Exercise Instructor Manual

By Sabrena Merrill, M.S. Produced for Cascade Health and Fitness

17280 Woodinville Redmond RD NE STE 800 Woodinville WA98072 Phone: (425) 402-4062 Fax: (425) 402-4063 www.ChairMaster.com

Table of Contents
Section I: State of the Nation Overweight/Obese Population Aging Population Section II: The Importance of Physical Activity for Improved Health in Older Adults Functional Training for Activities of Daily Living Balance Training Muscular Strength and Power Cardiorespiratory Endurance Flexibility Biomechanical Considerations for the Older Adult Section III: The ChairMaster Approach to Improving Health ChairMaster Apparatus Summary of Benefits of ChairMaster Exercise Section IV: ChairMaster Exercise Program Design Pre-exercise Precautions Warm-up Techniques Balance-training Guidelines Functional Movement and Strength Training Cardiorespiratory Exercise Mobility/Flexibility Exercise Putting It All Together Section V: Sample ChairMaster Exercise Routines Mobility Exercises Seated Without Using Bands Strength Exercises Seated Without Using Bands Strength Exercise Seated With Bands Attached to Front, Low Rings Strength Exercises Seated With Bands Attached to Back, High Rings Strength Exercises Standing Behind Chair With Bands Attached to Back, High Rings Strength Exercises Standing Behind Chair With Bands Attached to Back, Low Rings Strength Exercises Standing Behind Chair Without Using Bands Static Stretches Standing Behind Chair Aerobic Exercises Summary References Page 3 Page 4 Page 6 Page 8 Page 8 Page 10 Page 11 Page 12 Page 13 Page 14 Page 16 Page 16 Page 17 Page 19 Page 19 Page 20 Page 21 Page 25 Page 30 Page 34 Page 35 Page 37 Page 37 Page 38 Page 40 Page 42 Page 43 Page 45 Page 48 Page 49 Page 52 Page 52 Page 54

SECTION I
STATE OF THE NATION As advances in technology continue to eliminate the need for manual labor and promote sedentary leisure-time activities, and as convenient food choices increasingly become laden with higher calorie counts, the stage is set for a growing number of health problems. These so called lifestyle-related diseases are typically chronic in nature and tend to develop over many decades of associated lifestyle choices, such as physical inactivity and diets high in empty, non-nutritious calories. Thus, many lifestyle-related diseases can be addressed successfully by a combination of a sensible diet and a regular exercise program.

The major diseases that plague modern productivity include cardiovascular disease (CVD), diabetes, and overuse- and obesity-related musculoskeletal disorders such as osteoarthritis and low-back pain. While genetic predisposition can lead to increased risk of developing these diseases, it is obvious that lifestyle remains the single most influential factor in the incidence of these diseases.

The ChairMaster, from Cascade Health and Fitness, is an effective tool in promoting a healthy, physically active lifestyle. The design and ease of use of the ChairMaster eliminates two common barriers for individuals who have struggled to start or maintain a regular exercise program in the past: (1) inconvenience and (2) inappropriate intensity.

The ChairMasters unique design meets the specialty fitness needs of sedentary individuals and older adults by combining a low-impact aerobic workout with resistance training in a user-friendly seated workout. The ChairMaster includes a recumbent cycle for aerobic conditioning, which folds out of site when not in use, and resistance bands for muscular-fitness training. In addition, the ChairMaster is designed for functional aesthetics in that it serves as a chair that can be used anywhere.

The ChairMaster is a convenient facility or home workout solution, as its design takes up a small footprint (versus larger fitness equipment such as a treadmill) and it offers exercise options for the following important components of fitness: muscular strength and endurance, cardiorespiratory endurance, flexibility, and balance. The ChairMaster ensures appropriate intensity by providing seated exercise that imparts low-impact aerobic training along with smooth resistance without the use of heavy weights. These options make the ChairMaster optimal for older individuals or those with health concerns to achieve their fitness goals.

Overweight/Obese Population One of the most pernicious conditions that impacts the development of chronic disease is obesity. As such, the prevention and treatment of obesity are public health concerns that, if successful, could reduce the risk for developing many chronic diseases that result in reduced quality of life and disability. Due to the prevalence of inactive lifestyles and increased caloric consumption in modern society, as well as genetic factors that may lead to the excess accumulation of body fat, the incidence of overweight and obesity continues

to grow at an alarming rate. Obesity is defined as a body mass index (BMI) 30 kg/m2, whereas overweight is classified as a BMI between 25 and 29.9 kg/m2. Together, overweight and obesity affect more than 66% of the adult population in the United States, which is a trend that has been rising for more than a century, with a substantial increase noted in the past several decades (Ogden et al., 2006; Helmchen & Henderson, 2004).

Obesity is associated with many other adverse health conditions, including CVD, type 2 diabetes, and the metabolic syndrome (i.e., a cluster of factors associated with increased risk for coronary heart disease and diabetesabdominal obesity, dyslipidemia, and elevated levels of triglycerides, blood pressure, and fasting blood glucose) [National Heart, Lung, and Blood Institute (NHLBI), 1998]. In addition, chronic obesity may lead to functional impairment (Jensen, 2005) and reduced quality of life (Fontaine & Barofsky, 2001), as well as to greater mortality (Fontaine et al., 2003). Fortunately, when treatment is successful at producing small amounts of weight loss (even as little as 10 pounds), obese individuals experience many health benefits, including prevention of disease (especially type 2 diabetes) (Knowler et al., 2002) and reduced mortality rate (Bray, 2007). These factors, in combination with the estimated direct and indirect costs of obesity-related conditions that exceed $117 billion in the United States annually, make treating obesity a national healthcare concern (Stewart, 2001).

The basis for managing body weight is founded upon energy balance, which is influenced by energy intake (i.e., caloric consumption) and energy expenditure. Physical activity and structured exercise programs play an important role in weight management because they

contribute to long-term weight loss by facilitating energy expenditure. Overweight and obese individuals can exhibit weight loss when they expend more daily calories on average than they consume. When used regularly, the ChairMaster provides an effective, low-impact, whole-body workout that offers a means to directly increase energy expenditure through aerobic activity and promote enhanced muscle mass through resistance training, which can help to increase calorie burning indirectly by enhancing resting metabolic rate.

Aging Population In the Centers for Disease Control and Prevention (CDC) report, The State of Aging and Health in America 2007, the authors state that the combination of longer life spans and aging baby boomers will result in the doubling of the population of Americans aged 65 years and older during the next 25 years. Consequently, by 2030, there will be 71 million American older adults accounting for roughly 20% of the U.S. population (CDC, 2007).

Among older adults, chronic diseases and their associated health limitations are a major problem that can reduce seniors health-related quality of life. These conditions can cause years of pain, disability, and loss of function and independence. It has been reported that approximately 80% of older Americans are living with at least one chronic condition, and 50% have at least two (CDC, 2003). Since life expectancy in the United States has risen dramatically in the twentieth century, from about 47 years in 1900 to about 75 years for males and 80 years for females in 2003, older adults are living for an extended period with chronic ailments that tend to appear in the fourth decade of life (Arias, 2006).

Conditions such as CVD, cancer, diabetes, arthritis, and cognitive impairment are challenges that many seniors must manage as they advance in age. Fortunately, regardless of age and health limitations, older adults can expect to experience significant physiological and psychological benefits from regular physical activity, such as the kind of activity promoted by the ChairMaster exercise chair.

One of the most significant factors of quality of life for older adults is the ability to live independently. The mobility and functioning of frail and very old adults can be improved by regular physical activity. For midlife and older adults of all ages and abilities, adopting regular physical activity as part of a healthy lifestyle may extend years of active independent life, reduce or prevent chronic disease and disability, and improve overall quality of life. Clearly, few factors contribute as much to successful aging as having a physically active lifestyle.

