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Assessing & Enhancing

3/24/2014 The physical condition of Milan Cobelens

Job Spits, 491378

24-3-2014

Assessing & Enhancing

3/24/2014 The physical condition of Milan Cobelens

Job Spits, 491378

ABSTRACT

This report describes the process of the creation of a personalized health intervention for the client Milan Cobelens. After having had several meetings with the client, it was first decided that the intervention would span three different lifestyle aspects: nutrition, smoking and physical activity. During one of the following meetings, it became clear for both coach and client that trying to enhance those three facets, the necessary focus could easily become blurred. During the following week, it was decided that only physical activity would be getting attention in the twenty week period. Nonetheless, the test results of all three lifestyle aspects are included in the report, to provide a clear overview of how Milan Cobelens lives.The outcomes of the physical testing gave the possibility of creating an intervention, consisting of both cardiovascular and resistance workouts. In this period, the workouts are designed and discussed with the client. The next period, coming together with a separate report, will be dedicated to analyzing and redefining the overall progress.

CONTENTS

INTRODUCTION...............................................................................................................7

ASSESSMENT OF THE CLIENT......................................................................................9Intake...............................................................................................................................9

Personal Health Guide..................................................................................................9Behaviour Change Diary.............................................................................................10If-then plans.................................................................................................................11

Second meeting.............................................................................................................12Personal Health Guide................................................................................................12Behaviour Change Diary.............................................................................................12Rewards......................................................................................................................12Preparation for testing the client.................................................................................12

Physical testing of Milan Cobelens................................................................................14Harvard Step Test.......................................................................................................14Body weight, height & BMI..........................................................................................15Skinfold.......................................................................................................................15Blood pressure & heart rate........................................................................................17Strength.......................................................................................................................17Dietary intake of Milan Cobelens................................................................................19

CREATING THE INTERVENTION..................................................................................20Preparation....................................................................................................................20Cardiovascular training..................................................................................................20Resistance training........................................................................................................23

EVALUATION..................................................................................................................26Creating an evaluation plan...........................................................................................26

Process evaluation plan..............................................................................................26Product evaluation plan...............................................................................................26

Evaluation of the client..................................................................................................27Process evaluation......................................................................................................27Product evaluation......................................................................................................29

CONCLUSION AND CONTINUATION............................................................................33

APPENDICES..................................................................................................................34

BIBLIOGRAPHY.............................................................................................................44

Figure 1 Importance and Confidence......................................................................................................10Figure 2 VO2Max in men (Geijsel & Hlobil, 1996)...................................................................................14Figure 3 BMI calculation (UK Metric Association, sd)..............................................................................15

Table 1 seven point skinfold of milan cobelens.......................................................................................16

Table 2 forearm and hand strength test of milan cobelens.....................................................................17Table 3 1Rm tests of milan cobelens.......................................................................................................18Table 4 running scheme milan cobelens week 1 - 14..............................................................................21Table 5 total calories and fat calories expenditure in low and high intensity training (Waehner, 2014)...22Table 6 training schedule period one day one.........................................................................................23Table 7 training schedule period one day two.........................................................................................24Table 8 training schedule period two day one.........................................................................................24Table 9 training schedule period two day two..........................................................................................24Table 10 adapted training schedule for period two day one....................................................................28Table 11 adapted training schedule for period two day two.....................................................................28Table 12 increase in 1rm of milan cobelens............................................................................................30Table 13 Comparison of Milan Cobelens’ skinfold measurements..........................................................31

Text 1 Personal Health Guide..................................................................................................................34Text 2 Behavour Change Diary...............................................................................................................37Text 3 If-then plans..................................................................................................................................42Text 4 signed acknowledgement paper...................................................................................................43

INTRODUCTIONIn today’s world, health is one of life’s aspects where the most attention is paid to. Smoking is bad for you and deteriorates the overall physical condition of the body (Akers & Lee, 1996). Having an unhealthy diet can obviously be bad in numerous ways (Cecchini, et al., 2010). Not to speak of the negative effects of stress, alcohol or the lack of physical activity (Steptoe, Wardle, Davies, Canaan, & Pollard, 1996). But above all these issues, people especially want to avoid obesity, giving the same association with chronic health deficit as twenty years’ aging (Sturm, 2002). Every day, hour and minute, these possible problems need attention of the people in our society. All in order to maintain the view of a healthy and perhaps longer life. But living such a conscious life isn’t always that easy. There are too many aspects in going down this healthy road that should be taken into account. And if you don’t want to fail in trying to change your lifestyle, help can surely be needed. That is why advice needs to be given to those who need it. The difficult thing in offering this advice, is that the focus of it changes with every individual that tries to realize this big change. Individual counseling is the profession that deals with the difficulties in guiding a specific person. During the last eight weeks, an individual assessment program like this has been started. The person in the question, Milan Cobelens, desired a change in his physical condition. It began with a period of determining the starting situation and formulating specific goals. This first part of the program, lasting about ten weeks in total, will be fully explained in chapter ‘Assessment of the client’. This assessment period will find its continuation in a second period of ten weeks, including an evidence based intervention program to help the individual reach the determined goals.

So, the first of those two parts is what this report is all about: the summarization of the results of first ten-week period, where Milan Cobelens was assessed.

To make sure the right decisions would be made, the assessing started with a personalized intake. With the help of several tools this intake was done to find the right balance in aspects that needed change and the objectives that go with it. A very important side of conducting these intakes, is the part of motivational interviewing (Michie, et al., 2008). Using his promising technique increases the chance of having a successful change in someone’s situation (Burke, Arkowitz, & Menchola, 2003). Therefore it was used in this intervention program. Three big issues in the clients’ lifestyle submerged, namely his smoking addiction, an unsteady and unhealthy eating pattern and the lack of sufficient physical activity. During the intake, those problems were translated into these personal objectives:

1. I want to quit smoking before the end of this program.2. After this program, I want to have a more varied nutritional intake and an improved eating

pattern. 3. I desire a more active lifestyle, both regarding sportive and lifestyle issues.

A second meeting followed for a better focus, after which a few physical tests have been done. The reason of this was to determine the starting situation and for having a clear point of reference for future comparisons. This of course will be of interest in determining the effect of the eventual intervention program.The way of working, together with the tests, tools and outcome of the assessment are described in detail in the next chapter.

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When the starting situation was known, a vital question needed an answer: how will the client be able to realize his objectives in the given time? By considering the personal results that were found during the assessment, an intervention program was made. Obviously, this program needed to be adjusted to the individual needs of the client. The second part of the report describes the process of making this specialized intervention program.

With this intervention program, the coach and the client can start working on reaching the goals. This will be done in the second ten-week period, covered in this same report.

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ASSESSMENT OF THE CLIENT

IntakeIn a project like this, where somebody’s health needs a change, the most important thing is knowing where the trial needs to be started. Determining this starting situation includes everything from the person’s health current status to the goals he wants to achieve. And of course, no one explains this better than the individual that wants to undergo this change. According to the book Improving Health, interviewing the client is ‘… one of the most effective techniques to help people change behavior’ (Michie, et al., 2008). To kick start this behaviour change, an intake has been organized with Milan Cobelens. The intake was meant to determine the starting situation and as a first meeting between coach and client in order to establish a professional relationship. Within this relationship it was important to clarify certain topics, like the reach of the coach’s expertise and what was to be expected from the individual.

Also, to achieve the goals of the intake in a quick and right way, a few instruments were used: the Personal Health Guide, a Health Behavior Diary and several ‘If-then’ plans. These methods are very useful in the process of assessing an individual (Michie, et al., 2008). The effects and the outcome of the instruments used in the intake are further described in the following paragraphs.

Personal Health GuideThe Personal health Guide can be seen as the core of the intake. The initial goal was to clearly set one general and several specific goals to hold on to. By asking questions and guiding Milan in formulating his answers in the right way, a general goal and three specific goals became known:

General goal

Before the end of this program, I want my physical and conditional status to be better.

Specific goals

I want to quit smoking before the end of this program.

After this program, I want to have a more varied nutritional intake and an improved eating pattern.

I desire a more active lifestyle, both regarding sportive and lifestyle issues.

According to the book Improving Health, an important step after setting goals is to see what levels of certainty the client has (Michie, et al., 2008). A useful tool for this are two rulers. The first of these two rulers, the importance ruler, was to point out the importance of achieving the goal of smoking, nutritional enhancement and more physical activity. The second ruler indicates how much confidence Milan has on achieving that goal. The rulers are showed on the next page and present a different color per goal: red for smoking, blue for nutrition and black for physical activity.

