Components of a Fitness Assessment & Major Coronary Risk Factors and Pre-Participation Guidelines as Established by the American College of Sports Medicine (ACSM)

Components of a Fitness Assessment • Initial Consultation • Pre-participation Health Screening: – Lifestyle Questionnaire including Exercise History – PAR-Q – Medical History Questionnaire • Determine Positive and Negative Risk Factors for CAD • Determine Risk Stratification –Medical Clearance –Informed Consent

Components of a Fitness Assessment • Exercise Testing: – Vital Signs • Heart Rate • Blood Pressure – Height/Weight – Body Composition – Girth Measurements – Flexibility/Movement Analysis – Balance – Muscular Strength – Muscular Endurance – Cardiovascular Endurance

Performing A Fitness Assessment • Collect data to build an appropriate personal training plan • Assessment should be client centered and based on their short and long term goals • Explain to client what is being assessed and why • Choose assessment tests and tools appropriate to client’s: gender, age, developmental level, medical status, functional abilities • Perform assessment tests correctly

Performing A Fitness Assessment • Analyze and summarize findings • Document results • Communicate results to client and establish health/fitness program and goals

Personal Training Plan • What ought to be done?

–Am I doing what is best for my client?

• Goals –Prepare schedule for exercise program based on fitness assessment results –Discuss changes in nutritional habits –Discuss health-related lifestyle habits (smoking, alcohol use…) –Implement motivational techniques

Initial Consultation • Assess Client-Trainer Compatibility • Discuss Goals (Short and long term) • Establish Client-Trainer Agreement • Perform Pre-Participation Health Screening – Lifestyle Questionnaire including Exercise History – PAR-Q (Physical Activity Readiness Questionnaire) – Health/Medical Questionnaire – Informed Consent – Medical Release Form

What is a Risk Factor ?

• An aspect of personal behavior or lifestyle, an environmental exposure or inherited characteristic, which, on the basis of epidemiological evidence, is known to be associated with health related conditions considered to be important to prevent

Purpose of the Pre-Participation Health Screening as defined by the American College of Sports Medicine (ACSM)

1. To identify and exclude individuals with medical contraindications to exercise.

2. To identify persons with clinically significant disease conditions who should be referred to a medically supervised exercise program.

Purpose of the Pre-Participation Health Screening as defined by the American College of Sports Medicine (ACSM )

3. To identify individuals with disease symptoms and risk factors for disease development who should receive further medical evaluation before starting an exercise program.

4. To identify persons with special needs for safe exercise participation (e.g., elderly persons, pregnant women).

Pre-Participation Health Screening • PAR-Q –Physical Activity Readiness Questionnaire –Developed in Canada –A questionnaire for people aged 15-69 –Identifies individuals at increased risk for disease because of age, symptoms, and/or risk factors who should undergo medical evaluation

Pre-Participation Health Screening • Health History Questionnaire –Identifies: • Heart Disease Risk Factors • Injury or orthopedic conditions (such as a back, hip, or knee problem) • History of illness and medications • Known disease • Special needs • Activity level

Coronary Artery Disease • Narrowing of coronary arteries usually caused by arteriosclerosis (pathological condition resulting in thickening, hardening and loss of elasticity of arterial walls)

Risk Factors for Coronary Artery Disease (CAD) Established by the ACSM •

Positive Risk Factors

– Family History – Cigarette Smoking – Hypertension – Hypercholesterolemia – Diabetes Mellitus – Obesity – Sedentary Lifestyle •

Negative Risk Factors

– High Serum HDL Cholesterol

Risk Factors

• Count the number of positive risk factors and subtract the number of negative risk factors

Positive Risk Factor for CAD Established by the ACSM

Family History

•

At risk if Coronary Artery Disease is present or in the form of MI or Sudden Death:

–Father or Brother (1st degree relative) prior to the age of 55.

–Mother or Sister (1st degree relative) prior to the age of 65.

Positive Risk Factor for CAD Established by the ACSM

Cigarette/Cigar Smoking

•

At risk if,

–

Current

use is present –Residual effects may be manifest even if smoking has stopped •

Removal of Risk

–

Cessation for 6 months or greater

Positive Risk Factor for CAD Established by the ACSM

Hypertension (high blood pressure)

• Resting Blood Pressure > 140/90 mm Hg –Confirmed by 2 separate measurements –“Systolic>140

or

Diastolic >90” • Current Prescription for Blood Pressure Medicine (for hypertensive diagnosis)

Blood Pressure: Optimal Systolic <120 Normal 120-129 High Normal 130-139 Hypertension: Stage 1 140-159 Stage 2 160-179 Stage 3 >180 Diastolic <80 80-84 85-89 90-99 100-109 >110

Cholesterol • • •

Cholestero

l: a fatty waxy substance that occurs in all animal tissues.

High Density Lipoproteins (HDL’s):

Good cholesterol because it removes excess cholesterol from circulation

Low Density Lipoproteins (LDL’s):

A lipoprotein particle in the blood responsible for depositing cholesterol into the lining of the artery. Known as "bad" cholesterol because high LDL is linked to coronary artery disease

Positive Risk Factor for CAD Established by the ACSM • Hypercholesterolemia (positive risk) • On lipid lowering medications • If Lipoprotein profile is not available –at risk with Total Cholesterol > 200 mg/dL • If Lipoprotein profile is available –at risk with HDL cholesterol < 40 mg/dL –LDL>130 mg/dL

Negative

Risk Factor for CAD Established by the ACSM Hypercholesterolemia (Negative Risk) • Lipoprotein profile must be available.

