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HEALTH APPRAISAL/FITNESS TESTING

HEALTH APPRAISAL/FITNESS TESTING. Basic Procedures. 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.

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HEALTH APPRAISAL/FITNESS TESTING

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  1. HEALTH APPRAISAL/FITNESS TESTING

  2. Basic Procedures • 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…)

  3. 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.

  4. 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

  5. Components of the Informed Consent • Inquiries • Freedom of consent • Explanation of voluntary nature of testing • Confidentiality

  6. Informed Consent • Specificity • Any questions should be answered prior to signing • A signed informed consent form does not absolutely absolve you from legal responsibility for untoward events

  7. The Physical Activity Readiness Questionnaire (PAR-Q) Designed for screening of apparently healthy individuals beginning an exercise program of moderate intensity (40 - 60% VO2max)

  8. CAD Risk Factor Analysis • 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

  9. 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

  10. Components of the Health Fitness Questionnaire • Medications, drug allergies • Other habits (tobacco, alcohol, recreational drugs) • Exercise history • Work history • Family history

  11. Blood Profile

  12. Resting Values Blood pressure • Resting Diastolic 60-80 mmHg • Resting Systolic 110-140 mmHg • Heart rate • Measured by palpation, HR monitor, ECG • Avg. = 72 bpm but may be elevated due to pretest anxiety

  13. Resting Values • ECG • Resting ECG may not indicate what could happen during exercise.

  14. Environmental and Laboratory Concerns • Equipment must be well maintained and regularly calibrated • Testing equipment must be able to provide a wide range of intensities so that testing can be tailored to clients/patients

  15. Environmental and Laboratory Concerns Testing area must be environmentally controlled • 68O – 72O F • < 60% relative humidity • well-ventilated

  16. 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

  17. 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

  18. The Fitness Assessment Pulmonary Measures Pulmonary function is not normally a limiting factor in aerobic/functional capacity

  19. 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

  20. 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

  21. 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

  22. 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.

  23. 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

  24. 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)

  25. The Fitness Assessment Body Composition Assessment procedures: • Hydrostatic weighing – the gold standard • Bio-electrical impedance • Circumference measures - WHR • Skinfolds • BMI

  26. 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

  27. The Fitness Assessment Dynamic Strength Assessments: • 1 RM protocols • Specific to muscle group tested. • Submaximal repetition testing • Adds an endurance component • Normative values • Guidelines pages 81-86 • Heyward – Chapter 6

  28. 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

  29. The Fitness Assessment Assessment of flexibility • Sit and reach test lacks specificity and validity • Norms for sit and reach test

  30. The Fitness Assessment Assessment of Aerobic Capacity • Field tests • quick, easy, cheap • best for young healthy individuals i.e., PE classes • maximum effort? • environment? • cardiovascular/hemodynamic responses? • accuracy?

  31. The Fitness Assessment • Step tests • also quick, easy and cheap • cardiovascular/hemodynamic responses? • accuracy? • 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?

  32. The Fitness Assessment • 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. • Normative data in Guidelines (p. 77)

  33. 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)

  34. The Fitness Assessment Signs of exercise intolerance: (Box 4-5, 5-3) • HR response • BP response • Hyperventilation • Muscular fatigue • Dizziness, lightheadedness, incoherence • Volitional exhaustion • Cyanosis, pallor • Nausea • Inability to sustain workload • Chest pains

  35. The Fitness Assessment Legal Implications • There should be a written plan for emergency procedures: • Defines personnel responsibilities • Sets requirements of emergency training • Well-documented

  36. The Fitness Assessment • Nutritional Assessment • Weight Management

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