PA readiness screening - ANSWERSAlthough becoming PA is very safe for most people and yields many health benefits it is important to screen new clients to
... [Show More] identify those who may need more thorough evaluation before doing a fitness assessment or becoming much more physically active. The screening process also provides an opportunity for the ET to begin to gain insights on the clients motivations, aspirations, readiness for change and knowledge of PA, fitness and health.
No alcohol or vigorous exercise - 6 hrs
No smoking, caffeine or a heavy meal - 2 hrs
ASK - ANSWERS1. Discovery questions
2. Welcome letter
3. AAL-Q (Abilities for active living questionnaire)
4. PAR-Q+
5. PASB-Q (Physical Activity Sedentary Behaviour Questionnaire)
6. FANTASTIC lifestyle checklist
7. PARMED-X for pregnancy
8. Informed consent
* physician physical activity readiness clearance
Resting HR - ANSWERSHR is the number if times the heart beats (or contracts) usually recorded in beats per minutes (bpm). Resting Hr is considered an indicator of cardiorespiratory (or aerobic) fitness because it tend to lower for those who are more aerobically fit. RHR is influenced by certain medication and nervousness about the assessment.
Resting HR instructions - ANSWERS1. Sit and rest with their feet flat on the floor and arms on the chair rests for at least 5 minutes
2. Place the diaphragm on the sternum or over the second intercostal space
3. Manually palpating the radial artery using the index and middle fingers just distal to the thumb
4. Carotid artery between the larynx and the anterior border of the sternocleidomastoid muscle and at the level of the cricoid cartilage
5. Use a 15 second count (multiply by 4 to get beats per minute)
6. If the RHR is >99 bpm ask your client to sit quietly for an additional five minutes and then repeat
Resting BP - ANSWERSBlood pressure is the force of blood against the walls of the arteries created by the heart as it pumps blood to all parts of the body. Measured at the brachial artery and expressed in unites of mmHg.
Systolic BP is the max pressure in the arteries when the heart contracts during a heart beat.
Diastolic BP is the minimum pressure in the arteries when the heart relaxes.
This is the final check to ensure a client is ready to undertake the PA portions of the assessment.
Resting BP instruction - ANSWERS1. Sit and rest with their feet flat on the floor and arms on the chair rests for at least 5 minutes
2. Put the cuff on the left upper arm 2-3 cm above the antecubital space (bend of the elbow) with the lower edge of the cuff level with the heart.
3. Have the cuff snug so that 2 fingers can be slipped under the top edge of the cuff.
4. May be beneficial to palpate a brachial pulse with your fingers prior to applying or pumping the cuff.
5. While taking the radial pulse with one hand rapidly inflate the cuff until 30-40 mmHg above the point where the radial pressure is no longer palpable
6. Position the stethoscope diaphragm over the brachial artery applying minimal pressure (in complete contact with the skin) and not touching the cuff or tubing.
7. Release the cuff at 2 mmHg/sec
8. The SBP is the first Korotkoff sound
- At this point some blood is able to pass through the arm when the pressure in the artery rises during systole. The blood flows in spurts as the pressure in the artery rises above the pressure in the cuff, resulting in turbulence that produces an audible sound.
9. Keep releasing
- Thumping sounds continue to be heard as long as the pressure in the cuff is between the systolic and diastolic pressure
10. The DBP is determined when the sounds cease to be tapping and become fully muted or muffled (fourth/fifth Korotkoff sound)
- This is occurs when the pressure drops below diastolic pressure (the cuff no longer provides any restriction allowing the blood to flow to become smooth again with no turbulence)
* If the BP is >144/94 mmHg wait 5 minutes and then repeat - record to the nearest 2mmHg
Body composition assessment - ANSWERSAssessing body weight and body fat distribution is as important as excess body fat (particularly around the abdomen) signals increase risks of a variety of health problems including Type 2 diabetes, hypertension, dyslipidemia, coronary artery disease, stroke, osteoarthritis and some forms of cancer.
