18-Unit 1 Anatomy and Physiology For Health and Exercise

Unit One
Anatomy and
Physiology for Health
and Exercise
Anatomy and Physiology for Health and Exercise
Aim: to provide the learner with all the relevant information regarding anatomy and
physiology and the workings of the human body to support the role of a fitness
professional in advising and guiding clients in exercise and health.
.
Learning outcomes
At the end of this unit the learner will understand:
• the heart and circulatory system and its relation to exercise and health
• the musculoskeletal system and its relation to exercise postural and core
stability
• the nervous system and its relation to exercise
• the endocrine system and its relation to exercise
• energy systems and their relation to exercise
Copyright © 2010 Active IQ Ltd. Manual not for resale

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Level 3 Certificate in Personal Training - Manual
The skeletal system
The skeletal system is the foundation on which all movement is based. Knowledge
of its structure and function will, therefore, allow a greater understanding of exercise.
This section will cover the following areas:
• the physiology of bone tissue

• classification and structure of bones
• the anatomy of the skeleton
• the vertebral column
Bone physiology
Bone consists of a mixture of water, protein and mineral salts, the latter of which
constitutes roughly 50% of its structure. Bone strength is the result of a combination
of the hardness of these minerals combined with the tensile properties of collagen
(derived from protein). Too little of one (e.g. collagen) and the bone will shatter like
an egg shell, too little of the other (e.g. mineral salts) and bone will bend like a piece
of rubber.
50% mineral salts 25% water
25% protein
Ossification: the process of bone formation

Although bone is rigid, it behaves like any other living tissue, constantly being broken
down, rebuilt and adapting to the stresses placed on it (Meyers, 2001). The process
of bone formation is called ossification and as Tortora and Grabowski (1996) note,
it begins in the womb and continues throughout adult life.
The hardening and growth process involves replacing a cartilage ‘framework’ with
mineral salts. Bones of young children are softer than those of adults because they
still contain significant proportions of cartilage. The hardening process may not be
complete until 30 years of age. So, in early life, the emphasis of ossification is very
much on bone growth and bone hardening, whereas the process in adulthood is
more geared towards replacing and maintaining existing bone material. Whilst there
is quite a diversity of cells involved in the bone formation process, the primary cells
involved in bone growth are osteoblasts, which function to replace worn out or
damaged bone tissue. Their activity is coordinated with that of the osteoclast cells,
which remove the old bony tissue.
Maintenance of a healthy skeletal system is dependant upon a balance of osteoblast

and osteoclast activity. This can vary according to the region of bone concerned;
the end of the femur for example, can be completely remodelled every few months,
which contrasts with the bone shafts which may never be fully remodelled (Tortora
and Graboswki, 1996).

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It is also worth noting that remodelling will tend to follow the lines of stress placed
upon the bone (Meyers, 2001). Exercise and habitual posture therefore, have a
fundamental influence over the health of the skeletal system. Incorrect exercise
technique coupled with a generally poor alignment, will lead to a remodelling
process that may reinforce the predominating bad posture (Meyers, 2001; Schultz
and Feitis, 1996).
Hormonal regulation of bone

In the pre-puberty years, bone formation is predominantly regulated by human growth
hormone (HGH) produced by the pituitary gland (located in the brain). At puberty
however, testosterone produced by the male testes and oestrogen produced by the
female ovaries begin to exert a greater influence. In women, oestrogen promotes
growth of the skeleton and development of the unique female skeletal characteristics
(i.e. the broader pelvis). Testosterone on the other hand, causes males to have larger
more robust skeletons (McArdle et al, 2001).
Further aspects of bone growth are discussed with respect to the structure of a long
bone.
The skeletal system and calcium regulation

Although calcium provides the skeletal system with rigidity it is also involved in
a number of other important functions. These include muscular contraction,
transmission of nervous impulses and regulating fluid balance (McArdle et al.,1996;
Jones and Round, 1991). Too much or too little calcium in the body can easily
upset these processes, thus bones act as calcium reservoirs which can either take
up or release calcium depending on the body’s needs (Jones and Rounds, 1990;
Tortora and Grabowski, 1996). When calcium is scarce it will be withdrawn from
the bones, which is why diets that are chronically low in calcium tend to increase
the risk of osteoporosis.
Osteoporosis: brittle bone disease: bone remodelling is a delicate balance of

osteoblast and osteoclast activity. Osteoporosis is caused by an imbalance in this
process, whereby osteoblast activity decreases causing a drop in bone growth. This
leads to a gradual loss in bone density and ultimately gives rise to a skeletal system
that is unable to withstand the forces placed upon it.
There may be a number of causes of the condition; however one of the biggest is
the drop in oestrogen levels associated with the menopause. This makes women
significantly more likely to develop the condition than men. In men, a proportion
of circulating testosterone (which is produced throughout life) is converted into
oestrogen and this is thought to provide men with significant protection against loss
of bone mass.
Low calorific intake and/or overtraining also increase the risk of osteoporosis in
females by depleting body fat stores which are one of the primary sources of
oestrogen. Poor quality diets which are lacking in or have an imbalance of minerals
and vitamins also increase the risks by limiting the availability of calcium (Tortora
and Grabowski, 1996). The table below provides a summary of some of the risk
factors associated with osteoporosis.

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Osteoporosis risk factors:
• female sex – due to drop in oestrogen levels (particularly at the menopause)

• calcium deficiency – through poor diet or poor absorption
• lack of exercise
• smoking – causes a drop in oestrogen levels
• family history
• certain drugs, such as alcohol which interrupt normal hormonal and calcium
regulation
• low body fat
• overtraining
(McArdle et al., 2001; Tortora and Grabowski, 1996; National Institutes of Health
Osteoporosis and Related Bone Disease)
The classification and structure of bone
Compact and cancellous bone

Bone tissue varies in arrangement and depending on its location and functions,
comes in two forms; compact and cancellous. Compact bone has a relatively high
density of bone matter. It forms the external surfaces of bones, predominates in the
shafts of long bones and serves to resist compressive forces.
Cancellous bone in comparison is relatively more porous and if viewed closely has a
spongy appearance. It predominates in the interior of bones and especially at bone
ends (epiphyses). The spaces within the cancellous bone form a vital function by
housing red marrow, which is responsible for red blood cell production.
Classification of bone
Bones can be categorised according to their shape and will generally fall into four or
five shape categories; long, short, flat, irregular and sesamoid:
• long bones – have a greater length than width and consist of a shaft with
normally two extremities. They contain mostly cancellous bone in their
epiphysis and more compact bone in their diaphysis (see diagram), and
principally act as levers. These include the humerus, femur, fibula, tibia, ulna,
radius, metacarpals, metatarsals and phalanges.
• short bones – have a cubed appearance and are predominantly cancellous bone
with an outer shell of compact bone. These include the carpals (except for the
pisiform - sesamoid) and the tarsals (except for the calcaneus - irregular).
• flat bones – thin cancellous bones sandwiched between two compact layers
affording protection or large areas for muscle attachment. Examples of these
are the scapula, cranial bones, costals (ribs), sternum and ilium.
• irregular – form complex shapes and cannot be classified in the other groups.
The vertebrae are considered to be irregular and contain varying proportions
of compact and cancellous bone (reviewed in detail further on in this unit).
• sesamoid (‘seed-like’) – these bones develop within particular tendons at a site

of friction or tension. They serve to reduce wear and tear in the tendon and
increase leverage of muscle by moving the tendon away from the fulcrum.
Examples include the patella (kneecap) and pisiform (carpal bone).

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The anatomical features of a long bone
Although there are different classifications of bones, a closer analysis of a long bone
is useful as it helps highlight many of the properties and functions of the skeletal
system. The diagram below shows a cross section of a typical long bone (in this case
the humerus).
Articular (hyaline) Cancellous

Epiphyseal
cartilage (spongy) bone
growth plate
Epiphysis
Medullary Compact
cavity bone
Diaphysis
Periosteum
Epiphysis
Articular (hyaline)
cartilage

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• epiphysis (epiphyses) - the bone ends, which are mainly comprised of
cancellous bone, and house much of the red marrow involved in red blood cell
production. They are also one of the primary sites for bone growth, and during
growth periods can be quite vulnerable to breakage.
• diaphysis - is the shaft portion of a long bone, and in comparison to the bone
ends is predominantly compact bone (although the inside of the shaft is
hollow). The principle role of the diaphysis is support.
• epiphyseal plates - are part of the region connecting the diaphysis to the
epiphysis. It is a layer of subdividing cartilaginous cells where growth in length
of the diaphysis occurs. Multiplying cartilaginous cells are arranged like
columns of coins (Tortora and Grabowski, 1996) which move towards the
diaphysis, becoming more calcified as they go. Osteoblasts will eventually
complete the process of bone formation.
When adults finish growing the plates will harden and ‘close’, no further
growth will take place. If the plates are damaged before growth has finished,
then this may result in a shorter bone. Wilmore and Costill (2004) note
however, that little evidence exists that exercise has any affect on bone length
in children. Instead it is more likely to lead to broader stronger bones (provided
it is accompanied with appropriate diet).
• periosteum – this forms a tough fibrous membrane which coats the bone. It
contains nerves, blood vessels and bone producing cells. Its inner surface
provides the materials for repair and facilitates growth in the diameter of the
bone. It also plays a fundamental role in movement by providing the point of
attachment for tendons.
• medullary cavity – is a space which runs down through the centre of the
diaphysis. This contains fatty, yellow marrow which is predominantly
composed of adipose tissue, and serves as a useful energy reserve.
• articular (hyaline) cartilage – the ends of articulating bones are covered with
articular or hyaline cartilage. It is a hard, white shiny tissue which, along with
synovial fluid, helps reduce friction in freely moveable (synovial joints). It is
fundamental for smooth joint action.

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The anatomy of the skeleton
It is noted in the previous section that the bones of the skeleton can be classified
according to their individual shapes and characteristics. Yet in order to function
effectively, they must all be integrated in to one complete and coordinated system.
Having said this, this system is often described in two parts; the axial skeleton and
the appendicular (meaning ‘to hang’) skeleton.
Types of joint (articulations)

A joint is defined as the meeting point of two or more bones. The nature of these
joints determines both the stability of the skeletal system and the potential for
movement (Lee, 2001; Tortora and Grabowski, 1996). Although there are many
joints, they are traditionally categorised into three different types: fibrous, cartilaginous
and synovial.
• fibrous (immovable) joints - these represent some of the most rigid of the
joints, such as the cranial joints. The cranial bones interlock with one another
and are bound together with fibrous connective tissue. They possess high
levels of stability but lack the ability for movement.
Fibrous joint – skull bones

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• cartilaginous (slightly movable) joints - in these types of joint there is some
limited potential for movement. Articulating bones are connected by
fibrocartilage (see below). Examples include, the pubis symphysis and between
the vertebral bodies. In contrast to the fibrous joints described above, they
provide moderate stability and some limited movement.
Cartilaginous joint - spine
• synovial (freely movable) joints - these joints allow the ‘large’ movements we
associate with exercise, consequently they will be discussed in more detail.
These come in a variety of different configurations which allow different types
of movement. They do however, share common characteristics which will be
discussed first.
Synovial joint-shoulder

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The anatomy of a synovial joint
Unlike the other forms of joint, the synovial joint has no connective tissue joining the
articulating surfaces. Instead there is a joint space and the ends of the bones are
covered with a form of cartilage (hyaline cartilage) which serves to reduce the friction
between the moving surfaces.
Bony surfaces are held together by a fibrous articular capsule (joint capsule), which
is flexible enough to allow plenty of movement but tough enough to support the joint
where necessary. Sections of the joint capsule may thicken and form ligaments
which provide additional support to the joint (Prentice, 1988). On the inner surface
of the articular capsule is a synovial membrane which secretes a lubricant called
synovial fluid. Synovial fluid has the consistency of uncooked egg white and is more
viscous (thick) when the joint is inactive - fluidity increases as activity increases
(Tortora and Grabowski, 1996). Synovial fluid serves to help lubricate the joint
surfaces and provides nutrients to the articular cartilage, which has a poor blood
supply.
Types of synovial joints

Although synovial joints share the same basic features, their structure and
consequently the type of movements they allow, show considerable variation. Broadly
speaking, these variations can be classified in to six categories; ball and socket,
hinge, pivot, gliding, saddle and ellipsoid:
• ball and socket joint - a ball and socket joint allows for movement in almost
any direction. They are found in the hips and shoulders.
Synovial ball and socket joint

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• hinge joint - like the hinges of a door, this type of synovial joint is a relatively
simple structure. It primarily allows either flexion or extension movements
(e.g. elbow joint).
Synovial hinge joint
• pivot joint - this form of joint allows rotation around an axis. In the neck, the
top two cervical vertebrae (the atlas and the axis) form a pivot joint allowing
rotational movements of the head. In the forearm, the radius forms a pivot
joint with the ulna, causing it to ‘radiate’ around the ulna and allowing
supination and pronation of the forearm.
Synovial pivot joint

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• gliding joint – in this type of joint the articulating surfaces are typically flat,
thus the joint action is a relatively simple sliding movement. Ligaments
generally restrict movement to forwards, backward and side-to-side movements
(Tortora and Grabowski, 1996). Examples of this kind of joint would be the
patella and the femur (patellofemoral), between the carpals and tarsals and
the acromion process and clavicle (acromioclavicular).
Synovial gliding joint
• saddle joint – this form of joint resembles one upturned saddle resting on
another. It allows movement back and forth and up and down, but does not
allow for rotation like a ball and socket joint. The articulation between the
base of the metacarpal of the thumb and the trapezium (one of the carpals) is
an example of a saddle joint (carpometacarpal).
Synovial saddle joint

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• ellipsoid joint – these joints share similarities with the ball and socket joint in
that a rounded bone fits into a rounded cavity. The shape is however, more
oval in nature and consequently, movements tend to be restricted to side-to-
side and back and forth. The wrist joint between the radius and the carpals
(radiocarpal) and metacarpals and phalanges (metacarpophalangeal) are
examples of this kind of joint. It is sometimes referred to as a condyloid joint.
Synovial ellipsoid joint
The vertebral column
By virtue of its complexity and the important role vertebral alignment plays in
exercise, the vertebral column is worthy of a more detailed examination.
The vertebral column consists of a series of individual vertebra that are arranged to
form a strong and flexible rod, which provides the body with central support and
facilitates movement (Tortora and Graboski, 1996). It also offers protection for the
spinal cord and provides the means by which nerves are distributed throughout the
body.
The vertebral column usually consists of 33 individual vertebrae spread across five
distinct sections:
• the neck or cervical region is made up of 7 vertebrae

• the thoracic or chest section has 12 vertebrae
• the lumbar has 5 vertebrae
• the sacrum has 5 vertebrae
• the coccyx has 4 vertebrae
The fused vertebra in the sacrum and coccyx are often counted as one giving rise to
26 vertebrae. Interestingly, individual variation in the numbers of vertebra seems to
be quite common, it being noted that individuals may possess extra vertebra in some
regions and fewer in others. The cervical region appears to show the least variability
(Gray, 2003; Bergman, Afifi and Miyauchi, 2004).

