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The School of Natural Therapies

Training School for Massage & Holistic Therapies 

ITEC Sports and Remedial Massage


ITEC Level 3


                                   Submitted by:   Khaleem Ash


  • Understanding the benefits of an active, healthy, lifestyle.
  • Understand the effects of exercise on the body.
  • Know the components of fitness.
  • Know the principles of training.
  • Understand the importance of healthy eating.


  • Explain what constitutes an active healthy lifestyle.

Healthy active living includes eating healthy foods, staying physically active, and getting enough rest. Developing healthy habits starts in early childhood. Eating well and being physically active helps a child continue to grow and learn.

Research tells us that the way young children eat, move, and sleep can impact their weight now and in the future. Early childhood is an ideal time to start healthy habits before unhealthy patterns are set. It’s never too early to start:

  • Encouraging breastfeeding for at least the first 6 months of life
  • Eating healthy meals and snacks

Young children depend on parents, care givers, and others to provide environments that foster and shape healthy habits.  Eat at least 5 fruits and vegetables a day.

  • Keep screen time (like TV, video games, computer) down to 2 hours or less per day.
  • Get 1 hour or more of physical activity every day.
  • Drink 0 sugar-sweetened drinks. Replace soda pop, sports drinks and even 100% fruit juice with milk or water




1.2 Describe the benefits of leading an active healthy lifestyle.

An active lifestyle means you do physical activity throughout the day. Any activity that gets you up and moving is part of an active lifestyle. Physical activity includes exercise such as walking or lifting weights. It also includes playing sports. Physical activity is different from other kinds of activity, such as reading a book. This kind of activity is called sedentary. A sedentary lifestyle means you sit or do not move much during the day. An active lifestyle has many benefits, such as helping you prevent or manage health conditions. 

Benefits of an active lifestyle –

  • You may be able to do daily activities more easily.¬†Activity helps condition your heart, lungs, and muscles. This can help you get through your daily activities without feeling tired.
  • You can help control your weight.¬†Activity helps your body use the calories you eat instead of storing them as fat. Your body continues to burn calories at a higher rate after you are active.
  • Activity can increase your health.¬†Activity helps lower your risk for cancer, heart disease, diabetes, and stroke. Activity can help you control your blood pressure and blood sugar levels and lower your cholesterol. If you have arthritis, activity can help your joints move more easily and with less pain.
  • Your bones and muscles will get stronger.¬†This will help prevent osteoporosis and reduce your risk for falls.
  • Activity can help improve your mood.¬†Activity can reduce or prevent depression and stress. Activity can also help improve your sleep.

A sedentary lifestyle increases your risk for diseases such as diabetes, high blood pressure, and heart disease. Your immune system also becomes weaker. This means it cannot fight infections well.

Any activity is better than no activity at all. When you go from being mostly inactive to adding some activity, you will see health benefits.

Do aerobic activity several days each week. Aerobic activity includes walking, bicycling, dancing, swimming, and raking leaves. Aim for 150 to 300 minutes (2.5 to 5 hours) of moderate activity, or 75 to 150 of vigorous activity each week. You can also do a combination of moderate and vigorous activity.

Do strength training at least 2 times each week. Strength training helps you keep the muscles you have and build new muscles. Strength training includes push ups, yoga, tai chi, and weightlifting. If you do not have access to weights, you can lift items around your house. Try to work all the major muscle groups, such as your legs, arms, abdomen, and chest.


2.1 Describe the short and long term effects of exercise on the body systems

After exercising, the muscles need to rest, adapt and recover. There is a risk of injury if the body is not rested for long enough after exercise.

When we begin to exercise the body has to respond to the change in activity level in order to maintain a constant internal environment (homeostasis).

Short term effects of exercise on the muscles –

  • The higher rate of muscle contraction depletes energy stores and so stimulates a higher rate of¬†energy metabolism.
  • The body‚Äôs energy stores are slowly depleted
  • Myoglobinreleases its stored Oxygen to use in aerobic respiration. O2 can now be diffused into the muscle from the capillaries more quickly due to the decreased O2 concentration in the muscle.


Long Term Effects of Exercise

Regular exercise results in adaptations to the circulatory, respiratory and muscular systems in order to help them perform better under additional stress. Here are the changes which must take place within the muscles, respiratory system and circulatory system:

  • Increased numbers of¬†mitochondria¬†(the cell‚Äôs powerhouse) mean an increase in the rate of energy production.
  • The muscles, bones,¬†and ligaments become stronger to cope with the additional stresses and impact put through them.
  • The amount of¬†myoglobin¬†within skeletal muscle increases, which allows more Oxygen to be stored within the muscle and transported to the mitochondria.
  • Muscles are capable of storing a larger amount of glycogen for energy.
  • Enzymes involved in energy production become more concentrated and efficient to aid the speed of metabolism.