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SECTION II
THE IMPORTANCE OF PHYSICAL ACTIVITY FOR IMPROVED HEALTH IN OLDER ADULTS

A wide variety of age-related changes occur simultaneously in different systems throughout the body. Overall, the nervous, musculoskeletal, cardiovascular, and respiratory systems experience decreased functioning as aging advances. The cumulative effect of these changes, which include decreased balance, muscle strength, flexibility, and cardiorespiratory endurance, results in a reduced ability to respond appropriately to the stresses of everyday life. These declines in function highlight the importance of adopting and maintaining a physically active lifestyle throughout the lifespan in order to offset some of the known reductions in functional ability due to the natural aging process. The ChairMaster is ideal in assisting older individuals maintain healthy, independent, and active lifestyles through convenient, intensity-appropriate exercise.

Functional Training for Activities of Daily Living Functional training may be described as exercise with a purpose. Purposeful exercise entails any training movement performed with the intention of enhancing ones function, whether it is in the area of sports performance, fitness development, occupational performance, or activities of daily living (ADL). Through effective functional training, older adults may be able to avoid, postpone, reduce, or even reverse the declines in physical function associated with aging.

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Optimal performance of movement requires that the bodys muscles work together to produce force while simultaneously stabilizing the joints. Typically, individuals who have weak stabilizer muscles (e.g., deep abdominals, hip stabilizers, and scapula retractors) exhibit problems performing proper, efficient movement, which may lead to pain and/or injury. Because individuals with pain or injury frequently have stabilizer weakness, functional training is often incorporated into a rehabilitation and postrehabilitation training program, but this does not mean that functional training always focuses on the bodys stabilizing musculature. Instead, functional training provides a solid foundation that the participant can draw from when performing movements that require the muscles and joints to move in a coordinated, efficient manner.

An example of a program that develops functional strength and flexibility is a conditioning routine that incorporates squats, lunges, multidirectional reaches, and overhead presses to enhance the performance of an older adults everyday activities. Squatting and lunging are essential to human movement, as these tasks are required to stand up from a chair or stoop down to pick up a pair of shoes. Multidirectional reaches (i.e., reaching one or both arms in front of, to the side of, or behind the body) are important for training balance and postural control during dynamic activities that may place a persons center of gravity (COG) outside the typical position between the feet during standing. Unilateral or bilateral overhead shoulder presses are tied closely to function in older adults because age-associated declines in upper-body strength often make the simplest tasks, such as putting away groceries on a top shelf, a substantial

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effort. The ChairMaster allows an individual to practice all of these functional movements, and more, as part of a comprehensive physical-activity program.

To improve function and help counteract the diminished function of body systems that coincide with aging, a program of regular physical activity that includes modes of training that challenge the various systems is appropriate. In the sections that follow, information is provided that supports the concept of functional training in which exercise is performed with the intent of improving daily function.

Balance Training As adults mature and advance into old age, the constant pull of gravity on their upright postures begins to take its toll. Balance becomes more difficult, the chance of falling increases, and the quick, youthful actions of jogging, running, and jumping are replaced with walking. Maintaining an adequate sense of balance into old age is crucial for preventing trips and falls in the last decades of life. The goal of a balance-training program is to increase an older adults capacity to perform ADL (e.g., reaching for, picking up, and carrying objects; performing household tasks; and reacting to obstacles in the environment).

Appropriate balance-training progressions include starting in a seated position, then transitioning to a standing posture with different foot placements, followed by standing on a compliant surface (such as a foam balance pad). The ChairMaster allows all of these progressions to be performed in a safe and effective manner.

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Muscular Strength and Power Similar to maintaining balance capabilities, maintaining a minimum amount of muscular strength and endurance is essential for the performance of a variety of ADL. Carrying groceries, lifting boxes, climbing stairs, and rising from a chair all require a certain level of muscular function. Both muscular strength and endurance tend to decrease with age.

Loss in muscle function is likely due to the muscle atrophy that accounts for a significant decrease in lean mass with aging. In sedentary individuals, it is estimated that muscle mass declines 22% for women and 23% for men between the ages of 30 and 70 [National Institutes of Health (NIH), 2006]. Muscle atrophy that occurs as a natural part of the aging process is called sarcopenia and reflects a decrease in both the average fiber size and the number of muscle fibers. Since the amount of force an individual can produce depends, in part, on the amount of working muscle mass, sarcopenia has a dramatic negative effect on strength.

Age-related decreases in muscular strength, particularly in the lower body, are associated with a decreased ability to maintain balance, walk, prevent falls, and move quickly (i.e., produce muscular power). In addition, muscle strength of the lower body declines more quickly with age than does muscle strength of the upper body. Furthermore, isometric strength appears to be maintained better than dynamic strength, and strength during eccentric, lengthening contractions is better maintained in the elderly than strength during concentric, shortening contractions. As a result, many older adults find it easier to lower

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themselves into a chair, which requires a lengthening contraction of the quadriceps, than to rise from a chair, which requires a shortening contraction of these same muscles.

The ChairMaster provides opportunities to increase muscular fitness through the use of elastic resistance bands that easily attach to specific rigging points on the frame. The resistance bands offer various intensities and come equipped with handles and strap-on cuffs appropriate for working the upper and lower extremities. Furthermore, the frame of the ChairMaster acts as a safe, sturdy prop for assisting exercisers during the performance of body-weight resistance movements (e.g., sit-to-stand squats, one-legged squats, lunges, and incline push-ups).

Cardiorespiratory Endurance Maximal oxygen consumption (VO2max) declines, on average, by about 1% each year of a sedentary adults life. It also declines in masters athletes and individuals who have been physically active throughout their lives, but to a lesser extent. Typically, by the age of 65, aerobic power is 30 to 40% less than that of a young adult (Shepard, 1987). Possible reasons for age-related decreases in VO2max include a reduction in maximum heart rate with advancing age, decreases in muscle tissue and its ability to use oxygen, and a diminished ability to redirect blood flow from organs to working muscles (Spirduso, Francis, & MacRae, 2005).

The decline in aerobic capacity that occurs with aging tends to accelerate from ages 65 to 75 and again from 75 to 85. Very low aerobic capacity leads to constant fatigue in older

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adults, especially the frail elderly. The functioning of the structures responsible for oxygen delivery and utilization in many low-fit older adults falls below the minimum necessary to maintain an independent lifestyle. Thus, many 65-year-old sedentary people are dangerously close to becoming disabled (Shepard, 1987). Fortunately, regular physical activity can increase functional capacity and stamina and prevent or correct many of the fatigue-related problems of the elderly. Similar to young adults, older adults can elicit 10 to 30% increases in VO2max with prolonged endurance exercise training.

Flexibility Decreased flexibility is another important issue for older adults. The elasticity and compliance of connective tissue is altered with aging. As muscle fibers atrophy, they are replaced by fatty and fibrous (collagen) tissue. Collagen is a primary component of connective tissue that exhibits a low compliance, which contributes to the stiffening and decreased mobility of aging muscle. Additionally, a significant loss (up to 15%) of body water between the ages of 30 and 80 contributes to increased stiffness in soft tissues [American Council on Exercise (ACE), 2005]. Collectively, these changes appear to be partly responsible for flexibility loss due to aging. However, it is possible that the reduction in range of motion (ROM) is due, in part, to lack of physical activity, since not all older adults lose flexibility at the same rate.

With advancing age, any loss of ROM impairs most functions needed for good mobility. Maintaining lower-body flexibility is vital for preventing low-back pain, musculoskeletal injury, and gait abnormalities, and in reducing the risk of falling. Limited ROM in the

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shoulder girdle has been associated with pain and postural instability. Both upper- and lower-body flexibility decrease with age, but can be improved through stretching.

The ChairMaster is ideal for individuals with limited mobility as a tool to develop healthy ROM in joints with limited flexibility. Performing muscle-conditioning exercises using the resistance bands on the ChairMaster, as well as practicing specific stretches while seated on or standing near the ChairMaster, will serve to enhance flexibility at all the major joints throughout the body.