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FIGURE 1: IMPORTANCE AND CONFIDENCE

It is clear that Milan Cobelens really wants to change. The least significant, still scoring a seven for importance, seems to be the nutritional behaviour. Both smoking and enhancing his physicality are the most important things in Milan’s eyes, with a ten on the ruler. When asked about the reason, Milan explained that his girlfriend really wants him to quit, which made him giving this a ten on the ruler. As for the physical activity, the high score was explained by the client as just being a really important step in his life. He finds his physical appearance discomforting and ‘with the summer coming, a nice appearance is of course important’.

The second ruler displays the trust Milan has in itself, when it comes to actually achieving something. It is good to see that all of his goals score really high. It shows that he is confident, which will surely help him in achieving what was planned. There is another side of the coin though, namely possibility of a mental setback when Milan notices that changing his behaviour isn’t quite that easy. To avoid this from becoming reality, he was asked why he made the choice and if he was both certain of his decisions and aware of the ‘risks’ that came with it. Fine-tuning this with the client is an important step in the assessment (Michie, et al., 2008).

A few other essential things were discussed as well, like the places Milan would use to help him change his behaviour, such as work or the discotheque, as well as the people that could help or hold back this change. Obviously, to be aware of this goes prior to use these places or people to your advantage or knowing how to cope with the consequences of the negative effects.

More information on how Milan Cobelens filled in the Personal Health Guide can be found in the chapter Appendices, Text 1.

Behaviour Change DiaryAnother important instrument is the Behaviour Change Diary, which can be used to make the client aware of the behaviour that he is currently showing. Although it is part of the individual’s lifestyle, the awareness of the behaviour can be too low. By increasing this awareness, it will become easier for the client to change the behaviour (Michie, et al., 2008).

The intake was used to give a clear explanation about how the diary needed to be filled in and on what points the client needed to spend some extra attention. After explaining this, it was made clear that in the second meeting the diary would be discussed and some of the good and bad points would be highlighted to increase the awareness of the client somewhat more.

The client asked if it was sufficient if he only made a diary for his nutritional behaviour. A diary for physical activity would, in his opinion, not be useful, seeing he doesn’t have any physical activity at all.

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The same accounts for smoking. Milan told me right away that he smokes about twelve cigarettes per day, with a higher amount during the weekends.

The complete Behaviour Change Diary for the nutritional intake of Milan Cobelens can be viewed in the Appendices, Text 2.

If-then plans Also part of the intake are the so-called If-then plans. These are plans, made by the individual himself, which will prepare the client for difficult situations. One of the goals of this trial, is that Milan Cobelens stops smoking. But stopping to smoke cigarettes with other smoking friends around will not be just as easy as stopping to smoke when the client is alone or with his girlfriend. And this is where if-then plans come in. Consisting of an ‘if’-part, where the client describes the difficult situation (e.g. If I’m around friends that smoke cigarettes) and a ‘then’-part, where the client describes the solution for that situation (e.g., then I will look up other friends that don’t smoke).

Michie et all gave an explanation in the book the Personal Health Guide, that these If-then plans would make it easier for an individual to prepare himself for difficult situations (Michie, et al., 2008). When prepared, it is much easier face the problem and solve it, then when the problem appears suddenly. That is the reason these If-then plans were implemented in the assessment of Milan Cobelens.

Focused on the three parts of his lifestyle (smoking, eating and moving), Milan made up a number of plans, which will help him in the situations that he thought harmful for the process of changing. These plans can be seen in the Appendices, Text 3.

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Second meetingDuring the intake Milan Cobelens gave the upcoming trial a clear frame, composed of the most important goals of the lifestyle change, plans on how to cope with difficult situations and other information on how other people or places could help him succeed. But what missed, was a clearly filled in Personal Health Guide and a full Behaviour Change Diary. This was the purpose of the second meeting.

Personal Health GuideMilan was supposed to bring the Personal Health Guide, filled in with all his personal barriers, facilitators, an action plan and a schedule on when to change his behaviour. He did bring the Personal Health Guide, and when I gave him a compliment for handing this in, he told me he was very motivated to keep this going. Besides this new and obviously good sign, there wasn’t anything particularly noticeable. The checking of the guide, together with the improved if-then plans, was really more a recap than something totally new. Only now the client added a motivated attitude. Another new thing was to look for people who can help Milan keep up his motivation. This is slightly different that the facilitators. These are people with whom Milan can talk to, when he reached an important goal or did something he can be proud of. His girlfriend is a good example of this, because she really wants him to stop smoking. So when Milan didn’t smoke for a certain time, he can tell his girlfriend and she can get him motivated by telling how proud she is of him.

Behaviour Change DiaryBesides this guide, another thing needed to be done by the client: the Behaviour Change Diary. Focused on raising the awareness of the behaviour the client is currently showing, a diary needed to be made. For Milan, that would be very important for the nutritional change, because then he would know when to spend his energy on certain points. For the coach, it was of course important to see what aspects in his nutritional behaviour needed change. This review would be done after this meeting.The filling in of his smoking behaviour wasn’t that important. Milan already started quitting smoking and skipped the cigarettes on weekdays. This meant that only in the weekends he would buy a pack of cigarettes, which came to about 10 cigarettes a day. This also is the reason that there won’t be paid attention to set objectives per meeting, because Milan is already in a far stadium of change.

RewardsDuring the second meeting, we discussed another important part of changing a certain behaviour: rewards. These rewards can be given in certain situation, for example when the client didn’t smoke for a consecutive two weeks. These rewards can help the client keep up their motivation and increase the chance that the wanted behaviour will follow again, and thus can be seen as a very effective way of changing behaviour (Nemeroff & Karoly, 1991). The exact rewards will be given at the time that the change occurs, without the client knowing what the reward will be exactly. This is something the coach and the client came up with, to keep the whole idea of the rewards a little bit more exciting.

Preparation for testing the clientAt the end of the second meeting, we discussed another point: the measurements that needed to be done. This would be the next and final part of assessing the client. But before that, between the second

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meeting and these tests, the Behaviour Change Diary needed to be assessed. This way, a clear view on the healthy and unhealthy aspects in Milan’s diary could be discovered.With all those points; the outcome of the tests, the outcome of the diary and the goals of Milan Cobelens, the final intervention program could be made. But first, have a look at the results of the assessment of Milan’s dietary intake.

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Physical testing of Milan CobelensAfter these first two meetings a lot of information on the client already surfaced. A good start for the assessment, but there were missing some things as well, for example the nutritional values of Milan’s diet. But to know whether his intake was too high, too low or maybe just perfect, a research on his personal characteristics was needed, or better, his physical characteristics. This is why a number of tests needed to be done, to make sure the right decisions would be taken while making the intervention program and to make sure it would be possible to measure the positive effects of the program by comparing initial results with the final results.

The intervention program was going to consist of three different things, namely smoking, physical activity and nutritional values. That’s why the tests needed to be adjusted on those three aspects, logically because the intervention program would only have effect on a limited number of physical aspects. Smoking, for example, has a negative correlation with VO2max1, causing it to decrease after a period of smoking (Ingemann-Hansen & Halkær-Kristensen, 1977). The fact that smoking causes VO2max to decrease is the reason why that can be used as a good comparison, because it seems logical that one of the positive effects of the cessation of smoking will cause an increase of the VO2max. Also his nutritional behaviour will be assessed. The same accounts for some physical strength tests, but they were postponed to a later date because of a lack of time. This has been done three weeks after these tests were conducted. The results of these strength tests are displayed later during this chapter.

Harvard Step TestOne of the ways to measure someone’s VO2max, is to do a Harvard Step test (Geijsel & Hlobil, 1996). With this test, the coach makes sure that the client will use aerobic endurance, which can be converted to the person’s VO2max via a reference table. The reference table is shown here:

When Milan Cobelens finished the Harvard Step test, his heart rate was, measured for fifteen seconds time, 39 beats. To convert this to heart beats per minute, it is multiplied by four, which gives the result of 156 beats per minute.As you can see in the table, you will need more than only the heart rate of the client. To calculate the VO2max, the body weight needs to be known. That has been done, along with some other important physical tests, in the next paragraphs. So with 90 kilograms2 body weight and a heart rate of 156 beats per minute, the client has a VO2max is about 3.7 liters per minute. This result can be used to compare with the results of the same test after the cessation of smoking.

