NASM CPT 7th Edition Chapter 11: Health, Wellness, and Fitness Assessments

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Chapter Goals:

• Be able to discuss the importance of fitness assessments that surround the client’s goals and optimal health.
• Find and collect personal information from clients using health screening assessments. 
• Find the steps used to conduct physiological and body composition assessments appropriate for specific types of clients and goals.
• Find the steps for conducting the cardiorespiratory assessments right for specific clients and their goals. 

Introduction

Structured exercise and physical activities are well known to reduce the risk of mortality and morbidity. It also provides countless benefits physiologically, emotionally, and cognitively.

It is important that all clients new to exercising are given some form of health risk assessment before the start of the program. This is used to see the risks and benefits of starting a program.

The fitness assessments are separate from this health risk assessment, but they are still quite necessary. 

The purposes of assessments, in general, are these:

• To find the people who are at a higher risk for diseases, their signs and symptoms, and even the need for medical evaluations.
• To find people with medical contraindications that have been excluded from exercise until the right conditions are corrected or under the client’s control.
• To find the people who may only be able to do medically supervised programs.
• To reduce the need for unwarranted medical evals before entering into an exercise program for healthy adults.
• To educate people about their current physical condition.
• To enable effective evaluation of programs.
• To use the information to motivate people with realistic and relevant goal setting.

Preparticipation Screening

The Health Risk Assessment

Questionnaires are used for the collection of information about the existing risk factors 

Many new exercisers are worried about starting an exercise program, and using these assessments too much, for too long, may make the person even more anxious and worried about the programs. So, this is something to think about also. 

Physical activity readiness questionnaires are an important piece of screening for clients. It is also simplified into a PAR-Q+. This consists of seven basic questions about health, where answering yes to any of them would warrant looking into some aspect of health with a medical professional.

A PARQ is going to reflect these indicators of health:

• Someone’s level of physical activity
• The presence or signs or symptoms of certain diseases
• The desired exercise intensity of the individual

Health History Questionnaire (HHQ)

This thorough group of questions and information is done before the exercise to find the relevant past and present health indicators and complements the PARQ+.

This questionnaire is not normally a standard procedure for the fitness industry, but instead, it comes in when there is a need for additional or more detailed information.

This will typically collect the majority of information regarding the age, gender, weight, height, physician name and contact information, and emergency contact information of the client.

Lifestyle habits are another thing that can assist personal trainers in making their programs, and they are a good idea to come up before the program is made. 

It can be very good to know what kind of exercising habits the client is used to and the level of training they may have done in their life. 

Knowing their type of job and any physical limitations or problems you can get a good idea of beforehand is also a good idea. When someone has a desk job, they might need mobility or strengthening in certain areas to assist with possible problems. 

Some questions that are good to ask about the dietary information of clients are:

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• Do you consider your overall diet healthy on a scale of 0 to 10? (0 for unhealthy and 10 for very healthy).
• Are you currently following any diet? If so, what diet and for what reason(s)?
• How would you rank your low, medium, or high daily salt intake?
• How would you rank your low, medium, or high daily sugar intake?
• How would you rank your low, medium, or high daily fat intake?
• On a scale of 0 to 10, how effectively can you control your temptations for junk food (0 for easily and 10 for very difficult)?
• How many alcoholic drinks do you consume per week?
• Do you consume caffeinated beverages such as coffee, tea, soda, and/or energy drinks? How many per week?

Some other vital information about clients could be regarding sleep, stress, occupation, and hobbies of the clients.

The medical history would involve knowing past injuries, especially those involving the knees, ankles, lower back, and shoulder. These are vital areas that affect the entire kinetic chain in various ways.

Past surgeries, chronic diseases, and medications are rather important to know.

Conducting Health and fitness Assessments

Once we have done the health risk assessment, and someone does not need medical clearance to start a program, the professional should then look at the need for the different possible fitness assessments. 

Assessment Considerations

The fitness professional should always choose the assessment based on each case and individual. You should have a reason for each of the chosen assessments. 

The chosen assessments should be relevant, appropriate, valid, and reliable. 

Assessment Sequencing

The fitness assessments that don’t have physical exertion in them, they should be done before the others. 

It should then be followed by the most vigorous assessments and then moving down the line to the least.

Assessment: Safety and Legal Implications

All personnel that does the testing must be certified in CPR and AED. 

Exercise Test Termination Criteria

The fitness professional should be always aware of the signs and symptoms that merit tests to be terminated.

Fitness Assessment Protocols

These are a major part of the services given by personal trainers to their clients. The ability to assess clients is integral in making exercise programs that are specific to the individuals. 

Fitness professionals should have the knowledge, skills, and ability to select, administer, and interpret the results of the chosen assessments. 

Heart Rate

This is a valid indicator of work for both work intensity and stress. This can be done during work or during resting times. 

