Chapter 03 Principles of Assessment, Prescription, and Exercise Program Adherence

Principles of Assessment, Prescription, and Exercise Program Adherence Responsibilities of an Exercise Specialist Educating Clients / Health Screenings Pre-exercise screening Fitness test administration and evaluation Exercise Prescription Exercise Counseling Exercise Leadership Exercise Adherence

Principles of Assessment, Prescription, and Exercise Program Adherence Components of Physical Fitness Summary Cardiorespiratory Endurance Musculoskeletal Fitness strength endurance Body Composition Flexibility Balance

Principles of Assessment, Prescription, and Exercise Program Adherence Cardiorespiratory Endurance Testing Utilize clinical testing Max GXT on treadmill, bike, or arm ergometer Assess maximum oxygen consumption Measure peak work performance Determine any indication of cardiovascular compromise Utilize field testing Sub maximal GXT, usually 3-4 stage test, target HR Assess heart rate response per stage Predict maximum aerobic capacity

Principles of Assessment, Prescription, and Exercise Program Adherence Musculoskeletal Fitness Utilize clinical testing Determine Peak Force Production (Specialized Apparatus and software) Analyze force cuvre shape and magnitude Determine any signs of weakness or instability throughout the ROM May be combined with EMG to determine motor unit function.

Principles of Assessment, Prescription, and Exercise Program Adherence Musculoskeletal Fitness Utilize field testing Use or 1-RM or Multiple RM systems Individualized testing for both strength and endurance for all muscle groups Easy test-retest system Determine proper lift mechanics

Principles of Assessment, Prescription, and Exercise Program Adherence Body Composition Clinical Testing Densitometry – Hydrostatic Weighing, Bod-Pod. Assess the percentage of Fat vs. Lean Body Mass Field Testing Anthropometry Height Weight BMI Circumference Measures (W/H rations)

Principles of Assessment, Prescription, and Exercise Program Adherence Flexibility Clinical Testing Goniometry (both digital / software, and manual) Joint specific / bilateral comparisons Field Testing Instruments to more general body regions Sit and Reach Test Shoulder Flexibility Test

Principles of Assessment, Prescription, and Exercise Program Adherence Purpose of Fitness Testing ( see list of tests) Determine present level of fitness Determine improvements in fitness Determine test / retest reliability Determine presence of disease Client Motivation / Adherence Collection of Data / Research

Principles of Assessment, Prescription, and Exercise Program Adherence Recommended Testing Order Non-Exercise Data Collection HHQ, Informed Consent Resting BP and Heart Rate Anthropometry Body Composition Blood Chemistry Resting ECG Pulmonary Functions Nutrition Information Risk Factor Assessment

Principles of Assessment, Prescription, and Exercise Program Adherence Recommended Testing Order 2) Exercise Data Collection Order: Cardiorespiratory Endurance Muscular Fitness Flexibility / Balance

Principles of Assessment, Prescription, and Exercise Program Adherence Exercise Test Environment Stress free environment to combat client pre-test anxiety Ambient Temp = 21 to 23o C All equipment should be calibrated and prepared Conversation and attention should focus on the client

Principles of Assessment, Prescription, and Exercise Program Adherence Test Validity (stats help) Does the test measure what it is supposed to measure ? What are the reference / criterion measures ? Is the test a direct or indirect measurement ? Validity coefficient (ry1y2 values) ( relationship between the criterion and the predicted score ) The difference between the criterion and the predicted is the residual score. (Typical Field Test: r > 0.80 ) SEE measures the accuracy of the prediction as the average degree of deviation of each predicted score, likewise, it is used to quantify the accuracy of the prediction equation.

Principles of Assessment, Prescription, and Exercise Program Adherence Test Validity The regression is the prediction equation that accounts for the criterion and the residual. thus, the line of best fit is the method of determining the actual scores while accounting for the residual error

Line of best fit and SEE (prediction error).

