Week 4 Health Appraisal And Fitness Assesments Flashcards
Why test health-related physical fitness?
- To educate participants about their present health/fitness status relative to health-related standards & normative data
- To provide data to help develop individualized exercise prescriptions to address all health/fitness components
- To collect baseline and follow up data to allow the evaluation of progress by the participant
- To motivate the participant by establishing reasonable and attainable health/fitness goals
What do we need to consider?
• Test appropriateness
-Specific to the component of heath/fitness?
- Match the needs, goals and capacity of client?
• Testing order
1. Resting BP, HR & Body composition
2. Cardiorespiratory endurance
3. Muscular fitness
4. Flexibility
• Testing environment
-Friendly, quiet, private, safe and comfortable
-Temp & humidity should be consistent
What do we need to consider? Pt 2
• Test validity
-Ability of the test to measure accurately, with minimum error, a specific physical fitness component. Validity coefficient > 0.8
• Test reliability
-Ability to yield consistent and stable scores across trials and over time. Reliability coefficient > 0.9 – Intra-tester reliability
• Test objectivity
-Objective tests yield similar test scores for a given individual when the same test is administered by different exercise professionals. Inter-tester reliability
(Another tester)
Test Administration & Interpretation
You cannot obtain valid test score if you do not follow standardised testing procedures
Pre-test instructions: What instructions would you give?
• Wear suitable clothing
• Drink plenty of fluids during 24 hr period before the test
• Refrain from eating, smoking, drinking alcohol or caffeine 3hr prior to test
• Do not engage in strenuous physical activity the day of the test
• Get enough sleep (>6 hr) the night before the test
To classify your client’s health/fitness status, you should compare test scores to established, age and sex matched norms
Eg footballer on a footballer
Recap on static tests
• Resting heart rate
• Blood pressure
• Body composition
• Skinfold
• Body Mass Index (BMI)
• Waist circumference
• Waist-to-hip ratio
• Lung function
Resting CV function - HR
Bradycardia < 60 bpm
-high levels of CV fitness
-hypothermia
-hypothyroidism
-drugs (beta blockers)
Exercise increase stroke volume = lower heart rate
Tachycardia >100bpm at rest
Poor CV fitness
Alcohol, caffeine, nicotine
Stress, anxiety
Heart failure
Drugs (adrenaline)
Resting CV function - BP
Blood Pressure = Cardiac Output x Total Peripheral Resistance
-acute
-stress, anxiety, physical activity, caffeine, smoking
-chronic
Inactivity, obesity, high dietary salt intake/ low dietary potassium intake, excessive alcohol intake
Measurement error
Improper cuff width or length, too small cuff causes cuff hypertension
120/80
Systolic/ diastolic
Body composition
BC refers to body weight in terms of absolute and relative amounts of muscle, bone and fat tissue
How can we directly assess it?
• Dissolving a cadaver in a chemical solution to determine its mixture of fat
& fat-free components
• Dissecting the fat mass, muscle, bone and other organs to determine BC
Indirect
BMI
GIRTH MEAsures
Skinfold measures
BIA
Densitometry
X-ray
Absorba try (DXa)
Densitometry
• Density = Ratio of body mass to body volume (DB=BM/BV)
• Body volume determined from under water weighing and plethysmography
• % Body fat can be estimated once body density has been determined
• Two component model: divides body into fat & fat free mass
% fat =. 495/ body density - 450
• Assumes a constant density for fat and fat-free tissue among individuals which isn’t always the Case
Hydrostatic weighing
• Archimedes’ Principle
‘a submerged object is buoyed up by a force equal to the volume of water it displaces’
• BV = difference between BM measured in air and BM measured during water submersion
• BV = loss of weight in water
Bone & muscle has a greater density vs fat. Therefore, a person with more body fat will weigh less underwater and be more buoyant
Bod Pod
Uses air displacement rather than water displacement to estimate the volume of the body
• Pressure changes in the chamber are related to the size of the person
• BV = volume of the chamber without the client - volume of the chamber with the client
Bioelectrical Impedance Analysis
Uses low-level electrical current
• Water and electrolyte content of lean tissue will facilitate flow of current
• Adipose tissue will oppose (impede) flow of current
• Voltage drop from point A to point B is used to calculate % body fat.
