PERSONAL TRAINING QUARTERLY

PTQ VOLUME 4
ISSUE 4
DEC | 2017
 PERSONAL TRAINING QUARTERLY

PTQ
ABOUT THIS PUBLICATION
Personal Training Quarterly (PTQ)
publishes basic educational
information for Associate and
Professional Members of the NSCA
specifically focusing on personal
trainers and training enthusiasts. As VOLUME 4
a quarterly publication, this journal’s
mission is to publish peer-reviewed
ISSUE 4
articles that provide basic, practical DEC | 2017
information that is research-based
and applicable to personal trainers.

Copyright 2017 by the National

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Strength and Conditioning
Nick Tumminello, NSCA-CPT ATC, CSCS
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Scott Austin, MS, CSCS
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PTQ 4.4 | NSCA.COM

TABLE OF CONTENTS

4
FROM SUCCESSFUL TRAINER TO
GYM OWNER—9 STEPS TO OPEN
YOUR FIRST FACILITY: PART 1
DAVID CRUMP, NSCA-CPT

10 EFFECTS OF EXERCISE ON
OSTEOPOROSIS: PART 4
CARMINE GRIECO, PHD, CSCS,
AND MIKE REEDER, DO

16 HOW TO IMPROVE YOUR SALES SKILLS

AND GET MORE CLIENTS WITHOUT
COMPROMISING YOUR VALUES
RYAN KETCHUM

22
WHOLE FOOD, PLANT-BASED DIETS
JOHN MCNAMARA, PHD, CSCS,*D,
NSCA-CPT,*D, USAW

26
COMMON PRACTICE FOR PERSONAL
TRAINERS THAT SHOULD NOT BE SO
COMMON—PART 1: EXAMINATION
OF COMMON PRACTICES
ROBERT LINKUL, MS, CSCS,*D,
NSCA-CPT,*D, RCPT*D, FNSCA

30
SIMPLIFYING THE RULES
TO PROGRAMMING FOR
SPECIAL POPULATIONS
TOM CORMIER, CSCS, CSPS,
NSCA-CPT,*D, USAW

34
PRACTICAL APPLICATIONS FOR
ROTATIONAL POWER TRAINING
DAVID OTEY, CSCS, NSCA-CPT

42
EXAMINING THE EFFICACY OF
COMMON FITNESS AND MOVEMENT
TESTS—PERSONAL PERSPECTIVE
LEE BOYCE

44
THE UNDERVALUED LUNGE
JONI BOYD, PHD, CSCS, AND KATY MILTON, MS

50
ARE THE SEATED LEG EXTENSION,
LEG CURL, AND ADDUCTION MACHINE
EXERCISES NON-FUNCTIONAL OR RISKY?
NICK TUMMINELLO, NSCA-CPT, AND
ANDREW VIGOTSKY, NSCA-CPT

PTQ 4.4 | NSCA.COM

FEATURE ARTICLE

FROM SUCCESSFUL TRAINER TO GYM OWNER—9

STEPS TO OPEN YOUR FIRST FACILITY: PART 1
DAVID CRUMP, NSCA-CPT

INTRODUCTION product, where it is positioned against its competitors, and even

A
t some point in their career, almost every single fitness how it treats its customers.
professional will consider opening their own facility
to grow their business and make their mark on the The first and most important step for a trainer looking to open
industry. What most of these coaches and trainers will quickly their first fitness facility is to perform a brand audit on their
realize, however, is that while they have spent countless hours business. Taking the time to make sure that there is a clear
honing their craft, they have not accumulated the knowledge to vision of what their business stands for, what makes it different
confidently open their own facility. The transition from trainer from competitors, and specifically who are the target customers
to facility owner can be very intimidating and full of surprises. allows that professional to communicate clearly with the
This article series aims to prepare and guide fitness professionals intended market.
through the nine essential steps to opening their first fitness
facility. Each installment of this 3-part series will feature three The most successful fitness businesses understand their ideal
steps with actionable information that has helped multiple real customer and are able to properly articulate the solution they
trainers successfully open their first gym. provide. This is made possible by exploring their core values,
mission, and training philosophy. By breaking down each of these
Featured in this first installment is phase 1 of the process, “taking characteristics one at a time and analyzing what that means,
inventory.” Prior to searching for a location, purchasing equipment, a business owner can create a unified message known as a
or committing to a multi-year lease, a fitness professional should unique value promise that truly speaks to the community they
perform an evaluation of the current state of their business. Just as desire to serve.
any decent coach wouldn’t have a client perform a heavy deadlift
without first conducting a fitness or movement assessment, a MISSION STATEMENT
potential facility owner shouldn’t move forward without assessing A mission statement is a short, succinct statement of what a
the state of their current business. business stands for, its purpose, and why those things matter.
While the goal of many business ventures is to make money
STEP 1: CONDUCT A BRAND AUDIT and create freedom for the business owner, there has to be a
deeper purpose. Now, more than ever, customers want to feel
The “brand” of a business is ultimately the perception that connected to the establishments they frequent through a mutual
potential customers have of said business. It can be comprised of cause or belief.
multiple factors such as what the business does, how it delivers its

4 PTQ 4.4 | NSCA.COM

Coaches or trainers can formulate their mission statement by A fitness professional that is fully aware of their training
digging deep to uncover their personal beliefs about why their philosophy will not only have an incredibly accurate understanding
service is important. For example, some trainers may be motivated of the DNA of their business, but also a solid grasp of what sets
to help others because they too were once overweight and them apart from their competition; both of which will contribute
struggled with challenges such as low self-esteem, harassment, or to future success as a gym owner.
health issues. By proudly declaring its mission, a fitness facility will
attract and retain customers that are in alignment with that vision UNIQUE VALUE PROPOSITION
as well as recruit others to join the cause. A unique value promise is the specific message that is
communicated to the market about what a business delivers in its
A sample mission statement could be: customer’s own words. In the fitness space, this message is best
formulated by combining the mission statement of the business
“Our mission at John Doe Fitness is to help members of the with its training philosophy. The outcome should be a message
community live their best lives by using fitness as a catalyst that defines the specifics of the type of work done, who the ideal
for greatness.” customer is, what makes it different, and most importantly, why.

TRAINING PHILOSOPHY
In “The Power of Why,” C. Richard Weylman explains that the main
A training philosophy is the foundation of everything a coach
difference between a unique value proposition (UVP) and a unique
or trainer does and is of critical importance. It is a group of
selling proposition (USP) is that the former is customer-centric
principles and concepts that govern what a fitness professional
while the latter is business-centric. Business-centric companies
believes about fitness and how they approach helping their
focus on getting customers by talking about their accolades,
athletes or clients reach their goals. From an exercise selection
reputation, and what they have to offer. Customer-centric
perspective, the hierarchy of a training philosophy should look
businesses instead focus on communicating their understanding
something like this:
of their ideal customer’s needs and how they can give them what
they want (3).
Principles > Methods > Techniques > Tools > Exercises
To best illustrate his point, Weylman uses the comparison of the
Principles are universal and established. Examples include the
Goodyear and Michelin tire companies in the 90s. Throughout the
SAID (specific adaptations to imposed demands) principle as well
previous two decades, Goodyear had outsold Michelin easily by
as the principle of overload. These form the basis of research-
relying on its brand recognition and its slogan “we are number 1
supported exercise theory and are the “rules” from which all
in tires!” However, as soon as Michelin polled its customers and
professionals work.
discovered that the real reason they purchased their tires was
because they were on the cutting edge, they reworked their
Methods, on the other hand, are not quite as concrete and are the
message. Instead of using their current message “we sell steel-
first choice that allows a coach to differentiate their style. These
belted radials,” they switched to “a better way forward” and
can be best described as the way a trainer utilizes their knowledge
built their business around what their target customer wanted to
of the principles. For example, they may choose to employ full
support their new branding. They redefined how they operated
body training programs or implement a body part split. Either
and even started offering “promise plans” instead of warranties.
choice could produce overload for the athlete or client, but the
As a result, they finally overtook Goodyear as the leader
coach will likely make their choice based on their experience.
in market share.
Techniques are strategies like super-setting, circuit training, or
pre-exhaust training. There is research to support these strategies, STEP 2: ASSESS YOUR CURRENT NUMBERS
but they are not completely necessary and lend themselves more
to preference or situational needs which further allows a trainer to Any business, fitness oriented or otherwise, lives and dies by
customize their process. the numbers. If you are considering opening your own facility,
then you should be very familiar with the metrics of a fitness-
Finally, tools are simply the item that trainers use to create based business.
resistance for each exercise. Examples include resistance bands,
barbells, kettlebells, medicine balls, dumbbells, etc. The following key performance indicators will help you identify the
health of your business and make it easier to determine if opening
By defining their training philosophy, a coach or trainer can make your own facility is a good idea. With this data you will be able to
sure that they not only understand the reasoning behind the way determine an ideal rent for your facility, set equipment purchase
that they implement their exercise coaching, but also be able and start-up budgets, and make sure it is a good idea to move
to explain that philosophy to potential customers and have it forward in securing a brick and mortar location for your business.
resonate with them. Additionally, this training philosophy should
also include the soft side of coaching. Characteristics such as how If, however, these metrics are foreign to you or you struggle to
a trainer instills motivation in clients or reinforces behavior are just understand them and their calculations then you should reconsider
as important in appealing to the right demographic. whether it is time for you to move forward with opening
your own facility.

PTQ 4.4 | NSCA.COM 5

FROM SUCCESSFUL TRAINER TO GYM OWNER—9 STEPS
TO OPEN YOUR FIRST FACILITY: PART 1

REVENUE STATS the number of active customers the current month and dividing
Gross Revenue (Top Line Revenue): This is how much total it by the amount of those customers that are retained into
revenue a business generates before taxes, labor, utilities, or any the next month.
other expense for that matter. Usually this number is measured
monthly or yearly. A very simple example would be if you had 100 members at
your gym and 3 cancelled, then you would only have 97 of those
Net Income (Revenue): The “net” revenue is the amount of money members moving into the next month and a retention rate of 97%.
that is left after a business has paid all its expenses. This is how Obviously if you retain all the same customers then your retention
much the business actually made. This number is calculated by rate is 100%. Congrats!
taking the gross revenue and subtracting all of the various costs
(expenses) and taxes. This metric is one of the most important While this number is usually tracked monthly, it is also useful to
because if a business isn’t actually making money than its chances track over longer periods of time in order to calculate the lifetime
to success long-term are limited. value of a customer (see below).

In a service-based business such as fitness, net revenue should Average Customer Payment: The average customer payment is
be at least 25 – 30% of total gross revenue. More gross revenue the average amount of money that a fitness facility collects from
doesn’t always mean more net revenue. This is how potential one customer each month. This can be figured out by taking the
problems can be identified. For example, if the gross revenue of total monthly revenue of the business (for the specific service) and
a business is going up but the net stays the same or is reduced dividing it by the amount of customers that are currently using
for an extended period of time, then it is likely that there are too that service offering.
many expenses on the books. While substantial gross revenue is
necessary to get money flowing through a business, net revenue For example, if a group training facility wanted to figure out their
will ultimately keep it alive. average customer payment for their 60 members, they would
divide their monthly revenue of $7,500 by 60 and realize an
COSTS average monthly payment of $125.
Costs are easily defined as the expenses of a business. Also known
as “CODB” (cost of doing business) or “COGS” (cost of goods This metric is very helpful when a business is trying to
sold), these are the items that must be purchased or utilized predict future revenues, hit goals, or set its pricing structure
in order to conduct business. Costs can be broken down into 2 for profitability.
main categories:
Lifetime Value of a Customer (LVC): The LVC is how much money
Fixed Costs: These expenses are known as “fixed” because they the average customer will spend with a gym over the entire time
are predictable and usually occur monthly or on a regular basis. that they continue as a member. In order to calculate this, an
Some common fixed costs are utilities, rent, labor, and any other owner will need to know how long the average customer will do
expenditures that you allot a monthly budget for like marketing business with them (by looking at retention rates) and multiply
or advertising. that by their average monthly payment per customer.

Having a good handle on fixed costs will allow an owner to At a personal training studio, if most clients train for an average of
determine how much money they are actually making, generate 8 months and the average client payment is $400 per month, then
accurate projections for growth, and identify areas where they the LVC is $3,200.
may be overspending.
This metric is very important because it can help a coach or trainer
One Time Costs: These are expenses that are “one-off” that don’t decide the best client acquisition strategy for their business.
occur regularly. There will be times that you have to invest in your Knowing that each customer will spend $3,200 means that trainer
business in response to something unexpected. can spend a considerable amount of money to get a new client
and still come out ahead.
Maybe the air conditioning unit dies in the middle of summer, a
critical piece of equipment breaks, or a natural disaster damages STEP 3: FUND YOUR DREAM
the gym. The one thing that can be expected is that things can One of the biggest challenges that fitness professionals will
and will go wrong, leading to unexpected expenses. For this face when trying to open their own facility is starting out with
reason, business owners should always have reserve funds set adequate funding. No one gets into personal training to get rich
aside as a best practice. because there are certainly many other paths that would yield
a greater financial reward. Most coaches and trainers select this
CUSTOMER STATS career out of sheer passion and simply do their best to find a
Retention: This number is usually expressed in a percentage way to pay their bills as necessary. However, taking a “wing it”
and references the amount of customers/clients that a fitness approach will not work considering that undercapitalization is the
business keeps over a period of time. This is calculated by taking reason that many small businesses fail.

6 PTQ 4.4 | NSCA.COM

 NSCA.com

Fitness professionals that aim to open their first gym must more appealing to a trainer that prefers being part of a team and
determine how much capital they have available to get their would like someone to shoulder the responsibilities. Regardless of
project rolling. This process should begin with a self-assessment the arrangement chosen, it is imperative that the responsibilities
to determine their options. Below are some of the questions that of all involved are outlined in writing to facilitate a sound working
should be included in that assessment: relationship and create proper accountability.

• How much money can I contribute to this project in cash TRADITIONAL FINANCING
from my own accounts or reserve funds? The route of traditional financing has been a staple in acquiring
• What is my credit score and ability to get financing? business start-up capital for decades. There are many banks that
• What is my level of risk aversion? are still willing to loan money to open small businesses and the
• Do I want to be the sole owner of this facility or Small Business Association (SBA) can even help facilitate such
would I prefer to take on a partner who could transactions with approved lenders. This process, however, can be
contribute financially? very stringent and require a lot of supporting documentation. In
• Based on how the above questions were answered, the addition to a solid business plan and the standard loan application,
would-be entrepreneur will end up with 3 likely scenarios: the following items are usually needed to acquire traditional
self-funding, partner acquisition, or traditional financing. financing for a new business (2):

SELF-FUNDING • Personal history and financial statements

For a coach or trainer that desires to be the sole owner of their • Business financial statements or projected profit and
gym and prefers to minimize their risk, self-funding would be loss statements
the preferred way to finance the start-up costs of their business. • Ownership and affiliation documents
Taking on a large traditional loan can weigh heavily on a business • Business licenses and certificates
for the next 3 – 7 years and if the owner has decent credit and • Loan application history
some cash reserves, it is likely that they can get their first facility • Personal and business tax returns from previous years
off the ground with some creative boot-strapping techniques. • Owner resumes
The real benefit to self-funding is that a business will be able to • Business history and overview
be debt free sooner and won’t spend any money paying back • Business lease documentation
interest or have to worry about shouldering large loan payments
during slow months. Between the long and lengthy process and the long-term debt
of traditional financing, most new fitness businesses should be
The main challenge here is that many fitness professionals won’t discouraged from going this route. This is supported by statistics
have enough available cash to self-fund even a small, basic facility from the SBA that indicate that only 48.4% of all small businesses
as those can still cost tens of thousands of dollars; that’s where last for 5 years, which is usually the standard loan term (1).
boot-strapping techniques come in. Two strategies that work
very well in this instance are selling services in advance, such as CONCLUSION
large personal training packages or paid-in-full memberships of While many fitness professionals will undoubtedly consider
6 months or more, or utilizing 0% interest credit cards that offer making the transition from trainer to facility owner, it can be
a 12 or 18-month repayment period. Both of these options will very intimidating. The best way for coaches and trainers to
create some immediate funding with flexible repayment, however, alleviate these concerns is to follow the correct steps to prepare
they still need to be utilized responsibly based on your current accordingly. The first 3 steps of the process laid out above will
monthly revenue. serve as a self-evaluation that will help the future gym owner
identify where their business may be lacking and gain the clarity
PARTNER ACQUISITION of that is needed to move forward.
If a trainer does not have the ability to fund their facility personally
or does not have the risk tolerance or credit to obtain traditional REFERENCES
financing, then acquiring a partner could be a good move. Some 1. SBA Frequently Asked Questions. Retrieved from The Small
of the potential advantages include more market exposure, access Business Administration: https://www.sba.gov/sites/default/files/
to more capital, and someone to share the risk and workload. advocacy/SB-FAQ-2016_WEB.pdf. 2017.
Just like anything else, however, great care should be taken
2. U.S. Small Business Administration. 7(a) Loan Application
when choosing a partner in order to ensure a smooth working
Checklist. Retrieved May 2017 from https://www.sba.gov/loans-
relationship and an alignment of visions.
grants/see-what-sba-offers/sba-loan-programs/general-small-
business-loans-7a/7a-loan-application-checklist. 2017.
There are two main roles that a partner (or partners) could play:
investor/silent partner, or operating partner. The former may be 3. Weylman, CR. The Power of Why. New York:
more beneficial to a fitness professional that prefers to maintain New Harvest; 2013.
full control of the direction of their fitness business and doesn’t
mind sharing a percentage of their profits while the latter might be

PTQ 4.4 | NSCA.COM 7

 FROM SUCCESSFUL TRAINER TO GYM OWNER—9 STEPS
TO OPEN YOUR FIRST FACILITY: PART 1

ABOUT THE AUTHOR

David Crump is an entrepreneur, fitness business consultant, and
personal trainer. Since entering the fitness industry in 2006, he
has climbed the ranks of corporate management, opened multiple
fitness facilities, and helped hundreds of clients improve their
lives. Crump has been featured in PFP Magazine, Personal Training
Quarterly, and is a regular contributor to The Personal Trainer
Development Center. Additionally, he currently owns and operates
Spark Fitness, a personal training studio in Orlando, FL, and works
with trainers around the country to help them achieve their dream
of opening their own gym.

