1
Collagen powder 358 91.6 0 0
Pea protein 366 66 5 10
Rice protein 354 77.4 0 9.6
Whey Protein isolate 379 90 1.5 1.4
Whey protein concentrate 402 78 6.8 6.1
Chickpeas 338 21 5.4 46
Oats 392 12 8.1 64
Quinoa 319 14 5 51
Brown Rice 354 9.3 3.1 71
White rice 345 8.5 0 76
beetroot 45 1.7 0 7.2
Carrots 43 0 0 7.5
potato 84 1.9 0 18
Sweet potato 91 1.2 0 20
Apple 27 0.6 0.5 12
Banana 90 1.1 0 20
Coconut 378 3.8 36 3.5
Grape 74 0.6 0 16
Date (dried) 295 3.3 0 68
Mango 67 0.7 0 14
Watermelon 33 0 0 6.9
Orange 43 0.8 0 8
pineapple 50 0 0 9.9
Strawberry 42 0.6 0.5 6.1
Asparagus 32 2.9 0.6 2
Broccoli 47 4.3 0.6 3.1
Cabbage 37 1.8 0 4.4
Cauliflower 38 2.5 0 4.4
Cucumber 19 1 0.6 1.2
okra 43 2.5 1 2.9
onion 45 1 0 7.9
pea 82 5.3 0.7 10
spinach 19 2.6 0 0.6
avocado 201 1.9 20 1.9
butter 749 0.6 82 0.6
Chia seed 469 18 31 7.8
oil 901 0 100 0
Coconut milk 32 0 2 1.9
Feta cheese 253 15 20 1.4
Flax seeds 567 62 46 1.5
ghee 883 0 98 0
yogurt 84 5.6 3 7.6
Peanut butter 640 29 53 7.2
Cow milk 63 3.3 3.6 4.4
Soy milk 28 2.6 1.6 0.5
409
Almond milk 14 0.9 1.1 0
Source: https://www.stevegranthealth.com/wp-content/uploads/sgh-macros-common-foods.pdf
10.3 Digestion
1. What is Digestion?
2. Common issues
3. Cooked vs Raw Foods
4. Role of Fermented foods
5. A Note on Fiber in Diet
6. The Brain - Gut Connection
1. What is Digestion?
∙ The process of digestion breaks
food down into smaller
components that can be absorbed
by the body to function.
∙ There are two types of digestions:
o Mechanical digestion:
bolus of food is broken down
into smaller sized particles
o Chemical digestion: the
food particles are broken
down into molecules by
digestive enzymes, that can
be absorbed by the body in
gastrointestinal (GI) tract. (1)
∙ Types of digestive disorders:
o Organic: disorders that are
a consequence of another
disease. (more dangerous
and require medical
treatment)
o Functional: Causes of
functional disorders are
unclear (2) (more difficult to
diagnose as the disorder
manifests symptoms but
tests might not reveal
anything.)
2. Common Digestive Issues
Some digestive issues are acute while
others are chronic.
Acute, or chronic, these conditions
involve GI tract (esophagus, liver,
stomach, small and large intestines,
gallbladder and pancreas).
"Most digestive problems are to do with
lifestyle, the foods we've eaten, or
stress. Which means that taking steps
to change your lifestyle can help, and
often prevent, many of these problems."
~Dr Anton Emmanuel, consultant
gastroenterologist at University College
Hospital in London. (3)
The most common symptoms of
digestive disorders include:
1. HeartBurn/ Acid Reflux/
Gastroesophageal reflux (GER)
& Gastroesophageal reflux
disease (GERD)
2. Constipation
3. Celiac Disease and Gluten
Intolerance
4. Flatulence
5. Irritable Bowel Syndrome (IBS)
6. IBD
A. HeartBurn/ Acid Reflux/
Gastroesophageal reflux (GER) &
Gastroesophageal reflux disease
(GERD)
When ingested food from the stomach
comes back up into the esophagus, it is
called Gastroesophageal reflux (GER).
Gastroesophageal reflux disease
(GERD) is a long-lasting condition. It is
more severe as the symptoms
(heartburn: burning sensation in the
chest and regurgitation: feeling of fluid
or food coming up into the chest) occur
much more frequently (two or more
times a week) and the reflux damages
the esophagus lining (narrows it/erodes
it).
Many people can experience heartburn
as well as regurgitation, but some can
experience only one..
410
Are Acid Reflux, GERD and
Heartburn the same?
These terms have very different
meanings.
∙ GERD: disease or diagnosis that
has regular symptoms caused by
backing up of gastric contents into
the esophagus.
∙ Heartburn: one of the symptoms
of GERD.
∙ Acid reflux: the reason for
GERD.
Causes
∙ GERD is caused by acid reflux.
The body uses barriers such as a
flap valve at the bottom of the
esophagus called lower
esophageal sphincter (LES), the
diaphragm, and gravity- to prevent
gastric contents from refluxing into
the esophagus.
Reasons for weakening of these
barriers can be: poor lifestyle habits,
existing issues (hiatal hernia), and
Certain foods.
Heartburn and regurgitation are
caused when the gastric contents
come into contact with the
esophagus, possibly leading to
ulcers or even pre-cancerous
changes as these fluids are toxic to
the esophagus lining.
and can cause damage such as .
∙ production of too much acid
does not usually cause GERD.
Treatment
For Heartburn:
∙ Lifestyle modifications and proper
use of OTC medicines can many
times control heartburn if it's not
that frequent.
∙ OTC drugs available for
heartburn decrease the production
of fluids in the stomach, neutralize
stomach acids, and block flow of
fluids back into the esophagus.
∙ Frequent heartburn cases should
be reported to your doctor.
For GERD:
Follow these guidelines to decrease the
amount of gastric contents that back up into
the esophagus:
∙ Raise the bed Head by 6-10 inches. Use
an under-mattress foam wedge to
elevate the head about . Pillows are not
an effective alternative.
∙ Avoid lying down for two hours after
eating. This decreases the amount of
stomach acid available for reflux.
∙ Avoid Tight Clothing.
∙ Lose weight if overweight. Patients who
are overweight (esp those with excess
abdominal fat) are significantly more
likely to have GERD
∙ Avoid foods and medications that trigger
GERD (fats, citrus fruits and
juices, chocolate tomato juice,
pepper, and caffeinated drinks).
∙ Smoking and alcoholic beverages
contribute to acid reflux.
∙ Surgical management of GERD is an
option when a person doesn't respond to
medical management / is unable to
tolerate the medicines due to adverse
reactions. Surgical management
includes strengthening the barrier
between the stomach and the
esophagus to prevent gastric reflux.
When to Seek Medical Advice:
∙ Don't ignore or self medicate frequent
heartburn- Chronic, untreated
heartburn/GERD has been linked with
esophageal cancer. Consult with your
healthcare provider.
∙ If you are self-medicating for heartburn
two or more times a week, see a doctor.
References:
• https://gi.org/topics/acid-reflux/
• https://www.niddk.nih.gov/health-
information/digestive-diseases/acid-reflux-
ger-gerd-adults
411
B. Constipation
“Constipation is a condition in which you
may have fewer than three bowel
movements a week; stools that are hard,
dry, or lumpy; stools that are difficult or
painful to pass; or a feeling that not all
stool has passed.” (1)
If one does not have bowel movement
every day- that doesn't mean he/she is
constipated .
Causes:
∙ When the waste after digestion of
food (stool) moves too slowly, too
much water is absorbed from the stool
from the digestive tract back into the
body, making the stool hard and dry.
Low water intake, changes in diet, and
certain medicines can be the reasons
for slow transit of stool.
∙ Gradual enlargement of the rectum
and poor coordination of the pelvic and
anal muscles sometimes contribute to /
cause constipation.
∙ Medicines that can cause
constipation: narcotic pain relievers,
antidepressants, aluminum-containing
antacids, blood pressure medications,
drugs for Parkinson's disease, and iron
supplements .
∙ Lack of exercise..
∙ Bowel obstruction (blockage) can
cause constipation, but is uncommon.
Diagnosis
∙ Information from your medical and
family history
∙ a physical exam
∙ Tests to find the cause of
constipation.
Diet & Nutrition
Things that can treat constipation:
∙ Increasing the intake of fluids and
fiber is often the first step. Vegetables,
fruit (especially prunes), whole-grain
breads, and high-fiber cereals are
excellent sources of fiber.
∙ The only fiber that is proven to be
helpful in chronic constipation is
soluble, partially fermentable, viscous
gel forming fiber like psyllium.
∙ Be sure to add fiber to your diet a
little at a time so your body gets
used to the change.
∙ Try to get at least 25 grams of fiber
daily from your diet.
∙ Laxatives may seem like the
simplest solution, but they're not a
good idea. If people directly go to
stimulant laxatives, there is a risk
of developing dependence on
those, so turn to laxatives only if
changes in diet are insufficient.
Start with the osmotic type (such
as MiraLAX or Geri Care). The
osmotic laxatives are reasonably
safe, and work by absorbing water
into intestines, making the stool
easier to pass.
Treatment:
If the stool is impacted:
∙ Enemas
∙ If enemas fail to work, the next
option is manual removal of the
stool by a health care practitioner.
∙ After the impaction has been
removed, preventive measures are
recommended (add fiber to the
diet, use laxatives).
∙ If these treatments don’t
work, medicines are prescribed
or biofeedback is suggested or
surgery is recommended.
Can constipation be prevented?
∙ Adequate fluid intake + adequate
exercise + high-fiber diet may
prevent constipation.
∙ Laxatives are sometimes a helpful
addition when a person needs to
take a potentially constipating
drug.
When to Seek Medical Advice:
∙ If you have constipation and if you
are either bleeding from your
rectum, have blood in your stool, or
have continual pain in your
abdomen, that is a sign for you to
seek medical help.
412
References:

• https://www.niddk.nih.gov/health-information/digestive-diseases/constipation
• https://gi.org/topics/constipation-and-defection-problems/
• https://www.health.harvard.edu/bladder-and-bowel/natural-ways-to-relieve-
constipation

413
C. Celiac Disease and Gluten
Intolerance
Same symptoms in two people after
eating gluten e.g. bloating, stomach pain,
diarrhea might mean two different
gastrointestinal (GI) diseases: Celiac
disease and gluten intolerance, or non-
celiac gluten sensitivity (NCGS).
“Celiac disease is an autoimmune
disorder, whereas gluten intolerance is
sensitivity. NCGS does not typically have
a full negative impact on overall health like
celiac disease can.” ~Bethany Doerfler,
Clinical Dietitian, Northwestern Memorial
Hospital.
Both celiac disease and NCGS are treated
by not eating gluten.
A celiac disease patient must have to go
gluten free for his entire life, while
someone with NCGS may see symptom
improvement by simply reducing gluten
and carbohydrate intake.
Going Gluten Free?
∙ “Removing gluten from your
diet if you don’t have celiac or a
gluten intolerance will give you
no health advances,” ~ Bethany
Doerfler.
∙ It has not been scientifically proven
to help with weight loss.
∙ Many grains that contain gluten are
also fortified with various vitamins
and minerals. However, “Gluten-
free products are not required to
be fortified with these same
nutrients,” says Doerfler. “People
with celiac disease therefore
must work to incorporate
adequate vitamin D, vitamin
B12, calcium, magnesium, zinc,
iron and fiber into their diet
either with other foods like nuts
and seeds, or supplements.”
∙ Gluten-free diet followed long
enough can alter your gut
microbiome.
∙ Gluten-free products can be higher
in refined carbohydrates and
sugars e.g. tapioca starch, potato
starch and rice flour.
∙ “That’s why we only
recommend gluten-free diet
therapy if really needed,” says
Doerfler.
414
Celiac Disease NCGS
Genetic autoimmune disease where wheat triggers ∙ Cause not fully understood
antibodies to attack small intestine ∙ Not autoimmune disease or
allergy
Diagnosed with a blood test or biopsy during a scope to Diagnosed by ruling out celiac
detect antibodies produced in autoimmune response. disease and wheat allergies with a
blood test.
Prevalence of both is increasing, partially because screening frequency is increasing.
38% of the population carries genes for celiac disease, No genetic component is identified.
but only a small % develops it. Current research
suggests those with the gene may develop celiac
disease after overexposure to viruses.
• GI symptoms include bloating, difficulty with bowel Symptoms limited to GI tract and
movements, diarrhea, and abdominal pain. include bloating, difficulty with
• Can also have symptoms outside of GI tract bowel movements, diarrhea, and
including: abdominal pain.
• Anemia, fatigue, headaches, cavities, joint pain, low
vit D and vit B12, psychiatric disorders
• Some people with celiac disease have no symptoms.
∙ One crumb of gluten (20 parts gluten per million) ∙ Wide range of gluten
will produce symptoms. tolerance, depending on the
individual, and on the
frequency and amount of
∙ Symptoms can last hours or days. gluten consumed.

∙ Autoimmune markers will remain elevated in blood ∙ Symptom intensity and

for weeks. duration varies.
Treatment: Complete and lifelong avoidance of gluten Treatment: Reducing gluten or
carbs in diet has been shown to
help symptoms.

415
Difference between Food allergies,
intolerance, sensitivity, and Celiac
disease:
Food intolerances: Food intolerance is
the inability to process or digest certain
foods. The most common food reaction
appears to be lactose intolerance. As we
age, our ability to digest dairy decreases.
That’s because, with age, our intestines
make less of the enzyme (lactase) that
processes lactose (a sugar present in milk
and dairy products). As a result, the
unprocessed lactose we consume remains
in the digestive tract, causing bloating,
inflammation, and diarrhea. According to
research, only 35% of people worldwide
can digest lactose beyond the age of
about seven or eight. (1)
Food allergies: A possibly life threatening
situation (difficulty breathing and low blood
pressure) can occur when someone
develops a more serious allergic reaction
(an out of proportion immune response
triggered by a seemingly harmless
substance such as certain foods. If you
think you may have a food allergy, you
should undergo allergy testing and
treatment, especially if your symptoms are
severe (significant rashes, feeling of
passing out, facial swelling, and problems
breathing).
Celiac disease: This is an autoimmune
condition in which gluten consumption
initiates an inflammatory reaction that can
make people with celiac disease very sick.
Celiac disease is not a true allergy; eating
gluten once does not cause an immediate
life-threatening problem. However,
prolonged and continuous ingestion can
cause diarrhea, weight loss, and
malnutrition.
Food sensitivities: For a major chunk
of the population, consumption of
certain foods causes symptoms that are
not related to food intolerances, food
allergies, or celiac disease. These are
called food sensitivities. Though there
is controversy around what exactly
happens in the body of someone with a
food sensitivity, it appears that exposure
to specific foods may create an immune
reaction that generates a multitude of
symptoms. The symptoms are not life-
threatening, but they can be quite
disruptive and include joint pain,
stomach pain, fatigue, rashes, and brain
fog. Gluten is probably the best-known
trigger of food sensitivities.
The best tool we have to identify food
sensitivities is a process of careful
observation and experimentation.
Removing certain foods believed to
cause reactions from the diet for two to
four weeks, reintroducing them one by
one, and watching for symptoms is the
current gold standard to pin down what
may be causing symptoms.
References:
• https://www.scientificamerican.com
/article/why-we-got-milk/
• https://www.nm.org/healthbeat/hea
lthy-tips/celiac-disease-vs-gluten-
intolerance-infographic
• https://www.health.harvard.edu/blo
g/food-allergy-intolerance-or-
sensitivity-whats-the-difference-
and-why-does-it-matter-
2020013018736
416
D. Flatulence
The gas inside your digestive tract is
made of nitrogen and oxygen. It can
contribute to a sense of bloating (fullness),
belching, abdominal cramps, and
flatulence (gas). These symptoms are
usually brief and resolve once gas is
released by belching or flatulence. When
we digest food, gas, mainly in the form of
hydrogen, methane, and carbon dioxide, is
released. Some people can be more
sensitive to even normal amounts of gas
and develop the above symptoms.
Flatulence Facts (1):
∙ On an average, a human passes
gas 10 - 18 times a day.
∙ Healthy gas is harmless and has no
odor.
Causes:
∙ Lifestyle changes can often reduce
flatulence.
∙ Sometimes, there is an underlying
medical condition that needs urgent
attention, such as food poisoning or
an intestinal blockage.
Symptoms:
∙ Common symptoms related to gas
in the digestive tract include
belching, bloating and distention,
and passing gas. Gas normally
enters your digestive tract when
you swallow air and when bacteria
in your large intestine break down
certain undigested carbohydrates.
∙ Belching is emitting wind noisily
through mouth. It is normal and
results from swallowed air that
accumulates in the stomach. The
air can either be pushed back or
can be passed down the GI tract as
rectal gas (flatus).
∙ A sense of fullness caused by
accumulation of gas and/or food in
the stomach.
∙ Flatulence is passing of rectal
gas. This gas is a combination of
swallowed air and gas produced
by gut microbes acting on
undigested carbohydrates.
∙ Accumulation of gas in upper
region of colon can lead to pain
that might seem like gallbladder
pain.
∙ Accumulation of gas
accumulates in the left upper
portion of the colon can move to
the chest and feel like cardiac
pain.
∙ Excess gas accumulates due
to:
○ Swallowing air while
eating
○ Consumption of
carbonated beverages,
chewing on gum etc.
○ People suffering from
anxiety can end up
swallowing extra air
○ Poorly fitting dentures
○ Chronic postnasal “drip”
∙ Undigested carbs:
Carbohydrates such as beans,
cauliflower, cabbage, broccoli
etc. reach colon as these cannot
be digested by the digestive
enzymes. Bacteria in the colon
metabolize the undigested carbs
to CO2 and to hydrogen. This
can result in excess gas in some
cases.
417
 ∙ Lactose Intolerance: It happens
due to lack of the enzyme ‘lactase’ Fiber supplements: Fiber
in some individuals which breaks supplements (esp. with psyllium)
down milk sugar. should be slowly introduced if
∙ Bacterial Overgrowth: It is the one is new to those. If not, it can
excess amount of gut bacteria. This cause flatulence.
leads to excess intestinal gas.
∙ Constipation can also lead to ∙ Most starches (potatoes, corn,
bloating. noodles, wheat) produce gas as
they are digested. Rice is the
Why do some foods cause more gas? only starch that does not
∙ Some foods with higher amounts of cause gas.
certain carbohydrates
(oligosaccharides, such as inulin) ∙ Carbonated drinks: Cause gas
cause flatulence. build up.
∙ Examples of foods that can worsen
flatulence include: ∙ Onions, artichokes, Pulses,
Beans: Beans have raffinose- a Cashews.
type of carbohydrate that is acted
∙ Yeast in baked products.
upon by gut flora, producing
methane gas. Smaller amounts of
raffinose are found in cabbage,
Brussels sprouts, broccoli,
asparagus, other vegetables, and
whole grains. (2)

∙ Dairy: Some ethnicities (African,

Native American, Asian) have low
levels of lactase Also, as we age,
our lactase levels drop.

∙ Gluten: People with Celiac

disease have excessive flatulence
when they consume barley, wheat,
and rye.

∙ Artificial sweeteners (Sorbitol,

mannitol): Some people develop
diarrhea, gas or both when they
consume artificial sweeteners.
Sorbitol occurs naturally in some
fruits too (prunes, apples, pears,
418
peaches).
Diagnosis:
∙ Blood tests are not usually
helpful for flatulence related
problems.
∙ X-rays or endoscopy (examination
of esophagus and stomach with a
flexible tube while the patient is
sedated) can be used to diagnose
esophageal reflux or gastric
inflammation.
∙ Abdominal distension that occurs
when standing up but not when
lying down is an indication of weak
abdominal muscles.
∙ If lactose intolerance is suspected,
milk can be withdrawn from the diet
and symptoms observed.
∙ Postnasal discharge due to sinus
issues can cause considerable
amount of air to be swallowed.
∙ Your doctor can advise a hydrogen
breath test if he suspects bacterial
overgrowth.
∙ Testing for celiac disease can be
advised by your doctor if
consumption of wheat, barley, etc.
clauses excess gas.
Treatment:
∙ Swap gas causing carbs
(Raffinose, lactose, fructose,
sorbitol) for carbs that are easier to
digest, such as: bananas, citrus
fruits, grapes, lettuce, rice, and
yogurt.
∙ Avoid carbonated beverages.
∙ Ferment beans before cooking.
∙ Instead of dairy, Lactose intolerant
people can use Lactaid milk or non-
dairy milk such as soy or almond
milk.
∙ Avoid foods, beverages with
artificial sweeteners.
∙ To ensure that only symptom
causing foods are eliminated
without resulting in nutritional
deficiencies, food items should
be eliminated one by one and
symptoms (or lack of it) should
be observed.
∙ Efficacy of Simethicone products
and Charcoal tablets (promoted
as treatment for flatulence) has
not been convincing.
∙ Bismuth subsalicylate is used to
reduce the noxious odor of rectal
gases.
∙ Alpha-d-galactosidase, (available
Over The Counter (OTC)), helps
in the digestion of complex
carbohydrates.
∙ Individuals with IBS may benefit
from symptomatic therapy for
“gas pains” by using
antispasmodic therapy such as
dicyclomine or hyoscyamine
under the tongue.
∙ If abdominal distension is caused
due to weak abdominal muscles,
the muscles can be strengthened
by abdominal-tensing exercises.
However, it can get more and
more difficult as we age.
∙ Exercising improves digestion,
reducing gas and bloating.
419

Diet & Nutrition
Talk to your doctor/dietitian/nutritionist
about a healthy eating plan that may help
with flatulence.
References:
• https://www.medicalnewstoday.co
m/articles/7622#_noHeaderPrefixe
dContent
• https://iffgd.org/gi-
disorders/symptoms-
causes/intestinal-gas/foods-that-
may-cause-gas/
• https://gi.org/topics/belching-
bloating-and-flatulence/
• https://www.niddk.nih.gov/health-
information/digestive-
diseases/gas-digestive-tract
420
E. Irritable Bowel
Diagnosis:
Syndrome (IBS)
· For diagnosis, doctors need to
· IBS is a group of symptoms (frequent
review patient’s symptoms, medical
abdominal pain, changes in your bowel
and family history, and perform a
movements, such as diarrhea,
physical exam.
constipation, or both) that occur
· Doctors look for certain patterns. For
together. People with IBS can display
the problem to be diagnosed as IBD,
these symptoms without any visible
it has to have lasted for at least 3
damage or disease in the GI tract.
months over the previous year.
· IBS is more common in more · In some cases, doctors may order
common in women (almost twice as tests to rule out other health
much) than men. problems.
· Recent studies show that patients
· IBS is not life threatening, nor does it with IBS like symptoms who do not
shorten patient’s lifespan. Usually, it respond to reasonable treatment,
does not lead to more dangerous should consider testing (a simple
problems, such as Inflammatory Bowel blood test is required) for celiac
Disease (Crohn's disease or ulcerative disease.
colitis) or colon cancer.
Treatment:
· IBS does not put extra load on other
vital organs. · Doctors may recommend Lifestyle
· IBS is a lifelong condition, but most and dietary changes, medicines,
people with it can lead a pretty normal probiotics, and therapy if it is
life. induced by stress/anxiety. Most part
of the treatment comprises of these.
Symptoms & Causes: · There is no cure as such. It can
only be managed.
· Abdominal pain · Only a few treatments have been
· Changes in bowel movements shown to help all the symptoms of
(diarrhea or constipation, or both, IBS. There is no single treatment
depending on the type of IBS. that will help every patient with IBS.
· IBS is NOT associated with weight
loss, blood in the stool, waking up at
night to have bowel movements, and
does not commonly
· Usually doesn’t start after the age of
50.
· Causes of IBS aren’t known.
· It can be worsened by stress and
anxiety.
421
· It does not seem to be stemming from
food allergies or intolerances.
Diet & Nutrition:
∙ It is observed that up to 90% of IBS
References:
patients stop eating some foods
trying to improve the symptoms. To
• https://gi.org/topics/irritable-bowel-
avoid nutritional deficiencies, it is syndrome/#tabs2
important to keep a record of what • https://www.niddk.nih.gov/health-
symptoms are caused by eating information/digestive-
which foods. diseases/irritable-bowel-syndrome
∙ Avoid foods that produce excess
gas (fructose, lactose, beans,
onions, broccoli, cabbage etc.).
∙ People with trouble digesting gluten
can benefit from not eating wheat
products.
∙ Studies show usefulness of
following a low FODMAP diet for a
limited time period for many IBS
patients.
∙ If you have constipation, slowly
adding soluble fiber to your diet can
help decrease the symptoms. Make
sure to drink a lot of water when
you introduce additional fiber to
your diet, as without enough water,
the additional fiber may worsen the
constipation. Avoid insoluble fiber
as it may lead to bloating.
∙ It is a good idea to get a dietician to
make necessary changes to your
diet.
∙ Though psychological disorders
don’t cause IBS, some people may
benefit from behavioral therapies to
reduce stress.

422
F. Inflammatory Bowel Disease (IBD)
What is it?
· Inflammatory bowel disease (IBD) is a
term for two conditions (Crohn’s
disease and ulcerative colitis) that
are characterized by chronic
inflammation of the GI tract (1).
· Prolonged inflammation damages the
GI tract.
· Differences between Crohn’s disease
and ulcerative colitis(3):
Crohn’s Disease
Can affect any part of the GI tract (from
the mouth to the anus)—Most often it
affects the portion of the small intestine
before the large intestine/colon.
Damaged areas appear in patches that
are next to areas of healthy tissue
In
flammation may reach through the
multiple layers of the walls of the GI tract
· People with IBS may experience some
similar symptoms to IBD, but IBD is
NOT IBS. IBS is not caused by
inflammation and the tissues of the
bowel are not damaged the way they
are in IBD. Treatment is also different.
IBS
It is a syndrome, or group of symptoms
Doesn’t inflame or damage the intestines
imaging scans can’t detect it
doesn’t increase the risk of colon cancer
People with IBS rarely need hospitalization or
surgery
· Celiac disease has symptoms similar to
IBD (e. g. inflammation of the
intestines), but IBD is NOT Celiac
Disease. Unlike IBD, cause of celiac
disease is known and is very specific.
· People with IBS may experience
some similar symptoms to IBD, but
IBD is NOT IBS. IBS is not caused by
inflammation and the tissues of the
bowel are not damaged the way they
are in IBD. Treatment is also different.
Ulcerative Colitis
Occurs in the large intestine (colon) and
the rectum
Damaged areas are continuous (not
patchy) – usually starting at the rectum
and spreading further into the colon
Inflammation is present only in the
innermost layer of the lining of the colon
· IBD is a lifelong condition
· IBD doesn’t shorten the patient’s
lifespan.
· Proper treatment can help manage
the symptoms and lead a normal life.
IBD
It is a disease
Inflames or damages the
intestines
423
Can you have IBD and IBS?
Yes, it’s possible to have both IBD and
IBS. While IBD can cause IBS symptoms,
there’s no evidence that having IBS
increases your risk of IBD.
Symptoms:
∙ Persistent diarrhea
∙ Abdominal pain
∙ Rectal bleeding/bloody stools
∙ Weight loss
∙ Fatigue
Causes:
Researchers are still trying to determine
the exact cause. The major factors to play
a role are: (2)
∙ Genetics
∙ Immune system response: Our
immune system fights with
infections with the help of
antibodies (which are a type of
protein). With IBD, the immune
system releases antibodies to fight
food that we intake mistaking it as a
foreign body, which leads to IBD
symptoms.
∙ Environmental triggers: Family
history of IBD combined with
particular environmental stressors
(e. g. smoking, stress, certain
medicines, depression) may
develop IBD symptoms.
Diagnosis:
Crohn’s disease and ulcerative colitis
cause similar symptoms. No single test
can diagnose either.
To look for signs of intestinal
inflammation, your doctor will need to
know your symptoms, and can ask you to
get a complete blood count (CBC) and
stool test done.
Following diagnostic tests might also be
needed:
∙ Colonoscopy: to examine the large
and small intestines.
∙ EUS (endoscopic ultrasound): to
check the digestive tract for swelling
and ulcers.
∙ Flexible sigmoidoscopy: to examine
the inside of the rectum and anus.
∙ Imaging scan (CT scan or MRI): to
check for signs of inflammation or an
abscess.
∙ Upper endoscopy: to examine the
digestive tract from the mouth to the
start of the small intestine.
∙ Capsule endoscopy: It is done using
a small camera device that you
swallow.
Risks & Complications:
∙ People with IBD have a higher risk of
developing colon (colorectal) cancer.
Other potential complications include:
∙ Anal fistula (tunnel that forms under
the skin connecting an infected anal
gland and the anus).
∙ Anal stenosis or stricture (narrowing
of the anal canal where stool leaves
the body).
∙ Anemia (low levels of red blood cells)
or blood clots.
∙ Kidney stones.
∙ Liver disease, such as cirrhosis and
primary sclerosing cholangitis (bile
duct inflammation).
∙ Malabsorption and malnutrition
(inability to get enough nutrients
through the small intestine).
∙ Osteoporosis.
∙ Perforated bowel (hole or tear in the
large intestine).
∙ Toxic megacolon (severe intestinal
424
swelling).
Treatment (1):
∙ IBD treatments vary depending on
the particular type and symptoms.
Non- Surgical:
∙ Medications can help control
inflammation so you don’t have
symptoms (remission). Medications
to treat IBD include:
∙ Aminosalicylates (an anti-
inflammatory medicine like
sulfasalazine, mesalamine or
balsalazide) minimize irritation to the
intestines.
∙ Antibiotics treat infections and
abscesses.
∙ Biologics interrupt signals from the
immune system that cause
inflammation.
∙ Corticosteroids, such as prednisone,
keep the immune system in check
and manage flares.
∙ Immunomodulators calm an
overactive immune system.
∙ Antidiarrheal medication.
∙ Nonsteroidal anti-inflammatory drugs
(NSAIDs).
∙ Vitamins and supplements like
probiotics.
∙ Several vaccinations for patients with
IBD are recommended to prevent
infections.
Surgical:
Due to advances in treatment with
medications, surgery is less common than it
was a few decades ago.
For Crohn’s Disease:
During a bowel resection, a surgeon:
● Removes the diseased bowel
segment.
● Connects the two ends of the
healthy bowel together
(anastomosis).
After surgery, the remaining part of the
bowel adapts and functions as it did
before. Approximately 60% people who
undergo surgery for Crohn’s disease will
have a recurrence within 10 years, and
another bowel resection might be needed.
For ulcerative colitis:
After 30+ years of living with ulcerative
colitis, about 1 in 3 people need surgery.
A surgeon:
● Removes the colon (colectomy) or
the colon and rectum
(proctocolectomy).
● Connects the small intestine and
anus.
● Creates an ileal pouch that collects
stool, which then exits through the
anus.
Rarely, you may need an ileostomy bag (it
attaches outside of the belly to collect
stool) instead of an ileal pouch.
A proctocolectomy is curative.
Symptoms won’t return after surgery to
remove the colon and rectum.
However, you may have problems with
the ileostomy or ileal pouch, such as
pouchitis (inflammation and infection).
425
Lifestyle Changes to Manage the
Symptoms: References
∙ Eat smaller meals every two to four
hours. 1. http://www.crohnscolitisfoundatio
∙ Manage stress. n.org/assets/pdfs/updatedibdfact
∙ Get enough of sleep. book.pdf
∙ Exercise regularly. 2. https://my.clevelandclinic.org/hea
∙ Keep a food diary to identify food lth/diseases/15587-inflammatory-
triggers. bowel-disease-overview
∙ Reduce foods that irritate the 3. https://www.cdc.gov/ibd/what-is-
intestines (fibrous, spicy, greasy or IBD.htm
made with milk). During flares,
choose soft, bland foods that are
less inflammatory.
∙ Cut back on caffeinated,
carbonated and alcoholic
beverages.
∙ Prevent dehydration, drink a lot of
water.
∙ Avoid smoking.

