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Principles of fitness assessment student

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  • If you come into my office, and I have never met or spoken with you, I have no idea what you need, want, in terms of activity, exercise or fitness. To do this I need to learn more about you, your health, goals,
  • Purpose of an exercise prescription
  • Intensity more problematic than liking exercise equipment/machine/mode
  • Pros cons
  • Age: Men > 45 y.o.; Female > 55 y.o. 2. Cigarette smoking: Current cigarette smoker, OR those who quit within the previous 6 months, OR exposure to environmental tobacco smoke 3. Obesity: BMI of > 30 kg/m 2 , OR Waist girth of: > 102 cm (40 in) for men & > 88 cm (35 in) for women 4. Dyslipidemia: LDL-C > 130 mg/dL OR HDL < 40 mg/dl OR on lipid lowering medications If TC only measure available: TC > 200 mg/dL Family History: MI, coronary revascularization, or sudden death < 55 years of age in father or other male first-degree relative (brother or son), OR < 65 years of age in mother or other female first-degree relative (sister or daughter) 6.Impaired glucose (pre-diabetes): Impaired fasting glucose: > 100mg/dL but < 126 mg/dL OR Impaired glucose tolerance: > 140 mg/dL but <200mg/dL *both confirmed by measurements on at least 2 separate occasions 7. Sedentary lifestyle: Not participating in at least 30 minutes of moderate intensity physical activity on at least 3 days/week for at least 3 months 8. Hypertension: Blood pressure ≥140/90 mmHg, confirmed by measurements on at least 2 separate occasions, OR on antihypertensive medication
  • A CODFISH
  • Low Risk: Asymptomatic men and women who have < 1 CVD risk factor from Table 2.3 Moderate Risk Asymptomatic men and women who have > 2 CVD risk factors from Table 2.3 High Risk Individuals who have know CVD, pulmonary, or metabolic disease OR 1 or more signs and symptoms listed in Table 2.2
  • Girth measurements : Useful for obese people who may be uncomfortable with skinfold measurements or underwater weighing. Pattern of BF distribution imp. predictor of health risks of obesity
  • Estimated vs. actual Submaximal and maximal Graded exercise tests (GXTs) Field tests Maximal testing in clinical setting To aid in the diagnosis of CVD in moderate risk individuals or in those who are symptomatic To determine the safety of an exercise program To follow the progress of known disease To find the true max. HR for exercise prescription To measure or estimate VO2 max. To help plan a safe and effective exercise program Submax Evaluate progress and provide feedback. Use as a basis for educating clients about concepts of fitness. MAY provide a basis for exercise prescription. Sub-max. cycle ergometer test (Astrand-Rhyming or YMCA Protocol): Used to estimate VO 2 max. from heart rate at a sub-max. workload. 2. Step test: Can estimate VO 2 max. from heart rate achieved after stepping for 3 minutes. 3. Cooper’s 1.5 mile or 12 minute run Can estimate VO 2 max. from time for 1.5 mile run or distance completed in 12 minutes. 4. Rockport 1 mile walk test: Can estimate VO 2 max. from heart rate after walking 1 mile.
  • Muscle strength Max force or tension Muscle endurance Maintain submax force over time
  • Test of trunk flexion, measures low back & hip flexibility, common measure of overall flexibility.
  • Test may have high reliability but not high validity – sit and reach test – poor validity as a measure of lower back flexibility
  • Not interested in activities Don’t understand prescription Changes in health status No time! Overweight Smoker Personality factors such as anxiety & low self efficacy No spousal support Inconvenient exercise facilities No social support Not seeing improvement
  • Support of family & friends Doctor’s recommendation Convenient facilities, parking Non-threatening environment (dress etc.) Individualized program Personal attention Positive feedback (BP, assessments) Presence of successful peer role models Incentives Enjoy activities Improvement in health statu
  • Work a lot harder for less change as you get closer to genetic ceiling
  • Sonia Sotomayor
  • Transcript

