CH.6 FITNESS ASSESSMENT Flashcards
CAN SUBSTANTIALLY REDUCE RISK AND LEAD TO SIGNIFICANT HEALTH BENEFITS
AT LEAST 2.5 HOURS A WEEK OF MODERATE AEROBIC PHYSICAL ACTIVITY
INFO NECESSARY TO CREATE RIGHT PROGRAM FOR SPECIFIC INDIVIDUAL (OR GROUP) COMES THROUGH A PROPER WHAT ?
PROPER FITNESS ASSESSMENT
INVOLVES A SERIES OF MEASUREMENTS THAT HELP DETERMINE CURRENT HEALTH AND FITNESS LEVEL OF CLIENTS
COMPREHENSIVE FITNESS ASSESSMENT
SPECIFIC TESTS USED IN AN ASSESSMENT DEPEND ON WHAT ?
HEALTH AND FITNESS GOALS
TRAINERS EXPERIENCE
TYPE OF WORKOUT ROUTINES BEING PERFORMED
AND AVAILABILITY OF FITNESS ASSESSMENT EQUIPMENT
DESIGNED TO SERVES AS WAY OF OBSERVING AND DOCUMENTING CLIENTS INDIVIDUAL STRUCTURAL AND FUNCTIONAL STATUS
HEALTH AND FITNESS ASSESSMENT
PROVIDES A VARIETY OF SUBJECTIVE AND OBJECTIVE INFO INCLUDING PREPARTICIPATION HEALTH SCREENING, RESTING PHYSIOLOGIC MEASUREMENTS (HR, BP, HT, WT) AND SERIES OF MEASUREMENTS TO HELP DETERMINE FITNESS LEVEL OF CLIENT (HEALTH RELATED FITNESS TEST)
COMPREHENSIVE FITNESS ASSESSMENT
DONT’S FOR HEALTH AND FITNESS PROFESSIONALS
DO NOT:
- DIAGNOSE MEDICAL CONDITIONS
- PRESCRIBE TX
- PRESCRIBE DIETS
- PROVIDE TX FOR INJURIES OR DISEASE
- PROVIDE REHAB SERVICES
- PROVIDE COUNSELING SERVICES
GENERAL/ MEDICAL HISTORY, OCCUPATION, LIFESTYLE, MEDICAL AND PERSONAL INFO ARE ALL EXAMPLES OF WHAT TYPE OF INFO OF A FITNESS ASSESSMENT
SUBJECTIVE INFO
PHYSIOLOGIC ASSESSMENT, BODY COMPOSITION TESTING, CARDIORESPIRATORY ASSESSMENT, STATIC AND DYNAMIC POSTURAL ASSESSMENTS, PERFORMANCE ASSESSMENTS ARE ALL WHAT TYPE OF INFO OF A FITNESS ASSESSMENT ?
OBJECTIVE INFO
BEFORE ALLOWING NEW CLIENT TO PARTICIPATE IN ANY PHYSICAL ACTIVITY, SHOULD CONDUCT A WHAT ?
PREPARTICIPATION HEALTH SCREENING, INCLUDING MEDICAL HISTORY QUESTIONNAIRE (PAR-Q)
INDIVIDUALS WHO DO NOT HAVE ANY S/S OF CARDIOVASCUALR, PULMONARY OR METABOLIC DISEASE AND HAVE LESS THAN OR EQUAL TO 1 CARDIOVASCULAR DISEASE RISK FACTOR ARE WHAT TYPE OF RISK CLIENT ?
LOW RISK
INDIVIDUALS WHO DO NOT HAVE ANY S/S OF CARDIO, PULMONARY, OR METABOLIC DISEASE BUT HAVE MORE THAN OR EQUAL TO 2 CARDIO DISEASE RISK FACTORS ARE WHAT TYPE OF RISK CLIENTS ?
MODERATE
INDIVIDUALS WHO HAVE 1 OR MORE S/S OF CARDIO, PULMONARY, OR METABOLIC DISEASE ARE WHAT TYPE OF RISK CLIENTS ?
