Personal Fitness Assessment for NoMo Phat

Kelli Willer

Swan

EXW 420 MW 1:30pm

11/20/15

Table of Contents

Introduction……………………………………………………………………….. Page 3

Description of Subject and Health Appraisal Risk………………………………...Page 5

Resting Heart Rate and Blood Pressure………………………………... …………Page 6

Muscular Fitness/Flexibility Assessment………………………………………….Page 7

Body Composition…………………………………………………………………Page 8

Prediction of Aerobic Capacity…………………………………………………….Page 11

Maximal GXT Interpretation………………………………………………............Page 15

Conclusions………………………………………………………………………..Page 16

References………………………………………………………………………….Page 17

Appendices…………………………………………………………………………Page 18

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Introduction

The capacity to perform aerobic exercise depends on the function of pulmonary, cardiovascular and skeletal muscle systems. The combination of these systems work together to determine aerobic capacity and physical fitness. Physical activity utilizes muscle groups to create cardiovascular adaptations that increase aerobic capacity and improve the function of these systems. The better these systems work the more physically fit a person is. On the contrary, a lack of physical activity leads to poor physical fitness. Poor physical fitness is high risk for the development of disease and cancers. The risks of chronic diseases such as Type 2 Diabetes, coronary artery disease, cardiovascular disease, osteoporosis and obesity are associated with poor physical fitness. Exercise testing produces results that aid in diagnosing any signs or symptoms of disease. Furthermore, exercise testing results are used in exercise prescription to reduce risk of disease and improve an individual’s health and wellness.

There are many tests used to determine the overall health and fitness of an individual. Blood pressure is one of the vital signs checked by the physician. It is the pressure placed on the arteries and heart. High blood pressure puts a strain on these vital organs therefore it is necessary to test. This puts an individual at risk for hypertension. An electrocardiogram is a test that measures the electrical activity of the heartbeat. With each beat, an electrical wave travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart. By measuring time intervals on the EKG, we can determine how long the electrical wave takes to pass through the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. Heart rate is the number of beats the heart makes per minute. This is assessed prior, during, and after almost any fitness assessment. There are a few ways to determine heart rate. The physician may test heart rate manually or electronically. Heart rate is used to ensure a normal working heart at rest and during exercise. It also is used to determine proper exercise intensities and measuring VO2. There are multiple muscular fitness tests to determine the strength and endurance of the musculoskeletal system. Each test helps to establish a baseline for one’s fitness levels. The importance of muscular fitness testing relates to one’s ability to function in everyday life performing daily movements. Poor muscular fitness directly affects the musculoskeletal system leaving risk for osteoporosis, arthritis, muscle injury, joint injury, back pain, and other injuries or diseases. Furthermore, flexibility assessments are an important aspect of exercise and everyday life to fulfill tasks such as reaching, bending and completing active ranges of motion. Flexibility often deteriorates with age thus it is important to partake in these assessments to prevent any limited range of motion and protect the joints. Similar injuries and diseases from poor muscular fitness are also a risk of poor flexibility. Muscular strength and endurance and flexibility test results are all absolute and relative to the individual to most accurately interpret an individual’s functional fitness. An individual’s health is not only a combination of vital signs, muscular fitness and flexibility fitness, but also what the body is made up of. Body composition is the assessment of body fat percentage. This means the amount of body fat versus lean muscle tissue. Knowing body composition helps identify healthy and unhealthy ranges of body fat which are linked to cardiovascular and obesity related diseases. These results are achieved through a variety of body comp tests including skinfold measurements, circumference measurements, bioelectrical impedance analysis, BMI, relative weight, bod pod, and a variety of equations calculated using height, weight, age, skinfolds, and circumference measurements. Lastly, cardiorespiratory fitness tells us how healthy a person’s heart is by how much it has to work to deliver oxygen to the body (Lippincott, Williams, & Wilkins p 111).VO2 is the milliliters of oxygen per body weight per minute used by the body to do activity. This number reflects a person’s cardiovascular strength. VO2 is assessed through submaximal and maximal exercise tests. Submaximal tests require the client to stay within 85% of their predicted heart rate max. VO2 max can then be predicted using calculations or tested through maximal exercise testing. This is only done for individuals who are in the low to moderate risk categories as it requires maximal exertion on the body. VO2 values are used in exercise prescription tracking fitness levels and progress. With this, realistic goals can be set and improvement can be assessed. VO2 helps with choosing workouts at the right intensity to meet goals.

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Initial VO2 tests can determine the specific target heart rates that an individual should be exercising at. This helps clients understand the importance and link between heart rate, intensity and duration of exercise in regards to meeting their goals.

For this case study the client was told she needed to lose weight so she came in for an assessment. The client’s history is described followed by each test performed, the values and their corresponding interpretation. There is a final conclusion summing up each test value and the client’s overall fitness level. This report can then be used for exercise prescription to meet the client’s fitness goals.

