ISPP 2015

Career Opportunities in Pharmacy
Introduction to Exercise Assessment and Prescription

you hi I'm dr. Matthews I'm here today to give you a quick introduction description which is a series of video lecture videos that I have here that you can watch but this will give you a little bit of a feel for what's coming in the lectures ahead with this we're going to have a couple different textbooks that I'm recommending that you have at different times I'm going to refer to figures in those textbooks and I won't be putting those figures directly into the PowerPoint for copyright reasons so those two textbooks are going to be the American College of Sports Medicine or ACS Sam's resources for the exercise physiologists the second edition and you can scan this QR code here and it'll take you to where you can find the textbook I'm talking about and for this introduction I am going to be pulling some of my information from chapter 1 the other textbook is also an ACSM textbook this is the acs ms guidelines for exercise testing and prescriptions of the 10th edition again here is the QR code where you can find that for that textbook and also I will be pulling some information for this particular video from chapter 1 of that textbook so in order to understand why it's so important for us to study exercise assessment and prescription let's start from sort of a global big scale here and look at the leading causes of death in the United States all right so cardiovascular disease is the leading cause the single leading cause with 31 percent of all people who died in the United States at least back in 2007 it's about the same now but about 31 percent of people who died died from cardiovascular disease or something related to their development of cardiovascular disease the this is a head of cancer it's a head of different respire Tauri diseases a head of accidents a head of Alzheimer's as well as a head of lots of other conditions that fall under this other category so if you're look look here we do have other being a fairly large chunk of the pie but again that's a lot of different diseases clumped together as other or cardiovascular disease is a very large chunk cancer is a fairly large chunk as well but good thing is exercise is going to protect against cardiovascular disease as well as some types of cancers so this again is the reason why we're talking about this so when talking about mortality which just means death the major modifiable risk factors that lead to death regardless of the cause of the death are going to be smoking which causes about eighteen percent of the deaths in the United States the next one being a combination of poor diet and poor physical activity habits which together cause about 15% of the deaths in the United States and then the third modifiable risk factor that has the largest chunk of the pie is alcohol consumption with 3.5% of the all cause mortality so in other words people die regardless of what actually killed them and alcohol is associated with their deaths so the best thing that a person can do is not smoke that's easy to do is for special' it's easy to do if you've never started you have started compared to adopting up the selectivity regimen and controlling your diets it's probably a little easier of course I not being a smoker myself maybe I'm wrong and saying that but it's probably easier to not do something that it is to have to do something so the best thing you can do is not smoke but a close second is going to be eating a good diet and having good physical activity habits yeah so let's just branch off from that for a second though and looking at common risk factors that are associated with poor health and mortality outcomes so we have this separated out and see you biological factors environmental factors and behavioral factors and biological factor factors for the most part are non-modifiable meaning that we can't really do anything about it we're just born with it or it's something that we've developed and it's it's set there's nothing we can do about it so things like your age your sex your race your genetic predisposition for disease those are things that there's really nothing you can do about it the environmental factors are tend to be semi modifiable and what I mean by that is some people they can move they can get a better environment they can you know get new friends whatever it be but for other people a lot of people their environment is kind of set you know they're they're linked to their family for various reasons and they can't move away from them or they have financial reasons why they can't move and so things like pollution and crime and low income poor housing those are all things that can sometimes be modified but oftentimes they can't be what we are really gonna focus on are the behavioral risk factors because they tend to be highly modifiable all right again I already mentioned smoking I already mentioned exercise or physical activity which falls under the sedentary ISM categories of sedentary is a meaning person who is sedentary or a person who is not physically active poor diet alcohol stress drugs all those things are modifiable risk factors that if you don't do what you're supposed to do in those areas it's going to leave to poor health outcomes and potentially early mortality or depth so the focus of this class is going to be exercise and physical activities so we're not going to talk as much about the diet and that sort of stuff so let's just for a moment though define physical activity and defined exercise because they're not exactly the same thing so the physical activity is basically any bodily movement that's going to be produced by the contraction of skeletal muscle that's going to typically we define as something that is going to use a fair amount and energy or have a large cohort requirements for instance we're going to categorize as physical activity things like walking your dog or potentially yard work stuff like that but we're not going to associate with physical activity things like holding the remote control of TV that's that's just not going to have the chloric requirements enough to make it a part of physical activity within physical activity we have several categories of activities and types of activities one of which is the one we're going to focus the most on this course and that is exercise so exercise is a subset of physical activity so all exercise is physical activity but not all physical activity is exercise and the difference is exercise is going to be physical activity than it's planned structured and repetitive and it's specifically