Chapter 8: Physiological Assessments Flashcards
signs that a client needs to stop assessment (10)
- onset of angina, chest pain, or angina-like symptoms
- significant drop (>10 mmHG) in systolic blood pressure despite an increase in exercise intensity
- excessive rise in blood pressure: SBP reaches >250mmHg or diastolic BP reaches >115mmHg
- excess fatigue, shortness of breath, or wheezing
- signs of poor perfusion: lightheadedness, pallor (pale skin), cyanosis (bluish coloration, especially around the mouth), nausea, or cold and clammy skin
- Increased nervous system symptoms (e.g. ataxia, dizziness, confusion, or syncope)
- Leg cramping or claudication
- subject requests to stop
- physical or verbal manifestations of sever fatigue
- failure of testing equipment
Bioelectrical impedance analysis (BIA)
Method: whole body BIA machines are primarily found in lab settings, less sophisticated ones are in gyms
Description: Measures electrical signals as they pass through fat, lean mass, and water in the body. essentially assesses leanness, but calculations can be made based on this info. The accuracy is based on the sophistication of the machine and the validity of the prediction algorithms. Many fitness centers use it due to the simplicity of use. Optimal hydration in necessary for accurate results
Air displacement plethysmography (ADP)
Method: example (Bod Pod), marketed for the fitness setting, but it’s cost prohibitive for most facilities
Description: The Bod Pod is an egg-shaped chamber that measures the amount of air that is displaced when a person sits in the machine. Two values are needed to determine body fat: air displacement and body weight. ADP is very accurate, but expensive
Dual-energy x-ray absorptiometry (DXA)
Method: typically found in clinical settings, may be found in exercise physiology departments at colleges and universities
Description: It ranks among the most accurate and precise methods. It’s a whole body scanning system that delivers a low dose x-ray that reads bone and soft-tissue mass. It has the ability to identify regional body-fat distribution
Hydrostatic weighing
Method: the gold standard- many methods of body-fat assessment are based on calculations derived from hydrostatic weighing, may be found in exercise physiology departments at colleges and universities
Description: measures the amount of water a person displaces when completely submerged, thereby indirectly measuring body fat via body density. It’s not practical in a fitness setting due to set up and such.
Near-Infrared interactance (NIR)
Method: example- Futrex
Description: Uses a fiber optic probe connected to a digital analyzer that indirectly measures tissue composition (fat and water). Typically, the biceps are the assessment site. Calculations are then plugged into an equation that includes height, weight, frame size, and level of activity. It’s inexpensive and fast, but not as accurate as other techniques.
Total body electrical conductivity (TOBEC)
Method: Found in clinical and research settings
Description: It uses an electromagnetic force field to assess relative body fat. It is impractical and too expensive for fitness settings.
1) Skinfold Assessment
2) Skinfold Assessment Sites
3) Protocol
1) General Info: most practical tool for measuring body composition, very commonly used in fitness settings,
2) Sites: skinfold calipers are used to “pinch” a fold of skin and fat (subcutaneous body fat). Several sites on the body are typically measured. It is reccommended that multiple sites are measured: FOR MEN-1. chest (a diagonal skin fold taken midway between crease of the underarm and the nipple), 2. Thigh (a vertical skin fold taken on the anterior midline of the thigh between the inguinal crease at the hip an the proximal border of the patella-top of knee), 3. abdominal (a vertical skin fold taken 2 cm or approximately 1 inch from the umbilicus-belly button). FOR WOMEN– 1. Tricep (a vertical fold on the posterior midline of the upper arm taken halfway between the shoulder and elbow) 2. Thigh (same as men’s) 3. Suprailium (a diagonal fold following the natural line of the iliac crest taken immediately superior to the crest of the ilium and in line with the anterior axillary line) The measurements are plugged into an equation that calculates body-fat percentage.
