Chapter 6 Fitness Assessment:

This is going to be a very important chapter to know as a lot of test question will be taken from this chapter.

• Table 6.1 Guidelines for Health and Fitness Professionals
• Figure 6.1 Subjective vs. Objective information
• Figure 6.2 Sample Physical Activity Readiness Questionnaire
• Figure 6.3 Sample questions: client occupation
• Figure 6.4 Sample questions: client lifestyle
• Figure 6.5 Sample questions: client medical history
• Table 6.2 Common medications by classification
• Table 6.3 Effects of medication on heart rate and blood pressure
• Heart rate and blood pressure assessments
• Table 6.4 Target heart rate training zones
• Max Heart Rate formula (straight percentage method) for each zone
• Body Composition Assessments
• Circumference measurements
• Body Mass Index
• YMCA 3-minute step test
• Rockport Walk Test
• Table 6.9 Pronation Distortion Syndrome
• Table 6.10Lower Crossed Syndrome
• Table 6.11Upper Crossed Syndrome
• Be familiar with all of the assessment protocols and for the posture assessments all compensations

 

Subjective Information Provided in the Fitness Assessment

Preparticipation Health Screening

• Subjective information is gathered from a propsective client to give the personal trainer feedback regarding personal history – such as occupation, lifestyle, and medical background.
• Use medical history questionnaire and classify clients as:
• Low risk – No signs or symptoms of cardiovascular, pulmonary, or metabolic disease and have <1 cardiovascular risk factor.
• Moderate risk – Do not have signs or symptoms of cardiovascular, pulmonary, or metabolic disease but have >2 cardiovascular disease risk.
• High risk – One or more signs of cardiovascular, pulmonary, or metabolic disease

Physical Activity Readiness Questionnaire

• Designed to determine the safety or possible risk of exercising for a client based on answers to specific health history questions.
• Aimed at identifying individuals who require further medical evaluation before being allowed to exercise.
• When client answers yes to one or more questions then PT should refer client to physician.

General Health History

• Health History is collection of info that is generally part of medical physical or medical health history, discusses relevant facts about individual’s history, including biographic, demographic, occupational, and lifestyle.
• Focus on answers for occupation and general lifestyle traits.
• Occupation – determine common movement patterns, as well as typical energy expenditure levels.

 

• Extended periods of sitting means hips are flexed for long periods of time, lead to tight hip flexors and postural imbalances. Tendency for shoulders and head to fatigue, lead to postural imbalances including rounding of shoulders and a forward head.
• Repetitive movements can create pattern overload to muscles and joints. Working with arms overhead for long periods may lead to shoulder and neck soreness and tightness of lats and weakness in rotator cuff.
• Dress shoes put ankle complex in plantarflexed positions for long periods, lead to tightness in gastrocnemius, soleus, and achilles’ tendon, causing postural imbalance such as decreased dorsiflexion and overpronation of foot and ankle complex, resulting in flattening of the arch of the foot.

 

• Mental stress can elevate resting heart rate, blood pressure, and ventilation at rest and exercise. Lead to abnormal breathing patterns that may cause postural or musculoskeletal imbalances in the neck, shoulder, chest, and low-back muscles.

 

Medical History

• Vitally important because it provides PTs with info about known or suspected chronic diseases, such as coronary heart disease, high blood pressure, or diabetes.

 

Past Injuries

• All past or recent injuries should be recorded and discussed in sufficient detail to be able to make decisions about whether exercise is recommended or medical referral is necessary.
• Previous history of musculoskeletal injury is also strong predictor of future musculoskeletal injury during physical activity.
• Ankle sprains – decrease neural control of glueteus medius and gluteus maximus muscles, in turn lead to poor control of lower extremities during many functional activities, which can eventually lead to injury.
• Knee injuries involving ligaments: Knee injury can cause decrease in neural control to muscles that stabilize the patella(kneecap) and lead to further injury. Knee injuries that are not result of contact are often result of ankle or hip dysfunctions, such as result of ankle sprain.
• Low-back injuries – cause decreased neural control to stabilizing muscles of the core, resulting in poor stabilization of the spine. Can lead to further dysfunction in the upper and lower extremities.
• Shoulder injuries – cause altered neural control of rotator cuff muscles, which can lead to instability of shoulder joint during functional activities.

Past Surgeries

• Surgical procedures create trauma for body. Surgery will cause pain and inflammation that can alter neural control to affected muscles and joints if not rehabilitated properly.

