Sila." The Other Components - Proper Nutrition, Prevention or Cessation of Smoking

Rationale
A significant proportion of Filipinos are exposed to non-communicable

disease (NCD) risks which include tobacco and alcohol use, unhealthy diets, and
physical inactivity. In 2015, 68% of the total mortality rate in the Philippines is due
to NCDs. The figures from 2015 show that every third Filipino (29%) can die before
the age of 70 years from one of the four main NCDs – cardiovascular diseases,
diabetes, chronic respiratory disease and cancer.
The increase in NCDs are affecting populations of low and middle income
countries like the Philippines, at a young age, reducing the productivity of the
working age population and stifling economic growth. Hence, government and
private health organizations have launched healthy lifestyle programs to help
prevent and control NCDs in the country, and one of these organizations is
Southwestern University.
SWU utilizes the tertiary physical education (PE) curriculum as a conduit for
promoting fitness through physical activity among students, their family, friends
and community – the target population of this program. SWU believes that fitness
born in the psyche of students will transcend to people around them and those
they get acquainted with at present and in the future. Making these people fit will
form part of their social responsibility while in SWU, and in their organizations or
communities after their graduation; hence, the tagline – “Kung fit ako, fit din dapat
sila.” The other components – proper nutrition, prevention or cessation of smoking
and alcohol consumption and stress management will be integrated being co-
existent under the umbrella of wellness.
The tertiary physical education physical fitness program of Southwestern

University will produce living models of fitness who would manifest the following:
1. High quality of life which refers to becoming free from the discomfort of
symptoms of any form of illness, and functional in performing the activities of
daily living and tasks at home, in school, in the workplace and in the community.
It does not simply refer to living a liveable long life or adding years to life but life
to years.
2. Optimum productivity which means exhibiting highly efficient performances

within the set of standards defined by the organization or community to which
the person belongs to. The most common cause of absences and tardiness is
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health-related resulting from non-healthy conforming lifestyle. It does not only
lessen productivity but entails high medical expenditures which all boils down to
increasing the economic burden on the person, the organization and the nation.
3. Social influence which refers to demonstration of sense of social responsibility

in the aspect of health awareness so that the effect of this program on them will
also transcend to members of one’s family, the organization and the
community. By mentoring them, their fitness practices can become contagious
and will leave a positive imprint in the lives of these people.
In becoming living models of fitness, the students will strive first to become
fit and competitive by working on their own under the supervision of a physical
education instructor. PE 1 comprises of modules on becoming fit which focuses on
exercises that improve cardiopulmonary capacity and musculoskeletal strength and
endurance. PE 2 consists of modules on becoming competitive which prepares
individuals to engage in individual and team sports and other activities by meeting
the required speed, agility, flexibility, strength, and aerobic and anaerobic
capacities.
Fit and competitive individuals cannot be considered living models of fitness

when no one will walk their path and become like them. They need to inspire
people who will become their trainees, and facilitate their training under PE 3 and 4
using what they learned in PE 1 and 2. PE 3 covers PE 1 module where the role of
the PE instructors will be taken over by students who finished PE 1. This makes PE 1
a trainer’s training program also. While the PE 1 graduates work on becoming
contagious to their trainees, the latter will aim at becoming fit. Same is true for PE
4 when PE 2 or PE 3 graduates will work on becoming influential to a bigger group
of people like a team, an organization or a community who will toil toward
becoming either fit or competitive whether with or without medical comorbidities.
All the four PE programs are deemed project-based – PE 1 and 2 involve a

project of making one’s own self fit and competitive; and PE 3 and 4 make up a
project involving another individual or small group of individuals (PE 3) and the
community or a team (PE 4). All modules in the four PE programs may all be
delivered, accomplished, monitored and assessed asynchronously depending on
the progress of the training. However, final assessment at the end of the semester
may be done synchronously when public health condition allows it.
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The contrast between the traditional and the new SWU tertiary PE curriculum
shows the superiority of the latter over the former as tabulated below:
Traditional SWU
Co-terminus with each semester Lifetime commitment
Thematic, stand alone Continuous progression
Cannot be applied/practiced to their Can be applied/practiced when they get

future work unless if they become PE to work; cuts across disciplines
teachers; no use in most professions
Teacher-centered, forces students to Student-centered, drives students to

execute teacher-made structured formulate and implement their
activities preferred activities
Will be considered by students just an Will be considered by students an

academic requirement integral part of their existence
Self-centered High sense of social responsibility
Based on lectures and demonstration Problem-based, research-oriented
Exam-based assessment Project-based assessment
A laboratory for PE majors A laboratory for sports science students
Conforms to CHED in detail Conforms to CHED in toto
Below is the summary of the tertiary physical education program showing

the scope of each semester, intended learning outcomes, expected derived skills,
assessment to be used and recognition rites at the end of each semester.
FIRST YEAR
1st Semester – PE 1 2nd Semester – PE 2
Title: Individualized Fitness Program Title: Sports Conditioning Program
Becoming Fit Becoming Competitive
Description: Application of the self- Description: Application of the self-

designed fitness program that designed sports conditioning program
comprises of cardiopulmonary and for enhancement of speed, agility,
musculoskeletal strength and flexibility, strength, and aerobic and
endurance training in the context of anaerobic capacities to meet the
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Prochaska, DiClemente, and Norcross’ demands of the chosen sports or
model of change. activity.
Outcomes: Physically fit to maintain Outcomes: Physically conditioned to

healthy status and to engage in take part in the chosen sports or
advanced conditioning and sports activity, and readiness to transfer
training, and readiness to make other fitness and conditioning skills to a
individuals fit. group or community.
Skills: Screening, Assessment, Exercise Skills: Screening, Assessment, Exercise

Prescription, Motivational Approaches Prescription, Motivational Approaches
Assessment: Portfolio, Assessment: Portfolio, speed, agility,

anthropometric girth measurements, flexibility, strength, and aerobic and
BMI, peak heart rate, volume anaerobic capacity measurements
Celebration: Fitlympics (Fitness Fete) Celebration: Best Project Awards Rites
Certification: Fitness Training Certification: Conditioning Completion

Completion
SECOND YEAR
1st Semester – PE 3 2nd Semester – PE 4
Title: Peer/Group Fitness Program Title: Community Fitness/Sports

Program
Becoming Contagious
Becoming Influential
Description: Facilitation of designed Description: Facilitation of designed

fitness program to trainees for sports conditioning program for
optimization of their cardiopulmonary enhancement of speed, agility,
and musculoskeletal strength and flexibility, strength, and aerobic and
endurance in the context of Prochaska, anaerobic capacities to meet the
DiClemente, and Norcross’ model of demands of the chosen sports or
change. activity, or a medical condition.
Outcomes: Physically fit, healthy Outcomes: Physically conditioned

compliant trainees ready to engage in compliant members of the community
advanced conditioning and sports while trainer maintains one’s own
training while trainer maintains one’s
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own fitness level physical conditioning level
Skills: Screening, Assessment, Exercise Skills: Screening, Assessment, Exercise

Prescription, Motivational Approaches, Prescription, Motivational Approaches,
Coaching Coaching, Organization and
Administration
Assessment: Portfolio, trainer and Assessment: Portfolio, trainer and

trainees’ anthropometric girth trainees’ speed, agility, flexibility,
measurements, BMI, peak heart rate, strength, and aerobic and anaerobic
volume capacity scores
Celebration: Fitlympics (Fitness Fete) Celebration: Best Project Awards Rites
Certification: Fitness Trainer’s Certification: Conditioning Trainer’s
PHYSICAL EDUCATION 3
Course Title: Peer/Group Fitness Program Tagline: Becoming

Contagious
Generic Course Title: Physical Activities towards Health and Fitness 1
Course Number: PED 027 Credit: 2 units
Description: This deals with the facilitation of the designed fitness program to
chosen trainee or trainees through cardiopulmonary conditioning and
musculoskeletal strength and endurance training in the context of Prochaska,
DiClemente, and Norcross’ model of change.
Outcomes: Upon completion of this course, the student’s trainees shall have
achieved their physical fitness level in terms of cardiopulmonary conditioning and
musculoskeletal strength and endurance required to maintain healthy status and to
engage in advanced conditioning and sports training while maintaining the
student’s fitness level.
Skills: The students will be honed on coaching their chosen trainees in screening
their readiness for physical activity, formulating exercise prescription, designing a
fitness program, assessing the progress of their training, and applying Prochaska,
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DiClemente, and Norcross’ model of change by implicit self-motivation and explicit
self-actualization.
Assessment: The students will compile their outputs and other documents in a
portfolio (print or electronic) including the accomplished forms that show records
of their and their trainees’ serial anthropometric girth measurements, body mass
index, and peak heart rate.
Certification: The manifestation of the outcomes set for this course at the start of
the semester makes the students qualified to receive the Fitness Trainer’s
Certificate.
General Instruction: The student chooses one or two other individuals, preferably
from their community as his trainees, and uses his platform in motivating the
trainees as they traverse from one stage of change to another. As much as possible,
the student should make sure that they would not be backsliding to the initial
stages much so if they have reached the maintenance stage and have kept the
momentum to a higher level for so long. The trainees may not see their student’s
platform. However, the concepts needed in becoming physically fit are given in
their own platforms. The PE instructor monitors the activities of both the student
and his trainees, and compiles and evaluates the progress of their training.
Module 1 – Pre-contemplation Stage
Outcomes: Upon completion of this module, the trainees shall have achieved the
following while the student, the trainees’ coach motivates them and maintains or
progresses his own fitness level:
1. Defined their own life’s success and happiness.
2. Identified tangible and non-tangible things that make them happy.
3. Recognized stumbling blocks in the pursuit of their happiness and success.
4. Determined situations in their present lives that need to be changed.
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5. Found ways to effect the changes.
6. Established readiness to apply ways to effect the changes.
Estimated Duration: Two weeks
Basic Concept on Motivational Approach: The student uses this concept in

motivating the trainees to engage in physical fitness program.
‘‘Motivation is a state of mind (characterized as an emotion, feeling, desire, idea,

or intellectual understanding; or a psychological, physiological, or health need
mediated by a mental process) which leads to the taking of one or more actions.’’
In other words, ‘‘motivation is a mental process that connects a thought or a feeling
with an action.’’
Motivation is always potentially present in the mind, even if inactive, for it is

essential for self-preservation. Thus, ‘getting motivated’ is not a question of
developing or importing the mind-state. It is rather a matter of activating a
presently quiescent process; of mobilizing it; of removing barriers to its expression.
If a trainee is having a hard time getting motivated but seems ready to start, the
student’s task is to help the trainee locate these barriers and then help him
mobilize the mental process needed to remove them.
There are three phases in ‘‘finding’’ motivation:

1. Experiencing an emotional and/or intellectual thought process of the
motivational type
2. Establishing a clear mental pathway between those thoughts and the
potential for taking the related action
3. Taking the action as the result of being motivated
To be effective, motivation must be inner-directed, e. g., ‘‘I want to do this for

me, to look better, feel better, and feel better about myself, for me, not for anyone
else’’. External motivation, e.g. ‘‘I’m doing this for my spouse/friend/children/parents
or employer, almost invariably leads to feelings of guilt, anxiety, anger and
frustration.
With inner motivation your trainee will be able to take control of the way he
exercises and eats. With inner motivation, the chances are excellent that he will
become a regular exerciser, slowly, gradually, and carefully.
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Students can guide their trainees through the processes of internal motivation-
mobilization and goal setting leading to self-discovery and action. In addition,
students can provide positive reinforcement and be role models for the trainees.
Within limits, the student can also help trainees locate their own motivation and
mobilize it within themselves by taking control of the process.
Taking control by the trainee is central to both starting a regular exercise

program and sticking with it. And there is much to take control of: whether to
undertake a change process at all; what goals to set; which sport and activity to
engage in.
Stages of Change
In helping trainees to mobilize their motivation and then engage in behavioral

change, it is important for students to understand the stages of change. Prochaska,
DiClemente, and Norcross developed a model that is called ‘‘The Six Stages of
Change’’ This description and analysis of the change process is helpful in
understanding how and why motivation is successfully mobilized, as well the
factors that lead to failure to do so.
The 6 stages of change are:

1. Pre contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination.
This module focuses on pre-contemplation where the trainee has not yet
decided or determined that he has a problem that requires a change. Therefore, he
does not intend to take any action within the upcoming six months. He may be
unaware, or not fully aware, of the true benefits of making change or may be
demoralized from past unsuccessful attempts at change. Thus, he accepts his
present state of being, either happily or unhappily.
In pre-contemplative trainees, they are informed about the benefits of exercise

in an effort to move them toward at least contemplating regular physical activity.
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Trainees at the other end of the spectrum (in the Action through the Permanent
Maintenance phases) and who are already regularly active are counselled to
maintain or possibly increase their exercise. They are also taught about injury
prevention, rotation of exercise and ways to remain active. The middle group
(contemplative and planning students) who are not yet active require mobilizing
motivation, counselling and exercise prescription to initiate their physical activity
programs.
An important aspect of helping your trainee to mobilize his motivation, thereby

sending him successfully on his way through the six stages, is helping him to
effectively deal with ambivalence. Ambivalence is a state of mind characterized by
coexisting but conflicting feelings about a contemplated action, another person, or
a situation in which one finds oneself.
Feeling ambivalent about making a behavior change is perfectly normal.