2.2 Describe the blood pooling effect following exercise

Also known as ‚Äúblood pooling‚ÄĚ, occurs¬†when the blood in blood vessels expands during prolonged exercise, making it difficult for it to return to the heart from the legs. According to many health and fitness instructors, the total cool-down period should last three to 10 minutes, or until you are ready to stop.

Blood pooling is a condition where blood gathers in the lower limb (legs) for several reasons including exercise.

When blood gathers in a blood vessel it places excess stress on the small non-return valves that prevent the blood from being drawn back down to the feet due to the effect of gravity.

During exercise, the heart is pumping at an accelerated rate and the oxygenated blood has to be pumped from your heart and make it all the way through your lower extremities before working its way back to the heart (against gravity) to be re-oxygenated again. When the body goes from moving quickly or performing a lot of work during your last set to working less and moving slowly, the squeezing action provided by the working muscles is greatly diminished. When exercise is stopped abruptly, this can cause the blood to pool in the lower extremities and slow its return back to the heart and, subsequently, the brain.

Another factor that adds to this dilemma is the one-way valves that are present within our vascular system. Veins, which are generally responsible for returning deoxygenated blood back to the heart and lungs, come equipped with one-way valves spaced throughout to prevent back flow. When the movement of blood slows within the vascular system, there is less pressure available to move the blood through these doorways, which causes the blood to become somewhat ‚Äėtrapped‚Äô between these valves. All of this can lead to light headedness, dizziness, and fainting.




2.3 Identity the types of activities likely to cause delayed onset of muscle soreness.


DOMS occurs 24 to 48 hours after exercise due to microtears in the muscle fibres. This is a normal part of exercise, and some soreness is to be expected, especially with resistance training or a new form of exercise. However, considerable amounts of DOMS is not comfortable and can be rather debilitating when trying to stay on a consistent exercise schedule. DOMS that hangs around for more than two to three days may also be a sign of overtraining or illness or be a precursor to injury.

Cooling down after your workout is a great way to help minimize the DOMS effect. A recent study conducted at California State University looked at the effect of recovery interventions of moderate- and low-intensity cycling, as well as seated rest after strength training.

What they found was that when completed after the strength training bout, the moderate intensity cycling cool-down showed a significant decrease in DOMS due to increased blood flow to the exercised muscles.


3.1 Define the health-related components of fitness

Health-related components of Physical Fitness. There are five components of physical fitness: (1) body composition, (2) flexibility, (3) muscular strength, (4) muscular endurance, and (5) cardiorespiratory endurance

That’s where the five components of fitness come in physical activity guidelines and serve as a helpful tool for organizing and executing your own well-balanced workout routine

The five components of fitness are:

  • Cardiovascular endurance
  • Muscular strength
  • Muscular endurance
  • Flexibility
  • Body composition

Creating a fitness plan that incorporates each of these elements can help ensure that you get the most health benefits from your routine.

Cardiovascular endurance (also known as cardiorespiratory endurance or aerobic fitness) refers to your body’s ability to efficiently and effectively intake oxygen and deliver it to your body’s tissues by way of the heart, lungs, arteries, vessels, and veins. By engaging in regular exercise that challenges your heart and lungs, you can:

Maintain or even improve the efficient delivery and uptake of oxygen to your body’s systems

Enhance cellular metabolism

Ease the physical challenges of everyday life. Running, walking, cycling, swimming, dancing, circuit training, and boxing are just a few of the many workouts designed to benefit heart health.

The ACSM’s physical activity guidelines call for at least 150 minutes of moderate-intensity exercise each week, or 75 minutes of vigorous exercise.

The key, of course, is consistency. It may sound like a lot, but 150 minutes breaks down to just 20 to 30 minutes of exercise per day, five to seven days a week, depending on how hard you push yourself.

Muscular endurance is one of two factors that contribute to overall muscular health. Think of muscular endurance as a particular muscle group’s ability to continuously contract against a given resistance.

Long-distance cyclists offer a clear example. To continuously pedal a bike over a long distance, often up steep inclines, cyclists have to develop fatigue-resistant muscles in their legs and glutes. These are evidence of a high level of muscular endurance.


3.2 Define the skills related components of fitness

Skill related fitness consists of fitness components that are important to success in skilful activities and athletic events, and may not be as crucial to improved health. These components include agility, balance, coordination, power, reaction time, and speed.

Fitness is a condition in which an individual has sufficient energy to avoid fatigue and enjoy life.

Physical fitness is divided into four health and six skill-related components. Skill- or performance-related fitness involves skills that will enhance one’s performance in athletic or sports events. Health-related fitness involves skills that enable one to become and stay physically healthy.

Six Components of Skill-Related Fitness

There are six skill-related fitness components: agility, balance, coordination, speed, power, and reaction time. Skilled athletes typically excel in all six areas.

