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
Field Tests
- –Rockport fitness walking test (1 mile)
- -Appropriate use: good for most individuals except those who are well-conditioned, which will generally under-predict VO2 Max. Good for large groups of people and individuals can reassess on their own. This should be considered for a client who wants to walk/run outside as his or her mode of fitness training. Can also use treadmill.
- -Equipment:
- treadmill or quarter-mile track
- stopwatch
- RPE chart
- HR monitor with chest strap (optional)
- -Pre-Test:
- explain test, then define the one mile course.
- Only walking is allowed. Remind clients to pace themselves.
- Discuss RPE
- -Test Protocol:
- record client’s weight (kg) and age
- on trainer’s “go” the stopwatch begins and clients go
- Client’s 1-mile time, RPE, and immediate post-exercise heart rate are recorded on test form. Can do manual pulse for 15 sec then multiplied by 4 to determine an accurate HR immediately post-exercise.
- 3-5min cool-down, followed by stretching
- -Evaluation of performance:
- Females: VO2 (mL/kg/min)= 132.853 - (0.1692 x weight in kg) - (0.3877 x age) - (3.265 x walk time expressed in minutes to the nearest 100th) - (0.1565 x HR)
- Males: VO2 (mL/kg/min) = 139.168 - (0.1692 x weight in kg) - (0.3877 x Age) - (3.265 x walk time expressed in minutes to the nearest 100th) - (0.1565 x HR)
- record values on testing form
- evaluate client’s score using table 8-12 or 8-14 on page 227
- –1.5 mile run test
- -Equipment:
- treadmill or quarter-mile track
- stopwatch
- HR monitor with chest strap (optional)
- -Pre-test procedure:
- explain the purpose and define the one-mile course
- goal is to run as fast as possible for 1.5 miles, but walking is permitted, but itwill create an underestimate of VO2 Max score
- -Test Protocol:
- record the client’s weight (kg)
- when trainer says “go” test begins and stopwatch starts
- record client’s time and immediate post-exercise HR on testing form
- 3-5 min cool down with stretching of lower extremities
- Use formula: VO2 Max (mL/kg/min)= 88.02 - (0.1656 x weight in kg) - (2.76 x time, expressed in minutes to the nearest 100th) + (3.716 x sex*)
- 1 for males, 0 for females
- classify client’s score using table 8-12 or 8-15 on pages 228 and 229
Step Tests
Appropriate use: can be used in large groups and then for individual reassessment, not good for those who are extremely overweight, have balance concerns, with orthopedic problems, extremely deconditioned, those who are short in stature
- –YMCA sub maximal step test
- -Equipment:
- 12-inch step
- Stopwatch
- Metronome
- Stethoscope
- -Pre-Test:
- explain purpose, set metronome to cadence of 96 “clicks” per minute, which represents 24 step cycles/minute (or 96 foot placements)
- describe and demonstrate the four-part stepping motion (up, up, down, down), either foot can lead the sequence
- allow a short practice for clients
- goal is to do this for 3 minutes
- explain that HR will be measured through palpation for one full minute upon completion of the test, counting the number of beats during that first minute of recovery (they need to sit down immediately and be quiet)
- -Test protocol:
- on trainer’s cue, the client begins stepping and stopwatch is started
- can coach along the way, cue time remaining to keep the bitches on task
- at three-minute mark, the test is stopped, client sits down, and beats are recorded for one minute (important that the recording begins within 5 seconds of completing the test)
- record HR on test form
- 3-5minute cool down and stretch lower extremities
- classify client’s score using Table 8-16 or 8-17 (page 232 or something) and record values on testing form
Muscular endurance vs. muscular strength
End: represents a muscle’s ability to resist fatigue and perform work for successive repetitions
Strength: a muscle’s ability to overcome external resistance
Reasons for Muscular Fitness
- enhances the ability to carry out ADL, which translates to an increase in self-esteem and fosters a sense of independence
- Provides for musculoskeletal integrity, which translates to a reduction in common musculoskeletal injuries
- Enhances or maintains fat-free mass and ultimately positively impacts RMR, which is an important aspect of weight management
- Guards against osteoporosis by protecting or enhancing bone density
- Enhances glucose tolerance, which can protect against type 2 diabetes
- Reduces the cardiovascular response to resistance-type activities
Things to do prior to muscular endurance testing