BMI - ANSWERSIndirect measure of body fatness correlated with health risks. Does not distinguish between fat mass and fat free mass and provides no information on the distribution of body fat.
Correlation between BMI and body fatness can vary for gender and age (at the same BMI women tend to have more body fat and older people have higher body fat than younger, trained athletes have higher BMI because of muscularity rather than body fatness)
BMI=weight(kg)/height(m2)
Height measurement - ANSWERS1. Position the tape vertically against a wall
2. Ask the client without footwear to stand erect against the wall, feet together, arms by their side, heels touching the back wall, looking straight forward, standing as tall as possible with feet flat on the floor.
3. Place the square on the head depressing the hair
4. Measurement is taken on a deep breath
5. Mark the measurement to the nearest 0.5cm
Weight measurement - ANSWERS1. Stand without footwear and minimal clothing
2. Stand on the scale
3. Record to the nearest 0.1kg
Waist circumference - ANSWERSVisceral abdominal fat is a more important determinant of health outcomes than overall body fatness.
Increased WC are more likely to have hypertension, Type 2 diabetes, dyslipidemia, and metabolic syndrome.
High WC puts you at an elevated risk of coronary events except class 2/3 obesity because you are already at an extremely high risk.
High WC in normal BMI people is also a risk.
WC measurement - ANSWERS1. Standing shoulder width apart and arms crossed over the chest.
2. Start on the right side of the body
3. Take at the superior edge of the illiac crest (palpate the upper right hip bone)
4. Inferior edge of the tape should be along this line.
5. Make sure the tape is snug without causing indentation
6. Measure to the nearest 0.5cm
Aerobic fitness assessment - ANSWERSCardiorespiratory fitness is one of the most important determinants of health. Reflects the efficiency of an individuals heart, lungs and blood vessels in transporting O2 to working muscles and the muscles ability to use that oxygen to do work. Refers to an individuals ability to syustain physical effort over a period of time and ability to respond to emergencies.
* use the RPE to assist in developing a personalized physical activity prescription especially if HR determination is not likely
Aerobic fitness test TERMINATION criteria - ANSWERS1. Reaches the ceiling HR (85% of HRmax)
2. Asks to stop
3. Shows signs of physiological distress (begins to stagger, complain of dizziness, extreme leg pain, nausea, chest pain or facial pallor)
4. Cannot maintain the cadence (for the mCAFT, and Cycle ergometer)
5. Completes Stage 8 of mCAFT
Active recovery procedure - ANSWERS1. Once the test finishes continue moving for 3 minutes at a light intensity
2. Record HR at every minute of active recovery
3. Complete another 2 minutes of light recovery if the client is not sufficiently recovered
4. Measure HR and BP once the client is seated at 1 and 3 minutes
5. If after 3 minutes the clients values are below (HR >99 and BP >94/144mmHg) you can move on to musculoskeletal testing