Agility is the ability to change and control the direction and position of the body while maintaining a constant, rapid motion. For example, changing directions to hit a tennis ball.

Balance is the ability to control or stabilize the body when a person is standing still or moving. For example, in-line skating.

Coordination is the ability to use the senses together with body parts during movement. For example, dribbling a basketball. Using hands and eyes together is called hand-eye coordination.

Speed is the ability to move your body or parts of your body swiftly. Many sports rely on speed to gain advantage over your opponents. For example, a basketball player making a fast break to perform a layup, a tennis player moving forward to get to a drop shot, a football player out running the defense to receive a pass.

Power is the ability to move the body parts swiftly while applying the maximum force of the muscles. Power is a combination of both speed and muscular strength. For example, fullbacks in football muscling their way through other players and speeding to advance the ball and volleyball players getting up to the net and lifting their bodies high into the air.

Reaction Time is the ability to reach or respond quickly to what you hear, see, or feel. For example, an athlete quickly coming off the blocks early in a swimming or track relay or stealing a base in baseball.



3.3 Identify the factors that affect health and skill related fitness

Health related fitness can be broken down into the following components: cardiovascular fitness muscular strength muscular endurance flexibility, and body composition. Skill-related fitness can be broken down into speed quickness agility balance co-ordination, and power.

Skill Related Fitness –

There are different aspects of skill related fitness, and each can impact on performance in either a positive or negative way. Aspects include:

  • agility
  • balance
  • control
  • co-ordination
  • reaction time

Physical fitness basically refers to that condition of the body wherein an individual is able to carry out his lifestyle activities with greater ease while being immune to potential health issues and emergency situations. This can be totally determined by these established metrics which are described below accordingly.

  1. Body composition

This basically refers to the relative level of muscle, fat, bones, and other vital elements of the body. Measured using skin fold measuring calipers, DEXA, etc, it plays a highly significant role in determining the strength to weight ratio for better performance levels of the body in the day to day activities.

  1. Cardiovascular fitness levels

This particularly refers to the potential of the respiratory and the circulatory systems to send oxygen levels to the body parts when under physical activity. Measured using the VO2 MAX test, this is highly important in determining the lung capacity of the individual.

  1. Flexibility

This refers to the degree of motion variation, especially in the joints. Though flexibility cannot be measured superficially, stretches help one find out, how well a particular joint imbibes flexibility. It is one influencing factor that determines how well the other body functions are coordinated to the best of perfection.

  1. Speed

This highlights the ability of the body to perform a particular task within a short duration of time. It is measured in various sports and activities like running, swimming, etc., and has quite a significant role to play when it comes to determining how well a person can coordinate under stress.

  1. Power

This particular aspect is basically attributed to the muscular units applying the maximum force to any particular object. Characterized by speed and strength, power almost always determines the kind of motion you possess during any sports or activity.

  1. Coordination

Highly definitive of motor controls, coordination serves as the contributing factor for establishing movement skills. Coordination can be highly essential to keep the easy movement of the various body parts for a perfectly controlled activity.

  1. Balance

Balance refers to the act of stabilizing in a neutral position, irrespective of the state the person’s body is in. Tests for the same can be dynamic or static based upon the resistance power of the body against change factors can be measured.

  1. Agility

Agility refers to the quick movements of the person, with respect to the time and space factors. Agility plays a very important role in determining the speed of decisions taken and also the brisk personality of the corresponding individual.

  1. Muscular fitness

This basically refers to the endurance levels of the various muscles to the subliminal resistance activities of the body. A better muscular fitness level provides for a more energetic behavior on the part of the individual.

  1. Strength

Strength primarily refers to the ability to exert substantial force on the body. Strength levels are highly metric to the bone mass and definitive training is done to achieve greater strength levels on the whole.


4.1 Identify the principles of training.

In order to get the maximum out of your training, you need to apply the five key principles of training ‚Äď specificity, individualisation, progressive overload, variation and be aware of reversibility.

Specificity Рtraining must be relevant to the individual and their sport. This can be achieved by tailoring training specifically for the sport or even the position that the individual plays, the muscle groups that they use the most or the dominant energy system of the athlete aerobically.

Progressive overload¬†– training frequency, intensity, time or type (FITT ‚Äď see below) must be¬†increased¬†over the training period to ensure that the body is pushed beyond its normal rhythm. Increases must be gradual so that the athlete avoids a plateau in performance or, worse, injury.

FITT – (Frequency, Intensity, Time, Type)¬†–¬†Frequency¬†is increased by training a greater number of times each week.¬†Intensity¬†is increased by lifting a greater resistance, such as with weight training, or by training at a higher percentage of maximum heart rate (maxHR).

Individual needs¬†– all athletes are different. Training must be related to the athlete’s age and¬†gender, their injury status and fitness level. Any training that fails to be relevant to the individual will fail to motivate the athlete and will prove to be unsuccessful in the long term.