    • 1. Exercise Programming: From Initial Screening(s) and Baseline Assessments to the Exercise Prescription
    • 2. Fitness/Wellness Specialist Responsibilities • Educate clients • Conduct pretest health evaluationsConduct pretest health evaluations • Select, administer, interpret tests to assessSelect, 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!
    • 3. 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 and Prescription, 2000, pg 140
    • 4. Exercise Programming and Prescription Definition:
    • 5. Elements of Exercise Prescription FITT-P
    • 6. Exercise Prescription vs. Health Related Fitness
    • 7. 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
    • 8. Why do we care about health screening and risk stratification?
    • 9. 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
    • 10. 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)
    • 11. 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
    • 12. CVD Risk Factor Thresholds for Use with ACSM Risk Stratification •Positive and Negative Risk Factors (Table 2.2, p. 27, ACSM)
    • 13. CVD Risk Factor Thresholds for Use with ACSM Risk Stratification Positive Risk Factors (Table 2.2, p. 27, ACSM)
    • 14. CVD Risk Factor Thresholds for Use with ACSM Risk Stratification Positive Risk Factors (Table 2.2, p. 27, ACSM)
    • 15. 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 lb Height 5 ft. 9 in. What is the client’s BMI classification?
    • 16. BMI Classification
    • 17. Hypertension
    • 18. 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
    • 19. HDL–C Classification Classification HDL-C Low Normal High (this is good!)
    • 20. Fasting Blood Glucose From 70 to 99 mg/dL From 100 to 125 mg/dL >126 mg/dL on more than one test
    • 21. CVD Risk Factor Thresholds for Use with ACSM Risk Stratification Negative Risk Factors (Table 2.2, p. 27, ACSM)
    • 22. How do I remember all of those risk factors?
    • 23. 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
    • 24. • 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.
    • 25. 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 medicine, levothyroxine sodium (Synthroid, Levoxyl, or Levothroid)
    • 26. 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
    • 27. Medications Meds HR BP Beta Blocker Nitrate Calcium Channel Blocker Diuretics Ace Inhibitors Bronchodilators Thyroid meds Nicotine
    • 28. Table 2.1 ACSM Risk Stratification Categories for Atherosclerotic CVD (Figure 2.4 ACSM p. 28)
    • 29. • 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!
    • 30. 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
    • 31. ACSM Figure 2.3
    • 32. 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
    • 33. Exercise Testing and Participation Recommendation Based on Risk • Once risk classification established, appropriate recommendations may be made regarding:
    • 34. 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)
    • 35. Submaximal Exercise Tests
    • 36. • 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?
    • 37. Metabolic Syndrome
    • 38. >100
    • 39. 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
    • 40. 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
    • 41. Components of Health Related Fitness 1. Body weight and body composition 2. Cardiorespiratory Endurance (Fitness) 3. Muscular Endurance 4. Muscular Strength 5. Flexibility
    • 42. Measures of Weight or Body Comp. Anthropometric measures:
    • 43. 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
    • 44. Musculoskeletal Fitness • Ability of skeletal muscle systems to perform work • Muscle strength • Muscle endurance
    • 45. Muscular Strength Testing  Grip Strength  One Repetition Max.  4, 5, or 6 Rep Max • Muscular Endurance Testing  Curl Up  Push Up
    • 46. Flexibility • “Sit and Reach” test
    • 47. Components of Health Related Fitness 1. Body weight and body composition 2. Cardiorespiratory Endurance (Fitness) 3. Muscular Endurance 4. Muscular Strength 5. Flexibility
    • 48. Test Validity, Reliability, and Objectivity • Validity • Reliability • Objectivity
    • 49. Prediction equations • To whom is equation applicable? ▫ Population specific vs. general • How were variables measured by the researchers who developed equation?
    • 50. Feasibility Efficacy Health history Goals Things to keep inThings to keep in mind:mind:
    • 51. Preparing to Test Your Client/Athlete
    • 52. What should be the proper order of testing? • Flexibility • Body composition • Muscular fitness • HHQ/Risk stratification • CRE / CRF • Resting BP and HR
    • 53. Give client specific instructions as to what to wear, what to bring, and what to expect on testing day!
    • 54. Always have your supplies and equipment ready before the client arrives!
    • 55. Make the client as comfortable as possible!
    • 56. Be professional, be confident, be yourself!
    • 57. 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!
    • 58. 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
    • 59. Characteristics of Exercise Program Dropouts & Factors Related to “Dropping Out”
    • 60. Reinforcing Factors for Exercising (Promoting Adherence)
    • 61. Exercise Program Design Principles
    • 62. Exercise Program Design Principles • Specificity of Training • Overload training • Progression • Initial values • Inter-individual variability • Diminishing returns • Reversibility
    • 63. Principle of Specificity The training effects from any exercise are specific to the activity and the muscles involved.
    • 64. Overload Training Progression
    • 65. Inter-individual variability • Responses to a training stimulus vary amongst individuals • What are some factors that vary amongst individuals?
    • 66. Initial Values Diminishing Returns Reversibility
    • 67. Genetic Ceiling
    • 68. Clinical Tests • Physical Exam • Lipid Panel and Glucose Levels • Blood Pressure • 12-Lead ECG • Graded Exercise Test
    • 69. Case Study • Height: 5’5” • Weight: 138lbs
    • 70. 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
    • 71. 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
    • 72. • You have determined that Spencer is a high risk client. Spencer wants to begin a moderate walking program.

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