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Consult + Eval
| Question | Answer |
|---|---|
| Purpose of consultation and health appraisal | To screen participants for risk factors to optimize safety during exercise testing and participation |
| Factors to consider for implementation | Credentials of personal trainer Site of delivery Specific population served Legal statutes |
| Steps of client consultation and health appraisal | 1. Schedule interview 2. Conduct interview 3. Implement health appraisal forms 4. Evaluate coronary risk factors, disease, and lifestyle 5. Assess and interpret results 6. Refer to health professional if necessary 7. Obtain medical clearance/recs. |
| Scheduled appointment purpose | Mutually share with client Assess compatibility Develop SMART goals Establish client-personal trainer agreement Establish client-personal trainer fitness facility agreement |
| Assessing compatibility | Trainer identifies services/education/experience/certifications/expertise Evaluate level of exercise readiness Assess suitability and appropriateness |
| Client-Personal trainer agreement | Written documentation of all aspects of services, expectations, costs, and payment processes |
| Client-personal trainer facility agreement | Validates safe use of training facility Varies based on employment status of personal trainer (self-employed independent contractor/employee) |
| Purpose of preparticipation health appraisal screening | Identify known diseases and risk factors |
| Steps of preparticipation health appraisal screening | Client completes relevant forms Evaluate coronary risk factors, disease, and lifestyle Interpret results Refer if necessary |
| Forms | PAR-Q+ Health/Medical questionnaire Lifestyle questionnaire Informed consent Assumption of risk or waiver Preparticipation documents for children |
| PAR-Q+ | Physical activity readiness questionnaire for everyone Questions assessing S/S experienced by client and confirmation by physician Cost effective and easy to administer Does not determine risk for CVD |
| Health/Medical questionnaire | Effective for assessing the appropriateness of moderate to vigorous levels of intensity of exercise |
| Lifestyle questionnaires | Dietary intake, stress, physical activity, and other practices |
| Informed consent form | Description of program, risks, confidentiality clause, responsibilities, and documentation of acknowledgement Conveyed verbally and in writing prior to testing or participation |
| Assumption of risk or waiver | An agreement by a client to give up, relinquish, waive participants rights to legal remedy (damages) in the event of injur or negligence |
| Preparticipation documents for children | Little has been written about childrens participation Evaluation form approved by American Academy of pediatrics and the American Academy of Family Physicians |
| Record keeping | Strategy to collect, organize, and store vital information and materials |
| Health insurance portability and accountability | Protocols that must be followed by personal trainer that ensures confidentiality and integrity of client-personal trainer relationship |
| Role of PT in evaluation of coronary risk factors, disease, and lifestyle | Evaluate information to identify any potential risks requiring referral to a physician |
| CVD risk factors | Age- M= >45 F+ >55 Family history of coronary disease Smoker Physical inactivity- 75-150 mod/vigorous minutes/week BMI= >30 Waist- M=>40in /F=>35 SBP >130 DBP >80 High lipids and blood glucose |
| Pulmonary diseases affect | Ability to transport O2 during exercise (Chronic bronchitis, emphysea, and asthma) |
| Metabolic diseases | Diabetes mellitus |
| Identification of medical conditions and diagnosed diseases | CV and pulmonary disease Risk of sudden cardiac death Metabolic disease Orthopedic conditions and disease Medications |
| Lifestyle evaluation- Relationship between | Portential risk of CVD and other leaading causes of morbidity or premature death |
| Examples of lifestyle | Dietary intake and eating habits Exercise and activity patterns Stress management |
| Interpretation of results- PAR Q+ | Form provides direction and specific recommendations |
| ACSM preparticipation screening algorithm | Determines preparedness to begin an exercise program using current exercise status, known CV/metabolic/renal disease, and personal S/S |
| Referral processess | Medical examination Medical clearance Physician referral |
| Medical examination | Suggested guidelines developed for determining when a medical examination and submaximal or maximal exercise tests are needed |
| Medical clearance | It is PT's responsibility to encouragemedical clearance as a reasonable and safe course of action |
| Physician referral | If clearance is recommended, provide client a physician referral form |
| Program recommendations | Made by physicians after diagnositc medical exam and testing May be unsupervised, supervised, or medically supervised exercise program |
| Purposes of assessment | Gathering baseline data Goal and program development |
| Baseline Data | Show progress Identify strengths and weaknesses Helps determine intensities and volumes Helps clarify short, intermediate, and long term goals Identifies areas of potential injury or contraindications |
| Appropriate assessments | No standard battery of tests Based on clients apparent health and potential for adverse cardiovascular event as well as desired program outcomes |