HIGH RISK
A QUESTIONNAIRE DESIGNED TO DETERMINE SAFETY OR POSSIBLE RISK OF EXERCISING FOR A CLIENT BASED ON ANSWERS TO SPECIFIC HEALTH HISTORY QUESTIONS
PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)
PRIMARILY AIMED AT IDENTIFYING INDIVIDUALS WHO REQUIRE FURTHER MEDICAL EVAL BEFORE BEING ALLOWED TO EXERCISE BECAUSE THEY ARE AT HIGH RISK FOR CARDIOVASCULAR DISEASE (CVC)
PAR-Q
IF A CLIENT ANSWERS YES TO ONE OR MORE QUESTIONS ON THE PAR-Q, PT SHOULD TO WHAT ?
REFER THEM TO PHYSICIAN FOR FURTHER MEDICAL SCREENING BEFORE STARTING EXERCISE PROGRAM
COLLECTION OF INFO, GENERALLY PART OF MEDICAL PHYSICAL; DISCUSS RELEVANT FACTS ABOUT INDIVIDUALS HISTORY
HEALTH HISTORY
2 IMPORTANT AREAS OF HEALTH HISTORY FOR PT TO FOCUS ON ARE WHAT ?
CLIENTS OCCUPATION AND GENERAL LIFESTYLE TRAITS
IF CLIENTS ARE SITTING FOR PROLONGED PERIODS THROUGHOUT DAY IT CAN CAUSE WHAT TO HIPS ?
HIPS ARE FLEXED FOR PROLONGED PERIODS WHICH LEADS TO TIGHT HIP FLEXORS (RECTUS FEMORIS, TENSOR FASCIA LATAE, ILIOPSOAS) AND POSTURAL IMBALANCES
PERSISTENT MOTION THAT CAN CAUSE MUSCULOSKELETAL INJURY AND DYSFUNCTION
REPETITIVE MOVEMENT
CAN CREATE PATTERN OVERLOAD TO MUSCLE AND JOINTS, WHICH MAY LEAD TO TISSUE TRAUMA AND EVENTUALLY KINETIC CHAIN DYSFUNCTION
REPETITIVE MOVEMENT
WEARING THIS FOR EXTENDED PERIODS CAN PUT ANKLE COMPLEX IN PLANTAFLEXED POSITION CAUSING POSTURAL IMBALANCES
WEARING SHOES WITH HIGH HEELS
PROVIDES INFO ABOUT CLIENTS PAST AND CURRENT HEALTH STATUS AS WELL AS ANY PAST OR RECENT INJURIES, SURGERIES, OR OTHER CHRONIC HEALTH CONDITIONS
MEDICAL HISTORY
STRONG PREDICTOR OF FUTURE MUSCULOSKELETAL INJURY DURING PHYSICAL ACTIVITY
PREVIOUS HISTORY OF MUSCULOSKELETAL INJURY
SHOWN TO DECREASE NEURAL CONTROL TO GLUTEUS MEDIUS AND GLUTEUS MAXIMUS MUSCLES, CAN LEAD TO POOR CONTROL OF LOWER EXTREMITIES
ANKLE SPRAINS
CAUSE DECREASE IN NEURAL CONTROL TO MUSCLES THAT STABILIZE PATELLA (KNEECAP)
KNEE INJURIES INVOLVING LIGAMENTS
T OR F: KNEE INJURIES THAT ARE NOT THE RESULT OF CONTACT (NONCONTACT INJURIES) ARE OFTEN RESULT OF ANKLE OR HIP DYSFUNCTIONS
TRUE
CAUSE DECREASED NEURAL CONTROL TO STABILIZING MUSCLES OF CORE, RESULTING IN POOR STABILIZATION OF SPINE
LOW BACK INJURIES
CAUSE ALTERED NEURAL CONTROL OF ROTATOR CUFF MUSCLES
SHOULDER INJURIES
ESTIMATED THAT WHAT % OF AMERICAN ADULT POPULATION DOES NOT ENGAGE IN AT LEAST 30 MINS OF LOW TO MODERATE PHYSICAL ACTIVITY ON MOST DAYS OF WEEK
75%
GENERALLY USED AS ANTIHYPERTENSIVE (HIGH BP), MAY ALSO BE PRESCRIBED FOR ARRHYTHMIAS (IRREGULAR HR)
BETA BLOCKERS