Principles of Assessment, Prescription, and Exercise Program Adherence Sensitivity and Specificity of the Exercise Test (see pg 42, Text) Sensitivity = Measure disease (risk factors ) when present Specificity = Measure no disease (risk factors ) when not present

Principles of Assessment, Prescription, and Exercise Program Adherence Sensitivity and Specificity Disease Present Disease Not Present True Positive False Positive Test Positive False Negative True Negative Test Negative

Principles of Assessment, Prescription, and Exercise Program Adherence Test Reliability Are the results reproducible? What is the reliability coefficient for: Intra-tester Inter-tester ( Test Objectivity )

Principles of Assessment, Prescription, and Exercise Program Adherence Prediction Equation Evaluation ( See Table 3.1, p 43.) What is the criterion measure? What was the size and type of sample for the prediction equation (spec. population or general)? Multiple Correlations {MC}( sample size / predictor) What are the individual predictors? What are their “weights” – individual correlation coefficients ? What and how were the data collected for the MC’s? Population Specific, or generalized? Has the equation been cross validated on another sample?

Line of identity and total error (prediction error). Figure 3.2, p. 45 The total error (TE) is the average degree of deviation of individual data points from the line of identity. ( The line of identity has a slope of 1.0 and a y-intercept equal to 0. ). When an equation closely predicts the actual or measured scores of the cross-validation sample, individual data points fall close to the line of identity.

Principles of Assessment, Prescription, and Exercise Program Adherence Constant Error : difference between the predicted and actual means (actual = criterion) Determined during cross-validation. Are the Mean + SD of Criterion and Sample Different? Dependent t-test for same (the prediction equation is for the general population. Large Significant difference = bias (over or underestimation) Individual Accuracy – see figure 3.3 , p 46. (next slide) (Test of Difference)

Bland-Altman plot with 95% limits of agreement. Figure 3.3, p.46 In the example in figure 3.3, the predictive accuracy of the equation for estimating the actual %BF of individual clients is approximately ±6% BF (note the upper and lower limits of agreement on the y-axis of the graph).

Test Validity, Reliability, and Objectivity - Summary Apply all of the following evaluation criteria when selecting field tests and prediction equations that indirectly assess the physical fitness of your clients: ■ An acceptable method is used to derive reference measures of the physical fitness component. ■ A large sample (N = 100-400) and 20 to 40 subjects per predictor variable are used to develop the equation. ■ The sizes of the multiple correlation and validity coefficients exceed 0.80. ■ The group prediction errors (SEE and TE) are acceptable (see table 3.1). ■ Demographic characteristics (e.g., age, gender, race, fitness status) of the validation and cross-validation samples are described. (continued on next slide)

Test Validity, Reliability, and Objectivity - Summary Apply all of the following evaluation criteria when selecting field tests and prediction equations that indirectly assess the physical fitness of your clients: ■The prediction equation is cross-validated in the original study or on independent samples from other studies. ■ The constant error (bias), or difference between the measured and predicted means for the cross-validation sample, is not statistically significant. ■ The 95% limits of agreement are acceptable (see table 3.1).

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Pre-Test Preparation ■ Wear comfortable clothing, socks, and athletic shoes if available. ■ Drink plenty of fluids during the 24 hr. period before the test. ■ Refrain from eating, smoking, and drinking alcohol or caffeine for 3 hr. prior to the test. ■ Do not engage in strenuous physical activity the day of the test. ■ Get adequate sleep (6 to 8 hr.) the night before the test.

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Principles of Fitness (read definitions and discuss practical applications for each) Specificity of Training Overload Progression Initial Values Interindividual Variability Diminishing Returns Reversibility Why is it important for your client to know these principles?

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Art of Rx Mode = type (see also Table 3.2, p. 49) Intensity = how hard Duration = how long Frequency = how often Exercise Volume = total calories (sum of the above) Exercise Progression = building finished product Stages of Exercise Rx Progression Initial stage (6-8 weeks) Improvement stage ( 4-8 months) Maintenance Stage ( 8 months +) Inversely Related

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence Of those individuals starting an exercise program, almost 50% will drop out within 1 yr. As an exercise specialist, you must help the client to develop a positive attitude toward physical activity and to make a firm commitment to the exercise program. To increase adherence, you need to be aware of factors related to exercise attrition. Exercise specialists play an important role in educating the public about why regular physical activity is absolutely essential for good health and how to exercise safely and effectively. Many factors influence regular participation in physical activity and adherence to an exercise program (see table 3.3, next slide)

You should focus on factors that are potentially modifiable such as exercise facilities; program variables (e.g., exercise intensity and perceived exertion); enjoyable scenery during exercise; and support from spouse, family, friends, and peers.