Prevention:
You can’t prevent it. You can only manage
the symptoms.

When to Seek Medical Advice:

● Excess weight loss.
● Extreme abdominal pain or diarrhea.
● Fever or signs of infection.
● IBD flare.
● Signs of dehydration.

426
3. Cooked vs Raw Food ∙ The diet often includes fermented
foods, sprouted grains, nuts and
THE DEBATE:
seeds, in addition to raw fruits
∙ Cooking food can improve its taste,
and vegetables.
and alters the nutritional content.
∙ Interestingly, some vitamins are
lost when food is cooked, while
others become more available
for your body to use.
∙ Some claim that eating primarily
raw foods is the path to better
health. However, certain cooked
foods have clear nutritional
benefits.
∙ So, which way to go?

WHAT IS A RAW-FOOD DIET?

∙ Generally, raw foods are whole
foods that haven’t been processed
or cooked.
∙ For a food to be considered raw, it
shouldn’t be heated above a
specific temperature. Maximum
temperature ranges from 33ºC to
48ºC.
∙ While there are varying levels of
raw-food diets, all of them involve
eating mostly unheated, uncooked
and unprocessed foods. In general,
a raw-food diet is made up of at
least 70 percent raw foods.
∙ There are three broad types of raw
food diet:
○ A raw vegan diet excludes
all animal products, focusing
only on plant-based foods.
○ A raw vegetarian diet
includes plant-based foods
plus raw eggs and
unprocessed dairy products.
○ A raw omnivorous diet
includes plant-based foods,
427
raw animal products, and
raw or dried meat.
POPULAR CLAIMS BY RAW FOOD
PROPONENTS & WHERE DOES THE
RESEARCH STAND ABOUT THOSE:
1. Claim: Cooking May Destroy
Enzymes in Food.
∙ Enzymes are heat sensitive and
deactivate easily when exposed to
high temperatures. In fact, nearly
all enzymes are deactivated at
temperatures over 47°C.
∙ When enzymes in a food are
altered during the cooking process,
more enzymes are required from
your body to digest it.
∙ This puts stress on your body and
can lead to enzyme deficiency.
What The Research Says:
∙ Digestion is a scientifically proven
process that depends on enzymes
that the body generates, and not
food enzymes.
∙ The human body produces the
enzymes necessary to digest food.
And the body absorbs and re-
secretes some enzymes, making it
unlikely that digesting food will lead
to an enzyme deficiency
∙ Moreover, science has not yet
demonstrated any adverse health
effects of eating cooked foods with
denatured enzymes.
∙ However, there are no scientific
studies to support the claim that
cooking puts stress on your body
and can lead to enzyme deficiency.
The Verdict: Cooking foods may
deactivate the enzymes found in them
(depends on the cooking method),
however, there is no evidence that
food enzymes contribute to better
health.
2. Claim: Vitamins are lost while
cooking.
∙ Raw foods are richer in nutrients
than cooked foods.
What The Research Says:
∙ Some (Water-Soluble) Vitamins Are
Lost in the Cooking Process.
∙ But, it’s a tradeoff. Cooking
Increases the Antioxidant
Capacity of Some Vegetables.
∙ One study found that cooking
tomatoes reduced their vitamin C
content by 29%, while their
lycopene content more than
doubled within 30 minutes of
cooking. Also, the total antioxidant
capacity of the tomatoes increased
by more than 60%.
∙ Also, what about vitamin K?
o Spinach retains most of its
vitamin K content regardless
of how you cook it.
o Most cooking methods will
actually increase the levels
of available vitamin K in
chard.
o Vitamin K is fat-soluble so
preparing those veggies with
olive oil or another source of
beneficial fats will help your
body absorb the essential
nutrient.
o In a study, it was found that
the retention of vitamin K in
cooked vegetables ranged
from 44.28 to 216.65%.
o Moreover, vitamin K is
relatively heat stable and
is thus retained after the
cooking process.
428
 ∙ Cooking increases bioavailability
of certain vitamins!
∙ Not all forms of cooking result in
complete loss of nutrients.
Steaming, roasting and stir-frying
are some of the best methods of
cooking vegetables when it comes
to retaining nutrients. Boiling results
in the greatest loss of nutrients,
while other cooking methods more
effectively preserve the nutrient
content of food.
∙ ● Lastly, the length of time that a
food is exposed to heat affects its
nutrient content. The longer a food
is cooked, the greater the loss of
nutrients.
The Verdict: Some nutrients,
particularly water-soluble vitamins, are
lost during the cooking process. BUT,
some foods might prove to be more
nutritious when cooked. IT’S A TRADE
OFF!
3. Claim: Avoids unhealthy, high-
calorie processed foods
What the Research Says: Well, that’s
true!
The Verdict: Eating mostly raw foods
means no ultra-processed, high calorie
junk in your tummy!
REASONS WHY SOME FOODS ARE
HEALTHIER WHEN CONSUMED
RAW:
∙ Cooking certain foods may
reduce diversity of gut
microbes: Cooking increases the
ileal digestibility of carbohydrates
by gelatinizing starch, reducing
the quantity reaching the colon,
where the most gut microbes
reside, and potentially affecting
the fermentation capability of
amylolytic gut bacteria.
∙ Researchers have found that a diet
rich in raw vegetables can lower
your risk of breast cancer, while
eating lots of fruit can reduce
your risk for developing colon
cancer (study published in the May 1998
issue of the journal Epidemiology)
∙ Heat alters the physicochemical
properties of certain foods in
ways that could impact the gut
microbiome: Cooking can also
denature antimicrobial
compounds present naturally in
food or introduced through
agriculture, thus limiting their
bioactivity.
∙ Including fresh fruit as part of
your daily diet has been
associated with fewer deaths (by
as much as 24%) from heart
attacks and related problems.
(Study published in the September 1996
issue of the British Medical Journal)
429

∙ Intake of Raw Fruits and
HEALTHIER WHEN COOKED:
Vegetables Is Associated with
Better Mental Health Than Intake of
Processed Fruits and Vegetables:
The study (PMID: 23790900) showed that
consumption of raw fruits and vegetables
differentially predicted better mental
health than the consumption of
processed fruits and vegetables even
when controlling for demographic,
socioeconomic, and health covariates.
∙ Cooking causes Vitamin C loss:
o The vegetables rich in vitamin
C includes broccoli, Brussels
sprouts, and spinach.
o Boiling is one of the most
popular ways to prepare
broccoli and Brussels sprouts
but as vitamin C is water-
soluble, it seeps out of the
vegetables and into the water,
and in many cases, boiling
reduces the vitamin C
content of vegetables by
more than 50%!
o Vitamin C is also heat sensitive
which means exposing the
vegetables to heat for too long
which results in loss of Vitamin
C.
o It is a water-soluble and
temperature-sensitive vitamin,
so is easily degraded during
cooking, and elevated
temperatures and long cooking
times have been found to
cause particularly severe
losses of vitamin C.
REASONS WHY SOME FOODS ARE
● Cooking increases antioxidant content
of some foods.
○ Cooking increases the availability
of antioxidants like beta-carotene
(Our body converts Beta-carotene
into vitamin A) and lutein. Diet rich
in beta-carotene = reduced risk of
heart disease
○ Antioxidant lycopene (associated
with a decreased risk of prostate
cancer in men and lower risk of
heart disease) is also more easily
absorbed by your body when you
get it from cooked foods instead of
raw foods.
○ cooking increases the antioxidant
capacity of carrots, broccoli and
zucchini.
● Cooking reduces anti-nutrient content
of many foods.
○ Cooking – especially, moist heat
methods – Like Boiling or Stewing
reduce lectin content of foods such
as legumes and whole grains
○ Boiling, steaming reduce oxalate
content of foods such as Spinach,
Swiss chard, Sweet potatoes,
Beets, Beans, Berries, Nuts, Soy
beans. Excessive formation of
calcium oxalate stones in kidneys,
in which dietary and genetic
factors might be influential, leads
to renal insufficiency.
○ Processing methods, boiling or
cooking, and fermentation have
been reported by several studies
to cause significant reduction in
the cyanogenic glycosides
(Cyanogenic glucosides are
GOITROGENS as well as 430
CYANOGENS).
 ● All cooking methods don’t result in
COMPLETE loss of vitamin C. ● Cooking increases bioavailability
Certain cooking methods help of micro nutrients in some foods:
prevent Vitamin C loss up to 90%! A study found that the body more
o Microwaving (spinach, carrots, easily absorbs iron from 37 of 48
sweet potato, and broccoli) has less vegetables tested when they're
boiled, stir-fried, steamed, or grilled.
of an impact on vitamin C content,
Of note, the absorbable iron in
with high retention (> 90%). cabbage jumped from 6.7% to 27%
o Steaming and microwaving retained with cooking. That of broccoli
higher concentrations of vitamin C flowerets rose from 6% to 30%.
than boiling because of the reduced (~Rutgers University and Taiwanese
contact with water at relatively low researchers at American Chemical
Society meeting in San Francisco.)
temperatures.
● Foods that are healthier when
o Using minimal cooking water and
cooked:
cooking for shorter time periods
○ Asparagus: Cooking asparagus
should result in higher vitamin C
breaks down its fibrous cell walls,
retention.
making folate and vitamins A, C
o So, if the goal is to optimize vitamin
and E more available to be
C intake, the ideal way is to choose
absorbed.
a low heat, water-free cooking
○ Mushrooms: Cooking mushrooms
method.
helps degrade agaritine, a
potential carcinogen found in
● A study found that a raw food diet
mushrooms. Cooking also helps
increased the risk of dental erosion, and
release ergothioneine, a powerful
10% erosion of dental enamel was
mushroom antioxidant.
observed after extended practice (1, 2).
○ Spinach: It increases
● Unprocessed fresh fruits and green-
bioavailability of iron,
leafy vegetables are open to
magnesium, calcium and zinc
contamination of water borne
when spinach is cooked.
diseases.Furthermore, wash water used
○ Tomatoes: Cooking increases the
at markets and stores to keep vegetables
antioxidant lycopene.
fresh for the consumer is reported
○ Carrots: Cooked carrots contain
to cause microbiological contamination.
more beta-carotene than raw
● The health risk arising from the
carrots.
high quantity of heavy metal
○ Potatoes: The starch in potatoes
accumulation in leafy vegetables
is nearly indigestible until a potato
when consumed raw must not be
is cooked.
ignored.
○ Legumes: Raw or undercooked
● A study found that eating cooked
legumes contain anti-nutrient
tomatoes could improve your chances
called lectins. Lectins are
of avoiding prostate cancer. (December
eliminated with proper soaking and
6, 1995 issue of the Journal of the
cooking. 431
National Cancer Institute)
 ● Meat, fish and poultry: Raw meat,
fish and poultry may contain bacteria
that can cause food-borne illnesses.
Cooking these foods kills harmful
bacteria.
CONS OF RAW FOOD DIET:
● Due to the risk of food poisoning, a raw
foods diet isn't recommended for pregnant
women, young children, seniors, people
with weak immune systems, and those
with chronic medical conditions like kidney
disease.
● Inadequate in many essential nutrients,
such as protein, iron, calcium, vitamin
B12, and more.
● Some nutrient-rich superfoods can’t be
eaten raw, such as beans, whole grains.
● The limited sources of protein may
cause health problems. Even with
adequate calories, the limited protein may
cause subtle signs of malnutrition,
including skin changes and irregular
menstrual periods in women.
● One well-recognized side effect of the
raw food diet is WEIGHT LOSS. This is
because the diet consists of a good-deal
of low cal, high fiber foods that are quite
filling. For people not trying to lose
weight, a raw food diet is unlikely to
provide sufficient calories.
● Uncooked animal products are most
likely to cause food poisoning. This
includes: raw and undercooked meat,
including chicken, raw or lightly cooked
eggs, raw (unpasteurized) milk and
products made from it, raw shellfish
REASONS WHY IT MAKES SENSE
TO FIND THE RIGHT BALANCE AND
EAT RAW AS WELL AS COOKED
FOODS:
∙ ● If your aim is to derive
maximum nutrition from the
food you eat, sticking to an
extreme (raw or cooked) might
be a mistake!
∙ o For example, to make sure you
get the maximum amount of
vitamin E from your food, you will
have to cook certain foods, while
eating some foods raw.
∙ o No matter how you cook root
vegetables (potato, sweet potato,
and carrot) their levels of vitamin
E (α-tocopherol) will always
decrease because of the
breakdown of the cell walls.
∙ o Leafy greens (broccoli, chard,
mallow, crown daisy, perilla leaf,
spinach, and zucchini) however,
are the opposite. When leafy
greens are cooked, the quantities
of α-tocopherol increase
significantly.
∙ ● Results from many studies
show that raw as well as cooked
foods are important for us: The
research at UC San Francisco and
Harvard led to two key
conclusions: eating cooked food
increases its absorption in the
small intestine, leaving little
food for the good bacteria in the
large intestine - which then
starve and die. But many raw
foods contain antimicrobials
that kill gut bacteria - good as
well as bad.
432
∙ A study investigated the long-term
cardiovascular consequences of
consuming a diet with high intake of
raw fruits and vegetables. THE
RESULTS WERE BOTH POSITIVE
AND NEGATIVE. The study
indicates that consumption of a strict
raw food diet lowers plasma total
cholesterol and triglyceride
concentrations (positive
outcomes); but lowers serum HDL
cholesterol and increases tHcy
concentrations due to vitamin B12
deficiency (negative outcomes).
This provides a mechanistic
explanation of the higher mortality
from coronary heart disease in
vegans compared with ovo-lacto-
vegetarians, which was reported in a
meta-analysis of prospective studies.
∙ Raw food provides the healthy life
people desire, which stresses it
s significance to gastronomy.
However, a raw food diet
can lead to
a deficiency of some vitamins
and minerals in the long term.
Therefore, it is insalubrious to
practice a prolonged raw food diet.
The goal of this diet is generally to
solve a health problem, lose
weight or eliminate toxins, edema or
excess protein from the
body. Therefore, a mixed diet
should be observed instead of the
daily consumption of only raw foods.
FINAL THOUGHTS:
It May Depend on the Food and
your goal (or the problem you are
trying to address!)
● Neither only a raw nor only a cooked
diet can be justified by science. That’s
because both raw and cooked fruits
and vegetables have various health
benefits.
● There are three factors to
consider when looking at the
effect of cooking on nutrition:
o the method (as well as
duration) of cooking
o the vegetable
o and the specific nutrient being
measured
Note: While making sense of the
studies on raw and cooked foods, its
good to know that most raw food
studies are basically ‘vegan/vegetarian
AND raw’ so keep in mind the pros and
cons of that (e. g. this group is unlikely
to face GI issues as frequently as ‘Non-
vegetarian AND raw’ group would face).
References
1. Ganss, C., Schlechtriemen, M. ve
Klimek, J., (1999), Dental Erosions
in Subjects Living on a Raw Food
Diet. Caries Res, 33: 74–80
2. Atila, E. ve Eden, E., (2012),
Dental Erozyon: Etiyoloji, Tanı ve
Tedavi Yaklaşımı Dental Erosion:
Etiology, Diagnosis and
Management, Ege Üniversitesi Diş
hekimliği Fakültesi Dergisi, 33 (2):
56-63.
3. PMID: 10024612
4. PMID: 26675866
5. PMID: 30263756
6. Scognamiglio M, D’Abrosca B,
Pacifico S, Isidori M, Fiorentino A.
Fat-soluble vitamins. Vol. II, pp.
568–569. In: handbook of food
analysis-3rd ed. Nollet LML and
Toldrá F (ed). CRC Press Inc.,
Baca Raton, FL, USA (2015)
7. Food and Nutrition Controversies
Today: A Reference Guide By
Myrna Chandler Goldstein, Mark A.
Goldstein MD
8. https://www.webmd.com/diet/featur
es/eating-raw-foods#3
433
4. Role of Fermented Methods of fermentation: There are
Foods two main methods through which foods
are fermented:
● Naturally fermented (wild
What Is It? (1) ferments / spontaneous
ferments): the microbes that
● Fermented foods are defined as ‘foods carry out fermentation are
or beverages produced through present naturally in the raw food
controlled microbial growth and the or processing environment. E. g.
conversion of food components Sauerkraut, kimchi, certain
through enzymatic action.’ fermented soy products.
● Fermentation = breakdown of
carbohydrate and carbohydrate-like ● Fermented via the addition of
materials into products such as starter cultures (Culture-
organic acids, gases or alcohol, dependent ferments): E. g.
under either anaerobic or aerobic kefir, kombucha, please natto.
conditions.
Examples:
o Lactose → Lactic Acid: carried out
by streptococcus lactis bacteria,
Anaerobic.
o Ethyl Alcohol → Acetic Acid:
carried out by Acetobacter aceti
bacteria, Aerobic.
● Anaerobic fermentation is called ‘True’
fermentation, whereas Aerobic one is
actually ‘oxidation’, but when it comes to
its use by the general public, both are
referred to as ‘fermentation’.
● For use by general population, the term
has even wider scope, as only
scientifically when carb or carb like
materials are broken down, it is called as
fermentation. But in general use, when
other macros such as protein and fat are
broken down, those too are called
‘fermentation’.
● It is used to improve or enhance
texture and taste of certain foods. E.
g. when fermented, olives get rid of its
bitter taste (caused by phenolic
compounds). 434
Most common fermented foods: ● It is also well tolerated by
people with lactose
malabsorption since it contains
I. Kefir:
β-galactosidase expressing
∙ It’s a fermented milk drink.
bacteria (e.g., Kluyveromyces
∙ It has sour taste and creamy texture.
marxianus), which hydrolyses
∙ It is produced by adding kefir grains
lactose, thus reducing lactose
(starter culture) to milk. “Kefir
concentrations in the drink.
grains consist of symbiotic lactose-
● It also contains 60% more β-
fermenting yeasts (e.g.,
galactosidase than plain yogurt,
Kluyveromyces marxianus) and non-
while a 30% reduction in
lactose fermenting yeasts (e.g.,
lactose content has been shown
Saccharomyces cerevisiae,
in kefir compared with
Saccharomyces unisporus), as well
unfermented milk.
as lactic and acetic acid-producing
● Despite reportedly greater β-
bacteria, housed within a
galactosidase concentrations in
polysaccharide and protein matrix
kefir than yogurt, a small cross-
called kefiran.” (2)
over RCT in 15 people with lactose
∙ Water kefir is a dairy free version of
malabsorption showed that
kefir, made up of water, sugar, and
although kefir produced a
water kefir grains (different from
significantly lower breath
regular kefir starter cultures).
hydrogen concentration compared
∙ Several In vitro studies have shown
to milk, it was similar following
that kefir exhibits antimicrobial
kefir and plain yogurt, suggesting
activity. (3)
that kefir and plain yogurt
∙ In vitro and animal studies have also
improved lactose digestion to a
suggested potential anti-oxidative,
similar degree. (6)
anti-hypertensive, anti-
carcinogenic, and cholesterol-and
glucose-lowering effects of kefir,
its considerable impact on the gut
microbiota population. (4, 6)
∙ Although not yet confirmed in vivo,
several strains isolated from kefir
have indicated a potential ability to
colonize the human gut. (5)

