"What a great opportunity it has been to take and complete your course. After 5 years of university education that i now hardly remember, my faith has been renewed in the possibility of rational and meaningful education. I Thank you." Moosa Alissa

Tom Newton

Client Background
I met Tom and started training him in 2001, when he was 53 years old. He was looking for directions in fitness training to develop his leanness and, most importantly, to improve his health and quality of life. He has a family history of heart disease; his father had a heart attack at the age of 47... and he has been very conscious of the risk if proper exercise and healthy nutritional habits were not kept up. His business involved many trips across the United States throughout years, traveling by flying and long driving, but he was willing to make a commitment to fitness. He had been used to training previously, as he worked with a personal trainer prior to our initial meeting.

Problems To Be Solved
His first measurements were taken in January of 2001, when I taught a resistance-training course for 6 weeks in the local gym in Greensboro, on how to resistance train properly and effectively, in addition to basic nutritional information. He was one of my students in that class. At that time, his body fat % was approximately 25% at a body weight of 185 lbs (46lbs fat mass/139lbs lean mass), measured by skinfold testing. He had some noticeable amount of body fat in his mid-trunk that he worried about, but it was not internal abdominal fat, which is more risky for a heart condition. At the end of the course, his body fat % decreased to 21% at 174 lbs of body weight (37lbs fat mass/137lbs lean mass). His body fat in the trunk also decreased to some degree. After the course ended, he wished to continue with personal training. My job was to make his physique better by reducing body fat further and to maintain or slow the regression of lean mass and, as important, to work on his life habits so as to improve his overall health. I did not obtain his blood work at that time, but I should have.

He has a very busy schedule throughout the week. Finding consistent time to exercise proved to be difficult. At the same time, an appropriate eating plan while on roads needed to be taught. His job requires him to take care and entertain his customers at meetings, dinners, or company parties, and he often consumes alcohol. He needed to control the amount of the consumption if he wanted to reduce body fat further.

Physically, he had two disk surgeries in the region of L4~S1, and has recurrent left elbow tendinitis in the area of medial epicondyle. In addition, he often has neck and low back tightness, mainly due to day long driving, and putting himself in certain positions for prolonged periods (eg. knee in flexed position, hands on stirring wheel with rounded shoulder, etc) .Proper body posture must be trained adequately to educate him on ideal form ,to reduce muscular and joint strain. Exercise choices must be tailored toward reducing the risk of further damage to his spine and joints, and rehabilitating other physical ailments.

Another area in which we must be careful is recovery from physical training. During our training, I immediately noticed that he loves to push extra effort in every exercise as he is used to physical training. Hard training is good, but the total workout demand must be controlled as to avoid overexertion due to his age, but not to become so low in demands that he may decrease his enthusiasm for fitness training. The workout intensity, volume, and frequency of the training must be appropriate for him to avoid overtraining and injuries.

Plan of Action
In his early training, in order to reduce the risk of injuries and strains on his musculoskeltal system, I particularly insisted on him having good posture: neutral position of head, arch in chest, shoulders back and down, etc. Rounded shoulders and torso must be avoided to reduce the strain on his vertebra and spinal muscles. When there is long driving for his business trips, it often results in a tight neck and low back. Regular stretching of his hamstring and hip flexors are also recommended to help this problem. Included exercises are capital flexion/extension, cervical extensions, shoulder retractions, and lumber/hip extensions, recommended three times a week initially and eventually once a week when the demand of the exercises grow stronger. For his elbow tendinitis, I had him stretch wrist flexors and strengthen his extensors by using dumbbell wrist extensions.

He loves weight training and especially loves to train hard. He would push to limit in all the exercises if he was mentally/physically able. I will certainly train him hard, but the levels of total physical demands must be limited due to his age and recovery ability. However, if I were to reduce the workout volume too low, he would not be enthusiastic to workout. Through experiments, I concluded that less than 6 total sets in a workout would decrease his motivation for training. More than 12 sets would fatigue him too much as his heart rate also responded by slowing down during the recovery if such volume of exercises were performed for prolonged periods (eg. more than two weeks). His general workout volume is, therefore, kept at 8-12 sets total based on his intensity of effort (first 7-10 sets were performed with sub-maximum effort, and the last 2-3 sets performed close to muscular failure, depending on his daily condition).

In the 8-12 sets per workout, I planned to have him perform a split workout routine with each body part exercised once every 9-12 days while controlling the workout demand for each body parts (eg. this week will work harder on his triceps, and emphasize his thigh next week, etc). Therefore, actual hard training for each body parts was performed approximately once every 21 days. This rotation and change in physical demands seems to be ideal for someone who wishes to train hard but has slow recovery ability.

The above workout plan is his general routine. I also applied occasional full-body circuit training with the total volume of 10-15 sets, with briefer rest intervals (but lower intensity) in addition to the blitz cycles for two weeks with each cycle performed twice a year. These changes are made to stimulate his muscles and cardiovascular system so that his body will not de-condition from the regular routine. These also make workout sinteresting. In the blitz cycle, many intensity variables are performed in a workout, but with a controlled workout intensity (not pushing to muscular failure until the end of a workout).

