FITNESS ASSESSMENT FORM Name: ___________________________________ Class Schedule: _____________________ Goal: ____________________________________ Static Postural Assessment View Lateral Kinetic Chain Checkpoints Head Shoulder Lumbopelvic-hip Anterior Knees Feet Movement Observation L Anthropometry: Girth Measurement 1st RE IE R L R Forward head* Protracted* Retracted Anteriorly tilted* Posteriorly tilted Right Upper Arm Adducted Abducted Right Thigh Right Forearm Waist Hips Internally rotated* Right Calf Externally rotated Waist and Hip Ratio: Flat* Dynamic Postural Assessment: Overhead Squat View Feet Turns out Moves inward Interpretation 1st RE Moves outward Interpretation Lumbo-pelvichip L R L R 60-sec HR IE Excessive forward lean Low back arches Low back rounds Shoulder Arms fall forward Feet Heel of foot rises Foot flattens Assym. Weight shift Shoulder elevated Lumbo-pelvichip Shoulder IE RE Movement Observation Knees Posterior Cardiorespiratory Endurance: Step Test 1st Kinetic Chain Checkpoints Anterior Lateral 1st RE IE Chest Anaerobic:300-Yard (274m) Shuttle Trial 1 Trial 2 Average IE Interpretation 1st RE Interpretation Agility: Hexagon Test Trial 1 Flexibility: Sit-and-Reach Test Trial 1 Trial 2 Trial 3 Best (cm)*** Trial 2 Trial 3 Average IE IE Interpretation Interpretation 1st RE Interpretation Interpretation 1st RE Aerobic: 12-Minute Run Speed: 40-Yard (37m) Sprint Trial 1 Trial 2 Laps Average IE IE Interpretation Interpretation 1st RE 1st RE Interpretation Interpretation Distance Partial Curl Up Repetitions Strength 1 RM= IE Interpretation 1st RE Interpretation Result (m) Criterion Scores and Normative Values Cardiovascular Endurance: 3 Minute Step Test Duration of Exercise (sec) x 100/ Recovery pulse x 5.6 =CV Efficiency Zone One MHR x 0.65 MHR x 0.76 Zone Two MHR x 0.76 Zone Three MHR x 0.85 MHR x 0.86 MHR x 0.90 Very Poor Poor Below Average Average Above Average Good Excellent Aerobic: 12 Minute- Run (Male) Age Excellent Above Average Average Below Average Poor 13-14 >2000 24002700 22002399 21002199 <2100 15-18 >2800 25002800 23002499 22002299 <2200 17-20 >3000m 27003000m 25002699m 23002499m <2300m 20-29 >2800m 24002800m 22002399m 16002199m <1600m 30-39 >2700m 23002700m 19002299m 15001999m <1500m 40-49 >2500m 21002500m 17002099m 14001699m <1400m >50 >2400m 20002400m 16001999m 13001599m <1300m Zone One Zone One Zone Two Zone Two Zone Three Speed: 40-Yard (37m) Sprint Rating Men Women Very good Good Average <4.80 4.80-5.29 5.10-5.29 <5.30 5.30-5.59 5.60-5.89 Fair 5.30-5.60 5.90-6.20 Poor >5.60 >6.20 Anaerobic: 300-Yard (274m) Shuttle Aerobic: 12 Minute-Run (Female) Age 13-14 15-18 17-20 20-29 30-39 40-49 >50 Excellent >2000 >2100 >2300m >2700m >2500m >2300m >2200m Above Average Average 19002000 16001899 15001599 <1500 20002100 17001999 16001699 <1600 21002300m 18002099m 17001799m <1700m 22002700m 18002199m 15001799m <1500m 20002500m 17001999m 14001699m <1400m 19002300m 15001899m 12001499m <1200m 17002200m 14001699m 11001399m <1100m Below Average Poor Excellent Above Average Average Below Average Poor <50 secs 50-52 secs 52-53 secs 53-55 secs >55 secs Waist-to-Hip Ratio Formula: Waist measurement/Hip Measurement=Waist to Hip Ratio Prone to Chronic Diseases Partial Curl Up Age Excellent Good Above Average Average Below Average Poor Very Poor 18-25 >43 37-43 33-36 26-35 >39 33-39 29-32 36-45 >33 27-33 23-26 46-55 >27 22-27 18-21 56-65 >24 18-24 13-17 65+ >23 17-23 14-16 29-32 25-28 25-28 21-24 19-22 15-18 14-17 10-13 10-12 7-9 11-13 5-10 18-24 <18 13-20 <13 7-14 <7 5-9 <5 3-6 <3 2-4 <2 Men Women >0.95 >0.80 FLEXIBILITY: Sit and Reach Superior Excellent Good Average Fair Poor Very poor Men Women >42 32cm-41 cm >45 36-44 cm 21cm-29cm 15cm-20cm 8cm-15cm 26cm-35cm 16cm-25cm 7cm-15cm 1cm-2cm <1cm 5cm-6cm <5cm Agility: Hexagon Test Gender Male Female Excellent <11.2 secs <12.2 secs Above Average 11.2-13.3 secs 12.2-15.3 secs Average 13.4-15.5 secs 15.4-18.5 secs Below Average 15.6-17.8 secs 18.6-21.8 secs Poor >17.8 secs >21.8 secs