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Personal Fitness Assessment for “No Mo Phat”

Christian Fischer

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Table of Contents 1 Introduction ............................................................................................................. 3 2 Subject Description and Health Risk Appraisal ...................................................5 3 Resting HR and BP ..................................................................................................7 4 Muscular Fitness and Flexibility Assessment .......................................................9 5 Body Composition ....................................................................................................10 6 Aerobic Capacity Prediction ...................................................................................14 7 Maximal GXT Interpretation ..................................................................................17 8 Conclusion .................................................................................................................18 9 References ..................................................................................................................19 10 Appendices .................................................................................................................20-25

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Introduction This report is a personal fitness assessment, which is a collection of data and exercise assessments, of our client No Mo Phat. No Mo Phat will be assessed in many fitness areas, which include her health risk appraisal, heart rate, blood pressure, muscular fitness, flexibility, body composition, prediction of her Aerobic Capacity, and her maximal GXT interpretation. In this report, we will look at each of these assessments in a specific manner in accordance to the ACSM guidelines (2013). The details of each of these assessments will be detailed below, which will include the data and results of each of the tests. After the client, No Mo Phat’s data’s and assessments results are collected, an interpretation will be given for each specific section based on the ACSM standards and these standards will be used to judge our client’s fitness level.

To first understand why exercise professionals conduct exercise testing and why it is so important to our health, disease prevention, and overall wellness, we have to define the termination exercise, physical activity, and physical fitness and how they are related to one another. According to the U.S Center for Disease control (CDC), physical fitness is defined as “a set of attributes or characteristics that people have or achieve that relates to the ability to perform physical activity” (1985). Physical activity is then defined by the ACSM, “as the bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure” (2013). This leads us into the definition of exercise and the importance of it because physical fitness is achieved through exercise. Exercise, which is “a subclass of physical activity that is planned, structured, repetitive and purposive in the sense of that improvement or maintenance of one or more components of physical fitness”, according to the CDC (2011).

Exercising testing is used by clinical exercise professionals to tell a client’s overall physical fitness level. In a 1995, a report was released by the Surgeon General in correlation with the ACSM and CDC guidelines that drew attention of the general public to understand why physical activity was important. The report stated that significant health benefits can be obtained through moderate amount of physical activity and that just a little increase of daily activity can improve the population health and overall quality of life (1995). Through this report and the conducted ACSM tests, a dose-response relationship between physical activity and health outcomes was seen, which means that the more physical activity that is done the better the results, higher physical fitness level equals lower risks. This shows that the more physical activity that is done by the population the more reduced risk for chronic disease is seen and the populations personal fitness is also improved (2013). Many benefits of physical activity can be seen through this report such as decrease in heart disease, stroke, coronary disease, cardiovascular diseases and many other chronic diseases in the population with moderate to high intensity physical activity (1995). This is so important because the leading cause of death in 2015 was heart disease, with stroke and diabetes also being in the top five, according to the CDC (2016).

Now that we know the importance of an individual’s physical fitness, exercising testing is used by clinical exercise professionals to tell a client’s overall health-related physical fitness level. According to the ACSM and President’s Council on Physical Fitness, Health-related physical fitness is the five specific components of physical fitness that have a relationship with good health (2008). The five specific

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components are cardiovascular endurance, muscular strength, muscular endurance, flexibility, and body composition. The exercise tests that will be administered and performed by No Mo Phat will be for these specific components and allow us to see where our client stands with the assessments of health-related physical fitness or (HRPF).

Before starting these specific exercises tests, the client’s health and medical information will be evaluated by the clinical professional to determine the appropriate type of test, safety of the test, and if there is a need for a referral to a healthcare provider for further medical evaluation before the tests (Riebe). This information and talk with our client will also allow the clinical professional to better understand the goals of the client and the best way in achieving them from the starting information (Kaminsky). Before every exercise test, the clinical professional will go over the protocols and objective of each test (Kaminsky). Some exercise tests that measure cardiovascular fitness are the gold standard or true measure, like the GXT test. These gold standard tests are the true measure and the most accurate but require expensive equipment and high level of risk that not all populations can do (Kaminsky). This leads to the action of submaximal testing, which is a predicted measure of cardiovascular fitness and increases the errors of tests due to the factors of increased methods and predicted equations (Kaminsky). The results of these exercises tests will be interpreted through the two basic types of standards, according to the ACSM, which are normative standards and criterion-based standards. Normative standards are less reliable because they are based on compared results of populations that have previously taken the tests (Kaminsky). Criterion-based tests are more reliable because clinical exercise professionals have agreed that the desired result is beneficial to one’s health (2013).

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Description of Subject and Health Risk Appraisal

All the information for our client, No Mo Phat, that will be used for this report has been obtained with her consent. No Mo Phat is a 33-year-old female pacific islander that has a weight of 82.3 kg and a height of 167.6 cm. Our client has a very healthy family because that her mother has Type II Diabetes and her brother has pre-diabetes. No Mo Phat is very healthy with no signs or symptoms of disease but has been told that she needs to lose 50 lbs. because it could be putting her health at risk. No Mo Phat has been “plump” all her life, but has maintained her weight within the last 12 years of at least a net gain/loss of five pounds, and is regularly active as a hiker four days a week as well as a heavy gardener. The goal of this assessment is to determine her overall cardiovascular risk, determine if 50 lbs. weight loss will improve her health, and if her current fitness level will be acceptable to run a 10k to support Breast Cancer in 4 months. Through these assessments we will obtain the information through these goals and give No Mo Phat her self-esteem back.

