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 Contents • vii

Appendix B Cardiorespiratory Assessments 393

B.1 Summary of Graded Exercise Test and Cardiorespiratory

Field Test Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
B.2 Rockport Fitness Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
B.3 Step Test Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .398
B.4 OMNI Rating of Perceived Exertion Scales . . . . . . . . . . . . . . . . . . 400
B.5 Analysis of Sample Case Study in Chapter 5 . . . . . . . . . . . . . . . . . 404

Appendix C Muscular Fitness Exercises and Norms 407

C.1 Standardized Testing Protocols for Digital Handheld Dynamometry . . . . . 408

C.2 1-RM Squat and Bench Press Norms for Adults . . . . . . . . . . . . . . . 409
C.3 Isometric Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
C.4 Dynamic Resistance Training Exercises . . . . . . . . . . . . . . . . . . . 415

Appendix D Body Composition Assessments 421

D.1 Prediction Equations for Residual Volume . . . . . . . . . . . . . . . . . . 422

D.2 Standardized Sites for Skinfold Measurements . . . . . . . . . . . . . . . . 423
D.3 Skinfold Sites for Jackson’s Generalized Skinfold Equations . . . . . . . . . 428
D.4 Standardized Sites for Circumference Measurements . . . . . . . . . . . . 429
D.5 Standardized Sites for Bony Breadth Measurements . . . . . . . . . . . . . 430
D.6 Ashwell Body Shape Chart . . . . . . . . . . . . . . . . . . . . . . . . . . 431

Appendix E Energy Intake and Expenditure 433

E.1 Food Record and RDA Profile . . . . . . . . . . . . . . . . . . . . . . . . . 434

E.2 Physical Activity Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436
E.3 Gross Energy Expenditure for Conditioning Exercises, Sports,
and Recreational Activities . . . . . . . . . . . . . . . . . . . . . . . . . 437

Appendix F Flexibility and Low Back Care Exercises 441

F.1 Selected Flexibility Exercises . . . . . . . . . . . . . . . . . . . . . . . . . 442

F.2 Exercise Dos and Don’ts . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
F.3 Exercises for Low Back Care . . . . . . . . . . . . . . . . . . . . . . . . . 456

List of Abbreviations 461

Glossary 465
References 475
Index 531
About the Authors 545
 Video Contents

W e continue to offer online streaming video in this eighth edition, including over 70 videos of content
demonstrating key concepts from the book, such as assessments, procedures, tips, stretches, and exer-
cises. You can access the online video by visiting www.HumanKinetics.com/AdvancedFitnessAssessment
AndExercisePrescription. If you purchased a new print book, follow the instructions on the orange-framed
page at the front of your book. That page includes access steps and the unique key code that you’ll need the
first time you visit the Advanced Fitness Assessment and Exercise Prescription website. If you purchased an
e-book from HumanKinetics.com, follow the access instructions that were emailed to you after your purchase.
If you have purchased a used book, you can purchase access to the online video separately by following the
links at www.HumanKinetics.com/AdvancedFitnessAssessmentAndExercisePrescription.
Once at the Advanced Fitness Assessment and Exercise Prescription website, select Online Video in the
ancillary items box in the upper-left corner of the screen. You’ll then see an Online Video page with infor-
mation about the video. Select the link to open the online video web page. From the online video page, you
can select the chapter and then the desired video, numbered as they are in the text.
Following is a list of the clips in the online video.

Video 2.1 Resting BP measurement Video 6.1 Static muscle action

Video 2.2 Sources of BP measurement error Video 6.2 Concentric muscle action
Video 2.3 Measuring exercise BP Video 6.3 Eccentric muscle action
Video 2.4 Measuring resting HR by auscultation Video 6.4 Grip strength testing procedures
Video 2.5 Measuring resting HR by palpation— Video 6.5 Grip endurance testing procedures
radial artery Video 6.6 Side bridge test
Video 2.6 Measuring HR using a heart rate Video 6.7 Spotting exercises
monitor Video 6.8 1-RM testing
Video 2.7 ECG electrode placement—limb leads Video 6.9 Biodex (isokinetic) testing
Video 2.8 ECG electrode placement—chest leads Video 6.10 Pull-up tests
Video 2.9 Exercise ECG Video 6.11 Push-up tests
Video 3.1 Pedometer placement Video 6.12 Vertical jump with VerTec
Video 4.1 Measuring oxygen consumption (VO2) Video 7.1 Incline bench press
Video 4.2 Safely mounting a treadmill Video 7.2 Flat bench press
Video 4.3 Treadmill maximal exercise test Video 7.3 Decline bench press
Video 4.4 Setting workloads on a cycle ergometer Video 7.4 Pronated arm curl
Video 4.5 Cycle ergometer maximal exercise test Video 7.5 Supinated arm curl
Video 4.6 Treadmill submaximal exercise test Video 7.6 Hammer curl
Video 4.7 Cycle ergometer submaximal exercise Video 7.7 Common errors in performing the squat
test Video 7.8 Common errors in performing the
Video 4.8 20 m shuttle run/PACER test bench press
Video 4.9 6 min walk test Video 7.9 Eccentron training

viii

Video 8.1 Guidelines for hydrostatic weighing
Video 8.2 Testing procedures for the Bod Pod
Video 8.3 A-mode ultrasound
Video 8.4 Whole-body BIA measures
Video 8.5 Upper body BIA measures
Video 8.6 Lower body BIA measures
Video 10.1 Shoulder flexion
Video 10.2 Knee flexion
Video 10.3 Ankle flexion
Video 10.4 Inclinometer test procedures
Video 10.5 Modified sit-and-reach test
Video 10.6 Modified back-saver sit-and-reach test
Video 11.1 PNF stretching techniques
Video 12.1 Unipedal stance test
Video 12.2 BESS test
Video 12.3 Functional reach test
Video 12.4 Timed up-and-go test
Video 12.5 Y-balance test
Video C3.1 Chest push
Video Contents • ix
Video C3.2 Shoulder pull
Video C3.3 Triceps extension
Video D2.1 Measurement of the chest skinfold
Video D2.2 Measurement of the subscapular
skinfold
Video D2.3 Measurement of the abdominal
skinfold
Video D2.4 Measurement of the thigh skinfold
Video D2.5 Measurement of the calf skinfold
Video D4.1 Circumference measurement of the
waist
Video D4.2 Circumference measurement of the
hips
Video D5.1 Bony breadth measurement of the
hips
Video D5.2 Bony breadth measurement of the
elbow
Video F1.1 Hamstring stretch
Video F1.2 Chest stretch
 Preface
E xercise professionals need to have extensive
knowledge and technical skills in order to work
safely and effectively. Historically, individuals work-
ing in exercise settings, such as health and fitness
clubs, were not necessarily required to have spe-
cialized education and training in exercise science.
However, survey research indicates that a bachelor’s
degree in exercise science and certification from
the American College of Sports Medicine (ACSM)
or National Strength and Conditioning Association
(NSCA) are strong predictors of a personal trainer’s
knowledge (Malek et al. 2002). To carry the U.S.
Bureau of Labor and Statistics’ job title of “exercise
physiologist,” one must have earned the minimum of
a bachelor’s degree (Simpson 2015). There is also a
growing trend within health care facilities to require
their exercise physiologists to hold a master’s degree
(Collora 2017); this corroborates Wagner’s (2014)
finding that a master’s degree is commonly held by
exercise physiologists working in clinical settings
(69% of 140 survey respondents).
A global survey of fitness trends for 2018 revealed
that “educated, certified, and experienced fitness
professionals” is ranked number 6 in importance,
and this has been a top 10 concern since the annual
survey began more than a decade ago (Thompson
2017). These findings suggest that formal educa-
tion and certification by professional organizations
should be required for personal fitness trainers and
exercise science professionals. Their knowledge and
skills are instrumental in preparticipation screening,
cardiorespiratory fitness testing, muscular fitness
testing, flexibility assessment, results interpretation,
and scientifically sound exercise prescription design.
To promote exercise science as a profession, issues
surrounding accreditation, certification, national
boards, and licensure need to be understood and
addressed.
ACCREDITATION
Organizations and programs are awarded accredita-
tion by meeting or exceeding standards established
x
by an independent third-party accrediting agency.
Although no single accrediting agency exists for
health and fitness and clinical exercise science pro-
grams, exercise science professionals seem to agree
that some form of regulation is needed.
Independent third-party accrediting agencies
such as the Commission on Accreditation of Allied
Health Education Programs (CAAHEP) and the
National Commission for Certifying Agencies
(NCCA) may serve this purpose. The CAAHEP
accredits academic programs—graduate programs
in exercise physiology, baccalaureate programs
in exercise science, and certificate and associate
degree programs for personal fitness trainers. Also,
the American Society of Exercise Physiologists
(ASEP) has developed standards for the profession
of exercise physiology as well as accreditation
standards for universities and colleges offering
academic degrees in exercise science (ASEP 2018).
The NCCA accredits certification programs; many
organizations that provide professional credentialing
or licensing exams in the allied health professions
are accredited through the NCCA (ACSM 2004).
CERTIFICATION
Fitness and exercise science professionals obtain
certification by passing examinations developed
by professional organizations. These organizations
typically offer education and training programs,
administer their own examinations (written and
practical), and issue certifications to individuals
passing the examinations. These certifications are
generally issued for a 2 to 3 yr period; certification is
maintained by taking continuing education courses
and earning continuing education credits. Some
certification programs are accredited by third-party
agencies like the NCCA.
More than 75 organizations offer over 250 cer-
tifications for exercise science and fitness profes-
sionals (Cohen 2004; Pierce and Herman 2004).
Given that there is no governing entity to oversee
the development of certification examinations and