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EFFECTS OF EXERCISE ON OSTEOPOROSIS: PART 4

CARMINE GRIECO, PHD, CSCS, AND MIKE REEDER, DO

PREFACE osteoporotic fracture in their lifetime (23). While less frequent

T
his article is the last in a 4-part series, which will explore the in African Americans, those with osteoporosis have the same
impact of exercise on a variety of diseases and conditions. elevated fracture risk (5).
Despite the efficacy of exercise as both a prevention and
treatment for so many diseases and conditions, standard medical BONE HEALTH AND IMPACT OF PHYSICAL ACTIVITY
interventions (notably medications) remain the “go to” option While there are many factors that contribute to optimizing bone
for most individuals. Recent estimates by the National Center for density, physical activity and/or exercise plays an important role
Health Statistics suggest that nearly 50% of the United States in the development and maintenance of bone health. The skeletal
(U.S.) population have used a prescription drug within the last system is active tissue and responds to the amount and types
30 days (16). Comparatively, only 1 in 5 U.S. adults meet the of movement experienced during daily life. Lack of activity and
recommended physical activity guidelines (15). Therefore, the weight bearing, in addition to other factors such as genetics,
aim of this article series is to provide context for understanding smoking, malnutrition or corticosteroid therapy, contribute to low
the efficacy of exercise as adjunct therapy and compare this to bone mass or osteoporosis (17). Of the modifiable lifestyle factors,
commonly prescribed treatments. amount and type of physical activity have a significant impact on
the variance in BMD (11).
OSTEOPOROSIS OVERVIEW/EPIDEMIOLOGY
Diseases related to lifestyle (i.e., sedentary behavior, poor Bone, as a dynamic tissue, is undergoing a constant remodeling
nutrition, stress management, etc.), such as hypertension and process. Both intrinsic (i.e., genetics, hormone levels, etc.) as
type 2 diabetes, are becoming the norm in the United States., well as extrinsic factors (i.e., gravity, ground reaction forces)
where half of all adults have at least one chronic health condition will influence osteogenic activity. Forces that positively affect
(24). Another important example is osteoporosis, which is osteogenic remodeling are categorized as either joint reaction
defined by the National Osteoporosis Foundation as a chronic forces (i.e., muscular contractile forces) or ground reaction
disease with bone fragility, low bone mass, microarchitecture forces. According to Wolff’s Law, bone will increase (or decrease)
deterioration of bone and a subsequent increased risk of fracture strength in relation to mechanical loading (8). This remodeling of
(18). Osteoporosis is defined as a bone mineral density (BMD) bone mineral content and architecture (i.e., bone matrix) occurs
score (T-score) that is ≥-2.5 standard deviations below the mean in response to directional and load-specific stimuli. To optimize
value for healthy young adults, at the lumbar spine, femoral neck the osteogenic effect of mechanical forces, exercise should create
or hip (22). In addition, low trauma fractures of the hip and spine a strain upon the skeletal system that is “unique, variable and
are consistent with osteoporosis, even without BMD testing. dynamic in nature,” (11).
Osteopenia or low bone mass, a precursor to the diagnosis of
osteoporosis, is defined as a T-score that is >-1 and <-2.5 (22). The American College of Sports Medicine (ACSM), in their
Position Stand on Physical Activity and Bone Health, recognize
Osteoporosis contributes to almost 9 million fractures annually, the importance of exercise for optimal bone development, and
resulting in an osteoporotic fracture every 3 seconds (10). There promote two basic strategies (11):
are over 40 million people in the United States with osteoporosis
or low bone mass (osteopenia), which represents 55% of those 1. Achieving an optimal peak bone mass early in life (<30 years)
over the age of 50 (18). Women are more likely to be diagnosed 2. Minimizing bone loss later in life (>40 years)
with osteoporosis and approximately half of all Caucasian females
will have an osteoporotic fracture at some point in their lives. This blueprint highlights a concept that is of great importance
Men are less likely to be diagnosed, but 20% will sustain an for achieving optimal bone development. It recognizes that the

10 PTQ 4.4 | NSCA.COM

highly anabolic nature present throughout the developmental A fundamental factor that differentiates the effect of resistance
years (particularly childhood and adolescence) creates a unique training from high-impact weight-bearing exercise is that
environment for osteogenic activity. When this “window of resistance training creates an osteogenic stimulus primarily via
opportunity” is taken advantage of, BMD and peak bone mass joint reaction forces (i.e., muscular contractions) while high-impact
will be maximized, and the residual impact of this will continue weight-bearing exercise creates an osteogenic stimulus through
throughout the lifespan. Peak bone mass can be thought of as a the generation of ground reaction forces. It is important to note,
retirement account of sorts, or “bone bank,” as the body will draw however, that while high-impact weight-bearing exercise has
upon the “savings” accrued early in life. shown promise in its ability to promote osteogenic activity, this
type of activity can increase risk of injury in “at risk” populations,
For example, it is estimated that 26% of total adult bone mineral so care must be taken when implementing an exercise program.
content is laid down during a 2-year period of adolescence
(1). In order to maximize peak bone mass and BMD the ACSM Any type of exercise will generate contractile forces (i.e., joint
recommends children and adolescents engage in activities known reaction forces) and potentially influence bone remodeling.
to augment osteogenic activity, including activities that produce However, it is apparent that some types of exercise are better for
high ground reaction forces and muscle strengthening exercises stimulating significant osteogenic activity. This is a critical point
(11). The implication of this is that while osteoporosis is a disease in discussing overall health and wellness with specific endurance
presenting in adulthood, the importance of weight bearing athletes. As an example, cycling is a low-impact, non-weight
activity begins in childhood and adolescence and then continues bearing activity that may generate high levels of muscular force
throughout the lifetime (9,25). (i.e., joint reaction forces), but does not produce ground reaction
or impact forces. In fact, multiple studies have shown decreased
Exercise must impart a stimulus great enough to elicit an adaptive BMD in cyclists (2,19,21). Moreover, a 7-year longitudinal study
response (i.e., the SAID principle). Progressive high-intensity found a significantly greater decline in BMD of male master class
resistance training protocols have demonstrated an ability to cyclists than in active, but nonathletic, age-matched control
increase some measurements of BMD in individuals of all ages subjects. Importantly, the authors also found that participants
(3,20). However, results have not been universally consistent. A that reported engaging in weight training or impact exercises had
meta-analysis that investigated the effect of resistance training significantly less decline in BMD (19).
on bone preservation in post-menopausal women found a non-
significant increase in BMD at the femoral neck and lumbar spine Swimming, also a non-weight bearing aerobic activity, has
(28). Similarly, another meta-analysis found that increases in BMD demonstrated similar results in regard to BMD. Schofield and
occurred only in postmenopausal women that were concurrently Hecht, in a review of bone health in endurance athletes, state
receiving hormone replacement therapy (13). Males may fare “cross sectional studies in male and female adolescent and
better with resistance training interventions. A 2013 systematic collegiate swimmers have uniformly shown no benefit in BMD
review, which investigated the effect of a variety of types of over inactive controls and lower BMD when compared with other
exercise on BMD in older males, found that resistance training athletes,” (21). Endurance training that incorporates weight-
(alone, or in combination with impact-loading activities) positively bearing and impactful movements (e.g., running) positively
affected BMD (3). impacts osteogenic activity more than non-weight bearing
endurance training. Also, while BMD scores of endurance athletes
While resistance training alone has generated inconsistent results, are frequently superior to sedentary populations, they tend to
combined training (i.e., progressive high-intensity resistance be lower than athletes participating in sports which emphasize
training combined with high-impact weight-bearing exercise, multi-directional loading and power-oriented force production
such as aerobic dance/step, skipping, jumping, and weighted- (e.g., soccer, basketball, volleyball) (21). This is important in the
vest aerobic exercise) has shown greater promise in promoting recommendations and education of endurance athletes.
osteogenic activity. A 2015 meta-analysis compared resistance
training and combined resistance training on the preservation The American College of Sports Medicine (ACSM) Position
of BMD in post-menopausal women (28). Training interventions Stand on Physical Activity and Bone Health provides
were a minimum of 6 months and populations included only older exercise programming guidance for children and adults
(>50 years), previously sedentary females that were not receiving (Tables 1 and 2) (11).
pharmacological treatment to enhance BMD. Subgroup analysis
revealed that only combined training protocols significantly TABLE 1. ACSM PHYSICAL ACTIVITY
increased lumbar and hip BMD (2.4% and 1.8%, respectively), while RECOMMENDATIONS FOR CHILDREN (11)
resistance training alone had no significant effect.
Impact activities (e.g., jumping, plyometrics),
Mode moderate-intensity resistance training,
A more recent meta-analysis provided further evidence in support
sports that involve running and jumping
of combined training, concluding “combined exercise protocols
that integrated different exercise training modes tended to High (for bone loading forces),
Intensity
be effective in improving or preserving lumbar spine, femoral resistance training <60% 1RM
neck, total hip, and total body BMD in post-menopausal women, Frequency Minimum of 3x/week
which supports the concept that combined exercise protocols Duration 10 – 20 min/day (or more)
frequently generate non-site-specific effects on mechanical
loading sites,” (27).

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EFFECTS OF EXERCISE ON OSTEOPOROSIS: PART 4

TABLE 2. ACSM PHYSICAL ACTIVITY any osteoporotic fracture by 38% and a 45% decreased risk of
RECOMMENDATIONS FOR ADULTS (11) vertebral fracture in those on bisphosphonate therapy versus the
Weight-bearing aerobic activities, control group (4).
Mode jumping activities (i.e., volleyball,
basketball), and resistance training Bisphosphonates are generally regarded as an effective and safe
treatment option; however, adverse side effects are a concern,
Intensity Moderate to high (for bone loading forces)
with minor gastrointestinal issues being the most common. The
Weight-bearing aerobic activities 3 – 5x/ risk of rare, but serious side effects, such as atypical femoral
Frequency
week; resistance exercise 2 – 3x/week fractures with prolonged usage, remains a concern (7).
30 – 60 min/day of a combination of
Duration weight-bearing aerobic and jumping Differences in methodological design, statistical analysis, target
activities and resistance training variables and reporting among studies make direct comparisons
between the effect of drug therapy and exercise intervention
DRUG THERAPY difficult. However, as a point of comparison, a recent meta-analysis
There are a variety of pharmacological and nutritional options concluded that combined resistance training protocols, which
available for the treatment of osteoporosis, including hormone included study durations ranging from 6 to 36 months, increased
therapy (i.e., estrogen, parathyroid hormone), nutritional hip and spine BMD approximately 1.8% and 2.4%, respectively in
supplementation (i.e., calcium, vitamin D) and bisphosphonates. healthy post-menopausal women (28). In comparison, a large
Bisphosphonates are the first-line pharmaceutical treatment of randomized controlled trial investigating the drug Alendronate,
osteoporosis and work by inhibiting bone resorption (i.e., bone one of the most commonly prescribed bisphosphonates,
catabolism) (4). found increases of BMD at the hip and spine of 3.4% and 8.3%,
respectively, in healthy, post-menopausal females after four years
Bisphosphonates are an effective therapy for risk reduction of therapy (6).
of osteoporotic fracture, particularly in post-menopausal
females (12). A 2017 meta-analysis found a reduced risk of

FIGURE 1. BONE DENSITY ACROSS THE LIFESPAN

12 PTQ 4.4 | NSCA.COM

 NSCA.com

CONCLUSION 6. Cummings, SR, Black, DM, Thompson, DE, Applegate, WB,

Exercise and physical activity are necessary for the development Barrett-Connor, E, Musliner, TA, Palermo, L, Prineas, R, Rubin,
of optimal bone health, as well as the preservation of BMD SM, Scott, JC, Vogt, T, Wallace, R, Yates, AJ, and LaCroix, AZ.
throughout life. Physical activity during the developmental Effect of alendronate on risk of fracture in women with low bone
years is of utmost importance to achieve peak bone mass and density but without vertebral fractures: results from the Fracture
maximize “savings” accrued in the “bone bank.” After the fourth Intervention Trial. JAMA 280(24): 2077-2082, 1998.
decade of life the rate of bone loss is approximately 0.5% per 7. Crandall, CJ, Newberry, SJ, Diamant, A, Lim, YW, Gellad, WF,
year, but exercise can help to minimize this loss (11). Higher Booth, MJ, Motala, A, and Shekelle, PG. Comparative effectiveness
levels of physical activity are associated with a reduced risk of of pharmacologic treatments to prevent fractures. Annals of
osteoporotic fracture in men and women (14). In addition, fat-free Internal Medicine 161: 711-723, 2014.
mass is strongly associated with the preservation of bone mass
8. Frost, HM. Wolff’s law and bone’s structural adaptations
during aging (11).
to mechanical usage: An overview for clinicians. The Angle
Orthodontist 64(3): 175-188, 1994.
It is imperative as health and fitness professionals to understand
the impact of exercise on skeletal health and overall wellness 9. Janz, KF, Letuchy, EM, Eichenberger, Gilmore, JM, Burns,
and to continue to serve as an educational resource for clients TL, Torner, JC, Willing, MC, and Levy, SM. Early physical activity
and communities. Taken together, both cross-sectional as well as provides bone health benefits later in childhood. Medicine and
interventional studies point toward several important components Science in Sports and Exercise 42(6): 1072-1078, 2010.
for achieving and maintaining optimal bone health: 10. Johnell, O, and Kanis, JA. An estimate of the worldwide
prevalence and disability associated with osteoporotic fractures.
1. Appropriate weight-bearing activities and resistance training Osteoporosis International, 17:1726, 2006.
during the developmental years will ensure peak bone mass
11. Kohrt, WM, Bloomfield, SA, Little, KD, Nelson, ME, and
2. High-impact, multi-directional skeletal loading, combined with Yingling, VR, American College of Sports Medicine. American
resistance training that generates high-intensity joint-impact College of Sports Medicine Position Stand: Physical Activity and
forces appears to maximize bone remodeling stimuli across Bone Health. Medicine and Science in Sports and Exercise 36(11):
the age spectrum 1985-1996, 2004.
12. Levis, S, and Theodore, G. Summary of AHRQ’s comparative
3. Non-weight bearing aerobic activities may not create effectiveness review of treatment to prevent fractures in men
sufficient musculoskeletal strain to generate adequate and women with low bone density or osteoporosis: Update of
osteogenic activity the 2007 report. Journal of Managed Care Pharmacy 18(4 Suppl
B): S1-S15, 2012.
REFERENCES
13. Martyn-St James, M, and Carroll, S. High-intensity resistance
1. Bailey, DA, Mckay, HA, Mirwald, RL, Crocker, PRE, and
training and postmenopausal bone loss: A meta-analysis.
Faulkner, RA. A six-year longitudinal study of the relationship of
Osteoporosis International 17(8): 1225-1240, 2006.
physical activity to bone mineral accrual in growing children: The
University of Saskatchewan Bone Mineral Accrual Study. Journal of 14. Moayyeri, A, Besson, H, Luben, RN, Wareham, NJ, and
Bone and Mineral Research 14(10): 1672-1679, 1999. Khaw, KT. The association between physical activity in different
domains of life and risk of osteoporotic fractures. Bone
2. Barry, DW and Kohrt, WM. BMD decreases over the course of
47(3): 693-700, 2010.
a year in competitive male cyclists. Journal of Bone and Mineral
Research 23(4): 484-491, 2008. 15. National Center for Health Statistics. Exercise or Physical
Activity. Retrieved September, 2017 from
3. Bolam, KA, van Uffelen, JG, and Taaffe, DR. The effect of
https://www.cdc.gov/nchs/fastats/exercise.htm
physical exercise on bone density in middle-aged and older
men: A systematic review. Osteoporosis International 24(11): 16. National Center for Health Statistics. Health, United States,
2749-2762, 2013. 2015: With special feature on racial and ethnic health disparities.
Hyattsville, MD. Retrieved September, 2017 from http://www.cdc.
4. Byun, JH, Jang, S, Lee, S, Park, S, Yoon, HK, Yoon, BH, and Ha,
gov/nchs/data/hus/hus15.pdf#079
YC. The efficacy of bisphosphonates for prevention of osteoporotic
fracture: An update meta-analysis. Journal of Bone Metabolism 17. National Institutes of Health. Handout on Health:
24: 37-49, 2017. Osteoporosis. Retrieved September, 2017 from
https://www.niams.nih.gov/health_info/bone/osteoporosis/
5. Cosman, F, de Beur, SJ, Leboff, MS, Lewiecki, EM, Tanner,
osteoporosis_hoh.asp#5
B, Randall, S, and Lindsay, R. Clinicians guide to prevention and
treatment of osteoporosis. Osteoporosis International 25(10): 18. National Osteoporosis Foundation. Facts and Statistics.
2359-2381, 2014. Retrieved September, 2017 from
https://www.iofbonehealth.org/facts-statistics

