1. ACE Personal Trainer Manual
5th Edition
Chapter 8: Physiological Assessments
Lesson 8.1

2. After completing this session, you will be able to:
LEARNING OBJECTIVES
After completing this session, you will be able to:
Identify signs and symptoms that merit immediate test termination
Discuss various anthropometric measurements and body-composition assessments, and the appropriateness of each test
Demonstrate various measurements to determine and evaluate body composition or risk category, including skinfold, body mass index, girth, waist-to-hip ratio, and waist circumference

3. Identifiable signs or symptoms that merit immediate test termination:
TESTING AND MEASUREMENT
Identifiable signs or symptoms that merit immediate test termination:
Onset of angina, chest pain, or angina-like symptoms
Significant drop (>10 mmHg) in systolic blood pressure (SBP) despite an increase in exercise intensity
Excessive rise in blood pressure (BP): SBP reaches >250 mmHg or diastolic blood pressure (DBP) reaches >115 mmHg
Excess fatigue, shortness of breath, or wheezing (does not include heavy breathing due to intense exercise)
These signs and symptoms may also merit possible referral to a qualified healthcare professional.
There are a number of resources for gaining hands-on training in fitness assessments, including the following:
ACE-sponsored workshops
Local colleges or universities with exercise science departments
Experienced personal trainers, athletic trainers, or rehabilitation specialists
Repeated practice, using friends, family members, or other trainers until comfortable and competent

4. TESTING AND MEASUREMENT
Identifiable signs or symptoms that merit immediate test termination (cont.):
Signs of poor perfusion: lightheadedness, pallor, cyanosis, nausea, or cold and clammy skin
Increased nervous system symptoms (e.g., ataxia, dizziness, confusion, or syncope)
Leg cramping or claudication
Subject requests to stop
Physical or verbal manifestations of severe fatigue
Failure of testing equipment
These signs and symptoms may also merit possible referral to a qualified healthcare professional.
Pallor – pale skin
Cyanosis – bluish discoloration, especially around the mouth

5. ANTHROPOMETRIC MEASUREMENTS AND BODY COMPOSITION
Anthropometry – the measurement of the size and proportions of the human body for the purposes of understanding human physical variation
Anthropometric measures – measurements of height, weight, and/or circumference to assess body size or dimension:
Easy to administer
Require minimal equipment
Demonstrate strong correlations to health, morbidity, and mortality
Provide only estimations of body composition and fitness level

6. ANTHROPOMETRIC MEASUREMENTS AND BODY COMPOSITION
Body composition – the proportion of lean tissue to body-fat tissue
Lean body mass (LBM):
Muscles, connective tissue, bones, blood, nervous tissue, skin, and organs
Metabolically active tissue that allows the body to perform work
Essential body fat:
Necessary for insulation and thermoregulation, hormone production, cushioning of vital organs, and maintenance of certain body functions
Adipose tissue:
Non-essential body fat that is stored throughout the body
Either subcutaneously or viscerally
Acts as a readily available source of energy or to cushion and protect vital organs
For men, essential body fat is between 2 and 5%; for women, it is between 10 and 13%.
Just as lean tissue contributes to athletic performance, an appropriate percentage of body fat can also be related to successful athletic performance.

7. BODY COMPOSITION AND BODY SIZE MEASUREMENT TECHNIQUES

8. Overweight: Overfat: MEASUREMENT OF LEAN AND FAT MASS
An upward deviation in body weight, based on the subject’s height
20% or more above ideal weight
Overfat:
An excess amount of body fat
A more accurate depiction of body composition
If a client is extremely obese, some of the body-composition techniques will not be accurate.
In some cases, it may be more appropriate to utilize only BMI and girth measurements.
Overweight – since only height and weight are factored into the equation, excess body weight could be attributed to either fat mass or lean tissue.
The assessment of body composition can be quite invasive. It is important for personal trainers to conduct these assessments in a private area to put the client at ease. Clients should be instructed on appropriate attire to promote easy access to measurement sites. The trainer should act as a professional and be competent in the chosen method. Testing accuracy is improved by proper hydration, so it is important to instruct the client not to exercise prior to testing and to maintain adequate hydration throughout the day.
During subsequent reassessments, body composition will likely change due to a loss of body fat and an increase in lean tissue. Between measurements, a client may notice changes in the way his or her clothes fit. These subjective observations will be motivating to the client. Objective reassessments of body composition will be especially important for a client who has not noticed any significant change on the bathroom scale. Clients may need to be reminded that as lean mass increases and body fat decreases, the scale cannot differentiate between the two.