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The anatomy of a vertebra and vertebral disc
Before considering the different regions of the spine in more detail, it is important to
examine an individual vertebra more closely. Whilst differing considerably between
regions, the vertebrae share the same basic anatomical features.
Intervertebral
foramen
Vertebral body
Facet joints
Intervertebral disc
Structure of a vertebral disc
The diagram above shows a typical vertebra. To the anterior (the front) is the main
vertebral body, which is a cylindrical bony disc. This provides the surface for the
intervertebral discs to attach to and these form the main cartilaginous joints of the
spine. To the posterior (the back) are a series of bony projections (processes) which
interlink with adjacent vertebra to form synovial facet joints. A series of openings or
foramen punctuate the vertebra, these allow nerves and blood vessels to pass though
and out of the vertebral column.
The intervertebral discs are sandwiched between the bodies of neighbouring

vertebrae. They are composed of a fibrocartilage shell, that surrounds a softer gel –
like core, which is crudely described by McGill (2002) as looking and feeling ‘… like
heavy phlegm.’ Their primary function is shock absorption, however, they are
vulnerable to injury if the back is excessively loaded with poor alignment (discussed
below) or if the back is held in a chronically poor posture (i.e. sitting at a desk with
a rounded back) (McGill, 2002).

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Anatomical and functional variations in the vertebral column
Whilst it is noted above that the vertebra have the same basic features, there are
considerable anatomical and functional variations between the different regions
of the spine. These are summarised in the table below:
Region No. of vertebrae Key features

Cervical 7 • the smallest of the vertebrae
• facilitates movement of the head
• contains larger and a greater number
of openings (foramen) to accommodate
nerves and blood vessels
Thoracic 12 • forms joints with the costal bones
• capable of relatively more rotation than the
lumbar vertebrae
Lumbar 5 • the largest vertebrae, to support greater
loads
• capable of relatively more flexion, exten-
sion and lateral flexion than the thoracic
vertebrae
Sacrum 5 • forms a joint with the pelvis
• usually fully fused by the age of 30 years
Coccyx 4 • the lowest section of the vertebral column
• usually fused by the age of 30
A comparison of the different regions of the vertebral column
Vertebral alignment and posture

It was suggested earlier that a spine that is held in a ‘poor’ position is more likely to
suffer injury. In order to understand what constitutes a ‘good alignment' it is necessary
to examine the normal curvature of the spine.

The optimal arrangement of curves is referred to as a neutral spine and represents a
position where the vertebrae and associated structures are under the least load. The
adult human spine has three major curvatures (excluding the sacrococcygeal), these
are:
• a posterior cervical curvature – a posterior concavity of the cervical spine

• an anterior thoracic curvature – a posterior convexity of the thoracic spine
• a posterior lumbar curvature – a posterior concavity of the lumbar spine
Identifying optimum posture can be tricky as clothing and other parts of the anatomy
may obscure the vertebral column. Chek (2004) suggests that, if a line can be
dropped vertically from the ear through the middle of the shoulder and hip to a point
just in front of the ankle, then posture is probably ideal.

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Functional kinesiology
Kinesiology (‘the study of movement’)
An understanding of movement allows better judgments regarding choice of exercises

and their execution. The following chapter explores some of the ways in which
human anatomy and movement can be described in terms of levers, planes and
axes.
Levers
Humans move or pick up objects via a basic system of levers. A lever is a simple
machine consisting of a rigid rod that moves or pivots around a fixed point (fulcrum).
By varying the position of the fulcrum, the load or the effort; different combinations
of speed, range of movement and force can be generated. There are three basic
forms of lever.
• 1st class levers: the best example of this kind of lever is a seesaw. The fulcrum
is located between the effort and the load. By moving the fulcrum closer to, or
further away from the load; speed, range of movement and force generated
will vary. In spite of its simplicity, this form of lever is relatively scarce in the
body. Examples include the triceps extending the forearm; gastrocnemius and
soleus plantarflexing the foot when it is off the ground.
Load
Fulcrum
Effort
Load
Fulcrum
Load
Effort
Fulcrum
The seesaw: a 1st class lever

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• 2nd class levers: the best example of this type of lever is a wheel barrow. The
fulcrum and the effort are at opposite ends with load placed in between. This
arrangement produces plenty of force, but like 1st class levers there are
relatively few examples in the body.
Load
Fulcrum
Load
Effort
Fulcrum
Load
Effort
Fulcrum
The wheel barrow: a 2nd class lever

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• 3rd class levers: the most common form of lever in the body. The fulcrum and
the load are at opposite ends with the effort placed in between. This arrangement
is similar to the action of a drawer bridge and generally produces less force
than the other forms of lever, but provides a much greater range of movement
and speed.
Load
Fulcrum
Load
Effort
Fulcrum
Effort
Load
Fulcrum
The drawer bridge: a 3rd class lever

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Anatomical planes
Planes are imaginary flat surfaces along which movement can occur or that represent
anatomical cross-sections. There are three basic planes; frontal (coronal), sagittal
and transverse.
Frontal plane Sagittal plane Transverse plane
• frontal plane:
a vertical plane that divides the body into anterior and posterior parts
• sagittal plane:
a vertical plane that divides the body into left and right parts
• transverse plane:
a horizontal cross-section through the body separating the upper body from
the lower body
It is important to point out that human movement occurs simultaneously in multiple

planes.

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Axes of movement
An axis is a line that passes through a plane, about which movement (rotation)
occurs.
Anterior-posterior axis Medial-lateral axis Longitudinal axis
• medial-lateral axis:
passes through the sagittal plane: rotation would occur in the sagittal plane
• anterior-posterior axis:
passes through the frontal plane: rotation would occur in the frontal plane
• longitudinal axis:
passes through the transverse plane: rotation would occur in the transverse
plane

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The muscular system
Human movement is dependant upon the integrated activity of many different

systems, however, the driving force behind this is the muscular system. This section
will explore and discuss the microscopic structure of muscle which enables muscles
to generate force.
Types of muscle tissue
Smooth muscle
Smooth muscle is the most widely distributed and it predominates in the internal
tissues of the body, including the digestive, circulatory, urinary and reproductive
systems. One of its major functions is to regulate the diameter of tubular structures,
thus enabling the body to regulate blood flow and blood pressure, the passage of
food down the digestive tract and even the amount of light entering the eye. Control
of this form of muscle is involuntary and is exerted via the autonomic system.
Cardiac muscle (myocardium)

Cardiac muscle is found only in the heart, but like smooth muscle is also under
involuntary control. The unique feature of cardiac muscle is that it possesses the
capability of self excitation. In other words, it will continue to contract even if
completely separated from the rest of the body (for a short time at least). The
autonomic system exerts some control over cardiac muscle by both increasing or
decreasing heart rate and the strength of contractions. This is examined more closely
in the cardiovascular chapter.
Skeletal muscle
Skeletal muscles are attached from bone-to-bone across joints, and are the main
focus of this chapter. Unlike cardiac and smooth muscle, skeletal muscle is
predominantly under voluntary control via the somatic nervous system. Skeletal
muscle has a number of functions such as:
• producing movement
• stabilising body positions i.e. maintenance of posture
• facilitating the circulation of blood and lymphatic fluid
• generating heat

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The anatomy of skeletal muscle
In order to understand how muscles generate force it is necessary to review the basic
anatomy of a muscle. In simple terms, skeletal muscle is made up of a number of
rod-like structures called muscle fibres, and these fibres run parallel along its length.
Closer examination of muscle will reveal that each series of fibres are themselves
constructed from smaller parallel fibres and so on.
Surrounding and protecting muscles are a series of collagen based membranes, the
outer most of which covers the whole muscle and is called the epimysium (epi –
meaning ‘upon’). Within the epimysium are groups of muscle fibres formed into
bundles called fascicles. Each fascicle has its own outer sheath called a perimysium
(peri – meaning ‘around’). Within each fascicle are bundles of muscle fibres each
separated from the other by, yet another membrane called the endomysium (endo
– meaning ‘inside’).
This connective tissue is continuous throughout the length of the muscle fibres and
beyond, where it converges to form the tendons. These are strong, inelastic, strap-
like structures that attach muscle to the periosteum (tough fibrous layer that coats
the bones) e.g. Achilles tendon.

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Bone Tendon
Epimysium
Fasciculi
Myofibril
Perimysium
Muscle fibre
Myosin
Endomysium
globular
heads and
twisted tails
Tropomyosin Actin Troponin
Basic structure of a muscle

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Force generation
To explain how muscles generate force it is necessary to look even closer at the fine
structure of muscle fibres. Below the endomysium are even smaller rows of fibres
called myofibrils. Contained within these fibres are the structures which are
responsible for force production.
Myosin and actin and the sliding filament mechanism

The ‘business end’ so to speak of force generation are two contractile proteins called
myosin and actin, often referred to as thick and thin filaments respectively. These
are arranged in a series of compartments called sarcomeres that run the length of
the myofibril.
Sarcomere Myofibril
Myosin Actin
Thick Filament Thin Filament
The basic functional unit of the muscle
Spiralling from the myosin filament is a series of ‘hook like’ projections referred to as
myosin heads. During muscular contraction these heads attach themselves to the
actin filament and rotate. The result of this is that the thinner actin filaments are
drawn inwards dragging the ends of the sarcomeres together, this is referred to as
the sliding filament mechanism.

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Myosin and ATP: the power to drive the myosin head is provided by adenosine
triphosphate (ATP – see energy systems section). The ATP molecule primes the
myosin for activity by binding with the head. Energy from the ATP is almost
immediately transferred to the head rather like a finger cocking a gun. When the
conditions are right, the myosin head will bind with the actin and rotate.
Actin and calcium: although the myosin head may have been primed with energy
from the ATP, it will be unable to bind with the actin without the presence of calcium.
In a relaxed state, the myosin binding sites on the actin are blocked by a combination
of other molecules (troponin and tropomyosin), that must be moved before myosin
can be attached.
Surrounding the myofibrils is a network of tubes called the sarcoplasmic reticulum

(SR) that act as calcium reservoirs. Stimulation of the sarcoplasmic reticulum (by an
action potential) causes them to release their calcium into the fluid surrounding the
myosin and actin (sarcoplasm). The calcium causes the blocking molecule to move
away from the myosin binding site, thus allowing the ‘primed’ myosin head to bind
with the actin and rotate.

Without the influx of calcium into the muscle fibre, the sliding filament mechanism
could not take place. The question arises therefore, as to what triggers the
sarcoplasmic reticulum to flood the myofibril with calcium. To understand this
process, it is necessary to take a look at the point at which nervous impulses reach
the muscle.
Action potentials
The stimulus for the release of calcium is the spread of electrical activity (the action
potential) along the length of the muscles. In a resting state, muscle membranes
have a negatively charged interior and a positively charged exterior. The difference
between the two serves as a form of potential energy, rather like that stored in a
battery (Tortora and Grabowski, 1996). This is achieved through a combination of
a selective permeability of the cell membrane and the presence of sodium pumps
that actively remove positively charged sodium from the cell.

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The arrival of an action potential at the neuromuscular junction (where the nerve
meets the muscle) causes the release of a neurotransmitter (acetylcholine), which in
turn causes sodium to rush through the muscle membrane. As a result, there is a
reversal of electrical activity (depolarisation), which if great enough, will cascade
along the muscle fibre as an action potential, thereby triggering calcium release and
beginning the sliding filament mechanism.
Action potential arrives at the neuromuscular junction
Synaptic Neurotransmitters
vesicles
Synaptic
cleft Motor end
plate
Acetylactivates myosin binding sites on the actin Neuromuscular junction

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Action potential arrives at the
neuromuscular junction
Acetylcholine (AcH) is released

from the end of the nerve
AcH causes influx of sodium

in the muscle fibre, causing a
depolarisation and triggering a
muscles action potential
Action potential triggers release of

calcium
Calcium activates myosin binding

sites on the actin
Myosin head binds to actin and ATP energises myosin head

rotates. The filaments slide together
Initiation of a muscle action
Control of muscular activity
Having explored the fundamentals of muscular contraction, we now have a better

understanding of how they generate force. However, a number of questions remain
regarding the mechanisms through which muscle activity is controlled. The following
section will therefore, take a closer look at muscular control systems.
Motor units and the ‘all or nothing’ law

Muscles are divided in to motor units; a single motor unit consists of one motor
neuron (nerve) and the muscle fibres it innervates. As was discussed earlier, if the
stimulus is strong enough to trigger an action potential, then it will spread through
the whole length of the muscle fibre. More specifically, it will spread through all the
muscle fibres supplied by a single nerve. Conversely, if the stimulus is not strong
enough, then there will be no action potential and no muscle contraction. Motor
units cannot, therefore, vary the amount of force they generate, they either contract
maximally or not at all – hence the ‘all or nothing’ law.

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Control of muscular force is achieved through a combination of adjusting the number
of motor units recruited (i.e. the greater the number the greater the force) and also
increasing the frequency of their discharge.
It is worth noting that coordinating motor unit activity is fundamental to optimising

force generation and therefore, improving exercise performance (McArdle et al.,
2001).
Muscle proprioceptors
The muscles have two small neural sensors that help to provide feedback and
respond to changes within the muscle itself. The first is called the muscle spindle
and it is located deep within the muscle fibres. The spindle is a small sensory unit
wrapped tightly around the individual muscle fibres like a coiled spring. When the
muscle changes length the ‘coils’ of the muscle spindle are either pulled apart or
pushed together depending on whether the muscle is lengthening or shortening.
This change in muscular length and resulting change in the muscle spindle stimulates
neural firing to the central nervous system at the spinal level. The net result of a
lengthened muscle and muscle spindle is a stimulus to contract the same muscle.
The degree of contraction that occurs will depend on the degree of change in muscle
length and the rate at which the change in length occurs. As a general rule, the
greater the range of motion and the faster the muscle lengthens the greater the
resulting contraction will be. This process is often referred to as the stretch reflex.
The second proprioceptor that has an influence on the muscle is actually located in
the tendon and as such is called the Golgi Tendon Organ (GTO). The tendon is
inelastic and so the GTO cannot detect changes in muscle length. However, when a
muscle contracts, it pulls on the tendon, creating tension within that tendon. The
GTO is ideally located to measure the amount of tension created by a muscle. The
GTO, when activated, sends a signal to the spine which brings about an inhibitory
effect on the same muscle. This relaxation response brought about as a result of GTO
firing is called the inverse stretch reflex.
The muscle spindles will be continually activated during human movement as the
muscles will be changing lengths in conjunction with the movements being carried
out. This is providing a constant stream of valuable information to the CNS about
muscle length and where body parts are in space. The spindles also bring about
muscular contraction that assists with the movements being performed. The GTO
responds just after muscular contraction has engaged by inhibiting the muscular
contraction to allow the opposite action to be performed. Therefore, muscle spindles
and GTO’s serve like the on and off switches for muscle activity during exercise and
movement. It is also valuable to note that, when a muscle is causing its primary
actions to occur the opposing muscles need to be switched off to allow that movement
to take place. This inhibition of the opposing muscles is called reciprocal inhibition
(RI). RI is a necessary part of normal movement. However, it can also play a part in
creating muscular imbalance. A very tight muscle group will send a continuous RI
signal to the opposing muscle which can lead to that muscle becoming inhibited in
its function.