PTQ 4.4 | NSCA.COM 13

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19. Nichols, JF and Rauh, MJ. Longitudinal changes in bone ABOUT THE AUTHORS
mineral density in male master cyclists and nonathletes. Journal of Carmine Grieco received his Doctoral degree from Old Dominion
Strength and Conditioning Research 25(3): 727-734, 2011. University and is an Assistant Professor at Colorado Mesa University
20. Ryan, AS, Ivey, FM, Hurlbut, DE, Martel, GF, Lemmer, JT, in Grand Junction, CO. A personal trainer with over 15 years training
Sorkin, JD, Metter, EJ, Fleg, JL, and Hurley, BF. Regional bone experience, he successfully made the transition from personal
mineral density after resistive training in young and older men and trainer to professor in 2012. Grieco is a past West Virginia State
women. Scandinavian Journal of Medicine and Science in Sports Director for the National Strength and Conditioning Association
14(1): 16-23, 2004. (NSCA) and also holds certifications as a yoga teacher, exercise
physiologist, health coach, and Certified Strength and Conditioning
21. Schofield, KL and Hecht, S. Bone health in endurance athletes:
Specialist® (CSCS®) through the National Strength and Conditioning
Runners, cyclists, and swimmers. Current Sports Medicine Reports
Association (NSCA).
11(6): 328-334, 2012.
22. Siris, ES, Adler, R, Bilezikian, J, Bolognese, M, Dawson- Mike Reeder is a primary care sports medicine physician who
Hughes, B, Favus, MJ, Harris, ST, Jan de Beur, SM, Khosla, S, Lane, has been involved in the care of athletes from the Little League
NE, Lindsay, R, Nana, AD, Orwoll, ES, Saag, K, Silverman, S, and to Olympic level. He presently is the Director of the Monfort
Watts, NB. The clinical diagnosis of osteoporosis: A position Family Human Performance Lab at Colorado Mesa University in
statement from the National Bone Health Alliance Working Group. Grand Junction, CO.
Osteoporosis International 25(5): 1439-1443, 2014.

23. U.S. Department of Health and Human Services. Bone health

and osteoporosis: A report of the Surgeon General. Rockville,
MD: U.S. Department of Health and Human Services, Office of the
Surgeon General, 2004. Retrieved September 2017 from https://
www.ncbi.nlm.nih.gov/books/NBK45513/
24. Ward, BW, Schiller, JS, and Goodman, RA. Multiple chronic
conditions among US adults: A 2012 update. Preventing Chronic
Disease 11: 130389, 2014.

25. Welton, DC, Kemper, HC, Post, GB, Van Mechelen, W, Twisk,
J, Lips, P, and Teule, GJ. Weight-bearing activity during youth is a
more important factor for bone mass than calcium intake. Journal
of Bone Mineral Research 9(7): 1089-1096, 1994.

26. Wright, NC, Looker, AC, Saag, KG, Curtis, JR, Delzell, ES,
Randall, S and Dawson-Hughes, B. The Recent Prevalence of
Osteoporosis and Low Bone Mass in the United States Based
on Bone Mineral Density at the Femoral Neck or Lumbar Spine.
Journal of Bone Mineral Research 29(11): 2520-2526, 2014.

27. Zhao, R, Zhang, M, and Zhang, Q. The effectiveness of

combined exercise interventions for preventing postmenopausal
bone loss: A systematic review and meta-analysis. Journal of
Orthopaedic and Sports Physical Therapy 47(4): 241-251, 2017.

28. Zhao, R, Zhao, M, and Xu, Z. The effects of differing resistance

training modes on the preservation of bone mineral density
in postmenopausal women: A meta-analysis. Osteoporosis
International 26: 1605-1618, 2015.

14 PTQ 4.4 | NSCA.COM

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PTQ 4.4 | NSCA.COM 15
FEATURE ARTICLE

HOW TO IMPROVE YOUR SALES SKILLS AND GET MORE

CLIENTS WITHOUT COMPROMISING YOUR VALUES
RYAN KETCHUM

E
ver get thrown into a sales role during your time as a The key to selling without selling out is focusing on the value you
personal trainer? Usually before you are ready. If so, there bring to the prospect and taking a few, pre-determined steps to
is a good chance you have either shown promise as a top find out what is in their best interest. You are getting ready to
trainer in your club or you have taken the wonderful leap into discover the necessary steps to sell without selling out.
business ownership as a studio owner or independent contractor
relying on sales to generate your income. QUALIFY A GOOD FIT FOR YOU AND THE CLIENT
The first step in your sales process should be structured to ensure
Sales is a dirty word for most personal trainers. You would much the prospect is a good fit for you and that you are a good fit
rather study up on the latest nutrition, training or motivational for them. Many sales training methods for personal trainers use
coaching methods than shore up your skills as a sales person. qualifying to position the personal trainer as a high-end solution
No one is blaming you for that. Your passion lies in helping your or use it as some sort of ego boost. To sell without selling out you
clients get better results through your training programs. Once need to take a slightly different approach to qualifying and use it
you have developed a strong skill set for delivering those results, as a chance to connect with your prospect.
if you want to have control of your earning potential as a personal
trainer, it is important to master the art of the sale. Successful qualifying depends on an abundance mindset. You
need to be prepared to refer out or pass on a potential new client
SELLING WITHOUT SELLING OUT if they are not a good fit. A scarcity mindset, where you think
The biggest objection to learning sales is the fear that you will be there are not enough clients to go around, will keep you from truly
selling out or somehow negating your skills as a personal trainer qualifying clients. There is a fine line between persuading someone
or coach if you learn to sell. Nothing is further from the truth. that you are the best fit and pressing them to buy training because
Sales is not about tricking someone into doing something that you need a new client. Make sure you are confident in your abilities
is not good for them or swindling someone out of a few bucks. and are willing to refer out or recommend a different solution if
Sales is a skill that can be used for good or it can be misused, and someone is not a great fit for you.
abused, to trick prospects into deciding what is not in their best
interest. You are obviously a skilled personal trainer who values Usually, qualifying can take place on a 10 – 15-minute phone call
your education and has ethics. If not, you would not be reading with your potential new client. The sooner you can connect with
this publication, right? them after they have indicated interest the better off you will be
as you navigate the sales process. Aim to call the potential new
client within 24 hours of learning of their interest.

16 PTQ 4.4 | NSCA.COM

As a busy personal trainer, focused on delivering the best results THERE ARE 4 CRITICAL PHASES
for your clients, it is important to protect your time. This qualifying OF A SUCCESS SESSION:
step will keep you from meeting with prospects who are not
able to afford your training, are not seeking the results you can 1. Engagement
deliver or are not committed to the process. You are not taking 2. Discovery
an aggressive approach to evaluate your prospect during this call, 3. Value Building
rather you are working to discover a potential good fit prior to 4. The Surefire Close
investing more time and energy.
FIGURE 1. CRITICAL PHASES OF SUCCESS SESSION
THE 4 PHASES OF SUCCESSFUL CONSULTATION
Consultation sounds so stuffy, which is why “Success Session” is
my preferred title for your consultations or sales appointments.
The goal of this meeting is to figure out a success plan for
the prospective new client to reach their goals, which may or
may not include working with you. It frames this meeting as a
positive experience and interrupts the normal thought patterns of
your prospect.

The Success Session should last 60 minutes, up to 90 minutes

if you are performing an assessment during the meeting. The
assessment is not a critical part of the sales process, but it
often allows a personal trainer to feel more comfortable selling.
Remember, that as you go through your Success Session, any
assessment is more valuable to you for programming than it is to
the client for reaching their goals. If you choose to not perform
an assessment in the initial Success Session you can easily include
this in their first session or in an additional meeting.

FIGURE 2. QUESTIONS TO ASK DURING DISCOVERY PHASE

PTQ 4.4 | NSCA.COM 17

HOW TO IMPROVE YOUR SALES SKILLS AND GET MORE
CLIENTS WITHOUT COMPROMISING YOUR VALUES

During the Engagement Phase of your Succession Session you There are 6 parts to the Surefire Closing System:
want to establish a connection with your prospect. Building
rapport will help your prospect feel more comfortable in the FIGURE 3. SUREFIRE CLOSING SYSTEM
later stages of the Success Session and ensure that you get the
information needed to suggest the appropriate plan of action. The
prospect is often nervous about starting this new journey and this
short (3 – 5 minute) phase of your Success Session can calm them.

The Discovery Phase is the most important piece of a successful

Success Session. During this phase, you will work to uncover the
challenges, pains, goals, and desires of your prospect. Getting this
information and truly understanding your prospect will help you
more than any closing trick or tactic.

Ask questions that help you understand how the prospect sees
themselves and feel in their current state. Once you have a clear
picture in your head, and the prospect has described themselves
in detail, you can move on to a more positive approach of asking
them how they want to look, feel, live, etc.

FIGURE 2. QUESTIONS TO ASK DURING DISCOVERY PHASE

If you are asking the right questions there is a good chance The Transition is a scripted 2 – 3-line question that you will use
your prospect will get a little emotional or frustrated. That is each Success Session to train your brain to transition to the close.
okay. Be supportive and keep prodding so you can smoke out This allows you to eliminate any stumbling over the move from
the real issues they are experiencing and provide them with a building value to closing.
great solution.
Here is your transition script:
Now that you have a good idea of where the prospect is and
where they want to go it is time to help them see how you “Mrs. Jones clearly you are motivated to lose 20 lb and you
will help them get there. This is the Value Building Phase of see the benefit of working with one of our coaches, having
the Success Session, and it is your opportunity to establish your program individually designed and having a consistent
your expertise. source of motivation and accountability to ensure you meet
your goals, right?”
Clearly explain to the prospect how you will get them started,
the methods you will use to help them overcome their biggest The second step in this closing system is the Core Offer. This is
challenges and what you will do to help them reach their final the beginning of your traditional sales pitch and recommending
goal. It is important to remember that the prospect is not an the program that you feel will best help the prospective client
exercise or physiology expert. Speak to them in simple terms and get the results they desire. Recall the information you acquired in
help them understand how you will help them. Use phrases they your Discovery Phase and use that to determine the best fit for
used in explaining their challenges and their goals. frequency of training and the program.

Once you have laid out the path to success and answered the Here is your example script:
prospect’s questions it is time to move to the final phase of the
“Great! Based off our conversation I feel that we have two
Success Session.
programs that will help you lose 20 lb and start feeling great
again. Our personal training program is a great fit for you and
THE SUREFIRE CLOSING SYSTEM
will get you the best results. I suggest that you choose either
Spending an hour or more with a prospect and not closing a
our 2 days per week program or our 3 days per week program.
deal or having to discount your prices to sign up a new client is
frustrating. The Surefire Closing System was created to help you
The two days per week program is best for someone that may
stick to your values and sign up more new clients without having
want to do a little extra work outside the gym on their own or
to discount your prices.
has a tight schedule due to kids or travel.

This is the only time during the sales process that a script is
The three days per week program is best for someone that
recommended. The script allows you to comfortably transition to
needs all the guidance and accountability they can get and has
the close and eliminates the nerves you will inevitably face if you
the time to consistently get to the gym for workouts.”
try to do this without it. All in all, it should only take 2 – 3 minutes
to complete this phase of the Success Session.

18 PTQ 4.4 | NSCA.COM

 NSCA.com

It is not quite time to ask for the close yet. Now is the time to Here is your script:
over-deliver on value and make this offer irresistible. Typically,
this is where many personal trainers would discount their prices “I also want you to know that we offer a no questions asked
to get a prospect to sign up, but we are going to take a different money back guarantee on your program. If you are not happy
approach. You are going to add more value and justify the with your results or our program in any way during the first 30
prices you charge. days, we will give you a full refund and tear up your agreement.

The best way to make this offer irresistible is adding bonuses Sound like a deal?”
for action takers. You should aim to stack a few bonuses in the
form of accessories, equipment, or programs that will accelerate It is finally time! You get to ask for the close and this is the easiest,
the results for the new client. Examples include foam rollers, but often most intense step for personal trainers. If you have
bands, nutrition books, online nutrition programs, accountability followed the process up to this point it is all very painless for both
programs, or additional services that have high margins. you and your prospect.

Here is a script: The Call to Action is really the easiest part…

“Mrs. Jones, on top of the training program I have a few “Mrs. Jones, which program would you like to start with today?”
additional bonuses that I would like to add in for you today.
First, we have our Jump-Start Package that comes with all There is beauty in the simplicity. It is a simple question, but most
the tools and resources you will need to have success in our importantly it is not a “yes” or “no” question. You are asking to
program. We will give our proven nutrition manual, a cookbook decide on the two options you presented in the Core Offer step
for ideas, and a few additional workout and recovery resources of the close. It gives them a chance to talk through any remaining
that our clients have told us come in real handy. objections they have about joining and provides you with a chance
to overcome those objections.
Normally, we sell this for $199, but today it is included free
with your program. Once you have asked for the close sit tight and be quiet. It is
easy to talk yourself right out of a sale by jumping in too soon.
Also, I would like to offer you the chance to join our online Let the prospect speak first and then you can offer further
nutrition coaching program that will guide you step by step suggestions as needed.
through creating the nutrition habits that will help you get
results fast and keep them. This program normally costs $299, CONFIDENTLY CLOSE MORE SALES
but it is also included in your program today.” With the help of this sales process and closing system you will be
able to confidently close more sales and help more clients. Sales
Deadlines are great motivators, especially when making the is a skill that you can develop. It will require practice, role playing
decision to invest in personal training. Creating some urgency to and repetition to perfect it, but each time you go through you will
act immediately will get your prospect off the fence and ready to get a little better.
decide. To create urgency to buy you should set an expiration on
your bonuses. They are only free and included with the program if The ability to sell gives you a lot of power with your career and
they sign up immediately. your own personal income. If you take the right approach and
avoid having to sell out to sell your services it can be enjoyable as
Here is your script: well. Each time you sit with a new prospect you are helping them
discover a path to reach their goals and change their lives.
“Mrs. Jones, I know you are ready to get started, and I am
excited to help you lose your 20 lb and get your life back! If
you sign up today I can get you the Jump-Start Package and
Nutrition Course, a $498.00 value, free.

