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ACSM Resources for the Personal Trainer Chapter 12 Client Fitness Assessment

Terms in this set (76)

three common anatomical sites for measuring HR:
-Radial: lightly press the index and middle fingers against the radial artery in the groove on the anterior surface of the lateral wrist (bordered by the abductor pollicis longus and extensor pollicis longus musleces).
-Brachial: located in the groobe between the tricpes and biceps muscles of the medial side of this groove. This is also the location for auscultation of BP.
-Carotid: may be more visible or easily found than radial pulse, press fingers lightly along the medial border of the sternocleidomastoid muslce in the lower neck region (on either side). Avoid the carotid sinus area (stay below the thyroid cartilage) to avoid the reflexive slowing of HR or drop in BP by the barorecptor reflexTHis technique should only be used if you or the client fails to feel the pulse in the radial or brachial sites. Sometimes a HR monitor can be usd to check accuracy of te palpated HR with the monitor's HR may be desirable. An electrocardiogram is not often availabe to trainers. The techniques can be mastered through practice and should be taught to your clients. However due to anatomical aberrations some palpations may be difficult to obtain. The measure of the carotid artery may lead to an underestimation of the true HR because the baroreceptors in the carotid sinus region often become stimulated when touched. The reflex may reduce the client's HR as the baroreceptors sense a false increase in BP. therefore radial or brachial arteries are the location of choice. It is reccomended that a full 60-seconds count be performed for accuracy in resting HR. however 30 can be sufficient for the count. Resting conditions must be present (seated for 5 minuts) with the back supported, free of stimulants such as tobacco and caffeine for at least 30 minutes before taking the measurements. Resting Hr may alternatively be assessed by having clients take their own pulse at home in bed upon waking in the morning. Resting Hr is useful for the calculation of the exercise target HR zone.
1. Good position to hear the BP and see the manometer scale. Take control of the arm while having it supported. Place the stethescope flat and completely over the brachial artery. Done in a room with minimum noise and comfortable temperature.
2. Client should be seated with feet flat and legs uncrossed. Arm free of any clothes and relaxed. Arm should be well supported along with their back.
3. Measure after 5 minutes of quiet sitting, free of stimulants such as nicotine and caffeine for at least 30 minutes prior to the measure. And not have exercised strenuously in the last hour.
4. No difference between measuring the client seated or supine for resting BP, Systollic is about 6-7 mm Hg higher and dystolic is 1 mm Hg higher in supine.
5. Arm preference doesn't matter, recommends doing both on the initial evaluation and the arm with the higher pressure be chosen. Conventionally the left arm measures are taken.
6. Center the rubber band of the cuff over the client's brachial artery' the lower border of the cuff should be 2.5 cm above the antecubital foss or crease of the elbow. Palpated the client's brachial artery to determine it's location.
7. Secure the BP cuff snuggly around the arm, use the appropriate size. No clothes on the upper arm to secure the cuff properly. Clothing will also muffle the stethescope.
8. Have the client's arm slightly flexed. support the arm, if it's not the isometric contraction may elevate the DBP. supporting the arm reduces "noise: to get an accurate read.
9. position the cuff at heart level, every centimeter the cuff is below BP will be higher by 1 mm Hg, and vis versa.
10. Find the brachial artery, medial to the biceps tendon. Palm of the hand face up and rotate the arm outward on the thumb side with arm hyperextended.
11. Place the stethescope chest piece firmly on the artery in the antecubital space. No air space or clothing between the stethoscope and arm. Don't press too hard. Ear pieces should be slightly forward facing toward your noise and in the same direction as your ear canal. Should be cleaned each time.
12. Position the manometer so that the dial or tube is in clear visible eye level to aboid any parallax error.
13. Choose one of three inflation methods. Quickly inflate the cuff.
-20 mm Hg above the SBP, if known
-up to 140-180 mm Hg for resting BP
-up to 30 mm Hg above disappearance of the radial pulse if you palpate for radial pulse first. (palpation method, feeling for the SBP)
14. deflate the pressure slowly 2-3 mm Hg per heart beat, by opening the air exhaust balbe on the hand bulb. Rapid deflation leads to underestimation of SBP and overestimation of DBP. Slow deflation rete when in the anticipated ratio of systolic to diastolic BP, this will compensate for slow HRs.
15. Recorder SBP and DBP in even numbers, always round off upward to the nearest 2 mm Hg. Always listen to any BP sounds for at least 10 mm Hg below the 5th phase (making sure that 5th phase was correctly identified).