done to improve or maintain the fitness of the individual so that is what exercises where physical activity can include things like walking your dog doing yard work doing light work around the house exercise tends to be more the kind of things we associate with fitness things like running cycling swimming maybe even playing some sort of sports like basketball or soccer those are exercise which again is a subset of physical activity on this slide I'm going to be referring to figure 1.1 from the ACSM guidelines textbook so you can find that textbook again by skiing this QR code but please go ahead and get out that textbook now and flip to figure 1.1 and so what this is showing is on the x-axis we have percentile rank for physical activity and fitness so as people go further on the right on this graph they're going to have a greater physical activity integrative fitness and then on the y-axis we have their relative risk so a relative risk of one meter equally as likely to die as somebody who is not physically fit and it isn't has poor physical activity patterns so as we go up in the percentile rank for physical activity and fitness what we're going to see is that the relative risk of that individual is going to come down substantially so for physical activity for instance it comes down around 25% so you're 25% less likely to die if you're highly physically active or somebody who is not physically active at all so some way sedentary for her fitness if you were highly fit you are about 60% less likely to die and somebody who is not fit at all so physical activity and fitness both are going to impact your relative risk of disease and death fitness a little more so than physical activity but they're both independent predictors of mortality and death on this slide I'm also going to be pulling from a figure that can be found in the ACSM guidelines 10th edition guidelines textbook but you can also find this the original data of this it's a little bit of a different type of graph but you can find the original data at this link here which is what this QR code is going to so if you want to see the textbook version of this go look at their your ACSM guidelines 10th edition if you want the original data look here at the New England Journal medicines research article on this topic and so really what we're asking here with this is is exercise dangerous in to put it simply before we get to you the data yes yes exercise is dangerous however being sedentary so the opposite of exercise so having very little physical activity in your life is actually far more dangerous than exercise so if you're not going to exercise you're actually at greater risk and if you do exercise and so let's look at the figures together so I'm going to be looking at the ACSM version but again you can get the same data from the New England Journal Medicine link here or QR code there so essentially we have people split up into eight people who are sedentary and people who are physically active and perform vigorous exercise on either 1 to 2 days per week 3 to 4 days per week or 5 or more days per week when you take the person who is active they have half the risk on a day that they're not active as someone who is sedentary on the similar day where they're also not active so if you are exercising on a regular you're gonna have half the risk that someone who does not exercise has so that's a huge improvement on day to day basis so again talking about the dangers of exercise if you exercise in your sedentary individuals and you exercise at a vigorous intensity that's going to increase your risk of a heart attack or some other sort of acute myocardial event by about a hundred times during or the hours immediately following that bad exercise so yes it is dangerous especially for somebody who doesn't exercise and that's what we're going to get to in the next couple of things I talked about so now if you exercise at a various intensity one to two days per week while you exercise or immediately after and there's those following hours where your risk level is highest your risk level is only going to go up about thirty times compared to what it was if you didn't exercise at all so from a hundred times to thirty times it's a huge improvement just by being vigorously active one or two days per week now if we go up to three to four days per week the risk level only goes up by about eight or so so now again from a hundred to thirty now down to eight so huge improvements now if you're heavily active somebody who's active five or more days per week now your risk level during or immediately after that activity only goes up by about one and a half to two times so minimal increase on what was already a really low level of risk so the point here being is is exercise dangerous yes yes it can be during or the during exercise or the hours meet the after exercise especially vigorous intensity exercise your risk of an acute myocardial infarction or a heart attack are going to go up substantially however your risk is pretty low anyways so an increase is still you're still unlikely to have a heart attack but regardless you're much less likely if you do it on a regular basis than if you just do it once in a blue moon so your best bet is going to be to have physical activity be a part of your regular routine so that not only is your risk when you're active much much lower but your risk when you're not active is actually half as much as it would be if you are not active at all so again exercise is dangerous but much less dangerous than being sedentary on that note let's look at some of the benefits of exercise beyond just reduction of things like myocardial infarction or heart attack and death so reduction of body weight decreased risk of stroke decreased risk of metabolic syndrome decreased risk of hypertension or high blood pressure decreased risk of type 2 diabetes decreased depression decrease anxiety decreases in some forms of cancer decreases and arthritis decreases in your risk of falling which when you become older especially at the elderly level falling is one of the major ways people get hurt and actually die from complications from the fall so a decrease in fall risk is actually really important it's also going to elevate your mood it's going to increase your perceptions of energy so you're gonna feel like you have more energy throughout the day and you're gonna sleep better and these are this is just a relatively short list of the benefits of exercise so it could be much much longer than what I showed here but the point is exercise is really really good for a lot of things thinking