But that offer is only good for today.”

Prospect still a little hesitant? They have likely tried this before
and failed at getting the result they wanted so in their mind there
is a lot of risk in joining your program. While taking that risk
on yourself can be a little scary it is a great way to persuade a
prospect to buy on the spot. The easiest way to do this is with an
unconditional guarantee.

PTQ 4.4 | NSCA.COM 19

HOW TO IMPROVE YOUR SALES SKILLS AND GET MORE
CLIENTS WITHOUT COMPROMISING YOUR VALUES

ABOUT THE AUTHOR

Ryan Ketchum is a fitness business and marketing expert. As the
Executive Director and Co-Owner of Fitness Revolution, he helps
fitness professionals build high performing fitness businesses.
Ketchum graduated from Indiana University with a degree in
kinesiology. He has been recognized by USA Today as a leading
fitness business owner; is the author of the bestselling book, “Total
Body Breakthroughs;” and was named the Fitness Business Owner
of the Year in 2011. Prior to his time coaching fitness business
owners, Ketchum owned one of the top personal training studios
in the United States, eventually selling that business to focus on
building his current business.

20 PTQ 4.4 | NSCA.COM

 NSCA.com

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PTQ 4.4 | NSCA.COM 21

FEATURE ARTICLE

WHOLE FOOD, PLANT-BASED DIETS

JOHN MCNAMARA, PHD, CSCS,*D, NSCA-CPT,*D, USAW

EAT LIKE A CHAMPION vegetarian (no meat), lacto-vegetarian (no meat or eggs), or

O
ptimal athletic performance and health are dependent vegan (no meat, eggs or dairy) (7). A whole food, plant-based diet
on many key factors such as rest, exercise and nutrition stipulates that added fat and refined sugar be minimized.
(17,18,19). Sports champions such as LeBron James, and
Olympic Gold medalists like Michael Phelps, Simone Biles, and PLANT-BASED DIET – BENEFITS
Usain Bolt, must all balance healthy lifestyle habits in order As with any type of diet however, it is important to weigh the
to achieve peak performance. The same underlying principles pros and cons in an effort to determine if a whole food, plant-
used by professional athletes can be leveraged by anyone based diet is a nutritious and effective option for athletes. This is
(17). Any age or gender can reap the benefits of a strategically a difficult task considering that expert nutrition research scientists
aligned fitness plan. do not always agree on the basic components of a healthy diet
(30). Furthermore, dietary research is hampered by environmental
Although a person’s spiritual, mental, emotional, social, and control. Some studies do not have full monitoring
physical health are all tied closely together, healthy eating surveillance over participants (21).
habits are essential. One nutrition strategy gaining the attention
of athletes, coaches, and the medical community is a whole Limited research exists on a whole food, plant-based diet
food, plant-based diet. This diet claims it has the potential to and athletic performance, but considerable evidence exists
improve both athletic performance and overall health (4,10,20). A on vegetarian diets. Vegetarian diets are considered safe and
careful evaluation of this diet is warranted based on its growing effective for athletes by the Academy of Nutrition and Dietetics
popularity. In a research book entitled, “The China Study,” Colin and in some situations, may improve athletic performance (7,9).
Campbell and Thomas Campbell II suggest eating “a whole foods, The American College of Sports Medicine (ACSM) also supports
plant-based diet, which minimizes the consumption of refined a vegetarian diet for athletes (27). Other researchers have
foods, added salt, and added fat,” (3). They encourage foods such hypothesized that a vegan diet enhances the immune system
as fruits, vegetables, legumes, mushrooms, nuts, and whole grains; from eating adequate micronutrients. Through their experience
suggest minimizing refined carbohydrates, added vegetable oils working with amateur and professional athletes, they noted
and fish; and recommend avoiding meat, poultry, dairy, that the vegan diet was often chosen by athletes in an attempt
and eggs (Table 1). to improve immunocompetence (9).

The whole food, plant-based diet is slightly different from the Further evidence has indicated that a vegetarian diet may
three main variations of a vegetarian-eating plan: lacto-ovo- specifically enhance long-duration aerobic endurance

22 PTQ 4.4 | NSCA.COM

performance. In 1893, two vegetarians were the first to complete and expanded (8). This thick and expanded change is a dramatic
a 599-km walking race from Berlin, Germany to Vienna, Austria improvement in coronary artery function and structure.
(22). Also, Native Americans of northwestern Mexico (Tarahumara)
have been reported to possess unprecedented stamina (1,5,11). FIGURE 1. COMPARISON OF CORONARY ARTERY BEFORE
They play a game called raripuri, which involves kicking a wooden AND AFTER WHOLE FOOD, PLANT-BASED DIET (8)
ball 150 – 300 km. It is thought that their diet was the primary
means by which they achieved such remarkable endurance. They
mainly ate corn and beans for about 90% of their total diet; they
also ate a few greens, squash, 2 – 3 eggs per week, and very small
servings of meat, fish, poultry, dairy, and lard making up the other
10% of their total diet (1,5,6,11,22). Other studies also support
the effectiveness of a vegan diet on enhanced cardiovascular
performance (9,12,13).

The research that does exist on a whole food, plant-based diet has
been done almost exclusively in clinical settings. Several studies
show evidence that eating this way can minimize the chance
of stroke, obesity, hypertension, type 2 diabetes, cancer, heart
disease, arthritis, cataracts, Alzheimer’s disease, impotence, and
mortality when compared to the typical American diet, which
includes meat products, high fat intake, and high sugar intake
(8,21,28,31,34). It has also been reported to actually reverse heart
disease, cancer, and diabetes (8,16,23). Another piece of evidence
supporting a plant-based diet is found in a review article by
Caldwell Esselstyn (Figure 1) (8). Here, he shows a picture of a
coronary artery before (A), which is thin and constricted, and after
32 months of a whole food, plant-based diet (B), which is thick

TABLE 1. WHOLE FOOD, PLANT-BASED DIET FOOD EXAMPLES

RECOMMENDATION GENERAL CATEGORY SPECIFIC EXAMPLES

Orange, okra, kiwi, red pepper, apple, cucumber, tomato, avocado,

zucchini, blueberries, strawberries, green peppers, raspberries, butternut
Add Fruits
squash, pumpkin, blackberries, mangos, eggplant, pear, watermelon,
cranberries, acorn, squash, papaya, grapefruit, and peach
Broccoli and cauliflower (not many of the huge variety
Flower vegetables
of edible flowers are commonly eaten)
Spinach, artichokes, kale, lettuce (all varieties), cabbage, Swiss chard, collard greens,
Stems and leaf vegetables celery, asparagus, mustard greens, Brussels sprouts, turnip greens, beet greens,
bok choy, arugula, Belgian endive, basil, cilantro, parsley, rhubarb, and seaweed
Potatoes (all varieties), beets, carrots, turnips, onions,
Root vegetables
garlic, ginger, leeks, radish, and rutabaga
Legumes (seed bearing Green beans, soybeans, peas, peanuts, adzuki beans, black beans, black-eyed peas,
nitrogen fixing plants) cannellini beans, garbanzo beans, kidney beans, lentils, pinto beans, and white beans
Mushrooms White button, baby bella, cremini, portobello, shiitake, and oyster
Nuts Walnuts, almonds, macadamia, pecans, cashew, hazelnut, and pistachio
Whole grains (in Wheat, rice, corn, millet, sorghum, rye, oats, barley, teff,
breads, pastas, etc.) buckwheat, amaranth, quinoa, kamut, and spelt
Pastas (except whole grain varieties), white bread,
Minimize Refined carbohydrates
crackers, sugars, and most cakes and pastries
Added vegetable oils Corn oil, peanut oil, and olive oil
Fish Salmon, tuna, and cod
Avoid Meat Steak, hamburger, and lard
Poultry Chicken and turkey
Dairy Cheese, milk, and yogurt
Eggs Eggs and products with a high egg content (e.g., mayonnaise)

PTQ 4.4 | NSCA.COM 23

WHOLE FOOD, PLANT-BASED DIETS

Studies have reported the health benefits from a whole foods athletic performance, and positively impact
plant based diet. Chinese people who followed a whole food, the environment (7,26).
plant-based diet had very low incidences of coronary artery
disease (3,4). Comparably, those following the typical American ACKNOWLEDGEMENTS
diet (high in animal protein) showed a 16.7 greater chance of The author would like to thank Hety McNamara for her tireless
death from coronary artery disease (4). A few studies have efforts at editing and review.
indicated that there may be a link between animal protein and
cancer (15,29,35,37). It has been reported that higher levels of REFERENCES
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rats, while lower levels (5%) were beneficial (25,35,36). However, observations on Tarahumara endurance runners. American Journal
these studies have not been replicated in humans. of Physiology and Anthropology 23: 293-301, 1965.

2. Barr, SI, and Rideout, CA. Nutritional considerations for

PLANT NUTRITION STUDIES – LIMITATIONS vegetarian athletes. Nutrition 20: 696-703, 2004.
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5. Cerqueira, MT, Fry, MM, and Connor, WE. The food and
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ENVIRONMENTAL CONSIDERATIONS
8. Esselstyn, CB Jr. Resolving the coronary artery disease
Environmental concern also might affect diet choice. According
epidemic through plant-based nutrition. Preventative Cardiology
to some predictions, it may eventually become difficult, or
impossible, to feed the worlds growing population on a meat- 4: 171-177, 2001.
based diet. This is because a cow needs to eat 11 lb of grain feed 9. Fuhrman, J, and Ferreri, DM. Fueling the vegetarian (vegan)
for it to gain one pound of meat. For instance, if the grain were athlete. Current Sports Medicine Reports 9: 233-313, 2010.
eaten by humans as bread, cereal, or pasta, it would provide 11
10. Grant, JD. Food for thought…and health: Making a
times as much food as it would to feed it to a cow. To put things
case for plant-based nutrition. Canadian Family Physician
into perspective, the grain fed to livestock each year in the United
58: 917-919, 2012.
States could instead be used to feed 840 million people (24).
Currently 9 billion livestock are needed each year to feed 316 11. Groom, D. Cardiovascular observations on Tarahumara
million people. The livestock population outweighs the human Indian runners—The modern Spartans. American Heart Journal
population in the United States 5 to 1 (24). 81: 304-314, 1971.
12. Hietavala, EM, Puurtinen, R, Kainulainen, H, and Mero, AA.
PRACTICAL APPLICATION Low-protein vegetarian diet does not have a short-term effect
In summary, optimal health and athletic performance are greatly on blood acid-base status but raises oxygen consumption during
affected by many factors. Four powerful controllable factors submaximal cycling. Journal of International Sociology and
include rest, exercise, diet, and overall lifestyle. Perhaps the Sports Nutrition 9: 50, 2012.
most dramatic modification one can make to improve athletic
13. Kahleova, H, Levin, S, and Barnard, N. Cardio-Metabolic
performance and overall health is altering food intake. However,
Benefits of Plant-Based Diets. Nutrients 9(8): 848, 2017.
before adopting a vegan or whole food, plant-based diet, it would
be wise to consult with a physician or other qualified healthcare 14. Lanham-New, S, Stear, S, Shirreffs, S, and Collins, A. (Eds.).
professional. Any restrictive eating practices must be carefully Sport and Exercise Nutrition: Volume 8 of The Nutrition Society
monitored to ensure that all required nutrient intake is met (33). Textbook (1st ed.). John Wiley & Sons; 2011.
By following the guidelines of the American Dietetic Association, 15. Madhavan, TV, and Gopalan, C. The effect of dietary
a vegan or whole food, plant-based diet can be a viable option protein on carcinogenesis of aflatoxin. Archives in Pathology
for athletes as well as non-athletes to maintain health, support 85: 133-137, 1968.

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 NSCA.com

16. Massera, D, Zaman, T, Farren, GE, and Ostfeld, RJ. A whole- http://www.cnpp.usda.gov/sites/default/files/archived_projects/
food plant-based diet reversed angina without medications or GreatNutritionDebateSymposium.pdf.
procedures. Case Reports in Cardiology, 2015 31. The United States Department of Agriculture and U.S.
17. McNamara, JM, Chung, J, Miyazawa, Y, and Barnhart, M. Department of Health and Human Services. Dietary Guidelines
Fundamentals of speed improvement for all sports. Journal of for Americans 7th Edition. Washington, DC: U.S. Government
Strength and Conditioning Research 12(3): 12-15, 2013. Printing Office; 2010.
18. McNamara, JM, and Stearne, DJ. Effect of concurrent training, 32. Tuso, PJ, Ismail, HH, Ha, BP, and Bartolotto, C. Nutrition
flexible nonlinear periodization, and maximal-effort cycling update for physicians: Plant-based diets. Permanente Journal
on strength and power. Journal of Strength and Conditioning 17: 61-66, 2013.
Research 12: 1463-1470, 2013.
33. Venderley, AM, and Campbell, WW. Vegetarian diets:
19. McNamara, JM, Stearne, DJ, and Cummiskey, M. Losing 33 Nutritional considerations for athletes. Sports Medicine
billion pounds: New twists on old ideas. Pennsylvania Journal of 36: 293-305, 2006.
Health, Physical Education, Recreation and Dance, 2012.
34. Weikert, C, Walter, D, Hoffmann, K, Kroke, A, Bergmann, MM,
20. Medeiros, DM, and Wildman, REC. Advanced Human and Boeing, H. The relation between dietary protein, calcium and
Nutrition. Sudburt, MA: Jones and Bartlett Learning, 2012. bone health in women: Results from the EPIC-Potsdam cohort.
Annals of Nutrition and Metabolism 49: 312-318, 2005.
21. Mishra, S, Xu, J, Agarwal, U, Gonzales, J, Levin, S, and Barnard,
ND. A multicenter randomized controlled trial of a plant-based 35. Youngman, LD. The growth and development of aflatoxin
nutrition program to reduce body weight and cardiovascular risk B1-induced preneoplastic lesions, tumors, metastasis, and
in the corporate setting: The GEICO study. European Journal of spontaneous tumors as they are influenced by dietary protein
Clinical Nutrition 67: 718-724, 2013. level, type, and intervention. Cornell University, 1990.
22. Nieman, DC. Vegetarian dietary practices and endurance 36. Youngman, LD, and Campbell, TC. High protein intake
performance. American Journal of Clinical Nutrition promotes the growth of preneoplastic foci in Fischer#344 rats:
48: 754-761, 1998. Evidence that early remodeled foci retain the potential for future
growth. Journal of Nutrition 121: 1454-1461, 1991.
23. Ornish, DI, Scherwitz, LW, Billings, JH, Brown, SE, Gould,
KL, Merritt TA, Sparler S, Armstrong, WT, Ports, TA, Kirkeeide, 37. Youngman, LD, and Campbell, TC. Inhibition of aflatoxin B1-
RL, Hogeboom, C, and Brand, RJ. Intensive lifestyle changes induced gamma-glutamyl transpeptidase positive (GGT+) hepatic
for reversal of coronary heart disease. Journal of the American preneoplastic foci and tumors by low protein diets: Evidence that
Medical Association 280: 2001-2007, 1998. altered GGT+ foci indicate neoplastic potential. Carcinogenesis 13:
1607-1613, 1992.
24. Pimentel, D, and Pimentel, M. Sustainability of meat-based
and plant-based diets and the environment. American Society for
Clinical Nutrition 78: 6605-6635, 2003. ABOUT THE AUTHOR
25. Prince, LO, and Campbell, TC. Effects of sex difference and John McNamara is a Tenured Professor at St. Francis College in
dietary protein level on the binding of aflatoxin B1 to rat liver Brooklyn, NY. He received his Bachelor’s and Master’s degrees
chromatin proteins in vivo. Cancer Research 42: 5053-5059, 1982. at the University of Alberta in Canada, and his Doctorate degree
in Kinesiology from Temple University in Philadelphia, PA. He
26. Rodriguez, NR, Di Marco, NM, and Langley, S. American is currently a Certified Strength and Conditioning Specialist®
Dietetic Association, Dietitians of Canada, American College of with Distinction (CSCS,*D®) National Strength and Conditioning
Sports Medicine, American College of Sports Medicine position Association (NSCA) Certified Personal Trainer® with Distinction
stand. Nutrition and athletic performance. Medicine and Science (NSCA-CPT,*D®) through the NSCA. He is also a Certified Sport
in Sports and Exercise 41: 709-731, 2009.
Performance Coach with United States of Weightlifting (USAW),
27. Rogerson, D. Vegan diets: Practical advice for athletes and and a Certified Physical Best Health Fitness Specialist with the
exercisers. Journal of the International Society of Sports Nutrition Society of Health and Physical Educators. His research focus is
14: 14-36, 2017. training theory, flexible nonlinear periodization, nutrition, and
exercise program design.
28. Satija, A, Bhupathiraju, SN, Rimm, EB Spiegelman, D, Chiuve,
SE, Borgi, L, et al. Plant-based dietary patterns and incidence
of type 2 diabetes in US men and women: Results from three
prospective cohort studies. PLOS Medicine 14136: 1-18, 2016.
29. Schulsinger, DA, Root, MM, and Campbell, TC. Effect of dietary
protein quality on development of aflatoxin B1-induced hepatic
preneoplastic lesions. Journal of the National Cancer Institute 81:
1241-1245, 1989.
30. The United States Department of Agriculture. March 10,
2000. Great Nutrition Debate Symposium. Retrieved 2017 from