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Description of Subject and Health Risk Appraisal

NoMo Phat is a 33 year old female with no signs and symptoms of disease. She has the goal to run a 10k in four months. While she is considered physically active, she has been told she needs to lose 50lbs to reduce health risk. She hikes four days a week for an hour and is gone 8-10 hours on weekends hiking and exploring. Furthermore, she performs vigorous and moderate gardening and yard work during the week. Despite her activity level she is classified as overweight. She is a non-smoker and does not drink alcohol. Her diet is fairly normal taking in 2200 kcals/day. Her mother and father are both living; mother has type 2 diabetes at age 60 and her brother has pre-diabetes at age 27 while her sister and father are healthy with no CV disease.

Test Value Normal Values

Total Cholesterol 178 mg/dl <200 mg/dl is good

HDL Cholesterol 57 mg/dl < 40 mg/dl is bad

> 60 mg/dl is good

LDL Cholesterol 44 mg/dl > 130 mg/dl is bad

Triglycerides 88 mg/dl <150 mg/dl is good

Glucose Level 78 mg/dl 70-99 mg/dl is good

Figure 1. This table shows the client’s blood chemistry tests and their corresponding value compared to normal values.

Total cholesterol is the measure of all the cholesterol components. This value is considered good if measured less than 200mgdl. NoMo’s total cholesterol measures at 178mgdl which means she is not at risk for dyslipidemia. HDL cholesterol is known as the good cholesterol as it helps to remove the bad LDL cholesterol from the blood. This value is considered healthy is if it between 40 and 60mgdl and NoMo’s HDL is 57mgdl. LDL cholesterol is known as the clogging cholesterol. This value is considered healthy if it measures less than 130mgdl and NoMo’s LDLis 44mgdl.Triglycerides are a fat stored in the body for energy and high values can be linked to atherosclerosis (Guidelines for Exercise Testing and Prescription p113). A healthy triglyceride value is measured at less than 150mgdl. NoMo’s levels are 88mgdl which means she is not at risk for atherosclerosis. Glucose is a sugar stored in the body for energy. High levels of glucose are a risk for hyperglycemia. Healthy glucose levels measure between 70 and 99mgdl. NoMo’s levels measure at 78mgdl which means she is not at risk for hyperglycemia. In conclusion NoMo’s blood chemistry is normal and she is not at risk for disease.

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Resting Heart Rate and Blood Pressure

Heart rate and blood pressure are vital signs checked by a physician to assess the circulatory system’s functioning state. Blood pressure is the pressure placed on the arteries and heart. It is made up of two values which are diastolic and systolic. Diastolic is the pressure placed on the heart while it is relaxed. Systolic is the pressure placed on the heart while it is contracting. High blood pressure puts a strain on these vital organs which can lead to hypertension, stroke or myocardial infarction and is therefore necessary to test. A higher blood pressure is commonly associated with heavier set individuals or those with higher body composition because the heart has to work harder to get the blood through the body. Heart rate is the number of beats per minute by the heart. It can be read by palpating the most common sites on the body such as the carotid artery and the radial artery. Heart rate can be palpated for a full 60 seconds or by taking a 10, 15, or 30 second heart rate and multiplying. Normative values for a resting heart rate are 60-100bpm. Heart rate is, however, affected by numerous factors including but not limited to stress, anxiety, stimulants, exercise and temperature. Gender also affects heart rate as females are typically smaller than men and have a higher heart rate. Resting heart rate determines a baseline for exercise and proper intensity levels. Typically, the more fit an individual the lower their heart rate is. This is beneficial to the heart as it means it is working less hard compared to an individual who is less fit with a higher heart rate. It also is measured as a safety precaution to ensure the heart is working at an attainable intensity and overall cardiovascular health. It is important to monitor heart rate and blood pressure during exercise to ensure the safety of the client.

Figure 2a. EKG image showing the heart’s activity at rest.

Test Result Normal ValuesResting HR 68.1 bpm 60-100bpmResting Blood Pressure 118/74 mmHg <120/80 mmHgFigure 2b. This table shows the client’s resting heart rate and blood pressure in comparison to normal values.

NoMo’s resting heart rate and blood pressure values are both within normal values. This means she has a healthy cardiovascular and circulatory system with no indication of abnormalities or signs of disease.

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Muscular Fitness/ Flex assessment

