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)
Slide 3
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.
Slide 4
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
Slide 5
Components of the Informed Consent Inquiries Freedom of consent
Explanation of voluntary nature of testing Confidentiality
Slide 6
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
Slide 7
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)
Slide 8
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
Slide 9
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
Slide 10
Components of the Health Fitness Questionnaire Medications,
drug allergies Other habits (tobacco, alcohol, recreational drugs)
Exercise history Work history Family history
Slide 11
Blood Profile
Slide 12
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
Slide 13
Resting Values n ECG Resting ECG may not indicate what could
happen during exercise.
Slide 14
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
Slide 15
Environmental and Laboratory Concerns Testing area must be
environmentally controlled 68 O 72 O F < 60% relative humidity
well-ventilated
Slide 16
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
Slide 17
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
Slide 18
The Fitness Assessment Pulmonary Measures Pulmonary function is
not normally a limiting factor in aerobic/functional capacity
Slide 19
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
Slide 20
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
Slide 21
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
Slide 22
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.
Slide 23
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
Slide 24
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)
Slide 25
The Fitness Assessment Body Composition Assessment procedures:
Hydrostatic weighing the gold standard Bio-electrical impedance
Circumference measures - WHR Skinfolds BMI
Slide 26
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
Slide 27
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
Slide 28
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
Slide 29
The Fitness Assessment Assessment of flexibility Sit and reach
test lacks specificity and validity Norms for sit and reach
test
Slide 30
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?
Slide 31
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?
Slide 32
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)
Slide 33
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)
Slide 34
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
Slide 35
The Fitness Assessment Legal Implications There should be a
written plan for emergency procedures: Defines personnel
responsibilities Sets requirements of emergency training
Well-documented
Slide 36
The Fitness Assessment n Nutritional Assessment n Weight
Management