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Fitness Assessment Protocols
Resting Measures
Height –
Participant should stand with back against the wall and look straight ahead. Head, shoulders, rear end and
heels should touch the wall. Gently press a ruler or any flat stick down on the top of the head; then mark the
spot where the ruler touches the wall with a pencil. The participant then steps away from the wall and tape
measure is used to record the distance from the floor to the mark, without rounding up fractions of
centimeters or inches.
Weight –
Have participant remove any bulky clothing and shoes prior to weighing. Ensure scale is properly calibrated.
Resting Heart Rate –
Radial Pulse (wrist) - place index and middle fingers together on the wrist, about 1/2 inch to the inside of the
joint, in line with the index finger.
Carotid Pulse (neck) - place your first two fingers on either side of the neck just below the point of the
jawbone. Be careful not to press to hard or results may be skewed.
Count for 15 seconds and multiply by 4; 30 seconds and multiply by 2; or for a full 60 seconds. Record number
of beats per minute.
**A true resting heart rate is obtained in the morning prior to rising from bed.
***If using an automated heart rate monitor, heart rate is often calculated as well.
Target Heart Rate –
For Men: 220-age = est. max hr
For Women: 226-age = est. max hr
75% of max hr is recommended upper limit for cancer survivors, in the absence of contraindications.
Blood Pressure –
o Participant should be seated quietly for at least 5 minutes in a chair with back support, feet on the
floor and arm supported at heart level.
o Wrap cuff around upper arm at heart level; align cuff with brachial artery.
o Place stethoscope bell below the antecubital space over the brachial artery.
o Quickly inflate cuff pressure to 20mm Hg above where you hear the first Korotkoff sound.
o Slowly release pressure at a rate equal to 2 to 5 mm HG per second.
o Systolic BP is the point at which the first two or more Korotkoff sounds is heard, and diastolic BP is the
point before the disappearance of Korotkoff sounds.
**If using automated blood pressure cuff follow instructions provided with the unit.
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Circumference Measures
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Measurements to be taken with flexible, but inelastic tape measure
Tape placed on skin surface without compressing subcutaneous adipose tissue
Administrator positioned to the right side of the individual being measured
Two measures taken in rotation with re-measure for any sites that are not within 5mm
Shoulders –
With participant standing upright and relaxed, apply tape just below acromion process at maximum bulge
of deltoid muscle.
Chest –
With participant standing upright and relaxed, apply tape at the midpoint of the sternum – around upper
lats and below the arm pit. Once tape is in place arms should be relaxed by the side and measurement at
the end of a normal expiration.
Waist –
With participant standing, arms at sides, feet together, and abdomen relaxed, a horizontal measure is
taken at the narrowest part of the torso - above the umbilicus and below the xiphoid process.
Abdomen –
With participant standing upright and relaxed, a horizontal measure is taken at the greatest anterior
extension of the abdomen, usually at the level of the umbilicus.
Buttocks/Hips –
With participant standing erect and feet together a horizontal measure is taken at the maximal
circumference of the buttocks, above the gluteal fold. *This site is used for the hip measure in a waist/hip
measure.
Thigh/Hips –
With the participant standing and legs separated, a horizontal measure is taken at the maximal
circumference of the hip/proximal thigh for the right side, repeat on the left side. Note the distance in
inches from the top of the knee cap (in inches) on your sheet so that anyone who follows your work can
replicate the location and a true measure can be ascertained.
Calf –
With participant standing erect (feet apart ~20cm) a horizontal measure is taken at the level of the
maximum circumference between the knee and the ankle, perpendicular to the long axis. Note the
distance in inches from the bottom of the knee cap (in inches) on your sheet so that anyone who follows
your work can replicate the location and a true measure can be ascertained.
Biceps –
With the participant standing erect and arms hanging freely at the sides, hands facing the thigh, a
horizontal measure is taken midway between the acromion and olecranon processes. Note the distance in
inches from the elbow (in inches) on your sheet so that anyone who follows your work can replicate the
location and a true measure can be ascertained.
Forearm –
With the participant standing, arms hanging downward but slightly away from the trunk and palms facing
anteriorly, measure perpendicular to the long axis at the maximal circumference. Note the distance in
inches from the elbow (in inches) on your sheet so that anyone who follows your work can replicate the
location and a true measure can be ascertained.
