1. Unit 6 – Fitness Testing for Sport & Exercise
Health Screening
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2. Introduction to health screening
It is important that individuals are screened with a health appraisal questionnaire prior to participating in any fitness test. This ensures that the person carrying out the test:
Acts in a legally responsible way.
Identifies clients who need medical clearance prior to exercise.
Identifies any bone, joint or injury problem which may mean that certain tests should be avoided.
It is essential to determine an individual’s health status and lifestyle before a physical fitness test is performed.
Client confidentiality
Client confidentiality means that all the fitness test results and personal information both written and verbal remains between the tester and client. The tester should not discuss a person’s health or fitness with anyone else without the consent of the client.
Communication
Open and honest communication is essential between the tester and the client. It is essential that the tester listens carefully so he/she gets to know the client’s backgrounds and requirements. Appropriate non-threatening questioning can assist the tester to obtain a clear insight into the lifestyle potential goals the client may want to achieve. Keeping a record of meetings and consultations is essential so a client’s progress can be monitored.
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The following diagram shows a recommended procedure for health screening:
                                                                                  
Figure 1: Health screening procedure
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4. Physical activity and readiness questionnaire (PAR-Q)
For most people, physical activity should not pose any problem or hazard. Gyms, health clubs and laboratories will all use health screening questionnaires. One of the common health screening forms is called a PAR-Q. This form has been designed to identify the small number of adults for whom physical activity might be inappropriate and those who should have medical advice concerning the type of activity most suitable. Any person completing an exercise programme or fitness assessment must complete a PAR-Q.
Listed below are questions you will find on a PAR-Q form, together with an explanation.
Are you a man over the age of 45 or a woman over the age of 55? Persons with known heart disease are at increased risk of heart problems during exercise and fitness testing. They should consult a doctor and undergo a supervised exercise testing before starting an exercise programme in order to ensure that exercise prescription follows standard guidelines for cardiac patients. Medical supervision may be required during exercise training.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? A doctor should be consulted to identify the cause of the chest pain, whether it occurs at rest or with exertion.
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Do you feel pain in your chest when you do physical activity? See Question 2.
In the past month, have you had chest pain when you were not doing physical activity? A doctor should be consulted to establish the cause of these symptoms, which may be related to potentially life-threatening medical conditions. Exercise training or testing should not be undertaken until any serious cardiac disorders have been identified.
Do you lose your balance because of dizziness or do you ever lose consciousness? Existing conditions could be made worse with exercise training. A doctor should be consulted to determine whether any special precautions are required during exercise training.
Do you have a bone or joint problem that could be made worse by a change in your physical activity? See question 1.
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? The exercise prescription may have to be changed in accordance with the specific reason provided.
Do you know of any other reason why you should not do physical activity? This question gives the person being tested the chance to tell the tester of any other problems he/she may have during a fitness test
The PAR- Q provides the tester with information about the individual’s health. It is also useful to have an understanding of an individual’s lifestyle and activity level.
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Informed consent form
Informed consent is a procedure used to obtain an individual’s voluntary permission to participate in a fitness test. Before an individual participates in a fitness test the person performing the test needs to inform and explain the following:
The purpose of the fitness test
The possible risks and benefits of the fitness test
Allow the client to ask any questions about the fitness test
Advise the participant that participation is voluntary and he/she is free to withdraw at any time
On the following slide there is an example of an informed consent form that must be completed before subjects complete any exercise tests. The aim of informed consent is to ensure the person participating in the test is aware of any potential dangers. Once signed the form must be kept safely by the tester.
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7. Example informed consent form
I (print name)____________________ consent to participating in this fitness assessment on the following terms:
The test procedures have been explained to me and I understand what I will be required to do.
I understand that I will be taking part in physical exercise at or near the extent of my capacity and that there is a possible risk in the physical exercise at that level, i.e. episodes of light-headedness, fainting, abnormal blood pressure, chest discomfort, and nausea.
I understand that this may occur though the staff in this laboratory will take all proper care in the conduct of the assessment, and I will fully assume that risk.
I understand that I can withdraw my consent, freely and without prejudice, at any time before, during, or after testing.
I have completed the physical activity readiness questionnaire (Par-Q) and have told the person conducting the test about any illness or physical defect I have that might contribute to the level of that risk.
I understand that the information obtained from the test will be treated confidentially with my right to privacy assured.
I release this laboratory and its employees from any liability for any injury or illness that I may suffer while undertaking the assessment, or subsequently occurring in connection with the assessment or that is to any extent contributed to by it.
I hereby agree that I will present myself for testing in a suitable condition having abided by the requirements for diet and activity advised for me by the fitness testing staff.
Participant signature: _______________________ Date: __________
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Life Style Evaluation
A life style evaluation can provide information on physical activity, diet and general information regarding an individual’s lifestyle. There are many different ways of assessing lifestyle and this depends on the specific information that is required. The information from a lifestyle evaluation can help assist with the interpretation of health test results. This can help the tester provide more informed feedback and advice on how to improve an individual’s health.
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9. Health Monitoring Testing
Heart rate
Is often used as a health screening test.
Aim: To find out an individual’s resting heart rate
Equipment
Digital watch Optional use of heart rate monitors
Procedure
The individual should remain in a seated position for 5 minutes before heart rate is recorded. This enables the heart to reach a resting state.
