ACSM CPT Chapter 12: Client Fitness Assessments

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Chapter Objectives: 

• Know the right sequence of choosing fitness assessments.
• Show information on performing basic related physical fitness assessments that are common for the personal training field. These are tests like:
  • Taking someone’s blood pressure and heart rate.
  • The body composition including weight, height, BMI, waist and hip circumference, skinfold measures, and bioelectrical impedance.
  • Cardiovascular tests include field, step, and Submax cycle ergometer tests.
  • Muscular fitness, 1 RM, chest press, partial curl ups, and push-ups.
  • Flexibility like the sit and reach test.

Heart Rate: Resting Exercise, and Recovery

Heart rate is defined as the number of beats the heart has and is usually put in terms of per minute. This is shown by the term beats per minute. There aren’t any accepted standards used for resting heart rate, but it is thought to often be an indicator of CRF due to decreased resting heart rate when we are more physically fit. There is also no standard for exercise heart rate, but the response that heart rate has is an important variable and also the foundation of many endurance tests that we do. 

Measurement of Heart Rate

Palpation of Pulse

These are the three sites we use for palpation of our pulse: 

The radial artery: here, we lightly put the index and middle fingers on the radial artery inside the groove of the anterior surface of the lateral side of the wrist.

The brachial artery: Here, we find the area located between the triceps and biceps, which is on the medial side of our arm and anterior to the elbow. We palpate it with our first two fingers on the medial side of the groove.

The Carotid artery is more visible and quickly found than the radial pulse. We lightly put our fingers on the sternocleidomastoid’s medial border in the lower neck area. We can actually use either side. 

The procedure is as follows:

Locate the site that you wish to use.

Gently press two fingers over this site.

Count how many times you feel a pulse in a specific time period. Let’s use 15 seconds for this.

Start with the first pulse you feel at 0; if there is lag, start with 1 second.

Determine the heart rate by multiplying the number you got by the right number to get to 60 seconds. So, if you use 15 seconds, you would multiply by 4 for their heart rate.

Measurement of Exercise Heart Rate

The palpation method isn’t the most used method now, but when measuring it is more accurate to use a 30 second value.

Heart rate monitors are popular now since they are easily available and affordable these days. Some monitors are prone to error, but the technology is improving and more accurate.

Blood Pressure:

Blood pressure is defined as the force that blood puts on the walls of the arteries and veins when the heart is pumping blood to the parts of the body.

Systolic Blood pressure

This is the pressure of blood on the arteries at the time when the ventricles of the heart contract when there is a heartbeat. In a blood pressure reading this would be the top number. The average is 120 mmHg.

Diastolic Blood pressure

This is the minimum pressure on the arteries from blood that is present when the ventricles are relaxed. This is the bottom number when looking at a blood pressure reading.

Hypertension is known as high blood pressure. This is a condition in which the resting blood pressure, which can be either diastolic or systolic, or both, is elevated on a chronic basis. So, the average blood pressure is 120 over 80. Anything over is prehypertension until we reach 140 over 90. Anything equal to that or over will be at a hypertensive level.

Hypotension is defined as chronically low blood pressure, but we do not have any standards that we use to define this.

Measurement of Blood Pressure

Measuring blood pressure is an important part of resting health related physical fitness assessments. For us to get the most accurate blood pressure reading, the client should be made as comfortable as they can and also sit and rest for 2 minutes before testing. 

Korotkoff Sounds

These are important and used when measuring blood pressure by auscultation. These are the sounds that we listen to and hear. These sounds are created when the blood goes from high to low pressure, like when we are releasing the blood pressure cuff. These steps are as follows:

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Phase one is the systolic blood pressure

We look for the first sound or the onset of sound. It is typically like a clear and repetitive tapping. This is the pressure at the end of one left ventricle systole.

Phase two

This is a light tapping sound or even a murmur. This happens 10 – 15 mmHg after the phase one start.

Phase three 

This loud tapping starts to occur. They are crisper and louder than in phase 2.

Phase four is known as the true diastolic blood pressure

This is when the sound starts muffling an is less audible and distinct. It may seem like a soft blowing sound.

Phase five is what we call the clinical diastolic blood pressure.

Here there is a complete disappearance of sound.

Instruments used for Blood pressure Measurement

We use a sphygmomanometer, which is a manometer, and a blood pressure cuff together. This is a device used for measuring pressure. The width of the bladder is 40-50% of the circumference of the upper arm. The length is almost enough for encircling the upper arm. The cuff is put at the level of the heart for a proper reading.