6. If levels have not come down continue sitting for another 2 minutes and measure HR and BP again.
7. If levels remain high above pre screening cuff offs postpone the rest of the assessment.
Modified Canadian Aerobic Fitness Test (mCAFT) - ANSWERS1. Multistage test to estimate VO2max
2. Ages 15-69
3. Complete 3 minute stages at a predetermined speed depending on age and gender
4. Begin with a 2 step sequence (beginning stage is a intensity of 65-70% of average aerobic level of someone 10 years older than yourself)
5. Steps are 20.3cm high and 40.6cm
5. HR is taken at the end of each stage
6. Stages
20-29 female - 3
30-39 female - 3
40-49 female - 4
20-29 male - 4
30-39 male - 3
40-49 male - 3
mCAFT instructions - ANSWERS1. Describe the purpose and demonstrate (have client practice)
2. Calculate 85% HRmax
3. Step dont run, doesn't matter which foot you lead with
4. Both feet need to get on the top step and fully extend the leg with the back upright
5. Concentrate on the wall in front of you
6. STEP-STEP-UP-STEP-STEP-DOWN
7. Step along side the client if they have balance issues to prevent falls
8. Stop at the bottom and remain motionless when the music stops
9. Continue until >85%HRmax
10. At the start of stage 7 for males and 8 for females switch to the 40.6cm step
11. Calculate estimate VO2max
= [17.2 + (1.29 x O2cost) - (0.09 x weight kg) -(0.18 x age years)]
12. Record the score and associate health benefit rating on the client information sheet
Treadmill walking test (Ebbeling) - ANSWERS1. Single stage treadmill sub maximal walking test to estimate VO2max
2. Low risk, non athletic adults
3. Age 20-59
4. Good for those who prefer walking or experience knee pain when jogging or running
Treadmill walking test instructions - ANSWERS1. Explain the purpose and how it is conducted
2. Calculate 50% and 70% HRmax
3. Ask client to concentrate on the wall infront of them while walking
4. Warm up for 4 minutes at 0% grade and a speed that keeps the HR in between 50-70% (3.4-4.0mph)
Adjust the speed if HR is not within the range after the first minute
5. After the warm up increase the grade to 5%
6. Continue walking for another 4 minutes
7. Record the HR every minute
8. Steady state is reached when HR variation is <5bpm
9. If the HR is >5bpm between the 3rd and 4th minute extend the walk another minute
10. SSHR is the average of the last two minutes of the walking stages
11. Calculate the estimate VO2max
= 15.1 + (21.8 x speed mph) - (0.327 x SSHR bpm) - (0.263 x speed mph x age) + 0.00504 x SSHR bpm x age) + (5.98 for males)
12. Record the score and associate health benefit rating on the client information sheet
One mile walk (Rockport) - ANSWERS1. Submaximal test to estimate VO2max
2. Age 20-69
3. Sedentary or older clients
4. Walk 1.6km as fast as possible (inside lane of a 400m track)
One mile walk (Rockport) instructions - ANSWERS1. Explain the purpose of the test
2. Have the client walk at a light/moderate pace for 3 minutes (warm up)
3. Following those 3 minutes begin walking as fast as possible
4. Record the HR at the final minute of walking
5. Record the time in minutes
6. Estimate VO2 max
= equation
7. Record the score and associated health benefit rating on the client information sheet
Cycle ergometer test (YMCA) - ANSWERS1. Submaximal bike test used to measure estimated VO2max
2. Age 15-69
3. 3 or more consecutive 3 minute workloads
4. designed to raise your HR to between 110 bpm and 85% HRmax for 2 workloads
Cycle ergometer test (YMCA) instructions - ANSWERS1. Explain the purpose of the test
2. Calculate 85% HRmax
3. Set the metronome at 50 bpm
4. Set the cycle ergometers 1st workload at 150 kpm/min (0.5kp or 25 watts) 1W=6kpm/min
5. Have the client pedal at 50rpm for 3 minutes
6. Record HR at the end of each minute
7. SSHR is the average of the HR taken during the 2nd and 3rd minute of each workload (if HR differs by >5bpm extend the workload period by 1 minute)
8. HR during the last minute of the 1st workload determines the land sequence for subsequent workload periods
HR <80bpm - 125W, 150W, 175W (2.5kp, 3kp, 3.5kp)
HR 80-90 - 100W, 125W, 150W (2kp, 2.5kp, 3kp)
HR 90-100 - 75W, 100W, 125W (1.5kp, 2kp, 2.5kp)
9. Continue increasing the workload until the clients SSHR is within 10bpm of the 85%HRmax
10. Use the formula to calculate the VO2 for the last two completed workloads
11. Take the two VO2 values and calculate the slope based on the HR response to the last two workloads
12. Use the formula to calculate the clients estimated VO2
13. Record the score and associated health benefit rating on the client information sheet
Musculoskeletal Tests - ANSWERSMuscles and bones working well together to produce movement. Enhanced musculoskeletal fitness is associated with mobility, functional independence, glucose homeostasis, bone health, psychological well being and overall quality of life. Provides insight into a clients capacity to perform ADL, cope with emergencies, avoid injury, and disability, and maintain functional independence.
