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Comprehensive and research based, the second edition of NSCA's Essentials of Personal Training is the resource to rely on for personal training information and guidance. With state-of-the-art knowledge regarding applied aspects of personal training as well as clear explanations of supporting scientific evidence, NSCA’s Essentials of Personal Training,Second Edition, is also the authoritative preparation text for those preparing for the National Strength and Conditioning Association’s Certified Personal Trainer (NSCA-CPT) exam.
This essential reference was developed by the NSCA to present the knowledge, skills, and abilities required for personal trainers. With contributions from leading authorities in the field, the text will assist both current and future personal trainers in applying the most current research to the needs of their clients:
- A discussion on nutrition outlines the role of the personal trainer in establishing nutrition guidelines, including the application of nutrition principles for clients with metabolic concerns.
- The latest guidelines on client assessment from prominent organizations—such as the American Heart Association (AHA) and Centers for Disease Control and Prevention (CDC)—keep personal trainers up to speed on the latest assessment protocols.
- New information is presented on flexibility training and cardiovascular exercise prescription as well as a discussion of research on the effectiveness of stability ball training.
- Revised information on design of resistance training programs incorporates the latest information on the application of periodization of training.
- New information addressing injuries and rehabilitation prepares personal trainers to work with clients with special concerns such as orthopedic conditions, low back pain, ankle sprains, and hip arthroscopy.
- New guidelines for determining resistance training loads will assist those whose clientele includes athletes.
- A variety of fitness testing protocols and norms allows readers to select from several options to evaluate each component of fitness.
- A new instructor guide and image bank aid instructors in teaching the material to students.
NSCA’s Essentials of Personal Training, Second Edition, focuses on the complex process of designing safe, effective, and goal-specific resistance, aerobic, plyometric, and speed training programs. Featuring over 200 full-color photos with accompanying technique instructions, this resource offers readers a step-by-step approach to designing exercise programs with special attention to the application of principles based on age, fitness level, and health status. Using comprehensive guidelines and sample clients portrayed in the text, readers can learn appropriate ways to adjust exercise programs to work with a variety of clients while accommodating each client’s individual needs.
Personal trainers will appreciate the book’s presentation of detailed exercise programming guidelines for specific populations. Modifications and contraindications to exercise are given for prepubescent youth, older adults, and athletes as well as for clients who are overweight or obese or have eating disorders, diabetes, heart disease, hypertension, hyperlipedimia, spinall cord injury, multiple sclerosis, and cerebral palsyIn addition, the book provides clear, easy-to-understand guidelines for initial client consultation and health appraisal.
For those preparing for the NSCA-CPT exam, this second edition features new and revised study questions at the end of each chapter. These questions are written in the same style and format as those found on the NSCA-CPT exam to fully prepare candidates for exam day. For efficient self-study, answers to study questions and suggested solutions for the applied knowledge questions are located in the back of the text. Chapter objectives and key points provide a framework for study and review of important information, while sidebars throughout the text present practical explanations and applications of scientific concepts and theory.
The second edition of NSCA’s Essentials of Personal Training is the most comprehensive resource available for current and future personal trainers, exercise instructors, fitness facility and wellness center mangers, and other fitness professionals. Unmatched in scope, this text remains the leading source for personal training preparation and professional development.
