C S E P - PAT H : W E L C O M E L E T T E R
Welcome to the
.
Thank you for booking an appointment for the CSEP Physical Activity Training for Health (CSEP-PATH)
Assessment with:
at
.
Please review the materials provided and complete the key forms in advance of your appointment.
While physical activity has many benefits, and is very safe for most people, it is important to identify individuals
who require further screening before becoming much more physically active. Complete the Physical Activity
Readiness Questionnaire (PAR-Q+). If you answer ‘yes’ to one or more questions, contact us (at least 24 hours
prior to your appointment).
Review the Abilities for Active Living Questionnaire (AAL-Q) and contact us if you have a disability that may
require some accommodation on our part to make your first meeting with us a success.
Complete the Physical Activity and Sedentary Behaviour Questionnaire (PASB-Q) and the FANTASTIC Lifestyle
Checklist included in this package. We will discuss these during your appointment.
You may also wish to participate in a fitness assessment (e.g., body composition, aerobic and musculoskeletal
fitness tests). If so, please follow the instructions below:
•
ear clothes appropriate for exercise (e.g., shorts, t-shirt and running shoes)
•
Do not smoke, eat or drink caffeinated liquids (e.g., coffee, tea, cola, or chocolate) within
of your appointment
•
Do not drink alcohol (e.g., beer, wine, or liquor) within
•
Do not engage in strenuous exercise within
hours
hours of your appointment
hours of your appointment
A Consent Form is also provided and must be signed and witnessed prior to beginning the assessment.
Different forms are used for adults and youth (who require the signature of a parent or guardian).
We look forward to seeing you and please do not hesitate to contact us if you have any questions or concerns.
First Name
Last Name
Address
Telephone
City
Province
Postal Code
Email
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : A B I L I T I E S F O R A C T I V E
LIVING QUESTIONNAIRE
AAL-Q
Virtually anyone can participate in a physical activity, fitness and lifestyle assessment, and achieve health and fitness
benefits with coaching support from a qualified exercise professional. Individuals with disabilities (i.e., physical
or mental differences in function that affect their abilities to perform specific tasks and actions) are more likely to
encounter environmental barriers in their pursuit of a physically active lifestyle. Please help us to help you achieve
your health and fitness goals by reviewing and completing this form. Contact us in advance if you feel there are
specific accommodations we can make so that your initial meeting with us can be a complete success.
Do you have a physical limitation or disability that may affect how you engage in physical activity or exercise?
Yes
No
If you answered ‘Yes’, please expand on the nature of the disability by checking the items below that best
describe your situation. This information will help the qualified exercise professional consider specific
accommodations that may be appropriate to ensure you can successfully undertake a physical activity, fitness
and lifestyle assessment and explore physical activity and exercise options that are most appropriate for you.
I have trouble moving from place to place (e.g., walking or running) or moving my legs
I have trouble picking up objects or moving my hands or arms
I am not strong enough to do physical activity
I cannot move for long periods of time
I cannot move or stretch my joints
I have trouble cooperating, talking or being active with others
I have trouble controlling my emotions and reactions to others
I have trouble performing physical activity the way others do
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
I have a vision impairment. I may require printed information in alternative format
I have a hearing impairment. I read lips or use sign language
I have a verbal impairment
I have another sensory input impairment. Please specify
I have trouble understanding or remembering instructions
Other issues not covered here. Please specify:
We invite you to consider and describe how you currently manage normal activities of daily living, so the
qualified exercise professional can consider how these strategies and techniques may be used in the context
of helping you pursue a more active lifestyle. You can write your thoughts here and/or discuss them at the first
consultation meeting.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
CSEP PHYSICA ACTI ITY TRAINING
F O R H E A T H ( C S E P - PAT H ) A S S E S S M E N T
A D U LT I N F O R M E D C O N S E N T F O R M
I, the undersigned, do hereby acknowledge my consent to undergo an assessment of my physical activity,
sedentary behavior, lifestyle and fitness.
This CSEP-PATH assessment will be administered by a CSEP Certified Personal Trainer® or CSEP Certified
Exercise Physiologist® and may include:
•
Answering questions concerning my physical activity, sedentary behavior, and other lifestyle factors such as
smoking and nutrition.
•
Measures of my heart rate, blood pressure, height, weight and waist circumference.
•
A sub-maximal aerobic fitness test that involves either stepping, walking or cycling for a defined period of
time to measure your heart rate response.
•
A series of musculoskeletal fitness tests that may include Grip Strength, Push-ups (max #), Sit and Reach,
Vertical Jump, Back Extension, One Leg Stance.
I understand that the assessment results will be used to determine the type and amount of physical activity most
appropriate for my interests, goals, current physical activity and sedentary behavior, and fitness level.
I understand that I will be provided with advice about physical activity, sedentary behaviour and other healthy
lifestyle topics.
I understand that I may participate, if desired, in a follow-up supervised training session based on the findings
of the assessment, consisting of a warm-up, aerobic and musculoskeletal training (including a sub-maximal
resistance training load determination), and a cool-down.
I understand that there are small but potential risks during physical activity (e.g., episodes of transient
lightheadedness, loss of consciousness, abnormal blood pressure, chest discomfort, leg cramps, nausea), and
that I willfully assume those risks.
I understand my obligation to immediately inform the Assessor of any pain, discomfort, fatigue, or any other
symptoms that I may suffer during and immediately after the assessment.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
I understand that I may stop or delay any further testing at any time if I so desire, and that the assessment may
be terminated by the Assessor upon observation of any symptoms of undue distress or abnormal response.
I understand that I may ask any questions or request further explanation or information about the procedures at
any time before, during, and after the assessment.
I have read, understood, and completed the Physical Activity Readiness Questionnaire (PAR-Q+) and answered
NO to all the questions or received clearance to participate from my physician.
This form must be completed, signed and submitted to the Assessor, along with the completed PAR-Q+, at the
time of the assessment. The form must also be witnessed at the time of signing and the witness must be of the age
of majority and independent of the organization administering the assessment. The Assessor cannot be the witness.
I AGREE THAT I HAVE READ AND UNDERSTAND THIS DOCUMENT
Printed Name of Client
Signature of Client
Date
Printed Name of
Signature of
itness
itness
Date
CSEP
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : I N F O R M E D C O N S E N T – Y O U T H
I, the undersigned, do hereby acknowledge my consent for my dependent to undergo an assessment of their
physical activity, sedentary behaviour, lifestyle and fitness.
This CSEP-PATH assessment will be administered by a CSEP Certified Personal Trainer® or CSEP Certified
Exercise Physiologist® and may include:
•
Answering questions concerning his/her physical activity, sedentary behaviour, and other lifestyle factors such
as smoking and nutrition.
•
Measures of his/her rate, blood pressure, height, weight and waist circumference.
•
A sub-maximal aerobic fitness test that involves either stepping, walking or cycling for a defined period of
time to measure their heart rate response.
•
A series of musculoskeletal fitness tests that may include Grip Strength, Push-ups (max #), Sit and Reach,
Vertical Jump, Back Extension, One Leg Stance.
I understand that the assessment results will be used to determine the type and amount of physical activity most
appropriate for my dependent’s interests, goals, current physical activity and sedentary behaviour, and fitness level.
I understand that my dependent will be provided with advice about physical activity, sedentary behaviour and
other healthy lifestyle topics.
I understand that my dependent may participate, if desired, in a follow-up supervised training session based on
the findings of the assessment, consisting of a warm-up, aerobic and musculoskeletal training (including a submaximal resistance training load determination), and a cool-down.
I understand that there are small but potential risks during physical activity (e.g., episodes of transient
lightheadedness, loss of consciousness, abnormal blood pressure, chest discomfort, leg cramps, nausea), and
that my dependent willfully assumes those risks.
I understand my dependent’s obligation to immediately inform the Assessor of any pain, discomfort, fatigue, or
any other symptoms that he/she may have during and immediately after the assessment.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
I understand that my dependent may stop or delay any further testing at any time if so desired, and that
the assessment may be terminated by the Assessor upon observation of any symptoms of undue distress or
abnormal response.
I understand that my dependent may ask any questions or request further explanation or information about the
procedures at any time before, during, and after the assessment.
I have understood and completed a health screening process [e.g., using the Physical Activity Readiness
Questionnaire (PAR-Q+)] on behalf of my dependent and my dependent has been deemed ready to participate in the
CSEP-PATH fitness assessment and/or become much more physically active.
This form must be completed, signed and submitted to the Assessor, along with the completed PAR-Q+, at the
time of the assessment. The form must also be witnessed at the time of signing. The witness must be of the age
of majority and be someone other than the Assessor.
I AGREE THAT I HAVE READ AND UNDERSTAND THIS DOCUMENT
Printed Name of Dependent
Printed Name of Parent/Guardian
Signature of Parent/Guardian
Date
Printed Name of Witness
Signature of Witness
Date
Printed Name of Assessor
Signature of Assessor
Date
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : P H Y S I C I A N P H Y S I C A L
ACTIVITY READINESS CLEARANCE
Dear Physician,
Patient Name:
Date:
Your patient has consulted a Canadian Society for Exercise Physiology - Certified Personal Trainer® (CSEP-CPT)
for a physical activity, fitness and lifestyle assessment and/or personal training services.
Although evidence demonstrates that becoming more active is very safe for most people and yields many health
benefits, it is important to identify clients who may need a more thorough evaluation before doing a fitness
assessment or becoming much more physically active.
