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ACSM Resources for the Personal Trainer Chapter 12 Client Fitness Assessment
Terms in this set (76)
the process can be extremely intimidating to clients, especially the self conscious about appearance, or just the thought of joining a fitness club. Its important to make your client feel as comfortable as possible in this process, keep the client informed. If a certain measurement would be unsuccessful, for example, overweight a skinfold test wouldn't work. If the client is apprehensive, explain the importance of accurately recording the measurements. If still anxious, record any modifications to the measuring process for future reference. The success of this relationship is built on respect, this can be established by providing information about the assessment process, listening to and addressing the client's concerns, and demonstrating competence in the assessment procedures. Trainer guides the selection of the assessment (in consultation with client) and sequences these assessments.
Selection and Sequence of Assessment
mostly guided by the setting and equipment available; however there is a general sequence. A trainer also considers the client's needs/desires when sequencing an assessment. Resting measures: HR, BP, body composition typically should be taken prior to any exertional assessments, such as cardiorespiratory fitness (CRF) and flexibility. Should perform assessments after client complets a health and physical activity questionnaire.
Body composition: height, weight, BMI, waist-hip ratio (WHR), skinfolds, and/or submaximal cycle ergometer test
-cardiovasuclar assessment: rockport 1 mile walk test, 1.5 mile run, queens College Step Test, and/or the Astrand-Rhyming Submaximal Cycle Ergometer test
-Muscular fitness: muscle strength and endurance
-flexibility: sit and reach
Heart Rate: Resting, exercise, and recovery
it is the number of times the heart beats or contracts per minute (bpm). No known accepted standard resting rate, it is often thought of as an indicator of CRF because it tends to decrease as client becomes more physically fit. Also no standard in exercise HR, but response to a standard amount of exercise is an important fitness variable and the foundation for many cardiorespiratory endurance tests. Recovery HR often thought of as an excellent index of CRF and is used as a variable in some CRF tests (Queens College Step Test). There are certain medications that may affect resting HR and HR response to exercise, ex, beta-blockers (hypertension), will significantly decrease resting HR and therefore may affect exercise responses to HR.
Measurement of HR
palpation of pulse and measuirng hr during exercise
Palpation of pulse
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.
-locate anatomic site
-gently press down with the two fingers over palpation site
-count the number of pulsations for specific time period (10-30 sec) time occurs after the start time and first pulsation, begin with the number 1
-Determine HR based upon the number of pulsations in a given time period. Accuracy increases with longer palpation times
The baroreceptor reflex
is the bodies response to a false signal of increase BP, which can be trigger by slight pressure on the carotid artery HR measure. It causes a decrease in HR. It becomes more of an issue with HR counts longer than 15 seconds. It is recommended that a full 60-seconds count be performed for accuracy in resting HR. however 30 can be sufficient for the count.
Measurement of exercise HR
by measuring via palpation method, the number of beats felt in a 15-30 second period and multiply to gt a minute value. The longer count is more accurate and less prone to error than the shorter count, but the shorter count typically used immediately postexercise because HR may decrease rapidly during recovery. When the exercise Hr for a period less than 1 minute you should start the time period and the count at zero (reference) at the first eat felt.
A HR monitor has increased in popularity because of availability and affordability. Some are prone to error however some are more reliable. They rely on the opacity of blood at the earlobe or fingertip to measure/count flow which is not as accurate as a chest electrode strap monitory.
Blood Pressure: resting and Exercise
It is the force of blood against the walls of the arteries and veins created by the heart as it pumps blood to every part of the body. IT is typically expressed in millimeters of mercury (mm Hg). It is a dynamic variable with regard to location (artery vs vein and the level in an artery). Trainer are most concerned with arterial BP at the level of the heart. This arterial, heart level BP is the one typically measured at rest and during exercise. Measures the max pressure in the arteries the the relaxed (minimum) pressure in the arteries (peripheral or resistance pressure). Typically assessed using principle of indirect auscultation. Involves the use of a BP cuff, a manometer, and a stethoscope.
