Assessment

Question 1

Basic Assessment Concepts
1. Reasons for Assessing Clients
2. Validity and Reliability of Assessments

Answer 1

A comprehensive fitness assessment is comprised of several measurements that help determine a client’s past and present health, as well as his/her current fitness level, allow the personal trainer to help set realistic and achievable goals which can be used to improve adherence to the exercise program and encourage the positive lifestyle changes needed to reach each goal.
Fitness assessments also create a baseline of statistical info that allows progression to be accurately monitored. A pretest of abilities should be administered prior to beginning a training program to help the PT determine the client’s basic abilities. Program progression or regression can be determined by using a midtest., which is generally administered one or more times to assess the progress and effectiveness of a program. It also allows for proper modifications to be made to the exercise program, which will be needed in order to continue to maximize results. This includes allowing programs to be regressed or progressed according to client results.
Pertinent info (e.g. proper pre-workout nutrition, hydration, and even what to wear) will help prepare the individual for the assessment. A midtest should be scheduled after the initial assessment has been taken.
Formative Evaluation (行程性評估) — a periodic reevaluation based on midtest, allows the PT to monitor progress and make any adjustments to the exercise program based on the individual’s needs and concerns, can also be used as a time to ensure that the training program remains interesting to avoid boredom and low compliance of the exercise program.
*After the training program has been completed, the post-test can be administered to determine the overall effectiveness and success of the training program.
* Validity — the degree to which a test or test item measures what it’s supposed to. Validity is the most important characteristic of conducting successful testing.
* There are several different types of validity that PTs can use to help determine the accuracy of their testing results.
1. Construct Validity (建構效度) — the overall validity, or the extent to which the test actually measures what it’s designed to measure. Tests used to measure characteristics should be able to produce repeatable results.
2. Face Validity (表面效度) — based on a test “appearing” to measure what it’s intended to measure, ensure that the individual will respond positively to the test due to the fact that the test appears to accurately measure what it’s supposed to measure.
3. Content Validity — an assessment that ensures that the testing covers all the relevant component abilities in appropriate proportions. PT should make sure all the proper components are represented during exercise testing.
4. Criterion-referenced Validity (標準參考效度) — the extent to which test scores are related to an outcome with some other measure or a test of the same ability, can be broken into 3 categories:
4.1. Concurrent Validity (同時效度) — the extent to which test scores are related to those with other accepted tests that measure the same ability.
4.2. Predictive Validity (預測效度) — the extent to which the test scores correspond with future performance.
4.3. Discriminant Validity (區分效度) — the ability of a test to distinguish between 2 different concepts and shows evidence of a low correlation between the results of the test and the results of a test of a different concept.
* Reliability — the measure of the degree of consistency or repeatability of a test. A reliable test should deliver the same score/result no matter when the test is administered. In order for a test to be valid, it must be reliable.

Question 2

Types of Assessments
1. Questionnaire and Interviews
2. Static Postural Assessments (靜態姿勢評估)
3. Movement Assessments
4. Core Stability and Balance
5. Muscular Strength, Endurance, and Power Assessments
6. Speed, Agility, and Quickness Assessments
7. Flexibility Assessments
8. Cardiorespiratory Assessments
9. Physiological Assessments
10. Body Composition Assessments
11. Calculating Body Composition: The Formulas