Biomechanical Considerations for the Older Adult The prevalence of musculoskeletal pain and joint alterations in the aging population is remarkably high. About half of persons age 65 and older are affected by osteoarthritis (American Geriatrics Society, 2001), approximately half of adults age 80 and older experience sarcopenia (Baumgartner et al., 1998), and 55% of Americans age 50 and older have osteopenia or osteoporosis (National Osteoporosis Foundation, 2008). Decreased range of motion and loss of spinal flexibility in many older adults results in a stooped posture that is associated with a vertical displacement of the COG backward toward the heels. This change in postural alignment can lead to lowered self-confidence, faulty balance, and an increased risk for falls. These and other musculoskeletal conditions impart varying levels of discomfort and disability to older adults. Thus, an important exercise consideration for this population is to ensure that physical activity is as comfortable as possible for the older person. The ChairMaster accomplishes this goal by providing an ergonomically designed seat and reclining backrest that accommodates

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exercisers of all shapes and sizes. In addition, the resistance bands are equipped with comfortable handles and cushioned cuffs to allow for various handgrips and attachment sites on the limbs.

Chair-seated Exercise Older individuals who have issues related to endurance, mobility, and self-efficacy may find that a chair-seated exercise routine is one of the only types of physical activity that is tolerable and even enjoyable. For the frailest older-adult populations, seated exercise may be the only practical method.

During chair exercise, participants who have challenges with stability and proper posture should sit with their backs supported by the backrest of the chair. If, due to his or her body proportions, an individuals back does not contact the backrest of the ChairMaster, the ChairMaster support pad can be placed between the exerciser and the backrest to ensure adequate lumbar support during exercise. Additionally, the participants feet should be in full contact with the floor (when not using the pedals), which, if necessary, can also be facilitated by using the ChairMaster support pad between the exerciser and backrest to effectively shorten the distance between the edge of the seat and the backrest, allowing the users knees to line up properly with the edge of the seat. Another option for individuals who have good functional strength while standing, but who have balance and stability problems and/or a fear of falling, is to include standing work behind the chair, using the back of the chair for support.

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SECTION III
THE CHAIRMASTER APPROACH TO IMPROVING HEALTH The ChairMaster is an excellent mode of exercise for overweight or deconditioned individuals in that it provides for light resistance training, low-intensity aerobic exercise, and simple stretching. The ChairMaster is designed to conveniently fit in any setting and built to deliver a rewarding workout. Attractive and cordless, it can be positioned anywhere for maximum enjoyment. The ChairMaster is a comfortable chair, recumbent bike, strength-training device, and stretching station, all built into one compact unit.

ChairMaster Apparatus The ChairMaster was designed to be an unobtrusive and attractive addition to any facility or home. Its small profile and quiet drive mechanism allows the chair to be situated and used in almost any location with a minimum of disruption. The chosen location for the ChairMaster should provide adequate room for the equipment while it is in use and should be in an appealing setting that will encourage its use (e.g., a main living area or nearby a regularly watched television). The physical dimensions of the assembled chair are listed below: Length: 27 inches (68.6 cm) Width: 28.5 inches (72.4 cm) Height: 40 inches (101.6 cm)

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Some of the unique features of the ChairMaster include: Recumbent pedaling unit that stows under the seat. When the recumbent unit is out, there is no step-over height, which makes it easy to use Contour-fitting backrest for maximum support Small footprint (see the chair dimensions listed above) Reclining backrest that allows for a variety of positions Five levels of pedaling resistance Ratchet-style pedal straps for a more secure and comfortable positioning of the foot Three sets of elastic resistance bands, with each set varying in length for optimal function Sturdiness and stability: The chair can be held onto during standing strengthening and stretching exercises without fear of tipping over

Summary of Benefits of ChairMaster Exercise The following list outlines the many benefits of using the ChairMaster as a primary form of exercise: The ChairMasters unique design meets the specialty fitness needs of sedentary individuals and older adults by combining a low-impact aerobic workout with resistance training in a user-friendly seated workout. When used regularly, the ChairMaster provides an effective mode of exercise that directly and indirectly increases energy expenditure.

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Older, overweight/obese, and/or deconditioned individuals can experience physiological and psychological benefits from consistently performing ChairMaster exercise, regardless of age and health limitations.

The ChairMaster allows an exerciser to practice several functional movement patterns as part of a comprehensive physical-activity program, which is ideal in helping older individuals maintain healthy, independent, and active lifestyles.

The ChairMaster provides opportunities to increase muscular fitness through the use of resistance bands that easily attach to specific rigging points on the frame.

The ChairMaster offers non-impact aerobic exercise through seated pedaling, and low-impact, weightbearing exercise via step-ups while standing behind and holding onto the chair.

The ChairMaster is ideal for individuals with mobility restrictions to use as a tool for developing healthy ROM in joints with limited flexibility.

The ChairMaster is designed for comfort by providing an ergonomically designed seat and reclining backrest that accommodates exercisers of all shapes and sizes. In addition, the resistance bands are equipped with comfortable handles and cushioned cuffs to allow for various handgrips and attachment sites on the limbs.

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SECTION IV
CHAIRMASTER EXERCISE PROGRAM DESIGN Safe and effective exercise programming for older, overweight/obese, and/or deconditioned adults is based on addressing their specific health and fitness needs without exposing them to unnecessary risks. This can be accomplished by providing a conservative exercise stimulus initially, and then progressing to more challenging exercise bouts as participants become more conditioned. Exercisers using the ChairMaster should be encouraged to develop cardiorespiratory endurance, muscular strength and endurance, and flexibility, along with a special emphasis on balance. The following sections present guidelines for safe and effective exercise programming using the ChairMaster.

Pre-exercise Precautions To ensure that older and deconditioned individuals are medically safe to exercise, they should first see a physician and undergo a physical examination and evaluation before a physical-activity program is initiated. The extent of the evaluation depends on an individuals age, health status, and the strenuousness of the anticipated exercise regimen. Men over age 45, women over age 55, and all individuals at moderate-to-high risk (i.e., individuals with two or more coronary risk factors, one or more signs/symptoms listed in Table 1, or with known cardiovascular, pulmonary, or metabolic diseases) are strongly encouraged to undergo a medically supervised, graded exercise test, especially if vigorous exercise is contemplated [American College of Sports Medicine (ACSM), 2010].

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Table 1: Major Signs or Symptoms Suggestive of Cardiovascular and Pulmonary Disease* Pain, discomfort (or other anginal equivalents) in the chest, neck, jaw, arms, and other areas that may be due to myocardial ischemia Shortness of breath at rest or with mild exertion Dizziness or syncope (fainting) Orthopnea or paroxysmal nocturnal dyspnea (difficult or labored breathing) Ankle edema (swelling) Palpitations or tachycardia (elevated heart rate) Intermittent, severe leg pain (claudication) Known heart murmur Unusual fatigue or shortness of breath with usual activities *Adapted from American College of Sports Medicine (2010). ACSMs Guidelines for Exercise Testing and Prescription (8th ed.). Philadelphia, Pa.: Wolters Kluwer/Lippincott Williams & Wilkins.

Warm-up Techniques For older or deconditioned participants, transitioning from a resting state to moderate or vigorous physical activity requires more time than it does for a younger or more fit person. Similarly, the time it takes to return to the resting state after exercise is longer. Accordingly, warm-up periods of approximately 10 to 15 minutes are recommended for this population.

The warm-up should gradually prepare the body for movements that will be required during the workout. Each of the major joints and muscle groups should be gently engaged using continuous rhythmic movements that mimic the more intense exercises that will be performed. For example, if an overhead shoulder press with the ChairMaster bands is part of the exercise routine, the warm-up can include overhead shoulder presses without using any resistance. Furthermore, proper body alignment and ideal posture

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should be emphasized. Table 2 lists some practical ChairMaster warm-up techniques that are safe and effective for older or deconditioned exercisers.