Grip strength - ANSWERS1. Isometric strength as a indicator of hand and forearm strength
2. Predictive of functional limitations and disability later in life
Grip strength instructions - ANSWERS1. Have the client grasp the grip between the fingers and palm at the base of the thumb
2. Have the second joint of the finder fit snugly under the handle and takes the weight of the instrument
3. Lock the grip in place
4. Have them hold the dynamometer in line with the forearm at the level of the thigh away from the body
5. Concentrate on the wall infront of you
6. Squeeze maximally to exert max force and exhale
7. Don't let the hand or dynamometer touch anything
8. Measure each side 2x
9. Record the max score of each hand to the nearest kg
10. Combine the right and left max scores
11. Record the results and associated health benefit rating based on the normative data on the client information sheet
Push-up - ANSWERS1. A measure of muscular endurance
2. Chest, shoulders, and arms
3. Functional importance for carrying objects or activity that requires sub maximal contractions over a prolonged period of time
Push-up instructions - ANSWERS1. Have the client do as many push ups as they can (no time limit)
2. Lie face down on the mat with legs together, hands pointing forward and positioned under the shoulders
3. Push by fulling extending the arms
4. Women do the push ups on their knees
5. Upper body must remain in a straight line
6. Return to the starting position with chin coming to the mat (stomach and thighs dont touch the mat)
*incorrect repetitions dont count
7. Have the person concentrate on the floor
8. Practice 1-2 repetitions before beginning to ensure proper technique
9. Test ends if the client experiences:
pain/discomfort
appears strained forcibly
unable to maintain proper technique over two consecutive repetitions
10. Exhale on the upward phase (avoid holding breath)
11. Record the total number of pushups and associate health benefit rating in client information sheet
Sit and reach - ANSWERS1. Measures hamstring and lower back flexibility
2. Measure of general flexibility as tightness in the hamstrings and lower back is also an indicator or current poor back health
3. Poor flexibility is associated with adverse functional outcomes which may limit ones ability to perform activities of daily living leading to loss of independence
4. Reduction in stride length, owing to decreased flexibility about the pelvis and hip combined with recused leg strength and power is a major contributor to limited mobility and walking speeds of older adults
Sit and reach instructions - ANSWERS1. Warm up using the modified hurdler stretch (20sec x2 on each side - alternate legs)
2. Without shoes have client sit with legs fully extended and the soles of the feet placed flat against the flex-meter (balls of the feet against the upper cross board)
3. Have the feet (inner edge) 6 inches apart
4. Legs fully extended arms evenly stitched with palms down and hands together (one over the other) client bends and reaches forward to push the sliding marker forward along the scale with the fingertips as far as possible
5. Maximal flexion should be held for 2 seconds
6. Maintain concentration on pushing the sliding marker and to lower the head and exhale to the max distance
7. If the knees bend the trial doesn't count
8. Don't hold the knees down and dont allow bouncing or jerking
9. Repeat the test 2x
10. Record to the nearest 0.5cm on the client information sheet
11. Use the highest score to determine the health benefit rating
12. If the client is unable to reach the 0 mark on the flex-meter measure the distance form the fingertips to the 0 mark
Vertical jump - ANSWERS1. Measure of peak leg power
2. Ability to contract leg muscles with speed and force in one explosive action
3. Muscle power has important implications for functional capacity and independent living
Vertical jump instructions - ANSWERS1. Have the client stand erect with feet flat on the floor perpendicular to a wall marked with a measuring tape
2. Have the client reach as high as possible on the tape with arm and fingers fully extended
3. Record the stand and reach heigh to the nearest 0.5cm
4. Have the client move a safe distance from the a wall (hand on the hip the elbow shouldn't touch the wall)
5. Have the client bring the arms down and back, bending the knees in a semi squat position