Virtually everyone who even thinks about making a behavior change experiences it.
Allowing ambivalence to paralyze decision making, however, is a problem. Handled
correctly, the process of resolving ambivalent feelings can help your patient get
started on the road to success in regular exercise.
A key to success in dealing with ambivalence is to accept that it will always be

present to some extent. The ambivalent feelings will be weaker and sometimes
stronger. The trainee needs to be reminded occasionally that ambivalent feelings
are perfectly normal. It is how these feelings are handled, how they are responded
to, that determines whether they will trip one up or not get in one’s way. If
ambivalence destroys commitment, that is a problem.
If it simply questions commitment, if it does nothing more than taking your

trainee on a temporary detour, it can lead to a strengthening of resolve to proceed
forward. The person who is stuck with unresolved feelings of ambivalence is a
person who, in many cases, must look beyond or behind those feelings to
determine why he has them in the first place. Some people can resolve this on their
own while others may need help.
Below is the guide in interpreting the answers of trainees in the Physical Activity
States of Change questionnaire.
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Stage Q1 Q2 Q3 Q4
Pre-contemplation No No - -
Contemplation No Yes - -
Preparation Yes - No -
Action Yes - Yes No
Maintenance Yes - Yes Yes
Teaching-Learning Activities:
For the Trainees: The student asks his trainees to perform the following and
discusses the outputs with them:
1. Interview two persons – one closed relative and one not related by blood
line, both should be suffering from any chronic or debilitating disease
requiring maintenance medications and limitations in the performance of his
activities of daily living. A written narrative report from this interview shall be
submitted. The report shall contain the answers to but not limited to the
following questions:
a. How did you draw your road map to success in life? What did you
consider as essential factors that lead to the fruition of your life’s success?
What did you perceive as determinants of success that will make you
happy? Had you made your loved ones, your family collateral contributors
of your success?
b. How does your present condition affect the road map you charted a long
time ago? Have you thought of attaining or not attaining anymore what
you had drawn before?
c. Can you narrate the history of your present medical condition from onset
until at present? Do you have family members or relatives who are also
suffering from, or somewhat similar or related to what you have right
now? What are the diseases common in your family?
d. Prior to the onset of the present condition, did you indulge in the use of
illicit drugs, excessive consumption of alcoholic beverages, chain smoking,
skipping adequate sleep over work, and spending time for too much
worrying?
e. Prior to the onset of the present condition, had you been into any form of
physical activity like indoor and outdoor individual or team sports, fitness
exercise programs and recreational activities like trekking, leisure
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walking? If so, at what age did you start and end your participation? How
regular had you done it? How many days a week? How much time you
spent for this activity every session? Less than or more than 30 minutes?
f. What were your doctor’s advice now on dieting, compliance to
medications, and physical activity? What medications did your doctor
prescribe? Can you tell me what these are for? How long you have been
taking all of these?
g. If you were to look back, what lifestyle practices you would have changed
to prevent the onset of your present medical condition, to reach the
realm of success and happiness in life you dreamt of way back then? Is
physical inactivity like lack of exercise one of those you would consider
worth changing so as not to succumb to what you have now?
2. Write an essay on the pursuit their success and happiness with emphasis on:
a. defining their own life’s success and happiness;
b. identifying tangible and non-tangible things that make them happy and
successful;
c. recognizing stumbling blocks in the pursuit of their happiness and
success;
d. determining situations in their present lives that need to be changed;
e. finding ways to effect the changes
f. establishing readiness to apply ways to effect the changes.
3. Accomplish the table below. For each question below, please fill in the
square Yes or No. Please be sure to follow the instructions carefully. With the
supervision of your student coach, interpret your answer and draw
conclusion.
Questions Yes No
1. I am currently physically active.
2. I intend to become more physically active in the next 6

months.
For activity to be regular, it must add up to a total of 30 or

more minutes per day and be done at least 5 days per week.
For example, you could take one 30-minute walk or three 10-
minute walks each day.
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3. I currently engage in regular physical activity.
4. I have been regularly physically active for the past 6 months.
For the Student: Continue following the ongoing exercise prescription if you have
not progressed yet. Otherwise:
1. Record your new anthropometric measurements that include:
a. Weight in kilogram
b. Body mass index
c. Waist circumference in centimeter
2. Revise your exercise prescription using the FITT format for both
cardiovascular conditioning and strengthening based on your progress at the
end of the last prescription. Use the format in Annex A.
3. Document randomly the activities by video or photograph the activities
involved in the implementation of your newly revised cardiovascular
conditioning and muscular resistance training program.
4. Tabulate the parameters obtained in each session as shown in Annexes B
and C.
Basic Concept on Fitness: The student discusses these notes with their trainees
after completion of the three activities above.
Physical inactivity is a fast-growing public health problem and contributes to a

variety of chronic diseases and health complications, including obesity, heart
disease, diabetes, hypertension, cancer, depression and anxiety, arthritis, and
osteoporosis. The 2008 National Nutrition Survey of the Food and Nutrition
Research Institute (FNRI-DOST) found very high prevalence of physical inactivity
among adults. The prevalence of low physical activity for work- and non-work-
related physical activity was more than 85%, particularly among females, while that
of leisure-related physical activity was 83%. In fact the prevalence of low physical
activity increased significantly from 2003 to 2008, particularly for work-related and
travel-related physical activity.
In addition to improving a trainees’ overall health, increasing physical activity

has proven effective in the treatment and prevention of chronic diseases.
Regular physical activity at the correct intensity:
● Reduces the risk of death by 40%
● Lowers the risk of stroke by 27%
● Reduces the incidence of diabetes by almost 40%
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● Reduces the incidence of high blood pressure by almost 50%
● Can reduce mortality and the risk of recurrent breast cancer by almost
50%
● Can lower the risk of colon cancer by 60%
● Can reduce the risk of developing of Alzheimer’s disease by one-third
● Can decrease depression as effectively as medications or behavioral
therapy.
Exercise is indeed medicine!
Benefits of Exercise
There is overwhelming scientific evidence to support the positive relationship

between regular physical activity and health. The overall health benefits of physical
activity can be summarized in the table below:
Over-all Benefits of Physical Activity

Strong Evidence Moderate to Strong Evidence Moderate Evidence
Lower risk of early death Better functional health for Lower risk of hip fracture
older adults
Lower risk of coronary heart Lower risk of lung cancer

disease Reduced abdominal obesity
Lower risk of endometrial

Lower risk of stroke Weight maintenance after cancer
weight loss
Lower risk of high blood
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pressure Better cognitive function for Increased bone density
older adults
Lower risk of adverse lipid Improved sleep quality

profile
Lower risk of type 2 diabetes
Lower risk of metabolic

syndrome
Lower risk of colon cancer
Lower risk of breast cancer
Prevention of weight gain
Weight loss
Improved cardiorespiratory
and muscular fitness
Prevention of falls
Reduced depression
Source: The evidence rating was reported based on the 2008 review by the Office of Disease Prevention and Health
Promotion of US Department of Health and Human Services. Over 8000 articles reporting the health benefits of exercise were
reviewed in preparation for the report. These evidence ratings were also adopted in the recently released 2011 National
Physical Activity Guidelines by the Health Promotion Board.
The following sections will elaborate further on the health benefits of exercise
for common chronic conditions and the optimum level of physical activity that is
needed to achieve them.
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Premature death
● Individuals who are physically active for approximately 7 hours a week have a
40% lower risk of dying early from leading cause of death than those who are
active for less than 30 minutes a week.
● The Risk of Dying Prematurely Declines as People Become Physically Active
● High amounts of activity or vigorous-intensity activity are not necessary to

reduce the risk of premature death. Studies show substantially lower risk when
people do 150 minutes of at least moderate-intensity aerobic physical activity a
week.
15
● The most dramatic difference in risk is seen between those who are inactive (30
minutes a week) and those with low levels of activity 90 minutes or 1 hour and
30 minutes a week).
● The relative risk of dying prematurely continues to be lower with higher levels of
reported moderate or vigorous-intensity leisure-time physical activity.
Cardiorespiratory health
● Significant reductions in risk of cardiovascular disease occur at activity levels

equivalent to 150 minutes a week of moderate-intensity physical activity. Even
greater benefits are seen with 200 minutes (3 hours and 20 minutes) a week.
● In hypertension, blood pressure lowering effects of exercise are most

pronounced in people with hypertension who engage in moderate-intensity
exercise 30 minutes on most days; with systolic blood pressure decreasing
approximately 5-7 mm Hg after an isolated exercise session (acute) or following
exercise training (chronic).
● It has been estimated that as little as 2 mm Hg reduction in population average

systolic BP can reduce mortality from coronary heart disease and stroke, and all
causes by 6% and 10% respectively (Lewington et al. 2002).
Metabolic health
● Regular physical activity strongly reduces the risk of developing type 2 Diabetes
and also aids in the control of blood sugar for those already with diabetes.
● The Da Qing study in China included an exercise only treatment arm and
reported that even modest changes in exercise (20 min of mild or moderate, 10
min of strenuous, or 5 min of very strenuous exercise one to two times a day)
reduced diabetes risk by 46% (compared with 42% for diet plus exercise and
31% for diet alone).
● The Finnish Diabetes Prevention Study and the US Diabetes Prevention Program
(DPP) included intensive, lifestyle modifications with both diet and increased
physical activity. In the former, 522 middle-aged, overweight adults with
impaired glucose tolerance (IGT) completed either lifestyle modifications of at
least 30 min of daily, moderate physical activity, or no change in behaviour. The
DPP randomized 3234 men and women with IGT or impaired fasting glycemia
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(IFG) into control, medication (metformin), or lifestyle modification groups,
composed of dietary and weight loss goals and 150 min of weekly aerobic
activity. Lifestyle modification in both studies reduced incident diabetes by 58%
and, in the DPP, had a greater effect than metformin (31%).
● Both aerobic and resistance training improve insulin action, blood glucose
control and fat oxidation and storage in muscle. Physical activity/exercise can
result in acute improvements in systemic insulin action lasting from 2 to 72
hours. Hence, the benefits of regular exercise in clients with type 2 diabetes
mellitus include improved glucose tolerance, increased insulin sensitivity,
decreased HbA1c and decreased insulin requirements.
● Regular participation in aerobic physical activity and exercise results in beneficial