Risk Factor Defining Criteria Client Criteria Criteria Met Negative/Positive

Signs/Symptoms CVD, None No N/A

Age Women > 55 years

33 years old No Positive

Family History *Appendix No family history meets criteria

No Positive

Smoking Current or past 6 months

Never smoked No Positive

Sedentary 30 min. Moderate Intensity 3 days per week

Four days week hiker, Heavy gardening

No Positive

Obesity

BMI > 30 kg or > 88 cm waist girth

BMI=29.3

Waist=76.5cm

No Positive

Hypertension SBP > 140mmHg DBP > 90mmHg

BP=118/74 mm/hg

No Positive

Dyslipidemia LDL >130mgdL HDL < 40mgdL

Total>200mgdL

LDL=44mg/dL

HDL=57 mg/dL

Total=178 mg/dL

No Positive

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Pre-Diabetes *Appendix Glucose=78mg/dL Yes Positive

High serum HDL > 60 mg/dL HDL=57 No Negative

Fasting Blood Normal Blood Desirable Value Client Value Norm/Desirable

Total Cholesterol 120-240mg/dL 180-190 mg/dL 178 mg/dL Desirable

LDL 60-130 mg/dL Less than 85 mg/dL

44 mg/dL Desirable

HDL 35-130 mg/dL Greater then 60 mg/dL

57 mg/dL Normal

Triglycerides 0-200 mg/dL Less then 100 mg/dL

88 mg/dL Desirable

Glucose 60-100 mg/dL 85-87 mg/dL 78 mg/dL Normal

Total Ratio 2-6 3.0-4.0 4.0 Desirable

(See Appendix Health Appraisal) Number of Risk Factors: +1

Risk Classification: Low Risk

No Medical Exam or Medical supervision is necessary

No Mo Phat is an overall very healthy individual, she only has one risk factor putting her at a very low risk classification risk. No Mo Phat only has one risk factor in pre-diabetes because although she is very healthy in triglycerides, glucose, and total ratio, we do not know if her blood chemical work was tested twice. For this reason of unknown information and the factor that she is 33 years old with a BMI greater then 25 and has a brother with pre-diabetes in the family, we have to put it as a risk factor. No Mo Phat has a very healthy family and has never smoked in her life. She is very active in the sense that she hikes 4 times a week and is a heavy Gardner. She is not obese in the sense that her BMI is not over 30 or waist over 88 cm. Her blood pressure and blood work meets all criteria, besides as mentioned above on the factor that her blood work was only done once, meaning a plus one factor through the criteria stated in ACSM (2013).

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Resting Heart Rate and Blood Pressure

Heart rate and blood pressure are the most important numbers to keep track of during exercising testing. Resting heart rate and blood pressure are very important to take before starting any one of these test’s because they will help gauge the intensity of the test and show if the client’s cardiovascular health is optimal before starting the tests. Resting heart rate and blood pressure are also important indicators of health issues and very important to an individuals overall total well-being.

According to the ACSM, Blood pressure is defined as the force of blood against the walls of arteries and veins created by the heart as it pumps blood throughout the body (Kaminsky). There are two very important components of blood pressure, systolic and diastolic. Systolic blood pressure is the maximum pressure in a client’s arteries during the contraction phase of the heart, well the diastolic blood pressure is the minimum pressure in the arteries during the relaxation phase of the heart (Kaminsky). Clinical professionals will also take mean arterial pressure into consideration, which is the average blood pressure of an individual and normal standards are 70-110 mmHg (2013). Blood pressure plays an important role in the leading causes of diseases such as heart attacks and strokes (2016). It is noted in the 1995 General’s Report, that physical activity will help decrease these risks of disease and help get blood pressure values in the healthy norm (1995). The normal blood pressure according to the ACSM, is 120 systolic and 80 Diastolic for men, well for women it is 110 systolic and 70 diastolic (2013). There can be many factors that effect resting blood pressure like age, gender, the time of day, and body position (Kaminsky).

Heart rate is defined as the the number of times the heart contracts per unit of time to provide blood to the entire body (2013). Resting heart rate is a good determinant of training tolerance, and indicates the many blood and oxygen demands on the body. Heart rate is also a good factor of the overall cardiovascular fitness of an individual because the lower the resting heart rate of an individual the fitter they are because they have a higher cardiac output and stroke volume (Riebe). The healthy norm for resting heart rates are 60-70 bpm for men, well 70-80 bpm for females (2013). Resting heart rate can also be effected by many factors such as fitness status, temperature, fatigue, caffeine, alcohol and body position (Kaminksy).

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Client’s RHR Client’s Resting BP Client’s MAP

68 bpm 118/74 88.52 mmHg.

(See Appendix Heart Rate + Blood Pressure)

After taking our client, No Mo Phat’s resting heart rate, blood pressure, and mean arterial pressure we can conclude that our client has a very healthy cardiovascular system in a resting state, which will provide us with the information we need to determine their training tolerance and risk factors on many diseases. This means that our client is suitable for all tests with these resting values and her risk factors of many heart and chronic disease is low risk. As you can see, our client’s resting heart rate is 68 bpm, which is lower then the average of 70-80 bpm for women. This means that our client is in good cardiovascular fitness and could be a fitter individual then most because of the lower bpm but we can not conclude this until the exercise tests are completed due to many factors that can influence one’s resting values. No Mo Phat’s blood pressure is also very healthy with 118/74, which is a little high for systolic as a woman but still in the healthy norm because her MAP is 88.52 which is in the healthy norm of 70-110 mmHg.