Table 2: ChairMaster Warm-up Techniques Seated Slow, non-strenuous pedaling Rhythmic, limbering exercises working through a full, pain-free range of motion Neck rotation Shoulder rolls backward and forward Multidirectional arm reaches Arm circles backward and forward Spine rotation Side bend Marching Standing Easy-paced marching behind the chair, holding onto the back of the chair for balance Easy-paced walking around the chair in one direction and then the opposite direction Easy-paced step-ups standing behind the chair, holding onto the back of the chair for support

Balance-training Guidelines The ultimate goal of a balance-training program is to increase a persons capacity to perform ADL. Older adults and deconditioned individuals can incorporate balancetraining activities at the beginning of their exercise sessions or they may choose to perform a series of balance exercises on separate days apart from other types of training. A frequency of two to three nonconsecutive days per week is adequate for enhancing balance through training. However, fundamental balance principles can be applied on a

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daily basis as individuals transfer what they learn from their balance-training exercises to the functions of daily living.

Center of gravity (COG), or the area of the body wherein all the forces acting upon it are balanced and equal, is an important concept in balance training. While the location of COG varies from one person to the next, it is typically found just above the pelvis in a standing posture. When participants develop an increased awareness of COG, they are able to maintain a better upright position during sitting and standing, lean away from and return to the midline with more postural control, and move through space more quickly and confidently. Activities that enhance COG awareness are performed seated, standing, or while moving. Different levels of balance challenge can be added by manipulating the type of support surface used during exercise and reducing or eliminating visual feedback.

Balance-training Progressions An introductory seated balance exercise involves having the exerciser sit in the ChairMaster with back support while keeping the feet flat on the floor. The participant should practice sitting with the back against the chair and maintaining correct posture (Table 3). Have the participant hold the position for 15 seconds while breathing normally and relaxing the rest of the body. Individuals who are unable to achieve correct sitting posture while seated on a stable surface are not ready to progress to a more difficult seated balance challenge.

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If a participant successfully completes the introductory seated posture exercise, he or she is ready to try the same exercise in an unsupported sitting position. The individual should attempt to hold correct posture for 30 seconds with the eyes focused forward on a visual target. Next, the exercise can be repeated with the eyes closed. Finally, for added balance challenges, the exerciser can add arm and leg movements while focusing on maintaining a correct seated posture.

Introductory-level standing-balance activities teach participants how to maintain correct standing posture while performing various tasks. To begin, exercisers should check their standing postures (Table 3). Have the participant hold the position for 15 seconds while breathing normally and relaxing the rest of the body.

Table 3: Characteristics of Ideal Seated and Standing Postures Ideal Seated Posture Eyes focused forward on a target Chin gently pulled back Ears directly above the shoulders Shoulders placed slightly back and down Abdominal muscles gently pulled up and in Feet resting flat on the floor Ideal Standing Posture Eyes focused forward on a target Chin gently pulled back Ears directly above the shoulders Shoulders placed slightly back and down Abdominal muscles gently pulled up and in Hips level Kneecaps facing forward Ankles and feet in neutral alignment (facing forward) Weight evenly distributed on both feet

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Next, the participant should attempt to close his or her eyes for 15 seconds and concentrate on the feeling of standing correctly. To progress the standing-balance activities, the base of support can be altered so that subtle shifts of COG are required to maintain an upright posture. A typical altered base-of-support challenge starts with the individual standing with the feet together, holding the position for 15 to 30 seconds. The same exercise is repeated with the eyes closed. Next, the exerciser moves the feet to a tandem position (front foot ahead of the rear foot with a small space between the feet) and holds for 15 to 30 seconds. The same exercise is repeated with the eyes closed. Finally, the participant adopts a single-leg stance and holds the position for 15 to 30 seconds. The same exercise is repeated with the eyes closed. Other ways to manipulate the balance challenge during standing exercises are to alter the position of the arms or change the support surface beneath the feet (e.g., ChairMaster foam pad). Table 4 presents a summary of guidelines for balance training.

Table 4: Summary of Guidelines for Balance Training Training Variables 23 times per week Perform exercises toward the beginning of workouts before the onset of fatigue (which decreases concentration) Perform 1 set of 24 repetitions, each for 1530 seconds Training Progressions Base of support progresses from wide to narrow (e.g., standing with the feet shoulder-width apart to standing with the feet together) Small movements of the limbs progress to large movements (e.g., small arm reaches to large arm reaches with a body lean) Movement of the body progress from static to dynamic (e.g., standing to squatting or lunging)

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Functional Movement and Strength Training Optimal performance of movement requires that the bodys muscles work together to produce force while simultaneously stabilizing the joints. Typically, people who have weak stabilizer muscles (e.g., deep abdominals, hip stabilizers, and scapula retractors) exhibit problems performing proper, efficient movement, which may lead to pain and/or injury. Because individuals with pain or injury frequently have stabilizer weakness, functional training is often incorporated into a rehabilitation and post-rehabilitation training program, but this does not mean that functional training always focuses on the bodys stabilizing musculature. Instead, functional training provides a solid foundation that the exerciser can draw from when performing movements that require the muscles and joints to move in a coordinated, efficient manner.

Kinetic Chain A biomechanical concept that is used commonly in functional training is the idea that the bodys joints make up a kinetic chain, where each joint represents a link in the chain. Drawing on this principle, exercises may be described as either open- or closed-chain movements. In a closed-chain movement, the end of the chain furthest from the body is fixed, such as in the performance of a squat where the feet are fixed on the ground and the rest of the leg chain (i.e., ankles, knees, and hips) moves. In an open-chain exercise, the end of the chain furthest from the body is free, such as in the performance of a seated leg extension.

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Closed-chain exercises tend to emphasize compression of joints, which helps stabilize the joint, whereas open-chain exercises tend to involve more shearing forces at the joints. Furthermore, closed-chain exercises involve more muscles and joints than open-chain exercises, which results in better neuromuscular coordination and overall stability at the joints. Because both open- and closed-chain activities are required for typical ADL, incorporating both types of activities is an integral part of the ChairMaster exercise program.

An example of a program that develops functional strength through both open- and closed-chain activities is a conditioning routine that incorporates squats, lunges, multidirectional reaches, and overhead presses. Squatting and lunging are essential to human movement, as these tasks are required to stand up from a chair or stoop down to pick up a pair of shoes. Multidirectional reaches (i.e., reaching one or both arms in front of, to the side of, or behind the body) are important for training balance and postural control during dynamic activities that may place a persons COG outside the typical position between the feet during standing. Unilateral or bilateral overhead shoulder presses are tied closely to function in older adults because age-associated declines in upper-body strength often make the simplest tasks, such as putting away groceries on a top shelf, a substantial effort.

Primary Movement Patterns Human movement can essentially be broken down into five primary movement patterns that encompass all ADL. Movements can be as simple as one primary movement or as

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complex as the integration of several of them into a single motion. The five primary patterns are as follows: Bend-and-lift movements (e.g., squatting) Single-leg movements (e.g., single-leg stance and lunging) Pushing movements (primarily in the vertical/horizontal planes) Pulling movements (primarily in the vertical/horizontal planes) Rotational (spiral) movements

In essence, if a person can perform these five primary movements effectively, it improves his or her potential for efficient movement and decreases the likelihood for compensation, pain, or injury. When the five primary movements can be performed with proper form, external resistance may be applied for progressive strength development. It is essential that the external loads are increased gradually so that correct movement patterns are not altered during the exercise performance. The ChairMaster exercise program promotes the practice of the five primary movement patterns and allows for progression to develop strength via the ChairMaster bands and body-weight exercises (Table 5). Table 5: Sample ChairMaster Exercises Based on Primary Movements Primary Movement Bend-and-lift pattern Single-leg pattern Pushing pattern Pulling pattern Rotation pattern Exercise Examples Sit-to-stand squat Body-weight squat standing behind chair Single-leg squat behind the chair Single-leg abduction behind the chair with ChairMaster band Seated overhead press with ChairMaster bands Seated chest press with ChairMaster bands Seated biceps curl with ChairMaster bands Back row standing behind chair with ChairMaster bands Seated spine rotation Spine rotation standing behind chair with ChairMaster band

