body composition measurement via adipose tissue sites. low cost, easy, similar accuracy to expensive equipt. Cons: trainer error increases with lack of experience/familiarity.
50% of BF is stored beneath skin (subcutaneous fat)
less accurate in elderly, obese and very lean clients
height, weight and or circumference to assess body size dimensions. BMI, waist-to-hip-ration WHR. These are just estimations of body comp
lean body mass vs fat
lean: connective tissue, muscles, bones, blood, nervous tissue, skin and organs. anything that is metabolically active fat: adipose tissue. essential BF for M= 2-5% and F=10-13% certain amount of BF is necessary for overall health but too much is detrimental
body fat and health
BF has been linked to coronary artery disease (CAD), metabolic syndrome, diabetes, heart disease, osteoarthritis, sleep apnea, low-back dysfunction or premature death.
overweight vs overfat
weight: height and weight measurment. 20% over normal =overweight but could be due to lean mass overfat= too much fat which directly affects body composition.
measures water displaced when person is completely submerged after letting out all air (residual volume). density=mass/vol apparatus is expensive and impractical for fitness centers but is the gold standard in body comp measurements.
skin fold assessment
measures subcutaneous BF with error of +-2 to 3.5% depending on PTs experience and accuracy. Measuring 3 places is best. For men: chest between top crease of underarm and nipple, thigh between crease of hip and proximal patella, abdomen 1 inch to the R of the bellybutton. women: tricep post. midline of upper arm in the middle, thigh, suprailium immediately superior of iliac crest in line with arm crease.
calculating skin fold measurements
can add them up and plug them into chart on pg 181 or can calculate body density. *note that hip measurements for women and chest for men are diagonal along line.
skin fold protocol
need skinfold caliper and marking pencil (should be washable, eyeliner pencil works) client should be hydrated and pre-exercise. all measurements are on the right side of body while client is standing. mark skin, fold with L hand and measure with R. Open thumb and index to 8 mm or 3 in the pinch skin and put caliper on skin just below the pinch. release and read. wait 20-30 s to 2 accurate readings. *only measure monthly or bimonthly
body comp changes
if a client has gained or lost weight, it can be assumed that a change in body comp (lean mass or fat mass) has occurred. desired body weight = (lean body weight/ 100%-desired % fat) x 100
body mass index is an anthropometric measurement. it is the r'ship between height and weight. can sometimes unfairly categorize people. =weight(kg)/height squared (m) PT should look at ind and decide if BMI is accurate or if they should proceed to body comp measurements.
help motivate client if they are losing weight or if they are gaining muscle hypertrophy. - measure precisely and consistently the same places. - use non elastic, flexible tape - tape should be snug without pushing into subcutaneous layers. -duplicate measurements should be taken of each site.
WHR helps pts determine location of fat deposits as indicator of risk of disease. waist measurement/hip measurement android: apple shaped, more fat in waist and high risk for disease gynoid: more fat in the hips and thighs or pear shaped.
visceral fat (android/waist) very damaging and impedes on vital organs and inc risks including type 2 diabetes, hypertension, hypercholesterolemia for every 1-inch of waist inc in men, it inc blood pressure, blood cholesterol, lowers HDL, inc blood fat (triglycerides) and inc metabolic syndrome risk.
maximal oxygen uptake. measurement of body's ability to use o2 for energy and closely related to functional capacity of the heart.
inaccuracies in calculating this in submaximal testing include: using 220-age for MHR (+-12 bpm off) and assuming everyone expends the same energy
graded exercise tests
GXT. used extensively in clinical settings and fitness settings. can be maximal but this places more cardiac risks. Submaximal tests are safer for clients and can still calculate vo2
1 MET is the = of o2 consumption at rest or approx 3.5 ml/kg/min.
treadmill exercise testing
Bruce test advised for younger, fitter clients and Balke & Ware advised for older and deconditioned clients. Some clients may not feel comfortable walking on a treadmill and a bike should/can be used in this situation. contraindications: clients w poor balance/visual problems and can't walk on TM without hold rails. Orthopedic problems that get worse with prolonged walking or foot neuropathy
Bruce submaximal Treadmill Test
need stopwatch, TM, stethoscope, RPE scale, HR monitor and medical tape to secure BP cuff. -Have client warm up at or under 1.7 mph on treadmill (TM). test begins at 1.7 mph and 10% incline. Each stage is 3 min long, record clients vitals every min and at 2:15 of every stage. If HR is rising more than 6 bpm, they have not reached steady state yet (HRss) and should continue for one more minute.
Balke & Ware Treadmill exercise test
in fitness setting these tests are completed to 85% of MHR. starts at 3 mph for F and 3.3 mph for M and 0% incline. F: after 3 min inc incline to 2.5% and inc by 2.5% each 3 min after until 85% MHR reached M: after one minute inc incline to 2% and inc by 1% each minute after until 85% MHR reached. assess HR and RPE each minute and BP with 30s left in each stage (women) or every other stage (men)
Ebbeling Single-stage Treadmill test
single-stage optional TM test that estimates VO2 max in low-risk, apparently healthy 20-59 yos.
record resting HR and calc submaximal target HR using Tanaka, Monahan and Seals formula.
Have client warm up for 4 min w/o handrails until they reach 50-70% of age-predicted MHR.
Then up to 5% grade on TM and record last 15s of last 2 min HR and avg together.