- always screen for lower back pain and other orthopedic issues before testing
- If there is any pain during a test, terminate it and refer to doctor
- If client has a history of lower back pain or expresses some pain, have them consult a doctor before test
Push-up test
- Measures: upper bod (pectoralis muscles, triceps, and anterior deltoids), bad endurance can lead to poor posture or a variety of musculoskeletal problems
- Not appropriate for those with wrist, shoulder, or elbow issues
- After test, observe fitness categories on Table 8-18
Curl Up test
- Measures: abdominal strength and endurance
- Not good for: those with low back problems or those with cervical neck problems
Body-weight squat test
- Measures: muscular endurance of the lower extremity when performing repetitions of a squat and stand movement
- Not good for: a reconditioned, frail client with lower extremity weakness, one with balance problems, orthopedic issues (especially in the knees), and one who fails to demonstrate proper squatting technique
1-RM bench-press test
- use weight between 2.5lb and 45lb plates
- warm up with one set of light resistance (50% of predicted RM weight) that allows 5 to 10 repetitions and then rest for one minute
- have one or two spotters besides trainer
- have client perform one heavy set of 2 to three reps at approx. 85 to 90% of anticipated 1-RM weight and rest for 2min
- In general, should increase by approx. 5 to 10%
- Based on the client’s third set, determine the next workload to find the client’s 1-RM effort (table 8-23)
- Go through 1-5 (usually get it between 3 and 5) sets to determine 1-RM and rest appropriately
1-RM leg-press test
- warm up with one set of light ( approx. 50% of anticipated 1-RM) that allows 5-10 reps then rest for one minute
- determine a suitable workload for second set that allows for three to five reps (about 70-75%) rest for a min
- continue to increase weight for each set by 10 to 20%
- then perform heavy set of 2-3 reps at 85-90%, rest for 2 min
- base workload after third set
- attempt 1-RM then rest for 2-4min, maybe try again or heavier
1-RM squat test
- bar positioned below shoulders, but above nipple line, feet in split stance to unpack bar
- neutral position with head up and out
- lowering is initiated by flexion at hips first (focus on buttocks going back first before bending knees), bend until thighs are parallel to floor
- refer to leg press for process
Submaximal strength tests
- exercises that exceed 10 repetitions this muscular endurance and not strength
- determine number of reps based on client’s experience (many begin with three sets of eight reps at 60 pounds)
- begin with warmup of lower intensity and rest for one to two min between
- used to estimate 1-RM (refer to table 8-28)
Standing Long Jump Test (Anaerobic)
- Need jumping area (at least 20 feet) with good traction, tape measurer, tape
- encourage clients to use arms and legs for propulsion
- put tape on floor for starting line, have client position toes right behind it, after they jump measure the rearmost point of contact, allow three attempts (table 8-30, 8-31)
Vertical Jump Test (Anaerobic)
- Need:smooth wall with high ceiling, flat stable floor with good traction, chalk, measuring tape/stick, step stool or small ladder
- have client stand next to wall (6 in from it), and reach arm overhead to mark wall
- encourage client to use arms and legs for propulsion, 3 reps, table 8-32
Pro agility test
Measures: someone’s ability to accelerate, decelerate, change direction, then accelerate again
- Need: measuring tape, cones, stopwatch, place to do it
- start in middle, sprint to first 5 yard mark, then across middle to 10 yard mark, then back to middle (repeat two more times with resting between), record fastest of three trials
40-yard dash
- Determines acceleration and speed
- need running track, stopwatch, cones
- begin in 3 or 4 point stance, being watch at first movement and stop it when chest crosses line, time is measured to one hundredth of a sec, do just two trials (rest for two min in between at least) and record average of the two
Causes of Fitness Test inaccuracy
- Client (fatigue, lack of sleep, motivation, lack of conviction, excess activity prior to test, food intake prior, hydration level, chronic health conditions, medications or supplements)
- Trainer (inexperience with protocol, poor application of testing, partiality; trying to influence results, level of encouragement)
- Equipment (improper calibration, mismatched to subject, failure, out of order)
- Environment (distractions, privacy, temperature, weather conditions)