1 VO2 max is the maximal oxygen uptake or the maximum volume of oxygen that can be utilized in one minute during maximal or exhaustive exercise (Quinn, 2007).2 As can be seen on the next page, Milan’s weight is set on 90 kilograms.

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FIGURE 2 VO2MAX IN MEN (GEIJSEL& HLOBIL, 1996)

Body weight, height & BMI3

Milan’s body weight is important for two things: firstly for getting the results of the Harvard Step test and secondly to have a comparison for measuring the effects of the nutritional intervention on his body weight.

Using a normal weighing scale, Milan’s body weight was 91.5 kilograms, including clothes. When subtracting about 1.5 kilograms for the clothes (jeans, shirt, socks), the estimated weight of the client can be set at 90 kilograms.

With the help of a length indicator, Milan’s height could be measured. Standing in normal position, with his feet positioned against the meter and the meter put against the wall, the result was 1.895 meters.

To indicate the unhealthy effects and for having an easily measureable unit for later comparison, the weight and height of the client are converted into the queteletindex. The equation for this is weight / height in meters2. When doing this with Milan Cobelens’ results (90 / (1.8952)), his BMI comes to 25.06. When looking at the next chart, it becomes clear that the client is slightly overweight.

FIGURE 3 BMI CALCULATION (UK METRIC ASSOCIATION, SD)

SkinfoldSo the BMI here is just used as a general measure of Milan’s weight. But a general measure would not be specific enough when used in an intervention. This requires a more detailed way of calculating Milan’s body fat. The seven point skinfold method is a very handy tool here. The reason why the choice fell on the seven point method, is because this one leaves the least errors in the calculations. This clearly optimizes the effect of the measuring.

The seven point skinfold method consists of seven different points, all to be measured by a caliper, which then indicates how many millimeters of fat each point on the client’s body counts. The seven

3 Body Mass Index (BMI) is a relationship between weight and height that is associated with body fat and health risk.The equation is BMI = body weight in kilograms/height in meters squared.

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points and the calculations for Milan Cobelens, seen in the following table, are made with the help of ‘Personal Health: perspectives and lifestyles’ (Floyd, Mimms, & Yelding, 2008):

TABLE 1 SEVEN POINT SKINFOLD OF MILAN COBELENS

Score in millimeters Category

Chest 13 Good

Abdominal 29 Fair

Thigh 20 Average

Tricep 17 Average

Subscapular 14 Average

Midaxillary 13 Good

Suprailiac 33 Poor

Looking at this table, we can see that the client definitely isn’t on the safe side. Overall, he is a little bit less than average, having scored some ‘goods’ and a few ‘poors’. With the ratings of the skinfold, it is possible to calculate Milan’s body density with the next equation (Jackson & Pollock, 1978):

Body Density = 1.112 - (0.00043499 x sum of skinfolds) + (0.00000055 x square of the sum of skinfold sites) - (0.00028826 x age)

Thus, when entering Milan’s results in the equation:

Body Density = 1.112 - (0.00043499 x 139) + (0.00000055 x 19321) - (0.00028826 x 22) = 1.05582122

So Milan Cobelens has a body density of 1.055. Using that number of body density, the Siri equation is used to eventually calculate the real percentage of body fat that the client has:

% Body Fat = (495 / 1.05582122) – 450 = 18.83

So now it is known that Milan Cobelens has a body fat percentage of 18.83. This means that the client is above the usual boundary of 10 to 17 percent body fat for 20 to 24 year old men (Obesitas vereniging, 2012). Multiplying the body fat percentage with his total body weight, the fat free mass is calculable: 90 – (90 kilograms x 0.1883) = 73.5 kilograms of fat free mass.

Furthermore, it is easily detectible that Milan Cobelens has an apple figure. The fat percentages from the upper half of his body seem to be fine. Both chest and midaxillary have good ratings for example. But when working the way down to look at his abdomen and surroundings, the amount of fat seems to increase. And abdominal fat is known to bring more problems with it than the ‘more preferable’ type of fat, namely hip fat (Mercola, 2012). This fact, besides the fact that Milan is certainly overweight, is a good reason to start the training program. It also gives a proper referring moment for comparing at various stages during the training.

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Blood pressure & heart rateBeside the body fat measuring, there was a safety control over Milan’s body to check if he would be capable of doing – vigorous – exercises. To do this, his blood pressure was measured. Values which don’t indicate high blood pressure should be the under 140 mmHg systolic and under 90 mmHg diastolic (Rubin, 2007). In order to have safe, unconditioned training (assuming the client is injury free), the readings should be under this. Luckily, the client has a systolic blood pressure of 136 and a diastolic blood pressure of 75. Although he is not well under it, there is no doubt that Milan Cobelens has the opportunity of training without problems. Contributing to this fact is that he has no record of injuries.

Also, the coach and client took a look at the maximum heart rate, or HRmax. The heart rate is calculable with the next equation: MHR = 217- (0.85 x age) (Nes, Janszky, Wisloff, Stoylen, & Karlsen, 2012). Entering Milan’s age of 22 in the figure, the following comes out:

MHR = 217- (0.85 x 21) = 191.15 = 191. So Milan has a maximum heart rate of 191.

StrengthAlthough there was a difference of three weeks between the testing of the client’s strength and the testing of the other characteristics, these tests should give a view on what Milan Cobelens is capable of. This is going to be important when making a resistance training schedule for the client. The tests are mainly focused on the strength Milan Cobelens has, not particularly on this flexibility or agility for example.

The first test done is the hand grip strength test (Webb, Newman, Taylor, & Keogh, 1989). Since Milan would be working with dumbbells, the strength in his forearms and hands would be of certain significance. These were the results:

TABLE 2 FOREARM AND HAND STRENGTH TEST OF MILAN COBELENS

First try Second try

Hand Right hand Left hand Right hand Left hand

Score 38.8 37.4 40.3 39.1

Rating Average Average Average Average

Milan’s forearm and hand strength are all average (Webb, Newman, Taylor, & Keogh, 1989). This will be used as a reference when analyzing the results from the training.

Another conducted test is the 1RM rest. 1RM stands for one repetition maximum, describing the maximum amount of kilograms one can cope with during a certain exercise. This test will be done for a few different exercises, to see what starting situation Milan Cobelens has. Every 1RM is calculated by using the following equation: Weight × (1 + (0.033 × Number of repetitions)) = 1RM (Baechle, Earle, & Wathen, 2000). It is because Milan wants his upper body trained that the 1RM tests are focused on his

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chest, back and arms.

TABLE 3 1RM TESTS OF MILAN COBELENS

Bicep curl Dumbbell press Bench press Tricep kickback

Kilograms 12 12 45 10

Repetitions 9 13 8 8

Baechle 1RM

16 kilograms 18 kilograms 57 kilograms 13 kilograms

This should give a good reference on where Milan can begin his resistance training. The schedule that will be made is given in the chapter Resistance training.

A last measurement was done, namely the Push up test. This test is to see what the level of physical condition is in a person, especially in the upper region of one’s body. This is a supplement to the tests done earlier. Milan reached 22 consecutive push-ups, giving him an average rating (Golding & Myers, 1989).

After all these tests, it becomes clear that Milan’s stature and physical condition is not the worst, but certainly deserves some attention. Almost every aspect turned out to be a nice average, giving him enough confidence to actually train up to a better result.

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Dietary intake of Milan CobelensAfter the first meeting, the client got the instructions on how to fill in the Behaviour Change Diary. There were two purposes of this diary. The first one was to increase the awareness of the client on his behaviour. This would have a positive effect on the chance that the wanted behaviour change would actually occur (Michie, et al., 2008). The second reason of this diary, was of course for the coach: what is the nutritional value of the client’s diet? What positive and negative aspects can be found? The answers on these raised questions contain the information on how the intervention program can be filled in.

So, at the second meeting, Milan Cobelens took a filled in diary with him, which was discussed for a short time. After the second meeting, the coach would take the time to sift every detail from the diary. As already stated, the Behaviour Change Diary can be found as an appendix, Text 2.