Use the tips of the middle and index fingers. Do not use your thumb as it has a pulse of its own and may produce an inaccurate result.
The pulse is taken at the carotid artery in the neck. Place your fingers on the centre of the windpipe and move fingers slowly to the side of the neck until you can feel a pulse.
Hold your fingers on the pulse and time 15 seconds. The first beat you count should be zero.
Once you have counted and timed 15 seconds you need to multiply this value by four and this gives the individual’s heart rate per minute.
If you chose to use a heart rate monitor, ensure you repeat step 1.
Normative data
The average resting heart rate for an adult is beats per minute (bpm), with the average resting heart rate of women typically 7-10 bpm higher than that of men.
Heart rates as low as 25 – 40bpm have been reported for highly trained endurance athletes. Poorly trained sedentary individuals may have heart rates that exceed 100 bpm.
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Blood pressure
Blood pressure assessment is a commonly used painless test and provides a lot of useful information about the heart and the conditions of the blood vessels.
The test measures two things. The first value used is the maximum pressure (systolic). The second value used is the lowest pressure (diastolic) made by the beating of the heart.
Systolic pressure – is the maximum pressure in an artery at the moment when the heart is beating and pumping blood through the body.
Diastolic pressure – is the lowest pressure in an artery in the moments between beats when the heart is resting
Both systolic and diastolic pressure measurements are important; if either one is raised it means you have high blood pressure.
Equipment
Sphygnamometer Stethoscope Automatic blood pressure gauge
Procedure
The individual must be seated with his/her arm resting on a level surface such as a table.
A cuff that inflates is wrapped around the upper arm and kept in place with Velcro.
Air is then blown into the cuff and increasing pressure and tightening is felt on the upper arm.
A stethoscope is put to the arm to listen to the pulse when the air is let out.
The systolic pressure is measured when the doctor first hears the pulse.
This sound will slowly become more distant and finally disappear.
The diastolic pressure is measured from the moment you are unable to hear the sound of the pulse.
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11. Blood Pressure Continued
Blood pressure can be measured electronically; this is partly due to the toxic nature of mercury and is accurate enough to be used in a clinical setting and relatively inexpensive.
Normative values
Normal blood pressure should be 120 / 80 mmHg
High blood pressure can be a systolic reading of 140 or above and a diastolic reading of 90 or above.
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Lung Function
A lung function test evaluates how well your lungs work. The test determines how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs add oxygen and remove carbon dioxide from your blood.
Spirometry
Is the most commonly performed test of lung function. A device called a spirometer is used to measure how much air the lungs can hold and how well the respiratory system is able to move air into and out of the lungs. Spirometry is often used to diagnose and monitor lung problems.
Peak flow is a simplified measure of lung function; it measures the greatest flow that can be sustained for 10 milliseconds on forced expiration starting from full inflation of the lungs. Peak flow like spirometry can be used to detect narrowing of airways and can detect asthma.
Aim: To measure the maximal volume of air forcibly and rapidly exhaled
Equipment
Peak flow meter
Procedure
A nose clip is used to ensure all air is measured through the mouth.
The individual is instructed to inhale deeply before exhaling maximally through the tube of the peak flow meter.
Normative data
Peak flow is dependant on age, sex and size.
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Waist to Hip Ratio
The waist to hip ratio indicates potential health risk. Research has shown that people with apple shaped bodies, with more weight around their waist face more risks than those with pear shaped bodies that carry more weight around their hips.
Aim: To measure an individual’s level of fatness
Equipment
Tape measure
Procedure
Ensure the individual is standing in a relaxed position.
Measure the waist at the smallest place, usually at the navel; record this figure
Measure the hips at their largest spot over the buttocks and record this figure.
Ensure you do not pull too tightly on the tape measure.
To calculate the ratio, divide the waist measurement by the hip measurement.
Normative data
A waist to hip ratio for woman should fall below 0.85 and for men The higher the number above these values, the greater the risk of heart disease.
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Body Mass Index
Body mass index (BMI) is a measuring technique used to judge if a person’s weight is healthy. BMI uses height and weight.
Aim: To determine if a person’s weight is healthy.
Equipment
Scales Stadiometer
Procedure
The individual should be weighed in minimal clothing, and this should be noted for re-test purposes so he/she is weighed in the same clothing so this doesn’t affect the results.
The individual’s height is calculated using a stadiometer.
To calculate your BMI you need to multiply your height by itself to give your height squared. You then take your weight and divide this by your height squared to give your BMI.
Example
Height 1.60m Weight 65kg 1.6 x 1.6 = BMI would be 65kg divided by 2.56 = 25.39
Normative data
BMI less than 18.5 means that your underweight
BMI between 18.5 – 25 means that you are a healthy weight
BMI between means you are overweight
BMI between means that you are obese
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15. Feedback of Health Screening Results
It is essential that all the health screening test results are fed back to an individual. If you look at the diagram on the recommended procedure for health screening you can see that the feedback session happens at the end of the health screening process.
To enable the health professional to provide helpful and accurate advice he/she needs the following information:
PAR- Q form
Activity / lifestyle questionnaire
Health screening test results, such as blood pressure BMI etc.
Normative data
Before a consultation all documentation and results need to be analysed so clear feedback can be given. The aim of the feedback should provide the individual with a clear picture of the state of his/her health and areas that need to be improved and recommend lifestyle changes he/she can make to achieve this.
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