PTQ 4.4 | NSCA.COM 25

COMMON PRACTICE FOR PERSONAL TRAINERS THAT
SHOULD NOT BE SO COMMON—PART 1: EXAMINATION OF
COMMON PRACTICES
ROBERT LINKUL, MS, CSCS,*D, NSCA-CPT,*D, RCPT*D, FNSCA

O
ver the last three decades the personal training profession schedule is a common practice that many personal trainers
has progressed from a part-time or secondary income to implement with the mindset of locking up longer term
a full-time and financially sound career choice. However, investments and guaranteed income from a potential client.
during that time certain industry strategies have been put in place Although a longer commitment is achieved, the personal
as “common practice.” These common practices can include price trainer has devalued their services to a point that can be
discounts for larger session packages, huge startup discounts to challenging to raise in future purchases (2).
first-time clients, cookie-cutter program designs for any and all • For example, rates for a one-on-one training session could
clients, fluctuated discount pricing based on referrals, and low run $65 for a single session but if the client purchases 10
barrier marketing techniques to the masses, just to name a few. sessions the price drops to $55 each, with 25 sessions the
price drops to $45 each, and with 50 sessions the price
As new personal trainers enter the workforce they learn about drops again to $35 each. The question now becomes, what
these common practices by watching or working with other is the trainer’s “true value” for one session? Is it $65 or $35?
trainers in the industry. Observing, shadowing, interning, or Such a large discrepancy leaves the consumer wondering
mentoring programs are great ways to learn about the business why the price difference varies so much, ultimately
of personal training. Where the problem can occur is in “who” leaving them questioning the quality of the services they
they are observing and learning from and what type of “common are seeking (5).
practices” they are being taught. The following are a few common
practices new personal trainers might observe. • True professionals know their value and place a single
solid price on it as that is the exchange rate for their time.
High Foot Traffic with High Turnover Rates This process of learning one’s true value and establishing
• Some personal training businesses are run inside facilities a set price may take some time. However, competitive and
or in locations with extremely high numbers of potential reliable rates show a sturdy and sound business model
clients (foot traffic) searching for a personal trainer. With leaving the consumer feeling secure in their purchase and
a high number of interested leads, these personal trainers proud to be a paying customer.
will focus on signing clients up for large session packages
(30 to 50+ sessions) baiting the client with a large discount. The Sales Hook and Lateral Pass
The client bites and invests thousands of dollars with the • Some business models utilize a “tag-team” approach in
potential to be disappointed with the quality of their trainer. which the more sales-based team member meets with the
potential client and walks them through the initial interview
• In most cases, these non-refundable sessions are lost as and consultation (3). They take their measurements, sell
the client is frustrated with their lack of results, or the them a multi-vitamin, and walk them through the ladder of
professionalism of the trainer, and decides to discontinue session packages ultimately leading the client to purchasing
their training program. The trainer then books another the lowest single session rate (which also happens to be the
client on top of the original client’s scheduled time biggest initial investment).
collecting double on their commission. This type of
business model does not help build the reputation of a • With the paperwork signed and the non-refundable
career-based personal trainer and often ends in numerous sessions locked up, the salesman then introduces the new
complaints to management. client to their “new” personal trainer. The client is shocked
as the smooth-talking professional they thought they were
The More You Buy, the Cheaper the Price going to be working with informs them that they are just
• Discounting the overall investment for the client based on the first step of the client’s healthcare team and that their
how many sessions or how long they commit to a training trusted colleague will take good care of them.

26 PTQ 4.4 | NSCA.COM

 • The “trusted colleague,” may or may not have experience »» Third, is the personal trainer cannot establish and
working with clients; however, the bigger issue is that build trust, value, and rapport with the client prior to
the client and trainer rapport (trust and value) is best their training session. Personal training is just that,
established from the very beginning. Introducing a new “personal,” and without the opportunity to connect
professional into the mix this late in the processes can be a with the client, learn about their personality type,
cause for alarm. Unfortunately, this business model is run in and gauge their expectations, the personal trainer
many gyms and fitness centers around the world. However, will have a challenging time gaining the client’s
well educated consumers with high expectations have confidence during one trial workout. Meeting with
slowly started to make dents in this business model. a potential client prior to their trial session also
allows the trainer to showcase their experience and
Cookie Cutter Programing
expertise, to answer any questions, and to discuss
• Some facilities implement a “community” workout program
their training philosophy as to how and why it is a
design model that all members of the gym participate in.
good fit for them.
These workouts can be very challenging for some clients
and, in some cases, not appropriate for others. Cookie Referral Discounts
cutter program designs lack the ability to customize • It is common practice in many facilities to offer discounted
movement patterns per the specific demands/needs of rates for clients who refer in friends, family, or colleagues.
each client (4). Financial discount rewards are often useful marketing
techniques for personal trainers; however, they can
• This becomes a question of what the client “needs” versus
backfire in two ways:
what the personal trainer “wants” the client or group to
perform that day. As a fitness professional, the personal »» First, clients may get to know each other and spend
trainer needs to deliver a product specific to the goals, per time together outside of the gym. Price comparisons
the physical limitations and/or the ability level of the client. can occur making for some awkward discussion
In many cases, a community workout program design does for the personal trainer in the future. Even with the
not accomplish these goals. explanation of earning the financial discount in return
for referrals, longer tenured clients may take offense
Trial Workout with Health History and Paperwork
to the price cut.
• When a potential client is interested in pursuing personal
training they typically want to come in and sample the »» Second, is when a current client “quotes” a new
product before they commit. It is common practice for potential client their discounted price rate as the
personal trainers to offer a trial workout to a client. regular rate. With a preconceived price range set, the
However, in many cases the initial meeting, proper potential client comes to their first session prepared
paperwork, and health history is not attained beforehand. to pay a certain rate only to be told something
Often, a liability form is the only paperwork completed as different by the personal trainer. This can make for an
the client quickly initials a form and jumps into a workout awkward discussion and the potential loss of a new
(1). There are three risks a personal trainer takes by not client, and they may already have mixed emotions
having an initial interview and consultation with a new about their business practices.
potential client prior to their trial workout: Starting into the personal training business is a very exciting
»» First, the personal trainer has limited or no knowledge endeavor full of great potential, possibilities for success, and
of any existing physical limitations of the client. The endless opportunities to help others. However, many of the
potential risk of injury is very high as the trainer “common practices” found in today’s personal training industry
may put the client into vulnerable positions without are not the most ethical or effective tactics to implement in order
knowing it. The potential client could get injured to build a successful career as a fitness professional. Selecting
during their trial workout losing their business a mentor that can teach proper business practices as well as
and potentially damaging the reputation of the program design and other personal training components is
personal trainer. crucial to a novice trainer’s success. The development of sound,
consistent, and reliable business practices will set standards for a
»» Second, is the personal trainer has little or no
fitness professional as they build a long and potentially lucrative
knowledge of the client’s training goals. Without
career in the personal training industry.
knowing the reasons in which the client would like to
train, the personal trainer creates a workout without
purpose. The client may have a physical limitation
they want to improve, they may want to learn
the power lifts, or they may have plans to climb a
mountain. Without collecting this data, the personal
trainer creates a workout that lacks the intention of
the client’s goal and thus, showcases little or no value
to the client. The personal trainer may have the ability
to provide exactly what they client wants and needs;
however, the lack of proper procedure has limited the
trainer’s ability to showcase their value.

PTQ 4.4 | NSCA.COM 27

COMMON PRACTICE FOR PERSONAL TRAINERS THAT SHOULD NOT BE SO COMMON—
PART 1: EXAMINATION OF COMMON PRACTICES

REFERENCES ABOUT THE AUTHORS

1. Goodman, J. “Referrals” The Personal Trainers Handbook. 45- Robert Linkul was the National Strength and Conditioning
46, and 53-54, 2014. Association (NSCA) Personal Trainer of the Year in 2012. He is
currently a volunteer with the NSCA as the Southwest Regional
2. IHRSA. “What Every Personal Trainer Needs to Know About
Coordinator and Committee Chairman for the Personal Trainers
Sales.” IHRSA Blog Post. www.ihrsa.org/blog/2016/10/25/what-
Special Interest Group (SIG). Linkul is the Career Development
every-personal-trainer-needs-to-know-about-sales.html. 2017.
columnist for the NSCA’s Personal Training Quarterly (PTQ)
3. Lester, E. “How to Set a Pricing Structure for Your Personal publication and speaks internationally on career development
Training Business.” www.fitnessmentors.com/pricing-structure/ techniques for personal trainers. Linkul mentors personal training
4. Owen, P. “Why Custom Build Personal Training Sessions are students and rookie trainers entering the industry on business
Superior to a Cookie Cutter Fitness Mentality.” Cleveland Personal strategies, client retention, and professional longevity. Linkul has
Training. Accessed from www.clevelandpersonaltraining.com/ been in the industry since 1999, and owns and operates his own
cleveland_personal_traini/2012/03/why-custom-built-personal- personal training studio in Sacramento, CA.
training-sessions-are-superior-to-a-cookie-cutter-fitness-
mentality.html. 2012.
5. Sheppard, D. “How to Promote and Sell Multiple Personal
Training Options with Layered Pricing.” Personal Trainer
Quarterly 4(3): 2016.

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PTQ 4.4 | NSCA.COM 29
FEATURE ARTICLE

SIMPLIFYING THE RULES TO PROGRAMMING

FOR SPECIAL POPULATIONS
TOM CORMIER, CSCS, CSPS, NSCA-CPT,*D, USAW

T
he National Strength and Conditioning Association (NSCA) clients should physically bring the clearance paperwork to their
defines special populations as clients with temporary physician. Doing so requires the physician to complete the
or chronic health issues such as metabolic disease, paperwork as well as discuss any training concerns. Otherwise,
immunological disorders, cancer, cardiopulmonary disease, with faxing or emailing, the paperwork tends to sit in the doctor’s
musculoskeletal disorders, neuromuscular disorders, psychological inbox and may not be a priority.
disorders, older adults, children, and prenatal, postpartum, and
menopausal females (7). NSCA-Certified Personal Trainers® GENERAL PROGRAM DESIGN GUIDELINES
(NSCA-CPT®), especially those working in a clinical setting, must FOR SPECIAL POPULATIONS
know how to program for these health issues. This article simplifies The structure of the program for special populations mirrors
the process of programming for special populations clients. that of the general population, following the FITT principle
(frequency, intensity, time, and type). Programs will typically
PAR-Q+ AND PHYSICIAN RELEASE include a structure of 2 – 3 days per week focusing on 8 – 12
Literature regarding special populations states that it is different exercises emphasizing a total body workout, with most
recommended that clients consult their physician prior to populations completing 10 – 15 repetitions (5). In the program,
engaging in an exercise routine (9,11,12,13). Typically, the Physical only a few exercises will target a client’s condition (1). For
Activity Readiness Questionnaire (PAR-Q) determines if the example, a client with an anterior cruciate ligament (ACL) repair
client needs to consult with a physician. For special populations, does not need the entire training session focused on strengthening
however, the traditional PAR-Q found in most textbooks and the knee; instead, they should only perform two or three exercises
training articles is not enough. The PAR-Q+, an advanced version that focus on that area. The rest of the exercises will focus on total
of the PAR-Q, is a more detailed questionnaire that asks about body strength and general cardiovascular conditioning modified to
conditions like cancer, metabolic conditions, mental health reduce strain on the ACL.
problems, respiratory disease, and spinal cord injuries, in addition
to the heart disease risk factors found in the original PAR-Q (8). The ideal program design for special populations will also follow
Similar to the original PAR-Q, clients who answer “yes” to any these general rules:
of the questions on the PAR-Q+ should see a physician prior • Start the client at a novice level and progress to
to engaging in an exercise routine. For the physician’s release, intermediate; do not start off with intermediate exercises.
typically the Physician Physical Activity Readiness Clearance is
the simplest form of paperwork and personal trainers may want • Most special populations will require longer warm-up
to adapt it for their own brand or organization (3). Additionally, periods and longer rest periods between sets.

30 PTQ 4.4 | NSCA.COM

 • Work within the client’s painless range of motion. If the mobility and partial paralysis, the personal trainer may want to
client has an ever-present pain but still feels that they prescribe exercises using selectorized machines instead of free
can complete the exercise, then do not progress past weights. Moreover, the personal trainer should prescribe lower
that pain level. intensity sets with longer rest periods to allow the client to
recover properly (14).
• Use the rating of perceived exertion (RPE)
scale (measured within a 1 – 10 range) instead of heart
Know a progression and regression for every exercise prescribed.
rate. The client’s heart rate will vary depending on his
The client may progress faster than expected or be more
or her age, conditioning status, and medications being
conditioned than expected. Conversely, the client may be less
taken, which means that determining an appropriate
conditioned. Therefore, knowing how to progress and regress an
heart rate training range will be difficult. Additionally,
exercise will benefit the personal trainer and the client (2,4).
keeping the client at that determined training percentage
may also be difficult. Using the RPE intensity range of 2
– 4 (light – somewhat hard) will make sure that the client PROGRAMMING FOR THE PERSONAL
stays healthy and safe but continues to get a workout (5). TRAINING CLIENT VERSUS GYM MEMBER
Not every special populations client will be a personal training
• When in doubt of an exercise, do not prescribe it. The client. As a floor tech or a personal trainer, you will likely be
personal trainer’s first duty to their client is to keep them approached by a gym member who is categorized as a special
safe. If the personal trainer feels that performing a goblet population client and is looking for a new exercise. For example, a
squat with a client who suffers from osteoporosis might female gym member with chronic obstructive pulmonary disorder
not be beneficial, that is okay. Instead, give another wants advice on a new method for cardio. She wants to know how
exercise to the client that they are able to perform safely. long she should walk, how fast she should walk, and how many
• Similarly, do not prescribe unnecessary exercise days per week she should do it. In this example, in which you are
variations and combinations such as a kettlebell providing advice for someone who is not your personal training
thruster on a balance dome; an exercise like this has client, the following three actions are recommended:
no application to a special populations client (11,15). 1. Stick to the literature and use professional resources when
Remain focused on the client’s needs by providing providing exercises. It is important to have recourse if you are
exercises that are relevant to their condition(s) and are recommending exercises for those with health conditions.
simple to perform.
2. If you are not familiar with the literature, provide the general
MODIFIED EXERCISES rules mentioned above.
The client is most likely coming to a personal trainer for goals
such as weight loss, increasing strength and balance, improving 3. Book an appointment for a personal training assessment if
blood lipids, and overall health. The personal trainer’s exercise she requires more than what you just provided her. Doing
prescription should incorporate those goals while considering this will give you a better understanding of her condition and
the client’s contraindications and related modifications (1). limitations while providing useful information on the benefits
Sessions, however, should not focus on the likes of putting a of a personal trainer.
former cardiac rehabilitation client on a treadmill for 45 min to
constantly monitor blood pressure. Special populations clients Entering into a personal training contract with a special
typically have undergone some type of rehabilitation or therapy populations client establishes multiple safety nets (i.e., physician’s
already. It is within the therapy team’s scope of practice to release, prior physical therapy/rehabilitation programming,
prescribe exercises solely for their condition and to get them back additional waiver of liability, assessments, etc.) to keep you as well
to a baseline of physical fitness (6,10). Follow these rules to help as your client safe.
with modifications:
Use the client’s previous rehabilitation/therapy exercises as REFERRING OUT
modifications. This is beneficial for two reasons: If necessary, tell the potential client that you are not familiar with
an exercise prescription for a specific condition and to recommend
1. No need to overthink the exercise plan. If a new client has a another professional. For example, one client with sciatica
condition you have never heard of, you know a plan already could benefit from a simple hip stretch, while another sciatica
exists for the condition. patient may require a few weeks of physical therapy. If you are
providing personal training for those with temporary or chronic
2. Those clients who have gone through therapy require health issues, you may benefit by becoming a Certified Special
these exercises for maintenance, but most clients will Populations Specialist® (CSPS®) through the NSCA. Research what
discontinue right after therapy stops. Such modifications are additional benefits you could receive from your employer if you
a reintroduction to the routine. choose to study for the CSPS credential.