changes in lipid profile of patients with dyslipidaemia. These changes include
reductions in triglyceride levels and an increase in HDL (good cholesterol)
concentrations. The reductions in LDL levels in clinical trials have been
inconsistent.
● Good evidence exists that physical activity reduces the risk of metabolic
syndrome. Lower rates of these conditions are seen with 120 to 150 minutes (2
hours to 2 hours and 30 minutes) a week of at least moderate-intensity aerobic
activity.
Overweight and obesity
● A minimum of 150 minutes per week of moderate intensity physical activity for
overweight and obese adults improve health; however, greater amounts of
physical activity of > 250 minutes per week is necessary to achieve clinically
significant weight loss.
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● There is strong evidence that regular physical activity between 150 and 250
minutes per week reduces the risk of weight gain and is most effective when
combined with a balanced diet.
Musculoskeletal health
● Regular physical activity slows the decline in bone density especially in

individuals participating in weight bearing aerobic and resistance programs
using moderate or vigorous intensity. These changes are significant when
exercising at 90 minutes a week and continue up to 300 minutes a week.
● Physically active individuals, especially females, have lowered risk of hip fracture
than do inactive individuals. There is moderate evidence that 120-300 minutes
per week of regular physical activity at moderate intensity is associated with a
reduced risk of hip fractures.
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Module 2 – Contemplation Stage
following while the student, the trainees’ coach motivates them to go through the
contemplation stage of change and maintains or progresses his own fitness level:
1. Assessed their readiness to indulge in regular physical activity particularly,
exercise.
2. Defined the success of their engagement in exercise with set goals and
established priorities.
3. Identified ways of controlling their lives for the success of their exercise
engagement.
4. Screened themselves with the end goal of classifying themselves according to
the risk stratification for participation in exercise.
Basic Concept on Motivational Approach: The student uses this concept in

transitioning their trainees from pre-contemplation to contemplation stage of
change.
The trainee has recognized that he is engaging in a behavior, such as sedentary

lifestyle, that actually constitutes a problem. In this stage, he seriously intends to
take action within the next six months or so but is not prepared to do it just yet.
Mobilizing Motivation for Regular Exercise
When mobilizing a trainee’s motivation for regular exercise, two important

points to keep in mind are:
1. ‘‘Taking small steps’’
Gradual change is another helpful guiding concept for the person who is
becoming a regular exerciser. When starting a program from scratch, it is highly
recommended that a previously sedentary person start just with ordinary walking
for 10 minutes or so, three times a week. After a couple of weeks, he can increase
the time spent, and perhaps the frequency; and after a couple more weeks,
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perhaps the speed. ‘‘Too much, too soon’’, is bound to lead to muscle pain, perhaps
injury and a greater likelihood of quitting early. A gradual increase in time spent,
distance covered, and speed are the proven formula for sticking with it.
2. Goal Setting
The key to mobilizing motivation and to keep it going is goal setting. It is the
central element in the five-step process known as the Wellness Motivational
Pathway for Healthy Living (which will be discussed below). The exercise
prescription most usefully negotiated with the student provides Specific,
Measurable, Achievable, Realistic, and Timely (SMART) goals for the student to
pursue, and a SMART pathway for reaching them. It is what makes all efforts at
behavior change work.
The Wellness Motivational Pathway for Healthy Living
No single approach to helping trainees become regular exercisers will work for
everyone. In this segment, The Wellness Motivational Pathway (WMP) approach,
which is recommended by ACSM, will be discussed.
The WMP provides your trainee with the details of the bridge they need to cross
in order to advance from the Planning Stage (III) to the Action Stage (IV). The WMP
has been developed over time from observation, anecdotal interviews and
experience. While it has not been tested experimentally, it appears to be a logical
approach to how to cross the bridge from Stage III to Stage IV and also appears to
have no potential negative side-effects.
The WMP has five steps:
1. The first step is assessment, both self and professional.
2. The second step is defining success, for the person, by the person. To be
effective for each individual, ‘‘success’’ has to be defined within his or her
specific context. It has to be realistic for the person and its achievement has
to be within the realm of possibility for him.
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3. The third step is goal setting. This is the central element of the Wellness
Motivational Pathway.
4. The fourth is establishing priorities among the various sectors of a person’s
life. This is particularly important for achieving success if the person decides
to become a regular exerciser by engaging in a planned leisure time activity
or sport.
5. The fifth is taking control of the whole process. This final step itself has eight
elements.
Step 1: Assessment
Assessment has two components, assessment by oneself and assessment by

others, usually health professionals. Self-assessment is closely connected to goal
setting. Letting trainees answer questions is important in helping to define your
trainee’s long term goals and in mobilizing his motivation to achieve them. This is
their first activity in this module.
Step 2: Defining Success for Oneself
How you approach the subject of success can be either helpful or rather
harmful, to your trainees and to the process of setting and achieving their goals.
Whether it concerns how to stop smoking, lose weight, or become a regular
exerciser, just how your trainee defines success for himself will have a major impact
on the outcome. To be helpful and facilitating for health-promoting behavior
change, success must be defined in terms that make sense for each trainee and
must be realistically achievable for him. If success is defined in terms that are
objectively either impossible or difficult to achieve, then striving to achieve it
becomes frustrating, inhibiting, and anger provoking, and will eventually lead to
quitting. Thus, for your students, the concept of success should be facilitating, not
inhibiting.
For example, if someone is naturally slow of foot but decides to take up running,
success should not be defined in terms of absolute speed, e. g., ‘‘I will consider
myself successful when I can run a mile in eight minutes.’’ Success in this person’s
case might be better defined in terms of endurance, e. g., ‘‘As my first objective, I
want to be able to run for 20 minutes without stopping, at a comfortable pace.’’
Once that objective is achieved, another can be set if the person wishes to do so;
for success must also be defined with the recognition that its meaning for any one
person can change over time. In fact, for most people who experience success in
21
regular exercise, it will change over time. However, at the beginning of the process,
there is no way of knowing just how far an individual will get.
Step 3: Goal Setting
Goal setting is the central element of the WMP. This is the single most important
undertaking in developing a successful program of regular exercise. The initial goals
set must be reasonable at the time they are set. Recognizing that what is
considered to be realistic is likely to change over time, nothing can kill a change
process faster than the setting of unrealistic, unachievable goals. The goals set
should be SMART, that is, Specific, Measurable, Achievable, Realistic, and Timely.
The establishment of goals creates the mind-set, the mental environment, which
will permit and then facilitate what for most people is a major change in the way
they live. It is the thinking that gets one going and keeps one going, whether in
purposefully walking for 30 minutes five times per week, or using the stairs instead
of the elevator and getting off the bus ten blocks from work every day, or training
for six months to run a marathon or an Olympic distance triathlon.
Step 4: Establishing Priorities
Establishing priorities among the various possible health promoting behaviours

and between the planned personal health promotion program and the rest of one’s
life is the next step. Creating balance among the set of behaviour change goals, and
between the new goals and the rest of one’s life is central to making the whole
process work. If the person has set more than one goal, what is their ranking?
Which is considered to be the most important to achieve? Which the least? In
addition, what about priorities between the new goal(s) (in the case of athletics and
other leisure time activities) and other important things that are going on in other
parts of the patient’s life, like relationships with family and friends, and
employment? If juggling needs to be done, it will be very helpful to set priorities.
● Making the Time. Becoming a regular exerciser intrudes on one’s time for the
rest of one’s life. This aspect of the enterprise should not be swept under the
rug. It needs to be examined carefully. How is time being spent now? Can
your trainee give up four hours of television a week? Can your trainee get up
45 minutes earlier four days a week (including the two weekend days) and
cut down on dawdling time by 15 minutes on each of those days?
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Step 5: Taking Control
There are eight elements in Taking Control of the behavior that following
through on the Wellness Motivational Process is intended to lead to. Taking control
of your life means ‘‘running your life instead of letting it run you.’’
The eight elements are:
1. Understanding that motivation is not a thing, but a process that links a

thought to a feeling with an action.
2. Following the first four steps of the Wellness Motivational Process for
Healthy Living from the beginning.
3. Examining what one already does well; health- promoting behavioral

changes already made.
4. Recognizing that gradual change leads to permanent changes.
5. Dealing with the fear both of failure and of success. There are many reasons
for failure in becoming a regular exerciser, and it should be stressed that
none of them have moral content. One is not a “Bad” person if one doesn’t
make it this time around. One can always try again, and if one never makes
it, well, one just does not and that should be the end of it, unless you and the
trainees are open to referral to another health professional who may be
able, by taking a different approach, to ultimately achieve success. The
necessity of dealing with the ‘‘fear of success’’ may come as a surprise, but
this is a documented problem for certain persons, especially in the realm of
weight loss.
6. The readiness to explore one’s limits while recognizing one’s limitations. It is

very important for you to be able to help trainees recognize and accept their
limitations. Speed, strength, muscular bulk, flexibility, gracefulness, are in
part achieved through training and practice. But, as noted, they are in
significant part achieved also as a result of genetic makeup. Exactly what
proportion of each achievement is determined by one’s genetic endowment
and the proportion by one’s own effort is of course not yet as known.
23
7. Appreciating the process of psychological immediate gratification. It’s a
mental immediate gratification, not a physically measured one like scale
weight. It is the immediate gratification that comes from taking control,
taking responsibility, realizing self- empowerment realizing self-efficacy, and
doing something new and different.
8. Achieving balance, in the process of gradual change.
After the trainees have assessed their readiness to indulge in regular physical
activity particularly, exercise, defined the success of their engagement in exercise
with set goals and established priorities, and identified ways of controlling their
lives for the success of their exercise engagement, they will screened themselves
with the end goal of classifying themselves according to the risk stratification for
participation in exercise. This is done by answering the Physical Activity Readiness
Questionnaire.
When beginning an exercise prescription process, the question of safety to

exercise arises. There are documented risks associated with physical activity; the
major concern being the increased risk of sudden cardiac deaths as well as
myocardial infarction associated with vigorous physical exertion.
In this module, you are provided with a systematic method of assessing your
trainee’s medical status to reduce the chance that your trainee may risk injury or
illness (particularly to his or her heart) by exercising. Almost all students will benefit
from exercise, but some, especially those trainees with known disease, signs and
symptoms, or risk factors for cardio-vascular, pulmonary, or metabolic disease, may
need to have certain modifications or restrictions placed on their exercise program.
With a systematic approach, the screening process should not present a burden to
the student or prevent trainees from initiating light- or moderate-intensity
Considerations in Pre-participation Screening
As the student coach, the algorithms presented in this module will help to
identify factors that may (1) require pre-participation medical screening or exercise
testing; (2) warrant a clinically or professionally supervised program or limitations
24
on the intensity at which a trainee is safe to exercise, and (3) in a small number of
trainees) may exclude your trainee from participation.
Your responsibility is to follow a logical and practical sequence to acquire health
information, assess risk, and provide the exercise prescription with appropriate
precautions to your trainee.
For the Trainees: The student asks his trainees to accomplish the following and
1. Answer the following questions:
a. Where am I now in my life? How did I get here?
b. What do I like about myself, my body? What do I not like?
c. What is it about my body and mind that I am unhappy with that could be
positively affected by exercising regularly?
d. What would I like to change, if anything, and why?
e. What is going on in my life that would facilitate behavior change? Inhibit
it?
f. Where am I now in my physical activity level?
g. Have I tried regular exercise before and failed to stick with it?
h. Currently, what do I estimate my potential to stick with an exercise
program to be?
i. What unmet personal needs am I thinking of attempting to meet?
j. Am I ready, really ready, to try it? Would I really like to change, even if it
means giving up something I am accustomed to?
k. Do I think that I can mobilize the mental strength if that is what I want or
need to do?
l. What has my previous experience with personal health behaviour change
been? Good? Bad? Some success? None? Will that help me this time
around?
m. What can I learn from experience that will help this time? Am I being
realistic about this?
n. What is my self- image?
o. Do I think of myself as good-looking? Attractive? Not attractive? Healthy?
Unhealthy?
p. What do I see when I look in the mirror?
q. What kinds of feelings do those images elicit?
r. If I am planning to exercise to help in weight loss or simply to shape up a
currently out of shape body, will I be able to use the facts that smaller size
clothing now fits and that my waist is getting smaller as measures of
25
success, rather than scale weight (which might or might not change much,
even as I am redistributing body mass)?
s. And further, if I am going to exercise primarily for weight loss, is my true
goal to become really ‘‘thin,’’ rather than somewhat thinner?
2. Based on your answers to the questions above, write an essay about your
readiness to engage in exercises indicating the following:
a. SMART (Specific, Measurable, Achievable, Realistic, and Timely) Goals
b. Daily or weekly prioritized activities including its schedule
c. Ways to control factors that hamper your goals
3. Accomplish the Physical Activity Readiness Questionnaire below. The student
coach will help the trainee interpret the answers to the questions below.
b. Body mass index
and C.
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27
28
29
30
Basic Concept on Fitness: The student discusses with the trainee these notes prior
to accomplishing the PAR-Q form by the latter.
Risks of exercising -- Putting it in perspective
Before discussing the risk of exercising, it is important to begin by asking the

