This document provides an overview of physical fitness assessments. It defines physical fitness as the ability to carry out daily tasks without undue fatigue. Components of physical fitness include body composition, muscular strength and endurance, cardiorespiratory fitness, flexibility, agility, balance, coordination, reaction time, power, and speed. The document describes methods for assessing each component, such as BMI, pushups, sit-and-reach tests. It recommends that adults engage in moderate exercise for 30 minutes daily to improve health and reduce disease risk. Precautions are discussed to prevent cardiac events during exercise.

1. PHYSICAL FITNESS ASSESSMENT
Presented by- Suparna Banerjee Moderator: Dr. Shilpasree saha (PT)
1ST Year MPT (Neurology) Assistant Professor,NIHS, Kolkata

2. • Definitions
• Lifestyle for health, wellness & fitness
• Physical activity, exercise and physical fitness
• Benefits and risk factors associated with physical activity
• Physical activity pyramid
• Fitness components
• Assessment of physical fitness
• Public health perspective on current recommendations

3. What is physical fitness?
• According to the Centers for disease control and Prevention (CDC),
Physical fitness is defined as “the ability to carry out daily tasks with
vigor and alertness, without undue fatigue and with ample to
enjoy leisure time pursuits and respond to emergencies” 1
• Physical fitness is a set of attributes that
are either health- or skill-related fitness.2
• Fitness means “readiness”. Fit people are
better equipped than non-fit people.
• Level of fitness includes all aspects of health
(physical, mental social health) and lifestyle

4. Lifestyle for health wellness &fitness

5. Physical activity, exercise and physical fitness
Physical Activity (PA) and exercise are often used interchangeably, but these terms are
not synonymous.
• PA is defined as any bodily movement produced by the contraction of skeletal
muscles that substantially increases caloric requirements over resting energy
expenditure.
• Exercise is a type of PA consisting of planned, structured, and repetitive bodily
Movement is done to improve and/or maintain one or more components of physical
fitness.
• A fit person is able to carry out the typical activities of living and still has sufficient
energy and vigor to respond to emergency situations and to enjoy leisure time activities.

6. Health and fitness benefits associated with physical activity
IMPROVEMENT IN CARDIOVASCULAR AND RESPIRATORY FUNCTION
• Increased maximal oxygen uptake resulting from both central and peripheral adaptations
• Decreased minute ventilation at a given absolute submaximal intensity
• Decreased myocardial oxygen cost for a given absolute submaximal intensity
• Decreased heart rate and blood pressure at a given submaximal intensity
• Increased capillary density in skeletal muscle
• Increased exercise threshold for the accumulation of lactate in the blood
• Increased exercise threshold for the onset of disease signs or symptoms (e.g., angina pectoris, ischemic ST-segment
depression, claudication)

7. REDUCTION IN CORONARY ARTERY DISEASE RISK FACTORS
• Reduced resting systolic/diastolic pressures
• Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides
• Reduced total body fat, reduced intra-abdominal fat
• Reduced insulin needs, improved glucose tolerance
• Reduced blood platelet adhesiveness and aggregation
DECREASED MORBIDITY AND MORTALITY
• Higher activity and/or fitness levels are associated with lower death rates from coronary artery disease
• Higher activity and/or fitness levels are associated with lower incidence rates for combined cardiovascular diseases, coronary
artery disease, stroke, type 2 diabetes, osteoporotic fractures, cancer of the colon and breast, and gallbladder disease
• Based on meta-analyses (pooled data across studies), cardiovascular and all-cause mortality are reduced in post-myocardial
infarction patients who participate in cardiac rehabilitation exercise training, especially as a component of multifactorial risk
factor reduction
• Randomized controlled trials of cardiac rehabilitation exercise training involving post-myocardial infarction patients do not
support a reduction in the rate of nonfatal reinfarction

8. OTHER BENEFITS
• Decreased anxiety and depression
• Enhanced physical function and independent living in older persons
• Enhanced feelings of well-being
• Enhanced performance of work, recreational, and sports activities
• Reduced risk of falls and injuries from falls in older persons
• Prevention or mitigation of functional limitations in older adults
• Effective therapy for many chronic diseases in older adults

9. Activity pyramid
Inactivity
Exercise for
flexibility
Exercise for
strength and
endurance
Active aerobic exercise Active sports activities
Lifestyle activities
Level I
Level II
III
Level IV