If HR inc by more than 5 bpm between, add an additional minute.
cycle ergometer testing
YMCA bike test or Astrand-Ryhming cycle test
pros: arms stationary compared to TM so measuring HR and BP during is easier. Also better for clients w poor balance or fitness levels.
cons: clients may prematurely exp leg fatigue due to not being accustomed to cycling which underestmates their cardio fitness and VO2 max. Also BP may be higher due to muscles being contracted longer over the slow motions.
contraindications of cycle testing
obese inds who are uncomfortable on seats or can't keep with cadence.
Inds with ortho problems and can't get ROM in knee less than 110 degrees
Inds w neuromuscular problems who cannot maintain cadence of 50 rotations per min.
YMCA Bike Test
measures HRss in response to incremental 3-min workloads that progressively elicit higher HR. HR is then plotted and extended on graph to det. vo2 max bc HR correlates to vo2 score.
astrand-ryhming (A-R) cycle ergometer test
est vo2 max using a single stage test. this is easier to conduct for new PTs but clients may find riding at mod-to-hard intensity for 6 min fatiguing.
Ventilatory threshold testing
resting HR test
carotid or radial (wrist on thumb side)
use first two fingers and never the thumb bc it has it's own pulse.
count out HR for one full minute or 30s x 2
40 bpm and under= athletically fit
<60 bpm= bradycardia
>100 bpm= tachycardia.. discont fitness test and refer to physcian
blood pressure cuff test
cuff above crease of elbow on L or R arm. stethoscope goes on elbow over brachial artery (near elbow crease). pump up to mmHG 180-220.
let pump out until you hear a thump, record number at first heartbeat (systolic)
record number at last sound you hear (diastolic reading)
resting blood pressure ranges
ideal= <=120S and 80D
hypertension (refer)= 140S/90D
--If BP goes up between fitness evals, wait a few min and reeval. If someone has risk factors that were not BP related and now has BP risk factor, you may have to refer to physcian
skin fold M vs F
M=CAT (chest, abdomen, thigh). A= 1 in right of belly button, C= between arm crease and nipple, T= halfway down thigh (from thigh crease to knee)
F= TST (tricep, suprailium, thigh) Suprailium is on hip
if 2 measurements are more than 2 mm apart, take 3rd measurement and avg the three
an alternative to skin fold tests. It is a subjective test because there are no standards to perform these measurements. Just compare the client to themselves when you measure them later.
weight kg/height (m)2(squared)
lbs to kg= lbs/2.2
height= inches x 0.0254 = meters
American standard equation: 703 x body weight. That number divided by height in inches. Then divide again by height in inches.
19-25 is normal
>40 morbidly obese
*this will vary and not count toward very lean ind like bodybuilders.
waist to hip norms
lower risk: <.9M or <.8F
mod high risk .9-1M or .8-.85F
High Risk >1M or >.85F
*This kind of fat is very mobile fat under the abs and easily absorbed by blood vessels which inc. risk for cardiovascular disease
hip flexion test
tests HAMSTRING flexibility. person lays on table and you bring leg up with knee straight. test each leg. 80-85 is normal (eyeballing) if the ROM is below 80 degrees they may have tight hamstring muscles
ROM for hip flexors. Client sits on edge of table and lifts knee up to chest and lean back on table. You look at relaxed leg to see if it pops up off table or not. if it does, this may indicate tight hip flexors.
apley's scratch test
multi directional rotation of shoulder (looks like you would if you were adjusting your bra) and how close each hand can get. w/in two inches then they are scoring well and if they are further, they have limited ROM and you need to determine which arm it is. typically it's the top arm.
muscular strength test
how much you can lift the weight one time-- one rep max. this has a high risk of injury.
muscular endurance is how long you can perform this test-- lower risk of injury.
these are two separate categories but for testing, they are combined into one category.
half sit-up test
get in form to do a sit up. knees bent and lying on floor. put a piece of tape where the client's hands rest and then measure 3.5 inches away and put another piece of tape. then have client touch tape as many times in one min as possible
*this can be a strength test for one client (if they can only complete 5) or an endurance test for another (if they complete 50 or so)
push up test
men: standard position
women: modified w knees on floor.
knees hips and shoulders must be in straight line. Have them perform test until fatigue only resting in top position and coming down to 3 in of floor
*Females may NOT perform this test in the standard position bc it makes it HARDER and pt could be liable if there is an injury
only measuring fitness, not determining diseases. All tests are submaximal so no more than 85%
YMCA 3 minute step test
need: 12 in step platform
cadence: 96 bpm (24 stepping cyles: L up, R up, L down, R down)
time: perform this for 3 min
then they sit down immediately and take radial pulse for one full min. Do not use HR monitor bc it measures HR for a second and we are Looking for how quickly the HR slows down... more fit individuals HR slows faster
*not approp for unfit clients, back problems, knee problems, balance issues
alt: rockport walk test
*does not allow pt to est vo2
rockport walk test
alternative to YMCA 3 min step test if client shows contraindications.
measure out 1 mile (track, shopping mall) flat surface
client walks as fast as they can and then pt immediately takes a 10s pulse after mile
*can use this info to est. vo2 max
let the client know results. where they should improve and where they did really well. collaborate with client on how to develop exercise program.
set goals using test info and motivate them to achieve these.
reassess fitness tests 4-12 weeks after program.
don't want to do it too soon due to margin of error in tests (like skin fold) and not too late bc of motivation.
determine what's working and what's not and how to improve program.
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