Part I. Exercise Sciences
Chapter 1. Structure and Function of the Muscular, Nervous, and Skeletal Systems
The Muscular System
The Nervous System
The Skeletal System
Conclusion
Learning Aids
Chapter 2. Cardiorespiratory System and Gas Exchange
Cardiovascular Anatomy and Physiology
Respiratory System
Conclusion
Learning Aids
Chapter 3. Bioenergetics
Essential Terminology
Energy Systems
Substrate Depletion and Repletion
Oxygen Uptake and the Aerobic and Anaerobic Contributions to Exercise
Practical Application of Energy Systems
Conclusion
Learning Aids
Chapter 4. Biomechanics
Mechanical Foundations
Biomechanics of Human Movement
Muscular Control of Movement
Biomechanics of Resistance Exercise
Conclusion
Learning Aids
Chapter 5. Resistance Training Adaptations
Basic Adaptations to Resistance Training
Acute Adaptations
Chronic Adaptations
Factors That Influence Adaptations to Resistance Training
Overtraining
Detraining
Conclusion
Learning Aids
Chapter 6. Physiological Responses and Adaptations to Aerobic Endurance Training
Acute Responses to Aerobic Exercise
Chronic Adaptations to Aerobic Exercise
Factors That Influence Adaptations to Aerobic Endurance Training
Age
Overtraining
Detraining
Conclusion
Learning Aids
Chapter 7. Nutrition in the Personal Training Setting
Role of the Personal Trainer Regarding Nutrition
Who Can Provide Nutrition Counseling and Education?
Dietary Assessment
Energy
Nutrients
Weight Gain
Weight Loss
Evaluating Weight Loss Diets
Dietary Supplements
The Art of Making Dietary Recommendations
Conclusion
Learning Aids
Chapter 8. Exercise Psychology for the Personal Trainer
Mental Health Aspects of Exercise
Goal Setting
Motivation
Methods to Motivate a Client
Conclusion
Learning Aids
Part II. Initial Consultation and Evaluation
Chapter 9. Client Consultation and Health Appraisal
Purpose of Consultation and Health Appraisal
Delivery Process
Client Consultation
Preparticipation Health Appraisal Screening
Evaluation of Coronary Risk Factors, Disease, and Lifestyle
Interpretation of Results
Referral Process
Medical Clearance
Conclusion
Learning Aids
Chapter 10. Fitness Assessment Selection and Administration
Purposes of Assessment
Choosing Appropriate Assessments
Assessment Case Studies
Administration and Organization of Fitness Assessments
Interpretation and Review of Results
Reassessment
Conclusion
Learning Aids
Chapter 11. Fitness Testing Protocols and Norms
Vital Signs
Body Composition
Cardiovascular Endurance
Muscular Strength
Muscular Endurance
Flexibility
Conclusion
Learning Aids
Part III. Exercise Technique
Chapter 12. Flexibility, Body Weight, and Stability Ball Exercises
Defining Flexibility
Flexibility Training as Part of the Total Exercise Program
Benefits of Flexibility Training
Factors Affecting Flexibility
Elasticity and Plasticity
Types of Flexibility Training
Recommended Flexibility Routine and Guidelines
Warm-Up
Body Weight and Stability Ball Exercises
Conclusion
Flexibility, Body Weight, and Stability Ball Exercises
Learning Aids
Chapter 13. Resistance Training Exercise Techniques
Fundamental Exercise Technique Guidelines
Spotting Resistance Training Exercises
Conclusion
Resistance Training Exercises
Learning Aids
Chapter 14. Cardiovascular Training Methods
Safe Participation
Training on Cardiovascular Machines
Nonmachine Cardiovascular Exercise Techniques
Conclusion
Learning Aids
Part IV. Program Design
Chapter 15. Resistance Training Program Design
General Training Principles
Initial Fitness Consultation and Evaluation
Determination of Training Frequency
Exercise Selection
Exercise Order
Training Load: Resistance and Repetitions
Training Volume: Repetitions and Sets
Rest Intervals
Variation
Sequencing Training
Progression
Sample Programs for Targeted Training Outcomes
Conclusion
Learning Aids
Chapter 16. Aerobic Endurance Training Program Design
Specificity of Aerobic Endurance Training
Components of an Aerobic Endurance Training Program
Types of Aerobic Endurance Training Programs
Conclusion
Learning Aids
Chapter 17. Plyometric and Speed Training
Plyometric Mechanics and Physiology
When to Use Plyometric Exercise
Safety Considerations
