NASM-SFS cheat sheet

Scope covers exercise instruction, fitness assessment, and lifestyle/behavior coaching for older adults; it excludes diagnosis, medical clearance decisions, and prescription of diets or medications.

Referral triggers: chest pain or pressure, syncope, unexplained dyspnea at rest, new unilateral weakness, sudden vision change, resting BP ≥180/110 mmHg, or blood glucose <70 mg/dL - stop session and refer.

Physician clearance is required before exercise for symptomatic clients or those with known cardiovascular, metabolic, or renal disease who intend to progress to vigorous intensity.

Informed consent and a health-history/risk screening form must be completed and updated annually or after any change in health status.

Documentation minimum: session date, exercises and loads, RPE, pre/post HR and BP when taken, adverse events, and referrals made.

The specialist may administer standardized functional tests but may not interpret them as diagnostic findings; report results as performance data to the client and, with consent, to their clinician.

Nutrition scope is limited to general education aligned with national dietary guidelines; individualized meal plans, therapeutic diets, and supplement dosing are referred to a registered dietitian.

Confidentiality: health information is shared only with written client authorization or as legally required; keep records secured and retain per local regulation.

Maximal HR declines roughly 1 beat per year after age 30; HRmax estimates from 220 − age carry a standard deviation near ±10–12 bpm, so use RPE and talk test alongside HR.

VO2max falls about 10% per decade after age 30, accelerating after 60; endurance training can slow but not eliminate the decline.

Sarcopenia: muscle mass declines roughly 3–8% per decade after 30, faster after 60; resistance training 2–3 days/week is the primary countermeasure.

Arterial stiffness and reduced baroreflex sensitivity raise orthostatic hypotension risk; avoid abrupt supine-to-standing transitions and prolonged motionless standing.

Reduced vestibular and proprioceptive function plus slower reaction time elevate fall risk; balance training should be progressive and near but not at the limits of stability.

Bone mineral density loss accelerates after menopause (trabecular loss ~2–3%/year early postmenopause); include weight-bearing and loading exercise, and cue spinal alignment to reduce flexion loading in osteoporosis.

Psychological considerations: depression and social isolation reduce adherence; self-efficacy, autonomy, and social connection are strong predictors of long-term participation.

Thermoregulation and thirst perception decline, raising dehydration and heat-illness risk; schedule fluid intake rather than relying on thirst.

Senior Fitness Test battery: 30-second chair stand, 30-second arm curl, 2-minute step or 6-minute walk, chair sit-and-reach, back scratch, and 8-foot up-and-go.

8-foot up-and-go cutoffs commonly cited for fall risk: ≥13.5 s indicates increased risk; ≥8.5 s in generally healthy older adults signals below-average mobility.

30-second chair stand normative reference (60–64 y men): ~14–19 stands average; below ~12 indicates below-average lower-body strength.

Chair sit-and-reach and back scratch measure flexibility, not injury risk; record to nearest 0.5 inch or 1 cm and compare to age- and sex-matched norms.

Grip strength: values below ~26 kg (men) and ~16 kg (women) are associated with weakness and higher functional limitation risk.

Single-leg stance <5 s and 4-stage balance test failure at tandem stance indicate elevated fall risk and warrant balance-focused programming.

Order the session: PAR-Q/health history → resting HR/BP → body composition (optional) → functional tests → flexibility; avoid testing within 2 hours of a large meal or after strenuous activity.

Reassess every 8–12 weeks using the same protocol and equipment; report change scores rather than raw norms alone to guide progression.

Aerobic: accumulate 150–300 min/week moderate intensity or 75–150 min/week vigorous, in bouts of ≥10 min (commonly 30 min × 5 days).

Resistance: 2–3 nonconsecutive days/week, 8–10 exercises covering major muscle groups, 1–3 sets of 8–15 reps at 40–70% 1RM for novices.

Flexibility: static stretching ≥2–3 days/week, holding 30–60 s, 2–4 reps per muscle group, after a warm-up or at session end.