Systolic BP (SBP)
By definition it means contraction of the heart, it is the measure of the maximum pressure in the arteries when the ventricles of the heart contract during a heartbeat. It occurs late in ventricular systole, it is thought to represent the overall functioning of the left ventricle and is thus an important indicator of cardiovascular function during exercise. It is typically measured from the bracial artery at the heart level and is expressed in units of mm Hg.
Diastolic Blood Pressure (DBP)
By definition it means the relaxation of the heart. It is the measure of the minimum pressure in the arteries when the ventricles relax.. It occurs late in ventricular diastole and reflects the peripheral resistance to blood flow in the arterial vessels. It is typically measured from the brachial artery at the heart level and is expressed in units of mm Hg.
"Hypertension" or high BP
this is a condition of resting BP either SBP or DBP or both is chronically elevated above the optimal or desired level. A normal BP is around <120/<80. Pre is 120-130/80-89. And hypertension Stage 1 140-149/90-99. Stage 2 >160/>100. It can not be diagnosed with a single measure, serial measurements must be obtained on separate days. It should be based on the average of two or more resting BP records during each of two or more visits.
term for low BP, and there is no accepted standards for a value that classifies this. It exists medically if the individual has symptoms related to lo BP such as light headedness, dizziness, or fainting.
for accurate resting rates it is important that client be made as comfortable as possible. Take a few minutes to talk to the client after having him or her sit on a chair. Make sure they don't have their legs crossed. Also used the correct size of BP cuff. The client may experience "white coat" syndrome during the measurement of BP, which can cause an increase in BP. Thus it is important to have a client in a relaxed state when taking the measurement
"White Coat Syndrome"
refers to an elevation of BP resulting from the anxiety or nervousness associated with being in a doctors office or in a clinical setting.
the measure of BP by ausculation, the trainer must be able to head and distiniguish between the sounds of the blood as it makes it way from an aread of high pressure to that of low pressue as the air is let out of the pumped up cuff. These sounds are divided into five phases.
Phase 1 (SBP)
Phase 4 (DBP)
Phase 5 (DBP)
The true disappearance of sound usually occurs withint 8-10 mm Hg of the muffling of sound in Phase 4. this phase is the true DBP and should be read if decernable however often phase 5 is take for DBP measures.
Phase 1 Korotkoff Sounds (SBP)
the first initial sound or the onset of sound, sounds like clear, repetitive tapping. Sound approximates the SBP, the maximum pressure that occurs near the end of systole of the left ventricle.
Phase 2 Korotkoff Sounds
Sounds like a soft tapping or murmur; sounds are often longer than those in the first phase, described as having a swishing component. Typically 10-15 mm Hg after the onset of just below Phase 1 sounds.
Phase 3 Korotkoff Sounds
Sounds like loud tapping; high in both pitch and intensity, sounds are crisper and louder than phase 2 sounds.
Phase 4 (true DBP) Korotkoff Sounds
Sounds like muffling of the sound, sounds become less distinct and less audible' another way of describing this sound is a soft or blowing. This is often considered the tru DBP and is typically recorded as the DBP.
Phase 5 Korotkoff Sounds (clinicaly known as DBP)
sounds like the complete disappearance of sound
Instruments used for BP measurements
a sphygmomanometer consists of a manometer and a BP cuff, refers to the occlusion of the artery by a cuff, simple devise used to measure pressure. Two types the mercury and aneroid. Mercury is the standard but it is toxic nature that has lead to aneroid being more common. Position the manometer at eye leve to eliminate the potential for any reflex errors. Aneroid manometer are usually dial type, mercury are usually straight tube/column type. The cuff consists of a rubber bladder and two tubes one to the manometer and the other to a hand bulb with a bulb that is used for inflation. The bladder must be of appropriate size for accurate reading.
Width= 40-50% of upper arm circumference
Length=almost long enough (~80%) to circle upper arm.
Three BP cuff sizes are commonly used, child, normal ad large adult. A cuff too small leads to a false reading that is too high.
Should be position of heart level, too low and the BP will be falsely high. Apply snuggly if too loose the BP will typically b falsely high.
Resting BP measurement Procedures (1-16)
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.
