Health Screening:
Before beginning in any kind of physical activity/exercise routine, it is important for the participant to fill out an “informed consent” form and Physical Activity Readiness – Questionnaire (PAR-Q). This is so that the trainer is made aware of any possible barriers to physical activity and prevents injuries from occurring. It can be considered as a “screening process” for people who are not ready to engage in exercise (Scott, T., 1992). Pre-test heart rate and blood pressure are normally recorded. Heart rate signifies the amount of times the heart muscle pumps per minute in order to deliver blood (thus oxygen) to the cells of the body. Resting heart rate is lower in physically fit people because the heart does not have to work as hard (beats per minute) to deliver blood to the body as compared to an unfit person. Blood pressure (BP) is measured in milliliters of mercury (mmHg). BP is systole (pressure against arterial walls during heart contraction) over diastole (ease of blood flow in heart for relaxation/refilling; McArdle, D. A. et al., 2010); a normal reading is <120/<80. During exercise, systole increases as the heart works harder with increased workload. Diastole should not increase though, as that would indicate that the heart is working harder to relax and fill up. If diastole increases, exercise should stop immediately. Exercise lowers resting blood pressure (Whelton, S. P. et al, 2002).
Body Composition Assessment:
Height and weight are measured to find body mass index (BMI) which can indicate if a person is underweight (<18.5), normal weight (18.5-24.9), over weight (25-29.9), or obese (>30). This is not the most accurate way to distinguish what a “normal” weight may be though, because muscle weighs more than fat. Still, it is most common to take skin fold measurements at 5 locations on the body. This technique is done with calipers and measures subcutaneous fat. Common areas to take skin folds are at the: triceps, biceps, subscapula, thigh, iliac crest, supraspinale, abdominals, and calf. However, this method is not a great choice for muscular athletes (when it’s difficult to physically pinch any ‘surface level’ face due to body composition being mostly muscle) or in older adults, particularly males, whose fat is most likely around internal organs. Using calipers may also be uncomfortable for some clients as it does expose one’s body while being pinched and prodded. BMI may also be over or underestimated in very tall or very short individuals (Ross, W. D. et al., 1988). Thus, waist circumference is an important factor to consider since high abdominal fat is a major health concern and risk factor to many diseases (Katzmarzyk, P. T. et al., 2006). Males and females should have a waist circumference of less than 88cm and 102cm, respectively.
Aerobic Fitness Assessment:
“Sub-maximal testing” means that the a test of aerobic performance is not conducted at maximum exertion; values found are extrapolated to determine a predicted value of maximum aerobic capacity. One’s maximum aerobic capacity, or “VO2max” (maximum volume of oxygen) is the maximal rate at which the body is able to take up, transport, and use oxygen to perform work. In other words, it is the highest rate of oxygen consumption possible during large muscle mass activity (Coyle, E. F., 1995) meaning that a high VO2max relates to a higher cardiovascular and cardiorespiratory health profile because the body is able to efficiently consume and transport a high volume of oxygen.
The “Modified Canadian Aerobic Fitness Test” (mCAFT) is a type of sub-maximal test performed in order to predict a participant’s aerobic capacity. It involves stepping up and then down two steps. The test gradually increases speed and the participant must keep in time with the pace of the recording, which plays during the test. The test terminates when the participant reaches his or her 85% maximum heart rate (85%HRmax; Weller, I. M. R. et al., 1993) or if he or she feels any kind of discomfort or pain. 85% HRmax is calculated using the equation provided in table 1 of appendix A.
Knowing one’s VO2max is an important determinant of physical health. A lower than normal relative VO2max may be an indicator of disease (i.e. emphysema or anemia) or physical un-fitness, signifying the need to begin an exercise program to increase bodily functioning. A benefit to doing a sub-maximal test is that it puts little stress on the client. A disadvantage of a sub-maximal test would be that it predicts maximum oxygen uptake and is not an exact value – there is a greater potential for error in measurement. The step-test is not the best type of test for young, healthy, and/or elite athletes or people with joint problems.
Musculoskeletal Fitness Assessment:
Musculoskeletal fitness means health status of one’s muscles and bones. Having healthy bones and muscles is imperative to living an independent and vigorous life, as well as aiding in sport performance. Musculoskeletal fitness can be divided into strength, endurance, and power. Assessments of strength: 1 repetition maximum (the maximum amount of weight a person can lift in one repetition; known as “the gold standard” of strength measurement), and isometric (muscle length remains constant with an increasing force) or static strength tests via a handgrip dynamometer. In 2011, a Biometrics dynamometer and Jamar hydraulic dynamometer were tested and found to be highly reliable and valid measures of grip strength (Allen, D. et al.).
Endurance can be measured by implementing push-up and partial-curl up tests that analyze upper body and trunk endurance.
Power can be determined by means of a vertical jump test. It is important to note that increasing muscular power can also increase muscle endurance, as seen in 5km running performance after a group of athletes whose performance significantly increased after an explosive-strength training intervention was implemented (Paavolainen, L. L. et al., 2003).
For all testing, the Canadian Physical Activity, Fitness & Lifestyle Approach Protocol (CPAFLA protocol) is used. In CPAFLA protocol, healthy physical activity, healthy lifestyle (with a Health/Fitness Counselor) and health-related fitness (with a Fitness Appraiser) are assessed using questionnaires (i.e. PAR-Q) and techniques like the ones stated above to give full or partial fitness appraisals to clients of certified personal trainers or exercise physiologists (The Canadian Physical Activity, Fitness & Lifestyle Approach Protocol (CPAFLA), 2013).
Back Health Assessment:
Back health assessment is an important component to an individual’s health because it is a very common problem – second to headaches. Chronic lower back pain involves muscular as well as connective and neural systems (Rittweger, J. et al., 2002). Lower back pain is a large factor in economic impact due to time spent away from work, medical fees, disability payments, and long-term insurance. It was found that people who did return to work had fewer job, personal, or family related problems (Lancourt, J. et al., 1992).
Back health assessment can be divided into: flexibility, posture, and endurance of the back extensor muscles and abdominal muscles. Flexibility is measured with a sit-and-reach test where a client sits on the floor with legs extended and back straight. The client reaches with both hands as far as he or she can in between his or her feet and holds that spot for 2-3 seconds. The distance traveled is recorded. This also measures flexibility of the hamstring muscles. Posture tests can be performed but are not always accurate as “proper posture” is hard to define. The purpose of posture tests is to identify irregularities in lumbar and cervical spine curvature. Back endurance is measured via the Biering-Sorensenmethod, which is when the subjects support their upper body while their legs are fixed in place. Screening must be done before this test to ensure no potential injury as this test can put great stress on the back. Abdominal endurance is tested with the partial curl-up test where the subjects are on their backs with knees bent up. The subjects lay with their arms by their side. The curl is complete when the fingertips touch a marked spot 10cm away from the starting point and back to the starting point. This is done to a preset cadence. It is important to note that waist circumference also plays a role in identifying lower back pain as a higher waist circumference bears more weight on the spine. Also, high levels of physical activity are associated with increased lower back pain.