16. rapidly deflate the cuff to zer after the DBP is obtained.
1 firmly grasp double fold of skin and subcutaneous fat between thumb and index finger in your left hand and lift up and away from the body, make sure you have not grasped any muscle can check by asking subject to first flex the muscle below the sit . But measure when the subject is relaxed.
2. Grasp the skinfold site with two fingers about 8 cm apart on a line that is perpendicular to the long axis of the skinfold. All measues should be taken on the right side of the body.
3. Hold the calipers in your hand with the scale facing up to ease your viewing. place the contact surface of the calipers 1cm below your fingers. Placed on the exact skinfold site, whereas the fingers should be above the site by 1 cm. Place the caliper tips on the double fold of skin and fat. Marking the skin will allow measuring on the right site.
4. Release the scissor grip while continuing to support the weight of the calipers with that hand. Maintain a firm hold on the skinfold though the entire measure.
5. Record the reading on the calipers scale 1-2 seconds after releasing the grip Measure the skinfold to the nearest 0.5 mm. Avoid slippage of the caliper.
6. Measure each skinfold site at least twice. Rotate through the measuring sites to allow time for the skin to regain its normal texture and thickness. If duplicate measurements are not within 1-2 mm (or 10%) retest this site.
7. Sum the mean or average of each skinfold site to determine percent of body fat. It's suggested to use the Jackson-Pollock 3-site skinfold Formula. Table 12.3 rants skinfolds by sex.
a protocol requiring clients to perform a 6 minute submaximal exercise bout on the cycle ergometer, typically a single stage test. The client's HR response to this bout will determine his or her maximal aerobic capacity or CRF by plotting it on the test=specific nomogram. (pg 325).
1. Explain the test, adequate screening with questionnaires, doc supervision is not necessary with submaxiaml testing in low and moderate risk adults.
2.informed consent. That understand the client can stop the tests anytime but they are responsible for informing you of any and all symptoms they might develop.
3. Discuss general procedures to handle any emergencies.
4. Take baseline or resting measures of HR and BP with client seated.
5. Adjust seat height: knees flexed at 5-10 degrees in the pedal down with toes on the pedals. another check is if clients heel is on the pedal their leg should be straight. alight seat height with trochanter or hip if standing next to the cycle. Test for comfort, no rocking hips. Upright posture (adjusting the handlebars) don't grip too tight. Record the height and adjustments.
6. Start test
7. Have client free wheel without any resistance at pedaling cadence of 50 rpm (metronome at 100).
8. Remind client to maintain 50 rpm throughout test. Not valid if large variations from cadence.
9. Set first stage work output according to table 12.5 ([g 326) (men unconditioned 300-600 kgm/min or 50-100W, women 300-450kg or 50-75 W) (conditioned man 600 or 900 kgm/min or 100-140 , woman 450-600kg or 75-100W)
10. Start clock/timer
11. Measure HR after 1 min stating at minute 2. Record
12. Measure and record BP after the third minute HR
13. 5, 6th HR wil be used in the test determination of VO2 max, as long as there is no more than 5-beats difference between the two HRs.
14. HR:
-if there is a difference of less than or equal to 5bpm, consider the test finished
-if there is a difference greater than 5bpm continue on for another minute and check HR again.
15. Regularly check the work output of the cycle ergometer with the pendulum resistance scale on the side of the ergometer and the rpm of client. Adjust the work output if necessary.
16. Regularly check the client's rpm and correct if necessary. This specific protocol required the following for test completion:
-obtain 5, 6th minute HR (within 5bpm)
-For the most accurate prediction of VO2max, the protocol requires the HR be between 125 and 170 bpm.
-if the HR response to the initial work rate is not above 135 bpm after 6 minutes the test is continued for another 6 minute interval by increasing the work rate by 300kgxm/min.
-The HR at the 5th or 6th minute, if acceptable to the criteria above are averaged for the nomogram method.
17. Allow the client to cool down after the protocol is complete. Have them continue pedaling at 5 rpm and decrease the resistance 0.5-1 kg for 3 minutes. Take the client's HR and BP at the end of the 3 min active recovery period. Allow the cliet to sit quietly in a chair for 2-3 minutes to continue the recovery process. Check the client's Hr and BP before allowing the client to leave the lab. It should be near resting HR.
is a branching, multistage format that establishes a relationship between HR and work rate to estimate CRF. The test requires a minimum of two stages, with the possibility of four stages. Each stage is 3 minutes in duration. The goal of the protocol is to complete two separate stages that result in HR values between 110-150 bpm. All client begin with a workload of 150kgx m/min. The second stage is dependent upon the HR response from stage one. A diagram is on pg 327.