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Strength Training The acronym FIRST may be used to designate the five key components of strengthtraining program design: frequency, intensity, repetitions, sets, and type of exercise (Table 6). During the initial weeks of resistance training, motor learning plays a major role in the desired physical development and movement patterns. Consequently, during this training period, exercise repetition should be emphasized over exercise intensity. Frequency: Beginning exercisers experience excellent results by strength training two to three days per week. Intensity: Due to the emphasis on proper movement patterns, the training intensity is lower during the initial phase. Start with the light ChairMaster bands that allow participants to learn proper movement techniques and then progress to the more challenging ChairMaster bands. Repetitions: The number of repetitions performed varies inversely with the intensity of the exercise set. That is, fewer repetitions can be performed with a higher resistance and more repetitions can be completed with a lower resistance. Beginners should focus on lower training intensity to permit more repetitions in each exercise set. Furthermore, light resistance allows for proper movement patterns to be learned. Generally, if the resistance does not permit at least 12 repetitions, it should be reduced. In the case of the ChairMaster bands, if the lightest band resistance prohibits the completion of 12 repetitions, the exercise movement can be performed without any external resistance until the exerciser becomes strong enough to tolerate the light bands. When 16 repetitions can be

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properly performed, the exerciser should consider increasing the resistance to the next level of resistance of the ChairMaster bands. Sets: One set of resistance exercise can be as effective as multiple training sets, especially for beginning exercisers. For initial workouts, one set of each exercise is certainly a good starting point. As training progresses, more sets of each exercise may be performed as determined by the participants desire to do so. When the participant demonstrates consistent adherence and initial adaptations to a single-set program, the volume of sets can increase. Type: The type of exercise should be selected to help the exerciser learn and improve movement patterns with respect to his or her muscular fitness and strength-training experience. Participants with less muscle strength and training experience should begin with basic exercises performed with light or no external resistance and relatively stable conditions. Once a participant demonstrates progress with motor control and muscular strength, he or she can begin performing ground-based standing exercises that emphasize muscle integration.

Table 6: Summary of ChairMaster Resistance-training Guidelines Frequency 23 days per week Intensity Light ChairMaster bands, gradually increasing to moderate bands as tolerated Repetitions Sets 1215 Minimum of 1, progressing to 2 or 3 as desired Type ChairMaster bands and bodyweight exercises

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Cardiorespiratory Exercise Cardiorespiratory, or aerobic, exercise for older individuals should focus on a variety of non-impact modalities (such as pedaling while seated on the ChairMaster) and lowimpact weightbearing formats (such as step-ups performed standing behind the ChairMaster). For inactive individuals, 30 minutes of these types of activities most days of the week is sufficient for enhancing health and well-being. For deconditioned individuals, 30 minutes of exercise may be accumulated in shorter bouts throughout the day (e.g., 10-minute sessions, three times a day). Gradually increasing aerobic exercise intensity and duration is an appropriate goal for those who want increased body-fat reduction and improved cardiovascular fitness. Table 7 summarizes general aerobicactivity guidelines for use with the ChairMaster.

Table 7: Summary of ChairMaster Aerobic-activity Guidelines Frequency 57 days per week Intensity Light to moderate Time 30 minutes or more, which can be accumulated in short, 10-minute bouts Type ChairMaster pedaling or step-ups behind chair

Aerobic Exercise for Weight Loss For overweight or obese individuals, experts recommend a weekly energy expenditure of 2,000 calories per week, which equates to approximately 6090 minutes per day of moderate-intensity physical activity, for long-term weight loss [U.S. Department of Agriculture, 2010; ACSM, 2009; Sarris et al., 2003]. The basis for these recommendations is also supported by the National Weight Control Registry (NWCR), a cohort of approximately 10,000 successful losers who have lost an average of 66

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pounds and maintained this loss for approximately 5.5 years. The NWCR found that while dietary control was an important factor in the maintenance of weight loss, one of the most significant findings was that successful losers maintained consistently high daily physical-activity levels. In fact, 90% of the NCWR subjects exercise, on average, about 1 hour per day and 62% report watching fewer than 10 hours of television per week (NCWR, 2012).

The amount of physical activity suggested for weight loss and prevention of weight regain in overweight and obese individuals is clearly greater than that recommended for public health improvement for the average person. For improved health, a minimum of 150 minutes of physical activity per week, or 30 minutes of physical activity on most days of the week is advised (U.S. Department of Health & Human Services, 2008; Haskell et al., 2007). However, for obese individuals, a progression to approximately 250 to 300 minutes of physical activity per week, or 50 to 60 minutes five days each week, may be necessary for long-term weight loss success. In some cases, 60 to 90 minutes of daily exercise may be required (Zoeller, 2007).

The primary mode of initial activity to facilitate weight loss is aerobic exercise. Aerobic conditioning maximizes caloric expenditure in individuals who have obesity or are new to exercise, and reduces the risk of chronic disease associated with obesity (e.g., CVD, type 2 diabetes, and the metabolic syndrome). Because the intensity of aerobic exercise is an important variable related to its effectiveness in improving health and promoting

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weight loss, individuals using the ChairMaster cycling option should have a basic understanding of how hard they should be working.

Monitoring Aerobic Exercise Intensity An intensity-monitoring technique called the talk test takes into account an exercisers ability to breathe and talk during a workout. If a person can comfortably answer a question during exercise while still feeling like he or she is getting a good workout, it is likely that the activity being performed is appropriate for cardiorespiratory conditioning. The talk test is especially useful for beginners who are learning to pace themselves by monitoring their bodily responses to exercise.

An exerciser on the ChairMaster can take the talk test by simply answering questions while exercising. Ideally, the responses of the participants should be in the form of sentences, rather than one-word statements, such as fine or okay. For example, a participant could be asked to describe how he or she is feeling and the participant could respond by saying, I feel like Im working pretty hard. If the exerciser can string those words together in a sentence without stopping and gasping for air, he or she is probably working at an appropriate intensity. On the other hand, if the participant has a hard time talking or breathing, it is an indication that the exercise intensity is too difficult and he or she should be coached to slow down and resume at an intensity that is light to somewhat hard. This level of intensity corresponds well with light- to moderateintensity aerobic exercise as recommended for improvements in health and weight loss.

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Benefits of the ChairMaster on Aerobic-exercise Adherence Regardless of the reasons people have for engaging in physical activity, a ubiquitous barrier to committing to a regular program of exercise is lack of time. Add to this the inconvenience and cost of going to a fitness facility, and it is easy to see why many people shy away from physical activity. The ChairMaster eliminates these obstacles and provides a simple method for engaging in regular exercise. In fact, the ChairMaster allows the exerciser to sit in a comfortable chair and watch television or read, all while pedaling for aerobic exercise. ChairMaster users can do a leisure activity, such as watch their favorite program, while simultaneously getting fit. In other words, they can sit and get fit. Since the ChairMaster doubles as a functional piece of furniture, it can be left out in the open as a regular chair when not in use, which eliminates the need to move a piece of exercise equipment before and after working out.

As described above, the added convenience and ease of use of the ChairMaster effectively removes common barriers to exercise, which enhances the likelihood of sticking with a physical-activity program. These adherence-promoting benefits of the ChairMaster could make the difference between a workout program that is tried and quickly dropped and one that is performed regularly and improves the health of the exerciser.

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Mobility/Flexibility Exercise Physical inactivity is a major contributor to decreases in flexibility, such that physically inactive individuals tend to be less flexible than active individuals. Furthermore, regular exercise improves flexibility. Disuse as a result of physical inactivity or immobilization leads to contraction and shortening of the connective tissues, restricting joint mobility. Similarly, using the joints and muscles in repetitive activity patterns or maintaining habitual poor body postures can inhibit ROM because of the shortening and tightening of the muscle tissue. A physical-activity program using the ChairMaster offers the participant methods to improve mobility and ROM through dynamic and static flexibility exercises.