3. Protocol: 1. All measurements are taken on the right side of the body white client is standing 2. Sites should be marked with a pencil that can be washed off 3. thumb and index finger of left hand are opened to about 8cm or 3 inches and positioned about 1cm or 1/2 an inch above each site, pinch the site, pull the fat away from the tissue 4. calipers are placed 1 cm below thumb and midway between top and base of fold 5. slowly release caliper trigger, reading the dial to the nearest .5mm approximately 2 or three seconds after the release 6. After that is complete, gently squeeze the trigger to remove caliper before releasing the skin fold pinch (measure each site twice) 7. Record all measurements on a testing form *if measurements are reading a difference greater than 2mm, a third measurement must be taken, wait 20 to 30 seconds between each measurement for skin and fat to redistribute
Body mass index (BMI)
General Info: objective ratio describing the relationship between body weight and height, demonstrate strong correlations to morbidity and mortality, provide only estimations of body composition and fitness level
Protocol: BMI = Weight(kg)/Height^2(m) or Weight(lb)/Height^2(in) x703
*to convert pounds to kilograms, divide lbs by 2.2, to convert inches to cm to meters, multiply inches by 2.54, then divide by 100
Programming Considerations: it is important to explain the risks of being obese or overweight to a client…over 65% of Americans are overweight and 35.7% are obese, a BMI over 25 increases a person’s risk for cardiovascular disease, metabolic syndrome, hypertension, and type 2 diabetes
Girth measurements
General Info: good predictor of health problems (waist circumference as it correlates to heart disease) and it provides motivation as clients see changes in their body dimensions
Protocol: go through all the measurements in one rotation (Abdomen, waist, buttocks/hips, mid thigh, upper thigh, calf, arm, forearm), then do it again, if the difference is over 5mm, then remeasure after waiting 20-30 seconds
Waist-to-hip ratio
General Info: demonstrate strong correlations to morbidity and mortality, provide only estimations of body composition and fitness level, it also helps differentiate android (apple-shaped) individuals-carry more weight in the abdomen area- from gyroid (pear-shaped individuals)-carry more weight in the hips and thighs
Protocol: waist measurement is divided by hip measurement
Programming Considerations:
-Excellent/Good/Average/AtRisk WHR for men: .95
-Excellent/Good/Average/AtRisk WHR for women: .86
Equation for Skinfold Assessment (Body Density)
Calculation of Body Density:
MEN= 1.10938-0.008267 (sum of three skin folds) + 0.0000016 (sum of three skin folds ^2)- 0.0002574 (age)
WOMEN= 1.099421-0.0009929 (sum of three skin folds) + 0.0000023 (sum of three skin folds^2) - 0.0001392 (age)
General Body-Fat Percentage Categories for Women
Essential Fat: 10-13% Athletes: 14-20% Fitness: 21-24% Average: 25-31% Obese: 32% and higher
General Body-Fat Percentage Categories for Men
Essential Fat: 2-5% Athletes: 6-13% Fitness: 14-17% Average: 18-24% Obese: 25% and higher
Body Fat Equation (Part of Skinfold Assessment)
Siri equation (1961):
% Fat =
(495/Body Density)-450
Brozek et al. equation (1963):
% Fat =
(457/Body Density)-414
Programming Considerations: of Skinfold Assessment
Assessment is essential for a PT who is designing a personalized exercise program, especially if the primary goal is weight loss or weight gain. Reducing adipose tissue is also important for anyone trying to decrease the risk of disease or dysfunction. Programs should be partnered with evidence -based dietary recommendations. Note: With any weight loss or gain, there is typically a change in the amount of both lean body mass and fat mass
Waist circumference
Risk of high abdominal/android (visceral)fat:
- associated with insulin resistance, type two diabetes, hypertension, hypercholesterolemia
- For every 1 inch increase in men, the following risks are found: blood level increases by 10%, blood cholesterol level increases by 8%, high-density lipoprotein (HDL) decreases by 15%, triglycerides increase18%, metabolic syndrome risk increases by 18%
Criteria for Waist Cir. in Adults:
-Very low: women(<27.3 in), men (<31.2 in)
-Low: Women(27.3–34.7 in), Men(31.2–38.6 in)
High: Women (35.1–42.5 in) Men (39–36.8 in)
Very High:Women(>42.9 in) Men (>46.8 in)
Appropriate use of and reasons for administering CRF Test
- Determines functional capacity, using predetermined formulas based on age, gender, and in some cases, body weight