about health promotion and goals and those sorts of things this exists on a continuum that continuum is health on one side fitness in the middle and exercise athletic type performance on the other side what I mean by having an fitness health fitness and performance continuum is that obviously these are related to each other they're all outcomes related to physical activity and exercise however the types of outcomes are going to be cumulative so if you're exercising at a moderate intensity you're probably only going to get the health outcome meaning decreased risk of all-cause mortality in decrease obesity all those sorts of things and while those are probably the most important outcomes there are other outcomes that are worthwhile as well so if you increase from a moderate intensity to vigorous intensity exercise now you're going to start getting more fitness outcomes so it's going to come easier to do things on a regular basis walking up the steps are going to be easier you're going to be less Windy's when you get to the top your own do feel less tired when you get to the top was along with lots of other things it's going to increase your capacity for physical activity so you can do more in a day it's also going to increase your body aesthetics because you're going to lower your body fat and increase your lean muscle mass which are things we generally associate with good looks if you increase the intensity even further and start to incorporate lots of vigorous activity or some potential even your max walk TV the types of things that we associate with sports that's going to increase your performance abilities so again that's why we associated with sports is because people who are athletes tend to exercise at really high intensities and do so in order to be able to exercise with those high intensities and during their sports so for not all not all people want that though that's something that you as the future fitness future curb that this professional you need to be aware of is that the goals of people are going to determine the requirements that they need to meet all right everybody needs to at least meet the health requirements but going beyond that is only going to be necessary if that is what the client wants so if the client doesn't care to be able to run a mile quickly then there's no reason to get them to this level of intensity you can stop at one of these lower levels of intensity and still meet all their goals and desired outcomes and you know as long as they're meeting the health outcomes or what the health goals then they're probably gonna do just fine any is so this particular class is going to focus mostly on health and fitness we're not going to be focusing on performance other classes will focus on those sorts of things we are going to be mostly talking about the general public where health and fitness is really all there after and most of them are not athletes alright so again make sure that when you're thinking about exercise and exercise goals extra is prescription for your clients you're taking what they want into consideration and you're not just pushing on to them your own desires and what you're use to do it so on that topic how much exercise is enough and these recommendations are going to be specific about health not so much the fitness and athletic performance side of things so if you meet these recommendations you're most likely going to have health oriented outcomes not so much the others unless you start pushing into the bigger SAC levels of intensity and beyond alright so for aerobic exercise you need at least 30 minutes of moderate nca aerobic exercise 5 days per week or you can do 20 minutes of vigorous intensity aerobic exercise 3 days per week also you can combine this you induce somewhere in both in the middle if you're doing both moderate and vigorous intensity exercise on some days for resistance exercise we need moderate to high intensity resistance exercise is training all the major muscle groups on equal to or more than two days per week and this is important because while there are some overlap between the benefits of aerobic and resistance exercise resistance exercise does have different benefits that a verb exercises not invite first that aerobic exercise has something this that resistance exercise does not so you do need to do both of these and one of the key differences is resistance exercise is going to build lean tissue mass it's also going to build bone density better than what aerobic exercise can doing more than just the minimum recommendations that are listed here will turn into greater outcomes whether it's health fitness or athletic performance outcomes however these are the bare minimum recommended by the ACSM or the American College Sports Medicine all right so with all these in mind let's talk about how many people across the globe actually meet these recommendations as I mentioned before physical inactivity or sedentary ism is something that is a major problem it's a modifiable risk factor but unfortunately it's a global pandemic in the United States alone 51 point 6 percent of adults meet the aerobic exercise requirements which means about half of adults don't need this requirements 29% meet the strength training through the resistance training guidelines which again means about 70 percent of adults in the United States do not meet the resistance training requirements and we recombine the two together which everybody should be doing both only 20% of adults in the United States actually meet both requirements for aerobic exercise and resistance exercise so 80% of the adults are not mean ACSM guidelines for exercise and this is a really big deal for all think about all the benefits of exercise and now all those benefits are not being seen by 80% of the adult population in the United States these numbers are focused on the United States but these numbers are very similar to what most industrial societies across the globe are seeing talking about research and sources of information this is a chart that I have created that I want my students to follow because it gives an idea of what are good in credible sources and what are not so credible sources and I this is essentially a ranked order as well and it's not perfect but it's pretty good so we have our trust levels so how much I perceive the ability to trust that type of source we have whatever that source is and then we have some common characteristics of that source that essentially lead me to how much I trust it okay so at the top of this list we have major organizations position statements and the reason