Answer 2

• Assessing an individual’s general and medical history, as well as lifestyle, will provide the PT with the info needed to start designing an exercise program.
• PAR-Q (Physical Activity Readiness Questionnaire) — widely used by PTs to determine the general readiness of an individual to begin an exercise program, usually used for people between the ages of 15 and 69.
• PAR-Q — a questionnaire used to help PTs determine whether individuals have any health, medical, or physical conditions that may prevent them from participating in an exercise program, help identify individuals who may require further medical evaluation before starting an exercise program, primary objective is to help PT detect individuals who may be at a high risk for cardiovascular disease. Any individual who answers yes to 1 question or more should be referred to a physician for further medical screening before starting an exercise program. With this info, the PT will be able to determine if an individual has any signs or symptoms of cardiovascular, metabolic, or pulmonary disease.
• Medical History — obtaining the details of an individual’s medical history will provide the PT with info about known/suspected chronic diseases, provides info about the client’s past and present health status and any past or recent injuries, surgeries, or chronic health conditions. It’s important for the PT to know what conditions affect each individual to ensure a safe and effective exercise program. The PT should consult with the individual’s physician to gain a better understanding of the physiological effects that each prescribed medication may have on the client’s body. Gaining insight into family medical history will also help the PT determine if the potential client may be at a greater risk of chronic diseases.
• General Health History — such as occupation and lifestyle, lifestyle questionnaire (sleep habits, stress level, alcohol consumption, smoking habits, recreational behaviors and activities) will allow the PT to obtain info needed to determine if an individual should be referred to a medical professional prior to starting an exercise program.
• According to CDC, cigarette smoking is the leading preventable cause of death in the US.
• Static Postural Assessment (how an individual holds his/her body while standing) — provide info about joint misalignment, proper muscle length, possible muscular dysfunction, and overall poor posture, used to check the body for optimal alignment, symmetry, balanced muscle tone and specific postural abnormalities, provide info about problem areas of the body, PT must take the time to observe each kinetic chain checkpoint.
• Kinetic Chain checkpoints — allow PT to systematically view the body in an organized manner. The kinetic chain checkpoint refers to the major regions of the body (e.g. foot/angle, knees, lumbo/pelvic/hip complex (LPHC), shoulders, head).
• The PT will also view the body from 3 different angles in order to see gross deviations in posture: anterior view, lateral view, posterior view.
• 3 posture deviations generally observed during a static postural assessment:
  1. Pronation distortion syndrome (內旋扭曲症候群) — characterized by foot pronation or flat feet, and internally rotated and adducted knees.
  2. Lower crossed syndrome — characterized by anterior pelvic tilt of the pelvis creating the appearance of an arched low back.
  3. Upper crossed syndrome – characterized by rounded shoulders and a forward head position.
• Movement Assessment — used to determine dynamic posture, should be focused around analyzing basic movement patterns (e.g. squat movement, gait, unilateral balance). The overhead squat, single-leg squat, and gait assessment all provide detailed info about how an individual’s body moves.
  1. Overhead squat assessment — test neuromuscular efficiency, functional strength, and dynamic flexibility; assess bilateral symmetry, mobility, and stability of the hips, knees, and ankles; an indicator of the mobility of the shoulder and the extension of the thoracic spine.
  2. Single-leg squat assessment — evaluate single-leg functional strength, dynamic flexibility, balance, flexibility, core strength, and neuromuscular control.
  3. Gait assessment — determine dynamic posture, view manner of walking.
• Core Stability and Balance assessments:
  1. BESS (Balance Error Scoring System 平衡誤差評分系統) — assess static postural stability, performed on 2 testing surfaces: ground and foam pad; the form pad is used to challenge the task of balancing. The difficulty will vary depending on the body weight. An increase in body weight will increase the likelihood of deformities around the foot which can further challenge balance and stability; PT will need a stopwatch, a foam pad, a flat surface (or the ground), a BESS scorecard, the BESS testing protocol and a spotter.
  2. Star Excursion Balance Test (星行漫遊平衡測試) — assess dynamic balance, proprioception, and ankle stability; PT need athletic tape to perform this assessment.
• Muscular Strength, Endurance, and Power Assessments:
  1. Bench Press assessment — determine training intensities of the bench press and the overall strength of the upper body or pressing musculature.
  2. Barbell Squat assessment — determine bilateral maximal lower body strength and training intensities for the squat.
  3. Push-Up test — measure the stability and muscular endurance of the upper body’s ability to push muscles as well as upper body and LPHC stability, best viewed from the lateral angle. The cervical spine, shoulders, LPHC, and knees are the primary kinetic chain checkpoints.
  4. The Long Jump (Bilateral Broad Jump) — measure the total body bilateral power, best viewed in the front of the individual and slightly off to the side.
  5. Vertical Jump assessment — measure total body bilateral power, the PT will need a Vertec to properly administer this assessment, best viewed in the front of the individual and slightly off to the side.
  6. The Reactive Strength Index test — assess an individual’s ability to perform during plyometric activities by measuring reactive jump capacity, muscle-tendon stress, stretch-shortening cycle effort, and the ability to start stop and change direction.
  7. Margaria-Kalamen test (stair sprint 評估下肢爆發力和垂直跳躍能力) — assess the lower body’s power, P = (M * D) * 9.8/T (power (watts), body mass (kg), vertical distance between steps 3 and 9, time (secs), 9.8 = constant gravity)
• Speed, Agility, and Quickness Assessments:
  1. T-Test — determine overall agility while moving forward, laterally, and backward.
  2. Hexagon Test — determines the ability to change direction and stabilize the body at high speeds.
  3. 40-Yard Dash — measures reaction capabilities and maximal speed.
  4. Pro-Agility Test (5-10-5 Shuttle Test) — measure lateral speed and agility.
  5. LEFT (Lower-Extremity Functional Test 下肢功能測試) — assess the ability to run in the sagittal and frontal plane.
