Personal Wellness Profile™
Fitness Testing Guidelines
Guidelines
This manual is designed to help when filling out and completing the health tests used in the WellSuite® Personal
Wellness Profile™. Fitness testing is based on the American College of Sports Medicine (ACSM) Guidelines for
Exercise Testing and Prescription. It is recommended that you refer to the ACSM manual for a full and complete
understanding of fitness assessment and exercise counseling. Other tests and scoring are based on research from
the American Cancer Society (ACS), American Diabetes Association (ADA), National Heart, Lung, and Blood
Institute (NHLBI), National Institutes of Health (NIH), and the National Cholesterol Education Program Expert
Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP III).
Fitness testing and scoring prepared by Don Hall, DrPH, CHES for Wellsource, Inc.
© 2011 Wellsource, Inc.
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© 2011 Wellsource, Inc. Do not make unauthorized copies.
CONTENTS
4
Body Composition
Height and Weight
Waist Circumference Measurement
Body Mass Index (BMI)
Percent Body Fat
12
Strength
Grip Strength
Upper Body Fitness (Push-Ups)
Abdominal Fitness (Curl-Ups)
16
Flexibility
Sit-and-Reach Test
17
Blood Tests
PSA
A1C
Cholesterol – Total, HDL, LDL
Triglycerides
Glucose
22
Cardiovascular Fitness
Blood Pressure
Aerobic Capacity
METs
One-Mile Walk Test
1.5-Mile Run Test
Step Fit Test
29
Appendix
Sample Informed Consents
PAR-Q Screening Form
Note: All questions on the Health Tests section of the WellSuite® Personal
Wellness Profile™ questionnaire are optional. All reports (individual and group)
can be generated if clinical testing is not included.
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© 2011 Wellsource, Inc. Do not make unauthorized copies.
Body Composition
Body weight, or excess fat weight, is of major interest
to most people; especially those in a fitness program.
As people become more fit it is encouraging to show
how their body composition improves. Taking body
composition measurements is essential for demonstrating
these changes. Several techniques are available:
• Body mass index (BMI) based on height and weight
• Waist measurement
• Percent body fat
A person’s height and weight are measured using
standard procedures to assure accuracy for pre- and
post‑assessment comparisons. There is often quite a
difference in reported weight and measured weight.
People usually overestimate how tall they are and
underestimate their weight. For most accurate results, it
is best to actually measure height and weight rather than
taking reported values.
Taking Measurements
Required Equipment:
●● Accurate balance scales and height measuring system
●● Tape measure for measuring waist girth
●● BMI table or calculator
●● Skinfold calipers (for % fat) or bioelectric impedance
analysis equipment
Weight
Height
1.Use a scale with a height measuring system. If not
For accurate weights, use a balance scale if possible.
Home scales may be off several pounds. An accurate
weight is essential for monitoring change and giving
feedback.
1.Be sure the scales are set on a hard flat surface. If
on carpet, put a board under the scales. Arrange
the scales so you can adjust the weights from the
backside of the scale rather than reaching around the
participant.
2.The participant should be weighed without shoes, and
preferably, in exercise shorts. People dressed in regular
clothing when being weighed should be sure that they
are dressed similarly the next time they are weighed.
3.Record weight to the nearest pound.
available, fasten a measuring tape to a flat wall. Tape
paper alongside the measuring tape to allow for
marking heights with a pencil.
2.Measure height with shoes off. Have the person stand
with feet together, arms at side, and heels and back
against the wall.
3.Instruct participants to look straight ahead and stand
as tall as possible. Make sure heels stay on the floor.
4.Use a rectangular block of wood or a right triangle
that can slide down the wall to determine the top of
the head. Mark the person’s height on the paper next
to the tape measure, putting their initial after it to
keep their height separate from other marks. Record
the person’s height to the nearest inch.
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Waist Circumference
A measurement of the waist provides a quick look at how fat
is deposited on the body. A high amount of abdominal fat significantly
increases the risk for high blood pressure, diabetes, cardiovascular
disease, and certain cancers.
1.The waist is defined as the smallest circumference below the ribs and
at or above the navel. If there is a question about location, simply
measure the waist in the horizontal plane at the level of the navel.
2.Instruct the participant to stand relaxed. Take the measurement at
the end of a normal expiration. Pull the tape snug, but avoid pulling
the tape tight so it begins to sink into the skin.
Test Procedure
Equipment:
Measuring tape
Body Composition
known
% fat
Entering Waist
Circumference
0
1
2
3
4
5
6
7
8
9
●● Write the waist measurement value in
inches in the space provided and fill in the
corresponding bubbles.
●● Left justify.
●● When the value is a whole number, bubble
a zero to the right of the decimal.
Norms indicating obesity and high risk are:
Men more than 40 inches and women more than 35 inches.
Waist Circumference Standards
Adult Male
RISK CATEGORY
Adult Female
INCHES
CM
INCHES
CM
<31.5
<80
<27.5
<70
Desirable
31.5-39
80-101
27.5-34
70-87
Overweight
40-46
102-119
35-42
88-109
47+
120+
43+
110+
Lean
High Risk
Source: ACSM’s Guidelines for Exercise Testing and Prescription, 8th Ed, 2010, p.66.
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0
1
2
3
4
5
6
7
8
9
waist
circumference
(inches)
3
0
1
2
3
4
5
6
7
8
9
2.
0
1
2
3
4
5
6
7
8
9
0
0
1
2
3
4
5
6
7
8
9
Body Mass Index
Body Mass Index (BMI) is a measure of weight for height which correlates closely with longevity and risk for excess
weight-related problems: heart disease, certain cancers, diabetes, arthritis, high blood pressure, and high blood lipids.
BMI is defined as: (Weight in kg) ÷ (Height in meters)2
Note: BMI is automatically calculated in
U.S. Standard equation is: (Weight in lbs. x 703) ÷ (Height in inches)2
the program using height and weight values.
BMI is not entered on the questionnaire.
Body Mass Index Chart
Instructions: Find the height in the left column. Run your finger along the row to find the weight or closest weight.
Then run your finger up the column to the top of the page to find the BMI.
Body Mass Index Chart
BMI
19
20
21
22
23
24
25
27
28
29
30
31
Overweight (lb)
Healthy Weight Range (lb)
Ht (in)
26
32
33
34
35
Obese (lb)
58
91
96
100
105
110
115
119
124
129
134
138
143
148
153
158
162
167
59
94
99
104
109
114
119
124
128
133
138
143
148
153
158
163
168
173
60
97
102
107
112
118
123
128
133
138
143
148
153
158
163
168
174
179
61
100
106
111
116
122
127
132
137
143
148
153
158
164
169
174
180
185
62
104
109
115
120
126
131
136
142
147
153
158
164
169
175
180
186
191
63
107
113
118
124
130
135
141
146
152
158
163
169
175
180
186
191
197
64
110
116
122
128
134
140
145
151
157
163
169
174
180
186
192
197
204
65
114
120
126
132
138
144
150
156
162
168
174
180
186
192
198
204
210
66
118
124
130
136
142
148
155
161
167
173
179
186
192
198
204
210
216
67
121
127
134
140
146
153
159
166
172
178
185
191
198
204
211
217
223
68
125
131
138
144
151
158
164
171
177
184
190
197
203
210
216
223
230
69
128
135
142
149
155
162
169
176
182
189
196
203
209
216
223
230
236
70
132
139
146
153
160
167
174
181
188
195
202
209
216
222
229
236
243
71
136
143
150
157
165
172
179
186
193
200
208
215
222
229
236
243
250
72
140
147
154
162
169
177
184
191
199
206
213
221
228
235
242
250
258
73
144
151
159
166
174
182
189
197
204
212
219
227
235
242
250
257
265
74
148
155
163
171
179
186
194
202
210
218
225
233
241
249
256
264
272
75
152
160
168
176
184
192
200
208
216
224
232
240
248
256
264
272
279
76
156
164
172
180
189
197
205
213
221
230
238
246
254
263
271
279
287
Body Mass Index (BMI) Standards
Underweight
Healthy weight
Overweight
Obese, high risk
Obese, very high risk
Obese, extremely high risk
Less than 18.5
18.5 to 24.9
25.0 to 29.9
30.0 to 34.9
35.0 or 39.9
40.0 or higher
The recommended upper limit of healthy weight is a BMI under
25. Look at the chart above for the height and a BMI of 25.
People should weigh no more than this amount for good health.