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Muscular Fitness and Flexibility Assessment

Muscular Fitness is defined as the muscular strength and endurance of muscles in the human body. Muscle strength is often defined as the one-time maximal force exerted by the muscle group that is localized to a joint (Riebe). Muscular endurance is defined as the ability to exert force both static and dynamic for an extended period of time (Riebe) Muscular strength tests only involve tests that have less then three reps (2013). These muscular fitness tests can involve higher repetitions to predict the 1 Rep Maximum or 1 RP, around four to eight reps (Kaminsky). There are twelve reps or more involved in every muscular endurance test because each test will have to test if that muscle group can handle that many reps (Kaminsky). These muscular fitness tests are done because they show the personal trainer if the client has muscle imbalance and they are able to see the starting fitness level of their client. The health benefits for muscular fitness are numerous and include an improved glucose uptake, improved posture, and less risk of injuries to the musculoskeletal structure (Kaminsky). Flexibility is often referred to as the degree in which a joint move’s through a range of motion (Riebe). Physical exercise and everyday activity consists of many, many joint movements and it is very important that the muscular skeletal moves right and is not compromised. Flexibility is classified as a health related dimension of fitness by ACSM, which means that flexibility adds to the overall improved quality of life in clients (2013). Flexibility is important to overall health because if the range of motion is not at a functional level, everyday activities cannot be completed, such as picking something up off the ground. Range of motion that is not at the functional level not only effects everyday activities, but also the development of muscles imbalances (Kaminsky)There are seven flexibility tests that provide health assumptions for the general public. These tests provide a baseline for flexibility programs, provide information to see if the client has adequate range of motion, and show if the client has muscle imbalances or not (Kaminsky). Flexibility is important in the overall health of an individual- from doing activities that are pain free to the very function of the clients muscles that are effected by inadequate range of motion, flexibility is an important part of life.

Assessments Absolute Relative Interpretation

Bench Press 1-RM 122 lbs. .67 Excellent

Leg Press 1-RM 288 lbs. 1.59 Superior

Push Ups (knee bent) 26 N/A Very Good

Partial Curl Ups 58 N/A Well Above Average

Flexibility(Sit N Reach)@26 cm

35 cm N/A Good

(See Appendix Muscular Fitness and Flexibility Assessment)

After our client completed these muscular and flexibility assessments, we can conclude that her muscular fitness and flexibility are very good for her age and sex based on the normative standards. Her results are compared to the normative standards because there are no criterion standards for muscular and flexibility assessments. There are no criterion standards for these assessments because there is no set weight for muscular fitness tests and no set range of motion for flexibility tests, so we have to compare results to others before that have completed them. This is due to the fact that an individual that is at high risk can do well in these tests, well an individual at low risk could do poorly. We can conclude that are client has an adequate range of motion and muscular fitness for her overall well-being.

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Body Composition

Body composition is often referred to and defined as the relative proportion of fat and the fat-free tissue that is in the body, which is therefore called the percent body fat (Riebe). Body composition is important to health professionals for three major reasons: a factor in sports performance, correlated with many health risks, and helps establish a target or desirable weight for an individual. First, body composition can influence performance on a lot of fitness tests because it can affect an athlete’s strength, agility, and appearance. An individual with a lean body mass with have an advantage in sports where speed is a factor. Second, scientific research has shown a strong correlation between high levels of visceral body fat and an increased risk of chronic diseases such as diabetes, hypertension, and other chronic illnesses (Riebe). The third and final reason fitness professionals incorporate body composition testing for individuals is the factor that it is a great way to establish goals and an optimal appearance for a client. Body Composition is a very influential factor in an individual’s health from health risks to performance outcomes to an individual’s overall confidence. There are nine body composition tests that will be performed and the methods, reasoning, and errors behind each test will be explained below. Methodology, Reasoning, & Errors of Body Composition Tests Relative Weight The client was measured in inches with their shoes on and weighted in lbs. also with their shoes on. The trainer then measured the client’s elbow measurement by putting the calipers between the two prominent bones on each either side of the client’s elbow. This number measured is then used to determine frame size from the ASCM chart. The client’s frame size will give you a representation of where they stand based on the normal weight for someone with the same frame size and height in inches. The trainer then divided the measured weight by the client’s midpoint weight. This number will give you an interpretation as to where your client stands on the chart. Relative weight is an arbitrary number and is not based on representative population with 11% being ideal. Relative weight is more accurate then BMI because it takes frame size into account but still does not account for the differences seen in lean body mass and subcutaneous fat. Body Mass Index The client was measured in centimeters by the trainer without shoes and then recorded weight in kg. The trainer then divides the kg by meters squared to get a measurement. This measured number is then interpreted by the trainer based on the BMI chart to estimate disease risk. BMI is the worst body composition test due to the fact it only takes into account height and weight, not even frame, giving individuals that are muscular high BMI’s. Skinfold Measurements (3 Site & 7 Site) The trainer did eight skinfold sites on the client. The trainer grasped a double fold of skin by pulling the subcutaneous fat away from the body, not grabbing any muscle. The trainer grasped each skinfold site with two fingers that were about three inches apart, with the caliper held in the right hand and placed the it on the exact skinfold site, where the trainer’s fingers were 1 cm above the site. The caliper was perpendicular to the skinfold and half between the crest and base of fold. The trainer waited 1 to 2 seconds before the caliper was read. There were three trails done at each of the eight sites and the sites were rotated to allow time for the skin to regain normal thickness. The first site tested was the client’s Abdominal at a vertical fold about 2 cm to the right of umbilicus. The second site is the triceps at the same vertical fold on the posterior midline of the upper arm. The third site tested is the chest of the client at a diagonal fold, one half distance between nipple and axillary line. The fourth site tested was midaxillary, which was a vertical fold at midaxillary line level of the xiphoid process of the sternum. The fifth site taken was subscapular and was a 45-degree fold 2 cm’s from the angle of the scapula. The sixth

