Components of a Fitness
Assessment & Major Coronary Risk
Factors
and Pre-Participation
Guidelines as Established by the
American College of Sports
Medicine (ACSM)
Components of a Fitness Assessment
• Initial Consultation
• Pre-participation Health Screening:
– Lifestyle Questionnaire including Exercise
History
– PAR-Q
– Medical History Questionnaire
• Determine Positive and Negative Risk Factors for
CAD
• Determine Risk Stratification
–Medical Clearance
–Informed Consent
Components of a Fitness Assessment
• Exercise Testing:
– Vital Signs
• Heart Rate
• Blood Pressure
– Height/Weight
– Body Composition
– Girth Measurements
– Flexibility/Movement Analysis
– Balance
– Muscular Strength
– Muscular Endurance
– Cardiovascular Endurance
Performing A Fitness Assessment
• Collect data to build an appropriate personal
training plan
• Assessment should be client centered and
based on their short and long term goals
• Explain to client what is being assessed and
why
• Choose assessment tests and tools appropriate
to client’s: gender, age, developmental level,
medical status, functional abilities
• Perform assessment tests correctly
Performing A Fitness Assessment
• Analyze and summarize findings
• Document results
• Communicate results to client and
establish health/fitness program
and goals
Personal Training Plan
• What ought to be done?
–Am I doing what is best for my client?
• Goals
–Prepare schedule for exercise program
based on fitness assessment results
–Discuss changes in nutritional habits
–Discuss health-related lifestyle habits
(smoking, alcohol use…)
–Implement motivational techniques
Initial Consultation
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Assess Client-Trainer Compatibility
Discuss Goals (Short and long term)
Establish Client-Trainer Agreement
Perform Pre-Participation Health
Screening
– Lifestyle Questionnaire including Exercise History
– PAR-Q (Physical Activity Readiness
Questionnaire)
– Health/Medical Questionnaire
– Informed Consent
– Medical Release Form
What is a Risk Factor ?
• An aspect of personal behavior or
lifestyle, an environmental exposure
or inherited characteristic, which, on
the basis of epidemiological evidence,
is known to be associated with healthrelated conditions considered to be
important to prevent
Purpose of the Pre-Participation Health
Screening as defined by the American
College of Sports Medicine (ACSM)
1. To identify and exclude individuals
with medical contraindications to
exercise.
2. To identify persons with clinically
significant disease conditions who
should be referred to a medically
supervised exercise program.
Purpose of the Pre-Participation Health
Screening as defined by the American
College of Sports Medicine (ACSM)
3. To identify individuals with disease
symptoms and risk factors for
disease development who should
receive further medical evaluation
before starting an exercise program.
4. To identify persons with special needs
for safe exercise participation (e.g.,
elderly persons, pregnant women).
Pre-Participation Health Screening
• PAR-Q
–Physical Activity Readiness
Questionnaire
–Developed in Canada
–A questionnaire for people aged 15-69
–Identifies individuals at increased risk for
disease because of age, symptoms,
and/or risk factors who should undergo
medical evaluation
Pre-Participation Health Screening
• Health History Questionnaire
–Identifies:
• Heart Disease Risk Factors
• Injury or orthopedic conditions (such as a
back, hip, or knee problem)
• History of illness and medications
• Known disease
• Special needs
• Activity level
Coronary Artery Disease
• Narrowing of coronary arteries usually
caused by arteriosclerosis (pathological
condition resulting in thickening,
hardening and loss of elasticity of arterial
walls)
Risk Factors for Coronary Artery Disease
(CAD) Established by the ACSM
• Positive Risk Factors
– Family History
– Cigarette Smoking
– Hypertension
– Hypercholesterolemia
– Diabetes Mellitus
– Obesity
– Sedentary Lifestyle
• Negative Risk Factors
– High Serum HDL Cholesterol
Risk Factors
• Count the number of positive
risk factors and subtract the
number of negative risk factors
Positive Risk Factor for CAD
Established by the ACSM
Family History
• At risk if Coronary Artery Disease is
present or in the form of MI or Sudden
Death:
–Father or Brother (1st degree relative)
prior to the age of 55.
–Mother or Sister (1st degree relative)
prior to the age of 65.
Positive Risk Factor for CAD
Established by the ACSM
Cigarette/Cigar Smoking
• At risk if,
–Current use is present
–Residual effects may be manifest even if
smoking has stopped
• Removal of Risk
–Cessation for 6 months or greater
Positive Risk Factor for CAD
Established by the ACSM
Hypertension (high blood pressure)
• Resting Blood Pressure > 140/90 mm
Hg
–Confirmed by 2 separate measurements
–“Systolic>140 or Diastolic >90”
• Current Prescription for Blood
Pressure Medicine (for hypertensive
diagnosis)
Blood Pressure:
Systolic
Diastolic
Optimal
<120
<80
Normal
120-129
80-84
High Normal 130-139
85-89
Hypertension:
Stage 1
140-159
90-99
Stage 2
160-179
100-109
Stage 3
>180
>110
Cholesterol
• Cholesterol: a fatty waxy substance that
occurs in all animal tissues.
• High Density Lipoproteins (HDL’s):
Good cholesterol because it removes
excess cholesterol from circulation
• Low Density Lipoproteins (LDL’s): A
lipoprotein particle in the blood
responsible for depositing cholesterol
into the lining of the artery. Known as
"bad" cholesterol because high LDL is
linked to coronary artery disease
Positive Risk Factor for CAD
Established by the ACSM
• Hypercholesterolemia (positive risk)
• On lipid lowering medications
• If Lipoprotein profile is not available
–at risk with Total Cholesterol > 200
mg/dL
• If Lipoprotein profile is available
–at risk with HDL cholesterol < 40 mg/dL
–LDL>130 mg/dL
Negative Risk Factor for CAD
Established by the ACSM
Hypercholesterolemia (Negative Risk)
• Lipoprotein profile must be available.