• Women have the best life expectancy at a BMI of about 22-23.
• Men have the best longevity at a BMI of about 24-25.
• Weight lifters have a higher muscle mass and thus have a higher
BMI without negative health consequences. They should use a
percent fat test to determine ideal weight.
Source: NIH, NHLBI, Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults
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Percent Body Fat
Body fat percentage is an estimate of the fraction of the total body mass that is adipose tissue (referred to as fat
mass), as opposed to lean body mass (muscle, bone, organ tissue, blood, and everything else) – referred to as fat‑free
mass. This index is often used as a means to monitor progress during a diet or as a measure of physical fitness for
certain sports, such as body building.
It is more accurate as a measure of excess body weight than body mass index (BMI) since it differentiates between the
weight of muscle mass and that of the fat mass while BMI lumps all masses into one figure. However, its popularity
is less than BMI because equipment required to perform the body fat percentage is not readily available and skills are
required to perform the measurement. Even when measured by a skillful person, there are factors that contribute to a
significant margin of error.
Source: ACSM
Percent Fat Norms Table (Basic Standard)
Adult Male
Risk Category
Adult Female
Minimum
Maximum
Minimum
Maximum
<9.9
9.9
<19.9
19.9
Healthy Range
10
20.9
20
30.9
Overweight
21
24.9
31
36.9
Obese
25
>25
37
>37
Lean
Note: WellSuite® Personal Wellness Profile™ uses the Institute of Medicine’s Standards for scoring percent body
fat. If ACSM Standards are preferred they can be selected as an alternative in the program.
To change to ACSM percent fat scoring within the WellSuite® Personal
Wellness Profile Online program:
• Click the Assessment tab, then click the Scoring sub-tab
• Under the Scoring sub-tab, select the checkbox “Use ACSM Standard for Percent Fat,
otherwise use basic standard”
• Click the Save Settings button.
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Percent Body Fat (Continued)
Entering Percent Fat
• Round percent fat value to the nearest whole number.
• Write the value in the space provided and fill in the
corresponding number bubble in the same column.
• Right justify.
• A leading zero is NOT
Body Composition
required when values
are less than ten.
waist
known
circumference
% fat
(inches)
0
1
2
3
4
5
6
7
8
9
9
0
1
2
3
4
5
6
7
8
9
3
0
1
2
3
4
5
6
7
8
9
2.
0
1
2
3
4
5
6
7
8
9
0
0
1
2
3
4
5
6
7
8
9
Percent Body Fat Norms
Male
Percentile
Fitness Category
Age Range
20-29
30-39
40-49
50-59
60+
80-100
Excellent
4.2-10.5
7-14.5
9.2-17.4
10.9-19.1
11.5-19.7
60-79
Good
10.6-14.8
14.6-18.2
17.5-20.6
19.2-22.1
19.8-22.6
40-59
Average
14.9-18.6
18.3-21.3
20.7-23.4
22.2-24.6
22.7-25.2
20-39
High Risk
18.7-23.1
21.4-24.9
23.5-26.6
24.7-27.8
25.3-28.4
0-19
Obese
>23.1
>24.9
>26.6
>27.8
>28.4
40-49
50-59
60+
Female
Age Range
Percentile
Fitness Category
20-29
30-39
80-100
Excellent
9.8-16.5
11.0-17.4
12.6-19.8
14.6-22.5
13.9-23.2
60-79
Good
16.6-19.4
17.5-20.8
19.9-23.8
22.6-27.0
23.3-27.9
40-59
Average
19.5-22.7
20.9-24.6
23.9-27.6
27.1-30.4
28-31.3
20-39
High Risk
22.8-27.1
24.7-29.1
27.7-31.9
30.5-34.5
31.4-35.4
0-19
Obese
>27.1
>29.1
>31.9
>34.5
>35.4
Source: ACSM’s Guidelines for Exercise Testing and Prescription, 8th Ed, 2010, p.71-72.
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Percent Body Fat – Skinfolds
Percent body fat test using skinfolds directly measures the amount
of fat on the body and is more specific to each individual. Use this test in muscle
builders and athletes who may be “overweight” according to BMI charts but are
obviously in good health.
This method uses a skinfold caliper to measure the amount of fat deposited under
the skin at various specified sites. A prediction equation is then used to compute
percent body fat.
You can also estimate body fatness without computing percent fat by directly
comparing the thickness of skinfolds at a designated site to age- and genderspecific norms. This method works well with children who are sometimes overly
sensitive about their weight (especially teen girls) and you don’t want to give them
a percent body fat result. Both methods are common ways of measuring the degree
of fatness and how the fat is distributed on the body.
Test Procedure
Equipment:
Skinfold caliper
Most research determining skinfold norms
was done using Lange calipers. Calipers
conforming to this standard (exerting
a constant pressure of 10 g/mm2) are
recommended for best accuracy.
Measuring skinfolds is a practical and inexpensive way of estimating percent body
fat that correlates very closely with hydrostatic weighing. By using an appropriate
prediction equation and good technique, percent body fat can be estimated quite
accurately.
Testing Procedure
Good technique is imperative when
taking skinfold measurements to
insure accurate results and repeatability
in subsequent testing. This requires
careful practice and checking by an
experienced tester to develop accurate
and consistent results. Use the
following testing techniques to help
keep your results accurate.
1. Skinfold sites. Review the
skinfold sites to be sure you know
their correct position (see page 10).
This is critical. Participants should
be wearing shorts and tank top. To
insure the most consistent accuracy,
mark the sites with a water-soluble
pen before taking the measurement.
For standardization purposes,
always take skinfold measurements
on the participant’s right side.
An obvious exception would be a
deformity on the right side.
2. Skinfold. Grasp the skin firmly
with the thumb and index finger
and gently pull the fold together
and away from the body. The
amount of skin pulled up must be
big enough to make a fold with
parallel sides and must include the
full layer of fat underneath the skin
(not just the surface skin). If the fat
layer is thick, it may require using
both hands until an adequate fold
is achieved. It is usually easier to get
a good skinfold when the muscle
under the skin is relaxed rather
than tense.
3. Measurements. Use the
following testing procedure:
• Fingertips should be about
1 cm above the marked site so
the caliper tips can measure
the skinfold directly on the
marked site.
• The caliper should be placed 1 cm
away from the thumb and finger,
perpendicular to the skinfold, and
halfway between the crest and the
base of the fold.
• The pinch should be maintained
while reading the caliper.
• Wait 1 to 2 seconds (and not
longer) before reading caliper.
• Take duplicate measures at
each site and retest if duplicate
measurements are not within 1 to
2 mm.
• Rotate through measurement sites
or allow time for skin to regain
normal texture and thickness
between measurements.
9
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4. Practice. The ease and accuracy
of this test improves with practice. If
possible, have an experienced person
check your measurements at first to
give you feedback on your technique.
Persons who have recently undergone
hydrostatic weighing are ideal subjects
to practice on to compare results.
Overly fat people are difficult to
measure. Where the fat is extremely
thick, you often have to use two
hands to get a fold. If you are unable
to get an accurate reading on these
people, then use hydrostatic weighing,
bioelectrical impedance analysis (BIA),
or body mass index.
When repeat testing is done to
monitor change, it is best, if possible,
to have the same person retest. This
eliminates variance between tester
techniques.
Percent Body Fat – Skinfolds
Skinfold Site Descriptions
Chest - A diagonal fold on the chest, halfway between the anterior axillary
line and nipple for men, 1/3 the distance for women. (The anterior axillary
line is the crease where the top of the arm, when hanging down, and front of
the chest meet.)
Triceps - A vertical fold on the posterior (back side) midline of the upper
arm, over the triceps muscle, halfway between the acromion process (bony
process on top of shoulder) and the olecranon process (bony process on
elbow); elbow should be extended and arm relaxed.