When scrolling through the Diary, it became clear that working on three items at a time (namely smoking, improving nutritional intake and enhancing physical activity) would be too much. A small third meeting was organized, where this problem would be discussed with Milan. He agreed on the fact that putting 100 percent focus on just one of his ‘problems’ would be far more efficient than dividing that 100 percent over three subjects. He was asked to give the most important item a think-over and make his decision before the next meeting. That was not necessary, since Milan immediately name physical activity as his most important bottleneck lifestyle determinant. His reason for this was that, first of all, smoking would be the simplest, as he did not want to lose his girlfriend over this. And second, he would be searching for an apartment together with his girlfriend during the coming summer, and he was sure that his nutritional intake would change for the better.

Obviously, the effect of the diary wasn’t anymore to know what Milan could change, but more to get a general view of how he lived. He was very happy to get the diary with him, for now he could see for himself what he eats during a whole week. That would make it easier for his to be a little healthier than before.

Together with this shift of intervention, the goals of the project needed change as well. The main objective did not need any change, because it was rather broad to begin with4. The specific goals did need some change. Simply erasing the two otiose specific objectives would leave the most important one, that of physical activity5.

It should be clear that these two objectives were only set to make a clear deadline for clear wishes. The most specific goals are the ones that are made from week to week, or with an interval of two weeks, during the intervention program. Because the intervention program is unknown at this point, nothing can be said about this. Of course, it will be discussed in the next chapter. That is the chapter of creating the intervention.

4 Before the end of this program, I want my physical and conditional status to be better.

5 I desire a more active lifestyle, both regarding sportive and lifestyle issues.18

CREATING THE INTERVENTIONPreparationBefore the intervention can get a serious layout, research needs to be done. And before the research can be done, certain things have to be worked out. To start with, the intervention obviously has its focus on getting Milan Cobelens’ overall physical condition higher than it is now, by having a dedicated training schedule. In making this, the sequence of the intervention is of great importance. Since Milan has quite a high body fat percentage, like seen in the last chapter, it will be wise to not only include strength training, but cardio as well.

After having had a conversation about this with the client, he concluded that he would not want to have more training than cardio and strength training. He came up with the idea to set his own goals concerning the training:

Cardio Strength Body composition

I want to be able to run a consecutive ten kilometers after

this training program.

I want to feel distinctly stronger by the end of the training

program and be able to lift thirty percent more weight.

I want to have a maximum of sixteen percent body fat by the

end of the intervention.

When asked to give a reason for the relatively high aspiration on the cardio / running aspect in comparison to the other two, Milan had a clear answer. He doesn’t dislike jogging, but doesn’t necessarily like going to the gym. So he wants to put his focus on the cardio part, with something like a supplementary training program to increase his overall strength. The combination of those two will most likely cause him to lose more weight, like the coach explained to the client. Nevertheless, he chose for a somewhat lower decrease of body fat and that too has a reason. He didn’t want to end up demotivated again after a failure on trying to change, like the several times he tried to stop smoking. Besides that, his attention is already pretty divided between a few factors that he wants to change, so this appeared the best option to Milan Cobelens. Yet another reason for choosing 16 percent body fat is that that is the right amount of body fat for a person with healthy weight and body composition. The coach agreed on having these three main goals during the training.

Cardiovascular trainingCardiovascular exercise is the best training method when aiming to lose fat (Ballor & Keesey, 1991). It is wise to find out what frequency of exercise is needed in order to get significant decrements in weight loss. Especially because Milan would like to combine both cardiovascular training with resistance training, a well-balanced intervention is needed. Since Milan has a clear goal concerning this subject, namely being able to run or jog more than ten kilometers by the end of the fourteen week training6 period, it would be wise to create a training schedule specified for that. With a gradual increase in intensity, Milan can certainly work his way towards this goal. The weight loss will probably come naturally with that. There are two reasons for that. The first being that, after more than 150 minutes of 6 The originally planned amount of time was eighteen weeks, but due to multi-reasoned delay of every facet, the project lost time.

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moderate intensity training7 per week, there is a shift from maintaining one’s health and physical condition to increasing it (Haskell, et al., 2007). It might not be like that in the first few weeks, but after that, Milan will certainly need to move more than that. But that has something to do with the second reason: Milan Cobelens’ body is not used to working out. This probably caused the amount of fat he has on him, but it will also cause that his body will start losing fat without passing the line of 150 minutes of mildly intensive movement.

Now it is clear what Milan wants and at what intensity he can begin doing this, it is time to make a schedule. Important in this is that there is a gradual increment in the intensity, for Milan’s body is going to want to adjust to this. This is the schedule that Milan Cobelens will be following for the next fourteen weeks:

TABLE 4 RUNNING SCHEME MILAN COBELENS WEEK 1 - 14

Week# Monday Tuesday Wednesday Thursday Friday Saturday Sunday

1 Free 2.5 km Free 2.5 km Free 2.5 km Free

2 Free 3 km Free 3 km Free 3 km Free

3 Free 3.5 km Free 3 km 3.5 km 3.5 km Free

4 Free 3.5 km Free 3.5 km Free 4 km Free

5 Free 4 km Free 4 km 4 km 4.5 km Free

6 Free 5 km Free 4.5 km Free 5.5 km Free

7 Free 4.5 km Free 5 km 5 km 6 km Free

8 Free 5.5 km Free 6 km Free 6.5 km Free

9 Free 6 km Free 6.5 km 7 km 7.5 km Free

10 Free 7 km Free 7.5 km Free 8 km Free

11 Free 8 km Free 8.5 km 8 km 8.5 km Free

12 Free 9 km Free 8.5 km Free 9.5 km Free



During every training, Milan Cobelens is instructed to do a five to ten minute warming up, by simply walking on a slightly higher pace than normal. This will prevent injuries due to a too low temperature of his muscles (Fox, Bowers, & Foss, 2004). A cooling down is important to include in every training as well (Australian Sports Commission, sd). The cooling down consists of static stretching exercises,

7 Moderate intensity training notably increases the heart rate, while the person is still able to have a normal conversation (Haskell, et al., 2007).

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which Milan Cobelens will be taught during the first week. The absence of static stretching during the warming up is because that will cause the muscles to have less possible power, caused by the dilatation of blood vessels, among others. (Young & Behm, 2002).

It is because three to five days per week for endurance training is ideal, that this training schedule consists of either three or four work out days per week (Fox, Bowers, & Foss, 2004). Five days is in this case too much, since also strength training will be included in the same stages of the schedule and Milan does not want to perform for training purposes every day of the week.

So during the first week, Milan will start running two and a half kilometers only. This is because Milan is not really used to running and by giving him a short distance, he can get accustomed by the movement and the intensity. During the whole first week, the coach will guide Milan through the jogging session.

The client will also be carrying a heart rate monitor in order to check his heart rate. Important here is that Milan’s heart rate is quite a high one, somewhere between 80% and 85% HRmax. The opinions about this vary greatly, with some saying that there is an optimal fat burning zone in which the most fat calories are burned in relation to the amount of total calories. But many others say a far more logical thing: when a person burns a higher total of calories, as one would do when having a higher heart rate, the amount of fat calories will increase as well, even while the percentage of fat calories decreases. This becomes clearer when looking at the table presented here. It also has to do with the so-called afterburn effect8, which is not present in work outs with lower heart rates (Perry, 2013).

TABLE 5 TOTAL CALORIES AND FAT CALORIES EXPENDITURE IN LOW AND HIGH INTENSITY TRAINING (WAEHNER, 2014)

Low Intensity - 60-65% MHRHigh Intensity - 80-85% MHR

Total Calories expended per min. 4.86

6.86

Fat Calories expended per min. 2.43

2.7

Total Calories expended in 30 min. 146

206

Total Fat calories expended in 30 min. 73

82

Percentage of fat calories burned 50% 39.85%

8 Also called Excess Post-exercise Oxygen Consumption, this is metabolic disturbance burns calories for as long as 24 hours after a workout (Perry, 2013).

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Resistance trainingNot only is the reason of including resistance training in the intervention to let Milan Cobelens reach his goal of feeling and being stronger by the end of the period, it is also very important to do this when performing cardiovascular training. When strength training is not included in an intervention focused on losing fat, each amount of weight loss will include 25 percent weight loss coming from atrophy of muscles (Beck, sd). That is certainly not what Milan Cobelens wants. Yet another reason to include this in the intervention is the following: when increasing the lean body mass of a person, it is understandable that the body needs more calories, and thus wants to burn a bigger amount fat. The total amount of calories burnt per kilogram fat free mass per day varies between 19.7 and 24.5 kcals (Wang, et al., 200). This will help Milan to achieve his goals even faster.