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Body Composition –
**Taken with a BIA unit, follow instructions provided with the unit.
Balance & Agility
Balance Test – Perform the tests in the order given since they are arranged by degree of difficulty. Practice
once or twice before testing is fine. If unable to pass a test, stop at that level.
Preliminary Test: Stand in front of a support with feet side by side and touching. If you can remain in
this position for 10 seconds without using hands for support, proceed with the test. If unable to do
this, balance is extremely poor and do not attempt the other tests.
Test 1: Tandem Stand (Romberg test). Stand between 2 chairs, lightly holding on for balance. Position
one foot directly in front of the other; the heel of the front foot should be touching the toes of the foot
in back. Distribute body weight evenly on both feet. Steady yourself and let go of support. Hold this
position for 10 seconds without the aid of hands. Feet should not leave the floor.
Test 2: Single leg stance. Stand between 2 chairs with feet together, lightly holding on for support.
Shift weight to one foot. Bend the other knee to bring that foot up in back. When balanced on one leg,
let go of the support with one hand, then the other. Start timing when both hands are released. 30
seconds indicates good balance, <20 seconds indicates increased risk for falls, client must hold 10
seconds to pass and go to next level.
Test 3: Tandem stand with eyes closed. Same as Test 1 but with eyes closed. Close eyes before letting
go of support; steady yourself and let go. Hold for 10 seconds.
Test 4: Tandem stand with eyes closed and head turning. This adds an additional challenge to test 3.
After closing eyes, steadying yourself and letting go of support, slowly turn head to the right, to the left
and back to the center. (~10 seconds).
Test 5: Single leg stance with eyes closed. This is the same as test 2, except with eyes closed. Before
releasing hands, close eyes. Hold for 10 seconds.
Highest Test Passed
Test 5: One legged stand with eyes closed
Test 4: Tandem stand with eyes closed and head turning
Test 3: Tandem stand with eyes closed
Balance Level
Excellent
Very Good
Good
Test 2: One legged stand
Fair
Test 1: Tandem stand
Poor
Unable to pass any tests
Very Poor
Irrespective of results, balance can be improved significantly with strength training and balance exercises, regardless of age.
1
Miriam Nelson, Ph.D., School of Nutrition Science and Policy, Tufts University; 2000, Strong Women, Strong Bones, p 83-87
http://www.spokaneosteoporosis.com/balance_test.html
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8 ft. Up & Go –
Place straight back chair against wall, and cone 8’ in front of chair. Ensure path is clear. Participant begins
sitting on chair, hands resting on knees, feet flat on the ground. Upon the word “Go”, timing starts, participant
stands and walks as quickly as possible out/around the cone and back to a seated position in the chair. Timing
stops when participant is reseated. Perform two trials. Take the best time of the two trials to the nearest
1/10th second.
Cardiovascular Fitness
(NOTE: 2 minute step test is the standard test to use, an alternate test for a more fit client would be the treadmill test)
2 Minute Step Test –
Mark a point on the participant's thigh, half way between the participant's patella (knee) and iliac crest
(top of the hip). Measure from this point to the ground with the tape measure or ruler. Place a mark
on the wall with masking tape or a board with a white board marker at the height from the ground to
the participant's mid-thigh position. On the instruction to start, participant will march in place lifting
knees to the indicated mark on the wall. Continue stepping as fast as possible for 2 minutes.** Count
the number of times the right knee is raised to the level of the mark on the wall or board. If either
knee is not raised to the correct level, do not count the step. Encourage the participant to continue to
raise both knees to the correct level. Record the total number of times the right knee reaches the tape
level in two minutes. Note: Take two (2) Heart Rate readings for this test. The first should be
recoreded at the end of the test, the second should be recorded one minute after the conclusion of
the test. Also if possible, do not allow the subject to sit down right away have them walk around a bit
to allow the heart time to recover.
** If the participant cannot do any steps without holding onto a walker or a chair placed to their side
then the participant is not following the test protocol. The participant may still complete the test but if
they complete the test holding onto a chair or assistive device their score will be saved as “Did Not
Follow Protocol.” Only “Per Protocol” scores that are completed by the participant without holding
onto any assistive devices are recorded in the overall group outcomes reports. Both “Per Protocol”
scores and “Did Not Follow Protocol” scores are saved in the individual’s fitness assessment file.
