Chapter 6 Fitness Assessment

Purpose To provide the fitness professional with valuable techniques to build a complete fitness assessment for a client. To provide the fitness professional with information about how the human body should move and how kinetic chain imbalances alter movement.

Objectives After this presentation, the participant will be able to: Explain the components of and rationale for an integrated fitness assessment. Understand how to administer a health history questionnaire and then from that be able to stratify a client’s overall risk for fitness assessment. Understand the importance of posture, how it relates to movement observation, and how to assess it. Understand how to perform a comprehensive health-related fitness assessment, obtain subjective and objective information about clients, and how to use the information collected to help design an exercise program.

Introduction 2008 Physical activity guidelines show how inactive Americans are. As little as 2.5 hours a week can prevent illness Only 31% of Americans engage in the recommended amounts of physical activity To properly train people, an accurate assessment of readiness is important

Definition Fitness Assessment A systematic problem-solving method that provides the fitness professional with a basis for making educated decisions about exercise and acute variable selection Not designed to diagnose any condition, but rather to observe each client’s individual structural and functional status, creating a starting point from which to work Not intended to replace a medical examination

Guidelines Fitness professional should not Diagnose medical conditions Obtain exercise or health guidelines from a physician, physical therapist, registered dietitian, and so forth. Prescribe treatment Refer clients to a qualified medical practitioner for medical exercise prescription. Prescribe diets or recommend specific supplements unless qualified Refer clients to a qualified dietitian or nutritionist for specific diet plans. Provide treatment of any kind for injury or disease (aside from basic first aid) Refer clients to a qualified medical practitioner for treatment of injury or disease. Provide rehabilitation services for clients Design exercise programs for clients after they are released from rehabilitation. Provide counseling services for clients Act as a coach for clients.

Fitness Assessment Components Use a variety of observation methods to obtain a balanced overview of a client Subjective Information General and medical history Objective Information Physiologic assessment Body composition Cardiorespiratory assessments Static and dynamic postural assessments Performance assessments

Subjective Information Gathered from a prospective client to give the fitness professional feedback regarding personal history such as occupation, lifestyle, and medical background. One of the easiest forms of gathering this information is through a questionnaire. Physical Activity Readiness Questionnaire (PAR-Q) is directed toward detecting any possible cardiorespiratory dysfunction, such as coronary heart disease (CHD)

General History Ask some very basic questions concerning a client’s history and personal background to obtain a wealth of information. Occupation Does your occupation require extended periods of sitting? Does your occupation require extended periods of repetitive movements? Does your occupation require you to wear shoes with a heel (dress shoes)? Is your occupation mentally stressful (causes anxiety)? Lifestyle Recreation Hobbies

Medical History Find out a client’s medical history to obtain information about life-threatening or chronic diseases as well as structural and functional health Past injuries Past surgeries Chronic conditions Medications

Objective Information Gathered to provide the fitness professional with forms of measurable information. Can be used to compare beginning numbers to those measured weeks, months, or years later, denoting improvements in the client as well as the effectiveness of the training program. Physiologic assessments Body composition assessments Cardiorespiratory assessments Posture and movement assessments Performance assessments

Physiologic Assessments Provide valuable information regarding the status of the client’s health Heart rate Blood pressure

Physiologic Assessments Measuring Heart Rate Radial Pulse Lightly place two fingers along the arm in line with and just above the thumb Once pulse is identified, count the pulses for 30 seconds and multiply by two Record the 60-second pulse rate and average for 3 days

Physiologic Assessments Measuring Heart Rate Carotid Pulse Lightly place two fingers on the neck, just to the side of the larynx Once pulse is identified, count the pulses for 30 seconds and multiply by two Record the 60-second pulse rate and average for 3 days Average resting heart rates Males: 70 beats/min Females: 75 beats/min

Physiologic Assessments Training Heart Rate Calculate the client’s training heart rate zone for cardiorespiratory exercise Find estimated maximal heart rate (220 – age) Multiply the estimated maximum heart rate by the appropriate intensity (65–90%) Zone One: Maximum Heart Rate x 0.65 Maximum Heart Rate x 0.79 Zone Two: Maximum Heart Rate x 0.80 Maximum Heart Rate x 0.85 Zone Three: Maximum Heart Rate x 0.86 Maximum Heart Rate x 0.95

Heart Rate Reserve Method Heart rate and oxygen uptake are linearly related during dynamic exercise, selecting a predetermined training or target heart rate (THR) based on a given percentage of oxygen consumption is the most common and universally accepted method. The heart rate reserve (HRR) method is defined as: THR = [(HRmax – HRrest) × desired intensity] + HRrest

Physiologic Assessments Blood Pressure Systolic and diastolic readings Systolic (top number) The pressure produced by the heart as it pumps blood to the body Normal systolic pressure is <120 mm Hg. Diastolic (bottom number) The minimum pressure within the arteries through a full cardiac cycle Normal diastolic pressure is <80 mm Hg.

