Par-Q+: General Health Questions

Figure 2.
PAR-
The Physical Activity Readiness Questionnaire for Everyone
Q+
The health bene ts of regular physical activity are clear; more people should
engage in physical activity every day of the week. Participating in physical
activity is very safe for MOST people. This questionnaire will tell you whether it
is necessary for you to seek further advice from your doctor OR a quali ed
exercise professional before becoming more physically active.
GENERAL HEALTH QUESTIONS
Please read the 7 questions below carefully and answer each one honestly: YES NO
check YES or NO.
1) Has your doctor ever said that you have a heart condition OR high
blood pressure ?
2) Do you feel pain in your chest at rest, during your daily activities of living,
OR when you do physical activity?
3) Do you lose balance because of dizziness OR have you lost consciousness in the
last 12 months?
Please answer NO if your dizziness was associated with over-breathing (including during vigorous
exercise).
4) Have you ever been diagnosed with another chronic medical condition (other
than heart disease or high blood pressure)? PLEASE LIST CONDITION(S) HERE:
5) Are you currently taking prescribed medications for a chronic medical condition?
PLEASE LIST CONDITION(S) AND MEDICATIONS HERE:
6) Do you currently have (or have had within the past 12 months) a bone, joint, or
soft tissue (muscle, ligament, or tendon) problem that could be made worse by
becoming more physically active? Please answer NO if you had a problem in the past, but it
does not limit your current ability to be physically active.
If you
PLEASE LISTanswered
CONDITION(S)NO to all of the questions
HERE: above, you are cleared for
physical activity.
Go your
7) Has to Page 4 ever
doctor to sign
saidthe
thatPARTICIPANT DECLARATION.
you should only You do not
do medically supervised need to
physical
complete Pages 2 and 3.
activity?
Start becoming much more physically active – start slowly and build up gradually.
Follow International Physical Activity Guidelines for your age
If you are over the age of 45 yr and NOT accustomed to regular vigorous to
(www.who.int/dietphysicalactivity/en/).
consult
maximala equali ed exercise professional before engaging in this
ort exercise,
You may take part in a health and tness appraisal.
intensity of exercise. If you have any further questions, contact a
quali ed exercise professional.
If you answered YES to one or more of the questions above,

COMPLETE PAGES 2 AND 3.
Delay becoming more active if:

You have a temporary illness such as a cold or fever; it is best to wait until you feel better.
You are pregnant - talk to your health care practitioner, your physician, a quali ed exercise
professional, and/or complete the ePARmed-X+ at www.eparmedx.com before becoming
more physically active.
Your health changes - answer the questions on Pages 2 and 3 of this document and/or talk
to your doctor or a quali ed exercise professional before continuing with any physical
activity program.
01-01-
2016
From NSCA, 2018, NSCA’s essentials of training special populations, P. Jacobs (ed.), (Champaign, IL: Human Kinetics). Reprinted, by permission,
from the PAR-Q+ Collaboration and the authors of the PAR-Q+ (Dr. Darren Warburton, Dr. Norman Gledhill, Dr. Veronica Jamnik, and
Dr. Shannon Bredin).
18
PAR-
FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL
Q+
1 CONDITION(S)
. If the
Do above
you havecondition(s)
Arthritis,is/are present, answer
Osteoporosis, questions
or Back 1a-1c If NO
Problems? go to
1a
question 2
YES
. Do you have di culty controlling your condition with medications or other physician- NO
prescribed therapies? (Answer NO if you are not currently taking medications or other
1b Do you have joint problems causing pain, a recent fracture or fracture caused by
treatments)
. osteoporosis or cancer, displaced vertebra (e.g., spondylolisthesis), and/or YES
spondylolysis/pars defect (a crack in the bony ring on the back of the spinal column)? NO
1c Have you had steroid injections or taken steroid tablets regularly for more YES
. than 3 months? NO
2 Do you have Cancer of any kind?

.
If the above condition(s) is/are present, answer questions 2a-2b If NO go to
2a question 3 YES
. NO
Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple
2b myeloma (cancer receiving
Are you currently of plasma cells),therapy
cancer head, and neck?
(such as chemotheraphy or YES
. radiotherapy)? NO
3 Do you have a Heart or Cardiovascular Condition? This includes Coronary

. Artery Disease, Heart Failure, Diagnosed Abnormality of Heart Rhythm
If the above condition(s) is/are present, answer questions 3a-3d If NO go to question
4
3a YES
3b Do you have an irregular heart beat that requires medical
treatments) YES
. management? (e.g., atrial brillation, premature ventricular NO
contraction)
3c Do you have chronic heart YES
. failure? NO
3d Do you have diagnosed coronary artery (cardiovascular) disease and have not participated YES
. in regular physical activity in the last 2 months? NO
4 Do you have High Blood Pressure?

.
If the above condition(s) is/are present, answer questions 4a-4b If NO go to question
4a 5 YES
. NO
4b Do
Do you
you have
have di culty blood
a resting controlling yourequal
pressure condition
to orwith medications
greater or other
than 160/90 mmHg physician-
with or
prescribed therapies? (Answer
(AnswerYESNO ifif you
you do
arenot
notknow
currently YES
. without medication? your taking
resting medications or other
blood pressure)
treatments) NO
5 Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2
. Diabetes, Pre-Diabetes
5a If the above condition(s) is/are present, answer questions 5a-5e If NO go to

YES
. question 6 NO
5b Do you often
Do you often have
su erdifrom signs
culty and symptoms
controlling of low
your blood blood
sugar sugar
levels (hypoglycemia)
with following
foods, medications, or
. exercise and/or during
other physician- activities
prescribed of daily living? Signs of hypoglycemia may include shakiness,
therapies? YES
nervousness, unusual irritability, abnormal sweating, dizziness or light-headedness, mental NO
confusion, di culty speaking, weakness, or sleepiness.
5c Do you have any signs or symptoms of diabetes complications such as heart or YES
. vascular disease and/or complications a ecting your eyes, kidneys, OR the sensation NO
in your toes and feet?
5d Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic YES
. kidney disease, or liver problems)? NO
5e Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise YES
. in the near future? NO
01-01-
2016
(continued)
19
6
PAR-
Do you have any Mental Health Problems or Learning Di culties? This
Q+
. includes Alzheimer’s, Dementia, Depression, Anxiety Disorder, Eating Disorder,
Psychotic Disorder, Intellectual Disability, Down Syndrome
If the above condition(s) is/are present, answer questions 6a-6b If NO go to
question 7
6a YES
prescribed therapies? (Answer NO if you are not currently taking medications or other YES
6b Do you have Down Syndrome and back problems affecting nerves
treatments) NO
. or muscles?
7 Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary
. Disease, Asthma, Pulmonary High Blood Pressure
If the above condition(s) is/are present, answer questions 7a-7d If NO go to question 8

7a Do you have di culty controlling your condition with medications or other physician- YES
. prescribed therapies? (Answer NO if you are not currently taking medications or other NO
treatments)
7b Has your doctor ever said your blood oxygen level is low at rest or during exercise
YES
. and/or that you require supplemental oxygen therapy? NO
7c If asthmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing,
NO
. (more thancough
consistent 2 days/week), or have you used your rescue medication more than twice
in the last week? YES
7d Has your doctor ever said you have high blood pressure in the blood vessels YES
. of your lungs? NO
8 Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia
. If the above condition(s) is/are present, answer questions 8a-8c If NO go to
question 9
8a YES
8b Do you commonly exhibit low resting blood pressure signi cant enough to cause dizziness,
treatments) YES
. light-headedness, and/or fainting?
NO
8c Has your physician indicated that you exhibit sudden bouts of high blood pressure YES
. (known as Autonomic Dysre exia)? NO
9 Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or
. Cerebrovascular Event
9a
If the above condition(s) is/are present, answer questions 9a-9c If NO go to question
. 10 YES
NO
9b Do you have
Do you have any
di impairment
culty controlling your condition
in walking or with medications or other physician- YES
. mobility?
treatments)
NO
9c Have you experienced a stroke or impairment in nerves or muscles in the YES
. past 6 months? NO
10. Do you have any other medical condition not listed above or do you have two or more
medical conditions?
If you have other medical conditions, answer questions 10a-10c If NO read the Page 4
10a Have you experienced a blackout, fainted, or lost consciousness as a result of a head YES
.
recommendations
injury within the last 12 months OR have you had a diagnosed concussion within the last NO
12 months?
10b Do you have a medical condition that is not listed (such as epilepsy, neurological conditions,
. kidney problems)? YES
10c Do you currently live with two or more medical NO
. conditions?
PLEASE LIST YOUR MEDICAL CONDITION(S) YES
NO
AND ANY RELATED MEDICATIONS HERE:
GO to Page 4 for recommendations about

your current medical condition(s) and sign the
PARTICIPANT DECLARATION.
01-01-
2016
20
PAR-
Q+
If you answered NO to all of the follow-up questions about your medical
condition,
you are ready to become more physically active - sign the PARTICIPANT
DECLARATION below: It is advised that you consult a quali ed exercise professional to
help you develop a safe and e ective physical activity plan to meet your health needs.
You are encouraged to start slowly and build up gradually - 20 to 60 minutes of low to moderate
intensity exercise, 3-5 days per week including aerobic and muscle strengthening exercises.
As you progress, you should aim to accumulate 150 minutes or more of moderate intensity
physical activity per week.
If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal e
ort exercise, consult a quali ed exercise professional before engaging in this intensity of
exercise.
If you answered YES to one or more of the follow-up questions

about your medical condition:
You should seek further information before becoming more physically active or engaging in a tness appraisal.
You should complete the specially designed online screening and exercise recommendations program - the
ePARmed-X+ at www.eparmedx.com and/or visit a quali ed exercise professional to work through the
ePARmed-X+ and for further information.
Delay becoming more active if:

