Youth

Exercise
Specialist
Manual
NASM YOUTH EXERCISE SPECIALIST I

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NASM YOUTH EXERCISE SPECIALIST II

Contributors

TABLE OF CONTENTS DeWayne A. Smith, ATC, CSCS, NASM-CPT, CES, PES

Sports Medicine Content Development Coordinator
1 Rationale for Youth Fitness Training...................................................... 1 National Academy of Sports Medicine

Johna K. Register-Mihalik, PhD, ATC

2 Anatomical and Physiological Considerations for Youth.................5 Postdoctoral Research Associate
Human Movement Science Department
3 Psychological considerations for youth................................................10 The University of North Carolina at Chapel Hill

Kristin S. Ondrak, PhD

4 Fitness Assessment for Youth.................................................................18
Adjunct Professor
Seattle University
5 Youth Flexibility Guidelines................................................................... 33
Kat Barefield, RD, MS, ACSM-HFS, NASM-CPT, PES
6 Cardiorespiratory Training For Youth................................................. 38 Registered Dietician, dotFIT

7 Core and Balance Training Guidelines for Youth............................. 4!

Acknowledgements
8 Plyometric, Speed, Agility, Models: Hannah Potter and Adrian Amaya

and Quickness Training for Youth..........................................................#( Editors: Nicole Hicks, Spring Lenox, Jennifer Nemec, Angela
Snell, and Kelly Von Lunen
9 Resistance Training for Youth................................................................ $%

10 Integrated Program Design for Youth Clients................................. 6!

11 Nutrition for Youth...................................................................................&

12 Professional Development.................................................................... 8

Appendices........................................................................................................
'"
NASM YOUTH EXERCISE SPECIALIST 1

CHAPTER 1: RATIONALE FOR YOUTH FITNESS TRAINING

Learning Objectives will help to achieve successful outcomes. The course will
also cover the importance of safe environments that are
After completing this chapter, you will:
appropriate for youth who are exercising. In the past, most
⦁⦁ Understand the different terms that identify the of the established guidelines for exercise training for the
youth population. youth population focused on training for sport. But, with
⦁⦁ Be able to define and explain the difference cases of obesity and diabetes in youth on the rise, focus
between overweight and obesity. on the development of federal guidelines for school and
community activity programs is increasing (1).
⦁⦁ Describe why so many youths are overweight
or obese.
Clarification of Terms
Introduction It is important to clarify the terms in this course. The
term youth can encompass a wide age range and has
A majority of health and fitness literature pertaining
a broad meaning. The Centers for Disease Control
to exercise training programs, fitness guidelines, and
and Prevention (CDC) uses the terms children and
exercise techniques focuses on the adult population.
adolescents to help differentiate the two groups. In
And after extensive studies, exercise scientists widely
general, a child is age 2 to 11, while an adolescent is
accept the design parameters of these programs. between the ages of 12 and 19 (2). When referring to
However, responses to exercise and exercise guidelines exercise responses, the term child typically includes
for youth are not the same as they are for adults. For those who are 6 to 11 years olds. This is because those
example, hormonal, biomechanical, psychological, who are 2 to 5 years old are often not in research that
and physiological differences exist between adults and involves graded exercise tests or maximal efforts. (See
youth. These influence exercise responses. Therefore, Table 1.1 for a breakdown.)
these differences warrant the development of specific
exercise training guidelines and programs that are Table 1.1 Differences in Youth Age Terminology
specific for the youth population.
2-5 years (not included in exercise research)
The purpose of this course is to understand the unique Child
6-11 years
responses of youth during exercise and any adjustments
Adolescent 12-19 years
that need to be made during exercise programming. This
NASM YOUTH EXERCISE SPECIALIST 2

These terms also highlight the difference between The prevalence of overweight and obesity in youth
youth of different ages. Children have different needs differs greatly depending on age group, race, sex, or a
and exercise responses in comparison to adolescents, combination thereof. For boys, overweight and obesity
who are experiencing puberty. Also, both groups have is lowest in whites. Next are non-Hispanic blacks.
different exercise responses than fully grown adults. Lastly, the highest rates occur in Mexican Americans
Discussion of these differences and their implications (Figure 1.2). For girls, overweight and obesity is lowest
for exercise will occur in Chapter 2. in whites, then Mexican Americans. It’s the highest in
non-Hispanic Blacks (Figure 1.3).
Overweight and Obesity in Youth
Figure 1.2 U.S. Prevalence of Obesity Among
The development of youth fitness guidelines and training
Boys Aged 12-19 Years
is timely and important because of the overwhelming
number of youth who are not able to maintain a healthy
body weight. Unfortunately, a record number of children
and adolescents in the United States are overweight
or obese. Data from the National Health and Nutrition
Examination Survey (NHANES) conducted from 2007
to 2008 indicates that 19.6% of children and 18.1% of
adolescents were obese (3). These numbers are staggering
in relation to the 4% and 6.1% of children and adolescents,
respectively, who were obese in the 1971 to 1974 NHANES
data set (3). A recent study by Ogden et al. estimates that
37% of children ages 6 to 11 are overweight or obese. And,
if this study were to expand and include those who are 2 to
19 years old, the statistics would be similar (Figure 1.1) (4).

Figure 1.1 Trends in Obesity Among Children Figure 1.3 U.S. Prevalence of Obesity Among
and Adolescents: 1963-2008 Girls Aged 12-19 Years
NASM YOUTH EXERCISE SPECIALIST 3

■■ Definitions of Overweight and Obesity ■■ Why are so Many Youth Overweight or Obese?
The CDC defines overweight as having a body mass The dramatic increase in overweight and obese
index (BMI) percentile that is greater than or equal to youth in recent decades is attributable to a decline
the 85th percentile, and less than the 95th percentile in physical activity levels and poor nutrition, as well
when comparing youth of the same age and sex. Obese as other factors. Researchers state that physical
is having a BMI percentile that is greater than or equal activity levels decline with age in boys and girls
to the 95th percentile for a youth’s age and sex (1). (5, 6). These reductions in energy expenditure as
Normal weight is a BMI percentile that is greater than youth age are more visible in females than males, and
or equal to the 5th percentile and less than the 85th are particularly evident in activities of moderate to
percentile. Underweight refers to youth with a BMI vigorous intensity (7).
percentile of less than the 5th percentile. For youth, For example, only 11.4% of girls and 24.8% of boys in
using percentiles compares them to others of their high school achieve the recommendations for daily
age. For example, a youth in the 6th percentile is at physical activity, which is 60 minutes per day (8).
normal weight, and has a higher index than 6% of his Additionally, the majority of youth do not achieve the
age group. recommended amounts of activity in their leisure
time. Instead, they spend greater amounts of time in
Examples of the BMI for age charts are on the CDC
sedentary behaviors.
website (www.cdc.gov/growthcharts). The example
in Table 1.2 shows the BMI of a boy at ages 2, 4, 9, The most recent Youth Risk Behavior Surveillance
and 13. While his BMI is constantly changing, the System report shows that only 18.4% of high school
BMI percentile remains consistent. So, despite the students were active for 60 minutes per day for the
reduction in BMI from 2 to 4 years of age, the boy is week prior to the survey. And, nearly 33% of high school
still obese. students watch three or more hours of television on a
typical school day, while nearly 25% use a computer for
It’s important to note that these definitions differ three or more hours per school day (9). These figures
from that of adults in which BMI, not BMI percentile, suggest that today’s youth are increasingly reliant on
denotes weight status categories. It’s also important to technology, and as a result, physical activity levels
understand that the categories at risk for overweight are declining. With this decrease in physical activity,
and overweight were previously used by several the health and well-being of the youth population is
organizations. These terms had the same BMI changing dramatically (10, 11).
percentile cut points as the newer terms of overweight
and obese, which the CDC and the American Academy Summary
of Pediatrics now accepts (3). This course will use the
Current statistics, the relationship between
terms overweight and obese.
overweight and obesity, and an increase in disease risk
Table 1.2 Example of BMI Percentile indicate an immediate need for fun and safe exercise
opportunities for youth. This offers health and fitness
Age BMI Percentile
professionals a tremendous opportunity to affect
2 years 19.3 95th the lives of many youth through the construction of
4 years 17.8 95th appropriate exercise programs. This course will equip
9 years 21.0 95th health and fitness professionals with the knowledge
and tools they need to design safe and effective youth
13 years 25.1 95th
exercise programs.
NASM YOUTH EXERCISE SPECIALIST 4

References
1. US Department of Health and Human Services. Guidelines for school and community
programs to promote lifelong physical activity among young people. Morb Mort Weekly Rep.
1997;46:1-36.
2. CDC. Basics About Childhood Obesity. CDC. http://www.cdc.gov/obesity/childhood/
basics.html. Updated April 26, 2011. Accessed October 6, 2011.
3. Ogden C, Carroll M. Prevalence of Obesity Among Children and Adolescents: United States,
Trends 1963-1965 Through 2007-2008. http://www.cdc.gov/nchs/data/hestat/obesity_
child_07_08/obesity_child_07_08.htm. Updated June 4, 2010. Accessed October 6, 2011.
4. Ogden CL, Yanovski SZ, Carroll MD, et al. The Epidemiology of obesity. Gastroenterology.
2007;132:2087-2102.
5. Rowland TW. Children’s Exercise Physiology. Champaign, IL: Human Kinetics; 2005.
6. Sallis JF. Age-related decline in physical activity: a synthesis of human and animal
studies. Med Sci Sports Exerc. 2000;32(9);1598-1600.
7. Nelson MC, Neumark-Stzainer D, Hannan PJ, et al. Longitudinal and secular trends in
physical activity and sedentary behavior during adolescence. Pediatrics. 2006;118(6):1627-1634.
8. CDC. Adolescent and School Health. CDC. http://www.cdc.gov/healthyyouth/
physicalactivity/facts.htm. Updated September 15, 2011. Accessed October 6, 2011.
9. Centers for Disease Control and Prevention. Morbity and Mortality Weekly Report.
Surveillance Summaries. June 4, 2010. MMWR 2010;59(No. SS-5).
10. Roux-Lirange D. Studies warn against the hazards of obesity. Amer J Nursing.
2003;103(7):26.
11. Beals KA. Addressing an epidemic: treatment strategies for youth obesity. ACSM Fit
Society Page. Spring 2003:9-11.
NASM YOUTH EXERCISE SPECIALIST 5

CHAPTER 2: ANATOMICAL AND PHYSIOLOGICAL

CONSIDERATIONS FOR YOUTH

Learning Objectives explains and organizes many of the key differences

and their implications into the following sections:
After completing this chapter, you will:
musculoskeletal, cardiorespiratory, endocrine,
⦁⦁ Understand the key physiological differences bioenergetics/metabolic, and thermoregulation.
between children, adolescents, and adults.
⦁⦁ Understand how boys and girls undergo various The Musculoskeletal System
hormonal changes at different times, and the
implications this may have on exercise capacity. ■■ Muscular Strength
⦁⦁ Differentiate the exercise capacity between Childhood and adolescence are unique time periods
youth and adults. during which large gains occur in the musculoskeletal
system including muscular strength, endurance, and
Introduction bone mineral content and density. Chapter 10 discusses
in detail the exercise prescriptions that help facilitate
Many anatomical and physiological differences exist
these gains in youth. The key physiological differences
between youth and adults, both at rest and in response
between gains in muscular strength in youth in
to exercise. Youth are a completely different type of
relation to adults are the source of strength gains
client in relation to adults. They do not demonstrate
and improvements in performance. For youth, gains
the same aerobic and anaerobic capabilities or have
in muscular strength are due to neural adaptations,
the same hormonal levels, attention span, size, or body
rather than large gains in hypertrophy, which occurs in
proportions. The Optimum Performance Training™
adults (1, 2). The smaller degree of muscle hypertrophy
(OPT™) model still applies to youth for training purposes,
in youth is largely attributable to hormonal differences,
but several adjustments may need to be made to allow
because they have lower testosterone levels.
youth to progress at an appropriate pace. The full details
of these changes are in Chapter 10 of this course. Health
■■ Skeletal Muscle Mass
and fitness professionals should be aware of basic
anatomical and physiological differences that exist Age and sex determine increases in skeletal muscle
between children, adolescents, and adults; many of mass. Boys and girls have a linear increase in skeletal
which impact physical performance. This chapter muscle mass between the ages of 6 and about 12 (3).
NASM YOUTH EXERCISE SPECIALIST 6

Then, the rate of increase in muscle mass slows in ■■ Growth Spurts in Height and Weight
females, but continues in males (3). This explains
Health and fitness professionals need to be aware of
why post-pubertal males have greater amounts of
growth spurts in height and body mass in youth. These
total muscle mass than females (on average). This is
changes impact coordination, gait, body composition,
attributable to higher concentrations of testosterone.
flexibility and other aspects of physical fitness.
Accelerated gains in body mass and height occur
■■ Flexibility
approximately 2 years earlier in girls in comparison
Regardless of how youth gain strength, it is important to boys. And, these accelerations last for a longer
for them to maintain flexibility in the presence of their period of time in boys, which explains why they’re
stronger and potentially larger muscle mass. Research taller and weigh more, on average (9). These periods
shows that flexibility is greatest in childhood and of morphological change correspond to the onset of
declines with age, especially if exercises to maintain puberty and changes in hormone levels.
it are not part of a fitness routine (4, 5). This trend is
evident in boys and girls, both for static and dynamic
flexibility that involves large and small muscle groups.
The Cardiorespiratory System
■■ Heart Rate, Stroke Volume,
■■ Bone Mineral Content and Density
and Cardiac Output
Physical activity helps stimulate the development of bone
There’s documentation that shows how cardiorespiratory
mineral content (g) and bone mineral density (g/cm3)
function during exercises changes as youth age. As
in youth. Childhood and adolescence is a crucial time for
accruing bone, as this process begins to slow and cease children become adolescents and eventually full-grown
by the time a person reaches their mid-20s. Therefore, adults, heart rate (HR), stroke volume (SV), and the
it is important for youth to take part in weight-bearing resultant cardiac output (Q) show similar patterns of
physical activities, such as running, jumping and change at rest and during submaximal and maximal
dancing (3, 6). exercise (10). HR decreases with age due to reductions
in basal metabolic rate (BMR), while SV increases with
During puberty, bone mineral content accrues at a faster age as the left ventricle grows (10). As children age, the
rate than during earlier childhood (7). Researchers note increase in SV is slightly greater than the decrease in HR,
that early pubescence is a time during which bone is which results in a larger cardiac output (Q).
especially responsive to the benefits of weight-bearing
physical activity (9). These activities stimulate bone In a study of boys versus men (mean ages of 9.1 and 22.8
mineral acquisition as youth support their weight in years) and girls versus women (mean ages of 8.8 and
the presence of gravity. They also help increase ground 23.6 years), researchers found that the children’s SV
reaction forces and resultant loading on bones. was about half that of the adults’ SV. The differences
were larger for boys versus men (9). The correlations
During growth and development, bone mineral between SV and the mass of the left ventricle was about
density increases when the activity of the osteoblasts 0.90. And, blood pressure increases with age both at
exceeds that of osteoclasts. Many factors influence this rest and during exercise.
process, including genetics, diet (particularly calcium
levels), vitamin D, and the type and amount of physical Lastly, the youth had a lower Q than adults during
activities (8). In addition, growth hormone, testosterone, exercise at the same VO2. This may suggest that their
estrogen, and insulin-like growth factor 1 (IGF-1) also smaller hearts were not able to pump as much blood per
influence bone accrual. This primarily occurs during minute. However, the youth were able to compensate
puberty when these hormones are increasing (9). by having a higher absolute VO2max difference than the
NASM YOUTH EXERCISE SPECIALIST 7

adults, which allowed their tissues to extract a greater lung volumes. This requires them to breathe more
amount of oxygen as blood passed from the arterial to frequently than adults (higher fB). These differences
venous circulations (3, 10). will become important considerations when developing
age-appropriate exercise programs for growing youth.
■■ VO2max: Absolute and Relative
VO2max in L/min defines absolute aerobic capacity and The Bioenergetic/Metabolic Pathways
tends to increase with age in boys and girls until about age
11. It then continues to increase in boys and levels off for Metabolic Hormones
girls (3). An increase inVO2max as youth age is attributable
In comparison to adults, youth tend to have higher
to the growing size of their oxygen delivery system (i.e.,
levels of succinate dehydrogenase (SDH) and
heart, lungs, blood volume). Sexual differences that arise
at the start of puberty are likely attributable to hormonal citrate synthase (CS), which are markers of aerobic
differences that guide changes in body composition. metabolism. On the other hand, youth have lower
Males tend to have greater amounts of fat-free mass, while levels of phosphofructokinase (PFK) and lactate
females begin to accumulate more fat mass. dehydrogenase (LDH), which are markers of anaerobic
metabolism. These differences explain the decline in
In contrast, relative VO2max, which is mL/kg/min, does
aerobic potential and the increase in anaerobic potential
not change with age in boys, and decreases with age in
girls (3). This means that the oxygen consumption per as youth age. However, prior to puberty, aerobic and
kilogram of body mass is similar between a boy and a anaerobic potential are almost equal. Therefore, youth
grown man. The decrease in relative VO2max in females who have greater ability in anaerobic activities also tend
with age is likely attributable to fat accumulation, to perform well aerobically, and vice versa. Children are
which is metabolically less active. However, it still adds known as metabolic nonspecialists for this reason (10).
to the total body mass.
■■ Metabolic Rate and
■■ Red Blood Cell Count and Hemoglobin Respiratory Exchange Ratio
Another difference between children, adolescents, and
Other metabolic differences between youth and adults
adults are red blood cell counts (RBCs) and hemoglobin
include resting metabolic rate, anaerobic threshold,
levels. Both increase with age from birth until adulthood.
lactate levels, and respiratory exchange ratio (RER),
Males tend to have higher levels of both in comparison
to females after pubescence (10). These differences which is an indicator of whether an individual is
may give males an advantage in aerobic events, because burning fats or carbohydrates as fuel.
greater amounts of circulating RBCs equate to a greater
In general, resting metabolic rate declines with age. Youth
oxygen carrying capacity. This is independent of their
have a higher anaerobic threshold. However, their lactate
larger body size and greater blood volume.
levels during submaximal and maximal exercise are lower
■■ Ventilation, Frequency of Breathing, than adults. These differences support the idea that youth
and Tidal Volume are not as good anaerobically as adults. Rather, they are
better aerobically. Finally, RER tends to be lower in youth
The primary respiratory variables of frequency
of breathing (fB), tidal volume (VT), and minute versus adults during maximal exercise, which indicates
ventilation (VE) have trends that are similar to Q, HR, that youth rely more heavily on fats than carbohydrates.
and SV. At rest and during submaximal and maximal This point further suggests the trend that youth do not
exercise, youth have lower VE and VT due to smaller perform anaerobic events as well as adults (3, 10).
NASM YOUTH EXERCISE SPECIALIST 8

■■ Thermoregulation Table 2.1 Key Physiological Differences Between

Youth and Adults in Relation to Physical Activity
Another important area to consider in youth fitness is
and Performance
thermoregulation, or the ability to regulate one’s body
temperature. Many differences exist between children, Youth Adult
adolescents, and adults, but it’s important to note that Musculoskeletal
youth are less able to control their body temperature at
Overall muscular strength greater
rest and during exercise, in comparison to adults (9, 10).
Flexibility greater
For example, total body water and blood volume are Bone mineral content and density greater
lower in youth because of their smaller size. These
Total skeletal muscle mass greater
differences result in a smaller reserve volume when
fluid loss occurs. Also, youth tend to heat up faster than Height and weight greater
adults because of their greater metabolic rate. Lastly, Cardiovascular*
youth have a higher surface area to mass ratio, which
Heart rate greater
causes a greater rise in core body temperature. During
exercise in hot environments, youth have a difficult Stroke volume greater
time dissipating heat. And, when they exercise in cold Cardiac output greater
environments, they lose too much heat through exposed a-vO2 difference similar or
skin (e.g., swimming). greater

Therefore, it is important that youth monitor their Red blood cells and hemoglobin greater
vital signs to prevent heat- and cold-related illnesses. Blood pressure greater
When planning physical activity guidelines for youth, Minute ventilation greater
it is necessary to consider these thermoregulatory
Frequency of breathing greater
challenges. A summary of these anatomical and
physiological differences are in Table 2.1. Tidal volume greater
Metabolic
Summary Aerobic enzymes and potential greater
Anaerobic enzymes and potential greater
This chapter describes some key physiological
differences between children, adolescents, and VO2max in L/min greater
adults at rest and during exercise. Health and fitness VO2max in mL/kg/min similar similar
professionals should take these differences into
RER (during max exercise) greater
consideration when designing an exercise program
for youth and not treat them as small adults. It is also Resting metabolic rate greater
important to remember that youth grow and develop at Thermoregulation
different rates. Therefore, while they are all on the path Total body water greater
to becoming fully grown, mature adults, they are all
Surface area to body mass ratio greater
progressing at different rates.
Sweat rate greater
With these physiologic differences in mind, the Sweat threshold greater
challenge for program designers is to find appropriate
* At rest, during submaximal and maximal exercise
exercise modes, intensities, and durations that are safe,
fun, and rewarding for youth.
NASM YOUTH EXERCISE SPECIALIST 9

References 6. Pitukcheewanont P, Punvasavatsut N, Feuille M. Physical activity and bone health in

children and adolescents. Pediatr Endocrinol. Rev. 2010;7(3):275-282.
1. Ozmun JC, Mikesky AE, Sarburg PR. Neuromuscular adaptations following
prepubescent strength training. Med Sci Sports Exerc. 1994; 26(4):510-514. 7. MacKelvie KJ, Khan KM, McKay HA. Is there a critical period for bone response to
weight-bearing exercise in children and adolescents? A systematic review. Br J Sports
2. Ramsay JA, Blimkie CJ, Smith K, et al. Strength training effects in prepubescent
Med. 2002;36:250-257.
boys. Med Sci Sports Exerc. 1990;22(5):605-614.
8. Ondrak KS, Morgan DW. Physical activity, calcium intake and bone health in children
3. Turley KR, Wilmore JH. Cardiovascular responses to treadmill and cycle ergometer
exercise in children and adults. J. Appl. Physiol. 1997;83:948-957. and adolescents. Sports Medicine. 2007;37(7):587-600.

4. Milne C, Seefedlt V, Reuschlein P. Relationship between grade, sex, race, and motor 9. Malina RM, Bouchard C, Bar-Or O. Growth, Maturation, and Physical Activity.
development in young children. Res Q. 1976;47:726. Champaign, IL. Human Kinetics; 2004.
5. Clark HH. Joint and body range of movement. Phys Fit Res Digest. 1975;5:16-18. 10. Rowland TW. Children’s Exercise Physiology. Champaign, IL: Human Kinetics; 2005.
NASM YOUTH EXERCISE SPECIALIST 10

CHAPTER 3: PSYCHOLOGICAL CONSIDERATIONS FOR YOUTH

Learning Objectives psychological stress on a young female who feels that

her body looks different from her classmates. Or, a young
After completing this chapter, you will:
male who feels that he is the slowest person on his soccer
⦁⦁ Understand the five key traits of people who are team. Both examples are realistic scenarios that a health
high achievers, and those who are successful in and fitness professional may encounter when working
making lifestyle changes. with young clients. And, it’s important to consider these
⦁⦁ Understand how self-perceptions in youth play scenarios when developing a fitness program.
a role in the success of a fitness program.
Quality of life encompasses the physical, psychological,
⦁⦁ Be able to identify helpful strategies to aid emotional, and social well-being of an individual. Health
clients in understanding their vision and goals. and fitness professionals must recognize and understand
⦁⦁ Understand how self-belief and confidence this concept, because quality of life improvement is
affects a young client’s abilities to be successful often one of the main reasons youth pursue a new fitness
in a fitness program. program. The areas that make up quality of life directly
⦁⦁ Be able to implement strategies that help clients influence each other (Figure 3.1). And health and fitness
become successful in their fitness program. professionals can impact each of these areas.
⦁⦁ Understand factors and characteristics that
influence persistence in young clients. Figure 3.1 Cycle of Influence on Quality of Life
⦁⦁ Be able to provide young clients with tools
and ideas for self-monitoring, as well as better
methods for adapting activities and habits in
pursuance of fitness goals.

Introduction
When working with young clients, it is important to
help them understand that the body (physiological,
anatomical) and the mind (psychosocial, emotional) are
not separate; change in one generally leads to change
in the other. For example, consider the emotional and
NASM YOUTH EXERCISE SPECIALIST 11

Several factors affect quality of life in relation to health Self-esteem relates to an individual’s feelings of worth.
for youth. A number of these factors relate to health and And in the realm of health and exercise, this is body
fitness, which suggests the potential effect that health competence and body image (2). Body competence is
and fitness professionals can have on the overall quality essentially the same as self-esteem but is specific to
of life for young clients. These clients are certainly a the physical realm (2). It reflects how competent one
different population than young adults and seniors. The is at participating in a physical activity (e.g., exercise)
things they value and wish to achieve have different or performing a certain physical task (e.g., running a
expectations and shorter time frames. It is important mile, hitting a baseball, or playing a game of tag). Body
to understand how these values and expectations competence may play different roles in an individual’s
influence their self-perceptions and outcomes. self-perceptions, much like self-efficacy. However, this
depends on the goals and expectations of an individual.

