Transcript Health-screen questionnaire

Pg 171
Aims of fitness testing:
• Ensure person’s health is in a condition where
it is safe for them to continue to exercise.
• Note what their current level of fitness is.
• Identify their strengths and weaknesses.
• Gain information for writing a training
program.
• Be able to monitor any changes in fitness level.
• Show a professional and caring approach.
Conduct a detailed fitness consultation
– Informed consent form (Example pg 165)
– Health screening questionnaire (Example pg 162)
– Identification of coronary heart disease risk
factors (PAR-Q pg 241-2)
– Identification of any causes for medical referrals
Pg 171
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Pre-test Instructions
Wear appropriate clothing.
Should not have a heavy meal 3hrs before testing.
Have a good nights sleep.
No training on day of test.
Avoid stimulants (Tea, coffee, smoking etc.) for 2hrs
before test.
• Have a friend or family member with them to drive
them home as the tests may be fatiguing.
Informed Consent Form
Pg 165
An informed consent form is a document that
has been signed to show that your subjects
have been informed of the test (told what is
going to happen) and have given their consent
(agreed to undertake the test).
Informed Consent Form
Pg 165
1. Explanation of the tests.
You will perform a series of tests which will vary in their
demands on your body. Your progress will be observed
during the tests and stopped if you show signs of undue
fatigue. You may stop the tests at any time if you feel unduly
uncomfortable.
Informed Consent Form
Pg 165
2. Risks of exercise testing.
During exercise certain changes can occur, such as raised
blood pressure, fainting, raised heart rate, and in a very
small number of cases, heart attacks or even death. Every
effort is made through screening to minimize the risk of
these occurring during testing. Emergency equipment and
relevantly trained personnel are available to deal with any
extreme situation that occurs.
Informed Consent Form
Pg 165
3. Responsibility of the patient.
You must disclose all information in your possession
regarding the state of your health or previous experiences of
exercise, as this will affect the safety of the tests. If you
experience any discomfort or unusual sensations, it is your
responsibility to inform your trainer.
Informed Consent Form
Pg 165
4. Benefits to expect.
The results gained during your testing will be used to
identify any illnesses and the types of activities that are
relevant for you.
Informed Consent Form
Pg 165
5. Freedom of consent.
Your participation in these tests is voluntary and you are free
to deny consent or stop a test at any point.
I have read this form and understand what is expected of me
and the tests I will perform. I give my consent to participate.
Clients signature
Print name
Date
Trainer’s signature
Print name
Date
Health-screen questionnaire
Section 1: Personal Details
Name
Address
Home telephone
Mobile telephone
Email
Occupation
Date of birth
Pg 162-165
Health-screen questionnaire
Pg 162-165
Section 2: Sporting Goals
1. What are your long term sporting goals over the next year or
season?
2. What are your medium-term goals over the next three
months?
3. What are your short-term goals over the next four weeks?
Health-screen questionnaire
Section 3: Current Training Status
1. What are your main training requirements?
a.
b.
c.
d.
e.
f.
g.
h.
i.
Muscular strength.
Muscular endurance.
Speed.
Flexibility.
Aerobic fitness.
Power.
Weight loss or gain.
Skill-related fitness.
Other (Please state).
Pg 162-165
Health-screen questionnaire
Section 3: Current Training Status Continued
Pg 162-165
2. How would you describe your current fitness status?
3. How many times a week will you train?
4. How much time do you have available for each training
session?
Health-screen questionnaire
Pg 162-165
Section 4: Your Nutritional Status
1. On a scale of 1 to 10 (1 being very low quality and 10 being
very high quality), how would you rate the quality of your
diet?
2. Do you follow any particular diet?
a.
b.
c.
d.
e.
Vegetarian.
Vegan.
Vegetarian and fish.
Gluten-free.
Dairy-free.
Health-screen questionnaire
Pg 162-165
Section 4: Your Nutritional Status Continued
3. How often do you eat? Note down a typical day’s intake.
4. Do you take any supplements? If so, which ones?
Health-screening questionnaire
Pg 162-165
Section 5: Your Lifestyle
1. How many units of alcohol do you drink in a typical week?
2. Do you smoke?
If yes, how many a day?
3. Do you experience stress on a daily basis?
4. If yes, what causes your stress (if you know)?
5. What techniques do you use to deal with your stress?
Health-screening questionnaire
Section 6: Your Physical Health
1. Do you experience any of the following?
a.
b.
c.
d.
e.
f.
g.
h.
Back pain or injury.
Knee pain or injury.
Ankle pain or injury.
Swollen joints.
Shoulder pain or injury.
Hip or pelvic pain or injury.
Nerve damage.
Head injuries.
2. If yes, please give details.
Pg 162-165
Health-screening questionnaire
Pg 162-165
Section 6: Your Physical Health Continued
3. Are any of these injuries made worse by exercise?
4. If yes, what movements in particular cause the pain?
5. Are you currently receiving any treatment for any injuries? If
so, what?
Health-screening questionnaire
Pg 162-165
Section 7: Medical History
1. Do you have or have you had any of the following medical
conditions?
a.
b.
c.
d.
e.
f.
g.
h.