9. BODY-COMPOSITION ASSESSMENTS

10. BODY-COMPOSITION ASSESSMENTS

11. HYDROSTATIC WEIGHING The body is weighed on an underwater scale.
1.5 to 2.0% margin of error
Most other methods of measuring body composition are based on formulas derived from underwater weighing research.
Not a practical approach for the standard fitness center:
Expensive
Requires a lot of space
Testing takes time and expertise
Many people feel uncomfortable remaining submerged underwater after they have exhaled all available air from their lungs
Also called “underwater weighing”
The concept behind hydrostatic weighing is based on the Archimedes Principle, which provides the following equation:
Density = Mass/Volume
This technique originally measured the amount of water displaced when a person was completely submerged and exhaled all available air from the lungs [leaving only the residual volume (RV) and a small volume of air in the gastrointestinal tract]. Fat tissue is less dense than lean tissue and displaces more water despite weighing less.
As water buoyancy (i.e., the counterforce of water) reduces body weight significantly, and air and fat mass increase buoyancy, their respective contributions to underwater weight have to be determined. To minimize error with this protocol, the RV should be measured in water. This volume can be 100 to 200 mL lower underwater due to the non-compressible nature of water that helps compact the lungs. Given the costs, equipment, and expertise needed to accurately measure RV, mathematical calculations are often used to estimate RV, which may introduce a margin of error of 300 to 400 mL. For every 100 mL error in estimation of RV, the percent body fat error changes by 0.7%.
This evaluation tool is often found in elite clinical settings and in many colleges and universities.

12. Subcutaneous body fat – can be measured using a skinfold caliper:
SKINFOLD MEASUREMENTS
Subcutaneous body fat – can be measured using a skinfold caliper:
Most practical and widely used method
Ease of administration
Low cost
Produces a measurement that is ±2.0 to 3.5% of that obtained in hydrostatic weighing
Jackson and Pollock three-site skinfold measurements:
For men: Chest, thigh, and abdominal
For women: Triceps, thigh, and suprailium
Further measurement error can range as high as 6 to 8% if the trainer is inexperienced or uses poor technique, if the client is obese or extremely thin, or if the caliper is not properly calibrated. Before conducting skinfold measurements, trainers must familiarize themselves with the exact site locations and proper grasping technique.
Considering how critical a body-composition score can be to a client’s psyche and motivational levels, it is extremely important that trainers demonstrate strong skills and reliability when assessing body composition.

13. JACKSON AND POLLOCK 3-SITE SKINFOLD MEASUREMENTS: MEN
Chest skinfold measurement for men:
Locate the site midway between the anterior axillary line and the nipple.
Grasp a diagonal fold and pull it away from the muscle.
Newly certified personal trainers or those new to taking skinfold measurements should turn to more experienced colleagues for help with learning how to conduct this test properly.
It takes a lot of practice to perfect the technique, so trainers should ask friends or trusted clients to allow them to practice taking the skinfold measurements in an effort to become both accurate and consistent.

14. JACKSON AND POLLOCK 3-SITE SKINFOLD MEASUREMENTS: MEN
Thigh skinfold measurement for men:
Locate the hip and the knee joints and find the midpoint on the top of the thigh.
Grasp a vertical skinfold and pull it away from the muscle.

15. JACKSON AND POLLOCK 3-SITE SKINFOLD MEASUREMENTS: MEN
Abdominal skinfold measurement for men:
Grasp a vertical skinfold one inch to the right of the umbilicus.

16. JACKSON AND POLLOCK 3-SITE SKINFOLD MEASUREMENTS: WOMEN
Triceps skinfold measurement for women:
Locate the site midway between the acromial (shoulder) and olecranon (elbow) processes.
Grasp a vertical fold on the posterior mid-line and pull it away from the muscle.