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site taken was the supraliliac which was a diagonal fold alone the line of the iliac crest. The last site taken by the trainer was the thigh, which was a vertical fold on the anterior midline of the thigh. The three trails were averaged for the final seven numbers for the client, bicep number is always excluded. The seven numbers were then plugged into the seven-site formula to figure out the client’s bone density. Then the trainer uses the average of the chest, abdomen, and thigh for the three site formula for bone density for males and the triceps, suprailiac, and thigh for the females. The trainer then took these three bone density numbers and plugged them into the Siri equation based on the population specific formula of the client and the body fat percentage was then categorized based on the ACSM table (2013). Skinfold technique is relative accurate but a lot of assumptions and errors can occur during this test. Some of the assumptions are that all the same populations have the same amount of subcutaneous fat under their skin, and that the populations are fixed to the general equations (2013). The major error that can occur is the fact that the trainer has to be skilled and experienced or major data errors are going to occur from wrong measuring. The skinfold technique is very fast, simply, and widely available to the public that is why it is used so often. Circumference Measurements The trainer picked a flexible measuring tape to measure the waist and hip circumference of the client. The flexible measuring tape was placed at the smallest circumference above the umbilicus and below the xiphoid process. Then the client spun 360 degrees to get the exact measurement of the waist. The trainer then measured the hip circumference of the client, which is the largest circumference around the buttocks and above the gluteal fold. The client then spun around the flexible measuring tape to get the exact number. Three trails were done and then the averages of the trails were put into the WHR equation, which is the waist measurement divided by the hip measurement. This gives you a ratio that the trainer can look at that compares it to the norms based on the ACSM chart and then the trainer determined disease risk based on ASCM (2013). Circumference measurements are relatively accurate because there is a higher risk for chronic disease if you have more adipose fat around the abdominal. DXA The client starts by laying supine on the DXA table well holding their arms over their head. The DXA machine in a non-invasive procedure that basically scans the entire body. This machine scan is about to tell the difference between lean muscle mass and adipose tissue, which from there it estimates your body composition. The DEXA is considered to be the new gold standard because it is very accurate, easy to use, and quick but still some errors can occur. Some potential errors that can occur are that the client could lay wrong or move during the test and the DXA clinician could exam or misinterpret the information. BodPod The client arrived to the BodPod with not eating or drinking breakfast that morning and not working out that day. The trainer then made the client use the rest room before she began the test. The client then entered her weight, height, and name into the computer that controlled the BodPod. The Client then wore compression shorts and a swim cap. The trainer set up the BodPod by first calibrating its density with the air can. The trainer then told the client to step onto the scale, while the trainer was at the computer. The BodPod was fully calibrated by density with the air canister. The trainer got the accurate readings of the client on the scale. The client then stepped off of the scale and into the BodPod. The trainer then started the BodPod with the client in it. The trainer got one reading then re-opened the door and closed it so that the BodPod could get the second reading. The client then was able to step out while the trainer printed the results and got an accurate reading of the body fat percentage. The BodPod is very safe and effective and is extremely accurate. There are some problems and errors that could arise from the BodPod. A problem with the BodPod is that it is not that available to the general public and can be expensive. An error that can occur is not wearing tight clothes or eating or drinking before the test.

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BIA-Tanita The client first took off their shoes then cleaned their feet with an alcohol wipe. The trainer then entered the weight of 1.0 to 2.0 kg in the Tanita machine for the clothes of the client. The trainer then entered in the gender and then standard or athletic for their body type. The trainer then entered in the age and height in centimeters. The client then stepped on the Tanita with heels on posterior electrodes and balls of the feet on the anterior electrodes. The results of the client’s body fat were printed by the trainer. A potential error that could error is not cleaning the feet before the test. BIA-OMRON The client washed and dried their hands and the trainer entered in the correct height, weight, age and specific population. The client then stood with there feet slightly apart and wrapped their fingers around the groove of the handle with the electrodes in the palm of their hands. The client put their arms at a 90-degree angle and held the electrodes until the trainer saw the body fat displayed on the LCD. A potential error that can occur is not putting the information in for the right population or not washing hands before. The main problem with the handheld BIA is the fact that it relies mainly on how hydrated the client’s lean tissue is because the BIA works by conducting electrical current through the client’s body. The hydration status of the client can change day to day and therefore changing the client’s data from the handheld BIA, thus proving that BIA tests can be very inaccurate. Hydrodensitometry Underwater weighing is based off of the Archimedes’ principle, which states that a body that is immersed in fluid is buoyed up by a force equal to the weight of the displaced fluid (2013). This body composition uses the method of water displacement to determine the body composition of the client. This is done by having the client placed in a swing and lowered into water. This water displacement is influenced by the two factors, residual lung volume and gas in the GI tract. The body volume is found from this because bones and muscles will have a higher density of water, therefore fat is less dense. Once the client’s body volume is found, the bone density of the client can be determined and then calculated to determine the client’s body fat percentage. This method is very accurate but relies on two major components, time and a skilled technician. This is why this test is not very available for the general public. An error that can occur during this test is that technician is not skilled enough and misinterprets the data.

