Conduct Fitness Appraisal

A fitness assessment can be created incorporating the following health related components of fitness;

• Body composition - The proportion of body fat and non-fat mass (bones, muscles, and organs). It helps determine client health and fitness levels by indicating their body fat percentage. Less body fat and higher non-fat mass indicates a healthy body composition.  There are several tools for measuring body composition such Body Mass Index (BMI).

  The Heart Foundation has developed an user friendly BMI Calculator. It is accessible here. However, there are limitations to using these tools (calculators) on their own as they do not necessarily take all body composition factors into consideration. For example, muscle weighs more than fat and therefore the results can be indicative of obesity in a very muscular individual.

  Waist circumference is another good reference point for determining healthy body composition. The health risk is higher for people who are carrying excess body fat round their middle (as opposed to hips and thighs). For a woman the ideal waist measurement should be less than 80cm. For a man the ideal waist measurement should be less than 94cm. 

  Another instrument is the Caliper used for skinfold measurements to estimate how much fat is under the skin.  And another is Bioelectrical Impedance Analysis (BIA). This method involves electrodes that pass weak electrical currents throughout the body to determine body fat and muscle mass.

• Muscle endurance - Refers to the number of repetitions of a single exercise that can be done without needing to stop and rest. Common tests, fitness trainers use, to determine muscle endurance include Push-ups, Squats (or sitting down and getting up from a chair, repeatedly) and core and stability tests such as Planks.

• Muscle strength - Refers to the amount of force a muscle can produce in a single effort or the maximum amount of weight that a given muscle can move for one repetition.  Lifting as much weight as a client possibly can during a given exercise (the Chest press and Deadlift are popular choices) for one repetition only.

• Cardiovascular endurance - Refers to how efficiently the heart, blood vessels, and lungs supply oxygen rich blood to working muscles during physical activity for a prolonged period of time. The longer a client can continue aerobic fitness exercise without getting tired, the healthier their lungs and heart are. Stress tests on a treadmill or stationary bike involve running or riding for an extended period of time and comparing pre-test and post-test heart and respiration rates gives a good indication of endurance. 

• Flexibility - Determines the range of motion of joints. The focus is on muscle and connective tissue in the many joints and groups of joints in the body. Increased flexibility is known for preventing and relieving pain, correcting posture, preventing musculoskeletal injury. Flexibility is tested with stretching exercises, such as reach tests that target the lower back and hamstring muscles, supine hamstring test, hip flexor/Thomas test and shoulder flexion test.

A range of tools and methods are used to conduct tests in a fitness appraisal;

Based on a client's test results and goals, a fitness plan will be written and will include the design of an exercise program which utilises products, facilities, programs and equipment available to the client at a fitness club, their home or in the community.

Exercise intensity is defined by the amount of energy required for the performance of the physical activity per unit of time. Intensity is probably the most important element of a workout because when a workout is at a sufficient intensity, the body grows stronger, changes in weight, body fat percentage, endurance and strength are evident.

It is important that exercise intensity guidelines, incorporating light, moderate and vigorous activity are followed when directing a client to begin an exercise.

Fitness Australia has links to various fitness industry guidelines. They are viewable/downloadable here.

Methods to measure exercise intensity include:

Interpreting results from the following health and fitness assessments;

Cardio-Respiratory Endurance (Maximal And Submaximal Oxygen) - This is the body’s ability to maintain medium to high-level cardio workouts for long periods of time. Maximal and submaximal oxygen consumption tests can be conducted in order to formally assess the efficiency of the oxygen uptake of the body during exercise. When interpreting the results from maximal tests the results can be measured against the norms for each gender and age group.

Maximal oxygen consumption tests - Example: Maximal Oxygen Consumption Test (VO2max).

Submaximal oxygen consumption tests - Example: YMCA Sub-Maximal Cycle Ergometer Test.

To view Cardio-Respiratory Endurance Tests. Click here.

Blood Pressure - Blood pressure is recorded in the units of millimetres of mercury (mm Hg). Normal blood pressure reading would be:  Systolic blood pressure under 120 mm Hg. Diastolic blood pressure under 80 mm Hg - the same for both men and women. Medical treatment should be sought if measurements in the high category are recorded consistently. 

To understand how to use a sphygmomanometer. View article here.

To understand how blood pressure is measured. Click here.

Range Of Movement / Flexibility - The flexibility of a client can be assessed through the use of a goniometer or special joint measuring device.  The client is directed to perform set motion exercises. The measurement is the angle in degrees as read off the goniometer.

To understand how a goniometer is used to take a range of motion measurement. View article here.

To understand how to use a sit and reach box for a flexibility test. View article here.

Strength - Strength is the ability to carry out work against a resistance. There is no single test for strength. An example of an exercise to test strength would be push-ups where a client will conduct a number of push-ups within a set time limit and then be rated against a scale (Rooney's scale).

Rooney’s Rating Scale

• Below average: Less than 54

• Average: 55-74

• Good: 75-99

• Excellent: 100-110

• Extraordinary: More than 111

Weight And Height - This can be measured and assessed against the following chart, or a table approved for use by your organisation, in order to determine healthy weight ranges in relation to height. This height/weight chart is only suitable for adult men and women. It isn't suitable for children or people under 18. 

Body Mass Index (BMI) - Body mass index is an approved method of determining a healthy weight range. BMI is calculated by dividing the client's weight in kilograms by their height in meters squared. Depending on the BMI value calculated a person may be underweight, healthy weight, overweight or obese. Being either overweight (with a BMI of 25 or above) or underweight (with a BMI lower than 18.5) can affect a person's health.

The Heart Foundation has developed an user friendly BMI Calculator. It is accessible here.