Muscular fitness is a reflection of the overall health of the musculoskeletal system. There are two components to muscular fitness including strength and endurance. Muscular strength is the ability to exert force while muscular endurance is the ability to perform continuously without fatigue (Lippincott, Williams, & Wilkins p 349). These two things can be evaluated by a series of physical strength tests to determine overall muscular fitness. The test movements performed are similar to that of the way the body moves during physical activity. There are multiple muscular fitness tests that will be performed. Each test helps to establish a baseline for fitness levels. The importance of muscular fitness testing relates to one’s ability to function in everyday life performing daily movements. Poor muscular fitness affects an individual by limiting their capability to perform daily living activities. Muscular fitness testing is necessary prior to exercise prescription by identifying and preventing potential health issues related to poor muscular fitness. The client’s baseline for overall muscular fitness is established via muscular fitness testing and in turn used to determine the development and maintenance of an exercise prescription program. Flexibility is important not only in exercise but in everyday life to fulfill daily tasks such as reaching over head, bending down, reaching behind, and completing any necessary active range of motions. Flexibility often deteriorates with age or a sedentary lifestyle. Without flexibility, posture becomes compromised, joints become painful, and it may be impossible to daily activities. This is why it is important to stay active and stretch frequently to prevent loss of mobility. The purpose of flexibility training is to decrease the likelihood of injury to muscles and joints. It enhances performance in strength and resistance training, cardiovascular training, and sport conditioning. Flexibility also corrects muscle imbalances, decreases muscle soreness, relieves stress on joints, maintains the normal functional length of all muscles, and decreases unnecessary friction in joint structures. Flexibility testing is conducted to see a client’s range of motion of different joints which is then used in determining the ability to perform certain exercises and movements. There are multiple flexibility tests that will be performed. Each test helps to establish a baseline for fitness levels. Flexibility often deteriorates with lack of use and age thus it is important to partake in these assessments.

Test Absolute Relative InterpretationBench Press 1- RM 122 lbs 0.67 ExcellentLeg Press 1- RM 228 lbs 1.26 AveragePush Ups (knee bent) 26 26 Very GoodPartial Curl Ups 58 58 Well Above AverageFlexibilitySit and reach (0 @26 cm)

35 cm 35 cm Good

Figure 3. This table shows the client’s muscular fitness and flexibility assessments in absolute and relative terms and interpreted for age and gender.

NoMo’s values were recorded in absolute and relative terms and then compared to a table of normal values arranged gender and age. Her absolute values were compared to the data of norms and interpreted into a classification of her muscular and flexibility fitness. Her upper body strength was tested by the 1-rm bench press. She pressed122lbs, classified as excellent. Her lower body strength was tested by the1-rm leg press. She pressed 228lbs, classified as average. Her upper body endurance was tested by the female pushup position test. She did 26 pushups, classified as very good. Her endurance was further tested by curl-ups. She did 58 curl-ups, classified as well above average. Her flexibility was assessed by the sit and reach test. She reached 35cm, classified as good. In conclusion she has great muscular strength, good muscular endurance, and good flexibility.

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Body Composition

Body composition is used to determine percentages of fat, muscle, bone and water in the body. Regarding overall health, body composition is more important in understanding what the body is made of compared to using body weight because our weight does not break down the body’s composition. Body composition is used to assess body fat percentage. This means the amount of body fat versus lean muscle tissue. Not only is body composition a physical component, but an assessment of the tissues inside the body. Knowing body composition helps identify healthy and unhealthy ranges of body fat which is linked to cardiovascular and obesity related diseases (Lippincott, Williams, & Wilkins p 311). There are recommended ranges for body composition arranged by factors including age, height, weight, and gender. Having a body composition within your recommended range suggests less risk of developing disease related to obesity such as diabetes, dyslipidemia, cardiovascular disease, hypertension and some cancers. Likewise, having a body composition outside the recommended range increases risk for either obesity related diseases or having too low of a body composition increases risk of organ function, delivery of vitamins throughout the body, reproductive system’s function and overall well-being. There are multiple ways to test body composition including BMI, Bod Pod, Waist to hip ratio, BIA, skinfolds, relative weight, and a variety of mathematical equations. Each test description and its procedures are as follows:

Body Mass Index

1. Measure height without shoes (Cm)2. Measure weight (kg)3. Calculate BMI4. Interpret results

Bod Pod

1. Don’t eat or drink for at least 3 hours prior to the test.2. Don’t exercise for at least 3 hours prior to the test. 3. Wear form fitting clothing. 4. Don’t wear any jewelry. 5. Note how much body hair you have. If you shave any of your body or facial hair the day before

your first test, make sure you shave it again the day before your follow-up tests. 6. Sit in bod pod while tester performs the test.

Circumference Measurements

1. Perform circumference measurements (in cm) for waist and hips following the procedures in the lab manual

2. Calculate Waist-to-Hip (WHR) ratio3. Determine disease risk for both waist circumference and WHR

Bioelectrical Impedance Analysis – OMRON Handheld BIA

1. Have the participant wash and completely dry their hands 2. Input required information when prompted by device3. Setting personal data – select guest 4. Set mode – select normal or athlete5. Enter height in feet and inches6. Enter weight in pounds7. Enter age8. Select gender9. Stand with both feet slightly apart

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10. Place both hands on the monitor by holding the grip electrodes. Wrap middle finger around the groove of the handle. Place the palm of hand on the top and bottom of electrodes. Put thumbs up, resting on the top of the monitor. (Note: The position of the hands is important for the accuracy of the measurement)

11. Hold the arms straight out at a 90 degree angle12. Press the START button13. Hold the electrodes with both hands14. Record the results from the LCD display

Skinfold

1. Perform skinfold measurements for 8 sites2. Calculate body density using gender specific equations

a. Seven site formulab. Three-site formulas

3. Calculate percent body fat using population specific equations 4. Determine Fitness Category

Relative Weight

1. Measure height with shoes on2. Measure weight in pounds3. Elbow Measurement – place your thumb and index finger on the two prominent bones on either

side of your elbow, then measure the distance in inches between the bones with calipers. 4. Determine frame size – reference Ideal Weight Chart. The chart lists elbow measurements for a

medium frame. If your elbow measurement for a particular height is less than the number of inches listed, you are a small frame. If your elbow measurement for that particular height is more than the number of inches listed, you are a large frame.