During our standardized screening procedures we became aware that your patient:
Answered “Yes” to one or more questions on the Physical Activity Readiness Questionnaire (PAR-Q+) – see
copy attached. Specific concern:
Had a Resting Heart Rate of ____ (above the safety cut-off of 99 bpm)
Had a Resting Blood Pressure of ____/____ (above the safety cut-off of 144/94 mmHg)
To ensure that your patient proceeds in the safest way possible, they were advised to consult with you about
becoming more physically active. Please complete and sign this form, indicating any necessary physical activity
restrictions, and have your patient return the form to their CSEP-CPT.
Based upon my review of the health status of
, I recommend:
Unrestricted physical activity based on the Canadian Physical Activity Guidelines - start slowly and build
up gradually
Progressive physical activity:
With avoidance of:
With inclusion of:
Only a medically-supervised exercise program until further medical clearance
No physical activity
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
Physician Name (please print):
Signed:
Date:
Physician/Clinic Stamp:
If you have any questions regarding the physical activity, fitness and lifestyle assessment, the PAR-Q+, or the
services provided by the CSEP-CPT, please contact:
CSEP-CPT:
Email and Phone:
NOTE: This Physician Physical Activity Readiness Clearance is valid for a maximum of one year from the date it is
completed, and becomes invalid if your patient’s medical condition worsens.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
CSEP-CPT Certification and the CSEP-PATH Assessment
measurements. Some of these (e.g., height, body weight, waist circumference)
The Canadian Society for Exercise Physiology (CSEP) is the Gold Standard
require no physical exertion. Those that evaluate aerobic and musculoskeletal
for physical activity, health and fitness research and personal training in
fitness require physical exertion and are briefly outlined below. All clients sign
Canada. Our qualified exercise professionals strive to help Canadians
an Informed Consent Form prior to proceeding.
achieve the well-documented health and fitness benefits of regular physical
activity in a safe and effective manner. We provide the highest quality
specialized and customized physical activity guidance and advice based on
scientific evidence and extensive training, building on the foundation of the
Canadian Physical Activity Guidelines (CSEP, 2011 - see http://www.csep.
ca/english/view.asp?x=804 for more information).
The CSEP-CPT is certified and sanctioned to administer the assessment,
including appropriate submaximal fitness assessment protocols, to
apparently healthy individuals, interpret results, develop a client-centred
physical activity action plan, and act as a personal trainer (see http://www.
csep.ca/english/view.asp?x=741 for more information). [The CSEP Certified
Exercise Physiologist® (CSEP-CEP) is an advanced certification that includes
a broader repertoire of clients, and assessment and prescription services.]
CSEP-CPT Certification
To be certified as a CSEP-CPT, candidates must meet the following requirements:
•
Academic pre-requisites: A minimum of
years of College Diploma or
University Degree coursework addressing the CPT core competencies
(e.g., Anatomy and Physiology; Psychological Characteristics and
Motivational Strategies; Theory and Methods of Health-Related
Physical Fitness; Physical Activity/Exercise Prescription and Design;
Safety and Emergency Procedures; Documentation, Administration
and Professionalism);
•
Hold current emergency/standard first aid and CPR evel C
•
Successfully complete
hours of in-service training and a national theory
and practical exam;
•
Participate in continuing education/professional development and
•
Carry annual CSEP membership including mandatory insurance policy
($3M professional and commercial liability).
Aerobic Fitness Assessment Measures
Aerobic fitness is estimated based on heart rate response to one of four
sub-maximal protocols, depending on the client’s interests and capabilities: a
multi-stage step test, single-stage treadmill walking, one-mile walk, or a multistage cycle test. Post-exercise heart rate and blood pressure are monitored
after the respective protocol before proceeding to other measures to ensure an
appropriate recovery.
Musculoskeletal Fitness Assessment Measures
Six simple tests are performed to evaluate musculoskeletal fitness: grip strength
(strength of hands, forearms); push-up (endurance of chest, shoulders, arms);
sit and reach (flexibility of hips); vertical jump (power of legs); back extension
(endurance of back); one leg stance (balance and leg strength/endurance).
Physical Activity Prescription
CSEP-PATH assessment results are used to develop a client-centred physical
activity action plan, building on the foundation of the Canadian Physical Activity
Guidelines (CSEP, 2011), outlined below. The CSEP-CPT employs evidencebased methods to prescribe client-tailored physical activity intensity, duration
and frequency. (This does not include maximal effort aerobic physical activity or
muscle and bone strengthening exercise.)
Canadian Physical Activity Guidelines
Adults aged
-
years should accumulate at least
minutes of moderate-
to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes
or more. It is also beneficial to add muscle and bone strengthening activities
using major muscle groups, at least 2 days per week. More daily physical
activity provides greater health benefits.
Adults aged
years and older should accumulate at least
minutes of
moderate- to vigorous-intensity aerobic physical activity per week, in bouts of
CSEP-PATH Assessment
10 minutes or more. It is also beneficial to add muscle and bone strengthening
The physical activity, fitness and lifestyle assessment administered by the CSEP-
activities using major muscle groups, at least 2 days per week. Those with poor
CPT is exclusively that outlined in the CSEP Physical Activity Training for Health
mobility should perform physical activities to enhance balance and prevent falls.
(CSEP-PATH) resource manual. The assessment provides information to help
More daily physical activity provides greater health benefits.
clients safely and effectively build regular physical activity into their daily lives to
improve their health and well-being.
Children aged -
years and youth aged
-
years should accumulate
at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
The CSEP-PATH evaluates physical activity, sedentary behaviour and other
This should include: vigorous-intensity activities at least 3 days per week; and
lifestyle factors (e.g., healthy eating, tobacco and alcohol use) using simple
activities that strengthen muscle and bone at least 3 days per week. More daily
questionnaires. The fitness assessment involves a series of physical tests and
physical activity provides greater health benefits.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : P H Y S I C A L A C T I V I T Y A N D S E D E N TA R Y
B E H A V I O U R Q U E S T I O N N A I R E ( PA S B - Q )
A D U LT ( 1 8 A N D O V E R )
Please answer the following questions based on what you do in a typical week. To increase accuracy, you may
wish to log your physical activity and sedentary behavior for one week prior to answering the questions.
Aerobic Physical Activity
1. Frequency: In a typical week, how many days do you do moderate-intensity (like brisk walking) to vigorousintensity (like running) aerobic physical activity ?
days/week
2. Time or Duration: On average for days that you do at least moderate-intensity aerobic physical activity (as
specified above), how many minutes do you do?
minutes/day
Total: Multiply your average number of days per week by the average number of minutes per day.
minutes/week
Muscle Strengthening Physical Activity
3. In a typical week, how many times do you do muscle strengthening activities (such as resistance training or
very heavy gardening)?
times/week
Perceived Aerobic Fitness
4. In general, would you say that your aerobic fitness (ability to walk/run distances) is:
Excellent
Very Good
Good
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
Fair
Poor
C S E P. C A
Sedentary Behaviour
5. On a typical day, how many hours do you spend in continuous sitting: at work, in meetings, volunteer
commitments and commuting (i.e., by motorized transport)?
None
< 1 hour
1 to < 2
2 to < 3
3 to < 4
4 to < 5
5 to < 6
>6
6. On a typical day, how many hours do you watch television, use a computer, read, and spend sitting quietly
during your leisure time?
None
< 1 hour
1 to < 2
2 to < 3
3 to < 4
4 to < 5
5 to < 6
>6
Total Sedentary Behaviour (add responses to questions 5 and 6)
hours/day
7. When sitting for prolonged periods (one hour or more), at what interval would you typically take a break to
stand and move around for two minutes?
< 10 minutes
10 to < 20 minutes
20 to < 30 minutes
30 to < 45 minutes
45 to < 1 hour
1 to < 1.5 hours
1.5 to < 2 hours
> 2 hours
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : P H Y S I C A L A C T I V I T Y A N D S E D E N TA R Y
B E H AV I O U R Q U E S T I O N N A I R E ( PA S B - Q )
YOUTH (12 - 17 YEARS)
Please answer the following questions based on what you do in a typical week. To increase accuracy, you may
wish to log your physical activity and sedentary behavior for one week prior to answering the questions.
Aerobic Physical Activity
1. Frequency: In a typical week, how many days do you do moderate-intensity (like biking) to vigorous-intensity
(like running) aerobic physical activity?
days/week
2. Time or Duration: On average for days that you at least moderate-intensity aerobic physical activity (as
specified above), how many minutes do you do?
minutes/day
3. In a typical week, how many days do you do vigorous-intensity aerobic physical activity?
days/week
Muscle Strengthening Physical Activity
4. Frequency: In a typical week, how many times do you do muscle strengthening activities (such as resistance
training, wall climbing, or competitive sport)?
times/week
5. Time or Duration: On average for days that you do muscle strengthening activities (as specified above), how
many minutes do you do?
minutes/week
Total Physical Activity (add responses to questions 2 and 5)
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
minutes/day
C S E P. C A
Perceived Aerobic Fitness
6. In general, would you say that your aerobic fitness (ability to walk/run distances) is:
Excellent
Very Good
Good
Fair
Poor
Sedentary Behaviour
7. On a typical day, how many hours do you spend in continuous sitting: at school, work, volunteer commitments
and commuting (i.e., by motorized transport)?
None
< 1 hour
1 to < 2
2 to < 3
3 to < 4
4 to < 5
5 to < 6
>6
8. On a typical day, how many hours do you watch television, use a computer, play video games, read, and
spend sitting quietly during your leisure time?
None
< 1 hour
1 to < 2
3 to < 4
4 to < 5
5 to < 6
Total Sedentary Behaviour (add responses to questions 7 and 8)
hours/day
9. When sitting for prolonged periods (one hour or more), at what time interval would you typically take a break
to stand and move around for two minutes?
