Name: _Necellen Elum___________________________

Course/Yr. Level: _BSED MATH_2__________________

Age: ____20______
Sex: ___FEMALE_______

Test Items Test Results Final Rating

BMI _______

Standing Long Jump _______ cm.

(Power)

Sit and Reach _______ cm.

(Flexibility)

Stork Balance Left: _______ secs/minutes

(Balance)
Right: _______ secs/minutes

Hexagonal Step _______ secs/minutes

(Agility and Reaction Time)

3-Minute Step Test _____ pulse rate

(Cardiovascular)
Photo
INDIVIDUAL RECORD FORM
(Physical Fitness Pre-testing)

Final Rating:

Excellent Very Above Average Average Below Poor Very Poor

Good Average
5 4.5 4 3.5 3 2 1.5

PHYSICAL ACTIVITY READNIESS QUESTIONNAIRE (PAR-Q)

The DOH recommends that Filipinos participate in moderate to vigorous physical activities for at least
30 minutes for most days of the week. Physical activity is good for the heart and strengthens the body. Since
physical activity is safe for most people, everyone is encouraged to pursue an active lifestyle.
This questionnaire will help you check if moderate to vigorous physical activity is safe for you.
Instructions: Put a check mark on the box that corresponds to your answer. If you answer “NO” to all the
questions, you are ready to engage in an active lifestyle. Start an exercise program that has low to moderate
intensity activities and build your intensity gradually. If you answer “YES” to any question, you need to talk to
your physician about your condition before participating in an exercise program.
 Question Yes No
1. Has your doctor ever told you that you have a heart
condition or a high blood pressure?
2. Do you feel pain in your chest when you are doing your
daily activities or when you do physical activities?
3. Do you lose balance because of dizziness or have you
lost consciousness in the past 12 months?
4. Have you ever been diagnosed with chronic condition
other than heart disease or hypertension (i.e., cancer)?
5. Are you currently taking prescribed maintenance
medications?
6. Do you currently have a bone, joint, or other
musculoskeletal condition that can worsen as a result of
moderate to vigorous physical activity?
7. Has your doctor ever told you that you should only
engage in medically supervised physical activity?

Body Mass Index

equipment required: scales and stadiometer as for weight and height.
procedure: BMI is calculated from body mass (M) and height (H). BMI = M / (H x H), where M = body
mass in kilograms and H = height in meters. The higher the score usually indicating higher levels of
body fat.
scoring: Use the table below to determine your BMI rating. The table shows the World Health
Organization BMI classification system. The rating scale is the same for males and females. You can
also use the reverse lookup BMI table for determining your ideal weight based on height.

classification BMI (kg/m2) sub-classification BMI (kg/m2)

underweight < 18.50 Severe thinness < 16.00

Moderate thinness 16.00 - 16.99

Mild thinness 17.00 - 18.49

normal range 18.5 - 24.99 normal 18.5 - 24.99

overweight ≥ 25.00 pre-obese 25.00 - 29.99

Obese obese class I 30.00 - 34.99

(≥ 30.00)

obese class II 35.00 - 39.99

obese class II ≥ 40.00

Procedure:
Standing Long Jump
The student stands behind a line marked on the ground with feet slightly apart. A two foot take-off and
landing is used, with swinging of the arms and bending of the knees to provide forward drive. The subject
attempts to jump as far as possible, landing on both feet without falling backwards. Three attempts are
allowed.  The measurement is taken from take-off line to the nearest point of contact on the landing (back of
the heels). Record the longest distance jumped, the best of three attempts.

RESULT PROCEDURE
 Sit and Reach
Place the ruler/tape measure on the ground between your legs or on the top of the step. Place one
hand on top of the other, then reach slowly forward. At the point of your greatest reach, hold for a couple of
seconds, and measure how far you have reached.
PROCEDURE
RESULT

Stork Balance Test

Remove the shoes and place the hands on the hips, then position the non-supporting foot against the
inside knee of the supporting leg. The subject is given one minute to practice the balance. The subject raises
the heel to balance on the ball of the foot. The stopwatch is started as the heel is raised from the floor. The
stopwatch is stopped if any of the follow occur:

 The hand(s) come off the hips

 The supporting foot swivels or moves (hops) in any direction

 The non-supporting foot loses contact with the knee.

 The heel of the supporting foot touches the floor.

Rating Score (seconds)

Excellent > 50

Good 40 - 50

Average 25- 39

Fair 10 - 24

Poor < 10

Scoring: The total time in seconds is recorded. The score is the best of three attempts. The table lists general
ratings for this test.
Hexagonal Agility Te

test layout: Using athletic tape, mark a hexagon (six sided shape) on the floor. The length of each side should
be 24 inches (60.5 cm), and each angle should work out to be 120 degrees.

procedure: The participant begins with both feet together in the middle of the hexagon facing the front line.
On the command 'go', they jump ahead across the line, then back over the same line into the middle of the
hexagon. Then, continuing to face forward with the feet together, they jump over the next side and back into
the hexagon. Continue this pattern for three full revolutions, continuing to face forwards throughout the test.
Perform the test both clockwise and anti-clockwise.

scoring: The athletes score is the time taken to complete three full revolutions. The best score from two trials
is recorded. Comparison of the anti-clockwise and clockwise directions will show if any imbalances exist
between left and right movement skills.

3-minute Step Test

A 12 inch high bench (or a similar sized stair or sturdy box), a watch for timing minutes. Step on and off
the box for three minutes. Step up with one foot and then the other. Step down with one foot followed by the
other foot. Try to maintain a steady four beat cycle. It's easy to maintain if you say "up, up, down, down". Go
at a steady and consistent pace. This is a basic step test procedure.
PROCEDURE

At the end of three minutes, remain standing while you immediately check your heart rate. Take your
pulse for one minute (e.g. count the total beats from 3 minutes after starting the test). 

RESULT