Modified Bruce Protocol –
Have the individual paw at the treadmill with their foot to begin a two minute warm up followed by Stage 1
which starts at 0% at 1.7 mph walking pace. Stage 2 the grade increases to a 5% grade but the speed stays the
same. In stage 3 the percent grade is increased to 10% but the speed stays the same for one more stage. Stage
4 the percent grade and speed are increased simultaneously to 2.5mph at a 12% grade. Stage 5 has a similar
increase in grade and speed to 3.4 mph at a 14% grade. Stage 6 is again an increase in speed and grade to 4.2
mph at a 16% grade. Stage 7 the treadmill is set to 5.0 mph at 18% grade. Stage 8 the treadmill is set at 5.5
mph at a20% grade. Finally at stage 9 the treadmill is set at 6.0 mph at a 22% grade.
IMPORTANT: Heart rate must be taken every minute. Once the participant has completed two consecutive
stages with heart rate readings between 110-150 bpm, or when 75% of Heart rate max is reached, the test is
complete and patron finishes with the cool down. ** Adhere to ACSM General Indications for stopping an
exercise test (ACSM’s Guidelines for Exercise Testing and Prescription, 9th Ed, Wolter Kluwer Health: Lippincott
Williams & Wilkins, 2014)
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Muscular Strength
Chair Stand –
Place straight back chair against wall for safety. Direct participant to sit on the middle of the seat, with
feet shoulder width apart, and flat on the floor. Cross arms at wrist and rest them on the chest. From a
sitting position, the participant stands all the way up and sits all the way down. Count the total number
of chair stands completed in 30seconds. (one up and down equals one stand) last rep counts only if
their gluteal muscle touches the chair.
Grip Strength—
Use a Grip Strength Dynamometer. Ensure instrument is set at the correct grip for client (middle joint
of finger should rest on pull bar). Conduct (2) grip strength tests per side, resetting device between
measures. Record the results in KG.
Bicep Curl –
This test is conducted on both arms for each individual. Begin in a seated position with palm facing in,
arm hanging vertically down toward the floor. With upper arm locked in position parallel to trunk
(there should be no movement in this portion of the arm), curl the weight toward the upper arm,
slowly rotating palm so that the palm faces the shoulder. Elbow must reach full flexion/extension. Do
as many bicep curls as possible in 30 seconds, moving in a smooth, controlled manner. Use 5lb weight
for women/8lb weight for men.
** If the participant cannot lift the appropriate weight for their gender then the participant may do the
test without a weight, raising just the weight of their arm. The participant’s test will need to be scored
as “Did Not Follow Protocol” if they do not use a weight or if they use a lighter weight such as a 3lb or
1lb weight if they are a woman, or if they are a man and use a 5 lb, 3 lb or 1 lb weight. Only “Per
Protocol” scores are recorded in the overall group outcomes reports. Both “Per Protocol” scores and
“Did Not Follow Protocol” scores are saved in the individual’s fitness assessment file.
Muscular Endurance
Push ups –
Males, use traditional ‘military’ style, hands and toes on floor, maintaining a straight line from
shoulders to heels. Females, may choose to do modified push ups with hands and knees on the floor,
using knees as the pivot point, maintaining a straight line from shoulders through hips.
Participant will begin in the up position and return to a down position that allows the chin to touch the
mat. A straight back must be maintained and the arm must reach full extension. Maximal number of
pushups performed without rest is recorded. Test is stopped when participant strains forcibly, or is
unable to maintain appropriate technique within two repetitions.
**Alternative: Wall Push Ups –
To be used with participants who cannot complete one push up on the ground. Note “Did Not Follow
Protocol” if wall push ups are done in lieu of traditional or modified push ups.
Place hands against the wall at shoulder height, feet 3-4 feet away from the wall. Maintain a straight
line from shoulders to heels, and lower body toward the wall. Elbows bend to 90 degrees, stop before
fore head touches the wall. Maximal number of pushups performed without rest is recorded. Test is
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stopped when participant strains forcibly, or is unable to maintain appropriate technique within two
repetitions.
Curl ups –
Participant assumes a supine position on a mat with knees at 90 degrees. Arms are to the side, palms
facing down with middle fingers touching a piece of tape. A second piece of tape is placed 10cm apart.