435
 Kombucha:
∙ It is a flavorful, frizzy fermented drink
(aerobic fermentation of black/green
tea and white sugar symbiotic culture
of bacteria and yeast (SCOBY)).
∙ The yeast converts sucrose to ethanol
(in addition to organic acids and
carbon dioxide) which acetic acid
bacteria convert to acetaldehyde and
acetic acid. (7)
∙ The composition (microbial and
metabolite) of kombucha depends on
the composition of the SCOBY, the
type and concentration of tea and
sugar, oxygen concentrations,
fermentation time, temperature, and
storage duration.
∙ The low pH of kombucha, owing
mainly to the production of a high
concentration of acetic acid, has been
shown to prevent the growth of
certain pathogenic bacteria. (8)
∙ Animal studies have shown Kombucha
to be effective when it comes to (9,
10):
o blood glycemia
o oxidative stress
o diabetes-induced weight loss
o chemically-induced
nephrotoxicity
o hypercholesterolemia
o indomethacin-induced gastric
ulceration.
∙ prevention of liver toxicity and damage
caused by exposure to harmful
chemicals.
Sauerkraut:
∙ It is a flavorful, frizzy fermented drink
(aerobic fermentation of black/green
tea and white sugar symbiotic culture
of bacteria and yeast (SCOBY)).
∙ The yeast converts sucrose to
ethanol (in addition to organic
acids and carbon dioxide) which
acetic acid bacteria convert to
acetaldehyde and acetic acid. (7)
∙ The composition (microbial and
metabolite) of kombucha
depends on the composition of
the SCOBY, the type and
concentration of tea and sugar,
oxygen concentrations,
fermentation time, temperature,
and storage duration.
∙ The low pH of kombucha, owing
mainly to the production of a high
concentration of acetic acid, has
been shown to prevent the
growth of pathogenic bacteria
such as Helicobacter pylori,
Escherichia coli, Salmonella
typhimurium, and Campylobacter
jejuni. (8)
∙ Animal studies have shown
Kombucha to be effective when it
comes to (9, 10):
○ blood glycemia
○ oxidative stress
○ diabetes-induced weight
loss
○ chemically-induced
nephrotoxicity
○ hypercholesterolemia
○ indomethacin-induced
gastric ulceration.
∙ prevention of liver toxicity and
damage caused by exposure to
harmful chemicals.
436
Natto:
∙ Natto is a traditional Japanese food
made from yellow soybean cooked
and fermented with Bacillus subtilis
var. Natto.
∙ A study showed- consumption of
Natto-containing miso soup for two
weeks led to increased good gut
bacteria (increased stool Bacilli and
Bifidobacteria (probiotics) and
decreased Clostridia and
Enterobacteriaceae) in 8 healthy
volunteers. (17)
∙ In individuals with 3–5 bowel
movements per week, consumption
of 50 g/day Bacillus subtilis K-2
containing Natto for two weeks
resulted in greater stool frequency
and proportion of stool Bifidobacteria
compared to consumption of 50
g/day of boiled beans. (18)
Miso:
∙ Miso is produced by fermenting
soybeans with ‘Koji’, produced from a
mould, Aspergillus oryzae, although
Saccharomyces cerevisiae and lactic
acid bacteria may additionally be
used and it’s production varies
greatly in terms of ingredients,
temperature and fermentation time,
salt concentration and the strain of A.
oryzae used.
∙ One cross-sectional study reported
an inverse relationship between
miso soup intake and subjective
gastro-oesophageal reflux
disease, functional dyspepsia and
reflux scores. (19)
Kimchi:
∙ Kimchi are a group of salted and
fermented vegetables ( Chinese
cabbage and/or radishes) and
various flavouring ingredients (e.g.,
chili, pepper, garlic, onion, ginger),
seasonings (e.g., salt, soybean
sauce, sesame seed), and other
additional foods (e.g., carrot,
apple, pear, shrimps).
∙ To produce kimchi, the cabbage is
brined and drained, then the rest of
the seasonings, spices and food
products are added and mixed with
the cabbage, and the mixture is left
to be fermented.
∙ According to a study,
consumption of kimchi
fermented for 8 weeks led to
positive changes in expression
of genes related to metabolic
pathways and immunity. (20)
∙ Kimchi has a variety of ingredients
which have synergistic effect on
gut microflora. E.g. antimicrobial
and antioxidant effects of red
pepper seeds and garlic. (21)
437
Sourdough Bread:
∙ It is produced made from fermented Tempeh:
flour (by lactic acid and yeasts) that ∙ Tempeh is a traditional
originate from the flour and Indonesian food.
surrounding environment. ∙ It is made by fermenting boiled
∙ Unlike sourdough bread, the regular
and dehulled soybeans with a
bread is made through a yeast only
fermentation process. The starter culture (Rhizopus
fermentation in sourdough bread by oligoporus fungal species) at
bacteria and yeast improves texture, room temperature for 35–37
flavour, nutritional content and shelf- hours.
life. (22) ∙ Fermentation of soybeans has
∙ As the microbes responsible for been shown to reduce
fermentation in Sourdough bread
concentrations of protease
degrade non-digestible
oligosaccharides, it has lower inhibitors, phytic acid and
amount of oligosaccharides fructans phenols, antinutritional factors
and raffinose (types of FODMAPs), that are high in raw soybeans..
and as a result is is a better option (13)
(compared to standard bread) for ∙ Tempeh contains lactic acid
IBS patients. (23)
bacteria, Enterococcus faecium,
∙ The impact of sourdough wheat
breads fermented for different and Rhizopus filamentous fungi
lengths of time on the human gut and it’s microbial composition
microbiota was assessed, and it was varies according to variations in
seen that in healthy individuals- production. (14)
ingestion of sourdough bread ∙ A study suggests that tempeh
(fermented for 8 hr) compared to may positively influence gut
non-fermented bread, resulted in
microbiota in humans. (15)
increase in good gut bacteria
(bifidobacteria) cand decrease in
harmful gut bacteria (δ-
Proteobacteria and
Gemmatimonadetes) in healthy as
well as individuals with IBS,
compared to baseline.. (24)
∙ In a study, effect of a single meal of 2
sourdough croissants or 2 brewer’s
yeast croissants was compared by
magnetic resonance imaging
analysis of gastric emptying. “The
total gastric volume was significantly
reduced by 11% and hydrogen
production by 30% following
sourdough croissants compared to
brewer’s yeast croissants.” (25)
Individuals who had sourdough
croissants experienced reduced
438
abdominal discomfort, bloating,
and nausea.
Probiotics:
∙ Probiotics are “live microorganisms which
when administered in adequate amounts
confer a health benefit on the host”.
∙ Probiotics are usually found in fermented
foods or taken as supplements.
∙ Dairy products play a predominant role as
carriers of probiotics.
∙ Several studies suggest probiotic use is
associated with a reduced risk of
antibiotic-associated diarrhea (26)
∙ A large review of 35 studies found certain
strains of probiotics can reduce the
duration of infectious diarrhea by an
average of 25 hours (27)
∙ Probiotics reduced the risk of travelers’
diarrhea by 8%. They also lowered the
risk of diarrhea from other causes by
57% in children and 26% in adults.
Effectiveness varies, depending on the type
and dose of the probiotic taken. (28, 29)
∙ When probiotics are added to fermented
foods, several factors influence the ability of
the probiotics to survive in the product and
become active when entering the
consumer’s gastrointestinal tract. These
factors include
o The physiologic state of the probiotic
organisms added (whether the cells
are from the logarithmic or the
stationary growth phase),
o The physical conditions of product
storage (e.g. temperature),
o The chemical composition of the
product to which the probiotics are
added (e.g. acidity, available
carbohydrate content, nitrogen
sources, mineral content, water
activity, and oxygen content), and
o Possible interactions of the probiotics
with the starter cultures (e.g.
bacteriocin production, antagonism,
and synergism).
Indian fermented foods: Cereal-
based (with/without pulses):
∙ These include: Idli, dosa, dhokla,
koozhu, nan, parotta, ambali,
pazhaiya soru.
∙ These foods are made up of
cereals mixed with or without a
pulse (legume). The cereals
include rice, ragi flour, wheat flour,
barley flour.
∙ These legumes and cereals
contain non-digestible
carbohydrates that support the
growth of Lactobacilli and
Bifidobacteria. These bacteria are
probiotic bacteria that help in
enhancing overall gut health.
∙ These fermented foods contain
several lactic acid bacteria such as
Bacillus cereus, Staphylococcus,
aureus, Listeria monocytogenes,
Pseudomonas aeruginosa, V.
parahaemolyticus, and Aeromonas
hydrophila.
Indian fermented foods: Cereal/pulse
and buttermilk-based fermented
food:
∙ Food items include - mor
kuzhambhu, rabdi, kulu, kadi
∙ These types of foods contain
probiotic bacteria that prevent
foodborne pathogens such as
Salmonella typhi and L.
monocytogenes.
439
XII. Indian fermented foods: Cereal-
based fermented sweets and
snacks:
∙ Food items include - Jilebi , Gulgule
, Seera, Chhuchipatra pitha, Podo
pitha, Bhaturu ,
Kulcha, Chitou, Selroti , Manna,
Kurdi ,Thuktal, Torani ,
Chhangpa, Khatta, Mangjangkori,
Tchhoso roti, Tiskori
∙ These food items contain many Lactic
acid bacteria which includes L.
fermentum, L. buchneri, L. plantarum,
L. acidophilus, L. mesenteroides,
Lactococcus lactis, Streptococcus
lactis and E. faecalis.
XIII. Indian fermented foods: Milk-based
fermented foods:
∙ Food items include - Curd (dahi,
thayir), Chhurpi or durkha or churapi,
Chhur , chirpen, Churkham, Chhu,
Philu or Philuk, Shyow, Gheu, Mohi,
Somar, Maa , Jhol, Khadi
XIV. Indian fermented foods: Vegetable,
bamboo shoot (BS), and unripe
fruits-based fermented foods:
∙ Food items include - Gundruk, Sinki,
Sauerkraut or Sauerkohi ,Anishi,
Soibum or soijim, Soidon, Kardi or
handua, Bamboo, tenga, Hikhu,
Hiring, Ekung, Eup, Khorisa-tenga,
ushoi, amil, Iromba, Lungseij, Mesu,
Khalpi, Rai, (brassica juncea) seeds,
Goyang, Inziangsang, Kanji
∙ These foods contain several Lactic
acid bacteria such as Lactobacillus
plantarum, L. brevi, L. corniformis, L.
delbrueckii, Leuconostoc fallax, L.
lactis, L. mesenteroides, Enterococcus
durans, S. lactis, L. casei,
Tetragenococcus halophilus and L.
fermentum.
XV. Indian fermented foods: Meat-
based fermented foods:
∙ Food items include - Ngari,
Hentak, Tungtap. Fermented fish,
Lona ilish. Crab, Utonggari, Lang
kargyong, Yak kargyong, Faak
kargyong, Kheuri, Lang satchu,
Yak satchu, Suka Ko Masu, Chilu,
Chartayshya, Geema, Arjia.
∙ These foods contain several lactic
acid bacteria that prevent
pathogenic bacteria. These lactic
acid bacteria include L. lactis
subsp. cremoris, Lactococcus
plantarum, E. faecium,
Lactobacillus fructosus, L.
amylophilus and L. corneformis.
XVI. Indian fermented foods:
Pulse(legume)-based fermented
foods:
∙ Food items include - Kinema,
Tungrymbai, Axone, Bekang , Bari,
Peruyyan , Wadi, Papad, Wari,
Masyaura, Bedvin roti, Amriti,
Channa dal dhokla, Khaman,
Ballae, Borhe, Sepubari, Teliye
mah, Aakhuni, Bekanthu, Madrah
∙ Pulse-based fermented foods
contain several lactic acid bacteria
E. faecium, L. mesenteroides, L.
fermentum, L. bulgaricus,
Streptococcus thermophilus, P.
pentosaceous and P. acidilactici.
440
Health benefits of fermented foods:
I. Preservation of food:
Fermentation ensures not only
increased shelf life and
microbiological safety of a food but
also makes some foods more
digestible and in the case of cassava
(cassava is a starchy root vegetable)
fermentation reduces toxicity of the
substrate.
II. Enhancement of flavor:
Fermentation makes the food
palatable by enhancing its aroma
and flavor. These organoleptic
properties make fermented food
more popular than the unfermented
one in terms of consumer
acceptance.
III. Improvement of nutritional quality:
Fermented foods can be more
nutritious than their unfermented
counterparts because of three
reasons:
∙ Microorganisms not only are catabolic,
breaking down more complex
compounds, but they also are anabolic
and synthesize several complex
vitamins and other growth factors.
∙ The second mechanism by which
fermentation can enhance nutritional
value, especially of plant materials,
involves enzymatic splitting of
cellulose, hemicellulose, and related
polymers that are not digestible by
humans into simpler sugars and sugar
derivatives.
In addition to enhancing the activity
of enzymes, fermentation also
reduces the levels of antinutrients
such as phytic acid and tannins in
food leading to increased
bioavailability of minerals such as
iron, protein and simple sugars.
IV. Alleviation of lactose
intolerance:
Lactose intolerant individuals are
better able to consume
fermented dairy foods, such as
yoghurt, with fewer symptoms
than the same amount of
unfermented counterparts.
V. Prevention of toxic effects of
mycotoxins:
∙ Mycotoxins are secondary
metabolites produced by fungi
belonging mainly to the
Aspergillus, Penicillium and
Fusarium genera. Agricultural
products, food and animal feeds
can be contaminated by these
toxins and lead to various diseases
in humans and livestocks. (30)
∙ Various fermented food
microorganisms are able to some
extent and with varied efficiency to
degrade mycotoxins to less- or
non-toxic products.
VI. Bioavailability of nutrients:
Beneficial functions of probiotic
microorganism like yeasts are
improvement of bioavailability of
minerals through the hydrolysis
of phytate, folate biofortification
and detoxification of mycotoxins
due to surface binding capacity
of the yeast cell wall.
VII. Folate biofortification:
∙ Folates (vitamin B9) are the
essential cofactors in the
biosynthesis of nucleotides and
therefore crucial for the cellular
replication and growth.
∙ Plants, yeast and some bacterial
species in fermented food contain
the folate biosynthesis pathway
and produce natural folates, but
mammals lack the ability to
synthesize folate and they are
therefore dependent on sufficient
intake from the diet. (31)
441
VIII. Biodegradation of phytate:
∙ Fermented food has the ability to XI. Protection against infection:
biodegrade the phytic acid. Phytic acid Gastrointestinal infections
or phytate (myoinositol including diarrhoea result from a
hexakisphosphate, IP6) is the primary change in the gut microflora
storage form of phosphorus in mature caused by an invading pathogen
seeds of plants and it is particularly resulting from the interference of
abundant in many cereal grains, the viable lactic acid with the
oilseeds, legumes, flours and brans. colonization and subsequent
∙ Phytate has a strong chelating proliferation of food borne
capacity and forms insoluble pathogens, thus preventing the
complexes with divalent minerals of manifestation of infection.
nutritional importance such as iron,
zinc, calcium and magnesium and are NOTE: Fermented foods are considered
widespread in various microorganisms safe for most people. However, some
including filamentous fungi, individuals may face issues such as:
Grampositive and Gram-negative ∙ Increased bloating due to the high
bacteria and yeasts. probiotic content and it may
IX. Intestinal pH balance: worsen after consuming fiber-rich
∙ A healthy large intestine (or colon) has fermented foods, such as kimchi
a slightly acidic pH, which tends to and sauerkraut (32)
inhibit or destroy putrefactive bacteria. ∙ When fermenting at home,
Putrefactive bacteria can produce foul incorrect temperatures,
smelling wind and are damaging to fermentation times, or unsterile
health when present in large numbers equipment can cause the food to
in the intestine. spoil, making it unsafe to consume
∙ Naturally fermented foods contain
active Lactobacilli bacteria that
produce lactic acid, and many other
beneficial bacteria and yeasts that
also produce acids, which help to
keep the large intestine pH at a
healthy level.
X. Improvement of digestion and the
digestibility of foods:
∙ Healthy bacteria found in naturally
fermented foods produce enzymes
that can break down foods present in
the intestines, thus making the
nutrients easier absorption.
∙ The beneficial bacteria also produce
vitamins such as the water soluble
vitamin B and C, making the
fermented food richer in nutrients.
Yoghurt is a prime example. It is
easier to digest than the milk it is
made from, and richer in water soluble
vitamins.
442
References
1. Food Science: Fifth Edition By Norman N. Potter, Joseph H. Hotchkiss
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8. Tea, Kombucha, and health: a review https://doi.org/10.1016/S0963-
9969(00)00067-3
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15. PMID: 15752324
16. Effect of Tempeh Supplementation on the Profiles of Human Intestinal Immune
System and Gut Microbiota. Microbiol. Indones. 2017;11:2. doi:
10.5454/mi.11.1.2.
17. PMID: 8655094
18. Fujisawa T., Shinohara K., Kishimoto Y., Terada A. Effect of miso soup
containing Natto on the composition and metabolic activity of the human faecal
flora. Microb. Ecol. Health Dis. 2006;18:79–84. doi:
10.1080/08910600600931942.
19. Mitsui N., Tsukahara M., Murasawa H., Tamura M., Kajimoto O., Nishimura A.,
Kajimoto Y., Benno Y. Effect of Natto including Bacillus subtilis K-2 (Spore) on
defecation and fecal microbiota, and safety of excessive ingestion in healthy
volunteers. Jpn. Pharmacol. Ther. 2006;34:135–148
20. PMID: 30381627
21. PMID: 25688926
22. PMID: 22850370
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24. PMID: 27417338
25. PMID: 25356771
26. https://pubmed.ncbi.nlm.nih.gov/26695080/
27. https://pubmed.ncbi.nlm.nih.gov/21069673/
28. https://pubmed.ncbi.nlm.nih.gov/16728323/
29. https://pubmed.ncbi.nlm.nih.gov/18542041/
30. PMID: 29490103
31. https://doi.org/10.1111/j.1567-1364.2008.00398.x
32. Chemical and Nutritional Aspects of Folate Research: Analytical Procedures,
Methods of Folate Synthesis, Stability, and Bioavailability of Dietary Folates
33. PMID: 20208051

443
5. A Note on Fiber
Insoluble particles with large Recommended Daily Dose
enough size stimulate
colonic mucosa for easier Children Females Males
passage of stool, but can Age Intake Age Intake Age Intake
worsen diarrhea. (yrs.) (grams) (years) (grams) (years) (grams)
On the other hand, soluble,
partially fermentable, 1-3 19 9-18 26 9-18 38
viscous gel forming fiber like 4-8 25 19-50 25 19-50 38
psyllium is useful in cases - - 51 + 21 51 + 30
of constipation as well as - - Pregnant 28 - -
diarrhea and IBS, as /lactating
psyllium softens hard
stool in constipation Interpreting Nutrition Labels:
cases and firms it in ∙ When a product reads it ‘has fiber’, that means, it has
diarrhea cases. minimum 3g fiber per 100g of the product.
Any fiber that is non-viscous ∙ For a product to say it has ‘high fiber content’, it has to
(insoluble AND non-viscous have minimum 6g fiber per 100 g of the product.
like wheat bran; or soluble How to Add More Fiber to Your Diet?
AND non-viscous like ∙ Eat fruits instead of juices.
dextrin, inulin; or ∙ Eat apples, pears, cucumbers, boiled potatoes, cooked
fermentable AND non- eggplant, and carrots with the skin on.
viscous like guar gum, b- ∙ Add chia seeds and flax seeds to your salad.
glucan, barley) doesn’t have ∙ Add berries and nuts to your oats.
water holding capacity and ∙ Slowly increase your fiber intake if you aren’t
hence doesn’t provide consuming the daily recommended amount. Upping it
related laxative benefit. abruptly might not give enough time for the gut
microbes to adapt to this new composition of your
The only fiber that is meals and can cause flatulence, bloating, cramps,
proven to be helpful in upset stomach etc.
chronic constipation as An article by Michigan Medicine suggests adding 5g fiber
well as in IBS is psyllium. per day to start with and increase intake by 5g every two
In many cases, a specific weeks. Initially you can expect increased flatulence but it
fiber as an ingredient to start will normalize at the gut flora adapts.
with, has desired properties, ∙ Caffeine is a diuretic. If you drink a lot of coffee and
but during the processing you haven’t increased water intake when you start
(e.g. making nutrition bars/ eating more fibrous foods, it might cause/worsen
bread/cookies out of oat constipation.
bran) the physiochemical
properties of the fiber (e.g. References
viscosity of B-glucan in case 1. https://www.news-medical.net/health/What-is-
of oat bran) are altered Digestion.aspx
resulting in the loss of 2. Nahikian-Nelms M, Sucher K. Nutrition Therapy and
desired health benefit in the Pathophysiology.; 2015.
end product. 3. https://www.hopkinsmedicine.org/health/wellness-and-
prevention/digestive-disorders
4. ‘THE SCIENCE of GUT HEALTH: What the Research
Really Says About Your Gut Microbiome’ by Dr.
Gabrielle Fundaro, Dr. Jessie Hoffman. 444
6. The Brain – Gut Collection
Example: feeling nauseated after
learning about a bad news, or anxiety
causing upset stomach.
Anatomy of the brain-gut connection
The brain sends signals to the GI tract
via the sympathetic (“fight or flight”)
nervous system and the
parasympathetic (“rest and digest”)
nervous system. The balance of signals
from these two inputs can affect the
speed at which food moves through the
digestive system, absorption of
nutrients, secretion of digestive juices,
and level of inflammation in the
digestive system.
There is anatomical and physiologic
two-way communication between the
gut and brain via the vagus nerve. The
gut-brain axis offers us a greater
understanding of the connection
between diet and disease, including
depression and anxiety.
The digestive system also has its own
nervous system, the enteric nervous
system (ENS). The enteric nervous
system is sometimes referred to as a
"second brain" because it relies on the
same types of neurons and
neurotransmitters that are found in the
central nervous system (brain and
spinal cord). ENS consists of
approximately 100 million nerve cells in
and around the GI tract. These cells
survey the digestive system and convey
information, such as whether the
stomach is bloated or whether there is
infection in the GI tract or insufficient
blood flow, back to the brain. The
enteric nervous system receives inputs
from the sympathetic and
parasympathetic nervous systems but
can also function independently of them.
Thus, the brain and GI system
communicate with one another in both
directions.
Because of this strong brain-gut
connection, stress and a variety of
negative emotions such as anxiety,
sadness, depression, fear, and
anger can all affect the GI system.
When a person becomes stressed
enough to trigger the fight-or-flight
response, for example, digestion
slows or even stops so that the body
can divert all its internal energy to
facing a perceived threat. In
response to less severe stress, such
as public speaking, the digestive
process may slow or be temporarily
disrupted, causing abdominal pain
and other symptoms of functional
gastrointestinal disorders. Stressors
can speed up or slow down the
movements of the GI tract and the
contents within it; make the digestive
system overly sensitive to bloating
and other pain signals; make it
easier for bacteria to cross the gut
lining and activate the immune
system; increase inflammation in the
gut; and change the gut microbiota
(the types of bacteria that reside in
the gut). That’s why stress and
strong emotions can contribute to or
worsen a variety of GI conditions
such as inflammatory bowel disease
(Crohn’s disease and ulcerative
colitis), irritable bowel syndrome
(IBS), gastroesophageal reflux
disease (GERD), and food allergies
and sensitivities.
The negative changes in the GI
system can then feed back on the
brain, creating a vicious cycle. For
example, new research is
demonstrating that increased gut
inflammation and changes in the gut
microbiome can have profound
effects throughout the body and
contribute to fatigue, cardiovascular
disease, and depression.
445
The connection between the brain and
the gut can affect both men and women,
though in different ways.
Science is beginning to understand the
process behind this link, which
ultimately relates to hormones released
from different parts of our brain, as well
as other places — when we are
particularly stressed or excited.
Chemicals circulating in the
bloodstream affect the sensitivity and
function of nerves in the wall of the gut,
which can be collectively referred to as
the enteric nervous system (ENS), and
it is revolutionizing medicine’s
understanding of the links between
digestion, mood, health and even the
way you think.
The ENS is two thin layers of more than
100 million nerve cells lining your
gastrointestinal tract from esophagus to
rectum. “Its main role is controlling
digestion, from swallowing to the
release of enzymes that break down
food to the control of blood flow that
helps with nutrient absorption to
elimination,” ~ Jay Pasricha, M.D.,
director of the Johns Hopkins Center for
Neurogastroenterology
If you have IBS, the nerves in your gut
are extremely sensitive, and the brain
processes these signals from your gut
differently than it would if you did not
have IBS. Even small amounts of gas
can trigger pain, bloating, constipation
or diarrhea.
For decades, researchers and doctors
thought that anxiety and depression
contributed to these problems. But
studies show that it may also be the
other way around.
Researchers are finding evidence that
irritation in the gastrointestinal system
may send signals to the central nervous
system (CNS) that trigger mood
changes.
Some people with chronic
constipation also report a depressed
mood or even headaches. While
many natural health practitioners
focus on the negative effects of
toxins in the body, that's not what's
likely behind the brain-gut
connection. Some experts believe
being constipated actually causes
the enteric nervous system to send
certain signals to the brain, which
then trigger a cascade of feelings.
This new understanding of the ENS-
CNS connection helps explain the
effectiveness of IBS and bowel-
disorder treatments such as
antidepressants and mind-body
therapies like cognitive behavioral
therapy (CBT) and medical
hypnotherapy. Therapies that help
one may help the other (ENS-CNS).
Diet and depression
A recent study suggests that eating
a healthy, balanced diet such as the
Mediterranean diet and avoiding
inflammation-producing foods may
be protective against depression.
Another study outlines an
Antidepressant Food Scale, which
lists 12 antidepressant nutrients
related to the prevention and
treatment of depression. Some of
the foods containing these nutrients
are oysters, mussels, salmon,
watercress, spinach, romaine
lettuce, cauliflower, and
strawberries.
A better diet can help, but it’s only
one part of treatment. It’s important
to note that just like you cannot
exercise out of a bad diet, you also
cannot eat your way out of feeling
depressed or anxious.
446
Mind-body approaches to GI ailments:
Given this strong mind-body/brain-gut
connection, it should come as no surprise
that mind-body tools such as meditation,
mindfulness, breathing exercises, yoga, and
gut-directed hypnotherapy have all been
shown to help improve GI symptoms,
improve mood, and decrease anxiety. They
decrease the body’s stress response by
dampening the sympathetic nervous system,
enhancing the parasympathetic response,
and decreasing inflammation.
The evidence suggests that the following
psychotherapies may provide some relief for
many people with severe functional
gastrointestinal disorders
Cognitive behavioral therapy (CBT). This
standby of psychotherapy helps patients to
change counterproductive thoughts and
behavior and learn coping skills to better
manage stress and anxiety. CBT may be
most useful in helping patients to cope with
persistent gastrointestinal distress, rather
than reducing pain.
Relaxation therapy. This encompasses a
number of techniques designed to help
people relax and reduce reactivity to stress.
Techniques include progressive muscle
relaxation, visualization, and restful music. It
is effective for gastrointestinal disorders
when it is combined with CBT.
Hypnosis. Gut-directed hypnotherapy —
which combines deep relaxation with positive
suggestions focused on gastrointestinal
function — may be helpful for people whose
symptoms occur even without obvious stress.
Diet:
We’ve also learned that certain kinds of
foods can trigger specific reactions in the gut
of sensitive individuals. In those cases,
specific diets, such as low-FODMAP for IBS
or avoiding acidic foods for GERD, can be
helpful for managing symptoms.
Diet also profoundly affects the gut
microbiome. For example, eating a
more plant-based diet with few
refined carbohydrates and little or no
red meat often leads to a healthier
microbiome. These dietary changes
in turn reduce intestinal inflammation
and may help reduce systemic
symptoms such as fatigue or
depression and the risk of
cardiovascular disease.
Gastroenterologists may prescribe
certain antidepressants for IBS, for
example—not because they think
the problem is all in a patient’s head,
but because these medications calm
symptoms in some cases by acting
on nerve cells in the gut.
Psychological interventions like CBT
may also help to “improve
communications” between the big
brain and the brain in our gut,” he
says.
research suggests that digestive-
system activity may affect cognition
(thinking skills and memory), too.
References
• https://www.hopkinsmedicine.org/hea
lth/wellness-and-
prevention/gastrointestinal-issues-
whats-your-brain-have-to-do-with-it
• https://www.hopkinsmedicine.org/hea
lth/wellness-and-prevention/the-brain-
gut-connection
• https://www.health.harvard.edu/blog/
brain-gut-connection-explains-why-
integrative-treatments-can-help-
relieve-digestive-ailments-
2019041116411
• https://www.health.harvard.edu/newsl
etter_article/stress-and-the-sensitive-
gut
• https://www.health.harvard.edu/blog/
gut-feelings-how-food-affects-your-
mood-2018120715548
447
10.4 Anti-Nutrients
What are Some of the Common Anti
What are Anti Nutrients? – Nutrients?
∙ IN PLANTS: Anti-nutrients are bioactive There are lot of Anti – Nutrients,
compounds that serve as defense however 7commonly discussed are
mechanisms against insects, molds, fungi listed below:
and diseases. ∙ Lectins
∙ Phytates
∙ Oxalates
∙ RELEVANT DEFINITION TO HUMANS: ∙ Goitragens
Antinutrients are natural compounds found ∙ Phytoestrogens
in plant foods, including whole grains, ∙ Tannins
beans, lentils, nuts, seeds, and some ∙ Saponins
vegetables, that can interfere with the
absorption of other nutrients . What are Some of the Common
Symptoms Exhibited by large
∙ POTENTIAL IMPACT ON HUMANS – WHY number of Anti – Nutrients When
DO THE ANTI – NUTRIENTS MATTER? Consumed in Excess by Humans?
When plant based foods are consumed by ∙ Bloating
humans, these very mechanisms through which ∙ Headaches
anti-nutrients protect their hosts (the plants) can ∙ Rashes
also impair the body's absorption of nutrients. ∙ Nutritional Deficiencies.
∙ Stomach Distress – Including Pain
Antinutrients are compounds found in food ∙ Diarrhoea
that impair the digestion and absorption of ∙ Gastroesophageal Reflux
protein, vitamins, and minerals. All foods ∙ Heart Burn.
contain nutrients, however, certain plant foods; ∙ Acid Reflux
including grains, seeds, nuts, and legumes,
contain compounds that act as a form of
defense mechanism and help to protect the
plant from infections or consumption by animals
and insects & THESE VERY DEFENSE
MECHANISM COMPOUNDS THAT PROTECT
THE PLANTS FROM INFECTIONS OR
CONSUMPTION BY ANIMALS & INSECTS,
WHEN CONSUMED BY HUMANS –
INTERFERE WITH THE BREAKING DOWN
OF THAT FOOD & THEN, THE
SUBSEQUENT DIGESTION AND
ABSORPTION OF THAT PLANT FOOD’S
NUTRIENTS.

448
Potential Disadvantages & Harmful
Effects:
∙ Indirect role in vitamin & mineral
deficiencies: Anti-nutrients CAN
reduce the bioavailability of various
components of the cereals and
legumes. These factors can cause
micronutrient malnutrition and
mineral deficiencies. A nutrient
deficiency due to anti-nutrients more
likely occurs in developing countries
where a variety of food choices is
limited, the risk of malnutrition is
higher, and legumes or whole grains
are staples that are eaten with every
meal.
∙ Also, at risk are those who eat a
vegan diet (which not only consists
of plenty of seeds/nuts, legumes,
and grains but these foods contain
poorly absorbed non – heme iron),
or those who already have an iron
or zinc deficiency due to medical
reasons.
∙ Like other legumes, peanuts also
have anti-nutrients, which can
impair nutrient bioavailability
through the formation of
indigestible complexes with
minerals and proteins. In addition to
decreasing nutrient bioavailability,
anti-nutrients can become toxic when
present beyond a certain amount. (26)
∙ People who are at high risk for
diseases related to mineral
deficiencies, such as osteoporosis
with calcium deficiency or anaemia
with iron deficiency, may wish to
monitor their food choices for anti-
nutrient content. (27)
∙ The anti-nutritional factors, which
reduce the nutritional value of foods
can be reduced by the use of
traditional food preparation methods
such as fermentation, cooking,
soaking, and puffing. These food
processing techniques reduce anti-
nutritional factors, increase protein
digestibility and improve the biological
value of cereal crops.
Potential Benefits of Anti-nutrients:
∙ While antinutrients can be
problematic, some may also
provide health benefits.
∙ Antinutrients are valuable active
ingredients in food and drinks.
When used at low levels, phytic
acid, lectins, and phenolic
compounds as well as enzyme
inhibitors and saponins have
been shown to reduce blood
glucose and/or plasma
cholesterol and triacylglycerols.
∙ Phenolic compounds from plant
sources, phytic acid, protease
inhibitors, saponins, lignans,
and phytoestrogens have been
demonstrated to reduce cancer
risks.
∙ Another group of anti-nutrient
compounds, like tannins, were
found to possess possible
antiviral, antibacterial, and
antiparasitic effects. (2)
∙ Some compounds such as
phytoestrogens and lignans
have also been linked to the
induction of infertility in
humans.
LET’S LOOKING AT EACH ANTI
NUTRIENT IN DETAIL NOW
Most anti – nutrients have some
harmful, as well some positive features.
Each anti-nutrient is arranged in
subsections such as:
∙ ANTI NUTRIENT
∙ IT’S KEY FEATURES
∙ FOUND IN WHICH FOODS
∙ POTENTIAL BENEFITS
∙ POTENTIAL HARMFUL EFFECTS
∙ HOW TO MINIMISE THE
HARMFUL EFFECTS
∙ RESEARCH ON IT
449
LECTINS (HEMAGGLUTININS)
KEY ATTRIBUTES:
∙ Lectins are naturally occurring large
proteins found in most plants, that
bind to carbohydrates, especially
polysaccharides.
∙ One example of a sugar molecule
that lectins bind to is sialic acid,
which is found in the gut, the brain,
between nerve endings, in joints, in
bodily fluids, and in the lining of
blood vessels. This is why people
who consume a lot of foods that
are high in lectins are inflamed and
can have achy joints, brain fog, and
fatigue. (54)
∙ They resist being broken down in the
gut and are stable in acidic
environments.
∙ As a result, lectins can survive
digestion and bind cells lining the
digestive tract. This interaction leads
to a series of harmful local and
systemic reactions.
∙ Can alter Gut Function
∙ Can Cause Inflammation.
∙ Can interfere with the absorption of
calcium, iron, phosphorus, and zinc.
FOODS HIGH IN LECTINS:
∙ Raw Legumes – Major sources –
Beans, Lentils, Peas, Soybeans,
Chickpeas, Kidney Beans (contains
high levels of: phytohaemagglutinin)
and Peanuts.
∙ Whole Grains – Major sources –
Wheat primarily – also found in Oats
and Rice, but in lesser quantities.
∙ Unprocessed Fruits &
Vegetables – Mainly found in
(Although, insignificant
amounts of lections are
consumed through these):
∙ Tomatoes - Tomatoes also
contain lectins, though there is
currently no evidence that they
have any negative effects in
humans. The available studies
have been conducted on
animals or in test tubes,
SOURCE:
https://www.healthline.com/nutritio
n/foods-high-in-
lectins#TOC_TITLE_HDR_7
∙ Potatoes – Like Tomatoes,
potatoes cop bad rap – as there
is little evidence to support the
adverse effects of Lectins from
Potatoes, in fact 1 study showed
potatoes to be inflammation
reducing. SOURCE:
https://www.healthline.com/nutritio
n/foods-high-in-
lectins#TOC_TITLE_HDR_7
∙ Eggplant
∙ Fruits
∙ Wheat
∙ Corn
∙ Rice
∙ Quinoa
∙ Cucumbers
∙ Zuchhini
∙ Pumpkins
∙ Squashes
∙ Peppers
∙ Goji Berries
∙ Eggs – But, when you cook
eggs, you can virtually kills
most of the lectins in eggs.
450
NOTE ON LACTATE CONTENT:
∙ Unprocessed fruits and vegetables:
Insignificant amounts of lectins are
consumed through these.
∙ Raw legumes and whole grains: far
more concentrated sources of lectins.
∙ Lectin content may vary with
regards to plant variety, cultivation
area, and disease susceptibility of
the plant.
FOODS LOW IN LECTINS:
∙ Pasture Raised Meat – Meaning,
meat that is left to graze the open
grass lands, and especially that is
not fed corn or say, as corn and
soy both contain high amounts of
lectins and are known for
inflammation causing properties in
cattle
∙ Cooked Sweet Potatoes
∙ Leafy Green Vegetables – Kale,
Watercress, Spinach, Chard, Leaf
Lettuce, Collard Greens, Aragula,
Beet Greens, Cabbage.
∙ Broccoli
∙ Brussels Sprouts
∙ Asparagus
∙ Garlic
∙ Onions
∙ Mushrooms
∙ Olives
∙ A2 Milk
POSSIBLE HEALTH HAZARDS:
∙ Cases of food poisoning involving
raw or inadequately cooked legumes
∙ PHA toxicity (PHA is a known toxin
to any animal with a Single
Stomach Digestive System &
Humans fall under that category),
caused by consumption of fresh
kidney beans is common – But this
generally only occurs, when beans
are NOT COOKED PROPERLY –
ONCE YOU SOAK THEM
OVERNIGHT, AND COOK THEM ON
HIGH HEAT, THIS PROBLEM IS
GENERALLY ELIMINATED.
∙ Locally, they can:
o Affect the turnover and
loss of gut epithelial cells
o Damage the luminal
membranes of the
epithelium
o Interfere with nutrient
digestion and absorption
(Animal and cell studies
have found that active
lectins can interfere with
the absorption of minerals,
especially calcium, iron,
phosphorus, and zinc.
Legumes and cereals often
contain these minerals, so
the concurrent presence of
lectins may prevent the
absorption and use of these
minerals in the body.)
o Potentially cause an
autoimmune response and
are theorized to play a role in
inflammatory conditions like
rheumatoid arthritis and type
1 diabetes.
o Stimulate shifts in the
bacterial flora
o Modulate the immune state
of the digestive tract.
∙ Systemically, they can:
o Disrupt lipid, carbohydrate
and protein metabolism
o Promote enlargement and/or
atrophy of key internal
organs and tissues
o Alter the hormonal and
immunological status.
∙ Note: there is very limited research
in humans on the amount of active
lectins consumed in the diet and
their long-term health effects.
451
HOW TO REDUCE LECTINS IN FOOD:
∙ Cooking – Especially, High Wet
Heat Methods – Like Boiling or
Stewing
∙ Soaking in water for several hours
– especially overnight
∙ Soaking Overnight & then Cooking
in Water at High Heat – Especially
for foods like Kidney Beans and
many of the legumes, lentils and
Daals.
∙ Fermentation of over 72 Hours has
been shown to destroy almost all
lectin content of lentils.
HOW SOME METHODS CAN INCREASE
THE LECTIN CONTENT IN FOOD:
∙ Roasting and baking can often
increase the Lectin Content of foods
like Legumes, cereal grains, seeds,
nuts, fruits, vegetables
ANY CLINICAL IMPLICATIONS:
∙ Altered Gut function.
∙ Potential increase in Inflammation
∙ Can interfere with the absorption of
vitamins and minerals like Zinc,
Phosphorous, Iron, Calcium etc
WORD OF CAUTION ON
MINDLESSLY REMOVING ALL
FOODS CONTAINING LECTINS:
∙ Legume lectins isolated from
lentils, chickpeas, jack beans, peas
and common beans all show anti-
proliferative activity against various
cancer cell lines, however, human
clinical trials are still needed before
any conclusions can be made (37)
∙ Legumes and other lectin-rich
plant foods are excellent
sources of essential amino
acids, prebiotic fibers, vitamins,
minerals as well as powerful
antioxidant and anti-
inflammatory compounds (38)
∙ Diets rich in legumes and whole
grains are associated with
reduced inflammatory
biomarkers in both animal and
human trials (39)
KEY NOTE: Until further human
clinical trials demonstrate otherwise,
the health-promoting effects of
lectin-containing foods would seem
to far outweigh any possible
negative effects of lectins.
452
2. PHYTIC ACID/ PHYTATES
What are Phytates? FOODS HIGH IN PHYTATES
∙ IN PLANTS: ∙ Almonds
o Phytic acid is a substance ∙ Beans
found in many plant-based ∙ Brazil nuts
foods. It is also called inositol ∙ Hazelnuts
hexaphosphate and IP6. This ∙ Lentils
acid is the primary way ∙ Maize, corn
phosphorus is stored in many ∙ Peanuts
plants, including beans, ∙ Peas
seeds, and nuts. ∙ Rice
o When seeds sprout, phytate is ∙ Rice bran
degraded and the phosphorus ∙ Sesame seeds
released to be used by the ∙ Soybeans
young plant. ∙ Tofu
∙ Walnuts
∙ Wheat
∙ RELEVANT DEFINITION TO ∙ Wheat bran
HUMANS: Phytic acid impairs the ∙ Wheat germ NOTE ON PHYTATE
absorption of Calcium, Magnesium, CONTENT:
Iron, Zinc, Chromium, Manganese. ∙ The amount of phytic acid in foods
varies widely even within the same
∙ POTENTIAL IMPACT ON HUMANS – food, based on the seed type,
WHY DO PHYTATES MATTER? environmental conditions, climate,
∙ When Phytic acid is consumed, it and soil quality (42). For example,
binds to other minerals (Calcium, the amount contained in almonds
Magnesium, Iron, Zinc, Chromium, can vary up to 20-fold. (Additional
Manganese) to create Phytates. info at the end)
Because humans don't have any
enzymes that can break phytates
down, their nutrients cannot be
absorbed into your body. (53)
∙ However, recent studies have shown
that phytic acid's anti-nutrient effect
occurs only when large amounts of
phytates are consumed within a diet
that is already lacking nutrition. (This
is rarely a concern for those who
follow well-balanced diets but may be
a significant problem during periods of
malnutrition and in developing
countries where the main food source
is grains or legumes.)
∙ This applies to a single meal, not
overall nutrient absorption throughout
the day.