17. JACKSON AND POLLOCK 3-SITE SKINFOLD MEASUREMENTS: WOMEN
Thigh skinfold measurement for women:
Locate the hip and the knee joints and find the midpoint on the top of the thigh.
Grasp a vertical skinfold and pull it away from the muscle.

18. JACKSON AND POLLOCK 3-SITE SKINFOLD MEASUREMENTS: WOMEN
Suprailium skinfold measurement for women:
Grasp a diagonal skinfold just above, and slightly forward of, the crest of the ilium.

19. GENERAL BODY-FAT PERCENTAGE CATEGORIES
Body composition can be determined by adding the three skinfold measurements and plugging the values into the conversion tables (Tables 8-3 and 8-4) or by calculating body density (BD), from which body composition can be computed. Personal trainers can also evaluate and classify the client’s body composition using normative data (Tables 8-5 and 8-6).
Programming considerations:
Determination of body composition is essential for a personal trainer who is designing a personalized exercise program, especially if the primary goal is either weight loss or weight gain. Reducing excess adipose tissue is also important for any person trying to decrease his or her risk of major disease and dysfunction. To enhance the program’s effectiveness, appropriate exercise should be used in conjunction with evidence-based dietary recommendations. Body-composition values can also be used to determine a goal weight. This calculation is based on the assumption that throughout the fitness program, lean body weight or mass will not change. However, it should be noted that with any weight loss or gain, there is typically a change in the amount of both lean body mass and fat mass.

20. Cannot determine actual body composition
BODY MASS INDEX (BMI)
Extensively used in healthcare settings to determine health risk and/or to establish target weight levels
Provides an objective ratio describing the relationship between body weight and height
Cannot determine actual body composition
BMI can unfairly categorize some individuals:
Extremely muscular or large framed individuals can score high, resulting in “overweight” or “obese” category
Older adults with decreased lean tissue and excess body fat may score “normal”
BMI = Weight (kg)/Height2 (m)

21. BMI REFERENCE CHART As BMI increases, so do health risks.
A BMI greater than 25 increases a person’s risk for cardiovascular disease, metabolic syndrome, hypertension, and type 2 diabetes.
This BMI reference chart can be used to discuss the health risks of being overweight or obese and to set long-term weight-loss goals for clients.
Calculating BMI is not only quick, but also inexpensive. BMI charts are used by many healthcare agencies to assess body mass and associated risks. If BMI charts are the only method of assessing body structure, the results could be misinterpreted and healthy individuals could be misclassified. A simple visual inspection should make the personal trainer question the label in these situations and proceed with a body-composition assessment to gain a more accurate indicator of health risk.
Online BMI calculators are available where an individual can simply key in his or her height and weight and be given the BMI, including one on ACE’s website (www. ACEfitness.org/calculators). The Centers for Disease Control and Prevention (CDC) website provides a BMI calculator specifically for children and teens (apps.nccd. cdc.gov/dnpabmi).

22. How would you explain this discrepancy to your client?
BMI CATEGORIZATION
An active, well-muscled client has recently participated in his employer’s wellness fair. He reports to you that, based on his weight and height measurements, he falls into the “overweight” category.
However, according to the body-composition assessment you have conducted with him, he is considered healthy and not in danger of being overweight.
How would you explain this discrepancy to your client?

23. Provides motivation as clients see changes in their body dimensions:
GIRTH MEASUREMENTS
Good predictors of health problems (e.g., waist circumference as it correlates to heart disease)
Provides motivation as clients see changes in their body dimensions:
Those interested in weight loss will be inspired by smaller numbers
Individuals interested in muscular hypertrophy may be motivated by increases in girth
When taking girth measurements, precision is necessary to validate the results. To ensure accuracy, the personal trainer must use exact anatomical landmarks for taking each measurement (Table 8-9 and Figures 8-7 through 8-9).
Procedures must be followed in accordance with established guidelines:
When measuring body circumference, it is important to measure precisely and consistently.
All measurements should be made with a non-elastic, yet flexible tape. The tape should be snug against the skin’s surface without pressing into the subcutaneous layers. Individuals should wear thin, form-fitting materials that allow for accurate measurements.
Trainers should rotate through the battery of sites, initially measuring each site only once.
Duplicate measurements should be taken of each site. If recorded values are not within 5 mm, it is necessary to re-measure. Trainers should wait 20 to 30 seconds between measurements to allow the skin and subcutaneous tissue to return to its normal position.