Chronic Conditions

• Estimated more than 75% of American adult population does not engage in at least 30 minutes of low-to-moderate.
• Chronic conditions – cardiovascular disease, hypertension(high blood pressure), high cholesterol, stroke, peripheral artery disease, lung or breathing problems, obesity, diabetes, cancer.

 

 

Objective Information Provided in Fitness Assessment

• Physiological measurements
• Body composition assessments
• Cardiorespiratory assessments
• Static posture assessment
• Movement assessments
• Performance assessments

Heart Rate and Blood Pressure Assessment

• Resting heart rate and BP is sensitive indicator of client’s overall cardiorespiratory health as well as fitness status. Resting HR is fairly good indicator of overall cardiorespiratory fitness, where as exercise HR is strong indicator of how a client’s cardiorespiratory system is responding and adapting to exercise.
• Pulse – Most common sites used are radial and carotid arteries.
• Preferred to record HR with radial(inside wrist).
• Instruct clients to rise three mornings in a row and test resting HR, average those 3 readings.

 

Calculating Target Heart Rate

Straight Percent Method

• Straight Percentage Method – Subtracting age from 220 = MAX HR. Multiply HRmax by appropriate intensity(65 to 95%).
• Zone one – HRmax X .65 to .75
• Zone two – HRmax X .76 to .85
• Zone three – HRmax X .86 to .95

Heart Rate Reserve Method(HRR)

• Karvonen method, method of establishing training intensity on the basis of difference between a client’s predicted maximal HR and their resting HR.
• HR and oxygen uptake are linearly related during exercise, selecting predetermined training or THR based on given percent of oxygen consumption is most common and universally accepted method of establishing exercise training intensity.
• HRR is: THR = [(HRmax – HRrest) x desired intensity] + HRrest

Blood Pressure

• BP is pressure of the circulating blood against the walls of the blood vessels after blood is ejected fromt he heart. Two parts of a blood pressure measurement. First(top) is systolic, represents pressure within arterial system after heart contracts. Second(bottom) is diastolic, and it repesents pressure within arterial system when heart is resting and filling with blood.
• Ex. 120/80 120 systolic 80 diastolic.
• Acceptable systolic is less than 120 and acceptable diastolic is less than 80.
• Instruct client to assume comfortable position, place appropriate cuff on clients arm just above elbow. Inflate cuff to 20-30mm Hg above point at which pulse can no longer be felt. Release pressure at a rate of 2mm Hg per second, listening for pulse. Systolic pressure is first observation of pulse, diastolic is determined when pulse fades away. For greater reliability repeat on opposite arm.

Body Composition

• Refers to relative percentage of body weight that is fat versus fat-free tissue. Fat free mass includes muscles, bones, water, connective and organ tissues. Fat is essential and nonessential(adipose tissue).
• Skinfold measurement – uses calipers
• Bioelectrical impedance – portable instrument to conduct electrical current through body to estimate fat. Hypothesis that tissues that are higher in water conduct electrical currents with less resistance than those with little water(like adipose tissue).
• Underwater weighing – hydrostatic weighing, most common technique. Because bone and muscle are desner than water, person with larger percentage of lean body mass will weigh more in the water.

Skinfold Measurements

• Train with individual skilled in SKF and frequently compare results
• Take minimum of two measurements at each site, each site must be within 1 to 2mm to take average at each site.
• Open jaw of caliber before removing from site.
• Be meticulous when locating anatomic landmarks.
• Do not measure SKFs immediately after exercise.
• Instruct clients ahead of time regarding test protocol.
• Avoid performing SKFs on extremely obese clients.

Calculating Body Fat Percentage

• NASM uses Durnin formula to calculate client’s percentage of body fat. Four site skinfold measurement.
• Biceps – Vertical fold on front of the arm over biceps muscle, halfway between shoulder and elbow.
• Triceps – vertical fold on back of upper arm, with arm relaxed and held freely at the side, skin fold taken halfway between shoulder and elbow
• Subscapular – 45 degree angle fold or 1 to 2cm, below inferior angle of scapula.
• Iliac crest – 45 degree angle fold, taken just above iliac crest and medial to the axillary line.
• All skinfold measurements should be taken on the right side of the body. After four sites have been measured, add totals of four sites, find appropriate sex and age category.

