principles of fitness assessment student
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Exercise Programming:From Initial Screening(s) and Baseline Assessments to the Exercise Prescription
Fitness/Wellness Specialist Responsibilities
• Educate clients
• Conduct pretest health evaluationsConduct pretest health evaluations
• Select, administer, interpret tests to assess Select, administer, interpret tests to assess components of physical fitnesscomponents of physical fitness
• Design exercise prescriptionsDesign exercise prescriptions
• Lead classes/Give presentations
• Analyze client exercise performance and correct errors
• Motivate clients
• Reassess clients/athletes – be dynamic!
The Exercise “Science Artist”“….exercise prescription is the successful integration of exercise science with behavioral techniques that result in long term program compliance and attainment of the individual’s goals.”
ACSM Guidelines for Exercise Testing andPrescription, 2000, pg 140
Exercise Programming and Prescription
Definition:
Elements of Exercise Prescription
FITT-P
Exercise Prescription vs. Health Related Fitness
Factors To Consider When Designing An Exercise Prescription
• Health status
• Risk factor profile
• Medical evaluation
• Individual’s goals
• Baseline values
• Exercise preferences
• Program design principles
• Adherence factors
Why do we care about health screening and risk stratification?
Health Screenings• Par – Q
• Medical History Questionnaire
• Coronary Risk factor analysis
• Disease Risk Classification
• Informed Consent
• Physical Exam
• Lipid Panel and Glucose Levels
• Blood Pressure
• 12-Lead ECG
• Graded Exercise Test
Clinical Tests
Self-Guided Screening
•PAR-Q and You▫Physical Activity Readiness Form
Figure 2.1, p. 24 (ACSM) For pregnancy, p. 196 (ACSM)
•AHA/ACSM Health/Fitness Facility Pre-participation Screening Questionnaire ▫Figure 2.2, p. 25 (ACSM)
Professionally Guided Screening •Health fitness/clinical assessment and activity
programming conducted and supervised by appropriately trained personnel
•Professionally guided screening includes:▫Coronary Risk factor analysis▫Review more detailed health/medical hx info
and risk stratification▫Detailed recommendations for PA/exercise,
medical exam, exercise testing, physician supervision
CVD Risk Factor Thresholds for Use with ACSM Risk Stratification
•Positive and Negative Risk Factors
(Table 2.2, p. 27, ACSM)
CVD Risk Factor Thresholds for Use with ACSM Risk Stratification
Positive Risk Factors (Table 2.2, p. 27, ACSM)
CVD Risk Factor Thresholds for Use with ACSM Risk Stratification
Positive Risk Factors (Table 2.2, p. 27, ACSM)
Calculating BMI• BMI = weight in kg. / height in meters2
Weight: 180 lbs Height 5 ft. 8 in.
What is the client’s BMI classification?
Weight: 257 lbHeight 5 ft. 9 in.What is the client’s BMI classification?
BMI Classification
Hypertension
Cholesterol Classifications
ClassificationClassification TCTC LDL-CLDL-C TGTG
Optimal
Near/above optimal
100-129
Borderline High
High >240 160-189 200-499
Very High >190 >500
HDL–C Classification
Classification HDL-C
Low
Normal
High (this is good!)
Fasting Blood Glucose
From 70 to 99 mg/dL
From 100 to 125 mg/dL
>126 mg/dL on more than one test
CVD Risk Factor Thresholds for Use with ACSM Risk Stratification
Negative Risk Factors (Table 2.2, p. 27, ACSM)
How do I remember all of those risk factors?
Case Study #1•Bob Marley
▫54 year old male▫Cigarette smoker▫Brother died of MI age 55▫BP: 130/82▫HDL-C: 44 mg/dL▫TC: 188 mg/dl▫Fasting glucose: 112 mg/dl (verified 2x)▫Height: 5’7.5”; Weight: 160 lbs▫Light activity 3 days/week, 30 min (last 3
years)▫Medications: ACE-inhibitor, diuretic
• Jane is a 46 year old female. She has a family history of breast cancer (mom was diagnosed at 47 and sister at 36). She quit smoking when she was 21. She has been walking briskly (mod) for 45 minutes, 3 days per week, for the last 6 months. Her height is 5’2” and she is 130 lbs and her waist circumference is 33”. Her cholesterol and glucose levels are all within normal range, though her HDLs are 62mg/dl. Her blood pressure is 126/88.