Rest and recovery Рphysical adaptations occur during the recovery and non-active period of the training cycle. Therefore, athletes and trainers must achieve the right amount of rest between sessions, good sleep patterns and the right nutrition, including the use of protein, to help repair the damage caused by intense training.

Reversibility Рsystems reverse or de-adapt if training stops or is significantly reduced or injury prevents training from taking place. It is essential to avoid breaks in training and to maintain the motivation of the athlete.

Overtraining Рif an athlete does not have sufficient rest periods, then they are at risk of overtraining. This is when the body does not have time to adapt to the training and as a result the fitness of the athlete declines, and they are more at risk of becoming ill or injured.




4.2 Describe the physiological implications of each training principle


Training Principle 1: Overload

For any adaptation to take place, the human body is required to exert itself¬†beyond the normal stress levels of training.¬†Put simply, you need to ‚Äėsuffer‚Äô in training in order to progress. This doesn‚Äôt mean every single session you need to be putting yourself in the ‚Äėpain cave‚Äô but you will need to check in regularly to ensure you are pushing yourself enough for the body to reset its current fitness levels.

Training Principle 2: Progression

I like to think of progression as a very close relation of overload. Overload refers to the stress of a single session, progression relates to the short, medium and long-term development of an athlete. In a well-periodized program, the athlete should be challenged regularly to attain new levels of fitness to ensure better performance is given. The higher the caliber of the athlete the more difficult this becomes to elicit.

Training Principle 3: Recovery

The adaptation to overload occurs during rest periods. When you are pushing your limits, you are in the process of breaking down your body. During the recovery phase, the body experiences a ‚Äėsuper-compensation‚Äô which results in the body adjusting to new levels of fitness.

Training Principle 4: Specificity

This put simply means that you’ll get better at what you do. If you want to improve your swimming, then swim more. If you want to improve your riding, then ride more. If you want to improve your running, then run more. There are many other modalities of exercise that will have some transfer regarding their benefit to you, but nothing beats training specifically for the disciplines you are trying to improve.

Training Principle 5: Reversibility

Failure to regularly adhere to your training program will result in you going backward. So that massive training block you did 6 months ago won’t mean much now if you haven’t done anything since!







4.3 Describe signs and symptoms that may indicate overtraining

Training-related signs of overtraining

  • Unusual muscle soreness after a workout, which persists with continued training.
  • Inability to train or compete at a previously manageable level.
  • “Heavy” leg muscles, even at lower exercise intensities.
  • Delays in recovery from training.
  • Performance plateaus or declines
  1. Not eating enough

Weightlifters who maintain an intense training schedule may also cut back on calories. This can negatively affect health and performance. If your body consistently draws on its energy reserves, you may develop nutritional deficiencies such as anemia.

More serious conditions can arise that affect your cardiovascular, gastrointestinal, and endocrine systems. It’s also possible to develop nervous system and reproductive system complications, including period loss or irregular cycles.

  1. Soreness, strain, and pain

Pushing yourself past your limits during a high-intensity interval training (HIIT) workout can lead to muscle strain and pain. Overstressing your body can cause soreness and injuries. You may experience microtears in your muscles as well.

  1. Overuse injuries

Running too often can lead to overuse injuries such as shin splints, stress fractures, and plantar fasciitis. Other overuse injuries include joint strains, broken bones, and soft tissue injuries.

High impact exercise such as running puts stress and wear and tear on your body. If you have an injury, take a break from all types of training to allow it to heal.

  1. Fatigue

It’s somewhat normal to feel tired after exercise, but fatigue happens when your body repeatedly doesn’t fully recover after you work out. You may feel excessively drained, especially during or right after workouts.

Fatigue can also set in when you regularly don’t get enough fuel before you train. Your body then has to use its carbohydrate, protein, and fat reserves for energy.

  1. Reduced appetite and weight loss

Working out usually leads to a healthy appetite. However, working out too much can cause hormonal imbalances that can influence how hungry or full you feel. OTS can cause exhaustion, decreased appetite, and weight loss.

  1. Irritability and agitation

Overtraining can affect your stress hormone levels, which can cause depression, mental fog, and mood changes. You may also experience restlessness and a lack of concentration or enthusiasm.

  1. Persistent injuries or muscle pain

Extended muscle soreness and injuries that don’t heal are also signs of overtraining. You may have chronic injuries or nagging injuries that linger for a long time.

Rest between workouts is vital to recovery. It’s harder for your body to heal when too much stress is placed on it.

  1. Decline in performance

Overtraining can cause your performance to plateau or decrease rather than improve. You may find you have less strength, agility, and endurance, which makes it more difficult to reach your training goals. Overtraining can also slow your reaction time and running speed.