You have a temporary illness such as a cold or fever; it is best to wait until you feel better.
You are pregnant - talk to your health care practitioner, your physician, a quali ed
exercise professional, and/or complete the ePARmed-X+ at www.eparmedx.com
before becoming more physically active.
Your health changes - talk to your doctor or quali ed exercise professional before continuing
with any physical activity program.
You are encouraged to photocopy the PAR-Q+. You must use the entire questionnaire and NO
changes are permitted.
The authors, the PAR-Q+ Collaboration, partner organizations, and their agents assume no liability for
persons who undertake physical activity and/or make use of the PAR-Q+ or ePARmed-X+. If in doubt
after completing the questionnaire, consult your doctor prior to physical activity.
PARTICIPANT DECLARATION
All persons who have completed the PAR-Q+ please read and sign the declaration below.
If you are less than the legal age required for consent or require the assent of a care provider, your
parent, guardian or care provider must also sign this form.
I, the undersigned, have read, understood to my full satisfaction and completed this
questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12
months from the date it is completed and becomes invalid if my condition changes. I also
acknowledge that a Trustee (such as my employer, community/ tness centre, health care provider,
or other designate) may retain a copy of this form for their records. In these instances, the Trustee
will be required to adhere to local, national, and international guidelines regarding the storage of
For more
personal healthinformation, please that the Trustee maintains the privacy of the information
information ensuring
contact The PAR-Q+ was created using the evidence-based AGREE process (1) by
and does not misuse or wrongfully disclose such information.
the PAR-Q+ Collaboration chaired by Dr. Darren E. R. Warburton with Dr.
www.eparmedx.com
Norman Gledhill, Dr. Veronica Jamnik, and Dr. Donald C. McKenzie (2).
Email:
Citation for PAR-Q+ NAME Production of this document has been made possible DATE through nancial
Warburton DER, Jamnik eparmedx@gmail.com
VK, Bredin SSD, and Gledhill N on behalf of the PAR-Q+
Collaboration. contributions from the Public Health Agency of Canada and the BC Ministry
The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and Electronic
Physical Activity Readiness Medical Examination (ePARmed-X+). Health & Fitness
of Health Services. The views expressed herein do not necessarily represent
Journal of Canada 4(2):3-23, 2011.
1.Jamnik VK, Warburton DER, Makarski J, McKenzie DC, Shephard RJ, Stone J, and Gledhill N.
the views of the Public Health Agency of Canada or the BC Ministry of
Enhancing the e ectiveness of clearance for physical activity participation; background and overall
Key References
process. APNM 36(S1):S3-S13, 2011. Health Services.
SIGNATURE
2.Warburton DER,
WITNESS SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER
Gledhill N, Jamnik VK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, and Shephard RJ. Evidence-based risk assessment and recommendations for physical activity
clearance; Consensus Document. APNM 36(S1):S266-s298, 2011.
This document has been adapted (with permission) for inclusion in canfitpro
documents. 01-01-
2016
21
Figure 2.2 Medical History Questionnaire
Demographic Information
Last name First name Middle initial
Date of birth Sex Home phone
Address City, State Zip code
Work phone Family physician

Section A
1. When was the last time you had a physical examination?
2. If you are allergic to any medications, foods, or other substances, please name them.
3. If you have been told that you have any chronic or serious illnesses, please list them.
4. Give the following information pertaining to the last 3 times you have been hospitalized.
Note: Women, do not list normal pregnancies.
Hospitalization 1 Hospitalization 2 Hospitalization 3
Reason for hospitalization
Month and year of hospitalization
Hospital
City and state
Section B
During the past 12 months
1. Has a physician prescribed any form of medication for you? □Yes □No
2. Has your weight fluctuated more than a few pounds? □Yes □No
3. Did you attempt to bring about this weight change through diet or exercise? □Yes □No
4. Have you experienced any faintness, light-headedness, or blackouts? □Yes □No
5. Have you occasionally had trouble sleeping? □Yes □No
6. Have you experienced any blurred vision? □Yes □No
7. Have you had any severe headaches? □Yes □No
8. Have you experienced chronic morning cough? □Yes □No
9. Have you experienced any temporary change in your speech pattern,
such as slurring or loss of speech? □Yes □No
10. Have you felt unusually nervous or anxious for no apparent reason? □Yes □No
11. Have you experienced unusual heartbeats such as skipped beats or palpitations? □Yes □No
12. Have you experienced periods in which your heart felt as though it were racing
for no apparent reason? □Yes □No
22
At present
1. Do you experience shortness or loss of breath while walking with others
your own age? □Yes □No
2. Do you experience sudden tingling, numbness, or loss of feeling in your arms,
hands, legs, feet, or face? □Yes □No
3. Have you ever noticed that your hands or feet sometimes feel cooler than other
parts of your body? □Yes □No
4. Do you experience swelling of your feet and ankles? □Yes □No
5. Do you get pains or cramps in your legs? □Yes □No
6. Do you experience any pain or discomfort in your chest? □Yes □No
7. Do you experience any pressure or heaviness in your chest? □Yes □No
8. Have you ever been told that your blood pressure was abnormal? □Yes □No
9. Have you ever been told that your serum cholesterol or triglyceride
level was high? □Yes □No
10. Do you have diabetes? □Yes □No
If yes, how is it controlled?
□ Dietary means □ Insulin injection □ Oral medication □
Uncontrolled
11. How often would you characterize your stress level as being high?
□ Occasionally □ Frequently □ Constantly
12. Have you ever infarction
□ Myocardial been told that□
you have any of the following
Arteriosclerosis illnesses?
□ Heart disease □ Yes
□ Thyroid disease
□ No
□ Coronary thrombosis □ Rheumatic heart □ Heart attack □ Heart valve
□ Coronary occlusion □ Heart failure disease
□ Heart block □ Aneurysm □ Heart murmur
□ Angina
13. Have you ever had any of the following medical procedures? □ Yes □
No □ Heart surgery □ Pacemaker implant
□ Cardiac catheterization □ Defibrillator
□ Coronary angioplasty □ Heart transplantation
Section C
Has any member of your immediate family been treated for or suspected to have had any of
these conditions? Please identify their relationship to you (father, mother, sister, brother, etc.).
a. Diabetes
b. Heart disease
c. Stroke
d. High blood pressure
from V.H. Heyward and A.L. Gibson, 2014, Advanced fitness assessment and exercise prescription, 7th ed. (Champaign, IL: Human Kinetics),
366, 367.
23
Figure 2.3 Informed Consent
In order to assess cardiovascular function, body composition, and other physical fitness com-
ponents, the undersigned hereby voluntarily consents to engage in one or more of the following
tests (check the appropriate boxes):
D Graded exercise stress test
D Body composition tests
D Muscle fitness tests
D Flexibility tests
D Balance tests
Explanation of the Tests
The graded exercise test is performed on a cycle ergometer or motor-driven treadmill. The
workload is increased every few minutes until exhaustion or until other symptoms dictate that
we terminate the test. You may stop the test at any time because of fatigue or discomfort.
The underwater weighing procedure involves being completely submerged in a tank or tub
after fully exhaling the air from your lungs. You will be submerged for 3 to 5 seconds while
we measure your underwater weight. This test provides an accurate assessment of your body
composition.
For muscle fitness testing, you lift weights for a number of repetitions using barbells or exer-
cise machines. These tests assess the muscular strength and endurance of the major muscle
groups in the body.
For evaluation of flexibility, you perform a number of tests. During these tests, we measure
the range of motion in your joints.
For balance tests, we will be measuring the amount of time you can maintain certain stances
or the distance you are able to reach without losing balance.
Risks and Discomforts
During the graded exercise test, certain changes may occur. These changes include
abnormal blood pressure responses, fainting, irregularities in heartbeat, and heart attack. Every
effort is made to minimize these occurrences. Emergency equipment and trained personnel are
available to deal with these situations if they occur.
You may experience some discomfort during the underwater weighing, especially after you
expire all the air from your lungs. However, this discomfort is momentary, lasting only 3 to 5
seconds. If this test causes you too much discomfort, an alternative procedure (e.g., skinfold or
bioelectrical impedance test) can be used to estimate your body composition.
There is a slight possibility of pulling a muscle or spraining a ligament during the muscle
fitness and flexibility testing. In addition, you may experience muscle soreness 24 or 48 hours
after testing. These risks can be minimized by performing warm-up exercises before taking the
tests. If muscle soreness occurs, appropriate stretching exercises to relieve this soreness will
be demonstrated.
24
Expected Benefits From Testing
These tests allow us to assess your physical working capacity and to appraise your physical
fitness status. The results are used to prescribe a safe, sound exercise program for you. Records
are kept strictly confidential unless you consent to release this information.
Inquiries
Questions about the procedures used in the physical fitness tests are encouraged. If you have
any questions or need additional information, please ask us to explain further.
Freedom of Consent
Your permission to perform these physical fitness tests is strictly voluntary. You are free to stop
the tests at any point, if you so desire.
I have read this form carefully and I fully understand the test procedures that I will perform
and the risks and discomforts. Knowing these risks and having had the opportunity to ask
questions that have been answered to my satisfaction, I consent to participate in these tests.
Date Signature of patient

Date Signature of witness
Date Signature of supervisor
From NSCA, 2018, NSCA’s essentials of training special populations, P. Jacobs (ed.), (Champaign, IL: Human Kinetics). Reprinted, by
permission, from V.H. Heyward and A.L. Gibson, 2014, Advanced fitness assessment and exercise prescription, 7th ed. (Champaign, IL:
Human Kinetics), 381-382.
25
Figure 2.4 Medical Clearance Form Pertaining to a
Fitness Assessment and Exercise Program
Dear Health Care Professional:
Your patient, , has contacted us regarding the fitness
evaluation conducted by . The program is designed to evaluate the
individual’s fitness status before embarking on an exercise program. From this evaluation, an
exercise prescription is formulated. In addition, other parameters related to a health
improvement program are discussed with the participant. It is important to understand that
this program is preventive and is not intended to be rehabilitative in nature.
The fitness testing includes:
A comprehensive consultation will be provided to the participant that serves to review the
test results and explain recommendations for an individualized fitness program.
A summary of test results and our recommendations will be kept on file and may be made
available to you upon request.
In the interest of your patient and for our information, please complete the following:
a. Has this patient undergone a physical examination within the last year to assess functional
capacity to perform exercise? Yes No
b. I consider this patient (please check one):
Class I: presumably healthy without apparent heart disease eligible to
participate in an unsupervised program
Class II: presumably healthy with one or more risk factors for heart disease
eligible to participate in a supervised program
Class III: patient not eligible for this program, and a medically supervised
program is recommended
c. Does this patient have any preexisting medical/orthopedic condition(s) requiring continued or
long-term medical treatment or follow-up? Yes No
Please explain:
d. Are you aware of any medical condition(s) that this patient may have or may have had that
could be worsened by exercise? Yes No
e. Please list any currently prescribed medication(s):
f. Please provide specific recommendations and/or list any restrictions concerning this patient’s
present health status as it relates to active participation in a fitness program.
Comments:
26
Health Care Professional’s signature: Date:
Client’s name:
Phone (H): Phone (W):
Address:
AUTHORIZATION TO RELEASE MEDICAL INFORMATION