Abdomen - A vertical fold taken at a lateral distance of about 2 cm from
the umbilicus (2 cm to the side of the navel).
Suprailium - A diagonal fold above the crest of the ilium at the spot
where an imaginary line comes down from the anterior axillary line. In
other words, just above the hipbone and 2 to 3 cm forward.
Thigh - A vertical fold on the front of the thigh, halfway between the knee
and hip joints. In other words, halfway between mid kneecap and crease
where the thigh bends if leg is lifted. The leg should be relaxed and straight.
Have the participant shift their weight to the other leg.
Test Protocol
Selecting the right testing protocol and prediction equation is essential for
reliable results. The prediction equation must be appropriate for the group
you are testing. The following method is based on the generalized equations
of Jackson and Pollock and is considered a good choice for use on a general
population. These equations are designed for adults, generally age 18 and
above.
3-Site Method: Upper, Mid, and Lower Body (Uml)
This method is the most commonly used. It has good accuracy because it
measures fat in the upper, mid, and lower body (fat is distributed differently
in individuals). The standard error of measurement for this test is plus or
minus 3.4% body fat for men and 3.9% for women.
The three sites are:
Institute of Medicine
Percent Body Fat Norms
Men
Women
Normal
13-20.9
23-30.9
Overweight
21-24.9
31-36.9
Obese I
25-31
37-42
Obese II
>31
>42
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Men
Women
Chest
Triceps
Abdomen
Suprailium
Thigh
Thigh
Generalized Body Composition Equations
3-Site UML (MEN)
Density = 1.10938 - 0.0008267 (Sum of 3 skinfolds)
0.0000016 (sum of 3 skinfolds)2 - 0.0002574 (age)
3-Site UML (WOMEN)
Density = 1.0994921 - 0.0009929 (Sum of 3 skinfolds)
0.0000023 (sum of 3 skinfolds)2 - 0.0001392 (age)
10
Percent Body Fat –
Bioelectric Impedance Assessment (BIA)
Percent body fat is a good way to track changes in body composition
due to physical activity and/or dieting. Percent fat can be easily measured
using a bioelectric impedance assessment (BIA). Another method requiring
more training and practice for accuracy is taking skinfold measurements.
Results are usually accurate to within plus or minus 2-3% body fat if you
carefully follow the testing guidelines below.
Test Procedure
Equipment:
BIA testing instrument
The following instructions are for using a BIA instrument. For most accurate
results using BIA testing:
1.Take the test at least 1 or 2 hours after eating.
2.Don’t test soon after: exercise, getting out of a hot tub or shower, drinking
alcohol, or drinking a large amount of water.
3.If hands are cold, warm them first before testing (warm room or warm
water).
4.If hands are very dry, slightly moisten hands with a damp towel.
5.When doing repeat testing, take measurements at a similar time of the
day.
6.Follow good technique as described in the manual that came with the
equipment (arms fully extended and level in front of you, grip easily with
fingers around grips, thumbs on top of instrument, stand quietly until
measurement is completed).
7.Record test results.
Percent Body Fat Test Results
Test
Date
Percent
Fat
BMI
Weight
(lbs)
Your
Rating
Source: ACSM Guidelines for Exercise
Testing and Prescription. 2010.
11
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General Strength
Grip strength correlates fairly closely with overall upper body strength and is
easily administered. Grip is measured using a hand grip dynamometer. The
participant does a maximal grip using one hand and then the other.
The best scores from each hand are combined for the overall grip score.
1.Test participant should be screened for arm or shoulder pain. Persons
suffering arm/shoulder pain or who have high, uncontrolled blood
pressure should not do this test.
2.Be sure participants are well instructed in the proper technique. Describe
and, if needed, demonstrate the correct technique as follows:
• Adjust the hand grip dynamometer so the second joint of the
fingers fit snugly on the handle when gripping.
• The participant should hold the dynamometer with arm
extended down about thigh level.
• Instruct participant to make a maximal squeeze. Don’t let the
dynamometer touch any part of the body or any other object.
Also avoid sudden thrusts or jars which can make the reading
inaccurate.
• When squeezing, instruct participant to breath out or exhale
during contraction, to prevent high intrathoracic pressure.
• Measure both hands alternately giving two tries per hand.
Combine the best score of each hand to give a total grip
strength reading. Record test results accurately in the units
specified on the data sheet, generally kilograms.
Grip Strength (kg, both hands combined)
Male
Percentile
Fitness Category
Age Range
20-29
30-39
40-49
50-59
60+
80-100
Excellent
124+
123+
119+
110+
102+
60-79
Good
113-123
113-122
110-118
102-109
93-101
40-59
Average
106-112
105-112
102-109
96-101
86-92
20-39
Low
97-105
97-104
94-101
87-95
79-85
0-19
At Risk
<97
<97
<94
<87
<79
Female
Percentile
Fitness Category
80-100
Excellent
Age Range
20-29
30-39
40-49
50-59
60+
71+
73+
73+
65+
60+
60-79
Good
65-70
66-72
65-72
59-64
54-59
40-59
Average
61-64
61-65
59-64
55-58
51-53
20-39
Low
55-60
56-60
55-58
51-54
48-50
0-19
At Risk
<55
<56
<55
<51
<48
Source: The Canadian Physical Activity Fitness and Lifestyle Approach:
CSEP-Health & Fitness Program’s Appraisal & Counseling Strategy, 3rd Ed, 2003, p.7-46.
12
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Test Procedure
Equipment:
Handgrip dynamometer
Grip Strength Worksheet
Grip strength, measured with a handgrip dynamometer, correlates with
overall upper body strength and is an easy, safe test to perform. A good grip
is linked to higher lean body mass, lower risk of disability in old age, and
increased longevity. Compare your test results with the norms shown below.
1.Don’t do this test if you have arm or shoulder pain, or high, uncontrolled
blood pressure.
2.Use the proper technique as described below for accurate and consistent
results. If needed, ask for a demonstration.
3.Adjust the handgrip dynamometer so the second joint of the fingers fit
snugly on the handle when gripping. Hold the dynamometer with arm
extended down about thigh level.
4.Make a maximal squeeze. Don’t let the dynamometer touch any part of
the body or any other object. Also avoid sudden thrusts or jars, which can
make the reading inaccurate.
5.When squeezing, breathe out or exhale during contraction to prevent
high intrathoracic pressure. Don’t hold your breath and strain.
6.Measure both hands. Take two tries per hand. Combine the best
score of each hand to give a total grip strength reading. Record test
results in kilograms.
Test Procedure
Equipment:
Handgrip dynamometer
Grip Test Results
Test
Date
Left
Hand
Right
Hand
Total
(kg)
Your
Rating
Grip Strength Norms1
(kg, scores from both
hands added together)
Source: Canadian Society for Exercise
Physiology, The Canadian Physical
Activity, Fitness, and Lifestyle Appraisal,
2nd Edition, reprinted 2001.
13
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Upper Body Fitness
This test for upper body strength/endurance is easily
administered. The participant attempts as many consecutive pushups as they
can without stopping to rest. Men do pushups from the toes; women from
the knees.
1.The participant should be screened for shoulder or lower back impairment
or pain. Persons suffering back pain or high, uncontrolled blood
pressure, should not do this test.
2.Be sure participants are well instructed in the proper technique. Describe
and, if needed, demonstrate the correct technique. They may want to
practice once or twice before beginning the test. Instruct the participant to:
• Lie on stomach on a mat, legs together
• Hands should be pointing forward, positioned under shoulders
• Do pushup, keeping back straight, pivoting from toes for men,
from knees for women
• Return to starting position, but only let chin touch the mat
(chest and legs should not touch the mat)
• Do as many pushups using this technique as possible, without
undue strain, and without stopping to rest
• There is no time limit. Stop the test when the person is either
unable to maintain the proper technique over two consecutive
push-ups, or shows signs of excessive straining
3.Caution participants not to overstrain or hold their breath, but rather to
breathe rhythmically, exhaling on the upward phase, and inhaling on the
downward phase.