Dynamic mobility exercises that gently take the joints through their appropriate ROM can be performed in the warm-up segment of any workout. As discussed previously in the Warm-up Techniques section, continuous rhythmic movements that mimic the more intense exercises that will be performed during the workout can be used not only to warm up the muscles, but also to improve ROM in the joints. At the conclusion of an exercise session, static stretching techniques (e.g., holding a stretch position for 15 to 60 seconds) can be used to develop lasting increases in flexibility. It is important to stretch the muscle groups that have been used in the exercise activity as well as muscles that are commonly tight. It is also important that stretching be comfortable for the participant. Proper form can be encouraged by using cues such as move to the position where you can feel gentle tension, then hold; your muscles should not feel like a rubber band ready to snap; find a

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comfortable stretch and hold; if you are shaking, then back off the intensity of the stretch.

A flexibility program for older adults and deconditioned individuals should include a consistent routine of stretches for the important postural muscles of the chest, trunk, hips, and thighs. At minimum, stretching is recommended two to three days per week, but can be performed up to seven days per week (ACSM, 2010). A daily flexibility program performed after an appropriate warm-up or at the conclusion of a training session consisting of static stretches for the whole body can go a long way toward enhancing flexibility. Table 8 presents a summary of stretching guidelines for use with the ChairMaster.

Table 8: Summary of ChairMaster Stretching Guidelines Frequency 57 days per week Intensity Light to moderate; feels like a good stretch, but does not provoke pain Time Minimum of 510 minutes; holding static stretches for 15 60 seconds for 24 sets Type Mobility work in the warm-up and static stretching after the workout; Seated in the ChairMaster or standing behind or alongside the chair

Putting It All Together Once an exercisers goals are determined, an exercise session format can be developed. For example, if the primary goal is to improve cardiorespiratory endurance, an aerobiconly workout can be implemented. On the other hand, if a person wants to increase both strength and cardiorespiratory performance, the workout format should focus on both of

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those variables of fitness within the session. Table 9 presents examples of various workout formats.

Table 9: Examples of Various Workout Formats Aerobic-only Workout Warm-up: at least 1015 minutes Aerobic work: approximately 30 minutes or longer Stretching/relaxation: at least five to 10 minutes, longer if time permits Muscle Strengtheningonly Workout Warm-up: at least 1015 minutes Strength training: approximately 3040 minutes Stretching/relaxation: at least five to 10 minutes, longer if time permits Stretch-only Workout Warm-up: at least 1015 minutes Stretching/relaxation: approximately 3040 minutes, longer if desired Total-body Workout With Strength Work Preceding Aerobic Work Warm-up: at least 1015 minutes Strength training: approximately 15 minutes Brief stretching: approximately two to five minutes Repeat active rhythmic warm-up activities: approximately five minutes Aerobic work: approximately 1520 minutes Final stretching/relaxation: at least five to 10 minutes, longer if time permits Total-body Workout With Aerobic Work Preceding Strength Work Warm-up: at least 1015 minutes Aerobic work: approximately 1520 minutes Brief stretching: approximately two to five minutes Strength training: approximately 15 minutes Final stretching/relaxation: at least five to 10 minutes, longer if time permits Note: The outlines presented above represent examples of workable exercise formats, but are not intended to cover all viable training options. To keep workout duration manageable, choose numbers from each range of minutes that will combine to produce a workout lasting approximately one hour (or up to 30 minutes for novice and/or deconditioned exercisers). Keep in mind that balance-training techniques can be incorporated into all workout formats.

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SECTION V
SAMPLE CHAIRMASTER EXERCISE ROUTINES When performing any exercise in the ChairMaster routine, always avoid painful ROM and only move within tolerable limits.

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Mobility Exercises Seated Without Using Bands

For all of the exercises in this section, sit upright in the chairusing the backrest or the ChairMaster foam pad for support as neededwith the feet flat on the floor.

1) Neck rotation Rest the hands on the armrests or in the lap. Rotate the neck so that the head turns to the right and then to the left.

2) Shoulder rolls backward and forward* Roll the shoulders up, forward, and down and then roll the shoulders up, backward, and down.

3) Multidirectional arm reaches* Reach the arms above the head, out to the sides of the body, in front of the body, and across the body. For progression, add a weight shift (i.e., lean with the body) as the arms reach in each direction.

4) Arm circles backward and forward* Extend the arms to the sides and perform small arm circles forward and then backward. For progression, perform larger circles.

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5) Spine rotation Rest the hands on the armrests or in the lap. Rotate the spine so that the torso turns to the right and then to the left. For progression, reach across the body with one arm or hold both arms out to the sides while rotating.

6) Side bend Rest the hands on the armrests or in the lap. Flex the spine to each side so that the torso bends to the right and then to the left. For progression, reach overhead with one or both arms while bending.

7) Marching Rest the hands on the armrests or in the lap. Alternate lifting each knee upward toward the torso. For progression, reach overhead with one or both arms while marching.
*

These exercises can be performed with one limb at a time or with both limbs simultaneously. It is typically more challenging to use both extremities at the same time versus one at a time.

Strength Exercises Seated Without Using Bands 1) Sit-to-stand squat Sit at the edge of the chair with the feet shoulder-width apart and both arms reaching out in front of the body. Stand up, fully straightening the knees and hips. Return to the seated position, concentrating on the gluteal and thigh muscles to lower the body downward.

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2) Alternating straight-leg lift Sit at the edge of the chair with the hands resting on the armrests or in the lap. Straighten one knee and lift the leg as high as possible without changing the position of the spine in good sitting posture. Lower the foot to the floor and repeat with the other leg.

3) Alternating bicycle crunch Sit in the chair in the reclined position using the backrest or foam pad for back support as needed. Hold on to the arm rests for increased stability. Lightly contract the abdominals, lean back with the torso, and lift one knee toward the chest while the opposite foot remains on the floor. Switch the knee and the foot so that the opposite knee lifts toward the chest and the opposite foot touches down to the floor (i.e., in a bicycling motion).

4) Ab/knee tuck holding onto armrests* Sit in the chair using the backrest or foam pad for back support as needed. Hold on to the arm rests for increased stability. Lightly contract the abdominals, lean into the backrest or foam pad with the back, and lift (tuck) both knees toward the chest. Lower the feet down to the floor.
*This exercise can be performed with the chair in the reclined position.

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Strength Exercise Seated With Bands Attached to Front, Low Rings* 1) Biceps curl Grasp the tube handles with the palms facing forward and sit at the edge of the chair so that the backs of the hands touch the seat. Lift the handles toward the shoulders and then lower them to the starting position, moving only at the elbows (i.e., keep the shoulders still during the movement). 2) Upright row Grasp the tube handles with the palms facing backward and sit at the edge of the chair so that the palms touch the seat. Keeping the elbows bent, lift the arms so that the elbows lead the movement and at the end position the elbows are slightly higher than the shoulders (i.e., creating a V position with the elbows).Lower the handles, returning the arms to the starting position.

3) Overhead press Grasp the tube handles, keep the elbows bent and close to the body, and position the hands in front of shoulders with the palms facing forward. Lift the arms overhead, trying to achieve full elbow extension at the top of the movement. Lower the handles, returning the arms to the starting position. 4) Front-arm raise Grasp the tube handles with the palms facing toward the floor, keeping the arms straight and in front of the body. Lift the arms upward to shoulder height and then lower them, returning to the starting position. Avoid elevating the shoulders toward the ears during the movement; only lift the arms, keeping the space between the ears and the shoulders fixed.

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5) Side-arm raise Grasp the tube handles with the palms facing toward the floor, keeping the arms straight and toward the sides of the body. Lift the arms upward to shoulder height and then lower them, returning to the starting position. Avoid elevating the shoulders toward the ears during the movement; only lift the arms, keeping the space between the ears and the shoulders fixed. 6) Knee extension Attach the cuffed tubes just above the ankles. Sit upright in the chairusing the backrest or the ChairMaster foam pad for support as neededwith the feet flat on the floor. Lift one foot off of the floor by straightening the knee and then return the foot to the floor by bending the knee. Repeat with the opposite leg. *All of these exercises can be performed with one limb at a time or with both limbs simultaneously. It is typically more challenging to use both extremities at the same time versus one at a time.

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Strength Exercises Seated With Bands Attached to Back, High Rings*

For all of the exercises in this section, sit upright in the chairusing the backrest or the ChairMaster foam pad for support as neededwith the feet flat on the floor.