Circumference Measurements

• Measure of the girth of body segments(arm, thigh, waist, and hip)
• Affected by both fat and muscle, does not provide accurate estimate of fatness in general pop.
• Some uses: can be used on obese clients, good for comparisons and progressions, good for assessing fat pattern and distribution, inexpensive, easy to record
• Neck – across adam’s apple
• Chest – across nipple line
• Waist – narrowest point of waist, below rib cage, above top of hip bones
• Hips – feet together, circumference at widest portion of buttocks
• Thighs – measure 10 inches above top of patella(knee bone)
• Calves – At maximal circumference between ankle and knee
• Biceps – Maximal circumference of biceps, measure with arm extended, palm facing forward

Waist to Hip Ratio

• Most used clinical applications of girth measurements. Important because correlation between chronic diseases and fat stored in midsection. 
• Waist to hip ratio can be computed by dividing waist measurement by the hip measurement.

Body Mass Index

• Rough assessment based on concept that a person’s weight should be proportional to their height. 
• BMI = Weight(kg) / Height (m^2)
• BMI = [Weight(lbs)/Height (inch^2)]x703
• Lowest risk for disease lies within BMI range of 22 to 24.9

Cardiorespiratory Assessments

YMCA 3-Minute Step Test

• Designed to estimate individual’s cardiorespiratory fitness level on the basis of a submaximal bout of stair climbing at a set pace for 3 minutes.
• Step one – perform 3-minute step test by having client perform 24 steps per minute on 12 inch step for total of 3 minutes, roughly 96 steps total. Important that client performs steps with correct cadence.
• Step two – Within 5 seconds of completing exercise, client’s resting heart rate is measured for period of 60 seconds and recorded as recovery pulse.
• Step three – locate recovery pulse number in one of following categories.
• Step four – determine appropriate starting program using appropriate category. Poor Zone one(65-75%), Fair Zone one(65-75%), Average Zone Two(76-85%), Good Zone two(76-85%), Very good zone three(86-95%)
• Step five – determine client’s maximal heart rate by subtracting client’s age from the number 220 (220-age), then take maximal heart rate and multiply by zones to determine heart rate ranges for each zone.

Rockport Walk Test

• Designed to estimate cardiovascular starting point. Starting point is then modified baed on ability level.
• Step one – Record client’s weight. Have client walk one mile, as fast as he or she can control, on treadmill. Record time. Immediately record client’s heart rate at the 1 mile mark.
• Weight in lbs, gender male = 1, female = 0, time expressed in minutes and 100th of minutes, HR is beats per minute, age is years.

Posture and Movement Assessments

Importance of Posture

• Neuromuscular efficiency is ability of nervous system and musculature system to communicate properly producing optimal movement. Proper postural alignment allows optimal neuromuscular efficiency, helps produce effective and safe movement.
• Proper posture ensures muscles of the body are aligned at the proper length-tension relationships necessary for efficient functioning of force-couples. Proper posture will keep muscles at proper length, allowing muscles to properly work together, ensuring proper joint motion, maximizing force production, and reducing risk of injury.
• Static posture – how individual physically presents himself can be considered base from which an individual moves. Reflected int he alignment of the body.
• Janda identified three basic compensatory patterns. Suggested cascading effect of alterations or deviations in static posture that could more likely than not present themselves in a particular pattern.
• Pronation distortion syndrome – postural distortion syndrome characterized by foot pronation(flat feet) and adducted and internally rotated knees(knock knees)
• Lower crossed syndrome – postural distortion syndrome characterized by anterior tilt to the pelvis(arched lower back)
• Upper crossed syndrome – postural distortion syndrome characterized by a forward head and rounded shoulders

 

 

Static Postural Assessment

• One should be checking for neutral alignment, symmetry, balanced muscle tone, and specific postural deformities.
• Kinetic chain checkpoints refer to major joint regions of the body including – Foot and ankle, knee, lumbo-pelvic-hip complex (LPHC), shoulders, head and cervical spine
• Anterior View:
  • Foot/ankles – straight and parallel, not flattened or externally rotated
  • Knees – In line with toes, not adducted or abducted
  • LPHC – Pelvis level with both posterior superior iliac spines in same transverse plane
  • Shoulders – Level, not elevated or rounded
  • Head – Neutral position, not tilted or rotated
• Lateral View:
  • Foot/ankle – Neutral position, leg vertical at right angle to sole of foot
  • Knees – Neutral position, not flexed nor hyperextended
  • LPHC – Pelvis neutral position, not anterioly (lumbar extension) or posterioly (lumbar flexion) rotated
  • Shoulders – Normal kyphotic curve, not excessively rounded
  • Head – Neutral position, not in excessive extension (jutting forward)
• Posterior View
  • Foot/ankle – Heels are straight and parallel, not overly pronated
  • Knees – Neutral position, not adducted or abducted
  • LPHC – Pelvis is level with both posterior superior iliac spines and in same transverse plane
  • Shoulders/scapulae – Level, not elevated or protracted
  • Head – Neutral position, neither tilted nor rotated