In addition to weight training, we made sure that he also incorporated endurance exercises to accelerate calorie expenditure and fat loss. I started him at 20-25 minutes on the elliptical machine, which he liked, with a sustained intensity of 70% of maximum heart rate for the first four weeks. Then we included interval training: changing intensity of the exercise every 2-3 minutes, whereby he incremented the intensity until he achieved 85% of MHR, then reduced his heart rate to 50-60% for a brief recovery. He repeated this process for 25-30 min. I determined that he does not require more than 30 min. of endurance work because he can tolerate high level sof intensity, and this duration of training already resulted in a good amount of fat loss in the first two months while he performed it only 2-3 times a week.

He further refurbished his nutritional habits, choosing ideal healthy foods and coincided the choices with workouts (eg. pre- and post-workout meals). He travels a lot, therefore, having a lunch bag with protein bars and/or fruits were something we talked about in the beginning. He has been able to keep his meal frequency to 4~6 times a day. He has consumed daily multi-vitamin during the busiest time of the day or the time close to a workout, since an increased in stress demands an increase in the need for nutrients. He cut down simple carbohydrate as much as possible except for a post-workout meal, in which he consumed Gatorade or some high glycemic food (eg. banana) to restore muscle glycogen. He mainly consumed complex carbohydrates (eg. whole wheat bread) and protein from poultry, tuna, turkey, egg whites, and MetRx, which are all low in saturated fat. He worried about his blood cholesterol levels, and so the food choices needed to be low in these categories. The only problem can be when he attends company parties to entertain his customers. He has alcohol beverages on these occasions. The alcohol intake needs to be as minimum as possible if he expects significant body fat loss.

Assessment and Results

Date	Weight (lbs)	Body Fat %	Lean (lbs)	Fat (lbs)
January 2001	185	25%	139	46
March 2001	174	21%	137	37
May 2001	164	17%	136	28
2005	161~163	14-16%	136~139	22~24

His body fat percentage was measured by skinfold testing. In addition to the estimation of body fat percentages, I also summed up the thickness of skin (in mm.) to assess his relative fatness. He lost 9 lbs of fat mass when he took my educational course in January. When he started personal training, he had a body fat percentage of approximately 21%, with 137.0 lbs of lean mass and 37.0 lbs of fat mass at a body weight of 174 lbs. The sum of skinfold thickness, taken from his chest, axilla, biceps, triceps, subscapula, supraillium, abdomen, thigh and calf, was 145.1mm. In the next two-month period, his body fat was estimated at 17% (-4 %) with 136.0 lbs (-1.0 lbs) of lean mass and 28 lbs of fat mass (-8.0 lbs), with a body weight of 164.0 lbs (-10.0 lbs). The sum of skinfold thickness at this time was 111.0mm (-34.0mm), estimating that he lost a good amount of body fat while maintaining his lean mass (his upper arms and thighs were 1.0 inch bigger, and 2.0 inch smaller in his mid-trunk). After the initial two month, his rate of body fat loss slowed and eventually maintained over the course of months. His body fat percentage came down to as low as 14% at 162 lbs of body weight.

By 2005, his estimated body fat percentage fluctuated between 14~16%. His lean mass has maintained at 135~138 lbs approximately. Considering his age (now 57), this is in pretty good shape. He seems happy with maintaining his current body weight and fat percentage and feels confident in his looks. Over the course of years, he seemed to regain body fat in around December~February when his job stress increases and he spends more time out of town for business reasons. His regular workout pattern and eating habits are negatively affected during this period. We had a discussion on this problem, when his amount of physical activity slows and proper eating habits fluctuate. He currently realizes this pattern and manages it well.

He does not have tendinitis in his elbow any more. He has no orthopaedic problems except occasional back/neck tightness after long driving from business trips. Yet, I encourage him to still perform exercises that are intended to prevent future injuries and joint deterioration. He should continue to stretch his tight hamstring, hip flexors, and anterior shoulder capsule and strengthen cervical and lumber extensors. He is extremely happy with his current health status: the results of his annual visit to a family physician have suggested 'normal ' in all the physiological aspects, which include kidney, liver, thyroid functions, as well as blood cholesterol and sugar levels. Maintaining health is very important to him due to the known risk of heart disease in his family. At work, he provides the best performance in his company, having received the employee of the year in 2005, in which he won a Porsche as a prize... and this is not the first time he received the award. The hardest worker requires optimum health conditions, and he has been bringing his best effort in everything, from work and family to workouts in the gym. He has been an absolute winner.

Lessons Learned from Mistakes
I had to be careful about balancing his motivation for training and his recovery ability. He is over 50, but he has the kind of personality that brings his best effort into training; to push every set to muscular failure. Earlier in his training, I pushed him too much, and his recovery was not catching up to the physical strain of exercise; his resting heart rate was slower to come down after training; he became quicker to fatigue in workouts with some decrease in his strength; neck and low back tightness were evident after workouts, etc. Still, he loved to push hard. Consequently, I had to learn to control his physical effort to prevent him from overtraining, and irritation of injuries by changing up the demands of the workouts in a cyclic manner, including more sub-maximum effort with a circuit type of training and some intensity variables (in addition to occasional week off from weight training). I explained the purpose of controlling his effort and physiological recovery for a long-tern benefit, so that he will continue to progress or maintain his physical abilities and to prevent joint deteriorations and injuries. At this time in his life, improving the quality of life is more important. Pushing to his physical limits with the risk of injury does not seem to be appropriate.