why I put them at the very top as the most trustworthy is because it's used based on large Committees of experts there are people who do the research in this field who know the pitfalls know the limitations as well as know again those the strong suits of that research and they put it all together they get into a room or some sort of virtual space or whatever they need to do in order to meet and talk to each other and they essentially argue it out until they come to conclusions that everybody or most people agree to so with that being said major organizations position statements are going to be probably your best bet as far as getting credible information however it's not exactly going to be cutting edge information because it's something that most people will agree to it's not new it's not still being worked out from the most part coming down a level from that we have reputable textbooks there are several of these out there for exercise physiology I'll put some in the description below that you can use for this course and others the difference between the reputable textbooks in the position statements is well the position statements were large Committees of the experts in the field the most well known most renowned researchers out there textbooks are written usually by a handful of reasonably well-known individuals sometimes there are the best but there's still just a small collection of the best so you don't get as many opinions coming together and word create the content and so the textbooks aren't quite as good as the position statements the next one down is a journal review article so this is when a research journal publishes the work of usually one to maybe even a couple more than that but just a select number of researchers and that goes through a peer-review process and the real difference between the textbooks and the review article is the fact that the textbooks are typically older information more well-established information whether review articles are oftentimes getting more towards the cutting edge they're still not necessarily cutting-edge but they do pull in the newer research that's out there much more so than the textbooks so it's when you pull in new information there's gonna be flaws in the information that we some of that we know and some of it we won't know until the future when new information comes out that proves them wrong so because of that it's not quite as trustworthy of a source but it is still a really good resource the next source of information would be a journal peer-reviewed original research article there so a review article was when they take a bunch of these original research articles combined them together into some sort of summary of what's known or what's out there on a topic all right so this though is just a single research study done by one two experts maybe you know a couple more experts some student researchers they put their efforts together and they conduct a research study they analyze that study in the publish it every study has flaws every study has limitations so it's good it's peer reviewed which is the gold standard for literature is to have it to be peer reviewed but it is the only one attempt to answer that question and because of flaws that are often identified by the researchers themselves in their limitations section as well as flaws and we again we don't know yet because there's just information that we still haven't figured out no one paper or one research article is the definitive answer on any question so getting really good information but not quite as trustworthy as the information up here it's more likely to be sort of overturned by research that will come out in the future the next step down would be a website from a major organization in our field and I'll give you a list of those of some of those organizations on the next slide here but organizations like the American College of Sports Medicine so major organizations where exercise is what they do those are the types of websites I'm talking about so oftentimes their websites are going to be where you can find their position statements but they usually have some lay versions of those position statements that are a little easier shorter and they're just in sort of website formats and so good information much more lay oftentimes meaning it's not quite as nuanced it doesn't take into account all the limitations and whatever might prevent that research from being ideal or perfect it's not going to really go into that it's just going to kind of tell you the summary at the end result and what they currently think based on these other sources of information so still pretty good in my class specifically in an undergraduate level class you can cite anything within this green box here that I've already gone over anything in that green box is going to be good sources of information that are probably going to be accurate or at least as accurate as we have right now the next step down is a conference for speaking or a research abstract this is essentially that precursor to a journal peer-reviewed original research article so oftentimes people will present their research at a conference when it's still the preliminary stages when they're not exactly sure what's going on they're still collecting data oftentimes and then they will go and publish it when they finish the studies so it's okay information it's interesting information but it's oftentimes not going be the finals the results of that study so it's not something that you should be citing in most of your classes unless there's literally nothing else out there on the topic then maybe you can cite it but typically that's not the case the next one down would be websites from an organization that's not a major organization in the field so this could be some small group you know a gym a blog that kind of thing often it usually it's the information is only half good half half not so good think about you know magazine companies that have websites you know your muscle fitness those sorts of websites they're okay they have some good information but they're often sensationalized in some weight in order to bring viewers in and it's really not the best content and there's usually a lot of flaw the content and the people of writing the content oftentimes don't have as much information as they should to speak as authoritative ly as they do on the topic the next one on the list is companies trying to promote a product so if someone's trying to sell you something whether it's a gym membership or a piece of equipments or supplements or some sort of dietary plan whatever it is