Self-Perceptions A health and fitness professional will encounter

youth clients who are prepubescent or going through
Self-perception is how individuals perceive themselves.
significant growth spurts. These two factors can
And self-perception can dramatically affect quality of
influence overall body control and coordination,
life for young individuals. Two important components
which in turn may make some young clients feel less
of self-perception are self-efficacy and self-esteem.
competent in certain physical abilities.
Self-efficacy is an individual’s belief or confidence that
Body image relates to how individuals see themselves
he or she has the ability to accomplish a certain task
or how others see them in regard to physical appearance
or behavior (1). Many young individuals may have a
(e.g., overweight, too tall, slouched posture) (2). Because
higher level of self-efficacy for specific activities or
body image plays a large role in self-perceptions, it
tasks that relate to an activity they regularly enjoy.
ultimately impacts a young individual’s quality of life.
However, if activities are outside of their comfort
Also, youth are more prone to peer-pressure, and they
zone, the level of self-efficacy may decrease. The role
feel the need to look like their peers or individuals who
of self-efficacy in programs for youth clients may differ
are exceling at their specific activity of interest.
significantly depending on the goals and expectations
of these individuals. For instance, those who wish to Often, self-perceptions may not reflect the actual
gain a performance edge in a specific sport may have condition of the individual and are a result of societal
a higher self-efficacy in relation to physical activity and social pressures (1). It’s important to address the
than someone who wants to lose a significant amount concepts that people come in all shapes and sizes and
of weight. that what works for one individual may not work for
all. Furthermore, health and fitness professionals need
Assessing both short-term and long-term expectations, to teach and remind young clients about the benefits
as well as the comfort level with various activities, may of exercise and fitness. They also need to help clients
help a health and fitness professional clarify the role of focus on processes and the short-term outcomes
self-efficacy in a young client’s program. The health and concerning goals.
fitness professional should also assess and understand
the factors that play a role in the client’s self-efficacy.
This may help the client address any barriers to the
Emotional Well-Being
activities. When individuals become more willing to Youth are undergoing a significant number of changes
exercise and increase their belief in their ability to physically, socially, and emotionally. The cumulative
perform daily tasks, they will notice an increase in their impact of these physical and psychosocial changes
quality of life. can significantly affect their emotional well-being,
NASM YOUTH EXERCISE SPECIALIST 12

which pertains to the ability to control emotions. The challenge. Television, computers, and video games take
loss of this can lead to depression, anxiety, and other time away from exercise, as well as set expectations for
psychological disorders. In more minor forms, the other leisure activities.
loss may lead to misconceptions about oneself, which
may be common among young clients. Exercise and Young individuals want experiences that vary, and are
fitness may help to improve emotional well-being. fast-paced and interactive. Even youth who are active
Health and fitness professionals should be aware of the in competitive sports may consider other forms of
changes and perceptions in young individuals that may exercise, particularly in a health-club environment,
influence this well-being. to be boring. In addition, they often are impulsive and
expect to see results quickly.
Psychological Strategies for Working with So a health and fitness professional should hold some
Youth Clients: The Five-Step Process sessions outside of the health-club environment that
are interesting to the client. The health and fitness
Evidence suggests five key characteristics of those
professional also should focus on short-term and
who are high achievers and successful in making
lifestyle changes (3). These include vision, strategy, intermediate change for the client, rather than long-
belief, persistence, and learning. This chapter presents term change. Other tips for building rapport with young
practical, evidence-based techniques that health and clients include the following:
fitness professionals can use to help youth perform ⦁⦁ Incorporate activities that align with things
better in these five areas. However, it’s important to that are important to them.
consider the values and uniqueness of young clients
⦁⦁ Proactively acknowledge and address the fear
alongside these characteristics when developing,
of boredom.
overseeing, and encouraging change. Also, when
addressing any behavior, consider these values, because ⦁⦁ Emphasize commitment to making their
they’re often the key to the individual buying in experience fun and entertaining.
and complying. ⦁⦁ Explain how their workout routine will contain
Values that are important to youth include: peer variation, both to make the experience more
acceptance, societal acceptance, performance at school interesting and to provide greater physical
and potentially in sports, and having fun. benefits.
⦁⦁ Provide a menu of several potential exercises
Using techniques that surround these traits requires
or workout routines, and allow them to make
a health and fitness professional to first build rapport
choices about what interests them most.
with a client. He or she also should address the barriers
the client believes are standing in the way of a more ⦁⦁ Ask about their interests outside of the health
active lifestyle; reinforce the positive gains from a more club. Consider administering the Youth Activity
active lifestyle; and include the client in the program Interest Checklist (see appendix). With such
development and progression. an extensive list, even relatively inactive
clients will find activities that appeal to them.
Younger clients typically have a different mindset
This will spur their interest and allow time for
than older or more “traditional” clients. Some younger
customization of clients’ workouts.
clients will be overweight and will present the
challenges that usually accompany older clients, such ⦁⦁ Help younger clients who play sports
as fear of failure or injury. But for most youth, keeping understand the benefits of a program on their
things interesting and entertaining is the biggest performance and their lifestyle.
NASM YOUTH EXERCISE SPECIALIST 13

■■ Step One: Vision — The Science of Helping ⦁⦁ “What things most influence your decisions to
Youth Understand What They Really Want exercise or be active?”

Research shows that people who have a clear sense of ⦁⦁ “Why do you want to be more fit?”
what they want not only achieve more, but they are also
■■ Step Two: Strategy — The Science of
psychologically and physically healthier than those with
Helping Youth Turn Lofty Ambitions into
ambiguous or conflicting goals (4, 5). So, as a health a
fitness professional, it’s important to help clients identify
Consistent Action
and clarify their vision of what they want from life. Ask Individuals who are successful often have a strategy
them what they want and why they want to get fit. that leads to their success. The strategies below help
enhance behavior modification (6).
For young clients, this may be more difficult. It often
will center on more short-term and specific goals, such ⦁⦁ Have clients specify their strategies, priorities,
as performance improvements at a sport or activity. and values.
However, some young clients will want to lose weight ⦁⦁ Develop short-term and long-term goals (with a
and will willingly increase their fitness. To better focus on the short-term).
understand where on this spectrum their vision may fall, ⦁⦁ Promote action and self-care.
ask the following question: “Do you want to lose weight
Next, help clients craft strategies and near-term goals
and gain strength for the basketball court, or run a 5K?”
that align with their priorities and values. This will help
As previously discussed, young clients usually have make their vision a reality. It is important to reassess
a shorter attention span. So a health and fitness these priorities and values, as they may change over the
professional needs to focus on events and goals closer course of a fitness program.
in both timing and proximity to their interest. To do
The most important principles of setting goals with
this, ask them about what they want their lives to be
youth include those that are:
like in a few months, not a few years.
⦁⦁ Specific and challenging. Specific, challenging
Keep in mind that this information is only general advice, goals result in better performance than easy goals,
which means that it does not apply to every individual. For no goals, or simply trying to “do your best” (7).
example, young clients active in competitive sports may
⦁⦁ Time-bound and near-term. Supplementing
be looking forward to college athletics, or even dreaming
a long-term vision with near-term goals
of a career in professional sports. However, working
enhances performance, confidence,
toward understanding the immediate interests of young
determination, and happiness (8).
clients is important in helping provide specific guidance
as well as tips for a successful fitness program. Remember, Combining these principles leads to goals that
a short-term focus is advisable for most youth. Consider maximize performance and confidence. Remember to
asking these questions: base goals on an individual’s capabilities.

⦁⦁ “If you could accomplish anything in life, what Examples of those may include the following:
would it be?” ⦁⦁ Finding a friend to do a fun fitness activity
⦁⦁ “What activities do you find so interesting that with two times per week (e.g., bike riding,
you may lose track of time?” participating in a sport).
⦁⦁ “Who are your role models? Why do you admire ⦁⦁ Engaging in a favorite outdoor activity for
these individuals? 45 minutes at least two times per week.
NASM YOUTH EXERCISE SPECIALIST 14

⦁⦁ Completing 12 reps of lunges with great form by on nonweight metrics, as weight loss begins slowly and
the end of the month. can be discouraging.
⦁⦁ Taking the stairs instead of the elevator at least
Visualization
once a day.
⦁⦁ Doing one more push-up than in a Visualization and mental practice can reduce anxiety,
previous  session. build confidence, and enhance performance for world-
class and everyday athletes alike (16, 17). To do it right:
⦁⦁ Finding a sport or activity-specific goal.
⦁⦁ Envision means, rather than ends. Envisioning
■■ Step Three: Belief — The Science of Helping outcomes like “being fit” may be pleasant, but
Youth Believe They Will be Successful clients benefit more from visualizing the means
to those ends. For example, cardio workouts
People who have high self-confidence and self-efficacy that increase in length and intensity, or specific
work harder, achieve more, and perform better in many exercises that build stability and strength (18).
domains (9). Self-confidence and self-efficacy are both
⦁⦁ Practice, then visualize. Visualizing poor form
extremely important in youth due to pressures by peers,
or technique can actually hurt performance.
parents, and others (10, 11, 12). Finding ways to improve
(That’s why visualization helps elite athletes,
these two characteristics will help young clients
but can hamper novices) (16). For example,
believe in their abilities so they can move forward and don’t encourage clients to visualize lifting more
succeed. Belief in oneself and motivation are two of the weight until they master the proper form and
strongest predictors of ability to change (13, 14). technique.
Health and fitness professionals need to help young ⦁⦁ Distribute, rather than bunch. It’s better to
clients move toward an internal locus of control. visualize a little bit every day, versus everything
This focuses on an individual’s ability to change and at once.
influence their own lifestyles and behaviors. A client
Draw From Success
can achieve internal locus of control through an
increase in self-efficacy and self-confidence (15). Evidence shows that drawing from previous
experiences of success in other activities can increase
Think Baby Steps self-efficacy. Even if it is in another aspect of life,
helping a young client to see that they are successful
Tackling large goals too quickly undermines self-
and can continue to be successful will be an important
confidence and self-efficacy. A client can also
part in both their buy-in and sustainability in
experience soreness and increase his risk for injury,
the program (19).
which may discourage future workouts. In contrast,
slow but steady progress via “baby steps” builds ■■ Step Four: Persistence — The Science of
confidence. Therefore, it is easier for clients to Helping Youth Move Forward and Rebound
“behave their way” to a new level of confidence than from Setbacks
it is for them to “think their way” to a higher level
of performance. Research shows that people who are successful are
persistent. They work hard and rebound from setbacks.
Have clients focus on metrics that relate to their short- Encouraging and developing the characteristic of
term goals concerning stability, strength, or endurance. persistence may take some time. Health and fitness
This will improve and build confidence quickly. If youth professionals need to encourage clients to develop
aspire to lose weight, it is important to have them focus persistence techniques as seen below. However, discuss
NASM YOUTH EXERCISE SPECIALIST 15

overarching concepts with clients and incorporate ⦁⦁ Compliment a client’s progress (e.g., “You are
these into their programs. able to do twice as many pushups now than you
were just a month ago. That’s great!”).
⦁⦁ Have realistic expectations and rewards when
expectations are met. ⦁⦁ Start off corrective statements with confidence-
building statements (e.g., “Your form is good when
⦁⦁ Remind clients of their vision and goals. Have a
you perform lunges. To make it even better, try to
purpose that improves persistence (20).
keep your hands on your hips while lunging.”).
⦁⦁ Remind clients of positive role models
⦁⦁ Minimize comparisons to others (e.g., don’t tell
(potentially those they identified) who show
the client that she is doing better­—or worse—
persistence through difficult circumstances.
than a friend, sibling, or parent). Comparisons
Encourage Exercise Every Day may be appropriate in some circumstances. For
example, when tracking a young client’s BMI,
Encouraging clients to exercise daily helps turn habit it may be appropriate to examine percentiles.
and routine into positive forces for change. Help But remember, the goal is to build a sense of
clients think of days in between sessions as “light” individual confidence and mastery (internal
days rather than “off” days. Help them plan light days locus of control), not make clients feel better
by encouraging them to walk a certain number of (or worse) by comparing them to others.
steps, attend group exercise classes, or participate in
⦁⦁ Self rewards (e.g., treating oneself to a movie or
activities from the Youth Activity Interest Checklist.
shopping trip as a reward for making progress
Daily exercise is important for young clients who are toward fitness goals) can be a potent way of
trying to lose weight, because people who stick to their shaping behavior. Don’t overdo it, though.
eating and exercise habits without wavering are 1.5 Developing a sense of confidence and enjoyment
times more likely to maintain their weight loss than while exercising will create intrinsic motivation,
those who give themselves occasional “days off” (21). whereas relying on external rewards (bribes) can
Also, the well-being and fitness of those who are undermine long-term motivation.
active each day outside of traditional exercise is more
positive (22). Here are some examples of activities to Facilitate Networks of Excellence
incorporate on light days. Those with social support achieve more, live longer,
⦁⦁ Take the stairs instead of the elevator. feel happier, and are more persistent than others.
As supportive friends and family reward a client’s
⦁⦁ Participate in outside activities
progress, help celebrate successes and aid in recovery
(e.g., riding bikes).
from setbacks (24). Encourage clients to ask friends
⦁⦁ Participate in a sport or activity. and family to support their workout efforts, and help
⦁⦁ Walk the family pet or a neighbor’s pet. them find workout partners.

Reward Success Help Fight Boredom

Persistence improves when individuals reward their Varying a client’s routine will maximize physical
progress and forgive their setbacks; however, most benefits and motivation, particularly for younger
people tend to do the opposite (23). A health and fitness clients. Remember, to help fight boredom, vary a client’s
professional’s support and encouragement are powerful routine by incorporating activities that are more
rewards. To maximize this power, keep the following commonly seen outside a health club. Also, provide a
simple principles in mind: menu of exercises for the client.
NASM YOUTH EXERCISE SPECIALIST 16

■■ Step Five: Learning — The Science of ⦁⦁ Analyze data. Analyzing progress data
Helping Youth Make “Course Corrections” helps clients ascertain which goals they are
progressing toward and which goals require
Clients must learn whether they are persisting in
new strategies or additional effort. For example,
the right direction or whether course corrections are
a client may learn that she does well during the
necessary. To help this process, use self-monitoring. This
week but poorly on weekends. This knowledge
means recording aspects of behavior and measuring
enables course corrections.
progress toward goals. Self-monitoring enhances
performance and aids in making lifestyle changes (24).
⦁⦁ Capture experiences. Although recording
progress toward goals provides benefits, research
Evidence suggests that this learning is part of shows that journaling daily experiences can also
unlearning faulty behaviors through strategy and enhance psychological and physical health (27).
persistence (26). Recording progress rewards success, Young female clients may be more open to this
boosts confidence, and minimizes the black-or-white suggestion. However, journaling can help clients
thinking that leads to a snowball effect (i.e., suffering of both genders achieve more, clarify their goals,
a setback, considering oneself a failure, or letting that and navigate the challenges of adolescence.
lapse snowball into a big relapse). Another option is online tracking resources.

Below are four ways to promote self-monitoring:

Summary
⦁⦁ Use what’s available. Create charts and graphs Youth come from a variety of backgrounds with
based on information from a client’s workouts. goals ranging from weight loss to sport-performance
Because children are more familiar with current enhancement. Health and fitness professionals need
technology, generate graphs on a computer. to incorporate these differences into a client’s program
⦁⦁ Take the extra steps. Encourage clients to record to help improve quality of life. In addition, youth value
daily progress toward all of their goals on a 0 to 10 peer and parental approval as well as the security of
scale. This will enhance progress toward fitness belonging to peer groups.
goals, healthy eating, and personal/professional
As health and fitness professionals incorporate
development. Also, show clients how to track their
strategies to help youth be successful in their fitness
own daily progress using a system or technology
and health programs, they need to consider changes
that interests them.
among young clients, their goals, and their perceptions.
Table 3.1 Five Traits Characteristic of Achieving People And most importantly, they need consider a youth’s
quality of the life and the factors that may play a role
Identify and clarify vision of what is wanted
Vision in this such as physical, psychological, social, and
from life.
emotional well-being. Remember, exercise and fitness
Craft strategies and near-term goals that can impact each of these areas.
Strategy align with priorities and values for making
that vision a reality. If health and fitness professionals can help youth stick
Achieve internal locus of control through to exercise regimens using the five-step process, young
Belief
slow and steady progress. clients can make lasting lifestyle changes (Table 3.1).
Move forward and bounce back from This five-step process includes helping clients
Persistence
setbacks.
realize and understand their vision, aiding them in
Self-monitor to make adjustments and development of strategies that fit into their vision,
Learning
enhance performance.
helping them to believe in their abilities to achieve this
NASM YOUTH EXERCISE SPECIALIST 17

vision, encouraging them to be persistent as they move 9. Bandura A, Simon K. The role of proximal intentions in self-regulation of refractory
behavior. Cognitive Therapy and Research. 1977; 1: 177-193.
toward their fitness goals, and teaching them how to 10. Bandura A. Self-efficacy: The exercise of control. New York: W.H. Freeman; 1997.
monitor and achieve their fitness and health goals. 11. Shisslak CM, Crago M, McKnight KM, et al. Potential risk factors associated with
weight control behaviors in elementary and middle school girls. J Psychosom Res. March-
April 1998; 44(3-4): 301-313.
Accomplishing this process occurs by helping clients 12. Webster RA, Hunter M, Keats JA. Peer and parental influences on adolescents’
clarify their vision and ultimate objectives; assisting substance use: a path analysis. Int J Addict. April 1994; 29(5): 647-657.

them in setting effective, near-term goals that are 13. Cohen RY, Felix MR, Brownell KD. The role of parents and older peers in school-based
cardiovascular prevention programs: implications for program development. Health Educ
consistent with their vision; helping them build Q. Summer 1989; 16(2): 245-253.
14. Teixeira PJ, Palmeira AL, Branco TL, et al. Who will lose weight? A reexamination of
confidence that they can enact their strategies and predictors of weight loss in women. Int J Behav Nutr Phys Act. August 2, 2004; 1 (1): 12.
achieve their ultimate objectives; providing them with 15. Cochrane G. Role for a sense of self-worth in weight-loss treatments: helping patients
develop self-efficacy. Can Fam Physician. April 2008; 54 (4): 543-547.
techniques for being more persistent and resilient in
16. Duda JL, Tappe MK. Predictors of personal investment in physical activity among
the face of setbacks; and helping them analyze data to middle-aged and older adults. Percept Mot Skills. April 1988; 66 (2): 543-549.

learn when course corrections are necessary so they 17. Suinn RM. Psychological approaches to performance enhancement. New York:
Spectrum; 1987.
can record progress toward their goals. 18. Watson DL, Tharp RG. Self-directed behavior: Self-modification for personal
adjustment. Pacific Grove, CA: Brooks/Cole; 1993.
19. Pham LB, Taylor SE. From thought to action: Effects of process- versus outcome based
References mental stiumlations on performance. Personality and Social Psychology Bulletin. 1999;
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1. Marcus BH, Forsyth LH. Motivating People to be Physically Active. Champaign, IL: 20. Anderson ES, Winett RA, Wojcik JR, et al. Social cognitive mediators of change in a
Human Kinetics; 2003. group randomized nutrition and physical activity intervention: social support, self-efficacy,
2. Spirduso WW, Francis KL, MacRae PG. Health-Related Quality of Life. In: Spirduso outcome expectations and self-regulation in the guide-to-health trial. J Health Psychol.
WW, Francis KL, MacRae PG. Physical Dimensions of Aging. Champaign, IL: Human January 2010; 15(1): 21-32.
Kinetics; 2005: 233-257. 21. Estabrooks PA, Nelson CC, Xu S, et al. The frequency and behavioral outcomes of goal
3. Jauregui-Lobera I, Bolanos-Rios P, Santiago-Fernandez MJ, et al. Perception of weight choices in the self-management of diabetes. Diabetes Educ. May-June 2005; 31(3): 391-400.
and psychological variables in a sample of Spanish adolescents. Diabetes Metab Syndr 22. Gorin AA, Phelap S, Wing RR, et al. Promoting long-term weight control: does dieting
Obes. 2011; 4: 245-251. consistency matter. International journal of obesity and related metabolic disorders. 2004;
4. Kraus SJ. Psychological Foundations of Success: A Harvard-Trained Scientist 28 (2): 278-281.
Seperates the Science of Success from Self-Help Snake Oil. San Francisco: ChangePlanet 23. Okamoto N, Nakatani T, Okamoto Y, et al. Increasing the number of steps walked each
Press; 2002. day improves physical fitness in Japanese community-dwelling adults. Int J Sports Med.
5. Emmons RA, King LA. Conflict among personal strivings: Immedite and long-term April 2010; 31 (4): 277-282.
implications for psychological and physical well-being. J Pers Soc Psychol. 1988; 54: 1040- 24. Prochaska JO, DiClemente CC. Common processes of change in smoking, weight
1048. control and psychological distress. San Diego, CA: Academic Press; 1986.
6. Van Hook E, Higgins ET. Self-related problems beyond self-concept: Motiviational 25. House JS, Landis KR, Umberson D. Social relationships and health. Science. July 29,
consequences of discrepant self-guides. J Pers Soc Psychol. 1988; 55: 625-633. 1988; 241 (4865): 540-545.
7. Spahn JM, Reeves RS, Keim KS, et al. State of the evidence regarding behavior change 26. Kirschenbaum DS. Self-regulatory failure: A review with clinical implications. Clinical
theories and strategies in nutrition counseling to facilitate health and food behavior change. Psychology Review. 1987; 7: 77-104.
J Am Diet Assoc. June 2010; 110 (6): 879-891.
27. Beck A. Cognitive Therapy and Emotional Disorders. New York: Penguin; 1993.
8. Tubbs ME. Goal setting: A meta-analytic examination of the evidence. Journal of
applied psychology 1986; 71: 474-483. 28. Pennebaker JW. Opening up. New York: Morrow; 1994.
NASM YOUTH EXERCISE SPECIALIST 18

CHAPTER 4: FITNESS ASSESSMENT FOR YOUTH

Learning Objectives If a client exhibits difficulty or pain during any

observation or exercise, a health and fitness professional
After completing this chapter, you will:
should try and alleviate it with simple technique
⦁⦁ Understand the importance of subjective and modifications. If this doesn’t help, they should refer the
objective assessments for youth. client to a parent, legal guardian, or a physician, who may
⦁⦁ Recognize the expectations for health and be able to identify any underlying cause.
fitness professionals. When conducting a comprehensive fitness assessment
⦁⦁ Describe the steps in administering various for a youth client, it is essential to use a variety of tests.
questionnaires and fitness assessments. This will give an even view of the client (Table 4.2).
⦁⦁ Understand the special considerations for test And, by properly assessing the client prior to exercise,
administration in youth. the health and fitness professional can develop
appropriate exercise programs that will achieve safe
and effective results.
Introduction
A thorough pre-exercise assessment includes subjective
The first step in creating safe and effective exercise
and objective information. A health and fitness
programs for youth is to collect physiologic data during
professional gathers subjective information from a
a pre-exercise assessment. This information helps
prospective client to give feedback regarding personal
health and fitness professionals establish baseline
history, such as lifestyle and medical background.
values and quantify disease or injury risk. It also
helps identify possible contraindications to training, Typically, a client will answer subjective
and ensures an appropriate beginning point and questionnaires prior to objective tests. This gives the
progression sequence for each client. client time to relax and become comfortable in the
testing setting. And, it allows the client’s physiologic
Health and fitness professionals must understand
measurements, such as heart rate, to return to a
that a fitness assessment is not meant to diagnose any
baseline, resting level.
condition. Rather, the intent of the assessment is to
observe a client’s individual structural and functional Objective information provides a health and fitness
status (Table 4.1). Furthermore, NASM’s fitness professional with forms of measurable data. And,
assessments should not replace a medical examination. its purpose is to minimize bias from the participant
NASM YOUTH EXERCISE SPECIALIST 19

Table 4.1 Assessment Guidelines for Health and Fitness Professionals

Do not Do
⦁⦁ Do not diagnose ⦁⦁ Obtain exercise or health guidelines from a physician, physical therapist, registered dietitian, etc.
medical conditions.
⦁⦁ Follow national consensus guidelines of exercise prescription for medical disorders.

⦁⦁ Screen clients for exercise limitations.

⦁⦁ Identify potential risk factors or contraindications for clients, through screening procedures.

⦁⦁ Refer clients who experience difficulty, pain or exhibit other symptoms to a qualified medical practitioner.
⦁⦁ Do not prescribe ⦁⦁ Design individualized, systematic, progressive exercise programs.
treatment.
⦁⦁ Refer clients to a qualified medical practitioner for medical exercise prescription.
⦁⦁ Do not prescribe ⦁⦁ Provide clients with general information on healthy eating, according to MyPlate.
diets or recommend
specific supplements. ⦁⦁ Refer clients to a qualified dietitian or nutritionist for specific diet plans.

⦁⦁ Do not provide ⦁⦁ Refer clients to the appropriate qualified medical practitioner for treatment of injury or disease.
treatment of any kind
for injury or disease. ⦁⦁ Use exercise to help clients improve overall health.

⦁⦁ Assist clients in following the medical advice of a physician and/or therapist.

⦁⦁ Do not provide ⦁⦁ Design exercise programs for clients after they are released from rehabilitation.
rehabilitation
services for clients. ⦁⦁ Provide post-rehabilitation services.

⦁⦁ Do not provide ⦁⦁ Act as a coach for clients.

counseling services
for clients. ⦁⦁ Provide general information.

⦁⦁ Refer clients to a qualified counselor or therapist.

or interviewer. Health and fitness professionals can Table 4.2 Components of a Youth Fitness Assessment
also use objective information to compare beginning
numbers to those they measure weeks, months, or years Subjective information
later. Then, they can denote improvements in the client, ⦁⦁ Physical Activity Readiness Questionnaire (PAR-Q)
as well as the effectiveness of a training program. ⦁⦁ General and medical history questionnaire

⦁⦁ Medications
Subjective Assessments
Objective information
■■ Physical Activity Readiness Questionnaire ⦁⦁ Physiological assessments
(PAR-Q)
⦁⦁ Body composition testing
After obtaining written permission from a youth’s
⦁⦁ Cardiorespiratory assessments
parent or legal guardian, a health and fitness
professional should begin the assessment process ⦁⦁ Dynamic postural assessments
by having the client complete the Physical Activity ⦁⦁ Performance assessments
Readiness Questionnaire (PAR-Q) (Table 4.3). The
NASM YOUTH EXERCISE SPECIALIST 20

PAR-Q is a questionnaire that helps qualify a person General and Medical History Questionnnaire
for low-to-moderate-to-high activity levels (1, 2). Also, Once a client completes the PAR-Q, have them
it aids in identifying people for whom certain activities complete the General and Medical History
may not be appropriate, or who may need further Questionnaire (Table 4.4). This questionnaire, which
medical attention. includes questions about a client’s general and medical
history, provides a health and fitness professional with
Although it is less likely that a youth client will have
additional information about the client.
many unknown illnesses or is at risk for illness, it is
still important that a health and fitness professional
be aware. If a client answers yes to any question, refer Medications
the client to a medical professional before beginning a Health and fitness professionals should expect that the
physical activity program. If the client answers no to majority of youth clients won’t be under the direct care
all questions, continue with the assessment process. of a physician, nor will they be taking daily medications.
Because youth are under the age of 18, a youth’s legal However, it is crucial to ask questions and obtain this
guardian will help complete the PAR-Q, as well as the information. It is not the role of any health and fitness
General and Medical History Questionnaire. professional to administer, prescribe, or educate clients

Table 4.3. Sample Physical Activity Readiness Questionnaire (PAR-Q)

Questions Yes No
1 Has your doctor ever said that you have a heart condition and that you should only perform physical
activity recommended by a doctor?
2 Do you feel pain in your chest when you perform physical activity?
3 In the past month, have you had chest pain when you were not performing any physical activity?
4 Do you lose your balance because of dizziness or do you ever lose consciousness?
5 Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6 Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

Table 4.4 General and Medical History Questionnaire

Recreational questions Yes No
1 Do you play after-school sports (football, baseball, basketball, softball, volleyball, soccer, etc.)?
(If yes, please list.)
2 Do you have any hobbies (reading, video games, skateboarding, etc.)? (If yes, please explain.)
Medical questions Yes No
3 Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)? (If yes, please explain.)
4 Have you ever had any surgeries? (If yes, please explain.)
5 Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary
artery disease, hypertension (high blood pressure), high cholesterol or diabetes? (If yes, please explain.)
6 Are you currently taking any medication? (If yes, please list.)
NASM YOUTH EXERCISE SPECIALIST 21

or their parent or guardian on the use and effects of any Figure 4.1 Radial Pulse Measurement
medications. Health and fitness professionals need to
consult with a client’s parent and physician for health
information about any medications the client is taking.