453
POSSIBLE HEALTH HAZARDS:
∙ Phytic acid is labeled an antinutrient
because humans lack the phytase
enzyme needed to break it down. As it
passes through the gut, phytic acid
binds to minerals like iron, copper,
zinc, and calcium so they are not
well-absorbed in the intestine. This
will occur only when phytic acid is
eaten with foods containing these
minerals at the same meal. (40)
∙ However, ability of phytates to limit
absorption of the above mentioned
minerals is dependent on the
proportion of phytate to metal ions,
as well as pH (49)
∙ Low-income, developing countries that
rely predominantly on grains and
legumes as dietary staples are at risk
for zinc deficiency and/or insufficiency.
(41)
∙ Phytates can:
o Reduce the digestibility of
starches, proteins, and fats
o Influence digestive enzymes
POSSIBLE BENEFITS:
∙ Phytic acid is an antioxidant.
∙ Phytic acid helps prevent hardening of
the arteries and platelet formation.
∙ It may protect against certain cancers,
particularly against colon cancer by
suppressing oxidative damage to
intestinal cells. (55)
Can have a protective effect against
osteoporosis (56)
HOW TO REDUCE PHYTATES IN FOOD:
∙ Soaking: Cereals and legumes are
often soaked in water overnight to
reduce their phytate content.
∙ Sprouting: The sprouting of seeds,
grains and legumes, also known as
germination, causes phytate
degradation
∙ Fermentation: Organic acids, formed
during fermentation, promote phytate
breakdown. Lactic acid fermentation is
the preferred method, a good example
of which is the making of sourdough
∙ Combining these methods can
reduce phytate content substantially.
For example:
o soaking, sprouting and lactic acid
fermentation can reduce the
phytic acid content of quinoa
seeds by 98%
o In addition, sprouting and lactic
acid fermentation of white
sorghum and maize may almost
completely degrade the phytic
acid
WHAT DOES THE RESEARCH SAY:
∙ People who regularly consume high
amounts of phytic acid — such as
vegetarians and vegans — can benefit
from eating mineral-absorbing
enhancers like garlic and onions.
These foods increase the absorption
of minerals like iron and zinc. (53)
∙ Some studies have shown, in
developing countries where the main
food source is grains or legumes, to
compensate with decreased
bioavailability of minerals due to
phytates, increases in soluble minerals
in diet (esp in the same meal) DOESN’T
NECESSARILY MEAN INCREASED
BIOAVAILABILITY OF THOSE
MINERALS.
WORD OF CAUTION ON MINDLESSLY
REMOVING ALL FOODS CONTAINING
PHYTATES:
∙ In Western countries, increased
consumption of whole grain foods is
associated with improved health
outcomes, which does not justify advice
to refrain from grain-based foods
because they contain phytic acid. As it is
known that phytates only affect the
absorption of nutrients eaten at the
same meal, instead of removing
phytates from foods, it is advised to eat
foods rich in minerals (iron, zinc, copper,
calcium) and foods with phyates in
separate meals. 454
3. OXALATES/OXALIC ACID:
∙ because oxalates bind to calcium
WHAT ARE OXALATES? as they leave the body, they can
∙ IN PLANTS: increase the risk of kidney stones
o All major groups of photosynthetic in some people.
organisms produce oxalate. ∙ Due to their effects on nutrient
o It is suggested that plants absorption and possible role in
manufacture oxalate for a variety of kidney stone formation, oxalates
functions including calcium are considered by some to be
regulation, plant protection, and ‘antinutrients’.
detoxification of heavy metals ∙ Most people get between 200 and
∙ RELEVANT DEFINITION TO HUMANS: 300 milligrams of oxalates daily. If
o Oxalates — also known as oxalic you’re at risk for kidney stones,
acid — is a naturally-occurring sources suggest consuming less
compound in plants. These plant- than 100 milligrams a day. Doctors
based oxalates are consumed may also recommend “low-oxalate
through our diet as well as diets” of less than 50 milligrams
produced (endogenous oxalate) as daily for some people.
waste by your bodies (metabolite
of ascorbate, glyoxylate, FOODS HIGH IN OXALATES (57)
hydroxyproline and glycine). ∙ Spinach
o Urinary oxalate mostly consists of ∙ Swiss chard
endogenous oxalate, as opposed ∙ Amaranth
to exogenous dietary oxalate (if a ∙ Taro
person is not on consuming ∙ Sweet potatoes
excess oxalate through his diet). ∙ Beets
o A distinction should be made ∙ Rhubarb
between soluble and insoluble ∙ Sorrel
oxalate, as excess soluble oxalate ∙ Beans
has more of an effect on ∙ Beer
bioavailability and kidney stone ∙ Okra
formation (52). Absorbed dietary ∙ Beets
oxalates (soluble ones) are ∙ Berries
believed to contribute to calcium ∙ Chocolate
oxalate kidney stone formation. ∙ Cocoa
Insoluble oxalates, on the other ∙ Cranberries
hand, are excreted in the feces ∙ Nuts.
∙ Oranges
∙ POTENTIAL IMPACT ON HUMANS – ∙ Soda (cola)
WHY DO OXALATES MATTER? ∙ Soy beans
∙ A balanced human diet typically contains ∙ Soy milk
only small amounts of oxalates. ∙ Spinach
∙ Soluble oxalates can form insoluble salts ∙ Sweet potatoes
with minerals, including sodium, potassium, ∙ Tea (black)
calcium, iron, and magnesium. ∙ Tofu
∙ Wheat bran

455
NOTE ON OXALATE CONTENT:
∙ Raw legumes, whole grains, nuts, POSSIBLE HEALTH HAZARDS:
baking cocoa and tea also contain ∙ May inhibit calcium absorption
oxalate, though in smaller amounts. ∙ MAY increase calcium kidney
∙ Differences in total oxalate content is stone formation (recent studies
variable among plant varieties, show that dietary oxalate is not
season, harvesting time, and growing a major risk factor for stone
conditions. formation)
∙ Distribution of oxalate within a plant ∙ Because oxalates bind to minerals
can vary. Leaves (spinach, beet like calcium, they can prevent
greens) are reported to have far your body from absorbing
greater oxalate content than stalks beneficial nutrients in your
(rhubarb) or roots (beets, carrots). digestive tract. (They don’t block
absorption completely, and our
FOODS LOW IN OXALATES: bodies only use a portion of the
∙ Kale nutrients we consume.)
∙ Bok Choy ∙ Those with digestive disorders
∙ Cashews such as inflammatory bowel
∙ Peanuts disease (IBD) have been shown
∙ Walnuts to be at higher risk for calcium-
∙ Pumpkin oxalate kidney stones, assumed
∙ Bananas to be partially caused by oxalate
∙ Cherries hyperabsorption
∙ Strawberries
∙ Lemons POSSIBLE BENEFITS:
∙ Peaches ∙ Can (56)
∙ Eggs
∙ Meat
∙ Fish
∙ Poultry
∙ Sunflower Seeds
∙ Sweet Potatoes
∙ Broccoli
∙ Kidney Beans
∙ Blueberries and
∙ Blackberries Dried Figs
∙ Coffee
∙ fruit juice
∙ Onion
∙ Peas
∙ Zuccini
∙ Sugar (white), maple syrup, corn
syrup, honey

456
HOW TO REDUCE IMPACT OF
OXALATES IN FOOD:
∙ Boiling: Due to oxalate’s solubility in
water, wet processing methods such
as boiling seem to be the most
efficient solutions to decreasing
oxalate content.
∙ Steaming: has a comparatively lesser
impact, though still resulted in losses.
∙ Traditional and industrial cooking
methods such as soaking overnight
or autoclaving, significantly reduces
total and soluble oxalate content in
legumes.
∙ Good dietary and lifestyle choices
can also reduce the impact of
oxalates. This includes:
o Drinking plenty of water to
help your body flush oxalates
out
o Consuming enough calcium,
which binds to oxalates during
digestion (Aside from cooking,
pairing high-oxalate foods with
calcium-rich foods may offset
soluble oxalate absorption. A
normal calcium diet (800–1,000
mg/day) should be able to offset
potential inhibitory effects from
dietary oxalates)
o Limiting sodium and sugar int
ake, which may contribute to
kidney stones at high levels
o Getting the recommended
amounts of vitamin C — too
much can increase oxalic acid
production in your body
HOW SOME METHODS CAN INCREASE
THE OXALATE CONTENT IN FOOD:
∙ Roasting, grilling, baking, low-calcium
diet
∙ Roasting of peanuts, cashews and
almonds did not have any significant
impact on oxalate content
WHAT DOES THE RESEARCH SAY:
∙ Despite the demonization of
oxalate and promotion of a low-
oxalate diet in kidney stone
patients, more recent observational
studies of dietary patterns may
prompt a reevaluation of current
guidelines. Certain segments of
the population do seem to be at
greater risk of increased oxalate
excretion, and consuming oxalate-
rich foods may play a possible role
in kidney stone formation, but other
factors such as food preparation
techniques, calcium intake,
endogenous oxalate production,
and intestinal health may play a
larger role than once thought.
∙ Dietary oxalate is not a major risk
factor for stone formation, while
dietary calcium intake was
inversely associated with kidney
stone formation.
∙ The gut microbiome (oxalobiome),
may play a role in reducing dietary
oxalates. That DOESN’T imply
exogenous use of oxalate-
degrading probiotics will result in
the same. Human trials using
oxalate-degrading probiotics
have been unsuccessful for the
most part.
WORD OF CAUTION ON
MINDLESSLY REMOVING ALL
FOODS CONTAINING OXALATES:
∙ Oxalate containing foods possess
an array of protective, beneficial
compounds which may outweigh
any possible negative effects of
oxalate.
∙ If you’re prone to kidney stones or
have kidney disease, your doctor
may recommend you follow a low-
oxalate diet. However, for most
people, the benefits of nutrient-
dense, high-oxalate foods can
outweigh their risks. 457
4. GOITROGENS
∙ POTENTIAL IMPACT ON
WHAT ARE GOITROGENS? HUMANS – WHY DO
∙ IN PLANTS: GOITROGENS MATTER?

∙ Food plants species in the Cruciferae ∙ When eaten by animals or

(Brassicaceae) family contain humans, goitrogens can inhibit
substances called glucosinolates, which thyroid gland functioning, causing
probably play a role in the plant's enlargement and atrophy of the
defenses against predators and fungal thyroid, or goiter.
attack. ∙ Goitrogens usually exert their
effect after prolonged use and
have greater impact when iodine
∙ RELEVANT DEFINITION TO HUMANS: intakes are low.
o The term ‘goitrogen’ broadly refers to ∙ Some goitrogens act directly on
agents that interfere with thyroid the thyroid gland, while others
function, thus increase the risk of exert their effect indirectly.
goiter and other thyroid diseases. ∙ Infants and young children may be
Sources of these compounds include more susceptible to the effects of
medications, environmental toxins, as goitrogens
well as certain foods.
FOODS HIGH IN GOITROGENS:
∙ KEY NOTE: ∙ Cabbage
o GOITROGEN containing foods are ∙ Bamboo shoots
broadly classified into two ∙ sorghum
categories: CYANOGENIC plant ∙ Broccoli
foods (which are metabolized to ∙ Cauliflower
goitrogens such as : Goitrins, ∙ Rutabaga
Glucosinolates, and ∙ Kohlrabi
Thiocyanates), and flavonoids ∙ Rapeseed
containing plant foods. ∙ Canola
o Cyanogenic glucosides are ∙ Brussels sprouts
GOITROGENS as well as ∙ Cress
CYANOGENS (plant species produce ∙ Mustard greens
hydrogen cyanide (HCN) from ∙ Horse radish
cyanogenic glycosides when they are ∙ Stone fruit juices
consumed; but this section focuses ∙ Alcoholic beverages made from
only its thyroid affecting aspect. stone fruits
o When looking at Cyanogenic
glucosides as a goitrogen, we are not
looking at the effects of cyanide
toxicity caused by it, but, at the
effects caused by the end products of
cyanide detoxification in human
system: THIOCYANATE, GOITRINS,
GLUCOSINOLATES.
458
NOTE ON GOITROGEN CONTENT:
∙ Factors such as soil conditions, weather, growing location, use of plant growth
regulators or pesticides, pathogen challenges, plant stressors, as well as date of
harvest and storage time all can impact goitrogen content

MECHANISMS OF ACTION OF GOITROGENS

∙ Goitrogens can inhibit iodine uptake into the thyroid gland (Thiocynate,
Glucosinosilate) or impair the activity of key enzymes in the synthesis of
thyroid hormones (Flavonoids, Goitrin), and if the thyroid gland has
difficulty synthesizing thyroid hormone, it may enlarge to compensate for
this inadequate hormone production.
∙ Mechanisms of Action of GOITROGENS:

Image source: https://www.sciencedirect.com/science/article/pii/S1043452621000048

459
POSSIBLE HEALTH HAZARDS:
∙ For people with thyroid problems, high
intake of goitrogens can worsen thyroid function
by:
oBlocking iodine: Goitrogens may prevent
iodine from entering the thyroid gland, which is
needed to produce thyroid hormones.
oInterfering with TPO: The thyroid peroxidase
(TPO) enzyme attaches iodine to the amino acid
tyrosine, which together form the basis of thyroid
hormones.
oReducing TSH: Goitrogens may interfere with
thyroid stimulating hormone (TSH), which helps
the thyroid gland produce hormones.
∙ Other than goiter, altered thyroid function can
lead to:
oMental decline
oHeart disease
oWeight gain & Obesity
oDevelopmental delays
oBone fractures
POSSIBLE BENEFITS:
∙ Many nutritional studies have shown that
dietary fruits and vegetables, including those in
the Brassica group, have a protective effect
against certain cancers.
∙ In animal studies, glucosinolates and their
breakdown products have inhibited tumor
formation (although this anti-carcinogenic effect
depends on the study design, the type of cancer
being studied, whether other dietary components
are present, and the timing of the administration
of the glucosinolate compound).
HOW TO REDUCE GOITROGENS IN FOOD:
∙ Processing methods, such as peeling, drying,
grinding, soaking, boiling or cooking,
soaking and fermentation have been reported
by several studies to cause significant reduction
in the cyanogenic glycosides of processed foods
∙ Cooking by boiling will reduce exposure
through leaching of glucosinolates into water and
inactivation of myrosinase
∙ However, steaming, microwaving or stir-frying
results in NO SIGNIFICANT DECREASE in
glucosinolate concentrations
.
∙ For those with thyroid disease, or at
higher risk of thyroid disease, there are
a few simple ways to reduce the risk of
negative effects (58):
olong-term daily intake of progoitrin-rich
items should be cooked with iodized
salt to avoid reduced iodine uptake.
oVary your diet
oBlanch greens
oQuit smoking
oGet enough iodine and selenium
WHAT DOES THE RESEARCH SAY:
∙ Whether or how much the consumption
of Brassica vegetables contributes to ill
health in humans is unknown.
∙ Glucosinolates’ role in inducing goiter
in humans is less clear.
∙ The evidence published thus far
investigating the impacts of dietary
goitrogens is mixed and may be
more complex than initially thought.
Human studies investigating the
effects of dietary goitrogens in
healthy individuals are relatively
sparse. Evidence seems to suggest
that suboptimal iodine status may
potentiate any negative impacts of
dietary goitrogens on thyroid health.
WORD OF CAUTION ON
MINDLESSLY REMOVING ALL
FOODS CONTAINING GOITROGENS:
∙ Foods exist as complex matrix of
compounds, which often have
synergistic effects, that have yet to be
discovered. In this regard, foods
considered to be ‘goitrogenic’ also
contain thousands of other bioactive
compounds that may be protective
against thyroid cancer.
∙ It is important to evaluate the current
evidence of dietary goitrogens on
thyroid and human health, before
eliminating or modifying phytonutrient
rich plant foods from the diet.
460
5. PHYTOESTROGENS
WHAT ARE PHYTOESTROGENS?
∙ IN PLANTS:
oPlants use a phytoestrogen as part of their
natural defence against the overpopulation
of herbivore animals by controlling their
female fertility
These compounds in plants are an
important part of their defense system,
mainly against fungi.
∙ RELEVANT DEFINITION TO HUMANS:
oThese are bioactive compounds can bind
to estrogen receptors (ER), in turn,
modulating estrogenic activity.
oPhytoestrogens are classified into four
phenolic compounds: isoflavones, lignans,
stilbenes, and coumestrol but ISOFLAVONES
& LIGNANS have received much of the
attention, as they are the most relevant with
respect to the human diet.
∙ POTENTIAL IMPACT ON HUMANS – WHY
DO PHYTOESTROGENS MATTER?
∙ Consumption of phytoestrogens can vary
greatly depending on cultural food preferences.
Traditional Asian diets, for example, are
estimated to contain 5-20 times more of
isoflavones (per day) compared to Western
countries. (can be attributed to the long history
of soy products in Asian cuisine)
∙ As phytoesterogens are chemically very
similar to estradiol, they can confuse our
endocrine system leading to reduced
testosterone and increased estrogen.
FOODS HIGH IN PHYTOESTROGENS:
∙ Wheat
∙ Tempeh
∙ Miso soup
∙ Rice
∙ chick-pea
∙ alfalfa
∙ lupin
∙ groundnut
∙ linseed
∙ soybean
∙ Flax seed
∙ Sesame seed
FOODS LOW IN PHYTOESTROGENS:
∙ Fruits, vegetables, nuts, and other
legumes also contain isoflavones,
though in significantly lesser amounts.
∙ Lignans, in general, were found to be
negligible in legumes, fruits, vegetables
and cereals (Exceptions: garlic, olive oil,
winter squash, dried apricots, dried
dates, dried prunes and multigrain
bread)
NOTE ON PHYTOESTROGENS
CONTENT:
POSSIBLE HEALTH HAZARDS:
∙ Babies and infants are at higher risk of
the endocrine-disrupting potential
because of their small size and
underdeveloped digestive tract, but the
biological significance of increased
phytoestrogen exposure in infants is yet
to be determined
POSSIBLE BENEFITS:
∙ Reduced menopausal symptoms (A
recent systematic review and meta-
analysis concluded that phytoestrogen
supplementation resulted in significantly
greater reductions in hot flashes as
compared to placebo, but did not
significantly impact the Kupperman
Index, an index which included 11
symptoms of menopause)
∙ Reduced risk of:
ocardiovascular disease
oobesity
ometabolic syndrome
otype 2 diabetes
ocognitive disorders,
ovarious forms of cancer
461
HOW TO REDUCE PHYTOESTROGENS IN
FOOD:
∙ Dietary phytoestrogen glycosides must first
be transformed to aglycones by glucosidases
before they can be utilized by humans. These can
be hydrolyzed via intestinal glucosides,
intestinal bacterial glucosides, as well as
through various processing methods:
oBoiling
oPressure steaming (most effective)
oFermentation by Lactobacillus and
Bifidobacteria
∙ Consuming traditionally fermented soy products,
such as Korean cheonggukjang, Japanese natto,
and Thai Thua, may further enhance isoflavone
bioavailability, though more human trials are
necessary.
WHAT DOES THE RESEARCH SAY:
∙ Collective findings in adults have not identified
conclusive evidence that soy food or isoflavones
adversely affect thyroid function in euthyroid or
iodine-replete individuals MINERALS.
∙ Thus far, no evidence has demonstrated a link
between phytoestrogen-rich diets and
estrogen-sensitive malignant growths.
∙ Studies investigating the specific potential impact
on female reproductive health are mixed.
∙ In premenopausal women, soy isoflavone
consumption had no effect on circulating
estradiol, estrone or sex hormone binding
globulin (SHBG).
WORD OF CAUTION ON MINDLESSLY
REMOVING ALL FOODS CONTAINING
PHYTOESTROGENS:
∙ The microbial makeup of the gut, bio-individuality,
and the phytoestrogen source all play a significant
role in the decision to include phytoestrogen-rich
foods in one’s diet.
∙ epidemiological and observational data suggests
that including phytoestrogen-rich foods as part of
a varied, plant-based diet should not be of
concern, but may be beneficial. Additionally,
phytoestrogen-containing foods such as legumes,
grains, seeds, nuts, fruits, and vegetables, are rich
sources of essential vitamins, minerals, fiber and
other health-promoting phytochemicals.
6. TANNINS
WHAT ARE TANNINS?
∙ IN PLANTS:
oPlant tannins have toxic or anti-
nutritional effects on herbivores, both
mammals and insects, which can
reduce nutrient digestibility and protein
availability.
∙ RELEVANT DEFINITION TO HUMANS:
oTannins are responsible for the
astringent taste of many fruits and
beverages.
oInhibit the absorption of dietary
minerals such as iron, copper, and zinc
∙ POTENTIAL IMPACT ON HUMANS –
WHY DO TANNINS MATTER?
∙ They can be chemically classified into
two groups: hydrolysable tannins and
condensed tannins.
∙ Condensed tannins, or
proanthocyanidins, on the other hand, are
the most abundant in plant-derived foods.
FOODS HIGH IN TANNINS:
∙ Berries
∙ apples
∙ stone fruit
∙ cocoa
∙ legumes
∙ whole grains
∙ tea
POSSIBLE HEALTH HAZARDS:
∙ Tea, one of the richest sources of dietary
tannins, may inhibit iron absorption when
consumed directly with a nonheme iron-
rich meal. (In a study of healthy adults, iron
absorption was decreased by 37% when
tea was consumed with an iron-fortified
porridge, however, was not affected when
tea was consumed an hour after the meal)
462
POSSIBLE BENEFITS:
∙ Decreased risk of:
o T2DM, metabolic syndrome
o Ischemic stroke
o non-fatal cardiovascular events
o atherosclerotic vascular disease
∙ Inverse associations also existed for
mortality from digestive diseases.
Polyphenols in this population were
mainly derived from beverages such
as green tea and coffee.
∙ Furthermore, flavanol-rich foods, such
as fruits, vegetables, and cocoa
demonstrate positive effects on
cognition, executive function, and
even mood, although exact
mechanisms are yet to be elucidated.
∙ Flavanols may additionally act as
prebiotics, positively influencing the
gut microbiota, in turn alleviating
neuroinflammation and balancing
serotonin metabolism
HOW TO REDUCE TANNINS IN FOOD:
∙ Cooking
∙ Peeling skins of fruits and nuts
HOW SOME METHODS CAN INCREASE
THE TANNIN CONTENT IN FOOD:
∙ Catechin content in tea increases with
the amount of tea used and with
increased infusion time, however
catechin concentrations and
antiradical activity seem to peak at 4–
5 min of brew time
NOTE ON TANNIN CONTENT:
∙ Tannin content in foods and tea
can be influenced by region,
variety, processing methods, and
storage time
∙ Tannin content was found to vary
significantly between agricultural
methods, though not as much as
between plant varieties.
WHAT DOES THE RESEARCH SAY:
∙ factors, such as gender and
baseline iron status, may also
influence the impact of tannins on
iron parameters.
∙ Potential inhibitory effects of
tannins may be offset by the
inclusion of 30 mg of ascorbic acid
∙ A systematic review concluded that
total tannin intake did not interfere
with iron status but did improve
inflammatory biomarkers in
participants
WORD OF CAUTION ON
MINDLESSLY REMOVING ALL
FOODS CONTAINING TANNINS:
∙ Although the ‘anti-nutritional’
effects of tannins are debatable
and highly variable, evidence
supporting the many health
benefits of tannins are widespread.
∙ Overall, evidence suggests that the
many health benefits of consuming
a diverse, plant-based diet, rich in
tannins and bioactive containing
foods and beverages, far
outweighs the potential impact of
tannins on iron status.
463
7. SAPONINS
WHAT ARE SAPONINS?
∙ IN PLANTS:
∙ Saponins are soap-like compounds
found in plants characterized by their
ability to create foam in water.
∙ Many different saponins occur, even
within a single plant species.
∙ All parts of plants contain at least some
saponins. This includes flowers, leaves,
stems, bark, seeds, and fruit. However,
saponins are mostly concentrated in
plant roots.
∙ Plants synthesize and accumulate
saponins during normal growth and
development. But saponin levels often
rise in response to stress such as a
pathogen attack.
∙ RELEVANT DEFINITION TO HUMANS:
∙ They occur in a large number and a wide
variety of plants but only about 28 of
these are regularly used as food by
man.
∙ Not all saponins are created equal
∙ Saponins are responsible for imparting
a bitter taste and astringency to plant
materials containing a high
concentration of saponins.
∙ Saponins are found in many plant-based
foods. But they are also used
commercially in the food, cosmetic, and
pharmaceutical industries.
∙ saponins are the foaming agents in
carbonated beverages and cosmetics.
They also act as flavor modifiers for
baked goods, beverages, chewing gum,
candies, herbs, seasonings, and dietary
supplements.
∙ POTENTIAL IMPACT ON HUMANS –
WHY DO SAPONINS MATTER?
∙ Saponins have hemolytic (destruction of
RBCs with liberation of
hemoglobin) properties when given
intravenously
∙ They form insoluble saponin–
mineral complexes with iron,
zinc, and calcium.
∙ The ability to behave like a
detergent is due to their chemical
structure, with one end binding
easily to water and the other to
cholesterol and fat. (Similar to how
an emulsifier acts when you shake
up a bottle of salad dressing, this
ability to bridge between two polar
opposite types of molecules (e.g.
oil and water), enables saponins to
interact very easily with the
molecules on the surfaces of cell
membranes.)
∙ Saponins’ amphiphilic (with
affinity to water as well as fat)
structure allows them to latch
on to cholesterol molecules
attached to the surface of
intestinal cells. Once they
attach, they stimulate a reaction
(The release of hemoglobin from
red blood cells which causes an
increase in the permeability of
the plasma membrane) that
creates pores in the cell surface
, producing increased
permeability (i.e. leaky gut) and
allowing substances to enter the
bloodstream.
FOODS HIGH IN SAPONINS:
∙ kidney bean
∙ chickpea
∙ soybean
∙ groundnut
∙ lupin
∙ sunflower
∙ lucerne (alfalfa) sprouts
∙ navy beans
∙ haricot beans
∙ kidney beans
∙ licorice root
464
POSSIBLE HEALTH HAZARDS (59):
∙ Saponin in potatoes (Glycoalkaloids)
accumulate in potato tubers in
response to insect damage and also
during post-harvest deterioration after
exposure to light or as a result of
physical damage. Consumption of
potatoes containing elevated levels of
these glycoalkaloids can result in
vomiting, diarrhoea, disorientation and
death.
∙ People with the following diseases
may be more susceptible to saponin
triggered red blood cell death (64):
• Type 2 diabetes
• Renal insufficiency
• Hemolytic uremic syndrome
• Sepsis
• Malaria
• Sickle cell disease
• Wilson’s disease
• Iron deficiency
• Malignancy
• Metabolic syndrome
• Phosphate depletion
POSSIBLE BENEFITS (59):
∙ Ginseng (Ginsenoside- a saponin, is
the major bioactive compound in it),
the roots of which are widely used in
traditional Chinese medicine, has
multiple pharmacological properties,
including anti-tumour,
immunomodulatory and
neurological activity
∙ Saponin in liquorice (Glycyrrhizin) has
antiviral activity and is used in the
treatment of hepatitis. Glycyrrhizin is
also active against the HIV and
SARS viruses and in addition has
anti-inflammatory,
immunomodulatory, and anti-ulcer
activity.
∙ Plants rich in saponins, like ginseng or
licorice, have been used for medicinal
purposes since ancient times and to
date continue to play a significant role
not only in medicine but also in food
and cosmetic industry, where they are
utilized as emulsifiers or sweeteners.
∙ Saponins from the Australian desert
tree Acacia victoriae (Avicins) have
anti-tumour activity and are used in
the treatment of cancer. Avicins
have a range of physiological effects
in mammalian cells including
induction of apoptosis,
suppression of inflammatory
responses, inhibition of cell
proliferation and prevention of
mutagenesis caused by
environmental toxins all of which
may contribute to the anti-cancer
properties of this compound.
∙ An important adjuvant (a substance
which enhances the body's immune
response to an antigen) used to
improve the effectiveness of
vaccines is a saponin. (Derived from
the bark of the South American tree
Quillaja saponaria, known as QS21)
∙ Saponins ingested as part of the
human diet have been linked with a
variety of effects on health, including
reducing blood cholesterol levels
∙ Both tomato and potato steroidal
glycoalkaloids have antiproliferative
effects against human cancer cell
lines in vitro and have also been
shown to act as chemosensitisers,
increasing the effectiveness of
chemotherapeutic drugs
∙ A high saponin diet can be used in the
inhibition of dental caries and
platelet aggregation, in the
treatment of hypercalciuria in
humans, and as an antidote against
acute lead poisoning. (61)
465
HOW TO REDUCE SAPONINS IN FOOD
(62): WORD OF CAUTION ON
∙ Dehulling of seeds + Soaking + MINDLESSLY REMOVING ALL
pressure cooking: lowers the FOODS CONTAINING SAPONINS:
content of saponins to a maximum ∙ As saponins have low oral toxicity
extent and the potentially useful nutritive
∙ Dehulling of seeds + soaking + value in foods, if you are a healthy
ordinary cooking individual, it makes no sense to
∙ Dehulling of seeds + soaking toss saponin containing foods from
∙ Germination your diet.
∙ A study says “Saponins were not
destroyed by processing or cooking.
They were present in falafels
(prepared from chickpeas), canned
baked beans, canned broad beans
and protein isolate from faba beans”
(63)