Test Client Result Interpretation Body Mass Index 29.3 Overweight WHR 0.75 Good Relative Weight 1.43 43% above idea weight- Obese Underwater Weighing 30.2% Very poor (1%) BodPod 30.2% Very poor (1%) Skinfold 3-Site 45.3% Very poor (1%) Skinfold 7-Site 32.5% Very poor (1%) Ball and Swan 32.1% Very poor (1%) BIA in Lab 32% Very poor (1%) BIA at Health Fair 44% Very poor (1%) Body Fat % Average 31.4% Very poor (1%)

(See Appendix Body Composition) After finishing all body composition assessments on our client No Mo Phat, we can conclude her average body fat to be 31.4%. We got this average by first taking out the BIA at the health fair and next taking out the skinfold 3-site, then adding the five remaining tests and dividing to get the average. The BIA from the health fair was excluded from the average because it was not conducted in our lab and BIA tests relay heavily on the hydration of the client’s body that day which can change day to day, thus providing inaccurate data. The skinfold three site was taken out because of the inaccuracy of skin fold test site,

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which was the thigh that was difficult to get. The other five tests provided relatively similar body fat percent’s, which leads me to this average being the only conclusion. The single best test or gold standard for our client would be the BodPod because it was the gold standard before the DEXA was created. The BodPod has a very low chance of error and was one of the most accurate for our client. Our conclusion to No Mo Phat’s Body composition is that she is placed in a category of very poor, according to ACSM standards (2013). This allows us to determine that one major goal for our client is to increase lean muscle mass and loss body fat, which will in turn improve her overall body fat percentage. This body fat percent is not putting No Mo Phat at a greater health risk because her overall resting heart rate and blood pressure are very healthy, but a decrease in body fat would give our client the increased self-esteem she needs and the doctor off her back, this is one major reason why she came to us in the first place, to reduce body composition.

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Prediction of Aerobic Capacity Submaximal testing is an exercise test that limits the cardiovascular exertion of an individual in a clinical setting. Submaximal testing is done to assess a client’s overall cardiorespiratory fitness or predicted V02 Max. Cardiorespiratory fitness is the number one indicator for overall health in an individual and thus needs to be assessed (Kaminsky). cardiorespiratory fitness also assesses one’s functional status, which can be measured between ages and different populations producing health norms. The final thing that an individual’s cardiorespiratory fitness can determine is prognostic and diagnostic measurements which are grave indicators for chronic diseases (Kaminsky). The gold standard in testing an individual’s cardiorespiratory fitness is the maximal test. The maximal test tests the individual’s maximal V02 capacity, which elicits the client’s true cardiorespiratory fitness, but the maximal test involves more time, expenses, and a clinical exercise professional (Kaminsky). The maximal test also involves a higher level of risks of injury or death and not all populations can be maximally tested due to having a high risk factor. reasons submaximal testing is more popular in the common public and to the average individual. Submaximal testing allows more of the population to test their predicted cardiorespiratory fitness or predicted V02 Max, due to the factors that it is lower risk of health injuries and more time and cost effective. Submaximal testing predicts the individual’s V02 max by using the linear relationship between the individual’s heart and work rate to infer what the V02 max is (Kaminsky). The assumptions for submaximal exercise testing include that the workloads used are repeatable, the age-predicted maximal HR equation (220-age) is uniform for everyone, and that mechanical efficiency is the same for every population (2013). Methodology of Submaximal testing

YMCA Cycle Test The client is seated on a cycle ergometer with the seat and handle bars adjusted to their preference, with the initial workload being set at 25 Watts at 50 rpm, starting the stage. The client’s heart rate after three full minutes on this stage is recorded by the instructor and used to decide the intensity for the rest of the test. The next stage is set between 50 and 125 watts with the heart rate being monitored closely by the instructor every minute to make sure that the client is between 120-170 bpm. This test requires two full stages to be completed but it may take up to four stages to reach steady state heart rate. The instructor then used the final steady state in conjunction with plotting the Heart rate and work rate on a graph then plugged it into the equation to predict V02. Astrand-Rhyming Cycle Test The client is seated on a cycle ergometer with the handle bars and seat adjusted to their preference and an initial workload set for client based on how trained they are, 75 W, 100 W, or 150 W. The instructor recorded heart rate every minute to check if the client’s heart rate is above 125 bpm. The client’s heart rate was not above 125 bpm, therefore the workload was increased 50-75 W and the time reset. The client then reached a steady state heart rate above 125 bmp and below 85% of their max following the 6 minutes. The instructor then estimates V02 Max with the Astrand Rhyming Nomogram. YMCA Step Test This is a very simple submaximal test compared to the other tests, this test requires a 16.25-inch step to start. The client was a male so they stepped at a cadence of 24 steps per minute, while a women client would step at 22 steps per minute to a metronome set at 96 bpm for men and 88 bpm for women. The 24 step cadence means that the client stepped up one leg at a time on the step then stepped down one leg at a time, to the 24 steps a minute. This test was only done for 3 minutes and is only 1 stage. After these three minutes, the client checked their recovery heart rate within 5 seconds of completion of the test. This recovery heart rate is then plugged into the predicted equation by the instructor.