GENERALLY PRESCRIBED FOR HTN AND ANGINA (CHEST PAIN)
CALCIUM CHANNEL BLOCKERS
GENERALLY PRESCRIBED FOR HTN, CHF
NITRATES
GENERALLY PRESCRIBED FOR HTN, CHF AND PERIPHERAL EDEMA
DIURETICS
GENERALLY PRESCRIBED TO CORRECT OR PREVENT BRONCHIAL SMOOTH MUSCLE CONSTRICTION IN INDIVIDUALS WITH ASTHMA AND OTHER PULMONARY DISEASES
BRONCHODIALATORS
USED IN TX OF HTN AND CHF
VASODILATORS
USED IN TX OF VARIOUS PSYCHIATRIC AND EMOTIONAL DISORDERS
ANTIDEPRESSANTS
EFFECT OF BETA BLOCKERS ON HR AND BP
HR DECREASES
BP DECREASES
EFFECT OF CALCIUM CHANNEL BLOCKERS ON HR AND BP
HR: INCREASE, NO EFFECT, OR DECREASE
BP: DECREASE
EFFECT OF NITRATES ON HR AND BP
HR: INCREASE BP: NO EFFECT
HR: NO EFFECT BP: DECREASE
EFFECT OF DIURETICS ON HR AND BP
HR: NO EFFECT
BP: NO EFFECT OR DECREASE
EFFECT OF BRONCHODIALATORS ON HR AND BP
NO EFFECT ON HR OR BP
EFFECT OF VASODIALTORS ON HR AND BP
HR: INCREASE, NO EFFECT, OR DECREASE
BP: DECREASE
EFFECT OF VASSODILATORS ON HR AND BP:
HR: INCREASE OR NO EFFECT
BP: NO EFFECT OR DECREASE
COLLECTED DURING FITNESS ASSESSMENT, INCLUDES RESTING AND EXERCISE PHYSIOLOGICAL MEASUREMENTS (BP, HR), RESTING ANTHROPOMETRIC MEASUREMENTS (HT, WT, BODY FAT %, CIRCUMFERENCE MEASUREMENTS), AND SPECIFIC MEASURES OF FITNESS (MUSCULAR ENDURANCE, FLEXIBILITY, CARDIORESPIRATORY FITNESS)
OBJECTIVE INFO
CATEGORIES OF OBJECTIVE INFO
PHYSIOLOGICAL MEASUREMENTS, BODY COMPOSITION ASSESSMENT, CARDIORESPIRATORY ASSESSMENT, STATIC POSTURE ASSESS., MOVEMENT ASSESS. (DYNAMIC POSTURE), PERFORMANCE ASSESS.
FAIRLY GOOD INDICATOR OF OVERALL CARDIORESPIRATORY FITNESS
RESTING HR
STRONG INDICATOR OF HOW CLIENTS CARDIORESPIRATORY SYSTEM IN RESPONDING AND ADAPTING TO EXERCISE
EXERCISE HR
CREATED BY BLOOD MOVING OR PULSATING THROUGH ARTERIES EACH TIME HEART CONTRACTS
PULSE
PULSE RATE IS ALSO KNOWN AS WHAT ?
HR
HOW MANY PULSE POINTS ARE AVAILABLE ?
7
2 MOST COMMON SITES USED TO RECORD A PULSE
RADIAL AND CAROTID
TYPICAL RESTING HR
70-80 BPM
AVERAGE RESTING HR FOR MALE
70
AVERAGE RESTING HR FOR FEMALE
75
2 MOST COMMON WAYS TO CALCULATE TARGET HEART RATE (THR)
- USE % OF CLIENTS ESTIMATED MAXIMAL HR (STRAIGHT PERCENTAGE METHOD)
- USING % OF HEART RATE RESERVE (KARVONEN METHOD)
WHEN USING THE STRAIGHT % METHOD (PEAK MAXIMAL HR) HOW DOES ONE FIND CLIENTS MAXIMAL HR ?
SUBTRACT AGE FROM NUMBER 220 (220-AGE)
WHEN USING THE STRAIGHT % METHOD (PEAK MAXIMAL HR) HOW DO YOU CALCULATE THR ?
HRMAX X APPROPRIATE INTENSITY (65-95%)
DEPENDING ON CLIENTS INITIAL PHYSICAL CONDITION STATUS, WHAT INTENSITY SHOULD EXERCISE LEVELS BE AT ?