WHAT DOES THE RESEARCH SAY:

∙ Tomatine (saponin in tomatoes) is not
so toxic to humans as the potato
glycoalkaloids (saponin in potatoes).
∙ One research review concluded (in
regards to soy saponins versus non-
food saponins) that “most of the
available data indicate that these
compounds are very poorly absorbed
following oral administration to
animals and humans.” (60)
∙ Saponins, such as those found in
soy, do not seem to exert the same
harmful effects. This certainly makes
sense when you consider we don’t
inject soybeans into our veins, but
rather allow them to take the normal
route through our digestive system
∙ Most of the research remains
inconclusive regarding the negative
effects of saponins on humans
∙ Research shows that saponins have
mixed results on fertility in humans.

466
 Summary

Antinutrient Food source Clinical Implication Food prep method Food Prep
that reduces it method that
increases it
Lectins Legumes, cereal Altered gut function; Soaking, boiling, Roasting, baking
grains, seeds, nuts, inflammation autoclaving,
fruits, vegetables germination,
Can interfere with the fermentation
absorption of calcium, iron,
phosphorus, and zinc.

Oxalates Spinach, Swiss May inhibit calcium Soaking, boiling, Roasting, grilling,
chard, sorrel, beet absorption; May increase steaming, pairing baking, low-
greens, beetroot, calcium kidney stone with high calcium calcium diet
rhubarb, nuts, formation foods
legumes, cereal
grains, sweet, tea
potatoes, potatoes
Phytates Legumes, cereal May inhibit the absorption Soaking, boiling, NA
grains, pseudocereals of iron, zinc, magnesium, germination,
(amaranth, quinoa, and calcium; fermentation
millet), nuts, seeds
+ve effect: Acts as an
antioxidant; Antineoplastic
effects

have been found to lower

cholesterol, slow digestion,
and prevent sharp rises in
blood sugar.
Goitrogens / Brassica vegetables Hypothyroidism and/or Steaming, boiling NA
Glucosinolates (kale, Brussels goiter; Inhibit iodine uptake
sprouts, cabbage, that can lead to impaired
turnip greens, thyroid function, and goitre.
Chinese cabbage,
broccoli), millet,
cassava
Phytoestrogens Soy and soy Endocrine disruption; NA Boiling, steaming,
products, flaxseeds, Increased risk of estrogen- fermenting
nuts (negligible sensitive cancers (increases
amounts), fruits and aglycone content)
vegetables (negligible
amounts)
Tannins Tea, cocoa, grapes, Inhibit iron absorption; Cooking, peeling NA
berries, apples, stone Negatively impact iron skins of fruits and
fruits, nuts, beans, stores nuts
whole grains
Saponins legumes, whole can interfere with normal 467
grains nutrient absorption
References:
• Red kidney bean poisoning in the UK: an analysis of 50 suspected incidents between 1976
and 1989
• New research highlights: Impact of chronic ingestion of white kidney beans Phaseolus
vulgaris L. var. Beldia) on small-intestinal disaccharidase activity in Wistar rats.
• Reaction of Lectin-Specific Antibody with Human Tissue: Possible Contributions to
Autoimmunity.
• Structure-function and application of plant lectins in disease biology and immunity.
• Bioactive Compounds from Mexican Varieties of the Common Bean (Phaseolus vulgaris):
Implications for Health.
• Consumption of a legume-enriched, low-glycemic index diet is associated with biomarkers of
insulin resistance and inflammation among men at risk for colorectal cancer.
• Phytate, iron, zinc, and calcium content of common Bolivian foods and their estimated
mineral bioavailability.
• Dietary phytate, zinc and hidden zinc deficiency.
• Distribution of phytase activity, total phosphorus and phytate phosphorus in legume seeds,
cereals and cereal by-products as influenced by harvest year and cultivar.
• Cereal phytases and their importance in improvement of micronutrients bioavailability.
• Effects of soaking whole cereal and legume seeds on iron, zinc and phytate contents.
• Changes in phytates and HCl extractability of calcium, phosphorus, and iron of soaked,
dehulled, cooked, and sprouted pigeon pea cultivar
• Moderate decrease of pH by sourdough fermentation is sufficient to reduce phytate content
of whole wheat flour through endogenous phytase activity.
• Fermentation of pseudocereals quinoa, canihua, and amaranth to improve mineral
accessibility through degradation of phytate.
• Increased iron bioavailability from lactic-fermented vegetables is likely an effect of promoting
the formation of ferric iron
• Phytic Acid: From Antinutritional to Multiple Protection Factor of Organic Systems.
• Total Iron Bioavailability from the US Diet Is Lower Than the Current Estimate.
• Iron absorption in man: ascorbic acid and dose-dependent inhibition by phytate.
• Effect of different cooking methods on vegetable oxalate content.
• https://www.webmd.com/diet/foods-high-in-phytic-acid
• https://riordanclinic.org/2017/11/lectins-food-inflamed tired/?gclid=CjwKCAiA5t-
OBhByEiwAhR-hmwPBDuHfAs6zaORazkytzVwApkEja-
LfxlCQk1REVBvUI2MngkawjxoClrkQAvD_BwE
• https://doi.org/10.3390/toxins11010018
• https://doi.org/10.1007/s00394-012-0377-6
• https://www.uofmhealth.org/health-library/aa166321
• https://www.healthline.com/nutrition/goitrogens-in-foods
• https://link.springer.com/chapter/10.1007/978-1-4614-4063-5_28
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928447/
• https://pubmed.ncbi.nlm.nih.gov/15117556/
• https://pubmed.ncbi.nlm.nih.gov/11225178/
• https://onlinelibrary.wiley.com/doi/abs/10.1002/jsfa.2740340212
• https://www.researchgate.net/publication/263100867_Effect_of_saponin_on_erythrocytes

468
10.5 Comparative Analysis of
∙ Health professionals should offer a
Various Diet Methodologies
broad spectrum of diet options to
better match an individual’s food
1. Anti-Inflammatory
preferences and lifestyle. (3)
2. Keto
∙ Dietary adherence is the key to
3. IF
long-term success.
4. Mediterranean
∙ Moderate certainty evidence
5. South Beach
shows that most macronutrient
6. Raw Food
diets, over six months, result in
7. Vegetarian
modest weight loss and
8. Vegan
substantial improvements in
9. FODMAP
cardiovascular risk factors,
particularly blood pressure. At
Points of comparison:
12 months the effects on weight
∙ What is it
reduction and improvements in
∙ Salient Features
cardiovascular risk factors
∙ Weight of Evidence
largely disappear.
∙ Where it can be particularly useful
https://www.bmj.com/content/369/b
∙ Popular myths
mj.m696
∙ Deficiencies and Shortcomings
∙ Based on the available
∙ Overall Summary
literature, there is insufficient
evidence at present to expect
General Conclusions/Comments for all
any greater or lesser true inter-
the diets:
individual variation in body
∙ Reduced dietary adherence over 12
mass change in response to
months. (1)
low-carbs versus low-fat dietary
∙ Subconscious increase in calories
interventions.
from circumventing rules imposed by
https://onlinelibrary.wiley.com/doi/10.
dietary restriction:
1002/oby.22968
∙ Large discrepancies in the reporting of
∙ A high-fat, high-protein diet is
energy intake and expenditure in
associated with a less diverse
overweight individuals: individuals
microbiome that includes bacteria
underreported food intake by 47 ±
which degrade the mucous layer of
16% (1053 kcal/d) and overestimated
the intestine and release
energy expenditure from physical
compounds implicated in the
activity by 51 ± 75% (251 kcal/d) (2) It
pathogenesis of gastrointestinal
is important to note that such
diseases such as colorectal
individuals are not actively being
cancer. (27)
dishonest. The misreporting is a
product of the quirks of human
behaviour. Specifically, Hall and
Kahan note: “…it is entirely possible
that patients truly believe they are
sticking with their diet despite not
losing any more weight or even
regaining weight.”

469
∙ While most studies of low-
carbohydrate diets showed more Anti-Inflammatory Diet:
rapid rate loss at first, studies
found that the difference after 6 WHAT IS INFLAMMATION & IS ALL
months was not substantial. INFLAMMATION BAD?
https://iubmb.onlinelibrary.wiley.com/doi
“Inflammation is the body’s
/10.1002/bmb.2005.494033022445
response to microbial, autoimmune,
∙ Key challenges faced by individuals
metabolic or physical insults,”
attempting to maintain weight loss are
including burns and physical trauma,
(4)
said Hawiger, Distinguished
∙ Appetite changes: “…it has been
Professor of Medicine and Louise B.
estimated that for each kilogram of
McGavock Professor.
lost weight, calorie expenditure
White blood cells, including
decreases by about 20 to 30 kcal/d,
granulocytes and macrophages, are
whereas appetite increases by about
the “first responders” to sites of
100 kcal/d above the baseline level
infection and injury. They emit waves
before weight loss.” (5)
of chemicals that can kill germs
∙ Subconscious biases: “…signals to
outright, and protein messengers
the brain that increase appetite with
called cytokines to carry out a
weight loss could introduce
bewilderingly wide array of duties.
subconscious biases, such as portion
When these weapons misfire,
sizes creeping upwards over time.
however, they can wreak havoc. They
Such a slow drift upwards in energy
can even kill. (SOURCE:
intake would be difficult to detect given
https://medschool.vanderbilt.edu/van
the large 20% to 30% fluctuations in
derbilt-medicine/the-good-the-bad-
energy intake from day to day (6).”
and-the-ugly-of-inflammation/ )
∙ Increased calorie intake: “…the
exponential increase in calorie intake
There are primarily 2 Types of
from its initially reduced value is the
Inflammations:
primary factor that halts weight loss
1. Acute: The response to sudden
within the first year.”
body damage, such as cutting
your finger. To heal the cut, your
body sends inflammatory cells
to the injury. These cells start
the healing process.
2. CHRONIC: our body continues
sending inflammatory cells even
when there is no outside
danger.

470
IS INFLAMMATION ALWAYS BAD?
The short answer is no - ACUTE
INFLAMMATION IS GENERALLY GOOD
FOR YOU - BUT CHRONIC
INFLAMMATION IS OFTEN AN ISSUE.
Inflammation actually is good in the
short run. It's part of your immune
system's natural response to heal an
injury or fight an infection. It's
supposed to stop after that. But if it
becomes a long-lasting habit in your
body, that can be bad for you (SOURCE:
Google)
WHY IS INFLAMMATION BAD?
When you're living with chronic
inflammation, your body's inflammatory
response can eventually start damaging
healthy cells, tissues, and organs. Over
time, this can lead to DNA damage,
tissue death, and internal scarring. All
of these are linked to the development
of several diseases, including: cancer
(SOURCE: GOOGLE).
EXAMPLE OF GOOD INFLAMMATION:
For instance, the inflammation you
experience post a Strength Resistance
Training (SRT) Workout is good for
Hypertrophy - as it is an integral part of
the Adaptive Response triggered by
your workout to elicit Hypertrophy in
your muscles. So suppressing that, by
taking Anti Oxidants - or by other means
is not the best thing to do, if
Hypertrophy is your goal.
EXAMPLE OF BAD INFLAMMATION:
However, not all Acute (Short Term)
inflammation is good. A good example
of this would be, the inflammation you
suffer when you have high fever.
On the other hand, the inflammation
that lasts for a longer duration can
be harmful. A classic example of
harmful Chronic inflammation would
be Rheumatoid Arthritis (a chronic
progressive disease causing
inflammation in the joints and
resulting in painful deformity and
immobility, especially in the fingers,
wrists, feet, and ankles.)
- In RA inflammatory cells and
substances attack joint tissues
leading to an inflammation that
comes and goes and can cause
severe damage to joints with pain
and deformities
WHEN CAN INFLAMMATION
BECOME HARMFUL?
∙ Inflammation becomes harmful
when it is prolonged. Reasons:
o Genetic deviants cause the
body’s immune system to
constantly attack cells. E.g.
autoimmune disorders like
lupus, fibromyalgia,
multiple sclerosis,
rheumatoid arthritis, type-1
diabetes, and Crohn’s
disease.
o Unhealthy lifestyle from lack
of exercise, high stress, and
calorie-rich diets can trigger
chronic low levels of
inflammation throughout
the entire body, termed
metaflammation. This type
of low-grade inflammation
does not usually produce
noticeable symptoms, but
over time metaflammation
can pave the pathway for
chronic conditions like
cardiovascular disease, non-
alcoholic fatty liver disease,
type 2 diabetes, Alzheimer’s
disease, and certain cancers
(e.g., breast, colon). 471
WHAT ARE SOME OF THE COMMON
CONDITIONS ASSOCIATED WITH CHRONIC
INFLAMMATION?
∙ Rheumatoid arthritis
∙ Psoriasis
∙ Asthma
∙ Eosinophilic esophagitis
∙ Crohn’s disease
∙ Colitis
∙ Inflammatory bowel disease
∙ Lupus
∙ Hashimoto’s thyroiditis
ARE THERE ANY TESTS TO TEST/MEASURE
INFLAMMATION?
Yes there are tests to Test/Measure
Inflammation
∙ ESR
∙ CRP -
∙ IL 6 - One of the more common tests for
Covid, along with CRP & ESR.
∙ D DIMER - One of the more common
tests for Covid, along with CRP & ESR.
(It is not a Direct Inflammation marker,
however it’s increase can suggest there is
likely increased inflammation in the body)
NOTE: All inflammation tests need EXPERT
INTERPRETATION & ARE OFTEN DONE IN
CONJUNCTION WITH OTHER TESTS & THEN
NECESSARY CONCLUSIONS ARE DROWN
∙ . Aimed at minimizing inflammation - WHAT
DOES THIS MEAN - WHAT IS AIMED
AT?
∙ Research on its exact mechanism is not
conclusive. - WHAT IS “its” here?
∙ Does not follow strict rules about calories or
portion sizes. - WHAT DOES NOT
FOLLOW STRICT RULES?
∙ It suggests a variety of anti-inflammatory
foods to eat daily, rather than focusing on
eating one or two specific foods or
nutrients. - WHAT IS “it” here? Are we
talking about Anti -Inflammatory diet
here?
∙ Anti-inflammatory foods provide
plant chemicals (phytochemicals),
antioxidants, and fiber that prevent
cellular stresses, inhibit
inflammatory signals caused by the
immune system, promote
healthy gut microbiota, and slow
down digestion to prevent surges
in blood glucose. (7) They may
also favorably affect the
composition of fat cells to further
reduce inflammation.
∙ Eat: Fruits, Vegetables, High-fiber
whole grains, Legumes,
Monounsaturated fats (avocados,
olive oil, nuts, nut butters, seeds),
Polyunsaturated omega-3 fats
(walnuts, flaxseeds, chia seeds,
and aquatic foods including
salmon, herring, sardines,
mackerel), Tea, Coffee, Dark
chocolate with at least 70% or
higher cocoa solids, Herbs, spices
(turmeric, ginger), Moderate
amounts of alcohol (wine, beer),
Examples of inflammatory foods to
limit:
∙ In moderation: red meat, dairy,
high-fat meats like bacon,
sausage, hot dogs
∙ Avoid: Corn/veg oil, processed
foods and beverages, excess
alcohol
∙ The Mediterranean diet and DASH
diet are popular dietary plans that
already showcase many anti-
inflammatory foods.
472
∙ Pros:
o Curbs chronic inflammation
thereby reducing symptoms, and
sometimes preventing many
diseases. E.g. although
research is limited, it may also
help to lower inflammatory
markers in individuals with
autoimmune-type inflammation
such as with rheumatoid
arthritis.
o Promotes healthy eating.
o Not too restrictive.

∙ Cons:
o Some foods may contain
allergens (ironically). Can be a
bit complicated and potentially
costly.
o The anti-inflammatory diet is
flexible in that it does not include
rigid meal plans. However, this
requires people to plan their own
meals and find recipes
incorporating foods on the plan.
People who are not used to
meal planning or cooking may
need more specific guidance.
o Calorie levels and portion sizes
are not highlighted on this plan,
so it is possible to gain weight if
excessive portions are
consumed.

473
Keto
WHAT IS IT?
It is a low-carbohydrate, fat-rich eating
plan. Other low-carb diets (Paleo, South
Beach, and Dukan) are all high in
protein but moderate in fat. In contrast,
the ketogenic diet has exceptionally
high-fat content, (70-80%), though with
only a moderate intake of protein.
HISTORY:
∙ It has been used for centuries to treat
specific medical conditions.
∙ In the 19th century, the ketogenic diet
was commonly used to help control
diabetes.
∙ In 1920 it was introduced as an
effective treatment for epilepsy in
children in whom medication was
ineffective.
∙ It has also been tested and used in
closely monitored settings for cancer,
diabetes, polycystic ovary syndrome,
and Alzheimer’s disease.
∙ However, this diet is gaining
considerable attention as a potential
weight-loss strategy due to the low-
carb diet craze, which started in the
1970s with the Atkins diet (a very low-
carbohydrate, high-protein diet, which
was a commercial success and
popularized low-carb diets to a new
level).
THE DIET:
1. There is not one “standard”
ketogenic diet with a specific ratio
of macronutrients.
2. The ketogenic diet typically
reduces total carbohydrate
intake to less than 50 grams and
can be as low as 20 grams a
day.
3. General distribution:
o FAT: 70-80% fat
o CARBS: 5-10%
o PROTEIN: 10-20%
4. The protein amount on the
ketogenic diet is kept moderate in
comparison with other low-carb
high-protein diets, because amino
acids in protein can be converted
to glucose, so a ketogenic diet
specifies enough protein to
preserve lean body mass
including muscle, but that will
still cause ketosis.
5. Most ketogenic plans allow foods
high in saturated fat, such as fatty
cuts of meat, processed meats,
lard, and butter, as well as sources
of unsaturated fats, such as nuts,
seeds, avocados, plant oils, and
oily fish.
6. Many keto programs suggest
following a ketogenic diet until the
desired amount of weight is lost.
When this is achieved, to prevent
weight regain one may follow the
diet for a few days a week or a few
weeks each month, interchanged
with other days allowing a higher
carbohydrate intake.
474
TYPES OF KETO DIETS:
Traditional Ketogenic Diet (4:1)
o Macro ratio: 4:1 ratio
For every 4 grams of fat, you
can only eat 1 gram of
protein plus carbohydrate
(29).
Fat: 80%
Protein & Carbs: 20%
o The traditional Keto diet (or
classic Keto diet) was first
developed in the 1920’s as a
treatment for childhood
epilepsy. Researchers noticed
that as children went deeper into
ketosis, they experienced fewer
and less severe seizures.
o Requires the involvement of a
dietitian, who will make dietary
recommendations based on
individual characteristics such
as age, weight, physical activity
culture, and food preferences.
o The energy requirements for a
child following the ketogenic diet
is typically 10-20% less than
recommended daily amounts,
due to the high-density energy in
the fats that make up the
majority of the diet. The ratio of
fat to carbohydrates and protein
combined is approximately 4:1
but may be lower for young or
obese children.
o A typical meal on the classic
ketogenic diet consists of
heavy whipping cream,
protein-rich food such as
meat, low-carbohydrate
vegetable, and fats such as
butter or vegetable oil. Fruit
and vegetables that are high
in carbohydrates, such as
bananas, potatoes, peas,
and corn, are not included in
the diet.
o It is worth noting that the
classic ketogenic diet is
not balanced as it includes
very few portions of fruits,
vegetables, cereals, and
sources of calcium. As a
result, supplementation is
required to compensate for
this, which usually
includes multivitamin,
calcium, and vitamin D
supplements.
o Traditional Keto is great for
boosting ketone levels, but
it’s excruciatingly
restrictive.
o Best suited for therapeutic
purposes.
o A practitioner might
recommend this diet:
For the management of
epilepsy
As an adjuvant for certain
types of cancer (30)
To ameliorate
neurodegenerative
disease (31)
475
2. Standard ketogenic diet (SKD)
o Macronutrient ratio:
1. Fat: 75%
2. Protein: 15-20%
3. Carbs: 5-10%
o On the standard keto diet, you
plan all meals and snacks
around fat like avocados, butter,
ghee, fatty fish and meats,
olives and olive oil.
o You need to get about 150
grams a day of fat (the amount
in nearly ¾ cup of olive oil and
three times what you are likely
eating now) in order to shift your
metabolism so it burns fat as
fuel.
o At the same time, you need to
slash your carbs from about
300+ grams per day to no
more than 50 (which is about
the amount found in just one
blueberry muffin).
o That means sticking to leafy
greens, non-starchy veggies,
and low-carb fruits like
berries and melon.
o Finally, you'll eat a moderate
amount of protein, which is
about 90 grams per day or 30
grams at each meal (think 4
ounces of meat, fish, or poultry).
3. Medium-chain triglyceride (MCT)
variant
o MCTs generate more
ketones per unit of energy
than the long-chain
triglycerides that are present
in normal dietary fat.
o Therefore, a diet rich in
MCTs can have a lower
proportion of fat and more
protein and carbohydrates
while still producing the
same effect.
o This is preferable, as
individuals can have greater
variety in their diet while also
slightly increasing their
portion sizes.
o Caution in using high
quantities of MCT oil must be
practiced, as adverse effects
such as abdominal cramping,
diarrhea, and vomiting have
been reported in high doses.
o Approximately 45% of MCT
oil is considered to be a good
balance in the response and
risk of side effects.
476
4. Targeted keto diet (TKD)
o Macronutrient ratio:
Fat: 65-70%
Protein: 20% protein
Carbs: 10-15%
o The targeted keto diet is popular
among athletes and active
individuals who live a keto lifestyle
but need more carbs.
o It allots an additional 20-30 grams
of carbs immediately before and
after workouts to allow for higher-
intensity exercise and enhanced
recovery.
o The total carb count comes to 70-80
grams per day.
o The best options include fruit, dairy or
grain-based foods, or sports nutrition
products. Because the additional
carbs are readily burned off, they
don't get stored as body fat.
4. Cyclical keto diet (CKD)
o Macronutrient ratio on Keto Days:
Fat: 75%
Protein: 15-20%
Carbs: 5-10%
o Macronutrient ratio on Off Days:
Fat: 25%
Protein: 25%
Carbs: 50%
o Keto cycling is a way to cycle in and
out of ketosis while enjoying a
more balanced diet on your "days
off."
o One keto cycling approach includes
five days of traditional keto diet and
two non-keto days per week.
o Some people choose to save their off
days for special occasions, holidays,
birthdays, and vacations. For best
results, eat wholesome carbohydrate-
rich foods on your off days, including
fruits, starchy veggies, dairy
products, and whole grains (rather
than added sugars or highly-
processed fare).
6. High-Protein Keto Diet (HPKD)
o Macronutrient ratio:
Fat: 60-65%
Protein: 30% protein
Carbs: 5-10%
o 120 grams of protein per day
(or four 4-ounce servings of
meat, fish or poultry) and around
130 grams of fat per day.
o Carbs are still restricted to
less than 10% of daily
calories.
o easier to follow, because it
allows you to eat more protein
and less fat than the standard
keto diet.
o The caveat is that this approach
may not result in ketosis,
because like carbs, protein can
be converted into glucose for
fuel.
o But the high-protein keto diet will
generally result in weight
loss.
6. Modified Atkins diet (MAD)
o Macro Ratio:
1. Fats: 50%
2. Carbs & Proteins: 50%
o This variant is based on the
Atkins diet and stems from the
discovery that the induction
phase of the Atkins diet was
reported to help in the control of
epileptic seizures in 2003.
o The diet was then modified
with the aim to extend the
induction phase, which
involved higher fat intake
than a normal, balanced diet.
o Children following this diet
therefore generally require
less support from a dietician.
o Dietary supplements are still
required, however, to ensure
children receive essential
vitamins and minerals.
477
7. Low glycemic index treatment
(LGIT)
o Less limiting
o Based on the stabilization of
blood glucose levels.
o The concept that
carbohydrate restriction and
increased fat consumption in
the diet is thought to be
involved in the mechanism of
action of the ketogenic diet is
extrapolated to reduce seizure
by controlling blood glucose
levels.
o The restriction is based on the
type of carbohydrates, which
should have a glycemic index
lower than 50.
o Intake of fat remains high (60%)
o But more carbohydrates are
allowed than in other variants
such as the classic or Atkins
diet.
9. Well Formulated Ketogenic Diet
(WFKD)
o The term WFKD comes from
Steve Phinney, one of the
leading researchers into
ketogenic diets.
o similar to standard ketogenic
diet
o Well formulated means that the
macronutrients of fat, protein
and carbohydrate meet the
ratios of the standard ketogenic
diet and therefore provide the
best chance of ketosis
occurring.
HOW DOES IT WORK (FOR WEIGHT
LOSS)?
Premise: If you deprive the body of
glucose (the main source of energy for all
cells in the body, which is obtained by
eating carbs), an alternative fuel called
ketones is produced from stored fat (thus,
the term “keto”-genic).
THE PROCESS:
1. The brain demands the most glucose
in a steady supply, about 120g daily,
because it cannot store glucose.
During fasting, or when very little
carbohydrate is eaten, the body first
pulls stored glucose from the liver
and temporarily breaks down
muscle to release glucose.
2. If this continues for 3-4 days and
stored glucose is fully depleted, blood
levels of insulin decrease (as the
insulin requirement comes down),
which leads to resolution of insulin
resistance and reduction in insulin
secretion.
3. Low insulin levels also lead to
reduced lipogenesis and increased
lipolysis, both of which reduce fat
accumulation and the body begins to
use fat as its primary fuel.
4. Continued carbohydrate starvation
leads to the inability of usual metabolic
pathways (the Krebs cycle) to
provide adequate glucose supply to
the central nervous system (CNS).
(11)
5. To maintain CNS health, the liver kick-
starts a process of ketogenesis.
6. The liver produces ketone bodies
from fat, which can be used in the
absence of glucose. (10)
7. When ketone bodies accumulate in
the blood, this is called ketosis.
Healthy individuals naturally
experience mild ketosis during periods
of fasting (e.g., sleeping overnight)
and very strenuous exercise.
478
8. High levels of ketones cannot be
metabolized fast enough and ketone
levels rise in the circulation, leading to
ketonemia and ketonuria.
9. Rise in ketone levels → Excretion of
acetone, a volatile ketone body,
through the lungs, causes the sickly-
sweet odor of ketosis. Once ketone
bodies achieve a blood concentration
similar to that of glucose (4 mmol/l;
80 mg% glucose), they can be
transported preferentially, across the
blood brain barrier, into the brain.
Here, they are a more efficient source
of energy. (12)
10. Proponents of the ketogenic diet state
that if the diet is carefully followed,
blood levels of ketones should not
reach a harmful level (known as
“ketoacidosis”) as the brain will use
ketones for fuel, and healthy
individuals will typically produce
enough insulin to prevent excessive
ketones from forming (insulin prevents
overproduction of ketones).(13).
11. How soon ketosis happens and the
number of ketone bodies that
accumulate in the blood is variable
from person to person and depends
on factors such as body fat
percentage and resting metabolic rate
(14).
12. KD’s weight reduction is thought to
be mediated by a reduction in
hunger (general and protein
specific) and an increase in energy
expenditure (resting and
postprandial). (15)
13. Lipogenesis is reduced; lipolysis
increased. Gluconeogenesis, which
occurs in KD, has an increased
metabolic cost and leads to use of
body fat stores. (16)
14. KD-induced weight loss is
accompanied by a mitigation of
increase of circulating ghrelin. This
helps avoid hunger and cravings and
contribute to maintenance of weight
loss. (17)
THE RESEARCH:
∙ The ketogenic diet has been
shown to produce beneficial
metabolic changes in the short-
term.
∙ Along with weight loss, health
parameters associated with
carrying excess weight have
improved, such as insulin
resistance, high blood pressure,
and elevated cholesterol and
triglycerides. (13, 18) However,
these effects after one year when
compared with the effects of
conventional weight loss diets are
not significantly different. (19)
∙ A ketogenic diet has been shown
to provide short-term benefits in
some people including weight loss
and improvements in total
cholesterol, blood sugar, and blood
pressure.
∙ Several theories exist as to why
the ketogenic diet promotes weight
loss, though they have not been
consistently shown in research:
(13, 20, 21)
∙ A satiating effect with decreased
food cravings due to the high-fat
content of the diet.
∙ A decrease in appetite-stimulating
hormones, such as insulin and
ghrelin, when eating restricted
amounts of carbohydrate.
∙ A direct hunger-reducing role of
ketone bodies—the body’s main
fuel source on the diet.
∙ Increased calorie expenditure due
to the metabolic effects of
converting fat and protein to
glucose.
∙ Promotion of fat loss versus lean
body mass, partly due to
decreased insulin levels.
479
∙ “The data has shown that consuming
a higher percentage of calories from ATHLETIC PERFORMANCE AND
fat does not lead to greater net fat KETO (WHEN FAT LOSS IS NOT
loss, and that very high fat eating YOUR ONLY GOAL!):
plans such as a ketogenic diet do not Fats are not the best energy source
produce any unique metabolic for athletic performance. Carbs are!
advantages.” (22) So, why carbs are important for
∙ A meta-analysis of 13 randomized training? (Strength as well as
controlled trials (though extensive endurance)
research exists on the use of the ∙ Maintain high rates of
ketogenic diet for other medical carbohydrate oxidation
conditions, only studies that examined ∙ Reduce ratings of perceived
ketogenic diets specific to obesity or exertion
overweight were included in this list) ∙ Increase endurance capacity
following overweight and obese ∙ Delay the onset of fatigue
participants for 1-2 years on either ∙ Prevent hypoglycemia
low-fat diets or very-low-carbohydrate ∙ HIIT exercise capacity is
ketogenic diets found that the consistently improved with
ketogenic diet produced a small but adequate carbohydrate intake.
significantly greater reduction in When you choose types of carbs,
weight, triglycerides, and blood you want to choose those that
pressure, and a greater increase in result in high rates of oxidation.
HDL and LDL cholesterol compared Carbs are important for different
with the low-fat diet at one year. (23). team sports for different reasons:
BUT, at two years, the authors
acknowledged the small weight loss
difference between the two diets of Sport Why Carbs are
about 2 pounds, and that compliance important
to the ketogenic diet declined over Strength + To Maintain short
time, which may have explained the Power Field energy bursts
more significant difference at one Sports
year but not at two years. Endurance To maintain glycogen
∙ Available research on the ketogenic Field Sports stores
diet for weight loss is still limited. Battling To maintain blood
Most of the studies so far have had a Sports glucose
small number of participants, were for attention & decision
short-term (12 weeks or less), and did
making
not include control groups.
Court Sports To maintain glycogen
over time
Source: Table is made from
information from a study (28)