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Models / Theories for Enhancing Adherence ■ Behavior modification ■ Health belief model ■ Social cognitive model ■ Transtheoretical model of health behavior change (stages of motivational readiness for change) ■ Decision-making theory ■ Theory of reasoned action and theory of planned behavior ■ Self-determination theory

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Behavior Modification Model With use of the behavior modification model, clients become actively involved in the change process by setting realistic short- and long-term goals, developing a plan to achieve these goals, and signing a contract that describes each goal and how it may be achieved. Throughout the exercise program, you should provide your client with feedback and revise the plan as needed.

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Health Belief Model The health belief model is based on the assumption that individuals will engage in exercise on a regular basis because they perceive the threat of disease and believe that this threat is severe and that they are susceptible to disease. When the benefits outweigh the barriers, individuals will take action and adopt exercise into their lifestyle.

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Social Cognitive Model The social cognitive model is based on the concepts of self-efficacy and outcome expectation. The likelihood that people will engage in a specific behavior, like exercising regularly, depends on their self-efficacy or perception of their ability to perform the task, and their confidence about making the behavioral change. Techniques to improve your client’s exercise self-efficacy include performance mastery, modeling, positive reinforcement, and emotional arousal.

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Transtheoretical Model The five stages of motivational readiness in terms of changing exercise behavior: 1. Precontemplation: Client does not exercise and does not intend to start exercising. 2. Contemplation: Client is not exercising but intends to start. 3. Preparation: Client is exercising but is not meeting the recommended amount of physical activity. 4. Action: Client has been performing the recommended amount of exercise regularly for less than 6 mo. 5. Maintenance: Client has been exercising regularly at the recommended amount for 6 mo. or longer.

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Decision Making Theory Individuals decide whether or not to engage in a behavior by weighing the perceived benefits and costs of that behavior. Clients are more likely to exercise when they perceive that the benefits outweigh the costs (e.g., “I feel better about myself when I exercise even though it takes time from my busy schedule”). Clients in early stages of motivational change (e.g., precontemplation stage) tend to perceive more disadvantages compared to clients in later stages (e.g., action stage) of change.

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Reasoned Action Theory According to this theory, intention is the most important determinant of behavior; intention is highly influenced by the individual’s attitudes and subjective behavioral norms. Subjective behavioral norms, or perceptions about what others think or believe about exercise, also may influence your client’s intention

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Planned Behavior Theory The theory of planned behavior extends the theory of reasoned action by taking into consideration the client’s perception of behavioral control (i.e., perceived power and control belief). This theory proposes that individuals intend to perform a specific behavior (e.g., exercising) if they evaluate it positively (e.g., attitude), believe that others think it is important (subjective norms), and perceive the behavior to be under their control (e.g., power).

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Self-Determination Theory The self-determination theory describes how the presence or absence of specific psychological needs (i.e., autonomy, competence, and relatedness) affects behavior through a continuum of motivation. According to this theory, four levels of motivation with respect to exercise may be identified: 1. Amotivation 2. Other-determined motivation 3. Self-determined extrinsic motivation 4. Intrinsic motivation

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Self-Determination Theory 1. Amotivation - The individual has no intention or desire to engage in exercise. 2. Other-determined motivation - The individual is motivated to exercise by outside factors such as rewards, guilt, fear, or pressure; long-term adherence is unlikely. Possible motives for exercising may be “I exercise to lose weight” or “My partner thinks I should exercise more.”

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Exercise Adherence - Self-Determination Theory 3. Self-determined extrinsic motivation - The individual values exercise, is motivated by extrinsic factors like improved health or gains in fitness, and freely chooses (i.e., autonomously) to exercise without a sense of outside pressure 4. Intrinsic motivation - The individual engages in exercise for the sheer enjoyment and satisfaction it brings to his or her sense of well-being; enjoying exercise for its own sake leads to adherence. The ultimate goal of this approach is to get clients to value physical activity and to think of themselves as exercisers rather than using exercise to attain an external goal like weight loss.

Principles of Assessment, Prescription, and Exercise Program Adherence Physical Fitness Tests: Administration and Interpretation Other Adherence Strategies (see also info. boxes on p.54) Physician Support Spousal / Family Support Moderate Exercise Progression (motivation curve) Test – Retest Fitness Games Progression Charts / Photos Client Reward Systems Testimonials Education Sessions Newsletters

Principles of Assessment, Prescription, and Exercise Program Adherence Information beginning at “Using Technology To Promote Physical Education to the end of the chapter is FYI… END OF PRESENTATION