- Determine a level od cardiorespiatory function (maximal oxygen uptake or VO2 Max or MET-metabolic equivalent) that serves as a starting point for developing goals for aerobic conditioning
- Determine any underlying cardiorespiratory abnormalities that signify progressive stages of cardiovascular disease
- Periodically reassess progress following a structured fitness program
- Risk of heart attack or sudden cardiac death is three times more likely to happen to members of fitness facilities than those cardiac patients belonging to a supervised rehabilitation center (pre-screening helps this)
VO2 Max vs. Submaximal CRT Tests
VO2 Max: measures cardiorespiratur efficiency, an estimation of the body’s ability to use oxygen for energy, closely related to functional capacity of the heart. Measuring it involves being in a lab with the collection and analysis of exhaled air during maximal exercise. This can be harmful to some populations.
Submax: done in a fitness facility, they provide accurate values that can be determined based on expected maximal efforts. Repeated research demonstrates that as workload increases, so does HR and oxygen uptake (they have a fairy linear relationship)
Variables related to the lack of accuracy in estimated maximal oxygen uptake
- Many calculations are based on the equation: 220 - age for estimating MHR, but it can deviate by increasing or decreasing by 12 beats per minute
- Charts and equations reveal that reveal maximal oxygen uptake are based on the assumption that everyone expends the same amount of energy and oxygen at any given work rate. Therefore, submax is likely to under or overestimate the true maximum. Accuracy comes after the individual tests again a month later and then compares results
Methods available for determine MHR
- most accurate: use a EKG monitor to measure during a graded exercise test (GXT)
- Two Formulas:
- Tanaka, Monahan, and Seals: 208 - (.7 x Age)
- Gellish et al.: 206.9 - (.67 x Age)
*Note that 220 - Age typically contains deviations.
Cardiorespiratory assessment for the lab or fitness center
- Cycle ergometer Tests
- Ventilatory threshold Tests
- Field Tests
- Step Tests
Cycle ergometer Tests
Appropriate use: stationary cycles,
Programming considerations: it is easier to measure HR and BP because the arms are relatively stationary, best for those with balance issues, may underestimate actual cardiorespiratory fitness because of premature leg fatigue, BP may also be higher than treadmill because of the prolonged muscular contractions, based on initial MHR prediction. Should be avoided when working with obese clients who are not comfortable with using the bike or physically unable, clients with orthopedic problems that limit knee ROM to less than 110 degrees, clients with neuromuscular probes who cannot maintain a cadence of 50 rotations per minute
YMCA bike test: measures HR incremental (and predetermined) three-minute workloads the progressively elicit higher HR responses. These are then plotted on a graph against workloads performed. As HR correlates to a VO2 score, the HR response line is extended to determine the maximal effort and estimate the client’s VO2 Max
–Equipment:
-Cycle ergometer
-stopwatch
-HR monitor with chest strap
-metronome (optional)
-sphygmomanometer
-RPE chart
–Pre-test procedures:
-Estimate the submaximal target exercise HR as 85% of the predetermined MHR using one of the two formulas and multiply by .85 (Tanaka Monahan, and Seals or Gellish et al. then record the value on a testing form. If an HR strap r monitor are unavailable calculate a 15-sec count for this value
-Measure and record the client’s weight in pounds and convert that to kg by dividing weight by 2.2
-Discuss RPE (ratings of perceived exertion) with client
-Adjust seat position and take note of it for future tests
(Have client place heel on pedal so let is almost extended with ankle neutral, adjust seat as needed)
- If cadence meter is available, have client ride at 50 rpm. If not, use metronome set to 100 bpm to coincide with each pedal stroke
-Allow for a 2-3 minute warmup period at low intensity
-Let client know that the test will be stopped once they have achieved two steady HRs
–Protocol:
-Each stage is 3 min long (first workload is set at 150 kgm/min or .5 kg
-Continually coach the client to maintain 50 rpm cadence. Measure and record HR and RPE at the end of each minute. Measure and record BP at the start of the third minute. Before progressing, make sure the HR at the end of the third minute is within 5bpm of the HR at the end of second minute to indicate attainment of HRss. If this fails, have them do it another minute at the same workload.