Plyometric Program Design
Speed Training Mechanics and Physiology
Speed Training Safety Considerations
Combining Plyometrics and Speed Training With Other Forms of Exercise
Conclusion
Plyometric and Speed Drills
Learning Aids
Part V. Clients With Unique Needs
Chapter 18. Clients Who Are Preadolescent, Older, or Pregnant
Preadolescent Youth
Older Adults
Pregnant Women
Conclusion
Learning Aids
Chapter 19. Clients With Nutritional and Metabolic Concerns
Overweight and Obesity
Eating Disorders
Hyperlipidemia
Metabolic Syndrome
Diabetes Mellitus
Conclusion
Learning Aids
Chapter 20. Clients With Cardiovascular and Respiratory Conditions
Health Screening and Risk Stratification
Hypertension
Myocardial Infarction, Stroke, and Peripheral Vascular Disease
Chronic Obstructive Pulmonary Disease
Asthma
Conclusion
Learning Aids
Chapter 21. Clients With Orthopedic, Injury, and Rehabilitation Concerns
Injury Classification
Impact of Injury on Function
Tissue Healing Following Injury
Orthopedic Concerns and the Personal Trainer
Low Back
Shoulder
Ankle
Knee
Hip
Arthritis
Conclusion
Learning Aids
Chapter 22. Clients With Spinal Cord Injury, Multiple Sclerosis, Epilepsy, and Cerebral Palsy
Spinal Cord Injury
Multiple Sclerosis
Epilepsy
Cerebral Palsy
Conclusion
Learning Aids
Chapter 23. Resistance Training for Clients Who Are Athletes
Factors in Program Design
Periodization of Resistance Training
Linear and Nonlinear Models of Periodized Resistance Training
Conclusion
Learning Aids
Part VI. Safety and Legal Issues
Chapter 24. Facility and Equipment Layout and Maintenance
Facility Design and Planning
Facility Specification Guidelines
Selecting Exercise Equipment
Floor Plan and Equipment Organization
Special Considerations for a Home Facility
Facility and Equipment Maintenance
Conclusion
Learning Aids
Chapter 25. Legal Aspects of Personal Training
Claims and Litigation
Fitness Industry Response to Claims and Litigation
Claims in Health and Fitness Activities
Records and Documentation
Ethical Codes
Conclusion
Learning Aids
Founded in 1978, the National Strength and Conditioning Association (NSCA) is an international nonprofit educational association with members in over 56 countries. Drawing on its vast network of members, the NSCA develops and presents the most advanced information regarding strength training and conditioning practices, injury prevention, and research findings.
Unlike any other organization, the NSCA brings together a diverse group of professionals from the sport science, athletic, allied health, and fitness industries. By working to find practical applications for new research findings in the strength and conditioning field, the association fosters the development of strength training and conditioning as a discipline and as a profession.
Jared W. Coburn, PhD, CSCS,*D, FNSCA, FACSM, is a professor of kinesiology at California State University at Fullerton, where he has earned numerous awards for teaching and research excellence. Before entering the world of academia, Coburn worked as a personal trainer, strength and conditioning coach, and director of physical therapy clinics and fitness and wellness centers. His interest in applying scientific principles to the training of clients and athletes is based largely on his experience as a practitioner.
Coburn has published widely and frequently lectures on topics related to exercise training. He is particularly interested in studying muscle function during strength, power, and endurance exercises and has presented his work in peer-reviewed journals and textbook chapters. Coburn is an active member of the National Strength and Conditioning Association, where he has held membership since 1984. He holds bachelor’s and master’s degrees from California State University at Fullerton and a PhD from the University of Nebraska at Lincoln.
Coburn lives with his wife, Tamara, and their two children in Norco, California.
Moh H. Malek, PhD, CSCS,*D, NSCA-CPT,*D, FNSCA, FACSM, is an associate professor in the College of Pharmacy and Health Sciences and director of the Integrative Physiology of Exercise Laboratory at Wayne State University in Detroit, Michigan.