Also knowing the etiology of the client’s condition will help CONCLUSION
the personal trainer to better understand the necessary Special populations clients may fall into one or more health
programming. For example, knowing that multiple sclerosis is an categories, and therefore, the NSCA-CPT should be aware of these
erosion of the myelin surrounding the nerves causing impaired health issues and how to write an exercise prescription for each
one. By reviewing this simplified process of obtaining a client’s

PTQ 4.4 | NSCA.COM 31

SIMPLIFYING THE RULES TO PROGRAMMING FOR SPECIAL POPULATIONS

health history and physician release, designing an exercise routine 15. Willardson, J. The effectiveness of resistance exercises
with modified exercises, and providing exercises for paid clients performed on unstable equipment. Strength and Conditioning
versus general members, NSCA-CPTs can be confident prescribing Journal 26(5): 70-74, 2004
a routine for those who suffer from chronic or temporary health
issues. Furthermore, by knowing and following these rules, NSCA-
CPTs can expedite personalized plans, allowing clients to start ABOUT THE AUTHOR
training sooner while remaining safe. Lastly, if NSCA-CPTs train a Tom Cormier is a Certified Strength and Conditioning Specialist®
number of clients considered to be a special population and would (CSCS®), Certified Special Populations Specialist® (CSPS®), and
like to supplement their current certifications, the NSCA’s CSPS National Strength and Conditioning Association (NSCA) Certified
is recommended. Personal Trainer® with Distinction (NSCA-CPT,*D®) through the
NSCA. He is currently the supervisor for the CREATION Health
REFERENCES Wellness Center, a hospital-based fitness facility, where he
1. Bennet, S. What do you do when you have to program for designs programs for and trains special populations. He earned his
an athlete with an injury? Strength and Conditioning Journal Bachelor’s degree in Health Science from Stetson University and
31(1): 65-67, 2009. is currently working towards his Master’s degree through Setanta
College. In addition to the NSCA certifications, he is credentialed
2. Boyle, M. New Functional Training for as an Exercise Is Medicine through the American College of Sport
Sports. (2nd ed). Champaign, IL: Human Kinetics; 27, 2016.
Medicine (ACSM), Kettlebell Instructor through the International
3. Canadian Society for Exercise Physiology. Physician’s Kettlebell Lifting Federation (IKLF), and Olympic Weightlifting
clearance form CSEP-CPTs. CSEP.ca. Retrieved April 2017 Coach through United States of America Weightlifting (USAW).
from http://www.csep.ca/view.asp?ccid=517.  
4. Cressey, E. Do your strength and conditioning progressions
create context? EricCressey.com. 2016. Retrieved April 2016
from https://ericcressey.com/strength-and-conditioning-
progressions-create-context.
5. Ehlke, K, and Greenwood, M. Resistance Exercise for
post-myocardial infarction patients: current guidelines
and future considerations. Strength and Conditioning
Journal 28(6): 56-62, 2006.

6. Falsone, S. Bridging the gap from rehabilitation to

performance. In: Liebenson, C (Ed.), Functional Training
Handbook. Philadelphia, PA: Wolters Kluwer Health; 19, 2014.

7. National Strength and Conditioning Association. Become

a Certified Special Population Specialist® (CSPS®). NSCA.
com. Retrieved April 2017 from https://www.nsca.com/
Certification/CSPS.
8. PAR-Q+ collaboration. PAR-Q+. eparmedx.com. Retrieved
April, 2016 from http://eparmedx.com/?page_id=75.
9. Ross, MD, and Denegar, CR. Effect of exercise on bone mineral
density in postmenopausal women. Strength and Conditioning
Journal 23(4): 30-35, 2001.

10. Salamh, PA, and Speer, KP. Post-rehabilitation exercise

considerations following total shoulder arthroplasty. Strength and
Conditioning Journal 35(4): 56-63, 2013.

11. Santana, JC. Stability and balance training: Performance

training or circus acts? Strength and Conditioning
Journal 24(4): 75-76, 2002.

12. Sprod, L. Considerations for training cancer survivors.

Strength and Conditioning Journal 31(1): 39-46, 2009.

13. Tran, Q. Cerebral palsy: Considerations for training. Strength

and Conditioning Journal 27(6): 34-38, 2005.

14. Waller, M. Strength and conditioning in multiple sclerosis

patients. Strength and Conditioning Journal 22(2): 40-41, 2000.

32 PTQ 4.4 | NSCA.COM

 NSCA.com

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PTQ 4.4 | NSCA.COM 33
FEATURE ARTICLE

PRACTICAL APPLICATIONS FOR ROTATIONAL POWER TRAINING

DAVID OTEY, CSCS, NSCA-CPT

INTRODUCTION movements from multiple angles. “The Training Octagon,” as

R
otational training is an often overlooked piece in individual created by Santana et al., is one approach to identifying eight
strength programming. While most think of rotational patterns we commonly work through involving the anterior and
strength training as applying only to specific training for posterior core (5). These patterns were identified as a means of
sports and athletic activities, the practical applications of this developing a simple training system for the “power highways” that
type of training translate well for general population individuals, we commonly use. The development of this system can improve
excluding those with pre-existing contraindications. Core training movement efficacy, leading to less pain in vulnerable places such
has been a topic of conversation for many years, with topics as the lumbar spine.
ranging from spinal stabilization to aesthetic goals. This article will
address the specific approaches rotational training can have in an While the core has been traditionally trained in isolation for its
individual’s strength program to address core integrity, synergistic aesthetics, the core is the bridge that connects two major ball
muscular systems, and overall athletic capabilities as we age. and socket joints: the glenohumeral (shoulder) joint and the
acetabulofemoral (hip) joint. The core serves as either an anchor
WHY ROTATIONAL POWER TRAINING for limb movement, or a transition point for force generation
Rotational power is the generation of force around a singular between the upper and lower body (6). Most of the energy
axis through the integration of the muscular and joint systems. for rotation is developed in the hips, from overhead throwing
Clients today have goals that are focused on the idea of long- athletes to shoveling snow from a walkway, and is transitioned
term health and movement quality. Throughout everyday life, from the foot upward (3). When training to improve tasks in
individuals will encounter multiple activities that require the need everyday life and minimize injury risk, it is important to train in
for rotational movement, anti-rotational movement, or general accordance with the Specific Adaptations to Imposed Demands
power application in a rotational direction. In order to best (SAID) principle (4).
prepare ourselves, and the individuals we train, it is important
to address not only the needs of specific activities, but also THE APS AND THE ROTATIONAL CORE
everyday activities. In 1970, Logan and McKinney introduced the Serape effect (2).
A serape is a piece of cloth common in South American culture
Low back pain is a common occurrence for most people at some that wraps around the neck and crosses down in front of the body
point in their life (1). Transverse movements incorporating the diagonally. This similar pattern was found in four sets of muscles:
core are an inevitable part of our activities of daily living (ADLs). rhomboids, serratus anterior, external obliques, and internal
Through everyday activity, the body is asked to do full body obliques. In 2015, Santana et al. expanded on this by introducing

34 PTQ 4.4 | NSCA.COM

the anterior and posterior serape (APS) (6). This concept was
expanded to include the oblique sling system, with upper to lower With the foundation of rotational training established, the next
body connections designed to optimize rotational movement. three steps involve working the body as a synergistic mechanism.
The spiraling connection between lower body and upper body From there, power and locomotive power are added. Ballistic
movements helps explain the foot to finger coordination. While rotation can be seen in some daily tasks, but locomotive ballistic
the core stiffens for the transfer of energy, this connecting system rotation is primarily identified with sports. The appropriateness
helps transfer energy from one portion of the body around to the of exercise prescription and progression should be made with
other side as necessary. consideration of what will safely progress the individual, and what
can be deemed necessary and unnecessary due to their current
Rotational power is a product of power generated through the lifestyle and activities. There are a few considerations when
hips or shoulders and transferred through the core. Torso rotation, discussing rotational training with regard to skill demand, risk
with the intent to produce power, is important for improving management, and anticipated outcomes.
athletic ability while also improving injury prevention (5). In
light of this, the intention of implementing rotational training, FIGURE 2. BASE OF SUPPORT
specifically rotational power, has the following three benefits:

1. Enhance local mobility at glenohumeral and

acetabulofemoral junctions
2. Establish proper core stiffening in the presence
of outside change
3. Improve movement pattern quality for translation to ADLs

With so many patterns in our everyday life that are impacted by

rotational movement and rotational power, we can systematically
add this into strength programming to better prepare clients.

THE POWER PYRAMID

When approaching rotational power training with an individual
of any background, it is important to have a structured approach. BASE OF SUPPORT
Creating a program which yields maximum impact with minimum Rotational exercises can be seen from a segmental approach, or
risk is the goal. In order to accomplish this, the “Power Pyramid” a full body perspective. When building up the Power Pyramid
was developed to create a clear-cut line of progression, from from dynamic mobility upward, the progressions listed prime the
baseline movements to power training. system to allow movement at common junctions and establish
the necessary stability to withstand power transfer. With respect
This approach helps to solidify movement patterns, build integrity to rotational training, when building into the rotation phase, it is
into the mechanism, and over time, introduce the integration of important to understand the necessity of the appropriate stance
supporting muscular systems. Developing mobility at two primary to support the movement.
mobile joints (acetabulofemoral and glenohumeral) will establish
the necessary movement from the limbs for rotational power down Any movements from the rotational phase and above should be
the road. Next is building integrity to the anterior and posterior performed from the bilateral, staggered, or unilateral stances.
core through the resistance of movement. The core is responsible Integrating muscular and joint systems for rotational movement
for transferring power between upper and lower body regions and allows joints to absorb force and move naturally. With a fixed
is influenced by the level of stability. position closer to the hip joint, full acetabulofemoral range of
motion is compromised. This fixed position could, over time, lead
FIGURE 1. POWER PYRAMID
to harmful movement patterns or increase the demands required
from other supporting joints, such as the lumbar spine.

LEVER ARM
As the load translates further from the body, there is an increased
force demand due to increased torque. This must be considered
when deciding modalities for individuals (e.g., medicine ball,
cables, ViPR, sports equipment, etc.).

SKILL DEMAND
Movement complexity should only mirror the individual you are
working with. Creating more difficult demands in training may be
ideal, unless it is at the risk of the client’s muscular or orthopedic
health. Your clients’ training should be based on pre-existing
conditions, training goals, age, and training history.

PTQ 4.4 | NSCA.COM 35

PRACTICAL APPLICATIONS FOR ROTATIONAL POWER TRAINING

APPLICATION
The implementation of a program which incorporates rotation
training should be added according to the client’s place in the
Power Pyramid. With any new movement, it is important to allow
time for the system to acquire new skills and to accomplish them
with ease rather than racing to more advanced power applications.
At lower levels in the pyramid, moves can be added as dynamic
warm-ups, or even during active rest periods. As you progress
through rotation training and beyond, exercises should be
added into your program with the intention of learning and skill
proficiency. With this in mind, it would be best to implement the
movements in a similar manner to energy system development.
They should be added slowly into the program as 2 – 3 exercises
with the overall goal of solidifying movement quality.

Multiple modalities can be used for rotational training. The

modality should be selected based on availability, full range
of motion capability of the client, and adjustable lever arm. As
rotational training is added to a client’s program, it should be with
the intention of translating to more efficient movement patterns.
While certain high power rotational movements are beneficial
as a conditioning piece, the implementation of this training with
general clients should proceed with caution.

CONCLUSION
As rotation, power, and rotational power are all common pieces
FIGURE 3. ANTERIOR INFLUENCE
of our everyday life, it is important to train for efficiency in the
movements. Identifying movements through the APS model
and Training Octagon will allow individuals to understand the
synergistic connections in the body that help us accomplish
rotation. Implementing this work systematically with the Power
Pyramid will allow you to devise programs for clients with the
intention of maximizing movement quality while minimizing
risk. Understanding concepts such as base of support, lever
arm, and skill demand in relation to training is essential for
maintaining a healthy progression between steps in the pyramid.
These considerations can move individuals towards more
synergistic collaboration between muscle groups, allowing more
athleticism as we age.

FIGURE 4. LATERAL INFLUENCE

36 PTQ 4.4 | NSCA.COM

 NSCA.com

FIGURE 7. DEADBUG

FIGURE 5. QUADRUPED THORACIC ROTATION

FIGURE 8. DEADBUG

FIGURE 6. QUADRUPED THORACIC ROTATION

PTQ 4.4 | NSCA.COM 37

PRACTICAL APPLICATIONS FOR ROTATIONAL POWER TRAINING

FIGURE 9. SHUFFLE MEDICINE BALL TOSS FIGURE 12. SHUFFLE UNDERHAND

MEDICINE BALL TOSS

FIGURE 10. SHUFFLE MEDICINE BALL TOSS FIGURE 13. SHUFFLE UNDERHAND
MEDICINE BALL TOSS

FIGURE 11. SHUFFLE MEDICINE BALL TOSS FIGURE 14. SHUFFLE UNDERHAND
MEDICINE BALL TOSS

38 PTQ 4.4 | NSCA.COM

 NSCA.com

FIGURE 15. SINGLE-ARM LANDMINE PRESS

FIGURE 17. VIPR LUNGE WITH EXTENSION

FIGURE 16. SINGLE-ARM LANDMINE PRESS

FIGURE 18. VIPR LUNGE WITH EXTENSION

PTQ 4.4 | NSCA.COM 39

PRACTICAL APPLICATIONS FOR ROTATIONAL POWER TRAINING

FIGURE 19. VIPR PUNCH

FIGURE 22. STANCE 2 – FULL KNEEL

FIGURE 20. VIPR PUNCH

FIGURE 21. STANCE 1 – HALF KNEEL FIGURE 23. STANCE 3 – STANDING

40 PTQ 4.4 | NSCA.COM

 NSCA.com

REFERENCES ABOUT THE AUTHOR

1. Dunn, KM, and Croft, PT. Epidemiology and natural history of David Otey is the 2016 Fitness Manager of the Year for Equinox
low back pain. Eurapa Medicophysica 40: 9-13, 2004. Fitness Clubs. He currently is the Personal Training Manager for
Equinox in New York, NY, overseeing a staff of 60+ trainers with
2. Logan, G, and McKinney, W. The serape effect. In: Lockhart,
750 clients. Otey graduated with a degree in exercise science from
A (Ed.), Anatomic Kinesiology (3rd ed.) Dubuque, IA: Brown;
Rutgers University and currently holds both the Certified Strength
287-302, 1970.
and Conditioning Specialist® (CSCS®) and National Strength and
3. McGill, SM. Ultimate Back Fitness and Performance (5th ed). Conditioning Association (NSCA) Certified Personal Trainer®
Waterloo, Canada: Backfitpro; 111-122, 2014. (NSCA-CPT®) credentials through the NSCA. With 10 years in the
4. Sands, WA, Wurth, JJ, and Hewit, JK. Program design. In: industry, Otey has a knowledge base of commercial fitness centers
Basics of Strength and Conditioning Manual. Colorado Springs, and performance facilities. With his experience, he is a regular
CO: National Strength and Conditioning Association; 14, 2012. contributor to top fitness magazines and is a speaker on various
fitness topics. Otey currently mentors trainers in program design,
5. Santana, JC, Brown, L, and Ferrigno, V. The training octagon.
exercise protocols, and business development.
Strength and Conditioning Journal 38(5): 102-110, 2016.

6. Santana, JC, McGill, S, and Brown, L. Anterior and posterior

serape. Strength and Conditioning Journal 37(5): 8-13, 2015.
7. Santana, JC. The serape effect. Strength and Conditioning
Journal 25(2): 73-74, 2003.

8. Willems, JM, Jull, GA, and Ng, JK-F. An in vivo study of the
primary and coupled rotations of the thoracic spine. Clinical
Biomechanics 11: 311-316, 1996.