• Dependent on hydration status
BIA – Effect of prior exercise
Fluid shift by exercise
Dual x-ray absorptiometry (DXA)
Reliably and accurately quantifies bone mineral content, total fat mass & FFM
• Attenuation of x-rays dependent on the density & thickness of underlying tissue
• Analysis can include selective trunk regions for detailed study of tissue composition and its relation to disease risk
Body Mass Index
BMI = BM (kg) / stature (m2)
Doesn’t take into account muscle
Fine for general use, maybe use for athlete but need to note that it doesn’t take into account muscle
Waist Circumference
Abdominal obesity indicators such as WC and W:HR are stronger predictors for CVD risk than general obesity indicator i.e. BMI
Low risk. Males < 94 cm. Females < 80 cm
High risk. Males ≥ 102 cm. Females ≥ 88 cm
Public Health England – Adults with a large waist are 5x more likely to get type II diabetes
Song et al (2013); Public Health England (2014)
Hormonal changes could effect results
Waist-to-hip ratio
Waist measurement cm/ hip measurement
High risk. M > 1.0. F > 0.85
Mod risk. M 0.9 – 1.0. F 0.80 – 0.85
Low risk. M< 0.90. F< 0.80
3.5% error with mastered technique
Body fats can be calculated and used to determine the clients overall lean mean mass and body fat mass
Lean mass= higher metabolic rates
Skinfold measures
Body fat % can be calculated from this and used to determine the clients overall lean mass and body fat mass
% fat = 495/ body density - 450
Cardiorespiratory endurance
Reference of measure = Direct measurement of VO2max (ml.kg- 1min-1)
Lab or reference method = Maximal GXT
Indirect measures or field test = Submaximal GXT, distance run/walk tests, step tests
Group predicted error (SEE AND TE) = <5.0 ml.kg-1min-1
Db = total body density; FFM = fat-free mass, % BF = relative body fat; SEE = standard error of estimate; TE = total error; GXT = graded exercise tests; ROM = range of motion, RM = repetition maximum; NR = not reported, Nm = newton-meter
BODY COMPOSITION
Reference of measure = Db (g.cc-1), FFM (kg), or % BF
Lab or reference method = Hydrodensitometry or dual-energy X-ray absorptiometry
Indirect measures or field test= Bioimpedance, skinfolds, anthropometry
Group predicted error (SEE AND TE) = <0.0080 g.cc-1
<3.5 kg FFM (men) <2.8 kg FFM (women) <3.5 %BF
Db = total body density; FFM = fat-free mass, % BF = relative body fat; SEE = standard error of estimate; TE = total error; GXT = graded exercise tests; ROM = range of motion, RM = repetition maximum; NR = not reported, Nm = newton-meter
Muscular strength
Reference of measure = Maximal force (kg) or Torque (Nm)
Lab or reference method= Isokinetic or 1-RM tests
Indirect measures or field test= Submaximal tests (2 to 10-RM value)
Group predicted error (SEE AND TE) = <2.0 kg
Db = total body density; FFM = fat-free mass, % BF = relative body fat; SEE = standard error of estimate; TE = total error; GXT = graded exercise tests; ROM = range of motion, RM = repetition maximum; NR = not reported, Nm = newton-meter
Flexibility
Reference of measure = ROM at joints (degrees)
Lab or reference method= X-ray or goniometry
Indirect measures or field test= Linear measures of ROM
Group predicted error (SEE AND TE) = <6o
Db = total body density; FFM = fat-free mass, % BF = relative body fat; SEE = standard error of estimate; TE = total error; GXT = graded exercise tests; ROM = range of motion, RM = repetition maximum; NR = not reported, Nm = newton-meter
Cardiorespiratory Fitness
The ability of the heart, lungs and muscle to take in, transport and utilise oxygen during exercise
Why test Cardiorespiratory Fitness?
Higher levels of aerobic fitness are associated with:
– Reduced risk of chronic disease
– Improved endurance performance
Reasons for testing include:
– Providing a basis for exercise programming
– Evaluating the effectiveness of a training program – Screening for diseases (CHD)
– Determining physical function
How do we express Cardiorespiratory Fitness?