Medications
• Blood pressure control **▫ Diuretics ▫ Beta-blockers ▫ ACE Inhibitors▫ Angiotensin II receptor
blockers ▫ Calcium channel blockers▫ Vasodilators▫ Nitrates
• Asthma **▫ Oral or inhaled bronchodilators
• Glycemic control▫ Biguanides (Metformin,
Glucophage)▫ Alpha-glucosidase inhibitors
(Precose, Glyset)▫ Sulfonylureas (Glucotrol,
Amaryl)
• Cholesterol lowering▫ Statins (Lipitor, Zocor,
Provachol)▫ Nicotinic acid (Niacin)▫ Fibrates
• Thyroid **▫ Thyroid hormone medici
ne, levothyroxine sodium (Synthroid, Levoxyl, or Levothroid)
Medications• Beta blocker (BP)
▫ Decrease force of contraction▫ Decrease cardiac workload▫ Decrease demand for O2 in
myocardium• Nitrates (BP)
▫ Vasodilator▫ Decrease preload and cardiac
workload• Ca2+ channel blockers (BP)
▫ Prevent vasoconstriction▫ Prevent coronary artery spasm▫ Increase O2 supply to
myocardium
• Diuretic (BP)▫ Increase H2O
excretion▫ Decrease blood
volume• Ace inhibitor (BP)
▫ Prevent vasoconstriction
▫ Prevent H20 retention▫ Decrease blood
volume
MedicationsMeds HR BP
Beta Blocker
Nitrate
Calcium Channel Blocker
Diuretics
Ace Inhibitors
Bronchodilators
Thyroid meds
Nicotine
Table 2.1 ACSM Risk Stratification Categories for Atherosclerotic CVD (Figure 2.4 ACSM p. 28)
•CVD, pulmonary, or metabolic disease
▫CVD: Coronary, peripheral vascular, or cerebrovascular disease
▫Pulmonary: COPD, asthma, interstitial lung disease, cystic fibrosis
▫Metabolic: diabetes (I or II), thyroid disorders, renal, or liver disease
Cardiovascular, Pulmonary, and Metabolic Disease - - HIGH RISK!
Major symptoms or signs suggestive of cardiopulmonary or metabolic disease.* ___________________________________________________ 1. Pain, discomfort (or other anginal equivalent) in the chest, neck, jaw,
arms, or other areas that may be ischemic in nature 2. Shortness of breath at rest or with mild exertion 3. Dizziness or syncope (fainting) 4. Orthopnea/paroxysmal nocturnal dyspnea (labored breathing;
discomfort in breathing in any but erect position) 5. Ankle edema 6. Palpitations or tachycardia 7. Intermittent claudication 8. Known heart murmur 9. Unusual fatigue or shortness of breath with usual activities ___________________________________________________ *These symptoms must be interpreted in the clinical context in which they appear, since they are not all specific for cardiopulmonary or metabolic disease. See description of each in ACSM Guidelines. ___________________________________________________
Figure 2.3 ACSM p. 26
ACSM Figure 2.3
Case Study•Lolo Jones
▫26 years old, non-smoker▫BMI: 24.6 kg/m2▫Asthmatic, normal cholesterol and BP▫Fasting glucose: 85 mg/dl▫Sprint athlete – works out 6 days/week 2+
hours per day (vigorous activity) for last 2 years
▫No family history of heart disease▫Sister, 22, has Type 2 diabetes
Exercise Testing and Participation Recommendation Based on Risk
•Once risk classification established, appropriate recommendations may be made regarding:
Maximal Graded Exercise Test (GXT),
Reasons for Max. Testing in the Clinical Setting:
To find the true max. HR for exercise prescription
To measure or estimate VO2 max. To determine baseline aerobic fitness level
To help plan a safe and effective exercise program
To aid in the diagnosis of CVD in the mod. risk or in those who are symptomatic (*with ECG*)
To follow the progress of known disease (*with ECG)
Submaximal Exercise Tests
•Sheri is a low risk client. She was told by her previous trainer that she should not have a GXT done because according to ACSM GXTs are only for moderate to high risk clients.
•Do you agree or disagree with her previous trainer? Why?