32
Exercise and training has been shown to increase the neural side of the muscular
response with improvements in the stretch reflex and the net response from the
inverse stretch reflex. Training modalities like plyometrics have been developed
particularly to develop the stretch shortening cycle with effective results. Not only
does the muscle learn to develop more force through this type of training, but timing
and co-ordination of movement at speed also improves as the muscle spindles in
supporting muscle tissue are also trained to respond better.
Effects of exercise on muscle tissue type

Whilst it is acknowledged that exercise in general will have a positive impact on
muscle tissue development, certain types of activity have been shown to influence
different muscle fibre types. Simply put, muscles have three categories of muscle
tissue, Type 1 or slow twitch, Type 2a and Type 2b or fast twitch. Science is continuing
to expand this area of knowledge and other types of muscle tissue have been
determined based on function and response.
The Type 1 muscle fibres have been found to be the most aerobic in nature with
greater blood supply and more mitochondria and as a result respond well to aerobic,
low to moderate intensity training. The Type 2b muscle fibres are very anaerobic in
nature with a reduced blood supply in comparison to the Type 1 and much fewer
mitochondria. Type 2 fibres respond well to high intensity exercise with higher force
and power outputs. The Type 2a fibres have all the characteristics that one would
find in other fast twitch fibre types, but with the added ability to adapt a little more
and take on some of the properties of the Type 1 fibre. Type 2a fibres will respond to
varying levels of exercise intensity in the direction of the stimulus applied.
Muscle fatigue, soreness and oxygen debt

At some point, everybody experiences muscular fatigue, which is simply a decline in
the ability of the muscle to produce force. As should now be appreciated, there are
many stages to a muscular contraction, and thus the causes of muscle fatigue may
vary. In fact, McArdle et al. (2001), note that fatigue may result from an interruption
of any of ‘… the chain of events between the CNS and the muscle fibre.’
With respect to the nervous system, diminishing levels of neurotransmitter may

reduce the volume of action potentials reaching the muscle fibres. Also more complex
neural interactions associated with perceptions of pain and discomfort may serve to
diminish performance. Within the muscle fibres themselves, fatigue can arise from
a number of sources. Depletion of glycogen stores will limit the rate at which ATP
can be synthesised, whereas insufficient oxygen will lead to changes in the internal
chemistry which directly interrupts the sliding filament mechanism.
The cause of fatigue will very much be dependent on the mode of exercise being
undertaken.

33
Delayed onset muscle soreness (DOMS): in contrast to pain or discomfort felt during
exercise, delayed-onset muscle soreness (DOMS) typically occurs 24 – 72 hours
following a fairly heavy bout of exercise activity. The precise mechanisms behind
DOMS are still poorly understood, some suggest the soreness relates to structural
damage, whilst others suggest that they are an inflammatory response. Wilmore
and Costill (2004), indicate that both mechanisms may be involved.
Although the processes behind DOMS remain unclear, the causes seem to be
universally agreed upon; DOMS is associated with intense eccentric muscular activity
(Jones and Round, 1991; McArdle et al, 2001; Wilmore and Costill 2004). Although
Prentice (1998), also suggests that unfamiliarity with an exercise may contribute to
DOMS.
With respect to minimising DOMS, Wilmore and Costill (2004), highlight a number
of approaches. The first would involve minimising eccentric muscle activity during
the early stages of training, yet this may be difficult to implement, particularly in
sports. The second involves starting a progressive training programme at a very low
intensity and introducing overload fairly gently. It is reasonable to argue that this is
probably the best approach for a new client. The final approach is not for the faint
hearted and involves beginning training at a high intensity. Although DOMS will
initially be high, subsequent exercise will produce less and less muscle soreness.
Types of muscle action
Consider a bicep curl or a squat, think of the muscles used to perform the task - are
the muscles used to lift the weight the same as those used to lower it back down
again? The answer to this question should of course be ‘yes.’ However, the activities
of the muscles concerned are fundamentally different. When lifting the weight the
muscle will be shortening, when lowering the weight the muscle will be lengthening.
Pause the activity in the middle, and the muscle stays the same length. All the time,
however, be aware that the muscle is working.
In order to help distinguish between the different types of muscular activity a number
of terms are used:
• isotonic (same tone) - used to describe muscle actions involving movement,

i.e. concentric and eccentric
• concentric - muscle generates force whilst shortening
• eccentric - muscle generates force whilst lengthening
• isometric - muscle generates force and remains the same length
• isokinetic (same speed) - muscle actions involving movement at a constant
speed

34
Thus during the lifting action of a bicep curl, the bicep brachii would be working
concentrically. If at any point, the weight were held still, then this would represent
an isometric action. Finally, as the weight was lowered (in a controlled manner) the
biceps would be lengthening and thus working eccentrically.
Roles of muscles
Ultimately, efficient human movement is dependent on the coordinated activity of

whole groups of muscles and will involve varying combinations of different muscle
actions. In an attempt to distinguish between the diverse roles of muscle during
movement, muscles can be placed into the following categories:
• agonist/prime mover: the muscle(s) that causes a desired action. e. g. the

bicep brachii during a bicep curl or the quadriceps during a leg extension
• antagonist: the opposing muscle(s) to the agonist e.g. the triceps during a
bicep curl or the hamstrings during a leg extension
• synergist: the muscle(s) that assist or modify the movement of the prime
mover e.g. during hip extension the hamstrings act as synergists for the gluteus
maximus
• fixators: the muscle(s) that stabilises the part of the body that remains fixed
e.g. shoulder girdle muscles stabilise the scapula to allow efficient movement
at the shoulder joint

35
Level 2 : Black Primary concentric
Location Origin Insertion
Level 3 : Orange actions
Clavicle and Abduction, flexion and
Deltoids Shoulder Humerus
scapula extension of shoulder
Abduction, lateral
Lateral border Greater tuberosity rotation and
Teres minor
of scapula of humerus stabilisation of
shoulder joint
Superior Greater tuberosity Abduction and
Supraspinatus to spine of of humerus stabilisation of
scapula (superior) shoulder joint
Rotator cuff Shoulder Abduction, horizontal
Posterior
Greater tuberosity extension, lateral
surface below
Infraspinatus of humerus rotation and
spine of
(posterior) stabilisation of
scapula
shoulder joint
Medial rotation,
Anterior surface Lesser tuberosity adduction, extension
Subscapularis
of scapula of humerus and stabilisation of
shoulder joint
Medial lip of Extension, adduction
Inferior angle of
Teres major Shoulder bicipital groove of and medial rotation of
scapula
upper humerus shoulder
Transverse Elevation of shoulder
Upper back Superior angle of
Levator scapulae processes of girdle and lateral
and neck scapula
C1-C4 flexion of neck
Flexion of elbow,
Front of upper
Biceps brachii Scapula Radius supination of forearm
arm
and flexion of shoulder
Extension of elbow
Back of upper Humerus and
Triceps brachii Ulna and extension of
arm scapula
shoulder
Lower thoracic
Adduction, extension
Sides of the vertebrae,
Latissimus dorsi Humerus and medial rotation of
back lumbar
shoulder
vertebrae, ilium
Base of skull,
Elevation, retraction
cervical and Clavicle and
Trapezius Upper back and depression of
thoracic scapula
shoulder girdle
vertebrae

36
Level 3 : Orange Location Origin Insertion
actions
Spinous Medial border
Retraction and
Major Mid back processes of and inferior angle
elevation of scapula
T2-T5 of scapula
Rhomboids
Spinous
Medial border of Retraction and
Minor Mid back processes of
scapula elevation of scapula
C7-T1
Horizontal flexion,
Clavicle and adduction and
Pectoralis major Chest Humerus
sternum medial rotation of the
shoulder
Anterior surface Coracoid process Depression and
Pectoralis minor Chest
of 3rd-5th rib of scapula protraction of scapula
Surface of Anterior surface
Side of the
Serratus anterior upper 8 or 9 of medial border Protraction of scapula
torso
ribs of scapula
Either side of Sacrum, ilium, Ribs, vertebrae, Extension and lateral
Erector spinae
spine ribs, vertebrae occipital bone flexion of spine
Sacrum,
iliac crest
Ribs and
and spinous Lateral flexion of the
Iliocostalis (3 erector spinae Either side of transverse
processes of neck and extension of
muscles) spine processes of
lumbar and the vertebral column
cervical vertebrae
lower thoracic
vertebrae
Ribs and
Transverse transverse
processes of processes of the Lateral flexion of the
Longissimus (3 erector spinae Either side of
the lumbar thoracic and neck and extension of
muscles) spine
and thoracic cervical vertebrae the vertebral column
vertebrae and mastoid
process
Spinous Spinous
processes processes of the Lateral flexion of the
Spinalis (2 erector spinae Either side of
of lumbar upper thoracic neck and extension of
muscles) spine
and thoracic and cervical the vertebral column
vertebrae vertebrae
Posterior
superior iliac
spine (PSIS), Spinous
Either side of transverse processes of Extension and rotation
Multifidus
spine processes of 2nd-4th vertebrae of vertebral column
lumbar, thoracic above each origin
and C4-C7
vertebrae

37
12th rib and
Quadratus transverse Lateral flexion and
Lower back Iliac crest
lumborum processes of extension of spine
L1-L4
Along the Flexion of spine,
Rectus abdominis centre of the Pubis Sternum lateral flexion of spine
abdomen
Sides of the Ilium, pubis, ribs, Rotation and lateral

Internal obliques Ribs, ilium
abdomen linea alba flexion of spine
Rotation and
Sides of the
External obliques Ribs Ilium, pubis lateral flexion of spine
abdomen
Pubis and Support of internal

Transversus Iliac crest and
Abdomen linea alba organs and forced
abdominis lumbar fascia
expiration
Sternum, costal
Beneath rib cartilages Central tendon of Depresses and aids in
Diaphragm
cage and lumbar diaphragm expiration
vertebrae
Ribs and costal Superior border of Elevates ribs and aids
Intercostals Between ribs
cartilages next rib below in expiration
Lesser trochanter Flexion and lateral
Iliacus Iliac fossa
Through the of femur rotation of hip
Hip
pelvis and onto Transverse
flexors Lesser trochanter Flexes and laterally
Psoas major the femur processes of
of femur rotates hip
T12 –L5
Extension and external
Gluteus maximus Bottom Ilium Femur
rotation of the hip
Posterior and
Lateral and lateral surface of Abduction and medial
Gluteus medius
posterior ilium greater trochanter rotation of hip
of femur
Outside of
Abductors
upper thigh
Anterior surface of
Abduction and medial
Gluteus minimus Lateral ilium greater trochanter
rotation of hip
of femur
Upper surface of
Abduction and lateral
Piriformis Posterior hip Anterior sacrum greater trochanter
rotation of hip
of femur
Lateral upper tibia
Anterior iliac Flexion and abduction
Tensor fascia latae Outer thigh via iliotibial band
crest of hip
(ITB)
Magnus
Adductors Longus Inner thigh Pubis, ischium Femur Adduction of hip
Brevis
Lesser trochanter Adduction and flexion
Pectineus Inner thigh Anterior pubis
and upper femur of hip
Ischio-pubic Medial tibia Adduction of hip and
Gracilis Inner thigh
ramus below condyle flexion of knee

38
Flexion, abduction and
Anterior
Front and inner Medial condyle of lateral rotation of hip,
Sartorius superior iliac
thigh tibia flexion and medial
spine (ASIS)
rotation of knee
Anterior inferior
Tibial tuberosity Flexion of hip and
Rectus femoris iliac spine
via patella extension of knee
(AIIS)
Lateral femur
Tibial tuberosity
Vastus lateralis and greater Extension of knee
via patella
Quadriceps Front of thigh trochanter
Tibial tuberosity
Vastus intermedius Medial femur Extension of knee
via patella
Extension of knee,
Tibial tuberosity
Vastus medialis Anterior femur especially last 20°
via patella
motion
Ischial Head of fibula
Extension of hip and
Biceps femoris tuberosity and and lateral
flexion of knee
posterior femur condyle of tibia
Hamstrings Back of thigh Ischial Medial condyle of Extension of hip and
Semitendinosus
tuberosity tibia flexion of knee
Ischial Anterior medial Extension of hip and
Semimembranosus
tuberosity surface of tibia flexion of knee
Calf Plantarflexion of ankle,
Calcaneus (heel
Gastrocnemius Femur flexion of knee
bone)
Calf, beneath Calcaneus (heel

Soleus gastrocnemius Tibia Plantarflexion of ankle
bone)
Front of lower Metatarsal and Dorsiflexion and
Tibialis anterior limb (shin) Tibia
tarsal inversion of ankle

39
The nervous and endocrine systems
The nervous and endocrine systems are the means by which the body maintains
homeostasis (a stable internal environment). The nervous system does so via a
complex web of nerves, whereas the endocrine system supports homeostasis through
a series of glands and hormones (chemical messengers).
As exercise activity represents one of the biggest challenges to the internal environment
of the body, it is important to understand how these two systems help regulate this
environment. Although clearly distinct from one another, the two systems work
closely together, one often triggering a response in the other. However, for the
purposes of clarity each will be addressed separately here.
Role of the nervous system
At its simplest level the nervous system is a communication network, which has
three basic elements; sensation, analysis and response (Tortora and Grabowski,
1996):
• sensation - there are a vast array of sensors spread throughout the body which
continually gather information about both the internal environment (e.g. blood
CO2 levels) and the external environment (e.g. air temperature)
• analysis - sensory input represents massive amounts of information, thus the
second role of the nervous system is to analyse and interpret the information
being received and ‘decide’ on an appropriate response (many of these
‘decisions’ are automated – there is no voluntary control over them)
• response - the appropriate response must be initiated (e.g. muscular contraction
or glandular secretion)
Main components of the nervous system
The nervous system can be divided into two principle sections; the central nervous
system (CNS) and the peripheral nervous system (PNS).
The CNS is comprised of the brain and spinal cord and is responsible for interpreting
sensory input and generating appropriate responses. These processes can range in
complexity from basic reflex actions to intricate thoughts, memories and emotions.
The PNS on the other hand consists of the nerves that connect the CNS to the rest
of the body and the external environment. These are the means by which the CNS
receives sensory input and initiates responses.

40
Two further subdivisions of the PNS worthy of attention are the somatic and autonomic
nervous systems. The former are those nerves which serve the outer areas of the
body and skeletal muscle, they are largely responsible for the voluntary control of
movement. The autonomic nervous system on the other hand supplies neural input
to the involuntary systems of the body (e.g. heart, digestive systems and endocrine
glands).
CNS
PNS
Central nervous system and peripheral nervous system

41
With respect to the autonomic system, this too has subdivisions referred to as the
sympathetic and parasympathetic systems. In terms of exercise, these are of interest
because they serve to increase levels of activation in preparation for activity
(sympathetic) or serve to decrease levels of activation during rest and recovery
(parasympathetic). Owing to their roles, their actions are sometimes referred to as
‘war’ and ‘peace’ respectively.
CNS
Somatic
PNS Sympathetic (war)
Autonomic
Parasympathetic (peace)
The basic structure of a neuron
In order to better appreciate the way in which the nervous system functions, it is
useful to take a closer look at one of its most basic components – a neuron.
A neuron or nerve essentially behaves like any form of cable or wire, it allows signals
or impulses to travel from one part of the body to another. Distances may be short
for example, from one part of the CNS to another, or may be relatively long e.g. from
the bottom of the feet to the lumbar region (Tortora and Grabowski, 1996).
Nevertheless, different neurons possess the same fundamental anatomical
features.
The cell body of a neuron contains the same basic structures as the majority of other
cells in the body, such as a nucleus and various organelles (organelles are the
internal organs of individuals cells. They play a fundamental role in the normal
function of the cell).

42
Cell body
Dendrites
Nucleus
Axon
Peripheral
nerve
Axon terminal
Basic structure of a motor neuron
The primary distinguishing feature of the cell body is the array of projections known
as dendrites which spread out like the branches of a tree (dendro - pertaining to
tree). It is these that actually ‘sense’ the stimulus (e.g. heat, pain or pressure).
Also running from the cell body is a long cylindrical projection called an axon; it is
along this that nervous impulses travel. The distinctive covering of the axon is a lipid/
protein compound (myelin sheath) that serves the purpose of insulation, it is vital for
rapid transmission of impulses. At the end of the axon is the axon terminal which
represents the interface between the neuron and other cells, such as other neurons
or muscle cells.