480
∙ ‘Essential’ is not the same as
‘Optimal’:
‘Carbs aren’t essential’ is usually
misinterpreted as carbs aren’t needed.
That’s far from the truth, as we need
carbs for optimum health, and that’s the
goal of most people when they want to
change their dietary habits and start
training.
Essential in the above statement only
means that its unavailability doesn’t lead
to cell death. But very low or no carb
intake is still is detrimental to health!
Also, in scientific literature, ‘essential’
means something that CANNOT be
produced by the body. And by that
definition, if we do not consume ANY
carbs at all, body will go through
gluconeogenesis to produce required
amount of glucose, essential for
SURVIVAL, but not enough to THRIVE!
PROS:
∙ In conjunction with weight loss, we
observed altered skeletal muscle
mitochondrial function and
efficiency, an effect that may
contribute to the therapeutic use of
ketogenic diets in various clinical
conditions, especially those
associated with insulin resistance.
(24)
∙ Ketogenic diets reduce seizure
frequency in some individuals with
drug-resistant epilepsy. (25)
∙ Ketogenic diets can also lower
blood glucose, although their
efficacy typically wanes within
the first few months. (25)
481
CONS:
∙ Challenging to maintain
∙ Possible symptoms of extreme
carbohydrate restriction that may last
days to weeks include hunger,
fatigue, low mood, irritability,
constipation, headaches, and brain
“fog.” Though these uncomfortable
feelings may subside, staying satisfied
with the limited variety of foods
available may present new
challenges.
∙ Some negative side effects of a long-
term ketogenic diet:
o Increased risk of kidney
stones
o Increased risk of
osteoporosis
o Increased blood levels of uric
acid (a risk factor for gout).
∙ Possible nutrient deficiencies may
arise if a variety of recommended
foods on the ketogenic diet are not
included.
∙ An emphasis on foods high in
saturated fat also counters
recommendations from the Dietary
Guidelines of many countries and may
have adverse effects on blood LDL
cholesterol. However, it is possible to
modify the diet to emphasize foods
low in saturated fat such as olive oil,
avocado, nuts, seeds, and fatty fish.
(26)
∙ High-fat diets appear to reduce the
diversity of the microbiome, and
specifically reduce numbers of
good bacteria, while increasing
specific strains of Firmicutes that have
been associated with the development
of obesity. (27)
UNANSWERED QUESTIONS (26):
∙ What are the long-term (one year
or longer) effects of, and are there
any safety issues related to, the
ketogenic diet?
∙ Do the diet’s health benefits extend
to higher risk individuals with
multiple health conditions and the
elderly? For which disease
conditions do the benefits of the
diet outweigh the risks?
∙ As fat is the primary energy
source, is there a long-term impact
on health from consuming different
types of fats (saturated vs.
unsaturated) included in a
ketogenic diet?
∙ Is the high fat, moderate protein
intake on a ketogenic diet safe for
disease conditions that interfere
with normal protein and fat
metabolism, such as kidney and
liver diseases?
∙ Is a ketogenic diet too restrictive
for periods of rapid growth or
requiring increased nutrients, such
as during pregnancy, while
breastfeeding, or during
childhood/adolescent years?
IS KETO SUPERIOR FOR WEIGHT
LOSS? THE FINAL VERDICT:
Keto can reduce body weight,
although not more effectively
than other dietary approaches
over the long term or when
matched for energy intake. (25)
482
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JAMA. 2018 Jan 16;319(3):215-7.
• Gibson AA, Seimon RV, Lee CM, Ayre J, Franklin J, Markovic TP, Caterson ID, Sainsbury
A. Do ketogenic diets really suppress appetite? A systematic review and meta‐analysis.
Obes Rev. 2015 Jan 1;16(1):64-76.
• Hall, K. D., Chen, K. Y., Guo, J., Lam, Y. Y., Leibel, R. L., Mayer, L. E., Reitman, M. L.,
Rosenbaum, M., Smith, S. R., Walsh, B. T., & Ravussin, E. (2016). Energy expenditure
and body composition changes after an isocaloric ketogenic diet in overweight and obese
men. The American journal of clinical nutrition. https://doi.org/10.3945/ajcn.116.133561
• Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate
ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised
controlled trials. Br J Nutr. 2013 Oct;110(7):1178-87.
• https://journals.physiology.org/doi/abs/10.1152/ajpendo.00305.2020
• Crosby Lee, Davis Brenda, Joshi Shivam, Jardine Meghan, Paul Jennifer, Neola Maggie,
Barnard Neal D. ‘Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the
Risks’. Frontiers in Nutrition, Vol 8, 2021.
https://www.frontiersin.org/articles/10.3389/fnut.2021.702802/full
• https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/
• ‘THE SCIENCE of GUT HEALTH: What the Research Really Says About Your Gut
Microbiome’ by Dr. Gabrielle Fundaro, Dr. Jessie Hoffman.
• Francis E. Holway & Lawrence L. Spriet (2011): Sport-specific nutrition: Practical
strategies for team sports. Journal of Sports Sciences.
http://dx.doi.org/10.1080/02640414.2011.605459
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656445/
• https://pubmed.ncbi.nlm.nih.gov/31399389/
• https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/nyas.12999

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Intermittent Fasting
WHAT IS IT?
∙ Intermittent fasting (IF) is a diet
regimen that cycles between brief
periods of fasting, with either no
food or significant calorie
reduction, and periods of
unrestricted eating.
∙ It is promoted to change body
composition through loss of fat mass
and weight, and to improve markers of
health that are associated with
disease such as blood pressure and
cholesterol levels. (1)
∙ Prolonged very low calorie diets
can cause physiological changes
that may cause the body to adapt to
the calorie restriction and therefore
prevent further weight loss. IF
attempts to address this problem by
cycling between a low calorie level for
a brief time followed by normal eating,
which may prevent these adaptations.
HISTORY:
∙ Roots derive from traditional fasting,
(a universal ritual used for health or
spiritual benefit) (2)
∙ The reason behind the benefits of
intermittent fasting may be found in
human history. In earlier times, people
had to hunt and gather the foods they
ate. They couldn't just open the fridge
when they were hungry. Their bodies
adapted to these patterns, which often
included long periods of time without
any food at all.
TYPES OF IF:
The most common methods are
fasting on alternate days, for whole
days with a specific frequency per
week, or during a set time frame. (3)
∙ Alternate-day fasting: Alternating
between days of no food restriction
with days of fasting.
∙ Modified alternate-day fasting:
requires you to only eat 25 percent
of your usual intake every other
day
∙ Periodic Fasting: 1-2 days per
week of complete fasting or up to
25% of daily calorie needs, with no
food restriction on the other days.
Example: The 5:2 diet approach
advocates no food restriction five
days of the week, cycled with a
400-500 calorie diet the other two
days of the week.
∙ Time-restricted feeding:
Following a meal plan each day
with a designated time frame for
fasting. Example: Meals are eaten
from 8am-3pm, with fasting during
the remaining hours of the day.
485
MECHANISM:
∙ Normally the body relies on glucose and fatty acids, all derived from food, to make energy to
power the body's cells.
∙ The body burns the glucose and fatty acids it needs and stores the rest as fat (in the form of
triglycerides) to use later if needed, says Dr. Osama Hamdy, an associate professor of medicine
at Harvard Medical School and director of the obesity clinical program at the Joslin Diabetes
Center.
∙ When the body is temporarily without food, it manages the energy deficit by drawing on its
reserves. Between meals, as long as we don’t snack, our insulin levels will go down and our fat
cells can then release their stored sugar, to be used as energy. The entire idea of IF is to allow
the insulin levels to go down far enough and for long enough that we burn off our fat. So, when
you stop eating for a period of time, the body starts burning fat, releasing substances called
ketones into the bloodstream and using them for energy instead.
∙ "The brain can consume the ketones as energy in an efficient way. What usually happens when
this process occurs is that the body becomes more stress resistant and efficient, consuming less
oxygen to produce the same amount of carbon dioxide," he says.
∙ The stress that fasting puts on your body, rather than causing damage, actually is thought to
accelerate healing. The body starts pruning unhealthy and tired old cells and replacing them
with new ones. Fasting also seems to goad the powerhouses of the cells, structures called
mitochondria, to become more efficient, says Dr. Hamdy.
∙ It takes about eight hours without food for this process to kick into gear, sometimes a little
longer.

Image source: Metabolic Effects of Intermittent Fasting, Ruth E. Patterson and Dorothy D. Sears, Annual Review of Nutrition 2017 37:1, 371-393

486
THE RESEARCH:
Superiority when it comes to weight loss?
The research isn't conclusive!
∙ Alternate-day fasting regimens produce
superior weight loss in comparison to
standard, continuous calorie restriction
weight-loss plans.
∙ There’s a ton of incredibly promising
intermittent fasting (IF) research done on
fat rats. They lose weight, their blood
pressure, cholesterol, and blood sugars
improve. Studies in humans, almost across
the board, have shown that IF is safe and
effective, but really no more effective than
any other diet.
2. Efficacy of Circadian Rhythm fasting?
∙ We have evolved to be in sync with the
day/night cycle, i.e., a circadian rhythm.
Our metabolism has adapted to daytime
food, nighttime sleep. Nighttime eating is
well associated with a higher risk of
obesity, as well as diabetes.
∙ According to metabolic expert Dr. Deborah
Wexler, Director of the Massachusetts
General Hospital Diabetes Center and
associate professor at Harvard Medical
School, says "there is evidence to suggest
that the circadian rhythm fasting approach,
where meals are restricted to an eight to
10-hour period of the daytime, is effective."
But still she recommends that people "use
an eating approach that works for them and
is sustainable to them."
∙ There is some good scientific evidence
suggesting that circadian rhythm fasting,
when combined with a healthy diet and
lifestyle, can be a particularly effective
approach to weight loss, especially for
people at risk for diabetes.
∙ A growing body of research suggests that
the timing of the fast is key, and can make
IF a more realistic, sustainable, and
effective approach for weight loss, as well
as for diabetes prevention.
3. Efficacy for obese and pre-diabetic
patients?
o Based on this, researchers from
the University of Alabama
conducted a study with a small
group of obese men with
prediabetes. They compared a
form of intermittent fasting called
"early time-restricted feeding," (7
am to 3 pm), with a 12 hour
eating window (between 7 am
and 7 pm) group.
1. Both groups maintained their
weight (did not gain or lose)
2. But after five weeks, the ‘early
time-restricted feeding’ group
had dramatically lower insulin
levels and significantly
improved insulin sensitivity, as
well as significantly lower
blood pressure.
3. The best part? The eight-hours
group also had significantly
decreased appetite. They
weren’t starving.
4. Just changing the timing of
meals, by eating earlier in the day
and extending the overnight fast,
significantly benefited
metabolism even in people
who didn’t lose a single
pound.
487
4. Efficacy for other chronic diseases?
o Non-conclusive, for example:
1. One study says there is limited data
linking intermittent fasting regimens
with clinical outcomes, such as
diabetes, cardiovascular disease,
cancer, or other chronic diseases,
such as Alzheimer's disease.
2. Preclinical studies and clinical trials
have shown that intermittent fasting
has broad-spectrum benefits for many
health conditions, such as obesity,
diabetes mellitus, cardiovascular
disease, cancers, and neurologic
disorders.
An in-depth review of the science
of IF published in New England
Journal of Medicine sheds some
light. Fasting is evolutionarily
embedded within our physiology,
triggering several essential cellular
functions. Flipping the switch from
a fed to fasting state does more
than help us burn calories and lose
weight. The researchers combed
through dozens of animal and
human studies to explain how
simple fasting improves
metabolism, lowers blood sugar
levels; lessens inflammation,
which improves a range of
health issues from arthritic pain
to asthma; and even helps clear
out toxins and damaged cells,
which lowers risk for cancer and
enhances brain function.
∙ Animal models show that intermittent
fasting improves health throughout the life
span, whereas clinical studies have mainly
involved relatively short-term interventions,
over a period of months. It remains to be
determined whether people can
maintain intermittent fasting for years
and potentially accrue the benefits seen
in animal models.
5. Is it better or worse or just the
same in terms of compliance?
o unclear
6. Is it better or worse or just the
same in terms of changes in
appetite?
o Research in shift- and night-
workers, who eat most of
their daily calories at night
and who have an increased
risk for obesity, has
demonstrated alterations in
appetite-regulating hormones
(leptin, ghrelin, xenin) that
may lead to increases in total
energy intake (10).
o Recommendations for weight
loss frequently include
advice to eat regular meals
to avoid hunger. Some
guidelines also advise the
consumption of snacks
throughout the day.
However, current evidence
suggests that periods of
fasting do not necessarily
lead to overeating.
o CONTRADICTORY
EVIDENCE: Prolonged
periods of food deprivation or
semi-starvation places one at
risk for overeating when food
is reintroduced, and may
foster unhealthy behaviors
such as an increased fixation
on food. (4,5)
488
7. Effects on cardiometabolic health?
o Non-conclusive. For
example:
1. Intermittent fasting (IF) improves
cardiometabolic health; however,
it is unknown whether these
effects are due solely to weight
loss.
2. The potential effects of prolonged
nightly fasting on energy intake,
sleep, physical activity, and
circadian activity rhythm may act
in concert to reduce the risks of
cardiometabolic disease and
cancer.
3. In a study to test whether IF has
benefits independent of weight
loss (carried out by feeding
participants enough food to
maintain their weight), eTRF
improved insulin sensitivity, β
cell responsiveness, blood
pressure, oxidative stress, and
appetite.
4. A multicenter study showed that
daily caloric restriction improves
many cardiometabolic risk factors
in nonobese humans
(7). However, in a 12-month
study comparing alternate-day
fasting, daily caloric restriction,
and a control diet, participants in
both intervention groups lost
weight but did not have any
improvements in insulin
sensitivity, lipid levels, or blood
pressure, as compared with
participants in the control group
(8).
8. Adaptive Cellular Response?
o IF elicits evolutionarily conserved,
adaptive cellular responses that
improve glucose regulation,
increases stress resistance, and
suppresses inflammation.
o During fasting, cells activate
pathways that enhance intrinsic
defenses against oxidative and
metabolic stress and those that
remove or repair damaged
molecules.
o During the feeding period, cells
engage in tissue-specific processes
of growth and plasticity.
9. Effect on Microflora?
o The feeding pattern affected the
composition of the luminal
microflora, even when animals were
fed the same diet. The gut
microbiome plays an important role
in host metabolic homeostasis
(9). However, the mechanistic
basis for this metabolic effect is not
well understood.
489
10. Keep in Mind:
o clinical studies have focused mainly
on overweight young and middle-
age adults, and we cannot
generalize to other age groups the
benefits and safety of intermittent
fasting that have been observed in
these studies.
o Although we do not fully understand
the specific mechanisms, the beneficial
effects of intermittent fasting involve
metabolic switching and cellular stress
resistance.
o Further, properly powered, controlled
clinical research is needed to test
whether intermittent fasting regimens
can complement or replace energy
restriction
o Several lines of evidence support the
hypothesis that eating patterns that
reduce or eliminate nighttime eating
and prolong nightly fasting intervals
may result in sustained improvements
in human health. Although this
hypothesis has not been tested in
humans, support from animal research
is striking, and data from human time-
restricted feeding studies are
suggestive.
o Large-scale randomized trials of
intermittent fasting regimens in free-
living adults are needed and should
last for at least a year to properly
assess whether behavioral and
metabolic changes are sustainable and
whether they have long-term effects on
biomarkers of aging and longevity.
(11)
PROS:
∙ Even a single fasting interval in
humans (e.g., overnight) can
reduce basal concentrations of
many metabolic biomarkers
associated with chronic disease,
such as insulin and glucose. For
example, patients are required to
fast for 8–12 hours before blood
draws to achieve steady-state
fasting levels for many metabolic
substrates and hormones.
∙ Certain people who typically eat
one or two meals a day or do not
eat for long stretches of time may
show better compliance with this
type of regimen.
∙ eTRF is an efficacious strategy for
treating both prediabetes and likely
also prehypertension.
∙ eTRF—by virtue of combining daily
intermittent fasting and eating in
alignment with circadian rhythms in
metabolism—will prove to be a
particularly efficacious form of IF.
490
POSSIBLE CONS:
∙ Switching to an intermittent-fasting
regimen, many people will experience
hunger, headaches, lethargy,
irritability, constipation, and a reduced
ability to concentrate during periods of
food restriction. However, these initial
side effects usually disappear within 1
month. To decrease some of these
unwanted side effects, you may want
to switch from adf fasting to periodic
fasting or a time restricted eating plan
that allows you to eat everyday within
a certain time period.
∙ "It's human nature for people to
want to reward themselves after
doing very hard work, such as
exercise or fasting for a long period
of time, so there is a danger of
indulging in unhealthy dietary
habits on non-fasting days," says
Dr. Frank Hu, chair of the department
of nutrition at the Harvard T.H. Chan
School of Public Health.
∙ Some people who take medications
for blood pressure or heart disease
also may be more prone to
imbalances of sodium, potassium, and
other minerals during longer-than-
normal periods of fasting.
∙ Not suitable for people with following
conditions:
o Diabetes
o Eating disorders that involve
unhealthy self-restriction
(anorexia or bulimia nervosa)
o Use of medications that require
food intake
o Active growth stage, such as in
adolescents
o Pregnancy, breastfeeding
WARNING:
∙ People with advanced diabetes or
who are on medications for
diabetes, people with a history of
eating disorders like anorexia and
bulimia, and pregnant or
breastfeeding women should not
attempt intermittent fasting unless
under the close supervision of a
physician who can monitor them.
THE VERDICT:
∙ Research does not consistently
show that intermittent fasting is
superior to continuous low calorie
diets for weight loss efficiency.
∙ Strong recommendations on
intermittent fasting for weight loss
cannot be made at this time.
∙ POSSIBLE cardiometabolic
benefits
∙ Cellular cell resistance
lower insulin levels and significantly
improved insulin sensitivity, as well as
significantly lower blood pressure in
obese and prediabetic patients.
491
References:
• https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/intermittent-
fasting/
• Persynaki A, Karras S, Pichard C. Unraveling the metabolic health benefits of fasting
related to religious beliefs: A narrative review. Nutrition. 2017 Mar 1;35:14-20.
• Tinsley GM, La Bounty PM. Effects of intermittent fasting on body composition and clinical
health markers in humans. Nutrition reviews. 2015 Oct 1;73(10):661-74.
• Robertson LT, Mitchell JR. Benefits of short-term dietary restriction in mammals.
Experimental gerontology. 2013 Oct 31;48(10):1043-8.
• Horne BD, Muhlestein JB, Anderson JL. Health effects of intermittent fasting: hormesis or
harm? A systematic review. Am J Clin Nutr. 2015 Aug 1;102(2):464-70.
• https://www.nejm.org/doi/full/10.1056/NEJMra1905136
• Design and conduct of the CALERIE study: comprehensive assessment of the long-term
effects of reducing intake of energy. J Gerontol A Biol Sci Med Sci 2011
• Significant improvement in cardiometabolic health in healthy nonobese individuals during
caloric restriction-induced weight loss and weight loss maintenance. Am J Physiol
Endocrinol Metab 2018
• Effect of calorie restriction on mood, quality of life, sleep, and sexual function in healthy
nonobese adults: the CALERIE 2 randomized clinical trial. JAMA Intern Med 2016
• Effect of 6-month calorie restriction on biomarkers of longevity, metabolic adaptation, and
oxidative stress in overweight individuals: a randomized controlled trial. JAMA 2006
• A 2-year randomized controlled trial of human caloric restriction: feasibility and effects on
predictors of health span and longevity
• Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection
among metabolically healthy obese adults: a randomized clinical trial. JAMA Intern Med
2017
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255146/#R38
• Crispim CA, Waterhouse J, Damaso AR, Zimberg IZ, Padilha HG, et al. 2011. Hormonal
appetite control is altered by shift work: a preliminary study. Metabolism 60: 1726–35
• https://www.annualreviews.org/doi/full/10.1146/annurev-nutr-071816-
064634?url_ver=Z39.88-
2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