don't trust them all right they're trying to get your money they'll say whatever it is necessary to get that money and of course there are some good companies out there who won't sort of Bend and manipulate things in order to get your money but most companies are going to do what they need to in order to stay afloat or to prosper within this field and there's a lot of really terrible companies in the exercise physiology and exercise realm in general so don't trust someone who's trying to sell you something and the last one on this list is any random person that you meet so most often this is going to be some random person you meet at the gym who think they know everything is going to tell you what you're doing right and wrong so probably interrupt you while you're exercising to tell you how you should be exercising or this would be your your coaches your your teammates parents friends whatever it be even myself you know I am coming to you try my best to give you good information but I am NOT the final source of this information I'm getting my information from other sources in trying to give that to you in a nice user friendly manner but before you believe me before you trust what I say you really should go and look it up for yourself especially if it's going to be used in a context where there's risk involved or if you're going to be making career type decisions based on the information I give you you shouldn't trust me you should trust no one you should only trust yourself and the information that you get from credible sources that are peer reviewed that are from major organizations the kind of sources that I listed up here so again I would be listed as Iran a person that you may or may not know all right so it's not someone you should trust nobody no one person is someone you should trust they say they know everything they're lying to you so don't trust anyone look it up for yourself here's that list of major credible organizations that provide a lot of information in this field that I was discussing on the previous slide so there's two big ones I really want to talk about here are the American College of Sports Medicine or the ACSM and the national strength and conditioning Association the NSCA these are the two largest organizations in the exercise realm the biggest being a CSM by far it's probably two to three times as big as nscaa but they're both way bigger than any of the exercises organizations down here however a lot of these are organizations that are bigger than this but they just don't focus on exercise for instance the National Institutes of Health the Center for Disease Control those they do make some recommendations about exercise but they do lots of other things so I'm not saying they are smaller than the ACSM but organizations like for instance the American Council and exercise is much smaller than a CSM so the ACSM really is probably the best organ organization in this field NSCAA is probably the next best followed by some of these other exercise organizations down here and then all these other organizations that are listed here are just good organizations that do still publish exercise related information but not necessarily exclusively and if you're trying to find information research-based information in this field great ways to do so would be to go to a search engine or a database that collects research so the best to out there in my opinion are PubMed so you can find them at this website or if you scan this QR code it'll take you to this website the next one is Google Scholar here is the website for that and here is a QR code that will take you to that website both these are going to have original research peer-reviewed research primarily Google Scholar is not quite as filtered as PubMed PubMed the the research is generally good peer-reviewed research Google Scholar oftentimes is but occasionally some things slip in that maybe aren't as high quality is what you would find in PubMed so if you find in PubMed it's probably pretty good find out in Google Scholar it's generally pretty good but you both are gonna have some not-so-good stuff Google Scholar is gonna have a little more than not-so-good stuff but to be quite honest I use Google Scholar or the most just because it's a little more user friendly it's important for us to know what exactly the outcomes we are looking at are when we're talking about things like fitness all right so the ACSM defines five health-related components of fitness and then if you are going to do more of the athletic side of things or if you're working with somebody whose activities of daily living are becoming limited and we also have six skill related components of fitness years so quickly go over these the five health-related components which are the minimal that you really should be testing when you're working with a new client are kardi respite or endurance which is the ability of the cardiovascular system to work with a respite or a system to get blood and oxygen around the body so that you can sustain physical activity so that's a fancy way of saying you're a real big fitness you have body composition which is essentially your muscle and your fat and bone and other parts of the body and how much of your body is made up of those primarily we tend to focus on your body fat percentage when you look at body composition muscular strength now we're looking at how much force a muscle or muscle group can produce any maximal efforts most for their endurance you're looking at your ability to perform some sort of muscular task and to do it repetitively or for once continuous action for a long time without fatiguing flexibility this is your ability to move your joints through a range of motion so your ability to move your shoulder all the way through its range of motion your hip all the way through its range of motion that is measured through flexibility so again these are the five health-related components of fitness but we also have these skill related components which we're not going to focus on nearly as much in this course but I do want to go over them quickly here we have agility which is your ability to move your body through positions and space and to do so quickly and rapidly and with great accuracy so obviously that's really important for athletic performance but it's also important if you're somebody who is getting more Crale and elderly and who's trying to maintain activities daily living because your ability to kind of get around accurately is going to be important for that your coordination so this is your ability to use the senses that you have your sight