Measuring BP continued
wait for 1 full minute before repeating the BP measure. Average at least two readings to get a true sense of client's BP. And take on two separate occasions to screen for hypertension. They readings should be within 5 mm Hg of each other, if they aren't take another reading. Don't take the measures if they are on antihypertensive medication or are acutely ill. When the readings fall into two different categories the higher should be selected. It is recommended that all people above the age of 30 should have their BP checked annually. Normal is <120/<80. Pre is 120-139/80-89. Hypertension is +
the relative proportion of fat and fat-free tissue in the body (percent of body fat). The assessment of body composition is necessary for numerous reasons. There is a strong correlation between obeisty and increased risk of chronic diseases including coronary artery disease, diabetes, hypertension, certain cancers, and hyperlipidemia. These readings are mostly done to establish a target, desirable, or optimal weight for an individual. Can be estimated with various techniques. Ht and Wght, BMI, WHR (wrist and hip circumference measures), skinfolds, and bioelectrical impedance analysis (BIA).
Height and Weight Body Composition
An older and discontinued method of measuring body composition but the height in m and weight in kg would be taken and compared to a table in accordance with "frame size".
Body Mass Index also known as
also called Quetelet's Index
Body Mass Index definition
used to assess weight relative to height. Similar to the weight-to-height table this technique compares an individual's wight with his or her height, and compares the numbers on a range. It has a major short coming and that is that it difficult for a client to relate to and/or interpret needed weight loss or weight gain. Because this measure does not differentiated fat weight and fat-free weight and only has a modest correlation with body fat percentage predicted from hydrostatic weight.
Waist-to-Hip Ratio Body Composition
is a comparison between the circumference of the waist and the circumference of the hip, best represents the distribution of body weight and perhaps body fat in an individual. The patter of body weight distribution is recognized as an important predictor of health risks of obesity. The more weight or circumference on the trunk the higher risk for hypertension, type 2 diabetes, hyperlipidemia, and coronary artery disease.
this circumference has been frequently defined as the smallest circumference above the umbilicus or navel and below the xiphoid process.
the circumference has been defined as the largest circumference around the buttocks above the gluteal fold (posterior extension)
the ratio of hip to waist
Waist circumference Alone Body Composition
Suggest to indicate health risks alone, when it is greater than or equal to 35 in for women and 40 in for men. A very low risk is associated with a waist circumference less than 27.5 in for women and 31.5 in for men.
Skinfolds Body composition
determination of the percentage of body fat can be quite accurate if the technique is properly trained in the use of a caliper, and if it's of high quality. It is still an estimate and a predictor, not an absolute. Based on the principle that the amount of subcutaneous fat is proportional to the total amount of body fat. However this total varies by age, sex, and ethnicity. Regression equations make up for these factors. This type of measure can also be useful for tacking changes in body fat distribution that may occur with training. Box 12.1 and Figure 12. 6 pg 313-14.
Abdominal, Triceps, Biceps, Chest/pectoral, medial calf, midaxiallary, subscapular, suprailiac, and thigh
Skinfold measuring procedures
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.
Jackson-Pollock 3: site skinfold formula fo percent body fat
this formula was developed for the prediction of percent body fat or body composition. They developed 2 different formulas. Averaging the percent body fat averages for skinfolds at the chest, abdomen, thigh for men and triceps, suprailiac and thigh for women. Sum the means of the three sites measures and use the nomogram provided in this text. The table involves plotting the client's age along the age in years section and connecting that point with a straight line to point plotted along the "sum of 3 folds"
Bioelectrical Impedance Body Composition
is a noninvasive and easy-to-administer method for assessing body composition. The basic premise behind the procedure is that the volume of fat free tissue in the body will be proportional to the electrical conductivity of the body. the impedance analyzer passes a small electrical current into the body and then measures the resistance to that current. Fat is a poor electrical conductor containing little water (14-22%) whereas lean tissue contains mostly water (more than 90%) and electrolytes ans is a good electrical conductor. Fat tissue provides impedance to this current. That along with measuring total body water and calculations to find body fat percentage using assumptions about hydration levels and the exact water content of various tissues. The following must be controlled for the measures to be valid.
-no eating or drinking within 4 hours of the test
-no exercise within 12 hours of the test
-urinate (or void) completely within 30 minutes of the test.