  1. Workouts feel more challenging

If you have OTS, you may feel like your workouts are more difficult, like they take more effort to complete. This increase in your perceived effort can make you feel like you’re working harder even though your body is working at its usual rate.

You may have a higher heart rate while you’re working out and a higher resting heart rate during the day. Additionally, your heart rate may take longer to return to its resting rate once you finish exercising.

  1. Disturbed sleep

When your stress hormones are out of balance, you may find it hard to relax and let go of tension at bedtime. This cuts into the crucial time your body needs to rest, repair, and restore itself during sleep. Lack of quality sleep can also lead to chronic fatigue and mood changes.

  1. Decreased immunity or illness

Along with feeling run-down, you may find you get sick more often. You may also be prone to infections, mild illnesses, and upper respiratory tract infections (URTIs).

  1. Weight gain

Exercising too much without resting enough in between can lead to low testosterone levels and high levels of cortisol, the stress hormone. These hormonal changes are often associated with loss of muscle tissue, weight gain, and excess belly fat.

  1. Loss of motivation

You may find it difficult to stay motivated to work out. This can be due to mental or physical exhaustion, the feeling that you’re not achieving your fitness goals, or lack of enjoyment. Either way, try to make positive changes so you can feel inspired again.

When to take a break

Take an extended break from training if you have any injuries that need time to heal completely or if you’re experiencing burnout. During this time, stay away from any high impact or intense forms of exercise. Give yourself time to make a full recovery.


5.1 Explain the dietary role of key macro nutrients

Macronutrients are eaten in large amounts and include the primary building blocks of your diet protein, carbohydrates, and fat which provide your body with energy. Vitamins and minerals are micronutrients, and small doses go a long way

Nutrients¬†are substances needed for growth, energy provision and other body functions.¬†Macronutrients¬†are those nutrients required in large amounts that provide the energy needed to maintain body functions and carry out the activities of daily life. There are 3¬†macronutrients¬†‚Ästcarbohydrates,¬†proteins¬†and¬†fats.

Macronutrients give us energy

Although each of these macronutrients supplies the energy needed to run body functions, the amount of energy that each provides varies.

Carbohydrates and proteins each provide 17kJ/g whereas fats provide 37kJ/g. 1 kilojoule (kJ) = 1000 joules.

4.2 joules is the energy needed to raise the¬†temperature¬†of 1g of water by 1¬įC.

Nutritional research evidence shows that the relative proportion of energy-giving foods in the diet can increase or decrease the likelihood of problems such as heart disease. A balance of energy-giving nutrients is suggested.

For example, if an active teenager’s energy requirements are around 12,000kJ per day, an intake for energy purposes of about 388g of carbohydrate along with some protein (110g) and fat (97g) would meet this need. These values equate approximately to 55% of energy needed from carbohydrate, 30% from fats and 15% from protein.

Carbohydrates, in the form of starches and sugars, are the macronutrients required in the largest amounts. When eaten and broken down, carbohydrates provide the major source of energy to¬†fuel¬†our daily activities. It is recommended that carbohydrates should supply 45‚Äď65% of our total daily energy needs.

Some of the carbohydrate we consume is converted into a type of starch known as glycogen, which is stored in the liver and muscles for later use as an energy source.

Not all of the carbohydrates found in foods are digestible. For example,¬†cellulose¬†is a non-digestible carbohydrate present in fruits and vegetables. Although unable to be used as an energy source, this type of carbohydrate plays a very important role in maintaining the health of the¬†large intestine¬†and assisting with the removal of body waste. It is often referred to as ‚Äėdietary fibre

Proteins we consume as part of our diet are broken down in the gut to amino acids. The body can then use these amino acids in 3 main ways:

As ‚Äėbuilding blocks‚Äô in the production of ‚Äėnew‚Äô proteins needed for growth and repair of tissues, making essential¬†hormones¬†and¬†enzymes¬†and supporting immune function.

As an energy source.

As starting materials in the production of other compounds needed by the body.

All the proteins in the body are made up of arrangements of up to 20 different amino acids. Eight of these amino acids are described as ‚Äėessential‚Äô, which means that the food we eat must contain proteins capable of supplying them. The other amino acids can be synthesised by the liver if not provided by the diet.

Protein in the diet that comes from animal sources contains all of the essential amino acids needed, whereas plant sources of protein do not. However, by eating a variety of plant sources, the essential amino acids can be supplied.

Fats have received a bad reputation in relation to heart disease and weight gain, some fat in the diet is essential for health and wellbeing.

It is recommended that 20‚Äď35% of our daily energy requirement should be supplied through the consumption of¬†fats and oils. In addition to supplying energy, fats are needed to:

supply fatty acids that the body needs but cannot make (such as omega 3)

assist with absorption of the fat-soluble vitamins A, D, E and K and carotenoids

provide foods with flavour and texture.