| Two ways of looking at assessments | Formative evaluations and summative evaluations |
| Formative evaluations | Conducting assessments with a specified test protocol and subjective observations made by the personal trainer |
| Summative evaluations | Made when a client completes a specified training period, class, or season; they represent the total |
| To improve accuracy of a test | Ask: How reliable? What was the objective? valid? Equipment calibrated? Accurate results? Was the subject influenced by anything that may have affected results? Was the test protocol followed carefully? |
| Reliability | A measure of repeatability or consistency of a test or an observation |
| Intrarater reliability | Person conducting test gets the same result each time they tests |
| Interrater reliability | Different testers get the same result when testing the same individual |
| Objective of appropriate assessments | A test that has interrater reliability |
| Validity | A test measures what it is supposed to measure and is relevant |
| Types of validity | Face, Content, Construct, Criterion-related |
| Face validity | Test what it is supposed to test |
| Content validity | Covers all the topics or abilities it should |
| Construct validity | Differentiate between performance abilities |
| Criterion-related validity | A field test statistically compares to a lab tests |
| Good tests | Should be both reliable and valid |
| Factors that affect reliability and validity | Client factors, Tester, Equipment, and environment |
| All tests have a | Standard error of measurement |
| Test preparation | Conduct reassessment screening procedures and review safety considerations Reduces risk of complications when testing |
| Verify appropriateness of assessments | Valid, reliable, and safe Provide meaningful results for the client and support his or her goals Requires knowledge of the client and exp |
| Types of facilities and tests | Laboratory tests, field tests |
| Laboratory tests | Performed in clinical settings with specialized diagnostic equipment |
| Field tests | Practical, inexpensive, easy, less equipment, performed in more places, time efficient, performed in groups |
| Who are lab tests done by | Health professionals |
| Who are field tests done by | Certified fitness professional |
| Preassessment protocols | Scheduled in advance and given preinstructions (adequate rest, moderate food intake, hydrate, specific testing procedures and expectations, before, during, and after) |
| Prepare a record-keeping system | Organized method to collect and store data |
| Types of test implimentation | General fitness and athletic performance |
| General fitness tests | Resting test, non-fatiguing tests, muscular strength, local muscular endurance tests, submaximal aerobic capacity tests |
| Athletic performance tests | Resting tests, non-fatiguing tests, agility, maximum power and strength, sprint, local muscular endurance, anaerobic capacity tests, maximal or submaximal aerobic capacity |
| Defining and following testing protocols | Precise test instructions before appointment Demonstration and practice test Warm up and cool down Implement spotting practices when required by protocol |
| Interpretation and review of results | Interpretation of the baseline data is dependent on the specific purpose of the assessment and the goals of the client |
| Common methods to explain data use norm-referenced and criterion-referenced standards | Norm referenced standards (50th percentile) Criterion referenced standards identify if performance met a health standard and does not compare individuals to each other |
| Reassessment | Initial assessments, intermediate assessments, anecdotal records, exercise logs are all part of the formative evaluation of the client, providing frequent opportunities for feedback and guidance |
| Posttest | Can be eight or more weeks from program initiation and allows for the provision of a summative evaluation |
| Specific fitness testing protocols | Vital signs, training load, body comp, cardiovascular endurance, speed, agility, muscular strength/power/endurance, flexibility, postural alignment, movement assessment |
| Vital signs | Heart rate Blood pressure |
| Heart rate normative | Between 60-100 Bradycardia= >60 Tachycardi= >100 |
| Methods of heart rate assessment | Palpation of brachial, radial, carotid, or temporal artery Auscultation by use of a stethoscope Heart rate monitors |
| Blood pressure: Technique | Sphygmomanometry Imperative to use calibrated equipment that meets certification standards to follow standardized protocol |
| Korotkoff sounds | The sound emitted when forces of blood acting against vesse walls emit Detection and disappearance of these sounds under controlled pressure environments |
| Tips for blood pressure measurement | Client seated (back straight/no legs crossed) Upper arms bare/ no restrictive clothing Arm relaxed at heart level Cuff covers 80% of upper arm Cuff should be deflated 2 or 3 mm/s with first and last audible sound taken as SBP and DBP Quiet |
| Training Load | Relative balance between an external training load (exercise) and internal training load (body's physiological response to exercise) |
| External training load | RT= Total reps or volume load Endurance: Total distance of intensity |
| Internal training load | Session RPE or perceptual well-being |
| Training load aids | With day to day and long term program response |
