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. 2 © 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. 3 © 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. 4 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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. 5 © 2011 Wellsource, Inc. Do not make unauthorized copies. 9 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 6 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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. 7 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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. 8 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 © 2011 Wellsource, Inc. Do not make unauthorized copies. 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 24 © 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 5 6 7 8 9 min : sec 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 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 26 © 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. 27 © 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...