health appraisal/fitness testing

HEALTHHEALTHAPPRAISAL/FITNESSAPPRAISAL/FITNESS

TESTINGTESTING

Basic Procedures

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

Flexibility, Pulmonary, etc…)

Informed ConsentInformed Consent

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

Components of the Informed Components of the Informed ConsentConsent Explanation of the test in language that Explanation of the test in language that

the patient/subject/client understandsthe patient/subject/client understands Full disclosure of the risks and Full disclosure of the risks and

discomforts as well as benefits associated discomforts as well as benefits associated with testingwith testing

Explanation of patient/client Explanation of patient/client responsibilitesresponsibilites

Components of the Informed Components of the Informed ConsentConsent InquiriesInquiries

Freedom of consentFreedom of consent– Explanation of voluntary nature of testingExplanation of voluntary nature of testing

ConfidentialityConfidentiality

Informed ConsentInformed Consent

SpecificitySpecificity

Any questions should be answered prior to signingAny questions should be answered prior to signing

A signed informed consent form does not A signed informed consent form does not absolutely absolve you from legal responsibility for absolutely absolve you from legal responsibility for untoward eventsuntoward events

The Physical Activity Readiness The Physical Activity Readiness Questionnaire (PAR-Q)Questionnaire (PAR-Q)

Designed for screening of apparently Designed for screening of apparently healthy individuals beginning an exercise healthy individuals beginning an exercise program of moderate intensity (40 - 60% program of moderate intensity (40 - 60% VOVO22max)max)

CAD Risk Factor Analysis

Page 16 or 19 Heyward Will discuss in detail later. Classifies individuals as apparently healthy,

at increased risk, or as known disease. Increased Risk = greater than two risk factors

Components of the Components of the Health History QuestionnaireHealth History QuestionnaireBox 3-1 GuidelinesBox 3-1 Guidelines

Medical DiagnosesMedical Diagnoses Previous physical exam findingsPrevious physical exam findings History of symptomsHistory of symptoms Recent illnesses, hospitalization or surgical Recent illnesses, hospitalization or surgical

proceduresprocedures Orthopedic problemsOrthopedic problems

Components of the Health Fitness Components of the Health Fitness QuestionnaireQuestionnaire

Medications, drug allergiesMedications, drug allergies Other habits (tobacco, alcohol, Other habits (tobacco, alcohol,

recreational drugs)recreational drugs) Exercise historyExercise history Work historyWork history Family historyFamily history

Blood Profile

Resting ValuesResting Values

Blood pressure Blood pressure – Resting Diastolic 60-80 mmHg– Resting Systolic 110-140 mmHg

Heart rateHeart rate– Measured by palpation, HR monitor, ECGMeasured by palpation, HR monitor, ECG– Avg. = 72 bpm but may be elevated due to Avg. = 72 bpm but may be elevated due to

pretest anxietypretest anxiety

Resting Values ECG

– Resting ECG may not indicate what could happen during exercise.

Environmental and Laboratory Environmental and Laboratory ConcernsConcerns Equipment must be well maintained and Equipment must be well maintained and

regularly calibratedregularly calibrated

Testing equipment must be able to Testing equipment must be able to provide a wide range of intensities so that provide a wide range of intensities so that testing can be tailored to clients/patientstesting can be tailored to clients/patients

Environmental and Laboratory Environmental and Laboratory ConcernsConcerns

Testing area must be environmentally Testing area must be environmentally controlled controlled

– 6868OO – 72 – 72OO F F– < 60% relative humidity< 60% relative humidity– well-ventilatedwell-ventilated

Environmental and Laboratory Environmental and Laboratory ConcernsConcernsStaff must be able to:Staff must be able to: Instruct clients in proper use of exercise Instruct clients in proper use of exercise

equipmentequipment Intelligently interpret test data and assess its Intelligently interpret test data and assess its

validityvalidity Recognize normal/abnormal responsesRecognize normal/abnormal responses Recognize and respond to emergency Recognize and respond to emergency

situationssituations

Rationale for the Fitness Rationale for the Fitness Assessment Assessment Establishment of baseline Establishment of baseline Aid in program designAid in program design Establishment of realistic and prudent Establishment of realistic and prudent

goalsgoals Means to evaluate changes (and Means to evaluate changes (and

appropriateness of program)appropriateness of program) Provide feedback and motivationProvide feedback and motivation

The Fitness AssessmentThe Fitness Assessment

Pulmonary MeasuresPulmonary Measures

Pulmonary function is not Pulmonary function is not normallynormally a a limiting factor in aerobic/functional limiting factor in aerobic/functional capacitycapacity

The Fitness AssessmentThe Fitness AssessmentVital CapacityVital Capacity Defined as(TLC – RLV) or the maximum amount Defined as(TLC – RLV) or the maximum amount

of air expired after a maximal inspirationof air expired after a maximal inspiration Measured by spirometry or estimated (Table 3-6 Measured by spirometry or estimated (Table 3-6

Guidelines)Guidelines)Normal values: Normal values: Male 4.8 LMale 4.8 L Female 3.2 LFemale 3.2 L

The Fitness AssessementThe Fitness Assessement

Forced Expiratory Volume in 1 second Forced Expiratory Volume in 1 second (FEV(FEV11)) ““Static” measures of lung volumes and Static” measures of lung volumes and

capacity (TLC, FVC, etc.) may not reveal capacity (TLC, FVC, etc.) may not reveal changes in ventilatory functionchanges in ventilatory function

FEVFEV11 is a measure of lung power and is is a measure of lung power and is decreased in persons with COPDdecreased in persons with COPD


FEVFEV11 is assessed by spirometry (many is assessed by spirometry (many metabolic carts now have this metabolic carts now have this capability)capability)

FEVFEV11 should be at least 80% of FVC should be at least 80% of FVC The ratio of FEVThe ratio of FEV11/FVC may be reduced in /FVC may be reduced in

COPD but normal or higher than normal in COPD but normal or higher than normal in restrictive diseaserestrictive disease


Body CompositionBody Composition For the purpose of assessment, the body For the purpose of assessment, the body

is usually divided into two compartments:is usually divided into two compartments:– Fat weightFat weight– Lean weight – all non-fat tissue:Lean weight – all non-fat tissue:

bone, muscle, water, etc.bone, muscle, water, etc.


