FITNESS ASSESSMENT FORM

Name: ___________________________________ Class Schedule: _____________________

Goal: ____________________________________

Static Postural Assessment

Anthropometry: Girth Measurement
Kinetic Movement IE 1st RE
View Chain Observation IE 1st RE
L R L R Chest
Checkpoints
Head Forward head* Right Upper Arm
Shoulder Protracted*
Right Forearm
Retracted
Lateral Lumbo- Anteriorly Waist
pelvic-hip tilted* Hips
Posteriorly
Right Thigh
tilted
Adducted Right Calf
Anterior Knees Abducted Waist and Hip Ratio:
Internally
rotated*
Externally rotated
Feet Flat*

Dynamic Postural Assessment: Overhead Squat Cardiorespiratory Endurance: Step Test

View Kinetic Chain Movement IE 1st RE 60-sec HR
Checkpoints Observation L R L R IE
Feet Turns out Interpretation
Anterior Moves inward 1st RE
Knees Interpretation
Moves outward
Lumbo-pelvic- Excessive forward
Lateral hip lean
Low back arches
Low back rounds
Shoulder Arms fall forward
Anaerobic:300-Yard (274m) Shuttle
Feet Heel of foot rises
Foot flattens Trial 1 Trial 2 Average
Posterior Lumbo-pelvic- Assym. Weight IE 52-53 secs 50-52 secs
hip shift Interpretation Average above avaerage
Shoulder Shoulder elevated st
1 RE
Interpretation

Agility: Hexagon Test

Flexibility: Sit-and-Reach Test Trial 1 Trial 2 Trial 3 Average
IE
Trial 1 Trial 2 Trial 3 Best (cm)***
IE 36-44 cm 16cm- Interpretation
25cm 1st RE
Interpretation Interpretation
1st RE
Interpretation

Aerobic: 12-Minute Run

Speed: 40-Yard (37m) Sprint
Laps Distance Result (m)
Trial 1 Trial 2 Average
IE
IE Interpretation
Interpretation 1st RE

1st RE Interpretation
Partial Curl Up
Interpretation Repetitions
IE
Interpretation
1st RE
Interpretation
 Strength
1 RM=

Criterion Scores and Normative Values

Cardiovascular Endurance: 3 Minute Step Test

Duration of Exercise (sec) x 100/ Recovery
pulse x 5.6
=CV Efficiency

Zone One MHR x 0.65

MHR x 0.76

Zone Two MHR x 0.76

MHR x 0.85
Zone Three MHR x 0.86
MHR x 0.90
Very Poor Zone One
Poor
Below Average Zone One
Average Zone Two
Above Average
Zone Two
Good
Excellent Zone Three

Aerobic: 12 Minute- Run (Male) Speed: 40-Yard (37m) Sprint

Age 13-14 15-18 17-20 20-29 30-39 40-49 >50 Rating Men Women
Excellen >2000 >2800 >3000m >2800 >2700m >2500 >2400m Very good <4.80 <5.30
t m m Good 4.80-5.29 5.30-5.59
Above 2400- 2500- 2700- 2400- 2300- 2100- 2000- Average 5.10-5.29 5.60-5.89
Average 2700 2800 3000m 2800m 2700m 2500m 2400m
Fair 5.30-5.60 5.90-6.20
Average 2200- 2300- 2500- 2200- 1900- 1700- 1600-
2399 2499 2699m 2399m 2299m 2099m 1999m Poor >5.60 >6.20
Below 2100- 2200- 2300- 1600- 1500- 1400- 1300-
Average 2199 2299 2499m 2199m 1999m 1699m 1599m
Poor <2100 <2200 <2300m <1600 <1500m <1400 <1300m
m m Anaerobic: 300-Yard (274m) Shuttle
Excellen Above Average Below Poor
t Average Average
<50 50-52 52-53 53-55 >55
secs secs secs secs secs
Aerobic: 12 Minute-Run (Female)
Age 13-14 15-18 17-20 20-29 30-39 40-49 >50
Excellen >2000 >2100 >2300m >2700 >2500m >2300 >2200m Waist-to-Hip Ratio
t m m Formula: Waist measurement/Hip
Above 1900- 2000- 2100- 2200- 2000- 1900- 1700- Measurement=Waist to Hip Ratio
Average 2000 2100 2300m 2700m 2500m 2300m 2200m Men Women
Average 1600- 1700- 1800- 1800- 1700- 1500- 1400- Prone to Chronic >0.95 >0.80
1899 1999 2099m 2199m 1999m 1899m 1699m Diseases
Below 1500- 1600- 1700- 1500- 1400- 1200- 1100-
Average 1599 1699 1799m 1799m 1699m 1499m 1399m
Poor <1500 <1600 <1700m <1500 <1400m <1200 <1100m
m m

Agility: Hexagon
FLEXIBILITY: Test
Sit and Reach
Gender Excellent Above Average Average Below Average Poor
Male <11.2 secs 11.2-13.3 secs Men
13.4-15.5 secs Women
15.6-17.8 secs >17.8 secs
Female <12.2 secs Superior
12.2-15.3 secs >42
15.4-18.5 secs >45
18.6-21.8 secs >21.8 secs
Excellent 32cm-41 cm 36-44 cm
Good 21cm-29cm 26cm-35cm
Average 15cm-20cm 16cm-25cm
Fair 8cm-15cm 7cm-15cm
Poor 1cm-2cm 5cm-6cm
Very poor <1cm <5cm