The client wants the training schedule to be focused on gym exercises, so that is why there needed to be a second assessment of his strength capabilities, which can be viewed in chapter Strength. The following schedule has been made. Of course, everything can still change if Milan Cobelens wants to be it otherwise. He already concluded that he would not want to train his legs even more in the gym, since he will tire them too much. That wish has been processed in the program. Because Milan also preferred not to have a fixed day, the coach chose to give him the opportunity to choose this by himself. Since this can lead to quicker skipping of the training, close attention will be paid to this.

TABLE 6 TRAINING SCHEDULE PERIOD ONE DAY ONE

Period 1 – Day of training # 1

Series Repetitions Percentage of 1RM

Activation pattern9

Lat pulldown 3 - 5 10 - 20 50 – 80% 2-1-2-1

Dumbell row 3 - 5 10 - 20 50 – 80% 2-1-2-1

Upright barbell row 3 - 5 10 - 20 50 – 80% 2-1-2-1

Dumbell front raise 3 - 5 10 - 20 50 – 80% 2-1-2-1

Concentration curl 3 - 5 10 - 20 50 – 80% 2-1-2-1

Close grip pulldown 3 - 5 10 - 20 50 – 80% 2-1-2-1

9 The activation pattern describes the movement of the joints and muscles and at what speed that has to be done. The four numbers respectively stand for eccentric movement, rest, concentric movement and rest.

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TABLE 7 TRAINING SCHEDULE PERIOD ONE DAY TWO



Activation pattern

Bench press 3 - 5 10 - 20 50 – 80% 2-1-2-1

Peck deck 3 - 5 10 - 20 50 – 80% 2-1-2-1

Tricep kickback 3 - 5 10 - 20 50 – 80% 2-1-2-1

Reverse wrist curl 3 - 5 10 - 20 50 – 80% 2-1-2-1

TABLE 8 TRAINING SCHEDULE PERIOD TWO DAY ONE

Period 2 – Day of week # 1


Activation pattern

Lat pulldown 3 - 5 1 - 10 75 – 100% 4-1-1-1

Dumbell row 3 - 5 1 - 10 75 – 100% 4-1-1-1

Upright barbell row 3 - 5 1 - 10 75 – 100% 4-1-1-1

Dumbell front raise 3 - 5 1 - 10 75 – 100% 4-1-1-1

Concentration curl 3 - 5 1 - 10 75 – 100% 4-1-1-1

Close grip pulldown 3 - 5 1 - 10 75 – 100% 4-1-1-1

TABLE 9 TRAINING SCHEDULE PERIOD TWO DAY TWO



Activation pattern

Bench press 3 - 5 1 - 10 75 – 100% 4-1-1-1

Peck deck 3 - 5 1 - 10 75 – 100% 4-1-1-1

Tricep kickback 3 - 5 1 - 10 75 – 100% 4-1-1-1


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As seeable above, the training program is divided in two separate periods. The first period is where Milan Cobelens is going to get familiar with training and has the primary goal to let his muscles grow. This hypertrophy is achieved by a combination of many repetitions (between 10 and 20) and a lower amount of weight (about 50% - 80% of his 1RM) (Vrijens, 1995). This goes together with a regular concentric counting pattern, which has a bigger effect on hypertrophy (Fox, Bowers, & Foss, 2004). After seven weeks the second part of the training will start. This will be focused on getting a greater intramuscular coordination, where the focus will be on less repetitions (between 1 and 10), together with a bigger amount of weight (about 75% to 100% of his 1RM) (Vrijens, 1995). There also has been chosen to focus on the eccentric side of training. This eccentric has a more defining effect on the muscles, as the inner motor units are affected (Fox, Bowers, & Foss, 2004).

The first two weeks of training take place in the gym, under supervision of the coach. These workouts will be dedicated to teach Milan how to lift the weights, how to count the right pattern, how many seconds of resting he needs between the exercises and so on.

An important addition to this resistance program is to create clear goals, where Milan can draw his motivation from. Also this will be a good guideline during the training to monitor the progress the client makes. The goals will apply to every other week. That makes a total of seven objectives, conceived by the coach and the client together:

Week 2 Week 4 Week 6

I know how to properly lift the weight during each exercise.

I want to have increased the weight at each exercise with a

minimum of five percent.

I want to have increased the weight at each exercise with a

minimum of ten percent.

Week 8 Week 10 Week 12 Week 14

I want to have increased the weight at each

exercise with a minimum of fifteen percent.

I want to have increased the weight at each exercise with a minimum of twenty

percent.

I want to have increased the weight at

each exercise with a minimum of twenty-five

percent.

I want to have increased the weight at each

exercise with a minimum of thirty percent.

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EVALUATION Creating an evaluation planNow the final intervention program is known, it is of obvious significance that an evaluation program needs to be made. Evaluating needs to be done in order to check if the goals that were set at the beginning, will be reached or not. Also the expectations of the client are important, so looking at them with an evaluation program is also central. The eventual goal of the evaluation is to learn from these experiences and apply them to future cases.

The evaluation plan consists of two facets: process and product, or impact, evaluation. These are the planned evaluation programs.

Process evaluation plan The core of the process evaluation is to see if the way of working towards achieving the goals has had its desired route or not. The most personal and probably the most effective way to assess this, is to have conversations with the client. These coaching interviews are made to ask Milan Cobelens for his opinion on how the program was established and worked out. For every individual has different needs and wishes, it is important in an intervention like this to always ask the client for an opinion. This is why the evaluation is very qualitative.

So after the assessment conversation in which Milan’s goals etc. were clarified, the intervention was made up and the first training had begun, the evaluation plan could start. To start with, every week, after the second resistance training, there was a small evaluating conversation between coach and client. This was made to see if Milan liked the exercises and if he was able to keep up with it. The first two weeks, this was right after the training. After that, the evaluation interviews were done in another environment.

Besides these ‘simple’ evaluations that were done every week, a deeper interview was also advisable: a mid-term evaluation. This would go into detail concerning the working ways within the intervention program, the effects it had on Milan’s life until now, what Milan thought of everything and so on. This is planned in the week of June 9th 2014.

Product evaluation planBesides the process evaluation, the product evaluation is just as important. This is less about the opinion of Milan on the intervention program, but more based on the effects it brings with it for Milan’s daily life and especially his physical condition. To have a reference point on this, physical tests were done at the beginning of the period. These same tests need to be done during the intervention and after the intervention. Together with Milan, the coach decided to do this once when the midway point of the program was reach, and once when the program was done. Thus the first assessment is planned in the week of April 21th. The last evaluation will be done at the end of the training, in the week of June 9th.

Also, every other week the small-term resistance training goals will be tested. These goals, focused on the weight Milan can lift at each exercise, will be done together with the coach. The assessment is done by watching Milan lift the amount of weight at each exercise, increased with the wanted amount of kilograms and executed in the right manner.

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Evaluation of the clientThis is the part where the effects of the intervention program will be assessed. The assessment includes both a process evaluation and a product evaluation, like explained on the last page.

Process evaluationLike stated before, there will be a number of evaluations, namely the short term evaluations every two weeks, a mid-term evaluation and a final evaluation. This report will describe four different interviews with the client, of which one has already been handled: the intake interview. The other three will be filled in by one short term evaluation, the mid-term evaluation and the final evaluation. Unfortunately, due to a lack of recording, only a resume is provided. In the chapter Appendices, a form has been signed by Milan Cobelens, stating that he acknowledges that the information is based on his true opinions.

The most pertinent of the short term evaluations was the first one. This was after the two weeks in which the coach introduced Milan Cobelens to the proper lifting of weights in a gym. This was the result of that first evaluation, held on Sunday March 30th:The client was overall pretty excited about the fact that he started the training program and he was really motivated to go on with this. The muscle ache during the days after the training was unexpectedly heavy for Milan, but he actually liked it, because he felt that he had been training vigorously. The training program suited him really good and he graded that with an 8. Also, he gave himself a really good grade, namely a 9. This was mainly because he did not expect himself to be so motivated. Also the running went really well, together with the resistance training, so he did a really good job in his own eyes. The coach shared that opinion. The coach got a nice rating as well, because of the involvement during these weeks and the detailed instructions. The only less positive thing was that Milan found the training a little bit too long. The coach explained that was partially due to all the explanation that had to be done. If it would prove to be a problem in the future, the training program needed to be changed.