Overhead Squat Assessment

• Designed to assess dynamic flexibility, core strength, balance, and overall neuromuscular control. Shown to reflect lower extremity movement patterns during jump-landing tasks. Knee valgus(knock-knees) during overhead squat test is influenced by decreased hip abductor and hip external rotation strength, increased hip adductor activity, and restricted ankle dorsiflexion. 
• 1. Client stands with feet shoulders width apart and pointed straight ahead. Foot and ankle complex should be in a neutral position. Assessment performed with shoes off to better view foot and ankle complex.
• 2. Have client raise his or her arms overhead, with elbows fully extended.
• Movement – Instruct client to squat roughly to height of chair seat and return to starting position. 2. Repeat movement for 5 reps, observe frome ach position(anterior and lateral)
• Views – View feet, ankles, and knees from front. Feet should remain straight with knees tracking in line with foot. View lumbo-pelvic-hip complex, shoulder, and cervical complex from side. Tibia s hould remain in line with torso while arms also stay in line with torso.
• Compensations Anterior View – Feet, do feet flatten and/or turn out? Knees, do knees move inward(adduct and internally rotate)
• Compensations Lateral View – Lumbo-pelvic-hip complex – does the low back arch? Does the torso lean forward excessively? Shoulders: do the arms fall forward?

Single Leg Squat Assessment

• Transitional movement assessment also assesses dynamic flexibility, core strength, balance, and overall neuromuscular control.
• Reliable and valid measure of lower extremity movement patterns when standard application protocols are applied.
• Position – Client should stand with hands on hips and eyes focused on object straight ahead. Foot should be pointed straight ahead, and foot, ankle, and knee and lumbo-pelvic-hip complex should be in neutral position
• Movement – Have client squat to a comfortable level and return to starting position. Perform up to 5 repetitions before switching sides.
• Views – View knee from the front. Knee should track in line with the foot.
• Compensation – Does knee move inward(adduct and internally rotate?)

Pushing Assessment

• Like overhead and single leg squat assessments, this assesses efficiency and potential muscle imbalances during pushing movements.
• Position – Instruct client to stand with abdoment drawn inward, feet in a split stance and toes pointing forward
• Movement – Viewing from the side, instruct client to press handles forward and return to the starting position. Perform up to 20 repetitions in a controlled fashion. Lumbar and cervical spines should remain neutral while shoulders stay level.
• Compensations – Low back – does low back arch? Shoulders – do the shoulders elevate? Head – does the head migrate forward?

Pulling Assessment

• To assess movement efficiency and potential muscle imbalances during pulling movements
• Position – Stand with abdomen drawn inward, feet shoulders-width apart and toes pointing forward
• Movement – Viewing from side, instruct client to pull handles toward the body and return to starting position. Like pushing assessment lumbar and cervical spines should remain neutral while shoulders stay level.
• Compensations – Low back – does low back arch? Shoulders – Do shoulders elevate? Head – Does head migrate forward?

Davies Test

• Measures upper extremity agility and stabilization.
• Two pieces of tape, 36 inches apart. Client assumes push-up position. Alternating touch on each side for 15 seconds.

Chapter 4 Exercise Metabolism and Bioenergetics:

Be Familiar with all definitions throughout the chapter

Bioenergetics and Metabolism

• Bioenergetics – Study of energy in the human body. 
• Metabolism – All of chemical reactions that occur in the body to maintain itself. Metabolism is process in which nutrients are acquired, transported, used, and disposed of by the body. 
• Exercise Metabolism – Examination of bioenergetics as it relates to unique physiologic changes and demands placed on the body during exercise.
  

Fuel for Energy Metabolism

• Substrates – Material or substance on which enzyme acts. Proteins, carbs, fats are main substrates used to transfer metabolic energy to be used for all types of cellular activity and life.
  
• Carbohydrates – Organic compounds of carbon, hydrogen, oxygen which include starches, cellulose, and sugars. Important source of energy. All carbs broken down into glucose(simple sugar). 
• Glucose – Absorbed and transported in the blood. Simple sugar manufactured from carbs, fat, and lesser extent protein.
• Glycogen – Complex carb molecule used to store carbs in liver and muscle cells. When carb energy is needed, glycogen is converted into glucose for use by muscle cells.
• Fat – Helps the body use vitamins and keep skin healthy, serve as energy stores for the body. Two types of fats in food saturated and unsaturated.
• Triglycerides – Chemical substrate form in which most fat exists in food as well as in the body.
• Protein – Amino acids linked by peptide bonds, which consist of carbon, hydrogen, nitrogen, oxygen, and usually sulfur. Protein rarely supplies much energy during exercise, ignored as significant fuel for energy metabolism. Protein becomes significant source of fuel during starvation.
• Gluconeogensis – Formation of glucose from noncarbohydrate sources, such as amino acids.