Push-Up Norms (number completed)
Male
Percentile
Fitness Category
80-100
Excellent
60-79
40-59
Age Range
20-29
30-39
40-49
50-59
60+
36+
30+
25+
21+
18+
Good
29-35
22-29
17-24
13-20
11-17
Average
22-28
17-21
13-16
10-12
8-10
20-39
Low
17-21
12-16
10-12
7-9
5-7
0-19
At Risk
<17
<12
<10
<7
<5
50-59
60+
Female
Percentile
Fitness Category
Age Range
20-29
30-39
40-49
80-100
Excellent
30+
27+
24+
21+
17+
60-79
Good
21-29
20-26
15-23
11-20
12-16
40-59
Average
15-20
13-19
11-14
7-10
5-11
20-39
Low
10-14
8-12
5-10
2-6
2-4
0-19
At Risk
<10
<8
<5
<2
<2
Source: ACSM’s Guidelines for Exercise Testing and Prescription, 8th Ed, 2010, p.94
14
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Test Procedure
Equipment:
Exercise mat
Stop watch
Abdominal Fitness
The partial curl-up is a safe assessment of abdominal fitness.
1.The participant should be screened for lower back impairment or pain.
Persons suffering back pain or high, uncontrolled blood pressure should
not do this test.
2.Instruct the participant to lie on their back on a mat with knees bent at
90 degrees. The arms are at the side, palms facing down with the middle
fingers touching a piece of masking tape. A second piece of tape is placed
10 cm apart. Shoes remain on during the test.
3.Set a metronome to 50 beats/minute and have the participant do slow,
controlled curl-ups to lift the shoulder blades off the mat (trunk makes
a 30-degree angle with the mat) in time with the
metronome at a rate of 25 per minute. The test is done
for 1 minute. The low back should be flattened before
curling up.
4.The participant performs as many curl-ups as possible
without pausing, to a maximum of 25.
5.Caution participants not to over strain and to breathe
normally, exhaling while curling up, and inhaling
while relaxing back down.
Partial Curl-Ups
Percentile
Fitness Category
80-100
Excellent
60-79
40-59
Age Range
20-29
30-39
40-49
50-59
60+
25+
25+
25+
25+
25+
Good
21-24
18-24
18-24
17-24
16-24
Average
16-20
15-17
13-17
11-16
11-15
20-39
Low
11-15
11-14
6-12
8-10
6-10
0-19
At Risk
<11
<11
<6
<8
<6
Female
Age Range
Percentile
Fitness Category
20-29
30-39
40-49
50-59
60+
80-100
Excellent
25+
25+
25+
25+
25+
60-79
Good
18-24
19-24
19-24
19-24
17-24
40-59
Average
14-17
10-18
11-18
10-18
8-16
20-39
Low
5-13
6-9
4-10
6-9
3-7
0-19
At Risk
<5
<6
<4
<6
<3
Source: ACSM’s Guidelines for Exercise Testing and Prescription, 8th Ed, 2010, p.95
15
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Gym mat
Masking tape (or Velcro tape)
Metronome or watch
30°
Number of continuous curl-ups completed in 1 minute
Male
Test Procedure
Equipment:
Flexibility – Sit-and-Reach Test
Test Procedure
Equipment:
Flex bench or a meter stick
(The meter stick should be attached
or taped to the top of a bench or box
with the toe line at the 26 cm mark.)
Flexibility is the ability to move a joint through its full range of motion. This
is important to athletic performance, especially gymnastics, dance, and many
sports. It is also important for carrying out activities of daily living. Muscles and
joints are less likely to be injured if they have good flexibility. One good measure
of flexibility is the sit-and-reach test. It measures overall flexibility including the
legs, back, arms and shoulders.
1.The participant should be screened for lower back impairment or pain.
Persons suffering back pain should not do this test. Have the the participant
warm up by doing slow stretching while seated, reaching toward one foot for
15 to 20 seconds and then toward the other foot. Repeat twice on each leg.
Caution the person to move slowly and hold each stretch. Avoid bouncing or
dynamic stretches.
2.Be sure the participant has shoes removed. Have them sit on the floor or mat
with legs extended out in front, and feet against the flex bench (or a box with
a meter stick taped to the top). The feet should be at the 26 cm line on the
meter stick with the zero end pointing toward the participant.
3. With hands together, have the participant slowly bend forward reaching as far
as possible without discomfort, fingers on the ruler, and hold for 2 seconds.
Be sure fingertips are together and one hand is not ahead of the other. Make
sure the knees don’t flex and the participant stretches slowly and doesn’t
bounce. Record the better of two tries to the nearest centimeter.
Flexibility Sit and Reach (toe line at 26 cm)
Male
Age Range
Percentile
Fitness Category
20-29
30-39
80-100
Excellent
40+
38+
35+
35+
33+
60-79
Good
34-39
33-37
29-34
28-34
25-32
40-59
Average
30-33
28-32
24-28
24-27
20-24
20-39
Low
25-29
23-27
18-23
16-23
15-19
0-19
At Risk
<25
<23
<18
<16
<14
Female
Percentile
Fitness Category
80-100
Excellent
60-79
40-59
40-49
50-59
60+
Age Range
20-29
30-39
40-49
50-59
60+
41+
41+
38+
39+
35+
Good
37-40
36-40
34-37
33-38
31-34
Average
33-36
32-35
30-33
30-32
27-30
20-39
Low
28-32
27-31
25-29
25-29
23-26
0-19
At Risk
<28
<27
<25
<25
<23
Source: ACSM’s Guidelines for Exercise Testing and Prescription, 8th Ed, 2010, p.100.
16
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Blood Tests
Total Cholesterol (mg/dL)
Adults (18+)*
<160
Ideal (Excellent)
Desirable
<200
(Good, or Low Risk)
Needs Improving
200+
High Risk
240+
Source: NCEP III
Entering Blood Test Values:
Right justify values as shown. Leading zeros do not need to be added.
Blood Tests
Cholesterol
Total
0
1
2
3
4
5
6
7
8
9
Nonfasting
HDL
1
9
8
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
LDL
Triglycerides
4
5
1
4
2
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
5
0
1
2
3
4
5
6
7
8
9
Glucose
5
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
9
0
1
2
3
4
5
6
7
8
9
8
0
1
2
3
4
5
6
7
8
9
Note: Total cholesterol is scored if it is the only value entered. If LDL cholesterol is available, cholesterol
score risk is based on LDL level. If total cholesterol and HDL cholesterol values are entered, the non-HDL
cholesterol values for risk analysis is scored. (If no clinical cholesterol values are provided, the WellSuite®
Personal Wellness Profile™ scores “Personal History of High Cholesterol.”
*Risk values for children and adolescents (<18 years) are set by the National Cholesterol Program (NCEP) and
are recommended for children with a family history of high cholesterol (cholesterol of 240+), or history of early
CHD (MI before 55 years or angioplasty, etc.).
17
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Blood Tests (Continued)
Blood Test Norms – LDL Cholesterol
LDL Cholesterol (mg/dL)
Adults (18+)
Persons with CHF, Prior MI,
Stroke, or Diabetes
Children/Adolescents*
100 or less
<100
<100
(Good, or Low Risk)
<130
100 or less
<110
Needs Improving
130+
100+
110+
High Risk
160+
130+
130+
Ideal (Excellent)
Desirable
Note: Cholesterol risk score is based on LDL levels when available.
Blood Test Norms – Non-HDL Cholesterol
If LDL is not available, then non-HDL cholesterol evaluates cholesterol risk.
Non-HDL Cholesterol (mg/dL)
Adults (18+)
Persons with CHF, Prior
MI, Stroke or Diabetes
130 or less
<130
Desirable (Low Risk)
<160
130 or less
Needs Improving
160+
130+
High Risk
190+
160+
Ideal (Excellent)
Total Cholesterol
– HDL cholesterol
= Non-HDL
Non-HDL = Total Cholesterol – HDL cholesterol
Non-HDL cholesterol is a more accurate estimate of overall risk.
The non-HDL cholesterol is all the “bad” or atherogenic portion, including LDL,
IDL and VLDL cholesterol.