Resting Blood Pressure Measurement Procedures

We first use a blood pressure cuff properly sized to the person.

The cuff is wrapped around the upper arm, with the lower edge of the cuff one inch over the antecubital fossa.

The stethoscope is put over the client’s brachial artery and just below the edge of the cuff.

The cuff is then rapidly inflated to 180 mmHg.

The air in the cuff is released at a rate of 3 mm per second.

We then listen using the stethoscope and watch the sphygmomanometer and wait for the first knocking Korotkoff sound. This is recorded as systolic pressure.

When the sound then disappears, as noted in the phases, we record that number as the client’s diastolic pressure.

If their pressure is elevated, we then take the time to take two additional measurements and wait some minutes between the times.

Body Composition

Body composition is defined as the proportion of fat and fat free tissues of the body. This is also called our percent body fat. There is a strong relationship between both obesity and increases in the risk for chronic diseases.

Height and Weight

We measure the height of someone by having their shoes off and asking them to stand straight up with their heels together and head level. They will take a deep breath and hold it while looking ahead.

We measure someone’s weight by removing as much clothing as possible and then simply weighing them with a scale.

Body Mass Index

BMI is used for assessing weight relative to someone’s height. This involves the division of someone’s weight in kilograms by their height in meters squared.

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The categories are:

• Underweight is less than 18.5
• Normal is 18.5 to 24.9
• Overweight is 25 to 29.9
• Obesity 1 is 30 – 34.9
• Obesity 2 is 35 – 39.9
• Obesity 3 is greater than or equal to 40

Waist to Hip Ratio

This is a comparison between the circumference of the waist and the hip. The ratio is used to show the body’s distribution of weight and even potentially where body fat is. 

Waist Circumference Alone

Some professionals believe that waist circumference alone may be enough of an indicator for health risks. For women, a health risk begins when they have a waist circumference of 35 inches and for men, it is when they have a circumference of 40 inches.

Skinfolds

Determining body fat percentage using skinfolds is a really accurate way to measure. We use skin calipers to measure these.

The skinfold sites are: 

• Abdominal: This is a vertical fold that is located on the right side of our umbilicus.
• Biceps: This vertical fold is on the posterior midline of the upper arm, halfway between the olecranon and acromion processes, and we take it with our arms held freely to the sides of the body.
• Chest or Pectoral: This is a diagonal fold that is halfway between the anterior axillary line and the nipple when taking it on men, but one third the distance of the anterior axillary line and the nipple for when we take it on women.
• Medial Calf: This is another vertical fold that we take at the calf’s largest circumference on the medial border’s midline.
• Midaxillary: This is a vertical fold that we take in the midaxillary level of the xiphoid process that is on the sternum.
• Subscapular: This is one of our diagonal folds that is take 1 – 2 cm under the inferior angle of the scapula.
• Suprailliac: This is the last diagonal fold at the line of the natural iliac crest angle right above the iliac crest.
• Thigh: This is a vertical fold located midway between the inguinal crease and the proximal border of the patella on the anterior midline of the thigh.

Skinfold Measurement Procedures

The measurements are made always on the right side f the person’s body and with the person standing upright.

The caliper is put on the skin surface, one centimeter from the thumb and finger perpendicular to the skinfold, and halfway between the base of the fold and the crest.

We pinch the skin during the taking of the reading.

We wait one to two seconds before reading the caliper.

If the two measurements are not within one or two mm, then we retest with more measurements for the most accuracy.

We rotate through the measurement sites, allowing the skin enough time to regain normal texture and thickness.

Jackson-Pollock 3-Site Skinfold Formula for Percent Body Fat

There is a formula using just three sites and it differs on the sites depending on gender. There is also a formula using the seven skinfold sites.

Bioelectrical Impedance

This is the easiest and least invasive way to assess body composition. The idea behind it is that the amount of fat free tissue within the boy is proportional to the electrical conductivity in the body. So, by using a scale that sends an electrical signal through the feet or the hands, we can determine a close estimate to someone’s body fat percentage.

These are some conditions to help the process be more accurate:

• Do not eat or drink within 4 hours of testing.
• Do not exercise within 12 hours of the test.
• Urinate 30 minutes before testing.
• Do not consume alcohol 48 hours before testing.

