A fitness assessment will look at a clients health history, risks, posture, movements, fitness baseline, physiologic measurements, cardio assessment, and design an exercise program to safely progress to desired outcome (clients likes/dislikes, goals, needs, abilities).
What a Personal Trainer Can and Can’t Help With
- Diagnose medical conditions
- Prescribe treatment
- Prescribe diets
- Provide treatment of any kind of injury or disease
- Provide rehab services for clients
- Provide counseling services for clients
- Obtain health and exercise guidelines from a doctor, PT, or R.D.
- Follow national consensus guidelines of exercise prescription for medical disorders
- Screen clients for exercise limitations
- Identify potential risk factors for clients through screening procedures
- Refer clients who feel pain to a qualified medical practitioner
- Design individualized, systematic, progressive exercise programs
- Refer clients with general information on healthy eating according to the food pyramid
- Refer clients to a qualified dietician or nutritionist for specific diet plans
- Use exercise to help improve health
- Assist clients in following the medical advice of a physician or therapist
- Design exercise programs for clients after they are released from rehab
- Act as a coach for clients
- Provide general information
- Refer clients to a qualified counselor or therapist
Subjective information is gathered from a prospective client to give the trainer feedback of clients personal history like job, lifestyle, and medical background.
The physical activity readiness questionnaire will help trainers identify any medical, health, or physical condition that could restrict or limit the quantity or type of exercise the client could do. It will identify any individuals that require further health testing before going further into fitness testing and training. They may need to see a doctor first.
Things like chest pain, dizziness, medications, and other reasons someone shouldn’t jump into training.
Two areas of focus for trainers should be the clients occupation and general lifestyle traits.
If someone is sitting for long periods of time their hips are usually tight, shoulders rounded, forward head posture, and usually poor cardio conditioning.
Lots of repetitive work overhead can lead to muscle imbalances.
Dress shoes can lead to posture imbalances.
Mental stress can lead to increased HR, BP, and ventilation at rest and exercise.
Lifestyle – outside of the work life what recreational activities / hobbies does the client do?
What is their medical history?
Any past injuries or surgeries?
Chronic conditions – 75% of american adults do not engage in 30 minutes of low-moderate activity most days of the week. The CDC recommends 30 minutes of flow-moderate intensity exercise 5 days a week or more for good health. Risks go up for chronic diseases like high blood pressure, CHD, high cholesterol, stroke, lung problems, obesity, diabetes, cancer when this is not done.
- Beta blockers – Used for high blood pressure or irregular heart rate
- Calcium channel blockers – Chest pain or hypertension
- Nitrates – Hypertension, congestive heart failure, and peripheral edema
- Bronchodilators – Correct or prevent bronchial smooth muscle constriction in people with asthma or other pulmonary diseases
- Vasodilators – Hypertension or congestive heart failure
- Antidepressants – Various psychiatric and emotional disorders
Effects on HR and BP
- Beta blockers - HR and BP decreased
- Calcium channel blockers - HR increased, BP decrease
- Nitrates -HR increase or stay same, BP stay same or decrease
- Diuretics – HR no effect, BP same or decrease
- Bronchodilators – HR no effect, BP no effect
- Vasodilators – HR increase, stay same, or decrease, BP decrease
- Antidepressants – HR increase or same, BP same or decrease
Personal trainers do not prescribe, administer or educate clients on medications.
Objective Information includes exercise and resting physiological measurements like BP and HR, resting anthropometric measurements like height, weight, BF percentage, circumference measurements, and specific measures of fitness like muscle endurance, flexibility, and cardio status. This can form a baseline to measure progress against after a training period looking at physiological, body composition, cardio health, static and dynamic posture assessment, and performance.
Resting HR is a good indicator of overall cardio health, and exercise HR is a strong indicator to how a clients system is responding and adapting to exercise.
Pulse rate is also known as heart rate.
There are seven pulse points but two are mainly used (wrist which is preferred and neck with caution).