Dietary fats are of 3 main types:

Saturated fat¬†‚Äď found in foods like meat, butter and cream (animal sources).

Unsaturated fat¬†‚Äď found in foods like olive oil, avocados, nuts and canola oil (plant sources)

Trans fats¬†‚Äď found in commercially produced baked goods, snack foods, fast foods and some margarines.

Replacing saturated fats and trans fats in the diet with unsaturated fats has been shown to decrease the risk of developing heart disease.







5.2 Explain the dietary role of key micronutrients

Micronutrients are one of the major groups of nutrients your body needs. They include vitamins and minerals. Vitamins are necessary for energy production, immune function, blood clotting and other functions. Meanwhile, minerals play an important role in growth, bone health, fluid balance and several other processes

Micronutrients, often referred to as vitamins and minerals, are vital to healthy development, disease prevention, and wellbeing. With the exception of vitamin D, micronutrients are not produced in the body and must be derived from the diet1.

The role of six essential micronutrients is outlined below.


  • Iron is critical for motor and cognitive development. Children and pregnant women are especially vulnerable to the consequences of iron deficiency3.
  • Iron deficiency¬†is a leading cause of anaemia which is defined as low haemoglobin concentration. Anaemia affects 40% of children younger than 5 years of age and 30% of pregnant women globally4.
  • Anaemia during pregnancy increases the risk of death for the mother and low birth weight for the infant. Worldwide, maternal and neonatal deaths total between 2.5 million and 3.4 million each year.

Vitamin A

  • Vitamin A supports healthy eyesight and immune system functions. Children with vitamin A deficiency face an increased risk of blindness and death from infections such as measles and diarrhea6.
  • Globally, vitamin A deficiency affects an estimated 190 million preschool-age children6.
  • Providing vitamin, A supplements to children ages 6-59 months is highly effective in reducing deaths from all causes where vitamin A deficiency is a public health concern

Vitamin D

  • Vitamin D builds strong bones by helping the body absorb calcium. This helps protect older adults from osteoporosis.
  • Vitamin D helps the immune system resist bacteria and viruses.
  • Vitamin D is required for muscle and nerve functions7.
  • Available data suggest that vitamin D deficiency may be widespread globally8.
  • Bodies make vitamin D from sunlight, but this varies based on geography, skin colour, air pollution, and other factors. Also, sunlight exposure needs to be limited to¬†avoid risk of skin cancer.


  • Iodine is required during pregnancy and infancy for the infant‚Äôs healthy growth and cognitive development9.
  • Globally an estimated 1.8 billion people have insufficient iodine intake.
  • Iodine content in most foods and beverages is low.


  • Zinc promotes immune functions and helps people resist infectious diseases including diarrhoea, pneumonia and malaria14,15,16. Zinc is also needed for healthy pregnancies14.
  • Providing zinc supplements reduces the incidence of premature birth, decreases childhood diarrhoea and respiratory infections, lowers the number of deaths from all causes, and increases growth and weight gain among infants and young children17.


5.3 Identify common dietary sources for key macro and micro nutrients.

Carbohydrates are referred to as energy-giving foods. They provide energy in the form of calories that the body needs to be able to work, and to support other functions.

Carbohydrates are needed in large amounts by the body. Indeed, up to 65% of our energy comes from carbohydrates. They are the body’s main source of fuel because they are easily converted into energy. This energy is usually in the form of glucose, which all tissues and cells in our bodies readily use.

For the brain, kidneys, central nervous system and muscles to function properly, they need carbohydrates. These carbohydrates are usually stored in the muscles and the liver, where they are later used for energy.

The main sources of carbohydrates are bread, wheat, potatoes of all kinds, maize, rice, cassava, ‚Äėshiro‚Äô, pasta, macaroni, ‚Äėkocho‚Äô, banana, sweets, sugar cane, sweet fruits, and honey. Other foods like vegetables, beans, nuts and seeds contain carbohydrates, but in lesser amounts.

About 10‚Äď35% of calories should come from protein.¬†Proteins¬†are needed in our diets for growth (especially important for children, teens and pregnant women) and to improve immune functions.

The main sources of proteins are meats, chicken, eggs, breastmilk, beans, ground nuts, lentils, fish, cheese and milk.

All animal foods contain more protein than plants and are therefore usually better sources of body building foods. However, even though plant proteins are usually not as good for body-building as animal proteins, they can become more effective nutritionally when both are mixed with each other.

Meat is a good source of protein.  Fats and oils are concentrated sources of energy and so are important nutrients for young children who need a lot of energy-rich food. Fats can also make meals more tasty and satisfying. Fat is found in meat, chicken, milk products, butters, creams, avocado, cooking oils and fats, cheese, fish and ground nuts.