eligibility requirements, inequalities exist among
the certifications available to exercise science pro-
fessionals. Some certification programs are more
rigorous than others, having stringent eligibility
requirements; others may or may not be accredited
by a third-party accrediting agency like the NCCA.
To address the inequality among certification pro-
grams, the NCCA formally reviews applications for
the accreditation of certification programs. In 2004,
the International Health, Racquet, and Sportsclub
Association (IHRSA) recommended that all health
clubs belonging to their organization hire only per-
sonal fitness trainers certified by an NCCA-accred-
ited organization or agency. Wagner (2014) reported
results from a survey of 589 exercise physiologists
and indicated that 69% of the respondents held one
certification while 28% held two or more. Neverthe-
less, not all exercise science and fitness certifications
are equal. This leads to confusion for the consumer
in terms of knowing who is and who is not highly
trained and qualified as an exercise professional.
It also complicates selecting the most appropriate
certification for yourself. Some agencies sponsor
certification programs primarily for financial gain,
while others certify professionals in order to promote
exercise science as a profession.
Table 1 lists some of the organizations that offer
certifications accredited by the NCCA. Addition-
ally, the Coalition for the Registration of Exercise
Professionals (CREP), a not-for-profit corporation
composed of organizations that offer NCCA-accred-
Table 1 Selected Organizations Associated With National Commission for Certifying Agencies
(NCCA) and National Board of Fitness Examiners (NBFE)
NCCA affiliates
American Council on Exercise (ACE)
American College of Sports Medicine (ACSM)
Cooper Institute for Aerobics Research
National Exercise and Sports Trainers Association (NESTA)
National Exercise Trainers Association (NETA)
National Federation of Professional Trainers (NFPT)
National Strength and Conditioning Association (NSCA)
International Fitness Professionals Association (IFPA)
National Council on Strength and Fitness (NCSF)
National Academy of Sports Medicine (NASM)
Preface • xi
ited exercise certifications, established a registry of
professionals in the United States certified by any
of six organizations (www.usreps.org). This website
is a convenient means for locating professionals by
location, certification, or name. Registries are also
available for the United Kingdom (www.exercisereg-
ister.org), Europe (www.europeactive.eu/why-ereps),
and New Zealand (www.reps.org.nz).
NATIONAL BOARDS
Some professional organizations in the fitness indus-
try believe there should be alternatives to accred-
itation of certification programs by the NCCA or
other third-party agencies. In the United States, one
such alternative was the establishment of National
Board examinations for fitness professionals.
Unlike the multitude of certification examinations
developed by individual organizations and agencies,
National Boards are standardized tests to assess the
knowledge, skill, and competence of professionals.
Most medical and allied health professions utilize
National Boards.
In 2003, the National Board of Fitness Examiners
(NBFE) was founded as a nonprofit organization
with the twin purposes of defining scopes of practice
for all fitness professionals and determining stan-
dards of practice for various fitness professionals,
including floor instructors, group exercise instruc-
tors, personal fitness trainers, specialists in youth
and senior fitness, and medical exercise specialists.
NBFE affiliates
Aerobics and Fitness Association of America (AFAA)
American Aerobic Association International/International
Sports Medicine Association (AAAI/ISMA)
International Sports Sciences Association (ISSA)
National Association for Fitness Certification (NAFC)
National Council for Certified Personal Trainers (NCCPT)
National Exercise and Sports Trainers Association (NESTA)
National Gym Association (NGA)
National Personal Training Institute (NPTI)
National Strength Professionals Association (NSPA)
xii • Preface
The NBFE established national standards of excel-
lence that certifying organizations and colleges or
universities may adopt. The written portion of the
National Boards for personal fitness trainers is now
offered through the NBFE (for additional informa-
tion, visit www.NBFE.org). The practical portion
of this exam is still being developed and validated
under the supervision of the National Board of Med-
ical Examiners (NBME). The NBME and the NBFE
are engaged in preliminary discussions and planning
that will allow certification organizations to assist in
the delivery of practical exams for personal trainers.
To be eligible to sit for the National Boards, per-
sonal fitness trainers must successfully complete
a personal training certification program from an
approved NBFE affiliate. Affiliate status is avail-
able to qualified groups from the areas of medicine,
certification organizations, fitness professionals,
health clubs, and higher education. In the future, the
NBFE’s National Boards may be used by certifying
organizations, colleges and universities, and U.S.
state licensing programs to test the knowledge, skill,
and competence of fitness professionals (American
Fitness Professionals and Associates 2004). Table
1 lists some of the organizations offering personal
training certifications affiliated with the NBFE.
LICENSURE
Although many practitioners in the fitness and exer-
cise science fields agree that certification ensures
professional competency, other professionals believe
that licensure is better suited for protecting consum-
ers and for enhancing the credibility and profession-
alism of exercise science and fitness professionals
(Eickhoff-Shemek and Herbert 2007). For the first
time in the 12 yr history of the worldwide survey
of fitness trends, licensure for fitness professionals
broke into the top 20 trends (number 16 for 2018)
(Thompson 2017). In the United States, licensure
is decided at the state level; therefore, requirements
may vary from state to state. Louisiana was the first
state to pass a law requiring licensure of all clinical
exercise physiologists (Herbert 1995). Licensure of
clinical exercise physiologists has also been consid-
ered in Maryland, Massachusetts, Michigan, North
Carolina, Texas, and Utah (Clinical Exercise Phys-
iology Association, 2013). Several states including
Georgia, Maryland, Massachusetts, New Jersey,
Nevada, Oregon, and the District of Columbia have
considered licensure for personal trainers (Eick-
hoff-Shemek and Herbert 2008b; Herbert 2004;
Thompson 2017).
To promote exercise science and exercise phys-
iology as a profession, the ASEP is working with
exercise professionals throughout the United States
to develop uniform state licensure requirements
for exercise physiologists. Licensure would place
exercise physiologists and personal trainers on a par
with other allied health professionals (e.g., nurses,
nutritionists, physical therapists, and occupational
therapists) who are required to have licenses to
practice. Licensed fitness professionals may be more
likely to obtain referrals from health care profession-
als and to receive reimbursement for services from
third parties (e.g., insurance companies).
Along with advantages, added responsibilities and
disadvantages are associated with state licensure.
Licensure may limit the scope of practice and ser-
vices that exercise professionals are currently able
to provide to the public. For example, Louisiana
licensure law requires clinical exercise physiologists
to work under the direction of a licensed physician.
Also, the costs of licensure, continuing education
for licensure, and professional liability insurance
may be more expensive compared with the cost
of certifications. Professionals moving from state
to state may be required to obtain another license
because each state could require different creden-
tials for licensure (Eickhoff-Shemek and Herbert
2008a, 2008b).
STATUTORY
CERTIFICATION
Instead of licensure, some American states use
statutory certification for allied health profession-
als. Statutory certification regulates what titles
professionals can use and the qualifications needed
to obtain these titles. Only certified professionals
with the required credentials are allowed to use
the specific title (e.g., certified nutritionist). Other
professionals without the necessary credentials can
still practice in the state but must use a different title.
This approach could be promoted by the fitness and
exercise professions to prevent the use of titles, such
as personal trainer or exercise physiologist, by indi-