43
Action potentials, axon terminals and neurotransmitters
The term action potential describes the wave of electrical activity that passes along
electrically excitable cells, such as those found in nerves and muscles. The action
potential passes along the outer membrane of the cells and is created through the
controlled movement of electrolytes (sodium and potassium) into or out of the cells.
The mechanisms behind this are reviewed in more detail in the muscular system
section.
Action potential
At the end of the axon terminals are swellings (synaptic end bulbs) which contain
small sacs of neurotransmitter, which in the case of skeletal muscle is acetylcholine
(Ach).
When the action potential reaches the end of the axon terminals the Ach is released
into the space at the ends. The Ach then diffuses across the space between the axon
terminals and the muscle cell membrane. The Ach then binds with specialised
receptors on the muscle membrane, which in turn triggers a muscle action potential.
This ultimately stimulates muscles to contract. In summary, Ach enables the transfer
of an action potential from the end of a neuron to an adjoining cell.

44
Physical activity and the nervous system
It is stressed, that in the early stages of training the majority of performance

improvements are likely to be the result of changes in the way the central nervous
system controls and coordinates movement. This appears to be particularly so for
resistance training (Earle and Baechle, 2004).
When we perform an activity our senses provide constant feedback regarding limb
position, force generation and the performance outcome (i.e. was the movement
successful?). Unsuccessful or poor performances can be cross-referenced with other
sensory input and a new movement strategy can be tried (Schmidt and Wrisberg,
2000). Regular training and practice cause adaptations in the central nervous
system allowing greater control of movements. Thus movements become smoother
and more accurate and performance improves.
The role of the endocrine system
Along with the nervous system the endocrine system helps maintain homeostasis.
Instead of using action potentials however, the endocrine system exerts its influence
via hormones (chemical messengers), which are produced by glands and secreted
(put) into the bloodstream.
Much of the control of hormonal activity ultimately rests with the hypothalamus and
pituitary gland which are located in the brain. Together they represent ‘… the major
integrating link between the nervous and endocrine systems’ (Tortora and Grabowski,
1996). Many of the hormones produced in this region directly influence the activities
of other glands, thus the pituitary gland is often referred to as the ‘master gland’
(Tortora and Grabowski, 1996). However, for the purpose of this section we will
focus on those glands and hormones directly involved in exercise activity.
Hormones
Hormones are chemicals derived from lipids or proteins. Different hormones have
different chemical shapes which determine the effect the hormone will have. Each
hormone will have a target cell or cells that have specific receptors in their membranes
which will only be triggered by the ‘right’ hormone (i.e. in the same way that locks
can only be opened with the right key).
Insulin, glucagon and the control of blood glucose

The principle fuel for vigorous activity is carbohydrate (specifically glucose). It is also
worth noting that glucose is the principle fuel for the brain. Large fluctuations in
blood glucose levels can be extremely damaging, too little will certainly inhibit
performance but could eventually be fatal, whereas too much can damage the
vascular system.

45
Control of blood glucose levels is primarily directed by the pancreas, which occupies
an area posterior to and just below the stomach. As a gland it has multiple functions,
but the ones of interest here relate to the production of two hormones; insulin and
glucagon.
Insulin: after consuming a meal, glucose enters the blood at the small intestine
causing a rise in blood glucose levels. As this blood is circulated through the pancreas
the elevated levels of glucose trigger the release of insulin. The circulating insulin
binds with the receptors of its target cells (in this case skeletal muscle or liver cells)
and the cell membrane becomes more permeable to glucose. Glucose then diffuses
out of the bloodstream and into the cell. The net result being, a drop in blood
glucose levels.
At this point, it is also worth noting that insulin encourages the synthesis (manufacture)
of both protein and fat within the body. The extent to which this occurs is determined
by the nature of the meal consumed and the existing nutritional status of the
individual (McArdle et al. 2001, Tortora and Grabowski, 1996).
Glucose enters the

bloodstream
Pancreas detects
increased levels of
blood glucose
Cells become
less permeable to
insulin
Pancreas secretes
insulin in to
Pancreas reduces bloodstream
insulin secretion
Insulin increases
permeability of
cells (esp. muscle
Pancreas detects and liver) and
drop in levels of membranes to
blood glucose glucose
Blood glucose
levels begin to drop
A summary of insulin action

46
Glucagon: in contrast to insulin, glucagon serves to maintain blood glucose levels by
triggering the release of glycogen from the liver (glycogen is the stored form of
glucose). In the hours following the last meal, a combination of normal metabolic
processes and physical activity will begin to lower blood glucose levels (assuming
nothing has been eaten in the meantime). The drop in circulating blood glucose
levels triggers the release of glucagon from the pancreas. In contrast to insulin,
glucagon has a much more specific affect in stimulating the liver to convert some or
all of its glycogen stores back in to glucose which are then released in to the
bloodstream.
The effects of exercise: understanding the effects of exercise is helpful because they
help underline the interrelationship between insulin and glucagon. As activity levels
increase, glucose uptake by the body’s cells also increases. This is the result of an
increased sensitivity of the cells to insulin, thus insulin levels will drop during physical
activity (Wilmore and Costill, 2004). At the same time glucagon secretion by the
pancreas increases, thus helping maintain a steady supply of blood glucose.
Glucose levels
begin to drop
Pancreas detects
decreased levels of
blood glucose
Liver reduces
release of glucose
Pancreas secretes
glucagon in to
Pancreas reduces bloodstream
glucagon secretion
Glucagon
stimulates the
Pancreas detects release of glucose
rise in levels of from the liver
blood glucose
Blood glucose
levels begin to rise
A summary of glucagon action

47
Adrenalin (epinephrine)
Adrenalin is a hormone produced by the adrenal glands, which are situated on top
of each kidney. It is one of a category of hormones known as catecholamines.
Essentially, these hormones help prepare the body for activity, more specifically they
are part of the stress response.
In preparation for activity, the hypothalamus (part of the brain) triggers the adrenal
glands to secrete more adrenalin. This will have a number of specific physiological
effects that will help sustain exercise activity:
• increases heart rate and stroke volume

• elevates blood glucose levels
• redistributes blood to working tissues
• opens up the air ways
(Tortora and Grabowski, 1996; Wilmore and Costill, 2004)
Testosterone and oestrogen

Testosterone is produced in the testes of the male and in small amounts in the
ovaries and adrenals of the female. Males produce up to ten times more testosterone
than females (McArdle et al, 2001) and this is primarily responsible for the
development of the male secondary sexual characteristics, such as facial and body
hair and greater muscle mass. Oestrogen is produced primarily in the ovaries in the
female with small amounts produced in the adrenals in males. Women of reproductive
age have significantly higher levels of oestrogen than males which gives rise to
female secondary sexual characteristics such as breast development and regulation
of the menstrual cycle.
For both males and females however, testosterone pays a fundamental role in the
growth and repair of tissue. Raised levels of testosterone are indicative of an anabolic
(tissue building) training status. Oestrogen has many functions, but in particular has
an influence on fat deposition around the hips, buttocks and thighs.
Cortisol
In contrast to testosterone, cortisol is typically referred to as a catabolic hormone
(associated with tissue breakdown). Under times of stress, such as exercise, cortisol
is secreted by the adrenal glands and serves to maintain energy supply through the
breakdown of carbohydrates, fats and protein. High levels of cortisol brought about
through overtraining, excessive stress, poor sleep and inadequate nutrition can lead
to significant breakdown of muscle tissue, along with other potentially harmful side
effects (McArdle et al, 2001).
Growth hormone
The name of this hormone has particular reference to its primary functions. Growth
hormone is released from the pituitary gland in the brain and is regulated by the
nearby hypothalamus. Growth hormone is stimulated by several factors including
oestrogen, testosterone, deep sleep and vigorous exercise. Growth hormone is

48
primarily an anabolic hormone that is responsible for most of the growth and
development during childhood up until puberty when the primary sex hormones
take over that control. Growth hormone also increases the development of bone,
muscle tissue and protein synthesis, increases fat burning and strengthens the
immune system.
Thyroid hormones
The thyroid gland is located at the base of the neck just below the thyroid cartilage,
sometimes called the Adam’s apple. This gland releases vital hormones that are
primarily responsible for human metabolism. The release of thyroid hormones is
regulated by the master gland, the pituitary. Thyroid hormones have been shown to
be responsible for carbohydrate, protein and fat metabolism, basal metabolic rate,
protein synthesis, sensitivity to adrenalin, heart rate, breathing rate and body
temperature. Low thyroid function has become a well recognised disorder leading to
low metabolism, fatigue, depression, sensitivity to cold and weight gain. The
incidence of hypothyroidism today is relatively low with only 3% of the population
suffering the condition.
The effects of exercise

Research has indicated that testosterone and growth hormone levels increase
following strength training and moderate to vigorous aerobic exercise. It is also noted
that a similar pattern seems to emerge for cortisol (McArdle et al, 2001).
The presence of cortisol in the bloodstream is often taken to be indicative of

overtraining. This is perhaps a little simplistic as cortisol is a necessary part of
maintaining energy levels during normal exercise activity and may even facilitate
recovery and repair during the post-exercise period (McArdle et al, 2001).
Problems may arise however, as a result of extremely intense or prolonged bouts of

endurance training, which have been found to lower testosterone levels whilst raising
cortisol levels. Under these circumstances, catabolism (breakdown) is likely to
outstrip anabolism (build up) and give rise to symptoms of overtraining (Wilmore
and Costill, 2004; McArdle et al., 2001).

49
The respiratory system
To function effectively the cells of the body need a continuous supply of oxygen and
a means of removing carbon dioxide. This is achieved through the coordinated
activities of the respiratory system and the circulatory system. The respiratory
system’s primary function is to allow the efficient exchange of gases into and out of
the body. It is the interface between the external environment and the bloodstream.
The anatomy of the respiratory system
The key anatomical features of the respiratory system are illustrated in the diagram
below. The upper portions of the system are formed by a series of tubes in which
little or no gas exchange occurs.
At the top, the nose and mouth serve to warm and filter the air before it passes into
the lungs. The back of the throat is referred to as the pharynx and extends from a
region level with the nose down to the larynx. The larynx or voice box is a relatively
short passage which is lined with a series of cartilaginous folds. The inner most of
the folds (true vocal chords) vibrate to produce speech.
Extending from below the larynx is the trachea, which can be located just below the
level of the Adam’s apple. The distinct ridges that can be felt, are rings of hyaline
cartilage, these provide rigidity to the trachea which prevents it from collapsing
during inspiration (breathing in). At approximately mid - chest level the trachea
subdivides to form two bronchi, which connect to the lungs. Within the lungs the
bronchi further subdivide to form smaller bronchi, which eventually form into
bronchioles, the smallest of which are referred to as terminal bronchioles. The
network of vessels extending from the trachea look like the branches of a tree and is
sometimes referred to as the ‘bronchial tree’ (Tortora and Grabowski, 1996).
Trachea
Bronchi
Bronchioles
Gross anatomy of the lungs

50
The alveoli
At the ends of the terminal bronchioles are the alveoli. These small sac-like structures
mark the point at which atmospheric gases meet the blood supply. There are
approximately 300 million alveoli and each has a network of tiny blood vessels
surrounding them, causing the lungs to have the largest blood supply of any organ
in the body (McArdle et al, 2001).
Capillaries
Alveoli
Alveoli

The membranes of the alveoli are extremely thin, thus allowing oxygen and carbon
dioxide to diffuse easily in and out. The membrane of each alveolus is covered by
a dense network of capillaries. The blood in these capillaries carries the waste
products of respiration (carbon dioxide) which diffuse through the alveoli and are
expelled when we breathe out. At the same time, oxygen diffuses out of the alveoli,
into the blood and is transported back to the heart.
Exchange of gases in the alveoli

51
The mechanics of breathing
The process of taking air in to the lungs is referred to as inspiration, whereas expelling
air from the lungs is referred to as expiration. The mechanisms behind this process
involve muscular contractions which enlarge the chest cavity. The resultant drop in
pressure causes air to be drawn in to the lungs. The primary musculature involved
in inspiration is the diaphragm and the intercostals muscles, the most important of
these being the diaphragm (Tortora and Grabowski, 1996).
During normal expiration, relaxation of the respiratory muscles, coupled with the
effects of elastic recoil cause air to be forced back out of the lungs. When more
forceful expiration is required, it is facilitated by the abdominal musculature.

Inhalation Exhalation
Diaphragm
relaxes
Diaphragm Lungs size
contracts decreases
Lungs size
increases
The mechanics of breathing

52
Regulation of respiration
Regulation of breathing is controlled by the respiratory centre of the central nervous

system (the medulla and the pons). This region sets the basic rhythm for breathing
and coordinates the transition from inspiration to expiration. During exercise, the
respiratory centre receives input from movement receptors in skeletal muscle. Also,
chemoreceptors (sensors that detect chemical changes) in the medulla and arteries
detect increases in levels of circulating carbon dioxide. The medulla responds by
increasing the rate and depth of respiration.
The medulla also receives input from the cerebral cortex (the part of the brain
associated with higher cognitive processes). This allows us to exert voluntary control
of breathing where necessary, for example breath can be held when placing the
head underwater.
Smoking and the respiratory system
The dangers associated with smoking are well documented. Nevertheless, it is useful
to explore some of the specific effects on the respiratory system and their implications
for exercise performance.
The short term effects of cigarettes on the respiratory system begin with the reflexive
narrowing of the airways. The result of this being an increase in resistance to airflow
(McArdle et al, 2001). Note that this is unlikely to affect light exercise, however, it
may significantly inhibit vigorous exercise performance. The build up of irritants also
causes an increase mucus secretion and a swelling of the cells lining the airways,
thus further inhibiting airflow. The presence of carbon monoxide in cigarette smoke
further restricts performance by reducing the oxygen carrying capacity of the red
blood cells. Finally, smoking inhibits the natural ‘cleansing’ activities of the lungs
causing debris and mucus to accumulate, further limiting normal respiratory
function.
Over time smoking will lead to a destruction of the elastic fibres of the lungs, coupled
with the collapse of the terminal bronchioles and alveoli. Eventually emphysema
may develop in which exhalation becomes difficult due to the loss of the elasticity of
the lungs. Emphysema represents a major limit to physical activity.

53
The cardiovascular system
In order to sustain exercise, the cells of the body not only require a continuous
supply of nutrients, but also must have their waste products removed. The means
by which this is achieved is through the cardiovascular system. In the following
section, we will take a closer look at the control systems of the heart and review the
key variations between the blood vessels.
The heart
The heart is a muscular pump and is the means by which blood is pushed into the
tissues. It comprises of four chambers; two upper, smaller chambers called atria
(called an atrium when referring to one) and two lower, larger chambers called
ventricles. The predominant tissue of the heart is cardiac muscle which is referred
to as the myocardium (myo – meaning muscle, cardium – pertaining to the heart).
Position of the heart

54
Heart valves
Valves of the heart

In order that blood can be directed effectively through the heart and into the tissues,
the heart is equipped with a number of valves.
In order to prevent the back flow of blood from the ventricles into the atria,
atrioventricular (AV) valves are positioned between the two chambers. As the
ventricles contract, pressure rises and forces the AV valves to snap shut, thus
preventing blood flowing back in to the atria and allowing blood to be directed
through the arteries leaving the heart (pulmonary artery and aorta).
After each contraction there is a relative drop in pressure within the ventricles as they
relax. Potentially at this point, blood within the pulmonary artery and aorta can flow
back into the ventricles. To prevent this, both sets of arteries have valves positioned
at the point where they emerge from the ventricles. These are referred to as semilunar
(SL) valves. As the blood moves back towards the ventricles the SL valves snap shut,
thus blood cannot re-enter.