Maximum Oxygen Uptake (VO2max)
•Maximum volume of oxygen consumed by the body each minute during large muscle group exercise at sea level
Units
• Litres of oxygen used by the body per min (L.min) absolute
• Millilitres of oxygen used per kilogram of body weight per
minute (ml.kg-1min-1)
Relative (take into account body weight)
Compare both
How can we estimate VO2max?
Field based tests
• 20m Multistage Fitness Test (BleepTest)
• Coopers 12-min run [VO2 = 3.126(meters in 12min)-11.3]
• Rockport Fitness 1 mile Walking Test
Cycler ergometers
• Astrand-Rhyming (single stage test)
• YMCA (2-4 stage test)
Treadmill Tests
• Bruce (larger increments)
• Balke-Ware (smaller increments)
Step Tests
• McCardle / Siconolfi / Harvard / YMCA
Platu is VO2 Max
Max vs. sub-max exercise test
You can use a maximal or submaximal graded exercise test (GXT) to assess cardiorespiratory fitness, the selection depends on:
• Your clients age and risk stratification
• Your reasons for administrating the test
— Physical fitness, performance or clinical testing?
• The availability of appropriate equipment and qualified personnel
Assumptions of a sub-max test
- Linear relationship exist between VO2 and HR
– True for light to moderate workloads but relationship becomes curvilinear at heavier workloads - Efficiency /economy (VO2 at given work rate) during cycling or treadmill exercise is constant for all individuals
– But untrained individuals are more inefficient so have a higher HR at given workload
– Predicted VO2max tends to be overestimated for highly trained individuals and underestimated for untrained individuals - HRmax for clients of a given age is similar
1. But can vary as much as ± 11 bpm between people
2. + inaccuracy of using age-predicted HRmax
3. = error (± 10 – 15%) in estimating VO2max
When should you stop a test?
General indications for stopping exercise tests with low-risk adults (ACSM, 2011)
• Onset of angina-like symptoms
• Drop in SBP of > 10 mmHg from baseline despite increased workload
• Excessive rise in BP: SBP > 260 mmHg or DBP > 115 mmHg
• Signs of poor perfusion (light-headedness; confusion; ataxia; pallor; cyanosis; nausea or cold clammy skin)
• Failure of the HR to rise with increased exercise intensity
• Noticeable change in the heart rhythm
• Client request to stop
• Physical or verbal manifestations of severe fatigue
• Failure of testing equipment
Single-stage Treadmill Jogging Test (George et al. 1993)
~ 5 min (steady state) running at comfortable speed 4.3 – 7.5 mph, level gradient
• Steady state HR should not exceed 180 bpm and treadmill speed restricted to ≤7.5mph for males and ≤6.5mph for females
• Estimate VO2 max using an equation VO2 max = 54.07 + 7.062 * Gender (0=female, 1=male) – 0.1938 * weight (kg) + 4.47 * Speed (mph) – 0.1453 * Heart Rate (bpm). R=0.84
Astrand-Rhyming Cycle Ergometer Submax test
~ 6 min cycling at 75 – 150 W
• Measure HR every min & record average HR in 5th and 6th min
• Estimate VO2 max using the Astrand-Ryhming nomogram.
Muscular Fitness
Muscular Strength
• The ability of the muscles to exert a force
Muscular Endurance
• The ability of the muscles to perform successive exertion or many repetitions
Muscular Power
• The ability of the muscles to exert force per unit of time (i.e rate)
Why test muscular fitness?