Objective Assessments
After completion of the subjective questionnaires, a health
and fitness professional should administer objective
tests. If a client appears excited or nervous, allow plenty
of time to develop rapport and make them comfortable.
This is especially important when working with youth. If
a child or adolescent is not comfortable and relaxed, their
baseline resting values may elevate due to the white coat
■■ Heart Rate
effect; therefore, they won’t be accurate. If this occurs, To record resting heart rate, find the clients radial
the exercise prescription will also be erroneous, because pulse by lightly placing two fingers along the wrist in
a health and fitness professional calculates many values line with and just above the thumb (Figure 4.1). After
from these resting values. identifying the pulse, count the pulses for 30 seconds
and multiply by two. Record this value (the 60-second
Devote ample time to making a client comfortable. pulse rate) as the resting heart rate. It’s important
For example, explain all procedures thoroughly, and to use a gentle touch so there’s no constriction of
demonstrate on another person, if possible. This is blood flow. However, be sure it’s firm enough to feel
important when using any equipment that may appear the pulse.
scary or threatening to a child or adolescent.
Health and fitness professionals should use the general
Also, complete body composition measurements with equation 220 minus age for estimating maximal
professionalism and respect. This is important because heart rate (HRmax). Also, note that estimating HRmax
youth may be body-conscious and shy about these can produce results that are ±10 to 12 beats/min in
measurements. A member of the same sex as the client comparison to the actual reading (3). Health and fitness
should complete body composition measurements. professionals should use the estimated HRmax to develop
This should take place in a private room or area. The training zones in a client’s exercise program.
health and fitness professional should carefully record
the values in written form, and not share them orally ■■ Body Mass and Body Mass Index
(e.g., do not shout values across the room). The next step in the assessment is to measure body
Finally, for all objective measurements, a health and mass and height. Take the client’s body mass with them
barefoot. Also, have them remove as much extraneous
fitness professional should position themselves at
clothing as possible and empty pockets. Calibrate the
the same level as a client. This will help increase the
scale regularly and measure body mass twice. Then,
client’s comfort. The health and fitness professional
average the results. If the client doesn’t know their
may sit in a chair if the client is seated. They can also
height, ask the parent or guardian.
bend on a knee to be closer to the client’s eye level.
The objective tests the health and fitness professional After gathering the body mass and height
should perform include measuring resting heart rate, measurements, determine body mass index (BMI)
body mass, BMI, and body fat percentage. and BMI percentile. Although this assessment is not
NASM YOUTH EXERCISE SPECIALIST 22

exactly the same as assessments of body fat, the two ■■ Body Fat Measurements
measures correlate. The National Institutes of Health
The next step for a health and fitness professional is
recommends the use of BMI as a practical and reliable
to assess a client’s body composition. For youth, use
method of assessing weight disorders (4).
body fat and/or circumference measurements for body
Use the equations below to calculate BMI using meters composition assessment and reassessment.
and kilograms.
While this may be motivating or appropriate for a large
⦁⦁ Weight (kg) / height (m2) majority of youth, some may be self-conscious. So,
⦁⦁ [Weight (lb) / height (in2)] × 703 these assessments may not be appropriate for them. A
health and fitness professional should do the following:
Example ⦁⦁ Make the client comfortable.
A 12-year-old female client with a body weight of ⦁⦁ Collect all measurements in a private place.
100 lb (45 kg) is 60 inches (152 cm or 1.52 m2) tall.
⦁⦁ Always treat the client with respect.
Calculate these findings as follows:
⦁⦁ Have someone of the same sex complete the
⦁⦁ 45 kg / 1.52 m2 (2.31 m) = 19.5 measurements.
⦁⦁ [100 lb / 60 in2 (3600 inches)] × 703 = 19.5 ⦁⦁ Keep all results confidential.
Regardless of units, the client’s BMI is 19.5. Using Table Two common methods of body fat measurement are
4.5, BMI Percentiles by Age, check to see if the client taking the sum of skinfolds, which is done with caliper
is overweight (≥ 85th percentile) or obese (≥ 95th BMI measurement, and bioelectrical impedance. Both
percentile). involve portable equipment that is compatible with
It is important to use the appropriate age, gender, and youth and smaller budgets.
BMI score. In this example, the client’s BMI of 19.5 is ⦁⦁ Skin fold calipers measure a client’s amount
less than the cutoff for overweight or obesity for girls of of subcutaneous fat (or fat beneath the skin) by
her same age. So, she has a normal body weight. calculating the size of skinfolds.
⦁⦁ Bioelectrical impedance uses a portable
instrument to conduct an electrical current
Table 4.5 BMI Percentiles by Age through the body to measure fat. This form
of assessment relies on the hypothesis that
Male BMI percentile Female BMI percentile
tissues that are high in water content conduct
Age 85th 95th 85th 95th electrical currents with less resistance (and
8 18 20 18.2 19.6 greater speed) than those with little water
9 18.6 21 19 21.8 (such as adipose tissue).

10 19.4 22 20 23 ■■ Skinfold Caliper Measurements

11 20.2 23.2 20.8 24
When using skinfold caliper measurements, health
12 21 24.2 21.6 25.2 and fitness professionals must be consistent with the
13 21.8 25.2 22.5 26.2 exact areas of skinfolds that they measure. Also, the
14 22.6 26 23.2 27.2 conditions of administering the assessment should
be the same. For example, if a health and fitness
16 24.2 27.6 24.6 28.8
professional takes a skinfold measurement before a
18 25.6 28.9 25.6 30.2 client’s workout, this agenda should remain consistent
NASM YOUTH EXERCISE SPECIALIST 23

in future assessments. Take all measurements on the Figure 4.2 Biceps Measurement
right side of a client’s body (unless assessment form
notes otherwise).

■■ Calculating Body Fat Percentages

NASM uses the Durnin-Womersley formula to
calculate a client’s percentage of body fat (5). This
formula uses the simple four-site upper body
measurement process.

The Durnin-Wormersley formula’s four sites of

skinfold measurement: Figure 4.3 Triceps Measurement
⦁⦁ Biceps — Measure the vertical fold on the
front of the arm over the biceps muscle,
halfway between the shoulder and the elbow
(Figure 4.2)
⦁⦁ Triceps — Measure the vertical fold on the
back of the upper arm, with the arm relaxed
and held freely at the side. Take the skinfold
halfway between the shoulder and the elbow
(Figure 4.3).
⦁⦁ Subscapular — Measure a 45-degree angle fold
Figure 4.4 Subscapular Measurement
of 1 to 2 cm below the inner angle of the scapula
(Figure 4.4).
⦁⦁ Iliac crest — Measure 45-degree angle fold just
above the iliac crest and medial to the axillary
line (Figure 4.5).

After measuring the four sites, add the totals (in

millimeters). Then, find the appropriate sex and age
categories for the client’s body composition on the
Durnin-Womersley Body Fat Percentage Calculation
Table. (See Appendix.)
Figure 4.5 Iliac Crest Measurement
For example, a 14-year-old male client with the sum
of skinfolds equaling 45 mm has a body fat percentage
of 17.93.

So, to determine lean body mass, determine the actual

mass of the body fat first. Then, weigh the client and
multiply total body weight by measured body fat
percentage. Lastly, measure the client’s lean body
mass as total body weight and minus the total body fat
in pounds.
NASM YOUTH EXERCISE SPECIALIST 24

See the equations below. Muscular Strength Tests

⦁⦁ (Body weight) (Body fat percentage) = Muscular strength is a vital component of fitness in
Weight of body fat youth. And, proper assessment by a health and fitness
⦁⦁ Body weight – Weight of body fat = professional is crucial. The values from these tests will
Lean body mass serve as a starting point for exercise prescription. They
will also help to classify individuals according to their
Here’s a sample equation for a youth who weighs 95 lb
degree of strength, as well as identify any imbalances or
and has a body fat percentage of 12%.
areas that need improvement.
⦁⦁ (95) (0.12) = 11.4 lb of body fat
Muscular strength is the total amount of force that
⦁⦁ 95 – 11.4 = 83.6 lb lean body mass
can develop by a contracting skeletal muscle. This
Knowing lean body mass is important. If a client gains definition contrasts muscular endurance, which is
or loses weight, a health and fitness professional needs the number of repetitions a person can complete at a
to determine if the weight gain or loss is fat or lean body submaximal intensity before they experience fatigue.
mass. Gains in lean body mass are favorable, whereas
Health and fitness professionals may choose to assess
gains in fat mass are not.
the strength of numerous muscle groups. For example,
Fitness Assessments common muscular strength tests in youth include grip
strength, standing long jump, sit-up test, and upper
■■ Cardiorespiratory Endurance body strength tests (pull-ups). Recommendations
Next, perform the cardiorespiratory assessments. suggest that health and fitness professionals use, at
Cardiorespiratory assessments provide health and minimum, the sit-up, pull-up, and standing long-jump
fitness professionals with valuable information tests. This combination allows for the measurement
regarding cardiorespiratory efficiency and overall of lower and upper body strength, as well as
condition. They also provide a starting point for abdominal strength.
which heart rate zone the client should begin
cardiorespiratory exercise (specific to that person’s Upper Body: Right-Angle Push-Up Test (Figure 4.6) (9)
physical condition and goals). Chapter 6 will discuss A client should start with hands shoulder-width apart;
this in more detail. A common form that assesses extend arms, but don’t lock them; extend legs behind;
cardiorespiratory efficiency in youth is the one-mile feet slightly apart. Instruct the client to lower their
walk/run test. body until the elbows form a 90-degree angle, or the
upper arms are parallel to the ground.
One-Mile Walk/Run Test
Perform one complete repetition every 3 seconds until
The one-mile walk/run test is a simple way to assess
the client can’t perform any more at the proper pace.
cardiorespiratory endurance in youth. For this test, ask
Use a metronome for this test. (See Table 4.6.)
the client to run or walk 1 mile as fast as possible. Then,
compare the time in minutes and seconds to normative
Abdominal Strength: Curl-Up Test (10)
data for other youth of the same age and gender (8). A
health and fitness professional can modify this test for 1. Have the client lie on the ground and flex their knees;
6 to 7 year olds by having them complete 1/4 mile. For 8 feet need to be 12 inches from their buttocks.
to 9 year olds, have them run or walk 1/2 mile in place of 2. Next, have them cross their arms across their chest;
a full mile. keep elbows close to the chest.
NASM YOUTH EXERCISE SPECIALIST 25

Figure 4.6 Right-Angle Push-Up Test 3. Have a partner hold the client’s feet while they rise
up to touch their elbows to their thighs. Then, they will
lower their back to the floor, allowing their shoulder
blades to make contact with the ground. This makes
one repetition.
4. The client should perform this for 1 min.

Lower Body Strength and Power: Standing Long-Jump

Test (Figure 4.7) (11)
1. Mark a starting line with chalk or tape.
2. Have the client stand behind the starting line with
their feet together.
3. Starting from a stationary position, the client should
jump as far forward as possible.
4. Measure the distance in centimeters from the
starting line to the heel of the client’s foot in the back.
5. Repeat the test two additional times, and keep the
best score.
6. See Table 4.7 for scoring.

Table 4.6 Standards for Curl-Up and Right-Angle Figure 4.7 Standing Long-Jump Test
Push-Up Tests

Curl-ups in 1 min Right-angle push-ups in 1 min

Age Boys Girls Boys Girls
6 33 32 9 9
7 36 34 14 14
8 40 38 17 17
9 41 39 18 18
10 45 40 22 20
11 47 42 27 19
12 50 45 31 20
13 53 46 39 21
14 56 47 40 20
15 57 48 42 20
16 56 45 44 24
17 55 44 53 25
Based on 1985 National School Population Fitness Survey - Validated
in 1998
NASM YOUTH EXERCISE SPECIALIST 26

Table 4.7 Standing Long-Jump Test Percentile Values

Girls 10th 20th 30th 40th 50th 60th 70th 80th 90th
6-7 72.7 79.8 84.9 89.3 93.6 97.8 102.4 107.8 115.5
8-9 90.4 98.6 104.7 109.9 114.8 119.7 125.0 131.3 140.1
10-11 106.4 115.7 122.5 128.3 133.8 139.3 145.2 152.2 161.9
12-13 117.1 127.1 134.4 140.7 146.6 152.5 158.8 166.3 176.7
14-15 118.2 128.1 135.3 141.5 147.3 153.1 159.4 166.7 177.0
16-17 117.1 126.4 133.2 139.1 144.6 150.1 156.1 163.2 173.0
Boys 10th 20th 30th 40th 50th 60th 70th 80th 90th
6-7 74.9 83.6 89.9 95.3 100.3 105.2 110.5 116.7 125.2
8-9 93.1 103.5 110.9 117.1 122.9 128.6 134.7 141.8 151.4
10-11 109.9 121.3 129.4 136.2 142.6 148.8 155.5 163.2 173.8
12-13 127.3 139.3 147.8 155.0 161.8 168.4 175.5 183.8 195.1
14-15 145.5 158.6 167.8 175.4 182.3 189.2 196.4 204.6 215.8
16-17 164.6 178.6 188.1 195.9 202.8 209.6 216.5 224.4 234.9
Adapted from Castro-Pinero, et al. (11)

Posture and Movement Assessments ■■ Movement Assessment

Posture is often static (without movement). However,
■■ Importance of Posture everyday posture is constantly changing to meet the
Proper postural alignment allows optimal demands on the kinetic chain. So, a health and fitness
neuromuscular efficiency, which helps produce professional should perform a dynamic posture
effective and safe movement (14-20). Proper assessment. Faulty body alignments not seen during
the static postural assessment may appear during
posture ensures that the muscles of the body are in
dynamic postural observations. This assessment
optimal alignment. This results in proper length-
(looking at movements) is often the quickest way to
tension relationships that are necessary for efficient
gain an overall impression of a client’s functional
functioning of force-couples (14-20). status. Because posture is also a dynamic quality,
This allows for proper arthrokinematics ( joint observations may show postural distortion and
potential overactive and underactive muscles in a
motion) and effective absorption and distribution
naturally dynamic setting.
of forces throughout the human movement system
(kinetic chain), which ultimately alleviates excess Movement observations should relate to basic
stress on joints (14-20). functions such as squatting and balancing. These
observations will provide crucial information about
Proper posture keeps muscles at their proper length, muscle and joint interplay. Also, the observation
allowing them to properly work together. In turn, process should search for any imbalances in anatomy,
this ensures proper joint motion, maximizes force physiology, or biomechanics that may decrease a
production, and reduces the risk of injury. client’s results and possibly lead to injury (both in and
NASM YOUTH EXERCISE SPECIALIST 27

out of the fitness environment). Despite time limits as the overhead squat test (22). These assessments
for observation, health and fitness professionals need appear to be reliable and valid measurements of lower
to incorporate a systematic assessment sequence that extremity movement patterns with the applications of
is essential. standard protocols.

Kinetic Chain Checkpoints The overhead squat test shows lower extremity
movement patterns during jump-landing tasks (23).
Movement assessments require observation of the A decrease in hip abductor and hip external rotation
kinetic chain (human movement system). To structure strength, an increase in hip adductor activity, and
this observation, NASM suggests using kinetic chain a restriction in ankle dorsiflexion influences knee
checkpoints (Figure 4.8). These allow health and fitness valgus (knock-knees) during an overhead squat test
professionals to systematically view a client’s body in (24, 25, 26). These results suggest that the movement
an organized manner. The kinetic chain checkpoints
impairments during this transitional movement
refer to major joint regions of the body, and include
assessment may be the result of alterations in
the following:
available joint motion, muscle activation, and overall
1. Foot and ankle neuromuscular control. And, some hypothesize that
2. Knee these results point toward individuals with an elevated
injury risk.
3. Lumbo-pelvic-hip complex (LPHC)
4. Shoulders Procedure
5. Head and cervical spine Position
Focus on these primary areas when performing a 1. Have the client stand with the feet, shoulders-width
movement assessment. apart, and point them straight ahead. The foot and
ankle complex should be in a neutral position. Have
■■ Overhead Squat Assessment the client remove their shoes before the assessment to
The overhead squat assessment assesses dynamic better view the foot and ankle complex.
flexibility, core strength, balance, and overall 2. Have the client raise their arms overhead, and fully
neuromuscular control. There is evidence to support extend their elbows. The upper arms should bisect the
the use of transitional movement assessments, such torso (Figures 4.9, 4.10).

Figure 4.8 Kinetic Chain Checkpoints Figure 4.9 Overhead Squat Assessment, Lateral View
NASM YOUTH EXERCISE SPECIALIST 28

Movement Compensations: Anterior View

1. Instruct the client to squat to about the height of a chair 1. Feet: Do the client’s feet flatten and/or turn out
seat. Then, return to the starting position. (Figures 4.11, 4.12)?
2. Tell the client to repeat the movement five times. 2. Knees: Do the client’s knees move inward (adduct
Observe from each position (anterior and lateral). and internally rotate) (Figure 4.13)?
Views Compensations: Lateral View
1. View the client’s feet, ankles, and knees from the 3. LPHC
front (Figure 4.10). The feet should remain straight,
a. Does the client’s lower back arch
with the knees tracking in line with the foot (second
(Figure 4.14)?
and third toes).
b. Does the client’s torso lean forward
2. View the LPHC, shoulder, and cervical complex
from the side (Figure 4.9). The tibia should remain in excessively (Figure 4.15)?
line with the torso, while the arms should stay in line 4. Shoulder: Do the client’s arms fall forward
with the torso. (Figure 4.16)?

Figure 4.10 Overhead Squat Assessment, Figure 4.12 Feet Turn Out
Anterior View

Figure 4.13 Knees Move Inward

Figure 4.11 Feet Flatten
NASM YOUTH EXERCISE SPECIALIST 29

Figure 4.14 Low Back Arches Figure 4.15 Excessive Forward Lean

Figure 4.16 Arms Fall Forward

Record all findings when performing the assessment.
Then, refer to the solutions table (Table 4.8) or the
appendix to determine potentially overactive and
underactive muscles that require training through
corrective flexibility and strengthening techniques.
These will improve the client’s quality of movement,
decrease the risk for injury, and improve performance.

■■ Single-Leg Squat Assessment

This transitional movement assessment also assesses
dynamic flexibility, core strength, balance, and overall
neuromuscular control. Like the overhead squat, there
is evidence to support the use of the single-leg squat as
Procedure
a transitional movement assessment (22).
Position
This assessment also appears to be a reliable and valid
1. Have the client stand with hands on the hips. Their
measurement of lower extremity movement patterns
with the application of standard application protocols. eyes should focus on an object straight ahead.
A decrease in hip abductor and hip external rotation 2. The client should point their foot straight ahead.
strength (24), an increase in hip adductor activity (22), And, the foot, ankle, knee, and the LPHC should be in a
and a restriction in ankle dorsiflexion (22, 26) neutral position (Figure 4.17).
influences knee valgus.
Movement
These results suggest that the movement
1. Have the client squat to a comfortable level and
impairments seen during the transitional movement
return to the starting position.
assessments may be the result of alterations in
available joint motion, muscle activation, and overall 2. The client should perform up to 5 repetitions before
neuromuscular control. switching sides.
NASM YOUTH EXERCISE SPECIALIST 30

Table 4.8 Solutions Table

View Checkpoint Compensation Probable overactive muscles Probable underactive muscles
Lateral LPHC Excessive Soleus, gastrocnemius, hip flexor Anterior tibialis, gluteus maximus,
forward lean complex, abdominal complex erector spinae
Low back arches Hip flexor complex, erector Gluteus maximus, hamstring complex,
spinae, latissimus dorsi intrinsic core stabilizers (transverse
abdominis, multifidus, transversospinalis,
internal oblique pelvic floor)
Upper body Arms fall forward Latissimus dorsi, teres major, Mid/lower trapezius, rhomboids,
pectoralis major/minor rotator cuff
Anterior Feet Turn out Soleus, lateral gastrocnemius, Medial gastrocnemius, medial hamstring
biceps femoris (short head) complex, gracilis, sartorius, popliteus
Knees Move inward Adductor complex, biceps Gluteus medius/maximus, vastus
femoris (short head), TFL, medialis oblique (VMO)
vastus lateralis

Figure 4.17 Single Leg Squat Figure 4.18 Knees Move Inward

Views These will improve the client’s quality of movement,

decrease the risk for injury, and improve performance.
View the knee from the front. The knee should track in
line with the foot (second and third toes) (Figure 4.17).
Performance Assessments
Compensation
1. Knee: Does the client’s knee move inward (adduct Health and fitness professionals use performance
and internally rotate) (Figure 4.18)? assessments for youth or athletes who are trying to
improve athletic performance. Basic performance
Like the overhead squat assessment, record the assessments include the Davies and shark skill tests.
findings. Then, refer back to the solutions table or
the appendix to determine potential overactive and These assessments measure upper extremity stability
underactive muscles that will require training through and muscular endurance, lower extremity agility, and
corrective flexibility and strengthening techniques. overall strength.
NASM YOUTH EXERCISE SPECIALIST 31

■■ The Davies Test ■■ The Shark Skill Test

This assessment measures upper extremity agility This test assesses lower extremity agility and
and stabilization (27). Note: If a youth has shoulder neuromuscular control (view as a progression from
problems, this may not be a suitable test. the single-leg squat). This test may not be suitable for
all youth.
Procedure
Position Procedure
1. Place two pieces of tape on the floor, 36 inches apart. Position
2. Have the client assume a push-up position, with one 1. Position the client on the center box of a grid. Have
hand on each piece of tape (Figure 4.19). them place their hands on their hips and stand on one
Movement leg (Figure 4.20).

3. Instruct the client to quickly move their right hand Movement

to touch their left hand. 2. Instruct the client to hop to each box in a designated
4. Perform alternating touching on each side for pattern, always returning to the center box. Be
15 seconds. consistent with the patterns.

5. Have the client repeat for three trials. 3. Perform one practice run through with each foot.

6. Reassess in the future to measure improvement of 4. Perform test twice with each foot (four times total).
number of touches. Keep track of time.

7. Record the number of lines touched by both hands. 5. Record the times (Table 4.9).
6. Add 0.10 seconds for each of the following faults:
Figure 4.19 Davies Test a. Non-hopping leg touches ground.
b. Hands come off hips.
c. Foot goes into wrong square.
d. Foot does not return to center square.

Summary
It’s important for health and fitness professionals to
thoroughly assess youth clients prior to the initiation of
exercise to ensure safe and effective training programs

Figure 4.20 Shark Skill Test

NASM YOUTH EXERCISE SPECIALIST 32

Table 4.9 Observation Findings for Shark Skill Test

Total deducted (number of Final total (time – total
Trial Side Time (seconds) Deduction tally faults × 0.1) deduction)
Practice Right
Left
One Right
Left
Two Right
Left

and progressions. The use of both subjective and 8. The President’s Challenge. Physical Fitness Tests. Normative Data. http://www.
presidentschallenge.org/challenge/physical/activities/v-sit-reach.shtml. Accessed
objective information is essential to the assessment November 15, 2011.
9. The President’s Challenge. Physical Fitness Tests. Pull Up Tests. http://www.
process. Subjective information refers to the general presidentschallenge.org/challenge/physical/activities/pull-ups.shtml. Accessed November
and medical history of a client. Objective information 15, 2011.
10. The President’s Challenge. Physical Fitness Tests. Curl Up Tests. http://www.
provides measurable data that can help generate a presidentschallenge.org/challenge/physical/activities/curl-ups.shtml. Accessed November
starting point. It also has reassessment purposes 15, 2011.
11. Castro-Pinero J, Ortega FB, Artero EG, et al. Assessing muscular strength in youth:
to help evaluate the effectiveness of an exercise usefulness of standing long jump as a general index of muscular fitness. J Strength Cond Res
2010,24(7):1810-1817.
training program.
12. The President’s Challenge. Physical Fitness Tests. Sit and Reach Tests. http://www.
presidentschallenge.org/challenge/physical/activities/v-sit-reach.shtml. Accessed
Examples of objective information include BMI, November 15, 2011.

cardiorespiratory assessments, and postural and 13. Malina RM, Bouchard C, Bar-Or O. Growth, Maturation, and Physical Activity. Champaign,
IL: Human Kinetics, 2004.
movement assessments, such as the overhead squat 14. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis,
assessment. Transitional movement assessments, MO: Mosby, 2002.
15. Sahrmann SA. Posture and muscle Imbalance. Faulty lumbo-pelvic alignment and
such as the overhead squat assessment, assess associated musculoskeletal pain syndromes. Orthop Div Rev Can Phys Ther 1992, 12:13-20.
dynamic flexibility, core strength, balance, and overall 16. Kendall FP, McCreary EK, Provance PG. Muscles: Testing and Function. 4th ed. Baltimore,
MD: Williams & Wilkins, 1993.
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provide a foundation of personal information that Company, 1992.
18. Janda, V. Muscle Strength in Relation to Muscle Length, Pain and Muscle Imbalance. In:
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patella: a preliminary study. J Orthop Sports Phys Ther 2003, 33:677-685.
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Rehabilitation. St. Louis, MO: Mosby, 2002.
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Therapy of the Cervical and Thoracic Spine. St. Louis, MO: Churchill Livingstone, 2002:182-199.
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Questionnaire (PAR-Q). Can J Sports Sci. 1992;17:338-345 6. Ehrman JK, Gordon PM, Visich between men and women during the single-legged squat. Am J Sports Med 2003, 31:449-456.
PS, et al. Clinical Exercise Physiology. Champaign, IL: Human Kinetics, 2003.
23. Buckley BD, Thigpen CA, Joyce CJ, et al. Knee and hip kinematics during a double leg
3. Visich PS. Graded exercise testing. In: Ehrman JK, Gordon PM, Visich PS, Keteyian SJ, squat predict knee and hip kinematics at initial contact of a jump landing task. J Athl Train
editors. Clinical exercise physiology. Champaign, IL: Human Kinetics, 2003. 2007, 42:S81.
4. National Institutes of Health. Clinical guidelines on the identification, evaluation, and 24. Ireland ML, Willson JD, Ballantyne BT, et al. Hip strength in females with and without
treatment of overweight and obesity in adults. Bethseda, MD: National Institutes of Health, 1998. patellofemoral pain. J Orthop Sports Phys Ther 2003, 33:671-676.
5. Durnin JVGA, Womersley J. Body fat assessed from total body density and its estimation 25. Vesci BJ, Padua DA, Bell DR, et al. Influence of hip muscle strength, flexibility of hip
from skinfold thickness measurements on 481 men and women aged 16-72 years. Br J Nutr. and ankle musculature, and hip muscle activation on dynamic knee valgus motion during a
1974,32:77-97. double-legged squat. J Athl Train 2007, 42:S83.
6. Ehrman JK, Gordon PM, Visich PS, et al. Clinical Exercise Physiology. Champaign, IL: 26. Bell DR, Padua DA. Influence of ankle dorsiflexion range of motion and lower leg muscle
Human Kinetics, 2003. activation on knee valgus during a double-legged squat. J Athl Train 2007, 42:S84.
7. The President’s Challenge. Retrieved from: http://www.presidentschallenge.org/challenge/ 27. Goldbeck T, Davies GJ. Test-retest reliability of a closed kinetic chain upper extremity
physical/activities/index.shtml stability test: a clinical field test. J Sport Rehab 2000, 9:35-45.
NASM YOUTH EXERCISE SPECIALIST 33

CHAPTER 5: YOUTH FLEXIBILITY GUIDELINES

Learning Objectives the ability to move a joint through its complete range of
motion. This movement is either allowed, disallowed,
After completing this chapter, you will understand:
or hampered by the muscles surrounding it.
⦁⦁ General exercise guidelines for flexibility in youth.
Poor flexibility can lead to the development of relative
⦁⦁ Various flexibility options for youth. flexibility (or altered movement patterns), the process
⦁⦁ The rationale behind flexibility guidelines for in which the human movement system seeks the
youth. path of least resistance during functional movement
patterns (2). An example of relative flexibility is
Introduction children who squat with their feet externally rotated
(Figure 5.1). At a young age, this also may be observed as
This chapter explains the rationale behind youth a result of poor motor control or the child not knowing
flexibility training. It also outlines specific training how to properly perform the movement. However, over
guidelines for each flexibility training method. time these altered movement patterns may lead to
Childhood and adolescence are important times to muscle imbalances and potential injury. A youth’s body
establish proper movement patterns and habits. Not matures at different rates, and, during these phases
only are youth setting the stage for future health
behaviors, they also are growing and developing at
Figure 5.1 Child Squatting With Externally Rotated Feet
a rate faster than any other time in their lives. This
chapter provides health and fitness professionals with
guidelines for effective, fun, and safe youth flexibility
training programs.