< 10 minutes
10 to < 20 minutes
20 to < 30 minutes
30 to < 45 minutes
45 to < 1 hour
1 to < 1.5 hours
1.5 to < 2 hours
> 2 hours
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
FA N TA S T I C L I F E S T Y L E C H E C K L I S T
Pace an ‘X’ beside the box which best describes your behaviour over the last couple of weeks. Explanations of
questions and scoring are provided on the next page.
FAMILY
FRIENDS
ACTIVITY
NUTRITION
TOBACCO
TOXICS
I have someone to talk
to about things that are
important to me
almost never
seldom
some of
the time
fairly
often
almost
always
I give and
receive affection
almost never
seldom
some of
the time
fairly
often
almost
always
I am vigorously active
for at least 30 minutes
per day e.g., running,
cycling, etc
less than
once/week
1-2
times/
week
3 times/
week
4 times/
week
5 or
more
times/
week
I am moderately
active (gardening,
climbing stairs, walking,
housework)
less than
once/week
1-2
times/
week
3 times/
week
4 times/
week
5 or
more
times/
week
I eat a balanced diet
(see explanation)
almost never
seldom
some of
the time
fairly
often
almost
always
I often eat excess 1)
sugar, or 2) salt, or
3) animal fats, or 4)
junk food
four of these
three of
these
two of these
one of
these
none
of
these
I am within
kg of
my healthy weight
not within
8 kg
8 kg
(20 lbs)
6 kg
(15 lbs)
4 kg
(10 lbs)
2 kg
(5 lbs)
I smoke tobacco
more than
10 times/
week
1 – 10
times/
week
none in
the past 6
months
none in
the past
year
none
in the
past 5
years
I use drugs such as
marijuana, cocaine
sometimes
I overuse prescribed or
‘over the counter’ drugs
almost daily
fairly
often
only
occasionally
almost
never
never
I drink caffeinecontaining coffee,
tea or cola
almost never
seldom
some of
the time
fairly
often
always
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
never
C S E P. C A
My average alcohol
intake per week is
(see explanation)
more than
20 drinks
13-20
drinks
11-12
drinks
8-10
drinks
0-7
drinks
I drink more than four
drinks on an occasion
almost daily
fairly
often
only
occasionally
almost
never
never
I drive after drinking
sometimes
I sleep well and
feel rested
almost never
seldom
some of
the time
fairly
often
almost
always
I use seatbelts
never
seldom
some of
the time
most of
the time
always
I am able to cope with
the stresses in my life
almost never
seldom
some of
the time
fairly
often
almost
always
I relax and enjoy
leisure time
almost never
seldom
some of
the time
fairly
often
almost
always
I practice safe sex
(see explanation)
almost never
seldom
some of
the time
fairly
often
almost
always
I seem to be in a hurry
almost
always
fairly
often
some of
the time
seldom
almost
never
I feel angry or hostile
almost
always
fairly
often
some of
the time
seldom
almost
never
I am a positive or
optimistic thinker
almost never
seldom
some of
the time
fairly
often
almost
always
I feel tense or uptight
almost
always
fairly
often
some of
the time
seldom
almost
never
I feel sad or depressed
almost
always
fairly
often
some of
the time
seldom
almost
never
CAREER
I am satisfied with my
job or role
almost never
seldom
some of
the time
fairly
often
almost
always
STEP 1
Total the X’s in each
column
STEP 2
Multiply the totals by
The numbers indicated
(write your answer in the
box below)
STEP 3
Add your scores across
The bottom for your
ALCOHOL
SLEEP
SEATBELT
STRESS
SAFE SEX
TYPE OF
BEHAVIOUR
INSIGHT
Grand total
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
never
o
x
1
x
2
x
3
x
4
o
=
C S E P. C A
A BALANCED DIET
According to Canada’s Food Guide, different people need different amounts of food. The amount of food you
need every day from the 4 food groups and other foods depends on your age, body size, activity level, whether
you are male or female and if your are pregnant or breast feeding. That’s why the Food Guide gives a lower and
higher number of servings for each food group. For example, young children can choose the lower number of
servings, and male teenagers can select the higher number. Most other people can choose servings somewhere
in between. The ranges below are for adult men and women from 19 to 50+.
Grain
Products
Choose
whole grain
and enriched
products more
often
Vegetables
& Fruit
Choose
dark green
and orange
vegetables
more often
Milk Products
Meat &
Alternatives
Choose
lower fat milk
products more
often
Choose
learner meats,
poultry and
fish, as well
as dried peas,
beans and
lentils more
often
2-3
2-3
Other Foods
Taste and
enjoyment
can also come
from other
foods and
beverages
that are not
part of the 4
food groups.
Some of these
are higher in
fat or calories,
so use these
foods in
moderation.
Recommended number of servings per day
6-8
7 - 10
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
ALCOHOL INTAKE
1 drink equals:
Canadian
Metric
U.S.
1 bottle of beer
5% alcohol
12 oz.
340.8 ml
10 oz.
1 glass wine
12% alcohol
5 oz.
142 ml
4.5 oz.
1 shot spirits
40% alcohol
1.5 oz.
42.6 ml
1.25 oz.
SAFE SEX
Refers to the use of methods of preventing infection or conception
WHAT DOES THE SCORE MEAN?
85-100
70-84
55-69
35-54
EXCELLENT
VERY GOOD
GOOD
FAIR
0-34
NEEDS
IMPROVEMENT
NOTE: A low total score does not mean that you have failed. There is always the chance to change your
lifestyle – starting now. Look at the areas where you scored a 0 or 1 and decide which areas you want to
work on first.
TIPS:
1
Don’t try to change all the areas at once. This will be too overwhelming for you.
2
Writing down your proposed changes and your overall goal will help you to succeed.
3
Make changes in small steps towards the overall goal.
4
Enlist the help of a friend to make similar changes and/or to support you in your attempts.
5
Congratulate yourself for achieving each step. Give yourself appropriate rewards.
6
Ask your physical activity professional (CSEP-Professional Fitness and Lifestyle Consultant), family
physician, nurse or health department for more information on any of these areas.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : S TA G E S O F C H A N G E
QUESTIONNAIRE (SOC-Q)
Physical activity can include activities such as walking, cycling, swimming, climbing the stairs, dancing, active
gardening, walking to work, aerobics or sports. To achieve health benefits, Canadian Physical Activity Guidelines
recommend that: adults aged 18-64 years should accumulate at least 150 minutes of moderate-to-vigorous
intensity aerobic physical activity per week, in bouts of 10 minutes or more; and youth aged 12-17 years should
accumulate at least 60 minutes of moderate-to-vigorous intensity physical activity daily.
1. Here are a number of statements describing various levels of physical activity. Please check the box that
corresponds to the statement that most closely describes your current level of physical activity.
I am not physically active and I do not plan on becoming so in the next six months.
I am not physically active, but I have been thinking about becoming so in the next six months.
I am physically active once in a while, but not regularly.
I am currently physically active, but have only begun doing so within the last six months.
I participate in regular physical activity and have done so for more than six months.
2. If you are not currently physically active, were you physically active in the past?
Yes
No
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : E VA L U AT I O N S U M M A R Y R E P O R T
Client Name:
CSEP Professional:
Date (dd/mm/yr):
Location:
P HY SI C A L A CT IVI T Y & S EDE NTA RY B EHAVIOUR QUESTIONN A IRE (PASB -Q)
Health Benefit Ratings
Excellent
Very Good
Good
Fair
Poor
£ 300+
£ 225 - 299
£ 150 - 224
£ 75 - 149
£ 0 - 74
(times/week)
£4
£3
£2
£1
£0
Perceived Aerobic Fitness:
£
£
£
£
£
£ <2
£ 2-4
£4-6
£6-8
£ >8
Aerobic Activity:
(minutes/week)
Strength Activity:
Sedentary Behaviour:
(hours/day)
*PASB-Q scoring is different for youth (15-17 years). Use the Evaluation Summary Report for Youth which can be downloaded from the CSEP website.
FA N TA ST I C L IFE ST YL E C HEC KL I S T
Health Benefit Ratings
Excellent
Very Good
Good
Fair
Poor
Overall Score:
£ 85 - 100
£ 70 - 84
£ 55 - 69
£ 35 - 54
£ 0 - 54
Increased
High
Very High
Extremely High
£ 30 - 34.9 (Obese I)
£ 35 - 39.9 Obese II
£ > 40 Obese
Class III
£ Underweight
£ Normal Weight +
Unhealthy WC
£ Overweight +
Unhealthy WC
£ Obese +
Unhealthy WC
Very Good
Good
Fair
Poor
Noted Items:
BO D Y COM PO S IT IO N A S SES S M EN T
Health Risk Ratings
Least
Body Mass Index (BMI):
£ 18-24.9
(Normal Weight)
BMI-Waist
Circumference (cm):
£ Normal Weight +
Healthy WC
£ < 18.5
(Underweight)
£ 25 - 29.9
(Overweight)
A E RO B I C FI T NES S A SS ESS M E NT
Health Benefit Ratings
Excellent
Estimated VO2max:
(ml.kg–1.min–1)
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
M U SC U LO S KE L E TA L F I T NES S A S SE SS M E N T
Health Benefit Ratings
Excellent
Very Good
Good
Fair
Poor
Grip Strength (kg):
Push-ups (#):
Sit & Reach (cm):
Vertical jump (watts):
Back Extension (seconds):
Health Benefit Ratings
Above Mean
Below Mean
One-leg Stance – Eyes Open (sec):
One-leg Stance – Eyes Closed (sec):
H E A LTH BE NEF IT S RATING SU MMA RY
The CSEP-PATH assessment results are presented in terms of the Health Benefit Ratings calculated for each of the physical activity, sedentary
behavior, lifestyle and fitness assessments.