• Flexibility Assessments:
  1. Overhead Squat — can also be used to measure overall flexibility, requires flexibility in all the muscles that impact the joints of the kinetic chain checkpoints (e.g. hip flexors, abdominals, quads, pectorals, adductors, hamstrings, lats, gastrocnemius, soleus). Improving flexibility of these muscles will improve overhead squat capabilities by increasing the range of motion in the joints.
  2. Sit-and-Reach Test — measure the flexibility of lower back and hamstrings.
• Cardiorespiratory Assessments:
  1. 3-Minute STEP Test (YMCA Step Test) — provide a submaximal measure of cardiorespiratory fitness and assess how quickly the heart rate recovers from short bouts of exercise, the metronome (節拍器) should be set to 96 beats per min.
  2. Rockport (1 Mile) Walk Test —- estimate aerobic capacity (VO2 Max 最大耗氧量).
  3. 300-Yard Shuttle Test — measure anaerobic capacity.
  4. One-and-a-Half-Mile Run — measure aerobic power (cardiovascular endurance).
  5. 12-Minute Run Test — measure aerobic fitness by determining the ability to use oxygen pathways to produce energy while running.
• Physiological Assessments — used as indicators of a client’s general fitness and overall cardiorespiratory health. Determining heart rate and BP will help the PT design and progress an individual’s exercise program.
  1. Resting Heart Rate — help PT get a general idea of cardiorespiratory health, serve as an overall indicator of fitness level, used to monitor the progression of the exercise program. 2 mostly commonly used pulse landmarks are:
  1.1. Radial Pulse — preferred method for determining resting heart rate.
  1.2. Carotid (頸動脈) Pulse — should be taken with caution.
  1.3. In order to get an accurate reading, the PT should teach individuals how to take their own resting heart rate since the resting heart rate is most precise when taken upon rising in the morning. It should be taken 3 days in a row to ensure validity.
  1.4. Using the RPE (rate of perceived exertion) will allow the clients to express how they feel (how hard an individual is working) while they are exercising.
  2. Blood Pressure (BP) — assessing BP before starting an exercise program will give PT a general idea of overall health and notify PT if the client should be referred to a medical professional before starting an exercise program.
  2.1. Systolic BP — represents the pressure in the arterial system after the heart contracts.
  2.2. Diastolic BP — represent the pressure in the arterial system when the heart is resting and filling with blood.
  2.3. According to AHA, an acceptable BP is under 120/80.
  2.4. BP is measured with a sphygmomanometer or an electronic BP monitor.
• Body Composition Assessments — determine relative percentage of body weight that can be described as either fat-mass or fat-free mass. Fat-free mass includes muscle, bone, connective tissue, and teeth. Fat mass include essential fat (needed for normal body function) and nonessential fat (storage or adipose).
  1. Skinfold measurements — estimate the amount of fat found in subcutaneous (皮下的) regions of the body, most common test due to low cost, ease, and convenience.
  1.1. Several measurement sites can be used but the 7-site and 3-site assessments are the most common.
  1.2. The validity of skinfold measurements can be affected by PT experience, hydration, sex, and age.
  2. Air Displacement Plethysmography (aka BOD POD 空氣置換體積苗技法) — a whole-body densitometry device used to measure body composition, measures body mass by using a highly precise scale and volume while an individual sits inside.
  2.1. Once inside, body density can be measured. Once body density is determined, relative proportions of body fat and lean body mass are calculated.
  2.2. BOD POD is highly recognized for its accuracy, speed, and safety.
  3. Bioelectrical Impedance Analysis (生物店抗阻分析) — involves a low-level and safe electrical signal sent from metal electrodes (電擊) that are in contact with the hands, feet, and abdomen.
  3.1. In handheld models, the electrical signal passes through the water that is present in the muscle tissue but meets resistance when fat is encountered. This form of testing is based on the premise that tissues that are high in water content will conduct an electrical current with less resistance than fat tissue that does carry as much water.
  4. Near-Infrared Interactance (NIR 近紅外線相互作用) — use probes (探測器/探針) placed against an area of the body that emits infrared light that passes through muscle and fat. The infrared light proceeds to use this info, along with activity level and age, to estimate body composition. The biceps are most often used.
  5. Dual-Energy X-Ray Absorptiometry (DEXA 雙能量X設限吸收測定法) — uses two x-ray beams of different energy levels to measure bone mineral density. Once soft tissue absorption is measured, bone mineral density can be determined.
  5.1. The DEXA scan measures height, muscle mass, fat mass, and bone mass.
  5.2. The DEXA scan is widely known as the most accurate body composition assessment.
  6. Circumference measurements — measure the girth (周長) of body segments, affected by muscle and fat, used as an indicator of current health status and as a feedback source for clients having body composition goals.
  6.1. The following sites are generally measured: neck, chest (across the nipple line), waist (narrowest point of the waist; if no narrowing, directly above the navel), Hips (the widest portion of buttocks when standing with feet together), thighs, calves, biceps.
  6.2. Waist-to-Hip ratio — assess the correlation of chronic disease to excess fat stored in the midsection, an increase in waist-to-hip ratio reflects a rise in body fat. A ratio > 0.80 for women and > 0.95 for men may place these individual at a greater risk for diseases.
  7. Body Mass Index (BMI) — determine what an individual’s weight should be in proportion to height. Higher BMI measurements are related to an increased risk of disease, especially if the individual has a large waist circumference.
  7.1. BMI = Body Weight (kg) / Height squared (m) = 703 * Body Weight (lbs) / Height squared (inches).
  7.2. BMI testing only takes weight into consideration but does not distinguish between fat mass and fat-free mass; therefore BMI is not the most accurate way to measure body composition but still can be used to determine if an individual has a high level of body fat.
• Calculating Body Composition: The Formulas
  1. BMI
  1.1. Weight (kg) / Height (square meters)
  1.2. Weight (lb) / Height (square inches) * 703
  2. Waist-to-Hip Ratio — waist circumference / hip circumference
  3. Fat (Body) Mass — total body weight * body fat percentage, consist of nonessential and essential adipose tissue or fat. The total body weight represents the human body’s total mass.
  4. Lean Body Mass — total body weight - fat mass, consist of bones, muscles, ligaments, tendons, and internal organs.

