Fitness Assessment

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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, from the results, be able to
  stratify a clients 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, how to obtain
  subjective and objective information about
  clients, and how to use the information collected
  to help design an exercise program.

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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.

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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 clients individual
  structural and functional status, creating a
  starting point from which to work
• Not intended to replace a medical examination

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Guidelines

• Fitness professionals 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.

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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

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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).

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General History

• Ask some very basic questions concerning a
  clients 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

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Medical History

• Find out a clients 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

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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

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Physiologic Assessments

• Provide valuable information regarding the status
  of the clients health
• Heart rate
• Blood pressure

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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.

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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 2.
• Record the 60-second pulse rate and average for 3
  days.
• Average resting heart rates
• Males 70 beats/min
• Females 75 beats/min

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Physiologic Assessments

• Training Heart Rate
• Calculate the clients training heart rate zone
  for cardiorespiratory exercise.
• Find estimated maximal heart rate (220 age).
• Multiply the estimated maximum heart rate by the
  appropriate intensity (6590).
• 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

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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

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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 lt120 mm Hg.
• Diastolic (bottom number)
• The minimum pressure within the arteries through
  a full cardiac cycle
• Normal diastolic pressure is lt80 mm Hg.

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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
  clients 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.

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Body Composition

• There are a variety of methods used to estimate
  body composition, they vary in 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)

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Body Composition

• Some benefits of body composition testing
  include
• Identifying a clients health risk for
  excessively high or low levels of body fat
• Promoting a clients understanding of body fat
• Monitoring changes in body composition
• Helping estimate healthy body weight for clients
  and athletes
• Assisting in exercise program design

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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

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Body Composition

• Body Fat
• Skin-fold caliper method
• DurninWomersley formulas four sites of
  measurement
• Biceps
• Triceps
• Subscapular
• Iliac crest

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Body Composition

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

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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

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Body Composition

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

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Body Composition

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

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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.

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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

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Body Composition

• Circumference Measurements
• Neck
• Across the Adams apple

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Body Composition

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

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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.

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Body Composition

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

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Body Composition

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

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Body Composition

• Circumference Measurements
• Calf
• At the maximal circumference between the ankle
  and the knee

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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.

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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
  persons BMI exceeds 25.

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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

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Cardiorespiratory Assessments

• Step Test
• Determine the clients maximum heart rate by
  subtracting the clients 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

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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 clients pulse for 60 seconds and
  record the number as the recovery pulse.
• Locate score in the chart provided in your text.

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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

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Cardiorespiratory Assessments

• Rockport Walk Test
• Determine the clients maximum heart rate by
  subtracting the clients 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

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Cardiorespiratory Assessments

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

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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

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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

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Posture

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

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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

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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.

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Postural Distortions

• Predictable Patterns of Muscle Imbalance
• Pronation Distortion Syndrome
• Lower Crossed Syndrome
• Upper Crossed Syndrome

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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

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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

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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

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Movement Observations

• Dynamic postural observations (looking at
  movement) are often the quickest way to gain an
  overall impression of a clients 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

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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.

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Movement Observations

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

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Movement Observations

• Overhead Squat Assessment
• Views
• Anterior
• Foot
• Turns out
• Knee
• Moves inward or outward

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Movement Observations

• Overhead Squat Assessment
• Views
• Lateral
• Lumbo-pelvic-hip complex
• Excessive forward lean
• Low back arches
• Shoulder complex
• Arms fall forward

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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.

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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.

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Movement Observations

• Single-Leg Squat Assessment
• Views
• Anterior
• Knee
• Moves inward

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Movement Observations

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

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Movement Observations

• Pushing Assessment
• Lumbo-pelvic-hip complex
• Lumbar spine arches
• Shoulder complex
• Shoulders elevate
• Head
• Head protrudes forward while pushing

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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

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Movement Observations

• Pulling Assessment
• Lumbo-pelvic-hip complex
• Lumbar spine arches
• Shoulder complex
• Shoulder elevates
• Head
• Head protrudes forward while pulling

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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

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Performance Assessments

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

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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.

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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

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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

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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
  810 repetitions then rest 1 minute.
• Add 30 to 40 pounds (1020 of initial load) and
  perform 3 to 5 repetitions then rest 2 minutes.
• Repeat this step until a true one-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

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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 35 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.

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Summary

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