MAY NEED TO BE LOWER THAN 65% (40-55%)
METHOD OF ESTABLISHING TRAINING INTENSITY ON THE BASIS OF DIFFERENCE B/W CLIENTS PREDICTED MAXIMAL HR AND RESTING HR
HEART RATE RESERVE (HRR) AKA KARVONEN METHOD
HRR METHOD (KARVONEN METHOD)
THR = [(HRMAX - HRREST) X DESIRED INTENSITY] + HR REST
PRESSURE OF CIRCULATING BLOOD AGAINST WALLS OF BLOOD VESSELS AFTER BLOOD IS EJECTED FROM HEART
BP
REPRESENTS PRESSURE WITHIN ARTERIAL SYSTEM AFTER HEART CONTRACT
SYSTOLIC
REPRESENTS PRESSURE WITHIN ARTERIAL SYSTEM WHEN HEART IS RESTING AND FILLING WITH BLOOD
DIASTOLIC
ACCORDING TO AHA, ACCEPTABLE BP MEASUREMENT FOR HEALTH IS WHAT ?
SYSTOLIC: LESS THAN OR EQUAL TO 120 MMHG
DIASTOLIC: LESS THAN OR EQUAL TO 80 MMHG
MEASURED USING AN ANEROID SPHYGMOMANOMETER, WHICH CONSIST OF INFLATABLE CUFF, PRESSURE DIAL, BULB WITH VALVE AND STETHOSCOPE
BP
TO DETERMINE SYSTOLIC PRESSURE LISTEN FOR WHAT ?
FIRST OBSERVATION OF PULSE
TO DETERMINE DIASTOLIC PRESSURE LISTEN TO WHAT ?
PULSE FADES AWAY
REFERS TO RELATIVE % OF BODY WEIGHT THAT IS FAT VERSUS FAT FREE TISSUE (% BODY FAT)
BODY COMPOSITION
BODY WEIGHT EXCEPT STORED FAT, INCLUDES MUSCLES, BONES, WATER, CONNECTIVE AND ORGAN TISSUES AND TEETH
FAT FREE MASS
INCLUDES BOTH ESSENTIAL FAT (CRUCIAL FOR NORMAL BODY FUNCTIONING) AND NONESSENTIAL FAT (STORAGE FAT OR ADIPOSE TISSUE)
FAT MASS
ESSENTIAL BODY FAT FOR MEN
3-5%
ESSENTIAL BODY FAT FOR WOMEN
8-12%
% FAT RECOMMENDATION FOR ATHLETIC MEN
5-13%
% FAT RECOMMENDATION FOR ATHLETIC WOMEN
12-22%
RECOMMENDED %FAT FOR MALE 34 YEARS OR LESS
8-22%
RECOMMENDED %FAT FOR FEMALE 34 YEARS OR LESS
20-35%
RECOMMENDED %FAT FOR MALE 35-55 Y/O
10-25%
RECOMMENDED %FAT FOR FEMALE 35-55 Y/O
23-38%
RECOMMENDED %FAT FOR MALE 56 Y/O+
10-25%
RECOMMENDED %FAT FOR FEMALE 56 Y/O+
25-38%
USES CALIPER TO ESTIMATE AMOUNT OF SUBCUTANEOUS FAT BENEATH SKIN
SKINFOLD MEASUREMENT
USED PORTABLE INSTRUMENT TO CONDUCT ELECTRICAL CURRENT THROUGH BODY TO ESTIMATE FAT
BIOELECTRICAL IMPEDANCE
FORM OF ASSESSMENT BASED ON HYPOTHESIS THAT TISSUES THAT ARE HIGH IN WATER CONTENT CONDUCT ELECTRICAL CURRENTS WITH LESS RESISTANCE THAN THOSE WITH LITTLE WATER (SUCH AS ADIPOSE TISSUE)
BIOELECTRICAL IMPEDANCE
MOST COMMON TECHNIQUE USED IN EXERCISE PHYSIOLOGY LABORATORIES TO DETERMINE BODY COMPOSITION
UNDERWATER WEIGHING (HYDROSTATIC WEIGHING)
MAIN PRINCIPLE BEHIND HYDROSTATIC WEIGHING
BONE, MUSCLE AND CONNECTIVE TISSUES (LEAN MASS) SINK
WHEREAS BODY FAT FLOATS
IN HYDROSTATIC WEIGHING PERSONS WT IS COMPARED TO WHAT ?