Physiologic Assessments Blood Pressure Testing Instruct the client to assume a comfortable seated position and place the appropriate-size cuff just above the elbow. Rest the arm on a supported chair or support the client’s arm using yours and place the stethoscope over the brachial artery using a minimal amount of pressure. Rapidly inflate the cuff to 20 to 30 mm Hg above the point when the pulse can no longer be felt at the wrist. Release the pressure at a rate of about 2 mm Hg per second, listening for sounds. To determine the systolic pressure, listen for the first observation of sound. Diastolic pressure is determined when the sounds fade away.

Body Composition There are a variety of methods used to estimate body composition, they vary according to cost, accuracy, and skill needed to perform them. Skinfold: measures skin fold thickness Bioelectrical impedance: measures resistance to electrical current Hydrostatic weighing: Measure body density by measuring buoyancy (ability to float)

Body Composition Some benefits of body composition testing include: To identify client’s health risk for excessively high or low levels of body fat To promote client’s understanding of body fat To monitor changes in body composition To help estimate healthy body weight for clients and athletes To assist in exercise program design

Skinfold Measurement Effective for trainers without a lab at their disposal Indirect measure of adipose tissue through thickness of skin Take a minimum of two measurements at each site Be accurate when locating landmarks Do not measure after exercise Not effective on extremely obese clients

Body Composition Body Fat Skin-Fold Caliper method Durnin–Womersley formula’s four sites of measurement Biceps Triceps Subscapular Iliac crest

Body Composition Body Fat Biceps Vertical fold on the front of the arm over the bicep muscle Halfway between the shoulder and the elbow

Body Composition Body Fat Triceps Vertical fold on the back of the upper arm, with the arm relaxed and held freely at the side Halfway between the shoulder and the elbow

Body Composition Body Fat Subscapular At a 45-degree angle, 1 to 2 cm below the inferior angle of the scapula

Body Composition Body Fat Iliac Crest At a 45-degree angle, just above the iliac crest and medial to the axillary line

Body Composition Calculating Body Fat Percentages After the four sites have been measured, add the totals of the four sites. Use the table in the textbook for corresponding body fat percentage.

Body Composition Circumference Measurements Another source of feedback used with clients who have the goal of altering body composition Most important factor is consistency Take measurements on the same side of the body each time you test and retest

Body Composition Circumference Measurements Neck Across the Adam’s apple

Body Composition Circumference Measurements Chest Across the nipple line Or upper chest for women

Body Composition Circumference Measurements Waist At the narrowest point of the waist, below the rib cage and just above the top of the hip bones. If there is no apparent narrowing of the waist, measure at the belly button.

Body Composition Circumference Measurements Hips With feet together, at the widest portion of the buttocks

Body Composition Circumference Measurements Thigh 10 inches above the top of the patella, just below the buttocks

Body Composition Circumference Measurements Calf At the maximal circumference between the ankle and the knee

Body Composition Waist-to-Hip Ratio There is a correlation between chronic diseases and fat stored in the midsection. Measure the smallest part of the waist without instructing the client to draw abdomen in. Measure the largest part of the hips. Compute the waist-to-hip ratio by dividing the waist measurement by the hip measurement. A ratio higher than 0.80 for females and 0.95 for males may put people at risk for a number of diseases.

Body Composition Body Mass Index (BMI) To assess weight relative to height, divide body weight (in kilograms) by height (in meters squared) or kg/m2 Obesity-related health problems increase when a person’s BMI exceeds 25.

