{
  "resourceType": "ActivityDefinition",
  "id": "countertop-incline-push-up",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/countertop-incline-push-up",
  "version": "1",
  "name": "CountertopInclinePushUp",
  "title": "Countertop Incline Push-Up",
  "status": "draft",
  "experimental": true,
  "description": "A scaled push-up performed with both hands planted shoulder-width on the edge of a kitchen countertop while the feet stay back on the floor, creating an inclined body angle. The raised hand position reduces the percentage of body weight the arms must press, so the patient lowers the chest toward the counter and pushes back up under control. The higher and more vertical the counter, the easier the load — making it an ideal home starting point before progressing toward the floor.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "countertop-incline-push-up",
          "display": "Countertop Incline Push-Up"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "shoulder",
          "display": "Shoulder"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "85537004",
          "display": "Structure of glenohumeral joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "264190008",
          "display": "Structure of scapulothoracic joint"
        }
      ],
      "text": "Shoulder"
    },
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "elbow",
          "display": "Elbow"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "44034005",
          "display": "Structure of humeroulnar joint"
        }
      ],
      "text": "Elbow"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "2-3 sets of 8-12 controlled repetitions, resting 60-90 seconds between sets, 2-3 non-consecutive days per week. Choose a counter height at which the last 1-2 reps feel challenging but form stays perfect and the shoulder is pain-free; progress to a lower surface once you can complete 3 sets of 12 with good control."
    }
  ],
  "usage": "Evidence: moderate. Push-up EMG studies show pectoralis major, anterior deltoid, and triceps brachii as prime movers, with serratus anterior highly active in the closed-chain hand-fixed position (especially with an added protraction 'plus'). Raising the hands (incline) reduces ground-reaction force and overall muscle activation relative to a floor push-up, providing a lower-load version of the same recruitment pattern.",
  "note": [
    {
      "text": "Place both hands on the edge of the counter a little wider than shoulder width, then walk your feet back until your body forms a straight, gently angled line from head to heels."
    },
    {
      "text": "Squeeze your glutes and brace your abs so your hips do not sag or pike — move as one solid plank."
    },
    {
      "text": "Bend your elbows and lower your chest toward the counter over about two seconds, then press back up smoothly; keep elbows at roughly a 45-degree angle to your torso, not flared straight out."
    },
    {
      "text": "At the top, gently push the counter away and spread your shoulder blades apart to engage the muscles that stabilize the shoulder blade."
    }
  ],
  "relatedArtifact": [
    {
      "type": "successor",
      "label": "3×12 at counter height with a 2 s lowering phase",
      "display": "Knee Push-Up",
      "resource": "ActivityDefinition/knee-push-up"
    },
    {
      "type": "predecessor",
      "label": "Shoulder or wrist pain above 3/10, or the hips break the shoulder-to-heel line",
      "display": "Wall Push-Up",
      "resource": "ActivityDefinition/wall-push-up"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Pectoralis Major"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "60005003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Triceps Brachii"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "40284004"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Anterior Deltoid"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35259002"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Serratus Anterior"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "18346003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Anconeus"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Rectus Abdominis"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31243008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Transversus Abdominis"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "86493009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Maximus"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "206007"
          }
        }
      ]
    }
  ]
}