PTQ 4.4 | NSCA.COM 41

FEATURE ARTICLE

EXAMINING THE EFFICACY OF COMMON FITNESS AND

MOVEMENT TESTS­­—PERSONAL PERSPECTIVE
LEE BOYCE

T
here is a common trend in many companies today: the them and their coaching staff. When designing an assessment for
bigger you grow, the less attention is paid to quality of new members, the goal should be to help the client get a better
service/product, and the more attention is paid to volume, understanding of areas needing improvement. Whether the client
numbers, and mass consumption. To grow within an industry, is a novice, or has advanced training goals, the assistance of a
shrewd business measures often need to be taken that can involve personal trainer would be beneficial. For these reasons, fitness
short-changing the consumer for the sake of making the sale and assessments that are fit for the individual would prove much more
earning more revenue. beneficial than a standard rubric used as a selling tool.

In an industry as unregulated as fitness training is, there seems to In my experience in this field, I have found that a common tactic
be even more focus on sales when compared to other industries, is that of using exercise “tests” that are high in difficulty, but low
which makes sense. A huge facility is full of potential liability with in specificity—in other words, exercises that are hard to perform
thousands of square feet and the huge overhead that comes with the first time they are attempted. A client who is newer to exercise
it. That means the business mindset must change. Relying on and in need of help now suffers from two bouts of disservice: the
membership sales might have been enough in a smaller facility, embarrassment of doing a movement that he/she fails to perform
but large facilities need to hit an all-time high month after month. properly, and then being told they have several issues to work on.

Sadly, we see this as the existing case in many commercial chain When I worked for a large box gym, a perfect example of what
gym franchises. The quantity-over-quality mentality can easily I am talking about here would be the first exercise we were
distract a business’s original intention of providing quality service instructed to use as a test for new members: a rear leg elevated
for the masses, and instead turn things into a packaged and split squat, with the front foot on an unstable surface. This
generic, one-size-fits all product. In the push for personal training simultaneously exploits a lifter’s mobility, balance, flexibility,
sales, many gyms will use assessment protocols as a way to prove and proprioception, and is a tall order for anyone to achieve
to clients that they can indeed benefit from personal training. This on their first (or subsequent) attempt without falling off. The
article will examine the merits behind this concept. overused explanation of “weak stabilizing muscles” was then
delivered to the client to convey something of a scientific backing
EXPOSING WEAKNESSES VERSUS for such tests. Another movement that was used was the wall
COACHING STRENGTHS? sit. Most clients will feel it in their quadriceps, since in order to
This is a critical shift in perspective many gym owners would remain pinned to the wall, the legs have to remain isometrically
benefit from making, or at least analyzing whether this applies to contracted, making the quads work hardest. This is a technique

42 PTQ 4.4 | NSCA.COM

often used to increase the likelihood of a client saying their quads on a clinical level. In the example of a squat, a lack of warm-up
are working the most, which makes the transition to explaining will often yield a much different visual result (for instance, earlier
that their posterior chain muscles were weak in comparison much posterior tilting of the pelvis, or “butt wink”) than when that same
easier. My point in all of this is to show that many fitness tests individual is warmed up, or at least slightly prepared via simple
for initial assessment purposes are not adequate tests at all, and mobility drills to lubricate the hip and knee capsules.
it is important to separate the sales pitch from the actual act of
helping the client with accurate information. Furthermore, in my experience with both clients and personally as
a lifter, I have noticed plenty of differences between lightly loaded
BETTER TESTS compound movements versus those completely unloaded. For
Smarter, more accurate, and more honest ways to assess a client’s individuals who carry a heavy musculature, a muscle belly that
abilities come from the exercises you decide to implement with “blocks” the range of motion of a limb can easily be mistaken for
new clients. In general, using compound movements can enable inflexibility, immobility, or both. Allowing lighter loads can place
a trained eye to diagnose several imbalances or deficiencies the antagonistic groups into a loaded stretch, and properly display
worth working on. Basic squat variations work very well for the lifter’s extent of mobility and flexibility when performing
these diagnoses since they involve muscle activation from the a movement. A personal trainer who has a well-developed,
entire body. Using the overhead squat pattern can uncover even intermediate or advanced client with a 400-lb maximum squat,
more restrictions, especially immobility in the shoulder and may get further by assessing his patterning with 95 lb compared
hip complexes, evidenced by a lifter’s hands migrating forward to using just the empty bar, as it can provide a better picture of
overhead, and insufficient bottom end range of motion. what the client’s muscles do under load.

To gauge posterior chain strength, the kettlebell deadlift is SUMMARY

considered a safe test, due to the fact that you can effectively The exercise needs to fit the client—not the other way around.
perform them while making accommodations for your Contraindications only come when the client is not suited for
anthropometry (especially long extremities) in order to allow for the movement. Keeping all of this in mind will create a much
a safe starting back position. Add to the fact that the implement better framework for you as a personal trainer or gym owner to
will likely be much lighter than a loaded barbell (which can build your assessment protocols for new clients and members,
prove much less forgiving as far as ideal geometrical setup is regardless of their initial skill level when working with you or your
concerned), and this can serve as a good gauge to monitor the staff. It starts by giving the client a fighting chance to succeed,
isometric strength of the scapular muscles, and the capability of and using the tools and advice above can be a step in the
the lifter’s hip hinge under load. right direction.

I prefer a plank variation, such as a four-point-touch, before using

a classic held plank for time. This is because more of the trunk ABOUT THE AUTHOR
muscles become involved to properly exhibit spinal stabilization, Lee Boyce is a Certified Professional Trainers Network Certified
thanks to the constant removal of one base of support compared Personal Trainer (CPTN-CPT) with an educational background
to the classic held plank. To perform the four-point-touch, start in kinesiology from York University. Boyce is currently in his 11th
in a push-up position, remove one hand to touch the opposite year in the fitness industry and has published over 500 articles,
shoulder, then switch hands. Then using the first hand, touch the including in some of the largest publications in the world. In
opposite thigh, and switch hands once more. 2013, he was named to the Training and Treatment Staff for Team
Jamaica at the Penn Relays international track meet. Boyce is also
MISLEADING INFORMATION a speaker and regularly delivers presentations to members of the
One thing to beware of is whether the results of a given fitness general public, college students, and trainers in the industry.
test actually indicates a weak, inflexible, or immobile individual,
or if something else may contribute to this. For example, an
otherwise healthy 6 ft 8 in. basketball player may never achieve
a bodyweight equivalent squat, a double-bodyweight equivalent
deadlift, or other marker lifts, due to having long limbs when
compared to the majority of healthy adults. The basketball player’s
lower back will be bearing a much greater percentage of the load,
even with “good” form, unless liberties are taken to modify the
exercise to give more leverage over the implement. To further
explain this, if the goal is to maintain a neutral back, longer legs
in a barbell deadlift mean higher hips. This change in leverage
increases the amount of hip flexion and increases the knee angle,
encouraging greater involvement of the posterior chain muscles,
and lesser involvement from the quadriceps to support the lift.

Choosing proper assessments applies not only to personal trainers,

but also to other strength and conditioning professionals who may
use movement tests to diagnose problems and prescribe solutions

PTQ 4.4 | NSCA.COM 43

FEATURE ARTICLE

THE UNDERVALUED LUNGE

JONI BOYD, PHD, CSCS, AND KATY MILTON, MS

INTRODUCTION stabilizers at the knee joint through the lunge movement,

R
egular participation in strength training provides a increasing its effectiveness.
multitude of benefits, including increased muscular
strength and power, decreased risk of injury, and improved IMPROVES CORE STABILITY AND BALANCE
activities of daily living (8,10). The lunge is an option for a lower The lunge exercise involves several muscles in the abdomen and
body exercise that can help to achieve these benefits. The lunge is back that function as stabilizers. The lunge movement requires
a staple unilateral exercise for the lower body that aims to improve the torso to maintain stability in a split stance, where feet are
strength and range of motion (ROM), which can potentially apart with one leg in front of the other. This exercise helps the
carryover to improving the ability to perform activities of daily body stabilize for multiple positions in a staggered stance, such as
living. Additionally, the lunge can be beneficial since it includes walking or stair climbing (2). Additionally, a stronger core eases
the integral “triple extension” of the hips, knees, and ankles. The daily activities, helps to prevent lower back pain, and improves
utility of the lunge is often lost in its perceived difficulty and balance and posture (7).
poorly performed technique. Several common errors occur in
PROVIDES FUNCTIONALITY
the performance of a lunge that can go unrecognized, even for
The forward lunge most closely mimics the pattern used for
experienced personal trainers, which will be discussed in this
walking and stair climbing. The correct performance of a lunge
article. Additionally, there is also room for modification of the
mimics the gait pattern of walking, and challenges the body to
lunge and progressions, which the personal trainer may find useful
maintain balance during dynamic postures, such as walking (2).
for their clients.

TEACHING CUES FOR THE CORRECT

BENEFITS OF THE LUNGE EXERCISE
STRENGTHENS LOWER BODY MUSCULATURE PERFORMANCE OF A LUNGE
STARTING POSITION (FIGURE 1)
Research has shown that the lunge can improve muscular strength
• Start in a standing position and then take a
and running speed in athletes (6). Additionally, the lunge is a
step with one foot.
common exercise in rehabilitation settings for improved lower limb
strength and function (1,2). The lunge exercise strengthens the leg • One foot should be in front and one foot should be
muscles, primarily the gluteus maximus, hamstrings, quadriceps, behind the torso, similar to a split stance.
and gastrocnemius/soleus (calves). In addition to being prime • The feet should be about hip-width apart.
movers, the hamstrings and gastrocnemius function as dynamic
• The distance between the front foot and back foot should
be a length that is greater than a walking stride.

44 PTQ 4.4 | NSCA.COM

 • The torso should be straight and the abdominals UPWARD (CONCENTRIC) MOVEMENT PHASE
should be tight. • Push through the front heel to return to the
starting position while contracting the glutes,
• The scapula should be retracted and depressed with the
quadriceps, and calves.
eyes looking forward.
• The toes and knees of both legs should be CONCERNS WITH LUNGE TECHNIQUE
pointing forward. Poor performance of the lunge can be problematic. Several
• The back heel should be off the ground. The correct common errors occur in the performance of a lunge that can go
distance between the front and back foot will enable this unrecognized, even for experienced personal trainers. Due to
step to be performed more easily. the risks of the lunge to exacerbate previous lower body injuries,
it is extremely important that lunges are performed correctly
LOWERING (ECCENTRIC) MOVEMENT PHASE (FIGURES 2 AND 3) (3,4,5). The ability of the personal trainer to address the critical
• While keeping the torso straight and abdominals tight, issues of the lunge when teaching and critiquing will ultimately
lower the hips until both knees are bent at about a determine its value. Table 1 describes common concerns with the
90-degree angle, if possible. performance of the lunge exercise that often lead to poor exercise
• Make sure the front knee is directly above the ankle and execution. Stride distance, foot placement, and movement errors
not over the toe. are all problematic for inadequate technique. Table 1 also provides
methods for correction of these concerns and errors.

TABLE 1. COMMON ERRORS IN THE PERFORMANCE OF THE LUNGE EXERCISE

COMMON ERRORS

Error: Quite often, the lunge is plagued from the start due to a stride length that is too
short. If the feet are too close together, the downward movement results in an increased
amount of stress on the knee joint (specifically the patellar tendon) (4).

Feet Too Close

Solution: The foot placement should be consistent throughout the lunge exercise. Specifically,
the distance between the front foot and back foot should be a length that is greater than a
walking stride. Before movement begins, the back heel should be lifted. At the lowest point of the
downward movement, the hip, knee, and ankle joints should be no less than 90 degrees (3).

Error: Even a slight turn of the lead foot or lead knee inward during a forward lunge can increase
Over-Pronation
the torque stress of the knee joint of the front leg. This increase in stress could be problematic
of the Foot/
for previous knee injuries, and could potentially lead to increased knee pain (4).
Knee Caves Inward

Solution: Make sure the front foot and knee are pointed straight forward while performing a lunge. In
all cases of the lunge, the toes and knees (of the same leg) should point in the same direction.

Error: Because lunges challenge balance ability, the back foot is often externally rotated for stability
compensation. Rotating the back knee or foot outward during a forward lunge also increases torque
stress in the knee joint (4). Lunges performed without optimal technique can create unnecessary joint
External Rotation of
stress that can limit performance, exacerbate pre-existing injuries, and potentially cause pain (4).
the Back Foot/Knee
Solution: Make sure the back foot and knee are pointed straight forward while performing a lunge. In
all cases of the lunge, the toes and knees (of the same leg), should point in the same direction.

Error: Often, beginners tend to lean too far forward during the eccentric (downward) phase of the exercise.
This technique error can increase the shear force at the knee joint, increasing the risk of injury or pain (3,4).
Forward Knee
Movement
Solution: Once in the appropriate starting position, the hips should move down
in Downward Phase
and up in a straight line. The back and torso should be erected and the abdominals
should be contracted through the duration of the movement.

Error: To compensate for balance and strength challenges, the torso can lean forward during
the downward phase, even if the lower body is performing the correct technique (5).
Forward Torso Lean
Solution: Ensure that the torso maintains and upright in an erect posture with the
abdominals engaged, chest lifted, and shoulders and back are down.

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THE UNDERVALUED LUNGE

TABLE 2. MODIFICATIONS OF THE LUNGE EXERCISE (EASIER OPTIONS)

Performing the lunge with balance support reduces the difficulty. Holding on to anything
Supported (Figure 4) that is stable and non-moving increases the points of contact, and can assist the
individual in performing the lunge. One or two hands can help support the lunge.

The lunge does not have to be a full movement to be effective. Even a small ROM will
Reduce ROM
activate the muscles used, challenge balance, and incorporate functionality (2,3).

Once the initial position is achieved, the lunge can be performed effectively
Completely Stationary
without movement of the feet until the repetitions are completed.

Use a Box/Step (Figure 5) Elevate the front leg just a few inches to decrease stress on the front leg, thus reducing the difficulty.

Chair lunges can be a great way to combine support and reduced ROM for a lunge. Turn sideways to the
Use a Chair (Figure 6) chair, with the starting stance over the seat of the chair and under the front hip. When the lower phase
is performed, the glute of the front leg can sit on the chair, and then return to the starting position.

TABLE 3. PROGRESSIONS OF A LUNGE EXERCISE (MORE DIFFICULT OPTIONS)

Alternating lunges that require an opposite step forward for each repetition are more challenging.
Make it Mobile The challenge is even greater in walking lunges forward and backward. Side lunges are also more
difficult, and place more mechanical stress on the muscles of the hip joints (glutes and hamstrings).
Incorporating a balance disk, wobble board, BOSU ball, or foam pad under the front
Increase leg increases the instability of the movement, thus increasing difficulty. Instability
Instability (Figure 7) forces the stabilizer muscles to activate more than if the exercise was stable, and prime
movers work harder to execute the movement under unstable conditions (9).
There are several exercises that can be performed together with the lunge. Upper body exercises
Compound the Movement
for biceps, triceps, and deltoids are easily paired with the lunge. Lower body exercises such
(Add an Exercise)
as single-leg deadlifts or squats can be alternated with repetitions of a lunge in a set.
Of course, adding weight to any exercise can increase the difficulty, as long as the movement can
Add Resistance still be performed correctly. Taking the weight as far away from the moving joints can increase the
Away from the Body difficulty even more. Holding weight with straight arms overhead, in front, or to the sides of the body
(Figures 8 and 9) can increase the lever length, making it more difficult. Changing the mode of weight (i.e., dumbbell,
barbell, plate, medicine balls, kettlebell, etc.) can further challenge the body to adapt in different ways.
Performing split squat jumps, which are essentially explosive lunges from the split
Add Explosiveness stance without a forward step, can be great for increasing power (6). Split squat
jumps can be performed in place, or with the legs alternating in a cycle.