• Subtract one risk factor if HDL
cholesterol is equal to or greater than
60 mg/dL
LDL Cholesterol
<100
Risk
Optimal
100-129
Near optimal/above optimal
130-159
Borderline
160-189
High
≤190
Very high
Total Cholesterol
<200
200-239
≤240
Risk
Desirable
Borderline high
High
HDL Cholesterol
Risk
<40
Low
≤60
High
Triglycerides
<150
Risk
Normal
150-199
Borderline high
200-499
High
≤500
Very high
Positive Risk Factor for CAD
Established by the ACSM
Diabetes Mellitus
• At Risk if:
–Diagnosed with Diabetes
Mellitus
–Fasting glucose is greater than
100 mg/dL on two occasions
Positive Risk Factor for CAD
Established by the ACSM
Obesity
• Body Mass Index (BMI) of 30 or
greater
• Waist to hip ratio greater than 0.95
(Men) and 0.86 (Women)
• Waist girth greater than 40 inches
(Men) and 35 inches (Women)
Positive Risk Factors for CAD
Established by the ACSM
Sedentary Lifestyle
• At risk if:
–A combination of a sedentary job
involving sitting a large part of the day
–The absence of regular exercise or a
recreational pursuit (accumulating less
than 30 min or more of moderate
physical activity most days of the week)
Pre-Participation Screening
Guidelines Defined by the ACSM
ACSM Risk Stratification Categories
Low Risk (apparently healthy): = 0 -1 Risk
Factors and younger (males under 45 and
females under 55)
Moderate Risk:= > 2 Risk Factors OR
older (>45 males; >55 female)
High Risk= Current diagnosis of Cardiac,
Pulmonary, Metabolic disease (known
(disease) or
> 1 Sign/Symptom of CAD
Pre-Participation Screening
Guidelines Defined by the ACSM
• Low Risk: Not necessary to have a
current medical examination
• Moderate Risk: If two or more risk
factors are present it is recommended
to have medical clearance prior to an
exercise program
• High Risk: Medical clearance needed
Signs/Symptoms of CAD or Pulmonary
Disease
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Angina (pain in chest, arms and jaw)
Shortness of breath at rest or with exercise
Dizziness
Heart Murmur
Syncope (fainting)
Ankle edema (swelling)
Tachycardia or Heart Palpitations
Unusual fatigue
Claudicating (cramp-like pain in the calf
muscles; a specific limp caused by this pain)
Case Study
• A 48-year old female desires to start an exercise
program in your facility. Following an initial
questionnaire and interview you find that she has no
personal history of heart disease, but her father died
following a heart attack at the age of 60. In addition,
she has a resting BP of 145/85. Her total cholesterol
is 220 with an HDL of 69. She is not obese. She
currently walks 30 minutes 4 times per week, but does
not strength train
• According to ACSM, how many positive risk factors
does she have? Stratify her risk (low, moderate, or
high risk)
Case Study
• John Smith is 43-years-old. His blood
pressure is 128/82 mm/Hg, and his
cholesterol is 222 mg/dL. He has a very
stressful job and has not exercised in
seven years. John’s 70-year old mother
had a heart attack last year.
• According to ACSM, how many positive
risk factors does John have? Stratify his
risk (low moderate, or high risk)
Informed Consent
• Gives clients information about the
content and process of the fitness
assessment, exercise program
and the risks and benefits
associated with participation
Client Instructions for Fitness
Assessments
• Clients should refrain from ingesting food,
alcohol, or caffeine or using tobacco products
within 3 hours of testing
• Clients should drink plenty of fluids over the
24-hour period preceding testing
• Clients should be rested for the assessment,
avoiding exercise on the day of the assessment
• Clothing should permit freedom of movement
and include athletic shoes
Components of A Fitness
Assessment
1. Vital Signs
• Heart Rate
• Blood Pressure
2. Height/Weight
3. Body Composition
4. Girth Measurements
5. Flexibility/Movement Analysis
6. Balance
7. Muscular Strength
8. Muscular Endurance
9. Cardiovascular Endurance
Body Composition
• Distribution of muscle and fat in
the body, and its measurement
• Body composition is often
represented as a two
compartment system; lean body
weight and fat
Flexibility
• Flexibility is the capacity of a joint to
move through its full range of motion.
• There is no single test that gives you
a score for overall flexibility.
• Each test is specific to a particular
movement or joints.
Movement Screens
• These Screens are NOT designed to
diagnose any medical conditions.
• They are simple assessments to help personal
trainers get a better perspective of your clients'
movements.
• These screens give you an insight into where
your client has developed imbalances in
movements
– Overhead squat, single-leg squat, lunge, supine
active straight leg raise, seated chest press, seated
row
Balance
• Maintenance of a position without
moving for a given period of time
Muscular Endurance
• The ability of a certain muscle or muscle group
to perform repeated contractions
• Several seconds to several minutes
• Examples:
– Push-up
– Abdominal Crunch
– BW Squat
– Pull-Up
Muscular Strength
• A force a muscle or muscle group can
exert
• Examples:
– Multiple Repetition Max for bench press and
leg press
Cardiovascular Endurance
• The ability to exercise continuously for extended
periods without tiring
• A person's aerobic fitness level is dependent upon
the amount of oxygen which can be transported by
the body to the working muscles, and the efficiency
of the muscles to use that oxygen.
• Examples:
– 3 Minute Step Test
– 1.0 mile Walk Test
– 12 minute run
– 1.5 mile run
– Ergometer test