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Canadian Aerobic Fitness Step Test The instructor first selected the appropriate stage for the client based on their sex and age using the protocol table. The protocol table was then used again to determine the stepping cadence of the client. The CRAFT test used two steps that are eight inches high, which the instructor measured. The client then stepped in a six-step pattern for stage one for three minutes. The instructor then immediately recorded the client’s heart rate for ten seconds after this first stage. The client’s heart rate was below the limit on the chart protocol table, which indicated a need for a second stage. This test can have three total stages, if the client’s heart rate falls below the chart the first two times. The instructor then entered the client’s information to get an estimated V02, which was then plugged into the predicted equation. Ebbling Treadmill Walking Test This submaximal test should only be done by a specific population between 20-59 years of age that are low risk and disease free. The client fit this specific population and then proceeded on treadmill for a two-stage test that is 8-10 minutes. The first stage the client picked a mph between 2-4.5, while the instructor measured heart rate every minute for 4 minutes making sure the client elicited a heart rate between 50-79% of their predicted max. The instructor then began the second stage, which kept the treadmill at the same speed as the first stage but brought up the grade 5% for the last four minutes. The instructor then recorded the final steady state heart rate of the client and plugged it into the predicted equation. Cooper 12-minute Run Test This test is quite simple compared to the other submaximal tests as the instructor just had the client run at a steady pace for about 12 minutes, where the client tried to go as far as possible in that amount of time. The instructor measured the track to the exact distance of 400 meters per lap. The client then ran for around 12 minutes and then stopped after completing the final lap that they could do. The test can be between 12 and 15 minutes because the client has to complete the lap that they are on. The instructor then calculated the laps covered in meters and then used the regression formula to estimate the V02 max. Rockport One-Mile Walk Test The client walked one-mile as fast as they could without breaking into a jog. The client or individual being tested has to walk fast for the results to be accurate. The instructor calculated how many laps for one-mile and then immediately took the client’s heart rate after they finished, then converted to decimal form and plugged it into the predicted equation.

Submax-Tests

YMCA Step

Astrand- Bike

Intensity Method

Ebbling- Walk

YMCA Bike

Slope Method

Rock port

Cooper CAFT Average

V02 Ml/kg/min

34 39.2 40.4 33.3 37.62 39.052 37.4 37.4 30 36.5

V02 (Mets)

9.7 11.1 11.54 9.5 10.7 11.16 10.68 10.68 8.57 10.5

Classification Good. Good. Good. Average. Good. Good. High. Good. Avg. Good.

(See Appendix Aerobic Prediction)

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After these fitness assessments were completed on our client, No Mo Phat, we can conclude that our client’s V02 Max is between 10 to 11 Mets or an average of 36.5 ml/kg/min. The YMCA Step test, Astrand test, Ebbling test, YMCA Bike test, Rock pork and Cooper port were all with 1 Met of each other. The only test that was not within 1 Met of the average predicted V02 was the CAFT test, which was 1.93 Mets from the average. The closest tests to the average V02 were the Rockport and Cooper, which were .18 Mets within the average. Some sources of error that could result in some discrepancies between the tests is the fact that most of the tests use predicted Heart rate Max because of the assumption that everyone in that specific age has the same heart rate max (2013). This is a huge source of error that causes some discrepancies because it is saying everyone has the same heart rate max no mater the fitness level of the individual. Another source of error is the fact that an individual may have a better mechanical efficiency on the cycling tests because some clients could be more comfortable and used to this specific test then other client’s. After reviewing all the test, I believe the Ebbling test is the best for measuring the predicted V02 because of the reliability of this test and the factor of how easy it is to administer. The Ebbling test was exactly 1 Met within the average predicted V02, even though the Rockport and cooper port test were the closest Mets to the average, I believe the Ebbling is a more controlled test with accurate results.

051015202530354045

V02(ml/kg/m

in)