Health Benefit Ratings
Associated Health Benefits and Risks
General Recommendation
Excellent
Optimal health benefits
Keep up the good work! What are your long-term physical
activity goals? What do you plan to do to keep yourself on-track
to achieve them?
Very Good
Considerable health benefits
Keep up the good work! What are your specific short- and longterm physical activity goals? What are you planning to do to
achieve your goals to help you stay active for life?
Good
Many health benefits
What are your specific short- and long-term physical activity
goals? What are you planning to do to achieve your goals and
become more physically active?
Fair
Some health benefits, but also
some risks
What are your short-term physical activity goals? What are you
planning to do to achieve those goals, and then progress further
from there?
Considerable health risks
What are your short-term goals to begin building physical activity
into your daily life? (Evidence shows that starting with small
changes and building on your successes is the best way to go.)
What are you planning to do to achieve your goals?
Poor
CANADIAN PHYSICAL ACTIVITY GUIDELINES
Adults (18-64 years): For health benefits, accumulate at least
150 minutes per week of moderate-to-vigorous intensity physical
activity, in bouts of 10 minutes or more. It is also beneficial to add
muscle and bone strengthening activities at least 2 days per week.
More daily physical activity provides greater health benefits.
Older Adults (65 years and older): For health benefits and to
improve functional abilities, accumulate at least 150 minutes of
moderate- to vigorous-intensity aerobic physical activity per week,
in bouts of 10 minutes or more. It is also beneficial to add muscle
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
and bone strengthening activities using major muscle groups, at
least 2 days per week. Those with poor mobility should perform
physical activities to enhance balance and prevent falls.
Children (5-11 years) and Youth (12-17 years): For health benefits,
accumulate at least 60 minutes of moderate-to-vigorous intensity
physical activity daily. This should include: vigorous-intensity
activities at least 3 days per week; and activities that strengthen
muscle and bone at least 3 days per week. More daily physical
activity provides greater health benefits.
C S E P. C A
C S E P - PAT H : I N V E N T O R Y O F L I F E S T Y L E N E E D S
AND PHYSICAL ACTIVITY PREFERENCES
Please review and consider which of the lifestyle needs listed below are important to you. Once you have done
so, list the three that are most important to you and the kinds of physical activities that would most likely satisfy
those needs. Use the physical activity list below to guide you or add your own ideas.
I feel it is important to me to …
like the people I’m with
release energy
be in a group
improve my health
be independent
have common interests with other people
get to know other people well
be able to contribute something to a group
meet many new people
have other people like me
be a leader
be physically active
feel confident
use my imagination
learn something
create something
be in pleasant, attractive surroundings
find the activity challenging
be alone
feel safe and secure
have a structured activity
try something new and different
be able to do things at the last minute
be myself
follow rules
use my talents
be praised
improve myself and my skills
have fun and enjoy myself
accomplish something
release frustration
relax
take a risk
spend time with my family
enjoy the outdoors
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
For me, the three most important lifestyle needs are:
I think the following activity would satisfy those needs:
1.
1.
2.
2.
3.
3.
Inventory of Potential Physical Activities: Aerobics/exercise-to-music | Archery | Badminton | Baseball/softball
Basketball Bicycling (utility or pleasure) | Bowling | Broomball | Calisthenics | Camping | Canoeing/kayaking
Climbing Coaching | Curling | Dancing | Fencing | Floor hockey | Football | Gardening, yard work | Golf | Handball
Hiking Hockey | Horseback riding | Household chores | Ice skating | Inline skating | Martial arts | Orienteering
Racquetball | Ringette | Roller skating | Rowing | Running/jogging Sailing | Skateboarding | Skiing (X-country)
Skiing (downhill) | Snowshoeing | Soccer | Squash | Stair climbing | Swimming | t’ai chi | Table tennis | Tennis
Volleyball | Walking | Weight training | Wind surfing | Yoga
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : B A R R I E R S T O P H Y S I C A L A C T I V I T Y
Anyone considering integrating regular physical activity into their lives may face certain obstacles or barriers.
From the following list of commonly cited barriers to physical activity, indicate the level of importance to your
situation on a scale of 1 to 10 by circling the relevant number.
Not important
Very important
Previous negative experiences with
physical activity
1
2
3
4
5
6
7
8
9
10
Lack of time
1
2
3
4
5
6
7
8
9
10
Have other areas in my life that I feel
must take priority in my day
1
2
3
4
5
6
7
8
9
10
Costs
1
2
3
4
5
6
7
8
9
10
Lack of energy
1
2
3
4
5
6
7
8
9
10
Lack of knowledge
1
2
3
4
5
6
7
8
9
10
Lack of motivation
1
2
3
4
5
6
7
8
9
10
Lack of skill
1
2
3
4
5
6
7
8
9
10
Feeling uncomfortable or intimidated
in a gym
1
2
3
4
5
6
7
8
9
10
Fear of injury or re-injury
1
2
3
4
5
6
7
8
9
10
Fear of making an existing condition
worse
1
2
3
4
5
6
7
8
9
10
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
How I see my body
1
2
3
4
5
6
7
8
9
10
Failure to reach goals in past attempts
1
2
3
4
5
6
7
8
9
10
Know that I cannot achieve the goals
I want so why bother
1
2
3
4
5
6
7
8
9
10
Lack of access to opportunities such as
nearby facilities
1
2
3
4
5
6
7
8
9
10
Keep talking myself out of it
1
2
3
4
5
6
7
8
9
10
Lack of safe places
1
2
3
4
5
6
7
8
9
10
Lack of child care
1
2
3
4
5
6
7
8
9
10
Lack of partner
1
2
3
4
5
6
7
8
9
10
Lack of available and suitable exercise
programs at my level
1
2
3
4
5
6
7
8
9
10
Lack of support from others
1
2
3
4
5
6
7
8
9
10
Lack of transportation
1
2
3
4
5
6
7
8
9
10
Lack of ability to work at a level for it
to be worthwhile
1
2
3
4
5
6
7
8
9
10
Find that other people pressure me
and that bothers me
1
2
3
4
5
6
7
8
9
10
Other
1
2
3
4
5
6
7
8
9
10
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : D E C I S I O N B A L A N C E W O R K S H E E T
Think about the gains and losses/drawbacks you might face by increasing your level of physical activity. List all of
the gains and losses you anticipate (e.g., “I will have more energy” would be a gain for you, while “My husband
will have to look after the kids” might be a loss to others). After you have completed your list, score each item by
assigning a number from 1 to 3 to indicate the level of impact that item has on your behavior (1 = it has a very
significant impact; 3 = it has less of an impact). Add up the scores for each column to determine whether the
gains outweigh the losses for you and for others in your life.
Gains
Losses
For me
For me
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
Score: _________________________________________
For others in my life
Score: _________________________________________
For others in my life
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
Score: ________________________________________
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
Score: _________________________________________
C S E P. C A
Decision Balance
Do your total scores for the gains outweigh the losses?
Yes
No
Strategies for Success
Write down strategies for tipping the balance further in your favour (i.e., ways to increase the gains or
reduce the losses to yourself and others).
1.
2.
3.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : F I R S T S T E P P L A N N I N G W O R K S H E E T
Write down two benefits you hope to get from being more physically active.
Think about the easiest way to increase your physical activity. Choose one of the suggestions below or add
your own.
Go for a walk after dinner
Do some gardening
Try a 2-minute “stretch break” at work
Another option, please specify:
Try to be active for just one day. Write down the day and activity you will do.
Activity:
Day:
Think about how you did. Answer the questions below by circling the rating that applies. Add up the numbers to
get a score. If you score 6 or above, that option may be a good one for you to start with. If you scored less than
6, consider another option.
Not at all
A little
A lot
Did you enjoy it?
1
2
3
Was it convenient?
1
2
3
Could you fit it into
your schedule more
regularly?
1
2
3
Total score:
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : A LT E R N AT I V E S F O R A C T I O N
Generate a list of alternatives for realizing your goal to
Then, list the advantages and disadvantages attached to each alternative, making sure to consider the ‘pros’ and
‘cons’ for you personally and for others in your life. Circle the alternative that you feel best suits your needs and
consider what coping strategies you might employ to minimize the disadvantages.
Alternative #1:
Advantages
Disadvantages
Alternative #2:
Advantages
Disadvantages
Coping Strategies:
Example: Mary would like to increase her daily physical activity to lose weight and achieve better health. She
identifies two alternatives: a) walking after dinner each night and b) joining a fitness class during her lunch hour
at work. She identified the ‘pros’ and ‘cons’ as follows:
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
Advantages (S=to self | O = to others)
Walking after
dinner each night
Join a fitness class
at work
S = Time for myself, little
organization required
O = I can walk the dog
Disadvantages
S = Eats into family time
O = My husband will have to take
care of the kids on his own for
a bit
S = Set time for activity will be
easier to adhere to
S = No time for running errands,
having lunch with co-workers
O = Won’t eat into family time
O = Less working through lunch
Based on her review of the ‘pros’ and ‘cons’, Mary decides to try both options i.e. joining a lunchtime class on
Monday, Wednesday and Friday (so she has time on Tuesday and Thursday for errands) and walking after dinner
on Tuesday and Thursday (so her husband is on child duty only twice). She also raises a third option, that of
convincing her husband and kids to walk with her on Saturday and Sunday.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : G O A L S E T T I N G W O R K S H E E T
Complete the following exercise to make a formal record of your overall physical activity goals and obstacles.
Its OK to dream a little and make these long-term goals something you’d like to achieve over a year or so – just
be sure to keep them realistic for you. Once you have completed part 1, proceed to breaking down the overall
goals into a more specific set of short-term goals and actions for the next 1-4 weeks.