Vitamins are groups of related substances present in small amounts in foodstuffs and are necessary for the body to function normally. Vitamins are also called protective foods. They are grouped together because, as their name implies, they are a vital factor in the diet.

Classifications of vitamins

Vitamins are classified into two groups:

Fat soluble vitamins (vitamins A, D, E and K) are soluble in fats and fat solvents. They are insoluble in water. So these are utilised only if there is enough fat in the body.

Water soluble vitamins (vitamins B and C, and folic acid) are soluble in water and so they cannot be stored in the body.

The best sources of micronutrients in our diets are fruits and vegetables. These two food groups contain essential vitamins and minerals. Animal sources of foods are also both good sources of micronutrients. However, an adequate micronutrient intake can only be achieved through sufficient intake of a balanced diet that includes plenty of fruits and vegetables. Table 2.1 overleaf sets out the functions of some of the important vitamins and examples of sources of food for each of these.

Functions and sources of vitamins.



Food sources

Vitamin A

Night vision

Healing epithelial cells

Normal development of teeth and bones

Breastmilk, tomatoes, cabbage, lettuce, pumpkins

Mangoes, papaya, carrots

Liver, kidney, egg yolk, milk

Vitamin D

Needed for absorption of calcium from small intestines


Ultra violet light from the sun

Eggs, butter, fish

Fortified oils, fats and cereals

Vitamin K

For blood clotting

Green leafy vegetables

Fruits, cereals, meat, dairy

B complex

Metabolism of carbohydrates, proteins and fats

Milk, egg yolk, liver,

 and heart

Whole grain cereals, meat,

Vitamin C

Prevention of scurvy

Aiding wound healing

Assisting absorption of iron

Fresh fruits (oranges, banana, mango, grapefruits, lemons, potatoes) and vegetables (cabbage, carrots, pepper, tomatoes)




5.4 Explain the importance of adequate hydration

Drinking enough water each day is crucial for many reasons: to regulate body temperature, keep joints lubricated, prevent infections, deliver nutrients to cells, and keep organs functioning properly. Being well-hydrated also improves sleep quality, cognition, and mood

Water in the body is essential for many important processes to take place. From our blood system carrying essential glucose, oxygen and nutrients to cells, to the kidneys getting rid of waste products we no longer want, fluid in the body is vital to allow these to occur. It also lubricates our joints and eyes, helps our digestive system function and keeps our skin healthy.

Water levels in the body change as we age, with new borns having a higher body fluid level compared to adults. Elderly people have lower fluid levels still, but hydration is really important at all ages.

Fluid is so important in the body that even when levels drop only slightly, we begin to feel the consequences. Low levels of fluid in the body can cause headaches, feelings of dizziness, lethargy, poor concentration and a dry mouth. Over a longer term, dehydration can cause constipation and can be associated with urinary tract infections and the formation of kidney stones. Regular and adequate intakes of fluid can help to address these.

Adults need to drink around 1.5‚Äď2 litres of fluid a day. A typical mug or glass is about 200 millilitres (ml) so this equates to 8-10 drinks a day. Children need slightly less and should aim for around 6-8 drinks a day, but once they reach teenage years their requirements are similar to adults. Don‚Äôt forget that fluid needs can vary depending on various factors including level of physical activity and climate, so it is best to remember to drink regularly to keep thirst at bay. A few groups (listed in the box below) need to take particular care to make sure their fluid levels are kept topped up and these include:

Children: Often too busy to recognise the signs of thirst!

Pregnant and breastfeeding ladies: Fluid is critical for baby and breastmilk

Older people: Often don’t drink enough

Athletes: Need regular fluid top ups as they lose more through sweat








5.5 Explain current healthy eating guidelines

Most of us still are not eating enough fruit and vegetables. They should make up over a third of the food we eat each day. Aim to eat at least 5 portions of a variety of fruit and veg each day. Choose from fresh, frozen, tinned, dried or juiced.

Remember that fruit juice and smoothies should be limited to no more than a combined total of 150ml a day. Fruit and vegetables are a good source of vitamins, minerals and fibre.

Starchy food should make up just over a third of the food we eat. Choose higher fibre wholegrain varieties, such as wholewheat pasta and brown rice, or simply leave skins on potatoes.

There are also higher fibre versions of white bread and pasta.

Starchy foods are a good source of energy and the main source of a range of nutrients in our diet.

Milk, cheese, yoghurt and fromage frais are good sources of protein and some vitamins, and they’re also an important source of calcium, which helps¬†keep our bones healthy.

Try to go for lower-fat and lower-sugar products where possible, like 1% fat milk, reduced-fat cheese or plain low-fat yoghurt.

These foods are good sources of protein, vitamins and minerals. Pulses, such as beans, peas and lentils, are good alternatives to meat because they’re lower in fat and higher in fibre and protein, too.