6. Pause in the semi squat position (1-2 seconds)
7. Then jump as high as possible with the arms moving forward and up to touch the tape at the highest point they can reach
8. Concentrate on the tape as they jump
9. Test is repeated 3x (10-15 second rest)
* No run up, step up or pre jump is permitted
10. To score subtract the stand and reach from the best jump and reach to get the maximal difference
11. Calculate peak leg power in watts
= [60.7 x jump height (cm)] + [45.3 x body mass (kg)] - 2055
12. record the peak leg power and the associated health benefit rating on the client information sheet
Back extension - ANSWERS1. Measure of the isometric endurance of the trunk extensor muscles
2. Lower back pain is a significant public health concern
3. Good isometric trunk endurance may help to prevent lower back pain
* Not a suitable test for those with back discomfort or pain (do single leg extensions followed by bilateral and contralateral arm and leg extensions)
Back extension instructions - ANSWERS1. Have the client lay face down on the mat with the illiac crests positioned at the edge of the platform
2. Hips, shoulders and head should be aligned
3. Secure the clients lower torso by holding the lower thighs or upper calves (straps around the gluteal crest and below the knees - do not straddle the client or hold the ankles)
4. Have the client cross their arms over their chest and maintain the horizontal position without rotating for as long as possible (max 3 minutes)
5. Concentrate on the floor
6. Terminate the test if there is any pain/discomfort, fatigue, or if the torso drops below the horizontal (allow for one warning or adjustment) or reaches the max time
7. Recovery is laying on their back with both knees bent for 1 minute
8. Record the number of second maintained and the associated health benefit rating on the client information sheet
One leg stance - ANSWERS1. Simple, valid and reliable method to assess balance, balance impairments
2. Static balance, leg strength, and integration of visual and inner ear signals and receptors in the muscle and joints
3. Transient balance on a single limb is essential for normal gait and is important for ADL such as turning, stair climbing and dressing
4. Lower balance and falls are highly correlated
One leg stance instructions - ANSWERS1. Stand barefoot beside or behind a sturdy chair (for safety)
2. Arms crossed in front of the chest
3. Floor surface should be flat and stable
4. Have the client stand on the leg of their choice
5. Lift the other leg so that it is near but not touching the ankle of the other foot
6. Hold the position for 45 seconds (time starts when the client raises the foot)
7. Concentration should be on the wall infront of them
8. Time ends when:
arms are moved/uncrossed
the raised foot is moved towards or away from the standing foot or touches the floor
the weight bearing foot is moved to maintain balance
max time of 45 seconds
9. Record the time
10. Repeat the test on both legs with eyes open and closed
* If the client loses balance in the first 3 seconds of the eyes closed test allow a re try
11. Take the best time for each eyes open and eyes closed (compare to the mean data - not health benefit rating)
Prescription for poor/fair HBR - ANSWERSOverall goals
1. Improve health
2. Reduce health risk
3. Lose weight
4. Improve functional ability
Prescription Priority
1. Help the client get moving
2. Integrate PA into daily living
3. Encourage reductions in sedentary behaviour
Aerobic
F- Start with 1-2 days a week and build up to 3-5 days per week
I- Light to moderate (35-55% HRmax)
T- Start with 10-20 minute session build up to 30 minutes
T- Continuous aerobic activity (walking) and active living (stairs vs elevator)
Strength and Flexibility
1. Encourage some stretching after aerobic activity. Discuss adding in some resistance training such as light weights, resistance bands, or body weight after the client is meeting the 150min/week of aerobic activity
Prescription for good/very good HBR - ANSWERSOverall goals
1. Improve general fitness
2. Train for a new activity (compete in a 10km run)
Prescription Priority
1. Balanced program of aerobic, strength and flexibility training
2. Encourage reductions in sedentary behaviour
Aerobic
F- At least 150min/week. More is better. Daily training possible with proper recovery and rest between intense session.