Flexibility Training
Flexibility training is an important component of youth
physical fitness training. It serves several important
functions, including the maintenance of a full range of
motion for joints, reduced risk of injury, and improved
performance in many sporting events (1). Flexibility is
NASM YOUTH EXERCISE SPECIALIST 34

of growth, a child must adjust motor control. This Figure 5.3 SMR Gastrocnemius/Soleus
will help him or her learn how to apply new gains in
strength and effectively move a larger body.

General Guidelines
Researchers recommend that youth practice flexibility
training daily and stretch at the end of every resistance
training workout as a part of the cool-down period (3).
Flexibility training also is recommended following
cardiorespiratory exercise, because blood flow to
the muscle is high, and the muscle temperature is Figure 5.4 SMR Tensor Fascia Latae/Iliotibial Band
increasing from resting values.

The OPT™ model uses the integrated flexibility

continuum (Figure 5.2) to match certain flexibility
techniques to specific levels within the model. The
flexibility continuum consists of corrective, active,
and functional flexibility. Youth primarily perform
corrective and functional flexibility.
Figure 5.5 SMR Adductors
Figure 5.2 Integrated Flexibility Continuum

Figure 5.6 SMR Lattisimus Dorsi

Corrective Flexibility
Corrective flexibility includes self-myofascial release
(SMR) and static stretching. It increases joint range
of motion, improves muscle imbalances, and corrects
altered arthrokinematics. The best use of corrective
Figure 5.7 SMR Thoracic Spine
flexibility occurs in the stabilization level. Figures 5.3
through 5.12 are examples of self-myofascial release
and static stretching techniques that a health and
fitness professional can use with youth clients. See
Table 5.1 for corrective flexibility guidelines.
NASM YOUTH EXERCISE SPECIALIST 35

Figure 5.8 Static Gastrocnemius/Soleus Stretch Figure 5.11 Static Pectoralis Stretch

Figure 5.9 Static Kneeling Hip Flexor Stretch Figure 5.12 Static Ball Latissimus Dorsi Stretch

Figure 5.10 Static Standing Adductor Stretch

Table 5.1 Corrective Flexibility Guidelines

Technique Acute variables Coaching tips

Self-myofascial release ⦁⦁ 1-2 sets ⦁⦁ Find the tender spot.

⦁⦁ Maintain pressure for ⦁⦁ A little discomfort is okay.

minimum of 30 sec
⦁⦁ Roll and then stretch (static).
Static stretch ⦁⦁ 1-2 sets ⦁⦁ Use after foam rolling and after exercise.

⦁⦁ Hold each stretch 30 sec ⦁⦁ Avoid using before maximal effort and explosive activities.
NASM YOUTH EXERCISE SPECIALIST 36

Functional Flexibility Figure 5.16 Medicine Ball Lift and Chop

Functional flexibility uses dynamic stretching. It requires

movement without compensation through all three planes
of motion. Youth who are active typically practice this
type of stretching through their daily living. However, they
can also use it as part of a warm-up exercise (along with
corrective flexibility). Dynamic stretching mimics the
way youth move; therefore, it engages them. Figures 5.13
through 5.21 show examples of dynamic stretches that
can a health and fitness professional can use with youth
clients. See Table 5.2 for functional flexibility guidelines.
Figure 5.17 High Knee Step
Figure 5.13 Prisoner Squat

Figure 5.14 Side Squat Figure 5.18 Backwards Walking

Figure 5.15 Multiplanar Lunges Figure 5.19 Single-Leg Squat

NASM YOUTH EXERCISE SPECIALIST 37

Table 5.2 Functional Flexibility Guidelines

Technique Acute variables Coaching tips
Dynamic stretch ⦁⦁ 1 set ⦁⦁ Use as a warm-up before an activity.

⦁⦁ 10 repetitions ⦁⦁ Keep the exercises fun and progressive.

⦁⦁ 3-10 exercises ⦁⦁ Regress if unable to perform with proper form.

Figure 5.20 Pushup with Rotation Figure 5.21 Stability Ball Cobra

Summary
Flexibility is the ability to move a joint through its
full range of motion. Flexibility occurs positively
or negatively by the muscles surrounding it. Poor
facilitation by the surrounding muscles is poor
flexibility. As children mature, their bodies undergo
many changes. With these changes, it’s important
that they learn to fine-tune motor control so they can
effectively move their larger bodies. Health and fitness
professionals must be aware of this and remember
that the most important aspect of flexibility training
is movement. This occurs by maintaining mobility
through corrective and functional flexibility.

References
1. Mayo Clinic. Stretching: focus on flexibility. http://www.mayoclinic.com/health/
stretching/HQ01447. Updated February 23, 2011. Accessed October 5, 2011.
2. Gossman MR, Sahrman SA, Rose SJ. Review of length-associated changes in muscle:
experimental evidence and clinical implications. Phys Ther. 1982; 62: 1799–1808.
3. Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated
position statement paper from the National Strength and Conditioning Association. J
Strength Cond Res. 2009; 23 (4): 00-00.
NASM YOUTH EXERCISE SPECIALIST 38

CHAPTER 6: CARDIORESPIRATORY TRAINING FOR YOUTH

Learning Objectives General Guidelines for Cardiorespiratory

After completing this chapter, you will: Training for Youth
⦁⦁ Understand the rationale behind Any form of training must follow certain guidelines.
cardiorespiratory training for youth. These guidelines serve to quantify activity. For youth,
systematic programming is of prime importance. As
⦁⦁ Understand general cardiorespiratory training
mentioned earlier, youth today are prone to chronic
guidelines for youth.
disease more than ever before due to the increase
⦁⦁ Be able to develop fun cardiorespiratory of obesity.
training programs for youth.
The physiologic state of many of today’s youth makes
progression crucial, and it must be well monitored.
Introduction
Therefore, NASM recommends using the FITTE
With the rapid growth in childhood obesity today, principle to determine cardiorespiratory training
cardiorespiratory training has become important for programming. FITTE stands for frequency, intensity,
youth. Cardiorespiratory training can decrease the risk time, type, and enjoyment.
of youth obesity and type 2 diabetes as well as improve
mood and self-esteem (1-3) (Table 6.1). This chapter Frequency refers to the number of training sessions
reviews the basic guidelines for cardiorespiratory in a given time period, usually expressed as per week.
training for youth as well as unique ways to incorporate The CDC recommends that youth engage in a form of
cardiorespiratory exercise into a child’s fitness routine. aerobic exercises daily (4).

Intensity refers to the level of demand that a given

Table 6.1 Cardiorespiratory Training Benefits activity places on the body. It’s recommended that
⦁⦁ Decrease risk of youth obesity youth engage in moderately intense exercise daily or
vigorous intensity exercise 3 days per week (4). An easy
⦁⦁ Decrease risk of type 2 diabetes way to estimate if the activity is moderate or vigorous
⦁⦁ Improve mood in intensity is to rate the effort using the Ratings of
Perceived Exertion (RPE) scale from 6 (easy) to 20
⦁⦁ Improve self-esteem
(difficult). See Table 6.2 for a summary of the RPE
NASM YOUTH EXERCISE SPECIALIST 39

Table 6.2 The RPE Scale Cardiorespiratory exercise should begin with a
5‑to‑10‑minute warm-up period of stretching
Classification RPE (6–20 scale)
and dynamic movement and conclude with a
No exertion at all 6 5‑to‑10‑minute cool-down period of lower intensity
Extremely light 7-8 exercise and stretching.
Very light 9-10
Light 11-12 Integrating Cardiorespiratory Training
Somewhat hard 13-14 Into a Youth Program
Hard (heavy) 15-16 When designing a cardiorespiratory training program
for youth, creativity is important. Although traditional
Very hard 17-18
forms of cardiorespiratory training, such as treadmills,
Extremely hard 19 stationary bikes, and stair-climbers, are effective
Maximal exertion 20 in improving youth’s fitness levels, they can often
become boring. Any activity that raises one’s heart
rate to a certain level for an extended period of time is
scale. If placed into three categories, light activity
considered cardiorespiratory training; therefore, this
is categorized from 6 to 11, moderate from 12 to 14,
provides the health and fitness professional with a wide
and vigorous from 15 to 20. Another way to do this is
range of possibilities.
through the talk test, which involves engaging the youth
and gauging their response to your questions. Both of A useful way to integrate cardiorespiratory training
these methods are more thoroughly explained in the into a youth program is through circuit training with a
Fitness Assessment chapter. predetermined number of exercise stations. This allows
the health and fitness professional to incorporate a
Time refers to the length of time engaged in an range of exercises and activities into the routine while
activity or exercise training session and is typically constantly keeping the youth moving. The training can
expressed in minutes, with 60 minutes of daily activity be easily implemented working one-on-one with a child
recommended for youth (4). or in a small group. This section will provide examples
of different circuit training routines that will not only
Type refers to the mode or type of activity selected.
challenge stability, strength, power, and coordination,
For youth, it is important to choose a type of exercise
but improve cardiorespiratory fitness as well.
that is fun to keep them engaged. Although traditional
modes of training, such as a treadmill or stationary ■■ Body Weight Style Circuit
bike, can be used, implementing other unique
activities, such as circuit stations, games, and sport- For this circuit, each station consists of an exercise in
type drills will improve aerobic fitness while making which the resistance is simply the youth’s body weight.
the activity fun. This is covered in more detail later in This is an easy circuit to perform as it can be performed
this chapter. anywhere. The youth performs each exercise for 30
to 60 seconds depending on the fitness level. Once the
Enjoyment refers to the amount of pleasure derived allotted time frame passes, the client moves to the next
from engaging in a specific exercise or activity. As station until each station has been completed, resting
mentioned above, the more enjoyable the activity, afterward. This circuit is performed two or three times.
the better. Below is an example of a body weight circuit.
NASM YOUTH EXERCISE SPECIALIST 40

⦁⦁ Prisoner squats circuit. Below is an example of a functional movement-

⦁⦁ Push-ups style circuit.
⦁⦁ Jumping jacks ⦁⦁ Multiplanar lunges with reaches
⦁⦁ Mountain climbers ⦁⦁ Front-to-back jumping jacks
⦁⦁ Lunges ⦁⦁ Push-up with rotation
⦁⦁ Superman ⦁⦁ Squat to tubing rows
⦁⦁ Hurdle hops ⦁⦁ Single-leg medicine ball lift and chops
⦁⦁ Rest ⦁⦁ Hand walkovers
Refer to the exercise video library to view how these ⦁⦁ Power step-ups
exercises are performed.
⦁⦁ Rest
■■ Sport Performance Style Circuit Refer to the exercise video library to view how these
For this circuit, each station consists of a performance- exercises are performed.
type drill that challenges agility, quickness, coordination, These are just a few ideas for different types of circuits
and power. This circuit can be implemented the same way
that can be performed with youth. As mentioned
as the body weight circuit, only with different exercises.
earlier, be creative, and have fun with them.
The use of some equipment, such as a speed ladder, cones,
and hurdles, is also required in this style of circuit.
Summary
Below is an example of a sport performance style circuit.
Cardiorespiratory exercise helps prevent obesity;
⦁⦁ Squat jumps
improves blood lipid profile; reduces cardiovascular
⦁⦁ One-ins
disease risk; lowers the risk of developing type 2
⦁⦁ Side shuffles diabetes; and improves mood, self-esteem, and overall
⦁⦁ Box drill health. Each cardiorespiratory workout should contain
⦁⦁ Snake drill three phases: the warm-up, conditioning, and cool-
down. Cardiorespiratory training should follow the
⦁⦁ Hurdle hops
FITTE principle of frequency, intensity, time, type, and
⦁⦁ Box run steps
enjoyment as a guideline for development. Although
⦁⦁ Rest traditional forms of cardiorespiratory training, such
Refer to the exercise video library to view how these as treadmills, stationary bikes, and stair-climbers, are
exercises are performed. still effective in improving youth fitness levels, other
types of programming can be used. These include
■■ Functional Movement Circuit using body weight, sports performance, and functional
For this circuit, each station consists of exercises that movement circuits that keep youth moving throughout
are performed in all three planes of motion using total the training session. A training program should cater to
body exercises. This circuit is implemented the same the youth as an individual, but shouldn’t be mundane
way as the previous two circuits, only with different or boring, as this will cause loss of interest. Creativity
exercises. The use of equipment, such as a speed ladder is the key to creating fun and engaging programs that
or medicine balls, may also be required in this style of youth will enjoy and adhere to.
NASM YOUTH EXERCISE SPECIALIST 41

References
1. Centers for Disease Control and Prevention. Physical Activity for Everyone. Physical
Activity and Health. http://www.cdc.gov/physicalactivity/everyone/health/index.html.
Updated February 16, 2011. Accessed October 4, 2011.
2. Malina RM, Bouchard C, Bar-Or O. Growth, Maturation, and Physical Activity.
Champaign, IL: Human Kinestics, 2004.
3. Centers for Disease Control and Prevention. Physical Activity for Everyone. How
much physical activity do children need? http://www.cdc.gov/physicalactivity/
everyone/guidelines/children.html. Updated March 30, 2011. Accessed October 5, 2011.
4. Falk B, Tenenbaum G. The effectiveness of resistance training in children. A meta-
analysis. Sports Med 1996, 22:176-186.
NASM YOUTH EXERCISE SPECIALIST 42

CHAPTER 7: CORE AND BALANCE TRAINING GUIDELINES FOR YOUTH

Learning Objectives lower backs. However, this isn’t always the intention for
youth. Rather, core and balance training teaches them
After completing this chapter, you will:
basic reaction and motor skills they will use during their
⦁⦁ Understand the importance of core and balance lives. Because core and balance training go hand in hand,
training for youth. this chapter will discuss both.
⦁⦁ Be able to determine the appropriate core and
balance exercises according to the OPTTM model. Why Youth Need Core and
⦁⦁ Be able to design safe, effective, and fun core and Balance Training
balance training programs for youth.
The core is made of structures that make up the
lumbo-pelvic-hip complex (LPHC). This includes
Introduction the lumbar spine, pelvic girdle, abdomen, and hip
joint. For youth, the inclusion of exercises for the core
Core and balance training are fitness trends that
muscles is important for the development of balance
have become popular in recent years. They’re
and coordination (1).
common methods of training that health and fitness
professionals use. The objective of core training is to While growing, youth are learning to use their bodies
uniformly strengthen the deep and superficial muscles and developing habits – good or bad. In addition, having
that stabilize, align, and move the trunk of the body, a strong core aids youth in having proper posture and
especially the abdominals and muscles of the back. healthy spinal alignment. Studies show that core and
Balance training stresses an individual’s limit of balance training reduces the incidence of sports-related
stability, and is the key to all functional movements injuries in children and adolescents (1, 2). A weak
(running down a basketball court, exercising on a core is a fundamental problem that causes inefficient
stability ball, walking down stairs). movement and can lead to predictable patterns of injury
(3-6). This results in lack of stabilization and unwelcome
In the past, physical therapists prescribed core exercises motion of the spine and therefore, increases forces
for patients with lower-back problems. Today, core throughout the LPHC, resulting in low-back pain and
training is popular among all populations. Older clients injury (7). Teaching youth how to properly use their
take part in exercise programs that use core and balance cores will help their physical development, which will
training to flatten their midsections or strengthen their pay off later in life.
NASM YOUTH EXERCISE SPECIALIST 43

Balance training should stress the limit of stability (or Figure 7.1 Single-Leg Balance on an Unstable yet
balance threshold). The limit of stability is the distance Controlled Environment
outside of the base of support that individuals can move
into without losing control of their center of gravity.
A health and fitness professional should stress this
threshold in a multiplanar, proprioceptive (unstable
yet controlled) environment (Figure 7.1), which uses
functional movement patterns to improve dynamic
balance and neuromuscular efficiency. Training
functional movements in a proprioceptive environment
with appropriate progressions (floor, balance beam, half
foam roll, foam pad, balance disc), correct technique, and
Figure 7.2 The OPT Model for Core Training
at varying speeds facilitates maximal sensory input to the
central nervous system. This results in the selection of the
proper movement pattern. As youth grow and participate
in different sports, balance and neuromuscular efficiency
become important in preventing injury (1). Balance and
neuromuscular efficiency improve through repetitive
exposure to a variety of multisensory conditions (8, 9).

Levels of Core Training

The goal of core training is to develop optimal
levels of neuromuscular efficiency, intervertebral
and lumbopelvic stability, and functional strength.
There are three levels of training within the OPT Figure 7.3 Superman
model: stabilization, strength, and power. A proper
core training program follows the same systematic
progression (Figure 7.2).
⦁⦁ Core-stabilization training
⦁⦁ Core-strength training
⦁⦁ Core-power training

■■ Core-Stabilization Exercises
Core-stabilization exercises (Phase 1) involve little Figure 7.4 Prone Iso-Abs
motion through the spine and pelvis. The intent of these
exercises is to improve neuromuscular efficiency and
intervertebral stability. Their focus is on drawing in and
bracing. Examples of core stabilization exercises include
the Superman (Figure 7.3), prone iso-abs (Figure 7.4), and
a two-leg floor bridge (Figure 7.5).
NASM YOUTH EXERCISE SPECIALIST 44

■■ Core-Strength Exercises Figure 7.5 Two-Leg Floor Bridge

Core-strength exercises (Phases 2, 3, and 4) involve
more dynamic eccentric and concentric movements
of the spine throughout a full range of motion while
clients perform the activation techniques from the
core-stabilization training (drawing in and bracing).
Specificity, speed, and neural demands will progress in
this level.

Exercises include the rope climber (Figure 7.6),

stability ball crunch (Figure 7.7), and the medicine ball
give (Figure 7.8).

Figure 7.6 Rope Climber

Figure 7.8 Medicine Ball Give

Figure 7.7 Stability Ball Crunch

NASM YOUTH EXERCISE SPECIALIST 45

■■ Core-Power Exercises Levels of Balance Training

Core-power exercises (Phase 5) improve the rate of The three levels of balance training are similar to
force production of the core musculature. These forms the ones in core training (Figure 7.12). They are
of exercise prepare a client to dynamically stabilize stabilization, strength, and power progression. A
and generate force at more functionally applicable proper balance training program follows the same
speeds. Exercises include the medicine ball scoop systematic progression.
toss (Figure 7.9), medicine ball soccer throw (Figure
⦁⦁ Balance-stabilization training
7.10), and stability and medicine ball pullover throw
(Figure 7.11). Refer to the exercise video library for ⦁⦁ Balance-strength training
more examples of exercises. ⦁⦁ Balance-power training

Figure 7.9 Medicine Ball Scoop Toss Figure 7.12 The OPT Model for Balance Training

Figure 7.10 Medicine Ball Soccer Throw

A client can progress or regress through the three

levels by changing the surface, visual condition, and
body position or movement that an exercise requires.
Surfaces change in difficulty as a client moves from
stable surfaces (floor) to unstable surfaces (half foam
roll, foam pad, balance disc).

Closing the eyes or moving the contralateral limb

adds difficulty, as well as performing a cognitive task.
Standing on two legs versus a single leg simplifies
Figure 7.11 Medicine Ball Pullover Throw
the exercise.

■■ Balance-Stabilization Exercises
Balance-stabilization exercises involve little joint
motion. Instead, they improve reflexive (automatic)
joint stabilization contractions to increase joint
stability. During balance-stabilization training, the
body is placed in unstable environments, so it learns
NASM YOUTH EXERCISE SPECIALIST 46

to react by contracting the correct muscles at the ■■ Balance-Strength Exercises

right time to maintain balance. Exercises include the
Balance-strength exercises involve dynamic eccentric
single leg balance (Figure 7.13), single-leg lift and
and concentric movement of the balance leg, through
chop (Figure 7.14), and single-leg throw and catch
a full range of motion. Movements require dynamic
(Figure 7.15).
control in mid-range of motion, with isometric
stabilization at the end-range of motion. The
Figure 7. 13 Single Leg Balance specificity, speed, and neural demand of each exercise
will progress in this level. Strength exercises improve
the neuromuscular efficiency of the entire human
movement system. Exercises include the frontal plane
step-up to balance (Figure 7.16), single-leg touch down
(Figure 7.17), and lunge to balance (Figure 7.18).

Figure 7.16 Frontal Plane Step-Up to Balance

Figure 7.14 Single-Leg Lift and Chop

Table 7.17 Single-Leg Squat Touchdown

Figure 7.15 Single-Leg Throw and Catch

Figure 7.18 Lunge to Balance

NASM YOUTH EXERCISE SPECIALIST 47

■■ Balance-Power Exercises General Guidelines

Balance-power exercises develop a client’s ability to While there are no universally accepted guidelines
properly decelerate the body from a dynamic state to a for core exercise training in youth, clients generally
controlled, stationary position, as well as high levels of perform these exercises in combination with resistance
eccentric strength, dynamic neuromuscular efficiency, training. For this reason, it is recommended to practice
and reactive joint stabilization. Exercises include balance and core training a minimum of 2 or 3 days
the line hop with stabilization (Figure 7.19), leap frog each week. Both balance and core training exercises
(Figure 7.20), and hopscotch (Figure 7.21). Refer to the must be systematic and progressive.
exercise video library for more examples of exercises.
Health and fitness professionals should follow specific
program guidelines, proper exercise selection criteria,
and detailed program variables when incorporating
Figure 7.19 Line Hop with Stabilization
core and balance exercises into a youth program (Table
7.1). When selecting exercises, ask whether the exercise
is safe, progressive, and proprioceptively challenging,
as well as fun.

