1
Q
Describe the progression of dealing with a client
A
- Informed consent and pre-screening
- Training at low to moderate intensity
- Assessment of fitness (based on goals of the client)
- Training program (based on goals of the client)
2
Q
What participant information should be collected and why should you get informed consent?
A
-Gathering of personal information and performing procedures with associated risk
o An Informed Consent Form and Participant information sheet should include:
-Explaining the purpose of the assessments
-Describing the procedures/responsibilities of the participant/client
o What they need to do – lay terms
-Outlining the risks/discomforts and benefits
-Outlining how the client/participant can ask questions
-Explaining how their data will be handled/stored/de-identified
-Explaining that the client can withdraw at any time
3
Q
Why is pre-screening important?
A
-Vitally important
-Qualified to train healthy individuals
o Always remember scope of practice
o If unsure ask/consult
4
Q
What are the components of physical fitness (health)?
A
- Cardiorespiratory Endurance
- Body Composition
- Muscular Strength
- Muscular Endurance
- Flexibility
5
Q
What are the components of physical fitness (skill)?
A
- Reaction Time
- Power
- Speed
- Agility
- Coordination
- Balance
6
Q
What are the purposes of fitness assessments?
A
-Collecting baseline data and comparing to age and sex specific normative data therefore educating the client on their health status
o Identify strengths and weaknesses
-To inform exercise prescription and ensure it is individualised to the client’s initial values and goals
-To evaluate an exercise programs effectiveness and allow long term monitoring
-Motivation
7
Q
What are the types of laboratory based fitness tests?
A
o Allows for greater control of conditions (environment) and administration
o Enables better supervision
o One client at a time
o Availability of specialised equipment
8
Q
What are the types of field based fitness tests?
A
o Sometimes allows greater validity
-Closer replication of real-life situations
-Research and results in the field are easily/more transferable to sports
o Harder to control
9
Q
Describe muscular strength, power and endurance tests
A
Muscular Strength Tests -Multi-Stage Tests -1RM or Estimations of 1RM Muscular Power Tests -Vertical Jump -Broad Jump -1RM Power Clean Muscular Endurance Tests -Push Up Endurance Test
10
Q
Describe cardiorespiratory endurance and agility tests
A
Cardiorespiratory Endurance Fitness Tests -Beep Test Agility Tests -T-Test -Illinois Test
11
Q
Describe flexibility and body composition tests?
A
Flexibility Tests -Sit and Reach Test Body Composition Tests -Skin Folds -BMI -Girth Measurements
12
Q
Why do you asses body composition?
A
-Strong association between obesity, especially excess intraabdominal (visceral) fat and:
o Coronary artery disease
o Type 2 diabetes
o Hypertension
o Types of Cancer
-Excessively low levels of fat is detrimental to health
-Monitor growth of children and adolescents
-Determine optimal body composition for health and performance in athletes
-Monitor training and/or diet effects on modifying body composition
-Track long term changes that occur with ageing malnutrition and disease
13
Q
What is body composition?
A
-Body Composition: The body’s relative amounts of fat mass and fat free mass (bone, water, muscle, connective tissue and organ tissues, teeth)
14
Q
What is fat mass and fat free mass?
A
- Fat Mass (FM): extractible lipids from adipose tissue and other tissues
- Fat-Free Mass (FFM): is composed of all the body’s non-fat tissue including bone, muscle, organs and connective tissue
15
Q
What is lean body mass and % of body fat?
A
- Lean Body Mass (LBM): includes all FFM along with essential fat. Lean body mass is difficult to measure so the fat mass/fat-free mass model is most often used
- % Body Fat: Proportional amount of fat in the body based on the person’s total weight; includes both essential and storage fat
16
Q
What is essential and non-essential fat?
A
- Essential Fat (3-7%) = Crucial for normal body functioning (consists of stored fat in major organs, muscles and central nervous system)
- Non-essential (storage) fat = adipose tissue
17
Q
What is subcutaneous and visceral fat?
A
-Subcutaneous Fat o Fat stored in the subcutaneous tissue o Directly under the skin -Visceral Fat o Intra-abdominal fat o Fat inside the abdominal cavity
18
Q
What you use to assess body composition with field tests?
A
- Height to weight table
- Waist to hip ratio
- Skinfolds
- Body mass index
- Waist circumference
19
Q
What you use to assess body composition with laboratory tests?
A
- DEXA
- MRI, CT
20
Q
When measuring waist to hip ratio how do you use waist measurement?