I consent to and authorize to release any medical
information concerning my ability to participate in an exercise program or fitness assessment.
My authorization is not valid beyond one year of signature.
Patient’s name (print) Date
Patient’s signature
Please return this form to:
Name
Street address
City, State, Zip
From NSCA, 2018, NSCA’s essentials of training special populations, P. Jacobs (ed.), (Champaign, IL: Human Kinetics). Reprinted,
by permission, from NSCA, 2013, NSCA’s essentials of personal training, 2nd ed., J. Coburn and M. Malek (eds.), (Champaign, IL:
Human Kinetics), 178.
27
28 | NSCA’s Essentials of Training Special Populations
Recognizing the risk factors for disease is (13). The relative risks of exercise-related cardio-
vital for the accountability of the exercise vascular events are known to be markedly greater
professional and the reduction of health and from intense exercise than at rest; however, the
safety risks incurred by clients. Additionally, it absolute risk of a cardiac event during exercise
is the exercise professional’s responsibility to is low (1). Finally, warning signs or symptoms of
identify signs and symptoms of cardiovascular, disease, particularly cardiovascular disease, are
pulmonary, metabolic, immunologic, commonly exhibited before a serious cardiovas-
hematologic, orthopedic, neuromuscular, cular event (41). Thus, the recommendations for
cognitive, psychological, and sensory disorders medical referral are based on the known risks of
that require restrictions or modifications with exercise and include the client’s current exercise
exercise due to a potential exacerbation of an training status, the presence of disease, signs or
existing condition. Clients who have been diag- symptoms of disease, and the intensity of recom-
nosed with or exhibit symptoms of disease may mended exercise testing and training.
require modified assessment and programming Recommendations for referral of clients for
guidelines, which are outlined for various condi- medical clearance is based to a great degree on
tions in subsequent chapters in this text. the known presence of disease recognized to
The preparticipation screening affords data increase the risk of a serious exercise-related
critical in the consideration for medical referral. cardiovascular event. Diseases that should be
Exercise professionals should apply established considered in this regard include the following:
guidelines to determine the appropriateness of • Cardiovascular disease
medical clearance before initiating an exercise
program (36). The preparticipation tools include • Cardiac
a self-report of the presence of disease, signs of • Peripheral vascular disease
disease, and training status, all of which deter- • Cerebrovascular disease
mine the recommendations for medical clearance.
• Metabolic disease
Medical Clearance Process • Type I and Type II diabetes
A fitness assessment should not be • Renal disease
performed and an exercise program should not The exercise professional should use the results
begin until the exercise professional has of the PAR-Q+ and the medical history question-
determined that the client does not exhibit or naire to reveal any signs or symptoms that are
possess characteristics that potentially place suggestive of disease known to increase the risk of
the client at increased risk of a serious a cardiovascular event during exercise. Signs and
cardiovascular event. There are guidelines symptoms of cardiovascular, renal, or metabolic
specifying the conditions that war- rant disease include the following (2, 14, 18):
referral of clients to a medical professional for
clearance before the initiation of exercise • Pain or discomfort in the arms, neck, chest,
testing or training (36). These recommendations jaw, or other areas that could be indicative of
are based on factors (e.g., current activity level, angina or ischemia (impaired coronary artery
signs of potential disease, and known existence of blood flow)
disease) that increase the risk of a cardiovascular • Shortness of breath during mild exertion or
event during exercise and affect the parameters while resting
(e.g., intensity) of prescribed exercise. • Dizziness or syncope (fainting)
It is known that persons who are physically
inactive present a significantly greater risk of • Orthopnea (shortness of breath while lying
serious cardiovascular events as compared with supine) or paroxysmal dyspnea (shortness of
physically active individuals (16). Regular phys- breath that occurs while sleeping)
ical activity has also been shown to be inversely • Ankle edema (swelling or water retention)
related to the risk of a serious cardiovascular
event during or immediately following intense
exercise
Health Appraisal and Fitness Assessments |
29
• Heart palpations or tachycardia (elevated receive medical clearance for moderate-intensity

resting heart rate) exercise if they have received clearance in the pre-
• Intermittent claudication (cramps in the lower vious 12-month period. Physically inactive clients
leg) who have a known disease but are asymptomatic
• Heart murmur should be referred to a medical professional for
clearance prior to any exercise testing or training.
•Unusual fatigue occurring with usual Following medical clearance, these clients should
activities or shortness of breath with usual begin with light- to moderate-intensity exercise
activities Guidelines for the referral of clients for with intensity gradually increased as tolerated.
medical clearance are related to the prescribed Clients who develop new signs or symptoms of
intensity of the exercise program. Parameters disease should be referred for medical clearance
for light- intensity exercise, moderate-intensity regardless of training status or the presence of
exercise, and vigorous-intensity exercise are the disease. If the client is presently engaged in an
following exercise program, it must be discontinued and
(36):
• Light-intensity exercise: medical clearance should be obtained before
.
• 30% to <40% VO2 or heart rate reserve recommencing any exercise program. Following
medical clearance, inactive clients displaying
• 2 to <3 METs
symptoms of disease should initiate exercise at a
• 9-11 RPE (on 6- to 20-point Borg scale) light to moderate intensity level and progress as
• Intensity producing a slight increase in tolerated.
heart rate and respiration rate Program Supervision
• Moderate-intensity exercise:
. Recommendations
• 40% to <60% VO2 or heart rate reserve
Medical clearance provides the exercise pro-
• 3 to <6 METs fessional with approval and recommendations
• 12-13 RPE (on 6- to 20-point Borg scale) regarding specific concerns or restrictions to
• Intensity producing a noticeable increase exercise testing and programming. Based on the
in heart rate and respiration rate medical evaluation and diagnosis, the physician
or other health care professional will generally
• Vigorous-intensity exercise:
. recommend either a supervised or medically
• ≥60% to 90% VO2 or heart rate reserve supervised assessment and exercise program. A
• ≥6 METs supervised assessment and exercise program is
recommended for clients who have a medically
• ≥14 RPE (on 6- to 20-point Borg scale)
identified condition or limitation but are still
• Intensity producing a substantial increase allowed to participate in a fitness assessment
in heart rate and respiration rate or exercise program (14). The assessment and
Physically active clients who do not exhibit programming need to be overseen by a certified
known disease or signs or symptoms of disease fitness professional who can assess, monitor,
are not recommended to seek medical clearance and modify the testing or exercise session when
and may continue with moderate- to vigorous- necessary.
intensity training and may increase intensity as A medically supervised assessment and exer-
tolerated. Physically inactive clients without dis- cise program is recommended for high-risk cli-
ease or signs of disease may start exercise training ents who have medically identified participation
with light to moderate intensity without medical restrictions related to assessment tests, exercise
clearance, progressing intensity as tolerated. programming, or both (14). The assessments and
Clients who are physically active and have programming are directed and monitored by a
history of cardiovascular, metabolic, or renal health care professional in a controlled clinical
disease but are asymptomatic are not required to setting that offers immediate emergency care
(14).
Key Point • Establishment of appropriate exercise selec-

tion, frequency of exercise, intensity of exer-
Medical clearance provides the exercise profes- cise, and volume of exercise
sional with approval from a health care profes-
sional for the participation in either a supervised • Development of short-, medium-, and long-
program or a medically supervised program. term fitness goals
Exercise professionals should oversee the testing • Identification of a client’s needs and limita-
and training in supervised programs, while medi- tions before exercise program initiation, as
cally supervised programs should be managed by directed by a health care professional, and
a health care professional. information received from client interaction
• A method of recording decisions regarding
appropriate scope of practice in case the client
FITNESS ASSESSMENT experiences an injury or an exacerbation of a
current medical or health condition after the
After the medical and health history appraisal pro- program begins (21)
cess, the exercise professional needs to assess the
client’s current level of functional fitness capaci- Assessment Goals
ties before developing an exercise program. The
decision regarding the battery of tests to perform The exercise professional can use the results of
requires consideration of the client’s medical and an assessment in combination with information
health history and fitness-related goals, as well as gathered from the medical and health history
the exercise professional’s experience in conduct- questionnaire and medical clearance form to
ing assessments on clients who have the specific design a proper exercise program. Understand-
needs or conditions presented by the client. Test ing the client’s current physical fitness, medical
selection is also influenced by the availability and health concerns, and well-being enables the
and necessity of the appropriate environment, exercise professional to create a program that is
facilities, and equipment. reasonable in frequency, intensity, time, and type
After determining the tests, the exercise profes- of exercise to promote long-term participation.
sional is responsible for administering the tests, In conjunction, establishing program goals and
recording and managing the data, and interpret- objectives with the client as part of the assessment
ing the results. These steps need to be completed process is critical to adherence.
before short-, medium-, and long-term goals can
be established. Assessment Standardization
One of the responsibilities of the exercise profes-
Rationale for and Benefits of sional working with a client is to enhance
physical fitness without causing harm to the
Testing client (21). Assessment test batteries should be
Assessment (often simply called testing) is a crit- standardized as much as possible, but some
ical component in the development of a safe and variation in test selection may be necessary to
effective exercise program especially for clients accommodate individual needs. All fitness
who have a medical- or health-related condition. assessment tests should be of high validity,
In all cases, the selected tests should be specific reliability, and accuracy. Test administration
to each client and based on his needs. should be standardized as much as possible, and
The rationale for performing an assessment on the professional performing the assessments
a client includes the following (35): should be qualified and trained to administer each
• A baseline for future comparisons of test.
improvement or rate of progress
• Identification of current levels of fitness that Assessment Standards
will contribute to the exercise program The results obtained from fitness assessment
tests can be compared to standards derived from
norm-referenced data, from criterion-referenced
31
standards, longitudinally to the results of the Client Factors