Examples of engaging exercise options that challenge

a youth’s core and balance abilities include children’s
yoga, pilates, balancing on one leg or doing exercises on
a BOSU ball, jumping jacks, crab soccer, beam walking,
seated exercises on a stability ball, or jumping on
a trampoline.
Figure 7.20 Leap Frog

Table 7.1. Balance Training Parameters

Is it safe?
Is it progressive?
⦁⦁ Easy  hard ⦁⦁ Two arms/legs  single
arm/leg
⦁⦁ Simple  complex
⦁⦁ Eyes open  eyes
⦁⦁ Stable  unstable closed
⦁⦁ Static  dynamic ⦁⦁ Known  unknown
Figure 7.21 Hopscotch (cognitive task)
⦁⦁ Slow  fast
Is it proprioceptively challenging?
⦁⦁ Floor ⦁⦁ Foam pad*

⦁⦁ Balance beam ⦁⦁ Balance disc*

⦁⦁ Half foam roll ⦁⦁ BOSU ball

*These modalities come in many shapes and sizes that will dictate
proper progression.
NASM YOUTH EXERCISE SPECIALIST 48

Safety Recommendations A sufficiently strong core is essential to successful

balance training. Core and balance training both follow
To reduce the risk of injury, qualified professionals
the three stages of progression: stability, strength,
should supervise youth during core and balance and power. Because there are no universally accepted
training. This is especially important during exercises guidelines, youth should engage in core and balance
where balance is compromised (e.g., BOSU ball, training 2 or 3 times per week along with the other
stability ball, balance beam) to decrease the risk components of an integrated fitness program.
of falling. In addition, core and balance training in
youth should begin using only the individual’s body
weight for resistance as this will decrease the risk of
References
1. Malliou P, Gioftsidou A, Pafis G, Beneka A, et al . Proprioceptive training (balance
overuse injuries. exercises) reduces lower extremity injuries in young soccer players. J Back
Musculoskelet 2004; 17 (3-4): 101-104.
2. Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated
position statement paper from the National Strength and Conditioning Association. J
Summary Strength Cond Res. 2009; 23 (4): 00-00.
3. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine
Today, core and balance training are popular fitness associated with low back pain. A motor control evaluation of transversus abdominis.
Spine. 1996; 21: 2640-2650.
trends widely used by health and fitness professionals. 4. Ferreira PH, Ferreira ML, Hodges PW. Changes in recruitment of the abdominal
muscles in people with low back pain: ultrasound measurement of muscle activity.
Core and balance training teaches youth basic Spine. 2004; 29: 2560-66.
reaction and motor skills they will use throughout 5. Hodges PW, Richardson CA. Neuromotor dysfunction of the trunk musculature in
low back pain patients. In: Proceedings of the International Congress of the World
life. Core training strengthens the muscles that Confederation of Physical Therapists. Washington, D.C.; 1995.
stabilize the spine and generates the stabilization 6. Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with
movement of the lower limb. Phys Ther. 1997; 77: 132-134.
required for everyday movement. Balance training 7 Janda V. Muscle weakness and inhibition (pseudoparesis) in back pain syndromes. In:
stresses the limits of stability and is a key to all Grieve GP, ed. Modern Manual Therapy of the Vertebral Column. New York: Churchill
Livingstone, 1986: 197-201.
functional movements. 8. Lephart SM. Re-establishing Proprioception, Kinesthesia, Joint Position Sense,
and Neuromuscular Control in Rehabilitation. In: Prentice WE, ed. Rehabilitation
Techniques in Sports. 2nd ed. St. Louis: Mosby; 1993. 118-137.
It is important that youth properly learn to use
9. Guskiewicz KM, Perrin DM. Research and clinical applications of assessing balance.
both methods of training, as they go hand in hand. J Sport Rehabil. 1996; 5: 45-63.
NASM YOUTH EXERCISE SPECIALIST 49

CHAPTER 8: PLYOMETRIC, SPEED, AGILITY,

AND QUICKNESS TRAINING FOR YOUTH

Learning Objectives contraction (2). This is the essence of a plyometric

exercise and uses a characteristic of muscle known as
After completing this chapter, you will:
the stretch-shortening cycle.
⦁⦁ Understand the importance of plyometric and
Enhanced performance during functional activities
speed, agility, and quickness training (SAQ)
emphasizes the ability of muscles to exert maximal
for youth.
force output in a minimal amount of time, also known
⦁⦁ Be able to determine the appropriate exercises as rate of force production. Success in everyday
to incorporate into a youth program based on activities and sports depends on the speed at which
the OPT™ model. muscular force is generated. Speed of movement and
⦁⦁ Be able to design safe, effective, and fun reactive neuromuscular control are a function of
plyometric and SAQ programs for youth. muscular development and neural control; the first is a
function of training and the other of learning. The key
Introduction is muscular overload and rapid movements during the
execution of the training exercises.
Plyometric training, also known as jump or reactive
training, is exercise that uses explosive movements such The early years of life are the best time to expose
as bounding, hopping, and jumping to develop muscular children to the movements required by plyometric
power. Speed, agility, and quickness (SAQ) training is a training. While growing, their bodies undergo a
similar type of training that allows youth to enhance their multitude of changes that require them to adapt and
ability to change speed and direction of movement, as adjust. These formative years are possibly the best
well as appropriately react to all given stimuli. Both are time for youth to learn the motor skills associated with
important while youth are growing since they set the stage jumping, hopping, sprinting, and throwing — all of
for future development and aid in injury prevention (1). which can be improved through plyometric training (1).
This form of training also helps to strengthen bone and
■■ What is Plyometric Training? connective tissue and decrease the risk of injuries (3).

Plyometric training include exercises that generate Myths concerning youth and plyometric training
quick, powerful movements involving a rapid eccentric involve safety and development (3). Damaging the
contraction followed by an explosive concentric growth plates in bone at a young age is cited as a reason
NASM YOUTH EXERCISE SPECIALIST 50

to stay away from these forms of training. No study has Table 8.1 Three Questions for Plyometric
shown damage to a youth’s growth plate as a result of Exercise Selection
plyometric training (3). ⦁⦁ Is it safe?
Further, one study shows that youth plyometric training ⦁⦁ Is it progressive? (Difficulty level)
combined with resistance training is more beneficial ⦁⦁ Is it fun? And if not, how can I make it fun?
than just resistance training and static stretching for
enhancing upper and lower body power (4).
Figure 8.1 The OPT Model for Plyometric Training
■■ Fun Factor
The health and fitness professional should ask three
questions when developing a plyometric exercise
routine for youth (Table 8.1). Exercises can be modified
to be more or less challenging, or to further engage the
client. Ultimately, it comes down to the understanding
of plyometric exercise and the imagination of the
health and fitness professional to keep the workouts
safe, challenging, and fun. The appropriate progression
needs to be used to ensure the safety of this form of
exercise with youth.
Figure 8.2 Squat Jump with Stabilization
Levels of Plyometric Training
When designing a plyometric training program, the OPT
model should be used as a guide (Figure 8.1). Just like the
model, plyometric training exercises contain three levels
of training in a progressive manner (see Figure 8.1).
⦁⦁ Plyometric-stabilization training
⦁⦁ Plyometric-strength training
⦁⦁ Plyometric-power training.

■■ Plyometric-Stabilization Training
Plyometric-stabilization exercises (Phase 1) are Figure 8.3 Box Jump-Up with Stabilization
designed to establish optimal landing mechanics,
postural alignment, and reactive neuromuscular
efficiency (coordination during dynamic movement).

When clients land during these exercises, they

should hold the landing position (or stabilize) for
3 to 5 seconds. During this time they should be
encouraged to make any adjustments necessary to
correct faulty postures before repeating the exercise.
Example exercises include the following: squat jump
NASM YOUTH EXERCISE SPECIALIST 51

with stabilization (Figure 8.2), box jump-up with Figure 8.6 Repeat Squat Jumps
stabilization (Figure 8.3), line jumps with stabilization:
frontal (Figure 8.4), and leapfrog (Figure 8.5)

■■ Plyometric-Strength Training
Plyometric-strength exercises (Phases 2, 3 and 4)
involve more dynamic eccentric and concentric
movement through a full range of motion. These
exercises are intended to improve dynamic joint
stabilization, eccentric strength, rate of force
production, and neuromuscular efficiency of the entire
human movement system. Figure 8.7 Box Run Steps

Clients perform them in a repetitive fashion (spending

a relatively short amount of time on the ground before
repeating the drill). Example exercises include the
following: repeat squat jumps (Figure 8.6), box run
steps (Figure 8.7), power step-up (Figure 8.8), and
repeat lunge jumps (Figure 8.9)

Figure 8.4 Line Jumps with Stabilization: Frontal Figure 8.8 Power Step-Up

Figure 8.5 Leapfrog Figure 8.9 Repeat Lunge Jumps

NASM YOUTH EXERCISE SPECIALIST 52

■■ Plyometric-Power Training Speed, Agility, Quickness Training

Plyometric-power exercises (Phase 5) are designed to SAQ training is similar to plyometric training in which
further improve the rate of force production, eccentric the individual responds to the ground surface’s reaction
strength, reactive strength, reactive joint stabilization, forces. Speed refers to the speed or velocity of distance
dynamic neuromuscular efficiency, and optimal force covered, divided by time (i.e., straight ahead speed).
production (9, 10). Agility refers to short bursts of movement that involve a
change of movement direction, cadence, or speed. And
These exercises are performed as fast and as explosively
quickness refers to the ability to react to a stimulus and
as possible. Example exercises include the following:
appropriately change the motion of the body.
proprioceptive jumps: Z pattern  (Figure 8.10),
proprioceptive jumps: square pattern (Figure 8.11), and For youth, SAQ training effectively provides exposure
repeating line jumps: sagittal (Figure 8.12) to physiological, neuromuscular, and biomechanical
demands, resulting in the further development of
physical ability and potentially decreasing the risk
of injury. It allows youth to enhance their ability to
Figure 8.10 Proprioceptive Jumps: Z Pattern accelerate, decelerate, and dynamically stabilize their
entire body during higher velocity acceleration and
deceleration movements in all planes of motion, such
as running, cutting, and changing direction.

The majority of youth today spend little if any time

performing generalized, unstructured physical activity
(playtime) that would facilitate the development
of SAQ skills (5). SAQ programs for youth decrease
the likelihood of athletic injury (11–14), increase the
likelihood of exercise participation later in life (15,16),
and improve physical fitness (17,18).

Figure 8.11 Proprioceptive Jumps: Square Pattern Figure 8.12 Repeating Line Jumps: Sagittal
NASM YOUTH EXERCISE SPECIALIST 53

_______________________________________
■■ Example SAQ Drills for Youth Cone Drills 
_
SAQ drills should be performed as fast as possible
without losing proper form, or taking a faulty step. Figure 8.17 Five-Ten-Five Drill
Exercises can be progressed by speeding them up, or
regressed by slowing them down. Examples of SAQ
drills and games follow.

Speed Ladder Drills  _ _____________________________

Figure 8.13 One-Ins Figure 8.14 Two-Ins

Figure 8.18 Box Drill

Figure 8.15 Side Shuffle

Figure 8.19 T-Drill

Figure 8.16 In-In-Out-Out
NASM YOUTH EXERCISE SPECIALIST 54

Figure 8.20 Snake Drill Figure 8.21 Follow the Snake

Game: Red Light, Green Light

1. Participants line up shoulder-to-shoulder along
the base of a designated field that is a minimum of 20
yards long.
2. One participant is chosen as the “stoplight” and
begins at the opposite end of the field. Safety
3. The stoplight turns his or her back to the other Youth clients should possess adequate core strength,
participants and calls “green light.” joint stability, and range of motion, and have the ability
4. Upon calling green light, the participants all move as to balance efficiently before performing plyometric
quickly as possible toward the stoplight. or SAQ exercises. Plyometric training should only be
performed while wearing supportive shoes, and on a
5. Still with his or her back to the group, the stoplight
proper training surface such as a grass field, basketball
yells “red light!” and then immediately turns around.
court, or rubberized surface.
6. Upon hearing red light, the participants stop
movement and remain motionless.
Summary
7. If the stoplight sees anyone move, he or she calls
them to start over at the base of the field. Plyometric training, or reactive training, uses
explosive movements such as bounding, hopping,
8. This is repeated at arbitrary intervals until a
and jumping to develop muscular power. In a similar
participant is able to reach and touch the stoplight.
manner, SAQ training uses ground reaction forces to
9. This participant then becomes the stoplight. train speed, agility, and quickness and is an effective
way of providing exposures to various physiologic,
Game: Follow the Snake (Figure 8.21)
neuromuscular, and biomechanical demands, with the
1. The instructor or trainer lays 5-10 jump ropes or one end result of further development of physical ability.
long rope on the ground in a random S-type pattern.
These formative years may be the best time for youth
2. Participants line up on one side of the ropes.
to learn these movements, enhancing the motor skills
Keeping a foot on each side of the rope, they follow the
associated with jumping, hopping, sprinting, and
pattern of the rope first forward to the end, and then
throwing. When selecting exercise, the health and
backward to the beginning.
fitness professional should ask three questions about
Participants can be timed to create a competition. the exercise. Is it safe? Is it progressive? And is it fun?
NASM YOUTH EXERCISE SPECIALIST 55

References 8. Olsen OE, Myklebust G, Engebretsen L,et al. Exercises to prevent lower limb
injuries in youth sports: cluster randomised control group. BMJ. 2005;330:449.
1. Chu DA. Plyometric Training for Youth. http://www.donchu.com/articles/
article7/. 2004. Accessed November 8, 2011. 9. Ortega FB, Ruiz JR, Castillo MJ, et al. Physical fitness in childhood and
adolescence: a powerful marker of health. Int J Obes (Lond.) 2008;32:1-11.
2. Chu DA. Jumping into Plyometrics. 2nd ed. Champaign, IL: Human
Kinetics; 1998. 10. Wrotniak BH, Epstein LH, Dorn JM, et al. The relationship between motor
proficiency and physical activity in children. Pediatrics. 2006;118(6):e1758-1765.
3.Faigenbaum AD. Plyometrics for Kids: Facts and Fallacies. NSCA’s Performance
Training Journal. 2006;5(2):13-16. 11. Janz K, Dawson J, Mahoney L. Increases in physical fitness during childhood
4. Faigenbaum A, McFarland J, Hoffman J, et al. Effects of a short-term plyometric improve cardiovascular health during adolescence: the Muscatine Study. Int J
and resistance training program on fitness performance in boys age 12 to 15 years. Sports Med. 2002;23(Suppl 1):15-21.
Journal of Sports Science & Medicine. December 2007;6(4):519-525. 12. Balciunas M, Stonkus S, Abrantes C, et al. Long term effects of different training
5. Sokolove M. Warrior Girls. New York, NY: Simon & Schuster; 2008. modalities on power, speed, skill, and anaerobic capacity in young male basketball
6. Drabik J. Children and Sports Training. Island Pond, VT: Stadion players. J Sports Sci Med. 2006;5:163-170.
Publishing; 1996. 13. Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, et al. Relations of total physical activity
7. Etty Griffin LY. Neuromuscular training and injury prevention in sports. Clin and intensity to fitness and fatness in children: the European Youth Heart Study.
Orthop Relat Res. 2003;409:53-60. Am J Clin Nutr. 2006;84(2):299-303.
NASM YOUTH EXERCISE SPECIALIST 56

CHAPTER 9: RESISTANCE TRAINING FOR YOUTH

Learning Objectives increase their strength by as much as 30-74% (1). In

addition to gains in strength, resistance training has
After completing this chapter, you will:
numerous other benefits for youth, including positive
⦁⦁ Understand the benefits of youth resistance effects on gross motor skills (sprinting and jumping),
training. positive changes in body composition, improved
⦁⦁ Dispel myths about the safety of youth engaging bone mineral density, improved psychosocial well-
in resistance training. being, decreased risk for cardiovascular disease,
and decreased injury rates (Table 9.1) (1, 2, 3). Youth
⦁⦁ Understand general resistance training
resistance training yields fewer injuries compared
guidelines for youth.
with popular sports such as soccer, football and
⦁⦁ Be able to design and implement a safe, basketball (4). Furthermore, resistance training in the
effective, and progressive resistance training 5-to-14-year-old age group has been associated with a
program for youth. decreased number of common injuries (5).

Introduction While researchers have noted injuries to the growth

plates (the area at the ends of bones that continues
Youth resistance training has been met with some
to grow and mature through puberty), most of the
controversy over the years. However, research shows
injuries were in adolescents who trained with
that youth resistance training, when performed
improper technique and too much, or near maximal,
correctly, is both safe and effective in improving
resistance (6, 7, 8). However, injury to the growth
strength and overall function. This chapter reviews the
plates rarely affects normal growth, and if resistance
benefits of resistance training for youth, programming
training is performed less than 15 hours per week using
options, and how to apply resistance training exercises
moderate intensity, growth is not affected (9, 10).
using the OPTTM model.
Table 9.1 Benefits of Resistance Training for Youth
Myths and Benefits Positive effects on:
Youth resistance training is a controversial topic. ⦁⦁ Gross motor skills ⦁⦁ Psychosocial well-being
However, researchers have found that when performed ⦁⦁ Body composition ⦁⦁ Cardiovascular disease risk
properly with supervision, it is both beneficial and
safe for youth (1, 2, 3). Research shows that youth can ⦁⦁ Bone mineral density ⦁⦁ Resistance to injury
NASM YOUTH EXERCISE SPECIALIST 57

General Resistance Training Guidelines effective include the use of tubing, medicine balls, ropes,
sandbags, and even body weight. All of these forms of
Experts recommend that youth participate in resistance
resistance are easy to transport, can be used with a small
training 2 to 3 days each week with at least 1 rest day
group of children, and are less intimidating.
between each session (11, 12). It is important to include
exercises that stress both the upper and lower body Creativity is the only self-limiting factor in developing a
as well as the core muscles (abdominals and lower resistance training program for youth. If the health and
back). Researchers also recommend 1 to 3 sets of 6 to 15 fitness professional stays creative, the resistance training
repetitions for general muscle strength and endurance. program provides an engaging challenge for youth.
For exercises to develop power, they recommend 1 to 3 sets
of 3 to 6 repetitions (Table 9.2) (1). Finally, the resistance Youth Resistance Training and
should be increased at appropriate levels for youth. As
the OPT Model
strength improves, it is recommended to increase the load
5-10% to ensure a safe, gradual progression (1). As mentioned in the core, balance, and plyometric
chapters, proper progression is paramount when
It is also important to implement a proper warm-up designing a youth training program. Like those program
of 5 to 10 minutes using static stretching and dynamic components, resistance training follows the same
movements (e.g., calisthenics and core, balance, and progressions in the OPT model (Figure 9.1). The level of
plyometric exercises) prior to engaging in resistance OPT model the youth is working in determines which
training. A proper cool-down of static stretching also types of resistance training exercises are appropriate.
should be implemented post-resistance training. For example, the stabilization level of training includes
stabilization-specific exercises. The strength level
Exercise selection and implementation are key when
includes strength-specific exercises. And the power level
creating a resistance training program for youth. Keep includes power-specific exercises. The remainder of this
youth engaged by varying the programs from session chapter will discuss these categories of exercises further.
to session. Performing the exercises in a circuit-
type routine keeps the client moving and makes the Table 9.2 Resistance Training General Guidelines
program more fun. For example, the health and fitness
professional can time the sets (30 to 45 seconds) and Sets Reps Intensity Recovery
have the client count how many repetitions have been Stability 1-3 12-15 Low 0-30 sec
completed within that timeframe. This helps the client Strength 1-3 6-15 Moderate 30-90 sec
set goals and improve that number during the next
Power 1-3 3-6 High 1.5 sec-3 min
session versus simply counting a certain number of
repetitions and moving to the next exercise.
Figure 9.1 The OPT Model

Alternative Forms of Resistance

Resistance training shouldn’t be limited to dumbbells,
barbells, plates, and machines. These forms of
resistance, although effective when applied properly
and with supervision, are limiting and potentially
intimidating for youth clients. Also, these traditional
forms of resistance usually are located in areas of
the gym where children may not feel comfortable.
Alternative sources of resistance that are just as
NASM YOUTH EXERCISE SPECIALIST 58

Stabilization Exercises Figure 9.5 Legs: Lunge to Balance

Eliciting stabilization adaptations is the starting point
for youth who are new to resistance training. Resistance
training exercises at this level are performed in unstable,
yet controllable environments. This helps to improve
strength through the prime movers and also engages
other muscles throughout the chain to stabilize their
overall structure. It provides the foundation to their
structure so they can handle more intense exercises
as they progress. Figures 9.2 to 9.6 provide examples
of stabilization-oriented resistance training exercises
for youth. Refer to the exercise video library for more
stabilization-oriented resistance training exercises.
Figure 9.6 Total Body: Sagittal Plane Step-Up, Balance,
Curl to Overhead Press
Figure 9.2 Shoulders: Seated Ball Overhead Press

Figure 9.3 Chest: Push Up

Figure 9.4 Back: Single-Leg Tubing Row

NASM YOUTH EXERCISE SPECIALIST 59

Strength Exercises Figure 9.10 Shoulders: Seated Dumbbell Overhead Press

Once they have developed ample amounts of stability,
youth clients can progress to strength-oriented resistance
training exercises. At this level, the exercises are
performed in a more stable environment to focus more on
prime mover strength. Youth can handle slightly heavier
loads at this level and when training in this more stable
environment. Figures 9.7 to 9.11 provide examples of
strength-oriented resistance training exercises for youth.

Figure 9.7 Total Body: Medicine Ball Squat to

Overhead Press Figure 9.11 Legs: Dumbbell Squat

Figure 9.8 Chest: Staggered Stance Tubing Chest Press

Figure 9.9 Back: Seated Tubing Row

NASM YOUTH EXERCISE SPECIALIST 60

Power Exercises but help all youth to improve motor skills, expend
calories, and strengthen tissue and bone. Most of these
Once youth are both stable and strong, they can
exercises involve throwing or tossing implements, such
progress to power-oriented exercises. Power is the
as a medicine ball, as well as jumping. Figures 9.12 to
ability of the neuromuscular system to produce the
9.16 provide examples of power-oriented exercises
greatest possible force in the shortest possible time.
for youth. Refer to the exercise video library for more
Therefore, the exercises performed at this level
power-oriented resistance training exercises.
are done in a faster, more explosive manner. These
exercises are especially effective for youth athletes,
Summary
Figure 9.12 Total Body: Speed Squat to Overhead Press Performed with proper supervision and progression,
resistance training is a safe and effective way to for
children to improve strength, motor skills, enhance
overall performance, and decrease the risk of injuries.
Following a progressive approach as seen in the OPT
model provides the health and fitness professional with
a structured process to safely progress youth to their
goals. As a health and fitness professional, creativity
is key. Making the routines fresh and fun will keep the
children engaged throughout the program and want to
make exercise an important part of their lives.

Figure 9.13 Chest: Medicine Ball Chest Pass Figure 9.15 Shoulders: Medicine Ball Oblique Throw

FIgure 9.14 Back: Medicine Ball Soccer Throw Figure 9.16 Legs: Squat Jump
NASM YOUTH EXERCISE SPECIALIST 61

References 7. Brady TA, Cahill BR, Bodnar LM. Weight training-related injuries in the high school
athlete. Am J Sports Med. 1982; 1: 1-5.
1. Faigenbaum AD, Kraemer WJ, BlimkieCJR, et al. Youth resistance training: updated
position statement paper from the National Strength and Conditioning Association. J 8. Haff GG. Roundtable discussion: youth resistance training. Strength CondJ. 2003; 25
Strength Cond Res. 2009; 23 (4): 00-00. (1): 49-64.

2. Falk B, Tenenbaum G. The effectiveness of resistance training in children. A meta- 9. Demorest RA, Landry GL. Training issues in elite young athletes. Curr Sports Med
analysis. Sports Med. 1996; 22: 176-86. Rep. 2004; 3 (3): 167-172.
3. Payne V, Morrow J, Johnson L. Resistance training in children and youth: a meta- 10. Ramsey JA, Blimkie CJ, Garner S, et al. Strength training effects in prepubescent
analysis. Res Q Exerc Sport. 1997; 68: 80-89. boys.Med Sci Sports Exerc. 1990; 22: 605-614.
4. Hamill BP. Relative safety of weightlifting and weight training. J Strength Cond Res. 11. Mayo Clinic. Stretching: focus on flexibility. http://www.mayoclinic.com/health/
1994; 8 (1): 53-57. stretching/HQ01447. Updated February 23, 2011. Accessed October 5, 2011.
5. Jones CS, Christensen C, Young M. Weight training injury trends. A 20 year survey. 12.Centers for Disease Control and Prevention. Physical Activity for Everyone. How
PhysSportsmed. 2000; 7: 61-72. much physical activity do children need? http://www.cdc.gov/physicalactivity/
6. Benton JW. Epiphyseal plate fractures in sports. Physician Sports Med. 1983; 10: 63-71. everyone/guidelines/children.html. Updated March 30, 2011. Accessed October 5, 2011.
NASM YOUTH EXERCISE SPECIALIST 62

CHAPTER 10: INTEGRATED PROGRAM DESIGN FOR YOUTH CLIENTS

Learning Objectives Figure 10.1 The OPT Model

After completing this chapter, you will:

⦁⦁ Understand the basic levels and phases of the
Optimum Performance Training™ (OPT™)
model that health and fitness professionals
primarily use when training youth.
⦁⦁ Be able to define cardiorespiratory stage
training, the principles behind each stage, and
how each stage fits into the OPT model.
⦁⦁ Be able to use the ratings of perceived exertion
(RPE) method, and understand the Borg scale.
⦁⦁ Be able to correlate circuit training with
cardiorespiratory training.