1) Chest press Grasp the tube handles with the palms facing downward toward the floor, elbows fully flexed, and the wrists, elbows, and shoulders aligned in the same plane (shoulder height). Push the handles forward so that the arms extend in front of the body. Return the arms to the starting position. Be sure to keep the back positioned against the backrest or foam pad and avoid rounding the shoulders forward during the pushing movement.

2) Chest fly Grasp the tube handles with the palms facing toward each other, elbows fully flexed, and the wrists, elbows, and shoulders aligned in the same plane (shoulder height). Push the handles forward in front of the body in an arc (as if they are hugging a barrel), keeping a slight bend in the elbow, even in the fully extended position. Return the arms to the starting position. Be sure to keep the back positioned against the backrest or foam pad and avoid rounding the shoulders forward during the pushing movement.

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3) Overhead triceps press Grasp the tube handles with the backs of the hands on top of the shoulders and the palms facing upward toward the ceiling (the elbows will be fully flexed in this position). Prepare to begin by lifting the elbows upward toward the ceiling and keeping the arms as close as possible to the sides of the head. Push the handles upward above the head by extending only the elbows (the shoulders should remain fixed). Return the arms to the starting position.
*All of these exercises can also be performed with the chair in the reclined position. They also can be performed with one limb at a time or with both limbs simultaneously. It is typically more challenging to use both extremities at the same time versus one at a time.

Strength Exercises Standing Behind Chair With Bands Attached to Back, High Rings 1) Mid-back row* Stand facing the back of the chair with the feet shoulder-width apart, keeping a slight bend in the knees. Grasp the tube handles so that the palms are facing each other with the arms extended straight out in front of the body. Pull the handles toward the ribs by flexing the elbows while squeezing the muscles of the upper/mid back, being sure that the elbows move behind the body in the end position. Return the arms to the starting position.

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2) Chest scoop* Stand facing away from the back of the chair with the feet shoulder-width apart, keeping a slight bend in the knees. Grasp the tube handles so that the palms are facing forward with the arms extended down along the sides of the body. Pull (scoop) the handles upward toward the ceiling to shoulder height at the point where the handles almost touch each other, keeping a slight bend in the elbows throughout the motion. Return the arms to the starting position.

3) Horizontal spine rotations with both hands grasping the same band (twisting motion) Stand alongside the back of the chair with the right side of the body with the feet in a split-stance (tandem) position (right foot behind the left foot), keeping a slight bend in the knees. With both hands, grasp one tube handle so that the palms are facing each other with the arms extended forward in front of the body. Pull the handles away from the chair using a twisting motion with the torso, keeping a slight bend in the elbows throughout the motion, and focusing on squeezing the abdominal muscles during the movement. Return the arms to the starting position. Repeat on the other side with the feet in the opposite tandem position.
*These exercises can be performed with one limb at a time or with both limbs simultaneously. It is typically more challenging to use both extremities at the same time versus one at a time.

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Strength Exercises Standing Behind Chair With Bands Attached to Back, Low Rings 1) Bent-over row* Stand facing the back of the chair with the feet shoulder-width apart, keeping a slight bend in the knees. Lean slightly forward at the hips, keeping the back straight and maintaining a slight bend in the knees. Grasp the tube handles so that the palms are facing each other with the arms extended straight out in front of the body. Pull the handles toward the ribs by flexing the elbows while squeezing the muscles of the upper/mid back, being sure that the elbows move behind the body in the end position. Return the arms to the starting position.

2) Single-arm bent-over row with opposite hand leaning on back of chair Stand facing the back of the chair with the feet in a split-stance (tandem) position (right foot behind the left foot), keeping a slight bend in the knees. Lean slightly forward at the hips, keeping the back straight, maintaining a slight bend in the knees and placing the left hand on the back of the chair. With the right hand, grasp the tube handle so that the palm faces the midline of the body with the arm extended downward in front of the body. Pull the handle toward the ribs by flexing the elbow while squeezing the muscles of the upper/mid back, being sure that the elbow moves behind the body in the end position. Return the arm to the starting position. Repeat on the other side with the feet in the opposite tandem position.

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3) Diagonal spine rotations with both hands grasping the same band (opposite of wood-chop motion) Stand alongside the back of the chair with the right side of the body facing the chair holding the feet in a split-stance (tandem) position (right foot behind the left foot*), keeping a slight bend in the knees. (*reverse foot plant than shown in photo) With both hands, grasp one tube handle so that the palms are facing each other with the arms extended downward in front of the body. Pull the handles upward away from the chair using a twisting motion with the torso, keeping a slight bend in the elbows throughout the motion, and focusing on squeezing the abdominal muscles during the movement. Return the arms to the starting position. Repeat on the other side with the feet in the opposite tandem position.

4) Single-leg hamstrings curl Place a cuffed tube slightly above one ankle and stand facing the back of the chair with the feet hip-width apart. Lean slightly forward at the hips, keeping the back straight and maintaining a slight bend in the knees. Lift the cuffed ankle upward toward the back of the thigh by flexing at the knee. Return the ankle to the starting position by extending the knee. Repeat on the opposite side.

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5) Single, straight-leg hip extension Place a cuffed tube slightly above one ankle and stand facing the back of the chair with the feet hip-width apart. Lean slightly forward at the hips, keeping the back straight and maintaining a slight bend in the knees. Keeping the knee completely straight, lift the cuffed ankle upward toward the ceiling (however, avoid lifting the leg so high that the pelvis/hips start to shift). Return the ankle to the starting position. Repeat on the opposite side.

6) Single, straight-leg hip abduction Place a cuffed tube slightly above the right ankle and stand facing the back of the chair with the feet hipwidth apart. Keep the back straight and maintain a slight bend in the knee of the non-cuffed leg. Keeping the right knee completely straight, lift the cuffed ankle (in this case the right ankle) outward to the side of the body (however, avoid lifting the leg so high that the pelvis/hips start to shift). Return the ankle to the starting position. Repeat on the opposite side.

7) Single, straight-leg hip adduction Place a cuffed tube slightly above the right ankle and stand facing the back of the chair with the feet hipwidth apart. Keep the back straight and maintain a slight bend in the knee of the non-cuffed leg. Keeping the right knee completely straight, lift the cuffed ankle (in this case the right ankle) inward toward the midline of the body, crossing slightly in front of the other leg (however, avoid lifting the leg so high that the pelvis/hips start to shift). Return the ankle to the starting position. Repeat on the opposite side.
*This exercise can be performed with one limb at a time or with both limbs simultaneously. It is typically more challenging to use both extremities at the same time versus one at a time. These exercises require the cuff attachment instead of the handle attachment.

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Strength Exercises Standing Without Using Bands

Behind

Chair

1) Body-weight squat holding onto back of chair Stand facing the back of the chair with the feet shoulder-width apart, while reaching out both arms in front of the body to lightly grasp the back of the chair. Concentrating on the gluteal and thigh muscles, lower the hips downward into a squat position as far as is comfortable/tolerable for the knees. Stand up, fully straightening the knees and hips, and return to the starting position.

2) Single-leg squat holding onto back of chair Stand facing the back of the chair with one knee bent, holding the foot off of the floor while reaching out both arms in front of the body to lightly grasp the back of the chair. Concentrating on the gluteal and thigh muscles, lower the hips downward into a squat position as far as is comfortable/tolerable for the supporting knee. Stand up, fully straightening the supporting knee and hip, and return to the starting position.

3) Lateral lunge holding onto back of chair Stand facing the back of the chair with the feet together, while reaching out both arms in front of the body to lightly grasp the back of the chair. Concentrating on the gluteal and thigh muscles, take a large step out to the right side with the right leg, and lower the hips downward into a lateral lunge position as far as is comfortable/tolerable for the right knee (the left knee should remain straight). Return to the starting position. Repeat on the opposite side [i.e., take a large step out to the left side with the left leg, lower the hips downward into a lateral lunge position as far as is comfortable/tolerable for the left knee (the right knee should remain straight)].