My long-term physical activity goal is:
To achieve this, I need to focus on:
I am willing to do the following to make it happen:
Others will know about the change I am making when:
I might sabotage my plan by:
Therefore, my promise to myself is:
Goals and Actions
Goal #1:
Actions:
Goal #2:
Actions:
Goal #3:
Actions:
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
Success Indicators
1.
2.
3.
4.
5.
Date for next appraisal:
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : P H Y S I C A L A C T I V I T Y A N D
EXERCISE PRESCRIPTION CARD
Client name:
Date:
Exercise professional:
Aerobic Training
Goals:
Special Considerations
Warm-up:
Cool-down (including stretching):
Activity
Frequency & Duration
Intensity
(# sessions & minutes/week)
(HRR Range & RPE)
Progression
Additional Notes:
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
Resistance Training
Goals:
Special Considerations
Warm-up:
Cool-down (including stretching):
Exercise & Equipment
Weight
Sets & Repetitions/Set
Rest
Balance Training
Additional Notes:
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : W E E K LY P H Y S I C A L A C T I V I T Y
PLANNER AND LOG
Planning is an important part of making physical activity a regular part of your day. Use this planner to set aside
times for physical activity in your week and then make note of how you do. Use a ✔ to indicate an item was
completed as planned, an ✗ to indicate a plan did not work out (and note why). It may also be helpful to make
note of how you felt during/after each session of physical activity.
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : W E E K LY P H Y S I C A L A C T I V I T Y
PLANNER AND LOG
Planning is an important part of making physical activity a regular part of your day. Use this planner to set aside
times for physical activity in your week and then make note of how you do. Use a ✔ to indicate an item was
completed as planned, an ✗ to indicate a plan did not work out (and note why). It may also be helpful to make
note of how you felt during/after each session of physical activity.
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PA T H : R E L A P S E P L A N N I N G W O R K S H E E T
Congratulations on your decision to improve your health and quality of life by committing to an action plan for
regular physical activity. Evidence indicates that relapses are likely to occur. How you deal with a relapse can
be an important part of the learning process towards success. It is helpful to anticipate and plan for relapses to
determine what you can do to help keep yourself on-track.
How confident are you that you will maintain your physical activity action plan over the next three months?
Not confident
1
Very confident
2
3
4
5
If your score is 4 or 5, please outline the reasons for your confidence:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
If your score is 1 to 3, please respond to the following questions:
1. What would you need to change to move you up the confidence scale?
2. Have you experienced difficulty before in maintaining a physical activity action plan? Yes
No
If Yes, please explain the difficulty and reasons behind it:
What helped you get back on track?
3.What situations do you anticipate might make it difficult to maintain your current physical activity action plan?
How could you handle these situations to increase the likelihood of keeping yourself on-track?
4. If you do experience a relapse, what will help you to minimize it and get started again?
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : Q U I C K R E F E R E N C E – C L I E N T
INTERVIEW NOTES
With time and practice, many professionals will find the Client Information Sheet (CIS) to be a sufficient memory aid
for gathering and recording essential information in the initial stages of a client interview. For those new to the art of
interviewing, the following can help establish the kind of conversational flow that can help put clients at ease. Use the form
on the back of this sheet for capturing key notes of relevance that you can use later to complete the CIS and as a memory aid
in future meetings with the client.
Task
Welcome the client and
put them at ease
Ask the client a few ‘ice
breaking’ questions
about themselves
Sample Script
Hi [use the client’s name from the booking], my name is [your name]. I am so pleased you have come to
visit us today.
Have you ever been to our facility before? Have you had a chance to look around a little? [If it is a
client’s first time, take a few minutes to show them around, highlighting locations of washrooms/change
facilities, etc.]
How is today going for you? Have you been outside to enjoy the weather? Did this time fit into your
schedule or did you have to juggle things a little to fit it in? Is our facility close to where you live or
work? What do you do for a living? Where do you work? Where do you go to school?
So, what brings you here to see us today?Have you ever worked with a personal trainer before?
Inquire about the
client’s reasons
for booking the
appointment
What kinds of physical activity do you currently do?
Did you used to be more active? What did you like to do then?
What do you think you might enjoy now?
Have you ever had a fitness assessment before?
Why don’t we take a seat here and take care of some paperwork to get started.
Did you have a chance to review the materials provided in the Welcome package when you made your
appointment? Was there anything in there that you have questions about?
Let’s take a look at what we have.
The AAL-Q is designed to identify clients who may have a disability I should be aware of as a trainer/appraiser.
Have you noted anything on it?
Confirm completion
of the preliminary
screening devices
The PAR-Q+ is designed to help identify anyone who may have a health issue that I need to be aware
of before we start to work together. Let’s take a look at your form. [Review the form to ensure it has been
completed, signed and witnessed. Confirm the client lies within your scope of practice and whether their
answers affect the scope of the assessment you can undertake.]
The Informed Consent is another item I have to have on file. It confirms that you understand the nature of the
risks involved in undertaking a fitness assessment or becoming much more physically active. Do you have any
questions about it? Have you signed it and had it witnessed?
There are also two questionnaires in the package – the PASB-Q and the FANTASTIC Lifestyle Checklist. Did
you have a chance to review and complete them? We’ll go over those together a bit later.
Establish the client’s
preferences for the
fitness assessment
Let’s talk about what you want to accomplish today. [Broadly outline the purpose and three major
components of the assessment and the client’s options in that regard (e.g., receive information and
advice only, full or partial fitness assessment.]
In your welcome pages were a few pre-assessment instructions about not eating, drinking or exercising
in the hours leading up to your appointment. That’s so we can get accurate results in the tests. Did you
follow those instructions?
Great. Let’s get started by first taking your Resting Heart Rate and Blood Pressure measurements.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
QUICK REFERENCE – CLIENT INTERVIEW
SUMMARY NOTES
SOAP Notes (Subjective, Objective, Assessment, and Plan) is a basic record keeping method employed by many qualified
exercise health professionals to help clarify the thinking process and the rationale for a course of evaluation, action or both.
Unique needs and concerns are identified and the intervention is documented, largely so that follow-up evaluations can be
compared to earlier visits. It can be used by qualified exercise professionals as a way to summarize a session with a client and
can be kept on file in addition to the Client Information Sheet and other paperwork.
Date:
Client Name:
Subjective Notes:
Purpose of
Appointment
General physical activity/fitness goals:
Physical
Activity History
Present Activity:
Activity History/Previous Exercise Experience:
Activity Preferences:
Physical Activity
Barriers/Facilitators External
Perceived time restrictions:
Equipment/facility availability:
Other factors:
Objective Data:
Pertinent notes from
pre-screening
AAL-Q Issues:
PAR-Q+ Issues:
Assessment:
Assessment notes
Significant interpretation items from fitness assessment or other data collected:
Plan:
General Objectives
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H C L I E N T I N F O R M AT I O N S H E E T
Date (dd/mm/yr):
Qualified Exercise Professional:
Client Information
Name:
Email address:
Age (years):
£ Male
£ Female
Telephone:
Emergency Contacts
Physician:
Telephone:
Next of Kin:
Telephone:
Health Screening and Consent
£ AAL-Q completed
£ NA
£ Issues identified:
£ PAR-Q+ completed, signed
£ All NO
Page 2/3 All NO
£ PAR-Q+ witnessed
£ YES page 1 #_____
Page 2/3 YES:
£ PARmed-X for Pregnancy
£ Pregnancy (ask all females)
£ Observations
£ Referral:
£ CSEP-C
£ Difficulty breathing at rest
£ Followed
preliminary instructions
£ Illness or fever
£ Lower extremity swelling
£ Persistant cough
£ Physician
£ Informed Consent completed, signed, witnessed
£ Resting Heart Rate (RHR)
£ Resting Blood Pressure
RHR (15 sec):
RHR (bpm):
£ 1st RHR > 99
Wait 5 min, re-measure
RHR (15 sec):
RHR (bpm):
£ 2nd RHR > 99 Refer to physician
SBP (mmHg):
DBP (mmHg):
£ 1st SBP > 144 or DBP > 94 Wait
5 min, re-measure
SBP (mmHg):
DBP (mmHg):
£ 2nd SBP > 144 or DBP > 94
Refer to physician
£ Physician Physical Activity Clearance provided
Tools and Handouts provided:
£ Physician Physical Activity Clearance returned, signed
£ Stages of Change Questionnaire
£ Alternatives for Action Worksheet
£ Inventory of Lifestyle Needs and
Activity Preferences
£ Goal Setting Worksheet
£ CSEP-PATH Evaluation
Summary Report
£ Barriers to Physical Activity
£ Decision Balance Worksheet
£ First Step Planning Worksheet
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
£ Weekly Activity Planner & Log
£ Relapse Planning Worksheet
£ Canadian Physical
Activity Guidelines
£ Canada’s Food Guide
£ Other, specify:
C S E P. C A
Physical Activity and Lifestyle Assessment
£ PASB-Q completed
£ FANTASTIC Lifestlye Checklist
Aerobic Activity
Strength Activity
(m/wk):
(#/wk):
HBR:
HBR:
Score:
Noted Items:
Perceived
Aerobic Fitness:
Sedentary behavior
(h/day):
HBR:
HBR:
Body Composition Assessment
BMI (kg/m2):
Waist Circumference (cm):
Weight (kg):
[BMI = weight (kg) / height2 (m)]
Height (cm):
BMI Health Risk Category:
Combined BMI-WC
Health Risk Category:
Aerobic Fitness Assessment
Aerobic Fitness Test Used
85% Predicted HRmax:
[HRmax = .85(220-age)]
£ mCAFT
Predicted VO2max:
VO2max (ml.kg-1.min-1)
HR peak (bpm):
£ Treadmill Walking
£ One Mile Walk
RPE peak:
HBR:
£ Cycle Ergometer
Musculoskeletal Fitness Assessment
£ Grip Strength
Right hand 1 (kg):
Left hand 1 (kg):
Right hand 2 (kg):
Left hand 2 (kg):
Combined max (kg):
£ Push-ups
# completed:
£ Sit and Reach
Trial 1 (cm):
Trial 2 (cm):
Stand-reach (cm):
Jump height = maximum jump height – stand-reach (cm):
Jump 1 (cm):
Peak Leg Power (watts) = [(60.7 x jump height (cm)
+ (45.3 x body mass (kg)] – 2055 =
£ Vertical Jump
Jump 2 (cm):
Jump 3 (cm):
£ Back Extension
£ One Leg Stance
HBR:
Max (cm):
HBR:
HBR:
Time (secs):
HBR:
Eyes open - left (sec)
Eyes closed - left (sec)
Eyes open - right (sec)
Eyes closed - right (sec)
Best time (sec):
HBR:
Best time (sec):
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
Eyes open
Eyes closed
£ Above mean
£ Above mean
£ Below mean
£ Below mean
C S E P. C A
C S E P - PAT H : D ATA C O L L E C T I O N W O R K S H E E T
(mCAFT)
Name:
Date (dd/mm/yr):
Age (years):
Gender:
Predicted HRmax (bpm):
F
Weight (kg):
85% predicted HRmax:
HR (bpm) measured by:
Exercise
M
Auscultation
Starting Stage
(use Table 1 on
the back)
HR (bpm)
b/10 seconds
Palpation
Electronic HR Monitor
BP (mmHg)
1st stage
2nd stage
3rd stage
4th stage
5th stage
6th stage
7th stage
8th stage
Please Note: A standardized recovery protocol applies to each aerobic fitness assessment. At test completion,
use the table to record the client’s Heart Rate and Blood Pressure at the designated intervals.