24. CIRCUMFERENCE SITES AND PROCEDURES
Taking the stress out of circumference measurements:
Many overweight and obese clients find the process of having their circumference measurements taken to be an unpleasant and demotivating experience. To help alleviate their uneasiness, personal trainers should consider using an alternative technique that eliminates the numerical values that many clients find so upsetting. For example, personal trainers can use a ribbon to measure the circumferences, cutting the ribbon at the appropriate lengths. Then, when these measurements are repeated later in the program (and the ribbons are noticeably shorter), the personal trainer and clients have a very clear visual representation of the progress made.

25. CIRCUMFERENCE SITES AND PROCEDURES

26. ANATOMICAL LANDMARKS FOR GIRTH MEASUREMENTS

27. WHR helps to differentiate between:
WAIST-TO-HIP RATIO (WHR)
The location of fat deposits may be a better indicator of disease risk.
WHR helps to differentiate between:
Gynoid (pear-shaped) individuals – excess fat in the hips and thighs
Android (apple-shaped) individuals – excess fat in the abdominal area
Greater health risk with a high WHR
To determine a client’s WHR, the waist measurement is divided by the hip measurement.

28. Non-essential visceral fat contributes to android fat distribution:
WAIST CIRCUMFERENCE
Non-essential visceral fat contributes to android fat distribution:
Encroaches on the vital organs of the body
Excess abdominal fat has been associated with insulin resistance.
Strong correlation between excess abdominal fat and a number of health risks
For every 1-inch increase in waist circumference in men:
BP increases by 10%
Blood cholesterol level increases by 8%
High-density lipoprotein (HDL) decreases by 15%
Triglycerides increase by 18%
Metabolic syndrome risk increases by 18%

29. CRITERIA FOR WAIST CIRCUMFERENCE IN ADULTS
Estimating Body Fat From Circumference Measures
Body density for women and men can be predicted from generalized equations that use girth measurements:
BD for women = – ( x abdomen) + ( x abdomen2) – ( x hips) + ( x height) – ( x age)
BD for men = ( x weight) – ( x iliac) – ( x hip) – ( x abdomen)
Body density can then be converted to percent fat by using the following formula:
Percent fat = (495/BD) – 450
Note: All measurements are done in centimeters; weight is measured in kilograms.

30. Testing protocols are similar for all the anthropometric tests:
ANTHROPOMETRIC TESTING PROTOCOLS
Testing protocols are similar for all the anthropometric tests:
Perform prior to exercise
Explain the procedure and ensure the client is comfortable with the proposed measurement sites
Each measurement must be performed using the precise landmarks
Record values, evaluate, and classify the measurements using normative data
Discuss the concerns related to abnormal readings
Educate clients on strategies to reduce risk and improve overall health
Many of the tests measuring body size and proportions can be used in conjunction with body-composition testing.

31. LONG-TERM WEIGHT MANAGEMENT
Many people are often successful at losing weight or fat, but are unsuccessful at long-term weight management.
Personal trainers must emphasize that exercise is a key component not only in effective weight loss, but also in maintaining a healthy weight.
Exercise enhances daily caloric expenditure.
Exercise, especially strength training, can minimize the loss of lean body weight.
Exercise may suppress appetite and counteract the impact that diet may have on resting metabolic rate (RMR).
Exercise makes the body more efficient at burning fat.

32. Assessments are an integral part of any personal-training program.
SUMMARY
Assessments are an integral part of any personal-training program.
In addition to determining the appropriateness of various assessments, it is very important for a trainer to identify the signs and symptoms that merit immediate test termination.
When conducted properly, anthropometric measurements and body-composition assessments can provide valuable health information for a trainer to use in designing programs.
Periodic reassessments are also important to gauge progress and continue to foster the client–trainer relationship.