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4) Push-up holding onto back of chair Stand facing the back of the chair with the feet hipwidth apart, while reaching out both arms in front of the body to lightly grasp the back of the chair. Place most of the body weight onto the hands and rise up on the balls of the feet, keeping the back and knees straight and in good alignment. Lower the torso downward toward the back of the chair by flexing the elbows and allowing them to move behind the body. Return to the starting position by extending the elbows. Be sure to keep the abdominal muscles slightly contracted and the back in proper alignment throughout the movement. Static Stretches Standing Behind Chair
Each of these stretches should be held in position for 15 to 60 seconds.

1) Downward-facing dog holding onto back of chair

Stand facing the back of the chair with the feet shoulder-width apart, while reaching out both arms in front of the body to lightly grasp the back of the chair. Keeping the arms straight, hinge at the hips and lower the torso so that the chest is facing the floor. Keep the back straight and maintain a slight bend in the knees. The stretch should be felt in the backs of the legs, front of the torso, chest, shoulders, and arms.

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2) Calf stretch holding onto back of chair Stand facing the back of the chair with the feet in a split-stance (tandem) position (right foot behind the left foot), while reaching out both arms in front of the body to lightly grasp the back of the chair. Lean forward with the whole body, bending the left knee, keeping the right knee straight, and keeping the back straight, until a stretch in the right calf area is felt (be sure to keep the right heel down in contact with the floor throughout the stretch). Repeat on the opposite side.

3) Leaning side bend holding onto back of chair Stand with the right side of the body alongside the back of the chair with the feet together. Lightly grasp onto the back of the chair with the right hand. Reach the left arm up overhead and bend to the torso to the right side, leaning toward the chair. The stretch should be felt in the left side of the body. Repeat on the opposite side.

4) Straight-arm chest/shoulder stretch with one hand holding onto back of chair Stand with the right side of the body alongside the back of the chair with the feet together. Lightly grasp onto the back of the chair with the right hand and take a step or two to the side away from the chair so that the right arm is straight. Gently rotate the torso away from the right arm. The stretch should be felt in the chest, shoulder, and upper arm of the right side. Repeat on the opposite side.

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Aerobic Exercises 1) Seated pedaling Sit upright in the chairusing the backrest or the ChairMaster foam pad for support as needed. Place the feet in the pedal straps and check to ensure that the knees are slightly bent at the down position of the pedal stroke. Place the hands on the armrests or on the lap. Start pedaling using smooth, continuous pedal strokes at a resistance that is tolerable.

2) Step-ups standing behind the chair holding onto back of chair Place the step on the floor up against the back of the chair. Stand facing the back of the chair with the feet hip-width apart, while reaching out both arms in front of the body to lightly grasp the back of the chair. Step up onto the step and then down onto the floor leading with the right foot. Switch to the opposite side. Eventually, progress to stepping without holding onto the back of the chair, if possible.

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Summary The ChairMaster is an effective tool in promoting a healthy, physically active lifestyle with a unique design that meets the needs of sedentary individuals and older adults by combining a low-impact aerobic workout with resistance training in a user friendly seated workout. The ChairMaster includes a recumbent cycle for aerobic conditioning, which folds out of site when not in use, and resistance bands for muscular-fitness training. In addition, the ChairMaster is designed for functional aesthetics in that it serves as a chair that can be used anywhere.

The exercise programming provided in this manual addresses the specific health and fitness needs of older, overweight/obese, and/or deconditioned adults without exposing them to unnecessary risks. Adherence to the ChairMaster exercise system following the guidelines described on the previous pages is a practice that will benefit the functional capabilities of the user in important areas of health, including aerobic endurance, muscle strength and endurance, flexibility, body composition, and balance.

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References American College of Sports Medicine (2010). ACSMs Guidelines for Exercise Testing and Prescription (8th ed.). Philadelphia, Pa.: Wolters Kluwer/Lippincott Williams & Wilkins. American Council on Exercise (2005). ACEs Exercise for Older Adults (2nd ed.). San Diego, Calif.: American Council on Exercise. American Geriatrics Society (2001). Exercise prescription for older adults with osteoarthritis pain: Consensus practice recommendations. Journal of the American Geriatrics Society, 49, 808823. Arias, E. (2006). United States life tables, 2003. National Vital Statistics Reports, 54, 14. Baumgartner, R.N. et al. (1998). Epidemiology of sarcopenia among the older persons in New Mexico. American Journal of Epidemiology, 147, 755763. Bray, G.A. (2007). The missing linklose weight, live longer. New England Journal of Medicine, 357, 818820. Centers for Disease Control and Prevention (2007). The State of Aging and Health in America 2007. Centers for Disease Control and Prevention and the Merck Company Foundation. www.cdc.gov/aging. Centers for Disease Control and Prevention (2003). Public health and aging: Trends in agingUnited States and worldwide. Morbidity and Mortality Weekly Report, 52, 6, 101106. Fontaine, K.R. & Barofsky, I. (2001). Obesity and health-related quality of life. Obesity Reviews, 2, 173182. Fontaine, K.R. et al. (2003). Years of life lost due to obesity. Journal of the American Medical Association, 289, 187193. Haskell, W.L. et al. (2007). Physical activity and public health updated recommendations from the American College of Sports Medicine and the American Heart Association. Medicine & Science in Sports & Exercise, 39, 14231434. Helmchen, L.A. & Henderson, R.M. (2004). Changes in the distribution of body mass index of white US men, 18902000. Annals of Human Biology, 31, 174181. Jensen, G.L. (2005). Obesity and functional decline: Epidemiology and geriatric consequences. Clinics in Geriatric Medicine, 21, 677687.

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Knowler, W.C. et al. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346, 393403. National Heart, Lung and Blood Institute (1998). Obesity Education Initiative Expert Panel. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, Md.: National Institutes of Health. NIH publication No. 98-4083. National Institutes of Health (2006). National Institute on Aging: Aging Under the Microscope: A Biological Quest. NIH Publication No. 02-2756. Bethesda, Md. www.nia.nih.gov. National Osteoporosis Foundation (2008). http://www.nof.org. National Weight Control Registry (2012). NCWR Facts. National Weight Control Registry. www.nwcr.ws/Research/default.htm. Ogden, C.L. et al. (2006). Prevalence of overweight and obesity in the United States, 19992004. Journal of the American Medical Association, 295, 15491555. Sarris, W.H. et al. (2003). How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st Stock Conference and consensus statement. Obesity Reviews, 4, 101114. Shephard, R.J. (1987). Physical Activity and Aging (2nd ed.). London: Croom Helm. Spirduso, W.W., Francis, K.L., & MacRae, P.G. (2005). Physical Dimensions of Aging (2nd ed.). Champaign, Ill.: Human Kinetics. Stewart, A.L. (2001). Community-based physical activity programs for adults age 50 and older. Journal of Aging and Physical Activity, 9 (Suppl.), 7191. U.S. Department of Agriculture (2010). Dietary Guidelines for Americans 2010. www.dietaryguidelines.gov. U.S. Department of Health & Human Services (2008). 2008 Physical Activity Guidelines for Americans: Be Active, Healthy and Happy. www.health.gov/paguidelines/pdf/paguide.pdf. Zoeller, R.F. (2007). Physical activity and obesity: Their interaction and implications for disease risk and the role of physical activity in healthy weight management. American Journal of Lifestyle Medicine, 6, 437446.

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About the Author Sabrena Merrill, M.S., has been actively involved in the fitness industry since 1987, successfully operating her own personal-training business and teaching group exercise classes. Merrill is a former full-time faculty member in the Kinesiology and Physical Education Department at California State University, Long Beach. She has a bachelors degree in exercise science as well as a masters degree in physical education/biomechanics from the University of Kansas. Merrill, an ACE-certified Personal Trainer and Group Fitness Instructor, is an author, educator, and international fitness consultant who remains very active within the industry.

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17280 Woodinville Redmond RD NE Suite 800 Woodinville WA 98072 www.ChairMaster.com Phone: (425) 402-4062 Fax: (425) 402-4063