client, or from a combination of these
approaches. Standards for fitness In selecting a test, it is essential to evaluate
assessments based on norm-referenced data factors that may positively and negatively
are used to compare the fitness level of like influence a client’s performance and
individuals (sex, age, and so on) on the same subsequently affect the validity, reliability, and
test. These results are usually reported as a accuracy of the assessment results. It is
percentile rank. In this type of system, incumbent on the exercise professional to
results are often indicated as follows: recognize any condition that may result in the
alteration of the standard assessment test
• 0% to 20% = well below average or poor battery and make adjustments according to
• 21% to 40% = below average the client’s individual needs. For example, a
• 41% to 60% = average client who has trouble walking should use an
• 61% to 80% = above average arm ergometer and not a treadmill as a testing
mode during an assessment. Additionally,
• 81% to 100% = well above average or
fatigue, whether a function of recent activities,
excellent
insufficient nutrition or fluid intake, or the
Criterion-referenced physical fitness tests demands of the tests being administered, can
have predetermined levels of acceptable affect assessment outcomes and as such should
minimal outcomes for performance. If the be accounted for when one is determining the
results of a criterion- referenced test exceed the timing and duration of test administration.
minimal standard, then the client has A client’s maturity level and chronological age
successfully completed the test. A good may also affect her test performance. For exam-
example of a criterion-referenced fitness ple, a treadmill test using the Bruce protocol may
assessment is FitnessGram, which is a battery of be considered an appropriate test for younger
tests that includes assessment of aerobic endur- clients, but this protocol may need to be reduced
ance, strength, flexibility, and body composition in intensity for those with known disease or for
(44). The periodic and systematic collection older adult clients who have higher levels of risk.
of a client’s longitudinal data allows for the Sex-specific physiological factors can affect
observation of improvement in each fitness assessment scores or the protocol of some assess-
category over time. What is most critical for ments. Women generally have larger quantities of
clients to observe with repeated assessments is a body fat and less muscle mass than men, as well
positive improvement in assessment scores from as a smaller shoulder, hip, and knee structure that
the baseline level, which highlights supports less muscle mass; as a result they have
improvement and continuous movement less of a mechanical advantage than their male
toward the client’s goals. counterparts (15). For example, the 30-second
Currently, there are no general physical fitness arm curl test requires different fixed loads for men
standards based on normative or criterion- (8 pounds [3.6 kg]) than for women (5 pounds
referenced data for diseased or disabled [2.3 kg]), demonstrating the sex-specific differ-
populations; therefore it is essential that the ences related to client factors that an exercise
exercise professional establish realistic short-, professional needs to consider when selecting
medium-, and long-term goals for clients whose appropriate tests (38).
baseline scores place them below average or well
below average for healthy individuals. The Key Point
ability to set reasonable goals for improvements The exercise professional needs to be aware that
and progress levels for all clients who may not a client’s maturity level and chronological age
reach an average score based on norm- can both affect exercise test performance and
referenced standards is critical to exercise the evaluation of the results.
adherence for the client. Setting reasonable goals
that can be attained provides a client with
positive feedback upon attaining goals. Goal
setting can be a valuable tool for enhancing
participation in exercise programming (20). See
the discussion of SMART goal setting later in
Test Order before more active fitness assessments when the

person is resting and not subject to the rigors of
Assessment tests should generally be sequenced an exercise test. These measurements help
such that one test does not affect a subsequent establish a baseline to measure progress and play
test. For example, assessment of resting heart a role in the design of the subsequent exercise
rate should precede assessments of cardiovascular program (e.g., resting heart rate needs to be
endurance, as the cardiovascular endurance test known to calculate exercise heart rate using the
will result in a heart rate that is elevated above Karvonen formula).
resting levels. It is also important to always
perform assessments in the same order so that Assessment Protocol: Resting
comparisons can be made between assessments. Heart Rate
The following list places assessment tests in an
acceptable order (28): Equipment
1. Nonfatiguing tests such as height, weight, • Watch with a second hand
resting heart rate, resting blood pressure, • Chair
flexibility, body composition, anthropo-
metric measurements, and neuromuscular Procedure
assessments Have the client sit comfortably for 3 to 5 minutes.
Palpate the radial pulse using the tips of the index
2. Tests of agility such as the T-test and hex-
and middle fnger; do not use the thumb. Count
agon test
the number of beats starting at 0 and count for
3. Maximum muscular strength tests such as a 60 seconds.
one-repetition maximum (1RM) bench press Note: The exercise professional should not use
4. Local muscular endurance such as the par- the thumb to measure heart rate because the
tial curl-up test thumb has a pulse, which can cause inaccurate
counting.
5. Cardiovascular endurance such as the Bruce
protocol or the arm ergometer test Assessment Protocol: Resting
Blood Pressure
FITNESS ASSESSMENT
Blood pressure has two values: Systolic pressure
PROTOCOLS is generated during left ventricular contraction,
and diastolic pressure is generated when the left
Evaluating a client’s fitness level requires prepara-
ventricle heart is relaxing and reflling during the
tion and organization to ensure valid, accurate, and cardiac cycle.
reliable results and maintenance of client safety.
Proper and significant assessment outcomes Equipment
are greatly affected by the ability of the exercise • Mercury or aneroid sphygmomanometer (a
professional to prepare clients by educating them blood pressure measuring device) with cuffs
as to the measurement and assessment description, sized for children and adults
preparation guidelines, purpose and explanation • Stethoscope
of procedures, risks, benefits, and assessment
• Watch with a second hand
expecta- tions. Preparation to evaluate a client’s
fitness level requires preassessment measurements • Chair
and selection of appropriate fitness assessments, Procedure
which involves reviewing safety guidelines,
To obtain valid and reliable blood pressure meas-
calibrating equipment, and following
urements, the exercise professional should practice
documentation procedures. and become competent with this assessment
before testing. Systolic and diastolic blood pres-
Preassessment sure can be measured according to the following
Measurements protocol (see fgure 2.5):
A client’s resting heart rate, resting blood

pressure, weight, and height are commonly
measured
33
Assessment Protocol: Body

Weight
Equipment
• Scale or balance that can be calibrated for
accuracy
Procedure
Have the client empty his pockets and remove
shoes and any other heavy articles of clothing
(belts, jackets, heavy sweaters, shoes, and so
on). Have the client stand on the measuring device
Figure 2.5 Body and equipment positions for meas- until a stable measurement can be made, and
uring resting blood pressure.
report the weight (pounds or kilograms) to the
precision allowed by the measuring device.
• Position the client in an upright seated posture

with the back supported and legs uncrossed. Assessment Protocol:
• Select an appropriately sized cuff based on the Height
circumference of the upper arm.
• Locate the brachial artery of the client. Equipment
• Securely place the cuff of the sphygmomanom- • Medical stadiometer or a wall with a tape
eter on the upper arm in a manner that covers measure affxed to it
the brachial artery and with the bottom of the
cuff approximately 1 inch (2.5 cm) above the
Procedure
antecubital space. Have the client remove her shoes and stand erect
• The cuff of the sphygmomanometer should be with the feet together in front of the stadiometer
placed such that the dial or display is readily or facing away from the wall with the back of the
viewable by the exercise professional. heels touching the wall. Measure height as the
• When taking measurements, the bell of the vertical distance (inches or centimeters) from the
floor to the crown on the top of the head to the
stethoscope should be frmly placed directly
precision allowed by the measuring device. If using
over the antecubital space, and the client’s arm
a tape measure affxed to a wall, place a ruler (or
should be level with the heart and in a
similar object) on top of the client’s head and,
horizontal position.
while keeping it level, extend it straight back to
• Inflate the cuff rapidly to 160 mmHg or 20 the tape measure.
mmHg above known resting systolic blood
pressure (40).
• Begin to release the pressure from the cuff Assessment Protocol:
slowly (2-3 mmHg per second).
Lung Function
• Systolic blood pressure is recorded as the frst
audible Korotkoff sound. The forced expiratory volume (FEV 1) test is used
to determine the volume of air
• Diastolic pressure is recorded as the disappear-
exhaled in the frst
ance of all Korotkoff sounds. second following a maximal inhalation (3). This
• Record systolic and diastolic blood pressure in test can be used to determine a limitation in
even numbers and to the nearest 2 mmHg pulmonary flow rate.
(40).
• Consult table 2.1 near the end of the chapter Equipment
for the blood pressure classifcations for adults. • Spirometer
Note: The exercise professional should always • Nose clip
select an appropriately sized blood pressure cuff
for each client.
Procedure measurements, skinfold thicknesses, and