question, ’’Is the person safe to remain sedentary?’’ Physical inactivity has been
identified by the World Health Organization as the fourth leading risk factor for
global mortality (6% of deaths globally).
The risks of participation in exercise range from the most common – muscle
soreness and musculoskeletal injury to the most serious – myocardial infarctions
and sudden cardiac death, which will be discussed here. Vigorous physical activity
31
has been shown to transiently increase the risk of sudden cardiac death and
myocardial infarction (heart attack) among individuals with both diagnosed and
occult cardiac conditions. The absolute risk of sudden cardiac death during
vigorous physical activity has been estimated at one per year for every 15,000 -
18,000 people. Although these rates are low, the risk is relatively higher in
sedentary unscreened individuals who engage in unaccustomed vigorous activity.
As such, sedentary individuals who intend to exercise should begin with low to
moderate intensity exercises. For these individuals, an appropriate pre-
participation screening process should be administered to further lower the risk.
The important points on risk of exercising can be summarized below:

● Exercise generally does not provoke cardiovascular events in healthy
individuals with normal cardiovascular systems.
● Risk of sudden cardiac arrest or myocardial infarction is very low in healthy
individuals performing moderate intensity activities.
● Risk of sudden cardiac death and/or myocardial infarction increases
transiently and acutely in individuals performing vigorous exercise with
diagnosed or occult cardiovascular disease.
Even in patients with known cardiac disease undergoing a supervised

rehabilitation programs, the incidence of adverse cardiac events are rare: cardiac
arrest = 1 in 117,000; non-fatal myocardial infarction = 1 in 220,000; and death = 1
in 750,000 patient-hours of participation.
Considering the overwhelming benefits of physical activity, the risk of inactivity

and the relatively rare serious side effects of exercise, almost all patients will
benefit from physical activity; with some of them needing modifications or
restrictions on their exercise program. For patients with chronic diseases, it is
important that the clinician performs a risk stratification and exercise screening
prior to initiating an exercise prescription.
Aims of Pre-Participation Health Screening
● Identify individuals with medical contraindications for exclusion from exercise

programs until these conditions have been addressed and optimized.
● Identify individuals with clinically significant disease(s) who should participate in
a medically supervised exercise programs.
● Identify individuals who are at increased risk for disease because of age,
symptoms and risk factors who should undergo further medical evaluation and
32
exercise testing before initiating an exercise program or increasing the
frequency, intensity or the duration of the current program.
● Identify individuals with special needs e.g. Elderly or disabled population etc.
that may affect exercise testing and programming.
A self-guided questionnaire such as the Physical Activity Readiness

Questionnaire is the recommended entry level for screening. This self-guided
question screening tool is able to quickly identify conditions or risk factors that
require further assessment before commencing exercise. If the trainee answers no
to all 7 questions, he is at a LOW RISK for health complications, and is generally safe
to begin an exercise program without supervision at any intensity. The student
coach can expect to receive the New PAR-Q from trainees that require exercise
clearance.
However, for most patients with chronic disease, the PAR-Q typically produces a
positive response for at least one of the questions. With that in mind, the algorithm
presented in the figure below outlines the screening process that the student coach
and the trainee can go through to determine the student’s risk level. This is called
risk stratification. This assessment process is based on ACSM’s recommendation
available in the eighth edition of ACSM’s Guidelines for Exercise Testing and
Prescription.
Risk Stratification
The process of risk stratification is based on:

● Identifying the presence or absence of known cardiovascular, pulmonary
and/or metabolic disease.
● Identifying the presence or absence of signs and symptoms suggestive of
cardiovascular, pulmonary and/or metabolic disease. (see Table 1.1) for
definition of major signs and symptoms)
● Identifying the presence or absence of cardiovascular risk factors. (see Table
1.2 for Cardiovascular Risk Factors Threshold)
ACSM Risk Stratification Categories
Low risk:
● No signs/symptoms of or no diagnosed cardiovascular, pulmonary and/or
metabolic disease.
● No more than one cardiovascular risk factor.
33
● Low risk of acute cardiovascular event.
Physical activity/exercise program may be pursued safely without the
necessity of medical examination and clearance
Moderate risk:
● No signs/symptoms of or no diagnosed cardiovascular, pulmonary and/or
metabolic disease.
● Two or more cardiovascular risk factors.
● Increased risk of acute cardiovascular event.
● Individuals at moderate risk may safely engage in low to moderate intensity
physical activities while awaiting medical clearance.
● Medical clearance and exercise testing prior to participation in vigorous
intensity exercise is recommended.
High risk:
● One or more signs and symptoms of or diagnosed cardiovascular, pulmonary
and/or metabolic disease.
● High risk of acute cardiovascular event.
● Thorough medical examination and clearance must be sought prior to
initiation of physical activity or exercise at any intensity.
Placement of your trainee in the HIGH, MODERATE, or LOW RISK categories

helps the student coach determine the need for further testing and supervision
during exercise.
HIGH RISK: Trainees should undergo further medical testing before starting an
exercise program. Clinical supervision is recommended during exercise and stress
testing.
* Clinical supervision = under the direct supervision of a health/fitness professional

possessing a combination of advanced college training and certification equivalent to
the ACSM Registered Clinical Exercise Physiologist and Exercise Specialist or above
MODERATE RISK: The trainee is safe to begin light- or moderate-intensity

exercise (should undergo further medical assessment before partaking in vigorous-
34
intensity exercise) Supervision by a fitness professional during exercise is often
recommended (depends on the reason for falling into this category)
* Professional supervision = under the supervision of a health/fitness Professional

possessing a combination of academic training and certification equivalent to the EIMP
Clinical Fitness Professional or above.
LOW RISK: The trainee is safe to begin exercising without further assessment.
Exercise supervision is not necessary.
It is also important to note that trainees may require supervision for reasons
other than a medical condition. These may include learning to use the exercise
equipment, familiarization with exercise technique and if either the student coach
or the trainee feels that exercising under supervision will motivate trainee to
continue regular exercise.
Algorithm for the screening process:
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36
37
38
39
40
Important considerations for risk stratification
The algorithm serves as a guide that may be modified at the discretion of the
student coach. Some of the information may not be available to the student coach
at the screening to assess the risk level accurately. Under these circumstances,
student coaches are encouraged to use existing information and make a
conservative estimate of the trainee’s risk level.
● If the trainee’s disease is well controlled e.g. metabolic or pulmonary disease

such as thyroid and asthma and other stable chronic diseases or conditions)
the trainee will remain at HIGH RISK; however, the intensity of his exercise
may be increased at the discretion of the relevant specialist or cardiologist.
● A trainee in the moderate risk category based on cardiac risk factors may be
progressed to LOW RISK if the risk factors resolve (e. g. quitting smoking,
losing weight, or no longer sedentary).
● Hypertensive trainees with resting SBP ≥ 200 mm Hg or DBP ≥ 110 mm Hg should

not undergo exercise testing nor be allowed to exercise. It is important to establish blood
pressure control and assess for presence of end organ disease before initiating exercise.
For asymptomatic hypertensive trainees with BP < 180/110 mm Hg and no
evidence of end organ disease, they may begin low to moderate intensity
aerobic exercises without the need for exercise testing.
● For individuals with type 2 Diabetes (T2DM) desiring to participate in low-

intensity physical activity like walking, physicians should use clinical judgment
in deciding whether to recommend pre exercise testing. Conducting exercise
stress testing before walking is unnecessary. No evidence suggests that it is
routinely necessary and requiring it may create barriers to participation.
● To avoid automatic inclusion of lower-risk individuals with T2DM, exercise

stress testing is recommended primarily for previously sedentary T2DM
trainees who want to undertake activity more intense than brisk walking. The
goal is to more effectively target individuals at higher risk for underlying
cardiovascular disease. In general, ECG stress testing may be indicated for
individuals matching one or more of these criteria in the Table 1.3 below.
41
For a more in-depth look at pre-participation screening, please see the National
Sports Safety Committee’s report 2007 which can be downloaded from the website
below:
http://www.ssc.gov.sg/publish/etc/medialib/sports_web_uploads/gc/media_releases
_enclosures/sports_safety_committee.Par.0005.File.tmp/Sports_Safety
_Committee_26SEPO7.pdf
In this module, we have outlined both the health risks that trainees face if they
remain inactive, as well as the risks of exercising. Although most trainee s will
benefit from participating in regular exercise, trainees should be screened prior to
initiating an exercise program. For many, this will consist of the short PAR-Q, in
which they are able to answer NO to each of the questions. These trainees are safe
to begin an exercise program of any intensity without supervision.
42
For trainees who answer YES to at least one of the New PAR-Q questions, the
screening process needs to continue to assess their level of risk. The risk level (low,
moderate, or high) that the trainee is assessed at will determine:
a. Whether he needs further medical assessment prior to beginning an exercise
program.
b. The intensity at which he is safe to exercise.
c. Whether he needs supervision during his physical activity.
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Module 3 – Preparation/Planning Stage
planning stage of change and maintains or progresses his own fitness level:
1. Been cleared medically to engage in physical activity particularly, exercise.
2. Designed for themselves an exercise program for strengthening and
cardiovascular conditioning.
Basic Concept on Motivational Approach: The student coach uses this concept in
giving their trainees confidence and guarantee that it is safe to engage in the
exercise they designed based on the algorithm of the ACSM. They will also be
guided in the design of their personalized strengthening and cardiovascular
conditioning program.
In this stage, the trainee is seriously planning to engage in behavior change

within the next month or so. Upon entering this stage, the person has become
motivated. One has found those thoughts that will activate him, that will overcome
his or her ambivalent feelings and his doubts that he can, in fact, succeed. He
consciously chooses to engage in a new set of behaviours and believes that positive
change will indeed be possible.
For the Trainees: The student asks his trainees to do the following and discusses
the outputs with them:
1. Write an essay explaining their risk stratification and the exercise intensity
that fits their classification.
2. Record their baseline anthropometric measurements that include:
b. Height in meter
c. Body mass index = weight in kg divided by the square of the height in
meter
d. Waist circumference in centimeter
44
3. Make an exercise prescription using the FITT format for both cardiovascular
conditioning and strengthening. The format is found at the end of this
module.
b. Body mass index
and C.
Basic Concept on Fitness: The notes on the basic concepts of exercise prescription
shall be discussed by both the student coach with his trainees before the latter
accomplish the second and third activities for trainees above.
Every exercise prescription should be tailored to meet individual health and

physical fitness goals. The principles of exercise prescription are based on the
psychological, physiological and health benefits of exercise training, and are
generally intended for a healthy adult. Modifications are however, necessary to
accommodate the individual characteristics such as health status, physical ability,
age or athletic and performance goals.
Components of Exercise Training Sessions
● Warm up
⮚ Transitional phase that allows the body to adjust to the changing
physiological, biomechanical and bioenergetic demands during the
conditioning phase of the exercise session.
⮚ Minimum of 5-10 minutes of low to moderate intensity cardiovascular
and muscular endurance activities.
⮚ Increases body temperature.
45
⮚ Decreases the potential for post-exercise muscle soreness.
● Conditioning
⮚ 20-60 minutes of aerobic, resistance, neuromuscular and/or sports
activities (exercise bouts of 10 minutes are acceptable if the individual
accumulates at least 20-60 minutes each day of daily exercise).
● Cool down
⮚ Allows gradual recovery of heart rate and blood pressure, and removal of
metabolic end-products from the muscles used during the more intense
conditioning phase.
⮚ Minimum of 5-10 minutes of low to moderate intensity cardiovascular
and muscular endurance activities.
● Stretching
⮚ Minimum of 10 minutes of stretching performed after the warm up or
cool down phases.
Components of an Exercise Prescription
The components of a prescription for medication include the name of the