Malek conducts research in both human and animal models examining the underlying mechanisms of muscle fatigue. In 2010, Malek received the NSCA’s Terry J. Housh Outstanding Young Investigator of the Year Award. Malek has published over 60 peer-reviewed papers related to exercise physiology and has presented his research at the NSCA National Conference since 2004. Since 2007, he has served as associate editor of Journal of Strength and Conditioning Research. He also serves on the editorial board of Medicine & Science in Sport & Exercise. Malek received his bachelor’s degrees in biology and psychology from Pitzer College, his master’s degree in kinesiology from California State University at Fullerton, and a PhD in exercise physiology from the University of Nebraska at Lincoln.
Malek and his wife, Bridget, reside in Northville, Michigan. In his free time, Malek enjoys watching football, fitness training, and reading.
Instructor guide. Provides chapter summaries; sample lecture outlines; ideas for assignments, lab activities, and class projects; ideas for discussion or essay topics; lists of additional suggested readings; tips for presenting key concepts; and the study questions and answers from the book.
Image bank. Contains figures, tables, and photos from the text for easy incorporation into lectures and presentations.
The image bank is also available for purchase • ISBN 978-0-7360-8433-8
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors.
How much protein does my client need?
For centuries, protein was considered the staple of the diet and the source of speed and strength for athletic endeavors. Although we now know that carbohydrates are the main energy source for humans, protein remains a main nutrient of interest, especially among bodybuilders, weightlifters, and others who engage in resistance training.
When answering the question “How much protein does my client need?” the personal trainer must consider two key factors, energy intake and source of protein. Protein may be used for energy when fewer calories are consumed than are expended. If this is the case, protein intake will not be used solely for the intended purpose of building and replacing lean tissue. Thus, when caloric intake goes down, the protein requirement goes up. Dietary protein requirements were derived from research on subjects who were consuming adequate calories. Requirements for clients who are dieting for weight loss are higher than standard requirements.
Additionally, protein requirements are based on “reference proteins” such as meat, fish, poultry, dairy products, and eggs, which are considered high-quality proteins. If protein in the diet comes mostly from plants, the requirement is higher. The U.S. Recommended Dietary Allowance (RDA) for protein for healthy, sedentary adults is 0.8 g/kg of body weight for both men and women (31). The World Health Organization identifies the safe intake level, a level that is sufficient for 97.5% of the population, at 0.83 g protein/kg per day. The safe level ensures a low risk that needs will not be met but also includes the concept that there is no risk to individuals from excess protein intake up to levels considerably higher than 0.83 g/kg (51). Though the intake set by both of these organizations may be sufficient for nonactive healthy, young adults, it is not appropriate for clients who have greater protein needs to help offset protein-amino acid oxidation during exercise, repair muscle damage, and build lean tissue. A general recommendation for athletes is 1.2 to 2.0 g/kg per day depending on the sport, training intensity, total calorie intake, and overall health (10).
The personal trainer should be aware that excessively high protein intakes (e.g., greater than 4 g/kg body weight per day) are not indicated for clients with impaired renal function, those with low calcium intake, or those who are restricting fluid intake. These situations could be exacerbated by a high protein intake. For the most part, however, concerns about potential negative effects of high protein intakes are unfounded, especially in healthy individuals. Proteins consumed in excess of amounts needed for the synthesis of tissue are used for energy or are stored.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Helping a client after total knee arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia.
Total Knee Arthroplasty
Years of repetitive loading to the human knee can result in degeneration and degradation of the joint surfaces of the distal femur and proximal tibia. Often the degeneration is specifically located on either the medial or the lateral side of the knee joint, based on wear patterns and more specifically the individual's lower extremity alignment. People who are excessively bow-legged (genu varum) or knock-kneed (genu valgum), or who have had serious injury to the knee (such as extensive fractures through the joint, meniscal pathology, or instability of the knee due to unrepaired or failed repair of ligamentous structures), are often candidates for a total knee replacement.
Total knee arthroplasty (TKA) requires extensive exposure of the joint with a large central incision. Prosthetic components are selected and inserted to cover the worn areas at the ends of both the femur and tibia. Rehabilitation begins immediately with a ROM focus. Individuals perform open and closed kinetic chain exercises initially in the hospital and at home prior to formal outpatient rehabilitation.