-Refer to stages on page 219 and record what the HR is with 15 sec left in the first stage to determine which column to follow. Then follow that same column for the remainder of the 3 stages.
-Continue to record HR, RPE, and BP for each stage
-at least 2 stages must be recorded (must be between 110 bpm and 85% of MHR or 70% of heart-rate reserve (HRR)
-HR in second and third stages must be within 5 bpm of each other. If not, continue for another minute.
–Post-Test:
-cool down at rate equivalent to or lower than the first stage
-observe client for any negative symptoms
-determine their MHR and draw a line across the graph at this value.
*refer to page 220
Ventilatory threshold Tests
It is based on the physiological principle of ventilation. During sub maximal exercise, ventilation occurs primarily through an increase in tidal volume (volume of air inhaled and exhaled per breath). At higher or near-maximal intensities, the frequency of breathing becomes more pronounced and minute ventilation (VvE) (measured as the volume of air breathed per minute) rises disproportionately to the increase in oxygen uptake
—Submaximal talk test for VT1:
–Equipment:
-Treadmill, cycle ergometer, elliptical, or arm ergometer
-stopwatch
HR monitor with chest strap (optional)
-Client’s knowledge of alphabet or Pledge of Allegiance
- -Pre-test procedure:
- plan for small increments so HR increases by only 5 bpm (going .5 mph on treadmill, increase incline by 1%, increase levels by one or two on the others
- plan to complete test in 8-16 minutes
- Measure pre-exercise HR and BP, both sitting and standing and record them
- explain test to client. Each stage of test lasts one to two minutes
- toward the latter part of each stage (20-30 seconds), measure the HR and the ask client to do talk test, evaluate their ability (fats are the primary fuel below VT1, and carbohydrates are the primary fuel above VT1-noticable increase in breathing rate-able to only string 5 to 10 words together becomes challenging)
- Have client do a warm up to get used to machine for three to five minutes
- -Test protocol:
- adjust workload so client’s HR is about 120 bpm or intensity of 3 or 4 on a 10-point scale. Record the value.
- go through stages, asking client how they feel at the end of each stage
- Once the HR at VT1 is identified, progress to cool-down stage (matching warm-up) for three to five minutes
- –Lactate threshold testing (VT2)-onset of blood lactate (OBLA)
- -Appropriate use: best performed using HR telemetry (HR strap and watch) for continuous monitoring. People being tested should be experienced with the selected modality to effectively pace themselves at their max during the test. It should only be performed on clients who are low to moderate risk and who are successfully training in phase 3 (anaerobic endurance) of the ACE IFT Model
- -Pre-Test:
- briefly explain purpose of the test
- light warmup (2-3 out of 10 effort) for three to five minutes, maintaining a HR below 120 bpm
- -Test protocol:
- begin by increasing intensity to the predetermined level, remember that they have to maintain this for 20min
- during the last 5 min of exercise, record HR at each minute interval
- use the average HR collected over the last five minutes to account for any cardiovascular drift associated with fatigue, thermoregulation, and changing blood volume
- Multiply the average HR during the 15-20 minute high intensity exercise bout by .95 to determine the VT2 estimate