A
-Waist measurement
o Smallest circumference of the waist between the lower costal (rib) boarder and the iliac crest
o If no obvious minimum waist is evident then this measure is taken at the midpoint between these two landmarks
21
Q
When measuring waist to hip ratio how do you use hip measurement?
A
-Hip (Gluteal) measurement
o Greatest posterior protuberance of the buttocks with the feet of the subject together
22
Q
How do you measure waist to hip ratio?
A
-Waist to Hip Ratio o Waist (cm) / Hip (cm) o Often used to distinguish type of obesity
23
Q
Describe an android
A
-Android = Apple o Central obesity o Typically, males experience o More visceral fat o Increases risk of heart disease and metabolic syndrome
24
Q
Describe a gynoid
A
-Gynoid = Pear o Peripheral obesity o Less visceral fat o Typically, in females o Lower risk
25
Describe waist circumference
-Waist circumference is often used alone as an indicator of health risk because abdominal obesity is the issue
-Can be used alone or in combination with BMI (both preferable)
o Men = > 100 cm
o Women = > 90 cm
-Waist circumference is a valid measure of abdominal fat mass and disease risk in individuals with a BMI < 35
-If BMI > 35, waist circumference adds little to the absolute measure of risk provided by BMI.
26
Describe body mass index
-A population-based measure of obesity related disease risk
o BMI = Body Mass (kg) / Height 2 (m) = kgm-2
-A BMI > 30 kg/m-2 is associated with an increased risk for hypertension, total cholesterol/HDL ratio, CHD and mortality rate
-A BMI < 18.5 kg/m-2 is also associated with an increased risk of heart disease
27
What are the advantages of measuring body mass index?
o Calculation is simple, rapid and inexpensive
o Non gender specific Practical indicator of obesity
o More accurate measure of total body fat compared to weight
28
What are the limitations of measuring body mass index?
o Doesn’t distinguish between Fat and LBM or bone structure
o Overestimates body fat in very muscular or very short (< 1.52 cm) people
o Does not reflect body fat distributions
o Can underestimate body fat in people who have lost muscle mass (e.g. elderly) or in patients with oedema (swelling)
o Misleading in children and elderly where muscle and bone to height relationship is changing
o Imprecise indication of % body fat
29
What are skin folds as a measurement test?
- The measurement of compressed subcutaneous adipose tissue and the thickness of a double fold of skin
- The rationale for skinfold measurements is based on the relationship between fat located in deposits directly beneath the skin and both internal fat and body density
- Widely used technique for estimating % body fat
- Practical, cheap and useful in the lab and field
30
What is the equation of body density for females?
o Body Density = 1.20953 – [0.08294 x (log10 Sum of Six Skinfolds)]
o Triceps, subscapular, supraspinale, abdominal, front thigh, calf
31
What is the equation of body density for males?
o Body Density = 1.0988 – [0.0004 x (sum of seven skinfolds)]
o Triceps, subscapular, biceps, supraspinale, abdominal, front thigh, calf
32
What are some skinfolds assumptions?
1. Fat distribution is similar for all individuals
2. The sum of a number of skinfolds will be proportional to total body fat
3. A prediction equation can accurately assess the sum of skinfolds based on age and population data
4. Linear relationships between sum of skinfolds and body density
33
What are the disadvantages of skin fold measuring?
-You must familiarise yourself with the rules and procedures for taking measurements
o ISAK accreditation
-Calipers should be calibrated regularly
-3 measurements per site within 10% of each other
o Consider inter and intra
-Highly variable – needs a lot of practice!
o Compressibility of skin and fat tissue
o Consistent location of skinfold sites
-Other sources of errors including measuring body fat on obese patients and hydration status of patient
-A range of different equations are available to predict body density and % body fat (one site or multiple) for different ages and genders
34
What is Bioelectrical Impedance Analysis?
- Based on estimating the resistance to electrical current being passed through the body
- The resistance of current flow is greater in those with more body fat
- Body fat has less water content, and is thus a poorer conductor of electrical current
- BIA estimates total body water and uses equations to predict % body fat (and fat mass and lean mass)
35
When using Bioelectrical Impedance Analysis what are the client guidelines you give?
o No food or during within 4 hours
o No alcohol 48 hours prior
o No exercise within 12 hours
o No diuretic medications within 7 days (caffeine)
o No pacemakers or other internal metal devices
o No Jewellery
o Urinate 30 min prior to test
36
What are the advantages of Bioelectrical Impedance Analysis?