Submaximal Protocols

SubmaximalTest

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Maximal GXT Interpretation The maximal test tests the individual’s maximal V02 capacity, which elicits the client’s true cardiorespiratory fitness, but the maximal test involves more time, expenses, and a clinical exercise professional (Kaminsky). The maximal test also involves a higher level of risks of injury or death and not all populations can be maximally tested due to having a high risk factor. GXT or a graded exercise test is used to test the highest oxygen consumption or uptake for an individual. This is done by progressively increasing the speed and grade of the test until the subject reached exhaustion or the test is ended. This test is done to help diagnosis cardiovascular disease and see the prescription of an exercise program for individuals. Individuals that should conduct this type of test are only individuals that are low risk (2013). No Mo Phat achieved a peak V02 of 3542.5 ml.min or a value of 43 ml/kg/min (3542.5/82.3) based on the results from the GXT walking data. To see if this was No Mo Phat’s V02 peak or maximal V02, we first have to know the difference between V02 peak and maximal based on the ACSM guidelines (2013). V02 Max is the highest oxygen uptake during a GXT test that the client is physiologically capable of achieving. Whereas, Peak V02, is the highest V02 achieved during the GXT, but not the highest V02 possible by that client, meaning that the client had to stop before maximal exertion. The ACSM has no method of measuring if the client actually achieved V02 Max or not but the ACSM says that the best method to see if the client reached V02 or not is if there is a plateau of V02 with an increase in work, 150 ml or less increase with increase of work. If there is no plateau of V02 max, which is often seen, the ACSM says that two out of these four criteria must be met, which are RPE > 17, HR > age predicted HR (220-age, within 10 bpm), Lactate 8mM and RER > 1.12. The ACSM says that RPE and HR can not be used together as criteria because they are too closely correlated. The bottom line is that Peak RER is most accurate form of V02 MAX if no plateau is reached of V02. No Mo Phat did achieve V02 maximal because she met two out of the four criteria, therefore 43 ml/kg/min is her maximal V02. First, her heart rate got within 10 beats of her max at 180 bpm when the test was stopped, her max being 187 bpm because of the age predicted formula (220-33=187 bpm). The second criteria that she achieved was an RER greater then 1.12 because her RER when the test was stopped was 1.18. Therefore, this means that her best submaximal test was the Astrand-Rhyming Cycle test because it was only a 3.8 ml/kg/min difference between her actually V02 Max. Sub-maximal tests have the tendency to always be lower then the actual V02 Max of a client because there are a lot of discrepancies with submaximal testing. Submaximal tests use predicted equations based on the linear association between V02 a heart rate (2013). This can skew data from submaximal equations because the heart rate assumptions are based on being between 50-70% of their 85% predicted Heart max that is predicted equation that is the same for every age specific population. This causes discrepancies because many factors influence heart rate on a given day from the temperature in the room, to caffeine, stress, and emotional status (2013). Some other errors include not doing the right methods correctly for each test or messing up on the cadences during the tests. This being stated the best cardiovascular value for our client is 43 ml/kg/min because maximal assessments provide a true value of V02 for exercise prescription and our client No Mo Phat met the criteria of true V02 Max from the above stated criteria according to the ACSM (2013). Maximal exercise testing is the true gold standard for measuring cardiorespiratory fitness.

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Conclusion

Exercise Assessments Results Interpretation Health risk Low Good 1 or less Risk Factor. RHR 118/74 mmHg Normal. RBP 68 Bpm Normal. Body Composition 31.4% Very Poor (1%). MuscularStrength(Chest) Relative=0.67 Excellent. MuscularStrength(Leg) Relative=1.59 Superior. Flexibility 35cm Above Average. CardiorespiratoryFitness(Max) 43.14 ml/kg/min Good.

After the completion of all the exercise assessments we can conclude that No Mo Phat is overall very healthy because she scored in the normal range or above in all categories, but body composition. The first goal of this report was to see if our client was in good cardiovascular fitness. No Mo Phat had a great cardiovascular fitness of 43 ml/kg/min, which is great because according to the ACSM, cardiovascular fitness is the number one indicator for overall health (Kaminsky). The second goal of this report was to find out if our client overall fitness level allowed her to run a 10k in several months, and we can conclude that she is in great shape to do that judging by her cardiovascular fitness level and her great overall muscular strength. The third and final goal of this report was to see if No Mo Phat needed to lose 50 pounds for her health because she was told by the doctor that she did. Our client’s body composition was very poor, being 31%, but with her low risk factor for disease and overall good cardiovascular fitness, we can conclude that losing this weight would be more beneficial for her self-esteem and body image. From this report, we will make an exercise program that is best suitable for her, that will increase her exercise intensity to reduce body fat and increase lean muscle mass, which will in-turn reduce her body composition. This will result in giving her self-esteem back, improving her overall body image and confidence, and making the doctor happy on her next visit.

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References

Kaminsky, L. A. (2014). ACSM's health-related physical fitness assessment manual. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Riebe, D., Thompson, W. R., & O'Rourke, K. (2014). ACSM's Resources For The

Personal Trainer Fourth Edition. Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins

Wilkins.Thompson, W. R., Gordon, N. F., & Pescatello, L. S. (2013). ACSM's guidelines for exercise testing and prescription Ninth Edition. Philadelphia: Lippincott Williams & Wilkins.

United States. Public Health Service. Office of the Surgeon General, Centers for Disease Control,

National Center for Chronic Disease Prevention, Health Promotion (US), President's Council on Physical Fitness, & Sports (US).(1995).Physical activity and health: a report of the Surgeon General. Jones & Bartlett Learning.

Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public health reports, 100(2), 126.

Presiden’s Council on Physical Fitness and Sports Research Digests. Definitions: Health, fitness, and physical activity [Internet]. (2008) April 23. Avaiable from Fitness.gov/publications/digests/digest_mar200.html

U.S. Centers for Disease Control and Prevention. Physical Activity for Everyone: Glossary of Terms [Internet] (2011) Avaibale from CDC.gov/physicalactivity/everyone/glossary

Leading Causes of Death. (2016). Retrieved April 30, 2016, from http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

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Appendix

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Health Appraisal Family History Myocardial Infarction, coronary revascularization, or sudden death before 55 years of age in father or other male first- degree relative (i.e., brother or son), or before 65 years of age in mother or other female first-degree relative (i.e., sister or daughter) Pre-Diabetes Impaired fasting glucose (IFC) = fasting plasma glucose > 100 mg.dL-1 but < 126 mg.dL-1 or impaired glucose tolerance (IGT) = 2-hr values in oral glucose tolerance test (OGTT) > 140 mg.dL-1 but < 200 mg.dL-1 confirmed by measurements on at least two separate occasions For those who are younger than 45 years and have a body mass index ≥ 25 kg·m-2, and have additional risk factors for pre-diabetes (family history). Blood Pressure and Heart Rate 22 boxes = 22 mm x 0.04 sec = .88 sec

