{
  "resourceType": "ActivityDefinition",
  "id": "step-up-variations",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/step-up-variations",
  "version": "1",
  "name": "StepUpVariations",
  "title": "Step-Up Variations (Forward, Lateral, Cross-Over)",
  "status": "draft",
  "experimental": true,
  "description": "Stepping onto box from different directions. Lateral at 60% 5RM: VL 52.8%, VM 50.4%, glute med 42.8%. Standard: highest glute max/hamstrings. Crossover: highest glute med concentric. Step height matters: 8-inch VM 60% vs 4-inch 24% MVIC. In elderly, 30 cm step matches 60% 1RM resistance exercise.",
  "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": "step-up-variations",
          "display": "Step-Up Variations (Forward, Lateral, Cross-Over)"
        }
      ]
    }
  ],
  "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": "knee",
          "display": "Knee"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "129159008",
          "display": "Structure of femorotibial joint"
        }
      ],
      "text": "Knee"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×8-12 reps per leg; progress height 4→8→12+ inches [Muyor 2020, Simenz 2012]"
    }
  ],
  "usage": "Evidence: strong. Lateral: VL 52.8%, VM 50.4%, glute med 42.8% [Muyor 2020]. 8-inch: VM 60% vs 4-inch 24% [Brask 1984]. Crossover: highest glute med [Simenz 2012]",
  "note": [
    {
      "text": "Tall trunk, level pelvis — glute drives the rise",
      "authorString": "focus:internal"
    },
    {
      "text": "Push the standing foot through the box to stand tall",
      "authorString": "focus:external"
    },
    {
      "text": "Lower the trailing toe to gently kiss the floor",
      "authorString": "focus:external"
    },
    {
      "text": "Standing hip stays level — hand on top hip checks",
      "authorString": "focus:tactile"
    }
  ],
  "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": "Quadriceps Femoris"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "21989003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Maximus"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "206007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gluteus Medius"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "78333006"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Hamstrings (Group)"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        }
      ]
    }
  ]
}