55
Coronary arteries
Coronary arteries
Coronary blood supply and health

The heart, like any other tissue requires a constant supply of oxygen and nutrients.
To achieve this it has its own network of blood vessels. Blood is delivered to the
tissues of the heart via two coronary arteries (referred to as the left and right coronary
arteries). These arteries stem directly from the aorta, which is the major vessel
through which blood is ejected from the left ventricle. Blood is then circulated
through the cardiac tissue via a capillary network before being drained away through
the coronary veins.
Most regions of the heart are served by more than one branch of the coronary
arteries; should the blood flow through one vessel become reduced in someway (e.g.
through heart disease), blood supply to the tissues can be maintained through
collateral vessels.

56
Arterial fatty deposits
The coronary arteries have become renowned for their association to heart disease.
The flow of blood through these arteries and arterioles is critical to the health of the
heart. Multiple factors can lead to damage of these arteries and dysfunction which
in turn limits blood flow to sections of the heart. Mineral, protein and fatty deposits
can build up in the walls of the arteries when the internal environment allows
damage to occur to the thin epithelial membrane that lines the inside of arteries.
These hard mineral deposits reduce the elasticity of the arteries so they can’t stretch
in response to blood flow and increased blood pressure can result. If left unchecked
these deposits can become so large that they can, by themselves severely limit blood
flow by protruding into the inside of the artery. Sudden heart attack can often be a
result of one of these deposits bursting, releasing their contents and initiating a rapid
clotting process to stop the blood from escaping the artery. A forming clot can stop
blood flow which results in oxygen deprivation to a section of the heart. The body
responds with a rapid increase in heart rate to try and dislodge the blockage and
re-establish blood flow. This very rapid beating, oxygen deprived heart is what is
experienced during a heart attack.
Blood pressure
BUPA (2002) describes blood pressure (BP) as “a measure of the force that the
blood applies to the walls of the arteries as it flows through them”. It is measured in
millimetres of mercury (mmHg) and is expressed using two numbers. The ACSM
define optimal blood pressure, with respect to cardiovascular risk, as being below
120 mmHg for systolic and 80 mmHg for diastolic pressure (Franklin, 2000). Blood
pressure is an expression of the arterial blood flow and the peripheral resistance the
blood encounters as it flows round the body. Hypertension is the clinical term used
to describe a high blood pressure (BP) of 140/90mmHg or higher (National Institutes
of Health (NIH, 1997). Worldwide, high blood pressure affects 1 billion people
(NIH, 2003) and is estimated to be implicated in over 7.1 million deaths; 13% of
the total annual deaths (WHO, 2002). As acute exercise increases blood pressure in
the short term this must be carefully taken into account prior to beginning an exercise
programme with a hypertensive. Please refer to the section on hypertension.

57
Control of the heart - the conduction system
In order for the heart to work effectively, contraction of the various chambers must
be done in a systematic and coordinated manner. To facilitate this, the heart
possesses an elegant ‘conduction system’. This is basically a means to direct the
course of electrical activity (action potential) through the tissues of the heart so that
they contract in a particular sequence.
Central to this conduction system are two small bundles of fibres located in the right
atrium; the sinoatrial (SA) node and the atrioventricular (AV) node. The SA node is
a collection of self excitable cells; they require no neural input and are the site where
cardiac action potentials begin. From this point, action potentials spread across both
atria and thus, they will contract first.
The flow of action potentials to the ventricles is controlled and directed via the AV
node which is located at the base of the right atrium. The function of the AV node
is to slow down the action potential and give the atria time to contract. If this did not
occur the atria and ventricles would contract almost simultaneously. From here the
action potential travels down a specialised nerve bundle (AV node bundle) before
branching off into two bundles in the central wall of the heart (the septum). According
to Tortora and Grabowski (2002) the AV node bundle is the only place where action
potentials can cross between the atria and the ventricles. These two branches direct
the action potentials to the base of the ventricles, so that an action potential (or
contraction) will spread outwards and upward along the outer walls of the ventricles,
directing the blood upwards instead of downwards
The cardiac cycle
As noted above, the conduction system allows the heart to function effectively by
causing different portions of the heart to contract and relax in a coordinated manner.
The cardiac cycle is described as all the events associated with one beat. The key
elements of the cardiac cycle relate to the contraction and relaxation of the heart’s
chambers. A chamber under contraction is referred to as being in ‘systole’, whereas
one which is relaxing is referred to as being in ‘diastole’. The following is a brief
summary of the key events of the cardiac cycle:
• relaxation (diastole): relaxation of the atria allows blood to refill them from the
pulmonary veins and vena cava. This precedes, and continues with, the
ventricular relaxation which allows blood to flow in from the atria.
• atrial systole (contraction): stimulation from the SA node causes the atria to
contract and push any remaining blood into the ventricles.
• ventricular systole (contraction): the ventricles contract causing a rise in
pressure. This closes off the AV valves and directs the blood to be ejected from
the heart via the pulmonary artery and aorta.
• relaxation (diastole): the atria relax followed by the ventricles, until all four
chambers are in diastole and the cardiac cycle begins over again.

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Control of the heart - the autonomic system
Whilst the SA node dictates the basic rhythm of the heart beat, the autonomic
system is able to exert significant control over the amount of work the heart does.
This is primarily directed by the medulla oblongata of the brain. It responds to a
variety of different stimuli, such as; input from other brain centres (e.g. the cerebral
cortex and the hypothalamus), chemical changes in the blood, variations in blood
pressure and movement of the limbs (Tortora and Grabowski, 2002).
The activities of the autonomic system can basically be divided into two; those
which prepare the body for activity (the sympathetic system) and those which return
the body to rest (the parasympathetic system). The sympathetic system will increase
the output of the heart, whereas the parasympathetic system will decrease the
output.
When the need arises (e.g. starting to run), the autonomic system can increase the
volume of work done by the heart via two cardiac accelerator nerves running from
the medulla of the brain. These stimulate the SA node to generate action potentials
more rapidly, as well as directly causing the myocardium to contract more forcefully
(in other words, the heart beats quicker and harder).
In contrast, in a resting state, the vagus nerve (also from the medulla) causes the SA
node to generate action potentials less rapidly; consequently lowering the heart rate.
The SA node will naturally generate between 90 – 100 beats per minute, the
influence of the vagus nerve will usually reduce this to approximately 60 – 85 beats
per minute. For the trained athlete however, Wilmore and Costill (2004) note that
this may drop to less than 30 beats per minute.
Input from higher brain centres and

receptors throughout the body
Accelerator Medulla of brain Vagus

nerve nerve
SA node SA node
AV node AV node
Increases Decreases
output of heart output of heart
SYMPATHETIC PARASYMPATHETIC
Autonomic control of the heart

59
Measuring the output of the cardiovascular system
The work done by the heart is termed cardiac output (CO) and is defined as the
volume of blood pumped from the heart every minute. The determinants of cardiac
output are stroke volume (SV) and heart rate (HR). Stroke volume is the amount of
blood ejected from the ventricles every beat, and heart rate is the number of times
the heart beats in a minute. Thus to calculate cardiac output, multiply stroke volume
by heart rate:
CO = SV x HR
Practically speaking however, it is difficult to calculate cardiac output as determining

stroke volume can involve some fairly invasive procedures.
Blood vessels
Blood vessels provide the means through which blood is directed from the heart to
the tissues of the body and back again. Although blood vessels vary in terms of
shape and function, they all link to form a continuous loop – a circulation.
The circulatory system is composed of five types of vessels; arteries, arterioles,

capillaries, venules and veins. These vary in construction and size, depending on
their function and position in the body
Arteries
The main feature of arteries is that they carry blood away from the heart; consequently
the pressure exerted on them is considerably higher than in other vessels. This is
reflected in their construction. In contrast to other vessels, arteries are generally
more robust in design; they have thicker walls, a greater number of elastic fibres and
more smooth muscle. The elasticity is particularly pronounced in arteries closer to
the heart, which have to accommodate large surges of pressure during ventricular
contraction. The elastic recoil then facilitates the onward movement of the blood.
Further along the circulation, the larger elastic vessels give way to medium-sized
arteries, in which a greater proportion of smooth muscle is evident. Tortora and
Grabowski (2002) note that these larger amounts of smooth muscle allow for greater
vasoconstriction and vasodilatation; this adjusts the rate of blood flow to suit the
needs of the structure supplied.

60
Artery
Vein
Arteriole
Venule
Capillary
Cardiac cycle
Arterioles
As the arteries branch and subdivide, they become smaller. The smallest of these
arteries are the arterioles. Although microscopic, they still contain smooth muscle
and elastic fibres, albeit in relatively small amounts. The main purpose of the
arterioles is to regulate blood flow to the capillary beds.
Capillaries
Eventually the few sparse elastic and muscle fibres of the arterioles disappear,
leaving a capillary, which is comprised of only a single layer of cells.
The walls of capillaries are microscopically thin, which allows the efficient exchange
of nutrients and waste products between the circulating blood and the body’s cells.
Just about every cell in the body will have a capillary near by, although areas of high
metabolic activity will tend to have a higher density. It is also worth noting that
exercise will increase capillary density in trained muscle (Jones and Round, 1990).
Venules
Having passed through the tissues, capillaries start to join with other capillaries to
form venules (small veins). As with the arterioles, they have small amounts of
smooth muscle tissue and elastic fibres. Their primary function is to drain the blood
from the capillary beds and into the veins.

61
Veins
As venules connect to other venules, larger vessels are formed called veins. The
pressure of blood within the veins is relatively low, and whilst veins are comprised
of the same basic constituents as arteries (i.e. smooth muscle and elastic fibres), the
proportions tend to be lower when compared to an artery o f a similar size. One of
the major distinguishing features of veins is that they are equipped with non-return
valves. These are needed because blood pressure in the veins may be insufficient to
overcome gravity, thus valves help prevent reversed blood flow or pooling of blood in
the limbs.
Effects of exercise on the cardiovascular system
Exercise has been shown to have very positive effects on the cardiovascular system.
In healthy individuals, a regular exercise training programme including aerobic and
endurance-based resistance training can be expected to bring about the following
benefits:
• increased growth of cardiac muscle

• larger stroke volume
• lower heart rate for the same relative pre-trained exercise intensity
• stronger and more elastic arteries
• improved blood cholesterol markers
• increased network density of capillary beds
• increased haemoglobin count in blood
• lower blood pressure in the long term
Exercise has been shown to carry some risks in certain population groups with
regard to the cardiovascular system. The following points should be considered and
weighed up against specific clients prior to engaging in physical activity:
• increased blood pressure, especially during high intensity work, breath holding
and use of valsalva techniques
• increased risk of light headedness or postural hypotension in some clients

62
Energy systems
Adenosine triphosphate: energy currency
Our bodies, like all machines, require energy for movement, to produce force against
objects, generate heat and to grow or repair tissue. This energy comes from one
place, a substance known as adenosine triphosphate, or ATP. It is in this form that
our body uses the energy provided by the macronutrients in the food we eat;
carbohydrates (CHO), fats and protein. All three of these nutrients play important
parts in the complex processes of ATP production, although fat and CHO are the
preferred energy sources. Protein can also be used as an energy source in certain
circumstances, such as when carbohydrate stores are depleted or food is scarce.
ATP provides the energy to drive the sliding filaments in muscular contractions.
Therefore, as long as ATP supply is sufficient to meet exercise demands, muscular
activity can continue. To meet these ATP demands the body has three distinct energy
systems; the creatine phosphate system, the lactate system and the aerobic system.
Before reviewing the different energy systems however, it is important to take a
closer look ATP.
The structure of ATP

ATP is an energy rich compound, composed of one adenosine molecule, bound with
three phosphate molecules. Energy is stored in the bonds that link the phosphate
groups to the larger adenosine molecule, and are called high energy bonds. ATP
releases, or liberates, its energy when one of its two high energy bonds is broken (by
the enzyme ATPase), and 7.3kcals of energy are released per mol of ATP (McArdle
et al, 2001). After this breaking down reaction, an adenosine molecule bound with
two phosphate molecules (adenosine diphosphate, or ADP) and an unattached
phosphate group is left.
Adenosine Triphosphate Adenosine Diphosphate + Phosphate
p A p p A
Energy
Energy p
p p
This reaction will occur during muscular contractions and is controlled by the enzyme
myosin ATPase. The ATP, which is stored on the myosin head, is broken down to
ADP. Release of the subsequent ADP causes the myosin head to ‘nod’, which slides
the actin over the myosin. The myosin head then binds with another ATP molecule,
causing it to detach from the binding site. It is then able to attach to the next binding
site, and perform the same routine. This will continue as long as ATP is available,
nervous stimulation is present and other fatiguing factors do not interfere.

63
There is a very limited store of ATP within the muscles so they must be continually
replenished if exercise is to continue. The energy systems serve this purpose by
providing the energy to convert ADP back in to ATP, for use by the cells. These three
systems are the creatine phosphate system, the lactate system and the aerobic
system.
The energy systems
The creatine phosphate system: immediate energy

For high intensity, low duration activities, such as sprinting, long jumping, or shot
putting, energy for muscular contraction is required quickly. This is primarily supplied
by intramuscular (within the muscle) stores of ATP and creatine phosphate (CP).
ATP stores are extremely limited and may only last for the first few seconds of
exercise (McArdle et al, 2001). Once these have been depleted, they can be almost
immediately regenerated by the breakdown of creatine phosphate. This compound,
like ATP, has a high energy bond, which when broken down, will release enough
energy to yield an ATP molecule. This chemical reaction is very rapid and like the
ATP stores, CP stores are also limited, thus exercise will only last for a very short
period of time, approximately 5 – 8 seconds. In fact, it is noted that during a
100m sprint, lasting approximately 10 seconds, runners are usually slowing down
in the final few seconds; the winner being the one who slows down the least (McArdle
et al, 2001).
Creatine + Adenosine Triphosphate
C p A p
7.3 kcals
Energy for
p muscle
contraction
p p p
C A
Creatine Phosphate + Adenosine Diphosphate + Phosphate

64
As this system is derived exclusively from chemical energy stored within the muscles,
the process requires no oxygen (anaerobic) and places no immediate demands on
fat or carbohydrate stores. Depending on the intensity and duration of activity, the
recovery period for this system ranges from 30 seconds to 4 minutes (adapted from
Conley, 2003).
It is worth noting that a poor diet may limit CP stores, whilst resistance training and
creatine supplementation may increase free creatine and phosphocreatine stores
(Kreider, 1998). It is also worth noting that the long term effects of creatine
supplementation are still unclear.
Lactate system
Lactic acid is named after the acid found in sour milk (Robergs, Ghiasvand and
Parker, 2004) and the lactate system is generally associated with the burning
sensations felt during high intensity activities. The terms lactic acid and lactate are
sometimes used interchangeably, which is incorrect. Lactic acid is an acid, whilst
lactate is an acid salt. This is a subtle difference, but for the purposes of this text we
will be referring to lactate predominantly.
The lactate system can essentially bridge the gap between the aerobic and CP
systems. It allows rapid ATP production to continue beyond the few seconds of the
CP system, and at a rate significantly greater than the aerobic system can achieve.
It can sustain exercise activity for between 60 – 180 seconds e.g. 400m on the
track or 100m in the pool (McArdle et al, 2001).
It provides a fast supply of energy, produced by the incomplete breakdown of the

carbohydrate glucose, taken from the blood, or made from the breakdown of glycogen
(stored glucose). Glucose is converted in a number of stages to a substrate called
pyruvate. The pyruvate will then enter one of two directions, purely dependent on
whether oxygen is present or not. If there is sufficient oxygen, the pyruvate will enter
the aerobic energy system. If there is insufficient oxygen to meet energy demands, it
is converted, very rapidly, to lactate. This process will yield 3 ATP per glucose
molecule, and does not occur in the presence of oxygen.
Muscle glycogen
From blood Glucose
Pyruvate ATP + Lactate
Cellular respiration
in mitochondria
Glucose metabolism

65
It was previously thought that the conversion of pyruvate to lactate was to ‘top up’
the energy production of the aerobic energy system. When more energy was required
than the aerobic system could provide, this conversion would lead to production of
a few more ATP, allowing the athlete to work at higher intensities.
Research by Robergs et al (2004), cast severe doubt on the fatiguing effects of

lactate. Traditional theories describe lactate as the cause of the burning sensations
and fatigue during high intensity activities. The cause is in fact a concurrent build up
of hydrogen ions, which causes pH levels to drop, a state known as acidosis. This
state of acidosis inactivates various enzymes involved in energy production and can
interfere with the muscles contractile ability (McArdle et al, 2001).
The question arises; does lactate production cause an increase in hydrogen ions, or
does it just occur at the same time? Hydrogen ions are released when ATP is broken
down to ADP. These are normally absorbed in the aerobic energy system. But during
high intensity activities, the breakdown of ATP is occurring at a massive rate and
thus the build up of hydrogen is unavoidable. Pyruvate can be used to maintain the
pH and buffer these hydrogen ions, by binding with them; the result of which is the
formation of lactate. This study (Robergs et al, 2004) proposes that the production
of lactate is, therefore, a result of the body’s attempt to prevent acidosis and is not
actually the cause of it. This new theory is gaining a lot of popularity with exercise
physiologists, who realised the biochemical flaws in the original theory. Despite this
however, lactate levels can still be used indirectly to measure the intensity of exercise.
Even at rest, small amounts of ATP are produced using the lactate system;
consequently there is always a small amount of lactate present in the blood. During
low to moderate activity, energy requirements are easily met using the aerobic
system, thus lactate levels remain relatively unchanged. However, when the energy
demands of an activity become too great for the aerobic system to manage and
hydrogen ion levels increase, the lactate system will start to be utilised and blood
lactate levels will start to rise.
Although lactate levels increase, research has indicated that prolonged exercise can
continue provided levels stay below a certain threshold. At some point however, the
build-up of fatiguing waste products associated with the lactate acid system reaches
levels sufficient to bring about the familiar decline in performance and burning
sensations associated with this type of intensity. Recovery from this type of activity
can vary from 20 minutes to two hours depending on intensity and duration.