Post-Exercise Time (min)
Active Recovery
HR (bpm)
RPE
1
2
3
4*
5*
Passive Recovery
1
2
3
4**
5**
* If client does not feel sufficiently recovered by 3 min, then complete another 2 min of very light recovery, before sitting.
** If at 3 min of passive recovery, HR and BP is above prescreening cutoffs (SBP>144, DBP>94, and HR>99), wait another 2 minutes, and then
measure HR and BP. Clients with HR or BP values that remain above the cutoffs at this time should postpone the remainder of the assessment
to a later date.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
mC AFT E Q UATIO N S TO PREDICT VO2 MAX
VO2max (ml.kg-1.min-1) = 17.2 + (1.29 x O2 cost of the last
VO2max (ml.kg-1.min-1) = 17.2 + (1.29 x ______ ) (0.09 x ___________ kg) - (0.18 x ___________ )
completed stage) - (0.09 x mass in kg) - (0.18 x age in years)
Note: O2 cost is provided in Table 2 on the back of this worksheet.
Predicted VO2max __________________ (ml.kg-1min-1)
HBR _________________________________
TA BL E 1 : m CA FT STA R T IN G STA GE
Age
Females
Males
15-19
3
4
20-29
3
4
30-39
3
3
40-49
2
3
50-59
1
2
60-69
1
2
TABL E 2: O 2 COS T TA BLE F O R TH E VARIO U S M CA F T STEPPING STAGES
Females
Males
Stage
O2cost
VO2(ml.kg-1.min-1)
Stage
O2cost
VO2 (ml.kg-1.min-1)
1
15.9
1
15.9
2
18.0
2
18.0
3
22.0
3
22.0
4
24.5
4
24.5
5
26.3
5
29.5
6
29.5
6
33.6
7
33.6
7
36.2
8
36.2
8
40.1
TABL E 3: E S TIMAT ED V O 2 MA X - H EA LTH B ENE F IT R ATIN G
Age
Zone
Male
Female
15-19
Excellent
Very Good
Good
Fair
Poor
57.4+
52.4 - 57.3
48.8 - 52.3
43.6 - 48.7
<43.6
49.0+
43.7 - 48.9
39.5 - 43.6
36.8 - 39.4
<36.8
20-29
Excellent
Very Good
Good
Fair
Poor
55.6+
50.6 - 55.5
47.2 - 50.5
41.6 - 47.1
<41.6
47.2+
42.0 - 47.1
37.8 - 41.9
35.0 - 37.7
<35.0
30-39
Excellent
Very Good
Good
Fair
Poor
48.8+
45.4 - 48.7
40.1 - 45.3
33.7 - 40.0
<33.7
45.4+
40.1 - 45.3
36.0 - 40.0
33.0 - 35.9
<33.0
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
Age
Zone
Male
Female
40-49
Excellent
Very Good
Good
Fair
Poor
47.0+
42.7 - 46.9
35.5 - 42.6
31.9 - 35.4
<31.9
40.0+
35.1 - 39.9
31.9 - 35.0
27.1 - 31.8
<27.1
50-59
Excellent
Very Good
Good
Fair
Poor
41.8+
36.5 - 41.7
30.1 - 36.4
26.0 - 30.0
<26.0
36.6+
34.0 - 36.5
31.0 - 33.9
24.6 - 30.9
<24.6
60-69
Excellent
Very Good
Good
Fair
Poor
38.4+
32.8 - 38.3
28.7 - 32.7
23.5 - 28.6
<23.5
35.8+
32.8 - 35.7
29.6 - 32.7
23.5 - 29.5
<23.5
C S E P. C A
C S E P - PAT H : D ATA C O L L E C T I O N W O R K S H E E T
( Tre a d mi l l Wa lk)
Name:
Age (years):
Date (dd/mm/yr):
Weight (kg):
Warm-up HR Training Zone:
50% predicted HRmax (bpm) =
Warm-up
Workload
M
F
85% predicted HRmax (bpm):
(bpm)
70% predicted HRmax (bpm) =
HR (bpm) measured by:
Time
(min)
Gender:
Auscultation
Speed (mph)
Grade (%)
1
0
2
0
3
0
4
0
1
5
2
5
3
5
4
5
5*
5
Palpation
Electronic HR Monitor
HR
(bpm)
RPE
* If HR is not at steady state (differs by >5 bpm) between 3rd and 4th minute, extend workload to 5th minute
Please Note: A standardized recovery protocol applies to each aerobic fitness assessment. At test completion,
use the table to record the client’s Heart Rate and Blood Pressure at the designated intervals.
Post-Exercise Time (min)
HR (bpm)
BP (mmHg)
1
2
Active
Recovery
3
4*
5*
1
2
Passive
Recovery
3
4**
5**
* If client does not feel sufficiently recovered by 3 min, then complete another 2 min of very light recovery, before sitting.
** If at 3 min of passive recovery, HR and BP is above prescreening cutoffs (SBP>144, DBP>94, and HR>99), wait another 2 minutes, and then measure
HR and BP. Clients with HR or BP values that remain above the cutoffs at this time should postpone the remainder of the assessment to a later date.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
EQ U AT IO N T O P REDICT V O 2 M A X FOR T READ MILL WALK
VO2max (ml.kg-1.min-1) = 15.1 + (21.8 x speed in mph) – (0.327
x steady-state HR averaged from last two workloads) – (0.263 x
walking speed in mph x age in years) + (0.00504 x HR in bpm x age
in years) + (5.98 x gender)
VO2max (ml.kg-1.min-1) = 15.1 + (21.8 x ________ mph) – (0.327 x
________ bpm) – (0.263 x ________ mph x ________ years) +
(0.00504 x ________ bpm x ________ in years) + (5.98 x ________ )
Gender = 1 for males or 0 for females
Predicted VO2max __________________ (ml.kg-1.min-1)
HBR _______________________________
ESTI M ATE D VO 2 MA X - H EA LTH B ENEFIT R ATIN G
Age
Zone
Male
Female
15-19
Excellent
Very Good
Good
Fair
Poor
57.4+
52.4 - 57.3
48.8 - 52.3
43.6 - 48.7
<43.6
49.0+
43.7 - 48.9
39.5 - 43.6
36.8 - 39.4
<36.8
20-29
Excellent
Very Good
Good
Fair
Poor
55.6+
50.6 - 55.5
47.2 - 50.5
41.6 - 47.1
<41.6
47.2+
42.0 - 47.1
37.8 - 41.9
35.0 - 37.7
<35.0
30-39
Excellent
Very Good
Good
Fair
Poor
48.8+
45.4 - 48.7
40.1 - 45.3
33.7 - 40.0
<33.7
45.4+
40.1 - 45.3
36.0 - 40.0
33.0 - 35.9
<33.0
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
Age
Zone
Male
Female
40-49
Excellent
Very Good
Good
Fair
Poor
47.0+
42.7 - 46.9
35.5 - 42.6
31.9 - 35.4
<31.9
40.0+
35.1 - 39.9
31.9 - 35.0
27.1 - 31.8
<27.1
50-59
Excellent
Very Good
Good
Fair
Poor
41.8+
36.5 - 41.7
30.1 - 36.4
26.0 - 30.0
<26.0
36.6+
34.0 - 36.5
31.0 - 33.9
24.6 - 30.9
<24.6
60-69
Excellent
Very Good
Good
Fair
Poor
38.4+
32.8 - 38.3
28.7 - 32.7
23.5 - 28.6
<23.5
35.8+
32.8 - 35.7
29.6 - 32.7
23.5 - 29.5
<23.5
C S E P. C A
C S E P - PAT H D ATA C O L L E C T I O N W O R K S H E E T
( O n e M il e Wa lk )
Name:
Date (dd/mm/yr):
Age (years):
Gender:
HR (bpm) measured by:
Time to Complete One Mile:
M
Auscultation
(minutes:seconds)
F
Weight:
Palpation
(kg)
Electronic HR Monitor
Immediate Post-Exercise Heart Rate:
bpm
Please Note: A standardized recovery protocol applies to each aerobic fitness assessment. At test completion,
use the table to record the client’s Heart Rate and Blood Pressure at the designated intervals.