1-6. Steps 1-6 are the same as described in the Astrand-Rhyming protocol.
7. Exercise test should start with a 2-3 min warm-up phase. Once test has begun client is instructed to maintain a 50 rpm pedaling rate.
8. HR should be monitored near the end of minutes 2 and 3 of each stage. IF HR> 110bp and the client is in steady-state exercise (two HR within 5 bpm) the stage can be advanced to the next workload. However, if the client is not in steady-state exercise, tan an additional minute can be added to the stage to achieve steady-stat.
9. BP should be monitored during the last minute of the stage and repeated in the event of hypo or hypertensive response.
10. Perceived exertion (RPE) should be monitored near the end of the last minute of each stage using either the 6-20 or 0-10 scale
11. Client appearance and symptoms should be monitored continuously
12. Test should be terminated when subject reaches 70% HR reserve (calculation: (HR max-HR rest)x.7) +HRrest. or 85% of age-predicted max HR (HR max x 0.85). Fails to conform to the test protocol, experiences adverse signs or symptoms, requests to stop or experiences an emergency situation.
13. Cool down period should be conducted, equivalent to the workload of stage one. 50 rpm for 3 minutes.
The best weight lifted test for predicting total dynamic strength is the 1 RM bench press. Measuring the strength of the muscles involved in arm extension: triceps, pectoralis major, and anterior deltoids. IT involves a vigorous exertion on part of the client to complete this test. Explanation is imperative to prevent injury. Although a useful test to gain information concerning total dynamic strength it may inappropriate for some clients such as elderly or those with significant orthopedic limitations.
1. Allow the client to become comfortable with the bench press and its operation by practicing a light warm-up of 5-10 reps at 40-60% of perceived maximum.
2. For the test, client is to keep their back on the bench, both feet on the floor and hands shoulder width apart with palms up on the bar. using a closed grip with thumbs on one side of the bar and fingers on the other, encircling the bar. Free weight is preferred. A spotter must be present for all lifts. Spotter hands the bar to the subject, client starts the lift with the bar in up position and arms fully extended. Lower the bar to chest and then push backup until the arms are locked. Mindful of breathing, don't hold breath (Valsalva maneuver).
3. Following a 1 minute rest with light stretching, the subject does 3-5 reps at 60-80% of perceived maximum.
4.Client should be close to the perceived max. Add a small amount of weight and a 1 RM lift is attempted. If successful, a rest of 3-5 minutes is provided. Goal is to find it in 3-5 max efforts. Continue until a failed attempt occurs. The greatest amount lifted is considered the 1RM.
5. Another may to express muscular strength is as a ratio to total body weight. pg 332-333. Same procedures are used for the leg press (lower body) pg 334.
there is no single best test of overall flexibility, this test is the most common and most practical to use. Begin with a proper warm-up, it is easy to administer and interpret. IT measures only flexibility of the hamstrings, hip, and lower back. The practical significance of using the sit-and-reach test to measure of flexibility is the significant number of ppl who complain of low back pain. Some back pain is due to decreased flexibility, primarily of the hamstrings (which originate in the hip region). .
Pretest: stretch target muscle groups (ex modified hurdle stretch), refrain from fast, jerky movements, this can injury injury. Remove shoes.
1. Canadian Trunk Forward Flexion, sit without shoes and the soles of the feet flat against the flexometer at 26 cm mark. Inner soles are placed within 2 cm of measuring scale. YMCA sit-and-reach test, a yardstick is placed on the floor and tape is placed across it at a right angle to the 15 in mark. Participant sits with the yard stick between legs. With legs extended heals should touch tape on the floor, and be about 10-12 in apart.
2. Slowly reach forward (no bouncing) with both hands as far as possible (to the point of mild discomfort) holding this position approximately 2 sec. Keep hands parallel and don't reach out with one hand. Fingertips should overlap. To assist with a best attempt participant should exhale and drop the head between arms when reaching. Knees stay extended, and not pressed down. Breath normally and don't hold breath.
3. Score is most distant pint, the better two should be recorded. for the box, the "zero" starts at 26 in. Pg 338.