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Aerobic (oxygen) system
Aerobic simply means ‘with oxygen’, and refers to the energy system that produces
ATP from the complete breakdown of carbohydrate and fat, in the presence of
oxygen. The aerobic energy system is dominant during lower intensity activities
when ATP demands are low and oxygen consequently is relatively plentiful.
Fatty acids
Oxygen 1 Glucose
molecule
Cellular respiration
in mitochondria
CO2 ATP
ATP
H2O
Aerobic system
The aerobic system produces carbon dioxide, water and heat as by-products of the
breakdown of CHO and fat. With the abundance of these nutrients in the body, there
are almost no limits on the amounts of ATP that can be produced. There are, however,
limits on the rate of aerobic ATP production. As was mentioned earlier, when exercise
intensity reaches a certain point, the lactate system will start to provide more and
more energy during the buffering process. The point at which this occurs will vary
according to individual aerobic fitness (the ability to take in, transport and utilise
oxygen). The higher the aerobic fitness the higher the exercise intensity that can be
maintained without fatiguing waste products accumulating (i.e. one can run faster
for longer). This point will be explored further when we address training adaptations.
Assuming the absence of any overuse injury, the recovery time from this type of
exercise will be the time taken to eat, drink and replenish fuel stores.
Fuel and the aerobic system: fat (fatty acids) and carbohydrate (glucose) are the two
macronutrients that supply the body with ATP during aerobic metabolism. Whether
the body is at rest, or exercising aerobically, both carbohydrate and fat are required,
just in varying proportions. Fat is commonly said to ‘burn in a carbohydrate flame’,
meaning that fat cannot be broken down without carbohydrate present. The relative
proportions vary depending on nutritional status and/ or exercise intensity.
At rest or during low intensity activity most aerobic energy is supplied by fat. As
exercise demands increase and ATP is required more quickly, carbohydrates will
begin to contribute more to the process. Although protein contains as many calories
of energy as glucose, it will contribute little to energy production so long as sufficient
carbohydrates are available.

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Energy systems and training adaptations
Provided the right training stimulus is used, the energy systems show a variety of
differing adaptations which ultimately equate to improvements in exercise
performance. Even today however, many of these adaptations are not fully
understood, so for the purpose of clarity only the principle ones will be discussed
below.
Aerobic training adaptations

It was discussed earlier that the main limit on aerobic energy production is the
ability to take in, transport and utilise oxygen (these will be referred to as pulmonary,
cardiovascular and muscular changes respectively). Aerobic training has been
shown to enhance all three of these areas:
• pulmonary changes - evidence suggests that the principle adaptations

associated with the pulmonary system are improvements in the efficiency of
the respiratory muscles. This is indicated by an increase in maximal breathing
rate and tidal volume (i.e. one can breathe quicker and deeper at maximal
intensities). It is also suggested that more efficient respiratory muscles are
likely to use less oxygen, produce fewer waste products and thus potentially
increase oxygen availability to other working muscles (McArdle et al, 2001).
• cardiovascular changes - there are a number of training adaptations associated

with the cardiovascular system. Firstly, the heart of a trained individual shows
significant hypertrophy and improvements in coronary blood flow, thus
allowing a greater capacity for work.
The most significant coronary adaptation appears to be an increased stroke

volume. This is indicated by a lower resting heart rate, and a greater cardiac
output at maximal heart rates. These improvements are complimented by an
increase in blood plasma volume which may also contribute to the increased
stroke volume, and oxygen transport (McArdle et al, 2001).
The larger cardiac output of the heart facilitates a greater flow of blood to the
working tissues. However, changes in the control of blood distribution,
increased arterial diameter and capillary density also serve to maximise blood
flow to the muscles.
• muscular changes - improved blood supply to the active muscles is matched

by a greater ability of these muscles to extract and utilise oxygen from the
blood. In this respect, one of the key adaptations within the muscles is an
increased size and number of mitochondria. Mitochondria are the structures
within the muscle cells, where aerobic ATP production takes place, thus
bigger and more numerous mitochondria mean greater ATP production.

68
Furthermore, within the mitochondria there are significant increases in the
volume of aerobic enzymes, which increases the muscles ability to metabolise
(breakdown) fat and carbohydrate.
Finally, McArdle et al (2001) note that although aerobic training may not
‘change’ one fibre type into another (i.e. fast twitch into slow ), it will maximise
the aerobic potential of muscle fibres. A trained individual will tend to
demonstrate a predominance of slower twitch muscle fibres, in fact McArdle
et al (2001) also note that, ‘…highly trained endurance athletes have larger
slow twitch fibres than fast twitch fibres in the same muscle’.
Training and the lactate system

Training adaptations in the lactate system are a little harder to describe. As it appears,
changes in this system are related to improvements in the cardiorespiratory system.
Muscles that receive and utilise more oxygen for example, are going to produce less
lactic acid at a given exercise intensity.
It would also appear that regular anaerobic training improves tolerance to the build
up of fatiguing waste products. As yet however, researchers can only speculate as to
whether this is due to physiological adaptations or is simply the result of motivational
changes.
CP training adaptations
There is little doubt that activities emphasising the CP system, such as heavy weight
lifting and sprinting have a significant training effect; namely increased muscle mass
and a predomination of fast twitch muscle fibres (Jones and Round, 1991). It is also
reported that this form of training can significantly increase muscular stores of
anaerobic fuel sources i.e. ATP, creatine phosphate and glycogen (McArdle et al.,
2001).
Debate continues however, as to whether this form of training improves the ability of
enzymes within these muscles to generate greater amounts of ATP. To date there is
little research to support this idea.
In summary, the principle adaptations associated with training the CP system would
appear to be increased muscle size (fast twitch fibres) and improved activation of the
muscle by the nervous system.

69
Interaction between energy systems
Although the energy systems are presented separately here, it is important to

underline that there is considerable overlap between them. In fact, at any one time,
all three systems could be providing the body with energy. However, the relative
contribution of each is determined by the intensity of the activity. The table below
illustrates one view of the relative contribution of aerobic and anaerobic energy
systems for various sporting activities.
The energy continuum
Aerobic Anaerobic
Weight lifting 0% 100% 100m sprint; golf & tennis
Gymnastics swings; American football
200m sprint 10 90
Basketball; baseball;
Ice hockey
20 80 400m sprint
100m swim
Tennis 30 70 Lacrosse
Hockey
40 60
800m run 50 50
Boxing 200m swim; skating
60 40
2000m row
1 mile run 1500m run
70 30
400m swim
80 20 800m swim
2 mile run
3 mile run 90 10
Skating 10 km
100% 0%
Marathon
Adapted from
Bowers & Fox (1988)
The energy continuum
It is worth noting that as the demands of the activity change so do the relative
It oughtof
contributions to the
be remembered that at NO point
energy systems. Duringin time do we
a jog orsolely
run,use eitherthe
when aerobic
intensity is low,
or anaerobic energy sources.
ATP requirements are met by the aerobic system. At higher intensities, for example
when going up a long hill, there is a greater contribution from the lactate system. At
some point waste products would accumulate to a level where further increases in
intensity become difficult.
Also, as one energy system becomes exhausted the others can take over. For example,
a series of maximal vertical jumps will use the CP system; however, this system will
be exhausted within 5 – 10 jumps. Jumping beyond this point is likely to require
energy from the aerobic and lactate systems. Because the aerobic system takes a
period of time to meet this increased demand for ATP, the lactate system may well
provide the energy in the interim period. Jumping will continue, but performance
will drop off considerably because of a build up of fatiguing waste products.

55
Level 2 Certificate in Fitness Instruction (GYM) - MANUAL

70
Monitoring intensity, energy expenditure and performance
For the personal trainer one of the biggest challenges is to identify the best means of
monitoring intensity and performance. Objective measures, such as weight lifted,
speed and distance run are important, but are unable to provide much information
regarding physiological changes and sensations experienced by the exerciser. To this
end, there are a number of approaches to monitoring exercise intensity and
performance. These range from complex laboratory-based assessments to the use of
simple question and answer procedures.
Before discussing examples of assessments however, it is important to point out that

they are typically applied to activities that involve the lactate and aerobic energy
systems. Monitoring internal changes during the 6 second bouts of activity associated
with the CP system would prove difficult. It would appear therefore, that simple
measures such as, levels of force or power generated are more appropriate for this
system.
Lactate testing
It was noted earlier that levels of lactic acid provide a useful gauge as to the amount
of anaerobic activity going on in the muscles. Measurement protocols typically use
activities involving large muscle groups, such as running or cycling (results will differ
depending on the activity being tested, thus the principle of specificity must be taken
into account when selecting the mode of exercise).
Subjects are then required to perform exercise of incrementally increasing intensity.

This either takes the form of a single sustained bout of exercise activity which ends
when the subject can do no more (e.g. VO2max test), or a series of increasingly
intense bouts of exercise (typically 4 minutes long) followed by short recovery
periods. In both protocols, blood lactate responses are measured through blood
analysis and the key changes in lactate response are noted. These relate to the point
at which lactic acid first starts to accumulate and the point at which lactate
accumulation becomes greater than its removal.
The value of this form of assessment is that the information gained serves as a useful
indicator of current training status and as a predictor of endurance-based performance.
Furthermore, it can be used to establish the optimum intensity for training (McArdle
et al, 2001).
Researchers may argue about the finer points of this form of assessment, however
from the point of view of the trainer the main difficulty is that it is impractical to
administer in a ‘real’ training setting. In practice, lactate measurement is still largely
confined to the laboratory environment. In the field setting, the trainer must consider
using simpler procedures.

71
Heart rate monitoring
Since the development of the wireless heart rate monitor, monitoring heart rate
during exercise has become easy and affordable. The predictability of the heart rate
response (i.e. it goes up when we exercise and down when we rest), coupled with
strong correlations with other physiological measures, such as oxygen consumption,
make it an extremely useful measure of performance and exercise intensity.
Most modern cardiovascular machines will provide exercise intensities based upon
predicted heart rate responses. The typical example of this being the aerobic training
zone, which is taken to be between 60 - 90% of one’s maximum heart rate (220
– age) or 50 – 85% of one’s VO2max. Thus for a thirty year old client the calculation
would be the following:
MaxHR: 220 – 30 = 190 beats/ min

60% of MaxHR: 190 * 0.6 = 114 beats/ min
90% of MaxHR: 190 * 0.9 = 171 beats/ min
The recommended aerobic training zone, therefore, for this client would be between
114 and 171 bpm. The calculation is relatively straight forward and with the use of
a heart rate monitor it would be relatively easy to stay within prescribed training
zones.
One of the drawbacks with heart rate monitors concerns the assumption that heart
rate response is the same for everyone. Evidence suggests that although individual
heart rate responds in a predictable manner, the magnitude of the response may
differ from person-to-person. For example, women will generally have higher exercise
heart rates than men (Wilmore and Costill, 2004). Also, research findings reported
by McArdle et al (1992) clearly show that individuals of similar ages performing
identical activities can have significantly different heart rate responses.
Whilst some of these variations could be attributed to differing levels of fitness, it is

important to acknowledge the influence of genetic variations in heart rate response.
In this respect, methods of monitoring intensity based on more individualised
responses to exercise have proved extremely valuable.
Rating of perceived exertion (RPE)

In contrast to the methods described previously, RPE (also known as the Borg scale,
after its creator - Gunnar Borg, 1998) is a subjective rating of how hard the exerciser
feels they are working. Typically two scales have been used; either the 6 – 20 scale
(6 = no exertion at all, 20 = maximal exertion) or a simplified 1 – 10 scale. Either
way, research has indicated that when used correctly the scale provides an accurate
measure of exercise intensity and seems to correlate well with other physiological
measures of performance (Weltman, 1995; Wilmore and Costill, 2004). It is also
extremely easy to administer. Perhaps the only real draw back with the measure is
that it relies on the client being truthful about how hard an activity is!

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The talk test
As with RPE the talk test relies on the response of the exerciser. Simply put, it
identifies the exercise intensity at which ‘normal’ speech can no longer be sustained,
which is indicative of the increased breathing rate triggered by exercise activity.
Interestingly enough, the response is closely linked to the on-going physiological
processes. The breathing rate is dictated by the volume of circulating gases in the
blood which, in turn is directly determined by the level of work being undertaken by
the muscles. Apart from being very simple to administer, reported research has also
indicated that the talk test relates well to other measures of intensity (ACSM, 2004).
Metabolic equivalents (METs)

Another method of monitoring exercise intensity uses measures referred to as
metabolic equivalents (METs). These are based on multiples of an individual's resting
oxygen consumption. According to Wilmore and Costill (2004), at rest the average
individual will consume approximately 3.5 ml of oxygen per kg of their body mass.
This is the equivalent of 1.0 MET, thus energy expenditure at rest is 1.0 MET.
Increases in activity levels will lead to elevated oxygen consumption and therefore,
the number of METs will increase. Walking for example, will consume approximately
three times the oxygen as resting metabolism, therefore, is the equivalent of 3.0
METs. Running flat out for a couple of minutes on the other hand, could be rated as
high as 30.0 METs.
Tables of activities and their MET equivalents are readily available, thus the MET
system is a useful guide for selecting exercise intensities rather than monitoring
them. It is noted, however that the MET system is unable to take into account
variations in environmental conditions and changes in physical fitness (Wilmore and
Costill, 2004), thus it may be best combined with other methods of monitoring
exercise intensity.