492
Mediterranean Diet
WHAT IS IT?
• The concept ‘Mediterranean diet’ (MD)was
developed to reflect the typical dietary habits
followed during the early 1960s by inhabitants
of the Mediterranean basin, mainly in Crete,
much of the rest of Greece and Southern Italy
• It is most closely tied to traditional areas of
olive cultivation in the Mediterranean region
• It varies by country and region and has a
range of definitions, and is the result of the
long tradition of a century of sharing goods,
food, and culture between countries in the
Mediterranean area.
• Variations of Mediterranean dietary patterns
have existed around the Mediterranean region
with plant foods at the centre of the plate
and olive oil as the primary fat being
constant components.
• For example, couscous, vegetables and
legumes have been important in North Africa;
• Pasta, polenta, rice or potatoes along with
vegetables and legumes have been prominent
in southern Europe.
• At that time, these countries displayed low
rates of chronic disease and higher than
average adult life expectancy despite having
limited access to healthcare. It was believed
that their diet contributed to their health
benefits.
• Due to contemporary lifestyle and
environmental challenges, the traditional MD
pattern had to be updated, especially about
local, seasonal, and minimally processed food
consumption, sustainability, and cost of food,
while adapting to socio-economic, cultural, and
geographical contexts.
SALIENT FEATURES:
· The MD provides close to:
o 37% energy from total fat
o 15% from protein
o at least 43% energy from
carbohydrates (10)
· Primarily plant-based
· It suggests the proportion of foods to eat
but NOT PORTION SIZES or specific
amounts.
· When compared with other
‘healthy’ diets, two elements of the
Mediterranean diet are unique:
1) abundant fat intake is allowed
provided that it comes from virgin
olive oil, tree nuts and fatty fish
2) moderate intake of red wine
during meals
Other components (fish instead of
red meats, abundance of plant-
based foods) are common with other
‘healthy’ diets.
· Eight components of the
Mediterranean diet:
1. Vegetables
2. Legumes
3. Fruits & nuts
4. grains
5. meats
6. dairy
7. alcohol
8. dietary fats
9. fish (added later on as a
ninth component)
· Animal proteins are eaten in
smaller quantities, with the
preferred animal protein being
fish and seafood.
· Dispels the myth that people with or
at risk for heart disease must eat a
low fat diet. Which types of fats are
chosen matters more than the
percentage of calories from fat.
· In 1993 the Mediterranean Diet
Pyramid was published (the Harvard
School of Public Health, Old ways
Preservation and Exchange Trust,
and the European Office of the
World Health Organization) as a
guide to help familiarize people with
the most common foods of the
region.
· The pyramid is more of an eating
pattern, than a strictly regimented
diet plan.
· The pyramid also highlighted daily
exercise and the beneficial social
aspects of eating meals together. 493
WHAT TO EAT?
· Fats: Emphasis on healthy fats
such as Extra Virgin Olive Oil, nuts
and seeds (rather than fats like
butter, margarine)
· Vegetables and Fruits: High
intake of plant foods (fruits,
vegetables)
· Carbs: high intake of breads and
other cereals (traditionally minimally
refined), potatoes, beans)
· Proteins:
o fish as the preferred animal
protein, at least twice weekly.
o zero to four eggs a week
o Other animal proteins (poultry,
and dairy (cheese or yogurt)) in
smaller portions, either daily or a
few times a week.
o Red meat is limited to a few times
per month.
· 1.5–2 L of water/day or other
unsweetened, low-sodium liquids.
· Wine: 1 to 2 glasses per day for
men, 1 glass per day for women
· Dessert: fresh fruits as typical
dessert, with sweets containing
sugars or honey a few times per
week
· Exercise: Daily physical exercise
through enjoyable activities
∙ Studies have shown this diet to:
o improve glycemic control
o benefit weight loss in obese
patients and for preventing long-
term weight gain in non-obese
populations. (Rather than
focusing on reductions in total
calories or portion sizes, or on
increasing or decreasing
isolated nutrients, an emphasis
on overall diet quality according
to types of foods consumed has
the strongest evidence-base for
reducing adiposity and
preventing diabetes and
cardiovascular diseases)
o be effective in reducing the
risk of cardiovascular
diseases (changes in
inflammation, blood sugar,
and body mass index being
the drivers) and overall
mortality. (3,4)
∙ The PREDIMED Study:
Mediterranean diet (with total fat
intake = 39-42%, which is much
higher than the 20-35% fat
guideline stated by the Institute of
Medicine ) supplemented with
extra virgin olive oil or nuts and
without any fat and calorie
restrictions reduced the rates of
death from stroke by roughly 30%.
(5)
∙ Risk of type 2 diabetes was also
shown to be reduced in the
PREDIMED trial. (6)
∙ In a study (7), participants who
more closely followed the
Mediterranean diet were found to
have longer telomere length.
(Telomeres are a specific part of
DNA, they naturally shorten with
age, and their length size can
predict life expectancy and the risk
of developing age-related
diseases. Telomeres with long
lengths are considered protective
against chronic diseases and
earlier death, whereas short
lengths increase risk.) Antioxidants
from fruits, vegetables, nuts, and
whole grains are believed to help
combat cell stress and preserve
telomere length.
494
∙ It has been associated with less age-related
cognitive dysfunction and lower incidence
of neurodegenerative disorders,
particularly Alzheimer’s disease
∙ Another Nurses’ Health Study (8) found that
the women who followed a Mediterranean-
type eating pattern were 46% more likely to
age healthfully. (Healthy aging was defined
as living to 70 years or more, and having no
chronic diseases (e.g., type 2 diabetes,
kidney disease, lung disease, Parkinson’s
disease, cancer) or major declines in mental
health, cognition, and physical function.)
∙ Relatively low environmental impacts (water,
nitrogen and carbon footprint) of the MD is an
additional positive aspect. It can be part of a
sustainable lifestyle and food system model
that can be adapted to country-specific
agricultural resources and cultures.
CONS:
High intake of dairy products is considered as
adverse in the landmark publications on the
Mediterranean diet and health.
However, recent epidemiological evidence
suggests lower cardiometabolic risk associated
with consumption of dairy products, in particular
fermented dairy products.
· A drawback of this food-focused approach is
dietary additives such as sodium and trans fat,
because very similar foods that are included in this
diet can be either higher or lower in these
additives. This indicates a separate need to target
these nutrients.
· Wheat (whole and refined), is a major
ingredient of the Mediterranean diet (bread, pasta,
couscous). Physicians and nutritionists should be
careful in finding the balance between: selecting
alternatives to gluten-rich grains for people who
are gluten intolerant or have celiac disease, and
adhering to the basic principles of the modernized
Mediterranean diet.
HOW EASY OR DIFFICULT IT IS TO
ADHERE TO THIS DIET?
· The Mediterranean dietary pattern
provides satiety and enables long term
adherence, probably in part due to the
higher intake of olive oil and less
processed foods.
· In one of the most successful
weight loss trials to date, those
assigned to the Mediterranean diet
maintained weight loss over a period of
six years. (9)
WARNING:
· There is a risk of excess calorie
intake because specific amounts of
foods and portion sizes are not
emphasized, which could lead to weight
gain.
THE VERDICT:
Research supports the use of the
Mediterranean diet as a healthy
eating pattern for the prevention of
cardiovascular diseases, increasing
lifespan, and healthy aging. When
used in conjunction with caloric
restriction, the diet may also support
healthy weight loss.
495
References:
1. Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D.
Mediterranean diet pyramid: a cultural model for healthy eating. AJCN. 1995 Jun
1;61(6):1402S-6S.
2. Gifford KD. Dietary fats, eating guides, and public policy: history, critique, and
recommendations. Am J Med. 2002 Dec 30;113(9):89-106.
3. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean
diet and incidence of and mortality from coronary heart disease and stroke in women.
Circulation. 2009 Mar 3;119(8):1093-100.
4. Lopez-Garcia E, Rodriguez-Artalejo F, Li TY, Fung TT, Li S, Willett WC, Rimm EB, Hu
FB. The Mediterranean-style dietary pattern and mortality among men and women with
cardiovascular disease. AJCN. 2013 Oct 30;99(1):172-80.
5. Food and Nutrition Board, Institute of Medicine of the National Academies. Dietary
Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and
Amino Acids. The National Academies Press, 2005. Accessed 10/16/17.
6. Salas-Salvadó J, Bulló M, Babio N, Martínez-González MÁ, Ibarrola-Jurado N, Basora J,
Estruch R, Covas MI, Corella D, Arós F, Ruiz-Gutiérrez V. Reduction in the incidence of type 2
diabetes with the Mediterranean diet. Diabetes care. 2011 Jan 1;34(1):14-9.
7. Crous-Bou M, Fung TT, Prescott J, Julin B, Du M, Sun Q, Rexrode KM, Hu FB, De Vivo I.
Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort
study. BMJ. 2014 Dec 2;349:g6674.
8. Samieri C, Sun Q, Townsend MK, Chiuve SE, Okereke OI, Willett WC, Stampfer M,
Grodstein F. The Association Between Dietary Patterns at Midlife and Health in Aging: An
Observational Study. Annals of internal medicine. 2013 Nov 5;159(9):584-91.
9. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser
D, Bolotin A, Vardi H, Tangi-Rozental O. Weight loss with a low-carbohydrate, Mediterranean,
or low-fat diet. NEJM. 2008 Jul 17;2008(359):229-41.
10. Davis C, Bryan J, Hodgson J, Murphy K. Definition of the Mediterranean diet: a literature
review. Nutrients. (2015) 7:9139–53. doi: 10.3390/nu7115459

496
South Beach Diet
WHAT IS IT? o Aims to resolve insulin resistance
∙ The South Beach Diet is a commercial o It is meant to induce ketosis.
diet plan that cardiologist Dr. Arthur o Only foods low on the glycemic index are
Agatston and dietitian Marie Almon allowed.
designed in the mid-1990s. o Eat three balanced meals a day, with
∙ At first, it aimed to help people to desserts, plus snacks
lower the risk of heart disease, but it o Snacks are important, even if the
rapidly became popular as a diet for individual is not hungry (someone who
losing weight. feels satisfied is less likely to overeat at
∙ The diet claims not to be a the next meal)
traditional low-carb diet. Instead, it o Eat normal sized portions of:
focuses on selecting the right § lean meats
carbohydrates. § chicken
∙ Agatson believes that the saturated § turkey
fats promoted in the Atkins diet can § fish and shellfish
contribute to cardiovascular disease, § tofu
so South Beach is based on “good § eggs
carbs (Vegetables and other low-GI § reduced-fat cheese
foods)” and “good fats (unsaturated § nuts
fats found in foods like olive oil, § beans
seafood, nuts, and seeds).” § vegetables
o No bread, rice, potatoes, pasta, baked
SALIENT FEATURES: goods, fruit, sugar, or alcohol are
∙ More plant-based than the Atkins permitted.
∙ No calorie counting o This stage should elicit 8-13 pounds of
∙ No macro % counting weight loss.
∙ No rules about portion size
∙ The belief is that by choosing good ·
fats and good carbs, you simply won’t
be hungry all the time. (1)
∙ The diet promises (doesn’t mean it is
proven) sustainable weight loss and
improved cardiovascular health.
∙ According to the South Beach Diet
website, the approach differs from
other low-carb diets like the Atkins diet
because of its recommendation to
consume less sodium and saturated
fat

THE DIET FOLLOWS 3 PHASES:

∙ Phase 1: KICK-START THE
WEIGHT LOSS PROCESS
o lasts for 2 weeks
o Aims to Eliminate cravings for
sugary foods and refined
starches by stabilizing blood-
497
sugar levels.
498
Phase 2: ACHIEVE THE TARGET WEIGHT
o Slowly add prohibited foods back according to the “carbohydrate ladder”
inspired by the glycemic index.
o Its similar to Atkin’s ladder shown below.
Some participants worry about regaining the weight already lost when they
start eating the carbs again, but Dr. Agatston stresses that they must
reintroduce these carbs, because if they are going to follow this diet for life,
carbs will be essential long-term for maintaining good health.
o Weight loss should slow to 1-2 pounds per week for as long as desired.
o Suitable carbs include:
§ most fruits
§ some whole-grain breads, and pastas
§ some additional vegetables, including peas and potatoes
§ some treats
§ brown rice
o Introduce the carbs little by little:
§ Add one single carb to just one daily meal for one week
§ Monitor closely how your body responds to a reintroduced carb over
a few days.
§ If the body responds appropriately, add a second carb, again
monitoring the body’s reaction carefully.
§ Examples of an appropriate response to added carbohydrates are:
à improved energy
à better sleep quality
à better mood
à continued slow weight loss
à regular bowel movements
à better skin
§ continues until you have 2–3 servings of the right carbs each day.
o If a person does not feel comfortable at this stage, they can return to Phase
I for a few days, until they regain control.
o People might need to revisit Phase I if they experience:
§ food cravings
§ difficulty controlling carbohydrate portions
§ weight gain
§ a return to old, unhealthful eating habits
o On reaching the target weight, the dieter moves on to Phase 3

499
 Phase 3: MAINTAIN THE IDEAL
WEIGHT
o Learn to make good food
choices
o Maintain new weight in the
long term, while enjoying all
foods in moderation
o You should feel that you are
adopting a lifestyle, rather
than following a diet.
o If the food cravings return, or
if weight increases, you can
go back to Phase I or II.
o The creators of The South
Beach Diet say that, in Phase
III, people do not go back to
eating whatever they like.
Instead, they continue to
make good food choices, try
new recipes and ingredients,
and enjoy a new lifestyle.
POSSIBLE HEALTH BENEFITS:
· It relies on proven ways to lose
weight: eating smart carbs, healthy
fats, lean protein, low fat dairy, and
plenty of fiber to keep hunger at bay.
· As it limits the amount of processed
carbs consumed, it stabilizes blood
glucose and lowers insulin levels
· Potential weight loss
· May prevent food cravings
PROS:
· Flexible, no calorie counting.
· This diet is both vegetarian- and
vegan-friendly. Protein alternatives
to lean meat include beans,
legumes, and soy products.
POSSIBLE CONS:
· Restrictive first phase.
· The diet doesn’t provide enough
calcium, which is especially
important for women because
they are more prone to
osteoporosis, or bone loss.
(Although guidelines include 2
cups of dairy (like milk and
cheese) per day, this isn’t
enough)
· Be careful if you are taking
insulin or blood sugar-
lowering medications, as
blood sugar may drop quickly
on this diet. Speak to their
doctor and closely monitor your
blood sugar upon beginning the
South Beach Diet.
· No specific recommendations
for portions for many of the food
groups. This could lead to
overeating or even undereating.
500
WHAT DOES THE RESEARCH SAY?
!!!!!WARNING!!!! (2) References
· The South Beach Diet became 1. ‘Fueling performance: Determining
popular after 2003, with the launch the efficacy of low carbohydrate
of a best-selling book by Dr. Arthur diet models for athletic
Agatston. In 2006, three years after populations’. Chelsea Jackle
the South Beach Diet book 2. https://link.springer.com/article/10.
appeared, research published in the 1111%2Fj.1525-
Journal of General Internal Medicine 1497.2006.00501.x
suggested that up to 67% of the
“facts” stated in it may not have
scientific evidence to support
them.
Some of the health claims and
“facts” that were disproven or not
supported by an exhaustive medical
review of evidence include:
o “People lose 8 to 13 pounds
in the first 2 weeks.”
o “Carrots, beets, and
watermelon promote weight
gain because of a high GI
(glycemic index).”
o “Fats and protein cause
satiety more efficiently than
carbohydrates.”
o “This diet (South Beach) has
been scientifically studied and
proven effective.”
· A review published in November
2014 in ‘Circulation: Cardiovascular
Quality and Outcomes’ looked at the
effectiveness of the Atkins diet, the
South Beach diet, the Zone diet, and
the Weight Watchers diet, and
researchers did not find evidence
that any one plan was
significantly more effective than
the others.

501
 Raw Food Diet
∙ What is It?
∙ The raw food diet has been around
since the mid-19th century when
Sylvester Graham promoted the idea
that people would never become ill if
they only consumed uncooked foods.
Graham was an early supporter of a
vegetarian diet to promote health and
prevent disease and several of his
theories continue today in
recommendations for an eating style
that is based on whole plants and high
in fiber.
∙ A raw foods diet is based on a vegan
diet that includes fruits, nuts, seeds,
and sprouted grains and beans. The
actual amount of raw food consumed
ranges from 50% to 100% of total
calories. The only “cooking” that is
allowed is via a food dehydrator that
blows hot air through the food at
temperatures no higher than 118°F.
∙ Proponents of a raw food diet believe
that cooking destroys the enzymes
needed to digest food, making cooked
food less nutrient-dense.
∙ Assumptions:
o Cooking/heating food destroys
its nutrients and natural
enzymes, which is bad because
enzymes boost digestion and
fight chronic disease.
o Your body will be burning
calories while doing the work of
extracting nutrients from foods.
∙ Some proponents believe cooking
makes food toxic. They claim it can
clear up headaches and allergies,
boost immunity and memory, and
improve arthritis and diabetes.
∙ Food can be cold or even a little bit
warm, as long as it doesn’t go
above 118 degrees Fahrenheit.
∙ You can use blenders, food
processors, and dehydrators to
prepare foods.
∙ What to eat:
∙ Uncooked, unprocessed, mostly
organic foods.
∙ Carbs: raw fruits, vegetables
∙ Fats: Usually limited to nuts and
avocado. Some include cold-
pressed oils, like olive oil.
∙ Proteins: Limited to nuts and
sprouted grains and legumes.
Some eat unpasteurized dairy
foods, raw eggs, meat, and fish
∙ Pros:
∙ Emphasizes foods that are only
slowly digested and that contain
fewer calories for a given volume.
∙ Avoids unhealthy, high-calorie
processed foods
502
∙ Cons:
∙ Excludes many sources of fats and
protein
∙ Difficult to follow
∙ Because some uncooked and
unpasteurized foods are linked to
food-borne illness, you’ll need to wash
your food thoroughly and be extra
careful
∙ Due to the risk of food poisoning, a
raw foods diet isn't recommended for
pregnant women, young children,
seniors, people with weak immune
systems, and those with chronic
medical conditions like kidney
disease.
∙ Inadequate in many essential
nutrients, such as protein, iron,
calcium, vitamin B12, and more.
∙ You miss out on some nutrient-rich
super foods that can’t be eaten raw,
such as beans, whole grains.
∙ The limited sources of protein may
cause health problems. Even with
adequate calories, the limited protein
may cause subtle signs of
malnutrition, including skin changes
and irregular menstrual periods in
women.
∙ For people not trying to lose weight, a
raw food diet is unlikely to provide
sufficient calories.
∙ The Research:
∙ Contrary to the claims of many raw
food fans, cooking does not make
food toxic but instead makes some
foods digestible.
∙ Cooking also boosts some
nutrients, like beta-carotene and
lycopene, and kills bacteria, which
helps you avoid food poisoning.
There is no scientific evidence that
raw foods prevent illness.
∙ “Appropriately cooking, and not
overcooking, food allows for the
retention of most vital nutrients.
Light cooking adds enormous
palatability and tastiness to very
healthy foods that ideally should be
a dietary priority. In my mind, the
resulting increased consumption of
these foods more than makes up
for any nutrient losses caused by
heat.”~ Christopher Gardner, PhD,
Stanford nutrition specialist
∙ The limited sources of protein may
cause health problems. Even with
adequate calories, the limited
protein may cause subtle signs of
malnutrition, including skin
changes and irregular menstrual
periods in women.
Final Verdict:
It is a healthy short-term diet that
is difficult to follow long-term
because of the limited food
choices and the limited amounts
of protein and some important
nutrients. Can be considered as a
transition to more diverse healthy
diet.
References:
1. https://scopeblog.stanford.edu/201
9/02/28/a-skeptical-look-at-
popular-diets-hurrah-for-raw-food/
2. https://www.webmd.com/diet/a-
z/raw-foods-diet
503
Vegetarian Diet
∙ What is It?
∙ You can use blenders, food
processors, and dehydrators to
prepare foods.
∙ Unless you follow recommended
guidelines on nutrition, fat
consumption, and weight control,
becoming a vegetarian won't
necessarily be good for you. E.g. A
diet of soda, cheese pizza, and candy,
after all, is technically "vegetarian."
∙ Varieties of vegetarians:
Vegetarians are people who don't eat
meat, poultry, or seafood. But people
with many different dietary patterns
call themselves vegetarians, including
the following:
∙ Vegans (total vegetarians): No eat
meat, poultry, fish, or any products
derived from animals, including eggs,
dairy products, and gelatin.
∙ Lacto-ovo vegetarians: No meat,
poultry, or fish, but do eat eggs and
dairy products.
∙ Lacto vegetarians: No meat, poultry,
fish, or eggs, but do consume dairy
products.
∙ Ovo vegetarians: No meat, poultry,
fish, or dairy products, but do eat
eggs.
∙ Partial vegetarians: Avoid meat but
may eat fish (pesco-vegetarian,
pescatarian) or poultry (pollo-
vegetarian).
∙ Why People Choose
Vegetarianism:
∙ Religious convictions / concerns
about animal welfare or the use of
antibiotics and hormones in
livestock / desire to eat in a way
that avoids excessive use of
environmental resources/
affordability / opting for it has
become easier because of the year
round availability of fresh produce,
more vegetarian dining options,
and the growing culinary influence
of cultures with largely plant-based
diets.
∙ Pros:
∙ Lowered risk of chronic disease
associated with eating less meat
and more vegetables (heart
disease, hypertension, Type 2
diabetes, rheumatoid arthritis,
kidney disease, gallstones)
∙ Cutting down on meat lowers the
demand for mass-produced meats,
thereby possibly creating a positive
effect on the environment.
∙ Cons:
∙ Possible nutrient deficiencies
(Diets can be low in vitamin B12,
omega-3 fatty acids)
∙ Fewer food choices
504
The Research:
∙ Do vegetarians suffer any adverse
effects due to anti-nutrients (as they
consume large portions of plant based
foods)?
“Studies on vegetarians who eat diets
high in plant foods containing anti-
nutrients do not generally show
deficiencies in iron and zinc, so the body
may be adapting to the presence of anti-
nutrients by increasing the absorption of
these minerals in the gut.”
Source: Stevenson L, Phillips F,
O’Sullivan K, Walton J. Wheat bran: its
composition and benefits to health, a
European perspective. Int J Food Sci
Nutr. 2012 Dec; 63(8): 1001–1013.
∙ There still isn’t enough data to say exactly
how a vegetarian diet influences long-term
health. It's difficult to tease out the influence
of vegetarianism from other practices that
vegetarians are more likely to follow, such
as not smoking, not drinking excessively,
and getting adequate exercise.
∙ To get enough protein through vegetarian
options, it’s a little difficult to be able to stay
within the caloric limit, as most vegetarian
protein sources have quite low amount of
protein compared to non-vegetarian class A
sources- and to hit daily protein quota, one
has to eat considerably more food volume.
How to get enough protein when there is a
caloric limit on daily consumption?
∙ Vegetarian protein sources lack complete
amino acid profile.
∙ Plant based proteins are very low in EAA
∙ To get enough protein and a diverse profile
of AA, when making Vegetarian Diet Plans
- always use Whey for at least 30 to 40%
as part of overall daily protein content. Add
10-20g whey to each meal assuming 4-5
meals per day.
∙ You can increase the protein from
whey as high as 80% when you
the competition date- end of
extreme dieting is approaching.
∙ For, vegans - use a combination
of Pea & Rice Protein.
∙ You can add EAA but whey is
preferred to plug the AA diversity
gap as:
∙ Whey has EAA + Extra nutrients
∙ Whey is more satiating
∙ Final Verdict:
o Without Energy Restriction (ER)
and avoidance of
refined/processed food,
vegetarian diets don’t seem to
cause more weight loss
compared to non-vegetarians.
o For vegetarians, fulfilling protein
requirements with ER is very
difficult if not supplemented with
protein supplements like whey.
o Other practices that vegetarians
are more likely to follow (not
smoking, not drinking
excessively, and getting
adequate exercise) are
confounding variables when it
comes to determining superiority
of vegetarian diets for weight
loss.
References:
1.
https://www.health.harvard.edu/staying-
healthy/becoming-a-vegetarian
2.
https://academic.oup.com/ajcn/article/89
/5/1627S/4596952
3.
https://pubmed.ncbi.nlm.nih.gov/261380
04/
4. https://sphweb.bumc.bu.edu/otlt/mph
modules/ph/nutritionmodules/popular_di
ets/popular_diets6.html 505
Vegan
∙ What is It?
A vegan diet contains only plants (such
as vegetables, grains, nuts and fruits)
and foods made from plants.
Vegans do not eat foods that come from
animals, including dairy products and
eggs. Some people also avoid eating
honey.
Eat:
∙ Fruits and vegetables
∙ Legumes such as peas, beans, and
lentils
∙ Nuts and seeds
∙ Breads, rice, and pasta
∙ Dairy alternatives such as soymilk,
coconut milk, and almond milk
∙ Vegetable oils
Don’t Eat:
∙ Beef, pork, lamb, and other red meat
∙ Chicken, duck, and other poultry
∙ Fish or shellfish such as crabs, clams,
and mussels
∙ Eggs
∙ Cheese, butter
∙ Milk, cream, ice cream, and other
dairy products
∙ Mayonnaise (because it includes egg
yolks)
∙ Honey
Research:
∙ Avoiding animal protein can
shortchange you on a few
nutrients, like protein, calcium,
omega-3 fatty acids, zinc, vitamin
B12, and vitamin D. But you can
find substitutes for most of these
essential nutrients in plant-based
foods like:
∙ Protein: nuts, soy, beans, quinoa
∙ Calcium: soy milk, fortified orange
juice, tofu with calcium, broccoli,
kale, almonds
∙ Omega-3 fatty acids: flaxseeds,
vegetable oils, plant-based
supplements
∙ Iron: tofu, soy nuts, spinach,
peanut butter, fortified cereals
∙ A Harvard study (1) suggests that
a plant based diet may be of
significant benefit if you’re not
doing great health wise. If you are
healthy, then the effect becomes
negligible.
∙ There is a need for more studies
on the relation between vegan
diets and risk of cancer, diabetes,
and osteoporosis.
∙ For vegans, fulfilling protein
requirements with ER is very
difficult if not supplemented with
protein supplements like whey.
∙ Other practices that vegans are
more likely to follow (not smoking,
not drinking excessively, and
getting adequate exercise) are
confounding variables when it
comes to determining superiority of
vegan diets for weight loss.
506
Pros:
∙ Lowered risk of chronic disease
associated with eating less meat and
more vegetables (heart disease,
hypertension, Type 2 diabetes,
rheumatoid arthritis, kidney disease,
gallstones)
∙ Cutting down on meat lowers the
demand for mass-produced meats,
thereby possibly creating a positive
effect on the environment.
Cons:
∙ Complete Amino Acid profile is a
difficult goal to achieve through plant
based proteins.
∙ Avoiding animal protein can cause
vitamin B12 deficiency. You may need
a supplement to make up for it.
∙ BMD and the risk of bone fracture may
be a concern when there is an
inadequate intake of calcium and
vitamin D.
∙ During pregnancy and when
breastfeeding, women who follow a
vegan diet need to make sure they get
enough vitamins and minerals for their
child to develop healthily.
∙ “The protein you get from plant
products is less accessible to the body
and may or may not be complete —
and for that reason, people on vegan
diets need to eat more protein than
those on animal-based diets, to be on
the safe side.” ~ Claire McCarthy,
Harvard Health Publishing
The Verdict:
A vegan diet is only as healthy as
you make it. Products like "vegan"
ice cream, cookies, and candy are
tempting, but you don't want to
overdo. If you eat high-fat and
processed foods and supersize your
portions, you'll gain weight and
might end up with many of the same
health problems you'd have on a
meat-based diet.
References:
1.
https://pubmed.ncbi.nlm.nih.gov/274791
96/
2. https://www.webmd.com/diet/vegan-
diet-overview#2
3.
https://academic.oup.com/ajcn/article/89
/5/1627S/4596952
4. https://www.nhs.uk/live-well/eat-
well/the-vegan-diet/
5.https://www.health.harvard.edu/blog/w
hat-parents-need-to-know-about-a-
vegan-diet-2020010718625
507
FODMAP Diet (i.e. Diet low in FODMAP)
What is It?
∙ FODMAPS are mainly 5 Types of
Carbs/Sugars (both words are often
used interchangeably), that some
people’s bodies struggle to break
down.
WHAT ARE THOSE 5 TYPES OF CARBS
ON FODMAP?
1. Fructose: Fruits, honey, high-fructose
corn syrup, agave.
2. Lactose: Dairy.
3. Fructans: Wheat, onions, garlic.
4. Galactans: Legumes, such as beans,
lentils, and soybeans.
5. Polyols: Sugar alcohols and fruits that
have pits or seeds, such as apples,
avocados, cherries, figs, peaches, or
plums.
∙ The low FODMAP diet is designed
to help people with irritable bowel
syndrome (IBS) and/or small
intestinal bacterial overgrowth
(SIBO), to figure out which foods are
problematic and which foods reduce
symptoms.
What does FODMAP stand for?
∙ FODMAP stands for Fermentable
Oligosaccharides, Disaccharides,
Monosaccharides and Polyols, which
are short-chain carbohydrates
(sugars) that the small intestine
absorbs poorly.
∙ Some people experience digestive
distress after eating them.
Symptoms include:
o Cramping
o Diarrhoea
o Constipation
o Stomach bloating
o Gas and flatulence
How do you define, if a food is High
on the FODMAP scale, or low?
A food is categorized as high-
FODMAP according to predefined
cut-off levels.
Published cut-off levels suggest that
a high-FODMAP food contains more
than one of the following carbs:
∙ Oligosaccharides: 0.3 grams of
either fructans or galacto-
oligosaccharides (GOS)
∙ Disaccharides: 4.0 grams of
lactose
∙ Monosaccharides: 0.2 grams
more fructose than glucose
∙ Polyols: 0.3 grams of either
mannitol or sorbitol
Other Salient Features or things to
keep in mind:
∙ It is a temporary eating plan that’s
very restrictive.
∙ “It’s always good to talk to your
doctor before starting a new diet,
but especially with the low
FODMAP diet since it eliminates
so many foods — it’s not a diet
anyone should follow for long. It’s a
short discovery process to
determine what foods are
troublesome for you.” ~ Hazel
Galon Veloso, M.D.,
Gastroenterologist, Johns
Hopkins
How does it work?
Low FODMAP is a three-step
elimination diet:
∙ Step 1 (lasts 2-6 weeks): Stop
eating certain foods (high
FODMAP foods).
∙ Step 2: Every three days: add a
high FODMAP food back into your
diet, one at a time, to see if it
causes any symptoms.
∙ Step 3: If a particular high
FODMAP food causes symptoms, 508
then avoid this long term.
Why should High FODMAP Foods be eliminated?
∙ There is some evidence (although very weak)
that people, who suffer from IBS or IBS like
symptoms/issues, can benefit from avoid
FODMAPs in their diets.
∙ It is also proposed many of the HIGH FODMAP
foods promote Inflammation in the body –
Although, this statement is not 100%
substantiated, it is still one of the Key “claims”
by the FODMAP proponents.
But, people who HAVE issues with HIGH
FODMAP foods, avoiding HIGH FODMAP foods
can certainly help in “potentially” lowering
inflammation.
∙ The only way to really establish this, is by
MEASURING YOUR INFLAMMATORY
MARKERS (like CRP, ESR etc) BEFORE the
commencement of LOW FODMAP (for that
matter, ANY INTERVENTION) Protocol and
then AFTER A SIGNIFICANT PERIOD –
Perhaps 4 to 6 weeks AFTER the
commencement of the FODMAP diet.
∙ In fact, most people actually BENEFIT from
having high FODMAP foods in their diets, as a
lot of the high FODMAP food bring a lot of other
health benefits.
So, going on a “mindless” low FODMAP diet can
actually be counterproductive for otherwise
healthy adults.
What are some of the High FODMAP Foods &
their Alternatives?
1. Wheat & All Wheat Based (WB) foods – Like
WB Cereals, WB Breads, WB Crackers, WB
Pasta, WB Rotis, WB Pooris
Alternate Options To WB Foods:
∙ Brown Rice
∙ Buckwheat
∙ Maize
∙ Millet
∙ Oats
∙ Quinoa
∙ Polenta
NOTE: By weight wheat contains one of the lowest
quantities of FODMAP. And for this very reason, WB
thickeners and flavourings are perfectly ok.
2. Garlic: Why it should be avoided?
Because Garlic is high in Fructans
– One of the High FODMAP items
∙ Main type of FODMAP in Garlic is
Fructans – A high FODMAP item.
In fact, it is one of the most
concentrated sources of
FODMAPS.
∙ You must particularly avoid DRY
GARLIC, as the Dry Garlic
contains 3 times as many fructans
as fresh Garlic
∙ Alternatives to Garlic (Note:
Below alternatives are REALLY
WEAK, but nonetheless, could still
be OPTIONS).
∙ Chillies
∙ Fenugreek
∙ Chives
∙ Lemongrass
∙ Ginger
∙ Turmeric
∙ Mustard Seeds
NOTE: Garlic has a lot of health
benefits, so therefore, it must only be
avoided by people who really need to
avoid high FODMAP foods.
3. Onions:
Shallots (a form of an onion –
usually smaller, and has lot
sweeter and more delicate
flavour, when compared directly
with Onions) are one of the
highest sources of Fructans.
On the other hand, Spanish
Onions being the lowest.
(Spanish Onions are those with
the golden skin and white inside
– often easily available in India.)
Possible
Alternative: Asafoetida (‘Hing’
in Hindi) is a very strong Indian
spice, can be a potential
alternative – but is only limited to
cooking.
509
4. Some High FODMAP Fruits:
∙ Apples ∙ Fructose
∙ Cherries ∙ Mannitol
∙ Apricots ∙ High FODMAP veggies:
∙ Figs ∙ Asparagus
∙ Mangoes ∙ Brussels Sprouts
∙ Nectarines ∙ Cauliflower
∙ Peaches ∙ Chicory leaves
∙ Pears ∙ Globe
∙ Plums ∙ Jerusalem Artichokes
∙ Watermelon ∙ Bitter Gourd or Bitter Cucumber
∙ Prunes – although great in alleviating (Karela)
Constipation, but high in FODMAP. ∙ Leeks
∙ Lychees ∙ Mushrooms
∙ Custard Apple ∙ Snow Peas
∙ Figs ∙ Avocado (However, please note:
∙ Plums Avocados are only an issue, if
eaten in large quantities, especially
Alternate fruits, which are low for people who have issues with
FODMAP: SORBITOL)
∙ Bananas – Note: Less ripe the
banana, lower it is in FODMAP ∙ Low FODMAP veggies:
∙ Blueberries ∙ Bean Sprouts
∙ Kiwis ∙ Capsicum
∙ Mandarins (from the orange family) ∙ Carrots
∙ Oranges ∙ Eggplant
∙ Papaya ∙ Kale
∙ Pineapple ∙ Tomato
∙ Strawberries ∙ Spinach
∙ Rhubarb ∙ Zucchini
∙ Broccoli
NOTE: What is the issue with Fruits ∙ Celery
though? ∙ Red or Green Chilli
Well, the issue with fruits is, FRUCTOSE & ∙ Corn
Fructose falls on the FODMAP List – ∙ Cucumber
Higher the Fructose Content of Fruit – ∙ Ginger
Higher it’s FODMAP Score. ∙ Lettuce
∙ Potatoes
5. Some Vegetables: vegetables ∙ Sweet Potatoes
contain the most diverse range of ∙ Radish
FODMAPs. This includes Fructans, NOTE: Lot of High FODMAP
Galacto-Oligosaccharides (GOS), Veggies have a lot of health
Fructose, Mannitol and Sorbitol. benefits, so therefore, it MUST
∙ Some veggies contain more than 1 only be avoided by people who
type of FODMAP – For example, REALLY NEED to avoid HIGH
Asparagus. Asparagus contains: FODMAP foods.
∙ Fructans

