Transcript No Slide Title

HEALTH
APPRAISAL/FITNESS
TESTING
Basic Procedures
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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
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.
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
Components of the Informed
Consent
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Inquiries
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Freedom of consent
– Explanation of voluntary nature of testing
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Confidentiality
Informed Consent
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Specificity
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Any questions should be answered prior
to signing
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A signed informed consent form does not
absolutely absolve you from legal
responsibility for untoward events
The Physical Activity Readiness
Questionnaire (PAR-Q)
Designed for screening of apparently
healthy individuals beginning an exercise
program of moderate intensity (40 - 60%
VO2max)
CAD Risk Factor Analysis
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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
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
Resting Values
Blood pressure
– Resting Diastolic 60-80 mmHg
– Resting Systolic 110-140 mmHg
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Heart rate
– Measured by palpation, HR monitor, ECG
– Avg. = 72 bpm but may be elevated due to
pretest anxiety
Resting Values
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ECG
– Resting ECG may not indicate what could
happen during exercise.
Environmental and Laboratory
Concerns
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Equipment must be well maintained and
regularly calibrated
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Testing equipment must be able to
provide a wide range of intensities so that
testing can be tailored to clients/patients
Environmental and Laboratory
Concerns
Testing area must be environmentally
controlled
– 68O – 72O F
– < 60% relative humidity
– well-ventilated
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
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
The Fitness Assessement
Forced Expiratory Volume in 1 second
(FEV1)
 “Static” measures of lung volumes and
capacity (TLC, FVC, etc.) may not reveal
changes in ventilatory function
 FEV1 is a measure of lung power and is
decreased in persons with COPD
The Fitness Assessment
FEV1 is assessed by spirometry (many
metabolic carts now have this
capability)
 FEV1 should be at least 80% of FVC
 The ratio of FEV1/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.
The Fitness Assessment
Goal/Optimal Body Weight
Definitions of obesity:
 20% above “ideal” weight
(based on percent body fat)
 BMI > 30 kg/m2 (ACSM, NIH)
 WHR: > 0.94 for men, > 0.82 for women
or Waist Circumference > 100cm
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)
The Fitness Assessment
Body Composition Assessment
procedures:
 Hydrostatic weighing – the gold standard
 Bio-electrical impedance
 Circumference measures - WHR
 Skinfolds
 BMI
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
The Fitness Assessment
Dynamic Strength Assessments:
 1 RM protocols
– Specific to muscle group tested.
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Submaximal repetition testing
– Adds an endurance component
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Normative values
– Guidelines pages 81-86
– Heyward – Chapter 6
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
The Fitness Assessment
Assessment of flexibility
 Sit and reach test lacks specificity and
validity
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Norms for sit and reach test
The Fitness Assessment
Assessment of Aerobic Capacity
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Field tests
– quick, easy, cheap
– best for young healthy individuals i.e., PE
classes
– maximum effort?
– environment?
– cardiovascular/hemodynamic responses?
– accuracy?
The Fitness Assessment
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Step tests
– also quick, easy and cheap
– cardiovascular/hemodynamic responses?
– accuracy?
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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?
The Fitness Assessment
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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.
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Normative data in Guidelines (p. 77)
The Fitness Assessment
Assessment procedures
 Bicycle
 Treadmill
 Step
 Recording of data – timing and techniques
 Data – absolute vs relative values
 RPE’s – useful for exercise prescription (p. 79)
The Fitness Assessment
Signs of exercise intolerance: (Box 4-5, 5-3)
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HR response
BP response
Hyperventilation
Muscular fatigue
Dizziness, lightheadedness, incoherence
Volitional exhaustion
Cyanosis, pallor
Nausea
Inability to sustain workload
Chest pains
The Fitness Assessment
Legal Implications
 There should be a written plan for
emergency procedures:
– Defines personnel responsibilities
– Sets requirements of emergency training
– Well-documented
The Fitness Assessment
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Nutritional Assessment
Weight Management