73
Postural and core stability
Over the years ‘core training’ or more specifically ‘core stability training’ has become
extremely popular, both in the mainstream gym and sports training environments.
The development of a strong and stable core is championed by many as the key to
improved/pain free function and sporting excellence. Understanding static and
dynamic posture has also become a needed area of understanding in trying to
promote sound functional movement. There are a number of areas that must be
considered in gaining a complete and well balanced understanding of this controversial
and often misunderstood area:
• the structures that make up the core

• the function of the core
• core activation as the foundation to good posture
• what equipment is commonly used in core training
• exercise prescription
Core structure
Quite simply, if the arms and legs are discounted, the core is what remains. Often
the core is considered to include only the abdominal and lower back muscles. This
is too narrow a view since when discussing the core muscles the powerful hip and
upper back muscles should not be overlooked.
To truly appreciate the structures involved, it is useful to think of the body as being
composed of a series of muscle layers - deep, middle and outer.
Deep muscle layer (position sense muscles)

Movements of the spine and extremities can be divided into two categories,
physiological and accessory movements. Gross physiological movements are
responsible for large motions of the body and allow many functional tasks, such as
bending and lifting, to be performed. In contrast, accessory muscles are responsible
for controlling movements that occur within a joint, an example would be when
bending to pick up an object from the floor the spine moves into a flexed position,
but there is also accessory movement at each vertebral segment. Each segment
depending on the task will bend, slide (shear) or rotate on top of each other. To
control all accessory motions, there are small position sense muscles that cross from
one vertebral segment to another.
It is of vital importance to have good position sense muscle function if injury is to be

avoided. McGill (2002), showed through monitoring the electrical activity of muscles
that even small-uncontrolled movements of the spinal segments could lead to
significant impairment.

74
Position sense
muscles
Accessory movements
Rotatores
Intertransversarii
Interspinalis
Middle muscle layer (inner unit)

Middle layer muscles include the transversus abdominis (TVA), internal obliques,
lumbar multifidus, diaphragm and pelvic floor. When these muscles contract they
create a non-compressible cylinder where the spine is stabilised and forms the
working foundation from which the arms and legs can function optimally.
Richardson et al (1999), showed that inner unit activation occurs prior to involvement
of the extremities and that faulty inner unit recruitment increased the likelihood of
low back dysfunction.
Diaphragm
Multifidus
TVA
Pelvic floor
Inner unit muscles
Outer muscle layer (outer unit)

Outer layer muscles include rectus abdominis, external obliques, erector spinae,
latissimus dorsi, the gluteals and the adductors and form muscle slings. These
muscle slings contribute to the ability to maintain an optimal working relationship
between joints and to integrate the various body segments for successful motion.

75
Note: It should be seen that the core is made up of muscles from all three muscle
layers.
An example might be lifting shopping bags from the boot of a car. First, the hips and
trunk need to stabilise, then the shopping bags need to be brought closer to the body
to reduce the load. Activation of muscles such as latissimus dorsi and biceps brachii
perform the action of drawing the shopping closer to the body. However, all this can
only be done successfully if all muscle layers contribute.
Core function – fundamental principles
Defining core function

Elphinstone and Pook (1998), define the functional role of the core as:
“The ability of your trunk to support the effort and forces from your arms and
legs, so that muscles and joints can perform in their safest, strongest and
most effective positions.”
The core (trunk) can be thought of as the ‘crossroads’ of the body, providing a link
between the lower and the upper body.
With the above in mind, the main focus of core training is to address any functional
deficit in trunk stabilisation and/or movement in order to provide the necessary
spinal support and a strong and adaptable platform for the actions of our
extremities.
The risks of instability and postural deviation

Panjabi (1992) defines clinical spinal instability as:
“A significant decrease in the capacity of the stabilising system of the spine to

maintain the intervertebral neutral zones within physiological limits which
results in pain and disability”.
Failure to stabilise/control core movement increases the risk of acute (short term)
and chronic (long term) injury to the vertebral column. The key role of the trunk
muscles in providing stability to the lumbar spine is well established (Granata and
Marras, 2000). Many studies (Richardson et al, 1999; Hodges 2001; Hodges et al
2003) have identified changes in trunk muscle recruitment in clinical low back pain
either as a contributing factor to the development of pain or as a result of pain.
It should be noted, that our increasingly sedentary lifestyles do little to promote the
optimal function of the core. For example, habitual seated positions do little to
promote neutral spines (see note below on the importance of a neutral spine
position), but rather promote flexed postures which actually place the core at a
biomechanical disadvantage. Similarly, the use of back rests reduces the need for
core activation, therefore, increasing the risk of acute and chronic injury to the spine
and its associated structures.

76
Just as a sedentary lifestyle can have a negative impact on core function so too can
some of our exercise choices. Within the fitness industry, for example, there is often
an over reliance on fixed path resistance machines. Machines are popular choices
with both trainers and clients for many reasons; since they offer a supported
environment they place few if any demands on the core musculature. These machines
also train the body in terms of individual muscle groups and so do little to promote
the integrated function of our various body parts. So in effect, machines train us to
be strong in isolated muscle groups whilst placing limited demands on the core – if
not supplemented and balanced with exercises that progressively challenge the core,
this is a recipe for dysfunction and injury.
Postural deviations such as kyphosis or lordosis also create muscular dysfunction

around the core and reduce the ability to hold good form and maintain a neutral
spine during exercise and activity. When the exercise increases the forces placed
through the joints and the core, the muscles will shift into their ‘strongest’ positions,
which inevitably falls in line with their dominant posture. The images below show a
woman whose core has been challenged during a weighted squat. Her dominant
lordotic posture is evident as she squats despite her efforts to maintain good neutral
posture she has excessive flexion at the hip and too much extension in the lumbar/
thoracic spine. The abdominals, hamstrings and gluteals in this scenario are in a
relatively lengthened position compared to the much shorter lumbar erectors,
multifidus, and iliopsoas muscles. This illustrates how postural deviation can affect
core function through all exercises not just those specifically chosen to target the
core muscles. Kyphotic and scoliotic deviation will affect functional movement in a
similar way by drawing movement patterns towards the dominant postural
position.

77
It is often the case, but not the rule, that a predominantly sedentary lifestyle and
becoming overweight can lead to postural deviations and weakness within core
musculature. Too much time in a seated position can lead to reductions in core
muscle activation and a lack of neural drive, so that even relatively light loads placed
upon the core muscles exceed their ability to cope. Abdominal obesity shifts the
centre of gravity forward which in turn leads to an increased chance of postural
deviations like a lordotic lumbar curve or a sway back posture where the hips are
translated forward. Such deviations all lead to faulty loading patterns which increase
the strain on the spine and surrounding joint structures.
Passive support – ligaments and discs

Spinal discs sit between each pair of vertebrae, providing both shock absorption and
an element of support for the spine. Ligaments run the entire length of the vertebral
bodies (e.g. the anterior and posterior longitudinal ligaments) and between spinous
and transverse processes (interspinous and intertransverse ligaments) and also help
guide and support spinal movement. However, despite, these passive structures,
without its supporting musculature the human spine is inherently unstable and can
only withstand a load of 4-5 lb before it buckles into flexion (Panjabi et al, 1989).
It is, therefore, a basic principle of core stabilisation that during movement, a failure
to activate local stabiliser muscles will result in excessive forces being placed on
these passive structures.
Intra-abdominal pressure (IAP)

To maintain stability and reduce pressure on the intervertebral discs in the lumbar
spine some identifiable core muscles contract simultaneously causing an increase in
pressure within the abdomen.
As Norris (2000) states:
“Intra-abdominal pressure is created by synchronous contraction of the

abdominal muscles, the diaphragm, and the muscles of the pelvic floor.”
Diaphragm
Lumbar
multifidus TvA
Pelvic floor
Intra-abdominal pressure

78
The trunk should be thought of as a cylinder. The diaphragm forms the lid of the
cylinder and the pelvic floor the base. The walls of the cylinder are created by the
deep abdominals (TVA and the internal obliques).
During contraction of the abdominals the walls are pulled in and up while if a deep
breath is taken, the diaphragm is lowered, compressing the cylinder and the
abdominal contents from the top. Provided that the pelvic floor (the base of the
cylinder) has sufficient integrity, it will resist the action of the diaphragm and the
downward displacement of the internal organs (viscera). In this way, a non-
compressible cylinder is created. This gives the torso stiffness and a more rigid
structure. Such a structure is better able to resist the stresses placed on the lumbar
spine, particularly during lifting movements. The spine is stabilised and forms the
working foundation from which the arms and legs can function optimally. As Twomey
and Taylor (1987) state, making the trunk into a more rigid cylinder reduces axial
compression and shear loads and transmits loads over a wider area.
Note: a good example of the natural functioning of IAP would be when muscles
contract reflexively to defend the abdomen from a direct blow.
The thoracolumbar fascia (TLF)

The TLF is a broad, flat fascial sheath that stretches across the thorax and lumbar
region and is involved in passive and active stabilisation of the spine. It serves as an
anchor for many muscle attachments, especially that of the TVA, and aids stability
for the second to the fifth lumbar vertebrae.
The function of the TLF can be likened to the tightening of the strings on a girdle
around the waist. Stability is created by lateral tension or a pulling action from the
TVA and internal obliques that is transferred to the fibres of TLF creating a hoop-like
tension through the TLF. This tension produces an extension force on the lumbar
spine, which resists the natural pull of lifting movements into spinal flexion. This
phenomenon has been referred to as TLF gain (Gracovetsky, 1985).
Thoracolumbar
The TLF can be seen as adding to the tension and the ability to resist stress placed fascia
on the walls of the non-compressible cylinder created by IAP and therefore, enhancing
our core stability.
Neutral spine
A neutral position for the lumbar spine is midway between full flexion and full
extension as determined by the position of the pelvis. The greater the anterior tilt of
the pelvis, the greater the spinal extension, while the greater the posterior tilt of the
pelvis, the greater will be the degree of spinal flexion.
A neutral spine position is maintained exclusively through muscular activity, thereby

placing minimal stress on the passive structures of the spine (ligaments and discs).
Furthermore, since in the neutral position the postural alignment of the spine is
optimal, this is also the best position from which the trunk muscles can work.
Consequently, teaching clients to identify and maintain a neutral spine is a key part
of any back stability programme.

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Integrated core function
While the above description of the IAP mechanism reveals a significant role for the
inner unit musculature in providing core stability we should not overlook the
contribution of the more superficial outer unit musculature in this stabilising role. As
an example of this, it should be seen that the contraction of gluteus maximus muscles
via their attachment to the TLF will have the effect of tightening this fascia.
Consequently, efficient gluteal function is fundamental to back stability.
Activating the core
Abdominal bracing
The act of tightening or stiffening ones abdominal muscles (as if bracing for a punch
in the stomach) is believed (McGill, 2002) to be the most effective method of
stabilising the core. This bracing technique activates a simultaneous or co-contraction
of the abdominal and lumbar extensor muscles. McGill recommends the performance
of an abdominal brace in exercise/rehabilitative and functional situations (e.g.
picking up a child or getting in and out of a car).
To teach abdominal bracing McGill recommends

stiffening a joint, like the elbow, to demonstrate. Actively
stiffen the biceps and triceps and palpate the muscles
on each side of the joint to get the idea. This can be
practiced at different percentages of maximum
contractions e.g. 10, 20, 50%. Once the basic idea
has been grasped replicate this co-contraction on the
torso. With abdominal bracing the abdominal wall is
neither pushed out, nor pulled in.
The abdominal brace

Core equipment
Equipment such as stability balls, BOSU and wobble boards are commonly associated
with training for core stability. What all these mediums have in common is that they
all provide an unstable surface and thereby serve the purpose of amplifying the
instability of the user. This enforced instability increases the activation of the core
musculature which, has to work harder to provide the necessary stabilisation.
The heightened activation that these training mediums provide means that their use
is appropriate as a starting point for any programme targeted at the core musculature.
What must be remembered is that the core will be at work in all situations and,
therefore, core training is not solely about the use of these mediums. Consequently,
in the interests of maintaining the functionality of our training at some point in the
exercise progression these mediums should be sidelined in favour of exercises
performed on a more familiar surface – the floor!

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Exercise prescription
To progressively train the core muscles, select exercises based on increasing amounts
of core contribution. This may be done using a variety of different training modalities,
body positions and movements. A possible exercise progression is set out below.
This progression first utilises floor-based positions and unstable surface training to
address any existing deficiencies in core function. Clients would then be given more
functional exercises in standing positions which seek to place demands on the core
in all three planes of motion (sagittal, frontal and transverse).
Core progression
Reasons for participant exclusion

All trainers should be aware that there are some conditions which, may be aggravated
by physical activity and are beyond the scope of their practice. These would include
a prolapsed/bulging intervertebral disc or facet joint syndrome. Such conditions
should be identified during a thorough consultation/screening process.

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Flexibility and stretching
Flexibility definitions
There are a number of definitions that can be used when referring to flexibility:
• a measure of the range of motion (ROM) available at a joint or a group of joints

(Cotton, 1997)
• the ability to move the joints in the needed range of motion demanded by the
sport (Kraemer and Gomez, 2001)
• the ability to readily adapt to changes in position or alignment; may be
expressed as normal, limited, or excessive (Kendall et al, 1993)
Benefits
• increased range of motion

• reduced muscle tension and increased physical and mental relaxation
• reduced risk of joint sprains or muscle strains
• reduced risk of back problems
• decreased muscular soreness (DOMs) associated with other exercise activities
• decreased muscle viscosity, causing contractions to be easier and smoother
• improved co-ordination by allowing for greater ease of movement
• improvement and development of body awareness
• improved capability for circulation and air exchange
• improvements in posture
(adapted from Alter, 1998; Fredette, 1998)
Perhaps, a further benefit that could be added to this list is the opportunity that
flexibility work brings for interaction between the client and trainer. Those forms of
passive stretching that rely on the personal trainer directing, and physically moving
the client into stretch positions, demand a great deal of the trainers communication
and general client care skills. This therefore, is an opportunity to win client confidence
and to demonstrate skills.
Factors affecting flexibility
Age
Young people are normally more flexible than older people (Wilmore et al, 1978).
Babies and infants are very flexible and start to lose this natural flexibility as soon as
they start to walk (when the joints become weight-bearing and need more stability).
As we get older, muscle contractility remains, whilst elasticity is lost, resulting in
tighter, stiffer muscles. There is also a reduction in activity levels as we age, which
will cause a decrease in flexibility.
Gender
Studies have shown females to be more flexible than males in most joints and to
remain so throughout adult life (Getchell, 1979). The reasons for this are uncertain,
but may be attributed to the structural or anatomical differences or different activities
and training experiences of boys and girls early in life.

82
During pregnancy and in the post-natal period, women produce excess amounts of
a hormone called relaxin to assist the birth process. The effects of relaxin are not
restricted to solely the pelvic area, but act throughout the body, allowing greater
flexibility than normal. Small levels of relaxin are constantly present, and will fluctuate
slightly throughout a normal menstrual cycle.
Temperature
An increase in temperature due to either direct heat or the weather can increase
the range of motion and elasticity of muscle and tendons. Conversely, a decrease
in temperature can result in a decrease in flexibility of as much as 20% (Wear,
1963).
Exercise and resistance training

Active people tend to be more flexible than those with a sedentary lifestyle (Getchell,
1979). This is especially the case if the activity involves stretching exercises.
Although a comprehensive resistance training programme may increase ROM
(Leighton, 1964), resistance training exercises with a limited ROM and higher loads
may actually decrease ROM (deVries, 1974).
Heredity
Flexibility can be an inherited characteristic, as well as an acquired one. Some people
are born with a naturally excessive ROM. This can create a greater potential for injury
(e.g. joint dislocation) and it may be necessary to concentrate on strengthening the
muscles acting over the joint in order to increase stability.
Fashion
Female clients who constantly wear high heels may find that the muscles of the
lower limb (gastrocnemius, soleus, peroneals) adaptively shorten over a period of
time.
Physiology of stretching
The muscle spindles and golgi tendon organs (GTOs) have an influence on flexibility
and stretching because of the reflex actions that they stimulate.
Muscle spindles are located within muscle fibres and their main function is to send
messages back from the muscle to the central nervous system to inform about its
state of stretch. If the muscle is stretched, distortion of the muscle spindle causes
the myotatic reflex (automatic contraction) to come into play, thus avoiding damage
through over-stretching. This muscle spindle activation (muscle contraction) is felt
as the tension of the stretch. The amount and rate of contraction elicited from the
stretch reflex are proportional to the amount and rate of stretching. Hence, the faster
and more forceful the stretch, the faster and more forceful the reflex contraction
of the stretched muscle; therefore, the greater the likelihood of the muscle tearing
(particularly in an untrained muscle).
GTOs are sensory nerves located near the musculotendinous junction. They are
activated by a contraction in a muscle and help prevent excessive tension occurring
within the muscle, or the tendon of that muscle. In contrast to the muscle spindles,
stimulation of the GTOs will cause a reflex relaxation of that muscle (the inverse
stretch reflex). This resulting relaxation is important for certain stretches because
the inhibition of the muscle in which they are located, will allow muscle fibres to
lengthen and stretch further.