Post-Exercise Time (min)
Active
Recovery
HR (bpm)
BP (mmHg)
1
2
3
4*
5*
Passive
Recovery
1
2
3
4**
5**
* If client does not feel sufficiently recovered by 3 min, then complete another 2 min of very light recovery, before sitting.
** If at 3 min of passive recovery, HR and BP is above prescreening cutoffs (SBP>144, DBP>94, and HR>99), wait another 2 minutes, and then
measure HR and BP. Clients with HR or BP values that remain above the cutoffs at this time should postpone the remainder of the assessment
to a later date.
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
E QU AT IO N TO P RE DICT V O 2 MA X F OR R OCK POR T ONE M ILE WALK T EST
VO2max (ml.kg-1.min-1) = 132.853 – (0.0769 x mass in lbs) – (0.3877 x
age in years) + (6.315 x gender) – (3.2649 x time in minutes) –
(0.1565 x HR in bpm)
Gender = 1 for males or 0 for females
Predicted VO2max __________________ (ml.kg-1.min-1)
VO2max (ml.kg-1.min-1) = 132.853 – (0.0769 x _____ lbs)
– (0.3877 x _____ years) + (6.315 x _____ ) –
(3.2649 x _____ minutes) – (0.1565 x _____ bpm)
HBR _______________________________
E ST IM AT ED V O 2 MA X - H EA LTH B ENEFIT R ATING
Age
Zone
Male
Female
15-19
Excellent
Very Good
Good
Fair
Poor
57.4+
52.4 - 57.3
48.8 - 52.3
43.6 - 48.7
<43.6
49.0+
43.7 - 48.9
39.5 - 43.6
36.8 - 39.4
<36.8
20-29
Excellent
Very Good
Good
Fair
Poor
55.6+
50.6 - 55.5
47.2 - 50.5
41.6 - 47.1
<41.6
47.2+
42.0 - 47.1
37.8 - 41.9
35.0 - 37.7
<35.0
30-39
Excellent
Very Good
Good
Fair
Poor
48.8+
45.4 - 48.7
40.1 - 45.3
33.7 - 40.0
<33.7
45.4+
40.1 - 45.3
36.0 - 40.0
33.0 - 35.9
<33.0
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
Age
Zone
Male
Female
40-49
Excellent
Very Good
Good
Fair
Poor
47.0+
42.7 - 46.9
35.5 - 42.6
31.9 - 35.4
<31.9
40.0+
35.1 - 39.9
31.9 - 35.0
27.1 - 31.8
<27.1
50-59
Excellent
Very Good
Good
Fair
Poor
41.8+
36.5 - 41.7
30.1 - 36.4
26.0 - 30.0
<26.0
36.6+
34.0 - 36.5
31.0 - 33.9
24.6 - 30.9
<24.6
60-69
Excellent
Very Good
Good
Fair
Poor
38.4+
32.8 - 38.3
28.7 - 32.7
23.5 - 28.6
<23.5
35.8+
32.8 - 35.7
29.6 - 32.7
23.5 - 29.5
<23.5
C S E P. C A
C S E P - PAT H : D ATA C O L L E C T I O N W O R K S H E E T
( C y c l e Erg o met er)
Name:
Date (dd/mm/yr):
Age (years):
Gender:
85% predicted HR max:
bpm
M
F
Weight:
(kg)
Seat Height:
HR (bpm) measured by:
Auscultation
Palpation
Electronic HR Monitor
Determine the loading sequence using the table attached.
T im e
( m in )
R e s is t a n c e
(k g o r w a tt s )
C a d e n c e
(r p m )
H R
(b p m )
R P E
1
2
Workload
One
3
4*
1
2
Workload
Two
3
4*
1
2
Workload
Three
3
4*
1
2
Workload
Four
3
4*
* if HR is not at steady state (differs by >5 bpm) between 2nd and 3rd minute, extend workload to 4th minute
C A N A D I A N
S O
C I E T Y
F O R
E X E R C IS E
P H Y S I O
L O
G Y
C S E P . C A
Please Note: A standardized recovery protocol applies to each aerobic fitness assessment. At test completion, use the
table to record the client’s Heart Rate and Blood Pressure at the designated intervals.
P o s t- E x e r c i s e T i m e ( m i n )
Active
Recovery
H R (b p m )
B P (m m H g )
1
2
3
4*
5*
Passive
Recovery
1
2
3
4**
5**
* If client does not feel sufficiently recovered by 3 min, then complete another 2 min of very light recovery, before sitting.
** If at 3 min of passive recovery, HR and BP is above prescreening cutoffs (SBP>144, DBP>94, and HR>99), wait another 2 minutes, and then measure
HR and BP. Clients with HR or BP values that remain above the cutoffs at this time should postpone the remainder of the assessment to a later date.
E Q U AT IO N TO P REDICT VO 2 MA X FOR CY CLE E RGOMETER T EST
1. Determine power output for each workload
VO2 (ml.kg-1.min-1) = [(Watts/body mass in kg) x 10.8] + 7
SM1 = VO2 (ml.kg-1.min-1) = [( _______watts/ ______kg) x 10.8] + 7
SM1 = Sub-maximal VO2 at 2nd last workload
SM1 = ______
SM2 = Sub-maximal VO2 at last workload
SM2 = VO2 (ml.kg-1.min-1) = [(_______ watts/______ kg) x 10.8] + 7
1 Watt = ~6 kpm.min-1
SM2 = ______
2. Determine multi-stage slope of the line
b = ( ______ ml.kg-1.min-1)- ______ ml.kg-1.min-1) / ( _______ bpm) ________ bpm)
b = (SM2-SM1)/(HR2-HR1)
HR1 = Average of last two heart rates from the 2nd last workload
HR2 = Average of last two heart rates from the last workload
= ________
3. Determine VO2max
VO2max (ml.kg-1.min-1) = _______ + [ _____ x ( _____ - _____ )]
VO2max (ml kg min ) = SM2 + [b (HRmax-HR2)]
.
-1.
-1
= ________
Predicted VO2max __________________ (ml.kg-1.min-1)
C A N A D I A N
S O
C I E T Y
F O R
E X E R C IS E
P H Y S I O
L O
HBR _________________________________
G Y
C S E P . C A
H EA R T RATE A N D LO A DIN G SE Q U ENCE FOR T HE C Y CLE ERGOMETER TEST
1st workload
(3 minutes
150 kpm minute-1 (0.5 kp or 25W)
Heart Rate for the last minute of the 1st workload determines subsequent workloads
HR<80 bp
HR = 80-89 bpm
HR = 90-100 bpm
HR>100 bpm
2nd workload
750 kpm.min-1
(2.5 kp or 125W)
600 kpm.min-1
(2.0 kp or 100W)
450 kpm.min-1
(1.5 kp or 75W)
300 kpm.min-1
(1.0 kp or 50W)
3rd workload
900 kpm.min-1
(3.0 kp or 150W)
750 kpm.min-1
(2.5 kp or 100W)
600 kpm.min-1
(2.0 kp or 100W)
450 kpm.min-1
(1.5 kp or 75W)
4th workload
1050 kpm.min-1
(3.5 kp or 175W)
900 kpm.min-1
(3.0 kp or 150W)
750 kpm.min-1
(2.5 kp or 125W)
600 kpm.min-1
(2.0 kp or 100W)
If additional workloads are required to achieve within 10 bpm of 85%HRmax, add 150 kpm.min-1 (0.5 kp or 25W)
to the previous workload
Additional workloads
E STI M ATED VO 2 m ax - H EA LT H B EN EFIT R ATING
A g e
Z o n e
M a le
F e m a le
15-19
Excellent
Very Good
Good
Fair
Poor
57.4+
52.4 - 57.3
48.8 - 52.3
43.6 - 48.7
<43.6
49.0+
43.7 - 48.9
39.5 - 43.6
36.8 - 39.4
<36.8
20-29
Excellent
Very Good
Good
Fair
Poor
55.6+
50.6 - 55.5
47.2 - 50.5
41.6 - 47.1
<41.6
47.2+
42.0 - 47.1
37.8 - 41.9
35.0 - 37.7
<35.0
30-39
Excellent
Very Good
Good
Fair
Poor
48.8+
45.4 - 48.7
40.1 - 45.3
33.7 - 40.0
<33.7
45.4+
40.1 - 45.3
36.0 - 40.0
33.0 - 35.9
<33.0
C A N A D I A N
S O
C I E T Y
F O R
E X E R C IS E
P H Y S I O
L O
G Y
A g e
Z o n e
M a le
F e m a le
40-49
Excellent
Very Good
Good
Fair
Poor
47.0+
42.7 - 46.9
35.5 - 42.6
31.9 - 35.4
<31.9
40.0+
35.1 - 39.9
31.9 - 35.0
27.1 - 31.8
<27.1
50-59
Excellent
Very Good
Good
Fair
Poor
41.8+
36.5 - 41.7
30.1 - 36.4
26.0 - 30.0
<26.0
36.6+
34.0 - 36.5
31.0 - 33.9
24.6 - 30.9
<24.6
60-69
Excellent
Very Good
Good
Fair
Poor
38.4+
32.8 - 38.3
28.7 - 32.7
23.5 - 28.6
<23.5