-no alcohol consumption in the previous 48 hours before test.
It's more advantages than skinfold measures because it's not as discomfortable to clients and doesn't make them feel as self-conscious.
Calculation of Ideal or Desired Body Weight
determining this is useful for setting wight gain or loss goals. Table 12. 3 body composition for mean and women in accordance with age. pg 317.
CRF Assessment (Cardio Respiratory Fitness)
related to the ability to perform large muscle, dynamic, moderate-to-high intensity exercise for prolonged periods of time and reflects the functional capabilities of the heart, blood vessels, lungs, and relevant muscles during various types of exercise demands. It's synonymous for any terms that may be used for the same thing, ex.
-maximal aerobic capacity, functional capacity, physical work capacity, maximal oxygen uptake (VO2max) or maximal oxygen consumption or maximal oxygen intake, cardiopulmonary endurance, fitness or capacity.
Many methods can be used to measure this such as the 1.5 mile run and the step test or the lab test such as submaximal cycle egometer protocols. Decide which test is appropriate for the client. The measures obtained can be used for the following:
-Exercise prescription and programming
-Progress in and motivation of an individual in an exercise program (providing both feedback and motivation to keep client interested in exercise).
-Prediction of medical conditions such as coronary artery disease (to further identify or diagnose health problems)
A true measure involves maximal exertion as a result of graded exercise testing along with the collection of expired gases during this exercise test.
Simple technique (only height and weight) and good research to back the normative data for comparison purposes, does not account for difference in weight composition (fat vs muscle).
relatively simple-to-perform *some technician training) and good research data to back the normative data for comparison purposes weight distribution shown to be important to health.
body composition: skinfolds
highly regarded, many sites and formulas, technician training important, small prediction error (3-4%)
body composition: bioelectrical impedance
fairly accurate but many pretest conditions need to be met (hydration of client), technician training minimal, under ideal conditions similar prediction error to skinfold.
Skinfold site abdominal
vertical fold; 2 cm to the right side of the umbilicus
Skinfold site triceps
vertical fold; on the posterior midline of the upper arm, halfway between the acromion and olecranon processes, with the arm held freely to the side of the body
Skinfold site biceps
vertical fold; on the anterior aspect of the arm over the belly of the biceps muscle, 1 cm above the level used to mark the triceps site.
Skinfold site chest/pectoral
diagonal fold; one half one half the distance between the anterior axillary line and the nipple (men), one third of the distance between the anterior axillary line and the nipple (women).
Skinfold site Medial calf
vertical fold; at the maximum circumference of the calf on the midline of its medial border
Skinfold Site midaxillary
vertical fold; on the midaxillary line at the level of the xiphoid process of the sternum. An alternate method is a horizontal fold taken at the level of the xiphoid/sternal border in the midaxillary line.
the cartilaginous section at the lower end of the sternum, which is not attached to any ribs and gradually ossifies during adult life.
Skinfold site Subscapular
Diagonal fold (at 45 degree angle); 1-2 cm below the inferior angle of the scapula
Skinfold Site Suprailiac
Diagonal fold; in line with the natural angle of the iliac crest taken in the anterior axillary line immediately superior to the iliac crest
Skinfold Site Thigh
vertical fold; on the anterior mideline of the thigh, midway between the proximal border of the patella and the inguinal crease (hip).
It's important to standardize pretesting conditions for all clients who undergo these various tests for CRF. This can also increase the accuracy of prediction of CRF as well as aid in client safety. Instructing the client prior to the test can increase their comfort. Instructions could include:
-Abstain from prior eating (4 hours)
-Abstain from prior strenuous exercise (>24hr)
-Abstain from prior caffeine ingestion (.12-24 hr)
-Abstain from prior nicotine use (>3hr)
-Abstain from prior alcohol use (>24 hrs)
-Medication consideration (if client's medications affect resting or exercise Hr, it will invalidate the test)!!!