Cardiorespiratory Provide valuable information regarding cardiorespiratory efficiency and overall condition Provide a starting point for cardiorespiratory training zone specific to their physical condition and goal Two common forms Step Test Rockport Walk Test

Cardiorespiratory Assessments Step Test Determine the client’s maximum heart rate by subtracting the client’s age from the number 220 (220 – age). Take the maximum heart rate and multiply it by the following figures to determine the heart rate ranges for each zone. Zone One: Maximum Heart Rate x 0.65 Maximum Heart Rate x 0.75 Zone Two: Maximum Heart Rate x 0.86 Maximum Heart Rate x 0.85 Zone Three: Maximum Heart Rate x 0.86 Maximum Heart Rate x 0.95

Cardiorespiratory Assessments Step Test Perform a 3-minute step test by having a client do 24 steps per minute on an 12-inch step, for 3 minutes (96 steps total). Then, measure client’s pulse for 60 seconds and record the number as the recovery pulse. Locate score in the chart provided in your text

Cardiorespiratory Assessments Step Test Determine the appropriate starting program: Poor: Zone One Fair: Zone One Average: Zone Two Good: Zone Two Very Good: Zone Three

Cardiorespiratory Assessments Rockport Walk Test Determine the client’s maximum heart rate by subtracting the client’s age from the number 220 (220 – age). Then, take the maximum heart rate and multiply it by the following figures to determine the heart rate ranges for each zone. Zone One: Maximum Heart Rate x 0.65 Maximum Heart Rate x 0.75 Zone Two: Maximum Heart Rate x 0.76 Maximum Heart Rate x 0.85 Zone Three: Maximum Heart Rate x 0.86 Maximum Heart Rate x 0.95

Cardiorespiratory Assessments Rockport Walk Test Record the client’s weight and perform assessment. Have the client walk 1 mile, as fast as he or she can control on a treadmill. Record the time it takes the client to complete the walk. Immediately record the client’s heart rate (beats per minute) at the 1-mile mark. Use the formula listed in the textbook to calculate O2 score. . V

Cardiorespiratory Assessments Rockport Walk Test Determine the appropriate starting program: Poor: Zone One Fair: Zone One Average: Zone Two Good: Zone Two Very Good: Zone Three

Posture and Movement Every movement needs a base from which to generate (and accept) force. Better known as posture Posture is the alignment and function of all components of the HMS at any given moment. Allows for proper neuromuscular function and optimal movement

Posture Proper posture ensures that the muscles of the body are optimally aligned at the proper length–tension relationships necessary for efficient functioning of force–couples and joint motion (neuromuscular efficiency). Neuromuscular efficiency is the ability of the nervous system to properly recruit all muscles in all planes of motion.

Posture Without proper postural alignment, we set the body up for a series a traumas known as postural distortion patterns. Predictable patterns of muscle imbalance

Muscle Imbalance Condition in which the lengths of muscles are altered at a joint. Poor posture, repetitive movement, and a lack of daily movement are considered contributing factors. MUSCLE IMBALANCE

Postural Distortions Predictable Patterns of Muscle Imbalance Lower Crossed Syndrome Upper Crossed Syndrome Pronation Distortion Syndrome

Pronation Distortion Syndrome Characterized by Feet Flattened or externally rotated Knees Adducted and internally rotated Tight Gastrocnemius, soleus, peroneals, adductors, iliotibial band (IT band), hip flexors, and biceps femoris (short head) Weak Anterior and posterior tibialis, vastus medialis (VMO), gluteus maximus and medius, and hip external rotators

Lower Crossed Syndrome Characterized by Anterior Pelvic Tilt Tight gastroncnemius, soleus, hip flexors, adductors, latissimus dorsi, and erector spinae Weak Gluteus maximus and medius, anterior tibialis, posterior tibialis, transversus abdominis, and internal obliques

Upper Crossed Syndrome Characterized by Shoulders Protracted (rounded) Head Forward Tight Latissimus dorsi, pectoralis major and minor, upper trapezius, scalenes, teres major, subscapularis, levator scapulae, and sternocleidomastoid Weak Serratus anterior, rhomboids, rhomboids, mid/lower trapezius and deep cervical flexors, infraspinatus

Movement Observations Dynamic postural observations (looking at movement) are often the quickest way to gain an overall impression of a client’s functional status. Should relate to basic functions such as squatting, pushing, pulling, and balancing. Can also be incorporated as a first workout for your client.

Movement Observations Overhead Squat Assessment Designed to assess dynamic flexibility on both sides of the body as well as integrated total body strength. Position Client stands with feet shoulder-width apart and pointed straight ahead. The foot and ankle complex should be in a neutral position. Have client raise his or her arms overhead, with elbow fully extended. The upper arm should bisect the ears.