10. Components of physical fitness
Components of physical
fitness
Health-related
physical
fitness
Skill-related
physical
fitness

11. Components of health related fitness
1. Body composition
2. Muscle strength and endurance
3. Cardiorespiratory fitness
4. Flexibility

12. Body composition & it’s assessment
Basic body composition can be expressed as the relative percentage of body mass that is fat and fat-free tissue using a
two-compartment model.
ANTHROPOMETRIC METHODS
Measurements of height, weight, circumferences, and skinfolds are used to estimate body composition.
Body Mass Index
The BMI, or Quetelet index, is used to assess weight relative to height and is calculated by dividing body weight in
kilograms by height in meters squared(kg.m-2).
Circumferences
The pattern of body fat distribution is recognized as an important predictor of the health risks of obesity.
Following the WHO protocol, the measure is taken midway between the highest point of the iliac crest and the
bottom of the ribcage. Following the NIH protocol, the measure is taken at the highest point of the iliac crest.

13. Skinfold Measurements
Body composition determined from skinfold measurements correlates well (r =0.70–0.90) with body composition determined
by hydro densitometry. The principle behind this technique is that the amount of subcutaneous fat is proportional to the total
amount of body fat. It is assumed that close to one-third of The total fat is located subcutaneously. The exact proportion of
subcutaneous to total fat varies with sex, age, and ethnicity. Therefore, regression equations Used to convert the sum of
skinfolds to percent body fat must consider these variables for the greatest accuracy.
Skin fold measurement site:
• Tricep
• Bicep
• Mid axillary
• Subscapular
• Pectoral/chest
• Medial calf
• Supra iliac
• Thigh

14. Generalized Skinfold Equations:
MEN
Seven-Site Formula : (chest, midaxillary, triceps, subscapular, abdomen, supra iliac, thigh) Body density = 1.112 -
0.00043499 (sum of seven skinfolds) + 0.00000055 (sum of seven skinfolds)2 -0.00028826 (age)
Three-Site Formula: (chest, abdomen, thigh) Body density = 1.10938 - 0.0008267 (sum of three skinfolds)+ 0.0000016
(sum of three skinfolds)2 -0.0002574 (age)
• WOMEN
Seven-Site Formula: (chest, midaxillary, triceps, subscapular, abdomen, supra iliac, thigh)Body density = 1.097-
0.00046971 (sum of seven skinfolds)+ 0.00000056 (sum of seven skinfolds)2- 0.00012828 (age)
Three-Site Formula: (triceps, suprailiac, thigh) Body density = 1.099421 - 0.0009929 (sum of three skinfolds) + 0.0000023
(sum of three skinfolds)2 -0.0001392 (age)

15. Muscular strength and endurance assessment
Muscular strength refers to the external force (maximum voluntary contraction)
that can be generated by a specific muscle or muscle group, it is commonly expressed
in terms of resistance lifted. Strength can be assessed either statically (no overt muscular
movement or limb movement) or dynamically (movement of an external load
or body part, in which the muscle changes length).
• To improve muscle strength lift heavier weights than you are used to
• Upper Body Strength=weight pushed in Ibs /body weight in Ibs
Muscular endurance refers to the muscle’s ability to perform successive exertions or many repetitions
• To improve muscle endurance lift more times, not more weights.

16. Push-up Test Procedures for Measurement of Muscular Endurance:
1. The push-up test is administered with male subjects starting in the standard “down” position (hands pointing
forward and under the shoulder, back straight, head up, using the toes as the pivotal point)
2. The subject must raise the body by straightening the elbows and return to the “down” position until the chin
touches the mat. The stomach should not touch the mat.
3. The subject’s back must be straight at all times and the subject must push up to a straight arm position.
4. The maximal number of push-ups performed consecutively without rest is counted as the score.
5. The test is stopped when the client strains forcibly or is unable to maintain the appropriate technique within two
repetitions.