Heart Rate = (1500/1)(1/22) = 68.18 bpm

Pulse Pressure (PP) = 118-74 = 44

Mean Arterial Pressure (MAP) = 74 + .33(44) = 88.52mmHg

Strip 2: 1500/8=188bpm Predicted HR Max 220-33 = 187 Muscular Fitness and Flexibility

1 RM equation: !"#$%&()*%"+#,-.*./+0!"#$%&#,-.*

= 𝑤𝑒𝑖𝑔ℎ𝑡𝑟𝑎𝑡𝑖𝑜

Bench Press

122lb/2.2 = 55.45 kg 55.45/82.3=0.67

Leg Press

288lb/2.2=130.9 130.9/82.3=1.59

Body Composition

Frame size: Small Height: 5’6” (66in or 167.6cm) Weight: 181lbs; 82.3 kg Wrist Circumference: 6in; 15.24cm Forearm Circumference: 9in; 22.86cm

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BMI: kg/m2 = 82.3kg/(1.6762) = 29.3 WHR: waist/hip = 76.5cm/102.5cm = 0 .75 Skinfold (3 site)

S3SF = 16.5 + 28.4 + 45 = 89.9

Db = 1.0994921 – (0.0009929 (89.9)) + (0.0000023 (89.9)2

) – (0.0001392 (33)) = 1.00563BF% = (4.76/1.00563)-4.28 = 45.3%

7 site skinfold: Db = 1.097 – 0.00046971(sum) + .00000056(sum2) -0.00012828(age) Db = 1.097 – 0.00046971(163.7) + .00000056(163.72) -0.00012828(33) = 1.0308 % FAT = ((4.84/ Db )-4.37) x 100 = ((4.84/ 1.0308 )-4.37) x 100= 32.5% Ball and swan: %BF = -9.606 + 0.435(sum of 3SF) – 0.001429(Sum of 3SF2) + 0.153(hip) + 0.07292(age) %BF = -9.606 + 0.435(70.9) – 0.001429(70.92) + 0.153(102.5cm) + 0.07292(33) = 32.1% Bod pod: BF% = ((4.84/ Db )-4.37) x 100 = ((4.84/1.0369) – 4.37) x 100 = 30.18 % H2O weighing: Db kg/L = 82.3kg / [((82.3kg - 1.88kg)/0.9967kg/L) – (1.14L + .1)] = 1.036 kg/L BF% = ((4.84/ Db )-4.37) x 100 = ((4.84/1.036) – 4.37) x 100 = 30.18 % Relative Weight: weight/midpoint = 181/ [(133+120)/2] = 1.43

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Aerobic Capacity

YMCA Cycle Test VO2 ml.kg.-1min-1 = [1.8ml.min-1 x (work rate) kgM.min-1 / body mass] + 7 ml.kg.-1min-1 VO2 ml·kg-1min-1 = (1.8ml·min-1/kgM·min-1)( 1400kgM·min-1)/82.3kg + 7ml·kg-1min-1 VO2 ml·kg-1min-1 = 37.62ml/kg/min-1

YMCA Slope: SM1= [(1.8 X 600)/82.3]+7 METS= 20.12 SM2= [(1.8 X 750)/82.3]+7 METS= 23.4 23.4-20.12/144-135= .364 VO2= 23.4+.364(187-144) =39.052 mL/kg/min Ebbling Test VO2 max ml.kg-1.min-1= 15.1 + 21.8(spd)-0.327(HR) - 0.263(spd x age) + 0.00504(HR x age) + 5.98(gender) VO2 max ml.kg-1.min-1 = 15.1 + 65.4 - 43.164 - 26.037 + 21.95424 + 0 VO2 max ml.kg-1.min-1 = 33.3ml.kg-1.min-1

Cooper Test Time: 13min 12sec: 12/60 = .2 = 13.2minutes VO2 max (ml.kg-1.min-1) = 0.268(V) - 11.3 VO2 max ml.kg-1.min-1 = 0.268(2400 meters/13.2min) - 11.3 VO2 max ml.kg-1.min-1 = 37.4 ml.kg-1.min-1

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RockPort 1-Mile VO2 max (ml.kg-1.min-1) =132.853 - 0.0769(wt) - 0.3877(age) + 6.315(sex) - 3.2649(time) - 0.1565(HR) VO2 max ml.kg-1.min-1 = 132.853 - 13.9189 - 12.7941 + 0 - 47.112507 -21.6177 VO2 max ml.kg-1.min-1 = 37.4ml.kg-1.min-1 Astrand Test 2kp, 60rpm; Work rate: 720kp·m·min-1 Est. Max HR: 187bpm Work rate = (2kp)(6rev/min)(60rpm) = 720kp·m·min-1 Est. 85% Max HR: 159bpm Est. working VO2: 22.7ml·kg-1min-1 VO2 ml·kg-1·min-1 = (1.8ml·min-1/kgM·min-1) (720kgM·min-1)/82.3kg + 7ml·kg-1min-1 = 22.7 = VO2 ml·kg-1min-1 = 22.7 ml·kg-1min-1 3.6 liters (predicted) VO2 ml·kg-1·min-1 = (3.6liters/min)(1000ml/liter)(1kg/82.3kg) = 43.7ml·kg-1min-1 Age Corrected = 43.7 ml·kg-1·min-1(0.896) = 39.2ml·kg-1min-1

Intensity: 135-68/187-68=.563 [(1.8 X 720)/82.3]+7 METS= 22.747 VO2=22.747/.563= 40.4 mL/kg/min

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