medication, strength or dose, frequency of administration, route, refills, and
precautions. The components of an exercise prescription follow a similar format,
using the FITT principle: Frequency, Intensity, Time (or duration) and Type. An
important element to consider in exercise prescription is exercise progression.
Frequency refers to the number of times the activity is performed each week.
There is a positive dose-response relationship between the amounts of exercise
performed -- as the amount (frequency and time or duration) of exercise
performed increases, so do the benefits received.
Intensity of the physical activity is the level of vigour at which the activity is
performed. There are a number of ways in which intensity can be measured. Some
methods are easier to use but are generally less objective, while others are more
objective but may require additional equipment or simple calculations. The Table
2.1 provides an overview of some ways to measure exercise intensity.
46
In general, we recommend using a simple, though less objective, measure of
intensity, such as the talk test or the Rating of Perceived Exertion (RPE). Objective
measures of intensity are more accurate and often used in formal exercise testing.
● Subjective Measures of Intensity
The least objective but easiest measure of intensity is the ‘‘talk test.’’ When
performing physical activity at a low intensity, an individual should be able to talk or
sing while exercising. At a moderate intensity, talking is comfortable, but singing,
which requires a longer breath, becomes more difficult. At vigorous intensity,
neither singing nor prolonged talking is possible. A similarly easy but more robust
measure of intensity is ‘perceived exertion.’
The original perceived exertion scale, the Borg Rate of Perceived Exertion
(RPE) Scale ran from a minimum of 6 to a maximum of 20. This scale has been
simplified to a10-point scale in which intensity increases from a minimum (level 0)
to a maximum (level 10). Both are shown below. The talk test and RPE Scale are
practical measures for sedentary patients without significant cardiovascular risk
factors.
47
48
● Physiological/ Relative Physiological/Relative Measures of Intensity
Other more objective measures include percentages of maximal oxygen

consumption (VO2 max), oxygen consumption reserve (VO2 R), heart rate reserve
(HRR) and maximal heart rate (HRmax). Some of these more objective measures
are used in formal exercise testing. Perhaps the easiest but not the most accurate
measure is calculated using a percentage of the patient’s HRmax.
For example, exercising at a moderate intensity would be quantified as 64%-

76% of HRmax. You estimate your trainee’s HRmax using the formula 220 minus
the trainee’s age (220 - age).
Although this method is simple, it has a high degree of variability and tends to
underestimate HRmax in persons under the age of 40 and overestimate it in individuals over the
age of 40. This is generally true for both genders. A more accurate but more complicated formula
is 206.9 - (0.67 ◊ age). Depending on the situation, the clinician will need to decide whether ease
or accuracy is more important.
● Absolute Measures of Intensity Metabolic Equivalents
METs represent the absolute expenditure of energy needed to accomplish a

given task such as walking up two flights of stairs. One MET is defined as 1
kcal/kg/hour and is roughly equivalent to the energy cost of sitting quietly. A MET
is also defined as oxygen uptake in ml/kg/min with one MET equal to the oxygen
cost of sitting quietly, equivalent to 3.5 ml/kg/min. METs are a useful and
convenient way to describe the intensity of a variety of physical activities and are
helpful in describing the work of different tasks; however, the intensity of the
exercise needed to achieve that task is relative to the individual’s reserve. A simple
way of converting METs to calorie cost of physical activity makes use of the
following equation:
Calories expended/hr = *METs Rating X BW (kg)
49
* 2000 Compendium:?Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien
WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS. Compendium of Physical
Activities: An update of activity codes and MET intensities. Medicine and Science in Sports and
Exercise, 2000;32 (Suppl):S498-S516.1993 Compendium:?Ainsworth BE, Haskell WL, Leon AS, Jacobs
DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr. Compendium of physical activities: Classification of
energy costs of human physical activities. Medicine and Science in Sports and Exercise, 1993; 25:71-
80.
For example, a healthy, active person may report that climbing the two flights
of stairs as light-intensity, while an inactive, chronically ill person may report that
the same task requires vigorous effort. Light physical activity is defined as requiring
less than 3 METs, moderate activities 3-6 METs, and vigorous activities greater than
6 METs. Table 2.2 illustrates common physical activities with the associated
intensity in METs.
As with other aspects of this module, you and the trainee are offered
choices. Here, again, the choice of measure for intensity is used is up to the trainee
and you. For persons at risk for cardiac events, more objective measures may be
necessary; while for otherwise healthy, sedentary individuals, the easier, more
subjective measures will likely suffice.
Table 2.2. Common physical activities with the associated intensity in METs
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Time, or duration of the activity, refers to the length of time that the activity is
performed. Generally, bouts of exercise that last for at least 10 minutes are added
together to give a total time or duration for a given day. For example, a trainee who
brisk walks 10 minutes in the morning, and 10 minutes in the evening, can count a
total time or duration of 20 minutes for the day. Note that the exercise
recommendations are dosed in terms of minutes of activity.
Type of physical activity: Walking is the most common form of physical activity
that sedentary individuals can begin. Walking is a very familiar activity, and one that
can easily be incorporated into daily life. The main types of exercise are:
● Cardiovascular / Aerobic exercise

● Resistance Exercise Aerobic (Cardiovascular) Exercise
● Aerobic (cardiovascular) exercise: Continuous rhythmic exercise that uses a
large amount of muscle mass; require aerobic metabolic pathways to sustain
activity.
● Use of large amount of muscle? Sufficient? In total body oxygen
consumption? Central cardiopulmonary adaptations
e.g.: Walking, jogging, cycling, swimming, rowing, dancing, in-line skating
The quantity or volume of exercise is a function of the frequency (F), intensity (I)
and the duration/time (T) as well as the type of the exercise performed (T). The
exact composition of FITT varies depending on the characteristics and goals of the
individual. The FITT exercise prescription will need to be revised according to the
51
individual’s response, need, limitation and adaptation to exercise as well as the
evolution of goals and objectives of the exercise program.
Frequency
⮚ 3-5 days a week of a combination of moderate and vigorous aerobic exercise.
Intensity
⮚ Relative (physiologic) difficulty of the exercise (how hard the exertion feels).
⮚ Exercise of at least moderate intensity that noticeably increases heart rate

and breathing is recommended as the minimum exercise intensity for adults
to achieve health benefits.
⮚ A combination of moderate and vigorous intensity exercises that

substantially increases heart rate and breathing is recommended and ideal
for attainment of health improvements in most adults.
⮚ The risk of exercise, which includes cardiac and musculoskeletal

complications, increases with higher intensity.
⮚ Higher intensity interval training is time-efficient, especially for individuals

who have less time available for physical activity.
⮚ Intensity and duration interact and are inversely related.
⮚ Improvements in aerobic fitness from low intensity, longer duration exercise

(easy run for 90 min) are similar to those with higher intensity interval
training (various quantities of intervals between 30 sec and 4 min)
⮚ Exercise intensity may be estimated by various methods, the easiest

objective measure being Peak HR method:
Target HR = HRmax x % intensity desired

where predicted maximal heart rate (HRmax): 220 - age
⮚ Less objective but practical methods for sedentary subjects like the talk test
and RPE have been discussed above.
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Other methods are:
⮚ HR reserve (HRR) method:

Target HR = [(HRmax - HRrest) x % intensity desired] + HRrest
(HRmax is calculated by prediction equation).
⮚ VO2 reserve method:

Target VO2 R = [(VO2 max - VO2 rest) x % intensity desired] + VO2 rest (VO2
max is estimated by maximal or submaximal testing).
⮚ Peak VO2 method:

Target VO2 = VO2 max x % intensity desired.
⮚ Peak METs x (% METs) method:

Target METs = [(VO2 max)/3.5ml/kg/min] x % intensity desired. (Activities at
the target VO2 and METs can be determined using a compendium of physical
activity or metabolic equations).
HR reserve and VO2 reserve reflect the rate of energy expenditure during
physical activity more accurately than other exercise intensity prescription
methods but require more complex calculations and exercise testing.
Exercise quantity and duration (Time)
⮚ Measure of amount of time physical activity is performed i.e. per session, day
or week, or by the total caloric expenditure.
⮚ The quantity of physical activity may be performed continuously or

intermittently and accumulated over the course of a day through one or
more sessions of physical activity of at least 10 minutes in duration.
⮚ A total of 150 minutes of moderate intensity aerobic exercise or vigorous

intensity aerobic exercise done for a total of 75 minutes is recommended for
most adults. Both moderate and vigorous intensity exercises can be
accumulated over a week with 1 minute of vigorous intensity aerobic
exercise equivalent to 2 minutes of moderate intensity aerobic exercise.
⮚ To promote or maintain weight loss, 50-60 minutes a day (to total 300
minutes per week of moderate exercise), or 150 minutes per week of
53
vigorous exercise (or an equivalent combination of daily exercise) is
recommended.
⮚ Performing intermittent sessions of 10 minutes of exercise to accumulate the

minimum duration recommendations is an effective alternative to
continuous exercise.
⮚ Total caloric expenditure and step counts may be used as surrogate

measures of exercise duration.
⮚ A minimum caloric expenditure of 1000 kcal a week through physical activity

and exercise, as well as 3000-4000 steps per day of walking at moderate to
vigorous intensity is recommended.
Aerobic (Cardiovascular) exercise mode (Type)
⮚ Rhythmic, aerobic type exercises of at least moderate intensity involving

large muscle groups and requiring little skill to perform are recommended
for improving cardiovascular fitness.
⮚ Other exercise and sports requiring skill to perform or higher levels of fitness
are recommended only for individuals with adequate skill and fitness to
perform the activity.
⮚ Exercise can be classified into different groups according to exercise intensity

and energy expenditure (see Table 2.3)
54
55
⮚ Group A & B - useful to regulate and maintain intensity of effort
⮚ Provide predictable levels of energy expenditure - not affected by sex, age,
skill
⮚ As individuals progress to higher fitness levels, group C & D exercises provide
more variation. Rely on heart rate response or subjective RPE
⮚ Cardiovascular exercises can also be classified by body-weight dependency
56
Southwestern University will follow the FITT format using the training design of
the European Association of Preventive Cardiology, European Society of Cardiology
as shown below. In the absence of the results of the cardiopulmonary exercise test,
the intensity discussed above will be used: <64% for light intensity, 64 – 76% for
moderate intensity, and >74% for high intensity. The Karvonen’s formula will be
used to determine the target heart rate: [(HRmax - HRrest) x % intensity desired] +
HRrest; HRmax is 220 – age.
57
Muscular Fitness and Resistance Training
Resistance training is an essential component of any exercise training program.