Calculation of Ideal or Desired Body Weight

Ideal body weight is calculated by dividing lean body mass over 1 minus the desired body fat percentage over 100. LBM / 1 – (BF% / 100) = IBW

Cardiorespiratory Fitness Assessment

This is the ability for someone to perform large muscle, dynamic, moderate, and high intensity exercise over a long period of time, and it shows the ability of the heart, blood vessels, relevant muscles, lungs, and the blood to meet exercise demands. We also use terms like max aerobic capacity, functional capacity and more to discuss CRF.

Pretest Considerations

These are the general recommendations for pretesting conditions:

• Do not eat 4 hours before.
• Do not do strenuous exercise for 24 hours.
• Do not take in caffeine 12 – 24 hours prior.
• Do not use nicotine 3 hours before.
• Do not use alcohol within 24 hours.
• Consider any medications that the client might be on.

Various Field Test for Prediction of Cardiorespiratory Fitness

There are two typical field tests that we do. A timed completion for a set distance, or a max distance for a set time. These types of tests are typically very easy to run and administer for all individuals.

Walk or Run Performance Tests

The 1.5 mile test procedures

This is contraindicated for beginners that are not conditioned. Clients need to be able to jog for 15 minutes without stopping for proper measurement.

Make sure the area is 1.5 miles in distance.

Inform people of the test’s purpose and tell them to pace themselves for that distance.

A stopwatch is started with the starting of running and feedback is given during the assessment regarding pacing.

Record the total time and use the prediction formula to predict CRF.

Rockport 1 Mile walk test procedures

The clients for this test need to be able to walk at a brisk pace over a one mile course. It uses the same steps as the previous run test, but now with one mile and a different formula.

Step Tests

These tests have been available for 50 years or so and are popularly used in class settings. 

Queens college Step Test Procedures

The people will step up and down for 3 minutes at a height of 16.25 inches. Men step at 24 steps per minute, and women step for 22 steps per minute. The pulse is taken after the test and their CRF is determined from their recovery heart rate and it is based on gender. 

Submaximal Cycle Ergometer Tests

These tests are like the step test but with the use of a cycle.

Astrand Rhyming Test 

The client does 6 minutes of exercise n the cycle ergometer and their CRF is determined based upon their heart rate response to their exercise bout.

Prediction of Cardiorespiratory Fitness or VO2max from Astrand Rhyming Results

We use a prediction formula only found in the ACSM health related physical fitness assessment manual.

YMCA Submaximal Cycle Test 

This is a test that involves a branching and multistage format that will get a relationship between both heartrate and work rate to estimate the CRF.

Norms for Cardiorespiratory Fitness

The CRF is usually expressed as the VO2 max and put into mL of O2 consumed per kg of body weight per minute.

Muscular Strength Assessment: One Rep Maximum

The definition of muscular strength is the one time max force that can be put out and is localized to one joint or muscle group. We have many tests for muscular strength, but only one in this chapter. One way that is used t show muscular strength as a ratio of total body weight. 

The one rep max bench press test is the one that will be discussed. It is the amount weight that can be maximally lifted for only one rep. 

We make sure to warm up the with light reps of 40 – 60% of the estimated 1RM for 5 – 10 reps.

The client will assume proper position on the bench press, which should be taught beforehand.

After one minute of rest and some light stretching, the person will do 3 – 5 reps at 60 – 80% of 1RM.

The weight will go up after every lift with the goal being to be at the max in 3 – 5 lifts.

We can then express the work as a ration based on their body weight if they desire.

Muscular Endurance Assessment: Push-Up Test

Muscular endurance is specific to both the muscle group and joint, and like the muscular strength, there are many tests, but only one in this chapter.

The push up test:

Male subjects start in the down position, and females begin in the knee push up position.

The clients will raise their body, straighten their elbows, and then return to the start with each rep. The stomach won’t touch, however.

Back remains straight and the people must go to straight arm position.

The person’s score is the max number of pushups done consecutively without resting.

The test is stopped when they strain forcibly or are unable to maintain form with two reps.

Flexibility Assessment: Sit and Reach

There is no optimal test for flexibility, but the common test is the sit and reach. You should always attempt this test when properly warmed up. This test only measures the hamstrings, hips and the lower back.

Assessments as a Motivational Device

Testing may serve as motivation for some clients. For this, we should present the tests and the results in a goal-oriented approach.