Asthma.
Bronchitis.
Heart problems.
Chest pains.
Diabetes.
High blood pressure.
Epilepsy.
Other.
2. Are you taking any medication? If yes, state what, how much
and why.
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Eat 5 small meals a day.
Reduce high fat intake.
Reduce alcohol intake.
Reduce salt intake.
Drink 2L of water a day.
Stop smoking.
Exercise to manage stress.
Exercise at least 3x per week, for 45 minutes at a moderate
intensity to improve health.
Poor eating habits
High alcohol
intake
Diet high in fat
Smoking
Inadequate
sleep
Poor
Performance
PAR-Q
Pg 241-242
Physical Activity Readiness Questionnaire
The aim of the PAR Q and the initial consultation is to identify
any potential contraindications and then decide what needs
to be done about them to minimize their chances of being a
risk.
PARQ: Risk of CHD
• Coronary heart disease (CHD) – leading cause
of death in Western world
• 1/3rd deaths due to no physical activity
CHD
• Coronary arteries – blood vessels that bring
oxygenated blood to nourish the muscle cells of
the heart muscle.
• Atherosclerosis – build-up of fatty material
(cholesterol/plaque) in the coronary blood
vessels, which makes their diameter smaller.
• CHD – Narrowing of coronary
arteries due to atherosclerosis.
Implications of CHD to exercise
• Physically demanding task.
• Coronary arteries may not be able to supply heart
muscle with enough blood to keep up oxygen
demand.
• Leads to pain in chest – angina.
• Coronary artery completely blocked – heart
muscle will die - heart attack.
Pg 166
PARQ: Risk of CHD
• Lifestyle Factors that increase risk of CHD:
– Diet high in fat & table salt
– Obesity
– Smoking
– Excess alcohol consumption
– High blood pressure
– Type two diabetes
– Older age
(Non-modifiable)
– Male gender
(Non-modifiable)
CHD
REGULAR EXERCISE REDUCES THE RISK OF
HEART DISEASE
PAR-Q
Pg 241-242
Yes No
1 Do you have a bone or joint problem which could be made worse by exercise?
2 Has your doctor ever said that you have a heart condition?
3 Do you experience chest pains on physical exertion?
4 Do you experience light-headedness or dizziness with exertion?
5 Do you experience shortness of breath during light exertion?
6 Has your doctor ever said that you have a raised cholesterol level?
7 Are you currently taking any prescription medication?
8 Is there a history of coronary heart disease in your family?
9 Do you smoke, if so, how many?
10 Do you drink more than 21 units of alcohol per week for a male, and 14 units
for a female?
PAR-Q
Pg 241-242
Yes No
11 Are you diabetic?
12 Do you take physical activity less than 3 times a week?
13 Are you pregnant
14 Are you asthmatic
15 Do you know any other reason why you should not exercise?
If you have answered yes to any questions, please give more details.
If you have answered yes to one or more questions, you will have to consult with your
doctor before taking part in a program of physical exercise.
If you answered no to all questions, you are ready to start a suitable exercise program.
I have read, understood and answered all the questions honestly and confirm that I
am willing to engage in a program of exercise that has been prescribed to me.
Name:
Trainer’s name:
Signature
Signature
Date
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Contraindications to exercise:
High BP
Excess body fat
High resting heart rate
Medication for a heart
condition
Diabetes
Lung disorders
Coronary heart disease
Joint conditions
• Above 160/100mmHg
• 40%+ F; 30%+ M
• 100+ bpm
• e.g. Beta blockers
Pg 166
Medical Referral
If the person has a high risk for CHD, or you have
any doubt regarding their safety to exercise, it
is best to refer to a GP/Doctor for clearance
before you test/train them.
Pg 166
• If your client has any of the following they
should be referred to a GP:
– Muscle injuries
– Chest pain or tightness
– Light-headedness or dizziness
– Irregular or rapid pulse
– Joint pain
– Headaches
– Shortness of breath
Questions
1.
Define:
a.
b.
c.
d.
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5.
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7.
Coronary arteries.
Atherosclerosis.
Coronary heart disease.
Contraindication.
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List 5 aims of fitness testing.
5
List the 4 things you would do when conducting a detailed fitness
consultation.
4
List 5 instructions you would give to a client before the day of the testing. 5
In your own words, describe what an informed consent form is.
3
List and briefly explain all the headings in the informed consent form.
10
List the headings in the health screen questionnaire, and provide a few
questions under each heading.
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Questions
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List 8 healthy lifestyle recommendations.
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What does ‘PAR Q’ stand for?
2
What is the aim of the initial consultation?
3
What does ‘CHD’ stand for?
2
In your own words, what are the implications of CHD to exercise? 5
List the lifestyle factors which increase the risk of CHD; dividing them
into modifiable and non-modifiable.
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What effect does exercise have on heart disease?
2
List 10 questions found in a PAR Q form.
10
List 5 contraindications to exercise.
5
Why would you refer a client to the doctor before commencing with
exercise testing?
2
List 5 conditions which would call for a GP referral.
5
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