17. Cardiorespiratory (CR)fitness
Cardiorespiratory endurance: the ability of the circulatory and respiratory system to supply oxygen during sustained
physical activity
Modes of CR fitness testing
Field tests: consist of walking or running a certain distance in a given time(i.e., 12-minute and 1.5-mile [2.4-km]
run tests, and the 1- and 6-minute walk test).
Step testing: It is an inexpensive modality for predicting CR fitness by measuring the HR response to stepping
at a fixed rate and/or a fixed step height or by measuring postexercise recovery HR
Cycle ergometer test: The subject pedals on the cycle ergometer for 3 minutes at a resistance of 0.5 kg and a
pedaling frequency of 50 (this is the warm-up). The subject then pedals for 3 minutes at(0.5kg*50 RPM*6= 150
kg.m/min). Record the heart rate at 2 minutes and 3 minutes

18. Bruce treadmill test: It is a maximal exercise tolerance test, it requires a physician's clearance and expert supervision. While
performing the test, clinicians monitor the patient's vital signs continuously and stop the test at any sign of trouble
Modified bruce protocol for elderly and sedentary
individuals.

19. TEST TERMINATION CRITERIA:
• Onset of angina or anginalike symptoms
• Drop in systolic BP of '10 mm Hg from baseline BP despite an
increase in workload
• Excessive rise in BP: systolic pressure '250 mm Hg or diastolic pressure
'115 mm Hg
• Shortness of breath, wheezing, leg cramps, or claudication
• Signs of poor perfusion: light-headedness, confusion, ataxia, pallor,
cyanosis, nausea, or cold and clammy skin
• Failure of heart rate to increase with increased exercise intensity
• Noticeable change in heart rhythm
• Subject requests to stop
• Physical or verbal manifestations of severe fatigue
• Failure of the testing equipment

20. Flexibility and it’s measurements
Flexibility is the ability to move a joint through its complete range of motion
Sit & reach test for trunk flexion
Zipper test

21. :
COMPREHENSIVE HEALTH-FITNESS EVALUATION
• Prescreening/risk stratification
• Resting HR, BP, height, weight, BMI, ECG (if appropriate)
• Body composition
• Waist circumference
• Skinfold assessment
• Cardiorespiratory fitness
• Submaximal YMCA cycle ergometer test or treadmill test
• Muscular strength
• 1-, 4-, 6-, or 8-RM upper body (bench press) and lower body (leg press)
• Muscular endurance
• Curl-up test
• Push-up test
• Flexibility
• Sit-and-reach test or goniometric measures of isolated anatomic joints

22. Components of Skill-related physical fitness
1. Agility
2. Balance
3. Coordination
4. Reaction time
5. Power
6. Speed

23. Agility and its measurement
It is the ability to change the position of the body in space with speed and accuracy
Agility T-test
Subjects were asked to sprint forwards 9.14 m from the start line to the first cone and touch the tip with their right
hand, shuffle 4.57 m left to the second cone and touch with their left hand, then shuffle 9.14 m to the right to the third
cone and touch with their right, shuffle 4.57 m back left to the middle cone and touch with their left hand before finally
backpedaling to the start line. Time began upon subjects passing through the timing gates and stopped upon them
passing through on return.
The test will not be counted if the subject crosses one foot in front of the other while shuffling, fails to touch the base
of the cones, or fails to face forward throughout the test. Take the best time of three successful trials

24. Balance and its assessment
Balance is the ability of an individual to maintain their line of gravity within their base of support. It can be classified
into static and dynamic. Balance is control by three different system: somatosensory, visual and vestibular system.
1)One leg stance test- Individual is asked to stand on 1 leg for 10s with eyes open or closed
2)Sharpened Romberg’s test- Individual stands with both feet in tandem (feet touching heel to toe) with eyes closed
to mask the problem with balance.
3)Time up and Go test- This balance test measures the time needed to rise to stand from a chair, walk 3m, turn,
walk back to the chair, and sit down.
The Berg balance scale is a useful tool to assess static as well as dynamic balance.

25. Coordination and its assessment
It is the ability to use the senses, such as sight and hearing, together with body parts in performing motor tasks
smoothly and accurately.
• The alternate Hand wall toss test is one of the tests via which coordination can be assessed.
• Finger to Nose test- This test is designed to observe the smoothness and timing of arm movement. The
individual is asked to repetitively touch the nose using the index finger and then to touch the clinician’s
outstretched finger.

26. Reaction time and its assessment
Reaction time is related to the time elapsed between stimulation and the beginning of the reaction to it. Reaction time is
affected by several variables including attentive, cognitive, and motor functions.
Three basic reaction time paradigms have been described:
• Simple reaction time has a single stimulus and a single predefined response,
• Recognition reaction time has several false stimuli mixed with one correct stimulus prompting the response, and
• Choice reaction time involves multiple stimuli and differing responses for each stimulus.
• It can be assessed via the Drop-Ruler test. Please watch the video below to understand this test.