Five short term evaluations would follow, the fourth replaced by the mid-term evaluation. This is the second evaluation that will be described here. Milan had finished the first period of resistance training (muscle growth and adaption to training) rather successfully. That was the first question: how do you think you did? Milan continued to work like the first two weeks, barely losing his motivation to train. This was the reason that he still gave himself an 8, mainly because he did not miss any training at all. That is why he found that he finished the training successfully. Because Milan liked the instructions and individual guidance of the coach, he asked if this could be continued during the next few weeks, originally planned to be done without the coach. The coach obliged to this and continued the personal guidance during the training. But after the fourth week, Milan was used to the exercises and the coach was only there to train together with the client. This went on until this mid-term evaluation and Milan was very happy with that. That is why the coach was graded with an 8 as well. The last evaluation marked a difficulty in the training, namely that the client found the training to be a bit long. This went on during the third week, where the explanation was still going on at some points. But, like said, after this training, during the fourth week, Milan Cobelens totally controlled the exercises. This resulted in less time-consuming gym sessions. Milan of course combined all the trainings with jogging, three to four times per week. That proved to be a little bit too much for him in week three and he cut that down to a steady three times per week. In consultation with the coach, Milan found this the best option, while he was sure that the goal was still achievable. That was about it for the relationship between the coach, client and the training principles. He was very happy and luckily still motivated.

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The most surprising thing though, is that the goal that Milan set for himself for the resistance training, already was achieved by the time the mid-term evaluation needed to be done (this can be seen during the next chapter). The coach advised to change the ultimate goal to a higher standard, but Milan Cobelens did not considered that necessary. He already achieved his goal and was very content with that. Now he wanted to focus on training itself, instead of on achieving another objective.He was also asked about the content of the training itself. For seven weeks, he was doing the same two trainings every week. Firstly, he liked the exercises, especially because they were rather basic and good to start with. But he asked the coach to improve the schedule a little bit by replacing some of the exercises by others. It proved to be an exactly good period, because after these seven weeks, Milan’s resistance training would change to intra-muscular focus. The improved training schedule is shown below10. Note that the activation pattern, sets and repetitions will stay the same.

TABLE 10 ADAPTED TRAINING SCHEDULE FOR PERIOD TWO DAY ONE

Period 2 – Day of week # 1


Activation pattern

Pull ups 3 - 5 1 - 10 75 – 100% 4-1-1-1

Cable seated row 3 - 5 1 - 10 75 – 100% 4-1-1-1

Dumbbell shrugs 3 - 5 1 - 10 75 – 100% 4-1-1-1

Barbell front raise 3 - 5 1 - 10 75 – 100% 4-1-1-1

Barbell 3 - 5 1 - 10 75 – 100% 4-1-1-1

TABLE 11 ADAPTED TRAINING SCHEDULE FOR PERIOD TWO DAY TWO



Activation pattern

Bench press 3 - 5 1 - 10 75 – 100% 4-1-1-1

Cable incline fly 3 - 5 1 - 10 75 – 100% 4-1-1-1

Barbell lying triceps press

3 - 5 1 - 10 75 – 100% 4-1-1-1


Because the exercises changed, the short term goals also needed to be adjusted. Because Milan already achieved a lot more than he expected, the goals were upgraded to a higher standard as well.

10 Difficult here is that the 1RM of his exercises changed. This was solved by dedicating the first week to indicate the amount of weight Milan needed with every exercise. The product evaluation obviously stays the same, by calculating Milan’s 1RM for the same exercises as before.

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They were focused on the original exercises and since they disappeared, the last four short term goals stated:

Week 8 Week 10 Week 12 Week 14

I want to know every exercise and how many kilograms I lift at each

exercise.

I want to have increased the weight at the new exercises with a minimum of

ten percent.

I want to have increased the weight at the new exercises with a minimum of fifteen

percent.

I want to have increased the weight at the new

exercises with a minimum of twenty

percent.

The final evaluation was a little bit too short, because of the time pressure of both coach and client. The progress was briefly discussed, concluding that Milan Cobelens was very happy with everything. The fact that he got a free individual consultation program excited him, he was surprisingly motivated for the whole period and he was surprised by how he liked physical activity (since he never did much sports and movement in general). There were no critical comments to be thought of regarding the coaching quality. He was happy with the fact that the coach was also a friend.The second period of the training really excited the client as well. As said before, he was motivated during the whole period. The change in exercises between the two periods helped him in this, because he was ready for it. The trainings continued to include both the coach and the client and Milan was positive about that as well.

Product evaluationIn this part, the objectives of Milan Cobelens will be assessed. The first to be handled is the cardio training. Totally independent of the coach, the client went for three jogs every week, to achieve his goal of ‘being able to run a consecutive ten kilometers’. The first week, Milan ran at a pace of 6.8 minutes per kilometer, taking him around seventeen minutes to complete 2.5 kilometers. After struggling with the fourth day and continuing with just three days per week of jogging, Milan was able to run ten kilometers in week thirteen, on the first day. It took him exactly 62 minutes and twenty-three seconds to complete this. Like the client told the coach after this, he is not the fastest runner, but he was really content with the result. In the close to two weeks after he achieved his goal, he ended up running more than eleven kilometers. That was an important performance for his self-esteem.

The resistance training also had very positive results. The first weeks went really fast. Especially because Milan did not know how to lift the weights properly in the first week, this week’s kilograms were not too much. Because of that, during the weeks after this, the weights increased a lot. All the weights of the exercises during the first and second training, increased accordingly to Milan’s hopeful expectations. He wanted a five percent increase after the first week, this turned out to be even more than ten percent. The lateral pull-down for example, with which he started at thirty kilograms, was at 35 kilograms at the fourth week and at forty kilograms in week seven! That already is an increase of thirty percent, the amount of extra weight he wanted to be able to lift after fourteen weeks. Although the coach advised Milan Cobelens to adjust his goals, he did not want this. This was because he wanted to put his full focus on the training itself. Since he was already really motivated to keep going, the coach conceded this wish.

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Another example of the big increase in Milan’s strength is the concentration curl. He started with nine kilograms, completing the sets and repetitions the coach gave him. During week four, he was able to lift eleven kilograms (an increase of 18,2 percent) and twelve kilograms at the seven week midway point (33.3 percent increase). The repetitions and sets increased besides the weight. His bench press increased accordingly as well. He started with 35 kilograms, but after four weeks he increased this with 17.1 percent to 41 kilograms and after seven weeks with 28.6 percent to 45 kilograms. The least increased of them all, but still enough to have achieved his goals. Was the tricep kickback. He started with seven kilograms, went to eight during the fourth week and kept it that way until the seventh week. This was an increase of 14.4 percent.

The same showed for the second period. Milan increased his surprisingly well and adapted to the new exercises quickly. Due to the fact that Milan already achieved pretty much all of his resistance training goals during the first period and he wanted to put less focus on the objectives, these results will not be described here. What will be described here is the result it had on the original strength tests. These tests were done together with the final evaluation (also the reason the verbal evaluation did not get the time it deserved) and gave the following results:

In his forearm and strength test, Milan Cobelens originally scored 38.8 and 40.3 for his right arm and 37.4 and 39.1 for his left arm. The final evaluation showed that his right arm did 44.2 at the first try and 45 at the second try. The left arm, which again was stuck a little bit behind the right arm, also improved: 42.5 and 43.4.

The following table shows the increase in 1RM of Milan Cobelens:

TABLE 12 INCREASE IN 1RM OF MILAN COBELENS

Bicep curl Dumbbell press Bench press Tricep kickback

Kilograms 12 20 12 22 45 70 10 14

Repetitions 9 6 13 7 8 6 8 9

Baechle 1RM in kilograms

16 23 18 26 57 81 13 18

Increase in % 43.75 44.44 42.1 38.4

So the increment in strength lies far above forty percent for the first three 1RM’s and a little below forty for the tricep kickback (which was expected due to the slower increment of it during the trainings). Looking back at the original objective of the client’s resistance training, namely that he desired an increase in strength of thirty percent, it is to be concluded that Milan Cobelens has reached his desired strength. In fact, already during the first seven weeks, Milan reached a thirty percent increase in lifted weight in most of his exercises.

Looking at these facts, it might be reasonable to say that the resistance training program has been successful.