Question 3

Administering Assessments
1. Assessment Procedures
2. Relative and Absolute Contraindications (禁忌症)
3. Reassessment
4. Referrals

Answer 3

• A comprehensive fitness assessment should always being with gathering info about the potential client. After obtaining this subjective information, objective info can be collected.
• The following assessment sequence is recommended in order to prevent the client’s performance from being affected during the subsequent test:
  1. General and medical history
  2. Occupational, lifestyle, and medical information
  3. Physiological assessments (resting heart rate, BP)
  4. Body composition testing (body fat measurements, circumference measurements)
  5. Static postural assessments
  6. Flexibility assessments (sit-and-reach test)
  7. Movement-based assessments (overheat squat, single-leg squat)
  8. Speed and power assessments
  9. Strength assessments
  10. Muscular endurance assessments
  11. Aerobic assessments
• The order of fitness assessments should be based on prioritizing performance. Tests relying on the ATP-PC (線桿三磷酸-磷酸肌酸) energy system should be performed before tests relying primarily on the glycolytic anaerobic system (堂姊無氧系統). Following this order will help avoid the subject fatigue without interfering with tests that rely on the quick-burst energy of the ATP-PC system.
• Exercise Testing is the most effective way to begin an exercise program. Even though testing is necessary, there are still relative and absolute contraindications that may prevent the subject from completing exercise testing.
  1. Relative Contraindications — less threating conditions that may pose a risk to the subject during testing (e.g. severe HBP, a history of heart illness, chronic infectious diseases - hepatitis (肝炎) and AIDS, uncontrolled metabolic diseases - diabetes, neuromuscular and/or musculoskeletal disorders exacerbated by exercise).
  1.1. If a subject displays signs of any relative contraindications, the PT must be sure that the benefits of testing outweigh the potential risks. The exercise test may also be modified to meet the needs of each individual.
  2. Absolute Contraindications — a subject with absolute contraindications should NEVER proceed with exercise testing (e.g. severe infections, uncontrolled symptomatic heart failure 心臟衰竭, unstable angina 心絞痛, a recent history of myocardial infarction 心肌哽塞).
  2.1. The exercise test should be discontinued immediately if there are any signs of poor perfusion, such as dizziness, confusion, light-headedness, an onset of chest pain, failure of the heart rate to rise with an increase in workload, or if the subject requests to stop the exercise test.
• The PT should always deliver test results in a positive manner. The PT should never aim to discourage or embarrass the individual. A negative delivery may impact the client-trainer relationship and discourage the individual from proceeding with the training program. The objective should be to improve the outlook and self-esteem of the individual.
• Reassessment — in order to ensure that an exercise program is effective and to keep the client motivated, regular assessments of clients should be strategically scheduled, a reassessment will help the PT determine the next plan of action, generally performed every 4 to 6 weeks, should not be performed so often that adequate time has not passed to see noticeable changes, should include identical test and measurements that were administered at the initial assessment.
• During the initial goal setting process, the PT should encourage the individual to set physical, psychological, and mental goals. This will allow the individual to see continual success. It also allows the client to focus on accomplishing goals that aren’t focused around altering body composition. Having goals focused on the metal and psychological benefits will help clients develop positive lifestyle habits that will make accomplishing physical goas more attainable.
• After the reassessment, PT can make proper modifications to the exercise program to help the client stay on track or get back on track to accomplishing his goals. The reassessment period also serves as an excellent time to reevaluate the objectives of the exercise program to make sure that the original goals are still important to the client.
• It’s important for PTs to stay within their scope of practice when working with clients.
  1. PTs do NOT:
  1.1. diagnose disease or injury.
  1.2. prescribe medication or treatments.
  1.3. treat injury or disease.
  1.4. prescribe diets or nutrition advice outside of basic heathy eating info.
  1.5. administer diagnostic testing or procedures.
  1.6. provide psychological counseling.
  2. PT DO:
  2.1. assess movement dysfunction and muscular imbalance.
  2.2. use evidence-based protocols to enhance client exercise experience.
  2.3. administer pre-exercise assessments and screenings.
  2.4. design safe and effective exercise programs.
  2.5. provide basic info in regards to healthy eating.
• If a client has several risk factors (e.g. known cardiovascular/pulmonary/metabolic diseases), or if the PT believe the client’s condition is out of his scope of practice, then the PT should refer the client to a medical professional for further testing before proceeding with an exercise program.
• Referring individuals to the proper medical professional will allow PT to help the client get a clear and concise answer about possible medical problems. The referral will also show the client that the PT cares about the client’s health, and it will help build a strong professional relationship between the PT and the client.
• Once the PT has determined that a medical clearance is needed, he should give the client a medical clearance form to be completed by the client’s primary care physician. After the physician has determined if an unsupervised, supervised, or medically supervised exercise program is necessary, the PT will adhere to the program recommendations of the physician until the client is cleared to participate in normal activity. The PT should be sure to retain a copy of the completed medical clearance form for records and verification of completion.
• The PT should be sure to document any abnormal signs or symptoms during the assessments. This will allow the PT to share the right info with the medical professional in case a referral is needed.