• Subtract one risk factor if HDL cholesterol is equal to or greater than 60 mg/dL

LDL Cholesterol

<100 100-129 130-159 160-189 ≤190

Total Cholesterol

<200 200-239 ≤240

HDL Cholesterol

<40 ≤60

Triglycerides

<150 150-199 200-499 ≤500

Risk

Optimal Near optimal/above optimal Borderline High Very high

Risk

Desirable Borderline high High

Risk

Low High

Risk

Normal Borderline high High Very high

Positive Risk Factor for CAD Established by the ACSM

Diabetes Mellitus

•

At Risk if

: –Diagnosed with Diabetes Mellitus –Fasting glucose is greater than 100 mg/dL on two occasions

Positive Risk Factor for CAD Established by the ACSM

Obesity

• Body Mass Index (BMI) of 30 or greater • Waist to hip ratio greater than 0.95 (Men) and 0.86 (Women) • Waist girth greater than 40 inches (Men) and 35 inches (Women)

Positive Risk Factors for CAD Established by the ACSM

Sedentary Lifestyle

•

At risk if

: –A combination of a sedentary job involving sitting a large part of the day –The absence of regular exercise or a recreational pursuit (accumulating less than 30 min or more of moderate physical activity most days of the week)

Pre-Participation Screening Guidelines Defined by the ACSM

ACSM Risk Stratification Categories



Low Risk (apparently healthy): = 0 -1 Risk Factors and younger (

males under 45 and females under 55) 

Moderate Risk:= > 2 Risk Factors OR older (>45 males; >55 female)



High Risk= Current diagnosis of Cardiac,

Pulmonary, Metabolic disease (known (disease) or

> 1 Sign/Symptom of CAD

Pre-Participation Screening Guidelines Defined by the ACSM •

Low Risk

: Not necessary to have a current medical examination •

Moderate Risk

: If two or more risk factors are present it is recommended to have medical clearance prior to an exercise program •

High Risk

: Medical clearance needed

Signs/Symptoms of CAD or Pulmonary Disease • Angina (pain in chest, arms and jaw) • Shortness of breath at rest or with exercise • Dizziness • Heart Murmur • Syncope (fainting) • Ankle edema (swelling) • Tachycardia or Heart Palpitations • Unusual fatigue • Claudicating (cramp-like pain in the calf muscles; a specific limp caused by this pain)

Case Study • A 48-year old female desires to start an exercise program in your facility. Following an initial questionnaire and interview you find that she has no personal history of heart disease, but her father died following a heart attack at the age of 60. In addition, she has a resting BP of 145/85. Her total cholesterol is 220 with an HDL of 69. She is not obese. She currently walks 30 minutes 4 times per week, but does not strength train • According to ACSM, how many positive risk factors does she have? Stratify her risk (low, moderate, or high risk)

Case Study • John Smith is 43-years-old. His blood pressure is 128/82 mm/Hg, and his cholesterol is 222 mg/dL. He has a very stressful job and has not exercised in seven years. John’s 70-year old mother had a heart attack last year. • According to ACSM, how many positive risk factors does John have? Stratify his risk (low moderate, or high risk)

Informed Consent • Gives clients information about the content and process of the fitness assessment, exercise program and the risks and benefits associated with participation

Client Instructions for Fitness Assessments • Clients should refrain from ingesting food, alcohol, or caffeine or using tobacco products within 3 hours of testing • Clients should drink plenty of fluids over the 24-hour period preceding testing • Clients should be rested for the assessment, avoiding exercise on the day of the assessment • Clothing should permit freedom of movement and include athletic shoes

Components of A Fitness Assessment 1. Vital Signs • Heart Rate • Blood Pressure 2. Height/Weight 3. Body Composition 4. Girth Measurements 5. Flexibility/Movement Analysis 6. Balance 7. Muscular Strength 8. Muscular Endurance 9. Cardiovascular Endurance

Body Composition • Distribution of muscle and fat in the body, and its measurement • Body composition is often represented as a two compartment system; lean body weight and fat

Flexibility • Flexibility is the capacity of a joint to move through its full range of motion. • There is no single test that gives you a score for overall flexibility. • Each test is specific to a particular movement or joints.

Movement Screens •

These Screens are NOT designed to diagnose any medical conditions.

• They are simple assessments to help personal trainers get a better perspective of your clients' movements. • These screens give you an insight into where your client has developed imbalances in movements – Overhead squat, single-leg squat, lunge, supine active straight leg raise, seated chest press, seated row

Balance • Maintenance of a position without moving for a given period of time

Muscular Endurance • The ability of a certain muscle or muscle group to perform repeated contractions • Several seconds to several minutes • Examples: – Push-up – Abdominal Crunch – BW Squat – Pull-Up

Muscular Strength • A force a muscle or muscle group can exert • Examples: – Multiple Repetition Max for bench press and leg press

Cardiovascular Endurance • The ability to exercise continuously for extended periods without tiring • A person's aerobic fitness level is dependent upon the amount of oxygen which can be transported by the body to the working muscles, and the efficiency of the muscles to use that oxygen. • Examples: – 3 Minute Step Test – 1.0 mile Walk Test – 12 minute run – 1.5 mile run – Ergometer test