It improves all components of muscular fitness including strength, endurance and
power. The aims of resistance training include reducing the physiological stress
during activities of daily living, preventing muscular deconditioning, and for
effective management and prevention of chronic diseases.
● Frequency
⮚ For general muscular fitness, and for adults who are untrained or
recreationally trained, resistance training of each major muscle group is
recommended for 2 or more days a week with at least 48 hours separating
the exercise training sessions for the same muscle group.
⮚ All muscle groups to be trained may be done so in the same session, or each
session may focus on selected muscle groups so that only a few of them are
trained in any one session. (split routine)
● Type
⮚ Multi joint or compound exercises affecting more than one muscle group
and focusing on agonist and antagonist muscle groups are recommended for
all adults, to avoid creating muscle imbalances that may lead to injury.
⮚ Single joint exercises targeting major muscle groups may also be included in
a resistance training program.
● Volume of resistance exercise (Repetitions and sets)
⮚ Adults are encouraged to train each muscle group for a total of 2-4 sets,
derived from the same exercise or from a combination of exercises affecting
58
the same muscle group, with 8-12 repetitions per set i.e. 60-80% of one-
repetition maximum (1-RM), with a rest interval of 2-3 minutes between sets
to improve muscular fitness. 1-RM is the maximum amount of weight one
can lift in a single repetition for a given exercise.
⮚ Having different exercises training the same muscle group adds variety and
improves adherence to the training program.
⮚ Resistance training intensity and number of repetitions performed each set

are inversely related.
⮚ A higher number of repetitions with lower intensity not exceeding 50% 1-RM
should be performed per set along with shorter rest intervals and fewer sets
if the objective of the resistance training program is mainly to improve
muscular endurance.
⮚ For older adults and deconditioned individuals who are more susceptible to
musculotendinous injuries, 1 or more sets of 10-15 repetitions of moderate
intensity i.e. 60-70% 1-RM resistance exercises are recommended.
●
Technique
⮚ Each exercise should be performed with proper technique and include both
lifting (concentric contractions) and lowering (eccentric contractions) phases
59
of the repetition. Each repetition should be completed in a controlled
deliberate fashion throughout the full range of motion.
⮚ Maintain a regular breathing pattern i.e. exhaling during lifting phase and
inhaling during the lowering phase.
Flexibility Exercises (Stretching)
⮚ Stretching exercise is recommended in any exercise training program for all

adults.
⮚ Stretching exercise is most effective when the muscles are warm and should
be performed before and/or after the conditioning phase.
⮚ Stretching should be performed to the limits of discomfort within the range

of motion, perceived as the point of mild tightness without discomfort.
⮚ Stretching following exercise may be more preferable for sport activities

where muscular strength, power and endurance are important for
performance, rather than during the warm up period.
⮚ Stretching following warm up is still recommended for adults exercising for

overall physical fitness or athletes performing activities in which flexibility is
important.
⮚ There is minimal scientific evidence to demonstrate the efficacy of stretching

for injury prevention though limited evidence seems to suggest that it may
be beneficial in sports in which flexibility is an important part of
performance.
⮚ Stretching exercises improve the joint range of motion and physical function,
especially in the elderly.
⮚ Stretching should be performed at least 2-3 times a week, for at least 10

minutes in duration.
⮚ Stretching exercises should involve the major muscle tendon groups of the
body.
60
⮚ Four or more repetitions per group are recommended.
⮚ Static stretches should be held for 20-30 seconds.
Neuromuscular Exercise
⮚ Neuromuscular exercise is recommended for the elderly population who are

frequent fallers or with mobility impairment, and suggested for all adults.
⮚ Frequency: 2-3 days a week.
⮚ Examples include core conditioning, balance & gait exercises, and taijiquan.
SWU Exercise Prescription Format (See Annex A for Tabular Format)
● Cardiovascular Conditioning
Warm-up:
Static Stretch 1: _______________ Duration: _____ sec Reps: ______ Set: ____
Conditioning:
Frequency: _____ x a week
Intensity: Target Heart Rate (THR) = ______ beats/min %HRR + _______ RHR =
_______
For Light Intensity Interval Training:

30 30 30 30 30
sec sec sec sec sec
THR Borg 11-12
60ss 60ss 60ss 60ss

5 min ecn ecn ecn ecn 3 min
½ HRR
61
For Moderate Intensity Continuous Exercise:
20 - 30 min
THR Borg 11-14
5 min 3 min ½ HRR
For High Intensity Interval Training:

4 4 4 4
min min min min
THR Borg >15
3 min 3 min 3 min 3 min

5 min ½ HRR
Time: ______ min/session _______ min/week

Type (check): _____ Jogging _____ Treadmill _____ Ergo bike
_____ Rope skipping _____ Swimming _____ Rowing
_____ Stair climbing _____ Star jumps _____ Walking
Others: _______________________________________________________
Cool Down:
● Muscular Resistance Training
Frequency: _____ x a week
Type: ___ compound exercises ___ single joint exercises
Target muscles or class/Type of Exercise: For split routine, group the

exercises.
_____________________________ ______________________________
_____________________________ ______________________________
_____________________________ ______________________________
_____________________________ ______________________________
62
Volume (for each exercise above):
1 RM: ___ Load: ___ (kg) %1RM: ___ Reps: ___ Sets: ___
Module 4 – Action Stage
action stage of change and maintains or progresses his own fitness level:
1. Implemented regularly upon themselves the cardiovascular conditioning and
muscular resistance training program they designed.
2. Demonstrated improvement in the parameters or achieved the target
parameters of the cardiovascular conditioning and muscular resistance
training.
Estimated Duration: Four to six weeks
63
Basic Concept on Motivational Approach: The student coach uses this concept in
insuring regularity of exercise sessions and accurate execution of the exercises by
his trainees.
This step of the change process is taking the action itself. Weekly monitoring of
the progress of the training is imperative to obtain the desired outcomes for both
the student coach – a motivated trainee, and the trainee – enthusiasm to become
fit with improvement in the parameters or achievement of the targeted parameters
of the cardiovascular conditioning and muscular resistance training.
For the Trainees: The student asks his trainees to perform the following and
involved in the implementation of their designed cardiovascular conditioning
and muscular resistance training program.
and C.
b. Body mass index
and C.
Basic Concept on Fitness: The notes on the basic concepts of this module shall be
shared and discussed again by the student coach with his trainees.
64
Prerequisites:
▪ Exercise is better performed early in the morning or in the evening.
▪ It should not be done on a full stomach.
▪ People who have followed a sedentary or quiet lifestyle should begin an
exercise program slowly.
▪ It is not important how quickly one advances to a higher level of fitness.
Becoming fit eventually and maintaining that fitness is what matters.
▪ A slow and easy start can avoid musculoskeletal injuries. Be sure to
thoroughly warm up before beginning and cool down gradually by stretching,
appropriate to the exercise. This is very important to prevent cramping and
other discomforts.
▪ Choose activities that you like.
▪ Be realistic about what you can do.
▪ Exercising in a group is better than doing it alone because it makes it a social
event and encourages continuous participation.
▪ One has to consult a doctor before starting an exercise program. Also stop
and check with your doctor right away if you develop sudden pain, shortness
of breath, or feel ill.
▪ Choose your method of exercise carefully! Make sure it is suitable for your
body type. Avoid high-impact events. Certain exercises should not be
performed when people have certain diseases.
▪ People with diabetic retinopathy should not perform exercises that involve
bending forward too much or standing on their head.
▪ People with weak heart should not perform strenuous exercise. Those who
have had a heart attack cannot perform any exercise other than walking for a
certain period after recovery.
▪ Be very certain to remain hydrated by continuously drinking water
supplemented with vitamin C and electrolytes while exercising.
▪ Even those confined to bed should have some kind of physical activity or at
least physiotherapy to avoid bedsores, chest infection, and loss of strength of
bones, constipation and depression.
▪ Observe physical distancing, proper donning and doffing of mask and hand
washing when exercising in areas at risk for droplet or airborne infection.
▪ The mask does not compromise breathing. It is an effective way to prevent
viral transmission in a community context, provided that compliance is high.
65
Equipment, Gear and Environmental Considerations:
● Wear light clothing and sports shoes with medial arch support.
● Avoid exercising under the heat of the sun or in a humid environment.
● Exercise on even ground of floor.
● Be mindful of the surrounding when exercising in the park while listening to
music on your head phone or earphone as you may hit or may be hit by
others.
66
● Exercise with somebody so he can call for help when necessary.
● If equipment is needed for cardiovascular conditioning:
- Set the speed of motorized treadmill that stimulates your heart to beat
within the target heart rate. Maintain such a speed for your designed
duration.
- Observe the speed of manual treadmill or ergo bike that corresponds to
your target heart rate. Maintain such a speed for your designed duration.
- Set the resistance of your ergo bike that would give you the target heart
rate and maintain it for your designed duration.
● If you are not using an equipment but instead running, jogging, hopping and
other aerobic exercises, maintain the intensity of your activity that would give
you the target heart rate within the designed duration.
● Bottle filled with water and your body weight can be used for your muscular
resistance training. Other elastic materials at home may be used.
● Your heart rate can be monitored while exercising by:

- Counting your radial pulse (https://www.youtube.com/watch?
v=m8tzO_nreb0)
- Hooking a pulse oximeter to your finger
- Holding the pulse counter on the treadmill or ergo bike
- Downloading the measurement of HR application to your android phone
Normal Response to Exercise:

● Increased heart rate
● Increased breathing rate
● Mild to moderate sweating, depending on your exercise level
● Feeling or hearing your heart beat
● Muscle aches and tenderness that might last a day or two as you get started
Abnormal Response
● Severe shortness of breath
● Wheezing, coughing, or other difficulty in breathing
● Cramps, severe pain or muscle aches
● Excessive perspiration
● Chest discomfort, pain, pressure or tightness felt in the chest and possibly
extending to your left arm or neck
● Light-headedness, dizziness, fainting
67
● Severe, prolonged fatigue, or exhaustion after exercise
● Nausea
Module 5 – Maintenance Stage
following while the student, the trainees’ coach motivates them to sustain what
they have gained and maintains or progresses his own fitness level:
1. Progressed their cardiovascular conditioning and muscular resistance
training in a new exercise prescription.
2. Achieved the target parameters of the new cardiovascular conditioning and
muscular resistance training program that requires progression to much
higher levels.
Basic Concept on Motivational Approach:
68
This is the step that all people who have commenced an action want to reach.
Once they have become regular exercisers, there are three different possible
departures:
● Lapse
● Relapse
● Termination/Permanent Maintenance
Lapse
Lapse is a temporary abandonment of the positive behavior, followed by a quick

return to it. Lapse does not produce any significant alteration in progress towards
established goals or, having achieved them, any significant modification in fitness
or body configuration. Lapse is fine, can be fun for a limited time, and is perfectly
normal. Worrisome is what is called relapse.
Relapse
Relapse is abandonment of the positive behavior that has produced the desired
outcome, to the extent that the outcome disappears. The program of regular
exercise is given up indefinitely, the good feelings, changes in body shape, and
increased strength and endurance gained from doing it vanishes.
To reverse relapse requires first figuring out what happened, why the relapse
occurred. Then, it requires going back to the planning, or possibly even the
contemplation stage, recommencing the change process and remobilizing
motivation.
1. Write an essay about their experience in implementing their designed fitness
program in the past 4-6 weeks citing the reinforcing factors and the
stumbling blocks.
2. Record their new anthropometric measurements that include:
b. Body mass index
69
3. Revise their exercise prescription using the FITT format for both
cardiovascular conditioning and strengthening. Use the same format in
Annex A.
involved in the implementation of their newly revised cardiovascular
and C.
b. Body mass index
and C.
Basic Concept on Fitness: The notes on the basic concept of exercise progression
shall be shared and discussed again by the student coach with his trainees.
Rate of Progression in Cardiovascular Conditioning
The recommended rate of progression depends on the individual’s health

status, exercise tolerance and exercise program goals. Progression involves
increasing any of the FITT components.
● Frequency, intensity and duration of exercise are gradually adjusted over the
next 4-8 months or longer for the elderly and deconditioned patients.
● Progression in the FITT components of the exercise prescription should be

made gradually to avoid muscle soreness and injury.
70
● All individuals should be monitored for any adverse effects of the increased
volume, and downward adjustments should be made if the exercise is not
well tolerated.
Progression to National Physical Activity Recommendations
For sedentary trainees initiating an exercise program, a lower dose of exercise