Movement Observations Overhead Squat Assessment Movement Instruct client to assume a comfortable, controllable squat position. Have the client repeat the movement.

Movement Observations Overhead Squat Assessment Views Anterior Foot Turns out Knee Moves inward or outward vs.

Movement Observations Overhead Squat Assessment Views Lateral Lumbo-Pelvic-Hip Complex Excessive forward lean Low back arches Shoulder Complex Arms fall forward vs.

Movement Observations Single-Leg Squat Assessment Designed to assess ankle proprioception, core strength, and hip joint stability. Position Client should stand, place hands on the waist, and focus on an object straight ahead. The feet should be pointed straight ahead, and the foot, ankle, knee, and lumbo-pelvic-hip complex should be in a neutral position.

Movement Observations Single-Leg Squat Assessment Movement Instruct client to raise one leg and accept weight with opposite side (stance leg). The foot of the lifted leg should be positioned next to the stance leg. Once the single-leg stance is achieved, progress to a single-leg squat movement Have the client repeat the movement. Perform up to five repetitions before switching sides.

Movement Observations Single-Leg Squat Assessment Views Knee Moves inward

Movement Observations Pushing Assessment Position Instruct client to drawn abdomen in, feet shoulder width, and toes pointing forward. Movement Instruct client to press handles forward and return slowly. Perform up to 20 repetitions

Movement Observations Pushing Assessment Lumbo-Pelvic-Hip Complex Lumbar spine arches Shoulder Complex Shoulders elevate Head Head protrudes forward while pushing

Movement Observations Pulling Assessment Position Instruct client to draw abdomen in, feet shoulder width, and toes pointing forward. Movement Instruct client to pull handles toward body and return slowly. Perform up to 20 repetitions

Movement Observations Pulling Assessment Lumbo-Pelvic-Hip Complex Lumbar spine arches Shoulder Complex Shoulder elevates Head Head protrudes forward while pulling

Performance Performance assessments can be used for clients trying to improve athletic performance. Basic performance assessments include: Davies Test Shark Skill Test Bench Press Strength Assessment Leg Press Strength Assessment

Performance Assessments Davies Test Designed to assess upper extremity agility and stabilization May not be suitable for individuals who lack shoulder stability

Performance Assessments Davies Test Position Begin by placing two pieces of tape on the floor, 36 inches apart. Position client in a push-up position, with one hand on each piece of tape. Movement Instruct client to quickly move his or her right hand to touch the left hand. Perform alternating touching on each side, for 15 seconds. Repeat for three trials.

Performance Assessments Shark Skill Test Designed to assess lower extremity agility and neuromuscular control Should be viewed as a progression from the single-leg squat May not be suitable for all individuals

Performance Assessments Shark Skill Test Position Position client in the center box of a box grid, with hands on hips and standing on one leg. Movement Instruct client to hop to each box in a designated pattern, always returning to the center box. Be consistent with the pattern that you expect of the client. Perform one practice run through the boxes with each foot. Perform twice with each foot (four times total). Keep track of time. Penalize 0.10 seconds for each of the following faults: Nonhopping leg touches ground Hands come off hips Foot goes into wrong square Foot does not return to center square

Performance Assessments Bench Press Strength Assessment Designed to estimate the one-rep maximum, for training intensity purposes Advanced assessment (for strength-specific goals) May not be suitable for many clients

Performance Assessments Bench Press Strength Assessment Position Position client on a bench, lying on his or her back. Feet should be pointed straight ahead. The low back should be in a neutral position. Movement Instruct client to warm with a light weight for 8-10 repetitions then rest 1 minute Add 30 to 40 pounds (10–20% of initial load) and perform 3 to 5 repetitions then rest 2 minutes Repeat this step into a true 1 rep maximum has been achieved

Performance Assessments Squat Assessment Designed to estimate the one-rep leg press maximum, for training intensity purposes Advanced assessment (for strength-specific goals) May not be suitable for many clients

Performance Assessments Squat Strength Assessment Position Position standing with bar on his or her back. Feet should be pointed straight ahead and knees in line with the toes. The low back should be in a neutral position. Movement Instruct client to perform 3–5 repetitions with perfect form. Chart amount of weight used for accomplished repetitions. Refer to the appendix of the textbook for comparison charts to estimate the one-rep maximum.

Summary The fitness assessment enables the fitness professional to decide the appropriate selection of flexibility, cardiorespiratory, core, balance, power, and strength training exercises.