The instructions for the specifc spirometer being bioelectrical impedance analysis (BIA).
used for the test should be followed to obtain 6. Neuromuscular assessments measure the
correct measurement of FEV1. The exercise ability to do activities that require balance,
professional should use the nose clip to make coordination, skill, or a combination of
certain that no air will come out of the nostrils these.
during the test. The client is asked to perform a 7. Functional performance assessments
forced expiratory maneuver, which requires a measure the ability to do specific physical
maximal inhalation followed by a maximal activities of daily living. An example of a
exhalation while breathing into the spirometer.
functional performance test is the 8-foot
up-and-go test.
8. Assessments specific to clients who have a
Common Fitness Tests medical condition can be used in circum-
There are eight types or categories of fitness stances when other testing protocols may
assessments that are tied to the general compo- be inappropriate due to fitness or movement
nents of overall fitness (30); commonly, at least restrictions. These assessments include
one test from each of the following categories is the 6-minute walk test, 2-minute step test,
performed: 30-second chair stand test, 30-second arm
curl test, and the chair sit-and-reach test.
1. Cardiovascular endurance assessments
provide estimations of .the client’s maximal Cardiovascular Endurance
oxygen consumption (VO2max). Cardiovas- Assessments
cular endurance tests employ a variety of The ability to perform cardiovascular endurance
testing modalities including the treadmill, exercise is important for completing activities of
stair stepper, recumbent stepper (6), cycle daily living and is commonly directly assessed in
ergometer, and arm ergometer. a laboratory setting through the use of a graded
2. Muscular strength assessments determine exercise test or a comparable field test.
the maximum force that a muscle or However, some clients with chronic disease. or
muscle group can exert in a single
effort while maintaining proper disabilities may not be able to achieve a true
VO2max (30). Rather, they prematurely reach a
technique. Muscular strength is typically
assessed by the use of a one-repetition point at which they cannot continue and are
maximum (1RM) protocol. said to reach s.ymptom- limited exhaustion,
3. Local muscular endurance assessments
measure the ability of a muscle or muscle referred to as p. eak VO2. Many such people have
group to perform repeated submaximal con- a very low peak VO2; usually less than 25 ml ·
tractions. Local muscle endurance assess- kg−1 · min−1 and often less than 20 ml · kg−1 ·
ments typically count the total number of min−1 (30). Daily living activities, often taken for
repetitions per unit time, such as for the granted by those who are healthy and without
partial curl-up test. disability, require oxygen consumption in the
4. Flexibility assessments measure the ability range of 12 to 30 ml · kg−1 · min−1. Thus, some
to move joints through a prescribed range clients .with chronic dise.ase or disabilities may
of motion (ROM). Flexibility assessments
have a VO2max or peak VO2below what is
include the sit-and-reach and back scratch
tests. required for activities of daily living,
employment, and maintenance of client
5. Anthropometric assessments measure size,
independence, resulting in a reduced quality of
shape, and composition of the human body
life.
or body segments. Anthropometric assess-
In general, reduced-intensity graded exercise
ments include body mass index (BMI), girth
test protocols (e.g., a RAMP protocol) are
preferred for these populations over standard
protocols (e.g., Bruce protocol). Many standard
protocols increase work rate in relatively large,
35
linear gradients and are effective only in screening or any other sign indicative of poor blood
for ischemic heart disease. In the management perfusion.
of chronic disease or disabilities, however, it is 8. Failure of heart rate to increase with
valuable to discern the exercise response in the increasing work rate.
submaximal range to best establish a proper
9. Change in heart rhythm.
exercise intensity for the client’s exercise pro-
gram. Ramp protocols can be superior in this 10. Client requests to stop the test.
regard because they indicate exercise responses at 11. Physical or verbal indication of severe
smaller increments, enabling the exercise profes- fatigue.
sional to best determine the client’s submaximal 12. Malfunction of the testing equipment.
exercise capacity.
Another disadvantage of using a standard pro- Exercise Test Modalities The treadmill and
tocol is that the test cannot be individualized so cycle ergometer are the most commonly used
that each client can complete the 8 to 10 minutes devices for clinical exercise testing. Treadmill
of exercise time recommended for an accurate testing provides a more familiar form of
assessment (26, 32, 33, 40). In other words, per- physiological stress (because the client is walking
sons with chronic disease or disabilities may have or running), with clients more likely to attain a
low cardiovascular endurance exercise capacity slightly higher oxygen consumption and peak
and be unable to complete the test. Therefore, it heart rate than during cycle ergometer testing
is important for the exercise professional to know due to increased muscle mass utilization (3, 19,
the client’s approximate ability, estimate his peak 34). The treadmill should have readily accessible
exercise capacity, and design a test to yield three handrails for clients to steady themselves;
or four changes in work rates during an 8- to however, consistently holding the handrails can
10-minute test period (10). reduce the accuracy of exercise capacity and the
quality of the heart rate recording and so should
Test Termination The exercise professional be discouraged. However, it may be necessary
must understand that a client can stop the for some clients to hold the handrails lightly for
exercise test at any time and for any reason. balance. An emergency stop button should also
There are also test termination indicators that be readily available to the client and supervising
can be determined from observations of the exercise professional.
client during a test; every exercise professional Arm ergometry is an alternative method of
should be aware of these. An exercise test exercise testing for clients who cannot perform
should be stopped immediately if any of the leg exercise (e.g., due to a spinal cord injury) or
following occurs (22): for clients who primarily perform dynamic upper
1. Client reports symptoms of angina. body work during occupational or leis.ure-time
2. Systolic blood pressure drops >10 mmHg
activities (4, 23). At the current time, no
from baseline with increasing work rate. VO2max– peak normative data exist for
3. Extreme increase in blood pressure. comparing values derived from arm ergometry to
4. Systolic blood pressure >250 mmHg. the general population. Of additional concern is
5. Diastolic blood pressure >115 mmHg. the impact of the smaller muscle mass use. d
6. Client experiences shortness of breath, during arm ergometry, resulting in reports of
wheezing, leg cramps, or other symptoms VO2max–peak values that are approximately
of claudication due to inadequate blood flow
20% to 30% lower than the values obtained
to the leg muscles.
7. Client experiences ataxia (loss of voluntary during tread.mill testing (4, 23). The real
coordination of muscle movements), dizzi- benefits of testing VO2max–peak using arm
ness, pallor (pale skin color), cyanosis (blue ergometry are to evaluate a client’s progress and
or purple skin color due to a lack of oxygen measure the effectiveness of a training pro-
in the blood), cold or clammy skin, nausea, gram over time.
Testing Protocols Many resources
provide testing protocols for measuring
cardiovascular endurance.
General guidelines for all cardiovascular 5 minutes after the test. In the event of an
endurance tests include the following recommen- abnormal response to the test, an extended
dations (22): postexercise test observation period may be
warranted.
• Heart rate and blood pressure should be taken
.
immediately before the exercise test with the After estimating or calculating VO2max from
client in the same posture as will be used the various tests, consult table 2.2 near the end
during the exercise test. of the chapter for the cardiovascular endurance
• Clients should be familiarized with the mode classifications for adults.
of exercise that will be used for the test.
Key Point
• An adequate warm-up of approximately 2
to 3 minutes should be completed before an The exercise professional should always remind
exercise test. the client that she can stop the exercise test at
any time and for any reason.
• Every protocol used should consist of approx-
imately 3-minute exercise stages accompanied
by appropriate increments in work rate. Assessment Protocol:
• Heart rate should be measured a minimum of Treadmill Test
two times during each stage (near the end of
the second and third minutes of each stage). Equipment
• Blood pressure should be measured during • Treadmill with an emergency
the last minute of each stage so the exercise stop button
professional is aware of an abnormal blood • Stopwatch
pressure response to increasing work rate.
• Rating of perceived exertion
• Ratings of perceived exertion (RPE) should be chart
taken near the end of the last minute of each
Procedure
stage using an appropriate scale.
The Bruce treadmill test remains the most com-
• The exercise professional should monitor the
monly used protocol; however, it employs rela-
client for signs or symptoms to terminate the tively large intensity increments (i.e., 1-3 METs
test, such as these: [metabolic equivalents] per stage) every 3
• Attainment of 70% HRR or 85% of age- minutes. Consequently, changes in physiological
predicted maximal heart rate responses may be less uniform and exercise
capacity may be markedly overestimated when it
• If the client fails to conform to the exercise
is predicted from exercise time or work rate.
test protocol
Protocols with larger intensity increments are
• If the client requests to stop the test for better suited for screening younger or physically
any reason active clients, whereas protocols with smaller
• If the client experiences an emergency increments, such as Balke-Ware (i.e., 1 MET per
situation stage or less), are preferable for clients with
chronic disease or disabilities. Advan- tages of
• An adequate cooldown at an intensity less smaller incremental increases include the
than or equal to the work rate of the first stage following (2):
should be completed after the test (if the test
• Avoidance of large and unequal increments in
has not been terminated for an emergency). A
work rate
passive cooldown should be implemented if
• Uniform increases in hemodynamic and physi-
the client has experienced signs of discomfort
ological responses
or if an emergency situation has occurred.
• More accurate estimates of exercise capacity
• Measurement of heart rate, blood pressure,
and ventilatory threshold
and RPE should continue for a minimum of
• Individualization of the test protocol (individu-
alized incremental changes)
• Targeted test duration
37
Whichever exercise protocol is selected, it Procedure