To find a radial pulse lightly place two fingers on right side of arm just above thumb. Count pulse rate for 60 seconds. Average over 3 days.
Carotid pulse on the neck to the side of larynx. Count for 60 seconds and average over 3 days.
Excessive pressure can cause problems.
Resting heart rate can vary. Average is 70 bpm for male and 75 bpm for female.
Resting heart rate can be used to calculate target heart rate zones.
- Zone one builds aerobic base and aids in recovery
- Zone two increases aerobic and anaerobic endurance
- Zone three build high-end work capacity
A straight percentage method can be used to estimate max heart by subtracting 220 minus age.
- Zone 1 – Max HR x 0.65 to 0.75
- Zone 2 – Max HR x 0.76 to 0.85
- Zone 3 – Max HR x 0.86 to 0.95
I find the above formula to be off base. For exercises that a client is efficient in their HR could be lower than this level. And for something they are not accustomed to it may be higher.
A more accurate method is the HR reserve (HRR) or Karvonen method. Based on the fact that it now factors in the clients resting heart rate. But still guesses on max heart rate.
NOTE – To be correct I think you need to do a max heart rate tests doing the specific exercise to really define target heart rate zones.
THR = [ (HRmax - HRrest) x desired intensity ] + HR rest
Example – Myself at 65% – 220 – 30 = 190 (max HR), 190 – 40 = 150, 150 x .65 = 97.5, 97.5 + 40 = 137.5
For biking which I racer cross country mountain courses my HR is about 180 max while riding. Which brings my number more to 131. So the above formula would make my zones a little too high for that specific exercise. But the formula will get you in the ball park.
BP is the pressure of the blood circulating against the walls of the blood vessels after blood is ejected from the heart.
The first (top) number is systolic and is pressure within the arterial system after the heart contracts.
The second number (bottom) is diastolic and is pressure in the arterial system when the heart is resting and filling with blood. 120/80 or lower is the recommended blood pressure by the American Heart Association.
Measuring BP can be done with a sphygmomanometer on the bicep and a stethoscope over the brachial artery. Rapidly inflated cuff to 20-30 mm Hg above where pulse can no longer be felt at the wrist. Then release pressure about 2 Hg per second listening for a pulse. Systolic will be the first observation of a pulse. Diastolic pressure is when the pulse fades away.
It is recommended that trainers that a professional course in blood pressure assessment before assessing clients.
Monitoring body fat % helps:
- Find high or low levels
- Help client understand BF
- Monitor changes in body comp
- Help estimate healthy body weight
- Assist in program design
- Use a a motivational tool
- Monitor changes in body composition as they relate to chronic diseases
- Assess effectiveness of nutrition and exercise choices
There is no accepted body fat range, but generally 15% for men and 25% for women is accepted.
- 3-5% is essential body fat
- Athletic is 5-13% BF
- Recommended for 34 years and younger is 8-22%
- 35-55 years old 10-25%
- 56 years and older 10-25%
- 8-12% Essential
- 12-22% Athletic
- 20-35% 34 and younger
- 23-38% 25-55
- 25-38% 56 and older
You can test BF by skin calipers, bioelectrical impedance, and underwater testing.
The Durnin formula (NASM uses) uses a skin fold at four points; biceps, triceps, sub scapular, and iliac crest.
Don’t use the skin fold test on obese clients. Use a bioelectric test if available or just how clothes fit and how they look.
To calculate fat mass:
BF % x scale weight = fat mass
Scale weight – fat mass = lean body mass
A good easy to use, quick, inexpensive, method that can be used on obese clients.
- Neck – across adams apple
- Chest – Across nipple line
- Waist – narrowest point above hip bones
- Hips- feet together and measure widest part of butt
- Thighs – 10″ up from patella
- Calves – widest point
- Biceps – measure with arm extended to side and palm facing forward as widest part
Waist to hip ratio is a good indicator of chronic disease due to stored fat in the midsection. Divide waist by hip measurement and if .80 for women and .95 for men and greater may put someone at risk.
