1. Chapter 4 Health-Related Physical Fitness Testing and Interpretation WORDING IN RED WILL DEFINITELY BE ON THE TEST

2. Announcements Labs next week (March 1, 3-4) will be in 213 MAC.
Remember next week is the ECG test during lab times.
No labs March 8,
Labs March 22, 24-25, and 28, will be in 150 MAC
Labs starting April 5th will be back in 213 MAC.

3. The health-related components of physical fitness:
have a strong relationship with good health,
are characterized by an ability to perform daily activities with vigor, and
demonstrate the traits and capacities associated with low risk of premature development of the hypokinetic diseases (e.g., those associated with physical inactivity)

4. Purposes of Health-Related Fitness Testing
Educating participants about their present health-related fitness status relative to health-related standards and age- and sex-matched norms
Providing data that are helpful in the development of exercise prescriptions to address all fitness components
Collecting baseline and follow-up data that allow evaluation of progress by exercise program participants
Motivating participants by establishing reasonable and attainable fitness goals
Stratifying cardiovascular risk

5. Basic Principles and Guidelines
An ideal health-related physical fitness test:
is reliable, valid, relatively inexpensive, and easy to administer, and
should yield results that are indicative of the current state of fitness, reflect change from physical activity or exercise intervention, and be directly comparable to normative data.

6. Pretest Instructions
A minimal recommendation is that individuals complete a questionnaire such as the Physical Activity Readiness Questionnaire (PAR-Q) or the ACSM/AHA form.
A listing of preliminary instructions for all clients can be found in Chapter 3 (Patient Instructions). These instructions may be modified to meet specific needs and circumstances.

7. Test Order
The following should be accomplished before the participant arrives at the test site:
Ensure that all forms, score sheets, tables, graphs, and other testing documents are organized and available for the test’s administration.
Calibrate all equipment a minimum of once each month to ensure accuracy (e.g., metronome, cycle ergometer, treadmill, sphygmomanometer, skinfold calipers).

8. Test Order
Organize equipment so that tests can follow in sequence without stressing the same muscle group repeatedly.
Provide informed consent form.
Maintain room temperature of 68°F to 72°F (20°C to 22°C) and humidity of <60%.

9. Test Order (cont.)
Testing CR endurance after assessing muscular fitness (which elevates HR) can produce inaccurate results about an individual’s CR endurance status, particularly when tests using HR to predict aerobic fitness are used.
Dehydration resulting from CR endurance tests might influence body composition values if measured by bioelectrical impedance analysis (BIA).
Because certain medications, such as beta-blockers, which lower HR, will affect some fitness test results, use of these medications should be noted.

10. Test Environment
Test anxiety, emotional problems, food in the stomach, bladder distention, room temperature, and ventilation should be controlled as much as possible.
To minimize anxiety, the test procedures should be explained adequately, and the test environment should be quiet and private.
The room should be equipped with a comfortable seat and/or examination table to be used for resting BP and HR and/or ECG recordings.

11. Test Environment (cont.)
The demeanor of personnel should be one of relaxed confidence to put the subject at ease. 
Testing procedures should not be rushed, and all procedures must be explained clearly prior to initiating the process.

12. Test Order Resting measurements should be obtained first
Heart rate
Blood pressure
Height
Weight
Body composition
When all fitness components are assessed in a single session, resting measurements should be followed (in order) by tests of:
cardiorespiratory (CR) endurance,
muscular fitness, and
flexibility.

13. Body Composition
Before collecting data for body composition assessment, the technician must be trained, routinely practiced in the techniques, and already have demonstrated reliability in his or her measurements, independent of the technique being used.
Experience can be accrued under the direct supervision of a highly qualified mentor in a controlled testing environment.

14. Body Composition 67% and 32% of American adults are classified as overweight and obese.
Anthropometric methods
Body mass index
Circumferences
Skinfold measurements
Densitometry
Hydrodensitometry (underwater) weighing
Plethysmography
Other techniques
Dual energy x-ray absorptiometry
Total body electrical conductivity
Bioelectrical impedance analysis
Near-infrared intercadence

15. Body Mass Index (BMI)
The BMI is used to assess weight relative to height and is calculated by dividing body weight in kilograms by height in meters squared (kg·m-2)
For most people, obesity-related health problems increase beyond a BMI of 25, and the Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults lists a BMI of 25.0 to 29.9 kg·m-2 for overweight and a BMI of ≥30.0 kg·m-2 for obesity.