Muscular fitness is a health-related components of fitness that may improve or maintain the following:
• Bone mass, related to osteoporosis
• Glucose tolerance
• Musculotendinous integrity, related to lower risk of injury
• Physical Function
• FFM and resting metabolic rate, which are related to weight management
Muscular fitness test results can be compared to established standards, and be helpful in identifying weaknesses in certain muscle groups or imbalances that could be targeted in exercise training programmes
Static ‘isometric’ strength test
• No overt muscular movement at the given joint or group of joints
• Maximal voluntary contraction (MVC)
Dynamic strength test
Movement of an external load or body part in which the muscle changes length
• One-repetition maximum (1-RM): The maximum weight that can be lifted through the full range of motion, for one repetition, with proper form
• A multiple RM, such as 4 or 8 RM can also be used as measure of muscular strength
• Assessment of 10 – 15 RM recommended for some ‘at risk’ groups
Isokinetic Dynamometry
Criterion measure of muscle strength
• Assessment of static (MVC) and dynamic muscle (isokinetic) strength & joint function
• Allows manipulation of joint angle, ROM & joint angle velocity
• Requires correct positioning/ stabilisation and joint axes alignment
1-RM guidelines
Valid measures for upper body = Bench press & Shoulder press
• Valid measures for lower body = Leg press & Knee extension
• Warm-up by completing 5 – 10 repetitions of the exercise at 40 – 60% of the estimated 1-RM
• Follow this with 3 reps of the exercise at 70% of the estimated 1-RM
• Set the load at ~ 80% 1-RM and attempt repetition
• Progressively increase load in 5% increments until the participant cannot complete the selected repetition; all reps should be performed at the same speed of movement and ROM
• Determine the 1-RM (or multiples of 1-RM) within four trials with rest periods of 3 – 5 min between trials
• Record the 1-RM value as the maximum weight lifted for the last successful trial
Muscle Endurance
Select an appropriate submaximal level of resistance (absolute [20kg] or relative [70% 1-RM]) and perform……..
Isometric muscle endurance tests
• Measuring the duration of static muscle action before fatigue
• Time to failure measures (Time Max in s)
• Simple field tests: Planks, Side Plank, Back / Prone Extension, V-sit hold.
Dynamic muscle endurance tests
• Measuring the number of repetitions before fatigue
• Repetition maximum (Rep Max)
• Simple field tests: Press up, curl-up, bridging, calf raise
• Use exercises proportional to body mass
Muscle balance assessments
Maintaining a balance in strength between
Agonist and antagonist muscle groups
Contralateral (right vs left sides)
Upper and lower body
Is important because muscular imbalance may not only affect performance but also compromise joint stability it’s and increase risk of musculoskeletal injury
Recommended ratios
Hip extensors & flexors. 1:1
Elbow extensors & flexors. 1:1
Trunk extensors & flexors. 1:1
Ankle inverters & evertors. 1:1
Shoulder flexors & extensors. 2:3
Knee extensors & flexors. 3:2
Shoulder internal & external rotators. 3:2
Ankle plantar flexors & dorsiflexors. 3:1
Fitness Testing
Press Up Rep Max
• Prone/ Back Extension Time Max
• Single Leg Calf Raise Rep Max
• Single Leg Bridge Rep Max
• Side Plank Time Max
• Double Leg Lowering Rep Max
Flexibility
The ability to move a joint through its complete ROM
Why test it?
• Adequate levels of flexibility required for Physical Function
• Individuals with too little (ankylosis) or too much (hypermobility) flexibility are at higher risk than others for musculoskeletal injuries
How do we test it?
• Flexibility is joint specific, so no single flexibility test can be used to evaluate total body flexibility
• ROM expressed in degrees
Static flexibility and dynamic flexibility
Static flexibility is a measure of the total ROM at the joint, and it is limited by the extensibility of the musculotendinous unit
• ROM at the hip joint is influenced by tightness in the hip flexors & extensors
• Thomas Test - measure iliopsoas and quadriceps muscle flexibility
• Active knee extension test & sit and reach test - measure hamstring flexibility
Dynamic flexibility is a measure of the rate of torque or resistance developed during stretching throughout the ROM
Comprehensive health-fitness evaluation
• Pre-screening / risk stratification
• Resting HR, BP, height, weight, BMI and ECG (if appropriate)
• Body composition
—Waist circumference
—Skinfold assessment
• Cardiorespiratory fitness
• Submaximal or maximal test typically on a cycle ergometer or treadmill
• Muscular strength
• 1- to multiple – RM upper body (bench press) and lower body (leg press)
• Muscular endurance
• Muscle conditioning tests: Push up, prone extension, side plank etc
• Flexibility
• Sit-and-reach or goniometric measures of isolated anatomic joints
Take home points
- consider test appropriateness, validity, reliability and objectivity and standardise pre-test procedures
- resting measures of CV function, body composition and anthropometry can be used to asses health status and risk classification
- criterion “ gold standard” direct measures of fitness components are more valid but not always feasible
Be aware of the assumptions/ limitations and sources of error with indirect field based measures