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Besides the success of both the cardio part and strength part, the intervention needs evaluation on another point. That of Milan Cobelens’ weight loss. The utmost reason to start this assessment and intervention for Milan was that he needed to lose some weight. A few measurements were done in the beginning, which will be compared with the client’s new measurements.

His BMI was calculated with a height of 1.895 meters and a body weight of 90 kilograms (91.5 minus clothing). The same weight measurement has been done, including Milan’s clothes, which gave the amount of 87.5 kilograms. Subtracting the same 1.5 kilograms from that weight, Milan’s actual weight was set at 86 kilograms. With that number, his BMI is the following: (86 / (1.8952)) = 23.94. Comparing that with his original BMI of 25.06, this is a decrease of 4.43 percent. Putting the new number into the BMI score list, Milan now is just under the line of being slightly overweight. This weight is considered healthy for a man of his age and length, so this is a good start.

The second measurement that has been done is more significant. Since Milan has done a lot of weight lifting, his muscles should have grown in the last fourteen weeks as well. This means that Milan’s body weight, besides decreasing from the fat loss, has been increasing due to a bigger muscle mass. That is why the BMI calculations can be considered distorted. This second measurement was the skinfold, which has been done again after the fourteen week training period. The following table gives the results, before and after the intervention.

TABLE 13 COMPARISON OF MILAN COBELENS’ SKINFOLD MEASUREMENTS

Score in millimetersBefore training

Score in millimetersAfter training

Chest 13 7

Abdominal 29 20

Thigh 20 11

Tricep 17 9

Subscapular 14 8

Midaxillary 13 9

Suprailiac 33 18

In this case, the loss of body fat is clearly present. Especially the suprailiac point has decreased almost half. This is easily noticeable when looking at Milan’s belly. When transforming these numbers into the same equations used in the primary assessment, a comparison can be made between the first and last measurements.

Body Density = 1.112 - (0.00043499 x sum of skinfolds) + (0.00000055 x square of the sum of skinfold sites) - (0.00028826 x age)

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Thus, when entering Milan’s results in the equation:

Body Density = 1.112 - (0.00043499 x 82) + (0.00000055 x 6724) - (0.00028826 x 22) = 1.074

So Milan Cobelens has a body density of 10.74 instead of 1.055. Using that number of body density, the Siri equation is used to eventually calculate the real percentage of body fat that the client has:

% Body Fat = (495 / 1.073697) – 450 = 11.02.

This is Milan Cobelens’ new and rather astounding body fat percentage. Instead of the original 18.83 percent, he now has only 11.02 percent, which is a remarkable and healthy amount of fat. He went from an average body weight to pretty much an athlete’s body weight, with which he is really content.

The next interesting thing is comparing the actual amount of kilograms of both his fat free mass and his fat. His weight is now 86 kilograms with a percentage body fat of 11.02, which gives a total amount of 9.47 kilograms of fat. In comparison to the first 16.95 kilograms, he lost a total of almost 7.5 kilograms of body fat. This loss is about 56 percent of his original body fat in fourteen weeks.

His fat free mass must be his body weight minus his body fat, thus 86 – 9.5 kilograms is 76.5 kilograms of fat free mass. In comparison to his original 73.05 kilograms, this also has increased some. Due to the resistance and cardio training, his muscles gained about 3.5 kilograms, or 4.7 percent in mass. This also explains the rather small decrease in BMI, while Milan Cobelens has lost a lot of body fat.

Based on these evaluations, it can be concluded that it has worked as desired. Though beforehand, no difference was acknowledged between the first period’s exercises and the second period’s exercises. Not only did Milan Cobelens state that he wanted changed in this, but also the literature advises the same: create a change in the routine of the exercises to avoid adaptation of the muscles to these exercises (Vrijens, 1995). A thought should have been spend on this as well. Another thing is that Milan Cobelens was kind of exhausted after these fourteen weeks, because of the intensity of the program. Of course, Milan wanted to start off by both doing cardio and resistance workouts. But the last weeks, Milan’s results in the gym were less increasing than the first weeks. Obviously, due to the quick adaptation of the muscles to resistance training, the first weeks always come with a big increment of strength and therefore later increments may come slower (Fox, Bowers, &Foss, 2004). Still, Milan’s motivation suffered a little bit because of the last week’s decrease in improvement. This also could have been spread over more time. This has been a result of the fact that the intervention period actually lasted about four or five weeks shorter than originally planned. In the future, the resistance training and cardio training might have been separated or done at a lower intensity, to ensure that the client could continue with the intervention in good condition.That problem of planning can also be seen as a future improvement. The assessment started off quick enough, but the next follow-ups needed too much time. This decreased the effect of the intervention period and especially made the intensity higher, because eventual results were still desired.

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CONCLUSION AND CONTINUATION

Overall, the conclusion might be that this was a successful period. The intervention focused on just the right things, namely cardio, strength and body fat loss. This gave Milan the opportunity to get in touch with sports and get a more positive picture of himself and of course a better self-esteem. A side-effect of the training actually turned out to be that Milan Cobelens has stopped smoking since the eleventh week of the program. Besides that, he now puts a lot more attention on his food intake, which surely helped in the big amount of weight loss. It resulted in a proud and happy client, who wants to continue with this lifestyle.

But that continuation of course has to be promoted by some important factors. Only about 25 percent of the intervened individuals or groups still have the same healthy lifestyle one year after the intervention concluded (Holtzman, et al., 2004). This needs to be solved. One of the major factor in continuing an intervention seems to be motivation. If Milan keeps motivated about this style of life, he will find it much easier to actually submit to it. Having a motivated view towards training, gives the participant feelings of competence and attractiveness (Bélanger, et al., 2011). Coming from a situation of slight overweight, this will be really important in Milan’s life.

Besides the motivation, prominent results are important as well. Complying with the feeling of competence, this makes the client aware that the physical activity and the efforts done for it actually give the client the desired benefits.

Also, looking for social support is an important factor in maintaining the physical active lifestyle (McAuley, Jerome, Elavsky, Marquez, & Ramsey, 2003). Milan already made these kind of if-then plans and tried to think of situation where people around him could either harm his motivation and actions or positively influence them.

If all these things are taken into account and Milan tries to make them work in his own favor, there is a good chance that this intervention program will get a good continuation. Especially when combining this with the fact that Milan Cobelens was really positive about himself and physical activity.

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APPENDICES

TEXT 1 PERSONAL HEALTH GUIDE

Personal Health GuideMijn algemene doel is:

Denk eraan het SMART te houden: Specifiek, Meetbaar, Acceptabel, Realistisch, Tijdgebonden

Ik wil voor het eind van dit interventieprogramma er fysiek en conditioneel beter voorstaan dan nu.

Mijn specifieke doelen zijn:

Wat ga ik doen?

• Ik wil gestopt zijn met roken. 10 verandering, 9 vertrouwen.• Ik wil gevarieerder eten en zodoende afvallen. 7 verandering, 6 vertrouwen.• Ik wil meer beweging in mijn leven, over het algemeen en sport. 10 verandering, 8 vertrouwen

My action plan

Waar ga ik het doen?

• Roken: overal. In de vriendengroep met een biertje erbij. • Eten: Thuis, hier maak ik mijn brood klaar voor de gehele dag.• Bewegen: in het dagelijks leven, zoals op straat en thuis, en daarnaast in de sportschool

Wanneer ga ik het doen?

Roken: al mee bezig, en een grote stap genomen. Dit wordt natuurlijk voortgezet de komende tijd. Half juni is de deadline.

Eten: Al mee bezig, in plaats van kip kerrie en krab salade wissel ik dat af met pindakaas en worst en kaas.

Bewegen: ik wil meer gaan fietsen als ik naar mijn werk ga en ik wil graag een aantal avonden in de week naar de sportschool.

Met wie ga ik het doen?

Roken: vrienden die roken die steun moeten bieden. Ouders en vriendin.

Eten: Alleen

Bewegen: met mijn vriendin en natuurlijk met jou als coach.

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Hoe ga ik mijn vooruitgang bijhouden?

Het is belangrijk om de vooruitgang bij te houden, zodat je jezelf motiveert als iets lukt, en je voor jezelf kan nagaan wat er veranderd moet worden als iets niet lukt.

Wat zal ik in mijn dagboek bijhouden?

Roken: of er gerookt wordt of niet, en hoeveel en wat.