It is useful to consider BMI alongside waist circumference, as waist measurement helps to assess risk by measuring the amount of fat carried around the middle.

Waist To Hip Ratio - The waist to hip ratio of men and women can determine obesity and health risks by estimating fat distribution in the body. This is based on a division of the measurement of the waist by a measurement of the hips. For example, a person with a 76 cm waist and 97 cm hips has a waist-hip ratio of about 0.78.

The following health tool can be used to calculate ratios. Click here.

Girth Measurements - Waist girth or circumference is a measure of abdominal obesity. To measure a waist, place a flexible tape measure between the bottom rib and the hip bone. The tape measure should be approximately in line with the belly button.

Health-Risk rates can be assessed by using the following table:

Skin-Fold Measurements - Skinfold measurements are seen as an easy method for determining obesity and healthy weight ranges in clients as a part of a health and fitness assessment. The measurements can be taken on a range of different sites on the body using a calliper and can be interpreted by referring to a body fat interpretation chart. As the recommendations differ for each gender, there is a chart for females and a chart for males. The corresponding score (depending on the gender, age and calliper reading in mm) is the percentage of body fat.

The percentage should be within the ideal to average range of scores. As an example:

• For women over 17 years old, the recommended range is 16-33% body fat.

• For men over 17 years old, the recommended range is 7-25% body fat.

If the body fat percentage is above the recommended levels (above average), it falls into the obese category. Anyone above the recommended range may need to consult a doctor.

If the body fat percentage is lower than the recommended levels (lean), and the client is not an elite athlete, they may be at risk of health complications such as organ damage. Anyone below the recommended range may need to consult a doctor.

To understand how a calliper is used to take a skin fold measurement. View steps here.

The following considerations will assist in interpreting the initial test and progress test results:

• Relative importance - Determine how important each of the components that were tested are to the overall performance in the program. For example, while a poor result in a body fat test may be of concern, it is not as vital as a poor result in a cardiorespiratory endurance test. The relative importance of each fitness component normally requires a good understanding of the physiology involved.

• Comparison to norms - If the results are being compared to normative values (norms), you must consider if the norms used the same protocol, and the subject population and age group are similar. Also, published norms and rating charts may give the averages for a certain population. For general fitness activities, averaged result comparisons may be acceptable, but if there is any doubt, seek qualified advice.

• Significance - Are the changes seen from test to test significant? There are normal variations in results from test to test due to factors such as biological variation, tester error, equipment calibrations, conditions, etc., so you must decide if the differences recorded are significant to affect performance, and are greater than can be expected from general sources of error.

• Presentation or reporting - Following correct and thorough testing, the presentation of results to the client can be the most important step if any recommendations are to be implemented. A good way of illustrating the results is with a chart or plot, where initial and subsequent tests can be overlaid or compared side-to-side so that changes over time can be easily determined.

When conducting a fitness appraisal in preparation for a training program, or during training to check on a client's progress, a trainer will need to identify client behaviours in regards to exercise and discuss exercise adherence strategies. Areas to focus on include;

Habits: 

Habits are behaviours performed on a daily or otherwise regular basis and some component of it is 'automatic'. Habits are formed when three things come together - cue, behaviour, reward. With a habit, there’s a cue that triggers a behaviour. For example, if a person eats dinner at the same time each night, time is the trigger (cue) and eating is the behaviour. Habits are reinforced by rewards. In the earlier example, the pleasure of eating a meal is the reward.

To create a new, healthy habit, a client will want to be as intentional as possible with all three. That is, manipulate their environment to introduce triggers (cues) that they can then intentionally start to associate with a desired behaviour and reinforce it all with a pre-determined reward. For example, get home from work (cue) and put on workout clothes to exercise (behaviour), exercise and when finished, relax with an episode of favorite show (reward). Focus on the behaviours that enable the desired habits.

Motivations: 

There are two main types of motivation that can be used to positively motivate a client to success. These are;

• Intrinsic - Intrinsic motivations are internal and driven by the client. For example, the sense of achievement gained from learning a new activity or looking forward to working out with a friend. It is essential that a range of support is provided to assist the client in developing intrinsic motivation towards the exercise program.

• Extrinsic - Extrinsic motivations are external and may be provided by the fitness instructor. For example, external rewards can induce interest and participation in something in which the client had no initial interest. It is important to drive the client and assist them through the use of rewards, reinforcement and effective goal setting techniques.

Goal Setting:

Setting short and long-term goals is an excellent method of promoting and controlling behaviour change within a client and aiding in overcoming barriers to exercise adherence. It is important to ensure that goals are specific, measurable, realistic and achievable. Setting goals in terms of distance, time, amount lifted allows the client to clearly see changes. Knowing exactly what they are aiming to do (e.g. run 5 km or swim for 30 minutes) but begin with a realistic short-term goal (e.g. run 500 m and then walk 1 km). The client will easily see their progress toward their goal. 

Tips for exercise adherence:

• Work out with friends.

• Learn a new activity.

• Choose an activity that is liked.

• Start easy and slowly, increase effort.

• Cross-train to reduce boredom.

• Set realistic, measurable goals.

• Keep an exercise journal.

• Choose convenient activities or exercise.

• Establish a routine.

• Make exercise a priority.

• Combine family time with exercise.

As per safety guidelines for conducting exercise sessions, there are general health-related symptoms/signs which require the immediate cessation of the fitness appraisal:

• Chest pain.

• Leg cramps.

• Light-headedness.

• Confusion.

• Nausea.

• Slurred speech.

• Unnatural changes to the skin (ie. becomes cold and clammy or becomes very pale).

NOTE: Only clients who are in the low-risk category as per their pre-exercise health screening should undertake a fitness test. Other situations which may delay or preclude a fitness appraisal include acute temporary illness or injury.