| Anthropometry | Height and weight Best assessed in the morning |
| Body mass index | Measurement of body mass related to stature BMI (kg/m^2) = body weight/height |
| BMI has the possibility of incorrectly classifying | individuals with high amounts of muscle mass or body fat |
| Waist to hip girth ratio | Not truly a measure of body composition |
| Larger accumulation of fat in the trunk | Increased risk for a variety of CVDs and metabolic diseases |
| Procedure for waist to hip girth ratio | Place tape around girth of the waist and hip Apply tension to tape but doesn't compress Align tape in horizontal plane parallel to floor Divide waist circumference by hip circumference |
| Skin folds | Indirectly measures thickness of subcut fat Multiple SF sites to predict body density Correlates highly with underwater weighing Accuracy affected by skil of tester, caliper, client factors, and equation to estimate BF% |
| General considerations for skinfold testing | Measure on right side Take when skin is dry and before exercise Identify, measure, and mark landmark Use thumb and fingers 1cm from site Lift fold by placing thumb and index finger 8cm apart on axis of SF |
| General considerations for skin fold testing continued | Keep fold elevated Jaws perpendicular; 1cm from site Record skinfold after 1 to 2 seconds Read dial to nearest mm Take minimum of 2 measurements Values should not vary more than 2 mm |
| Bioelectrical impedance analysis | Noninvasive measure of impedance or resistance to an electrical current passed through the body between electrodes to determine BF% |
| BIA pretesting guidelines | No eating or drinking w/in 4 hours No exercise within 12 hours No alcohol consumption within 48 hours No diuretic medications within seven days of test Not retaining water on period Empty bladder within 30 minutes |
| Submax cardiovascular endurance tests are used | To attain a reasonably accurate estimate of VO2 max |
| Submax cardiovascular endurance tests require | Monitoring HR, BP, RPE or a combination of these until a predetermined point is achieved at the end of tests |
| True measures of CV endurance requires | Max tests where client is taken to extreme limits of HR |
| Assumptions of submax exercise | HR measurements must be steady state True max HR for a given age must be the same for all clients Relationship between HR and work rate must be strong, positive, and linear Mechanical efficiency is the same for all clients |
| Solution for steady state | Record HR at end of contant work-rate stage or agter 2-3 minutes of exercise at a constant work rate |
| Solution for True max HR | Typical equations to calculate age-predicted maximal HR can introduce an unknown error into the model |
| Solutions for relationship between HR and work rate | HR values between 50-90% of max HR should be considered |
| Solution for mechanical efficiency being the same for all clients | Choose a test that is specific to the client's exercise modes, daily activities, or both |
| Cycle ergometer tests | YMCA Cycle ergometer test Astrand-Rhyming cycle ergometer test |
| YMCA step test | Does not provide estimation of VO2 max Basic test that can be easily administered to large groups |
| Distance run/walk tests considerations | Based on assumption that a more 'fit' client would be able to run a given distance in less time or run a greater distance in a given period of time Effort based assessments suited for clients who can run or walk briskly for a given time or distance |
| Distance run/walk test types | 12-minute run/walk 1.5 mile run Rockport walking test 1 mile run |
| VO2 max estimates and error ranges | Comes from various demographics; Reasonable estimates for trained and untrained +/- 10% |
| Sprint tests assess | maximal speed |
| agility tests provide | indication of planned or unplanned change of direction speed using movement patterns |
| Common athletic performance tests | Straight line spring, 300 yard shuttle, t test, pro agility |
| Muscular strength | Important component of physical fitness Minimal strength neeed for activities of daily living and to participate in recreational/occupational activities without undue risk of injury |
| Absolute strength | Raw strength score a person achieves |
| Relative strength | Load relative to body weight |
| Muscular strength test options | Multiple repetition maximum strength testing 1 rep max |
| Muscular power | Ability to produce force within a short time Relevant to occupational activities and activities of daily living |
| Muscular power test options | Vertical jump, standing long jump, med ball chest pass |
| Muscular endurance | Ability of a muscle of muscle group to exert submaximal force for extended periods |
| Muscular endurance test options | YMCA bench press Sit up test Prone double straight-leg raise test |
| Flexibility | Range of motion around a joint or a series of joints No single test that can measure whole body flexibility Common tests focus on low back and shoulder |
| Flexibility test options | Sit and reach Back scratch |
| Postural alignement and movement assessment | Allow for evaluation of potential limitations or functional imbalances Qualitative or subjective in ature May be useful with the appropriate combination of human anatomy knowledge, experience, and training |
| Postural alignment and movement test options | Plumb line assessment Closed chain upper extremity stability Single leg squat and forward step down test |
Created by:
jrivas21