35.8+
32.8 - 35.7
29.6 - 32.7
23.5 - 29.5
<23.5
C S E P . C A
C S E P - PAT H : D ATA C O L L E C T I O N W O R K S H E E T
( E s t i m a t in g 1 - R M a n d Re s i s t a n c e P re s cr ip t i on )
Name:
Gender:
Male
Body
segment
Exercise
Legs
Squats
Chest
Chest
press
Back
Seated
Row
Shoulders
Overhead
shoulder
press
Back
Cable lat
pull down
Upper
arms
Triceps
kickback
Upper
arms
Bicep curl
Hips,
thighs
Lunge
Legs
Hamstring
Curl
Legs
Leg
extension
Female
Set 1 –
weight
(Kg or lbs)
Date (dd/mm/yr):
Age (years):
Weight (kg):
Equipment used:
Repetitions
completed
Set 2 –
weight
(Kg or lbs)
Repetitions
completed
Set 3 –
weight
(kg or lbs
Repetitions
completed
1-RM
Lower
% 1-RM
(______)
Upper
% 1-RM
(______)
Formula to Estimate 1-RM
1-RM = Weight (kg or lbs) ÷ [% 1-RM value from the table below ÷ 100]
1-RM = ______ (kg or lbs) ÷ ( _____ / 100)
Reps
Completed
1
2
3
4
5
6
7
8
9
10
% 1-RM
100
95
93
90
87
85
83
80
77
75
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : D ATA C O L L E C T I O N W O R K S H E E T
( E s t i m a t in g 1 - R M a n d Re s i s t a n c e P re s cr ip t i on )
Name:
Gender:
Male
Body
segment
Female
Exercise
Set 1 –
weight
(Kg or lbs)
Date (dd/mm/yr):
Age (years):
Weight (kg):
Equipment used:
Repetitions
completed
Set 2 –
weight
(Kg or lbs)
Repetitions
completed
Set 3 –
weight
(kg or lbs)
Repetitions
completed
1-RM
Lower
% 1-RM
(______)
Upper
% 1-RM
(______)
Equation to Estimate 1-RM
1-RM = Weight (kg or lbs) ÷ [% 1-RM value from the table below ÷ 100]
1-RM = ______ (kg or lbs) ÷ (______ / 100)
Reps
Completed
1
2
3
4
5
6
7
8
9
10
% 1-RM
100
95
93
90
87
85
83
80
77
75
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : Q U I C K R E F E R E N C E – H E A LT H
B E N E F I T S R AT I N G S ( H B R )
P HY SI C A L A CT IVI T Y A N D S E DE N TA RY B EHAVIOU R QU ESTIONN A IRE ( PA SB -Q)
Health Benefit Ratings
Aerobic Physical
Activity (min/week)
Strength
Physical Activity
(times/week)
Perceived
Aerobic Fitness
Sedentary Behaviour
(hours/day)
Excellent
300+
4+
Excellent
<2
Very Good
225-299
3
Very Good
2-4
Good
150-224
2
Good
4-6
Fair
75-149
1
Fair
6-8
Poor
0-74
0
Poor
>8
For youth (12-17 years), the HBRs are different than those for adults. Refer to the PASB-Q interpretation table in the B2 ASSESS chapter of
your Resource Manual.”
A ER O B I C F I T NES S
Age
Zone
Male
Female
15 - 19
Excellent
Very Good
Good
Fair
Poor
57.4+
52.4-57.3
48.8-52.3
43.6-48.7
43.6
49.0+
43.7-48.9
39.5-43.6
36.8-39.4
36.8
20 - 29
Excellent
Very Good
Good
Fair
Poor
55.6+
50.6-55.5
47.2-50.5
41.6-47.1
41.6
47.2+
42.0-47.1
37.8-41.9
35.0-37.7
35.0
30 - 39
Excellent
Very Good
Good
Fair
Poor
48.8+
45.4-48.7
40.1-45.3
33.7-40.0
33.7
45.4+
40.1-45.3
36.0-40.0
33.0-35.9
33.0
Age
Zone
Male
Female
40 - 49
Excellent
Very Good
Good
Fair
Poor
47.0+
42.7-46.9
35.5-42.6
31.9-35.4
31.9
40.0+
35.1-39.9
31.9-35.0
27.1-31.8
27.1
50 - 59
Excellent
Very Good
Good
Fair
Poor
41.8+
36.5-41.7
30.1-36.4
26.0-30.0
26.0
36.6+
34.0-36.5
31.0-33.9
24.6-30.9
24.6
60 - 69
Excellent
Very Good
Good
Fair
Poor
38.4+
32.8-38.3
28.7-32.7
23.5-28.6
23.5
35.8+
32.8-35.7
29.6-32.7
23.5-29.5
23.5
B A L A N CE AND S TA B ILI TY – O N E- L EG S TA N CE M EA N SC O RES
The following values represent means times based on the best of two trials conducted. Interpretation will simply categorize clients as above
or below the mean values (i.e., given the lack of evidence upon which to base a more detailed Health Benefit Rating)
Age Group
Eyes Open
Eyes Closed
Male
Female
Male
Female
18-39
44.4
45.0
16.9
13.1
40-49
41.6
42.1
12.0
13.5
50-59
41.5
40.9
8.6
7.9
60-69
33.8
30.4
5.1
3.6
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
MU SC UL O S K E L ETA L F I T N ESS
Age (years)
Grip Strength (kg)
Push-ups (#)
Sit and Reach (cm)
Vertical Jump (watts)
Back Extension
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
≥ 108
98-107
90-97
79-89
≤ 78
≥ 68
60-67
53-59
48-52
≤ 47
≥ 39
29-38
23-28
18-22
≤ 17
≥ 33
25-32
18-24
12-17
≤11
≥ 39
34-38
29-33
24-28
≤ 23
≥ 43
38-42
34-37
29-33
≤ 28
≥ 4644
4185-4683
3858-4184
3323-3857
≤ 3322
≥ 3167
2795-3166
2399-2794
2156-2398
≤ 2155
158-180
135-157
119-134
91-118
≤ 90
169-180
141-168
122-140
91-121
≤90
≥115
104-114
95-103
84-94
≤83
≥ 70
63-69
58-62
52-57
≤51
≥ 36
29-35
22-28
17-21
≤16
≥ 30
21-29
15-20
10-14
≤9
≥ 40
34-39
30-33
25-29
≤24
≥ 41
37-40
33-36
28-32
≤27
≥5094
4640-5953
4297-4639
3775-4296
≤ 3774
≥ 3250
2804-3249
2478-2803
2271-2477
≤ 2270
176-180
109-146
91-108
56-90
≤ 85
180
136-179
102-135
66-101
≤65
≥ 115
104-114
95-103
84-94
≤ 83
≥ 71
63-70
58-62
51-57
≤ 50
≥ 30
22-29
17-21
12-16
≤ 11
≥ 27
20-26
13-19
8-12
≤7
≥ 38
33-37
28-32
23-27
≤ 22
≥ 41
36-40
32-35
27-31
≤ 26
≥ 4860
4389-4859
3967-4388
3485-3966
≤ 3484
≥ 3193
2550-3192
2335-2549
2147-2334
≤ 2146
147-180
109-146
91-108
56-90
≤ 55
180
141-179
112-140
61-111
≤ 60
≥ 108
97-107
88-96
80-87
≤ 79
≥ 69
61-68
54-60
49-53
≤ 48
≥ 25
17-24
13-16
10-12
≤9
≥ 24
15-23
11-14
5-10
≤4
≥ 35
29-34
24-28
18-23
≤ 17
≥ 38
34-37
30-33
25-29
≤ 24
≥ 4320
3700-4319
3242-3699
2708-3241
≤ 2707
≥ 2675
2288-2674
2101-2287
1688-2100
≤ 1687
130-180
84-129
71-85
32-70
≤ 31
180
115-179
80-114
42-79
≤ 41
≥ 101
92-100
84-91
76-83
≤ 75
≥ 61
54-60
49-53
45-48
≤ 44
≥ 21
13-20
10-12
7-9
≤6
≥ 21
11-20
7-10
2-6
≤1
≥ 35
28-34
24-27
16-23
≤ 15
≥ 39
33-38
30-32
25-29
≤ 24
≥ 4019
3567-4018
2937-3566
2512-2936
≤ 2511
≥ 2559
2161-2558
1701-2160
1386-1700
≤ 1385
120-180
88-119
54-87
20-53
≤ 19
110-180
75-109
47-74
15-46
≤ 14
≥ 100
91-99
84-90
73-83
≤ 72
≥ 54
48-53
45-47
41-44
≤ 40
≥ 18
11-17
8-10
5-7
≤4
≥ 17
12-16
5-11
2-4
≤1
≥ 33
25-32
20-24
15-19
≤ 14
≥ 35
31-34
27-30
23-26
≤ 22
≥ 3764
3291-3763
2848-3290
2383-2842
≤ 2382
≥ 2475
1717-2474
12317-1717
1198-1316
≤ 1197
≥ 117
78-116
52-77
20-51
≤ 19
91-180
40-90
19-39
6-18
≤5
15 - 19
Excellent
Very Good
Good
Fair
Poor
20 - 29
Excellent
Very Good
Good
Fair
Poor
30 - 39
Excellent
Very Good
Good
Fair
Poor
40 - 49
Excellent
Very Good
Good
Fair
Poor
50 - 59
Excellent
Very Good
Good
Fair
Poor
60 - 69
Excellent
Very Good
Good
Fair
Poor
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY
C S E P. C A
C S E P - PAT H : R AT I N G O F P E R C E I V E D
EXERTION (RPE) (scale of 6 -20)
6
Very, very light
7
8
Very light
9
10
Fairly light
11
12
Somewhat hard
13
14
Hard
15
16
Very hard
17
18
Very, very hard
19
20
(BORG, 1982)
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C S E P. C A