5. Determine the midpoint for the weight range at the corresponding participant height6. Calculate relative weight by dividing the measured weight by the midpoint value7. Provide interpretation – desirable (0.90 – 1.10), overweight (1.11 – 1.20), obese (> 1.20)

Ball and Swan

Procedures for women

1. Record age in years2. Record hip circumference in cm3. Calculate 3SF – sum the triceps, supra iliac, and thigh skinfold measurements 4. Calculate body fat percentage: %BF = -9.606 + 0.435(3SF) - 0.001429(3SF)2 + 0.153(hip) +

0.07292(age)

Procedures for men

1. Record age in years2. Calculate 7SF – sum the chest, Midaxillary, triceps, subscapular, abdomen, supra-iliac, and

thigh skinfold measurements 3. Calculate body fat percentage: %BF = 0.465 + 0.180(7SF) - 0.0002406(7SF)2 + 0.06619(age)

No single assessment can truly determine exact body composition as there are discrepancies with each test but using multiple can be useful in comparing the results. It is likely no two assessments will

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have the same result. This is because discrepancies accompany each body composition assessment making it hard to determine a precise and accurate measurement. It is arguable which assessment is the most accurate and even then the test results depend on numerous factors. BMI uses height and weight to determine the recommended value for an individual. These values do not consider an individual’s genetics, metabolism, frame size or activity level. While these values are an estimated number used as a guideline, it is not realistic for everyone. Clients should understand that ethnicity has a huge impact on body composition and is not taken into account in a BMI table. This relates to other body composition tests as well. Each test has its own list of discrepancies that can affect the result. With underwater weighing there are sources of error in the RV measurement such as when people estimate the value. It is also difficult for a client to blow out all of their air under water. And finally there is always equation assumption error. Skinfolds are based on the assumption that half of the body’s fatty tissue is directly underneath the skin. There are many different equations for calculating skinfolds which can cause a range of body fat percentages and the accuracy of the test depends on the skill and experience of the technician.

Test Result Interpretation/ClassificationBMI 29.4% OverweightBod Pod 29.8% (population specific) OverweightWaist Circumference 74cm Not at riskBIA (Lab) 32% OverweightSkinfold 7 site 30.2% OverweightSkinfold 3 site (thigh, triceps, suprailiac)

33.3% Overweight

Skinfold 3 site (abdomen, thigh, suprailiac)

29% Overweight

Relative Weight 1.43 ObeseBall and Swan 35.96% ObeseUnderwater weighing 26.4% HealthyFigure 4. This table shows the client’s body composition test results and the risk classification. All calculations are shown in the appendices section.

After looking at the results from multiple body composition assessments, NoMo scored six overweight classifications, two obese classifications, two healthy classifications and one not at risk. Averaging all the tests results in a body fat percentage of 30 and classifies the client as obese. Some tests, however, are not considered the most accurate. It was noted in the skinfold tests that her thigh was hard to measure and could therefore affect the results proving the skinfold measurements and results less accurate than other tests. Additionally, underwater weighing is noted to be difficult to set up and challenging for the client to give an accurate reading. I believe the bod pod is the most accurate which I will use to determine her final body fat percentage. Using the population specific equation she has a 29.8% body fat resulting in an overweight classification. In contrast NoMo’s waist to hip ratio proves she is not at risk for obesity. Furthermore, her bod pod result using the non-population specific equation classifies her as healthy.

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Prediction of Aerobic Capacity

VO2 is the milliliters of oxygen per body weight per minute used by the body to do activity. This number reflects a person’s cardiovascular strength. Knowing VO2 is useful for trainers and clients to track fitness levels and progress. With this, realistic goals can be set and improvement can be assessed. VO2 helps with exercise prescription and choosing workouts at the right intensity to meet goals. Initial VO2 max tests can determine the specific target heart rates that an individual should be exercising at. This helps clients understand the importance and link between heart rate, intensity and duration of exercise in regards to meeting their goals. VO2 is determined through maximal and submaximal exercise testing. While these tests are beneficial, maximal tests can pose a danger for clients who are overweight and obese. Submaximal testing poses less risk to the patient and requires less effort than maximal testing. Max heart rate is predicted prior to starting a sub-max test. The client stays within 85% of the predicted heart rate max during the submaximal exercise test. Once the test is finished, VO2 is calculated and then this number is used for the client’s exercise prescription. There are a variety of submaximal exercise tests used to predict VO2 max including a variety of equipment that can be utilized. The following submaximal tests and procedures are described.