I- Moderate to vigorous (55-85% HRmax)
T- 30-45 minutes
T- Continuous aerobic activity (brisk walking, jogging and swimming) and active living (stairs vs elevator)
Strength and Flexibility
1. 2 days/week of strength training with free weights or machine weights
2. Stretching after aerobic and/or strength training
Prescription for excellent HBR - ANSWERSOverall goals
1. Increase power, endurance or some other fitness component specific to the clients sport or occupation
Prescription Priority
1. Balanced program of aerobic, strength and flexibility training
2. Include proper rest/recovery work
3. Injury prevention
4. Encourage reductions in sedentary behaviour
Aerobic
F- As often as daily with active recovery
I- Moderate (active recovery) to vigorous (for performance enhancement) (70-95% HRmax)
T- 30-60 minutes or more depending on intensity
T- Combination of continuous aerobic/intervals. Ensure sufficient recovery/rest
Strength and Flexibility
1. 3-4 days/week of strength training with full body or split routine weights, free weights or machine weights
2. Stretching after aerobic and/or strength training
Strength gains - ANSWERSFrequency - 2-3x/full or half body split
Intensity - 80-100%
Repetitions - 1-8
Rest - 2-3 minutes
Sets - 3-6
Tempo - slow, controlled
Time of each set - <10 seconds
Method of progression - Load
Hypertrophy gains - ANSWERSFrequency - 3-6x/half body to 1-3 muscle group split
Intensity - 70-85%
Repetitions - 6-12
Rest - 60-120 seconds
Sets - 2-5
Tempo - slow, moderate
Time of each set - 10-30 seconds
Method of progression - reps than load
Endurance gains - ANSWERSFrequency - 2-3x/full body or half body split
Intensity - 50-75%
Repetitions - >12-15, 15-25
Rest - 0-60 seconds
Sets - 2-3
Tempo - slow <10-15 reps, moderate-fast >15 reps
Time of each set - 30-60 seconds
Method of progression - reps or sets
Aerobic training progression - ANSWERSStart up (1st week)
3x/week
40-50% HRR
10-15 minutes
Improvement (5-7th week)
3-4x/week
60-70% HRR
20-25 minutes
Maintenance (24+ weeks)
3-5x/week
70-85% HRR
30-60 minutes
Considerations - ANSWERSSMART goals (specific, measurable, attainable, relevant, times)
Prescription principles (overload, progression, specificity, reversibility, individuality)
FITT
Barriers to PA
Planning and goal setting
Back - ANSWERS1. Lat pull down
2. Resistance band pull down
3. Regular or assisted chin ups
4. Back extension machine
5. Weighted chin ups
Back, poster - ANSWERS1. Supermans
2. Cable row
3. Bent over barbell row
4. Arm - leg extensions
Upper arms (back) - ANSWERS1. Tricep kick backs
2. Tricep dips
3. Tricep pushups
4. Narrow dumbbell press
5. Chest press
6. Overhead shoulder press
Upper arms (front) - ANSWERS1. Bicep curl
2. Resistance band curl up
3. Cable front raise
Gluts, hips, thighs - ANSWERS1. Squat (stability ball)
2. Squat (barbell)
3. Lunges (body weight)
4. Knee extension machine
Legs, hamstrings - ANSWERS1. Hamstring curl machine
2. Deadlift
Core - ANSWERS1. Sit up
2. Plank
3. Side bridge
Chest - ANSWERS1. Chest press machine
2. Push up
3. Bench press
4. Dumbbell press on stability ball [Show Less]