Balance: 2–3 days/week for those at fall risk; progress from static to dynamic, eyes-open to eyes-closed, and firm to compliant surfaces, with support nearby.

Warm-up 5–10 min of light aerobic and mobility work; cool-down 5–10 min including gradual HR reduction and stretching.

Progression rule: increase one variable at a time (volume before intensity) by no more than ~10% per week; use RPE 11–13 (6–20 scale) as the starting target.

Demonstrate and cue key alignment points; use external support (chair, wall, rail) for balance and standing exercises until form is stable.

Session structure for deconditioned clients: 5 min warm-up, 15–20 min conditioning, 5–10 min cool-down, with seated intervals as needed.

Use the OPT model progression: stabilization (low load, high reps, unstable/supported) → strength (8–12 reps, moderate load) → power (light load, fast concentric) only after movement competency is established.

Initial phase duration for a sedentary older adult: 2–4 weeks of stabilization and aerobic base before adding intensity.

Frequency: 2–3 resistance sessions/week, 3–5 aerobic sessions/week; allow ≥48 h between resistance sessions for the same muscle groups.

Intensity anchors: RPE 11–13 for beginners, 13–15 for intermediate; talk test - can speak in full sentences at moderate intensity.

Power training (30–40% 1RM, 6–10 reps, fast intent) improves stair climbing and fall recovery; introduce only with adequate strength and no unstable medical conditions.

Periodize with a planned deload every 4–6 weeks or after illness; reduce volume ~40–50% during deload weeks.

Individualize by functional goal (e.g., floor transfer, carrying groceries, stair negotiation) and build exercises that mimic those demands.

Contraindication-based modification: avoid Valsalva and breath holding (cue exhale on exertion), avoid deep spinal flexion under load with osteoporosis, and limit overhead pressing with shoulder impingement.

Protein target for older adults: roughly 1.0–1.2 g/kg body weight/day, up to 1.2–1.5 g/kg for those with illness or higher training loads; distribute 25–30 g per meal.

Hydration: about 1.6 L/day for women and 2.0 L/day for men from all beverages, adjusted upward for heat and exercise; thirst is an unreliable guide.

Fiber: 21 g/day for women and 30 g/day for men over 50 (or ~14 g per 1,000 kcal).

Calcium: 1,200 mg/day for women over 50 and men over 70; vitamin D 600–800 IU/day, higher per clinician guidance.

Vitamin B12 absorption declines with age; fortified foods or supplements are commonly recommended - refer to a physician or RD for dosing.

Energy needs decline with age due to loss of lean mass; avoid aggressive calorie restriction, which accelerates muscle and bone loss.

Pre/post exercise: a small carbohydrate-plus-protein snack within 1–2 hours post resistance training supports adaptation; whole foods preferred.

Red flags to refer: unintentional weight loss ≥5% in 1 month or ≥10% in 6 months, dysphagia, or new food-avoidance behavior.

Positioning: define a niche (post-rehab transition, fall prevention, Parkinson's, active older adults) and state measurable outcomes in marketing materials.

Pricing models: per-session, package of 8–12 sessions, and monthly small-group memberships; small-group formats typically raise revenue per hour versus 1:1.

Referral network: primary care, physical therapy, senior centers, assisted living, and registered dietitians; provide one-page outcome summaries to referral sources with client consent.

Risk management: liability insurance covering older-adult populations, signed waivers, emergency action plan, and current CPR/AED certification.

Retention drivers: measurable progress reviews every 8–12 weeks, social connection in group sessions, and scheduling aligned with morning medication and transportation patterns.

Unit economics: track revenue per session, cost per acquisition, and retention months; a 5% retention gain has a larger effect on profit than an equivalent price increase.

Regulatory: comply with local licensing, business registration, and privacy law; never bill insurance as medical treatment without proper credentialing.

Community channels: free fall-risk screenings, senior-expo talks, and partnership classes at senior centers convert well because they demonstrate competence directly.