Blood Test Norms – HDL Cholesterol
HDL Cholesterol (mg/dL)
Adult Male
Adult Female
60+
60+
(Good, or Low Risk)
45+
55+
Needs Improving
<45
<55
High Risk**
<40
<50
Ideal (Excellent)*
Desirable
*Gives some protection against heart disease
**Major heart disease risk factor
© 2011 Wellsource, Inc. Do not make unauthorized copies.
18
Source: American Heart
Association. 2010.
Blood Tests (Continued)
Blood Test Norms – Triglycerides
Triglycerides (mg/dL) Fasting
Risk Category
Adult or Person with Prior MI
Ideal (Excellent)
<100
Desirable (Low Risk)
100-149
Needs Improving
150-199
High Risk
200+
Triglycerides (mg/dL) Non-Fasting
Adult Male
Adult Female
<115
<115
Desirable (Low Risk)
115-169
115-149
Needs Improving
170-259
150-214
260+
215+
Risk Category
Ideal (Excellent)
High Risk
Note: Accurate triglyceride levels require a 12-14 hour fast.
Source: NIH, National Cholesterol Education Program III (for blood lipid values).
Blood Test Norms – Blood Glucose (mg/dL)
Adult (Non-Diabetic)
Risk Category
Ideal (Excellent)
Desirable (Low Risk)
Needs Improving
Note: Standards based on fasting blood
glucose levels.
Non-fasting blood glucose of 200+ indicates
diabetes or high risk.
*Persons with existing diabetes are already
at high risk.
Source: American Diabetes Association
definition of diabetes (fasting glucose of
126+ or non-fasting of 200+).
High Risk*
NON-FASTING
<90
<120
90-99
120-139
100-125
140-199
126+
200+
Adult (Diabetic)
Risk Category
Ideal (Excellent)
Desirable (Low Risk)
Needs Improving
High Risk*
19
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FASTING
FASTING
NON-FASTING
<90
<120
90-99
120-139
100-129
140-179
130+
180+
Blood Test – PSA
PSA (Prostate-Specific Antigen) test results report the
level of PSA detected in the blood. The test results are
usually reported as nanograms of PSA per milliliter (ng/
mL) of blood. In the past, most doctors considered PSA
values below 4.0 ng/mL as normal. However, recent
research found prostate cancer in men with PSA levels
below 4.0 ng/mL.
When prostate cancer develops, the PSA level usually
goes above 4. But it is important to remember that
about 15% of men with a PSA below 4 will have prostate
cancer on biopsy. If the level is in the borderline range
between 4 and 10, a man has about a 25% chance of
having prostate cancer. If it is more than 10, his chance
of having prostate cancer is over 50% and increases more
as the PSA level increases.
PSA
Entering PSA
●● Write the value in the space provided and fill in the
corresponding number bubble in each column.
●● Use decimal. When value is a whole number bubble
the zero to the right of the decimal. A bubbled value
is required to the right of all decimals.
●● Leading zeros are NOT required.
Desirable
0 - 2.49 ng/mL
Borderline Low
2.5 - 3.99 ng/mL
Borderline High
Higher Risk
4 - 10 ng/mL
10.001 ng/mL or more
Source: American Cancer Society. 2010.
Blood Tests
and Pulse
c
4
0
1
2
3
4
5
6
7
8
9
resting pulse
A1C
7
0
1
2
3
4
5
6
7
8
9
4.
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
5
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
PSA
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
2.
0
1
2
3
4
5
6
7
8
9
0
0
1
2
3
4
5
6
7
8
9
20
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Blood Test – A1C
A1C is a test that measures the
amount of glycosylated hemoglobin
in your blood. Glycosylated
hemoglobin is a molecule in red
blood cells that attaches to glucose
(blood sugar). People have more
glycosylated hemoglobin if they
have more glucose in their blood.
The A1C test measures their average
blood glucose control for the past 2
to 3 months.
A1C
Risk Category
Adult
Adult-Diabetic
Adolescents
Adolescents-Diabetic
<5.7
<7
<5
<7
7+
5+
7+
Desirable
Pre-diabetes
5.7-6.4
High Risk
6.5+
Sources: NEJM, 362:800-811; Diabetes Care, 33, January, March, and April.
Blood Tests
Blood Pressure and Pulse
Blood Pressure
Entering A1C resting pulse
ystolic
4
0
1
2
3
4
5
6
7
8
9
2
0
1
2
3
4
5
6
7
8
9
●● Write the value in the space
provided
7 4and fill in the7 5
corresponding number bubble
0 column.
0 0 0 0
0 in each
1 when
1 value
1●● Use1decimal,
1 is 1
2 number
2 2bubble
2 a whole
2 the2
zero
bubble
to
the
right
3 3 3 3 3 of 3
the decimal. A bubbled value
4 4to the4right4of all 4
4 is required
5 5 5 5 5
5 decimals.
6 zeros
6 are
6 NOT6 6
6●● Leading
required.
7 7 7 7 7 7
8
9
8
9
8
9
8
9
8
9
8
9
PSA
A1C
diastolic
0
1
2
3
4
5
6
7
8
9
4.
0
1
2
3
4
5
6
7
8
9
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
2.
0
1
2
3
4
5
6
7
8
9
21
© 2011 Wellsource, Inc. Do not make unauthorized copies.
0
0
1
2
3
4
5
6
7
8
9
Cardiovascular Fitness – Blood Pressure
A resting blood pressure test is an important screening
test for cardiovascular health. Regular exercise is one good way to
help keep blood pressure normal and avoid damage to the heart,
brain, kidneys, eyes, and other organs damaged by high blood
pressure.
1.The person being tested should avoid vigorous exercise and be
free from smoking or drinking coffee in the 30 to 60 minutes
before testing. Have the the participant sit quietly for 5
minutes. 2.Select the appropriate cuff size. The bladder in the cuff should
encircle at least two-thirds of the upper arm. Persons with large
arms should use the large cuff size for accurate tests. Children
with small arms should have a child’s cuff. If using the wrist
cuff, one size fits all. Be sure wrist is held at level of heart when
testing.
3.Wrap the cuff firmly around the upper arm at the level of the
person’s heart. Align the cuff so the arrow on the cuff lines up
with the brachial artery. (You can feel for the artery to locate
its position.) Place the bell of the stethoscope over the brachial
artery in the antecubital space. Quickly inflate cuff pressure to
at least 20 mm Hg above the estimated systolic blood pressure.
4.Slowly release pressure at a rate equal to 2 to 3 mm Hg per
second. Listen carefully for the first Korotkoff sound. When
you first hear a beat, note the systolic blood pressure. Continue
letting out the air until the sound disappears (or sounds
significantly muffled). This is the diastolic blood pressure.
Record blood pressure reading. On automatic cuffs this is all
done automatically.
5.If the blood pressure reading is 140/90 or higher, have the
person rest a few more minutes and check it again. If lower,
record the lower reading.
Entering
Blood Pressure
●● Write the value in the space provided
and fill in the corresponding number
bubble in each column.
●● Right justify.
●● Leading zeros are not required.
Blood Pressure and Pulse
Blood Pressure
Systolic
1
0
1
2
3
4
5
6
7
8
9
4
0
1
2
3
4
5
6
7
8
9
2
0
1
2
3
4
5
6
7
8
9
Diastolic
Resting
Pulse
7
0
1
2
3
4
5
6
7
8
9
7
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
4
0
1
2
3
4
5
6
7
8
9
Resting Blood Pressure (mm/Hg)
Adults
Children/Adolescents*
115/75 or less
112/70 or less
Desirable (Good, or Low Risk)
116/76 - 119/79
113/71 - 119/79
Needs Improving (Pre-hypertension)
120/80 - 139/89
120/80 - 131/85
140/90+
132/86+
Ideal (Excellent)
High Risk (Hypertension)
Source: NIH, HeartMemo, National High Blood Pressure Education Program, Update on High Blood Pressure in Children.
*Per the AHA website, “When it comes to blood pressure in children, ‘normal’ is relative. It depends on three factors:
gender, age, and height.” Your child’s doctor can tell you what’s right for your child because “normal” is a complicated
calculation based on these factors.