Introduction NASM designed the OPT model as a systematic,

periodized, training program. Its design allows a client
The comprehensive youth assessment process provides
to simultaneously improve all functional abilities
a wealth of valuable information concerning a client’s
such as flexibility, core stabilization, balance, power,
goals, needs, and abilities. To be safe, effective, and
strength, and cardiorespiratory endurance. Health
productive, this information is best when in a practical
and fitness professionals can help a client achieve this
programming system.
if they construct the client’s workout to include the
This chapter discusses proper use of acute variables components shown in Figure 10.2. (Also refer to the
(repetitions, sets), scientific concepts, progressive programming manualthat accompanies this course.)
exercises, and specific health and safety guidelines The OPT model proves to be extremely successful
for youth clients. The OPT model will provide all of in helping all populations reduce body fat, increase
this information to the health and fitness professional lean muscle mass and/or strength, and improve
(Figure 10.1). overall health.
NASM YOUTH EXERCISE SPECIALIST 63

Figure 10.2 The OPT Workout Template

Professional’s name:
Client’s name: Date:
Goal: Phase:
Warm-up
Exercise Sets Duration Coaching tip

Core/Balance/Plyometric
Exercise Sets Reps Tempo Rest Coaching tip

Speed/Agility/Quickness
Exercise Sets Reps Tempo Rest Coaching tip

Resistance
Exercise Sets Reps Tempo Rest Coaching tip

Cool-down
Exercise Sets Duration Coaching tip

Coaching tips:
NASM YOUTH EXERCISE SPECIALIST 64

The OPT Model The stabilization level of training in the OPT model
consists of a single phase of training — Stabilization
The OPT model consists of three main levels of training.
Endurance Training (Phase 1). See Table 10.1 for acute
These include stabilization, strength, and power. Within
variables within this phase.
each of these levels are specific phases of training that
elicit a specific adaptation. Five total phases exist, but for ■■ The Strength Level
youth clients primarily use the first two phases.
The second level of training, the strength level of
Sometimes a health and fitness professional will the OPT model, focuses on the main adaptation of
encounter a youth client who is adept at progression, strength. It includes three phases of training: Strength
or one who is more mature with exceptional dynamic
Endurance Training (Phase 2), Hypertrophy Training
postural control. These clients may also train in the
(Phase 3), and Maximal Strength Training (Phase 4).
higher phases of the OPT model, such as power training.
The strength level and its phases increase the amount
Often, these clients are athletes that excel at their
of stress on the body. It is a necessary progression
respective sports.
from stabilization for anyone who desires to increase
A health and fitness professional may use power training caloric expenditure, muscle size, muscle strength and/
for a general youth client. However, that’s only under or bone mineral density. The strength level focuses on
the assumption that they have progressed through the the following principles:
stabilization and strength levels of training. Discussion ⦁⦁ Increased ability of the core musculature to
of this scenario will occur later in the course. stabilize the pelvis and spine under heavier
loads and through more complete ranges
■■ The Stabilization Level of motion.
The first level of training in the OPT model focuses ⦁⦁ Increased load-bearing capabilities of muscles,
on the main anatomical adaptation of stabilization. tendons, ligaments, and joints.
Its design prepares a client’s body for the demands
⦁⦁ Increased volume of training with more reps,
of the higher levels of training that will follow and/or
sets, and intensity.
increases the current level of postural stability. This
level is crucial for a youth client because it provides the ⦁⦁ Increased metabolic demand by taxing the
appropriate intensity of training to establish proper ATP/CP and glycolysis energy systems to
exercise technique. By training in this level, youth induce cellular changes in muscle (weight loss
greatly increase their neuromuscular coordination. The and/or hypertrophy).
stabilization level focuses on the following: ⦁⦁ Increased motor unit recruitment, frequency
⦁⦁ Increased stability. of motor unit recruitment, and motor unit
synchronization (maximal strength).
⦁⦁ Increased muscular endurance.
⦁⦁ Increased neuromuscular efficiency of the core A health and fitness professional can use the
musculature. Hypertrophy and Maximal Strength Training Phases,
but the typical youth client will predominantly train
⦁⦁ Improved inter and intramuscular
in Phase 2 (Table 10.2). The Hypertrophy Training
coordination.
Phase is for individuals who have a goal of maximal
⦁⦁ Improved overall cardiorespiratory and muscle growth, and the Maximal Strength Training
neuromuscular condition. Phase maximizes prime mover strength by lifting heavy
⦁⦁ Proper movement patterns and exercise loads. However, most youth will not need to train in
technique. these phases.
NASM YOUTH EXERCISE SPECIALIST 65

Table 10.1 Stabilization Endurance Training — Acute Variables

Reps Sets Tempo Intensity Rest interval Frequency Duration Exercise selection
Flexibility 1 1-3 30 sec N/A N/A 3-7 times/ 4-6 SMR and static
hold week weeks
Core 12-20 1-4 Slow 4/2/1 N/A 0-90 sec 2-4 times/ 4-6 1-4 core
week weeks stabilization
Balance 12-20 1-3 Slow 4/2/1 N/A 0-90 sec 2-4 times/ 4-6 1-4 balance
week weeks stabilization
6-10 (SL)
Plyometric 5-8 1-3 3-5 sec N/A 0-90 sec 2-4 times/ 4-6 0-2 plyometric
hold week weeks stabilization
SAQ 2-3 1-2 Moderate N/A 0-90 sec 2-4 times/ 4-6 4-6 drills with
week weeks limited horizontal
inertia and
unpredictability
Resistance 12-20 1-3 Slow 4/2/1 50-70% 0-90 sec 2-4 times/ 4-6 1-2 stabilization
week weeks progression
Repetitions may be adjusted to 8-10 for those with arthritis. Repetition tempos may be adjusted to 4/1/1 or 4/0/1 or 3/0/1 for those with hypertension
or CAD.
N/A = not applicable; SL = single leg

Table 10.2 Strength Endurance Training — Acute Variables

Reps Sets Tempo Intensity Rest interval Frequency Duration Exercise selection
Flexibility 5-10 1-2 1-2 sec. N/A N/A 3-7 times/ 4 weeks SMR and active
hold week
Core 8-12 2-3 Medium N/A 0-60 sec 2-4 times/ 4 weeks 1-3 core strength
week
Balance 8-12 2-3 Medium N/A 0-60 sec 2-4 times/ 4 weeks 1-3 balance
week strength
Plyometric 8-10 2-3 Repeating N/A 0-60 sec 2-4 times/ 4 weeks 1-3 plyometric
week strength
SAQ 3-5 3-4 Fast N/A 0-60 sec 2-4 times/ 4 weeks 6-8 drills allowing
week greater horizontal
inertia, but limited
unpredictability
Resistance 8-12 2-4 Str 2/0/2 70-80% 0-60 sec 2-4 times/ 4 weeks 1 strength superset
week with 1 stabilization
Sta 4/2/1
Each resistance training exercise is a superset of a strength level exercise immediately followed by a stabilization level exercise.
Str = strength; Sta = stabilization
NASM YOUTH EXERCISE SPECIALIST 66

For the youth population, flexibility and core and (P = F × V). Therefore, any increase in either force or
balance training are paramount in helping to establish velocity produces an increase in power. This occurs by
proper neuromuscular coordination. Self-myofascial increasing the load (or force), as in progressive strength
release, static, active, and dynamic stretching are training, or by increasing the speed by which you move
appropriate for this population if a client has sufficient a load (or velocity). The combination produces a better
ability to perform the necessary movements. rate of force in daily activities and sporting events.

Just like the stabilization level, the power level has one
■■ The Power Level
phase, which is Phase 5: Power Training (Table 10.3).
The third level of the OPT model is the power level. Remember, this phase is typically for youth who are
This level emphasizes the development of speed athletes or have mature and exceptional dynamic
and power. The premise behind this phase is the postural control. However, a health and fitness
execution of a traditional strength exercise superset professional can use this phase and its power-type
with a power exercise of similar joint dynamics. This exercises to shake up a youth’s workout. Knowing
enhances prime mover strength while also improving that most youth jump and run, power training may
the rate of force production. Power training is not a be appropriate for all youth clients. That’s only with
common practice in the fitness environment, but has the assumption that they’ve progressed through the
a very viable and purposeful place in a well-planned stabilization and strength levels of the OPT model. No
training program. Power is force multiplied by velocity matter the youth client, they need physician approval

Table 10.3 Power Training — Acute Variables

Reps Sets Tempo Intensity Rest interval Frequency Duration Exercise selection
Flexibility 10-15 1-2 Controlled N/A N/A 3-7 times/ 4 weeks SMR and dynamic
week 3-10 exercises
Core 8-12 2-3 X/X/X N/A 0-60 sec 2-4 times/ 4 weeks 0-2 core power
week
Balance 8-12 2-3 Medium N/A 0-60 sec 2-4 times/ 4 weeks 0-2 balance power
week
Plyometric 8-12 2-3 X/X/X N/A 0-60 sec 2-4 times/ 4 weeks 0-2 plyometric
week power
SAQ 3-5 3-4 X/X/X N/A 0-90 sec 2-4 times/ 4 weeks 6-10 drills allowing
week maximal horizontal
inertia, but limited
unpredictability
Resistance 1-5 (S) 2-4 X/X/X 85-100% (S) 1-2 min 2-4 times/ 4 weeks 1 strength superset
between week with 1 power
8-10 (P) 1-3 X/X/X Up to pairs; 3-5 min
10%BW or between
30-45% of circuits
1RM (P)
Each resistance training exercise is a superset of a strength level exercise immediately followed by a stabilization level exercise.
S = strength; P = power
NASM YOUTH EXERCISE SPECIALIST 67

before undergoing power training. The range of use the FITTE principle, which stands for frequency,
training intensities is important to stimulate different intensity, time, type, and enjoyment.
physiologic changes. Table 10.3 shows the intensity
for traditional strength training exercises as 85-100%. By combining and altering these factors, health and
However, these intensities are specific to an adult. fitness professionals can individualize appropriate
Therefore, they may require adjustments (lowering) for programs for clients.
a youth client.
Frequency
These exercises and loads increase power by increasing
the force side of the power equation (force multiplied Frequency refers to the number of training sessions in
by velocity), whereas the 30% to 45% intensity range a certain time period — usually per week. For general
is used for speed exercises, such as speed squats. Here, health, preferable frequency of activity is every day
a client will perform squats as fast as possible with
a lighter load. The 10% of bodyweight intensity is an
Table 10.4 Basic Exercise Guidelines for Youth Training
indicator for medicine ball training that requires the Mode ⦁⦁ Walking, jogging, running, games,
throwing or release of a medicine ball. activities, sports, water activity,
resistance training
These last two forms of training affect the velocity side
Frequency ⦁⦁ 2-5 days per week
of the power equation (force multiplied by velocity).
By using both heavy loads with explosive movement Intensity ⦁⦁ 50-90% of maximum heart rate
for cardiorespiratory training
and low resistance with a high velocity, there’s an
enhancement in power output (1, 2-5). Because the ⦁⦁ Phases 1-3 can be used if
goal of this phase of training is primarily power, health progressed appropriately.
and fitness professionals will want to progress by Duration ⦁⦁ 30-120 min per day (for sports)
increasing volume (sets), intensity (load), and velocity.
Assessment ⦁⦁ See Recommended Assessments
General exercise guidelines for youth clients are in for Youth Population (Chapter 4)
Table 10.4. A health and fitness professional should Flexibility ⦁⦁ Follow the Flexibility Continuum
follow the NASM assessment guidelines in Chapter 4. specific for each phase of training
There are also sample OPT youth programs in the Resistance ⦁⦁ 1-5 sets of 6-20 repetitions at
programming manual. training 40-70% 2-3 days per week
⦁⦁ Phases 1 and 2 of OPT model
Cardiorespiratory Training should be mastered prior to
moving on.
■■ Benefits ⦁⦁ Phases 4-5 should be reserved
As the obesity epidemic grows, it is important that for mature adolescents based
on dynamic postural control
youth develop healthy living habits when they’re
and a licensed physician’s
young. According to the CDC, children who are obese recommendation.
while they’re young will likely be obese as adults.
Special ⦁⦁ Progression for the youth
Cardiorespiratory training helps reduce the risk factors
considerations population should be based upon
that link to obesity, such as cancer, high cholesterol, postural control and not on the
hypertension, and prediabetes (6-10). An easy and amount of weight that can be used.
methodical way for health and fitness professionals
⦁⦁ Make exercise fun!
to prescribe cardiorespiratory fitness programs is to
NASM YOUTH EXERCISE SPECIALIST 68

of the week for small quantities of time (11). For Figure 10.3 The Borg Scale
improvement in fitness levels, the frequency is 3 to 5
days per week at higher intensities (11).

Intensity
Intensity refers to the level of demand that activity
places on the body. During cardiorespiratory exercise,
there’s numerous ways of establishing and monitoring
it in adults. But for youth, calculating heart rate, power
output (watts), or a percentage of maximal oxygen
consumption (VO2max) or oxygen uptake reserve is not
always practical (12).

If this is the case, use either the Ratings of Perceived

Exertion (RPE) or talk test method.

Ratings of Perceived Exertion Method

The RPE method is a subjective technique used to
express or validate how hard a youth feels they’re
working during exercise. When using this method, a
client is subjectively rating the perceived difficulty of between the talk test, VO2, ventilatory threshold, and
exercise on a scale of 6 to 20. It is based on the physical heart rate during both cycle ergometer and treadmill
sensations the client experiences during physical exercise (13, 14). So, for adults, it appears that the talk test
activity, including an increase in heart rate, respiration can help personal trainers and clients monitor proper
rate, sweating, and muscle fatigue. exercise intensity without having to rely on measuring
Report the client’s subjective rating on how hard they heart rate or VO2max. This may be applicable to youth
feel they are working, or how tired they are during the in a cross-functional manner, where the health and
activity. Although the RPE scale is a subjective measure, fitness professional can gauge a youth’s intensity levels
if clients report their exertion ratings accurately, RPE during exercise. If the RPE scale proves unsuccessful
provides a good estimate of the actual heart rate during in retrieving accurate subjective reporting from a youth
physical activity. Moderate-intensity activity is equal client, use the talk test as an alternative.
to somewhat hard (12 to 14) on the 6 to 20 Borg scale
(Figure 10.3). Time
Time is how long a client engages in an activity or
Talk Test Method exercise training session. It’s typically expressed
Until recently, the talk test has been an informal method in minutes. The U.S. government’s 2008 Physical
that gauges exercise training intensity during exercise Activity Guidelines for Americans represents the
in adults. It was believed that if a client reached a point most current and comprehensive set of guidelines to
where they weren’t able to carry on a simple conversation help Americans ages 6 and older improve their health
during exercise due to heavy breathing, then they were through appropriate physical activity and exercise.
probably exercising at too high of an intensity level. A The guidelines are based on scientific evidence and
number of studies now confirm that there is a correlation recommend that children and adolescents 6 to 17 years
NASM YOUTH EXERCISE SPECIALIST 69

old engage in 1 hr or more of physical activity per day. thoroughly describe circuit training as it pertains to
For cardiorespiratory exercise, those 60 min should be cardiorespiratory training.
at moderate or vigorous intensities. Three days of the
Circuit training programs consist of a series of
week should include vigorous physical activity (15).
strength-training exercises that an individual performs
one after the other with minimal rest.
Type
Type refers to the mode or type of activity. Three Several research studies have compared the effects
criteria must be met for an activity or exercise to be of circuit weight training with traditional endurance
aerobic. First, it should be rhythmic in nature. Next, forms of exercise (treadmills, cross-country skiing,
it should use large muscle groups. Lastly, it should jogging, bicycling) in relation to energy expenditure,
strength, and improving physical fitness. They found
be continuous in nature. Some examples of aerobic
the following results (16–18):
exercise to improve cardiorespiratory fitness include
the following: ⦁⦁ Circuit training is just as beneficial as
traditional forms of cardiorespiratory exercise
⦁⦁ Running or jogging
for improving or contributing to improved
⦁⦁ Walking fitness levels (16, 19, and 20).
⦁⦁ Tag ⦁⦁ Circuit training results in higher post-exercise
⦁⦁ Keep-away with a soccer ball metabolic rates, as well as strength levels (16-18).

Enjoyment It is possible to incorporate traditional exercise training

components, such as flexibility and cardiorespiratory
Enjoyment refers to the amount of pleasure fitness training, into circuit-training routines.
from engaging in a specific exercise or activity.
Unfortunately, health and fitness professionals
The Programming Manual
overlook or don’t always take this component of the
exercise prescription seriously. A client’s exercise The programming manual provides a complete
adherence rates will decline significantly when a periodized and modifiable program for the youth
specific exercise is selected for them that doesn’t client. It includes an annual plan, monthly plans, and
consider their personality type, previous exercise workout programs for different goals. An annual plan
experiences, and other interests. shows how an exercise program will progress over
the course of a year and details the monthly phases of
If the activity or exercise training program in general training. It also discusses cardiorespiratory training.
is not enjoyable to the client, it is likely that they won’t Monthly plans show which phases of training, cardio,
adhere to it. A youth client is much more likely to and flexibility to use throughout each week of each
continue with a program that is fun and challenging month. Then, it shows when to reassess the client.
than one that is dull and boring. The programming manual also provides premade daily
workouts that a health and fitness professional can use
■■ Circuit Training with youth clients.
Another beneficial form of cardiorespiratory training is
Summary
circuit training. Circuit training allows for comparable
fitness results without spending long periods of time A comprehensive assessment for a youth client
to achieve them. And, it’s a very time-efficient method provides valuable information regarding the client’s
in which to train a client. The information below will goals, needs, and abilities. A typical youth client is
NASM YOUTH EXERCISE SPECIALIST 70

going to spend the majority of their time training in the 6. Guo SS, Chumlea WC. Tracking of body mass index in children in relation to
overweight in adulthood. American Journal of Clinical Nutrition 1999,70:S145-148.
first two phases of the OPT model: Stabilization and 7. Freedman DS, Kettel L, Serdula MK, et al. The relation of childhood BMI to adult
Strength Endurance Training. However, those clients adiposity: the Bogalusa Heart Study. Pediatrics 2005, 115:22-27.
8. Freedman D, Wang J, Thornton JC, et al. Classification of body fatness by body mass
with exceptional dynamic postural control or higher index-for-age categories among children. Archives of Pediatric and Adolescent Medicine
levels of maturity will also be able to train in higher 2009, 163:801-811.
9. Freedman DS, Khan LK, Dietz WH, et al. Relationship of childhood obesity to
phases, such as the power phase. The FITTE principle coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics
is best used for cardiorespiratory training, and circuit 2001, 108:712-718.
10. Kushi LH, Byers T, Doyle C, et al. American Cancer Society guidelines on nutrition
training provides a great alternative to traditional and physical activity for cancer prevention: reducing the risk of cancer with healthy
cardiorespiratory training. food choices and physical activity. CA: A Cancer Journal for Clinicians 2006, 56:254-
281.
11. U.S. Department of Health and Human Services (USDHHS). Physical Activity
To ensure safe and effective training for this Guidelines Advisory Committee Report, 2008. Washington, D.C.: USDHHS; 2008.
population, health and fitness professionals must http://www.health.gov/paguidelines. Accessed November 15, 2011.
12. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and
place this information into a systematic programming Prescription. 8th ed. Philadelphia, PA: Wolters Kluwer Williams & Wilkins, 2010.
scheme, follow specific guidelines, and then implement 13. Persinger R, Foster C, Gibson M, et al. Consistency of the talk test for exercise
prescription. Med Sci Sports Exerc 2004, 36(9):1632-1636.
them with precision. The OPT model provides health
14. Foster C, Porcari JP, Anderson J, et al. The talk test as a marker of exercise training
and fitness professionals with the system of training to intensity. J Cardiopulm Rehabil Prev 2008, 28(1):24-30.
optimize their safety and effectiveness. 15. U.S. Department of Agriculture and U.S. Department of Health and Human Services.
Dietary Guidelines for Americans, 2010. 7th ed. Washington, D.C.: U.S. Government
Printing Office; December 2010.
16. Kaikkonen H, Yrlama M, Siljander E, et al. The effect of heart rate controlled low
References resistance circuit weight training and endurance training on maximal aerobic power in
1. Wilson GJ, Newton RU, Murphy AJ, et al. The optimal training load for the sedentary adults. Scand J Med Sci Sports. 2000;10(4):211-215.
development of dynamic athletic performance. Med Sci Sports Exerc 1993:1279-1286. 17. Jurimae T, Jurimae J, Pihl E. Circulatory response to single circuit weight and
2. Ebben WP, Blackard DO. Complex training with combined explosive weight and walking training sessions of similar energy cost in middle-aged overweight females.
plyometric exercises. Olympic Coach 1997, 7:11-12. Clin Physiol 2000, 20(2):143-149.

3. Newton RU, Hakkinen K, Hakkinen A, et al. Mixed-methods resistance training 18.Burleson MA, O’Bryant HS, Stone MH, et al. Effect of weight training exercise and
increases power and strength of young and older men. Med Sci Sports Exerc 2002, treadmill exercise on post-exercise oxygen consumption. Med Sci Sports Exerc 1998,
34:1367-1375. 30(4):518-522.
4. Schmidtbleicher D. Training for Power Events. In: Chem PV, ed. Strength and Power 19. Gillette CA, Bullough RC, Melby CL. Postexercise energy expenditure in response to
in Sports. Boston: Backwell Scientific, 1992:381-396. acute aerobic or resistive exercise. Int J Sport Nutr 1994, 4(4):347-360.
5. Crewther B, Cronin J, Keogh J. Possible stimuli for strength and power adaptation: 20.Weltman A, Seip RL, Snead D, et al. Exercise training at and above the lactate
acute mechanical responses. Sports Med 2005, 35:967-989. threshold in previously untrained women. Int J Sports Med 1992, 13:257-263.
NASM YOUTH EXERCISE SPECIALIST 71

CHAPTER 11: NUTRITION FOR YOUTH

Learning Objectives activity habits in childhood are critical to reducing

disease risk and optimizing health (3). Other common
After completing this chapter, you will:
nutrition issues among youth include dental caries;
⦁⦁ Understand the effects of obesity on the youth iron-deficiency anemia; food insecurity; and inadequate
population. intakes of fiber, calcium, vitamin D, and potassium.
⦁⦁ Recognize the current trends of youth Excessive intake of calories, saturated fat, added sugars,
sodium, and refined-grain products also are problematic.
eating habits.
⦁⦁ Understand nutrition recommendations This chapter will discuss general nutrition
for youth. guidelines for children and adolescents ages 2 to 18,
along with obesity-prevention strategies and fluid
⦁⦁ Be aware of basic guidelines for weight
recommendations during exercise. Remember, this
management in youth.
information is not intended to diagnose, treat, or
⦁⦁ Understand basic fluid intake guidelines replace recommendations by a youth’s physician or
for youth. registered dietitian. Additionally, do not underestimate
the influence parents, caregivers, fitness professionals,
Introduction and other role models have on the behavior of youth.

Proper nutrition for youth can support optimal growth

and development, reduce the risk of chronic disease, Trends and General Recommendations
and help achieve and maintain a healthy body weight. Recent trends in the eating patterns of youth include more
Over the past several decades, the infant death rate and meals eaten away from home. These meals are usually
occurrence of nutrient deficiencies among children in the at fast food restaurants where foods tend to be higher
United States have decreased. However, the incidences in calories, fat, added sugars, and sodium, and lower in
of being overweight, obese, and having a chronic disease fiber and other key nutrients (4, 5). Large portion sizes,
have risen dramatically (1). Among children and soda consumption, and the frequency of snacking are
adolescents ages 2 to 19, one-third are overweight, and also on the rise (6). Collectively, these food choices are
nearly one in five are obese (2). Because children who contributing to additional caloric intake and poor diet
are obese are more likely than normal-weight children quality. Almost 40% of the total energy that children and
to become obese adults, healthful eating and physical adolescents ages 2 to 18 consume is empty calories (7).
NASM YOUTH EXERCISE SPECIALIST 72

Empty calories are foods with poor nutrient content, Specific nutrient recommendations known as the
such as sweetened drinks (soda, energy and sport drinks), dietary reference intakes were set by the National
pizza, processed snack foods, ice cream, and grain-based Academy of Science’s Institute of Medicine’s Food
desserts (donuts, pastries, and cookies). The consumption and Nutrition Board. This includes the recommended
of empty calories displaces more healthful foods, which dietary allowance, adequate intake, tolerable upper
can result in suboptimal intake of nutrients, excess weight intake level, and estimated average requirement. The
gain, and a compromise in growth and development. acceptable macronutrient distribution range (AMDR)
Therefore, youth need to minimize their intake of these represents intake guidelines for carbohydrates, protein,
foods, particularly the intake of soda and sugar-sweetened and fat (5). A summary of youth recommendations for
beverages. Children who consume more of these macronutrients, fiber, and water are in Table 11.2.
beverages tend to take in more total calories and have a
higher body weight than those who drink less (5, 10). Health and fitness professionals need to place emphasis
on nutrient-dense foods, such as whole grains, fruits,
The U.S. Departments of Agriculture and Health and
Human Services have created the Dietary Guidelines Table 11.2 Youth Nutrition Recommendations
for Americans (DGA). These guidelines provide
Nutrient Daily recommended total calorie intake
strategies to help Americans 2 years and older improve
eating and physical activity behaviors that promote 1-3 4-8 9-13 14-18
years years years years
health and reduce the risk for chronic disease. Updates
to the DGA occur every 5 years, with the most recent Protein 5-20% 10-30%
version being published in 2010 (8). The cornerstone of Carbohydrate 45-65%
these guidelines is to consume the appropriate number Dietary fiber 19 g 25 g Males Males
of calories to optimize health, allow for normal growth 31 g 38 g
and development, and support a healthy body weight. Females Females
Table 11.1 shows estimates for daily caloric needs by 26 g 26 g
age, gender, and physical activity level (9). Fat 30-40% 25-35%