Using a metronome set to 50 beats-min, the individual does slow, controlled curl ups, in time with the
metronome, making sure to lift the shoulder blades off the mat. The test is done for 1 minute at the
rate of 25 per minute. Ie. Tick - up, tock - down… Perform as many curl ups as possible without
pausing, up to a max of 25. Ensure the trunk reaches a 30 degree angle with the mat.
Flexibility
Shoulder Flexibility (R/L)-(Straight arms raising to the front)
Standing with back flat against a wall, start with arms down at side, raise arms slowly, in frontal plane
raising toward the wall. Stop test at any point where: arms can no longer move up, form is
compromised, or wrists touch the wall. Measure (to nearest ¼ inch) the distance from wrists to wall
Shoulder Lateral External Rotation (R/L) – (Neutral to Goal post arms)
Stand against a wall, back flat. Raise arms lateral to shoulder height, elbows bent to 90 degrees and
held parallel to the floor. Rotate at shoulder bringing arms up toward ceiling (as close to a ‘goal post’
position as possible) Stop test at any point where: arms can no longer move up, from is compromised,
or wrists touch the wall. Measure (to nearest ¼ inch) the distance from wrists to wall
Shoulder Lateral Internal Rotation (R/L) – (Neutral to Scarecrow arms)
Stand against a wall, back flat. Raise arms lateral to shoulder height, elbows bent to 90degrees and
held parallel to the floor. Rotate at shoulder bringing arms down toward floor (as close to a
‘scarecrow’ position as possible) Stop test at any point where: arms can no longer move up, from is
compromised, or wrists touch the wall. Measure (to nearest ¼ inch) the distance from wrists to wall.
Shoulder External Rotation (R/L) – (Elbows at sides)
Stand back flat against a wall. Start with arms held to the side, elbows into the waist. Bend elbows to
90degrees and held parallel to the ground. Palms facing one another in toward the body. Externally
rotate the shoulder, bringing wrists toward the wall. Stop test at any point where: arms can no longer
move up, from is compromised, or wrists touch the wall. Measure (to nearest ¼ inch) the distance
from wrists to wall.
Shoulder Mobility/Back Scratch –
Reach one hand over shoulder palm down, and the other behind the back palm up (note: for
accuracy/consistent reporting—record the right side when RIGHT ELBOW is raised above the
shoulders, LEFT SIDE is when LEFT ELBOW is up). With fingers extended try to cross fingers upper over
lower hand. Measure the distance between middle fingers. Repeat with arms in opposite position.
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Trunk Flexion/Sit-and-reach – Canadian Trunk Forward Flexion Test OR YMCA sit-and-reach test
 Canadian TFF Test-Using a flexometer (sit-n-reach box) the participant sits without shoes and soles of
feet flat against the box at the 26 cm mark. Inner edges of soles are placed within 2cm of measuring
scale.
 YMCA sit-and-reach – a yardstick is placed on the floor and tape is placed across it at a right angle to
the 15” mark. The participant sits with the yardstick between the legs, with legs extended at right
angles to the taped line on the floor. Heels of feet should touch the edge of the taped line and be
about 10-12” apart.
Participant reaches slowly forward, with both hands, as far as possible. Hold this position ~ 2 seconds. Ensure
participants’ hands remain parallel and they do not lead with one hand. Fingertips can be overlapped and
should be in contact with the measuring instrument, yardstick or box. Record the most distant point (Canadian
TFF = centimeters; YMCA sit-and-reach = inches) reached with fingertips. Participant should exhale and allow
head to drop between arms when reaching. Testers should ensure knees of participant stay extended. Best of
two attempts is recorded.
Chair sit-n-reach (alternative) –
Participant will sit on the edge of a chair (placed against a wall for safety), with one foot flat on the
floor. The other leg is extended, knee straight, heel resting on the floor and ankle flexed to 90 degrees.
The participant will place one hand on top of the other with middle fingers even, with hands resting on
straight leg, exhale as hands reach toward toes. Back should remain straight with head up. Do not
bounce, hold for 2 seconds. Measure distance between fingertips and toes. If fingers touch toes, score
is zero, if short of toes measure (negative) distance, if fingers go past toes measure (positive) distance.
Complete 2 trials, record best result in centimeters.