MODIFICATIONS AND PROGRESSIONS CONCLUSION

OF THE LUNGE EXERCISE Performing the lunge exercise regularly can provide several
The forward lunge exercise can be modified and progressed benefits for everyone. It is critical for the exercise to be performed
in a variety of ways. It is imperative that the personal trainer with correct technique. Learning to lunge correctly can strengthen
is competent in prescribing the level of lunge that is most the lower body musculature, improve core stability and balance,
appropriate for the client performing the exercise. Modifications enhance hip flexibility, and increase functionality. There are a
can be an “easier” version of the exercise, which may reduce total plethora of modifications and progressions to consider, based on
stress, energy requirement, and/or intensity. Modifications are the level of the individual that is performing the exercise. Through
appropriate for situations where individuals are novice, injured, correct technique and appropriate modification, the lunge can be
recovering from injury, fatigued, or disabled (4,5). A variety of an exercise all individuals can utilize.
modifications are presented in Table 2. Progressions occur when
exercise difficulty is increased without compromising safety.
Progressions are most appropriate when an “easier” version
can be performed with ease, and the adaptation response from
the exercise is losing effectiveness. Options for lunge exercise
progressions are provided in Table 3.

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 NSCA.com

FIGURE 1. STEP OUT FROM STARTING POSITION FIGURE 4. SUPPORTED LUNGE

FIGURE 2. BOTTOM POSITION OF LUNGE FIGURE 5. LUNGE WITH A STEP

FIGURE 3. BOTTOM POSITION OF LUNGE (FRONT VIEW) FIGURE 6. LUNGE ONTO A CHAIR

PTQ 4.4 | NSCA.COM 47

THE UNDERVALUED LUNGE

REFERENCES
1. Alkjaer, T, Simonsen, EB, Magnusson, SP, Aagaard, H,
and Dyhre-Poulsen, P. Differences in the movement pattern
of a forward lunge in two types of anterior cruciate ligament
deficient patients: Copers and non-copers. Clinical Biomechanics
17(8): 586-593, 2002.
2. Cook, G, Burton, L, and Hoogenboom, B. Pre-participation
screening: The use of fundamental movements as an assessment
of function – Part 1. North American Journal of Sports Physical
Therapy 1(2): 62-72, 2006.

3. Cronin, J, Mcnair, P, and Marshall, R. Lunge performance and

its determinants. Journal of Sports Sciences 21(1): 49-57, 2003.
4. Escamilla, RF, Zheng, N, MacLeod, TD, Edwards, WB, Hreljac,
A, Fleisig, GS, et al. Patellofemoral joint force and stress between
a short-and long-step forward lunge. Journal of Orthopaedic and
Sports Physical Therapy 38(11): 681-690, 2008.
FIGURE 7. LUNGE ONTO AN UNSTABLE SURFACE
5. Farrokhi, S, Pollard, CD, Souza, RB, Chen, Y-J, Reischl, S, and
Powers, CM. Trunk position influences the kinematics, kinetics,
and muscle activity of the lead lower extremity during the forward
lunge exercise. Journal of Orthopaedic and Sports Physical
Therapy 38(7): 403-409, 2008.

6. Jonhagen, S, Ackermann, P, and Saartok, T. Forward lunge: A

training study of eccentric exercises of the lower limbs. Journal of
Strength and Conditioning Research 23(3): 972-978, 2009.

7. Richardson, CA, Snijders, CJ, Hides, JA, Damen, L, Pas, MS,

and Storm, J. The relation between the transversus abdominis
muscles, sacroiliac joint mechanics, and low back pain. Spine
27(4): 399-405, 2002.
8. Phillips, S. Resistance exercise: Good for more than just
Grandma and Grandpa’s muscles. Applied Physiology, Nutrition,
and Metabolism 32(6): 1198-1205, 2007.

9. Sapsford, RR, Hodges, PW, Richardson, CA, Cooper, DH,

Markwell, SJ, and Jull, GA. Co-activation of the abdominal and
FIGURE 8. LUNGE WITH WEIGHT AT SIDES pelvic floor muscles during voluntary exercises. Neurourology
Urodynamics 20(1): 31-42, 2001.

10. Stiegler P, and Cunliffe A. The role of diet and exercise for the
maintenance of fat-free mass and resting metabolic rate during
weight loss. Sports Medicine 36(3): 239-262, 2006.

FIGURE 9. LUNGE WITH WEIGHT OVERHEAD

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 NSCA.com

ABOUT THE AUTHORS

Joni Boyd is an Assistant Professor of exercise science in the
Department of Physical Education, Sport, and Human Performance
at Winthrop University in Rock Hill, SC. She is also a Certified
Strength and Conditioning Specialist® (CSCS®) through the National
Strength and Conditioning Association (NSCA).

Katy Milton earned her Bachelor’s degree in Exercise Science from

Gardner Webb University, where she was also a four-year athlete
for track and field. She earned her Masters of Science degree
in Sport and Fitness Administration from Winthrop University,
and served as the Graduate Assistant for the track and field
program. She currently works as an Inside Sales Representative at
Professional Sports Publications of Charlotte and Scottsdale. She is
also a certified personal trainer.

PTQ 4.4 | NSCA.COM 49

FEATURE ARTICLE

ARE THE SEATED LEG EXTENSION, LEG CURL, AND ADDUCTION

MACHINE EXERCISES NON-FUNCTIONAL OR RISKY?
NICK TUMMINELLO, NSCA-CPT, AND ANDREW VIGOTSKY, NSCA-CPT

M
any single-joint, machine exercises, like the seated hip and injury risk reduction has nothing to do with what the exercise
adduction, lying hamstring curl, and leg extension, are looks like, nor does it have to do with the type of equipment
commonly believed to be “non-functional” and even one is using; instead, functional training is all about positive
“risky.”. Many personal trainers base this conclusion on the criteria transfer to one’s training goals, which is the purpose of training.
that such exercises are 1) performed in the seated or lying position In other words, the goal of exercise programming for enhanced
and 2) are isolation exercises that are designed to create a performance and the reduction of injury risk is to maximize
resistance challenge mostly on a single-joint action. training transfer.

This article highlights the scientific evidence on exercises like With the above in mind, since exercises such as the seated hip
the seated leg extension, leg curl, and adduction machines to adduction and leg curl machine do not generally mimic specific
highlight their potential benefits on enhanced performance and movement patterns of many common actions in athletics, their
potentially reducing injury risk. This article will also demonstrate benefits for improved performance and injury risk reduction are
that simply because a given exercise is performed in the seated less obvious (24). This fact can lead fitness professionals into
position and targets a single-joint action (i.e., an isolation exercise) mistakenly labeling them as “non-functional” and, therefore, not
does not necessarily mean that a given exercise provides little-to- valuable. The research provided in this section suggests that
no positive training transfer or, alternatively, is universally risky. seated exercises that target a single-joint action (i.e., an isolation
Therefore, such conclusions or claims made from using such highly exercises), such as seated hip adductions and leg curls, may
questionable criteria are less likely to be sound. indeed offer a positive training transfer. Thus, it is misguided and
inaccurate to believe such exercises to be non-beneficial when it
FUNCTIONAL BENEFITS OF THE LYING LEG CURL comes to improving performance and reducing injury risk.
AND SEATED HIP ADDUCTION EXERCISE
For clarity of communication, it is important to first define exactly Askling et al. studied the effects of prescribing elite soccer players
what “functional training” is—and what it is not—when discussing additional specific eccentric hamstring training using the lying
the functional benefits of given exercises, such as the lying leg leg curl machine (1). In their study, 30 players from two of the
curl and seated hip adduction machine. According to the Oxford best premier-league division teams in Sweden were divided into
English Dictionary, the word functional is defined as, “of or having two groups: one group received additional specific hamstring
a special activity, purpose, or task,” or, alternatively, “designed training using the lying leg curl machine, whereas the other group
to be practical and useful, rather than attractive,” (12). With this did the same strength and conditioning programs without the
definition in mind, functional training for improved performance additional specific hamstring training using the lying leg curl

50 PTQ 4.4 | NSCA.COM

machine. The results showed that the occurrence of hamstring specificity and basic biomechanics work, it does strengthen the
strain injuries were clearly lower in the group (3 out of 15) that overall rationale for isolated adductor work.
did additional specific hamstring training using the lying leg curl
machine than in the control group (10 out of 15) that did not get It is important to see how scientific and anecdotal evidence falls
the additional hamstring training (1). Additionally, compared to in line with universal training principles in order to make decisions
the group that was not prescribed lying leg curls, the group that on practical programming strategies. For example, research
received the addition of lying curl increased sprint speed (1). demonstrates that strength gains are highly specific to the part
Furthermore, one should also consider the principle of specificity, of the movement one trains in, with limited transfer to the rest of
which dictates that the adaptations to training will be specific the untrained ranges of the movement that may not be addressed
to the demands the training puts on the body. According to Dr. in a given exercise (13,18). These results are in line with the
Everett Harman in the NSCA’s Essentials of Strength Training and principle of specificity. With this in mind, exercises developed to
Conditioning (3rd Edition), “The simplest and most straightforward train the hip adductors directly, such as standing hip adductions
way to implement the principle of specificity is to select exercise with a band or cable, the Copenhagen hip adduction exercise,
similar to the target activity with regard to the joints about which and the seated hip adductor machine, involve moving through
movement occur and the direction of the movements. In addition, larger ranges of motion than exercises such as squats, single-leg
joint ranges of motion in the training should be at least as great squats, and lunges. Therefore, as with training the hamstrings,
as those in the target activity,” (2). In sporting activities, such as when training the adductor musculature, it makes sense to also
running, sprinting, and changing direction, the hamstrings are incorporate such exercises designed to target the adductors into
controlling forces concentrically and eccentrically from various a comprehensive resistance training program in order to train in
angles of knee flexion. So, it stands to reason why the addition of ranges of motions that may not be sufficiently addressed by more
the lying leg curl machine exercise created superior results in both compound exercises.
improved performance and hamstring injury risk reduction.
IS THE KNEE EXTENSION DANGEROUS?
A comprehensive approach to hamstring training would Another controversial single-joint exercise, the knee extension, has
incorporate at least one exercise focused on the hip joint been on the receiving end of heavy criticism by personal trainers
movement (such as the deadlift or other similar compound and strength and conditioing coaches. The concerned is about
exercises) and one exercise focused on the knee joint (such the forces that are placed upon structures within the knee during
as the leg curl machine or other similar isolation exercises), as its execution including the anterior cruciate ligament (ACL) and
each offer unique but complimentary training benefits. Another patellofemoral joint (PFJ) (4). Some argue that the knee extension
example of using isolation exercises for performance are exercises places tensile forces on the ACL, which can be considered
for hip adductors. A scientific review found that hip adductor dangerous, and instead, recommend exercises like squats (4). This
strength was one of the most common risk factors for groin injury perspective is not only shallow, but is also logically inconsistent.
in sport (26). One particular study on professional ice hockey Indeed, tensile forces are placed on the ACL during the knee
players found that athletes were 17 times more likely to sustain extension exercise (11). However, when examining these forces,
groin injury if their adductor strength was less than 80% of their it is important to bear in mind that they exist on a continuum,
abductor strength (25). This study’s results do not necessarily and injury is not a concern until a certain threshold is reached.
mean that stronger adductors always decrease injury. However, For the ACL, this threshold has been reported to be upwards of
strong evidence exists that strength training can help reduce the 2,000 N, depending on an individual’s age (27). Thus, one can see
risk of sports injury and overuse injury, so exercises designed that the tensile forces experienced by the ACL during the knee
to help strengthen the adductor musculature are reasonable to extension (158 – 396 N, using loads ranging from a dynamic 12
include in a resistance training program (17). repetition-maximum to a maximum voluntary isometric effort)
are less than one-fifth of its ultimate strength (11). Moreover,
Many fitness professionals think that specific exercises to target ACL forces during the knee extension are less than or equal to
the adductors are unnecessary, believing compound exercises like many other “functional” tasks, such as walking or landing (11,22).
squats and lunges will effectively and sufficiently target them. Therefore, knee extensions do not appear to be any more unsafe
However, research in this arena, along with the universal principle for the ACL than tasks like walking. Moreover, the recommendation
of specificity, call this common belief into question. First, one must of the squat being a safer exercise for knee ligament health is
consider that different adductor muscles have different actions also logically inconsistent. For example, one study suggests that
and that during hip extension-based movements, they may not be posterior cruciate ligament (PCL) forces in the squat are about an
adequately stressed to create training adaptation (8). With respect order of magnitude, or ten-times, greater than those placed on the
to both eliciting greater adductor electromyography (EMG) ACL during the knee extension (10). To put this into perspective,
amplitude and the principle of specificity, exercises developed the PCL:ACL ultimate strength ratio does not approach such a
to train the hip adductors directly—specifically, all of the fibers difference (10:1) and is closer to 1.5 – 2:1 (14,15). Thus, many of
that partake in hip adduction rather than just those that assist in the arguments against utilizing the knee extension in healthy
hip extension—such as standing hip adductions with a band or populations out of concern for ACL health are unfounded and
cable, the Copenhagen hip adduction exercise, or the seated hip logically inconsistent.
adductor machine may be superior to exercises like wide-stance
squats, single-leg squats, and lunges (3,5,9). It is important to PFJ forces have been considered to be a biomechanical
note that, while EMG amplitude itself may not be a marker of contributor to the development or maintenance of patellofemoral
adaptation, when considered in conjunction with the principle of pain (16). While this perspective is likely overly simplistic, due to

PTQ 4.4 | NSCA.COM 51

ARE THE SEATED LEG EXTENSION, LEG CURL, AND ADDUCTION
MACHINE EXERCISES NON-FUNCTIONAL OR RISKY?

the complex, biopsychosocial nature of pain, one shouldl address disability in anterior knee pain patients. Knee Surgery, Sports
the biomechanical inconsistencies with the argument (6,7,18). Traumatology, Arthroscopy 21: 1562-1568, 2013.
First, when it comes to the PFJ, speaking about forces is not
8. Dostal, WF, Soderberg, GL, and Andrews, JG. Actions of hip
enough; instead, one must consider the stresses, as the force is
muscles. Physical Therapy 66: 351-361, 1986.
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knee flexion elicit greater peak PFJ stress than EMG amplitude- Lattermann, C. Comparison of lower extremity kinematics and
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Nevertheless, if working with symptomatic individuals, exercise Journal of Athletic Training 45: 181-190, 2010.
selection and range of motion should be tailored to the individual 10. Escamilla, RF, Fleisig, GS, Zheng, N, Barrentine, SW, Wilk, KE,
as per the recommendation of a physical therapist or medical and Andrews, JR. Biomechanics of the knee during closed kinetic
professional; otherwise, the knee extension, like the squat, should chain and open kinetic chain exercises. Medicine and Science in
not be considered universally contraindicated. Sports Exercise 30: 556-569, 1998.

11. Escamilla, RF, Macleod, TD, Wilk, KE, Paulos, L, and Andrews,
CONCLUSION
JR. Anterior cruciate ligament strain and tensile forces for weight-
The research discussed in this article, along with the principle of
bearing and non-weight-bearing exercises: A guide to exercise
specificity, highlights the importance of incorporating exercises
selection. Journal of Orthopaedic and Sports Physical Therapy
focused on a single-joint action (i.e., isolation exercises), such as
42: 208-220, 2012.
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be looked at as mutually exclusive. Rather, they should be viewed SH. Specificity of limited range of motion variable resistance
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(23). Furthermore, fear-mongering surrounding exercise variations
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all exercises are safe, but should be prescribed in a context- BA, Kusayama, T, et al. The human posterior cruciate ligament
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squat. Journal of Strength and Conditioning Research 24: ABOUT THE AUTHORS
2749-2754, 2010. Nick Tumminello is the owner of Performance University, which
21. Powers, CM, Ho, KY, Chen, YJ, Souza, RB, and Farrokhi, S. provides practical fitness education for fitness professionals
Patellofemoral joint stress during weight-bearing and non-weight- worldwide, and is the author of the book, “Strength Training
bearing quadriceps exercises. Journal of Orthopaedic and Sports for Fat Loss.” Tumminello has worked with a variety of clients
Physical Therapy 44: 320-327, 2014. from National Football League (NFL) athletes to professional
bodybuilders and figure models to exercise enthusiasts. He also
22. Shelburne, KB, Pandy, MG, Anderson, FC, and Torry, MR.
served as the conditioning coach for the Ground Control Mixed
Pattern of anterior cruciate ligament force in normal walking.
Martial Arts (MMA) Fight Team and is a fitness expert for Reebok.
Journal of Biomechanics 37: 797-805, 2004.
Tumminello has produced 15 DVDs, is a regular contributor to
23. Tumminello, N. Resistance exercise programming: A mixed- several major fitness magazines and websites, and writes a very
training approach. Personal Training Quarterly 2: 8-11, 2015. popular blog at PerformanceU.net.
24. Tumminello, N. Resistance training – General vs. specific
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PTQ 4.4 | NSCA.COM 53

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