YMCA Cycle Test

1. Adjust seat and handlebars.

2. Set pedal speed to 50 rpm (metronome = 100 bpm) with .5 KP on the bike which is your initial work rate.

3. You decide the next stage based on the HR response to this initial work rate. Once you determine the work rate for the stage make sure that this exact workload is maintained.

4. Each stage is 3 minutes. You need to complete at least 2 full stages that elicit a HR of between 120 and 170 bpm (or 85% HR max). If your HR is too low – do another stage—if your HR is too high—STOP –REST—then start again at a lower work rate.

5. Monitor HR and work rate constantly-- Make sure that the subject stays with the metronome and that the pendulum on the flywheel has not drifted.

6. Take heart rate every minute. Record the HR at the end of minute 2 and 3 of each stage. If HR is not steady state at the end of 3 minutes continue another minute. ONLY report the final Steady State HR and the work rate for each stage. STOP increasing stages if the subject reaches a HR of 85% of HR max or when 4 total stages are completed (initial plus 3 more).

7. When the test is completed decrease the resistance and have the subject cool down by pedaling for 3-5 more minutes.

Astrand-Rhyming Cycle Test

1. Adjust seat and handlebars.

2. Set pedal speed to 50 rpm (metronome = 100 bpm) 3. Set initial workload at about 75 W, 100 W or 150 W for untrained, moderately trained or

well-trained subjects respectively. (Note 1 Watt 6 kgM.min-1 ) 4. This exact workload should be maintained for 6 minutes. (Monitor HR and work rate

constantly-- Make sure that the subject stays with the metronome and that the pendulum on the flywheel has not drifted).

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5. HR should be recorded every minute for the first 3 minutes. After 3 minutes if the HR is not at least 125 bpm then increase the work by about 50-75 Watts. Begin timing again!

6. The heart rate must reach at least 125 bpm. If the heart rate is above 170 bpm or above 85% of age predicted HR then stop the test and cool the subject down, rest for a while and then try again.

7. If the HR is within 125 bpm to – about 85% of age predicted HR then continue at this SAME workload for 3 more minutes (this is a 6 minute test).

8. Check HR every 30 seconds to make sure that HR is at steady state. The object is to have the subject be in steady state for the last 3-4 minutes of the 6 minute test. Remember steady state means that the HR is within 5 beats per minute of each reading.

9. When the test is completed then decrease the resistance and have the subject cool down by pedaling for 3-5 more minutes.

Queens College Step Test

1. The athlete steps up and down on the platform at a rate of 22 steps per minute for females and at 24 steps per minute for males. 16.25in height for step.

2. The subjects are to step using a four-step cadence, 'up-up-down-down' for 3 minutes.3. The athlete stops immediately on completion of the test, and the heart beats are counted for

15 seconds standing up. Multiply this 15 second reading by 4 will give the beats per minute (bpm) value to be used in the equation listed in the appendices.

Canadian Aerobic Fitness Step test

1. Select the appropriate stage for your sex and age using Table 1 (see protocol sheet) 2. Then determine the stepping cadence (beats per minute to set on the metronome) for that

stage using Table 2. 3. Note that the stepping pattern is a 6-step sequence. You can use stairs anywhere to do this

test as long as you have a metronome and the steps are about 8 inches high. 4. You perform each stage at the appropriate cadence for 3 minutes.

5. Immediately after stopping, check HR for 10 seconds. If the # beats in 10 seconds is above or equal to the number for your age group then you are done. If your 10 second HR is lower, you go on to the next stage.

6. Repeat the process at the next stage. Check the HR table again for your age group.

7. Determine if you need to do one final stage or if you need to stop. NOTE: You should ALWAYS stop the test if the HR is above 85% of predicted HR max.

8. If your 10 second HR is equal to or higher than the recommended value you are to stop. If it is lower you go on to do one final stage.

9. If your pulse is still under the value then you are to perform a final 3-minute stage. 10. If at any time you cannot keep up the stepping sequence or stepping cadence you must stop

the test. 11. In your VO2 equation, you are to use the corresponding VO2 value for the last stage

completed. The last stage is only considered final if ALL 3 minutes were completed and only if HR is below 85% of predicted HR max.

Ebbling Treadmill Walking

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INITIAL STAGE:

1. Pick a walking pace that is “brisk” but comfortable for the subject between 2 - 4.5 mph2. Monitor HR constantly—Record HR each minute for 4 minutes3. Must elicit HR between 50-79% of age predicted max

STAGE 2:

4. Once HR is steady state and between 50-79% of age predicted max – keep the speed the same and bring grade up to 5% for 4 minutes

5. Again monitor HR constantly—Record HR each minute for 4 minutes6. Record the final steady state HR for this stage and put into formula

Cooper 12-minute Run Test1. The Cooper is a 12-minute RUN as fast as you can. This is not to be done if you are in the

moderate or high-risk category because it is nearly maximal exertion.