Various Field Tests for Prediction of CRF
a field test is generally a test done out side of the lab such as a 1.5 mile run at near-maximal exertion. Field tests are considered by some to be submaximal, and may be inappropriate for safety reasons for sedentary individuals at moderate to high risk for cardiovascular or musculoskeletal complications. There are two types of common filed tests used to predict aerobic capacity: a timed completion of a set distance (1.5 mi run) or a maximal distance for a set time (12 min wlk/run). They are relatively easy and inexpensive to administer and thus idea for testing large groups of clients. A CRF test can be difficult to chose, here are some criteria to help select one for your client:
-What the date will be used for (ex. exercise programming)
-need for data accuracy
-client's age and health status
In general the run/walk performance tests and step tests are appropriate for a wide range of clients as long as the appropriate health risk screening has occurred first.
One important note it that this test asks for near-maximal exertion, which way not be desirable for some clients.
Walk/Run Performance Test
This test used to predict CRF has two common protocols. These tests tend to be more accurate than the step tests. It can be classified into tow groups: walk/run test or pure walk tests. In the walk/run clients can walk, run or usea a combinatio of both to complete the test. The pure walk tests clients are strictly limited to walking (one foot on the ground at any given time) the entire test. Another classification for the test is performed over a set distance (e.g. 1 mile or 1.6 km) over a set time period (e.g. 12 min). These specific tests are distance tests. The first test uses a 1.5 mile distance and required the client to complete the distance as fast as they can using any combination. For the purely walking test the distance is a 1 mile course.
The 1.5 mile test procedure (CRF)
1. this test is contraindicated for unconditioned beginners, individuals with symptoms of heart disease, and those with known heart disease or risk factors for heart disease. Clients should be able to jog for 15 min continuously to complete this test and obtain a reasonable prediction of their aerobic capacity.
2. Ensure that the area for performing the test measures 1.5 miles in distance.
3. Inform clients of the purpose of the test and the need to pace themselves over the 1.5 mile distance. Effective pacing and the clients' motivation are key variables in the outcome of the test.
4. Have clients start the test and start a stop watch to coincide with the start. Give your clients feedback on time throughout the assessment to help them with pacing.
5. Record the total time to complete the test and use the formula below to predict CRF as measured by VO2max and recorded in ML/kgxmin
-men and women: VO2max (ML/kg x min)= 3.5+483/time
Rockport 1 mile walk test procedure
This CRF test is useful for those unable to run because of low fitness level and/or injury. Clients should be able to walk briskly and should get the exercise HR above 120 bpm for the 1 mile test.. This test requires the participant to walk as fast as they can around a measured 1 mile course without breaking into a run, thus one foot on the ground at all times. The time is measured and recorded. Immediately following completion of the course count the recovery HR for 15 secs to get bpm. HR can also be taken the last quarter mile of the test. A HR monitor may be more accurate than a manual palpation. The VO2max formula for this test is sex specific. VO2max (ML/kgx min)
-women=132.853-(0.1692xWT)-(0.3877xAGE)+ (6.315 for men)- (0.1565x140)= 43.9 mL/kg x min
Queens College Step Test for CRF prediction
there are several versions of this test, in general it relies on having the client step up and down on a standardized step or bench period for a period of time at a set stepping cadence. After the test a recovery Hr is obtained and used in prediction of CRF. The lower the recovery HR the more fit the individual. Other variation use the client's HR response to a standard amount of exertion. All that's needed is a watch, metronome, and a standardized bench height). extra precaution may be needed for clients with balance problems or difficulty with stepping. This test is considered submaximal for many clients however it may be near maximal exertion for others.
Queens College Step Test Procedures
1. Requires that the individual step up and down on a standardized step height of 16.25 in for 3 minutes. Many gym bleachers are this height.
2. Men step at a cadence of 24 steps per minute, whereas women step at a rate of 22 per minute for a total of 3 minutes of exercise. This cadence should be closely monitored and set with the use of an electronic metronome. A step is both feet on the step and back on the floor. For more help the metronome can be set for beats per movement (4 times the step rate for the leg up other leg up leg down other leg down which is 96 bpm for men and 88 for women). Can test more than one client at a time but it more challenging to do each sex.
3. After 3 minutes of stepping are completed, the client stops and has his or her pulse taken (preferably at the radial site) while standing and with in the first 5 seconds. Recovery HR should occur between 5-20 seconds of immediate recovery from the end of the step test.