Energy and Muscle Contraction

• Adenosine Triphosphate – Energy storage and transfer unit within the cells of the body. When chemical bonds holding ATP are broken, energy is released for cellular work(such as muscle contraction), breaking the bond leaves behind molecule called adenosine diphosphate (ADP).
  
• Adenosine Diphosphate – High-energy compound occuring in all cells from which ATP is formed. Free energy is harnessed, used to attach phosphate group to an ADP and retore ATP levels back to normal to perform more work.
• Energy is used to form myosin-actin cross-bridges that faciliate muscle contraction. Cross-bridges is an enzyme that separates phosphate from ATP, releasing energy. Energy is needed to allow cross-bridge to ratchet thin actin filament toward center of sarcomere. Once that process is complete another ATP is needed. For one cycle of a cross-bridge two ATPs are needed.

Energy and Mechanical Work

• Any form of exercise can be defined by intensity and duration. 
• 40% of energy released from ATP is actually used for cellular work, remainder is released as heat.
• ATP = ADP + Pi + Energy release
• Phosphorylation – process of adding phosphate group onto ADP to create ATP
• Three metabolic pathways cells can use to generate ATP – 1. ATP-PC system, 2. Glycolytic system(glycolysis), 3. Oxidative system(oxidative phosphorylation)
• ATP-PC System – Transfers phosphate group from another high energy molecule called phosphocreatine(PC or CP) to ADP molecule enough energy can be produced to faciliate one cross-bridge cycle. ATP and PC are called phosphagens. Creating new ATP from phosphocreatine molecule(ATP-PC system) is simplest and fastest way. Occurs without presence of oxygen(anaerobic). Only supplies energy for 10-15 secs before exhausted, this system is activated at onset of activity regardless of intensity.
• Glycolysis – The other anaerobic means of producing ATP. Chemical breakdown of glucose. Anaerobic glycolysis. Glucose or glycogen must be converted to glucose-6-phosphate before it can generate energy. Conversion of glucose to glucose-6-phosphate takes 1 ATP molecule, with glycogen it does not. Glucose and glycogen are broken down into pyruvic acid(aerobic glycolysis) or lactic acid(anaerobic glycolysis). 2 ATP for each mole or unit of glucose and 3ATP for each unit of glycogen. This system can produce significantly greater amount of energy than ATP-PC system, it too is limited to approximately 30 to 50 seconds of duration.
• Oxidative System – Most complex of three energy systems. Uses substrates with aid of oxygen to generate ATP. Three oxidative systems include aerobic glycolysis, krebs cycle, elecron transport chain(ETC).
• B-oxidation – Breakdown of triglycerides into smaller subunits called free fatty acids(FFAs) to convert FFAs into acyl-CoA molecules, which then are available to enter the Krebs cycle and ultimately lead to the production of additional ATP. 

Energy During Exercise

• Most important factor regulating energy utilization during exercise is the intensity and duration of exercise. 
• After 90 mins of exercise majority of muscle glycogen stores are depleted.

Metabolism during Steady-State Exercise

• Excess Postexercise Oxygen Consumption(EPOC) – State in which the body’s metabolism is elevated after exercise. Energy demands fall back to baseline after exercise but oxygen consumption remains elevated for short period to keep generating ATP aerobically, this is the EPOC. ATP Above and beyond what is needed for recovery is produced to help reestablish baseline levels of ATP and PC and assist in clearing metabolic end products(like lactic acid).
  

Metabolism during Intermittent Work

• Most of energy comes from anaerobic metabolism. When intensity is decreased there is a continued period of high, but briefly elevated oxygen consumption. If high intensity work is short, fueld by ATP-PC, then recovery period if brief. Recovery of ATP-PC cycle is complete in 90 seconds. If period of high intensity work is longer recovery period will take longer. 

 

The Myth of the Fat Burning Zone

• Even though a RQ of .8 results in 67% of energy coming from fat and 33% from carbs, you’re only expending 4.8 cals per minute equaling 3.2 from fat. If you double intensity to RQ of .86, 54% of energy comes from fat. But 9.75 cals are expended per minute, thus more cals from fat are still expended even though fat burning % is lower.