2. Try to maintain a steady pace. 3. Run on a measured track using the following modified procedures:

4. Instead of going exactly 12 minutes, run on a track with a known exact distance (i.e., 400 meters) per lap.

5. Run between 12 and 15 minutes and record how many complete laps you finish and the exact time it took.

6. Calculate the distance covered in meters (i.e., # laps x 400 m/lap). 7. Then estimate velocity by calculating the distance covered / time in minutes and tenths of

minutes. Rockport One-Mile Walk Test

1. The Rockport Test is a one-mile walk as fast as you can without jogging. If you are not walking fast, it won’t be accurate.

2. Make sure you know exactly how far (number of laps) one mile is. 3. You will need to record your time and record your HR immediately after you finish.

4. Remember to convert time to a decimal. 5. Put your data into the equation below.

Test VO2 (ml/kg/min) Mets InterpretationYMCA Cycle Test 36.52 10.4 GoodAstrand Cycle Test 42.45 12.13 GoodYMCA Step Test 34 9.71 GoodCanadian Fitness Step Test 30 8.5 AverageEbbling Treadmill Test 34.38 9.8 AverageCoopers Run Test 37 10.57 GoodRockport Walking Test 45 12.85 High

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Figure 5a. This table shows each submaximal test, its result shown in VO2 and mets, and their corresponding classification.

From each cardiovascular assessment, NoMo’s average predicted VO2 is 37.05ml/kg/min which is classified as good.

YMCA CYCLE ASTRAND YMCA STEP CAFT EBBLING COOPERS ROCKPORT0

5

10

15

20

25

30

35

40

45

50

VO2 (ml/kg/min)

Figure 5b. This graph shows each submaximal test and its VO2 result. The red vertical line represents the average VO2.

After analyzing the results from the submaximal tests, it is noted that the Rockport and the Astrand cycle test are the highest VO2 values and are both 12 mets. Similarly, the YMCA cycle test, YMCA step test, Ebbling test, and Coopers run test are all within 1 met of each other ranging from 9.71 to 10.57 mets. There are a couple of factors that affect these results. The Rockport test is generally for the older population as it is a walking test. It is not uncommon for a younger or fit client to score a high VO2 on that test. Furthermore, the Astrand could have been performed at the beginning of the day and therefore scoring a higher VO2. In terms of the tests within a close met range, the closer the mets are for these tests show validity among the results. This lessons the risk of discrepancies and increases the reliability of the submaximal tests. On the contrary, the YMCA cycle test uses a graph and plots to predict VO2 max. Likewise, the Astrand uses the nomogram to predict VO2 max. These two methods can produce error as it is slightly subjective to the physician. The Coopers test, however, simply has the client run for 12 minutes and uses heart rate and number of laps completed to calculate VO2. I feel this test is the best indication of a client’s VO2 which is 37 ml/kg/min. The average VO2 will be used to for NoMo which is 37.05 ml/kg/min.

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Maximal GRX Interpretation

NoMo made it to stage 4 in the graded maximal exercise test. Her VO2 peak is 3542.5 ml/min, or 43.04 ml/kg/min. This value is NoMo’s VO2 max. The possible criteria for VO2 max include failure of heart rate to increase with increased workload, respiratory exchange ratio greater than 1.12, a plateau in VO2 determined by the failure to increase VO2 by 150ml with increased workload, rate of perceived exertion is greater than 17, heart rate reaches greater than age predicted heart rate max, and lactate values of 8mm, (Lippincott, Williams, & Wilkins p 387). The criteria for NoMo’s VO2 includes oxygen plateau from stages 2 to 3 and 3 to 4, RPE greater than 17 in stage 4, and RER greater than 1.12 in stages 3-4. NoMo’s average predicted VO2 max from her submaximal exercise tests is a lower value than her actual VO2. NoMo’s average predicted VO2 is 37.08ml/kg/min where as her VO2 max is 43.04ml/kg/min. The closest submaximal predicted VO2 was the Astrand test which predicted a VO2 of 42.45ml/kg/min. Therefore the Astrand test was within one met of the graded maximal exercise test concluding that the Astrand was the most accurate in predicting VO2. These discrepancies exist between submaximal predictions and actual VO2 max because of factors that affect heart rate. Air temperature, body position, body size and weight, environment, stress, stimulants and diet can all affect heart rate at any time which allows room for discrepancies among different tests. Another factor that can play a role in variation among VO2 assessments is specificity. This is explicit training to achieve a specific outcome. Training for the Astrand cycle test can improve VO2 for that test, but may fail to achieve a similar value for say the Coopers test. This is because the body becomes accustomed to what it is trained for and will lack where it is not trained.

