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HEALTHAPPRAISAL/FITNESSTESTING

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Basic Procedures n Informed Consent n PAR-Q n CAD Risk Factor Analysis n Health History n Lifestyle Profile n Cholesterol/Lipoprotein Screening n Resting BP, HR, ECG n Fitness Assessment (Strength, Body Comp, Cardio, Flexibility, Pulmonary, etc)

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Informed Consent Rationale: To provide the client with sufficient information to be able to make an informed decision. That is, be able to fully evaluate the risks and benefits associated with testing protocol.

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Components of the Informed Consent Explanation of the test in language that the patient/subject/client understands Full disclosure of the risks and discomforts as well as benefits associated with testing Explanation of patient/client responsibilites

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Components of the Informed Consent Inquiries Freedom of consent Explanation of voluntary nature of testing Confidentiality

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Informed Consent Specificity Any questions should be answered prior to signing A signed informed consent form does not absolutely absolve you from legal responsibility for untoward events

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The Physical Activity Readiness Questionnaire (PAR-Q) Designed for screening of apparently healthy individuals beginning an exercise program of moderate intensity (40 - 60% VO 2 max)

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CAD Risk Factor Analysis n Page 16 or 19 Heyward n Will discuss in detail later. n Classifies individuals as apparently healthy, at increased risk, or as known disease. n Increased Risk = greater than two risk factors

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Components of the Health History Questionnaire Box 3-1 Guidelines Medical Diagnoses Previous physical exam findings History of symptoms Recent illnesses, hospitalization or surgical procedures Orthopedic problems

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Components of the Health Fitness Questionnaire Medications, drug allergies Other habits (tobacco, alcohol, recreational drugs) Exercise history Work history Family history

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Blood Profile

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Resting Values Blood pressure Resting Diastolic 60-80 mmHg Resting Systolic 110-140 mmHg n Heart rate Measured by palpation, HR monitor, ECG Avg. = 72 bpm but may be elevated due to pretest anxiety

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Resting Values n ECG Resting ECG may not indicate what could happen during exercise.

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Environmental and Laboratory Concerns Equipment must be well maintained and regularly calibrated Testing equipment must be able to provide a wide range of intensities so that testing can be tailored to clients/patients

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Environmental and Laboratory Concerns Testing area must be environmentally controlled 68 O 72 O F < 60% relative humidity well-ventilated

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Environmental and Laboratory Concerns Staff must be able to: Instruct clients in proper use of exercise equipment Intelligently interpret test data and assess its validity Recognize normal/abnormal responses Recognize and respond to emergency situations

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Rationale for the Fitness Assessment Establishment of baseline Aid in program design Establishment of realistic and prudent goals Means to evaluate changes (and appropriateness of program) Provide feedback and motivation

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The Fitness Assessment Pulmonary Measures Pulmonary function is not normally a limiting factor in aerobic/functional capacity

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The Fitness Assessment Vital Capacity Defined as(TLC RLV) or the maximum amount of air expired after a maximal inspiration Measured by spirometry or estimated (Table 3-6 Guidelines) Normal values: Male 4.8 L Female 3.2 L

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The Fitness Assessement Forced Expiratory Volume in 1 second (FEV 1 ) Static measures of lung volumes and capacity (TLC, FVC, etc.) may not reveal changes in ventilatory function FEV 1 is a measure of lung power and is decreased in persons with COPD

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The Fitness Assessment FEV 1 is assessed by spirometry (many metabolic carts now have this capability) FEV 1 should be at least 80% of FVC The ratio of FEV 1 /FVC may be reduced in COPD but normal or higher than normal in restrictive disease

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The Fitness Assessment Body Composition For the purpose of assessment, the body is usually divided into two compartments: Fat weight Lean weight all non-fat tissue: bone, muscle, water, etc.

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The Fitness Assessment Goal/Optimal Body Weight Definitions of obesity: 20% above ideal weight (based on percent body fat) BMI > 30 kg/m 2 (ACSM, NIH) WHR: > 0.94 for men, > 0.82 for women or Waist Circumference > 100cm

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The Fitness Assessment Obesity and Risk for CAD NIH now combines measures of BMI and waist circumference to assess risk: High risk if BMI > 40 or 25 - 39.9 and Waist circumference > 40 in (males) Waist circumference > 35 in (females)

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The Fitness Assessment Body Composition Assessment procedures: Hydrostatic weighing the gold standard Bio-electrical impedance Circumference measures - WHR Skinfolds BMI

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The Fitness Assessment Tests of Muscular Strength and Endurance Testing modality should be specific to muscle group involved Static assessments: Dynamometers (i.e., handgrip) can establish baseline

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The Fitness Assessment Dynamic Strength Assessments: 1 RM protocols Specific to muscle group tested. Submaximal repetition testing Adds an endurance component Normative values Guidelines pages 81-86 Heyward Chapter 6

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The Fitness Assessment Flexibility Important for Performance in athletic events Decreasing the likelihood of injury Activities of daily living Reducing muscular tension Relief of muscular soreness

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The Fitness Assessment Assessment of flexibility Sit and reach test lacks specificity and validity Norms for sit and reach test

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The Fitness Assessment Assessment of Aerobic Capacity Field tests quick, easy, cheap best for young healthy individuals i.e., PE classes maximum effort? environment? cardiovascular/hemodynamic responses? accuracy?

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The Fitness Assessment Step tests also quick, easy and cheap cardiovascular/hemodynamic responses? accuracy? Submaximal testing allows for measurement of HR, BP, ECG and RPE response to exercise without taking subject to max (safety issues) requires more equipment and time accuracy?

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The Fitness Assessment Max testing allows for evaluation of response to exercise through larger range of intensities. Requires more time, equipment and expertise but has much greater accuracy and diagnostic value. Normative data in Guidelines (p. 77)

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The Fitness Assessment Assessment procedures Bicycle Treadmill Step Recording of data timing and techniques Data absolute vs relative values RPEs useful for exercise prescription (p. 79)

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The Fitness Assessment Signs of exercise intolerance: (Box 4-5, 5-3) HR response BP response Hyperventilation Muscular fatigue Dizziness, lightheadedness, incoherence Volitional exhaustion Cyanosis, pallor Nausea Inability to sustain workload Chest pains

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The Fitness Assessment Legal Implications There should be a written plan for emergency procedures: Defines personnel responsibilities Sets requirements of emergency training Well-documented

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The Fitness Assessment n Nutritional Assessment n Weight Management