viduals having no formal education or professional
certifications.
All these approaches demonstrate the pressing
need to get a handle on certifications for exercise
professionals so we can gain control of who is
practicing in our field. This will ensure the safety
of exercise program participants and enable individ-
uals working in the fitness field to be recognized as
exercise science professionals. Until these issues are
resolved and a list of accredited certification agen-
cies and organizations is finalized, you should select
a professional certification that matches your level
of education and career goals. For more information
about certification programs, visit the websites of
those professional certifying organizations.
Many advantages are associated with obtaining
either state licensure or certification with profes-
sional organizations. You will have a better chance
of finding a job in the health and fitness field because
many employers are now hiring only professionally
Preface • xiii
certified health and fitness instructors. Certification
by reputable professional organizations upgrades the
quality of the typical person working in the field and
assures employers and their clientele that employees
have mastered the knowledge and skills needed to
be competent exercise science professionals. Hence,
the likelihood of lawsuits resulting from negligence
or incompetence may be lessened. Also, certification
and licensure help validate exercise specialists as
health professionals who are equally deserving of
the respect afforded to professionals in other allied
health professions. Individuals holding a Registered
Clinical Exercise Physiologist (RCEP) or Certified
Clinical Exercise Physiologist (CEP) certification
now have a National Provider Identifier code
that may be used for service reimbursement from
insurance companies. For more information on this
development, visit the website of the Clinical Exer-
cise Physiology Association (www.acsm-cepa.org).
 Acknowledgments
T he first edition of this textbook was titled
Designs for Fitness and was published by
Burgess Publishing in 1984. It was a softcover
book of about 200 pages. Dr. Swede Schoeller took
the photos for that edition. Eileen Fletcher, our
department secretary, typed the manuscript on her
Smith-Corona.
The second edition was published by Human
Kinetics in 1991. This edition was a hardcover book
consisting of 350 pages. For this edition, Linda K.
Gilkey took the photos. For the first time, the man-
uscript was typed using a DOS word processing
system, by department secretary Sandi Travis.
In 1998, the third edition was published by
Human Kinetics. The book grew in size from a 7"
× 9" format to an 8.5" × 11" format. Once again,
Linda K. Gilkey took the photos, and the computer
graphics were done by Dr. Robert Robergs, Dr. Brent
Ruby, and Dr. Peter Egan.
The fourth edition, published by Human Kinet-
ics in 2002, was 370 pages. Our colleagues Dr.
Christine Mermier, Dr. Virginia Wilmerding, Dr.
Len Kravitz, and Dr. Donna Lockner shared their
excellent ideas and expertise. The developmental
editors, Elaine Mustain and Maggie Schwarzen-
traub, meticulously edited this edition.
In 2006, the fifth edition was released. For this
edition, the total number of pages increased to 425,
and Human Kinetics updated all the photos. Sarah
xiv
Ritz did an excellent job organizing and taking
these photos. Dr. Dale Wagner contributed the test
question bank that accompanied this edition.
The sixth edition was released in May 2010. For
the first time, this book was also published as an
ebook. The book expanded to 465 pages. Dr. Dale
Wagner updated the test question bank, and Dr.
Ann Gibson prepared the slides for the presentation
package.
The seventh edition, published in 2014 by Human
Kinetics, was coauthored with Dr. Ann Gibson.
In addition to being published as an ebook, the
537-page seventh edition was supplemented with
instructional videos.
The eighth edition is coauthored with Dr. Ann
Gibson and Dr. Dale Wagner. Dr. Wagner’s exten-
sive background as a researcher and professor of
exercise science has been invaluable in updating
and revising this edition. We also acknowledge Cyn-
thia McEntire, our Human Kinetics developmental
editor, Martha Gullo, who obtained the publication
permissions for this edition, and Amy Stahl, the
senior managing editor assigned to this edition.
Many individuals have contributed to the con-
tinued success of Advanced Fitness Assessment
and Exercise Prescription. We are indebted to each
person who played a role in the metamorphosis of
this book.
 1
Chapter 1
Physical Activity, Health,
and Chronic Disease
KEY QUESTIONS
Are adults in the United States and other coun-
uu
tries getting enough physical activity?
How does physical inactivity differ from seden-
uu
tarism?
What diseases are associated with a sedentary
uu
lifestyle, and what are the major risk factors for
these diseases?
What are the benefits of regular physical activity
uu
in terms of disease prevention and healthy aging?
A lthough physical activity plays an important
role in preventing chronic diseases and reduc-
ing the hazardous effects of extended periods of
sitting time, an alarming percentage of adults in
the United States report no physical activity during
leisure time. One of the national health objectives for
the year 2020 is to increase to 47.9% the proportion
of people aged 18 yr and older who regularly (pref-
erably daily) engage in moderate physical activity at
least 30 min per day (U.S. Department of Health and
Human Services 2010). According to a U.S. national
survey, in 2014 only a small percentage (21.5%) of
adults over the age of 18 met the 2008 federal phys-
ical activity guidelines for adults in terms of both
aerobic and muscle strengthening activities. Slightly
more than half (53.2%) met either the aerobic activity
or the muscle-strengthening guidelines, but not both
(Centers for Disease Control and Prevention 2015a).
Generally, women (50%) are less likely to meet the
full aerobic and muscle-strengthening recommenda-
tions than men (43.4%), and older (≥65 yr) adults are
less likely (58.7%) to meet them than younger (18-24
yr) adults (40.8%) (Centers for Disease Control and
Prevention 2015a).
CHAPTER
uuHow does physical activity improve health?
uuHow much physical activity is needed for
improved health benefits?
uuWhat kinds of physical activities are suitable
for typical people, and how often should they
exercise?
Physical inactivity, the failure to meet the rec-
ommended physical activity guidelines, is not just
a problem in the United States; it is a global issue
and the fourth leading cause of global mortality
(World Health Organization 2010). Cardiovascular
diseases, diabetes, obesity, chronic respiratory disor-
ders, and cancers as a group of noncommunicable
diseases (NCDs) are the leading causes of death
worldwide. These chronic conditions are heavily
influenced by poor lifestyle factors including phys-
ical inactivity and unhealthy diet (World Medical
Association 2017). NCDs accounted for approxi-
mately 52% of worldwide deaths occurring before
age 70 in 2012 (World Health Organization 2016d).
Physical inactivity became a targeted priority of the
World Health Organization’s Global Action Plan
for 2013-2020 (World Health Organization 2013);
a global goal was set to reduce physical inactivity
levels by 10% by the year 2025 (Sallis et al. 2016).
Results from survey data collected from 146
countries representing all income levels estimated
that 23% of the global adult (≥15 yr) population
was physically inactive in 2016. However, an 8%
decrease in physical inactivity between 2012 and
1
2 • Advanced Fitness Assessment and Exercise Prescription

USING TECHNOLOGY TO INCREASE

PHYSICAL ACTIVITY AT WORK
Active workstations (e.g., treadmill desks or pedal desks) and adjustable-height work surfaces that allow
employees to stand (sit-stand desks) are becoming more commonplace. They provide a means to reduce
prolonged periods of sitting. Some employees have their own active workstations, while others have access
to one located in a common area. A recent review of studies about active workstations (Cao et al. 2016)
indicates that the calories burned may increase two- to fourfold for employees who change from sitting in
a chair (~70-90 kcal·h−1) to active workstations. Additionally, daily step counts and physical activity (min/
day) increase dramatically for those using active workstations during the workday. Crandall and colleagues
(2016) found that using sit-stand workstations reduces sitting time by approximately 85 min/day. They also
reported that employees using a shared treadmill desk accumulate slightly fewer than 9,000 steps·day−1
while at work. Ongoing longitudinal research in this area may identify long-term effects of using active
workstations on employee health. Currently, these effects are not well documented.

2016 may be less reflective of changes in activity
levels than in updated physical activity recommen-
dations (150 min of moderate-intensity activity or
75 min of vigorous-intensity activity per week, or
combination thereof). The current recommendations
changed the frequency of exercise bouts from 5 days
per week (moderate-intensity) or 3 days per week
(vigorous-intensity) to weekly totals of minutes.
The prevalence of physical inactivity ranges from
approximately 38% in the eastern Mediterranean
countries to a low of 14.8% in southeast Asia; by
World Bank income classification, the low- and low-
er-middle-income countries were more physically
active than their upper-middle- and high-income
counterparts (Sallis et al. 2016). In England and
Scotland, more than 65% of men and at least 50%
of women met the government’s physical activity
guidelines in 2012 (British Heart Foundation 2015a).
However, only 18% of Canadian adults responding
to the 2014-2015 Canadian Health Measures Survey
met the recommendation of 150 minutes of mod-
erate-to-vigorous intensity activity in bouts lasting
at least 10 minutes (Statistics Canada 2017). Thus,
as an exercise specialist, you face the challenge of
educating and motivating your clients to incorporate
physical activity as a regular part of their lifestyles
and to reduce the amount of time spent being seated
(Benatti and Ried-Larsen 2015; Bergouignan et al.
2016; Levine 2015; Same et al. 2016).
This chapter deals with the physical activity
trends, risk factors associated with chronic noncom-
municable diseases, the role of regular exercise and
physical activity in disease prevention and health,
physical activity guidelines and recommendations
for improved health, and the importance of includ-
ing exercise and physical activity as one of the vital
signs (i.e. heart rate, blood pressure, etc.) monitored
during annual visits to the doctor. For definitions of
terminology used in this chapter, see the glossary.
PHYSICAL ACTIVITY,
HEALTH, AND DISEASE:
AN OVERVIEW
Technological advances affecting nearly every facet
of life have substantially lessened work-related
physical activity as well as the energy expenditure
required for performing activities of daily living
like cleaning the house, washing clothes and dishes,
mowing the lawn, and traveling to work. What
would have once required an hour of physical work
now can be accomplished in just a few seconds by
pushing a button or setting a dial. Survey results
from 23 low-income and 25 upper-middle-income
countries suggest that access to modern technolog-
ical conveniences underlies an inverse relationship
between both education level and financial assets
with the prevalence of physical inactivity (Allen
et al. 2017). The unfortunate fact is, however, that
many individuals do not engage in physical activity
during their leisure time and sit too much at work
and after hours.
Although the human body is designed for move-
ment and strenuous physical activity, exercise is
not part of the average person’s lifestyle. Industri-
alization and urbanization have led to increased
 Physical Activity, Health, and Chronic Disease • 3

sedentarism and sedentary behaviors (performing
activities of ≤1.5 METs while in a sitting or reclining
posture) (Benatti and Ried-Larsen 2015; Sedentary
Behaviour Research Network 2012). One cannot
expect the human body to function optimally and to
remain healthy for extended periods if it is abused
or is not used as intended.
Physical inactivity is recognized as a major
contributor to the physical and economic burden of
disease nationally and globally. The identification of
physical inactivity as the fourth leading risk factor
for mortality supports what experts noted nearly a
decade ago—physical inactivity may well be the
most important public health problem in the 21st
century (Blair 2009). To highlight this, a global
action plan was developed to increase the number
of people meeting the recommended weekly amount
of physical activity by 10% (World Health Organi-
zation 2013). The World Health Organization (2014)
reported that physical inactivity causes an estimated
3.2 million deaths annually. Data from large cohort
studies conducted around the world were pooled
and analyzed; resulting estimations revealed that
between 6% and 10% of coronary heart disease, type
2 diabetes, and breast and colon cancers are due to
physical inactivity (Lee et al. 2012). As a risk factor,
physical inactivity is basically equivalent to the
combined risk of smoking and obesity. Sedentarism
has repeatedly been identified as an independent risk
factor associated with an increased risk for all-cause
mortality and metabolic and heart disorders (Benatti
and Ried-Larsen 2015). Individuals who do not
exercise regularly and sit too much are at greater risk
for developing chronic noncommunicable diseases
such as those in figure 1.1.
For years, exercise scientists as well as health and
fitness professionals have maintained that regular
physical activity is the best defense against the devel-
opment of many diseases, disorders, and illnesses.
The importance of regular physical activity in
maintaining a high quality of life and in preventing
disease and premature death received recognition as
a national health objective in the first U.S. surgeon
general’s report on physical activity and health
(U.S. Department of Health and Human Services
1996). This report identified physical inactivity as a
serious nationwide health problem, provided clear-
cut scientific evidence linking physical activity to

Coronary heart disease Congestive heart failure

Cardiomyopathy Cardiovascular Hypertension

diseases
Hypercholesterolemia Atherosclerosis
Over fat Low back pain
Osteoarthritis

Metabolic Musculoskeletal
Obesity
disorders disorders

Bone fractures and

Diabetes Physical Inactivity connective tissue tears
and
Osteoporosis
Breast Sedentary Lifestyle
Colon Depression

Cancer Psychological Mood

disorders

Prostate
Lung Anxiety
Pulmonary
diseases
Emphysema Asthma
Chronic bronchitis

FIGURE 1.1 Role of physical activity and exercise in disease prevention and rehabilitation.