510
6. Some Legumes, Pulses & Nuts:
∙ Legumes, Pulses & Nuts are often a
massive contributing factor in causing
all sorts of stomach discomforts. This
happens due to the often higher
content of FODMAP in Legumes and
Pulses.
∙ Key FODMAP often found in Legumes
and Pulses is called: Galacto –
Oligosaccharides (often referred to as
GOS, in short).
∙ NOTE: The GOS content of any food
can often be dictated by how a certain
food is prepared & its form. For
example boiled lentils contain almost
DOUBLE the amount of GOS, of
Canned Lentils.
∙ Why Does That Happen?
Because, GOS being water soluble, and
when you prepare/cook lentils in water (and
especially if you drain the initial preparation
– water, the lentils were boiled in) lot of the
GOS goes with the drained water.
∙ Below issues are often caused by
Legumes and Pulses
∙ Flatulence
∙ Bloating
∙ Indigestion
∙ Stomach Pains
∙ Constipation
∙ Gas
∙ High FODMAP legumes & pulses:
∙ Baked Beans
∙ Black Eyed Peas
∙ Broad Beans
∙ Butter Beans
∙ Kidney Beans
∙ Soybeans
∙ Lentils
∙ Chickpeas – Although Canned are
often proposed as Low FODMAP. But,
the information is conflicting.
∙ Low FODMAP alternatives:
∙ Tofu
∙ Most Nuts & Seeds
∙ Canned Lentils
∙ Urid Daal
∙ Chana Daal
∙ Black Beans (This is debatable, as the
information regarding this is conflicting.)
∙ Baked Beans
∙ Green Lentils
∙ Red Lentils
∙ RICE: Almost all kinds – Although NOT
PART OF THE LEGUMES OR PULSES,
Rice is still worth mentioning here, because
it can often offer a great ALTERNATIVE to
lot of High FODMAP Pulses and Legumes.
∙ Nuts which are ok for low FODMAP diet:
∙ Walnuts
∙ Almonds : Always a good idea to soak
almonds overnight. Reason why you soak
Almonds in water overnight or for few hours
before eating is, because Almonds skin
contains, what’s called Tannin, which
essentially inhibits the Nutrient Absorption.
It also helps in releasing the Fat Digesting
Enzyme, Lipase. However, please
remember, there is limited evidence of the
benefits of soaking almonds (or any other
nuts for that matter) overnight.
One study (
https://www.healthline.com/nutrition/soaking-
almonds#benefits ) showed, soaking almonds for
24 hours can reduce the Phytic Acid Content in
(More on Phytic Acid in the upcoming Anti
Nutrient Lecture)
∙ Cashews
∙ Pecans
∙ Pine Nuts
∙ Macadamia
∙ Peanuts – But, be very vary of peanuts –
because many people have other health
issues with Peanuts, too.
NOTE: Lot of the foods change their FODMAP
status, based on the
cooking/preparation/aging (bananas for
instance, more they ripe, higher they go on the
FODMAP scale). Lentils and Legumes are no
511
different.
7. Dairy:
∙ Lactose being high on the FODMAP
score, dairy (not all dairy though,
because not all dairy foods are high
in FODMAP, or even contain
Lactose – for example, matured
cheeses- as most of the Lactose
content is lost during the
cheesemaking process)
automatically becomes an issue for
anyone wanting to pursue a Low
FODMAP Diet. Most Dairy scores high
on FODMAP.
∙ High FODMAP Dairy Foods:
∙ Cream Cheese
∙ Cottage Cheese
∙ Milk
∙ Ricotta
∙ Yoghurt
∙ Low FODMAP Dairy Foods:
∙ Cheddar Cheese
∙ Fetta Cheese
∙ Camembere Cheese (Low Quantity is
ok – Generally below 30 – 40 Grams)
∙ Brie (Same as Camembere)
∙ Cream
∙ Lactose Free Milk
∙ Parmesan Cheese
NOTE: Other Alternatives can
include:
∙ Almond Milk – Low quantities only.
∙ Soy Milk (But ONLY if it’s made from
Soy Protein Extract – otherwise, if it’s
made from Soybeans, then it is high
on the FODMAP score)
∙ Coconut Milk – In limited quantities
only, though – because, Coconuts
contain High Amounts of Fructose
(part of the High FODMAP)
∙ Hemp Milk – Upto about 250Mls a day
is ok.
∙ Rice Milk – Upto about 200Mls a day
is ok, as anything above 250Mls has
been proposed to have high quantity
of Fructans (part of the High
FODMAP)
8. Certain Beverages:
∙ Not all beverages are high in
FODMAP of course. However as
mentioned earlier, KEY factor to
remember is, when you change the
original state of a given food, it can
also gravely change the ultimate
FODMAP score of that food. For
example, even though oranges
are low on the FODMAP Scale,
but when you extract juice from
Oranges, it automatically becomes
high FODMAP –by the sheer
volume of concentrated fructose.
So, one has to be mindful of the
fact – what might be perfectly in it’s
is “one” particular form, might be
the total opposite in it’s “altered”
form.
∙ High FODMAP Beverages:
Some Teas – Indian Chai for
example.
Some Alcoholic Beverages –
Like Dessert Wine and
Rum – Because of their
higher Fructose content.
Avoid any sweetish
alcoholic Beverages (like
Malibu, Tia Maria and
alike)
∙ Low FODMAP Beverages:
∙ Black Coffee (But, be mindful,
caffeine can be an irritant for lot of
people with IBS.)
∙ Green Tea
∙ Peppermint
∙ Vodka (But, be mindful, alcohol
can be an irritant for lot of people
with IBS)
∙ Lime/Lemon Juice: (These can a
great option for many, especially in
summers, when you can make
Lime/Lemon Juice drinks)
512
9. SOME OF THE OTHER GRAINS:
∙ Not all grains fall on the HIGH FODMAP
scale. In fact, there are many, which
don’t. Rye Bread for instance, falls LOW on
the FODMAP scale, even though Rye in it’s
original form, falls under HIGH FODMAP
food. As mentioned above,
Cooking/Preparation/ form changing can ALL,
ALTER THE FODMAP SCORE of many
foods, and Rye Bread is a classic example. It
is the Process of Fermentation, which the
Rye Bread goes under, significantly
REDUCES the FODMAP SCORE of Rye
Bread, as many of the FODMAPS are
BROKEN DOWN, INTO READY TO
ABSORB SUGARS.
∙ High FODMAP Grains:
• Amaranth
• Barley
• Rye
Low FODMAP grains:
∙ Brown Rice – Even though, “technically” not a
grain – but nevertheless, it makes for a great
alternative.
∙ Buckwheat
∙ Maize
∙ Millet (Jowar, Bajra and Ragi, all come
under Millets)
∙ Oats
∙ Poltenta
∙ Quinoa
∙ Topioca
NOTE: Turning raw grains, into BREAD can often
lower the FODMAP of that grain – even if that is
the case, you still want to ensure, you are not
OD’ing (Over Dosing) on those either.
Other notable low FODMAP foods:
• Eggs
• Meat – All kinds, Beef, Chicken, Fish etc.
Other notable high FODMAP items to avoid:
Some of the Artificial Sweeteners:
∙ Agave Nectar
∙ High Fructose Corn Syrup
∙ Honey
∙ Added Polyols (Naturally occurring Sugar
Alcohols) in Chewing Gum and often found in
many of the stone fruits.
8. Certain Beverages:
∙ Not all beverages are high in
FODMAP of course. However as
mentioned earlier, KEY factor to
remember is, when you change the
original state of a given food, it can
also gravely change the ultimate
FODMAP score of that food. For
example, even though oranges
are low on the FODMAP Scale,
but when you extract juice from
Oranges, it automatically becomes
high FODMAP –by the sheer
volume of concentrated fructose.
So, one has to be mindful of the
fact – what might be perfectly in it’s
is “one” particular form, might be
the total opposite in it’s “altered”
form.
∙ High FODMAP Beverages:
• Some Teas – Indian Chai for
example.
• Some Alcoholic Beverages – Like
Dessert Wine and Rum – Because of
their higher Fructose content. Avoid
any sweetish alcoholic Beverages
(like Malibu, Tia Maria and alike)
∙ Low FODMAP Beverages:
∙ Black Coffee (But, be mindful,
caffeine can be an irritant for lot of
people with IBS.)
∙ Green Tea
∙ Peppermint
∙ Vodka (But, be mindful, alcohol
can be an irritant for lot of people
with IBS)
∙ Lime/Lemon Juice: (These can a
great option for many, especially in
summers, when you can make
Lime/Lemon Juice drinks)
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SOME OTHER KEY & COMMON
QUESTIONS RELATING TO FODMAPS
1. Is FODMAP intolerance an immune
reaction or an autoimmune disorder?
Short answer is: No – It is not.
Unlike gluten sensitivity, FODMAP
intolerance is not an immune reaction.
Instead, the condition is an intolerance to
certain types of food.
This food intolerance is due to bacteria in
the colon, that ferment carbohydrates and
to the presence of too much water in the
large intestine, leading to diarrohea.
NOTE: Coach, please note – the above
question is from google – I just felt, it
could probably make a useful part of the
lecture.
How do you ascertain, if you need to or
you should consider going low fodmap?
Well, there isn’t a black or white rule.
However, a general approach, that most
people adopt is, to keep a diary of the
foods that seem to cause IBS like
symptoms (please refer above for IBS like
Symptoms) and then match them to the
FODMAP LIST OF HIGH AND LOW
FODMAP FOODS, and see where do most
of those foods fall on that spectrum.
Where can Low FODMAP approach be
useful?
∙ The low FODMAP diet is part of the
therapy for those with IBS and SIBO.
Research has found that it reduces
symptoms in up to 86% of people.
(8)
What are the Key Deficiencies and
Shortcomings of Low FODMAP
Foods?
∙ Complex and confusing.
∙ Requires substantial food
knowledge. For instance, most
varieties of soymilk are high-
FODMAP. Extra-firm tofu, on the
other hand, while also made from
soybeans, is low-FODMAP. (9)
∙ Might increase the potential for
nutritional deficiency risks if
some high FODMAP foods aren’t
reintroduced.
∙ Below are the Potential
shortcomings and issues, when it
comes to Vitamins & Minerals.
o Inadequate calcium intake
in people avoiding dairy,
many veggies, certain
grains like Amaranth.
o Magnesium is a concern:
Some of the best dietary
sources of magnesium
come from beans and nuts
like almonds and cashews,
which are usually
restricted during the initial
phase of the diet. In
addition, people with IBS
may already be at
increased risk of
magnesium deficiency due
to digestive symptoms like
diarrhoea.
514
o Long-term restriction of high-
FODMAP foods changes the
makeup of bacterial colonies in
the gut, which may negatively
impact intestinal health and
possibly worsen digestive issues
over time. Oligosaccharides, in
particular, are an important
energy source for beneficial
bacteria. This is particularly
worrisome for individuals with
IBS, who have been shown to
have lower levels of protective
intestinal bacteria and higher
levels of potentially harmful
inflammatory microbes.
Probiotics have been suggested
to restore such bacterial
imbalances, but this remains
contentious.
o The diet is not as well
researched for other
gastrointestinal conditions.
o Restriction of High FODMAP
foods can reduce natural
prebiotics, which are “a
substrate that is selectively
utilized by host microorganisms
conferring a health benefit”,
such as FOS
(fructooligosaccharides), GOS
(galactooligosaccharides), and
fibers, with possible changes in
intestinal microbiota which lack
the substrate for fermentation
and for its natural metabolic
activity.
Are There Any Phases Of
FODMAP?
(SOURCE: https://cdhf.ca/health-
lifestyle/phases-of-the-fodmap-diet-
explained/ )
Yes. Generally 3 Distinct Phases of
FODMAP are proposed, as listed
below:
1. Identification (there is no
mentioning of this, but when you
look at the content, it becomes
obvious, that the VERY FIRST
STEP is IDENTIFICATION OF
HIGH FODMAP FOODS in your
diet, hence I added
IDENTIFICATION) +
2. Elimination Phase:
∙ Generally, lasts for 2 to 6 weeks.
Sometimes even 8 to 10 Weeks
∙ Key Objective in this phase is to
IDENTIFY all possible High
FODMAP Foods in your Diet.
∙ Next is to ELIMINATE those foods
from the diet.
∙ Another thing that is proposed by
FODMAP proponents is, NOT TO
GET IMPATIENT during this
phase. Even though, many people
can start to feel the difference
(often improvement) within the 1st
week (often as little as 2 days), but
the KEY here is PERSISTENCE,
as sometimes it can take up to
even 4 to 6 Weeks to start to see
and feel the NOTICEABLE
difference.
515
3. Reintroduction Phase
∙ This is where you start reintroducing
some of the High FODMAP foods (as
many of the High FODMAP foods are
very nutrient dense, for example foods
like Garlic and FORTIFIED Grains).
∙ Foods are often introduced back ONE
AT A TIME & OFTEN NO FASTER
THAN 3 TO 6 DAYS – So that, you
can IDENTIFY OBJECTIVELY –
Which foods don’t cause/bring back
any of the previously experienced IBS
symptoms.
4. INTEGRATION PHASE:
∙ You bring back AGREEABLE High
FODMAP FOODS & then keep them
in your diet for good.
Weight of evidence:
∙ A meta-analysis of six randomized
controlled trials (RTC) 16 non
randomised control trials (Non
RTC) support the efficacy of the
LFD as a treatment for functional
gastrointestinal symptoms.
∙ Another meta-analysis included nine
RCTs with a total of 596 patients.
They found that an LFD, in
comparison to other diets, i.e.,
habitual diet, diet high in FODMAPs
(HFD), sham diet, and usual dietary
recommendations for IBS, was
effective and safe in the short-term.
Warning:
∙ “Anyone who is underweight
shouldn’t try this on their own. The
low FODMAP diet isn’t meant for
weight loss, but you can lose
weight on it because it
eliminates so many foods. For
someone at an already too low
weight, losing more can be
dangerous.” ~ Hazel Galon Veloso,
M.D., Gastroenterologist, Johns
Hopkins
∙ People with already restricted
diets, such as vegans or those with
food allergies, may be unable to
meet their nutritional needs on the
diet
Summary:
∙ There are also some potential LFD
limitations and concerns, including
nutritional adequacy, cost, and
difficulty in teaching the diet and
maintaining it. Most of these
limitations can be solved with the
involvement of a skilled nutritionist,
who can clearly explain the
different phases of the LFD and
ensure nutritional adequacy and
compliance.
∙ An LFD is currently suggested as
an effective treatment for IBS
despite the lack of long-term,
randomized controlled studies on
large numbers of patients. To date,
many existing studies are of a low
quality.
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E. All About Alcohol
What is Alcohol?
∙ Ethanol / ethyl alcohol
∙ Produced by the fermentation of
sugars and starches by yeast.
∙ Also found in some medicines,
mouthwashes, and household
products (including vanilla extract and
other flavorings).
∙ 1 gram of alcohol = 7 calories
∙ A Standard drink:
o 14.0 grams (0.6 ounces) of pure
alcohol (1 ounce = 30ml)
o This amount of pure alcohol is
found in:
▪ 12 ounces of beer
▪ 8–9 ounces of malt liquor
▪ 5 ounces of wine
▪ 1.5 ounces
▪ a "shot," of 80-proof liquor
∙ Heavy drinking (42):
o For women: 4 or more drinks a
day or 8 or more drinks a week.
o For men: 5 or more drinks a day
or 15 or more drinks per week.
∙ risks of these cancers are
substantially higher if one consumes
this amount of alcohol as well as uses
tobacco (45)
∙ even at moderate levels, alcohol use
increases all-cause mortality and risk
of death from several cardiovascular
diseases and reduces life expectancy.
(14)
∙ Another study found that alcohol use
uniformly increases blood pressure
and stroke risk; even moderate
drinking (2 drinks per day or less)
increased the risk of stroke by about
15%. (15)
Infectious diseases: Alcohol consumption
(more than 40g pure alcohol/day) has a
detrimental impact (via the immune system,
which is adversely affected by alcohol
consumption, especially heavy drinking )on
key infectious diseases, such as TB, HIV,
and pneumonia. (1)
Health Risks:
∙ Overall, 4% of the global burden of
disease is attributable to alcohol,
which accounts for about as much
death and disability globally as
tobacco and hypertension.
∙ Moderate to heavy alcohol
consumption is associated with
higher risks of certain head and
neck cancers.
∙ Moderate drinkers:
o 1.8-fold higher risks of oral
cavity and pharynx cancers
o 1.4-fold higher risks of larynx
cancers
∙ Heavy drinkers:
o 5-fold higher risks of oral
cavity and pharynx cancers
o 2.6-fold higher risks of larynx
cancers
∙ Any amount of alcohol
consumption is associated with
an increased risk of a type of
esophageal cancer. (1.3-fold
higher for light drinking to nearly 5-
fold higher for heavy drinking)
(43,44)
∙ Increased risk of breast cancer:
o light drinkers: 1.04 fold
higher risk
o moderate drinkers: 1.23 fold
higher risk
o heavy drinkers: 1.6-fold
higher risk
∙ Affects many aspects of
metabolism: impairs hepatic
gluconeogenesis and
subsequent glucose output and
storage. (27)
517
Effect on Protein Synthesis:
∙ Alcohol impairs myofibrillar protein
synthesis (MPS). The main affected muscle
fibers are type II, especially type IIx.
∙ Upto 15-20% decrease in basal protein
synthesis post 24 hrs of alcohol
consumption. (28)
∙ When you exercise, muscles undergo
stress and become damaged. To repair this
damage, muscles need protein. Protein
synthesis occurs to repair muscle protein.
MPS is the process that promotes protein
turnover.
∙ protein breakdown due to alcohol >
protein synthesis from nutrition (When
the body degrades muscle protein, it breaks
down more muscle than it builds)
∙ Many try combining protein sources with
alcohol to outweigh the negative effects.
This does not diminish the effects of alcohol
on muscle growth.
To help limit the severity of negative effects,
work out earlier in the day. Leave as much
time in between workouts and consumption
of alcohol as you can. This limits the effect it
has on muscle protein synthesis.
Effect on Hormones:
∙ Suppresses testosterone: by 23% On
ingesting higher doses of ethanol, 1.5 g/kg
when measured between 10-16 hrs (29)
∙ Alcohol has a major impact on the
conversion of testosterone to estrogen.
Effect on Fat %:
∙ Excess alcohol consumption creates a fatty
liver. Fatty liver influences your metabolism
and how your body stores energy.
∙ The buildup of fat is a result of the body
prioritizing alcohol calories over stored
energy. This takes away from burning
fats, carbs, and protein in the body.
∙ Alcohol → resistance to insulin → the
body’s blood sugar and estrogen levels
rise → fat storage increases
Effect on Sleep:
∙ Alcohol → disturbed sleep (esp
REM sleep) → hormone
imbalance
During REM sleep brain activity,
muscle repair, and learning is at
its highest.
∙ Alcohol → sleep disorders,
insomnia → hunger and satiety
issues.
Effect on Digestion:
∙ Disrupted Digestion → inflamed
stomach lining, Excess acid and
irritation of the stomach →
dehydration → low energy levels
and decreased athletic
performance.
Effect on Performance & Recovery:
∙ A strong immune system = higher
performance levels, weight loss,
and muscle growth.
Alcohol creates inflammation,
especially the stomach. This
impacts the immune system,
which is responsible for
protecting against injury and
sickness. Consuming alcohol
puts extra stress on the immune
system. Over time this weakness
takes focus away from
recovery and performance.
Instead the body tries to protect
itself against chronic alcohol
consumption.
∙ alcohol → weight gain and
stress → higher heart rate and
blood pressure → Hypertension
and cardiovascular disease
Effect on Nutrient Absorption:
∙ Impairs absorption Calcium, leads
to osteoporosis, mainly in women.
518
References:
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• PMID: 19949966
• PMID: 23584062
• PMID: 17431955
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• PMID: 21461366
• PMID: 11070527
• PMID: 20482788
• PMID: 21455813
• PMID: 29676281
• PMID: 30955975
• doi: https://doi.org/10.1136/bmj.h4238
• JAMA. 1999;281(17):1632-1637. doi:10.1001/jama.281.17.1632
• https://doi.org/10.1093/aje/kwx137
• Plasma Folate, Vitamin B6, Vitamin B12, Homocysteine, and Risk of Breast
Cancer - https://doi.org/10.1093/jnci/95.5.373
• Change in Alcohol Intake in Relation to Weight Change in a Cohort of US
Men with 24 Years of Follow-Up - https://doi.org/10.1002/oby.21979
• https://www.ahajournals.org/doi/abs/10.1161/circ.103.3.472
• Alcohol drinking and cancer - https://doi.org/10.1016/j.canep.2015.01.007
• Alcohol Consumption and Risk of Coronary Heart Disease in Older Adults:
The Cardiovascular Health Study
• The mechanism by which Alcohol and Wine Polyphenols Affect Coronary
Heart Disease Risk
• PMID: 8041531
• Moderate Alcohol Consumption Lowers the Risk of Type 2 Diabetes: A meta-
analysis of prospective observational studies
• PMID : 9815011
• PMID : 11584159
• PMID : 2128439
• PMID : 10029201
• Concurrent alcohol and tobacco dependence: mechanisms and
treatment

519
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• PMID: 25561386
• PMID: 12500123
• PMID: 10740940
• PMID: 15219332
• PMID: 25436842
• PMID: 17484067
• PMID: 24858377
• PMID: 25422909
• PMID: 24307268
• PMID: 19190158
• https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet
• Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a
comprehensive dose-response meta-analysis. British Journal of Cancer 2015;
112(3):580-593.
• LoConte NK, Brewster AM, Kaur JS, Merrill JK, Alberg AJ. Alcohol and cancer: A
statement of the American Society of Clinical Oncology. Journal of Clinical Oncology
2018; 36(1):83-93.
• Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use
and the risk of head and neck cancer: pooled analysis in the International Head and Neck
Cancer Epidemiology Consortium. Cancer Epidemiology, Biomarkers & Prevention
2009;18(2):541-550.

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F. Periodization
Why Periodization?
What is Periodization? ∙ reduced risk of over-training
Why Periodization? ∙ Performance optimization in a
Periodization Hierarchy specific time period
∙ For general fitness purposes,
1. What is Periodization? periodization helps maintain
∙ Whatever your performance goals are, training variation, and keep
improvement on each of the performance progress from plateauing.
variables needs a structured approach ∙ For athletes, the tapering period
towards manipulating the stimulii (load, before the competition reduces the
speed, weight, resistance, time etc) to risk of injury around the time of
optimize adaptive response. competition.
∙ “Periodization is long-term cyclic
structuring of training and practice to 3. Periodization Hierarchy
maximize performance to coincide with ∙ Periodization divides the training
important competitions.” (1) programs into time blocks (and sub
∙ It has many different profiles blocks).
∙ As an athlete becomes more experienced, ∙ Multilayer training structure
it becomes more and more difficult to ∙ A training year has smaller blocks
invoke adaptive response. of time where each has its own
∙ In both cases, the key is to structure the goals.
training (adjust training variables) in such
a manner that you optimize the athlete’s
performance to meet his goals, in the least
amount of time, without risking any injury
to the athlete. This is called ‘Periodization’.
∙ Athlete’s current performance →
modulating training variables in a pre-
planned, structured manner
(periodization) → Adaptive response →
Athlete achieves his performance goals
∙ What variables are relevant to an athlete
depends on the type of sport he’s in and
secondly to his goals. E.g. For a
bodybuilder, the relevant variables can be:
number of reps, amount of weight etc. For
a marathon runner, relevant variables can
be: pace/speed, or distance.
∙ Interestingly, for two sports, one variable
e.g. LOAD can mean two different things.
For example, in bodybuilding, LOAD
would mean amount of weight. For
Marathon running, LOAD would mean
speed! (2)

521
 Planning and Periodization Principle
(Image Source: ∙ Hierarchy:
https://fitnesswellnessworld.com/2012/03/1 o Quadrennial Cycle: Multi-
1/10-step-plan-for-tip-top-periodization/) year plan; >= 4 years
Planning and Periodization Principle o Macrocycle: Description of
(Image complete training period; <=
1 year
o Mesocycle (phase):
Description of single training
cycle/block; 3-4 weeks
o Microcycle: Description of
the structural unit of a
mesocycle; 1 week
o Training Day: Description of
multiple training sessions
designed in the context of
the particular microcycle it is
in; 1 day
o Workout: description of the
structural unit of a
microcycle, hours/minutes (If
the workout includes >30 min
of rest between bouts of
training, it would comprise
multiple sessions); Hours

Source:
https://fitnesswellnessworld.com/2012/03/1
1/10-step-plan-for-tip-top-periodization/)

References:
1. Verkhoshansky, Y., “Sport Strength Training Methodology”. Comment on Magnush. 2007
2. https://www.healthline.com/health/fitness/periodization-training#what-it-is
3. https://breakingmuscle.com/fitness/a-simple-guide-to-periodization-for-strength-training/

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