16. Know: Body Type or Somatype

17. Know BMI categories below
Pg. 63
Know BMI categories below

18. Pg. 64

19. Android
Vs.
Gynoid

20. The ratio of waist-to-hip circumference (WHR) has been used to determine android vs. gynoid type of obesity. The waist circumference is the smallest circumference below the rib cage and above the umbilicus. The hip circumference is the largest circumference of the buttocks-hip area. The waist circumference alone is also used than the WHR.

21. Circumferences
The pattern of body fat distribution is recognized as an important predictor of the health risks of obesity.
Android obesity, which is characterized by more fat on the trunk (abdominal fat), provides an increased risk of hypertension, metabolic syndrome, type 2 diabetes, dyslipidemia, coronary artery disease, and premature death compared with individuals who demonstrate gynoid or gynecoid obesity (fat distributed in the hip and thigh).
Significant amounts of waist circumference are:
40 inches for males and 35 inches for females. Above these values disease risk increases.

22. Circumferences (cont.)
Procedures
All measurements should be made with a flexible yet inelastic tape measure.
The tape should be placed on the skin surface without compressing the subcutaneous adipose tissue.
If a Gulick spring-loaded handle is used, the handle should be extended to the same marking with each trial.

23. Circumferences (cont.)
Procedures (cont.)
Take duplicate measures at each site and retest if duplicate measurements are not within 5 mm.
Rotate through measurement sites or allow time for skin to regain normal texture.

24. Waist-to-hip ratio (WHR)
The waist-to-hip ratio is the circumference of the waist divided by the circumference of the hips (buttocks/hips measure) and has been used as a simple method for determining body fat distribution.
Health risk increases with WHR, and standards for risk vary with age and sex.

25. Waist-to-hip ratio (cont.)
Health risk is very high for young men when WHR is >0.95 and for young women when WHR is >0.86.
For people 60 to 69 years old, the WHR values are >1.03 for men and >0.90 for women for the same risk classification.

26. Skinfold Measurements
When performed correctly, skinfold measures provide an fairly good estimate of percent body fat (r = with underwater weighing). The goal is to measure a double fold of skin and subcutaneous tissue (with sides of skinfold approximately parallel). The thicker the fat layer, the wider the fold. Technician error is the greatest source of error.

27. Skinfolds measure subcutaneous fat.
Amount of subcutaneous fat is proportional to the total amount of body fat.
It is assumed that close to one-third of the total fat is located subcutaneously.

28. The exact proportion of subcutaneous to total fat varies with sex, age, and ethnicity.
Regression equations used to convert sum of skinfolds to percent body fat must consider these variables for greatest accuracy.

29. Skinfold Procedures – page 67, Box 4.2
All measurements should be made on the right side of the body with the subject standing upright.
Caliper should be placed directly on the skin surface, 1 cm away from the thumb and finger, perpendicular to the skinfold, and halfway between the crest and the base of the fold.
Pinch should be maintained while reading the caliper.

30. Skinfold Procedures (cont.)
Wait 1 to 2 seconds (not longer) before reading caliper.
Take duplicate measures at each site and retest if duplicate measurements are not within 1 to 2 mm.
Rotate through measurement sites or allow time for skin to regain normal texture and thickness (at least 15 seconds apart).

31. Do not take measurements when the subject's skin is moist (ensure that the skin is dry, and has no lotion). Also do not take measurements immediately after exercise or when the person being measured is overheated because the shift of body fluid to the skin will inflate normal skinfold size.

33. 33

34. 34

35. Factors that may contribute to measurement error within skinfold assessment include:
poor technique,
an inexperienced evaluator,
an extremely obese or extremely lean subject, and
an improperly calibrated caliper (tension should be set at ~12 g·mm-2).

37. Abdomen Skinfold Vertical fold 2 cm to the right of the umbilicus.
Horizontal fold, one inch to the right side of and ½ inch below the navel.
Alternate method
-will not be done in 4315

38. Triceps Skinfold
Vertical fold on posterior midline of the upper arm, halfway between the acromion and olecranon process, with the arm held freely to the side of the body.