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4 • Advanced Fitness Assessment and Exercise Prescription

numerous health benefits, presented demographic
data describing physical activity patterns and trends
in the U.S. population, and made physical activity
recommendations for improved health. In 1995, the
CDC and the American College of Sports Medicine
(ACSM) recommended that every U.S. adult should
accumulate 30 min or more of moderate-intensity
physical activity on most, preferably all, days of the
week (Pate et al. 1995). This recommendation has
since been adopted by many international organi-
zations.
Since 1995, new scientific evidence increased our
understanding of the benefits of physical activity
for improved health and quality of life. In light of
these findings, the American Heart Association
(AHA) and the ACSM updated physical activity
recommendations for healthy adults and older adults
(Haskell et al. 2007; Nelson et al. 2007). These rec-
ommendations address how much and what type of
physical activity are needed to promote health and
reduce the risk of chronic disease in adults. Table 1.1
summarizes the ACSM and AHA physical activity
recommendations for adults.
The recommended amounts of physical activity
are in addition to routine activities of daily living
(ADLs) such as housework, cooking, shopping, and
walking around the home or from the parking lot.
The intensity of exercise is expressed as a metabolic
equivalent of task (MET). An MET is the ratio of
the person’s working (exercising) metabolic rate to
the resting metabolic rate, with 1 MET defined as
the energy cost of sitting quietly. Moderate-intensity
aerobic activity (3.0-6.0 METs or 5 or 6 on a 10-point
perceived exertion scale) is operationally defined as
activity that noticeably increases heart rate and lasts
more than 10 min (e.g., brisk walking at 3.0-4.0 mph
[4.8-6.4 km·hr−1]). Vigorous-intensity activity (>6.0
METs or 7 or 8 on a 10-point perceived exertion
scale) causes rapid breathing and increases heart
rate substantially (e.g., jogging or running at 4.5
mph [7.2 km·hr−1] or higher). For adults (18-65 yr)
and older adults (>65 yr), the ACSM recommends a
minimum of 150 min of moderate-intensity aerobic
activity per week or 75 min of vigorous-intensity
aerobic exercise per week. It is also recommended
that these totals be spread over the course of a week
to avoid injury). They also recommend moderate- to
high-intensity (8- to 12-repetition maximum [RM]
for adults and 10-RM to 15-RM for older adults)
resistance training for a minimum of 2 nonconsecu-
tive days per week. Balance and flexibility exercises
are also suggested for older adults.
Table 1.2 summarizes the physical activity
guidelines (U.S. Department of Health and Human

Table 1.1 ACSM/AHA Physical Activity Recommendations

MUSCLE-STRENGTHENING FLEXIBILITY AND
AEROBIC ACTIVITIESa ACTIVITIES BALANCE ACTIVITIES
Population Durationb Frequency Intensity or # of Frequency
group (min/day) Intensity (days/wk) Sets exercises (days/wk)
Healthy 30 Moderate Minimum 5 1 8-RM to 12-RM; 8-10 ≥2 noncon- No specific recommen-
adults (3.0-6.0 exercises for major secutive dation
18-65 yr METS) muscle groups days

20 Vigorous Minimum 3
(>6.0
METS)
Older adults 30 Moderate Minimum 5 1 10-RM to 15-RM; 8-10 2 noncon- For flexibility at least 2
>65 yr (5 or 6 exercises for major secutive days/wk for at least 10
on 10 pt. muscle groups; days min each day; include
scale) Moderate intensity (5 balance exercises for
or 6 on 10 pt. scale) those at risk for falls
20 Vigorous Minimum 3 Vigorous intensity (7
(7 or 8 or 8 on 10 pt. scale)
on 10 pt.
scale)
a
Combinations of moderate and vigorous intensity may be performed to meet recommendation (e.g., jogging 20 min on 2 days and brisk walking
on 2 other days).
b
Multiple bouts of moderate-intensity activity, each lasting at least 10 min, can be accumulated to meet the minimum duration of 30 min.
 Table 1.2 2008 Physical Activity Guidelines for Americans
BONE- FLEXIBILITY
STRENGTHENING AND BALANCE
AEROBIC ACTIVITIES MUSCLE-STRENGTHENING ACTIVITIES ACTIVITIES ACTIVITIES
*
Population group Duration Intensity Frequency Sets Intensity* Frequency
Children and adoles- ≥60 min Moderate Daily Moderate to high 3 days/wk 3 days/wk
cents 6-17 yr
Vigorous 3 days/wk
Adults 18-64 yr
Inactive 60-150 min/wk Light (1.1-2.9 METs) to 1 Light to moderate 1 day/wk All adults should
moderate (3.0-5.9 METs) stretch to main-
tain flexibility for
Active 150-300 min/wk Moderate (3.0-5.9 METs) ≥1 Moderate to high ≥2 days/wk
regular physical
or 8-RM to 12-RM activity (PA) and
75-150 min/wk Vigorous (≥6.0 METs) activities of daily
living (ADLs).

Highly active >300 min/wk Moderate (3.0-5.9 METs) 2 or 3 Moderate to high ≥2 days/wk
>150 min/wk Vigorous (≥6.0 METs)
Older adults ≥65 yr
Inactive 150 min/wk Light (RPE = 3 or 4) to 5 days/wk 1 Light (RPE = 3 or 4) to 2 or 3 days/ Older adults
moderate (RPE = 5 or 6) moderate (RPE = 5 or 6) wk should stretch to
maintain flexibil-
Active 150-300 min/wk Moderate (RPE = 5 or 6) ≥3 days/wk ≥1 Moderate (RPE = 5 or 6) ≥2 days/wk,
ity for regular PA
or to high (RPE = 7 or 8) nonconsec-
and ADLs.
8-RM to 12-RM utive days
≥3 days/wk
75-150 min/wk Vigorous (RPE = 7 or 8) balance
*
Intensity is expressed in METs and repetition maximums (RM) for adults; for older adults, intensity is expressed as a rating of perceived exertion (RPE; 0-10 scale) and RM.

5
6 • Advanced Fitness Assessment and Exercise Prescription
HEALTH BENEFITS OF PHYSICAL ACTIVITY
Lower risk of
• dying prematurely;
• coronary artery disease;
• stroke;
• type 2 diabetes and metabolic syndrome;
• high blood pressure;
• adverse blood lipid profile;
• colon, breast, lung, and endometrial cancers;
and
• hip fractures.
Data from U.S. Department of Health and Human Services 2008.
Services 2008) for children and adolescents (6-17
yr), adults (18-64 yr), and older adults (≥65 yr). The
key message in these guidelines is that for substan-
tial health benefits, adults should engage in aerobic
exercise at least 150 min/wk at a moderate intensity
or 75 min/wk at a vigorous intensity or an equivalent
combination thereof. In addition, adults of all ages
should do muscle-strengthening activities at least 2
days/wk. In addition to stretching to support physical
activity and activities of daily living, those who are
at risk for falling should also perform balance exer-
cises. Children should do at least 60 min of physical
activity every day. Most of the 60 min per day should
be either moderate or vigorous aerobic activity and
should include vigorous aerobic activities at least 3
days/wk. Part of the 60 min or more of daily physical
activity should be muscle-strengthening activities (at
least 3 days/wk) and bone-strengthening activities
(at least 3 days/wk).
The term exercise deficit disorder (EDD) has
been used to identify children who do not attain
at least 60 min of moderate- to vigorous-intensity
physical activity (MVPA) on a daily basis (Faigen-
baum and Myer 2011). Children with EDD are at
an increased risk for developing harmful health
effects in their adolescent and adult years due to
a physically inactive lifestyle (Stracciolini, Myer,
and Faigenbaum 2013). For example, results from
a study that monitored children for 14 yr revealed
that those who maintained their active childhood
MVPA levels through adolescence were less likely
Reduction of
• abdominal obesity and
• feelings of depression and anxiety.
Helps in
• weight loss, weight maintenance, and preven-
tion of weight gain;
• prevention of falls and improved functional
health for older adults;
• improved cognitive function;
• increased bone density; and
• improved quality of sleep.
to become obese as young adults (Kwon et al. 2015).
Exercising 150 min/wk equates to expending
approximately 1,000 kcal·wk−1. Results from a
meta-analysis (Sattelmair et al. 2011) indicated
that individuals meeting the 2008 physical activity
guidelines decrease their risk for coronary heart
disease by 14% compared with those reporting no
leisure-time physical activity (LTPA). Participating
in regular physical activity and exercise on a daily
basis provides numerous preventative benefits for
no fewer than 25 chronic medical conditions (War-
burton and Breden 2016) such as cardiovascular
disease, hypertension, diabetes, stroke, dementia,
and several types of cancer. Disease risk is further
reduced when moderate-intensity physical activity
(150-180 min/wk) is performed throughout the week
(i.e., 30 min/day on 5 days/wk) and in bouts lasting
at least 10 min as opposed to in one single session
(Kesäniemi et al. 2010).
Sattelmair and colleagues (2011) reported that
300 min/wk of moderate-intensity physical activity
results in a 20% reduction in the risk for coronary
heart disease (CHD). Furthermore, a review of
studies on asymptomatic adults (19-65 yr) revealed
that 90 min of vigorous-intensity physical activity
accumulated throughout the week (90 min/wk) in
increments of no fewer than 10 min reduces the risk
of all-cause mortality by 30%, as well as the risk
for cardiovascular disease (CVD), hypertension,
stroke, type 2 diabetes, and breast and colon cancer
(Kesäniemi et al. 2010).