BMI = [ weight (lbs) / height (inch) ] x 703
Lowest risk of disease is 22-24.9. 25 someone is considered overweight and increased risk. 30 and up is considered obese.
Most accurate is a VO2 max test. But client and equipment are not always available or willing to do a max test. So a submax test is often preferred.
The YMCA 3-minute step test and the Rockport Walk test are most common sub max tests.
YMCA test – Step in correct cadence on a 12″ step for 3 minutes and measure HR for a period of 60 seconds within 5 seconds of completing the test or use HR monitor and get HR within 5 seconds.
Apply to chart and it will show zone 1-3 cardio starting recommendations depending on how poorly or well they did.
Rockport is based on using the clients weight and walking as fast as they can on a treadmill for one mile then measuring HR bpm at the one mile mark
Proper posture ensures the muscles in the body are functioning and aligned properly with their length and tension relationships to allow proper joint motion and movement.
A quick static observation can provide a good deal of information.
Three basic compensatory patterns that have been found and studied are:
- Pronation distortion syndrome
- Lower crossed syndrome – hips tilting forward
- Upper cross syndrome – back rounded kinda like forward head
Kinetic Chain Checkpoints
- Foot and ankle – straight and parallel
- Knee – in line with toes not adducted or abducted
- Lumbo pelvic hip complex – level with spines
- Shoulders – Level not rounded or elevated
- Head and cervical spine – Neutral not tilted nor rotated
Dynamic posture is with movement. Look for overactive or under active muscles or imbalances.
The overhead squat test is a good indicator of lower extremity movement patterns.
Client should stand shoulder width apart feet pointed straight ahead. Shoes off. Raise arms overhead fully extended. Upper arm bisects the torso.
Squat to roughly chair height and return to starting position.
Repeat for 5 reps and observe from front side and back.
Single Leg Squat assessment
Assess dynamic flexibility, core strength, balance, and overall neuromuscular control.
Hand on hips and stand on one leg. Squat to a comfortable level then return for 5 reps. Knee should stay in line with toe and hip, and shoulders and waist parallel.
Pushing and pulling assessment
Stand split stance on a free motion machine and look for forward head, arching back, or shoulders elevating.
Push up test – test the muscle endurance of the upper body. Go until exhaustion and count how many were done. Test the same way in the future and the client should be able to do more.
Davies test – measures upper extremity agility and stabilization. Not good for people with poor shoulder stability.
- Place two pieces of tape 36″ apart, one long piece between the two for proper alignment
- Place hands on both sides in push up position
- Client quickly move one hand to touch the other
- Perform alternating sides for 15 seconds a side
- Repeat 3 times
- Record number of touches and repeat later
Shark skill test – Looks at lower extremity agility and neuromuscular control. Its kinda a profession from single leg squat test and may not be for everyone.
- Client stand in center box of a grid with hands on hips and standing on one leg
- Hop in designated pattern always returning to center each time
- Perform a practice run with each foot
- Perform test with each foot (four times total) while keeping track of time
- Record the times
- Add .10 seconds for other leg touching ground, hands off hips, foot into wrong square, foot not returning to center
Upper extremity strength assessment – Bench Press
This is mainly for select people who strength is important and not for people wanting to lose fat only. Can be used to determine training intensities for the bench press.
- Lie in position
- Warm up with weight for 8-10 reps
- 1 minute rest
- Add 10-20 pounds and perform 3-5 reps
- Take a 2 minute break
- Repeat until failure between 2-10 reps but 3-5 reps more accurate
- Use one rep max chart to estimate
Lower Extremity Strength Assessment – Squat
Figure out one rep max on squat for overall lower body strength. May again not be suited for all clients.
- Feet shoulder width apart, knees in line with toes, lower back in neutral position
- Warm up for 8-10 reps easy
- 1 minute break
- Add 30-40 pounds and perform 3-5 reps
- 2 minute break
- Repeat until failure between 2-10 reps but 3-5 reps more accurate
- Use a one rep max chart
In all tests make sure client performs with minimal movement compensations.