22
© 2011 Wellsource, Inc. Do not make unauthorized copies.
0
1
2
3
4
5
6
7
8
9
5
0
1
2
3
4
5
6
7
8
9
Cardiovascular Fitness – Aerobic Capacity
Aerobic Capacity
Aerobic capacity is a measure of the body’s ability to transport and utilize
oxygen for energy production. A high aerobic capacity or oxygen transport
system is the best measure of cardiovascular fitness. It reflects the ability
of the heart, lungs, circulation, and blood to transport oxygen for energy
to accomplish work. A high aerobic capacity increases endurance, reduces
fatigue, is a strong predictor of heart health, and is linked to a longer,
healthier life.
Aerobic capacity (often called “peak aerobic capacity,” “maximum oxygen
uptake,” and “VO2 max”) is measured in terms of peak oxygen uptake in
milliliters of oxygen used per minute per kilogram of body weight (VO2 max
= ml/kg/min) or in METs (multiples of resting metabolism). Any number of
aerobic capacity tests can be performed in the laboratory using a treadmill or
bicycle ergometer. A number of field tests can be performed which are more
cost effective and simpler to administer. Recommended field tests are the
one-mile walk, 1.5 mile run, or a step test. Once a VO2 max is determined
use the Aerobic Capacity (VO2 max) table to identify the fitness rating by
age and gender. To calculate METs divide VO2 max by 3.5 and refer to the
Aerobic Capacity (METs) table to identify the METs fitness standard by
age and gender. Before any testing, verify that the pre-test screening has
been completed including PAR-Q, consent and release forms, resting blood
pressure, and heart rate. A warm-up is recommended before any testing.
Aerobic Capacity Norms (VO2 max) Table
MEN
AGES
Percentile
Excellent 80 – 100
Doing Well 60 – <80
20-29
30-39
40-49
50-59
60-69
51.1+
47.5+
46.8+
43.3+
39.5+
45.7-51.0
44.4-47.4
Needs Improving 40 – <60 42.2-45.6
42.4-46.7 38.3-43.2
35.0-39.4
41.0-44.3 38.4-42.3
35.2-38.2
31.4-34.9
36.7-40.9
34.6-38.3
31.1-35.1
27.4-31.3
High Risk 0 – <20 26.6-38.3 26.6-36.6
25.1-34.5
21.3-31.0
18.6-27.3
At Risk 20 – <40 38.4-42.1
WOMEN
AGES
Percentile
20-29
30-39
40-49
50-59
60-69
Excellent 80 – 100
44.0+
41.0+
38.9+
35.2+
32.3+
Doing Well 60 – <80 39.5-43.9
36.7-40.9
35.1-38.8
31.4-35.1
29.1-32.2
Needs Improving 40 – <60 35.5-39.4
33.8-36.6
31.6-35.0
28.7-31.3
26.6-29.0
At Risk 20 – <40
31.6-35.4
29.9-33.7
28.0-31.5
25.5-28.6
23.7-26.5
High Risk 0 – <20 22.6-31.5
22.7-29.8
20.8-27.9
19.3-25.4
18.1-23.6
Source: ACSM’s Guidelines for Exercise Testing and Prescription, 8th Ed, 2010, p.84-89.
23
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Cardiovascular Fitness – METs
METs
Peak aerobic capacity is often expressed as METs (multiples of resting metabolism
or metabolic equivalents). It is a measure of the rate of oxygen consumed based on
exercise intensity. When sitting quietly, the body expends 1.0 MET of energy. A
4.0 Met activity, such as brisk walking, burns 4 times as many calories per minute
as when sitting resting. Men in good health generally have a peak aerobic capacity
of 10 METs or more, and women at least 9 METs. Highly fit persons may have
peak aerobic capacities as high as 12 or 15 METs. Athletes can have peak aerobic
capacities as high as 20 or more METs.
Aerobic Capacity Norms (METs) Table
MEN
Age Range
20-29
30-39
40-49
50-59
60-69
14.6+
13.6+
13.4+
12.4+
11.3+
Good (60-79)
13.1 - 14.5
12.7 - 13.5
12.1 - 13.3
10.9 - 12.3
10.0 - 11.2
Average (40-59)
12.1 - 13.0
11.7 - 12.6
11 .0 - 12.0
10.1 - 10.8
9.0 - 9.9
Low (20-39)
10.9 - 12.0
10.5 - 11.6
9.9 - 10.9
8.9 - 10.0
7.8 - 8.9
< 10.9
< 10.5
< 9.9
< 8.9
< 7.8
Fitness Rating (%)
Excellent (80-100)
High Risk (0-19)
WOMEN
Age Range
20-29
30-39
40-49
50-59
60-69
12.6+
11.7+
11.1+
10.1+
9.2+
Good (60-79)
11.3 - 12.5
10.5 - 11.6
10.0 - 11.0
9.0 - 10.0
8.3 - 9.1
Average (40-59)
10.1 - 11.2
9.7 - 10.4
9.0 - 9.9
8.2 - 8.9
7.6 - 8.2
Low (20-39)
9.0 - 10.0
8.5 - 9.6
8.0 - 8.9
7.3 - 8.1
6.8 - 7.5
<9
< 8.5
<8
< 7.3
< 6.8
Fitness Rating (%)
Excellent (80-100)
High Risk (0-19)
Source: ACSM’s Guidelines for Exercise Testing and Prescription, 8th Ed, 2010, p.84-89.
Aerobic Capacity Norms1 (METs)
One MET = 3.5ml/kg/min
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© 2011 Wellsource, Inc. Do not make unauthorized copies.
Cardiovascular Fitness – One-Mile Walk
One-Mile Walk
Test Procedure
Equipment:
The one-mile walk fitness test is a safe and effective means for estimating peak
aerobic capacity. This test requires:
• A one-mile track or carefully measured course
• An accurate heart rate in the last minute of the test or immediately upon
completion of the walk
• An accurate finish time measured to the nearest second
One-mile track or course
Heart rate monitor
Stop watch
Test Procedure
1.Only people in good health should complete this test and those who pass the
Par-Q screening test with no problems. People with health problems should
have permission and guidance from their doctor before completing this test.
2.Instruct the participants to walk a one-mile course as quickly as possible
without undo strain. No running is allowed. Walk at a brisk, steady pace
that you can keep up to completion.
3.Time the test with a stopwatch to the nearest second.
4.Use a heart rate meter to check their heart rate in the last minute of the
test or take an accurate heart rate immediately upon completion of the
walk (take a 10 second count and multiply by 6 for beats per minute). A
stethoscope on the chest over the apex of the heart is a good way to get
an accurate pulse count. If pulse is taken at the end of the test, it must
be started within 5 seconds of completion of the walk as the heart rate
immediately begins to slow down.
5.Choose One-Mile Walk GXT option in the admin settings of the
Wellsource WellSuite® application.
6.Record the finish time and finish heart rate in the clinical section of the
WellSuite® application. Peak aerobic capacity is computed using a regression
equation including weight, age, gender, walk time, and heart rate.
One-Mile Walk
METs
Time
METs =
VO2 / 3.5
Exercise
HR
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
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7
8
9
min : sec
0
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2
3
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5
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9
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0
1
2
3
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0
1
2
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4
5
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8
9
Entering One-Mile Walk
0
1
2
3
4
5
6
7
8
9
●● Enter Exercise Heart Rate in the space provided under Exercise
HR. Fill in the corresponding bubbles completely.
●● Enter the time it took to complete the walk in minutes and
seconds. Fill in the corresponding bubbles.
●● You do not need to fill in the METs value. The program will
calculate METs if exercise heart rate and time are entered for
the one-mile walk.
●●
25
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Note: Enter METs if other exercise protocols are used.
To calculate METs, use VO2 max divided by 3.5.
One-Mile Walk Worksheet
Heart Rate Chart
Name
10 sec
count
Heart
rate/min
Date
Weight
Age
Gender (M/F)
29
174
28
168
27
162
26
156
25
150
24
144
23
138
22
132
21
126
20
120
19
114
18
108
17
102
16
96
Instructions
1.The one-mile walk is a safe test
for healthy people to estimate
peak aerobic capacity without a
maximal effort.