In 2009, an international consensus conference
was convened to review Canada’s Physical Activity
Guide to Healthy Active Living (Health Canada
2003). The consensus panel recommended that
asymptomatic Canadian adults (19-65 yr) accu-
mulate 150 min/wk of moderate-intensity physical
activity or 90 min/wk of vigorous-intensity activity
as a primary prevention against cardiovascular
disease, stroke, hypertension, colon cancer, breast
cancer, type 2 diabetes, and osteoporosis. They also
recommended multiple exercise sessions in a week,
with each session lasting a minimum of 10 min
(Kesäniemi et al. 2010). In addition to the aerobic
exercise, they recommended strength activities (2-4
days/wk) and flexibility activities (4-7 days/wk). The
duration of the activity depends on the intensity or
effort: Perform light activities (e.g., walking, video
gaming that promotes light effort, gardening, car-
rying small children, or hairstyling) for 60 min,
moderate activities (e.g., brisk walking, swimming,
vacuuming, moving furniture, or chopping wood) for
30 to 60 min, and vigorous activities (e.g., jogging,
hockey, wheelchair basketball, felling large trees,
or rollerblading) for 20 to 30 min.
Improvements in health benefits depend on the
volume (i.e., combination of frequency, intensity,
and duration) of physical activity. This is known as
the dose-response relationship (Loprinzi 2015).
Because of the dose-response relationship between
physical activity and health, even a low level of
100
Percent of potential improvement achieved
80
60
40
20
0
0 500
FIGURE 1.2 Dose-response relationship for health benefits and volume of physical activity.
E7227/Gibson/F01.02/589291/mh-R1
Courtesy of N. Gledhill and V. Jamnik of York University School of Kinesiology and Health Science.
Physical Activity, Health, and Chronic Disease • 7
MVPA each week is better than none; doses less
than one-half of the recommended guidelines may
lead to notable health benefits for those with elevated
risks for chronic conditions and premature mortality
(Warburton and Breden 2016). Exceeding the min-
imum recommended MVPA dose by a factor of 5
(i.e., 750 min/wk or ≥10,000 MVPA MET-min/mo)
may confer the greatest reduction in all-cause mor-
tality risk; no additional mortality-related benefit is
associated with a dose 10 times higher than recom-
mended (Arem et al. 2015; Loprinzi 2015). MVPA
MET-min/mo is easily computed by multiplying
the respective MET level for the specific activities
(see appendix E.3) by the number of minutes one
engages in those MVPA activities within a month.
Figure 1.2 illustrates the general dose-response
relationship between the volume of physical activity
participation and selected health benefits (e.g., mus-
cular strength and aerobic fitness) that do not require
a minimal threshold intensity for improvement. The
volume of physical activity participation needed for
the same degree of relative improvement (%) varies
among health benefit indicators. For example, to
improve triglycerides from 0% to 40% requires 250
kcal·wk−1 of physical activity compared with 1,800
kcal·wk−1 for the same relative improvement (0%-
40%) in high-density lipoprotein (HDL; see figure
1.2). It appears that aerobic-style activities that can
be maintained for longer periods (e.g., bicycling,
dancing, jogging) are positively related to beneficial
Triglycerides (TG)
Blood pressure
Body composition
High-density
lipoproteins (HDL)
1000 1500 2000 2500 3000
Volume of physical activity (kcal/wk)
8 • Advanced Fitness Assessment and Exercise Prescription

changes in HDL (Loprinzi 2015). Jogging at a slow
or average pace ≤3 days/wk for a total of 60 to 150
min/wk confers a favorable increase in heart func-
tion and a similar decrease in mortality, whereas
decades-long strenuous endurance training routines
(≥12 METs) in preparation for extreme endurance
competitions may actually damage the cardiovas-
cular system (Schnohr et al. 2015). Therefore, too
much physical activity, defined as engaging in 5 hr
of structured high-intensity activity per week, may
be associated with negative health consequences or
overuse injuries.
Although no specific dose of sedentary behavior
has been found, a direct linear relationship between
total daily time in sedentary behavior and negative
health indicators associated with metabolic syn-
drome (high triglycerides, high fasting blood glu-
cose, and low HDL-C) has been reported (Gennuso
et al. 2015). Each 60 min increase in daily time spent
being sedentary is associated with a 9% increase
in the odds of satisfying the criteria for metabolic
syndrome (Gennuso et al. 2015).
Although the physical activity guideline—a min-
imum of 150 min of moderate- to vigorous-intensity
aerobic activity weekly, preferably performed on a
daily basis—reduces disease risk, additional physical
activity is needed to mitigate weight gain over time
(Moholdt et al. 2014). Levine (2015) describes how
standing and walking double the energy expended as
compared with sitting; he also illustrates how office
workers can expend approximately 1,000 kcal·day−1
and increase time spent being active by incorporat-
ing walking meetings and short activity breaks in
the typical business day. In 2002, the Institute of
Medicine (IOM) recommended 60 min of daily mod-
erate-intensity physical activity. In the IOM report,
the expert panel stated that 30 min of daily physical
activity is insufficient to maintain a healthy body
weight and to fully reap its associated health benefits.
The IOM recommendation addresses the amount of
physical activity necessary to maintain a healthy
body weight and to prevent unhealthful weight gain
(Brooks et al. 2004). The IOM recommendation of
60 min of daily physical activity is consistent with
recommendations for preventing weight gain made
by other organizations (i.e., Health Canada, Inter-
national Association for the Study of Obesity, and
World Health Organization) (Brooks et al. 2004).

EXAMPLES OF MODERATE-INTENSITY AND

VIGOROUS-INTENSITY AEROBIC ACTIVITIES
This list provides several examples of moderate- and vigorous-intensity aerobic activities. Some activities
can be performed at varied intensities. This list is not all-inclusive; examples are provided to help people
make choices. For a detailed list of energy expenditures (METs) for conditioning exercises, sports, and
recreational activities, see appendix E.3 and http://links.lww.com/MSS/A82. Generally, light activity is
defined as <3.0 METs, moderate activity as 3.0 to 6.0 METs, and vigorous activity as >6.0 METs.
Moderate Intensity Vigorous Intensity
• Walking briskly (3.0 mph [4.8 km·hr−1] or faster, • Race walking, jogging, running, or vigorous
but not race walking) lap swimming
• Skateboarding (noncompetitive) • Tennis (singles)
• Water aerobics and water calisthenics • Dancing (e.g., folk, line, competitive ballroom)
• Bicycling slower than 10 mph (16 km·hr−1) • Bicycling 10 mph (16 km·hr−1) or faster
• Tennis (doubles) • Jumping rope
• Ethnic and cultural dancing (e.g., Middle East- • Backpacking
ern, salsa, merengue, swing) • Circuit training (resistance based with some
• General gardening aerobics and minimal rest intervals)
• Yoga (e.g., hatha, power)

Data from http://links.lww.com/MSS/A82 (accessed June 28, 2018).