Choose lean cuts of meat and mince, and eat less red and processed meat like bacon, ham and sausages. Aim for at least 2 portions of fish every week, 1 of which should be oily, such as salmon or mackerel.

Unsaturated fats are healthier fats and include vegetable, rapeseed, olive and sunflower oils. Remember all types of fat are high in energy and should be eaten sparingly.

These foods include chocolate, cakes, biscuits, sugary soft drinks, butter, ghee and ice cream. They’re not needed in our diet, so should be eaten less often and in smaller amounts.

Water, lower-fat milks and lower-sugar or sugar-free drinks, including tea and coffee, all count. Fruit juice and smoothies also count towards your fluid consumption, but they contain free sugars that can damage teeth, so limit these drinks to a combined total of 150ml a day.





5.6 Explain the importance of healthy eating in relation to growth, repair and injury.

A well-balanced diet provides all of the: energy you need to keep active throughout the day. nutrients you need for growth and repair, helping you to stay strong and healthy and help to prevent diet-related illness, such as some cancers

A well-balanced diet provides all of the energy you need to keep active throughout the day nutrients you need for growth and repair, helping you to stay strong and healthy and help to prevent diet-related illness, such as some cancers

Keeping active and eating a healthy balanced diet can also help you to maintain a healthy weight.

Deficiencies in some key nutrients – such as vitamin A, B, C and E, and zinc, iron and selenium – can weaken parts of your immune system.

More about vitamins, minerals and nutrients

Type 2 diabetes

Maintaining a healthy weight and eating a balanced diet that’s low in saturated fat and high in fibre found in whole grains can help to reduce your risk of developing type 2 diabetes.

More about type 2 diabetes

Heart health

A healthy diet rich in fruits, vegetables, whole grains and low-fat dairy can help to reduce your risk of heart disease by maintaining blood pressure and cholesterol levels.

High blood pressure and cholesterol can be a symptom of too much salt and saturated fats in your diet.

Eating a portion of oily fish – such as salmon and trout – each week can also help to lower your risk of developing heart disease. The high levels of omega-3 fatty acids in oily fish are good for heart health.

Strong bones and teeth

A diet rich in calcium keeps your teeth and bones strong and can help to slow bone loss (osteoporosis) associated with getting older.

Calcium is usually associated with dairy products, but you can also get calcium by eating:

sardines, pilchards or tinned salmon (with bones)

dark green vegetables – such as kale and broccoli

calcium-fortified foods – such as soya products, fruit juices and cereals

As vitamin D helps your body absorb calcium, make sure you get outside (your body gets vitamin D from the sun) and have plenty of foods containing vitamin D in your diet – such as oily fish and fortified cereals.

5.7 Explain professional boundaries when offering healthy eating advice.

Gather information before giving any form of advice

No matter how well intentioned it is, the generic advice that is so often provided is virtually useless.¬† What’s the point in telling a client to increase their intake of fruit and vegetables if you haven’t established that their intake is actually deficient in the first place?

Any advice that isn’t relevant to your client equates simply to ‘irritating background noise’.¬† The more of this noise that you provide, the harder it is for your client to actually hear the important messages.¬† Even if you find numerous areas in your client‚Äôs diets that have room for improvement, limit your advice to one or two changes your clients can realistically implement in order to improve their nutritional intake.

The harder the change is for a client the less likely they’ll be to succeed with it.¬† This is a major reason why diets dont work in the long term as they require radical changes to established eating habits that are simply too hard to sustain.¬†

Be realistic

For example – telling a client that drinks six cups of coffee everyday with three teaspoons of sugar in each, to give up coffee completely, will require a significant change in an established behaviour.¬† So, it’s unlikely to be sustained.¬† Setting an initial target of eliminating one teaspoon of sugar from each cup is more realistic.¬† And if sustained would result in that client consuming over two thousand less teaspoons of sugar per annum.

Bear in mind that success breeds success – so feeling good about sustaining this goal may well result in the client reducing to one teaspoon of sugar per coffee and eventually becoming sugar free.¬† Try to always remember, ‘Rome wasn’t built in a day’ and ‘patience is definitely a virtue’!¬†

‘Carbs’ aren’t ‘the enemy’, just as ‘fat’ isn’t the enemy – these are quite simply nutrients found in the foods we all eat. It’s the eating habits and behaviours of people that determine whether the intake of these nutrients is healthy or not.¬† So, focus on habits and behaviours rather than the pros and cons of different nutrients.¬† It’s also a heck of a lot easier for clients to understand foods rather than the nutrients within foods, so talk in terms of ‘bread, fruit and vegetables’ rather than ‘carbs’, or ‘butter and margarine’ instead of ‘fat’ for example.

Most countries have simple nutritional guidelines for good health – as a therapist you should know these and realise that success for your clients comes from supporting them to make small sustainable changes in their eating habits to help them move closer to achieving their goals.