This test requires:
• A stop watch
• A track or accurately measured
one mile course
• A heart rate monitor or other
means for taking an accurate
heart rate at end of test
2.Complete Par-Q screening form.
3.Instruct the the participant to
walk the one-mile course as
quickly as possible without undue
strain. No running is allowed.
Walk at a brisk, steady pace.
Based on 85% of max heart rate
One MET = 3.5ml/kg/min
4.Upon completing the one-mile
walk immediately check the heart
rate using a heart rate monitor, a
stethoscope, or by taking a pulse.
If taking a pulse, start within 5
seconds of completing the walk.
Take a 10 second pulse and
multiply by 6.
5.Record final heart rate. Record
the time to complete the walk to
the nearest second. Compute peak
aerobic capacity.
6. Choose 1.5 Mile Run GXT
option in the admin settings
of the Wellsource WellSuite®
application.
7.Record the finish time in the
clinical section of the Wellsource
WellSuite® application.
One-Mile Walk Statistics
Heart Rate
Testing Dates
/10 sec
1
2
3
4
5
6
7
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© 2011 Wellsource, Inc. Do not make unauthorized copies.
/min
Time
VO2 Peak
min : sec
METs
Cardiovascular Fitness – 1.5-Mile Run
Test Procedure
Equipment:
Stop watch
Heart monitor
1.5-Mile Run
The 1.5 mile run was developed by Dr. Kenneth Cooper. It is a
maximum effort test and is very accurate, essentially as accurate
as a maximum treadmill test. Because it is a maximum effort
test, only healthy, fit people who regularly compete in 5 to 10 K
races should complete it.
Test Procedure
1. Only people in good health should complete this test and
those who pass the Par-Q screening test with no problems.
2. Instruct the participants to run 1.5 miles as quickly as possible
without undo strain. Intermittent walking is allowed. Time
the test with a stopwatch to the nearest second.
3. Choose 1.5-Mile Run GXT option in the admin settings of
the Wellsource WellSuite® application.
4.Record the finish time in the clinical section of the
Wellsource WellSuite® application.
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© 2011 Wellsource, Inc. Do not make unauthorized copies.
Cardiovascular Fitness – Step Fit Test
Step Fit Test
The Step Test is a simple test for measuring cardiovascular fitness of
populations including sedentary, overweight, or elderly persons.
Test Procedure
1.Step Height: 8 inches
2.Cadence: Set a metronome at 76 bpm
allowing one step for each beat.
3.Test Instructions: Step up and down
on an 8-inch platform.
a. Right foot up on platform
(can start with the left
foot if desired)
b. Left foot up on platform
c. Right foot down on floor
d. Left foot down on floor
This pattern of up-up-down-down,
is considered a 4-count sequence.
Keep a steady, comfortable pace.
Maintain a cadence of 76 counts
per minute for 3 minutes.
4.Time of recovery heart rate
measurement: 5 to 20 seconds after
stopping, take the participant’s pulse
for the next 15 seconds. Multiply this
by 4.
5.Make sure the following
exercise questions are
displayed in the Wellsource
WellSuite® application and are
completed by the participants:
a.Physical Activity Status
b.Time Spent Exercising
Each Week
6.Choose Step Fit GXT option
in the admin settings of
the Wellsource WellSuite®
application.
7.Record the heart rate in
the clinical section of the
Wellsource WellSuite®
application.
Test Procedure
Equipment:
Step platform
Metronome
Stop watch
Heart monitor
The Step Fit Test Worksheet
Name _______________________________________________
Gender________Age__________ Height_______ Weight_______
Calculated one-minute heart rate: __________________________
Mark the response that best describes your current physical activity level.
n I have no regular exercise program: generally avoid
n I participate regularly in more active physical
walking or exertion when possible.
n I occasionally walk for pleasure or exercise sufficiently
to cause heavy breathing or perspiration (sweat).
n I get regular exercise in work or recreation requiring
modest physical activity such as golf, yard work,
calisthenics, weight lifting, table tennis; up to 1 hour
per week.
n I get regular exercise in work or recreation requiring
modest physical activity such as golf, yard work,
calisthenics, weight lifting, table tennis; more than 1
hour per week.
exercise (brisk walking, jogging, swimming, cycling,
rowing, active sports like tennis or handball).
IF YES, indicate below how much time you spend
exercising each week.
n Less than 1 hour per week
n 1 hour, or run up to 5 miles weekly
n 2 to 3 hours, or run 6 to 10 miles weekly
n 4 to 5 hours, or run 11 to 15 mile weekly
n 6 to 8 hours, or run 16 to 20 miles weekly
n 9 to 11 hours, or run 21 to 25 miles weekly
n 12+ hours, or run 26+ miles weekly
28
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Instructions for Using
Consent and Release Form
1. The consent must be signed at the beginning of the assessment (before any tests are performed or information is
gathered from the HRA).
2. If a participant looks young, ask them their age. If they are under 18, they MUST have their parent or legal
guardian sign their consent form before they can participate. (Under the law, minors are deemed incapable of
consenting themselves.)
3. A health professional should review the participant’s PAR-Q questionnaire prior to administering the aerobic
capacity test on that person. A health professional should also be available to answer any questions or explain the
tests to participants to ensure the participant understands the test and they have offered their informed consent.
4. The consent/release forms should be retained after the health screening for a minimum of 2 years (certain state laws
may require a longer retention period) to ensure they are available to defend against a possible tort claim.
5. If you find yourself in possession of any identifiable health information after performing the health screening, it
should either be returned to the participant before they leave, or destroyed (i.e., shredded). Until such action is
taken, it must be protected against disclosure. For example, if a participant hands you a PAR-Q questionnaire with
his/her name on it, you must treat it as confidential health information and properly dispose of it.
6. Certain sections of the form highlighted in gray must be tailored to accurately describe your specific program. As
a result, this form will need to be modified before using it at future health screening functions. Section 4 will also
need to be revised if a PAR-Q questionnaire is not used.
READ BEFORE USING THIS FORM
No legal form, including the following, should be adopted by any program until legal counsel and the medical director
or risk manager for the program have first reviewed it. For the consent form to be valid and enforceable, consent
language must be written in accordance with the prevailing state’s laws and should inform the participant, in easy
to understand language, how the information obtained from the program will be used, who will have access to their
information and for what purpose(s), and the risks and benefits of any testing procedures that may be used.
When making modifications to this form, use language that will be easily understandable to your participants. Keep
in mind that for participant consent to be considered voluntary and enforceable, it must:
a. be in writing;
b. be written in a way that the individual is reasonably likely to understand;
c. explain the type of information that will be obtained and the general purposes for which it will be used; and
d. describe the restrictions in place to protect against unlawful disclosures of their protected information.
29
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Sample Consent and Release Form
for Health Screening
1. Purpose of the Screening. The primary purpose of this health screening is to [increase awareness and
knowledge of personal health and wellness, inform and refer participants to specific wellness resources, assist
with establishing and achieving health goals, and promote programs and services that enhance wellness].* As a
participant, you will have the opportunity to complete a health risk assessment (HRA). Completion of the HRA is
voluntary and failure to participate will not jeopardize your employment status in any way.
2. Explanation of the Screening and Associated Risks. This health screening will include one or more
of the following tests: [the taking of a small blood sample drawn by needle from your arm for the blood chemistry
analysis (lab fees to be paid by ______), a blood pressure check, strength testing, aerobic fitness testing, and a
body composition analysis that may involve skinfold measurements]. You could experience symptoms during this
health screening such as abnormal blood pressure, fainting, irregular, or fast or slow heart rhythm that may, in
rare instances, lead to a heart attack, stroke, or other serious health condition, or even death. Emergency personnel
and equipment [are/are not] on site to deal immediately with these situations should they arise. You are strongly
encouraged to ask questions of the screening staff if you do not understand the risks or the procedures to be
performed.