Resting heart rate can be a good indicator of improving fitness levels as the lungs and the heart become more and more conditioned.

Resting heart rate is most accurate right after waking and getting out of bed. You can either manually measure your heart rate or use a device to do this. 

Blood Pressure

This is defined as the outward pressure that is exerted by our blood onto our arterial walls. We have two main numbers that we look at: systolic and diastolic.

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Systolic blood pressure is when the heart is beating, and diastolic is when the heart is not beating. These represent the top and bottom numbers in a blood pressure reading.

Blood pressure is measured either manually with devices or digitally with a machine.

Normal blood pressure is one below 120/80

Elevated blood pressure is between 120 – 129 and diastolic under 80.

Stage one hypertension is between 130 – 139 over 80 – 89.

Stage two hypertension is systolic of 140 or more and/or a diastolic of 90 or higher.

Anthropometry and Body Composition Measurements

Anthropometry is the field of study of measurement of living humans to understand the physical variations in size, weight, and proportion.

We have many different measures for this that we may take, and they all come with their own pros and cons.

Body Mass Index

This is a very popular method of finding “health.” It comes from the idea that a person’s weight must be proportional to height. So, it may have some obvious flaws right off the bat.

This is not designed to assess body fat, but for the general population, it is good at looking at this.

The formula for BMI is the weight in kg divided by the height in meters squared.

The BMI classifications are as follows:

• Underweight is a BMI of less than 18.5
• Healthy is a BMI of 18.5 – 24.9
• Overweight is a BMI of 25 – 29.9 
• Obese is a BMI of 30 – 34.9
• Obesity 2 is a BMI of 35 – 39.9
• Obesity 3 is a BMI of 40 or greater

A major setback for BMI is that it doesn’t consider lean body weight, which often causes athletes and very fit people to have high BMIs.

Circumference measures

This involves measuring the girth of various of the body to find health risks or to use as a stat to see improvements over time.

Waist circumference is commonly used for health assessments.

Waist to hip ratios and the circumference of the neck, chest, hips, thighs, calves, and arms are useful. These are all mostly used to see progression in fitness levels and changes caused in the body by exercise programs. Taking these measures often to find progress can be a good idea.

Skinfold Measures

This is a popular method to find the body’s composition, but it requires much skill and practice to find the sites properly and then measure them correctly with calipers.

The sites represent the places on the body where a significant amount of fat can be found compared to other places. 

The common skinfold sites that are used are:

• Triceps
• Biceps
• Chest
• Abdomen
• Mid-axillary
• Subscapular 
• Suprailiac
• Thigh

It is important to train this method well to ensure that you get it right. 

There are a few different formulas using variations of these common skinfold sites.

Bioelectrical Impedance

This technique uses electricity that passes through the body and a machine like a scale tracking the electricity. 

This method works because the muscle and fat of the body will have electricity pass through them differently.

This is often easily found in most gyms these days.

Hydrostatic Underwater Weighing

This is a common technique for the exercise physiology labs to test. It is done because bone, muscle, and connective tissues are all heavier and denser than that fat. 

The method involves fully submerging the person in the water and weighing them, and then working it out with an equation based on gender and other factors like weight and height. 

This is generally more expensive and a longer procedure than the others.

Cardiorespiratory Assessments

Cardiorespiratory fitness is known as cardio fitness or aerobic fitness. It is used for evaluating the capacity of the client to do work.

Cardiorespiratory assessments may use multiple formats like any of the cardio machines in gyms and can range from simple to super complex.

VO2max

This is a valid measure of the aerobic fitness of an individual. It looks at oxygen consumption and usage. It is the difference that exists between inspired and expired oxygen.

A Higher VO2 max would show greater oxygen utilization and thus a greater ability for physical work.

VO2 usually peaks at age 25 to the early 30s, but it is highly trainable, so age doesn’t matter as much. 

The VO2 max will decrease by 5% every decade for fit people and then around 10% per decade for fit people.

VO2 max takes some expensive equipment and well-trained people actually to test.

Ratings of Perceived Exertion

This technique uses a scale, and the. Numbers will represent how hard the client believes they are working. Usually, this is done on a scale of 6 – 20 or a scale of 1 – 10. The highest number represents max work.

YMCA 3 Minute Step Test

This cardio assessment looks at the aerobic fitness of deconditioned people by having them step on and off a box for 3 minutes and then look at the RHR instead of VO2 max.

The Rockport Walk Test

This is a 1 mile walking test that predicts the max oxygen consumption with a timed performance or a heart rate response.

1.5 mile Run Test

This test is used to measure the aerobic endurance of the client by scoring their time or their heart rate response, and then the VO2 max is estimated by the calculations or results.

The Talk Test

This is used as an informal test where the activity intensity is gauged based on the client’s ability to converse when working.