PERSONS WT UNDERWATER TO DETERMINE FAT %
INDIRECT MEASURE OF THICKENESS OF SUBCUTANANEUOS ADIPOSE TISSUE
SKINFOLD (SKF)
WHEN TAKING SKINFOLD, MUST TAKE A MINIMUM OF HOW MANY MEASUREMENTS AT EACH SITE AND EACH SITE MUST BE WITHIN EACH OTHER ?
TAKE MIN. 2 MEASUREMENTS AT EACH SITE, EACH SITE MUST BE WITHIN 1-2 MM
T OR F: YOU SHOULD TAKE SKF’S IMMEDIATELY AFTER EXERCISE
FALSE
YOU SHOULD AVOID PERFORMING SKF’S ON WHAT CLIENTS ?
EXTREMELY OBESE CLIENTS
NASM USES WHAT FORMULA TO CALCULATE CLIENTS % OF BODY FAT AT 4 SITES IN UPPER BODY ?
DURNIN FORMULA (DURNING-WOMERSLEY FORMULA)
HOW TO GET FAT % OF BICEP
VERTICAL FOLD ON FRONT OF ARM OVER BICEP MUSCLE, HALFWAY BETWEEN SHOULDER AND ELBOW
HOW TO GET FAT % OF TRICEP
VERTICAL FOLD ON BACK OF UPPER ARM, HALFWAY BETWEEN SHOULDER AND ELBOW
HOW TO GET SUBSCAPULAR FAT %
45* ANGLE FOLD OF 1-2 CM, BELOW INFERIOR ANGLE OF SCAPULA
HOW TO GET ILIAC CREST FAT %
45* ANGLE FOLD, ABOVE ILIAC CREST AND MEDIAL TO AXILLARY LINE
T OR F: USING DURNIN FORMULA, ALL SKIN FOLDS SHOULD BE TAKE ON LEFT SIDE OF BODY
FALSE, ON RIGHT SIDE OF BODY
HOW TO FIND TOTAL FAT% USING DURNIN FORMULA
MEASURE 4 SITES, ADD TOTALS OF 4 SITES, FIND APPROPRIATE SEX AND AGE CATEGORIES FOR BODY COMPOSITION ON DURNIN CALCULATION TABLE
BENEFIT OF ASSESSING BODY COMPOSITION
ABILITY TO DETERMINE APPROX. HOW MUCH OF INDIVIDUALS BODY WT COMES FROM FAT AND HOW MUCH OF IT IS LEAN BODY MASS
FORMULA TO ASSESS FAT MAS
BODY FAT % X SCALE WT = FAT MASS
FORMULA TO CALCULATE LEAN BODY MASS
SCALE WT - FAT MASS = LEAN BODY MASS
MEASURE OF GIRTH OF BODY SEGMENTS (ARM, THIGH, WAIST, AND HIP)
CIRCUMFERENCE
CIRCUMFERENCE METHODS ARE AFFECTED BY WHAT ?
AFFECTED BY FAT AND MUSCLE, DO NOT PROVIDE ACCURATE ESTIMATES OF FATNESS IN GENERAL POPULATION
T OR F: BENEFIT OF CIRCUMFERENCE MEASUREMENTS IS THAT IT CAN BE USED ON OBESE CLIENTS
TRUE
USED FOR WAIST CIRCUMFERENCE, INEXPENSIVE, EASY TO RECORD, USED FOR WAIT TO HIP RATIO (WHR), GOOD FOR COMPARISONS AND PROGRESS
CIRCUMFERENCE MEASUREMENTS
MOST IMPORTANT FACTOR TO CONSIDER WHEN TAKING CIRCUMFERENCE MEASUREMENTS IS WHAT ?