may be initially recommended. It is assumed that your trainee will eventually set a
goal to reach the recommended levels of 150 minutes a week of moderate-
intensity exercise or 75 minutes a week of vigorous-intensity exercise, or some
combination thereof. He might do this at the outset, or he might do it only after
conquering the ‘‘regular’’.
This progression can occur by increasing the duration, the frequency, the
intensity, or a combination of these. There is no single correct order to progress
these components, and the best option will vary depending on each trainee’s
preferences, health status, and lifestyle. We will describe two different paths that
your patients can choose to follow, each focusing on a different component:
duration and frequency.
In each case, it is assumed that your trainee is beginning his program for a
duration that he is confident of maintaining at least 3 times per week (frequency) at
a low to moderate intensity. For example, over a course of one month, he may go
from walking five minutes a day three times each week, up to 20 or even 30
minutes a day three times each week. Once a duration of 30 minutes is reached,
your trainee can then increase the frequency of the exercise from three times each
week ( see Figure 2.1, this occurs at the end of level 6), to four, and then five times
each week.
71
An alternative method is to progressively increase the frequency of activity.
Your trainee can begin their progression by first increasing the frequency of activity
up to at least five days each week, while maintaining the same duration for each
session. Some trainees will be able to increase their frequency directly from three
to five times per week; others will want to progress more slowly first, to four times
per week, and then up to five.
72
This option has the advantage of helping your trainee establish a more regular
habit of incorporating exercise into his daily routine. The hardest part of regular
exercise is the regular, not the exercise. Following this progression pathway
focusing on frequency, your trainee establishes the pattern of regular exercise for a
duration that is not intimidating or overwhelming. Once your trainee has reached a
frequency of at least five times each week, he can then consider increasing the
intensity of the exercise to a moderate level, i.e. an RPE of 3-4 out of 10, or a level at
which he is able to talk but not sing. Your trainee can also consider increasing the
duration of the exercise sessions by 5-10 minutes per week, while still maintaining
the good habit of exercising five days each week. The order in which the intensity
and duration are increased is not important, and will depend on your trainee’s
preference and health/fitness/age status. Figure 2.2 illustrates this progression
path.
Figure 2.2. Progression along the frequency path
73
Progression in Muscular Resistance Training
● If continued gains in muscular fitness and mass are desired, the individual
will have to progressively overload the muscles to present a greater training
stimulus, by using a higher resistance or more weights, performing more
repetitions but not exceeding 12 repetitions, or training muscle groups more
frequently.
● If the individual is satisfied with the muscular fitness improvements made, a
maintenance program is adopted where the same regimen of sets,
repetitions, resistance and frequency is performed without the need for
overloading. Muscular fitness may be maintained by training muscle groups
only 1 day each week provided the intensity remains the same.
Module 6 – Termination Stage
74
following while the student, the trainees’ coach motivates them to sustain or
progress what they have gained as he maintains or progresses his own fitness level:
1. Regularized their cardiovascular conditioning and muscular resistance
training using the revised prescription.
2. Achieved the target parameters of the new cardiovascular conditioning and
muscular resistance training program that requires progression to much
higher levels.
Basic Concept on Motivational Approach:
In this stage which is also called as permanent maintenance stage, lapses can
still happen but often do not last for long. This is because most regular exercisers
find that if they stop for too long, they just do not feel well and are almost impelled
to take up their activity again. There are, in fact, some regular exercisers who,
because of this phenomenon, find it difficult to take the occasional break for
recharging that is beneficial for most.
The following flow chart describes the rate of progression of the fitness level of
your trainees throughout the semester. This evidence of success has to be shared
with your trainees.
Module 6
Module 5
Module 4
Module 3
Module 1 Module 2 The thicker is the line, the more motivated they
are. The higher is the level, the more fit they
1. Write an essay about:
a. Their experience derived from the implementation of your revised fitness
program in the past 4-6 weeks citing the reinforcing factors and the
stumbling blocks.
b. Their experience with the motivational approach of their student coach
from the start of the semester until at present, and how this approach
75
would motivate also other people to follow their footstep in this
endeavour.
c. The effect of their physical education experience this semester to their
pursuit for happiness and success in life.
2. Record their new anthropometric measurements that include:
b. Body mass index
3. Revise their exercise prescription using the FITT format for both
cardiovascular conditioning and strengthening based on theirr progress at
the end of Module 5. Use the same format in Annex A.
involved in the implementation of their newly revised cardiovascular
and C.
b. Body mass index
and C.
Basic Concept on Fitness: The principle of progression in Module 5 still applies here.
On the other hand, your tendency to progress further may it be within the
physiological bounds or not, may fire back at you. Here are some guides in avoiding
over exercising.
Health experts recommend moderate-intensity exercise on most days of the

week. So, you may be surprised to learn that you can get too much exercise. If you
76
exercise often and find that you are often tired, or your performance suffers, it may
be time to back off for a bit. Learn the signs that you may be exercising too much.
Find out how to keep your competitive edge without overdoing it.
How too much exercise can hurt
To get stronger and faster, you need to push your body. But you also need to
rest. Rest is an important part of training. It allows your body to recover for your
next workout. When you do not get enough rest, it can lead to poor performance
and health problems. Pushing too hard for too long can backfire. Here are some
symptoms of too much exercise:
● Being unable to perform at the same level

● Needing longer periods of rest
● Feeling tired
● Being depressed
● Having mood swings or irritability
● Having trouble sleeping
● Feeling sore muscles or heavy limbs
● Getting overuse injuries
● Losing motivation
● Getting more colds
● Losing weight
● Feeling anxiety
If you have been exercising a lot and have any of these symptoms, cut back on
exercise or rest completely for 1 or 2 weeks. Often, this is all it takes to recover. If
you are still tired after 1 or 2 weeks of rest, contact or see your student coach. You
may need to keep resting or dial back your workouts for a month or longer. Your
student coach can help you decide how and when it is safe to start exercising again.
How to avoid overtraining
You can avoid overdoing it by listening to your body and getting enough rest.
Here are some other ways to make sure you are not overdoing it:
● Eat enough calories for your level of exercise.

● Decrease your workouts before a competition.
● Drink enough water when you exercise.
77
● Aim to get at least 8 hours of sleep each night.
● DO NOT exercise in extreme heat or cold.
● Cut back or stop exercising when you don't feel well or are under a lot of
stress.
● Rest for at least 6 hours in between periods of exercise. Take a full day off
every week.
Compulsive exercising
For some people, exercise can become a compulsion. This is when exercise is no
longer something you choose to do, but something you feel like you have to do.
Here are some signs to look for:
● You feel guilty or anxious if you do not exercise.
● You continue to exercise, even if you are injured or sick.
● Friends, family, or your provider are worried about how much you exercise.
● Exercise is no longer fun.
● You skip work, school, or social events to exercise.
● You stop having periods (women).
Compulsive exercise may be associated with eating disorders, such as anorexia

and bulimia. It can cause problems with your heart, bones, muscles, and nervous
system.
When to call a medical professional
Call your student coach who will refer you a medical professional once you:
● Have signs of overtraining after 1 or 2 weeks of rest
● Have signs of being a compulsive exerciser
● Feel out of control about how much you exercise
● Feel out of control about how much you eat
Your medical provider may recommend that you see a counselor who treats
compulsive exercise or eating disorders. Your provider or counselor may use
cognitive-behavioral therapy (CBT), antidepressant medicines and support groups
as treatments.
ASSESSMENT
78
At the end of the semester, the following will be evaluated: (File folder may
be submitted to Cloud, or mailed to SWU or, when health crisis is gone, hand
carried to SWU)
A. Portfolio must contain as shown in the table below. Absence of any of the
outputs would mean a grade of INCOMPLETE.
Modul Outputs Chec

e k
1 Trainee/s
Interview Report* (Relative)
Interview Report* (Non-Relative)
Essay* on Pursuit of Happiness and Success in life
Accomplished Table Physical Activity States of Change

Questionnaire
Interpretation of the Table
Student
New Anthropometric Measurements
Progressed Exercise Prescription for Cardiovascular

Conditioning
Progressed Exercise Prescription for Muscular Resistance

Training
Compilation of videos or photos each session
Cardiovascular Conditioning Monitoring Chart
Muscular Resistance Training Monitoring Chart
2 Trainee/s
Answers to Self-Assessment Questions
Essay* on Readiness for Exercise, Goals Setting, Prioritizing,

Controlling
79
Accomplished 2020 PAR-Q
Interpretation of 2020 PAR-Q
Student

Conditioning

Training
3 Trainee/s
Essay* on Risk Stratification and Exercise Intensity
Baseline Anthropometric Measurements
Exercise Prescription for Cardiovascular Conditioning
Exercise Prescription for Muscular Resistance Training
Student

Conditioning

Training
80
Modul Outputs Chec
e k
4 Trainee/s
Student

Conditioning

Training
5 Trainee/s
Essay* on experience derived from training using the first

prescription
Student/Trainee/s

Conditioning

Training
81
6 Trainee/s
Essay* on experience derived from training using the 2nd

prescription
Essay* on the motivational approach of the PE instructor
Essay* on effects of PE 1 to the pursuit of one’s

happiness/success
Student/Trainee/s

Conditioning

Training

*Minimum for all essay and narrative reports = 1,500 words
B. Progression in Cardiovascular Conditioning and Muscular Strength and

Endurance: The rating for these outcomes will be based on the mean of the
target and the baseline. The mean is the passing mark.
Cardiovascular Conditioning (Separate tables for Student and Trainee)
Parameters Baselin 2nd 4th 6th 8th nth week
82
e week week week week
Waist Circumference
Weight
BMI
Target Heart Rate
Peak Exercise Heart

Rate
Borg RPE
Muscular Strength and Endurance (Separate tables for Student and Trainee)
Parameters Baselin 2nd 4th 6th 8th nth week