3. Confidentiality and Use of Personal Information. By participating in this health screening
and completing an HRA, you are granting permission to [My Company] to use the information for program
development, evaluation, [wellness coach contact], and emergency follow up if warranted, in the sole discretion of
[Your Company]. You may revoke this authorization of consent by providing written notice to [Your Company]
at any time. Any personally identifiable health information obtained in conjunction with your health screening
and HRA will be protected and will only be used in accordance with this consent agreement and applicable laws
pertaining to the use of personal health information. Your information in aggregate form may be used for research,
educational, or statistical purposes so long as the data does not personally identify you.
4. Responsibilities of the Participant. By choosing to participate in this screening you certify that you are in
good health and that you have accurately completed the PAR-Q test presented to you by the health screening staff.
Information you possess about your health status or previous experiences of heart-related symptoms during physical
effort (such as shortness of breath while participating in low-level activity, pain, pressure, tightness, heaviness in the
chest, neck, jaw, back and/or arms) may affect the safety of your aerobic fitness test. You should promptly report
these and any other unusual symptoms before, during, and/or after the aerobic fitness test to your test administrator.
5. Release of Claims. In consideration of your participation in this health screening, you hereby agree to assume
all risks of injury or death to yourself. You also understand that your HRA results are intended to be used for
educational purposes only and are not designed to replace the care or advice of a medical provider. If you have a
disease condition, fall into certain high health risk categories, and/or receive abnormal laboratory tests, you should
promptly consult with a physician and obtain his or her approval prior to engaging in any health improvement
program or lifestyle change activity. Neither Wellsource, Inc., the developer of the HRA, nor [Your Company] is
liable for any health consequences resulting from your participation in this program, and neither entity or its staff
is responsible for ensuring that you have consulted with your physician regarding any recommendations you may
receive as a result of your participation. Your results [will/will NOT] be automatically sent to a healthcare provider
on your behalf. Your signature below authorizes [Your Company] to seek immediate medical assistance on your
behalf if warranted, in the sole discretion of [Your Company]. YOU HEREBY RELEASE THE PROGRAM AND
ALL OF ITS PERSONNEL AND AGENTS FROM ANY AND ALL DAMAGES AND CLAIMS CAUSED BY
OR RESULTING FROM YOUR PARTICIPATION IN THIS HEALTH SCREENING. This release shall also
be binding upon your heirs, executors, and administrators.
30
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Sample Consent and Release Form
for Health Screening (continued)
6. Freedom of Consent. This notice contains our policy with respect to our security and privacy practices. This
policy and notice may change at any time, but material modifications will only be effective after you have been
given the opportunity to (i) review the amended policy, and (ii) withdraw your consent. You acknowledge that you
have read this document in its entirety (or that it has been read to you), and that you understand and agree to the
above. If you are under age 18, you agree not participate in this health screening without the written consent of
your parent or legal guardian. Your permission to perform this health screening is given voluntarily and extends
to all screening personnel, including volunteers. You understand that you are free to stop the tests at any point, if
you so desire. You also fully understand the attendant risks and discomforts, and have had an opportunity to ask
questions that have been answered to your satisfaction.
To agree to participate in this health screening and HRA, please sign and date this consent and release form. We
cannot process your health questionnaire unless you have signed and dated below. Thank you.
Signature of Participant
Date
Signature of Parent or Legal Guardian
if Participant is under 18 years of age
Date
31
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Informed Consent for an Exercise Test
(Sample from ACSM)
1.Purpose and Explanation of the Test - You will perform an exercise test on a cycle ergometer or a
motor-driven treadmill. The exercise intensity will begin at a low level and will be advanced in stages depending
on your fitness level. We may stop the test at any time because of signs of fatigue or changes in your heart rate,
electrocardiogram (ECG), or blood pressure, or symptoms you may experience. It is important for you to realize that
you may stop when you wish because of feelings of fatigue or any other discomfort.
2.Attendant Risks and Discomforts - There exists the possibility of certain changes occurring during the
test. These include abnormal blood pressure, fainting, irregular, fast or slow heart rhythm, and in rare instances,
heart attack, stroke, or death. Every effort will be made to minimize these risks by evaluation of preliminary
information relating to your health and fitness and by careful observations during testing. Emergency equipment
and trained personnel are available to deal with unusual situations that may arise.
3.Responsibilities of the Participant - Information you possess about your health status or previous
experiences of heart-related symptoms (such as shortness of breath with low-level activity, pain, pressure, tightness,
heaviness in the chest, neck, jaw, back and/or arms) with physical effort may affect the safety of your exercise test.
Your prompt reporting of these and any other unusual feelings with effort during the exercise test itself is of great
importance. You are responsible for fully disclosing your medical history, as well as symptoms that may occur
during the test. You are also expected to report all medications (including non-prescription) taken recently and, in
particular, those taken today, to the testing staff.
4.Benefits to be Expected - The results obtained from the exercise test may assist in the diagnosis of your
illness, in evaluating the effect of your medications or in evaluating what type of physical activities you might do
with low risk.
5.Inquiries - Any questions about the procedures used in the exercise test or the results of your test are encouraged.
If you have any concerns or questions, please ask us for further explanations.
6.Use of Medical Records - The information that is obtained during exercise testing will be treated as privileged
and confidential. It is not to be released or revealed to any person except your referring physician without your
written consent. The information obtained, however, may be used for statistical analysis or scientific purposes with
your right to privacy retained.
7.Freedom of Consent - I hereby consent to voluntarily engage in an exercise test to determine my exercise
capacity and state of cardiovascular health. My permission to perform this exercise test is given voluntarily. I
understand that I am free to stop the test at any point, if I so desire. I have read this form, and I understand the test
procedures that I will perform and the attendant risks and discomforts. Knowing these risks and discomforts, and
having had an opportunity to ask questions that have been answered to my satisfaction, I consent to participate in
this test.
Date_______________________Signature of Participant_____________________________________
Date_______________________Signature of Witness_______________________________________
32
© 2011 Wellsource, Inc. Do not make unauthorized copies.
Before you start an exercise program, complete this
Physical Activity Readiness Questionnaire (PAR-Q).
PAR-Q & YOU
Physical Activity Readiness
Questionnaire - PAR-Q
(revised 2002)
(A Questionnaire for People Aged 15 to 69)
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most
people. However, some people should check with their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the
ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being
very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.
YES
NO
If
you
answered
1.
Has your doctor ever said that you have a heart condition and that you should only do physical activity
recommended by a doctor?
2.
Do you feel pain in your chest when you do physical activity?
3.
In the past month, have you had chest pain when you were not doing physical activity?
4.
Do you lose your balance because of dizziness or do you ever lose consciousness?
5.
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a
change in your physical activity?
6.
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
7.
Do you know of any other reason why you should not do physical activity?
YES to one or more questions
Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell
your doctor about the PAR-Q and which questions you answered YES.
• You may be able to do any activity you want — as long as you start slowly and build up gradually. Or, you may need to restrict your activities to
those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
• Find out which community programs are safe and helpful for you.
➔
NO to all questions
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
• start becoming much more physically active – begin slowly and build up gradually. This is the
safest and easiest way to go.
• take part in a fitness appraisal – this is an excellent way to determine your basic fitness so
that you can plan the best way for you to live actively. It is also highly recommended that you
have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor
before you start becoming much more physically active.
DELAY BECOMING MUCH MORE ACTIVE:
• if you are not feeling well because of a temporary illness such as
a cold or a fever – wait until you feel better; or
• if you are or may be pregnant – talk to your doctor before you
start becoming more active.
PLEASE NOTE: If your health changes so that you then answer YES to
any of the above questions, tell your fitness or health professional.
Ask whether you should change your physical activity plan.
Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing
this questionnaire, consult your doctor prior to physical activity.
No changes permitted. You are encouraged to photocopy the PAR-Q but only if you use the entire form.
NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes.
"I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction."
NAME ________________________________________________________________________
SIGNATURE _______________________________________________________________________________
DATE______________________________________________________
SIGNATURE OF PARENT _______________________________________________________________________
or GUARDIAN (for participants under the age of majority)
WITNESS ___________________________________________________
Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and
becomes invalid if your condition changes so that you would answer YES to any of the seven questions.
© Canadian Society for Exercise Physiology
Supported by:
Health
Canada
Santé
Canada
continued on other side...