your hearing your bodily Kenneth is your sensitive where your body is in space in order to perform a task in a smooth and coordinated fashion next is balance which is your ability to maintain your equilibrium so in other words to stay upright in or to stay in the position that you want to be in whether it's upright or supine or laying on your side or whatever that is or your ability to regain your equilibrium after something knocks it off so if you were to trip your ability to prevent yourself and fall in kind of a situation your power so this is specifically talking about muscular power most of the time this is your ability to produce force quickly all right so we talked up here about muscular strength which is the ability to produce a lot of force but we weren't talking about how fast you produce that force muscular power is when we actually look at how fast you're producing that force reaction time so this is your ability to respond to some sort of stimulus in your environments whether it's something you see something you hear how quickly you can change and react to that that is a reaction time and then the last skill related component is your speed so how quickly you know so think about sprinting speed here but this is also something that's going to be important again if you start thinking about the older elderly people their ability to move quickly from one place to another is going to allow them to get out of the way of say a moving car or to just be able to kind of get through their day and to do so with relative ease the last thing I want to talk about in this video is a sequence of exercise prescription tasks that I recommend and you're gonna see the sequence in all of the videos in this this lecture series for this course so the first thing that I recommend you do is become educated on exercise physiology and it's related topics we're going to cover a little bit of that in this class you really should take an extras physiology course before or during this course so you can really solidify the information we're covering in this course because we're gonna kind of brief past some of that exercise physiology and so what I'm actually going to do is put a card in here as well as a link in the description below for a lecture series that I have on exercise physiology that will hopefully help with this we need to be to learn about legal considerations things like the various safeguards to prevent yourself from getting sued or from doing something illegal things we'll talk about things like insurance and a coming video so we also need to learn about informed consent so you need to or you need to do an important consents you need to tell the person what you plan on doing with them and have them agree to it and understand the risks of that activity the next thing is you need to perform so these are the things you need to do in order to actually work with the client so the next thing you need to do working with the client is to get their health history or medical history and you're going to be doing that to find out what kind of issues they have that may affect their ability to exercise safely or their ability to exercise at certain intensities or do certain types of tasks the next thing that you would do is do risk assessments which is associated with a screening essentially you're looking for different contraindications exercise or even just risk to their health that they should know about that you should have a conversation with them so things like smoking right so if they smoke that's a risk factor and you should have a conversation with them about that in smoking cessation for that individual the next thing you would do is complete all your resting tests so tests that don't actually involve physical activity of any kind said things like resting blood pressure resting heart rate electrocardiogram their height their weight their body composition that was discussed on the previous slide all those can be done at rest without them exercising and so those should happen first because they are going to be affected by the things that would come later which is going to require exercise so for instance you wouldn't want to try to measure someone's resting blood pressure after having them do some sort of bicycle test because it's going to take a long time for the rest of the blood pressure to return so the next thing you would do are the cars fire Ettore fitness testing so this is things like measuring their vo2 max which we'll talk about later on and actually all these topics are things we're gonna go to later on in this course and so let's go ahead and skip past this for now it's a pretty complicated topic that will gets you later on you're also going to want to test their muscular strength and endurance and I will say that some of these exercise testing orders are going to be different depending on where you're looking they may be different depending on which video in this series that you watch but essentially these need to happen closely close together and the actual order is going to be based somewhat on opinion based on the test that you're actually using as well as based on the source that you look at so after the Kardos part or a fitness testing you would test their muscular strength and endurance following that you would test their flexibility now they're warmed up and then finally you start to establish goals with the individuals you ask them what they want to do giving them the information from all these fitness tests and letting them know where they are strong and whether where they are weak and where they may want to think about trying to improve themselves so that's when you would establish goals and from the goals you'd prescribed the exercise then eventually you would schedule a retest of all their fitness tests that you did to see if your exercise prescription plan actually made them better or not and if not that's okay sometimes you obviously don't want that but if it happens that means you need to adapt the prescription plan so that the next time you do a retest they actually do get better if they have gotten better maybe that's time to bump it up again as well so that they continue to get better for the next time you test them alright so this is the end of what we're going to cover in this lecture again it was just an introduction to the topic of exercise testing in exercise prescription we're going to go into each of these topics listed here in further detail in future videos within your lecture sets so please come back and watch one of those thanks

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