Jessie Newell by Jessie Newell
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This blog is geared primarily toward the case study chapters appearing in the ACE Personal Trainer Manual, but this information can be very useful for any health coach or exercise professional. This chapter is 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. This blog highlights key things to identify, and how to apply the 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 prepare for the exam.

There are a couple of things to identify to make the safest and most effective program for a client based on his or her attitude, current health and fitness status, and goals. As exercise 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.

-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 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 currently?! 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 enough (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 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 to 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 from 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  “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 in creating an initial cardiovascular training program. What should the focus of the initial 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 to 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.

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 CAD 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 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 has goals of completing three body-weight pull-ups. We need to get into the Load Training phase to accomplish an activity that is 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.