- BIA is a rapid, non-invasive and relatively inexpensive methods for estimating fat and FFM
- BIA is more comfortable, less intrusive and requires less technical skills than skinfolds
37
What are the disadvantages of Bioelectrical Impedance Analysis?
-Accuracy and precision are affected by:
-Instrumentation (calibration and brand)
-Subject factors (hydration status, exercise)
-Technical skill (location of electrodes)
o Prediction equations used to estimate FFM (based on similar population)
38
What is Hydrostatic Weighing?
-Underwater weighing
-Computes body volume by the difference between;
o Body mass measured in air and body mass measured submerged in water
39
What are the advantages of Hydrostatic Weighing?
- Several variables need to be known e.g. gases in lungs and gastrointestinal tract and density of the water
- Much equipment is required
- Fear from individuals being submerged for a time
40
What are the disadvantages of Hydrostatic Weighing?
- Can be accurate if all measure taken are accurate
| - Cost effective if the equipment is available
41
What is an MRI/CT?
- Computed Tomography (CT) scan
- Magnetic Resonance Imaging (MRI) scan
- Both create pictorial images and give quantitative information about tissue, fat and muscle areas.
- Expensive and under demand for other medical purposes
42
What is a DEXA?
- Dual-Energy X-ray Absorptiometry (DEXA)
- Quantifies fat, LBM and mineral content of the bone structure
- Expensive and does emit a low dose of radiation
43
What is validity and construct validity?
- Validity: The degree to which a test or test item measures what it is supposed to measure
- Construct validity: Ability of the test to represent the underlying construct
44
What is face validity?
Face Validity: Appearance to the athlete and other observers that the test measures what it is reported to measure
- If so the athlete will likely respond +ve = higher motivation
- Appearance of validity to non-experts
45
What is content validity and criterion referenced validity?
- Content Validity: The assessment by experts that the testing covers all topics or component abilities in correct proportions
- Criterion-Referenced Validity: Extend to which the test scores are associated with another measure of the same ability
46
What is concurrent validity and convergent validity?
o Concurrent Validity
-Extent to which test scores are associated with other accepted tests of the same nature
o Convergent Validity
-High positive relationship between the test and the gold standard measure of that same construct
47
What is predictive validity and discriminant validity?
o Predictive Validity
-Extend to which the test score corresponds to future performance
o Discriminant Validity
-The ability of a test to distinguish between two different constructs
48
What is reliability?
-Reliability: Ability of a test to repeatedly measure performance abilities or physiologic variables and provide the same result
o Measuring the degree of repeatability and consistency of a test
49
How do you determine validity and where can differences come from?
-How do you determine reliability?
o Test-retest reliability
-Calculate measurement error
-Typical error of measurement (equipment and biological variation)
o Differences can come from:
-Intra-subject variability (within subject)
-Inter-rater reliability (between raters)
-Intra-rater variability (within raters)
-Failure of the test to provide repeated results
-A test must be reliable to be valid
50
In test selection what is sport specificity?
```
-Sport Specificity
o Energy requirements
-Sport Specificity
o Energy requirements
o Biomechanics (movement patters)
```
51
In test selection what is experience and training status?
-Experience
o Technical tests for experts NOT a novice/beginner
-Training Status
o Test to current training status
52
What is age & sex and environmental conditions?
-Age and Sex
o What test is most suited to the appropriate age group?
-Environmental conditions
o Room temperature and ventilation
-Hot conditions should be avoided
-Aim for similar conditions when doing comparisons
-Quiet and Private
53
What is the test order?
- Maintain reliability and performance
- One test should not affect the following test
1. Non fatiguing tests
2. Agility Tests
3. Maximum Power and Strength Tests
4. Sprint Tests
5. Muscular Endurance Tests
6. Fatiguing anaerobic capacity Tests
7. Aerobic capacity Tests
54
What are the pre test instructions?
- Provided well in advance to maximise understanding and adherence:
- Refrain from alcohol, caffeine, food and tobacco within 3 hours prior
- Refrain from vigorous exercise within 24 hours and come rested avoiding exertion on the day of testing
- Be well hydrated and bring a water bottle and maintain hydration post test
- Wear appropriate clothing (allows movement and tests to be carried out e.g. blood pressure) and bring appropriate accessories (e.g. sweat towel)
- Continue using movement aids and normal/prescribed intake of medication
55
What should you do prior to the participant arriving?
o Ensure all data sheets and consent forms are available
o Ensure equipment is working and calibrated
o Ensure the environment is safe
56
What should you do on the arrival of the participant?
o Orientate the participant to the surroundings
-Emergency procedures
o Go back over the procedures, risks, benefits and allow question time
o Check informed consent and pre exercise adherence to procedures
o Physiological measures to check on the day health
-BP
-Resting HR – may be higher due to anticipation.