Beweging: hoeveel er wordt gefietst, en wat er in de sportschool gedaan wordt.

Eten: wat ik eet en wat ik drink op een dag.

Wanneer zal ik het bijhouden?

Elke keer wanneer nodig. Vast tijdstip: ’s avonds, 19.00.

Waar zal ik het bijhouden?

Digitaal, op de computer thuis.

Barrières

a) Plaatsen en dingen. Welke aspecten uit mijn omgeving zouden mijn gedragsverandering kunnen vermoeilijken? Wat kan ik doen om dit te veranderen?

Werk, thuis (beneden), uitgaan en bij vrienden thuis.

Eigenlijk kan ik hier weinig aan doen aangezien ik hier altijd ben.

b) Mensen. Zijn er mensen in mijn omgeving die het moeilijker kunnen maken om mijn gedrag te veranderen? Wat kan ik doen om dit te veranderen?

Vrienden en m'n moeder.

Minder omgaan met vrienden die roken. Maar dat is niet echt een optie aangezien er bij mijn beste vrienden regelmatig gerookt wordt.

Voor het eten, ik woon nog thuis en eet gewoon wat mijn ouders eten. Kan alleen wel voor de vrijdag zelf iets maken/halen wat beter voor me is dan friet.

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c) Gedachtes en gevoelens. Is er iets wat ik voel of denk dat het moeilijker zijn kunnen maken om mijn gedrag te veranderen? Hoe kan ik ervoor zorgen dat ik dit verander?

Ja ik wil nog wel is laks zijn. Dan denk ik ach nog een sigaretje kan geen kwaad.

Qua eten ben ik niet echt moeilijk. Kan makkelijk nee zeggen tegen snacks en lust bijna alles.

Voor bewegen denk ik dat ik wel kan gaan veranderen, zoals fietsen. Toch is het naar de sportschool gaan na mijn werk wel lastig.

Facilitators

a) Plaatsen en dingen. Welke aspecten uit mijn omgeving zouden mijn gedragsverandering kunnen vergemakkelijken? Hoe kan ik deze aspecten gebruiken?

Mijn kamer thuis, hier rook ik niet en ben hier ook wel vaak te vinden. Ben ook vaak te lui om naar beneden te lopen voor eten o.i.d.

Bij David thuis, hier halen we vaak een patatje of gooien we wat in de frituurpan.

b) Mensen. Zijn er mensen in mijn omgeving die het makkelijker kunnen maken om mijn gedrag te veranderen? Hoe kan ik hen vragen om mij te helpen?

Mijn vriendin, als ik bij haar ben denk ik niet eens aan roken. Verder zullen vrienden mij ook wel kunnen steunen door geen sigaret aan mij te geven als ik het vraag.

Wat het eten betreft David, Als we samen bepalen is een keer iets anders te eten.

c) Gedachtes en gevoelens. Is er iets wat ik voel of denk dat het makkelijker zijn kunnen maken om mijn gedrag te veranderen? Hoe kan ik deze gedachtes en gevoelens bemoedigen?

Denken aan mijn vriendin en aan de belofte die ik aan haar heb gedaan.

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TEXT 2 BEHAVOUR CHANGE DIARY

WednesdayTime of day Product Amount Kcals Carbs Fats Proteins

Breakfast Brown bread 1 slice 24 4.3 0.2 1

Filet americain 1 portion 48 0.6 3.8 2.8

Snack Brown bread 1 slice 24 4.3 0.2 1

Chicken Curry salad 1 portion 84 2.4 7.4 2.6

Lunch Brown bread 3 slices 72 12.9 0.6 3


Crab salad 2 portions 182 4.2 16 5

Dinner Babi pangang 2 plates 2547 181.3 156.9 90.6

Drinks Coffee 7 cups 7 0.7 0 1.4

Orangina 1 cup 138 33.7 0 0.3

Water 2 cups 0 0 0 0

Totals 3210 246.8 204.1 110.3

ThursdayTime of day Product Amount Kcals Carbs Fats Proteins





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Tangerine 1 piece 25 5.4 0.1 0.4





Dinner Shoarma 350 grams 836 1.8 48.3 98.7

Pita bread 3 pieces 330 67.5 0.9 11.7

Garlic sauce 150 grams 372 20.7 31.5 1.3


Orangina 1 cup 138 33.7 0 0.3


Totals 2251 166.3 116.5 132.2

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FridayTime of day Product Amount Kcals Carbs Fats Proteins










Snack Tangerine 1 piece 25 5.4 0.1 0.4

Dinner Fries 150 grams 458 57.2 21.4 6.7

Salad 100 grams 27 4.4 0.3 1

Satay 4 sticks 400 15.6 24.8 27.6


Orangina 1 cup 138 33.7 0 0.3


Beer 12 bottles 1620 104.4 0 14.4

Totals 3243 263.3 82.4 70.2

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SaturdayTime of day Product Amount Kcals Carbs Fats Proteins

Lunch Tosti 2 pieces 72 12.9 0.6 3

Dinner ‘Frikandelbroodje’ 2 pieces 850 55 66 22

Baguette 0.5 piece 404 80.1 1.8 14.7

Smoked salmon ~ 70 grams

130 0 7.6 27.6

Drinks Beer 12 bottles 1620 104.4 0 14.4


Totals 3076 252.4 76 81.7

SundayTime of day Product Amount Kcals Carbs Fats Proteins

Snack ‘Snelle Jelle’ 2 pieces 340 78 1 2.8

Dinner Lasagne 2 pieces 850 55 66 22

Drinks Beer 4 bottles 540 34.8 0 4.8


Totals 1730 167.8 67 26.6

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MondayTime of day Product Amount Kcals Carbs Fats Protein

s







Crab salad 2 portions

182 4.2 16 5


Snack Tangerine 1 piece 25 5.4 0.1 0.4

Dinner Fillet of the haddock 1 piece 306 3 18.3 32.5

Potatoes 175 grams

145 30.2 0.5 3.2

Peas 100 grams

69 10.9 0 4

Carrots 100 grams

32 5.2 0.3 0.7


Orangina 1 cup 138 33.7 0 0.3


Totals 1265 125.6 54.9 60.9

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TEXT 3 IF-THEN PLANS

ALS – DAN PLANNEN & MOEILIJKE SITUATIES

Moeilijke situaties

Zijn er bepaalde situaties die het extra moeilijk voor jou kunnen maken om je gewenste gedrag uit te voeren? Denk hierbij aan een plaats, een tijd of een gevoel die je zou kunnen bemoedigen om terug te gaan naar het oude gedrag. Noteer deze situaties hieronder.

Voorbeeld: op een zondagavond word ik erg gestrest als ik denk aan het werken op de maandag, en wil ik graag een sigaret roken.

1) De kantine op mn werk vrijdag middag als we een biertje drinken en er collega's roken.

2) Net als ik thuis kom van werk om alle stress een beetje van me af te laten vallen.

3) Het middag bieren bij Andrea (vrijdag en zaterdag) waar ook wordt gerookt en vaak friet wordt gegeten.

4) Als ik in de stad ben op vrijdag/zaterdag avond en we gaan uit.

5) Bij vrienden thuis als er gerookt wordt.

Als – dan plan

Maak nu een plan voor het vermijden van elke situatie afzonderlijk, of om ze handelbaarder te maken. Bedenk dus per situatie iets om het risico van terugval naar het oude gedrag te verkleinen.

Voorbeeld: Als ik op een zondagavond gestrest raak, dan zet ik rustige muziek op in plaats van een sigaret op te steken.

1) Hier een biertje overslaan en wat eerder vertrekken.

2) Meteen naar boven gaan om de verleiding te weerstaan beneden te roken.

3) Hier zal ik vooral veel aan mn vriendin moeten gaan denken en de belofte wil ik hier geen sigaret roken. Ook als ik hier vertel dat ik gestopt ben zullen ze me geen sigaret geven. Voor het eten moeten we het is afwisselen in plaats van steeds friet eten.

4) Tijdens uitgaan gewoon binnen blijven, meestal mag hier toch niet gerookt worden en na het stappen niet meer ergens eten.

5) Hier moet ik ook gewoon vertellen dat ik ben gestopt, aan mn vriendin denken en misschien vragen of ze niet zoveel willen roken of buiten.

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TEXT 4 SIGNED ACKNOWLEDGEMENT PAPER

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