CONSISTENCY
CIRCUMFERENCE FOR NECK
ACROSS ADAMS APPLE
CIRCUMFERENCE FOR CHEST
ACROSS NIPPLE LINE
CIRCUMFERENCE FOR WAIST
NARROW PART OF WAIST, BELOW RIB CAGE AND JUST ABOVE TOP OF HIPBONES, IF NO NARROWING MEASURE AT NAVAL
POSITION OF BODY TO OBTAIN CIRCUMFERENCE OF HIPS
FEET TOGETHER, MEASURE AT WIDEST PORTION OF BUTTOCKS
CIRCUMFERENCE OF THIGHS
MEASURE 10 IN. ABOVE TOP OF PATELLA
CIRCUMFERENCE OF CALVES
BETWEEN ANKLE AND KNEE
CIRCUMFERENCE OF BICEPS
WITH ARM EXTENDED PALM FACING FORWARD AT BICEP
MOST USED CLINICAL APPLICATIONS OF GIRTH MEASUREMENTS
WAIST TO HIP RATIO
THIS ASSESSMENT IS IMPORTANT B/C THERE IS CORRELATION B/W CHRONIC DISEASE AND FAT STORED IN MIDSECTION
WAIST TO HIP RATIO
COMPUTED BY DIVIDING WAIST MEASUREMENT BY HIP MEASUREMENT
WAIST TO HIP RATIO
WAIST TO HIP RATIO MEASUREMENT
MEASURE SMALLEST PART OF CLIENT WAIST AND LARGEST PART OF CLIENTS HIPS, DIVIDE WAIST MEASUREMENTS
ROUGH ASSESSMENT BASED ON CONCEPT THAT PERSONS WT SHOULD BE PROPORTIONAL TO HT; NOT DESIGNED TO ASSESS BODY FAT
BODY MASS INDEX (BMI)
T OR F: ELEVATED BMI IS LINKED TO INCREASED RISK OF DISEASE
TRUE
2 FORMULAS TO CALCULATE BMI
- WT (KG)/ HT (M^2) = BMI
2. [WT (LBS)/ HT (IN^2)] X 703 = BMI
LOWEST RISK OF DISEASE LIES WITHIN A BMI RANGE OF WHAT ?
22- 24.9
T OR F: INDIVIDUALS WHO ARE UNDERWEIGHT ARE ALSO AT RISK OF DISEASE
TRUE
USEFUL TOOL TO SCREEN GENERAL POP., BUT ONE WEAKNESS IS THAT IT FAILS TO DIFFERENTIATE FAT MASS FROM LEAN BODY MASS
BMI
HELP PT IDENTIFY SAFE AND EFFECTIVE STARTING EXERCISE INTENSITIES
CARDIORESPIRATORY ASSESSMENT
MOST VALID MEASUREMENT FOR FUNCTIONAL CAPACITY OF CARDIOPULMONARY SYSTEM IS WHAT ?
CARDIOPULMONARY EXERCISE TESTING (CPET) ALSO KNOWN AS MAXIMAL O2 UPTAKE (VO2MAX)
WHY IS IT NOT PRACTICAL TO MEASURE VO2MAX ?
B/C OF EQUIPMENT REQUIREMENTS, TIME INVOLVED, AND WILLINGNESS OF CLIENTS
PREFERRED METHOD FOR DETERMINING CARDIORESPIRATORY FUNCTIONAL CAPACITY AND FITNESS
SUBMAXIMAL TESTS
ALLOWS FOR ESTIMATE OF VO2MAX; TERMINATED AT PREDETERMINED HR INTENSITY OR TIME FRAME
SUBMAXIMAL TEST
OFTEN CATEGORIZED BY TYPE (RUN/WALK WESTS, CYCLE ERGOMETER TESTS, AND STEP TEST)
SUBMAXIMAL TEST
2 MOST COMMON SUBMAXIMAL TEST FOR ASSESSING CARDIORESPIRATORY EFFICIENCY
YMCA 3 MINUTE STEP TEST AND ROCK PORT WALK TEST
DESIGNED TO ESTIMATE AN INDIVIDUALS CARDIORESPIRATORY FITNESS LEVEL ON BASIS OF SUBMAXIMAL BOUT OF STAIR CLIMBING AT A SET PACE OF 3 MINUTES
YMCA 3 MINUTE STEP TEST
DESIGNED TO ESTIMATE CARDIOVASCULAR STARTING POINT, STARTING POINT THEN MODIFIED BASED ON ABILITY LEVEL
ROCKPORT WALK TEST
CLIENT WALKS 1 MILE AS FAST AS POSSIBLE ON TREADMILL, RECORD TIME IT TAKES CLIENT TO COMPLETE WALK AND RECORD CLIENTS HR AT 1 MILE MARK
ROCKPORT WALK TEST