e week week week week
Volume
Load, % 1RM
Exercise 1
Exercise 2
Exercise 3
Exercise 4
RPE
Exercise 1
Exercise 2
Exercise 3
Exercise 4
83
REFERENCES
A. Most of the content of these modules were lifted from the Exercise is Medicine,
Philippines Pre-Course Book 2017 with the following references:
⮚ ACSM’s Guidelines for Exercise Testing and Prescription 8th Edition
⮚ ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription
Sixth Edition
⮚ ACSM’s Exercise Management for Persons with Chronic Diseases and
Disabilities; J. Larry Dustine, Geoffrey E. Moore, Patricia L. Painter and Scott
O. Roberts
⮚ ACSM’s Exercise is Medicine; A Clinician’s Guide to Exercise Prescription by
Steven Jonas and Edward Phillips
⮚ ACSM’s Exercise is Medicine; A quick guide to Exercise Prescription by
Technogym Medical Scientific Department
⮚ 2011 National Physical Activity Guidelines Health Promotion Board Singapore
⮚ Exercise and Type 2 Diabetes: American College of Sports Medicine and the
American Diabetes Association: Joint Position Statement by the American
College of Sports Medicine and the American Diabetes Association; approved
by Executive Committee of the American Diabetes Association Medicine &
Science in Sports & ExerciseR and Diabetes Care; July 2010
⮚ Appropriate Physical Activity Intervention Strategies for Weight Loss and
Prevention of Weight Regain for Adults; ACSM Position Stand ; Donnelly,
Joseph E. Ed.D (Chair); Blair, Steven N. Ped; Jakicic, John M. Ph.D.; Manore,
84
Melinda M. Ph.D., R.D.; Rankin, Janet W. Ph.D.; Smith, Bryan K. Ph.D.; Med Sci
Sports Exerc. 2009; 41(2):459-71
⮚ Exercise and Hypertension; ACSM Position Stand by; Pescatello, Linda S.
Ph.D., FACSM, (Co-Chair); Franklin, Barry A. Ph.D., FACSM, (Co-Chair); Fagard,
Robert M.D., Ph.D. FACSM; Farquhar, William B. Ph.D.; Kelley, George A. D.A.,
FACSM; Ray, Chester A. Ph.D., FACSM; Medicine & Science in Sports &
Exercise: March 2004 - Volume 36 - Issue 3 - pp 533-553
⮚ Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the
International Diabetes Federation Task Force on Epidemiology and
Prevention; National Heart, Lung, and Blood Institute; American Heart
Association; World Heart Federation; International Atherosclerosis Society;
and International Association for the Study of Obesity; K.G.M.M. Alberti,
FRCP; Robert H. Eckel, MD, FAHA; Scott M. Grundy, MD, PhD, FAHA; Paul Z.
Zimmet, MD, PhD, FRACP; James I. Cleeman, MD; Karen A. Donato, SM; Jean-
Charles Fruchart, PharmD, PhD; W. Philip T. James, MD; Catherine M. Loria,
PhD, MS, MA, FAHA; Sidney C. Smith, Jr, MD, FAHA; Circulation 2009,
120:1640-1645
⮚ National Physical Activity Guidelines for Americans 2008: Office of Disease
Prevention and Health Promotion of US Department of Health and Human
Services
⮚ Ministry of Health Clinical Practice Guidelines, Management of Asthma
1/2008
⮚ Australian Association for Exercise and Sports Science position statement on
exercise and asthma Alan R. Morton, Kenneth D. Fitch Journal of Science and
Medicine in Sport 14 (2011) 312-316
⮚ Department of Health (2010, March-April). Philippine National Guidelines on
Physical Activity: Galaw-galaw baka pumanaw. Healthbeat, 58, 6-8 Retrieved
from: http://www. doh.gov.ph/node/1025.html
⮚ Department of Health, National Epidemiological Center. (2009). ‘‘The 2009
Philippine Health Statistics’’. Retrieved from
http://www.doh.gov.ph/sites/default/files/ PHILIPPINE%20HEALTH
%20STATISTICS%202009_0.pdf
⮚ Department of Health (2013, April 26). ‘‘Leading causes of Mortality.’’
Retrieved from http://www.doh.gov.ph/node/198.html
85
⮚ Masoli, M., Fabian, D.; Holt , S. , Richard, B. (2004, May) ‘‘Global Burden of
Asthma’’. Retrieved from:
http://www.ginasthma.org/local/uploads/files/GINABurdenReport_1. Pdf
⮚ National Statistics Office & ICF Macro. (2009, December) ìPhilippines
-National Demographic and Health Survey 2008î. Retrieved from:
http://dhsprogram.com /pubs/pdf/FR224/FR224.pdf
⮚ Philippine Statistics Authority (2012, August 30). The Age and Sex Structure of
the Philippine Population: (Facts from the 2010 Census). Retrieved from
http://www.census.gov.ph/content/age-and-sex-structure-philippine-
population-facts-2010-census
⮚ The Problem of Mental Health in the Philippines (n.d.) Retrieved on May 15,
2014) from wikispaces:
http://mentalhealthph.wikispaces.com/2.%09The+Problem+of+Mental+
Health+in+the+Philippines
B. American Council on Exercise website. 9 signs of overtraining.

www.acefitness.org/ education-and-resources/lifestyle/blog/6466/9-signs-of-
overtraining?pageID=634. Accessed August 8, 2018.
C. Carfagno DG, Hendrix JC 3rd. Overtraining syndrome in the athlete: current

clinical practice. Curr Sports Med Rep. 2014;13(1):45-51. PMID: 24412891
www.ncbi.nlm.nih.gov/ pubmed/24412891.
D. Meeusen R, Duclos M, Foster C, et al. Prevention, diagnosis, and treatment of

the overtraining syndrome: joint consensus statement of the European College
of Sport Science and the American College of Sports Medicine. Med Sci Sports
Exerc. 2013;45(1):186-205. PMID: 23247672
www.ncbi.nlm.nih.gov/pubmed/23247672.
E. Rothmier JD, Harmon KG, O'Kane JW. Sports medicine. In: Rakel RE, Rakel DP,
eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders;
2016: chap 29.
F. Preventive Cardiology, Cardiac Rehabilitation and Sports Cardiology Course:

From Set-up to Frontiers, European Society of Cardiology and European
Association of Sports Cardiology, Inselspital Bern University Hospital,
Switzerland.
86
ANNEX A
EXERCISE PRESCRIPTION
Cardiovascular Conditioning Prescription
Name of Student or Trainee: _________________________________________ Age: _________

Date of 1st Day of Training: _________________ Initial Prescription/No. of Progression:
_______
Components Target
Frequency
Intensity
Resting Heart Rate
Heart Rate Reserve
Target Heart Rate
HR @ High Interval
HR @ Low Interval
Borg Rate of Perceived

Exertion
Time
Warm up
Stimulus
87
Cool down
Number of cycles
Type
For Light Intensity Interval Training:

30 30 30 30 30
sec sec sec sec sec
THR Borg 11-12
60ss 60ss 60ss 60ss

5 min ecn ecn ecn ecn 3 min
½ HRR
For Moderate Intensity Continuous Exercise:

20 - 30 min
THR Borg 11-14
5 min 3 min ½ HRR

4 4 4 4
min min min min
THR Borg >15

5 min ½ HRR
Example: A 25 year-old male medically cleared to engage in high intensity

interval training.
Components Target
Frequency 5 x a week
Intensity
Resting Heart Rate 88 beats/min
Heart Rate Reserve 76%
88
Target Heart Rate (220-25-88)0.76 + 88 = 169
HR @ High Interval 169 beats/min
HR @ Low Interval (220-25-88)0.38 + 88 = 128 beats/min
Borg Rate of Perceived 15

Exertion
Time
Warm up 5 min @ low interval
Stimulus 23 min
Cool down 3 min @ low interval
Number of cycles 4
Type HIIT on Motorized Treadmill
4 4 4 4
min min min min
THR = 169 beats/min Borg >15

5 min ½ HRR = 128 beats/min
89
Muscular Resistance Training Prescription
Name of Student or Trainee: ______________________________________________ Age: ____

Date of 1st Day of Training: _________________ Initial Prescription/No. of Progression:
_______
Training Age
Goal
Volume
Frequency
Session/Duratio
n
Warm up Duration Sets Reps

Stretch
Exercise Sets Reps Rest Load RPE
Cool down Duration Sets Reps

Stretch
90
Name of PE Instructor: ___________________________________________________________
Name of Student Coach: _________________________________________________________
Date Submitted/Finished: ________________________________________________________
Example:
Training Age 28
Goal Increase strength
Volume Moderate
Frequency 2x week
Session/Duratio 80 min including warm up and cool down

n
91
Warm up Duration Sets Reps
Stretch
Arms across 30 sec 2 1

chest
Prone quad 30 sec 2 1

stretch
Hams stretch 30 sec 2 1
Exercise Sets Reps Rest Load RPE
Squat 5 4 2-3 min 85% 1RM 17
Bench press 3 5 2-3 min 80% 1 RM 17
Power clean 3 4 2-3 min 70% 1 RM 15
Deadlift 5 4 2-3 min 85% 1RM 17
Bench pull 3 8 1-2 min 75% 1RM 14
DB Split squat 3 8 1-2 min 75% 1RM 14
Military Press 3 8 1-2 min 75% 1RM 14
Cool down Duration Sets Reps

Stretch
Arms across 30 sec 2 1

chest
Prone quad 30 sec 2 1

stretch
Hams stretch 30 sec 2 1
92
93
ANNEX B
CARDIOVASCULAR CONDITIONING MONITORING CHART
Name of Student or Trainee:

____________________________________________________________________________ Age: ____
Name of Student Coach:

_______________________________________________________________________________________
PE Instructor: ________________________________________________________________________
Section: _________________
Parameters Baselin Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Da

e
Date Measured
Initial or Progression
No.
Waist Circumference,
cm
Height, m
Weight, kg
BMI
Target Heart Rate
Peak Exercise Heart

Rate
Borg RPE
*5 days a week
Parameters Day 9 Day 10 Day 11 Day 12 Day 13 Day 5 Day 14 Da
Date Measured
Initial or Progression
94
No.
Waist Circumference,
cm
Height, m
Weight, kg
BMI
Target Heart Rate
Peak Exercise Heart

Rate
Borg RPE
*at least 5 days a week

ANNEX C
MUSCULAR RESISTANCE TRAINING MONITORING CHART
Name of Student or Trainee:

___________________________________________________________________________ Age: _____
Name of Student Coach:

_______________________________________________________________________________________
PE Instructor: ________________________________________________________________________
Section: _________________
Parameters Baselin Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Da

e
Date Measured
Volume/Intensity
Load, % 1RM
Exercise 1
Exercise 2
Exercise 3
95
RPE
Exercise 1
Exercise 2
Exercise 3
Parameters Day 9 Day 10 Day 11 Day 12 Day 13 Day 14 Day 15 Da
Date Measured
Volume/Intensity
Load, % 1RM
Exercise 1
Exercise 2
Exercise 3
RPE
Exercise 1
Exercise 2
Exercise 3
*With 48 hours interval
96

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Rationale

A significant proportion of Filipinos are exposed to non-communicable

The tertiary physical education physical fitness program of Southwestern

2. Optimum productivity which means exhibiting highly efficient performances

3. Social influence which refers to demonstration of sense of social responsibility

Fit and competitive individuals cannot be considered living models of fitness

All the four PE programs are deemed project-based – PE 1 and 2 involve a

Co-terminus with each semester Lifetime commitment

Thematic, stand alone Continuous progression

Cannot be applied/practiced to their Can be applied/practiced when they get

Teacher-centered, forces students to Student-centered, drives students to

Will be considered by students just an Will be considered by students an

Self-centered High sense of social responsibility

Based on lectures and demonstration Problem-based, research-oriented

Exam-based assessment Project-based assessment

A laboratory for PE majors A laboratory for sports science students

Conforms to CHED in detail Conforms to CHED in toto

Below is the summary of the tertiary physical education program showing

1st Semester – PE 1 2nd Semester – PE 2

Title: Individualized Fitness Program Title: Sports Conditioning Program

Becoming Fit Becoming Competitive

Description: Application of the self- Description: Application of the self-

Outcomes: Physically fit to maintain Outcomes: Physically conditioned to

Skills: Screening, Assessment, Exercise Skills: Screening, Assessment, Exercise

Assessment: Portfolio, Assessment: Portfolio, speed, agility,

Celebration: Fitlympics (Fitness Fete) Celebration: Best Project Awards Rites

Certification: Fitness Training Certification: Conditioning Completion

1st Semester – PE 3 2nd Semester – PE 4

Title: Peer/Group Fitness Program Title: Community Fitness/Sports

Description: Facilitation of designed Description: Facilitation of designed

Outcomes: Physically fit, healthy Outcomes: Physically conditioned

Skills: Screening, Assessment, Exercise Skills: Screening, Assessment, Exercise

Assessment: Portfolio, trainer and Assessment: Portfolio, trainer and

Celebration: Fitlympics (Fitness Fete) Celebration: Best Project Awards Rites

Certification: Fitness Trainer’s Certification: Conditioning Trainer’s

Course Title: Peer/Group Fitness Program Tagline: Becoming

Generic Course Title: Physical Activities towards Health and Fitness 1

Course Number: PED 027 Credit: 2 units

Module 1 – Pre-contemplation Stage

Estimated Duration: Two weeks

Basic Concept on Motivational Approach: The student uses this concept in

‘‘Motivation is a state of mind (characterized as an emotion, feeling, desire, idea,

Motivation is always potentially present in the mind, even if inactive, for it is

There are three phases in ‘‘finding’’ motivation:

To be effective, motivation must be inner-directed, e. g., ‘‘I want to do this for

Taking control by the trainee is central to both starting a regular exercise

In helping trainees to mobilize their motivation and then engage in behavioral

The 6 stages of change are:

In pre-contemplative trainees, they are informed about the benefits of exercise

An important aspect of helping your trainee to mobilize his motivation, thereby

Feeling ambivalent about making a behavior change is perfectly normal.

A key to success in dealing with ambivalence is to accept that it will always be

If it simply questions commitment, if it does nothing more than taking your

Action Yes - Yes No

Maintenance Yes - Yes Yes

1. I am currently physically active.

2. I intend to become more physically active in the next 6

For activity to be regular, it must add up to a total of 30 or

4. I have been regularly physically active for the past 6 months.