27. Power & its assessment
It is the rate at which one is able to exert maximal force. Vertical jump test and hop test are some examples of
power testing for lower extremities. A medicine ball throw test can be used to assess upper extremity power.

28. Speed assessment
It relates to the ability to perform a movement within a short period of time.
• The Sprint test is one example of a test that can be used to examine a person's speed.

29. The ACSM-AHA Primary Physical Activity (PA)Recommendations
■ All healthy adults aged 18–65 yr should participate in moderate-intensity aerobic PA for a minimum of 30 min
on 5 d/ wk or vigorous-intensity aerobic activity for a minimum of 20 min on 3 d /wk
■ Combinations of moderate and vigorous intensity exercise can be performed to meet this recommendation.
■ Moderate-intensity aerobic activity can be accumulated to total the 30 min minimum by performing bouts each
lasting 10 min.
■ Every adult should perform activities that maintain or increase muscular strength and endurance for a
minimum of 2 d wk 1
■ Because of the dose-response relationship between PA and health, individuals who wish to further improve
their fitness, reduce their risk for chronic diseases and disabilities, and/or prevent unhealthy weight g

30. Prolonged periods of sitting or sedentary behavior are associated with deleterious health consequences
independent of PA levels. Population-based studies have demonstrated that more than 50% of an average
person’s waking day involves activities associated with prolonged sitting such as television viewing and
computer use. A recent meta-analysis demonstrated that after statistical adjustment for PA, sedentary time was
independently associated with a greater risk for all-cause mortality, CVD incidence or mortality, cancer
incidence or mortality (breast, colon, colorectal, endometrial, and epithelial ovarian), and Type 2 diabetes
mellitus (T2DM) in adults

31. SUDDEN CARDIAC DEATH AMONG YOUNG INDIVIDUALS

32. EXERCISE-RELATED CARDIAC EVENTS IN ADULTS

33. EXERCISE TESTING AND THE RISK OF CARDIAC EVENTS

34. PREVENTION OF EXERCISE-RELATED
CARDIAC EVENTS
• Health care professionals should know the pathologic conditions associated with exercise-related events so that
physically active children and adults can be appropriately evaluated.
• Physically active individuals should know the nature of cardiac prodromal symptoms ( e.g. , excessive, unusual
fatigue and pain in the chest and/or upper back) and seek prompt medical care if such symptoms develop.
• High school and college athletes should undergo preparticipation screening by qualified professionals.
• Athletes with known cardiac conditions or a family history should be evaluated prior to the competition using
established guidelines
• Healthcare facilities should ensure their staff is trained in managing cardiac emergencies and have a specified plan
and appropriate resuscitation equipment
• Physically active individuals should modify their exercise program in response to variations in their exercise
capacity, habitual activity level, and the environment

35. Reference
1. Physical Activity Guidelines Advisory Committee . Physical Activity Guidelines Advisory Committee Report, 2008
[Internet] . Washington (DC) : U.S. Department of Health and Human Services ; 2008 [updated Sep 24]. 683 p. Available
from: http://www.health.gov/paguidelines/Report/pdf /CommitteeReport.pdf
2. Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions
and distinctions for health-related research. Public health reports (Washington, D.C. : 1974), 100(2), 126–131.
3. Concepts of Physical Fitness ACTIVE LIFESTYLES FOR WELLNESS Fourteenth Edition Charles B. Corbin Arizona
State University Gregory J. Welk Iowa State University William R. Corbin Yale University
4. ACSM’S Guidelines for Exercise Testing and Prescription EIGHTH EDITION AMERICAN COLLEGE OF SPORTS
MEDICINE
5. Essentials of Exercise Physiology FOURTH EDITION Victor L. Katch (Ann Arbor, MI) William D. McArdle (Sound
Beach, NY) Frank I. Katch (Santa Barbara, CA)
6. Farley JB, Stein J, Keogh JW, Woods CT, Milne N. The relationship between physical fitness qualities and sport-specific
technical skills in female, team-based ball players: A systematic review. Sports medicine-open. 2020 Dec;6(1):1-20.