should be individualized so the treadmill speed
Set the metronome to 96 beats (24 steps) per
and increments in grade are based on the client’s
minute and the stopwatch to 3 minutes. Instruct
capability. For example, increases in grade of 1%
the client to keep pace with the metronome by
to 3% per stage, with constant belt speeds of 1.5
stepping up on the box or bench with the right
to 2.5 miles per hour (2.4-4 km/h), can be used
foot, then the left foot, and then stepping down
for treadmill tests for clients with a chronic
with the right foot, then the left foot. The client
disease or other limitation.
should practice stepping in time to the metronome
Due to the fatiguing effect of cardiovascular
before doing the test.
endurance assessments, they should be adminis-
Clients can measure their heart rate in one
tered after all other tests have been completed.
of two ways: either by locating their radial pulse
During each stage of a treadmill test the exercise
(marking it with a felt tip pen) and taking it manu-
professional can obtain RPE and heart rate data
ally, or by wearing a heart rate monitor. Time
that can be used to compare the level of fatigue to
starts when the client begins stepping.
future tests on the same client. Protocols for the
Bruce and Balke-Ware treadmill tests are Scoring
presented next. After time expires, have the client immediately
sit down and take the pulse for 1 minute. The
Bruce Treadmill Protocol
score for the test is the heart rate during this
The Bruce treadmill test begins with a very
minute. Results from this test can be compared
slow speed but at a relatively steep incline, and
to the normative data found in table 2.5 near the
every 3 minutes, both the speed and the percent
end of the chapter. Clients should stop the test if
grade are increased until volitional fatigue is
they can no longer keep up with the metronome
attained by the client (9). See table 2.3 near the
or if they become too fatigued to continue. If
end of the chapter for the time and intensity
this occurs, record the ending pulse rate and
assignments for each stage of the test.
the amount of time completed. On the next
Balke-Ware Treadmill Protocol test, the goal will be to complete the full 3
The Balke-Ware treadmill test begins at a minutes, or at least a greater
speed of 3.4 miles per hour (5.5 km/h) and 0% percentage of it than the last time.
grade. The speed of the treadmill does not
change again during the test. At the beginning
Assessment Protocol:
of the second minute, the grade is set to 2% and Recumbent Stepper
increases by 1% every minute until volitional (7)
Scoring
fatigue is reached (5).
.
To estimate VO2max for the Bruce and Balke-Ware Equipment
treadmill tests, the exercise duration spent during • Recumbent stepper
the test should be used in one of the equations
• Stopwatch
from table 2.4 near the end of the chapter.
Exercise duration should be expressed as time in • Rating of perceived exertion
minutes and in decimal format; for example, 9 chart
minutes and 15 seconds would equal 9.25 Procedure
minutes.
Individuals are required to maintain a constant
step rate of 100 steps per minute for the entire
Assessment Protocol: test. The work rate for stage 1 is the same for all
YMCA Step Test (40) clients (30 watts), and subsequent work rates are
assigned based on the heart rate response from
Equipment stage 1. Heart rate should be taken during the
• Box or bench 12 inches (30 fnal 10 seconds of minutes 2 and 3 of each stage
cm) in height to determine if steady-state heart rate (a change
of no more than ±5 beats per minute) has been
• Metronome
attained. If steady-state heart rate has not been
• Stopwatch attained, then the current work rate should be
maintained for an additional minute and heart
rate should be taken again. Use the following • Stopwatch

information to determine appropriate work rates • Rating of perceived exertion chart
for stages 2 through 4:
Procedure
Work Rates for the Recumbent Stepper
Clients are required to maintain a constant pedal
Test
rate of 50 rpm (using a 6 m per revolution
Stage 2 flywheel) for the entire test. The work rate for
• Heart rate <80 beats/min: 125 watts (W) stage 1 is the same for all clients—150 kgm/min
• Heart rate 80-89 beats/min: 100 W (a 0.5-kg workload)—and subsequent work
• Heart rate 90-100 beats/min: 75 W rates are assigned based on the heart rate
response from stage 1. Heart rate should be
•Heart rate >100 beats/min: 50 taken during the fnal 30 seconds of minutes 2
W Stage 3 and 3 of each stage to determine if steady-state
• Heart rate <80 beats/min: 150 W heart rate (±5 beats per minute) has been
• Heart rate 80-89 beats/min: 125 attained. If steady-state heart rate has not been
W attained, then the current work rate should be
maintained for an additional minute and heart
• Heart rate 90-100 beats/min:
rate should be taken again. Rating of perceived
100 W
exertion should be measured during the fnal
• Heart rate >100 beats/min: 75 W minute of each work rate and recorded. The test
Stage 4 should continue until volitional fatigue or
achievement of 85% age-predicted maximal heart
• Heart rate <80 beats/min: 175 W
rate. Use the information in table 2.6 near the
• Heart rate 80-89 beats/min: 150 end of the chapter to determine appropriate work
W rates for stages 2 through 4.
• Heart rate 90-100 beats/min: Scoring
125 W .
To estimate VO2max from the YMCA cycle
• Heart rate >100 beats/min: 100 ergometer test, the exercise professional must
W extrapolate estimated maximal work rate from
Adapted from Billinger et al., 2012. the heart rate and work rate data obtained from
the submaximal test. Plot each heart rate
Rating of perceived exertion should be obtained for every work rate from the test. Draw
measured during the fnal minute of each work a diagonal line through the data points that
rate and recorded. The test should continue until extends to the age-predicted maximal heart rate
volitional fatigue or achievement of 85% age- (220 − age). Extend a line downward to the
predicted maximal heart rate. horizontal axis of the graph. The estimated
Scoring
VO2 peak (in ml · kg · min ) = 125.707 −
−1 −1 maximal work rate is the value obtained where
(0.476)(age in years) + (7.686)(sex [0= this line bisects the horizontal axis.
T.he following equation
female;was developed to Figure 2.6 shows an example based on a
estimate 1= 2male])
VO
(watts max )from
end submax
−−(0.451)(weight
the work
(0.415)(HR in )kg)(watts
rate
end submax
+ end 38-year-old individual who had an exercise heart
(0.179)
) and heart rate in the fnal stage (7): rate at the end of stage 1 (150 kgm/min), stage 2
submax
. (450 kgm/min), and stage 3 (600 kgm/min) of 91,
Assessment Protocol: YMCA 130, and 155 beats/min, respectively.
Cycle Ergometer Test (17) Using the following formula, the exercise pro-
fessional
. can.use the estimated maximal work rate
Equipment
to calculate VO2max:
• Cycle ergometer
VO2max = [(1.8 × estimated maximal work rate in
kgm/min) / body mass in kg] + 7
39
STAGE HR
I 150 (kgm/min) 91
II 450 (kgm/min) 130
III 600 (kgm/min) 155
190 220 - 38 years = 182 (beats/min)
Heart rate (beats/min)

140
90
max work rate =

750 (kgm/min)
40
150 300 450 600 750 900 1050 1200
Power (kgm/min)
Figure 2.6 Plotting heart rate and work rate to estimate maximal work rate.
Reprinted, by permission, from V.H. Heyward and A.L. Gibson, 2014, Advanced fitness assessment and exercise prescription, 7th ed. (Champaign,
IL: Human Kinetics), 105.
Assessment Protocol: Arm Scoring

Ergometer Test (4) First, one converts watts to kgm/min by multiplying
watts by 6.12; then, using the following formula,
Equipment use the maxim. al work rate attained during the
• Upper body ergometer or a cycle ergometer
with the pedals replaced by handgrips test to ca. lculate VO2max:
• Stopwatch VO2max (in ml · kg−1 · min−1) = [(3 × work
• Rating of perceived exertion chart rate in kgm/min) / body mass in kg] + 3.5
Procedure Muscular Strength Assessments

The protocol for the arm ergometry tests requires
Muscle strength testing can reveal several impor-
that clients be seated in an upright position, with
tant aspects of strength, including maximal force,
the feet flat on the ground, and the center of
the axis of rotation of the crank arms adjusted
the smoothness of contraction and relaxation
to approximately shoulder height. The elbows (lack of spasticity), balance of strength between
should remain slightly flexed during the range of extensor and flexor muscle groups, symmetry
motion for every revolution of the crank arms. A between left and right sides of the body, and
crank arm speed of 75 to 80 rpm must be main- resistance to fatigue (40).
tained for the duration of the test. Beginning Muscular strength is defined as the force that
work rate is 10 watts, and this work rate should a muscle or muscle group can exert in a single
be increased an additional 10 watts every 2 maximal effort—a 1RM—while maintaining
minutes until volitional fatigue or until 75 rpm proper form (28). Muscular strength is an impor-
cannot be maintained. tant component of fitness, as a minimal level of
muscular strength is necessary to conduct func- is that the movement is performed through a
tions of daily living and participate in recreational standardized range of motion. To perform the
activities (14). test, follow the same procedure as for the 1RM
bench press test, though the loads that are lifted
are usually heavier than for the 1RM bench press
Assessment Protocol: 1RM Bench test, so the load increases in each trial set will be
Press (28) greater (28).
Equipment Scoring
The 1RM must be divided by the client’s body
• Bench press bench
weight in order to compare to normative values in
• Barbell table 2.8 near the end of the chapter.
• Weight plates
• Barbell clips or locks
• Spotter
Local Muscular Endurance
Procedure Assessments
The client should perform an exercise-specifc
warm-up of 5 to 10 repetitions using a light to Local muscular endurance is the ability of mus-
moderate load frst. Then the client should perform cles or groups of muscles to perform repeated
at least two additional heavier warm-up sets of two submaximal contractions (28). Tests that evaluate
to fve repetitions at approximately 60% to 80% local muscle endurance typically count the total
of the estimated 1RM. The resistances should be number of repetitions per unit time.
progressively increased in a conservative manner,
and the client should attempt to perform one rep-
etition at each increment in resistance. Following Assessment Protocol: Partial
each attempt, allow a recovery period of 2 to 4 Curl-Up Test (22)
minutes. Increase and decrease the load until the
client can complete only one repetition with proper Equipment
technique and no assistance from the spotter. The
• Metronome
client’s 1RM should be attained within three to
fve total trials. • Ruler
• Adhesive tape
Scoring
• Exercise mat
The 1RM must be divided by the client’s body
weight in order to compare to normative values in Procedure
table 2.7 near the end of the chapter. The client lies supine on an exercise mat, arms
by the sides, elbows extended, palms flat on
Assessment Protocol: 1RM Leg the mat, and knees flexed to 90°. Place a piece
of tape at the tip of the fngers of each hand
Press (22) and a second piece of tape parallel to the frst
piece 10 cm (4 in.) away (see fgure 2.7). Set the
Equipment metronome to 50 beats per minute and have
• Leg press machine the client curl forward and upward, lifting the
shoulder blades off of the exercise mat by flexing
Procedure the trunk to 30° in time with the metronome
Before testing begins, the exercise professional (25 curl-ups per minute). Clients should avoid
should adjust the seat, foot platform, or both flexing the neck and perform as many curl-ups
(depending on the design of the machine) so that as possible in 1 minute without pausing until they
when the client is in the bottom (or most forward) can no longer reach the distant piece of tape at
position of the leg press, his thighs are parallel to the end of the curl-up or until they complete a
the foot platform. The result of this adjustment maximum of 25 repetitions.
41
performance also suggests the inclusion of the

