NASM CPT 7th Edition Chapter 11: Health, Wellness, and Fitness Assessments
NASM CPT 7th Edition Chapter 11: Health, Wellness, and Fitness Assessments 5

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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 the personal information from clients with the use of 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. 


Structured exercise and physical activities are well known to reduce the risk for 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, or 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 programs that are medically supervised.
  • 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 

A lot of 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 the 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 sign or symptoms of certain diseases
  • The desired exercise intensity of the individual

Health History Questionnaire (HHQ)

This is a thorough group of questions and information that is done before exercise to find the relevant past and present health indicators and it 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 the emergency contact information of the client.

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

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

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

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  • On a scale of 0 to 10, do you consider your overall diet to be healthy? (0 for unhealthy and 10 for very healthy).
  • Are you currently following any kind of diet? If so, what diet and for what reason(s)?
  • How would you rank your daily salt intake: low, medium, or high?
  • How would you rank your daily sugar intake: low, medium, or high?
  • How would you rank your daily fat intake: low, medium, or high?
  • On a scale of 0 to 10, how effectively are you able to 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 the sleep, stress, occupation, and hobbies of the clients.

The medical history would involve knowing the 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 is not in need of medical clearance for the start of 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 do 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. 

The 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 heart rate or use a device to do this. 

Blood Pressure

This is defined as the pressure outward 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 the pressure when the heart is beating, and diastolic is the pressure when the heart is not beating. These represent the top and the bottom numbers in a blood pressure reading, respectively.

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 a 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 for the purpose of understanding 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 needs to be proportional to their 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 take lean body weight into account, and this 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 just use as a stat to see improvements over time.

Waist circumference is used commonly for health assessments.

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

Skinfold Measures

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

The sites represent the places on the body where a significant amount of fat can be found in comparison 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 of fat. 

The method involves fully submerging the person in 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.


This is a valid measure of the aerobic fitness of an individual. It looks at the 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 is going to 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 to actually 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 is a cardio assessment that looks at aerobic fitness of deconditioned people by having them step on and off a box for 3 minutes and then looking at the RHR instead of VO2 max.

The Rockport Walk Test

This is a 1 mile walking test that predicts the max consumption of oxygen 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 intensity of activity is gauged based on the client’s ability to hold a conversation when working.

NASM CPT 7th Edition Chapter 11: Health, Wellness, and Fitness Assessments 6
NASM CPT 7th Edition Chapter 11: Health, Wellness, and Fitness Assessments 7
NASM CPT 7th Edition Chapter 11: Health, Wellness, and Fitness Assessments 8

Tyler Read

Tyler Read, BSc, CPT. Tyler holds a B.S. in Kinesiology from Sonoma State University and is a certified personal trainer (CPT) with NASM (National Academy of sports medicine), and has over 15 years of experience working as a personal trainer. He is a published author of running start, and a frequent contributing author on Healthline and Eat this, not that.

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