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Conclusion

Test Result InterpretationHealth Risk Low risk Not at risk for diseaseResting HR 68.1 bpm NormalResting BP 118/74 mmHg NormalBody Composition 30% ObeseMuscular Strength (bench press) 122lbs. ExcellentMuscular Strength (leg press) 228lbs. AverageFlexibility 35cm GoodCardiorespiratory Fitness (max) 43.04ml/kg/min Good

After assessing the values from the blood chemistry, body composition, muscular and flexibility fitness, and cardiorespiratory fitness, client NoMo Phat is a healthy individual. She is at low risk for disease with no signs or symptoms. She has healthy resting values for heart rate and blood pressure. She has good muscular strength for both upper and lower body. She also has good flexibility. Lastly, she has good cardiorespiratory fitness from both her submaximal and maximal exercise tests. This means that NoMo has healthy cardiorespiratory, circulatory and musculoskeletal systems. My only concern is her body composition as it is 30% classified as obese. Her weight is also higher than recommended for her height, which is most likely due to her high body fat percentage. An ideal body composition for NoMo is 24.9%. In conclusion, NoMo is a healthy individual with low risk of disease but a high body fat percentage. She is able to do exercise prescription without concerns for her muscular and cardiorespiratory health.

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References

American College of Sports Medicine. (2013). ACSM's health-related physical fitness assessment

manual. Kaminsky, L. A. (Eds.). Baltimore, MD: Lippincott Williams & Wilkins.

Swan, D.(2015). Blood Pressure, Heart Rate, EKG [powerpoint presentation]. Retrieved from Lecture Notes Online Web site: https://myasucourses.asu.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_298756_1

Swan, D.(2015). Body Composition [powerpoint presentation]. Retrieved from Lecture Notes Online Web site: https://myasucourses.asu.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_298756_1

Swan, D.(2015). Sub-maximal testing [powerpoint presentation]. Retrieved from Lecture Notes Online Web site: https://myasucourses.asu.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_298756_1

Thompson, P. D., & Buchner, D., et. Al. (2003). Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease. AHA Scientific Statement. doi: 10.1161/01.CIR.0000075572.40158.77. Retrieved

from http://circ.ahajournals.org/content/107/24/3109.

17

Appendices

Resting HR from EKG

Box count= 1 + 5 + 5 +5 + 5 + 1 = 22

1500/22= 68bpm

Body Composition Calculations

BMI:

Height= 1.676m

Weight= 82.3kg

BMI= weight / height

BMI= 29.4

Bod pod:

Lohman (5.09/1.0369)-4.65= 0.258 = 25.8%

Japanese native female (4.76/1.0369)-4.28= 0.298= 29.8%

Waist Circumference:

Waist= 30in

Hip= 40.4

= Waist / hip

=0.74

Skinfolds:

Skinfold 7 site (chest, midaxillary, tricep, subscapular, abdominal, suprailium and thigh):

Db = 1.097 – (0.0004697 (7SF)) + (0.00000056 (7SF)2) – (0.00012828 (age))

Db = 1.097 – (0.0004697 (7SF)) + (0.00000056 (7SF)2) – (0.00012828 (age))

Db= 1.03

% Fat= (4.95 / Db) – 4.50 x 100

% Fat= 30.2%

Skinfold 3 site (triceps, thigh and suprailium):

Db = 1.0994921 – (0.0009929 (3SF)) + (0.0000023 (3SF)2) – (0.0001392 (age))

18

Db = 1.0994921 – (0.0009929 (89.9)) + (0.0000023 (8082.01) – (0.0001392 (33))

Db= 1.024

% Fat= (4.95 / Db) – 4.50 x 100

% Fat= 33.3%

Skinfold 3 site (abdomen, triceps and suprailium):

Db = 1.089733- (0.0009245 (3SF)) + (0.0000025 (3SF)2) – (0.0000979 (age))

Db = 1.089733- (0.0009245 (70.9)) + (0.0000025 5026.81) – (0.0000979 (33))

Db= 1.033

% Fat= (4.95 / Db) – 4.50 x 100

% Fat= 29%

Relative Weight:

Small frame (120 +133) / 2 = 126.5

181/126.5= 1.43

Ball and Swan:

(triceps, suprailiac and thigh)

%BF = -9.606 + 0.435(3SF) - 0.001429(3SF)2 + 0.153(hip) + 0.07292(age)

%BF = -9.606 + 0.435(89.9) - 0.001429(8082.01) + 0.153(102.5cm) + 0.07292(33)

%BF= 35.96%

Underwater weighing:

mass (on land)/

{mass (land) - mass(in water) - (RV + .1)

Density of water}

(82.3kg)/

{(82.3kg) – (1.88kg) - (1.14 L + .1)

0.9967kg/L}

Db= 1.034

19

% Fat= (4.95 / Db) – 4.50 x 100

% Fat= 26.4%

Prediction of aerobic capacity

Ebbling

VO2= 15.1 + 21.8(spd)-0.327(HR) - 0.263(spd x age) + 0.00504(HR x age) + 5.98(sex)