-“White Coat Effect” – exhibiting higher than normal blood pressure in a clinical setting opposed to other settings due to anxiety
57
What should occur in a warm up?
```
-Warm up is composed of different categories:
o General warm up
-5-10 minutes including slow activities e.g. running
-Purpose is to increase:
-Heart Rate
-Blood Flow
-Muscle Temperature
-Perspiration
-Respiration Rate
o Dynamic Stretches
o Sport-specific drills
```
58
What occurs during the test?
```
-Continual monitoring:
o HR
o BP
o RPE
o Verbal ‘are you feeling well’
-Completion of data sheet
o Record Data
o Efficient timing
-Encouragement
-Equipment monitoring
```
59
What occurs after the test?
-After final measures
-Cool down
o E.g. Continue cycling at a low intensity for 3-5 minutes
-Continued monitoring
o Physiological variables
-HR
-RPE
-BP
o If the participant experiences dizziness, then lie them down with their legs raised above the level of their heart
o Vomiting can occur a few minutes after the test so continue monitoring and have biological waste bags available
-Before they leave ensure near pre exercise baseline values have been obtained
60
What is the termination of a test?
o Diagnostic
-Diagnosing a medical condition via an exercise test
o Non-diagnostic
-E.g. only assessing cardiorespiratory fitness
61
What are the general indications for stopping an exercise test?
- Onset of angina or angina-like symptoms.
- Drop in SBP of ≥ 10 mmHg with an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing.
- Excessive rise in BP: systolic > 250 mmHg and/or diastolic pressure > 115 mmHg
- Shortness of breath, wheezing, leg cramps, or claudication
- Signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin
- Failure of HR to increase with increased exercise intensity
- Noticeable change in heart rhythm by palpation or auscultation
- Subject requests to stop
- Physical or verbal manifestations of severe fatigue
- Failure of the testing equipment
62
What is absolute vs relative contradictions?
- Absolute = A reason which make it inadvisable to continue the test. The participant will be at a higher risk of a detrimental effect occurring if the test continues.
- Relative = A reason that will be given much consideration. Factors such as risk vs benefit, medical support, qualifications and knowledge of those testing will be considered
- Both relative and absolute risk factors being present the test should not continue until the condition is stabilised or adequately treated.
63
Describe absolute contradictions?
- Drop in SBP (≥ 10 mmHg) with an increase in work rate
- Signs or symptoms of angina (chest pain)
- Increasing NS pathology symptoms e.g. dizziness, lack of voluntary muscle coordination, loss of consciousness
- Signs of poor perfusion e.g. blue or purple colouration of skin, deficiency of colour in the face
- Technical problems with monitoring equipment e.g. ECG or blood pressure
- Participant wants to stop
64
Describe relative contradictions?
- Drop in SBP (≥ 10 mmHg) with an increase in work rate
- Fatigue, shortness of breath, wheezing, leg cramps or pain in the legs when walking
- Increasing chest pain
- Hypertensive response (SBP > 250 mmHg and or DBP > 115 mmHg)
65
What is interpretation?
1. Was the test valid and reliable
2. How do the results compare to normative/classification tables
3. Report red flags and refer
4. Prepare for feedback
66
What is normative values and criterion referenced values?
- Normative values: Based on performance of a group of people & are often expressed as percentages (within 10th - 90th percentile)
- Criterion-referenced values: Based on an individual score & are often expressed as pass/fail or achievement of a health standard
67
What is feedback and its steps?
-Ability to explain exercise physiology testing results to your client is essential
o Often ignored or provided superficially
-If you do not or cannot explain test results & provide your clients with effective messages to improve their exercise performance
o You are probably better off not testing at all
1. Explain the test
2. State the results
o Both quantitative and most importantly qualitative
3. What now?
o Can they be improved?
o Do they need to improve?
o How can they be improved?
68
What is discussion?
-Encourage discussion
-Make time for questions and ask for questions
-Engage empathetically
o Not all fitness tests give back excellent results
-Can’t answer a question
o DON’T
o “I will have to look into that and get back to you”
o There is nothing wrong with wanting to give the right answer
Exercise Science for Health
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Decks in class (10)
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