This blog is geared primarily toward the case study chapters appearing in the ACE Personal Trainer Manual and the ACE Health Coach Manual, but this information can still be very useful for any health professional. These chapters are often overlooked and underused because there is no new information presented in this chapter. However, this is a HUGE mistake! This chapter facilitates some of the best practice in putting all the information together, and learning how to approach working with various types of clients. In this blog, I highlight the key things you’re looking to identify, and how to apply that information to someone’s health-risk appraisal, assessments and initial workout program. Doing so will provide you with some clarity on how to use these case studies, which will also help you pass the exam.
There are a couple of things that you’re really trying to identify to make the most safe and effective program for this person based on his or her attitude, current health and fitness status, and goals. As fitness professionals, we are looking to identify the following things from our clients:
-What stage of change is your client in? By first getting an idea of how ready your client is to change, we can determine the most appropriate strategies to take with this client. For more information on the Transtheoretical Model of Behavior Change, please see our Motivation and Behavior Change Blog.
-What is your client’s atherosclerotic cardiovascular disease (ACD) risk stratification? The Health-Risk Appraisal is the ONLY part of the assessments that is mandatory. While it is ideal to perform postural and movement assessments, as well as physiological assessments that could identify strengths, weaknesses, current fitness level, etc., if a client does not wish to perform them, it’s not mandatory. This is because the health-risk appraisal is used to determine if this person is healthy enough to begin an exercise program or if he or she needs to obtain medical clearance first. It’s our responsibility as fitness professionals to recognize the signs, symptoms and risk factors that determine an individual’s risk. For more information on this, please see our Risk Stratification Blog and Health-Risk Appraisal Blog.
-In what phase of the ACE Integrated Fitness TrainingTM (ACE IFTTM) Model should this client begin? This requires an understanding of what is generally occurring in each of the four Resistance and Cardiovascular Phases. It’s a little easier when a client is new to exercise because he or she is most likely to start in Phase 1. If the client has some exercise experience, then it is up to you to determine in which of these phases it is appropriate for him or her to start. See sidebar for more information on the ACE IFT Model.
-What is the appropriate end-phase for your client based on his or her goals? According to the ACE IFT Model, the last phases of the Resistance and Cardiorespiratory Training are appropriate only for elite athletes whose goals are related to performance in a sport or event. By having a thorough understanding of each of the phases of the ACE IFT Model, you will also gain the ability to recognize where the appropriate end-phase is and how to best reach your client’s goals. For example, most people will never need to progress past Phase 2: Aerobic Efficiency of their cardiorespiratory training unless they have some performance goal they need to accomplish.
-What assessments (if any) are appropriate to perform at this time? Again, keep in mind that besides the health-risk appraisal, none of the other assessments are required, but some are definitely recommended! When determining which assessments to perform, refer back to the client’s goals and current fitness status. You will generally perform posture and movement assessments with most clients, but you will want to pick and choose which ones you do based on individual needs. For example, if you’re working with just your average, healthy client, some general assessments are sufficient (e.g., static posture analysis, Thomas test, Core Function Assessment) to gain insight into what you should focus on. However, if you’re working with someone who plays in an adult softball league and is concerned with his lack of range of motion (ROM) in his shoulder, you might elect to perform all of the shoulder movement assessments. Regarding physiological assessments, If a client is new to exercise and you know you’re going to be starting her in Phase 1 for either cardio and/or resistance training, there is no need to perform cardiovascular and/or muscular fitness assessments at this time (and unless the client is an athlete, you would not need perform sports-skills assessments at all). Why? Because these assessments might challenge the client beyond what his or her body is ready for. If it aligns with a client’s goals, even beginning exercisers might benefit anthropometric measurements (body composition, girth measurements, etc.) and the McGill’s Torso Endurance Test Battery. These assessments can provide us with some great starting points to track progress. For more information on the assessments, please refer to our Posture and Movement Assessment Blog Anthropometric Assessments Blog and Cardiovascular Assessments Blogs.
More on the ACE IFT Model
Because ACE is required to structure exams in such a way that people can prepare without purchasing the manuals or other various materials, you will NOT see the words “Phase” or “ACE IFT Model” on your actual exam. Instead, you will read a description of what a theoretical client is currently doing and be asked what the most appropriate progression might be. The ACE IFT Model was designed to help you as a trainer design programs based on a client’s current fitness level. Here is an example of a question you might see and how to use the ACE IFT Model to help you figure out the answer:
Question: Your client is brand new to exercise and needs help creating an initial cardiovascular training program. What should the focus of the initial program of their program be?
Answer: Gradually work their way up to 20-30 minutes of moderate-intensity cardiovascular exercise.
Reasoning: If someone is brand new to exercise, you’re going to start him in Phase 1: Aerobic Base Training to establish his aerobic base and get his body used to moving for extended periods of time. The end goal for Phase 1 is 20 tp 30 minutes of moderate-intensity exercise, so we want to start the client at a level that is appropriate for his fitness level (e.g., 5-10 minute bouts of walking) and gradually increase the duration. Once the client can complete that, we know he’s ready to progress to Phase 2.
For more information about the ACE IFT Model, check out this FREE IFT Model Webinar. Simply go to the ACE Store and add it to your account. TIP: This is a continuing education course (CEC), so while I highly encourage you to watch the video as many times as you’d like, wait until after you’ve earned your certification to take the quiz because you will be awarded 0.1 CEC credits upon passing. If you complete the quiz prior to your certification exam you will NOT get the CEC credit.
Let’s look at a case study and put it all together! Refer to Case Study 1: Sharon in Chapter 12 (begins on page 412) of the ACE Personal Trainer Manual. Click HERE to see this information if you do not have this manual.
-Stage of Change: Sharon is in preparation. She has previously been active, but has been sedentary since her second child. She knows the benefits of exercise and has begun to make the necessary arrangements to get active again.
-Risk Stratification: Sharon is a low-risk candidate. Her only positive ACD risk factor is her sedentary lifestyle so she is cleared to participate in both moderate and vigorous activity as well as submaximal and maximal exercise tests without physician’s clearance or supervision.
-Appropriate Beginning Phase: Because Sharon is brand new to exercise, we will start her in Phase 1 for BOTH cardio and resistance training.
-Appropriate End Phase: Based on her goals, we want to take her to Phase 2 for cardio so she works on the efficiency to feel good and have fun during her soccer games (but because she has no competitive goals we do not need to take her beyond phase 2). For resistance training we want to take her to Phase 3 because she had goals of completing three body-weight pull-ups. We need to get into the Load Training phase to accomplish an activity that is that advanced.
-Appropriate Assessments Based on the Needs of her Goals: Because Sharon is currently sedentary, we do not need to perform any cardiovascular or muscular fitness assessments at this time. However, we should still do the McGill’s Torso Test because it can help identify muscular imbalances that could potentially lead to low-back pain. A body-composition assessment should also be performed to establish a starting point, but all other assessments should focus on general posture and movement analysis until she has progressed to more advanced stages of cardio and resistance training.
I hope that this breakdown of a case study was helpful for you, and that you feel more comfortable with how to practically apply this information. As always, if you have any questions or concerns regarding this or any other topic, please contact our Resource Center at firstname.lastname@example.org or by calling 800-825-3636, Ext. 195, where our Study Coaches attend the line 7 a.m. – 6 p.m. PST, Monday-Friday. Please allow 24 hours for response time.