Metabolic Syndrome
>100
Factors To Consider When Designing An Exercise Prescription
• Health status
• Risk factor profile
• Medical Evaluation
• Individual’s goals
• Baseline Values
• Exercise preferences
• Program Design Principles
• Adherence factors
Purpose of Health Related Fitness Testing•Educate participants about present
health-related fitness status relative to standards and age and gender norms
•Provide data helpful in development of exercise prescriptions▫Address all fitness components▫Baseline data and follow – up▫Motivate participants▫Stratify risk
Components of Health Related Fitness1. Body weight and body composition
2. Cardiorespiratory Endurance (Fitness)
3. Muscular Endurance
4. Muscular Strength
5. Flexibility
Measures of Weight or Body Comp.
Anthropometric measures:
Cardiorespiratory Endurance (CRE) / Cardiorespiratory Fitness (CRF)
•Ability of heart, lungs, and circulatory system to supply O2 and nutrients effectively to working muscles
•Typically expressed as VO2max
•Clinical submaximal and maximal tests
▫Field tests
Musculoskeletal Fitness• Ability of skeletal muscle systems to perform
work
• Muscle strength
• Muscle endurance
Muscular Strength Testing
Grip Strength One Repetition
Max. 4, 5, or 6 Rep Max
•Muscular Endurance Testing
Curl Up Push Up
Flexibility• “Sit and Reach”
test
Components of Health Related Fitness1. Body weight and body composition
2. Cardiorespiratory Endurance (Fitness)
3. Muscular Endurance
4. Muscular Strength
5. Flexibility
Test Validity, Reliability, and Objectivity•Validity
•Reliability
•Objectivity
Prediction equations
•To whom is equation applicable?▫Population specific vs. general
•How were variables measured by the researchers who developed equation?
Feasibility
Efficacy
Health history
Goals
Things to keep in Things to keep in mind:mind:
Preparing to Test Your Client/Athlete
What should be the proper order of testing?
• Flexibility
• Body composition
• Muscular fitness
• HHQ/Risk stratification
• CRE / CRF
• Resting BP and HR
Give client specific instructions as to what to wear, what to bring, and what to expect on testing day!
Always have your supplies and equipment ready before the client arrives!
Make the client as comfortable as possible!
Be professional, be confident, be yourself!
Test Interpretation
•Calculate necessary values
•Classify client results by comparing to established norms or percentile rank
•Discuss results with clients▫Provide hard copy of results to client▫Keep a copy for your records!
Factors To Consider When Designing An Exercise Prescription
• Health status
• Risk factor profile
• Medical Evaluation
• Individual’s goals
• Baseline Values
• Program Design Principles
• Exercise preferences
• Adherence factors
Characteristics of Exercise Program Dropouts & Factors Related to “Dropping Out”
Reinforcing Factors for Exercising (Promoting Adherence)
Exercise Program Design Principles
Exercise Program Design Principles•Specificity of Training•Overload training•Progression•Initial values•Inter-individual variability•Diminishing returns•Reversibility
Principle of Specificity
The training effects from any exercise are specific to the activity and the muscles involved.
Overload Training
Progression
Inter-individual variability
•Responses to a training stimulus vary amongst individuals
•What are some factors that vary amongst individuals?
Initial Values
Diminishing Returns
Reversibility
Genetic Ceiling
Clinical Tests• Physical Exam
• Lipid Panel and Glucose Levels
• Blood Pressure
• 12-Lead ECG
• Graded Exercise Test
Case Study
•Height: 5’5”•Weight: 138lbs
Case Study
•Sonia Sotomayor ▫ 44 year old female with BMI of 23 kg/m2; ▫ WC = 35inches▫ BP: 134/82; does not smoke▫ HDL-C: 42 mg/dl▫ Father had MI age 42, Sister MI age 50▫ Brother has T2DM, diagnosed age 35▫ Fasting glucose: 95 mg/dl ▫ Mod exercises 5 days per week, 30 min (last 2
months)▫ Meds: aspirin for knee pain from a sporting
injury
Case Study• Mike Magiske
▫62 year old, sedentary male▫Quit smoking 5 months ago▫Impaired fasting glucose
(Pre-diabetes/insulin resistance)▫Obese --Low HDLs▫Normal Triglycerides▫Mother died of CVD age 57
•You have determined that Spencer is a high risk client. Spencer wants to begin a moderate walking program.