Goal/Optimal Body WeightGoal/Optimal Body WeightDefinitions of obesity:Definitions of obesity: 20% above “ideal” weight 20% above “ideal” weight

(based on percent body fat)(based on percent body fat) BMI BMI >> 30 kg/m 30 kg/m22 (ACSM, NIH) (ACSM, NIH) WHR: > 0.94 for men, > 0.82 for womenWHR: > 0.94 for men, > 0.82 for womenor Waist Circumference > 100cmor Waist Circumference > 100cm


Obesity and Risk for CADObesity and Risk for CAD

NIH now combines measures of BMI and NIH now combines measures of BMI and waist circumference to assess risk:waist circumference to assess risk:High risk if BMI High risk if BMI >> 40 or 25 - 39.9 40 or 25 - 39.9 andandWaist circumference Waist circumference >> 40 in (males) 40 in (males) Waist circumference Waist circumference >> 35 in (females) 35 in (females)


Body Composition Assessment Body Composition Assessment procedures:procedures: Hydrostatic weighing – the gold standardHydrostatic weighing – the gold standard Bio-electrical impedanceBio-electrical impedance Circumference measures - WHRCircumference measures - WHR SkinfoldsSkinfolds BMIBMI

The Fitness AssessmentThe Fitness AssessmentTests of Muscular Strength and Tests of Muscular Strength and EnduranceEndurance Testing modality should be specific to Testing modality should be specific to

muscle group involvedmuscle group involved Static assessments:Static assessments:

– Dynamometers (i.e., handgrip) can establish Dynamometers (i.e., handgrip) can establish baselinebaseline

The Fitness AssessmentThe Fitness AssessmentDynamic Strength Assessments:Dynamic Strength Assessments: 1 RM protocols1 RM protocols

– Specific to muscle group tested. Specific to muscle group tested. Submaximal repetition testingSubmaximal repetition testing

– Adds an endurance componentAdds an endurance component Normative values Normative values

– Guidelines pages 81-86Guidelines pages 81-86– Heyward – Chapter 6Heyward – Chapter 6


FlexibilityFlexibilityImportant for Important for Performance in athletic eventsPerformance in athletic events Decreasing the likelihood of injury Decreasing the likelihood of injury Activities of daily livingActivities of daily living Reducing muscular tensionReducing muscular tension Relief of muscular sorenessRelief of muscular soreness


Assessment of flexibilityAssessment of flexibility Sit and reach test lacks specificity and Sit and reach test lacks specificity and

validityvalidity

Norms for sit and reach test Norms for sit and reach test

The Fitness AssessmentThe Fitness AssessmentAssessment of Aerobic CapacityAssessment of Aerobic Capacity Field tests Field tests

– quick, easy, cheapquick, easy, cheap– best for young healthy individuals i.e., PE classesbest for young healthy individuals i.e., PE classes– maximum effort?maximum effort?– environment?environment?– cardiovascular/hemodynamic responses?cardiovascular/hemodynamic responses?– accuracy?accuracy?

The Fitness AssessmentThe Fitness Assessment Step tests Step tests

– also quick, easy and cheapalso quick, easy and cheap– cardiovascular/hemodynamic responses?cardiovascular/hemodynamic responses?– accuracy?accuracy?

Submaximal testing Submaximal testing – allows for measurement of HR, BP, ECG and RPE allows for measurement of HR, BP, ECG and RPE

response to exercise without taking subject to max response to exercise without taking subject to max (safety issues)(safety issues)

– requires more equipment and timerequires more equipment and time– accuracy?accuracy?


Max testing allows for evaluation of Max testing allows for evaluation of response to exercise through larger range response to exercise through larger range of intensities. Requires more time, of intensities. Requires more time, equipment and expertise but has much equipment and expertise but has much greater accuracy and diagnostic value.greater accuracy and diagnostic value.

Normative data in Guidelines (p. 77)Normative data in Guidelines (p. 77)


Assessment proceduresAssessment procedures BicycleBicycle TreadmillTreadmill StepStep Recording of data – timing and techniquesRecording of data – timing and techniques Data – absolute vs relative valuesData – absolute vs relative values RPE’s – useful for exercise prescription (p. 79)RPE’s – useful for exercise prescription (p. 79)

The Fitness AssessmentThe Fitness AssessmentSigns of exercise intolerance: (Box 4-5, 5-3)Signs of exercise intolerance: (Box 4-5, 5-3) HR responseHR response BP responseBP response HyperventilationHyperventilation Muscular fatigueMuscular fatigue Dizziness, lightheadedness, incoherenceDizziness, lightheadedness, incoherence Volitional exhaustionVolitional exhaustion Cyanosis, pallorCyanosis, pallor NauseaNausea Inability to sustain workloadInability to sustain workload Chest painsChest pains


Legal ImplicationsLegal Implications There should be a written plan for There should be a written plan for

emergency procedures:emergency procedures:– Defines personnel responsibilitiesDefines personnel responsibilities– Sets requirements of emergency trainingSets requirements of emergency training– Well-documentedWell-documented

The Fitness Assessment

Nutritional Assessment Weight Management

health appraisal/fitness testing

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