{
  "resourceType": "ActivityDefinition",
  "id": "wall-push-up",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/wall-push-up",
  "version": "1",
  "name": "WallPushUp",
  "title": "Wall Push-Up",
  "status": "draft",
  "experimental": true,
  "description": "Standing push-up against a wall. Combines shoulder flexion/adduction with elbow extension and scapular protraction. Low-load entry point for pushing exercises.",
  "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": "wall-push-up",
          "display": "Wall 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": "3×10-15 reps; add 'plus' at top for serratus activation"
    }
  ],
  "usage": "Evidence: moderate. Serratus anterior 27.55% RVC in wall variation; 77.09% in standard push-up plus [Park 2014]",
  "note": [
    {
      "text": "Wide shoulder blades — serratus wraps the ribs",
      "authorString": "focus:internal"
    },
    {
      "text": "Push the wall away from the chest",
      "authorString": "focus:external"
    },
    {
      "text": "Drive the upper back toward the ceiling at the top",
      "authorString": "focus:external"
    },
    {
      "text": "Body stays straight as a plank from crown to heel",
      "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"
      }
    },
    {
      "type": "citation",
      "label": "ho-pushup-upper-extremity-2019",
      "citation": "Ho AJ, Cudlip AC, Ribeiro DC, Dickerson CR. (2019). Examining Upper Extremity Muscle Demand During Selected Push-Up Variants",
      "document": {
        "url": "https://doi.org/10.1016/j.jelekin.2018.12.008"
      }
    },
    {
      "type": "citation",
      "label": "park-pushup-plus-serratus-2014",
      "citation": "Park KM, Cynn HS, Kwon OY, et al.. (2014). Comparison of Pectoralis Major and Serratus Anterior Muscle Activities During Different Push-Up Plus Exercises",
      "document": {
        "url": "https://doi.org/10.1519/JSC.0000000000000443"
      }
    },
    {
      "type": "citation",
      "label": "marcolin-pushup-variants-2015",
      "citation": "Marcolin G, Petrone N, Moro T, et al.. (2015). Selective Activation of Shoulder, Trunk, and Arm Muscles: A Comparative Analysis of Different Push-Up Variants",
      "document": {
        "url": "https://doi.org/10.4085/1062-6050-50.9.09"
      }
    },
    {
      "type": "citation",
      "label": "youdas-pushup-comparison-2010",
      "citation": "Youdas JW, Budach BD, Ellerbusch JV, et al.. (2010). Comparison of Muscle-Activation Patterns During the Conventional Push-Up and Perfect Pushup Exercises",
      "document": {
        "url": "https://doi.org/10.1519/jsc.0b013e3181cc23b0"
      }
    },
    {
      "type": "citation",
      "label": "herrington-press-up-progressions-2015",
      "citation": "Herrington L, Waterman R, Smith L. (2015). EMG Analysis of Shoulder Muscles During Press-Up Variations and Progressions",
      "document": {
        "url": "https://doi.org/10.1016/j.jelekin.2014.10.002"
      }
    },
    {
      "type": "successor",
      "label": "Advancing from the wall to the floor increases load; wall-push-up's named 'Floor Push-Up' progression corresponds to the floor push-up-plus node. Distinct roster nodes, valid reciprocal progression.",
      "display": "Push-Up Plus",
      "resource": "ActivityDefinition/push-up-plus"
    },
    {
      "type": "successor",
      "label": "3×12 wall push-ups with the trunk rigid and the scapulae protracting at lockout",
      "display": "Countertop Incline Push-Up",
      "resource": "ActivityDefinition/countertop-incline-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": "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": "Triceps Brachii"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "40284004"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Serratus Anterior"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "18346003"
          }
        }
      ]
    },
    {
      "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": "Rhomboid Major"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "88530003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Middle Trapezius"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31764008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Biceps Brachii"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "16225001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Brachialis"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "75915005"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Brachioradialis"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "72111005"
          }
        }
      ]
    }
  ]
}