Fitness Assessment Log
Membership #
39725
Date:
Name:
Sally Turner
D.O.B.:
3/07/1965
Home Phone:
Gender:
M / F
Work Phone:
Occupation:
Accounts payable clerk
Details
Date of assessment:
10/09/05
Girth Measurements
Arm – R
(cm)
32
Arm – L
(cm)
31.5
Chest
(cm)
95
Waist
(cm)
86
Hip
(cm)
114
Calf – R
(cm)
34
Calf – L
(cm)
33.5
Skin fold Measurements
Biceps
(mm)
12
Triceps
(mm)
18
Subscapular
(mm)
20
Abdominal
(mm)
23
Suprailium
(mm)
21
Calf
(mm)
12
Total
(mm)
85
(%)
32
Sit & Reach
(mm)
30
Shoulder
(mm)
NA
Body fat
Flexibility
THIS FORM IS FOR TRAINING PURPOSES ONLY.
Date of assessment:
10/09/05
0 – 75
Waist to Hip Ratio (WHR)
Weight
(kg)
73
Height
(cm)
164
Body Mass Index (BMI)
Resting Heart Rate
Blood Pressure
27
(bpm)
(mm Hg)
70
120 / 80
Muscle Endurance Tests
Push ups
NA
Dips
NA
Sit-ups
NA
Muscle Endurance Tests - Gym
20RM Shoulder Press
NA
20RM Leg Press
NA
20RM Lat Pull Down
NA
20RM Bench Press
NA
Muscle Strength
Abdominals (Level)
Level 1
Chest
NA
Legs
NA
4 km Time Trial (min)
NA
Cardiovascular Endurance (VO2)(ml/kg/min) 1–716L/MIN
Cycle Ergonometer
Time
Load
Heart rate
Cadence
0 min
70
0
1 min
84
70
4 min
112
62
7 min
132
58
10 min
148
53
THIS FORM IS FOR TRAINING PURPOSES ONLY.
Instructions for Use
Girth Measurements
The measurements are made at the following positions.
Arm
Half way between the point of the elbow and the shoulder
Chest
At the line of the nipples with the person half way through a breath
Waist
In line with the umbilicus
Hip
At the level of the greatest girth of the buttocks posteriorly, standing with feet together
Thigh
At the crotch level and just below the gluteal fold
Calf
At the widest part of the calf
Skin fold Measurements
Skin folds are measured in the following positions.
Bicep
On the anterior side of the right arm half way between elbow and shoulder. The crest
of the fold is parallel with the axis of the humerus.
Tricep
On the posterior of the right arm half way between elbow and shoulder. The crest of
the fold is parallel with the axis of the humerus.
Subscapular
10 mm below the inferior angle of the right scapula. The crest of the fold runs at 45
degrees down and away from the spine.
Abdominal
Vertical fold 20 mm to the right of the umbilicus.
Suprailium
Diagonal fold in line with the natural line of the iliac crest taken in the anterior axillary
line immediately superior to the iliac crest.
Calf
Vertical fold at the maximum circumference on the midline of the vertical border.
Total
A average of a total of 3 or 4 measurements are used to determine body fat
composition.
Flexibility
Sit & Reach
The distance the slide is moved to as measured from the line of the feet. Distances
less than the foot line are negative and distance beyond the foot line are positive.
Shoulder
The distance the fingers overlap or are apart. An overlap is a positive measurement
and a gap is a negative measurement.
Waist to Hip Ratio (WHR)
WHR = Waist Girth / Hip Girth. People with a Waist to Hip ratio greater than 0.9 for men and greater than
0.8 for women are considered to be at greater risk of health problems.
Body Mass Index (BMI)
BMI = Mass(kg)/Height2. A body Mass index of greater than 27 kg/m2 is considered to indicate an
elevated risk of cardiovascular disease.
Resting heart rate and blood pressure
Resting Heart
Rate
Measured in the sitting position by counting heart beats for 15 seconds and
multiplying by 4
Blood Pressure
Measured in the sitting position
THIS FORM IS FOR TRAINING PURPOSES ONLY.