The bottom line is that 150 min/wk of moder-
ate-intensity physical activity provides substantial
health benefits but may be insufficient to prevent
weight gain for many individuals. It is a good initial
goal and a sufficient amount of activity to move
individuals from a sedentary to low physical activ-
ity level (Brooks et al. 2004). As individuals adopt
regular physical activity and improve their lifestyle
and fitness, they should increase the duration of
daily physical activity to a level (60 min) that pre-
vents short-term weight gain and provides additional
health benefits. Progression to daily engagement in
physical activity, inclusive of resistance training,
for 60 to 90 min is important for long-term weight
maintenance after weight loss (Bray et al. 2016;
Ryan and Heaner 2014). Although there appears to
be little overall effect on long-term weight loss based
Balance activities
• 3 or more days a week, for
prevention of falls
• Tai chi, yoga, Pilates,
and dance improve balance
Resistance exercise
• 2 or more days a week
• 8-12 repetitions
• 8-10 exercises
• Rest at least one day
between workouts
Activities of
daily living
• Daily physical activity is the base for physical fitness
• Try to be active for at least 30 min every day
FIGURE 1.3 The Exercise and Physical Activity Pyramid.
Adapted by permission from “Exercise and Activity Pyramid,” Metropolitan Life Insurance Company, 1995.
E7227/Gibson/F01.03/589292/mh-R1
Physical Activity, Health, and Chronic Disease • 9
on exercise type (aerobic vs. resistance) or intensity
(lower vs. higher), the reduced time requirement
for equivalent energy expenditure of high-intensity
exercise as compared with low-intensity exercise
may increase exercise adherence and, hence, weight
maintenance (Bray et al. 2016).
The Exercise and Physical Activity Pyramid
illustrates a balanced plan of physical activity and
exercise to promote health and to improve physical
fitness (see figure 1.3). Encourage your clients to
engage in physical activities around the home and
workplace on a daily basis to establish a foundation
(base of pyramid) for an active lifestyle. Strategies
for increasing energy expenditure in the workplace
are built on encouraging active breaks from sitting
in order to move around (e.g., step in place, walk
laps around the office, perform light calisthenics,
Sports and recreational activities
• 2-3 days a week
• Intersperse days of training with a variety
of sport and recreational activities
• Follow safety rules for each activity
• Wear protective equipment
Flexibility exercise
• 2 or more days a week, preferably daily
• 10 min duration minimum
• 3-4 repetitions
• Hold each stretch 10-30 sec
Aerobic exercise
• 30 min, moderate-intensity
(3-6 METs), 5 days a week or
• 20 min, vigorous-intensity
(>6 METs), 3 days a week
• Activity can be continuous or
in multiple segments of at
least 10 min
10 • Advanced Fitness Assessment and Exercise Prescription
walk down the hall to a colleague’s office instead
of calling or e-mailing to deliver a message, climb
a flight of stairs to get a drink of water or use the
restroom). Your clients should perform aerobic
activities a minimum of 3 days/wk; they should do
weight-resistance exercises and flexibility or balance
exercises at least 2 days/wk. Recreational sport activ-
ities (middle levels of pyramid) are recommended
to add variety to the exercise plan. High-intensity
training and competitive sport (top of pyramid)
require a solid fitness base and proper preparation
to prevent injury; most adults should engage in these
activities sparingly.
CARDIOVASCULAR
DISEASE
Cardiovascular disease (CVD) is projected to
cause more than 26 million deaths by 2030 (World
Health Organization 2011b). CVD caused 17.9
million deaths (46% of the deaths attributed to all
noncommunicable diseases) worldwide in 2015. Of
the deaths due to CVD in 2015, the combination
of stroke and ischemic heart disease accounted for
the great majority (85%) (GBD 2015 Mortality and
Causes of Death Collaborators 2016). More than
75% of cardiovascular deaths occurred in low- and
middle-income countries (World Health Organiza-
tion 2016a). CVD is the principal cause of premature
death in Europe, accounting for a nearly equal per-
centage of all deaths before age 75 in women (36%)
and men (35%). Interestingly, however, CVD was
surpassed by cancer as the leading cause of death
in several Western European countries (Townsend
et al. 2016). CVD is also a leading cause of disease
burden in developing low- and middle-income coun-
tries; deaths due to CVD range from a low of 10%
in sub-Saharan Africa to 58% in Eastern Europe
(Wagner and Brath 2012).
In a 2015 report by the CDC identifying the
underlying causes of death in the United States
between 1999 and 2003, diseases of the heart and
blood vessels claimed the lives of about 610,000
people (Centers for Disease Control and Prevention
2015a). CVD accounted for 25% of all deaths (one
out of every four) in the United States. Extrapolating
to 2014 levels, the CDC estimated that more than 92
million Americans have some form of CVD such
as hypertension (~86 million), CHD (27.6 million),
or stroke (7.2 million) (American Heart Association
2017). Among American adults 20 yr of age or older,
the estimated age-adjusted prevalence of coronary
heart disease is higher for black men and women
compared with Hispanic and white men and women
(American Heart Association 2017).
One myth about CVD is that it is much more
prevalent in men than in women. Between 2011 and
2014, the prevalence of CVD in adult women (35.9%)
and men (37.7%) in the United States was similar
(American Heart Association 2017). Nearly 399,000
females died from CVD in 2014 in the United States.
Another misconception about CVD is that it afflicts
only the older population. Although it is true that
older people are at greater risk, more than 50%
of the people in the United States with CVD are
younger than 60 yr (American Heart Association
2017), and CVD ranks as the second-leading cause
of death for children under age 15 (American Heart
Association 2012).
The prevalence of American adults with CHD
was 45.1% in 2014 (American Heart Association
2017). In Europe, CHD accounts for more than 1.7
million deaths, with nearly 19% of those occurring
in adults below the age of 65 (Townsend et al. 2016).
Coronary heart disease (CHD) is caused by a lack
of blood supply to the heart muscle (myocardial
ischemia) resulting from a progressive degenerative
disorder known as atherosclerosis. Atherosclerosis
is an inflammatory process involving a buildup of
low-density lipoprotein (LDL) cholesterol, scav-
enger cells (monocytes), necrotic debris, smooth
muscle cells, and fibrous tissue. This is how plaques
form in the intima, or inner lining, of the medium-
and large-sized arteries throughout the cardiovas-
cular system. As more lipids and cells gather in the
plaques, they bulge into the arterial lumen (Barquera
et al. 2015). In the heart, these bulging plaques
restrict blood flow to the myocardium and may
produce angina pectoris, which is a temporary sen-
sation of tightening and heavy pressure in the chest
and shoulder region. A myocardial infarction, or
heart attack, can occur if a blood clot (thrombus) or
ruptured plaque obstructs the coronary blood flow.
In this case, blood flow through the coronary arteries
is usually reduced by more than 80%. The portion
of the myocardium supplied by the obstructed artery
may die and eventually be replaced with scar tissue.

CARDIOVASCULAR
DISEASE RISK FACTORS
Epidemiological research indicates that many factors
are associated with the risk of CVD. The greater
the number and severity of risk factors, the greater
the probability of CVD. The positive risk factors
for CVD are
•• age,
•• family history,
•• hypercholesterolemia,
•• hypertension,
•• tobacco use,
•• diabetes mellitus or prediabetes,
•• overweight and obesity, and
•• physical inactivity.
An increased level (≥60 mg·dl−1) of high-density
lipoprotein cholesterol, or HDL-cholesterol (HDL-
C), in the blood decreases CVD risk. If the HDL-C
is high, you should subtract one risk factor from
the sum of the positive factors when assessing your
client’s CVD risk.
PHYSICAL ACTIVITY
AND CORONARY HEART
DISEASE
Approximately 12% of CHD deaths in the United
States can be attributed to a lack of physical activ-
ity (American Heart Association 2017). As cited in
American Heart Association (2017), the percentage
of physically inactive people worldwide in 2012
(35%) surpassed the percentage of those who smoked
(26%); however, Sallis and colleagues (2016),
reported the global percentage of physically inactive
adults to be closer to 23%. As an exercise scientist,
you must educate your clients about the benefits of
physical activity and regular exercise for preventing
CHD. Physically active people have lower incidences
of myocardial infarction and mortality from CHD
and tend to develop CHD at a later age compared
with their sedentary or less active counterparts
(American Heart Association 2017). Leading a phys-
ically active lifestyle and sitting less than 4 hr a day
may reduce cardiovascular disease mortality rates
by 23% to 74% (Ekelund et al. 2016). Alternatively,
in their analysis of multiple studies investigating
Physical Activity, Health, and Chronic Disease • 11
sedentary behavior and incidence of CVD, Biswas
and associates (2015) reported an increase in odds
ranging from 6% to more than doubled.
Physical activity, just like sedentary behavior and
cardiorespiratory fitness levels, exerts its effect inde-
pendently of other risk factors related to premature
death from CHD and all causes (Bouchard, Blair,
and Katzmarzyk 2015). Another conclusion about
the independent effect of sedentary behavior (Carter
et al. 2017) is that evidence increasingly points to the
likely link between sedentarism and its ability to fur-
ther exacerbate the traditional, modifiable CV risk
factors (Benatti and Ried-Larsen 2015; Bergouignan
et al. 2016; Same et al. 2016). Also, in a meta-analy-
sis of studies dealing with the dose-response effects
of physical activity and cardiorespiratory fitness on
CVD and CHD risk, Williams (2001) reported that
cardiorespiratory fitness and physical activity have
significantly different relationships to CVD and
CHD risk. Although physical fitness and physical
activity each lower the risk of developing CVD and
CHD, the reduction in relative risk was almost twice
as great for cardiorespiratory fitness as for physical
activity. These findings suggest that in addition to
physical activity level, low cardiorespiratory fitness
level should be considered a potential risk factor
for CHD (U.S. Department of Health and Human
Services 2008).
HYPERTENSION
Hypertension, or high blood pressure, is a chronic,
persistent elevation of blood pressure. Individuals
with this diagnosis are often prescribed antihy-
pertensive medicine. Elevated blood pressure is
the term used to identify systolic blood pressure
(SBP) values between 120 and 129 mmHg, even
if diastolic blood pressure (DBP) is lower than 80
mmHg. Stage 1 hypertension describes a value of
130 to 139 mmHg for SBP or a DBP value of 80 to 89
mmHg; stage 2 hypertension denotes SBP values
≥140 mmHg or DBP values ≥ 90 mmHg (Whelton
et al. 2017). An expanded link exists between hyper-
tension and several forms of CVD (Rapsomaniki et
al. 2014). The World Health Organization (2011b)
identified hypertension as the leading cardiovascular
risk factor, attributing 13% of deaths worldwide to
high blood pressure. If not kept in check, hyperten-
sion becomes a primary risk factor for stroke, heart
Another random document with
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The Project Gutenberg eBook of Kommunisti- ja
bolshevikkipakinoita
This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
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Title: Kommunisti- ja bolshevikkipakinoita

Author: Ilmari Kivinen

Release date: January 16, 2024 [eBook #72733]

Language: Finnish

Original publication: Helsinki: Kust.Oy Kirja, 1928

Credits: Juhani Käkkäinen and Tapio Riikonen

*** START OF THE PROJECT GUTENBERG EBOOK

KOMMUNISTI- JA BOLSHEVIKKIPAKINOITA ***
KOMMUNISTI- JA BOLSHEVIKKIPAKINOITA

Kirj.

Tiitus [Erkki Kivinen]

Helsingissä, Kustannusosakeyhtiö Kirja, 1928.