sit-and-reach test for health-related ftness testing.
Equipment
• Sit-and-reach box or adhesive tape
• A measuring tape or stick
Procedure
Whether using a sit-and-reach box or a
measuring tape or stick, the client should frst
warm up with exercises that engage the
hamstrings and lower back, such as walking or
jogging for 3 to 5 minutes. This should be
followed by several repetitions of alternating
between flexing forward and reaching toward
the toes with the knees extended in a
standing or sitting position, then reaching upward
toward the ceiling in a smooth continuous motion
Figure 2.7 Starting and ending positions for the (without jerking). Make a note of the warm-up
partial curl-up test.
routine used by the client so it can be replicated
for future testing to assist in reliability of the test
results.
Scoring When using a sit-and-reach box, the client
The score is the total number of curl-ups com- should be in a seated position facing the box with
pleted; see table 2.9 near the end of the chapter the shoes off. The knees should be fully extended
for norms for this test. with the feet placed on the base of the box and
the medial edges of the feet 6 inches (15 cm)
apart. The client should keep the knees fully
Flexibility Assessments extended during the duration of the test, arms
Flexibility is defined as the range of motion (in fully extended, and hands overlapped, with the
degrees) that can be performed by a joint of the palm of one touching the dorsal surface of the
body (28). Maintaining flexibility of all joints other. The client should then reach forward
slowly, flexing at the hips, and push the fngertips
facilitates optimal movement and function; in
over the scale on the box in a controlled manner.
contrast, when an activity moves the structures
When full extension is obtained, the client should
of a joint beyond a joint’s range of motion, tissue
hold this position for approximately 2 seconds.
damage can occur. The degree of flexibility of a To maximize the best stretch, ask the client to
joint depends on the distensibility of the joint exhale when reaching forward.
capsule, appropriate warm-up, muscle viscosity, When using a measuring tape or stick, frst
and compliance of connective tissues such as lig- tape it to the floor; then place one piece of
aments and tendons. Flexibility is joint specific, tape 24 inches (61 cm) long across and at a right
and as a result, no single test of flexibility exists angle to the measuring stick at the 15-inch (38
that can be used to evaluate total body flexibility. cm) mark. After warming up, the client should
sit without shoes in a position with the
measuring stick between the legs and its zero
Assessment Protocol: Sit-and- end toward the body. The feet should be
Reach Test (22) approximately 12 inches (30 cm) apart, toes
The sit-and-reach test has been used commonly pointed upward, and heels touching the edge of
to assess low back and hip joint flexibility since the taped line at the 15-inch (38 cm) mark. Clients
low back pain affects a signifcant number of should keep the knees fully extended during the
people in their lifetime (40). The relative duration of the test, arms fully extended, and
importance of ham- string flexibility to activities of hands overlapped with the palm of one touching
daily living and sport the dorsal surface of the other. The client should
then be instructed to reach forward in a
controlled manner with both hands as far as
possible on the
possible. The elbow should be pointed up toward

the ceiling. The client should then place the oppo-
site arm around her back with the dorsal surface
of the hand touching the back. With this hand, the
client should reach up the back as far as
possible in an attempt to touch or overlap the
extended middle fngers of both hands. Practice
attempts are allowed in order to determine the
preferred position. Clients should not grip the
fngers of opposite hands together and pull.
Scoring
Clients are allowed two practice trials in the pre-
ferred position before administration of two test
trials. Record both scores to the nearest 0.5 inch or
1 cm, measuring the distance of overlap or
distance between the tips of the middle fngers,
with the higher of the two values recorded as the
overall score. Clients are awarded one of the
following scores:
• Minus (−) score if the middle fngers do not
touch
• Zero (0) score if the middle fngers just barely
Figure 2.8 Starting and ending positions for the sit-
and-reach test using a measuring tape or stick. touch
• Plus (+) score if the middle fngers overlap
measuring stick. When full extension is obtained, Anthropometric and

the client should hold this position for approxi-
mately 2 seconds with the fngertips remaining in Body Composition
contact with the measuring stick (see fgure 2.8). To Assessments
maximize the best stretch, ask the client to
exhale when reaching forward. The exercise Measurements of limbs and body segments—
professional may hold the client’s knees down, if typically the largest circumference of those
necessary, to keep them straight. areas—are commonly performed by an exercise
professional before a client begins an exercise
Scoring program, especially if the goal is to lose body
The client is allowed three trials, with the highest fat or gain muscle tissue. Those assessments do
taken as the score to the closest 0.25 inch (1 not determine the body composition of a client,
cm). See table 2.10 near the end of the however. Commonly, measurements of skinfold
chapter for norms for this test. thicknesses at three to seven anatomical sites or
a bioelectrical impedance analysis (BIA) test is
Assessment Protocol: performed to give better insight into the client’s
Back Scratch Test (38) fat weight and lean body mass.
Equipment
Body Mass Index (BMI)
• Yardstick (meterstick)
Equipment
Procedure
The client should stand and place her preferred • Scale or balance that can be calibrated for
hand over the same-side shoulder with the palm accuracy
down and fngers fully extended. The client should • Medical stadiometer or a wall with a tape
then reach down the middle of the back as far as measure affxed to it
43
Procedure could be predicted. The thicknesses of the

skinfolds at various sites (depending on the
Measure the client’s height and weight (refer to
formula used based on the client’s
the “Preassessment Measurements” section).
demographic) are used to estimate body
Scoring density and calculate the client’s percentage of
Determine the client’s BMI by using one of the body fat. The body density equations for men and
following formulas: women typically use the sum of three or seven
skinfolds. To be accurate and valid, the exact
BMI (in kg/m2) = [body weight in pounds / skinfold techniques that were used to derive the
(height in inches × height in inches)] × equations must be applied, and appropriate
703 levels of training and experience of the exercise
BMI (in kg/m2) = [body weight in kg / (height in professional should be observed.
meters) × (height in meters)]
Based on the client’s BMI, he is then placed
Equipment
into one of the following classifcations: • Skinfold caliper that is valid and reliable and
• Normal: between 18.5 and 24.9 kg/m2 can be calibrated for accuracy
• Overweight: between 25 and 29.9 kg/m2 • Gulick or other nonelastic measuring tape
• Obese: 30 kg/m2 or more • Marking pen
Procedure
Assessment Protocol: Skinfold measurements should be made on dry
Waist-to-Hip Girth Ratio skin, before exercise, on the right side of the
body. The skin should be frmly pinched with the
Equipment thumb and index fnger, and the caliper arms
should be placed 1 to 2 cm (0.4 to 0.8 in.)
• Gulick or other nonelastic away from the thumb and fnger, perpendicular
measuring tape to the skinfolds, and halfway between the crest
Procedure and base of the fold. Wait 1 to 2 seconds
(maximum) before reading the caliper, and keep
Measure the circumference of the waist (the
the skin pinched while reading the caliper. Take
narrowest portion of the abdomen) and the hip
duplicate measurements at each site and retest if
(maximum protrusion of the buttocks) in either
duplicate measurements are not within 10%.
inches or centimeters. Apply adequate tension to
Rotate through measurement sites or allow time
the measuring tape to promote an accurate
for skin to regain normal texture and thickness
measurement of circumference, but the tape
before taking the duplicate measurement and any
should not be tight enough to indent the skin.
additional retests. Average the two closest
Make certain the measuring tape is horizontal and
measurements to the nearest 0.5 cm.
parallel to the floor before taking measurement
Based on the formula selected to estimate body
readings.
density (see table 2.12 near the end of the chap-
Scoring ter), choose the number and location of the sites
Determine the client’s waist-to-hip girth ratio by for measuring the skinfolds using the following
dividing the waist circumference by the hip circum- techniques (40):
ference; see table 2.11 near the end of the • Chest: A diagonal fold one-half of the distance
chapter for norms for this test. between the anterior axillary line and the nipple
for men
Assessment Protocol: • Midaxillary: A vertical fold on the midaxillary
Skinfold Measurements line at the level of the xiphoid process of the
A caliper is used to measure the thickness of a sternum (an alternate method is a horizontal
double fold of skin at various anatomical sites. fold taken at the level of the xiphoid–sternal
The test relies on the observation that within any border in the midaxillary line)
population a certain fraction of the total body fat • Triceps: A vertical fold on the posterior mid-
lies just under the skin (subcutaneous fat), and line of the upper arm, halfway between the
that if one could obtain a representative sample of acromion and olecranon processes, with the
the fat, overall body fat (density and composition)
arm held relaxed to the side of the body in the anterior auxiliary line immediately superior to
anatomical position the iliac crest
• Subscapular: A diagonal fold (at a 45° angle) • Thigh: A vertical fold on the anterior midline of
extending from the vertebral border to a point the thigh, midway between the proximal border
1 to 2 cm (0.4 to 0.8 in.) below the inferior of the patella and the inguinal crest (hip)
angle of the scapula • Calf: A vertical fold at the maximum circum-
• Abdomen: A vertical fold 2 cm (0.8 in.) to the ference of the calf on the midline of its medial
right side of the umbilicus border
• Suprailiac: A diagonal fold in line with the Photographs of the common sites are shown
natural angle of the iliac crest taken in the in fgure 2.9.
a b c
d e f
g h
Figure 2.9 Skinfold measurements: (a) chest skinfold, (b) midaxilla skinfold, (c) triceps skinfold, (d) subscapula
skinfold, (e) abdomen skinfold, (f) suprailium skinfold, (g) thigh skinfold, and (h) medial calf skinfold.
45
Scoring It is recommended that people with implanted