4. The client's VO2 max is determined from the recovery HR using the sex-specific formulas in table 12.4 ( men = 111.33-(0.42xHR) (women=65.81-(0.1847xHR)
Submaximal Cycle Ergometer Tests (CRF test)
type of CRF test that has several testing methodologies that vary from maximal to submaximal. Astrand-Ryming test procedures, and YMCA submaximal cycle test procedures.
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.
-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.
Prediction of CRF or VO2max from Astrand-Rhyming Results
1. A popular nomogram technique in figure 14.8
2. A calculation-based formula found in the ACSM Health-Related Physical Fitness Assessment Manual
Connect the plots ans scales
YMCA Submaximal Cycle test Procedures
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.
Prediction of VO2max form YMCA Cycle Test Protocol
CRF cna be estimated by using graphing and plotting on page 328. The work rate value is the predicted maximal work rate, and is used in the ACSM metabolic equation for leg cycling to predict VO2max. The second method for predicting VO2max from the test is to calculate the slope of the HR and VO2max relationship.
Norms for CRF (VO2max)
CRF is commonly expressed as VO2max. which is expressed as ml or oxygen consumed per kilogram of body weight per minute. Norms are on pg 329.
Muscular Strength assessment: One-Repitition Maximum
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.
a one-time maximal force that may be exerted and is localized to a joint or muscle group. Many assessment tests. another way to express this is a ratio to total body weight.
One-Repetition Maximum (1RM)
stands for a one-time maximum amount of weight lifted.
Muscular Endurance Assessment: Partial Curl-Up and Push-Up Tests
is joint and muscle group specific and there are many tests available for this component of health-related fitness. the two most common are the partial curl-up and push-up tests. The first was developed to minimized the criticism of traditional and bent-leg sit-up test, but it's also criticized for being easy to perform (especially for younger and fitter clients).
the ability to apply a force repeatedly over time, common assessments include the partial curl-up and push-up tests.
Procedures for the Muscular Endurance Push-Up test
1. starting position in the standard "down" position (hands pointed forward and under the shoulders, back straight, head-up, using toes as the pivotal point. A variation can be the modified "knee push-ups" position with legs together and lower leg in contact with mat ankles plantar flexed, back straight, hands shoulder width apart, head up, using knees as the pivot point.
2. Subject raise the body by straightening the elbows and return to the "down" position, until chin touches mat, stomach should not touch the mat.
3. The subject's back must be straight at all times and the subject must push up to a straight arm position.
4. The maximal number of push-ups performed consecutively without rest is counted as the score.
5. The test is stopped when the client strains forcibly or is unable to maintain the appropriate technique within two repetitions.
Curl-Up (Crunch) Test
1. Two strips of masking tape are to be placed on a mat on the floor at a distance 12 cm apart or 8 cm (if older than 45).
2. Subjects are to lie in a supine position across the tape, knees bent at 90 degrees with feet on the floor and arms extended to their sides, such that their fingertips touch the nearest strip (bottom position). To reach the top position, subjects are to flex their spines to 30 degrees reaching hands forward until fingers touch second strip of tape.
3. Metronome is to be set at 40 beats/min. At the first beep, the subject begins the curl-ups, reaching the top at the second beep, returning to the starting position at the third, and top position at the fourth.
4. Repetitions are counted each time the subject reaches the bottom position. The test is concluded either when the subject reaches 75 curl-ups or the cadence is broken.
5. Every subject will be allowed several practice repetitions prior to the start of the test. pg 336
Flexibility Assessment: Sit and reach test
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.
Assessments as a Motivational Device.
health related assessments can serve not only for exercise programming bu also for motivational purposes when the results of various assessment are explained and used in the goal-setting approach. Use only the tests that are pertinent to clients goals. The tests should be performed on a regular basis to determine whether established goals have been met. As goals are set, often a time frame for attainment of those goals is included. Flexibility test might be re-performed every 4-6 wks to measure progress toward that goal. Too frequently using assessment may fail to demonstrate desired changes as some components of physical fitness may take time and effort to change. A standard follow-up may be 4wk to 3 months, depending on what is being assessed.
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