Table 11.1 Youth Estimated Daily Calorie Requirements Total water 1.3 L 1.7 L Males Males
from fluid 2.4 L 3.3 L
Calorie Range in food and Females Females
Children Sedentary Active beverages 2.1 L 2.3 L
2-3 years 1,000 1,400 Calcium 700 mg 1,000 mg 1,300 mg
Females Vitamin D 600 IU
4-8 years 1,200 1,800 Iron 7 mg 10 mg 8 mg Males
9-13 years 1,600 2,200 11 mg
4-18 years 1,800 2,400 Females
15 mg
Males
Sodium 1,000 mg 1,200 mg 1,500 mg
4-8 years 1,400 2,000
9-13 years 1,800 2,600 Potassium 3,000 mg 3,800 mg 4,500 mg 4,700 mg
Sources: Bowman SA, Gortmaker SL, Ebbeling CB, et al. Effects of fast-
14-18 years 2,200 3,200
food consumption on energy intake and diet quality among children in a
SOURCE: USDA Food Patterns. U.S Department of Agriculture. national household survey. Pediatrics. 2004; 113 (1): 112-118.
Available at http://www.cnpp.usda.gov/Publications/ Institutes of Medicine. Dietary Reference Intakes for Water, Potassium,
USDAFoodPatterns/USDAFoodPatternsSummaryTable.pdf. Sodium, Chloride, and Sulfate (2005). http://www.nap.edu. Accessed
Accessed March 1, 2012. September 28, 2011.
NASM YOUTH EXERCISE SPECIALIST 73

vegetables, beans, low-fat dairy products, lean meats, ■■ Protein

skinless poultry, seafood, beans, and nuts, to achieve
Protein is the major structural component of all body
optimal nutrient intake and meet recommendations.
cells. It functions as enzymes and hormones. It is
especially important during periods of rapid growth,
■■ Carbohydrates such as childhood. Good sources include lean red
Carbohydrates should represent the majority of meats, seafood, poultry, eggs, low-fat milk, yogurt,
calories for youth because they provide vitamins, cheese, soy products, legumes, nuts, and seeds. Protein
minerals, and the fuel (glucose) that the brain, nervous also contains B vitamins, vitamin E, iron, zinc, and
system, muscles, and red blood cells require. Good magnesium. Although many Americans consume
carbohydrate sources include whole grains and whole- adequate protein, many can benefit from eating a wider
grain products such as brown rice, wild rice, oats and variety foods containing protein, especially seafood and
oat products, 100% whole-wheat bread and pasta, unsalted nuts. Seafood, particularly fatty fish such as
quinoa, corn, barley, fruits, and vegetables. Bran and salmon and mackerel, contains the beneficial omega-3
bran cereals are also wise choices. White bread, sugary fats, eicosapentaenoic acid and docosahexaenoic acid,
cereals, and other refined grain products lack dietary which are important in preventing heart disease. Also,
fiber and other nutrients, because the grains in these nuts contain dietary fiber and may reduce the risk for
products do not have the outer bran layer and germ. heart disease when part of a healthy diet (5).
This enhances texture and shelf life.
■■ Dietary Fat
The germ and bran layer contain beneficial nutrients
Dietary fat provides energy and helps with the
such as fiber, iron, and B vitamins. Most children and
absorption of the fat-soluble vitamins A, D, E, and K,
adolescents do not consume enough dietary fiber,
which are essential for proper growth and function.
which promotes a feeling of fullness and regular bowel
Both plant and animal foods contain dietary fat,
movements. Naturally occurring fiber in whole grains,
but plant sources such as olive oil, canola oil, and
bran, beans, peas, fruits, vegetables, and nuts also may
avocado have more healthy fats than animal sources.
reduce the risk of obesity, type 2 diabetes mellitus, and
Animal fats are higher in saturated fat and are solid at
heart disease (5). Clients need to select whole grains
room temperature.
as often as possible. Half of their daily recommended
intake should be grains (5). High intake of saturated fat raises the risk of heart
disease. Therefore, clients should limit their intake to
Fruits and Vegetables less than 10% of total calories (9). The major sources
of solid fats include regular cheese, pizza, cakes, pies,
Fruit and vegetable intake is also inadequate in
donuts, cookies, pastries, ice cream, milkshakes,
children. Of those ages 4 to 13, 80-90% fail to consume
butter, and margarine. Also, trans fat is not an essential
the recommended number of daily servings (11). As a
nutrient for the human body, and it increases the risk
result, the nutrients in fruits and vegetables often are
of heart disease. Therefore, a client’s intake should be
lacking in the American diet, including vitamins A,
kept as low as possible. Some trans fat occurs naturally,
C, and K; potassium; magnesium; and dietary fiber. In
and others form during the processing (hydrogenation)
comparison to snack foods, fruits and vegetables have
of fats.
additional benefits that provide fewer calories and
more nutrients. This makes them essential for weight Clients should limit intake of stick margarine, snack
management. Finally, regular fruit and vegetable foods, and desserts to control trans fat intake. A
consumption lowers clients’ risk of several chronic prudent approach is to consume lean meat, seafood,
diseases. Some may protect against certain cancers (5). and poultry, instead of fatty cuts of beef, sausage, bacon,
NASM YOUTH EXERCISE SPECIALIST 74

and poultry with skin. Encourage clients to select fat- Table 11.3 Vitamin D Content in Various Foods
free or low-fat cheese, milk, and yogurt instead of full-
fat versions. Finally, clients should use vegetable oils Item Vitamin D (IU)
in place of butter, margarine, or lard, which will reduce Cooked sockeye salmon, 3 oz 792
their intake of saturated and trans fat. Smoked salmon, 3 oz 580
Tuna, light, in oil, drained, 3 oz 228
■■ Calcium, Vitamin D, and Potassium
Orange juice, fortified, 1 cup 136
Clients don’t always consume the recommended
amounts of calcium, vitamin D, and potassium, Sardines, canned in oil, drained, 3 oz 164
which are normally found in fortified milk and other Vitamin D-fortified milk, 1% or 2%, 1 cup 116
beverages (12). Inadequate intake of bone-building Soymilk, fortified, 1 cup 112
nutrients, along with a lack of physical activity, may
Fortified cereal, 1 oz 36-100
prevent maximal growth and bone mass. This increases
the risk of osteoporosis later in life (5). Table 11.2 shows Egg, 1 28
the recommendations for calcium and vitamin D (13).
■■ Potassium
To help meet daily recommended amounts, advise
children ages 2 to 8 to drink 2 cups of fat-free or low- Dietary potassium is beneficial for lowering and
fat milk per day. For youth ages 9 to 18, advise them maintaining healthy blood pressure, yet most youth
to consume 3 cups per day. Fortified orange juice, soy do not consume enough. Rich sources of potassium
products, and low-lactose and lactose-free products are include milk, milk products, fruits, and vegetables.
good alternatives. Table 11.2 shows the adequate intake for youth. Those
with kidney disease need a physician or another health
Vitamin D requirements are more challenging to
care provider’s guidance regarding potassium intake.
achieve. This is because there are few foods that are
rich in this vitamin (Table 11.3). And individuals don’t
always get the sun exposure they need to produce
■■ Iron
adequate amounts of vitamin D from cholesterol Iron is a mineral that is essential for energy production,
stores in their body. As a result, clients with lower oxygen transport in red blood cells, and immune
than optimal vitamin D levels may need to take a function. A significant number of adolescent girls
dietary supplement. are deficient in iron because monthly losses through
menstruation and inadequate intakes. Lean meat,
■■ Sodium poultry, and seafood contain heme iron, which is
Sodium is an essential nutrient that maintains fluid easier to absorb than nonheme iron, which is in beans,
balance and other essential functions. The estimated spinach, and enriched foods. Again, Table 11.2 lists the
average intake in the United States among those older daily requirements for iron.
than age 2 is 3,400 mg. The daily recommendation is
1,500 mg for 18-year-olds. The recommendations are Practical Application
even less for those who are younger. Moderate evidence
shows that when blood pressure rises in children, it Several tools provide a means of translating nutrition
increases their risk of heart and kidney disease (5). recommendations into practical application. The first is
Children need to minimize salty snacks, deli meat, and MyPlate (Figure 1.1), which is an extension of the Food
other processed foods. Encourage them to eat fresh Guide Pyramid. MyPlate is a good educational resource
foods, which are naturally low in salt. for healthful eating. Next, the USDA Food Patterns
NASM YOUTH EXERCISE SPECIALIST 75

denote how much of each food group an individual It is important to note that youth learn food
needs to consume to meet daily caloric needs. Table 11.4 preferences, and regular exposure to foods (8 to 10
shows the USDA food pattern for several calorie levels. times at minimum) helps youth develop a preference
For more information, including vegan and vegetarian for that food (14). Also, families should plan
versions, go to www.choosemyplate.gov. regular family meals. This will help youth improve
their nutritional intake as well as support their
In 2010, MyPlate was created as an extension of the
developmental needs.
2010 DGA. It serves as an update to the MyPyramid.
Unlike the Food Guide Pyramid, the MyPlate provides a Provide age-appropriate portion sizes during meals
visual reminder of how to fill one’s plate when selecting and at snack time. Also, limit the amount of empty-
foods (Figure 11.1). The website www.choosemyplate. calorie foods in the home. Both of these actions will
gov provides resources for consumers and prevent excess caloric intake and improve diet quality,
professionals, including age-appropriate brochures, a especially when healthful foods are available.
nutrition education series, sample menu, and recipes.
For youth facing food insecurity, or not knowing
Another useful tool is the Healthy Eating Plate (www.
where they will find their next meal, school and
health.harvard.edu/plate/healthy-eating-plate), which
nutrition assistance programs can provide relief.
was created by experts at the Harvard School of Public
Health and Harvard Medical School. It is similar to
MyPlate, except that it was developed independent of Table 11.4 USDA Food Patterns
the government. Daily calories 1,200 1,600 2,000
Grains 4 oz-eq* 5 oz-eq 6 oz-eq
Parents, teachers, and caregivers have a tremendous
impact on how young people select food and form Whole grains 2 oz-eq 3 oz-eq 3 oz-eq
eating habits. Therefore, providing a variety of Enriched grains 2 oz-eq 2 oz-eq 3 oz-eq
healthful foods in appropriate portion sizes will
Vegetables 1 ½ cup 2 cup 2 ½ cup
support growth and development in youth and help
Fruits 1 cup 1 ½ cup 2 cup
them establish lifelong eating habits.
Protein foods
Seafood 5 oz/week 8 oz/week 8 oz/week
Figure 11.1 MyPlate
Meat, poultry, 14 oz/ 24 oz/ 26 oz/
eggs week week week
Nuts, seeds, soy 2 oz/week 4 oz/week 4 oz/week
products
Dairy 2 ½ cup 3 cup 3 cup
Oils** 17 g 22 g 27 g
Solid fats and 121 121 258
added sugars*** calories calories calories
* 1 oz equivalent (oz-eq) is: one 1 oz slice of bread; 1 oz of uncooked
pasta or rice, ½ cup of cooked rice, pasta or cereal; 1 6-inch tortilla, one
5-inch pancake, 1 oz of ready-to-eat cereal (about 1 cup cereal flakes).
** Oils and soft margarines include vegetable, nut and fish oils, and soft
vegetable oil spreads without trans fat.
*** Maximum amount of calories left for solid fats and added sugars
after selecting the specified amounts in each food group in forms that
are fat-free or low-fat without added sugars
NASM YOUTH EXERCISE SPECIALIST 76

The National School Lunch and Breakfast programs psychological benefits, increase intake of beneficial
have had a positive effect on the nutritional intake, nutrients, and help lower incidence of obesity (12).
health, and well-being of participating children (15).
Because eating and activity patterns begin to develop
School breakfasts and lunches must meet U.S. Dietary
at a young age, it’s important to establish good habits
Guidelines and provide one-third of the recommended
from the get-go. These habits will influence nutritional
amounts of target nutrients. These nutrition assistance
and health status throughout one’s lifetime. The
programs also provide nutrition education to families
American Medical Association Expert Committee
and are available for youth who are at risk for poor
for the Prevention, Assessment, and Treatment of
nutritional intakes because of low socioeconomic
Child and Adolescent Overweight and Obesity has
status; ethnic, racial, or linguistic diversity; lack of
identified specific behaviors to help prevent obesity
access to health care services; or the presence of special
and promote the maintenance of a healthy body weight
health care needs (15).
(18). The recommendations below target children
with a healthy BMI. Their basis relies on clinical
Preventing Overweight and Obesity in Youth experience and evidence-based data. Children who are
overweight or obese need to seek appropriate treatment
Overweight and obesity occurs when energy (caloric)
by a physician or other health care professional with
intake from food and beverages chronically exceeds
training in pediatric weight management.)
calorie expenditure from metabolism and movement.
Children who are overweight or obese are at greater 1. Limit the consumption of beverages that are
risk for chronic disease, and are more likely to become sweetened with sugar.
overweight or obese adults. A health and fitness 2. Consume the recommended amounts of fruits and
professional should use growth charts specific to vegetables according to the DGA.
gender and age to assess and plot the body mass index 3. Limit television and other screen time to 2 hr per
(BMI) of growing children and adolescents (16). The day for children older than 2. It is recommended that
percentile represents the child’s BMI in relation children younger than 2 should not spend any time
to children of the same age and gender. For this watching television (19).
information, refer to Table 11.5. It’s important that
4. Eat breakfast daily.
a health care provider determine a child’s BMI
annually. Also, the provider needs to assess other 5. Limit restaurant dining, especially fast food or other
risk factors in conjunction with BMI to determine restaurants that serve large portions of high-calorie foods.
appropriate treatment. 6. Schedule regular family meals.

The dramatic rise in youth obesity is due to several

factors, including more sedentary activities such Table 11.5 BMI for Age Percentile and Weight Status
as television and computer time; less physical BMI for age percentile Category
activity at school and at home; and an increase in the
Less than the 5th Underweight
consumption of sugary beverages, more fast food, and percentile
large portions (17). Parental influence is important in
5th percentile to less than Healthy weight
establishing eating and activity behaviors such as food
the 85th percentile
attitudes, food preferences, activity and exercise habits,
85th percentile to less than Overweight
and meal and snack patterns. For example, the absence
the 95th percentile
of family meals leads to a lower consumption of fruits
and vegetables and a higher intake of fatty foods and Equal to or greater than the Obese
95th percentile
carbonated drinks (17). Family meals also provide
NASM YOUTH EXERCISE SPECIALIST 77

7. Limit portion sizes. Table 11.6 Preventing Obesity: Tips for Parents
8. Eat a diet rich in calcium. The Do’s The Don’ts
9. Eat a diet high in fiber. ⦁⦁ Do limit television ⦁⦁ Don’t allow eating in
viewing and front of TV.
10. Eat a diet with balanced macronutrients in video games.
accordance with the AMDRs. ⦁⦁ Don’t provide food as
⦁⦁ Do establish regular comfort or a reward.
11. Breastfeed infants until 6 months of age. Then, family activity such as
introduce solid foods while continuing to breastfeed walks, trips to the park, ⦁⦁ Don’t offer sweets for a
hikes, and ball games. finished meal.
until 12 months of age.
12. Incorporate at least 60 min of moderate to vigorous ⦁⦁ Do provide healthy ⦁⦁ Don’t force your child to
food choices. finish a meal.
activity each day.
⦁⦁ Don’t provide fast food.
13. Limit consumption of energy-dense foods. ⦁⦁ Do respect
their appetite. ⦁⦁ Don’t purchase and
For the prevention and treatment of childhood obesity keep high-calorie foods
⦁⦁ Do provide fiber in diet.
to be effective, health care providers and families must in the house.
develop and reinforce goal-setting strategies that help ⦁⦁ Do designate meals
children learn and retain healthful eating and activity times, and eat at
the table.
behaviors. Table 11.6 contains additional tips from
Dr. Rebecca Moran to help parents and caregivers
prevent obesity in their children (20). occur at lower temperatures, because sweat does not
evaporate from the skin as easily, which prevents the
body from dissipating heat.
Fluid Balance for Youth During Exercise
To determine the index of heat stress, measure the wet
Youth who exercise do not adapt to extreme
bulb global temperature on the field or surroundings
temperatures as well as adults; therefore, take
using a psychrometer. If the wet bulb temperature is
measures prevent heat-related illness. Exposure to
greater than 82° F, delay, reschedule, or move events
high temperatures or humidity during exercise causes
into an air-conditioned space (22). Progressive heat
youth to produce more heat than adults. This causes
acclimatization consisting of 10 to 12 exposures can
irregularity in body temperature. As a result, core body
help youth adapt to hot and/or humid conditions (22).
temperature can increase to unsafe levels (21). Here are
the major differences between youth and adults. A hypohydration status is also a risk factor for heat
illness, particularly for youth. They usually don’t
⦁⦁ Youth have a greater surface area to body
replenish fluids lost during exercise, and they may not
mass ratio. So they gain more heat from the
adequately hydrate for the next session. A practical
environment.
way of assessing hydration levels is to conduct a weigh-
⦁⦁ Youth produce more metabolic heat per unit in before and after exercise. The client’s body weight
of mass. should not vary greater than 2%. Ensuring this lessens
⦁⦁ Youth have higher skin temperatures and lower the risk of acute dehydration and decreases the risk of
sweating capacity. So they cannot dissipate as heat-related illness (23). Awareness and prevention
much heat (22). are critical steps in avoiding heat illness in youth
who exercise.
Exercise tolerance decreases and the risk of heat
illness increases as temperature rises above 95° F. During most activities, adequate water intake can
Humid conditions also cause heat stress. This can even prevent dehydration and heat exhaustion.  However,
NASM YOUTH EXERCISE SPECIALIST 78

during endurance events or activities greater than 60 ⦁⦁ Water is adequate for activities of less than 1 hr,
min, a sports drink with carbohydrates provides fuel provided that there is regular consumption of
for the nervous and muscular systems. It also increases meals and fluids.
palatability, which makes fluid replacement easier ⦁⦁ For endurance events, training sessions
(23). During multiple daily workouts and endurance longer than 60 min, or multiple practices a
events in which sweat losses are high, carbohydrate day, choose a sports drink that contains 4-8%
and electrolyte (e.g., sodium, potassium) intake is carbohydrates (e.g., Gatorade).
necessary (23).
⦁⦁ For early morning workouts, consume a liquid
Parents, caregivers, coaches, and staff need to ensure meal replacement 10 to 40 min before the
that young athletes drink enough fluid before, during, activity. This is due to rapid digestion and
and after events. Coaches, staff, and trainers should absorption.
make water available during practices. They also should
allow youth to drink at will. Younger children should ■■ During Exercise Guidelines
be able to drink water every time they request it. Water ⦁⦁ Depending on the type of activity, consume 3 to
breaks need to be more regular and frequent in hot or 6 oz of water or sports drink every 15 min.  This
humid weather. Finally, every coach and staff member equals about 12 to 24 oz per hr.
should receive proper training regarding this policy. ⦁⦁ For exercise greater than 4 hr, choose a sports
Guidelines for maintaining fluid balance follow (23). drink with small amounts of electrolytes.

■■ General Fluid Requirements ■■ Post-Exercise Guidelines

⦁⦁ Select fluids that are cold, palatable, and ⦁⦁ Immediately following activity, drink at least
appropriate for the type and duration of 16 to 20 oz of fluid for every pound of weight
the activity.   lost to ensure proper rehydration. Supervise
⦁⦁ Sports drinks need to contain 4-8% youth athletes to ensure they drink the entire
carbohydrates. Drinks that have more than 10% amount of fluid.
carbohydrates may slow stomach emptying, ⦁⦁ Drink an additional 16 oz with a post-workout
cause abdominal cramping, and impair meal within 2 hr after activity.
performance.
Table 11.7 details the signs and symptoms of
⦁⦁ Drinks with a combination of glucose, glucose
dehydration. All parents, coaches, trainers, and staff
polymers, and fructose may enhance water
should closely monitor youth who are exercising.
absorption.
Table 11.7 Signs and Symptoms of Dehydration
⦁⦁ Avoid giving solutions that primarily contain
fructose. These can cause an upset stomach. ⦁⦁ Thirst ⦁⦁ Dry skin (sweating stops)

⦁⦁ Nausea ⦁⦁ Fatigue
■■ Pre-Exercise Guidelines
⦁⦁ Dry mouth/ cotton mouth ⦁⦁ Rapid breathing
⦁⦁ Drink 16 to 24 oz of water or sports drink 2 hr
before activity. ⦁⦁ Vomiting ⦁⦁ Weakness
⦁⦁ On warm or humid days, drink and an additional ⦁⦁ Headaches ⦁⦁ Increased heart rate
8 to 16 oz, 30 to 60 min before activity.
⦁⦁ Flushing (red) skin ⦁⦁ Muscle cramps
⦁⦁ On warm or humid days, complete a pre- and
⦁⦁ Lightheadedness ⦁⦁ Dark yellow urine
post-exercise weigh-in.
NASM YOUTH EXERCISE SPECIALIST 79

Summary rest periods, and wear appropriate clothing during

high humidity and temperatures. These actions will
It is imperative that children in the United States
provide youth with the best opportunity to achieve
develop more healthful eating patterns and physical
optimal health and well-being so they can grow into
activity habits. This will help support physical and
healthful adults.
cognitive growth and development, minimize the risk
of chronic disease, and achieve and maintain a healthy
body weight. At present, children and adolescents are References
1. National Center for Health Statistics. Health, United States. 2010; With Special Feature
consuming excessive amounts of added sugars, sodium on Death and Dying. Hyattsville, MD: National Center for Health Statistics; 2011.
from soft drinks, and sweetened beverages. They’re 2. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of high body mass index in U.S.
children and adolescents, 2007-2008. JAMA. 2010; 303 (3): 242-49.
also eating too many solid fats from pizza, baked
3. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into
goods, desserts, and fast food. These individuals don’t adulthood: A systematic review of the literature. Obes Rev. 2008; 9 (5): 474-488.

consume enough whole grains, fat-free or low-fat milk 4. Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in energy intake in US between 1977
and 1996; Similar shifts seen across age groups. Obes Res. 2002; 10: 370-378.
products, fruits, and vegetables. 5. Bowman SA, Gortmaker SL, Ebbeling CB, et al. Effects of fast-food consumption
on energy intake and diet quality among children in a national household survey.
Pediatrics. 2004; 113 (1): 112-118.
Parents, caregivers, and other people of influence need
6. American Dietetic Association. Position of the American Dietetic Association:
to help youth meet nutritional requirements and attain Nutrition Guidance for Healthy Children Ages 2 to 11 years. J Am Diet Assoc. 2008; 108:
1038-1047.
optimal health. To do this, provide healthful foods in
7. Reedy J, Krebs-Smith SM. Dietary sources of Energy, Solid Fats, and Added Sugars
appropriate portion sizes, practice eating patterns Among Children & Adolescents in the US. J Am Diet Assoc. October 2010; 110 (10):
1477-1484.
with regular family meals at home, and minimize 8. U.S. Department of Agriculture and U.S. Department of Health and Human Services.
television watching. This will help prevent youth from Dietary Guidelines for Americans 2010. 7th ed. Washington, D.C.: U. S Government
Printing Office; December 2010.
becoming overweight or obese. Children who do not 9. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber,
consume or have access to adequate nutrients and Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, D.C.: The National
Academies of Press; 2002/2005. http://www.nap.edu. Accessed September 28, 2011.
calories are at risk for growth retardation, nutrient 10. Institutes of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium,
Chloride, and Sulfate (2005). http://www.nap.edu. Accessed September 28, 2011.
deficiency, psychosocial problems, and poor academic
11. Guenther PM, Dodd KW, Reedy J, et al. Most Americans eat much less than
performance. All of these can lead to the development recommended amounts of fruits and vegetables. J Am Diet Assoc. 2006; 106: 1371-1379.

of chronic disease. School lunch and breakfast 12. Nielsen SJ, Poplin BM. Changes in beverage intake between 1977 and 2001. Am J
Prev Med. 2004; 27: 205-210.
programs are available to children in need, and have a 13. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. 2011.
positive impact on the health of participating youth. http://www.nap.edu. Accessed October 3, 2011.
14. Birch LL, Marlin DW. I don’t like it; I never tried it; Effects of exposure on two-year-
old children’s food preferences. Appetite. 1982; 3: 353-360.
The USDA Food Guide Pyramid and MyPlate, and the
15. American Dietetic Association Position of the American Dietetic Association: Child
Harvard Healthy Eating Plate are credible sources and Adolescent Nutrition Assistance Programs. J Am Diet Assoc. 2010; 110: 791-799.

that contain healthy eating patterns, tools, and other 16. Centers for Disease Control and Prevention. Growth Charts http://www.cdc.gov/
growthcharts. Accessed 12/1/11.
resources to encourage healthful eating and regular 17. Gilman MW, Rifas-Shiman SL, Frazier AL, et al. Family dinner and diet quality
among older children and adolescents. Arch Fam Med. 2000; 9: 235-240.
physical activity. Daily moderate or vigorous activity
18. Barlow SE, et al. Expert committee recommendations regarding the prevention,
for at least 60 min is recommended for all children. assessment and treatment of child and adolescent overweight and obesity: Summary
report. Pediatrics. 2007; 120: S164-S192.
This is an excellent way to increase energy expenditure
19. American Academy of Pediatrics, Committee on Public Education. Children,
and help maintain a healthy body weight. adolescents and television. Pediatrics. 2001; 107: 423-426.
20. Moran R. Evaluation and treatment of childhood obesity. American Family
However, youth who exercise are more prone to Physician. February 15, 1999; http://aafp.org/afp/990215ap/861.html. Accessed June
30, 2003.
dehydration and heat illness than adults. Therefore, 21. Anderson SJ, Griesemer BA, Johnson MD, et al. Climatic heat stress and the
exercising child and adolescent. Pediatrics. 2000; 106; 158-159.
health and fitness professionals need to take the
22. Binkley HM, Beckett J, Casa DJ, et al. National Athletic Trainers’ Association position
appropriate steps to ensure that youth receive proper statement: exertional heat illnesses. J of Athletic Training. 2002; 37 (3): 329-343.

hydration and rehydration, have access to water or 23. Sawka MN, Burke, LM, Eichner, R, et al. American College of Sports Medicine.
Position Stand: Exercise and Fluid Replacement. Med Sci Sports Exerc. 2007. http://
a carbohydrate-electrolyte beverage, have proper www.acsm-msse.org. Accessed 12/1/11.
NASM YOUTH EXERCISE SPECIALIST 80

CHAPTER 12: PROFESSIONAL DEVELOPMENT

Learning Objectives Legal and Ethical Responsibilities

After completing this chapter, you will: When a client engages in exercise and accepts training
services, he or she assumes a certain degree of risk,
⦁⦁ Understand the legal and ethical
such as sustaining an injury while performing an
responsibilities related to a health and fitness
exercise. In the case of a youth, a parent or legal
professional working with youth.
guardian must sign a consent form on behalf of
⦁⦁ Understand the NASM Code of Professional the youth.
Conduct and apply this code when working
with youth. Health and fitness professionals have a duty to use
reasonable care to prevent and avoid risk of injury or
⦁⦁ Be able to identify unique marketing
harm to the youth (1). Duty is established and based
opportunities and implement various strategies
upon legal standards of care set forth by the health
to expand your clientele to include youth.
and fitness profession. Certified health and fitness
professionals are responsible for following NASM
Introduction standards as published within the National Academy of
Sports Medicine Board of Certification (NASM-BOC)
A health and fitness professional must understand
Code of Professional Conduct (2). By upholding high
and practice legal and ethical responsibilities when
ethical and professional standards, NASM ensures
working with youth. Health and fitness professionals
consistency and excellence for the entire health and
need to be aware of the physical capabilities of a youth
fitness profession. Some of the key components to this
client and take adequate steps to avoid injury or harm
code of conduct are listed below.
to the client as well as litigation. They additionally
must be mindful of the ethical responsibilities of an In following and adhering to the NASM–BOC Code of
NASM-certified health and fitness professional. Professional Conduct, NASM personal trainers must:

From a business standpoint, the professional must 1. Maintain their competencies through continuing
be able to employ strategies to allow for visibility and education.
capitalize on opportunities presented, especially when 2. Adhere to safe and ethical training practices
there is a high demand for the service. (e.g., OSHA).
NASM YOUTH EXERCISE SPECIALIST 81

