1. Chapter 6 Fitness Assessment

2. 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.

3. 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.

4. 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

5. 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

6. 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.

7. 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

8. 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)

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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.

19. 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)

20. 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

21. 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

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

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

24. 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

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

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

27. 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.

28. 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

29. Body Composition Circumference Measurements Neck
Across the Adam’s apple

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

31. 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.

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

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

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

35. 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.

36. 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.

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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.

46. 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

47. 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

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

49. 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

50. 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

51. 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

52. 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.

53. 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.

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

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

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

57. 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.

58. 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.

59. Movement Observations
Single-Leg Squat Assessment
Views
Knee
Moves inward

60. 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

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

62. 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

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

64. 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

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

66. 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.

67. 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

68. 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

69. 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

70. 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

71. 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

72. 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.

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