defbrillators avoid BIA assessment until the safety
Use the appropriate formula from table 2.12 to
of BIA with these clients has been determined
estimate body density (Db) and then use the Siri
(22). Also, any substance that alters the
equation (% body fat = 495 / Db − 450) where
body’s hydration state such as alcohol or
needed to calculate estimated percent body fat.
diuretics, including caffeine (for clients who do
Percent body fat standards for adults, children, and
not ingest it on a regular basis), should be
physically active adults are presented in table 2.13
avoided for at least 48 hours before the test.
near the end of the chapter.
(Note that diuretics taken under a physician’s
direction should not be stopped, however.)
Assessment Protocol: Exercise should be avoided for 12 hours before
the test, and clients should avoid eating and
Bioelectrical Impedance should drink only enough to maintain hydration
Bioelectrical impedance analysis is a simple, quick, during the fnal 4 hours before the test
noninvasive method that can be used to estimate (22). A client’s menstrual cycle phase should
percentage of body fat. This technique requires be noted for future testing because of its ability
that a small electrical current be sent through the to alter hydration level.
body. This current is undetectable to the person
Procedure
being tested and is based on the assumption that
tissues high in water content (e.g., skeletal Remove any oil and lotion from the skin with
muscle) will conduct electrical currents with less alcohol before placing the electrodes on the
resistance than those with little water (e.g., skin, if necessary. Place the electrodes precisely as
adipose tissue) directed by the manufacturer of the impedance
(22). Because adipose tissue contains little water, device used. Incorrect electrode placement greatly
fat will impede the flow of electrical current. reduces the accuracy of the test.
There are several types of commercially avail- Scoring
able BIA devices. Some place electrodes on the
hand and foot; some are handheld devices; and Percent body fat standards for adults, children,
others, which look much like bathroom scales, and physically active adults are presented in table
have contact points at the bottom of the feet. 2.13.
Whatever the design of the machine, as the intro- Neuromuscular Assessments
duced current passes through the body, voltage Neuromuscular tests assess balance, coordination,
decreases. This voltage drop (impedance) is used and skill and are most useful for testing clients
to calculate percentage of body fat. Typically, with a neuromuscular disability or deficits and
other information such as sex, height, and age those who are severely debilitated from chronic
is used in conjunction with impedance to predict
disease or are frail, therefore needing specific
percentage of body fat.
assessment and programming (30).
Bioelectrical impedance analysis has gained
wide use in the ftness industry because it is easy
to use, relatively inexpensive, and noninvasive. Assessment Protocol: Balance
The accuracy of this technique depends on the Assessment (37)
type of equipment and equations used; however,
a standard error of approximately ±4% commonly The Balance Error Scoring System (BESS) is used
is reported (22). In other words, the percentage of to evaluate a client’s static postural stability on
body fat value from BIA is typically within 4% of hard and soft surfaces.
that obtained using hydrostatic weighting, consid- Equipment
ered the gold standard for body composition.
One problem with the use of BIA is that the • Hard floor surface
relationship between impedance and percentage • Medium-density foam balance pad (45 cm2 ×
of body fat varies among populations. This means 13 cm [~18 in.2 × 5 in.] thick with a density of
that the best equation to predict percentage of 60 kg/m3 and a load deflection of 80-90)
body fat depends on the person being tested and • Stopwatch
the corresponding equation used.
Procedure Functional Performance Assessments

Static postural stability is evaluated while the client A wide array of tests and test batteries have
stands in three defned positions on a hard floor
been developed to assess various aspects of
surface and a foam balance pad for a total of six
functional performance. These test batteries
evaluation positions. The foot positions for the
vary in their total number of tasks, but
BESS are as follows:
typically the tasks are timed or ranked using a
• Double-leg support with the feet together and simple scale. Many functional performance
parallel to each other measures have components that relate directly
• Single-leg support while standing only on the to the mobility and strength of an individual.
nondominant foot with the knee of the domi- These can be important assessment tools since,
nant leg flexed to approximately 90°. as an example, independent-living individuals
• Tandem with the dominant foot in the front and who barely surpass these functional thresholds
the nondominant foot in the back, with the toes of mobility and strength are at risk for future
of the nondominant foot touching the heel of disability (30).
the dominant foot
Scoring 8-Foot Up-and-Go Test (38)
While standing in each position, the client must
close her eyes and place hands on hips while Equipment
attempting to remain as steady as possible for
• Stopwatch
20 seconds. If the client loses her balance, the
exercise professional should instruct her to attempt • Folding chair with a 17-inch (43 cm) seat height
to regain the initial position as quickly as • Tape measure
possible. Clients are assessed 1 point for each • Cone
of the following errors:
Procedure
• Lifting hands off the hips
The chair should be placed against a wall and be
• Opening the eyes facing the cone. The cone should be placed 8
• Stepping, stumbling, or falling feet (2.4 m) away from the front edge of the
• Moving the hip into more than 30° of flexion chair. The client should be instructed to sit
or abduction upright in the middle of the chair with his feet
flat on the floor and with hands on knees. When
• Lifting the forefoot or heel
the exercise professional says “go,” the client
• Remaining out of the test position for more gets up from the chair and walks as quickly as
than 5 seconds possible around the cone and back to the chair
and returns to a seated position. The exercise
A trial is counted as incomplete if the client professional should start the stopwatch on the
cannot maintain the position a minimum of 5 “go” signal regardless of whether or not the
seconds, and for each incomplete position the client has begun moving. The stopwatch should
client receives a maximum of 10 points. During be stopped as soon as the client has returned to
each trial the exercise professional counts the the seated position. The client is allowed
total number of errors and awards 1 point for practice trials before being scored.
each error up to a maximum of 10 errors per
trial. The total number of errors from all six trials Scoring
is counted as the overall score. Normative data The exercise professional should administer two
for the BESS test are provided in table 2.14 near test trials and record both times to the nearest
the end of the chapter. tenth of a second. The faster of the two trials is
recorded as the score. Standards for the test are
presented in table 2.15 near the end of the
chapter.
47
Assessments Specific to Clients With Scoring

a Limited Ability or Restrictions Record the score of each client as total yards (or
meters) walked in the 6-minute time period. Each
Although most assessments can be performed by lap marker represents 50 yards (46 m), with the
clients who have a wide range of fitness levels, distance of the fnal partial lap added to the
some have limited physical ability to complete a product of the lap markers × 50 (or × 46 for
test or have a medical condition that restricts total meters). For example, if a client has
them from even beginning a test. In either case, collected eight lap markers (representing eight
there are valid assessments an exercise laps) and stopped next to the 45-yard (41 m)
professional can use that apply reduced stress marker, the score would be a total of 445 yards
on a client when other procedures are not (407 m). Only one trial should be administered
appropriate or recommended. per day. Standards for the test are shown in table
2.16 near the end of the chapter.
6-Minute Walk Test (38) Assessment Protocol:
2-Minute Step Test (38)
Equipment
• Long measuring tape Equipment
• Two stopwatches • Stopwatch
• Four cones • Measuring tape or a piece of string or cord
• Masking or painter’s tape approximately 30 inches (76 cm) long
• Felt tip marker • Masking or painter’s tape
• 12 to 15 lap markers per person (ice pop • Tally counter
sticks or index cards and pencils to keep track
Procedure
of laps walked)
Determine the minimum step height for each
Procedure client by fnding the midway point between the
The area for the test is a rectangle 5 yards (4.6 patella (kneecap) and the front of the hip (iliac
m) by 20 yards (18 m). The long sides should be crest). The midway point can be found using a
marked off in 5-yard (4.6 m) segments identifed tape measure or stretching a piece of string or
by strips of tape, and a cone should be placed at cord from the middle of the patella to the iliac
each corner. The cumulative distance of each crest and then folding in half. This midway point
segment should be written on the piece of tape. on the thigh can be tem- porarily marked with a
A skilled exercise professional can test up to 12 piece of tape. To monitor step height, have the
people at once, using partners to assist with client stand next to a wall, and transfer the
scoring, but 6 at a time is more manageable. To marking tape from the thigh to the wall at the
keep the clients motivated, two or more persons same height as it was on the thigh. On the “go”
should be tested at a time. signal the client begins stepping in place and
On the “go” signal, the exercise professional continues for the 2-minute time period. Use the
starts the two stopwatches and the clients begin tally counter to count the number of times that
walking counterclockwise as fast as possible (not the right knee reaches the height of the tape on
running) around the course, covering as much the wall. If the knee cannot be lifted to the height
distance as possible in the 6-minute time limit. of the tape, the client can be asked to slow down
To keep track of the distance walked, the exercise (decrease step rate), or to stop to momentarily
professional gives a lap marker to each client rest so the client can resume lifting the knee to
every time a lap of the course is completed. the right height (but do not stop the stopwatch).
Clients should be made aware of the time
Scoring
remaining in the test and be provided with verbal
encouragement. At the end of the 6-minute test The score is the number of high enough steps
period, clients should stop, stand next to the completed with the right leg in 2 minutes. Only
closest 5-yard (4.6 m) segment tape marker on one trial should be administered per day. Standards
their right, and keep moving in place for a 1- for the test are shown in table 2.17 near the end
minute cooldown. of the chapter.

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Figure 2.

If you answered YES to one or more of the questions above,

Delay becoming more active if:

2 Do you have Cancer of any kind?

3 Do you have a Heart or Cardiovascular Condition? This includes Coronary

4 Do you have High Blood Pressure?

5a If the above condition(s) is/are present, answer questions 5a-5e If NO go to

If the above condition(s) is/are present, answer questions 7a-7d If NO go to question 8

GO to Page 4 for recommendations about

If you answered YES to one or more of the follow-up questions

Delay becoming more active if:

Last name First name Middle initial

Date of birth Sex Home phone

Address City, State Zip code

Work phone Family physician

Date Signature of patient

AUTHORIZATION TO RELEASE MEDICAL INFORMATION

• Heart palpations or tachycardia (elevated receive medical clearance for moderate-intensity

Key Point • Establishment of appropriate exercise selec-

standards, longitudinally to the results of the Client Factors

Test Order before more active fitness assessments when the

A client’s resting heart rate, resting blood

Assessment Protocol: Body

• Position the client in an upright seated posture

Procedure measurements, skinfold thicknesses, and

Whichever exercise protocol is selected, it Procedure

rate should be taken again. Use the following • Stopwatch

Heart rate (beats/min)

max work rate =

Assessment Protocol: Arm Scoring

Procedure Muscular Strength Assessments

performance also suggests the inclusion of the

possible. The elbow should be pointed up toward

measuring stick. When full extension is obtained, Anthropometric and

Procedure could be predicted. The thicknesses of the

Scoring It is recommended that people with implanted

Procedure Functional Performance Assessments

Assessments Specific to Clients With Scoring

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