39. Chest Skinfold
the chest/pectoral skinfold site is one half the distance between the anterior axillary line and the nipple for men, and one third of this distance for women

40. Midaxillary Skinfold
Vertical fold taken on midaxillary line at level of xiphisternal junction.

41. Subscapular Skinfold
Diagonal fold just below the inferior angle of scapula.

42. Suprailiac Skinfold a diagonal fold is taken with the natural angle of the iliac crest at the anterior axillary line immediately superior to the iliac crest
Alternate method: Diagonal fold just above iliac crest at the midaxillary line.

43. Thigh Skinfold Vertical fold on anterior thigh, midway between inguinal crease and proximal border of patella.

45. Densitometry
Whole-body density, using the ratio of body mass to body volume
In this technique, the body is divided into two components: the fat mass (FM) and the fat-free mass (FFM). TWO COMPARTMENT MODEL.
The limiting factor in the measurement of body density is the accuracy of the body volume measurement because body mass is measured simply as body weight.
RESIDUAL VOLUME is the issue

46. Hydrodensitometry (underwater) weighing
Based on Archimedes’ principle
When a body is immersed in water, it is buoyed by a counterforce equal to the weight of the water displaced.
Bone and muscle tissue are denser than water, whereas fat tissue is less dense. Therefore, a person with more FFM for the same total body mass weighs more in water and has a higher body density and lower percentage of body fat.

47. Subjects must follow pre-test guidelines completely
Subjects must follow pre-test guidelines completely. (no food ingestion 4 hrs prior, smoking, caffeine, exercise).
5-10 trials necessary
light weight clothing needed, removal of air bubbles from suit, hair, and skin while underwater.

48. RV = residual lung volume (mL)
Body Density (Db) = body mass (g) / body volume (mL)
Db = Wa / {[(Wa - Ww) / Dw] - (RV mL)}
where;
Db = body density (g/mL)
Wa = body mass out of water
Ww = body mass underwater
Dw = density of water (g/mL)
RV = residual lung volume (mL)
100 mL = volume of air trapped in gastrointestinal tract that cannot be measured.
Siri Equation - % body fat = [(4.95 / Db) ] x 100
Brozek Equation - % body fat = [(4.57 / Db) ] x 100

49. Plethysmography Measured by air rather than water displacement
Based on 2 compartment model as well.
Uses a dual-chamber plethysmograph that measures body volume by changes in pressure in a closed chamber
This technology shows promise and generally reduces the anxiety associated with the technique of hydrodensitometry.

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51. Other Techniques
Dual energy x-ray absorptiometry (DEXA) and total body electrical conductivity (TOBEC) are reliable and accurate measures of body composition, but these techniques are not popular for general health fitness testing because of cost and the need for highly trained personnel.
BIA and near-infrared intercadence are used for general health fitness testing. The accuracy of BIA is similar to skinfolds, as long as a stringent protocol is followed and the equations are valid and accurate for the populations being tested. Near-infrared intercadence requires additional research to substantiate the validity and accuracy for body composition assessment.

52. Bioelectrical Impedance
Bioelectrical impedance (BIA)
Based on the premise that the volume of fat fee tissue will be proportional to the electrical conductivity of the body
Passes a small electrical current into the body and measures resistance
Fat is a poor conductor of electricity
Lean body tissue (mostly water) will be a good electrical conductor
BIA is acceptable when measuring total body water
BIA is not as accurate for % of body Fat (Hydration levels)

53. Techniques BIOELECTRICAL IMPEDANCE (BIA) Relatively new technique
Dependent upon several assumptions (State of hydration)
Standard Error about the same as skinfold technique
More costly
Quicker than skinfolds
Privacy less of a problem
Looks more high tech than other methods

54. BIA Problems Electrolyte status may be altered due to:
alcohol consumption (48 hrs)
food or eating consumption (4 hrs)
recent exercise (12 hrs)
Urination 30 minutes of the test

55. BIA Problems Electrolyte status may be altered due to:
diuretic therapy (Physician approved) within 7 days of the test
menstrual cycle (avoid 3 days prior through three days following or belief of water retention. )
Oil and lotions should be removed from the skin
Room should have normal ambient temperature.

56. Body Composition Norms
Table 4-5

57. Body Composition Norms (cont.)
Table 4-6

58. A consensus opinion for an exact percentage body fat value associated with optimal health risk has yet to be defined.
A range of 10% to 22% and 20% to 32% for men and women, respectively, is considered satisfactory for health.