Question 4

Assessments in Special Populations

Answer 4

• The PT should know what to expect and which test will be the most effective for each population (e.g. youth, senior, prenatal clients).
• The PT should perform static and dynamic postural assessments as well as physiological assessments with each special population. Test selection should be based on safety and any special considerations.
• Youth — children and adolescents between the age of 6 and 20 are often considered youth clients. Considerations that the PT must consider when assessing youth are:
  1. Youth have a higher oxygen demand than adults, which will increase the chance of fatigue and heat production.
  2. Youth have a decreased ability to perform longer duration, higher intensity tasks.
  3. Youth have less tolerance to environmental extremes, such as high heat and humidity.
  4. Youth are comparable to adults in their ability to perform endurance tasks.
• Senior — generally used to describe individuals who are 65 years of age or older. The PT must consider physiological and training considerations when assessing seniors. Normal changes that occur with aging include:
  1. a reduction in cardiac output
  2. reduced balance capabilities
  3. a decrease in coordination
  4. a decrease in muscle mass
  5. reduced VO2 max capacity
• Useful assessments for seniors would include:
  1. overhead squat assessment
  2. gait assessment
  3. BESS (balance error scoring system)
  4. Rockport walk test or half-mile walk test
• Prenatal — used to describe a woman currently pregnant. Before assessing prenatal clients, the PT should have an understanding of some of the absolute and relative contraindications for exercise this population may face.
  1. Absolute contraindications include:
  1.1. multiple gestation (e.g. twins, triplets, etc.) that puts the client at a higher risk for premature labor.
  1.2. pregnancy-induced hypertension
  1.3. premature labor during current pregnancy
  2. Relative contraindications include:
  2.1. poorly controlled hypertension
  2.2. poorly controlled type 1 diabetes
  2.3. extreme level of obesity
  2.4. history of high levels of a sedentary lifestyle
• It’s important that PTs be familiar with the physiological changes that women experience during pregnancy when assessing prenatal clients which include:
  1. a decrease in available oxygen for aerobic activity
  2. an increase in metabolic demand to main proper energy balance
  3. an overall decrease in work capacity.
• Safe assessments for prenatal women are:
  1. Rockport walk test
  2. overhead squat assessment
  3. BESS