3. Adhere to strict facility maintenance (e.g., ⦁⦁ Records of visits and activities of each visit
equipment, safety, layout, disinfection). ⦁⦁ Documentation of incidents, injuries, and
4. Understand scope of practice with respect to special significant events
considerations for training diverse clientele (e.g., age,
Keep the files in a secure, locked location to maintain
sex, cultural background, ability).
confidentiality. Conduct initial assessments, such as the
5. Clearly understand the role and professional medical history questionnaire, at least once a year, and
limitations of a personal trainer (e.g., referral to keep the results in the file. If any changes in the youth’s
registered dieticians, allied health care professionals). status warrant physician consent or parental reconsent,
6. Adhere to the following professionalism and ethical obtain these prior to continuing with training.
business practices:
a. Liability insurance Marketing Services
b. Record keeping A common question is how to market oneself and put
c. Medical clearance these skills into action. This section details simple
suggestions to help health and fitness professionals
d. Physical appearance and attire
use their new skills and market themselves to the
e. Timeliness youth population.
f. Sexual harassment awareness
Having a specialty or a niche is a great way to help stand
g. Client confidentiality (e.g., HIPAA) out and provide a unique product in a competitive
For a complete transcript of the NASM Code of market. Specialized training, such as this course,
Professional Conduct visit www.nasm.org. should bestow the confidence to work with a target
population. Targeting a specific category with many
potential clients and very few other trainers can
Importance of Documentation position the fitness professional to dominate a specific
To avoid litigation, the health and fitness professional niche and greatly improve earning potential. It is
should document as much as possible. Documentation essential to market the services to the community.
is powerful against litigation. Organizing and
maintaining documentation of all youth and legal ■■ Strategies to Build Your Business
guardian interaction is imperative. To do this, The list below highlights suggested target areas to begin
create a file for each client. The file should include marketing efforts. By networking with individuals
the following: in these groups and locations, the health and fitness
⦁⦁ Initial assessment results professional can quickly spread the word about skills,
services offered, and expertise.
$$ Physical Activity Readiness Questionnaire
(PAR-Q) ⦁⦁ Parents — Start with parents! Often the health
and fitness professional is already training the
$$ Medical history
parents. Inform them that services extend to
$$ Physician release their children as well.
$$ Signed liability waiver or informed consent, ⦁⦁ Schools — Local grammar, junior, and senior
signed by legal guardian high schools are also a great place to market
$$ Results of all baseline physiological and youth training services. Talk with physical
functional measures education (PE) teachers or athletic directors
NASM YOUTH EXERCISE SPECIALIST 82

about offered services. This may involve The parents’ or youths’ first-hand endorsement
volunteering to lead a PE class at a local school or of services will go a long way in generating new
giving a health promotion lecture to a health class. business and reaching many people.
⦁⦁ Workshops — Health and fitness professionals ⦁⦁ Church — Advertise services in local church
can provide complimentary in-house member bulletins. This low-cost form of advertising
workshops at their training venue. By providing allows a health and fitness professional a way of
information on the benefits of exercise for getting his or her name in front of many potential
youth and discussing the provided services, customers in a low-pressure environment.
current members and parents learn the value of ⦁⦁ Competitive rates — Be creative with rates,
working with a health and fitness professional especially in an underserved or lower-to-middle
that specializes in youth fitness. class population. For example, train a small group
⦁⦁ Physicians — The medical community can of youth and charge a set rate for the session, but
always be a source of help in growing a training divide the cost among the members of the group.
business. Many youth are already under the It allows the health and fitness professional to
attention of a medical professional (e.g., general earn more and hold more sessions throughout the
practitioners and pediatricians). Often, these day, while allowing clients to spend less.
doctors are actively involved in an exercise
program themselves and may even using the Summary
facility the health and fitness professional
Health and fitness professionals must be cognizant of
already uses to train his or her clients.
the various legal and ethical responsibilities they have to
Volunteering to train medical professionals for
youth clients and the profession as a whole. They should
free can produce great results in gaining their
be aware of the youth’s needs and avoid causing injury
trust as well as their referrals. If none frequent
or harm, but also protect their own interests to avoid
the training facility, the health and fitness
potential litigation. Keeping precise documentation is
professional should proactively contact their
the best way to avoid litigation.
offices and inform them of offered services.
⦁⦁ Community — Community gatherings are also Training youth is considered a specialty or a niche and
an excellent venue for generating new business helps health and fitness professionals stand out and
and interest. Whether it is having a table at a provide a unique product in a competitive market. This
farmer’s market or a town festival, or simply course was designed to empower the health and fitness
placing brochures at the local youth centers, the professional to work with youth in almost any setting.
word will spread. The key to marketing services is getting out in the
community and networking with various groups that may
⦁⦁ Web — Posting a listing describing services and
be interested. By networking with individuals in these
expertise on local forum-based websites or using
groups and locations, the health and fitness professional
social media also works well for advertising.
can quickly spread the word about skills, services offered,
⦁⦁ Referrals — Once the health and fitness and expertise in what may be an underserved market.
professional has established several regular
clients, he or she should tell friends and
neighbors about the services provided. Offer a
References
1. Allen JV. Legal Standards, Risk Management, and Professional Ethics. In: Jones CJ,
“bring a friend for free” special or offer some Rose DJ, eds. Physical Activity Instruction for Older Adults. Champaign, IL: Human
Kinetics, 2005: 352-363.
sort of benefit (e.g., free training session) for
2. Clark MA, Lucett SC, Corn RJ. NASM Essentials of Personal Fitness Training. 3rd ed.
every new client that an existing client brings. Baltimore, MD: Lippincott, Williams, and Wilkins, 2008.
NASM YOUTH EXERCISE SPECIALIST 83

APPENDIX A: NASM CODE OF PROFESSIONAL CONDUCT

The following code of conduct is designed to assist procedures prescribed and supervised by a
certified members of the National Academy of Sports valid licensed medical professional, or if the
Medicine Board of Certification (NASM-BOC) to certified or noncertified member is legally
maintain (both as individuals and within an industry) licensed to do so and is working in that capacity
the highest levels of professional and ethical conduct. at that time.
This Code of Professional Conduct reflects the level
c. Not begin to train a client prior to receiving
of commitment and integrity necessary to ensure that
and reviewing a current health history
all NASM-BOC certified members provide the highest
level of service and respect for all colleagues, allied questionnaire signed by the client.
professionals and the general public d. Hold a current cardio pulmonary resuscitation
(CPR) and automated external defibrillator
Professionalism (AED) certification at all times.

Each certified member must provide optimal 7. Refer the client to the appropriate medical
professional service and demonstrate excellent client practitioner when, at a minimum, the certified or
care in their practice. Each member must: noncertified member:

1. Abide fully by the NASM-BOC Code of Professional a. Becomes aware of any change in the client’s
Conduct. health status or medication.
b. Becomes aware of an undiagnosed illness,
2. Conduct themselves in a manner that merits the
injury, or risk factor.
respect of the public, other colleagues, and NASM.
c. Becomes aware of any unusual client pain or
3. Treat each colleague and client with the utmost
discomfort during the course of the training
respect and dignity.
session that warrants professional care after
4. Not make false or derogatory assumptions the session has been discontinued and assessed.
concerning the practices of colleagues and clients.
8. Refer the client to other healthcare professionals
5. Use appropriate professional communication in all when nutritional and supplemental advice is requested
verbal, nonverbal, and written transactions. unless the certified or noncertified member has been
specifically trained to do so or holds a credential to do
6. Provide and maintain an environment that ensures
so and is acting in that capacity at the time.
client safety that, at minimum, requires that the
certified and non-certified member must: 9. Maintain a level of personal hygiene appropriate for a
a. Not diagnose or treat illness or injury unless health and fitness setting.
for basic first aid or if the certified member is
10. Wear clothing that is clean, modest, and
legally licensed to do so and is working in that
professional.
capacity at that time.
b. Not train clients with a diagnosed health 11. Remain in good standing and maintain current
condition unless the certified member has certification status by acquiring all necessary
been specifically trained to do so, is following continuing-education requirements.
NASM YOUTH EXERCISE SPECIALIST 84

Confidentiality Business Practice

Each certified professional must respect the Each certified or noncertified member must practice
confidentiality of all client information. In his or her with honesty, integrity, and lawfulness. In his or her
professional role, the certified professional must: professional role, the certified professional must:
1. Protect the client’s confidentiality in conversations, 1. Maintain adequate liability insurance.
advertisements, and any other arena, unless otherwise
agreed to by the client in writing, or as a result of 2. Maintain adequate and truthful progress notes for
medical or legal necessity. each client.

2. Protect the interest of clients who are minors by law, 3. Accurately and truthfully inform the public of
or who are unable to give voluntary consent by securing services rendered.
the legal permission of the appropriate third party or
guardian. 4. Honestly and truthfully represent all professional
qualifications and affiliations.
3. Store and dispose of client records in secure manner.
5. Advertise in a manner that is honest, dignified, and
Legal and Ethical representative of services that can be delivered without
the use of provocative or sexual language or pictures.
Each certified or noncertified member must comply
with all legal requirements within the applicable 6. Maintain accurate financial, contract, appointment,
jurisdiction. In his or her professional role, the certified and tax records including original receipts for a
or noncertified member must: minimum of four years.

1. Obey all local, state, provincial, or federal laws. 7. Comply with all local, state, federal, or providence
laws regarding sexual harassment.
2. Accept complete responsibility for his or her actions.
The NASM-BOC expects each professional to uphold
3. Maintain accurate and truthful records.
the Code of Professional Conduct in its entirety. Failure
4. Respect and uphold all existing publishing and to comply with the NASM-BOC Code of Professional
copyright laws. Conduct may result in disciplinary actions including
5. Not be convicted of, plead guilty to, or plead nolo but not limited to suspension or termination of
contendere (no contest) to a felony. Not be convicted of, membership and/or certification. All members are
plead guilty to, or plead nolo contendere (no contest) to obligated to report any unethical behavior or violation
a misdemeanor. Misdemeanors may be appealed to the of the Code of Professional Conduct by other certified
NASM-BOC by the candidate. NASM-BOC professionals.
NASM YOUTH EXERCISE SPECIALIST 85

APPENDIX B: YOUTH ACTIVITY INTEREST CHECKLIST

Currently Don’t do, Don’t do,

do regularly Do occasionally Do rarely but interested not interested
Aerobics
Baseball/softball
Basketball
Bicycing
Bowling
Canoeing/kayaking
Dancing (e.g., jazz)
Football
Frisbee
Hiking
Ice skating
Jumping rope
Karate/martial arts
Rock climbing
Rollerblading
Running (e.g., 5K)
Skateboarding
Skiing/snowboarding
Soccer
Swimming
Tennis
Traveling
Volleyball
Walking
Weight training
Yoga
Other activities of interest: __________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________
NASM YOUTH EXERCISE SPECIALIST 86

APPENDIX C: PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

Name: ______________________________________________________________ Date: __________________________________

Height: ___________________________ Weight: ____________________________ Age: __________________________________

Physician’s name: _____________________________________________________ Phone: ________________________________

Questions Yes No
1. Has your doctor ever said that you have a heart condition and that you should only perform physical
activity recommended by a doctor?
2. Do you feel pain in your chest when you perform physical activity?
3. In the past month, have you had chest pain when you were not performing any physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
7. Do you know of any other reason why you should not engage in physical activity?
If you answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which
questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.
NASM YOUTH EXERCISE SPECIALIST 87

APPENDIX D: GENERAL AND MEDICAL HISTORY QUESTIONNAIRE

Date: __________________

I.  Participant Information

Last name: _________________________________________ First name: _____________________________

Address: _________________________________________________________________________________
Number Street City State ZIP

Email: ____________________________________

Home phone: (_______) _____________________ Cell phone: (_______)_____________________

Birthdate: ____/____/_______ Age: _____________ Gender: ______________

Month Day Year

Estimated height: __________ Estimated weight: ________________________

Primary physician: __________________________________ (_______)______________________________

Name Phone number

II.  Medical History

Do you have a history of any of the following? (Yes to one of any of the below indicates a high risk condition
and/or a major sign or symptom of a known cardiovascular, pulmonary, or metabolic disease. Therefore we
recommend consulting your physician before beginning a training program.)

Y/N Heart problems (please specify) Y/N Metabolic disease (please specify)
Heart/vascular disease, heart attack, angina Kidney disease
Coronary angioplasty/cardiac surgery Thyroid or metabolid disorder
Rapid heartbeats/palpitations Y/N Other (please specify)
Heart murmurs or unusual cardiac findings Major surgery/hospitalization
Peripheral vascular disease Chest discomfort at rest or during exertion
Stroke Fainting or dizziness
Other Unusual fatigue or shortness of breath
Y/N Respiratory problems (please specify) Ankle swelling
Asthma Pregnancy (current)
Chronic bronchitis Musculoskeletal/joint issues/injuries
Emphysema or COPD
Other
NASM YOUTH EXERCISE SPECIALIST 88

Please explain anything marked as YES on previous page.

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Please indicate any medications that you are taking below.

Medication/dosage: __________________________ Purpose: _____________________________________

Medication/dosage: __________________________ Purpose: _____________________________________

Medication/dosage: __________________________ Purpose: _____________________________________

Medication/dosage: __________________________ Purpose: _____________________________________

IV.  Recreational Activities and Behaviors

List your current hobbies or sports.

Activity: ______________________________________________________________

Activity: ______________________________________________________________

Activity: ______________________________________________________________

V.  Informed Consent

By signing this document, I acknowledge that I have voluntarily chosen to participate in a program of progressive
physical exercise. In signing this document, I acknowledge being informed of the nature of the program and the
potential for unusual but possible physiological results including, but not limited to, abnormal blood pressure, fainting,
heart attack, or death. By signing this document, I assume all risk for my health and well-being and hold harmless of any
responsibility the instructor, facility, or any persons involved with this program and testing procedures.

Parent or guardian signature: _______________________________________________________________

Trainer name: ___________________________________________________________________________

Referral name: ___________________________________________________________________________

In case of emergency contact: _______________________________________________________________

NASM YOUTH EXERCISE SPECIALIST 89

APPENDIX E: DURNIN–WOMERSLEY BODY FAT PERCENTAGE CALCULATION

Sum of folds (in mm) Males Females Sum of folds (in mm) Males Females
5 –7.23 –2.69 105 28.42 36.74
10 0.41 5.72 110 29.00 37.40
15 5.00 10.78 115 29.57 38.03
20 8.32 14.44 120 30.11 38.63
25 10.92 17.33 125 30.63 39.21
30 13.07 19.71 130 31.13 39.77
35 14.91 21.74 135 31.62 40.31
40 16.51 23.51 140 32.08 40.83
45 17.93 25.09 145 32.53 41.34
50 19.21 26.51 150 32.97 41.82
55 20.37 27.80 155 33.39 42.29
60 21.44 28.98 160 33.80 42.75
65 22.42 30.08 165 34.20 43.20
70 23.34 31.10 170 34.59 43.63
75 24.20 32.05 175 34.97 44.05
80 25.00 32.94 180 35.33 44.46
85 25.76 33.78 185 35.69 44.86
90 26.47 34.58 190 36.04 45.25
95 27.15 35.34 195 36.38 45.63
100 27.80 36.06 200 36.71 46.00
NASM YOUTH EXERCISE SPECIALIST 90

APPENDIX F: YOUTH BMI TABLES

Males, 6-18 years

5th 10th 25th 50th 75th 85th 90th 95th
Age percentile percentile percentile percentile percentile percentile percentile percentile
(in years) BMI value BMI value BMI value BMI value BMI value BMI value BMI value BMI value
6 13.73624 14.03772 14.6112 15.38353 16.36346 17.01418 17.52335 18.41421
7 13.72113 14.04216 14.66082 15.51287 16.63112 17.40122 18.02183 19.15236
8 13.79575 14.14712 14.82965 15.78231 17.05799 17.95575 18.69225 20.06793
9 13.96212 14.34903 15.10433 16.16712 17.60683 18.63222 19.48149 21.08893
10 14.21866 14.6426 15.4727 16.64614 18.24521 19.39041 20.3427 22.15409
11 14.56001 15.02022 15.92268 17.20089 18.94588 20.19667 21.23679 23.21358
12 14.97745 15.47187 16.44158 17.81463 19.68614 21.02386 22.1329 24.22985
13 15.45918 15.9852 17.01583 18.4718 20.44731 21.85104 23.00842 25.17811
14 15.99065 16.54568 17.63086 19.15759 21.21433 22.66325 23.84887 26.04662
15 16.55481 17.1367 18.27093 19.85766 21.97532 23.45117 24.64778 26.83688
16 17.1325 17.73974 18.919 20.55765 22.72115 24.21087 25.40668 27.56393
17 17.70284 18.33444 19.55629 21.24248 23.4449 24.94362 26.13515 28.25676
18 18.24349 18.89854 20.1619 21.89587 24.14166 25.65601 26.8512 28.95862
Table adapted from Centers for Disease Control and Prevention, National Center for Health Statistics – Data Table of BMI-for-age Charts
http://www.cdc.gov/growthcharts/html_charts/bmiagerev.htm. Accessed 3/7/2012.

Females, 6-18 years

5th 10th 25th 50th 75th 85th 90th 95th
Age percentile percentile percentile percentile percentile percentile percentile percentile
(in years) BMI value BMI value BMI value BMI value BMI value BMI value BMI value BMI value
6 13.42587 13.74694 14.36552 15.2169 16.33273 17.09974 17.71678 18.83778
7 13.43276 13.7919 14.48765 15.45357 16.73462 17.62557 18.34873 19.67794
8 13.5405 13.94445 14.73005 15.827 17.29206 18.31718 19.15262 20.69525
9 13.74413 14.19478 15.07378 16.30609 17.95912 19.11937 20.06647 21.81725
10 14.03535 14.531 15.49992 16.86231 18.6952 19.984 21.03669 22.98258
11 14.4029 14.93913 15.98919 17.46907 19.46462 20.86984 22.01829 24.14141
12 14.83262 15.40311 16.52179 18.10149 20.23648 21.74263 22.97493 25.25564
13 15.30749 15.90476 17.07738 18.73643 20.98472 22.57506 23.87895 26.2988
14 15.80753 16.42378 17.63509 19.35257 21.68819 23.34689 24.71141 27.25597
15 16.30974 16.93767 18.1736 19.93057 22.3309 24.04503 25.46204 28.12369
16 16.78787 17.42171 18.67121 20.45326 22.90219 24.66372 26.12945 28.90981
17 17.21234 17.84878 19.10585 20.90576 23.39696 25.20482 26.72125 29.6335
18 17.55015 18.18937 19.45491 21.27532 23.81564 25.67786 27.25433 30.32554
Table adapted from Centers for Disease Control and Prevention, National Center for Health Statistics – Data Table of BMI-for-age Charts
http://www.cdc.gov/growthcharts/html_charts/bmiagerev.htm. Accessed 3/7/2012.
NASM YOUTH EXERCISE SPECIALIST 91

APPENDIX G: BOYS' BMI-FOR-AGE PERCENTILES

NASM YOUTH EXERCISE SPECIALIST 92

APPENDIX H: GIRLS' BMI-FOR-AGE PERCENTILES

NASM YOUTH EXERCISE SPECIALIST 93

APPENDIX I: OVERHEAD SQUAT SOLUTIONS TABLE

Probable Probable Example flexibility Example

overactive underactive exercise (SMR & strengthening
View Checkpoint Compensation muscles muscles static) exercise
Foot Turns outward Soleus Med. gastrocnemius Calf stretch Single-leg
Lat. gastrocnemius Med. hamstring Hamstring stretch balance reach
Bicep femoris Gracilis Standing TFL stretch
(short head) Sartorius
Anterior

Popliteus
Knee Moves inward Adductor complex Gluteus medius/ Adductor stretch Lateral tube
Bicep femoris maximus Hamstring stretch walking
(short head) Vastus medialis TFL stretch Ball squat w/
Tensor fascia latae oblique (VMO) abduction
(TFL) Ball bridge w/
Vastus lateralis abduction

Lumbo-pelvic Excessive Soleus Anterior tibialis Calf stretch Ball squat

hip complex forward lean Gastrocnemius Gluteus maximus Hip flexor stretch
Hip flexor complex Erector spinae Ball abdominal
Abdominal complex stretch
(rectus abdominus,
external oblique)
Low back arches Hip flexor complex Gluteus maximus Hip flexor stretch Ball squat
Erector spinae Hamstrings Latissimus dorsi Floor bridge
Latissimus dorsi Intrinsic core stretch Ball bridge
stabilizers Erector spinae
(transverse stretch
abdominis,
multifidus,
internal oblique,
transversospinalis,
pelvic floor
Lateral

muscles)
Upper Body Arms fall forward Latissumus dorsi Mid/lower trapezius Latissumus dorsi Floor cobra
Pectoralis major/ Rhomboids stretch Ball cobra
minor Rotator cuff Pec stretch Squat to row
Teres major SMR thoracic spine
Forward head Upper trapezius Deep cervical Levator scapula Tuck chin,
(pushing/pulling Sternocleidomastoid flexors stretch keeping head in
assessment) Sternocleidomastoid neutral position
Levator scapuale stretch during all
exercises
Scalene stretch
Shoulder Upper trapezius Mid/lower trapezius Upper trapezius Floor cobra
elevation Sternocleidomastoid stretch Ball cobra
(pushing/pulling Sternocleidomastoid
assessment) Levator scapuale stretch
Levator scapulae
stretch
NASM YOUTH EXERCISE SPECIALIST 94

APPENDIX J: OPT SAMPLE PROGRAMMING TEMPLATE

Professional’s name:
Client’s name: Date:
Goal: Phase:
Warm-up
Exercise Sets Duration Coaching tip

Core/Balance/Plyometric
Exercise Sets Reps Tempo Rest Coaching tip

Speed/Agility/Quickness
Exercise Sets Reps Tempo Rest Coaching tip

Resistance
Exercise Sets Reps Tempo Rest Coaching tip

Cool-down
Exercise Sets Duration Coaching tip

Coaching tips:
NASM YOUTH EXERCISE SPECIALIST 95

APPENDIX K: USDA FOOD PATTERNS

The Food Patterns suggest amounts of food to consume foods in each group (e.g., lean meats and fat-free milk).
from the basic food groups, subgroups, and oils to meet The table also shows the number of calories from solid
recommended nutrient intakes at 12 different calorie fats and added sugars (SoFAS) that can be accommodated
levels. Nutrient and energy contributions from each group within each calorie level, in addition to the suggested
are calculated according to the nutrient-dense forms of amounts of nutrient-dense forms of foods in each group.

Daily Amount of Food From Each Group

Calorie level1 1,000 1,200 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 3,200
1 cup 1 cup 1½ 1½ 1½ 2 2 2 2 2½ 2½ 2½
Fruits 2
cups cups cups cups cups cups cups cups cups cups
1 cup 1½ 1½ 2 2½ 2½ 3 3 3½ 3½ 4 4
Vegetables 3
cups cups cups cups cups cups cups cups cups cups cups
3 4 5 5 6 6 7 8 9 10 10 10
Grains4 oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq
2 3 4 5 5 5½ 6 6½ 6½ 7 7 7
Protein foods5 oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq oz-eq
2 2½ 2½ 3 3 3 3 3 3 3 3 3
Dairy6 cups cups cups cups cups cups cups cups cups cups cups cups
Oils7 15 g 17 g 17 g 22 g 24 g 27 g 29 g 31 g 34 g 36 g 44 g 51 g
Limit on calories 137 121 121 121 161 258 266 330 362 395 459 596
from SoFAS8
1
Calorie Levels are set across a wide range to accommodate the needs of different individuals. The following table “Estimated Daily Calorie Needs” can
be used to help assign individuals to the food pattern at a particular calorie level.
2
Fruit Group includes all fresh, frozen, canned, and dried fruits and fruit juices. In general, 1 cup of fruit or 100% fruit juice, or ½ cup of dried fruit can be
considered as 1 cup from the fruit group.
3
Vegetable Group includes all fresh, frozen, canned, and dried vegetables and vegetable juices. In general, 1 cup of raw or cooked vegetables or
vegetable juice, or 2 cups of raw leafy greens can be considered as 1 cup from the vegetable group.
4
Grains Group includes all foods made from wheat, rice, oats, cornmeal, and barley, such as bread, pasta, oatmeal, breakfast cereals, tortillas, and grits.
In general, 1 slice of bread, 1 cup of ready-to-eat cereal, or ½ cup of cooked rice, pasta, or cooked cereal can be considered as 1 ounce-equivalent from
the grains group. At least half of all grains consumed should be whole grains.
5
Protein Foods Group includes meat, poultry, seafood, eggs, processed soy products, and nuts and seeds. In general, 1 ounce of lean meat, poultry, or
seafood, 1 egg, 1 tbsp peanut butter, or ½ ounce of nuts or seeds can be considered as 1 ounce-equivalent from the protein foods group. Also, ¼ cup of
beans or peas may be counted as 1 ounce-equivalent in this group.
6
Dairy Group includes all milks, including lactose-free products and fortified soymilk (soy beverage), and foods made from milk that retain their calcium
content, such as yogurt and cheese. Foods made from milk that have little to no calcium, such as cream cheese, cream, and butter, are not part of the
group. Most dairy group choices should be fat-free or low-fat. In general, 1 cup of milk or yogurt, 1½ ounces of natural cheese, or 2 ounces of processed
cheese can be considered as 1 cup from the dairy group.
7
Oils include fats from many different plants and from fish that are liquid at room temperature, such as canola, corn, olive, soybean, and sunflower oil.
Some foods are naturally high in oils, like nuts, olives, some fish, and avocados. Foods that are mainly oil include mayonnaise, certain salad dressings, and
soft margarine.
8
SoFAS are solid fats and added sugars. The limits for calories from SoFAS are the remaining amount of calories in each food pattern after selecting the
specified amounts in each food group in nutrient-dense forms (forms that are fat-free or low-fat and with no added sugars).
NASM YOUTH EXERCISE SPECIALIST 96

Vegetable Subgroup Amounts Per Week

Calorie Level 1,000 1,200 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 3,200
Dark-green ½ cup 1 cup 1 cup 1½ 1½ 1½ 2 2 2½ 2½ 2½ 2½
vegetables cups cups cups cups cups cups cups cups cups
Red and orange 2½ 3 3 cups 4 5½ 5½ 6 6 7 7 7½ 7½
vegetables cups cups cups cups cups cups cups cups cups cups cups
Beans and peas ½ cup ½ cup ½ cup 1 cup 1½ 1½ 2 2 2½ 2½ 3 3
(pintos, lentils) cups cups cups cups cups cups cups cups
Starchy 2 3½ 3½ 4 5 5 6 6 7 7 8 8
vegetables cups cups cups cups cups cups cups cups cups cups cups cups
Other 1½ 2½ 2½ 3½ 4 4 5 5 5½ 5½ 7 7
vetetables cups cups cups cups cups cups cups cups cups cups cups cups

Protein Foods Subgroup Amounts Per Week

Calorie level 1,000 1,200 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 3,200
Seafood 3 oz 5 oz 6 oz 8 oz 8 oz 8 oz 9 oz 10 oz 10 oz 11 oz 11 oz 11 oz
Meat, poultry, 10 oz 14 oz 19 oz 24 oz 24 oz 26 oz 29 oz 31 oz 31 oz 34 oz 34 oz 34 oz
eggs
Nuts, seeds, soy 1 oz 2 oz 3 oz 4 oz 4 oz 4 oz 4 oz 5 oz 5 oz 5 oz 5 oz 5 oz

Calorie Range Estimated Daily Calorie Needs

Children Sedentary Active To determine which food intake pattern to use for
2-3 years 1,000 1,400 an individual, the adjacent chart gives an estimate of
Females individual calorie needs. The calorie range for each
4-8 years 1,200 1,800 group is based on physical activity level, from sedentary
to active.
9-13 years 1,600 2,200
4-18 years 1,800 2,400 Sedentary means a lifestyle that includes only the
Males light physical activity associated with typical day-to-
day life.
4-8 years 1,400 2,000
9-13 years 1,800 2,600 Active means a lifestyle that includes physical activity
4-18 years 2,200 3,200 equivalent to walking more than 3 miles per day at 3 to
SOURCE: USDA Food Patterns. U.S Department of Agriculture. 4 miles per hour, in addition to light physical activity
Available at http://www.cnpp.usda.gov/Publications/ associated with typical day-to-day life.
USDAFoodPatterns/USDAFoodPatternsSummaryTable.pdf.
Accessed March 1, 2012.