OHJELMA JA TYÖJÄRJESTYS
PÖLLÖLÄN KYLÄN
KANSANKÄRÄJILLE

Pöytäkirja, pidetty Hölmölän pitäjän Pöllölän kylän kansankäräjäin

valmistuslautakunnan kokouksessa Iso-Hölön pirtissä viime
sunnuntaina klo 8 a.p. Läsnä oli 11 henkilöä sekä Sinkkosen akka,
ynnä Pussisen poika, joka makasi uunilla, jota ei merkitty
pöytäkirjaan.

*****

1:si §:llä:

Hyväksyttiin, että Pöllölän kylän kansankäräjät kokoutuvat tänä

päivänä klo 3 i.p. tässä Ison-Hölön pirtissä, koska ei suutari
Näppinen päässyt eduskuntaan, vaikka sai 18:toista äänilippua.

*****

2:nen pyk.
 Merkittiin, että kansankäräjäin kanslia on tuolla kyökissä, mutta
pitää piika-Reetan siivota sitä ennen tiskit pois pöydältä ja pyyhkiä
pöytä.

Kysymyksen johdosta, onko oltava myöskin piikakirjoituskanslia,

tiedusteli lautakunnan puheenjohtaja lois Mikko Tarjus, osaako
Reeta kirjoittaa. Kun Reeta sanoi, ettei oikein muuten kuin mallin
jälkeen, ja että Sinkkoskan pennut olivat hävittäneet mallin,
päätettiin, ettei tarvitse olla piikakirjoituskansliaa.

Sinkkoska sanoi, että eikö ne lie olleet Reetan omat pennut, mikä
merkittiin pöytäkirjaan.

Sihteeri kysyi, että oliskos tästä asiasta vielä muuta, johon kokous
yksiäänisesti vastasi, että liekkös tuossa sitten muuta.

Israel Huttunen ilmiantoi, että Helsingin eduskunnassa on

ravintolakin, johon Reeta sanoi, että kyllä hän pitää kahvipannun
tulella, mutta pitäisi olla jokaisella omat sokerit, mikä hyväksyttiin.

Kysyttiin, että kutka ovat oikeutetut edustamaan Pöllölän kyläläisiä

kansankäräjillä ja hyväksyttiin ilman äänestystä, että tulkoot ne, jotka
töiltään joutavat.

*****

Kolmas §.

Keskusteltiin ja päätettiin kansankäräjäin avajaisohjelma kuin

seuraa.

Että kansankäräjät kokoutuvat aika ja paikka kuin yllä.

 Että aluksi lauletaan yksiäänisesti pelimannin sävellystä »Voi
minua poika raukkaa».

Että kokouksen avaa lautakunnan puheenjohtaja lois Mikko Tarjus

ilman ikämiespuhetta ja käskee valitsemaan suutari Näppisen
puhemieheksi ja itsensä ensimmäiseksi ja Israel Huttusen toiseksi
varapuhemieheksi, mikä hyväksyttiin.

Että, sitten kun puhemiesmiehistö on valittu ja suutari Näppinen

istunut puhemiespaikalle

jättää tämän valmistuslautakunnan esimies Mikko Tarjus

Issakaisen rengin seuraamana kansankäräjille kertomuksen
valmistuslautakunnan toiminnasta sekä tämän pöytäkirjan,

kuin myöskin lautakunnan esitykset kansankäräjille.

*****

4:s §:lä.

Israel Huttunen ilmineerasi, että kun Mikko Tarjus ja Issakaisen

renki tulevat kyökistä jättämään pöytäkirjan ja esitykset, niin pitää
kansankäräjien nousta seisomaan, mikä hyväksyttiin yksinkertaisella
äänten enemmistöllä.

Sinkkosen akka sanoi, ettei se ole kyökki, vaan kanslia, mikä

merkittiin pöytäkirjaan.

*****

5 §:lä.
 Päätettiin, että äänestykset kansankäräjillä toimitetaan avonaisella
lippuäänestyksellä, joka on oleva sinivalkoinen lippu, mutta jos sitten
vaaditaan huutoäänestystä, niin on se toimitettava.

Sinkkosen akka käski merkitä pöytäkirjaan, että jos hän ei saa

äänestää punaisella lipulla, niin saa olla äänestämättä.

Kokous hyväksyi yksimielisellä ääntenenemmistöllä, että

pyydetään kansakoululta lippu lainaksi lippuäänestyksiä varten.

*****

6:uudes §.

Merkittiin pöytäkirjaan, että kansankäräjät valitsevat seuraavat

valiokunnat:

perustuslakivaliokunnan;

kielikysymysvaliokunnan;

sotilasvaliokunnan;

kirkko- ja kouluvaliokunnan

sekä tupakkavaliokunnan, jos osuuskauppaan tulee huomenna

tupakkoja, mikä hyväksyttiin.

*****

7:mäs §:lä.

Sihteeri sanoi, että pitäisi lopettaa tämä kokous, koska

pöytäkirjapaperi rupeaa loppumaan, johon kokous sanoi, että olet
tainnut kirjoittaa liian suuria puustaimia, etkä olisi tarvinnut kirjoittaa
kaikkia päätöksiä.

Sihteeri vastasi, ettei hän ole kirjoittanut puoliakaan, mikä

hyväksyttiin.

Puhemiehen välikysymykseen, lopetetaanko kokous, vastattiin

huutoäänestyksellä, että lopetetaan vain.

Israel Huttunen pani vastalauseen sitä vastaan että Pussisen

poika oli ottanut osaa uunin päältä huutoäänestykseen, vaikka ei
ollut vielä ripillä käynyt, mikä merkittiin pöytäkirjaan.

Puhemiehen ehdotuksesta huudettiin Pussisen poika alas.

Pussisen poika sanoi, ettei hän voi tulla alas, kun hänen housunsa
ovat pesussa, mikä hyväksyttiin.

Pöytäkirjan tarkastajaksi valittiin allekirjoittanut sihteeri.

Puhemiehen ehdotuksesta kohotettiin kaksinkertainen

eläköönhuuto.

Lopuksi laulettiin moniäänisesti »Hiljaa juuri kuin lammen laine».

Aika ja paikka kuin yllä.

(1919)
KOMMUNISTIEN PUOLUEKOKOUS
PÖLLÖLÄSSÄ

»Pöytäkirja pidetty kommunististen ylenmääräisessä

puoluekokouksessa Pöllölän kylässä Iso-Hölön tuvassa
ehtoopuolella päivää.

Läsnä oli 13 kommunismia ja Pussisen poika, joka istui

ovenpielessä.

*****

Yksi pyk.

Laulettua yksimielisesti »Aamulla varhain» valittiin puhemieheksi

suutari Näppinen useinmainitun Näppisen akan ääntenenemmistöllä.
Aika ja paikka kuin yllä.

Kysyttyä onko kokous laillisesti kutsuttu katsottiin kutsutuksi.

Otettiin esityslistalle alustus kommunistin puolueen

järjestäytymisestä, minkä oli luvannut pohjustaa väliaikalainen
puoluetoimikunta Makkosen leski.
 Tarkastettuna havaittua Makkosen lesken ei läsnäolevaiseksi esitti
puhemies vastattavaksi kysymyksen, tietääkö kukaan missä
Makkoska on.

Pussisen poika ilmoitti ilman äänioikeutta, että se taisi pistäytyä

navettaan katsomaan niitä mustankirjavia sianporsaita. Julistettiin.

Sanottiin kansalta, että pohjusta sinä Näppinen sitten. Olethan

sinä koko ikäsi pohjustanut.

Pussisen pojan naurettua tämän johdosta ja ulos käskettyä

häiriöstä julkisella paikalla pohjusti suutari Näppinen kommunistin
aatteen selvässä valossa tulevilla huomautuksilla vallankumouksen
perusteella.

*****

2 pyk.

Kysyttiin, onko sallittava lähetekeskustelua, mikä sallittiin.

Väliaikalainen puoluetoimikunta tuli navetasta ja sanoi emännälle,

että jos hän saisi yhden porsaan, minkä johdosta puhemies koputti
pöytään mainitun porsaan ei asiaan ja parlamentaariaan kuuluvana.

Käsiteltiin periaatteet puolueen ohjelman pohjalle niinkuin alla

seuraa:

1. Että on porvarillinen valtiokoneisto poistaminen. Huomautettiin,

että ei päätös koske puimakonetta, koska on osuuskunnassa
myöskin kommunisteja eikä Pahakosken myllyä, koska on mylläri
punikki. Merkittiin pöytäkirjaan.
 2. Karkoittaen virkavallan kaikkialta, mikä hyväksyttiin suurella
huutoäänestyksellä. Ja annettiin puhemiehelle valtuus edeskantaa
kansan tahto raittiuslautakunnalle ja konstaapeli Toloselle.

3. Sen sijaan köyhälistön vallan järjestäminen työväen

neuvostojärjestelmän muodossa.

Palstatilallisen Miettisen kysyttyä, kuuluuko maamiesseuran

konsulentti neuvostojärjestelmän muotoon päätettiin panna kysymys
viheriän veran alle, mutta koska ei ollut viheriäistä verkaa niin pantiin
pöydälle.

Edelläolevat kolme monumenttia tarkastettiin ja asia julistettiin

loppuunkäsitellyksi toisessa lukemisessa.

*****

3:mas pyk.

Koskeva kapitaalien riisto-omaisuutta leikattiin lehdestä

julkiluettavaksi haltuun ottamisen ohjesääntö:

»Työväen neuvostovallan haltuun on otettava kaikki valtion ja

kuntain taloudelliset laitokset, samoin kapitalistien pankit, tehtaat,
suuret kauppaliikkeet, varastot ja talot sekä muu kapitalistinen riisto-
omaisuus».

