{
  "resourceType": "ActivityDefinition",
  "id": "kettlebell-swing",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/kettlebell-swing",
  "version": "1",
  "name": "KettlebellSwing",
  "title": "Kettlebell Swing (Two-Hand)",
  "status": "draft",
  "experimental": true,
  "description": "Explosive hip hinge swing to chest height. Hip hinge produces greater hamstring activation than squat swing (MD 3.92, p=0.002). Low back ~50% MVC, glutes ~80% MVC, spine compression ~3,200 N at 16 kg. Unique posterior shear L4 on L5. 8-week RCT: neck/shoulder pain -2.1 points, lumbar extensor strength increased. Acute swings increase pressure pain thresholds.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: intermediate"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "kettlebell-swing",
          "display": "Kettlebell Swing (Two-Hand)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hip",
          "display": "Hip"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "24136001",
          "display": "Structure of hip joint"
        }
      ],
      "text": "Hip"
    },
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "ankle",
          "display": "Ankle"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "70258002",
          "display": "Structure of ankle joint"
        }
      ],
      "text": "Ankle"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "Cardio: 15:15 protocol 20 min 3x/week. Strength: 3-5×8-10 at 8-10RM. Pain: 8 rounds 20s swings/10s rest [Falatic 2015, Keilman 2017]"
    }
  ],
  "usage": "Evidence: moderate. Hip hinge: hamstrings MD 3.92 vs squat swing (p=0.002). Medial hamstrings > BF (MD 9.93, p=0.022) [Del Monte 2020]. Low back ~50% MVC, glutes ~80% MVC [McGill 2012]",
  "note": [
    {
      "text": "Hinge, not squat — glutes snap the bell",
      "authorString": "focus:internal"
    },
    {
      "text": "Snap the hips forward to launch the bell to chest height",
      "authorString": "focus:external"
    },
    {
      "text": "Hike the bell back between the legs above the knees",
      "authorString": "focus:external"
    },
    {
      "text": "Hips fire like a slingshot, arms only the rope",
      "authorString": "focus:imagery"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Maximus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "206007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Hamstrings (Group)"
        },
        {
          "url": "role",
          "valueCode": "primary"
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Erector Spinae Group"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "44947003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Quadratus Lumborum"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "6001004"
          }
        }
      ]
    },
    {
      "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"
          }
        }
      ]
    }
  ]
}