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HEALTH APPRAISAL/FITNESS TESTING. 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 Consent. - PowerPoint PPT Presentation
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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
The Fitness AssessmentThe Fitness Assessment
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
The Fitness AssessmentThe Fitness Assessment
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.
The Fitness AssessmentThe Fitness Assessment
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
The Fitness AssessmentThe Fitness Assessment
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)
The Fitness AssessmentThe Fitness Assessment
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
The Fitness AssessmentThe Fitness Assessment
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
The Fitness AssessmentThe Fitness Assessment
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?
The Fitness AssessmentThe Fitness Assessment
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)
The Fitness AssessmentThe Fitness Assessment
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
The Fitness AssessmentThe Fitness Assessment
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
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