Matikaisen kysyttyä että tuleeko ne sitten ikäänkuin otettavaksi

lahtarilta kommutistille vastattiin välikysymystietä että tulee.

Matikainen sanoi, että hyvähän ne olisi ottaa, mutta ei taida

porvari piru antaa, ja lausuttiin porvaristolle halveksuminen, mikä
päätettiin merkitä pöytäkirjaan.
 Makkosen kysymys, onko Matikainen katsottava kommutismiksi
lähetettiin valmistusvaliokuntaan, joka läksi porstuaan kokousta
pitämään, vieden Matikaisen muassaan kuulustelemista varten.

*****

4 pyk.

Esitettiin vastattavaksi, onko laajaan sosialistisoimiseen viipymättä

ryhdyttävä rengastuneilla ja strudsiutuneilla tuotannon aloilla;
vastattiin laajan ja vaihtelevan keskustelun jälkeen, vaihtuen joskus
yleis-mölinäksi, kielteisellä suhtautumisella seuraavien
monumenttien perustuksella:

A.) Ei ole sosialistisoimiseen ryhdyttävä, koska on kommunistinen

maailmankatsomus eronnut herrassosialisteista.

P.) Koska strudsit ovat Aafrikan lintuja joita ei ole Pohjolassa, niin
on alotteen herättäminen johtunut joko pilkanteosta taikka
prowogaattorista, mikä hyväksyttiin.

Monumentit päätettiin pitää heti tarkistettuina.

*****

5 pyk.

Puheenjohtajan kysymykseen että mitä se valmistava valiokunta

siellä porstuassa vielä vöhnii, ilmoitti Pussisen poika ovenraosta
ilman äänestysoikeutta, että ne läksivät Matikaisen mökille
tarkastamaan, onko Matikainen kommutismi, mutta lupasivat tulla
pian takaisin.
 Laulettiin odotellessa moniäänisesti »Tuonne taakse metsämaan».
Ehdotus, että laulettaisiin »Työn orjat, sorron yöstä nouskaa», ei
saavuttanut kannatusta, ollen oikeistososialistinen laulu vanhan
mädännyksen perustalla.

*****

6 pyk.

Valmistava valiokunta palasi takaisin ja ilmoitti, että Matikaisella on

todellakin se punertava kommuuti, jonka Matikaisen veli huusi sieltä
lukkarivainajan avisuunista, minkä johdosta kokous yksimielisesti
myönsi Matikaisen kommutistiksi.

Matikainen kiitti liikutetuin mielin ja tarjosi muillekin samasta

pullosta, joka vetää kaksi litraa.

Kokous päätettiin yhteisellä soololaululla:

»Hunttarulla vaan,
Vasikannahka vaan.
Se riippuu vaan.
Kun se pannaan riippumaan».
KOMMUNISTIEN
ULKOPARLAMENTTAARINEN
TOIMINTA PÖLLÖLÄSSÄ

Kommunistien ulkoparlamenttaarinen toiminta edestuotiin Pöllölän

Hölölässä toissapäivänä klo 6,13 i.p.p.

Läsnä oli puoli tiuta kommunismin soluja ja Pussisen poika, kuin

on vähän ristiverinen.

Puheenmiehenä toimitsi ikäsolu Jerobeam Näppinen

taidehikkaasti.
Pikapöytäkirjaa piti tunteellisella taipumuksella lois Mikko Tarjus.

Laulettiin viehkeästi:

»Tässä kylässä tyttöjä on ainoastaan viisi, neljä on ryssien

narraamaa ja viidettä vaivaa riisi».

Jerobeam Näppinen esiintoi alentavassa äänilajissa, että uunin

peltit on suljettava, koska on hänellä salaperäinen ilmianto suuressa
tärkeydessä.
 Sulkemisen toimitti Pussisen poika.

Puheenmies edeskantoi Herra Toveri Rotskin terveiset, jotka yksi

jätkämies oli tuonut langattomalla etappitiellä, että hedelmä on kypsä
ja kirves pantu puun juurelle. Ilmoitus herätti vilkasta
mielenliikkumista luokkatietoisessa kansalaisainehistossa.

Kaisa Kompura ehdotti, että jätkämiehen mukana lähetettäisiin

kommunistinen uskollisuusvala Rotskille, mikä hyväksyttiin
yksimielisesti 4 äänellä viittä vastaan. Aiheuttaen halpa-arvoista
naurun tyrskähdystä Pussisen pojan puolelta. Kokous lausui
Pussisen pojalle kummastuksensa. Merkittiin pöytäkirjaan.

Pussisen poika ilmeneerasi, ettei ollut nauranut vaan että oli häntä
muuten kakisuttanut, mikä hyväksyttiin. Toimeenpanevan
Keskusneuvoston ylikomissari Israel Huttunen esiintoi lennättävällä
tavalla valkosuomalaisen hirmuhengen mädännäisyydet, mitkä
kaameassa valaistuksessa yksimielisellä ääntenenemmistöllä
hyväksyttiin.

Väkevän toverihengen vallalleen päästessä ja uuninpeltien tultua

jälleen avatuiksi yhteiskunnalliseen tarkoitukseensa luki Jerobeam
Näppinen voimakkaalla paahtoksella »Tuonen Työmiehen»
aartikkelin eduskunnan ulkopuolisesta taistelusta luokkakaarti-
apurahojen kieltämiseksi.

Hyväksyttiin keskustelutta arvoisan äänenkannattajan mielipuoli,

että ottamalla laajat valitsijajoukot Pöllölän kommuunista mukaan
tähän taisteluun saadaan enemmän pontta.

Huutoäänestyksellä vahvistettiin Tuonen Työmiehen vaatimus, että

»on annettava myöskin kansanjoukkojen ulkopuolella eduskunnan
sanoa sanansa».

Mikko Tarjuksen kysymykseen, millä tavoin se kävisi päinsä,

selvitti Israel Huttunen tosiperäisellä taktillisuudella tulevan
koottavaksi joukkoja Helsinkiin eduskunnan ulkopuolelle huutamaan
eduskuntaa alas.

Eräiden kysyttyä, voisiko myös täräyttää kivillä muutamia ruutuja

rikki vallankumouksellisen joukkotahdon tehostamiseksi lausui toveri
Huttunen inviditualistisena mielipiteenään tämän riippuvan
paikallisista olosuhteista ja siitä, sattuuko olemaan poliiseja lähellä.

Pussisen aikamiespoika huusi vastavallankumouksellisella

ivamielisyydellä, katukivien Helsingissä olevan tiukkaan iskettyjä,
niin että pitäisi ottaa kanget mukaan tai viedä tarvittavat kivet
kontissa selässään, mille ala-arvoiselle puheelle kuultiin muutamien
vähemmän harkitsevien toverien nauraa räkättävän.

Puheenmiehen esityksestä ilmaisi kokous halveksimisensa

Pussisen pojalle musertavalla kommunistisella äänettömyydellä.

Keskusteltiin kysymyksestä, olisiko Pöllölästä lähetettävä joukkoja

Helsinkiin ulkoparlamentaariseen toimintaan kadulle eduskunnan
ulkopuolelle lahtareiden ja ohranoiden hätkäyttämiseksi, ja
hyväksyttiin, että lähetettävä on.

Kysyttiin kutka lähtevät vapaaehtoisesti.

Merkittiin pöytäkirjaan, ettei kukaan ilmoittautunut.

Puheenmies Näppinen piti leveäperäisen puheen ohranoiden

kurjasta kätyröimisestä taantumuksen helmassa, ja kehoitti
vakuuttavin sanoin kansankerroksia nousemaan
ulkoparlamentaariseen toimintaan.

Sinkkosen Reetan kysymyksen, mitä sitten tehdään, jos porvalit

sanovat että top, ehdotti puhemies pantavaksi vihreän veran alle.

Useiden karjuessa yhtyvänsä Sinkkosen akkaan peräytti toveri

Näppinen ehdotuksensa, koska ei ollut saatavissa viheriäistä verkaa.

Puheenmies ilmoitti vallankumouksellisella tiktatuurilla

määräävänsä läsnäolevat lähtemään eduskuntaa painostamaan.

Sinkkosen Reetan kysymykseen, että tuletkos sitten itse mukaan,

ilmoitti Jerobeam Näppinen vallankumouksen ohjelman mukaan ei
voivansa poistua paikkakunnalta, koska oli hänen jäätävä Pöllölään
vartioimaan vallankumouksen saavutuksia.

Monen huutaessa häpeällisiä solvauksia jäniksenpesästä

Näppisen pöksyissä ja keskustelun muututtua yleiseksi mölyksi
laulettiin myllertävien maininkien rauhoittamiseksi Israel Huttusen
mestarillisella johdolla:

»Meijerskall' on pienet silmät,

Iso nenä päässä.
Kilon köntti kädessä
Ja kävelee kuin jäässä».

Laajapiirteisen puheenvaihdon jälkeen hyväksyttiin kompromissi,

että ei mennä ulkoparlamentaariseen toimintaan Helsinkiin, vaan
siirrytään Hölön pihalle, kuin myöskin paikalla toteutettiin.

Kaikkien siirryttyä tuvasta pihalle huudettiin puheenmiehen

ehdotuksesta paljastetuin päin kolminkertaisesti alas ohranat ja
suojeluskuntamäärärahat.

Tapauksesta eduskunnan kommunistisoluille kirjallista tietoa

antamaan valtuutettiin Näppinen ja Mikko Tarjus.

Jerobeam Näppisen lausuttua vakaumuksenaan tämän tapauksen

muodostuneen kuoliniskuksi ohranoille ja määrärahoille läksi
puoluekokous nurkkatansseihin Rötkylän torpalle.

(1921.)