83
Relaxation that occurs in the same muscle because of GTO activation is called
autogenic inhibition (Condon et al, 1987). This is achieved by contracting a muscle
immediately before passively stretching it. The contraction will increase GTO
activation, thus increasing the subsequent muscle relaxation during the stretch.
Reciprocal inhibition is the relaxing effect that occurs in a muscle when the antagonist
is contracting (Condon et al, 1987). This occurs to allow an easier contraction of
the antagonist. Hence, contracting the antagonistic muscle will allow for a greater
stretch in the muscle being elongated.
The various forms of passive stretching to be discussed in detail in this section rely
on the exploitation of both the autogenic and reciprocal inhibition mechanisms to
enable the trainer to move and encourage the client into a greater range of motion.
Methods of stretching
There are several methods of stretching muscles:
Method of stretching Type of stretching Example
Static Standing chest stretch

Active stretching Dynamic Leg swings
Ballistic Toe touches
Static Wall chest stretch

Passive stretching PNF Supine partner hamstring
stretch
Active
Active stretching is accomplished using antagonist muscles and without assistance
from an external force or object (Alter, 1998). It involves actively contracting one
muscle or muscle group in order to stretch its opposing muscle group. For example,
pectorals actively contract to stretch posterior deltoids and tibialis anterior actively
contracts to stretch gastrocnemius. This type of stretching is very important for
athletes, because it is an essential aspect of dynamic flexibility and thus has a
greater correlation with sports performance than passive stretching (Iashvili1983).
Passive
This is where another body part or external factor, such as a wall or a partner, is used to
facilitate the stretch. For example, a lying hamstring stretch where the hands are held
behind the thigh or on the calf. This method is used by physiotherapists to increase
joint range and muscle length. A trainer partner can assist by gently pressing parts
of the subject’s body through full range. Great care and communication is required
between partners using this method and so it is not recommended for beginners.
Applying the external force incorrectly, excessively or too quickly may cause the
stretch reflex to initiate, perhaps causing injury. However, it can be beneficial if the
agonist is too weak and will provide a greater ROM than active stretching (Alter,
1998).

84
Types of stretch
Ballistic
This form of stretching involves quick, repetitive bouncing or bobbing actions. It is
undertaken in order to increase the stretch beyond the muscle’s normal range using
momentum and body weight. It is generally considered unacceptable for the average
exerciser, due to the intramuscular damage that may occur as a result of the stretch
reflex. These stretching exercises can produce muscle soreness and even losses in
resilience and elasticity. However, they are sometimes necessary as a more radical
method of stretching adhesions and stubborn fibrous tissue in physiotherapy and
rehabilitation.
Dynamic
This is similar to ballistic stretching, however, the limb movements do not end with
bouncing or jerky movements, but instead, are performed under control (Alter, 1998).
These stretches should mimic the movements of the following sport or activity and
act as a kind of rehearsal.
• perform 10-15 repetitions of each stretch under control, gradually increasing

the ROM
Static maintenance
Static maintenance stretching is where the muscle is taken to the end of its normal
range and held without bouncing. These are short stretches, held for 10-15 seconds
(Moffat, 1988), and are used to maintain the normal length of the muscle. Following
repeated contractions during exercise, the muscle becomes shorter and thicker and a
maintenance stretch is used to return the muscle to its normal length. The following
guidelines should be observed:
• take the stretch to the point of bind, maintaining good alignment and posture
• hold for 10-15 seconds
• repeat the stretch if desired
Static developmental
These stretches are used in flexibility training to develop the length of the fibres
themselves, thereby increasing range of movement at a joint. The following guidelines
should be observed:
• take the stretch to the 'point of bind', maintaining good alignment and posture
• hold for 10 or more seconds, until the tension within the muscle has
reduced
• relax and passively increase the ROM of the stretch until tension is felt again
• again hold for 10 or more seconds, until the tension within the muscle has
reduced
• again increase the ROM of the stretch until tension is felt again
• hold until the tension reduces, then slowly return the limb to its normal
position
• repeat the stretch if desired

85
Muscle energy techniques (METs)
MET is a form of passive stretching from the world of osteopathic technique.
According to Chaitow (1996), MET, “…targets the soft tissues primarily, although it
also makes a major contribution towards joint mobilisation…”. The technique itself
evolved from the rehabilitative technique known as proprioceptive neuromuscular
facilitation (PNF), developed by Herman Kabat in the late 1940s and early 1950s.
Like PNF techniques, MET commonly uses an isometric contraction of the target
muscle before the stretch is applied. MET, unlike PNF (which uses near maximal
muscle contractions), uses only minimal force during the isometric phase. The
stretching phase is generally, though not always, done passively.
Perhaps the main form in which MET is applied is post isometric relaxation (PIR).
The following is an example of a hamstring stretch, utilising PIR:
• under the trainer’s instruction the client should adopt a comfortable and
manageable position
• the trainer explains to the client what is to be done and how the technique is
to be carried out
• the trainer lifts the leg into hip flexion and takes the passive stretch to the point
of bind, maintaining good alignment and posture throughout
• the trainer holds the limb at the point of bind for 10 or more seconds, until the
tension within the muscle has reduced
• the client performs an isometric contraction of 20-30% maximum force and
holds this for 6-8 seconds. The trainer should direct the client to begin slowly
and progressively build the level of contraction
• the client relaxes (this can be aided by a deep inhalation followed by an
exhalation as the stretch is administered) while the trainer passively increases
the ROM of the stretch (increase hip flexion) until tension is felt again
• this cycle is repeated 2-3 times, always finishing with a stretch and not a
contraction
• the trainer slowly returns the limb to its normal position
By isometrically contracting the target muscle (hamstrings in the above example)

against the trainer, the client will activate the GTOs in that muscle and stimulate an
autogenic inhibition response. This will create the necessary level of relaxation in
that muscle to allow it to be stretched.
Since, the technique is very hands on and necessitates the trainer and client
communicating clearly to create a stretch, passive stretching using PIR provides an
excellent medium for establishing a rapport with the client.
When to apply: PIR based techniques are best suited to the post-exercise period.
This will allow the trainer to stretch out the muscles worked during the main session
and provides a relaxing ‘wind down’ for the client after their exertions. A good passive
stretching session, performed by a competent trainer really embodies the personal,
one-to-one nature of personal training.
Safety issues: safety should always be a priority for both the client and the trainer. An
awareness of body mechanics and posture are vital for the trainer throughout the PIR
protocols, but particularly during the isometric contraction phase. Consequently, the
trainer should plan carefully and communicate clearly and freely with the client.

86
Trainer safety: the trainer may be at risk of injury if they do not take care of themselves
during the application of PIR. However, by paying attention to their body mechanics
and posture, the risk of injury can be virtually eliminated. Some useful tips for the
trainer include:
• if standing, pay close attention to the legs and feet. A wide stance should be
used to maintain balance and stability, especially when resisting the isometric
contraction of the client
• be conscious of keeping the spine lengthened, rather than flexing and collapsing
in on yourself. This will reduce the stress imposed on the spine
• maintain a neutral lumbar spine. This will again reduce the stresses imposed
on the back
• brace the abdominals to prevent overarching of the spine
• avoid unnecessary twisting or bending. Instead, the trainer should try and get
the client to move to accommodate them
• always try to use the trunk rather than the arms to resist the client’s isometric
contractions. For instance, during the hamstring stretch the trainer should
block the client’s contraction with their shoulder rather than the arm
• always control the strength of the client’s contraction. The client should be
instructed to “slowly build” the level of the contraction
• remain in control at all times. For instance, the client should only contract the
target muscles on the trainer’s instruction. In this way, the trainer will be able
to prepare, and stabilise themselves effectively
Client safety: the client should be encouraged to play an active role in the application
of PIR techniques. They should be encouraged to develop an awareness of the
muscles being targeted. Clients should also provide as much feedback as possible;
this might include what they are feeling during PIR stretches or their levels of fatigue.
To ensure safety clients must:
• ask the trainer to stop if they experience pain at anytime. If the client does
experience pain, the trainer should try repositioning the limb or ask the client
to exert less force during the isometric contraction. If pain persists, do not
continue until the cause of pain has been determined
• follow the trainers instruction at all times
• communicate freely with the trainer

87
When to stretch
Although always advocated after a warm up, stretching can be performed at any
time of the day, appropriate to the client. Clients can be advised to stretch at home,
watching TV, or at the office, in order to balance out periods of immobility in positions
of poor posture.
Stretching should form an integral part of the warm up and cool down. Static stretching
in the warm up has not been shown to decrease the incidence of injury, but may be
selectively included in a ‘corrective’ form. An example of corrective static stretching
would be to relax hypertonic pectorals when training the upper back (rhomboids
and middle trapezius), for a more effective ROM during retraction. Corrective static
stretching should only be used selectively on hypertonic muscles.
Dynamic stretching can be more easily prescribed as part of the warm up, using
exercises that will mimic the general movement of the following session. Corrective
static and dynamic stretches should be performed after some kind of pulse raising/
temperature rising warm up (Alter, 1998). In the post-training, cool down part of the
session, some kind of static stretching is advised. This may be static maintenance,
static developmental, or a form of PNF stretch.
Warm up Cool down

Static stretching Static stretching
Dynamic stretching Developmental
Ballistic stretching Muscle energy techniques (METs)

88
As well as setting specific and realistic flexibility goals, there are a number of
guidelines an exercise specialist should follow for flexibility training (adapted and
expanded from Alter, 1998; Fredette, 1998; and Holcomb, 2000):
Guidelines for flexibility training
• ensure correct position, posture and alignment prior to and during the
stretch
• take the stretch to a point of mild discomfort and do not strain or passively
force a joint beyond its normal ROM
• ensure correct breathing patterns are maintained and try to breathe calmly
and rhythmically
• exhalation during increases in ROM will aid whole body relaxation
• closing the eyes, where applicable, may aid relaxation, focus and awareness
• do not force a stretch whilst holding the breath
• do not bounce or spring whilst statically stretching
• wait until the stretch reflex has subsided, and the muscle has ‘relaxed’
before attempting to increase ROM during developmental stretches
• unilateral stretches should be performed on both sides, where required
• emphasise stretching the weight-bearing muscles and in particular, the
multi-joint muscles
• stretch towards the end of each workout as a minimal requirement, to
prevent any unwanted adaptive shortening. The muscles should be very
warm and receptive to extension, thus promoting recovery and relaxation
• stretching in either a sitting or reclining position may aid relaxation for
corrective and post-exercise stretching
• concentrate and communicate when working with a partner
• come out of a stretch as carefully as going into it
Alter (1998) suggests some additional guidelines when undertaking a stretching

programme:
• wear loose, comfortable and appropriate clothing

• remove all jewellery and discard any chewing gum
• choose a clean, quiet place with a non-slip surface, preferably a firm mat
Following the guidelines above will be sufficient for most, but there are still a number
of precautions when undertaking flexibility training (adapted and expanded from
Fredette, 1998; and Holcomb, 2000).

89
Precautions for flexibility training
• decrease the stretch intensity or stop if the client experiences any local or
radiating pain, or any loss of sensation
• any mild soreness following stretching should last no longer than 24 hours.
If the soreness is prolonged, then the stretching was too aggressive
• use extreme caution when stretching any hypermobile joint, and question if
developmental stretching is necessary
• avoid excessive or aggressive stretching of recently immobilised tissues
(casting). These tissues can become dehydrated and lose tensile strength
• stretch with caution when working with any individuals with known or
suspected osteoporosis (loss of bone integrity)
For most individuals, stretching will provide many of the benefits previously
mentioned. However, there are certain individuals or groups for whom flexibility
training may be likely to cause injury, or where the possible concerns outweigh the
potential benefits. The table below lists the reasons why flexibility training (stretching)
may be contraindicated (adapted from Alter, 1998; Fredette, 1998; and Minor and
Kay, 1997).
Contraindications for flexibility training
• any developmental, excessive, uncontrolled or ballistic stretching should

be avoided during pregnancy, due to the softening effects of relaxin
• if the movement is limited by a bony block
• avoid stretching a fracture site for approximately 8-12 weeks post-fracture
• any sharp pain occurring during a stretch
• any uncontrolled muscle cramping occurring during a stretch
• any infected joint or nearby tissue
• any acute inflammation, except for the majority of arthritic clients
• a local haematoma (bruise), resulting from an overstretch injury
• a client suffering with certain vascular or skin diseases
Student Task
Design and perform a cool down stretching routine using PIR techniques
and suitable for use at the end of a general whole body muscular endurance
workout.
Ensure the routine includes stretches for all major muscle groups. The routine
also should provide a relaxing experience for a client.
Carefully consider the stretch sequence. The stretches should flow logically and
require minimal unnecessary movement from the client.

90
Stretch Muscle group(s)

91
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Unit One

At the end of this unit the learner will understand:

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• the physiology of bone tissue

50% mineral salts 25% water

Ossification: the process of bone formation

Maintenance of a healthy skeletal system is dependant upon a balance of osteoblast

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Hormonal regulation of bone

The skeletal system and calcium regulation

Osteoporosis: brittle bone disease: bone remodelling is a delicate balance of

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• female sex – due to drop in oestrogen levels (particularly at the menopause)

The classification and structure of bone

Compact and cancellous bone

• sesamoid (‘seed-like’) – these bones develop within particular tendons at a site

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Articular (hyaline) Cancellous

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Types of joint (articulations)

Fibrous joint – skull bones

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Cartilaginous joint - spine

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Types of synovial joints

Synovial ball and socket joint

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Synovial hinge joint

Synovial pivot joint

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Synovial gliding joint

Synovial saddle joint

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Synovial ellipsoid joint

The vertebral column

• the neck or cervical region is made up of 7 vertebrae

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Structure of a vertebral disc

The intervertebral discs are sandwiched between the bodies of neighbouring

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Region No. of vertebrae Key features

A comparison of the different regions of the vertebral column

Vertebral alignment and posture

• a posterior cervical curvature – a posterior concavity of the cervical spine

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Kinesiology (‘the study of movement’)

An understanding of movement allows better judgments regarding choice of exercises

The seesaw: a 1st class lever

The wheel barrow: a 2nd class lever

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The drawer bridge: a 3rd class lever

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Frontal plane Sagittal plane Transverse plane

It is important to point out that human movement occurs simultaneously in multiple

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Anterior-posterior axis Medial-lateral axis Longitudinal axis

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Human movement is dependant upon the integrated activity of many different

Types of muscle tissue

Cardiac muscle (myocardium)

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