VO2= 15.1 + 21.8(3)-0.327(125) - 0.263(3 x 33) + 0.00504(125 x 33) + 5.98(0)

VO2= 34.378 ml/kg/min

Astrand

HR= 135

Intensity= 720kpm/min

VO2= 3.9 L

VO2= 3.9L x age correction factor x 1000/body weight (kg)

VO2= 3.9 x 0.896 x 1000/ 82.3kg

VO2= 42.45ml/kg/min

YMCA Cycle

VO2 max workrate= 1350kpm/min

VO2= (1.8 x workrate) / bodyweight (kg) + 7

VO2= (1.8 x 1350) / 82.3kg + 7

VO2= 36.526ml/kg/min

Cooper

13 min + 12/60seconds = 13.2

2400m/13.2min= 181.81m/min

VO2= 0.268 x m/min – 11.3

VO2= 0.268 x 181.81m/min – 11.3

VO2= 37ml/kg/min

Rockport

20

14 + 26/60=14.43minutes

VO2= 132.853 - 0.0769(wt) - 0.3877(age) + 6.315(sex) - 3.2649(time) - 0.1565(HR)

VO2= 132.853 - 0.0769(82.3kg) - 0.3877(33) + 6.315(0) - 3.2649(14.43) - 0.1565(138)

VO2= 45ml/kg/min

Intensity

Intensity = (Exercise Heart Rate) - (Resting Heart Rate)

(Maximal Heart Rate) - (Resting Heart Rate)

Intensity= (149 – 68.1) / (187- 68.1) = 0.68

Max = Exercise Workrate / Intensity

VO2= 2.9 mets / .68 = 4.26 x 3.5

VO2= 14.92 ml

Slope

b = (SM2 - SM1) < from ACSM equations

(HR2- HR1) <from steady state HR

b= (3.3-2.5) / (153-145) = 0.1

VO2 max = SM2 + b(HRmax - HR2)

VO2 max = 3.3 + .1 (187-153) = 6.7 mets x 3.5

VO2= 23.45ml/kg/min

21

Astrand Age Correction Graph & Nomogram

22

AgeCorrection

Factor AgeCorrection

Factor14 1.11 40 0.83015 1.10 41 0.82016 1.09 42 0.81017 1.08 43 0.80018 1.07 44 0.79019 1.06 45 0.78020 1.05 46 0.77421 1.04 47 0.76822 1.03 48 0.76223 1.02 49 0.75624 1.01 50 0.75025 1.00 51 0.74226 0.987 52 0.73427 0.974 53 0.72628 0.961 54 0.71829 0.948 55 0.71030 0.935 56 0.70431 0.922 57 0.69832 0.909 58 0.69233 0.896 59 0.68634 0.883 60 0.68035 0.870 61 0.67436 0.862 62 0.66837 0.854 63 0.66238 0.846 64 0.65639 0.838 65 0.650

YMCA Cycle Test

YMCA Cycle Protocols

23

150 300 450 600 750 900 1050 1200 1350 1500 1650 1800 1950 210090

100110120130140150160170180190200210

Hea

r Rat

e (b

pm)

Kgm.min-1

YMCA Cycle Test

HRHRHR > 100HR < 80

600750 kgm.min-1

450600 kgm.min-1

450 kgm.min-1

300

900

750

kgm.min-

600 kgm.min-1

900 kgm.min-1

1050

750 kgm.min-1

Stage 2

Stage 4

Stage 3

Initial Stage

CAFT Table 1: Stage

AGE MEN WOMEN

60-69 1 1

50-59 2 1

40-49 3 2

30-39 4 3

20-29 5 3

15-19 5 4

CAFT Table 2: Cadence

STAGE MEN WOMEN

1 66 66

2 84 84

3 102 102

4 114 114

5 132 120

6 144 132

7 156 --

CAFT Table 3: HR after stages

AGE After 1st Session After 2nd Session

60-69 24 --

50-59 25 23

40-49 26 24

30-39 28 25

20-29 29 26

24

15-19 30 27

CAFT Table 4: VO2 value

STAGE MEN WOMEN

1 1.1391 0.9390

2 1.3466 1.0484

3 1.6250 1.3213

4 1.8255 1.4925

5 2.0066 1.6267

6 2.3453 1.7867

7 2.7657 ---

CAFT Stepping Sequence

25

Women’s VO2 Standards

Men’s Vo2 Standards

Age Low Fair Average Good High20-29 <25 25-33 24-42 43-52 53+30-39 <23 23-30 31-38 39-48 49+40-49 <20 20-26 27-35 36-44 45+50-59 <18 18-24 25-33 34-42 43+60-69 <16 16-22 23-30 31-40 41+

26

Age Low Fair Average Good High20-29 <24 24-30 31-37 38-48 49+30-39 <20 20-27 28-33 34-44 45+40-49 <17 17-23 24-30 31-41 42+50-59 <15 15-20 21-27 28-37 38+60-69 <13 13-17 18-23 24-34 35+