Movement and Exercise Guidelines

Following discharge from formal rehabilitation, clients often have 100° to 120° of knee flexion and nearly complete knee extension. Indications for exercise include cycling, swimming, and endurance-based activities that minimize joint impact loading and improve muscular and cardiovascular function and fitness levels. Specific exercises such as leg press, multidirection hip strengthening, calf raises, and knee flexion and extension exercises using a low resistance and high repetition format are recommended. As an example, lunges onto a BOSU ball (figure 21.16) are not only a strategy for strengthening; they also benefit balance and proprioception for the entire kinetic chain.
Again, closed kinetic chain exercises that place the knee in greater than 100° of flexion are risky and impose added stresses on the knee. Further, because kneeling is generally contraindicated during the first few weeks following TKA, it is necessary for clients to avoid exercises requiring that position (e.g., kneeling lat pulldown, bent-over dumbbell row using a bench) or exercises that may cause them to kneel inadvertently (e.g., lunges performed too deeply). Exercises using less than 90° knee flexion postures are recommended in both open and closed kinetic chain exercises.
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.
Exercise testing and training guidelines for clients with multiple sclerosis
Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- Complex skill-oriented exercises should be avoided in most persons with MS, partly because of the loss of proprioception, or ability to perceive muscle and joint position in space.
- The energy cost of walking may be two to three times higher than normal for people with MS, particularly those with advanced disease; thus adjustments in workloads to maintain a 60% to 75% maximal heart rate are necessary.
- Persons with MS are thermosensitive and therefore at increased risk for both heat- and cold-related injuries; this emphasizes the need to ensure adequate hydration and to have persons with MS exercise in thermoneutral environments. In addition, dehydration during exercise could be exacerbated in persons with MS who have bladder dysfunction (incontinence or sense of urgent need to urinate or both) and sometimes limit their fluid intake.
- It is important to be cautious with large muscle lower limb exercise, since muscle spasticity may be particularly predominant in the hip abductor and adductors.
- Sensory loss may preclude certain exercises such as free weights because of a client's inability to grasp the bars effectively, and may necessitate modification in other forms of exercise.
- Strapping may be necessary if more severe spasticity is present.
- Some evidence suggests that morning, when circadian body temperature is at its lowest, may be the preferred time for exercise.
- Recumbent bicycling may be preferred over upright cycling in clients with balance problems.
- Imbalances between agonist and antagonist muscles are common.
- Muscle weakness tends to be greatest in the lower limb and trunk muscles.
- Neuromuscular problems such as foot drop may be present in more advanced cases.
- Some clients may have cognitive deficits and are prone to depression; caution is warranted in education of these individuals, and constant reinforcement to enhance compliance is generally needed in clients with MS.
- The variable nature of MS symptoms and progression requires that the personal trainer adjust the exercise program on a daily basis.
- It is advisable to monitor heart rate before, during, and after aerobic exercise to ensure the appropriate metabolic intensity and stimulus.
- Regular follow-ups to monitor progress are highly recommended with persons who have MS in order to facilitate compliance and to adjust the exercise prescription appropriately.
- In the case of an exacerbation, exercise should be discontinued until complete remission.
- Since some individuals with MS have cognitive impairments, it may be necessary to provide information and instruction in both written and diagram formats. Frequent reminders of exercises, technique, and proper use of equipment may be necessary.
- If the client has incoordination in either the upper or the lower limbs, the use of a synchronized leg and arm ergometer may improve exercise performance by allowing the arms or legs to assist the weaker limbs.
- Resistance training should be performed on nonendurance training days to avoid fatigue.
- Resistance training should be done in the seated position initially if balance is impaired.
- Flexibility exercises should be performed from either a seated or a lying position (16, 41, 56).
Read more from NSCA's Essentials of Personal Training, Second Edition By the National Strength & Conditioning Association.